bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of myokines susceptible to improve glucose homeostasis after bariatric surgery
Authors: Orioli Laura , Canouil Mickaël , Sawadogo Kiswendsida , Ning Lijiao , Deldicque Louise , Lause Pascale , de Barsy Marie , Froguel Philippe , Loumaye Audrey , Deswysen Yannick , Navez Benoit , Bonnefond Amélie , Thissen Jean-Paul
Published: August 2023

Importance and Objective

The identification of myokines susceptible to improve glucose homeostasis following bariatric surgery could lead to new therapeutic approaches for type 2 diabetes.

Methods

Changes in the homeostasis model assessment (HOMA) test were assessed in patients before and 3 months after bariatric surgery. Changes in myokines expression and circulating levels were assessed using real-time quantitative polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). Myokines known to regulate glucose homeostasis were identified using literature (targeted study) and putative myokines using RNA-sequencing (untargeted study). A linear regression analysis adjusted for age and sex was used to search for associations between changes in the HOMA test and changes in myokines.

Results

In the targeted study, brain-derived neurotrophic factor (BDNF) expression was upregulated (+30%, P = .006) while BDNF circulating levels were decreased (−12%, P = .001). Upregulated BDNF expression was associated with decreased HOMA of insulin resistance (HOMA-IR) (adjusted estimate [95% confidence interval {CI}]: −0.51 [−0.88 to −0.13], P = .010). Decreased BDNF serum levels were associated with decreased HOMA of beta-cell function (HOMA-B) (adjusted estimate [95% CI] = 0.002 [0.00002-0.0031], P = .046). In the untargeted study, upregulated putative myokines included XYLT1 (+64%, P < .001), LGR5 (+57, P  < .001), and SPINK5 (+46%, P < .001). Upregulated LGR5 was associated with decreased HOMA-IR (adjusted estimate [95% CI] = −0.50 [−0.86 to −0.13], P = .009). Upregulated XYLT1 and SPINK5 were associated with increased HOMA of insulin sensitivity (HOMA-S) (respectively, adjusted estimate [95% CI] = 109.1 [28.5-189.8], P = .009 and 16.5 [0.87-32.19], P = .039).

Conclusions

Improved glucose homeostasis following bariatric surgery is associated with changes in myokines expression and circulating levels. In particular, upregulation of BDNF, XYLT1, SPINK5, and LGR5 is associated with improved insulin sensitivity. These results suggest that these myokines could contribute to improved glucose homeostasis following bariatric surgery.

Study registration

NCT03341793 on ClinicalTrials.gov (https://clinicaltrials.gov/).
Communication Breakdown: Sports Federations and Media Politics in the Weimar Republic
Authors: Young Christopher
Published: August 2023

Organized sport in the Weimar Republic was dominated by three strands—so-called bourgeois sport, the gymnastics movement (Turnen) and the workers’ sports movement (Arbeitersport). While scholarship has rightly pointed out the differences between their federations, it has neglected a significant feature they had in common: the struggle to communicate key messages to their members. For the first time, this article examines debates about and developments in the communications of Weimar’s leading sports organizations. It shows that through the 1920s producing journals, running news services and lobbying the press became as important as competing in or watching sport itself, as the organizations sought to raise their profile, gain new members and retain the members they already had. Each of them, while envying the others, failed to meet its goals for similar reasons: inadequate internal structures, poor decision-making and the allure of commercialized sport and the papers and magazines it fed and produced. While scholarship has often noted the high level of sports coverage in the mainstream press, it has not explored the dynamic pull of such reporting on readers. By examining the effects of the professional media on the active members of the three main federations, this article therefore also sheds light on the power of new forms of writing and entertainment to influence individuals as the shift to consumer habits increased in all social classes throughout the Weimar Republic. In doing so, it bridges between empirically orientated forms of sports history and cultural histories of the press.
Autumn in New York: The Case of Long-Term Care Facilities in the “Safe Staffing” Lawsuit With Less Staffing But Similar COVID-19 Outcomes
Authors: Semprini Jason , Kaskie Brian
Published: August 2023

Background and Objectives

In 2022, 239 New York state long-term care facilities (LTCFs) challenged a “Safe Staffing” law in court. Our study compares LTCFs involved and not involved in the lawsuit, testing for differences in staffing measures and resident outcomes during the first year of the coronavirus disease 2019 (COVID-19) pandemic.

Research Design and Methods

New York LTCF-level data were obtained from the Centers for Medicare and Medicaid Services 2019 organization and 2020 COVID-19 data files. These data were then linked to data from the Long-Term Care Community Coalition, which identified the LTCFs involved in the “Safe Staffing” lawsuit. We first tested for differences in reported 2019 staffing levels by lawsuit involvement. Second, we specified “Doubly Robust” regression models to test if lawsuit involvement was associated with differences in resident COVID-19 infections, COVID-19 deaths, and overall mortality.

Results

LTCFs involved in the lawsuit reported lower staff ratings and fewer staffing hours compared to LTCFs not involved in the lawsuit. Despite finding higher rates of admissions with COVID-19 in LTCFs involved in the lawsuit, we did not find that COVID-19 infections, COVID-19 deaths, or overall mortality differed by lawsuit involvement.

