bluuebunny/crossref_metadata_2025 huggingface dataset:
Minced Cartilage Implantation in Acetabular Cartilage Defects: Case Series with 2-Year Results
Authors: Gebhardt Sebastian , Hofer Andre , Wassilew Georgi I. , Sobau Christian , Zimmerer Alexander
Published: August 2023

Objective

The objective was to evaluate clinical outcome and safety of arthroscopic, autologous minced cartilage implantation for acetabular cartilage lesions observed during hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS).

Design

Eleven male patients, average age: 29.4 ± 5.4 years, average body mass index (BMI): 24.2 ± 2.2 kg/m2, scheduled for hip arthroscopy due to FAIS accompanied by an acetabular cartilage lesion were included in the case series. Cartilage tissue was harvested and minced from the loose cartilage flap at the chondrolabral lesion by arthroscopic shaver, augmented with autologous conditioned plasma, implanted into the defect, and fixated by autologous thrombin. Concomitant interventions were performed as indicated. The patients were evaluated preoperatively and at 24-month follow-up, using the International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) pain score and by magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) grading scale at the 2-year follow-up.

Results

The defect size was on average 3.5 cm2 (1.5-4.5 cm2). From preoperatively to 2 years postoperatively, the iHOT-12 significantly improved from 50.2 ± 18 to 86.5 ± 19 ( P < 0.0001), and pain score decreased from 5.6 ± 1.8 to 1.0 ± 1.5 ( P < 0.0001) on the Visual Analog Scale pain score. Regarding functional outcome and pain, 10 of the 11 patients and all patients reached the minimal clinically important difference (MCID), respectively. The postoperative average MOCART score was 87.2 (± 9.2). No adverse events or reoperations were observed.

Conclusions

Arthroscopic, autologous minced cartilage implantation for treating full-thickness acetabular cartilage lesions in FAIS shows statistically and clinically significant improvement at short-term follow-up.
Spinal decompression and stabilisation in a cat with lumbar vertebral pathological fracture and subluxation, following discospondylitis and spinal epidural empyema
Authors: Proteasa Adelina , Walton Myles Benjamin , Carrera Ines , Garosi Laurent S , Alcoverro Emili , Heyes Menai , Tauro Anna
Published: August 2023

Case series summary

A 1-year-old castrated male Maine Coon cat was referred because of a 1-week history of progressive spastic non-ambulatory paraparesis. An MRI examination of the thoracolumbar spine showed multiple lytic lesions, with the most aggressive one centred on the adjacent endplates of L1–L2 and its associated disc. Ventral new bone formation, L1 vertebral body shortening and mild dorsal displacement of the caudal aspect of L1 were noted. Contrast enhancement of both paravertebral soft tissue and extradural lesion was present. These findings were compatible with L1–L2 discospondylitis (DS), spinal epidural empyema (SEE), with secondary L1 pathological vertebral fracture, subluxation and spinal cord compression. CT of the thoracolumbar spine, abdomen and thorax confirmed these findings. The patient deteriorated to paraplegia with absent nociception, despite initial medical therapy. A right-sided L1–L2 hemilaminectomy and spinal decompression were then performed, followed by application of a unilateral construct comprising four smooth arthrodesis wires and polymethylmethacrylate (PMMA). S taphylococcus aureus was isolated from both epidural material, intraoperatively sampled and blood culture. Antibiotic therapy was continued for 6 weeks, based on susceptibility results. The outcome was excellent, with a gradual improvement and complete neurological recovery at the 8-week postoperative check. Repeated spinal radiographs showed an intact apparatus and marked signs of vertebral fusion. At the 14-month follow-up examination, the cat remained free of clinical signs.

Relevance and novel information

To the authors’ knowledge, this is the first case report of SEE and DS in a cat that required surgical stabilisation. The outcome was still optimal, despite the rapid neurological deterioration.
Counter-Institutional Identities and Product Innovation: “Core-Satellite” as a Response to Competing Logics Shaping Artisan Businesses
Authors: Nguyen Van Dai , Thuc Anh Phan Thi , Nguyen Thi Tuyet Mai , Nguyen Quynh Hoa , Van Trinh Mai , Long Pham Sy , Nhat Vo Hong
Published: August 2023

The recent increase in the number of business studies lends us a better understanding of the multi-faceted behaviors of artisans whose product innovation is made to strategically respond to different logics. The purpose of this study is to develop an analytical framework for artisan product innovation based on the interplay between institutional logics, counter-institutional identities, and product innovation. We argue that craft product innovation results from the comparative power between oppositional identity (artisan identity) and relational identity (entrepreneurial identity) when coping with multiple logics. A qualitative methodology that incorporates in-depth interviews and field observations is applied to offer insights into product innovation among Vietnamese artisan businesses. Our research discovers a new strategy, “Core-Satellite,” that is a tactic in reconciling competing logics. When oppositional identity is strong and relational identity is either strong or moderate at the same time, artisan business owners will create a “core” that provides a strong foundation for innovated products (satellite).
We’re Monitored Too Much! Workplace Bullying or Managerial Control in the Maldivian Tourist Resorts
Authors: Leeza Aishath , Kumar Shamala
Published: August 2023

