bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for delayed recovery in postanesthesia care unit after surgery: a large and retrospective cohort study
Authors: Zhang Qingtong , Xu Feng , Xuan Dongsheng , Huang Li , Shi Min , Yue Zichuan , Luo Dongxue , Duan Manlin
Published: April 2023

Background:

Delayed recovery in the postanesthesia care unit (PACU) after surgery, as a severe occurrence, influences enhanced recovery after surgery. The data from the observational clinical study is a paucity.

Materials and Methods:

This large, retrospective, and observational cohort study initially included 44 767 patients. The primary outcome was risk factors for delayed recovery in PACU. A generalized linear model and nomogram were employed to identify risk factors. Discrimination and calibration were used to evaluate the performance of the nomogram via internal and external validation.

Results:

Of 38 796 patients, 21 302 (54.91%) were women. The delayed recovery aggregate rate was 1.38% [95% CI, (1.27, 1.50%)]. In a generalized linear model, risk factors for delayed recovery were old age [RR, 1.04, 95% CI, (1.03,1.05), P<0.001], neurosurgery [RR, 2.75, 95% CI, (1.60, 4.72), P<0.001], using antibiotics during surgery [RR, 1.30, 95% CI, (1.02, 1.66), P=0.036], long anesthesia duration [RR, 1.0025, 95% CI, (1.0013, 1.0038), P<0.001], ASA grade of III [RR, 1.98, 95% CI, (1.38, 2.83), P<0.001], and postoperative analgesia [RR, 1.41, 95% CI, (1.10, 1.80), P=0.006]. In the nomogram, old age and neurosurgery had high scores in the model and contributed significantly to the increased probability of delayed recovery. The area under the curve value of the nomogram was 0.77. The discrimination and calibration of the nomogram estimated by internal and external validation were generally satisfactory.

Conclusion:

This study demonstrates that delayed recovery in PACU after surgery was associated with old age, neurosurgery, long anesthesia duration, an ASA grade of III, using antibiotics during surgery, and postoperative analgesia. These findings provide predictors of delayed recovery in PACU, especially neurosurgeries and old age.
Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study
Authors: Hattori Yoshitsugu , Pai Betty C.-J. , Saito Takafumi , Chou Pang-Yun , Lu Ting-Chen , Chang Chun-Shin , Chen Yu-Ray , Lo Lun-Jou
Published: April 2023

Background:

Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature.

Patients and methods:

A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis.

Results:

A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient.

Conclusion:

Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.
Local excision as a viable alternative to hysterectomy for early-stage cervical cancer in women of reproductive age: a population-based cohort study
Authors: Chen Ying , Zheng Yongqiang , Wu Yaling , Dai Jun , Zhu Xiaoran , Wu Tong , Tang Weicheng , Yang Shuhao , Zhang Jinjin , Zhou Su , Wu Meng , Zhang Chun , Wang Shixuan
Published: April 2023

Background:

Local excision as the main alternative for fertility-sparing surgery (FSS) has been widely used in patients with early-stage cervical cancer to achieve fertility preservation, but its safety and practicability are still questioned. Therefore, The authors evaluated the current application of local excision in early-stage cervical cancer with this population-based study and compared its efficacy with hysterectomy.

Materials and methods:

Women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I cervical cancer at childbearing age (18–49 years) recorded in the Surveillance, Epidemiology and End Results (SEER) database from 2000 to 2017 were included. Overall survival (OS) and disease-specific survival (DSS) rates were compared between local excision and hysterectomy.

Results:

A total of 18 519 patients of reproductive age with cervical cancer were included, and 2268 deaths were observed. 17.0% of patients underwent FSS via local excision, and 70.1% underwent hysterectomy. Among patients younger than 39 years, OS and DSS of local excision were comparable to those of hysterectomy, whereas, in patients older than 40 years, OS and DSS of local excision were significantly worse than those of hysterectomy. In addition, OS and DSS of local excision were similar to hysterectomy in patients with stage IA cervical cancer, but OS and DSS were inferior to hysterectomy in patients with stage IB cervical cancer who underwent local excision.

Conclusion:

For patients without fertility requirements, hysterectomy remains the best therapeutic option. However, for patients under 40 years of age diagnosed with stage IA cervical cancer, FSS via local excision is a viable option that can achieve a well-balanced outcome between tumour control and fertility preservation.
How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners
Authors: van Dusseldorp Loes , Groot Marieke , van Vught Anneke , Goossens Peter , Hulshof Hugo , Peters Jeroen
Published: April 2023

Background:

Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP).

Purpose:

To explore what meaning people with SMI associate with the care provided by a PMHNP.

Methodology:

A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP).

Results:

Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia.

Conclusions:

The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance.

