bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Structured Female Pelvic Medicine and Reconstructive Surgery Resident Rotation Curriculum
Authors: Funfar Brenna , Godecker Amy , Spencer Ryan J. , Giles Dobie L. , Heisler Christine A.
Published: February 2023

Importance

Residency education is moving toward competency-based learning, which requires novel educational methods. One solution is structured learning through a formalized curriculum.

Objective

The purpose of this study is to evaluate the educational aspects of a novel structured curriculum in female pelvic medicine and reconstructive surgery.

Study Design

This was a prospective cohort study of third-year obstetrics and gynecology residents who rotated on the female pelvic medicine and reconstructive surgery service. The curriculum was organized into 7 specific topics with weekly required reading, key specialty articles, and reviewed quizzes on subspecialty topics adapted from the American Board of Obstetrics and Gynecology Guide to Learning. A prerotation and postrotation self-assessment of pelvic anatomy and pelvic floor dysfunction content comprehension was assessed using a Likert scale (0–10) for each domain.

Results

Obstetrics and gynecology residents from 4 academic years resulted in a total of 17 paired assessments for analysis. Each of the 7 domains showed significant improvement among all academic years, with a mean increase of 4.9 ± 0.8 points (P < 0.001). The 2 domains that showed the greatest improvement were stress urinary incontinence (5.5 ± 1.3, P < 0.001) and pelvic organ prolapse (5.5 ± 1.9, P < 0.001). There was no significant association between score improvement and the number of previous surgical rotations or having the rotation in the first or second half of the academic year.

Conclusions

This study demonstrated that a structured curriculum in female pelvic medicine and reconstructive surgery was associated with significant improvement in self-assessed perceived resident knowledge during the subspecialty rotation. This approach could be applied to other rotations and direct education curriculum development.
Non-Surgical Management and Analgesia Strategies for Older Adults with Multiple Rib Fractures: a Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma
Authors: Mukherjee Kaushik , Schubl Sebastian D. , Tominaga Gail , Cantrell Sarah , Kim Brian , Haines Krista L. , Kaups Krista L. , Barraco Robert , Staudenmayer Kristan , Knowlton Lisa M. , Shiroff Adam M. , Bauman Zachary M. , Brooks Steven E. , Kaafarani Haytham , Crandall Marie , Nirula Raminder , Agarwal Suresh K. , Como John J. , Haut Elliott R. , Kasotakis George
Published: February 2023

Background

Chest wall injury in older adults is a significant cause of morbidity and mortality. Optimal nonsurgical management strategies for these patients have not been fully defined regarding level of care, incentive spirometry, noninvasive positive pressure ventilation, and the use of ketamine, epidural and other locoregional approaches to analgesia.

Methods

Relevant questions regarding older patients with significant chest wall injury with patient Population(s), Intervention(s), Comparison(s), and appropriate selected Outcomes (PICO) were chosen. These focused on ICU admission, incentive spirometry, noninvasive positive pressure ventilation, and analgesia including ketamine, epidural analgesia, and locoregional nerve blocks. A systematic literature search and review was conducted, and our data were analyzed qualitatively and quantitatively and the quality of evidence assessed per the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. No funding was utilized.

Results

Our literature review (PROSPERO 2020-CRD42020201241,MEDLINE,EMBASE, Cochrane,Web of Science,1/15/2020) resulted in 151 studies. ICU admission was qualitatively not superior for any defined cohort other than by clinical assessment. Poor incentive spirometry performance was associated with prolonged hospital length of stay, pulmonary complications, and unplanned ICU admission. Noninvasive positive pressure ventilation was associated with 85% reduction in odds of pneumonia (p < 0.0001) and 81% reduction in odds of mortality (p = 0.03) in suitable patients without risk of airway loss. Ketamine use demonstrated no significant reduction in pain score but a trend toward reduced opioid use. Epidural and other locoregional analgesia techniques did not affect pneumonia, length of mechanical ventilation, hospital length of stay or mortality.

Conclusion

We do not recommend for or against routine ICU admission. We recommend use of incentive spirometry to inform ICU status and conditionally recommend use of noninvasive positive pressure ventilation in patients without risk of airway loss. We offer no recommendation for or against ketamine, epidural or other locoregional analgesia.

Level of Evidence

Guideline; systematic review/meta-analysis, level IV
Neighborhood deprivation and childhood opportunity indices are associated with violent injury among children in Los Angeles County
Authors: Sarnthiyakul Sasithorn , Ross Erin E. , Ourshalimian Shadassa , Spurrier Ryan G. , Chaudhari Pradip P.
Published: February 2023

BACKGROUND

Previous research has demonstrated mixed relationships between individual neighborhood socioeconomic factors and incidences of violence, such as poverty level, population density, and income inequality. We used the Childhood Opportunity Index and Area Disadvantage Index to evaluate the relationship between neighborhood characteristics and the number of incidents of violence among children across the zip codes of Los Angeles (LA) County.

METHODS

We performed a retrospective cross-sectional study of children younger than 18 years from 2017 to 2019 who were entered in the LA County Trauma and Emergency Medicine Information System registry with violent mechanisms of injury, including gunshot, stabbing, or assault. Mechanisms classified as self-inflicted injuries were excluded from the study. The number of incidences of violent mechanism per 100,000 persons younger than 18 years for each zip code was calculated using population data from the US Census American Community Survey 5-Year estimates from 2019. The incidences of violence per capita younger than 18 years for each zip code was compared with the zip code Area Deprivation Index and Childhood Opportunity Index using logistic regression models.

