bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic diversity, demography and connectivity in the marine snail Thaisella chocolata (Duclos, 1832): implications for sustainable fisheries management along the Peruvian coast
Authors: Louis Victoria , Kochzius Marc , Jiménez Juana , Fourdrilis Séverine , Yamashiro Carmen , Jossart Quentin
Published: March 2024

Thaisella chocolata is a marine gastropod (family Muricidae) occurring from northern Peru to central Chile. It is of economic importance in these countries, where hundreds of tons are caught every year. In combination with El Niño–Southern Oscillation events, fishing activity has led to the collapse of Chilean populations, raising concerns about the state of Peruvian populations. The aim of this study is to assess the demography, genetic diversity and connectivity of T. chocolata along the Peruvian coast. This would provide important insights into the resilience of this species to anthropogenic disturbance. In this study, four locations along the coast of Peru were investigated for the first time. Mitochondrial cytochrome c oxidase subunit I (COI) sequences were obtained from 116 individuals and four microsatellites from 95 individuals. Both COI (combined with 156 publicly available sequences) and microsatellite data revealed very low genetic differentiation, despite a few significant φST and FST values between population pairs. The most likely gene flow model (MIGRATE-N) is panmixia between all locations, with gene flow occurring equally northwards and southwards. This pattern may be related to the surface currents along the Peruvian coastline combined with the high pelagic larval duration of T. chocolata. Hyperdiversity was found for the COI marker (πsyn > 5%). Microsatellite loci were also polymorphic, with a mean diversity of 12.69 alleles per locus per population. No recent population bottleneck was observed (microsatellite data), while at least one past demographic expansion was suggested (COI data). Given the high genetic diversity and connectivity, T. chocolata is expected to show high evolutionary resilience and can be considered as one management unit in terms of fisheries management. However, further studies, on, for example, the characterization of effective population size (using numerous nuclear loci), are required to confirm this hypothesis. In addition, precautionary fisheries measures should be maintained, given the recent collapse of T. chocolata stocks in Chile.
Post-renal acute kidney injury complicated by urinary tract obstruction due to massive blood clots and severe thrombocytopenia in a patient with systemic lupus erythematosus: A case report
Authors: Fujita Yuya , Sato Shuzo , Yoshida Shuhei , Asano Tomoyuki , Matsumoto Haruki , Temmoku Jumpei , Matsuoka Naoki , Ohkawara Hiroshi , Shakespear Norshalena , Migita Kiyoshi
Published: March 2024

Systemic lupus erythematosus (SLE) is often seen with antiphospholipid antibody syndrome (APS), and these conditions may occur concurrently with severe immune thrombocytopenia (ITP) and even acute kidney injury (AKI); however, post-renal AKI due to bleeding is uncommon. Here, we describe a case of post-renal AKI and anuria in a patient with SLE and APS, which were attributable to urinary tract obstruction due to massive blood clots caused by secondary ITP. A 50-year-old Japanese woman was admitted to our hospital with anuria, abdominal tenderness, purpura in the trunk and in both legs, and severe thrombocytopenia. She had been receiving medical treatment for APS and SLE till the age of 45 years. Computed tomography revealed a blood clot without extravasation in both urinary tracts, and she was diagnosed with post-renal AKI due to complete obstruction of the urinary system. Additionally, based on her medical history, elevated platelet-associated Immunoglobulin G (IgG) levels, and increased megakaryocyte count, she was diagnosed with secondary ITP complicated by SLE and APS. She also had elevated APS-related autoantibodies, including antiphosphatidylserine/prothrombin Immunoglobulin M (IgM), and IgG. However, concomitant serositis such as lupus enteritis or cystitis was not seen. She was treated with a combination of glucocorticoids, intravenous immunoglobulin, and continuous haemodialysis/haemofiltration, which resulted in rapid improvement of her symptoms and renal dysfunction. Secondary ITP-induced massive bleeding of urinary tract can cause post-renal AKI. Appropriate diagnosis and aggressive treatment are necessary to improve prognosis in such patients.
CO2-facilitated upcycling of polyolefin plastics to aromatics at low temperature
Authors: Ding Yi , Zhang Shuchi , Liu Cheng , Shao Yu , Pan Xiulian , Bao Xinhe
Published: March 2024

Plastics are one of the most produced synthetic materials and largest commodities, used in numerous sectors of human life. To upcycle waste plastics into value-added chemicals is a global challenge. Despite significant progress in pyrolysis and hydrocracking, which mainly leads to the formation of pyrolysis oil, catalytic upcycling to value-added aromatics, including benzene, toluene and xylene (BTX), in one step, is still limited by high reaction temperatures (>500°C) and a low yield. We report herein CO2-facilitated upcycling of polyolefins and their plastic products to aromatics below 300°C, enabled by a bifunctional Pt/MnOx-ZSM-5 catalyst. ZSM-5 catalyzes cracking of polyolefins and aromatization, generating hydrogen at the same time, while Pt/MnOx catalyzes the reaction of hydrogen with CO2, consequently driving the reaction towards aromatization. Isotope experiments reveal that 0.2 kg CO2 is consumed per 1.0 kg polyethylene and 90% of the consumed CO2 is incorporated into the aromatic products. Furthermore, this new process yields 0.63 kg aromatics (BTX accounting for 60%), comparing favorably with the conventional pyrolysis or hydrocracking processes, which produce only 0.33 kg aromatics. In this way, both plastic waste and the greenhouse gas CO2 are turned into carbon resources, providing a new strategy for combined waste plastics upcycling and carbon dioxide utilization.
Statewide Cancer Drug Repository Reducing Waste in the Setting of Shortage Crisis
Authors: Mackler Emily R , Norman Siobhan , Jalloul Farah
Published: March 2024