Implications:

For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.
Social and biologic determinants in lung transplant allocation
Authors: Calhoun Kara , Smith Joshua , Gray Alice L.
Published: April 2023

Lung transplant is a life-saving intervention for many with end-stage lung disease. As usable donor lungs are a limited resource and the risk of death on the waitlist is not uniform among candidates, organ allocation must consider many variables in order to be equitable. The lung allocation score (LAS) system, implemented in 2005, accounted for disease severity, risk of death without transplant, and 1-year survival estimates; however, recipient size, allosensitization, and blood type, biologic features that influence donor pool for a given recipient, do not impact allocation priority. Additionally, social determinants such as geography, socioeconomic status, race, and ethnicity can impact the likelihood of receiving a transplant. This has resulted in certain groups being transplanted at lower rates and at higher risk of dying on the waitlist. In order to address these disparities, lung organ allocation in the United States transitioned to a continuous distribution system using the composite allocation score (CAS) on 9 March 2023. In this article, we will review some of the data demonstrating the impact that biologic and social determinants have had on lung allocation in order to provide background as to why these have been incorporated into the CAS.
Clearing Up the Mystery of Food Allergies
Authors: Weston Eva , Myers Esther
Published: April 2023

With the increase in prevalence in food allergies and an increase in food allergy research, there is a corresponding increase in public confusion about the best way to identify and manage food allergies. Current descriptions are provided to clarify the various types of adverse food reactions, specifically what is classified as food allergy and the different types of food allergies. Understanding the type of food allergy can be crucial to making a formal medical diagnosis and providing high-quality nutrition care. Patients rely on healthcare teams' expertise to manage their food allergy and improve their quality of life. A summary of current evidence-based guidelines and roles of the multidisciplinary healthcare team set the stage for this series of articles on food allergies.
Doris Howes Calloway
Authors: King Janet C. , Yates Allison A. , Butte Nancy F. , Murphy Suzanne P. , Kretsch Molly J. , Blackburn Mary L.
Published: April 2023

During her career of over 40 years, Dr Doris Calloway held a variety of leadership/administrative positions while conducting groundbreaking research in human nutrition. In those positions, she illustrated the characteristics of dynamic, successful leaders. She led change in the nutritional sciences program at the University of California, Berkeley; she valued and prioritize personal development while prioritizing the development of others; and she practiced and encouraged strategic thinking, innovation, and action while being honest and ethical. Plus, she communicated effectively across cultures.
Low Energy Availability in Athletes
Authors: Kuikman Megan A. , Burke Louise M.
Published: April 2023

Relative Energy Deficiency in Sport (REDs) is a syndrome of impaired physiological function due to low energy availability (LEA) such that there is insufficient energy intake after subtracting the cost of energy expended through exercise. There are no universal criteria to identify an athlete with REDs. Rather, physiological outcomes and functional impairments that occur because of LEA are used for identification purposes. Once an athlete is identified with REDs, treatment should focus on addressing the underlying cause of LEA. This may include increasing energy intake and/or decreasing exercise energy expenditure as well as addressing factors that may exacerbate LEA. Much has been uncovered about the negative consequences of LEA. Early models were for women, whereas newer models include athletes of both sexes. More research is needed to increase the understanding of LEA so that the model of REDs and best practice guidelines to prevent, identify, and treat REDs will continue to evolve.
Renaming Grade Group 1 Prostate “Cancer” From a Pathology Perspective: A Call for Multidisciplinary Discussion
Authors: Paner Gladell P. , Zhou Ming , Simko Jeffry P. , Eggener Scott E. , van der Kwast Theodorus
Published: April 2023

Despite the innovations made to enhance smarter screening and conservative management for low-grade prostate cancer, overdiagnosis, and overtreatment remains a major health care problem. Driven by the primary goal of reducing harm to the patients, relabeling of nonlethal grade group 1 (GG 1) prostate cancer has been proposed but faced varying degrees of support and objection from clinicians and pathologists. GG 1 tumor exhibits histologic (invasive) and molecular features of cancer but paradoxically, if pure, is unable to metastasize, rarely extends out of the prostate, and if resected, has a cancer-specific survival approaching 100%. Most of the arguments against relabeling GG 1 relate to concerns of missing a higher-grade component through the unsampled area at biopsy. However, the designation of tumor benignity or malignancy should not be based on the shortcomings of a diagnostic procedure and sampling errors. This review explores possible solutions, mainly the feasibility of renaming GG 1 in radical prostatectomy (RP) with ramifications in biopsy diagnosis, acceptable for both pathologists and clinicians. One workable approach is to rename GG 1 in RP with a cautious neutral or nonbenign non-cancer term (eg, acinar neoplasm) using “defined criteria” that will stop the indiscriminate reporting of every GG 1 in biopsy as carcinoma including eventual insignificant microtumors in RPs. Use of a corresponding noncommittal term at biopsy while commenting on the possibility of an undersampled nonindolent cancer, might reduce the pathologist's concerns about upgrading. Dropping the word “carcinoma” in biopsy preempts the negative consequences of labeling the patient with cancer, including unnecessary definitive therapy (the root cause of overtreatment). Renaming should retain the status quo of contemporary grading and risk stratifications for management algorithms while trying to minimize overtreatment. However, the optimal approach to find answers to this issue is through multidisciplinary discussions of key stakeholders with a specific focus on patient-centered concerns and their ramifications in our practices. GG 1 renaming has been brought up in the past and came up again despite the continued counterarguments, and if not addressed more comprehensively will likely continue to reemerge as overdiagnosis, overtreatment, and patient’s sufferings persist.
Alar Crease Creation Suture in Nasal Reconstruction
Authors: Yen Cheng-I , Huang Chih-Jung , Chang Chun-Shin , Chen Hung-Chang , Yang Shih-Yi , Chang Shu-Yin , Yang Jui-Yung , Chuang Shiow-Shuh , Hsiao Yen-Chang
Published: April 2023