RESULTS

There were 6,791 trauma activations in LA County over the study period, 12.8% (n = 866) of which were due to violence. The mean prevalence of pediatric violent mechanism of injury per zip code was 4 cases per 100,000 persons younger than 18 years. Most injuries were the result of firearms (n = 345 [60.4%]) and occurred among Hispanic/Latino children (n = 362 [57.1%]). There were significantly greater rates of violent injury among children from highest disadvantage (odds ratio, 8.84) and lowest opportunity (odds ratio, 42.48) zip codes.

CONCLUSION

Children living in high disadvantage or low opportunity zip codes had greater rates of violent injury. Further study of neighborhood factors is needed to develop targeted effective interventions to reduce violent injuries among children living in low opportunity areas.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Using the LASSI-L to Detect Robust Interference Effects in Premanifest Huntington Disease
Authors: Sierra Luis A. , Ullman Clementina J. , Frank Samuel A. , Laganiere Simon
Published: February 2023

Background:

Diagnosis of manifest Huntington disease (HD) is based primarily on motor symptoms, but premanifest HD (preHD) is often associated with subtle cognitive decline. The Loewenstein–Acevedo Scales for Semantic Interference and Learning (LASSI–L) is a validated verbal learning test that can be used to detect early cognitive decline.

Objective:

To determine the utility of the LASSI–L for detecting early cognitive decline in individuals with preHD and to compare the results of the LASSI–L with those of commonly used neuropsychological tests in HD.

Method:

We administered the LASSI–L to 13 individuals with preHD and 13 healthy controls matched for age, sex, and education as part of a longitudinal study of disease progression. For comparison purposes, we administered the Mini-Mental State Examination; Stroop Color and Word Test; Symbol Digit Modalities Test; Trail-Making Test, Parts A and B; and category fluency (animals) task.

Results:

Five of the seven sections on the LASSI–L captured group differences: Proactive Semantic Interference (PSI; P < 0.001), Failure to Recover From PSI (P = 0.038), Retroactive Semantic interference (RSI; P = 0.013), Delayed Recall (P < 0.001), and B1 Cued Recall Intrusions (P = 0.036). Using a false discovery rate of <0.05, PSI, RSI, and Delayed Recall remained significant.

Conclusion:

The LASSI–L is a sensitive instrument for detecting early interference effects in individuals with preHD that outperforms commonly used neuropsychological tests. The LASSI–L could be a useful addition to clinical and research protocols involving individuals with preHD.
Influence of Tumor Characteristics on Visual Field Outcomes After Pituitary Adenoma Surgery
Authors: Ito Munekatsu , Suda Kenji , Nakano Eri , Tagawa Miho , Miyata Manabu , Kashii Satoshi , Tanji Masahiro , Miyamoto Susumu , Tsujikawa Akitaka
Published: February 2023

Background:

There were few reports about the influence of tumor characteristics on the postoperative visual field outcomes after transsphenoidal surgery for pituitary adenoma. The purpose of this study was to explore the tumor characteristics that influenced perioperative visual field changes.

Method:

Patients who underwent transsphenoidal surgery under a diagnosis of pituitary adenoma at the Kyoto University Hospital between April 2012 and December 2018 were retrospectively enrolled. Correlations among circumpapillary retinal nerve fiber layer thickness, preoperative and postoperative mean deviation (MD) of visual field, MD change after the surgery, and maximum tumor diameter were evaluated by measuring Pearson correlation coefficient. We evaluated the influences on postoperative MD using a generalized estimating equation for univariate and multivariate regression analyses. We also compared the characteristics of cystic and solid tumors.

Results:

Thirty-two eyes of 18 patients were included in this study (9 male and 9 female patients). Postoperative MD positively correlated with maximum tumor diameter only in multivariate regression {β = 0.22 (95% confidence interval [CI], 0.004–0.43), P = 0.046}, although maximum tumor diameter negatively correlated with postoperative MD in univariate regression (β = −0.16 [95% CI, −0.58 to 0.26], P = 0.46). In the investigation of perioperative MD changes, eyes with cystic tumors showed significantly better improvement those with solid tumors (8.93 ± 7.85 vs 0.18 ± 6.56 dB, P = 0.007).

Conclusion:

Cystic and solid tumors show different characteristics of visual loss and visual field defects. The MD in eyes with cystic tumors improved significantly more than that in eyes with solid tumors.
Does the American College of Surgeons New Level I Children’s Surgery Center Verification Affect Treatment Efficiency and Narcotic Administration in Treating Pediatric Trauma Patients with Femur Fracture?
Authors: White Carter R , Leshikar Holly B , White Micaela R , White Spencer R , Semkiw Karen , Farmer Diana L , Haus Brian M
Published: February 2023

Background:

In 2015, the American College of Surgeons (ACS) created a new hospital improvement program to enhance the performance of pediatric care in US hospitals. The Children’s Surgery Verification (CSV) Quality Improvement Program is predicated on the idea that pediatric surgical patients have improved outcomes when treated at children’s hospitals with optimal resources. Achieving ACS level I CSV designation at pediatric trauma centers may lead to greater benefits for pediatric trauma patients; however, the specific benefits have yet to be identified. We hypothesize that achieving the additional designation of ACS level I CSV is associated with decreased narcotic use perioperatively and improved efficiency when managing pediatric patients with femur fractures.

