bluuebunny/crossref_metadata_2025 huggingface dataset:
Friend turned foe: selfish behavior of a spontaneously arising mitochondrial deletion in an experimentally evolved Caenorhabditis elegans population
Authors: Sequeira Abigail N , O’Keefe Ian P , Katju Vaishali , Bergthorsson Ulfar
Published: January 2024

Selfish mitochondrial DNA (mtDNA) mutations are variants that can proliferate within cells and enjoy a replication or transmission bias without fitness benefits for the host. mtDNA deletions in Caenorhabditis elegans can reach high heteroplasmic frequencies despite significantly reducing fitness, illustrating how new mtDNA variants can give rise to genetic conflict between different levels of selection and between the nuclear and mitochondrial genomes. During a mutation accumulation experiment in C. elegans, a 1,034-bp deletion originated spontaneously and reached an 81.7% frequency within an experimental evolution line. This heteroplasmic mtDNA deletion, designated as meuDf1, eliminated portions of 2 protein-coding genes (coxIII and nd4) and tRNA-thr in entirety. mtDNA copy number in meuDf1 heteroplasmic individuals was 35% higher than in individuals with wild-type mitochondria. After backcrossing into a common genetic background, the meuDf1 mitotype was associated with reduction in several fitness traits and independent competition experiments found a 40% reduction in composite fitness. Experiments that relaxed individual selection by single individual bottlenecks demonstrated that the deletion-bearing mtDNA possessed a strong transmission bias, thereby qualifying it as a novel selfish mitotype.
Association between low-normal thyroid function and advanced liver fibrosis in metabolic dysfunction-associated fatty liver disease patients: a retrospective cohort study
Authors: Li Zixuan , Wu Xiaoying , Chen Zebin , Wei Xiuqing , Chen Weiqing
Published: January 2024

Background

Recent studies have found that thyroid function may be associated with the occurrence and development of advanced liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). However, the majority of such research has consisted of cross-sectional studies. This retrospective cohort study aimed to investigate the effect of low-normal thyroid function on advanced liver fibrosis in MAFLD patients over a 5-year period.

Methods

This retrospective cohort study enrolled 825 outpatients and inpatients with MAFLD who attended the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between January 2011 and December 2018. Based on plasma thyroid hormone and thyroid-stimulating hormone levels, these patients were divided into two groups, namely a low-normal thyroid function group and a strict-normal thyroid function group. The fibrosis-4 score was used to assess advanced liver fibrosis. A chi-square test was conducted to compare the occurrence of advanced fibrosis between the groups.

Results

Among the 825 MAFLD patients, 117 and 708 were defined as having low-normal thyroid function and strict-normal thyroid function, respectively. Follow-up data were available for 767 patients (93.0%) during a 5-year period. Eight (7.5%) MAFLD patients with low-normal thyroid function and 26 (3.9%) with strict-normal thyroid function developed advanced liver fibrosis and the cumulative incidence was not significantly different (P = 0.163). Stratification analysis showed that the lean MAFLD patients (body mass index ≤ 23 kg/m2) with low-normal thyroid function had a higher risk of advanced liver fibrosis than the lean MAFLD patients with strict-normal thyroid function (P < 0.05).

Conclusion

Low-normal thyroid function is associated with advanced liver fibrosis among lean MAFLD patients.
External technical assistance and its contribution to donor transition and long-term sustainability: experience from China and Georgia
Authors: Huang Aidan , Cao Chunkai , Zhao Yingxi , Soselia Giorgi , Uchaneishvili Maia , Chikovani Ivdity , Gotsadze George , Lyu Mohan , Tang Kun
Published: January 2024

External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of ‘graduating’ from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor–recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries.
Should a gamete bank verify the non-medical information provided by a donor?
Authors: Pennings Guido
Published: January 2024

Over the years, cases of fraud have been discovered where donors have been lying about their characteristics. The question raised by such cases is what the responsibility of the gamete bank is for the non-medical information provided by the donor. The problem is that extended donor profiles contain a large amount of information about different aspects of the donor’s life and that not all this information can be verified or is worth verifying. Two cases are scrutinized in more detail: education and criminal record. The proposed solution is to split the donor information into a verified and a non-verified part with the non-verified part falling under the responsibility of the donor. The question of what information should be included in the verified part of the donor profile is still open.
Genome-wide DNA methylation and transcriptomic patterns of precancerous gastric cardia lesions
Authors: Liao Xiaoqi , Lin Runhua , Zhang Zhihua , Tian Dongping , Liu Zhaohui , Chen Songqin , Xu Guohua , Su Min
Published: January 2024

Background

Intestinal metaplasia (IM) and intraepithelial neoplasia (IEN) are considered precursors of gastric cardia cancer (GCC). Here, we investigated the histopathologic and molecular profiles of precancerous gastric cardia lesions (PGCLs) and biomarkers for risk stratification of gastric cardia IM.

Methods

We conducted a hospital-based evaluation (n = 4578) for PGCL profiles in high-incidence and non-high-incidence regions for GCC in China. We next performed 850K methylation arrays (n = 42) and RNA-seq (n = 44) in tissues with PGCLs. We then examined the protein expression of candidate biomarker using immunohistochemistry.

