bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated With Supraspinatus Atrophy in Patients 50 Years and Older With Atraumatic Shoulder Pain
Authors: K.S. Meghashyama , Ulhaque Furquan , Desai Mohan Madhav
Published: December 2024

Background:

Atrophy and fatty infiltration of the supraspinatus (SS) muscle are prognostic indicators of poor functional outcomes and higher retear rates after rotator cuff repair. While older patients, female patients, and those with massive and retracted rotator cuff tears are at a higher risk for these indicators, it is unclear whether tear characteristics, acromion morphology, and acromioclavicular (AC) joint arthritis affect SS atrophy in older patients with chronic shoulder pain.

Purpose:

To investigate the multifactorial influences associated with SS atrophy in rotator cuff tears.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A review was conducted on 391 patients with atraumatic shoulder pain (mean age, 60.88 ± 8 years; range, 50-93 years; 200 men and 191 women) who underwent magnetic resonance imaging between May 2019 and April 2020. SS atrophy was calculated using the occupation ratio. Logistic regression was performed to evaluate the association of SS atrophy with patient age and sex, rotator cuff tear type (partial- vs full-thickness), anteroposterior (AP) tear size, AC and glenohumeral (GH) joint arthritis, and acromion shape. A subgroup analysis was performed in patients without tears to investigate whether SS atrophy and fatty infiltration were independent phenomena.

Results:

Overall, 91 patients had full-thickness tears without retraction, 131 had partial-thickness tears, and 169 had no tears. The prevalence of SS atrophy was associated with patient age and was more prevalent in women (67.6%), full-thickness tears (91.1%), an AP tear size of >15 mm (92.6%), and GH joint arthritis (100%) ( P < .001 for all). The severity of atrophy (indicated by a decrease in the occupation ratio) increased with older age. In the patients without tears, SS atrophy prevalence was 33.1%. Logistic regression analysis showed significant independent associations of SS atrophy with age ( P < .001), female sex ( P < .001), nonretracted full-thickness tears ( P < .001), an AP tear size of >15 mm ( P < .001), and hook-shaped acromion ( P = .007). A subgroup analysis of the nontear group revealed a significant association of SS atrophy with fatty infiltration ( P < .001).

Conclusion:

This study identified significant associations between SS atrophy and older age, female sex, full-thickness tear without retraction, an AP tear size of >15 mm, and hook-shaped acromion. Notably, partial-thickness tears were not significantly associated with SS atrophy.
Evaluating the Effectiveness of an Evidence-Based Practice in Neonatal Resuscitation among Birth Asphyxiated Newborns in a Developing Country
Authors: Owusu Lydia Boampong , Issifu Joseph Shahadu , Owiredu Emmanuel Odame , Addai-Henne Sandra , Aniewu Stella Kofie , Manu Joyce Boatemaa , Ntiamoah Perpetual , Dwumfour Catherine Kroamah , Emikpe Abigael , Zakaria Abdul-Fatawu Suglo
Published: December 2024

Introduction

The World Health Organization emphasizes that neonatal resuscitation performed in the first “golden minute” following birth can influence both immediate and long-term outcomes of newborns, especially asphyxiated ones. The modes of resuscitation, which is an evidenced-based practice, require evaluation to identify their effectiveness.

Objectives

This study evaluated neonatal resuscitation techniques and their effectiveness in the management of asphyxiated neonates during the perinatal period.

Design

Cross-sectional design with observation of delivery and immediate care of 254 newborns in five hospitals from April to June 2022.

Methods

Neonatal resuscitation and demographic characteristics were noted. Data were analyzed descriptively using STATA 17 and Cramer’s V test of association between APGAR scores and resuscitation modes was done with statistical significance established at p ≤ .05.

Results

Neonatal resuscitation was primarily performed by midwives (98.4%), with 48.8% of the infants resuscitated after birth. The most common modalities of resuscitation were drying, keeping warm, rubbing the back, and flicking the feet, with 46.0% started on bag and mask ventilation. The success rate of resuscitation was impressive (58.1%), satisfactory (38.7%), and poor (3.2%). There was a strong association of the first minute APGAR score with drying the neonate ( p = .0001, φc = 0.619), keeping the neonate warm, and rubbing the back of the neonate ( p = .0001, φc = 0.613). However, their association with the fifth minute APGAR score was weak ( p = .002, φc = 0.222). Feet flicking has no significant association with the fifth minute APGAR score.

Conclusion

Neonatal resuscitation, which is an evidence-based practice, is more effective in the first minute than in the fifth minute. Regular training of midwives to update their resuscitation skills is important to promote timely and efficient resuscitation of newborns. Further studies into the advancements in resuscitation modes and the use of technology to improve resuscitation beyond the first minute are recommended.
Experiences and Motivations Regarding The Roles in the Medical Student's Association at an Undergraduate Medical School in Saudi Arabia: A Qualitative Study
Authors: Sajid Muhammad Raihan , Kashir Junaid , Yasin Randa Khalid , Jijakli Leen Darwish , Obeidat Akef , Howden Stella
Published: December 2024

OBJECTIVES

This qualitative study aimed to explore student perspectives toward extracurricular activities and motivating and/or demotivating factors of students for involvement with medical student association (MSA) at Alfaisal University, Riyadh, Saudi Arabia.

