bluuebunny/crossref_metadata_2025 huggingface dataset:
Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: a single-centre retrospective study
Authors: Ponna Priyanka , Tarraf Nour Eldin , Dalci Kerem , Wilmes Benedict , Darendeliler Mehmet Ali , Dalci Oyku
Published: February 2024

Objectives

This study assessed the dental and skeletal effects of pure bone-borne, non-surgical maxillary expansion, using a modified force-controlled polycyclic protocol.

Methods

Records of 17 adult patients, mean age 24.1 years; range 18–39 years, who had undergone maxillary expansion using a bone-borne Quad-expander (with 4 mini-screws), were analysed. In all patients, 0.17 mm/day of expansion was completed for 1 week, followed by a cyclic protocol of expansion of forward and backward turns until the force needed to turn the expander was below 400 cN, assessed weekly. After this, expansion continued at a rate of 0.17 mm/day until the desired amount of expansion was achieved. Cone beam computer tomography scans were taken pre- and post-expansion.

Results

The mid-palatal suture was successfully opened in 100% of patients included in this study. Axially, the amount of skeletal opening at the posterior nasal spine was 61% of the anterior nasal spine. Expansion was pyramidal in the coronal plane. Significant increases at the dental and skeletal levels were achieved, with changes at the skeletal level reaching 73%. The alveolar bone angle increased more than the angular changes at the molars and premolars.

Limitations

This is a retrospective study with short-term results.

Conclusion

The Quad-expander, with a force-controlled polycyclic expansion protocol, effectively produced a significant increase in maxillary width in skeletally mature subjects in the short term.
An expression-directed linear mixed model discovering low-effect genetic variants
Authors: Li Qing , Bian Jiayi , Qian Yanzhao , Kossinna Pathum , Gau Cooper , Gordon Paul M K , Zhou Xiang , Guo Xingyi , Yan Jun , Wu Jingjing , Long Quan
Published: February 2024

Detecting genetic variants with low-effect sizes using a moderate sample size is difficult, hindering downstream efforts to learn pathology and estimating heritability. In this work, by utilizing informative weights learned from training genetically predicted gene expression models, we formed an alternative approach to estimate the polygenic term in a linear mixed model. Our linear mixed model estimates the genetic background by incorporating their relevance to gene expression. Our protocol, expression-directed linear mixed model, enables the discovery of subtle signals of low-effect variants using moderate sample size. By applying expression-directed linear mixed model to cohorts of around 5,000 individuals with either binary (WTCCC) or quantitative (NFBC1966) traits, we demonstrated its power gain at the low-effect end of the genetic etiology spectrum. In aggregate, the additional low-effect variants detected by expression-directed linear mixed model substantially improved estimation of missing heritability. Expression-directed linear mixed model moves precision medicine forward by accurately detecting the contribution of low-effect genetic variants to human diseases.
Feeling for the Anthropocene: affective relations and ecological activism in the global South
Authors: Badri Adarsh
Published: February 2024

How do emotions shape ecological activism in the global South? Despite growing interest in researching ecological activism in International Relations (IR), there hasn't been much work that draws insights from the global South due to the predominant focus on western societies. Against the backdrop of the recent ‘relational’, ‘emotional’ and ‘Anthropocene’ turns in IR scholarship, this article examines how emotions can contribute to ecological activism in the global South. The article seeks to move beyond the dominant rationalist technocratic fixes to the Anthropocene condition and conceptualize the ‘affective relations’ as a frame for situating and sustaining relations between humans and nature. It argues that the ‘international’ in IR is a relational sphere of society—and emotions act as the purveyor of those social relations. Empirically, this article examines historical insights from ecological activism in the Chipko (tree-hugging) movement in India. The article argues that feelings as the non-violent practice (in their hugging of trees, silent demonstrations, protest slogans, street plays, songs and performances) become sites of resistance in ecological activism in India's Chipko movement. Finally, the article explains how affective relations sustain humans, nature and the state.
An Analogue of Ladder Representations for Classical Groups
Authors: Atobe Hiraku
Published: February 2024

In this paper, we introduce a notion of ladder representations for split odd special orthogonal groups and symplectic groups over a non-archimedean local field of characteristic zero. This is a natural class in the admissible dual, which contains both strongly positive discrete series representations and irreducible representations with irreducible $A$-parameters. We compute Jacquet modules and the Aubert duals of ladder representations, and we establish a formula for describing ladder representations in terms of linear combinations of standard modules.
Tamely Ramified Geometric Langlands Correspondence in Positive Characteristic
Authors: Shen Shiyu
Published: February 2024

