bluuebunny/crossref_metadata_2025 huggingface dataset:
Co-existence of malignant phylloid tumor and metaplastic malignant spindle cell carcinoma: case report
Authors: Jamjoum Ghader , Alrefaei Mariya , Alhamed Wasan , Alsefri Joud , Abuzinadah Ahmed
Published: July 2024

Phyllodes tumors (PTs) and Metaplastic Malignant Spindle Cell Carcinoma (MMSCC) are rare and challenging breast malignancies. MMSCC is even rarer and highly aggressive. Surgical excision is the mainstay of treatment for both, but MMSCC generally carries a poorer prognosis. A 46-year-old woman with a history of breast augmentation 4 years ago presented with a rapidly progressing right breast mass. Imaging and core biopsy suggested a malignant PT. A right mastectomy with latissimus dorsi flap reconstruction was done. Initially diagnosed as a malignant PT, the post-operative pathology revealed a co-existence of malignant PT and MMSCC, an extremely rare finding. This case reports the unique challenge of a patient harboring both malignant PT and MMSCC within the same breast tissue. This exceedingly rare co-existence emphasizes the diagnostic complexities associated with uncommon breast malignancies. Our case highlights the challenges of diagnosing and managing uncommon and aggressive breast malignancies.
Sporothrix brasiliensis-specific polymerase chain reaction for the diagnosis of cat and human sporotrichosis through non-invasive samples
Authors: Trápaga Mariana Rodrigues , Poester Vanice Rodrigues , Sanchotene Karine Ortiz , Basso Rossana Patrícia , Bernardon Fabiana Fedatto , Luvielmo Rejane , Severo Cecília Bittencourt , Almeida-Paes Rodrigo , Zancopé Oliveira Rosely Maria , von Groll Andrea , Xavier Melissa Orzechowski
Published: July 2024

Zoonotic sporotrichosis caused by Sporothrix brasiliensis is an emerging mycosis in Latin America. One of the problems to quickly treat infected animals and break the transmission chain is associated with the time-consuming gold-standard diagnosis method (culture). We aimed to evaluate a species-specific polymerase chain reaction (PCR) for the diagnosis of sporotrichosis caused by S. brasiliensis using non-invasive samples. We performed a retrospective cross-sectional study using samples collected with swabs from humans and cats with clinical suspicion of sporotrichosis. Deoxyribonucleic acid (DNA) was extracted using a commercial kit, and a species-specific PCR for S. brasiliensis detection was performed. One hundred ten samples were included. PCR showed a good concordance with culture (86% of agreement) for human and cat samples (Kappa coefficient = 0.722, and 0.727, respectively). In conclusion, our data shows that this adapted PCR using non-invasive samples can be applied to sporotrichosis diagnosis, being a good alternative mainly in regions with a lack of mycologists to identify the fungus in culture, contributing to the control of this emergent zoonosis.
Constraining modified gravity scenarios with the 6dFGS and SDSS galaxy peculiar velocity data sets
Authors: Lyall Stuart , Blake Chris , Turner Ryan J
Published: July 2024

The detailed nature of dark energy remains a mystery, leaving the possibility that its effects might be explained by changes to the laws of gravity on large scales. The peculiar velocities of galaxies directly trace the strength of gravity on cosmic scales and provide a means to further constrain such models. We generate constraints on different scenarios of gravitational physics by measuring peculiar velocity (PV) and galaxy clustering two-point correlations, using redshifts and distances from the 6-degree Field Galaxy Survey and the Sloan Digital Sky Survey PV samples, and fitting them against models characteristic of different cosmologies. Our best-fitting results are all found to be in statistical agreement with general relativity, in which context we measure the low-redshift growth of structure to be $f\sigma _8 = 0.329^{+0.081}_{-0.083}$, consistent with the prediction of the standard Lambda cold dark matter model. We also fit the modified gravity scenarios of Dvali–Gabadadze–Porrati and a Hu–Sawicki model of $f(R)$ gravity, finding the $2\sigma$ limit of their characteristic parameters to be $r_{\rm c}H_0/c\gt 6.987$ and $-\log _{10}(|f_{R0}|)\gt 4.703$, respectively. These constraints are comparable to other literature values, though it should be noted that they are significantly affected by the prior adopted for their characteristic parameters. When applied to much larger upcoming PV surveys such as DESI, this method will place rapidly improving constraints on modified gravity models of cosmic expansion and growth.
The gravitational-wave emission from the explosion of a 15 solar mass star with rotation and magnetic fields
Authors: Powell Jade , Müller Bernhard
Published: July 2024

Gravitational waveform predictions from 3D simulations of explosions of non-rotating massive stars with no magnetic fields have been extensively studied. However, the impact of magnetic fields and rotation on the core-collapse supernova gravitational-wave signal is not well understood beyond the core-bounce phase. Therefore, we perform four magnetohydrodynamical simulations of the explosion of a $15\, {\rm M}_{\odot }$ star with the SFHx and SFHo equations of state. All of the models start with a weak magnetic field strength of $10^{8}$ G, and two of the models are rapidly rotating. We discuss the impact of the rotation and magnetic fields on the gravitational-wave signals. We find that the weak pre-collapse fields do not have a significant impact on the gravitational-wave signal amplitude. With rapid rotation, the f/g-mode trajectory can change in shape, and the dominant emission band becomes broader. We include the low-frequency memory component of the gravitational-wave signal from both matter motions and neutrino emission anisotropy. We show that including the gravitational waves from anisotropic neutrino emission increases the supernova gravitational-wave detection distances for the Einstein Telescope. The gravitational waves from anisotropic neutrino emission would also be detectable out to Mpc distances by a moon-based gravitational-wave detector.
Shell mergers in the late stages of massive star evolution: new insight from 3D hydrodynamic simulations
Authors: Rizzuti F , Hirschi R , Varma V , Arnett W D , Georgy C , Meakin C , Mocák M , Murphy A StJ , Rauscher T
Published: July 2024

