bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Virtual Interactive Patient Encounters to Prepare First-Year Medical Students for Clinical Practice
Authors: Roberts John K. , Sullivan Meghan , Atwater Sierra , Desai Katha , Prabhu Neel K. , Hertz Julian T. , Buhr Gwendolen T. , Peyser Bruce , Weigle Nancy
Published: May 2023

Problem

With the dissolution of the Step 2 Clinical Skills exam, medical programs have a greater responsibility to teach and assess clinical skills in the preclerkship years. Clinical teaching this early has traditionally been avoided because of insufficient integration with biomedical sciences, curricular time constraints, and concerns about overwhelming novice learners with clinical learning objectives. To overcome these barriers, the authors created a clinical framework for the biomedical science curriculum by integrating a series of virtual interactive patient (VIP) videos.

Approach

Matriculating first-year medical students were enrolled in a clinically integrated biomedical science course that used VIP videos to teach and assess clinical skills. The VIP videos were enhanced with interactive pop-in windows, and at the conclusion of each video, students performed a clinical documentation task and received immediate feedback. The authors implemented 7 VIP cases during fall 2021 in which first-year medical students wrote the patient care plan, problem representation statement, or clinical reasoning assessment. Student responses were independently evaluated by course faculty using a 4-level scoring scale. The authors calculated the pooled mean scores for each documentation task and examined student feedback.

Outcomes

Seven VIP encounters were assigned to 124 students (mean response rate, 98.5%). Pooled mean scores on the clinical documentation tasks showed that most students were able to achieve levels 3 or 4 when writing the patient care plan (97 [82%] to 113 [94%]), addressing social determinants of health (80 [67%]), writing an accurate problem representation statement (113 [91%] to 117 [94%]), and performing clinical reasoning skills (48 [40%] to 95 [82%]).

Next Steps

VIP encounters were feasible to produce, effective at integrating course content, successful at assessing student clinical documentation skills, and well received. The authors will continue to produce, implement, and study the VIP as an integrating learning tool in undergraduate medical education.
Consensus-Based Best Practice Guidelines for the Management of Spinal Deformity and Associated Tumors in Pediatric Neurofibromatosis Type 1: Screening and Surveillance, Surgical Intervention, and Medical Therapy
Authors: Xu Amy L. , Suresh Krishna V. , Gomez Jaime A. , Emans John B. , Larson A. Noelle , Cahill Patrick J. , Andras Lindsay M. , White Klane K. , Miller Daniel J. , Murphy Joshua S. , Groves Mari L. , Belzberg Allan J. , Hwang Steven W. , Rosser Tena L. , Staedtke Verena , Ullrich Nicole J. , Sato Aimee A. , Blakeley Jaishri O. , Schorry Elizabeth K. , Gross Andrea M. , Redding Gregory J. , Sponseller Paul D. ,   Pediatric Spine Study Group
Published: May 2023

Background:

Spinal conditions, such as scoliosis and spinal tumors, are prevalent in neurofibromatosis type 1 (NF1). Despite the recognized importance of their early detection and treatment, there remain knowledge gaps in how to approach these manifestations. The purpose of this study was to utilize the experience of a multidisciplinary committee of experts to establish consensus-based best practice guidelines (BPGs) for spinal screening and surveillance, surgical intervention, and medical therapy in pediatric patients with NF1.

Methods:

Using the results of a prior systematic review, 10 key questions that required further assessment were first identified. A committee of 20 experts across medical specialties was then chosen based on their clinical experience with spinal deformity and tumors in NF1. These were 9 orthopaedic surgeons, 4 neuro-oncologists/oncologists, 3 neurosurgeons, 2 neurologists, 1 pulmonologist, and 1 clinical geneticist. An initial online survey on current practices and opinions was conducted, followed by 2 additional surveys via a formal consensus-based modified Delphi method. The final survey involved voting on agreement or disagreement with 35 recommendations. Items reaching consensus (≥70% agreement or disagreement) were included in the final BPGs.

Results:

Consensus was reached for 30 total recommendations on the management of spinal deformity and tumors in NF1. These were 11 recommendations on screening and surveillance, 16 on surgical intervention, and 3 on medical therapy. Five recommendations did not achieve consensus and were excluded from the BPGs.

Conclusion:

We present a set of consensus-based BPGs comprised of 30 recommendations for spinal screening and surveillance, surgical intervention, and medical therapy in pediatric NF1.
Infection and Nonunion Following Operative Treatment of Lateral Humeral Condyle Fractures
Authors: Bridges Callie S. , Taylor Tristen N. , Pang Lon Kai , Beauvais Dorothy H. , May Megan M. , Smith Brian G.
Published: May 2023

Background:

Lateral humeral condyle fractures (LHCF) are the second most frequent type of pediatric elbow fracture. The purpose of this study is to characterize infections and nonunions of LHCF treated at a single institution. This is the largest series on infections and nonunions of LHCF to date.

Methods:

Pediatric patients undergoing surgical treatment for a LHCF from 2012 to 2022 at a single children’s hospital were identified for a retrospective review. Patients who were diagnosed with an active infection or nonunion after surgery were included. Data collected included demographics, original treatment course, presentation, effective treatments, outcomes, and timing of events.