Discussion and Implications

LTCFs involved in the lawsuit were deemed by policymakers as reducing staff, earning excess profits, and placing residents at risk. While these LTCFs reported lower staffing levels, we observed no differences in resident outcomes during the first year of the COVID-19 pandemic. Researchers and policymakers should develop more nuanced perspectives concerning the relationship among LTCF staffing, outcomes, and organizational profitability.
College students’ preferences for tobacco treatment: a discrete choice experiment
Authors: Choi S H , Templin T
Published: August 2023

The purpose of this study was to elicit preferences for the ‘format’ and ‘content’ of tobacco treatment among college student smokers, using an online discrete choice experiment (DCE) survey. A DCE survey, supplemented with a think-aloud method, was conducted among 54 college students who smoked combustible cigarettes and/or e-cigarettes. Conditional logistic regression models were constructed to determine optimal profiles of treatment. Cutting down nicotine rather than quitting ‘cold turkey’ (P < 0.001) and two-way communication (P < 0.001) were viewed as the most critical attributes for the intervention ‘format’; changing behaviors rather than social groups/peers (P < 0.001) and autonomy (P < 0.001) were viewed as the most critical attributes for the intervention ‘content’. Some preferences varied based on smoking subgroups. Combustible cigarette users preferred interventions with a longer time commitment (P < 0.05) and without nicotine replacement therapies (NRTs) (P < 0.001). Think-aloud data supported the DCE findings and further revealed a strong desire for cutting down nicotine and keeping social groups/peers and misconceptions regarding NRTs. Our study findings can guide tobacco treatment tailored to college students. These treatments should be tailored to specific smoker subgroups.
Physical Medicine Applications in Hand Burns: Treatment or Rehabilitation
Authors: Ergani Hasan Murat , Yalçın Topçuoğlu Elif , Yaşar Burak , Akgün Ali Emre , Acicbe Okan , Akın Merve , Erkin Ünlü Ramazan , Yastı Ahmet Çınar
Published: August 2023

The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 of 1578 burn patients who attended the clinic were included in this study. The patients’ age, sex, total BSA with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, the joint restrictions, contractures, and compliance with physical therapy were assessed and recorded. Among the 67 patients included, 82.1% (n = 55) had no limitation in terms of their joint range of motion, whereas 17.9% (n = 12) had a limitation of movement in their finger joints. When the prevalence of movement limitation was examined by gender, such limitation was found to be more common in females (P = .041). Moreover, contractures were found to occur more frequently in patients with full-thickness burns (P = .032). It was also found that the limitation of movement was more severe in patients with skin grafts (P = .044). In addition, it was observed that the recovery time of the burn area was longer in those patients who had movement limitations (P = .004). In this study, we found that applying early physical therapy to patients after burn injuries facilitated the recovery of hand functions.
External Application of Human Umbilical Cord-Derived Mesenchymal Stem Cells in Hyaluronic Acid Gel Repairs Foot Wounds of Types I and II Diabetic Rats Through Paracrine Action Mode
Authors: Chen Jingan , Liu Yi , Zhang Jingwen , Yang Yuping , Liang Haowei , Li Ting , Yan Li , Zhou Li , Shan Letian , Wang Hui
Published: August 2023

Diabetic foot ulcer (DFU) is a main diabetic complication with unmet treatment needs. This study applied human umbilical cord-derived mesenchymal stem cells-hyaluronic acid (hucMSCs-HA) gel to treat DFU in a noninvasive external way and investigated its paracrine action and mechanism. In this study, after analyzing the physical and biological properties of HA gel, hucMSCs-HA gel was applied in 2 in vivo models (types I and II DFU), and a molecular mechanism was investigated. To evaluate the paracrine action of hucMSCs, hucMSCs-conditional medium (MSC-CM) was collected to treat 1 in vivo model (type I DFU) and 2 in vitro models (high glucose (HG)-injured human umbilical vein endothelial cells (HUVECs) and human skin fibroblasts (HSFs)). The results indicated that HA gel with a porous microstructure underwent over 90% degradation and swelled to the maximum value within 48 h. In vivo, hucMSCs-HA gel accelerated wound healing of DFU rats by improving re-epithelialization, collagen deposition, and angiogenesis, in which a paracrine action of hucMSCs was confirmed and the phosphorylation of p38, ERK1/2, JNK, and Akt was increased. In vitro, MSC-CM improved cell viability, wound healing, migration, tube formation, cell senescence, and abnormal expressions (TNF-α, IL-1β, IL-6, ET-1, p16 genes, and PCNA protein) of HUVECs, also improved cell viability, wound healing, antioxidant stress, and abnormal expressions (COL1, COL3, COL4, SOD1, SOD2 genes, and PCNA protein) of HSFs. Summarily, noninvasive external application of hucMSCs-HA gel shows great perspective against DFU and exerts wound healing effects through the MAPK and Akt pathways-mediated paracrine mechanism.
Drought Shifts Sorghum Root Metabolite and Microbiome Profiles and Enriches for Pipecolic Acid
Authors: Caddell Daniel F. , Pettinga Dean , Louie Katherine , Bowen Benjamin P. , Sievert Julie A. , Hollingsworth Joy , Rubanowitz Rebeckah , Dahlberg Jeffery , Purdom Elizabeth , Northen Trent , Coleman-Derr Devin
Published: August 2023

