bluuebunny/crossref_metadata_2025 huggingface dataset:
Subtrochanteric Femur Fractures: The Association Between Obesity and Perioperative, Clinical, and Radiographic Outcomes
Authors: Merrell Lauren A. , Gibbons Kester , Ganta Abhishek , Konda Sanjit R. , Egol Kenneth A.
Published: April 2024

OBJECTIVES:

To evaluate the association between obesity and treatment approaches, perioperative factors, and clinical and radiographic outcomes following subtrochanteric fracture fixation.

METHODS: Design: Retrospective Cohort

Setting:

Academic Medical Center

Patient Selection Criteria:

Patients operatively treated for an AO/OTA 32Axa, 32Bxa, or 32Cxa subtrochanteric femur fracture.

Outcome Measures and Comparisons: Injury characteristics, perioperative parameters, fixation information, postoperative complications, clinical and radiographic outcomes. Univariable analyses were conducted between the obese (BMI > 30 kg/m2) and the non-obese (BMI < 30 kg/m2) cohorts. Regression analyses were performed to assess BMI as a continuous variable

RESULTS:

Of 230 operatively treated subtrochanteric fracture patients identified, 49 (21%) were obese and 181 (79%) were non-obese. The average age of the obese cohort was 69.6 ± 17.2 years, with 16 (33%) males and 33 (77%) females. The average age of the non-obese cohort was 71.8 ± 19.2 years, with 60 (33%) males and 121 (77%) females. Aside from BMI, there were no significant differences in demographics between the obese and non-obese (age [p=0.465], gender [p=0.948], ASA Score [p=0.739]). Both cohorts demonstrated similar injury characteristics including mechanism of injury, atypical fracture type, and AO/OTA fracture pattern (32A, 32B, 32C). Obese patients underwent more open reduction procedures (59% open obese, 11% open non-obese, p<0.001), a finding further quantified by a 24% increased likelihood of open reduction for every 1 unit increase in BMI (OR: 1.2, 95% CI: 1.2-1.3, p<0.001). There was no difference in average nail diameter, 1 vs 2-screw nail design, or number of locking screws placed. The obese cohort was operated on more frequently on a fracture table (p<0.001) when compared to the non-obese cohort which was operated on more frequently on a flat table (p<0.001). There were no significant differences (p>0.050) in postoperative complications, mortality/readmission rates, hospital quality measures, fixation failure or time to bone healing.

CONCLUSIONS:

The treatment of subtrochanteric fractures in obese patients is associated with a higher likelihood of surgeons opting for open fracture reduction and the use of different operating room table types, but no difference was observed in postoperative complications, mortality or readmission rates, or healing timeline when compared to non-obese patients.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Enhancing the evaluation of physical function following orthopaedic trauma care: comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment (SMFA)
Authors: Luijten Michiel A.J. , Haverman Lotte , Terwee Caroline B. , Poeze Martijn , Verbeek Diederik O.
Published: April 2024

OBJECTIVES:

To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (Physical Function (PF) and Pain Interference (PI)) computerized adaptive testing (CAT) to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index (DI) and bother index (BI)). To explore factors associated with PROMIS scores.

METHODS:

Design: Cross-sectional study.

Setting:

Level-I Trauma Center.

Patient Selection Criteria:

isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023).

Outcome measures:

Correlations (Pearson), reliability (Standard error (SE)(T score), efficiency (amount of information per item(1 – SE2/ Nitems)) and floor/ceiling effects were assessed. An r>0.7 represented high correlation, SE≤2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified.

RESULTS:

In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0(PROMIS-PF), SE 2.1(PROMIS-PI) and SE 1.2(SMFA-DI), SE 1.8(SMFA-BI)). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8(SD2.5), and 4.1(SD1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores.

CONCLUSIONS:

PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As CATs are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients.

LEVEL OF EVIDENCE:

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Factors Influencing Optimal Bracing Compliance in Adolescent Idiopathic Scoliosis
Authors: Asada Tomoyuki , Kotani Toshiaki , Sakuma Tsuyoshi , Iijima Yasushi , Sakashita Kotaro , Ogata Yosuke , Akazawa Tsutomu , Minami Shohei , Ohtori Seiji , Koda Masao , Yamazaki Masashi
Published: April 2024

Study Design.

Retrospective cohort study.

Objective.

To identify factors contributing to optimal bracing compliance in adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

Poor brace compliance is a key factor affecting brace treatment success in AIS. Predictive factors influencing optimal brace compliance to achieve brace treatment success remain unknown.

Materials and Methods.

This study included AIS patients aged 10 to 15, with a Cobb angle of 20° to 40°. Demographics data, radiographic assessments, and patient-reported outcomes (including the SRS-22r patient questionnaire) were collected. Brace compliance was monitored using in-brace thermometers, defining optimal bracing time as >18 h/d. Multivariable logistic regression analysis was used to identify predictors of optimal bracing time from the demographic and patient-reported outcomes score before bracing.

Results.

Among 122 patients, 59.0% achieved optimal bracing time by six months. The achieved group indicated higher scores in the satisfaction domain before bracing (3.3±0.7 vs. 3.1±0.6; P=0.034). Multivariable logistic regression analysis demonstrated that the satisfaction domain before bracing was an independent factor associated with the achievement of the optimal bracing time [OR 1.97 (95% CI: 1.00–3.89), P=0.049]. The model with bracing at one-month follow-up also demonstrated the bracing at 1 month was a significant factor [OR 1.52 (95% CI: 1.30–1.79), P<0.001].