Study Design:

This study is a retrospective analysis of traumatic pediatric orthopaedic femur fractures treated at a verified level I pediatric trauma center before and after CSV designation (2010-2014 vs. 2015-2019). Efficiency parameters, defined as time from admission to surgery, duration of surgery, and duration of hospital stay, and narcotic administration in oral morphine equivalents (OME) were compared.

Results:

Of 185 traumatic femur fractures analyzed, 80 occurred before meeting ACS level I CSV criteria and 105 occurred after. Post-CSV, there was a significant decrease in mean wait time from admission to surgery (16.64hrs pre-CSV, 12.52hrs post-CSV (p<0.01)), and duration of hospital stay (103.49hrs pre-CSV, 71.61hrs post-CSV (p<0.01)). Narcotic usage was significantly decreased in both the preoperative period (40.61 OME pre-CSV, 23.77 OME post-CSV (p<0.01)), and postoperative period (126.67 OME pre-CSV, 45.72 OME post-CSV (p<0.01)).

Conclusion:

Achieving ACS level I CSV designation is associated with increased efficiency and decreased preoperative and postoperative narcotic use when treating pediatric trauma patients.
Impact of Rurality on Geriatric Emergency General Surgery Patients in New Hampshire
Authors: Burney Charles P , Baumann Laura , Carlos Heather A , Briggs Alexandra
Published: February 2023

Background:

Geriatric patients requiring Emergency General Surgery (EGS) have significant risk of morbidity and mortality. Rural patients face decreased access to care. We sought to characterize the EGS needs and impact of rurality for geriatric residents of New Hampshire (NH).

Study Design:

A retrospective cohort study of the NH Uniform Healthcare Facility Discharge Dataset, including patients 65 years-old and older with urgent/emergent admission who underwent one of 7 EGS procedures, grouped by urban or rural county of residence, discharged between 2012-2015.

Results:

NH has 26 acute care hospitals of which 10 (38.5%) are in urban counties and 16 (61.5%) are in rural counties. 13 (50.0%) are critical access hospitals (1 urban and 12 rural). Of 2,445 geriatric patient discharges, 40% of patients were from rural counties and were demographically similar to urban patients. Rural patients were more likely to present as a hospital transfer (15.4% vs 2.5%, p<0.01), receive care at a critical access hospital (24.1% vs 1.0%, p<0.01), receive care outside their home county (32.5% vs 12.8%, p<0.01), and be transferred to another hospital after surgery. Rural and urban patients underwent similar procedures, with similar length of stay, cost of index hospitalization, and mortality.

Conclusion:

Rural geriatric patients in NH are more likely to receive care outside of their home county or be transferred to another hospital. Costs of care were similar but are likely underestimated for rural patients. There was no difference in unadjusted mortality. Further investigation is merited to determine the reasons for hospital transfer in the geriatric EGS population to evaluate which patients may benefit most from remaining close to home versus transferring to other facilities.
Closed Incision Negative Pressure Therapy to Reduce Surgical Site Infection in High-Risk Gastrointestinal Surgery: A Randomized Controlled Trial
Authors: Ceppa Eugene P , Kim Rachel C , Niedzwiecki Donna , Lowe Melissa E , Warren Dana A , House Michael G , Nakeeb Attila , Zani Sabino , Moyer Ashley N , Blazer Dan G ,   for the ciNPT Investigators
Published: February 2023

Background:

Despite institutional perioperative bundles and national infection prevention guidelines, surgical site infection (SSI) after major abdominal surgery remains a significant source of morbidity. Negative pressure therapy has revolutionized care for open wounds but the role of closed incision NPT (ciNPT) remains unclear.

Study Design:

We conducted a multi-institutional randomized controlled trial evaluating SSI after major elective colorectal or hepatopancreatobiliary surgery. Patients were randomized to receive conventional wound care versus ciNPT (PREVENA Incision Management System, KCI USA, Inc, San Antonio, TX). The primary endpoint was postoperative incisional SSI. SSI incidence was evaluated at inpatient day 4-5 and postoperative day 30. With 144 patients studied estimated power was 85% to detect the difference in SSI between 17% and 5%, conventional vs ciNPT (1-sided α=0.1). Secondary endpoints included incidence by SSI type, length of stay, 30-day readmission, and mortality. T-tests were used to compare continuous variables between treatments, similarly chi-square tests were used to compare categorical variables, p<0.05 considered significant, except for primary comparison of incisional and organ SSI.

Results:

164 patients from 2013-2021 were randomized. 138 patients were evaluable (n=63 ciNPT, n=75 conventional). Incisional SSI occurred in 9 (14%) patients in the ciNPT group and in 13 (17%) patients in the conventional group (p= 0.31). Organ space SSI occurred in 7 (11%) patients in ciNPT and 10 (13%) conventional therapy (p=0.35).

