bluuebunny/crossref_metadata_2025 huggingface dataset:
Advance Care Planning Engagement Among Family Members of Community-Dwelling Elderly Patients With Chronic Diseases in China
Authors: Liu Xuebing , Chen Hui , Zhang Lingli , Zhang Qiongwen , Feng Ting , Liu Dongling
Published: January 2022

In China, traditional culture advocates family consensus, and the advance care planning (ACP) engagement of family members is crucial to the implementation of ACP. However, there is still a lack of research on family members' engagement in ACP in mainland China. This study investigated the ACP engagement of family members of community-dwelling elderly patients with chronic diseases and provided evidence for further ACP intervention research. We conducted a mixed-methods sequential explanatory study, 273 family members were surveyed, and semistructured interviews were conducted. Following that, 12 family members were selected after statistical analysis to supplement the quantitative results. The results showed that the ACP engagement of family members of elderly patients with chronic diseases in the community was low, but the self-efficacy was higher. The age of family members, severity, and duration of patients' diseases were the main influencing factors for family members' ACP engagement. Traditional cultural, clinical decision-making mode, lack of understanding of ACP, and factors within the family may impede family members' engagement. This study showed that family-centered ACP practice has significant advantages in China and that future research should focus on the Chinese culture and medical system and highlight the role of families.
Management of Posterior Digital Skin Defect by Pico Negative Pressure Wound Therapy
Authors: Ollat Didier , Vuilletet Emma , Zadegan Frédéric , Rougereau Grégoire
Published: January 2022

The use of negative pressure therapy for digital skin loss is uncommon. A reason for this is the difficulty of applying dressings to the hand, which are often difficult to seal. However, negative pressure therapy offers some benefits, especially when associated with local infection. We present a nonspecific, simple and original technique using a Pico negative pressure dressing that may be easily applied in daily practice.
Estimation of the Proportion of Potential Nondisclosed Men Who Have Sex With Men Among Self-Reported Heterosexual Men With HIV Using a Randomized Response Technique
Authors: Chen Yi , Ruan Yuhua , Shen Zhiyong , McNeil Edward B. , Xing Hui , Shao Yiming , Lin Mei , Lan Guanghua , Chongsuvivatwong Virasakdi
Published: January 2022

Background

Because of HIV-related stigma and gender minority stigma, the number of men who have sex with men (MSM) among registered HIV/AIDS cases may be underreported in Guangxi, China. In addition to the sensitivity of direct inquiry of sexual identity and behavior, our study aims to determine the proportion of potential nondisclosed MSM (pnMSM) among self-reported heterosexual men with HIV.

Method

The study subjects were self-reported heterosexual men with HIV who were diagnosed in recent 20 years in Guangxi, China. A randomized response technique was executed by randomly putting them to secretly answer either whether their birthday was odd or even day, or whether they experienced anal sex in the last 3 years. Personal characteristics were linked with randomized response technique answers for subgroup analysis.

Results

The proportion of pnMSM ever having anal sex was estimated to be 14.3% in Guangxi, China. Being younger, having a college or above education level, single, employed, of Han ethnicity, diagnosed with HIV in the past 6 years, and not on antiretroviral therapy were associated with giving positive answer.

Conclusions

The reported number of MSM cases with HIV in the past may have been underestimated in Guangxi, China. Information about preexposure and postexposure prophylaxis should be provided to this stigmatized subgroup—pnMSM, especially those who are younger and with a higher socioeconomic status among self-reported heterosexual men with HIV.
Sarcomatoid Yolk Sac Tumor Harbors Somatic Mutations That Are Otherwise Rare in Testicular Germ Cell Tumors
Authors: Acosta Andres M. , Al-Obaidy Khaleel I. , Sholl Lynette M. , Dickson Brendan C. , Lindeman Neal I. , Hirsch Michelle S. , Collins Katrina , Fletcher Christopher D. , Idrees Muhammad T.
Published: January 2022

In testicular germ cell tumors (TGCTs), components with nonspecific sarcomatous features that express keratins and glypican 3 are classified as sarcomatoid yolk sac tumor (SYST). SYST is most frequently seen in metastatic sites after chemotherapy. Like so-called “somatic-type” malignancies arising in TGCTs, SYST is markedly resistant to systemic therapy and has a more aggressive clinical course than conventional types of TGCT. However, the clinicopathologic and molecular features of SYST remain incompletely described. This study evaluated a multi-institutional series of 20 SYSTs using massively parallel sequencing and p53 immunohistochemistry. The histologic and clinical characteristics of the cases were also assessed, including analyses of disease-specific outcomes. DNA sequencing identified somatic mutations in 12/20 cases (60%), including recurrent TP53 and RIF1 mutations (present in 4/20 cases, 20% each). In 3 of the 4 SYST with TP53 mutations, there was molecular evidence of loss of heterozygosity. Immunohistochemistry demonstrated diffuse overexpression of p53 protein in 3/4 (75%) cases with TP53 mutations. The remaining TP53-mutant case demonstrated multifocal overexpression of p53, suggestive of subclonal inactivation of the gene. Overexpression of p53 protein was not seen in any of 15 TP53 wild-type cases evaluated by immunohistochemistry. A subset of 4 cases underwent RNA sequencing (fusion panel), which demonstrated the absence of oncogenic gene fusions. A 2-tiered grading system based on 3 histologic parameters (cellularity, number of mitoses, and necrosis) demonstrated that high-grade SYSTs have a higher risk of disease-specific death compared to low-grade tumors. The risk of disease-specific mortality was also higher in SYSTs with somatic mutations. In conclusion, this study demonstrated that 60% of SYSTs harbor somatic oncogenic mutations that are otherwise rare in TGCTs, and the presence of these mutations is associated with an aggressive clinical course. In addition, the results presented herein suggest that grading SYSTs may be clinically relevant.
Molecular Characterization of Dermatofibrosarcoma Protuberans
Authors: Lee Pei-Hang , Huang Shih-Chiang , Wu Pao-Shu , Tai Hui-Chun , Lee Chih-Hung , Lee Jen-Chieh , Kao Yu-Chien , Tsai Jen-Wei , Hsieh Tsung-Han , Li Chien-Feng , Li Wan-Shan , Liu Ting-Ting , Su Yu-Li , Yu Shih-Chen , Huang Hsuan-Ying
Published: January 2022