In the Maldives, the tourism accommodations offer a unique working environment, which makes employees vulnerable to exploitation, abuse and likely to create its own profile of bullying. Therefore, this study places the spotlight on a setting about which little is known by the broader community of academics and professionals working in the field of human resource management. We used both quantitative and qualitative methods in this study to understand the phenomenon of workplace bullying, where participants faced an interview and then complete a questionnaire. Our study reveals that workplace bullying can be a strategy used by management to get work done in the short term. The managers’ primary goal is to achieve an organisational objective by leveraging the formal power and control structures they possess within the organisation. This approach gives off the impression of being unfair and inherently unjust towards those lower in the organisational hierarchy. As a result, individuals fail to report bullying incidents to the appropriate authorities and do not receive the necessary assistance; instead, they suffer in silence. Workers regard bullying as inherent to the system and ‘natural’ and ‘normal’ in this environment, as a result of the systems and the processes that they see operating.
Neonatal Jaundice: Its Determinants Among Neonates Admitted to Neonatal Intensive Care Units of Tigray Region General Hospitals, Northern Ethiopia
Authors: Kiros Berhe Mengesha , Fisseha Girmatsion , Gebreslassie Assefa Ayalew , Gufue Zenawi Hagos , Ebuy Haftamu , Belew Molla Teferi , Reda Getachew Zinabu , Mohammed Hayat Maeruf
Published: August 2023

Background. Despite the significant public health impact of neonatal jaundice on neonatal survival, local epidemiologic data are scarce. Methods. A multi-centered, unmatched case-control study was conducted among 180 consecutively admitted neonates (60 cases and 120 controls). The independent determinants of newborn jaundice were determined using a multivariable binary logistic regression model, and a P-value of <0.05 was used to indicate statistical significance. Results. Maternal medical complications during the index pregnancy (AOR = 2.45; 95% CI 1.01-5.97), rural residence (AOR = 3.1; 95% CI 1.02-9.42), being a low birthweight neonate (AOR = 3.42; 95% CI 1.12-10.41), neonatal B blood group (AOR = 10.19; 95% CI 2.89-35.9), neonatal O blood group (AOR = 2.99; 95% CI 1.04-8.59), and a longer duration of hospital stay (AOR = 9.83; 95% CI 3.11-31.02) were the independent determinants of neonatal jaundice. Conclusions. Early assessment of high-risk neonates might reduce the long-term neurodevelopmental consequences.
Revisiting Decentralised Governance of Natural Resources in India: Conceptual Binaries and Restrictive Policy Design
Authors: Baral Kabita
Published: August 2023

In India, in the post-1990s, fresh and renewed attention has been given to promoting participatory decentralised governance of natural resources (DGNR). The current paper reviews research on the DGNR in India. The paper observes that DGNR has failed in implementing its several objectives, such as ensuring meaningful and effective local participation, incorporation of local knowledge and conservation of natural resources. The paper goes further to claim failure of DGNR in India is beyond procedural. The reasons for failure are deep-rooted in the conceptual assumption underlying policy design. The paper finds that some of the problematic conceptualisations predominantly resulted from policy designing from an objectivist strandpoint. The paper reviews the available literature on the decentralised governance in India and the state’s decentalised resource governance policies. The current paper claims that the current designing of decentralised governance of natural resources (DGNR) is restrictive in nature and limits effective participation of local community in natural resources governance. As an improvement to the current design, the paper argues for a reflexive understanding of human–nature relation to be incorporated into DGNR designing.
Arthroplasty as Primary Treatment for Metadiaphyseal Proximal Humerus Fractures: A Viable Alternative to Osteosynthesis for the Elderly
Authors: Helal Asadullah , Heimdal Tyler , Lo Eddie Y , Montemaggi Paolo , Lund Julia , Garofalo Raffaele , Ouseph Alvin , Krishnan Sumant G
Published: August 2023

Introduction

in the elderly patient population, where fracture comminution, osteoporotic fractures, and associated arthritis or rotator cuff pathologies dominate, metadiaphyseal proximal humeral fracture is a challenging subset of fractures to treat. This study reports on cementless long-stem reverse total shoulder arthroplasty (RTSA) as primary treatment of metadiaphyseal proximal humeral fractures in elderly patients.

Materials & Methods

Between January 2018 and October 2021, 22 consecutive patients sustained proximal humerus fractures with metadiaphyseal extension and underwent surgery with cementless long-stem RTSA. Patients older than 60 years with minimum 1 year of clinical and radiographic follow-up were included. Patient demographics, range of motion, and patient reported outcomes [Visual Analog Scale (VAS) pain scale, Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), and American Shoulder Elbow Surgeon (ASES) scores] were retrospectively collected. Postoperative X-rays were evaluated for fracture and tuberosity union.

Results

There were 14 eligible patients with a median age of 71 years (range 61-91 years) and a median 13 months follow-up. At final follow-up, the median active elevation was 120° (range 80°-150°), external rotation was 40° (range 0°-50°), and internal rotation was 40° (range 0°-80°). Median VAS was 2 (range 0-8), SST was 71% (range 33%-92%), SSV was 78% (range 20-90%), and ASES was 73 (range 17-90). All patients exhibited radiographic union. There were five minor complications in three patients: postoperative neuropathy, tuberosity nonunion, scapula notching, and proximal humeral stress shielding.

Conclusion

Cementless long-stem RTSA is a viable alternative to primary fracture fixation in the elderly patient population with metadiaphyseal proximal humerus fractures.
‘It’s not just about me’: a qualitative study of couples’ narratives about home death when one of the partners is dying of cancer
Authors: Aurén-Møkleby Margareta , Thoresen Lisbeth , Mengshoel Anne Marit , Solbrække Kari N. , Aasbø Gunvor
Published: August 2023

Background:

Most cancer patients state a preference for home death. Care and support from primary caregivers are important to enable dying at home. A preference for home death from the perspective of couples has rarely been investigated.

