bluuebunny/crossref_metadata_2025 huggingface dataset:
Original Research: Patient Perception of Fall Risk in the Acute Care Setting
Authors: Tymkew Heidi , Taylor Beth , Vyers Kara , Costantinou Eileen , Arroyo Cassandra , Schallom Marilyn
Published: May 2023

Purpose:

Hospitals are implementing a variety of fall prevention programs to reduce the fall rates of hospitalized patients. But if patients don't perceive themselves to be at risk for falling and don't adhere to fall prevention strategies, such programs are likely to be less effective. The purpose of this study was to describe the perceptions of fall risk among hospitalized patients across four acute care specialty services.

Methods:

One hundred patients who had been admitted to the study hospital and who had a Morse Fall Scale score over 45 were asked to complete the Patient Perception Questionnaire, a tool designed to explore a patient's confidence regarding their fall risk, fear of falling, and intention to engage in fall prevention activities. Morse Fall Scale scores were collected via retrospective chart review. Data were analyzed using descriptive statistics, Pearson correlation coefficients, and independent sample t tests.

Results:

Participants' mean age was 65 years; 52% were male, 48% female. Although all 100 participants were deemed at risk for falls per their Morse Fall Scale scores, only 55% considered themselves to be at such risk. As patients' confidence in their ability to perform mobility tasks increased, their intention to ask for help and fear of falling significantly decreased. Patients who had been admitted as the result of a fall demonstrated significantly lower confidence scores and higher fear scores.

Conclusions:

Patients who score high on fall risk assessments often don't perceive themselves to be at high risk for falling, and thus might not engage in fall prevention activities. Developing a fall risk assessment method that incorporates both a patient's physiological condition and their perception of their fall risk could help reduce fall rates in the acute care setting.
Peer Support Physical Activity Interventions Partnering Unknown Survivors of Cancer: A Scoping Review
Authors: Smith-Turchyn Jenna , Vani Madison F. , Murray Ross M. , McCowan Michelle E. , Edward Holly , Nayiga Brenda K. , Sabiston Catherine M.
Published: May 2023

Background:

Social support is known to facilitate exercise among individuals with cancer; however, this support usually comes from a known source. The use of peer support, from an unknown peer, may facilitate exercise in survivors; however, this has not been well explored in the literature.

Purpose:

To examine the literature regarding the use, parameters, matching characteristics, and effectiveness of peer support physical activity interventions partnering unknown peers for individuals living beyond a cancer diagnosis.

Methods:

Six databases were searched for relevant reports up to December 17, 2021. Title/abstract screening, full-text review, and data extraction were completed in duplicate. Data were extracted for information on population, intervention and partner matching characteristics, and study outcomes. A qualitative synthesis was used to summarize findings and descriptive statistics were used to summarize applicable results.

Results:

Twelve reports were included in this review, describing 6 unique partner-based peer support physical activity interventions. Most interventions (83%) incorporated peers using a mentor/mentee relationship, where one peer acted as a topic “expert,” assisting the other peer around physical activity. All peers were “unknown” prior to the intervention and all interventions described physical activity level as a primary outcome. All articles including results demonstrated that peer support interventions led to significantly higher levels of physical activity post-treatment.

Discussion:

Promoting social support via unknown peers has potential to improve physical activity behavior in individuals living beyond a cancer diagnosis. Further research should examine the most appropriate mode of partner communication and the overall effectiveness of these interventions using social support as a primary outcome.
The Effect of Dehydroepiandrosterone Administration during Rehabilitation on White Matter Integrity Among Individuals With Polysubstance Use Disorder
Authors: Bilaus Ben , Turchinski Nuphar Rotem , Ahdoot Hadas Levi , Gavish Rina Eden , Shany Ofir , Maayan Rachel , Rosca Paola , Weizman Abraham , Delayahu Yael , Yadid Gal , Admon Roee
Published: May 2023

Objectives

Individuals with polysubstance use disorder (pSUD) exhibit vulnerability to relapse even after prolonged abstinence, with rehabilitation efforts achieving limited success. Previous studies highlighted dehydroepiandrosterone (DHEA) as a putative therapeutic agent that may aid rehabilitation, potentially by impacting white matter (WM) properties. The current study tested, for the first time, the effect of DHEA administration during rehabilitation on WM integrity among pSUD individuals, while assessing its putative association with long-term relapse rates.

Methods

Immediately after admission to rehabilitation, 30 pSUD individuals were assigned to receive either placebo or DHEA (100 mg) daily for 3 months, via a randomized double-blind counterbalanced design. Participants also provided blood samples to assess circulating DHEA levels at treatment initiation and completed a diffusion tensor imaging (DTI) scan approximately 1 month after treatment initiation. Clinical status was evaluated 16 months after treatment initiation. Thirty matched healthy controls also underwent a DTI scan without any intervention.

Results

DHEA administration was not associated with reduced relapse rates compared with placebo. Nevertheless, exploratory analysis revealed that DHEA was associated with successful rehabilitation among pSUD individuals with low circulating DHEA levels at treatment initiation. White matter integrity in the splenium corpus callosum (CC) was reduced in pSUD individuals compared with healthy controls, yet pSUD individuals receiving DHEA exhibited recovery of splenium CC WM integrity.

