bluuebunny/crossref_metadata_2025 huggingface dataset:
The performance and costs of XTT, resazurin, MTS and luciferin as viability dyes in in vitro susceptibility testing of Madurella mycetomatis
Authors: Ma Jingyi , Eadie Kimberly , Fahal Ahmed , Verbon Annelies , van de Sande Wendy W J
Published: May 2024

Background

in vitro susceptibility testing for the non-sporulating fungus Madurella mycetomatis is performed with a hyphal suspension as starting inoculum and a viability dye for endpoint reading. Here we compared the performance of four different viability dyes for their use in in vitro susceptibility testing of M. mycetomatis.

Methods

To compare the reproducibility and the agreement between the viability dyes 2,3-bis-(2-methoxy-4-nitro-5-sulfphenyl)-2H-tetrazolium-5-carboxanilide salt (XTT), resazurin, 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium salt (MTS) and luciferin, the in vitro susceptibilities of 14 genetically diverse M. mycetomatis isolates were determined for itraconazole and amphotericin B. The reproducibility, agreement, price and ease of use were compared.

Results

Each of the four dyes gave highly reproducible results with >85.7% reproducibility. Percentage agreement ranged between 78.9% and 92.9%. Resazurin was the most economical to use (0.0009 €/minimal inhibitory concentration [MIC]) and could be followed in real time. Luciferin omitted the need to transfer the supernatant to a new 96-well plate, but cost 6.07 €/MIC.

Conclusion

All four viability dyes were suitable to determine the in vitro susceptibility of M. mycetomatis against itraconazole and amphotericin B. Based on the high reproducibility, high percentage agreement, price and possibility to monitor in real time, resazurin was the most suited for routine in vitro susceptibility testing in the diagnostic laboratory in mycetoma-endemic countries. Because luminescence could be measured directly without the need to transfer the supernatant to a new 96-well plate, luciferin is suitable for drug-screening campaigns.

Lay summary

To determine the in vitro susceptibility testing in the non-sporulating fungus Madurella mycetomatis, a viability dye is needed for endpoint reading. In this study we tested the viability dyes XTT, resazurin, MTS and luciferin for their use in in vitro susceptibility testing. It appeared that they all could be used but there were differences in time to result and costs associated with them.
Fungal Communities Shift with Soybean Cyst Nematode Abundance in Soils
Authors: López Melanie Medina , Lopez-Nicora Horacio D. , Ponce Maria Soledad Benitez
Published: May 2024

Plant parasitic nematodes pose a significant threat to food security. Management strategies for these pathogens are limited, and additional tools for their control are needed. Some fungi have shown promise for biocontrol; however, their success in the field has varied. In contrast, some fungal plant pathogens form synergistic associations with nematodes, resulting in increased plant disease severity. However, how the two groups of fungi change with different plant parasitic nematode abundances in the soil is underexplored. In this study, we used the soybean cyst nematode as a model to understand these changes. We sampled soil from 171 Ohio soybean fields in 2019 and 2021 and determined soybean cyst nematode abundance. We identified the fungi in the samples through amplicon sequencing of the 18S-ITS rDNA regions. Edaphoclimatic factors were used to classify samples into geographic regions to account for environmental differences between sampling locations. We hypothesized that fungal communities would be influenced by both region and soybean cyst nematode abundance. K-near-neighbor analysis revealed that fungal communities follow regional patterns. We also found that soybean cyst nematode abundance was associated with changes in these communities regardless of the region. Two potential nematophagous fungi were found to be prevalent in Ohio through core community analysis, although they were enriched when soybean cyst nematode abundance was high. Finally, differential network analysis showed that interactions among fungal community members change when soybean cyst nematode is present in the soil. Together these results suggest that this nematode significantly shifts the fungal community composition in field soils.

[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 .
Evaluating UV-C Sensitivity of Calonectria pseudonaviculata in Model Buffer Solution Using a UV-C Light-Emitting-Diode System
Authors: Ghimire Bhawana , Pendyala Brahmaiah , Patras Ankit , Baysal-Gurel Fulya
Published: May 2024

Calonectria pseudonaviculata, responsible for boxwood blight, produces sticky conidia that pose a contamination risk in boxwood production via cross-contamination from tools, equipment, and other resources. This study evaluated UV-C light-emitting-diode (LED) irradiation (263 to 287 nm) as a disinfection method by examining its effectiveness in inactivating conidia and determining the UV-C sensitivity. Conidial suspensions were exposed to quantifiable UV-C doses under a dynamic stirring condition. Average volumetric intensity was quantified by accounting for UV gradients and UV dose was calculated as a product of average fluence rate (mW⋅cm−2) and exposure time (s). UV-C irradiation effectively inactivated the tested pathogen following log-linear + shoulder kinetics as identified by parameters of goodness of model fit (i.e., high R2 and low root mean square error [RMSE] values). The model predicted the UV sensitivity of C. pseudonaviculata conidia as 46.6 mJ⋅cm−2 per log. A total of 2.04 log reductions of the population could be obtained by an exposure of 60 mJ⋅cm−2 of UV-C dose. The calculated decimal reduction dose (D10) was 13.53 ± 0.98 mJ⋅cm−2 (R2 = 0.97, RMSE = 0.14), inactivation rate constant (Kmax) = 0.17 ± 0.01, and shoulder length = 33.06 ± 1.81 mJ⋅cm−2. These findings indicate that UV-C irradiation could be a viable option for disinfecting tools, equipment, and possibly propagation cuttings in nurseries.
Cultivars and Production Environments Shape Shoot Endophyte Profiles of Boxwood with Different Blight Resistance
Authors: Li Xiaoping , Weiland Jerry E. , Ohkura Mana , Luster Douglas G. , Daughtrey Margery L. , Gouker Fred E. , Chen Gloria , Kong Ping , Hong Chuanxue
Published: May 2024

