bluuebunny/crossref_metadata_2025 huggingface dataset:
Dual Inhibition of Factor XIIa and Factor XIa Produces a Synergistic Anticoagulant Effect
Authors: Jiang Shuai , Li Yitong , Zhang Jiali , Jia Wenhui , Zheng Yizheng , Jia Zhiping , Yu Chenming , Kong Yi
Published: April 2024

Clinical practice shows that a critical unmet need in the field of thrombosis prevention is the availability of anticoagulant therapy without bleeding risk. Inhibitors against FXIa or FXIIa have been extensively studied because of their low bleeding risk. However, whether these compounds produce synergistic effects has not yet been explored. In this study, analyses of activated partial thromboplastin time in combination with the FXIa inhibitor PN2KPI and the FXIIa inhibitor Infestin4 at different proportions were performed using the SynergyFinder tool identifying synergistic anticoagulation effects. Both an FeCl3-induced carotid artery thrombosis mouse model and a transient occlusion of the middle cerebral artery mouse model showed that the combination of PN2KPI and Infestin4, which are 28.57% and 6.25% of the effective dose, respectively, significantly prevents coagulation, and furthermore, dual inhibition does not cause bleeding risk.
Immediate Lymphatic Reconstruction with Vascularized Omentum Lymph Node Transplant: Reducing the Risk of Both Painful Contracture and Lymphedema
Authors: Brown Stav , Kokosis George , Graziano Francis D. , Haran Oriana , Smith-Montes Elizabeth , Zivanovic Oliver , Ariyan Charlotte E. , Coit Daniel G. , Coriddi Michelle , Mehrara Babak J. , Dayan Joseph H.
Published: April 2024

Patients undergoing extensive lymph node dissection and radiation are at high risk for not only lymphedema but also painful contracture. In a standard lymphadenectomy, immediate lymphatic reconstruction using a lymphovenous bypass is effective in reconstructing the lymphatic defect. However, a more aggressive nodal clearance leaves the patient with a large cavity and skeletonized neurovascular structures, often resulting in severe contracture, pain, cosmetic deformity, and venous stricture. Adjuvant radiotherapy to the nodal bed can lead to severe and permanent disability despite physical therapy. Typically, these patients are referred to us after the fact, where surgery will rarely restore the patient to normal function. In an effort to avoid lymphedema and contracture, we have been reconstructing both the lymphatic and soft tissue defect during lymphadenectomy, using vascularized omentum lymphatic transplant (VOLT). A total of 13 patients underwent immediate reconstruction with VOLT at the time of axillary (n = 8; 61.5%) or groin (n = 5; 38.5%) dissection. No postoperative complications were observed. The mean follow-up time was 15.1 ± 12.5 months. Only one lower extremity patient developed mild lymphedema (11% volume differential), with excellent scores in validated patient-reported outcomes. All patients maintained full range of motion with no pain. None of the 13 patients required a compression garment. Immediate lymphatic reconstruction with VOLT is a promising procedure for minimizing the risk of lymphedema and contracture in the highest risk patients undergoing particularly extensive lymph node dissection and radiotherapy.
Utilizing the Subunit Concept to Achieve Better Outcomes in Lower Limb Reconstruction: A Clinical Experience in an Asian Population
Authors: Hong Qi En , Kua Jonah Ee Hsiang , Tay Vincent K.S. , Chan Stephanie L.S. , Ho Christopher Wei Guang , Sun Jeremy Mingfa
Published: April 2024

Background:

The goals of reconstruction have progressed from filling a defect to enhancing function and aesthetic appearance. We aimed to achieve better aesthetic and functional outcomes in terms of shoe fitting and mobility. This is accomplished via a classification of the subunits and aesthetic considerations of the lower limb.

Methods:

Between April 2017 and December 2021, 66 cases of lower extremity free fasciocutaneous flap reconstruction cases were included in this retrospective study. Data parameters include age, sex, comorbidities, etiology of lower limb wounds, choice of free flap reconstruction, recipient arterial vessels, complications of flap reconstruction, and need for secondary debulking procedures. Physiotherapy records were also examined to determine the time to independent ambulation.

Results:

In total, 66 subjects were identified. The mean age was 48.6. An estimated 74.2% (n = 49) were men, 50% (n = 33) had diabetes, and 16.6% (n = 11) had peripheral vascular disease. Of the total wounds, 65.1% (n = 43) were caused by infection, whereas the remaining 34.9% (n = 23) were due to trauma. Of the cases, 72.7% (n = 48) had free anterolateral thigh flap reconstruction, 25.8% (n = 17) were reconstructed with superficial circumflex iliac artery perforator flaps, and 1.5% (n = 1) was reconstructed with medial sural artery perforator flaps. Cases that required secondary debulking procedures comprised 7.6% (n = 5).