Conclusions

DHEA administration during rehabilitation may restore WM integrity in the CC among pSUD individuals. Although DHEA was not associated with reduced relapse rates in here, its therapeutic efficacy may depend on circulating DHEA levels at treatment initiation.
The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee
Authors: Aksoy Taha , Bakircioglu Sancar , Ozdemir Erdi , Ramazanov Rafik , Aksoy Mehmet Cemalettin , Yilmaz Guney
Published: May 2023

Background:

Tension band plating is widely used in the surgical treatment of coronal plane deformities around the knee. The rebound phenomenon after implant removal is a common complication of this technique. Overcorrection of joint orientation angles is a method to minimize the effect of the rebound phenomenon. This study aims to investigate the natural course of overcorrected joint orientation angles after plate removal in patients with genu valgum deformity.

Methods:

Patients who underwent hemiepiphysiodesis with tension band plating due to genu valgum deformity between 2010 and 2019 were retrospectively analyzed. Mechanical lateral distal femoral angles (mLDFA) and mechanical medial proximal tibial angles were calculated before plate application, before implant removal, and at the last follow-up. At the implant removal, mLDFA>90 degrees and mechanical medial proximal tibial angles <85 degrees were accepted as overcorrected.

Results:

Seventy-two segments from 45 patients were included. For femoral valgus deformities (n=59), the mean mLDFAs at index surgery, implant removal, and the last follow-up were 79.8±3.9 degrees, 95.5±3.7 degrees, and 87.3±5.1 degrees, respectively. In the more and less than 10 degrees rebound groups, the median age of patients at index surgery were 66 and 101 months (P=0.04), the mLDFA during implant removal were 97.8 degrees and 94.4 degrees (P=0.005), and the mean amount of correction in mLDFA was 17 degrees and 13 degrees (P=0.001), respectively. At the last follow-up, joint orientation angles were found to be still overcorrected in 16 (22%), within normal limits in 36 (50%), and undercorrected in 20 (28%) segments. Ten (13%) segments required additional surgery due to residual deformity.

Conclusions:

Overcorrection with tension band plating is an effective modality in the treatment of genu valgum deformity. Rebound after plate removal increases as the age at index surgery decreases and the amount of conscious overcorrection increases. Most segments return to normal joint orientation angle limits after overcorrection. We recommend a mean of 5 degrees routine overcorrection in patients with genu valgum deformity to overcome the rebound phenomenon and to make future interventions easier if ever needed.

Level of Evidence:

Level III.
Radiographic Evaluation after Arthroscopic Partial Trapeziectomy with Suture-button Suspensionplasty for Thumb Carpometacarpal Arthritis
Authors: Shinya Yuki , Ikeguchi Ryosuke , Noguchi Takashi , Ando Maki , Yoshimoto Koichi , Sakamoto Daichi , Iwai Terunobu , Matsuda Shuichi
Published: May 2023

Background:

Arthroscopic partial trapeziectomy with suture-button suspensionplasty was developed for the surgical treatment of thumb carpometacarpal arthritis. However, the relationship between clinical results and radiographic evidence is unclear.

Methods:

The authors retrospectively reviewed 33 consecutive patients who underwent arthroscopic partial trapeziectomy with suture-button suspensionplasty for thumb carpometacarpal arthritis between 2016 and 2021. Clinical and radiographic outcomes were recorded, and the correlations between them were evaluated.

Results:

The average patient age at surgery was 69 years. Patient radiologic evidence was Eaton stage Ⅱ in three thumbs, Ⅲ in 25 thumbs, and Ⅳ in five thumbs. The average trapezial space ratio (TSR) was 0.36 immediately after the operation but declined to 0.32 after 6 months. In contrast, the average joint subluxation was reduced to 0.005 immediately after the operation compared with 0.28 before, and was maintained at 0.04 at final follow-up. A statically significant correlation was detected between grip strength and TSR (P = 0.03), and between pinch strength and TSR (P = 0.02). A significant correlation was detected between TSR and trapezium height (P = 0.0215), which remained after partial trapeziectomy. No correlation was detected between rope position and other clinical or radiographic scores.

Conclusions:

Suture-button can have an effect on the medialization of the first metacarpal base. Excessive trapeziectomy can result in functional deficiency of the thumb through metacarpal subsidence, which potentially causes loss of grip and pinch strength.
Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature
Authors: Liu Jiamin , Guo Xiaoyan , Wei Zhenyu , Zhang Yuheng , Zhang Zijun , Xu Xizhan , Liang Qingfeng
Published: May 2023

Objectives:

To summarize the clinical manifestations, microbiological profile, treatment, and prognosis of corneal infections after different keratorefractive surgery.

Methods:

To obtain relevant studies, English-language databases, including PubMed, Ovid Embase, Web of Science, and CLNAHL, were searched from January 1979 to March 2022. The fundamentals of the literature, clinical characteristics, pathogens, and treatments were retrieved for each included article.

Results:

Eighty-four studies involving 306 infectious eyes were included in this review. Risk factors of potential infection included a history of blepharitis, contact lens usage, and contaminated surgical instruments. The mean onset time was 22.9±38.7 days (range: 1 day to 3 years). The most common organism isolated from infectious keratitis after keratorefractive surgery were Staphylococcus aureus, followed by Mycobacterium and coagulase-negative Staphylococcus. Most of the infections after refractive procedures were sensitive to medical treatment alone, and the ultimate best-corrected visual acuity after medical treatment was as follows: 20/20 or better in 82 cases (37.0%), 20/40 or better in 170 cases (76.5%), and worse than 20/40 in 52 cases (23.5%). Surgical interventions including flap lift, flap amputation, ring removal, and keratoplasty were performed in 120 eyes (44.5%).