The clinicopathologic relevance of various gene rearrangements underlying dermatofibrosarcoma protuberans (DFSP) remains insufficiently characterized. In 188 DFSPs, we determined PDGFB, COL1A1, PDGFD, COL6A3, and EMILIN2 rearrangements by fluorescence in situ hybridization (FISH). The clinicopathologic significance of rearrangement types and factors related to recurrence and metastasis were statistically analyzed. In all, classic PDGFB rearrangement, cryptic COL1A1-PDGFB fusion, and PDGFD rearrangement were identified in 172 (91.4%), 8 (4.3%), and 8 (4.3%: 4 COL6A3-PDFGD, 4 EMILIN2-PDGFD) cases, respectively. In an index DFSP harboring the cryptic fusion, the COL1A1-PDGFB transcript was confirmed by both RNA sequencing and reverse transcription-polymerase chain reaction. In comparison with cases harboring classic PDGFB rearrangement, cryptic PDGFB-rearranged DFSPs usually exhibited higher 5′-COL1A1 copy numbers. In a combined reappraisal of published and current cases, COL6A3-PDGFD-positive DFSPs (n=16) predominated in females (n=14, 88%) and torso (n=14, 88%), especially the breast (n=7, 44%); EMILIN2-PDGFD-positive DFSPs (n=6) preferentially demonstrated near exclusively subcutaneous growth (n=5, 83%) and fibrosarcomatous transformation (n=5, 83%). In our cohort, local recurrence was related to fibrosarcomatous variant (P=0.029, odds ratio=3.478) and head and neck location (P=0.046, odds ratio=3.508). Distant metastasis only occurred in the fibrosarcomatous variant (9/73, 12.3%) but not in other cases. In conclusion, 8.6% of DFSPs are negative for PDGFB break-apart FISH, which, especially those with challenging subcutaneous and circumscribed manifestation, require complementary diagnosis by FISH assays targeting COL1A1 and PDGFD. The types of fusion gene rearrangements, head and neck location, and fibrosarcomatous transformation may account for clinicopathologic and prognostic variations in DFSPs and warrant future independent validation.
African Americans and Women Have Lower Functional Gains During Acute Inpatient Rehabilitation After Hemorrhagic Stroke
Authors: Somani Sana , Nanavati Hely , Zhou Xiaohua , Lin Chen
Published: January 2022

Objective

Intracerebral hemorrhage can lead to significant long-term disability. While research in stroke rehabilitation has focused primarily on ischemic strokes, identifying factors that impact recovery in patients with intracerebral hemorrhage is necessary. Our purpose is to identify factors, including racial and sex disparities, associated with functional outcomes in intracerebral hemorrhage patients after inpatient rehabilitation.

Design

This was a retrospective analysis of consecutive patients with intracerebral hemorrhage admitted to an inpatient rehabilitation facility at an academic tertiary facility in the Southeastern United States from 2016 to 2019. Clinical characteristics, demographics, admission, and discharge Functional Independence Measure scores were collected.

Results

We evaluated 59 patients (54.4 ± 14.1 yrs, 39% females, 48.2% African American) with a median intracerebral hemorrhage volume of 13.4 (4.2–33.0) and a mean (SD) Functional Independence Measure efficiency of 1.8 ± 1.3. In multiple regression, being female was negatively associated with Functional Independence Measure efficiency (β = −1.13, P = 0.0037) when adjusting for race and intracerebral hemorrhage score. The Functional Independence Measure efficiency was lower in African Americans (β = −0.97, P = 0.0119) when adjusting for sex and intracerebral hemorrhage volume.

Conclusions

The results of our study indicate that Functional Independence Measure efficiency was worse for African Americans and female patients with intracerebral hemorrhage. Future research should consider these racial and sex disparities and focus on providing targeted rehabilitation therapy.
An Intervention to Optimize Attitudes Toward Adverse Events Reporting Among Tunisian Critical Care Nurses
Authors: Tlili Mohamed Ayoub , Aouicha Wiem , Sahli Jihene , Mtiraoui Ali , Ajmi Thouraya , Laatiri Houyem , Chelbi Souad , Ben Rejeb Mohamed , Mallouli Manel
Published: January 2022

Objective

This study aimed at evaluating the impact of a combined-strategies intervention on ICUs nurses’ attitudes toward AE reporting.