Phyllosphere colonizers, including bacteria and fungi, are critical for plant growth and health. However, how they are affected simultaneously by the host plant cultivar, local environment, and agricultural practices was not well understood. We used boxwood, an iconic landscape plant and a major evergreen shrub crop in the United States nursery industry, as a model plant and sequenced 16S rRNA and ITS amplicons to examine the assemblages of endophytic bacteria and fungi in the shoots of four cultivars representing three levels of boxwood blight resistance under two distinct climates and production systems in Oregon and Virginia. Cultivar and local environment were the two main drivers shaping the composition and structure of the boxwood endophytic microbial community, particularly the fungal community. Three bacterial and seven fungal genera were consistently identified with high prevalence and abundance as the core taxa from four cultivars and two locations across three sampling times. The microbial composition varied among the levels of boxwood blight resistance, and taxa specific to the tolerant cultivar were fewer compared to the susceptible one. Identification of these microbial indicators, along with the core taxa, is foundational for developing a microbiome-based plant breeding program and a systems approach to improve boxwood health and production under a changing climate.

[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 .
IL1β‐NFκβ‐Myocardin signaling axis governs trophoblast‐directed plasticity of vascular smooth muscle cells
Authors: Das Priyanka , Bose Rumela , Paul Madhurima , Nandy Debdyuti , Basak Trishita , Ain Rupasri
Published: May 2024

Vascular smooth muscle cell (VSMC) plasticity is fundamental in uterine spiral artery remodeling during placentation in Eutherian mammals. Our previous work showed that the invasion of trophoblast cells into uterine myometrium coincides with a phenotypic change of VSMCs. Here, we elucidate the mechanism by which trophoblast cells confer VSMC plasticity. Analysis of genetic markers on E13.5, E16.5, and E19.5 in the rat metrial gland, the entry point of uterine arteries, revealed that trophoblast invasion is associated with downregulation of MYOCARDIN, α‐smooth muscle actin, and calponin1, and concomitant upregulation of Smemb in VSMCs. Myocardin overexpression or knockdown in VSMCs led to upregulation or downregulation of contractile markers, respectively. Co‐culture of trophoblast cells with VSMCs decreased MYOCARDIN expression along with compromised expression of contractile markers in VSMCs. However, co‐culture of trophoblast cells with VSMCs overexpressing MYOCARDIN inhibited their change in phenotype, whereas, overexpression of transactivation domain deleted MYOCARDIN failed to elicit this response. Furthermore, the co‐culture of trophoblast cells with VSMCs led to the activation of NFκβ signaling. Interestingly, despite producing IL‐1β, trophoblast cells possess only the decoy receptor, whereas, VSMCs possess the IL‐1β signaling receptor. Treatment of VSMCs with exogenous IL‐1β led to a decrease in MYOCARDIN and an increase in phosphorylation of NFκβ. The effect of trophoblast cells in the downregulation of MYOCARDIN in VSMCs was reversed by blocking NFκβ translocation to the nucleus. Together, these data highlight that trophoblast cells direct VSMC plasticity, and trophoblast‐derived IL‐1β is a key player in downregulating MYOCARDIN via the NFκβ signaling pathway.
Trainees as Agents of Change: A Theory-Informed Model for Trainee-Driven Curricular Advocacy in Medical Education
Authors: Clarke Lauren
Published: May 2024

Trainees (medical students, residents, and fellows) are beginning to make strides in pushing for changes to their education. While there are many examples of successful trainee-led curriculum reform efforts, the path to success remains unclear. To better understand the process of trainee-driven curricular advocacy, the author analyzes this process through the lens of ecological systems theory (EST) not only to provide readers with context for the barriers and facilitators to trainee-driven curricular advocacy but also to further medical education’s understanding of the sociopolitical forces influencing the process of trainee-driven curricular advocacy and reform through the lens of the trainee. EST explains how individuals are influenced by a complex web of social and environmental forces. The theory outlines 5 ecological systems of influence: the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Using EST to explore the process of trainee-driven curricular advocacy therefore clarifies the many layers of influence that trainees must navigate while advocating for curriculum change. The author then draws on this theory and their own experience as a medical student advocating for local and national curriculum reform to develop a model to facilitate trainee-driven curricular advocacy in medical education. The proposed model outlines concrete steps trainees can take while going through the process of curricular advocacy both within their own institutions and on a national level. Through developing this model, the author hopes not only to empower trainees to become agents of change in medical education but also to encourage faculty members and administrators within health professional training programs to support trainees in these efforts.
A Guiding Model for Undergraduate Medical Education Well-Being Programs
Authors: Lawrence Elizabeth C. , Sheridan Chantal , Hurtado Alicia , Lee Wei Wei , Lizotte-Waniewski Michelle , Rea Margaret , Zehle Christa
Published: May 2024

Most medical schools have instituted undergraduate medical education (UME) well-being programs in recent years in response to high rates of medical student distress, but there is currently significant variability in the structure of UME well-being programs and limited guidance on how to best structure such programs to achieve success. In this article, the authors, all leaders of medical student well-being programs at their home institutions and members of the Association of American Medical Colleges Group on Student Affairs Committee on Student Affairs Working Group on Medical Student Well-Being between 2019 and 2023 offer guidance to the national community on how best to structure a UME well-being program. They use the current literature and their professional experiences leading well-being efforts at 7 different institutions to review the case for addressing medical student well-being, propose a guiding model, and make recommendations for strategies to implement this model.

