bluuebunny/crossref_metadata_2025 huggingface dataset:
Field Assessment of Turkish fir (Abies bornmuelleriana) Resistance to Five Root-Rotting Phytophthora Species
Authors: McKeever Katie , Johnson Jeremy , Chastagner Gary
Published: February 2025

Turkish fir (Abies bornmuelleriana) has been evaluated as a Phytophthora Root Rot (PRR)-resistant alternative to other PRR-susceptible Abies Christmas tree species. Though Turkish fir survival under heavy PRR disease pressure exceeds that of other host species, previous research has suggested that there may be variability in resistance owing to pedigree, ambient environment, and Phytophthora species. To assess differences in PRR survival in the field, 36 open-pollinated families of Turkish fir were challenged with a mixture of five species of Phytophthora under conditions conducive for disease. Seedlings were grown from seed that was gathered during a provenance collection effort from three provinces in Turkey. At the collection locations in each province, mother trees were located along an altitudinal gradient. The goals for this study included determining Turkish fir resistance in comparison to susceptible fir spp., evaluating phenotype among Turkish fir families, assessing if differences in phenotypes could be attributable to source location or elevation, determining if source province or elevation influenced mortality, and comparing recovery of the five Phytophthora spp. used as inoculum. Turkish fir was demonstrated to be more resistant than noble fir (A. procera) or Fraser fir (A. fraseri) under the experimental conditions. Among the 36 Turkish fir families, six families had a significantly lower probability of PRR mortality compared to all other families; half of these families were from the Karabük province. Similarly, the Karabük province had the lowest overall mortality when family mortality proportions were totaled and compared among provinces. Evaluation of mortality among families from higher elevation sites within a province showed reduced mortality in comparison to mid and lower elevation sites, with variation among seed sources from different provinces. Among the five species of Phytophthora bulked for inoculum, P. cryptogea was the predominant species recovered from dead seedlings in both years. Results suggest that Turkish fir may be a viable PRR-resistant option for utilization in the Christmas tree industry despite some variability in phenotype among family.
Field trial of biologicals for managing potato early dying complex in Maine, 2024
Authors: Morris Shayli , Fan Xiaowei , Askarizadeh Mandana , Teng Lijie , Zhang Xiuyan , Gao Yihang , Hynes Georgia , Chim Bee , Hao Jianjun
Published: February 2025

Potato early dying complex is caused by fungal pathogen Verticillium dahliae and Pratylenchus root lesion nematodes. It is an economically impactful potato disease in the United States. Symptoms include decreased tuber yield, unilateral wilting, chlorosis, and necrosis of leaves, and brown vascular discoloration in stems and tubers. This report evaluates the efficacy of two biological controls in conjunction with a traditional chemical management of potato early dying complex. This trial was conducted in Presque Isle, ME in 2024 on potato (Solanum tuberosum) ‘Kennebec’. Results from this study can help advise potato producers in the U.S. in managing this disease complex.
OsHARBI1‐1 enhances cadmium tolerance in yeast through YAP1 mediated modulation of cell wall integrity genes and catalase genes
Authors: Shi Yang , Jiang Nan , Jiang Wenjun , Chen Ji , Wu Lijuan , Jiao Yuan , Zhou Yingxu , Wu Longying , Huang Yanyan , Li Deqiang , Kumar Vinod , Hu Binhua , Huang Jin
Published: February 2025

Harbinger transposase‐derived 1 proteins (HARBI1s) play important roles in plant growth, development, and response to abiotic stress. OsHARBI1‐1 has been identified as a gene encoding HARBI1‐1 protein in rice and has been shown to be responsive to Cadmium (Cd) stress. However, the function of OsHARBI1‐1 protein under heavy metal stress remains unclear. In this study, the function of a novel rice Cd‐responsive gene, OsHARBI1‐1, under Cd stress was characterized by heterologous expression in yeast. The heterologous expression OsHARBI1‐1 conferred yeast with increased tolerance to Cd. In addition, the yeast cells expressing OsHARBI1‐1 exhibited enhanced tolerance to Congo red and exhibited an increase in cell wall thickness under Cd stress, suggesting a potential correlation between increased Cd tolerance and cell wall thickness in the transgenic yeast. When OsHARBI1‐1 was expressed in ∆yap1 or ∆yap1∆ycf1 yeast mutants, there was no significant difference in the tolerance of transgenic yeast to Cd and Congo red, as well as in cell wall thickness compared to the control. Meanwhile, the expression of cell wall integrity (CWI) genes and catalase genes in transgenic yeast was up‐regulated in a YAP1‐dependent manner under Cd or Congo red stress. The above facts supported the inference that OsHARBI1‐1 may counteract Cd toxicity by enhancing the expression of YAP1, thereby increasing the thickness of the cell wall and activating the expression of catalase genes.
Factors Affecting Retention Intention Among Married Nurses With Preschool-Aged Children
Authors: Shin Hyeseon , Jo Minjeong
Published: February 2025

