bluuebunny/crossref_metadata_2025 huggingface dataset:
The LOFAR two metre sky survey data release 2: probabilistic spectral source classifications and faint radio source demographics
Authors: Drake A B , Smith D J B , Hardcastle M J , Best P N , Kondapally R , Arnaudova M I , Das S , Shenoy S , Duncan K J , Röttgering H J A , Tasse C
Published: September 2024

We present an analysis of 152 355 radio sources identified in the second data release of the LOFAR Two Metre Sky Survey (LoTSS-DR2) with Sloan Digital Sky Survey (SDSS) spectroscopic redshifts in the range $0.00 \lt z \lt 0.57$. Using Monte Carlo simulations, we determine the reliability of each source exhibiting an excess in radio luminosity relative to that predicted from their H $\alpha$ emission, and, for a subset of 124 023 sources we combine this measurement with a full BPT analysis. Using these two independent diagnostics, we determine the reliability of each source hosting a supermassive black hole of high or low Eddington-scaled accretion rate, and combine the measurements to determine the reliability of sources belonging to each of four physical classes of objects: star-forming galaxies (SFGs), radio-quiet active galactic nuclei (RQAGN), and high- or low-excitation radio galaxies (HERGs or emission-line LERGs). The result is a catalogue that enables user-defined samples of radio sources with a reliability threshold suited to their science goal, for example prioritizing purity or completeness. Here, we select high-confidence samples of radio sources (>90 per cent reliability) to report: 38 588 radio-excess AGNs in the LoTSS-DR2 sample (362 HERGs, and 12 648 emission-line LERGs), together with 38 729 SFGs, and 18 726 RQAGN. We validate these results through comparison to literature using independent emission-line measurements, and to widely adopted WISE photometric selection techniques. While our use of SDSS spectroscopy limits our current analysis to $\sim 4$ per cent of the LoTSS-DR2 catalogue, our method is directly applicable to data from the forthcoming WEAVE-LOFAR survey, which will obtain over a million spectra of 144 MHz selected sources.
A systematic study of planetary envelope growth with 3D radiation-hydrodynamics simulations
Authors: Bailey Avery , Stone James M , Fung Jeffrey
Published: September 2024

In the core accretion model of planet formation, envelope cooling regulates the accretion of material and ultimately sets the time-scale to form a giant planet. Given the diversity of planet-forming environments, opacity uncertainties, and the advective transport of energy by three-dimensional (3D) recycling flows, it is unclear whether one-dimensional models can adequately describe envelope structure and accretion in all regimes. Even in 3D models, it is unclear whether approximate radiative transfer methods sufficiently model envelope cooling, particularly at the planetary photosphere. To address these uncertainties, we present a suite of 3D radiation-hydrodynamics simulations employing methods that directly solve the transfer equation. We perform a parameter space study, formulated in terms of dimensionless parameters, for a variety of envelope optical depths and cooling times. We find that the thermodynamic structure of the envelope ranges from adiabatic to isothermal based on the cooling time and, by extension, the background disc temperature and density. By adopting a dimensionless framework, these models can be applied to a wide range of formation conditions and assumed opacities. In particular, we dimensionalize them to the case of a super-Earth and proto-Jupiter and place upper limits on the 3D mass accretion rates prior to runaway growth. Finally, we evaluate the fidelity of approximate radiative transfer methods and find that even in the most challenging cases more approximate methods are sufficiently accurate and worth their savings in computational cost.
Dynamics and spin alignment in massive, gravito-turbulent circumbinary discs around supermassive black hole binaries
Authors: Bourne Martin A , Fiacconi Davide , Sijacki Debora , Piotrowska Joanna M , Koudmani Sophie
Published: September 2024

Parsec-scale separation supermassive black hole binaries in the centre of gas-rich galaxy merger remnants could be surrounded by massive circumbinary discs (CBDs). Black hole mass and spin evolution during the gas-rich binary inspiral are crucial in determining the direction and power of relativistic jets that radio observations with LOFAR (Low-Frequency Array) and SKAO (Square Kilometer Array Observatory) will probe, and for predicting gravitational wave (GW) emission that the IPTA (International Pulsar Timing Array) and LISA (Laser Interferometer Space Antenna) will measure. We present 3D hydrodynamic simulations capturing gas-rich, self-gravitating CBDs around a $2\times 10^6$ M$_{\odot }$ supermassive black hole binary, that probe different mass ratios, eccentricities, and inclinations. We employ a subgrid Shakura–Sunyaev accretion disc to self-consistently model black hole mass and spin evolution together with super-Lagrangian refinement techniques to resolve gas flows, streams, and mini-discs within the cavity, which play a fundamental role in torquing and feeding the binary. We find that higher mass ratio and eccentric binaries result in larger cavities, while retrograde binaries result in smaller cavities. All of the simulated binaries are expected to shrink with net gravitational torques being negative. Unlike previous simulations, we do not find preferential accretion onto the secondary black hole. This implies smaller chirp masses at coalescence and hence a weaker GW background. Critically this means that spin alignment is faster than the binary inspiral time-scale even for low-mass ratios. When considering initially misaligned systems, the orientation of the mini-discs around each black hole can vary significantly. We discuss the implications of this behaviour for black hole spin alignment and highlight the need for broader parameter space studies of misaligned systems to understand the impact on black hole recoil velocities.
Spondyloarthritis and Tietze’s syndrome: A re-evaluation
Authors: Matsuki Yasunori , Nakamura Tadashi
Published: September 2024