Objectives:

To explore how a preference for home death is understood and enacted in couples where one of the partners is dying of cancer.

Design:

A qualitative interview research design with a narrative approach was used.

Methods:

Five couples participated in dyad interviews. During the analysis, two interviews that particularly illuminated couples’ shared and individual views were chosen as the primary cases.

Results:

The interviews show, in two highly different ways, how a preference for home death is a significant relational matter. The interviews are presented as two cases: ‘Struggles in an Unknown Terrain’ and ‘Reliance at the Kitchen Table’. They show how a preference for home death can be understood and enacted as a struggle or as reliance based on the couple’s shared biography and the partner’s ability to care for the partner during the end-of-life phase. The analysis highlighted the negotiations that underpin a preference for home death. In these negotiations, the couples drew on idealised understandings of home death. These ideas were supported by cultural values related to autonomy and independence as well as participation and citizenship. Thus, in the negotiations about being cared for and caring, legitimate dependency and the maintenance of a reciprocal relationship were balanced. The presence of healthcare professionals and medical devices in the home had to be balanced with the need to maintain a sense of self and an authentic home.

Conclusion:

A relational perspective on a preference for home death made us attentive to couples’ negotiations. These negotiations give couples the opportunity to re-evaluate and reconfirm individual and mutual needs in the end-of-life phase.
Arthroscopic Meniscus Ramp Repair: The Shoelace Technique
Authors: Gupta Sheetal , Kovvuru Kranthi Kiran , Vashistha Deepak
Published: August 2023

Background:

A “ramp lesion” is described as an injury involving the peripheral attachment of the posterior horn of the medial meniscus. Ramp lesions are associated with increased loads on anterior cruciate ligament and leads to rotatory instability of knee. During anterior cruciate ligament reconstruction, failure to identify and treat ramp lesion leads to increased forces on the reconstructed graft and residual instability which ultimately increases chances for graft failure. It is important to identify the ramp lesions by looking at the posterior compartment and repair ramp lesion. Ramp lesions are still a challenge to treat due to misdiagnosis and long learning curve of current techniques. In this technique, we are presenting margin convergence shoelace technique to repair a large ramp lesion.

Indications:

Isolated ramp lesions or ramp lesions associated with other ligamentous injuries.

Technique Description:

Through standard anteromedial and anterolateral portals, diagnostic arthroscopy is done. Using Gillquist maneuver, posteromedial compartment is visualized to look for ramp lesion. Probing is done with 18-gauge spinal needle from posteromedial aspect of knee to look for hidden lesions and extent of tear. We use 2 additional portals, low and high posteromedial portals for ramp repair. Visualizing from anterolateral portal entry is made in the posteromedial compartment; low posteromedial portal is created at the level of meniscus; 8-mm passport cannula is inserted and used as working portal; and then, high posteromedial portal is created and used as viewing portal. Visualizing through high posteromedial portal rasping of ramp lesion is done. Now with knee scorpion loaded with 2-0 fiber wire, bites are taken along posterior margin of meniscus and capsular portion of tear edges alternatively in shoelace manner from lateral to medial. Finally, compression and knot tying are done and secured with multiple half hitches.

Results:

Surgical repair of ramp lesions is associated with good healing, and it restores stability of knee. Follow-up of more than 2 years shows better functional outcome and reduced retear rates.

Discussion/Conclusion:

Currently, there are a lot of techniques described for ramp repair. We present arthroscopic ramp repair with dual posteromedial portals by shoelace technique, which is a safe, easy, and cost-effective method and gives excellent results and good healing especially in larger tears.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
OsAAI1 Increases Rice Yield and Drought Tolerance Dependent on ABA-Mediated Regulatory and ROS Scavenging Pathway
Authors: Long Qing , Qiu Shichun , Man Jianmin , Ren Denghong , Xu Ning , Luo Rui
Published: August 2023

In this study, we investigated the function of OsAAI1 in yield and drought tolerance by constructing overexpression line OE-OsAAI1 and mutant line osaai1. Bioinformatics analysis showed that the AAI gene-OsAAI1- belongs to the HPS_like subfamily of the AAI_LTSS superfamily, and OsAAI1 was localized in the nucleus. The expression of OsAAI1 was significantly induced by ABA and drought stress. OsAAI1 overexpression (OE19) significantly increased, and gene mutant (osaai1-1) repressed plant height, primary root length, lateral root number, grain size and yield in rice. Moreover, physiological and biochemical analyses showed that osaai1 was sensitive to drought stress, while OE19 enhanced the drought tolerance in rice. DAB and NBT staining revealed that under drought treatment, osaai1 accumulated a large amount of ROS compared with the wild type, while OE19 accumulated the least, and CAT, APX, GPX, GR activities were higher in OE19 and lower in osaai1, suggesting that OE19 improves rice tolerance to drought stress by enhancing ROS scavenging ability. OE19 also induce the expression of ABA-mediated regulatory pathway genes and enhance accumulation of ABA content in rice seedling. Predictably, OE19 displayed enhanced sensitivity to ABA, and ROS accumulation was significantly higher than in wild type and osaai1 under 3 µM ABA treatment. Thus, these results suggest that OsAAI1 is a positive regulator of rice yield and drought tolerance dependent on the ABA-mediated regulatory and ROS scavenging pathway.
Proton beam therapy for hepatocellular carcinoma with bile duct invasion
Authors: Iizumi Takashi , Okumura Toshiyuki , Hasegawa Naoyuki , Ishige Kazunori , Fukuda Kuniaki , Seo Emiko , Makishima Hirokazu , Niitsu Hikaru , Takahashi Mizuki , Sekino Yuta , Takahashi Hiroaki , Takizawa Daichi , Oshiro Yoshiko , Baba Keiichiro , Murakami Motohiro , Saito Takashi , Numajiri Haruko , Mizumoto Masashi , Nakai Kei , Sakurai Hideyuki
Published: August 2023

Aim

Hepatocellular carcinoma (HCC) with bile duct invasion (BDI) (BDIHCC) has a poor prognosis. Moreover, due to the paucity of reports, there is no consensus regarding optimal management of this clinical condition yet. The aim of this study was to clarify the efficacy and safety of proton beam therapy (PBT) for BDIHCC.

