bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Costs and Proceedings Otherwise Than in Open Court
Authors: Tan Paul , Goh Nelson , Lim Jonathan
Published: June 2024

This chapter discusses the assessment of costs by an arbitral tribunal, as well as the confidentiality of court proceedings relating to arbitration, with reference to Sections 21, 22, and 23 of the IAA. Section 21 of the IAA addresses the assessment of costs and provides that an award for costs would be taxable by the Registrar of the Singapore International Arbitration Centre unless the award otherwise directs. Section 22 of the IAA provides that proceedings under the IAA are to be heard in private although a court, on its own motion, or the application by a person (including a non-party), could order proceedings to be heard in open court. Section 23 provides that, to the extent that a hearing is heard in camera, the court may give directions as to whether, and if so what, information relating to the proceedings may be published.
Recognition and Enforcement of Foreign Awards
Authors: Tan Paul , Goh Nelson , Lim Jonathan
Published: June 2024

This chapter explores the recognition and enforcement of foreign awards, with a focus on the provisions in Part III of the IAA. The chapter begins with a discussion of Sections 27 and 28 of the IAA, which sets out the scope and interpretation of Part III of the IAA. It then discusses Sections 29 and 30, which set out the procedure for enforcement of foreign awards. The chapter then examines Section 31, which sets out the grounds for refusing enforcement of a foreign award under Part III of the IAA. It discusses in detail the following provisions: Section 31(2)(f), which provides that Singapore courts may refuse the enforcement of a foreign award if the award has not yet become binding, was set aside, or suspended; Section 31(3), which provides for the partial non-recognition of a foreign award; and Section 31(5), which provides that a Singapore court may adjourn an application to enforce a foreign award, if it is satisfied that an application for the setting aside or suspension of the award has been made in the seat of arbitration. The chapter concludes with a discussion of Section 33, which provides for the enforcement of awards under other provisions of law.
Intellectual Property and Private International Law
Authors: Torremans Paul L C
Published: June 2024

Intellectual property has traditionally been regulated on a territorial basis. However, the protection and commercial exploitation of intellectual property rights such as patents, trade marks, designs, and copyright occurring across borders are now seldom confined to one jurisdiction. Nationally protected trade marks are now used globally on websites and copyright material is distributed, communicated, and copied in a world without borders. Patents have already been licensed on a transnational basis for several decades. This book considers how the introduction of a foreign element inevitably raises potential problems of private international law, ranging from establishing which court has jurisdiction and which is the applicable law to securing the recognition and enforcement of foreign judgments. As such, intellectual property and private international law, two distinct legal disciplines, are increasingly obliged to cooperate. This new edition encompasses the numerous and sometimes major legal developments seen over the past 12 years: the new Court of Justice of the European Union case law on Article 7.2 Brussels I Regulations, and its divergent approach to Eurasian Economic Union intellectual property rights; recent EU directives and national case law, including the fundamental change in patent law that will result from the introduction of the European Patent with Unitary Effect and the Unified Patent Court; as well as the implications of Britain's departure from the European Union. The book is a systematic and comprehensive analysis of the topic that will be welcomed by practitioners and scholars alike.
Infringement: Jurisdiction Under the European Union/European Free Trade Association Rules
Authors: Torremans Paul L C
Published: June 2024

This chapter explores the provisions related to jurisdiction under the European Union/European Free Trade Association rules and their application in infringement cases. After Brexit, the Brussels I Regulation and the Lugano Convention no longer apply in the UK and can no longer form a basis of jurisdiction for UK courts. However, even without the provisions, an action for infringement will be treated as a civil and commercial matter. On the other hand, an action for infringement of an intellectual property right brought against the European Commission must be heard by the Court of Justice instead of a national court. The chapter also considers the correlation between infringement, licensing agreements, and settlement agreements.
Complementary Torts and Other Causes of Action: Jurisdiction
Authors: Torremans Paul L C
Published: June 2024

This chapter looks into the wide variety of causes of action under English and foreign law, which are complementary to the tort of infringement. It notes that the causes of action include passing-off, malicious falsehood, defamation, unfair competition, wider Continental protection in delict, breach of competition rules, and breach of confidence. Moreover, most of the actions are considered tortious. The chapter also considers the overlap between the common law and the Continental civil law approaches. It elaborates on the substantive law, jurisdictional provisions, and problems of other causes of action like passing-off and breach of competition rules and confidence.
Creation, Scope, and Termination of Intellectual Property Rights: The Applicable Law
Authors: Torremans Paul L C
Published: June 2024

This chapter looks into the creation, scope, and termination of intellectual property rights in correlation with the applicable law. It clarifies that conventions do not provide a complete conflict of laws rule to address all issues. Thus, national treatment means foreign works, inventions, or marks can rely on the domestic intellectual property laws of the country where protection is sought. The chapter explains how negative rights are mainly relevant and mainly raise choice of law issues at the infringement stage. It then details how choice of law problems arise in multiple ways such as international exploitation of inventions and copyright works.
Choice of Law Reform
Authors: Torremans Paul L C
Published: June 2024