Conclusions:

Free fasciocutaneous flaps are useful in lower extremity reconstruction. Based on the subunit principle and aesthetic considerations for lower limb reconstruction, it can aid in optimizing functional rehabilitation and decreasing secondary procedures.
Delayed Abdominal Flap for Upper Extremity Soft Tissue Coverage
Authors: Bakhos Fadi , Ferri Francisco A. , Andre John , Foran Lindsey , Dreszer George , Fletcher James W.
Published: April 2024

Unlike other body parts, the upper extremity has critical structures close to the skin, making soft tissue injuries more complex. These injuries can result from various causes, including trauma and necrotizing soft tissue infections, necessitating reconstruction. Historically, pedicled flaps from the groin and abdomen were commonly used for upper extremity reconstruction, but they had limitations, such as the need for flap division and debulking, patient discomfort, and stiffness. Free flap reconstruction has become the preferred method, but it still faces challenges like patient and facility issues, the absence of recipient vessels after injury, and multi-surface wounds. This case report describes a 67-year-old patient with a severe necrotizing soft tissue infection in the right upper extremity. After multiple debridement procedures, the patient underwent hand amputation and soft tissue coverage using an abdominal wall-based flap. The objectives of achieving stable soft tissue coverage while preserving maximal length of the upper extremity were successfully achieved, and the patient expressed satisfaction with the outcomes. Inadequate management of upper extremity wounds can lead to amputation and psychological distress. The reconstructive ladder is used to approach upper extremity soft tissue defects, with free tissue transfer being the standard for larger defects. However, abdominal flaps still have indications when free tissue transfer is not feasible or contraindicated. It is imperative that plastic surgeons have these techniques in their armamentarium to provide a service to the ever more complex patient with an upper extremity wound.
Plasma Concentrations of Tranylcypromine in Depressed Patients With Chronic Kidney Disease
Authors: Först Christiane , Ulrich Sven , Zurek Gabriela , Seifert Sabine , Frank Markus , Scheidel Bernhard
Published: April 2024

Purpose

The prevalence of comorbid depression and chronic kidney disease (CKD) is high. The aim of this brief report was to review 2 cases of treatment with tranylcypromine (TCP) in patients with treatment-resistant depression (TRD) and CKD. Tests of the plasma concentration of TCP were included.

Methods

Medical and psychiatric notes of the 2 patients were reviewed with plasma concentrations of TCP as a key aspect of the discussion. The data are evaluated in the context of relevant medical and pharmacokinetic literature.

Findings

Plasma concentrations of TCP are highly variable both in patients with and without CKD. Plasma concentrations of TCP were not increased in the 2 cases with CKD as compared with literature data of patients without CKD. No signs of intoxication were detected in 2 cases with CKD that impaired continuous treatment of depression with TCP.

Implications

TCP may be considered in selected cases of TRD with concomitant CKD. More clinical data and tests of plasma concentrations of TCP are needed in patients with CKD.
Long-Term Impairment From Irritant-Induced Occupational Asthma
Authors: Lantto Jussi , Suojalehto Hille , Vasankari Tuula , Karvala Kirsi , Lindström Irmeli
Published: April 2024

Objective

The aim of the study is to assess the long-term physical condition, health-related quality of life, employment, and work ability of irritant-induced asthma (IIA) patients.

Methods

Forty-three IIA patients completed a follow-up questionnaire a median of eight (interquartile range 4–11) years after asthma diagnosis. We compared their results with those of 43 low-molecular-weight (LMW) sensitizer-induced occupational asthma (OA) patients and those of 206 adult-onset asthmatics in the general population.

Results

Of the IIA patients, 40% reported depressive symptoms. Of the <65-year-olds, 56% were employed, of whom 39% assessed their work ability as limited. IIA patients had more difficulty climbing several flights of stairs than LMW-induced OA patients (70% vs 47%, OR = 4.83 95% CI: 1.51–15.47). Most of the IIA patients’ outcomes were inferior to those of the adult-onset asthmatics in the general population.

Conclusions

IIA prognosis appeared poor but resembled that of LMW-induced OA.
Multilevel Mindfulness
Authors: Koopmans Linda , Bruel Danielle , de Geit Ellemarijn , van den Bergh Roos , Bouwens Luuk , de Korte Elsbeth , Wiezer Noortje , van der Torre Wouter
Published: April 2024

Objective

This study aimed to examine which factors in the organizational context stimulate and/or hinder employee mindfulness. Methods: Two methods were used: 1) scientific literature review, and 2) qualitative interviews with scientists, trainers, and managers. Results: The individual and the work environment interact with each other when it comes to mindfulness in the workplace. Factors at the task, team, supervisor, organizational, and context level stimulate employee mindfulness. Conclusions: Mindfulness is effective in dealing with stress but also positively impacts work-related outcomes such as engagement, concentration, and productivity. A multilevel approach can strengthen the positive effects of individual mindfulness training in the workplace, ultimately contributing to healthy workplaces.
Expressing the Complexities of the Student-Cadaver Relationship Through Visual Artwork
Authors: Loder Rayne , Buyea Beth , Otte Michael , Johansen Krista , Lufler Rebecca
Published: April 2024

Many physician assistant (PA) students first encounter death in the earliest days of their training when working with cadavers in the gross anatomy laboratory. Developing a deep knowledge of human anatomy is fundamental to health profession training programs and modern medical practice. Despite decreased laboratory hours and integration of technology and diagnostic imaging into modern anatomy courses, there remains value in the cadaver dissection experience. Medical learners experience diverse and complex feelings toward cadavers; learning to regulate one's personal responses within the anatomy laboratory is a skill that can be extrapolated to clinical practice. Art is one way for students to process their experiences with cadavers, and creating art for cadaver memorial ceremonies is an opportunity for student emotional processing while honoring the lives of their cadaveric teachers. A PA program in New England incorporated student art into a cadaver memorial ceremony, with 4 pieces of artwork and corresponding artist statements from that ceremony included in this piece. The works of art are visually diverse, but there is a shared sentiment in the artist statements of reflection, awe, appreciation, and humanity. Encouraging students to process complex experiences artistically may provide an enduring practice throughout a career in medicine.
The risk factors for postoperative temporary vocal cord paralysis after thyroid cancer surgery: an observational retrospective cohort study
Authors: Han Yujia , Zhao Yishen , Kou Jiedong , Li Jingting , Li Fang , Du Rui , Dionigi Gianlorenzo , Frattini Francesco , Liang Nan , Sun Hui
Published: April 2024

Objective:

To analyze the potential factors influencing new-onset postoperative transient vocal cord paralysis (VCP) in thyroid cancer patients.