Results:

Out of 863 surgical patients, 12 (1.4%) patients developed 13 infections: 8 were diagnosed with superficial cellulitis, 3 with soft tissue infections, and 2 with osteomyelitis. Eleven fractures were stabilized with percutaneous pins and 1 with buried pins. The average time to infection diagnosis was 29 days and the most common presenting symptom was increased or new onset of pain. All 12 patients received antibiotics for an average 18 days, 6 required hospital admission, 3 required surgical incision and drainage, and 2 required intravenous antibiotics without admission. One patient that developed osteomyelitis developed a nonunion. Ten (1.2%) surgical patients developed nonunion. There were 3 Weiss type II fractures and 7 type III fractures. On average, nonunions were diagnosed 12 weeks after initial treatment. Nine patients underwent nonunion surgery, and all went on to union. Patient’s elbows were immobilized for an average 16 weeks and at least 5 patients required an average of 10 physical therapy sessions to regain their range of motion.

Conclusion:

Infection and nonunion are rare complications of LHCF, but greatly change the timeline and number of healthcare interactions required for healing. Infectious complications typically require admission, additional surgery, or emergency department visits. Nonunions require extensive cast time, additional surgery, and rehabilitation.

Level of Evidence:

Level IV – case series.
Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal
Authors: Benes Gregory , Shufflebarger Harry L. , Shah Suken A. , Yaszay Burt , Marks Michelle C. , Newton Peter O. , Sponseller Paul D.
Published: May 2023

Background:

Late infection after posterior spinal arthrodesis for adolescent idiopathic scoliosis (AIS) is the leading cause of late revision. While implant removal and antibiotic therapy are usually curative, patients may experience deformity progression. The goal of this study was to compare outcomes after implant exchange (IE) or removal (IR) to treat late-onset (≥1 y postoperative) deep surgical site infection (SSI) after spinal arthrodesis in patients with AIS.

Methods:

Using a multicenter AIS registry, patients who underwent posterior spinal fusion between 2005 and 2019 and developed late deep SSI treated with IE or IR were identified. Radiographic, surgical, clinical, and patient-reported outcomes at most recent follow-up were compared.

Results:

Of 3,705 patients, 47 (1.3%) developed late infection 3.8±2.2 years (range 1 to 9.7 y) after index surgery. Mean follow-up after index surgery was 6.1 years, with 2.8 years (range 25 to 120 mo) of follow-up after revision surgery. Twenty-one patients were treated with IE and 26 with IR. At the latest follow-up, average major-curve loss of correction (1° vs 9°, P<0.001) and increase in kyphosis (1° vs. 8°, P=0.04) were smaller in the IE group than in the IR group. Two IR patients but no IE patients had reoperation. Patients who underwent IE had higher Scoliosis Research Society 22-Item Patient Questionnaire (SRS-22) total scores (4.38 vs. 3.81, P=0.02) as well as better subscores for self-image, function, and satisfaction at the latest follow-up than those who underwent IR only. There were no significant between-group differences in operative duration, estimated blood loss, length of hospital stay, or changes in SRS-22 total scores. No patient had a subsequent infection during the follow-up period.

Conclusions:

When treating late-onset deep SSI after posterior spinal fusion for AIS, single-stage IE is associated with better maintenance of major curve correction, sagittal profile, and patient-reported outcomes and fewer reoperations compared with IR, with no significant differences in blood loss, operative duration, or length of stay. No time interval from index surgery to IR was observed where the corrected deformity remained stable. Both techniques were curative of infection.

Level of Evidence:

Level III
Current immune therapeutic strategies in advanced or metastatic non-small-cell lung cancer
Authors: Xu Jing , Liu Caixia , Wu Xiaonan , Ma Jie
Published: May 2023

Immune escape mechanisms in non-small cell lung cancer (NSCLC) can disrupt every step of the anti-cancer immune response. In recent years, an increased understanding of the specific mechanisms fueling immune escape has allowed for the development of numerous immunotherapeutic treatments that have been introduced into the clinical practice. The advent of immunotherapy has dramatically changed the current treatment landscape of advanced or metastatic NSCLC because of its durable efficacy and manageable toxicity. In this review, we will first present a brief overview of recent evidence on immune escape mechanisms in NSCLC. We will then discuss the current promising immunotherapeutic strategies in advanced or metastatic NSCLC tumors.
Predicting survival and prognosis of postoperative breast cancer brain metastasis: a population-based retrospective analysis
Authors: Nie Yan , Ying Bicheng , Lu Zinan , Sun Tonghui , Sun Gang
Published: May 2023

Background

Breast cancer is one of the most common cancer in women and a proportion of patients experiences brain metastases with poor prognosis. The study aimed to construct a novel predictive clinical model to evaluate the overall survival (OS) of patients with postoperative brain metastasis of breast cancer (BCBM) and validate its effectiveness.

Methods

From 2010 to 2020, a total of 310 female patients with BCBM were diagnosed in The Affiliated Cancer Hospital of Xinjiang Medical University, and they were randomly assigned to the training cohort and the validation cohort. Another 173 BCBM patients were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database as an external validation cohort. In the training cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression model was used to determine the fundamental clinical predictive indicators and the nomogram was constructed to predict OS. The model capability was assessed using receiver operating characteristic, C-index, and calibration curves. Kaplan–Meier survival analysis was performed to evaluate clinical effectiveness of the risk stratification system in the model. The accuracy and prediction capability of the model were verified using the validation and SEER cohorts.