Disparities in cancer treatment, including access to medications, continue to exist. Rising drug prices and cancer drug shortages are 2 causes of inequitable access to treatment. This article introduces pilot outcomes for a solution to improve access to medications while also decreasing medication waste. Cancer drug repositories are an innovative patient-centered model where donations of unused cancer medications from patients are repurposed and provided to patients who are most vulnerable and disproportionately harmed by financial toxicity. This model demonstrates efficiency and sustainability that complements integrated care and provides an approach to increase medication access and decrease medication waste.
The biogenesis and maintenance of PSII: Recent advances and current challenges
Authors: Komenda Josef , Sobotka Roman , Nixon Peter J
Published: March 2024

The growth of plants, algae, and cyanobacteria relies on the catalytic activity of the oxygen-evolving PSII complex, which uses solar energy to extract electrons from water to feed into the photosynthetic electron transport chain. PSII is proving to be an excellent system to study how large multi-subunit membrane-protein complexes are assembled in the thylakoid membrane and subsequently repaired in response to photooxidative damage. Here we summarize recent developments in understanding the biogenesis of PSII, with an emphasis on recent insights obtained from biochemical and structural analysis of cyanobacterial PSII assembly/repair intermediates. We also discuss how chlorophyll synthesis is synchronized with protein synthesis and suggest a possible role for PSI in PSII assembly. Special attention is paid to unresolved and controversial issues that could be addressed in future research.
Comprehensive transcriptional atlas of human adenomyosis deciphered by the integration of single-cell RNA-sequencing and spatial transcriptomics
Authors: Chen Tao , Xu Yiliang , Xu Xiaocui , Wang Jianzhang , Qiu Zhiruo , Yu Yayuan , Jiang Xiaohong , Shao Wanqi , Bai Dandan , Wang Mingzhu , Mei Shuyan , Cheng Tao , Wu Li , Gao Shaorong , Che Xuan
Published: March 2024

Adenomyosis is a poorly understood gynecological disorder lacking effective treatments. Controversy persists regarding “invagination” and “metaplasia” theories. The endometrial-myometrial junction (EMJ) connects the endometrium and myometrium and is important for diagnosing and classifying adenomyosis, but its in-depth study is just beginning. Using single-cell RNA sequencing and spatial profiling, we mapped transcriptional alterations across eutopic endometrium, lesions, and EMJ. Within lesions, we identified unique epithelial (LGR5+) and invasive stromal (PKIB+) subpopulations, along with WFDC1+ progenitor cells, supporting a complex interplay between “invagination” and “metaplasia” theories of pathogenesis. Further, we observed endothelial cell heterogeneity and abnormal angiogenic signaling involving vascular endothelial growth factor and angiopoietin pathways. Cell-cell communication differed markedly between ectopic and eutopic endometrium, with aberrant signaling in lesions involving pleiotrophin, TWEAK, and WNT cascades. This study reveals unique stem cell-like and invasive cell subpopulations within adenomyosis lesions identified, dysfunctional signaling, and EMJ abnormalities critical to developing precise diagnostic and therapeutic strategies.
Risk attitude, innovativeness, and financial literacy—A cross-occupational comparison of German farmers and foresters
Authors: Michels Marius , Rieling Jonas Adrian , Musshoff Oliver
Published: March 2024

Factors such as risk attitude, innovativeness, and financial literacy are crucial in agricultural and forest economics, especially amidst weather and market risks. Hence, understanding them is central for fostering a resilient primary sector. We surveyed 371 German farmers and 215 foresters in 2022 online. Both groups were financial literate, reported a neutral generalized risk attitude, leaned toward risk aversion in their professional context, were open to innovation, and showed statistically significant differences between contextualized and generalized risk attitude. Unlike foresters, farmers displayed statistically significant differences between their self-reported general and contextualized innovativeness. Among other things, the results highlight the value of context-specific methods in primary sector research. The study showcases a commitment to open science by using a synthetic dataset to make the analysis transparent and allowing for replication while ensuring participant privacy through the differential privacy framework.
Considering Decoupled Phenotypic Diversification Between Ontogenetic Phases in Macroevolution: An Example Using Triggerfishes (Balistidae)
Authors: Dornburg Alex , Zapfe Katerina L , Williams Rachel , Alfaro Michael E , Morris Richard , Adachi Haruka , Flores Joseph , Santini Francesco , Near Thomas J , Frédérich Bruno
Published: March 2024