METHODS

Qualitative analysis of focus group interviews was employed. Inclusion criteria required participants to be College of Medicine students in years 1-5 of undergraduate study and have been a member of the MSA for at least a year or more. A total of four focus group interviews were conducted with four to six participants in each interview. All interviews were recorded and transcribed verbatim, following which an inductive thematic framework analysis was employed for data analyses. Similar ideas and concepts were grouped using codes, and themes were developed.

RESULTS

The first theme identified was motivating factors of students for joining the MSA, which included improvement of self-esteem and résumé, to avoid burnout, social experiences, to overcome shyness, to adjust to the university environment, and to increase research opportunities. The second theme revealed were the skills gained including problem-solving, conflict resolution and communication skills, organizational planning and management skills, and peer mentorship. The third theme identified were the various demerits of being involved with the MSA, including a lack of commitment from other students, lack of recognition, and for some, adverse effects on academic activities.

CONCLUSION

We conclude that the MSA appears to provide a positive opportunity to medical students to be part of various activities, creating a conducive environment for supporting overall well-being and potentially supporting adjusting to the university environment and facilitating the acquisition of various skills.
Reversal of epigenetic age and body composition improvement in consumers of resveratrol-enriched wine
Authors: Pastor Raúl Francisco , Iermoli Roberto Héctor , Saporito-Magriña Christian Martín , Pastor Isabel , Pastor Elena , Manfredi Carabetti Zulma , Iermoli Laura Valeria , Lairion Fabiana , Chiesa Iris , Martinez Sarrasague Margarita , Cimato Alejandra , Rodriguez Aldana , Taborda Claudia , Carbia Claudio , Bavasso Carlos Amadeo , Auzmendi Jerónimo , Lazarowski Alberto , Repetto Marisa Gabriela
Published: December 2024

Biological aging (BA) is a universal process involving vital function deterioration. One of the root causes of BA is epigenetic DNA hypermethylation. Epigenetic age (EA) is defined as the most important risk factor for chronic non-communicable diseases, so its modulation is an exciting emerging field of science. Although there are numerous investigations on the mechanisms of aging, today there are few studies that measure EA in humans after an intervention. The objective of this research study was to evaluate EA and body composition after the consumption of wine enriched with Resveratrol. The results showed a decrease in EA ( p 0.011) and a deceleration in epigenetic age acceleration ( p 0.006) after three and a half months. Also, we were able to confirm significant improvements in body composition with a 1.6 kg decrease in fat mass, ( p 0.0004); and an increase in muscle mass of 300 g ( p 0.019). To our knowledge, this is the first time a highly significant EA reduction has been demonstrated in consumers of resveratrol-enriched wine combined with healthy remodeling of body composition. These findings might be relevant to maintain health, increase life expectancy, and prevent the damage caused by aging. The study was registered in ClinicalTrials.gov (NCT05981053).
3D Morphology of the 1-5 TMT Joints: A Surface Mapping Based Cadaveric Study
Authors: Wipf Caleb , Zhu Mingjie , Barg Taylor , Nolte Charles , Oudakker Jessica , Orr Caley M. , Li Shuyuan , Myerson Mark
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

The tarsometatarsal (TMT) joints play a crucial role in maintaining the stability of the midfoot and medial column. Disorders of these joints are associated with hallux valgus, hallux rigidus, flatfoot, Lisfranc injury and arthritis. It has been demonstrated that there is a high variability in the morphology of the joint which may influence joint stability thereby leading to or aggravating certain deformities. Understanding the morphology of the articular surfaces comprising the joint is necessary. While prior studies have used XR and CT to analyze the joint, we present our work using 3D surface mapping to evaluate the cartilaginous articulation of the TMT and their related intraarticular joints.

Methods:

19 fresh-frozen cadaveric feet with no history of trauma, surgery or deformities were dissected to expose the cuneiforms, cuboid, metatarsal (MT) bones, and related articular surfaces. Surface mapping of the bones and articular surfaces was completed using an Artec Spider 3D Scanner (Figure 1). Further digital analysis was completed using GeoMagic Studio 10. Descriptive and correlation analyses were performed using SAS software. Pearson’s correlation coefficient was used for correlation analysis and statistical significance level was set to P < .05.

Results:

Means and SDs of the articular surface and the bone length are summarized for the TMT joints (Table 1) and the related intraarticular joints (Table 2). There were statistically significant correlations between the articular-area and the length of the bone in each TMT joint, except for the cuboid (Figure 2). 1 mm bone length increase was correlated with 11.48 mm2 articular-area increase on MeC; and 10.33 mm2 articular-area increase on 1st MT. There were three types of morphologies of the 1st TMT joint (Type 1, with 2 facets linked to each other; Type 2, with 2 facets separated; Type 3, 1 large dorsal facet and two separate smaller facets inferiorly). The facet pattern is more obvious on the 1st MT than the MeC side.

