bluuebunny/crossref_metadata_2025 huggingface dataset:
Siderophores and competition for iron govern myxobacterial predation dynamics
Authors: Contreras-Moreno Francisco Javier , Moraleda-Muñoz Aurelio , Marcos-Torres Francisco Javier , Cuéllar Virginia , Soto María José , Pérez Juana , Muñoz-Dorado José
Published: May 2024

Bacterial predators are decisive organisms that shape microbial ecosystems. In this study, we investigated the role of iron and siderophores during the predatory interaction between two rhizosphere bacteria: Myxococcus xanthus, an epibiotic predator, and Sinorhizobium meliloti, a bacterium that establishes nitrogen-fixing symbiosis with legumes. The results show that iron enhances the motility of the predator and facilitates its predatory capability, and that intoxication by iron is not used by the predator to prey, although oxidative stress increases in both bacteria during predation. However, competition for iron plays an important role in the outcome of predatory interactions. Using combinations of predator and prey mutants (nonproducers and overproducers of siderophores), we have investigated the importance of competition for iron in predation. The results demonstrate that the competitor that, via the production of siderophores, obtains sufficient iron for growth and depletes metal availability for the opponent will prevail in the interaction. Consequently, iron fluctuations in soils may modify the composition of microbial communities by altering the activity of myxobacterial predators. In addition, siderophore overproduction during predation can alter soil properties, affecting the productivity and sustainability of agricultural operations.
Surgical approach through the anterior scalene muscle resection for invasive tumours in the supraclavicular fossa (with video)
Authors: Matsumoto Yoshifumi , Kobayashi Kenya , Eguchi Kohtaro , Watanabe Takane , Sakai Azusa , Omura Go , Yoshimoto Seiichi
Published: May 2024

Background

The supraclavicular fossa contains many vital organs to be preserved, such as the brachial plexus, subclavian artery and vertebral artery. Various surgical methods have been reported. However, no well-standardized surgical procedure has been established.

Methods

Between 2010 and 2020, we performed 28 surgical treatments of the superior mediastinum and supraclavicular fossa. Of these, we retrospectively reviewed seven cases of supraclavicular invasion using a unified surgical technique in which the anterior scalene muscle was resected, and the inter-scalene triangle was approached.

Results

We performed claviculectomy in four cases and a transmanubrial approach in three cases. In all cases, by resecting the anterior scalene muscle, the brachial plexus, subclavian artery and vertebral artery were preserved. There were no critical postoperative complications other than tracheostomy and lymphatic leakage. Median bleeding amount and operative time were 438 (range; 76–1144) ml and 328 (range; 246–615) minutes, respectively.

Conclusions

The anterior scalene muscle resection method might be a safe and standardized method for preserving the brachial plexus, subclavian artery and vertebral artery.
Estimating the population size of persons contending with homelessness using electronic health records
Authors: Dong Gracia Y , Moselle Kenneth , Robertson Stanley , Brown Patrick , Cowen Laura L E
Published: May 2024

The majority of attempts to enumerate the homeless population rely on point-in-time or shelter counts, which can be costly and inaccurate. As an alternative, we use electronic health records from the Vancouver Island Health Authority, British Columbia, Canada from 2013 to 2022 to identify adults contending with homelessness based on their self-reported housing status. We estimate the annual population size of this population using a flexible open-population capture–recapture model that takes into account (1) the age and gender structure of the population, including aging across detection occasions, (2) annual recruitment into the population, (3) behavioural-response, and (4) apparent survival in the population, including emigration and incorporating known deaths. With this model, we demonstrate how to perform model selection for the inclusion of covariates. We then compare our estimates of annual population size with reported point-in-time counts of homeless populations on Vancouver Island over the same time period, and find that using data extracts from electronic health records gives comparable estimates. We find similarly comparable results using only a subset of interaction data, when using only ER interactions, suggesting that even if cross-continuum data is not available, reasonable estimates of population size can still be found using our method.
Implications of palustrine wetland configuration on the biodiversity of urban aquatic macroinvertebrate communities
Authors: Toroitich Caleb , Njuguna Mugwima , Karanja Dennis
Published: May 2024

