bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolutionarily conserved protein motifs drive interactions between the plant nucleoskeleton and nuclear pores
Authors: Mermet Sarah , Voisin Maxime , Mordier Joris , Dubos Tristan , Tutois Sylvie , Tuffery Pierre , Baroux Célia , Tamura Kentaro , Probst Aline V , Vanrobays Emmanuel , Tatout Christophe
Published: September 2023

The nucleoskeleton forms a filamentous meshwork under the nuclear envelope and contributes to the regulation of nuclear shape and gene expression. To understand how the Arabidopsis (Arabidopsis thaliana) nucleoskeleton physically connects to the nuclear periphery in plants, we investigated the Arabidopsis nucleoskeleton protein KAKU4 and sought for functional regions responsible for its localization at the nuclear periphery. We identified 3 conserved peptide motifs within the N-terminal region of KAKU4, which are required for intermolecular interactions of KAKU4 with itself, interaction with the nucleoskeleton protein CROWDED NUCLEI (CRWN), localization at the nuclear periphery, and nuclear elongation in differentiated tissues. Unexpectedly, we find these motifs to be present also in NUP82 and NUP136, 2 plant-specific nucleoporins from the nuclear pore basket. We further show that NUP82, NUP136, and KAKU4 have a common evolutionary history predating nonvascular land plants with KAKU4 mainly localizing outside the nuclear pore suggesting its divergence from an ancient nucleoporin into a new nucleoskeleton component. Finally, we demonstrate that both NUP82 and NUP136, through their shared N-terminal motifs, interact with CRWN and KAKU4 proteins revealing the existence of a physical continuum between the nuclear pore and the nucleoskeleton in plants.
MADS8 is indispensable for female reproductive development at high ambient temperatures in cereal crops
Authors: Shen Chaoqun , Zhang Yueya , Li Gang , Shi Jin , Wang Duoxiang , Zhu Wanwan , Yang Xiujuan , Dreni Ludovico , Tucker Matthew R , Zhang Dabing
Published: September 2023

Temperature is a major factor that regulates plant growth and phenotypic diversity. To ensure reproductive success at a range of temperatures, plants must maintain developmental stability of their sexual organs when exposed to temperature fluctuations. However, the mechanisms integrating plant floral organ development and temperature responses are largely unknown. Here, we generated barley and rice loss-of-function mutants in the SEPALLATA-like MADS-box gene MADS8. The mutants in both species form multiple carpels that lack ovules at high ambient temperatures. Tissue-specific markers revealed that HvMADS8 is required to maintain floral meristem determinacy and ovule initiation at high temperatures, and transcriptome analyses confirmed that temperature-dependent differentially expressed genes in Hvmads8 mutants predominantly associate with floral organ and meristem regulation. HvMADS8 temperature-responsive activity relies on increased binding to promoters of downstream targets, as revealed by a cleavage under targets and tagmentation (CUT&Tag) analysis. We also demonstrate that HvMADS8 directly binds to 2 orthologs of D-class floral homeotic genes to activate their expression. Overall, our findings revealed a new, conserved role for MADS8 in maintaining pistil number and ovule initiation in cereal crops, extending the known function of plant MADS-box proteins in floral organ regulation.
Differences in adverse outcomes across race and ethnicity among Veterans with similar predicted risks of an overdose or suicide-related event
Authors: Garrido Melissa M , Legler Aaron , Strombotne Kiersten L , Frakt Austin B
Published: September 2023

Objective

To evaluate the degree to which differences in incidence of mortality and serious adverse events exist across patient race and ethnicity among Veterans Health Administration (VHA) patients receiving outpatient opioid prescriptions and who have similar predicted risks of adverse outcomes. Patients were assigned scores via the VHA Stratification Tool for Opioid Risk Mitigation (STORM), a model used to predict the risk of experiencing overdose- or suicide-related health care events or death. Individuals with the highest STORM risk scores are targeted for case review.

Design

Retrospective cohort study of high-risk veterans who received an outpatient prescription opioid between 4/2018–3/2019.

Setting

All VHA medical centers.

Participants

In total, 84 473 patients whose estimated risk scores were between 0.0420 and 0.0609, the risk scores associated with the top 5%–10% of risk in the STORM development sample.

Methods

We examined the expected probability of mortality and serious adverse events (SAEs; overdose or suicide-related events) given a patient’s risk score and race.

Results

Given a similar risk score, Black patients were less likely than White patients to have a recorded SAE within 6 months of risk score calculation. Black, Hispanic, and Asian patients were less likely than White patients with similar risk scores to die within 6 months of risk score calculation. Some of the mortality differences were driven by age differences in the composition of racial and ethnic groups in our sample.

