bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Two Novel QTL for Fusarium Head Blight Resistance in German Wheat Cultivar Centrum
Authors: Ren Hui , Zhang Xin , Zhang Yibo , Zhang Ziyang , Cheng Muzi , Zhang Lu , Zhang Xiangxue , Li Chunchun , Duan Jiangli , Zhang Chuanliang , Xiang Mingjie , Liu Shengjie , Jiang Chengzhi , Zeng Qingdong , Wu Jianhui , Kang Zhensheng , Yang Zujun , Li Chunlian , Huang Shuo , Han Dejun
Published: March 2024

Fusarium head blight (FHB) is a devastating disease that occurs in warm and humid environments. The German wheat ‘Centrum’ has displayed moderate to high levels of FHB resistance in the field for many years. In this study, an F6:8 recombinant inbred line (RIL) population derived from cross ‘Centrum’ × ‘Xinong 979’ was evaluated for FHB response following point inoculation in five environments. The population and parents were genotyped using the GenoBaits Wheat 16 K Panel. Stable quantitative trait loci (QTL) associated with FHB resistance in ‘Centrum’ were mapped on chromosome arms 2DS and 5BS. The most effective QTL, located in 2DS, was identified as a new chromosome region represented by a 1.4 Mb interval containing 17 candidate genes. Another novel QTL was mapped in chromosome arm 5BS of a 5BS to 7BS translocation chromosome. In addition, two environmentally sensitive QTL were mapped on chromosome arms 2BL from ‘Centrum’ and 5AS from ‘Xinong 979’. Polymorphisms of flanking phenotypic variance explained (PVE) markers (allele-specific quantitative PCR [AQP]) AQP-6 for QFhb.nwafu-2DS and 16K-13073 for QFhb.nwafu-5BS were validated in a panel of 217 cultivars and breeding lines. These markers could be useful for marker-assisted selection (MAS) of FHB resistance and provide a starting point for fine mapping and marker-based cloning of the resistance genes.
The Effect of Boxwood Leaf Volatiles on Conidial Germination of Calonectria pseudonaviculata, the Causal Agent of Boxwood Blight
Authors: Ohkura Mana , Beck Bryan R. , Scagel Carolyn F. , Weiland Jerry E.
Published: March 2024

The fungal pathogen Calonectria pseudonaviculata causes boxwood blight and is a significant threat to the boxwood industry, as well as historic boxwood gardens. The pathogen produces conidia in sticky masses that are splash dispersed, which germinate and infect through stomata on the leaves or stems, causing leaf spots and stem lesions. Despite its ability to cause severe infections on boxwood plants, the pathogen often has a low germination rate on artificial media under lab conditions. To identify cues that stimulate germination, we explored whether host factors could induce high germination rates. In this study, we demonstrate that C. pseudonaviculata spores achieve high germination rates when they are placed on detached leaves of boxwood and other known hosts, compared to potato dextrose agar and glass coverslips. We also demonstrate that germination is induced by volatiles from detached leaves of boxwood, as well as the nonhost Berberis thunbergii. When C. pseudonaviculata spores were exposed to volatiles from boxwood leaves in the presence of ethylene scrubber packs that contained potassium permanganate, the stimulatory effect on spore germination was reduced. However, ethylene, a regulator of leaf senescence, did not stimulate germination of C. pseudonaviculata spores. This suggests that the pathogen may have evolved to recognize one or more host volatiles, other than ethylene to induce germination, thus limiting its growth until it senses the presence of a host plant.
Pragmatic Approach to In Situ Simulation to Identify Latent Safety Threats Before Moving to a Newly Built ICU
Authors: Sarwal Aarti , Morris Nicholas A. , Crumpler Janet , Gordon Terri , Saunders Ian , Johnson James E. , Carter Jeff E.
Published: March 2024

OBJECTIVES:

Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU.

DESIGN:

Descriptive review of a patient safety initiative.

SETTING:

A newly built 24-bed neurocritical care unit at a tertiary care academic medical center.

SUBJECTS:

Care providers working in neurocritical care unit.

INTERVENTIONS:

We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with “test” patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose.

MEASUREMENTS AND MAIN RESULTS:

We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats.

CONCLUSIONS:

In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units.
Impact of Early Mobilization Within the Intensive Care Unit After Coronary Artery Bypass Grafting: A Systematic Review
Authors: Thomas Bini , Morgan Sandra , Smith James M.
Published: March 2024

Purpose:

Coronary artery bypass grafting (CABG) surgery treats complications from coronary artery diseases, and its recovery traditionally consisted of bedrest. Recent research emphasizes the benefits of early mobilization for hospitalized patients. However, the functional outcomes and effectiveness of early mobilization for persons within the intensive care units after CABG has not been investigated thus far. The objective of this review was to determine the effectiveness of early mobilization in reducing hospital and intensive care unit length of stay (LoS) and improving functional outcomes of persons after CABG.

Methods:

This study was registered with PROSPERO and followed PRISMA guidelines. PubMed, Embase, CINAHL, and PEDro databases were searched using MeSH terms. Studies with early mobilization interventions for adults in the intensive care unit after CABG that recorded outcomes of LoS or functioning were included. Methodological quality was measured using the PEDro scale and Oxford Level of Evidence.

