bluuebunny/crossref_metadata_2025 huggingface dataset:
What Went Right? South African Democracy and the Study of Political Science
Authors: Holmes Carolyn E
Published: August 2023

South Africa has been an important case in both scholarship and the public eye for decades. The anti-apartheid struggle saw mass international participation, and there was significant international optimism about the South African transition to multiracial democracy in 1994. Yet in the years since the advent of the new democratic dispensation in South Africa, a kind of pessimism has set in about the prospects for the country and for its democracy. Into this conversation Evan Lieberman's book, Until We Have Won Our Liberty, inserts a new perspective, arguing that South African democracy has been remarkably successful. Relying on a largely descriptive analysis of progress in infrastructure, rights guarantees, and dignified development, Lieberman argues that democratic performance in the country, especially given the starting point for democracy, has exceeded reasonable expectations. Lieberman's focus on what has gone right in South African democracy bucks many disciplinary and scholarly norms but presents a compelling argument for introspection on the part of the field.
Co-design and its consequences: developing a shared patient engagement framework in the IMI-PARADIGM project
Authors: Gunn Callum J , Fruytier Sevgi E , Finlay Teresa , Vat Lidewij Eva , Zuiderent-Jerak Teun , Schuitmaker-Warnaar Tjerk Jan
Published: August 2023

Whilst patient engagement (PE) activities have become increasingly prevalent in development of medicines, collaborating actors have different perspectives on the goals of PE and its added value. In the production of PE standards and frameworks, the significance of these differences tends to be minimised. Boundary objects have been shown to mediate knowledge exchange between multiple social worlds, thereby playing an important role in participatory technology governance processes. In this article, we draw on boundary objects to learn from the process of co-designing a PE monitoring and evaluation (M&E) framework within the Innovative Medicines Initiative–Patients Active in Research and Dialogues for an Improved Generation of Medicines (IMI-PARADIGM) consortium (2018–20). As facilitators of PARADIGM’s co-design process, we report on the challenges encountered in developing a practicable M&E framework that serves a variety of needs and interests. We argue these challenges of co-design reflect a negotiation of different frames throughout, thereby providing insight into how such work may contribute to addressing the challenge of knowledge integration in institutional medicines development settings.
Protocol for a randomized controlled study examining the role of rapid eye movement sleep in fear-related mechanisms: rapid eye movement fragmentation and fear inhibition in adults with insomnia disorders before and after cognitive behavioral therapy for insomnia
Authors: Vuong Vivien , Mellor Alix , Risbrough Victoria B , Bei Bei , Drummond Sean P A
Published: August 2023

Insomnia confers a 2.5-to-3-fold risk of developing posttraumatic stress disorder (PTSD) after a traumatic event. The mechanism underlying this increased risk, however, remains unknown. We postulate insomnia may contribute to PTSD by disrupting rapid eye movement (REM) sleep, as REM sleep disruption has been shown to impair fear inhibitory processes, which are central to the natural recovery from trauma. To test this hypothesis, the following protocol aims to: (1) examine the relationship between REM sleep and fear inhibition in insomnia, and (2) examine whether reducing REM fragmentation by treating insomnia, in turn, improves fear inhibition. Ninety-two adults with Insomnia Disorder will be block randomized (1:1; stratified by sex) to an active treatment (7 weekly sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) via telehealth) or waitlist control condition. REM sleep (latent variable derived from REM %, REM efficiency, and REM latency) and fear inhibition (i.e. safety signal and extinction recall) will be assessed pre- and post-treatment in a 4 night/3 day testing protocol via at-home polysomnography and the fear-potentiated startle paradigm, respectively. Fear extinction recall will serve as the primary outcome, while safety signal recall will serve as the secondary outcome. In summary, this study aims to test an underlying mechanism potentially explaining why insomnia greatly increases PTSD risk, while demonstrating an existing clinical intervention (CBT-I) can be used to improve this mechanism. Findings will have potential clinical implications for novel approaches in the prevention, early intervention, and treatment of PTSD.
Rapid Detection of Colletotrichum siamense from Infected Tea Plants Using Filter-Disc DNA Extraction and Loop-Mediated Isothermal Amplification
Authors: Zou Huayan , Li Taiwen , Zhang Jing , Shao Huijuan , Kageyama Koji , Feng Wenzhuo
Published: August 2023

The pathogen Colletotrichum siamense causes tea anthracnose, resulting in economic losses to the Chinese tea industry. To effectively diagnose this pathogen in the field, we developed a loop-mediated isothermal amplification (LAMP) method using highly specific primers with a sensitivity of 1 pg/μl designed for amplifying the CAL gene, which was 10 times higher than that of conventional PCR. Additionally, to improve the method for obtaining DNA samples required for on-site diagnosis, we used the filter-disc DNA extraction method, which does not require special instruments and can be completed in a few minutes, and found that it effectively meets the requirements for the LAMP reaction. Finally, we combined LAMP with a filter-disc DNA extraction method (FDE-LAMP) to diagnose different degrees of disease in inoculated samples and 20 samples from the field. The results showed that the procedure had sufficient sensitivity for pathogen detection. Therefore, the FDE-LAMP procedure could greatly contribute to managing and preventing tea anthracnose in the field.
Variation in Isolate Virulence and Accession Resistance Associated with Diaporthe aspalathi, D. caulivora, and D. longicolla in Soybean
Authors: Mohan Karthika , Kontz Brian , Okello Paul , Allen Tom W. , Bergstrom Gary C. , Bissonnette Kaitlyn , Bonkowski John , Bradley Carl A. , Buck James , Chilvers Martin I. , Dorrance Anne , Giesler Loren , Kelly Heather , Koehler Alyssa , Lopez-Nicora Horacio D. , Mangel Dylan , Markell Samuel G. , Mueller Daren , Price III Paul P. , Rojas Alejandro , Shires Madalyn , Smith Damon , Spurlock Terry , Webster Richard W. , Wise Kiersten , Yabwalo Dalitso , Mathew Febina M.
Published: August 2023