Conclusion:

Previous studies of the TMT morphology were done using either direct manual measurements with descriptive reporting which does not reflect the exact contour of the joint, or XR/WBCT which cannot demonstrate the cartilaginous articulation. This study used a novel technique of surface mapping which overcame the above issues. The remodeled cartilaginous articular surfaces provide foundations for further comparison study, as well as integration of 3D surface mapping with weight-bearing CT analysis, which is currently under investigation by our research group. This will provide important information for diagnosis, surgical planning, and follow-up treatment for relevant disorders.
A Hypertrophic Distal Fascicle of the Anterior Tibiofibular Ligament is Associated with a High Rate of Osteochondral Lesions of the Talus
Authors: Butler James J. , Randall Grace W. , Dalmau-Pastor Miki , Lin Charles , Schoof Lauren , Kennedy John G.
Published: December 2024

Category:

Ankle; Arthroscopy

Introduction/Purpose:

A hypertrophic distal fascicle of the anterior tibiofibular ligament (ATiFLdf) is commonly encountered in patients with anterior ankle impingement. Repetitive snapping of the hypertrophic ATiFLdf has the potential to create osteochondral lesions (OCLs) at the lateral talar dome. However, the clinical manifestations of these OCLs in the setting of a hypertrophic ATiFLdf has not been described to date. The purpose of this retrospective review was to determine the prevalence of OCLs of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic ATiFLdf. In addition, we sought to evaluate the anatomy of the ATiFL to fully elucidate its role in creating chondral wear of the talus.

Methods:

Retrospective chart review identified 40 patients who underwent arthroscopy of the anterior ankle joint for the management of anterior ankle impingement. Pre-operative magnetic resonance imaging (MRI) scans were obtained and correlated with intra-operative arthroscopic findings. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), complications, failures, secondary surgical procedures, return to work data and return to sport data.

Results:

Thirty-two patients with a mean follow-up time of 29.3±10.4 months were included. The ATiFLdf was hypertrophic in 29 patients (90.6%), the mean thickness of which was 2.5±0.4 mm. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic ATiFLdf visualized during arthroscopy. The international cartilage repair society gradings of the lesions included: 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from pre-operative to post-operative (p< 0.001). No cases of syndesmotic instability were observed following resection of ATiFLdf. The mean post-operative Likert score was 4.1±0.4. There were 5 failures (15.6%) at a mean time of 9.0±4.7 months.

Conclusion:

This retrospective case series demonstrated that a hypertrophic ATiFLdf was closely associated with the development of an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, pre-operative MRI proved to demonstrate poor sensitivity for the detection of these OCLs. Suspicion should be raised for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf. Figure 1. (a) Hypertrophic ATiFLdf with associated OCL of the lateral talar dome; (b) Biter resecting hypertrophic ATiFLdf; (c) Resected hypertrophic ATiFLdf; (d) and (e) Hypertrophic ATiFLdf identified on coronal and axial MRI scans
Acute Achilles Tendon Ruptures: How Well Can Artificial Intelligence Chatbots Answer Patient Inquiries?
Authors: Dzieza Wojciech , Hampton Hailey , Farmer Kevin , Roach Ryan , Kwon John Y. , Toussaint Rull J.
Published: December 2024

Category:

Sports; Trauma

Introduction/Purpose:

Artificial intelligence (AI) chatbots have recently gained popularity as a source of information that can be easily accessed by patients given their human-like responses to prompts and questions. Within orthopaedics, the treatment of acute Achilles tendon ruptures is not uniform due to varying surgical repair techniques, postoperative protocols, and nonoperative treatment options dependent on surgeon preference and patient factors. Given that patients are increasingly turning toward AI for questions about medical diagnoses and treatment options, our study looked to compare the adequacy of AI chatbot responses to frequently asked questions regarding acute Achilles tendon ruptures.

Methods:

Three popular AI platforms (ChatGPT, Google Gemini, and Microsoft Bing AI) were prompted for a concise response to ten commonly asked questions regarding Achilles tendon rupture management (Table 1). Four board-certified subspecialty-trained orthopaedic surgeons (two in foot and ankle, two in sports medicine) were asked to assess the value of the AI response using a four-point scale (1 – satisfactory; 2 – satisfactory requiring minimal clarification; 3 – satisfactory requiring substantial clarification; 4 – unsatisfactory). A Kruskal-Wallis test was used to compare the responses between the three AI platforms using the scores assigned by the surgeons.

Results:

All three AI chatbots provided comparable answers to 7 of 10 questions (70%). Of all the responses (30 total), only two (6.7%) had a mean rating of 3 or higher. Significant differences were noted between the AI systems for questions 4 [H(2) = 7.258, p = .027], 7 [H(2) = 6.308, p = .043], and 10 [H(2) = 6.796, p = .033]. Post hoc analyses revealed Bing AI had significantly worse scores as compared to ChatGPT for all three of these questions.

Conclusion:

AI chatbots can appropriately answer concise prompts about the diagnosis and management of acute Achilles tendon ruptures often sought out by patients prior to or after evaluation by an orthopaedic surgeon. The responses provided by the three AI chatbots analyzed in our study were uniform and satisfactory, with only one of the platforms scoring worse on three of the ten questions. As AI chatbots advance, they will become a valuable tool for patient education in orthopaedics. Future studies will be needed to assess performance as new AI chatbots develop and large language models continue to evolve. Table 1: List of 10 selected frequently asked questions regarding acute Achilles tendon ruptures
Analysis of Predictor Factors and Comorbidities About Lower-Extremity Repetitive Amputation in Diabetic Foot Ulcer and Infection: A Retrospective Study
Authors: Hwang Yeokgu
Published: December 2024

Category:

Diabetes

Introduction/Purpose:

About 12-25% of diabetic patients had foot ulcers during their lifetime, which has been reported in several studies that not only reduce the quality of life but also increase the risk of amputation due to infection and increase mortality. However, there are insufficient studies on risk factors and comorbidities on re-amputation due to uncontrolled infection and necrosis after amputation. Therefore, the purpose of this study is to investigate the predictors of lower-extremity amputation or re-amputation in diabetic foot ulcer patients and the effects of comorbidities.