Across the Tree of Life, most studies of phenotypic disparity and diversification have been restricted to adult organisms. However, many lineages have distinct ontogenetic phases that differ from their adult forms in morphology and ecology. Focusing disproportionately on the evolution of adult forms unnecessarily hinders our understanding of the pressures shaping evolution over time. Non-adult disparity patterns are particularly important to consider for coastal ray-finned fishes, which can have juvenile phases with distinct phenotypes. These juvenile forms are often associated with sheltered nursery environments, with phenotypic shifts between adults and juvenile stages that are readily apparent in locomotor morphology. Whether this ontogenetic variation in locomotor morphology reflects a decoupling of diversification dynamics between life stages remains unknown. Here we investigate the evolutionary dynamics of locomotor morphology between adult and juvenile triggerfishes. We integrate a time-calibrated phylogenetic framework with geometric morphometric approaches and measurement data of fin aspect ratio and incidence, and reveal a mismatch between morphospace occupancy, the evolution of morphological disparity, and the tempo of trait evolution between life stages. Collectively, our results illuminate how the heterogeneity of morpho-functional adaptations can decouple the mode and tempo of morphological diversification between ontogenetic stages.
Analyzing the training of PAs in ophthalmology
Authors: Gutierrez L. Carlos , Ayars Candace
Published: March 2024

Objective:

This study sought to determine the role of physician associates/assistants (PAs) in ophthalmology, the balance between barriers and facilitators in training, and optimal training for PAs in ophthalmology.

Methods:

In this explanatory qualitative case study, 17 of the 94 PAs in ophthalmology in the United States participated in qualitative, semistructured interviews. Qualitative interviews were conducted using a validated interview guide. Interpretational data analysis methods helped in the development of various themes.

Results:

Themes suggest that PAs play a unique role in assisting ophthalmologists in surgery, performing procedures autonomously, and evaluating and treating patients autonomously. PAs in ophthalmology reported current training programs as unfavorable, reported satisfaction in their careers, and identified formal postgraduate training programs as optimal training for PAs.

Conclusions:

Findings of this study suggest that formal postgraduate training programs can help PAs gain the necessary skills to successfully fulfill their roles in ophthalmology.
A clinician's guide to pulmonary hypertension
Authors: Wilson Bailey K. , Sadowski Catherine K. , Baeten Robert G.
Published: March 2024

Despite advances in diagnosis and treatment, pulmonary hypertension has high morbidity and mortality. The presenting symptoms often are vague and may mimic other more common diseases, so patients can be misdiagnosed or missed early in the disease process. Early detection of pulmonary hypertension by primary care providers can play an important role in patient outcomes and survival. Identifying signs and symptoms, understanding the causes and classifications, and knowing the systematic approach to evaluating and diagnosing patients with suspected pulmonary hypertension are key to preventing premature patient decline.
Phase 1 Study of Bortezomib, Fludarabine, and Melphalan, With or Without Total Marrow Irradiation, as Allogeneic Hematopoietic Stem Cell Transplant Conditioning for High-risk or Relapsed/Refractory Multiple Myeloma
Authors: Ladbury Colton , Sanchez James , Chowdhury Arnab , Palmer Joycelynne , Liu An , Stein Anthony , Htut Myo , Farol Leonardo , Cai Ji-Lian , Somlo George , Rosenzweig Michael , Wong Jeffrey C. , Sahebi Firoozeh
Published: March 2024

Objectives:

We conducted a phase 1 study of a conditioning regimen with or without total marrow irradiation (TMI) before allogeneic hematopoietic stem cell transplantation for patients with high-risk or refractory multiple myeloma.

Methods:

Eighteen patients were enrolled on one of 2 strata. Patients with no prior radiation received TMI (900 cGy), fludarabine (FLU), and melphalan (MEL) conditioning, with bortezomib added in the second cohort (stratum I). Patients with prior radiation received FLU, MEL, and bortezomib, without TMI (stratum II).

Results:

Eight patients were enrolled in the TMI arm (stratum I). One of 3 patients in cohort 1 experienced dose-limiting toxicity (DLT), which led to the expansion to 3 more patients with no DLT. Cohort 2 enrolled only 2 patients due to low accrual, with bortezomib, added at 0.5 mg/m2; neither experienced DLT. Nine patients were enrolled in the non-TMI arm (stratum II). Three patients were enrolled in cohort 1 (bortezomib 0.5 mg/m2) and none experienced DLT. Three were enrolled in cohort 2 (bortezomib 0.7 mg/m2), and 1 experienced DLT; therefore, the cohort expanded to 3 more patients. One more patient experienced DLT. Median overall survival on strata I and II was 44.5 months (95% CI: 1.73-not reached) and 21.6 months (95% CI: 4.1-72.7), respectively. Median progression-free survival on strata I and II was 18.1 months (95% CI: 1.73-not reached) and 8.9 months (95% CI: 2.7-24.4), respectively.

Conclusion(s):

TMI 900 cGy, FLU, and MEL are considered feasible as conditioning for allogeneic stem cell transplantation and may warrant further investigation due to favorable response rates and survival.
Estimating the impacts of nonoptimal temperatures on mortality: A study in British Columbia, Canada, 2001–2021
Authors: Shrestha Rudra K. , Sevcenco Ioana , Casari Priscila , Ngo Henry , Erickson Anders , Lavoie Martin , Hinshaw Deena , Henry Bonnie , Ye Xibiao
Published: March 2024

Background:

Studies show that more than 5.1 million deaths annually are attributed to nonoptimal temperatures, including extreme cold and extreme heat. However, those studies mostly report average estimates across large geographical areas. The health risks attributed to nonoptimal temperatures in British Columbia (BC) are reported incompletely or limit the study area to urban centers. In this study, we aim to estimate the attributable deaths linked to nonoptimal temperatures in all five regional health authorities (RHAs) of BC from 2001 to 2021.

