bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure pain sensitivity is independent of structural pathology in patients with subacromial pain syndrome: a cross-sectional analysis
Authors: Pierson Chris , Wilson Richard , Brewer-Mixon Karen , Tzen Yi-Ting , Williamson Jon , Hansen Kristine , Hisel Terri , Jain Nitin
Published: November 2024

Objective

To compare localized (primary) and widespread (secondary) hyperalgesia through the measurement of the pressure pain threshold (PPT) of patients with normal imaging findings, rotator cuff tear, or other pathologies.

Design

This was a cross-sectional design with data collected at a single time point.

Setting

This study was performed at 2 large, urban, academic medical centers.

Subjects

The included participants had had chronic subacromial pain syndrome for 3 months or longer. Each participant was categorized into 1 of 3 imaging groups: normal imaging, rotator cuff tear, or other structural pathology.

Methods

Primary hyperalgesia was assessed with PPT at the midsection of the painful shoulder’s lateral deltoid. Secondary hyperalgesia was assessed with PPT at the contralateral tibialis anterior muscle (TA). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were performed for each objective. ANCOVA covariates included age, sex, education level, and pain duration.

Results

The 103 participants included 55 males and had a median age of 55 years, a median pain duration of 14.0 months, and a median composite Shoulder Pain and Disability Index (SPADI) score of 43.1%. The ANCOVA for primary hyperalgesia showed no significant difference in square-root-adjusted deltoid PPT among imaging groups (F = 1.04, P = .3589). The ANCOVA for secondary hyperalgesia showed no significant difference in log-adjusted TA PPT among imaging groups (F = 0.24, P = .7900).

Conclusions

No significant difference was observed in the analysis of ipsilateral deltoid or contralateral TA PPT among patients with differing structural shoulder pathologies. These findings suggest that the 3 types of structural shoulder abnormalities we examined are not significantly associated with differences in one measure of hyperalgesia.

Trial registration

ClinicalTrials.gov ID NCT03752619.
Can talent policy promote green technology innovation?
Authors: Liu Yiyang , Wang Ying , Loh Lawrence
Published: November 2024

Talent policy is conducive to attracting, motivating, and retaining vital, innovative talents to provide continuous motivation and innovation for green development. However, there is a dearth of literature on the impact of talent policy on enterprises’ green technology innovation (GTI). To bridge this gap, we take China’s A-share listed enterprises from 2010 to 2021 as samples, construct a Poisson model to test the relationship between talent policy and GTI, and further reveal the mechanism of executive environmental attention on the relationship between them. The research results are: (1) Talent policy significantly promotes GTI. After a series of tests, this positive effect is robust. (2) Executive environmental attention mediates this relationship. (3) The positive impact of talent policy is more significant in heavy polluting enterprises and non-state-owned enterprises, as well as in the power sector. These findings enrich the literature on incentive policy and GTI and have important practical implications for enterprises and policymakers.
Anxiety symptoms are differentially associated with facial expression processing in boys and girls
Authors: Doucet Gaelle E , Kruse Jordanna A , Keefe Ahrianna , Rice Danielle L , Coutant Anna T , Pulliam Haley , Smith OgheneTejiri V , Calhoun Vince D , Stephen Julia M , Wang Yu-Ping , White Stuart F , Picci Giorgia , Taylor Brittany K , Wilson Tony W
Published: November 2024

Facial expressions convey important social information and can initiate behavioral change through the processing and understanding of emotions. However, while this ability is known to evolve throughout development, it remains unclear whether this ability differs between girls and boys or how other variables such as level of anxiety can modulate it. Furthermore, understanding the underlying neural mechanisms of facial expression processing and how they are linked by sex and anxiety during development is essential, as alterations in this processing have been associated with psychiatric disorders. Herein, 191 typically developing youth (6- to 15-years old) completed an implicit face processing task involving three facial expressions (angry, happy, and neutral) during functional magnetic resonance imaging. We conducted linear models on the fMRI data to investigate the impact sex and anxiety on brain responses to emotional faces, accounting for age. Our findings indicated a significant anxiety-by-sex interaction in a posterior network covering bilateral visual and medial temporal cortices during the happy > neutral contrast. Specifically, girls with higher anxiety showed weaker activation while boys showed the opposite pattern. These findings suggest that the inter-subject variability reported in typically developing individuals in response to facial emotions may be related to many factors, including sex and anxiety level.
Evaluating imatinib in severe COVID-19: a systematic review and meta-analysis
Authors: Chagas João Pedro Sarcinelli , de Oliveira Juliana Ribeiro , Brandão Vinicius Andreata , Bellucio Ana Paula Brandão , Dutra João Victor de Azevedo , Dutra Julia Ramos , Cerutti Crispim
Published: November 2024

Background

Considering the potential antiviral and immunomodulatory properties of imatinib, this drug has been investigated in several studies as a potential treatment option for severe cases of COVID-19, given that treatment modalities available remain limited.

Objectives

To evaluate the benefits or otherwise of imatinib for COVID-19 in severely ill patients, we performed a systematic review of studies that tested the efficacy and the safety of imatinib for COVID-19 and executed a meta-analysis.

