bluuebunny/crossref_metadata_2025 huggingface dataset:
(O-38) SEXUAL FUNCTION OF WOMEN WITH NORMAL WEIGHT, OVERWEIGHT AND OBESITY FROM 18 TO 50 YEARS OLD
Authors: Castiglione M , Silva Cardoso E , De Avila V , Maas Soldi N , Marques Nicastro D , Moura Rodrigues S , Benetti F , Estevão A , Lie Utiyamada N , Glina S
Published: March 2024

Introduction

Female sexual dysfunctions (FSD) can influence physical and mental health, causing limitations in the ability to respond to or enjoy sexual pleasure. Studies show that overweight and obesity can lead to the onset of FSD, but the evidence found remains conflicting.

Objective

To investigate and compare the sexual function of women between 18 and 50 years old, obese, overweight and eutrophic.

Materials and methods

Observational and comparative study. A link to the questionnaire was sent through social networks to women between 18 and 50 years old, sexually active in the last four weeks before answering the questionnaire, after agreeing to participate in the study and signing the consent form, they filled out a form. with demographic data and the Female Sexual Function Index questionnaire, postmenopausal women were excluded from the survey. This study was approved by the ethics and research committee of the FMABC University Center with opinion number: 4,229,411.

Results

325 women participated in the study, with an average age of 28 years, where 186 were classified as obese (49.60%), 109 as overweight (29.07%) and 80 as obese (21.33%, the majority married in a stable union). . union (50.13%) or single (42.93%).In the total score of the FSFI questionnaire (median), non-obese participants obtained 16.4 points, overweight participants obtained 16.4 points, and obese participants they obtained 17.1, without significant difference. in the comparison of DSF according to BMI classification (p=0.887).

Conclusions

There were no statistically significant results on sexual function in obese, overweight and normal weight women in the study.

Financing

No conflict.
(O-40) THERAPEUTIC GROUPS FOR MEN WITH PENILE OR TESTICULAR CANCER
Authors: Silva I M , Naccarato A M E P , Fiolo B , Denardi F , Matheus W E , Ferreira U
Published: March 2024

The incidence of cancer in the world population in 2002 was estimated at 11 million new cases, in 2020 this estimate is approximately 20 million. Cancer is a global public health problem. Testicular cancer (TC) mainly affects men aged 15 to 40 years, and the incidence is about 5/100,000. Typically, tumors are aggressive and cause a great psychological impact on patients.

Penile cancer (PC) represents 2% of all types of tumors that affect men in Brazil. The majority of the affected population are elderly men. Normally the tumor is identified at an advanced stage, when the only available treatment is total or partial penectomy, causing great emotional impact.

This work aims to evaluate the impact of psychotherapy, in an open group, on the Quality of Life Related to Health and Sexuality in patients with CT and CP who have been diagnosed, are undergoing treatment or are being monitored after treatment. Data are collected through an initial interview (Identification, Anamnesis, Health Anamnesis, Degree of Satisfaction with Life and Sexuality, Affective-Emotional Assessment and Treatment Data), SF-36 questionnaire and IIEF-5 short form, in patients who were diagnosed, underwent treatment or are being monitored at the outpatient clinic, and reapplied at the end of 12 sessions. At each session, 5 questions are answered regarding the perception of the previous session. The group is available once a week for 12 weeks. Sessions last 90 minutes, led by the same psychologist.

The research is being developed considering the ethical principles of secrecy, privacy and confidentiality. At the beginning of the process, the Free and Informed Consent Form is delivered as well as details regarding the research. It is also explained that participation is voluntary and that the participant may leave the research at any time, without this affecting their treatment and follow-up.

Financing

No conflict.
(PM-07) EVALUATION OF SEXUAL HEALTH EDUCATION IN THE FACULTY OF MEDICAL SCIENCES OF THE UNIVERSITY OF CAMPINAS: SEXUAL COMMUNICATION IN PATIENT-DOCTOR RELATIONSHIP APPROACH
Authors: Ribeiro M L , Naccarato A , Negreiros M E , Barbuio M E , Silva I m , Matheus W E
Published: March 2024

Introduction/objectives

Sexual dysfunction, present in 43% of women and 31% of men, is the result of several pathological conditions and must be properly investigated and treated. About 50 to 72% of physicians experience difficulty and do not regularly investigate their patients' sexual health.

The study investigates the teaching and approach to sexual health in the medical graduation at the Faculty of Medical Sciences of the State University of Campinas, in order to detect gaps that justify the difficulty in discussing this aspect.

Materials and Methods

Descriptive and transversal study is in progress, including medical students that are above 18 years old and are in the fifth or sixth year of their graduation. Anonymously and after reading the Informed Consent Form, the online questionnaire, composed of questions related to the theoretical and practical approaches in sexuality and the knowledge that they have been receiving in medical school, can be answered.

Results

The online questionnaire was answered by 64 students in the fifth and sixth year of graduation (1.6% and 98.4%, respectively). 43.5% denied being effectively prepared and confident, 35.5% are uncertain and only 21% feel prepared to discuss the subject with their patients.

The main theme approached involves mostly the female sexuality, being the reproductive focus (85.2%), abortion (85.2%) and sexual violence (83.6%) the most discussed subjects. Only 4 students indicate that they understand male dysfunctions. A minority of participants (21.9%) felt safe to address sexual issues with their patients.