Important stem and grain diseases of soybean ( Glycine max [L.] Merr.) caused by Diaporthe aspalathi, D. caulivora, and D. longicolla reduce yield in the United States. Sources of resistance to these pathogens have previously been reported; however, there is limited information regarding their resistance when exposed to geographically distinct isolates of the same species. In this study, four accessions from the USDA Soybean Germplasm Collection with reported resistance to D. aspalathi, D. caulivora, or D. longicolla were evaluated using geographically representative isolates within each species from the United States. For each fungus, a greenhouse experiment was conducted as a completely randomized design with a factorial arrangement (isolate × accession). Plants were inoculated at the second to third trifoliate growth stage using toothpicks infested with isolates of each Diaporthe species. Pathogenicity was assessed 21 days postinoculation as 0 = no lesion, 0.5 = lesion length > 1 cm, and 1 = dead plant. A significant isolate-by-accession interaction ( P < 0.05) was observed to affect pathogenicity as analyzed using nonparametric statistics (relative treatment effects [RTEs]), indicating that accessions responded differently to the isolates. Correlation analyses suggested that the RTEs on ‘Tracy-M’, ‘Dowling’, and ‘Crockett’ were weakly to moderately correlated with those of the D. aspalathi-susceptible ‘Bragg’, as well as for ‘PI567473B’ and ‘Century’ ( D. caulivora), and ‘PI417507’ ( D. longicolla), with the RTEs on ‘Hawkeye’ ( P > 0.05) indicating possible genetic variation for resistance within these accessions. Our results provide information related to the resistance of previously identified accessions to develop commercial cultivars with resistance to important pathogens within the genus Diaporthe.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Exaggerated Plurivory of Macrophomina phaseolina: Accounting for the Large Host Range Claim and the Shifting of Scientific Language
Authors: Pennerman Kayla K. , Dilla-Ermita Christine Jade , Henry Peter M.
Published: August 2023

Macrophomina phaseolina is a plant pathogenic fungus that is frequently described as having a broad host range encompassing more than 500 species. We noticed that citations provided in support of this statement do not actually demonstrate such a broad host range. To elucidate the true documented host range of this fungus, we initiated a literature meta-analysis of 894 publications on M. phaseolina since 1913. We discovered that the first host range summaries did not require Koch's postulates or other experimental demonstrations of pathogenicity. Most of the available early host claims were based on tenuous associations between the fungus and symptoms, sometimes without reporting isolation or morphological examination in vitro. These statements apparently led to a pattern of increasingly exaggerated host range claims, without support from a primary reference, until the claim that M. phaseolina has 500 hosts became common in the early 2000s. At present, the scientific community typically requires Koch's postulates to characterize pathogenicity on a new host. Among all the available literature, we only found primary experimental evidence for M. phaseolina’s pathogenicity on 97 hosts; 74 hosts confirmed by Koch's postulates and 23 hosts with all steps from Koch's postulates completed except for recovery of the pathogen from symptomatic tissues. This study demonstrates how scientific concepts can change over time and necessitate changes to historic axioms. We propose that the hyperbole surrounding the host range of M. phaseolina has obscured an accurate depiction of its biology.
Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series
Authors: Cwaliński Jarosław , Hermann Jacek , Banasiewicz Tomasz
Published: August 2023

One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors’ surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10–21 days), and the vacuum dressings were changed an average of four times (range, 3–7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.
Mesenchymal Stem Cells and Regenerative Therapy with Bilateral Gracilis Flaps for Perineal Reconstruction of a Wound Infection in the Setting of Anal Squamous Cell Carcinoma
Authors: Garcia Matthew F. , Tiwari Kirti K. , Gendreau Julian L. , Burgess Pamela L. , Taupin Philippe , Martin Eric D.
Published: August 2023

Many patients are affected by HIV/AIDS, and these conditions are highly prevalent worldwide. Patients with HIV/AIDS can experience debilitating wound infections that often require flap reconstruction and become challenging for surgeons to treat. In the past 5 years, mesenchymal stem cells have been tested and used as regenerative therapy to promote the growth of tissues throughout the body because of their ability to successfully promote cellular mitogenesis. To the authors’ knowledge, the use of mesenchymal stem cell grafting following necrosis of a myocutaneous gracilis flap (as part of perineal wound reconstruction) has never been reported in the literature.

In addition, the use of mesenchymal stem cells and regenerative medicine combined in the setting of squamous cell carcinoma of the anus with prior radiation (along with comorbid AIDS) has not been previously documented.