Conclusion:

In this multi-institutional, randomized controlled trial among patients undergoing colorectal or hepatopancreatobiliary surgery, the difference in incisional SSI between ciNPT and conventional wound therapy was not statistically significant. Future trials should focus on patient populations undergoing the highest SSI risk procedures with more focus on specific procedure types.
Fluoroscopic Intraoperative Breast Neoplasm and Node Detection
Authors: Weiser Roi , Manno Gabrielle C , Cass Samuel H , Chen Lu , Kuo Yong-fang , He Jing , Robinson Angelica S , Posleman Monetto Flavia , Silva H Colleen , Klimberg V Suzanne
Published: February 2023

Background:

Preoperative localization is necessary for non-palpable breast lesions. A novel procedure, Fluoroscopic Intraoperative Neoplasm and Node Detection (FIND), obviates the preoperative painful and potentially expensive localization, by using intraoperative visualization of the standard clip placed during diagnostic biopsy. We hypothesized FIND would improve negative margin rates.

Study Design:

This is an IRB-approved retrospective study (9/2016-3/2021). Electronic chart review identified breast and axillary node procedures using wire localization (WL) or FIND. Primary outcome was margin status. Secondary outcomes included re-excision rate, specimen weight, surgery time and axillary node localization rate.

Results:

We identified 459 patients, 116(25.3%) underwent FIND and 343(74.7%) WL. Of these, 68.1% of FIND and 72.0% of WL procedures were for malignant lesions. Final margin positivity was 5.1%(4/79) for FIND and 16.6%(41/247) for WL (p=0.0083). This difference lost statistical significance upon multivariable logistic regression (p=0.6521). Re-excision rates were 7.6% and 14.6% for FIND and WL (p=0.1246), with an equivalent mean specimen weight (p=0.5025), and mean surgery time of 177.5 ± 81.7 and 157.1 ± 66.8 minutes, respectively (p=0.0224). FIND identified all (29/29) targeted axillary nodes, while WL identified only 80.1%(21/26) (p=0.0189).

Conclusion:

FIND has lower positive margin rates and a trend towards lower re-excision rates compared to WL, proving its value in localizing non-palpable breast lesions. It also offers accurate localization of axillary nodes, valuable in the era of targeted axillary dissection. It is a method of visual localization, using a skill and equipment surgeons already have, and saves patients and medical systems an additional schedule-disruptive, painful procedure, especially valuable when using novel localization devices is cost-prohibitive.
Illuminating the Use of Trauma Whole Body CT Scan During the Global Contrast Shortage
Authors: Ramsey Walter A , O’Neil Jr Christopher F , Ramdev Rajan A , Sleeman Ella A , Danton Gary H , Kaufman Joyce I , Pizano Louis R , Meizoso Jonathan P , Proctor Kenneth G , Namias Nicholas
Published: February 2023

Introduction:

The use of whole-body CT scan (WBCT) is widespread in the evaluation of traumatically injured patients and may be associated with improved survival. WBCT protocols include the use of IV contrast unless there is a contraindication. This study tests the hypothesis that using plain whole-body CT (WBCT) scan during the global contrast shortage would result in greater need for repeat contrast-enhanced CT, but would not impact mortality, missed injuries, or rates of acute kidney injury (AKI).

Methods:

All trauma encounters excluding burns and prehospital cardiac arrests at an academic level-I trauma center from 3/1/22 to 6/24/22 were reviewed. Imaging practices and outcomes before and during contrast shortage (beginning May 3rd) were compared.

Results:

The study population was comprised of 1,109 consecutive patients (72% male), including 890 (80%) blunt and 219 (20%) penetrating traumas. Overall, 53% of patients underwent WBCT, and contrast was administered to 73%. The overall rate of AKI was 6% and the rate of renal replacement therapy (RRT) was 1%. Contrast usage in WBCT was 99% before and 40% during the shortage (p<0.001). There was no difference in the rate of repeat CT scans, missed injuries, AKI, RRT, or mortality.

Conclusions:

Trauma imaging practices at our center changed during the global contrast shortage; the use of contrast decreased despite the frequency of trauma WBCT scans remaining the same. The rates of AKI and RRT did not change, suggesting that WBCT with contrast is insufficient to cause AKI. The missed injury rate was equivalent. Our data suggest similar outcomes can be achieved with selective use of WBCT and IV contrast.
Hypercapnic Tissue Gene Expression and Survival in Early-Stage Pancreatic Ductal Adenocarcinoma
Authors: Nevler Avinoam , Khalilieh Saed , Lavu Harish , Bowne Wilbur , Yeo Charles J
Published: February 2023

Background:

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and lethal cancer. Hypercapnic tumor microenvironments were previously shown to promote cancer chemoresistance. In this study, we aimed to investigate the impact of tissue hypercapnia on PDAC prognosis.

Study Design:

PDAC cancer-cell lines were cultured in normocapnic (5%CO2) and hypercapnic conditions (10%CO2). RNA was extracted and whole-exome transcriptome was sequenced. Differentially-expressed genes were identified and used to construct a ‘hypercapnic gene-set’. PDAC transcriptomic patient data from the Tumor Cancer Genome Atlas was used to calculate single-sample gene-set enrichment scores based on each patient’s tissue expression of the ‘hypercapnic gene-set’. Tissue hypercapnic scores (HS) in PDAC patients (TMN Stages Ia-IIb) were determined and correlated with clinico-pathological parameters and overall survival.