Conclusions

Most of the students do not feel comfortable or confident and lack specific knowledge and skills to deal with questions related to sexuality.

More time should be dedicated to education, theoretical and practical classes, concerning human sexuality and its cultural, societal, and health aspects in the graduation during medical school.

Financing

No conflict.
(PM-15) THE EFFECT OF A PELVIC FLOOR TRAINING PROGRAM APPLIED IN PREGNANT WOMEN WITH URINARY INCONTINENCE
Authors: Lohane da Silva Muniz E , Pereira Ribeiro da Silva I , Estevão A , Castiglione M
Published: March 2024

Introduction

Urinary incontinence is a common symptom during pregnancy, the most common type of incontinence in pregnant women is SUI. Stress urinary incontinence affects 54% of all pregnant women. These symptoms are usually experienced during pregnancy and postpartum and can negatively affect quality of life, interfering with social, professional and family activities. Pelvic floor muscle training supervised by a therapist is an effective treatment for UI in women and has been shown to be effective; However, there is still clinical uncertainty about the application of these exercises in pregnant women.

Objective

The objective of this study is to conduct a review of the literature and present the effect of pelvic floor exercise in pregnant women with urinary incontinence, in order to validate whether there are benefits or not.

Methods

An integrative review of the literature was carried out, surveys were carried out in the electronic databases PubMed and PEDro, using the descriptors “Exercise”, “Physical Activities”, “Urinary Incontinence” and “Pregnant Women”. Only randomized clinical trials were selected and the search was carried out between April and May 2022.

Results

71 studies were found, only 10 met the established criteria and agreed with the objective of the present review.

Conclusion

An integrative review of the literature was carried out and it was observed that pelvic muscle training helps reduce urinary incontinence in pregnant women and promotes a better quality of life, without associated risks.

Financing

No conflict.
(PM-17) THE ROLE OF PHOSPHODIESTERASE-5 INHIBITORS IN THE TREATMENT OF COMPLEX PENILE WOUNDS: A CASE REPORT AND LITERATURE REVIEW
Authors: de Oliveira C , Fregonesi A , Costa de Salles L , Chahade Sibanto Simões G , Pereira de Souza A B , Degani Ottaiano A , Canettieri Rubez A , Ricardo Di Domenico B , Franco de Oliveira Júnior F , Akel Ferruccio A , Destro Saad R
Published: March 2024

Introduction/Objective

Phosphodiesterase-5 inhibitors (PDE5i) are traditionally employed for the management of erectile dysfunction and lower urinary tract symptoms. However, their role in the healing of complex penile wounds remains scarcely discussed. This study aims to describe the case of a 27-year-old man who suffered from penile strangulation, treated with sildenafil. Additionally, a literature review concerning the use of PDE5i for the treatment of complex penile injuries will be conducted.

Methods

A 27-year-old man presented to the emergency room after a self-induced penile strangulation using a ring placed at the base of the penis. Extensive necrosis of the corpus cavernosum was identified through magnetic resonance imaging. Considering the psychosocial implications of penile amputation, organ preservation was chosen, and conservative treatment with sildenafil and daily local dressings was initiated. Thirty days after admission, Doppler ultrasound revealed symmetrical corpus cavernosum with normal echogenicity and usual blood flow patterns. Subsequently, the patient underwent superficial necrotic tissue debridement followed by partial skin grafting in a second stage, leading to hospital discharge after 55 days of hospitalization.

Results

PDE5 inhibitors enhance nitric oxide bioavailability, promoting vasodilation and improved tissue oxygenation, thereby facilitating various phases of the healing process. Evidence indicates their benefit in microvascular perfusion in skin and soft tissues. Reports suggest satisfactory outcomes of topical PDE5i application in radiation-induced lesions, implying their role in epidermal cell expansion, reduction of inflammatory infiltrates, enhanced vascularization, and decreased collagen deposition.

Conclusion

This study presents a successful case of sildenafil use in treatment of a complex penile wound, shedding light on an unconventional application of PDE5i.

Financing

No conflict.
(PM-18) EXPLORING THE CONNECTIONS BETWEEN HYPERSEXUALITY AND SEX HORMONE: A PRELIMINARY STUDY IN BRAZILIAN MEN
Authors: O  Ferreira B , Talib L , T  Scanavino M
Published: March 2024

Introduction

Compulsive sexual behavior disorder (CSBD) or hypersexual behavior has gained global attention due to its adverse impact on health. However, there is just a few data on sex hormones of people reporting CSBD/hypersexual behavior.

Objective

Here, we investigate correlations between CSBD/hypersexual behavior and sex hormone in a sample of 34 Brazilian men who met the diagnostic criteria for CSBD/hypersexual disorder.

Methods

After ethical approval, participants provided informed consent and were assessed through the Instrument of Investigation of CSBD Diagnostic Criteria – ICD11, Hypersexual Disorder Screening Inventory (HDSI), Compulsive Sexual Behavior Inventory (CSBI), Sexual Compulsivity Scale (SCS), and Childhood Trauma Questionnaire (CTQ). Additionally, participants' basal blood levels were evaluated.

