bluuebunny/crossref_metadata_2025 huggingface dataset:
The Truthmaker Conception of Metaphysics
Authors: Thomasson Amie L
Published: February 2025

This chapter argues that the truthmaker conception of metaphysics relies on a problematic functional monist assumption. Attempts to determine the “fundamental ontology” of the world by finding the “fundamental truthmakers” face troubles, given the ontological flexibility of language. For given the range of grammatical alternatives, there is no typically unique statement of what entities must be in the world to make a given sentence true. More often, the truthmaker approach is employed as a constraint used to “catch cheaters” by insisting that a theorist give some account of what the truthmakers are for the truths one accepts. But this demand simply assumes that all forms of language function to track some “portion of reality” in virtue of which they are true or false. As a result, it rules out without argument a whole range of interesting and plausible non-descriptive approaches to mathematical, moral, modal, and other areas of discourse.
IBC Oxford University Oral Abstract 8 - Feasibility and outcome of laparoscopic sleeve gastrectomy in patients with Crohn’s disease: single centre experience from Saudi Arabia
Authors: Alenazi N , Ahmed K
Published: February 2025

Background

Combined obesity and Crohn's disease (CD) are becoming an increasing issue worldwide and in Saudi Arabia. In this series, we evaluate the feasibility and the outcomes of laparoscopic sleeve gastrectomy (LSG) in obese patients with CD.

Methods

This series is a retrospective analysis of our database with patients undergoing LSG from 2015 to 2020. Obese patients with CD were included.

Results

Sixty-one obese patients with CD underwent LSG with a mean preoperative body mass index (BMI) of 42.6 ± 4.3. The mean excess weight loss (% EWL) at 3, 6, 9 months, and 1 year was 41 ± 1.8, 51 ± 2.3, 67 ± 1.2, and 71 ± 3.1, respectively. There were no identified intra-operative complications. The mean intra-operative time was 40 ± 20. Only one patient developed a postoperative leak and was treated conservatively. No late postoperative complications were reported. During the follow-up period, 6 (9.8%) patients were noted to have CD-related medications discontinued (azathioprine and sulfasalazine), and 8 (13.1%) patients showed a reduction in the dosage of their medications.

Conclusion

LSG appears to be a safe and effective option for carefully selected patients with CD.
IBC Oxford University Oral Abstract 16 - Video abstract: distalisation of Roux-en-Y gastric bypass for weight loss
Authors: Clapp B
Published: February 2025

Background

Insufficient weight loss or weight recurrence can occur in 15% of patients that undergo a Roux-en-Y gastric bypass (RYGB). Performing a distalisation and altering the length of the total alimentary limb length (TALL) can cause more weight loss.

Methods

This video discusses the types of distalisation of a RYGB and outcomes. It highlights the technical aspects of the surgery.

Results

A robotic distalisation is performed on a patient that had weight recurrence after a RYGB. The TALL was changed to 400 cm.

Conclusion

Decreasing the TALL is an effective method to combat weight recurrence after RYGB. Surgeons should be careful to not cause malnutrition and closely follow these patients.
IBC Oxford University Oral Abstract 18 - Video abstract: LAGB to RYGB to open proximalisation to LSG to manage severe dumping syndrome
Authors: Abdelsalam A , Ghobashy A , Elhaway R , Magdy M
Published: February 2025

Introduction

Revisional bariatric surgery is performed to repair a previous weight-loss surgery. It might be appropriate if there is less-than-optimal weight loss, weight gain, or both. There are complications from the original procedure. Complications include ulcers, pouch enlargement, reflux, or an unsatisfactory lifestyle. Revisional surgeries are often more complex than initial bariatric surgeries; thus, they need skilled professional surgeons for better evaluation of the condition, reviewing of the case, determination of causes of failure of the previous procedure, and putting in place the most appropriate management plan to achieve the best outcome.

Objectives

We present here a case of a 56-year-old gentleman known to have uncontrolled diabetes mellitus, hypertension, osteoarthritis, and dyspnoea grade 3. The patient has morbid obesity with a starting weight of 160 kg (BMI ∼56.7 kg/m2) and underwent an adjustable gastric band with weight gain reaching 189 kg in 4 years with no improvement in diabetic status. The patient went for RYGB as a revisional surgery after the removal of the band with good weight loss and better control of the diabetic status, but the patient developed severe attacks of dumping symptoms that failed to improve with medical treatment, lifestyle modification, and even after open proximal alimentary diversion surgery. The patient presented to our facility with 134 kg (BMI ∼47.5 kg/m2) and underwent laparoscopic conversion RYGB to sleeve gastrectomy.

Methods

Laboratory and imaging investigations were done, including MSCT gastric volumetry, which revealed a gastric pouch size of 50–75 cm with a hiatus hernia. Laparoscopic sleeve gastrectomy was done after resection of the gastrojejunostomy part, anastomosis between the alimentary and biliopancreatic limbs as a restoration of GI continuity and dismantling of the previous jejunojejunostomy.

Results

The patient was discharged POD2, following uneventful recovery on clear fluids, full fluids, a soft diet, and a regular diet, each for 5 days, respectively. The patient was put on a nutritional plan, including a diet plan, supplements, and multivitamins. Follow-up monthly revealed significant improvement in the dumping symptoms, improvement of the diabetic status, and relative improvement in weight loss (109 kg, BMI∼38.6 kg/m2).