This cross-sectional study examined the effects of parenting stress, resilience, and social support on the retention intentions of married nurses with preschool-aged children in South Korea. Data from 150 nurses were collected through an online survey. The findings indicate that age, household income, job satisfaction, the presence of caregiver cohabitants, and resilience significantly influence retention intentions, explaining 30.7% of the variance. The results underscore the urgent need for healthcare organizations to develop and implement customized support programs targeting midcareer married nurses with young children, emphasizing resilience building, job satisfaction, and financial support.
Multi-institutional Analysis of Immune-Oncology Combination Therapy for Metastatic MiT Family Translocation Renal Cell Carcinoma
Authors: Ged Yasser , Touma Amina , Meza Contreras Luis , Elias Roy , Van Galen Joseph , Cupo Olivia , Baraban Ezra , Singla Nirmish , Lee Chung-Han , Pal Sumanta , Zibelman Matthew , Kotecha Ritesh R.
Published: February 2025

Metastatic translocation renal cell carcinomas (mtRCCs) are rare and aggressive tumors with limited treatment options. Recent studies demonstrated promising activity of immune-oncology (IO) combinations in mtRCC. However, the effectiveness of dual IO combinations versus IO plus VEGF-TKI combinations remains unclear. We conducted a retrospective analysis of IO combinations in mtRCC patients at 4 institutions. Eligible patients had confirmed mtRCC by genitourinary pathologist and received IO combination therapy (IO+IO or IO+VEGF-TKI). Clinical data and treatment outcomes were recorded from the start of systemic therapy. Objective response rate (ORR) was retrospectively evaluated, and time to treatment failure (TTF), and overall survival (OS) were compared for IO+IO and IO+VEGF-TKI groups. We identified 22 mtRCC patients who received IO combinations, all confirmed to have TFE3 rearrangement by FISH. Most patients were female (68%) with a median age of 41 years (16–79). Treatment breakdown included: IO+IO (n=8, 36%) and IO+VEGF-TKI (n=14, 64%). In the evaluable patients for the efficacy analysis, ORR was 14% (1/7) for the IO+IO group and 54% (6/11) for the IO+VEGF-TKI group. With a median follow-up of 32.4 months, the median TTF was 1.2 months and 6.2 months in the IO+IO and IO+VEGF-TKI groups, respectively (P=0.12). There was no statistically significant difference in median OS between both groups, 36.7 months in the IO+IO group and 15.6 months in IO+VEGF-TKI (P=0.9). Our findings demonstrate that IO+VEGF-TKI resulted in higher ORR and TTF point estimates without statistically detectable differences, compared with IO+IO therapy. Larger studies are needed to validate these findings and optimize treatment selection.
Impact of Consensus Guidelines, Clinical Trials, and COVID-19 on Fractionation Practices for Node-negative Intact Breast Cancer
Authors: Cruttenden Jessica , Grant Jonathan , Evans Jaden , Cannon George , Gaffney David K. , Poppe Matthew , Burt Lindsay M. , Avizonis Vilija , Boothe Dustin
Published: February 2025

Objective:

To evaluate whether hypofractionated radiotherapy (HF-RT) in node-negative intact breast cancer significantly increased after guideline updates, trial publications, and COVID-19.

Methods:

Patients with node-negative breast cancer undergoing lumpectomy and adjuvant RT were identified in the National Cancer Database. Receiving ≥25 and <50 Gy in 5-20 fractions defined HF-RT. Receiving 50 to 66 Gy in >20 fractions defined conventional RT (CF-RT). Patient characteristics were compared with X2 testing. Joinpoint analysis identified when fractionation significantly changed. Variables associated with HF-RT were identified by univariate and multivariate (MVA) logistic regression. Two-sided P-value <0.05 was significant.

Results:

Patients meeting criteria totaled 236,336; 54.8% received CF-RT and 45.2% HF-RT. HF-RT and 5-fraction RT significantly increased after 2015 and 2019, respectively (P<0.05). On MVA, HF-RT was positively associated with: age older than or equal to 65 years (OR 2.14, P<0.001); private insurance (OR 1.27, P=0.03); treatment in Midwest (OR 1.66, P<0.001) or Western United States (US) (OR 3.77, P<0.001); distance ≥50 miles (OR 1.16, P=0.001); later year of diagnosis (OR 1.44, P<0.001); and partial breast irradiation (OR 2.08, P<0.001). HF-RT was negatively associated with: community (OR 0.49, P<0.001) or integrated network (0.55, P<0.001) centers; grade 2 (OR 0.83, P<0.001) or 3 (OR 0.49, P<0.001), hormone receptor negative (OR 0.66, P<0.001), and HER2+ (OR 0.74, P<0.001) disease; positive surgical margins (OR 0.61, P<0.001); and presence of lympho-vascular invasion (OR 0.86, P<0.001).