Conclusions

Our results suggest that relying on the STORM model to identify patients who may benefit from an interdisciplinary case review may identify patients with clinically meaningful differences in outcome risk across race and ethnicity.
Are Humans the Only Rational Animals?
Authors: Melis Giacomo , Monsó Susana
Published: September 2023

While growing empirical evidence suggests a continuity between human and non-human psychology, many philosophers still think that only humans can act and form beliefs rationally. In this paper, we challenge this claim. We first clarify the notion of rationality. We then focus on the rationality of beliefs and argue that, in the relevant sense, humans are not the only rational animals. We do so by first distinguishing between unreflective and reflective responsiveness to epistemic reasons in belief formation and revision. We argue that unreflective responsiveness is clearly within the reach of many animals. We then defend that a key demonstration of reflective responsiveness would be the ability to respond to undermining defeaters. We end by presenting some empirical evidence that suggests that some animal species are capable of processing these defeaters, which would entail that even by the strictest standards, humans are not the only rational animals.
Flight to Safety: How Economic Downturns Affect Talent Flows to Startups
Authors: Bernstein Shai , Townsend Richard R , Xu Ting
Published: September 2023

Using proprietary data from AngelList Talent, we study how startup job seekers’ search and application behavior changed during the COVID-19 downturn. We find that workers shifted their searches and applications away from less-established startups and toward more-established ones, even within the same individual over time. At the firm level, this shift was not offset by an influx of new job seekers. Less-established startups experienced a relative decline in the quantity and quality of applications, ultimately affecting their hiring. Our findings uncover a flight-to-safety channel in the labor market that may amplify the procyclical nature of entrepreneurial activities.
Effect of smoking on thrombotic antiphospholipid syndrome: a 10-year prospective cohort study
Authors: Jiang Hui , Huang Can , Shi Yu , Wang Chu-Han , Chen Si-Yun , Li Jun , Wang Qian , Li Meng-Tao , Tian Xin-Ping , Zeng Xiao-Feng , Zhao Yan , Zhao Jiu-Liang
Published: September 2023

Objectives

Cigarette smoking is an established risk factor for autoimmune diseases. However, whether smoking plays a clear role in thrombotic APS (TAPS) has not been determined. We aimed to investigate the effects of smoking on the clinical characteristics and prognosis of TAPS.

Methods

This was a prospective cohort study from 2013 to 2022. During the study period, 297 patients were diagnosed with TAPS, including 82 smokers and 215 non-smokers. After propensity score matching, 57 smokers and 57 non-smokers matched by age and sex were analysed.

Results

Overall, smokers with TAPS had more cardiovascular risk factors than non-smokers, including hypertension (36.59% vs 14.42%, P < 0.001), obesity (15.85% vs 7.44%, P = 0.029), dyslipidaemia (64.63% vs 48.37%, P = 0.012) and hyperhomocysteinaemia (62.20% vs 36.28%, P < 0.001). Arterial thrombotic events were more common in smokers at diagnosis (62.20% vs 46.05%, P = 0.013), especially myocardial infarction, visceral thrombosis and peripheral vascular thrombosis. After matching, smokers showed balanced cardiovascular risk factors with non-smokers at baseline, but retained a higher prevalence of arterial thrombosis (59.65% vs 33.33%, P = 0.005), mainly distributed in cerebral vascular, cardiovascula and retinal vascular territories. During follow-up, smokers presented a tendency for more recurrent arterial thrombosis and less recurrent venous thrombosis. Smokers had significantly poorer outcomes for organ damage with higher Damage Index for APS score (median 2.00 vs 1.00, P = 0.008), especially in the cardiovascular (26.32% vs 3.51%, P = 0.001), gastrointestinal (15.79% vs 1.75%, P = 0.016) and ophthalmologic (10.53% vs 00.00%, P = 0.027) systems.

Conclusion

Smoking is related to increased arterial events and poor prognosis in TAPS patients. Patients with TAPS should be fully encouraged to avoid smoking.
Comparison of the conversion method with gravel unfolding to obtain dose values from photon spectra
Authors: Dombrowski Harald
Published: September 2023

Modern gamma-ray spectrometers based on solid-state scintillators are increasingly being used in fields where previously dosemeters were applied. From the spectra, precise fluence and dose information can be derived. The most important methods of doing this are investigated in detail; the conversion method, which is based on weighing functions; and unfolding, here using the GRAVEL algorithm. Both methods can be used to process any kind of spectra, regardless of the type of spectrometer employed. The GRAVEL algorithm is described in detail. The implementation of both methods is shown and results of examples are compared. Advantages and disadvantages of both techniques are discussed. For the first time, most precise conversion data up to 20 MeV are published, even extending the quantity H*(10) to this energy. They may serve for the improvement and harmonisation of dose rate measurements using scintillation spectrometers, e.g. those used in early warning systems.
Young Black Women’s Perceptions of Otherfather Involvement
Authors: Johnson Maria S
Published: September 2023

A limited number of studies have examined how Black children, particularly daughters, perceive Black men who provide care—financial, material, or emotional support—to children who are not their biological or legal children (these men are here conceptualized as “otherfathers”). Using accounts from in-depth interviews with twenty-six young Black women from two-parent and single-mother households, this study explores how daughters identify and assign meaning to otherfathers. Findings reveal a heterogeneous category with no single definition or set of criteria; rather, the young women enact a process of parental ascription to determine who “counts” as an otherfather. Otherfathers’ contributions are understood in relation to biological fathers’ involvement but not always in expected ways. The study challenges assumptions about how daughters think about otherfathers and reveals the importance of examining the perspectives of Black girl youth and young women.
Radiographic and Patient-Reported Outcomes in Anteriorly Placed Transforaminal Lumbar Interbody Fusion Cage Versus Anterior Lumbar Interbody Fusion With Posterior Instrumentation
Authors: Lee Yunsoo , Heard Jeremy C. , McCurdy Michael A. , Lambrechts Mark J. , Fras Sebastian I. , Purtill William , Millar Ben , Kolowrat Samantha , Issa Tariq Z. , D’Antonio Nicholas D. , Rihn Jeffrey A. , Kurd Mark F. , Kaye Ian David , Canseco Jose A. , Vaccaro Alexander R. , Hilibrand Alan S. , Kepler Christopher K. , Schroeder Gregory D.
Published: September 2023

Study Design.

