bluuebunny/crossref_metadata_2025 huggingface dataset:
Appropriate Statistical Methods to Assess Cross-study Diagnostic 23-Gene Expression Profile Test Performance for Cutaneous Melanocytic Neoplasms
Authors: Goldberg Matthew S. , Cockerell Clay J. , Rogers Jason H. , Siegel Jennifer J. , Russell Brooke H. , Hosler Gregory A. , Marks Etan
Published: August 2024

Comparing studies of molecular ancillary diagnostic tests for difficult-to-diagnose cutaneous melanocytic neoplasms presents a methodological challenge, given the disparate ways accuracy metrics are calculated. A recent report by Boothby-Shoemaker et al investigating the real-world accuracy of the 23-gene expression profile (23-GEP) test highlights this methodological difficulty, reporting lower accuracy than previously observed. However, their calculation method—with indeterminate test results defined as either false positive or false negative—was different than those used in previous studies. We corrected for these differences and recalculated their reported accuracy metrics in the same manner as the previous studies to enable appropriate comparison with previously published reports. This corrected analysis showed a sensitivity of 92.1% (95% confidence interval [CI], 82.1%–100%) and specificity of 94.4% (91.6%–96.9%). We then compared these results directly to previous studies with >25 benign and >25 malignant cases with outcomes and/or concordant histopathological diagnosis by ≥3 dermatopathologists. All studies assessed had enrollment imbalances of benign versus malignant patients (0.8–7.0 ratio), so balanced cohorts were resampled according to the lowest common denominator to calculate point estimates and CIs for accuracy metrics. Overall, we found no statistically significant differences in the ranges of 23-GEP sensitivity, 90.4%–96.3% (95% CI, 80.8%–100%), specificity, 87.3%–96.2% (78.2%–100%), positive predictive value, 88.5%–96.1% (81.5%–100%), or negative predictive value, 91.1%–96.3% (83.6%–100%) between previous studies and the cohort from Boothby-Shoemaker et al with this unified methodological approach. Rigorous standardization of calculation methods is necessary when the goal is direct cross-study comparability.
Metastatic Adrenocortical Carcinoma to the Skin: A Case Report and Review of This Unusual Neoplasm
Authors: Lee-Diaz Efrain , Contreras Carlo , Plaza Jose A.
Published: August 2024

Adrenocortical carcinoma is a very rare oncologic condition with poor prognosis that usually metastasizes to the lungs, liver, local lymph nodes, and peritoneum at initial presentation. However, skin metastasis is very uncommon and has rarely been reported even in advanced stages of the disease. We present a case of a 41-year-old man with a known history of adrenocortical carcinoma of the right adrenal gland that presented with an arm mass. The histopathologic sections showed a multinodular necrotic malignant neoplasm in dermis and subcutaneous fat composed of atypical epithelioid cells with ample granular cytoplasm and pleomorphic vesicular nuclei with frequent intranuclear inclusions and atypical mitoses. The immunohistochemical stains showed tumor cells that were strongly positive for synaptophysin and inhibin, only focally positive for Melan-A, and negative for AE1/AE3. The histopathologic features and the immunohistochemical profile confirmed the diagnosis of metastatic carcinoma consistent with adrenal cortical origin. The diagnosis can be difficult (especially when no clinical data are provided), and an immunohistochemical battery is often useful in distinguishing this tumor from other tumors with similar cytomorphological features.
Anetoderma in the Setting of a Hematologic Abnormality and COVID-19 Infection
Authors: Xu Kathryn K. , Proffer Sydney L. , Torgerson Rochelle R. , Peters Margot S.
Published: August 2024

Anetoderma is an uncommonly reported dermatosis clinically characterized by discrete skin lesions resulting from elastic fiber loss within the dermis. Although primary anetoderma has been considered idiopathic, a range of associated disorders, particularly prothrombotic abnormalities, have been reported. We present a 79-year-old woman with a heterozygous Factor V Leiden mutation who developed anetoderma shortly after COVID-19 infection complicated by a thromboembolic event. Our patient adds to the literature on the occurrence of anetoderma in the setting of infection and/or a prothrombotic disorder.
Examining How National Levels of Life Expectancy, Education, and Income Influence Early Childhood Development: The Mediating Role of the Child's Nurturing Context
Authors: Rothenberg W. Andrew , Bornstein Marc H. , Putnick Diane L. , Lansford Jennifer E.
Published: August 2024

Objective:

Forty-three percent of children younger than 5 years in low- and middle-income countries (LMICs) are at risk of not meeting their developmental potential. This study investigated how 3 aspects of national development (national life expectancy, education, and income levels) are associated with early childhood development by influencing 5 domains of nurturing care (caregiving, the learning environment, safety and security, nutrition, and the health of the home environment).

Methods:

In total, 159,959 families with children aged 36 to 59 months living in 51 LMICs provided data. National development was measured using 3 indicators (national life expectancy, education, and income levels), and nurturing care was measured using 10 indicators that collectively captured the 5 nurturing care domains. Path analyses examined how nurturing care indicators mediated the effects of national development on early childhood development.

Results:

Higher national life expectancy was directly associated with more advanced childhood development. Higher national levels of education and income were indirectly associated with more advanced childhood development through aspects of nurturing care, such as reduced caregiver psychological aggression or physical violence, increased learning materials and wired appliances in the home environment, and greater caregiver education and child height-for-age. Greater caregiver cognitive caregiving practices promoted childhood development, regardless of levels of national development.

