bluuebunny/crossref_metadata_2025 huggingface dataset:
Signs and Symptoms Clusters Among Patients With Acute Heart Failure
Authors: Pokhrel Bhattarai Sunita , Dzikowicz Dillon J. , Carey Mary G.
Published: May 2023

Background

Patients with acute heart failure present to the emergency department with a myriad of signs and symptoms. Symptoms evaluated in clusters may be more meaningful than those evaluated individually by clinicians.

Objective

Among emergency department patients, we aimed to identify signs and symptoms correlations, clusters, and differences in clinical variables between clusters.

Methods

Medical record data included adults older than 18 years, International Classification of Diseases, Tenth Revisions codes, and positive Framingham Heart Failure Diagnostic Criteria. Exclusion criteria included medical records with a ventricular assist device and dialysis. For analysis, correlation, and the Gower distance, the independent t test, Mann-Whitney U test, χ2 test, and regression were performed.

Results

A secondary analysis was conducted from the data set to evaluate door-to-diuretic time among patients with acute heart failure in the emergency department. A total of 218 patients were included, with an average age of 69 ± 15 years and predominantly White (74%, n = 161). Two distinct symptom clusters were identified: severe and mild congestion. The severe congestion cluster had a more comorbidity burden compared with the mild congestion cluster, as measured by the Charlson Comorbidity index (cluster 1 vs cluster 2, 6 [5–7] vs 5 [4–6]; P = .0019). Heart failure with preserved ejection fraction was associated with the severe congestion symptom cluster (P = .009), and heart failure with mildly reduced ejection fraction was associated with the mild congestion cluster (P = .019).

Conclusions

In conclusion, 2 distinct symptom clusters were identified among patients with acute heart failure. Symptom clusters may be related to ejection fraction or overall cardiac output and comorbidity burden.
Gender-Specific Clustering of Lifestyle Behaviors and Its Impacts on Cardiovascular Health
Authors: Noh Songwhi , Choo Jina
Published: May 2023

Background

Unhealthy lifestyle behaviors associated with cardiovascular risk manifest a clustering pattern.

Objective

Our aim was to identify behavioral clusters by using 5 unhealthy lifestyle behaviors among the Korean population and examine the impacts of identified behavioral clusters on cardiovascular health (CVH).

Methods

A cross-sectional study was conducted using data from the sixth Korea National Health and Nutrition Examination Survey. The participants were 7898, aged 19 to 64 years. The cluster analysis was performed using the behaviors of current smoking, binge drinking, physical inactivity, insufficient fruit intake, and sugar-sweetened beverage drinking. Cardiovascular health was defined as a composite modified z score calculated using biophysical factors.

Results

Men manifested 4 clusters (ie, risky binge drinkers, dominant smokers, dominant sugar-sweetened beverage drinkers, and nonsubstance/low-fruit eaters) characterized predominantly by substance use; women had 4 clusters (ie, substance users, physically inactive/low-fruit eaters, physically inactive/fruit eaters, and active adherers) characterized predominantly by physical inactivity. Among men, the clusters of dominant smokers and risky binge drinkers had significantly lower CVH scores than those with poor eating behaviors. Among women, the clusters of substance users and physically inactive/low-fruit eaters had significantly lower CVH scores than the active adherers. All the clusters in men had lower CVH scores than the worst cluster in women.

Conclusions

There was a gender difference in the clustering pattern. The clusters with smoking and binge drinking in men and women were associated with negative impacts on CVH. Healthcare professionals should pay attention to the clustering pattern to design an efficient lifestyle intervention for cardiovascular disease prevention.
Lived Experience of Violence Perpetrated by Treated Patients and Their Visitors in Intensive Care Units: A Qualitative Study of Nurses
Authors: FANG I-Lu , HSU Mei-Chi , OUYANG Wen-Chen
Published: May 2023

Background

Patient and visitor violence (PVV) is a widespread problem for health professionals. Nurses working in intensive care units (ICUs) face a relatively high risk of experiencing PVV, which significantly impacts both the health of nurses and the institution as a whole. The subjective perceptions of ICU nurses regarding PVV are inadequately explored in the literature.

Purpose

The purpose of this study was to explore the perspectives, experiences, and perceptions of PVV in ICU nurses and to better understand the precipitating factors of violence.

Methods

A phenomenological qualitative design and purposive sampling were used. A semistructured interview guide was used to conduct in-depth interviews with 12 ICU nurses with PVV experiences. Giorgi's method of analysis was used to discover and identify the essential categories of experience.

Results

Five main experience categories were identified: family and patient factors as flashpoints, managing suppressed emotions by weathering the emotional storm, spiritual awakening after violence, and strategies for surviving further violence. The participants' experiences with PVV included a range of caring and mental health difficulties. In ICU settings, patient progress is often unpredictable, resulting in discrepancies between patient/family expectations and reality. Because feelings of frustration and powerlessness can eventually cause exhaustion in ICU nurses, implementing effective emotional management, stress adjustment, psychological counseling, team support, and violence intervention programs are crucial.