We prove a version of the tamely ramified geometric Langlands correspondence in positive characteristic for $GL_{n}(k)$, where $k$ is an algebraically closed field of characteristic $p> n$. Let $X$ be a smooth projective curve over $k$ with marked points, and fix a parabolic subgroup of $GL_{n}(k)$ at each marked point. We denote by $\operatorname{Bun}_{n,P}$ the moduli stack of (quasi-)parabolic vector bundles on $X$, and by $\mathcal{L}oc_{n,P}$ the moduli stack of parabolic flat connections such that the residue is nilpotent with respect to the parabolic reduction at each marked point. We construct an equivalence between the bounded derived category $D^{b}(\operatorname{QCoh}({\mathcal{L}oc_{n,P}^{0}}))$ of quasi-coherent sheaves on an open substack $\mathcal{L}oc_{n,P}^{0}\subset \mathcal{L}oc_{n,P}$, and the bounded derived category $D^{b}(\mathcal{D}^{0}_{{\operatorname{Bun}}_{n,P}}\operatorname{-mod})$ of $\mathcal{D}^{0}_{{\operatorname{Bun}}_{n,P}}$-modules, where $\mathcal{D}^{0}_{\operatorname{Bun}_{n,P}}$ is a localization of $\mathcal{D}_{\operatorname{Bun}_{n,P}}$ the sheaf of crystalline differential operators on $\operatorname{Bun}_{n,P}$. Thus, we extend the work of Bezrukavnikov–Braverman [ 8] to the tamely ramified case. We also prove a correspondence between flat connections on $X$ with regular singularities and meromorphic Higgs bundles on the Frobenius twist $X^{(1)}$ of $X$ with first-order poles.
Surface-active antibiotic production as a multifunctional adaptation for postfire microorganisms
Authors: Liu Mira D , Du Yongle , Koupaei Sara K , Kim Nicole R , Fischer Monika S , Zhang Wenjun , Traxler Matthew F
Published: February 2024

Wildfires affect soils in multiple ways, leading to numerous challenges for colonizing microorganisms. Although it is thought that fire-adapted microorganisms lie at the forefront of postfire ecosystem recovery, the specific strategies that these organisms use to thrive in burned soils remain largely unknown. Through bioactivity screening of bacterial isolates from burned soils, we discovered that several Paraburkholderia spp. isolates produced a set of unusual rhamnolipid surfactants with a natural methyl ester modification. These rhamnolipid methyl esters (RLMEs) exhibited enhanced antimicrobial activity against other postfire microbial isolates, including pyrophilous Pyronema fungi and Amycolatopsis bacteria, compared to the typical rhamnolipids made by organisms such as Pseudomonas spp. RLMEs also showed enhanced surfactant properties and facilitated bacterial motility on agar surfaces. In vitro assays further demonstrated that RLMEs improved aqueous solubilization of polycyclic aromatic hydrocarbons, which are potential carbon sources found in char. Identification of the rhamnolipid biosynthesis genes in the postfire isolate, Paraburkholderia kirstenboschensis str. F3, led to the discovery of rhlM, whose gene product is responsible for the unique methylation of rhamnolipid substrates. RhlM is the first characterized bacterial representative of a large class of integral membrane methyltransferases that are widespread in bacteria. These results indicate multiple roles for RLMEs in the postfire lifestyle of Paraburkholderia isolates, including enhanced dispersal, solubilization of potential nutrients, and inhibition of competitors. Our findings shed new light on the chemical adaptations that bacteria employ to navigate, grow, and outcompete other soil community members in postfire environments.
The Perceived Informational Needs of Family Caregivers of Children Hospitalized in a Burn Department: A Cross-sectional Study
Authors: Yavari Sima , Vahidi Maryam , Namdar Areshtanab Hossein , Lotfi Mojgan , Jafarzadeh Kohneloo Aarefeh
Published: February 2024

Children are most vulnerable to burn injuries, and their families are their most important source of support. Therefore, it is necessary to identify the information needs of such parents and support them to help children adapt to the new situation, recover to pre-accident conditions, and reintegrate into school and society. This study aimed to investigate the perceived information needs of family caregivers of children admitted to the burn wards of hospitals. This cross-sectional study was conducted on 200 family caregivers of children admitted to the burn ward of a hospital in Tabriz, Iran. Participants were selected through convenience sampling, and the required data were collected by using questionnaires on socio-demographic information, information needs, information resources, and information acquisition methods. The obtained data were analyzed statistically using descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics (Mann–Whitney, Kruskal–Wallis, and Spearman correlation tests). Results indicated that the greatest informational need among family caregivers was related to the child’s condition. The treatment team was identified as the most important source of information for them. It was found that information should be provided in a comprehensive and understandable manner, while maintaining honesty and human dignity. The study findings contribute to our understanding of the specific information needs of family caregivers in managing the medical care of children with burns. These findings can serve as a basis for interventions and support services aimed at meeting the needs of these families and improving the quality of care for children with burns.
Two transcription factors, RhERF005 and RhCCCH12, regulate rose resistance to Botrytis cinerea by modulating cytokinin levels
Authors: Liu Xintong , Cao Xiaoqian , Chen Meng , Li Dandan , Zhang Zhao
Published: February 2024

Gray mold caused by the necrotrophic fungal pathogen Botrytis cinerea is one of the most destructive diseases in rose (Rosa spp.). Rose infection by B. cinerea leads to severe economic losses due to necrosis, tissue collapse, and rot. In rose, cytokinins (CKs) positively regulate a defense response to B. cinerea, but little is known about the underlying molecular mechanisms. Here, we characterized two ethylene/jasmonic acid-regulated transcription factors, RhEFR005 and RhCCCH12, that bind to the promoter region of PATHOGENESIS-RELATED 10.1 (RhPR10.1) and promote its transcription, leading to decreased susceptibility to B. cinerea. The RhEFR005/RhCCCH12–RhPR10.1 module regulated cytokinin content in rose, and the susceptibility of RhEFR005-, RhCCCH12-, and RhPR10.1-silenced rose petals can be rescued by exogenous CK. In summary, our results reveal that the RhERF005/RhCCCH12–RhPR10.1 module regulates the CK-induced defense response of rose to B. cinerea.
‘As a Black woman, there’s no winning in law enforcement’: Black women’s experiences in policing
Authors: Haakmat Narissa , Ruffin Joshua R
Published: February 2024

