bluuebunny/crossref_metadata_2025 huggingface dataset:
Documentary Forms and Realist Theater
Authors: Kempf Lucie
Published: November 2024

The notion of realism in theater is fundamentally problematic because even though it tries to recreate the illusion of reality on stage, everything in the performance is in fact based on theatrical conventions. During the performance the spectator agrees to believe in the existence of the “fourth wall,” pretending that what they see is “real life” and not a work of fiction staged by actors: in other words, an attempt to reproduce reality. However, the aim of documentary theater is not to reproduce reality but to immerse the spectator in it. It does not rely on dramatic art, that is, on works of fiction, but on “documents,” whatever their material form. In the documentary theater productions created by two Russian theaters, Teatr.doc and KnAM, the spectator is confronted with testimonies and invited to compare them to their own life experience. This chapter examines the way contemporary documentary theater breaks the theatrical codes of the realist tradition by suppressing mediation: fiction is replaced by documents, theatrical text by journalistic-style investigations; the author disappears behind collective stage composition; characters give way to actors, who sometimes speak in their own name, or even to witnesses who are not professional actors.
Undoing Italy with Ferrante, Sapienza, Scego, and Lahiri
Authors: Bazzoni Alberica
Published: November 2024

This chapter begins with the global success of Elena Ferrante’s tetralogy known as the Neapolitan Novels to sketch an alternative configuration of contemporary Italian literature based on a transnational approach. The author places Ferrante next to case studies of transnational success (Goliarda Sapienza), postcolonial narrative (Igiaba Scego), and translingual authorship (Jhumpa Lahiri) that showcase the porosity of the boundaries of a national canon. Considered together, these authors reveal and institute difference at the very heart of Italian identity, and concomitantly place Italian literature into a transnational network of references and readerships. Reflecting on diverging methodologies and disciplinary confines at play in canon formation in Italian studies in Italy and in Anglophone academia, the chapter foregrounds the categories of trauma, gender, translingualism, hybridity, and multiplicity of identity as central to the definition of a transnational corpus of contemporary literature in Italian. The chapter is divided into two parts: the first addresses a transnational perspective in Italian studies, argues for an enlarged canon that is representative of difference within contemporary literature in Italian, and describes the analytical categories that emerge from the application of a transnational approach to the selected hybrid corpus. The second part introduces works by Ferrante, Sapienza, Scego, and Lahiri, and offers a snapshot of the working of this approach and these categories in these authors’ production.
Lived Buddhism and Mount Wutai, China, in the Northern Dynasties (439–589) and Tang (618–907) Periods
Authors: Andrews Susan
Published: November 2024

This chapter explores how Buddhism and religion more broadly figured in the ordinary lives of humans dwelling nearby Mount Wutai (Wutai shan 五臺山, the Mountain of Five Plateaus) in the sixth and seventh centuries. Focusing on stories compiled in Huixiang’s 慧祥 (ca. seventh century)Ancient Chronicle of Mount Clear and Cool (Gu Qingliang zhuan 古清涼傳)—particularly tales preserved in its less often-studied, final “Miscellaneous Accounts of Branches and Tributaries” (Zhiliu zashu 支流雜述) chapter––the work highlights food’s centrality to lived religion in this setting. It argues that the narratives collected in this fascinating source give voice to tensions surrounding the encounter between long-standing local foodways and Buddhist perspectives and practices related to food’s procurement, distribution, and consumption introduced to the region as part of its reimagining as the center of the Bodhisattva Mañjuśrī cult.
Noli me Tangere in a Reflection on Touch, Taboo, Clergy Child Sexual Abuse, and Pastoral Care
Authors: Demasure Karlijn
Published: November 2024

The phrase “Noli me tangere” (Do not touch me) is the Latin translation of a passage from John 20:17, in which the risen Jesus meets Mary Magdalene, and prohibits her not to touch him “because I have not yet ascended to the Father” (NRSV). Interpretations vary as to why Jesus refused to be touched by Mary Magdalene, and this essay places the passage in the context of clergy sexual abuse within the Catholic Church. “Noli me tangere” is typically uttered in a register of warning before a danger. Physical and sexual touching can cause harm and leave marks on the victim, and victims/survivors feel defiled and have a distorted view of their body and often do not like to be touched. Sexual relations between a child and an adult belong to the realm of taboo. The transgression of a taboo leads to the feeling of defilement and shame. A closer look at the characteristics of the sense of touch explains why the child feels involved in the act of sexual abuse. Provided with these insights, the author explores their implications for the use of touch in the care of victims/survivors of clergy sexual abuse.
Mary Magdalene and Pilgrimage
Authors: Anderson Joanne W.
Published: November 2024

This essay evaluates the role of pilgrimage in the development and spread of the cult of Mary Magdalene, taking as its focus the north-south dynamic in western Europe as expressed through art, architecture, and sacred topography. It draws together key primary sources and catalytic scholarly literature on the topic, from the earliest relic collecting and display strategies in the Byzantine East through to the establishment of the major shrines in France, which were to attract thousands of Christian pilgrims. From there, it continues with diffused cultural responses to the major shrines north and south of the Alps, as well as within the mountains themselves. In doing so, the essay offers critical perspective on the shifting approaches of scholars from archival and architectural investigations through regionalism to experiential and ethnographic considerations of the pilgrim’s encounter with these managed sites, past and present.
Mary Magdalene Within and Beyond the Medieval Cloister
Authors: Jansen Katherine L.
Published: November 2024