Methods

We searched Medline, Embase and Cochrane with the following search terms: ‘coronavirus’, ‘SARS-Cov2’, ‘covid’, ‘covid-19’ and ‘imatinib’. The latest search date was November 2023. We used Cochrane Collaboration's tool to assess bias in randomized trials.

Results

We included three randomized controlled trials with 561 participants. A total of 276 patients received imatinib and 285 received placebo. The mortality results showed no statistically significant differences between imatinib and controls (RR 0.61; 95% CI 0.37 to 1.01; p=0.06). There was no significant difference in length of hospital stay or severe adverse events occurring between groups.

Conclusions

Current evidence suggests that the potential benefits of imatinib should be further evaluated in randomized controlled trials in patients hospitalized for COVID-19.
Examining the Severity and Progression of Illicitly Manufactured Fentanyl Withdrawal: A Quasi-Experimental Comparison
Authors: Sharma Anjalee , Dunn Kelly E. , Schmid-Doyle Katja , Dowell Sarah , Kim Narie , Strain Eric C. , Bergeria Cecilia
Published: November 2024

Objective

Illicitly manufactured fentanyl has largely replaced heroin throughout the United States. Characteristics of fentanyl-specific withdrawal are not well understood compared to traditional opioid withdrawal. This study examines opioid withdrawal severity among 2 cohorts of study participants who underwent identical morphine stabilization procedures before and after fentanyl was introduced to the local drug market.

Methods

The Non-Fentanyl study (n = 103) included participants testing positive for non-fentanyl opioids, and the Fentanyl study (n = 30) included participants testing positive for fentanyl. Both studies completed a 7-day morphine stabilization protocol (30 mg subcutaneous, 4 times daily) and multiple daily self-report and observer-rated assessments of opioid withdrawal and vital signs. Two-way repeated-measures analyses of variance (ANOVAs) examined the effects of study, time, and study × time on daily peak ratings for each outcome.

Results

There were significant elevations in self-report and observer-rated withdrawal scores among the Fentanyl versus Non-Fentanyl study (study × time, P < 0.05) during stabilization days 2–5 and days 2–6, respectively. There was a higher rate of tachycardia among the Fentanyl group compared to the Non-Fentanyl study, and peak diastolic blood pressure was greater among the Fentanyl study compared to the Non-Fentanyl study.

Conclusions

Individuals with fentanyl exposure were less stabilized by morphine and experienced more severe opioid withdrawal via several metrics compared to persons with non-fentanyl opioid exposure. Withdrawal also remained elevated for several days despite morphine initiation. Adjustments to existing treatment induction protocols may be needed given the permeation of fentanyl into the heroin supply.
Clinical Validation of a Prenatal Cell-Free DNA Screening Test for Fetal RHD in a Large U.S. Cohort
Authors: Gilstrop Thompson Marisa , Xu Wenbo , Moore Bridget , Wang Tina , Sun Nicholas , Pewar Hemant , Avent Neil D. , Vernaza Abelardo , Acosta Felipe , Saben Jessica L. , Souter Vivienne , Parmar Sheetal , Sengupta Urmi , Altug Yucel , EmBree Joshua , Cantos Carlos , Kotwaliwale Chitra , Babiarz Joshua , Zimmermann Bernhard , Swenerton Ryan , Meltzer Jeffrey T.
Published: November 2024

OBJECTIVE:

To present a large U.S. clinical validation of a next-generation sequencing–based, noninvasive prenatal cell-free DNA test for fetal RHD.

METHODS:

This clinical validation study assessed the performance of a commercially available, next-generation sequencing–based cell-free DNA test for fetal RHD status. Samples that passed quality metrics were included if the patient had a previously reported cell-free DNA result for fetal aneuploidy, maternal RhD-negative serology, newborn RhD serology, and maternal RHD deletion or RHD-CE-D hybrid(r's) genotype. Dizygotic twin pregnancies were excluded. Maternal and fetal RHD genotypes were evaluated with prospective cell-free DNA next-generation sequencing analysis. At the time of analysis, investigators were blinded to fetal RhD status.

RESULTS:

The cohort consisted of 655 pregnant patients with serologic results for RhD antigen. Patient demographics included a representative distribution of race and ethnicities in the RhD-negative U.S. population (74.0% White, 13.7% Hispanic, 7.0% Black, and 2.1% Asian). Cell-free DNA fetal RHD was not reported in two cases. There were zero false-negative cases; 356 of 356 fetuses were correctly identified as fetal RhD positive (sensitivity 100%, 95% CI, 98.9–100%). Of the 297 RhD-negative fetuses, 295 were correctly identified as RhD negative (specificity 99.3%, 95% CI, 97.6–99.8%). Of the fetuses with a negative RhD phenotype, the cell-free DNA test accurately identified three with the fetal RHD pseudogene (RHDΨ) genotype.