Retrospective cohort study.

Objective.

To compare outcomes in anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs).

Summary of Background Data.

TLIF and ALIF are surgical techniques that have become more prevalent in recent years. Although studies have compared the two, none have considered TLIFs with anteriorly placed cages, which may serve as a better comparison to ALIFs.

Patients and Methods.

Patients undergoing TLIF or ALIF with posterior instrumentation from 2010 to 2020 at a tertiary care institution were retrospectively identified. TLIF cage position was assessed and those with anterior placement were included. Electronic medical records were reviewed to identify patient characteristics and patient-reported outcomes. Radiographic outcomes included posterior disc height (DH), lumbar lordosis (LL), sacral slope, pelvic incidence, and pelvic tilt. Statistical analysis was performed to compare the two groups.

Results.

Of the 351 patients, 108 had ALIF with posterior instrumentation and 207 had a TLIF. Preoperatively, patients undergoing TLIF had less LL (53.7° vs. 60.6°, P < 0.001), sacral slope (38.3° vs. 43.7°, P < 0.001), and pelvic incidence (60.1° vs. 66.1°, P < 0.001), all of which remained significant at 1-year and long-term follow-up (P < 0.001). The TLIF group had less ∆DH (1.51° vs. 5.43°, P < 0.001), ∆LL (1.8° vs. 2.97°, P = 0.038), and ∆segmental lordosis (0.18° vs. 4.40°, P < 0.001) at 1 year postoperatively. At 2 to 3 years, ∆DH (P < 0.001) and ∆segmental lordosis (P = 0.001) remained significant, but ∆LL (P = 0.695) did not. Patients in the TLIF group had higher Visual Analog Scale-Back scores 1 year postoperatively (3.68 vs. 2.16, P = 0.008) and experienced less improvement in Oswestry Disability Index (−17.1 vs. −28.6, P = 0.012) and Visual Analog Scale-Back (−2.67 vs. −4.50, P = 0.008) compared with patients undergoing ALIF.

Conclusions.

Our findings suggest that ALIF with posterior instrumentation performed superiorly in radiographic outcomes and patient-reported outcomes compared with anteriorly placed TLIFs. Anteriorly placed TLIF cages may not achieve the same results as those of ALIF cages.
Biomechanics of Cervical Disk Replacement
Authors: Yee Timothy J. , Mummaneni Praveen V.
Published: September 2023

Cervical disk arthroplasty has been employed with increased frequency over the past 2 decades as a motion-preserving alternative to anterior cervical discectomy and fusion in select patients with myelopathy or radiculopathy secondary to degenerative disk disease. As indications continue to expand, an understanding of cervical kinematics and materials science is helpful for optimal implant selection. Cervical disk arthroplasty implants can be classified according to the mode of articulation and df, articulation material, and endplate construction. The incorporation of translational and rotational df allows the implant to emulate the dynamic and coupled centers of movement in the cervical spine. Durable and low-friction interfaces at the articulation sustain optimal performance and minimize particulate-induced tissue reactions. Endplate materials must facilitate osseous integration to ensure implant stability after primary fixation. These cardinal considerations underlie the design of the 9 implants currently approved by the FDA and serve as the foundation for further biomimetic research and development.
Cervical Total Disc Replacement in Athletes
Authors: Clohisy John C.F. , Maayan Omri , Asada Tomoyuki , Qureshi Sheeraz A.
Published: September 2023

Study Design:

Systematic review.

Objective:

To perform a systematic review to describe clinical characteristics, outcomes, and return to play after cervical total disc replacement (cTDR) in athletes.

Summary of Background Data:

The role of cTDR in treating athletes with symptomatic cervical degenerative disc disease is undefined.

Methods:

A systematic search using MEDLINE through PubMed, EMBASE, and the Cochrane Library was conducted to identify all relevant literature. Data regarding study type, country in which the study was conducted, sample size, mean age, sex, type of sport, level of patient participation in sports, surgical indication, levels operated, type of implant, duration of follow-up, reoperations, surgical complications, extent of postoperative return to sports (RTSs), time to RTSs, and outcome notes were extracted from the included studies and analyzed.

Results:

Seven studies, including 4 case series and 3 case reports, and a total of 57 cTDR cases, were included. There was significant heterogeneity among the cTDR cases in terms of chosen sport and level of participation. Prestige LP was utilized in 51 out of 57 (89.5%) cases and 53 out of 57 (93%) cases were single-level. No reoperations were noted at a mean follow-up of 51.6 months. All patients returned to sports postoperatively. Return to training and competition occurred at a mean of 10.1 weeks and 30.7 weeks postoperatively, respectively.

