bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital precession in short-period hot Jupiter exoplanet systems
Authors: Alexander Murray E
Published: April 2023

In several exoplanet systems the stellar rotation axis is not aligned with the normal to the orbital plane. For the class of ‘hot Jupiters’, a significant fraction of total angular momentum resides in the orbit. Orbit precessional motion has been observed in several such systems. We expect the tides raised by the orbiting exoplanet to induce normal mode oscillations in the host star, with the possibility of normal mode-orbit resonance. Gravity modes possess frequencies in the range of typical orbital Keplerian frequencies and their overtones. These resonances, confined to very narrow ranges of frequency space, would be highly improbable unless ‘resonance locking’ occurs, driven, for example, by structural and spin rate changes of the host star, operating on nuclear evolutionary time-scales. Resonance locking amplifies the amplitude of tidally driven oscillations, possibly by orders of magnitude, compared to the equilibrium tide displacements. We address the problem of precession and nutation in a system with a single exoplanet, with non-aligned spin and orbit axes, coupling the gravitational perturbations of normal mode distortions with orbital motion. Resonant modes are expected to have large amplitudes, contributing significantly to the gravitational perturbation already present due to rotational distortion of the star that gives rise to uniform orbital precession. The relative magnitude of rotational distortion and normal-mode perturbations is estimated. For Kepler-13Ab, estimates of their influence on transit time variations are given, and suggest they may be discernible with modern space telescope missions.
Efficient reconstruction of cell lineage trees for cell ancestry and cancer
Authors: Jang Yeongjun , Fasching Liana , Bae Taejeong , Tomasini Livia , Schreiner Jeremy , Szekely Anna , Fernandez Thomas V , Leckman James F , Vaccarino Flora M , Abyzov Alexej
Published: April 2023

Mosaic mutations can be used to track cell ancestries and reconstruct high-resolution lineage trees during cancer progression and during development, starting from the first cell divisions of the zygote. However, this approach requires sampling and analyzing the genomes of multiple cells, which can be redundant in lineage representation, limiting the scalability of the approach. We describe a strategy for cost- and time-efficient lineage reconstruction using clonal induced pluripotent stem cell lines from human skin fibroblasts. The approach leverages shallow sequencing coverage to assess the clonality of the lines, clusters redundant lines and sums their coverage to accurately discover mutations in the corresponding lineages. Only a fraction of lines needs to be sequenced to high coverage. We demonstrate the effectiveness of this approach for reconstructing lineage trees during development and in hematologic malignancies. We discuss and propose an optimal experimental design for reconstructing lineage trees.
Immunotherapy May Improve Tumor Sensitivity to Palliative Chemotherapy in Platinum Resistant Ovarian Cancer
Authors: Kinney Rachel E , Nair Suresh , Kim Christine H , Thomas M Bijoy , DelaTorre Martin
Published: April 2023

Ovarian cancer is the second most common gynecologic cancer in the US and ranks among the top 10 causes of female cancer-related deaths. Platinum-resistant disease carries a particularly poor prognosis and leaves patients with limited remaining therapeutic options. Patients with platinum-resistant disease have significantly lower response rates to additional chemotherapy, with estimates as low as 10%-25%. We hypothesize that in patients with platinum-resistant ovarian cancer, treatment with immunotherapy followed by cytotoxic chemotherapy with antiangiogenic therapy results in prolonged survival without compromising quality of life. Our experience of 3 patients with recurrent, metastatic platinum-resistant ovarian cancer treated with immunotherapy followed by anti-angiogenic treatment plus chemotherapy resulted in progression-free survival durations significantly above previously published averages. Further studies evaluating the role of immunotherapy followed by chemotherapy in combination with drugs targeting angiogenesis are needed and may provide a long-sought after breakthrough for advancing survival in platinum-resistant ovarian cancer.
Effects of Post-Anthesis High-Temperature Stress on Carbon Partitioning and Starch Biosynthesis in a Spring Wheat (Triticum aestivumL.) Adapted to Moderate Growth Temperatures
Authors: Harris P J , Burrell M M , Emes M J , Tetlow I J
Published: April 2023

This study investigates carbon partitioning in the developing endosperm of a European variety of spring wheat subjected to moderately elevated daytime temperatures (27°C/16°C d/night) from anthesis to grain maturity. Elevated daytime temperatures caused significant reductions in both fresh and dry weights and reduced the starch content of harvested grains compared to plants grown under a 20°C/16°C d/night regimen. Accelerated grain development caused by elevated temperatures was accounted for by representing plant development as thermal time (°C DPA). We examined the effects of high-temperature stress (HTS) on the uptake and partitioning of [U-14C]-sucrose supplied to isolated endosperms. HTS caused reduced sucrose uptake into developing endosperms from the second major grain-filling stage (approximately 260°C DPA) up to maturity. Enzymes involved in sucrose metabolism were unaffected by HTS, whereas key enzyme activities involved in endosperm starch deposition such as ADP-glucose pyrophosphorylase and soluble isoforms of starch synthase were sensitive to HTS throughout grain development. HTS caused a decrease in other major carbon sinks such as evolved CO2, ethanol-soluble material, cell walls and protein. Despite reductions in the labeling of carbon pools caused by HTS, the relative proportions of sucrose taken up by endosperm cells allocated to each cellular pool remain unchanged, except for evolved CO2, which increased under HTS and may reflect enhanced respiratory activity. The results of this study show that moderate temperature increases can cause significant yield reductions in some temperate wheat cultivars chiefly through three effects: reduced sucrose uptake by the endosperm, reduced starch synthesis and increased partitioning of carbon into evolved CO2.
Effect of duloxetine on opioid consumption and pain after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials
Authors: Azimi Amirali , Hooshmand Elham , Mafi Amir Ali , Tabatabaei Fatemeh-Sadat
Published: April 2023

Objectives

The purpose of this study was to investigate the analgesic effects of duloxetine, specifically on postoperative pain, opioid consumption, and related side effects following total hip or knee arthroplasty.