Conclusion:

Intervening to promote caregiver education, appropriate discipline strategies, cognitive caregiving practices, and family access to wired appliances, learning materials, and adequate nutrition is key to promoting childhood development in nations with lower levels of national development.
DYNAMIC VIRAL LOAD MONITORING AND METAGENOMIC SEQUENCING IN ACUTE RETINAL NECROSIS CAUSED BY VARICELLA-ZOSTER VIRUS
Authors: Gu Junxiang , Lei Boya , Wang Zhujian , Zhang Ting , Jiang Tingting , Zhang Peijun , Chen Wenwen , Zhang Yanqiong , Jiang Rui , Xu Gezhi , Chang Qing , Zhou Min
Published: August 2024

Purpose:

To analyze the trend of intraocular viral load after antiviral treatment in patients with varicella-zoster virus–induced acute retinal necrosis and to explore the effect of viral genotypes on clinical manifestations.

Methods:

In this case series, viral load was detected using polymerase chain reaction from aqueous humor during treatment; viral load curves were fitted, and the time required to reach the inflection point between plateau phase and logarithmic reduction phase was estimated. Variations in viral genomes were detected by metagenomic sequencing.

Results:

Twenty eyes of 20 patients were included. The median (interquartile range) initial viral load was 5.9 × 107 (1.1 × 107–1.1 × 108) copies/mL. The average duration of retinitis was 5 ± 3 weeks. The average time required to reach the inflection point was 4.2 ± 1.6 days. Time required to reach the inflection point was correlated with the duration of retinitis (P = 0.025). Patients with varicella-zoster virus carrying the p.S715* variation in ribonucleotide reductase (RNR) subunit 1 gene had lower initial viral loads (median 1.3 × 107 copies/mL) than those without (median 1.1 × 108 copies/mL; adjusted P = 0.030).

Conclusions:

The inflection of viral load curve is helpful to estimate the length of plateau phase and the duration of retinitis during antiviral treatment in patients with acute retinal necrosis. Loss-of-function variation in RNR gene might be correlated with lower virulence of varicella-zoster virus.
Progressive Paracentral Visual Field Loss at Low Intraocular Pressures Following LASIK
Authors: Kaplan Tyler M. , Sit Arthur J. , Patel Sanjay V. , Roddy Gavin W.
Published: August 2024

Intraocular pressure is currently the only known reliable, modifiable risk factor for the development and progression of glaucoma. Other risk factors for glaucoma include increasing age, myopia, decreased central corneal thickness, and low corneal hysteresis (CH) measurements. Photoablative keratorefractive surgery including laser assisted in situ keratomileusis (LASIK) has become a common way to treat refractive error, with over 25 million procedures performed in the United States alone. Though myopic LASIK has been associated with a decrease in CH measurements, relatively little is known about the risk of LASIK on glaucoma onset and progression. Here we present an observational study of 4 consecutive relatively young and otherwise healthy glaucoma patients with a history of myopic LASIK who showed progression of paracentral visual field deficits at intraocular pressures of 12 mm Hg or less while being carefully monitored. Therefore, these patients required lower targets of intraocular pressure, in the single-digit range, to slow or halt progression. In this cohort, the average corneal hysteresis was more than 2 standard deviations below normal values. This series suggests that additional study into the association of LASIK and glaucoma is warranted, including the potential risk contribution of diminished CH. These studies may be particularly relevant as patients who underwent LASIK procedures in the early 2000s may now be at increased risk of glaucoma due to the risk factor of age.
Peripapillary and Macular Vessel Density in Unilateral Early Pseudoexfoliation Glaucoma
Authors: Solmaz Nilgun , Oba Turker
Published: August 2024

Précis:

In early pseudoexfoliation glaucoma (PXG), radial peripapillary capillary vessel density (RPC-VD) was reduced nasally, while the retinal nerve fiber layer (RNFL) thinned from the nasal to temporal sectors. Nonglaucomatous fellow eyes demonstrated no RPC-VD or RNFL loss in comparison to the controls.

Purpose:

To evaluate peripapillary and macular vessel density (VD) in unilateral early PXG and unaffected fellow eyes compared with healthy controls.

Methods:

This cross-sectional study included 28 eyes with PXG and 28 nonglaucomatous, pseudoexfoliation-free fellow eyes of 28 patients, and 28 eyes of 28 healthy participants. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RPC-VD, macular VD, retinal nerve fiber layer (RNFL) thickness, and ganglion cell complex (GCC) thickness were compared among the groups.

Results:

The average RPC-VD and RNFL thickness were significantly reduced in PXG eyes compared with both fellow eyes and the control group (P<0.001–0.002). In fellow eyes, neither RNFL thickness nor RPC-VD parameters differed from controls. In sector-based analysis, RPC-VD loss in the PXG eyes was significant in the nasal-superior, nasal-inferior, superonasal, and inferonasal sectors (P=0.005–0.031), while RNFL thinning extended from the nasal sectors toward the superotemporal and temporal-superior sectors (P<0.001–0.014). RPC-VD was strongly correlated with average and all sector RNFL thicknesses (r=0.402–0.759, P<0.001–0.034). While perifoveal GCC differed from both fellow and control eyes (P<0.001), there was no significant difference in macular VD parameters among the groups. RPC-VD and RNFL had comparable area under receiver operating curve (AUROC) values in the average and nasal sectors, while RPC-VD had no ability to distinguish PXG from controls in the superotemporal and inferotemporal sectors.