Conclusions:

The available evidence regarding cTDR in athletes indicates that these patients RTSs at high rates, with return to training occurring around 10 weeks and return to competition occurring around 30 weeks. Clinical outcomes in these patients are like those reported for the general population. Low-level evidence, small numbers of cases, heterogeneity in chosen sport and participation level, and predominance of a single implant type limit the conclusions that can be drawn from the current literature on this patient population.
Technique Pearls for Successful Cervical Disc Arthroplasty From More Than 20 Years of Surgical Experience
Authors: Ye Jason , Sasso Willa , Boody Barrett , Sasso Rick
Published: September 2023

Study Design:

Surgical technique paper.

Objective:

To describe tips and pearls for cervical disc arthroplasty (CDA).

Background:

CDA has proven to be an effective means of treatment for degenerative cervical disc disease and cervical radiculopathy in properly selected patients who have previously failed non-operative treatment.

Methods:

Surgical tips and pearls garnered from more than 20 years of experience with CDA surgery are described.

Results:

This discussion focuses on pearls for successful procedures, including patient selection, patient positioning, surgical technique, and postoperative protocols.

Conclusions:

In correctly selected patients, CDA can be effective in treating cervical degenerative disc disease and radiculopathy. The techniques described here can increase the chance of success and decrease complications.
Distinctive Characteristics of Thoracolumbar Junction Region Stenosis
Authors: Houten John K. , Spirollari Eris , Ng Christina , Greisman Jacob , Vaserman Grigori , Dominguez Jose F. , Kinon Merritt D. , Betchen Simone A. , Schwartz Amit Y.
Published: September 2023

Study Design:

Retrospective case series and systemic literature meta-analysis.

Background:

Thoracolumbar junction region stenosis produces spinal cord compression just above the conus and may manifest with symptoms that are not typical of either thoracic myelopathy or neurogenic claudication from lumbar stenosis.

Objective:

As few studies describe its specific pattern of presenting symptoms and neurological deficits, this investigation was designed to improve understanding of this pathology.

Methods:

A retrospective review assessed surgically treated cases of T10–L1 degenerative stenosis. Clinical outcomes were evaluated with the thoracic Japanese Orthopedic Association score. In addition, a systematic review and meta-analysis was performed in accordance with guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results:

Of 1069 patients undergoing laminectomy at 1477 levels, 31 patients (16M/15F) were treated at T10–L1 a mean age 64.4 (SD=11.8). Patients complained of lower extremity numbness in 29/31 (94%), urinary dysfunction 11/31 (35%), and back pain 11/31 (35%). All complained about gait difficulty and objective motor deficits were detected in 24 of 31 (77%). Weakness was most often seen in foot dorsiflexion 22/31 (71%). Deep tendon reflexes were increased in 10 (32%), decreased in 11 (35%), and normal 10 (32%); the Babinski sign was present 8/31 (26%). Mean thoracic Japanese Orthopedic Association scores improved from 6.4 (SD=1.8) to 8.4 (SD=1.8) (P<0.00001). Gait subjectively improved in 27/31 (87%) numbness improved in 26/30 (87%); but urinary function improved in only 4/11 (45%).

Conclusions:

Thoracolumbar junction stenosis produces distinctive neurological findings characterized by lower extremity numbness, weakness particularly in foot dorsiflexion, urinary dysfunction, and inconsistent reflex changes, a neurological pattern stemming from epiconus level compression and the myelomeres for the L5 roots. Surgery results in significant clinical improvement, with numbness and gait improving more than urinary dysfunction. Many patients with thoracolumbar junction stenosis are initially misdiagnosed as being symptomatic from lumbar stenosis, thus delaying definitive surgery.
Antigen-loaded Monocyte Administration and Flt3 Ligand Augment the Antitumor Efficacy of Immune Checkpoint Blockade in a Murine Melanoma Model
Authors: D’Anniballe Vincent M. , Huang Min-Nung , Lueck Benjamin D. , Nicholson Lowell T. , McFatridge Ian , Gunn Michael D.
Published: September 2023

Undifferentiated monocytes can be loaded with tumor antigens (Ag) and administered intravenously to induce antitumor cytotoxic T lymphocyte (CTL) responses. This vaccination strategy exploits an endogenous Ag cross-presentation pathway, where Ag-loaded monocytes (monocyte vaccines) transfer their Ag to resident splenic dendritic cells (DC), which then stimulate robust CD8+ CTL responses. In this study, we investigated whether monocyte vaccination in combination with CDX-301, a DC-expanding cytokine Fms-like tyrosine kinase 3 ligand (Flt3L), could improve the antitumor efficacy of anti-programmed cell death (anti-PD-1) immune checkpoint blockade. We found that Flt3L expanded splenic DC over 40-fold in vivo and doubled the number of circulating Ag-specific T cells when administered before monocyte vaccination in C57BL/6 mice. In addition, OVA-monocyte vaccination combined with either anti-PD-1, anti-programmed cell death ligand 1 (anti-PD-L1), or anti-cytotoxic T lymphocyte antigen-4 (anti-CTLA-4) suppressed subcutaneous B16/F10-OVA tumor growth to a greater extent than checkpoint blockade alone. When administered together, OVA-monocyte vaccination improved the antitumor efficacy of Flt3L and anti-PD-1 in terms of circulating Ag-specific CD8+ T cell frequency and inhibition of subcutaneous B16/F10-OVA tumor growth. To our knowledge, this is the first demonstration that a cancer vaccine strategy and Flt3L can improve the antitumor efficacy of anti-PD-1. The findings presented here warrant further study of how monocyte vaccines can improve Flt3L and immune checkpoint blockade as they enter clinical trials.
The Long-term Outcomes of Sacral Neuromodulation for Fecal Incontinence: A Single Center Experience
Authors: Martin Sarah , O’Connor Alexander D. , Selvakumar Deepak , Baraza Wal , Faulkner Gemma , Mullins Domini , Kiff Edward S. , Telford Karen , Sharma Abhiram
Published: September 2023

BACKGROUND:

Sacral neuromodulation is an effective treatment for fecal incontinence.