The proposed guiding model emphasizes the importance of the learning environment and efficiency of learning to medical student well-being, as well as personal resilience. Based on this model, the authors recommend specific and tangible well-being strategies to implement systemic interventions to improve the learning environment, efficiency of learning, and personal resilience, including formalizing the well-being program; hiring qualified, dedicated, and empowered well-being leadership with clear responsibilities; acting as a central hub for resources and as a liaison with mental health care; and establishing robust program evaluation methods.
Ligamentous Augmentation to Prevent Proximal Junctional Kyphosis and Failure
Authors: Weng Chong , Niemeier Thomas , Mohammed Zuhair J. , Eberhardt Alan , Theiss Steven M. , Rajaram Manoharan Sakthivel R.
Published: May 2024

Study Design:

Biomechanical cadaveric study (level V).

Objective:

To evaluate the effectiveness of polyethylene bands looped around the supra-adjacent spinous process (SP) or spinal lamina (SL) in providing strength to the cephalad unfused segment and reducing junctional stress.

Background:

Proximal junctional kyphosis (PJK) is a pathologic kyphotic deformity adjacent to posterior spinal instrumentation after fusion constructs. Recent studies demonstrate a mismatch in stiffness between the instrumented construct and nonfused adjacent levels to be a causative factor in the development of PJK and proximal junction failure. To our knowledge, no biomechanical studies have addressed the effect of different methods of polyethylene band placement at the proximal junction.

Materials and Methods:

Twelve fresh frozen cadavers were divided into 3 groups of 4: pedicle screw-based instrumentation from T10 to L5 (“control”), T10–L5 instrumentation with a polyethylene band to the T9 “SP,” T10–L5 instrumentation with 2 polyethylene bands to the T9 “SL.” Specimens were tested with an eccentric (10 mm anterior) load at 5 mm/min for 15 mm or until failure occurred. Failure was defined by the inflection point on the load versus deformation curves. Linear regression was utilized to evaluate the effect of augmentation on the load-to-failure. Significance was set at 0.05.

Results:

Fractures occurred in all specimens tested. The mean peak load to failure was 2148 N (974–3322) for the SP group, and 1248 N (742–1754) for the control group (P > 0.05) and 1390 N (1080–2004) for the SL group. No difference existed between the control group and the SP group in terms of fracture level (P > 0.05). Net kyphotic angulation shows no differences among these 3 groups (P > 0.05).

Conclusion:

Although statistical significance was not achieved, ligament augmentation to the SP increased mean peak load-to-failure in a cadaveric PJK model.
Feasibility of Using Intraoperative Neurophysiological Monitoring for Detecting Bone Layer of Cervical Spine Surgery
Authors: Zuo Weiyang , Yu Lingjia , Tan Haining , Li Xiang , Zhu Bin , Liu Yuquan , Peng Xuan , Yang Yong , Fei Qi
Published: May 2024

Study Design:

Intraoperative neurophysiological monitoring (IONM) as a guide to bone layer estimation was examined during posterior cervical spine lamina grinding.

Objective:

To explore the feasibility of IONM to estimate bone layer thickness.

Summary of Background Data:

Cervical laminoplasty is a classic operation for cervical spondylosis. To increase safety and accuracy, surgery-assistant robots are currently being studied. It combines the advantages of various program awareness methods to form a feasible security strategy. In the field of spinal surgery, robots have been successfully used to help place pedicle screws. IONM is used to monitor intraoperative nerve conditions in spinal surgery. This study was designed to explore the feasibility of adding IONM to robot safety strategies.

Methods:

Chinese miniature pig model was used. Electrodes were placed on the lamina, and the minimum stimulation threshold of DNEP for each lamina was measured (Intact lamina, IL). The laminae were ground to measure the DNEP threshold after incomplete grinding (Inner cortical bone preserved, ICP) and complete grinding (Inner cortical bone grinded, ICG). Subsequently, the lateral cervical mass screw canal drilling was performed, and the t-EMG threshold of the intact and perforated screw canals was measured and compared.

Result:

The threshold was significantly lower than that of the recommended threshold of DENP via percutaneous cervical laminae measurement. The DNEP threshold decreases with the process of laminae grinding. The DNEP threshold of the IL group was significantly higher than ICP and ICG group, while there was no significant difference between the ICP group and the ICG group. There was no significant relationship between the integrity of the cervical spine lateral mass screw path and t-EMG threshold.

Conclusions:

It is feasible to use DENP threshold to estimate lamina thickness. Cervical lateral mass screw canals by t-EMG showed no help to evaluate the integrity.
Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients
Authors: Goder Noam , Gerstenhaber Fabian , Gal Oz Amir , Stavi Dekel , Angel Yoel , Nini Asaph , Lichter Yael , Sold Oded
Published: May 2024

IMPORTANCE:

To explore the correlation between cortisol levels during first admission day and clinical outcomes.

