bluuebunny/crossref_metadata_2025 huggingface dataset:
Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study
Authors: Melo Valeria D. , Saifuddin Hiba , Peng Lillian T. , Wolanskyj-Spinner Alexandra P. , Marshall Ariela L. , Leep Hunderfund Andrea N.
Published: August 2024

Purpose

Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school.

Method

The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) in June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective.

Results

Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers.

Conclusions

This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.
Relative Value Unit (RVU) and Medicare Severity Diagnosis-related Group (MS-DRG) Reimbursement in Cervical Spinal Fusion
Authors: Asthana Shravan , Bajaj Pranav M. , Staub Jacob R. , Workman Connor D. , Reyes Samuel G. , Follett Matthew A. , Patel Alpesh A. , Hsu Wellington K. , Divi Srikanth N.
Published: August 2024

Study Design:

Level 3 retrospective database study.

Objective:

This study aims to compare work RVU (wRVU), practice expense RVU (peRVU), malpractice RVU (mpRVU), and inflation-adjusted facility price alongside MS-DRG relative weight length of stay (LOS) for cervical spine fusions between 2011 and 2023.

Summary of Background Data:

Both RVU and MS-DRG reimbursement have been studied in various surgical subspecialties; however, little investigation has centered on cervical spine fusions. To the best of our knowledge, this is the first study to investigate trends in RVU and MS-DRG reimbursement in cervical spine fusion throughout the COVID-19 pandemic.

Methods:

Center for Medicaid and Medicare Services (CMS) physician fee schedule was queried between 2011 and 2023 for RVU and facility reimbursement using common single and multilevel anterior and posterior cervical fusion codes. RVU facility prices were inflation adjusted to 2023. MS-DRG reimbursement data from 2011 to 2022 were compiled for cervical spinal fusion procedures with major complication or comorbidity (MCC) 471, complication or comorbidity (CC) 472, and without CC/MCC 473. Compound annual growth rates (CAGRs), Mean Annual Change, and yearly percent changes were calculated.

Results:

No changes in wRVU were seen for all cervical CPT codes; however, the CAGR of peRVU (−0.51%±0.60%) and mpRVU (0.69%±0.41%) demonstrated marginal fluctuations. Every CPT code displayed an inflation-adjusted facility price decrease (−2.18%±0.24%). When assessing MS-DRG, there were marginal changes in geometric mean LOS (0.17%±0.45%), arithmetic mean LOS (−0.15%±0.84%), and relative weight (1.09%±0.68%). Unlike RVU reimbursement, the yearly percent change differs between each MS-DRG code.

Conclusions:

Inflation-adjusted RVU reimbursement facility prices demonstrated a consistent decrease, while DRG code reimbursement stayed relatively consistent over the study period. This data may help surgeons and hospitals become cognizant of temporal variations in reimbursement patterns as it may affect their personal practice.

Level of Evidence:

Level III retrospective study.
Using a Mobile Application to Promote Patient Education for Patients With Liver Cirrhosis
Authors: Lee Wen-Ying , Lee Ting-Ting , Hou I-Ching , Guo Chao-Yu , Chen Ming-Yao , Mills Mary Etta
Published: August 2024

Patient education and self-management are essential for patients with liver cirrhosis. Based on Fisher and Fisher's Information-Motivation-Behavior Skills model, a Cirrhosis Care App was developed to support the education and self-management of these patients. To evaluate the effectiveness of the application, a randomized controlled trial was conducted with patients having liver cirrhosis who were being followed up in the outpatient area of ​​a medical center in Taiwan. The experimental group used the app for 1 month, whereas a control group continued to receive conventional patient education. A pretest and posttest questionnaire was used to evaluate the app's effectiveness in improving the knowledge and practice of self-care. In addition, a questionnaire was developed based on the Technology Acceptance Model to understand satisfaction with the app. Results showed that following the implementation of the Cirrhosis Care App, patients' self-care knowledge and ability to promote self-care practice improved. User satisfaction with the app was measured and reflected in its frequency of use. This study confirmed that the Cirrhosis Care App, based on the Information-Motivation-Behavior Skills model, can improve patient knowledge and self-care practice and be actively promoted to benefit patients with cirrhosis.
Ninerafaxstat in the Treatment of Diabetic Cardiomyopathy and Nonobstructive Hypertrophic Cardiomyopathy
Authors: Feldman Jared M. , Frishman William H. , Aronow Wilbert S.
Published: August 2024