Spondyloarthritis (SpA) comprises a number of related but different disorders with distinct phenotypes: psoriatic arthritis, reactive arthritis, arthritis related to inflammatory bowel disease, undifferentiated arthritis, and ankylosing spondylitis (the well-known prototypic subtype). Differentiating rheumatic diseases, such as rheumatoid arthritis, synovitis-acne-pustulosis-hyperostosis-osteitis syndrome, pustulotic arthro-osteitis, gout, and SpA, is difficult because they all may manifest swelling at the upper anterior chest wall, often involve the sternocostal and/or sternoclavicular joints, and clearly show cutaneous nodular symptoms, so that they may mimic Tietze’s syndrome in the presentation. Tietze’s syndrome is a benign, self-limiting entity with tender, non-suppurative swelling in the upper anterior chest wall, especially at the second and third costosternal junctions and the sternoclavicular joint. Therefore, distinguishing SpA from Tietze’s syndrome during an entire disease course is important, even after an initial tentative diagnosis. This article aims to re-evaluate the importance of Tietze’s syndrome in the differential diagnosis of SpA, while keeping in mind information about rheumatic diseases affecting the upper anterior chest wall.
RTP801 interacts with the tRNA ligase complex and dysregulates its RNA ligase activity in Alzheimer’s disease
Authors: Campoy-Campos Genís , Solana-Balaguer Julia , Guisado-Corcoll Anna , Chicote-González Almudena , Garcia-Segura Pol , Pérez-Sisqués Leticia , Torres Adrian Gabriel , Canal Mercè , Molina-Porcel Laura , Fernández-Irigoyen Joaquín , Santamaria Enrique , de Pouplana Lluís Ribas , Alberch Jordi , Martí Eulàlia , Giralt Albert , Pérez-Navarro Esther , Malagelada Cristina
Published: September 2024

RTP801/REDD1 is a stress-responsive protein overexpressed in neurodegenerative diseases such as Alzheimer’s disease (AD) that contributes to cognitive deficits and neuroinflammation. Here, we found that RTP801 interacts with HSPC117, DDX1 and CGI-99, three members of the tRNA ligase complex (tRNA-LC), which ligates the excised exons of intron-containing tRNAs and the mRNA exons of the transcription factor XBP1 during the unfolded protein response (UPR). We also found that RTP801 modulates the mRNA ligase activity of the complex in vitro since RTP801 knockdown promoted XBP1 splicing and the expression of its transcriptional target, SEC24D. Conversely, RTP801 overexpression inhibited the splicing of XBP1. Similarly, in human AD postmortem hippocampal samples, where RTP801 is upregulated, we found that XBP1 splicing was dramatically decreased. In the 5xFAD mouse model of AD, silencing RTP801 expression in hippocampal neurons promoted Xbp1 splicing and prevented the accumulation of intron-containing pre-tRNAs. Finally, the tRNA-enriched fraction obtained from 5xFAD mice promoted abnormal dendritic arborization in cultured hippocampal neurons, and RTP801 silencing in the source neurons prevented this phenotype. Altogether, these results show that elevated RTP801 impairs RNA processing in vitro and in vivo in the context of AD and suggest that RTP801 inhibition could be a promising therapeutic approach.
PerturbDB for unraveling gene functions and regulatory networks
Authors: Yang Bing , Zhang Man , Shi Yanmei , Zheng Bing-Qi , Shi Chuanping , Lu Daning , Yang Zhi-Zhi , Dong Yi-Ming , Zhu Liwen , Ma Xingyu , Zhang Jingyuan , He Jiehua , Zhang Yin , Hu Kaishun , Lin Haoming , Liao Jian-You , Yin Dong
Published: September 2024

Perturb-Seq combines CRISPR (clustered regularly interspaced short palindromic repeats)-based genetic screens with single-cell RNA sequencing readouts for high-content phenotypic screens. Despite the rapid accumulation of Perturb-Seq datasets, there remains a lack of a user-friendly platform for their efficient reuse. Here, we developed PerturbDB (http://research.gzsys.org.cn/perturbdb), a platform to help users unveil gene functions using Perturb-Seq datasets. PerturbDB hosts 66 Perturb-Seq datasets, which encompass 4 518 521 single-cell transcriptomes derived from the knockdown of 10 194 genes across 19 different cell lines. All datasets were uniformly processed using the Mixscape algorithm. Genes were clustered by their perturbed transcriptomic phenotypes derived from Perturb-Seq data, resulting in 421 gene clusters, 157 of which were stable across different cellular contexts. Through integrating chemically perturbed transcriptomes with Perturb-Seq data, we identified 552 potential inhibitors targeting 1409 genes, including an mammalian target of rapamycin (mTOR) signaling inhibitor, retinol, which was experimentally verified. Moreover, we developed a ‘Cancer’ module to facilitate the understanding of the regulatory role of genes in cancer using Perturb-Seq data. An interactive web interface has also been developed, enabling users to visualize, analyze and download all the comprehensive datasets available in PerturbDB. PerturbDB will greatly drive gene functional studies and enhance our understanding of the regulatory roles of genes in diseases such as cancer.
Will ChatGPT-4 improve the quality of medical abstracts?
Authors: Gravel Jocelyn , Dion Chloé , Fadaei Kermani Mandana , Mousseau Sarah , Osmanlliu Esli
Published: September 2024

Background

ChatGPT received attention for medical writing. Our objective was to evaluate whether ChatGPT 4.0 could improve the quality of abstracts submitted to a medical conference by clinical researchers.