Conclusion:

In the early stages of PXG, RNFL parameters mostly appear to have better diagnostic ability than RPC-VD parameters. Fellow eyes in the preclinical stage may not exhibit any RPC-VD and RNFL loss detectable by current OCTA technology.
Manual-delineation and dissection technique for posterior polar cataract
Authors: Singhal Lalit , Sood Gitanjli
Published: August 2024

In posterior polar cataract (PPC), the posterior capsule is weak or dehiscent. This can lead to posterior capsular rent at any time during cataract surgery, leading to complications. Various techniques have been used to manage such cataracts, and modifications are advised at each and every step of cataract surgery. We describe a new technique in which a blunt chopper is used to manually delineate the epinucleus from the nucleus at 360 degrees, and the nucleus is chopped and removed by phacoemulsification. Then, the chopper is inserted in the plane between the capsule and the epinucleus, and manual dissection is performed, followed by rotation and pushing it centrally. This epinucleus that is separated is aspirated simultaneously. Thus, with no pressure fluctuations and undue stress on the posterior capsule from the fluid jets, we manage to do surgery in tricky cases of PPCs successfully using manual delineation and dissection.
Visualizing the modulation of neurokinin 1 receptor–positive neurons in the superficial dorsal horn by spinal cord stimulation in vivo
Authors: Xu Qian , Zheng Qin , Cui Xiang , Cleland Andrew , Hincapie Juan , Raja Srinivasa N. , Dong Xinzhong , Guan Yun
Published: August 2024

Spinal cord stimulation (SCS) is an effective modality for pain treatment, yet its underlying mechanisms remain elusive. Neurokinin 1 receptor–positive (NK1R+) neurons in spinal lamina I play a pivotal role in pain transmission. To enhance our mechanistic understanding of SCS-induced analgesia, we investigated how different SCS paradigms modulate the activation of NK1R+ neurons, by developing NK1R-Cre;GCaMP6s transgenic mice and using in vivo calcium imaging of superficial NK1R+ neurons under anesthesia (1.5% isoflurane). Neurokinin 1 receptor–positive neurons in the lumbar spinal cord (L4-5) showed a greater activation by electrical test stimulation (TS, 3.0 mA, 1 Hz) at the hindpaw at 2 weeks after tibia-sparing nerve injury (SNI-t) than in naïve mice. Spinal cord stimulation was then delivered through a bipolar plate electrode placed epidurally at L1-2 level. The short-term 50-Hz high-intensity SCS (80% motor threshold [MoT], 10 minutes) induced robust and prolonged inhibition of NK1R+ neuronal responses to TS in both naïve and SNI-t mice. The 30-minute 50-Hz and 900-Hz SCS applied at moderate intensity (50% MoT) also significantly inhibited neuronal responses in SNI-t mice. However, at low intensity (20% MoT), the 30-minute 900-Hz SCS only induced persistent neuronal inhibition in naïve mice, but not in SNI-t mice. In conclusion, both 10-minute high-intensity SCS and 30-minute SCS at moderate intensity inhibit the activation of superficial NK1R+ neurons, potentially attenuating spinal nociceptive transmission. Furthermore, in vivo calcium imaging of NK1R+ neurons provides a new approach for exploring the spinal neuronal mechanisms of pain inhibition by neuromodulation pain therapies.
The clinical effect of dienogest on urinary and sexual symptoms in endometriosis patients
Authors: Long Cheng-Yu , Chang Chih-Ting , Lin Kun-Ling , Yeh Chang-Lin , Feng Chien-Wei , Loo Zi-Xi
Published: August 2024

Background:

To evaluate the effect of dienogest on urinary symptoms and sexual functioning within a 6-month follow-up period.

Methods:

We recruited 22 women with symptoms with dysmenorrhea, deep dyspareunia, and dyschezia accompanied with irritative urinary symptoms including frequency and urgency at Kaohsiung Medical University Chung-Ho Memorial Hospital from 2017 Jan 1 to 2019 Jan 1. The diagnosis of endometriosis mainly focused on vaginal examination and transvaginal ultrasound was performed in each patient. The participating patients took a daily dose of 2 mg Dienogest and underwent outpatient visits at the beginning, 1, 2, 3, and 6 months following treatment.

Results:

Our data showed a significant improvement in the visual Analog Scale (VAS) score from the first month till the sixth month after DNG treatment. The Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) were significantly improved after the DNG treatment. Besides, serum estradiol was also decreased. Our data also showed that DNG treatment for 6 months did not affect Female Sexual Function Index (FSFI) score. Some patients with heavy menstruation also improved; however, some patients with regular periods missed or skipped a period after DNG treatment, while other adverse effects were also observed.

Conclusion:

Our study demonstrated that DNG could not only alleviate endometriosis pelvic pain but reduce urinary symptoms within the 6-month follow-up as well. DNG did not affect sexual function as measured by the FSFI score, although some adverse effects were recorded.
The preferred surgical choice for intermediate-risk papillary thyroid cancer: total thyroidectomy or lobectomy? A systematic review and meta-analysis
Authors: Cao Mingyu , Yu Tiexin , Miao Xingyu , Wu Zhijing , Wang Wenlong
Published: August 2024

Background:

The optimal surgical approach for intermediate-risk papillary thyroid carcinoma (IR-PTC) (according to ATA definition), whether total thyroidectomy (TT) or lobectomy (LT), has remained a contentious clinical gray area for several decades. This systematic review and meta-analysis aim to provide robust evidence and address this clinical dilemma comprehensively.

Materials and methods:

A comprehensive literature search was conducted in Pubmed, Embase, Web of Science, and the Cochrane Library from 1st January 2009 to 29th December 2023 to evaluate the impact of different surgical options (TT or LT) on patients with IR-PTC. The primary outcomes included survival, recurrence rates, and postoperative complications. I
2 and sensitivity analysis was used to explore the heterogeneity.