Aquatic macroinvertebrates (AM) have a special ecological niche in the functionality of urban wetland communities. This class of animals also play a crucial role in urban environmental and water quality assessments through bio-indication and bio-monitoring. However, the continued loss and isolation of palustrine wetlands, driven by urbanization and other anthropogenic processes, result in reduced biodiversity of macroinvertebrate communities. This study sought to determine how palustrine wetland configuration affect biodiversity structure of AM in Nairobi. Wetland configuration attributes of area, perimeter, shape, and edge were examined. For wetland biodiversity, family richness and Shannon index of diversity were assessed. It was hypothesized that wetland configuration affects the biodiversity of AM. From a population of 303 wetlands, this study used heterogeneous sampling to identify and investigate 31 palustrine wetlands spread across the city of Nairobi. Data were collected using observation checklists and archival review. Correlations and multiple regression analysis were performed in IBM SPSS Statistics 21. It was found that wetland configuration significantly affected the biodiversity of AM at R2 = 0.587, F (6, 23) = 5.447, P < 0.001. The study highlights the need to identify the optimum wetland configuration pattern for the biotic enhancement and conservation of AM in palustrine wetland habitats in urban landscapes. Consequently, the ecological stability of urban wetland communities, their accessibility, as well as the innate affection by urban residents, become a desired conservation goal in urban planning and design.
Meningioma: International Consortium on Meningiomas consensus review on scientific advances and treatment paradigms for clinicians, researchers, and patients
Authors: Wang Justin Z , Landry Alexander P , Raleigh David R , Sahm Felix , Walsh Kyle M , Goldbrunner Roland , Yefet Leeor S , Tonn Jörg C , Gui Chloe , Ostrom Quinn T , Barnholtz-Sloan Jill , Perry Arie , Ellenbogen Yosef , Hanemann C Oliver , Jungwirth Gerhard , Jenkinson Michael D , Tabatabai Ghazaleh , Mathiesen Tiit I , McDermott Michael W , Tatagiba Marcos , la Fougère Christian , Maas Sybren L N , Galldiks Norbert , Albert Nathalie L , Brastianos Priscilla K , Ehret Felix , Minniti Giuseppe , Lamszus Katrin , Ricklefs Franz L , Schittenhelm Jens , Drummond Katharine J , Dunn Ian F , Pathmanaban Omar N , Cohen-Gadol Aaron A , Sulman Erik P , Tabouret Emeline , Le Rhun Emelie , Mawrin Christian , Moliterno Jennifer , Weller Michael , Bi Wenya (Linda) , Gao Andrew , Yip Stephen , Niyazi Maximilian ,   The International Consortium on Meningiomas (ICOM), Aldape Kenneth , Wen Patrick Y , Short Susan , Preusser Matthias , Nassiri Farshad , Zadeh Gelareh
Published: May 2024

Meningiomas are the most common primary intracranial tumors in adults and are increasing in incidence due to the aging population and increased access to neuroimaging. While most exhibit nonmalignant behavior, a subset of meningiomas are biologically aggressive and are associated with treatment resistance, resulting in significant neurologic morbidity and even mortality. In recent years, meaningful advances in our understanding of the biology of these tumors have led to the incorporation of molecular biomarkers into their grading and prognostication. However, unlike other central nervous system (CNS) tumors, a unified molecular taxonomy for meningiomas has not yet been established and remains an overarching goal of the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official World Health Organization (cIMPACT-NOW) working group. Additionally, clinical equipoise still remains on how specific meningioma cases and patient populations should be optimally managed. To address these existing gaps, members of the International Consortium on Meningiomas including field-leading experts, have prepared this comprehensive consensus narrative review directed toward clinicians, researchers, and patients. Included in this manuscript are detailed overviews of proposed molecular classifications, novel biomarkers, contemporary treatment strategies, trials on systemic therapies, health-related quality-of-life studies, and management strategies for unique meningioma patient populations. In each section, we discuss the current state of knowledge as well as ongoing clinical and research challenges to road map future directions for further investigation.
Transcription factors Pbr3RAV2 and PbrTTG1 regulate pear resistance to Botryosphaeria dothidea via the autophagy pathway
Authors: Sun Xun , Wang Fei , Wang Yun , Zhang Ye , Zhang Yue , Liu Yuting , Sun Xiaolei , Qi Kaijie , Xie Zhihua , Zhang Shaoling
Published: May 2024

Pear ring rot, caused by Botryosphaeria dothidea, is the most serious disease of pear (Pyrus spp.) trees. However, the molecular mechanisms underlying pear resistance to B. dothidea remain elusive. In this study, we demonstrated that the pear AuTophagy-related Gene 1a (PbrATG1a) plays a key role in autophagic activity and resistance to B. dothidea. Stable overexpression of PbrATG1a enhanced resistance to B. dothidea in pear calli. Autophagy activity was greater in PbrATG1a-overexpressing calli than in wild-type calli. We used yeast 1-hybrid screening to identify a transcription factor, related to ABI3 and VP1 (Pbr3RAV2), that binds the promoter of PbrATG1a and enhances pear resistance to B. dothidea by regulating autophagic activity. Specifically, the overexpression of Pbr3RAV2 enhanced resistance to B. dothidea in pear calli, while transient silencing of Pbr3RAV2 resulted in compromised resistance to B. dothidea in Pyrus betulifolia. In addition, we identified Transparent Testa Glabra 1 (PbrTTG1), which interacts with Pbr3RAV2. Pathogen infection enhanced the interaction between Pbr3RAV2 and PbrTTG1. The Pbr3RAV2–PbrTTG1 complex increased the binding capacity of Pbr3RAV2 and transcription of PbrATG1a. In addition to providing insights into the molecular mechanisms underlying pear disease resistance, these findings suggest potential genetic targets for enhancing disease resistance in pear.
Diabolical devil’s advocates and the weaponization of illocutionary force
Authors: Terzian Giulia , Corbalán María Inés
Published: May 2024

A standing presumption in the literature is that devil’s advocacy is an inherently beneficial argumentative move; and that those who take on this role in conversation are paradigms of argumentative virtue. Outside academic circles, however, devil’s advocacy has acquired something of a notorious reputation: real-world conversations are rife with self-proclaimed devil’s advocates who are anything but virtuous. Motivated by this observation, in this paper we offer the first in-depth exploration of non-ideal devil’s advocacy. We draw on recent analyses of two better known discursive practices—mansplaining and trolling—to illuminate some of the signature traits of vicious devil’s advocacy. Building on this comparative examination, we show that all three practices trade on a manipulation of illocutionary force; and we evaluate their respective options for securing plausible deniability.
Polydopamine-modified black phosphorus nanosheet drug delivery system for the treatment of ischemic stroke
Authors: Yin Shujiang , Hou Jing , Li Jie , Zeng Caiyun , Chen Shuang , Zhang Han , Tian Xing
Published: May 2024