Conclusion

LSG after RYGB is a tedious procedure, with only a few cases found in the literature.
IBC Oxford University Oral Abstract 19 - Video abstract: disaster in MGB-OAGB—lessons learned
Authors: Hassan M Ul , Bhatti S , Ashraf M H
Published: February 2025

Introduction

While One Anastomosis Gastric Bypass (OAGB) has proven to be an effective surgical treatment for obesity, a significant number of patients experience excessive weight loss, leading to malnutrition and related complications. Rapid and excessive weight loss can result in protein-energy malnutrition, vitamin and mineral deficiencies, and dehydration, which can have severe consequences on overall health and quality of life.

Case Presentation

We present a case of management of a patient who had severe weight loss and its consequences after OAGB. He is a 55-year-old male who presented with the complaint of severe retrosternal burning, pain, nausea and increased frequency of stools. He gave a history of more than 70 kg weight loss 6 months after OAGB done at another institution. On careful evaluation he had severe malnutrition indicated by severe hypoproteinaemia and hypoalbuminemia. After careful discussion with the patient, we decided to do a diagnostic laparoscopy with a plan to reverse the OAGB and normalise the anatomy by gastro-gastric anastomosis. Intraoperative findings showed a biliopancreatic limb length of 400 cm and common channel length of just 100 cm. Moreover, the gastrojejunostomy was done in an anti-peristaltic manner. We reversed the gastrojejunostomy and did a gastro-gastric anastomosis. The operation was uneventful, and the patient recovered well.

Conclusion

OAGB is a safe procedure in expert hands. This case shows the difficulty of surgery done by inexperienced surgeons but was managed by bypass reversal.
IBC Oxford University Oral Abstract 27 - Single anastomosis sleeve ileal (SASI) bypass versus single anastomosis sleeve jejunal (SAS-J) bypass: one year follow-up
Authors: Sewefy A M
Published: February 2025

Background

Single anastomosis sleeve ileal (SASI) bypass is a modification of Santoro's operation (sleeve gastrectomy with transit bipartition) which is a bypass weight loss surgery but keeps the tnormal food pathway and allow endoscopic examination. The procedure is rapidly modified to single anastomosis sleeve jejunal (SAS-J) bypass to minimize the nutritional deficiency. The study aimed to compare SASI to SAS-J bypass.

Material and Methods

This was a randomized controlled trial that included 180 patients. Patients were randomly assigned to 2 equal groups: Group 1, was operated with SASI bypass while Group 2 was operated with SAS-J bypass. All cases were followed up for one year.

Results

In this study, 63% of patients were female and 37% were male. The mean body mass index (BMI) was 47.6 kg/m2. The mean age was 37 years. Regarding comorbidities, 23.3% of the patients had type 2 diabetes, 19% were hypertensive, 19% had obstructive sleep apnoea syndrome, 16% had gastroesophageal reflux disease (GERD), and 26% had hyperlipidaemia. %EWL at one year was 94.7 in Group 1 versus 91.3 in Group 2. Regarding late complications.

Biliary gastritis occurred in 4.4% Group 1 versus 7.8% in Group 2.

Diarrhoea occurred in 21.1% Group 1 versus 7.8% in Group 2.

Protein malnutrition occurred in 15.6% Group 1 versus 4.4% Group 2.

Vitamin D deficiency occurred in 14.4% in Group 1 versus 11.1% in Group 2.

Hypocalcaemia occurred in 12.2% in Group 1 versus 5.6% in Group 2.

Anaemia occurred in 14.4% in Group 1 versus 4.4% in group 2.

The incidence of excessive weight loss (EWL) was 20% in Group 1 versus 7.8% in Group 2. The rate of reoperation was11.1% in group 1 versus 3.3% in Group 2.

Conclusions

Laparoscopic SAS-J bypass is an effective metabolic and weight loss surgery with less nutritional deficiency and late complications compared to SASI bypass.
IBC Oxford University Oral Abstract 30 - Laparoscopic single anastomosis duodeno–ileal bypass (SADI) versus one anastomosis gastric bypass (OAGB) as revisional procedures after sleeve gastrectomy: meta-analysis and systematic review
Authors: Ahmed Y , Ataya K , Almubarak I , Almubarak A , Ali M , Yusuf W , Aljaafreh A , Simeonovski S , Yang W
Published: February 2025

Introduction

It has been observed that 5–8% of primary bariatric procedures result in treatment failure, necessitating the need for revisional surgery. Single anastomosis duodeno-ileal bypass (SADI) and one anastomosis gastric bypass (OAGB) have been suggested as technically less complex but equally efficient substitutes for the Roux-en-Y procedures. In this systematic review and meta-analysis, our aim is to compare the effectiveness of SADI and OAGB in addressing weight regain following sleeve gastrectomy.

Methods

We systematically searched PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials databases. Studies were considered eligible if compared SADI with OAGB as revisional surgeries following sleeve gastrectomy. Weight loss parameters included total weight loss percentage (TWL%) and excess weight loss percentage (EWL%).

Results

Our search strategy yielded 4 articles with a total of 309 patients. 151 patients were assigned to SADI group, on the other hand 158 patients were assigned to OAGB group. For weight loss parameters comparing both procedures at 1 year, the results were in favor of SADI with an EWL% (95% c.i. 3.90 to 17.66; P < 0.01) and a TWL% (95% c.i. 2.43 to 6.17; P < 0.01). At 2 years of follow-up EWL% did not show a statistically significant difference between both operations (95% c.i. −1.18 to 25.86; P = 0.07). In contrast, TWL% was significantly higher in SADI compared to OAGB (95% c.i. 0.96 to 9.68; P = 0.02) at 2 years of follow-up. Regarding post-operative bile reflux, OAGB group had a significantly higher incidence of biliary reflux (OR 0.15; 95% c.i. 0.04 to 0.53; P = 0.003). Patients enrolled in SADI did not develop anastomotic ulcers according to the 4 studies included in the analysis. In contrast, 7 patients in OAGB group did develop anastomotic ulcers but the difference was not statistically significant (OR 0.23; 95% c.i. 0.05 to 1.10; P = 0.07).