This article proceeds on two tracks. Part one lays out the historiographical foundation for the second, by arguing that the uptick in Magdalenian studies and interest in the historical figure of Mary Magdalene at the end of twentieth and into the twentieth-first century was due to particular social movements and the specific “turns” in historical writing that accompanied them. First was Second Wave Feminism of the 1960s and 1970s and the scholarship inspired by it that put the spotlight on the roles of women, gender, and body in society. Second was a new interest in the role of the laity in the Roman Catholic Church, partly inspired by Vatican II, and partly inspired by trends in the field of history itself, which had moved historical studies away from studying the institutional church and its elites and toward the everyday people of the parish. And third was the acceptance in scholarly circles of hagiographical materials as a viable source for the study of medieval religion. The second part of the article then uses the insights, methods, and sources of these historical turns to examine how devotion to Mary Magdalene developed in monastic circles in the eleventh century but soon moved beyond the cloister to make her one of the most popular and admired saints of the premodern period.
Nudging recommendation algorithms increases news consumption and diversity on YouTube
Authors: Yu Xudong , Haroon Muhammad , Menchen-Trevino Ericka , Wojcieszak Magdalena
Published: November 2024

Recommendation algorithms profoundly shape users’ attention and information consumption on social media platforms. This study introduces a computational intervention aimed at mitigating two key biases in algorithms by influencing the recommendation process. We tackle interest bias, or algorithms creating narrow nonnews and entertainment information diets, and ideological bias, or algorithms directing the more strongly partisan users to like-minded content. Employing a sock-puppet experiment (n=8,600 sock puppets) alongside a month-long randomized experiment involving 2,142 frequent YouTube users, we investigate if nudging the algorithm by playing videos from verified and ideologically balanced news channels in the background increases recommendations to and consumption of news. We additionally test if providing balanced news input to the algorithm promotes diverse and cross-cutting news recommendations and consumption. We find that nudging the algorithm significantly and sustainably increases both recommendations to and consumption of news and also minimizes ideological biases in recommendations and consumption, particularly among conservative users. In fact, recommendations have stronger effects on users’ exposure than users’ exposure has on subsequent recommendations. In contrast, nudging the users has no observable effects on news consumption. Increased news consumption has no effects on a range of survey outcomes (i.e. political participation, belief accuracy, perceived and affective polarization, and support for democratic norms), adding to the growing evidence of limited attitudinal effects of on-platform exposure. The intervention does not adversely affect user engagement on YouTube, showcasing its potential for real-world implementation. These findings underscore the influence wielded by platform recommender algorithms on users’ attention and information exposure.
Design science in public administration: producing both situational interventions and generic knowledge
Authors: Meijer Albert
Published: November 2024

Design science is making a comeback in the discipline of public administration: inspired by the growing popularity of design thinking, various scholars have highlighted the value of design science for the public sector. This theoretical and methodological article aims to contribute to the academic value of design science and focuses on the “double burden” of design science: how can it be applied in such a way that it generates both (relevant) situational interventions and contributes to (robust) generic academic knowledge? We identify which types of generic academic knowledge can be generated through design science in public administration: theoretical knowledge, design exemplars, methodological knowledge, and normative knowledge. We use these four types of generic knowledge to develop a new perspective on design science. We also present guidelines for design research that aim to generate both situational interventions and generic knowledge. These guidelines emphasize the need to be more rigorous and systematic in the process of design research as to ensure the validity and reliability of the contributions to generic knowledge for the discipline of public administration.
Tailoring cell therapies for diabetic metabolic phenotypes: a comparative study on the efficacy of various umbilical cord-derived cell regimens
Authors: Wang Lingshu , Wang Liming , He Falian , Song Jia , Qiao Jingting , Qin Jun , Chen Li , Hou Xinguo
Published: November 2024

Given the high heterogeneity of type 2 diabetes mellitus (T2DM), it is imperative to develop personalized stem cell infusion regimen for targeted metabolic phenotype in order to ensure optimal therapeutic efficacy. In this study, we conducted a comparative analysis of 4 infusion regimens involving single and repeated infusions of human umbilical cord Wharton’s jelly-derived MSCs (hucMSCs), single infusions of umbilical cord blood mononuclear cells (UCB), and sequential infusions of hucMSCs and UCB in T2DM rats. Results showed all 4 infusion regimens exhibited comparable efficacy in lowering fasting blood glucose levels and suppressing glucagon secretion. Single and double infusions of hucMSCs exhibited a tendency to migrate to the liver, thereby better at ameliorating hepatic glucose metabolism by enhancing glycogen synthesis and storage, promoting glycolysis, inhibiting gluconeogenesis, and improving insulin signal transduction. The sequential infusion of hucMSCs and UCB demonstrated specific cell tropism toward the pancreas, leading to prolonged glucose-lowering effects following a glucose tolerance test, restoration of early-phase insulin secretion, stimulation of islet beta cell proliferation and improvement in the beta/alpha ratio. Multiple injections, regardless of cell type, reduced the expression of systemic chronic inflammatory markers such as IL-1β, IL-6, IL-17, IL-22, and IFN-γ. Finally, a single dose of UCB exhibited a greater tendency to target visceral fat and enhanced effectiveness in regulating levels of total cholesterol and triglycerides. In conclusion, our study provided personalized stem cell regimens for diverse T2DM metabolic phenotypes, thereby offering improved treatment alternatives for future clinical trials and applications.
Statutory trusts, planning law and open spaces: R (on the application of Day) v Shropshire Council
Authors: Brown Lloyd Andrew
Published: November 2024