Methods

This was an experimental study involving 24 international researchers (the participants) who provided one original abstract intended for submission at the 2024 Pediatric Academic Society (PAS) conference. We asked ChatGPT-4 to improve the quality of the abstract while adhering to PAS submission guidelines. Participants received the revised version and were tasked with creating a final abstract. The quality of each version (original, ChatGPT and final) was evaluated by the participants themselves using a numeric scale (0–100). Additionally, three co-investigators assessed abstracts blinded to the version. The primary analysis focused on the mean difference in scores between the final and original abstracts.

Results

Abstract quality varied between the three versions with mean scores of 82, 65 and 90 for the original, ChatGPT and final versions, respectively. Overall, the final version displayed significantly improved quality compared to the original (mean difference 8.0 points; 95% CI: 5.6–10.3). Independent ratings by the co-investigators confirmed statistically significant improvements (mean difference 1.10 points; 95% CI: 0.54–1.66). Participants identified minor (n = 10) and major (n = 3) factual errors in ChatGPT’s abstracts.

Conclusion

ChatGPT 4.0 does not produce abstracts of better quality than the one crafted by researchers but it offers suggestions to help them improve their abstracts. It may be more useful for researchers encountering challenges in abstract generation due to limited experience or language barriers.
A DUF21 domain–containing protein regulates plant dwarfing in watermelon
Authors: Sun Piaoyun , Zhao Hongjiao , Cao Lihong , Zhang Tian , Zhang Helong , Yang Tongwen , Zhao Bosi , Jiang Yanxin , Dong Junyang , Chen Tianrui , Jiang Biao , Li Zheng , Shen Junjun
Published: September 2024

Dwarf or semidwarf plant structures are well suited for intensive farming, maximizing yield, and minimizing labor costs. Watermelon (Citrullus lanatus) is classified as an annual vine plant with elongated internodes, yet the mechanism governing watermelon dwarfing remains unclear. In this study, a compact watermelon mutant dwarf, induced by the insertion of transferred DNA (T-DNA), was discovered. Through resequencing, a gene named domain of unknown function 21 (ClDUF21), located downstream of the T-DNA insertion site, was identified as the candidate gene for the dwarf mutant, and its functionality was subsequently confirmed. Watermelon mutants generated through CRISPR/Cas9-mediated knockout of ClDUF21 revealed that homozygous mutants displayed a pronounced dwarfing phenotype, and protein–protein interaction analysis confirmed the direct interaction between ClDUF21 and ClDWF1. Subsequently, we employed CRISPR/Cas9 technology to precisely modify the homologous gene CsDUF21 in cucumber (Cucumis sativus) and performed protein interaction validation between CsDUF21 and CsDWF1, thereby demonstrating that the CsDUF21 gene also exhibits analogous functionality in plant dwarfing. These findings demonstrate that ClDUF21 governs plant dwarfism by modulating the brassinosteroid synthesis pathway via ClDWF1.
Case-based peer teaching for pain medicine fellows: a curriculum for diverse residency backgrounds
Authors: Chai Nu Cindy , Brar Nikhraj , Su Po-Yi Paul
Published: September 2024

Introduction

Pain medicine is an advanced medical subspecialty incorporating trainees from diverse primary disciplines. A curriculum that does not assess or promote the trainees’ differential expertise developed from their primary specialties may silo instead of promoting collaborative learning in a multidisciplinary subspecialty.

Methods

We created a Kern-guided curriculum for the pain medicine fellowship utilizing case-based modules and a novel note-taking and knowledge-sharing format. Nine faculty-led, case-based modules of increasing complexity were developed based on pain medicine competency content. Pain medicine fellows were instructed to actively designate prior and new knowledge into 4 categories: prior knowledge that is accurate and relevant, inaccurate prior knowledge, new knowledge gained from peers, and new knowledge for all trainees. After each case study, each fellow acknowledged “new knowledge gained from peers” and prepared a brief teach-back of “new knowledge for all trainees” at the beginning of the next session. Fellow participants were assessed for their reactions to the curriculum via anonymized surveys.

Results

The curriculum was implemented at a single institution pain medicine fellowship from 2021 to 2023. At the end of this curriculum, 90% of participants reported improved knowledge retention through participating in this case-based curriculum compared to the traditional didactic format, and 80% of participants reported increased respect for their peers.