Conclusions.

Optimal bracing compliance in AIS is significantly influenced by prebracing satisfaction and brace compliance at earlier time points. These findings highlight the need to address psychological factors and early compliance in AIS bracing treatment. SRS-22r can be useful to identify the need for psychological support.
Evaluation of Cervical Vertebral Motion and Foraminal Changes During the Spurling Test Using Zero Echo Time Magnetic Resonance Imaging and Computed Tomography-Based Micromotion Analysis
Authors: Hutchins John , Lagerstrand Kerstin , Hebelka Hanna , Palmér Emilia , Brisby Helena
Published: April 2024

Study Design.

Clinical experimental diagnostic study.

Objective.

The objective of the study was to investigate cervical spine dynamics including changes in the cervical foramina in patients experiencing intermittent arm radiculopathy.

Background.

Cervical foraminal stenosis is a frequent cause of radicular arm pain. The Spurling test, while specific, lacks the precision to identify symptomatic nerve roots. The relationship among vertebral motion, foraminal changes, and radiculopathy during a Spurling test remains underexplored.

Patients and Methods.

Ten patients with positive Spurling tests and magnetic resonance imaging (MRI) confirmed 1 or 2-level cervical foraminal stenosis were scanned using the Dynamic MRI Compression System enabling a simulated Spurling test inside the MRI gantry of a 3T MRI scanner with a dedicated neck coil. First, a relaxed image acquisition was undertaken, followed by slowly applying the Spurling test until the patient reported aggravation of radiculopathy or discomfort, where the next image series was taken. Zero echo time MRI was employed to obtain computed tomography (CT)–like images. The images were thereafter analyzed using the Sectra® CT-based Micromotion Analysis software for motion analysis.

Results.

The C4/C5 level exhibited the most significant movements both in translation and rotation, with less movements observed in C5 to C6 and C6 to C7 levels. No uniform pattern emerged that differentiated suspected stenotic levels from nonsuspected levels. Despite relatively small vertebral movements, 9/10 of patients reported arm pain during provocation, indicating extremely narrow margins of tolerance.

Conclusion.

This study demonstrates the utility of zero echo time MRI and CT-based Micromotion Analysis in detecting subtle yet clinically relevant vertebral motions influencing the foramina in the cervical spine during the Spurling maneuver. These findings could lead to a better understanding and potentially improved diagnostic strategies for cervical foraminal stenosis, although further research with a larger cohort is necessary to confirm these results.
B7-H3 in acute myeloid leukemia: From prognostic biomarker to immunotherapeutic target
Authors: Tan Xiao , Zhao Xiangyu
Published: April 2024

B7-H3 (CD276), an immune checkpoint protein of the B7 family, exhibits significant upregulation in solid tumors and hematologic malignancies, exerting a crucial role in their pathophysiology. The distinct differential expression of B7-H3 between tumors and normal tissues and its multifaceted involvement in tumor pathogenesis position it as a promising therapeutic target for tumors. In the context of acute myeloid leukemia (AML), B7-H3 is prominently overexpressed and closely associated with unfavorable prognoses, yet it has remained understudied. Despite various ongoing clinical trials demonstrating the potential efficacy of immunotherapies targeting B7-H3, the precise underlying mechanisms responsible for B7-H3-mediated proliferation and immune evasion in AML remain enigmatic. In view of this, we comprehensively outline the current research progress concerning B7-H3 in AML, encompassing in-depth discussions on its structural attributes, receptor interactions, expression profiles, and biological significance in normal tissues and AML. Moreover, we delve into the protumor effects of B7-H3 in AML, examine the intricate mechanisms that underlie its function, and discuss the emerging application of B7-H3-targeted therapy in AML treatment. By juxtaposing B7-H3 with other molecules within the B7 family, this review emphasizes the distinctive advantages of B7-H3, not only as a valuable prognostic biomarker but also as a highly promising immunotherapeutic target in AML.
Abstinence for sperm sample collection and ART outcome: an unsubstantiated myth
Authors: Schlegel Peter N.
Published: April 2024

Purpose of review

Semen analysis is a basic component of male evaluation. Reproductive centers typically instruct men to provide a semen specimen based on recommendations from WHO Standard for semen examination. Evidence that these recommendations optimize sperm reproductive capacity is lacking. Existing data to optimize sperm quality with shorter abstinence were reviewed.

Recent findings

Several recent studies have reviewed the effects of shorter ejaculatory abstinence of semen quality and assisted reproductive technology (ART) outcomes. Shorter abstinence was defined as 1 h–1 day in one review, and <4 h in the other systematic meta-analysis and review.

Prior instructions for male patients have not been designed to optimize fertility potential for semen analyses. Optimal sperm quality is obtained by instructing men to have a short abstinence (certainly <1 day, and preferably <4 h) for semen specimens used for in vitro fertilization (assisted reproduction)
GnRH agonist trigger in poor prognosis patients undergoing a multicycle approach through DuoStim or consecutive stimulations: a SWOT analysis
Authors: Vaiarelli Alberto , Ruffa Alessandro , Cerrillo María , García-Velasco Juan Antonio
Published: April 2024

Purpose of review

Identify the most recent and significant evidence regarding the ovulation trigger within the framework of a multicycle approach through DuoStim, providing valuable insights for improving treatment strategies in patients with a poor prognosis.