Studies examining the experiences of Black officers often negate gendered nuances. In this qualitative study, we draw upon the lived experiences of Black women employed at a mid-sized police agency in Virginia. Between August 2021 and March 2022, in-depth interviews were conducted with Black women across ranks to learn about how their identity as Black women impacted their social environment at work. Thematic findings reflected the impact that the lack of representation had on Black women officers, the self-reported victories and downfalls associated with Black women achieving rank, and the presence of tokenism, primarily seen in these women’s interactions with other peers. Policy and practical implications are discussed.
Prevalence of central sleep apnea among veterans and response rate to continuous positive airway pressure therapy
Authors: Ibrahim Nesrine Adly , Sankari Abdulghani , Aldwaikat Ahmad , Pandya Nishtha , Chowdhuri Susmita , Salloum Anan , Martin Jennifer L , Zeineddine Salam , Badr M Safwan
Published: February 2024

Study Objectives

Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans.

Methods

Veterans were screened from a single VA medical center who had polysomnography (PSG) study from 2017 to 2021 to ascertain the presence, severity, and type of SDB by measuring the apnea–hypopnea index (AHI) and central apnea index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/hour. Diagnostic “CSA only” was defined as AHI ≥ 10 events/hour and CAI ≥ 50% of AHI. “OSA only” was defined if AHI ≥ 10 events/hour and CAI < 5 events/hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI ≥ 10 events/hour and CAI > 5 events/hour but < 50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/hour on the titration study.

Results

A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI (p < 0.05).

Conclusions

Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.
The Effects of Reverse-Role Simulation on Nursing Students’ Ethnocultural Empathy: A Quantitative Study
Authors: Lalande Fabiola D.
Published: February 2024

AIM

The aim of this study was to examine the impact of reverse-role simulation on nursing students’ empathy levels toward ethnoculturally diverse patients.

BACKGROUND

Empathy is an essential component of culturally competent care; however, it is often left out of cultural competence education. Enhancing nursing students’ cultural empathy may benefit students and patients.

METHOD

The study used a quasi-experimental one-group pretest-posttest design in a private nursing school in the Northeast. The sample consisted of 37 undergraduate nursing students.

RESULTS

Pretest and posttest scores were statistically different, indicating a significant increase in the students’ ethnocultural empathy, t(36) = −3.20, p = .003.

CONCLUSION

This study supports using reverse-role simulation as an effective teaching strategy to enhance nursing students’ empathy toward ethnocultural diverse patients. Placing students in the “shoes” of an ethnoculturally diverse patient can increase their empathy levels and enhance cultural competence education.
Combined Therapy of Paravertebral Nerve Pulsed Radiofrequency and Subcutaneous Block for Acute/subacute Herpetic Neuralgia
Authors: Zhang Wei , Yu Bin , Jia Zipu , Zhao Chunmei , Luo Fang
Published: February 2024

Objectives:

This retrospective study aimed to investigate the effectiveness and safety of early combined therapy with CT-guided paravertebral nerve (PVN) pulsed radiofrequency (PRF) and subcutaneous block on acute/subacute herpes zoster (HZ).

Methods:

A total of 98 medical records were analyzed. All patients underwent CT-guided PRF on PVN immediately followed by a single subcutaneous block with lidocaine and dexamethasone in acute/subacute phase. The therapy efficacy was evaluated by pain numeric rating scale (NRS) and effective rate, which was defined as a percent of cases with a reduction in pain NRS＞50%, at day 1, week 2, 4, 12 and 24 after procedure. The incidences of medication reduction and postherpetic neuralgia (PHN) were also retrieved. Further comparison was conducted between acute group (disease duration<30 d from HZ onset) and subacute group (30 d<duration<90 d from HZ onset).

Results:

Early combined therapy indicated an immediate and sustained improvement in pain NRS as compared to before treatment (P<0.0001), with the effective rates of 74%, 79%, 80%, 76% and 79% at day 1, week 2, 4, 12 and 24 after procedure, respectively. At the end of follow-up, the proportion of patients with a reduction of>50% in prior medications amounted to 83% and the incidence of clinically meaningful PHN decreased to 23%. The clinical efficacy was more profound in acute group than in subacute group at every time points (P<0.05). No severe complications occurred.

Discussion:

Our data revealed surprising levels of pain relief by combination therapies of PRF and subcutaneous block targeting different sites of pain pathway, thus suggesting a valuable treatment option for acute/subacute herpetic neuralgia.
Depression Screening in Pediatric Orthopedic Surgery Clinics and Identifying Patients At-Risk
Authors: Catanzano Anthony A. , Bastrom Tracey P. , Bartley Carrie E. , Yaszay Burt , Upasani Vidyadhar V. , Newton Peter O.
Published: February 2024

Background:

Up to 25% of youth experience a depressive episode by 18 years of age, leading the US Preventive Services Task Force to recommend depression screening within this population. This study aimed to understand the prevalence of depression identified within pediatric orthopedic clinics compared with primary care clinics after the implementation of a screening program and present data on the prevalence of moderate-severe depression across specific pediatric orthopedic clinics, characterizing and identifying specific populations at higher risk.

