bluuebunny/crossref_metadata_2025 huggingface dataset:
Autologous Reconstruction of Anomalous Origin of a Right Pulmonary Artery From the Aorta
Authors: Talwar Sachin , Jha Pratik Kumar , George Niwin , Choudhury Arindam , Satsangi Amitabh , Choudhary Shiv Kumar
Published: March 2024

Anomalous origin of a pulmonary artery branch from the aorta is a rare congenital anomaly in which one of the pulmonary arteries arises from the aorta. These patients require early surgery to prevent development of severe irreversible pulmonary arterial hypertension. Multiple techniques have been described for repair of this condition. In this report, we describe a different technique compared with previously described procedures and discuss its advantages.
Maternal near miss hospitalizations in the Borana Zone, Ethiopia: A facility-based longitudinal cross-sectional study
Authors: Kamangira Boboh , Ayele Gudeta , Dube Polite , Melaku Kaleb , Vushoma Eubert
Published: March 2024

Background:

Maternal near miss refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of pregnancy termination. While there has been considerable progress in reducing maternal mortality rates, maternal near miss cases can provide valuable insights into the quality of maternal healthcare and help identify areas for improvement. However, there is limited evidence on the factors contributing to maternal near miss cases, including health system failures, delays in care, and provider-related factors. Therefore, this study aimed to assess the incidence, causes, and factors associated with maternal near misses in public Hospitals of Borena Zone.

Methods:

A facility-based longitudinal cross-sectional study design was employed at four Public Hospitals in Borena Zone from August 15, 2022, to November 15, 2022, using the WHO criteria for maternal near miss event. In total, 117 participants were included in the study. Eligibility was determined using key clinical, organ dysfunction, laboratory, and management criteria, as per the WHO guidelines for near-miss events. Underlying and contributing causes of maternal near misses were documented from each participant’s records.

Result:

There were 1421 deliveries during the study period and 117 eligible women developed potentially life-threatening conditions. Only 61 women experienced severe maternal outcomes (55 near misses and six maternal deaths). The maternal near miss incidence ratio was 38.7 per 1000 live births, with a mortality index of 9.8%. Hypertensive disorders and obstetric hemorrhage are the leading underlying causes of maternal near misses.

Conclusion:

The incidence of maternal near miss was remarkably high when compared to previous studies. Giving special emphasis to life-saving interventions, critical care, reducing delays and improving the referral system are critical to improve quality of care.
Short-Term Postoperative Complications in Flexor Tendon Repair: A Subcategory Analysis by Surgical Specialty
Authors: Rich Matthew D. , Solaiman Rafat H. , Hillard Christopher
Published: March 2024

Introduction: We aimed to investigate and compare the 30-day postsurgical complication rates and total operative times for hand or wrist flexor tendon injury repair procedures. Methods: We performed a retrospective cohort analysis of the American College of Surgeon National Quality Improvement Program database between 2015 and 2019. Patients were included in our study if they were 18 years or older and underwent surgical repair of a wrist or hand flexor tendon by a plastic surgeon, general surgeon, or orthopedic surgeon. Primary endpoint of the study was 30-day postsurgical complications. Secondary endpoint included subcategory analysis of 30-day postsurgical complications. Another variable of interest included total operative time. Results: There were 2614 surgeries performed for wrist or hand flexor tendon injury repair during the 5-year period. Orthopedic surgeons performed the majority of the operations (1548, 59.2%). Repair or advancement of the flexor tendon zone 2 without grafts (1284, 49.1%) were the most common surgeries performed. Overall surgical site complication rate was 2%, with no significant associations between the complication and the surgical specialty performing the operation. A significant difference in total operative time between surgical specialties was only found in single flexor tendon repairs ( P < .001). Conclusions: Surgical repair for hand and wrist flexor tendon injury is a safe surgical procedure with a low short-term postoperative complication rate. Despite variations in training, complications remain similar between specialties for flexor tendon repairs.
Women’s Land Access and Gendered Outcomes in Northern Ghana
Authors: N-yanbini Nelson Nyabanyi , Owusu-Ansah Justice Kufour
Published: March 2024

In rural Ghana, women encounter patriarchal values that restrict their access to productive agricultural lands. This undermines the productive capacity of women, affecting sustainable food production. Using mixed methods, we provide new insights into gendered land access in Northern Ghana. A sample of 228 household heads was surveyed from seven major communities across the study area. In-depth interviews were conducted with chiefs and women associations. Findings indicate that land-based decisions are mainly made by men as women were assigned to less fertile farmlands. As a result, women are disproportionately poorer and experienced occasional bouts of hunger. Outcomes of gendered land access were precarious, affecting poverty reduction, food security and women empowerment. The study recommends joint ownership of lands as a point of entry into customary land decision-making platforms by women. A deeper understanding of women’s land access dynamics in order to mainstream the same into land-sector policies was proffered.
General practitioners’ experiences of providing somatic care for patients with severe mental illness: a qualitative study
Authors: Jønsson Alexandra Brandt Ryborg , Brodersen John Brandt , Reventlow Susanne , Svanholm Christina , Møller Anne , Kousgaard Marius Brostrøm
Published: March 2024

Background

Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties.