Methods

Between 2009 and 2018, 15 patients with BDIHCC underwent PBT at our institution. The overall survival (OS), local control (LC), and progression-free survival (PFS) curves were constructed using the Kaplan-Meier method. Toxicities were assessed using the Common Terminology Criteria of Adverse Events version 4.0.

Results

The median follow-up time was 23.4 months (range, 7.9–54.3). The median age was 71 years (range, 58–90 years). Many patients were Child A (n = 8, 53.3%) and most had solitary tumors (n = 11, 73.3%). Additionally, most patients had central type BDI (n = 11, 73%). The median tumor size was 4.0 cm (range, 1.5–8.0 cm). The 1-, 2-, and 3-year OS rates were 80.0%, 58.7% and 40.2%, respectively, and the corresponding LC and PFS rates were 93.3%, 93.3%, and 74.7% and 72.7%, 9.7%, and 0.0%, respectively. Acute grade 1/2 dermatitis (n = 7, 46.7%), and grades 2 (n = 1, 6.7%) and 3 (n = 1, 6.7%) cholangitis were observed. Late toxicities such as grade 3 gastric hemorrhage and pleural effusion were observed. No toxicities of grade 4 or higher were observed.

Conclusions

PBT was feasible with tolerable toxicities for the treatment of BDIHCC.
Rationale and study design of a randomized controlled trial to investigate the renoprotective effect of canagliflozin assessed by test of renal hemodynamics in diabetic kidney disease (the FAGOTTO study)
Authors: Kato Sawako , Kuwatsuka Yachiyo , Ando Masahiko , Tatematsu Yoshitaka , Nishibori Nobuhiro , Maruyama Shoichi
Published: August 2023

Background

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are considered to have the potential to maintain renal function by correcting glomerular hypertension in patients with diabetic kidney disease (DKD). The aim of this study is to demonstrate the renoprotective effect of SGLT2i by measuring renal hemodynamics, including glomerular filtration fraction (FF), in type 2 diabetic patients with moderate renal dysfunction.

Methods

Renoprotective effect of canagliflozin derived from test of renal hemodynamics in diabetic kidney disease (FAGOTTO) study is a 12-week multicenter, open-label, randomized (1:1), parallel-group trial of type 2 diabetic patients with diabetic kidney disease (30 ≤ estimated glomerular filtration rate [eGFR] ≤ 60 mL/min/1.73 m2). A total of 110 patients are to be randomly allocated to receive once-daily canagliflozin 100 mg or control (standard therapy). FF will be calculated by dividing the measured GFR (mGFR) by the effective renal plasma flow (eRPF). mGFR and eRPF will be measured by the clearance of inulin and para-aminohippuric acid (PAH), respectively. The primary endpoint of this trial is the percentage change in FF after 4 weeks of treatment in the canagliflozin and control groups.

Discussion

The FAGOTTO study will elucidate the mechanism of the renoprotective action of SGLT2i. The background, rationale, and study design of this trial are presented. To date, > 80 patients have been enrolled in this trial. The study will end in 2025.

Trial registration

jRCT (Japan Registry Of Clinical Trials) jRCTs041200069. Date of registration: November 27, 2020.
The time interval between laparoscopic tubal ligation and frozen-thawed embryo transfer does not affect the reproductive outcomes
Authors: Fan Lijuan , Li Xiaojuan , Shi Juanzi , Duan Haixia
Published: August 2023

Background

Hydrosalpinx may decrease implantation and pregnancy rates after embryo transfer. Laparoscopic tubal ligation after embryo freeze and before frozen-thawed embryo transfer (FET) is effective at improving reproductive outcomes for hydrosalpinx patients. This study is to find out the optimal interval between laparoscopic tubal ligation and FET.

Methods

We retrospectively analyzed 259 infertile women who performed laparoscopic tubal ligation for embryo freeze and FET. Participants were divided into three groups, based on the interval between laparoscopic tubal ligation and FET. Group I: <30 days; Group II: 31– 60 days; Group III: >60 days. Outcomes of cleavage-stage and blastocyst-stage embryo FET were analyzed respectively.

Results

There was no significant difference in clinical pregnancy rate, live birth rate, implantation rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate and preterm birth rate among the three groups, in both cleavage-stage and blastocyst-stage embryo FET cycles. In cleavage-stage embryo FET cycle, singleton gestational age was significantly younger in group III (38.11 ± 2.28 weeks) compared with group I (39.29 ± 1.06 weeks, P = 0.001) and group II (38.96 ± 1.05, P = 0.026). Singleton birth weight was significantly heavier in group II (3.65 ± 0.32 Kg) compared with group I (3.38 ± 0.29 Kg, P = 0.001) and group III (3.35 ± 0.60 Kg, P = 0.004). Twin birth weight was significantly heavier in group III (2.72 ± 0.43 Kg) compared to group I (2.23 ± 0.67 Kg, P = 0.002). In blastocyst-stage embryo FET cycles, twin gestational age was significantly younger in group II (34.07 ± 3.18 weeks) compared with group I (35.56 ± 2.27 weeks, P = 0.049) and group III (36.50 ± 1.47 weeks, P = 0.005). Twin birth weight was significantly heavier in group III (2.71 ± 0.39 Kg) compared to group II (2.39 ± 0.67 Kg, P = 0.009).