This case comment argues that the Supreme Court decision in R (on the application of Day) v Shropshire Council [2023] UKSC 8 is significant for two reasons. From a technical standpoint, the judgment rightly preserves the public recreation rights afforded under a statutory trust following an unlawful disposal by a council to a private developer. Not only does this show that statutory trusts bestow subsisting rights, but that public bodies must comply with the statutory schemes imposed upon them. From a public policy standpoint, the ruling also protects local communities’ rights to open spaces and the environment over private development.
Effect of shade and limit feeding in growing beef heifers during periods of heat stress
Authors: DeBord Zachary L , Duncan Zachary M , Pflughoeft Madison G , Suhr Kyler J , Ellis William C , Hollenbeck William R , Montgomery Sean P , Spore Tyler J , Titgemeyer Evan C , Blasi Dale A , Tarpoff Anthony J
Published: November 2024

Experiments were conducted during the summers of 2021 and 2022 to evaluate the effects of feeding strategy and shade on growth performance, animal comfort, water usage, apparent diet digestibility, and ruminal fermentation characteristics of growing heifers during periods of heat stress. In Exp. 1, 852 heifers (initial body weight [BW] = 251 ± 13 kg) were assigned to one of 4 treatments: high-energy diet limit-fed at 2.2% of BW (dry matter [DM] basis; LIM) or high-roughage diet fed for ad libitum intake (ADLIB) with shade (SH) or without shade (NSH). Pen BWs were measured on day 0, weekly from days 14 to 84, day 90, and day 97. Pen weights were used to adjust weekly intakes of LIM. Refusals for ADLIB were targeted at 5% of feed consumed the previous day. Following the 90-d feeding period, a gut-fill equilibration diet was fed to all cattle at 2.5% of BW (DM basis) for 7 d to balance differences in gut-fill between dietary treatments. Dry matter intake was lesser (P < 0.01) for LIM compared with ADLIB. Average daily gain (ADG) and gain:feed (G:F) were greater (P < 0.01) for LIM compared with ADLIB. In addition, ADG and G:F were greater (P < 0.01) for SH compared with NSH. Water usage was less (P < 0.01) for SH heifers compared with NSH and was also less (P < 0.01) for LIM compared with ADLIB. Mean panting scores were lower (P < 0.01) for SH compared with NSH and LIM compared with ADLIB. In Exp. 2, 16 heifers (initial BW = 254 ± 22 kg) were arranged in 4 replicated 4 × 4 Latin squares to evaluate treatments from Exp. 1. Apparent total tract digestibility of DM and organic matter was greater (P < 0.01) for LIM compared with ADLIB. Ruminal pH was more acidic (P = 0.02) for LIM compared with ADLIB. Shade did not affect (P ≥ 0.68) apparent diet digestibility; however, ruminal pH was greater (P < 0.01) for SH compared with NSH. In conclusion, LIM improved feed efficiency, reduced mean panting score, and reduced water usage compared with ADLIB. In addition, SH improved growth performance, reduced water usage, and improved animal comfort during periods of heat stress.
Rates and determinants of COVID-19 vaccine uptake among people living with HIV in Federal Capital Territory, Nigeria
Authors: Etuk Victoria Peter , Sanni Charity , Omonijo Oluwafemi , Atema Stella Ijioma , Lawal Temitayo , Yashim-Ankut Anthonia Murna , Ejinkeonye Ifeyinwa , Onyegbutulem Henry Chijioke , Oyedele Oyewole K , Williams Imoiboho , Andrew Nifarta Peingurta , Okpokoro Evaezi
Published: November 2024

Background

We investigated coronavirus disease 2109 (COVID-19) vaccine uptake and determinants among people living with human immunodeficiency virus (PLHIV) in Federal Capital Territory (FCT), Nigeria.

Methods

This was a cross-sectional study among PLHIV attending antiretroviral therapy clinics in FCT, Nigeria. We utilized an interviewer-administered, semi-structured questionnaire to collect data on COVID-19 vaccine uptake. Vaccine uptake was measured using the question ‘Have you received a COVID-19 vaccine?’ and was confirmed with a vaccination card by the interviewer. Data were analysed using descriptive statistics, χ2 and binary logistic regressions in Stata version 18.0.

Results

Of the 252 study participants, 87 (34.5%) had received at least one dose of a COVID-19 vaccine, with uptake lower in females than males (30.5% vs 46.1%; p=0.022). Being >50 y of age (adjusted odds ratio [aOR] 2.870 [95% confidence interval {CI} 1.049 to 7.858], p=0.040) was associated with higher vaccine uptake, while being virally unsuppressed (aOR 0.313 [95% CI 0.099 to 0.985], p=0.047) and not believing COVID-19 disease is real (aOR 0.324 [95% CI 0.147 to 0.717], p=0.005) were associated with lower odds of vaccine uptake.

Conclusions

Vaccination uptake was low among PLHIV in our study. It is critical to target vaccination campaigns to PLHIV, particularly females and younger people. Proper education about COVID-19 itself would contribute to vaccine uptake.
Quality Metrics for Cesarean Delivery: More Than Just General Anesthesia Rates
Authors: Hofkamp M.P. , Sharpe E.E. , Zakowski M.I. , White R.S.
Published: November 2024

(J Clin Anesth. 2024;94:111398. https://doi.org/10.1016/j.jclinane.2024.111398)