Results

Of the 4578 participants, 791 were diagnosed with PGCLs (600 IM, 62 IM with IEN, and 129 IEN). We found that individuals from high-incidence regions (26.7%) were more likely to develop PGCLs than those from non-high-incidence areas (13.5%). DNA methylation and gene expression alterations, indicated by differentially methylated probes (DMPs) and differentially expressed genes (DEGs), exhibited a progressive increase from type I IM (DMP = 210, DEG = 24), type II IM (DMP = 3402, DEG = 129), to type III IM (DMP = 3735, DEG = 328), peaking in IEN (DMP = 47 373, DEG = 2278). Three DEGs with aberrant promoter methylation were identified, shared exclusively by type III IM and IEN. Of these DEGs, we found that OLFM4 expression appears in IMs and increases remarkably in IENs (P < .001).

Conclusions

We highlight that type III IM and IEN share similar epigenetic and transcriptional features in gastric cardia and propose biomarkers with potential utility in risk prediction.
Relaxing the exclusion restriction in shift-share instrumental variable estimation
Authors: Apfel Nicolas
Published: January 2024

Many economic studies use shift-share instruments to estimate causal effects. Often, all shares need to fulfil an exclusion restriction, making the identifying assumption strict. This paper proposes to use methods that relax the exclusion restriction by selecting valid shares. I apply the methods to estimate the effect of immigration on wages. The coefficient becomes much lower and often changes sign, which is in line with arguments made in the literature.
Colouterine fistula relating to diverticulitis: a rare clinical entity
Authors: Aslam Anoosha , Lewis David J , Veerasingham Mayooran , Afzal Mohamed Z , Alsaffar Asar
Published: January 2024

Colouterine fistula is a rare but recognizable complication of diverticulitis. This case illustrates the presence of a colouterine fistula in an elderly patient who had an atypical presentation for diverticulitis. She was initially treated with intravenous antibiotics for diverticulitis with a contained abscess. This gave her an opportunity to avoid surgery. However, her sepsis failed to respond to the initial treatment. Progress computerized tomography imaging demonstrated the presence of a colouterine fistula for which she required source control. Thus she underwent laparotomy, Hartmann’s procedure, and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The diagnosis of colouterine fistula was confirmed intraoperatively and on histopathology. Subsequently, the patient had an uneventful recovery following the operation. This case highlights the rarity but also the veracity of this clinical entity.
Innate programmable DNA binding by CRISPR-Cas12m effectors enable efficient base editing
Authors: Bigelyte Greta , Duchovska Brigita , Zedaveinyte Rimante , Sasnauskas Giedrius , Sinkunas Tomas , Dalgediene Indre , Tamulaitiene Giedre , Silanskas Arunas , Kazlauskas Darius , Valančauskas Lukas , Madariaga-Marcos Julene , Seidel Ralf , Siksnys Virginijus , Karvelis Tautvydas
Published: January 2024

Cas9 and Cas12 nucleases of class 2 CRISPR-Cas systems provide immunity in prokaryotes through RNA-guided cleavage of foreign DNA. Here we characterize a set of compact CRISPR-Cas12m (subtype V-M) effector proteins and show that they provide protection against bacteriophages and plasmids through the targeted DNA binding rather than DNA cleavage. Biochemical assays suggest that Cas12m effectors can act as roadblocks inhibiting DNA transcription and/or replication, thereby triggering interference against invaders. Cryo-EM structure of Gordonia otitidis (Go) Cas12m ternary complex provided here reveals the structural mechanism of DNA binding ensuring interference. Harnessing GoCas12m innate ability to bind DNA target we fused it with adenine deaminase TadA-8e and showed an efficient A-to-G editing in Escherichia coli and human cells. Overall, this study expands our understanding of the functionally diverse Cas12 protein family, revealing DNA-binding dependent interference mechanism of Cas12m effectors that could be harnessed for engineering of compact base-editing tools.
CMC: Cancer miRNA Census – a list of cancer-related miRNA genes
Authors: Suszynska Malwina , Machowska Magdalena , Fraszczyk Eliza , Michalczyk Maciej , Philips Anna , Galka-Marciniak Paulina , Kozlowski Piotr
Published: January 2024

A growing body of evidence indicates an important role of miRNAs in cancer; however, there is no definitive, convenient-to-use list of cancer-related miRNAs or miRNA genes that may serve as a reference for analyses of miRNAs in cancer. To this end, we created a list of 165 cancer-related miRNA genes called the Cancer miRNA Census (CMC). The list is based on a score, built on various types of functional and genetic evidence for the role of particular miRNAs in cancer, e.g. miRNA–cancer associations reported in databases, associations of miRNAs with cancer hallmarks, or signals of positive selection of genetic alterations in cancer. The presence of well-recognized cancer-related miRNA genes, such as MIR21, MIR155, MIR15A, MIR17 or MIRLET7s, at the top of the CMC ranking directly confirms the accuracy and robustness of the list. Additionally, to verify and indicate the reliability of CMC, we performed a validation of criteria used to build CMC, comparison of CMC with various cancer data (publications and databases), and enrichment analyses of biological pathways and processes such as Gene Ontology or DisGeNET. All validation steps showed a strong association of CMC with cancer/cancer-related processes confirming its usefulness as a reference list of miRNA genes associated with cancer.
Cooperativity between Cas9 and hyperactive AID establishes broad and diversifying mutational footprints in base editors
Authors: Berríos Kiara N , Barka Aleksia , Gill Jasleen , Serrano Juan C , Bailer Peter F , Parker Jared B , Evitt Niklaus H , Gajula Kiran S , Shi Junwei , Kohli Rahul M
Published: January 2024