CONCLUSION:

Validation of this test in this large U.S. cohort of RhD-negative patients provides data on early and accurate noninvasive prenatal identification of fetal RHD genotype at 9 weeks of gestation or more. This test has the potential to assist patients and clinicians in the prevention and management of RhD alloimmunization.
Effects of prolonged cold stress on vascular function in guinea pigs with atherosclerosis
Authors: Guan Wen-Xiang , Lan Zhuo , Wang Qing-Chun , Wa HaoRi , Muren Huhe , Bai Li-Li , Men SiRi , Liu Guo-Qing , Gao Jing-Xian , Bai Chang-Xi
Published: November 2024

Research Objective:

This study explored the effects of long-term cold stress on aortic vascular function in guinea pigs. Research Methods: Hartley guinea pigs (n=32) were divided into following groups: atherosclerosis (AS), cold stress (CS), and menthol-stimulated (M) and control (C). On days 1, 15, 30, 45, and 60, guinea pigs in the AS, CS, and M groups were intraperitoneally injected with bovine serum albumin. The C group was provided with maintenance feed and room-temperature water. The AS group was provided with a high-fat diet and room-temperature water. The CS group was maintained in a refrigerator at 4 °C，while providing a high-fat diet and iced water. The M group was administered menthol solution, and provided with a high-fat diet and room-temperature water. The modeling period lasted for 120 days. On day 121, abdominal aortic sera and aortic samples were obtained after intraperitoneal injection of sodium pentobarbital. Blood rheology tests were conducted to assess blood adhesion, biochemical tests to assess lipid levels, and enzyme-linked immunosorbent assays to detect serum nuclear factor-κB, tumor necrosis factor-α, and interleukin-1β, and endothelial nitric oxide (NO) synthase, NO, and endothelin-1(ET-1) in aortic tissue. Hematoxylin and eosin and Oil Red O staining were used to examine pathologic changes in the aorta, western blotting to detect TRPM8 and PKG protein expression, qPCR was used to measure VCAM-1 mRNA expression level. Research findings: Prolonged exposure to cold stress exacerbated lipid-metabolism disorders in guinea pigs fed a high-fat diet, increased aortic vascular cell adhesion, and exacerbated vascular inflammation, leading to endothelial injury, ultimately worsening pathologic changes associated with aortic atherosclerosis.
Subperiosteal Abscess of the Orbit: Long-term Trends in Bacteriology and Clinical Outcomes and Current Management Recommendations
Authors: Boal Nina S. , Ataei Yasaman , Hong Sang H. , Wells Timothy S. , Griepentrog Gregory J. , Esmaili Neda , Chisholm Smith Ann M. , Harris Gerald J.
Published: November 2024

Purpose:

To evaluate the impact over time of evolving upper respiratory pathogens, modified microbial terminology, and improved laboratory isolation on the bacteriology and management of sinusitis-related subperiosteal abscess of the orbit.

Methods:

Comparative case series of pediatric patients with bacterial sinusitis-related subperiosteal abscess from 2012 to 2022. Outcomes, culture results, age-specific findings, and antibiotic duration were compared with those in 1977 to 1992, 1988 to 1998, 1999 to 2008, and 2002 to 2012 cohorts at the same institution.

Results:

Ninety-one patients met the inclusion criteria. Forty-nine patients (53.8 %) recovered with medical therapy alone; 42 (46.2 %) underwent surgical drainage. There was increased representation in surgical cases of Streptococcus anginosus group (52.4%) and anaerobes (26.2%). Anaerobes were isolated from 2 patients <9 years of age, the youngest age 5; recovery in prior series was limited to patients ≥9 years old. Among 61 of 91 patients <9 years old, 41 (67.2%) were managed medically and 20 (32.8%) underwent surgery. Comparable proportions were 67.5%/32.5%, 85%/15%, and 72%/28% in prior cohorts. Among nonsurgical patients <9 years old, the mean duration of intravenous antibiotics was 4.02 ± 1.2 days. Four patients had multiple admissions. In cases positive for aggressive pathogens, initial findings prompted timely drainage. All patients had favorable visual and systemic outcomes.

Conclusions:

This study extends to 45 years a unique analysis of the bacteriology and clinical course of subperiosteal abscess at a single center with comparatively stable patient demographics and environmental factors, using a relatively uniform treatment algorithm. Despite the increased representation of S. anginosus group and anaerobes, a multifactor protocol with minor modifications remains an effective strategy.
A Case of Supraorbital Hypoesthesia Following Double Orbital Sphere Volume Implant
Authors: Khan Shamir A. , Karowadia Kais M. , Sokol Jason A.
Published: November 2024

The patient is a 63-year-old female with past ocular history of end-stage glaucoma in her OD. To maintain symmetry and achieve cosmesis with her right orbit, she chose to proceed with enucleation of the eye with a donor sclera-wrapped 20-mm silicone sphere implant. After 1 year, she developed right enophthalmos due to volume loss. The patient opted for an additional sphere to be placed posterior to the original sphere. A 14-mm silicone sphere was placed through a lateral orbitotomy into the intraconal space. On postoperative day 1, the patient developed numbness along the V1 trigeminal nerve in the supraorbital region, extending past her hairline. The implant was removed 1 week later, and the authors are currently waiting for nerve recovery. This is a rare and challenging postoperative complication, possibly explained by nerve compression, demyelination, or nerve ischemia.
Rosai-Dorfman Disease of the Lacrimal Sac
Authors: Bothra Nandini , Mishra Dilip K. , Ali Mohammad Javed
Published: November 2024