Results:

A total of 8 studies involving 2984 participants were included in this meta-analysis and systematic review. The results indicated that LT was a superior choice for mitigating complications compared to TT [risk ratio (RR), 0.32; 95% CI: 0.24–0.44, P<0.01], particularly for transient complications (RR, 0.24; 95% CI: 0.08–0.65, P<0.01), such as the transient parathyroid dysfunction (RR, 0.04; 95% CI: 0.01–0.15, P<0.01). However, TT did not increase the risk of recurrent laryngeal nerve palsy (RR, 0.78; 95% CI: 0.24–2.47, P=0.67), hemorrhage/seroma (RR, 0.77; 95% CI: 0.48–1.25, P=0.30), and permanent complications (RR, 0.18; 95% CI: 0.02–1.42, P=0.10). Besides, both LT and TT presented similar effect on survival outcomes (overall survival: RR, 1.00; 95% CI: 0.97–1.03, P=0.92, disease-specific survival: RR, 0.99; 95% CI: 0.97–1.02, P=0.69, recurrence-free survival: RR, 1.00; 95% CI: 0.96–1.05, P=0.86), recurrence (RR, 1.05; 95% CI: 0.76–1.46, P=0.76).

Conclusion:

The present meta-analysis revealed that TT did not yield improved outcomes in IR-PTC patients, but was associated with an increased incidence of temporary complications. In light of these findings, it may be advisable to consider LT as the optimal choice for IR-PTC patients.
Report of a novel recurrent homozygous variant c.620A>T in three unrelated families with thiamine metabolism dysfunction syndrome 5 and review of literature
Authors: Mascarenhas Selinda , Yeole Mayuri , Rao Lakshmi Priya , do Rosario Michelle C , Majethia Purvi , Nair Karthik Vijay , Sharma Suvasini , Barala Praveen Kumar , Puri Ratna Dua , Pal Swasti , Siddiqui Shahyan , Shukla Anju
Published: August 2024

Introduction

Biallelic variants in thiamine pyrophosphokinase 1 (TPK1) are known to cause thiamine metabolism dysfunction syndrome 5 (THMD5). This disorder is characterized by neuroregression, ataxia and dystonia with basal ganglia abnormalities on neuroimaging. To date, 27 families have been reported with THMD5 due to variants inTPK1.

Methods

We ascertained three individuals from three unrelated families. Singleton exome sequencing was performed on all three individuals, followed byin silicomutagenesis of the mutant TPK protein. Additionally, we reviewed the genotypic and phenotypic information of 27 previously reported individuals with THMD5.

Results

Singleton exome sequencing revealed a novel homozygous variant c.620A>T p.(Asp207Val) inTPK1(NM_022445.4) in all three individuals.In silicomutagenesis of the mutant protein revealed a decrease in protein stability and altered interactions with its neighboring residues compared to the wild-type protein. Thus, based on strikingly similar clinical and radiological findings compared to the previously reported individuals and with the support ofin silicomutagenesis findings, the above-mentioned variant appears to be the probable cause for the condition observed in the affected individuals in this study.

Conclusion

We report a novel homozygous variant inTPK1, which appears to be recurrent among the Indian population.
Dilated aorta in CNOT3-related neurodevelopmental disorder: ‘expanding’ the phenotype
Authors: Lau Sandra Hui Min , Jiin Ying Lim , Goh Chew Yin Jasmine , Choo Jonathan , Chow Cristelle , Ling Simon , Ng Yong Hong , Yi Hua Tan , Teo Jing Xian , Chua Khi Pin , Chin Minning , Lim Weng Khong , Jamuar Saumya Shekhar , Lai Angeline Hwei Meeng , Goh Jeannette Lay Kuan
Published: August 2024

Introduction

Neurodevelopmental disorders (NDDs) comprise conditions that emerge during the child’s development and contribute significantly to global health and economic burdens. De novo variants in CNOT3 have been linked to NDDs and understanding the genotype–phenotype relationship between CNOT3 and NDDs will aid in improving diagnosis and management.

Methods

In this study, we report a case of a patient with CNOT3-related NDD who presented with progressive aortic dilatation, a feature not reported previously.

Results

Our patient presented with intellectual disorder, dysmorphic facial features, and cardiac anomalies, notably progressive aortic dilatation – a novel finding in CNOT3-related NDD. Genetic testing identified a de novo 6.3 kbp intragenic deletion in CNOT3, providing a possible genetic basis for her condition.

Conclusion

This study presents the first case of CNOT3-related NDD in Southeast Asia, expanding the phenotype to include progressive aortic dilatation and suggesting merit in cardiac surveillance of patients with CNOT3-related NDD. It also emphasizes the importance of genetic testing in diagnosing complex NDD cases as well as reanalysis of ‘negative’ cases using advanced sequencing technologies to uncover potential hidden genetic etiologies in undiagnosed NDDs.
Massive Bone Marrow Infiltration by Disseminated Alveolar Rhabdomyosarcoma Mimicking Acute Leukemia
Authors: De Leonardis Francesco , Linsalata Claudio Oronzo , Koronica Roberta , Tombolan Lucia , Servedio Mariachiara , Pentassuglia Enza , Santoro Nicola
Published: August 2024

RMS is a malignant tumor of soft tissues affecting primarily children and adolescents. Around 6% to 23% RMS patients present bone marrow infiltration but leukemia-like involvement is very rare; in these patients cytomorphology on bone marrow smears can lead to misdiagnosis. Differential diagnosis with alveolar RMS should be kept in mind in every pediatric patient presenting with a marked bone marrow involvement in the absence of typical lymphoproliferative findings.
Allogeneic Hematopoietic Cell Transplantation With Reduced Toxicity Conditioning for Pediatric B Lymphoid Malignancy
Authors: Naito Yuki , Osone Shinya , Mitsuno Kohei , Kanayama Takuyo , Mayumi Azusa , Imamura Toshihiko , Iehara Tomoko
Published: August 2024

Background:

Conventional conditioning regimens for children with lymphoid malignancy undergoing allogeneic hematopoietic cell transplantation (HCT) are myeloablative and involve high-dose total body irradiation (TBI). Such regimens are associated with significant late complications.