Methods

We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group.

Results

GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations.

Conclusion

The GPs’ interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.
Regional variation of COVID-19 admissions, acute kidney injury and mortality in England - a national observational study using administrative data
Authors: Kolhe Nitin V , Fluck Richard J , Taal Maarten W
Published: March 2024

Background

This study explores regional variations in COVID-19 hospitalization rates, in-hospital mortality, and acute kidney injury (AKI) in England. We investigated the influence of population demographic characteristics, viral strain changes, and therapeutic advances on clinical outcomes.

Methods

Using hospital episode statistics, we conducted a retrospective cohort study with 749,844 admissions in 337,029 adult patients with laboratory-confirmed COVID-19 infection (March 1, 2020, to March 31, 2021). Multivariable logistic regression identified factors predicting AKI and mortality in COVID-19 hospitalized patients.

Results

London had the highest number of COVID-19 admissions (131,338, 18%), followed by the North-west region (122,683, 16%). The North-west had the highest population incidence of COVID-19 hospital admissions (21,167 per million population, pmp), while the South-west had the lowest (9,292 admissions pmp). Patients in London were relatively younger (67.0 ± 17.7 years) than those in the East of England (72.2 ± 16.8 years). The shortest length of stay was in the North-east (12.2 ± 14.9 days), while the longest was in the North-west (15.2 ± 17.9 days). All eight regions had higher odds of death compared to London, ranging from OR 1.04 (95% CI 1.00, 1.07) in the South-west to OR 1.24 (95% CI 1.21, 1.28) in the North-west. Older age, Asian ethnicity, emergency admission, transfers from other hospitals, AKI presence, ITU admission, social deprivation, and comorbidity were associated with higher odds of death. AKI incidence was 30.3%, and all regions had lower odds of developing AKI compared to London. Increasing age, mixed and black ethnicity, emergency admission, transfers from other providers, ITU care, and different levels of comorbidity were associated with higher odds of developing AKI.

Conclusions

London exhibited higher hospital admission numbers and AKI incidence, but lower odds of death compared to other regions in England.

Trial registration

Registered on National Library of Medicine website (www.clinicaltrials.gov) with registration number NCT04579562 on 8/10/2020.
CD13 expression affects glioma patient survival and influences key functions of human glioblastoma cell lines in vitro
Authors: Zhang Wenying , Blank Anne , Kremenetskaia Irina , Nitzsche Anja , Acker Güliz , Vajkoczy Peter , Brandenburg Susan
Published: March 2024

CD13 (APN) is an Alanyl-Aminopeptidase with diverse functions. The role of CD13 for gliomas is still unknown. In this study, data of glioma patients obtained by TCGA and CGGA databases were used to evaluate the survival rate and prognostic value of CD13 expression level. Protein expression of CD13 was confirmed by immunofluorescence staining of fresh patient tissues. Eight human glioblastoma cell lines were studied by RT-PCR, Western Blot, immunofluorescence staining and flow cytometry to define CD13 expression. Cell lines with different CD13 expression status were treated with a CD13 inhibitor, bestatin, and examined by MTT, scratch and colony formation assaysas well as by apoptosis assay and Western Blots. Bioinformatics analysis indicated that patients with high expression of CD13 had poor survival and prognosis. Additionally, CD13 protein expression was positively associated with clinical malignant characteristics. Investigated glioblastoma cell lines showed distinct expression levels and subcellular localization of CD13 with intracellular enrichment. Bestatin treatment reduced proliferation, migration and colony formation of glioma cells in a CD13-dependent manner while apoptosis was increased. In summary, CD13 has an impact on glioma patient survival and is important for the main function of specific glioma cells.
Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo
Authors: Malemo Luc Kalisya , Yap Ava , Mitume Boniface , Salmon Christian , Karafuli Kambale , Poenaru Dan , Onyango Rosebella
Published: March 2024

Introduction

Surgical services are an essential part of a functional healthcare system, but the Lancet Commission of Global Surgery (LCoGS) indicators of surgical capacity such as perioperative workforce and surgical volume are unknown in many low- and middle-income countries (LMICs) including the Democratic Republic of Congo (DRC). We aimed to determine the surgical capacity and its associated factors within the DRC.

Methods

Hospitals were assessed in the North Kivu province of the DRC. Hospital characteristics and surgical rates were determined using the WHO-PGSSC hospital assessment tool and operating room (OR) registries. The primary outcome of interest was the number of Bellwether operations (i.e. Caesarean sections, laparotomies, and external fixation for bone fractures) per 100,000 people. Univariate and multiple linear regressions were performed. Primary predictors were the number of trained surgeons, anaesthesiologists, and obstetricians (SAOs) and the number of perioperative providers (including clinical officers and nurse anaesthetists) per 100,000 people.