Conclusions

The duration of the interval between laparoscopic tubal ligation and FET does not affect the reproductive outcomes; however, it may affect the neonate outcomes to some extent.
Involved site radiation therapy in stage I-III nasopharyngeal carcinoma with limited lymph node burden (ISRT-NPC) or elective region irradiation: a study protocol for a multicenter non-inferiority randomized controlled phase III clinical trial
Authors: Liu Yang , Han Yaqian , Liu Feng , Hu Desheng , Chen Zhijian , Wang Peiguo , Li Jingao , Qin Jiyong , Jin Feng , Li Yexiong , Wang Jingbo , Yi Junlin
Published: August 2023

Background

Current radiotherapy guidelines and consensus statements uniformly recommend elective region irradiation (ERI) as the standard strategy for nasopharyngeal carcinoma (NPC). However, given the scarcity of skip-metastasis, the improved assessment accuracy of nodal involvement, and the striking advancements in chemotherapy for NPC, a one-fits-all delineation scheme for clinical target volumes of the nodal region (CTVn) may not be appropriate anymore, and modifications of the CTVn delineation strategy may be warranted. Involved site irradiation (ISI) covering merely the initially involved nodal site and potential extranodal extension has been confirmed to be as effective as ERI with decreased radiation-related toxicities in some malignancies, but has not yet been investigated in NPC. This study aims to compare the regional control, survival outcomes, radiation-related toxicities, and quality of life (QoL) of ISI with conventional ERI in NPC patients with a limited nodal burden.

Methods

ISRT-NPC is a prospective, multicenter, open-label, noninferiority, phase III randomized controlled trial. A total of 414 patients will be randomly assigned in a 1:1 ratio to receive ISI or ERI. Randomization will be stratified by institution scale and N stage. Generally, in the ISI group, the high-risk CTV1 (dose: 60 Gy) includes a 1-cm expansion of the positive LN as well as the VIIa and the retrostyloid space above the bilateral transverse process of the atlantoaxial spine (C1), regardless of N status. The low-risk CTV2 (dose: 50 Gy) covers the cervical nodal region with a 3-cm caudal expansion below the transverse process of C1 for N0 disease and a 3-cm expansion below the positive LN for positive LNs.

Discussion

The results of this trial are expected to confirm that ISI is a non-inferior strategy to ERI in stage I-III patients with low LN burden, enabling the minimization of treatment-related toxicity and improvement of long-term QoL without compromising regional control.

Trial registration

ClinicalTrails.gov, NCT05145660. Registered December 6, 2021.
Urachal xanthogranuloma: a rare but important case presenting as a urachal mass
Authors: Jain Kunal , Jain Esha , DiLena Richard , Saleeb Rola , Jain Umesh
Published: August 2023

Background

A urachal mass is a relatively rare presentation to the urologists’ practice, often requiring radical surgical excision for a definitive diagnosis. Xanthogranulomatous inflammation of the urachus is an extremely rare entity with few cases reported worldwide, and to the best of our knowledge, no cases reported in the western world.

Case presentation

In this case, a 55-year-old male patient presented with bothersome lower urinary tract symptoms and computed tomography findings demonstrating a urachal mass that was worrisome for urachal carcinoma. Following surgical intervention, histopathology revealed urachal xanthogranuloma. Post-operatively, the patient recovered well, and eventually, he had symptomatic and radiologic improvement.

Conclusion

This case brings awareness to a rare presentation of a urachal mass—urachal xanthogranuloma. While operative intervention was both diagnostic and therapeutic, we highlight the challenge in differentiating between benign and malignant processes for urachal masses. Herein, we show the importance of including urachal xanthogranuloma in the differential diagnosis of a urachal mass to prevent further morbidity associated with the treatment of this disease.
Standard ophthalmology residency training in China: an evaluation of resident satisfaction on training program in Guangdong Province
Authors: Yang Xiaonan , Zheng Danying , Wan Pengxia , Luo Xiaoling , Zhang Mingzhi , Zhang Liang , Zhang Shaochong , Huang Jingjing , Zhuo Yehong
Published: August 2023

Background

National standardized training for resident doctors (STRD) in mainland China has been formally established since 2014 as a kind of postgraduate education. The purpose of this survey was to assess the satisfaction of the training residents in Guangdong Province on the ophthalmology STRD program after a duration of 5 years.

Method

A 48-item survey was sent to all postgraduate ophthalmology residents from bases in Guangdong Province to inquire about their attitude towards the program. The survey contained questions about demographic and work-related information, job satisfaction, psychological resilience, and job performance. All responses were verified, and invalid questionnaires were excluded. Statistical analyses were performed using SPSS software version 22.0 (SPSS, Inc., Chicago, IL). Multiple logistic regression analysis was used to evaluate the factors (demographic information, working environment, clinical exposure, supervision and hands-on training opportunities, and involvement in academic activities) impacting the overall satisfaction. P < 0.05 was considered statistically significant.