In this report, the authors outline the case of a 60-year-old patient who had a recipient bed (perineum) complication from prior radiation therapy. Complicating the clinical picture, the patient also developed a Pseudomonal organ space infection of the pelvis leading to the failure of a vertical rectus abdominis myocutaneous flap and myocutaneous gracilis flaps. As a result, the patient underwent serial operative debridements for source control, with the application of mesenchymal stem cells, fetal bovine dermis, porcine urinary bladder xenograft, and other regenerative medicine products, achieving a highly successful clinical outcome. A procedural description for future use and replication of this method is provided.
Replacing Monitoring Electrodes on Infant Skin Every 12 Versus 24 Hours
Authors: Demirci Kader , Uğur Esra , Öntürk Zehra Kan
Published: August 2023

OBJECTIVE

To examine the effect of varying the frequency of monitoring electrode replacement on skin moisture and condition of infants hospitalized in the pediatric ICU.

METHODS

The population of the study consisted of 1- to 12-month-old infants receiving treatment in the pediatric ICU. The control group of the study (n = 33) included infants whose monitoring electrodes were replaced every 24 hours during monitoring, and the experimental group (n = 33) included infants whose monitoring electrodes were replaced every 12 and 24 hours during monitoring. Before assessment, the skin moisture of the monitoring areas was measured and evaluated with the Skin Condition Assessment Scale.

RESULTS

When the difference in skin moisture was compared for all measurement areas of the infants before monitoring and at the 24-hour mark, an increase in moisture was seen in both groups, and the difference in the experimental group was greater than that in the control group. Increased moisture is a risk factor for medical device-related pressure injuries. When comparing between-group differences in skin condition, the researchers noted a greater increase in skin condition score in the experimental group. An increased score indicates that the infant's skin condition is worsening.

CONCLUSIONS

Replacing the monitoring electrodes every 24 hours positively affected skin moisture and condition, whereas replacing them every 12 hours negatively affected skin moisture and condition.
Polylactic Acid-Based Biomaterials in Wound Healing: A Systematic Review
Authors: Chen Hui Ling , Chung Joanne Wai Yee , Yan Vincent Chun Man , Wong Thomas Kwok Shing
Published: August 2023

OBJECTIVE

To examine (1) the effectiveness of polylactic acid (PLA)-based biomaterials in wound healing, (2) their effects on wound infection prevention, and (3) their safety compared with existing biomaterials.

DATA SOURCES

Data sources included PubMed, MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CNKI (China National Knowledge Infrastructure), WEIPU, and WANFANG databases.

STUDY SELECTION

Investigators included 14 studies discussing the effects of PLA-based biomaterials in cutaneous wound healing published from 2000 to 2021.

DATA EXTRACTION

Authors extracted the following information from the selected studies: general information, study type, type of wound, PLA-based biomaterials and techniques, study period, outcome measures, and results.

DATA SYNTHESIS

Polylactic acid-based biomaterials may promote wound healing through wound area repair, collagen deposition, angiogenesis, and cell activities, which are related to the good biocompatibility, biodegradability, and moisture management properties of PLA. A proper product structure may also help. Both the native PLA materials and PLA blends seem to be antibacterial, although more evidence is needed for the native PLA products. Because there was no severe adverse event or obvious cytotoxicity observed in the included studies, PLA-based biomaterials are likely safe.

CONCLUSIONS

Polylactic acid-based biomaterials may be good wound dressing materials, although more evidence is needed to support their broader application in wound care.
Using an Elastomeric Skin Protectant to Manage Donor Site Wounds of Split-thickness Skin Grafts: A Case Series
Authors: Peters Ellen , Hanssens Valerie , De Henau Melissa , Dupont Yamina , Spinnael Jeannine , Giunta Gabriele , Zeltzer Assaf , De Baerdemaeker Randy , Hamdi Moustapha
Published: August 2023

Split-thickness skin grafting (STSG) is a common surgical procedure to manage acute and chronic wounds. A plethora of dressings exists to treat STSG donor site wounds (DSWs). Recently, a new elastomeric skin protectant was adopted (Cavilon Advanced Skin Protectant; 3M) in the treatment of incontinence-associated dermatitis. In this report, the authors assess the effects of this elastomeric skin protectant as an alternative wound dressing for STSG donor sites.

The authors report a single-center prospective case series that was performed to establish a treatment protocol. Nine consecutive patients with different indications for treatment with an STSG from May to September 2018 were included. Collected data included general patient information, comorbidities, complications, blood loss, pain during dressing change, and the duration of DSW healing.