This chapter notes the concept of choice of law reform. It primarily focuses on the absence of a choice made by the parties in contracts in relation to intellectual property, ubiquitous, and multi-State cases about infringement (tort), issues of contributory liability, and the security interests in intellectual property. Many of the existing jurisdiction provisions are somewhat dated if one wishes to use that word in an internet and intellectual property context. Modern circumstances of the exploitation of intellectual property rights suggested a need for reform. The chapter also notes the emergence of security interests in intellectual property which inevitably correlates to private international law.
Effects of asymmetric jurisdiction clauses under the Recast and 2007 Lugano Convention and their relationship with Third State court proceedings
Authors: Marshall Brooke
Published: June 2024

This Chapter explores the effects of asymmetric jurisdiction agreements under the EU’s Brussels I Recast Regulation and 2007 Lugano Convention before EU Member State courts. It examines the particular circumstance where multiple proceedings are on foot — whether in two EU Member State courts or in one EU Member State court and one Third State court — and at least one of those proceedings is pursuant to an asymmetric clause. The Chapter addresses the issue of effects by asking what the intended and actual effects of asymmetric jurisdiction agreements on the competence of EU Member State courts are, and which court should decide these questions. The Chapter demonstrates that the Brussels I Recast Regulation will, in some intra-EU cases and in many cases involving a Third State, produce a result that the parties, or at least the drafting party, did not intend. It suggests two key solutions for asymmetric jurisdiction clauses in circulation.
NEO212, temozolomide conjugated to NEO100, exerts superior therapeutic activity over temozolomide in preclinical chemoradiation models of glioblastoma
Authors: Minea Radu O , Thein Thu Zan , Yang Zhuoyue , Campan Mihaela , Ward Pamela M , Schönthal Axel H , Chen Thomas C
Published: June 2024

Background

The chemotherapeutic standard of care for patients with glioblastoma (GB) is radiation therapy (RT) combined with temozolomide (TMZ). However, during the twenty years since its introduction, this so-called Stupp protocol has revealed major drawbacks, because nearly half of all GBs harbor intrinsic treatment resistance mechanisms. Prime among these are the increased expression of the DNA repair protein O6-guanine-DNA methyltransferase (MGMT) and cellular deficiency in DNA mismatch repair (MMR). Patients with such tumors receive very little, if any, benefit from TMZ. We are developing a novel molecule, NEO212 (TMZ conjugated to NEO100), that harbors the potential to overcome these limitations.

Methods

We used mouse models that were orthotopically implanted with GB cell lines or primary, radioresistant human GB stem cells, representing different treatment resistance mechanisms. Animals received NEO212 (or TMZ for comparison) without or with RT. Overall survival was recorded, and histology studies quantified DNA damage, apoptosis, microvessel density, and impact on bone marrow.

Results

In all tumor models, replacing TMZ with NEO212 in a schedule designed to mimic the Stupp protocol achieved a strikingly superior extension of survival, especially in TMZ-resistant and RT-resistant models. While NEO212 displayed pronounced radiation-sensitizing, DNA-damaging, pro-apoptotic, and anti-angiogenic effects in tumor tissue, it did not cause bone marrow toxicity.

Conclusions

NEO212 is a candidate drug to potentially replace TMZ within the standard Stupp protocol. It has the potential to become the first chemotherapeutic agent to significantly extend overall survival in TMZ-resistant patients when combined with radiation.
Recommendations for Updating Fever and Inflammation of Unknown Origin From a Modified Delphi Consensus Panel
Authors: Wright William F , Stelmash Lauren , Betrains Albrecht , Mulders-Manders Catharina M , Rovers Chantal P , Vanderschueren Steven , Auwaerter Paul G ,   International Fever and Inflammation of Unknown Origin Research Working Group, Baicus Cristian , Bharucha Tehmina , Bor David , Bosilkovski Mile , Brown Michael , Carroll Karen , Fusco Francesco Maria , Harris Gavin , Naito Toshio , Oyen Wim JG , Pascal Seve , Rowe Steven , Rupali Priscilla , Saxinger Lynora , Teruhiko Terasawa , Yenilmez Ercan , Zenone Thierry
Published: June 2024

Background

Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are syndromes commonly used as medical diagnoses. Since the existing literature has a mixture of diagnostic approaches, developing consensus-based recommendations would be helpful for clinicians, researchers, and patients.

Methods

A modified Delphi process was performed from October 2022 to July 2023, involving 4 rounds of online surveys and 2 live video conferences. The panel comprised international experts recruited based on peer-reviewed published publications and studies.

Results

Among 50 invited experts, 26 (52.0%) agreed to participate. Twenty-three panelists completed round 1 of the survey, 21 completed rounds 2 and 3, 20 completed round 4, and 7 participated in round 5 live video discussions. Of the participants, 18 (78.3%) were academic-based clinicians and researchers, 5 (21.7%) practiced in a community-based hospital, and 6 (26.1%) were female. Consensus was reached on 5 themes: (1) incorporating epidemiologic factors, such as geographic location and travel history; (2) updated criteria for classifying FUO or IUO; (3) initial evaluation approaches; (4) a classification system for diagnoses; and (5) recommendations for judicious limitation of empiric therapies. Experts strongly disagreed with using 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography as part of the diagnostic criteria for FUO. There were mixed opinions about the importance of the temperature measurement site, the 3-week minimum illness criterion, the need for a standard definition of relapsing fevers, and the use of similar evaluation strategies for FUO and IUO.