OBJECTIVES:

Although most patients exhibit a surge in cortisol levels in response to stress, some suffer from critical illness-related corticosteroid insufficiency (CIRCI). Literature remains inconclusive as to which of these patients are at greater risk of poor outcomes.

DESIGN:

A retrospective study.

SETTING:

A surgical ICU (SICU) in a tertiary medical center.

PARTICIPANTS:

Critically ill patients admitted to the SICU who were not treated with steroids.

MAIN OUTCOMES AND MEASURES:

Levels of cortisol taken within 24 hours of admission (day 1 [D1] cortisol) in 1412 eligible patients were collected and analyzed. Results were categorized into four groups: low (0–10 µg/dL), normal (10–25 µg/dL), high (25–50 µg/dL), and very high (above 50 µg/dL) cortisol levels. Primary endpoint was 90-day mortality. Secondary endpoints were the need for organ support (use of vasopressors and mechanical ventilation [MV]), ICU length of stay (LOS), and duration of MV.

RESULTS:

The majority of patients (63%) had high or very high D1 cortisol levels, whereas 7.6% had low levels and thus could be diagnosed with CIRCI. There were statistically significant differences in 90-day mortality between the four groups and very high levels were found to be an independent risk factor for mortality, primarily in patients with Sequential Organ Failure Assessment (SOFA) less than or equal to 3 or SOFA greater than or equal to 7. Higher cortisol levels were associated with all secondary endpoints. CIRCI was associated with favorable outcomes.

CONCLUSIONS AND RELEVANCE:

In critically ill surgical patients D1 cortisol levels above 50 mcg/dL were associated with mortality, need for organ support, longer ICU LOS, and duration of MV, whereas low levels correlated with good clinical outcomes even though untreated. D1 cortisol level greater than 50 mcg/dL can help discriminate nonsurvivors from survivors when SOFA less than or equal to 3 or SOFA greater than or equal to 7.
Direct reprogramming of fibroblasts into functional hepatocytes via CRISPRa activation of endogenous Gata4 and Foxa3
Authors: Li Jiacheng , Li Ruopu , Bai Xue , Zhang Wenlong , Nie Yu , Hu Shengshou
Published: May 2024

Background:

The ability to generate functional hepatocytes without relying on donor liver organs holds significant therapeutic promise in the fields of regenerative medicine and potential liver disease treatments. Clustered regularly interspaced short palindromic repeats (CRISPR) activator (CRISPRa) is a powerful tool that can conveniently and efficiently activate the expression of multiple endogenous genes simultaneously, providing a new strategy for cell fate determination. The main purpose of this study is to explore the feasibility of applying CRISPRa for hepatocyte reprogramming and its application in the treatment of mouse liver fibrosis.

Method:

The differentiation of mouse embryonic fibroblasts (MEFs) into functional induced hepatocyte-like cells (iHeps) was achieved by utilizing the CRISPRa synergistic activation mediator (SAM) system, which drove the combined expression of three endogenous transcription factors—Gata4, Foxa3, and Hnf1a—or alternatively, the expression of two transcription factors, Gata4 and Foxa3. In vivo, we injected adeno-associated virus serotype 6 (AAV6) carrying the CRISPRa SAM system into liver fibrotic Col1a1-Cre

ER
; Cas9

fl/
fl
mice, effectively activating the expression of endogenous Gata4 and Foxa3 in fibroblasts. The endogenous transcriptional activation of genes was confirmed using real-time quantitative polymerase chain reaction (RT-qPCR) and RNA-seq, and the morphology and characteristics of the induced hepatocytes were observed through microscopy. The level of hepatocyte reprogramming in vivo is detected by immunofluorescence staining, while the improvement of liver fibrosis is evaluated through Sirius red staining, alpha-smooth muscle actin (α-SMA) immunofluorescence staining, and blood alanine aminotransferase (ALT) examination.

Results:

Activation of only two factors, Gata4 and Foxa3, via CRISPRa was sufficient to successfully induce the transformation of MEFs into iHeps. These iHeps could be expanded in vitro and displayed functional characteristics similar to those of mature hepatocytes, such as drug metabolism and glycogen storage. Additionally, AAV6-based delivery of the CRISPRa SAM system effectively induced the hepatic reprogramming from fibroblasts in mice with live fibrosis. After 8 weeks of induction, the reprogrammed hepatocytes comprised 0.87% of the total hepatocyte population in the mice, significantly reducing liver fibrosis.

Conclusion:

CRISPRa-induced hepatocyte reprogramming may be a promising strategy for generating functional hepatocytes and treating liver fibrosis caused by hepatic diseases.
SIRT3 protects endometrial receptivity in patients with polycystic ovary syndrome
Authors: Zeng Zhonghong , Shan Hongying , Lin Mingmei , Bao Siyu , Mo Dan , Deng Feng , Yu Yang , Yang Yihua , Zhou Ping , Li Rong
Published: May 2024

Background:

The sirtuin family is well recognized for its crucial involvement in various cellular processes. Nevertheless, studies on its role in the human endometrium are limited. This study aimed to explore the expression and localization of the sirtuin family in the human endometrium, focusing on sirtuin 3 (SIRT3) and its potential role in the oxidative imbalance of the endometrium in polycystic ovary syndrome (PCOS).