Plant-associated microbial communities shift in composition as a result of environmental perturbations, such as drought. It has been shown that Actinobacteria are enriched in plant roots and rhizospheres during drought stress. However, the correlations between microbiome dynamics and plant response to drought are poorly understood. Here we apply a combination of bacterial community composition analysis and plant metabolite profiling in Sorghum bicolor roots, rhizospheres, and soil during drought and drought recovery to investigate potential contributions of host metabolism to shifts in bacterial composition. Our results provide a detailed view of metabolic shifts across the plant root during drought and show that the response to rewatering differs between root and soil; additionally, we identify drought-responsive metabolites that are highly correlated with the observed changes in Actinobacteria abundance. Furthermore, we find that pipecolic acid is a drought-enriched metabolite in sorghum roots, and that exogenous application of pipecolic acid inhibits root growth. Finally, we show that this activity functions independent of the systemic acquired resistance pathway and has the potential to impact Actinobacterial taxa within the root microbiome.
Yes‐associated protein regulates cortical actin architecture and dynamics through intracellular translocation of Rho GTPase‐activating protein 18
Authors: Zhang Yanshu , Kitagawa Takao , Furutani‐Seiki Makoto , Yoshimura Shige H.
Published: August 2023

Yes‐associated protein (YAP) is a transcriptional co‐activator that controls the transcription of target genes and modulates the structures of various cytoskeletal architecture as mechanical responses. Although it has been known that YAP regulates actin‐regulatory proteins, the detailed molecular mechanism of how they control and coordinate intracellular actin architecture remains elusive. Herein, we aimed to examine the structure and dynamics of intracellular actin architecture from molecular to cellular scales in normal and YAP‐knockout (YAP‐KO) cells utilizing high‐speed atomic force microscopy (HS‐AFM) for live‐cell imaging and other microscope‐based mechanical manipulation and measurement techniques. YAP‐KO Madin–Darby canine kidney cells had a higher density and turnover of actin filaments in the cell cortex and a higher elastic modulus. Laser aberration assay demonstrated that YAP‐KO cells were more resistant to damage than normal cells. We also found that Rho GTPase‐activating protein 18 (ARHGAP18), a downstream factor of YAP, translocated from the cortex to the edge of sparsely cultured YAP‐KO cells. It resulted in high RhoA activity and promotion of actin polymerization in the cell cortex and their reductions at the edge. HS‐AFM imaging of live cell edge and a cell‐migration assay demonstrated lower membrane dynamics and motility of YAP‐KO cells than those of normal cells, suggesting lower actin dynamics at the edge. Together, these results demonstrate that a YAP‐dependent pathway changes the intracellular distribution of RhoGAP and modulates actin dynamics in different parts of the cell, providing a mechanistic insight into how a mechano‐sensitive transcription cofactor regulates multiple intracellular actin architecture and coordinates mechano‐responses.
The Long-Term Use of Diagnostic Subdural Electroencephalogram Electrodes and Subdural Hematoma: A Prospective Cohort Study*
Authors: Won Sae-Yeon , Freiman Thomas M. , Lee-Müller Sara Sujin , Dubinski Daniel , Willems Laurent M. , Reif Philipp S. , Hattingen Elke , Ullmann Joana , Herrmann Eva , Melzer Nico , Seifert Volker , Gessler Florian , Rosenow Felix , Konczalla Juergen , Strzelczyk Adam
Published: August 2023

OBJECTIVES:

Seizures and status epilepticus (SE) are frequent complications of acute subdural hematoma (aSDH) associated with increased morbidity and mortality. Therefore, we aimed to evaluate whether invasive subdural electroencephalogram recording leads to earlier seizure detection and treatment initiation in patients with aSDH.

DESIGN:

Prospective, single-center, cohort trial.

SETTING:

Neurologic and neurosurgical ICUs of one academic hospital in Germany.

PATIENTS:

Patients with aSDH undergoing surgical treatment. In total, 76 patients were enrolled in this study, 31 patients (40.8%) were assigned to the invasive electroencephalogram (iEEG) monitoring group and 45 patients (59.2%) to control group.

INTERVENTIONS:

The electrode group was implanted with a subdural strip electrode providing up to 7 days of real-time electroencephalogram recording in the neurointensive care unit, whereas the control group received regular normal surface electroencephalograms during the 7-day period. The primary outcomes were the prevalence and time to seizures and SE occurrence. Secondary outcomes included neurologic outcomes assessed using the Glasgow Outcome Scale (GOS) at discharge and 6-month follow-up and the prevalence of focal structural epilepsy within 2 years after discharge.

MEASUREMENTS AND MAIN RESULTS:

The trial was stopped after a study committee meeting when the prespecified criteria were met. The iEEG and control groups were well-matched for clinical characteristics at admission. Frequencies of seizures and SE detection were significantly higher in the iEEG group than in the control group (61% vs 15.6%; p < 0.001 and 38.7% vs 11.1%; p = 0.005). Time to seizure and SE detection was significantly earlier (median 29.2 vs 83.8 hr; p = 0.018 and 17.2 vs 83.8 hr; p = 0.033) in the iEEG group than in the control group. Favorable outcomes (GOS 4–5) were more frequently achieved in the iEEG group than in the control group (58% vs 31%; p = 0.065). No significant differences were detected in long-term mortality or post-traumatic epilepsy.