OBJECTIVE:

This study aimed to assess the long-term outcomes of sacral neuromodulation and establish the outcomes of patients with inactive devices.

DESIGN:

This is an observational study of patients treated for more than 5 years. A positive outcome was defined as a >50% reduction in fecal incontinence episodes or improvement in a symptom severity score. Data were reviewed from a prospectively managed database.

SETTINGS:

This study was conducted at a single tertiary referral center.

PATIENTS:

Data from 74 patients (72 female) were available at long-term follow up.

MAIN OUTCOME MEASURES:

Bowel diary, St. Mark’s incontinence score, and Manchester Health Questionnaire data were prospectively recorded at baseline, after peripheral nerve evaluation, and at last follow-up.

RESULTS:

Patients were analyzed in cohorts based on time since sacral neuromodulation implantation: Group 1: 5-10 years (n = 20), Group 2: >10 years (n = 35), and Group 3: inactive SNM devices (n = 19). Median St. Mark’s incontinence score and Manchester Health Questionnaire improved from baseline to last follow-up in Group 1 (p ≤ 0.05) and Group 2 (p ≤ 0.05), but in Group 3 results returned to baseline levels at last follow-up. Similarly, weekly fecal incontinence episodes improved in both active device groups at last follow-up. However, in Group 3 incontinence episodes were no different from baseline (p = 0.722). Despite active devices, fecal urgency episodes increased at last follow-up after more than 10 years since peripheral nerve evaluation (p ≤ 0.05). Complete continence was reported by 44% of patients, and at least a 50% improvement in 77% with active devices.

LIMITATIONS:

This study is retrospective with some gaps in the available data at last follow-up.

CONCLUSIONS:

Sacral neuromodulation is an effective treatment for fecal incontinence in the long term, but all outcomes are adversely affected by device inactivity. Therefore, ongoing stimulation is required for continued benefit..
Dose Individualization of Cefepime for Febrile Neutropenia in Patients With Lymphoma or Multiple Myeloma: Implications for Therapeutic Drug Monitoring
Authors: Oda Kazutaka , Yamaguchi Ayami , Matsumoto Naoya , Nakata Hirotomo , Higuchi Yusuke , Nosaka Kisato , Jono Hirofumi , Saito Hideyuki
Published: September 2023

Background:

Optimal cefepime dosing is a challenge because of its dose-dependent neurotoxicity. This study aimed to determine individualized cefepime dosing for febrile neutropenia in patients with lymphoma or multiple myeloma.

Methods:

This prospective study enrolled 16 patients receiving cefepime at a dose of 2 g every 12 hours. Unbound concentrations were determined at 0.5 hours, 7.2 hours [at the 60% time point of the 12 hours administration interval (C7.2h)], and 11 hours (trough concentration) after the first infusion (rate: 2 g/h). The primary and secondary end points were the predictive performance of the area under the unbound concentration–time curve (AUCunbound) and the effect of unbound cefepime pharmacokinetic parameters on clinical response, respectively.

Results:

The mean (SD) AUCunbound was 689.7 (226.6) mcg h/mL, which correlated with C7.2h (R2 = 0.90), and the Bayesian posterior AUCunbound using only the trough concentration (R2 = 0.66). Although higher exposure was more likely to show a better clinical response, each parameter did not indicate a statistical significance between positive and negative clinical responses (P = 0.0907 for creatinine clearance (Ccr), 0.2523 for C7.2h, 0.4079 for trough concentration, and 0.1142 for AUCunbound). Cutoff values were calculated as 80.2 mL/min for Ccr (sensitivity: 0.889, specificity: 0.714), 18.6 mcg/mL for C7.2h (sensitivity: 0.571, specificity: 1.000), and 9.2 mcg/mL for trough concentration (sensitivity: 0.571, specificity: 1.000). When aiming for a time above 100% the minimum inhibitory concentration, both continuous infusion of 4 g/d and intermittent infusion of 2 g every 8 hours achieved a probability of approximately 100% at a minimum inhibitory concentration of 8 mcg/mL.