Conclusions:

HF-RT in node-negative intact breast cancer increased after 2015, coinciding with US and European guideline updates. Five-fraction RT increased after 2019, coinciding with COVID-19 and FAST-Forward trial results.
Mucosal immunity in acute HIV: a review of recent work
Authors: Shacklett Barbara L.
Published: February 2025

Purpose of review

This review summarizes recent research literature relevant to mucosal immunity and acute/early HIV infection.

Recent findings

Recent findings include new insights on the HIV transmission “bottleneck” at mucosal surfaces, the impact of acute HIV on germinal centers and mucosal B-cell function, the expression of cytotoxic effector molecules by mucosal CD8+ T-cells, and an enhanced understanding of the impact of acute HIV on innate cell-mediated defenses including mucosa-associated invariant T-cells invarant natural killer T-cells and natural killer cells.

Now more than 40 years since the beginning of the HIV/AIDS pandemic, extensive research has elucidated the dynamics of HIV replication and the corresponding host response. However, the vast majority of HIV-related immunopathogenesis studies have focused on innate and adaptive immune responses in peripheral blood. Mucosal tissues serve as the primary portals of entry for HIV and house the majority of the body's lymphocytes. Innate and adaptive immune responses in mucosal tissues are of particular relevance during the acute phase of HIV disease, as successful defenses can both limit viral dissemination within the host and prevent transmission to a new host, yet until recently these responses were poorly understood.
Population Pharmacokinetics of Perampanel in Chinese Pediatric and Adult Patients With Epilepsy
Authors: Yang Jiayu , Zhang Sitian , Zhao Zhigang , Mei Shenghui , Feng Weixing
Published: February 2025

Background:

Perampanel is a promising epilepsy treatment with an innovative mechanism of action. This study was performed to investigate the factors affecting perampanel clearance in a population pharmacokinetic (PPK) model of Chinese pediatric and adult patients with epilepsy.

Methods:

A total of 135 perampanel plasma concentrations from 125 patients with epilepsy were analyzed using the PPK model with nonlinear mixed-effects modeling. One-compartment and proportional residual models best described the pharmacokinetics of perampanel. Covariate effects on the model parameters were assessed using forward and backward elimination. Goodness-of-fit, bootstrapping, visual predictive checks, and normalized prediction distribution errors were used to evaluate the model. Monte Carlo simulations were conducted to assess the impact of covariate combinations on perampanel plasma concentrations at different dosages.

Results:

In the final PPK model, body weight (BW), concomitant carbamazepine (CBZ), oxcarbazepine (OXC), and C-reactive protein (CRP) levels significantly influenced perampanel clearance. The interindividual clearance was calculated as follows: 0.84 × (BW/70)0.53 × eCBZ × eOXC × eCRP (CBZ = 0.98, when comedicated with carbamazepine; OXC = 0.43, when comedicated with oxcarbazepine; CRP = −0.69, when CRP >15 mg/L, otherwise = 0). The estimates (relative standard error) for clearance and apparent volume of distribution of the final model were 0.84 L/h (8.75%) and 64.35 L (19.78%), respectively. The model maintained its stability and effectiveness with moderate predictability.

Conclusions:

BW and CBZ, OXC, and CRP levels may influence perampanel clearance in both pediatric and adult patients with epilepsy according to a population pharmacokinetic model that included real-world data.
Management and Outcomes of Coronary Artery Aneurysms: A Patient-level Systematic Review
Authors: Rahimov Daler , Nasher Nayeem , Ahmad Danial , Morris Rohinton J. , Upadhyaya Anjali , Yost Colin , Wong Daniella , Patel Preeyal , Vishnevsky Alec , Ruggiero Nicholas J. , Entwistle John W. , Tchantchaleishvili Vakhtang
Published: February 2025

Background:

Data are lacking to guide standardized management of coronary artery aneurysms (CAA). We sought to analyze the available evidence in a quantitative manner.

Methods:

Electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups with (CAAF) and without fistulous connections (CAAO) were analyzed separately.

Results:

Fistulous connection was present in 24.0% (117/488) of patients with CAA. Angina was a presenting symptom in 64.7% (301/465), with higher preponderance in the CAAO group [CAAO: 71.1 % (249/350) vs CAAF: 45.2% (52/115), p<0.01). Median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 [1.5–5.0] cm vs CAAF: 5.0 [3.0–7.0], p<0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) vs CAAF: 13.8% (16/116), p<0.01]. For any given diameter, CAAF had a higher risk of rupture compared to CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) vs CAAF: 75.2% (88/117), p<0.01]. Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. Hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical vs interventional management.