General anesthesia should be avoided for cesarean deliveries when possible but used when necessary, and sometimes it may be the preferred option. The shift in obstetric anesthesia practices to minimize general anesthesia for cesarean deliveries for maternal safety began in 1997. Hawkins and colleagues reported a 17-fold increase in mortality for patients undergoing general anesthesia for cesarean delivery compared with those receiving regional anesthesia. From 2011 to 2013, maternal mortality in the United States was 17 per 100,000 births, and the proportion of anesthesia-related maternal deaths decreased from 1.6% (1990 to 1997) to 0.2% (2011 to 2013). This reduction is partly attributed to decreased general anesthesia rates for cesarean deliveries.
General Anesthesia for Cesarean Delivery: Can Interinstitutional Variation in Practice Offer Deeper Insights Into Our Choice of Anesthetic Modality?
Authors: Munro A. , Sjaus A.
Published: November 2024

(Can J Anesth/J Can Anesth. 2024;71:169–174. doi: 10.1007/s12630-023-02634-9)

The practice of using general anesthesia (GA) for cesarean deliveries (CD) has changed over the past 5 decades. This change was sparked by a study demonstrating a high rate of maternal deaths caused by GA that was published in 1997. Significant practice adjustments led to improved safety and decreased anesthesia-related deaths. GA rates differ between institutions.
Presence of the Partner in the Operating Room During A Category 1 Cesarean Section: A Prospective Explorative Study
Authors: Nedergaard H.K. , Weitling E.E. , Rahbech M. , Frøslev-Friis C. , Quitzau L.H. , Strøm T. , Brøchner A.C. , Jensen H.I.
Published: November 2024

(Int J Obstet Anesth. 2024;57:103939. https://doi.org/10.1016/j.ijoa.2023.103939)

In anesthesiology, numerous clinical emergencies occur daily, with increasing attention to the presence of a partner or relative during these situations. Studies indicate that both patients and families prefer having relatives present, even in severe emergencies, as it may reduce relatives’ posttraumatic stress. This preference extends to parents of severely ill children, who often choose to be present during resuscitation. However, little is known about the partner’s role during emergency cesarean deliveries (CD). A recent review found few studies on this topic, and none focused on the partner’s presence during category 1 CD (CD-1), where there is an immediate threat to the mother and/or fetus.
Risk Factors for Preeclampsia: Received Wisdom Versus Reality
Authors: Kane S.C. , Da Silva Costa F.
Published: November 2024

(BJOG. 2024;131(1):63. doi: 10.1111/1471-0528.17311)

Prevention of many pregnancy-related complications can be better accomplished when risk factors (RF) for these conditions are considered. An example of this is preeclampsia (PEC), where the preventative measures of aspirin and calcium have been shown to reduce the incidence of the condition. Preventive strategies for PEC are determined heavily by clinical practice guidelines (CPGs), which rely on screening for RFs.
Intrathecal Dexmedetomidine Analgesia After Cesarean Delivery: A Feasibility Trial
Authors: Lamontagne C. , Ouellet A.-M. , Lesage S. , Crochetiere C.
Published: November 2024

(Can J Anesth/J Can Anesth. 2024;71:161–162. doi:10.1007/s12630-023-02630-z)

A small feasibility study comparing intrathecal dexmedetomidine given for pain after cesarean delivery to the standard treatment found that dexmedetomidine did not control pain as well as the standard treatment of bupivacaine with combined morphine and fentanyl.
Marital status as an independent prognostic factor for survival in women with vaginal cancer: evidence from the SEER database analysis
Authors: Xu Yanhong , Shu Xinru , Xu Wenhuang , Hu Yiming
Published: November 2024

This study aimed to evaluate the influence of marital status on the survival outcomes of women diagnosed with vaginal cancer, considering the potential role of sociodemographic factors in patient prognosis. Utilizing data from the Surveillance, Epidemiology, and End Results database, the study included 6046 women with primary vaginal cancer diagnosed between 2000 and 2020. The propensity score matching (PSM) method was employed to balance comparison groups and account for confounding factors. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS), with Cox proportional-hazards regression models used for statistical analysis. Married patients exhibited better survival outcomes than their unmarried counterparts [OS: hazard ratio = 1.520, 95% confidence interval (CI) = 1.430–1.630, P < 0.001; CSS: hazard ratio = 1.380, 95% CI = 1.270–1.490, P < 0.001]. Subgroup analyses stratified by age and race highlighted a significant survival benefit for married individuals, particularly those aged 50–69 years and white patients. After PSM, the widowed subgroup within the unmarried category showed worse survival outcomes (OS: hazard ratio = 1.580, 95% CI = 1.430–1.750, P < 0.001; CSS: hazard ratio = 1.360, 95% CI = 1.200–1.530, P < 0.001). This study demonstrates that marital status serves as an independent prognostic factor for OS and CSS among patients with primary vaginal cancer, which supports that unmarried people need more individualized care strategies.
CO2 Laser Versus Surgical Deroofing for the Treatment of Hidradenitis Suppurativa Tunnels: A Comparative Multicentric, Retrospective Study
Authors: Sechi Andrea , Caposiena Caro Raffaele Dante , Michelucci Alessandra , Dini Valentina , Piaserico Stefano , Zalaudek Iris , Savoia Francesco , Tartaglia Jacopo
Published: November 2024

BACKGROUND

Tunnels of hidradenitis suppurativa (HS) are one of the most challenging aspects to manage, and different surgical techniques have been proposed for their treatment. CO2 laser and surgical deroofing are 2 of the most widely used techniques, but no studies have compared them directly.

OBJECTIVE

The objective of this study was to compare the efficacy and outcomes of CO2 laser treatment versus surgical deroofing for HS tunnels, with a focus on healing time, complication rates, pain perception, and cosmetic outcomes.

MATERIALS AND METHODS

The authors performed a multicentric retrospective analysis of 20 patients with HS tunnels who were treated with either CO2 laser (n = 10) or surgical deroofing (n = 10). The primary end point was to compare the 2 procedures in terms of healing time, complication rates, pain, and cosmetic outcome. Outcome measures included Visual Analog Scale for pain, the Vancouver Scar Scale for scar evaluation, and the relapse rate at 6 months. Secondary end point included the identification of variables associated with the healing time.