Extranodal Rosai-Dorfman disease involving the orbit and sinuses is well documented in the literature. However, those involving the lacrimal drainage system alone are rare. A woman presenting with Rosai-Dorfman disease involving the lacrimal drainage system, masquerading as a lacrimal sac malignancy, and its treatment is highlighted in the report described. Minimally invasive treatment for lacrimal drainage system involving Rosai-Dorfman disease in the form of intralesional steroids can be a safe and effective option.
Factor Structure and Measurement Invariance Across Sex of the Sport Concussion Assessment Tool Symptom Inventory
Authors: D'Alonzo Bernadette A. , Barnett Ian J. , Master Christina L. , Hamilton Roy H. , Wiebe Douglas J. , Schneider Andrea L. C. ,   Ivy League-Big Ten Epidemiology of Concussion Study Investigators
Published: November 2024

Objective:

Describe the factor structure of the 22-symptom Sport Concussion Assessment Tool (SCAT), using confirmatory factor analysis (CFA) for a priori hypothesized symptom domains.

Study Design:

Prospective observational study.

Setting/Participants:

Collegiate student-athletes with concussion.

Independent Variables:

Symptoms were collected via the SCAT symptom checklist.

Outcome Measures:

We created symptom domains based on previous literature, guided by clinical expertise. To determine which symptom grouping best represent the data, we used CFA and compared a single-domain model to 3- and 6-domains. We examined fit statistics to assess relative and absolute model fit. Motivated by differences in the prevalence of some individual symptoms by sex in our study, we also examined model invariance by sex to determine if symptoms were being measured as part of the same underlying construct(s).

Results:

Among 1160 concussions (male, n = 667; female, n = 493) between 2015 and 2020, all 3 symptom structures seemed to fit the data well, with 3- and 6-domains fitting better than 1-domain. The 6-domain structure fit the data best with the following domains: headache, vestibulo-ocular, sensory, cognitive, sleep, and affective. All 3 structures showed configural and metric invariance by sex.

Conclusions:

We demonstrate that the SCAT symptom structure is best represented through 6 specific factors; however, the 3-factor model also demonstrated good fit. Key differences between the 3- and 6-domain models may make 1 model more appropriate than the other depending on the research question being addressed. Symptom structures were configurally and metrically invariant by sex, meaning that symptom measures represent symptom domain factors in the same way across sex.
Tracheostomy: update on why, when and how
Authors: Lais Giulia , Piquilloud Lise
Published: November 2024

Purpose of review

The aim of this review is to summarize available data, including the most recent ones, to help develop the best possible strategy regarding the use of tracheostomy in ICU patients requiring prolonged mechanical ventilation or who experience loss of airway-protecting mechanisms.

Recent findings

Tracheostomy facilitates the weaning process by reducing the patient's work of breathing and increasing comfort. It thus allows for a reduction in sedation levels. It also helps with secretions clearance, facilitates disconnection from the ventilator, and enables earlier phonation, oral intake, and mobilization. Despite these advantages, tracheostomy does not reduce mortality and is associated with both early and late complications, particularly tracheal stenosis. The timing of tracheostomy remains a subject of debate, and only a personalized approach that considers each patient's specific characteristics can help find the best possible compromise between avoiding unnecessary delays and minimizing the risks of performing a needless invasive procedure. In the absence of contraindications, the percutaneous single dilator technique under fibroscopic guidance should be the first choice, but only if the team is properly trained.

A step-by-step individualized approach based on the available evidence allows identifying the best strategy regarding the use of tracheostomy in ICU patients.
Association between metabolic dysfunction-associated steatotic liver disease and risk of thyroid cancer: a systematic review and meta-analysis
Authors: Chen JiaHao , Gao YingZheng , Fu Tao , Gu Yi , Du WeiDong
Published: November 2024

Several studies have reported associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of various cancers. However, studies focusing specifically on the association between MASLD and thyroid cancer are relatively limited, and the conclusions drawn, thus, far remain inconclusive. In response, we conducted a meta-analysis of relevant cohort studies to clarify the association between MASLD and the risk of thyroid cancer. We systematically searched the Web of Science, Embase, Cochrane Library, and PubMed databases for articles published before 24 September 2024. We utilized the R software (version 4.4.1) for the comprehensive execution of all statistical analyses. Our meta-analysis included eight cohort studies (six retrospective and two prospective), comprising 18 925 396 participants. The pooled results of the eight cohort studies indicate that MASLD is linked to an increased risk of thyroid cancer (HR = 1.46; 95% CI: 1.14–1.86; I² = 69%; P < 0.01). A random-effects model was employed due to moderate heterogeneity (I² > 50%). Subgroup analyses revealed that the association between MASLD and thyroid cancer risk was stronger in the Chinese population (HR = 2.24; 95% CI: 1.32–3.81; I² = 51%) and among overweight individuals (HR = 1.29; 95% CI: 1.02–1.63; I² = 90%). No significant differences were identified between male and female subgroups. This meta-analysis demonstrates that MASLD increases the risk of developing thyroid cancer.
Alcohol-related liver and extrahepatic malignancies: burden of disease and socioeconomic disparities in 2019
Authors: Danpanichkul Pojsakorn , Suparan Kanokphong , Chaiyakunapruk Nathorn , Auttapracha Thanida , Kongarin Siwanart , Wattanachayakul Phuuwadith , Ramadoss Vijay , Suenghataiphorn Thanathip , Sukphutanan Banthoon , Pang Yanfang , Lui Rashid N. , Yang Ju Dong , Noureddin Mazen , Díaz Luis Antonio , Liangpunsakul Suthat , Arab Juan Pablo , Wijarnpreecha Karn
Published: November 2024

Background

Alcohol is linked to various cancers. While many studies have focused on developed countries, the burden of alcohol-related cancers in developing countries remains underexplored.