Results

LASSO Cox regression analysis revealed that lymph node metastasis, molecular subtype, tumor size, chemotherapy, radiotherapy, and lung metastasis were statistically correlated with BCBM. The C-indexes of the survival nomogram in the training, validation, and SEER cohorts were 0.714, 0.710, and 0.670, respectively, which showed good prediction capability. The calibration curves demonstrated that the nomogram had great forecast precision, and a dynamic diagram was drawn to increase the maneuverability of the results. The Risk Stratification System showed that the OS of low-risk patients was considerably better than that of high-risk patients (P <0.001).

Conclusion

The nomogram prediction model constructed in this study has a good predictive value, which can effectively evaluate the survival rate of patients with postoperative BCBM.
Geolocation to Identify Online Study-Eligible Gay, Bisexual, and Men who have Sex with Men in Philadelphia, Pennsylvania
Authors: Tran Nguyen K. , Welles Seth L. , Goldstein Neal D.
Published: May 2023

Background:

Data collection and cleaning procedures to exclude bot-generated responses are used to maintain the data integrity of samples from online surveys. However, these procedures may be time-consuming and difficult to implement. Thus, we aim to evaluate the validity of a single-step geolocation algorithm for recruiting eligible gay, bisexual, and men who have sex with men in Philadelphia for an online study.

Methods:

We used a 4-step approach, based on common practices for evaluating bot-generated and fraudulent responses, to assess the validity of participants’ Qualtrics survey data as our referent standard. We then compared it to Qualtrics’ single-step geolocation algorithm that used the MaxMind commercial database to map participants’ Internet protocol address to their approximate location. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the single-step geolocation approach relative to the 4-step approach.

Results:

There were 826 respondents who completed the survey and 440 (53%) were eligible for enrollment based on the 4-step approach. The single-step geolocation approach yielded a sensitivity of 91% (95% CI = 88%, 93%), specificity of 79% (95% CI = 74%, 83%), PPV of 83% (95% CI = 80%, 86%), and NPV of 88% (95% CI = 85%, 91%).

Conclusions:

Geolocation alone provided a moderately high level of agreement with the 4-step approach for identifying geographically eligible participants in the online sample, but both approaches may be subject to additional misclassification. Researchers may want to consider multiple procedures to ensure data integrity in online samples.
Immunogenicity and Safety of a Hexavalent DTwP-IPV-HB-PRP~T Vaccine Versus Separate DTwP-HB-PRP~T, bOPV, and IPV Vaccines Administered at 2, 4, 6 Months of Age Concomitantly With Rotavirus and Pneumococcal Conjugate Vaccines in Healthy Infants in Thailand
Authors: Sanchez Leilani , Rungmaitree Supattra , Kosalaraksa Pope , Jantarabenjakul Watsamon , Leclercq Julie , Yaiprayoon Yuvadee , Midde Venkata Jayanth , Varghese Kucku , Mangarule Somnath , Noriega Fernando
Published: May 2023

Background:

This study investigated the immunogenicity and safety of a fully liquid, hexavalent, diphtheria (D)-tetanus (T)-whole-cell pertussis (wP)-inactivated poliovirus (IPV)-hepatitis B (HB)-Haemophilus influenzae b (PRP-T) vaccine compared to licensed DTwP-HB-PRP~T, IPV, and bivalent oral poliovirus (bOPV) vaccines following co-administration with other pediatric vaccines [pneumococcal conjugate vaccine (PCV13) and rotavirus vaccine].

Methods:

Phase III, randomized, open-label study in Thailand. Healthy infants received DTwP-IPV-HB-PRP~T at 2, 4 and 6 months of age (N = 228), or DTwP-HB-PRP~T and bOPV (2, 4 and 6 months of age) and IPV (4 months of age) (N = 231). All participants received PCV13 (2, 4 and 6 months of age) and rotavirus vaccine (2 and 4 months of age). Immunogenicity for all antigens was assessed using validated assays, and noninferiority post-third dose was evaluated for anti-D, anti-T, anti-pertussis [anti-pertussis toxin (anti-PT) and anti-fimbriae 2/3 (anti-FIM)], anti-polio 1, 2, 3, anti-HB, and anti-PRP~T. Safety was assessed using parental reports.

Results:

Noninferiority was demonstrated for each antigen, and overall noninferiority of DTwP-IPV-HB-PRP~T versus DTwP-HB-PRP~T+bOPV+IPV was concluded. Similarity in each group was observed for the GMC ratio for antirotavirus antibodies (20.9 and 17.3, respectively) and anti-PCV13 antibodies (range: 8.46–32.6 and 7.53–33.1, respectively). Two serious adverse events were related to DTwP-IPV-HB-PRP~T (febrile convulsion and acute febrile illness) and 1 was related to DTwP-HB-PRP~T+bOPV+IPV (febrile seizure), but overall there were no safety concerns with similar rates of participants experiencing solicited (99.1% and 98.3%) and unsolicited (19.3% and 19.5%) adverse events in each group.