Methods

We conducted a quasi-experimental study from January to October 2020 which consisted of an intervention to improve attitudes toward incident reporting among nurses working in 10 intensive care units at a university hospital using the Reporting of Clinical Adverse Events Scale. The intervention consisted of a 2-hour educational presentation for nurse unit managers and a 30-minute in-units educational training for intensive care unit nurses, which encompassed technical aspects of reporting, the reporting process, a nonpunitive environment, and the importance of submitting reports. The educational presentation was reinforced with distributing posters and brochures and biweekly patient safety rounds that inquired about events, reinforced education, and provided follow-up to incident reports.

Results

All dimensions were significantly improved. Score increased from 27.4% to 42.1% (P < 0.01) for perceived blame, from 35.2% to 52.5% for perceived criteria for identifying events that should be reported (P < 0.01), from 34.3% to 46% for perceptions of colleagues’ expectations (P = 0.04), from 37.1% to 51.4% for perceived benefits of reporting (P = 0.01), and from 29.2% to 51.4% for perceived clarity of reporting procedures (P < 0.01).

Conclusions

Interventions using a combination of several strategies such as training, safety round, and messaging can be effective and should be considered by hospitals attempting to increase adverse events reporting. Results reinforce the assumption that a nonpunitive environment and the resulting feeling of safety and reassurance are crucial to foster the submission of reports.
Identification of Inappropriate Antibiotic Orders During Implementation of a Multidisciplinary Antimicrobial Stewardship Program Within the Primary Care Setting
Authors: Singh-Franco Devada , Hosein Mohammed Sheerida , Eckardt Paula A. , Goldman Jennifer , Wolowich William R.
Published: January 2022

Objective

The aim of the study was to describe implementation of an outpatient antibiotic stewardship program at primary care practices in South Florida and the proportion of appropriate and inappropriate orders and reasons for inappropriateness during the intervention.

Methods

An antibiotic stewardship committee at a large hospital system implemented aspects of The Core Elements of Outpatient Antibiotic Stewardship at outpatient facilities in 2018. Interventions included an education/awareness campaign directed at prescribers (audit and feedback, routine education at prescribers’ meetings, availability of updated guidelines in a shared drive and antibiogram via intranet) and patients (posters, tear-off sheets on symptom relief for viral illness). Orders were evaluated using clinical documentation, current antibiogram, and Infectious Diseases Society of America guidelines. An appropriate order was defined as a correct antibiotic and dose/frequency and duration of therapy. An inappropriate antibiotic order was defined as not meeting 1 or more of the abovementioned conditions. Descriptive statistics assessed the data.

Results

In this retrospective review of 2934 oral antibiotic orders from January 1 to December 31, 2018, 2565 (87.4%) were necessary while 369 (12.6%) were unnecessary. Of 2565 necessary orders, 1448 (56.5%) were appropriate while 1117 (43.5%) were inappropriate. Of 1117 inappropriate orders, 24.9% had all 3 conditions; 41.5% of inappropriate orders were solely due to wrong duration of therapy.

Conclusions

Although our institution demonstrated commitment to optimizing antibiotic prescribing by providing resources to clinicians and patients about evidence-based antibiotic prescribing, inappropriate antibiotic prescribing was persistent. The interventions used must continue to evolve and include point-of-care access to guidelines and clinical decision support tools.
A Peer-Led Online Community to Increase HIV Self-Testing Among African American and Latinx MSM: A Randomized Controlled Trial
Authors: Young Sean D. , Cumberland William G. , Singh Parvati , Coates Thomas
Published: January 2022

Objective:

We sought to assess the effectiveness of using a peer-led online community to increase HIV self-testing among Latinx and African American men who have sex with men (MSM).

Design:

Randomized controlled trial.

Methods:

Throughout 6 waves, between February 18, 2017, and January 8, 2021, 900 HIV negative and/or serostatus unknown Los Angeles–based MSM (68.9% Latinx, 16.0% African American, and 7.4% White) participated in an online 12-week HIV prevention randomized controlled trial. A total of 79 trained role models (peer leaders) were randomly assigned to participants within clusters to build trust and deliver HIV testing information on Facebook groups. Participants in control groups were assigned to groups without peer leaders. Participants were not required to respond to peer leaders or to remain group members. Participants completed self-report assessments at baseline and 12-week follow-up and could receive a free HIV self-testing kit during the study period.

Results:

Compared with control group participants, intervention group participants were significantly more likely to accept the offer for the HIV self-testing kit (intervention 130 of 450, 29%; control 102 of 450, 22.7%; odds ratio = 1.43, 95% confidence interval: 1.04 to 1.95, P = 0.03), report having taken an HIV self-test within the past 3 months (odds ratio = 1.47, 95% confidence interval: 1.01 to 2.13, P = 0.04), and report drinking fewer glasses of alcohol in an average week (P = 0.01). Effects seemed concentrated within later study waves. Study retention was greater than 93%.