CONCLUSIONS:

Invasive subdural electroencephalogram monitoring is valuable and safe for early seizure/SE detection and treatment and might improve outcomes in the neurocritical care of patients with aSDH.
Recent updates on the role of the gut-liver axis in the pathogenesis of NAFLD/NASH, HCC, and beyond
Authors: Ohtani Naoko , Kamiya Tomonori , Kawada Norifumi
Published: August 2023

The gut and the liver are anatomically and physiologically connected, and this connection is called the “gut-liver axis,” which exerts various influences on liver physiology and pathology. The gut microbiota has been recognized to trigger innate immunity and modulate the liver immune microenvironment. Gut microbiota influences the physiological processes in the host, such as metabolism, by acting on various signaling receptors and transcription factors through their metabolites and related molecules. The gut microbiota has also been increasingly recognized to modulate the efficacy of immune checkpoint inhibitors. In this review, we discuss recent updates on gut microbiota-associated mechanisms in the pathogenesis of chronic liver diseases such as NAFLD and NASH, as well as liver cancer, in light of the gut-liver axis. We particularly focus on gut microbial metabolites and components that are associated with these liver diseases. We also discuss the role of gut microbiota in modulating the response to immunotherapy in liver diseases.
Return to Work Experience of Young and Middle-Aged Patients With Acute Myocardial Infarction
Authors: Zhang Qian , Ning Li , Yang Xiangying , Yu Mengying , Zheng Beibei , Wang Yongmei , Lu Jun
Published: August 2023

Background

Return to work (RTW) is a critical component of rehabilitation for most young and middle-aged patients after an acute myocardial infarction (AMI). Its success is related to the quality of life and social psychological function of patients, and their social economic growth. However, healthcare professionals often do not deeply understand the patients' experience and their difficulties and coping methods during this process, which limits their ability to institute effective management and support.

Objective

In this study, we aimed to explore the lived experiences and change processes of young and middle-aged patients with AMI at the different stages of RTW.

Methods

A descriptive qualitative approach was used. Patients aged 20 to 59 years with AMI were recruited from the Department of Cardiology of 3 general hospitals. Data were collected via semistructured interviews. Data analysis was performed by conventional content analysis methods.

Results

In total, 18 participants were included. Five main themes emerged: (1) “chaos,” (2) “rebuilding,” (3) “conflict,” (4) “coping,” and (5) “benefits.” Patients may be more concerned about physical recovery during the initial clinical event. They then begin to plan and adjust for an RTW. Patients in the maintenance phase need strategies to prevent, identify, and respond to conflicts and challenges to maintain long-term stable work.

Conclusion

We identified several post-AMI stages spanning from the initial illness event to the maintenance of stable work. We described their perceived barriers, coping strategies, and support needs at these various stages. These data are crucial for healthcare professionals to develop improved vocational rehabilitation strategies for patients with AMI.
Implementation of a National Liver Review Board for exception requests in the United States: A 2-year monitoring report
Authors: Kwong Allison J. , Foutz Julia , Cafarella Matt , Biggins Scott W. , Shah Neil D. , Eason James , Perito Emily R. , Pomposelli James , Trotter James
Published: August 2023

The exception point system for liver allocation in the United States allows for additional waitlist priority for candidates where the Model for End-Stage Liver Disease or Pediatric End-stage Liver Disease does not effectively represent their urgency or need for a transplant. In May 2019, the review process for liver exception cases transitioned from 11 Regional Review Boards (RRBs) to 1 National Liver Review Board (NLRB), intended to increase consistency nationwide, improve efficiency, and balance transplant access for candidates with and without exception scores. This report provides a review of liver exception request and review practices, waitlist outcomes, and transplant activity in the first 2 years after implementation of the NLRB and acuity circle–based distribution in the United States. We compared initial and extension exception request forms submitted from May 13, 2017 to May 13, 2019 (prepolicy or RRB era) to the period from February 4, 2020 to February 3, 2022 (postpolicy or NLRB era). During this time, the NLRB reviewed 10,083 initial exception requests and 12,686 extension requests. Notable postpolicy highlights include (1) an increase in the proportion of initial and extension requests that were automatically approved instead of manually reviewed; (2) a decrease in the overall approval rates of initial exception requests (87.8% for adult HCC, 64.3% for adult other diagnoses, and 71.5% for pediatric); and (3) reduction in the time from exception request submission to adjudication to a median of 3.73 days. The proportions of waitlist registration and deceased donor liver transplants for patients with exception scores decreased, and waitlist outcomes between patients with and without exception scores are now comparable. Implementation of the NLRB improved efficiency, reduced case workloads, and standardized criteria for exception cases, with similar waitlist outcomes between patients with and without exception scores and improved equity in terms of access to liver transplants.
A Case of Cerebral Large-Vessel Vasculitis Concomitant Fahr Syndrome in Systemic Lupus Erythematosus
Authors: Jiang Wen , Mei Song , Deng Qionghua , Lei Chunyan , Pang Ailan
Published: August 2023

Introduction:

Systemic lupus erythematosus (SLE) is a heterogenous, devastating autoimmune inflammatory disease with multiorgan involvement. A variety of neurological and psychiatric symptoms may be caused by nervous system involvement, termed neuropsychiatric systemic lupus erythematosus.

Case Report:

We describe a young man newly diagnosed with SLE who had a stroke as an initial symptom and was found to have cerebral large-vessel vasculitis and Fahr syndrome.

Conclusions:

The novelties of this report are the extensive cerebral calcification demonstrated on head computerized tomography in a patient with SLE, and the depiction of an underlying vasculitis on high-resolution magnetic resonance vessel wall imaging. It is our aim to describe this atypical form of neuropsychiatric systemic lupus erythematosus onset and to make known the usefulness of the new magnetic resonance imaging techniques for the diagnosis of cerebral large-vessel vasculitis.
Case Report: Unilateral Cranial Nerve VI Palsy Secondary to Intracranial Hypotension
Authors: Han Alice , Jun Weon , Winges Kimberly
Published: August 2023

Significance

Intracranial hypotension is a condition that occurs from a cerebrospinal fluid leak. Various visual symptoms have been associated with this condition. Cranial nerve VI (CN VI) palsies are the most common ocular manifestation, as the abducens nerve is prone to injury due to its intracranial anatomical course.