Methods:

We applied the widely used distributed lag nonlinear modeling approach to estimate temperature–mortality association in the RHAs of BC, using daily all-cause deaths and 1 × 1 km gridded daily mean temperature. We evaluated the model by comparing the model-estimated attributable number of deaths during the 2021 heat dome to the number of heat-related deaths confirmed by the British Columbia Coroners Service.

Results:

Overall, between 2001 and 2021, we estimate that 7.17% (95% empirical confidence interval = 3.15, 10.32) of deaths in BC were attributed to nonoptimal temperatures, the majority of which are attributed to cold. On average, the mortality rates attributable to moderate cold, moderate heat, extreme cold, and extreme heat were 47.04 (95% confidence interval [CI] = 45.83, 48.26), 0.94 (95% CI = 0.81, 1.08), 2.88 (95% CI = 2.05, 3.71), and 3.10 (95% CI = 1.79, 4.4) per 100,000 population per year, respectively.

Conclusions:

Our results show significant spatial variability in deaths attributable to nonoptimal temperatures across BC. We find that the effect of extreme temperatures is significantly less compared to milder nonoptimal temperatures between 2001 and 2021. However, the increased contribution of extreme heat cannot be ruled out in the near future.
Assessing the Relationship between Obesity and Trigger Point-specific Outcomes after Headache Surgery
Authors: Ormseth Benjamin H. , Kavanagh Kaitlin J. , Saffari Tiam M. , Palettas Marilly , Janis Jeffrey E.
Published: March 2024

Background:

Trigger point deactivation surgery is a safe and effective treatment for properly selected patients experiencing migraine, with 68.3%–100% experiencing symptom improvement postoperatively. However, it is still unknown why certain patients do not respond. Obesity has been shown to be associated with worsened migraine symptoms and a decreased response to select pharmacotherapies. This study aimed to determine whether obesity may also be associated with an attenuated response to surgery.

Methods:

A retrospective chart review was conducted to identify patients who had undergone trigger point deactivation surgery for migraine. Patients were split into obese and nonobese cohorts. Obesity was classified as a body mass index of 30 or higher per Centers for Disease Control and Prevention guidelines. Outcomes and follow-up periods were determined with respect to individual operations. Outcomes included migraine attack frequency, intensity, duration, and the migraine headache index. Differences in demographics, operative characteristics, and operative outcomes were compared.

Results:

A total of 62 patients were included in the study. The obese cohort comprised 31 patients who underwent 45 total operations, and the nonobese cohort comprised 31 patients who underwent 34 operations. Results from multivariable analysis showed no impact of obesity on the odds of achieving a more than 90% reduction in any individual outcome. The overall rates of improvement (≥50% reduction in any outcome) and elimination (100% reduction in all symptoms) across both cohorts were 89.9% and 65.8%, respectively.

Conclusion:

Obese patients have outcomes comparable to a nonobese cohort after trigger point deactivation surgery for migraine.
New forays into measurement of ocular biomechanics
Authors: Hammelef Emma , Rapuano Christopher J. , Benedetto Dominick A. , Syed Zeba A. , Myers Jonathan S. , Razeghinejad M. Reza , Silver Fred H. , Pulido Jose S.
Published: March 2024

Purpose of review

The field of corneal biomechanics has rapidly progressed in recent years, reflecting technological advances and an increased understanding of the clinical significance of measuring these properties. This review will evaluate in-vivo biomechanical properties obtained by current technologies and compare them regarding their relevance to established biomechanical properties obtained by gold-standard ex-vivo techniques normally conducted on elastic materials.

Recent findings

Several new technologies have appeared in recent years, including vibrational optical coherence tomography (VOCT) and the corneal indentation device (CID). These techniques provide promising new opportunities for minimally invasive and accurate measurements of corneal viscoelastic properties.

Alterations in corneal biomechanics are known to occur in several corneal degenerative diseases and after refractive surgical procedures. The measurement of corneal biomechanical properties has the capability to diagnose early disease and monitor corneal disease progression. Several new technologies have emerged in recent years, allowing for more accurate and less invasive measurements of corneal biomechanical properties, most notably the elastic modulus.
Understanding network meta-analysis methodology for the ophthalmologist
Authors: Phillips Mark , Chaudhary Varun
Published: March 2024

Purpose of review

Over the past decade, the number of studies published using network meta-analyses (NMAs) has rapidly increased, and there have been continued advancements to further advance this analysis approach. Due to the fast moving and changing landscape in the infancy of NMA methodology, there is a lack of consistency and standardization for this approach. This article aims to summarize the crucial components of an NMA for both future readers, and for potential NMA authors.

Recent findings

Key components of NMAs include, but are not limited to, reporting the proposed analysis methods, assessment of risk of bias within the included studies, reporting the overall quality of the available evidence, and defining the parameters in which the results will be presented. Although NMA allows for a comprehensive evaluation of all available treatment options for a given condition, we believe that there is importance in ensuring clear understanding and appropriate interpretation of results to inform clinical practice.