RESULTS

The mean time to healing was 4.7 ± 1.9 weeks in the CO2 laser group and 10.9 ± 4.1 weeks in the surgical deroofing group (p < .01). Pain score at the first dressing change was lower in the CO2 laser group, with a mean Visual Analog Scale score of 1.7 ± 0.8 in the CO2 laser group and 4.9 ± 1.7 in the surgical deroofing group (p < .01). The mean scar evaluation score using the Vancouver Scar Scale at 6-month follow-up was 2.5 ± 1.3 in the CO2 laser group and 3.4 ± 1.1 in the surgical deroofing group. The number of postprocedural complications was low in both groups (1 in the CO2 laser group and 3 in the surgical deroofing group). The proportion of patients achieving complete healing of the tunnels at 6 months was similar among the CO2 laser and the surgical deroofing group (90% in the CO2 laser group vs 80% in the surgical group).

CONCLUSION

CO2 laser is a safe and effective treatment for HS tunnels, with fast healing rates and low pain perception.
Graded Eyelid Crease Approach to the Superior Orbital Apex: An Anatomical Study
Authors: Tong Jessica Y. , Sung Jeffrey , Chan WengOnn , Psaltis Alkis J. , Selva Dinesh
Published: November 2024

Purpose:

To describe a graded eyelid crease approach to access the superior orbital apex, and to quantify the working space enabled with the sequential release of structures along the superior orbital rim.

Methods:

Cadaveric dissection study of 7 cadaver heads (14 orbits). This technique involved a subperiosteal approach to the superior orbital apex. This was performed by sequential dissection from 1) the supraorbital neurovascular bundle (SNB) to the zygomaticofrontal suture, 2) extension of this plane to the Whitnall’s tubercle, 3a) dissection around the SNB up to the trochlea while preserving the SNB, or 3b) release and division of the SNB, and finally 4) subperiosteal release of the trochlea. Measurements were taken between each landmark (mean ± 1 SD). With each step, a silicone mold was created of the subperiosteal cavity with maximal orbital retraction, which was maintained within 10 mm from the superior orbital rim. The length (mm), width (mm), height (mm), and weight (g) of the mold were quantified.

Results:

The mean distance from SNB to the zygomaticofrontal suture is 27.0 ± 2.9 mm; zygomaticofrontal suture to Whitnall’s tubercle 8.9 ± 3.1 mm, and SNB to trochlea 4.6 ± 2.7 mm. There was a linear increase in the length, width, and height of the silicone mold with each progressive step. The largest gains in height and weight of the silicone mold were noted progressing from step 2 to 3a.

Conclusion:

Quantitative analysis of the transorbital approach to the superior orbital apex demonstrates that dissection around the SNB provides a wider surgical corridor of access.
The Granulomas of Orbital Sarcoidosis Often Show Foci of Necrosis: A Retrospective Observational Study
Authors: Vongsachang Hursuong , Wolkow Natalie , Stagner Anna M.
Published: November 2024

Purpose:

To characterize the frequency and extent of necrosis within granulomas among patients diagnosed with orbital sarcoidosis on biopsy.

Methods:

A retrospective review was conducted of patients diagnosed with orbital sarcoidosis at a single institution from 2018 to 2024. Histopathology slides were re-reviewed for evidence of any necrosis or infection. Demographic, laboratory, histopathologic, and radiographic data were gathered for these patients. All findings were presented using descriptive statistics.

Results:

There were 19 total cases of orbital sarcoidosis in the study timeframe. The majority were female (15, 78.9%) with a median age of 49 (range: 11–85) presenting with a unilateral, mass-occupying orbital lesion (n = 16, 84.2%). The lacrimal gland and orbital fibroadipose tissue were the most frequently involved and biopsied. Biopsies from 13 patients (68.4%) had granulomas containing varying amounts of necrosis on histopathology on retrospective review. No fungal or acid-fast microorganisms were detected with special stains; a subset of patients had additional molecular genetic-based microbiologic studies which were also unrevealing.

Conclusions:

Although the histopathology of sarcoidosis is classically described as a “non-necrotizing (noncaseating) granulomas,” granulomas with varying extents of necrosis are more frequently seen in orbital sarcoidosis than previously recognized, or than reported in biopsies from patients with sarcoidosis at other anatomic sites. The presence of necrosis within sarcoidal granulomas should not exclude a diagnosis of sarcoidosis at this site, given that infection is adequately excluded.
Recurrent Solitary Neurofibroma Involving the Proximal Lacrimal Drainage System
Authors: Maddi Lavanya , Jakati Saumya , Ali Mohammad Javed
Published: November 2024

Solitary eyelid neurofibroma is a rare condition, and there have been no reported cases of solitary eyelid neurofibroma involving the proximal lacrimal drainage system. A 6-year-old male presented with recurrent painless swelling in the medial part of the left lower eyelid. The patient was misdiagnosed as eyelid polyp and underwent excision biopsy twice elsewhere. Subsequently, the patient presented with a recurrence of swelling and was treated with full-thickness eyelid resection and reconstruction by direct closure. Histopathology showed the presence of spindle cells with hyperchromatic nuclei in a myxoid background. These cells showed S100 and CD 34 positivity. The systemic evaluation did not show any signs of neurofibromatosis.
From the armchair to contemporary cardiac rehabilitation: the remarkable ongoing journey of exercise training in ischemic heart disease
Authors: Vilela Eduardo M. , Almeida Marta Catarina , Oliveira Cláudia , Nogueira Teresa , Torres Susana , Teixeira Madalena , Sampaio Francisco , Ribeiro José , Oliveira Marco , Bettencourt Nuno , Viamonte Sofia , Fontes-Carvalho Ricardo
Published: November 2024