Results

Twenty-eight hospitals in North Kivu were assessed over one year in 2021; 24 (86%) were first-level referral health centres while 4 (14%) were second-level referral hospitals. In total, 11,176 Bellwether procedures were performed in the region in one year. Rates per 100,000 people were 1,461 Bellwether surgical interventions, 1.05 SAOs, and 13.1 perioperative providers. In univariate linear regression analysis, each additional SAO added 239 additional cases annually (p = 0.023), while each additional perioperative provider added 110 cases annually (p < 0.001). In our multiple regression analysis adjusting for other hospital services, the association between workforce and Bellwether surgeries was no longer significant.

Conclusions

The surgical workforce in DRC did not meet the LCoGS benchmark of 20 SAOs per 100,000 people but was not an independent predictor of surgical capacity. Major investment is needed to simultaneously bolster healthcare facilities and increase surgical workforce training.
Correlation between dental and skeletal maturity in Korean children based on dental maturity percentile: a retrospective study
Authors: Ong Seung-Hwan , Kim Hyuntae , Song Ji-Soo , Shin Teo Jeon , Hyun Hong-Keun , Jang Ki-Taeg , Kim Young-Jae
Published: March 2024

Background

The correlation between dental maturity and skeletal maturity has been proposed, but its clinical application remains challenging. Moreover, the varying correlations observed in different studies indicate the necessity for research tailored to specific populations.

Aim

To compare skeletal maturity in Korean children with advanced and delayed dental maturity using dental maturity percentile.

Design

Dental panoramic radiographs and cephalometric radiographs were obtained from 5133 and 395 healthy Korean children aged between 4 and 16 years old. Dental maturity was assessed with Demirjian’s method, while skeletal maturity was assessed with the cervical vertebral maturation method. Standard percentile curves were developed through quantile regression. Advanced (93 boys and 110 girls) and delayed (92 boys and 100 girls) dental maturity groups were defined by the 50th percentile.

Results

The advanced group showed earlier skeletal maturity in multiple cervical stages (CS) in both boys (CS 1, 2, 3, 4, and 6) and girls (CS 1, 3, 4, 5, and 6). Significant differences, as determined by Mann-Whitney U tests, were observed in CS 1 for boys (p = 0.004) and in CS 4 for girls (p = 0.037). High Spearman correlation coefficients between dental maturity and cervical vertebral maturity exceeded 0.826 (p = 0.000) in all groups.

Conclusion

A correlation between dental and skeletal maturity, as well as advanced skeletal maturity in the advanced dental maturity group, was observed. Using percentile curves to determine dental maturity may aid in assessing skeletal maturity, with potential applications in orthodontic diagnosis and treatment planning.
Enhancing feedback by health coaching: the effectiveness of mixed methods approach to long-term physical activity changes in nurses. An intervention study
Authors: Nerek Agnieszka , Wesołowska-Górniak Katarzyna , Czarkowska-Pączek Bożena
Published: March 2024

Background

Although knowledge of the barriers and motivators to physical activity participation among nurses is increasing, the factors influencing motivation methods’ effectiveness are not completely defined. This study aimed to identify the methods that support increasing the level of daily physical activity and the factors that influence the effectiveness of motivation methods among nurses.

Methods

This study was based on an intervention study protocol. All registered nurses in clinical settings were invited to participate in the study. The study involved 71 professionally active nurses. A self-reported questionnaire was used to collect sociodemographic and employment data. The level of physical activity was assessed using the International Physical Activity Questionnaire, and the daily number of steps was assessed using a pedometer. Body composition was measured using a bioimpedance method, and the 5-year risk of cardiovascular events was assessed using the Harvard Score. The intervention included self-monitoring daily steps using a pedometer and completing a diary daily for one month. Additionally, a few-minute speech was sent to each participant via email on the intervention’s 7th, 14th, and 21st days.

Results

The analysis revealed a higher value of physical activity recorded in the follow-up compared to the initial and final measurement in the Recreation domain [Met] (p < 0.001) and a higher value of daily steps in the follow-up compared to the final measurement (p = 0.005). Participants with a higher Harvard Score were more likely to increase their daily number of steps (OR = 6.025; 95% CI = 1.70-21.41), and nurses working in hospital wards were less likely to do so (OR = 0.002; 95% CI = 0.00-0.41).

Conclusions

Recommendations for physical activity in the nursing population should focus on increasing leisure time physical activity and regular risk assessment of cardiovascular events. A mixed methods approach, such as feedback enhanced by health coaching, effectively achieves long-term physical activity changes in nurses.
Job crafting, positive psychological capital, and social support as predictors of job embeddedness on among clinical nurses- a structural model design
Authors: Yun Mi-Soon , Lee Miyoung , Choi Eun-Hi
Published: March 2024

Background

This study establishes the relationships among role conflict, positive psychological capital, social support, job crafting, and job embeddedness among clinical nurses. The results are expected to provide a basis for efficient human resource management in hospitals.