Black phosphorus (BP), as a representative metal-free semiconductor, has been extensively explored. It has a higher drug loading capacity in comparison to conventional materials and also possesses excellent biocompatibility and biodegradability. Furthermore, BP nanosheets can enhance the permeability of the blood–brain barrier (BBB) upon near-infrared (NIR) irradiation, owing to their photothermal effect. However, the inherent instability of BP poses a significant limitation, highlighting the importance of surface modification to enhance its stability. Ischemic stroke (IS) is caused by the occlusion of blood vessels, and its treatment is challenging due to the hindrance caused by the BBB. Therefore, there is an urgent need to identify improved methods for bypassing the BBB for more efficient IS treatment. This research devised a novel drug delivery approach based on pterostilbene (Pte) supported by BP nanosheets, modified with polydopamine (PDA) to form BP-Pte@PDA. This system shows robust stability and traverses the BBB using effective photothermal mechanisms. This enables the release of Pte upon pH and NIR stimuli, offering potential therapeutic advantages for treating IS. In a middle cerebral artery occlusion mouse model, the BP-Pte@PDA delivery system significantly reduced infarct size, and brain water content, improved neurological deficits, reduced the TLR4 inflammatory factor expression, and inhibited cell apoptosis. In summary, the drug delivery system fabricated in this study thus demonstrated good stability, therapeutic efficacy, and biocompatibility, rendering it suitable for clinical application.
Digitalization and Retirement Contribution Behavior: Evidence from Administrative Data
Authors: Daminato Claudio , Filippini Massimo , Haufler Fabio
Published: May 2024

Retirement savings decisions are increasingly mediated by digital technologies that promise to help individuals plan adequately for their retirement. We exploit a natural experiment to show that introducing a digital pension application increases the probability of making a voluntary retirement contribution by 1.8 percentage points, from an average pretreatment contribution rate of 2.8%. Men and higher-income earners are more likely to respond to the app introduction. We then leverage a field experiment to show that using the app affects contribution behavior mainly through reducing the “hassle” costs of making contributions, rather than by providing information on the associated tax savings.
Assessment of the Distribution and Occurrence of Dagger Nematodes and Associated Nematode Transmitted Viruses in Pacific Northwest Small Fruit Crops
Authors: Olaya Cristian , Reinhold Lauri , Platt McKenna , Peetz Amy , Donahue Kelly , Zasada Inga
Published: May 2024

Small fruit production is an important component of the agricultural sector in the Pacific Northwest of the United States (Oregon and Washington). A diversity of small fruits is produced in the region including wine grape, blueberry, strawberry, and caneberry (red raspberry, black raspberry, and blackberry). Plant-parasitic nematodes and viruses both impact the production of small fruits in the region, but there is no up-to-date understanding of the distribution of potential virus-vectoring dagger nematodes ( Xiphinema spp.) and associated nematode-transmitted viruses. Soil and leaf samples were collected from 43 wine grape vineyards, 24 blueberry fields, 23 caneberry fields, 5 strawberry fields, and 1 currant field in 2021 and 2023. The samples were analyzed to determine the presence of dagger nematodes and the nepoviruses tomato ringspot virus (ToRSV) and tobacco ringspot virus (TRSV). Dagger nematodes were found in 52% of the fields. ToRSV was detected in two blueberry fields in Washington, while in Oregon ToRSV was detected in one field each of blueberry, red raspberry, currant, and wine grape. TRSV was not conclusively found in any of the surveyed samples. To our knowledge, this is the first time ToRSV has been reported in wine grapes in Oregon and in the red currant species Ribes spicatum. This study provides an up-to-date assessment of the distribution of dagger nematodes and nepoviruses associated with small fruits in the Pacific Northwest.
The Association of Psychotherapy With Burnout, Depression, and Measures of Well-Being in Residents and Fellows: A Pilot Study
Authors: Zisook Sidney , Doran Neal , Downs Nancy , Shapiro Desiree , Haddad Angela , Lee Daniel , Newton Isabel , Kawasaki Julie , Nestsiarovich Anastasiya , Davidson Judy
Published: May 2024

Purpose

Resident physicians experience high rates of burnout and depression but rarely prioritize their well-being or seek mental health care. The Accreditation Council for Graduate Medical Education mandated that training programs prioritize resident wellness and emotional and mental health to ensure readily available and accessible mental health care. To help meet that requirement and circumvent barriers to accessing care, the University of California San Diego Healer Education Assessment & Referral (HEAR) Program offers residents and fellows short-term therapy for coping with challenges that threaten their well-being. This report describes the results of a pilot study designed to evaluate the feasibility and effectiveness of the HEAR Program’s resident therapy program.

Method

The cohort included residents and fellows who completed at least 1 postbaseline assessment from January to May 2022. Measures of fulfillment, burnout, self-compassion, quality of life, depression, and suicidal ideation were assessed and compared before and up to 12 weeks after enrollment.