Conclusions/Implications for Practice

This study provides new information on the process by which nurses can progress from inner trauma to self-recovery, moving from a negative affectivity disposition to a better understanding of threat appraisals and coping response options. Nurses should increase their awareness of the complexity of the phenomenon and of the interplay among the factors underlying PVV. The results of this study suggest that routine confusion and delirium assessments to rule out patients with ICU delirium in ICUs are important to preventing PVV. This study considers some of the implications of the research findings for nursing managers. Interventions, training programs, and/or management action should be used to ensure psychological and mental support is extended to all witnesses of PVV events and not only to those targeted by violence.
Promoting physical activity in clinical practice through wearable technology
Authors: Carter LaGary , Ford Cassandra D.
Published: May 2023

The negative health consequences of physical inactivity continue to be a global problem that must be addressed from the highest levels of government down to local primary care providers. Physical activity has been identified as a useful patient vital sign in health care. Advanced practice nurses should aggressively prescribe physical activity as an evidence-based intervention to help mitigate the increased mortality and morbidity associated with a sedentary lifestyle. A focused literature review was conducted using PubMed, CINAHL, and the Cochrane online databases. Fitness wearables and mobile health trackers are a catalyst for lifestyle behavior change and cultivate a health care partnership between the patient and their provider. The evolution of fitness wearables into mainstream health care hinges on the ability of devices to integrate into electronic health records, uniformity of manufacturer standards, intuitiveness, and the assurance of user privacy and security. It is incumbent on nurse practitioners to educate themselves about the reliability and practicality of fitness trackers for their patient population. Future research should focus on adopting quality standards for all consumer devices, the seamless integration of device data into electronic health records and ensuring personal privacy and security.
New metrics of dietary carbohydrate quality
Authors: Tan Denise , Drewnowski Adam , Lê Kim-Anne
Published: May 2023

Purpose of review

The aim of this study was to introduce novel metrics of dietary carbohydrates quality relevant for products and diets.

Recent findings

Carbohydrate quality has long been associated with a low glycemic index. More recently, novel metrics of carbohydrate quality featuring variations of total carbohydrates-fibers-free sugars ratios have been applied to carbohydrate-rich foods, including grains, beans, vegetables, and fruit. High scoring products had higher levels of health-promoting nutrients (protein, dietary fiber, iron, magnesium, zinc, potassium, selenium, and various B-vitamins) and lower levels of nutrients of public health concern (total sugar, added/free sugars, and fat profile). Cross-sectional studies also found variants of carbohydrate quality metrics to be associated with better markers of cardiometabolic disease, including lower levels of blood triglycerides:high-density lipoprotein cholesterol ratio, homeostatic model assessment of insulin resistance, and SBP.

New ratio-based carbohydrate quality metrics are built around high fiber and whole grain content, combined with a low free sugar content. Such metrics allow the identification of food products of higher overall nutritional quality, and are associated with improved diet quality and certain health outcomes.
Impediments to Signing Advance Directives in Nursing Home Residents
Authors: Lee Hsin-Tzu Sophie , Yang Chia-Ling , Hu Wen-Yu
Published: May 2023

Although public opinion in Taiwan has shifted to favoring self-determination regarding end-of-life care, many nursing home residents still entrust their end-of-life care decision making to family members. This study examined Chinese cultural impediments to nursing home residents signing advance directives. A descriptive qualitative study was conducted using content analysis. In total, 18 nursing home residents participated in face-to-face interviews. Five main themes were identified: (1) bad omens, (2) inability, (3) traditional culture, (4) uncertainty, and (5) unmet needs. The death taboo that is a prominent feature of Chinese culture and the delivery of generic information are primary impediments. Therefore, health care providers should provide tailored information about advance directives, communicate directly with residents, ensure that residents understand the relationship between signing an advance directive and having a good death, and respect the final decisions of residents.
Malignant Self-Regard as an Overarching Framework for the Theory and Treatment of Depressive and Masochistic (Self-Defeating) Personalities
Authors: Malone Brady C. , Huprich Steven K.
Published: May 2023

Kernberg and McWilliams have spawned differing conceptualizations of the relationship between depressive and masochistic (self-defeating) personalities. Kernberg describes these personality styles as largely overlapping in features, whereas McWilliams accentuates important clinical differences that make up two distinct personalities. In this article, their theoretical perspectives are discussed and framed as more complementary than competitive. The malignant self-regard (MSR) construct is introduced and reviewed as an integrative self-representation that is shared by both depressive and masochistic personalities, as well as those often referred to as vulnerably narcissistic. We investigate developmental conflicts, motivations for perfectionism, countertransference patterns, and overall level of functioning as four primary clinical features through which a therapist may differentiate a depressive from a masochistic personality. We argue that depressive personalities tend to have more dependency-related conflicts and perfectionistic strivings motivated by lost object reunification, elicit more insidiously positive countertransference reactions in session, and are generally higher-functioning individuals. Masochistic personalities have more oedipal-related conflicts and perfectionistic strivings motivated by object control, elicit more aggressive countertransference reactions, and are relatively lower functioning. MSR is positioned as a bridge between Kernberg's and McWilliam's ideas. We close with a discussion of treatment implications for both disorders as well as how to understand and treat MSR.
Social stigma associated with cancer in the Newfoundland and Labrador population: an exploratory study
Authors: Savas Sevtap , Winsor Mercy , Tenkorang Eric Y. , Simmonds Charlene , Stuckless Teri
Published: May 2023

Background:

Among all Canadians, residents of the province of Newfoundland and Labrador (NL) have the highest risk of developing and dying of cancer. Effects of cancer-associated stigma and discrimination can contribute to the negative consequences of cancer and unnecessarily burden individuals diagnosed with cancer. In this study, we aimed to examine stigma and discrimination-related experiences of individuals diagnosed with cancer and predictors of experiencing stigma in NL.