Results:

This systematic review collectively addressed 2280 participants through 14 studies in 7 countries. The initiation time frames for early mobilization varied, with the majority beginning within 24 to 48 hours after surgery and interventions were heterogenous. Early mobility was found to be effective in reducing atelectasis, improving oxygen saturation, and decreasing time spent on mechanical ventilation. Among early mobilization participants, the LoS was reduced in all studies; intensive care unit LoS decreased by one day or greater in 6 of 14 studies, and hospital LoS decreased by one day or greater in 5 of 7 studies.

Conclusions:

Data analysis found that early mobilization achieved better functional outcomes. It was found that implementing early mobilization led to decreased intensive care and hospital lengths of stay, reduced atelectasis and pleural effusion, and improved functional and respiratory outcomes in persons who underwent CABG surgery.
Changes in Perampanel Pharmacokinetics and Cytochrome P450 3A4 Activity Before, During, and After Pregnancy
Authors: Yamamoto Yoshiaki , Akita Naoto , Nogimoto Hiroki , Suzuki Wakana , Imai Katsumi , Takahashi Yukitoshi , Kagawa Yoshiyuki
Published: March 2024

This study evaluated perampanel pharmacokinetics and cytochrome P450 3A4 (CYP3A4) activity, assessed using the level of 4β-hydroxycholesterol (4β-OHC) as an endogenous biomarker of CYP3A4, before, during, and after pregnancy in a woman with epilepsy and compared these measurements with those from a control group of nonpregnant women with epilepsy. A 21-year-old pregnant woman was being treated with perampanel (serum concentration: 1120 ng/mL), lacosamide, and lamotrigine. After the first trimester, the lamotrigine concentration decreased markedly; however, the perampanel concentration remained almost unchanged (range, 1130–1320 ng/mL). Similarly, serum 4β-OHC levels did not change during pregnancy (before pregnancy, 78.2 ng/mL; during pregnancy, 62.2–83.2 ng/mL). To compare these measurements with those in nonpregnant women, we enrolled 27 nonpregnant women with epilepsy (age range, 16–40 years). In the control patients, we found a strong negative correlation between the concentration-to-dose ratio of perampanel and the 4β-OHC level (r = −0.78, P < 0.001). As there was no significant change in CYP3A4 activity, we concluded that the serum perampanel concentration did not change significantly before, during, or after pregnancy. More patients need to be studied to confirm these early results.
A randomized multicenter trial of a chronic disease management intervention for decompensated cirrhosis. The Australian Liver Failure (ALFIE) trial
Authors: Wigg Alan J. , Narayana Sumudu , Woodman Richard J. , Adams Leon A. , Wundke Rachel , Chinnaratha Mohamed A. , Chen Bin , Jeffrey Gary , Plummer Joan-Lee , Sheehan Vanessa , Tse Edmund , Morgan Joanne , Huynh Dep , Milner Margery , Stewart Jeffrey , Ahlensteil Golo , Baig Asma , Kaambwa Billingsley , Muller Kate , Ramachandran Jeyamani
Published: March 2024

Background and Aims:

Improving the care of decompensated cirrhosis is a significant clinical challenge. The primary aim of this trial was to assess the efficacy of a chronic disease management (CDM) model to reduce liver-related emergency admissions (LREA). The secondary aims were to assess model effects on quality-of-care and patient-reported outcomes.

Approach and Results:

The study design was a 2-year, multicenter, randomized controlled study with 1:1 allocation of a CDM model versus usual care. The study setting involved both tertiary and community care. Participants were randomly allocated following a decompensated cirrhosis admission. The intervention was a multifaceted CDM model coordinated by a liver nurse. A total of 147 participants (intervention=75, control=71) were recruited with a median Model for End-Stage Liver Disease score of 19. For the primary outcome, there was no difference in the overall LREA rate for the intervention group versus the control group (incident rate ratio 0.89; 95% CI: 0.53–1.50, p=0.666) or in actuarial survival (HR=1.14; 95% CI: 0.66–1.96, p=0.646). However, there was a reduced risk of LREA due to encephalopathy in the intervention versus control group (HR=1.87; 95% CI: 1.18–2.96, p=0.007). Significant improvement in quality-of-care measures was seen for the performance of bone density (p<0.001), vitamin D testing (p<0.001), and HCC surveillance adherence (p=0.050). For assessable participants (44/74 intervention, 32/71 controls) significant improvements in patient-reported outcomes at 3 months were seen in self-management ability and quality of life as assessed by visual analog scale (p=0.044).

Conclusions:

This CDM intervention did not reduce overall LREA events and may not be effective in decompensated cirrhosis for this end point.
Efficacy of a Novel Antibiotic Drug Combination Toward Multidrug-Resistant Ocular Pathogens
Authors: Gowtham Lakshminarayanan , Wozniak Rachel A. F. , Dunman Paul M. , Sheba Esther , Garg Prashant , Joseph Joveeta
Published: March 2024

Purpose:

Antimicrobial resistance is a global health threat, compounded by the reduction in the discovery of new antibiotics. A repurposed drugs-based approach could provide a viable alternative for the treatment of multidrug-resistant (MDR) bacterial infections. In this study, we sought to evaluate the in vitro efficacy of a novel drug combination, polymyxin B/trimethoprim (PT) + rifampin on MDR isolates from patients with bacterial keratitis in India.