Methods:

Endometrial specimens were collected from both patients with PCOS and controls undergoing hysteroscopy at the Center for Reproductive Medicine, Peking University Third Hospital, from July to August 2015 and used for cell culture. The protective effects of SIRT3 were investigated, and the mechanism of SIRT3 in improving endometrial receptivity of patients with PCOS was determined using various techniques, including cellular bioenergetic analysis, small interfering ribonucleic acid (siRNA) silencing, real-time quantitative polymerase chain reaction, Western blot, immunofluorescence, immunohistochemistry, and flow cytometry analysis.

Results:

The sirtuin family was widely expressed in the human endometrium, with SIRT3 showing a significant increase in expression in patients with PCOS compared with controls (P <0.05), as confirmed by protein and gene assays. Concurrently, endometrial antioxidant levels were elevated, while mitochondrial respiratory capacity was reduced, in patients with PCOS (P <0.05). An endometrial oxidative stress (OS) model revealed that the downregulation of SIRT3 impaired the growth and proliferation status of endometrial cells and reduced their receptivity to day 4 mouse embryos. The results suggested that SIRT3 might be crucial in maintaining normal cellular state by regulating antioxidants, cell proliferation, and apoptosis, thereby contributing to enhanced endometrial receptivity.

Conclusions:

Our findings proposed a significant role of SIRT3 in improving endometrial receptivity in patients with PCOS by alleviating OS and regulating the balance between cell proliferation and apoptosis. Therefore, SIRT3 could be a promising target for predicting and improving endometrial receptivity in this patient population.
Oncologic Outcomes for Squamous Cell Carcinoma In Situ With a Clinically Resolved Biopsy Site Managed by Watchful Waiting
Authors: Logan Sam , Porter Hannah J. , Lowry Joy , Carpenter Cari , Seward David J. , Holmes Todd , Goldman Glenn , Bui Melanie R.
Published: May 2024

BACKGROUND

Treatment option decisions for low-risk squamous cell carcinoma in situ (SCCIS) are hampered by a paucity of management-type–specific outcomes data.

OBJECTIVE

Describe SCCIS tumor outcomes managed by watchful waiting and risk factors associated with poor cancer outcomes.

MATERIALS AND METHODS

Retrospective cohort study. Setting: Single academic hospital in a rural setting. Patients: Adults with SCCIS diagnosed between January 01, 2014, and December 31, 2016. Main Outcomes and Measures: Hazard ratios (HRs) for local recurrence (LR), nodal metastases (NM), distant metastases (DM), and disease-specific death (DSD).

RESULTS

A total of 411 consecutive SCCIS tumors that were considered clinically resolved at follow-up and managed with watchful waiting were included. Seventeen tumors recurred locally. No instances of NM, DM, or DSD were identified. Multivariate analysis found that solid-organ transplant recipient status conferred the highest risk of local recurrence [HR, 9.979 (95% CI, 2.249–39.69)]. Additional risk factors predicting LR include anatomic location on the vermilion lip or ear [HR, 9.744 (95% CI, 1.420–69.28)], anatomic location on the head and neck [HR, 6.687 (95% CI, 1.583–36.15)], and a biopsy with tumor extending to the deep edge [HR, 6.562 (95% CI, 1.367–39.04)].

CONCLUSION

Watchful waiting for SCCIS with a clinically resolved biopsy site has a local recurrence rate of 4%.
Growing Adoption of Immunohistochemistry by Mohs Micrographic Surgeons: A National Medicare Trend Analysis
Authors: Gronbeck Christian , Feng Hao , Knackstedt Thomas
Published: May 2024

BACKGROUND

Immunohistochemical (IHC) staining can be used alongside Mohs micrographic surgery to aid in margin assessment of subtle tumors, yet existing estimates of IHC utilization have primarily relied on survey or older data that lacks stratification.

OBJECTIVE

To characterize national IHC utilization trends by Mohs surgeons, stratifying by surgeon characteristics and modeling future adoption.

METHODS

Longitudinal analysis of 2014 to 2021 Medicare Public Use Files.

RESULTS

In 2021, 158 of 2,058 Mohs surgeons (7.7%) used IHC as compared with 4.0% in 2014 (average annual growth rate [AAGR] +3.6%). Adoption change was highest in the Northeast (AAGR +19.9%), whereas volume growth was greatest in the West (AAGR +25.2%). Multivariable regression revealed significantly greater utilization propensity among Mohs surgeons in academics (adjusted odds ratio [aOR] 3.36), American College of Mohs Surgery (ACMS) members (aOR 2.12), and Micrographic Dermatologic Surgery (MDS)-certified surgeons (aOR 1.66).

CONCLUSION

Mohs surgeons are steadily incorporating IHC into practice across all regions, with volume growth driven by higher adoption rates. Greater utilization among ACMS members, recipients of MDS certification, and those in academics suggests value of formalized training in enhancing comfort. Additional educational opportunities at conferences may aid in recognition of value and help identify solutions to address integration challenges.
Nonsurgical Gluteal Volume Correction with Hyaluronic Acid: A Retrospective Study to Assess Long-term Safety and Efficacy
Authors: Crabai Piero , Marchetti Francesco , Santacatterina Fulvio , Fontenete Silvia , Galera Teresa
Published: May 2024

Background:

Augmentation and reshaping of body volume, particularly in the gluteal area, presents a significant challenge in aesthetic surgery. Hyaluronic acid (HA) fillers have emerged as an effective and safe tool for such indications, but literature examining nonsurgical gluteal reshaping with HA remains limited. This study aims to evaluate the long-term safety of using recommended volumes of HA body fillers for nonsurgical gluteal augmentation.