The crescentic alar groove serves as a topographic landmark that frames the ala and separates this convex structure from the surrounding cosmetic subunits. This aesthetic landmark can be attenuated or even obliterated during wound repair in this area. Flaps spanning the alar crease are often noticeably bulky with a pin-cushioned appearance in nasal reconstruction, and it is challenging to reproduce a natural-appearing alar groove. The authors proposed a novel technique with a modified, interrupted inverted horizontal mattress suture to create an alar groove. From March of 2016 to May of 2021, 22 consecutive patients with alar defects who underwent nasal reconstruction with the paramedian forehead flap were identified. All patients underwent the authors’ novel technique for the creation of the alar groove. The mean follow-up time was 3 years 7 months (range, 14 months to 5 years). A total of 32 alar crease creation suture operations were performed. All uneven wounds healed uneventfully within 2 weeks. Two cases of postoperative fading alar grooves required alar crease creation sutures to be redone. The authors’ novel alar crease creation suture is a safe, straightforward, and reliable technique to create an aesthetic alar groove in forehead flap nasal reconstruction. It can create a medially shallow and laterally deep alar crease without apparent complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship–Trained Women
Authors: Abdou Salma A. , Sharif-Askary Banafsheh , Sayyed Adaah A. , Charipova Karina , Song David H. , Fan Kenneth L. , Evans Karen K.
Published: April 2023

Background:

The “leaky pipeline” phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The purpose of this study was to evaluate the current representation of women in academic microsurgery and to determine the impact of mentorship on career progression.

Methods:

An electronic survey was designed to determine the availability and quality of mentorship respondents received at different stages of their career (from medical student to attending physician). The survey was distributed to women who completed a microsurgery fellowship and were current faculty at an academic plastic surgery program.

Results:

Twenty-seven of 48 survey recipients participated (56.3% response rate). Most held an associate professor (20.0%) or assistant professor (40.0%) position. Respondents had an average of 4.1 ± 2.3 mentors throughout their entire training. A minority of mentors were microsurgery trained (28.3%), and only 29.2% of respondents reported female mentorship throughout their training. Attending physicians least often received formative mentorship (52.0%). Fifty percent of respondents sought female mentors, citing that they desired female insight. Of those who did not seek female mentors, 72.7% cited a lack of access to female mentors.

Conclusions:

Evidenced by female trainees being unable to find female mentors and low rates of mentorship at the attending physician level, there is currently not enough capacity to meet the demand for female mentorship by women pursuing academic microsurgery. Many individual and structural barriers to quality mentorship and sponsorship exist within this field.
Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction
Authors: Andersen Emily S. , Chishom Taylor Ann , Rankin Jackson , Juan Hui Yu , Coots Lesley , Mountziaris Paschalia M.
Published: April 2023

Background

Infection following implant-based breast reconstruction can lead to devastating complications. Risk factors for infection include smoking, diabetes, and obesity. Intraoperative hypothermia may represent another modifiable risk factor. This study analyzed the effect of hypothermia in post-mastectomy immediate implant-based reconstruction on postoperative surgical site infection.

Methods:

This was a retrospective review of 122 patients with intraoperative hypothermia, defined as <C;35.5 °C, and 106 normothermic patients who underwent post-mastectomy implant-based reconstruction between 2015-2021. Demographics, comorbidities, smoking status, hypothermia (and its duration), and length of surgery were collected. The primary outcome was surgical site infection. Secondary outcomes included reoperation and delayed wound healing.

Results:

81% (185) of patients underwent staged reconstruction with tissue expander placement and 18.9% (43) had a direct to implant procedure. Over half (53%) of the patients experienced intraoperative hypothermia. In the hypothermic group, a higher proportion of patients had surgical site infections (34.4% versus 17% of normothermic patients, p < 0.05) and wound healing complications (27.9% versus 16%, p < 0.05). Intraoperative hypothermia predicted surgical site infection (OR 2.567, 95% CI: 1.367-4.818, p < 0.05) and delayed wound healing (OR 2.023, 95% CI: 1.053-3.884, p<0.05). Longer duration of hypothermia significantly correlated with surgical site infection, with an average 103 minutes versus 77 minutes (p < 0.05).