Exercise is an important physiological activity with several health benefits. In the setting of ischemic heart disease (IHD), the view toward exercise has greatly evolved throughout the years, concurrently to several major advances in the management of this complex entity. Currently, exercise training has broad applications across the IHD continuum as a powerful tool in its overall management, being a core component of comprehensive cardiac rehabilitation programs. Beyond this, exercise has also been incorporated as an integral part of contemporary methodologies aiming to provide diagnostic and prognostic data, such as cardiopulmonary exercise stress testing or stress echocardiography. In this article, we provide a pragmatic overview concerning the role of exercise in IHD, with a focus on its incorporation in cardiac rehabilitation frameworks, while also discussing some of the challenges and unmet needs concerning these interventions.
Preexisting chronic pain is not associated with moderate-to-severe acute pain after laparoscopic cholecystectomy: a prospective cohort study
Authors: Nepali Bishal , Subedi Asish , Pokharel Krishna , Ghimire Ashish , Prasad Jagat Narayan
Published: November 2024

Introduction:

We aimed to evaluate the relationship between preexisting chronic pain and acute postoperative pain after laparoscopic cholecystectomy (LC) and to identify predictors of acute postsurgery pain.

Methods:

In this prospective cohort study, patients undergoing LC with general anesthesia were enrolled. The primary outcome was the incidence of moderate-to-severe pain during movement in the first 24 hours after surgery. Logistic regression analysed the association of perioperative risk factors with acute postoperative pain. Model performance was assessed using receiver operating characteristic curves (ROC), calibration belt plots, and 10-fold cross-validation.

Results:

Of the 193 patients analysed, 49.74% experienced moderate–severe acute pain. Univariable analysis indicated that preoperative chronic pain increased the likelihood of acute postoperative pain (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.40–4.55). Risk factors identified in the multivariable analysis were higher preoperative pain intensity (OR, 1.28; 95% CI, 1–1.65), sleep disturbances (OR, 1.42; 95% CI, 1.24–1.61), intraoperative fentanyl supplementation (OR, 3.68; 95% CI, 1.48–9.12), incision extension for gallbladder retrieval (OR, 7.27; 95% CI, 1.58–33.39), and abdominal drain placement (OR, 6.09; 95% CI, 1.08–34.34). Dexamethasone use was associated with reduced pain (OR, 0.05; 95% CI, 0.004–0.74). The model demonstrated strong discrimination (ROC = 0.909) and good calibration (test statistic = 0.02; P = 0.89). Cross-validation showed slightly lower accuracy (ROC = 0.896).

Conclusions:

Preexisting chronic pain was not associated with acute postoperative pain following laparoscopic cholecystectomy. Significant predictors for acute pain included higher preoperative pain intensity, sleep disturbances, intraoperative fentanyl, incision extension, and abdominal drain placement, while dexamethasone use was associated with reduced pain.
Long-Term Surgical Outcomes of Intermediate Cleft Rhinoplasty
Authors: Ng Jinggang J , Cheung Liana , Massenburg Benjamin B , Cho Daniel Y , Wu Meagan , Romeo Dominic J , Swanson Jordan W , Jackson Oksana A , Low David W , Taylor Jesse A
Published: November 2024

Background:

The risk/benefit ratio of operating on the cleft nasal deformity in the period of mixed dentition remains debated. This study characterizes our 18-year experience with intermediate cleft rhinoplasties to add data and nuance to the discussion.

Methods:

We performed a retrospective cohort study of patients who underwent intermediate cleft rhinoplasty from 2006 to 2023. Demographic information and operative details were collected. Primary outcomes were operative complications and need for subsequent rhinoplasty.

Results:

Three-hundred and forty-two patients undergoing 372 intermediate rhinoplasties were included: 150 (40.3%) with no graft/implant, 165 (44.4%) with iliac crest cartilage graft, 36 (9.7%) with ear cartilage, 19 (5.1%) with a resorbable plate, and 3 (0.8%) with nasal cartilage. Use of iliac crest graft predicted fewer subsequent rhinoplasties independent of age at surgery, age at most recent follow-up, sex, race, syndromic status, cleft severity, intranasal stenting duration, and surgeon (β=-0.234, p=0.012). Employment of a V-Y chondromucosal flap in the unilateral cleft lip group (β=-0.401, p=0.002) and placement of a columellar strut graft in the bilateral cleft lip group (β=-0.450, p=0.028) predicted fewer subsequent rhinoplasties. The proportion of rhinoplasties utilizing iliac crest grafts increased over time (r(372)=0.806, p<0.001). Most (55.0%) patients with follow-up beyond age 18 (n=60) did not require subsequent rhinoplasty.

Conclusions:

Iliac crest cartilage grafting as a columellar strut in bilateral clefts and a chondromucosal V-Y advancement in unilateral clefts were associated with a decreased need for future rhinoplasty. Further work is needed to understand the risk/benefit ratio, surgical burden, and patient-reported outcomes of intermediate rhinoplasty.
Predictors of Facial Synkinesis Severity
Authors: Rail Benjamin , Gault Natalie A. , Dragun Anthony J. , Bhatia Sahejbir S. , Geltser Chaia S. , Lee MinJae , Rozen Shai M.
Published: November 2024

BACKGROUND:

There is a lack of studies exploring factors influencing synkinesis severity. This study aims to identify factors that may contribute to variations in severity of facial synkinesis.