Results

Of the 39 residents who consented to participation, 30 completed at least 1 postbaseline assessment. Most outcomes improved after therapy, with significant increases in fulfillment (mean [SE] coefficient, 0.24 [0.08]; z score, 2.86; P = .004), self-compassion (mean [SE] coefficient, 0.37 [0.07]; z score, 5.72; P < .001), and quality of life (P < .001) and significant reductions in burnout (Stanford burnout scale: mean [SE] coefficient, −0.27 [0.07]; z score, −4.01; P < .001; single-item burnout scale: mean [SE] coefficient, −0.34 [0.08]; z score, −4.37; P < .001) and depression severity (mean [SE] coefficient, −1.08 [0.25]; z score, −4.36; P < .001).

Conclusions

This pilot study noted improvements in fulfillment, compassion, quality of life, and function, as well as reductions in burnout and depression severity, among resident physicians. Future studies in larger cohorts are needed to validate these findings and inform further optimization of this program.
Surgical Field Separation in Total Laparoscopic Hysterectomy
Authors: Meyer Raanan , Niino Clarissa , Schneyer Rebecca , Hamilton Kacey , Siedhoff Matthew T. , Wright Kelly N.
Published: May 2024

We aimed to study whether separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection rates. This was a retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery subspecialists between January 2016 and May 2023. Among 680 included patients, the rate of infection was 0.8% with surgical field separation and 1.3% without (3/377 vs 4/303; odds ratio 0.60, 95% CI, 0.13–2.70). There was no statistical difference between groups; however, the difference in infection rates between groups was extremely small, which led to inadequate power. Our findings suggest that rates of infection after TLH are low, with or without surgical field separation. Treating the vagina, perineum, and abdomen as a single, continuous operative field during TLH may be an acceptable practice.
Assessment of a Decade of Change in U.S. Assisted Reproductive Technology Cumulative Live-Birth Rates
Authors: Wang Sarah F. , Seifer David B.
Published: May 2024

OBJECTIVE:

To assess the effects of demographic shifts, changes in contemporaneous clinical practices, and technologic innovation on assisted reproductive technology (ART) success rates by conducting an analysis of cumulative live-birth rates across different time periods, age groups, and infertility diagnoses.

METHODS:

We conducted a retrospective cohort study of autologous linked cycles comparing cumulative live-birth rates over successive cycles from patients undergoing their first retrieval between 2014 and 2019 in the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) database. All cycles reported for these individuals up to 2020 were included for analysis. We compared cumulative live-birth rates stratified by age and infertility cause with published data from the 2004–2009 SART CORS database.

RESULTS:

From 2014 to 2019, 447,042 patients underwent their first autologous index retrieval, resulting in 1,007,374 cycles and 252,215 live births over the period of 2014 to 2020. In contrast, between 2004 and 2008, 246,740 patients underwent 471,208 cycles, resulting in 140,859 births by 2009. Noteworthy shifts in demographics were observed, with an increase in people of color seeking reproductive technology (57.9% vs 51.7%, P<.001). There was also an increase in patients with diminished ovarian reserve and ovulatory disorders and a decrease in endometriosis, tubal, and male factor infertility (P<.001). Previously associated with decreased odds of live birth, frozen embryo transfer and preimplantation genetic testing showed increased odds in 2014–2020. Preimplantation genetic testing rose from 3.4% to 36.0% and was associated with a lower cumulative live-birth rate for those younger than age 35 years (P<.001) but a higher cumulative live-birth rate for those aged 35 years or older (P<.001). Comparing 2014–2020 with 2004–2009 shows that the overall cumulative live-birth rate improved for patients aged 35 years or older and for all infertility diagnoses except ovulatory disorders (P<.001).

CONCLUSION:

This analysis provides insights into the changing landscape of ART treatments in the United States over the past two decades. The observed shifts in demographics, clinical practices, and technology highlight the dynamic nature of an evolving field of reproductive medicine. These findings may offer insight for clinicians to consider in counseling patients and to inform future research endeavors in the field of ART.
Recent advances on anti-HIV chimeric antigen receptor-T-cell treatment to provide sustained HIV remission
Authors: Su Hang , Mueller April , Goldstein Harris
Published: May 2024

Purpose of review

Successful sustained remission of HIV infection has been achieved after CCR5Δ32/Δ32 allogeneic hematopoietic stem cell transplantation for treatment of leukemia in a small cohort of people living with HIV (PLWH). This breakthrough demonstrated that the goal of curing HIV was achievable. However, the high morbidity and mortality associated with bone marrow transplantation limits the routine application of this approach and provides a strong rationale for pursuing alternative strategies for sustained long-term antiretroviral therapy (ART)-free HIV remission. Notably, long-term immune-mediated control of HIV replication observed in elite controllers and posttreatment controllers suggests that potent HIV-specific immune responses could provide sustained ART-free remission in PLWH. The capacity of chimeric antigen receptor (CAR)-T cells engineered to target malignant cells to induce remission and cure in cancer patients made this an attractive approach to provide PLWH with a potent HIV-specific immune response. Here, we review the recent advances in the design and application of anti-HIV CAR-T-cell therapy to provide a functional HIV cure.

Recent findings

HIV reservoirs are established days after infection and persist through clonal expansion of infected cells. The continuous interaction between latently infected cells and the immune system shapes the landscape of HIV latency and likely contributes to ART-free viral control in elite controllers. CAR-T cells can exhibit superior antiviral activity as compared with native HIV-specific T cells, particularly because they can be engineered to have multiple HIV specificities, resistance to HIV infection, dual costimulatory signaling, immune checkpoint inhibitors, stem cell derivation, CMV TCR coexpression, and tissue homing ligands. These modifications can significantly improve the capacities of anti-HIV CAR-T cells to prevent viral escape, resist HIV infection, and enhance cytotoxicity, persistence, and tissue penetration. Collectively, these novel modifications of anti-HIV CAR-T cell design have increased their capacity to control HIV infection.