Methods:

Forty-three isolates, which included 20 Staphylococcus aureus, 19 Pseudomonas aeruginosa, 3 Pseudomonas stutzeri, and 1 Acinetobacter baumannii, were evaluated for their antibiotic resistance by minimum inhibitory concentration (MIC). Fractional Inhibitory Concentration Index (FICI) testing was performed to measure the antimicrobial impact of PT + rifampin in combination.

Results:

Among S. aureus isolates, 100% were resistant to at least 1 antibiotic class, 12 (60%) were MDR, and 14 (70%) were classified as methicillin-resistant. Among the gram-negative isolates, >90% were classified as MDR. Fractional Inhibitory Concentration (FIC) testing revealed that PT + rifampin was effective in completely inhibiting growth of all isolates while also displaying additive or synergistic activity in approximately 70% of the strains. Mean FICI values were 0.753 ± 0.311 and 0.791 ± 0.369 for S. aureus and gram-negative isolates, respectively, and a >2-fold reduction in MIC was measured for both PT and rifampin when tested in combination versus alone.

Conclusions:

Our data demonstrate the ability of PT + rifampin to eliminate all isolates tested, even those conferring MDR, highlighting the promise of this drug combination for the treatment of bacterial keratitis.
Drug-Induced Liver Injury During a Glaucoma Neuroprotection Clinical Trial
Authors: Shukla Aakriti Garg , Cioffi George A. , Liebmann Jeffrey M.
Published: March 2024

There are several ongoing, worldwide clinical trials with a cumulative target enrollment of over 1300 participants on the role of nicotinamide (a specific form of vitamin B3) as a therapeutic neuroprotective treatment for glaucoma. We describe a serious adverse event of drug-induced liver injury (DILI) likely related to the use of 3 g/day nicotinamide in a glaucoma clinical trial (clinicaltrials.gov identifier: NCT05695027) based in the United States. This report is important to share with the medical community, as other participants in glaucoma nicotinamide trials globally may have similar adverse events and many patients are using nicotinamide as a health supplement without medical supervision. We recommend that investigators, physicians, and patients remain vigilant about DILI as they seek novel vision-preserving neuroprotective therapies.
The Increase in Household Transmission of Pertussis Associated With Diagnostic Delays
Authors: Arakkal Alan T. , Cavanaugh Joseph E. , Polgreen Philip M. , Miller Aaron C.
Published: March 2024

Background:

Pertussis is a highly contagious respiratory illness that can be especially dangerous to young children. Transmission of pertussis often occurs in household settings and is impacted by the timing of treatment and postexposure chemoprophylaxis. This study analyzes the risk for secondary household transmission and if delays in diagnosing pertussis increased the risk for household transmission.

Methods:

We conducted 2 population-based studies using a large nationally representative administrative claims database. The first study utilized a stratified monthly incidence model to compare the incidence of pertussis among enrollees exposed to a family member with pertussis versus those not exposed. The second study was conducted at a household level following the index case of pertussis in each household. We identified diagnostic delays in the initial household case and used a logistic regression model to evaluate if such delays were associated with a greater risk for transmission.

Results:

The incidence rate ratio of pertussis was 938.99 [95% confidence interval (CI): 880.19–1001.73] among enrollees exposed to a family member with pertussis relative to those not exposed. The odds of secondary household transmission in households where the index case experienced a diagnostic delay was 5.10 (CI: 4.44–5.85) times the odds of transmission when the index case was not delayed. We found that longer delays were associated with a greater risk for secondary household transmission (P < 0.0001).

Conclusions:

There is a high rate of secondary transmission of pertussis in household settings. Diagnostic delays increase the likelihood that pertussis will transmit in the household.
Is SARS-CoV-2 Now More Like the Seasonal Coronaviruses Following Its Evolution?
Authors: Bayhan Gülsüm İclal , Altan Işıl , Mercan Halise , Özkaya Parlakay Aslınur , Coşkun Zehra Nihan , Dinç Bedia , Gülhan Belgin , Kanık-Yüksek Saliha
Published: March 2024

Background:

SARS-CoV-2 has evolved significantly since the beginning of the COVID-19 pandemic. COVID-19 mortality has decreased due to increased population immunity and possibly the reduced intrinsic severity of the new variants. SARS-CoV-2 is now considered an endemic virus, but the extent to which its clinical findings resemble those of seasonal coronaviruses (sCoV) is not fully understood.

Methods:

Pediatric patients under 18 years of age who were sent for SARS-CoV-2 polymerase chain reaction real-time reverse transcription polymerase chain reaction between January 1, 2022 and January 14, 2023 and whose results were positive were included in this study. To include only symptomatic COVID-19 patients in the study, asymptomatic patients who were positive in their screening tests were excluded. For the sCoV patients’ group, patients who had a respiratory viral polymerase chain reaction assay between January 10, 2022 and January 11, 2023 and were positive for any type of sCoV were included in the study. The 2 groups were compared for clinical and laboratory characteristics.

Results:

The study included 213 patients with COVID-19 and 194 patients with sCoV infection. Fever was a more common symptom in patients with COVID-19. sCoV was associated with lower respiratory involvement while increasing age was protective. The likelihood of hospitalization was decreased by increasing age but increased by the presence of comorbid conditions and lower respiratory tract involvement. The type of virus had no effect on the likelihood of hospitalization.