While many components of NMA mirror those of traditional pairwise meta-analysis, there are many novel methodologies that are specific to this approach. It is imperative that future NMAs follow guidance from key methodology groups, as these provide valuable tools for conducting and reporting NMAs.
‘Dumpling suture method’ versus traditional suture method of protective loop ileostomy in laparoscopic anterior rectal resection with specimen extraction through stoma incision: a retrospective comparative cohort study
Authors: Gu Jiani , Wang Jin , Hu Xingwang , Ding Wenjun , Cui Long , Du Peng , Liang Zhonglin , Wu Tingyu
Published: March 2024

Background:

A diverting loop ileostomy (DLI) is performed in laparoscopic anterior rectal resection (LAR) surgery at high risk of anastomotic fistula. Minimally invasive surgery promotes postoperative recovery and cosmetics. To reduce abdominal trauma, specimen extraction through stoma incision (EXSI) is usually performed to avoid auxiliary abdominal incision with enlarged stomal incision. The traditional suture method (TSM) reduces the incision size by suturing the ends of the enlarged incision, leading to peristomal incisions and a higher risk of stomal complications. The study aimed to introduce the dumpling suture method (DSM) of PLI and compare this new method with TSM.

Materials and Methods:

The authors propose a novel stoma suture technique, which utilized a method of skin folding suture to reduce the enlarged incision size. A retrospective analysis was conducted on 71 consecutive patients with rectal cancer who underwent LAR-DLI with EXSI, and the intraoperative details and postoperative outcomes of the two groups were measured.

Results:

The DSM group showed a lower stomal complication rate (10.3 vs. 35.7%, P=0.016) than that of the TSM group. The scores of DET (Discoloration, Erosion, Tissue overgrowth), stomal pain, quality of life were all significantly lower in DSM group than in TSM group. In multivariate analysis, DSM was an independent protective factor for stoma-related complications. Operative time, time to first flatus, defecation and eat, nonstomal related postoperative complications were similar in both groups.

Conclusion:

DSM utilizes a method of skin folding suture to reduce the enlarged incision size, which is safe and effective in reducing the incidence of peristomal skin infections and stomal complications. This procedure offers a novel suturing approach for loop ileostomy with enlarged incision, effectively reducing the postoperative trauma and incidence of stomal complications.
Comparative long-term outcomes of natural orifice specimen extraction surgery and conventional laparoscopic colectomy for left-sided colorectal cancer: a propensity score-matched analysis
Authors: Xu Shu-Zhen , Wang Zhen-Fa , Ding Zhi-Jie , Zhang Shi-Feng , Yuan Si-Bo , Yan Feng , Liu Guo-Yan , Cai Jian-Chun
Published: March 2024

Background:

Natural orifice specimen extraction surgery (NOSES) is currently widely used in left-sided colorectal cancer. Some clinical comparative studies have been conducted, providing evidence of its safety and oncological benefits. However, these studies are typically characterized by small sample sizes and short postoperative follow-up periods. Consequently, in this research, the authors adopt the propensity score matching method to undertake a large-scale retrospective comparative study on NOSES colectomy for left-sided colorectal cancer, with the goal of further augmenting the body of evidence-based medical support for NOSES.

Methods:

This retrospective study involved patients who underwent NOSES colectomy and conventional laparoscopic (CL) colectomy for left-sided colorectal cancer between January 2014 and April 2021. In the NOSES group, specimens were extracted through the anus with the help of a Cai tube (homemade invention: ZL201410168748.2). The patients were matched at a ratio of 1:1 according to age, sex, BMI, tumor diameter, tumor location (descending and splenic flexure colon/ sigmoid colon/ middle and upper rectum), tumor height from anal verge, ASA grade, previous abdominal surgery, clinical pathologic stage, preoperative CEA. After matching, 132 patients in the NOSES group and 132 patients in the CL group were eligible for analysis.

Results:

Compared with CL group, NOSES group was associated with decreased postoperative maximum pain score (2.6±0.7 vs. 4.7±1.7, P=0.000), less additional analgesia required (6.8 vs. 34.8%, P=0.000), faster time to passage of flatus (2.3±0.6 days vs. 3.3±0.7 days, P=0.000), less wound infection (0.0 vs. 6.1%, P=0.007), and longer operative time (212.5±45.8 min vs. 178.0±43.4 min, P=0.000). No significant differences were observed in estimated blood loss, time to resume regular diet, postoperative hospital stay, conversion to open surgery or conventional minilaparotomy, total morbidity, readmission, mortality, pathologic outcomes, and Wexner incontinence score between groups. After a median follow-up of 63.0 months, the 5-year overall survival rates were 88.3 versus 85.0% (P=0.487), disease-free survival rates were 82.9 versus 83.6% (P=0.824), and the local recurrence rates were 4.4 versus 4.0% (P=0.667) in the NOSES and CL groups, respectively.

Conclusions:

This study suggests that NOSES colectomy using a Cai tube for left-sided colorectal cancer is a safe and feasible option with better cosmetic results, less pain, faster recovery of gastrointestinal function, and comparable long-term clinical and oncologic outcomes to CL colectomy.
Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury
Authors: Gerber Kathryn S. , Alvarez Gemayaret , Alamian Arsham , Behar-Zusman Victoria , Downs Charles A.
Published: March 2024

BACKGROUND:

Patients with traumatic brain injury (TBI) experience a variety of physical, cognitive, and affective symptoms. However, the evolution of symptoms, especially during the 3- to 12-month convalescence period (when recovery of function is still possible), is understudied.