Results:

A cohort of 135 resected Stage I-II PDAC patients were assessed in this study. The average age was 65 ± 11.0 years and the male:female ratio was 74:61. Median overall survival was 19.5 ± 1.4 months. High HS were associated with increased tumor stage (P<0.05), and higher lymph-node ratio (P<0.05). In active smokers, high HS also correlated with smoking pack-years (P<0.05). Cox regression analysis revealed high HS to be an independent prognostic factor for overall survival (HR 2.66, P=0.004), along with lymph-node ratio (HR 4.2, P=0.002) and age at diagnosis (HR 2.63, P=0.01).

Conclusions:

The pancreatic tumor microenvironment plays an integral role in tumor aggressiveness and our previous in-vitro data suggests hypercapnia promotes an aggressive, more-resistant phenotype. Herein we show that in early-stage pancreatic cancer, hypercapnic tissue signatures corresponded with a worse overall survival.
Four-Day Robotic Whipple: Early Discharge after Robotic Pancreatoduodenectomy
Authors: Fong Zhi Ven , Lwin Thinzar M , Aliaj Agim , Wang Jiping , Clancy Thomas E
Published: February 2023

Background:

We aim to assess the safety of an ERAS and early discharge pathway in a robotic pancreatoduodenectomy (PD) program and compare outcomes with an open PD cohort as controls to determine the synergistic effects of robotic surgery and enhanced recovery pathways on length of stay (LOS).

Study Design:

Consecutive patients undergoing open or robotic pancreatoduodenectomy by a single surgeon from analysis from March 2020 to July 2022 was identified. Logistic regression models were used for adjusted analyses of postoperative outcomes.

Results:

There were 134 consecutive patients who underwent PD, of which 40 (30%) were performed robotically. Pancreatic adenocarcinoma was the most common indication in both the open (56%) and robotic (55%, p=0.51) groups, with a similar proportion of them being borderline resectable or locally advanced tumors (78% vs 82% in robotic group, p=0.82). The LOS was significantly shorter in the robotic PD group (median 5 days, IQR 4-7 days) when compared to the open PD group (median 6 days, IQR 5-8 days, p<0.001). A LOS of ≤4 days was observed in 40% of the robotic PD group compared to only 3% of patients in the open PD group (p<0.001), with no differences in the overall readmission rates (10% vs 12% in the robotic PD group, p=0.61). On multivariable logistic regression, robotic PD was independently associated with higher odds of LOS of ≤4 days (OR 22.4, p=0.001) when compared to open PD.

Conclusions:

An enhanced recovery and early discharge pathway could be safely implemented in a robotic PD program. Patients undergoing robotic PD have significantly shorter lengths of stay without increased complication or readmission rates compared to open PD, with 40% of patients undergoing robotic PD achieving a LOS of ≤4 days.
Predicting Futility in Severely Injured Patients: Using Arrival Lab Values and Physiology to Support Evidence-Based Resource Stewardship
Authors: Van Gent Jan-Michael , Clements Thomas W , Lubkin David T , Wade Charles E , Cardenas Jessica C , Kao Lillian S , Cotton Bryan A
Published: February 2023

Background:

The recent pandemic exposed a largely unrecognized threat to medical resources, including daily available blood products. Some of the most severely injured patients who arrive in extremis consume tremendous resources yet succumb shortly after arrival. We sought to identify cut-points available early in the patient’s resuscitation that predicted 100% mortality.

Study Design:

Cut-points were developed from a previously collected dataset of all level-1 trauma patients admitted 01/10-12/16. Objective values available on or shortly after arrival were evaluated. Once generated, we then validated these variables against (1) a prospective dataset 11/17-10/21 of severely injured patients and (2) a multicenter, randomized trial of hemorrhagic shock patients. Analyses were conducted using STATA 17.0 (College Station, TX), generating positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity.

Results:

The development dataset consisted of 9,509 patients (17% mortality), with 2,137 (24%) and 680 (24%) in the two validation datasets. Several combinations of arrival vitals and labs had 100% PPV. Patients undergoing CPR in the field or on arrival (with subsequent ROSC) required lower fibrinolysis LY-30 (30%) than those with systolic pressures (SBP) of ≤50 (30-50%), ≤70 (80-90%), and ≤90 mmHg (90%). Using a combination of these validated variables, the Suspension of Transfusions and Other Procedures (STOP) criteria were developed, with each element predicting 100% mortality, allowing physicians to cease further resuscitative efforts.

Conclusion:

The use of evidence-based STOP criteria provides cut-points of futility to help guide early decisions for discontinuing aggressive treatment of severely injured patients arriving in extremis.
Effects of Patient Sex on Neurocognitive Decline after Cardiac Surgery
Authors: Stanley Madigan E , Kant Shawn , Raker Chris , Sabe Sharif , Sodha Neel R , Ehsan Afshin , Sellke Frank W
Published: February 2023

Background:

Neurocognitive decline (NCD) is a common complication of cardiac surgery. Understanding risk factors helps surgeons counsel patients pre- and peri-operatively about risk, prevention, and treatment.

Results:

Eighty-four patients undergoing cardiac surgery utilizing cardiopulmonary bypass underwent pre- and post-operative neurocognitive testing. Neurocognitive data are presented as a change from baseline to either postoperative day four (POD4) or to one month. The score is standardized with respect to age. There was no significant difference in baseline neurocognitive function. NCD was more common in female patients (71%) than male patients (26.4%) on POD4. By one month the incidence of NCD is similar between female (15.0%) and male patients (14.3%). Of note, female patients differed from male patients in preoperative hematocrit, preoperative creatinine, and type of surgery.