One-dimensional (1D) stellar evolution models are widely used across various astrophysical fields, however they are still dominated by important uncertainties that deeply affect their predictive power. Among those, the merging of independent convective regions is a poorly understood phenomenon predicted by some 1D models but whose occurrence and impact in real stars remain very uncertain. Being an intrinsically multi-D phenomenon, it is challenging to predict the exact behaviour of shell mergers with 1D models. In this work, we conduct a detailed investigation of a multiple shell merging event in a 20 M$_\odot$ star using 3D hydrodynamic simulations. Making use of the active tracers for composition and the nuclear network included in the 3D model, we study the merging not only from a dynamical standpoint but also considering its nucleosynthesis and energy generation. Our simulations confirm the occurrence of the merging also in 3D, but reveal significant differences from the 1D case. Specifically, we identify entrainment and the erosion of stable regions as the main mechanisms that drive the merging, we predict much faster convective velocities compared to the mixing-length theory velocities, and observe multiple burning phases within the same merged shell, with important effects for the chemical composition of the star, which presents a strongly asymmetric (dipolar) distribution. We expect that these differences will have important effects on the final structure of massive stars and thus their final collapse dynamics and possible supernova explosion, subsequently affecting the resulting nucleosynthesis and remnant.
Radial halo substructure in harmony with the Galactic bar
Authors: Dillamore Adam M , Belokurov Vasily , Evans N Wyn
Published: July 2024

Overdensities in the radial phase space $(r,v_{\rm r})$ of the Milky Way’s halo have previously been associated with the phase-mixed debris of a highly radial merger event such as Gaia Sausage–Enceladus. We present and test an alternative theory in which the overdense ‘chevrons’ are instead composed of stars trapped in resonances with the Galactic bar. We develop an analytic model of resonant orbits in the isochrone potential, and complement this with a test particle simulation of a stellar halo in a realistic barred Milky Way potential. These models are used to predict the appearance of action space $(J_\phi ,J_{\rm r})$ and radial phase space in the Solar neighbourhood. They are able to reproduce almost all salient features of the observed chevrons. In particular, both the analytic model and simulation predict that the chevrons are more prominent at $v_{\rm r}\ \lt\ 0$ when viewed near the Sun, as is observed by Gaia. This is inconsistent with formation by an ancient merger event. We also associate individual chevrons with specific resonances. At a bar pattern speed of $\Omega _\mathrm{b}=35$ km s$^{-1}$ kpc$^{-1}$, the two most prominent prograde chevrons align very closely with the corotation and outer Lindblad resonances. The former can be viewed as a highly eccentric extension of the Hercules stream. Finally, our model predicts that the $v_{\rm r}$ asymmetry changes sign as a function of Galactic radius and azimuth, and we find evidence that this is indeed the case in the Milky Way.
The FLAMINGO simulation view of cluster progenitors observed in the epoch of reionization with JWST
Authors: Lim Seunghwan , Tacchella Sandro , Schaye Joop , Schaller Matthieu , Helton Jakob M , Kugel Roi , Maiolino Roberto
Published: July 2024

Motivated by the recent JWST discovery of galaxy overdensities during the Epoch of Reionzation, we examine the physical properties of high-z protoclusters and their evolution using the Full-hydro Large-scale structure simulations with All-sky Mapping for the Interpretation of Next Generation Observations (FLAMINGO) simulation suite. We investigate the impact of the apertures used to define protoclusters, because the heterogeneous apertures used in the literature have limited our understanding of the population. Our results are insensitive to the uncertainties of the subgrid models at a given resolution, whereas further investigation into the dependence on numerical resolution is needed. When considering galaxies more massive than $M_\ast \, {\simeq }\, 10^8\, {\rm M_\odot }$, the FLAMINGO simulations predict a dominant contribution from progenitors similar to those of the Coma cluster to the cosmic star formation rate density during the reionization epoch. Our results indicate the onset of suppression of star formation in the protocluster environments as early as $z\, {\simeq }\, 5$. The galaxy number density profiles are similar to NFW (Navarro–Frenk–White profile) at $z\, {\lesssim }\, 1$ while showing a steeper slope at earlier times before the formation of the core. Different from most previous simulations, the predicted star formation history for individual protoclusters is in good agreement with observations. We demonstrate that, depending on the aperture, the integrated physical properties including the total (dark matter and baryonic) mass can be biased by a factor of 2 to 5 at $z\, {=}\, 5.5$–7, and by an order of magnitude at $z\, {\lesssim }\, 4$. This correction suffices to remove the ${\simeq }\, 3\, \sigma$ tensions with the number density of structures found in recent JWST observations.
Denoising diffusion delensing: reconstructing the non-Gaussian CMB lensing potential with diffusion models
Authors: Flöss Thomas , Coulton William R , Duivenvoorden Adriaan J , Villaescusa-Navarro Francisco , Wandelt Benjamin D
Published: July 2024