Methods:

A retrospective, observational study was carried out across multiple centers in Italy and the United Arab Emirates. The study involved participants between 22 and 53 years of age who underwent gluteal augmentation using HA body filler (HYAcorp MLF1/2) between 2017 and 2021, with up to 4 years and 7 months of follow-up. Participants and investigators independently evaluated the procedure’s effectiveness by comparing pre- and posttreatment photographs. The Global Aesthetic Improvement Scale was used to assess posttreatment satisfaction by both participants and investigators. All adverse effects (AEs) were recorded.

Results:

The study included a diverse group of 91 participants. No serious adverse events were reported, with the majority of AE occurring shortly after treatment and resolving in 1 week. AEs were more frequently observed in participants with previous treatments using different substances in the treatment area.

Conclusions:

The real-world application of HA body filler (HYAcorp MLF1/2) for gluteal augmentation in the participants of this study showed the treatment’s effectiveness, with no severe adverse events reported among the participants. High levels of satisfaction were reported among both participants and investigators.
Reporting guidelines for clinical practice guidelines of traditional Chinese medicine: Current status and future prospects
Authors: Luo Xufei , Wang Xiaohui , Chen Yaolong
Published: May 2024

High-quality Traditional Chinese Medicine (TCM) guidelines can standardize the clinical practices of relevant healthcare professionals, enhance medical quality, reduce healthcare costs, and promote the standardization of TCM. This article provides a summary and analysis of the status and quality of guidelines in the TCM. Additionally, it briefly introduces the reporting standards for three types of TCM guidelines, aiming to serve as a reference for those involved in the development and reporting of TCM guidelines.
Epidemiology, screening, and co-management of type 2 diabetes mellitus and metabolic dysfunction–associated steatotic liver disease
Authors: Qi Xiaolong , Li Jie , Caussy Cyrielle , Teng Gao-Jun , Loomba Rohit
Published: May 2024

Metabolic dysfunction–associated steatotic liver disease (MASLD), previously known as NAFLD, is increasingly recognized as a prevalent global burden. Type 2 diabetes mellitus (T2DM), another important metabolic disease, is considered a major contributor to the development of MASLD. MASLD and T2DM have a strong association with each other due to shared pathogenic mechanisms. The co-existence of the 2 diseases increases the risk of liver-related adverse outcomes and imposes a heavier burden on extrahepatic outcomes, representing a substantial public health issue. Effective assessment and management of T2DM combined with MASLD necessitate a multidisciplinary approach. The emergence of numerous RCTs has shed light on the treatment of T2DM combined with MASLD. This review uncovers the epidemiology of the intertwined T2DM and MASLD, offers insights into the evaluation of hepatic fibrosis in patients with T2DM, glucose monitoring in the MASLD population, and provides comprehensive co-management strategies for addressing both diseases.
Overview of Mycotic Keratitis
Authors: Arboleda Alejandro , Ta Christopher N.
Published: May 2024

Keratomycosis is a serious corneal infection associated with high ocular morbidity that can lead to severe vision loss. It is estimated to affect more than 1 million patients annually, most commonly occurring in tropical climates, and represents a growing threat to patients worldwide. Despite aggressive medical management, fungal infections have a higher rate of perforation requiring surgical intervention compared with other infectious etiologies. Early diagnosis and appropriate treatment are keys to preserving vision and saving patients' eyes.

Timely diagnosis of fungal keratitis helps minimize corneal damage and scarring and increases the likelihood of a favorable outcome. Studies have shown that correct identification of fungal infections is often delayed up to 2 to 3 weeks after initial presentation. This leads to incorrect or ineffective treatment for many patients. Diagnostic techniques explored in this study include corneal scrapings with staining and culture, visualization with in vivo confocal microscopy, molecular diagnostic techniques including polymerase chain reaction, and recently developed omics-based technologies.

Treatment of fungal keratitis begins with topical antifungals. Medical management has been proven to be effective, but with limitations including poor drug penetration and low bioavailability. Cases that do not respond to topical therapy require more invasive and novel treatments to control the infection. We review the clinical trials that have shaped current practice patterns, with focus on the efficacy of topical natamycin as the primary therapy for filamentous fungal keratitis. We explore additional management strategies such as localized intrastromal and intracameral injections of antifungal medications, photodynamic therapy, and surgical intervention.
The Effect of Exercise on Intraocular Pressure and Glaucoma
Authors: Gildea David , Doyle Aoife , O’Connor Jeremy
Published: May 2024

Précis:

A review of the literature found that certain types of exercise and physical activity result in transient reductions in intraocular pressure and may have a beneficial effect on glaucoma severity and progression.

Introduction:

Glaucoma is the most common cause of irreversible vision loss worldwide. Raised intraocular pressure (IOP) is the most important risk factor for the disease. Exercise is known to result in changes in IOP. The purpose of this review was to investigate the effect of exercise on IOP and glaucoma.

Methods:

A comprehensive search of multiple literature databases was performed. Medline, EMBASE, and Cochrane libraries were used to search for the relevant terms. 16 original studies were selected for the review.