Conclusions:

This study confirmed the suitability of DTwP-IPV-HB-PRP~T primary series vaccination in combination with rotavirus and PCV13 vaccines.
Changing Patterns of Infectious Diseases Among Hospitalized Children in Hokkaido, Japan, in the Post-COVID-19 Era, July 2019 to June 2022
Authors: Fukuda Yuya , Togashi Atsuo , Hirakawa Satoshi , Yamamoto Masaki , Fukumura Shinobu , Nawa Tomohiro , Honjo Saho , Kunizaki Jun , Nishino Kouhei , Tanaka Toju , Kizawa Toshitaka , Yamamoto Dai , Takeuchi Ryoh , Sasaoka Yuta , Kikuchi Masayoshi , Ito Takuro , Nagai Kazushige , Asakura Hirofumi , Kudou Katsumasa , Yoshida Masaki , Nishida Takeshi , Tsugawa Takeshi
Published: May 2023

Background:

Many reports have reported a reduction in respiratory infectious diseases and infectious gastroenteritis immediately after the coronavirus disease 2019 (COVID-19) pandemic, but data continuing into 2022 are very limited. We sought to understand the current situation of various infectious diseases among children in Japan as of July 2022 to improve public health in the post-COVID-19 era.

Methods:

We collected data on children hospitalized with infectious diseases in 18 hospitals in Japan from July 2019 to June 2022.

Results:

In total, 3417 patients were hospitalized during the study period. Respiratory syncytial virus decreased drastically after COVID-19 spread in early 2020, and few patients were hospitalized for it from April 2020 to March 2021. However, an unexpected out-of-season re-emergence of respiratory syncytial virus was observed in August 2021 (50 patients per week), particularly prominent among older children 3–6 years old. A large epidemic of delayed norovirus gastroenteritis was observed in April 2021, suggesting that the nonpharmaceutical interventions for COVID-19 are less effective against norovirus. However, influenza, human metapneumovirus, Mycoplasma pneumoniae, and rotavirus gastroenteritis were rarely seen for more than 2 years.

Conclusions:

The incidence patterns of various infectious diseases in Japan have changed markedly since the beginning of the COVID-19 pandemic to the present. The epidemic pattern in the post-COVID-19 era is unpredictable and will require continued careful surveillance.
Hemostatic cover in orthopedic surgery
Authors: Álvarez Román María Teresa
Published: May 2023

Bleeding into joints, known as hemarthrosis, is the most common kind of bleeding experienced by patients with hemophilia. Repeat bleeds into the same joint lead to the so-called hemophilic arthropathy. Patients with this condition tend to require surgery earlier and most frequently than the general population.

Successful hemostasis is essential to carry out such procedures. Thanks to the advances made in the treatment of hemophilia, most surgical techniques can be performed safely and reliably.

The present review shall focus on the international recommendations related to the performance of these surgical procedures. We shall be examining the available treatments, including the way they should be administered as well as the requirements regarding the postoperative period and the subsequent rehabilitation program.
Orthopedic surgical procedures in people with hemophilia
Authors: Encinas-Ullan Carlos A. , De la Corte-Rodriguez Hortensia , Gomez-Cardero Primitivo , Rodriguez-Merchan E. Carlos
Published: May 2023

People with hemophilia tend to develop joint lesions secondary to the recurrent hemarthroses typical of their condition. These usually include chronic synovitis and arthropathy chiefly affecting their ankles, knees, and elbows. In addition, muscular hematomas, albeit less frequently, may also result in complications such as acute compartment syndrome, pseudotumors, bone cysts and peripheral nerve compression. Joint lesions may require some of the following surgical interventions: arthroscopic synovectomy (in cases of synovitis), arthroscopic joint debridement, radial head resection, opening-wedge tibial osteotomy, arthrodesis, arthrodiastasis (of the ankle), tendon lengthening (hamstrings, Achilles tendon), progressive extension of the knee by placing an external fixator in cases of flexion contracture of the knee, supracondylar femoral extension osteotomy in cases of knee flexion contracture and, eventually, a total joint arthroplasty when the affected joint has been destroyed and the patient experiences severe joint pain. Total knee arthroplasty in hemophilic patients is associated with a high infection risk (7% on average). As regards the complications following muscle hematomas, acute compartment syndrome requires urgent performance of a fasciotomy when hematological treatment is incapable of resolving the problem. Surgical resection of hemophilic pseudotumors is the best solution, with those affecting the pelvis (secondary to iliopsoas hematomas) being particularly difficult to resolve. Peripheral nerve lesions can often be effectively addressed with hematological treatment, although a surgical neurolysis of the ulnar nerve is indicated if nonoperative treatment fails.
Hematological treatment and prophylaxis in patients with and without inhibitors
Authors: Marco-Rico Ana
Published: May 2023

This document focuses on the hematological treatment and prophylaxis that should be indicated in three groups of patients with hemophilia: Patients with inhibitors; Patients without inhibitors; and Patients receiving nonfactor replacement therapy.

Inhibitors contribute to refractoriness to replacement treatment, leading to more severe bleeds. Immunotolerance and bypassing agents are essential to eradicate the inhibitors and bleeding control, respectively.

Noninhibitors patients may receive standard half-life or extended half-life products, either on demand or prophylactically. Replacement factor concentrates are essential to control severe bleedings. Dose and frequency should be adjusted depending on the bleeding severity and type of factor concentrates (standard versus extended half-life products).

Patients on emicizumab require bypassing agents (Novoseven is the agent of choice) in case of inhibitors and factor replacement in noninhibitor patients.
The impact of prenatal inflammation on hematopoietic development
Authors: Tseng Nicole A. , Beaudin Anna E.
Published: May 2023

Purpose of review

Inflammation is now recognized as a major regulator of hematopoietic stem cell (HSC) function. Adult hematopoietic stem cells can adaptively modulate hematopoietic output in direct response to acute infection and inflammation. Conversely, prolonged exposure to inflammation can drive impaired HSC function, clonal expansion, and malignant transformation. As compared with adult hematopoiesis, the effects of prenatal inflammation on developing hematopoietic stem cells are understudied.

