bluuebunny/crossref_metadata_2025 huggingface dataset:
Unusual presentation of a giant recurrent inguinal hernia: a case report
Authors: Tahir Senol , Jovanovska Frosina , Abdiu Suad , Glavinov Maja Sofronievska
Published: January 2025

The recurrence rate of inguinal hernia is 1–10%, most often in the inguinal region, and seldom in different locations. A 72-year-old man with a large soft swelling in the right ventrolateral abdominal region without swelling in the scrotum, operated on right inguinal hernia at pediatric age. Clinical findings revealed a giant right ventrolateral hernia and abdominal CT showed weakness of the abdominal wall with a 25 cm long hernial sac with an apex under the right costal arch and a base at the deep inguinal opening, that was diagnosed as a recurrent inguinal hernia with unusual presentation. Hernioplasty without opening the hernial sac was performed in an atypical manner. The patient was discharged from the hospital without pain or discomfort at the follow-up. The common presentation of recurrent inguinal hernia is inguinal-scrotal but an unusual presentation should be reconsidered with a proper diagnosis and adequate surgical treatment.
Risk factors associated with pain and pain relief in patients with chronic pancreatitis
Authors: Li Bingqing , Chu Yuning , Wang Xiaowei , Meng Pin , Fang Liang , Tian Zi-Bin , Li Xiaoyu
Published: January 2025

Background

Abdominal pain is one of the most prominent symptoms in patients with chronic pancreatitis (CP) and can manifest intermittently or persistently. The mechanism of pain is not yet clear, and no effective treatment is currently available. This study aimed to explore the risk factors for pain in patients with CP, which may provide new insights for developing effective pain control modalities.

Methods

This clinical study was based on a single-centre research database that included 570 patients with CP. We compared the differences in baseline data, clinical characteristics, and psychophysiology traits between patients with and without pain. Subsequently, patients will be followed up to assess changes in their risk factors and explore their relationship with pain.

Results

In the final risk factor model, young age (P = .031; odds ratio [OR] = 0.986 [0.973, 0.999]), prolonged disease duration (P < .001; OR = 1.307 [1.127, 1.516]), heavy smoking (P = .014; OR = 1.331 [1.060, 1.617]), alcohol consumption (P = .003; OR = 1.419 [1.127, 1.788]), low body mass index (P < .001; OR = 0.786 [0.703, 0.879]), pancreatic exocrine insufficiency (P = .040; OR = 1.683 [1.024, 2.767]), acute pancreatitis attacks (P = .027; OR = 1.759 [1.067, 2.902]), anxiety, and depression (P = .016; OR = 1.047 [1.009, 1.088]; P = .014; OR = 1.068 [1.013, 1.126]) were associated with CP pain. Reducing tobacco and alcohol intake (P = .001; OR = 2.367 [1.525, 4.637]; P = .024; OR = 2.011 [1.085, 3.199]), increasing the body mass index (P = .005; OR = 1.968 [1.265, 3.805]), and improving anxiety (P = .001; OR = 1.164 [1.081, 1.340]) were identified to be beneficial for pain relief. Compared to the effects on persistent pain, pancreatic enzyme supplementation (P = .004; OR = 1.794 [1.186, 2.502]) had a clear effect on intermittent pain in patients with CP.

Conclusion

We identified a multifactorial model of pain risk factors for CP and confirmed that modifying these risk factors could influence patient pain symptoms.
Robert Lee and his Undisciplined Medical Self: Life Writing, Character and ‘Technologies of Self’ in the Victorian Medical Profession
Authors: Bradley James
Published: January 2025

Robert Lee was a divisive figure who, for much of his professional life, mismanaged his reputation. In this article, I use a diary written between 1837 and 1873 to explore the part character played in Lee’s fraught relationship with the medical profession. Special attention is paid to Lee’s dual use of life writing. On the one hand, he was an avid reader of biographies, memoirs and obituaries, which he then recorded in his diary. On the other, his diary writing was designed to audit his behaviour and then transform his self, making him a disciplined medical professional. Presented like this, his diary bears the hallmarks of a Foucauldian ‘technology of self’. However, Lee’s dual engagement with life writing revealed the character flaws that did much to damage his professional standing, and despite the diary’s use as a tool for self-fashioning, an unruly professional subject emerged from its pages.
Two-Year Outcomes of Umbilical Cord Milking in Nonvigorous Infants: A Secondary Analysis of the MINVI Randomized Clinical Trial
Authors: Katheria Anup C. , El Ghormli Laure , Clark Erin , Yoder Bradley , Schmölzer Georg M. , Law Brenda H.Y. , El-Naggar Walid , Rittenberg David , Sheth Sheetal , Martin Courtney , Vora Farha , Lakshminrusimha Satyan , Underwood Mark , Mazela Jan , Kaempf Joseph , Tomlinson Mark , Gollin Yvonne , Rich Wade , Morales Ana , Varner Michael , Poeltler Debra , Vaucher Yvonne , Mercer Judith , Finer Neil , Rice Madeline Murguia
Published: January 2025