Conclusions:

Therapeutic drug monitoring by sampling at C7.2h or trough can facilitate rapid dose optimization. Continuous infusion of 4 g/d was recommended. Intermittent dosing of 2 g every 8 hours was alternatively suggested for patients with a Ccr of 60–90 mL/min.
Recurrent Lateral Abdominal Wall Hernias: Options for Reconstruction
Authors: Mattison Gennaya Lynn , Lee Seung Ah , Wong Daniel Enjay , Leevan Elyse , Carmichael Joseph Christopher , Evans Gregory Randolph Dean
Published: September 2023

Management of lateral abdominal wall hernias presents a surgical challenge, and best management is controversial. Flank hernias as a surgical sequela occur more commonly, whereas flank hernias resulting from trauma are a rare occurrence. In this article, we present a review of the literature and a case of flank hernia presenting after trauma and recurring after repair. An anchored suture repair was performed and reinforced by the addition of a polyester underlay mesh.
Clinical and genetic definition of serum bilirubin levels for the diagnosis of Gilbert syndrome and hypobilirubinemia
Authors: Poynard Thierry , Deckmyn Olivier , Peta Valentina , Sakka Mehdi , Lebray Pascal , Moussalli Joseph , Pais Raluca , Housset Chantal , Ratziu Vlad , Pasmant Eric , Thabut Dominique ,   for the FibroFrance Group
Published: September 2023

Background and Aims:

Gilbert syndrome (GS) is genotypically predetermined by UGT1A1*28 homozygosity in Europeans and is phenotypically defined by hyperbilirubinemia using total bilirubin (TB) cutoff ≥1mg/dL (17 μmol/L). The prevalence of illnesses associated with GS and hypobilirubinemia has never been studied prospectively. As TB varies with UGT1A1*28 genotyping, sex, and age, we propose stratified definitions of TB reference intervals and report the prevalence of illnesses and adjusted 15 years survival.

Methods:

UK Biobank with apparently healthy liver participants (middle-aged, n=138,125) were analyzed after the exclusion of of nonhealthy individuals. The stratified TB was classified as GS when TB >90th centile; <10th centile indicated hypobilirubinemia, and between the 10th and 90th centile was normobilirubinemia. We compared the prevalence and survival rates of 54 illnesses using odds ratio (OR), logistic regression, and Cox models adjusted for confounders, and causality by Mendelian randomizations.

Results:

In women, we identified 10% (7,741/76,809) of GS versus 3.7% (2,819/76,809) using the historical cutoff of ≥1 mg/dL (P<0.0001). When GS and hypobilirubinemia participants were compared with normobilirubinemia, after adjustment and Mendelian randomizations, only cholelithiasis prevalence was significantly higher (OR=1.50; 95% CI [1.3–1.7], P=0.001) in men with GS compared with normobilirubinemia and in causal association with bilirubin (

P

=0.04). No adjusted survival was significantly associated with GS or hypobilirubinemia.

Conclusions:

In middle-aged Europeans, the stratified TB demonstrates a careless GS underestimation in women when using the standard unisex 1 mg/dL cutoff. The prevalence of illnesses is different in GS and hypobilirubinemia as well as survivals before adjusting for confounding factors. With the exception of cholelithiasis in men, these differences were no more significant after adjustment and Mendelian randomization.
SAVE Testis-sparing score: A multicenter retrospective study of a novel predictive tool for quantifying testicular tumors
Authors: Liu Zhenhua , Xie Junyi , Gao Xiaofeng , Lin Yuan , Sun Mengkui , Sun Yubo , Peng Ding , Xie Haibiao , Li Xiangdong , Li Zhiyong , Cai Taonong , Chen Pengyu , Wu Zhiming , Guo Shengjie , Li Yonghong , Zhang Zhilin , Qin Zike , Han Hui , He Zhisong , Liu Jiumin , Fu Wen , Li Shoulin , Xia Dan , Wang Xiang , Deng Chunhua , Xu Zhe , Zhou Fangjian , Yao Kai , Yu Wei , Ye Yunlin , Liu Zhuowei
Published: September 2023

Background:

Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly standardized, partially because testicular anatomical elements cannot be quantitatively described.

Materials and Methods:

We developed a scoring method known as SAVE testis-sparing score based on four critical and accessible anatomical features of testicular tumor. The SAVE score ranges from 0 to 8 and is divided into four risk classes (low, medium, high, and extremely high) to evaluate the feasibility of TSS, wherein low risk indicates high feasibility and vice versa. This study included 444 testicular tumor patients from eight centers. Among them, 216 patients (model group: 151 patients, validation group: 65 patients) were included in the modeling analysis, and the other 228 patients from children’s centers were included in the proportion analysis. Using retrospective data, patient characteristics associated with surgical methods were identified. Furthermore, multivariate logistic regression model was built quantify the associations between these characteristics and the surgery method. The receiver operator characteristic curve was used to evaluate the classification efficiency of SAVE.

Results:

The SAVE testis-sparing score includes size (tumor size as maximal diameter), available testicular tissue volume, volume ratio of the tumor to the testis, and the exophytic/endophytic properties of the tumor. The SAVE scoring system accurately classified the suitability of TSS based on the complexity of benign testicular tumors.

Conclusion:

The SAVE score is a reproducible and robust tool for quantitatively describing the anatomical characteristics of benign testicular tumors and guide the preoperative evaluation of TSS.
Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis
Authors: An Yongkang , Gao Jihua , Xu Jiancheng , Qi Wenyue , Wang Linyue , Tian Maosheng
Published: September 2023

Background:

Considering the difficulty of treating complex anal fistula (CAF), various surgical techniques exist in clinical work. However, none are ideal. Evidence on the efficacy and safety of different surgical treatments is scarce. We aimed to compare the outcomes of the 13 surgical techniques and tried to find the best surgical method for treating CAF.

