bluuebunny/crossref_metadata_2025 huggingface dataset:
317 A Systematic Review of Quality-of-Life Instruments in Acute and Chronic Pancreatitis: A Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Approach
Authors:   STARSurg Collaborative
Published: August 2023

Aim

To identify and evaluate the methodological quality of the quality of life (QoL) instruments used for patients with acute or chronic pancreatitis.

Method

Prospective studies that evaluated QoL in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 5th August 2021 (PROSPERO: CRD42021274743). Characteristics of QoL instruments were extracted, and their methodological quality assessed using COSMIN guidelines and GRADE approach. A narrative synthesis was conducted, with recommendations for instrument use based on COSMIN criteria regarding internal consistency and content validity (evaluated according to WHO QoL domains: physical health, psychological health, social relationships, level of independence, environment, and personal values).

Results

From 3850 records screened, 43 QoL instruments were identified across 131 studies included, involving 20,331 patients. The majority (69.8%, n = 30) were designed to assess general health related QoL, with 7 (16.3%) specific to abdominal pathologies, and 6 (14.0%) specific to chronic pancreatitis. Approximately half of the instruments (51.1%, n = 22) demonstrated sufficient content validity, incorporating items in ≥3 WHO QoL domains. However, only a minority of instruments incorporated public and patient involvement (34.8%, n = 15) or had undergone validation (22.3%, n = 10). Only the “Gastrointestinal Quality of Life Index” met the criteria to be recommended for use based on COSMIN methodological assessment.

Conclusions

There is significant heterogeneity in instruments used to assess QoL after pancreatitis, with almost all studies incorporating instruments with either insufficient methodological quality or construct validity. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve QoL for these patients.
373 Scoping Review: Definition of Major Abdominal Surgery
Authors: Clymo J , Dorudi Y , Courtney A , Dorudi S , Moonesinghe S R
Published: August 2023

Aim

The aim of this scoping review was to propose a definition major abdominal surgery (MAS).

Method

We searched the following databases: Medline, EMBASE, Web of Science, Global Health, Health Management Information Consortium, APA PsycInfo. Original research articles, systematic reviews or meta-analyses published between 1980 and 26 April 2022 were included in this scoping review. Inclusion criteria consisted of: specific reference to the operation, adult population, treatment within secondary care, and availability of full text. Three authors assessed each article’s eligibility for inclusion.

Results

5,663 articles were identified in our search, of which 767 underwent full-text review and 312 were included in the scoping review. Half of the included articles were observational trials (54.5%) and one third were randomised control trials (37.8%). A significant proportion of studies were conducted in Europe (47.4%) or North America (19.2%), with a minority of studies conducted in the UK (4.5%). Just under half of these studies were led by anaesthetists (47.4%) rather than surgeons with 45.8% of studies focused on post-operative care and outcomes. Analysis of these studies revealed that the description of major abdominal surgery fell into 4 broad categories: anatomical criteria, procedure-based criteria, specialty-specific resections, and arbitrary procedures.

Conclusions

We established that there is no agreed definition of major abdominal surgery. We propose that any definition of major abdominal surgery should be based on anatomical criteria alone. Research is underway to confirm a difference in the post-operative recovery profiles of patients undergoing MAS and non-MAS procedures as per our classification.
1058 Jejunal or Ileal Exocrine Drainage in Pancreas Transplantation?
Authors: Tan J , Doherty D , McFarlane R , Kingston J , Moinuddin Z , Khambalia H , Augustine T , van Dellen D
Published: August 2023

Aim

Pancreas transplantation (PT) is performed for restoration of endocrine function in type 1 diabetes mellitus with amelioration of diabetic complications. However, PT can have serious complications requiring salvage pancreatectomy and surgical approaches should be carefully considered. Anastomoses to jejunum or ileum are most often employed. We compare outcomes between these techniques.

Method

A retrospective analysis was performed on simultaneous pancreas and kidney transplants (SPK) at Manchester University Hospitals NHS Foundation Trust between 2013 and 2015. Follow up was completed until 2020.

Results

86 SPK were performed. 59.2% were male with mean age of 41.5yo (SD±8.4). 72.4% (n = 55) were donors after brain death and 98.7% (n = 75) were receiving first PT. 43 SPK were performed with ileal anastomosis, 33 jejunal. There were no significant differences in demographics of recipients, donors, immunosuppression regimens, overall patient and graft survival and frequency of GI complications. Length of hospital stay was higher with ileal anastomosis (median 14 v 19 days, p<0.05), as was cold ischaemic time (median 8:48 v 9:31 hours, p<0.05). Three patients required salvage pancreatectomy and loop ileostomy formation with multi-organ support and prolonged ITU stay.

Conclusions

Long term outcomes between groups were comparable in this cohort. Catastrophic complications occur in the minority requiring salvage surgery. Here more occurred with ileal anastomosis, but this approach allows graft pancreatectomy and formation of loop ileostomy, avoiding a more proximal stoma in a clinically unstable patient. Further powered studies are required to rigorously examine the impact of enteric anastomosis site.
104 Audit on Adherence to the BOAST Guidelines on the Safe Use of Intraoperative Tourniquets
Authors: Dosani S , Devarakonda S
Published: August 2023

Aim

Tourniquets can prevent blood loss and improve the surgical viewing field however incorrect use leads to local tissue damage and production of harmful metabolites, causing further damage. The aim of this audit was to investigate the usage of correct tourniquet techniques during intraoperative procedures, comparing them to updated BOA guidelines.