Conclusion:

CAAF appears to have a higher risk of rupture but may be associated with better survival than CAAO. Management for patients with CAA differs based on presence or absence of fistula, however, both surgical and interventional mode of management result in similar survival.
Optical coherence tomography features of atypical congenital hypertrophy of retinal pigment epithelium in a patient with familial adenomatous polyposis
Authors: Mennecozzi Stefano , Spada Elena , Sacconi Riccardo , Bandello Francesco , Querques Giuseppe
Published: February 2025

Purpose:

To describe optical coherence tomography (OCT) features of atypical congenital hypertrophy of retinal pigment epithelium (CHRPE) associated with familial adenomatous polyposis (FAP).

Methods:

Case report.

Results:

A 34-year-old patient diagnosed with FAP was referred to our clinic for fundus examination. We characterized the lesions we found using multimodal imaging (infrared, autofluorescence, OCT and widefield and ultra-widefield fundus image). We described 3 possible stages of progression of the lesions in a single patient and we found a possible evolutionary stage with a “2 binary reflective sign”.

Conclusions:

CHRPE lesions can show a progression from only retinal pigment epithelium (RPE) hyperreflectivity to complete outer retinal atrophy and even intraretinal RPE migration. We hypothesize that the 2 binary reflective sign could represent an hemorrhage between RPE and outer retina which could lead, together with the reduced catabolic activity of pathological RPE, to overlying retinal atrophy.
Evaluation of the Long-Term Effects of Selective Laser Trabeculoplasty on Patients with Primary Open Angle Glaucoma
Authors: Lanza Michele , Serra Luigi , Boccia Rosa , Cangiano Teresa , Coniglio Maria , Fattore Italo , Simonelli Francesca
Published: February 2025

Precis:

Data coming from this study suggest that selective laser trabeculoplasty could be a very important tool in the overall management of glaucoma patients at every stages, aiming to better control the visual field deterioration.

Purpose:

To evaluate selective laser trabeculoplasty (SLT) effectiveness in lowering intraocular pressure (IOP) and in visual field defect progression in eyes affected by primary open angle glaucoma (POAG) at long term follow up.

Methods:

A retrospective study were conducted with 67 eyes of 67 patients affected by POAG who underwent SLT between 2014 and 2021. Each patient was routinely observed in the Glaucoma Office of Università della Campania Luigi Vanvitelli and underwent a complete eye visit and visual field (VF) test with 30-2 SITA standard automated perimetry (SAP) every 6 months. When both eyes in same patient were treated, only the eye with lower mean deviation (MD) of SAP was included. Patients were observed at 6, 12, 18, 24, 30, 36, 42, 48, 54 months.

Results:

A mean significant (P<0.01) lower IOP was detected at 6 months (12.92±2.7 mm Hg) ad at 54 months (13.08±2.42 mm Hg) compared to baseline (17.91±4 mm Hg). Mean MD values showed significant (P<0.01) reduction both at 6 month follow up (−0.07±0.21 dB) and at 54 month follow up (−0.3±0.34 dB) demonstrating satisfactory clinical deceleration of the progression of the disease.

Mean IOP medical lowering therapy was 1.34±0.9 drugs, showing a significant (P<0.01) decrease 6 months after SLT (0.87±0.85), that remained stable (P= at 54 month follow up (0.9±0.76).

Conclusions:

The results observed confirm not only the high level of effectiveness of SLT in lowering IOP and reducing the need for topical medications, but also its role in decelerating visual field deterioration in eyes affected by POAG.
Walking More Than 10,000 Steps Per Day May be Associated with Increased Optic Disc Vessel Density in Patients With Primary Open Angle Glaucoma
Authors: Liang Yuanbo , Yu Yun , Wen Xin , Wang Mei , Lan Yuqing , Pan Xiafei
Published: February 2025

Purpose:

The study aimed to investigate the relationship between average daily steps (ADS) and optic disc angioflow vessel density (VD) in patients with primary open angle glaucoma (POAG).

Materials and Methods:

This is a cross-sectional study. Forty-one POAG patients (74 eyes) were recruited from Wenzhou Glaucoma Progression Study (WGPS) who were divided into two groups based on international physical activity guidelines: 21 subjects (38 eyes) in the ADS>10,000 group and 20 patients (36 eyes) in the ADS≤10,000 group. ADS was monitored using a waist-worn accelerometer (ActiGraph wGT3x-BT) worn on the waist for seven consecutive days, while optic disc VD was assessed by the optical coherence tomography angiography.