(Abstracted from JAMA Network Open 2024;7:e2416870)

Delaying umbilical cord clamping at least 30 to 60 seconds at birth has been shown to improve neurodevelopmental outcomes in full-term infants and survival in preterm infants. However, in nonvigorous infants who may need resuscitation, the optimal umbilical cord management is unclear.
Risk of Stillbirth After a Previous Caesarean Delivery: A Swedish Nationwide Cohort Study
Authors: Al Khalaf Sukainah Y. , Heazell Alexander E.P. , Kublickas Marius , Kublickiene Karolina , Khashan Ali S.
Published: January 2025

(Abstracted from BJOG 2024;131:1054–1061)

The rate of cesarean delivery (CD) rose from 12% in 2000 to 21% in 2015. There may be as many as 6.2 million CDs performed each year without a specific medical indication.
Virtual Compared With In-Office Postoperative Visits After Urogynecologic Surgery: A Randomized Controlled Trial
Authors: Lua-Mailland Lannah L. , Nowacki Amy S. , Paraiso Marie Fidela R. , Park Amy J. , Wallace Shannon L. , Ferrando Cecile A.
Published: January 2025

(Abstracted from Obstet Gynecol 2024;144:562–572

Since the pandemic, telehealth visits have been widely adopted in a variety of healthcare systems and medical specialties. Previous studies have suggested that in general, telehealth visits increase patient satisfaction as well as engagement and adherence to care.
Incidence Rates and Risks for Reoperations for Nonunion and Adjacent Level Disease
Authors: Guppy Kern H. , Chang Richard , Fennessy Jacob , Prentice Heather A. , Harris Jessica E. , Ho Allen L. , Babhadi Amir Goodarzi , Brara Harsimran S. , Kuo Calvin
Published: January 2025

Study Design.

A retrospective cohort study.

Objective.

To determine if there is a difference in reoperations for adjacent segment disease (operative ASD) and nonunion (operative nonunion) in lumbar fusions that stop at T10/T11/T12 versus L1.

Summary of Background Data.

Current lumbar spine surgery is based on the belief that ASD occurs if fusions are stopped at L1 although there is varying evidence to support this assumption.

Methods.

We conducted a cohort study using data from a US-based integrated healthcare system’s Spine Registry of adult patients ≥18 years old with degenerative disc disease/adult lumbar deformity who underwent primary lumbar fusions. The exposure of interest was lumbar fusions stopping at L1 versus T10/T11/T12. Propensity score-weighted Cox proportional hazards regressions were used to evaluate reoperation risk for ASD and for nonunion.

Results.

The study cohort included 227 lumbar fusions that stop at L1 and 228 stop at T10/T11/12. Mean age for the cohort was 68.4 years with mean follow-up time of 6.3 years. For caudal level at L5 and S1, we found no statistical differences between operative ASD stopping at L1 versus T10/11/12 (HR=1.03, 95% CI=0.53-2.02, P=0.93 and HR=0.67, 95% CI=0.27-1.67, P=0.39, respectively). For the Short-segment fusions (caudal level: L3,4,5) and Long-segment fusions (L5, S1. S1+ilium) we also found no statistical difference in operative ASD (HR=1.44, 95% CI=0.68-3.09, P=0.34 and HR=0.83, 95% CI=0.52-1.30, P=0.41, respectively). For Long-segment fusions we also found no statistical difference in operative nonunion (HR=0.65, 95% CI=0.20-2.11, P=0.47).

Conclusion.