Methods:

A retrospective review was performed to identify all patients screened using the 2-item and 9-item versions of the Patient Health Questionnaire (PHQ-2/PHQ-9) and the Columbia-Suicide Severity Rating Scale over a 2-year period (October 2018 to January 2021) within pediatric primary care and orthopaedic clinics. Demographic and clinical characteristics were collected. Statistical analysis was performed to compare scores between orthopedic and primary care clinics, as well as between the different pediatric orthopedic subspecialties and included χ2 test, ANOVA, and logistic regression.

Results:

There were 32,787 unique adolescent patients screened in primary care clinics, with an additional 14,078 unique adolescent patients screened in orthopaedic clinics, leading to a 30% increase in the overall number of patients receiving depression screening. 5.2% of patients in primary care pediatric clinics screened positive for moderate-severe depression versus 2.0% in pediatric orthopaedic clinics (P<0.001). 2.7% of primary care patients were at risk of self-harm compared with 0.8% of orthopedic patients (P<0.001). Within orthopaedic subspecialty clinics, the spine patients were at the highest risk of moderate-severe depression (3.5%), significantly higher than both the sports (1.4%, P=0.006) and patients with acute fracture (1.3%, P<0.001).

Conclusions:

This study demonstrates the high incidence of patients screening positive for depression in pediatric and adolescent orthopaedic clinics. By identifying high-risk clinics and patient groups, health care systems can apply a more practical approach and appropriately deploy behavioral health specialists for timely counseling and treatment discussions.

Level of Evidence:

Level—III.
Changes in Pulmonary Vascular Resistance and Obstruction Score Following Acute Pulmonary Embolism in Pigs
Authors: Merit Victor T. , Kirk Mathilde E. , Schultz Jacob G. , Hansen Jacob V. , Lyhne Mads D. , Kramer Anders D. , Pedersen Christina C. E. , Karout Lina , Kalra Mannudeep K. , Andersen Asger , Nielsen-Kudsk Jens Erik
Published: February 2024

OBJECTIVES:

To investigate the contribution of mechanical obstruction and pulmonary vasoconstriction to pulmonary vascular resistance (PVR) in acute pulmonary embolism (PE) in pigs.

DESIGN:

Controlled, animal study.

SETTING:

Tertiary university hospital, animal research laboratory.

SUBJECTS:

Female Danish slaughter pigs (n = 12, ~60 kg).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

PE was induced by infusion of autologous blood clots in pigs. CT pulmonary angiograms were performed at baseline, after PE (first experimental day [PEd0]) and the following 2 days (second experimental day [PEd1] and third experimental day [PEd2]), and clot burden quantified by a modified Qanadli Obstruction Score. Hemodynamics were evaluated with left and right heart catheterization and systemic invasive pressures each day before, under, and after treatment with the pulmonary vasodilators sildenafil (0.1 mg/kg) and oxygen (Fio
2 40%). PE increased PVR (baseline vs. PEd0: 178 ± 54 vs. 526 ± 160 dynes; p < 0.0001) and obstruction score (baseline vs. PEd0: 0% vs. 45% ± 13%; p < 0.0001). PVR decreased toward baseline at day 1 (baseline vs. PEd1: 178 ± 54 vs. 219 ± 48; p = 0.16) and day 2 (baseline vs. PEd2: 178 ± 54 vs. 201 ± 50; p = 0.51). Obstruction score decreased only slightly at day 1 (PEd0 vs. PEd1: 45% ± 12% vs. 43% ± 14%; p = 0.04) and remained elevated throughout the study (PEd1 vs. PEd2: 43% ± 14% vs. 42% ± 17%; p = 0.74). Sildenafil and oxygen in combination decreased PVR at day 0 (–284 ± 154 dynes; p = 0.0064) but had no effects at day 1 (–8 ± 27 dynes; p = 0.4827) or day 2 (–18 ± 32 dynes; p = 0.0923).

CONCLUSIONS:

Pulmonary vasoconstriction, and not mechanical obstruction, was the predominant cause of increased PVR in acute PE in pigs. PVR rapidly declined over the first 2 days after onset despite a persistent mechanical obstruction of the pulmonary circulation from emboli. The findings suggest that treatment with pulmonary vasodilators might only be effective in the acute phase of PE thereby limiting the window for such therapy.
Pregnancy and the disease recurrence of patients previously treated for differentiated thyroid cancer: A systematic review and meta analysis
Authors: Shan Rui , Li Xin , Tao Ming , Xiao Wucai , Chen Jing , Mei Fang , Song Shibing , Sun Bangkai , Yuan Chunhui , Liu Zheng
Published: February 2024

Background:

Differentiated thyroid cancer (DTC) is commonly diagnosed in women of child-bearing age, but whether pregnancy influences the prognosis of DTC remains controversial. This study aimed to summarize existing evidence regarding the association of pregnancy with recurrence risk in patients previously treated for DTC.

Methods:

We searched PubMed, Embase, Web of Science, Cochrane, and Scopus based on the prespecified protocol registered at PROSPERO (CRD42022367896). After study selection, two researchers independently extracted data from the included studies. For quantitative data synthesis, we used random-effects meta-analysis models to pool the proportion of recurrence (for pregnant women only) and odds ratio (OR; comparing the risk of recurrence between the pregnancy group and the nonpregnancy group), respectively. Then we conducted subgroup analyses to explore whether risk of recurrence differed by response to therapy status or duration of follow-up time. We also assessed quality of the included studies.