Method

Conducted a retrospective clinical audit documenting discrepancies between operation notes/data against BOA standard guidelines. All procedures, both elective and emergency, during the period of November 2021 to February 2022 which required the use of tourniquets were included.

Results

A total 291 procedures were carried out, 90% were limb and the remaining 10% were finger/toe tourniquets. In the former pressure was recorded in 230 (87.8%) procedures and the mean pressure in upper limbs was 248 (+-14)mmHg and 270 (+-27) in lower limbs. 95.2% of patients in the study were >16 years old and the mean tourniquet time was 61.5 (+-36.4) mins, exceeding 120 minutes in only 13 cases. The Tourniquet type was documented for only 8.2% of procedures and the method of exsanguination for 34.7%. There was no record of skin isolation methods and skin condition.

Conclusions

Adherence to guidelines was not sufficient for some components of the procedures, including site information, method of isolation and method of exsanguination. Possible interventions include educational tutorials for staff and setting up visual aids within the OT. Results were presented in a local meeting and a re-audit is planned for 3-4 months’ time.
301 Weight Bear That Ankle ASAP
Authors: Hammond R , Wong M , Ibrahim Y , Janipireddy S
Published: August 2023

Background

BOAST guidelines suggest that most patients should be advised to weight bear as tolerated, immediately after surgery, in a splint or cast unless there are specific concerns about the stability of the fixation or any contraindications.

The purpose of this audit is to determine the weight-bearing practice of surgically managed ankle fractures. Secondarily we aimed to assess whether a reduction in time to weight-bear would impact patient outcomes.

Method

Sixty-one surgically managed ankle fractures were included (35 retrospectively between March 2021 - September 2021 and 26 prospectively between March 2022 - July 2022).

Intervention after primary data analysis included the presentation of audit findings in T&O MDT meeting. The foot and Ankle consultant body encouraged the department to weight-bear patients as soon as possible post-operatively.

Results

There was a significant (p = 0.0072) reduction in the time-to-weight-bear between cycle 1 (39.7 ±15.2 days) and cycle 2 (27.3 ±19.7 days).

After intervention, 22% more people were weight-bearing before 14 days (ie. a significant increase from 8.6% to 30.8%; p = 0.025). This was not associated with an increased incidence of complications.

64.3% of all post-operative complications occurred in patients’ weight-bearing only after 6 weeks. There was no increase in complications if patients weight bear before the traditional '6 week' rule (p = 0.11). The presence of pre-operative risk factors was significantly associated with an increase in complication rates (p = 0.017).

Conclusions

This audit suggests reducing the time-to-weight-bear in patients with surgically managed ankle fractures is safe and does not result in worse patient outcomes.
1035 Puppy Pandemic: A Review of Injuries Sustained from Dogs Before and After the UK Lockdowns in a Major Trauma Centre
Authors: Northway J , Garus P , Jack C
Published: August 2023

Aim

The COVID-19 pandemic saw a boom in UK pet ownership, dogs in particular, with 3.2 million households acquiring a pet during the lockdown period. While dog bites are well-documented, there is little research on other injuries sustained from dogs. This study aimed to identify and describe the various dog-associated injuries and their management, as well as determine if there was an increase in hospital attendance with dog-associated injuries during the lockdown period.

Method

A retrospective review of all patients seen by the orthopaedic team at a major trauma centre with dog-related injuries was conducted, comparing attendances between June and September 2019 (‘pre-panemic’) and the same period in 2021 (‘post-pandemic’). Demographics, injuries sustained, mechanism of injury, length of stay and operative management required were among the data analysed.

Results

There was a 32.7% increase in dog-related injuries between 2019 (n = 49) and 2021 (n = 65), the majority being fractures and lacerations. The most common mechanism of injury was tripping over a dog, followed by falls while walking and bites/scratches. Most injuries occurred in the home, with 71% of patients being the dog owner. Operative management was required in 51% of cases in the 2019 group and 29% in 2021.

Conclusions

To our knowledge, this is a novel research area, describing all dog-related injuries versus only bites. Fractures were the most common dog-related injury in both groups. This mechanism of injury presents a burden to healthcare in terms of resources. Fragility fractures need to be considered for this mechanism of injury.
996 Circumcisions in the Community; a New Initiative
Authors: Caratella S , Desai B , Patel J , Rai J
Published: August 2023

Introduction

The average waiting time for an initial outpatient appointment in urology at UHL is 23 weeks and waiting times for circumcisions are significantly longer. A new initiative in Leicester has enabled a proportion of fit and healthy NHS patients to have their circumcision under LA within the community.

Our aim was to audit our practice to determine if this initiative could be trialled across other urological departments in the UK.

Method

A prospective database has been maintained and 76 patients who underwent a circumcision in the community between November 2021 and August 2022 were identified. 16 patients were excluded since they were not contactable via telephone. Online hospital records and GP records were used in addition to contacting patients via telephone to collect data.

Results

The mean satisfaction level with the service provided was 8.28. The total post-operative complication rate was 35% with a 25% post operative surgical site infection rate.