Conclusions:

Most infections after keratorefractive surgery occur within a week, whereas more than half of the cases after laser-assisted in situ keratomileusis happen after about a month. Gram-positive cocci and mycobacterium are the most common isolates. Infections after LASIK, intracorneal ring (ICR) implantation, and small incision lenticule extraction, which primarily occur between the cornea layers, require irrigation of the tunnels or pocket with antibiotics.
Factors Affecting the Effectiveness of Discharge Planning Implementation: A Case-Control Cohort Study
Authors: PO Hui-Wen , LIN Fang-Ju , CHENG Hsing-Jung , HUANG Mei-Ling , CHEN Chung-Yu , HWANG Juey-Jen , CHIU Yi-Wen
Published: May 2023

Background

In many hospitals, a discharge planning team works with the medical team to provide case management to ensure high-quality patient care and improve continuity of care from the hospital to the community. However, a large-scale database analysis of the effectiveness of overall discharge planning efforts is lacking.

Purpose

This study was designed to investigate the clinical factors that impact the efficacy of discharge planning in terms of hospital length of stay, readmission rate, and survival status.

Methods

A retrospective study was conducted based on patient medical records and the discharge plans applied to patients hospitalized in a regional medical center between 2017 and 2018. The medical information system database and the care service management information system maintained by the Ministry of Health and Welfare were used to collect data and explore patients' medical care and follow-up status.

Results

Clinical factors such as activities of daily living ≤ 60, having indwelling catheters, having poor control of chronic diseases, and insufficient caregiver capacity were found to be associated with longer hospitalization stays. In addition, men and those with indwelling catheters were found to have a higher risk of readmission within 30 days of discharge. Moreover, significantly higher mortality was found after discharge in men, those ≥ 75 years old, those with activities of daily living ≤ 60, those with indwelling catheters, those with pressure ulcers or unclean wounds, those with financial problems, those with caregivers with insufficient capacity, and those readmitted 14–30 days after discharge.

Conclusions

The findings of this study indicate that implementing case management for discharge planning does not substantially reduce the length of hospital stay nor does it affect patients' readmission status or prognosis after discharge. However, age, underlying comorbidities, and specific disease factors decrease the efficacy of discharge planning. Therefore, active discharge planning interventions should be provided to ensure transitional care for high-risk patients.
“It's Just a Checklist”
Authors: Adams Alexa , Joe Claire , Klinger Nathalie , Laforest Erika , Shankar Janki , Chen Shu-Ping
Published: May 2023

Objectives

New immigrant workers (NIWs) are overrepresented in hazardous workplaces. Sufficient Occupational Health and Safety (OH&S) training could minimize workplace injuries. This study aims to identify the current status of OH&S and training for NIWs in Canada.

Methods

Generic qualitative research was conducted. Seven NIWs and nine service providers were interviewed to understand OH&S issues, perceptions on rules and regulations, and expectations for training. Thematic analysis was used for data analysis.

Results

Four themes that affect OH&S for NIWs include attitudes toward safety and training, personal barriers, Canadian workplace culture, and macrolevel interconnected systems. Three needs on OH&S training are increasing accessibility, ensuring full understanding, and building confidence.

Conclusions

Current training does not mitigate safety risks in workplaces, and NIWs do not feel empowered to exercise their rights. New training protocols would be beneficial to equip NIWs to enter the workforce.
Superior Mesenteric Artery Syndrome: A Case Report and Literatures Review
Authors: Xie Yingqiu , Chen Yang , Xia Dong , Zhu Youfeng
Published: May 2023

Superior mesenteric artery syndrome (SMAS) is a rare clinical disease caused by obstruction of the duodenum at the angle between the abdominal aorta and superior mesenteric artery. We report a male patient admitted to our hospital with a chief complaint of obvious postprandial vomiting and nausea. SMAS was confirmed by abdominal computed tomography images and clinical symptoms. After admission, the patient was treated with fasting, antibiotics, fluid resuscitation, parenteral nutrition, and other conservative treatments. However, the patient deteriorated rapidly and died because of multiple organ failure. SMAS is easily missed, which may delay timely treatment. Clinicians should improve their clinical understanding of SMAS.
Psyllium is a natural nonfermented gel-forming fiber that is effective for weight loss: A comprehensive review and meta-analysis
Authors: Gibb Roger D. , Sloan Kyle J. , McRorie Johnson W.
Published: May 2023

Background:

Psyllium is a natural, predominantly soluble fiber that forms a viscous gel when hydrated and is not digested or fermented. In the small intestine, psyllium gel increases chyme viscosity, slowing the degradation and absorption of nutrients. Psyllium has a significant effect in patients with metabolic syndrome and type-2 diabetes on glycemic control, while lowering serum cholesterol in hypercholesterolemic patients. Some randomized controlled studies have shown that psyllium also facilitates weight loss in overweight and obese participants.

Objectives:

A comprehensive review and meta-analysis assessing psyllium's impact on body weight, body mass index (BMI), and waist circumference in overweight and obese participants.

Data sources:

A comprehensive search was performed (Medline, Scopus, Cochrane Database) through March 21, 2022, using search terms to identify randomized, controlled, clinical studies designed to assess weight loss in overweight and obese participants over at least 2 months. Data were analyzed using the inverse variance method with random effects models.