Ninerafaxstat is a novel mitotrope under investigation in 2 large clinical trials: IMPROVE-DiCE (a phase IIa trial investigating ninerafaxstat) and IMPROVE-hypertrophic cardiomyopathy (HCM). IMPROVE-DiCE is a single-center, open-label, phase 2a trial investigating the effectiveness of ninerafaxstat in diabetic cardiomyopathy. Ninerafaxstat significantly improved phosphocreatine/adenosine triphosphate median by 32% (P < 0.01) and reduced myocardial triglyceride content by 34% (P = 0.026). Magnetic resonance imaging (MRI) analysis showed improved left ventricular peak circumferential diastolic strain rate by 15% (P < 0.047) and peak left ventricular filling rate by 11% (P < 0.05). Pyruvate dehydrogenase flux was increased in 7 of 9 patients (P = 0.08), consistent with improved glucose utilization. IMPROVE-HCM (ninerafaxstat safe, effective for nonobstructive hypertrophic cardiomyopathy patients) is a phase 2, multicenter, randomized controlled and double-blinded study. From baseline to 12 weeks, ninerafaxstat was associated with a significantly improved ventilatory efficiency slope compared with placebo (P = 0.006). In a post hoc analysis with 35 patients with baseline Kansas City Cardiomyopathy Questionnaire score ≤80, changes in ventilatory efficiency slope favored ninerafaxstat versus placebo (P = 0.02). Left atrial size, a surrogate marker of diastolic dysfunction, was significantly decreased in patients on ninerafaxstat versus placebo (P = 0.01). These findings support a larger phase 3 study in symptomatic nonobstructive HCM patients to further investigate ninerafaxstat. Several drugs that also improve glucose utilization including fatty acid oxidation inhibitors, carnitine palmitoyltransferase I inhibitors, and glucagon-like peptide-1 receptor agonists are presently under investigation in clinical trials.
Immunogenicity of Botulinum Toxin A: Insights
Authors: Rahman Eqram , Carruthers Jean D. A.
Published: August 2024

BACKGROUND

Botulinum toxin A (BoNT-A) is widely used in treating dystonia and spasticity to managing chronic migraine and cosmetic applications. However, its immunogenic potential presents challenges, such as the development of neutralizing antibodies that lead to diminished therapeutic efficacy over time, known as secondary nonresponse.

OBJECTIVE

This review aims to bridge the knowledge gap regarding the immunogenic mechanisms of BoNT-A and to explore effective management strategies to mitigate these immune responses.

MATERIALS AND METHODS

The authors conducted a systematic search in databases including PubMed, Embase, and Web of Science, using keywords related to BoNT-A's immunogenicity. The selection process refined 157 initial articles down to 23 relevant studies, which underwent analysis to investigate the underlying mechanisms of immunogenicity and the factors influencing it.

RESULTS

The analysis revealed that both the neurotoxin component and the neurotoxin-associated proteins could elicit an immune response. However, only antibodies against the core toxin influence therapeutic outcomes. Various patient-specific factors such as genetic predispositions and prior immune experiences, along with treatment-related factors such as dosage and frequency, play crucial roles in shaping these responses.

CONCLUSION

Understanding the specific immunogenic triggers and responses to BoNT-A is critical for optimizing treatment protocols and improving patient outcomes.
Contouring With Neuromodulators
Authors: Minokadeh Ardalan , Cheng Charles , Bertucci Vince
Published: August 2024

BACKGROUND AND OBJECTIVE

Botulinum toxins, originally used for facial rejuvenation, have emerged as a promising tool for sculpting and refining contours for both the face and body.

METHODS

The peer-reviewed literature on neuromodulator contouring treatments was analyzed, with a particular emphasis on studies and case reports involving the use of botulinum toxin type A.

RESULTS

Modification of face, neck, shoulder, arm, and calf contour has been reported. Treatment and dosing protocols vary with the strength and depth of the target muscle. Regional effects of neuromodulator treatment begin to appear approximately 2 weeks after injection and are often most prominent at the 70- to 90-day time point. Although treatments are generally well tolerated, short-term muscle weakness and other side effects may occur.

CONCLUSION

The use of neuromodulators to enhance facial and body contours has demonstrated efficacy, but further research is needed to validate their use and explore the full potential of this intervention through larger randomized controlled trials. The application of neuromodulators as a minimally invasive tool to address the rising demand for nonsurgical body sculpting represents a promising frontier in aesthetics.
New and Future Developments in Neurotoxins
Authors: Yoelin Steve , Hooper Deirdre
Published: August 2024

BACKGROUND

There are 7 known serotypes of botulinum neurotoxins (A through G). Currently, commercially available toxins are those in serotypes A and B. This paper will discuss new toxins on the horizon, developments in prolonging and shortening the duration of outcomes, and novel therapeutic indications on the horizon.

OBJECTIVE

To provide insight into new toxins and new therapeutic modalities surrounding toxins on the horizon.

METHODS

The authors have reviewed the relevant literature and shared their insights and opinions as to future developments in toxin research and potential clinical applications.

CONCLUSION

Botulinum neurotoxin type E's faster onset and shorter duration of effect represent true clinical differentiators. Future development of botulinum neurotoxin type E for aesthetic and therapeutic uses will be in areas where fast onset and short duration of effect are desirable. Current challenges with neuromodulators include the need for frequent treatments and lack of reversal agents. Agents to address both challenges and novel indications, including inhibition of melanogenesis, are being developed.
A Review of Current Data on Duration of Effect in Glabellar Lines After Treatment With AbobotulinumtoxinA 50 U
Authors: Cohen Joel L. , Cox Sue Ellen , Glaser Dee Anna , Moradi Amir , Dayan Steven , Jacob Carolyn , Schlessinger Joel , Joseph John , Kaufman-Janette Joely , El-Qadi Sami , Persson Cecilia , Prygova Inna
Published: August 2024

BACKGROUND

AbobotulinumtoxinA has become well established as a treatment option for moderate to severe glabellar lines since its first aesthetic approval in 2009.