Methods

In this systematic review and meta-analysis, Medline, Cochrane, EMBASE, Scopus, and Web of Science were searched until November 2022 for studies which compared duloxetine with placebo when added to routine pain management protocols. Individual study risk of bias assessment was conducted based on Cochrane risk of bias tool 2. Random effect model meta-analysis was done on mean differences, to evaluate the outcomes.

Results

Nine randomized clinical trials (RCT) were included in the final analysis, totaling 806 patients. Duloxetine reduced opioid consumption (oral morphine milligram equivalents) on postoperative days (POD) 2 (mean difference (MD): −14.35, P  = .02), POD 3 (MD: −13.6, P < .001), POD 7 (MD: −7.81, P < .001), and POD 14 (MD: −12.72, P < .001). Duloxetine decreased pain with activity on POD 1, 3, 7, 14, 90 (All P < .05), and pain at rest on POD 2, 3, 7, 14, and 90 (all P < .05). There was no significant difference in the prevalence of the side effects, except for increased risk of somnolence/drowsiness (risk ratio: 1.87, P = .007).

Conclusion

Current evidence shows low to moderate opioid sparing effects of perioperative duloxetine and a statistically but not clinically significant reduction in pain scores. Patients treated with duloxetine had an increased risk for somnolence and drowsiness.
Governing wickedness in megaprojects: discursive and institutional perspectives
Authors: Esposito Giovanni , Terlizzi Andrea
Published: April 2023

Megaprojects are now as important as ever. As a response to the pandemic, the European Union has put forward the Next Generation EU policy, making available a 2021–2027 long-term budget of €1.8 trillion to fund projects with ecological and digital applications in the field of telecommunication, transportation, and energy infrastructures. Similarly, in the United States a $1.9 trillion Covid relief plan is on the way. Also, China has planned to expedite the rollout of 102 infrastructure megaprojects earmarked for the 2021–25 development plan. Despite their importance to policy-makers, megaprojects are often met with criticism and opposition by citizens, and often go off the rails—either with regard to budget or time, or both. This introductory article presents the aim and scope of the themed issue. It positions the problem areas beyond technical issues and connects them to the social and institutional environment within which megaprojects are planned and implemented. Moreover, the article makes the case for conceptualizing megaprojects as wicked policy fields. In doing so, we specify the three defining elements of megaprojects, namely, complexity, uncertainty, and conflict. The article argues that megaproject development cannot be seen as a rational, straightforward process. It is often a non-linear, conflictual process shaped by the collective action of different stakeholder groups (e.g., project managers, policy-makers, and citizens). Driven by divergent interests, sociotechnical imaginaries, as well as behavioral and discursive logics, groups of actors construct and mobilize narratives to influence final decision-making while interacting with the institutional context.
3D printing of cell-delivery scaffolds for tissue regeneration
Authors: Xue Jianmin , Qin Chen , Wu Chengtie
Published: April 2023

Tissue engineering strategy that combine biomaterials with living cells has shown special advantages in tissue regeneration and promoted the development of regenerative medicine. In particular, the rising of 3D printing technology further enriched the structural design and composition of tissue engineering scaffolds, which also provided convenience for cell loading and cell delivery of living cells. In this review, two types of cell-delivery scaffolds for tissue regeneration, including 3D printed scaffolds with subsequent cell-seeding and 3D cells bioprinted scaffolds, are mainly reviewed. We devote a major part to present and discuss the recent advances of two 3D printed cell-delivery scaffolds in regeneration of various tissues, involving bone, cartilage, skin tissues etc. Although two types of 3D printed cell-delivery scaffolds have some shortcomings, they do have generally facilitated the exploration of tissue engineering scaffolds in multiple tissue regeneration. It is expected that 3D printed cell-delivery scaffolds will be further explored in function mechanism of seeding cells in vivo, precise mimicking of complex tissues and even organ reconstruction under the cooperation of multiple fields in future.
PAs as principal investigators of FDA-regulated clinical trials
Authors: Nalepinski Colleen Elizabeth Gosa
Published: April 2023

A misconception exists that only physicians can be principal investigators for FDA-regulated human clinical trials such as interventional studies. This article reviews existing guidelines and dispels the notion that physician associates/assistants (PAs) cannot be principal investigators for clinical trials. Additionally, this article describes an implementation plan to correct the misconception and establish a reference for future PAs seeking the role of principal investigator in clinical trials.
Precision Medical Education
Authors: Triola Marc M. , Burk-Rafel Jesse
Published: April 2023