There were 2 (3.3%) admissions to hospital secondary to penile abscesses and possible skin necrosis of which both required drainage in theatre. The average length of admission for these patients was 2.5 days. 3 (5%) patients were unhappy with cosmesis, and 2 patients have had/are awaiting a redo circumcision.

Conclusions

Through this new initiative 76 patients have been removed from the NHS waiting lists for circumcision thereby reducing waiting times with very high patient satisfaction. This indicates that this new initiative could be trialled in other departments and could also be used to reduce waiting lists for other minor procedures.
529 Institutional Experience of Patients with Complex Abdominal Aorta Aneurysms Undergoing Fenestrated Endovascular Repair: A Retrospective, Single-Centre Study
Authors: Joyce D , Kerr S , Gannon M , Renwick B , Bachoo P
Published: August 2023

Aim

To determine the short- and long-term outcomes of patients with complex abdominal aorta aneurysms (CAAAs) managed with fenestrated endovascular aneurysm repair (fEVAR) at a tertiary vascular unit.

Method

All patients undergoing fEVAR for elective CAAA between January 2013 and December 2021 were retrospectively identified. Primary outcomes were mortality rate and stent patency (assessed by CT imaging). Secondary outcomes included rates of reintervention. Follow-up intervals were at 30 days, 1 year, 3 years and 5 years. Descriptive statistics are reported.

Results

61 patients were identified; 5 were excluded due to follow-up in a different health board. Of the 56 analysed, 49 (88%) were male and median age was 75 (IQR 68-83). The average number of fenestrations used per fEVAR graft was 3 (range 2-6). Mortality rate was 2% at 30-day, 9% at 1-year and 25% at 5-year. At 5-year follow-up, all patients (n = 11) had grafts with all fenestrations patents. There was an 11% (n = 6) reintervention rate in a 5-year period. Median time to reintervention was 12 months (range 5-36 months). Reintervention included 4 requiring embolization for a Type II endoleak, 1 patient required an iliac stent extension, and 1 patient required a renal stent.

Conclusions

With fEVAR being a relatively newly adopted technique, this data demonstrates technical success with low re-intervention rates when used for CAAAs. Future work should include organising a multi-centre study to gain a larger sample size to compare rates of fEVAR success in different centres.
1040 Impact of Common Femoral Artery Calcification on the Comparative Efficacy of Vascular Closure Device Deployments Following Large Bore Vascular Access
Authors: Hakeem A , Khokher Z , Najem M , Chaudhuri A
Published: August 2023

Introduction

The suture-mediated ProGlide and more recently, the plug-based MANTA are commonly used vascular closure devices (VCDs) for large-bore vascular access haemostasis, though both devices operate differently. The site and extent of the common femoral artery (CFA) calcification are significant determinants of the choice of VCD. Anterior calcification may hamper ProGlide deployments, while posterior calcification may represent a similar consideration for the MANTA.

Method

A retrospective analysis of procedures with large-bore CFA access from 2017 to 2022 was undertaken. The access sites are grouped as Group A (Proglide) and Group B (MANTA). Calcification graded as (0 = none, 1 = Anterior, 2 = Posterior and 3 = Anterior & Posterior) on preoperative CTA along 10mm segments with 0.625mm slice thickness. Minitabv21 was used for Statistical analysis, particularly analysing the correlation of calcification to VCD deployment success rates.

Results

We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A, 127 Group B). The mean age was 74.9±8 (183 males), the average BMI was 28±5.8 (44 diabetics), and 180 (86.9%) were smokers. Grade 1 Calcification was 1.8%, Grade 2, 49% (120 Group A, 63 Group B) and Grade 2, 14.3% (31 Group A, 22 Group B). Successful deployment was achieved in 91% (337 groins, p = 0.86). The correlation of calcification with successful deployment was not significant p = 0.33.

Conclusions

Posterior calcification was more common in both groups. The site of calcification did not impact the efficacy of the closure device. All our percutaneous accesses were ultrasound-guided, we concluded it can improve the effectiveness of VCD, avoiding calcification.
New clues to the elusive aetiology of nodding syndrome
Authors: Spencer Peter S
Published: August 2023

Nodding syndrome is a paediatric epileptic encephalopathy of unknown aetiology that affects children in impoverished communities of Eastern Africa subject to internal displacement. Set in southcentral South Sudan, where nodding syndrome first surfaced circa 1990, an important new study of recent-onset cases of nodding syndrome examined parasitic, bacterial, viral, immune-mediated, metabolic and nutritional factors associated with the brain disease. Infection with the nematode Mansonella perstans, but not with Onchocerca volvulus, was the most prominent finding in nodding syndrome cases versus controls. While M. perstans is unlikely to be causal of nodding syndrome, investigation of the freshwater habitats, where insect-to-human transmission of the filarial larvae takes place, may reveal a clue as to the aetiology of this neurodegenerative disease. The culpable environmental agent(s) must be able to induce neuroinflammation and tau pathology preferentially in infants and children.
Venous thromboembolism in patients with psoriasis: a retrospective single-centre chart review of an overlooked comorbidity
Authors: Hillary Tom , Grymonprez Michèle , Vanhooren Emma , Güvenç Canan , Garmyn Maria , Vermeire Séverine
Published: August 2023

