bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacts of economic factors influencing net returns of beef feedlot heifers administered two implant programs and fed for differing days-on-feed from pooled randomized controlled trials
Authors: Horton Lucas M , Depenbusch Brandon E , Schroeder Ted C , Pendell Dustin L , Streeter Marshall N , Hutcheson John P , Renter David G
Published: February 2024

The objective of this research was to evaluate the effects of two implant programs and differing days-on-feed (DOF) on net returns of beef feedlot heifers using sensitivity analyses of key economic factors. Crossbred beef heifers [n = 10,583; initial weight 315 kg (± 20.1 SD)] were enrolled across three trials (one Kansas, two Texas feedlot trials). Heifers were blocked by arrival and randomly allocated to one of six pens, resulting in a total of 144 pens and 24 blocks. Pen was randomly assigned to treatment as a 2 × 3 factorial. Implant programs were: IH + 200—Revalor-IH at initial processing, and a terminal implant after approximately 90 DOF (Revalor-200), or, XH—a single implant at initial processing (Revalor-XH). The DOF treatments were: heifers fed to a standard baseline endpoint (BASE) or heifers fed for an additional + 21 or + 42 d beyond BASE. Pen-level partial budgets were used for economic sensitivity analyses, which varied price points of single pricing components with all other components fixed. Variable components were live-fed cattle prices, base carcass prices (i.e., dressed), Choice-Select spread (CS-spread), and feed and yardage prices (FYP). For each, a Low, Mid-Low, Middle, Mid-High, and High price was chosen. Linear mixed models were fit for statistical analyses (α = 0.05). There were no significant two-way interactions (P-values ≥ 0.14). Regardless of the variable component evaluated, XH heifers had poorer net returns than IH + 200 at all prices (P ≤ 0.04). Selling live, the + 21 and (or) + 42 heifers had lower net returns than BASE at every fed cattle price point (P < 0.01). Selling dressed, the + 21 and (or) + 42 heifers had lower returns than BASE at Low, Mid-Low, and Middle fed cattle base prices (P < 0.01); there were no significant DOF differences at Mid-High, or High prices (P ≥ 0.24). Net returns were lower for + 42 than BASE at all CS-spreads (P ≤ 0.03), while BASE and + 21 did not differ significantly. Longer DOF had lower net returns than BASE when selling live at every FYP (P < 0.01) except at the Low price (P = 0.14). Selling dressed, there was no significant effect of DOF at Low or Mid-Low FYP (P ≥ 0.11); conversely, extended DOF had lower net returns than BASE at Middle, Mid-High, and High FYP (P < 0.01). Overall, there was minimal economic evidence to support extending feedlot heifer DOF beyond the BASE endpoint, and when feeding longer, larger reductions in return were observed when marketing live as opposed to dressed.
Parenteral nutrition-associated liver injury: clinical relevance and mechanistic insights
Authors: Mihajlovic Milos , Rosseel Zenzi , De Waele Elisabeth , Vinken Mathieu
Published: February 2024

Intestinal failure-associated liver disease (IFALD) is a relatively common complication in individuals receiving parenteral nutrition (PN). IFALD can be manifested as different types of liver injury, including steatosis, cholestasis, and fibrosis, and could result in liver failure in some cases. The onset and progression of IFALD are highly dependent on various patient and PN-related risk factors. Despite still being under investigation, several mechanisms have been proposed. Liver injury can originate due to caloric overload, nutrient deficiency, and toxicity, as well as phytosterol content, and omega-6 to omega-3 fatty acids ratio contained in lipid emulsions. Additional mechanisms include immature or defective bile acid metabolism, acute heart failure, infections, and sepsis exerting negative effects via Toll-like receptor 4 and nuclear factor κB inflammatory signaling. Furthermore, lack of enteral feeding, gut dysbiosis, and altered enterohepatic circulation that affect the farnesoid x receptor-fibroblast growth factor 19 axis can also contribute to IFALD. Various best practices can be adopted to minimize the risk of developing IFALD, such as prevention and management of central line infections and sepsis, preservation of intestine’s length, a switch to oral and enteral feeding, cyclic PN, avoidance of overfeeding and soybean oil-based lipid formulations, and avoiding hepatotoxic substances. The present review thus provides a comprehensive overview of all relevant aspects inherent to IFALD. Further research focused on clinical observations, translational models, and advanced toxicological knowledge frameworks is needed to gain more insight into the molecular pathogenesis of hepatotoxicity, reduce IFALD incidence, and encourage the safe use of PN.
Comparing Methods for Detection and Quantification of Plasmodesmal Callose in Nicotiana benthamiana Leaves During Defense Responses
Authors: Sankoh Amie F. , Adjei Joseph , Roberts Daniel M. , Burch-Smith Tessa M.
Published: February 2024