Methods:

Case information of 8340 thyroid cancer patients hospitalized at China-Japan Union Hospital of Jilin University, Jilin Province, China, in the Thyroid Surgery Department from January 2018 to December 2020 was collected retrospectively and analyzed. The possible influencing factors were analyzed using a χ
2 test, rank-sum test, and multiple logistic regression analysis. A nomogram was used to construct the clinical prediction model that was validated in the validation set by receiver operating characteristic, calibration curves, and Decision curve analysis.

Results:

The strengthening the reporting of cohort, cross-sectional, and case–control studies in surgery (STROCSS) guideline was followed to conduct a retrospective cohort study. A total of 8340 patients, including 1817 (21.8%) men and 6523 (78.2%) women, were enrolled in this study. The rate of temporary VCP was 3.6% (308/8340). Based on the results of postoperative laryngoscopy, the patients were divided into VCP group and non-VCP group. Comparative analysis between the groups revealed that potential factors associated with postoperative transient VCP were tumor location on the dorsal side of the gland (P=0.042), ultrasound showing a maximum nodal diameter >1 cm (P=0.002), multifocal carcinoma (P<0.001), invasion of surrounding tissue (P=0.005), lymph node metastases in the central compartment (P=0.034), lateral cervical lymph node metastasis (P<0.001), and prolonged operation (P<0.001). A multiple logistic regression analysis showed that the independent risk factors in postoperative transient VCP were T stage (OR=1.411, P=0.013, 95% CI: 1.075–1.853), multifocal carcinoma (OR=1.532, P=0.013, 95% CI: 1.095–2.144), and duration of surgery (OR=1.009, P<0.001, 95% CI: 1.006–1.012). Finally, a clinical prediction model was established via a nomogram and was validated in the validation set, although its diagnostic efficacy needs to be improved further.

Conclusion:

High T stage, multifocal carcinoma, and prolonged operation time may be independent risk factors for the occurrence of postoperative transient VCP in patients undergoing initial surgery for thyroid cancer.
Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia–bradycardia syndrome: A systematic review and updated meta-analysis
Authors: Su Lijun , Wang Xiaoqi , Kang Fengguang , Gong Caidi , Chen Dezhu
Published: April 2024

Background:

Tachycardia–bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS.

Methods:

We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy.

Results:

Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR] = 0.62 and 95% confidence interval [CI]: 0.14–2.65), procedural complications (OR = 1.53 and 95% CI: 0.67–3.48), and cardiovascular rehospitalization (OR = 0.57 and 95% CI: 0.26–1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (OR = 0.37 and 95% CI: 0.17–0.82), thromboembolism (OR = 0.25 and 95% CI: 0.12–0.49), stroke (OR = 0.28 and 95% CI: 0.13–0.57), heart failure (OR = 0.27 and 95% CI: 0.13–0.56), freedom from AF (OR = 23.32 and 95% CI: 7.46–72.92), and prevention of progression to persistent AF (OR = 0.12 and 95% CI: 0.06–0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (OR = 0.21 and 95% CI: 0.08–0.59).

Conclusion:

AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.
Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report
Authors: Yang Mengya , Wang Danmin , Xu Xia , Yu Xiaobo , Xu Hefei , Zeng Zhaoqiang , Dai Jingwei
Published: April 2024

Background:

Thoracic surgery without general anesthesia can be traced back to the First World War, and thoracic epidural block was used to complete the operation due to a large number of patients with gunshot wounds who needed emergency thoracic surgery. By reducing the intraoperative opioid dose, intraoperative and postoperative opioid-related adverse events such as respiratory depression, nausea and vomiting, delirium, hyperalgesia, and other side effects can be reduced to the benefit of patients.

Methods:

A 72-year-old male patient was admitted to the hospital with a 5-day history of multifocal pain throughout the body caused by a fall. The injury was not treated at that time, and the pain gradually increased, accompanied by cough with difficulty expelling sputum.

Diagnoses:

Left lung contusion; traumatic pneumonia; multiple left rib fractures; left fluid pneumothorax; thyroid tumor of unknown nature, possibly malignant. Grade I tracheal stenosis; Sequelae of cerebral infarction. Because of goiter and severe tracheal compression, the patient was not intubated and received deopiated general anesthesia combined with epidural anesthesia to preserve spontaneous breathing.

Outcomes:

At the end of the video-assisted thoracoscopic exploration, the patient was immediately conscious and returned directly to the ward 6 min later. The patient was able to move freely after surgery and eat normally within 6 h of surgery. The postoperative visual analog scale score was 2 points, and there were no anesthetic complications during the follow-up.