Conclusions:

A peer-led online community seems to be an effective method of increasing HIV self-testing among MSM of color. We discuss the implications of the wave effects on public health research and policy.
Intense 68Ga-DOTA-FAPI-04 Uptake in Diffuse Sclerotic Skeletal Metastases of Gastric Cancer
Authors: Erol Fenercioğlu Özge , Beyhan Ediz , Arslan Esra , Çermik Tevfik Fikret , Ergül Nurhan
Published: January 2022

Diffuse sclerotic metastases of the bone as initial presentation at gastric carcinoma are very rare. We present a 48-year-old man who was examined for pancytopenia and diagnosed with gastric cancer. 18F-FDG PET/CT showed moderate uptake in the primary gastric tumor and mild uptake in diffuse sclerotic metastatic lesions in the bone matrix, whereas 68Ga-DOTA-FAPI-04 showed mild uptake in the gastric lesion and intense uptake at the whole skeleton.
Symptomatic and Physiological Outcomes Following Laparoscopic Heller Myotomy for Achalasia Cardia: Is There a Correlation?
Authors: Kumar Aditya , Tripathi Samarendra N. , Mittal Sonali , Abraham Joyner , Makharia Govind K. , Parshad Rajinder
Published: January 2022

Background:

Symptomatic evaluation using Eckardt score and achalasia-specific health-related quality-of-life and physiological evaluation using timed barium examination (TBE) and high-resolution manometry is integral to the diagnosis of achalasia. However, the correlation of physiological outcomes with symptomatic outcomes and their role in routine follow-up after laparoscopic Heller cardiomyotomy (LHCM) is controversial. In this study, we evaluated the role of physiological testing in achalasia patients undergoing LHCM and its correlation with symptomatic evaluation.

Materials and Methods:

Case records of patients undergoing LHCM for achalasia between January 2017 and March 2020 were reviewed for symptom scores (Eckardt score and achalasia-specific health-related quality-of-life) and physiological parameters [5-min column height on TBE and median integrated relaxation pressure (IRP) on high-resolution manometry]. Sixty-one patients with complete data in the preoperative period and on follow-up were included in the study. The data was analyzed for symptomatic and physiological outcomes and their correlation using paired t test and the Spearman correlation test.

Results:

At a median follow-up of 16 months following LHCM, there was a significant improvement in Eckardt score (7.03±1.53 to 0.93±1.10, P<0.001), achalasia-specific health-related quality-of-life (58.34±7.81 to 14.57±13.45, P<0.001), column height on TBE (115.14±46.9 to 27.89±34.31, P<0.001) and IRP (23.95±8.26 to 4.61±4.11, P<0.001). Eckardt score correlated significantly with achalasia-specific health-related quality-of-life scores preoperatively (ρ=0.410, P<0.001) and on follow-up (ρ=0.559, P<0.001). There was no correlation between symptomatic parameters and physiological parameters.

Conclusions:

In patients of achalasia, LHCM leads to significant improvement in symptomatic and physiological parameters. Symptom scores correlate among themselves but not with physiological scores. Thus, physiological testing may not be needed for routine follow-up.
The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis
Authors: Li Junsheng , Wang Yong , Wu Lisheng
Published: January 2022

Background:

Open sublay technique and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the most common used procedures in ventral and incisional hernia repair, however, each technique has its own disadvantages. The enhanced view total extraperitoneal technique (eTEP) aims to put the mesh in the retromuscular space by minimal invasive technique. This study is to investigate the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair.

Methods:

The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through May 1, 2021, using the keywords “enhanced view extraperitoneal,” “extended view totally extraperitoneal,” “eTEP,” “TEP,” “laparoscopic retromuscular,” “ventral hernia,” “incisional hernia,” “laparoscopic intraperitoneal onlay mesh,” “IPOM.” All relevant articles and reference lists in these original studies were also obtained from the above databases.

Results:

Five trials containing 433 patients were included in the present study. Compared with the IPOM technique, the eTEP ventral/incisional hernia repair was associated a longer operative time [mean difference=44.79; 95% confidence interval (CI): 26.57, 63; P=0.00001], less acute pain on postoperative day 1 (standardized mean difference=−3.90; 95% CI: −4.42, −3.38; P<0.00001), and day 7 (standardized mean difference=−3.72; 95% CI: −6.09, 1.35; P=0.002), and the eTEP group had a shorter hospital stay compared with the IPOM group (mean difference=−0.56; 95% CI: −0.74, −0.39; P=0.00001). There was no significant difference concerning the incidence of seroma, hematoma, intraoperative complication, and postoperative ileus between eTEP and IPOM groups.

Conclusions:

The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time. In addition, there is no significant difference in terms of intraoperative or postoperative complications. Further randomized controlled studies with long-term follow-up are needed to evaluate the eTEP technique.
Firearm trauma: Race and insurance influence mortality and discharge disposition
Authors: Lumbard Derek C. , Freese Rebecca L. , Marek Ashley P. , Endorf Frederick W. , Richardson Chad J. , Nygaard Rachel M.
Published: January 2022

BACKGROUND

Health insurance and race impact mortality and discharge outcomes in the general trauma population. It remains unclear if disparities exist by race and/or insurance in outcomes following firearm injuries. The purpose of this study was to assess differences in mortality and discharge based on race and insurance status following firearm injuries.

METHODS

The National Trauma Data Bank (2007–2016) was queried for firearm injuries by International Classification of Diseases, Ninth/Tenth Revision, Ecodes. Patients with known discharge disposition, age (18–64 years), race, and insurance were included in analysis (N = 120,005). To minimize bias due to missing data, we used multiple imputation for variables associated with outcomes following traumatic injury: Injury Severity Score, Glasgow Coma Scale score, respiratory rate, systolic blood pressure, and sex. Multivariable regression analysis was additionally adjusted for age, sex, Injury Severity Score, intent, Glasgow Coma Scale score, systolic blood pressure, heart rate, respiratory rate, year, and clustered by facility to assess differences in mortality and discharge disposition.