The partnership of DNA deaminase enzymes with CRISPR-Cas nucleases is now a well-established method to enable targeted genomic base editing. However, an understanding of how Cas9 and DNA deaminases collaborate to shape base editor (BE) outcomes has been lacking. Here, we support a novel mechanistic model of base editing by deriving a range of hyperactive activation-induced deaminase (AID) base editors (hBEs) and exploiting their characteristic diversifying activity. Our model involves multiple layers of previously underappreciated cooperativity in BE steps including: (i) Cas9 binding can potentially expose both DNA strands for ‘capture’ by the deaminase, a feature that is enhanced by guide RNA mismatches; (ii) after strand capture, the intrinsic activity of the DNA deaminase can tune window size and base editing efficiency; (iii) Cas9 defines the boundaries of editing on each strand, with deamination blocked by Cas9 binding to either the PAM or the protospacer and (iv) non-canonical edits on the guide RNA bound strand can be further elicited by changing which strand is nicked by Cas9. Leveraging insights from our mechanistic model, we create novel hBEs that can remarkably generate simultaneous C > T and G > A transitions over >65 bp with significant potential for targeted gene diversification.
On-surface synthesis and characterization of polyynic carbon chains
Authors: Gao Wenze , Zheng Wei , Sun Luye , Kang Faming , Zhou Zheng , Xu Wei
Published: January 2024

Carbyne, an elusive sp-hybridized linear carbon allotrope, has fascinated chemists and physicists for decades. Due to its high chemical reactivity and extreme instability, carbyne was much less explored in contrast to the sp2-hybridized carbon allotropes such as graphene. Herein, we report the on-surface synthesis of polyynic carbon chains by demetallization of organometallic polyynes on the Au(111) surface; the longest one observed consists of ∼60 alkyne units (120 carbon atoms). The polyynic structure of carbon chains with alternating triple and single bonds was unambiguously revealed by bond-resolved atomic force microscopy. Moreover, an atomically precise polyyne, C14, was successfully produced via tip-induced dehalogenation and ring-opening of the decachloroanthracene molecule (C14Cl10) on a bilayer NaCl/Au(111) surface at 4.7 K, and a band gap of 5.8 eV was measured by scanning tunnelling spectroscopy, in a good agreement with the theoretical HOMO–LUMO gap (5.48 eV).
Measuring Afrocentrism: A Review of Existing Instruments
Authors: Lateef Husain , Gale Adrian , Parker Meredith , Frempong Melody Konadu
Published: January 2024

Measurement of Afrocentrism and investigation of Afrocentricity’s significance in the lives of Black Americans has gained momentum, given the current evidence suggesting that cultural factors matter in the lives of diverse populations. In particular, factors associated with African philosophical constructs may have significant relationships with improved mental health and overall well-being among African and African diaspora populations. However, the prior conceptual literature suggests that Afrocentrism is a heterogenous concept with a multitude of domains associated with its measurement. The present study was envisioned given the relative absence of studies evaluating the availability and psychometric properties of Afrocentric measures within social work. Utilizing systematic analysis methodology and PRISMA guidelines, a search for Afrocentric measures was undertaken using four key databases. Spanning the literature between 1980 and 2021, this review identified a total of seven instruments that fully met the study’s inclusion-specific criteria. In accordance with the call for continued research and practice emphasizing resilience and protective factors within the lives of Black populations, the present study provides accessible knowledge to researchers and practitioners on the currently available instruments to evaluate Afrocentrism in the lives of populations of African descent.
Neurodevelopment of Children Whose Mothers Were Randomized to Low-Dose Aspirin During Pregnancy
Authors: Hoffman Matthew K. , Goudar Shivaprasad , Dhaded Sangappa , Figueroa Lester , Mazariegos Manolo , Krebs Nancy F. , Westcott Jamie , Tikmani Shiyam Sunder , Karim Fatima , Saleem Sarah , Goldenberg Robert L. , Lokangaka Adrien , Tshefu Antoinette , Bauserman Melissa , Patel Archana , Das Prabir , Hibberd Patricia , Chomba Elwyn , Mwenchanya Musaku , Carlo Waldemar A. , Trotta Marissa , Williams Alexis , Moore Janet , Nolen Tracy , Goco Norman , McClure Elizabeth M. , Lobo Michele A. , Cunha Andrea B. , Derman Richard J.
Published: January 2024

OBJECTIVE:

Because low-dose aspirin is now commonly prescribed in pregnancy, we sought to assess the association between early antenatal exposure and child neurodevelopment.