Anti-HIV CAR-T cells can be engineered to provide potent and sustained in-vitro and in-vivo antiviral function. The combination of anti-HIV CAR-T cells with other immunotherapeutics may contribute to long-term HIV remission in PLWH.
Surveillance MRI is associated with improved survival in patients with primary sclerosing cholangitis
Authors: Tan Natassia , Ngu Natalie , Worland Thomas , Lee Tanya , Abrahams Tobie , Freeman Elliot , Hannah Nicholas , Gazelakis Kathryn , Madden Richie G , Lynch Kate D , Valaydon Zina , Sood Siddharth , Dev Anouk , Bell Sally , Thompson Alexander J , Ding John Nik , Nicoll Amanda J , Liu Ken , Pandya Keval , Gow Paul , Lubel John , Kemp William , Roberts Stuart K , Majeed Ammar
Published: May 2024

Background:

The benefits of regular surveillance imaging for cholangiocarcinoma in patients with primary sclerosing cholangitis (PSC) are unclear. Hence, we aimed to evaluate the impact of regular magnetic resonance cholangiopancreatography (MRCP) on outcomes of patients with PSC in Australia, where the practice of MRCP surveillance is variable.

Methods:

The relationship between MRCP surveillance and survival outcomes was assessed in a multicenter, retrospective cohort of patients with PSC from 9 tertiary liver centers in Australia. An inverse probability of treatment weighting approach was used to balance groups across potentially confounding covariates.

Results:

A total of 298 patients with PSC with 2117 person-years of follow-up were included. Two hundred and twenty patients (73.8%) had undergone MRCP surveillance. Regular surveillance was associated with a 71% reduced risk of death on multivariate weighted Cox analysis (HR: 0.29, 95% CI: 0.14–0.59, p < 0.001) and increased likelihood of having earlier endoscopic retrograde cholangiopancreatography from the date of PSC diagnosis in patients with a dominant stricture (p < 0.001). However, survival posthepatobiliary cancer diagnosis was not significantly different between both groups (p = 0.74). Patients who had surveillance of less than 1 scan a year (n = 41) had comparable survival (HR: 0.46, 95% CI 0.16–1.35, p = 0.16) compared to patients who had surveillance at least yearly (n = 172).

Conclusions:

In this multicenter cohort study that employed inverse probability of treatment weighting to minimize selection bias, regular MRCP was associated with improved overall survival in patients with PSC; however, there was no difference in survival after hepatobiliary cancer diagnosis. Further prospective studies are needed to confirm the benefits of regular MRCP and optimal imaging interval in patients with PSC.
Femtosecond-Assisted Mushroom Deep Anterior Lamellar Keratoplasty
Authors: Villarrubia Cuadrado Alberto , Sánchez-Ventosa Álvaro , Villalba-González Marta , Palacín Miranda Elisa , López Pérez María Dolores , Castillo Eslava Rosa , González-Cruces Timoteo , Cano-Ortiz Antonio
Published: May 2024

Purpose:

The aim of this study was to describe our technique for performing femtosecond laser (FSL)–assisted mushroom configuration in deep anterior lamellar keratoplasty (DALK).

Methods:

We describe our surgical technique for a mushroom-configuration DALK using a femtosecond laser (FSL) both to prepare the graft and to perform a precut of the recipient cornea, as well as the steps for the dissection of the recipient cornea and for donor cornea implantation. Moreover, we show the parameters of energy and spot separation and the external and internal diameters as well as the thickness of the external and internal keratotomy.

Results:

We performed a retrospective case series study of 20 patients with a mean follow-up of 4.36 ± 2.54 years. The indication for surgery was leukoma in 15 cases (75%), keratoconus in 4 cases (20%), and stromal corneal dystrophy in 1 case (5%). Four cases had to be converted to penetrating keratoplasty. The overall results were as follows: The mean preoperative corrected distance visual acuity increased from 0.11 ± 0.09 (0.01–0.30) to 0.78 ± 0.22 (0.30–1.0) with spectacles and to 0.92 ± 0.13 (0.5–1.0) with a gas permeable contact lens. The mean final cylinder was 3.90 ± 1.86 (1.25–7.0). The mean endothelial cell count at 6 months was 2033.83 ± 570.53 cells/mm2 (930–3207), and the mean final spherical equivalent was −4.67 ± 2.91 (−0.25 to −9.00).

Conclusions:

FSL-assisted technology is useful to achieve a predictable and safe procedure when using mushroom configuration to perform DALK. Our conversion rate from DALK to penetrating keratoplasty was similar to or even lower than that reported in the literature. In the successful DALK cases, the visual and refractive results were similar to those reported in other studies using FSL-assisted DALK (with a standard or mushroom configuration).
Retinal Detachment Rates After Uncomplicated DMEK Versus Cataract Surgery Combined (Triple-)DMEK
Authors: Schöneberger Verena , Tahmaz Volkan , Menghesha Leonie , Lüke Jan Niklas , Cursiefen Claus , Schaub Friederike , Bachmann Björn O.
Published: May 2024

Purpose:

To evaluate the rate of and risk factors for rhegmatogenous retinal detachment (RRD) after Descemet membrane endothelial keratoplasty (DMEK) either alone or in combination with cataract surgery.