METHODS:

Patients with a diagnosis of facial synkinesis presenting between 2009 and 2024 were reviewed. The synkinesis score of the eFACE Facial Nerve Clinician-Graded Scale was analyzed for associations with patient characteristics and facial palsy history using univariable and multivariable analysis.

RESULTS:

Two-hundred-forty-nine synkinesis patients were included in the study. The etiology of facial palsy was infectious or idiopathic in 185 patients (74%), tumor resection in 40 patients (16%), trauma in 17 patients (7%), and compression of the facial nerve by a benign tumor in seven patients (3%). Factors independently associated with more severe synkinesis scores included age of facial palsy onset over 50 years (-7.4, 95% CI, [-10.9, -3.9]; p < 0.001), diabetes (-8.6, 95% CI, [-14.9, -2.3]; p = 0.007), smoking (-4.9; 95% CI, [-8.0, -1.8]; p = 0.003), and intratemporal facial nerve injury (-19.4; 95% CI, [-27.8, -10.8]; p < 0.001). Other variables including sex, race, hypertension, and etiology were not found to be independently associated with synkinesis severity.

CONCLUSIONS:

Older age at facial palsy onset, diabetes, smoking, and intratemporal facial nerve injury were found to be independently associated with more severe synkinesis. These findings are novel and may aid in prognostication and treatment selection.
Thromboembolism prophylaxis timing is associated with center mortality in traumatic brain injury: A Trauma Quality Improvement Program retrospective analysis
Authors: Coaston Troy N. , Vadlakonda Amulya , Shen Aricia , Balian Jeffrey , Cho Nam Yong , Benharash Peyman , Barmparas Galinos ,   on behalf of the Academic Trauma Research Consortium (ATRIUM)
Published: November 2024

BACKGROUND

Timing of venous thromboembolism chemoprophylaxis (VTEPPx) in traumatic brain injury (TBI) is complex given concerns for potential worsening of hemorrhage. While timing of VTEPPx for TBI patients is known to vary at the patient level, to our knowledge, variation at the hospital level and correlation with quality metrics have not been quantified in a cohort of nonneurosurgical patients.

METHODS

This was a retrospective cohort study of the Trauma Quality Improvement database from 2018 to 2021. The primary outcome was variation in VTEPPx timing. This was ascertained by empirical Bayesian methodology using multilevel mixed-effects logistic regression. Secondary outcomes included the association of risk-adjusted VTEPPx timing and hospital characteristics such as volume and risk-adjusted mortality, which was assessed through Pearson's correlation coefficient (r). Risk-adjusted mortality was similarly calculated using multilevel mixed-effects modeling.

RESULTS

Of 132,028 patients included in the current study, 38.7% received care at centers in the earliest quartile of VTEPPx timing, classified as Early (others labeled Delayed). Patients receiving care at Early centers presented with severe TBI at a similar rate to Delayed (17.4% vs. 19.0%; absolute standardized mean difference, 0.04). Early center patients more commonly received unfractionated heparin as opposed to low-molecular-weight heparin compared with Delayed (40.5% vs. 27.6%; absolute standardized mean difference, 0.28). At the center level, 12% of observed variation in VTEPPx was attributable to differential hospital practices. Overall trauma volume (r = −0.22, p < 0.001) and TBI volume (r = −0.19, p < 0.001) were inversely associated with risk-adjusted VTEPPx timing. In addition, centers initiating VTEPPx earlier had lower overall (r = 0.17, p < 0.001) and TBI-related mortality (r = 0.17, p < 0.001).

CONCLUSION

There is significant center-level variation in timing of VTEPPx among TBI patients. Earlier VTEPPx was associated with improved center outcomes overall and among TBI patients, supporting usage of VTEPPx timing as a holistic measure of quality.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Does time to operating room affect outcomes after pediatric blunt hollow viscus injury? A Trauma Quality Improvement Program analysis
Authors: Johnston William R. , Croughan Allison L. Mak , Hwang Rosa , Allukian Myron , Nance Michael L. , Nace Gary
Published: November 2024

BACKGROUND

Blunt hollow viscus injuries (HVIs) are relatively rare and difficult to diagnose. Whether a delay in operative intervention impacts outcomes for pediatric patients with blunt HVI has not been investigated via analysis of multicenter databases.

METHODS

We queried the Trauma Quality Improvement Program database from 2016 to 2020 for patients younger than 18 years who underwent an operation of the stomach, small intestine, large intestine, or rectum within 72 hours of emergency department arrival after blunt injury. We excluded patients with solid organ injury and additional extra-intestinal abdominal or thoracic operations. Patients were categorized by the time from emergency department presentation to operating room arrival: 1 to 5, 5 to 12, 12 to 24, and 24 to 72 hours. We analyzed baseline characteristics and outcomes between groups.

RESULTS

We identified 1,700 patients, including 147 (9%) who were operated on >24 hours after arrival. Patients with delayed operations demonstrated higher Injury Severity Scores and higher Abbreviated Injury Scale scores for the head, face, and upper extremities and were more likely to require an orthopedic operation. Patients who received a delayed operation were less likely to have full-thickness injury noted in the operating room and demonstrated longer hospital and intensive care unit stays. However, there was no difference in superficial surgical site infection (SSI), deep SSI, organ space SSI, severe sepsis, or mortality between groups.