Results

The sample had a mean age of 38.2 years (SD ± 10.05). The median hormone levels of total testosterone 484 ng/dL [356;560], free testosterone 372 pmol/L [285;472], prolactin 9.50 ng/mL [8.30;13.4], estradiol 23.9 pg/mL [23.9;27.5], SHBG 26.7 nmol/L [21.8;33.5], FSH 4.10 IU/L [2.8;5.3], and LH 2.90 IU/L [2.18;3.85]. Mean scores for HDSI, CSBI, SCS, and CTQ were 23.2 (SD ± 3.80), 66.3 (SD ± 8.26), 33.7 (SD ± 4.14), and 37.6 (SD ± 8.03), respectively. Spearman's correlation analyses showed a positive correlation between total with free testosterone levels (Rho: 0.87); Total testosterone levels with SHBG (Rho: 0.59); a negative correlation between total and free testosterone levels with SCS score (Rho: –0.38; Rho: –0.35, respectively); a negative correlation between LH levels and CTQ total scores (Rho: –0.63); a negative correlation between CSBI with SCS scores (Rho: –0.58).

Conclusion

Our data shows the first exploration between hypersexuality and sex hormones in a Brazilian men sample, supporting previous findings about a relationship of testosterone levels with SCS scores in hypersexual individuals.

Financing

FAPESP.
(PM-19) INSIGHTS INTO THE PATHOPHYSIOLOGY OF HYPERSEXUALITY: A COMPREHENSIVE LITERATURE EXPLORATION
Authors: O  Ferreira B , J  Teixeira B , Talib L , T  Scanavino M
Published: March 2024

Introduction

Hypersexuality or Compulsive Sexual Behavior Disorder (CSBD) is characterized by a spectrum of sexual behaviors and fantasies marked by compulsion, obsession, and impulsivity. The pathophysiology of CSBD remains poorly understood despite the arousing of articles exploring the potential biomarkers associated with hypersexuality.

Objective

We aimed to review the literature regarding the investigation on CSBD pathophysiology from a neuroimaging, neuroendocrine and molecular perspective.

Methods

We raised papers related on neuroimaging, neuroendocrine and molecular biomarkers investigated in individuals that reached diagnosis of CSBD or similar, written in English language in the last 10 years, through PubMed, Scopus, and Web of Science with biomarkers and compulsive sexual behavior/hypersexuality key terms.

Results

Neuroimaging studies revealed the activation of the anterior cingulate cortex, ventral striatum, and amygdala, in individuals with CSBD. Neuroendocrine markers revealed abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis, including elevated adrenocorticotropic hormone (ACTH) levels and non-suppression of dexamethasone. Findings concerning the hypothalamic-pituitary-gonadal (HPG) axis, responsible for sexual function regulation, varied among CSBD individuals, including testosterone and luteinizing hormone (LH) levels. Oxytocin levels have been noted to rise in CSBD individuals and subsequently decrease following psychotherapy. Genetic and epigenetic markers associated with CSBD suggest involvement of addiction-related genes and epigenetic modifications near the corticotropin-releasing hormone (CRH) gene.

Conclusion

Most of the findings point to HPA axis alterations. Molecular analysis is in the beginning, as well as more research on the HPG axis is needed. The exploration of CSBD biomarkers potentially will provide insights into its pathophysiology, diagnosis, and treatment.

Financing

FAPESP.
The Impact of a Pandemic on a Military Oral and Maxillofacial Pathology Biopsy Service
Authors: Miller Trevor E , Dickens Noel E , Rehmel Matthew R , Jones Bradley E , Hamlin Nicholas J , Robbins Quinn C
Published: March 2024

Introduction

Coronavirus disease 2019 (COVID-19) and the resulting societal reaction presented new challenges to the medical community by limiting patient access to care in 2020 and 2021. The Navy Postgraduate Dental School (NPDS) oral and maxillofacial pathology biopsy service is dependent on in-office physician or dentist appointments and patient biopsies. The purpose of this study was to understand the regulatory and societal impacts of COVID-19 restrictions on biopsy service submissions by assessing NPDS biopsy submission quantities and disease distribution.

Materials and Methods

All NPDS oral and maxillofacial pathology biopsy submissions from calendar years 2015 to 2016 and 2019 to 2021 were evaluated, and patient demographics and biopsy diagnoses were recorded in a biopsy registry. Data collected included age, sex, biopsy site, and diagnosis. Data from 2015, 2016, and 2019 were defined as pre-COVID and 2020 and 2021 as COVID. Biopsy reports for each year were organized in quarters. Diagnoses were categorized as malignant, pre-malignant, or benign. Categorical and continuous data were evaluated and presented as counts with percentages and means or medians with standard deviations, respectively. Significant differences in proportions or means were assessed using chi-square analysis or Student t-test, respectively. Cases were aggregated by quarter and year and assessed for temporal trends using linear regression analysis.

Results

The study evaluated 9,351 biopsy submission reports. The annual pre-COVID count mean (± standard deviation) and yearly counts for 2020 and 2021 were 2,063 ± 33.3, 1,421, and 1,742, respectively. The mean (± standard deviation) percentage of diagnoses classified as malignant from pre-COVID, 2020, and 2021 were 2.46 ± 0.005%, 3.59%, and 3.04%, respectively. Case counts and representation as a percentage of all biopsy diagnoses for Human Papillomavirus (HPV)-associated squamous cell carcinoma increased significantly during COVID compared to pre-COVID years (P < .05).