This case series showed promising results in terms of duration of DSW healing when applying the elastomeric skin protectant. The authors also observed less blood loss and less pain during dressing changes. No infections were seen during the trial.
Safety of pharmacologically induced lactation
Authors: Thøgersen Patrick L. , Gotfredsen Ditte R. , Gade Christina , Horwitz Henrik , Andersen Jon T.
Published: August 2023

Pharmacologically induced lactation has the potential to help parents of all sexes who wish to breastfeed their children without a preceding pregnancy, and the interest in this possibility is increasing. A combination of hormones, physical stimulation and domperidone to mimic the hormonal changes of pregnancy and birth can be used to induce lactation. However, off-label uses of estrogen, progestin and domperidone or metoclopramide in high doses and for a long period of time have been associated with adverse drug reactions. Before prescribing drugs for induced lactation, it is important to discuss and help manage the parent's expectations regarding the outcome and, in detail, discuss the potential risks.
Estradiol enhances the mirtazapine effects on the expression of cocaine-induced locomotor sensitization in female rats
Authors: Barbosa-Méndez Susana , Salazar-Juárez Alberto
Published: August 2023

Epidemiological studies have mentioned that cocaine use disorder (CUD) has increased in the last decade among women; these show endocrine and reproductive disorders and a high propensity to stress and depression disorders. Mirtazapine—a tetracyclic antidepressant—decreases cocaine-induced locomotor activity and locomotor sensitization in male rats. The objective of this study was to evaluate if estradiol alters the efficacy of mirtazapine to decrease cocaine-induced locomotor activity in sham and ovariectomized female rats. Three hundred and twenty adult female Wistar rats were assigned to three experimental protocols. For experiments, 1–3, female rats were daily dosed with 10 mg/kg of cocaine during the 10 days of induction and expression of locomotor sensitization. During drug withdrawal (30 days), cocaine was withdrawn and the groups received daily mirtazapine, estradiol, or saline. In addition, the females underwent sham or ovariectomy surgery. Tamoxifen was administered during the antagonism phase. After each administration, locomotor activity for each animal was recorded for 30 min in activity chambers. The dosage of mirtazapine reduces estradiol-induced enhancement in cocaine-dependent locomotor activity during the expression of locomotor sensitization in sham and ovariectomized female rats. As well as they showed that estradiol co-dosed with mirtazapine enhances the efficacy of mirtazapine to decrease cocaine-induced locomotor activity. Finally, tamoxifen enhanced the estradiol and mirtazapine-induced decrease in the cocaine motor effect in female rats. Mirtazapine may be considered an effective therapeutic option for the treatment of CUD in women, even in those who are on hormonal treatment or antidepressant therapy with estradiol.
A Modified Dissection of the Superomedial Pedicle
Authors: Fotiou Antonia , Savva Demetris , Vassiliou Andreas
Published: August 2023

Background:

The superomedial pedicle is a widely used technique in mammaplasty, with various modifications formed over the years. This technique is often used in patients requiring major reduction in size, and optimization of the steps involved in the technique during the operation is of utmost importance to the plastic surgeon.

Methods:

We included 27 female patients who underwent mammaplasty between January 2018 and December 2020, with the modified superomedial pedicle technique. The technique of dissection is described in detail, by changing some of the steps of the pedicle dissection. We then assessed for patient satisfaction, complication rate, and operative duration, compared with a control group of 27 patients who underwent superomedial pedicle mammaplasty without the modification.

Result:

The use of this technique resulted in major reduction in operative time, with a similar complication rate and a high satisfaction rate among the patients.

Conclusion:

By changing some of the steps in the dissection of the superomedial pedicle, the surgeon can achieve optimal results and safety, with major gain in operative time reduction and surgical flexibility.
New keratoconus staging system based on OCT
Authors: Lu Nan-Ji , Hafezi Farhad , Koppen Carina , Alió del Barrio Jorge L. , Aslanides Ioannis M. , Awwad Shady T. , Ní Dhubhghaill Sorcha , Pineda Roberto , Torres-Netto Emilio A. , Wang Lin , Chen Shi-Hao , Cui Le-Le , Rozema Jos J.
Published: August 2023

Purpose:

To establish a numerical spectral-domain optical coherence tomography (SD-OCT)-based keratoconus (KC) staging system and compare it with existing KC staging systems.

Setting:

Eye Hospital of Wenzhou Medical University, Wenzhou, China.

Designs:

Retrospective case-control study.

Methods:

Scheimpflug tomography, air-puff tonometry, and SD-OCT were performed on 236 normal and 331 KC eyes. All SD-OCT-derived parameters of the corneal epithelium and stroma were evaluated based on their receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity to discriminate between normal and KC eyes. The best performing parameters were subsequently used to create an OCT-based staging system, which was compared with existing tomographic and biomechanical staging systems.

Results:

236 eyes from 236 normal patients and 331 eyes from 331 KC patients of different stages were included. The highest ranked AUC ROC SD-OCT parameters, derived from stroma and epithelium, were stroma overall minimum thickness (ST: AUC 0.836, sensitivity 90%, specificity 67%) and epithelium overall SD (EP: AUC 0.835, sensitivity 75%, specificity 78%). A numerical SD-OCT staging system called STEP including 2 parameters—“ST” and “EP”—with 5 stages was proposed.