Venous thromboembolism (VTE), although not commonly associated with psoriasis, was prevalent in a cohort of > 2000 patients with psoriasis. We identified older age (> 70 years), a history of malignancy and arterial hypertension as being significantly associated with the development of VTE. Dermatologists should be aware of this comorbidity and consideration of thromboprophylaxis in at-risk patients with psoriasis might be warranted.
Transcriptomic response of peripheral blood mononuclear cells to dupilumab in a 65-year-old patient with bullous pemphigoid
Authors: Li Meng-Ling , Hong Yi-Kai , Lin Yu-Chen , Natsuga Ken , Ujiie Hideyuki , Izumi Kentaro , Iwata Hiroaki , Hsu Chao-Kai
Published: August 2023

This article presents a case study of a patient with bullous pemphigoid (BP) who was treated with dupilumab and showed significant improvement in skin lesions and reduced levels of autoantibodies. RNA sequencing analysis showed that dupilumab reduced the expression of genes related to interleukin signalling, myeloid leucocyte activation and T-cell activation, suggesting that it may effectively reduce disease activity in patients with BP.
British Society for Dermatological Surgery guidance on antithrombotics and skin surgery 2023
Authors: Wernham Aaron G H , Bray Adam P J J
Published: August 2023

Our letter highlights some of the key changes and updates to the British Society for Dermatological Surgery antithrombotic and skin surgery guidance in 2023. An updated flowchart advises clinicians on assessing bleeding risk and when discontinuation of antithrombotics can be considered.
Myocarditis with concomitant tuberculosis infection presenting with solitary ventricular tachycardia: a case report
Authors: Clivillé David Belmar , Moliner-Abós Carlos , Gallego Irene Menduiña , Camprecios Marta
Published: August 2023

Background

Myocarditis is an infrequent extrapulmonary manifestation of tuberculosis that confers an unfavourable prognosis.

Case summary

A 36-year-old man presented to the hospital with palpitations and dyspnoea. Tests revealed the presence of non-sustained ventricular tachycardia, with mild elevation of troponin and C-reactive protein levels. Coronary angiography showed normal results. A cardiac magnetic resonance (CMR) showed moderate hypertrophy, preserved ejection fraction, and an extensive multi-segmental pattern of fibrosis and oedema. An 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG-PET–CT) scan revealed multiple hypermetabolic adenopathies and patchy cardiac uptake. A tuberculin skin test and interferon-gamma release assay were both positive. An endomyocardial biopsy (EMB) showed inflammation without granulomas; and microbiological stains were negative. Biopsy of an adenopathy revealed the presence of multiple necrotizing granulomas with Langhans cells. Based on the test results and clinical presentation, the suspected diagnosis was tuberculous myocarditis. Treatment with anti-tuberculosis drugs was started. One month later, the presence of mycobacterium tuberculosis (MT) was detected in the lymph node culture. At 7 months of follow-up, the patient remains asymptomatic, ventricular arrhythmias have ceased, and radiological signs of inflammation have resolved.

Discussion

Ventricular arrhythmia is one of the clinical manifestations of tuberculous myocarditis. Cardiac magnetic resonance and 18F-FDG-PET–CT imaging are an essential component of the non-invasive evaluation of inflammatory cardiomyopathy. However, a confirmatory biopsy may be required to identify potentially treatable aetiologies. Although the diagnosis of tuberculous myocarditis requires an isolation of MT by staining or culture in EMB, the diagnostic yield is very low. For this reason, extra-cardiac findings may provide the definitive diagnostic clue.
Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations
Authors: Wu Jinlin , Zeng Weiyue , Li Xiaoshan , Zhu Jiade , Zhou Chenyu , Fan Ruixin , Sun Tucheng , Fei Hongwen , Li Xin
Published: August 2023

Aims

Large-scale investigations on ascending aortic diameter, especially in the Asian population, are lacking. Furthermore, relevant evidence regarding the distribution of hypertension (HP), bicuspid aortic valve (BAV), and Marfan syndrome (MFS) is scarce. We aimed to examine the distribution of ascending aortic diameter in these populations in China.

Methods and results

The data of a total number of 698 795 individuals who underwent cardiac ultrasound were subjected to retrospective analysis. After screening, 647 087 individuals were included in the final analysis. In the normal population, the mean ascending aortic diameter was 28.1 ± 3.2 mm (27.2 ± 3.1 mm in women vs. 29.0 ± 3.1 mm in men) (P < 0.001). Aortic diameter increased gradually with age (P < 0.001). The prevalence of aortic dilation, aneurysm, and dissection in individuals with HP was 12.83%, 2.70%, and 4.77%, respectively. In individuals with MFS, the corresponding rates were 43.92%, 35.31%, and 26.11%. Notably, although BAV patients had high incidences of aortic dilation (37.00%) and aortic aneurysm (16.46%), the incidence of aortic dissection was relatively low (0.74%). Most cases of aortic dissection occurred at an aortic diameter of less than 55 mm. However, in the overall population, the incidence of aortic dissection significantly increased with the increase in the aortic diameter, revealing the existence of an ‘aortic paradox’.