Conclusions

Overall, preventative COVID-19 health measures and protocols resulted in a reduction in biopsy submission frequency, particularly during the second quarter (April to June) of 2020. However, case counts for malignant biopsies remained consistent between pre-COVID and COVID time intervals, suggesting that the identification and analysis of cases requiring follow-on care were unaffected by COVID-19 protocols.
An improved halo occupation distribution prescription from UNITsim Hα emission-line galaxies: conformity and modified radial profile
Authors: Reyes-Peraza Guillermo , Avila Santiago , Gonzalez-Perez Violeta , Lopez-Cano Daniel , Knebe Alexander , Ramakrishnan Sujatha , Yepes Gustavo
Published: March 2024

Emission-line galaxies (ELGs) are targeted by the new generation of spectroscopic surveys to make unprecedented measurements in cosmology from their distribution. Accurately interpreting these data require understanding the imprints imposed by the physics of galaxy formation and evolution on galaxy clustering. In this work, we utilize a semi-analytical model of galaxy formation (sage) to explore the necessary components for accurately reproducing the clustering of ELGs. We focus on developing a halo occupation distribution (HOD) prescription able to reproduce the clustering of sage galaxies. Typically, HOD models assume that satellite and central galaxies of a given type are independent events. We investigate the need for conformity, i.e. whether the average satellite occupation depends on the existence of a central galaxy of a given type. Incorporating conformity into HOD models is crucial for reproducing the clustering in the reference galaxy sample. Another aspect we investigate is the radial distribution of satellite galaxies within haloes. The traditional density profile models, Navarro–Frenk–White (NFW) and Einasto profiles, fail to accurately replicate the small-scale clustering measured for sage satellite galaxies. To overcome this limitation, we propose a generalization of the NFW profile, thereby enhancing our understanding of galaxy clustering.
Super-Eddington accretion in high-redshift black holes and the emergence of jetted AGN
Authors: Piana Olmo , Pu Hung-Yi , Wu Kinwah
Published: March 2024

In this work, we study the co-evolution of central black holes (BHs) and host galaxies by utilizing an advanced iteration of the DELPHI semi-analytical model of galaxy formation and evolution. Based on dark matter halo merger trees spanning the redshift range from z = 20 to z = 4, it now incorporates essential components such as gas heating and cooling, cold and hot BH accretion, jet and radiative AGN feedback. We show how different BH growth models impact quasar and galaxy observables at z ≥ 5, providing predictions that will help discriminate between super-Eddington and Eddington-limited accretion models: despite being both consistent with observed properties of SMBHs and their host galaxies at z ∼ 5–7, they become very clearly distinguishable at higher redshift and in the intermediate mass regime. We find that the super-Eddington model, unlike the Eddington-limited scenario, predicts a gap in the BH mass function corresponding to the intermediate-mass range 104 M⊙ < Mbh < 106 M⊙. Additionally, it predicts black holes up to two orders of magnitude more massive for the same stellar mass at z = 9. The resulting velocity dispersion–BH mass relation at z ≥ 5 is consistent with local measurements, suggesting that its slope and normalization are independent of redshift. Depending on the Eddington ratio, we also model the emergence of AGN jets, predicting their duty cycle across as a function of BH mass and their potential impact on the observed number density distribution of high-redshift AGN in the hard X-ray band.
Stellar wind bubbles of OB stars as Galactic cosmic ray re-accelerators
Authors: Meyer D M -A
Published: March 2024

Cosmic rays are highly energetic messengers propagating in magnetized plasma, which are, possibly but not exclusively, accelerated at astrophysical shocks. Amongst the variety of astrophysical objects presenting shocks, the huge circumstellar stellar wind bubbles forming around very massive stars, are potential non-thermal emitters. We present the 1D magneto-hydrodynamical simulation of the evolving magnetized surroundings of a single, OB-type main-sequence $60\, \rm {\rm M}_{\odot }$ star, which is post-processed to calculate the re-acceleration of pre-existing non-thermal particles of the Galactic cosmic ray background. It is found that the forward shock of such circumstellar bubble can, during the early phase ($1\, \rm Myr$) of its expansion, act as a substantial re-accelerator of pre-existing interstellar cosmic rays. This results in an increasing excess emission flux by a factor of 5, the hadronic component producing γ-rays by π0 decay being more important than those by synchrotron and inverse Compton radiation mechanisms. We propose that this effect is at work in the circumstellar environments of massive stars in general and we conjecture that other nebulae such as the stellar wind bow shocks of runaway massive stars also act as Galactic cosmic ray re-accelerators. Particularly, this study supports the interpretation of the enhanced hadronic emission flux measured from the surroundings of κ Ori as originating from the acceleration of pre-existing particles at the forward shock of its wind bubble.
Adding value to JWST spectra and photometry: stellar population and star formation properties of spectroscopically confirmed JADES and CEERS galaxies at z > 7
Authors: Duan Qiao , Conselice Christopher J , Li Qiong , Harvey Thomas , Austin Duncan , Ormerod Katherine , Trussler James , Adams Nathan
Published: March 2024