Results:

Exercise of varying intensity and type has differing effects on IOP. Moderate-intensity aerobic exercise results in transient reductions in IOP, while high-intensity resistance exercise and weight-lifting lead to transient elevations in IOP. There is evidence to suggest that exercise and higher levels of fitness may be protective against the development of glaucoma. In addition, increased daily physical activity may be associated with less visual field progression in patients with glaucoma. While secondary causes of glaucoma are included in some of the studies discussed in this review, the findings are largely applicable to primary open angle glaucoma.

Conclusion:

Exercise may be a beneficial lifestyle modification in the management of glaucoma; however, further longitudinal studies are required to validate this.
False Passage of 5-0 Polypropylene Suture into Episcleral Vein during Gonioscopy-Assisted Transluminal Trabeculotomy
Authors: Palan Parth , Senthil Sirisha
Published: May 2024

Gonioscopy-assisted transluminal trabeculotomy (GATT) is a promising cost-effective minimally invasive glaucoma surgery (MIGS). The main advantage is safety with regards to low risk for hypotony and its related complications. However, the Schlemm’s canal (SC) based procedures have a different set of complications, the most common being hyphema and transient intraocular pressure spike. The other rare complications being, the false passage of the suture by traversing the external wall of the SC into the suprachoroidal space or posterior chamber or breaching the internal wall of the SC into the anterior chamber. Although these complications are rare, knowledge about them is important not only for early identification but for prevention and management if they occur. Through this case report, we describe a rare complication where the suture had traversed through a dilated episcleral vein during GATT. To our knowledge, there has been no prior report of such a complication.
A Case of Lepromatous Leprosy (Lucio’s Phenomenon) Presenting as Periorbital Edema
Authors: Swain David L. , Green Michael B. , Kupcha Anna C.
Published: May 2024

Despite low prevalence of leprosy worldwide, new cases continue to present and require swift evaluation and diagnosis to prevent complications. Here, we describe a case of lepromatous leprosy with Lucio’s phenomenon initially presenting with facial and periorbital edema. A 38-year-old Brazilian woman presented to the emergency department with facial swelling and erythema, initially treated as cellulitis. Due to rapid worsening despite broad-spectrum antibiotics, she underwent soft tissue exploration and biopsy due to concern for necrotizing fasciitis. During her course, she also developed retiform purpura of bilateral upper and lower extremities. Periorbital and lower extremity pathological specimens ultimately revealed acid-fast bacilli consistent with Mycobacterium leprae, and the patient improved with multidrug therapy. This case illustrates the diagnostic difficulty of lepromatous leprosy with Lucio’s phenomenon, which can initially present with periorbital edema.
Herpes Simplex Virus Dacryoadenitis Preceding Skin Vesicles
Authors: Ataei Yasaman , Boal Nina S. , Esmaili Neda
Published: May 2024

Herpes simplex virus involvement of the orbit is rare. We report the case of an immunocompetent patient who presented with preseptal edema, erythema, decreased vision, and dacryoadenitis prior to the appearance of vesicular skin lesions and in the absence of corneal dendrites. The patient’s clinical picture failed to improve on empiric therapy with intravenous antibiotics. The patient subsequently developed skin vesicles and a nucleic acid amplification swab of the ocular surface was positive for herpes simplex virus-1. The patient demonstrated rapid clinical improvement after initiation of oral antivirals. This is an unusual case of presumed herpes simplex virus dacryoadenitis preceding skin vesicles in an immunocompetent patient.
Meibography-Guided Electroepilation for Congenital Distichiasis: A Novel Surgical Technique
Authors: Sinha Prerna , Anklesaria Vidhi , Singh Swati
Published: May 2024

Purpose:

Congenital distichiasis is managed either by ablation, using laser, cryotherapy, or electroepilation, or by surgical excision with mucous membrane grafting. Ablative procedures are usually blind as the exact depth of distichiatic eyelashes is unknown. The described surgical technique utilizes meibography for imaging the root and depth of distichiatic eyelashes that aided in performing electroepilation.

Methods:

Six patients (n = 24 eyelids; mean age 15.5 ± 12.2 years) underwent infrared meibography (Oculus Keratograph 5 M) and noninvasive tear breakup time prospectively. Eyelashes were electroepilated using a premarked needle inserted at a depth based on meibography findings in 4 patients. Surgical success was defined as no distichiatic eyelash regrowth and functional success was defined as the resolution of symptoms at a minimum of 3 months of follow-up.

Results:

All 6 patients had all 4 eyelids involved to varying degrees, with a total of 230 distichiatic eyelashes. The median number of distichiatic eyelashes was 9 in the upper eyelids and 4.5 in the lower eyelids. Meibography revealed visible distichiatic eyelash roots in 70% of eyelashes in the upper eyelid and 87.8% in the lower eyelid, respectively. The median eyelash root depth was 2.7 mm (mean 2.9 mm, range 1.8–5.4 mm). The mean noninvasive tear breakup time was 12.2 seconds despite absent or rudimentary meibomian gland segments seen on meibography. The anatomical success was 75% (12/16 eyelids), and functional success was 87.5% (7/8 eyes) at a median follow-up of 5.5 months.