Conclusion

SADI is a feasible procedure with a favorable outcome compared to OAGB as a revisional surgery following sleeve gastrectomy regarding weight loss at 1 year with a lower incidence of post-operative biliary reflux.
IBC Oxford University Oral Abstract 39 - Use of PSDV-SG in robotic sleeve gastrectomy is safe and effective
Authors: Hill R , Hill R , Hobson L , Johnson S
Published: February 2025

Introduction

Despite the reliability and safety of the current generation of surgical staplers, staple line complications can still occur and may result in significant morbidity and mortality. While the incidence of haemorrhage and leak is relatively low (1–6% for bleeding, 1–6% for leakage) the results can have serious implications for the patient and high costs for the facility. The Peri-Strips Dry Staple Line Reinforcement with Veritas Collagen Matrix is derived from bovine pericardium to produce a non-crosslinked collagen matrix that has been shown to reduce the risk of staple line bleeding and leaks. In 2019, the FDA approved Peri-Strips Dry Staple Line Reinforcement with Veritas Collagen Matrix with Secure Grip Technology (PSDV-SG). This new product may allow for greater ease of use and reduced preparation time. The aim of this study is to demonstrate that buttressing with PSDV-SG will reduce staple line complications in robotic sleeve gastrectomy and is safe and effective.

Methods

We conducted a retrospective study of 60 patients who underwent robotic-assisted sleeve gastrectomy with buttressing using PSDV-SG between May 2020 and May 2022 at a single institution. We evaluated the patients' charts for post-operative leak rates, presence of staple line bleeding, blood transfusions, re-admission rates, and mortality.

Results

A total of 60 patients were identified, with a 100% follow-up rate within 1 month and 91% follow-up rate over a period of 3–6 months. The majority of the patients were female and from underrepresented minority populations. There were no cases of postoperative leaks or staple line bleeding, and no patients required blood transfusions. One patient was readmitted due to nausea and vomiting, and there were no instances of reoperation or mortality in the study.

Conclusion

Safety and precision of stapling devices in bariatric surgery is crucial to avoid staple line complications which are associated with increased morbidity, mortality and costs. PSDV-SG is a product that is made from the same biologic material as PSDV but is applied to the surgical stapler via a pressure-sensitive adhesive strip which is time-saving and efficient. Our study demonstrated that the application of PSDV-SG is safe and effective in patients undergoing robotic sleeve gastrectomy.
IBC Oxford University Oral Abstract 49 - AI-assisted surgical fellowship training assessment through laparoscopic sleeve gastrectomy video analytics
Authors: Moreno D , Cardenas V , Ortiz A , Martinez A , Acosta H
Published: February 2025

Background

The advent of artificial intelligence (AI) in surgical training presents a transformative opportunity to enhance the assessment and education of surgical fellows. This study investigates the application of AI in evaluating the performance of surgeons by analyzing videos of laparoscopic sleeve gastrectomy procedures uploaded to a specialized platform, Surgeryview.ai.

Methods

Three surgeons contributed to this study: two were professor bariatric surgeons and one was a fellow bariatric surgeon in training. A total of 466 videos of gastric sleeve surgeries were analyzed. Of these, 413 videos were performed by the professor surgeons (Surgeon 1: 180, Surgeon 2: 233) between September 2022 and May 2024, and 53 surgeries were performed by the fellow surgeon in training over a period of 10 months (August 2023–May 2024). The analyzed videos were chosen randomly, and any surgeries Involving an additional procedure to the gastric sleeve (for example hiatal hernia repair) were excluded. Patient data, including gender, age, and initial BMI, were recorded, ensuring anonymity.

Results

The AI platform provided comprehensive longitudinal analytics, detailing the time taken to complete each surgical step: access to the abdominal cavity, greater curvature dissection, stapling, specimen removal, oversewing, and leak test. The platform also analyzed the impact of patient demographics on surgery time. Professors showed consistent efficiency, while fellows demonstrated significant improvement over time. Notably, surgery duration was influenced by patient-specific factors such as BMI and age. The fellow bariatric surgeon in training showed significant improvement across all metrics over the trimesters, with overall surgery time reduced by approximately 23.83%, greater curvature dissection (step 2) time by 28.37%, and oversuture of the staple line (step 5) time by 28.74%. When broken down by BMI, age, and gender, indicate that improvements are generally consistent across these variables, with the most significant improvements seen in lower BMI and younger age groups. These advancements indicate that the fellow has substantially closed the performance gap, particularly in the critical surgical steps.