Methods:

Among the patients who underwent amputation or re-amputation for diabetic foot ulcer at a single institution from April 2019 to March 2021, 60 cases, who were followed up for at least 1 year, were investigated. The group that underwent amputation and the group that had more than one amputation were divided into two groups, and the clinical characteristics and comorbidities of each group were comparatively evaluated. Clinical factors were Wagner stage, the anatomical level of the amputation, the presence or absence of osteomyelitis in radiology, glycated hemoglobin, the difference in results according to the bacterial culture test, and the presence or absence of peripheral blood vessel occlusion, and the reperfusion procedure.

Results:

The average follow-up period was 12.7 (6-24 months), and the higher the Wagner stage, the higher the rate of re-amputation was statistically significant (OR 1.8, 95%CI 1.4 to 2.4; p=.001). The rate of re-amputation was significantly higher in the group that failed to re-perfuse peripheral blood vessels preoperatively than in the group that succeeded (OR 7.4, 95% CI 2.0 to 27.5; p=.003). Uncontrolled diabetes was confirmed by glycated albumin was predicted the need for repetitive amputation (OR 1.08, 95% CI 0.8 to 2.7; p=.001). In addition, there was a high rate of re-amputation in diabetic foot ulcers and infections identified by polymicrosomal infection. (OR 8.4, 95% CI 1.0 to 69.5; p=.026)

Conclusion:

In patients with diabetic foot ulcers and severe infections, who have a peripheral vascular obstruction, which failed vascular intervention, and who had high glycated albumin was performed from the initial amputation below the major joint in the proximal lower extremity, resulting in reduced patient mortality and morbidity. In addition, the results of the treatment varied depending on the infected bacteria. Re-amputation free survival of diabetic foot ulcer Kaplan-Meier curves for reamputation-free survival of diabetes patients with diabetic foot ulcers over 3 year, depending on enterococal infection (log-rank test p= 0.03).
Analysis of Racial, Ethnic, and Gender Trends in Foot and Ankle Fellowships from 2007 to 2022
Authors: Narendra Hiredesai Annika , Holle Alejandro M. , Lin Eugenia , Moore M. Lane , Patel Karan
Published: December 2024

Category:

Other

Introduction/Purpose:

Racial and gender disparities in the field of orthopedic surgery are well-documented in the literature. A diverse population of physicians and surgeons is imperative to foster progress in our field and improve the quality of the care provided to patients. To further address disparities within the field of orthopedic surgery, further analysis of demographic composition at various career timepoints is warranted. The purpose of this study was to describe the historical demographic composition of fellows, including race, ethnicity, and gender, within the subspecialty of orthopedic foot and ankle from 2007 to 2022.

Methods:

Gender, race, and ethnicity data were collected from the Accredited Council for Graduate Medical Education (ACGME) annual data resource books for all years available. Published data points included the total number of fellows, race and ethnicity (White, Asian, Hispanic, Latino or of Spanish origin, Black or African American, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, Multiple Race/Ethnicity, Other, and Unknown), and gender (male, female, and not reported). Percentage equivalents for racial and ethnic groups from 2011 to 2022 and gender groups from 2007 to 2022 were calculated. Trends in representation were analyzed by calculating Sen’s slope — the median of slopes calculated between all possible pairs of time points – to reduce sensitivity to outliers.

Results:

During the 12-year period, White, Asian, Hispanic, and Black fellows represented on average 80.7%, 14.7%, 1.9%, and 2.3%, respectively. Fellows that identified as Hispanic and Black were underrepresented throughout the study period, with several years of no representation. Male trainees made up the majority of foot and ankle trainees throughout the 15-year period, averaging 79.5%. There were no female foot and ankle fellows from 2007 to 2008. We found no significant trends (p > 0.05) in representation for any racial, ethnic, or gender group across the study period.

Conclusion:

Our analysis shows a persistent underrepresentation of racial and ethnic minorities and women among foot and ankle trainees. Racial and ethnic minority representation was below that of other orthopedic subspecialties. Female representation, while among the highest among orthopedic fellowships, falls short of parity and is in line with the current female orthopedic surgery resident representation. Targeted efforts are required to improve representation among foot and ankle orthopedic surgeons moving forward. Strategies should consist of early mentorship and exposure, continued career promotion, and, ultimately, retention within the field of orthopedic surgery.
Anatomic, Radiographic, and Ultrasound Correlation for Therapeutic Treatment of Heel Pain
Authors: Albert Kuechly Henry , Kurkowski Sarah , Gerak Samuel , Thimmesch Michael , Grischy Robbie , Laughlin Richard T.
Published: December 2024

Category:

Ankle; Sports

Introduction/Purpose:

Entrapment of the First Branch of the Lateral Plantar Nerve (FBLPN), also known as Baxter’s Nerve (BN), has been identified as a cause of plantar heel pain in up to 20% of cases. Treatments for entrapment of the FBLPN often involve ultrasound guidance to ensure accurate placement of the treatment or injection. Knowledge of the gross anatomy of neurovascular structures is required to facilitate accurate placement of the therapeutic treatment. The purpose of this study was to utilize radiography to describe the course of the FBLPN relative to palpable anatomic landmarks that can be used to guide ultrasound interventions for plantar heel pain.