Conclusion:

This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative infection in post-mastectomy implant-based breast reconstruction. Maintaining strict normothermia during implant-based breast reconstruction procedures may improve patient outcomes by reducing the risk of postoperative infection and delayed wound healing.
Comparative Impact Analysis of Low-Deductible Insurance Versus In-house Hospital Assumption of Risk and Management on Medical Malpractice Claims
Authors: Vetrugno Giuseppe , Grassi Simone , Foti Federica , Siodambro Chiara , Grassi Vincenzo M. , Conte Celeste , Ghisellini Renato , De-Giorgio Fabio , Ausania Francesco , Cittadini Francesca , Rossi Riccardo , Morte Gabriele Della , Caputo Matteo , Pascali Vincenzo L. , Ozonoff Al , Oliva Antonio
Published: April 2023

Objectives

Claims management is critical to ensure the safe and high-quality medical care for which liability insurers and/or hospitals are responsible. The aim of this research is to determine whether increasing hospital malpractice risk exposure, with increasing deductibles, has an impact on malpractice claims and payouts.

Methods

The study was conducted at a single tertiary hospital, the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Payouts on closed reported and registered claims were analyzed during 4-study periods, which ranged from 1.5 million euro annual aggregate deductibles entirely managed by the insurance company to 5 million euro annual aggregate deductibles entirely managed by the hospital. We retrospectively analyzed 2034 medical malpractice claims submitted between January 1, 2007, and August 31, 2021. Four periods were examined depending on the claims management model adopted, ranging from total outsourcing to the insurer (period A) to an almost total hospital assumption of risk method (period D).

Results

We found that progressive hospital assumption of risk is associated with a decrease in the incidence of medical malpractice claims (average variation per year: −3.7%; P = 0.0029 if the 2 initial periods and the 2 last periods—characterized by the highest risk retention—are respectively aggregated and compared), an initial decrease in the mean claims cost followed by an increase that is still lower than the national increase (−5.4% on average), and an increase in the total claims cost (when compared with the period where the insurer solely managed claims). We also found that the rate of increase in payouts was less than the national average.

Conclusions

The assumption of more malpractice risk by the hospital was associated with the adoption of numerous patient safety and risk management initiatives. The decrease in claims incidence could be due to the implementation of patient safety policies, while the cost increase could be attributed to inflation and rising costs of healthcare services and claims. Notably, only the hospital assumption of risk model with a high-deductible insurance coverage is sustainable for the studied hospital, while also being profitable for the insurer. In conclusion, as hospitals progressively assumed more risk and management responsibility of malpractice claims, there was a progressive decrease in the total number of claims, and a less rapid rise in claim payouts as compared with the national average. Even a small assumption of risk appeared to elicit meaningful changes in claim filings and payouts.
Evaluation of the Diagnostic Efficacy of EC-Test for Latent Tuberculosis Infection in Ambulatory People Living with HIV
Authors: Chongxing Zhou , Yuanchun Li , Yan Huang , Dabin Liang , Zhezhe Cui , Liwen Huang , Huifang Qin , Jing Ye , Fengxue Long , Xiaoyan Liang , Lifan Zhang , Xiaoqing Liu , Yanlin Zhao , Mei Lin
Published: April 2023

Background:

Latent tuberculosis infection (LTBI) co-infected with human immunodeficiency virus (HIV) is more likely to develop into active tuberculosis (ATB), recombinant Mycobacterium tuberculosis fusion protein (ESAT6/CFP10, EC) Test is a latest developed method for LTBI. Compared with the interferon γ release test assays (IGRAs), the diagnostic performance of EC-Test to LTBI screening in HIV needs to be evaluated.

Methods:

A population-based multicenter prospective study was conducted in Guangxi Province, China. The baseline data was collected and LTBI were measured by QuantiFERON-TB Gold In-Tube (QFT-GIT), EC-Test and T-cell spot of the TB assay (T-SPOT.TB).

Results:

A total of 1478 patients were enrolled. when taking T-SPOT.TB as reference, the value of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and consistency that EC-Test to diagnosis LTBI in HIV is 40.42%, 97.98%, 85.26%, 85.04% and 85.06% respectively; when taking QFT-GIT as reference, the value is 36.00%, 92.57%, 55.10%, 85.09% and 81.13%, respectively. When the CD4+ <200 /μl, the accuracy of EC-Test to T-SPOT.TB and QFT-GIT were 87.12% and 88.89%, respectively; when the 200 ≤ CD4+ ≤ 500 /μl, the accuracy of EC-Test were 86.20% and 83.18%, respectively; when the CD4+ >500/μl, the accuracy of EC-Test were 84.29% and 77.94%, respectively. The incidence of adverse reactions in EC-Test is 34.23% and the serious adverse reactions is 1.15%.