Design:

Retrospective analysis of prospective database.

Methods:

Consecutive eyes with Fuchs endothelial corneal dystrophy that received DMEK surgery with a minimum follow-up of 1 year between July 2011 and January 2021 at the Department of Ophthalmology at the University of Cologne were analyzed. Exclusion criteria were complicated history including repeat DMEK within 1-year, previous retinal or glaucoma surgery, complicated phacoemulsification, congenital cataract, history of trauma.

Results:

From 3858 consecutive DMEKs, 1961 patients were identified suitable for analysis. 846 (43.1%) were pseudophakic DMEK, 91 (4.6%) phakic DMEK and 1,024 (52.2%) combined with cataract surgery. RRD occurred in 13 eyes (12 patients). Within two years after DMEK RRD occurred in 0.49% and 0.47% after DMEK and DMEK with cataract surgery, respectively. Mean age of 59.24 ± 8.42 years with subsequent RRD was significantly lower than overall 68.81 ± 9.89 years (t-test two-tailed; p < 0.001). The spherical equivalent was -4.69 ± 3.98 D (range -9.00 to 0.5) in RRD after pseudophakic DMEK compared to -2.79 ± 3.54 D (range -7.5 to 0.75) in combined procedures. Re-bubbling had no influence on RRD rate.

Conclusions:

DMEK alone or in combination with cataract surgery showed similar postoperative RRD rates in the first two years, generally in the range of pseudophakic RRDs. Risk factors such as myopia and younger age could be identified. Re-bubbling has no influence on RRD rates.
Demographic Trends at the American Academy of Ophthalmology Annual Cornea Subspecialty Day
Authors: Zaloga Alexandra R. , Syed Zeba A.
Published: May 2024

Purpose:

The purpose of this study was to identify trends in female representation and years since training completion among speakers and moderators at the American Academy of Ophthalmology (AAO) Annual Cornea Subspecialty Day between 2007 and 2022.

Methods:

Speakers and moderators at each AAO Cornea Subspecialty Day from 2007 to 2022 were sorted by sex and year of training completion. Sex and time from training completion were identified based on the individual's institutional profile or publicly available databases.

Results:

Five hundred eighty-three speakers and 48 moderators were identified from the AAO Cornea Subspecialty Day meeting archives over 15 years. Overall, women represented 199 (34.1%) speakers and 19 (39.6%) moderators. The proportion of female speakers increased from 10.0% in 2007 to 54.8% in 2022 (P < 0.001). The ratio of female moderators increased from 4 of 21 (19.0%) in 2007 to 2014 to 15 of 27 (55.6%) in 2015 to 2022 (P = 0.017). In years where there were less than 50% female moderators, women represented 26.3% of speakers versus 44.4% of speakers in years with greater than 50% female moderators (P = 0.014). Female speakers were overall earlier in practice than male speakers, with fewer average years since training completion (16.4 ± 1.8 vs. 22.3 ± 2.1 years; P < 0.001).

Conclusions:

Female representation among speakers and moderators at AAO's Cornea Subspecialty Day increased between 2007 and 2022. Sessions with a majority of female moderators were associated with a higher number of female speakers. Female speakers were generally earlier in their career than male speakers. These trends highlight the overall increases in female representation in academic ophthalmology.
Small-incision lenticule extraction in a patient with congenital motor nystagmus: case report
Authors: Chan Ian Chi Yeung
Published: May 2024

Introduction:

In patients with congenital motor nystagmus, vision correction might be challenging, and laser refractive surgery is thought to be not advisable because of the patient's inability to fixate and uncontrollable eye movements.

Patient and Clinical Findings:

A 25-year-old man presented with congenital motor nystagmus and reported that he could not wear contact lenses and that spectacles gave him headaches.

Diagnosis, Intervention, and Outcomes:

Diagnosis of motor nystagmus was established clinically, with exclusion of other abnormalities, intact vision, and a history dating back decades. Small-incision lenticule extraction (SMILE) surgery using a 2000-kHz VisuMax 800 (VM800) femtosecond laser was performed successfully on both eyes. Preoperative uncorrected distance visual acuity (UDVA) was 6/24-1 in the right eye and 6/60-1 in the left eye, improving to 6/7.5+1 and 6/9-1, respectively, on postoperative day 1. At day 7, UDVA further improved to 6/6+2 and 6/7.5-1, and after 1 month, it reached 6/6 for the right eye and 6/7.5-1 for the left eye. The patient had a vision gain of 1 line compared with preoperative best spectacle-corrected visual acuity. Refraction at 1 month was right +0.25 diopter sphere and left +0.25 diopter sphere. No intraoperative complications were observed.

Conclusions:

SMILE surgery using VM800 proved effective for a patient with congenital motor nystagmus, resulting in a vision gain of 1 line compared with preoperative best spectacle-corrected visual acuity, with no intraoperative complications. Centration was within 0.2 mm of the target. These objective outcomes demonstrate the feasibility and effectiveness of SMILE surgery using a newer generation laser in this population.
Applications of artificial intelligence in facial plastic and reconstructive surgery: a systematic review
Authors: Souza Spenser , Bhethanabotla Rohith M. , Mohan Suresh
Published: May 2024

Purpose of review

Arguably one of the most disruptive innovations in medicine of the past decade, artificial intelligence is dramatically changing how healthcare is practiced today. A systematic review of the most recent artificial intelligence advances in facial plastic surgery is presented for surgeons to stay abreast of the latest in our field.