Callose, a β-(1,3)-d-glucan polymer, is essential for regulating intercellular trafficking via plasmodesmata (PD). Pathogens manipulate PD-localized proteins to enable intercellular trafficking by removing callose at PD or, conversely, by increasing callose accumulation at PD to limit intercellular trafficking during infection. Plant defense hormones like salicylic acid regulate PD-localized proteins to control PD and intercellular trafficking during immune defense responses such as systemic acquired resistance. Measuring callose deposition at PD in plants has therefore emerged as a popular parameter for assessing likely intercellular trafficking activity during plant immunity. Despite the popularity of this metric, there is no standard for how these measurements should be made. In this study, three commonly used methods for identifying and quantifying plasmodesmal callose by aniline blue staining were evaluated to determine the most effective in the Nicotiana benthamiana leaf model. The results reveal that the most reliable method used aniline blue staining and fluorescence microscopy to measure callose deposition in fixed tissue. Manual or semiautomated workflows for image analysis were also compared and found to produce similar results, although the semiautomated workflow produced a wider distribution of data points.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
A Colletotrichum tabacum Effector Cte1 Targets and Stabilizes NbCPR1 to Suppress Plant Immunity
Authors: Xue Yuan , Pan Shouhui , Zhang Quan , Dai Fei , Zhang Junxiang
Published: February 2024

Colletotrichum tabacum, causing anthracnose in tobacco, is a notorious plant pathogen threatening tobacco production globally. The underlying mechanisms of C. tabacum effectors that interfere with plant defense are not well known. Here, we identified a novel effector, Cte1, from C. tabacum, and its expression was upregulated in the biotrophic stage. We found that Cte1 depresses plant cell death initiated by BAX and inhibits reactive oxygen species (ROS) bursts triggered by flg22 and chitin in Nicotiana benthamiana. The CTE1 knockout mutants decrease the virulence of C. tabacum to N. benthamiana, and the Cte1 transgenic N. benthamiana increase susceptibility to C. tabacum, verifying that Cte1 is involved in the pathogenicity of C. tabacum. We demonstrated that Cte1 interacted with NbCPR1, a Constitutive expresser of Plant Resistance (CPR) protein in plants. Silencing of NbCPR1 expression attenuated the infection of C. tabacum, indicating that NbCPR1 negatively regulates plant immune responses. Cte1 stabilizes NbCPR1 in N. benthamiana. Our study shows that Cte1 suppresses plant immunity to facilitate C. tabacum infection by intervening in the native function of NbCPR1.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2024.
Phytophthora nicotianae: A Quick Diagnostic Guide for Black Shank of Tobacco
Authors: Cochran Sarah , Quesada-Ocampo Lina M. , Kerns James P. , Thiessen Lindsey D.
Published: February 2024

Phytophthora nicotianae is an oomycete pathogen that causes black shank of tobacco and is a major threat to tobacco production worldwide. P. nicotianae has been reported on 255 plant genera. Tobacco roots and crowns are the primary areas for disease symptoms, but lower canopy leaf lesions can arise following initial infection. P. nicotianae can be isolated with semiselective media from symptomatic tissue, contaminated water, and soil samples. The objective of this diagnostic guide is to provide a collection of current descriptions and methods for the symptomology, isolation, storage, and identification of P. nicotianae.
Plant-Derived, Nodule-Specific Cysteine-Rich Peptides as a Novel Source of Biopesticides for Controlling Citrus Greening Disease
Authors: Higgins Steven A. , Igwe David O. , Coradetti Samuel , Ramsey John S. , DeBlasio Stacy L. , Pitino Marco , Shatters Robert G. , Niedz Randall , Fleites Laura A. , Heck Michelle
Published: February 2024

Nodule-specific cysteine-rich (NCR) peptides, encoded in the genome of the Mediterranean legume Medicago truncatula (barrelclover), are known to regulate plant−microbe interactions. A subset of computationally derived 20-mer peptide fragments from 182 NCR peptides was synthesized to identify those with activity against the unculturable vascular pathogen associated with citrus greening disease, ‘ Candidatus Liberibacter asiaticus’ ( CLas). Grounded in a design of experiments framework, we evaluated the peptides in a screening pipeline involving three distinct assays: a bacterial culture assay with Liberibacter crescens, a CLas-infected excised citrus leaf assay, and an assay to evaluate effects on bacterial acquisition by the nymphal stage of hemipteran vector Diaphorina citri. A subset of the 20-mer NCR peptide fragments inhibits both CLas growth in citrus leaves and CLas acquisition by D. citri. Two peptides induced higher levels of D. citri mortality. These findings reveal 20-mer NCR peptides as a new class of plant-derived biopesticide molecules to control citrus greening disease.
Practices of Patient Relatives Aimed at Preventing Pressure Injuries and Their Experiences of Coping with the Burden of Care: A Qualitative Study
Authors: Ulutaşdemir Nilgün , Ay Halil , Göçmen Adalet , Uzun Sevda , Kulakaç Nurşen
Published: February 2024

OBJECTIVE

To determine the practices and coping experiences of the relatives of patients with pressure injuries (PIs).

METHODS

The authors used a qualitative, phenomenologic research design. They interviewed 20 relatives of patients with PIs face-to-face using an in-depth semistructured interview form. The data were analyzed using the Colaizzi phenomenologic method.