Medical schools and residency programs are increasingly incorporating personalization of content, pathways, and assessments to align with a competency-based model. Yet, such efforts face challenges involving large amounts of data, sometimes struggling to deliver insights in a timely fashion for trainees, coaches, and programs. In this article, the authors argue that the emerging paradigm of precision medical education (PME) may ameliorate some of these challenges. However, PME lacks a widely accepted definition and a shared model of guiding principles and capacities, limiting widespread adoption. The authors propose defining PME as a systematic approach that integrates longitudinal data and analytics to drive precise educational interventions that address each individual learner’s needs and goals in a continuous, timely, and cyclical fashion, ultimately improving meaningful educational, clinical, or system outcomes. Borrowing from precision medicine, they offer an adapted shared framework. In the P4 medical education framework, PME should (1) take a proactive approach to acquiring and using trainee data; (2) generate timely personalized insights through precision analytics (including artificial intelligence and decision-support tools); (3) design precision educational interventions (learning, assessment, coaching, pathways) in a participatory fashion, with trainees at the center as co-producers; and (4) ensure interventions are predictive of meaningful educational, professional, or clinical outcomes. Implementing PME will require new foundational capacities: flexible educational pathways and programs responsive to PME-guided dynamic and competency-based progression; comprehensive longitudinal data on trainees linked to educational and clinical outcomes; shared development of requisite technologies and analytics to effect educational decision-making; and a culture that embraces a precision approach, with research to gather validity evidence for this approach and development efforts targeting new skills needed by learners, coaches, and educational leaders. Anticipating pitfalls in the use of this approach will be important, as will ensuring it deepens, rather than replaces, the interaction of trainees and their coaches.
Hemostatic In Vitro Properties of Novel Plasma Supernatants Produced from Late-storage Low-titer Type O Whole Blood
Authors: Mihalko Emily P. , Srinivasan Amudan J. , Rahn Katelin C. , Seheult Jansen N. , Spinella Philip C. , Cap Andrew P. , Triulzi Darrell J. , Yazer Mark H. , Neal Matthew D. , Shea Susan M.
Published: April 2023

Background

The use of low-titer group O whole blood is increasing. To reduce wastage, unused units can be converted to packed red blood cells. Supernatant is currently discarded post-conversion; however, it could be a valuable transfusable product. The aim of this study was to evaluate supernatant prepared from late-storage low-titer group O whole blood being converted to red blood cells, hypothesizing it will have higher hemostatic activity compared to fresh never-frozen liquid plasma.

Methods

Low-titer group O whole blood supernatant (n = 12) prepared on storage day 15 was tested on days 15, 21, and 26 and liquid plasma (n = 12) on 3, 15, 21, and 26. Same-day assays included cell counts, rotational thromboelastometry, and thrombin generation. Centrifuged plasma from units was banked for microparticle characterization, conventional coagulation, clot structure, hemoglobin, and additional thrombin generation assays.

Results

Low-titer group O whole blood supernatant contained more residual platelets and microparticles compared to liquid plasma. At day 15, low-titer group O whole blood supernatant elicited a faster intrinsic clotting time compared to liquid plasma (257 ± 41 vs. 299 ± 36 s, P = 0.044), and increased clot firmness (49 ± 9 vs. 28 ± 5 mm, P < 0.0001). Low-titer group O whole blood supernatant showed more significant thrombin generation compared to liquid plasma (day 15 endogenous thrombin potential 1,071 ± 315 vs. 285 ± 221 nM·min, P < 0.0001). Flow cytometry demonstrated low-titer group O whole blood supernatant contained significantly more phosphatidylserine and CD41+ microparticles. However, thrombin generation in isolated plasma suggested residual platelets in low-titer group O whole blood supernatant were a greater contributor than microparticles. Additionally, low-titer group O whole blood supernatant and liquid plasma showed no difference in clot structure, despite higher CD61+ microparticle presence.

Conclusions

Plasma supernatant produced from late-storage low-titer group O whole blood shows comparable, if not enhanced, in vitro hemostatic efficacy to liquid plasma.

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Association of Neighborhood Socioeconomic Disadvantage and Postpartum Readmission
Authors: Meiman Jenna , Grobman William A. , Haas David M. , Yee Lynn M. , Wu Jiqiang , McNeil Becky , Wu Jun , Mercer Brian , Simhan Hyagriv , Reddy Uma , Silver Robert , Parry Samuel , Saade George , Lynch Courtney D. , Venkatesh Kartik K.
Published: April 2023

We assessed whether neighborhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI), was associated with an increased risk of postpartum readmission. This is a secondary analysis from nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be), a prospective cohort of nulliparous pregnant individuals from 2010 to 2013. The exposure was the ADI in quartiles, and the outcome was postpartum readmission; Poisson regression was used. Among 9,061 assessed individuals, 154 (1.7%) were readmitted postpartum within 2 weeks of delivery. Individuals living with the most neighborhood deprivation (ADI quartile 4) were at increased risk of postpartum readmission compared with those living with the lowest neighborhood deprivation (ADI quartile 1) (adjusted risk ratio 1.80, 95% CI 1.11–2.93). Measures of community-level adverse social determinants of health, such as the ADI, may inform postpartum care after delivery discharge.
A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation
Authors: Xu Jing , Mo Shaodong , Ma Xiangyang , Wang Jianhua , Zhang Kai , Wu Zenghui , Xia Hong , Yin Qingshui , Ai Fuzhi
Published: April 2023

Study Design.