Our study provides some evidence against crossing the thoracolumbar junction (TLJ) for individual constructs terminating at S1, as well as for Long-segment fusions, based on comparisons of operative ASD and operative nonunion. However, further research is needed to determine whether this finding holds true for individual constructs with caudal levels at L2, L3, L4, and S1+ilium.
Effects and Safety of Botulinum Toxin Injection in Treatment of Androgenetic Alopecia: A Meta-analysis and Systematic Review
Authors: Cheng Fengrui , Cai Xingrui , Zhang Ying , Wu Jingping , Yin Sisi
Published: January 2025

BACKGROUND

Androgenetic alopecia (AGA) is a prevalent condition that significantly affects the psychosocial well-being of many individuals, and its treatment remains a clinical challenge. Botulinum toxin (BTX) injections have been reported to have a therapeutic effect on AGA. Although several studies have explored the efficacy and safety of this novel treatment, most are clinical studies with small sample sizes.

OBJECTIVE

To evaluate the efficacy and safety of BTX injections in the treatment of AGA through a meta-analysis and systematic review.

METHODS

A comprehensive literature search was conducted using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, ScienceDirect, Springer, and Web of Science to identify studies investigating the use of BTX in the treatment of AGA. The primary outcome was hair count.

RESULTS

Eight studies were included in the systematic review. The pooled data demonstrated a statistically significant increase in hair count in patients treated with BTX compared with the control group (standardized mean difference = 1.02; 95% confidence interval, 0.30–1.74, p < .05).

CONCLUSION

Injectable BTX seems to be a promising treatment for AGA, showing significant efficacy and good safety.
A diagnostic conundrum: a patient with only complaints of palpitations and dyspnea was diagnosed with thyroid storm: a rare case report
Authors: Sajjad Waseem , Ur Rehman Ubaid , Maha  , Maqbool Maham , Fatima Arooj , Memon Zauha Fawad , Nasrallah Jamil
Published: January 2025

Introduction and background:

The life-threatening side effect of hyperthyroidism, the thyrotoxic storm, can be difficult to diagnose because of its wide range of vague clinical symptoms. Patient survival depends on early diagnosis and treatment.

Case presentation:

This report presents the case of a male patient, age 58, who had no previous history of hyperthyroidism and initially complained of palpitations and dyspnea. He had supraventricular tachycardia (SVT) and thyrotoxicosis upon evaluation. His Burch-Wartofsky Point Scale (BWPS) score of 50 indicated a high probability of thyroid storm. Propranolol and propylthiouracil were started on time, stabilizing the patient’s vital signs and converting SVT to atrial fibrillation. With further care, the thyrotoxicosis resolved.

Clinical discussion:

This example emphasizes how critical it is to identify thyroid storm and treat it quickly in order to maximize patient outcomes, especially when it is exacerbated by SVT. It also emphasizes how helpful the BWPS is in helping diagnose and treat patients in such cases.

Conclusion:

It is important for clinicians to evaluate each patient presented with cardiac symptoms of thyroid function abnormality. In order to manage thyroid storm, early intervention with beta-blockers and antithyroid drugs is essential. Better patient outcomes result from early diagnosis and treatment, which is made possible by the BWPS, particularly in cases with unexplained new-onset atrial fibrillation.
Drusen volume as clincial outcome measure in subjects with malattia leventinese
Authors: Ehrenzeller Clara , Cancian Giuseppe , Paris Arianna , Grimaldi Gabriela , Pfau Maximilian , Menghini Moreno
Published: January 2025

Purpose:

To assess if drusen volume can serve as structural clinical outcome marker in Malattia Leventinese (ML), and to evaluate whether cones or rods are more affected by its progression, using multimodal imaging and mesopic and two-color scotopic microperimetry.

Methods:

This was a prospective monocentric cross-sectional cohort study of participants with genetically confirmed ML. Participants were classified according to morphology. Mean drusen volume, calculated from SD-OCT, was compared to microperimetry parameters (mesopic retinal sensitivity, scotopic red and cyan function, difference between scotopic cyan-red function).

Results:

Fourteen participants (28 eyes) were enrolled. Mean drusen volume increased (bilaterally P=0.028) and mesopic retinal sensitivity decreased with later stage (OD: P=0.028; OS: P=0.050). Scotopic microperimetry showed that scotopic cyan function was lower than scotopic red function in moderate stage. Scotopic red function decreased in severe stage. Mean drusen volume correlated to mesopic retinal sensitivity (OD: P<0.001; OS: P=0.007).

Conclusion:

Retinal sensitivity diminishes with ML progression. Rod function declines prior to cone function, while at late stages, cone loss predominates. Drusen accumulation, initially speckled around the macula and optic disc and confluent with disease progression, correlates well with visual function loss and impaired quality of life. Thus, therapeutically reducing drusen accumulation could be efficacious.
Long-Term Outcomes of Pediatric Keratoplasty at a Tertiary Care Center
Authors: Majmudar Shivani P. , Chhadva Priyanka , Tu Elmer Y. , Djalilian Ali R. , de la Cruz Jose , Cortina Maria Soledad
Published: January 2025

Purpose:

To report the indications, postoperative visual outcomes, and long-term graft survival of primary pediatric keratoplasties performed at a single tertiary care center.