Conclusions:

Six studies meeting inclusion criteria were identified (total n = 354). The meta-analysis showed that psyllium, dosed just before meals (mean dose 10.8 g/day, mean duration 4.8 months), was effective for decreasing body weight (MD = −2.1 kg [95% confidence interval [CI]: −2.6 to −1.6]; p < .001), BMI (MD = −0.8 kg/m2 [95% CI: −1.0 to −0.6]; p < .001) and waist circumference (MD = −2.2 cm [95% CI: −2.9 to −1.4]; p < .001) in overweight and obese populations.

Implications for practice:

Gel-forming nonfermented psyllium fiber, dosed just before meals, is effective in facilitating weight loss in overweight and obese participants.
Virtual Reality for Anxiety Reduction in Women Undergoing Colposcopy: A Randomized Controlled Trial
Authors: Hecken Julia M. , Halagiera Pia , Rehman Sadia , Tempfer Clemens B. , Rezniczek Günther A.
Published: May 2023

Objective

To test whether headset-delivered virtual reality (VR) content affects satisfaction and/or anxiety in women with cervical squamous intraepithelial lesions undergoing colposcopy and colposcopically guided cervical biopsy.

Methods

In this single-center, randomized trial, the authors measured overall satisfaction (100-mm visual analog scale) and situation-specific anxiety (STAI-S) in 247 women with suspected cervical squamous intraepithelial lesions wearing either no VR headset (arm 1, control) or a VR headset before (arm 2) or before and during colposcopy (arm 3). Secondary endpoints were pain, discomfort, and anxiety during colposcopy, heart rate, and 72-hour follow-up parameters: overall satisfaction, bleeding severity, bleeding duration, pain, and use of analgesics. Analysis was by intention to treat.

Results

Median values for overall satisfaction were 100 (interquartile range, 90–100) in controls (n = 83), 100 (95–100) in arm 2 (n = 82), and 100 (95–100) in arm 3 (n = 82), respectively (p = .92). The median Δ of situational anxiety (baseline vs after colposcopy) was −8 (−13 to −3), −8 (−16.5 to −4), and −10 (−20.5 to −4.5), respectively (p = .09). The secondary endpoints pain during colposcopy (20 [10–50] vs 20 [10–40] vs 30 [10–50]; p = .65), discomfort during colposcopy (30 [10–50] vs 30 [10–50] vs 20 [10–50]; p = .46), and anxiety during colposcopy (20 [0–50] vs 10 [0–40] vs 10 [0–30]; p = .44), were not different between arms. Follow-up data showed no improvement in the 2 VR arms compared with controls (overall satisfaction, p = .37; bleeding severity, p = .09; pain level, p = .89; duration of pain; p = .23; and use of analgesics; p = .39). Per-protocol analysis did not change the results.

Conclusions

A VR headset showing a 360-degree surround vision film has no effect on satisfaction or anxiety in women undergoing colposcopy.
Coping With Pandemics
Authors: Espí Forcén Fernando , Freudenreich Oliver
Published: May 2023

Throughout history, society has dealt with several devastating pandemics. Our objective is to analyze society's coping mechanisms to deal with pandemic-related stress in history congruent with the values of the time. For that purpose, we have carefully selected some of the most significant pandemics based on their impact and the available psychosocial literature. After a brief introduction, society's coping tools are reviewed and analyzed for the Antonine Plague, the second bubonic plague, the third cholera pandemic, the Spanish flu, the HIV pandemic, and the COVID-19 pandemic. Despite occurring at different times in history, parallels can be established in the study of society's psychological reactions among different pandemics. Magical thinking, political skepticism, fake accusations, and discrimination of minorities are recurrent reactions in society among different pandemics in history.
How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD
Authors: Kratzer Leonhard , Heinz Peter , Knefel Matthias , Weindl Dina , Tschöke Stefan , Biedermann Sarah V. , Schröder Johanna , Karatzias Thanos
Published: May 2023

Treatment guidelines for complex presentations of posttraumatic stress disorder (PTSD) are often cautious about the reprocessing of traumatic memories and recommend multicomponent treatments that are widely used in clinical practice. Yet, the role of reprocessing in these multicomponent treatments remains unknown. Using naturalistic data of 97 patients treated for PTSD, we used a linear mixed model to investigate the role of reprocessing for the outcome at discharge and at 6-month follow-up. Treatment effects were significant and large (g = 0.91–1.05). The final model showed good fit and explained 51% of the variance. There was a significant main effect of time (B = −8.1 [−11.5; −4.8], p < 0.001), as well as a reprocessing by time interaction (B = −17.2 [−30.5; −3.8], p = 0.012), indicating better outcomes with higher levels of reprocessing. Hence, maximizing the amount of reprocessing used in multicomponent treatments for PTSD may significantly enhance outcomes.
Efficacy of Buzzy Device Versus EMLA Cream for Reducing Pain During Needle-Related Procedures in Children
Authors: Haidar Nasser A. , Al Amri Mohammed H. , Sendad Nora G. , Toaimah Fathi H. S.
Published: May 2023

Objectives

Several pain management tools exist but with limitations in their efficacy or applicability. The EMLA (eutectic mixture of local anesthetics) cream is currently used for pain relief for needle-related procedures; however, it needs a minimum of 30 to 45 minutes to be effective. The Buzzy is a device that generates vibrations with cold leading to quicker pain relief. Our aim was to evaluate the effect of the Buzzy device in pain and anxiety reduction compared with EMLA cream in children requiring intravenous cannulation or venepuncture.