RESULTS

The average age was 31 years, 88.6% were male, and 50% non-Hispanic Blacks. Overall mortality was 11.5%. Self-pay insurance was associated with a significant increase in mortality rates in all racial groups compared with non-Hispanic Whites with commercial insurance. Hispanic commercial, Medicaid, and self-pay patients were significantly less likely to discharge with posthospital care compared with commercially insured non-Hispanic Whites. When examining racial differences in mortality and discharge by individual insurance types, commercially insured non-Hispanic Black and other race patients were significantly less likely to die compared with similarly insured non-Hispanic White patients. Regardless of race, no significant differences in mortality were observed in Medicaid or self-pay patients compared with non-Hispanic White patients.

CONCLUSION

Victims of firearm injuries with a self-pay insurance status have a significantly higher rate of mortality. Hispanic patients regardless of insurance status were significantly less likely to discharge with posthospital care compared with non-Hispanic Whites with commercial insurance. Continued efforts are needed to understand and address the relationship between insurance status, race, and outcomes following firearm violence.

LEVEL OF EVIDENCE

Prognostic and epidemiologic, Level IV.
The anchor point algorithm: A morphometric analysis of anatomic landmarks to guide placement of temporary aortic Rescue stent grafts for noncompressible torso hemorrhage
Authors: Go Catherine , Fish Larry , Chun Youngjae , Alarcon Louis , Tillman Bryan W.
Published: January 2022

BACKGROUND

Noncompressible hemorrhage remains a high-mortality injury, which requires rapid damage control within minutes to avoid exsanguination. Retrievable stent grafts offer perfusion preserving hemorrhage damage control, and yet algorithms for device selection and positioning are lacking for an anatomically diverse human population. We hypothesized that easily acquired external measurements could be used to rapidly triage patients to receive one of several presized stents and that these metrics may further predict a single target on the aorta by which to optimize both mesenteric perfusion and aortic hemorrhage control.

METHODS

Metrics were acquired from computed tomography imaging of 203 male and female patients aged 18 to 50 years. Algorithms for metric based triage and stent sizing were examined against the cohort for effectiveness. Linear regression was used to predict a single target on the aorta for alignment of a multitiered stent. Next, the relationship of the anchor point to the palpable xiphoid was determined.

RESULTS

Clavicle to pubis measurements correlated with aortic length and was used to triage patients to one of three stent grafts. Stents for each triage group were sized to achieve >75% coverage of aortic Zones 1 and 3 in most patients while preserving carotid and visceral perfusion. A metric/sex-based equation that predicts the location of the superior mesenteric artery relative to the palpable xiphoid was derived. By alignment of a single point on the stent with this target, known as the anchor point, the remainder of the stent can be rapidly deployed while minimizing coverage of critical branches. When applied back to the cohort, only 10.4% had potential serious branch coverage events predicted.

CONCLUSION

Simple anatomic metrics offer rapid triage in this study population to one of three presized stent grafts and predict the location of key vascular branches. Confirmatory human trials will be essential to demonstrate safety and effectiveness of this approach.

LEVEL OF EVIDENCE

Prognostic/Epidemiological; Level IV.
It is time to look in the mirror: Individual surgeon outcomes after emergent trauma laparotomy
Authors: Hu Parker , Jansen Jan O. , Uhlich Rindi , Hashmi Zain G. , Gelbard Rondi B. , Kerby Jeffrey , Cox Daniel , Holcomb John B.
Published: January 2022

BACKGROUND

Multiple quality indicators are used by trauma programs to decrease variation and improve outcomes. However, little if any provider level outcomes related to surgical procedures are reviewed. Emergent trauma laparotomy (ETL) is arguably the signature case that trauma surgeons perform on a regular basis, but few data exist to facilitate benchmarking of individual surgeon outcomes. As part of our comprehensive performance improvement program, we examined outcomes by surgeon for those who routinely perform ETL.

METHODS

A retrospective cohort study of patients undergoing ETL directly from the trauma bay by trauma faculty from December 2019 to February 2021 was conducted. Patients were excluded from mortality analysis if they required resuscitative thoracotomy for arrest before ETL. Surgeons were compared by rates of damage control and mortality at multiple time points.

RESULTS

There were 242 ETL (7–32 ETLs per surgeon) performed by 14 faculties. Resuscitative thoracotomy was performed in 7.0% (n = 17) before ETL. Six patients without resuscitative thoracotomy died intraoperatively and damage-control laparotomy was performed on 31.9% (n = 72 of 226 patients). Mortality was 4.0% (n = 9) at 24 hours and 7.1% (n = 16) overall. Median Injury Severity Score (p = 0.21), new injury severity score (p = 0.21), and time in emergency department were similar overall among surgeons (p = 0.15), while operative time varied significantly (40–469 minutes; p = 0.005). There were significant differences between rates of individual surgeon's mortality (range [hospital mortality], 0–25%) and damage-control laparotomy (range, 14–63%) in ETL.

CONCLUSION

Significant differences exist in outcomes by surgeon after ETL. Benchmarking surgeon level performance is a necessary natural progression of quality assurance programs for individual trauma centers. Additional data from multiple centers will be vital to allow for development of more granular quality metrics to foster introspective case review and quality improvement.