Results:

A total of ten studies were included. The sample size ranged from 8 to 235, with participants’ age at pregnancy or delivery ranging from 28 to 35 years. The follow-up time varied from 0.1 to 36.0 years. The pooled proportion of recurrence in all pregnant patients was 0.13 (95% confidence intervals [CI]: 0.06–0.25;I2: 0.58). Among six included studies reporting response to therapy status before pregnancy, we observed a trend for increasingly higher risk of recurrence from excellent, indeterminate, and biochemically incomplete to structurally incomplete response to therapy (Ptrend<0.05). The pooled risk of recurrence in the pregnancy group showed no evidence of a significant difference from that in the nonpregnancy group (OR: 0.75; 95% CI: 0.45–1.23;I2: 0). The difference in follow-up time (below/above five years) was not associated with either the proportion of recurrence in all pregnant patients (P>0.05) or the OR of recurrence in studies with a comparison group (P>0.05). Two included studies that focused on patients with distant metastasis also did not show a significant difference in disease recurrence between pregnancy and nonpregnancy groups (OR: 0.51 [95% CI: 0.14–1.87;I2: 59%]).

Conclusion:

In general, pregnancy appears to have a minimal association with the disease recurrence of DTC with initial treatment. Clinicians should pay more attention to progression of DTC among pregnant women with biochemical and/or structural persistence.

Registration:

PROSPERO, https://www.crd.york.ac.uk/PROSPERO/; No. CRD42022367896.
How to Start and Build a Practice in Microsurgical Breast Reconstruction: Success and Sustainability in a Private Practice Setting
Authors: Pisano Steven M. , Ochoa Oscar , Gassman Andrew A. , Ledoux Peter R. , Nastala Chet L. , Whipple Lauren A. , Arishita Gary I. , Chrysopoulo Minas T.
Published: February 2024

The aim of this article is to provide a template for building and sustaining a microsurgical breast reconstruction practice in a private practice setting. The target audience including residents, microsurgical fellows, and reconstructive microsurgeons were currently employed in an academic setting, and reconstructive microsurgeons were currently employed in a private group entity. We present five pillars that initiate, support, and sustain a successful practice in microsurgical breast reconstruction. The five key concepts are (1) establishing a practice vision and culture, (2) obtaining funding, (3) assembling staff, (4) negotiating insurance and other contracts, and (5) striving for efficiency and sustainability. These concepts have been at the core of Plastic, Reconstructive and Microsurgical Associates of South Texas—a private practice eight-physician group based in San Antonio, Tex.—since its inception. However, these concepts have evolved as the practice has grown and as the economic landscape has changed for reconstructive microsurgeons. In the article, we will present what we have done well, what we could have done better, and some pitfalls to avoid.
How to Start and Build Microsurgery Practice—Topics on Success and Sustainability: Global/International
Authors: Kwon Jin Geun , Suh Hyunsuk Peter , Pak Changsik John , Hong Joon Pio
Published: February 2024

Many young microsurgeons begin their careers at established hospitals where microsurgery resources are limited. This article shares the authors’ experiences in overcoming challenges and establishing a microsurgery practice in a new hospital. Due to the lack of equipment, limited support from colleagues, absence of discussion partners, fear of failure, and unpredictable situations, many aspiring microsurgeons lose their motivation. The purpose of this article is to guide future microsurgeons by describing the author’s actions and suggesting improvements for their first free flap case. Key factors for building a successful, sustainable, and enjoyable microsurgery practice include remembering your training and mentors, acquiring fundamental knowledge of microsurgery, creating a supportive ecosystem, and having fun.
Improved outcomes after hypothermic oxygenated machine perfusion in liver transplantation–Long-term follow-up of a multicenter randomized controlled trial
Authors: Czigany Zoltan , Uluk Deniz , Pavicevic Sandra , Lurje Isabella , Froněk Jiří , Keller Theresa , Strnad Pavel , Jiang Decan , Gevers Tom , Koliogiannis Dionysios , Guba Markus , Tolba Rene H. , Meister Franziska A. , Neumann Ulf P. , Kocik Matej , Kysela Marek , Sauer Igor M. , Raschzok Nathanael , Schöning Wenzel , Popescu Irinel , Tacke Frank , Pratschke Johann , Lurje Georg
Published: February 2024

Background:

While 4 randomized controlled clinical trials confirmed the early benefits of hypothermic oxygenated machine perfusion (HOPE), high-level evidence regarding long-term clinical outcomes is lacking. The aim of this follow-up study from the HOPE-ECD-DBD trial was to compare long-term outcomes in patients who underwent liver transplantation using extended criteria donor allografts from donation after brain death (ECD-DBD), randomized to either HOPE or static cold storage (SCS).

Methods:

Between September 2017 and September 2020, recipients of liver transplantation from 4 European centers receiving extended criteria donor-donation after brain death allografts were randomly assigned to HOPE or SCS (1:1). Follow-up data were available for all patients. Analyzed endpoints included the incidence of late-onset complications (occurring later than 6 months and graded according to the Clavien-Dindo Classification and the Comprehensive Complication Index) and long-term graft survival and patient survival.