Methods:

Ten preserved feet from five cadaveric donors were dissected beginning with an incision 25 cm proximal to the medial malleolus. The skin and soft tissues were carefully dissected to identify the origin of the lateral plantar nerve and FBLPN. A radiopaque wire was inserted distally in each of the two nerves and a lateral radiograph was obtained. (Figure 1) A line designated as the malleolar-calcaneal (MCN) line was drawn from the center of the medial malleolus (point A) to the most distal tip of the calcaneus (point B). The distance between the point at which the FBLPN intersected the MCN line (point C) and the origin of the FBLPN (point D) was measured in millimeters. Using the MCN line, the distance from the medial malleolus (point A) to the point at which the FBLPN transected the MCN line (point C) was measured in millimeters.

Results:

In all ten cases, the FBLPN arose proximal to the malleolar-calcaneal line and originated directly from the lateral plantar nerve. The average distance from the malleolar-calcaneal line to the origin of the FBLPN was 25.70 ± 19.56 mm with a range of 10mm to 76mm. The average distance between the medial malleolus and the intersection of the FBLPN and the MCN line was 65.90 ± 33.80mm with a range of 15mm to 138mm.

Conclusion:

Plantar heel pain is a common reason to visit the orthopedic clinic and entrapment of the FBLPN is a common etiology for this pain. Treatments for entrapment of the FBLPN such as radiofrequency ablation and steroid injections rely on precise placement of the probe or needle in order to maximize therapeutic benefit and minimize side effects. Bony landmarks which are palpable on the patient’s intact skin such as the center of the medial malleolus and the distal tip of the calcaneus can serve to identify the likely course of the FBLPN. Lateral radiograph of a right foot Point A: center of the medial malleolus, Point B: Distal Calcaneus, Point C: intersection of the First Branch of the Lateral Plantar Nerve and the Malleolar-Calcaneal line, Point D: origin of the First Branch of the Lateral Plantar Nerve. Line A-B: Malleolar-Calcaneal line.
Are Large Language Models Efficient as Triage Tools for Surgical Management of Foot and Ankle Patients?
Authors: Lintz François , Acker Antoine , Carvalho Kepler A.M. , Labidi May , Gonzi Gianluca , Munoz Marie-Aude , Joan Luo Emily , Bernasconi Alessio , Easley Mark E. , Cesar Netto Cesar de
Published: December 2024

Category:

Other; Basic Sciences/Biologics

Introduction/Purpose:

Large Language Models (LLMs) like ChatGPT and Bard have emerged as potential but not risk-less tools in science, offering specialized answers to queries based on elements of context. In Foot and Ankle (FA) surgery, efficient triage is crucial due to the variety of conditions and limited surgical time. This study evaluates LLMs' ability to guide patients towards appropriate medical or surgical management compared to a panel of board certified FA surgeons.

Methods:

Forty-four fictitious clinical scenarios were created, incorporating chronicity, onset, and anatomic localization. Outcomes were assessed on a Likert scale (1-5) for the likelihood of needing surgical management, alongside the 3 most probable diagnoses and 2 indicated imaging modalities. Two FA surgeons and the LLMs ChatGPT and Bard were evaluated, with agreement analyzed using Fleiss' and Cohen's Kappas.

Results:

Initial Likert scale agreement (Fleiss' Kappa) was 0.233, indicating low concordance. Recategorizing outcomes into binary (surgical vs. medical orientation of patients) improved agreement to fair (0.423). Pairwise comparison using Cohen's Kappa showed slight to moderate agreement among LLMs and surgeons, with Bard aligning more closely with surgeons (77.27% agreement) than ChatGPT.

Conclusion:

LLMs show promise in FA triage but require refinement for clinical reliability. Bard's higher surgeon agreement suggests some models may better capture clinical judgment nuances. Future research should enhance LLM interpretive algorithms and explore their supportive role in medical decision-making.
Case Report: Complex Regional Pain Syndrome Involving the Head and Face After Severe Malignant Otitis Media and Mastoiditis
Authors: Collins Hunter
Published: December 2024

Background

Complex regional pain syndrome (CRPS) is a rare condition characterized by intense chronic pain, vascular changes, swelling, and trophic changes leading to significant morbidity. It is often related to crush/mechanical injury or surgery and most commonly affects the limbs. There have only been a few rare documented cases affecting the head and face, and more scarce are CRPS cases of the head and face unrelated to trauma.

Case

We report a 79-year-old woman referred to Neurology after three months of severe, persistent left-sided head and face pain associated with discrete episodic swelling and localized autonomic symptoms, skin and hair changes in the affected area, following severe otitis media complicated by mastoiditis. Her history and neurologic exam did not meet a categorical diagnosis based on criteria in The International Classification of Headache Disorders-3rd edition and International Classification of Orofacial Pain, 1st edition but her symptoms and signs met the Budapest Criteria (BC) for a diagnosis of CRPS of the head and face. The patient had been on carbamazepine with only marginal benefit. After the initial Neurology evaluation, she started duloxetine and was referred for mirror visual feedback therapy. During an acute attack, she had a very good response to a sphenopalatine ganglion block and compounded intranasal and topical lidocaine-ketamine preparations were adjunctively added. Eleven months after initial symptom onset, she reported significant symptomatic improvement with markedly decreased disability and return to her premorbid quality of life.