In this paper, we discuss measurements of the stellar population and star-forming properties for 43 spectroscopically confirmed publicly available high-redshift z > 7 JWST galaxies in the JADES and CEERS observational programs. We carry out a thorough study investigating the relationship between spectroscopic features and photometrically derived ones, including from spectral energy distribution (SED) fitting of models, as well as morphological and structural properties. We find that the star formation rates (SFRs) measured from H β line emission are higher than those estimated from Bayesian SED fitting and ultraviolet (UV) luminosity, with ratios SFRH β/SFRUV ranging from ∼2 to 13. This is a sign that the star formation history is consistently rising given the time-scales of H β versus UV star formation probes. In addition, we investigate how well equivalent widths (EWs) of H β λ4861, [O iii] λ4959, and [O iii] λ5007 can be measured from photometry, finding that, on average, the EW derived from photometric excesses in filters is 30 per cent smaller than the direct spectroscopic measurement. We also discover that a stack of the line emitting galaxies shows a distinct morphology after subtracting imaging that contains only the continuum. This gives us a first view of the line or ionized gas emission from z > 7 galaxies, demonstrating that this material has a similar distribution, statistically, as the continuum. We also compare the derived SFRs and stellar masses for both parametric and non-parametric star formation histories, where we find that 35 per cent of our sample formed at least 30 per cent of their stellar mass in recent (<10 Myr) starburst events.
Urinary bladder involvement in IgG4-related disease: A case-based review
Authors: Vijayvergia Parag , Mukherjee Sayan , Singh Lily , Dhakad Urmila
Published: March 2024

Immunoglobulin G4–related disease (IgG4-RD) is an immune-driven fibroinflammatory disease that presents as tumefactive lesions that not only commonly affects the pancreas, lacrimal and salivary glands, lung, liver and kidney but can also affect any organs. However, involvement of the urinary bladder in IgG4-RD is rarely reported. We describe a case of IgG4-RD involving the urinary bladder mimicking carcinoma and review the published literature—a 39-year-old male presented with complaints of dysuria, urgency and hesitancy. Ultrasound revealed a hyperechoic lesion protruding from the anterior of the urinary bladder wall with partial obstruction to bladder outflow, likely to be a pedunculated bladder mass with high suspicion for malignancy. A contrast-enhanced computed tomography abdomen showed a large irregular lobulated heterogeneously enhancing lesion involving the anteroinferior wall of the urinary bladder extending from mid-body up to the neck region with significant perivesical fat stranding and multiple ill-defined perivesical deposits along with hypodense soft tissue lesion in the perigastric region at the level of the body of the stomach. CT-guided perigastric and ultrasound-guided biopsy from the urinary bladder mass confirmed the diagnosis of IgG4-RD. The patient was treated with glucocorticoids. He is doing well after a 1-year follow-up without recurrence, and a repeat ultrasound showed a significant reduction in the size of the urinary bladder mass. The diagnosis of IgG4-RD should be considered in the differential diagnosis of a urinary bladder mass. High index of suspicion and prompt initiation of therapy are required to minimise residual damage and the need for surgical intervention.
Abscisic acid activates transcription factor module MdABI5–MdMYBS1 during carotenoid-derived apple fruit coloration
Authors: Jia Dongjie , Li Yuchen , Jia Kun , Huang Benchang , Dang Qingyuan , Wang Huimin , Wang Xinyuan , Li Chunyu , Zhang Yugang , Nie Jiyun , Yuan Yongbing
Published: March 2024

Carotenoids are major pigments contributing to fruit coloration. We previously reported that the apple (Malus domestica Borkh.) mutant fruits of “Beni Shogun” and “Yanfu 3” show a marked difference in fruit coloration. However, the regulatory mechanism underlying this phenomenon remains unclear. In this study, we determined that carotenoid is the main factor influencing fruit flesh color. We identified an R1-type MYB transcription factor (TF), MdMYBS1, which was found to be highly associated with carotenoids and abscisic acid (ABA) contents of apple fruits. Overexpression of MdMYBS1 promoted, and silencing of MdMYBS1 repressed, β-branch carotenoids synthesis and ABA accumulation. MdMYBS1 regulates carotenoid biosynthesis by directly activating the major carotenoid biosynthetic genes encoding phytoene synthase (MdPSY2-1) and lycopene β-cyclase (MdLCYb). 9-cis-epoxycarotenoid dioxygenase 1 (MdNCED1) contributes to ABA biosynthesis, and MdMYBS1 enhances endogenous ABA accumulation by activating the MdNCED1 promoter. In addition, the basic leucine zipper domain TF ABSCISIC ACID-INSENSITIVE5 (MdABI5) was identified as an upstream activator of MdMYBS1, which promotes carotenoid and ABA accumulation. Furthermore, ABA promotes carotenoid biosynthesis and enhances MdMYBS1 and MdABI5 promoter activities. Our findings demonstrate that the MdABI5–MdMYBS1 cascade activated by ABA regulates carotenoid-derived fruit coloration and ABA accumulation in apple, providing avenues in breeding and planting for improvement of fruit coloration and quality.
Developing an Accumulative Assessment System of Upper Extremity Motor Function in Patients With Stroke Using Deep Learning
Authors: Lin Gong-Hong , Lee Shih-Chieh , Huang Chien-Yu , Wang Inga , Lee Ya-Chen , Hsueh I-Ping , Hsieh Ching-Lin
Published: March 2024

Objective

The Fugl-Meyer assessment for upper extremity (FMA-UE) is a measure for assessing upper extremity motor function in patients with stroke. However, the considerable administration time of the assessment decreases its feasibility. This study aimed to develop an accumulative assessment system of upper extremity motor function (AAS-UE) based on the FMA-UE to improve administrative efficiency while retaining sufficient psychometric properties.