Optimal extraction of cosmological information from observations of the cosmic microwave background (CMB) critically relies on our ability to accurately undo the distortions caused by weak gravitational lensing. In this work, we demonstrate the use of denoising diffusion models in performing Bayesian lensing reconstruction. We show that score-based generative models can produce accurate, uncorrelated samples from the CMB lensing convergence map posterior, given noisy CMB observations. To validate our approach, we compare the samples of our model to those obtained using established Hamiltonian Monte Carlo methods, which assume a Gaussian lensing potential. We then go beyond this assumption of Gaussianity, and train and validate our model on non-Gaussian lensing data, obtained by ray-tracing N-body simulations. We demonstrate that in this case, samples from our model have accurate non-Gaussian statistics beyond the power spectrum. The method provides an avenue towards more efficient and accurate lensing reconstruction, which does not rely on an approximate analytical description of the posterior probability. The reconstructed lensing maps can be used as an unbiased tracer of the matter distribution, and to improve delensing of the CMB, resulting in more precise cosmological parameter inference.
High-level tumour methylation of BRCA1 and RAD51C is required for homologous recombination deficiency in solid cancers
Authors: Xu Lijun , Liddell Brett , Nesic Ksenija , Geissler Franziska , Ashwood Lauren M , Wakefield Matthew J , Scott Clare L , Waddell Nicola , Kondrashova Olga
Published: July 2024

In ovarian and breast cancer, promoter methylation of BRCA1 or RAD51C is a promising biomarker for PARP inhibitor response, as high levels lead to homologous recombination deficiency (HRD). Yet the extent and role of such methylation in other cancers is not clear. This study comprehensively investigated promoter methylation of eight homologous recombination repair genes across 23 solid cancer types. Here, we showed that BRCA1 methylated cancers were associated with reduced gene expression, loss of heterozygosity (LOH), TP53 mutations and genomic features of HRD. We identified BRCA1 methylation in 3% of the copy-number high subtype of endometrial cancer, and as a rare event in six other cancer types, including lung squamous cell, pancreatic, bladder and stomach cancer. RAD51C promoter methylation was widespread across multiple cancer types, but HRD features were only observed for cases which contained high-level tumour methylation and LOH of RAD51C. While RAD51C methylation was frequent in stomach adenocarcinoma (6%) and low-grade glioma (2.5%), it was mostly detected at a low tumour level, suggestive of heterozygous methylation, and was associated with CpG island methylator phenotype. Our findings indicate that high-level tumour methylation of BRCA1 and RAD51C should be explored as a PARP inhibitor biomarker across multiple cancers.
Fertility preserving techniques in neuro-oncology patients: A systematic review
Authors: Osborne-Grinter Maia , Sanghera Jasleen Kaur , Bianca Offorbuike Chiamaka , Kaliaperumal Chandrasekaran
Published: July 2024

Background

Advancements in cancer treatments have enhanced survival rates and quality of life for patients with central nervous system (CNS) tumors. There is growing recognition of the significance of fertility preservation methods. Currently, techniques, including oocyte cryopreservation and sperm cryopreservation are established. Nevertheless, oncologists may exhibit reluctance when referring patients to reproductive specialists. This review aimed to assess the best evidence for fertility preservation techniques used in patients with CNS cancers and evaluate outcomes relating to their success and complications.

Methods

Two reviewers performed a search of Pubmed, Embase, Medline, Cochrane, and Google Scholar. Papers were included if they reported at least 1 fertility preservation technique in a neuro-oncology patient. Non-English studies, editorials, animal studies, and guidelines were excluded. Meta-analysis was performed using the random effects model.

Results

Sixteen studies containing data from 237 participants (78.8% female) were included in the systematic review and meta-analysis, of whom 110 (46.4%) underwent fertility preservation techniques. All patients (100%) successfully underwent fertility preservation with 1 participant (2.9%) returning to rewarm their oocytes, embryos or sperm. On average, 17.8 oocytes were retrieved with 78%, ultimately being cryopreserved. Five (6.0%) patients successfully conceived 9 healthy-term children after utilizing their cryopreserved sperm, embryos, or oocytes. Moreover, 6 patients successfully conceived naturally or using intrauterine insemination, resulting in 7 healthy-term children.

Conclusions

Fertility preservation techniques could offer a safe and effective way for neuro-oncology patients to deliver healthy-term babies following treatment. However, further studies concerning risks, long-term pregnancy outcomes, and cost-effectiveness are needed.
A Qualitative Investigation of Nicotine and Tobacco use in Young Pregnant and Birthing Sexual Minority People
Authors: De Genna Natacha M , Boss Nicole , Hossain Fahmida , Frankeberger Jessica , Mark Elyse , Coulter Robert W S
Published: July 2024

Introduction

Sexual minority (SM) youth, especially those who identify as bisexual, have higher rates of nicotine and tobacco use and are more likely to become pregnant at a younger age than heterosexual youth. The goal of this study was to investigate the nicotine and tobacco experiences and motivations of SM people before and during pregnancy.

Aims and Methods

Pregnant and birthing individuals ages 16–24 who identified as a SM in an online survey were recruited for semi-structured video interviews about nicotine and tobacco use. Thirteen participants described nicotine and tobacco initiation, current or recent use, and cessation efforts. Using thematic analysis, the research team coded de-identified interview transcripts and identified themes related to their nicotine and tobacco use.