Conclusion

AI assisted platforms like Surgeryview.ai offer valuable insights into surgical performance, enabling objective assessment and personalized feedback for fellows. This technology can enhance surgical training programs by identifying specific areas for improvement and tracking progress over time, ultimately aiming to standardize surgical education and improve patient outcomes.
IBC Oxford University Poster Abstract 2 - Duodenal-ileal self-forming magnetic anastomosis in patients with inadequate weight loss or weight regain following sleeve gastrectomy
Authors: Contreras J E , Marín P , Guerra A , Mellafe M E , Darvich Í
Published: February 2025

Background

Magnetic anastomosis has the potential to reduce anastomosis complications such as leaks and bleeding, as well as reduce complex procedure steps and time to create a safe anastomosis. We report the procedure feasibility and 30-day results of a new surgical technique and new self-forming nitinol magnetic anastomosis procedure (SNAP-PS) and delivery devices on post-sleeve gastrectomy patients.

Methods

Prospective non-randomized single-centre trial. Surgery consisted of creating a side-to-side duodenal-ileal anastomosis 300 cm from the IC valve using a new self-forming magnetic (SFM) octagonal anastomosis. The proximal SFM was deployed through the endoscope, and the distal SFM through a 5 mm laparoscopic trocar.

Results

A total of 3 patients were recruited, with a mean age of 36.3 25–42) years, sex-ratio (100% F) of 100%, and initial BMI of 41.0 ± 1.4 kg/m2. All procedures were performed using a combination of endoscopy and laparoscopy. There was no conversion or peri-operative mortality. All SFMs were delivered and connected with no delivery malfunctions and completed in an anastomosis creation time on average of 30.6 minutes (enterotomy to magnet coupling). 0 procedure adverse events (AE) occurred, and 0 AD occurred during the 30-day follow-up period. All patients tolerated the surgery and were discharged within 24 hours.

Conclusion

Preliminary and procedural feasibility data for these new devices suggest that SNAP-PS is feasible and safe. Based on prior studies, it provides a minimally invasive surgical option for patients needing additional weight loss and improved comorbidities. Additional follow-up is required.
IBC Oxford University Poster Abstract 9 - Laparoscopic sleeve gastrectomy for endoscopic sleeve gastroplasty non-responder
Authors: Al Haifi M , Hassan I
Published: February 2025

Background

Endoscopic Sleeve Gastroplasty (ESG)is an endoscopic minimally invasive weight loss procedure based on full thickness endoscopic suturing using Apollo’s Overstitch device. In ESG procedure a series of sutures are placed through the gastric wall reducing the stomach volume by 80% creating a restrictive endoscopic sleeve.

Case Presentation

Our case is a 32-year-old lady with a BMI 35.5 kg/m2 had a history of ESG on 1/2018, presented to our clinic with stationary weight following losing only eight kgs during the first month after the procedure. Following full preoperative assessment including dietary history and psychiatric assessment the patient was counselled for Laparoscopic Sleeve Gastrectomy (LSG). Preoperative gastroscope was done to rule out any gastric inflammations and to confirm that all endoscopic stitches are away from the expected 36 fr bougie tube. LSG was done smoothly using 4 reloads (3 black and 1 green) with staple line plication using vicryl 2/0 sutures and omental patching. Hiatal hernia was repaired with mattress silk sutures, gastric fundus was fixed to left crus with vicryl 2/0 sutures and antrum was fixed to the peripancreatic fascia. All these measures were done to avoid gastric pouch twist or migration. Postoperative recovery was smooth. Weight loss was satisfactory, BMI reached 27.5 at 11 months post LSG.

Conclusion

ESG can be reversed easily to LSG for procedure non responders.
IBC Oxford University Poster Abstract 21 - OverStitch procedure- can this be an alternative to revisional surgery?
Authors: Haider I , Kaur M , Raslan C , Barua B , Javed S , Stewart D , Darrien J , Almerie Q , Kerrigan D
Published: February 2025

Introduction

OverStitch is an endoscopic procedure. It is done under general anaesthesia as a day case procedure. It is an alternative procedure for gastrojejunal anastomosis (GJA) dilatation post bypass procedure. Wide GAJ is associated with reactive hypoglycaemia, dumping, weight regain and inadequate weight-loss.

Materials and Methods

Our data from OverStitch procedure was analysed using SPSS software. We compared the results available in literature to outcomes from revision RYGB. We also look at the size of the GJA and the size of GJA after placing the stitch and its association with resolution of symptoms. All the patients who underwent OverStitch procedure were included in the study.

Results and Outcomes

Patients underwent OverStitch procedure for hypoglycaemia, dumping and weight-regain. Our results from OverStitch procedures about hypoglycaemia and dumping gave about 90% resolution of symptoms. The results from weight regain were modest. Further analyses suggested the underlying eating disorders in this group of patients.

Conclusion

OverStitch procedure can be a suitable alternative to revision RYGB Larger numbers of patients are needed for statistically significant results.
Extensive skin necrosis secondary to idiopathic thrombotic vasculopathy associated with ulcerative colitis
Authors: Kasser Camille , Lepelletier Clémence , Cordoliani Florence , Charvet Estelle , Jachiet Marie , Bresteau Clément , Gottlieb Jeremy , Boutboul David , Battistella Maxime , Bouaziz Jean-David , Mahévas Thibault
Published: February 2025

Cutaneous and mucosal manifestations associated with inflammatory bowel disease (IBD) are frequent. We report three cases of patients with ulcerative colitis who presented with extensive retiform purpura and/or cutaneous necrosis secondary to idiopathic thrombotic vasculopathy of the dermis. A review of the literature revealed six similar cases of thrombotic vasculopathy in the context of ulcerative colitis. Diagnosis requires skin biopsy and the exclusion of alternative diagnosis. Empiric treatment includes corticosteroids, anticoagulation and UC management, with a favorable prognosis and low recurrence risk. We believe that clinicians should be aware of this entity, which can sometimes serve as a revealing feature of ulcerative colitis.
Deeper affection, more consumptions: consumer decision-making among people with different levels of intimacy—evidence from fNIRS
Authors: Zhang Chenyu , Liu Jingyue , Zhong Yifei , Zhang Ye , Meng Yujia , Huang Rui , Wang He , Liu Yingjie
Published: February 2025