Recent findings

The trigger method plays a pivotal role in optimizing in-vitro fertilization (IVF) stimulation, influencing oocyte retrieval and maturation rates, as well as follicle recruitment in consecutive ovarian stimulations such as double stimulation. Decision-making involves multiple factors and, while guidelines exist for conventional stimulation, specific recommendations for the multicycle approach are not well established.

The different methods for inducing oocyte maturation underscore the need for personalization of IVF protocols. The GnRH agonist trigger induces rapid luteolysis and establishes favorable hormonal conditions that do not adversely affect the recruitment of consecutive follicular waves in the context of DuoStim. It serves as a valid alternative to hCG in freeze-all cycles. This strategy might enhance the safety and flexibility of ovarian stimulations with no impact on oocyte competence and IVF efficacy.
Beyond the reproductive tract: gut microbiome and its influence on gynecological health
Authors: Pérez-Prieto Inmaculada , Rodríguez-Santisteban Aida , Altmäe Signe
Published: April 2024

Purpose of review

The analysis of microbiome in association with female health is today a “hot topic” with the main focus on microbes in the female reproductive tract. Nevertheless, recent studies are providing novel information of the possible influence of the gut microbiome on gynecological health outcomes, especially as we start to understand that the gut microbiome is an extended endocrine organ influencing female hormonal levels. This review summarizes the current knowledge of the gut microbes in association with gynecological health.

Recent findings

The gut microbiome has been associated with endometriosis, polycystic ovary syndrome, gynecological cancers, and infertility, although there is a lack of consistency and consensus among studies due to different study designs and protocols used, and the studies in general are underpowered.

The interconnection between the gut microbiome and reproductive health is complex and further research is warranted. The current knowledge in the field emphasizes the link between the microbiome and gynecological health outcomes, with high potential for novel diagnostic and treatment tools via modulation of the microenvironment.
Gender affirming care for the minimally invasive gynecologic surgeon
Authors: Simko Sarah , Popa Otilia , Stuparich Mallory
Published: April 2024

Purpose of review

Given the current political climate and the release of an updated version of the World Professional Association for Transgender Health's guidelines, this review assesses recent updates in the care of transgender and gender diverse (TGD) patients, specifically related to care provided by gynecologists.

Recent findings

The number of people identifying as TGD and pursuing gender affirming care is increasing. Contraception for these patients is underdiscussed and high rates of pelvic pain and irregular bleeding were identified. Rates of regret are low following gender affirming surgeries, and studies have repeatedly shown their benefits for gender dysphoria. A minimally invasive approach is recommended for gender affirming hysterectomy, and the decision to proceed with bilateral salpingo-oophorectomy should be based on shared decision making. Surgical techniques include ensuring an adequate margin when taking the infundibulopelvic ligament, and consideration for two-layer vaginal cuff closure.

Gynecologists play a key role in the care of TGD patients. Recent reviews have found extensive gaps in our knowledge, including a lack of guidelines for cancer prevention, effects of testosterone on benign conditions, and the long-term effects of bilateral salpingo-oophorectomy on health outcomes for patients on testosterone.
Free Flap Reconstruction of Sternal Defects after Cardiac Surgery: An Algorithmic Approach for Dealing with Sparse Recipient Vessels
Authors: Bigdeli Amir K. , Falkner Florian , Schmidt Volker J. , Thomas Benjamin , Engel Holger , Reichenberger Matthias , Germann Günter , Gazyakan Emre , Kneser Ulrich
Published: April 2024

Background:

Sparsity of recipient vessels poses a challenge for microsurgical free flap reconstruction of sternal defects following deep sternal wound infection after cardiac surgery.

Methods:

From January 2013, a standardized algorithm for dealing with sparse recipient vessels was strictly followed. In this retrospective study including 75 patients, we compared operative details, surgical complications, and reconstructive outcomes of patients treated according to this algorithm (group A: January 2013–May 2021; n = 46) with a historical control group (group B: January 2000–December 2012, n = 29).

Results:

The left internal mammary artery had been harvested for arterial bypass grafting in 40 of 46 cases (87%) in group A and in all cases in group B. The right internal mammary artery (RIMA) and right internal mammary vein (RIMV) were the first choice as recipient vessels. In case of unsuitability of the RIMV, a right cephalic vein (CV) turndown was used for venous outflow. If both RIMA and RIMV proved insufficient, a single-stage arterio-venous loop (AVL) between the CV and subclavian artery (CV–SA AVL), CV and thoracoacromial artery (CV–TA AVL), or subclavian artery and subclavian vein (SA–SV AVL) was established. The algorithmic approach significantly reduced partial flap necrosis [group A: n = 3 (7%) versus group b: n = 7 (24%); P = 0.04], and overall operation time [group A: 360 ± 88 min versus group B: 415 ± 80 min; P = 0.01].

Conclusions:

Standardized approaches improve clinical outcomes in microsurgical free flap sternal reconstruction after cardiac surgery.
Impact of scleral tunnel length on the position of intraocular lenses in flanged intrascleral haptic fixation
Authors: Jun Jong Hwa , Kwak Joon-Ho , Park Chang-Hyun , Lee Jiyeon , Seong Jueun , Shim Kyu Young , Afshari Natalie A.
Published: April 2024

Purpose:

To investigate the effect of scleral tunnel length on the effective lens position and tilt of the intraocular lens (IOL) in flanged intrascleral haptic fixation (ISHF) using anterior segment optical coherence tomography (AS-OCT).