Discussion

We created a novel note-taking and knowledge-sharing platform, anchored by a well-established case-based educational strategy, to improve the learning environment and knowledge retention for multidisciplinary trainees with heterogeneous baseline knowledge.
Death-associated protein kinase 3 modulates migration and invasion of triple-negative breast cancer cells
Authors: Wang Junkai , Tran-Huynh Anh M , Kim Beom-Jun , Chan Doug W , Holt Matthew V , Fandino Diana , Yu Xin , Qi Xiaoli , Wang Jin , Zhang Weijie , Wu Yi-Hsuan , Anurag Meenakshi , Zhang Xiang H F , Zhang Bing , Cheng Chonghui , Foulds Charles E , Ellis Matthew J
Published: September 2024

Sixteen patient-derived xenografts (PDXs) were analyzed using a mass spectrometry (MS)-based kinase inhibitor pull-down assay (KIPA), leading to the observation that death-associated protein kinase 3 (DAPK3) is significantly and specifically overexpressed in the triple-negative breast cancer (TNBC) models. Validation studies confirmed enrichment of DAPK3 protein, in both TNBC cell lines and tumors, independent of mRNA levels. Genomic knockout of DAPK3 in TNBC cell lines inhibited in vitro migration and invasion, along with down-regulation of an epithelial–mesenchymal transition (EMT) signature, which was confirmed in vivo. The kinase and leucine-zipper domains within DAPK3 were shown by a mutational analysis to be essential for functionality. Notably, DAPK3 was found to inhibit the levels of desmoplakin (DSP), a crucial component of the desmosome complex, thereby explaining the observed migration and invasion effects. Further exploration with immunoprecipitation–mass spectrometry (IP–MS) identified that leucine-zipper protein 1 (LUZP1) is a preferential binding partner of DAPK3. LUZP1 engages in a leucine-zipper domain–mediated interaction that protects DAPK3 from proteasomal degradation. Thus, the DAPK3/LUZP1 heterodimer emerges as a newly discovered regulator of EMT/desmosome components that promote TNBC cell migration.
Ultrasonography-led multimodal diagnostic pathway for giant cell arteritis
Authors: Mukhtyar Chetan B , Beadsmoore Clare , Ducker Georgina , Fordham Sarah , Sisson Katherine , Jones Colin
Published: September 2024

Objectives

This study aims to establish the sensitivity and negative predictive value of a multimodal pathway incorporating ultrasonography, 18-fluorodeoxyglucose labelled PET-CT and temporal artery biopsy for the diagnosis of giant cell arteritis.

Methods

In total, 1000 consecutive referrals for a new diagnosis of giant cell arteritis were analysed. All patients had a protocolized examination. Patients with a negative ultrasonography and a CRP of ≥20 mg/L received an extended ultrasound examination. If that was negative, and there was no other explanation for their presentation, a second test in the form of either a temporal artery biopsy or an 18-fluorodeoxyglucose labelled PET-CT was offered. We calculated the sensitivity and negative predictive value of the interventions for diagnosing giant cell arteritis.

Results

279/1000 patients had positive ultrasonography for giant cell arteritis. 202 had bilateral superficial temporal arterial involvement. Ultrasonography of the axillary artery and other head/neck arteries increased the yield by 53 and 24 patients, respectively. 181 patients were referred for a second test. 24/139 temporal artery biopsies and 7/42 18-fluorodeoxyglucose labelled PET-CT scans were positive. The sensitivity and negative predictive value rise from 62.3% and 84.7%, respectively, for imaging superficial temporal arteries alone, to 95.7% and 98.0%, respectively, for extended ultrasonography plus a second test.

Conclusion

This is the first real-world evidence of the utility of ultrasonography for the diagnosis of giant cell arteritis as part of a multimodal diagnostic pathway.
Associations of Primary Spoken Language With Individual Perception of Hearing-Related Disability
Authors: Bell Rebecca K. , Dillard Lauren K. , McRackan Theodore R. , Zhan Kevin Y. , Dubno Judy R. , Saunders James E. , Dixon Peter R.
Published: September 2024

Objectives:

Hispanic/Latino adults are less likely than non-Hispanic White adults to seek treatment for hearing disability. While differential socioeconomic factors may contribute to this finding, differences in phonology and syntax in the Spanish, versus English, language may also influence patient perception of hearing disability. The objective of this study is to investigate the association between primary language spoken and participant perception of hearing disability.

Design:

This study represents a cross-sectional cohort study using National Health and Nutrition Examination Study cycles 2015–2016 and 2017–2020 data. Multivariable logistic regressions estimated the association between respondent-selected interview language, which was used as a proxy for primary spoken language, and participant perception of hearing disability. Models were adjusted for age, gender, highest degree of education, pure-tone average, and self-reported general health. Participants included 4687 individuals from the United States population who elected to speak English (n = 4083) or Spanish (n = 604) during the interview. Perception of hearing disability was assessed by (1) frequency of reported difficulty in following a conversation in noise, (2) frequency with which hearing caused respondents to experience frustration when talking with members of their family or friends, and (3) participants’ subjective overall assessment of their hearing.

Results:

Speaking Spanish, versus English, as a primary language was associated with a 42% lower odds of reporting difficulty hearing and understanding in background noise (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48 to 0.70). Spanish speakers had 28% lower odds of reporting feeling frustrated when talking to family members or friends due to hearing (OR: 0.72, 95% CI: 0.59 to 0.88) as compared with the English-speaking cohort. Speaking Spanish additionally conferred 31% lower odds of describing their own general hearing as “a little trouble to deaf” than participants speaking English (OR: 0.69, 95% CI: 0.53 to 0.90). These observed associations were independent of age, gender, highest degree of education, better pure-tone average? and self-reported general health.