Conclusion:

Preoperative infrared meibography in eyelids with congenital distichiasis helps estimate the eyelash depth and can be used to guide eyelash ablation procedures.
The Profuse Bleeding Potential of Orbital Epithelioid Hemangioendotheliomas
Authors: Jassar Ziad , Al Barazi Randa , Hourany Roula , Alameddine Ramzi
Published: May 2024

Epithelioid hemangioendothelioma is a rare vascular tumor originating from vascular endothelial or pre-endothelial cells. We present the case of a 4-month-old male with a rapidly enlarging left zygomatico-orbital tumor causing mass effect on the eye globe. Examination revealed a large, nontender, solid lesion. CT angiography showed no major feeder or intralesional vessels. Complete surgical excision was performed, which was complicated by life-threatening intraoperative bleeding and successfully controlled with electrocautery. Microscopically, tumor cells exhibited varying morphologies. Immunohistochemistry confirmed the diagnosis of epithelioid hemangioendothelioma (positive for CD31 and CD34, negative for CK AE1/AE3). We also highlight 2 similar case reports with life-threatening bleeding complications. Surgeons should be aware of this condition and optimize surgical preparation, including blood products, to manage potential bleeding complications.
Dermatologic drug safety in lactation
Authors: Yaghi Marita , Truong Thu M. , Murase Jenny E.
Published: May 2024

In 2014, the US FDA removed the Pregnancy Category Drug lettering system and enacted the “Pregnancy and Lactation Label Ruling.” This ruling required drug products to contain contact information for drug-specific exposure pregnancy registries, narrative-style sections summarizing the known effect of pregnancy, lactation counseling data, and data describing risks for females and males of reproductive potential. This new ruling has added more dialogue and discussion to the patient-provider decision-making process and requires clinicians to provide more individualized counseling based on the current medical literature. This article summarizes the recent evidence for the safety of the most common dermatological therapies for pregnant and lactating women.
The role of hematopoiesis in bone repair: an update
Authors: Jeffery Elise C.
Published: May 2024

Purpose of review

The repair of bone after injury requires the participation of many different immune cell populations, which are derived from the hematopoietic lineage. The field of osteoimmunology, or the study of the interactions between bone and the immune system, is a growing field with emerging impact on both the basic science and clinical aspects of fracture healing.

Recent findings

Despite previous focus on the innate immune system in fracture healing, recent studies have revealed an important role for the adaptive immune system in bone repair. The composition of adaptive and innate immune cell populations present at the fracture site is significantly altered during aging and diet-induced obesity, which may contribute to delayed healing. Recent data also suggest a complicated relationship between fracture repair and systemic inflammation, raising the possibility that immune populations from distant sites such as the gut can impact the bone repair process.

These findings have important implications for the treatment of fracture patients with antibiotics or anti-inflammatory drugs. Furthermore, the effects of systemic inflammation on fracture repair in the contexts of aging or obesity should be carefully interpreted, as they may not be uniformly detrimental.
Immunohistochemical Approach to Mismatch Repair Deficiency in Pediatric High-Grade Glioma
Authors: Inan Mehmet Arda , Ogut Betul , Toker Meral , Poyraz Aylar
Published: May 2024

Knowledge of the molecular pathways of pediatric high-grade gliomas is increasing. Gliomas with mismatch repair deficiency do not currently comprise a distinct group, but data on this topic have been accumulating in recent publications. Immunohistochemistry can effectively determine mismatch repair status, indirectly suggesting the microsatellite instability of the tumor. This study aimed to determine the number of mismatch repair-deficient pediatric high-grade gliomas in a tertiary institution and assess the relationship between the survival and mismatch repair status of the patients. It also aimed to assess the potential for further clinical studies including immunotherapy. Of 24 patients with high-grade gliomas, 3 deceased patients were mismatch repair-deficient. Mismatch repair deficiency was significantly associated with shorter survival (P=0.004). Immunotherapy trials need to progress, and patients with mismatch repair-deficient pediatric high-grade gliomas are the most suitable candidates for such studies.
Preventing Hump Recurrence in Dorsal Preservation Rhinoplasty: The 5 Key Tenets
Authors: Cason Roger W. , Goksel Abdulkadir , Sergesketter Amanda R. , Cotofana Sebastian , Rohrich Rod J.
Published: May 2024

Preservation rhinoplasty has re-emerged over the past decade and continues to gain traction in the rhinoplasty community. Dorsal preservation rhinoplasty (DPR), one of the tenets of preservation rhinoplasty, centers on preservation of the native osseocartilaginous joint of the dorsum, with changes instead achieved through modification of the underlying septal cartilage and surrounding bony nasal pyramid. However, one complication unique to DPR is the phenomenon of hump recurrence, where tensile forces or memory lead to a recurrent convexity of the dorsal hump. Hump recurrence is the most common complication after DPR and often requires revisionary surgery. Therefore, strategies to reduce the incidence of hump recurrence are highly sought after. In this article, the authors describe the senior author’s (R.J.R.) 5 main tenets of preventing hump recurrence in DPR, focusing on (1) appropriate patient selection; (2) addressing anatomic blocking points; (3) adding mechanical fixation of the cartilaginous vault with suture techniques depending on the level of septal manipulation; (4) applying a graduated approach to DPR procedural selection; and (5) ancillary measures to control the shape of the nasal dorsum. Implementation of each of these 5 tenets is crucial for modern rhinoplasty surgeons to reduce the incidence of hump recurrence in their preservation rhinoplasty practices.