RESULTS

Three categories, 8 main themes, and 22 subthemes emerged from the interviews. The category of “the impact of the need for care on the lives of the patient’s relatives” was analyzed according to psychological, social, and physical effects. In the category of “practices to prevent pressure injuries,” two themes emerged: practices toward the patient and the environment. Relatives of individuals with PIs have psychological, physical, and social needs.

CONCLUSIONS

Providing care to a patient with PIs has psychological, social, and physical effects on the patient’s relatives. The care burden mostly affects these caregivers negatively, and they mainly need time for themselves and moral and companion support.
Conservative versus surgical treatment of Gartland type II supracondylar humeral fractures in children
Authors: Zhu Danjiang , Wen Yuwei , Wang Qiang , Son Baojian , Feng Wei
Published: February 2024

The purpose of the study was to compare the efficacy of conservative and surgical treatments for Gartland type II supracondylar humerus fractures in children. We assessed 142 patients with type II supracondylar humerus fractures treated in our hospital from February 2018 to February 2019. The patients were divided into two groups: initial conservative treatment (Group A) and initial surgical treatment (Group B). Clinical outcomes were measured by the Flynn scoring system. Variables were analyzed using a statistical approach between those groups. All patients were followed up for 6–12 months. The rate of loss reduction was 19.8% in patients treated conservatively, and the incidence of pin infections was 7.1% in patients treated surgically. Although there were no statistical differences between the three groups in fracture healing time and Flynn score, the conservative treatment was superior to surgical treatment in functional recovery times. At the last follow-up, all fractures had healed without iatrogenic vascular or nerve injury, Volkmann’s contracture, or cubit varus deformity. Conservative treatment is safe and effective for the treatment of Gartland type II supracondylar fracture and represents a faster recovery time of elbow range of motion as compared with surgical treatment. Type IIB had a 41.3% risk of secondary displacement versus 5.3% for IIA, but we still prefer closed reduction. However, closed reduction of Garland type II must be followed accurately in the first 2 weeks to identify patients with loss of reduction. The patients who loss reduction can be treated with percutaneous pinning, and the clinical effect was consistent with immediate surgical treatment. Level of evidence: level III.
Evaluation of posterior tibial slope relationship with common knee pathologies in pediatric and adolescent age groups in the Turkish population
Authors: Yaka Haluk , Bilge Onur , Kekeç Ahmet Fevzi , Demiryürek Mehmet , Doral Mahmut Nedim
Published: February 2024

Anterior cruciate ligament rupture (ACLR), tibial eminence fracture (TEF), and Osgood-Schlatter disease (OSD) have been linked to a steep posterior tibial slope (PTS) in children and adolescents. This study aims to examine and compare these associations. 418 patients aged 8–18, 237 males and 181 females with knee pain between 2010 and 2019 were included and the patients belonged to the Turkish population. They consisted of ACLR (n = 47), TEF (n = 22), OSD (n = 51), and a control group (n = 298). The study and control groups were compared for PTS, sex, and age, with ACLR, TEF, OSD, retrospectively. The ACLR, OSD, and TEF groups had higher PTS values than the control group (P < 0.001). There was no significant difference in ACLR-OSD, ACLR-TEF, and OSD-TEF comparisons (P = 0.22, P = 0.99, and P = 0.99, respectively). PTS increase was linked to ACLR, TEF, and OSD in the multinomial regression analysis, (P < 0.001). Increase in PTS was associated with ACLR, TEF, and OSD for both males and females (independently of other factors; ACLR: P < 0.001, P < 0.001, OR: 1.59, OR: 2.63, TEF: P = 0.001, P < 0.001, OR: 1.98, OR: 1.44; OSD: P = 0.001, P < 0.001, OR: 1.49, OR: 1.28 for males and females respectively). ACLR, TEF, and OSD are associated with increased PTS in the pediatric and adolescent age groups, and there are differences between these pathologies in terms of the amount of PTS increase, age, and sex. Consideration of age and gender in pediatric and adolescent patients with increased PTS may be useful in predicting pathologies associated with increased PTS. Level of evidence: III retrospective comparative study.
Complication Rates Following Adult Spinal Deformity Surgery
Authors: Lafage Renaud , Bass R. Daniel , Klineberg Eric , Smith Justin S. , Bess Shay , Shaffrey Christopher , Burton Douglas C. , Kim Han Jo , Eastlack Robert , Mundis Gregory , Ames Christopher P. , Passias Peter G. , Gupta Munish , Hostin Richard , Hamilton Kojo , Schwab Frank , Lafage Virginie ,   on behalf of the International Spine Study Group
Published: February 2024

Objective.

Provide benchmarks for the rates of complications by type and timing.

Study Design.

Prospective multicenter database.

Background.

Complication rates following adult spinal deformity (ASD) surgery have been previously reported. However, the interplay between timing and complication type warrants further analysis.

Methods.

The data for this study were sourced from a prospective, multicenter ASD database. The date and type of complication were collected and classified into three severity groups (minor, major, and major leading to reoperation). Only complications occurring before the two-year visit were retained for analysis.

Results.