Results

A total of 471/635 (74.17%) valid questionnaires were returned from all the STRD bases of Guangdong Province, which included 38 hospitals. 60.3% of the respondents reported overall satisfaction with their training. The satisfaction with operative teaching (60.7%) was slightly lower than the other settings of teaching experience (above 65%). Meanwhile, the satisfaction on different secessions of operative experience was all below 70%, of which in the areas of cornea and orbit were 55.42% and 57.53%, respectively. Some potential factors were found to affect general satisfaction, including the training grade, marriage, working time, income level, the doctor-patient relationship, family members working as doctors, the time proportion spent on writing medical documents during clinical work, and the frequency of attending academic meetings. Improvement was observed in both performing and reporting clinical examinations in the last year of training in comparison to the first year. Finally, 82.8% of the residents acknowledged this training was helpful for future clinical work. The first five career preferences for residents were cataract (67.1%), refractive surgery (42.3%), vitreo-retina (36.5%), optometry (28.7%), and oculoplastic (27.2%).

Conclusion

Ophthalmology residents in Guangdong Province expressed comparable satisfaction with the STRD program. To further improve satisfaction, factors such as resident subsidy, harmonious marriage, the patient-doctor relationship, and chances of attending academic conferences should be emphasized.
Measuring informal workplace learning outcomes in residency training: a validation study
Authors: Heim Markus , Schulz Christian M. , Schneider Frederick , Berberat Pascal O. , Gartmeier Martin , Schick Kristina
Published: August 2023

Background

Informal workplace learning (WPL) has no concrete learning objective and takes place without a responsible supervisor, which makes it difficult to assess its learning outcomes. Formal learning situations, as they are known from universities or schools, do not exist in this context and make a conventional assessment of learning goals and achievements impossible. Informal learning in the workplace is of central importance, and the assessment of informal learning outcomes in medical education is an under-researched area. The aim of our study was to adapt and validate an informal WPL questionnaire (originally developed for social workers) to assess learning outcomes due to informal WPL in residency training.

Methods

A total of 528 residents (n = 339 female; age: M = 29.79; SD = 3.37 years) completed an adapted questionnaire on informal WPL outcomes and the Freiburg Questionnaire to Assess Competencies in Medicine (i.e. medical knowledge, communication, and scholarship). Exploratory factor analysis was used to determine the underlying factor structure. The reliability of the factors was tested using McDonald’s omega, and the correlation between the factors and the three subscales of the Freiburg questionnaire was tested using Spearman’s rho correlation coefficient. To investigate construct validity, a structural equation model was calculated to examine the relationships between medical competencies and informal learning outcomes.

Results

The exploratory factor analysis yielded a four-factor solution that best fit the data. The scores of all four factors (GLO-CD: generic learning outcomes—competence development, GLO-R: generic learning outcomes—reflection, JSLO: job-specific learning outcomes, and OLLO: organisational learning outcomes) showed good internal consistency (Ω ≥ .69). The structural equation model showed that "medical expertise" had an impact on all four factors of informal learning at work. “Scholarship” seemed to predict GLO-CD and GLO-R.

Conclusions

Our four-factor model reveals meaningful determinants of informal WPL in relation to residency training. The instrument is therefore the first promising attempt to assess informal WPL in the broader context of medical education during residency, thus supporting its construct validity.
Integration of single-cell sequencing and bulk expression data reveals chemokine signaling pathway in proliferating cells is associated with the survival outcome of osteosarcoma
Authors: Yu Lin , Hongyu Sun , Yuxi Chen
Published: August 2023

Background

Osteosarcoma, as the most common primary bone malignancy, is urgent to be well-studied on the biomarkers and therapeutic targets to improve the five-year survival rate. Transcriptomic analysis using single-cell RNA or bulk RNA sequencing has been developed to detect biomarkers in various cancer types.

Methods and results

We applied Scissor to combine single-cell RNA-seq data and bulk transcriptome data of osteosarcoma, providing cell-level information and sample phenotypes to identify the survival-associated cell subpopulations. By investigating the differences between the survival-associated cell subpopulations, we identified CCL21, CCL22, CCL24, CXCL11, CXCL12, CXCL13, GNAI2, and RAC2 in the proliferating cells that are significantly associated with osteosarcoma patient outcome. Then we assigned the risk score for each sample based on the cell proportion-normalized gene expression and validated it in the public dataset.

Conclusions

This study provides the clinical insight that chemokine signaling pathway genes (CCL21, CCL22, CCL24, CXCL11, CXCL12, CXCL13, GNAI2, and RAC2) in proliferating cells might be the potential biomarkers for treatment of osteosarcoma.
Production, bioprocessing and antiproliferative activity of camptothecin from Aspergillus terreus, endophyte of Cinnamomum camphora: restoring their biosynthesis by indigenous microbiome of C. camphora
Authors: Eldeghidy Abeer , Abdel-Fattah Gamal , El-Sayed Ashraf S. A. , Abdel-Fattah Ghada G.
Published: August 2023