Methods

The study used secondary data from 3 previous studies having FMA-UE datasets, including 2 follow-up studies for subacute stroke individuals and 1 test–retest study for individuals with chronic stroke. The AAS-UE adopted deep learning algorithms to use patients’ prior information (ie, the FMA-UE scores in previous assessments, time interval of adjacent assessments, and chronicity of stroke) to select a short and personalized item set for the following assessment items and reproduce their FMA-UE scores.

Results

Our data included a total of 682 patients after stroke. The AAS-UE administered 10 different items for each patient. The AAS-UE demonstrated good concurrent validity (r = 0.97–0.99 with the FMA-UE), high test–retest reliability (intra-class correlation coefficient = 0.96), low random measurement error (percentage of minimal detectable change = 15.6%), good group-level responsiveness (standardized response mean = 0.65–1.07), and good individual-level responsiveness (30.5%–53.2% of patients showed significant improvement). These psychometric properties were comparable to those of the FMA-UE.

Conclusion

The AAS-UE uses an innovative assessment method, which makes good use of patients’ prior information to achieve administrative efficiency with good psychometric properties.

Impact

This study demonstrates a new assessment method to improve administrative efficiency while retaining psychometric properties, especially individual-level responsiveness and random measurement error, by making good use of patients’ basic information and medical records.
Advances in Hand Therapy: Best Practice in Conservative Management of Proximal Phalangeal Fractures in Children
Authors: Kilty Rebecca , Baxter Sarah , McKay Marnee J. , Hiller Claire E.
Published: March 2024

Background:

Proximal phalangeal fractures are one of the most commonly treated hand injuries in children. Conservative management of these fractures is often to splint for 5 weeks post injury, despite children presenting as clinically healed at 3 weeks post injury. Therefore, we investigated the effect of splinting for only 3 weeks in children who present with clinically healed proximal phalangeal fractures at 3 weeks compared with usual care.

Methods:

Participants (n=80, aged 10.3 ±2.5 years) presenting to the Hand Clinic of a tertiary Children’s Hospital in Sydney, Australia, were randomly allocated into a Current Protocol and a New Protocol group. Following were the inclusion criteria: aged between 5 and 16 years; present with an non-displaced or minimally displaced and stable fracture; no surgical intervention; assessed as clinically healed at 3-week visit. The primary outcome measure was total active motion (TAM) of the injured digit compared with the contralateral digit (deg), at 5 weeks post injury. Secondary outcome measures were grip strength, and a parent-reported questionnaire. Statistical analysis used χ2 test and the absolute difference described by a 90% CI. The New Protocol was considered noninferior if the 90% CI overlap was > 20% of the Current Protocol. Analysis was by intention to treat.

Results:

There was a 10% loss to follow up at 5 weeks (Current Protocol =4, New Protocol =4). All CIs between groups overlapped by >10%. TAM 90% CI for Current Protocol was 17.7 to 5.4 degrees and for the New Protocol was 4.7 to 1.6 degrees.

Conclusions:

A change in practice is warranted to cease immobilization for children with conservatively managed proximal phalangeal fractures who present as clinically healed at 3 weeks. Therapist assessment of fracture healing is an appropriate indicator for intervention and can be utilized in a therapist-led model of care.

Level of Evidence:

Level 1—noninferiority randomized control trial with 2 parallel arms.
Restoration of Spinopelvic Alignment After Reduction of High-grade Spondylolisthesis
Authors: Viroli Giovanni , Ruffilli Alberto , Ialuna Marco , Barile Francesca , Manzetti Marco , Traversari Matteo , Vita Fabio , Faldini Cesare
Published: March 2024

Study Design:

Systematic review and meta-analysis of literature.

Objective:

The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms.

Summary of Background Data:

HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)].

Methods:

A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P<0.05 was considered significant.

Results:

Eighteen studies were included. PT showed a statistically significant decrease of −2.1217 (95% CI: −3.4803 to −0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462–6.9236). Conversely, both LL and TK showed nonsignificant changes, −4.7043 (95% CI: −10.4535 to 1.0449) and 6.3881 (95% CI: −0.8344 to 13.6106), respectively. VAS significantly decreased by −3.1950 (95% CI: −4.9462 to −1.4439).

Conclusions:

The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable.

Level of Evidence:

Level IV.
Impact of Controlled Versus Uncontrolled mFI-5 Frailty on Perioperative Complications After Adult Spinal Deformity Surgery
Authors: Olson Jarod , Mo Kevin C. , Schmerler Jessica , Durand Wesley M. , Kebaish Khaled M. , Skolasky Richard L. , Neuman Brian J.
Published: March 2024

Study Design:

Retrospective review.

Objectives:

We substratified the mFI-5 frailty index to reflect controlled and uncontrolled conditions and assess their relationship to perioperative complications.