Results

Participants were cisgender women (average age = 19.6). Most identified as bisexual (86%) in addition to Black (36%) or biracial (36%). Four themes about nicotine and tobacco use were identified from participant interviews. Participants’ reasons for nicotine and tobacco initiation were social, yet reasons for more regular use were stress-related. Participants’ use of cigarettes was triggered by their cannabis use, and several substituted cannabis for cigarettes during cessation attempts. Participants identified pregnancy as a strong motivator to quit smoking, and attempted cessation without clinical assistance.

Conclusions

Young SM people’s greater risk of initiation and dependence on nicotine and tobacco products prior to conception may be related to social needs, stress, and use of cannabis. Current approaches and materials on smoking cessation are not being utilized by this population.

Implications

This is the first qualitative study of nicotine and tobacco use among young pregnant SM people, primarily bisexual-identified, who are underrepresented in prenatal tobacco research. By telling their own stories, SM participants with lived experience of nicotine and tobacco use described the evolution of their motivations to use these products over time, cannabis use as a precipitant, the importance of pregnancy for smoking cessation, and perceptions about effective and ineffective factors in cessation efforts. The results of this study provide key information for prevention efforts to reduce tobacco-related health disparities for SM people.
Patient-reported outcome measures for paediatric gender-affirming care: A systematic review
Authors: Jackman Liam , Chan Cynthia , Jacklin Chloë , Deck Eve , Lee Ann C , Stepney Melissa , Harrison Conrad , Jain Abhilash , Rodrigues Jeremy , Kamran Rakhshan
Published: July 2024

Objectives

Patient needs must be comprehensively measured to offer paediatric gender-affirming care in line with clinical standards. Patient-reported outcome measures (PROMs) are self-report tools that measure outcomes deemed to be of importance to patients. PROMs may assess a single outcome or multiple outcomes simultaneously, such as symptoms, functional ability, and quality of life. This study aims to identify PROMs for paediatric gender-affirming care.

Methods

This systematic review is PRISMA-compliant and was prospectively registered on PROSPERO (CRD42023461959). Six databases were searched: PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science from inception to December 16, 2022. Articles meeting the following criteria were included: 1) Original article; 2) Administers a formally-developed PROM; 3) Focuses on gender-affirming care; and 4) Focuses on paediatric populations. Screening and data extraction occurred independently and in duplicate. Data extracted include study/demographic information, and details of PROM used.

Results

In total, 20 articles were included, representing a total of 5793 paediatric patients undergoing gender-affirming care. Most studies (13, 65%) focused on hormonal gender-affirming care. A total of 38 different PROMs for paediatric gender-affirming care were identified, ranging from 4 to 120 items each (mean 23 items; median 14 items). Most PROMs (n = 22) measured psychological functioning, with eight PROMs measuring quality of life, and three PROMs measuring gender-related concepts (i.e., gender dysphoria/euphoria). Commonly used PROMs include the Utrecht Gender Dysphoria Scale (n = 4; 20%), Body Image Scale (n = 5;25%), and Youth Self-Report (n = 8; 40%).

Conclusions

A total of 38 PROMs were identified measuring a range of concepts for paediatric gender-affirming care.
Employer Dominance and Worker Earnings in Finance
Authors: Ma Wenting
Published: July 2024

A few large firms in the U.S. financial system achieve substantial economic gains. Their dominance sets them apart while also raising concerns about the suppression of worker earnings. Utilizing administrative data, this study reveals that the largest financial firms pay workers an average of 30.2% more than their smallest counterparts, significantly exceeding the 7.9% disparity in nonfinance sectors. This positive size-earnings relationship is consistently more pronounced in finance, even during the 2008 crisis or compared to the high-tech sector. Evidence suggests that large financial firms’ excessive gains, coupled with their workers’ sought-after skills, explain this distinct relationship. (JEL G20, J31, J42, L11, L12, L13)
The evolution and ongoing challenge of unproven cell-based interventions
Authors: Brinsfield Taylor N , Pinson Noah R , Levine Aaron D
Published: July 2024

Unproven cell-based interventions (CBIs) emerged early in the 2000s as a particularly problematic form of unproven therapy and remain a vexing policy problem to this day. These unproven interventions can harm patients both physically and financially and can complicate the process of developing a rigorous evidence base to support the translation of novel stem cell or other cell therapies. In this concise review, we examine the emergence of unproven CBIs and the various policy approaches that have been pursued or proposed to address this problem. We review the evolution of this field over the last 2 decades and explore why these policy efforts have proven challenging. We conclude by highlighting potential directions that the field could evolve and urging continued attention to both current and future forms of unproven CBIs to minimize future risks to patients and the field and to promote the development of evidence-based cell therapies.
11Plastic Theory/Studies
Authors: Martell James
Published: July 2024

While this year’s chapter on plastic theory/studies is relatively short, with only three texts reviewed, it is a harbinger of important texts in preparation that, next year, will broaden the field into dimensions as diverse as world literature and theology. Such an expansion is logical when we see that the texts published this year include: an important and practical textbook introduction as part of MIT Press’s Essential Knowledge series (Imari Walker-Franklin and Jenna Jambeck’s Plastics); a chapter in a book on flashpoint epistemologies (Ranjan Ghosh’s ‘Plastic Pedagogy: Rabindranath Tagore Revisited’); and a book that links plasticity to political thought (Fathali M. Moghaddam’s Political Plasticity). As this review will show, together these texts speak not only of the contemporary anxieties of a world enmeshed in climate and political catastrophes, but also of the pedagogical and political hopes of new generations of scholars and artists, who are thinking about plasticity and plastic theory—not only in texts but also in their practices and art—in relation to a future still in formation.
The advantages of inhouse testing to manage vaginitis treatment
Authors: Wilson Mariafrancesca Zampogna
Published: July 2024