Fungal producing potency of camptothecin (CPT) raise the hope for their usage to be a platform for industrial production of CPT, nevertheless, attenuation of their productivity of CPT with the subculturing and preservation is the challenge. So, screening for novel endophytic fungal isolates with a reliable CPT-biosynthetic stability was the objective. Among the isolated endophytic fungi from the tested medicinal plants, Aspergillus terreus OQ642314.1, endophyte of Cinnamomum camphora, exhibits the highest yield of CPT (89.4 μg/l). From the NMR, FT-IR and LC–MS/MS analyses, the extracted CPT from A. terreus gave the same structure and molecular mass fragmentation pattern of authentic CPT (349 m/z). The putative CPT had a significant activity against MCF7 (0.27 µM) and HEPG-2 (0.8 µM), with a strong affinity to inhibits the human Topoisomerase 1 activity (IC50 0.362 μg/ml) as revealed from the Gel-based DNA relaxation assay. The purified CPT displayed a strong antimicrobial activity for various bacterial (E. coli and B. cereus) and fungal (A. flavus and A. parasiticus) isolates, ensuring the unique tertiary, and stereo-structure of A. terreus for penetrating the microbial cell walls and targeting the topoisomerase I. The higher dual activity of the purified CPT as antimicrobial and antitumor, emphasize their therapeutic efficiency, especially with growth of the opportunistic microorganisms due to the suppression of human immune system with the CPT uses in vivo. The putative CPT had an obvious activity against the tumor cell (MCF7) metastasis, and migration as revealed from the wound healing assay. The overall yield of A. terreus CPT was maximized with the Blackett-Burman design by twofolds increment (164.8 μg/l). The CPT yield by A. terreus was successively diminished with the multiple fungal subculturing, otherwise, the CPT productivity of A. terreus was restored, and increased over the zero culture upon coculturing with C. camphora microbiome (1.5% w/v), ensuring the restoring of CPT biosynthetic potency of A. terreus by the plant microbiome-derived chemical signals “microbial communication”. This is the first report exploring the feasibility of A. terreus “endophyte of C. camphora” to be a preliminary platform for commercial production of CPT with a reliable sustainability upon uses of indigenous C. camphora microbiome.
Semaphorin 3 C enhances putative cancer stemness and accelerates peritoneal dissemination in pancreatic cancer
Authors: Tomizawa Satoshi , Takano Shigetsugu , Eto Ryotaro , Takayashiki Tsukasa , Kuboki Satoshi , Ohtsuka Masayuki
Published: August 2023

Purpose

Semaphorins, axon guidance cues in neuronal network formation, have been implicated in cancer progression. We previously identified semaphorin 3 C (SEMA3C) as a secreted protein overexpressed in pancreatic ductal adenocarcinoma (PDAC). We, therefore, hypothesized that SEMA3C supports PDAC progression. In this study, we aimed to investigate the clinical features of SEMA3C, especially its association with chemo-resistance and peritoneal dissemination.

Methods

In resected PDAC tissues, we assessed the relationship between SEMA3C expression and clinicopathological features by immunohistochemistry. In vitro studies, we have shown invasion assay, pancreatosphere formation assay, colony formation assay, cytotoxicity assay, and activation of SEMA3C downstream targets (c-Met, Akt, mTOR). In vivo, we performed a preclinical trial to confirm the efficacy of SEMA3C shRNA knockdown and Gemcitabine and nab-Paclitaxel (GnP) in an orthotopic transplantation mouse model and in peritoneal dissemination mouse model.

Results

In resected PDAC tissues, SEMA3C expression correlated with invasion and peritoneal dissemination after surgery. SEMA3C promoted cell invasion, self-renewal, and colony formation in vitro. We further demonstrated that SEMA3C knockdown increased Gem-induced cytotoxicity by suppressing the activation of the Akt/mTOR pathway via the c-Met receptor. Combination therapy with SEMA3C knockdown and GnP reduced tumor growth and peritoneal dissemination.

Conclusions

SEMA3C enhances peritoneal dissemination by regulating putative cancer stemness and Gem resistance and activates phosphorylation of the Akt/mTOR pathway via c-Met. Our findings provide a new avenue for therapeutic strategies in regulating peritoneal dissemination during PDAC progression.
Selenium nanoparticles based on Amphipterygium glaucum extract with antibacterial, antioxidant, and plant biostimulant properties
Authors: Garza-García Jorge J. O. , Hernández-Díaz José A. , León-Morales Janet M. , Velázquez-Juárez Gilberto , Zamudio-Ojeda Adalberto , Arratia-Quijada Jenny , Reyes-Maldonado Oscar K. , López-Velázquez Julio C. , García-Morales Soledad
Published: August 2023

Background

In recent years, crop production has expanded due to the variety of commercially available species. This increase in production has led to global competition and the search for biostimulant products that improve crop quality and yield. At the same time, agricultural products that protect against diseases caused by phytopathogenic microorganisms are needed. Thus, the green synthesis of selenium nanoparticles (SeNPs) is a proposal for achieving these needs. In this research, SeNPs were synthesized from methanolic extract of Amphipterygium glaucum leaves, and chemically and biologically characterized.

Results

The characterization of SeNPs was conducted by ultraviolet–visible spectrophotometry (UV–Vis), scanning electron microscopy (SEM), electron microscopy transmission (TEM), Dynamic Light Scattering (DLS), energy dispersion X-ray spectroscopy (EDX), and infrared spectrophotometry (FTIR) techniques. SeNPs with an average size of 40–60 nm and spherical and needle-shaped morphologies were obtained. The antibacterial activity of SeNPs against Serratia marcescens, Enterobacter cloacae, and Alcaligenes faecalis was evaluated. The results indicate that the methanolic extracts of A. glaucum and SeNPs presented a high antioxidant activity. The biostimulant effect of SeNPs (10, 20, 50, and 100 µM) was evaluated in vinca (Catharanthus roseus), and calendula (Calendula officinalis) plants under greenhouse conditions, and they improved growth parameters such as the height, the fresh and dry weight of roots, stems, and leaves; and the number of flowers of vinca and calendula.