Conclusions:

In conclusion, sCoV infections carry a higher risk for lower respiratory involvement than COVID-19, and COVID-19 has a milder course than sCoV infections in children.
Enterococcal Central Nervous System Infections in Children: A 22 Years’ Experience in a Tertiary Center and Review of the Literature
Authors: Schnapp Aviad , Elber-Dorozko Sergei , Temper Violeta , Gordon Oren , Averbuch Dina
Published: March 2024

Background:

Enterococcal meningitis in children is rare, and its clinical presentation, laboratory characteristics and outcomes are not well defined.

Methods:

We conducted a retrospective analysis of Enterococcal meningitis cases during 2002–2023 at our tertiary center.

Results:

We identified 10 cases in children 2 weeks to 15 years old (median age: 8 months). Seven children were males and 9 had comorbidities, including a ventriculoperitoneal shunt in 5 children. All children with shunt infections presented with nonspecific signs and symptoms. While 8 children presented with fever, only 3 had signs of meningeal irritation and altered consciousness. Cerebrospinal fluid pleocytosis was evident in almost all children with a median of 173 cells/mL. Nine cases were due to Enterococcus faecalis, and 1 case was due to E. faecium. All 5 children with ventriculoperitoneal shunt underwent shunt removal and replacement. All children recovered without documented sequelae.

Conclusions:

Enterococcal meningitis is rare, especially in healthy neonates. It typically occurs following neurosurgical interventions and may only present with fever and shunt malfunction, without overt meningeal signs and with mild inflammation. The prognosis is favorable.
Invasive Squamous Cell Carcinoma Arising From a Cystic Brow Mass
Authors: Li Chloe Y. , Weiss Madison E. , Coombs Allison V. , Yu Sun , Kazim Michael
Published: March 2024

An 82-year-old woman presented with a 6-month history of an enlarging brow mass that developed after trauma. Clinical and MRI appearance of the lesion appeared consistent with epidermal inclusion cyst. However, excisional biopsy demonstrated invasive squamous cell carcinoma, which recurred 6 weeks later and required repeat surgical excision. To our knowledge, this represents the first case of squamous cell carcinoma arising from a posttraumatic epidermal inclusion cyst.
Effects of reduction in intraocular pressure after trabeculotomy on axial length and intraocular lens selection
Authors: Kanda Satoru , Fujishiro Takashi , Karakawa Ayako , Nakagawa Suguru , Ishii Kiyoshi
Published: March 2024

Purpose:

To investigate the relationship between intraocular pressure (IOP) and axial length (AL) and to compare the refractive predicted error in patients who have undergone cataract surgery alone or in combination with trabeculotomy.

Setting:

Hospital.

Design:

Single-center, retrospective, case–control.

Methods:

The medical records of patients who had undergone cataract surgery alone or in combination with trabeculotomy using the Tanito microhook were retrospectively reviewed. Patients were grouped into cataract surgery alone (CAT) or cataract surgery combined with trabeculotomy (LOT) groups. Demographic data, preoperative and postoperative IOP and AL, and surgically induced astigmatism (SIA) were analyzed before and 1 month postoperatively to evaluate the interplay between IOP, AL, and refractive outcomes.

Results:

52 eyes (52 patients) underwent LOT, and 67 eyes (67 patients) underwent CAT. The mean IOP at baseline did not differ between the groups; the change in IOP (dIOP) was significantly higher in the LOT group than in the CAT group. The mean AL at baseline and the change in AL (dAL) were 24.0 ± 1.2 mm and 0.16 ± 0.11 mm, respectively, in the LOT group, and 23.8 ± 1.1 mm and 0.11 ± 0.070 mm, respectively, in the CAT group. The difference in dAL was also significant. In the LOT group, dIOP and dAL were significantly correlated. The mean SIA vectors did not significantly differ between the groups.

Conclusions:

AL decreased because of the reduction in IOP after cataract surgery combined with trabeculotomy. Consequently, the refractive target error was greater, and the postoperative refractive outcome showed a tendency toward hyperopia.
The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis
Authors: Zhang Chenxiong , Tan Hao , Xu Han , Ding Jiaming
Published: March 2024

Background:

Rectal cancer poses a significant global health burden. There is a lack of concrete evidence concerning the benefits of robotic-assisted surgery (RAS) for rectal cancer surgery as compared to laparoscopic and open techniques. To address this gap, we conducted a meta-analysis to assess the intraoperative, postoperative, and safety outcomes of robotic surgery in this context.

Research methodology:

A search of MEDLINE, Scopus and the Cochrane Library. Randomized and non-randomized studies up to February 2, 2024 comparing robotic surgery versus laparoscopic or open surgery for rectal cancer. The outcomes of interest were operative time, blood loss, harvested lymph nodes, conversion rate, postoperative hospital stay, survival to hospital discharge, urinary retention rate, and anastomotic leakage rate. A random-effects meta-analysis was performed to pool means and dichotomous data to derive weighted mean differences and odds ratios, respectively.

Results:

A total of 56 studies were shortlisted after the study selection process with a total of 25 458 rectal cancer patients. From the intraoperative outcomes, RAS was significantly associated with an increased operative time (WMD: 41.04, P<0.00001), decreased blood loss (WMD: −24.56, P<0.00001), decreased conversion rates (OR: 0.39, P<0.00001), lesser stay at the hospital (WMD: −1.93, P<0.00001), and no difference was found in lymph nodes harvested. Similarly, RAS group had a significantly greater survival to hospital discharge (OR: 1.90, P=0.04), decreased urinary retention rate (OR: 0.59, P=0.002), and no difference was seen in anastomotic leakage rate.