Results:

A total of 46 patients were randomized, 23 in both arms. The median follow-up was 48 months (95% CI: 41–55). After excluding early perioperative morbidity, a significant reduction in late-onset morbidity was observed in the HOPE group (median reduction of 23 Comprehensive Complication Index-points [p=0.003] and lower incidence of major complications [Clavien-Dindo ≥3, 43% vs. 85%, p=0.009]). Primary graft loss occurred in 13 patients (HOPE n=3 vs. SCS n=10), resulting in a significantly lower overall graft survival (p=0.029) and adverse 1-, 3-, and 5-year survival probabilities in the SCS group, which did not reach the level of significance (HOPE 0.913, 0.869, 0.869 vs. SCS 0.783, 0.606, 0.519, respectively).

Conclusions:

Our exploratory findings indicate that HOPE reduces late-onset morbidity and improves long-term graft survival providing clinical evidence to further support the broad implementation of HOPE in human liver transplantation.
The RIVET RCT: Rifamycin SV MMX improves muscle mass, physical function, and ammonia in cirrhosis and minimal encephalopathy
Authors: Bajaj Jasmohan S. , Fagan Andrew , Gavis Edith A. , Mousel Travis , Gallagher Mary L. , Puri Puneet , Fuchs Michael , Davis Brian C. , Hylemon Phillip B. , Zhou Huiping , Ahluwalia Vishwadeep , Cadrain Robert , Sikaroodi Masoumeh , Gillevet Patrick M.
Published: February 2024

Background:

Minimal hepatic encephalopathy (MHE) negatively affects the prognosis of cirrhosis, but treatment is not standard. Rifamycin SV MMX (RiVM) is a nonabsorbable rifampin derivative with colonic action.

Methods:

In a phase 2 placebo-controlled, double-blind randomized clinical trial patients with MHE were randomized to RiVM or placebo for 30 days with a 7-day follow-up. The primary endpoint was a change in stool cirrhosis dysbiosis ratio. Gut-brain (cognition, stool/salivary microbiome, ammonia, brain magnetic resonance spectroscopy), inflammation (stool calprotectin/serum cytokines), patient-reported outcomes (sickness impact profile: total/physical/psychosocial, high = worse), and sarcopenia (handgrip, bioelectric impedance) were secondary. Between/within groups and delta (post-pre) comparisons were performed.

Results:

Thirty patients (15/group) were randomized and completed the study without safety concerns. While cirrhosis dysbiosis ratio was statistically similar on repeated measures ANOVA (95% CI: −0.70 to 3.5), ammonia significantly reduced (95% CI: 4.4–29.6) in RiVM with changes in stool microbial α/β-diversity. MHE status was unchanged but only serial dotting (which tests motor strength) improved in RiVM-assigned patients. Delta physical sickness impact profile (95% CI: 0.33 = 8.5), lean mass (95% CI: −3.3 to −0.9), and handgrip strength (95% CI: −8.1 to −1.0) improved in RiVM versus placebo. Stool short-chain fatty acids (propionate, acetate, and butyrate) increased post-RiVM. Serum, urine, and stool bile acid profile changed to nontoxic bile acids (higher hyocholate/ursodeoxycholate and lower deoxycholate/lithocholate) post-RiVM. Serum IL-1β and stool calprotectin decreased while brain magnetic resonance spectroscopy showed higher glutathione concentrations in RiVM.

Conclusions:

RiVM is well tolerated in patients with MHE with changes in stool microbial composition and function, ammonia, inflammation, brain oxidative stress, and sarcopenia-related parameters without improvement in cognition. RiVM modulates the gut-brain axis and gut-muscle axis in cirrhosis.
Forensic Psychiatric Patients' Experiences of Personal Recovery
Authors: Lumén Katja , Louheranta Olavi , Kuosmanen Lauri
Published: February 2024

Psychiatric patients' recovery processes have been studied rather extensively, and a relatively clear consensus on what recovery is already exists. We examined whether the personal recovery of forensic psychiatric patients varies from this definition. We conducted a concept analysis to assess the personal recovery of patients in forensic psychiatric hospitals based on 21 articles and then evaluated how our results compared with existing definitions on psychiatric and forensic recovery. On the basis of this comparison, we concluded that the personal recovery of forensic psychiatric patients does differ from that of other psychiatric patients. The recovery process of forensic psychiatric patients can be described through five themes: personal development and autonomy, social inclusion and normality, redemption and overcoming, future orientation and hope, and advancing process. The burden of a psychiatric disorder causes similar challenges, yet a criminal history and long hospitalization periods are distinctive issues for forensic patients, both of which can lead to severe alienation from society and deterioration of skills needed in life outside an institution. The results suggest that processing the criminal offense should be part of the care; furthermore, institutions should support forensic psychiatric patients in their reintegration into society and personal development. Identifying special recovery challenges can be useful when designing effective care and promoting the recovery of forensic patients. Thus, our results suggest that certain features of forensic psychiatric patients' recovery should be considered when planning their psychiatric care.
Imprinted immune abnormalities in liver transplant patients cured of hepatitis C with antiviral drugs
Authors: Doyle Erin H. , Aloman Costica , El-Shamy Ahmed , Eng Francis J. , Kim-Schulze Seunghee , Rahman Adeeb , Schiano Thomas , Heeger Peter , Branch Andrea D.
Published: February 2024