Methods:

We conducted a retrospective review of pediatric patients (16 years and younger) who underwent surgical intervention for corneal opacity at a tertiary care center to evaluate long-term graft survival and visual rehabilitation.

Results:

Seventy-three eyes of 46 patients met inclusion criteria. The mean patient age at the time of transplantation was 7.44 years (range, 5 months–15.72 years), and the average follow-up time was 5.82 years. Forty eyes (56%) had graft failure occurring at a mean time of 16.33 months (range, 27 days–12.58 years), of which 25 eyes (62.5%) underwent repeat keratoplasty. Cumulative graft survival probabilities at 1, 3, 5, and 7 years after keratoplasty were 60%, 55%, 44%, and 44%, respectively. Cox proportional hazards regression analysis showed Black ethnicity [hazard ratio (HR) = 4.72; confidence interval (CI), 1.16–19.23], mixed/other ethnicity (HR = 6.67, CI, 1.58–28.16), and keratoplasty in combination with another procedure (HR = 2.88; CI, 1.35–6.15) as significant risk factors of graft failure. 47 eyes (64%) achieved ambulatory vision (20/800 or better) at the last follow-up. Age younger than 5 years at time of keratoplasty was associated with better visual outcomes in patients with congenital disease (P = 0.0017).

Conclusions:

Pediatric keratoplasty has a high rate of graft failure but can achieve ambulatory vision in >60% of patients. Keratoplasty outcomes are improved in non-Hispanic, White patients and when the intervention is performed alone. Younger age at time of keratoplasty for congenital conditions improves the likelihood of overall visual rehabilitation.
Multicentric Mucinous Adenocarcinoma of Bilateral Eyelids
Authors: Nakasian Nicholas W. , Hofer Llwyatt K. , Buckley Kaila A. , Foster Jill A.
Published: January 2025

A 59-year-old female patient presented with a purple, fluid-filled lesion on her left upper eyelid that contained a solid component. Excisional biopsy revealed a diagnosis of mucinous adenocarcinoma. Extensive oncological workup was negative for a distant primary tumor or metastasis and confirmed a diagnosis of primary mucinous adenocarcinoma. Further excision and eyelid reconstruction were required. One year later, another suspicious, fluid-filled lesion was excised from the patients’ left lower eyelid. Biopsy and subsequent oncological workup confirmed a mucinous adenocarcinoma in situ, a known precursor of primary mucinous adenocarcinoma. This case contributes to the limited literature reporting multicentric primary mucinous adenocarcinoma of the eyelids and suggests that there may be underlying factors that heighten a patient’s risk for developing these tumors.
Visual outcomes, contrast sensitivity and defocus profile with an aspheric monofocal intraocular lens utilizing positive spherical aberration
Authors: Law Elizabeth M. , Aggarwal Rajesh K. , Buckhurst Phillip J.
Published: January 2025

Purpose:

To evaluate visual outcomes following bilateral implantation of the RayOne EMV intraocular lens with targeted micro-monovision.

Setting:

Southend Private Hospital, UK

Design:

Retrospective cohort

Methods:

50 subjects (100 eyes) assessed at 12 to 18 months post-operatively. Emmetropia was targeted in the dominant eye and myopia of -0.50 to -1.00D in the non-dominant eye. Uncorrected and distance corrected visual acuity was assessed monocularly and binocularly at distance (6m), intermediate (70cm) and near (40cm). Defocus was assessed from +1.50D to -4.00D monocularly and binocularly. Contrast sensitivity was assessed using a computerised Pelli-Robson chart.

Results:

Mean Spherical Equivalent (MSE) was -0.05±0.34D and -0.91±0.60D in the dominant and non-dominant eyes respectively. Uncorrected distance visual acuity (UDVA) was significantly different in the dominant (0.08±0.10LogMAR) and non-dominant eye (0.29±0.17LogMAR). (p<0.01). Corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were similar between eyes. However, significant differences were found between binocular uncorrected intermediate visual acuity (UIVA) (0.16±0.11LogMAR) and DCIVA (0.31±0.11LogMAR) (p <0.01) also, binocular uncorrected near visual acuity (UNVA)(0.30±0.17LogMAR) and DCNVA (0.50±0.19 LogMAR) (p<0.01). The non-dominant eye shows superior acuity eye in both UIVA (p<0.01) and UNVA(p<0.01). Contrast sensitivity showed no significant difference between eyes (p = 0.06). Significant improvement binocularly compared to monocularly was seen through imposed defocus -0.50 to -2.50D.