Methods

We analyzed data from the Global Burden of Disease Study (2000–2019) to assess mortality and disability-adjusted life years (DALYs) from alcohol-related cancers in low and low-to-middle sociodemographic index (SDI) countries.

Results

In 2019, there were 494 730 mortality from alcohol-related cancer. Low and low-middle SDI countries contributed over 15% of global mortality of alcohol-related cancer. Among multiple types of cancer, other pharyngeal cancers in these countries accounted for over 30% of global mortality of alcohol-related cancer. Primary liver cancer exhibited the highest mortality (n = 16 090) in low and low-middle SDI countries. While deaths and DALYs rates from alcohol-related cancers decreased globally between 2000 and 2019, the related burden increased in low and low-middle SDI countries with a rise in all types of alcohol-related cancers, except for primary liver cancer. The most rapidly growing mortality rates in low SDI were from other pharyngeal cancers (+2.25%), whereas in low-middle SDI countries, colorectal cancer evidenced the highest increase (+2.76%).

Conclusion

The burden from alcohol-related cancer has risen in countries with low and low-to-middle SDI, especially other pharyngeal cancers and colorectal cancer. Policymakers should focus on improving alcohol-related policies as well as screening availability to tackle the associated burden of cancer in resource-constrained countries. However, the difficulty in isolating the impact of alcohol due to limited data on other confounders necessitates caution in interpreting these findings.
Delirium due to any cause is associated with higher resource utilization in patients undergoing liver transplantation: analysis of the National Inpatient Sample
Authors: Singh Carol , Billing Harbir S. , Bhupal Sahiljot Singh , Kohli Isha , Sohal Aalam , Roytman Marina
Published: November 2024

Objective

The only curative treatment for patients with end-stage liver disease (ESLD) is liver transplantation (LT). Patients with ESLD can develop delirium due to multiple etiologies. In this study, we aimed to assess the prevalence and impact of delirium on outcomes and resource utilization among hospitalized patients undergoing LT.

Methods

We used the National Inpatient Sample Database 2016–2020 to identify adult patients undergoing LT. Patients were stratified into two groups based on the presence of delirium. The outcomes studied were in-hospital mortality, perioperative adverse events, and resource utilization. Multivariate logistic and linear regression analysis was used to identify the relationship between delirium and outcomes.

Results

Of 34 405 included patients, 4930 (14.3%) patients had delirium. Patients with delirium had a higher need for renal replacement therapy (31.7% vs. 17.6%, P < 0.001), vasopressor support (16.8% vs. 11.1%, P < 0.001), and mechanical ventilation (34.1% vs. 15.3%, P < 0.001). They also had higher total perioperative complications (77.3% vs. 60.4%, P < 0.001), longer length of stay (34.8 vs. 17. 7, P < 0.001), and total hospitalization charges ($927 200 vs. $565 486 P < 0.001). After multivariable analysis, patients with delirium had higher odds of perioperative complications (adjusted odds ratio: 1.54, 95% confidence interval: 1.24–1.92, P < 0.001) and resource utilization.

Conclusion

Our finding suggests the need for physicians to identify and reverse delirium as soon as possible.
Analysis of independent risk factors for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with cirrhosis combined with diabetes
Authors: Chen Huan , Cai Zihao , Da Binlin , Wang Chunxiang , Yin Qin , Xiao Jiangqiang , Zhang Ming , Zhuge Yuzheng , Zhang Feng
Published: November 2024

Objective

This study aimed to reveal the independent risk factors for overt hepatic encephalopathy (OHE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with decompensated cirrhosis complicated with diabetes.

Patients and methods

This study retrospectively analyzed 126 consecutive patients with cirrhosis combined with diabetes who underwent TIPS in our department from January 2016 to June 2022. The patients were divided into two groups according to the presence or absence of OHE after TIPS. Data were analyzed using the χ2-tests, unpaired t-tests, logistic regression, receiver operating characteristic curves, and Kaplan–Meier curves.

Results

Age and ascites were independent risk factors for OHE after TIPS in patients with cirrhosis and diabetes. Elder patients had a higher risk of postoperative OHE than younger patients [odds ratio (OR): 1.040; 95% confidence interval (CI): 1.003–1.079]. Compared with patients without ascites, patients with ascites were significantly more likely to develop OHE (OR: 3.757; 95% CI: 1.274–11.080; OR: 4.338; 95% CI: 1.069–17.603).

Conclusion

Age and ascites are independent risk factors of post-TIPS OHE in cirrhotic patients with diabetes.
Proximal Muscle Resistance Training to Improve Walking in People With Multiple Sclerosis: A Pilot Study
Authors: Mañago Mark M. , Forster Jeri E. , Biondi Eliza , Schenkman Margaret , Cameron Michelle H. , Christiansen Cory L.
Published: November 2024

Background and Purpose:

This pilot study examined the feasibility of a proximal muscle resistance training program to improve walking in people with multiple sclerosis using a combination of in-person, virtual, and independent exercise sessions.