Setting:

Tertiary institution.

Design:

Retrospective case–control study.

Methods:

This study included 55 and 42 eyes that underwent ISHF with 1.0 and 2.0 mm scleral tunnels, respectively. 23 eyes that underwent sutured fixation were used as a control. The anterior chamber depth (ACD), scleral tunnel length, incident angle of haptic, and tilting of optic were analyzed using AS-OCT.

Results:

The mean postoperative ACD, vertical tilt angle, and spherical equivalent of the 1.0 mm were 5.27 ± 0.39 mm, 6.04 ± 4.87 degrees, and 0.38 ± 1.03 diopters, respectively. The ACD and vertical tilt angle of the 1.0 mm were larger than those of the others (P < .001 and P < .05, respectively), and the postoperative spherical equivalent was more hyperopic (P < .05). The 2.0 mm exhibited a lower frequency of tilting greater than 7 degrees. The intereye difference in ACD between in-the-bag fixation and ISHF of the 1.0 mm tunnel was significantly greater than that in the 2.0 mm tunnel (P < .05). The 1.0 mm tunnel had a significantly larger incident angle and a longer tunnel length (P < .001, respectively) and showed a greater difference in the tunnel length on both sides (P < .05).

Conclusions:

A shorter tunnel yielded a more unstable IOL position, greater variation in angle and tunnel length, and longer ACD during ISHF. An exact 2.0 mm tunnel must be created on both sides to achieve a stable and predictable IOL position.
Advanced practice nurse pharmacogenomics capacity and utilization
Authors: Fulton Cathy R. , Macagno Anna L.M. , Dickinson Stephanie L. , Calzone Kathleen
Published: April 2024

Background:

Guided by Clinical Pharmacogenomic Implementation Consortium (CPIC) guidelines for >140 medications, pharmacogenomic tests inform medication selection and dosing to optimize efficacy while minimizing toxicities.

Purpose:

This study assessed pharmacogenomic self-reported curricular content, knowledge, skills, attitudes, and usage in advanced practice registered nurses (APRNs) with prescriptive privileges.

Methodology:

An online survey was administered assessing pharmacogenomic curricular content, knowledge, skills, attitudes, and usage.

Results:

Data from 266 APRNs were analyzed. Most graduated with their highest nursing degree ∼10 years ago and reported pharmacogenomic curricular content (n = 124, 48%). Pharmacogenomic curricular content was associated with pharmacogenomic familiarity (p = .045) but not with knowledge confidence (p = .615). Pharmacogenomic usage, defined as ordering a pharmacogenomic test within the past year, was low (n = 76, 29%) and most (n = 210, 84%) reported never using CPIC Guidelines. Advanced practice registered nurses (n = 162) who did not anticipate ordering a pharmacogenomic test in the next year (n = 77, 48%) indicated that they did not know what test to order.

Conclusions:

Deficits were identified in APRN pharmacogenomic knowledge and skills despite academic training. Most reported not ordering pharmacogenomic tests, did not know what test to order, and did not use CPIC guidelines.

Implications:

Pharmacogenomics is a quality and safety issue. Academic training did not result in practice integration and most reported capacity deficits. Recommendation for overcoming academic deficits include: (1) assessment of pharmacogenomics curricular content and faculty teaching capacity; (2) training addressing identified deficiencies; and (3) Commission of Collegiate Nursing Education policies that include pharmacogenomics in advanced pharmacology. Practicing APRN plans include on-the-job training and/or mandatory training at the time of relicensure.
Donor Age More Than 20 Years Greater Than Recipient Age Is Associated With Worse 5-Year Survival in Young Adult Heart Transplantation
Authors: Lo Bryan , Nordan Taylor , Sparks Aaron , Lee Lawrence , Zhan Yong , Chen Frederick Y. , Couper Gregory S. , Kawabori Masashi
Published: April 2024

Prior studies indicate donor age-recipient age (DA-RA) difference may be of prognostic value in adolescents, although not adults. We aim to analyze the relationship between DA-RA difference and long-term survival of young adult heart transplantation (HTx) recipients. First-time, single-organ HTx recipients aged 18–30 who underwent HTx between 2010 and 2020 were analyzed from the United Network for Organ Sharing (UNOS) registry. Four cohorts were created based on DA-RA difference. The primary outcome was 5 year post-HTx survival. Secondary outcome was post-HTx complications. One thousand eight hundred three donor-recipient pairs were divided into four groups: DA-RA < 0, 0 ≤ DA-RA < 10, 10 ≤ DA-RA < 20, and DA-RA ≥ 20 with 682 (37.8%), 651 (36.1%), 356 (19.7%), 114 (6.3%) pairs in each cohort, respectively. The estimated 5 year survival of the DA-RA ≥ 20 cohort was 66.5% compared to the other three groups at ~75%. After adjustment, DA-RA ≥ 20 was independently associated with worse survival compared to DA-RA < 0 (adjusted hazard ratio [HR] = 1.55; 95% confidence interval [CI] = 1.06–2.27; log-rank p = 0.008). There was no significant difference in complication incidence across cohorts. Among young adults, accepting a donor heart more than 20 years older than the recipient was associated with worse 5 year survival. We did not detect a significant difference up to 20 years. This information may help guide appropriate donor selection in the young adult population.
An Unexpected Partnership: Alexis Carrel, Charles Lindbergh, and Normothermic Machine Perfusion
Authors: Cui Ervin Y. , Gouchoe Doug A. , Salmon-Rekhi Suhavi T. , Whitson Bryan A. , Black Sylvester M.
Published: April 2024