Recent findings

Artificial intelligence applications developed for use in perioperative patient evaluation and management, education, and research in facial plastic surgery are highlighted. Selected themes include automated facial analysis with landmark detection, automated facial palsy grading and emotional assessment, generation of artificial facial profiles for testing and model training, automated postoperative patient communications, and improving ethnicity-sensitive facial morphometry norms. Inherent bias can exist in artificial intelligence models, and care must be taken to utilize algorithms trained with diverse datasets.

Artificial intelligence tools are helping clinicians provide more standardized, objective, and efficient care to their patients. Increasing surgeon awareness of available tools, and their widespread implementation into clinical workflows are the next frontier. Ethical considerations must also shape the adoption of any artificial intelligence functionality. As artificial intelligence applications become a fixture in medicine, surgeons must employ them effectively to stay at the vanguard of modern medicine.
Endotherapy for the Proximal Migration of Pancreatic Stents
Authors: Cai Yi-Li , Wang Fan , Li Zhao-Shen , Hu Liang-Hao
Published: May 2024

Objectives

Proximal migration is one of the complications after pancreatic duct stenting. This study aimed to determine the incidence of proximal migration and to analyze the rescue methods.

Materials and Methods

A search was performed in MEDLINE/Embase database. The literatures included were reviewed and analyzed. Retrieval tools were classified into the following 3 classes: class A works by indirectly contacting the outer surface of the stent. Class B works by directly contacting the outer surface. Class C works by directly contacting the inner surface.

Results

416 literatures were retrieved from 1983 to 2021. 15 literatures were included. The incidence of proximal migration of pancreatic stents was 4.7% (106/2246). The success rate of endotherapy was 86.6% (214/247), and the surgical conversion rate of it was 9.3%. Among the 214 cases in which the displaced stents were successfully removed under endoscopy, 49 cases (22.9%) used class A methods, 154 cases (72.0%) used class B methods, and 11 cases (5.1%) used class C methods. The overall rate of postoperative complication was 12.1%, including postprocedure pancreatitis (9.1%, 18/247), followed by bleeding (1.5%), perforation (1.0%), and biliary infection (0.5%).

Conclusions

Endoscopy is an effective method for the treatment of proximal displacement of pancreatic stents with acceptable complication rate.
The Population-Level Prevalence of Exocrine Pancreas Insufficiency and the Subsequent Risk of Pancreatic Cancer
Authors: Babajide Oyedotun , Desai Aakash , Eruchalu Chinelo , Sedarous Mary , Adekunle Ayooluwatomiwa Deborah , Youssef Michael , Mahmud Muftah , Okafor Philip N.
Published: May 2024

Objectives

The aim of this study was to study the prevalence of exocrine pancreas insufficiency (EPI) at a population level and the subsequent risk of pancreatic ductal adenocarcinoma (PDAC).

Materials and Methods

Using TriNetX (a database of over 79 million US residents), we included patients ≥18 years with EPI (identified via ICD-10 codes) and continuous follow-up from 2016–2022. Patients with prior pancreas resection and PDAC before an EPI diagnosis were excluded. The primary outcome was EPI prevalence. Secondary outcomes included imaging utilization, PDAC risk, and pancreatic enzyme replacement therapy (PERT) utilization. We performed 1:1 propensity score matching (PSM) of patients with EPI versus patients without an EPI diagnosis.

Results

The population prevalence of EPI was 0.8% (n = 24,080) with a mean age of 55.6 years. After PSM, PDAC risk among patients with EPI was twice as high compared with patients without EPI (aHR, 1.97; 95% CI, 1.66–2.36). This risk persisted even after excluding patients with a history of acute or chronic pancreatitis (adjusted odds ratio, 4.25; 95% CI, 2.99–6.04). Only 58% (n = 13, 390) of patients with EPI received PERT. No difference was observed in PDAC risk between patients with EPI on PERT and those not on PERT (aHR, 1.10; 95% CI, 0.95–1.26; P = 0.17).

Conclusions

Despite a low prevalence, patients with EPI may have a higher risk of PDAC, and majority with EPI were not on PERT. PERT did not impact incident PDAC risk after an EPI diagnosis.
An Argument for Decentralized Clinical Trials in Gynecologic Oncology
Authors: Mokshagundam Shilpa , McGree Michaela E. , Fought Angela J. , Ishitani Karen P. , Langstraat Carrie L. , Yadav Siddhartha , Dowdy Sean C. , Kumar Amanika
Published: May 2024

To evaluate factors that may influence clinical trial enrollment, we compared demographics, clinical characteristics, and patient-reported social determinants of health for patients with advanced ovarian cancer who were approached for enrollment in a prehabilitation trial. Although no significant differences were found in the majority of demographic and clinical characteristics, distance to study institution was associated with decision to enroll; 21.9% of enrolled compared with 42.2% of not enrolled patients lived 200 miles or more from the study institution (P< .05). In addition, compared with not enrolled patients, enrolled patients were more likely to be receiving neoadjuvant chemotherapy within the study institution compared with a nonstudy institution clinician (81.2% vs 53.1%, P=.02). These findings highlight barriers to enrollment that can be addressed through decentralization of clinical trials.
Clinical Full-Time Equivalent in PICUs: Survey of the U.S. Pediatric Critical Care Chiefs Network, 2020–2022
Authors: Ettinger Nicholas A. , Loscalzo Steven , Liu Hongyan , Griffis Heather , Mack Elizabeth H. , Agus Michael S. D.
Published: May 2024

OBJECTIVES:

To inform workforce planning for pediatric critical care (PCC) physicians, it is important to understand current staffing models and the spectrum of clinical responsibilities of physicians. Our objective was to describe the expected workload associated with a clinical full-time equivalent (cFTE) in PICUs across the U.S. Pediatric Critical Care Chiefs Network (PC3N).