Conclusion:

EC-Test has good consistency compared with IGRAs in detecting LTBI in HIV no matter in different immunosuppression status or different regions, and the safety of EC-Test is also well, suitable for LTBI screening in HIV in high prevalence settings.
FAPI PET Positivity in Fibrolamellar Hepatocellular Carcinoma
Authors: Suthar Ritesh Ramesh , Purandare Nilendu , Shah Sneha , Agrawal Archi , Puranik Ameya , Rangarajan Venkatesh
Published: April 2023

Fibrolamellar hepatocellular carcinoma (HCC) is a variant of HCC. It is a malignant tumor, but its imaging features often overlap focal nodular hyperplasia, which is a benign entity. FDG PET/CT is also not much help in these cases because both lesions do not concentrate FDG. We present one such case of fibrolamellar HCC with FAPI PET/CT positivity.
Characterizing Early-Onset Alzheimer Disease Using Multiprobe PET/MRI
Authors: Xu Xiaojun , Ruan Weiwei , Liu Fang , Liu Qingyao , Gai Yongkang , Su Ying , Liang Zhihou , Sun Xun , Lan Xiaoli
Published: April 2023

Purpose

Early-onset Alzheimer disease (EOAD) is rare, highly heterogeneous, and associated with poor prognosis. This AT(N) Framework–based study aimed to compare multiprobe PET/MRI findings between EOAD and late-onset Alzheimer disease (LOAD) patients and explore potential imaging biomarkers for characterizing EOAD.

Methods

Patients with AD who underwent PET/MRI in our PET center were retrospectively reviewed and grouped according to the age at disease onset: EOAD, younger than 60 years; and LOAD, 60 years or older. Clinical characteristics were recorded. All study patients had positive β-amyloid PET imaging; some patients also underwent 18F-FDG and 18F-florzolotau PET. Imaging of the EOAD and LOAD groups was compared using region-of-interest and voxel-based analysis. Correlation of onset age and regional SUV ratios were also evaluated.

Results

One hundred thirty-three patients were analyzed (75 EOAD and 58 LOAD patients). Sex (P = 0.515) and education (P = 0.412) did not significantly differ between groups. Mini-Mental State Examination score was significantly lower in the EOAD group (14.32 ± 6.74 vs 18.67 ± 7.20, P = 0.004). β-Amyloid deposition did not significantly differ between groups. Glucose metabolism in the frontal, parietal, precuneus, temporal, occipital lobe, and supramarginal and angular gyri was significantly lower in the EOAD group (n = 49) than in the LOAD group (n = 44). In voxel-based morphometry analysis, right posterior cingulate/precuneus atrophy was more obvious in the EOAD (P < 0.001), although no voxel survived family-wise error correction. Tau deposition in the precuneus, parietal lobe, and angular, supramarginal, and right middle frontal gyri was significantly higher in the EOAD group (n = 18) than in the LOAD group (n = 13).

Conclusions

Multiprobe PET/MRI showed that tau burden and neuronal damage are more severe in EOAD than in LOAD. Multiprobe PET/MRI may be useful to assess the pathologic characteristics of EOAD.
SPECT/CT Lymphoscintigraphy Accurately Localizes Clipped and Sentinel Nodes After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer
Authors: Dilege Ece , Celik Burak , Falay Okan , Boge Medine , Sucu Serkan , Toprak Safa , Agcaoglu Orhan , Kapucuoglu Nilgun , Demirkol Onur
Published: April 2023

Purpose

The aim of this study was to evaluate the impact of SPECT/CT lymphoscintigraphy on targeted axillary dissection (TAD) in node-positive breast cancer (BC) patients who had undergone neoadjuvant chemotherapy (NAC).

Methods

Sixty-two female BC patients with biopsy-confirmed axillary nodal metastases underwent NAC, followed by breast surgery with TAD. A metallic clip was placed in the sampled LN before NAC. On the day of surgery, a periareolar intradermal 99mTc-nanocolloid injection was administered, followed by SPECT/CT lymphoscintigraphy. The clipped nodes were localized on CT images, assessed for 99mTc uptake before surgery, and confirmed during the procedure.

Results

T1–4, N1–2 patients were enrolled in the study. All patients underwent sentinel lymph node (SLN) biopsy. The clipped node was the SLN in 54 (88.5%) patients. In 3 patients (4.9%), a clip was found in a nonsentinel lymph node. In 4 patients, the clips were not visible on SPECT/CT images, and lymph nodes were not found during the procedure. SPECT/CT correctly localized the clipped lymph node in all patients. The overall false-negative rate for TAD was 3.33%. The mean follow-up duration was 29 months, and there were no axillary recurrences.