Methods

This was a randomized clinical trial comparing pain and anxiety reduction by Buzzy device with the standard care (EMLA cream) in children aged 2 to 14 years who required blood extraction or intravenous cannulation based on their clinical needs. Eligible patients were randomized to either Buzzy device as the intervention or EMLA cream as the control. The outcome measures were the degree of pain scores and anxiety ratings at different stages of the needle-related procedures.

Results

A total of 300 patients with a mean age of 6.5 ± 3.1 years were enrolled. Baseline characteristics were similar between the Buzzy device and EMLA cream groups. The observed pain scores by research nurses and a parent were significantly lower in the EMLA group compared with the Buzzy device group; however, the pain scores by the self-assessment scale were not statistically significant with mean difference of −0.332, 95% confidence interval, −0.635 to −0.028 (P = 0.062). The level of anxiety was significantly lower in EMLA compared with Buzzy device (P = 0. 0.0001). Both staff and parents' satisfaction, success rate of cannulation, type of blood tests, and comment on the physician on the results were similar in both groups.

Conclusions

Pain and anxiety relief using the Buzzy device is not as effective as EMLA cream in children requiring venepuncture. However, rapid onset of action of the Buzzy device is valuable in decreasing waiting time in a busy emergency department.

Trial Registration

clinicaltrials.gov Identifier: NCT05354739.
Autologous fat grafting in breast augmentation: A systematic review highlighting the need for clinical caution
Authors: Seth Ishith , Bulloch Gabriella , Gibson Damien , Chow Oliver , Seth Nimish , Mann G Bruce , Hunter-Smith David J , Rozen Warren M
Published: May 2023

Background:

Autologous fat grafting (AFG) is a breast augmentation method for treating volume and contour abnormalities. This systematic review aims to summarize complications, radiological safety, volume retention, and patient satisfaction associated with AFG.

Methods:

PubMed, EMBASE, Google Scholar, Cochrane CENTRAL, Wiley library, clinical key/Elsevier, and EBSCO databases were searched for relevant studies from January 2009 to March 2022. Articles describing AFG for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The ROBINS-I assessment was used to assess the quality of studies and the risk of bias was measured using the ACROBAT- NRSI.

Results:

Total of 35 studies comprising 3757 women were included. The average follow-up duration was 24.5 months (range, 1-372 months). The overall complication rate was 27.8%, with fat necrosis making up 43.7% of all complications. Average fat volume injected was 300mls (range: 134-610ml) and average volume retention was 58% (range: 44-83%). Volume retention was greater with supplementation of fat with plasma-rich-protein (PRP) and stromal vascular fractioning (SVF). The most common radiological changes were fat necrosis (9.4%) and calcification (1.2%). After follow-up of one year, patient satisfaction was on average 92% (range; 83.2-97.5%). The included studies were of good quality and consisted of a moderate risk of bias.

Conclusions:

AFG was associated with an overall complication rate of 27.8%, and additional supplementation of fat with PRP and SVF may improve graft survival. Despite poor volume retention being a persistent drawback patient satisfaction remains high.
Wise-pattern Mastectomy with an Inferior Dermal Sling: A Viable Alternative to Elliptical Mastectomy in Prosthetic Based Breast Reconstruction
Authors: Huang Anne , Kuchta Kristine , Alva Duanny , Sisco Mark , Seth Akhil K
Published: May 2023

Background:

Prosthetic based post-mastectomy breast reconstruction in patients with large or pendulous breasts remains challenging due to inelastic and redundant skin, with various approaches to skin reduction at the time of mastectomy. This study describes our experience with a Wise pattern inferior dermal sling approach to skin sparing mastectomy.

Methods:

Retrospective chart review was performed on patients who underwent immediate prosthetic-based breast reconstruction after mastectomy from 2009 to 2021. Two hundred and forty patients who underwent Wise pattern skin sparing mastectomy (WSSM) were compared to a cohort of patients who had traditional elliptical skin sparing mastectomy (ESSM), matched for mastectomy weight, prior radiation, and smoking. 90-day post-surgical outcomes were examined.

Results:

The WSSM cohort had significantly higher BMI (30.3 vs 26.9, p < 0.0001) and mastectomy weight (831 g vs 607 g, p < 0.0001). After propensity score matching, there was no significant difference in complication or treatment rates between WSSM and ESSM breasts except for mastectomy flap necrosis (11.6% vs 5.0%, p = 0.0082). WSSM patients who had mastectomy flap necrosis did not have significantly different treatment rates of admission, return to operating room, or explantation compared to ESSM patients.

Conclusions:

In the largest reported series to date, WSSM was associated with a higher rate of mastectomy flap necrosis, but this did not translate to statistically significant differences in treatment. The inferior dermal flap likely acts as a protective layer of vascularized tissue, which appears to prevent evolution of mastectomy skin flap necrosis into more serious adverse outcomes.
Using Failure Mode and Effect Analysis to Identify Potential Failures in a Psychiatric Hospital Emergency Department
Authors: Gur-Arieh Sharon , Mendlovic Shlomo , Rozenblum Ronen , Magnezi Racheli
Published: May 2023

Objectives

Failure mode and effect analysis (FMEA) is a powerful tool for accessing potential failures, but the participants are limited. It has not been used in psychiatric hospitals. Objectives were to implement FMEA in a psychiatric hospital and determine whether the FMEA process can be expanded by including participants who are familiar with the emergency department (ED) admission process and those who are not.