Conclusion:

RAS demonstrates favorable outcomes for rectal cancer patients, contributing to global prevention and control efforts, health promotion, and addressing non-communicable disease risk factors. Further research and public awareness are needed to optimize RAS utilization in this context.
Metabolic tumor burden as a prognostic indicator after neoadjuvant chemotherapy in pancreatic cancer
Authors: Lee Woohyung , Oh Minyoung , Kim Jae Seung , Sung Minkyu , Hong Kwangpyo , Kwak Bong Jun , Park Yejong , Jun Eunsung , Song Ki Byung , Hwang Dae Wook , Lee Jae Hoon , Yoo Changhoon , Kim Kyu-pyo , Park Inkeun , Jeong Jae Ho , Chang Heung-Moon , Ryoo Baek-Yeol , Lee Jung Bok , Kim Song Cheol
Published: March 2024

Background:

There is no standardized assessment for evaluating response although neoadjuvant chemotherapy (NAT) is widely accepted for borderline resectable or locally advanced pancreatic cancer (BRPC or LAPC). This study was aimed to evaluate NAT response using positron emission tomography (PET) with 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG-PET/CT) parameters alongside carbohydrate antigen (CA) 19-9 levels.

Methods:

Patients who underwent surgery after NAT for BRPC and LAPC between 2017 and 2021 were identified. The study assessed the prognostic value of PET-derived parameters after NAT, determining cutoff values using the K-adaptive partitioning method. It created four groups based on the elevation or normalization of PET parameters and CA19-9 levels, comparing survival between these groups.

Results:

Of 200 eligible patients, FOLFIRINOX and gemcitabine-based NAT was administered in 166 and 34 patients, respectively (mean NAT cycles, 8.3). In a multivariate analysis, metabolic tumor volume (MTV) demonstrated the most robust performance in assessing response [hazard ratio (HR) 3.11, 95% confidence interval (CI) 1.73–5.58, P<0.001] based on cutoff value of 2.4. Patients with decreased MTV had significantly better survival than those with elevated MTV among individuals with CA19-9 levels less than 37 IU/l (median survival; 35.5 vs. 20.9 months, P<0.001) and CA19-9 levels at least 37 IU/l (median survival; 34.3 vs. 17.8 months, P=0.03). In patients suspected to be Lewis antigen negative, the predictive performance of MTV was found to be limited (P=0.84).

Conclusion:

Elevated MTV is an influential prognostic factor for worse survival, regardless of post-NAT CA19-9 levels. These results could be helpful in identifying patients with a poor prognosis despite normalization of CA19-9 levels after NAT.
An MRI radiomics approach to discriminate haemorrhage-prone intracranial tumours before stereotactic biopsy
Authors: Zhang Yupeng , Cao Tingliang , Zhu Haoyu , Song Yuqi , Li Changxuan , Jiang Chuhan , Ma Chao
Published: March 2024

Purpose:

To explore imaging biomarkers predictive of intratumoral haemorrhage for lesions intended for elective stereotactic biopsy.

Method:

This study included a retrospective cohort of 143 patients with 175 intracranial lesions intended for stereotactic biopsy. All the lesions were randomly split into a training dataset (n=121) and a test dataset (n=54) at a ratio of 7:3. Thirty-four lesions were defined as “hemorrhage-prone tumors” as haemorrhage occurred between initial diagnostic MRI acquisition and the scheduled biopsy procedure. Radiomics features were extracted from the contrast-enhanced T1 Weighted Imaging and T2 Weighted Imaging images. Features informative of haemorrhage were then selected by the LASSO algorithm, and an Support Vector Machine model was built with selected features. The Support Vector Machine model was further simplified by discarding features with low importance and calculating them using a “permutation importance” method. The model’s performance was evaluated with confusion matrix-derived metrics and area under curve (AUC) values on the independent test dataset.

Results:

Nine radiomics features were selected as haemorrhage-related features of intracranial tumours by the LASSO algorithm. The simplified model’s sensitivity, specificity, accuracy, and AUC reached 0.909, 0.930, 0.926, and 0.949 (95% CI: 0.865–1.000) on the test dataset in the discrimination of “hemorrhage-prone tumors”. The permutation method rated feature “T2_gradient_firstorder_10Percentile” as the most important, the absence of which decreased the model’s accuracy by 10.9%.

Conclusion:

Radiomics features extracted on contrast-enhanced T1 Weighted Imaging and T2 Weighted Imaging sequences were predictive of future haemorrhage of intracranial tumours with favourable accuracy. This model may assist in the arrangement of biopsy procedures and the selection of target lesions in patients with multiple lesions.
Long-term cardiovascular risk reduction after gastric cancer surgery: a nationwide cohort study
Authors: Kwon Yeongkeun , Kim Dohyang , Kim Sangwoo , Ha Jane , Hwang Jinseub , Park Sungsoo , Kwon Jin-Won
Published: March 2024

Background:

Gastrectomy for gastric cancer is associated with postoperative changes in cardiovascular risk factors, however, the impact of gastrectomy on cardiovascular events remains unclear. The authors assessed the incidence of cardiovascular events between patients undergoing gastrectomy or endoscopic resection for gastric cancer, and the general population.