Vaginal discharge is a common presenting complaint in ambulatory care medicine, emergency medicine, primary care, and gynecology, accounting for nearly 10 million office visits annually in the United States. This article discusses management of abnormal vaginal discharge among women of childbearing age and the clinical significance of inhouse diagnostic tools. Provider-performed microscopy is an invaluable clinical skill that allows for immediate diagnosis, treatment, and management of infections and coinfections and should be strongly considered when evaluating a patient.
Perceptions of telehealth use by PAs post-COVID-19
Authors: Raspet Erin , Gietzen Lindsay
Published: July 2024

Objective:

Use of telemedicine and remote patient monitoring can provide significant cost savings through improved disease control and reduced exacerbations. This study investigated physician associates'/assistants' (PAs') perceptions of telemedicine to inform future use and expansion of these programs.

Methods:

The Telehealth Usability Questionnaire was completed by 30 PAs recruited via social media. Data were coded and analyzed through an electronic spreadsheet program.

Results:

PAs generally felt that telemedicine was a helpful tool to increase access to care (M = 4.129) but did not replace in-person visits. Variation in responses related specifically to the platform indicated PAs' varying experiences about ease of use.

Conclusions:

Findings demonstrated that PAs from a variety of practice settings found telemedicine to be a helpful tool to reduce barriers and improve access to care. However, PAs did not feel that telemedicine replaces in-person visits.
Implicit Bias in Patient Care Assignments
Authors: Mosher Macy , Sailsman Sonique
Published: July 2024

Identifying and acknowledging biases and working to eliminate them
Panniculus Retractor Use for Visualization of Fetal Anatomy
Authors: Wise Melissa L. , Okon Marvin , Pratt Katelyn N. , Lane Andrew S. , Carlson Laura M. , Eichelberger Kacey Y. , Crockett Amy H. , Zhang Lu , Pasko Daniel N.
Published: July 2024

OBJECTIVE:

To evaluate whether use of a panniculus retractor device for pregnant patients with body mass index (BMI) 40 or higher and a panniculus improves the completion rate of the fetal anatomic examination.

METHODS:

This was a randomized trial in which eligible patients with BMI 40 or higher and a panniculus were randomized to undergo their detailed fetal anatomic examination with a panniculus retractor device in place compared with usual care. The primary outcome was the completion rate of 16 prespecified views from the anatomic examination. Secondary outcomes included completion rate of all 64 views from our institution's detailed anatomic examination, duration of examination, major fetal anomaly detection rate, depth from the skin to amniotic cavity before and after retractor placement, patient and ultrasonographer satisfaction, and prespecified adverse events. We assumed a baseline completion rate of 23% for the primary outcome and targeted a twofold improvement with 80% power and two-sided α of 0.05, which resulted in a sample size of 132 participants. The goal enrollment was increased to 150 participants to account for potential dropout. Statistical tests included the Student’s t test, χ2, and relative risks (RRs) as appropriate.

RESULTS:

From March to July of 2023, 150 participants completed the study: 74 in the retractor group and 76 in the usual care group. Baseline characteristics were similar between groups except for panniculus grade. The completion rate of 16 prespecified views was 25.7% (19/74) in the retractor group and 31.6% (24/76) in the control group (RR 0.81, 95% CI, 0.49–1.35). There were no significant differences between groups for any of the secondary outcomes. Patient satisfaction and ultrasonographer satisfaction were similar between groups.

CONCLUSION:

Use of a panniculus retractor device during the fetal anatomic examination for patients with BMI 40 or higher and a panniculus was well tolerated by patients and ultrasonographers but did not improve the completion rate of 16 prespecified fetal anatomic views.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT05764408.
Efficacy and Safety of Extended-Release Dinalbuphine Sebacate for Postoperative Analgesia: A Systematic Review and Meta-analysis
Authors: Hsieh Yu-Lien , Wang Chi-Fei , Lin Chung-Ren
Published: July 2024

Background

Multimodal analgesia, which combines multiple medications with different analgesic mechanisms, is recommended for optimizing postoperative pain control and minimizing opioid-related side effects. Dinalbuphine sebacate (DNS), a prodrug of nalbuphine, has a 7-day long-acting analgesic effect on moderate to severe postoperative pain. We conducted a systematic review and meta-analysis to analyze the efficacy and safety of dinalbuphine sebacate for postoperative pain management.

Materials and Methods

We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) of DNS for postoperative analgesia. We assessed the quality of all included studies using the risk-of-bias tool. The primary outcome was postoperative pain score, and the secondary outcomes included analgesic consumption, need for rescue analgesics, adverse events, and length of hospital stay. A meta-analysis was performed for the pooled data, and the level of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results

We included five RCTs with 497 patients who underwent surgery. Compared with the control group, DNS significantly reduced the visual analog scale (VAS) through postoperative 48 hours {mean difference (MD) -37.54 (95% confidence interval [CI]: -70.47, -4.62)} to 7 days [MD -165.99 (95% CI: -231.44)], and decreased the requirement for rescue analgesics [RR 0.89 (95% CI: 0.81, 0.97)]. No significant difference was noted in VAS scores within postoperative 24 hours [MD -10.13 (95% CI: -30.11, 9.85)] or in total analgesic consumption. Patients receiving DNS had a higher risk of dizziness and injection site reactions, without an increased occurrence of other adverse events.