Conclusion

Complex regional pain syndrome is difficult to recognize, there are no diagnostic tests, there is no definitive cure and management is symptomatic. Early identification and treatment may prevent significant morbidity and we recommend review and classification of such cases using the BC.
Experiences of intervention for people serving short prison sentences in New South Wales
Authors: Ross Bonnie B. Y. , Mahajan Yatin , Howard Mark
Published: December 2024

In New South Wales, people serving less than five months in prison can be eligible for the Short Sentence Intensive Program (SSIP), a custody-based intervention featuring therapeutic activities and reintegration services to reduce reoffending. This study aimed to explore experiences of the SSIP from the incarcerated person's perspective and to gain an understanding of needs and experiences among the short-sentence cohort more broadly. Semi-structured interviews were conducted with 22 SSIP-eligible individuals. Reflexive thematic analysis of the interviews produced five themes: salience matters; those who want change see opportunity; Rome wasn’t built in a day; little did we know; and, work with us not against us. These give insight into strengths and weaknesses of the SSIP which reflect universal principles of effective case management while highlighting the challenges that are inherent to supporting the rehabilitation of individuals in prison who are within a short time to release.
A recipe for success: The design, use, and effectiveness of multimodal online baking instructions
Authors: van der Sluis Ielka , Mellema Hanna
Published: December 2024

This paper presents three studies on the design, use and effectiveness of multimodal online baking blogs that present cookie recipes in two forms: illustrated step-by-step Instructions with Pictures and printable text-only Recipe Cards. Firstly, a corpus study describes how authors combine text and pictures in 15 blogs. Secondly, an eye-tracking study was conducted to explore how 12 participants read and evaluate baking blogs and the Instructions with Pictures in them. Finally, a user study was conducted to explore how 4 teams of participants execute and evaluate either an Instruction with Pictures or a Recipe Card of a typical baking blog. Questionnaire data on the readers’ and users’ judgments of the comprehensibility, design and their (expected) performance of the instructions, as well as eye-tracker data and videos capturing the reading and baking practices were collected and analysed. Thus, the triangulation of exploratory studies displays how different research methodologies inform the relevance and evaluation of particular characteristics of multimodal presentations given the readers’ and users’ judgments as well as through objective measurements that provide complementary insights on multimodal baking instructions in terms of multimodal information presentation, reading strategies and situated use.
Scenes of entanglement: Towards a posthuman understanding of the transglobal noise music scene
Authors: Woods Peter J. , Ortega Yecid
Published: December 2024

Drawing on the growing interest in affective and relational approaches to scene studies, we use this paper to explore a reimagining of DIY music scenes, and the transglobal noise music scene in particular, through a posthuman lens. This retheorization situates music scenes as becoming entanglements that incorporate space and time rather than historicized communities bounded by these notions. To ground this work, we present an arts-based duoethnographic exploration of the researchers lived experience within one manifestation of the transglobal noise scene at various times and geographic locations. By embodying a posthuman conceptualization of noise music scenes through our analysis, we construct new ways of theorizing, experiencing, and hearing noise music by critically reimagining the musical, spatial, and sociopolitical boundaries that traditionally define DIY music scenes. In doing so, we present a model for future scene studies that embrace the intra-active nature of these socio-musical contexts.
Fc mutagenesis enhances the functionality of anti-RhD monoclonal antibodies
Authors: Heydarchi Behnaz , D'Silva Damian B , Wong Huon L , Goddard-Borger Ethan D , Wicks Ian P
Published: December 2024

Haemolytic disease of the foetus and newborn (HDFN) due to Rhesus D (RhD) antigen mismatch between the mother and foetus has been a significant cause of neonatal jaundice, recurrent miscarriage and stillbirth throughout history. Anti-RhD prophylaxis using polyclonal immunoglobulin G (RhD-pIgG) derived from the plasma of RhD-negative donors immunised with RhD-positive red blood cells (RBCs), has reduced the incidence of HDFN, but this approach is currently restricted to developed countries. Monoclonal antibodies (mAbs) offer a promising alternative to address this pressing need, but prior attempts to develop effective anti-RhD mAbs have failed, in some cases due to differences in fucosylation patterns between mAbs produced in cell lines and RhD-pIgG. CHO cell lines, commonly used for pharmaceutical protein production, induce high levels of fucosylation, reducing the antibody-dependent cellular cytotoxicity (ADCC) activity crucial for clearing RhD-positive RBCs. In contrast,RhD-pIgG has lower fucosylation levels, which enhances ADCC activity. Regulating the glycan levels of mAbs during production requires specialized cell lines and culture conditions. In this study, we took an alternative approach through antibody engineering. The Fc regions of two existing anti-RhD mAbs (Brad3 and Fog1) were subjected to mutagenesis to introduce ADCC enhancing mutations and then expressed in CHO cells under standard conditions. We demonstrate that targeted Fc mutagenesis significantly enhanced ADCC compared to the wild-type mAbs, while preserving RhD binding and efficient production in CHO cells. Furthermore, these Fc variants achieved comparable efficacy to RhD-pIgG, suggesting a new strategy for producing anti-RhD mAbs with improved functionality, without the need for glycoengineering.
Endothelial-specific deletion of connexin 43 improves renal function and structure after acute kidney injury
Authors: Genest Magali , Kinugasa Satoshi , Roger Elena , Boutin Louis , Placier Sandrine , Figueroa Stefanny , Dorison Aude , Hadjadj Safia , Baba Ines , Gautier Emmanuel L. , Kavvadas Panagiotis , Chatziantoniou Christos , Chadjichristos Christos E.
Published: December 2024

Background

We have previously reported that the gap junction protein connexin 43 (Cx43) was upregulated in chronic renal disease in humans and rodents and plays a crucial role in the progression of experimental nephropathy. In this study, we investigated its role after renal ischemia/reperfusion (rIR), which is a major mechanism of injury in acute renal injury (AKI) and renal transplant graft dysfunction.