Summary of Background Data:

Risk assessment before adult spinal deformity (ASD) surgery is critical because the surgery is highly invasive with a high complication rate. Although frailty is associated with risk of surgical complications, current frailty measures do not differentiate between controlled and uncontrolled conditions.

Methods:

Frailty was calculated using the mFI-5 index for 170 ASD patients with fusion of ≥5 levels. Uncontrolled frailty was defined as blood pressure >140/90 mm Hg, HbA1C >7% or postprandial glucose >180 mg/dL, or recent chronic obstructive pulmonary disease (COPD) exacerbation, while on medication. Patients were divided into nonfrailty, controlled frailty, and uncontrolled frailty cohorts. The primary outcome measure was perioperative major and wound complications. Bivariate analysis was performed. Multivariable analysis assessed the relationship between frailty and perioperative complications.

Results:

The cohorts included 97 nonfrail, 54 controlled frail, and 19 uncontrolled frail patients. Compared with nonfrail patients, patients with uncontrolled frailty were more likely to have age older than 60 years (84% vs. 24%), hyperlipidemia (42% vs. 20%), and Oswestry Disability Index (ODI) score >42 (84% vs. 52%) (P<0.05 for all). Controlled frailty was associated with those older than 60 years (41% vs. 24%) and hyperlipidemia (52% vs. 20%) (P<0.05 for all). On multivariable regression analysis controlling for hyperlipidemia, functional independence, motor weakness, ODI>42, and age older than 60 years, patients with uncontrolled frailty had greater odds of major complications (OR 4.24, P=0.03) and wound complications (OR 9.47, P=0.046) compared with nonfrail patients. Controlled frailty was not associated with increased risk of perioperative complications (P>0.05 for all).

Conclusions:

Although patients with uncontrolled frailty had higher risk of perioperative complications compared with nonfrail patients, patients with controlled frailty did not, suggesting the importance of controlling modifiable risk factors before surgery.

Level of Evidence:

3.
Chat Generative Pretraining Transformer Answers Patient-focused Questions in Cervical Spine Surgery
Authors: Subramanian Tejas , Araghi Kasra , Amen Troy B. , Kaidi Austin , Sosa Branden , Shahi Pratyush , Qureshi Sheeraz , Iyer Sravisht
Published: March 2024

Study Design:

Review of Chat Generative Pretraining Transformer (ChatGPT) outputs to select patient-focused questions.

Objective:

We aimed to examine the quality of ChatGPT responses to cervical spine questions.

Background:

Artificial intelligence and its utilization to improve patient experience across medicine is seeing remarkable growth. One such usage is patient education. For the first time on a large scale, patients can ask targeted questions and receive similarly targeted answers. Although patients may use these resources to assist in decision-making, there still exists little data regarding their accuracy, especially within orthopedic surgery and more specifically spine surgery.

Methods:

We compiled 9 frequently asked questions cervical spine surgeons receive in the clinic to test ChatGPT’s version 3.5 ability to answer a nuanced topic. Responses were reviewed by 2 independent reviewers on a Likert Scale for the accuracy of information presented (0–5 points), appropriateness in giving a specific answer (0–3 points), and readability for a layperson (0–2 points). Readability was assessed through the Flesh-Kincaid grade level analysis for the original prompt and for a second prompt asking for rephrasing at the sixth-grade reading level.

Results:

On average, ChatGPT’s responses scored a 7.1/10. Accuracy was rated on average a 4.1/5. Appropriateness was 1.8/3. Readability was a 1.2/2. Readability was determined to be at the 13.5 grade level originally and at the 11.2 grade level after prompting.

Conclusions:

ChatGPT has the capacity to be a powerful means for patients to gain important and specific information regarding their pathologies and surgical options. These responses are limited in their accuracy, and we, in addition, noted readability is not optimal for the average patient. Despite these limitations in ChatGPT’s capability to answer these nuanced questions, the technology is impressive, and surgeons should be aware patients will likely increasingly rely on it.
Epidemiology of Spondylolisthesis
Authors: Longo Umile Giuseppe , De Salvatore Sergio , Denaro Luca , Mazzola Alessandro , Piergentili Ilaria , Denaro Vincenzo
Published: March 2024

Study Design:

Epidemiological study.

Objective:

This study aimed to evaluate the annual incidence of spondylolisthesis requiring surgery in Italy and the epidemiological characteristics of the patients.

Background:

The health care system continues to incur considerable costs as a result of low-back pain. Segmental instability of the lumbar spine has attracted significant interest from researchers as a potential mechanism leading to mechanical low back pain.

Materials and Methods:

The Italian Ministry of Health’s National Hospital Discharge Reports database in the 2001–2016 period was considered.

Results:

A total of 55,804 hospital admissions for spondylolisthesis were performed in Italy. The cumulative incidence was 6.8 interventions for every 100,000 Italian adult residents. The highest amount of procedures was recorded in the 65–69 years of age group. The overall patient's age was 56.8 ± 15.1 years. The 62.2% of patients were females. The average hospital stay length was 8.1 ± 7.3 days. On average, older patients require more days of hospital stay. Over the study period, it was observed a decreasing trend in the average number of days of hospital stay. The main primary diagnoses included were “acquired spondylolisthesis” [International Classification of Diseases (ICD) code: 738.4; 57.8%] and “spondylolisthesis” (ICD code: 756.12; 42.2%). By far, the main primary procedure performed was “lumbar and lumbosacral fusion of the anterior column, posterior technique” (ICD code: 81.08; 60.3%).