Consumer decision-making varies according to an individual’s relationship with the recipient of the gift. This study used a mock purchase task to investigate consumer decision-making and its underlying neurological mechanisms when purchasing gifts of different prices for recipients with varying levels of intimacy. Functional near-infrared spectroscopy was used to record neural activity during the task. Behavioral results found that the lover group had a much higher purchasing rate than the friend group, particularly when acquiring premium products. Analysis of the functional near-infrared spectroscopy data found that neural activity in the dorsolateral prefrontal cortex and orbitofrontal cortex decreased when items were discounted, with lower activation in the dorsolateral prefrontal cortex in lovers during the purchasing of premium products. Furthermore, we identified significant differences in functional connectivity between the dorsolateral prefrontal cortex and orbitofrontal cortex under different conditions. We compared the support vector machine algorithm and logistic regression, finding that logistic regression better predicts purchasing tendencies based on neuroactivation levels. In our view, a stronger emotional connection leads to a more rewarding experience for consumers when buying premium products. This study reveals the impact of intimate relationships on consumer decision-making and provides guidance for businesses in developing marketing strategies targeted at the lover’s market.
Glutamate uptake is transiently compromised in the perilesional cortex following controlled cortical impact
Authors: Garcia Jacqueline P , Armbruster Moritz , Sommer Mary , Nunez-Beringer Aliana , Dulla Chris G
Published: February 2025

Glutamate, the primary excitatory neurotransmitter in the central nervous system (CNS), is regulated by the excitatory amino acid transporters glutamate transporter 1 (GLT-1) and glutamate aspartate transporter (GLAST). Following traumatic brain injury, extracellular glutamate levels increase, contributing to excitotoxicity, circuit dysfunction, and morbidity. Increased neuronal glutamate release and compromised astrocyte-mediated uptake contribute to elevated glutamate, but the mechanistic and spatiotemporal underpinnings of these changes are not well established. Using the controlled cortical impact model of TBI and iGluSnFR glutamate imaging, we quantified extracellular glutamate dynamics after injury. Three days postinjury, glutamate release was increased, and glutamate uptake and GLT-1 expression were reduced. Seven and 14 days postinjury, glutamate dynamics were comparable between sham and controlled cortical impact animals. Changes in peak glutamate response were unique to specific cortical layers and proximity to injury. This was likely driven by increases in glutamate release, which was spatially heterogeneous, rather than reduced uptake, which was spatially uniform. The astrocyte K+ channel, Kir4.1, regulates activity-dependent slowing of glutamate uptake. Surprisingly, Kir4.1 was unchanged after controlled cortical impact and accordingly, activity-dependent slowing of glutamate uptake was unaltered. This dynamic glutamate dysregulation after traumatic brain injury underscores a brief period in which disrupted glutamate uptake may contribute to dysfunction and highlights a potential therapeutic window to restore glutamate homeostasis.
Examining avian influenza virus exposure in seabirds of the northwest Atlantic in 2022 and 2023 via antibodies in eggs
Authors: McLaughlin Angela , Giacinti Jolene , Sarma Sailendra Nath , Brown Michael G C , Ronconi Robert A , Lavoie Raphaël A , Eng Margaret L , Enright Bridget , Lang Andrew S , Rahman Ishraq , Wight Jordan , Hargan Kathryn E , Mallory Mark L , Baak Julia E , Jones Megan , Saunders Michelle , Dupuis-Smith Reyd , Elliott Kyle , Gilchrist H Grant , Hennin Holly , Guillemette Magella , Martigny Pauline , Montevecchi William , Petersen Aevar , Berhane Yohannes , Provencher Jennifer F
Published: February 2025

Seabirds are frequently infected by avian influenza virus (AIV), which prior to 2021 primarily consisted of low-pathogenic AIV with limited reports of disease during infection. However, since highly pathogenic AIV (HPAIV) H5N1 clade 2.3.4.4b was introduced to North America in late 2021, HPAIV outbreaks in seabirds have occurred in multiple regions, with high levels of morbidity and mortality in many species. While monitoring active viral infections is critical for tracking disease burden, monitoring prior viral exposure via antibody detection in species that experienced large outbreaks is important for identifying individual- and population-level impacts of AIV on immunity and survival. We capitalized on ongoing egg collection programmes to assess the prevalence of antibodies against AIV nucleoprotein (NP) and hemagglutinin subtype 5 (H5) in 523 eggs collected in 2022 and 2023 from 11 seabird species that breed in the northwestern Atlantic, including primarily samples from eastern Canada and two from western Iceland. The prevalence of AIV antibodies in eggs varied across regions, species and years. American common eider (Somateria mollissima dresseri) eggs had the highest AIV antibody prevalence compared to sympatric species in 2023. Longitudinal samples were available for northern gannets (Morus bassanus) and American herring gulls (Larus argentatus smithsoniansus) at several sites, where the prevalence of anti-NP and anti-H5 antibodies increased from 2022 to 2023. Examining AIV antibody prevalence in seabird eggs can be a useful tool to investigate population-level AIV exposure, while we acknowledge our limited understanding of differential antibody waning rates and the relationship between titre and susceptibility.
Spatial mapping of dextran sodium sulphate‐induced intestinal inflammation and its systemic effects
Authors: Adams Lauren , Rasid Orhan , Hulme Heather , Quon Tezz , Burchmore Richard , Milling Simon , Goodwin Richard J. A. , Wall Daniel M.
Published: February 2025