Retrospective cohort study.

Objective.

To verify the clinical efficacy of a novel transoral stepwise release technique (TSRT) for the treatment of irreducible atlantoaxial dislocations (IAAD).

Summary of Background Data.

Anterior release for IAAD remains challenging, with a 3.2 times higher complication rate than posterior release. However, there are some patients who cannot achieve successful reduction from a posterior approach and require the higher-risk anterior release. Our work presents a novel anterior release technique that aims to minimize iatrogenic injury and associated complications from an anterior release.

Materials and Methods.

IAAD cases who were treated with TSRT were retrospectively studied. Primary outcomes included fusion rate, complications, and neurological function over the course of a minimum 1-year follow-up. Radiographic differences between preoperative and postoperative imaging were also considered. A preoperative prediction model for the actual release grade was developed using multivariate logistic regression based on demographic factors and the craniovertebral abnormalities identified on preoperative images, evaluating the need for higher-grade TSRT release.

Results.

We included 201 IAAD cases, with 42% (84/201) demonstrating degeneration of the atlantoaxial joint or anterior–hook-like dens. The reduction was achieved in all cases, with 80% (160/201) of cases only requiring relatively low-grade or grade I types TSRT release. Degeneration of the atlantoaxial joint was significantly associated with the need for higher-grade TSRT release (odds ratio:16.68, CI: 2.91–94.54, P = 0.002). The overall complication rate was 4.5% (9/201). Over the course of follow-up, the fusion rate reached 98.5%, and the American Spinal Injury Association and Japanese Orthopedic Association scores were significantly improved to 97.28 and 16.25 (P < 0.01 and P < 0.01), respectively.

Conclusion.

This study demonstrated that our novel TSRT anterior release technique demonstrated complication rates similar to those published in the literature for posterior release. TSRT can be used as an alternative to posterior release techniques for refractory cases or when a posterior approach is not considered viable.
Development of a prediction model to identify undiagnosed chronic obstructive pulmonary disease patients in primary care settings in China
Authors: Zhang Buyu , Sun Dong , Niu Hongtao , Dong Fen , Lyu Jun , Guo Yu , Du Huaidong , Chen Yalin , Chen Junshi , Cao Weihua , Yang Ting , Yu Canqing , Chen Zhengming , Li Liming ,   on behalf of the China Kadoorie Biobank Collaborative Group
Published: April 2023

Background:

At present, a large number of chronic obstructive pulmonary disease (COPD) patients are undiagnosed in China. Thus, this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD.

Methods:

The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China. We stepwisely selected the predictors using logistic regression model. Then we tested the model validity through P-P graph, area under the receiver operating characteristic curve (AUROC), ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China.

Results:

The final prediction model involved 14 independent variables, including age, sex, location (urban/rural), region, educational background, smoking status, smoking amount (pack-years), years of exposure to air pollution by cooking fuel, family history of COPD, history of tuberculosis, body mass index, shortness of breath, sputum and wheeze. The model showed an area under curve (AUC) of 0.72 (95% confidence interval [CI]: 0.72–0.73) for detecting undiagnosed COPD patients, with the cutoff of predicted probability of COPD=0.22, presenting a sensitivity of 70.13% and a specificity of 62.25%. The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68 (95% CI: 0.66–0.69). Moreover, the ten-fold cross validation reported an AUC of 0.72 (95% CI: 0.71–0.73), and the external validation presented an AUC of 0.69 (95% CI: 0.68–0.71).

Conclusion:

This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.
Global burden and trends of lung cancer incidence and mortality
Authors: Li Chao , Lei Shaoyuan , Ding Li , Xu Yan , Wu Xiaonan , Wang Hui , Zhang Zijin , Gao Ting , Zhang Yongqiang , Li Lin
Published: April 2023

Background:

Lung cancer has been the leading cause of cancer-related deaths worldwide for many years. This study aimed to investigate the global patterns and trends of lung cancer.

Methods:

Lung cancer incidence and mortality were derived from the GLOBOCAN 2020 database. Continuous data from Cancer Incidence in Five Continents Time Trends were used to analyze the temporal trends from 2000 to 2012 using Joinpoint regression, and average annual percent changes were calculated. The association between the Human Development Index and lung cancer incidence and mortality was assessed by linear regression.

Results:

An estimated 2.2 million new lung cancer cases and 1.8 million lung cancer-related deaths occurred in 2020. The age-standardized incidence rate (ASIR) ranged from 36.8 per 100,000 in Demark to 5.9 per 100,000 in Mexico. The age-standardized mortality rate (ASMR) varied from 32.8 per 100,000 in Poland to 4.9 per 100,000 in Mexico. Both ASIR and ASMR were approximately twice higher in men than in women. The ASIR of lung cancer showed a downward trend in the United States of America (USA) between 2000 and 2012, and was more prominent in men. The age-specific incidence rates of lung cancer for ages of 50 to 59 years showed an upward trend in China for both men and women.