Materials and methods:

This retrospective nationwide cohort study included patients with gastric cancer undergoing gastrectomy (n=37 698), endoscopic resection (n=2773), and matched control population (n=161 887) between 2004 and 2013. The authors included patients without a history of cancer other than gastric cancer, myocardial infarction, or ischemic stroke. The primary outcome was the incidence of major adverse cardiovascular events (MACE) such as acute myocardial infarction, revascularization, or acute ischemic stroke, in patients with gastric cancer.

Results:

Among patients who underwent gastrectomy for gastric cancer, 2.9% (4.69 per 1000 person-years) developed novel MACE within the 1-year follow-up period. The gastrectomy group demonstrated a significantly decreased risk for MACE than the control population [hazard ratio (HR), 0.65; 95% CI: 0.61–0.69; P<0.001). Among the patients undergoing endoscopic resection for gastric cancer, 5.4% (8.21 per 1000 person-years) developed novel MACE within the 7-year follow-up period. The risk for MACE in the endoscopic resection group was not significantly different from the control population.

Conclusion:

Patients with gastric cancer who have undergone gastrectomy exhibit a reduced risk of cardiovascular diseases in comparison to the general population. In contrast, the risk for cardiovascular diseases in patients with gastric cancer who underwent endoscopic resection did not demonstrate a significant difference in cardiovascular risk in comparison to the general population.
Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study
Authors: Chen Yin , jiang Jiahong , He Min , Zhong Kuiyan , Tang Shuai , Deng Li , Wang Yanzhou
Published: March 2024

Background:

Total laparoscopic hysterectomy (TLH) is the most commonly performed gynaecological surgery. However, the difficulty of the operation varies depending on the patient and surgeon. Subsequently, patient’s outcomes and surgical efficiency are affected. The authors aimed to develop and validate a preoperative nomogram to predict the operative difficulty in patients undergoing TLH.

Methods:

This retrospective study included 663 patients with TLH from Southwest Hospital and 102 patients from 958th Hospital in Chongqing, China. A multivariate logistic regression analysis was used to identify the independent predictors of operative difficulty, and a nomogram was constructed. The performance of the nomogram was validated internally and externally.

Results:

The uterine weight, history of pelvic surgery, presence of adenomyosis, surgeon’s years of practice, and annual hysterectomy volume were identified as significant independent predictors of operative difficulty. The nomogram demonstrated good discrimination in the training dataset [area under the receiver operating characteristic curve (AUC), 0.827 (95% CI, 0.783–0.872], internal validation dataset [AUC, 0.793 (95% CI, 0.714–0.872)], and external validation dataset [AUC, 0.756 [95% CI, 0.658–0.854)]. The calibration curves showed good agreement between the predictions and observations for both internal and external validations.

Conclusion:

The developed nomogram accurately predicted the operative difficulty of TLH, facilitated preoperative planning and patient counselling, and optimized surgical training. Further prospective multicenter clinical studies are required to optimize and validate this model.
Perioperative outcomes and long-term survival of cryosurgery on unresectable pancreatic cancer: a systematic review and meta-analysis
Authors: Xue Kang , Liu Xiaofeng , Xu Xiaolin , Hou Shengzhong , Wang Li , Tian Bole
Published: March 2024

Background:

Pancreatic cancer (PC) continues to rank as one of the deadliest forms of cancer, with the majority of patients being diagnosed with unresectable disease. The implementation of cryoablation-based comprehensive treatment is expected to lead to a reduction in tumour size and potentially achieve complete resection. However, the availability of systematic and evidence-based treatment guidelines for cryoablation in pancreatic cancer is currently limited.

Materials and methods:

A computerized search was conducted in the Medline, Embase, Cochrane Library databases, and Clinicaltrials to retrieve studies published from August 1987 to June 2023. The perioperative outcomes and long-term survival of patients with locally advanced pancreatic cancer (LAPC) or metastatic pancreatic cancer (mPC) who underwent cryosurgery were systematically collected. Heterogeneity was assessed using Cochran’s Q test, and a funnel plot was implemented to evaluate publication bias. Data were pooled and analyzed using Stata 14.0 software. The Newcastle–Ottawa Quality Assessment Form tool was employed for quality evaluation.

Results:

Nine studies, including 368 patients, were identified. The pooled overall incidence rate was 4% (95% CI: 0–14%; I²=54.06%) for acute pancreatitis, 0% (95% CI: 0–0%; I²=0.0%) for delayed gastric emptying, 0% (95% CI: 0–1%; I²=0.0%) for postoperative pancreatic fistula (POPF) or bile leakage, 2% (95% CI: 0–5%; I²=0.0%) for bleeding, and 4% (95% CI: 0–12%; I²=70.46%) for fever. The subgroup analysis revealed that the percutaneous treatment group had a lower incidence of complications compared to laparotomy but had higher incidences of POPF, bleeding, and pancreatitis than the intraoperative group. Median overall survival (OS) varied from 5 to 16.2 months. The median survival rates at 6, 12, 24, and 36 months for patients who underwent cryosurgery were as follows: 94.9%, 64.8% (range: 4.8–63.1%), 22.80%, and 9.5%, respectively.