Conclusion:

In the acute postoperative period, female patients are both more likely to experience NCD and experience a more severe change from baseline cognitive function. This difference between male and female patients resolves by the one month follow-up point. Female patients had a lower preoperative hematocrit and were more likely to receive intraoperative and perioperative blood transfusions. Lower pre-operative hematocrit appears to mediate the difference in NCD between male and female patients.
Unhealthy lifestyle impacts on biological systems involved in stress response: hypothalamic–pituitary–adrenal axis, inflammation and autonomous nervous system
Authors: Mandelli Laura , Milaneschi Yuri , Hiles Sarah , Serretti Alessandro , Penninx Brenda W.
Published: February 2023

An unhealthy lifestyle has a critical role in the pathogenesis and course of several chronic disorders. It has been hypothesized that lifestyle may also impact biological systems involved in stress response. A global index of unhealthy lifestyle was calculated based on the cumulative presence of five self-reported lifestyle habits (smoking, excessive alcohol use, drug use, low physical activity and short sleep) in 2783 participants (18–65 years) from the Netherlands Study of Depression and Anxiety. The functioning of biological stress systems was based on multiple physiological measures of cortisol, inflammatory cytokines and autonomic cardiac activity. The unhealthy lifestyle index was associated with hyperactivity of hypothalamus–pituitary–adrenal axis and increased inflammation, indicating that with increasing unhealthy habits, the level of biological stress increases. No association with the autonomic nervous system activity was observed; however, the use of drugs increased parasympathetic cardiac activity and significantly impacted on ANS. Results were not impacted by a recent episode of depression or anxiety disorder. An unhealthy lifestyle may unfavorably impact on biological systems involved in stress response, which may underlie progression of several psychiatric as well as somatic chronic disorders.
Investigating the psychological effects of home quarantine during the early peaks of the COVID-19 pandemic: a survey from Iran
Authors: Nahidi Mahsa , Ghalandarzadeh Mojtaba , Sinichi Farideh , Sahebzadeh Narjes , Eslami Saeid , Reihani Hamidreza , Emadzadeh Maryam , Fayyazi Bordbar Mohammad Reza
Published: February 2023

We assessed psychological symptoms among individuals who were quarantined during early coronavirus disease 2019 (COVID-19) peaks. This cross-sectional study was performed during April–October 2020 in Iran. We surveyed 100 individuals with COVID-19 patients in their families and 100 others with health conditions associated with a higher risk of developing critical forms of COVID-19 infection, who have completed at least 14 days of home quarantine. Validated Persian versions of the 21-item Depression, Anxiety, and Stress and 22-item Impact of Event Scale-Revised were used to measure the symptoms of depression, anxiety, stress and distress. The rates of stress, anxiety, depression and quarantine-related distress were 46.5, 48.5, 57.0 and 80.5%, respectively; however, they were not significantly different between the contact and no-contact groups. Female sex and being unemployed were significantly associated with quarantine-related distress, P = 0.007 and P = 0.018, respectively. Independent risk factors for anxiety were a history of medical comorbidity (P = 0.025) and contact with COVID-19 patients (P = 0.007). Findings show high prevalence rates of psychological symptoms among quarantined individuals, regardless of whether they had contact with COVID-19 patients or not. Female sex and unemployment were risk factors for quarantine-related distress.
Multiplex analysis of cytokines and chemokines in persons aging with or without HIV
Authors: Kroll Kyle W. , Woolley Griffin , Terry Karen , Premeaux Thomas A. , Shikuma Cecilia M. , Corley Michael J. , Bowler Scott , Ndhlovu Lishomwa C. , Reeves R. Keith
Published: February 2023

People with HIV (PWH) on combined antiretroviral therapy (cART) are living longer lives due to modern cART advances and increased routine medical care. The full landscape of aging with HIV is unclear; given that HIV emerged relatively recently in human history and initially had a high mortality rate, there has not been a substantially aged population to evaluate. In the present study, we set out to perform high throughput plasma analyte profiling by multiplex analysis, focusing on various T helper (Th)-related cytokines, chemokines, and pro- and anti-inflammatory cytokines. The primary goals being to provide reference ranges of these analytes for aging PWH cohorts, as well as testing the utility of high throughput multiplex plasma assays. The cohort used in this study was comprised of age-matched healthy donors (aged 32.6-73.5), PWH on cART (aged 26.7-60.2), and viremic PWH (aged 27.5-59.4). The patients in each group were then stratified across the age span to examine age-related impacts of these plasma biomarkers. Our results largely indicate feasibility of plasma analyte monitoring by multiplex and demonstrate a high degree of person-to-person variability regardless of age and HIV status. Nonetheless, we find multiple associations with age, duration of known infection, and viral load, all of which appear to be driven by either prolonged HIV disease progression or long-term use of cART.
m6A RNA methylation orchestrates transcriptional dormancy during developmental pausing
Authors: Collignon Evelyne , Cho Brandon , Fothergill-Robinson Julie , Furlan Giacomo , Ross Robert L. , Limbach Patrick A. , Ramalho-Santos Miguel
Published: February 2023