LEVEL OF EVIDENCE

Therapeutic/care management, level III.
Intensive physical therapy after emergency laparotomy: Pilot phase of the Incidence of Complications following Emergency Abdominal surgery Get Exercising randomized controlled trial
Authors: Boden Ianthe , Sullivan Kate , Hackett Claire , Winzer Brooke , Hwang Rita , Story David , Denehy Linda
Published: January 2022

BACKGROUND

Postoperative pneumonia and delayed physical recovery are significant problems after emergency laparotomy. No randomized controlled trial has assessed the feasibility, safety, or effectiveness of intensive postoperative physical therapy in this high-risk acute population.

METHODS

The internal pilot phase of the Incidence of Complications after Emergency Abdominal Surgery: Get Exercising (ICEAGE) trial was a prospective, randomized controlled trial that evaluated the feasibility, safety, and clinical trial processes of providing intensive physical therapy immediately following emergency laparotomy. Fifty consecutive patients were recruited at the principal participating hospital and randomly assigned to standard-care or intensive physical therapy of twice daily coached breathing exercises for 2 days and 30 minutes of daily supervised rehabilitation over the first 5 postoperative days.

RESULTS

Interventions were provided exactly as per protocol in 35% (78 of 221 patients) of planned treatment sessions. Main barriers to protocol delivery were physical therapist unavailability on weekends (59 of 221 patients [27%]), awaiting patient consent (18 of 99 patients [18%]), and patient fatigue (26 of 221 patients [12%]). Despite inhibitors to treatment delivery, the intervention group still received twice as many breathing exercise sessions and four times the amount of physical therapy over the first 5 postoperative days (23 minutes [interquartile range, 12–29 minutes] vs. 86 minutes [interquartile range, 53–121 minutes]; p < 0.001). One adverse event was reported from 78 rehabilitation sessions (1.3%), which resolved fully on cessation of activity without escalation of medical care.

CONCLUSION

Intensive postoperative physical therapy can be delivered safely and successfully to patients in the first week after emergency laparotomy. The ICEAGE trial protocol resulted in intervention group participants receiving more coached breathing exercises and spending significantly more time physically active over the first 5 days after surgery compared with standard care. It was therefore recommended to progress into the multicenter phase of ICEAGE to definitively test the effect of intensive physical therapy to prevent pneumonia and improve physical recovery after emergency laparotomy.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level II.
A new nitronyl nitroxide radical with salicylic acid framework attenuates blood–brain barrier disruption and oxidative stress in a rat model of middle cerebral artery occlusion
Authors: Chen Lei , Ma Shanbo , Shi Min , Wang Qiaofeng , Miao Yi
Published: January 2022

Objectives

A new nitronyl nitroxide radical with a salicylic acid framework (SANR) has been demonstrated to exert antioxidant effects in the previous study by our team. The current study has assessed the protective effect of SANR on cerebral ischemia and reperfusion (I/R) in rat models.

Methods

Sprague–Dawley rats were randomly divided into four groups: sham, I/R, 10, and 20 mg/kg SANR + I/R groups. A total of 120 min of middle cerebral artery occlusion (MCAO) caused cerebral ischemia. Survival rates were calculated, and neurological deficits were evaluated by a blinded experimenter. Cerebral infarct area, apoptosis cells, and blood–brain barrier (BBB) leakage were measured by 2,3,5-triphenyltetrazolium chloride staining, terminal deoxynucleotidyl transferase dUTP nick-end labeling, and Evans blue assay, respectively. Reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and 8-hydroxy-2-deoxyguanosine (8-OHdG) also were detected to assess oxidation damage caused by cerebral I/R.

Results

Treatment with SANR significantly promoted survival of rats with cerebral I/R injury. SANR meliorated neurologic deficit and infarct area, improved BBB permeability, and reduced neuronal apoptosis. SANR also reduced ROS levels and the content of MDA and increased SOD and GSH-Px activity in a dose-dependent manner. Furthermore, SANR could inhibit the expression of 8-OHdG.

Conclusion

Our results suggested that SANR has a neuroprotective effect against cerebral I/R injury, and its effect mechanism is related to the antioxidant function.
Again with feeling: modes of visual representation of popular astronomy in the mid-nineteenth century
Authors: Bush Martin
Published: January 2022

Visualization is central to both the practice of astronomical science and its popularization. However, the dominant forms of imagery in many forms of mid-nineteenth century astronomical popularization are not observational images but rather geometrical diagrams. I describe two modes of visual representation of astronomy in this period and argue that these were based in two different conceptions of the science itself: as the sublime science revealing the power of Creation, or as the first and perfect mathematically pure science. Whereas these two modes were often kept distinct, there are notable examples of them being combined.
Kre28–Spc105 interaction is essential for Spc105 loading at the kinetochore
Authors: Roy Babhrubahan , Sim Janice , Han Simon J. Y. , Joglekar Ajit P.
Published: January 2022

Kinetochore (KTs) are macromolecular protein assemblies that attach sister chromatids to spindle microtubules (MTs) and mediate accurate chromosome segregation during mitosis. The outer KT consists of the KMN network, a protein super-complex comprising
K
nl1 (yeast Spc105),
M
is12 (yeast Mtw1), and
N
dc80 (yeast Ndc80), which harbours sites for MT binding. Within the KMN network, Spc105 acts as an interaction hub of components involved in spindle assembly checkpoint (SAC) signalling. It is known that Spc105 forms a complex with KT component Kre28. However, where Kre28 physically localizes in the budding yeast KT is not clear. The exact function of Kre28 at the KT is also unknown. Here, we investigate how Spc105 and Kre28 interact and how they are organized within bioriented yeast KTs using genetics and cell biological experiments. Our microscopy data show that Spc105 and Kre28 localize at the KT with a 1 : 1 stoichiometry. We also show that the Kre28–Spc105 interaction is important for Spc105 protein turn-over and essential for their mutual recruitment at the KTs. We created several truncation mutants of kre28 that affect Spc105 loading at the KTs. When over-expressed, these mutants sustain the cell viability, but SAC signalling and KT biorientation are impaired. Therefore, we conclude that Kre28 contributes to chromosome biorientation and high-fidelity segregation at least indirectly by regulating Spc105 localization at the KTs.
Live imaging YAP signalling in mouse embryo development
Authors: Gu Bin , Bradshaw Brian , Zhu Min , Sun Yu , Hopyan Sevan , Rossant Janet
Published: January 2022