Methods

In this prospective, questionnaire-based study, a multidisciplinary team experienced in ED admissions was trained in FMEA and determined potential failures in the process. They developed a questionnaire regarding the failures, which were ranked by 17 ED and 28 non-ED healthcare providers. Risk priority numbers were calculated for each.

Results

By applying FMEA, we found 6 steps of the ED admission process, with 32 potential failures. Risk priority numbers ranged from 91 to 225. The most notable potential failure identified was during a patient’s initial telephone call to the ED, before arrival. Emergency department and non-ED workers ranked 94% of the potential failures similarly.

Conclusions

Failure mode and effect analysis can be implemented in psychiatric hospitals and can be a useful tool for anticipating potential failures. The number of participants in an FMEA can be increased to include those who are not directly involved in the process and should involve several specialists from diverse fields. Increasing the number of participants allows more detailed analyses. A checklist detailing the actions to take when processing a patient’s initial phone call should be implemented to decrease hazards related to ED admissions.
Pulmonary Embolism Detected by Bone Scintigraphy in a Patient With Intrahepatic Cholangiocarcinoma
Authors: Messerschmidt Konstantin , Witt Robin , Krischer Lucas , Sabri Osama , Hesse Swen
Published: May 2023

A 99mTc-DPD bone scintigraphy with SPECT/CT was performed in a 64-year-old woman with intrahepatic cholangiocarcinoma to exclude osseous metastases. The images demonstrated central focal tracer uptake in the left lung without any visible morphological correlate in the low-dose CT scan. For further clarification, a contrast-enhanced CT scan was carried out, which revealed a subsegmental pulmonary artery embolism in the left lower lobe. Subsequently, the patient was therapeutically anticoagulated. This case highlights the importance of clarifying focal pulmonary uptake in order not to overlook concomitant diseases.
A New Radiopharmaceutical 225Ac-DOTA-IBA in the Treatment of a Case of Bone Metastases
Authors: Xu Tingting , Qu Gengcuo , Liu Guangfu , Wang Li , Chen Yue
Published: May 2023

α-Emitter 225Ac has been considered a candidate for targeted α-therapy. DOTA-IBA is new a precursor targeting bone metastasis. It can be used for radionuclide labeling with 225Ac. We present a case with refractory bone pain for bone metastasis, who demonstrated an excellent therapy response after 1 cycle of 225Ac-DOTA-IBA therapy. Moreover, the patient did not have any observable adverse effects.
68Ga-FAPI PET/CT Detection of Non–FDG-Avid Poorly Differentiated Adenocarcinoma of the Trachea
Authors: Ding Haoyuan , Guo Chunmei , Liang Juan , Liu Ya , Chen Yue
Published: May 2023

Primary tracheal adenocarcinoma is relatively rare in clinical practice. We describe the 68Ga-FAPI-04 and 18F-FDG PET/CT findings of primary poorly differentiated tracheal adenocarcinoma in a 48-year-old woman. In the present case, the tumor showed increased 68Ga-FAPI uptake but not significant 18F-FDG activity.
Metastatic Small Cell Neuroendocrine Carcinoma of Endometrium
Authors: Gupta Nitin , Kumar Dinesh , Chandra Anjana , Kaur Satinder , Aiyer Hema Malini
Published: May 2023

Primary small cell neuroendocrine carcinoma of endometrium is very rare and aggressive carcinoma. Most patients present with metastases at the time of diagnosis and have very poor prognosis. Only very few cases are reported in literature. Here we present a case of 67-year-old woman, who on evaluation for mild pain abdomen was subsequently diagnosed to have metastatic small cell neuroendocrine carcinoma of endometrium on PET/CT scan and biopsy.
Neuroprotective effect by naringin against fluorosis-induced neurodegeneration in adult Wistar rats
Authors: Swamy Ravindra Shantakumar , Kumar Naveen , Shenoy Smita , Cheruku Sri Pragnya , Rao Vanishree , Kumar Nitesh , Kumar Sachindra , Ravichandiran Velayutham
Published: May 2023

Fluorosis is widespread in several areas of the world and including India leading to dental and skeletal fluorosis as well as neurological manifestations. With a limited number of treatment options available, we have tried to address the issue with a nutraceutical such as naringin which is an alkaloid derived from the citrus fruit. Naringin is a potent antioxidant and has neuroprotective action which can counteract the redox imbalance induced by sodium fluoride ingestion. Neurological effects of fluorosis were evaluated in Wistar rats by open field test (OFT) and novel object recognition test (NORT) along with lipid peroxidation (LPO) and glutathione estimation in brain homogenate and cresyl violet staining of CA3 neurons in the hippocampus. Animals were divided into groups namely, normal, vehicle, fluoride, naringin 100 mg/kg bd.wt group and fluoride with naringin (FLU-NAR) group. Fluorosis was induced by providing 100 ppm of sodium fluoride ad libitum in drinking water for 30 days and prophylactic treatment of naringin for 15 days per oral. OFT, NORT and forced swim test showed significant (P ≤ 0.05) changes in the FLU-NAR group as compared to the fluoride group indicating behavioral changes in the fluoride group and positive changes in the FLU-NAR group with attenuation of stress, fear, hyperactivity and memory impairment. The decrease in LPO and increase in glutathione levels in the treatment group compared to the fluoride group were supported by histological improvement as compared to the fluoride group. Prophylactic treatment of naringin showed its possible neuroprotective effect, thus giving an alternative treatment strategy to deal with neurological manifestations of fluorosis.
Accessory microbiomes
Authors: Vos Michiel
Published: May 2023