Conclusions:

The new SD-OCT-based KC staging system is the first to take the epithelium with its sublayer stroma information into account, showing a strong agreement to the existing staging systems. This system could be incorporated into daily practice, potentially leading to an overall improvement in KC treatment and follow-up management.
Placebo and nocebo responses in painful diabetic neuropathy: systematic review and meta-analysis
Authors: Frisaldi Elisa , Vollert Jan , Al Sultani Husam , Benedetti Fabrizio , Shaibani Aziz
Published: August 2023

This preregistered (CRD42021223379) systematic review and meta-analysis aimed to characterize the placebo and nocebo responses in placebo-controlled randomized clinical trials (RCTs) on painful diabetic neuropathy (PDN), updating the previous literature by a decade. Four databases were searched for PDN trials published in the past 20 years, testing oral medications, adopting a parallel-group design. Magnitude of placebo or nocebo responses, Cochrane risk of bias, heterogeneity, and moderators were evaluated. Searches identified 21 studies (2425 placebo-treated patients). The overall mean pooled placebo response was −1.54 change in the pain intensity from baseline [95% confidence interval (CI): −1.52, −1.56, I2 = 72], with a moderate effect size (Cohen d = 0.72). The pooled placebo 50% response rate was 25% [95% CI: 22, 29, I2 = 50%]. The overall percentage of patients with adverse events (AEs) in the placebo arms was 53.3% [95% CI: 50.9, 55.7], with 5.1% [95% CI: 4.2, 6] of patients dropping out due to AEs. The year of study initiation was the only significant moderator of placebo response (regression coefficient = −0.06, [95% CI: −0.10, −0.02, P = 0.007]). More recent RCTs tended to be longer, bigger, and to include older patients (N = 21, r
s = 0.455, P = 0.038, r
s = 0.600, P = 0.004, r
s = 0.472, P = 0.031, respectively). Our findings confirm the magnitude of placebo and nocebo responses, identify the year of study initiation as the only significant moderator of placebo response, draw attention to contextual factors such as confidence in PDN treatments, patients' previous negative experiences, intervention duration, and information provided to patients before enrollment.
Working from home: Changes in radiologist reporting behavior in response to the COVID-19 pandemic
Authors: Kuo Yu , Lee Kang-Lung , Chen Yi-Lun , Weng Ching-Yao , Chang Feng-Chi , Chen Tzeng-Ji , Wu Hsiu-Mei , Wu Chia-Hung
Published: August 2023

Background:

Remote reporting is an important preventive measure against coronavirus disease 2019 (COVID-19) for radiology departments; it reduces the chance of cross-infections between coworkers. The purpose of this study was to evaluate how the preferred locations that radiologists filed reports from changed in response to COVID-19 by measuring the use of internal teleradiology workstations.

Methods:

Data were obtained from the radiological information system (RIS) database at our institution, which recorded the reporting workstation for each radiological examination. The reporting activities in 2021 were divided into computed radiography (CR) and computed tomography (CT)/magnetic resonance imaging (MRI) groups. The Wilcoxon signed-rank test was used to measure differences in the use of off-site workstations in prepandemic, midpandemic, and postpandemic periods.

Results:

There were statistically significant increases in the number of reports filed from off-site workstations for each attending physician from the prepandemic period to the midpandemic period in both the CR (15.1%-25.4%, p = 0.041) and CT/MRI (18.9%-28.7%, p = 0.006) groups. There was no significant difference noted between the prepandemic and postpandemic periods for either the CR (15.1% vs 18.4%, p = 0.727) or CT/MRI group (18.9% vs 23.3%, p = 0.236).

Conclusion:

In response to the COVID-19 outbreak, radiologists used internal teleradiology to report CR and CT/MRI examinations significantly more frequently. In contrast to the predictions of previous studies, the use of internal teleradiology returned to baseline levels after the pandemic was under control.
Evaluation of the Real-time Teleradiology Consultation System in the Emergency Department
Authors: Gulacti Umut , Turgut Kasim , Aydin Irfan , Yavuz Erdal , Arslan Ebru , Aksoy Fatih Mehmet , Gurbuz Mustafa , Erten Burak , Ozcan Oguzhan
Published: August 2023

Background and Objectives:

Teleradiology involves the transmission of all radiological images to a radiologist in a remote location to ensure an accurate diagnosis. Although various teleradiology systems exist, there is not a fully accepted real-time interactive teleradiology system yet. In this study, we analyzed “the teleradiology consultation system which includes a real-time and instant messaging program (Skype®)” established in an emergency department.

Methods:

The consultations requested from the teleradiology system implemented in the emergency department (ED) of a Medical Faculty Training and Research Hospital were evaluated between January 2018 and June 2018 retrospectively.

Results:

A total of 18,284 teleconsultations were included in the study. The mean age of the patients who required teleconsultation was 40.6 ± 24.8 years (range: 0–109 years) and 10,069 (55.1%) were male. And 17,079 (93.4%) computed tomography (CT) was consulted. The majority of CT scans were cranial CT (n = 7113, 41.6%) and upper-lower abdominal CT (n = 5436, 31.8%). And 1205 magnetic resonance imaging (MRIs) (6.6%) were consulted. The majority of MRIs were diffusion MRIs (n = 975, 80.9%). The mean evaluation time of radiological imaging was 66.3 minutes. In 7238 (39.6%) of all consultations, a problem or a demand was reported via interactive communication by radiologists or emergency physicians. They are as follows; the desire to speed up delayed reports (33.0%, n = 2388), problems related to radiological images (32.0%, n = 2316); demand for correction of delay problems from health system technicians (11.6%, n = 839), incomplete reporting (6.6%, n = 477), demand for the acceleration of reports of critical patients (6.4%, n = 463), request for re-evaluation of radiological images (5.2%, n = 376), the demand for additional clinical information of the radiology doctor (2.0%, n = 144), asking radiology doctor the statements in the report or to request for disclosure of findings (1.1%, n = 78), the other reasons (2.0%, n = 144). All of these problems were answered with real-time interviews and solved. Conclusion: The teleradiology system is important in health institutions where there is no 7/24 radiologist.