Conclusion:

The RayOne EMV with micro-monovision is a reliable method for improving intermediate and near visual acuity, by increasing the range of focus without compromise of distance acuity or contrast sensitivity.
Comparison of ticagrelor and clopidogrel in primary percutaneous coronary intervention patients: a single-center retrospective study
Authors: Yan Yufeng , Xu Haimei , Zhao Yingying , Lin Song , Zheng Yaguo
Published: January 2025

Background

It is uncertain whether ticagrelor is more effective and safer than clopidogrel in ST-segment elevation myocardial infarction (STEMI) patients in the East Asian population in the real world. This study compared the clinical outcomes of ticagrelor and clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Methods

We retrospectively enrolled 1124 patients diagnosed with STEMI in Nanjing First Hospital from July 2011 to April 2019. Propensity score matching was used to balance baseline covariates between the ticagrelor and clopidogrel groups. The primary efficacy endpoint was all-cause death, and the primary safety endpoint was major bleeding, defined as Bleeding Academic Research Consortium type 3–5 bleeding.

Results

We enrolled 1124 STEMI patients in the analysis. After propensity score matching, 420 patients were included in each group. There was a lower incidence of all-cause death in the ticagrelor group when compared with the clopidogrel group during the follow-up (8.3 vs. 17.1%; hazard ratio: 0.481; P < 0.001). Ticagrelor was also associated with reduced myocardial infarction, cardiovascular death, and stent thrombosis. However, no difference was detected in major bleeding. Multivariate Cox regression analysis showed that age, Killip classification, creatinine, low-density lipoprotein, left ventricular ejection fraction, single vessel disease, inhospital intra-aortic balloon pump implantation, β-blockers, and ticagrelor were independent predictive parameters of all-cause death.

Conclusion

Compared with clopidogrel, ticagrelor reduced all-cause death but did not increase the incidence of major bleeding in primary PCI patients. Therefore, ticagrelor may be considered a viable substitute for clopidogrel.
Effect of selenium on the dysfunction of rat salivary glands induced by 131 I and expression of insulin-like growth factors and aquaporins
Authors: Fang Ju , Huang Nan , Li Xiaoqian , Yue Rongli , Qin Zhuoqi , Cheng Qiyao , Wang Yunzhi , Li Huiling , Hao Xinzhong , Cheng Yan
Published: January 2025

Objectives

To investigate the effects of selenium on functional and histopathological changes and mRNA expression levels of insulin-like growth factors 1 and 2 (IGF-1 and -2) and aquaporins 4 and 5 (AQP-4 and -5) in 131I-induced damaged rat parotid glands.

Methods

Rats were divided into three groups: iodotherapy-with-selenium, iodotherapy-only, and control. Rats in the iodotherapy-with-selenium group were intragastrically administered 131I on the first day and selenomethionine through drinking water. Rats in the iodotherapy-only group were only administered 131I. Changes in parotid gland function were evaluated using the functional parameters of salivary gland dynamics imaging pre-experiment and on days 7, 30, and 90 post-treatment. Immunofluorescence and quantitative real-time PCR analyses detected IGF-1, IGF-2, AQP-4, and AQP-5 expression levels in tissues.

Results

The gland-to background ratio at a maximum count (G/BGmax), Tmax/Tmin, and Smax values were significantly impacted over time in the iodotherapy-with-selenium group; on day 30, the G/BGmax value was significantly higher than that in the iodotherapy-only group. Histopathological analysis revealed that on days 30 and 90, the iodotherapy-with-selenium group displayed greater parotid gland repair than the iodotherapy-only group. In the iodotherapy-with-selenium group, fluorescence intensity and mRNA levels of AQP-5 increased with the selenium supplementation period, reaching significantly higher levels on days 30 and 90 than in the iodotherapy-only group. Whereas the fluorescence intensity and mRNA levels of IGF-1 in the iodotherapy-with-selenium group were significantly higher on day 7 than on day 30 in the iodotherapy-only group.