Organ transplantation is a triumph of modern medicine which represents a culmination of science and imagination, saving thousands of lives a year. However, transplantation is severely limited by suitable donor allografts. To expand the donor pool and make transplantation achievable for all, normothermic machine perfusion (NMP) is being employed more frequently. Normothermic machine perfusion involves the utilization of a device to approximate the physiology of the human body, preserve organs outside of the donor, and provide a dynamic assessment platform to determine organ suitability for transplantation. As NMP technology advances, it will soon be possible to genetically modify and actively repair these organs. Although its application to the field of transplantation is relatively new, the concept, foundation, and development of NMP can be traced back to the pioneering work of the surgeon-scientist, Alexis Carrel and the famous aviator, Charles Lindbergh in the 1930s. Their collaboration resulted in the Carrel–Lindbergh Perfusion device, an early perfusion device that was able to keep organs alive ex vivo for weeks and is most appropriately viewed as a precursor to modern machine perfusion technologies. As NMP technology becomes more advanced and refined, it is important to acknowledge the historical context in which these technologies emerged.
United States-Mexico Border Disparities in Alcoholic Liver Disease Mortality
Authors: Folk Akira , Mouhaffel Rama , Grewal Harneet , Noh Sangkyu , Le Cam Elise , Liu Franklin , Ho Sabrina , Loveland Macklin , Sainbayar Enkhsogt , Pham Hoang Nhat , Ferreira João Paulo , Ibrahim Ramzi
Published: April 2024

Background:

US-Mexico (US-MX) border regions are impacted by socioeconomic disadvantages. Alcohol use disorder remains widely prevalent in US-MX border regions, which may increase the risk of alcoholic liver disease (ALD).

Goals:

We aimed to characterize ALD mortality trends in border regions compared to non-border regions from 1999 to 2020 in the United States (US).

Methods:

We performed a cross-sectional analysis using the CDC repository. We queried death certificates to find ALD-related deaths from 1999 to 2020, which included demographic information such as gender, race/ethnicity, and area of residence. We estimated age-adjusted mortality rates (AAMR) per 100,000 population and compared the AAMRs across border and non-border regions. We also explored yearly mortality shifts using log-linear regression models and calculated the average annual percentage change (AAPC) using the Monte Carlo permutation test.

Results:

In all, 11,779 ALD-related deaths were identified in border regions (AAMR 7.29) compared with 361,523 in non-border regions (AAMR 5.03). Border male (AAMR 11.21) and female (AAMR 3.77) populations were higher compared with non-border male (AAMR 7.42) and female (2.85) populations, respectively. Border non-Hispanic populations (AAMR 7.53) had higher mortality compared with non-border non-Hispanic populations (4.79), while both populations experienced increasing mortality shifts (AAPC +1.7, P<0.001 and +3.1, P<0.001, respectively). Border metropolitan (AAMR 7.35) and non-metropolitan (AAMR 6.76) regions had higher mortality rates compared with non-border metropolitan (AAMR 4.96) and non-metropolitan (AAMR 5.44) regions.

Conclusions:

Mortality related to ALD was higher in border regions compared with non-border regions. Border regions face significant health disparities when comparing ALD-related mortality.
Evaluation of skull bone viability and effect of early surgical intervention in electrical contact burns using 18F-Sodium Fluoride PET-CT imaging
Authors: Kumar Parmod , Arora Pulkit , Kumar Rajender , Singh Harmandeep , Parashar Atul , Mittal Bhagwant R. , Bhattacharya Anish
Published: April 2024

Objective

Electrical contact burns of the scalp cause serious morbidity and mortality. Early necrotic bone debridement and flap cover are crucial for successful wound closure. 18F Sodium Fluoride (NaF), with high bone-to-soft tissue activity ratio, is useful for bone viability assessment. This study evaluated the role of 18F NaF PET-computed tomography (CT) in objectively defining the extent and depth of nonviable calvarial bone, to guide adequate bone debridement.

Method

Of 20 patients referred to our institute with electrical contact burns of the scalp during a 2-year period, 15 were enrolled in the study. Two weeks after the initial management, tracer uptake pattern was noted on 18F NaF PET-CT of the head and exposed bone measured. Surgical bone debridement was based on scan findings, followed by wound closure. All patients underwent clinical evaluation and follow-up scan 3 months after surgery.

Results

Eight patients showed a central photopenic area in the exposed bone (maximum standardized uptake value [SUVmax] of 0.76 ± 0.14 with mean maximum dimensions 4.10 ± 1.76/2.67 ± 1.54 cm). High tracer uptake (SUVmax, 9.66 ± 6.03) was seen peripheral to the exposed bone (mean maximum dimensions, 8.14 ± 3.03/4.75 ± 1.61 cm). Postoperatively, there was no significant change in tracer uptake in the central debrided region or peri-debridement bone area under the flap. Clinically all patients showed a well-healed flap.