Conclusions

The antibacterial, antioxidant, and biostimulant properties of SeNPs synthesized from A. glaucum extract demonstrated in this study support their use as a promising tool in crop production.

Graphical Abstract
Decreased MFN2 activates the cGAS-STING pathway in diabetic myocardial ischaemia–reperfusion by triggering the release of mitochondrial DNA
Authors: Xiong Yonghong , Leng Yan , Tian Hao , Deng Xinqi , Li Wenyuan , Li Wei , Xia Zhongyuan
Published: August 2023

Background

The cause of aggravation of diabetic myocardial damage is yet to be elucidated; damage to mitochondrial function has been a longstanding focus of research. During diabetic myocardial ischaemia–reperfusion (MI/R), it remains unclear whether reduced mitochondrial fusion exacerbates myocardial injury by generating free damaged mitochondrial DNA (mitoDNA) and activating the cGAS-STING pathway.

Methods

In this study, a mouse model of diabetes was established (by feeding mice a high-fat diet (HFD) plus a low dose of streptozotocin (STZ)), a MI/R model was established by cardiac ischaemia for 2 h and reperfusion for 30 min, and a cellular model of glycolipid toxicity induced by high glucose (HG) and palmitic acid (PA) was established in H9C2 cells.

Results

We observed that altered mitochondrial dynamics during diabetic MI/R led to increased mitoDNA in the cytosol, activation of the cGAS-STING pathway, and phosphorylation of the downstream targets TBK1 and IRF3. In the cellular model we found that cytosolic mitoDNA was the result of reduced mitochondrial fusion induced by HG and PA, which also resulted in cGAS-STING signalling and activation of downstream targets. Moreover, inhibition of STING by H-151 significantly ameliorated myocardial injury induced by MFN2 knockdown in both the cell and mouse models. The use of a fat-soluble antioxidant CoQ10 improved cardiac function in the mouse models.

Conclusions

Our study elucidated the critical role of cGAS-STING activation, triggered by increased cytosolic mitoDNA due to decreased mitochondrial fusion, in the pathogenesis of diabetic MI/R injury. This provides preclinical insights for the treatment of diabetic MI/R injury.

Graphical Abstract
The pattern and spread of invasion can predict late cervical lymph node metastasis in early tongue squamous cell carcinoma
Authors: Kato Koroku , Miyazawa Hiroki , Kobayashi Hisano , Kishikawa Yoshiaki , Funaki Hayato , Noguchi Natsuyo , Ooi Kazuhiro , Kawashiri Shuichi
Published: August 2023

To determine the predictive indexes of late cervical lymph node metastasis in early tongue squamous cell carcinoma (TSCC). We retrospectively analyzed the cases of 25 patients with stage I/II TSCC who had undergone surgical treatment without elective neck dissection. We evaluated the relationships between clinicopathologic factors and the occurrence of late cervical lymph node metastasis. Of the 25 cases, metastasis to the cervical lymph nodes was observed in nine cases (36.0%). The clinicopathological factors associated with late cervical lymph node metastasis were the mode of invasion (MOI, p = 0.032), depth of invasion (DOI, p = 0.004), and perineural invasion (PNI, p = 0.040). A multivariate analysis revealed that only the DOI was an independent predictor of late cervical lymph node metastasis. The combination of the DOI and MOI or the PNI and MOI was significantly correlated with late cervical lymph node metastasis (p = 0.004 and p = 0.012, respectively). Our findings suggest that combinations of the MOI, DOI, and PNI could be used as an index for predicting late cervical lymph node metastasis in early TSCC.
Development of cassava common mosaic virus-based vector for protein expression and gene editing in cassava
Authors: Tuo Decai , Yao Yuan , Yan Pu , Chen Xin , Qu Feihong , Xue Weiqian , Liu Jinping , Kong Hua , Guo Jianchun , Cui Hongguang , Dai Zhaoji , Shen Wentao
Published: August 2023

Background

Plant virus vectors designed for virus-mediated protein overexpression (VOX), virus-induced gene silencing (VIGS), and genome editing (VIGE) provide rapid and cost-effective tools for functional genomics studies, biotechnology applications and genome modification in plants. We previously reported that a cassava common mosaic virus (CsCMV, genus Potexvirus)-based VIGS vector was used for rapid gene function analysis in cassava. However, there are no VOX and VIGE vectors available in cassava.

Results

In this study, we developed an efficient VOX vector (CsCMV2-NC) for cassava by modifying the CsCMV-based VIGS vector. Specifically, the length of the duplicated putative subgenomic promoter (SGP1) of the CsCMV CP gene was increased to improve heterologous protein expression in cassava plants. The modified CsCMV2-NC-based VOX vector was engineered to express genes encoding green fluorescent protein (GFP), bacterial phytoene synthase (crtB), and Xanthomonas axonopodis pv. manihotis (Xam) type III effector XopAO1 for viral infection tracking, carotenoid biofortification and Xam virulence effector identification in cassava. In addition, we used CsCMV2-NC to deliver single guide RNAs (gMePDS1/2) targeting two loci of the cassava phytoene desaturase gene (MePDS) in Cas9-overexpressing transgenic cassava lines. The CsCMV-gMePDS1/2 efficiently induced deletion mutations of the targeted MePDS with the albino phenotypes in systemically infected cassava leaves.

Conclusions

Our results provide a useful tool for rapid and efficient heterologous protein expression and guide RNA delivery in cassava. This expands the potential applications of CsCMV-based vector in gene function studies, biotechnology research, and precision breeding for cassava.