Of the 1260 patients eligible for two-year follow-up, 997 (79.1%) achieved two-year follow-up. The overall complication rate was 67.4% (N=672). 247 patients (24.8%) experienced at least one complication on the day of surgery (including intraoperatively), 359 (36.0%) between postoperative day 1 and six weeks postoperatively, 271 (27.2%) between six weeks and one-year postoperatively, and finally 162 (16.3%) between one year and two years postoperatively. Using Kaplan-Meier survival analysis, the rate of remaining complication-free was estimated at different time points for different severities and types of complications. Stratification by type of complication demonstrated that most of the medical complications occurred within the first 60 days. Surgical complications presented over two distinct timeframes. Operative complications, incision-related complications, and infections occurred early (within 60 d), while implant-related and radiographic complications occurred at a constant rate over the two-year follow-up period. Neurological complications had the highest occurrence within the first 60 days but continued to increase up to the two-year visit.

Conclusion.

Only one-third of ASD patients remained complication-free by two years, and 2 of 10 patients had a complication requiring a reoperation or revision. An estimation of the timing and type of complications associated with surgical treatment may prove useful for more meaningful patient counseling and aid in assessing the cost-effectiveness of treatment.

Level of Evidence.

3.
Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review
Authors: Gorsky Kevin , Cuninghame Sean , Jayaraj Kesikan , Slessarev Marat , Francoeur Conall , Withington Davinia E. , Chen Jennifer , Cuthbertson Brian H. , Martin Claudio , Chapman Martin , Ganesan Saptharishi Lalgudi , McKinnon Nicole , Jerath Angela ,   on behalf of the SAVE-ICU Study Investigators
Published: February 2024

OBJECTIVES:

Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients.

DATA SOURCES:

MEDLINE, Cochrane Central Register of Controlled Trials, and Embase.

STUDY SELECTION:

Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021.

DATA EXTRACTION:

Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials.

DATA SYNTHESIS:

Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol.

CONCLUSIONS:

Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed.
Superior Pedicle Inverted T-reduction Mammaplasty with Short Horizontal Scar
Authors: Arbeláez Sergio , Arbeláez Sergio A. , Eslait Rosa C. , Lacouture Carlos J.
Published: February 2024

Background:

Superior pedicle breast reduction is a very popular technique among plastic surgeons. This technique has had many variations looking for fewer complications and better long-lasting results. The aim of this article is to present a novel technique of breast reduction, making variations in the design of the periareolar incision, using a superior pedicle with a constant vertical incision of 5 cm and a shortened horizontal incision.

Methods:

The superior pedicle inverted T-mammoplasty with a shortened horizontal scar technique was performed in 1200 patients who underwent surgery between 2010 and 2023; follow-up examination was carried out for an average of 1 year (3 months to 3 years). A patient satisfaction survey was conducted.

Results:

Patient satisfaction rate was 99%. There were no cases of total necrosis of the areola–nipple complex, 2.7% of the patients presented partial necrosis of the areola–nipple complex, 1.4% of the patients presented local infection, 1.7% presented dehiscence at some point of the vertical or horizontal suture, 4% of the patients presented a widened scar, 8% of the patients presented alteration in the sensibility of the areola–nipple complex, and 0.6% of the patients presented hematoma. With this technique, a rise of the areola–nipple complex of up to 22cm was achieved.

Conclusions:

The superior pedicle inverted T-mammaplasty with shortened horizontal scar technique showed a lower number of surgical complications compared with other techniques previously used for breast reduction, even when applied in gigantomasty. It provides lasting results and a high rate of patient satisfaction.
Sleep-disordered breathing in heart failure
Authors: Jackson Gregory R. , Durland Justin , Hoyland Frank
Published: February 2024

Purpose of review

This review addresses the evolving intersection of sleep-disordered breathing (SDB) and heart failure, a topic of increasing clinical significance due to the high prevalence of SDB in heart failure patients and its impact on morbidity and mortality. It reflects recent advancements in diagnostic methodologies and therapeutic strategies. It emphasizes the need for heightened awareness among healthcare providers about the complex relationship between SDB and various forms of heart failure.

Recent findings

Recent studies underscore the high incidence of SDB in heart failure patients, varying with the cause of heart failure. Emerging diagnostic tools, including home sleep tests and advanced inpatient screening methods, have improved the early detection and accurate diagnosis of SDB. Novel treatment modalities, like hypoglossal and phrenic nerve stimulation, are promising, especially where conventional therapies are inadequate. The review also discusses the complexities of managing SDB in the context of different heart failure subtypes.