Conclusions:

This study showed that the establishment of a teleradiology consultation system integrated with a messaging service in the ED might provide real-time and immediate resolution of the occurring problems.
Neophallus and Urethroplasty Revisions: Step-by-step Surgical Techniques and Key Reconstructive Maneuvers
Authors: Raheem Omer A. , Hajiyev Parviz , Al-Malki Ahmad , Kocjancic Ervin
Published: August 2023

Objective:

The aim of this video is to demonstrate step-by-step surgical techniques for neophallus and urethroplasty revisions, emphasizing key reconstructive maneuvers and improving patient outcomes.

Materials and Methods:

Neophallus and urethroplasty revisions can be challenging procedures associated with complications. We present a 25-year-old male with a history of ambiguous genitalia and micropenis due to 17-hydroxylase deficiency. The patient presented with bothersome penile skin redundancy at the base of the neophallus and a history of intermittent urinary incontinence, necessitating “milking the base of the neophallus” to completely evacuate his urethra. The patient also reported foul-smelling discharge with urine. Imaging evaluation, including retrograde urethrogram and voiding cystogram, revealed a smooth cystic dilatation of the posterior urethra with a normal bladder contour and capacity. Further evaluation with cystoscopy identified a Mullerian duct remnant in the urethra. We recommend surgical excision of the remnant and neophallus skin revision using intraoperative SPY Indocyanine green to carefully delineate the blood supply to the neophallus and mitigate potential risks and complications.

Results:

This paper demonstrates step-by-step surgical techniques for neophallus and urethroplasty revisions, highlighting key surgical maneuvers such as using intraoperative SPY Indocyanine green to delineate blood supply, excision of the Mullerian duct cystic lesion, and urethroplasty. These techniques aim to improve patient outcomes by addressing penile skin redundancy and urinary incontinence while minimizing potential complications.

Conclusion:

As neophallus reconstruction becomes increasingly common, familiarity with surgical anatomy, complications management, and outcomes is essential. This video provides a valuable resource for surgical education and may aid in the improvement of patient outcomes.
Molecular testing for indeterminate thyroid nodules: past, present, and future
Authors: Raghunathan Rajam , Praw Stephanie Smooke , Livhits Masha
Published: August 2023

Purpose of review

To examine the origin, current progress, and future directions of molecular testing in indeterminate Bethesda III and Bethesda IV thyroid nodules.

Recent findings

The diagnostic performance of current genomic tests shows improved benign call rates, specificity and positive-predictive values over prior test versions. The choice of test platform for clinical use should consider test performance, institutional rate of malignancy, nodule cytology and the potential for prognostication to help guide decision-making. Current challenges include test reliability, defining the optimal duration of surveillance, and improving test performance in challenging cytology, such as oncocytic nodules and NIFTP. Opportunities also remain to optimize cost-effectiveness across multiple clinical and practice settings and to refine the use of molecular testing for dynamic risk stratification, such as with BRAF V600E mutation testing.

Molecular testing of indeterminate thyroid nodules has helped to reduce the burden of diagnostic surgery, associated healthcare costs, and potential complications. Current-generation tests have demonstrated improvement in diagnostic performance, but challenges remain in improving test performance and refining the scope of testing in care. Decision-making for the management of indeterminate thyroid nodules should consider cytology, clinical and sonographic features, patient values and preferences and molecular testing results, whenever available.
Idiopathic hypersomnia with a video recording of a spontaneous sleep attack: A case report
Authors: Asaga Takamasa , Hashimoto Kenichi , Kawamura Yusuke , Fujita Naoya , Kimata Motohiro , Sekizawa Akinori , Ono Yosuke , Obuchi Yasuhiro , Kobayashi Nanase , Hirasawa Hideto , Kanbayashi Takashi , Tanaka Yuji
Published: August 2023

  

Abstract

Rationale: Although patients with central disorders of hypersomnolence (CDH) exhibit characteristic symptoms of hypersomnia frequently, it takes 5–15 years from the onset for its diagnosis due to the lack of symptom recognition. Here, we present a case of idiopathic hypersomnia (IH), a CDH, wherein early diagnosis was aided by a video footage of a spontaneous sleep attack.

Patient concerns: A 21-year-old man lost consciousness while driving and experienced an accident. He had complained of excessive daytime sleepiness (EDS) over half a year. During his hospitalization for close monitoring of the loss of consciousness, an in-room surveillance camera captured a 14-min long spontaneous sleep attack, during which he experienced general muscle weakness and loss of consciousness without warnings or convulsions leading to a fall from the bed. There were no abnormalities in vital signs.

Diagnoses: There was no significant cataplexy and less than two sleep-onset rapid eye movements in two sleep latency tests, with a mean sleep latency of 2.1 and 4.6 minutes. Other sleep deprivation syndromes were excluded from differential diagnosis and finally a diagnosis of IH was confirmed according to the criteria of the Third Edition of the International Classification of Sleep Disorders. During the course of the disease, attention-deficit/hyperactive disorder (ADHD) and a gaming disorder also diagnosed. 