Observations:

Here, we used a reduced-toxicity conditioning regimen comprising fludarabine, cytarabine, melphalan, and low-dose TBI (FLAMEL) to treat 5 patients with lymphoid malignancy before HCT. Four patients maintained complete remission (range, 18 to 63 mo), whereas the remaining patient who had positive minimal residual disease (MRD) before HCT relapsed.

Conclusions:

FLAMEL might be a suitable conditioning regimen for children with lymphoid malignancy if pre-HCT MRD is negative.
Late Relapse in Genetically Determined Infantile Myofibromatosis. A Case Report and Brief Focus on Recurrences
Authors: Conte Alessio , De Padova Damiana , Giglio Serena , Livellara Virginia , Manzitti Carla , De Marco Patrizia , Capra Valeria , Sorrentino Stefania
Published: August 2024

Background:

Infantile myofibromatosis (IM) is a rare disorder characterized by benign tumors in the skin, subcutaneous tissue, muscle, and occasionally viscera. IM can be hereditary due to PDGFRB or NOTCH3 variants. Treatment is mainly conservative or surgical. Combination regimens have been used in case of disseminated disease.

Observation:

We present relapsed disease of IM 11 years after diagnosis in a 2-year-old child initially treated by microscopically complete resection. A new heterozygous c.1687G>A (p.Glu563Lys) mutation in the PDGFRB gene was identified (considered likely pathogenic).

Conclusions:

In association with initial treatment, genetic testing is crucial for tailored clinical practice and follow-up in patients diagnosed with IM.
Effects of a range of 6 prefabricated orthotic insole designs on plantar pressure in a healthy population: A randomized, open-label crossover investigation
Authors: Cooper Stephanie , Hanning Jennifer , Hegarty Carol , Generalis Christian , Smith Adam , Hall Tanya , Starbuck Chelsea , Kaux Jean François , Schwartz Cédric , Buckley Carolyn
Published: August 2024

Background:

Prefabricated orthotic insoles are widely commercially available for self-selection to treat foot and lower-body musculoskeletal pain, without requiring advice from health care professionals. Although they are generally designed to mimic traditional design features of custom-made orthotics used in clinical practice, the effects of prefabricated insoles on plantar pressure distribution are poorly understood.

Objective:

This investigation aimed to evaluate and directly compare the effects of a range of 6 different commercially available prefabricated orthotic insole designs on plantar pressure in healthy individuals.

Methods:

This was a single-center, randomized, open-label, crossover investigation. In-shoe dynamic pressure (F-scan) was investigated in 24 healthy subjects with normal foot posture, wearing standard shoes alone and in combination with 6 different orthotic insoles, consecutively, measured on a single day. The biomechanical impact of each insole was determined by the statistical significance of changes from baseline measurements (standard shoe alone).

Results:

Insoles with heel cups and medial arch geometries consistently increased contact area at medial arch and whole-foot regions and reduced both plantar peak pressure (PP) and pressure time integral at medial arch and heel regions.

Conclusions:

This investigation has aided in further understanding the mode of action of prefabricated insoles in a healthy population. The insoles in this study redistributed plantar pressure at key regions of the foot, based on design features common to prefabricated insoles. Prefabricated orthotic insoles represent an easily accessible means of reducing lower-body musculoskeletal stress for those who spend prolonged periods of time on their feet.
Long-term Results and Efficacy of Intermediate Rhinoplasty in Patients With Unilateral Cleft Lip: A Single Surgeon’s Experience
Authors: Bae Yong Chan , Lee Chi Hyun , Seo Hyung Joon , Park Min Suk , Lee Seungbeom , Kim Ryuck Seong
Published: August 2024

Intermediate rhinoplasty, the correction of cleft lip nose deformities, is performed between the time of primary and secondary rhinoplasties, which is at ~6 years of age. Although intermediate rhinoplasty reduces psychological stress in school-aged children through improvements in appearance, studies on intermediate rhinoplasty are scarce. Hence, in this study, we aimed to evaluate the long-term outcomes of intermediate rhinoplasty in patients with unilateral cleft lip. Twenty-three patients with unilateral cleft lip who underwent intermediate rhinoplasty without primary rhinoplasty from 1997 to 2004 were enrolled in this retrospective study. They were categorized into total, male, and female groups. Photogrammetric analysis of 9 proportional, 5 angular, and 6 nostril-related parameters was performed using photographs that were taken after skeletal maturity had been reached; these parameters were compared with those of normal controls. The cleft group had significantly lower dome-to-columellar ratio, nasal sill ratio, labial-columellar angle, nostril width ratio, nostril height (base) ratio, nostril one-fourth medial part ratio, and nostril area ratio measurement and significantly higher alar width/mouth width ratio, columella height/alar width ratio, nasal tip protrusion/alar base width ratio, nasal dorsum angle, and nostril dimension in the cleft side values than the control group. After intermediate rhinoplasty, significant nasal improvement was achieved, including sufficient nasal tip projection, nasal height, nasal protrusion, and a relatively symmetric nasal tip without tip deviation. Intermediate rhinoplasty may contribute to reducing the psychosocial stress of school-aged children with unilateral cleft lip.
Social Capital and Surgery Access Among Medicare Beneficiaries
Authors: Myers Hannah E. W. , Kunnath Nicholas , Ibrahim Andrew M.
Published: August 2024

Objective:

To compare the rates of unplanned procedures for access-sensitive surgical conditions among beneficiaries living in census tracts of varying social capital levels.