OBJECTIVE:

This study aims to identify symptoms and the relationships with functional outcomes that occur during the 3- to 12-month period after a TBI.

METHODS:

Participants who were 3 to 12 months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. Clinical data were obtained from the electronic health record. Participants completed the Brain Injury Association of Virginia Symptom Checklist, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep Disturbance assessments to report symptoms, and the Disability Rating Scale and Satisfaction with Life Scale. Descriptive statistics were used to characterize demographics and symptoms. Linear regression was performed to analyze the relationships between symptoms and outcomes.

RESULTS:

A total of N = 39 patients participated in the study. Memory problems and difficulty concentrating were the most common symptoms. Hospital length of stay, intensive care unit length of stay, cognitive, and physical symptoms were significantly associated with the Disability Rating Scale score. Physical, cognitive, depressive, and anxiety symptoms had significant associations with the Satisfaction with Life Scale.

CONCLUSION:

Cognitive symptoms should be integrated into the clinical care of rehabilitating TBI patients. Nurses should monitor for physical, affective, and cognitive symptoms during the recovery phase of TBI.
Evaluation of a Novel Mechanical Venous Thromboembolism Compression Device in Trauma Patients: A Pilot Study
Authors: Girardot Kellie , Powers Jan , Morgan Lisa , Hollister Lisa
Published: March 2024

BACKGROUND:

Venous thromboembolism (VTE) is the fourth most common preventable hospital-acquired complication for hospitalized trauma patients. Mechanical prophylaxis, using sequential compression or intermittent pneumatic compression (IPC) devices, is recommended alongside pharmacologic prophylaxis for VTE prevention. However, compliance with device use is a barrier that reduces the effectiveness of mechanical prophylaxis.

OBJECTIVE:

This study aimed to determine whether using the Movement and Compressions (MAC) system compared with an IPC device impacts compliance with mechanical VTE prophylaxis in trauma patients.

METHODS:

This study used a before-and-after design with historical control at a Level II trauma center with a convenience sample of adult trauma patients admitted to the intensive care unit or acute care floor for at least 24 h. We trialed the MAC device for 2 weeks in November and December 2022 with prospective data collection. Data collection for the historical control group occurred retrospectively using patients from a point-in-time audit of IPC device compliance from August and September of 2022.

RESULTS:

A total of 51 patients met inclusion criteria, with 34 patients in the IPC group and 17 patients in the MAC group. The mean (SD) prophylaxis time was 17.2 h per day (4.0) in the MAC group and 7.5 h per day (8.8) in the IPC group, which was statistically significant (p < .001).

CONCLUSION:

Our findings suggest that the MAC device can improve compliance with mechanical prophylaxis.
Renal dysfunction in adults following cardiopulmonary bypass is linked to declines in S-nitrosohemoglobin: a case series
Authors: Moyal Andrew , Nazemian Ryan , Colon Edwin Pacheco , Zhu Lin , Benzar Ruth , Palmer Nicole R. , Craycroft Martha , Hausladen Alfred , Premont Richard T. , Stamler Jonathan S. , Klick John , Reynolds James D.
Published: March 2024

Background:

Impaired kidney function is frequently observed in patients following cardiopulmonary bypass (CPB). Our group has previously linked blood transfusion to acute declines in S-nitrosohemoglobin (SNO-Hb; the main regulator of tissue oxygen delivery), reductions in intraoperative renal blood flow, and postoperative kidney dysfunction. While not all CPB patients receive blood, kidney injury is still common. We hypothesized that the CPB procedure itself may negatively impact SNO-Hb levels leading to renal dysfunction.

Materials and methods:

After obtaining written informed consent, blood samples were procured immediately before and after CPB, and on postoperative day (POD) 1. SNO-Hb levels, renal function (estimated glomerular filtration rate; eGFR), and plasma erythropoietin (EPO) concentrations were quantified. Additional outcome data were extracted from the patients’ medical records.

Results:

Twenty-seven patients were enroled, three withdrew consent, and one was excluded after developing bacteremia. SNO-Hb levels declined after surgery and were directly correlated with declines in eGFR (R=0.48). Conversely, plasma EPO concentrations were elevated and inversely correlated with SNO-Hb (R=−0.53) and eGFR (R=−0.55). Finally, ICU stay negatively correlated with SNO-Hb concentration (R=−0.32).

Conclusion:

SNO-Hb levels are reduced following CPB in the absence of allogenic blood transfusion and are predictive of decreased renal function and prolonged ICU stay. Thus, therapies directed at maintaining or increasing SNO-Hb levels may improve outcomes in adult patients undergoing cardiac surgery.
Efficacy and outcomes of antiplatelet therapy versus oral anticoagulants in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis
Authors: Goyal Aman , Abbasi Fatima Qayyum , Tariq Muhammad Daoud , Kanagala Sai Gautham , Changez Mah I. Kan , Safi Darsh , Basit Jawad , Sulaiman Samia Aziz , Marsool Mohammed Dheyaa Marsool , Daoud Mohamed , Sohail Amir H.
Published: March 2024

Background:

Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in the absence of long-term oral anticoagulation (OAC) indications in patients post-transcatheter aortic valve replacement (TAVR). The superiority of one method over the other remains controversial.