Findings from recent literature suggest that improved screening, diagnosis, and innovative treatment of SDB in heart failure patients can reduce morbidity, mortality, and healthcare costs. This review emphasizes the need for personalized treatment approaches tailored to individual patient profiles, highlighting the potential of new technologies and multidisciplinary strategies in clinical practice.
Oleic acid-PPARγ-FABP4 loop fuels cholangiocarcinoma colonization in lymph node metastases microenvironment
Authors: Zhang Honghua , Zhu Ke , Zhang Rui , Guo Yabin , Wang Jin , Liu Chaoqun , Lu Xinjun , Zhou Ziyu , Wu Wenrui , Zhang Fapeng , Song Zhixiao , Lin Shusheng , Yang Caini , Li Xiuxian , Liu Yang , Tang Qibin , Yu Xianhuan , Xu Leibo , Liu Chao
Published: February 2024

Background and Aims:

Lymph node metastasis is a significant risk factor for patients with cholangiocarcinoma, but the mechanisms underlying cholangiocarcinoma colonization in the lymph node microenvironment remain unclear. We aimed to determine whether metabolic reprogramming fueled the adaptation and remodeling of cholangiocarcinoma cells to the lymph node microenvironment.

Approach and Results:

Here, we applied single-cell RNA sequencing of primary tumor lesions and paired lymph node metastases from patients with cholangiocarcinoma and revealed significantly reduced intertumor heterogeneity and syntropic lipid metabolic reprogramming of cholangiocarcinoma after metastasis to lymph nodes, which was verified by pan-cancer single-cell RNA sequencing analysis, highlighting the essential role of lipid metabolism in tumor colonization in lymph nodes. Metabolomics and in vivo CRISPR/Cas9 screening identified PPARγ as a crucial regulator in fueling cholangiocarcinoma colonization in lymph nodes through the oleic acid-PPARγ-fatty acid–binding protein 4 positive feedback loop by upregulating fatty acid uptake and oxidation. Patient-derived organoids and animal models have demonstrated that blocking this loop impairs cholangiocarcinoma proliferation and colonization in the lymph node microenvironment and is superior to systemic inhibition of fatty acid oxidation. PPARγ-regulated fatty acid metabolic reprogramming in cholangiocarcinoma also contributes to the immune-suppressive niche in lymph node metastases by producing kynurenine and was found to be associated with tumor relapse, immune-suppressive lymph node microenvironment, and poor immune checkpoint blockade response.

Conclusions:

Our results reveal the role of the oleic acid-PPARγ-fatty acid–binding protein 4 loop in fueling cholangiocarcinoma colonization in lymph nodes and demonstrate that PPARγ-regulated lipid metabolic reprogramming is a promising therapeutic target for relieving cholangiocarcinoma lymph node metastasis burden and reducing further progression.
Incidence and characteristics of neovascular age-related macular degeneration with over a 12-month remission after three monthly aflibercept administration: 60 months results of a pro re nata regimen.
Authors: Kikushima Wataru , Sakurada Yoichi , Fukuda Yoshiko , Matsubara Mio , Yoneyama Seigo , Shijo Taiyo , Sugiyama Atsushi , Kotoda Yumi , Kashiwagi Kenji
Published: February 2024

Purpose:

To investigate the characteristics of patients with over a 12-month remission after three monthly intravitreal aflibercept injections (IVA) followed by a pro re nata regimen for exudative age-related macular degeneration (AMD).

Methods:

One-hundred and forty-four eyes with exudative AMD were included. All patients received three monthly IVA as a loading dose, followed by an as-needed regimen for 60 months. Patients were classified into the remission and recurrence groups depending on the presence or absence of a 12-month remission. ARMS2 A69S and CFH I62V were genotyped in all cases.

Results:

During the study, 82 eyes (56.9%) showed 12 months or more remission at least once. The cumulative incidence rate of a 12-month remission showed a plateau pattern and converged to 60% (y=-166.26x-2.172+0.6, R2=0.8168). Patients in the remission group were younger than those in the recurrence group (p<0.001) and had less risk allele frequency of the ARMS2 gene than the recurrence group (p<0.001). The longer the remission interval was prolonged, the better visual acuity was achieved at the 60-month visit (p<0.001).

Conclusion:

Fifty-seven percent of patients showed a 12-month remission or more at least once during a 60-month follow-up, suggesting that patients with no reactivation can prolong the treatment interval.
Consideration of patient preference and life expectancy in the management of basal cell carcinoma
Authors: Fahlstrom Kathryn
Published: February 2024

The purpose of this article is to review existing literature regarding the current role of patient preference and life expectancy in the management approach of basal cell carcinoma (BCC) in very elderly patients. Very elderly individuals are identified as those 85 years or older of age. This article aims to further evaluate the potential risks and benefits of the treatment of BCC compared with nonintervention in the very elderly with limited life expectancy. Current clinical guidelines do not include an evaluation of patient preference or life expectancy to determine the appropriate treatment for BCC. In the very elderly population, who are expected to experience an increased incidence of BCC, this consideration could improve patient satisfaction and quality of life while simultaneously decreasing the level of burden to the health care system from unnecessary treatment of BCC.
Calciphylaxis: complexity from presentation to treatment
Authors: Bush Laura P. , Patton Sarah B.W.
Published: February 2024

Calciphylaxis is a rare but potentially life-threatening condition most often observed in patients with end-stage renal disease. The following case illustrates the presentation of non-nephrogenic and nephrogenic calciphylaxis. The prevalence of calciphylaxis appears to be rising; therefore, it is important to maintain a high index of suspicion in the evaluation of painful ulcerating skin lesions.
Black and Hispanic Representation Declined After Increased Degree Requirements for Physician Assistants
Authors: Herring Jordan , Brantley Erin , Ritsema Tamara S. , Luo Qian , Straker Howard , Salsberg Ed
Published: February 2024

Introduction

The physician assistant (PA) profession is one of the least racially and ethnically diverse health professions requiring advanced education. New PA graduates are even less diverse than the current PA workforce and less diverse than professions requiring doctoral degrees. Between 1995 and 2020, the percent of all PA graduates that were Black individuals fell from 7% to 3.1%, while Hispanic representation increased from 4.5% to 7.9%.