Conclusions

SPECT/CT lymphoscintigraphy can accurately localize clipped nodes and SLNs after NAC in patients with node-positive BC.
The Role of the Advanced Practice Provider in a Subspecialty Practice
Authors: Paz Mary , Galdi Riya , Staller Kyle , Thurler Andrea , Vélez Christopher
Published: April 2023

The advanced practice provider collaborates with other clinicians and works to educate, advocate, and increase access for patients in the clinical setting. Research has shown that advanced practice providers working collaboratively with physicians yield improved quality of care and outcomes; however, the current level of understanding of this role in gastroenterology has not been explored in detail. Across two academic institutions, we conducted 16 semi-structured interviews to examine how the environment of the gastroenterology department aligns with the professional satisfaction of its advanced practice providers. Thematic saturation was achieved, revealing four themes: (1) productivity of the working relationship; (2) inconsistent understandings of the advanced practice provider role in clinical care; (3) mixed advanced practice provider experience relating to colleague support; and (4) autonomy impacts satisfaction. These themes highlight not only a reasonable degree of advanced practice provider satisfaction, but also the need to engage with colleagues regarding the advanced practice provider role in care to allow for better integration into the overall gastroenterology healthcare team. The results from different institutions suggest the need to interview gastroenterology advanced practice providers in different settings to better understand whether similar themes exist.
Variation in how cognitive control modulates sentence processing
Authors: Patra Abhijeet , Kirkwood Jeremy , Middleton Erica L. , Thothathiri Malathi
Published: April 2023

Prior research suggests that cognitive control can assist the comprehension of sentences that create conflict between interpretations, at least under some circumstances. However, the mixed pattern of results suggests that cognitive control may not always be necessary for accurate comprehension. We tested whether cognitive control recruitment for language processing is systematically variable, depending on the type of sentential ambiguity or conflict, individual differences in cognitive control, and task demands. Participants completed two sessions in a web-based experiment. The first session tested conflict modulation using interleaved Stroop and sentence comprehension trials. Critical sentences contained syntax-semantics or phrase-attachment conflict. In the second session, participants completed three cognitive control and three working memory tasks. Exploratory factor analysis was used to index individual differences in a cognitive control factor and a working memory factor. At the group level, there were no significant conflict modulation effects for either syntax-semantics or phrase-attachment conflict. At the individual differences level, the cognitive control factor correlated with offline comprehension accuracy but not online processing measures for both types of conflict. Together, the results suggest that the role of cognitive control in sentence processing may vary according to task demands. When overt decisions are required, individual differences in cognitive control may matter such that better cognitive control results in better language comprehension performance. The results add to the mixed evidence on conflict modulation and raise questions about the situations under which cognitive control influences online processing.
Feeding without teeth: the material properties of rhamphothecae from two species of durophagous sea turtles
Authors: Ingle Danielle N. , Perez Eliza , Porter Marianne E. , Marshall Christopher D.
Published: April 2023

The feeding apparatus of sea turtles comprises cornified keratinous rhamphothecae overlaying a bony rostrum. Although keratin is less stiff than the enamel of toothed animals, certain species of sea turtles are capable of withstanding large forces when feeding on hard prey. We aimed to quantify the mineral density, water content and compressive mechanical properties of rhamphothecae from two durophagous species: loggerhead (Caretta caretta) and Kemp's ridley (Lepidochelys kempii) sea turtles. Since loggerheads theoretically produce the greater bite forces of these two species, we predicted that keratin from their rhamphothecae would have a greater mineral density and be stiffer, stronger and tougher compared with Kemp's ridley sea turtles. We found that total water weight of hydrated specimens (20%) was consistent between species. Rhamphotheca mineral density ranged between 0 and 0.069 g cm−3; loggerheads had significantly greater mineral density compared with Kemp's ridleys, for which several specimens had no mineral detected. Despite the greater mineral density in loggerheads, we found no significant difference in Young's modulus, yield strength or toughness between these species. In addition to mineral density, our findings suggest that other material components, such as sulfur, may be influencing the material properties of keratin from sea turtle rhamphothecae.
Escaping ESKAPE resistance:
in vitro
and
in silico
studies of multifunctional carbamimidoyl-tethered indoles against antibiotic-resistant bacteria
Authors: Gulia Kanika , Hassan Ahmed H. E. , Lenhard Justin R. , Farahat Abdelbasset A.
Published: April 2023

Combining the hybridization and repurposing strategies, six compounds from our in-house library and having a designed hybrid structure of MBX-1162, pentamidine and MMV688271 were repurposed as potential antibacterial agents. Among, compounds
1a
and
1d
elicited potential sub-µg ml
−1
activity against the high-priority antibiotic-resistant Gram-positive members of ESKAPE bacteria as well as antibiotic-susceptible Gram-positive bacteria. Furthermore, they showed potential low µg ml
−1
activity against the explored critical-priority antibiotic-resistant Gram-negative members of ESKAPE bacteria. In time–kill assay, compound
1a
has effective 0.5 and 0.25 µg ml
−1
antibacterial lethal concentrations against MRSA in exponential growth phase.
In silico
investigations predicted compounds
1a
and
1d
as inhibitors of the open conformation of undecaprenyl diphosphate synthase involved in bacterial isoprenoid synthesis. In addition, compounds
1a
and
1d
were predicted as inhibitors of NADPH-free but not NADPH-bound form of ketol-acid reductoisomerase and may also serve as potential B-DNA minor groove binders with possible differences in the molecular sequence recognition. Overall, compounds
1a
and
1d
are presented as multifunctional potential antibacterial agents for further development against high- and critical-priority Gram-positive and Gram-negative antibiotic-resistant ESKAPE bacterial pathogens as well as antibiotic-susceptible Gram-positive bacterial pathogens.
Ready to detect a reversal of time's arrow: a psychophysical study using short video clips in daily scenes
Authors: Hanyu Nao , Watanabe Kei , Kitazawa Shigeru
Published: April 2023