OBJECTIVE

Pivotal trials leading to regulatory approval showed that abobotulinumtoxinA treatment was associated with high responder rates when defined as achievement of none or mild glabellar lines (0 or 1 on the glabellar line severity scale) and a duration of action of up to 5 months. More recently, the goals for treatment of glabellar lines have shifted toward not only achieving a decrease in glabellar line severity but also ensuring that patients are satisfied with their experience.

MATERIALS AND METHODS

Patients seek an improvement in the appearance of their glabellar lines while maintaining a “natural look,” fast onset of effect, and long duration of response.

RESULTS

Trial designs have evolved to meet these new targets, including expanding the definition of responders to those having at least 1-grade improvement in the glabellar line severity scale score from baseline coupled with the use of subject satisfaction and psychological well-being questionnaires.

CONCLUSION

The findings demonstrate that abobotulinumtoxinA remains a well-tolerated and consistently effective treatment option associated with a rapid onset of effect, duration of efficacy lasting up to 6 months, and high, long-lasting levels of patient satisfaction.
Unpredictable Cyclosporine Clearance in a Korean Patient With Aplastic Anemia With Adverse Effects: A Case Study
Authors: Shihmanter Renata , Miller Edward B. , Shvartsman Ekaterina , Shmuely Haim
Published: August 2024

A 29-year-old Korean woman with chronic aplastic anemia presented with seizures due to cyclosporine-induced posterior reversible encephalopathy syndrome, caused by unpredictable oral cyclosporine (CS) accumulation and prolonged elimination. This case demonstrates the need to monitor CS drug levels with careful dose adjustments.
The unseen burden: the tangled web of paternal postpartum depression and childhood resilience
Authors: Habib Ashna , Ali Tooba , Nazir Zainab , Ismail Areeba , Farrag Doha A. , Haque Md Ariful
Published: August 2024

Postpartum depression (PPD) is a significant mental health disorder that has received little attention (both clinically and experimentally) and is underdiagnosed. PPD is most associated with mothers after giving birth. However, it may also affect fathers for unknown reasons. Poverty, a family history of depression, and hormonal changes are all risk factors for PPD in fathers. Although not much is known about paternal PPD, research indicates that it is often 8.7% prevalent in the first year, peaking between 3 and 6 months after childbirth (9.2%).
Risk factors and consequences of a rare obstetric complication: Intrapartum fetal decapitation
Authors: Fahim Muhammad A.A , Saleem Muhammad M. , Zubair Muhammad S. , Hojeij Moussa
Published: August 2024

Intrapartum fetal decapitation is an extremely rare and devastating birth complication that involves the horizontal laceration and discontinuation of the neck and its contained soft structures. This article examines the limited literature on this topic, identifying risk factors and complications associated with fetal decapitation during childbirth. Risk factors such as macrosomia, high body mass index, cephalopelvic disproportion, high gestational age, prolonged second stage of labor, maternal diabetes, and breech position increase the likelihood of this traumatic event. Complications such as shoulder dystocia can progress to fetal decapitation, especially in cases involving vacuum-assisted deliveries. The article highlights the importance of appropriate management and ethical considerations in cases of fetal decapitation, emphasizing the need for transparency and communication with the parents. The involvement of medical staff’s competence and education is also addressed as a crucial factor in preventing such tragic outcomes. The article suggests that pre-birth checkups should assess the risk factors and guide obstetricians in determining the appropriate mode of delivery to minimize the chances of fetal decapitation. Effective risk management and improved staff qualifications are advocated to mitigate the occurrence of such rare but devastating events. Ultimately, this article underscores the importance of comprehensive evaluation, communication, and education to prevent fetal decapitation and ensure the well-being of both mothers and infants during childbirth.
A Breast Reduction Technique for the Free DIEP Flap Post Breast Reconstruction
Authors: Cordoba Magdalena , Cordoba Tomas , Delisle Éolie , Mozafarinia Maryam , Cordoba Carlos
Published: August 2024

Breast flap remodeling is a common procedure after breast reconstruction. We present a unique approach to breast reduction using a superomedial pedicle inverted “T” technique in patients with previous free deep inferior epigastric perforator (DIEP) flap breast reconstruction, not previously reported. Breast reduction can be a valid option for reshaping breasts after free DIEP flap reconstruction. Breast reduction using the superomedial pedicle inverted T technique is performed in patients who have undergone free DIEP flap breast reconstruction. The superomedial pedicle inverted T breast reduction technique in breast reconstruction with free DIEP flaps seems promising, as the reduced DIEP flaps survived. The superomedial pedicle inverted T breast reduction technique in breast reconstruction with free DIEP flaps offers a good option for secondary breast reshaping. Preservation of the pedicle and blood supply are potential advantages. However, the limited evidence and surgical expertise needed are important considerations. This technique shows promise for breast reductions after free DIEP flap breast reconstruction.
Correlation of Binocular Perimetry Screening Using imo: A Portable Head Mounted Perimeter With 10-2 Standard Automated Perimetry for Early Glaucoma With Central Visual Field Defects
Authors: Nishijima Euido , Itoh Yoshinori , Noro Takahiko , Ogawa Shumpei , Okude Sachiyo , Nakano Tadashi
Published: August 2024

Précis:

The screening program using imo strongly correlates with 10-2 standard automated perimetry in detecting central visual field defects in early glaucoma, highlighting its potential as a valuable tool for efficient screening and severity quantification.