Methods:

This was a cross-sectional and self-administered online survey study. The survey instrument included both open-ended and closed-ended items, and data were collected between June 2019 and February 2020. Descriptive statistics, thematic analyses, and regression techniques were used for data analysis.

Results:

A total of 325 respondents participated in this study. Self-perceived stigmatization and discrimination were reported by 24% and 14% of the participants, respectively. The most common sources contributing to these experiences were friends, insurance and financial companies, and workplace relations. Issues related to insurance, social relations, and workplace opportunities were among the most common reported impacts of cancer. A large portion of the participants had not experienced stigma and discrimination or experienced anything but positive support from others. Several factors associated with experiencing stigma were also identified, such as age, disease stage, ethnicity, and socioeconomic status. Misconceptions related to cancer, issues with insurance companies, and change of life after cancer were the top themes identified by thematic analysis.

Conclusions:

This study identified a rich overview of cancer-associated lived experiences in the NL population. Educational campaigns on cancer, integration of stigma-related support in cancer care, and stronger antidiscriminatory legislations and practices should be encouraged in NL.
The mediating effect of environmental reward on activity restriction and depressive mood in cancer survivors: a cross-sectional study
Authors: Hata Kotone , Tajima Emi , Suzuki Shin-ichi
Published: May 2023

Background:

Activity restriction is known as a predictor of depressive mood in cancer survivors. However, there is inconsistent evidence about precisely how this takes place. Environmental reward is a state where a person senses mastery or pleasure because of their activity, and this is known to be a possible mediator of the activity restriction effect on depressive mood. We sought to investigate that the mediating effect environmental reward could have on the relationship between activity restriction and depressive mood when moderated by cancer-related fatigue.

Methods:

Cancer survivors (n = 94; mean age, 60.07 years) recruited through cancer support groups in Japan participated in this study. They completed a battery of questionnaires, including demographic and clinical information about the respondents, the Activity Restriction Scale for Cancer Patients—Revised, the Environmental Reward Observation Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale.

Results:

Moderated mediation analysis revealed that high levels of activity restriction predict a decrease in environmental reward, and a decrease in environmental reward exacerbates depressive mood. The full mediating effect (when the indirect effect is statistically significant and there is no direct effect from the antecedent to outcome) of environmental reward was observed when cancer-related fatigue was moderated by ±1 SD of the mean score. This implies that, regardless of the level of fatigue cancer survivors experience, it is not the activity restriction per se that predicts depressive mood but rather the inability to experience pleasurable emotions because of the activity restriction that leads to the exacerbation of depressive mood.

Conclusion:

From these results, environmental reward was found to be a possible mediator of activity restriction on depressive mood, consistent with behavioral models of depression. These results could explain the inconsistent findings about the direct effect of activity restriction on depressive mood and provide theoretical evidence for the effectiveness of psychological treatments for cancer survivors that focus on positive affect, such as behavioral activation interventions.
Medical Examiner Surveillance of the COVID-19 Pandemic in King County, Washington, USA
Authors: Harruff Richard C. , De Silva Malintha , Lubin Micheline
Published: May 2023

The King County Medical Examiner's Office in Seattle, Wash, initiated a surveillance project with a dedicated team and database tracking the spread of severe acute respiratory syndrome coronavirus 2, deaths due to coronavirus disease 2019 (COVID-19), and deaths occurring within 28 days of COVID-19 vaccination. From January 2020 through July 2022, the results of 13,801 nasal/nasopharyngeal swabs from 7606 decedents tested for the virus were assembled in the surveillance database. Generally, 2 samples were collected and tested separately by 2 different laboratories. Positive rates increased from 5.7% in 2020 to 14.3% in 2022. Of 744 decedents positive for the virus, autopsies were performed on 418 (56%); of these, 106 (25%) died of COVID-19 as either the primary or a contributing cause. Comparison of autopsy findings of those dying of COVID-19 with those positive for the virus but dying of other causes demonstrated increased risk for those with preexisting conditions. Of 1035 deaths reported within 28 days of vaccination, the rates of thrombotic complications and myocarditis were no higher than in other decedents. This study provides evidence of the value to public health surveillance of an adequately resourced medical examiner office in tracking viral spread in the community, understanding disease mortality, and assessing vaccine safety.
Somatic Sequencing and Microsatellite Instability Results From Mismatch Repair–deficient Endometrial Carcinoma Patients Without Lynch Syndrome (“Lynch-like” tumors)
Authors: Makia Ngome L. , Thomas Martha , Ring Kari L. , Moskaluk Christopher A. , Mills Anne M.
Published: May 2023