Conclusion:

With the advancements in cryoablation and anti-tumour therapy, cryoablation has emerged as a promising treatment modality for patients with unresectable pancreatic cancer. According to existing literature, the combination of cryoablation with radioactive particle implantation or immunotherapy has demonstrated considerable efficacy and safety. However, while the majority of included data is derived from retrospective studies, it is imperative to conduct larger sample sizes or prospective trials for further validation.
Controversies in terlipressin and transplantation in the United States: How do we MELD the two?
Authors: Przybyszewski Eric M. , Wilechansky Robert M. , McLean Diaz Paige , Allegretti Andrew S. , VanWagner Lisa B. , Cullaro Giuseppe , Levitsky Josh , Ginès Pere , Piano Salvatore , Asrani Sumeet K. , Patidar Kavish R. ,   from the HRS-Harmony Consortium
Published: March 2024

Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a severe complication of cirrhosis that carries a poor prognosis. The recent Food and Drug Administration approval of terlipressin has substantial implications for managing HRS-AKI and liver allocation in the United States. Terlipressin has been available in Europe for over a decade, and several countries have adapted policy changes such as Model for End-Stage Liver Disease (MELD) score “lock” for HRS-AKI. In this article, we outline the European experience with terlipressin use and explore the question of whether terlipressin treatment for HRS-AKI should qualify for the MELD score “lock” in the United States in those who respond to therapy. Arguments for the MELD lock include protecting waitlist priority for terlipressin responders or partial responders who may miss offers due to MELD reduction in the terlipressin treatment window. Arguments against MELD lock include the fact that terlipressin may produce a durable response and improve overall survival and that equitable access to terlipressin is not guaranteed due to cost and availability. We subsequently discuss the proposed next steps for studying terlipressin implementation in the United States. A successful approach will require the involvement of all major stakeholders and the mobilization of our transplant community to spearhead research in this area.
Gut motility and hormone changes after bariatric procedures
Authors: Gala Khushboo , Ghusn Wissam , Abu Dayyeh Barham K.
Published: March 2024

Purpose of review

Metabolic and bariatric surgery (MBS) and endoscopic bariatric therapies (EBT) are being increasingly utilized for the management of obesity. They work through multiple mechanisms, including restriction, malabsorption, and changes in the gastrointestinal hormonal and motility.

Recent findings

Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) cause decrease in leptin, increase in GLP-1 and PYY, and variable changes in ghrelin (generally thought to decrease). RYGB and LSG lead to rapid gastric emptying, increase in small bowel motility, and possible decrease in colonic motility. Endoscopic sleeve gastroplasty (ESG) causes decrease in leptin and increase in GLP-1, ghrelin, and PYY; and delayed gastric motility.

Understanding mechanisms of action for MBS and EBT is critical for optimal care of patients and will help in further refinement of these interventions.
Isolated injury, Charlson Comorbidity Index, and transfer from another facility are associated with delay in antibiotic administration: a retrospective study of 963 patients with open fractures
Authors: Pease Tyler J. , Ducas G. Wells , Raffetto Michael L. , Bernard Andrew C. , Martin Jalen A. , Matuszewski Paul E.
Published: March 2024

Purpose:

To identify factors associated with delays in administration and pharmacy and nursing preparation of antibiotics for patients with open fractures.

Design:

Retrospective review.

Setting:

Level I trauma center.

Patients:

Nine hundred sixty-three adults with open fractures administered antibiotics.

Main Outcome Measurements:

Delay in antibiotic administration greater than 66 minutes from arrival and significant pharmacy-related and nursing-related delay.

Results:

Isolated injury, Charlson Comorbidity Index, and transfer from another facility were associated with delay in antibiotic administration greater than 66 minutes. Injury Severity Score, transfer, and trauma team activation were associated with pharmacy-related or nursing-related delay.

Conclusion:

Interventions to reduce antibiotic administration time for open fractures should focus on early identification of open fractures and standardization of antibiotic protocols to ensure timely administration even in complex or resource-scarce care situations.

Level of Evidence:

Prognostic level III.
68Ga-FAPI PET/CT in an Interesting Case of Metastatic Pulmonary Meningioma
Authors: Purohit Priyavrat , Mittal Bhagwant Rai , Kumar Rajender , Singh Harmandeep , Shukla Jaya , Bal Amanjit , Singh Navneet
Published: March 2024

Meningiomas are one of the major primary CNS tumors. Most meningiomas are benign, but rarely, these metastasize to distant organs, the lungs being the commonest site of metastasis. 18F-FDG PET/CT has been used to evaluate metastatic pulmonary meningioma. However, 68Ga-FAPI PET/CT has not yet been evaluated. The present case highlights the 68Ga-FAPI uptake in metastatic pulmonary meningioma in a postoperated case of left tentorial meningioma presenting with lung masses. Image-guided biopsy from the lung mass was consistent with metastatic meningioma.
Inferior Alveolar Nerve Repositioning With the Computer-Aided Design in Hemimandibular Hyperplasia
Authors: Liao Zhiling , Zhu Zihe , Wu Guomin
Published: March 2024

A 34-year-old man presented with facial asymmetry and was diagnosed with left-sided hemimandibular hyperplasia. Orthognathic surgery and mandibular angle osteotomy combined with inferior alveolar nerve repositioning were performed with computer-aided design. The facial asymmetry was successfully corrected with acceptable cosmetic results. Inferior alveolar nerve repositioning provided sufficient space for the osteotomy of the affected side with the abnormal mandibular canal. Inferior alveolar nerve repositioning with computer-aided design can be used as an effective and reliable technique for hemimandibular hyperplasia.
Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Meizoso Jonathan P. , Cotton Bryan A. , Lawless Ryan A. , Kodadek Lisa M. , Lynde Jennifer M. , Russell Nicole , Gaspich John , Maung Adrian , Anderson Christofer , Reynolds John M. , Haines Krista L. , Kasotakis George , Freeman Jennifer J.
Published: March 2024

INTRODUCTION

Whole blood (WB) resuscitation has reemerged as a resuscitation strategy for injured patients. However, the effect of WB-based resuscitation on outcomes has not been established. The primary objective of this guideline was to develop evidence-based recommendations on whether WB should be considered in civilian trauma patients receiving blood transfusions.