In microbiome research, considerable effort has been invested in finding core microbiomes, which have been hypothesized to contain the species most important for host function. Much less attention has been paid to microbiome members that are present in only a subset of hosts. Such accessory microbiomes must in large part consist of species that have no effect on fitness, but some will have deleterious effects on fitness (pathogens), and it is also possible that some accessory microbiome members benefit an ecologically distinct subset of hosts. This short paper discusses what we know about accessory microbiomes, specifically by comparing it with the concept of accessory genomes.
Antigenic responses are hallmarks of fibrotic interstitial lung diseases independent of underlying etiologies
Authors: Yoon Young me , Velez Tania E. , Upadhyay Vaibhav , Vazquez Sara E. , Lee Cathryn T. , Selvan Kavitha C. , Law Christopher S. , Blaine Kelly M. , Hollinger Maile K. , Decker Donna C. , Clark Marcus R. , Strek Mary E. , Guzy Robert D. , Adegunsoye Ayodeji , Noth Imre , Wolters Paul J. , Anderson Mark , DeRisi Joseph L. , Shum Anthony K. , Sperling Anne I.
Published: May 2023

Interstitial lung diseases (ILD) are heterogeneous conditions that may lead to progressive fibrosis and death of affected individuals. Despite diversity in clinical manifestations, enlargement of lung-associated lymph nodes (LLN) in fibrotic ILD patients predicts worse survival. Herein, we revealed a common adaptive immune landscape in LLNs of all ILD patients, characterized by highly activated germinal centers and antigen-activated T cells including regulatory T cells (Tregs). In support of these findings, we identified serum reactivity to 17 candidate auto-antigens in ILD patients through a proteome-wide screening using phage immunoprecipitation sequencing. Autoantibody responses to actin binding LIM protein 1 (ABLIM1), a protein highly expressed in aberrant basaloid cells of fibrotic lungs, were correlated with LLN frequencies of T follicular helper cells and Tregs in ILD patients. Together, we demonstrate that end-stage ILD patients have converging immune mechanisms, in part driven by antigen-specific immune responses, which may contribute to disease progression.
Squigulator: simulation of nanopore sequencing signal data with tunable noise parameters
Authors: Gamaarachchi Hasindu , Ferguson James M. , Samarakoon Hiruna , Liyanage Kisaru , Deveson Ira W.
Published: May 2023

In silicosimulation of next-generation sequencing data is a technique used widely in the genomics field. However, there is currently a lack of optimal tools for creating simulated data from ‘third-generation’ nanopore sequencing devices, which measure DNA or RNA molecules in the form of time-series current signal data. Here, we introduceSquigulator, a fast and simple tool for simulation of realistic nanopore signal data.Squigulatortakes a reference genome, transcriptome or read sequences and generates corresponding raw nanopore signal data. This is compatible with basecalling software from Oxford Nanopore Technologies (ONT) and other third-party tools, thereby providing a useful substrate for testing, debugging, validation and optimisation of nanopore analysis methods. The user may generate noise-free ‘ideal’ data, realistic data with noise profiles emulating specific ONT protocols, or they may deterministically modify noise parameters and other variables to shape the data to their needs. To highlight its utility, we useSquigulatorto model the degree to which different types of noise impact the accuracy of ONT basecalling and downstream variant detection, revealing new insights into the properties of ONT data. We provideSquigulatoras an open-source tool for the nanopore community:https://github.com/hasindu2008/squigulator
Immunomodulatory Leptin Receptor+Sympathetic Perineurial Cells Protect Against Obesity by Facilitating Neuroendocrine-Mediated Brown Adipose Tissue Thermogenesis
Authors: Haberman E R , Sarker G , Arús B A , Yilmaz-Özcan S , Martínez-Sánchez N , Freibergerová E , Fernández-González I , Zentai C , O’Brien C J O , Grainger D E , Chakarov S , Raimondi A , Iannacone M , López M , Ginhoux F , Domingos A I
Published: May 2023

Adipose tissues (ATs) are innervated by sympathetic nerves, which drive reduction of fat mass via lipolysis and thermogenesis. Here, we report a population of immunomodulatory leptin receptor (LepR)-expressing barrier cells which ensheath sympathetic axon bundles in adipose tissues. These LepR-expressing Sympathetic Perineurial Cells (SPCs) produce IL33, a factor for maintenance and recruitment of regulatory T cell (Treg) and eosinophils in AT. Brown adipose tissues (BAT) of mice lacking IL33 in SPCs (SPCIL33cKO) have fewer Treg and eosinophils, resulting in increased BAT inflammation. SPCIL33cKOmice are more susceptible to diet-induced obesity, independently of food intake. Furthermore, SPCIL33cKOmice have impaired adaptive thermogenesis, and are unresponsive to leptin-induced rescue of metabolic adaptation. We, therefore, identify LepR-expressing SPCs as a source of IL33 which orchestrate an anti-inflammatory environment in BAT, preserving sympathetic-mediated thermogenesis and body weight homeostasis. LepR+IL33+SPCs provide a cellular link between leptin and immune regulation of body weight, unifying neuroendocrinology and immunometabolism as previously disconnected fields of obesity research.