Conclusions

(i) The ascending diameter increases with age and is larger in men than in women; (ii) ‘Aortic paradox’ is explained; (iii) BAV bears a high rate of aortic dilation, but a low incidence of aortic dissection.
Arrhythmogenic substrate elimination for safe testosterone therapy in symptomatic Brugada syndrome patients
Authors: Negro Gabriele , Boccellino Antonio , Napolano Antonio , Micaglio Emanuele , Calovic Zarko , Anastasia Luigi , Ciconte Giuseppe
Published: August 2023

Background

Brugada Syndrome (BrS) is a cardiogenetic disease known for its association with sudden cardiac death (SCD) in individuals with structurally normal hearts. The prevalence of BrS is higher in males, who also face a greater risk of SCD. Its higher prevalence and worse outcome in male subjects may be due to testosterone effects on ion channels expression and function. The influence of testosterone on cardiac action potentials, both genomically and non-genomically, underscores its potential role in unmasking the syndrome and triggering life-threatening arrhythmias. Notably, testosterone replacement therapy (TRT), used for hypogonadism and gender reassignment, has been linked to BrS unmasking. The role of epicardial ablation in symptomatic BrS patients where hormonal therapy cannot be discontinued is unknown.

Methods and results

In this study we describe the first two cases of substrate mapping and ablation in BrS patients experiencing arrhythmic events while on TRT. In both cases, high-density epicardial mapping revealed abnormal areas of prolonged and fragmented electrograms in the right ventricular (RV) outflow tract and anterior wall. These abnormalities were completely abolished by radiofrequency ablation (RFA). After ablation, both patients showed a persistent normalization of the ECG and were free from ventricular arrhythmias at follow-up, despite ongoing TRT.

Conclusion

RFA can be considered as a therapeutic option in symptomatic BrS patients with a high-risk profile who cannot discontinue TRT, being essential for restoring their normal physiology or preserving their sexual identity. As testosterone use is increasing, further studies are warranted to define a standardized diagnostic and therapeutic strategy in this specific subset of BrS patients.
COPI coatomer subunit α-COP interacts with the RNA binding protein Nucleolin via a C-terminal dilysine motif
Authors: Custer Sara K , Gilson Timra , Astroski Jacob W , Nanguneri Siddarth R , Iurillo Alyssa M , Androphy Elliot J
Published: August 2023

The COPI coatomer subunit α-COP has been shown to co-precipitate mRNA in multiple settings, but it was unclear whether the interaction with mRNA was direct or mediated by interaction with an adapter protein. The COPI complex often interacts with proteins via C-terminal dilysine domains. A search for candidate RNA binding proteins with C-terminal dilysine motifs yielded Nucleolin, which terminates in a KKxKxx sequence. This protein was an especially intriguing candidate as it has been identified as an interacting partner for Survival Motor Neuron protein (SMN). Loss of SMN causes the neurodegenerative disease Spinal Muscular Atrophy. We have previously shown that SMN and α-COP interact and co-migrate in axons, and that overexpression of α-COP reduced phenotypic severity in cell culture and animal models of SMA. We show here that in an mRNA independent manner, endogenous Nucleolin co-precipitates endogenous α-COP and ε-COP but not β-COP which may reflect an interaction with the so-called B-subcomplex rather a complete COPI heptamer. The ability of Nucleolin to bind to α-COP requires the presence of the C-terminal KKxKxx domain of Nucleolin. Furthermore, we have generated a point mutant in the WD40 domain of α-COP which eliminates its ability to co-precipitate Nucleolin but does not interfere with precipitation of partners mediated by non-KKxKxx motifs such as the kainate receptor subunit 2. We propose that via interaction between the C-terminal dilysine motif of Nucleolin and the WD40 domain of α-COP, Nucleolin acts an adaptor to allow α-COP to interact with a population of mRNA.
Discrete Gagliardo–Nirenberg inequality and application to the finite volume approximation of a convection–diffusion equation with a Joule effect term
Authors: Calgaro Caterina , Cancès Clément , Creusé Emmanuel
Published: August 2023

A discrete order-two Gagliardo–Nirenberg inequality is established for piecewise constant functions defined on a two-dimensional structured mesh composed of rectangular cells. As in the continuous framework, this discrete Gagliardo–Nirenberg inequality allows to control in particular the $L^4$ norm of the discrete gradient of the numerical solution by the $L^2$ norm of its discrete Hessian times its $L^\infty $ norm. This result is crucial for the convergence analysis of a finite volume method for the approximation of a convection–diffusion equation involving a Joule effect term on a uniform mesh in each direction. The convergence proof relies on compactness arguments and on a priori estimates under a smallness assumption on the data, which is essential also in the continuous framework.
Outcome of a conservatively treated large Pipkin I fracture dislocation: a case report
Authors: Alfreihi Omar , Alrashedan Bander S , Aljohani Hamid T , Alturaisi Sarah O , Mahmoud Jameel , Serhan Hani S
Published: August 2023

Pipkin I fracture dislocation is a rare injury. They commonly present following high mechanism trauma with possible devastating complications regardless of the treatment option. Treatment consensus depends on fracture reduction, size, site, and displacement. Surgical management is reserved for large fragments. We present a 42-year-old female presented with multiple chest injuries and left sided Pipkin I fracture dislocation Two days following the trauma. The fracture was found to be vertical in nature and was managed by closed reduction and a period of bed rest and skeletal traction. She was followed over a 3-year period and showed satisfactory results. We believe that the vertical nature of the fracture and maintenance of the anatomic reduction led to her successful outcome.
Proxy Survey Cost Indicators in Interviewer-Administered Surveys: Are they Actually Correlated with Costs?
Authors: Wagner James , Centeno Lena , Dulaney Richard , Edwards Brad , Suzer-Gurtekin Z Tuba , Coffey Stephanie
Published: August 2023