Inflammatory bowel disease (IBD) is a multifactorial disease, and patients frequently experience extraintestinal manifestations affecting multiple sites. Causes of systemic inflammation remain poorly understood, but molecules originating from the intestine likely play a role, with microbial and host small molecules polarizing host immune cells towards a pro‐ or anti‐inflammatory phenotype. Using the dextran sodium sulfate (DSS) mouse model, which mimics the disrupted barrier function, microbial dysbiosis, and immune cell dysregulation of IBD, we investigated metabolomic and phenotypic changes at intestinal and systemic sites. Using spatial biology approaches, we mapped the distribution and relative abundance of molecules and cell types across a range of tissues, revealing significant changes in DSS‐treated mice. Molecules identified as contributing to the statistical separation of treated from control mice were spatially localized within organs to determine their effects on cellular phenotypes through imaging mass cytometry. This spatial approach identified both intestinal and systemic molecular drivers of inflammation, including several not previously implicated in inflammation linked to IBD or the systemic effects of intestinal inflammation. Metabolic and inflammatory pathway interplay underpins systemic disease, and determining drivers at the molecular level may aid the development of new targeted therapies.
Differential Professional and Personal Impacts of the COVID-19 Pandemic on Early Career Researchers
Authors: Alejandro Lucy O. , Kowalczyk Monica , Ham Sandra A. , Press Valerie G. , Wolfson Rachel K. , Arora Vineet M. , Volerman Anna
Published: February 2025

Purpose

Early career researchers (ECRs) are crucial to scientific advancement, but ECRs, particularly those from underrepresented groups, face unique challenges as they establish careers. Given the disruptions of the COVID-19 pandemic, this study aimed to identify the pandemic’s professional and personal impacts on ECRs.

Method

This national cross-sectional survey study assessed the effects of the COVID-19 pandemic among ECRs by gender, sexual orientation, race, and ethnicity. Between September and December 2021, the authors invited the 4,440 ECRs with National Institutes of Health training awards in 2020 to complete an online survey with measures assessing career, personal life, and demographics.

Results

Of 4,440 eligible ECRs, 1,524 (34.3%) completed the survey and 1,458 (32.8%) met inclusion criteria. Most respondents reported negative impacts to in-person conference cancellations (1,355 [93.1%]), research productivity (K award, 1,148 [87.4%]; overall, 1,192 [81.8%]), career trajectory (891 [61.2%]), and mental health (1,189 [88.1%]). Respondents with childcare responsibilities commonly reported negative impacts (801 [80.1%]). On average, respondents reporting negative impacts identified with more underrepresented groups than those reporting nonnegative impacts for certain measures, such as research productivity (K award, 0.92 vs 0.73, P < .001; overall, 0.92 vs 0.79, P = .01) and mental health (0.92 vs 0.81, P = .03). In free responses, respondents expressed stress as they balanced overwhelming demands of emerging careers and personal lives. Despite setbacks, many respondents cited new opportunities, including new projects (1,156 [79.3%]), new collaborators (926 [63.5%]), and increased flexibility (894 [61.3%]).

Conclusions

The pandemic had significant, largely negative, and unequal impacts on ECRs. Underrepresented ECRs were particularly susceptible to pandemic disruptions, potentially exacerbating existing challenges. Individual- and organizational-level interventions are critical to rejuvenate and sustain the early career research pathway. These interventions will foster the success of the next generation of biomedical scientists and the future of scientific advancement.
Fostering Global Research Collaborations: An Update on Duke-NUS Medical School, the Duke University and National University of Singapore Partnership
Authors: Yeo May May , Casey Patrick J. , Williams R. Sanders , Vogel Silke , James Michael L.
Published: February 2025

Problem

Navigating the complexities of international research collaborations is a challenge. This article provides a detailed examination of the international collaboration between Duke University and the National University of Singapore to establish the Duke-NUS Medical School. It explores the evolution and impact of the partnership, focusing on outcomes, knowledge advancement, and the dynamics of international collaborations in academic medicine.

Approach

The partnership began in 2005 and applies a collaborative approach, including aligning research foci with Singapore’s national health priorities, the formation of an academic medical center, faculty exchanges, joint funding for pilot research, and pooling of expertise, diverse and multiethnic data, and samples.

Outcomes

The collaboration has led to educational and research advancements, including significant contributions to global health, such as the development of the first U.S. Food and Drug Administration–approved SARS-CoV-2 antigen test and a nasal COVID-19 vaccine candidate. Additionally, it has enhanced academic medicine capabilities within Singapore by transforming teaching hospitals into fully integrated academic medical centers. This experience suggests the following toward advancing the partnership: (1) agreement on and revisiting of the shared vision of the partnership by institutional leaders, (2) middle- and end-period reviews within multiyear funding cycles from local ministries, (3) faculty engagement through collaborative resources and spaces, and (4) similar first languages and health systems of the partners.