Conclusion:

The opioid-free anesthesia strategy of tubeless general anesthesia, allowing spontaneous breathing combined with epidural anesthesia in elderly patients with tracheal stenosis undergoing video-assisted thoracoscopic surgery can not only avoid accidents and injuries caused by tracheal intubation and mechanical ventilation, but can also significantly reduce postoperative respiratory complications, optimize postoperative analgesia, and help achieve enhanced recovery after surgery.
Machine learning developed a fibroblast-related signature for predicting clinical outcome and drug sensitivity in ovarian cancer
Authors: Fu Wei , Feng Qian , Tao Ran
Published: April 2024

Ovarian cancer (OC) is the leading cause of gynecological cancer death. Cancer-associated fibroblasts (CAF) is involved in wound healing and inflammatory processes, tumor occurrence and progression, and chemotherapy resistance in OC. GSE184880 dataset was used to identify CAF-related genes in OC. CAF-related signature (CRS) was constructed using integrative 10 machine learning methods with the datasets from the Cancer Genome Atlas, GSE14764, GSE26193, GSE26712, GSE63885, and GSE140082. The performance of CRS in predicting immunotherapy benefits was verified using 3 immunotherapy datasets (GSE91061, GSE78220, and IMvigor210) and several immune calculating scores. The Lasso + StepCox[forward] method-based predicting model having a highest average C index of 0.69 was referred as the optimal CRS and it had a stable and powerful performance in predicting clinical outcome of OC patients, with the 1-, 3-, and 5-year area under curves were 0.699, 0.708, and 0.767 in the Cancer Genome Atlas cohort. The C index of CRS was higher than that of tumor grade, clinical stage, and many developed signatures. Low CRS score demonstrated lower tumor immune dysfunction and exclusion score, lower immune escape score, higher PD1&CTLA4 immunophenoscore, higher tumor mutation burden score, higher response rate and better prognosis in OC, suggesting a better immunotherapy response. OC patients with low CRS score had a lower half maximal inhibitory concentration value of some drugs (Gemcitabine, Tamoxifen, and Nilotinib, etc) and lower score of some cancer-related hallmarks (Notch signaling, hypoxia, and glycolysis, etc). The current study developed an optimal CRS in OC, which acted as an indicator for the prognosis, stratifying risk and guiding treatment for OC patients.
A retrospective study of combination therapy with glucocorticoids and pirfenidone for PD-1 inhibitor-related immune pneumonitis
Authors: Li Yong , Huang Huiqin , Ye Xiangli , Zeng Bangwei , Huang Feijian , Chen Limin
Published: April 2024

Immune checkpoint inhibitor pneumonitis (ICIP) is thought to be a self-limiting disease; however, an effective treatment option does not currently exist. This study aimed to determine the clinical efficacy of combination therapy with glucocorticoids and pirfenidone for ICIP related to programmed cell death protein-1 (PD-1) inhibitors. We conducted a retrospective analysis of 45 patients with advanced non-small cell lung cancer who developed ICIP following PD-1 inhibitor and albumin-bound paclitaxel or carboplatin treatment at our hospital. The PD-1 inhibitor was discontinued, and glucocorticoids were used alone or in combination with pirfenidone to treat ICIP. The relevant clinical data of these patients were collected and analyzed. Compared with the glucocorticoid alone group, the glucocorticoid-pirfenidone group showed significant improvement in forced vital capacity (FVC), carbon monoxide diffusing capacity [%], peripheral capillary oxygen saturation, and 6-minute walk distance (P < .05). There were benefits with respect to the St. George’s Respiratory Questionnaire score and the recurrence rate of ICIP, but there was no significant difference between the 2 groups (P > .05). Adding pirfenidone to glucocorticoid treatment was shown to be safe and may be more beneficial than glucocorticoids alone for improving pulmonary interstitial lesions, reversing ICIP, and preventing its recurrence.
Acute right extremity deep vein thrombosis and left-sided inferior vena cava thrombosis treated by percutaneous mechanical thrombectomy (PMT) combined with catheter directed thrombolysis (CDT): A case report
Authors: Ju Zhinan , Chen Wei , Min Xixi , Dai Kanghui , Zheng Henan , Qiu Jiehua
Published: April 2024

Introduction:

Left-sided inferior vena cava (IVC) is an uncommon condition with a prevalence rate of 0.2% to 0.5%. Most of them remain asymptomatic and are discovered incidentally. The patient condition in this case is critical, and conventional procedures are not applicable. The surgical approach being considered is innovative, but it carries significant risks and uncertain therapeutic efficacy.

Patient concerns:

A 42-year-old male presented with acute right lower extremity pain with swelling for 2 days.

Diagnosis:

The patient was subsequently diagnosed with acute right lower extremity deep vein thrombosis, inferior vena cava thrombosis, and a left-sided IVC.

Interventions:

Based on the treatment guidelines for lower extremity deep venous thrombosis.

Outcomes:

We successfully cured him with percutaneous mechanic thrombectomy (PMT) combined with catheter directed thrombolysis (CDT).

Conclusion and significance:

The relatively low incidence of left-sided IVC does not diminish the significance of its identification. PMT combined with CDT is a safe way to treat acute thrombosis. It provides a new approach for similar patients in the future.
A novel ABCD1 gene mutation causes adrenomyeloneuropathy presenting with spastic paraplegia: A case report
Authors: Liu Jinxin , Wang Xin , Huang Di , Qi Yuna , Xu Lei , Shao Yankun
Published: April 2024

Rationale:

X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene leading to very long chain fatty acid (VLCFA) accumulation. The disease demonstrates a spectrum of phenotypes including adrenomyeloneuropathy (AMN). We aimed to identify the genetic basis of disease in a patient presenting with AMN features in order to confirm the diagnosis, expand genetic knowledge of ABCD1 mutations, and elucidate potential genotype-phenotype associations to inform management.