YAP protein is a critical regulator of mammalian embryonic development. By generating a near-infrared fusion YAP reporter mouse line, we have achieved high-resolution live imaging of YAP localization during mouse embryonic development. We have validated the reporter by demonstrating its predicted responses to blocking LATS kinase activity or blocking cell polarity. By time lapse imaging preimplantation embryos, we revealed a mitotic reset behaviour of YAP nuclear localization. We also demonstrated deep tissue live imaging in post-implantation embryos and revealed an intriguing nuclear YAP pattern in migrating cells. The YAP fusion reporter mice and imaging methods will open new opportunities for understanding dynamic YAP signalling
in vivo
in many different situations.
Drug Contraindications in Comorbid Diseases: a Protein Interactome Perspective
Authors: Karunakaran Kalyani B. , Ganapathiraju Madhavi K. , Jain Sanjeev , Brahmachari Samir K. , Balakrishnan N.
Published: January 2022

Adverse drug reactions (ADRs) are leading causes of death and drug withdrawals and frequently cooccur with comorbidities. However, systematic studies on the effects of drugs in comorbidities are lacking. Drug interactions with the cellular protein-protein interaction (PPI) network give rise to ADRs. We selected 6 comorbid disease pairs, identified the drugs used in the treatment of the individual diseases ‘A’ and ‘B’– 44 drugs in anxiety and depression, 128 in asthma and hypertension, 48 in chronic obstructive pulmonary disease and heart failure, 58 in type 2 diabetes and obesity, 58 in Parkinson’s disease and schizophrenia, and 84 in rheumatoid arthritis and osteoporosis – and categorized them based on whether they aggravate the comorbid condition. We constructed drug target networks (DTNs) and examined their enrichment among genes in disease A/B PPI networks, expressed across 53 tissues and involved in ~1000 pathways. To pinpoint the biological features characterizing the DTNs, we performed principal component analysis and computed the Euclidean distance between DTN component scores and feature loading values. DTNs of disease A drugs not contraindicated in B were affiliated with proteins common to A/B networks or uniquely found in the B network, similarly regulated common pathways, and disease-B specific pathways and tissues. DTNs of disease A drugs contraindicated in B were affiliated with common proteins or those uniquely found in the A network, differentially regulated common pathways, and disease A-specific pathways and tissues. Hence, DTN enrichment in pathways, tissues, and PPI networks of comorbid diseases will help identify drugs contraindications in comorbidities.
Structure-Based Survey of the Human Proteome for Opportunities in Proximity Pharmacology
Authors: Rovers Evianne , Schapira Matthieu
Published: January 2022

Proximity pharmacology (ProxPharm) is a novel paradigm in drug discovery where a small molecule brings two proteins in close proximity to elicit a signal, generally from one protein onto another. The potential of ProxPharm compounds as a new therapeutic modality is firmly established by proteolysis targeting chimeras (PROTACs) that bring an E3 ubiquitin ligase in proximity to a target protein to induce ubiquitination and subsequent degradation of the target protein. The concept can be expanded to induce other post-translational modifications via the recruitment of different types of protein-modifying enzymes. To survey the human proteome for opportunities in proximity pharmacology, we systematically mapped non-catalytic drug binding pockets on the structure of protein-modifying enzymes available from the Protein Databank. In addition to binding sites exploited by previously reported ProxPharm compounds, we identified putative ligandable non-catalytic pockets in 188 kinases, 42 phosphatases, 26 deubiquitinases, 9 methyltransferases, 7 acetyltransferases, 7 glycosyltransferases, 4 deacetylases, 3 demethylases and 2 glycosidases, including cavities occupied by chemical matter that may serve as starting points for future ProxPharm compounds. This systematic survey confirms that proximity pharmacology is a versatile modality with largely unexplored and promising potential, and reveals novel opportunities to pharmacologically rewire molecular circuitries.
Transcranial alternating current stimulation does not modulate corticospinal activity in humans
Authors: Ibáñez J. , Zicher B. , Brown K. , Rocchi L. , Casolo A. , Del Vecchio A. , Spampinato D. , Vollette C-A. , Rothwell J. C. , Baker S. N. , Farina D.
Published: January 2022