Methods:

People with multiple sclerosis (Expanded Disability Status Scale Score is <6.0) were recruited to a study of resistance training exercises targeting hip abduction and trunk muscles for 10 weeks. Feasibility criteria were: enrolling 40 participants, retaining ≥80%, ≥80% visit adherence, no serious intervention-related adverse events, and ≥80% satisfaction. The 6-Minute Walk Test, Timed 25-Foot Walk Test, muscle performance (hip abduction and lateral trunk flexion strength, and trunk flexion endurance), patient-reported outcomes, daily step count, and pelvis and trunk kinematics were measured before and after intervention. Patient-reported outcomes and step count were measured again 12 weeks after intervention.

Results:

Twenty-eight people (median Expanded Disability Status Scale is 3.5) enrolled and 92.8% were retained. Visit adherence was 86.5% (96% for virtual visits, 74% for in-person visits), and 48% of participants preferred virtual visits, while 20% preferred in-person visits. There were no serious intervention-related adverse events, and there was 100% satisfaction. Following intervention, 6-Minute Walk Test distance increased 29.6 m (95% confidence interval [CI], 12.2-47.0), Timed 25-Foot Walk Test decreased by 0.57 seconds (95% CI, −0.85 to −0.29), and all muscle performance outcomes improved. Patient-reported outcomes also improved immediately following intervention. There were no changes in average daily step count or trunk and pelvis kinematics.

Discussion and Conclusions:

This proximal muscle resistance training program was feasible, with benefits in walking and muscle strength, warranting a future efficacy study.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A499).
Walking as a Mediator Between Strength and Health-Related Quality of Life in Multiple Sclerosis
Authors: Simaitis Laura B. , Gromisch Elizabeth S. , Demeule Alyssa , Murphy Rhiannon , Palumbo Corinne , DelMastro Heather M.
Published: November 2024

Background and Purpose: Lower limb (LL) weakness and gait impairment are prevalent among persons with multiple sclerosis (PwMS) and can impede functional independence and impact health-related quality of life (HR-QoL). The purpose of this study was to examine the mediation effect of walking speed and perceived walking ability on the relationship between LL weakness and HR-QoL in ambulatory PwMS.

Methods:

Participants (n = 175) were PwMS in this secondary analysis of a cross-sectional study. Demographics, pain (visual analog scale), fatigue (5-item Modified Fatigue Impact Scale), LL strength (hip extensors [HE] and flexors [HF], knee extensors [KE] and flexors [KF], and ankle plantarflexors [APF] and dorsiflexors [ADF]), Timed 25-Foot Walk, 12-item MS Walking Scale, and HR-QoL (MS Impact Scale-Physical [MSIS-29-Phys] and Psychological [MSIS-29-Psych]) were collected. Bivariate and mediation analyses using Hayes’ PROCESS were performed to determine if LL strength had an indirect effect through walking speed or perceived walking ability on physical and psychological HR-QoL while controlling for fatigue and pain.

Results:

There were significant (P < 0.01) correlations for all strength measures with the MSIS-29-Phys and for HF, KE, KF, and APF with the MSIS-29-Psych. In the mediation analyses, LL strength indirectly influenced PwMS’ MSIS-29-Phys through walking speed and perceived walking ability. There was only partial mediation between HE, HF, KF, ADF, and MSIS-29-Phy when walking speed was in the model. LL strength did not influence MSIS-29-Psych.

Discussion and Conclusions:

LL strength impacts physical HR-QoL through walking but does not indirectly affect PwMS’ perceived psychological HR-QoL. These findings may prompt physical therapists to create individualized care plans that address LL weakness and walking impairments with the goal of promoting optimal outcomes and improving HR-QoL.

Video Abstract available

for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A504).
Understanding the Impact of Ergonomic Practices on Musculoskeletal-Related Symptoms and Emotional Wellness in Craniofacial Surgeons
Authors: Scarcella Joshua , Keane Charles A. , Hoque Asef R. , Feczko Robert J. , Janis Jeffrey E.
Published: November 2024

Background:

A systematic review conducted in 2017 found that Musculoskeletal (MSK) injuries were prevalent among surgeons. Few studies have assessed the role that poor surgical ergonomic practices have had in the development of MSK injuries in plastic and reconstructive surgery (PRS), and fewer specifically in craniofacial surgeons. The impact that MSK injuries have on the emotional well-being of craniofacial surgeons is also not well understood.

Methods:

A branched logic survey with a maximum of 35 questions pertaining to surgical practices, MSK injuries, and emotional well-being was distributed to all active attending physicians who were members of the American Society of Maxillofacial Surgeons (ASMS). The responses were divided into 2 groups, surgeons who reported developing MSK injuries or physical discomfort and those who denied developing MSK injuries or physical discomfort. Data analysis was performed to determine which factors contributed to the incidence of MSK injury and the emotional impact that these injuries had on craniofacial surgeons.

Results:

A total of 82 active craniofacial surgeons completed responses to the survey for an overall response rate of 16.6%. Of these respondents, 65.9% (n=54) suffered MSK injuries or physical discomfort, and 53.7% (29/54) reported difficulty with either falling asleep or staying asleep because of these symptoms within the last year. Both male and female respondents reported experiencing some level of anxiety or depression because of their MSK injuries.