Recent findings

Inflammatory cues directly activate adult HSCs in the bone marrow, but the response of fetal HSCs to maternal inflammation is underexplored. Recent evidence demonstrates that maternal inflammation can be detected by fetal hematopoietic stem and progenitor cells (HSPCs) within the fetal liver and that the same inflammatory cues evoke fundamentally distinct responses during development. The responses of developing stem and progenitor cells and the specialized immune cells they produce have important implications for postnatal hematopoietic output and immune function.

We discuss recent insights into the response of fetal hematopoiesis to prenatal inflammation and examine how recent discoveries regarding the contribution of fetal hematopoiesis to the adult hematopoietic system will influence future studies.
COVID-19 and the gastrointestinal tract in children
Authors: Riera-Canales Claudia , Llanos-Chea Alejandro
Published: May 2023

Purpose of review

This is an overview of the effects of COVID-19 in the gastrointestinal tract in children, and current evidence of the impact of COVID-19 in pediatric patients with chronic gastrointestinal conditions, including inflammatory bowel disease (IBD), chronic liver disease, and disorders of the gut-brain interaction.

Recent findings

Children with COVID-19 have a milder course and more favorable outcomes than adults, even in those with immunosuppression due to IBD or liver transplantation. Children with chronic gastrointestinal conditions do not have worse clinical outcomes than healthy children and infection itself has not been linked to an increased incidence of conditions such as IBD and celiac disease, but results regarding post-infectious irritable bowel syndrome are mixed.

Research specific to pediatrics is needed, particularly in post-infectious disorders of the gut-brain interaction (PI-DGBIs) and long COVID-19. Data extrapolated from adult trials may not apply to children, as their clinical course is different. PI-DGBIs and long COVID-19 require special attention, as they represent a major morbidity burden in children.
Sepsis Prognostic Scores Accuracy in Predicting Adverse Outcomes in Children With Sepsis Admitted to the Pediatric Intensive Care Unit From the Emergency Department
Authors: Marchetto Luca , Comoretto Rosanna , Gregori Dario , Da Dalt Liviana , Amigoni Angela , Daverio Marco
Published: May 2023

Objective

To compare the performance of several prognostic scores calculated in the first 24 hours of admission (day 1) in predicting mortality and morbidity among critically ill children with sepsis presenting to the pediatric emergency department (PED) and then admitted to the pediatric intensive care unit (PICU).

Methods

Single-center, retrospective cohort study in children with a diagnosis of sepsis visiting the PED and then admitted to the PICU from January 1, 2010 to December 31, 2019. Sepsis organ dysfunction scores—pediatric Sequential Organ Failure Assessment (pSOFA) (Schlapbach, Matics, Shime), quickSOFA, quickSOFA-L, Pediatric Logistic Organ Dysfunction (PELOD)-2, quickPELOD-2, and Pediatric Multiple Organ Dysfunction score—were calculated during the first 24 hours of admission (day 1) and their performance compared with systemic inflammatory response syndrome (SIRS) and severe sepsis—International Consensus Conference on Pediatric Sepsis(ICCPS)-derived criteria—using the area under the receiver operating characteristic curve. Primary outcome was PICU mortality. Secondary outcomes were: a composite of death and new disability (ie, change from baseline Pediatric Overall Performance Category score ≥1); prolonged PICU length of stay (>5 d); prolonged invasive mechanical ventilation (MV) (>3 d).

Results

Among 60 patients with sepsis, 4 (6.7%) died, 7 (11.7%) developed new disability, 26 (43.3%) experienced prolonged length of stay, and 21 (35%) prolonged invasive MV. The prognostic ability in mortality discrimination was significantly higher for organ dysfunction scores, with PELOD-2 showing the best performance (area under the receiver operating characteristic curve, 0.924; 95% confidence interval, 0.837–1.000), significantly better than SIRS 3 criteria (0.924 vs 0.509, P = 0.009), SIRS 4 criteria (0.924 vs 0.509, P < 0.001), and severe sepsis (0.924 vs 0.527, P < 0.001). Among secondary outcomes, PELOD-2 performed significantly better than SIRS criteria and severe sepsis to predict prolonged duration of invasive MV, whereas better than severe sepsis to predict “poor outcome” (mortality or new disability).

Conclusions

Day 1 organ dysfunction scores performed better in predicting mortality and morbidity outcomes than ICCPS-derived criteria. The PELOD-2 was the organ dysfunction score with the best performance for all outcomes.
Two Rare Cases of Paratubal Leydig Cell Nodules: Clinical Relevance and Debated Terminology of a Noteworthy Incidentaloma
Authors: Fischer Edgar G.
Published: May 2023

Cells with cytologic and immunohistochemical features of Leydig cells are normally present in the ovary and the ovarian hilum, are testosterone-producing, and have been referred to as ovarian hilus cells. Rarely these cells form nests or nodules in extraovarian sites such as the mesovarium or mesosalpinx. Because they are so rare, these nodules can present a diagnostic challenge when first encountered. This report describes 2 such incidental nodules in the mesosalpinx associated with a small paratubal cyst and suggests that the term Leydig cell nodule be preferred over the nonspecific and confusing historical term ovarian hilus cell nest.
“Super-Microsurgical Anastomosis training using the chick embryos within the “Egg-in-Cube” system.”
Authors: Karakawa Ryo , Yoshimatsu Hidehiko , Nakatsuka Kengo , Fuse Yuma , Nishiyama Shohei , Kawahara Tomohiro , Yano Tomoyuki
Published: May 2023