Methods

Considering a 15% dropout rate, we distributed 300 copies of our questionnaire, of which 290 were returned. We used 260 responses in the final analysis after excluding 40 responses that were incomplete or showed an identical pattern in the item responses. Participants were clinical nurses with less than one year of experience in general and tertiary general hospitals in G province and D metropolitan city in South Korea. A structured questionnaire was administered from January 10 to February 28, 2022. The collected data were analyzed using SPSS 26.0 and AMOS 26.0. We assessed the statistical significance using the bootstrapping method.

Results

The direct and total effects (both β = 0.806, p =.007) of positive psychological capital on job crafting were significant. The direct and total effects (both β = 0.451, p =.004) of social support on job crafting were significant. The direct (γ = 0.292, p =.055), indirect (γ = -. 671, p =.003), and total (γ = − 0.379, p =.008) effects of role conflict on job crafting were significant. The direct (γ = − 0.382, p =.007), indirect (γ = − 0.208 p =.003), and total (γ = − 0.589, p =.006) effects of role conflict on job embeddedness were significant. The direct and total (both β = 0.548, p =.005) effects of job crafting on job embeddedness were significant.

Conclusions

Nurses’ job embeddedness is directly influenced by their job crafting, which is shaped by high levels of positive psychological capital and social support. When job crafting takes place, role conflict increases, and if job crafting becomes difficult because of severe role conflict, job embeddedness decreases. Therefore, to increase job embeddedness among clinical nurses, hospitals must implement support systems and programs to increase job autonomy, and positive psychological capital to promote job crafting.
Statins as a risk factor for diabetic retinopathy: a Mendelian randomization and cross-sectional observational study
Authors: Chen Chengming , Zhang Huan , Lan Yanyan , Yan Weiming , Liu Sida , Chen Yixuan , Xie Tingke , Ning Jiayi , Yan Xiaolong , Shang Lei , Han Jing
Published: March 2024

Background

Diabetic retinopathy (DR) is the foremost cause of vision loss among the global working-age population, and statins are among the most frequently prescribed drugs for lipid management in patients with DR. The exact relationship between statins and DR has not been determined. This study sought to validate the causal association between statins usage and diabetic retinopathy.

Methods

The summary-data-based Mendelian randomization (SMR) method and inverse-variance-weighted Mendelian randomization (IVW-MR) were used to identify the causal relationship between statins and DR via the use of expression quantitative trait loci (eQTL) data for 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) (31,684 blood samples), low density lipoprotein cholesterol-related GWAS data (sample size: 440,546), and DR-related GWAS data (14,584 cases and 176,010 controls). Additionally, a cross-sectional observational study based on the data from the National Health and Nutrition Examination Survey (NHANES) was conducted to supplement the association between DR and statins (sample size: 106,911). The odds ratios (ORs) with corresponding 95% confidence intervals (CIs) was employed to evaluate the results.

Results

Based on the results of the MR analysis, HMGCR inhibitors were causally connected with a noticeably greater incidence of DR (IVW: OR = 0.54, 95% CI [0.42, 0.69], p = 0.000002; SMR: OR = 0.66, 95% CI [0.52, 0.84], p = 0.00073). Subgroup analysis revealed that the results were not affected by the severity of DR. The sensitivity analysis revealed the stability and reliability of the MR analysis results. The results from the cross-sectional study based on NHANES also support the association between not taking statins and a decreased risk of DR (OR = 0.54, 95% CI [0.37, 0.79], p = 0.001).

Conclusions

This study revealed that a significant increase in DR risk was causally related to statins use, providing novel insights into the role of statins in DR. However, further investigations are needed to verify these findings.
Chemodiversity, pharmacological activity, and biosynthesis of specialized metabolites from medicinal model fungi Ganoderma lucidum
Authors: Du Yupeng , Tian Lixia , Wang Yu , Li Zhenhao , Xu Zhichao
Published: March 2024

Ganoderma lucidum is a precious fungus, particularly valued for its dual use as both medicine and food. Ganoderic acids (GAs), the distinctive triterpenoids found in the Ganoderma genus, exhibit a wide range of pharmacological activities. However, the limited resources of GAs restrict their clinic usage and drug discovery. In this review, we presented a comprehensive summary focusing on the diverse structures and pharmacological activity of GAs in G. lucidum. Additionally, we discussed the latest advancements in the elucidation of GA biosynthesis, as well as the progress in heterosynthesis and liquid fermentation methods aimed at further increasing GA production. Furthermore, we summarized the omics data, genetic transformation system, and cultivation techniques of G. lucidum, described as medicinal model fungi. The understanding of Ganoderic acids chemodiversity and biosynthesis in medicinal model fungi Ganoderma lucidum will provide important insights into the exploration and utilization of natural products in medicinal fungi.
Targeted protein degradation in hematologic malignancies: latest updates from the 2023 ASH annual meeting
Authors: Zhong Guangcai , Kong Ran , Feng Shi , Wang Cong , Hao Qingbo , Xie Weilin , Zhou Xiangxiang
Published: March 2024