Methods

Wild-type mice (WT) and mice in which Cx43 expression was genetically reduced by half (Cx43 ±) were unilaterally nephrectomized. The left renal artery was subsequently clamped, with reperfusion of varying duration. Mice with tubular- or endothelial-specific deletion of Cx43 were also used to assess the effect of this connexin in each cell type after rIR. Kidneys were assessed for histological evaluation, immunohistochemistry, and RT-PCR.

Results

Blood urea nitrogen and creatininemia were progressively elevated in WT mice and picked up 48 h after rIR. At the same time point, severe tubular necrosis and dilation occurred in the cortico-medullary junction of the injured kidneys with accompanying massive neutrophil infiltration. Interestingly, Cx43 expression was progressively increased within the tubulointerstitial compartment during kidney damage progression and was paralleled closely by that of markers of renal dysfunction. Cx43 ± mice showed fewer tubular lesions, less inflammation, and further improved renal function. Similar results were observed in mice where Cx43 was specifically deleted within the vascular endothelium. In contrast, Cx43 deletion in renal tubules did not significantly improve renal structure and function after rIR.

Conclusion

Our findings suggest that endothelial Cx43 plays a crucial role in AKI.
Targeting programmed cell death in diabetic kidney disease: from molecular mechanisms to pharmacotherapy
Authors: Liu Fengzhao , Yang Zhenyu , Li Jixin , Wu Tao , Li Xiangyu , Zhao Lijuan , Wang Wenru , Yu Wenfei , Zhang Guangheng , Xu Yunsheng
Published: December 2024

Diabetic kidney disease (DKD), one of the most prevalent microvascular complications of diabetes, arises from dysregulated glucose and lipid metabolism induced by hyperglycemia, resulting in the deterioration of renal cells such as podocytes and tubular epithelial cells. Programmed cell death (PCD), comprising apoptosis, autophagy, ferroptosis, pyroptosis, and necroptosis, represents a spectrum of cell demise processes intricately governed by genetic mechanisms in vivo. Under physiological conditions, PCD facilitates the turnover of cellular populations and serves as a protective mechanism to eliminate impaired podocytes or tubular epithelial cells, thereby preserving renal tissue homeostasis amidst hyperglycemic stress. However, existing research predominantly elucidates individual modes of cell death, neglecting the intricate interplay and mutual modulation observed among various forms of PCD. In this comprehensive review, we delineate the diverse regulatory mechanisms governing PCD and elucidate the intricate crosstalk dynamics among distinct PCD pathways. Furthermore, we review recent advancements in understanding the pathogenesis of PCD and explore their implications in DKD. Additionally, we explore the potential of natural products derived primarily from botanical sources as therapeutic agents, highlighting their multifaceted effects on modulating PCD crosstalk, thereby proposing novel strategies for DKD treatment.
Mutation on JmjC domain of UTX impaired its antitumor effects in pancreatic cancer via inhibiting G0S2 expression and activating the Toll-like signaling pathway
Authors: Shen Xiao-hua , Xiong Shu-ping , Wang Sheng-peng , Lu Shan , Wan Yi-ye , Zhang Hui-qing
Published: December 2024

Background

Recently, the incidence of pancreatic cancer (PC) has gradually increased. Research has shown that UTX mutants are critical in tumors. However, the underlying mechanisms remain incompletely understood. This study aimed to explore how UTX mutation would affect its related function in PC.

Method

Exome sequencing was used to analyze PC samples. MTT, transwell, and colony formation assays were performed to determine the cellular functions of PC cells. qRT-PCR, Western Blot, TUNEL, immunohistochemistry, CHIP, bioinformatics, and xenograft experiments were used to investigate the mechanism of UTX mutants in PC in vitro and in vivo.

Results

We compared exome sequencing data from 12 PC samples and found a UTX missense mutation on the JmjC structure. Through cellular functions and xenograft experiments, wild-type UTX was found to significantly inhibit PC malignant progression in vitro and in vivo, while UTX mutation notably impaired this effect. Furthermore, G0S2 was identified as the key target gene for UTX, and wild-type UTX significantly increased its expression, while mutant one lost this function to a certain extent both in vitro and in vivo. More importantly, G0S2 overexpression not only inhibited tumor malignant phenotype and drug resistance for Gemcitabine in PC but also effectively reversed the roles of UTX mutant with Toll-like signaling pathway involved. In terms of mechanism, UTX mutation elevated the H3K27me3 modification level of the G0S2 promoter, which decreased its expression in PC cells.