Conclusions

These Delphi-generated consensus-based recommendations offer potential improvements compared with earlier definitions and a guide for clinical practice and future research.
Sceptical hypotheses and subjective indistinguishability
Authors: Doerksen Lisa
Published: June 2024

The notion of subjective indistinguishability has long played a central role in explanations of the force of Cartesian sceptical hypotheses. I argue that sceptical hypotheses do not need to be subjectively indistinguishable to be compelling and I provide an alternative diagnosis of their force that explains why this is the case. My diagnosis focuses on the relation between one's experiences and third-personal accounts of the circumstances in which these experiences occur. This relation is characterized by a distinctive gap that leaves room for questions about the nature of one's circumstances, providing sceptical hypotheses with a foothold. I argue that this gap lends sceptical hypotheses their force and renders the stipulation of subjective indistinguishability unnecessary.
Variation in perceptions of genital ablation between aspiring eunuchs and individuals with paraphilic sexual fantasies
Authors: Agapoff Jamie , Wassersug Richard J , Johnson Thomas W , Wibowo Erik
Published: June 2024

Background

Although uncommon, some individuals assigned male at birth (AMAB) seek voluntary genital ablative procedures, and others fantasize about it.

Aim

To learn more about the views of genital ablation and injuries in those who aspire to be castrated as compared with those who only fantasize about it.

Methods

A survey was run on the Eunuch Archive internet community. Content analysis was conducted on the responses of 342 AMAB individuals with castration fantasy but no desire for actual surgery (fantasizers) vs 294 AMAB individuals who expressed a desire for genital ablation (aspiring).

Outcomes

Study outcomes were responses to open-ended questions about genital ablations and injury.

Results

Aspiring individuals were more likely to perceive a “physical appearance benefit” from orchiectomy, but fewer could recall how they first learned about the procedure. Some reasons that aspiring persons gave for desiring an orchiectomy included “achieving preferred self” and “health reasons.” Fantasizers, in contrast, worried about the potential side effects of orchiectomy, and more believed there to be no benefit to it.

Clinical Implications

Psychiatrists and other clinicians need to understand their patients’ views on genital ablation to properly diagnose and provide the best personalized care.

Strengths and Limitations

Strengths include a large sample of respondents. Limitations include the accuracy of the anonymous survey data.

Conclusions

This study demonstrates divergent interests on genital ablation among AMAB individuals who have not had an any genital ablation yet have intense interest in the topic.
The role of primary care in improving health outcomes in young foster children
Authors: Sitzman Carol , Quincy Brenda
Published: June 2024

Children removed from their biological families because of abuse, neglect, and/or violence have increased healthcare needs and are susceptible to poor health outcomes compared with children who are not in the child welfare system. Developmental delays occur in about 75% of children in foster care. Up to 80% of children entering out-of-home care have at least one physical health problem and more than 40% experience educational challenges. In most US states, newly removed children are required to have a medical evaluation shortly after placement in a foster or kinship family. The initial evaluation is important for identifying urgent concerns and developing a rapport with children who may not have had regular medical care. In addition, the child's complete social, trauma, and medical history may be unknown because of system barriers such as inconsistent medical care by biological parents, privacy laws protecting records, and unavailability of birth histories and biological parents' medical and psychosocial histories. As a result, a series of visits is required to fully evaluate the child's development and healthcare needs. This article provides guidance for physician associates/assistants who provide care to children in foster care.
Be the Qualitative Researcher
Authors: Morgan Deidra D. , Hargett Jennifer L. , McBride Melissa M. , Princiotta Allison L. , Riddick Johnna C. , Tullos Stephanie S.
Published: June 2024

A team-based, active learning activity was created to facilitate undergraduate nursing students’ understanding of qualitative research concepts. Working in small groups, students utilized the full-text lyrics of albums by recording artist Taylor Swift to analyze phrasing, create a qualitative coding scheme, code the data, and create a content and thematic analysis. The students then collaboratively created a Google Slide to present their findings for the class. An anonymous postactivity survey indicated greater student satisfaction with this activity than with traditional didactic lectures.
Iatrogenic Sciatic Nerve Injury in Posterior Acetabular Surgery: Surgeon More Predictive Than Position
Authors: Schaffer Nathaniel E. , Luther Lauren , Ponce R. Brandon , Wrenn Sean P. , Cave Joseph R. , Moreno-Diaz A. Fidel , Morris Cade A. , Tatman Lauren M. , Mitchell Phillip M.
Published: June 2024

OBJECTIVES:

To identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher–Langenbeck approach and to evaluate if variation among individual surgeons exists.

METHODS:

Design:

Retrospective cohort.

Setting:

Level I trauma center.