Immunostaining of endometrial carcinomas for mismatch repair (MMR) protein loss is standard-of-care for Lynch syndrome screening, but also identifies MMR-deficient tumors without germline pathogenic variants. While the majority show MLH1 hypermethylation (MLH1hm), somatic MMR pathogenic variants are increasingly recognized drivers of immunohistochemistry-germline discordance. Because MMR abnormalities with both germline and somatic origins have prognostic significance and impart susceptibility to immune checkpoint inhibitors, it is important to understand how frequently tumors with MMR immunohistochemical loss and normal germline testing (“Lynch-like” tumors) have underlying somatic MMR pathogenic variants. Somatic tumor sequencing±microsatellite instability (MSI) testing was performed on 18 endometrial cancers with MMR immunohistochemical loss but negative MMR germline results and negative MLH1hm where relevant. Tumor sequencing and MSI testing were successful in 94%. Where successful, 80% were MSI-high and 94% had a molecular correlate for the initial immunohistochemical interpretation. The single case without an identified somatic pathogenic variant was MSI-low and initially showed loss of MSH6 by immunohistochemistry but with extremely limited internal control staining. On review, MSH6 immunohistochemistry was reclassified as equivocal, and repeat staining revealed improved control expression with intact MSH6. Following reclassification of this case, 100% tumors with MMR deficiency by immunohistochemistry had at least 1 confirmed somatic MMR pathogenic variant, and 86% were MSI-high. These results demonstrate that when correctly interpreted immunohistochemistry is a strong surrogate for somatic MMR pathogenic variants and support its use as the frontline MMR biomarker in endometrial cancer for heritable screening, molecular prognostic classification, and immunotherapeutic biomarker testing purposes.
Springs Produce Favorable Morphologic Outcomes Relative to H-Craniectomy According to a Two-Center Comparison of Matched Cases
Authors: Fischer Sara , Unander-Scharin Jesper , Bhatti-Söfteland Madiha , Nysjö Johan , Maltese Giovanni , Lif Hanna , Tarnow Peter , Enblad Per , Kölby Lars , Nowinski Daniel
Published: May 2023

Background:

Sagittal synostosis is the most common type of premature suture closure, and many surgical techniques are used to correct scaphocephalic skull shape. Given the rarity of direct comparisons of different surgical techniques for correcting craniosynostosis, this study compared outcomes of craniotomy combined with springs and H-craniectomy for nonsyndromic sagittal synostosis.

Methods:

Comparisons were performed using available preoperative and postoperative imaging and follow-up data from the 2 craniofacial national referral centers in Sweden, which perform 2 different surgical techniques: craniotomy combined with springs and H-craniectomy (the Renier technique). The study included 23 pairs of patients matched for sex, preoperative cephalic index, and age. Cephalic index, total intracranial volume (ICV), and partial ICV were measured before surgery and at 3 years of age, with volume measurements compared against those of preoperative and postoperative controls. Perioperative data included operation time, blood loss, volume of transfused blood, and length of hospital stay.

Results:

Craniotomy combined with springs resulted in less bleeding and lower transfusion rates than H-craniectomy. Although the spring technique requires 2 operations, the mean total operation time was similar for the methods. Of the 3 complications that occurred in the group treated with springs, 2 were spring-related. The compiled analysis of changes in cephalic index and partial volume distribution revealed that craniotomy combined with springs resulted in superior morphologic correction.

Conclusion:

The findings showed that craniotomy combined with springs normalized cranial morphology to a greater extent than H-craniectomy based on changes in cephalic index and total and partial ICVs over time.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
“Pain Sketches Demonstrate Patterns of Pain Distribution and Pain Progression following Primary Targeted Muscle Reinnervation in Amputees.”
Authors: Gomez-Eslava Barbara , Raasveld Floris V. , Hoftiezer Yannick AJ. , McCarty Justin C. , Daddario Jenna L. , Valerio Ian L. , Heng Marilyn , Eberlin Kyle R.
Published: May 2023

Background

Numerical scales are validated methods to report pain outcomes after Targeted Muscle Reinnervation (TMR) but do not include the assessment of qualitative pain components. This study evaluates the application of pain sketches within a cohort of patients undergoing primary TMR and describes differences in pain progression according to early postoperative sketches.

Methods

This study included 30 patients with major limb amputation and primary TMR. Patients’ drawings were categorized into four categories of pain distribution (focal (FP), radiating (RP), diffuse (DP) and no pain (NP)) and inter-rater reliability was calculated. Secondly, pain outcomes were analyzed for each category. Pain scores were the primary and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments were the secondary outcomes.

Results

The inter-rater reliability for the sketch categories was good (overall Kappa coefficient of 0.8). The NP category reported a mean decrease in pain of 4.8 points, followed by the DP (2.5 points) and FP categories (2.0 points). The RP category reported a mean increase in pain of 0.5 points. For PROMIS Pain Interference and Pain Intensity, the DP category reported a mean decrease of 7.2 and 6.5 points respectively, followed by the FP category (5.3 and 3.6 points). The RP category reported a mean increase of 2.0 points in PROMIS Pain Interference and a mean decrease of 1.4 points in PROMIS Pain Intensity. Secondary outcomes for the NP category were not reported.