Chronic HCV infection induces interferon and dysregulates immune responses through inflammation and chronic antigenic stimulation. Antiviral drugs can cure HCV, providing a unique opportunity to examine the immunological restoration that does and does not occur when a chronic viral infection is eradicated. We quantified blood cytokines levels and used mass cytometry to immunophenotype peripheral blood mononuclear cells before and after HCV cure in 2 groups of patients and controls. At baseline, serum interferon α and soluble CD163 (a macrophage product) were elevated in both liver transplant and nonliver transplant patients compared to controls; the frequencies of several peripheral blood mononuclear cell populations differed from controls; and programmed death protein 1-positivity was increased in nearly all T cell subsets. Many abnormalities persisted after HCV cure, including elevated programmed death protein 1 expression on CD4 naïve and central memory T cells, elevated soluble CD163, and expansion of the plasmablast/plasma cell compartment. Several myeloid-lineage subsets, including Ag-presenting dendritic cells, remained dysregulated. In mechanistic studies, interferon α treatment increased programmed death protein 1 on human T cells and increased T cell receptor signaling. The data identify immunological abnormalities that persist after curative HCV treatment. Before cure, high levels of interferon α may stimulate programmed death protein 1 expression on human T cells, causing persistent functional changes.
Clinical Analysis of Pediatric Acute Megakaryocytic Leukemia With CBFA2T3-GLIS2 Fusion Gene
Authors: Du Yu , Yang Li , Qi Shanshan , Chen Zhi , Sun Ming , Wu Min , Wu Bin , Tao Fang , Xiong Hao
Published: February 2024

CBFA2T3-GLIS2 is the most frequent chimeric oncogene identified to date in non–Down syndrome acute megakaryocytic leukemia (AMKL), which is associated with extremely poor clinical outcome. The presence of this fusion gene is associated with resistance to high-intensity chemotherapy, including hematopoietic stem cell transplantation (HSCT), and a high cumulative incidence of relapse frequency. The clinical features and clinical effects of China Children’s Leukemia Group–acute myeloid leukemia (AML) 2015/2019 regimens and haploidentical HSCT (haplo-HSCT) for treatment of 6 children harboring the CBFA2T3-GLIS2 fusion gene between January 2019 and December 2021 were retrospectively analyzed. The 6 patients included 4 boys and 2 girls with a median disease-onset age of 19.5 months (range: 6–67 mo) who were diagnosed with AMKL. Flow cytometry demonstrated CD41a, CD42b, and CD56 expression and lack of HLA-DR expression in all 6 patients. All the children were negative for common leukemia fusion genes by reverse transcription polymerase chain reaction, but positive for the CBFA2T3-GLIS2 fusion gene by next-generation sequencing and RNA sequencing. All patients received chemotherapy according to China Children’s Leukemia Group–AML 2015/2019 regimens, and 4 achieved complete remission. Four children underwent haplo-HSCT with posttransplant cyclophosphamide-based conditioning; 3 had minimal residual disease negative (minimal residual disease <0.1%) confirmed by flow cytometry at the end of the follow-up, with the remaining patient experiencing relapse at 12 months after transplantation. Transcriptome RNA sequencing is required for the detection of the CBFA2T3-GLIS2 fusion gene and for proper risk-based allocation of pediatric patients with AML in future clinical strategies. Haplo-HSCT with posttransplant cyclophosphamide–based conditioning may improve survival in children with AMKL harboring the fusion gene.
Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study
Authors: Devgan Yuvraj , Mayilvaganan Sabaretnam , Mishra Anjali , Chand Gyan , Agarwal Gaurav , Agarwal Amit
Published: February 2024

Introduction:

Indocyanine green (ICG) angiography is the ‘real-time intraoperative imaging’ technique used to reduce the chances of hypoparathyroidism in post-thyroidectomy patients. In our study, the authors predicted the risk of early post-thyroidectomy hypocalcemia by intraoperative evaluation of parathyroid gland perfusion by ICG angiography.

Materials and methods:

In patients who underwent total thyroidectomy, ICG angiography was done using the SPY PHI imaging system (Stryker). Post-thyroid specimen removal, scoring of parathyroids was done in spy contrast mode. All 4 or <4 visualized parathyroids were scored for vascularity with the highest score of 8. Serum ionized calcium was done 6 h postsurgery and on the morning and evening of postoperative days 1 and 2. Calcium supplements were given to only those who developed clinical or severe biochemical hypocalcemia.

Results:

Out of 60, postoperative hypocalcemia was noted in 41 patients. Total ICG score ≤5 was seen in 34 patients, out of which 28 developed postoperative hypocalcemia showing PPV 82.3% and diagnostic accuracy of 68.3% while iPTH (4.28 pmol/l) showed PPV 76.7 and diagnostic accuracy 70 %. In eight patients, none of the glands was scored as 2 (White) and all these patients developed hypocalcemia requiring calcium infusion.