Conclusions

With a low-to-moderate level of evidence, intramuscular DNS provides long-lasting analgesia from postoperative 48 hours to 7 days and may reduce the requirement for postoperative rescue analgesics. However, DNS does not offer additional pain relief within the first 24 hours postoperatively. Further high-quality studies are warranted.

International Prospective Register of Systematic Reviews (PROSPERO) registry: identifier: CRD42023494130
Pressurized intraperitoneal aerosol chemotherapy (PIPAC): Why it will transform cancer surgery
Authors: Reymond Marc Andre , Sautkin Yaroslv , Schönfelder Hans , Solass Wiebke
Published: July 2024

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) represents an innovative method for delivering chemotherapy directly into the abdominal cavity, offering a targeted, effective, and less toxic treatment option for patients with nonresectable peritoneal metastasis (PM). PIPAC is increasingly adopted due to its benefits over traditional therapies, including enhanced drug penetration, reduced systemic toxicity, and improved efficacy in chemoresistant PM. Performed laparoscopically, PIPAC is minimally invasive, often outpatient, and well-tolerated, preserving patients’ quality of life. So far, PIPAC has been mainly used in advanced PM from ovarian, gastric, and colorectal cancers, where it can be effective even after other treatments have failed. The repeatable nature of PIPAC offers opportunities for maintenance therapy and long-term disease control. A recent meta-analysis of PIPAC studies reported a 4% nonaccess rate and 39% of patients completing three or more cycles, with only 4% experiencing severe toxicities. Pathological responses were observed in 68% of cases, indicating reliable efficacy. A first randomized trial showed PIPAC’s superiority in objective response rates and quality of life compared with intravenous chemotherapy for platinum-resistant ovarian cancer. Research in PIPAC is dynamic and multidisciplinary, aiming to refine the technique, minimize side effects, and expand its applicability to various cancers. Studies focus on the efficacy of aerosolized drug delivery, including nanoparticles and RNA-based therapies, which offer targeted treatment options with promising therapeutic potential. Innovations such as electrostatic precipitation PIPAC (ePIPAC) combine enhanced drug distribution with increased tissue penetration, representing significant advancements in PM treatment. Future developments will focus on optimizing aerosol characteristics, drug formulations, and personalized medicine approaches.
IBAT inhibitors in pediatric cholestatic liver diseases: Transformation on the horizon?
Authors: Sutton Harry , Sokol Ronald J. , Kamath Binita M.
Published: July 2024

Historically, the therapeutic options available to hepatologists managing cholestasis have been limited. Apart from bile acid–-binding resins and the choleretic ursodeoxycholic acid, the medical management of cholestasis in children has been predominately focused on managing the complications of cholestasis, namely pruritus, malnutrition, fat-soluble vitamin deficiencies, and portal hypertension. As such, invasive surgical procedures such as biliary diversion and liver transplantation may become the only options for progressive and unremitting cases of cholestasis. Particularly in the pediatric population, where debilitating pruritus is a common indication for a liver transplant, effective anti-cholestatic medications have the potential to prolong native liver survival without the need for biliary diversion. Ileal bile acid transporter (IBAT) inhibitors are a relatively new class of drugs which that target the ileal re-uptake of bile acids, thus interrupting the enterohepatic circulation and reducing the total bile acid pool size and exposure of the liver. Oral, minimally absorbed IBAT inhibitors have been demonstrated to reduce serum bile acid levels and pruritus with a minimal side effect profile in clinical trials in Alagille Ssyndrome and progressive familial intrahepatic cholestasis, leading to FDA and EMA approval. The indications for IBAT inhibitors will likely expand in the coming years as clinical trials in other adult and pediatric cholestatic conditions are ongoing. This review will summarize the published clinical and pre-clinical data on IBAT inhibitors and offer providers guidance on their practical use.
Uranium Mine Proposed Experimental Design for Natural Background Gross Gamma Exposure Rates, Post Remediation Final Status Survey Sampling Density, and Radiological Water Quality Modeling for a Worst-case Catastrophic Failure, Coles Hill, Virginia
Authors: Weyant David B. , Yoon Jaewan
Published: July 2024

Completely randomized experimental design statistical modeling techniques were employed to analyze exposure rate measurements for evaluating hypothetical natural background post uranium mill operations at Coles Hill, Virginia uranium milling processes. The proposed Coles Hill Uranium Mine is situated upstream of the Banister River. This River is nearly homogenous throughout the reach length used in analysis and feeds into the mouth of Kerr Reservoir, Lake Gaston, which serves as the main drinking water source for cities in the Hampton Roads area including Norfolk, Virginia Beach, and Chesapeake. A critical scan value (=DCGLscan) was developed to flag anomalies of surface contamination during simulated post remediation final status surveys. The natural background was critical for meeting the Multi-Agency Radiation Survey and Site Investigation Manual guidance for post remediation final status surveys. The overarching null hypothesis suggested that the selected mean natural background is equal to the survey unit’s mean natural background. Using SAS Procedures Shapiro-Wilk Test, ANOVA, and CR, it was decided the exposure rate data was normal, had no extreme outliers, and no collinearity between the number of samples (=treatment) and the areas (=block). Using the q-hyper (hypergeometric) distribution, the soil sampling density was decided for a final status survey unit. The most likely worst-case catastrophic failure analysis, 500-year event, such as the1969 Hurricane Camille of 69 centimeters of rain in Nelson County, Virginia was included in the model. The model showed impact was minimal at most to the Banister River’s drinking water and likely less than the Virginia’s Drinking Water Standards for gross alpha, 226Ra and 228Ra, and total uranium.
Association between bariatric surgery and outcomes of total joint arthroplasty: a meta-analysis
Authors: Liu Pan , Meng Jiahao , Tang Hang , Xiao Yifan , Li Xi , Wu Yumei , Liu Weijie , Xiong Yilin , Gao Shuguang
Published: July 2024