Conclusions

Pain sketches demonstrated reliability in pain morphology assessment and might be an adjunctive tool for pain interpretation in this setting.
Pharmacologic and Other Noninvasive Treatments of the Aging Face: A Review of the Current Evidence
Authors: Bustos Samyd S. , Vyas Krishna , Huang Tony C. T. , Suchyta Marissa , LeBrasseur Nathan , Cotofana Sebastian , Wyles Saranya P. , Mardini Samir
Published: May 2023

Aging of the face is the result of the interrelation of three-dimensional changes occurring over time among the 5 different layers of the face and its associated structures. Knowledge regarding the causes of these changes and identification of new key anatomic structures have helped elucidate one of the most complex areas of the human body. This has resulted in the introduction of pharmacologic agents to help stop, mitigate, or counteract signs of aging and restore the youthful appearance of the face. The authors performed a systematic search of the literature to review the current highest-level evidence of facial antiaging pharmacologic agents. Pharmacologic and minimally invasive antiaging treatments can target different components of facial aging and continue to evolve. With continuous research efforts, traditional treatments, such as botulinum toxin type A, injectable fillers, and chemical peels, are emerging in newer, more effective formulations, with longer lasting clinical results. However, for soft-tissue descent and facial volume loss, surgery remains the standard treatment. An adequate understanding of the three-dimensional process of facial aging over time (the fourth dimension), facial anatomy, and the pharmacologic properties of antiaging/rejuvenation agents are the sine qua non of facial antiaging treatment. The specific modality should be tailored to patient characteristics, preferences, and goals.
A Study of Two Novel Techniques for One-stage Closure of Chronic Oroantral Fistula and Sinus Floor Lift
Authors: Hu Ying-Kai , Qian Wen-Tao , Xu Guang-Zhou , Zou Duo-Hong , Yang Chi
Published: May 2023

Purpose:

This study aimed to compare two novel techniques for chronic oroantral fistula (OAF) closure combined with maxillary sinus floor elevation.

Materials and Methods:

Ten patients who had implant installation needs but suffered from a chronic OAF were enrolled in the study from January 2016 to June 2021. The technique applied involved OAF closure and simultaneous sinus floor elevation by either a transalveolar or lateral window approach. Bone graft material evaluation results, postoperative clinical symptoms and complications were compared between the two groups. Student’s t-test and χ2 test were used to analyze the results.

Results:

In this study, 5 patients with a chronic OAF were treated with the transalveolar approach (group I), and 5 were treated with the lateral window approach (group II). The alveolar bone height was significantly higher in group II than in group I (P＜0.001). The pain at 1 day (P=0.018) and 3 days (P=0.029) postoperatively and facial swelling at 7 days (P=0.016) postoperatively were obviously greater in group II than in group I. There were no severe complications in either group.

Conclusions:

The techniques combined OAF closure with sinus lifting to reduce surgical frequency and risks. The transalveolar approach resulted in milder postoperative reactions, but the lateral approach could provide more bone volume.
How Do the Faces of Kyrgyz Beauties Look? A Photogrammetric Analysis of Beauty Pageant Winners
Authors: Hwang Se Won , Wu Xiajing , Tukeshov Sultan K. , Hwang Kun
Published: May 2023

The aim of this study was to assess how the eyes of Kyrgyz beauties look through an anthropometric analysis of beauty pageant winners. Eleven winners of the Miss Kyrgyzstan contest (2011–2021) were included. Ten other beauty contest winners were added, resulting in a total of 21 beauties who were included. The horizontal corneal diameter, which is 11.75 mm, was used as a standard distance. Other distances were calculated in millimeters based on the proportions of the pixels measured. Twenty-six distances (face: 10, eyebrows: 2, eyes: 4, nose: 4, lips: 4, and chin: 2) and 9 angles (forehead-brow, cantal tilt, 5 face angles, the mandible angle, and the chin angle) were measured. Thereafter, 16 indices (forehead: 1, eyes: 5, nose: 4, lips and chin: 3, and contours 3) were calculated. The forehead-brow angle was 82.2±7.2 degrees. The canthal tilt was 9.0±2.0 degrees. The overall face angles 1 and 2 were 108.6±4.1 degrees and 69.6±2.3 degrees, respectively. The midface angles 1 and 2 were 129.9±3.8 degrees and 125.1±3.9 degrees, respectively. The lower face angle was 139.6±4.1 degrees. The mandible angle and chin angle were 136.9±4.0 degrees and 106.0±4.0 degrees, respectively. The ratio of forehead height to total face height was 0.33±0.03. The ratio of nose height to total face height was 0.25±0.02. The lower face width/face width ratio was 0.82±0.05. The ratio of face width to total face height was 0.72±0.03. The ratio of midface height to total face height was 0.34±0.02. The data from this study might serve as the recommended esthetic proportions for performing plastic surgical procedures.
Appropriate Total Rehabilitation in the Bilateral Maxillectomy Defected Diabetic Patient Secondary to Aggressive Aspergillosis
Authors: Mustakim Kezia Rachellea , Eo Mi Young , Kim Myung-Joo , Yoon Hye Jung , Kim Soung Min
Published: May 2023

Aggressive aspergillosis is a life-threatening fungal infection with rapid progress, mainly affecting the maxillofacial area, especially the nose and paranasal sinuses, in patients with immunocompromised conditions such as diabetes mellitus. Aggressive aspergillosis infection should be differentiated from other invasive fungal sinusitis for early recognition with correct prompt treatment. The main treatment is aggressive surgical debridement such as maxillectomy. Although aggressive debridement should be performed, preservation of the palatal flap should be considered for better postoperative outcomes. In this manuscript, we report the case of a diabetic patient with aggressive aspergillosis affecting the maxilla and paranasal sinuses and describe the appropriate surgical management and prosthodontic rehabilitation.
Myocardial alterations following traumatic hemorrhagic injury
Authors: Simpson Rebecca , Praditsuktavorn Banjerd , Wall Johanna , Morales Valle , Thiemermann Christoph , Tremoleda Jordi L. , Brohi Karim
Published: May 2023