Patient Selection Criteria:

Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022.

Outcome Measures and Comparisons:

The prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and the presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high-volume (>1 patient/month) and low-volume surgeons.

RESULTS:

A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39 years, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% confidence interval [CI], 1.9%–4.9%) and lateral (3.3%, 95% CI, 1.3%–8.1%) positions (P = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for positions (odds ratio 1.0, 95% CI, 0.3–3.9). Transverse fracture pattern was associated with increased palsy risk (odds ratio 3.0, 95% CI, 1.1–7.9). Individual surgeon was significantly associated with iatrogenic palsy (P < 0.02).

CONCLUSIONS:

Surgeon and the presence of a transverse fracture line predicted iatrogenic nerve palsy after a posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the Kocher–Langenbeck approach for acetabular fixation in the position they deem most appropriate, as the position was not associated with the rate of iatrogenic palsy in this series.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Epidemiology of Pediatric Firearm Injuries in the United States: The Progression of Gunshot Injury Rates Through the Coronavirus Disease 2019 Pandemic
Authors: Welbeck Arakua , Torres-Izquierdo Beltran , Mittal Mehul M. , Momtaz David , Gonuguntla Rishi , Guisse Ndéye , Hu Jesse , Pereira Daniel E. , Hosseinzadeh Pooya
Published: June 2024

Objectives:

Ballistic injuries among pediatric populations have become a public health crisis in the United States. The surge in firearm injuries among children has outpaced other causes of death. This study aims to assess the trend in pediatric gunshot injuries (GSIs) over the last decade and investigate the impact, if any, of the pandemic on GSIs statistics.

Methods:

A comprehensive retrospective analysis was conducted using a federated, real-time national database. A total of 15,267,921 children without GSIs and 6261 children with GSIs between 2017 and 2023 were identified. The study evaluated the incidence and annual proportions of GSIs among different demographics. In addition, the incidence proportions per 100,000 for accidental, nonaccidental, fracture-related, and fatal GSIs were analyzed.

Results:

The incidence proportions per 100,000 for GSIs, accidental GSIs, nonaccidental GSIs, fatal GSIs, wheelchair-bound cases, and fracture-related GSIs increased significantly from 2017 to 2023, going from 9.7 to 22.8 (Relative Risk: 2.342, 95% CI: 2.041, 2.687, P < 0.001). The overall increase was mostly a result of accidental GSI when compared with nonaccidental (incidence proportion 25.8 vs 2.1; P < 0.001) in 2021 at the height of the pandemic. In patients with an accidental GSI, the incidence proportion per 100k between 2017 and 2023 increased from 8.81 to 21.11 (Relative Risk: 2.397, 95% CI: 2.076, 2.768, P < 0.001).

Conclusion:

The study supports the shift in the leading cause of death among children from motor vehicle accidents to GSIs, with the continued rise in rates despite the coronavirus disease 2019 pandemic. Accidental injuries constituted the majority of GSIs, indicating the need for enhanced gun safety measures, including requirements for gun storage, keeping firearms locked and unloaded, requiring child supervision in homes with guns, and enforcing stricter punishments as penalties. Comprehensive efforts are required to address this public health crisis. Pediatricians play a vital role in counseling and educating families on firearm safety.

Level of Evidence:

Level III.
An Exploration of the Supportive Care Needs of Caribbean Families of Critically Ill Adults
Authors: Burlar Amy , Conroy Shelley
Published: June 2024

Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU.
How Grounded Are Our Ideals? Rethinking Nursing's Covenant of Care
Authors: Wolfs Dorolen
Published: June 2024

Covenant has been used to describe the special relationship between nurses and patients yet has been misunderstood in nursing literature. Covenantal elements of keeping promises and nurturing relationship resonate with the work of nursing. However, unlimited devotion puts the nurse at risk for exploitation and burnout. One's conceptualization of covenant is important because it impacts beliefs about allegiance, identity, and responsibilities. This article offers a critical analysis of how the conceptualization of covenant in nursing literature compares to a theological understanding of covenant. The covenantal dimension of a nurse's practice is reframed from the nurse–patient relationship to a professional–societal relationship.
A Free Bypass Flap for Chronic Limb-threatening Ischemia
Authors: Umekawa Kohei , Kurabayashi Takashi , Asato Hirotaka , Iida Takuya , Suzuki Ayako , Tasaki Masanori
Published: June 2024

Background:

Recently, significant inframalleolar disease seems to increase in chronic limb-threatening ischemia (CLTI) patients, making identifying sufficient outflow vessels in the foot challenging. In these difficult situations, free tissue transfer is a valuable tool to provide a low-resistance vascular bed to the affected part. However, there remains concern that free tissue transfer may impede adequate perfusion of the higher resistance diseased vascular bed.

Methods:

To improve perfusion of the affected area directly, the authors have developed a concept of a free bypass flap, adding bypass surgery to free tissue transfer. After anastomosis with the recipient vessels in a conventional manner for free tissue transfer, bypass surgery to the foot is performed by anastomosis of the branch of the flap pedicle with the diseased artery to the foot. A retrospective chart review of nine CLTI patients was performed to analyze the outcomes of free bypass flap transfer between 2018 and 2023.