Purpose:

To investigate the correlation between abnormalities within the central 10 degrees of the screening program using imo, a portable head-mounted perimeter, and 10-2 standard automated perimetry in early-stage glaucoma with central visual field defects.

Methods:

This retrospective study included early glaucoma with (26 eyes) and without (38 eyes) central visual field defects. The correlation between the numbers of abnormal points within the central 10 degrees of the imo screening program and those in the probability plot of 10-2, and mean total deviation and pattern deviation, were analyzed.

Results:

The imo screening program demonstrated sensitivity (80%) and specificity (98.7%) in detecting abnormalities, with a 91.6% agreement rate of 10-2. The mean number of anomalies in the 10-2 plot (pattern deviation) with P<1% was 0.85, 7.75, and 9.69 (95% CI: 0.18–1.51, 5.38–10.1, and 6.89–12.5, respectively) for no, 1, and 2 anomalies in the imo screening program, respectively. The number of anomalies with P<1% was significantly higher when the imo screening program detected 1 anomaly versus none (P<0.01) and 2 versus 1 (P<0.05). Mean total deviation values were −1.15, −7.5, and −15.2 (95% CI: −2.32 to 0.03, −11.21 to −3.78, and −19.7 to −10.6, respectively), while mean pattern deviation values were −1.57, −9.0, and −16.0 (95% CI: −2.57 to −0.57, −12.5 to −5.49, and −21.4 to −10.7, respectively), for no, 1, and 2 anomalies in the imo screening program, respectively.

Conclusions:

The imo portable head-mounted perimeter was found to correlate with 10-2 standard automated perimetry in glaucoma patients with central visual field defects and has the potential to shorten visual field testing times.
Increasing Sexual Violence Reporting and Disclosure in Higher Education Institutions: A Proposed Approach to Critically Analyze the Internal Organizational Context
Authors: Kennedy Karen , Malinen KelleyAnne , Gunn Virginia
Published: August 2024

Aims

This article explores the underreporting of sexual violence (SV) in higher education, highlighting serious implications for survivors who may silently cope with its aftermath instead of accessing crucial resources.

Methods

We utilize Bolman and Deal's four-frame model for organizational change to assess how internal factors within organizations may influence reporting of SV. The four frames—symbolic, structural, human resources, and political—offer a systematic analysis of the internal organizational context in higher education institutions concerning SV reporting.

Results

Our suggested approach offers concrete dimensions and probing questions for examination. Derived from a qualitative study, our recommendations align with Bolman and Deal's four-frame model, aiding in assessing the organizational environment. This approach assists stakeholders in identifying barriers/facilitators in the internal organizational context of higher education institutions, enabling effective planning for improved SV reporting/disclosure.

Conclusions

A thorough analysis is essential for understanding factors influencing campus SV reporting. Our proposed critical analysis and recommendations serve as a starting point to identify organizational barriers/facilitators, informing the revision of SV policies and processes, including reporting.

Potential Impact of Improved Sexual Assault Reporting in Higher Education Institutions on Forensic Nursing and Survivors/Victims' Allies

Enhanced reporting of sexual assault in higher education benefits forensic nurses and allies, like student affairs, advocacy groups, unions, SV coordinators, health centers, equity departments, human rights officers, and administration. Improved analysis of institutional and cultural contexts allows for tailored services to better meet survivors' needs. Increased reporting should lead institutions to higher service utilization, requiring careful planning for resource allocation.
A Hemorrhagic Brain Mass in a Child With Encephalocraniocutaneous Lipomatosis
Authors: Hall Erin , Perez Francisco A. , Cole Bonnie , Paulson Vera , Leary Sarah , Ronsley Rebecca
Published: August 2024

Encephalocraniocutaneous lipomatosis (ECCL) is a rare genetic condition with well-described skin, ocular, and central nervous system findings. Several case reports have been documented demonstrating the presence of low-grade gliomas in patients with ECCL and the association with certain FGFR1 mutations. We report on a case of diffuse low-grade glioma, mitogen activated protein kinase pathway altered in a patient with ECCL, who was found to have a distinct FGFR1 mutation.
Bayesian interpretation of likelihood ratios in clinical diagnosis and public health
Authors: Kostoulas Polychronis , Doi Suhail A.
Published: August 2024

Purpose of review

This study provides a Bayesian interpretation of likelihood ratios and their role in updating the pretest probability of disease, typically represented by the prevalence, to a posttest probability.