BACKGROUND

Cardiac dysfunction (CD) has emerged as a key contributor to delayed organ failure and late mortality in patients surviving the initial traumatic hemorrhagic response. Inflammatory processes are implicated in the initial stages of this CD; however, downstream pathways leading to a characteristic rapid fall in stroke volume and cardiac output are not yet fully defined. Currently, no cardioprotective treatments are available. We investigated the role of myocardial oxidative stress in the pathogenesis of CD associated to traumatic hemorrhagic injury, and its related metabolomic profile.

METHODS

Ex vivo tissue from a 3-hour murine model of pressure-controlled trauma hemorrhagic shock (THS) was analyzed. Animals were randomized to echocardiography-guided crystalloid fluid resuscitation or a control group (sham: cannulation and anesthesia only, or naïve: no intervention). Trauma hemorrhagic shock and naïve samples were assessed by immunohistochemistry for nuclear 8-hydroxy-2′-deoxyguanosine expression as a marker of oxidative stress. Metabolomic analysis of THS and sham group tissue was performed by LC-MS.

RESULTS

8-Hydroxy-2′-deoxyguanosine expression across the myocardium was significantly higher following THS injury compared to naïve group (33.01 ± 14.40% vs. 15.08 ± 3.96%, p < 0.05). Trauma hemorrhagic shock injury significantly increased lysine (p = 0.022), and decreased aconitate (p = 0.016) and glutamate (p = 0.047) in the myocardium, indicating activation of a catabolic metabolism and oxidative stress response.

CONCLUSION

We confirm the acute development of oxidative stress lesions and altered cardiac energy metabolism following traumatic hemorrhage injury, providing insight into the relationship between inflammatory damage and impaired cardiac contractility. These findings may provide targets for development of novel cardioprotective therapeutics aiming to decrease late mortality from trauma.
An Indian Young-onset Dementia With Parkinsonism With Double Heterozygous Mutations in ABCA7 and PRKN Identified Through Whole-exome Sequencing
Authors: Sadhukhan Dipanwita , Mallick Aishwarya , Mishra Smriti , Mukherjee Adreesh , Biswas Atanu , Hui Subhra P. , Biswas Arindam
Published: May 2023

Alzheimer disease and Parkinson disease dementia are the 2 most common neurodegenerative diseases have substantial overlap in pathologic, genetic, and clinical manifestation and complex in nature. Here, for the first time, we report an Indian female young patient who presented with clinical manifestation of both Alzheimer disease and Parkinsonism, including dystonia with rapid disease progression. We identified a heterozygous mutation in the ATP-binding cassette transporter A7 gene and double heterozygous mutation in PRKN by whole-exome sequencing. This case is an example of complex etiology of neurodegenerative disorders and highlights the importance of genetic tests, including whole-exome sequencing in complex diseases.
Convergent molecular evolution of thermogenesis and circadian rhythm in Arctic ruminants
Authors: Li Manman , Li Xinmei , Wu Zhipei , Zhang Guanghui , Wang Nini , Dou Mingle , Liu Shanlin , Yang Chentao , Meng Guanliang , Sun Hailu , Hvilsom Christina , Xie Guoxiang , Li Yang , Li Zhuo hui , Wang Wei , Jiang Yu , Heller Rasmus , Wang Yu
Published: May 2023

The muskox and reindeer are the only ruminants that have evolved to survive in harsh Arctic environments. However, the genetic basis of this Arctic adaptation remains largely unclear. Here, we compared a de novo assembled muskox genome with reindeer and other ruminant genomes to identify convergent amino acid substitutions, rapidly evolving genes and positively selected genes among the two Arctic ruminants. We found these candidate genes were mainly involved in brown adipose tissue (BAT) thermogenesis and circadian rhythm. Furthermore, by integrating transcriptomic data from goat adipose tissues (white and brown), we demonstrated that muskox and reindeer may have evolved modulating mitochondrion, lipid metabolism and angiogenesis pathways to enhance BAT thermogenesis. In addition, results from co-immunoprecipitation experiments prove that convergent amino acid substitution of the angiogenesis-related gene hypoxia-inducible factor 2alpha (
HIF2A
), resulting in weakening of its interaction with prolyl hydroxylase domain-containing protein 2 (PHD2), may increase angiogenesis of BAT. Altogether, our work provides new insights into the molecular mechanisms involved in Arctic adaptation.
Preparation of antiviral multispray with cationic antimicrobial dialkyldimethyl ammonium salt and sulfobetaine against new coronaviruses (SARS-CoV-2)
Authors: Morioka Masahiko , Shimaoka Daisuke , Ohnishi Mamoru , Shimoda Hiroshi , Hayasaka Daisuke
Published: May 2023