Conclusion:

The absence of visualization of at least 1 well-perfused (score 2) gland on ICG angiography is highly predictive of hypocalcemia and the majority of patients with total ICG score ≤5 developed hypocalcemia in the immediate postoperative period. ICG is a good predictor of the absence of hypoparathyroidism after thyroidectomy and is comparable to iPTH in the prediction of post-thyroidectomy hypocalcemia.
Insights into the management of Lewy body dementia: a scoping review
Authors: Khan Sajjad Ahmed , Khan Sadab , Kausar Huma , Shah Rajat , Luitel Anish , Gautam Sakshyam , Parajuli Surya Bahadur , Rauniyar Vivek K. , Khan Moien A.B.
Published: February 2024

Lewy body dementia (LBD) is situated at the convergence of neurodegenerative disorders, posing an intricate and diverse clinical dilemma. The accumulation of abnormal protein in the brain, namely, the Lewy body causes disturbances in typical neural functioning, leading to a range of cognitive, motor, and mental symptoms that have a substantial influence on the overall well-being and quality of life of affected individuals. There is no definitive cure for the disease; however, several nonpharmacological and pharmacological modalities have been tried with questionable efficacies. The aim of this study is to figure out the role of different interventional strategies in the disease. Donepezil, rivastigmine, memantine, and galantamine were the commonly used drugs for LBD. Together with that, levodopa, antipsychotics, armodafinil, piracetam, and traditional medications like yokukansan were also used, when indicated. Talking about nonpharmacological measures, exercise, physical therapy, multicomponent therapy, occupational therapy, psychobehavioral modification, transcranial stimulation, and deep brain stimulation have been used with variable efficacies. Talking about recent advances in the treatment of LBD, various disease-modifying therapies like ambroxol, neflamapimod, irsenontrine, nilotinib, bosutinib, vodobatinib, clenbuterol, terazosin, elayta, fosgonimeton, and anle138b are emerging out. However, there drugs are still in the different phases of clinical trials and are not commonly used in clinical practice. With the different pharmacological and nonpharmacological modalities we have for treatment of LBD, all of them offer symptomatic relief only. Being a degenerative disease, definite cure of the disease can only be possible with regenerative measures.
Utilization of patient-reported outcomes in joint replacement care design
Authors: Marcus-Aiyeku Ulanda , Fake Pamela , Fetzer Christine , Hessels Amanda , Kilpatrick Rachel , Markiewicz Dorothy , McNicholas Miriam , Mills Kimberly , Nedumalayil Seera , Paliwal Mani , Panten Angie , Schuld Clare , Ullero Amarlyn
Published: February 2024

Analysis finds health disparities among the elective surgery population
Surgical Treatment of Anterior Plagiocephaly With Limited Calvarial Osteotomy
Authors: Kalantar Hormozi Abdoljalil , Moradi Ehsan , Rahnama Ahmad , Noori Mehran , Kalantar Hormozi Hadis
Published: February 2024

Objective:

Anterior plagiocephaly is a condition in which the unicoronal suture is prematurely fused and the skull shape will change due to asymmetric growth.

Methods:

This is a retrospective study describing the unilateral limited frontal osteotomy for remodeling deformed areas in the frontal and orbital bone and its pros and cons.

Results:

Twenty-eight patients were included in the study, with a mean age of 16.8 (±11.7) months. Mean intraoperative bleeding was 78.1 (±23.6) mL. One (3.57%) patient developed postoperative bleeding, around 200 mL. After 12 months, all patients (100%) had grade I Whitaker.

Conclusion:

The described technique is safe and may have promising short-term outcomes for the correction of anterior plagiocephaly.
IDENTIFICATION OF POTENTIALLY MODIFIABLE FACTORS TO IMPROVE RECOGNITION AND OUTCOME OF NECROTIZING SOFT-TISSUE INFECTIONS
Authors: Suijker Jaco , Pijpe Anouk , Hoogerbrug Denise , Heymans Martijn W. , van Zuijlen Paul P.M. , Halm Jens A. ,   NSTI Knowledge Collaborative Group, Meij-de Vries Annebeth
Published: February 2024

Background: Necrotizing soft-tissue infections (NSTIs) present a surgical emergency of increasing incidence, which is often misdiagnosed and associated with substantial mortality and morbidity. A retrospective multicenter (11 hospitals) cohort study was initiated to identify the early predictors of misdiagnosis, mortality, and morbidity (skin defect size and amputation). Methods: Patients of all ages who presented with symptoms and were admitted for acute treatment of NSTIs between January 2013 and December 2017 were included. Generalized estimating equation analysis was used to identify early predictors (available before or during the first debridement surgery), with a significance level of P < 0.05. Results: The median age of the cohort (N = 216) was 59.5 (interquartile range = 23.6) years, of which 138 patients (63.9%) were male. Necrotizing soft-tissue infections most frequently originated in the legs (31.0%) and anogenital area (30.5%). More than half of the patients (n = 114, 54.3%) were initially misdiagnosed. Thirty-day mortality was 22.9%. Amputation of an extremity was performed in 26 patients (12.5%). Misdiagnosis was more likely in patients with a higher Charlson Comorbidity Index (β = 0.20, P = 0.001), and less likely when symptoms started in the anogenital area (β = −1.20, P = 0.003). Besides the established risk factors for mortality (septic shock and age), misdiagnosis was identified as an independent predictor of 30-day mortality (β = 1.03, P = 0.01). The strongest predictors of the final skin defect size were septic shock (β = 2.88, P < 0.001) and a skin-sparing approach to debridement (β = −1.79, P = 0.002). Conclusion: Recognition of the disease is essential for the survival of patients affected by NSTI, as is adequate treatment of septic shock. The application of a skin-sparing approach to surgical debridement may decrease morbidity.