Results:

Papillary VD was significantly denser in the ADS>10,000 group (ADS:12782±2925) compared to the ADS≤10,000 group (ADS:7418±1543) for both whole image-all VD (WIAVD) and whole image-capillary VD (WICVD) (P=0.026, 0.032, respectively). Univariate analysis indicates that WIAVD was more denser in ADS>10,000 vs ADS≤10,000 (P=0.013) and that WICVD was more denser in ADS>10,000 vs ADS≤10,000 (P=0.019). Furthermore, every 1 μm thicker in retinal nerve fiber layer (RNFL) thickness was associated with a 0.24 denser in WIAVD (P<0.0001) and a 0.23 denser in WICVD (P<0.0001). Each 1-dB improvement in mean deviation (MD) was linked to a 0.75 increase in WIAVD (P<0.0001) and a 0.83 increase in WICVD (P<0.0001). Additionally, a 1 mmHg increase in intraocular pressure was associated with a 0.5 decrease in WIAVD (P<0.009) in univariate analysis and a 0.31 decrease in multivariate analysis (P<0.012). Multivariate analysis revealed that patients with ADS>10,000 had 1.75 higher WIAVD and 1.64 higher WICVD compared to those with ADS≤10,000 after adjusting for other risk factors.

Conclusion:

POAG patients with ADS>10,000 exhibited higher papillary VD compared to those with ADS≤10,000, implying that increasing daily steps, particularly exceeding 10,000 steps, may potentially enhance ocular blood flow.
Do Nurse Practitioners Deliver? A Retrospective Self-audit Comparing Nurse Practitioner Care for People With HIV in Australia to Screening and Monitoring Guidelines
Authors: Woodward Shannon , Tilley Donna , Spinks Adam , Thompson El , Collins Danielle
Published: February 2025

In Australia, nurse practitioners (NPs) provide care to people with HIV (PWH) in hospital and community settings. We describe a national audit evaluating NP care for PWH, assessing adherence to 2 HIV monitoring guidelines. Five NPs conducted a retrospective case note self-audit. Deidentified data were collected, pooled, and analyzed using Microsoft Excel and compared with HIV monitoring guideline targets. The review was undertaken for 212 NP patients, the majority being cisgendered men (86%), ages 45–49 years, identifying as gay (65%). The majority (95%) of PWH were on an appropriate HIV treatment, meeting the United Nations Programme on HIV/AIDS target of 95%. HIV viral load testing was current for 211 (99%) individuals. Of 138 individuals eligible for cardiovascular screening, 84 (60%) were screened, below a guideline target of 90%. Compliance with HIV monitoring guidelines exceeded targets in most areas. Our audit demonstrates that NPs provide effective and guideline compliant HIV care to PWH in Australia.
ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study
Authors: Gan Wenyi , Ouyang Jianfeng , She Guorong , Xue Zhaowen , Zhu Lingxuan , Lin Anqi , Mou Weiming , Jiang Aimin , Qi Chang , Cheng Quan , Luo Peng , Li Hua , Zheng Xiaofei
Published: February 2025

Background:

Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored.

Methods:

In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires.

Results:

Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P<.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels.

Conclusions:

ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.
Daily physical activity habits influence surgeons’ stress in the operating room: a prospective cohort study
Authors: Skinner Sarah C , Awtry Jake A. , Pascal Léa , Polazzi Stéphanie , Lifante Jean-Christophe , Duclos Antoine
Published: February 2025

Background:

Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons’ physical activity habits and their stress, assessed as heart rate variability, at the start of surgery.

Materials and methods:

This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons.

Results:

We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42–55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Senior surgeons presented lower lnRMSSD (−0.437, −0.749 to −0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (−0.337, −0.646 to −0.027, P = 0.033), compared to their counterparts.

Conclusions:

Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons’ stress in the operating room.
Intra- and early postoperative predictors of delirium risk in cardiac surgery: results from the prospective observational FINDERI study
Authors: Itting Paul T. , Sadlonova Monika , Santander Manuel J. , Knierim Maria , Derad Carlotta , Asendorf Thomas , Celano Christopher M. , Hansen Niels , Esselmann Hermann , Heinemann Stephanie , Eberhard Charlotte , Hoteit Melanie , Schröder Mirjam F. , Kutschka Ingo , Wiltfang Jens , von Arnim Christine A.F. , Baraki Hassina
Published: February 2025

Background:

Postoperative delirium (POD) is a severe complication following cardiac surgery and is associated with increased morbidity and mortality. The impact of intra- and early postoperative factors on the occurrence of POD following cardiac surgery remains controversial. To close this gap, we investigated intra- and early postoperative factors and their predictive values for POD.

Methods:

We performed a prospective observational study that aimed to FIND DElirium RIsk factors (FINDERI) for patients undergoing elective cardiac surgery. POD was assessed using the Confusion Assessment Method (CAM) algorithm. Intra- and early postoperative factors were extracted from electronic medical records and reviewed by cardiac surgeons. To identify potential predictors of POD, we used univariate and multivariate logistic regression along with machine learning (ML) with tenfold cross-validation.