Conclusions:

Primary Spanish speakers may be less likely than English speakers to report hearing-related disability, an effect which may be independent of ethnicity. Patient perception of hearing-related disability is an important component of the assessment of and counseling for hearing-related disability and discussion of the need for amplification or other hearing intervention.
Comparative Analysis of Taper Point and Reverse Cutting Needles on Skin Puncture Force
Authors: Maloney McKenzie E. , Potter Christian T. , Chun Benjamin D. , Montilla Richard D. , Schanbacher Carl F.
Published: September 2024

BACKGROUND

Reverse cutting needles are commonly used in cutaneous surgery due to their perceived ease of use. Despite this, there is limited research evaluating the force required to puncture skin using contemporary needles.

OBJECTIVE

This study aims to compare the puncture forces required for two different needle geometries across various gauge sizes.

MATERIALS AND METHODS

The authors assessed the force necessary to penetrate samples of human abdominal skin samples using taper needles of three different United States Pharmacopeia gauge sizes with their respective reverse cutting needle counterparts. Taper point needles tested were RB-1 (3-0), TF (4-0), and C-1 (5-0), while reverse cutting needles included PS-2 (3-0) and P-3 (4-0, 5-0). An electronic force meter was used to record the puncture force required by each needle type.

RESULTS

The mean puncture force in newtons (N) for taper point needles was 1.00, 0.74, and 0.48 for RB-1, TF, and C-1, respectively. The mean puncture force for reverse cutting needles was 0.95 N, 0.60 N, and 0.51 N for PS-2, P-3 (4-0), and P-3 (5-0), respectively. There was a direct relationship between needle body diameter and puncture force for both needle geometries.

CONCLUSION

There was no clinically significant difference in skin puncture force between needle geometries.
A Systematic Review of Questionnaires Assessing Patient Satisfaction in Plastic Surgery: Tools, Topics, and Surgical Types
Authors: Gelidan Adnan G. , Al Qurashi Abdullah A. , Dahlawi Maryam , Hafiz Bayan F. , Halawani Ibrahim R. , Mandora Roaa M. , Tariq Shahad , Hennawi Yasser B. , Bukhari Rahaf I. , Alobaidi Hussain Amin
Published: September 2024

Background:

Patient satisfaction is crucial for evaluating healthcare services, including plastic surgery. This systematic review aims to analyze questionnaires assessing patient satisfaction in plastic surgery, identifying their strengths and weaknesses to improve outcomes and enhance the quality of care.

Methods:

A comprehensive literature search was conducted using electronic databases. Studies were included if they were original research articles, written in English, and focused on patient satisfaction questionnaires in plastic surgery. Data extraction and descriptive statistics were used to summarize the data.

Results:

A total of 105 studies were included. General/overall satisfaction was the most common topic addressed (99.04%). Cosmetic outcomes were the most frequently assessed category (34.3%). Breast reconstruction was the most common procedure (33.3%). Most studies used a combination of generic and procedure-specific questionnaires (45.71%). The most frequently used measurement tools were BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61%.

Conclusions:

This review provides a comprehensive analysis of patient satisfaction questionnaires in plastic surgery, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving plastic surgery outcomes and enhancing the quality of care. Future research should refine assessment tools to address patients’ needs and promote patient-centered outcomes in plastic surgery.
Optimal Technique for Cutting Peripheral Nerves in Nerve Transfer Surgery: A Survey of Peripheral Nerve Surgeons
Authors: Catapano Joseph , Wong Chloe R. , Sarkhosh Tara , Stefaniuk Stephanie , Dengler Jana
Published: September 2024

Background:

Nerve transfer procedures are performed in patients with proximal nerve injuries to optimize their potential for functional recovery. The study aimed to determine the preferred surgical technique and tool used by peripheral nerve surgeons to transect nerves in nerve transfers.

Methods:

All current members of the American Society of Peripheral Nerve were invited to complete a cross-sectional 10-question survey. Data on practice demographics, nerve-cutting instruments/techniques used, and their belief on whether this impacted patient outcomes were collected.

Results:

A total of 49 American Society of Peripheral Nerve members participated in the study, the majority of whom were over 10 years into practice (n = 30/49; 61%). The most common response was a scalpel blade (n = 26/49; 53%), with the remaining 47% using iris scissors, micro-serrated scissors, a razor blade, specialized nerve microscissors, or a specialized nerve-cutting device. The number of years in practice (P = 0.0271) and the percentage of practice that involves treating patients with peripheral nerve injuries (P = 0.0054) is significantly associated with the belief that crushing the donor nerves during transection may result in worse outcomes following nerve transfer. Only the latter is significantly associated with this belief in recipient nerves (P = 0.0214).