It is generally believed that time flows in one direction and that a reversal of time's arrow would render the external world non-sensical. We evaluated our ability to tell the direction of time's arrow in a wide range of dynamic scenes in our daily life by presenting 360 video clips in the correct or incorrect direction. Participants, who judged the direction in a speeded manner, erred in 39% of trials when a video was played in reverse, but in only 9% when it was played normally. Due to the bias favouring the ‘forward’ judgement, the reaction was generally faster for the forward response. However, the reaction became paradoxically faster and more synchronous for the detection of reversal in some critical occasions such as forward motion, free fall, diffusion, division and addition of materials by hand. Another experiment with a fraction of the video clips revealed that reversal replay of these videos provided instantaneous evidence strong enough to overtake the forward judgement bias. We suggest that our brain is equipped with a system that predicts how the external organisms behave or move in these critical occasions and that the prediction error of the system contributes to the fast ‘reversal’ detection.
Chryseobacterium oryctis sp. nov., isolated from the gut of the beetle Oryctes rhinoceros, and Chryseobacterium kimseyorum sp. nov., isolated from a stick insect rearing cage
Authors: Shelomi Matan , Han Chiao-Jung , Chen Wen-Ming , Chen Hsin-Kuang , Liaw Shwu-Jen , Mühle Estelle , Clermont Dominique
Published: April 2023

Two strains of

Chryseobacterium

identified from different experiments are proposed to represent new species. Strain WLa1L2M3T was isolated from the digestive tract of an Oryctes rhinoceros beetle larva. Strain 09-1422T was isolated from a cage housing the stick insect Eurycantha calcarata. Sequence analysis of the 16S rRNA and rpoB genes found both strains to be similar but not identical to other

Chryseobacterium

species. Whole-genome sequencing suggested the isolates represent new species, with average nucleotide identity values ranging from 74.6 to 80.5 %. Genome-to-genome distance calculations produced values below 25.3 %, and digital DNA–DNA hybridization values were 13.7–29.9 %, all suggesting they are distinct species. The genomic DNA G+C content of WLa1L2M3T is approximately 32.53 %, and of 09-1422T is approximately 35.89 %. The predominant cellular fatty acids of strain WLa1L2M3T are C15 : 0 iso, summed feature 9 (C16 : 0 10OH or C17 : 1 iso ω6c), C17 : 0 iso 3OH, summed feature 3 (C16 : 1 ω7c and/or C16 : 1 ω6c), C15 : 0 iso 3OH, C15 : 0 anteiso and C13 : 0 iso, and those of strain 09-1422T are C15 : 0 iso, summed feature 3 (C16 : 1 ω7c and/or C16 : 1 ω6c), C17 : 0 iso 3OH, C15 : 0 anteiso, C15 : 0 iso 3OH, C16 : 1 ω7c, C17 : 0 2OH and C18 : 0. In addition, physiological and biochemical tests revealed phenotypic differences from related

Chryseobacterium

type strains. These cumulative data indicate that the two strains represent novel species of the genus

Chryseobacterium

for which the names Chryseobacterium oryctis sp. nov. and Chryseobacterium kimseyorum sp. nov. are proposed with WLa1L2M3T (=BCRC 81350T=JCM 35215T=CIP 112035T) and 09-1422T (=UCDFST 09-1422T=BCRC 81359T=CIP 112165T), as type strains, respectively.
Predicting Distant Recurrences in Invasive Breast Carcinoma Patients Using Clinicopathological Data: A cross-institutional and AI-based study
Authors: Sukhadia Shrey S. , Muller Kristen E. , Workman Adrienne A. , Nagaraj Shivashankar H.
Published: April 2023