Background:

Total joint arthroplasty (TJA) alongside bariatric surgery (BS) is frequently operated on in obese arthritis patients. The controversy persists regarding BS before TJA, and the extent of its impact on the prognosis of TJA patients remains uncertain. To explore this, we conducted a meta-analysis.

Methods:

As of 1 October 2023, the latest search on PubMed, Cochrane Library, Embase, and Web of Science was conducted to compare outcomes between patients who underwent preoperative BS and those who did not. The analysis focused on parameters such as length of stay (LOS), infection risk, venous thromboembolism, revision, transfusions, dislocations, periprosthetic fractures, knee stiffness, medical complications, and all-cause mortality in the eligible studies.

Results:

This meta-analysis included 18 trials with a total of 292 196 patients. Pooled findings indicated that preoperative BS significantly shortened the LOS (MD, −0.16; 95% CI, −0.25 to 0.07; I
2=58%; P=0.0004) and increased the risk of dislocation within 90 days (OR, 1.70; 95% CI, 1.20–
2
.42; I
2=21%; P=0.003) and all-cause mortality within 30 days (OR, 3.69; 95% CI, 1.81–7.49; I
2= 0%; P =0.0003) for TJA, in comparison with patients without BS. In the total hip arthroplasty (THA) subgroup, BS was more favorable, exhibiting significantly reduced risk of short-term revision (OR, 0.77; 95% CI, 0.61–0.99; I
2=0%; P=0.04) and long-term infection (OR, 0.72; 95% CI, 0.61–0.85; I
2=0%; P≤0.0001). For total knee arthroplasty (TKA) patients, no significant benefit was identified. In addition, there was no statistically significant correlation between preoperative or postoperative BS and the occurrence of complications in TJA patients.

Conclusions and Relevance:

Compared with the control group without BS, preoperative BS can shorten the LOS, increase the risk of dislocation within 90 days and all-cause mortality within 30 days in TJA, and reduce the risk of specific surgical complications in the THA subgroup but shows no significant difference in the TKA subgroup. There are no differences in clinical outcomes whether BS is performed before or after TJA. More high-quality trials are needed to further clarify the impact of BS on obese patients undergoing TJA.
Extubated, Rehabilitation-Focused Extracorporeal Membrane Oxygenation for Pediatric Coronavirus Disease 2019: A Case Series
Authors: Kilgallon Kevin B. , Leroue Matthew , Shankman Sara , Shea Taryn , Buckvold Shannon , Mitchell Max , Morgan Gareth , Zablah Jenny , Maddux Aline B.
Published: July 2024

During the coronavirus 2019 (COVID-19) pandemic, children suffered severe lung injury resulting in acute respiratory distress syndrome requiring support with extracorporeal membrane oxygenation (ECMO). In this case series, we described our center’s experience employing a rehabilitation-focused ECMO strategy including extubation during ECMO support in four pediatric patients with acute COVID-19 pneumonia hospitalized from September 2021 to January 2022. All four patients tolerated extubation within 30 days of ECMO initiation and achieved mobility while on ECMO support. Duration of ECMO support was 35–152 days and hospital lengths of stay were 52–167 days. Three of four patients survived. Two of three survivors had normal functional status at discharge except for ongoing respiratory support. The third survivor had significant motor deficits due to critical illness polyneuropathy and was supported with daytime oxygen and nocturnal noninvasive support. Overall, these patients demonstrated good outcomes and tolerance of a rehabilitation-focused ECMO strategy.
Complex actions of sodium glucose transporter-2 inhibitors on lipids, calcific atherosclerosis, and bone density
Authors: Pradhan Stuti , Kalanski Sophia , Tintut Yin , Demer Linda L.
Published: July 2024

Purpose of review

Inhibitors of sodium-glucose cotransporter-2 (SGLT2) lower renal glucose reabsorption and, thus, are used to treat patients with type 2 diabetes mellitus. Clinical trials coincidentally showed that SGLT2 inhibitors also benefitted patients with heart failure. This review explores the impact of SGLT2 inhibitors on other aspects of cardiovascular disease and skeletal health.

Recent findings

In some, but not all, clinical and preclinical studies, SGLT2 inhibitors are found to reduce serum levels of free fatty acids and triglycerides. Their effects on total and low-density lipoprotein cholesterol and cardiac function also vary. However, SGLT2 inhibitors reduce lipid accumulation in the liver, kidney, and heart, and alter expression of lipid metabolism genes. Effects on free fatty acid uptake in abdominal fat depots depend on the location of adipose tissue. In male, but not female, mice, SGLT2 inhibitors reduce the atherosclerotic lesions and aortic calcium deposition. With respect to skeletal health, recent literature has reported conflicting associations with the risks of fracture and amputation.