Results:

The flap success rate was 100% (n = 9). Postoperative angiography or echo confirmed the patency of all but one bypass vessel (n = 8). There were six fatalities, however, due to causes other than foot lesions, with an average observation period of 16 months. The limb salvage rate was 89% (n = 8).

Conclusions:

A free bypass flap enhances the overall blood circulation to the foot. Due to its high patency rate of bypass vessels, it is a valuable method for preserving the limbs of highly comorbid patients with CLTI.
A Single-center Comparison of Surgical Outcomes following Prepectoral and Subpectoral Implant-based Breast Reconstruction
Authors: Villanueva Karie , Patel Harsh , Ghosh Durga , Klomhaus Alexandra , Slack Ginger , Festekjian Jaco , Da Lio Andrew , Tseng Charles
Published: June 2024

Background:

Prepectoral implant placement continues to gain widespread acceptance as a safe and effective option for breast reconstruction. Current literature demonstrates comparable rates of complications and revisions between prepectoral and subpectoral placement; however, these studies are underpowered and lack long-term follow-up.

Methods:

We performed a retrospective cohort study of patients who underwent immediate two-staged tissue expander or direct-to-implant breast reconstruction at a single center from January 2017 to March 2021. Cases were divided into prepectoral and subpectoral cohorts. The primary outcomes were postoperative complications, aesthetic deformities, and secondary revisions. Descriptive statistics and multivariable regression models were performed to compare the demographic characteristics and outcomes between the two cohorts.

Results:

We identified 996 breasts (570 patients), which were divided into prepectoral (391 breasts) and subpectoral (605 breasts) cohorts. There was a higher rate of complications (P < 0.001) and aesthetic deformities (P = 0.02) with prepectoral breast reconstruction. Secondary revisions were comparable between the two cohorts. Multivariable regression analysis confirmed that prepectoral reconstruction was associated with an increased risk of complications (odds ratio 2.39, P < 0.001) and aesthetic deformities (odds ratio 1.62, P = 0.003).

Conclusions:

This study evaluated outcomes in patients undergoing prepectoral or subpectoral breast reconstruction from a single center with long-term follow-up. Prepectoral placement was shown to have an inferior complication and aesthetic profile compared with subpectoral placement, with no difference in secondary revisions. These findings require validation with a well-designed randomized controlled trial to establish best practice for implant-based breast reconstruction.
Global biomarker trends in triple-negative breast cancer research: a bibliometric analysis
Authors: Wang Xingxin , Li Xuhao , Dong Tiantian , Yu Wenyan , Jia Zhixia , Hou Yi , Yang Jiguo , Liu Yuanxiang
Published: June 2024

Background:

Triple-negative breast cancer (TNBC) is defined as breast cancer that is negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) in cancer tissue. The lack of specific biomarkers makes the diagnosis and prognosis of TNBC challenging.

Method:

A comprehensive literature review and bibliometric analysis was performed using CiteSpace, VOSviewer and Scimago Graphica.

Results:

TNBC biomarker research has been growing rapidly in recent years, reflecting the enormous academic interest in TNBC biomarker research. A total of 127 journals published relevant studies and 1749 authors were involved in the field, with developed countries such as the United States, France, and the United Kingdom contributing greatly to the field. Collaborative network analysis found that the research in this field has not yet formed good communication and interaction, and the partnership should be strengthened in the future in order to promote the in-depth development of TNBC biomarker research. A comprehensive analysis of keywords and co-cited literature, etc. found that TNBC biomarker research mainly focuses on immune checkpoint markers, microenvironment-related markers, circulating tumor DNA, metabolic markers, genomics markers and so on. These research hotspots will help to better understand the molecular characteristics and biological processes of TNBC, and provide more accurate biomarkers for its diagnosis, treatment and prognosis.

Conclusions:

The bibliometric analysis highlighted global trends and key directions in TNBC biomarker research. Future developments in TNBC biomarker research are likely to be in the direction of multi-omics integration, meticulous study of the microenvironment, targeted therapeutic biomarkers, application of liquid biopsy, application of machine learning and artificial intelligence, and individualized therapeutic strategies. Young scholars should learn and collaborate across disciplines, pay attention to new technologies and methods, improve their data analysis skills, and continue to follow up on the latest research trends in order to meet the challenges and opportunities in the field of TNBC biomarkers.
Recent Advancements and Innovations in Pediatric Precision Oncology
Authors: Mangum Ross , Lin Frank Y. , Parsons D. Williams
Published: June 2024