Conclusion:

The impact of a MSK injury may impact both physical and emotional wellness of craniofacial surgeons. This study found that a high percentage of craniofacial surgeons have MSK-injuries whereas some have reported a negative impact on their sleep and emotional well-being.
Advancement Flap in Paralateronasal Defect Reconstruction
Authors: Gualtieri Matteo , Scivoletto Giulia , Pitino Francesca , D’Archivio Lanfranco , Valentini Valentino
Published: November 2024

Various techniques for local flap reconstructions of the facial region have been documented in the literature, including the advancement flap. This flap is one of the most versatile options for reconstructing various skin defects across different areas of the body. The purpose of this study is to demonstrate the safety and effectiveness of the advancement flap for reconstructing the paralateronasal region after the excision of skin cancer. The following article presents a retrospective case series of 6 patients in whom the advancement flap was used to reconstruct skin defects resulting from malignant tumor resections in the paralateronasal region. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano, and the study was conducted in collaboration with Sapienza University of Rome, from February 2023 to February 2024. All the flaps settled with no complications, and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the advancement flap turns out to be a rapid and reliable option that could be easily applied for cutaneous defects of the face even for the oldest and/or emaciated patient.
Assembly of Custom Implant and Ready-Made Distractor for Precise Maxillary Movement Vector Control in Cleft Patient With Midfacial Hypoplasia
Authors: Jeong Ye-Eun , Kim Eun-Young , Lee Ui-Lyong
Published: November 2024

This study presents a novel approach for maxillary advancement in a patient with cleft lip and palate, utilizing the assembly of a custom titanium implant and a ready-made distractor. The patient exhibited significant maxillary hypoplasia and had concerns regarding the possible deterioration of hypernasality after conventional surgical methods. Distraction osteogenesis was initiated to address these challenges. A custom plate was designed using 3-dimensional printing technology. Integrating the plates with off-the-shelf distractors enables precise control of the distraction vector to optimize surgical precision and outcomes. The treatment plan involved Le Fort I osteotomy, followed by a distraction protocol that achieved a skeletal Class I relationship and total advancement of 7.5 mm and elongation of 2 mm, with no reported complications. This case demonstrates that combining custom implants with standard distractors can provide precise maxillary repositioning at reasonable costs, while mitigating the risks associated with traditional surgical interventions and reducing the need for secondary corrective surgeries.
The Integration of Nurse Practitioners Into Mass Gathering Medical Teams
Authors: Seiler Sarah , Russ Stephan , McKinney Jared , Panas Ashley
Published: November 2024

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a “treat and release” disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.
Relationship Between Alzheimer Disease Imaging Biomarkers and Performance on the NIH Toolbox Cognition Battery in Late-middle Age Hispanics
Authors: Tahmi Mouna , Rippon Brady , Palta Priya , Sherwood Greysi , Hernandez Gabriela , Soto Luisa , Cespedes Sandino , Pardo Michelle , Laing Krystal , Igwe Kay , Johnson Aubrey , Tomljanovic Zeljko , He Hengda , Gutierrez José , Teresi Jeanne A. , Moreno Herman , Kreisl William , Razlighi Qolamreza , Brickman Adam M. , Luchsinger José A.
Published: November 2024

Purpose:

The National Institute of Health Toolbox Cognition Battery (NIHTB-CB) is increasingly used in Alzheimer disease (AD) research. We examined the relation of AD biomarkers with performance in the NIHTB-CB in late middle age.

Methods:

This is a cross-sectional analysis of 334 Hispanic participants aged 64.22±3.35 years from a study of AD biomarkers. White matter hyperintensities (WMH), infarcts, and cortical thickness in AD regions (CT) were assessed with 3T magnetic resonance imaging. Amyloid and tau were assessed with 18F-Florbetaben and 18F-MK6240 positron emission tomography, respectively.

Results:

Lower CT and infarcts were associated with worse Oral Reading Recognition and Cognition Crystallized Composite scores. Lower CT and higher WMH were associated with worse Pattern Comparison Processing Speed. Amyloid and tau were not associated with any test.

Discussion:

Amyloid and tau, the culprits of AD, are not related to the NIHTB-CB in late middle age. Continued follow-up will reveal if AD impacts performance on the NIHTB-CB.
Assessment of Knowledge, Attitude, and Practice Towards the First Aid Management of Foreign Body Aspiration and Obstruction Among Parents of Children Visited Sphmmc, Addis Ababa, Ethiopia
Authors: Hailu Yohannes , Yifru Sisay
Published: November 2024

Background

Foreign body aspiration and obstruction are the main cause of accidental death in childhood, and Foreign bodies (FBs) in the aerodigestive tract provide diagnostic and therapeutic problems and are significant sources of morbidity and mortality. Lack of community awareness toward the FBA presentation and its management further aggravate the problem. Despite this, there are very few studies in this area which necessitates further study. Therefore the present study may help as an output to increase parents’ awareness towards immediate first aid intervention, in preventing delayed healthcare access and intervention at a community level in general.

Objective

Assessing the knowledge, attitude, and practice towards the first aid management of foreign body aspiration and obstruction among parents of children coming to St. Paul’s Hospital Millennium Medical College.