Embryos across metazoan lineages can enter reversible states of developmental pausing, or diapause, in response to adverse environmental conditions. The molecular mechanisms that underlie this remarkable dormant state remain largely unknown. Here we show that m6A RNA methylation by Mettl3 is required for developmental pausing in mice by maintaining dormancy of paused embryonic stem cells and blastocysts. Mettl3 enforces transcriptional dormancy via two interconnected mechanisms: i) it promotes global mRNA destabilization and ii) suppresses global nascent transcription by specifically destabilizing the mRNA of the transcriptional amplifier and oncogene N-Myc, which we identify as a critical anti-pausing factor. Our findings reveal Mettl3 as a key orchestrator of the crosstalk between transcriptomic and epitranscriptomic regulation during pausing, with implications for dormancy in stem cells and cancer.
TMS-induced inhibition of the left premotor cortex modulates illusory social perception
Authors: Peylo Charline , Sterner Elisabeth F. , Zeng Yifan ,   the EMPRA students, Friedrich Elisabeth V. C.
Published: February 2023

Communicative actions from one person are used to predict another person’s response. However, in some cases, these predictions can outweigh the processing of sensory information and lead to illusory social perception such as seeing two people interact, although only one is present (i.e., seeing a Bayesian ghost).

We applied either inhibitory brain stimulation over the left premotor cortex (i.e., real TMS) or sham TMS. Then, participants indicated the presence or absence of a masked agent that followed a communicative or individual gesture of another agent.

As expected, participants had more false alarms (i.e., Bayesian ghosts) in the communicative than individual condition in the sham TMS session and this difference between conditions vanished after real TMS. In contrast to our hypothesis, the number of false alarms increased (rather than decreased) after real TMS.

These pre-registered findings confirm the significance of the premotor cortex for social action predictions and illusory social perception.

Highlights

Social predictions can outweigh sensory information and lead to illusory perception

Premotor cortex is linked to the illusory social perception of a Bayesian ghost

TMS over premotor cortex modulates how social predictions influence our perception
The attractor landscape of duplicated networks
Authors: Borriello Enrico
Published: February 2023

We study the effect that network duplication has on the topology of the state space of dynamical Boolean networks with thresholds. We show that the problem of finding the attractor dynamics is just as hard as finding the attractors of the unduplicated network. We also show that a reverse algorithm –normally not computationally advantageous in determining the basins of attraction– can now exploit the symmetry of the system and its computational complexity does not scales exponentially anymore with the size of the network. Lastly, we show that when a chain of network duplication events is considered, only the first events change the nature of the attractors, while successive events only affect/reinforce the basins of attraction.
An efficient method for viable cryopreservation of hookworms and other gastrointestinal nematodes in the laboratory
Authors: Li Hanchen , Gazzola David , Hu Yan , Aroian Raffi V.
Published: February 2023

Hookworms (generaAncylostomaandNecator) are amongst of the most prevalent and important parasites of humans globally. These intestinal parasites ingest blood, resulting in anemia, growth stunting, malnutrition, and adverse pregnancy outcomes. They are also critical parasites of dogs and other animals. In addition, hookworms and hookworm products are being explored for their use in treatment of autoimmune and inflammatory diseases. There is thus a significant and growing interest in these mammalian host-obligate parasites. Laboratory research is hampered by the lack of good means of cryopreservation. Here, we describe a robust method for long-term (≥3 year) cryoprotection and recovery of bothAncylostomaandNecatorhookworms that is also applicable to two other intestinal parasites that passages through the infective third larval stage,Strongyloides rattiand Heligmosomoides polygyrus bakeri. The key is the use cryo-preserved first-staged larvae raised to the infective third larval stage using activated charcoal mixed with uninfected feces from a permissive host. This technique will greatly facilitate research on and availability of gastrointestinal parasitic nematodes with great importance to global health, companion animal health, and autoimmune/inflammatory disease therapies.
WDR5 represents a therapeutically exploitable target for cancer stem cells in glioblastoma
Authors: Mitchell Kelly , Sprowls Samuel A. , Arora Sonali , Shakya Sajina , Silver Daniel J. , Goins Christopher M. , Wallace Lisa , Roversi Gustavo , Schafer Rachel E. , Kay Kristen , Miller Tyler E. , Lauko Adam , Bassett John , Kashyap Anjali , D'Amato Kass Jonathan , Mulkearns-Hubert Erin E. , Johnson Sadie , Alvarado Joseph , Rich Jeremy N. , Holland Eric C. , Paddison Patrick J. , Patel Anoop P. , Stauffer Shaun R. , Hubert Christopher G. , Lathia Justin D.
Published: February 2023