Survey design decisions are—by their very nature—tradeoffs between costs and errors. However, measuring costs is often difficult. Furthermore, surveys are growing more complex. Many surveys require that cost information be available to make decisions during data collection. These complexities create new challenges for monitoring and understanding survey costs. Often, survey cost information lags behind reporting of paradata. Furthermore, in some situations, the measurement of costs at the case level is difficult. Given the time lag in reporting cost information and the difficulty of assigning costs directly to cases, survey designers and managers have frequently turned to proxy indicators for cost. These proxy measures are often based upon level-of-effort paradata. An example of such a proxy cost indicator is the number of attempts per interview. Unfortunately, little is known about how accurately these proxy indicators actually mirror the true costs of the survey. In this article, we examine a set of these proxy indicators across several surveys with different designs, including different modes of interview. We examine the strength of correlation between these indicators and two different measures of costs—the total project cost and total interviewer hours. This article provides some initial evidence about the quality of these proxies as surrogates for the true costs using data from several different surveys with interviewer-administered modes (telephone, face to face) across three organizations (University of Michigan’s Survey Research Center, Westat, US Census Bureau). We find that some indicators (total attempts, total contacts, total completes, sample size) are correlated (average correlation ∼0.60) with total costs across several surveys. These same indicators are strongly correlated (average correlation ∼0.82) with total interviewer hours. For survey components, three indicators (total attempts, sample size, and total miles) are strongly correlated with both total costs (average correlation ∼0.77) and with total interviewer hours (average correlation ∼0.86).
Comparative morphoanatomy and transcriptomic analyses reveal key factors controlling floral trichome development in Aristolochia (Aristolochiaceae)
Authors: Suárez-Baron Harold , Alzate Juan F , Ambrose Barbara A , Pelaz Soraya , González Favio , Pabón-Mora Natalia
Published: August 2023

Trichomes are specialized epidermal cells in aerial plant parts. Trichome development proceeds in three stages, determination of cell fate, specification, and morphogenesis. Most genes responsible for these processes have been identified in the unicellular branched leaf trichomes from the model Arabidopsis thaliana. Less is known about the molecular basis of multicellular trichome formation across flowering plants, especially those formed in floral organs of early diverging angiosperms. Here, we aim to identify the genetic regulatory network (GRN) underlying multicellular trichome development in the kettle-shaped trap flowers of Aristolochia (Aristolochiaceae). We selected two taxa for comparison, A. fimbriata, with trichomes inside the perianth, which play critical roles in pollination, and A. macrophylla, lacking specialized trichomes in the perianth. A detailed morphoanatomical characterization of floral epidermis is presented for the two species. We compared transcriptomic profiling at two different developmental stages in the different perianth portions (limb, tube, and utricle) of the two species. Moreover, we present a comprehensive expression map for positive regulators and repressors of trichome development, as well as cell cycle regulators. Our data point to extensive modifications in gene composition, expression, and putative roles in all functional categories when compared with model species. We also record novel differentially expressed genes (DEGs) linked to epidermis patterning and trichome development. We thus propose the first hypothetical genetic regulatory network (GRN) underlying floral multicellular trichome development in Aristolochia, and pinpoint key factors responsible for the presence and specialization of floral trichomes in phylogenetically distant species of the genus.
Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2
Authors: Quinn John , Panasenko Serhii I , Leshchenko Yaroslav , Gumeniuk Konstantyn , Onderková Anna , Stewart David , Gimpelson A J , Buriachyk Mykola , Martinez Manuel , Parnell Tracey A , Brain Leonid , Sciulli Luke , Holcomb John B
Published: August 2023

The ongoing war in Ukraine presents unique challenges to prehospital medical care for wounded combatants and civilians. The purpose of this article is to identify, describe, and address gaps in prehospital care, casualty evacuation, and medical evacuation throughout Ukraine to share lessons for other providers. Observations and experiences of medical personnel were collected and analyzed, focusing on pain management, antibiotic use, patient assessment, mass casualty triage, blood loss, hypothermia, transport immobilization, and clinical governance. Gaps identified include limited access to pain management, lack of antibiotic guidance, inadequate patient assessment and triage, access to damage control resuscitation and blood, challenged transport immobilization practices, and challenges with clinical governance for both local and foreign providers. Improved prehospital care and casualty and medical evacuation in Ukraine are required, through increased use of empiric pain management, focused antibiotic guidance, enhanced patient assessment and triage in the form of training, access to prehospital blood, and better transport immobilization practices. A robust and active lessons learned program, trauma data capture, and quality improvement process is needed to reduce preventable morbidity and mortality in the war zone. The recommendations presented in this article serve as a starting point for improvements in prehospital care in Ukraine with potential to change prehospital training for the NATO alliance and other organizations operating in similar areas of conflict.