Recent findings

We highlight the importance of likelihood ratios in this process, particularly in low prevalence settings. For example, we demonstrate that a high LR+ can significantly increase the posttest probability of disease, providing crucial information for clinical decision-making. Furthermore, we emphasize the significance of the fold increase in the probability of disease given a positive test result, particularly in low prevalence settings.

This study underscores the importance of considering likelihood ratios on our posttest updated probability of disease and highlights their implications for public health and individual diagnosis. Understanding these factors can enhance the accuracy and effectiveness of diagnostic decision-making, ultimately leading to improved public health outcomes and patient care.
FDG PET/MRI in a Case of Isolated Abdominal Incisional Site Metastasis After Laparoscopic Surgery for Colon Cancer
Authors: Ji Xia , Dong Aisheng , Wang Yang , Zuo Changjing
Published: August 2024

Abdominal-wall metastasis following laparoscopic surgery for colorectal cancer is rare. We describe FDG PET/MRI findings in a case of isolated abdominal incisional site metastasis after laparoscopic surgery for colon cancer. The abdominal-wall metastasis showed slight hyperintensity on T2-weighted fat-suppressed image and intense focal FDG uptake on PET. This case demonstrates the usefulness of FDG PET/MRI in detecting the atypical metastasis from colon cancer.
Detection of Muscular Metastasis in a Case of Parathyroid Carcinoma Using 18F-FAPI-04 PET/CT
Authors: Chen Jie , Zhao Min , An Qi , Wei Lan , Chen Bin
Published: August 2024

A 46-year-old woman underwent surgery for parathyroid carcinoma 2 years ago. During follow-up, the patient presented with elevated parathyroid hormone (127.50 pg/mL; normal, 15–65). No abnormal uptake of 18F-FDG or 11C-choline was observed on 18F-FDG and 11C-choline PET/CT imaging. The patient was enrolled in a clinical trial for 18F-FAPI PET/CT imaging, revealing a lesion with intense focal uptake within the left sternocleidomastoid muscle. The patient underwent surgery. Postoperative pathology and immunohistochemical analysis confirmed parathyroid carcinoma metastasis.
Early Impact of Bevacizumab on the 99mTc-HYNIC-PSMA-11 Uptake in a Case of Recurrent Glioblastoma Multiforme
Authors: Ghaedian Tahereh , Alipour Abdolmajid , Rakhsha Abbas , Nasrollahi Hamid , Saffarian Arash
Published: August 2024

Glioblastoma multiforme (GBM) is a highly vascularized tumor with reported high prostate-specific membrane antigen (PSMA) expression. On the other hand, bevacizumab as an antiangiogenesis drug is increasingly used in the treatment of GBM recurrence. We present a case of GBM recurrence with significant reduction of 99mTc-HYNIC-PSMA-11 uptake in her tumor 1 week after administration of 2 doses of bevacizumab with 2 weeks’ interval. This case emphasizes the main mechanism of PSMA uptake in GBM secondary to angiogenesis and also implies a potential interaction of bevacizumab with PSMA uptake that should be especially considered during diagnostic and therapeutic application of PSMA radiotracers in GBM.
Changes in Ventricular Volume After Posterior Vault Distraction Osteogenesis in Patients With Syndromic and Nonsyndromic Craniosynostosis
Authors: Pontell Matthew E. , Barrero Carlos E. , Naidu Kirin , Hitchner Michaela , Wagner Connor S. , Salinero Lauren K. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: August 2024

Objective:

Little is known about the response of the ventricular system to cranial vault surgery in patients with craniosynostosis. This study aims to evaluate the changes in the cerebral ventricular system in response to posterior vault distraction osteogenesis (PVDO) in patients with syndromic and nonsyndromic craniosynostosis.

Methods:

A single-institution retrospective review of all patients with craniosynostosis undergoing PVDO from 2000 to 2022 was completed. Patients were included for analysis if they had pre and postoperative cranial computed tomography scans. Ventricular volume (VV) and intracranial volume (ICV) were calculated using segmentation software.

Results:

Both patients with syndromic synostosis and nonsyndromic synostosis (NSS) experienced a significant increase in ICV after PVDO, but only patients with NSS experienced a significant VV change (P = 0.004). After normalization by ICV, total, lateral, and third VV changes retained significance with percentage increases of 114%, 117%, and 89%, respectively (P < 0.05 for all).

Conclusion:

The differing results between cohorts reinforce the concept that the intracranial milieu is different between patients with syndromic synostosis and NSS. The results of the NSS cohort suggest that these patients may exist in a compensated state in which a reduction in cerebral blood flow and VV allows for the maintenance of parenchymal health to prevent the development of intracranial hypertension. Further studies may explore VV as a surrogate marker of ICP elevation, and the utility of cranial vault remodeling on nonsynostotic pathologies with cephalocranial disproportion.
Polyfracture and Cranial Injuries Drive the Cost and Inpatient Burden of Zygoma Fractures
Authors: Weitzman Rachel E. , Zhao Karena , Subramanian Tejas , Shomorony Andre , Sclafani Anthony P.
Published: August 2024

Importance:

Facial trauma makes up a significant number of emergency room visits, with morbidity costs in excess of 1 billion dollars each year. Few studies have evaluated the economic outcomes of management and inpatient burden of facial trauma, most focusing solely on the mandible and isolated midface fractures.