Transcranial alternating current stimulation (TACS) is commonly used to synchronise the output of a cortical area to other parts of the nervous system, but evidence for this based on brain recordings in humans is challenging. The brain transmits beta oscillations (~21Hz) to tonically contracted limb muscles linearly and through the fastest corticospinal pathways. Therefore, muscle activity may be used as a proxy measure for the level of beta entrainment in the corticospinal tract due to TACS over motor cortex. Here, we assessed if TACS is able to modulate the neural inputs to muscles, which would provide an indirect evidence for TACS-driven neural entrainment. In the first part of this study, we ran a series of simulations of motor neuron (MN) pools receiving inputs from corticospinal neurons with different levels of beta entrainment. Results indicated that MNs should be highly sensitive to changes in corticospinal beta activity. Then, we ran experiments on healthy human subjects (N=10) in which TACS (at 1mA) was delivered over the motor cortex at 21Hz (beta stimulation), or at 7Hz or 40Hz (control conditions) while the abductor digiti minimi (ADM) or the tibialis anterior muscle (TA) were tonically contracted. Muscle activity was measured using high-density electromyography, which allowed us to decompose the spiking activity of pools of motor units innervating the studied muscles. By analysing motor unit pool activity, we observed that none of the tested TACS conditions could consistently alter the spectral characteristics of the common neural inputs received by the muscles. These results suggest that 1mA-TACS over motor cortex given at frequencies in the beta band does not affect corticospinal beta entrainment.

Highlights

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TACS is commonly used to entrain the communication between brain regions

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It is challenging to find direct evidence supporting TACS-driven neural entrainment

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Simulations show that motor neurons are sensitive to corticospinal beta entrainment

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Motor unit activity from human muscles does not support TACS-driven entrainment
Transverse and axial resolution of femtosecond laser ablation
Authors: Wang Yao L. , Grooms Noa W. F. , Chung Samuel H.
Published: January 2022

Femtosecond lasers are capable of precise ablation that produce surgical dissections in vivo. The transverse and axial resolution of the laser damage inside the bulk are important parameters of ablation. The transverse resolution is routinely quantified, but the axial resolution is more difficult to measure and is less commonly performed. In some in vivo samples, fine dissections can also be difficult to visualize, but in vitro samples may allow clear imaging. Using a 1040-nm, 400-fs pulsed laser, we performed ablation inside agarose and glass, producing clear and persistent damage spots. Near the ablation threshold of both media, we found that the axial resolution is similar to the transverse resolution. We also ablated neuron cell bodies and fibers in C. elegans and demonstrate submicrometer resolution in both the transverse and axial directions, consistent with our results in agarose and glass. Using simple yet rigorous methods, we define the resolution of laser ablation in transparent media along all directions.
Caenorhabditisnematodes colonize ephemeral resource patches in neotropical forests
Authors: Sloat Solomon A. , Noble Luke M. , Paaby Annalise B. , Bernstein Max , Chang Audrey , Kaur Taniya , Yuen John , Tintori Sophia C. , Jackson Jacqueline L. , Martel Arielle , Salome Correa Jose A. , Stevens Lewis , Blaxter Mark , Rockman Matthew V.
Published: January 2022

Factors shaping the distribution and abundance of species include life-history traits, population structure, and stochastic colonization-extinction dynamics. Field studies of model species groups help reveal the roles of these factors. Species ofCaenorhabditisnematodes are highly divergent at the sequence level but exhibit highly conserved morphological uniformity, and many of these species live in sympatry on microbe-rich patches of rotten material. Here, we use field experiments and large-scale opportunistic collections to investigate species composition, abundance, and colonization efficiency ofCaenorhabditisin two of the world’s best studied lowland tropical field sites: Barro Colorado Island in Panamá and La Selva in Sarapiquí, Costa Rica. We observed seven species ofCaenorhabditis, four of them known only from these collections. While these localities contain species from many parts of the phylogeny, both localities were dominated by globally distributed androdiecious species. We found thatCaenorhabditiswere able to colonize baits accessible only by phoresy, preferring to colonize baits making direct contact with the ground. We estimate founder numbers per colonization event to be low.
Obesity associated with attenuated tissue immune cell responses in COVID-19
Authors: Guo Shuang A. , Bowyer Georgina S. , Ferdinand John R. , Maes Mailis , Tuong Zewen K. , Gilman Eleanor , Liao Mingfeng , Lindeboom Rik G. H. , Yoshida Masahiro , Worlock Kaylee , Gopee Huda , Stephenson Emily , Lyons Paul A. , Smith Kenneth G.C. , Haniffa Muzlifah , Meyer Kerstin B. , Nikolić Marko Z. , Zhang Zheng , Wunderink Richard G. , Misharin Alexander V. , Dougan Gordon , Navapurkar Vilas , Teichmann Sarah A. , Conway-Morris Andrew , Clatworthy Menna R.
Published: January 2022

Obesity is common and associated with more severe COVID-19, proposed to be in part related to an adipokine-driven pro-inflammatory state. Here we analysed single cell transcriptomes from bronchiolar lavage in three adult cohorts, comparing obese (Ob, body mass index (BMI) >30m2) and non-obese (N-Ob, BMI <30m2). Surprisingly, we found that Ob subjects had attenuated lung immune/inflammatory responses in SARS-CoV-2 infection, with decreased expression of interferon (IFN)α, IFNγ and tumour necrosis factor (TNF) alpha response gene signatures in almost all lung epithelial and immune cell subsets, and lower expression of IFNG and TNF in specific lung immune cells. Analysis of peripheral blood immune cells in an independent adult cohort showed a similar, but less marked, reduction in type I IFN and IFNγ response genes, as well as decreased serum IFNα, in Ob patients with SARS-CoV-2. Nasal immune cells from Ob children with COVID-19 also showed reduced enrichment of IFNα and IFNγ response genes. Altogether, these findings show blunted tissue immune responses in Ob COVID-19 patients, with clinical implications.