Although the super-microsurgery technique is an essential skill for lymphatic surgery or perforator flap surgery, an ideal training model is yet to be found. Living animal models, such as rodents, are considered to be ideal microsurgical training models. However, the use of living animal models is costly and there are bioethical considerations. Hence, we aimed to develop a novel, cost-effective, highly reproducible, and easy-to-handle super-microsurgical anastomosis training system using the chicken embryo within the “Egg-in-Cube.” The chick embryos were fertilized in the artificial cubic eggshell, which was fabricated by integrating a polycarbonate frame structure and five polydimethylsiloxane (PDMS) membranes. Seven days later, the trainees underwent super-microsurgical training using the vitelline artery of the chick embryo. The trainees were able to perform super-microsurgical training using all eleven surviving chicken embryos. The average diameter of the vitelline artery was 0.43 mm. Patency and pulsation were observed after the anastomosis in four of the eleven cases. The super-microsurgical training system using the chicken embryo within the “Egg-in-cube” has several advantages. First, this system is ethically acceptable. Second, this system is less costly and easier to manage than other animal models. Third, this model is suitable as a super-microsurgical training model such as lymphovenular anastomosis (LVA) because the diameter of the vitelline artery was similar to that of the lymphatic vessels in lymphedema patients. Moreover, the trainee can confirm patency and leakage after the anastomosis because this model has a circulation system. The trainee can practice the super-microsurgical technique efficiently with simultaneous feedback on anastomosis results.
Impact of Two Urethral Stent Types on the Complications After One-Stage Hypospadias Repair Using the Duckett Procedure: A retrospective cohort study.
Authors: Zhou Shiying , Zhang Jian , Zhang Jiaqi , Xiao Xiaolian , Su Zheng , Liu Meng , Huang Zhaolun , Tian Dongjun , Liang Weiqiang , Jinming Zhang
Published: May 2023

Purpose:

The purpose of this study was to evaluate whether the new nickel-titanium alloy stents are superior to traditional silicone stents in hypospadias repair surgery to prevent complications such as urinary fistula.

Methods:

This retrospective cohort study included 576 patients with hypospadias who underwent the placement either with nickel-titanium alloy stents or traditional silicone stents after hypospadias surgery between March 2002 and August 2019. The patients were assigned into the nickel-titanium alloy stent group (group NTAS) and the silicone stent group (group SS). The primary outcome was assessed with the rate of urinary fistula occurrence at four weeks (stent removal time), and the secondary outcomes were decided on the rate of other complications such as urethral stricture, and urethral diverticulum, infection, etc. The occurrence of complications in both groups was compared and the important contributing factors of urinary fistula and urethral stricture were determined.

Results:

Among 576 patients, 398 were assigned into group NTAS while 178 were into group SS. 35 patients in the group NTAS and 30 in the group SS developed urinary fistula with a ratio of 8.8% and 16.9%, respectively (p = 0.005). Subgroup analysis showed that the differences were mainly in preschool patients (≤ 6 years) (p = 0.004) and those with the penile type of hypospadias (p = 0.008). In addition, urethral stricture complicated five patients in the NTAS group and two in the SS group with a ratio of 1.3% and 1.1%, respectively (p = 1.000). Logistic regression showed that hypospadias type (p = 0.001) and stent type (p = 0.001) are the important risk factors for urethral fistula.

Conclusions:

Nickel-titanium alloy stents reduced the occurrence of urinary fistula complications after hypospadias repair in preschool patients, and can be optioned as a better choice for hypospadias surgery.
Soft Palate Dysplasia: Properties and Surgical Techniques
Authors: Qin Chuanqi , Li Jian , Yang Jiegang , Cheng Yibin , Fu Xiazhou
Published: May 2023

Background:

The authors aimed to report a hitherto undescribed class of patients with the obvious phenotype of a novel soft palate dysplasia (SPD) combining unilateral soft palate hypoplasia with a fully developed uvula. The authors also aimed to investigate and evaluate the corresponding surgical approaches.

Methods:

Twelve patients were clinically diagnosed with SPD. Clinical examination, including radiographic tests, was performed to characterize the congenital deformity. The effectiveness of velopharyngeal closure and speech were tested preoperatively and postoperatively.

Results:

SPD was featured with velopharyngeal insufficiency, food regurgitation, and speech disorders. It was commonly manifested as structural deformities of the soft palate, tongue palatine arch, pharyngeal palatine arch, and pterygomandibular fold, but with complete uvula shape. According to radiographic analysis, in five patients, the lateral pterygoid processes were poorly developed, and other malformations were present. Velopharyngoplasty based on the unilateral posterior pharyngeal flap can well restore the velopharyngeal closure and speech intelligibility without respiration obstruction.