METHODS

An Eastern Association for the Surgery of Trauma working group performed a systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation methodology. One Population, Intervention, Comparison, and Outcomes question was developed to analyze the effect of WB resuscitation in the acute phase on mortality, transfusion requirements, infectious complications, and intensive care unit length of stay. English language studies including adult civilian trauma patients comparing in-hospital WB to component therapy were included. Medline, Embase, Cochrane CENTRAL, CINAHL Plus, and Web of Science were queried. GRADEpro (McMaster University; Evidence Prime, Inc.; Ontario) was used to assess quality of evidence and risk of bias. The study was registered on International Prospective Register of Systematic Reviews (CRD42023451143).

RESULTS

A total of 21 studies were included. Most patients were severely injured and required blood transfusion, massive transfusion protocol activation, and/or a hemorrhage control procedure in the early phase of resuscitation. Mortality was assessed separately at the following intervals: early (i.e., emergency department, 3 hours, or 6 hours), 24 hours, late (i.e., 28 days or 30 days), and in-hospital. On meta-analysis, WB was not associated with decreased mortality. Whole blood was associated with decreased 4-hour red blood cell (mean difference, −1.82; 95% confidence interval [CI], −3.12 to −0.52), 4-hour plasma (mean difference, −1.47; 95% CI, −2.94 to 0), and 24-hour red blood cell transfusions (mean difference, −1.22; 95% CI, −2.24 to −0.19) compared with component therapy. There were no differences in infectious complications or intensive care unit length of stay between groups.

CONCLUSION

We conditionally recommend WB resuscitation in adult civilian trauma patients receiving blood transfusions, recognizing that data are limited for certain populations, including women of childbearing age, and therefore this guideline may not apply to these populations.

LEVEL OF EVIDENCE

Systematic Review/Meta-Analysis; Level III.
Convergently evolved placental villi show multiscale structural adaptations to differential placental invasiveness
Authors: Laundon Davis , Sengers Bram G. , Thompson James , Harris Shelley E. , Beasley Olivia , Basford Philip J. , Katsamenis Orestis L. , Goggin Patricia , Derisoud Emilie , Fanelli Diana , Bocci Carlotta , Camillo Francesco , Shotton Justine , Constable-Dakeyne Georgina , Gostling Neil J. , Chavatte-Palmer Pascale , Lewis Rohan M.
Published: March 2024

Despite having a single evolutionary origin and conserved function, the mammalian placenta exhibits radical structural diversity. The evolutionary drivers and functional consequences of placental structural diversity are poorly understood. Humans and equids both display treelike placental villi, however these villi evolved independently and exhibit starkly different levels of invasiveness into maternal tissue (i.e. the number of maternal tissue layers between placental tissue and maternal blood). The villi in these species therefore serve as a compelling evolutionary case study to explore whether placentas have developed structural adaptations to respond to the challenge of reduced nutrient availability in less invasive placentas. Here, we use three-dimensional X-ray microfocus computed tomography and electron microscopy to quantitatively evaluate key structures involved in exchange in human and equid placental villi. We find that equid villi have a higher surface area to volume ratio and deeper trophoblastic vessel indentation than human villi. Using illustrative computational models, we propose that these structural adaptations have evolved in equids to boost nutrient transfer to compensate for reduced invasiveness into maternal tissue. We discuss these findings in relation to the ‘maternal–fetal conflict hypothesis’ of placental evolution.
Ultimate drivers of forced extra-pair copulations in birds lacking a penis: jackdaws as a case-study
Authors: Hooper Rebecca , Maher Kathryn , Moore Karen , McIvor Guillam , Hosken David , Thornton Alex
Published: March 2024

Forced copulation is common, presumably because it can increase male reproductive success. Forced extra-pair copulation (FEPC) occurs in birds, even though most species lack a penis and are widely thought to require female cooperation for fertilization. How FEPC persists, despite a presumed lack of siring success and likely non-negligible costs to the male, is unknown. Using the jackdaw (
Corvus monedula
) as a case study, we use SNPs to quantify the extra-pair paternity rate through FEPC and evaluate explanations for the persistence of FEPC in species without a penis. We then collate evidence for FEPC across penis-lacking birds. Combining genetic and behavioural analyses, our study suggests that the most likely explanations for the maintenance of FEPC in jackdaws are that it provides a selective advantage to males or it is a relic. Our literature review shows that across birds lacking a penis, FEPC is taxonomically widespread, and yet, little is known about its evolution. A broader implementation of the approach used here, combining both genetic and behavioural data, may shed light on why this widespread sexual behaviour persists. Additional work is necessary to understand whether a penis is needed for paternity through forced copulation and to quantify the costs of FEPC.