Methods

A descriptive-based cross-sectional study was carried out in the study area using pretested, structured, and self-administered questionnaires. The collected data was analyzed using SPSS version 25. Multiple logistic regression analysis was used to identify factors associated with the Knowledge, attitude, and practice of parents towards first aid management of foreign body aspiration and obstruction.

Results

A total of 423 parents were involved in the study. Only 218 (51.5%) of them were knowledgeable. Most of the respondents (76.3%) had a positive attitude towards foreign body that foreign body aspiration needs immediate intervention, and 75 (17.7%) faced a child who aspirated foreign body. Of these, only 53 (70.7%) had provided first aid to the victim. Most of the respondents 40 (75.5%)had scored below 80% of practice towards foreign body aspiration and obstruction. Multiple Logistic Regression Analysis showed that parents who are literates were 3.6 times more knowledgeable than those illiterates. (AOR:3.612, 95% CI: 1.758, 7.420, P≤0.05).

Conclusions

The level of knowledge and skills for providing first aid for foreign body aspiration, and obstruction in children among parents are low. So education and increasing awareness among them to reduce morbidity and mortality in children suffering from aspiration and obstruction from foreign bodies has to be one of the strategies.
Tau Aggregation is Altered by Variations in its Projection Domain
Authors: Mason-Chalmers Kayleigh , Sachdeva Aanzan , Kolk Gabryelle , Touchon Justin C. , Donhauser Zachary J.
Published: November 2024

The intrinsically disordered microtubule-associated protein tau is known for its aberrant aggregation into neurofibrillary tangles as found in neuropathologies such as Alzheimer’s disease. This study compares three N-terminal isoforms of R5L and of wild type tau to investigate how this mutation and the length of the projection domain affects aggregation behavior. The total amount of polymerization was analyzed using a thioflavin S assay where tau aggregation is induced using arachidonic acidin vitro. Tau polymers were also analyzed using atomic force microscopy imaging to compare tau filament lengths and morphologies. We observed that the R5L mutation has a greater impact on filament length in shorter N-terminal isoforms of tau, whereas in longer N-terminal isoforms the mutation impacts the total amount of tau aggregation. These observations suggest that the R5L mutation affects the kinetic nucleation-elongation pathway of tau fibrillization, where the mutant impacts nucleation in 2N and 1N isoforms, but has a more significant impact on elongation in the 0N isoform.
THE BRAIN-MESH MODEL: A UNIFIED FRAMEWORK FOR NEURAL SYNCHRONY, PLASTICITY, AND COHERENCE
Authors: Ballús Andreu
Published: November 2024

The brain-mesh model introduces a novel three-layered architecture that integrates local and macro-regional connectivity with an underlying, mesh-inspired network layer. This foundational mesh layer, based on metallic mesh structures, spans the entire brain and generates interference patterns, noise, and resonance effects that modulate both local and global neural dynamics. The fused model goes beyond traditional connectivity frameworks by providing a unified explanation for phenomena such as brain-wide phase gradients, stable low-frequency resonance frequencies, and long-range plasticity effects, which are often difficult to explain cohesively within existing models.

In addition to accounting for classical neurobiological observations—such as phase synchrony, functional connectivity fluctuations, and local Hebbian plasticity—the fused model offers novel insights into less understood phenomena. Specifically, it predicts connectivity-independent phase gradients across non-synaptic regions, harmonic resonance peaks consistent across individuals, and diffuse plasticity driven by global interference patterns, all of which are challenging to explain under current frameworks.

These unique predictions align with partial empirical observations, such as traveling wave dynamics, consistent low-frequency oscillations, and task-induced connectivity shifts, underscoring the model’s relevance. Additionally, the brain-mesh model generates testable hypotheses that distinguish it from traditional approaches, providing a promising framework for future experimental validation and opening new avenues for understanding global brain function.
The tetrapod fauna of the upper Permian Naobaogou Formation of China: a new mid-sized pareiasaurYinshanosaurus angustusgen. et sp. nov. and its implication for the phylogenetic relationship of pareiasaurs
Authors: Yi Jian , Liu Jun
Published: November 2024

Pareiasauria is a specialized clade of herbivorous tetrapods that existed throughout Pangaea during the mid to late Permian period. The phylogenetic relationships of Chinese pareiasaur species remain controversy for several decades, primarily due to the poor preservation of known specimens. Until the report ofShihtienfenia completusin 2019, no complete skull had been documented for Chinese pareiasaurs. The present study describes a mid-sized pareiasaur,Yinshanosaurus angustusgen. et sp. nov., based on a nearly complete skull and an articulated partial postcranial skeleton collected from the Naobaogou Formation in 2018. It presents several significant new morphological features such as high and narrow skull, with the length of the skull table exceeding the width between the two quadratojugals; snout dimension as high as wide; long frontal with a length-to-width ratio of ∼3.0; U-shaped paraoccipital process in occipital view; and maxillary teeth oriented vertically, with only 7-9 cusps. Although the phylogenetic framework of pareiasaurs still requires further refinement, the current analysis yields distinct phylogenetic positions for Chinese pareiasaurs and establishes a new monophyletic clade that includesS.completusandY.angustus.