Objective:

The authors aim to evaluate characteristics associated with increased cost and length of hospitalization of zygoma fracture management.

Design:

Cross-sectional study.

Setting:

Level 1—trauma academic medical center.

Participants:

Patients with zygoma fractures who presented to our institution from 2008 to 2021.

Main Outcomes and Measures:

Demographics, injury mechanisms, associated injuries, treatment information, and associated costs were collected. Univariate and multivariate analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization.

Results:

Our 14-year experience identified 689 patients with zygoma fractures who presented from 2008 to 2021. Seventy percent were male, and 40% occurred in Caucasian patients. The mean cost, adjusted for inflation, was $21,799.34, and the mean length of hospitalization was 5.5 days. Four or more fractures, associated cranial or intracranial injuries, and length of stay were associated with significantly higher cost, and 4 or more fractures, associated cranial or intracranial injuries, and female gender were associated with significantly longer length of hospitalization.

Conclusions and Relevance:

This study represents one of the largest comprehensive databases of zygoma fractures and one of the first to provide a descriptive cost and inpatient burden analysis. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to address the factors that the authors identified as contributing to increased cost and length of hospitalization.
METTL14/IGF2BP2-MEDIATED M6A MODIFICATION OF STEAP1 AGGRAVATES ACUTE LUNG INJURY INDUCED BY SEPSIS
Authors: Lai Junhua , Yu Shaochi , Li Xia , Wei Qiuxing , Qin Jian
Published: August 2024

Background: Acute lung injury (ALI) is a severe complication of sepsis, characterized by inflammation, edema, and injury to alveolar cells, leading to high mortality rates. Septic ALI is a complex disease involving multiple factors and signaling pathways. STEAP family member 1 (STEAP1) has been reported to be upregulated in a sepsis-induced ALI model. However, the role of STEAP1 in the regulation of septic ALI is not yet fully understood. Methods: The study stimulated human pulmonary microvascular endothelial cells (HPMECs) using lipopolysaccharides (LPS) to establish an in vitro ALI model. The study used quantitative real-time polymerase chain reaction to measure mRNA expression, and western blotting assay or immunohistochemistry assay to analyze protein expression. Cell Counting Kit-8 assay was performed to assess cell viability. Flow cytometry was conducted to analyze cell apoptosis. Tube formation assay was used to analyze the tube formation rate of human umbilical vein endothelial cells. Enzyme-linked immunosorbent assays were used to measure the levels of interleukin 1beta and tumor necrosis factor alpha. The levels of Fe2+ and reactive oxygen species were determined using colorimetric and fluorometric assays, respectively. The glutathione level was also determined using a colorimetric assay. m6A RNA immunoprecipitation assay, dual-luciferase reporter assay, and RNA immunoprecipitation assay were performed to identify the association of STEAP1 with methyltransferase 14, N6-adenosine-methyltransferase noncatalytic subunit (METTL14) and insulin like growth factor 2 mRNA binding protein 2 (IGF2BP2). The transcript half-life of STEAP1 was analyzed by actinomycin D assay. Finally, a rat model of polymicrobial sepsis was established to analyze the effects of STEAP1 knockdown on lung injury in vivo. Results: We found that the mRNA expression levels of STEAP1 and METTL14 were upregulated in the blood of ALI patients induced by sepsis compared to healthy volunteers. LPS treatment increased the protein levels of STEAP1 and METTL14 in HPMECs. STEAP1 depletion attenuated LPS-induced promoting effects on HPMECs’ apoptosis, inflammatory response, and ferroptosis, as well as LPS-induced inhibitory effect on tube formation. We also found that METTL14 and IGF2BP2 stabilized STEAP1 mRNA expression through the m6A methylation modification process. Moreover, METTL14 silencing attenuated LPS-induced effects by decreasing STEAP1 expression in HPMECs, and STEAP1 silencing ameliorated cecal ligation and puncture-induced lung injury of mice. Conclusion: METTL14/IGF2BP2-mediated m6A modification of STEAP1 aggravated ALI induced by sepsis. These findings suggest potential therapeutic targets for the treatment of this disease.
Homogenization for convection-enhanced thermal transport in sea ice
Authors: Kraitzman Noa , Hardenbrook Rebecca , Dinh Huy , Murphy N. Benjamin , Cherkaev Elena , Zhu Jingyi , Golden Kenneth M.
Published: August 2024