Protein degraders, emerging as a novel class of therapeutic agents, have gained widespread attention due to their advantages. They have several advantages over traditional small molecule inhibitors, including high target selectivity and ability to target “undruggable” targets and overcome inhibitor drug resistance. Tremendous research and development efforts and massive investment have resulted in rapid advancement of protein degrader drug discovery in recent years. Here, we overview the latest clinical and preclinical updates on protein degraders presented at the 2023 ASH Annual Meeting.
Novel trypanosomatid species detected in Mongolian pikas (Ochotona pallasi) and their fleas in northwestern China
Authors: Wang Shiyi , Wang Suwen , Han Xiaoshuang , Hornok Sándor , Wang Huiqian , Wang Nan , Liu Gang , Yang Meihua , Wang Yuanzhi
Published: March 2024

Background

In the family Trypanosomatidae, the genus Trypanosoma contains protozoan parasites that infect a diverse range of hosts, including humans, domestic animals, and wildlife. Wild rodents, as natural reservoir hosts of various pathogens, play an important role in the evolution and emergence of Trypanosomatidae. To date, no reports are available on the trypanosomatid infection of pikas (Lagomorpha: Ochotonidae).

Methods

In this study, Mongolian pikas and their fleas were sampled at the China–Mongolia border, northwestern China. The samples were analyzed with polymerase chain reaction (PCR) and sequencing for the presence of Trypanosomatidae on the basis of both the 18S ribosomal RNA (18S rRNA) gene and the glyceraldehyde-3-phosphate dehydrogenase (gGAPDH) gene. The morphology of trypomastigotes was also observed in peripheral blood smears by microscopy.

Results

Molecular and phylogenetic analyses revealed a new genotype of the Trypanosoma lewisi clade that was found both in pika blood and flea samples. This genotype, which probably represents a new species, was provisionally designated as “Trypanosoma sp. pika”. In addition, a novel genotype belonging to the genus Blechomonas of Trypanosomatidae was detected in fleas. On the basis of its molecular and phylogenetic properties, this genotype was named Blechomonas luni-like, because it was shown to be the closest related to B. luni compared with other flea-associated trypanosomatids.

Conclusions

To the best of our knowledge, this is the first study to report any trypanosomatid species in Mongolian pikas and their fleas. Further studies are needed to investigate the epidemiology of these protozoan parasites, as well as to evaluate their pathogenicity for humans or domestic animals.

Graphical Abstract
Canadian Internal Medicine Ultrasound (CIMUS) consensus statement: recommendations for mandatory ultrasound competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterization
Authors:   Canadian Internal Medicine Ultrasound, Walsh Michael H. , Balan Marko , Montague Steven J. , Butler Dayna , Chan Barry , Tran Allen , Viau-Lapointe Julien , Wiseman Jeffrey , Traquair Hugh , Yu Jeffrey , Lépine Pierre-Alexis , Desy Janeve , Friesen Tyler B. , Gaudreau-Simard Mathilde , Kolbenson Linden , Jayaraman Dev , Lubbers Sonja , Mayette Michael , Sattin Michael , Smyth Leo M. , Sandhu Monty , Spiegle Gillian , Lacasse Audrey , Lam Ada W. , Wiskar Katie , Arishenkoff Shane , Wong Jonathan , Ma Irene W. Y.
Published: March 2024

Objectives

To develop a Canadian Internal Medicine Ultrasound (CIMUS) consensus statement on recommended mandatory point-of-care ultrasound (POCUS) competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterizations (CVC) for internal medicine physicians.

Methods

The 2022 CIMUS group consists of 27 voting members, with representations from all 17 Canadian academic institutions across 8 provinces. Members voted in 3 rounds on 46 procedural competencies as “mandatory, must include”, “optional, could include” or “superfluous, do not include”. These 46 competencies included 6 general competencies that apply to all POCUS-guided procedures, 11 competencies for thoracentesis, 10 competencies for paracentesis, and 19 competencies for CVC.

Results

In the first round, members reached consensus on 27 competencies (5 general, 6 thoracentesis, 8 paracentesis, 8 CVC). In the second round, 10 competencies (1 general, 2 thoracentesis, 1 paracentesis, 6 CVC) reached consensus. In the third round, 2 additional competencies (1 paracentesis, 1 CVC) reached consensus for being mandatory and 3 as optional (1 thoracentesis and 2 CVC). Overall, a total of 28 competencies reached consensus as mandatory, 3 as optional, while 11 competencies reached consensus as superfluous. Four competencies did not reach consensus for either inclusion or exclusion.

Conclusions

The CIMUS group recommends 28 competencies be considered mandatory and 3 as optional for internal medicine physicians performing POCUS guided thoracentesis, paracentesis, and CVC placement. National curriculum development and implementation efforts should include training these mandatory competencies.
Giant cell tumor of soft tissue involving thyroid gland: a case report and review of the literature
Authors: Chen Jianrong , Zhang Haiyong , Li Xiufang , Hu Mengjun , Dai Xiaomin
Published: March 2024

Background

Giant cell tumor of soft tissue is a low malignant uncommon neoplasm, with histologic features and immunophenotype similar to its bone counterpart. Primary giant cell tumor of soft tissue in the thyroid gland is considered an exceedingly rare entity.