Materials and Methods:

We searched worldwide databases, including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed, from inception to March 2023. All randomized controlled trials (RCTs) comparing the outcomes of 13 surgical techniques were included according to the PICO principles. The indicators of the cure rate, the recurrence rate, the complication rate, the operating time, the postoperative pain on day 1 (VAS), and the postoperative incontinence in month 1 (Wexner) were extracted and analyzed using STATA software 15.1, Review Manager 5.4, and GeMTC14.3.

Results:

Twenty-eight RCTS with a total of 2274 patients were included in the network meta-analysis. There was no statistically significant difference in the comparison among any surgical interventions in terms of the cure rate (P>0.05 Table 2) and recurrence rate (P>0.05 Table 3). However, in terms of complication rate, fistulectomy was lower than FPS (Median: 0.14; 95% CI: 0.02, 0.70) or fistulotomy (Median: 0.09; 95% CI: 0.01, 0.55), and fistulotomy was lower than EAFR (Median: 0.24; 95% CI: 0.05, 0.84), LIFT (Median: 0.17; 95% CI: 0.02, 0.66) or LIFT-EAFR(Median: 0.11; 95% CI: 0.01, 0.69) (P>0.05 Table 4). The surface estimated the advantages and disadvantages under the cumulative ranking (SUCRA). The ranking results indicated that fistulectomy might have the lowest complication rate (SUCRA=7.9%). Because the network results of the operating time, the postoperative pain, and the postoperative incontinence contained no closed loops, the results of their probability ranking could only be referenced, demonstrating that fistulectomy might have the shortest operating time (SUCRA=23.4%), VAMLIFT might have the lowest postoperative pain on day 1 (VAS) (SUCRA=0.4%) and LIFT might have the lowest postoperative incontinence in month 1(Wexner) (SUCRA=16.2%).

Conclusion:

Fistulectomy might have the lowest complication rate, which might be the relatively superior surgical technique for treating CAF.
Low-molecular-weight heparin is associated with lower venous thromboembolism events than factor Xa inhibitors in patients with severe blunt trauma: a cohort study from the trauma quality improvement program
Authors: Chan Sheng-Yu , Huang Jen-Fu , Cheng Chi-Tung , Hsu Chih-Po , Liao Chien-Hung , Fu Chih-Yuan
Published: September 2023

Background:

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common complication of major trauma. Pharmacological VTE prophylactics are widely used, and low-molecular-weight heparin (LMWH) is recommended. Factor Xa inhibitors are increasingly being used for VTE prophylaxis in both medical and surgical patients. Evidence comparing LMWH and factor Xa inhibitors as VTE prophylactics for severe blunt trauma is lacking. This study aims to compare the efficacy and safety of factor Xa inhibitors and LMHW in VTE prophylaxis.

Materials and Methods:

Patients with severe blunt trauma who received LMWH or a factor Xa inhibitor for VTE prophylaxis in the Trauma Quality Improvement Program between 2017 and 2019 were included. The comparison was performed after using propensity score matching. The outcomes included mortality and incidence of DVT, PE, post-prophylactics hemorrhage control procedures and length of stay.

Results:

After 2:1 propensity score matching, 1,128 patients (n=752, LMHW group; n=376, factor Xa inhibitor group) were included in the analysis. Patients in the LMWH group had fewer VTE events than those in the factor Xa inhibitor group (DVT, 3.7% vs. 7.2%, P=0.013; PE, 0.4% vs. 3.2%, P <0.001). VTE risk was higher in the factor Xa group (DVT: odds ratio [OR], 1.97; 95% confidence interval [95%CI], 1.12–3.44; P=0.018 and PE: OR, 9.65; 95%CI, 2.91–44.12; P=0.001). The mortality rate was higher in the LMWH group; however, there was no significant difference (4.0% vs. 1.9%; P=0.075). The difference in the risk of undergoing hemorrhage control surgery after VTE prophylaxis between both groups was insignificant (0.3% vs. 0.0%; P=0.333).

Conclusions:

LMWH was associated with a lower risk of VTE than factor Xa inhibitors in patients with severe blunt trauma. The mortality rate was higher in the LMWH group; however, there was no statistically significant difference observed.
A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: A prospective study
Authors: Pu Jane J , Lo Anthony W I , Wong May C M , Choi Wing-Shan , Ho Grace , Yang Wei-Fa , Su Yu-Xiong
Published: September 2023

Background:

Positive bone margins have been shown to be associated with worse locoregional control and survival performance in oral oncology patients. With the application of computer-assisted surgery (CAS) and patient-specific surgical guides, we can accurately execute the preoperative osteotomy plan. However, how well we can predict the margin distance in the final histopathology with a preoperative CT scan, the factors associated with it, and how much leeway we should spare when designing the osteotomy planes during virtual surgical planning remain to be investigated.

Materials and Methods:

Patients from Jan 2021 to Dec 2022 with benign or malignant jaw tumors and with signs of bone marrow involvement in the preoperative CT scan in our center were prospectively recruited to the study. Virtual surgical planning (VSP) and measurement of the closest margin distance in the CT scan were performed by the single team of surgeons. The resection specimen was processed, and the margin distances were measured by a dedicated senior pathologist with the knowledge of orientation of the osteotomy planes.