Conclusion

18F NaF PET-CT appears useful for objective evaluation of skull bone viability and planning necrotic bone debridement in patients with electrical contact burns. However, additional studies with longer patient follow-up are required to validate these results.
The Potential Mediating Effect of Symptom Burden on Demoralization Through Locus of Control and Coping Strategies in Chinese Patients With Cancer
Authors: Liu Xiaoxin , Li Yanhua , Li Lezhi , Li Juan , Yang Jiao , Huang Lirong , Yao Min , Yang Linlin , Yang Qun
Published: April 2024

Background

Demoralization is a psychological syndrome that is highly prevalent in patients with cancer and detrimental to individuals’ physical and mental health. To explore effective intervention, we first determined the relationships between locus of control, coping strategies, symptom burden, and demoralization.

Objective

The aim of this study was to determine the relationship between symptom burden, locus of control, coping strategies, and demoralization in patients with cancer.

Methods

In this descriptive-correlational study, 273 valid patients were selected with convenience sampling method from a hospital in China. Data were collected using the Chinese version of the M.D. Anderson Symptom Inventory, the Chinese version of the Multidimensional Health Locus of Control Scale, the Chinese version of the Medical Coping Modes Questionnaire, and the Mandarin version of the Demoralization Scale. Data were analyzed using descriptive and inferential statistics using SPSS and AMOS.

Results

A total of 115 patients (42.12%) experienced clinical demoralization (Mandarin version of the Demoralization Scale > 30). Symptom burden (β = 0.295,P< .001), confrontation (β = −0.117,P= .028), and resignation (β = 0.456,P< .001) had direct effects on demoralization. Symptom burden also had an indirect effect on demoralization through the mediating role of resignation (β = 0.026,P= .002). Meanwhile, locus of control can affect demoralization entirely through the indirect mediating role of coping strategies (chance locus of control via resignation [β = 0.138,P< .01], powerful locus of control via confrontation [β = −0.017,P< .05]).

Conclusions

Symptom burden affects demoralization not only directly but also indirectly. Coping strategies play an important mediating role between symptom burden, locus of control, and demoralization in patients with cancer.

Implications for Practice

It is urgent to screen demoralization and identify patients with high symptom burden, maladaptive locus of control, or coping strategies. For the patients targeted, a more comprehensive and systematic approach to symptom management and more appropriate guidance related to adaptive coping strategies are needed.
Competence and Confidence With Quality and Safety Education for Nurses Competencies by Newly Licensed Registered Nurses
Authors: Cadorette Joyce H. , McCurry Mary K. , Letourneau Rayna M. , Viveiros Jennifer Dunbar
Published: April 2024

Understanding newly licensed registered nurses' perceived confidence in the Quality and Safety Education for Nurses (QSEN) competency domains and corresponding knowledge, skills, and attitudes will help inform clinical leaders to develop successful transition-to-practice programs. Newly licensed registered nurses and prelicensure nursing students had confidence in their understanding of QSEN competencies as they began their transition to practice. Online learning and virtual practicums were effective for attaining QSEN competencies, offering support for using these interventions in academic settings and transition-to-practice programs.
Cross-Sectional Imaging Characteristics of Pancreatic Intraductal Oncocytic Papillary Neoplasms
Authors: Iranpour Negaur , Singhi Aatur , Salimian Kevan Jonathan , Azadi Javad R. , Slivka Adam , Ngan Ka-Kei , McGrath Kevin , Fasanella Kenneth , Zureikat Amer , Paniccia Alessandro , Zaheer Atif , Dasyam Anil K.
Published: April 2024

Purpose

Pancreatic intraductal oncocytic papillary neoplasms (IOPN) are rare precursors to pancreatic ductal adenocarcinoma. We report cross-sectional computed tomography and magnetic resonance imaging (where available) findings of pancreatic IOPNs.

Materials and Methods

Consecutive cases of pancreatic IOPNs identified on pathology between 2008 and 2020 at University of Pittsburgh and Johns Hopkins University were included in the study. Cross-sectional imaging of all patients was reviewed by two subspecialty trained abdominal radiologists. Patient demographics, cross-sectional imaging appearances and growth characteristics were evaluated.

Results

In this dual-center study, 14 patients with IOPNs were included. Median age was 64 years, and 64% were male. The median size of the lesions was 5.4 cm (range, 1.4–12.3 cm). All patients had either an enhancing mural nodule (93% of patients) and/or thick internal septations (29%). Thin/imperceptible outer wall was seen in 93%. Main duct was involved in 64% of the cases. Only 14% of the cases did not demonstrate abutment of the main duct. Histologic evaluation of surgical specimen showed high-grade dysplasia without invasive carcinoma in 57% and invasive carcinoma in 43% of cases. Lesions with invasive carcinoma were larger (7.1 cm vs 4.3 cm, P = 0.05) and tended to have larger mural nodule (3.7 cm vs 1.8 cm) compared with those without invasive carcinoma.

Conclusion

Pancreatic IOPNs are rare cystic premalignant lesions, which among resected cases, are predominantly seen in middle aged men, are often large, have enhancing mural nodules and frequently harbor invasive carcinoma.
Coronal Diffusion-Weighted Imaging Does Not Improve Detection of Posterior Fossa Infarcts Compared With Conventional Axial Diffusion-Weighted Imaging
Authors: Mehan Jr William A. , Shin Donghoon , Buch Karen
Published: April 2024

Purpose

Recent publications have suggested incorporating coronal diffusion-weighted imaging (DWI) sequences and axial DWI sequences to enhance the detection of posterior fossa infarcts (PFIs). This study evaluated the utility of coronal DWIs compared with axial DWIs for assessing PFIs in the emergency department (ED).