Graphical Abstract
Perineural Injection Therapy for Chronic Exertional Compartment Syndrome Refractory to Initial Compartment Release: A Case Report
Authors: Bui Tam , Anies Lt Ervin , Super Eric , Jahja Erol , Janze Aeneas
Published: August 2023

This is a case of a 26-year-old active duty male with a 1-year history of distal anterolateral leg pain and numbness which would persist following activity cessation. He was referred to physical therapy and eventually orthopedic surgery for bilateral anterior exertional compartment syndrome and underwent bilateral anterolateral fasciotomies. One year after surgery, he continued to have pain along the posterior aspect of his lower legs with residual numbness over his left dorsomedial foot. He was referred to sports medicine for further evaluation and Botox injections without significant symptomatic changes. He subsequently underwent diagnostic ultrasound of his lower legs which showed multiple entrapment points of the left superficial peroneal nerve along the fasciotomy scar. An additional electrodiagnostic study showed left superficial peroneal sensory mononeuropathy. Eighteen months following surgery, he received his first perineural injection therapy (PIT) treatment. A mixture of lidocaine and D5W was prepared to achieve 1 mg/cc which was then injected along his tibial, saphenous, and sural nerves. Following four PIT sessions, the patient’s overall lower extremity pain, weakness, and functionality had improved. This case demonstrates potential benefit with PIT in patients with refractory symptoms following surgery for chronic exertional compartment syndrome. These symptoms may be due to chronic irritation of cutaneous nerves and they may benefit from treatment with PIT. Our case may represent a possible paradigm shift in the conservative treatment of chronic exertional compartment syndrome, especially when refractory to surgical compartment release.
The X-ray polarization of the Seyfert 1 galaxy IC 4329A
Authors: Ingram A , Ewing M , Marinucci A , Tagliacozzo D , Rosario D J , Veledina A , Kim D E , Marin F , Bianchi S , Poutanen J , Matt G , Marshall H L , Ursini F , De Rosa A , Petrucci P-O , Madejski G , Barnouin T , Gesu L Di , Dovčiak M , Gianolli V E , Krawczynski H , Loktev V , Middei R , Podgorny J , Puccetti S , Ratheesh A , Soffitta P , Tombesi F , Ehlert S R , Massaro F , Agudo I , Antonelli L A , Bachetti M , Baldini L , Baumgartner W H , Bellazzini R , Bongiorno S D , Bonino R , Brez A , Bucciantini N , Capitanio F , Castellano S , Cavazzuti E , Chen C-T , Ciprini S , Costa E , Del Monte E , Lalla N Di , Marco A Di , Donnarumma I , Doroshenko V , Enoto T , Evangelista Y , Fabiani S , Ferrazzoli R , García J A , Gunji S , Heyl J , Iwakiri W , Jorstad S G , Kaaret P , Karas V , Kislat F , Kitaguchi T , Kolodziejczak J J , Monaca F La , Latronico L , Liodakis I , Maldera S , Manfreda A , Marscher A P , Mitsuishi I , Mizuno T , Muleri F , Negro M , Ng C-Y , O’Dell S L , Omodei N , Oppedisano C , Papitto A , Pavlov G G , Peirson A L , Perri M , Pesce-Rollins M , Pilia M , Possenti A , Ramsey B D , Rankin J , Roberts O J , Romani R W , Sgrò C , Slane P , Spandre G , Swartz D A , Tamagawa T , Tavecchio F , Taverna R , Tawara Y , Tennant A F , Thomas N E , Trois A , Tsygankov S S , Turolla R , Vink J , Weisskopf M C , Wu K , Xie F , Zane S
Published: August 2023

We present an X-ray spectro-polarimetric analysis of the bright Seyfert galaxy IC 4329A. The Imaging X-ray Polarimetry Explorer (IXPE) observed the source for ∼500 ks, supported by XMM–Newton (∼60 ks) and NuSTAR (∼80 ks) exposures. We detect polarization in the 2–8 keV band with 2.97σ confidence. We report a polarization degree of 3.3 ± 1.1 per cent and a polarization angle of 78° ± 10° (errors are 1σ confidence). The X-ray polarization is consistent with being aligned with the radio jet, albeit partially due to large uncertainties on the radio position angle. We jointly fit the spectra from the three observatories to constrain the presence of a relativistic reflection component. From this, we obtain constraints on the inclination angle to the inner disc (<39° at 99 per cent confidence) and the disc inner radius (<11 gravitational radii at 99 per cent confidence), although we note that modelling systematics in practice add to the quoted statistical error. Our spectropolarimetric modelling indicates that the 2–8 keV polarization is consistent with being dominated by emission directly observed from the X-ray corona, but the polarization of the reflection component is completely unconstrained. Our constraints on viewer inclination and polarization degree tentatively favour more asymmetric, possibly out-flowing, coronal geometries that produce more highly polarized emission, but the coronal geometry is unconstrained at the 3σ level.
Probing the impact of WIMP dark matter on universal relations, GW170817 posterior, and radial oscillations
Authors: Routaray Pinku , Quddus Abdul , Chakravarti Kabir , Kumar Bharat
Published: August 2023