METHODS:

We performed a noninferiority, masked, neurodevelopmental follow-up study of children between age 33 and 39 months whose mothers had been randomized to daily low-dose aspirin (81 mg) or placebo between 6 0/7 and 13 6/7 weeks of gestation through 37 weeks. Neurodevelopment was assessed with the Bayley-III (Bayley Scales of Infant and Toddler Development, 3rd Edition) and the ASQ-3 (Ages and Stages Questionnaire, 3rd Edition). The primary outcome was the Bayley-III cognitive composite score with a difference within 4 points demonstrating noninferiority.

RESULTS:

A total of 640 children (329 in the low-dose aspirin group, 311 in the placebo group) were evaluated between September 2021 and June 2022. The Bayley-III cognitive composite score was noninferior between the two groups (−1, adjusted mean −0.8, 95% CI, −2.2 to 0.60). Significant differences were not seen in the language composite score (difference 0.7, 95% CI, −0.8 to 2.1) or the motor composite score (difference −0.6, 95% CI, −2.5 to 1.2). The proportion of children who had any component of the Bayley-III score lower than 70 did not differ between the two groups. Similarly, the communication, gross motor, fine motor, problem-solving, and personal–social components of the ASQ-3 did not differ between groups. Maternal characteristics, delivery outcomes, breastfeeding rates, breastfeeding duration, and home environment as measured by the Family Care Indicators were similar.

CONCLUSION:

Antenatal low-dose aspirin exposure was not associated with altered neurodevelopmental outcomes at age 3 years.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04888377.
Outcomes After Induction of Labor Compared With Dilation and Evacuation for the Management of Rupture of Membranes in the Second Trimester
Authors: Hoffman Elizabeth A. , Kaufman Jason , Koelper Nathanael C. , Sonalkar Sarita , Roe Andrea H.
Published: January 2024

Previable and periviable rupture of membranes is associated with significant morbidity for the pregnant patient. For those who have a choice of options and undergo active management, it is not known how the risks of induction of labor compare with those for dilation and evacuation (D&E). We performed a retrospective cohort study of patients with rupture of membranes between 14 0/7 and 23 6/7 weeks of gestation who opted for active management. Adverse events (52.2% vs 16.9%, P<.01) and time to uterine evacuation greater than 24 hours (26.7% vs 9.6%, P=.01) were more common among patients undergoing induction of labor. In a multivariable regression, induction of labor was an independent risk factor for complications (odds ratio 5.70, 95% CI, 2.35–13.82) compared with D&E. Severe complications were rare across both groups (4.4% for patients undergoing induction vs 2.6% for D&E, P=.63). Given the differing risks by termination method, access to D&E is an important treatment option for this patient population.
Characteristics and outcomes of non-operatively managed hip fracture patients using the Dutch Hip Fracture Audit (DHFA).
Authors: Bremen Hanne-Eva van , Seppala Lotta J. , Hegeman Johannes H. , van der Velde Nathalie , Willems Hanna C. ,   on behalf of Dutch Hip Fracture Audit Group
Published: January 2024

OBJECTIVE:

This study aims to identify and compare characteristics of hip fracture patients treated non-operatively versus those treated operatively.

METHODS:

Design:

Retrospective cohort study.

Setting:

Hip fracture population-based study.

Patient Selection Criteria:

All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded.

Outcome Measures and Comparisons:

Patients were categorized according to the type of management (operative vs non-operative) and type of fracture (nondisplaced vs other). Patient- and fracture characteristics associated with non-operative management were analyzed.

RESULTS:

A total of 94.930 hip fracture patients were included. 3.2% of the patients were treated non-operatively. Patients receiving non-operative management were older (86 years [interquartile range 79-91] vs 81 years [interquartile range 72-87] P <.001), more frequently institutionalized (42.4% vs 17.6%), and were more dependent in activities of daily living (22.2% vs 55.0%) . Various clinical characteristics, including dementia (odds ratio 1.31 [95% confidence interval, 1.18-1.45] P < .001), no functional mobility (odds ratio 4.39 [95% confidence interval 3.14-3.68] P <.001), and KATZ-6-ADL (OR 1.17 [95% CI 1.14-1.20] P < .001) were independently associated with non-operative management. 7-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively.

CONCLUSIONS:

The first step in understanding which patients potentially benefit from non-operative management is evaluating the current standard of care. This study provides insight to the current hip fracture population treated non-operatively. These patients are older, have higher percentage of dementia, more dependent and show higher short-term mortality rates.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Gamification in Critical Care Education and Practice
Authors: Bass Gary Alan , Chang Cherylee W. J. , Sorce Lauren R. , Subramanian Sanjay , Laytin Adam D. , Somodi Reka , Gray Jaime R. , Lane-Fall Meghan , Kaplan Lewis J.
Published: January 2024

OBJECTIVES:

To explore gamification as an alternative approach to healthcare education and its potential applications to critical care.

DATA SOURCES:

English language manuscripts addressing: 1) gamification theory and application in healthcare and critical care and 2) implementation science focused on the knowledge-to-practice gap were identified in Medline and PubMed databases (inception to 2023).