Methods

A retrospective, institutional review board-approved study was conducted at a level I stroke center, including 118 patients who presented to the ED between 2016 and 2023 with suspected PFI. Inclusion criteria involved patients who underwent emergent 1.5 T magnetic resonance imaging (MRI) and had axial and coronal DWI sequences. Two neuroradiologists independently evaluated the DWI sequences for PFI detection in 2 rounds, with a 4-week interval between rounds. The neuroradiologists assessed the quality of axial and coronal DWIs using a 5-point Likert scale. Descriptive statistics, interrater reliability, and marginal homogeneity tests were performed.

Results

Among the 118 MRI scans, 23 (19%) showed PFI on axial and coronal DWI sequences. All 23 cases were identified on axial DWI, whereas 8 cases of PFI (35%) were not detected on coronal DWI (P value = 0.013). No PFIs were observed on coronal DWI that was not identified on axial DWI. The quality scores for both raters were significantly higher for axial DWIs than coronal DWIs (P value <0.00001).

Conclusion

Despite recent recommendations advocating for the inclusion of coronal DWI in PFI detection, this study's findings indicate no improvement in PFI detection or image quality using coronal DWI. Further research is necessary to validate these results and explore the potential benefits of incorporating coronal DWI in assessing posterior fossa strokes.
Factors Associated With Distress Related to Perceived Dignity in Patients With Rheumatic Diseases
Authors: Pascual-Ramos Virginia , Contreras-Yáñez Irazú , Cuevas-Montoya Maximiliano , Guaracha-Basañez Guillermo Arturo , García-Alanis Mario , Rodríguez-Mayoral Oscar , Chochinov Harvey Max
Published: April 2024

Background

The loss of perceived dignity is an existential source of human suffering, described in patients with cancer and chronic diseases and hospitalized patients but rarely explored among patients with rheumatic diseases (RMDs). We recently observed that distress related to perceived dignity (DPD) was present in 26.9% of Mexican patients with different RMDs. The study aimed to investigate the factors associated with DPD.

Methods

This cross-sectional study was performed between February and September 2022. Consecutive patients with RMDs completed patient-reported outcomes (to assess mental health, disease activity/severity, disability, fatigue, quality of life [QoL], satisfaction with medical care, and family function) and had a rheumatic evaluation to assess disease activity status and comorbidity. Sociodemographic variables and disease-related and treatment-related variables were retrieved with standardized formats. DPD was defined based on the Patient Dignity Inventory score. Multivariate regression analysis was used.

Results

Four hundred patients were included and were representative of outpatients with RMDs, while 7.5% each were inpatients and patients from the emergency care unit. There were 107 patients (26.8%) with DPD. Past mental health–related comorbidity (Odds Ratio [OR]: 4.680 [95% Confidence Interval [CI]: 1.906–11.491]), the number of immunosuppressive drugs/patient (OR: 1.683 [95% CI: 1.015–2.791]), the physical health dimension score of the World Health Organization Quality of Life—Brief questionnaire (WHOQOL-BREF) (OR: 0.937 [95% CI: 0.907–0.967]), and the emotional health dimension score of the WHOQOL-BREF (OR: 0.895 [95% CI: 0.863–0.928]) were associated with DPD.

Conclusions

DPD was present in a substantial proportion of patients with RMDs and was associated with mental health–related comorbidity, disease activity/severity-related variables, and the patient QoL.
The polysaccharides from Balanophora polyandra enhanced neuronal autophagy to ameliorate brain function decline in natural aging mice through the PI3K/AKT/mTOR signaling pathway
Authors: Zhong Wenyan , Chen Jingjing , He Yumin , Xiao Li , Yuan Chengfu
Published: April 2024

The decline of aging brain neurons is the main cause of various neurodegenerative disease. This study aimed to examine the impact of Balanophora polyandra polysaccharides (BPP) against aging related neuronal deterioration. C57BL/6 mice were fed with regular feed for 27 months to establish a natural aging mouse model. From 3 months of age, mice in the drug-treated group were respectively fed with feed containing 0.05 or 0.18% BPP until 27 months of age. The effects of BPP treatment on the pathological changes of neurons in mice brain were evaluated, as well as autophagy-related and signaling pathway proteins. BPP treatment had a notable positive impact on the pathological injury of cortical and hippocampal neurons, alleviated neuronal degeneration, and enhanced the staining of Nissl bodies in natural aging mice. Furthermore, BPP upregulated autophagy-related proteins LC3 II/I, Parkin, and PINK1 in the cortex and hippocampus of aging mice, and significantly decreased the expression of p62, PI3K, p-protein Kinase B (AKT), and p-mTOR. Immunofluorescence results showed a reduction in the brightness of LC3, which mainly coexpressed with NeuN in natural aging mice brain, and increased LC3-positive neurons were observed after BPP treatment. Collectively, BPP treatment enhanced neuronal autophagy to improve brain functional degradation through the PI3K/AKT/mTOR signaling in natural aging mice. These finding suggested that BPP has potential to mitigate or delay the neurodegeneration associated with aging and further investigation was needed to validate its efficacy in elderly populations.
Coupling an agent-based model and an ensemble Kalman filter for real-time crowd modelling
Authors: Suchak Keiran , Kieu Minh , Oswald Yannick , Ward Jonathan A. , Malleson Nick
Published: April 2024