Methods

Using the federal Integrated Postsecondary Education Data System, we examine the impact of transitions to master’s degrees for PAs on Black and Hispanic representation between 1995 and 2020, using individual universities as the unit of analysis.

Results

After adjusting for state and year effects, PA programs that transitioned from bachelor’s to master’s degrees experienced a 5.3% point decline in Black representation and a 3.8% point decline in Hispanic representation. Relative to the already low proportions of Black and Hispanic graduates in PA programs, these declines are significant.

Discussion

Steps should be taken to ensure that underrepresented populations have greater access to PA education.
Lesbian, Gay, Bisexual, Transgender, Queer, Plus Curriculum in Physician Assistants/Associate Education: A Call to Action
Authors: Lechien Nathan M. , Dempsey Shea A.
Published: February 2024

Healthcare avoidance of the LGBTQIA+ community is growing, in part, due to a knowledge gap in medical learners on LGBTQIA+-related topics. Barriers of including LGBTQIA+ topics in medical education include perceived lack of applicability and preceptor knowledge gaps. Advocating for a weave-like integration approach, topics such as personal biases, hormone replacement therapy, STI prevention, and health inequities should be included. It is imperative that PA educators use this call to action to avoid perpetuating the cultural incompetence of new graduate PAs.
Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017 to 2021 Match Cycles
Authors: Hinojosa-Gonzalez David E. , Kronstedt Shane , Saffati Gal , Corsi Nicholas , Wintner Anton , Zlatev Dimitar , Mayer Wesley A. , Korets Ruslan , Eisner Brian H.
Published: February 2024

Purpose:

Urology is one of the most competitive specialties for residency matches in the United States. Data reported by the American Urological Association from match cycles spanning 2014 to 2021 reveal a median of 0.34% (0%-3%) of unfilled spots, a median of 1.48 (1.28-1.87) applicants per position, and a median of 75% (63%-87%) match rate. Recent research has shown that program directors value applicants' research highly. We sought to assess the research productivity of matched urology residency applicants, identify trends in research volume over time, and investigate the potential correlation between research output and program ranking.

Materials and Methods:

Doximity Urology program ranking list from the 2017 to 2021 match cycles was sorted by reputation, extracted, and populated using each program's official website resident roster, including name, medical school, postgraduate year, and additional degrees. Rosters were crossed-checked against social media posts from the official accounts. Each identified urology resident was queried in PubMed. Journal ranking was determined through Scimagojr; top-quartile journals were classified as Q1.

Results:

In total 131 of 145 programs were identified, and 1605 matched applicants spanning the 2017 to 2021 match cycles. The mean and median total publications were 2.44 and 1, respectively, and 2.17 and 1 when excluding case reports. 64.2% of applicants had at least one publication, and 42.2% had at least one urological publication. Applicants matching into higher-ranked programs had more research and urological research. Multivariable regression analysis revealed that Q1 research (β 2.38) and urology research (β 2.33) significantly affected rank. Match cycle analysis revealed an increase in total and urology-focused research, whereas regression analysis demonstrated significant increases in total publications (β 0.019) per cycle.

Conclusion:

Overall research, urology-focused research, first authorship, and publication in higher-ranked journals play an essential role in the urology match.
Ankyloglossia, a Contributor to Pelvic Pain: A Case Report
Authors: Guan Jennifer
Published: February 2024

Background:

Ankyloglossia is a congenital condition of the tongue in which the lingual frenulum is shortened, causing restrictions in the mobility of the tongue. Improper tongue mechanics have an impact on breathing, and impairments can cause a strain on the diaphragm, muscles of the head and neck, as well as the pelvic floor via the connective tissue and fascia. Evidence is largely lacking for the impact ankyloglossia has on pelvic floor function and pain.

Case Description:

The patient is a 31-year-old woman who reported primary dyspareunia, with significant exacerbation of symptoms postpartum. Six months after the physical therapy initial evaluation she was diagnosed with ankyloglossia, with the frenotomy performed 1 month later.

Outcomes:

The connective tissue restrictions, muscular restrictions, and myofascial trigger points were addressed via manual therapy. Her planned home exercise program was focused on down-training and breathing. She was initially improving at a slower rate than patients with similar symptoms and history. The first time she attempted intercourse following the frenotomy, she noticed a marked difference in her dyspareunia symptoms and her ability to relax her pelvic floor voluntarily.