Patient concerns:

A 29-year-old male presented with a 4-year history of progressive spastic paraplegia, weakness of lower limbs, fecal incontinence, sexual dysfunction, hyperreflexia, and positive Babinski and Chaddock signs.

Diagnoses:

Neuroimaging revealed brain white matter changes and spinal cord thinning. Significantly elevated levels of hexacosanoic acid (C26:0) and tetracosanoic acid (C24:0) suggested very long chain fatty acids (VLCFA) metabolism disruption. Genetic testing identified a novel hemizygous ABCD1 mutation c.249dupC (p.F83fs). These findings confirmed a diagnosis of X-linked ALD with an AMN phenotype.

Interventions:

The patient received dietary counseling to limit VLCFA intake. Monitoring for adrenal insufficiency and consideration of Lorenzo’s oil were advised. Genetic counseling and testing were offered to at-risk relatives.

Outcomes:

At present, the patient continues to experience progressive paraplegia. Adrenal function remains normal thus far without steroid replacement. Family members have undergone predictive testing.

Lessons:

This case expands the known mutation spectrum of ABCD1-linked X-ALD, providing insight into potential genotype-phenotype correlations. A thoughtful diagnostic approach integrating clinical, biochemical and genetic data facilitated diagnosis. Findings enabled genetic counseling for at-risk relatives regarding this X-linked disorder.
Improving Self-Reported Person-centered Care Competency in Nursing Students
Authors: Zadvinskis Inga M. , Hoying Jacqueline , Martini Kady , Taylor Tracy , Czaja Rebecca , Terry Ayanna E. , Fortney Christine A.
Published: April 2024

Background:

To prepare nursing students to deliver high-quality care, educators need strategies to foster person-centered care (PCC).

Purpose:

This pilot study evaluated an intervention with interactive case studies on undergraduate nursing students’ PCC competency.

Methods:

We conducted a pilot study with sophomore undergraduate nursing students (n = 39) from a Midwestern US university. We developed a 90-minute class seminar with interactive case studies highlighting how patient preferences, values, and circumstances could influence fall risk. We assessed PCC using the Patient-Centered Care Competency Scale.

Results:

Although there was no statistically significant change in overall PCC competency before and after the intervention, we noted a small to medium effect size on PCC competency per Cohen’s d standards (d = 0.35). Content analysis of students’ open-ended responses reflected PCC and clustered into 5 themes.

Conclusions:

Findings suggest that educators may use interactive case studies to foster nursing student PCC competency.
Efficacy and Safety of OnabotulinumtoxinA for the Treatment of Platysma Prominence: A Randomized Phase 2 Dose-Ranging Study
Authors: Rohrich Rod J. , Bertucci Vince , Dayan Steven , Jones Derek , Solish Nowell , Rivers Jason K. , Weiss Robert A. , Muhn Channy Y. , Harutunian Christy , Park Grace S. , Shimoga Sandhya , Lee Elisabeth , Tong Warren
Published: April 2024

Background:

With aging, repetitive contraction of the platysma leads to an increase in platysma prominence (PP), characterized by the accentuation of vertical neck bands and blunting of the jawline contour.

Methods:

This multicenter, double-blind, phase 2 study evaluated onabotulinumtoxinA treatment in adults with moderate to severe PP. Participants were randomized to receive 1 treatment of onabotulinumtoxinA low dose (LD), onabotulinumtoxinA high dose (HD), or placebo, and were followed up for 4 months. Efficacy end points were achievement of a 1 grade or greater improvement on both the left and right sides at day 14 at maximum contraction as assessed by the investigator (primary) or by participants (secondary) using validated scales. Safety was evaluated throughout.

Results:

Participants in the modified intent-to-treat population (n = 164) had a mean age of 50 years; 95.1% were women and 93.9% were White. The primary end point was met for both onabotulinumtoxinA groups, with investigator-assessed 1 grade or greater improvement in 77.8% (LD) and 88.2% (HD) versus 12.0% (placebo) of participants on day 14 (P < 0.0001 versus placebo). Based on participant self-assessment, 75.9% (LD) and 88.2% (HD) versus 18.0% (placebo) achieved 1 grade or greater improvement on day 14 (P < 0.0001 versus placebo). Most treatment-related adverse events were procedure-related, transient, and mild in severity. The most frequent onabotulinumtoxinA-related adverse event was neck muscle weakness, reported in the HD group.