Conclusions:

SPD is characterized as congenital velopharyngeal insufficiency manifested as a primary soft palate defect. It is highly associated with other physical deformities but independent of conventionally known syndromes. The cause may be an abnormal development of the pterygoid process. Unilateral velopharyngoplasty based on the posterior pharyngeal flap is a great technique to repair SPD.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Bivalent mRNA COVID-19 Vaccine–Related Pericarditis on 18F-FDG PET/CT
Authors: Wu Yu-Chin , Kao Chia-Hung , Liao Chiung-Wei , Sun Shung Shung , Hsieh Te-Chun
Published: May 2023

A 13-year-old boy was suspected with pericarditis after a second booster dose of bivalent mRNA COVID-19 vaccine. After specific preparation for cardiac inflammation with carbohydrate-free, high-fat diet, the 18F-FDG PET/CT successfully demonstrated simultaneous presentation of vaccination-related axillary lymphadenopathy and pericarditis without the interference of physiological myocardial uptake.
Operative management and outcomes of colorectal injuries after gunshot wounds in the deployed military setting versus civilian trauma centers
Authors: Dilday Joshua , Owattanapanich Natthida , Benjamin Elizabeth R. , Biswas Subarna , Shackelford Stacy , Demetriades Demetrios
Published: May 2023

INTRODUCTION

Colon and rectal injuries have been diverted at higher rates in military trauma compared with civilian injuries. However, in the last few years, there has been a shift to more liberal primary anastomosis in wartime injuries. The purpose of this study was to compare the management and outcomes in colorectal gunshot wounds (GSWs) between military and civilian settings.

METHODS

The study included Department of Defense Trauma Registry and Trauma Quality Improvement Program database patients who sustained colorectal GSWs, during the period 2013 to 2016. Department of Defense Trauma Registry patients were propensity score matched 1:3 based on age, sex, grade of colorectal injury, and extra-abdominal Abbreviated Injury Scale. Patients without signs of life, transfers from an outside hospital, and nonspecific colorectal Organ Injury Scale were excluded. Operative management and outcomes were compared between the two groups. Subanalysis was performed on the military cohort to identify any differences in the use primary repair, colectomy, or fecal diversion based upon military affiliation or North Atlantic Treaty Organization status.

RESULTS

Overall, there were 2,693 patients with colorectal GSWs; 60 patients in the military group were propensity score matched with 180 patients in the civilian group. Overall, colectomy was the most common procedure performed (72.1%) and was used more frequently in the military group (83.3% vs. 68.3%; p < 0.05). However, the rate of fecal diversion was similar in the two groups (23.3% vs. 27.8%; p = 0.500). Among those in the military group, no difference was seen in primary repair, colectomy, or fecal diversion based upon military affiliation or North Atlantic Treaty Organization status. The rates of in-hospital compilations and mortality were similar between the military and civilian groups.

CONCLUSION

The severity of GSW colorectal injuries in military and civilian trauma was comparable. There was no significant difference in terms of fecal diversion, mortality, and complications between groups. Military personnel are treated similarly regardless of affiliation.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Macroscopic dental measures in guinea pigs (
Cavia porcellus
) fed natural and pelleted diets of different abrasiveness: implications for wear and compensatory growth in a hypselodont species
Authors: Martin Louise Françoise , Codron Daryl , Winkler Daniela Eileen , Tütken Thomas , Hatt Jean-Michel , Clauss Marcus
Published: May 2023

The drivers of dental wear and compensatory hypselodont tooth growth are of current research interest. Expanding previous macroscopic dental wear measurements based on microtomographic scans of guinea pigs (
Cavia porcellus
) fed natural diets, we added diet groups with different predicted drivers of dental wear and analysed how measured variables relate to each other. The teeth of guinea pigs fed either pelleted diets containing external abrasives of various shapes, sizes and percentages (
n
= 66) or natural whole-leaf diets (
n
= 36, low-phytolith lucerne or grass or high-phytolith bamboo) were evaluated. The bamboo-fed animals showed the lowest tooth height with deep dentine basins, similar to the pellet-fed animals. Deeper dentine basins generally correlated with higher occlusal surfaces, allowing the hypothesis that changes in the pressure signal due to lower basins could initiate compensatory growth and broadening of the whole tooth surface in hypselodont teeth. Macroscopic dental wear did not categorically differ between whole-leaf or pelleted diets or between diets with internal phytoliths or with external silicate abrasives. Supporting interpretations that tooth wear should be viewed as a response to the biomechanical properties of ingested feed which may or may not be aptly summarized by broad descriptors such as ‘whole/pelleted’ or ‘natural/artificial’.
The campfire stories of Russell Marker, a pioneer of chemistry
Authors: Kovács Lajos
Published: May 2023

The maverick American chemist Russell Earl Marker (1902–1995) is known for his studies on the fragmentation of organic mercury compounds, establishing the concept of the octane number, investigating the rearrangements of hydrocarbons and exploring the relationship between optical rotation and the configuration of organic compounds. His greatest achievement, however, is the elaboration of seminal isolation and synthetic methods of an important class of natural products that helped found a new industry, based on the pharmaceutical chemistry of steroids. The nomadic life of this extraordinary man demonstrates that the enormous obstacles thwarting the progress of science and technology can be surmounted by serendipity, acumen and devotion. However, his premature retirement from chemistry is a warning sign that every scientist is vulnerable and even the toughest man's perseverance can fade if the conditions worsen.
Walking like a robot: do the ground reaction forces still intersect near one point when humans imitate a humanoid robot?
Authors: Vielemeyer Johanna , Staufenberg Nora-Sophie , Schreff Lucas , Rixen Daniel , Müller Roy
Published: May 2023