STUDY SELECTION:

Studies delineating gamification underpinnings, application in education or procedural mentoring, utilization for healthcare or critical care education and practice, and analyses of benefits or pitfalls in comparison to other educational or behavioral modification approaches.

DATA EXTRACTION:

Data indicated the key gamification tenets and the venues within which they were used to enhance knowledge, support continuing medical education, teach procedural skills, enhance decision-making, or modify behavior.

DATA SYNTHESIS:

Gamification engages learners in a visual and cognitive fashion using competitive approaches to enhance acquiring new knowledge or skills. While gamification may be used in a variety of settings, specific design elements may relate to the learning environment or learner styles. Additionally, solo and group gamification approaches demonstrate success and leverage adult learning theory elements in a low-stress and low-risk setting. The potential for gamification-driven behavioral modification to close the knowledge-to-practice gap and enable guideline and protocol compliance remains underutilized.

CONCLUSIONS:

Gamification offers the potential to substantially enhance how critical care professionals acquire and then implement new knowledge in a fashion that is more engaging and rewarding than traditional approaches. Accordingly, educational undertakings from courses to offerings at medical professional meetings may benefit from being gamified.
Effect of Virtual Game–Based Integrated Clinical Practice Simulation Program on Undergraduate Nursing Students' Attitude Toward Learning
Authors: Kim Hyun Jin , Oh Juyeon , Lee Seonhye
Published: January 2024

Game-based virtual reality simulation programs can capitalize on the advantages of non–face-to-face education while effectively stimulating the interest of trainees and improving training efficiency. This study aimed to develop a game-based virtual reality simulation program for nervous system assessment and to evaluate the effects of the program on the learning attitudes of nursing students. Using a one-group pretest-posttest design, 41 senior nursing students were enrolled, and their learning attitudes (self-directed learning attitude, academic self-efficacy, flow-learning experience, and learning presence) were evaluated. The effect of the program was statistically significant in self-directed learning attitude (t = −2.27, P = .027) and learning presence (t = −3.07, P = .003), but the difference was not statistically significant in academic self-efficacy (t = −1.97, P = .054) and learning flow (t = −0.74, P = .459). The virtual gaming simulation program can be used to effectively replace field training in situations wherein field training is limited, such as during the COVID-19 pandemic.
Delayed Postnatal Synostosis without Spheno-occipital Synchondrosis Fusion: A Curious Case of Apert Syndrome
Authors: Ng Jinggang J. , Massenburg Benjamin B. , Wu Meagan , Romeo Dominic J. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P.
Published: January 2024

Apert syndrome classically presents with craniosynostosis at birth, most commonly of the bilateral coronal sutures, which may lead to cephalocranial disproportion and elevated intracranial pressure, the latter of which is associated with optic atrophy, visual loss, and developmental delays. A small number of patients with syndromic craniosynostosis demonstrate open sutures at birth; however, all previously reported patients of this subtype have been reported to develop premature suture fusion in the early postnatal period and/or require cranial vault expansion for increased intracranial pressure. Here, we report on a patient with Apert syndrome who did not have closed sutures at birth, and only began to demonstrate unilateral coronal suture fusion between ages 4 and 6 years, yet neither developed phenotypic signs of craniosynostosis nor evidence of intracranial hypertension. Moreover, despite demonstrating patency of the spheno-occipital synchondrosis, the patient developed progressive midface hypoplasia, requiring a subcranial Le Fort 3 advancement with external distraction at age 9. Now at skeletal maturity, this patient has a normal cranial shape and will likely never require cranial vault surgery for functional or aesthetic concerns. We are not aware of any prior reports of a patient with Apert syndrome who did not require intracranial surgery over long-term follow-up.
Educating Future Generations of Surgeons across Borders: Novel Global Linked Hybrid Live Cadaveric Peripheral Nerve Surgical Training Course
Authors: Burahee Abdus S. , Duraku Liron S. , Hundepool Caroline A. , Eberlin Kyle R. , Moore Amy , Dy Christopher J. , Abdullah Shalimar , Rajaratnam Vaikunthan , Zuidam J. Michiel , Power Dominic M.
Published: January 2024

Background:

This study aimed to evaluate a novel, multi-site, technology-facilitated education and training course in peripheral nerve surgery. The program was developed to address the training gaps in this specialized field by integrating a structured curriculum, high-fidelity cadaveric dissection, and surgical simulation with real-time expert guidance.

Methods:

A collaboration between the Global Nerve Foundation and Esser Masterclass facilitated the program, which was conducted across three international sites. The curriculum was developed by a panel of experienced peripheral nerve surgeons and included both text-based and multimedia resources. Participants’ knowledge and skills were assessed using pre- and postcourse questionnaires.

Results:

A total of 73 participants from 26 countries enrolled and consented for data usage for research purposes. The professional background was diverse, including hand surgeons, plastic surgeons, orthopedic surgeons, and neurosurgeons. Participants reported significant improvements in knowledge and skills across all covered topics (p < 0.001). The course received a 100% recommendation rate, and 88% confirmed that it met their educational objectives.