Glioblastomas (GBMs) are heterogeneous, treatment-resistant tumors driven by populations of cancer stem cells (CSCs). However, few molecular mechanisms critical for CSC population maintenance have been exploited for therapeutic development. We developed a spatially resolved loss-of-function screen in GBM patient-derived organoids to identify essential epigenetic regulators in the SOX2-enriched, therapy-resistant niche and identified WDR5 as indispensable for this population. WDR5 is a component of the WRAD complex, which promotes SET1 family-mediated Lys4 methylation of histone H3 (H3K4me), associated with positive regulation of transcription. In GBM CSCs, WDR5 inhibitors blocked WRAD complex assembly and reduced H3K4 trimethylation and expression of genes involved in CSC-relevant oncogenic pathways. H3K4me3 peaks lost with WDR5 inhibitor treatment occurred disproportionally on POU transcription factor motifs, including the POU5F1(OCT4)::SOX2 motif. Use of a SOX2/OCT4 reporter demonstrated that WDR5 inhibitor treatment diminished cells with high reporter activity. Furthermore, WDR5 inhibitor treatment and WDR5 knockdown altered the stem cell state, disrupting CSC in vitro growth and self-renewal, as well as in vivo tumor growth. These findings highlight the role of WDR5 and the WRAD complex in maintaining the CSC state and provide a rationale for therapeutic development of WDR5 inhibitors for GBM and other advanced cancers.
Open-up or stay closed: the effect of TMT gender diversity on open innovation
Authors: Saeed Abubakr , Ali Ashiq , Riaz Hammad
Published: February 2023

Purpose

Despite the importance of top management team (TMT) gender diversity in a firm's strategic decisions and the high degree of innovation activities that several firms have experienced in recent years, little or no research has examined how TMT gender diversity affects a firm's open innovation decision. The authors examine how TMT gender diversity impacts firms' open innovation activities. The authors further examine how this impact is affected by women executives' personal attributes and institutional conditions.

Design/methodology/approach

The sample comprised of 62,745 firm-year observations (9,831 firms) from 25 countries from 1990 to 2010. The authors employed the system generalized method of moments (GMM) estimation technique to estimate the results.

Findings

Employing novel panel data on co-owned patents across 25 economies, the authors find that proportion of women in TMTs has a positive impact on open innovation activities. Moreover, the authors find that women managers' power and institutional gender parity strengthen the association between gender diversity and open innovation.

Practical implications

The findings of this study indicate that firms committed to optimizing their open innovation policies and practices should include women in TMTs and create such conditions that are supportive for women executives to effectively express their innate inclinations. Importantly, our study supports the business case for gender diversity in top leadership positions by providing a compelling evidence for the positive impact of TMT gender diversity on open innovation.

Originality/value

This study contributes to the gender diversity literature by showing how women leaders' values and character become embedded in their companies' strategy and present empirical evidence that having women in TMTs increase the likelihood of conducting open innovation. Further, the authors show how women executives' power and institutional level gender parity provide boundary conditions that moderate the relationship between TMT gender diversity and open innovation.
Multi-demand supply chain triads and the role of Third-Party Logistics Providers
Authors: Vlachos Ilias , Polichronidou Vasiliki
Published: February 2023

Purpose

Third-party logistics providers (3PLs) have significantly evolved during the last decades, yet their role within a supply chain triad has been overlooked; this study examines empirically the 3PLs' role using four established theories: resource-based view, social capital perspective, agency theory and transaction cost economics.

Design/methodology/approach

This study examines the role of 3PLs in four supply chain triads, using the case study approach. Sources of evidence include interviews and secondary data.

Findings

The 3PL had different roles in multi-demand triads as service developer, customer adaptor and customer developer. The 3PL, by offering advanced services, became a service developer. The 3PL as a customer adaptor offered customised services and gain the client's trust. As a customer developer, the 3PL acted on behalf of its client in expanding its operations and meeting competitive needs.

Research limitations/implications

The results of the case study methodology can only be generalised to similar types of 3PL. Supply chain triads are an emerging research field; theories like the resource-based view and transaction cost economics are established in the dyadic context and require further elaboration when applied in triadic contexts.

Practical implications

The findings provide practical insights into the role that 3PL can play in supply chain triads, how they can upgrade their role by long-range planning and extending their services to create supply chain efficiency.

Social implications

Understanding the 3PL's role in triads can improve how companies and economies respond to crises like the recent pandemic outbreak.

Originality/value

It uncovers three different 3PL roles in supply chain triads by using four established theories.
Cultural participation and extra disability and health costs of Syrian migrants in Turkey
Authors: Giovanis Elefherios
Published: February 2023

Purpose

The effects of disability are well recognised by the social security systems worldwide. This study aims to examine the disability and health-related costs of Syrian migrants in Turkey using the standard of living (SoL) approach.

Design/methodology/approach

The empirical analysis relies on primary data collected from 1,067 Syrian migrants in Turkey, and the author applies the ordered Probit model. The SoL is operationalized by frequency of attendance to a Turkish theatrical play or movie, inviting Turkish friends for food and attending a theatrical play or movie with Turkish friends.

Findings

The findings show that health problems and disability are negatively related to the frequency of participation in socio-cultural activities. Moreover, employed, wealthier and educated Syrian migrants participate more frequently in the social and cultural activities explored.

Practical implications

The results show that the costs range between 9% and 38%, which translates in monetary values between 3,700 and 10,700 Turkish Liras (TL) per annum or between US$530 and US$1,530 expressed in 2020 values. These findings highlight the significant cost and burden that disability and health problems may put in migrant households.

Social implications

Policies encouraging immigrants to participate in socio-cultural events, particularly those with disabilities and health issues, may promote their integration into the host society’s social and cultural values. Furthermore, policies improving employment opportunities, income and educational attainment of Syrian migrants may enhance their participation in socio-cultural activities.

Originality/value

To the best of the author’s knowledge, this is the first study exploring the disability and health costs of migrants related to integration and participation in cultural activities.