Conclusion:

OnabotulinumtoxinA was effective in improving the appearance of PP based on both investigators’ and participants’ ratings. Treatment was well tolerated.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Perception of Patients, Physicians, and Chaperones Regarding the Use of Chaperones During Patient Examinations for Plastic Surgery: A Systematic Review
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu
Published: April 2024

In this systematic review, we searched electronic databases for literature addressing physician use of chaperones during examinations of patients undergoing plastic surgery from the perspective of the patient, physician, and chaperone from inception of the database until April 2023. After screening 939 articles, we included seven studies in a systematic review. We conducted an inductive thematic analysis of four domains (physician perspective, patient perspective, chaperone perspective, and chaperone documentation). The results of the analysis showed that surgeons who are experienced, are men, or have received education related to using chaperones are more likely to provide chaperones during patient examinations for medicolegal protection and patient comfort. A small percentage of surgeons have faced accusations from patients of inappropriate behavior. Most of these incidents have occurred without a chaperone present. Patients who have long associations with a particular plastic surgery practice are less likely to want a chaperone. When physicians examine nonsensitive areas, most patients prefer having no chaperone. However, young patients and patients undergoing reconstructive procedures are more likely to request chaperones. Patients prefer having family members or friends serve as chaperones. Notably, despite the presence of a chaperone, we found that documentation of the presence of a chaperone was inadequate. Using a chaperone helps establish trust and ensure patient comfort. Further research, including qualitative studies and multinational approaches, is warranted to gain deeper insights and develop comprehensive guidelines for chaperone use that empowers both patients and health care providers.
Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death
Authors: Murphy Nicholas B. , Shemie Sam D. , Capron Alex , Truog Robert D. , Nakagawa Thomas , Healey Andrew , Gofton Teneille , Bernat James L. , Fenton Kathleen , Khush Kiran K. , Schwartz Bryanna , Wall Stephen P.
Published: April 2024

In controlled organ donation after circulatory determination of death (cDCDD), accurate and timely death determination is critical, yet knowledge gaps persist. Further research to improve the science of defining and determining death by circulatory criteria is therefore warranted. In a workshop sponsored by the National Heart, Lung, and Blood Institute, experts identified research opportunities pertaining to scientific, conceptual, and ethical understandings of DCDD and associated technologies. This article identifies a research strategy to inform the biomedical definition of death, the criteria for its determination, and circulatory death determination in cDCDD. Highlighting knowledge gaps, we propose that further research is needed to inform the observation period following cessation of circulation in pediatric and neonatal populations, the temporal relationship between the cessation of brain and circulatory function after the withdrawal of life-sustaining measures in all patient populations, and the minimal pulse pressures that sustain brain blood flow, perfusion, activity, and function. Additionally, accurate predictive tools to estimate time to asystole following the withdrawal of treatment and alternative monitoring modalities to establish the cessation of circulatory, brainstem, and brain function are needed. The physiologic and conceptual implications of postmortem interventions that resume circulation in cDCDD donors likewise demand attention to inform organ recovery practices. Finally, because jurisdictionally variable definitions of death and the criteria for its determination may impede collaborative research efforts, further work is required to achieve consensus on the physiologic and conceptual rationale for defining and determining death after circulatory arrest.
Autologous Pancreatic Islet Cell Transplantation Following Pancreatectomy for Pancreas Diseases Other Than Chronic Pancreatitis: A 15-y Study of the Milan Protocol
Authors: Piemonti Lorenzo , Melzi Raffella , Aleotti Francesca , Capretti Giovanni , Nano Rita , Mercalli Alessia , Magistretti Paola , Caldara Rossana , Pecorelli Nicolò , Catarinella Davide , Gremizzi Chiara , Gavazzi Francesca , De Cobelli Francesco , Poretti Dario , Falconi Massimo , Zerbi Alessandro , Balzano Gianpaolo
Published: April 2024

Background.

Pancreatogenic diabetes, a consequence of pancreatic tissue loss following pancreatectomy, poses a significant challenge for patients undergoing pancreatic surgery. Islet autotransplantation (IAT) offers a promising approach to prevent or alleviate pancreatogenic diabetes, but its application has been limited to individuals with painful chronic pancreatitis.

Methods.

This study presents a 15-y clinical experience with the Milan Protocol, which expands IAT after pancreatectomy to a broader spectrum of patients with malignant and nonmalignant pancreatic diseases. The analysis evaluates feasibility, efficacy, and safety of IAT. Modified Igls criteria validated through the arginine test and mixed meal tolerance tests were used to assess long-term metabolic outcomes.

Results.

Between November 2008 and June 2023, IAT procedures were performed on 114 of 147 candidates. IAT-related complications occurred in 19 of 114 patients (16.7%), with 5 being potentially serious. Patients exhibited sustained C-peptide secretion over the 10-y follow-up period, demonstrating a prevalence of optimal and good beta-cell function. Individuals who underwent partial pancreatectomy demonstrated superior metabolic outcomes, including sustained C-peptide secretion and a reduced risk of developing diabetes or insulin dependence compared with those who underwent total pancreatectomy. For patients who had total pancreatectomy, the quantity of infused islets and tissue volume were identified as critical factors influencing metabolic outcomes. An increased risk of recurrence or progression of baseline diseases was not observed in subjects with neoplasms.

Conclusions.