Precision oncology incorporates comprehensive genomic profiling into the individualized clinical care of pediatric cancer patients. In recent years, comprehensive pan-cancer analyses have led to the successful implementation of genomics-based pediatric trials and accelerated approval of novel targeted agents. In addition, disease-specific studies have resulted in molecular subclassification of myriad cancer types with subsequent tailoring of treatment intensity based on the patient’s prognostic factors. This review discusses the progress of the field and highlights developments that are leading to more personalized cancer care and improved patient outcomes. Increased understanding of the evolution of precision oncology over recent decades emphasizes the tremendous impact of improved genomic applications. New technologies and improved diagnostic modalities offer further promise for future advancements within the field.
The Differences of Serum Thrombopoietin Levels Between Acquired Aplastic Anemia and Immune Thrombocytopenia in Pediatric Patients
Authors: Chen Hui , Ma Jie , Ouyang Juntao , Fu Lingling , Ma Jingyao , Yao Jiafeng , Wu Runhui , Chen Zhenping
Published: June 2024

Thrombopoietin (TPO) is the critical regulator of platelet production. However, the role of TPO in pediatric patients with thrombocytopenic disorders has not been fully elucidated. In the present study, we attempted to investigate serum TPO levels in patients with acquired aplastic anemia (aAA) and immune thrombocytopenia (ITP). We analyzed the endogenous plasma concentration of TPO and platelet count at the time of TPO measurement in 166 patients with aAA and 280 patients with ITP retrospectively. We further observed a correlation between platelet counts and TPO. Serum TPO levels were significantly higher in aAA compared with ITP (1142 vs. 77.99 pg/mL, P<0.001). In patients with aAA, an elevation for TPO levels in very severe AA (VSAA) was seen when compared with non-severe AA (NSAA) (1360 vs. 984.4 pg/mL, P<0.05). In contrast, the circulating TPO levels with chronic ITP (CITP) showed a decrease than newly diagnosed ITP (NITP) and persistent ITP (PITP) (62.28 vs. 81.56 pg/mL, P<0.01, 62.28 vs. 87.82 pg/mL, P<0.05, respectively). There was a negative correlation between platelet counts and TPO levels in aAA (rs=−0.3325, P<0.001) as well as ITP (rs=−0.2570, P<0.001). Especially, TPO levels were inversely correlated with platelet counts in NSAA (rs=−0.3672, P<0.001) and NITP (rs=−0.3316, P<0.001). After grouping by age or sex, there were no statistical differences in aAA or ITP. Serum TPO levels were markedly elevated in pediatric patients with aAA compared with ITP. It was higher in VSAA and lower in CITP, suggesting that serum TPO level could play a role in classifying disease severity or clinical course in aAA and ITP.
Hematologic Manifestations in Primary Mitochondrial Diseases
Authors: Selvanathan Arthavan , Teo Juliana , Parayil Sankaran Bindu
Published: June 2024

Primary mitochondrial disorders (PMDs) are known for their pleiotropic manifestations in humans, affecting almost any organ or system at any time. Hematologic manifestations, such as cytopenias and sideroblastic anemia, occur in 10% to 30% of patients with confirmed PMDs. These can be the initial presenting features or complications that develop over time. Surveillance for these manifestations allows for prompt identification and treatment. This article provides an overview of the pathophysiology underpinning the hematologic effects of mitochondrial dysfunction, discussing the 3 key roles of the mitochondria in hematopoiesis: providing energy for cell differentiation and function, synthesizing heme, and generating iron-sulfur clusters. Subsequently, the diagnosis and management of mitochondrial disorders are discussed, focusing on hematologic manifestations and the specific conditions commonly associated with them. Through this, we aimed to provide a concise point of reference for those considering a mitochondrial cause for a patient’s hematologic abnormality, or for those considering a hematologic manifestation in a patient with known or suspected mitochondrial disease.
Does a delay to surgery for preoperative echocardiogram affect outcomes in patients with hip fracture?
Authors: Saad Bishoy N. , Menken Luke G. , Keller David M. , Rampertaap Yajesh , Tang Alex , Hong Ian S. , Liporace Frank A. , Yoon Richard S. , Jankowski Jaclyn M.
Published: June 2024

Introduction:

Delay to surgery >24 hours has been shown to correlate with mortality rates in patients with hip fracture when left untreated. Many of these patients have multiple comorbidities, including aortic stenosis (AS), and undergo workup for operative clearance, which may delay time to surgery. The purpose of this study was to examine whether preoperative echocardiogram workup affects time to surgery, complications, and mortality after operative fixation for hip fracture.

Methods:

Our institutional hip fracture registry was retrospectively reviewed for inclusion over a 3-year period. Patients who had a preoperative echocardiogram (yECHO) for operative clearance were compared with those who did not (nECHO). Demographic data, time to surgery, overall complication rate, and mortality at 30 days, 90 days, and 1 year were collected.

Results:

Two cohorts consisted of 136 yECHO patients (45.8%) and 161 nECHO patients (54.2%). Thirty-two yECHO patients (23.5%) had AS. Patients in the yECHO cohort were more likely to have a complication for any cause compared with nECHO patients (25.7% vs. 10.6%, P = 0.01) and have a higher mortality rate at 1 year (38.9% vs. 17.4%, P = 0.001). There was no association found between AS and all-cause complication (P = 0.54) or 30-day (P = 0.13) or 90-day mortality rates (P = 0.79). However, patients with AS had a significantly higher mortality rate at 1 year (45.8% vs. 25.1%, P = 0.03).