Results:

In our study cohort of 490 patients, 106 screened positive for POD (21.6%). In the multivariate analysis, we found a positive association between POD occurrence and age (p<0.001), duration of surgery (p = 0.027), combined (versus isolated) surgical procedures (p = 0.024), opening of the cardiac chambers (p = 0.046), and ventilation time (p<0.001). The ML-based decision tree identified a two level-algorithm including ventilation time and aortic cross-clamping time, with an AUC of 0.7116 (p = 0.0002) in the validation set. In the ML-based LASSO regression analysis, we identified ventilation time, administration of erythrocyte concentrates (EC), and usage of cardiopulmonary bypass (CPB) as predictors of POD, with an AUC of 0.7407 (p<0.0001) in the validation set.

Conclusion:

The results of this analysis highlight the associations between ventilation time, aortic cross-clamping time, administration of EC, and usage of CPB and POD. Additionally, they suggest that the optimization of surgical protocols has the potential to reduce POD risk in individuals undergoing cardiac surgery.
Artificial intelligence-assisted precise preoperative prediction of lateral cervical lymph nodes metastasis in papillary thyroid carcinoma via a clinical-CT radiomic combined model
Authors: Du Junze , He Xinyun , Fan Rui , Zhang Yi , Liu Hao , Liu Haoxi , Liu Shangqing , Li Shichao
Published: February 2025

Objectives:

This study aimed to develop an artificial intelligence-assisted model for the preoperative prediction of lateral cervical lymph node metastasis (LCLNM) in papillary thyroid carcinoma (PTC) using computed tomography (CT) radiomics, providing a new noninvasive and accurate diagnostic tool for PTC patients with LCLNM.

Methods:

This retrospective study included 389 confirmed PTC patients, randomly divided into a training set (n = 272) and an internal validation set (n = 117), with an additional 40 patients from another hospital as an external validation set. Patient demographics were evaluated to establish a clinical model. Radiomic features were extracted from preoperative contrast-enhanced CT images (venous phase) for each patient. Feature selection was performed using analysis of variance and the least absolute shrinkage and selection operator algorithm. We employed support vector machine, random forest (RF), logistic regression, and XGBoost algorithms to build CT radiomic models for predicting LCLNM. A radiomics score (Rad-score) was calculated using a radiomic signature-based formula. A combined clinical-radiomic model was then developed. The performance of the combined model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results:

A total of 1724 radiomic features were extracted from each patient’s CT images, with 13 features selected based on nonzero coefficients related to LCLNM. Four clinically relevant factors (age, tumor location, thyroid capsule invasion, and central cervical lymph node metastasis) were significantly associated with LCLNM. Among the algorithms tested, the RF algorithm outperformed the others with five-fold cross-validation on the training set. After integrating the best algorithm with clinical factors, the areas under the ROC curves for the training, internal validation, and external validation sets were 0.910 (95% confidence interval [CI]: 0.729–0.851), 0.876 (95% CI: 0.747–0.911), and 0.821 (95% CI: 0.555–0.802), respectively, with DCA demonstrating the clinical utility of the combined radiomic model.

Conclusions:

This study successfully established a clinical-CT radiomic combined model for predicting LCLNM, which may significantly enhance surgical decision-making for lateral cervical lymph node dissection in patients with PTC.
PLACE: Multicenter Study for Right Ventricular Failure on Mechanical Cardiocirculatory Supports
Authors: Lo Coco Valeria , Di Mauro Michele , Loforte Antonio , Fux Thomas , Wiedemann Dominik , Verbelen Tom , Broman Lars Mikael , Kremer Jamila , Pozzi Matteo , Takeda Koji , Boeken Udo , Chen Yih-Sharng , Masiello Paolo , Vogel Dominik J. , Maas Jacinta J. , Ballotta Andrea , Pappalardo Federico , Hryniewicz Kasia , Lorusso Roberto ,   On behalf of PLACE Study Group
Published: February 2025

Isolated acute right ventricular failure (aRVF) is associated with poor prognosis in different scenarios. In severe conditions, temporary mechanical cardiocirculatory support (tMCS) is required. PLACE is an international, retrospective, multicenter registry including 17 centers that investigated patients affected by isolated aRVF and treated with various types of tMCS from January 2000 to December 2020. The registry included 644 (69.6% males, mean age: 55 years) patients. The most frequent etiologies were post-left ventricular assist device implantation (LVAD) and postcardiotomy shock. These patients received mostly mechanical circulatory support (MCS) and veno-arterial extracorporeal membrane oxygenation. Mean tMCS duration was 9 days, weaning was achieved in 70.5% of the patients, and the major cause of death on support was multiorgan failure (50.5%). The mortality rate was 45 and 48.4% in-hospital and at 3 month follow-up, respectively. Multivariable logistic regression analysis identified age, aRVF due to acute pulmonary hypertension, bilirubin level, and oliguria or anuria at tMCS implantation as risk factors for in-hospital mortality. Conversely, aRVF after LVAD was found to be associated with a lower risk of early mortality. In-hospital and 3 months mortality occurred in less than half of the aRVF-supported subjects. Furthermore, several preimplant aspects such as age, organ function, and type of tMCS are independently associated with in-hospital and 3 month mortality.
Prehabilitation in surgery – an update with a focus on nutrition
Authors: Gillis Chelsia , Weimann Arved
Published: February 2025