Conclusions:

This study underscores the potential of technology-enabled, collaborative expert-led training programs in overcoming geographical and logistical barriers, setting a new standard for globally accessible, high-quality surgical training. It highlights the practical and logistical challenges of multi-site training, such as time zone differences and participant fatigue. It also provides practical insights for future medical educational endeavors, particularly those that aim to be comprehensive, international, and technologically facilitated.
Identifying and Predicting Subgroups of Veterans With Mild Traumatic Brain Injury Based on Distinct Configurations of Postconcussive Symptom Endorsement: A Latent Class Analysis
Authors: Kinney Adam R. , Schneider Alexandra L. , King Samuel E. , Yan Xiang-Dong , Forster Jeri E. , Bahraini Nazanin H. , Brenner Lisa A.
Published: January 2024

Objective:

To identify distinct subgroups of veterans with mild traumatic brain injury (mTBI) based on configurations of postconcussive symptom (PCS) endorsement, and to examine predictors of subgroup membership.

Setting:

Outpatient Veterans Health Administration (VHA).

Participants:

Veterans with clinician-confirmed mTBI who completed the Neurobehavioral Symptom Inventory (NSI), determined using the Comprehensive Traumatic Brain Injury Evaluation database. Individuals who tended to overreport symptoms were excluded via an embedded symptom validity scale.

Design:

Retrospective cohort study leveraging national VHA clinical data from 2012 to 2020. Latent class analysis (LCA) with a split-sample cross-validation procedure was used to identify subgroups of veterans. Multinomial logistic regression was used to examine predictors of subgroup membership.

Main Measures:

Latent classes identified using NSI items.

Results:

The study included 72 252 eligible veterans, who were primarily White (73%) and male (94%). The LCA supported 7 distinct subgroups of veterans with mTBI, characterized by diverging patterns of risk for specific PCS across vestibular (eg, dizziness), somatosensory (eg, headache), cognitive (eg, forgetfulness), and mood domains (eg, anxiety). The most prevalent subgroup was Global (20.7%), followed by Cognitive-Mood (16.3%), Headache-Cognitive-Mood (H-C-M; 16.3%), Headache-Mood (14.2%), Anxiety (13.8%), Headache-Sleep (10.3%), and Minimal (8.5%). The Global class was used as the reference class for multinomial logistic regression because it was distinguished from others based on elevated risk for PCS across all domains. Female (vs male), Black (vs White), and Hispanic veterans (vs non-Hispanic) were less likely to be members of most subgroups characterized by lesser PCS endorsement relative to the Global class (excluding Headache-Mood).

Conclusion:

The 7 distinct groups identified in this study distill heterogenous patterns of PCS endorsement into clinically actionable phenotypes that can be used to tailor clinical management of veterans with mTBI. Findings reveal empirical support for potential racial, ethnic, and sex-based disparities in PCS among veterans, informing efforts aimed at promoting equitable recovery from mTBI in this population.
Automated detection of vitritis using ultrawide-field fundus photographs and deep learning
Authors: Mhibik Bayram , Kouadio Desire , Jung Camille , Bchir Chemsedine , Toutée Adelaide , Maestri Federico , Gulic Karmen , Miere Alexandra , Falcione Alessandro , Touati Myriam , Monnet Dominique , Bodaghi Bahram , Touhami Sara
Published: January 2024

Purpose:

Evaluate the performance of a deep learning (DL) algorithm for the automated detection and grading of vitritis on ultra-wide field (UWF) imaging.

Design:

Cross-sectional non-interventional study.

Method:

UWF fundus retinophotographs of uveitis patients were used. Vitreous haze was defined according to the 6 steps of the SUN classification. The DL framework TensorFlow and the DenseNet121 convolutional neural network were used to perform the classification task. The best fitted model was tested in a validation study.

Results:

1181 images were included. The performance of the model for the detection of vitritis was good with a sensitivity of 91%, a specificity of 89%, an accuracy of 0.90 and an area under the ROC curve of 0.97. When used on an external set of images, the accuracy for the detection of vitritis was 0.78. The accuracy to classify vitritis in one of the 6 SUN grades was limited (0.61), but improved to 0.75 when the grades were grouped in three categories. When accepting an error of one grade, the accuracy for the 6-class classification increased to 0.90, suggesting the need for a larger sample to improve the model performances.

Conclusion:

We describe a new DL model based on UWF fundus imaging that produces an efficient tool for the detection of vitritis. The performance of the model for the grading into 3 categories of increasing vitritis severity was acceptable. The performance for the 6-class grading of vitritis was limited but can probably be improved with a larger set of images.
NON-EXUDATIVE INTRARETINAL FLUID IN INTERMEDIATE AGE-RELATED MACULAR DEGENERATION
Authors: Servillo Andrea , Kesim Cem , Sacconi Riccardo , Battist Marco , Capuano Vittorio , Fragiotta Serena , Querques Lea , Parravano Mariacristina , Souied Eric H. , Bandello Francesco , Querques Giuseppe
Published: January 2024

Background:

To describe the occurrence of non-exudative intraretinal fluid (IRF) in intermediate age-related macular degeneration (iAMD).