Sea ice regulates heat exchange between the ocean and atmosphere in Earth’s polar regions. The thermal conductivity of sea ice governs this exchange, and is a key parameter in climate modelling. However, it is challenging to measure and predict due to its sensitive dependence on temperature, salinity and brine microstructure. Moreover, as temperature increases, sea ice becomes permeable, and fluid can flow through the porous microstructure. While models for thermal diffusion through sea ice have been obtained, advective contributions to transport have not been considered theoretically. Here, we homogenize a multiscale advection–diffusion equation that models thermal transport through porous sea ice when fluid flow is present. We consider two-dimensional models of convective flow and use an integral representation to derive bounds on the thermal conductivity as a function of the Péclet number. These bounds guarantee enhancement in the thermal conductivity due to the added flow. Further, we relate the Péclet number to temperature, making these bounds useful for global climate models. Our analytic approach offers a mathematical theory which can not only improve predictions of atmosphere–ice–ocean heat exchanges in climate models, but can provide a theoretical framework for a range of problems involving advection–diffusion processes in various fields of application.
Intra-individual variability in the effects of transcranial direct current stimulation on free choice saccade behaviour
Authors: Caie Brandon , Blohm Gunnar
Published: August 2024

Transcranial direct current stimulation (tDCS) is used as a tool to causally influence neural activity in humans non-invasively. Although most studies recruit a large number of participants in order to uncover population-level effects, growing evidence suggests that tDCS may be expected to induce different effects in different individuals, leading to large inter-individual variability and confounds in population-level testing. Alternatively, this variability may arise from intra-individual sources that are difficult to assess in standard designs. Here, we performed between 8 and 10 sessions of tDCS within individuals to understand how intra-individual variability impacts the inference of tDCS effects. We recruited 5 participants who underwent functional MRI to localize the human frontal eye field (FEF) homologue. An HD-tDCS montage was used to stimulate the target location based on individual MRI localizations, alternating the polarity between anodal or cathodal current over 8-10 repeated sessions during a 5 week period. Participants performed a free choice task before and after stimulation while recording EEG activity. We then developed a difference-in-difference method based on permutation testing to assess the likelihood of a causal effect of tDCS at different levels of abstraction: group-level, inter-individual, and intra-individual. At the group-level, we found evidence for an influence of tDCS on choice reaction times, which followed a reaction-time dependent change in alpha-band activity, and on how choices depended on recent history. However, individuals showed heterogeneous, and often contradictory, effects. We then analyzed the distribution of session permutations at the intra-individual level, and found a discrepancy between the inter-individual effects that survived significance testing and the intra-individual effects that correlated on a session-session basis. We argue that, while the observed variability may have arisen from a combination of inter and intra-individual differences relevant to tDCS-dependent mechanisms of action, it may be equally well explained by spurious effects arising from history-dependence between repeated measures that are typically assumed to be independent. In light of this, we assess the counterfactuals that must be evaluated in order to make data-driven inferences about the causal effects of tDCS on free choice behaviour and its neural correlates.
Mozambican Food Pyramid
Authors: Fotinho Ernesto Francisco Maborre
Published: August 2024

Introduction

In order to support nutritionists and other food and nutrition education actors in Mozambique in improving the approaches of intervention messages to fight for chronic malnutrition and other nutritional related diseases that plague the country, this work brings the adaptation of the American food pyramid published in 1993 to the local reality.

Methods

The pyramid was built with the foods distributed in eight groups (Basic Foods, fruits, vegetables, legumes, milk, meats, fats and sugars) and in 5 levels. Each level was presented in minimum and medium portions to be consumed according to the established standard diets. The portions and the food equivalents tables were defined according to the caloric contribution of each food group using an automated spreadsheet of Microsoft Excel, version 19, and based on the principle of linear programming. The pyramid was based on two standard diets (1693 kcal and 2300 kcal) with four meals for both.

Results

The percentage distribution of macronutrients in both diets is within the recommended range: Carbohydrates (45 to 65%), lipids (20 to 35%) and proteins (10 to 35%). Special attention was given to the milk group by calculating the bioavailable calcium values.

Discussion

Factors such as food availability, dietary reference intake, and eating habits of the local population were elements of adaptation to the local context.

Conclusion

Further studies are needed to validate and implement the instrument so that it becomes an effective and practical tool.

Key message

What is already known on this topic:

The tools that are currently used to promote healthy eating habits existing in parents present a gap regarding the portions of each food group that should be consumed, constituting a limitation for professionals in the area, who have been struggling to seek information on graphic representations of foods from other countries that do not fit the local reality.

What this study adds:

This study brings an adaptation of a graphic representation of foods closer to the local reality, which includes foods that are part of the usual diet of the local population, their recommended portions and a list of substitute foods.

How this study might affect research, practice or policy

This study will contribute to the improvement of food and nutrition education messages and will serve as basic elements in the design of programs, strategies and intervention policies to combat chronic malnutrition that affects the country.
The phenomenology of psilocybin’s experience mediates subsequent persistent psychological effects independently of sex, previous experience or setting
Authors: Klučková Tereza , Nikolič Marek , Tylš Filip , Viktorin Vojtěch , Vejmola Čestmír , Viktorinová Michaela , Bravermanová Anna , Androvičová Renáta , Andrashko Veronika , Korčák Jakub , Zach Peter , Hájková Kateřina , Kuchař Martin , Balíková Marie , Brunovský Martin , Horáček Jiří , Páleníček Tomáš
Published: August 2024

Background

Recent studies have intensively explored the potential antidepressant effects of psilocybin. However, important variables such as previous experience, repeated administration, setting and sex remain underexplored. This study describes the acute psilocybin experience and long-term effects in a small sample of healthy individuals.