Conclusions:

Our findings demonstrate that peripheral nerve surgeons believe that the technique used to transect nerves before coaptation influences outcomes after nerve transfer. Further ex vivo studies are necessary to investigate how different cutting techniques influence nerve morphology and scarring at the coaptation site to optimize outcomes after peripheral nerve surgery.
Work Where You Live or Live Where You Work? Resident Work and Sleep Patterns While on “Home Call”
Authors: Mitchell David T. , Koppin Noa G. , Talanker Michael T. , Bhadkamkar Mohin A. , Marques Erik S. , Greives Matthew R. , Hopkins David C.
Published: September 2024

Background:

Unlike in-house call, the Accreditation Council for Graduate Medical Education (ACGME) does not require a postcall day for “home call” shifts. Despite this, we hypothesize that on-call residents are still in the hospital for the majority of their shift despite having the luxury of home call and, thus, are not protected by ACGME postcall duty hour regulations.

Methods:

A prospective single center survey study was conducted by surveying junior and senior residents who completed overnight call shifts from January 2023 to April 2023 at one of the busiest level 1 trauma centers in the United States. Data include number of trips into the hospital, hours spent in the hospital, and hours of sleep.

Results:

Response rate was 195 of 200 (97.5%) total call shifts from 7 pm to 7 am the next morning. Junior residents reported an average of 3.25, 3.92, and 0.73 hours of sleep when on hand call, face call, and triple call (hand + face + general), respectively. Senior residents reported an average of 4.18 and 4.75 hours of sleep for hand and face call, respectively.

Conclusions:

Hours of sleep when taking home call varies widely based on type of call. Junior residents reported significantly decreased sleep and more time in the hospital when taking hand, face, and triple call compared with general call alone. Senior residents reported that both hand and face call result in significantly decreased hours of sleep compared with general call alone. These results highlight the need to discuss ACGME protection for residents taking home call.
Case report: incarcerated gestational uterine rectal prolapse managed with manual reduction and Thiersch procedure
Authors: Buote Jacob , Regush Lexy , Irvine Kyle , Manz Joren , Adey Kaitlin
Published: September 2024

Introduction and Importance:

Incarcerated gestational uterine rectal prolapse is a rare obstetrical complication, with only three other cases reported worldwide. Risk factors for uterine incarceration and anal sphincter deficiency are predisposing factors. The authors report a case of gestational uterine rectal prolapse with successful reduction and prevention, discuss previous approaches and provide recommendations for future cases.

Case Presentation:

A 33-year-old G5P3 woman presented with a 9 h history of an incarcerated 14-week gestational uterine rectal prolapse, which occurred following a bowel movement. Examination revealed prolapsed rectal lumen containing a gravid uterus with a live fetus demonstrated using point-of-care ultrasound. Under general anesthesia in the left lateral decubitus position, the prolapse was successfully reduced manually and the anal sphincter was secured with a Thiersch perianal encirclement procedure. The pregnancy remained uncomplicated, and she delivered a viable infant via Cesarean section at term.

Discussion:

This case report is unique in that there have only been three other published reports worldwide and we successfully employ the use manual reduction and placement of a Thiersch encirclement in the management of our case. Manual reduction under general anesthesia in the left lateral decubitus position is noninvasive and was shown to optimally manage gestational uterine rectal prolapse. A Thiersch perianal encirclement procedure coupled with aggressive bowel care was shown to be successful at prevention of recurrence of rectal prolapse in pregnancy following reduction.

Conclusion:

Manual reduction under general anesthesia and Thiersch encirclement is an effective management for incarcerated gestational rectal prolapse.
Intraoperative measurement technique for improved accuracy of femoral offset and leg length in total hip replacement: a retrospective cohort study
Authors: Geller-Hinich Maayan , Reshef Noam , Ben Natan Merav , Rothem David E.
Published: September 2024

Introduction:

Restoration of limb length equality and femoral offset is critical for the success of total hip replacement (THR). The purpose of this study was to investigate the efficacy of a novel intraoperative measurement technique in minimizing errors in leg length and offset in THR.

Methods:

This retrospective cohort study included 50 consecutive patients who underwent THR. All surgeries were performed by the same orthopedic surgeon, using the posterior approach. In all patients, the same technique of intraoperative measurement of the femoral offset and limb length was used, which entailed calculation of the distances between reference points on the ischium, greater trochanter, and the screwdriver. Measurements were collected from radiographic imaging data and surgical reports.

Results:

The mean preoperative+intraoperative limb length discrepancy was −1.7 mm (SD=5.9), with a range of −8 to +4 mm. The mean postoperative limb length discrepancy was 1 mm (SD=4.3), with a range of −4 to +5 mm. The mean difference between the preoperative+intraoperative and postoperative measurements was 1 mm (P=0.004). The mean preoperative+intraoperative femoral offset was 36.5 mm (SD=5.4), with a range of 29.6 to 47.6 mm. The mean postoperative femoral offset was 40.10 mm, with a range of 30.8 to 50.0 mm. The mean difference between the premeasurement+intrameasurement and the postoperative measurement was 3.6 mm.