Purpose of the review

Since the introduction of the prehabilitation concept for optimizing functional capacity before surgery 20 years ago, evidence and interest has grown considerably. This review summarizes the recent evidence and proposes questions for prehabilitation with special regard to the nutritional component.

Recent findings

Several meta-analyses of multimodal prehabilitation (exercise, nutrition, and psychological support) have been published recently. These reviews suggest that preoperative conditioning can improve functional capacity and reduce the complication rate for many patient groups (risk of bias: moderate to low). A prerequisite is the identification of high-risk patients using suitable screening and assessment tools. Additionally, there are currently no standardized, clear recommendations for the organization and implementation of prehabilitation programs. The programs vary greatly in duration, content, and outcome measurement. Although the preoperative nutrition interventions enhanced outcomes consistently, there was no clear evidence for which nutritional intervention should be applied to whom over consistent time frame four to six weeks (timeframe consistent with most prehabilitation programs).

To advance our understanding of which prehabilitation interventions work best, how they work, and for whom they work best, additional low risk of bias and adequately powered trials are required. Nevertheless, our review presents evidence that prehabilitation should be offered before major surgery on a risk-stratified basis.
Skull base osteoradionecrosis: from pathogenesis to treatment
Authors: Rampinelli Vittorio , Testa Gabriele , Arosio Alberto Daniele , Piazza Cesare
Published: February 2025

Purpose of review

This review aims to provide a comprehensive analysis of skull base osteoradionecrosis (ORN), a severe and rare complication of radiotherapy for head and neck malignancies. It explores pathogenesis, clinical presentation, diagnostic strategies, and management approaches, emphasizing the importance of multidisciplinary care in addressing this challenging condition.

Recent findings

Skull base ORN results from radiotherapy-induced tissue damage, characterized by hypovascularity, hypoxia, and necrosis, often compounded by secondary infections. Advances in radiotherapy techniques, such as intensity-modulated radiotherapy and heavy particles, have reduced ORN incidence, though cases persist, particularly in high-dose radiotherapy fields. Emerging treatments, including hyperbaric oxygen therapy and the pentoxifylline–tocopherol protocol, show promise but lack robust evidence for standardized use. Surgical interventions, especially those incorporating vascularized tissue reconstruction, have demonstrated favorable outcomes in refractory cases. Recent studies underscore the utility of multimodal imaging techniques, including MRI and PET/CT, for distinguishing ORN from tumor recurrence.

Skull base ORN represents a complex and potentially life-threatening condition requiring tailored, multidisciplinary management. Although advancements in diagnostics and therapeutics have improved outcomes, significant challenges remain, particularly in developing standardized protocols. Further research is needed to refine treatment strategies and improve evidence-based practices for this entity.
Antiviral activity of contact lens care solutions and rub-and-rinse regimen against adenovirus
Authors: Lourenco Nogueira Christiane , Boegel Scott Joseph , Shukla Manish , Ngo William , Hui Alex , Jones Lyndon W. , Aucoin Marc G.
Published: February 2025

SIGNIFICANCE

Although human adenoviruses are the leading cause of acute viral conjunctivitis, there is a lack of data surrounding the efficacy of contact lens care products against these viruses.

PURPOSE

This study investigates the antiviral activity of several commercially available contact lens care solutions against human adenovirus type 5 (Ad5).

METHODS

Six contact lens care solutions (Biotrue, Boston Simplus, OPTI-FREE Puremoist, Clear Care, cleadew, and cleadew GP) were investigated. Quantitative suspensions tests were conducted on Ad5 solutions after interaction with the different contact lens care solutions for 4 or 6 hours. For the hydrogen peroxide solution (Clear Care), interaction times of 0, 2, 4, and 6 hours prior to neutralization were also investigated. Finally, the impact of rubbing and rinsing of Ad5 contaminated contact lenses with the solutions was studied.

RESULTS

Solutions based on povidone-iodine demonstrated a more than 3-log reduction in virus after 4 and 6 hours of incubation. In contrast, hydrogen peroxide only demonstrated a 0.52-log reduction after 6 hours of incubation. Increasing the contact time with hydrogen peroxide increased Ad5 inactivation, with a 2.18-log reduction after 6 hours of incubation with the solution prior to neutralization. Nonoxidative systems did not demonstrate a significant log reduction after 4 hours of incubation. However, rubbing and rinsing of contact lenses using the nonoxidative systems reduced the virus counts from contaminated contact lenses to below the limit of quantification.