Breast cancer ranks second in the most common cancer in women worldwide with 30% of cases resulting into recurrence of the disease at distant organs post the treatment. While clinicians have utilized several clinicopathological measurements for prediction of distant recurrences in invasive breast carcinoma (IBC), none of those studies have showcased the potential of combining clinicopathological evaluations of IBC tumors pre and post therapies using machine learning (ML) or artificially intelligent (AI) models to predict the distant recurrence of the disease in respective patients. The goal of our study was to determine whether classification-based ML/AI techniques can predict distant recurrences in IBC patients using key clinicopathological measurements that includes pathological staging of tumor and surrounding lymph nodes deemed both pre- and post-neoadjuvant therapy, imaging-based therapy responses, and the status of adjuvant therapy administered to patients. We trained and tested clinicopathological ML/AI model using dataset from Duke University and validated it using external dataset from Dartmouth Hitchcock Medical Center (DHMC). Random Forest (RF) model performed best compared to C-Support Vector Classifier (SVC) and Multi-Layer Perceptron (MLP) yielding AUC ranging 0.75-1.0 (p<0.002) across both the institutions, thereby demonstrating the cross-institutional portability and validity of ML/AI models in the field of clinical research in cancer.
Does the syrinx, a peripheral structure, constrain effects of sex steroids on behavioral sex reversal in adult canaries?
Authors: dos Santos Ednei B. , Logue David M. , Ball Gregory F. , Cornil Charlotte A. , Balthazart Jacques
Published: April 2023

We previously confirmed that effects of testosterone (T) on singing activity and on the volume of brain song control nuclei are sexually differentiated in adult canaries: females are limited in their ability to respond to T as males do. Here we expand on these results by focusing on sex differences in the production and performance of trills, i.e., rapid repetitions of song elements. We analyzed more than 42,000 trills recorded over a period of 6 weeks from 3 groups of castrated males and 3 groups of photoregressed females that received Silastic™ implants filled with T, T plus estradiol or left empty as control. Effects of T on the number of trills, trill duration and percent of time spent trilling were all stronger in males than females. Irrespective of endocrine treatment, trill performance assessed by vocal deviations from the trill rate versus trill bandwidth trade-off was also higher in males than in females. Finally, inter-individual differences in syrinx mass were positively correlated with trill production in males but not in females. Given that T increases syrinx mass and syrinx fiber diameter in males but not in females, these data indicate that sex differences in trilling behavior are related to sex differences in syrinx mass and syrinx muscle fiber diameter that cannot be fully reversed by sex steroids in adulthood. Sexual differentiation of behavior thus reflects organization not only of the brain but also of peripheral structures.
Polychromatic neutron phase-contrast imaging of weakly absorbing samples enabled by phase retrieval
Authors: Østergaard Maja , Naver Estrid Buhl , Kaestner Anders , Willendrup Peter K. , Brüel Annemarie , Sørensen Henning Osholm , Thomsen Jesper Skovhus , Schmidt Søren , Poulsen Henning Friis , Theil Kuhn Luise , Birkedal Henrik
Published: April 2023

The use of a phase-retrieval technique for propagation-based phase-contrast neutron imaging with a polychromatic beam is demonstrated. This enables imaging of samples with low absorption contrast and/or improving the signal-to-noise ratio to facilitate e.g. time-resolved measurements. A metal sample, designed to be close to a phase pure object, and a bone sample with canals partially filled with D2O were used for demonstrating the technique. These samples were imaged with a polychromatic neutron beam followed by phase retrieval. For both samples the signal-to-noise ratios were significantly improved and, in the case of the bone sample, the phase retrieval allowed for separation of bone and D2O, which is important for example for in situ flow experiments. The use of deuteration contrast avoids the use of chemical contrast enhancement and makes neutron imaging an interesting complementary method to X-ray imaging of bone.
Resilient and sustainable supply chain criteria for performance evaluation: selection and ranking through fuzzy Delphi
Authors: Torres Vergara Javier Isaac , Saucedo Martínez Jania Astrid , Olivo Lucio Daniela
Published: April 2023

Purpose

In the supply chain performance measurement (SCPM) there seems to be no consensus about measures for performance evaluation and suitable criteria from resilience and sustainability paradigms. In this way, this research aims to identify the attributes that a supply chain (SC) should follow to be resilient and sustainable, and then to evaluate their importance according to industry experts.

Design/methodology/approach

This study suggests a hybrid approach. The authors identified the most commonly used criteria using literature review, and then applied fuzzy Delphi technique (FDT) with the objective of surveying experts to find the attributes used in practice and asked to assess their relevance.

Findings

The resilient-sustainable supply chain (RSSC) is formed by four dimensions: resiliency, economic, environmental and social. A total of 15 criteria are identified, and the most important are visibility, flexibility, supply chain risk management (SCRM) culture, work conditions and communication.

Research limitations/implications

This study used a literature review, so it is subject to a time frame, and the criteria could no longer be relevant as the time and business conditions change. Also, the findings may not be completely applicable throughout different industries, and therefore the finding cannot be replicated to other businesses.

Practical implications

This study will assist decision-makers among other interested parties to construct and/or strengthen an integrated SC that mixes resiliency and sustainability.

Originality/value

This study contributes to the state-of-art by producing a characterization of the resilient and sustainable supply chain for the automotive industry. Also, this research produces a new and holistic framework for resilient and sustainable SCPM supporting the decision-making process.