Conclusions:

The burden of lung cancer is still unsatisfactory, especially in developing countries like China. Considering the effectiveness of tobacco control and screening in developed countries, such as the USA, there is a need to strengthen health education, accelerate the establishment of tobacco control policies and regulations, and improve early cancer screening awareness to reduce the future burden of lung cancer.
Scimitar syndrome and distal tracheoesophageal fistula with esophageal atresia (type III b): a case report of diagnostic and therapeutic approach
Authors: Nađ Ida , Šijak Dorotea , Miculinić Andrija , Bartoniček Dorotea , Hrabak Paar Maja , Malčić Ivan
Published: April 2023

Scimitar syndrome is a rare congenital heart defect (CHD) manifested by a partial abnormal inflow of pulmonary veins of the right lung into the suprahepatic segment of the inferior vena cava (VCI), making an angiographic image with the right heart edge similar to a Turkish saber (“scimitar”). It is found in only 1 to 3 per 100,000 births. Here we are presenting a patient who, in addition to the basic finding and presentation of a special partial anomalous inflow of pulmonary veins, also had other features of the Scimitar syndrome; dextroposition of the heart, without signs of heterotaxy, hypoplasia of the right lung, aberrant arterial supply of the right lung from the descending aorta (lung sequestration) with all hemodynamic signs of left-right flow (dilated right heart cavity and pulmonary artery), but without pulmonary hypertension. In addition, the patient had esophageal atresia with distal tracheoesophageal fistula (TEF). Treatment included operative occlusion of TEF with termino-terminal esophageal anastomosis. In the further course, esophagography revealed circular esophageal stenosis at the anastomosis site, but without the need for dilatation, which resolved spontaneously. Tracheotomy was needed due to the inability to separate from mechanical ventilation. Considering cardiopulmonary stability and the absence of pulmonary hypertension, a complete cardiosurgical correction was postponed to after the first year of life. The review is exceptional due to the concomitant occurrence of a TEF Vogt type IIIb, because the unusual combination of Scimitar syndrome with such type of TEF has not been described in the literature so far. To our knowledge, there is only one described case report with an H-type of TEF.
Does Sternal Displacement During Functional Activities Vary with Time and Adherence to Traditional Sternal Precautions? An Observational Study
Authors: Rodrigues Jeff , Beneck George J.
Published: April 2023

Purpose:

The purpose of this study was to determine whether sternal displacement occurs, decreases over time, and varies with adherence to sternal precautions during functional activities after median sternotomy.

Methods:

Seventeen subjects had ultrasound images taken at two and then six to eight weeks after median sternotomy to measure the sternal gap and displacement during five activities commonly limited by sternal precautions. The subjects were divided into two groups based on self-reported compliance with sternal precautions.

Results:

At the upper sternal site, displacement occurred with all activities in both sessions and decreased over time. At the lower sternal site, displacement only occurred during dynamic activities and decreased over time. Subjects who fully complied with sternal precautions had less upper sternal displacement during stand-to-sit (P = .043; ES = −1.076) and trend toward reduced displacement during sit-to-stand and horizontal abduction with large effect sizes, −.893 and −.975, respectively.

Conclusion:

Sternal displacement may vary with the task performed and between sternal sites. Reduced sternal displacement identified over time indicates sternal healing. Pectoralis major tension seems to be a primary mechanism of sternal displacement during common functional activities. Our findings suggest that full compliance with sternal precautions may promote sternal healing.
The Resident Cosmetic Clinic: An Institutional Review and Outcomes Analysis of the Loma Linda University Experience
Authors: Desai Mansee , Chou Peichi Peggy , Luke Janiene
Published: April 2023

BACKGROUND

As the number of dermatologists offering cosmetic procedures continues to increase, so does the need for hands-on exposure to cosmetic dermatology during residency. A resident cosmetic clinic (RCC) model presents as a mutually beneficial opportunity for trainees to obtain first-hand experience, while patients have access to more affordable pricing.

OBJECTIVES

(1) To assess volume and variety of cosmetic dermatological procedures during residency. (2) To compare Loma Linda University (LLU) Dermatology RCC data with national residency program data. (3) To provide guidance for other dermatology residency programs who wish to incorporate cosmetic training into their educational curriculum.

MATERIALS AND METHODS

In this cross-sectional, retrospective, chart review study, resident training in cosmetic procedures at the LLU RCC was quantified and compared with that of national program averages, minimums, and maximums as reported by the Accreditation Council for Graduate Medication Education.

RESULTS

LLU RCC residents performed more nonablative skin rejuvenation, intense pulsed light, and soft tissue augmentation procedures as the resident surgeon compared with other dermatology residents across the nation.

CONCLUSION

Institutional review highlights an unmet need for greater exposure to and training in a variety of dermatologic cosmetic procedures during residency. Practical considerations for achieving optimal learning experiences were provided through the implementation of a resident cosmetic clinic.
Factors Associated With Musculoskeletal Pain Among Hair Transplant Surgeons: Analyses of Survey Data and Review of the Literature
Authors: Gupta Aditya K. , Wang Tong , Polla Ravi Shruthi , Richards Dillon , Cooper Elizabeth A. , Jimenez Francisco
Published: April 2023

BACKGROUND

The prevalence of work-related musculoskeletal disorders (WRMD) is increasing among all surgical specialties.