Purpose

This case report presents a CN VI palsy secondary to intracranial hypotension from ventriculoperitoneal shunt over-filtration. Diagnosis, treatment, and management considerations are discussed. No identifiable health information was included in this case report.

Case Report

A 70-year-old Caucasian male was referred to the eye clinic for evaluation of binocular horizontal diplopia. The patient had a recent history of a left ventriculoperitoneal shunt for a persistent cerebrospinal fluid leak after complex mastoid surgery. The patient was also symptomatic for positional headaches which improved in a recumbent position. He was diagnosed with a left CN VI palsy secondary to intracranial hypotension from a ventriculoperitoneal shunt over-filtration. The patient was followed by neurosurgery for shunt adjustments to resolve the over-filtration. Binocular horizontal diplopia was managed conservatively with Fresnel prism.

Conclusions

Intracranial hypotension should be considered in patients presenting with cranial nerve palsies and positional headaches. Obtaining neuroimaging and co-managing with neurology or neurosurgery is advised to make prompt diagnosis and treatment. Careful clinical monitoring and conservative diplopia therapy is recommended as visual symptoms improve upon resolution of the cerebrospinal fluid leak.
Drug Interaction Between Tacrolimus and Paxlovid (Nirmatrelvir/Ritonavir) in an Adolescent with Inflammatory Bowel Disease
Authors: Zaarur Leenoy , Patel Ashish , Pasternak Brad
Published: August 2023

The coronavirus disease of 2019 (COVID-19) led to a worldwide pandemic. The emergency use of a combination of nirmatrelvir/ritonavir (paxlovid) was approved for high-risk individuals (such as immunocompromised) testing positive for the disease. We present a patient with ulcerative colitis being treated with tacrolimus, as well as ustekinumab, who was diagnosed with COVID-19 and placed on paxlovid due to her immunosuppressed state. She stopped her tacrolimus while on paxlovid and did well clinically. Tacrolimus was restarted 12 hours after completion of paxlovid, but she became symptomatic with vomiting, headache, and malaise and was found to have a toxic tacrolimus level. Tacrolimus was stopped and symptoms resolved, but levels remained elevated for a prolonged period. There is a paucity of literature on this drug–drug interaction, and with the resurgence of COVID-19, it is important to be cognizant of the potential for adverse effects and toxicity.
A Rare Presentation of Pediatric Lynch Syndrome Presenting with Recurrent Adenomatous Polyps
Authors: Liepert Maryah , Brundler Marie-Anne , Galante Gary J.
Published: August 2023

Lynch syndrome (LS) is the most common cause of inherited colorectal cancer and the increases risk of developing extracolonic cancers. We present the first case of pediatric-onset LS with recurrent adenomatous colonic polyps presenting with rectal prolapse. This case highlights the importance of considering polyposis syndromes such as LS as possible diagnoses for pediatric patients who present with colorectal adenomatous polyps, as well as the need to consider immunohistochemical staining of polyps for mismatch repair protein expression in pediatric populations to rule out LS as a diagnosis. We demonstrate the need to consider pediatric patients in LS guidelines.
Translation and validation of the Malay version of modified orthotics and prosthetics users’ survey
Authors: Hashim Natiara Mohamad , Che Daud Ahmad Zamir , Ibrahim Al Hafiz , Ab Majid Mohammad Hafidzi , Mohd Ghazali Mohd Nasrul , Abdul Razak Muhammad Mahdi , Mohd Rusli Muhamad Rahimi
Published: August 2023

Background:

An excellent validated and reliable instrument is paramount in holistically evaluating the prosthetic and orthotic (P&O) service, encompassing functional outcomes, health-related quality of life (HRQoL), and patient satisfaction with devices and service.

Objective:

To perform a translation and cross-cultural adaptation of 3 modules of the Orthotics and Prosthetics Users' Survey (OPUS): (1) lower-extremity functional status (LEFS), (2) client satisfaction with device and services (CSDS), and (3) HRQoL in Malay language, and analyze its psychometric properties.

Study Design:

Translation and validation study.

Methods:

This translation process consisted of 4 phases: (1) a forward–backward translation, (2) content and face validity by utilizing content and face validity indices, (3) pilot testing and psychometric analysis using exploratory factor analysis, and (4) test–retest reliability.

Results:

One item from OPUS Health Quality of Life Index-Malay pilot version, 5 items from OPUS LEFS-Malay pilot version, and 4 items of OPUS Satisfaction with Device and Services-Malay pilot version were deleted because of poor factor loading of <0.6. The final version of Modified OPUS HRQoL-M, Modified OPUS LEFS-M, and Modified OPUS CSDS-M consisted of 22 items, 15 items, and 17 items, respectively. The final versions of all 3 Modified OPUS Malay version possess good internal consistency of 0.854, 0.927, and 0.98, and intraclass correlation of 0.773, 0.871, and 0.821, respectively.

Conclusion:

Modified OPUS HRQoL-M, Modified OPUS LEFS-M, and Modified OPUS CSDS-M are valid and reliable instruments to be adopted into the local Malaysia population.
Do the Histological Differences of Soft Tissue Sarcomas Affect the Rate of Skin Defect Reconstruction?
Authors: Tokumoto Hideki , Akita Shinsuke , Kosaka Kentaro , Kubota Yoshitaka , Mitsukawa Nobuyuki
Published: August 2023

Background

In soft tissue sarcoma (STS) resection, flap reconstruction and/or skin grafting is frequently required. However, it is not clear whether the histological difference affects the rate of reconstruction. The present study aimed to investigate it.