Conclusion

In conclusion, UTX mutant weakened the antitumor effect of wild-type UTX in PC by inhibiting G0S2 expression and activating the Toll-like signaling pathway.
Osthole ameliorates wear particle-induced osteogenic impairment by mitigating endoplasmic reticulum stress via PERK signaling cascade
Authors: Yu Xin , Jiang Juan , Li Cheng , Wang Yang , Ren Zhengrong , Hu Jianlun , Yuan Tao , Wu Yongjie , Wang Dongsheng , Sun Ziying , Wu Qi , Chen Bin , Fang Peng , Ding Hao , Meng Jia , Jiang Hui , Zhao Jianning , Bao Nirong
Published: December 2024

Background

Periprosthetic osteolysis and subsequent aseptic loosening are the leading causes of failure following total joint arthroplasty. Osteogenic impairment induced by wear particles is regarded as a crucial contributing factor in the development of osteolysis, with endoplasmic reticulum (ER) stress identified as a key underlying mechanism. Therefore, identifying potential therapeutic targets and agents that can regulate ER stress adaption in osteoblasts is necessary for arresting aseptic loosening. Osthole (OST), a natural coumarin derivative, has demonstrated promising osteogenic properties and the ability to modulate ER stress adaption in various diseases. However, the impact of OST on ER stress-mediated osteogenic impairment caused by wear particles remains unclear.

Methods

TiAl6V4 particles (TiPs) were sourced from the prosthesis of patients who underwent revision hip arthroplasty due to aseptic loosening. A mouse calvarial osteolysis model was utilized to explore the effects of OST on TiPs-induced osteogenic impairment in vivo. Primary mouse osteoblasts were employed to investigate the impact of OST on ER stress-mediated osteoblast apoptosis and osteogenic inhibition induced by TiPs in vitro. The mechanisms underlying OST-modulated alleviation of ER stress induced by TiPs were elucidated through Molecular docking, immunochemistry, PCR, and Western blot analysis.

Results

In this study, we found that OST treatment effectively mitigated TiAl6V4 particles (TiPs)-induced osteolysis by enhancing osteogenesis in a mouse calvarial model. Furthermore, we observed that OST could attenuate ER stress-mediated apoptosis and osteogenic reduction in osteoblasts exposed to TiPs in vitro and in vivo. Mechanistically, we demonstrated that OST exerts bone-sparing effects on stressed osteoblasts upon TiPs exposure by specifically suppressing the ER stress-dependent PERK signaling cascade.

Conclusion

Osthole ameliorates wear particle-induced osteogenic impairment by mitigating endoplasmic reticulum stress via PERK signaling cascade. These findings suggest that OST may serve as a potential therapeutic agent for combating wear particle-induced osteogenic impairment, offering a novel alternative strategy for managing aseptic prosthesis loosening.
Metabolomic signature of pediatric diabetic ketoacidosis: key metabolites, pathways, and panels linked to clinical variables
Authors: Spagnolo Paolo , Tweddell David , Cela Enis , Daley Mark , Clarson Cheril , Rupar C. Anthony , Stranges Saverio , Bravo Michael , Cepinskas Gediminas , Fraser Douglas D.
Published: December 2024

Background

Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes (T1D), arising from relative insulin deficiency and leading to hyperglycemia, ketonemia, and metabolic acidosis. Early detection and treatment are essential to prevent severe outcomes. This pediatric case–control study utilized plasma metabolomics to explore metabolic alterations associated with DKA and to identify predictive metabolite patterns.

Methods

We examined 34 T1D participants, including 17 patients admitted with severe DKA and 17 age- and sex-matched individuals in insulin-controlled states. A total of 215 plasma metabolites were analyzed using proton nuclear magnetic resonance and direct-injection liquid chromatography/mass spectrometry. Multivariate statistical methods, machine learning techniques, and bioinformatics were employed for data analysis.

Results

After adjusting for multiple comparisons, 65 metabolites were found to differ significantly between the groups (28 increased and 37 decreased). Metabolomics profiling demonstrated 100% accuracy in differentiating severe DKA from insulin-controlled states. Random forest analysis indicated that classification accuracy was primarily influenced by changes in ketone bodies, acylcarnitines, and phosphatidylcholines. Additionally, groups of metabolites (ranging in number from 8 to 18) correlated with key clinical and biochemical variables, including pH, bicarbonate, glucose, HbA1c, and Glasgow Coma Scale scores.

Conclusions

These findings underscore significant metabolic disturbances in severe DKA and their associations with critical clinical indicators. Future investigations should explore if metabolic alterations in severe DKA can identify patients at increased risk of complications and/or guide future therapeutic interventions.
Elongation factor 2 in cancer: a promising therapeutic target in protein translation
Authors: Jia Xuechao , Huang Chuntian , Liu Fangfang , Dong Zigang , Liu Kangdong
Published: December 2024

Aberrant elongation of proteins can lead to the activation of oncogenic signaling pathways, resulting in the dysregulation of oncogenic signaling pathways. Eukaryotic elongation factor 2 (eEF2) is an essential regulator of protein synthesis that precisely elongates nascent peptides in the protein elongation process. Although studies have linked aberrant eEF2 expression to various cancers, research has primarily focused on its structure, highlighting a need for deeper exploration into its molecular functions. In this review, recent advancements in the structure, guanosine triphosphatase (GTPase) activity, posttranslational modifications, regulatory factors, and inhibitors of eEF2 are summarized. These findings provide a comprehensive cognition on the critical role of eEF2 and its potential as a therapeutic target in cancer. Furthermore, this review highlights important unanswered questions that warrant investigation in future research.

Graphical Abstract