Agent-based modelling has emerged as a powerful tool for modelling systems that are driven by discrete, heterogeneous individuals and has proven particularly popular in the realm of pedestrian simulation. However, real-time agent-based simulations face the challenge that they will diverge from the real system over time. This paper addresses this challenge by integrating the ensemble Kalman filter (EnKF) with an agent-based crowd model to enhance its accuracy in real time. Using the example of Grand Central Station in New York, we demonstrate how our approach can update the state of an agent-based model in real time, aligning it with the evolution of the actual system. The findings reveal that the EnKF can substantially improve the accuracy of agent-based pedestrian simulations by assimilating data as they evolve. This approach not only offers efficiency advantages over existing methods but also presents a more realistic representation of a complex environment than most previous attempts. The potential applications of this method span the management of public spaces under ‘normality’ to exceptional circumstances such as disaster response, marking a significant advancement for real-time agent-based modelling applications.
Molecular and cytogenetic analyses in
Geranium macrorrhizum
L. wild Italian plants
Authors: Cardinali Irene , Ceccarelli Marilena
Published: April 2024

Geranium macrorrhizum
L. is a herbaceous species native to southern Europe and was introduced in central Europe and North America. It is also widely distributed in Italy. In this study, molecular and cytogenetic analyses were carried out on 22 wild plants, collected in central and southern Italy, compared with five cultivated plants, with the main purpose to identify those living near the Marmore waterfalls in central Italy, recently described as the new species
Geranium lucarinii
. Four barcoding markers (
rbcL
,
matK
,
trnH-psbA
intergenic spacer and internal transcribed spacer region) were sequenced and their variability among the plants was evaluated. Chromosome numbers were determined and 45S rDNA was physically mapped by fluorescence
in situ
hybridization. Moreover, genomic affinity between wild and cultivated plants was evaluated by genomic
in situ
hybridization. The results of this study supported that all the plants belong to
G. macrorrhizum
, including the Marmore population. Barcoding analyses showed a close similarity among the wild plants, and a differentiation, although not significant, between the wild plants on one hand and the cultivated plants on the other. Integrated studies focusing on morphological, genetic and ecological characterization of a larger number of wild populations would allow us to know the extent of the variability within the species.
Placental Nanoparticle-mediated IGF1 Gene Therapy Corrects Fetal Growth Restriction in a Guinea Pig Model
Authors: Davenport Baylea N , Wilson Rebecca L , Williams Alyssa A , Jones Helen N
Published: April 2024

Fetal growth restriction (FGR) caused by placental insufficiency is a major contributor to neonatal morbidity and mortality. There is currently no in utero treatment for placental insufficiency or FGR. The placenta serves as the vital communication, supply, exchange, and defense organ for the developing fetus and offers an excellent opportunity for therapeutic interventions. Here we show efficacy of repeated treatments of trophoblast-specific humaninsulin-like 1 growth factor(IGF1) gene therapy delivered in a non-viral, polymer nanoparticle to the placenta for the treatment of FGR. Using a guinea pig maternal nutrient restriction model (70% food intake) of FGR, nanoparticle-mediatedIGF1treatment was delivered to the placenta via ultrasound guidance across the second half of pregnancy, after establishment of FGR. This treatment resulted in correction of fetal weight in MNR +IGF1animals compared to sham treated controls on an ad libitum diet, increased fetal blood glucose and decreased fetal blood cortisol levels compared to sham treated MNR, and showed no negative maternal side-effects. Overall, we show a therapy capable of positively impacting the entire pregnancy environment: maternal, placental, and fetal. This combined with our previous studies using this therapy at mid pregnancy in the guinea pig and in two different mouse model and three different human in vitro/ex vivo models, demonstrate the plausibility of this therapy for future human translation. Our overall goal is to improve health outcomes of neonates and decrease numerous morbidities associated with the developmental origins of disease.
Zero-shot animal behavior classification with vision-language foundation models
Authors: Dussert Gaspard , Miele Vincent , Van Reeth Colin , Delestrade Anne , Dray Stéphane , Chamaillé-Jammes Simon
Published: April 2024

1. Understanding the behavior of animals in their natural habitats is critical to ecology and conservation. Camera traps are a powerful tool to collect such data with minimal disturbance. They however produce very a large quantity of images, which can make human-based annotation cumbersome or even impossible. While automated species identification with artificial intelligence has made impressive progress, automatic classification of animal behaviors in camera trap images remains a developing field.

2. Here, we explore the potential of foundation models, specifically Vision Language Models (VLMs), to perform this task without the need to first train a model, which would require some level of human-based annotation. Using an original dataset of alpine fauna with behaviors annotated by participatory science, we investigate the zero-shot capabilities of different kind of recent VLMs to predict behaviors and estimate behavior-specific diel activity patterns in three ungulate species.

3. Our results show that using these methods, it is possible to achieve accuracies over 91% in behavior classification and produce activity patterns that closely align with those derived from participatory science data (overlap indexes between 84% and 90%).

4. These findings demonstrate the potential of foundation models and vision-language models in ecological research. Ecologists are encouraged to adopt these new methods and leverage their full capabilities to facilitate ecological studies.