OBJECTIVE

Results of a cross-sectional survey of hair transplant surgeons were analyzed, with the aims to (1) determine the prevalence of WRMD, (2) assess risk factors associated with musculoskeletal (MSK) symptoms, and (3) identify mitigation measures.

MATERIALS AND METHODS

A survey pertaining to demographics, MSK-related symptoms and its impacts, and pain mitigation measures taken, if any, were distributed to 834 hair transplant surgeons. Risk factors associated with pain severity were assessed using linear regression.

RESULTS

Overall, 78.5% (73 of 93) respondents had experienced pain when performing surgery. Musculoskeletal symptoms were most severe in the neck, followed by upper/lower back, and extremities. Number of grafts performed per session of follicular unit extraction positively correlated with pain severity; female surgeons and surgeons aged >71 years were at higher risk. A majority expressed concern that WRMD may limit their career and agreed to a need for improved workplace education. Strength training and ergonomic improvements of surgical procedure were not commonly adopted.

CONCLUSION

In sum, WRMD can be debilitating in health care professionals. Workplace ergonomic adjustments and physical exercise programs may be warranted to better mitigate MSK symptoms.
SK Forceps: New Monopolar Electrosurgical Forceps Designed Specifically for Blepharoptosis Surgery
Authors: Kinoshita Shinsuke , Ukyo Hisaki , Masuda Naonori , Osawa Shunsuke
Published: April 2023

The electrode tips of conventional monopolar forceps are relatively blunt, complicating the delicate detachment manipulations required for blepharoptosis repair. This study describes the SK forceps, which is a new monopolar electrosurgical forceps we specifically designed for blepharoptosis surgery. The electrode tips in our design were engineered to be as fine as possible. The SK forceps can cut tissues with the electrode tips in contact in the closed position and coagulate bleeding while clasping the blood vessels. When inactivated, the SK forceps can perform similar manipulations to regular surgical forceps. Surgeons holding the nonactivated SK forceps in one hand and regular forceps in the other benefit from greatly improved maneuverability at every step of the procedure. Incision and dissection procedures performed with the SK forceps result in a surgical field with minimal bleeding because the forceps can simultaneously perform hemostasis and incision, which is a characteristic of a high-frequency electrosurgical unit. However, when unexpected bleeding is encountered in the operative field, the SK forceps can clamp the injured vessels and coagulate the bleeding more rapidly and confidently compared with the needle-type monopolar electrodes without switching instruments. Our design allows surgeons to perform successive procedural steps without switching instruments. This characteristic makes the SK forceps a beneficial instrument for blepharoptosis surgery.
3D Volume Assessment as an Objective Tool in Breast Asymmetry Management
Authors: Makram Mahmoud , Noaman Ayman , Abozeid Mohammed
Published: April 2023

Background:

Throughout history, the female breast has been a universal symbol of femininity. The breast’s normal symmetrical appearance is an important aspect of the female form. Female breasts are not perfectly symmetrical by nature, and minor differences in shape or volume are common. However, it can be psychologically distressing for patients and affect their perception of their bodies. Aesthetic breast surgeons strive to minimize these differences in order to make them more acceptable to patients. This study aimed to provide an objective and practical strategy for effectively managing breast asymmetry.

Method:

This study was conducted between November 2017 and September 2021 on 20 female patients seeking breast asymmetry correction at Kasr El-Ainy Hospital. All patients had volumetric breast assessment using a three-dimensional (3D) imaging system (3D LifeViz, Quantificare system), and MRI breast volumetry was done preoperatively in all patients. The patients were managed with different single-stage surgical procedures depending on the objective assessment of the volume differences between their breasts.

Results:

Breast volume assessment using the 3D camera was done preoperatively and postoperatively. The preoperative mean volume difference was 159.45 cm3, and the postoperative mean difference was 16.75 cm3 with an overall reduction in mean volume difference of 89.5%. Comparing the 3D camera and MRI in assessing breast volume difference showed no statistical significance.

Conclusions:

The 3D technology is a useful objective tool to augment the surgeon’s experience. It helped achieve an 84.57% reduction in volume difference in managing breast asymmetry with a single-stage procedure.
miR-34a regulates macrophage-associated inflammation and angiogenesis in alcohol-induced liver injury
Authors: Wan Ying , Slevin Elise , Koyama Sachiko , Huang Chiung-Kuei , Shetty Ashok K , Li Xuedong , Harrison Kelly , Li Tian , Zhou Bingru , Lorenzo Sugeily Ramos , Zhang Yudian , Salinas Jennifer Mata , Xu Wenjuan , Klaunig James E. , Wu Chaodong , Tsukamoto Hidekazu , Meng Fanyin
Published: April 2023

Background:

Alcohol-associated liver disease (ALD) is a syndrome of progressive inflammatory liver injury and vascular remodeling associated with long-term heavy intake of ethanol. Elevated miR-34a expression, macrophage activation, and liver angiogenesis in ALD and their correlation with the degree of inflammation and fibrosis have been reported. The current study aims to characterize the functional role of miR-34a-regulated macrophage- associated angiogenesis during ALD.