The novel sudden acute respiratory syndrome coronavirus 2 is an enveloped virus currently causing severe illness and death worldwide. Common antiseptics such as alcohol have some efficacy in disinfecting everyday surroundings, but development of more effective disinfectants is imperative. A series of studies focusing on cationic antimicrobials resulted in the development of a safe and effective novel coronavirus disinfectant, DEA-171, which provides ≥99.98% inhibition of all novel coronavirus variants within 1 min.
Actinoplanes maris sp. nov., isolated from marine sediment
Authors: Xie Qing-Yi , Ma Qing-Yun , Yi Ke-Xin , Yang Li , Dai Hao-Fu , Zhao You-Xing
Published: May 2023

A novel actinobacterium strain (M4I6T) was isolated from marine sediment collected in Megas Gialos, Syros, Greece. On the basis of 16S rRNA gene sequence analysis, strain M4I6T was indicated as belonging to the genus

Actinoplanes

, with high similarity to ‘Actinoplanes solisilvae’ LAM7112T (97.9 %),

Actinoplanes ferrugineus

IFO 15555T (97.6 %),

Actinoplanes cibodasensis

LIPI11-2-Ac042T (97.2 %) and

Actinoplanes bogorensis

LIPI11-2-Ac043T (97.2 %). Phylogenetic analysis of the 16S rRNA gene sequence of strain M4I6T showed that the strain formed a stable subclade with ‘A. solisilvae’ LAM7112T. The cell wall of the novel isolate contained meso-diaminopimelic acid and the whole-cell sugars were xylose, glucose and ribose. The predominant menaquinones were MK-9(H4), MK-9(H2) and MK-9(H8). The phospholipid profile comprised phosphatidylethanolamine, phosphatidylinositol, diphosphatidylglycerol, phosphatidylglycerol, phosphatidylinositol mannosides and an unknown phospholipid. The major fatty acids (>5 %) were anteiso-C16 : 0, iso-C17 : 0, 10-methyl-C16 : 0, C15 : 0, iso-C16 : 0 and C17 : 0. Genome sequencing showed a DNA G+C content of 70.9 mol%. However, the low average nucleotide identity value, digital DNA–DNA hybridization and average amino acid identity values demonstrated that strain M4I6T could be readily distinguished from its closest related species. Based on data from this polyphasic study, strain M4I6T represents a novel species of the genus

Actinoplanes

, for which the name Actinoplanes maris sp. nov. is proposed. The type strain is M4I6T (=DSM 101017T=CGMCC 4.7854T).
Halobacterium wangiae sp. nov. and Halobacterium zhouii sp. nov., two extremely halophilic archaea isolated from sediment of a salt lake and saline soil of an inland saltern
Authors: Wang Bei-Bei , Bao Chen-Xi , Sun Ya-Ping , Hou Jing , Cui Heng-Lin
Published: May 2023

Two novel halophilic archaeal strains, Gai3-17T and XZYJT26T, were isolated from the sediment of Gaize salt lake and the saline soil of Mangkang ancient solar saltern in Tibet, PR China, respectively. Strains Gai3-17T and XZYJT26T were related to each other (96.5 and 89.7% similarity, respectively) and showed 97.5–95.4 and 91.5–87.7% similarities to the current members of

Halobacterium

based on 16S rRNA and rpoB′ genes. The phylogenomic analysis indicated that strains Gai3-17T and XZYJT26T formed two distinct clades and clustered with the

Halobacterium

species. The two strains can be differentiated from the type strains of the six species with validly published names based on several phenotypic characteristics. The phospholipids of the two strains were phosphatidic acid, phosphatidylglycerol and phosphatidylglycerol phosphate methyl ester. One major glycolipid, sulphated galactosyl mannosyl glucosyl diether, was detected in strain Gai3-17T, while four glycolipids, mannosyl glucosyl diether, sulphated mannosyl glucosyl diether, disulphated mannosyl glucosyl diether and sulphated galactosyl mannosyl glucosyl diether were observed in strain XZYJT26T. The average nucleotide identity, digital DNA–DNA hybridization and amino acid identity values among the two strains and the members of

Halobacterium

were no more than 81, 25 and 77 %, respectively. These overall genome-related indices were below the threshold values for species boundary, indicating that strains Gai3-17T and XZYJT26T represent two novel species of

Halobacterium

. Thus, two novel species, Halobacterium wangiae sp. nov. and Halobacterium zhouii sp. nov., are proposed to accommodate strains Gai3-17T (=CGMCC 1.16101T=JCM 33551T) and XZYJT26T (=CGMCC 1.16682T=JCM 33556T), respectively.
The Face of a Surgeon: An Analysis of Demographic Representation in Three Leading Artificial Intelligence Text-to-Image Generators
Authors: Ali Rohaid , Tang Oliver Y. , Connolly Ian D. , Abdulrazeq Hael A. , Mirza Fatima N. , Lim Rachel K. , Johnston Benjamin R. , Groff Michael W. , Williamson Theresa , Svokos Konstantina , Libby Tiffany J. , Shin John H. , Gokaslan Ziya L. , Doberstein Curtis E. , Zou James , Asaad Wael F.
Published: May 2023

Background

This study investigates the accuracy of three prominent artificial intelligence (AI) text-to-image generators—DALL-E 2, Midjourney, and Stable Diffusion—in representing the demographic realities in the surgical profession, addressing raised concerns about the perpetuation of societal biases, especially profession-based stereotypes.