Conclusion:

This study reinforces the benefits of ensuring less than a 24-hour time to surgery in the setting of a hip fracture and identifies an area of preoperative management that can be further optimized to prevent unnecessary prolongation in time to surgery. Patients with known aortic stenosis are not associated with increased 30-day or 90-day mortality or all-cause complications. Surgical delays in the yECHO cohort were attributed to preoperative medical assessments, including echocardiograms and the management of comorbidities. Therefore, the selective utilization of preoperative echocardiograms is needed and should be reserved to ensure they have a definitive role in guiding the perioperative care of patients with hip fracture.

Level of Evidence:

III.
A paradigm for characterizing motion misperception in people with typical vision and low vision
Authors: Chin Benjamin M. , Wang Minqi , Mikkelsen Loganne T. , Friedman Clara T. , Ng Cherlyn J. , Chu Marlena A. , Cooper Emily A.
Published: June 2024

SIGNIFICANCE

Motion perception is an essential part of visual function. Understanding how people with low vision perceive motion can therefore inform rehabilitation strategies and assistive technology. Our study introduces the notion of Bayesian biases in motion perception and suggests that some people with low vision are susceptible to these systematic misperceptions.

PURPOSE

We aimed to develop a paradigm that can efficiently characterize motion percepts in people with low vision and compare their responses with well-known misperceptions made by people with typical vision when targets are hard to see.

METHODS

We recruited a small cohort of individuals with reduced acuity and contrast sensitivity (n = 5) as well as a comparison cohort with typical vision (n = 5) to complete a psychophysical study. Study participants were asked to judge the motion direction of a tilted rhombus that was either high or low contrast. In a series of trials, the rhombus oscillated vertically, horizontally, or diagonally. Participants indicated the perceived motion direction using a number wheel with 12 possible directions, and statistical tests were used to examine response biases.

RESULTS

All participants with typical vision showed systematic misperceptions well predicted by a Bayesian inference model. Specifically, their perception of vertical or horizontal motion was biased toward directions orthogonal to the long axis of the rhombus. They had larger biases for hard-to-see (low contrast) stimuli. Two participants with low vision had a similar bias, but with no difference between high- and low-contrast stimuli. The other participants with low vision were unbiased in their percepts or biased in the opposite direction.

CONCLUSIONS

Our results suggest that some people with low vision may misperceive motion in a systematic way similar to people with typical vision. However, we observed large individual differences. Future work will aim to uncover reasons for such differences and identify aspects of vision that predict susceptibility.
Factors Associated With Symptoms of Anxiety and Depression in People Living With HIV in Northeast Brazil
Authors: da Cunha Gilmara Holanda , Fontenele Marina Soares Monteiro , Galvão Marli Teresinha Gimeniz , Dantas Maiara Bezerra , Gomes Maria Elisa Curado , Fechine Francisco Vagnaldo , de Sousa Paiva Simone
Published: June 2024

Background:

The diagnosis of HIV infection can cause mental disorders or exacerbate existing symptoms because of the stigma, psychological stress, and need for the self-management of the illness. The aim of this study was to determine the prevalence of anxiety and depression symptoms in people with HIV and to identify the associated factors.

Methods:

This is a cross-sectional study. A sample of 385 people living with HIV (PLWH) was interviewed using the Sociodemographic, Epidemiological, and Clinical Form; the Beck Anxiety Inventory; the Beck Depression Inventory; and Pittsburgh Sleep Quality Index. Univariate and multivariate logistic regression analysis were performed. The odds ratio and 95% confidence interval were calculated.

Results:

The prevalence of anxiety was 27.1% and depression was 39.8%. Being female (P = 0.0227), antiretroviral therapy (ART) for 8 years or less (P = 0.0042), and having depression (P < 0.0001) were associated with the occurrence of anxiety. Having a detectable viral load (P = 0.0476), not exercising regularly (P = 0.0070), and having sleep disorders (P = 0.0001) and anxiety (P < 0.0001) were associated with depression. Retired and on leave or sick pay were, respectively, 2.67 and 3.90 times more likely to have depression than those who were employed.

Conclusions:

A considerable percentage of PLWH have anxiety and depression symptoms. Being female, less than 8 years of ART, and depression are associated with anxiety, while detectable viral load, not practicing physical exercise, having sleep disorders, anxiety, and being retired or on leave or sick pay are associated with depression. The study showed important data for health interventions by members of the multidisciplinary team for PLWH.
One-Stage Deep Inferior Epigastric Perforator Flap Salvage of Infected Tissue Expanders
Authors: Sergesketter Amanda R. , Shammas Ronnie L. , Tian William M. , Glenney Anne , Sisk Geoffroy C. , Hollenbeck Scott T.
Published: June 2024

Background

Tissue expander-based breast reconstruction is associated with high rates of infectious complications, often leading to tissue expander explants and delays in receipt of definitive breast reconstruction and adjuvant therapy. In this study, we describe a single-stage technique where deep inferior epigastric artery perforator (DIEP) flaps are used to salvage actively infected tissue expanders among patients originally planning for free flap reconstruction.