CONCLUSIONS

Povidone-iodine solutions have a significant effect on reducing the viability of Ad5. Hydrogen peroxide care solutions are effective only if unneutralized contact time is increased. Nonoxidative systems can be effective in combating contaminated lenses only with the addition of a rub-and-rinse step.
Single-stage reconstruction of congenital multi-finger syndactyly with contiguous cross-shaped advancement flaps
Authors: Yang Guang , Yin Fei , Yin Chunhua , Liu Wei , Yu Wentao , Yu Qinyuan , Shen Xiaofang
Published: February 2025

Purpose:

The purpose of this paper is to report the techniques and results of contiguous dorsal cross-shaped advancement flaps for reconstruction of the three- or four-finger syndactyly in a single-stage operation for congenital syndactyly.

Methods:

Thirty-five patients with multiple-finger syndactyly for web-space reconstruction using the contiguous dorsal cross-shaped advancement flaps in a single operation were retrospectively studied. The patients were treated between January 2019 and October 2022. There were 20 patients with Poland syndrome, nine with constriction ring sequence, and six with synpolydactyly. One patient had bilateral hands involved. Twenty-three hands had three-finger syndactyly, and 13 hands had four-finger syndactyly. The patients’ ages ranged from 5 to 96 months, with an average age of 29.6 months. The contiguous dorsal cross-shaped flaps were advanced to reconstruct both web space and lateral walls of the bases of the conjoined fingers. Withey grading was used for postoperative evaluation of web creep of each reconstructed web. Scar hyperplasia was assessed using the Vancouver Scar Scale (VSS). Visual Analogue Scale (VAS) of 0 to 10 was applied to evaluate the subjective satisfaction of the parents with the overall appearance and function.

Results:

In all cases the syndactyly was successfully released in a single operation. There were no perioperative complications such as finger necrosis, incision infection, or skin graft failure in this group. During a 12-to-58-month follow-up period, all the reconstructed web spaces exhibited satisfactory appearance, and there was no obvious web creep. The scars on the dorsal side of the hand were acceptable. Revision surgery was not needed in any patients. Web creep averaged 0.45, and the VSS score averaged 1.6. The average VAS score of appearance was 1.2, and that of function was 2.5.

Conclusions:

Multiple syndactyly release in one stage is feasible and safe. The contiguous cross-shaped flaps can be used to reconstruct two or more web spaces simultaneously after releasing.
Utility of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis
Authors: Medhati Pourya , Dang Jerry , Sheu Eric G , Tavakkoli Ali , Nimeri Abdelrahman , Shin Thomas H
Published: February 2025

Background:

Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS).

Study Design:

A retrospective cohort analysis was performed on 58,327 MBS revisions and anastomotic conversions from the 2020-2022 MBSAQIP registry. Approximately all cases studied were performed laparoscopically (98.8%). A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia. We utilized descriptive statistics, univariate and multivariable logistic regression, and 1:1 nearest neighbor matching in complete-case analyses to explore the relationship between albumin levels and postoperative outcomes.

Results:

While univariate analyses illustrate an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation, or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (SSI) (OR 8.138, p=0.049) and readmission (OR 1.75, p=0.045) associated with albumin levels lower than 3.5 g/dL.

Conclusions:

Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.
Is There an Optimal Electrode Placement for Patients With Schizophrenia Undergoing Electroconvulsive Therapy?
Authors: Tan Weng Jun , Choo Kimberly Wan Xin , Foo Jenies Hui Xin , Tor Phern Chern
Published: February 2025

Electroconvulsive therapy (ECT) is a recognized treatment option for patients with schizophrenia, especially when patients do not respond adequately to antipsychotic medication or when rapid response is needed in severe cases. The 3 common electrode placements, namely, bitemporal, bifrontal and right unilateral (RUL) modalities, have all been described by various studies to be efficacious in symptom reduction. However, the optimal electrode placement with the greatest success rate in the treatment of schizophrenia has yet to be ascertained. Furthermore, the benefit of switching ECT modalities after poor response to the initial electrode placement has not been well studied. Hence, to illustrate the twin issues of the optimal ECT modality as well as the effect of switching ECT modalities after initial nonresponse in patients with schizophrenia, we describe 2 distinct patients who underwent multiple courses of bifrontal and RUL ECT, but only responded well to bifrontal ECT. This is possibly due to the patients' anatomical differences as well as varying brain stimulation patterns produced by the different electrode placements. Thus, we believe that the prescription of ECT in patients with schizophrenia should be individualized, and a switch to a different ECT modality should be strongly considered if there is a lack of response to a particular modality.