Materials and methods:

Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity.

Results:

Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45–1.01; P=0.05], cardiovascular death [RR:0.91; 95% CI:0.73–1.14; P=0.42], MI [RR:1.69; 95% CI:0.43–6.72; P=0.46], Stroke/TIA [RR:0.79; 95% CI:0.58–1.06; P=0.12], ischaemic stroke [RR:0.83; 95% CI:0.50–1.37; P=0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23–5.15; P=0.92], major bleeding [RR:0.79; 95% CI:0.51–1.21; P=0.28], minor bleeding [RR:1.09; 95% CI: 0.80–1.47; P=0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55–1.30; P=0.45], any bleeding [RR:0.98; 95% CI:0.83–1.15; P=0.78], and systemic embolism [RR:0.87; 95% CI:0.44–1.70; P=0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56–4.36; P =0.0002].

Conclusions:

Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.
Moyamoya disease in a 2-year-old patient from the middle east: a case report and literature review
Authors: Habes Haneen Mahmoud Nimer , Alshareef Raneen B. , Amleh Areen , Doudin Ali A.A. , Habes Yousef Mahmoud Nimer , Abdulrazzak Mohammed , Basal Sharif Issa
Published: March 2024

Introduction and importance:

Moyamoya disease (MMD) is a condition characterized by progressive narrowing of arteries in the brain and abnormal development of small collateral vessels. It is commonly found in East Asia but has never been reported in Palestine.

Case presentation:

A 2-year-old female, part of a twin born to non-consanguineous parents, presented with recurring seizures and developmental regression. The physical examination revealed signs of hypotonia, reflex abnormalities, and bilateral Babinski signs. Comprehensive laboratory tests and imaging investigations confirmed the diagnosis of MMD, marking this patient as the reported case in Palestine.

Clinical discussion:

The diagnostic criteria for this condition were revised in 2021 to focus on findings seen in angiography and magnetic resonance angiography (MRA) scans. MMD has not been curative so far, and the management is focused on preventing complications, sometimes with surgical revascularization, including its different approaches: direct, indirect, and a combination of both.

Conclusion:

This case highlights the importance of identifying MMD in regions where it is uncommon to be diagnosed. It emphasizes the need for diagnosis and appropriate intervention to reduce complications.
Cardiac Surgery-Associated Acute Kidney Injury in Neonates Undergoing the Norwood Operation: Retrospective Analysis of the Multicenter Neonatal and Pediatric Heart and Renal Outcomes Network Dataset, 2015–2018
Authors: Bertrandt Rebecca A. , Gist Katja , Hasson Denise , Zang Huaiyu , Reichle Garrett , Krawczeski Catherine , Winlaw David , Bailly David , Goldstein Stuart , Selewski David , Alten Jeffrey ,   on behalf of the Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) Investigators
Published: March 2024

OBJECTIVES:

Cardiac surgery-associated acute kidney injury (CS-AKI) is associated with adverse outcomes. Single-center studies suggest that the prevalence of CS-AKI is high after the Norwood procedure, or stage 1 palliation (S1P), but multicenter data are lacking.

DESIGN:

A secondary analysis of the Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) multicenter cohort who underwent S1P. Using neonatal modification of Kidney Disease Improving Global Outcomes (KDIGO) criteria, perioperative associations between CS-AKI with morbidity and mortality were examined. Sensitivity analysis, with the exclusion of prophylactic peritoneal dialysis (PD) patients, was performed.

SETTING:

Twenty-two hospitals participating in the Pediatric Cardiac Critical Care Consortium (PC4) and contributing to NEPHRON.

PATIENTS:

Three hundred forty-seven neonates (< 30 d old) with S1P managed between September 2015 and January 2018.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 347 patients, CS-AKI occurred in 231 (67%). The maximum stages were as follows: stage 1, in 141 of 347 (41%); stage 2, in 51 of 347 (15%); and stage 3, in 39 of 347 (11%). Severe CS-AKI (stages 2 and 3) peaked on the first postoperative day. In multivariable analysis, preoperative feeding was associated with lower odds of CS-AKI (odds ratio [OR] 0.48; 95% CI, 0.27–0.86), whereas prophylactic PD was associated with greater odds of severe CS-AKI (OR 3.67 [95% CI, 1.88–7.19]). We failed to identify an association between prophylactic PD and increased creatinine (OR 1.85 [95% CI, 0.82–4.14]) but cannot exclude the possibility of a four-fold increase in odds. Hospital mortality was 5.5% (n = 19). After adjusting for risk covariates and center effect, severe CS-AKI was associated with greater odds of hospital mortality (OR 3.67 [95% CI, 1.11–12.16]). We failed to find associations between severe CS-AKI and respiratory support or length of stay. The sensitivity analysis using PD failed to show associations between severe CS-AKI and outcome.