Discussion:

The impact ankyloglossia had on the patient's pelvic floor was missed and her slow progress was attributed solely to other factors. Asking the proper patient history questions and understanding the potential impact that ankyloglossia can have on pelvic floor function can help physical therapists identify an easily missed underlying contributor for pelvic pain.
Diagnosis and management of immune mediated liver injury from checkpoint inhibitors
Authors: Likhitsup Alisa , Fontana Robert J.
Published: February 2024

Purpose of review

The aim is to summarize the latest data on the incidence, clinical manifestations, and management of immune- mediated liver injury from checkpoint inhibitors (ILICI).

Recent findings

ILICI develops in 10–15% of oncology patients receiving immunotherapy with most having asymptomatic serum aminotransferase and/or alkaline phosphatase elevations. Most grade 1–2 ILICI patients improve with drug discontinuation and/or short-term oral corticosteroids. In contrast, the 2–3% with grade 3/4 hepatotoxicity frequently require oral or intravenous corticosteroids and some are hospitalized to initiate further immunosuppression with mycophenolate mofetil or azathioprine. Liver biopsy is generally reserved for patients with atypical features or those with severe hepatotoxicity who fail to respond to treatment. Up to 3% of ILICI patients with a cholestatic profile have MRI evidence of intra or extrahepatic cholangitis that responds poorly to immunosuppression. Most ILICI patients improve during follow-up and liver-related death is very uncommon (<1%). Up to 30% of rechallenged ILICI patients develop recurrent hepatotoxicity with a shorter latency.

ILICI is increasingly encountered by gastroenterologists evaluating oncology patients with abnormal liver biochemistries. A stepwise approach to exclude viral hepatitis, alcohol, hepatic metastases, and pancreaticobiliary disease is recommended. The majority of ILICI patients fully recover with ICI discontinuation and short-term corticosteroids or a second line immunosuppressant.
The AWARE Framework
Authors: Virkstis Katherine , Balá LouAnn , Taylor Jennifer , Forester Robin
Published: February 2024

The alarming rise in workplace violence against healthcare workers, particularly nurses, is concerning. Addressing this complex issue requires a systematic, technology-driven approach. The AWARE Framework offers nurse leaders an actionable strategy to create a safer care environment by integrating advanced digital solutions.
Convergent construct validity of the Brazilian version of the Houghton scale
Authors: Secco Milena Zavatini , Balbi Larissa Lavoura , Pereira Maira Stéfanie de Castro , Santos Costa Wilker , Barros Ana Regina de Souza Bavaresco , Registro Fonseca Marisa de Cássia
Published: February 2024

Background:

After lower limb amputations, a decrease in gait capacity, even with prostheses, is common and persistent. Functional ability involves multiple constructs; therefore, several outcome measures, such as performance tests or self-report questionnaires, should be used to evaluate people with amputation who use prostheses.

Objective:

To analyze the convergent construct validity of the Brazilian version of the Houghton scale in a sample of lower limb prosthesis users.

Methods:

Volunteers selected were older than 18 years with any level of lower limb amputation and prosthesis use for at least 6 months. In this study, evidence of construct validity of the Houghton scale was established by the Spearman rho correlation with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility and with the Physical Function (PF) and Emotional Well-being subdomains of the Medical Outcomes Study 36-Short Form Health Survey.

Results:

Seventy-one volunteers were recruited for the study. The sample consisted mainly of men (70.4%) with a mean age of 50 ± 12 years. The primary cause of amputation was traumatic (53.5%), and most participants (54.9%) had a transtibial amputation. The Houghton questionnaire correlated strongly with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility questionnaire (rho: 0.74, p < 0.01) and weakly with the PF and Emotional Well-being of the 36-Short Form Health Survey (rho: 0.06 and rho: 0.22, respectively, p > 0.05).

Conclusion:

This study showed evidence of convergent construct validity of the Houghton questionnaire to measure and classify functional use of lower limb prostheses, with great value to clinical practice. Additional work is needed to assess other measurement properties in different samples.
Hemangioma of the Ilium Simulating Bone Metastasis on 18F-PSMA-1007 PET/CT
Authors: Dong Aisheng , Nian Shensheng , Bai Yushu , Zuo Changjing
Published: February 2024

A 64-year-old man was referred for 18F-PSMA-1007 PET/CT scan for initial staging of biopsy-proved prostate adenocarcinoma. 18F-PSMA-1007 PET/CT showed focal intense 18F-PSMA-1007 of the prostate adenocarcinoma and a focal intense activity with SUVmax of 10.5 in the left ilium. The 18F-PSMA-1007–avid iliac bone lesion corresponded to a hemangioma, which was initially detected on pelvic MRI 13 months ago and remained stable in size. This case indicates that hemangioma should be included in the differential diagnosis of PSMA-avid iliac bone lesions.
FDG Uptake Caused by Right Varicocele
Authors: Deng Jia , Sun Yuanyuan , He Renjie , Cai Liang , Chen Yue
Published: February 2024