Background:

Access-sensitive surgical conditions are conditions ideally screened for and treated in an elective setting. However, when left untreated, these conditions may result in unplanned (i.e., urgent or emergent) surgery. It is possible that social capital—the resources available to individuals through their membership in a social network—may impact the likelihood of a planned procedure occurring.

Methods:

Medicare beneficiaries who underwent one of three access-sensitive procedures (abdominal aortic aneurysm repair, colectomy for cancer, and ventral hernia repair) between 2016-2020 were stratified by their census tract level of social capital, the exposure variable. Outcomes included rate of unplanned surgery, readmission, 30-day mortality, and complications which were risk-adjusted with a logistic regression model that accounted for patient age, sex, race, comorbidities, and area deprivation.

Results:

A total of 975,048 beneficiaries were included (mean [SD] patient age, 76 [7.6] years; 443,190 were male [45.45%]). Compared to patients from census tracts in the highest overall social capital decile, those from census tracts with the least social capital were on average more likely to undergo unplanned surgery (40.67% versus 35.28%, OR=1.26 P<0.001). Additionally, beneficiaries in these communities were also more likely to experience postoperative complications (24.99% versus 22.90%, OR=1.12 P<0.001), but there was no significant difference in rates of readmission or mortality. When evaluating only elective procedures, the differences between the lowest and highest social capital decile groups reduced significantly for complications (12.77% versus 12.11%, OR=1.06 P=0.04), the differences in mortality rates collapsed, and differences in readmission rates remained insignificant.

Conclusion:

These data suggest that Medicare beneficiaries who live in communities with lower social capital are more likely to undergo unplanned surgery for access-sensitive conditions. Efforts to improve social capital in these communities may be one strategy for reducing the rate of unplanned operations.
Validation and Optimisation of the ISGPS Risk Classification for Postoperative Pancreatic Fistula after Pancreatoduodenectomy for Periampullary Tumours
Authors: Kapoor Deeksha , Desiraju Yajushi , Chaudhari Vikram A. , Bagwan Afroj Ismail , Chopde Amit , Namachivayam ArunKumar , Bhandare Manish S. , Shrikhande Shailesh V.
Published: August 2024

Objectives:

To externally validate the International Study Group of Pancreatic Surgery (ISGPS) classification and test its performance for predicting clinically relevant pancreatic fistula (CRPF) for periampullary tumours (P-amps).

Background:

The ISGPS is a simple two-factor, four-tier classification of pancreas-related risk for CRPF after a pancreatoduodenectomy (PD). External validation and performance of the classification specific to P-amps are lacking. P-amps have different disease biology, lesser need for neoadjuvant therapy, softer pancreas, and a higher rate of CRPF, underscoring the importance of site-specific prediction.

Methods:

Validation was performed in a cohort of 1422 patients, with CRPF as the primary outcome. Model performance was tested by plotting the receiver operating curve and calibration plots. After analysing the factors predicting CRPF, the model was optimised for P-amps.

Results:

CRPF rate was 22.2% (315/1422), for P-amps being 25.8%. The ISGPS model performed moderately (AUC=0.632, 95% CI 0.598–0.666, P<0.001), with worse performance for P-amps (AUC=0.605, 95% CI 0.566-0.645, P<0.001). On multivariate analysis, soft pancreas (OR 1.689, 95% CI 1.136-2.512, P=0.010), body mass index ≥23 kg/m2 (OR 2.112, 95% CI 1.464–3.046, P<0.001) and pancreatic duct ≤3 mm (OR 2.113 95% CI 1.457–3.064, P<0.001), emerged as independent predictors and the model was optimised. The adjusted ISGPS for P-amps showed improved discrimination (AUC=0.672, P<0.001, 95% CI 0.637–0.707), with adequate performance on internal validation.

Conclusion:

The adjusted ISPGS performs better than the original ISGPS in predicting CRPF for P-amps. Large-scale multicenter data is needed to generate and validate site-specific predictive models.
Patient-Reported Preoperative Depression as a Predictor of Psychosocial Outcomes After Gender-Affirming Facial Feminization Surgery
Authors: Taylor Jeremiah M. , Nguyen Nghiem H. , Huang Kelly X. , Pfaff Miles J. , Ranganathan Kavitha , Rada Rebecca C. , Litwin Mark S. , Hidalgo Marco A. , Lee Justine C.
Published: August 2024

Objective:

To understand psychosocial functioning before and after gender-affirming facial feminization surgery (FFS) as well as identify predictors of postoperative psychosocial functioning.

Summary Background Data:

Few investigations have rigorously explored the impact of gender-affirming FFS on psychosocial functioning in transgender and gender non-binary (TGNB) individuals. This knowledge gap hinders the identification of methods to optimize mental health quality-of-life outcomes after FFS and carries repercussions for access to care.

Methods:

Adult TGNB participants awaiting gender-affirming FFS were prospectively enrolled and administered Patient-Reported Outcomes Measurement Information System (PROMIS) instruments assessing anxiety, anger, depression, global mental and physical health, positive affect, emotional support, social isolation, companionship, and meaning and purpose before and 3-6 months after FFS. Paired t-tests compared pre- and postoperative scores. Multivariable linear models identified predictors of postoperative psychosocial outcomes.

Results:

Among the domains, psychosocial scores improved for anxiety, depression, global mental health, social isolation, and positive affect after FFS. When accounting for potential variables contributing to postoperative psychosocial scores including other gender-affirming surgeries, hormone therapy duration, and private versus public insurance type, we found that preoperative depression scores independently predicted the variance in all other postoperative scores with global mental health (β=−0.52, 95%CI −0.58-−0.31 P<0.001), anxiety (β=0.40, 95% CI 0.21-0.51, P<0.001), and meaning and purpose (β=−0.52, 95% CI −0.78-−0.42 P<0.001) as the strongest models.