Case presentation

We describe a case of primary thyroid giant cell tumor of soft tissue in a 69-year-old Chinese female patient. Neck ultrasonography showed a 19 mm × 12 mm × 5 mm nodule with heterogeneous echo and clear boundary located within the left thyroid. Histopathological examination revealed that the neoplasm was composed of two morphological components, mononuclear cells admixed with multinucleated osteoclast-like giant cells. Immunohistochemically, the tumor cells were positive for CD68 and vimentin, but were negative for epithelial membrane antigen, cytokeratin, and additional muscle markers. She underwent left unilateral thyroidectomy, and total thyroidectomy was performed for local recurrence 3 months later. The patient remained well without recurrence or metastasis following up for 12 months.

Conclusion

The significance of this case lies in its rarity, the challenge of preoperative clinical diagnosis, and the differential diagnosis with other malignancies.
Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis
Authors: Zou Peilin , Liu Chang , Zhang Yucong , Wei Chao , Liu Xiaming , Xu Shengfei , Ling Qing , Chen Zhong , Du Guanghui , Yuan Xiaoyi
Published: March 2024

Background

The efficacy of surgical treatment for benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU) remains controversial.

Methods

To summarize relevant evidence, three databases (PubMed, Embase, and Web of Science) were searched from database inception to May 1, 2023. Transurethral surgical treatment modalities include transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), and transurethral incision of the prostate (TUIP). The efficacy of the transurethral surgical treatment was assessed according to maximal flow rate on uroflowmetry (Qmax), International Prostate Symptom Score (IPSS), postvoid residual (PVR), quality of life (QoL), voided volume, bladder contractility index (BCI) and maximal detrusor pressure at maximal flow rate (PdetQmax). Pooled mean differences (MDs) were used as summary statistics for comparison. The quality of enrolled studies was evaluated by using the Newcastle–Ottawa Scale. Sensitivity analysis and funnel plots were applied to assess possible biases.

Results

In this study, 10 studies with a total of 1142 patients enrolled. In BPH patients with DU, within half a year, significant improvements in Qmax (pooled MD, 4.79; 95% CI, 2.43–7.16; P < 0.05), IPSS(pooled MD, − 14.29; 95%CI, − 16.67–11.90; P < 0.05), QoL (pooled MD, − 1.57; 95% CI, − 2.37–0.78; P < 0.05), voided volume (pooled MD, 62.19; 95% CI, 17.91–106.48; P < 0.05), BCI (pooled MD, 23.59; 95% CI, 8.15–39.04; P < 0.05), and PdetQmax (pooled MD, 28.62; 95% CI, 6.72–50.52; P < 0.05) were observed after surgery. In addition, after more than 1 year, significant improvements were observed in Qmax (pooled MD, 6.75; 95%CI, 4.35–9.15; P < 0.05), IPSS(pooled MD, − 13.76; 95%CI, − 15.17–12.35; P < 0.05), PVR (pooled MD, − 179.78; 95%CI, − 185.12–174.44; P < 0.05), QoL (pooled MD, − 2.61; 95%CI, − 3.12–2.09; P < 0.05), and PdetQmax (pooled MD, 27.94; 95%CI, 11.70–44.19; P < 0.05). Compared with DU patients who did not receive surgery, DU patients who received surgery showed better improvement in PVR (pooled MD, 137.00; 95%CI, 6.90–267.10; P < 0.05) and PdetQmax (pooled MD, − 8.00; 95%CI, − 14.68–1.32; P < 0.05).

Conclusions

Our meta-analysis results showed that transurethral surgery can improve the symptoms of BPH patients with DU. Surgery also showed advantages over pharmacological treatment for BPH patients with DU.

Systematic review registration

PROSPERO CRD42023415188.
What should rheumatologists know about Gaucher disease and Fabry disease? Connecting the dots for an overview
Authors: Cordeiro Rafael Alves , Rosa Neto Nilton Salles , Giardini Henrique Ayres Mayrink
Published: March 2024

Gaucher and Fabry diseases are lysosomal storage disorders in which deficient enzyme activity leads to pathological accumulation of sphingolipids. These diseases have a broad phenotypic presentation. Musculoskeletal symptoms and pain complaints are frequently reported by patients. Thus, rheumatologists can be contacted by these patients, contributing to the correct diagnosis, earlier indication of appropriate treatment and improvement of their prognosis. This review describes important concepts about Gaucher and Fabry diseases that rheumatologists should understand to improve patients’ quality of life and change the natural history of these diseases.
Metformin Use in Type 2 Diabetics and Delirium After Noncardiac Surgery: A Retrospective Cohort Analysis
Authors: Paredes Stephania , Harb Ayoub , Rössler Julian , Nikoo Maedeh Zokaei , Ruetzler Kurt , Turan Alparslan , Pu Xuan , Sessler Daniel I.
Published: March 2024

INTRODUCTION:

The cause of postoperative delirium is unknown, but it is thought to result at least in part from inflammation. Metformin, besides its hypoglycemic properties, demonstrates anti-inflammatory effects systemically and in the brain. We tested the primary hypothesis that chronic metformin use in adults with type 2 diabetes is associated with less delirium during the first 5 days after major noncardiac surgery. Secondary outcomes were a composite of serious complications (myocardial infarction, cardiac arrest, stage 2–3 acute kidney injury [AKI], and mortality) and time to discharge alive.