Conclusions:

Spondylolisthesis is a problem in Italy and a leading cause requiring spine surgery. Females were the majority of patients requiring surgery for spondylolisthesis. However, for younger age groups, males showed superior or equal need for spine surgery. The socioeconomic impact of spondylolisthesis in Italy is relevant, affecting patients still in the working population. The increasing trend of spine surgery for spondylolisthesis in Italy may be attributable to the widespread diffusion of modern diagnostic and surgical technologies.

Level of Evidence:

Level II.
External Validation of Prognostic Models in Critical Care: A Cautionary Tale From COVID-19 Pneumonitis
Authors: Bate Sebastian , Stokes Victoria , Greenlee Hannah , Goh Kwee Yen , Whiting Graham , Kitchen Gareth , Martin Glen P. , Parker Alexander J. , Wilson Anthony ,   on behalf of the MRI Critical Care Data Group
Published: March 2024

OBJECTIVES (BACKGROUND):

To externally validate clinical prediction models that aim to predict progression to invasive ventilation or death on the ICU in patients admitted with confirmed COVID-19 pneumonitis.

DESIGN:

Single-center retrospective external validation study.

DATA SOURCES:

Routinely collected healthcare data in the ICU electronic patient record. Curated data recorded for each ICU admission for the purposes of the U.K. Intensive Care National Audit and Research Centre (ICNARC).

SETTING:

The ICU at Manchester Royal Infirmary, Manchester, United Kingdom.

PATIENTS:

Three hundred forty-nine patients admitted to ICU with confirmed COVID-19 Pneumonitis, older than 18 years, from March 1, 2020, to February 28, 2022. Three hundred two met the inclusion criteria for at least one model. Fifty-five of the 349 patients were admitted before the widespread adoption of dexamethasone for the treatment of severe COVID-19 (pre-dexamethasone patients).

OUTCOMES:

Ability to be externally validated, discriminate, and calibrate.

METHODS:

Articles meeting the inclusion criteria were identified, and those that gave sufficient details on predictors used and methods to generate predictions were tested in our cohort of patients, which matched the original publications’ inclusion/exclusion criteria and endpoint.

RESULTS:

Thirteen clinical prediction articles were identified. There was insufficient information available to validate models in five of the articles; a further three contained predictors that were not routinely measured in our ICU cohort and were not validated; three had performance that was substantially lower than previously published (range C-statistic = 0.483–0.605 in pre-dexamethasone patients and C = 0.494–0.564 among all patients). One model retained its discriminative ability in our cohort compared with previously published results (C = 0.672 and 0.686), and one retained performance among pre-dexamethasone patients but was poor in all patients (C = 0.793 and 0.596). One model could be calibrated but with poor performance.

CONCLUSIONS:

Our findings, albeit from a single center, suggest that the published performance of COVID-19 prediction models may not be replicated when translated to other institutions. In light of this, we would encourage bedside intensivists to reflect on the role of clinical prediction models in their own clinical decision-making.
Simultaneous Determination of Ibrutinib, Dihydroxydiol Ibrutinib, and Zanubrutinib in Human Plasma by Liquid Chromatography–Mass Spectrometry/Mass Spectrometry
Authors: Guo Yu-Jiao , Du Tian-Tian , Yang Yan-Ling , Zhao Yang , Chen Xiang-Long , Ma Hong , Sun Lu-Ning , Wang Yong-Qing
Published: March 2024

Background:

Ibrutinib and zanubrutinib are Bruton tyrosine kinase inhibitors used to treat mantle cell lymphoma, chronic lymphocytic leukemia, and small lymphocytic lymphoma. Dihydroxydiol ibrutinib (DHI) is an active metabolite of the drug. A liquid chromatography–tandem mass spectrometry method was developed to detect ibrutinib, DHI, and zanubrutinib in human plasma.

Methods:

The method involved a protein precipitation step, followed by chromatographic separation using a gradient of 10 mM ammonium acetate (containing 0.1% formic acid)–acetonitrile. Ibrutinib-d5 was used as an internal standard. Analytes were separated within 6.5 minutes. The optimized multiple reaction monitoring transitions of m/z 441.1 → 304.2, 475.2 → 304.2, 472.2 → 455.2, and 446.2 → 309.2 were selected to inspect ibrutinib, DHI, zanubrutinib, and the internal standards in positive ion mode.

Results:

The validated curve ranges included 0.200–800, 0.500–500, and 1.00–1000 ng/mL for ibrutinib, DHI, and zanubrutinib, respectively. The precisions of the lower limit of quantification of samples were below 15.5%, the precisions of the other level samples were below 11.4%, and the accuracies were between −8.6% and 8.4%. The matrix effect and extraction recovery of all compounds ranged between 97.6%–109.0% and 93.9%–105.2%, respectively. The selectivity, accuracy, precision, matrix effect, and extraction recovery results were acceptable according to international method validation guidelines.

Conclusions:

A simple and rapid method was developed and validated in this study. This method was used to analyze plasma concentrations of ibrutinib and zanubrutinib in patients with mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, or diffuse large B-cell lymphoma. The selected patients were aged between 44 and 74 years.