Conclusions:

This study suggests that gender-affirming FFS improves psychosocial functioning; however, such improvements are highly influenced by the baseline psychological functioning of each individual. These findings indicate that preoperative psychological functioning may be a potential avenue for improving outcomes after FFS via perioperative psychological interventions.
The Near-Infrared Visualization and Preemptive Ligation of the Thoracic Duct Effectively Reduce the Chyle Leak Incidence After Minimally Invasive Esophagectomy
Authors: Puccetti Francesco , Cinelli Lorenzo , Barbieri Lavinia A. , Socci Davide , Clelia Di Serio , De Cobelli Francesco , Elmore Ugo , Rosati Riccardo ,   OSR CCeR Collaborative Group†∥
Published: August 2024

Objective:

The aim of the present study is to assess the effectiveness of indocyanine-green (ICG)-guided lymphography (ICG-Lg) in reducing the incidence of chyle leak (CL) after esophagectomy.

Background:

Chylothorax may severely impact esophageal cancer surgery, and the pre-emptive ligation of the thoracic duct (TD) is the most widespread control of this complication. Intraoperative ICG-Lg has been recently embedded in minimally invasive esophagectomy to facilitate TD detection and pre-emptive ligation.

Methods:

This retrospective analysis included consecutive patients who underwent minimally invasive Ivor Lewis esophagectomy for cancer at a tertiary referral center between January 2018 and August 2023. Patients were routinely submitted to extended lymphadenectomy with TD ligation and removal. All patients treated after January 2021 underwent ICG-Lg for TD identification and ligation (ICG group) and compared with the previous series (no-ICG group). The primary outcome was the incidence of postoperative CL, while univariate and backward stepwise multivariate logistic regression models were performed to identify associated factors.

Results:

After including 320 patients, 151 (ICG group) were submitted to ICG-Lg before the pre-emptive TD ligation. Both groups presented similar characteristics, except for neoadjuvant therapy (P<0.001) and preoperative comorbidities (P=0.045). Intraoperative ICG-Lg significantly reduced the incidence of postoperative CL (11.8% vs 4.6%, P=0.026) and was significantly associated with shorter median length of hospital stay (13 vs 9 d, P=0.006). However, CL after ICG-Lg was more likely to require repairing reoperation (P=0.050).

Conclusions:

Intraoperative ICG-Lg demonstrated significantly lower rates of CL after total minimally invasive esophagectomy and, therefore, it should be routinely embedded in the standardized surgical technique of high-volume centers for esophageal cancer.
Multinational Analysis of Marginal Liver Grafts Based on the Eurotransplant Extended Donor Criteria
Authors: Moosburner Simon , Patel Madhukar S. , Wang Benjamin K. , Prasadh Jai , Öllinger Robert , Lurje Georg , Sauer Igor M. , Vagefi Parsia A. , Pratschke Johann , Raschzok Nathanael
Published: August 2024

Objective:

To evaluate the outcome of marginal liver grafts based on the Eurotransplant extended criteria donor (ECD) criteria.

Background:

Eurotransplant uses a broad definition of ECD criteria (age >65 years, steatosis >40%, body mass index >30 kg/m2, intensive care unit stay >7 days, donation after circulatory death, and certain laboratory parameters) for allocating organs to recipients who have consented to marginal grafts. Historically, marginal liver grafts were associated with increased rates of dysfunction.

Methods:

Retrospective cohort analysis using the German Transplant Registry and the U.S. Scientific Registry of Transplant Recipients (SRTR) from 2006 to 2016. Results were validated with recent SRTR data (2017–2022). Donors were classified according to the Eurotransplant ECD criteria, donation after circulatory death was excluded. Data were analyzed with cutoff prediction, binomial logistic regression, and multivariate Cox regression.

Results:

The study analyzed 92,330 deceased brain-dead donors (87% SRTR) and 70,374 transplants (87% SRTR) in adult recipients. Predominant ECD factors were donor age in Germany (30%) and body mass index in the United States (28%). Except for donor age, grafts meeting ECD criteria were not associated with impaired 1 or 3-year survival. Cutoffs had little to no predictive value for 30-day graft survival (area under the receiver operating curve: 0.49–0.52) and were nominally higher for age (72 vs 65 years) in Germany as compared with those defined by current Eurotransplant criteria.

Conclusions:

The outcome of transplanted grafts from higher risk donors was nearly equal to standard donors with Eurotransplant criteria failing to predict survival of marginal grafts. Modifying ECD criteria could improve graft allocation and potentially expand the donor pool.
Embolism propagation in
Adiantum
leaves and in a biomimetic system with constrictions
Authors: Keiser Ludovic , Dollet Benjamin , Marmottant Philippe
Published: August 2024

Drought poses a significant threat to forest survival worldwide by potentially generating air bubbles that obstruct sap transport within plants’ hydraulic systems. However, the detailed mechanism of air entry and propagation at the scale of the veins remains elusive. Building upon a biomimetic model of leaf which we developed, we propose a direct comparison of the air embolism propagation in
Adiantum
(maidenhair fern) leaves, presented in Brodribb
et al
. (Brodribb TJ, Bienaimé D, Marmottant P. 2016 Revealing catastrophic failure of leaf networks under stress.
Proc. Natl Acad. Sci. USA
113
, 4865–4869 (doi:
10.1073/pnas.1522569113
)) and in our biomimetic leaves. In particular, we evidence that the jerky dynamics of the embolism propagation observed in
Adiantum
leaves can be recovered through the introduction of micrometric constrictions in the section of our biomimetic veins, mimicking the nanopores present in the bordered pit membranes in real leaves. We show that the intermittency in the propagation can be retrieved by a simple model coupling the variations of pressure induced by the constrictions and the variations of the volume of the compliant microchannels. Our study marks a step with the design of a biomimetic leaf that reproduces particular aspects of embolism propagation in real leaves, using a minimal set of controllable and readily tunable components. This biomimetic leaf constitutes a promising physical analogue and sets the stage for future enhancements to fully embody the unique physical features of embolizing real leaves.
Characterizing offshore polar ocean soundscapes using ecoacoustic intensity and diversity metrics
Authors: Mattmüller Ramona M. , Thomisch Karolin , Hoffman Joseph I. , Van Opzeeland Ilse
Published: August 2024