These findings provide valuable insights into the benefits and applications of IAT as a therapeutic option for pancreatogenic diabetes after pancreatic surgery, expanding its potential beyond painful chronic pancreatitis.
Sex-controlled differences in sertraline and citalopram efficacies in major depressive disorder: a randomized, double-blind trial
Authors: Shamabadi Ahmad , Karimi Hanie , Fallahzadeh Mohammad Ali , Vaseghi Salar , Arabzadeh Bahri Razman , Fallahpour Bita , Abdolghaffari Amir Hossein , Akhondzadeh Shahin
Published: April 2024

To investigate the response to antidepressants while controlling for sex, which has been controversial, 92 outpatient males and females with major depressive disorder were assigned to sertraline (100 mg/day) or citalopram (40 mg/day) in two strata and were assessed using Hamilton depression rating scale (HDRS) scores and brain-derived neurotrophic factor (BDNF), interleukin (IL)-6 and cortisol serum levels in this 8-week, randomized, parallel-group, double-blind clinical trial. Data of 40 sertraline and 40 citalopram recipients with equal representation of males and females assigned to each medication were analyzed, while their baseline characteristics were not statistically different (P > 0.05). There were no significant differences between sertraline and citalopram recipients in outcome changes (P > 0.05), all of which indicated improvement, but a significant time-treatment-sex interaction effect in BDNF levels was observed (P = 0.035). Regarding this, subgroup analyses illustrated a significantly greater increase in male BDNF levels following sertraline treatment (P = 0.020) with a moderate to large effect size (Cohen’s d = 0.76 and

). Significant associations were observed between percentage changes in IL-6 levels and BDNF levels in sertraline recipients (P = 0.033) and HDRS scores in citalopram recipients (P < 0.001). Sex was an effect modifier in BDNF alterations following sertraline and citalopram administration. Further large-scale, high-quality, long-term studies are recommended.
Molecular phylogeny and morphology of Sporodiniella sinensis sp. nov. (Syzygitaceae, Mucorales), an invertebrate-associated species from Yunnan, China
Authors: Fan Qi , Cheng Zhu-Yu , Xie Liu-Yi , Tang Mei , Yang Zhu-Liang , Shen Pei-Hong , Wang Yuan-Bing
Published: April 2024

During investigations of invertebrate-associated fungi in Yunnan Province of China, a new species, Sporodiniella sinensis sp. nov., was collected. Morphologically, S. sinensis is similar to Sporodiniella umbellata; however, it is distinguished from S. umbellata by its greater number of sporangiophore branches, longer sporangiophores, larger sporangiospores, and columellae. The novel species exhibits similarities of 91.62 % for internal transcribed spacer (ITS), 98.66–99.10 % for ribosomal small subunit (nrSSU), and 96.36–98.22 % for ribosomal large subunit (nrLSU) sequences, respectively, compared to S. umbellata. Furthermore, phylogenetic analyses based on combined sequences of ITS, nrLSU and nrSSU show that it forms a separate clade in Sporodiniella, and clusters closely with S. umbellata with high statistical support. The phylogenetic and morphological evidence support S. sinensis as a distinct species. Here, it is formally described and illustrated, and compared with other relatives.
Streptomyces profundus sp. nov., a novel marine actinobacterium isolated from deep-sea sediment of Madeira Archipelago, Portugal
Authors: Ribeiro Inês , Correia Sofia , Blümel Martina , Albuquerque Pedro , Gorb Stanislav N. , Mendes Marta V. , Tasdemir Deniz , Mucha Ana P. , Carvalho Maria F.
Published: April 2024

A novel strain, MA3_2.13T, was isolated from deep-sea sediment of Madeira Archipelago, Portugal, and characterized using a polyphasic approach. This strain produced dark brown soluble pigments, bronwish black substrate mycelia and an aerial mycelium with yellowish white spores, when grown on GYM 50SW agar. The main respiratory quinones were MK-10(H4), MK-10(H6) and MK-10(H8). Diphosphatidylglycerol, phosphatidylethanolamine, three unidentified phospholipids and two glycophospholipids were identified as the main phospholipids. The major cellular fatty acids were iso-C16 : 1, iso-C16 : 0, anteiso-C17 : 1 and anteiso-C17 : 0. Phylogenetic analyses based on 16S rRNA gene showed that strain MA3_2.13T is a member of the genus Streptomyces and was most closely related to Streptomyces triticirhizae NEAU-YY642T (NR_180032.1; 16S rRNA gene similarity 97.9 %), Streptomyces sedi YIM 65188T (NR_044582.1; 16S rRNA gene similarity 97.4 %), Streptomyces mimosae 3MP-10T (NR_170412.1; 16S rRNA gene similarity 97.3 %) and Streptomyces zhaozhouensis NEAU-LZS-5T (NR_133874.1; 16S rRNA gene similarity 97.0 %). Genome pairwise comparisons with closest related type strains retrieved values below the threshold for species delineation suggesting that strain MA3_2.13T represents a new branch within the genus Streptomyces. Based on these results, strain MA3_2.13T (=DSM 115980T=LMG 33094T) is proposed as the type strain of a novel species of the genus Streptomyces, for which the name Streptomyces profundus sp. nov. is proposed.
Joint Gray and White Matter Networks Predict Mindfulness and Mind Wandering Traits: A Data Fusion Machine Learning Approach
Authors: Chang Minah , Sorella Sara , Crescentini Cristiano , Grecucci Alessandro
Published: April 2024