Results:

A total of 35 patients were recruited, with 21 malignant and 14 benign cases. Sixty-eight bone margins were quantitatively analyzed. No significant difference in margin distances measured from the CT scan and final histopathology was detected (P=0.19), and there was a strong correlation between the two (rs=0.74, P<0.01). A considerable amount of variance was detected in the level of discrepancy between margin distances measured in CT scan and final histopathology (overall SD=6.26▓mm, malignancy SD=7.44▓mm, benign SD=4.40▓mm). No significant correlation existed between the two margin distances when only maxilla tumor margins were assessed (P=0.16).

Conclusion:

Bone margin distance in VSP is reliably correlated to final pathological margin distance. A leeway distance of 15▓mm and 9▓mm should be considered when designing the osteotomy planes for malignancy and benign cases respectively. Extra attention should be paid to maxilla cases when pre-determining the osteotomy planes during virtual surgical planning.
Risk factors prediction of 6-month mortality after non-cardiac surgery of older patients in China: A multicentre retrospective cohort study
Authors: Wu Xiao-Dong , Wang Qian , Song Yu-Xiang , Chen Xian-Yang , Xue Teng , Ma Li-Bin , Luo Yun-Gen , Li Hao , Lou Jing-Sheng , Liu Yan-Hong , Wang Di-Fen , Wu Qing-Ping , Peng Yu-Ming , Mi Wei-Dong , Cao Jiang-Bei
Published: September 2023

Background:

Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large data sets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after non-cardiac surgery using the clinical data from 11,894 older patients in China.

Materials and Methods:

A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. We retrospectively included 11,894 patients (aged ≥ 65 years) who underwent non-cardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality.

Results:

We predicted 12 preoperative risk factors associated with 6-month mortality in older patients after non-cardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By random forest model, we constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97).

Conclusion:

We identified 12 preoperative risk factors associated with 6-month mortality in non-cardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.
Hospital-physician Integration and Value-based Payment
Authors: Thai Ngoc H. , Post Brady , Young Gary J.
Published: September 2023

Background:

Hospital-physician integration is often justified as a driver of clinical quality improvement due to joint resources covering a broad spectrum of care. Value-based programs, such as the Medicare Merit-Based Incentive Payment System (MIPS), are intended to tie financial incentives to clinical quality, which may confer an advantage on such integrated practices.

Objectives:

We assessed the relationship between hospital-physician integration and MIPS performance by comparing hospital-integrated practices and independent practices.

Research Design:

This was a cross-sectional study using data from the Quality Payment Program for the performance year 2020.

Subjects:

Physician practices with a valid MIPS composite score in performance year 2020.

Measures:

Hospital integration was based on whether at least 75% of a practice’s physicians either billed most of their services using hospital outpatient department codes or billed through a hospital tax identifier. The primary outcome was the MIPS quality category score, and the secondary outcomes were the specific quality measures reported by practice groups.

Results:

Of the 20 most frequently reported measures, 14 were common in both groups. No difference was observed in the quality category score between hospital-integrated practices and independent practices in either unadjusted comparisons or after adjusting for practice characteristics, including practice size, geography, specialty mix, and case mix. In the secondary outcome models for specific quality measures, hospital-integrated practices achieved higher scores on most overlap measures but not all.

Conclusions:

The findings on quality category score suggest that hospital integration does not confer much advantage in the context of MIPS quality performance.
Effect of Adaptive Seating Systems on Postural Control and Activity Performance: A Systematic Review
Authors: Acharya Bishnu Dutta , Karki Arpita , Prasertsukdee Saipin , Reed Darren , Rawal Lal , Baniya Prem Laxmi , Boyd Roslyn N.
Published: September 2023

Purpose:

To systematically review the effectiveness of adaptive seating systems on sitting posture, postural control, and seated activity performance in children with cerebral palsy (CP).

Summary of Key Points:

From 5 databases, 3 of 21 (14%) articles were of good quality based on the Downs and Black checklist. Commercial modular contoured seating and paper-based low-cost, and contoured foam seating were effective at improving sitting posture, postural control, and seated activity performance. Parents and service providers reported that seating systems reduced stress, burden and psychosocial well-being, and quality of life in children with CP.

Conclusion:

Limited evidence demonstrated that adaptive seating systems were effective at improving sitting ability and postural control. Randomized controlled trials with objective outcome measures of seating performance in children with CP are needed to evaluate effectiveness.

Recommendations for Clinical Practice:

Adaptive seating devices are preferred by parents and therapists for children with CP; however, objective measures of seating outcomes are needed.
2022 APTA Pediatrics Knowledge Translation Lecture: Clinicians and Researchers Collaborate to Implement a Segmental Approach to Trunk Control
Authors: Christensen Catie , Bellows Danielle Moeske
Published: September 2023

The aim of this special communication is to describe a clinician/researcher collaboration that supported implementation of the segmental approach to trunk control into physical therapy practice at a large, multisite, pediatric hospital. A 6-phase, multifaceted iterative process including use of educational strategies, the knowledge-to-action (KTA) cycle, the Consolidated Framework for Implementation Research, and the Theoretical Domains Framework was used. The total number of Segmental Assessments of Trunk Control (SATCos) completed increased from 0 to 57. Fifteen of 23 physical therapists representing 7 clinic locations referred a child for a SATCo. Using education alone or education plus the KTA cycle resulted in minimal uptake. Using more formal contextual assessments and mapping of barriers to strategies using implementation frameworks, collaborative goal setting, and planning resulted in more effective strategies and increase in uptake of the segmental approach in later phases.