Methods

This study compared in 5 classifications (105 adipocytic tumors, 102 fibroblastic tumors, 39 muscle tumors, 31 peripheral nerve sheath tumors, and 178 tumors of uncertain differentiation). In addition, the reconstruction rates of detailed tumor sites were compared. The median and case number (percentage) were calculated.

Results

Tumor size (adipocytic 112 mm vs fibroblastic 79 mm, muscle 72 mm, nerve 90 mm, uncertain 74 mm, P < 0.0001 in all comparisons), histological low-grade rates (adipocytic 43.8% vs uncertain 3.9%, P < 0.0001; fibroblastic 46.1% vs muscle 15.4%, P = 0.003; fibroblastic vs uncertain, P < 0.0001; nerve 19.4% vs uncertain, P = 0.003) and reconstruction rates (adipocytic 5.7% vs fibroblastic 42.2%, muscle 33.3%, nerve 32.3%, uncertain 25.8%, P < 0.0001 in all comparisons) were significantly different. In the region of lower extremity, the regions of thigh [adipocytic 1/62 (1.6%) vs fibroblastic 7/32 (21.9%), P = 0.002], and lower leg [adipocytic 1/16 (6.3%) vs fibroblastic 11/19 (57.9%), P = 0.002] were significantly different.

Conclusions

In adipocytic tumors, the tumor size was significantly large; however, the skin defect reconstruction rate was significantly lower than that of the other STS. Histologically, the reconstruction rate of STS derived from superficial tissue increases, whereas the reconstruction rate derived from deep tissue such as adipocytic tumor decreases.
Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction
Authors: Woo Soo Hyun , Kim Young Chul , Jeong Woo Shik , Oh Tae Suk , Choi Jong Woo
Published: August 2023

In general, flap volume decreases over time and further in the case of a denervated muscle flap. In our institution, dynamic reconstruction, including functional muscle flaps, has been used to aid functional recovery in the past 6 years. This study aimed to determine the effect of volume change of the fat and muscular sections of reconstructed tongue flaps after motor nerve reinnervation in dynamic total tongue reconstruction using 3-dimensional measurement and analysis. A retrospective chart review was performed on 21 patients who underwent total tongue reconstruction using an anterolateral thigh free flap from 2015 to 2020. The fat and muscle volumes of the flap were measured using computed tomography data obtained before surgery (T0), 2 weeks after surgery (T1), and 6 months after surgery (T2) using a 3-dimensional rendering software. Among the 21 patients that underwent tongue reconstruction, 10 underwent dynamic reconstruction, whereas 11 underwent conventional reconstruction using a fasciocutaneous flap. T2 volume compared with T1 was 69.08% in the conventional reconstruction group, and the fat and muscle portions in the dynamic reconstruction group were 77.04% and 69.06%, respectively. No significant difference was noted in the volume change between the 2 groups. After dynamic tongue reconstruction, the muscular volume of the flap had similar volume reduction rate as the fat volume. The dynamic reconstruction was effective not only for functional muscle transfer but also for maintaining the volume of the reconstructed muscle flap.
Mixed Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference
Authors: Abahuje Egide , Yang Sohae , Hu Yue-Yung , Alam Hasan B. , Rosenblatt Audrey , Ballard Heather , Slocum John Dwight , Stey Anne M , Johnson Julie K.
Published: August 2023

Objective:

This study assessed incivility during Mortality and Morbidity (M&M) Conference.

Background:

A psychologically safe environment at M&M Conference enables generative discussions to improve care. Incivility and exclusion demonstrated by “shame and blame” undermine generative discussion.

Methods:

We used a convergent mixed-methods design to collect qualitative data through non-participant observations of M&M conference and quantitative data through standardized survey instruments of M&M participants. The M&M conference was attended by attending surgeons (all academic ranks), fellows, residents, medical students on surgery rotation, advanced practice providers, and administrators from the department of surgery. A standardized observation guide was developed, piloted and adapted based on expert non-participant feedback. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to the Department of Surgery clinical faculty and categorical general surgery residents in an academic medical center.

Results:

We observed 11 M&M discussions of 30 cases, over six months with four different moderators. Case presentations (virtual format) included clinical scenario, decision-making, operative management, complications, and management of the complications. Discussion was free form, without a standard structure. The central theme that limited discussion participation from attending surgeon of record, as well as absence of a systems-approach discussion led to blame and blame then set the stage for incivility. Among 147 eligible to participate in the survey, 54 (36.7%) responded. Assistant professors had a 2.60 higher Negative Affect score (p-value=0.02), a 4.13 higher Exclusion Behavior score (p-value=0.03), and a 7.6 higher UBCNE score (p-value=0.04) compared to associate and full professors. Females had a 2.7 higher Negative Affect Score compared to males (p-value=0.04).

Conclusion:

Free-form M&M discussions led to incivility. Structuring discussion to focus upon improving care may create inclusion and more generative discussions to improve care.
Surrogacy of Recurrence-free Survival for Overall Survival as an Endpoint of Clinical Trials of Perioperative Adjuvant Therapy in Hepatobiliary-pancreatic Cancers
Authors: Imamura Taisuke , Ohgi Katsuhisa , Mori Keita , Ashida Ryo , Yamada Mihoko , Otsuka Shimpei , Uesaka Katsuhiko , Sugiura Teiichi
Published: August 2023

Objective:

To assess the correlation between recurrence-free survival (RFS) and overall survival (OS) in the hepato-biliary-pancreatic (HBP) surgical setting in order to validate RFS as a surrogate endpoint.