Methods & Results:

We identified that knockout of miR-34a in 5 weeks of ethanol-fed mice significantly decreased the total liver histopathology score and miR-34a expression, along with the inhibited liver inflammation and angiogenesis by reduced macrophage infiltration and CD31/VEGF-A expression. Treatment of murine macrophages (RAW 264.7) with lipopolysaccharide (20 ng/mL) for 24 h significantly increased miR-34a expression, along with the enhanced M1/M2 phenotype changes and reduced Sirt1 expression. Silencing of miR-34a significantly increased oxygen consumption rate (OCR) in ethanol treated macrophages, and decreased lipopolysaccharide-induced activation of M1 phenotypes in cultured macrophages by upregulation of Sirt1. Furthermore, the expressions of miR-34a and its target Sirt1, macrophage polarization, and angiogenic phenotypes were significantly altered in isolated macrophages from ethanol-fed mouse liver specimens compared to controls. TLR4/miR-34a knockout mice and miR-34a Morpho/AS treated mice displayed less sensitivity to alcohol-associated injury, along with the enhanced Sirt1 and M2 markers in isolated macrophages, as well as reduced angiogenesis and hepatic expressions of inflammation markers MPO, LY6G, CXCL1, and CXCL2.

Conclusion:

Our results show that miR-34a-mediated Sirt1 signaling in macrophages is essential for steatohepatitis and angiogenesis during alcohol-induced liver injury. These findings provide new insight into the function of microRNA-regulated liver inflammation and angiogenesis and the implications for reversing steatohepatitis with potential therapeutic benefits in human alcohol-associated liver diseases.
Regulation of immune responses in primary biliary cholangitis: a transcriptomic analysis of peripheral immune cells
Authors: Mulcahy Victoria , Liaskou Evaggelia , Martin Jose-Ezequiel , Kotagiri Prasanti , Badrock Jonathan , Jones Rebecca L. , Rushbrook Simon M , Ryder Stephen D. , Thorburn Douglas , Taylor-Robinson Simon D. , Clark Graeme , Cordell Heather J. , Sandford Richard N. , Jones David E. , Hirschfield Gideon M. , Mells George F.
Published: April 2023

Background & Aims:

In patients with primary biliary cholangitis (PBC), the serum liver biochemistry measured during treatment with ursodeoxycholic acid—the UDCA response—accurately predicts long-term outcome. Molecular characterization of patients stratified by UDCA response can improve biological understanding of the high-risk disease, thereby helping to identify alternative approaches to disease-modifying therapy. In this study, we sought to characterize the immunobiology of the UDCA response using transcriptional profiling of peripheral blood mononuclear cell subsets.

Methods:

We performed bulk RNA-sequencing of monocytes and TH1, TH17, TREG, and B cells isolated from the peripheral blood of 15 PBC patients with adequate UDCA response (“responders”), 16 PBC patients with inadequate UDCA response (“nonresponders”), and 15 matched controls. We used the Weighted Gene Co-expression Network Analysis to identify networks of co-expressed genes (“modules”) associated with response status and the most highly connected genes (“hub genes”) within them. Finally, we performed a Multi-Omics Factor Analysis of the Weighted Gene Co-expression Network Analysis modules to identify the principal axes of biological variation (“latent factors”) across all peripheral blood mononuclear cell subsets.

Results:

Using the Weighted Gene Co-expression Network Analysis, we identified modules associated with response and/or disease status (q<0.05) in each peripheral blood mononuclear cell subset. Hub genes and functional annotations suggested that monocytes are proinflammatory in nonresponders, but antiinflammatory in responders; TH1 and TH17 cells are activated in all PBC cases but better regulated in responders; and TREG cells are activated—but also kept in check—in responders. Using the Multi-Omics Factor Analysis, we found that antiinflammatory activity in monocytes, regulation of TH1 cells, and activation of TREG cells are interrelated and more prominent in responders.

Conclusions:

We provide evidence that adaptive immune responses are better regulated in patients with PBC with adequate UDCA response.
Photobiomodulation therapy for large soft drusen and drusenoid pigment epithelial detachment in age-related macular degeneration: a single-center prospective pilot study
Authors: Benlahbib Manal , Cohen Salomon Yves , Torrell Nuria , Colantuono Donato , Crincoli Emanuele , Amoroso Francesca , Semoun Oudy , Jung Camille , Souied Eric H
Published: April 2023

Purpose:

To evaluate visual acuity and morphologic changes after photobiomodulation (PBM) for patients affected with large soft drusen and/or drusenoid pigment epithelial detachment (dPED) associated to dry age-related macular degeneration (AMD).

Method:

Twenty eyes with large soft drusen and/or dPED AMD were included and treated with the LumiThera® ValedaTM Light Delivery System. All subjects underwent 2 treatments per week for 5 weeks. Outcome measures included best corrected visual acuity (BCVA), microperimetry- scotopic testing, drusen volume (DV), central drusen thickness (CDT), quality of life (QoL) score at baseline and month 6 (M6) follow up. Data of BCVA, DV and CDT was also recorded at week 5 (W5).

Results:

BCVA significantly improved at M6 with a mean score gain of 5.5 letters (p = 0.007). Retinal sensitivity (RS) decreased by 0.1 dB (p=0.17). Mean fixation stability increased by 0.45 % (P=0.72). DV decreased by 0.11 mm3 (p=0.03). CDT was reduced by a mean of 17.05 µm (p=0.01). GA area increased by 0.06 mm2 (p=0.01) over a 6 months follow up, quality of life score increased by 3,07 points on average (p=0.05). One patient presented a dPED rupture at M6 after PBM treatment.