Methods:

A retrospective study was designed to include consecutive cases with iAMD associated with IRF. A multimodal imaging (MMI) approach was used to confirm diagnosis of IRF in iAMD. MMI included color fundus photograph, fundus autofluorescence, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) and OCT angiography (OCT-A).

Results:

Ten eyes of 10 patients (2 males and 8 females, ages 68-80) showing IRF in iAMD were included in the study. Mean best-corrected visual acuity was 20/40 Snellen equivalent. MMI including FA/ICGA, and OCT demonstrated the absence of macular neovascularization (MNV) in all cases; OCT-A did not detect any abnormal flow signal associated with IRF. Seven out of 10 patients developed IRF in correspondence of pigment epithelium detachment. Three out of 10 patients presented IRF in correspondence of an area of nascent geographic atrophy.

Conclusion:

Non-exudative intraretinal fluid in intermediate AMD is a novel, distinctive feature that is characterized by the presence of IRF with no evidence of MNV. We described different phenotypes of IRF in iAMD. The definite diagnosis of this condition requires further studies with thorough application of multimodal imaging.
Ten-year results of scleral-fixated intraocular lens implantation: outcomes of ab externo scleral fixation with 10-0 polypropylene suture
Authors: Desai Arjun , Pappuru Rajeev Reddy , Tyagi Mudit
Published: January 2024

Purpose:

To describe long-term visual and anatomical outcomes of sutured scleral-fixated intraocular lens (SF IOL) implantation.

Setting:

Tertiary eyecare hospital in India.

Design:

Retrospective interventional noncomparative study.

Methods:

Postoperative change in corrected distance visual acuity (CDVA) and occurrence of complications were assessed from the patient medical records. Long-term SF IOL survival rates and factors affecting the occurrence of postoperative IOL-related complications were assessed. Patients with postoperative follow-up less than 10 years or incomplete medical records were excluded.

Results:

64 eyes of 53 patients were included. Follow-up duration was 11.4 ± 1.2 years. Mean preoperative CDVA was 0.71 ± 0.43 logMAR (Snellen equivalent: 6/30), and mean CDVA at the final visit was 0.52 ± 0.49 logMAR (Snellen equivalent: 6/18) (P < .01). 48% cases had CDVA of 6/12 or better at the last follow-up. 58% cases had coexistent ocular pathology affecting the final visual outcome. IOL and suture-related complications were the commonest and included IOL decentration (17% cases), IOL drop (14%), and suture exposure (6%). The probability of IOL survival (postoperative period without IOL-related complications) was 90.6% at 8 years and 81.2% at 10 years (Kaplan-Meier analysis). Occurrence of postoperative IOL-related complications was unaffected by patient sex, age, indication for surgery (trauma or other), previous intraocular surgery, or technique of scleral fixation (2-point or 4-point) (multivariate regression analysis).

Conclusions:

Although sutured SF IOL implantation is viable with favorable long-term visual outcomes, there is a risk of postoperative IOL-related complications. Occurrence of postoperative IOL-related complications is unaffected by patient and ocular factors.
A Systematic Review of Cochlear Implant-Related Magnetic Resonance Imaging Artifact: Implications for Clinical Imaging
Authors: Berry Joseph M. , Tansey James B. , Wu Lin , Choudhri Asim , Yawn Robert J. , MacDonald Charles Bruce , Richard Celine
Published: January 2024

Objective

To conduct a systematic review of the existing literature with the aim of evaluating and consolidating the present understanding of strategies for mitigating magnetic resonance imaging (MRI) artifacts related to cochlear implants in adult and pediatric patients, covering both in-vivo and ex-vivo investigations.

Data Sources

A systematic review of MEDLINE-Ovid, Embase, Google Scholar, The Cochrane Library, and Scopus was performed from inception through April 2022. The protocol was registered with PROSPERO before commencement of data collection (CRD CRD42022319651).

Review Methods

The data were screened and collected by two authors independently, and eligibility was assessed according to Cochrane Handbook and Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations, whereas the quality of the articles was evaluated using the NIH Study Quality Assessment.

Results

The search yielded 2,354 potentially relevant articles, of which 27 studies were included in the final review. Twelve studies looked at 1.5-T MRI, four studies looked at 3-T MRI, eight studies looked at both 1.5 and 3 T, one study looked at 0.2 and 1.5 T, and one study looked at 3- and 7.0-T MRI. Nineteen studies focused on MRI sequences as a means of artifact reduction, nine studies focused on implant magnet positioning, two studies focused on head positioning, and one study focused on both magnet and head positioning. In terms of MRI sequences, diffusion-weighted imaging produced larger artifacts compared with other sequences, whereas fast spin echo/turbo spin echo sequences and fat suppression techniques produced smaller artifacts. The position of the magnet was also found to be important, with a magnet position more than 6.5 cm posterior to the external auditory canal producing the best images with the least distortion. The angle at which the magnet is placed also affects visibility of different brain structures.