Methods

In a double-blind, placebo-controlled, cross-over study, 40 healthy participants (20 females, mean age 38, sd 8) received two doses of psilocybin 0.26 mg/kg per os at least 56 days apart (mean 354 days) in two study arms (EEG and fMRI). Near half of participants had experience with psychedelics. The Altered State of Consciousness Scale (ASC) and a visual analogue scale (VAS) on emotional valence of the phenomenology assessed acute phenomenology. The Persisting Effects Questionnaire (PEQ) assessed long- term effects. Venous blood samples were taken to measure serum psilocin levels.

Results

All results were independent of previous experience, sex, EEG or fMRI arm/setting. Acute psychedelic effects were of moderate intensity on ASC. The VAS showed mostly pleasant and fluctuating, and only one unpleasant only experience. All experiences resolved in a positive or neutral state at the end of the session. Psilocybin induced sustained positive effects on all domains of the PEQ, with negligible negative effects. Oceanic Boundlessness and Visual Restructuralization were associated with positive effects on PEQ. Contrary to expectations, Dread of Ego Dissolution, typically associated with fearful experiences, was not associated with PEQ negative outcomes. The type of experience (pleasant or mixed) did not correlate with the intensity or direction of the lasting effect; however, peak experiences culminating in a positive mood were associated with positive long- term effects.

Conclusion

In our sample repeated administration of psilocybin to healthy volunteers, induces positive, lasting effects. This underscores the psychological safety of psilocybin in a laboratory setting and supports its repeated use in clinical trials. In particular, challenging or anxiety-provoking experiences in controlled environments did not lead to adverse long-term outcomes.

Clinical trial registration: EudraCT 2012-004579-37,https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-004579-37/CZ.
An updated molecular diagnostic for surveillance oftetMinNeisseria gonorrhoeae
Authors: Palace Samantha G. , Reyes Jordan A. , Neubauer Vickers Eric , Aatresh Aishani V. , Shen Wei , Iqbal Zamin , Grad Yonatan H.
Published: August 2024

Doxycycline post-exposure prophylaxis (doxy-PEP) for sexually transmitted bacterial infections reduces the risk of syphilis and chlamydia, but effectiveness against gonorrhea is variable, likely attributable to varying resistance rates. As doxy-PEP is incorporated into clinical practice, an urgent unanswered question is whether increased doxycycline use will drive tetracycline-class resistance inNeisseria gonorrhoeae. Here, we report an updated RT-PCR molecular diagnostic to detect thetetMgene that confers high-level tetracycline resistance inN. gonorrhoeae.
NewZNHIT3Variants Disrupting snoRNP Assembly Cause Prenatal PEHO Syndrome with Isolated Hydrops
Authors: Rahman Md Lutfur , Bonnard Adeline A. , Wang Feng , Ruaud Lyse , Guimiot Fabien , Li Yangping , Defer Ines , Wang Yilin , Marchand Virginie , Motorin Yuri , Yao Bing , Drunat Séverine , Ghalei Homa
Published: August 2024

ZNHIT3 (zinc finger HIT type containing protein 3) is an evolutionarily conserved protein required for ribosome biogenesis by mediating the assembly of small nucleolar RNAs (snoRNAs) of class C/D into ribonucleoprotein complexes (snoRNPs). Missense mutations in the gene encoding ZNHIT3 protein have been previously reported to cause PEHO syndrome, a severe neurodevelopmental disorder typically presenting after birth. We discuss here the case of two fetuses from a single family who presented with isolated hydrops during the early second trimester of pregnancy, resulting in intrauterine demise. Autopsy revealed no associated malformation. Through whole-genome quartet analysis, we identified two novel variants within theZNHIT3gene, both inherited from healthy parents and occurring as compound heterozygotes in both fetuses. The c.40T>C p.Cys14Arg variant originated from the father, while the c.251_254delAAGA variant was of maternal origin. Analysis of the variants in human cell culture models reveals that both variants reduce cell growth, albeit to different extents, and impact the protein’s stability and function in distinct ways. The c.251_254delAAGA results in production of a stable form of ZNHIT3 that lacks a domain required for mediating snoRNP biogenesis, whereas the c.40T>C p.Cys14Arg variation behaves similarly to the previously described PEHO-associatedZNHIT3variants that destabilize the protein. Interestingly, both variations lead to a marked decrease in specific box C/D snoRNA levels, reduced rRNA levels and cellular translation. Analysis of rRNA methylation pattern in fetus samples reveals distinct sites of hypo 2’-O-methylation. RNA-seq analysis of undifferentiated and differentiated SHSY5Y cells transfected with theZNHIT3variants reveals differential expression of a set of genes, many of which are associated with developmental processes and RNA binding compared to cells expressing wild-type ZNHIT3. In summary, this work extends the phenotype of PEHO syndrome to include antenatal manifestations and describe the molecular defects induced by two novelZNHIT3variants.