Studies suggest that SGLT2 inhibitors reduce tissue lipid accumulation, and in a sex-dependent manner, atherosclerosis and vascular calcification. However, their effects on lipid levels and bone health are complex and remain to be established.
Clonal Hematopoiesis Without Malignant Transformation Lasting Over 2 Years in a 9-Year-old Boy, Following Treatment for Acute Lymphocytic Leukemia
Authors: Yagasaki Hiroshi , Shimozawa Katsuyoshi , Kanezawa Koji , Tamura Takeaki , Kamiyama Makoto , Yamamoto Toshiyuki , Morioka Ichiro
Published: July 2024

Children with acute lymphocytic leukemia rarely develop secondary hematological neoplasms. A 5-year-old boy was diagnosed with standard-risk precursor B-cell acute lymphocytic leukemia. The patient exhibited aberrant chromosomal changes in the bone marrow at 6 months postchemotherapy: 46,XY,der(6) t(1;6)(q12;p22) dup(6)(p22p12)[15]. Clinically, the patient has sustained complete remission and has not developed myeloid malignancy over the subsequent period (27 mo). The cytogenetic aberration was observed in 11% of CD34+ cells isolated from the bone marrow. We infer that the abnormal clone acquires self-renewal potency, differentiation, and growth advantage. Further long-term observation is needed to determine the nature of this cytogenetic aberration.
Nivolumab-associated IgA Nephropathy in a Child With Malignant Melanoma
Authors: Yildiz Gizem , Torun Bayram Meral , Ünlü Şadiye Mehtat , Soylu Alper , Kavukçu Salih , Olgun Nur
Published: July 2024

Immune checkpoint inhibitors are humanized antibodies that inhibit downregulatory receptors on T cells, enhancing the antitumor activity of these cells. However, they have been associated with a wide range of systemic immune-related adverse events, including renal toxicities, among others. Most renal immune-related adverse events are acute interstitial nephritis causing acute kidney injury. Recently, immune checkpoint inhibitors-associated glomerular diseases, including IgA nephropathy, have been reported in adults. Most of the adult cases with glomerular involvement had also concomitant acute interstitial nephritis and acute kidney injury. We present the first pediatric case of IgA nephropathy without acute kidney injury during nivolumab treatment.
Operator syndrome
Authors: Ivory Rebecca Ann , Graber Jennifer S. , Frueh B. Christopher , Cady Harrison
Published: July 2024

Operator syndrome is a common and predictable constellation of interrelated medical and psychiatric conditions and social and functional impairments experienced by special operations forces. Nurses in all settings should be aware of this emerging trend among veterans they encounter in practice so they may identify and intervene using evidence-based approaches and effect a positive outcome.
Brain death
Authors: Hills Teresa E.
Published: July 2024

The incidence of brain death/death by neurologic criteria (BD/DNC) among all hospital deaths in the US is approximately 2.06% or 15,000-20,000 cases annually. This article reviews the latest guidelines for adult and pediatric BD/DNC. Although there have not been many changes to the guidelines over the years, BD/DNC guideline updates maintain consistency in determining BD/DNC.
A survey of nurses' experiences with patient visitation restrictions during the COVID-19 pandemic
Authors: Cliff Barbara , Keiser Elina , Malinowski Stacey , Wilson Meagan
Published: July 2024

Purpose:

To characterize nurses' experiences of restrictive visitation during the COVID-19 pandemic.

Methods:

In early 2023, an exploratory study investigated professional RNs' perceptions of restrictive visitation policies and end-of-life care during the COVID-19 pandemic, focusing on experiences between March and September 2020. An 11-question online survey containing qualitative and quantitative elements was sent to postlicensure nursing students and alumni of American Public University System (American Military University/American Public University).

Results:

Among the 41 survey respondents (response rate of 4%), 75.6% observed patients dying alone due to visitation restrictions during March-September 2020, with 87.8% noting strict no-visitation policies, yet only 10% found it effective. A majority (68.3%) supported allowing some family presence, reflecting negative sentiments toward strict policies; suggestions for enhancing family involvement included technology (78%) and employing volunteers or liaisons (34.1%) to improve patient/family well-being and alleviate nurse burden.

Conclusion:

The findings revealed insights into nurses' experiences and perspectives on end-of-life care and visitation limitations during the pandemic. While the isolation of patients during times of strict visitation restrictions has some merit, exploring options for modified family visitation at the end of life is critical.
Seafood poisoning
Authors: Strickler Jeff , Kellish Ashley
Published: July 2024

Seafood poisoning is common worldwide but is relatively unknown by clinicians and the general public and can be confused with other causes. This article discusses two common seafood poisoning cases—ciguatera and scombroid poisoning—and offers recommended nursing considerations.
Impact of the MOVE (Mobility Optimizes Virtually Everything) Program
Authors: Knight Tara , Bruzzi Bethany , Wright Angela , Bohnenkamp Susan K.
Published: July 2024

Early mobility of hospitalized patients has been associated with improved postoperative results and psychological outcomes, decreased length of stay, and other benefits. This article discusses Mobility Optimizes Virtually Everything (MOVE), an interactive bingo-like activity for patients, and its impact on patient satisfaction, mobility documentation, and decompensation rates.