Methods

In this technique, patients with tissue expander infections without systemic illness are maintained on oral antibiotics until the day of their DIEP flap surgery, at which time tissue expander explant is performed in conjunction with aggressive attempt at total capsulectomy and immediate DIEP flap reconstruction. Patients are maintained on 1–2 weeks of oral antibiotics tailored to culture data. Patients undergoing this immediate salvage protocol were retrospectively reviewed, and complications and length of stay were assessed.

Results

In a retrospective series, a total of six consecutive patients with culture-proven tissue expander infections underwent tissue expander removal and DIEP flap reconstruction in a single stage and were maintained on 7–14 days of oral antibiotics postoperatively. Within this cohort, no surgical site infections, microvascular complications, partial flap losses, reoperations, or returns to the operating room were noted within a 90-day period.

Conclusions

Among a select cohort of patients, actively infected tissue expanders may be salvaged with free flap breast reconstruction in a single surgery with a low incidence of postoperative complications. Prospective studies are needed to evaluate the influence of this treatment strategy on costs, number of surgeries, and dissatisfaction after staged breast reconstruction complicated by tissue expander infections.
Improving the Care and Cost of Treating Community-Acquired Stage 3 and 4 Decubitus Ulcers
Authors: Le Paulina B. , Kelly-Brown Joseph , Yturralde Kylee J. , McGreevy Donna J. , Lindler Leslie , Hurley Deborah M. , Friedman Harold I.
Published: June 2024

Introduction

The healthcare costs for treatment of community-acquired decubitus ulcers accounts for $11.6 billion in the United States annually. Patients with stage 3 and 4 decubitus ulcers are often treated inefficiently prior to reconstructive surgery while physicians attempt to optimize their condition (debridement, fecal/urinary diversion, physical therapy, nutrition, and obtaining durable medical goods). We hypothesized that hospital costs for inpatient optimization of decubitus ulcers would significantly differ from outpatient optimization costs, resulting in significant financial losses to the hospital and that transitioning optimization to an outpatient setting could reduce both total and hospital expenditures. In this study, we analyzed and compared the financial expenditures of optimizing patients with decubitus ulcers in an inpatient setting versus maximizing outpatient utilization of resources prior to reconstruction.

Methods

Encounters of patients with stage 3 or 4 decubitus ulcers over a 5-year period were investigated. These encounters were divided into two groups: Group 1 included patients who were optimized totally inpatient prior to reconstructive surgery; group 2 included patients who were mostly optimized in an outpatient setting and this encounter was a planned admission for their reconstructive surgery. Demographics, comorbidities, paralysis status, and insurance carriers were collected for all patients. Financial charges and reimbursements were compared among the groups.

Results

Forty-five encounters met criteria for inclusion. Group 1’s average hospital charges were $500,917, while group 2’s charges were $134,419. The cost of outpatient therapeutic items for patient optimization prior to wound closure was estimated to be $10,202 monthly. When including an additional debridement admission for group 2 patients (average of $108,031), the maximal charges for total care was $252,652, and hospital reimbursements were similar between group 1 and group 2 ($65,401 vs $50,860 respectively).

Conclusions

The data derived from this investigation strongly suggests that optimizing patients in an outpatient setting prior to decubitus wound closure versus managing the patients totally on an inpatient basis will significantly reduce hospital charges, and hence costs, while minimally affecting reimbursements to the hospital.
The Impact of Obesity on Success of Immediate Lymphatic Reconstruction for Prevention of Breast Cancer–Related Lymphedema
Authors: Wainwright D'Arcy J. , Le Nicole K. , Weinstein Brielle , West William , Tavares Tina , Panetta Nicholas J.
Published: June 2024

Background

Breast cancer–related lymphedema (BRCL) is a potential sequela of high-risk breast cancer treatment. Preventive treatment with immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) has emerged as the standard of care; however, there is relatively little known about factors that may contribute to procedural failure.

Methods

A retrospectively maintained, institutional review board–approved study followed patients who underwent ILR at the time of ALND at our tertiary care center between May 2018 and May 2023. Patients who presented for at least one follow-up visit in our multidisciplinary lymphedema clinic met the criteria for inclusion. Patients who developed lymphedema despite ILR and potential contributing factors were further explored.

Results

349 patients underwent ILR at our institution between May 2018 and May 2023. 341 of these patients have presented for follow-up in our multidisciplinary lymphedema clinic. 32 (9.4%) patients developed lymphedema despite ILR. This cohort was significantly more likely to be obese (56% vs 35%, P = 0.04). Multivariate logistic regression demonstrates increased odds of procedural failure in patients with a body mass index (BMI) ≥30 kg/m2 (odds ratio 2.6 [1.2–5.5], P = 0.01).

Conclusion

These data comment upon our institutions outcomes following ILR. Patients who develop lymphedema despite ILR tend to have a higher BMI, with a significantly increased risk in patients with a BMI of 30 or greater. Consideration of these data is critical for preprocedural counseling and may support a BMI cutoff when considering candidacy for ILR going forward, as well as when optimizing failures for secondary lymphedema procedures.