Conclusion:

This study presented an intraoperative measurement technique that is simple, low-cost, and requires minimal equipment. This technique was found to be effective in minimizing errors in femoral offset and leg length after THR.
Quality of life and patient satisfaction after single-port endoscopic thoracic sympathectomy for primary focal hyperhidrosis: a follow-up of 250 patients
Authors: Majeed Zryan S. , Baram Aram , Izac Ashur Y.
Published: September 2024

Background:

If left untreated, severe types of primary focal hyperhidrosis (PFH) would have a negative impact on the quality of life (QoL) of the affected person. This study aimed to determine the efficacy of an endoscopic thoracic sympathectomy (ETS) and the degree of improvement in QoL and satisfaction after surgery. The intraoperative and postoperative complications were evaluated, especially compensatory hyperhidrosis (CH). We hypothesized that the selected sympathectomy levels will neither prevent nor reduce CH.

Methods:

A single-center retrospective study of 250 adult patients diagnosed with bilateral PFH underwent ETS of the second, third, and fourth thoracic sympathetic ganglion. We compared preoperative and postoperative hyperhidrosis severity score (HDSS) and QoL using Pearson correlation. The rate of CH and other complications during follow-up of 4 years were recorded.

Results:

Among 250 patients, 217 had a preoperative HDSS of three and 33 patients had a score of 4, when compared postoperatively HDSS was 0 in 145 patients (58%), one in 82 patients (32.8%), two in 22 patients (8.8%), and score 3 in one patient (0.4%) (P=0.097). QoL before operation in 201 patients was very bad (80.4%), while postoperatively, QoL was much better in 206 patients (82.4%) (P=0.0001). CH was seen only in 27 patients (10.8%), and only one was severe.

Conclusion:

ETS is safe and effective for severe cases of PFH. Sympathectomy at second, third, and fourth ganglion levels has an excellent outcome and higher patient satisfaction with minimal perioperative complications, including CH.
A combined four-point atlantoaxial fixation using Magerl and Harms techniques for the treatment of C1-C2 instability: a case report
Authors: Haddadi Kaveh , Hosseini Seyed M. , Javadian Siavash , Kargar-Soleimanabad Saeed
Published: September 2024

Background:

The instability of the first and second cervical vertebral complexes (C1-C2) can have a variety of etiologies, generally involving the C1-C2 axis and associated soft tissues.

Case Presentation:

A 52-year-old man presented to our emergency department with cervical spine pain and limited range of motion following cervical spine trauma from a fall. The computed tomography scan with good reconstruction showed a complex C2 fracture. After obtaining informed consent, a combined C1 lateral mass-C2 pedicular screw fixation and C1-C2 transarticular screw rod fixation were applied as a four-point fixation technique to achieve immediate rigid immobilization of the C1-C2 motion segment.

Conclusion:

Transarticular screw fixation is an effective technique for the fusion of atlantoaxial complex that provides good fusion rates and is particularly important in patients at risk of nonunion. Nonetheless, a complementary fixation and grafting system is required to improve the integrity of the technique. The authors conclude that combined C1 lateral mass-C2 pedicular screw fixation (Harms techniques), and C1-C2 transarticular polyaxial screw rod fixation is a novel and effective four-point fixation technique to achieve immediate rigid immobilization of the C1-C2 motion segment. Further biomechanical studies should be performed to substantiate our clinical results.
Hepatocellular carcinoma revealed par bone metastasis: three cases report
Authors: Niasse Abdou , Ndiaye Papa I. , Mané Maimouna , Ndiaye Abdoulaye , Dieng Papa S. , Sall Fallou , Gaye Ahmadou , Niang Abdou , Konaté Ibrahima
Published: September 2024

Introduction and importance:

Bone metastases from hepatocellular carcinoma (HCC) are rare. They are exceptionally revealing. The elective sites are the vertebrae, the ribs, and the sternum. Treatment remains palliative most often, which makes the prognosis very poor.

Case presentation:

We report three cases of vertebral metastases revealing HCC. Their management consisted of a laparoscopic biopsy followed by decompressive radiotherapy, supportive care in two cases, and sorafenib in one case. Median survival was 3 and 6 months, respectively. These observations allowed us to carry out a review of the literature on this particular clinical entity and to take stock of the therapeutic modalities.

Clinical discussion:

The discovery of HCC at the stage of bone metastases is rare. The prognosis is bad. The biopsy is justified by the rarity of these metastases. Radiotherapy on metastases improves quality of life without extending survival.

Conclusion:

Lytic bone lesions on HCC should suggest secondary localizations. Their prognosis remains bleak since the treatment is often only palliative.
Prevalence, causes, and early outcomes of shunt revisions at a tertiary hospital in Northern Tanzania: a cross-sectional study
Authors: Machaku Dennis , Chilonga Kondo , George Johnston , Rabiel Happiness
Published: September 2024

Background:

The mainstay treatment for patients with hydrocephalus is surgical, with ventriculoperitoneal shunt (VPS) placement being a routine practice in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident, compounding significant patient morbidity and mortality. We review an analysis of the causes and outcomes of the shunt revisions.

Methods:

A cross-sectional study was carried out at a tertiary hospital between March 2020 and March 2023. It included 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for 3 months, at which time their characteristics in relation to shunt complications were evaluated. SPSS, version 26, was utilized to analyze the data that had been gathered.

Results:

VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. Of the revisions, the majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). Surgical site infection increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 min. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating into longer hospital stays.