METHODS:

We considered adults with type 2 diabetes who did or did not routinely use metformin daily and had noncardiac surgery. Delirium was assessed by Confusion Assessment Method for Intensive Care Unit (CAM-ICU) or brief Confusion Assessment Method (bCAM) for 5 postoperative days. Postoperative AKI was defined by Kidney Disease Improving Global Guidelines. Logistic regression and generalized estimating equation models accounted for within-patient correlation across multiple surgeries and explored the association between metformin use and postoperative delirium and complications. Inverse propensity score weighting and propensity score calibration (PSC) adjusted for confounding variables.

RESULTS:

No significant difference was observed in the incidence of postoperative delirium between the 2 groups, with 260 of 4744 cases (5.5%) among metformin users and 502 of 5918 cases (8.5%) cases in nonmetformin users, for an odds ratio of 0.88 (95% confidence interval [CI], 0.73–1.05; P = .155), number-needed-to-expose = 118 patients. Similarly, there were fewer composite complications in metformin users (3.3%) than in nonusers (11.7%); However, the common-effect odds ratio of 0.67 was not statistically significant (97.5% CI, 0.39–1.17; P = .106). Discharge from the hospital was significantly faster in patients who took metformin (3 [interquartile range, IQR, 1–5] days for metformin users and 3 [IQR, 2–6] days for nonmetformin users), with a hazard ratio of 1.07 for early discharge, and tight CIs (1.01–1.13).

CONCLUSIONS:

Chronic metformin use was associated with slightly and nonsignificantly less delirium. However, patients who used metformin had clinically meaningfully fewer major complications, mostly stage 2 to 3 kidney injury. While not statistically significant, the reduction was substantial and warrants further investigation because there is currently no effective preventive measure for perioperative renal injury. Benefit would be especially meaningful if it could be produced by acute perioperative treatment. Finally, metformin was associated with faster hospital discharge, although not by a clinically meaningful amount.
Managing the Farm
Authors: Hamilton Shane
Published: March 2024

“Management” is routinely understood by agricultural historians as an exercise in rational expertise, targeted at driving ever more efficient, “businesslike” practices on the farm. However, insights from critical management studies suggest that farm management, as a body of theory and as a form of practice, may be grounded in something less savory than epistemological superiority or the ability to improve farming practice. This article explores how the meaning of farm management changed substantially over the course of the twentieth and early twenty-first centuries, from a pragmatic approach for empowering individual farmers to a more abstract set of theories offering a chimera of control.
Disability Worlds
Authors: Ginsburg Faye , Rapp Rayna
Published: March 2024

In Disability Worlds, Faye Ginsburg and Rayna Rapp chronicle and theorize two decades of immersion in New York City's wide-ranging disability worlds as parents, activists, anthropologists, and disability studies scholars. They situate their disabled children's lives among the experiences of advocates, families, experts, activists, and artists in larger struggles for recognition and rights. Disability consciousness, they show, emerges in everyday politics, practices, and frictions. Chapters consider dilemmas of genetic testing and neuroscientific research, reimagining kinship and community, the challenges of “special education,” and the perils of transitioning from high school. They also highlight the vitality of neurodiversity activism, disability arts, politics, and public culture. Disability Worlds reflects the authors' anthropological commitments to recognizing the significance of this fundamental form of human difference. Ginsburg and Rapp's conversations with diverse New Yorkers reveal the bureaucratic constraints and paradoxes established in response to the disability rights movement, as well as the remarkable creativity of disabled people and their allies who are opening pathways into both disability justice and disability futures.
Teacher Education and Pedagogical Conditions As a Factor in the Development of Student LeadershipD > = 0
Authors: Krasnova E. , Mel'nikov A. , Kashaeva E. , Shayhullina L.
Published: March 2024

The article presents a program of experimental work on the formation of leadership qualities among members of the university student body. The course program “Innovative and educational activities of student group curators” has been developed. The program is aimed at increasing the theoretical and methodological level of group curators to develop leadership qualities among student activists. Also, to develop leadership qualities among student activists, an experimental course “I am a leader” was developed.
An Algorithmic Solution to the Blotto Game Using Multimarginal Couplings
Authors: Perchet Vianney , Rigollet Philippe , Le Gouic Thibaut
Published: March 2024