CONCLUSION

Diagnosis and operative intervention for blunt HVI may be delayed in the presence of distracting injuries and in the absence of full-thickness perforation. While these patients typically have a more severe injury profile and require longer hospital stays, they do not appear to have increased rates of SSI, sepsis, or mortality.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Long-term accuracy of the National Emergency Laparotomy Audit risk score: Analysis of the impact of comorbidities on mortality 5 years after emergency laparotomy
Authors: Barazanchi Ahmed W.H. , Bhat Sameer , Park Brittany , Zeng Irene , MacFater Wiremu , Xia Weisi , MacCormick Andrew D. , Taneja Ashish , Hill Andrew G.
Published: November 2024

BACKGROUND

The National Emergency Laparotomy Audit (NELA) risk prediction tool has demonstrated superiority in predicting 30-day mortality after emergency laparotomy (EL). The aim of our study was to evaluate the accuracy of NELA in calculating long-term (5 year) mortality and determine factors predicting long-term risk of death after EL.

METHODS

This retrospective cohort study included consecutive patients who underwent EL for any indication other than trauma between May 2012 and June 2017 at a large tertiary and academic teaching center. The primary outcome was all-cause postoperative mortality at 1 and 5 years. The c statistic (<1.0, excellent; <0.90, good; 0.80, fair; 0.70, poor) was used to assess accuracy of the NELA. Multivariable regression was used to identify independent risk factors for 5-year mortality after EL.

RESULTS

From a total of 758 patients, observed mortality continued to increase from 15.4% at 1 year up to 31.4% at 5 years. The NELA risk score accurately classified deceased patients at both 1 year (c = 0.82; 95% confidence interval [CI], 0.78–0.85) and 5 years (c = 0.82, 0.79–0.85) after EL. History of ascites (adjusted odds ratio [aOR], 3.3; 1.0–11.3; p = 0.048), chronic obstructive pulmonary disease (aOR, 1.9; 1.1–3.4; p = 0.030), congestive heart failure (aOR, 3.6; 1.2–11.5; p = 0.025), myocardial infarction (aOR, 2.6; 1.5–4.6; p = 0.001), and a new cancer diagnosis (aOR, 2.8; 1.7–4.8; p < 0.0001) were independent prognostic factors for death 5 years after EL.

CONCLUSION

Long-term prognosis after EL remains poor for at least 5 years postoperatively. The NELA score is accurately able to predict risk of death up to 5 years after EL. History of ascites, chronic obstructive pulmonary disease, congestive heart failure, myocardial infarction, and a new diagnosis of cancer were independent prognostic factors for long-term mortality after EL.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
The PrfA regulon of Listeria monocytogenes is induced by growth in low-oxygen microaerophilic conditions
Authors: Alnakhli Lamis A. , Goldrick Marie , Lord Elizabeth , Roberts Ian S.
Published: November 2024

Listeria monocytogenes is a food-borne pathogen that must adapt to several environments both inside and outside the host. One such environment is the microaerophilic conditions encountered in the host intestine proximal to the mucosal surface. The aim of this study was to investigate the expression of the PrfA regulon in response to microaerophilic growth conditions in the presence of either glucose or glycerol as a carbon source using four transcriptional (Phly, PactA, P/prfA and P/plcA) gene fusions. Further, RNAseq analysis was used to identify global changes in gene expression during growth in microaerophilic conditions. Following microaerophilic growth, there was a PrfA-dependent increase in transcription from the Phly, PactA and P/plcA promoters, indicating that microaerophilic growth induces the PrfA regulon regardless of the carbon source with increased expression of the PrfA, LLO and ActA proteins. A sigB mutation had no effect on the induction of the PrfA regulon under microaerophilic conditions when glucose was used as a carbon source. In contrast, when glycerol was the carbon source, a sigB mutation increased expression from the Phly and PactA promoters regardless of the level of oxygen. The RNAseq analysis showed that 273 genes were specifically regulated by microaerophilic conditions either up or down including the PrfA regulon virulence factors. Overall, these data indicated that L. monocytogenes PrfA regulon is highly responsive to the low-oxygen conditions likely to be encountered in the small intestine and that SigB has an input into the regulation of the PrfA regulon when glycerol is the sole carbon source.
Meioc-Piwil1 complexes regulate rRNA transcription for differentiation of spermatogonial stem cells
Authors: Kawasaki Toshihiro , Nishimura Toshiya , Tani Naoki , Ramos Carina , Karaulanov Emil , Shinya Minori , Saito Kenji , Taylor Emily , Ketting Rene F. , Ishiguro Kei-ichiro , Tanaka Minoru , Siegfried Kellee R. , Sakai Noriyoshi
Published: November 2024

Ribosome biogenesis is vital for sustaining stem cell properties, yet its regulatory mechanisms are obscure. Herein, we show unique properties of zebrafishmeiocmutants in which spermatogonial stem cells (SSCs) do not differentiate or upregulate rRNAs. Meioc colocalized with Piwil1 in perinuclear germ granules, but Meioc depletion resulted in Piwil1 accumulation in nucleoli. Nucleolar Piwil1 interacted with 45S pre-rRNA.piwil1+/-spermatogonia with reduced Piwil1 upregulated rRNAs, andpiwil1+/-;meioc-/-spermatogonia recovered differentiation later than those inmeioc-/-. Further, Piwil1 interacted with Setdb1 and HP1α, andmeioc-/-spermatogonia exhibited high levels of H3K9me3 and methylated CpG in the 45S-rDNA region. These results indicate that zebrafish SSCs maintain low levels of rRNA transcription with repressive marks similar toDrosophilapiRNA targets of RNA polymerase II, and that Meioc has a unique function on preventing localization of Piwil1 in nucleoli to upregulate rRNA transcripts and to promote SSC differentiation.