Mind wandering is a ubiquitous part of our normal cognition and daily lives, with people reporting that their mind wanders during 25-50% of their waking hours. Studies suggest that mind wandering shares an inverse relationship with mindfulness skills. Our aim was to expand this evidence directly by investigating the mediating effect among mindfulness, mind wandering, and brain features. The main goal of our study in particular was to find out which morphometric brain features are associated with mindfulness and mind wandering, and to investigate how mindfulness mediates deliberate and spontaneous mind wandering in terms of these associated brain components. GM and WM MRI scans of 76 individuals and self-reported questionnaires were included in the analysis. We predicted that specific gray matter (GM) and white matter (WM) networks would also influence deliberate and spontaneous mind wandering tendencies with mindfulness as a mediator. We found that GM and WM networks including structures that have been consistently linked to mindfulness, such as the cingulate, the insula, the basal ganglia and fronto-parietal attentive regions, exert direct effects on mindfulness, and deliberate and spontaneous mind wandering. We also found an indirect mediating effect of the FFMQ facetacting with awarenesson spontaneous mind wandering in terms of increased and decreased GM volume concentrations. This study elicited the link between mind wandering and mindfulness and expands our knowledge on the neural bases of these two psychological constructs.
Spatio-temporal transformers for decoding neural movement control
Authors: Candelori Benedetta , Bardella Giampiero , Spinelli Indro , Ramawat Surabhi , Pani Pierpaolo , Ferraina Stefano , Scardapane Simone
Published: April 2024

Deep learning tools applied to high-resolution neurophysiological data have significantly progressed, offering enhanced decoding, real-time processing, and readability for practical applications. However, the design of artificial neural networks to analyze neural activity remains a challenge, requiring a delicate balance between efficiency in low-data regimes and the interpretability of the results. To this end, we introduce a novel specialized transformer architecture to analyze single-neuron spiking activity. We test our model on multi electrodes recordings from the dorsal premotor cortex (PMd) of non-human primates while performing a motor inhibition task. The proposed architecture provides a very early prediction of the correct movement direction - no later than 230ms after the Go signal presentation across animals - and can accurately forecast whether the movement will be generated or withheld before a Stop signal, unattended, is actually presented. We also analyze the internal dynamics of the model by computing the predicted correlations between time steps and between neurons at successive layers of the architecture. We find that their evolution mirrors previous theoretical analyses. Overall, our framework provides a comprehensive use case for the practical implementation of deep learning tools in motor control research.
Axon demyelination and degeneration in a zebrafishspastizinmodel of hereditary spastic paraplegia
Authors: Garg Vranda , Heyer Luisa , Ruhwedel Torben , André Selina , Kracht Gudrun , Scholz Patricia , Ischebeck Till , Werner Hauke B. , Dullin Christian , Engelmann Jacob , Möbius Wiebke , Dosch Roland , Göpfert Martin C. , Geurten Bart R.H.
Published: April 2024

Hereditary spastic paraplegias (HSPs) are a diverse set of neurological disorders characterized by progressive spasticity and weakness in the lower limbs caused by damage to the axons of the corticospinal tract. More than 88 genetic mutations have been associated with HSP, yet the mechanisms underlying these disorders are little understood. We studied the pathogenesis of one form of HSP known as spastic paraplegia 15 (SPG15). This disorder is caused by mutations in theZFYVE26gene, which codes for a protein called SPASTIZIN. We show that, in zebrafish, the significant reduction of Spastizin caused degeneration of Mauthner (M)-cells. M-cell degeneration is associated with axon demyelination in the spinal cord and impaired locomotion in thespastizinmutants. Our findings reveal that the mutation not only compromises axonal integrity but also affects the structural molecules of the myelin sheath, laying the foundation for degeneration and advancing our understanding of the intricate mechanisms underlying HSPs.
Prevalence of non-tuberculous mycobacteria among people presumed to have tuberculosis, positive for acid-fast bacilli in Mali
Authors: Cisse Aissata Boubakar , Dean Anna S. , Van Deun Armand , Keysers Jelle , De Rijke Willem-Bram , Gumusboga Mourad , Samake Hawa , Arama Seydou , Diarra Bassirou , Djilla Ibrahim , Coulibaly Fatoumata N. , Simpara Hawa , Berthe Mamadou , Ouattara Khadidia , Toloba Yacouba , Guindo Ibrehima , de Jong Bouke , Rigouts Leen
Published: April 2024

Background

Non-tuberculosis mycobacteria (NTMs) are environmental agents that can cause opportunistic pulmonary disease in humans and animals which is often misdiagnosed as tuberculosis (TB). In this study, we describe the cases of NTMs identified during the first national anti-TB drug-resistance survey conducted in Mali, and associated risk factors.

Methods

Sputum was collected from people presenting for pulmonary TB diagnosis, from April to December 2019, regardless of age. Microscopy-positive patients were enrolled and were tested by GeneXpert MTB/RIF. Cases that tested negative for theMycobacterium tuberculosiscomplex (MTBc) were tested for presence of mycobacteria by amplification of the IS6110and 16SrRNA genes through double quantitative real-time PCR, followed by nested PCR and Sanger sequencing of the IS6110-negative samples for NTM species identification.

Results

A total of 1,418 sputum smear-positive patients were enrolled, including 1,199 new cases, 211 previously treated cases and 8 whose previous treatment history was unknown. Based on the results of GeneXpert MTB/RIF and in-house PCR methods, 1331 (93.9%) patients were positive for MTBc, 48 (3.4%) for NTMs and for 39 (2.7%) no species identification was possible. Advanced age (65 and over) (OR 8.8, p=0.001) and previous TB treatment (OR 3.4 and p=0.016) were the risk factors statistically associated with NTM detection.M. avium complex(MAC) was the predominant NTM species, detected in 20 cases.

Conclusion

Detection of NTMs in people presumed to have TB is an ongoing challenge, confounding correct TB diagnosis. Concomitant use of microscopy and GeneXpert testing among at-risk individuals could lessen confusion.