Conclusion:

The emphasis on lengthy surgeries and a surgeon’s skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice of the index operation be enhanced to reduce complications. These findings serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.
Exploring drug utilization patterns in postoperative patients to combat post-surgical complication: a descriptive cross-sectional study
Authors: Palikhey Anjan , Sharma Satya Prakash , Lamsal Ashish , Shrivastava Amit Kumar , Shrestha Laxmi , Banjade Dilip Sharma , Thapaliya Ishwor
Published: September 2024

Background:

Post-surgical pharmacotherapy with multiple agents is marked in the modern indoor hospital context to prevent postoperative infections, pain, nausea, and vomiting. The primary objective of this research was to assess postoperative patients’ drug use patterns using WHO indicators.

Method:

A descriptive cross-sectional study was done among 385 postoperative patients of the surgery ward in the hospital over six months from (22 November 2022 to 2 May 2023) after IRC approval. Data regarding prescribed drugs were obtained and recorded in structured case proforma using the patient’s treatment cardex. The different drug use indicators provided by the WHO were used to analyze the data.

Results:

Of the total 385 Patients, the commonest cause of hospitalization was elective lower segment caesarean section (93.2%), followed by appendicitis (3.6%). Analgesics (21.82%), antimicrobials (21.48%), anti-ulcer (10.81%), and anti-emetic (15.06%) were the most commonly prescribed drugs. Metronidazole (97.66%) was the most commonly prescribed drug among antimicrobials, followed by Ceftriaxone (77.4%). The average number of drugs per prescription was 9.17, and the average number of antibiotics per prescription was 1.97. The percentage of generic drugs and national essential medicine list prescriptions was 19.64% and 59.25%, respectively.

Discussion and conclusion:

Polypharmacy was very common, particularly in the case of antimicrobial agents. Urgent steps like specific guidelines, training, and monitoring of drug use are needed to correct some irrational approaches and reduce the cost of treatment. Similarly, prescriptions should be encouraged according to the national essential list of medicines.
Artificial intelligence in medicine: advantages and disadvantages for today and the future
Authors: Salomon Izere , Olivier Sibomana
Published: September 2024

The term ‘artificial intelligence’ (AI) is used to describe the application of computers and technology to mimic human problem solving and creativity. The possibility of AI in medicine is rapidly evolving and its utility in clinical practice may soon become commonplace. The application of AI in medicine has been considered an opportunity to advance medicine as it helps to store, analyze, and interpret large amounts of data and lead to increased diagnostic accuracy, speed, and optimize treatment strategies. On the other hand, many physicians are concerned that AI will replace medical professionals and lead to the ‘dehumanization’ of medicine. In medicine, the evolution of AI promises better outcomes through more efficient diagnosis and accuracy of individualized treatments. As such, appropriate regulatory policies must be explored to ensure the safe implementation of AI in medicine to avoid losing the humanistic art of medical practice. The aim of this correspondence is to shed light on the AI in medicine, advantages, and their disadvantages in this today and future medical field.
Standardized Management of Sickle Cell Disease Patients and the Effects on Care Utilization and Costs
Authors: Ross Dylan H. , Wozniak Amy W. , Markossian Talar , Kellberg Gail , Gazi Sadia K. , Smith Kevin
Published: September 2024

An individualized management program for patients with sickle cell disease (SCD) was created to reduce health care utilization and cost. The program was implemented to standardize the management of patients with SCD. SCD encounters from January 2010 to December 2020 were reviewed for analysis. Preintervention utilization of inpatient, emergency room, and outpatient settings was compared to postintervention. There were 7114 encounters analyzed. Outpatient encounters increased from 36.5% to 70.9%; inpatient encounters decreased from 38.6% to 20.3%; and emergency department visits decreased from 20.3% to 8.8%. The number of high inpatient utilizers decreased 8.4% and the number of individuals who received any emergency care decreased 11.9%. When comparing average charges per time period, the median charge per encounter decreased by $1838 postintervention compared to preintervention. This newly implemented SCD program demonstrated success through shifting the care of the SCD patient to the outpatient setting rather than the emergency department or inpatient hospitalizations.
A Post-Acute COVID-19 Syndrome (PACS) Clinic in Rural New England
Authors: Bardach Shoshana H. , Lichtenstein Jonathan D. , Velcani Frida , Perry Amanda N. , Oliver Brant J. , Martin Christina F. , Parsonnet Jeffrey
Published: September 2024

This article explores the demand and utilization of a rural post-acute COVID syndrome clinic. Electronic health records were used to identify referrals between April 2021 and April 2022 and to describe characteristics of referred patients and referrals generated to specialty services. Of the 747 referrals received, 363 (48.6%) met the criteria for an appointment and were seen, the vast majority (89.6%) via Telehealth. Most patients resided in rural communities (63.1%) and were female (75.2%); mean age was 49, and 17% were hospitalized during their acute illness. Nearly half of patients (49%) had at least one pre-existing mental health diagnosis. Referrals to specialty care for further evaluation and/or intervention were most commonly to occupational therapy (27.3%), physical therapy (24.8%), psychiatry (19.8%), and neurology (17%). Telehealth expanded the availability of health care resources. Additional research on how to meet care needs, ameliorate symptoms, and aid recovery in rural communities is warranted.