DESIGN:

Cross-sectional survey.

SETTING:

PICUs participating in the PC3N.

SUBJECTS:

PICU division chiefs or designees participating in the PC3N from 2020 to 2022.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A series of three surveys were used to capture unit characteristics and clinical responsibilities for an estimated 1.0 cFTE intensivist. Out of a total of 156 PICUs in the PC3N, the response rate was 46 (30%) to all three distributed surveys. Respondents used one of four models to describe the construction of a cFTE—total clinical hours, total clinical shifts, total weeks of service, or % full-time equivalent. Results were stratified by unit size. The model used for construction of a cFTE did not vary significantly by the total number of faculty nor the total number of beds. The median (interquartile range) of clinical responsibilities annually for a 1.0 cFTE were: total clinical hours 1750 (1483–1858), total clinical shifts 142 (129–177); total weeks of service 13.0 (11.3–16.0); and total night shifts 52 (36–60). When stratified by unit size, larger units had fewer nights or overnight hours, but covered more beds per shift.

CONCLUSIONS:

This survey of the PC3N (2020–2022) provides the most contemporary description of clinical responsibilities associated with a cFTE physician in PCC. A 1.0 cFTE varies depending on unit size. There is no correlation between the model used to construct a cFTE and the associated clinical responsibilities.
Feasibility Analysis of Individualized Low Flow Rate Abdominal Contrast-Enhanced Computed Tomography in Chemotherapy Patients: Dual-Source Computed Tomography With Low Tube Voltage
Authors: Zhang Yicun , Yuan Dian , Qi Ke , Zhang Mengyuan , Zhang Weiting , Wei Nannan , Li Linfeng , Lv Peijie , Gao Jianbo , Liu Jie
Published: May 2024

Purpose

The aim of the study is to investigate the feasibility of using dual-source computed tomography (CT) combined with low flow rate and low tube voltage for postchemotherapy image assessment in cancer patients.

Methods

Ninety patients undergoing contrast-enhanced CT scans of the upper abdomen were prospectively enrolled and randomly assigned to groups A, B, and C (n = 30 each). In group A, patients underwent scans at 120 kVp with 448 mgI/kg. Patients in group B underwent scans at 100 kVp with 336 mgI/kg. Patient in group C underwent scans at 70 kVp with of 224 mgI/kg. Quantitative measurements including the CT number, standard deviation of CT number, signal-to-noise ratio, contrast-to-noise ratio, subjective reader scores, and the volume and flow rate of contrast agent were evaluated for each group.

Results

There was no statistically significant difference in the subjective image scores within the three groups except for the kidney (all P > 0.05). Group C showed significantly higher CT values, lower noise levels, and higher signal-to-noise ratio and contrast-to-noise ratio values in the majority of the regions of interest compared to the other groups (P < 0.05). In group C, the contrast agent dose was decreased by 46% compared to group A (79.48 ± 12.24 vs 42.7 ± 8.6, P < 0.01), and the contrast agent injection rate was reduced by 22% (2.7 ± 0.41 vs 2.1 ± 0.4, P < 0.01).

Conclusions

The use of 70 kVp tube voltage combined with low iodine flow rates prove to be a more effective approach in solving the challenge of compromised blood vessels in postchemotherapy tumor patients, without reducing image quality and diagnostic confidence.
Imaging Diagnosis of Thoracic Elastofibroma Dorsi
Authors: Pi Yeli , Hammer Mark M.
Published: May 2024

Objective

Elastofibroma dorsi (ED) is an uncommon benign tumor that is commonly incidentally discovered on thoracic imaging and at times misinterpreted as a more aggressive lesion. The objective of the study is to characterize the typical cross-sectional imaging findings of elastofibroma dorsi and quantify the risk of masquerading malignancy.

Methods

Retrospective search of radiology and pathology reports over a 12-year period identified 409 cases of suspected ED. Pertinent imaging was reviewed with a focus on computed tomography (CT) and magnetic resonance imaging (MRI), specifically assessing lesion location, presence of interspersed fat, and appearances on follow-up.

Results

Typical imaging appearances of 310 ED, including 10% with pathologic confirmation, were that of a mass deep to the serratus anterior (98%) and near the scapular tip (98%). Intralesional interspersed fat was present in 87% of cases imaged with CT and in 90% of cases imaged with MRI. In the 43 cases imaged with both modalities, 8 (19%) did not have interspersed fat on CT, but 7 (88%) of these did have interspersed fat on MRI. Twelve tumors (benign and malignant) were included, of which only 17% were deep to serratus anterior and 25% were at the scapular tip, P = 0.0001 and P < 0.0001 versus ED. Only a single tumor contained interspersed fat, P < 0.001 versus ED, which had benign pathology on biopsy.

Conclusions

Elastofibroma dorsi can be diagnosed with a high degree of certainty in the presence of classic location and imaging characteristics, obviating the need for further imaging or biopsy.