Graphical Abstract

Highlights

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Sympathetic Perineurial Cells (SPCs) co-express LepR+and IL33

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SPC-derived IL33 prevents BAT inflammation via Treg and eosinophil recruitment

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Obesity is worsened in high fat diet-fed SPCIL33cKOmice, despite normal food intake

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Adaptive thermogenesis is impaired in SPCIL33cKOmice

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Rescue of metabolic adaptation to fasting by leptin is impaired in SPCIL33cKOmice

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SPCs link leptin to immunometabolic regulation of body weight homeostasis
Transcriptomic investigation of the molecular mechanisms underlying resistance to the neonicotinoid thiamethoxam and the pyrethroid lambda-cyhalothrin inEuschistus heros(Hemiptera: Pentatomidae)
Authors: Lira Ewerton C. , Nascimento Antonio R.B. , Bass Chris , Omoto Celso , Cônsoli Fernando L.
Published: May 2023

Strains ofEuschistus heros(Hemiptera: Pentatomidae) with resistance to thiamethoxam (NEO) and lambda-cyhalothrin (PYR), generated by selection with these insecticides in the laboratory, have been recently reported in Brazil. However, the mechanisms conferring resistance to these insecticides inE. herosremain unresolved. We utilized comparative transcriptome profiling and single nucleotide polymorphism (SNP) variant calling of susceptible and laboratory-selected resistant strains ofE. herosto investigate the molecular mechanism(s) underlying resistance. TheE. herostranscriptome was assembled using approximately 190.1 million paired-end reads, which generated 91,673 transcripts with a mean length of 720 bp and N50 of 1795 bp. Approximately, 54.8% of the assembled transcripts ware functionally annotated against the NCBInrdatabase, with most sequences (43%) being similar to the pentatomidsHalyomorpha halys(43%) andNezara viridula(29%). Comparative gene expression analysis between the susceptible (SUS) and NEO strains identified 215 significantly differentially expressed (DE) transcripts. DE transcripts associated with the metabolism of xenobiotics were all up-regulated in the NEO strain. The comparative analysis of the SUS and PYR strains identified 204 DE transcripts, including an esterase (esterase FE4), a glutathione-S-transferase, an ABC transporter (ABCC1), and aquaporins that were up-regulated in the PYR strain. We identified 9,588 and 15,043 non-synonymous SNPs in the PYR and NEO strains respectively in comparisons with the SUS strain. One of the variants (D70N) detected in the NEO strain occurs in a subunit (α5) of the nicotinic acetylcholine receptor, the target-site of neonicotinoid insecticides. Nevertheless, the position of this residue was found very variable among α5 from insect species. In conclusion, neonicotinoid and pyrethroid resistance in laboratory-selected strains ofE. herosis associated with a potential metabolic resistance mechanism mediated by the overexpression of several proteins commonly involved in the three phases of xenobiotic metabolism. Together these findings provide insight into the potential basis of resistance inE. herosand will inform the development and implementation of resistance management strategies against this important pest.

Highlights

419 DE genes were observed inE. herosinsecticide-resistant strains

24,631 SNPs were identified inE. herosinsecticide-resistant strains

E. herosinsecticide-resistant strains overexpress metabolic resistance genes

Lambda-cyhalothrin-resistantE. herosoverexpresses cuticular proteins

Thiamethoxam-resistantE. heroscarries the target-site mutation D70N in nAChRalpha5
Robust discovery of causal gene networks via measurement error estimation and correction
Authors: Biswas Rahul , Brintha V P , Dumrewal Amol , Narayanan Manikandan
Published: May 2023

Discovering causal relations among genes from observational data is a fundamental problem in systems biology, especially in humans where direct gene interventions or perturbations are unethical/infeasible. Furthermore, causality is emerging as an integral factor for building interpretable and generalizable machine-learning models of complex phenotypes. Existing methods can discover causal relations from observed gene expression and matched genetic data using the well-established framework of Mendelian Randomization. But, the prevalence of expression measurement errors can mislead most existing methods into making wrong causal discoveries, especially among genes transcribed at low to moderate levels and using data with large sample size (say thousands as in modern genomic or GWAS studies).

In this study, we propose a new framework for causal discovery that is robust against measurement noise by extending an established statistical approach CIT (Causal Inference Test). We specifically developed a two-stage approach called RCD (Robust Causal Discovery), wherein we first estimate measurement error from gene expression data and then incorporate it to get consistent parameter estimates that could be used with appropriately extended statistical tests of correlation or mediation done in the original CIT. By quantifying and accounting for noise in the data, our RCD method is able to significantly outperform the baseline method in recovering ground-truth causal relations among simulated noisy genes and transcription factor to target gene relations among noisy yeast genes using data on 1012 yeast segregants. Encouraged by these results, we applied our RCD to a human setting where perturbations are infeasible and identified several causal relations, including ones involving transcriptional regulators in the skeletal muscle tissue.

Data and Code Availability

The code that implements our two-stage RCD framework is available here:https://github.com/BIRDSgroup/RCD; code for reproducing the figures/tables in this manuscript is also provided in this link.