Polar offshore environments are considered the last pristine soundscapes, but accelerating climate change and increasing human activity threaten their integrity. In order to assess the acoustic state of polar oceans, there is the need to investigate their soundscape characteristics more holistically. We apply a set of 14 ecoacoustic metrics (EAMs) to identify which metrics are best suited to reflect the characteristics of disturbed and naturally intact polar offshore soundscapes. We used two soundscape datasets: (i) the Arctic eastern Fram Strait (FS), which is already impacted by anthropogenic noise, and (ii) the quasi-pristine Antarctic Weddell Sea (WS). Our results show that EAMs when applied in concert can be used to quantitatively assess soundscape variability, enabling the appraisal of marine soundscapes over broad spatiotemporal scales. The tested set of EAMs was able to show that the eastern FS, which is virtually free from sea ice, lacks seasonal soundscape dynamics and exhibits low acoustic complexity owing to year-round wind-mediated sounds and anthropogenic noise. By contrast, the WS exhibits pronounced seasonal soundscape dynamics with greater soundscape heterogeneity driven in large part by the vocal activity of marine mammal communities, whose composition in turn varies with the prevailing seasonal sea ice conditions.
Enhancing Thyroid Nodule Assessment: Leveraging Contrast-Enhanced Ultrasonography as a Screening Modality - A Meta-Analysis
Authors: Desai Dev , Malafi Maria Eleni , Shah Hetvi , Parikh Aneri , Shah Abhijay B. , Gami Vismit , Gupta Parth
Published: August 2024

Introduction

CEUS has become an emerging radio diagnostic technique of modern times. The use of these contrasts offers a way better alternative than materials that cause radiation. Thyroid nodules are notorious for their effect on normal physiology and the routine best diagnostic modality apart from biopsy is Radioactive Iodine.

Aim

To conduct a diagnostic test accuracy meta-analysis to understand the role of CEUS in diagnosing thyroid nodules.

Methodology

According to Prisma guidelines, literature on the topic was found using the Keywords CEUS, Thyroid Nodule, and Radioactive Iodine. Two independent reviewers conducted a quality check on the papers and decided on the studies that should be included. Any discrepancies were solved by a third reviewer. Meta Disc, Review Manager, and Excel were used to analyze the extracted data from the selected studies as per the inclusion and exclusion criteria. Biopsy was taken as a Reference Gold Standard.

Result

A total of 47 RCTs with 5,527 patients were selected for the study. The pooled sensitivity of CEUS is 0.87, with a CI of 95% in a range of 0.86 to 0.88. The specificity of CEUS is 0.84, with a CI of 95% in a range of 0.82 to 0.85. The summary of the ROC curve shows that the area under the curve for CEUS was 0.9292 and the overall diagnostic odds ratio (DOR) was 40.59.

Conclusion

It can be concluded from the results that CEUS can be used as a Screening tool for high suspicion groups but it is still not a perfect test. The newer generation of Contrasts may yield higher accuracy but for the currently available contrasts, Biopsy remains the best tool for a definitive and accurate diagnosis.
Brain cerebral blood flow with MRI-visible enlarged perivascular space in adults
Authors: Yu Chunyan , Wang Baijie , Sun Qiyuan , Huo Huiyan , Zhang Lingyan , Du Hongyan
Published: August 2024

Objective

To explore the correlation between enlarged perivascular spaces (EPVS) in the basal ganglia (BG-EPVS) and centrum semiovale (CSO-EPVS) and changes in adult brain cerebral blood flow (CBF).

Methods

This cross-sectional single-center cohort study included individuals with varying degrees of EPVS, divided into the BG and CSO based on the established rating scale. Subsequently, the arterial spin labeling (ASL) sequence and its post- processing operation were utilized to obtain CBF values for different grades of BG- EPVS and CSO-EPVS. Logistic regression was conducted to identify risk factors associated with BG-EPVS and CSO-EPVS, and correlation analysis was employed to explore the associations between different grades of BG-EPVS and CSO-EPVS with CBF of the whole brain and specific regions of interest.

Results

The regression analysis revealed that BG-EPVS was associated with age (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 1.04–1.15), hypertension (4.91,1.55–15.6), and periventricular white matter hyperintensities (PVWMH) (4.34,1.46–12.95). Conversely, CSO-EPVS was linked to hypertension (4.40,1.43– 13.57), drinking history (2.84,1.08–7.45), sleep duration (2.01,1.19–3.40), and PVWMH (12.20,3.83–38.85). Correlation analysis revealed a negative correlation between BG-EPVS and the CBF of the whole brain (r=-0.28, p=0.00) and most brain regions, except for the brain stem (r=-0.19, p=0.05). Conversely, CSO-EPVS was negatively correlated with CBF of temporal lobe white matter (r=-0.25, p=0.01); however, the significance was lost after FDR correction. CSO-EPVS was not correlated with CBF across various brain regions.

Conclusion

Brain CBF decreased with the increasing severity of BG-EPVS, suggesting that BG-EPVS could serve as an imaging marker for reflecting the changes in brain CBF and an effective indicator for early ischemic stroke.