Next Steps

The Duke-NUS Medical School partnership aims to expand its research areas to address more global health challenges, such as the impact of climate change on health and the advancement of precision medicine. This article offers valuable insights for understanding the dynamics, benefits, and challenges of international collaborations in academic medicine.
Electrocochleography Latency: Correlation With Electrode Position During Cochlear Implantation
Authors: Andonie Raphael R. , Wimmer Wilhelm , Wildhaber Reto A. , Mantokoudis Georgios , Caversaccio Marco , Weder Stefan
Published: February 2025

Objectives:

Cochlear implant (CI) candidates increasingly exhibit some degree of residual hearing, which should be preserved despite the implantation. Today, cochlear health is monitored during CI surgery by tracking the cochlear microphonic (CM) amplitude from intracochlear electrocochleography (ECochG) measurements. However, recent studies indicate that the insertion depth of the measuring electrode must be considered to accurately interpret these signals. The acoustic path from the cochlear base to the apex induces excitation delays in deeper regions, which should be reflected in the CM measurements. In this study, we analyzed the potential of cochlear microphonic latency (CML) as an objective method for continuously tracking CI electrode position during cochlear implantation. In addition, we examined whether CML can be associated with residual hearing.

Design:

We recorded intraoperative pure-tone ECochG at maximum stimulation levels from 30 CI patients to derive CML. During CI electrode insertion, ECochG was continuously recorded at the 2 stimulation frequencies of 0.5 and 0.75 kHz. After complete insertion, ECochG was measured on all evenly numbered electrodes at frequencies of 0.25, 0.5, 0.75, and 1 kHz. The electrode locations (i.e., linear insertion depth) were identified by postoperative computed tomography (CT) scans. The location of the measuring electrode during the insertion period was then calculated backward, assuming a constant insertion speed. Finally, we used a linear regression model to relate CML to linear insertion depth. In addition, we evaluated the relationship between CML and preoperative residual hearing.

Results:

CML is significantly correlated to the linear insertion depth (p < 0.001) during and after electrode insertion (with restrictions on 0.25 kHz stimulus, presumably since the characteristic 0.25 kHz region is not within reach of the used CI electrode arrays). Despite high inter-individual variability, our results align with documented delays in the basilar membrane observed in other studies. However, we could not identify a significant association between CML and residual hearing.

Conclusions:

Our study demonstrates that objectively extracted CML encodes the intracochlear electrode location in CI patients but is not directly linked to residual hearing. Consequently, CML has the potential to enhance intraoperative ECochG analysis by providing real-time tracking of electrode position. To better understand the inter-individual variations in CML, future studies with larger patient cohorts are needed.
Prognostic Impact of Early Appropriate Antimicrobial Therapy in Critically Ill Patients With Nosocomial Pneumonia Due to Gram-Negative Pathogens: A Multicenter Cohort Study
Authors: Barbier François , Buetti Niccolò , Dupuis Claire , Schwebel Carole , Azoulay Élie , Argaud Laurent , Cohen Yves , Hong Tuan Ha Vivien , Gainnier Marc , Siami Shidasp , Forel Jean-Marie , Adrie Christophe , de Montmollin Étienne , Reignier Jean , Ruckly Stéphane , Zahar Jean-Ralph , Timsit Jean-François ,   on behalf of the OutcomeRéa Study Group
Published: February 2025

Objectives:

To evaluate whether early appropriate antimicrobial therapy (EAAT) is associated with improved outcomes in critically ill patients with hospital-acquired pneumonia (HAP), ventilated HAP (vHAP), or ventilator-associated pneumonia (VAP) involving Gram-negative bacteria (GNB).

Design:

Retrospective cohort study based on prospectively collected data.

Setting:

Thirty-two-French ICUs (OutcomeRéa network).

Patients:

All patients with a first HAP, vHAP, or VAP due to GNB during their ICU stay.

Interventions:

None.

Measurements and Main Results:

The relationship between EAAT and day 28 all-cause mortality (primary endpoint) was explored through Cox proportional-hazard models, with subgroup analyses according to pneumonia types, causative GNB, features of EAAT, and the occurrence of septic shock at pneumonia diagnosis. The course of Sequential Organ Failure Assessment (SOFA) score values, the clinical cure rate at day 14, and the time to mechanical ventilation (MV) weaning and ICU discharge after pneumonia diagnosis were investigated as secondary endpoints. Among the 804 included patients, 495 (61.6%) received EAAT (single-drug, 25.4%; combination, 36.2%). Day 28 mortality was 32.6%. EAAT was not independently associated with this outcome (adjusted hazard ratio, 0.87; 95% CI, 0.67–1.12). This result was confirmed in subgroup analyses as in a second model considering all episodes of pneumonia occurring during the ICU stay. EAAT was not associated with a faster decrease in SOFA score values (p = 0.11), a higher day 14 clinical cure rate (overall, 43.7%), or a shorter MV duration (cause-specific hazard ratio [HR] for extubation, 0.84; 95% CI, 0.69–1.01) or ICU stay (cause-specific HR for discharge alive, 0.85; 95% CI, 0.72–1.00).