Computing the solution of Blotto games, a century-year-old open problem

The Blotto game has been introduced by Borel more than a century ago in a seminal game theory paper. Surprisingly, characterizing and computing the optimal solutions (or the Nash equilibria) of this game in general was still open! This paper combines theoretical tools from statistics and auction theory to provide an almost explicit characterization of the strategies that are then computed using techniques from optimal transport (and other algorithmic ideas). The complexity of the final algorithm is even polynomial in the number of battlefields (a key parameter of a Blotto game) and the approximation level.
Reference Dependence in Queue Design and Pricing Strategies
Authors: Liu Jian , Zhou Yongpin , Chen Jian , Li Peng
Published: March 2024

This research investigates the effect of reference dependence on waiting times in service systems which formerly used a first-in-first-out (FIFO) service but have introduced a priority line with a fee. Our model combines reference-dependent gain-loss utility with standard customer utility, and we posit that customers are pleased with shorter-than-expected waiting times, whereas longer-than-expected times lead to dissatisfaction and an increased likelihood of balking. The study explores two scenarios: a captive customer system (CCS) and a noncaptive customer system (NCCS), with a focus on optimal pricing and segmentation strategies for revenue and social welfare maximization. The results reveal that, in a CCS, the service provider should implement observed and unobserved customer segmentation to optimize revenue and social welfare, respectively. In an NCCS, the impact of customer segmentation on revenue maximization depends on the value of regular customers, their loss reference-dependent preferences, and the system’s offered load. Alternatively, if the service provider seeks to maximize social welfare, the provider’s use of customer segmentation relies solely on the system’s offered load and customers’ reference-dependent preferences. Our findings also indicate that reference dependence can have varying impacts under different conditions, suggesting the effectiveness of tailored service and pricing strategies. Notably, a CCS generates more revenue than does an NCCS because of its captive nature, and, surprisingly, increasing the service rate can decrease revenue while improving social welfare. These insights have significant implications for service management strategies for a CCS and an NCCS.

Funding: J. Liu was supported by the National Natural Science Foundation of China (General Program) [Grant 72071112]. J. Chen was supported by the National Natural Science Foundation of China (Major Program) [Grant 71490723].

Supplemental Material: The online appendix is available at https://doi.org/10.1287/serv.2023.0033 .
Consensus on managing open ankle fractures in the frail patient
Authors: Guryel Enis , McEwan Jo , Qureshi Amir A. , Robertson Alastair , Ahluwalia Raju
Published: March 2024

Aims

Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest.

Methods

A modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS).

Results

In the first stage, there were 36 respondents to the survey, with over 70% stating their unit treats more than 20 such cases per year. There was a 50:50 split regarding if the timing of surgery should be within 36 hours, as per the hip fracture guidelines, or 72 hours, as per the open fracture guidelines. Overall, 75% would attempt primary wound closure and 25% would utilize a local flap. There was no orthopaedic agreement on fixation, and 75% would permit weightbearing immediately. In the second stage, performed at the BLRS meeting, experts discussed the survey results and agreed upon a consensus for the management of open elderly ankle fractures.

Conclusion

A mutually agreed consensus from the expert panel was reached to enable the best practice for the management of patients with frailty with an open ankle fracture: 1) all units managing lower limb fragility fractures should do so through a cohorted multidisciplinary pathway. This pathway should follow the standards laid down in the "care of the older or frail orthopaedic trauma patient" British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guideline. These patients have low bone density, and we should recommend full falls and bone health assessment; 2) all open lower limb fragility fractures should be treated in a single stage within 24 hours of injury if possible; 3) all patients with fragility fractures of the lower limb should be considered for mobilisation on the day following surgery; 4) all patients with lower limb open fragility fractures should be considered for tissue sparing, with judicious debridement as a default; 5) all patients with open lower limb fragility fractures should be managed by a consultant plastic surgeon with primary closure wherever possible; and 6) the method of fixation must allow for immediate unrestricted weightbearing.

Cite this article: Bone Jt Open 2024;5(3):236–242.
EFEITOS DA CRIMINALIDADE NO RIO DE JANEIRO: uma análise espacial para o período entre os anos 2014 e 2016
Authors: Carvalho Luiza Daniele Silva , Montenegro Rosa Livia , Martins Marina Alves
Published: March 2024

O elevado crescimento demográfico e o acelerado processo de urbanização causam pressão sobre as infraestruturas e orçamentos dos municípios, além de expansão descontrolada das periferias, principalmente em metrópoles como o Rio de Janeiro. Dessa forma, o artigo teve como objetivo investigar os fatores socioeconômicos e urbanos que afetaram a criminalidade no estado do Rio de Janeiro entre os anos de 2014 e 2016. A metodologia contou com a análise exploratória de dados espaciais (AEDE), que exibiu padrões espaciais (clusters espaciais) não aleatoriamente distribuídos no estado do Rio de Janeiro, e o modelo econométrico de dados em painel com variáveis relacionadas à densidade populacional, ao mercado de trabalho e à educação. Os resultados revelaram que a atuação pública na área de educação e na geração de emprego é importante canal que contribui para a redução da criminalidade no estado.