Summary Background Data:

Reliable surrogate endpoints for OS are still limited in the field of HBP surgery.

Methods:

We analyzed patients who underwent curative resection for HBP disease (986 patients with pancreatic ductal adenocarcinoma [PDAC], 1168 with biliary tract cancer [BTC], 1043 with hepatocellular carcinoma [HCC], and 1071 with colorectal liver metastasis [CRLM]) from September 2002 to June 2022. We also conducted meta-analyses of randomized controlled trials of neoadjuvant or adjuvant therapy to validate the surrogacy in PDAC and BTC.

Results:

Correlation coefficients between RFS and OS were low for HCC (ρ = 0.67) and CRLM (ρ = 0.53) but strong for PDAC (ρ = 0.80) and BTC (ρ = 0.75). In a landmark analysis, the concordance rates between survival or death at 5 years postoperatively and the presence or absence of recurrence at each time point (1, 2, 3, and 4 y) were 50%, 70%, 74%, and 77% for PDAC and 54%, 67%, 73%, and 78% for BTC, respectively, both increasing and reaching a plateau at 3 years. In a meta-analysis, the correlation coefficients for the RFS hazard ratio and OS hazard ratio in PDAC and BTC were ρ = 0.88 (P < 0.001) and ρ = 0.87 (P < 0.001), respectively.

Conclusion:

Three-year RFS can be a reliable surrogate endpoint for OS in clinical trials of neoadjuvant or adjuvant therapy for PDAC and BTC.
The Association of Cannabis use After Discharge from Surgery with Opioid Consumption and Patient-Reported Outcomes
Authors: Bicket Mark C , Ladha Karim S , Boehnke Kevin F , Lai Yenling , Gunaseelan Vidhya , Waljee Jennifer F , Englesbe Michael , Brummett Chad M
Published: August 2023

Objective:

Compare outcomes of patients using versus not using cannabis as a treatment for pain after discharge from surgery.

Summary Background Data:

Cannabis is increasingly available and is often taken by patients to relieve pain. However, it is unclear whether cannabis use for pain after surgery impacts opioid consumption and postoperative outcomes.

Methods:

Using Michigan Surgical Quality Collaborative registry data at 69 hospitals, we analyzed a cohort of patients undergoing sixteen procedure types between January 1, 2021, and October 31, 2021. The key exposure was cannabis use for pain after surgery. Outcomes included post-discharge opioid consumption (primary) and patient-reported outcomes of pain, satisfaction, quality of life and regret to undergo surgery (secondary).

Results:

Of 11,314 included patients (58% female, mean age 55.1 years), 581 (5.1%) reported using cannabis to treat pain after surgery. In adjusted models, patients who used cannabis consumed an additional 1.0 (95% CI 0.4 to 1.5) opioid pills after surgery. Patients who used cannabis were more likely to report moderate-to-severe surgical site pain at 1 week (aOR 1.7, 95% CI 1.4 to 2.1) and 1 month (aOR 2.1, 95% CI 1.7 to 2.7) after surgery. Patients who used cannabis were less likely to endorse high satisfaction (72.1% vs. 82.6%), best quality of life (46.7% vs. 63.0%), and no regret (87.6% vs. 92.7%) (all P<0.001).

Conclusions:

Patient-reported cannabis use to treat postoperative pain was associated with increased opioid consumption after discharge from surgery that was of clinically insignificant amounts, but worse pain and other postoperative patient-reported outcomes.
Association Between Emergency Medical Service Agency Volume and Mortality in Trauma Patients
Authors: Silver David S. , Sperry Jason L. , Beiriger Jamison , Lu Liling , Guyette Francis X. , Wisniewski Stephen , Moore Ernest E. , Schreiber Martin , Joseph Bellal , Wilson Chad T. , Cotton Bryan , Ostermayer Daniel , Fox Erin E. , Harbrecht Brian G. , Patel Mayur , Brown Joshua B.
Published: August 2023

Objective:

Evaluate the association of annual trauma patient volume on outcomes for emergency medical services (EMS) agencies.

Summary Background Data:

Regionalization of trauma care saves lives. The underlying concept driving this is a volume-outcome relationship. EMS are the entry point to the trauma system, yet it is unknown if a volume-outcome relationship exists for EMS.

Methods:

Retrospective analysis of prospective cohort including eight trauma centers and 20 EMS air medical and metropolitan ground transport agencies. Patients 18-90 years old with injury severity scores >9 transported from scene were included. Patient and agency-level risk-adjusted regression determined the association between EMS agency trauma patient volume and mortality.

Results:

33,511 were included with a median EMS agency volume of 374 patients annually (IQR 90-580). Each 50-patient increase in EMS agency volume was associated with 5% decreased odds of 6-hour mortality (aOR 0.95; 95%CI 0.92-0.99, P=0.03) and 3% decreased odds of 24-hour mortality (aOR 0.97; 95%CI 0.95-0.99, P=0.04). Pre-specified subgroup analysis showed EMS agency volume was associated with reduced odds of mortality for patients with prehospital shock, requiring prehospital airway placement, undergoing air medical transport, and those with traumatic brain injury. Agency-level analysis demonstrated that high-volume (>374 patients/year) EMS agencies had a significantly lower risk-standardized 6-hour mortality rate than low-volume (<374 patients/year) EMS agencies (1.9% versus 4.8%, P<0.01).