Conclusion:

The visual and anatomical improvements in our patients support previous reports on PBM. PBM may provide a valid therapeutic option for large soft drusen and dPED AMD and may potentially slow the natural course of the disease.
Traditional Chinese medicine regulates inflammatory factors in chronic prostatitis/chronic pelvic pain syndrome: A review
Authors: Wang Hao , Zhao Ming , Zhang Jiwei , Yan Bin , Gao Qinghe , Guo Jun
Published: April 2023

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common male urological disease, and its clinical manifestations are closely related to the dysregulation of inflammatory factors. Nonsteroidal anti-inflammatory drugs have been shown to be effective in managing inflammation and providing pain relief, but their clinical application remains controversial. Traditional Chinese medicine (TCM) is widely used to regulate inflammatory factors in CP/CPPS, and treatment with TCM has gained some advantages based on an “individualized” or “personalized” medical approach. In addition, TCM extracts and acupuncture therapy have also been proven to be effective for CP/CPPS, as they regulate related inflammatory factors. However, current systematic reviews tend to verify the efficacy and safety of TCM therapies in CP/CPPS, and there is still a deficiency in sorting out their mechanisms of modulating inflammatory factors. Based on the current evidence, our review summarizes the application of TCM in regulating inflammatory factors in CP/CPPS to provide a reference for the treatment of CP/CPPS with TCM therapy and a potential direction with future studies in this field.
The invisible cost of pain management by the current International Classification of Diseases coding system: a study in a tertiary care inpatient setting
Authors: Eiamtanasate Sarasate , Smithiseth Kannika , Zinboonyahgoon Nantthasorn , Korwisi Beatrice , Barke Antonia , Rief Winfried , Treede Rolf-Detlef
Published: April 2023

The International Classification of Diseases (ICD) is applied worldwide for public health data collection among other use cases. However, the current version of the ICD (ICD-10), to which the reimbursement system is linked in many countries, does not represent chronic pain properly. This study aims to compare the ICD-10 with the ICD-11 in hospitalized patients in terms of specificity, clinical utility, and reimbursement for pain management. The medical records of hospitalized patients consulted for pain management at Siriraj Hospital, Thailand, were reviewed, and all pain-related diagnoses were coded into ICD-10 and ICD-11. The data of 397 patients showed unspecified pain was coded 78% in the ICD-10 and only 0.5% in the ICD-11 version. The difference gap in the proportion of unspecified pain between the 2 versions is wider than in the outpatient setting. The 3 most common codes for ICD-10 were other chronic pain, low back pain, and pain in limb. The 3 most common codes for ICD-11 were chronic cancer pain, chronic peripheral neuropathic pain, and chronic secondary musculoskeletal pain. As in many other countries, no pain-related ICD-10 codes were coded for routine reimbursement. The simulated reimbursement fee remained the same when adding 397 pain-related codings, even if the cost of pain management, such as cost of labor, existed. Compared with the ICD-10 version, the ICD-11 is more specific and makes pain diagnoses more visible. Thus, shifting from ICD-10 to ICD-11 has the potential to improve both the quality of care and the reimbursement for pain management.
Vaporized cannabis extract–induced antinociception in male vs female rats with persistent inflammatory pain
Authors: Craft Rebecca M. , Gogulski Hannah Y. , Freels Timothy G. , Glodosky Nicholas C. , McLaughlin Ryan J.
Published: April 2023

Although preclinical studies generally report robust antinociceptive effects of cannabinoids in rodent persistent pain models, randomized controlled trials in chronic pain patients report limited pain relief from cannabis/cannabinoids. Differences between animal and human studies that may contribute to these discrepant findings include route of cannabis/cannabinoid administration, type of cannabis/cannabinoid, and how pain is measured. To address these factors, rats with complete Freund adjuvant (CFA)–induced hind paw inflammation were exposed acutely or repeatedly to vaporized cannabis extract that was either tetrahydrocannabinol (THC) or cannabidiol (CBD)dominant. One measure of evoked pain (mechanical threshold), 2 functional measures of pain (hind paw weight-bearing, and locomotor activity), and hind paw edema were assessed for up to 2 hours after vapor exposure. Acute exposure to vaporized THC-dominant extract (200 or 400 mg/mL) decreased mechanical allodynia and hind paw edema and increased hind paw weight-bearing and locomotor activity, with no sex differences. After repeated exposure to vaporized THC-dominant extract (twice daily for 3 days), only the antiallodynic effect was significant. Acute exposure to vaporized CBD-dominant cannabis extract (200 mg/mL) did not produce any effects in either sex; repeated exposure to this extract (100, 200, or 400 mg/mL) decreased mechanical allodynia in male rats only. Sex differences (or lack thereof) in the effects of vaporized cannabis extracts were not explained by sex differences in plasma levels of THC, CBD, or their major metabolites. These results suggest that although vaporized THC-dominant extract is likely to be modestly effective against inflammatory pain in both male and female rats, tolerance may develop, and the CBD-dominant extract may be effective only in male rats.