In this study, we investigate the impact of weakly interacting massive particles (WIMPs) dark matter (DM) on C–Λ universal relations, GW170817 posterior, and radial oscillations of neutron stars (NSs) by considering the interactions of uniformly trapped neutralinos as a DM candidate with the hadronic matter through the exchange of the Higgs boson within the framework of the Next-to-Minimal Supersymmetric Standard Model (NMSSM). The hadronic equation of state (EOS) is modelled using the relativistic mean-field (RMF) formalism with IOPB-I, G3, and quark–meson coupling (QMC)-RMF series parameter sets. The presence of DM softens the EOS at both the background and the perturbation levels that implies a small shift to the left in the posterior accompanied by a much larger jump in the left of the mass–radius curves with increasing DM mass. It is observed that EOSs with DM also satisfy the C–Λ universality relations among themselves but get slightly shifted to the right in comparison to that without considering DM. Additionally, we find that the inclusion of DM allows the mass–radius (M–R) curves to remain consistent with observational constraints for HESS J1731−347, indicating the possibility of classifying it as a dark matter-admixed neutron star (DMANS). Moreover, we explore the impact of DM on the radial oscillations of pulsating stars and investigate the stability of NSs. The results demonstrate a positive correlation between the mass of DM and the frequencies of radial oscillation modes.
Lymphopenia is a risk factor for severe infections in older patients with microscopic polyangiitis: a retrospective cohort study in Japan
Authors: Yamaguchi Makoto , Sugiyama Hirokazu , Nobata Hironobu , Kinashi Hiroshi , Asai Akimasa , Kitamura Fumiya , Katsuno Takayuki , Ando Masahiko , Kubo Yoko , Banno Shogo , Ito Yasuhiko , Ishimoto Takuji
Published: August 2023

Objective

Previous studies have identified the predictors of severe infections in ANCA-associated vasculitis. However, lymphopenia has not been fully evaluated as a predictor of subsequent severe infections in patients with microscopic polyangiitis (MPA). The aim of this study was to assess the association between lymphopenia and severe infections requiring hospitalization after receiving immunosuppressive therapy for MPA.

Methods

This single-centre retrospective cohort study included 130 consecutive patients with newly diagnosed MPA from Aichi Medical University Hospital, Japan, who received immunosuppressive therapy between March 2004 and December 2020. The relationship between lymphopenia and subsequent severe infections was assessed using time-dependent multivariate Cox proportional hazard models adjusted for clinically relevant factors.

Results

During the follow-up period (median: 38 months; interquartile range: 15–63 months), 56 severe infectious episodes occurred in 51 patients (39.2%). Time-dependent multivariate Cox proportional hazard analyses identified older age [adjusted hazard ratio (HR) = 1.74 per 10 years, 95% CI: 1.13, 2.67], methylprednisolone pulse therapy (adjusted HR = 2.04, 95% CI: 1.03, 4.02), moderate lymphopenia (vs normal, adjusted HR = 7.17, 95% CI: 3.10, 16.6) and severe lymphopenia (vs normal, adjusted HR = 36.1, 95% CI: 11.8, 110.9) as significant predictors of severe infection.

Conclusion

Lymphopenia is a predictor of subsequent severe infections in patients with MPA who receive immunosuppressive therapy. These results suggest the importance of sustained infection surveillance, particularly in older patients who develop lymphopenia during strong immunosuppressive therapy.
Scale or Yield? A Present-Value Identity
Authors: Cho Thummim , Kremens Lukas , Lee Dongryeol , Polk Christopher
Published: August 2023

We propose a loglinear present-value identity in which investment (“scale”), profitability (“yield”), and discount rates determine a firm’s market-to-book ratio. Our identity reconciles existing influential market-to-book decompositions and facilitates novel insights from three empirical applications: (1) Both investment and profitability are important contributors to the value spread and stock return news variance. (2) Any cross-sectional return predictability has a mirror image in cash-flow fundamentals, providing asset pricing theories with additional moments to match. (3) The investment spread significantly improves the predictability of time-series variation in the value premium and justifies the poor performance of value in recent years.
Body composition parameters in systemic sclerosis—a systematic review and meta-analysis
Authors: Radić Mislav , Kolak Ela , Đogaš Hana , Gelemanović Andrea , Bučan Nenadić Dora , Vučković Marijana , Radić Josipa
Published: August 2023

Background

The aim of this systematic review and meta-analysis was to summarize current evidence regarding body composition (BC) in SSc in order to gain new insights and improve clinical care in the context of the nutritional status of SSc patients.

Methods

The databases Web of Science, PubMed, Scopus and Cochrane Library were searched on 4 January 2023. Studies were included if they provided data regarding BC obtained by dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) in patients with SSc and healthy controls (HC). The study design criteria for inclusion were cohort and observational studies. The risk of bias assessment was performed using the Newcastle–Ottawa scale. For meta-analysis, mean difference with a 95% confidence interval was obtained and all results were depicted as forest plots.

Results

The number of retrieved publications was 593, of which nine were included in a random-effects meta-analysis totalling 489 SSc patients and 404 HC. Overall, significantly lower body mass index, lean mass (LM), fat mass (FM) and phase angle values were found in SSc patients when compared with HC. Furthermore, FM and LM were significantly lower in SSc patients when the DXA method was applied, whereas the same parameters were comparable between two groups of participants when BIA was applied.

Conclusion

Altered BC is characteristic of SSc patients indicating the need for regular nutritional status assessment in order to improve the quality of life and clinical care of patients with SSc.