Bipedal walking while keeping the upper body upright is a complex task. One strategy to cope with this task is to direct the ground reaction forces toward a point above the centre of mass of the whole body, called virtual pivot point (VPP). This behaviour could be observed in various experimental studies for human and animal walking, but not for the humanoid robot LOLA. The question arose whether humans still show a VPP when walking like LOLA. For this purpose, ten participants imitated LOLA in speed, posture, and mass distribution (LOLA-like walking). It could be found that humans do not differ from LOLA in spatio-temporal parameters for the LOLA-like walking, in contrast to upright walking with preferred speed. Eight of the participants show a VPP in all conditions (
R
2
> 0.90 ± 0.09), while two participants had no VPP for LOLA-like walking (
R
2
< 0.52). In the latter case, the horizontal ground reaction forces are not balanced around zero in the single support phase, which is presumably the key variable for the absence of the VPP.
van der Waals interaction energies for ferric ion sensors using prismatic and cylindrical pore approximations for a MOF pore
Authors: Louw K. I. , Bradshaw-Hajek B. H. , Hill J. M.
Published: May 2023

Using the Lennard–Jones potential, we determine analytical expressions for van der Waals interaction energies between a point and a rectangular prism-shaped pore, writing them in terms of standard elementary functions. The parameter values for a new ferric ion sensor are used to compare these calculations with the cylindrical pore approximation for the interactions between an ion and a metal organic framework (MOF) pore. The results using the prismatic pore approximation predict the same qualitative outcomes as a cylindrical pore approximation. However, the prismatic approximation predicts lower magnitudes for both the interaction potential energy minimum and the force maximum, since the average distance from the centre-line to the surface of the prism is greater. We suggest that in some circumstances it is sufficient to use the simpler cylindrical approximation, provided that the cylinder radius is chosen so that the cross-sectional area is equal to the area of the prism pore opening. However, atoms at the nodes should remain approximated by semi-infinite lines. We also determine the interaction between a second ferric ion and a blocked MOF pore; as expected, the second ferric ion experiences a force away from the pore, implying that approaching ferric ions can only occupy vacant MOF pores.
Wolbachia
springs eternal: symbiosis in Collembola is associated with host ecology
Authors: Rodrigues Jules , Lefoulon Emilie , Gavotte Laurent , Perillat-Sanguinet Marco , Makepeace Benjamin , Martin Coralie , D'Haese Cyrille A.
Published: May 2023

Wolbachia
are endosymbiotic alpha-proteobacteria infecting a wide range of arthropods and nematode hosts with diverse interactions, from reproductive parasites to obligate mutualists. Their taxonomy is defined by lineages called supergroups (labelled by letters of the alphabet), while their evolutionary history is complex, with multiple horizontal transfers and secondary losses. One of the least recently derived, supergroup E, infects springtails (Collembola), widely distributed hexapods, with sexual and/or parthenogenetic populations depending on species. To better characterize the diversity of
Wolbachia
infecting springtails, the presence of
Wolbachia
was screened in 58 species. Eleven (20%) species were found to be positive, with three
Wolbachia
genotypes identified for the first time in supergroup A. The novel genotypes infect springtails ecologically and biologically different from those infected by supergroup E. To root the
Wolbachia
phylogeny, rather than distant other Rickettsiales, supergroup L infecting plant-parasitic nematodes was used here. We hypothesize that the ancestor of
Wolbachia
was consumed by soil-dwelling nematodes, and was transferred horizontally via plants into aphids, which then infected edaphic arthropods (e.g. springtails and oribatid mites) before expanding into most clades of terrestrial arthropods and filarial nematodes.
Meltwater generation in ice stream shear margins: case study in Antarctic ice streams
Authors: Ranganathan Meghana , Barotta Jack-William , Meyer Colin R. , Minchew Brent
Published: May 2023

Liquid water within glacier ice and at the glacier beds exerts a significant control on ice flow and glacier stability through a number of processes, including altering the rheology of the ice and lubricating the bed. Some of this water is generated as melt from regions of rapid deformation, including shear margins, due to heating by viscous dissipation. However, how much meltwater is generated and drained from shear margins remains unclear. Here, we apply a model that describes the evolution of ice temperature, melting, and water transport within deforming ice to estimate the flux of meltwater from shear margins in glaciers. We estimate the flux of meltwater from temperate ice zones in three Antarctic regions: Bindschadler and MacAyeal Ice Streams, Pine Island Glacier, and Byrd Glacier. We show that the flux of meltwater from shear margins in these regions may be as significant as the meltwater produced by frictional heating at the bed, with average fluxes of

∼
0.005
–
0.1
 

m

 

yr

−
1

. This contribution of shear heating to meltwater flux at the bed may thus affect both the rheology of the ice as well as sliding at the bed, both key controls on fast ice flow.
Higher-order degenerations of Fay’s identities and applications to integrable equations
Authors: Klein Christian , Pillet Jordi
Published: May 2023

Higher-order degenerated versions of Fay’s trisecant identity are presented. It is shown that these lead to solutions for Schwarzian Kadomtsev–Petviashvili equations.
Enhancing the performance of solenoidal spectrometers for inverse reactions
Authors: Butler P. A.
Published: May 2023

Helical-orbit solenoidal spectrometers, in which the target and detector are placed inside a uniform magnetic field, have been utilized for more than a decade to study nuclear reactions in inverse kinematics, induced by radioactive beams. Methods to improve the final-state energy resolution are presented, and the inclusion of an active gas target is proposed to improve the performance of the spectrometer.