Interventions: Pharmacological treatment with modafinil was administered for IH and methylphenidate for ADHD. Cognitive behavioral therapy was performed for the gaming disorder.

Outcomes: The EDS improved, and sleep attacks were no longer observed. The disruption of daily life caused by the gaming disorder was also reduced.

Lessons: Video recordings of sleep attacks are beneficial for identifying the cause of loss of consciousness. Home video recordings may be helpful in the early diagnosis of IH.
DNA Methylation Signatures of Functional Somatic Syndromes: Systematic Review
Authors: Fischer Susanne , Kleinstäuber Maria , Fiori Laura M. , Turecki Gustavo , Wagner Julia , von Känel Roland
Published: August 2023

Objective

Functional somatic syndromes (FSS) are highly prevalent across all levels of health care. The fact that they are characterized by medically unexplained symptoms, such as fatigue and pain, raises the important question of their underlying pathophysiology. Psychosocial stress represents a significant factor in the development of FSS and can induce long-term modifications at the epigenetic level. The aim of this review was to systematically review, for the first time, whether individuals with FSS are characterized by specific alterations in DNA methylation.

Methods

MEDLINE and PsycINFO were searched from the first available date to September 2022. The inclusion criteria were as follows: a) adults fulfilling the research diagnostic criteria for chronic fatigue syndrome, fibromyalgia syndrome, and/or irritable bowel syndrome; b) healthy control group; and c) candidate-gene or genome-wide study of DNA methylation.

Results

Sixteen studies (N = 957) were included. In candidate-gene studies, specific sites within NR3C1 were identified, which were hypomethylated in individuals with chronic fatigue syndrome compared with healthy controls. In genome-wide studies in chronic fatigue syndrome, a hypomethylated site located to LY86 and hypermethylated sites within HLA-DQB1 were found. In genome-wide studies in fibromyalgia syndrome, differential methylation in sites related to HDAC4, TMEM44, KCNQ1, SLC17A9, PRKG1, ALPK3, TFAP2A, and LY6G5C was found.

Conclusions

Individuals with chronic fatigue syndrome and fibromyalgia syndrome seem to be characterized by altered DNA methylation of genes regulating cellular signaling and immune functioning. In chronic fatigue syndrome, there is preliminary evidence for these to be implicated in key pathophysiological alterations, such as hypocortisolism and low-grade inflammation, and to contribute to the debilitating symptoms these individuals experience.

Preregistration

PROSPERO identifier: CRD42022364720.
Incidence of Bowel Wall Swelling Induced by Iodine-Contrast Media and Its Association With Gastrointestinal Manifestation
Authors: Ishii Shiro , Yamakuni Ryo , Tsuchiya Takao , Yamaki Anna , Hara Junko , Sugawara Shigeyasu , Sekino Hirofumi , Fukushima Kenji , Ito Hiroshi
Published: August 2023

Purpose

The aim of this study was to investigate the incidence of bowel wall swelling after iodine-contrast media injection and its relationship with gastrointestinal symptoms.

Methods

The incidence of bowel wall swelling was examined in 75 patients who showed adverse reactions to iodine-contrast media (AR[+] group) and 75 controls without adverse reactions (AR[−] group). Bowel wall swelling was identified if there was increased wall thickness on postcontrast computed tomography when compared with precontrast computed tomography. Swelling less than 2-fold of the original wall thickness was defined as grade 1 bowel angioedema, and swelling more than 2-fold was defined as grade 2.

Results

The incidence of bowel wall swelling was significantly higher in the AR(+) group (26.6%) than in the AR(−) group (10.6%) (P = 0.01). Grade 1 bowel wall swelling was observed in 12.0% and 10.7% of AR(+) and AR(−) groups, respectively, whereas grade 2 was observed in 14.7% and 0%, respectively. Bowel wall swelling was observed in the duodenum and jejunum but not in the stomach, ileum, or colon in any patient in either group. In the AR(+) group, nausea and/or vomiting was observed in 15 patients, among whom bowel wall swelling was observed in 9 patients (60%). The frequency of nausea and/or vomiting was significantly higher in the patients with bowel wall swelling (45.0%, 9/20) compared with those without (10.9%, 6/55).

Conclusion

Bowel wall swelling was more frequent and severe in patients with adverse reactions to iodine-contrast media than those without and was associated with nausea and/or vomiting.
Correlation Between Intranodular Vessels and Tumor Invasiveness of Lung Adenocarcinoma Presenting as Ground-glass Nodules
Authors: Zhao Baolian , Wang Xiang , Sun Ke , Kang Han , Zhang Kai , Yin Hongkun , Liu Kai , Xiao Yi , Liu Shiyuan
Published: August 2023

Purpose:

To evaluate the role of quantitative features of intranodular vessels based on deep learning in distinguishing pulmonary adenocarcinoma invasiveness.