Conclusion

Proper head positioning, magnet placement at a distance of over 6.5 cm from the external auditory canal, use of spin echo sequences, and fat suppression techniques reduce the size and shape of MRI artifacts.
Tight junction proteins and biliary diseases
Authors: Merlen Grégory , Tordjmann Thierry
Published: January 2024

Purpose of review

In the pathophysiological context of cholangiopathies and more broadly of hepatopathies, while it is conceptually clear that the maintenance of inter-cholangiocyte and inter-hepatocyte tight junction integrity would be crucial for liver protection, only scarce studies have been devoted to this topic. Indeed, in the liver, alteration of tight junctions, the intercellular adhesion complexes that control paracellular permeability would result in leaky bile ducts and bile canaliculi, allowing bile reflux towards hepatic parenchyma, contributing to injury during the disease process.

Recent findings

Last decades have provided a great deal of information regarding both tight junction structural organization and signaling pathways related to tight junctions, providing clues about potential intervention to modulate paracellular permeability during cholangiopathies pathogenesis. Interestingly, several liver diseases have been reported to be associated with abnormal expression of one or several tight junction proteins. However, the question remains unanswered if these alterations would be primarily involved in the disease pathogenesis or if they would occur secondarily in the pathological course.

In this review, we provide an overview of tight junction disruptions described in various biliary diseases that should pave the way for defining new therapeutic targets in this field.
Leadership Behaviors of Frontline Nurse Managers
Authors: Frangieh Jihane , Jones Terry , Kinser Patricia Anne , Baker Kathy , Elswick Ronald K. , Thacker Leroy R.
Published: January 2024

OBJECTIVE

This study examined how frontline nurse managers (FLNMs) perceive and experience formal and informal social support and how personal factors and social support relate to their transformational leadership (TL) behaviors.

BACKGROUND

Ineffective leadership by FLNMs is associated with costly outcomes. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed.

METHODS

A convergent mixed-methods design was used. The quantitative strand included a cross-sectional survey in a sample of FLNMs. The qualitative strand used a semistructured interview and a descriptive qualitative approach with a subset of this sample.

RESULTS

Formal and informal social support is positively related to the TL behaviors of FLNMs as evidenced by the convergent data. The influence of family members in the work-related decisions of FLNMs has been underreported in the literature and is an area for consideration in supporting retention and desired leadership behaviors.

CONCLUSION

The findings of this study imply a need for organizations to establish systems that endorse the growth of FLNMS, create opportunities for career advancement, and integrate members of the FLNMs' personal support systems into recognition initiatives.
Developing Nurses and Interdisciplinary Teams in Caring Science
Authors: Cartwright Tina , Jenkins Peggy , Florom-Smith Aubrey L.
Published: January 2024

This program evaluation assessed a caring science program's impact on nurse and interdisciplinary professionals' self-reported caring, compassion satisfaction, and intent to leave at an academic-affiliated community hospital. A 3-session program resulted in self-caring and intent to leave significant increases at 60 days post intervention. Findings demonstrated caring science interventions alone are insufficient to impact staff engagement and intent to leave. Further actions for organizational culture changes are discussed.
Short-term and Long-term Outcomes of Robotic Enucleation of Tumors Located in the Pancreatic Head and Uncinate Process
Authors: Ou Huiyi , Chen Mengmin , Qin Kai , Zhao Shiwei , Li Dan , Shi Yusheng , Weng Yuanchi , Gemenetzis Georgios , Deng Xiaxing , Peng Chenghong , Shen Baiyong , Jin Jiabin
Published: January 2024

Objective:

To assess short-term and long-term outcomes following robotic enucleation (REn) of tumors in the proximal pancreas.

Background:

Despite the advantages of preserving function via pancreatic enucleation, controversies persist, since this can be associated with severe complications, such as clinically relevant postoperative pancreatic fistula, especially when performed near the main pancreatic duct. The safety and efficacy of REn in this context remain largely unknown.

Methods:

A retrospective analysis was performed of all patients who underwent REn for benign and low-grade malignant neoplasms in the pancreatic head and uncinate process between January 2005 and December 2021. Clinicopathologic, perioperative, and long-term outcomes were compared with a similar open enucleation (OEn) group.

Results:

Of 146 patients, 92 underwent REn with a zero conversion-to-open rate. REn was superior to OEn in terms of shorter operative time (90.0 minutes vs 120.0 minutes, P<0.001), decreased blood loss (20.0 mL vs 100.0 min, P=0.001), and lower clinically relevant postoperative pancreatic fistula rate (43.5% vs 61.1%, P=0.040). Bile leakage rate, major morbidity, 90-day mortality, and length of hospital stay were comparable between groups. No post-REn grade C POPF or grade IV/V complication was identified. Subgroup analyses for uncinate process tumors and proximity to the main pancreatic duct did not demonstrate inferior postoperative outcomes. In a median follow-up period of 50 months, REn outcomes were comparable to OEn regarding recurrence rate and pancreatic endocrine or exocrine function.

Conclusions:

REn for pancreatic head and uncinate process tumors improved clinically relevant outcomes without increased major complications compared to OEn, while demonstrating comparable long-term oncological and functional outcomes.