Conclusions:

In this study, EAAT was not associated with a reduced day 28 mortality, a faster resolution of organ failure, a higher day 14 clinical cure rate, or a shorter time to MV weaning or ICU discharge in critically ill patients with HAP, vHAP, or VAP due to GNB. However, a prognostic benefit from EAAT cannot be ruled out due to lack of statistical power.
Safety of Onasemnogene Abeparvovec Administration to Type 1 SMA Patients Who Have Received Risdiplam
Authors: Chelladurai Sivakami , D'Urso Sarah , Atherton Mark , Ong Min Tsui
Published: February 2025

Three therapies are now available for the treatment of type 1 spinal muscular atrophy: onasemnogene abeparvovec (OA), nusinersen, and risdiplam. We present a retrospective, single-center case series detailing our center's experience with six patients diagnosed with type 1 spinal muscular atrophy who switched from risdiplam to OA. Risdiplam was discontinued the day before the OA infusion, and we evaluate the safety aspects of this switch. All patients continued risdiplam until the day before administration of OA, with a wash out period of between 24 and 33 hours prior. All patients have had follow-up for at least 12 weeks, while 3 patients who lived locally received ongoing follow-up ranging from 14 to 27 months after OA infusion. All patients remained stable or improved in their motor scores and need for ventilatory support and feeding support requirement. Adverse events reported after OA switch included tachycardia, fever, nausea, vomiting, raised transaminases, and mild neutropenia. All adverse events in these children were either known adverse events of OA or were not considered secondary to OA or risdiplam treatment. No unexpected adverse event was demonstrated post-OA in patients stopping risdiplam a day before OA infusion. Data presented here suggest that stopping risdiplam a day before OA treatment did not seem to be associated with increased risk.
Nurses’ Knowledge, Attitude, Practice, and Perceived Barriers of Infection Control Measures in the Intensive Care Units at Northwest Bank Hospitals
Authors: Bawaqneh Khaled Ali , Ayed Ahmad , Salameh Basma
Published: February 2025

The foremost challenge encountered by patients in intensive care units is nosocomial infections impacting their prognosis. Nurses play a vital role in infection control, necessitating adequate knowledge and adherence to protocols. Therefore, the study aims to assess nurses’ knowledge, attitude, practice, and perceived barriers of infection control measures in the Intensive care units at the Northwest Bank Hospitals. The study employed a quantitative cross-sectional and observational design, utilizing a self-administration questionnaire and checklist distributed among 115 ICU nurse working in governmental hospitals in the Northwest Bank. The study revealed that the majority of nurses demonstrated a moderate to low knowledge level. However, 63.5% exhibited a positive attitude toward infection control measures, and 72.9% demonstrated good practice levels. Among the sociodemographic determinants, gender was the only significant factor in relation to practice, where male nurses demonstrated better practices than female nurses (P < .05). Nursing staff identified several barriers to achieving infection standards, including lack of equipment, inadequate training courses on infection control, challenges posed by visitors, absence of infection control policies and standards, insufficient isolation rooms, and heavy workload. The majority of nurses displayed good practice levels and positive attitudes toward infection prevention. Additionally, male nurses practiced infection control measures significantly more effectively than female nurses. The major barriers were lack of equipment, lack of training courses, and challenges related to visitors. Addressing these barriers is essential to improving infection control measures in critical care units.
Antimicrobials in the Management of Sepsis in the Intensive Care Unit (ICU)
Authors: Betancourth Adriana , Bangash Salman , Bajwa Yousaf , Garbinski Ashley , DuMont Tiffany , Bajwa Omer , Bhanot Nitin
Published: February 2025

Sepsis is a severe and often life-threatening condition which can lead to widespread organ dysfunction, septic shock, and even death. Antimicrobials are critical in improving outcomes for patients with sepsis. This chapter details the general principles of antimicrobial therapy, appropriate selection and de-escalation of antimicrobials, and challenges in antimicrobial stewardship.
The psychic melting pot in surgical departments and how to manage it: A narrative review
Authors: Patriti Alberto , Fortugno Maria Elisa , Corallino Diletta
Published: February 2025

Effective personnel management in a surgical department requires more than technical expertise and organizational skills, it demands a deep understanding of the psychological traits of surgeons. Recognizing these traits is essential for promoting a supportive environment that enhances team dynamics and ensures patient safety. This review highlights the critical role of communicative leadership and psychological awareness in managing emotional stress, improving team cohesion, and driving professional growth. By integrating strategies that address both individual and collective well-being, surgical departments can create a resilient and efficient work environment where excellence in patient care becomes a shared commitment.
Subretinal implantation of a human amniotic membrane plug prepared using a modified corneal punch technique for the treatment of large full-thickness macular holes
Authors: Tang Wenyi , Qin Ling , Chen Xin , Zhang Lili , Zhang Ting , Jiang Rui , Xu Gezhi
Published: February 2025

Purpose:

To report a new technique using tailored corneal punches to prepare round human amniotic membrane (hAM) plugs for the treatment of large full-thickness macular holes (FTMHs).

Methods:

Eight eyes with large FTMHs (>650 μm) in eight patients were included. Pars plana vitrectomy (23 G) was performed and round hAM plugs were prepared from the hAM patch by using tailored corneal punches. The size of the hAM plug was chosen according to the size of the FTMH. Endotamponade was performed using 14% C3F8 after subretinal implantation of the hAM plugs. The patients were followed up for ≥6 months.

Results:

The mean FTMH size was 737.0 ± 86.2 μm. All FTMHs (100%) were closed within the 6-month follow-up period. The best-corrected visual acuity (LogMAR, [Snellen]) improved significantly from 1.74 ± 0.30 (20/1000) before surgery to 0.76 ± 0.32 (20/100) at 6 months after surgery (P < 0.05). We did not observe any iatrogenic injuries associated with the surgical procedure, rejection of the hAM plug, or parafoveal atrophy throughout the six-month follow-up.

Conclusion:

Subretinal implantation of hAM plugs prepared using tailored corneal punches was safe and effective for repairing large FTMHs. The procedures were successful and associated with promising visual acuity recovery.