A 67-year-old man underwent 18F-FDG PET/CT for lung cancer staging. Interestingly, the PET scan revealed strip-shaped FDG uptake in the right inguinal contoured area, which was later confirmed as a right varicocele through ultrasound imaging.
Elevated FAPI Activity in an Adult Brodie Abscess
Authors: Xie Yang , Tang Wenxin , Liu Huipan , Wang Yudi , Chen Yue
Published: February 2024

We report an adult Brodie abscess with elevated activity of 18F-FDG and 68Ga-FAPI (fibroblast activating protein inhibitor), mimicking bone metastasis. Our case illustrates that Brodie abscess should also be contemplated in the differential diagnosis of osteolytic lesions with increased 68Ga-FAPI uptake.
Uptake of 99mTc-DTPA in Bone Metastases From Follicular Thyroid Carcinoma
Authors: Liang Zhiying , Li Wei
Published: February 2024

A 53-year-old man with follicular thyroid carcinoma (FTC) was referred for renal scintigraphy using 99mTc-DTPA to assess the kidney function. Unexpectedly, the images showed an abnormal uptake of radiotracer in the right pelvic region. It corresponded to the site of metastasis in the right ilium revealed on 131I SPECT/CT images. The biopsy pathology of the ilium lesion demonstrated follicular thyroid cancer.
The Use of Eye-Tracking Technology in Dento-Maxillofacial Esthetics: A Systematic Review
Authors: Zhang Yimeng , Wang Xiaobo , Xu Xi , Feng Shi , Xia Long
Published: February 2024

The use of eye-tracking technology in dental esthetics has gained popularity over the past decade because of its ability to assess observers’ visual preferences in an objective manner. The goal of this study was to provide a comprehensive review of eye-tracking studies in dentistry, which could provide a reference for the rational and effective application of eye-tracking technology by dentists in the future. A comprehensive search of articles on eye tracking, published from January 1946 to June 2023, was conducted across several databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The major criterion for inclusion was that the study evaluated the use of eye-tracking technology in the field of dentistry. Two independent reviewers screened the eligible studies. A total of 67 articles were identified, 41 of which met our inclusion criteria. The most common application of eye tracking was the assessment of perceptions of changes in specific dental conditions among different classes of observers. Overall differences between groups (different classes of observers, different types of conditions) among different areas or regions of interest were analyzed. This systematic review demonstrated the utility of eye-tracking technology as a quantifiable objective assessment and emerging research tool for evaluating outcomes in several domains of dentistry.
What Do You See? Signature Pedagogy in Continuous Electroencephalography Teaching
Authors: Fernandez Andres , Asoodar Maryam , van Kranen-Mastenbroek Vivianne , Majoie Marian , Balmer Dorene
Published: February 2024

Purpose:

Electroencephalography (EEG) is commonly used in neurology, but there is variability in how neurologists interpret EEGs, potentially from variability in EEG teaching. Little is known about how EEG teaching is done to prepare neurologists for professional practice.

Methods:

We interviewed a group of EEG experts to characterize their teaching practices around continuous EEG (cEEG). We used signature pedagogy as a framework to analyze and interpret the data.

Results:

We identified pervasive and characteristic forms of cEEG teaching. Teaching is based on apprenticeship, relying on “learning by doing” in the context of real-life clinical practice. There are habitual steps that learners take to anchor teaching, which typically occurs during rounds. There is a common language and core knowledge that trainees need to master early in their training.

Conclusions:

There are pervasive characteristic forms of cEEG teaching. These findings can help facilitate instructional design and implementation of complementary or enhanced cEEG teaching practices.
Safety of Same-Day Discharge after Bariatric Surgery: Retrospective 6-Year North American Analysis
Authors: Bharani Tina , Tavakkoli Ali , Tsai Thomas C , Robinson Malcolm K , Sheu Eric G
Published: February 2024

BACKGROUND:

With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID-19, there has been interest in same-day discharge (SDD) for bariatric surgery. The aim of this study was to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric surgery.

STUDY DESIGN:

We analyzed the MBSAQIP database from 2016 to 2021 to characterize trends in SDD for minimally invasive bariatric operation. Multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. A comparative analysis of postoperative outcomes within 30 days was performed for SDD and admission after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities.

RESULTS:

SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black race, history of MI, renal insufficiency, deep vein thrombosis, and smoking. SDD for Roux-en-Y gastric bypass had 72% increased risk of postoperative complications compared with sleeve gastrectomy. The overall major complications were lower in SDD cohort vs admission cohort (odds ratio [OR] 0.62, p < 0.01). However, there was a significant increase in deaths within 30 days (OR 2.11, p = 0.01), cardiac arrest (OR 2.73; p < 0.01), and dehydration requiring treatment (OR 1.33; p < 0.01) in SDD cohort compared with admission cohort.

CONCLUSIONS:

Nationally, there has been a rise in SDD for bariatric operation from 2016 to 2021. Matched analysis demonstrates that SDD is associated with a significantly higher mortality rate. Additionally, the risk of complications with SDD is higher for RYGB compared with sleeve gastrectomy. Therefore, further studies are required to appropriately select patients for whom bariatric surgery can be safely performed as an outpatient.