Methods

A cross-sectional analysis was conducted on 2,400 images generated across eight surgical specialties by each model. An additional 1,200 images were evaluated based on geographic prompts for three countries. Images were generated using a prompt template, “A photo of the face of a [blank]”, with blank replaced by a surgical specialty. Geographic-based prompting was evaluated by specifying the most populous countries for three continents (United States, Nigeria, and China).

Results

There was a significantly higher representation of female (average=35.8% vs. 14.7%, P<0.001) and non-white (average=37.4% vs. 22.8%, P<0.001) surgeons among trainees than attendings. DALL-E 2 reflected attendings’ true demographics for female surgeons (15.9% vs. 14.7%, P=0.386) and non-white surgeons (22.6% vs. 22.8%, P=0.919) but underestimated trainees’ representation for both female (15.9% vs. 35.8%, P<0.001) and non-white (22.6% vs. 37.4%, P<0.001) surgeons. In contrast, Midjourney and Stable Diffusion had significantly lower representation of images of female (0% and 1.8%, respectively) and non-white (0.5% and 0.6%, respectively) surgeons than DALL-E 2 or true demographics (all P<0.001). Geographic-based prompting increased non-white surgeon representation (all P<0.001), but did not alter female representation (P=0.779).

Conclusions

While Midjourney and Stable Diffusion amplified societal biases by depicting over 98% of surgeons as white males, DALL-E 2 depicted more accurate demographics, although all three models underestimated trainee representation. These findings underscore the necessity for guardrails and robust feedback systems to prevent AI text-to-image generators from exacerbating profession-based stereotypes, and the importance of bolstering the representation of the evolving surgical field in these models’ future training sets.
Proteomic predictors of physical, cognitive and imaging outcomes in multiple sclerosis: 5-year follow-up study
Authors: Jalaleddini Kian , Jakimovski Dejan , Keshavan Anisha , McCurdy Shannon , Leyden Kelly , Qureshi Ferhan , Ghoreyshi Atiyeh , Bergsland Niels , Dwyer Michael G. , Ramanathan Murali , Weinstock-Guttman Bianca , Benedict Ralph HB , Zivadinov Robert
Published: May 2023

Background

A quantitative measurement of serum proteome biomarkers that would associate with disease progression endpoints can provide risk stratification for persons with multiple sclerosis and supplement the clinical decision-making process.

Materials and Methods

202 persons with multiple sclerosis were enrolled in a longitudinal study with measurements at two time points with an average follow-up time of 5.4 years. Clinical measures included the Expanded Disability Status Scale, Timed 25-foot Walk, 9-Hole Peg and Symbol Digit Modalities Tests. Subjects underwent magnetic resonance imaging to determine the volumetric measures of the whole brain, gray matter, deep gray matter and lateral ventricles. Serum samples were analyzed using a custom immunoassay panel on the Olink™ platform and concentrations of 18 protein biomarkers were measured. Linear mixed-effects models and adjustment for multiple comparisons were performed.

Results

Subjects had a significant 55.6% increase in Chemokine Ligand 20 (9.7pg/mL vs. 15.1pg/mL, p<0.001) and Neurofilament light polypeptide (10.5 pg/ml vs. 11.5 pg/ml, p=0.003) at the follow-up time point. Additional changes in CUB domain-containing protein 1, Contactin 2, Glial fibrillary acidic protein, Myelin oligodendrocyte glycoprotein, and Osteopontin were noted but did not survive multiple comparisons correction. Worse clinical performance in the 9-HPT was associated with Neurofilament light polypeptide (p=0.001). Increases in several biomarker candidates were correlated with greater neurodegenerative changes as measured by different brain volumes.

Conclusion

Multiple proteins representing diverse biological pathways (neuroinflammation, immune modulation, and neuroaxonal integrity) associate with physical, cognitive and radiographic outcomes. Future studies should determine the utility of multiple protein assays in routine clinical care.
Relationships between age, fMRI correlates of familiarity and familiarity-based memory performance under single and dual task conditions
Authors: Chastelaine Marianne de , Horne Erin D , Hou Mingzhu , Rugg Michael D
Published: May 2023

Using fMRI, we investigated the effects of age and divided attention on the neural correlates of familiarity and their relationship with memory performance. At study, word pairs were visually presented to young and older participants under the requirement to make a relational judgment on each pair. Participants were then scanned while undertaking an associative recognition test under single and dual (auditory tone detection) task conditions. The test items comprised studied, rearranged (words from different studied pairs) and new word pairs. fMRI familiarity effects were operationalized as greater activity elicited by studied pairs incorrectly identified as ‘rearranged’ than by correctly rejected new pairs. The reverse contrast was employed to identify ‘novelty’ effects. Behavioral familiarity estimates were equivalent across age groups and task conditions. Robust fMRI familiarity effects were identified in several regions, including medial and superior lateral parietal cortex, dorsal medial and left lateral prefrontal cortex, and bilateral caudate. fMRI novelty effects were identified in the anterior medial temporal lobe. Both familiarity and novelty effects were age-invariant and did not vary according to task condition. In addition, the familiarity effects correlated positively with a behavioral estimate of familiarity strength irrespective of age. These findings extend a previous report from our laboratory, and converge with prior behavioral reports, in demonstrating that the factors of age and divided attention have minimal impact on behavioral and neural estimates of familiarity.