Materials and Methods:

This retrospective study included 512 confirmed ground-glass nodules from 474 patients with 241 precursor glandular lesions (PGL), 126 minimally invasive adenocarcinomas (MIA), and 145 invasive adenocarcinomas (IAC). The pulmonary blood vessels were reconstructed on noncontrast computed tomography images using deep learning-based region-segmentation and region-growing techniques. The presence of intranodular vessels was evaluated based on the automatic calculation of vessel prevalence, vascular categories, and vessel volume percentage. Further comparisons were made between different invasive groups by the Mantel-Haenszel χ2 test, χ2 test, and analysis of variance.

Results:

The detection rate of intranodular vessels in PGL (33.2%) was significantly lower than that of MIA (46.8%, P = 0.011) and IAC (55.2%, P < 0.001), while the vascular categories were similar (all P > 0.05). Vascular changes were more common in IAC and MIA than in PGL, mainly in increased vessel volume percentage (12.4 ± 19.0% vs. 6.3 ± 13.1% vs. 3.9 ± 9.4%, P < 0.001). The average intranodular artery and vein volume percentage of IAC (7.5 ± 14.0% and 5.0 ± 10.1%) was higher than that of PGL (2.1 ± 6.9% and 1.7 ± 5.8%) and MIA (3.2 ± 9.1% and 3.1 ± 8.7%), with statistical significance (all P < 0.05).

Conclusions:

The quantitative analysis of intranodular vessels on noncontrast computed tomography images demonstrated that the ground-glass nodules with increased internal vessel prevalence and volume percentages had higher possibility of tumor invasiveness.
Ian Michael Glynn. 3 June 1928—7 July 2022
Authors: Lew Virgilio L. , Karlish Steven J. D.
Published: August 2023

In the mid 1950s the convergence of crucial discoveries on nerve and muscle physiology brought to centre stage the question of how sodium and potassium concentration gradients needed for nerve conduction and muscle contraction are maintained. This was the subject Ian Glynn set out to investigate when he returned to Cambridge as a Trinity College graduate student in 1953. His initial results on the sodium and potassium permeabilities of the human red blood cell membrane, published in 1956–1967, established these cells as an ideal experimental system for studying the transport properties of the ‘sodium pump’ because of the ease with which the ionic composition of intra- and extracellular environments could be controlled, cell metabolism managed and ionic fluxes measured using isotopes. This work was followed by ground-breaking contributions from his research group over the next decades in a long series of brilliantly designed experiments, setting the foundations of our current understanding of the molecular mechanism of the sodium/potassium pump. Ian became a Trinity College fellow in 1960, advanced rapidly to a professorship in the Department of Physiology after being elected Fellow of the Royal Society in 1970, and was appointed head of department in 1986 until his retirement in 1995.
Adult presence does not ameliorate juvenile feeding challenges in a leaf-footed bug
Authors: Zlotnik Sam , Miller Christine W.
Published: August 2023

Herbivores often grapple with structural defences in their host plants, which may pose especially difficult challenges for juveniles due to their underdeveloped feeding morphology. The degree to which juvenile herbivore survival is limited by structural defences as well as the strategies used to overcome them are not well understood. We hypothesized that juveniles benefit from feeding near adults because adults pierce through physical barriers while feeding, enabling juveniles to access nutrients that they otherwise could not. We tested this feeding facilitation hypothesis in the leaf-footed bug
Leptoglossus zonatus
(Hemiptera: Coreidae). Bugs were raised with an adult or a juvenile conspecific and fed a diet of pecans with or without shells. As predicted, we found that juveniles suffered greater mortality when fed nuts with shells than when fed nuts without shells. Contrary to our expectations, the presence of an adult feeding on the same nut did not lessen this effect. Therefore, the presence of an adult does not ameliorate the feeding difficulties faced by juvenile
L. zonatus,
despite evidence for feeding facilitation in related insect species. This study adds to our understanding of how host plant defences can limit the survival of even highly generalist herbivores.
Reports of deaths are an exaggeration: all-cause and NAA-test-conditional mortality in Germany during the SARS-CoV-2 era
Authors: Rockenfeller R. , Günther M. , Mörl F.
Published: August 2023

Counts of SARS-CoV-2-related deaths have been key numbers for justifying severe political, social and economical measures imposed by authorities world-wide. A particular focus thereby was the concomitant excess mortality (EM), i.e. fatalities above the expected all-cause mortality (AM). Recent studies,inter aliaby the WHO, estimated the SARS-CoV-2-related EM in Germany between 2020 and 2021 as high as 200 000. In this study, we attempt to scrutinize these numbers by putting them into the context of German AM since the year 2000. We propose two straightforward, age-cohort-dependent models to estimate German AM for the ‘Corona pandemic’ years, as well as the corresponding flu seasons, out of historic data. For Germany, we find overall negative EM of about −18 500 persons for the year 2020, and a minor positive EM of about 7000 for 2021, unveiling that officially reported EM counts are an exaggeration. In 2022, the EM count is about 41 200. Further, based on NAA-test-positive related death counts, we are able to estimate how many Germans have dieddue torather thanwithCoViD-19; an analysis not provided by the appropriate authority, the RKI. Through 2020 and 2021 combined, our due estimate is at no more than 59 500. Varying NAA test strategies heavily obscured SARS-CoV-2-related EM, particularly within the second year of the proclaimed pandemic. We compensated changes in test strategies by assuming that age-cohort-specific NAA-conditional mortality rates during the first pandemic year reflected SARS-CoV-2-characteristic constants.