Conclusions:

A higher volume of trauma patients transported at the EMS agency-level is associated with improved early survival. Further investigation of this volume-outcome relationship is necessary to leverage quality improvement, benchmarking, and educational initiatives.
Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference
Authors: Hakeem Abdul Rahman , Mathew Johns Shaji , Aunés Carmen Vinaixa , Mazzola Alessandra , Alconchel Felipe , Yoon Young-In , Testa Giuliano , Selzner Nazia , Sarin Shiv Kumar , Lee Kwang-Woong , Soin Arvinder , Pomposelli James , Menon Krishna , Goyal Neerav , Kota Venugopal , Abu-Gazala Samir , Rodriguez-Davalos Manuel , Rajalingam Rajesh , Kapoor Dharmesh , Durand Francois , Kamath Patrick , Jothimani Dinesh , Sudhindran Surendran , Vij Vivek , Yoshizumi Tomoharu , Egawa Hiroto , Lerut Jan , Broering Dieter , Berenguer Marina , Cattral Mark , Clavien Pierre-Alain , Chen Chao-Long , Shah Samir , Zhu Zhi-Jun , Ascher Nancy , Bhangui Prashant , Rammohan Ashwin , Emond Jean , Rela Mohamed
Published: August 2023

Small-for-size syndrome (SFSS) is a well-recognized complication following liver transplantation (LT), with up to 20% developing this following living donor LT (LDLT). Preventing SFSS involves consideration of factors before the surgical procedure, including donor and recipient selection, and factors during the surgical procedure, including adequate outflow reconstruction, graft portal inflow modulation, and management of portosystemic shunts. International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplant Society of India Consensus Conference was convened in January 2023 to develop recommendations for the prediction and management of SFSS in LDLT. The format of the conference was based on the Grading of Recommendations, Assessment, Development, and Evaluation system. International experts in this field were allocated to 4 working groups (diagnosis, prevention, anesthesia, and critical care considerations, and management of established SFSS). The working groups prepared evidence-based recommendations to answer-specific questions considering the currently available literature. The working group members, independent panel, and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and evidence-based recommendations provided by working group 2 that can be implemented to prevent SFSS in LDLT patients.
Technical Variant Liver Transplant Utilization for Pediatric Recipients: Equal Graft Survival to Whole Liver Transplants and Promotion of Timely Transplantation Only When Performed at High-volume Centers
Authors: Stoltz Daniel J. , Gallo Amy E. , Lum Grant , Mendoza Julianne , Esquivel Carlos O. , Bonham Andrew
Published: August 2023

Background.

Technical variant liver transplantation (TVLT) is a strategy to mitigate persistent pediatric waitlist mortality in the United States, although its implementation remains stagnant. This study investigated the relationship between TVLT utilization, transplant center volume, and graft survival.

Methods.

Pediatric liver transplant recipients from 2010 to 2020 (n = 5208) were analyzed using the Scientific Registry of Transplant Recipients database. Transplant centers were categorized according to the average number of pediatric liver transplants performed per year (high-volume, ≥5; low-volume, <5). Graft survival rates were compared using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models were used to identify predictors of graft failure.

Results.

High-volume centers demonstrated equivalent whole liver transplant and TVLT graft survival (P = 0.057) and significantly improved TVLT graft survival compared with low-volume centers (P < 0.001). Transplantation at a low-volume center was significantly associated with graft failure (adjusted hazard ratio, 1.6; 95% confidence interval, 1.14-2.24; P = 0.007 in patients <12 y old and 1.8; 95% confidence interval, 1.13-2.87; P = 0.013 in patients ≥12 y old). A subset of high-volume centers with a significantly higher rate of TVLT use demonstrated a 23% reduction in waitlist mortality.

Conclusions.

Prompt transplantation with increased TVLT utilization at high-volume centers may reduce pediatric waitlist mortality without compromising graft survival.
The current clinical perception of myotonic dystrophy type 2
Authors: Kleefeld Felix , Schoser Benedikt
Published: August 2023

Purpose of review

Myotonic dystrophy type 2 (DM2) is a genetic disorder belonging to the spectrum of myotonic dystrophies. DM2 is characterized by progressive muscle weakness, wasting and muscle pain (myalgia), but can also affect many other organ systems. In this review, we provide an updated overview on the research literature on DM2 with a focus on the management of multisystemic involvement and atypical clinical phenotypes.

Recent findings

Recent studies have focused on different aspects of multisystemic involvement. Early and severe cardiac involvement can occur in DM2 and needs to be managed appropriately. Diabetes has been shown to be more common in DM2 than in DM1, while a combination of symptoms (cataracts, myotonia, tremor) can be used to raise clinical suspicion and initiate genetic testing for DM2. Autoimmune disease has been shown to occur in up to one-third of DM2 patients, possibly due to altered immune pathways. New evidence also suggests a childhood-onset phenotype presenting with foot deformities.

The multisystemic aspects of the disease require a multidisciplinary approach for some patients, most likely even including state-of-the-art cardiac and brain imaging to detect and treat complications earlier. Of note, our concept of DM2 as an adult-onset disease is somewhat challenged by evidence suggesting a few pediatric DM2 patients and possibly anticipation, at least in some DM2 families. More studies, including larger cohorts, are needed to better understand this possible early-onset DM2 phenotype variant.