CONCLUSIONS:

KDIGO-defined CS-AKI occurred frequently and early postoperatively in this 2015–2018 multicenter PC4/NEPHRON cohort of neonates after S1P. We failed to identify associations between resource utilization and CS-AKI, but there was an association between severe CS-AKI and greater odds of mortality in this high-risk cohort. Improving the precision for defining clinically relevant neonatal CS-AKI remains a priority.
Adverse drug reaction profile of third-generation smallpox vaccines used in France during the 2022 monkeypox epidemic
Authors: Fresse Audrey , Massy Nathalie , Fournier Dorine , Pinel Sylvine , Beurrier Mathilde , Antoine Marie-Lauren , Petitpain Nadine , Gillet Pierre
Published: March 2024

Due to the start of the monkeypox epidemic in 2022, we retrospectively analyzed the adverse drug reactions (ADRs) reported in France after monkeypox vaccinations with the third-generation smallpox vaccine. Ninety-eight cases, representing 172 ADRs, were reported. ADRs were mostly expected reactogenicity reactions occurring within days after the first dose of vaccine and having a quick favorable outcome. Unexpected facial palsy and vaccination failure are discussed.
A Pilot Study Using Machine-learning Algorithms and Wearable Technology for the Early Detection of Postoperative Complications After Cardiothoracic Surgery
Authors: Beqari Jorind , Powell Joseph R. , Hurd Jacob , Potter Alexandra L. , McCarthy Meghan L. , Srinivasan Deepti , Wang Danny , Cranor James , Zhang Lizi , Webster Kyle , Kim Joshua , Rosenstein Allison , Zheng Zeyuan , Lin Tung Ho , Fang Zhengyu , Zhang Yuhang , Anderson Alex , Madsen James , Anderson Jacob , Clark Anne , Yang Margaret E. , Nurko Andrea , Li Jing , El-Jawahri Areej R. , Sundt Thoralf M. , Melnitchouk Serguei , Jassar Arminder S. , D’Alessandro David , Panda Nikhil , Schumacher Lana Y. , Wright Cameron D. , Auchincloss Hugh G. , Sachdeva Uma M. , Lanuti Michael , Colson Yolonda L. , Langer Nathaniel B. , Osho Asishana , Yang Chi-Fu Jeffrey , Li Xiao
Published: March 2024

Objective:

To evaluate whether a machine-learning algorithm (ie, the “NightSignal” algorithm) can be used for the detection of postoperative complications before symptom onset after cardiothoracic surgery.

Background:

Methods that enable the early detection of postoperative complications after cardiothoracic surgery are needed.

Methods:

This was a prospective observational cohort study conducted from July 2021 to February 2023 at a single academic tertiary care hospital. Patients aged 18 years or older scheduled to undergo cardiothoracic surgery were recruited. Study participants wore a Fitbit watch continuously for at least 1 week preoperatively and up to 90 days postoperatively. The ability of the NightSignal algorithm—which was previously developed for the early detection of Covid-19—to detect postoperative complications was evaluated. The primary outcomes were algorithm sensitivity and specificity for postoperative event detection.

Results:

A total of 56 patients undergoing cardiothoracic surgery met the inclusion criteria, of which 24 (42.9%) underwent thoracic operations and 32 (57.1%) underwent cardiac operations. The median age was 62 (Interquartile range: 51–68) years and 30 (53.6%) patients were female. The NightSignal algorithm detected 17 of the 21 postoperative events at a median of 2 (Interquartile range: 1–3) days before symptom onset, representing a sensitivity of 81%. The specificity, negative predictive value, and positive predictive value of the algorithm for the detection of postoperative events were 75%, 97%, and 28%, respectively.

Conclusions:

Machine-learning analysis of biometric data collected from wearable devices has the potential to detect postoperative complications—before symptom onset—after cardiothoracic surgery.
A Randomized Clinical Trial: Patient Satisfaction of Paper Versus Electronic Provider Feedback
Authors: Margulies Samantha Lee , Bernard Adele , Leone Anna M. , Geller Elizabeth J.
Published: March 2024

Importance

Minimal data compare patient satisfaction with completing paper versus electronic evaluations.

Objectives

This study aimed to compare patient satisfaction with completing paper versus electronic evaluations. Secondary objectives were assessing age, education, and socioeconomic status with comfort with technology; preference for evaluation type; and timeliness of completing evaluations.

Study Design

This was a single-center randomized trial comparing paper versus electronic patient evaluations of health care providers. Study participation occurred at the end of clinic visits.

Results

Among 145 participants, 73 (50.3%) were analyzed as paper versus 72 (49.7%) as electronic. Groups were similar in age, race, education level, income, insurance type, technology comfort, and technology use. Groups were similar in finding ease (P = 0.99) and satisfaction (P = 0.76) with their randomized method. For participants randomized to paper, 34% preferred paper, 25% preferred electronic, and 41% had no preference. Electronic feedback took longer to complete (4.5 minutes vs 3.4 minutes, P < 0.001). Older participants took longer to complete the evaluation (4.5 minutes vs 3.2 minutes, P < 0.001), had less internet use (P = 0.01), and were less likely to own a computer (P = 0.03) than younger participants. There were differences by education level for comfort with technology (P = 0.007) and internet use (P = 0.016). There were no differences in ease of feedback completion or satisfaction when comparing age, education status, or income status.

Conclusions

Patients were satisfied with paper and electronic health care provider evaluations, regardless of age or other demographics. Evaluations were completed quickly during visits. Requesting feedback from patients via multiple modalities is feasible in a varied patient population.