Conclusion

Selenium may repair 131I-induced tissue and functional damage in rat salivary glands by upregulating AQP-5 and IGF-1 expression.
Young Adult Community Health Advisor–Led Intervention to Promote Colorectal Cancer Screening Uptake Among South Asians in Hong Kong
Authors: Rana Tika , Chan Dorothy N. S. , Choi Kai Chow , So Winnie K. W.
Published: January 2025

Background

Colorectal cancer is the most common cancer globally, and its prevalence is high in minority populations.

Objectives

To investigate the effectiveness of a young adult community health advisor (YACHA)–led intervention in enhancing the colorectal cancer (CRC) screening uptake rate among asymptomatic South Asians aged 50 to 75 years residing in Hong Kong and to investigate the acceptability of this intervention.

Methods

A randomized controlled trial design was adopted. Eighty asymptomatic South Asian participants aged 50 to 75 years were recruited from the community in Hong Kong and then randomly allocated either to a YACHA-led intervention group or a control group. The intervention group received YACHA-led intervention, whereas the control group would receive the intervention after all follow-up assessments. The outcome measure was the uptake of CRC screening test. The acceptability of the intervention was explored through semistructured interviews.

Results

The findings showed that the CRC screening uptake rate of the intervention group was significantly higher than that of the control group (85.0% vs 2.5%, P < .001). All the interviewees were satisfied with the intervention.

Conclusion

The YACHA-led intervention improves the uptake of CRC screening among asymptomatic South Asians.

Implications for Practice

It is suggested that more resources should be allocated to empower young members of minority groups to reduce the health disparity.
Perceptions From Non-Magnet® Organizations
Authors: Rollins Scott M.
Published: January 2025

OBJECTIVE

The aim of this study was to investigate the correlation between nurse leaders' transformational leadership and clinical nurses' structural empowerment in non-Magnet® hospitals, and the differences in this correlation by Magnet status.

BACKGROUND

Nurse leaders' transformational leadership has been positively correlated to increased structural empowerment in clinical nurses, primarily in Magnet-designated hospitals and those pursuing Magnet designation.

METHODS

A descriptive correlational study design was used to investigate the study aim. Clinical nurses from 1 hospital system in the northeast were offered the opportunity to participate.

RESULTS

In non-Magnet hospitals, nurse leaders' transformational leadership behaviors were strongly correlated to clinical nurses' structural empowerment (r = 0.831, P < .001). No statistically significant differences were found in this correlation by Magnet status.

CONCLUSIONS

Regardless of Magnet status, nurses experienced higher levels of structural empowerment when they perceived their nurse leaders' leadership behaviors as transformational in nature.
A Single-Site Approach
Authors: Smith-Miller Cheryl A. , Cline Michaela
Published: January 2025

OBJECTIVE

This study serves as a replicable model for other healthcare institutions to gather information directly from nurses about their interactions within the work environment and the factors affecting their decision to stay.

BACKGROUND

Persistently high turnover rates reflect nurses' discontent. Although personal reasons, career advancement, and relocation are cited as the top reasons for departures, macro-level data overlook the organizational and unit-level factors that erode nurses' desire to stay.

METHODS

Survey methods were used for data collection. The analysis included statistical and qualitative methods.

RESULTS

Salary, benefits, and work schedules were important in influencing nurses' decisions to stay, but their importance varied by career stage. Ergonomic aspects of nurses' daily work were key themes.

CONCLUSIONS

Organizational and unit elements play enduring roles in job satisfaction. Critically examining nurses' work environment from meso- and micro-level ergonomic perspectives can enhance understanding of nurse retention and provide evidence to fine-tune retention strategies.
PICC Lines in Pregnancy and Other Peripartum Vascular Access Considerations
Authors: Sarosi Ellery , Gatta Luke A. , Berman Deborah R. , Bauer Melissa , Kuller Jeffrey A.
Published: January 2025

Importance

To decrease associated infectious and thrombotic morbidity, it is important to understand the indications and risks of peripherally inserted central catheters (PICCs) and other vascular access means in pregnancy.

Objective

The objectives are 3-fold: (1) discuss indications and contraindications, approach to placement, and associated complications for PICC lines, arterial catheters, centrally inserted central catheters, and peripheral intravenous catheters; (2) review available data regarding complications associated with these catheters in pregnancy; and (3) propose an evidence-based approach to clinical decision making regarding vascular access in 2 clinical scenarios among pregnant patients.

Evidence Acquisition

A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines, with a focus on obstetrical anesthesia and obstetric literature.

Results

Data on vascular access complications in pregnancy are limited; therefore, rates of complications are extrapolated from studies including nonpregnant subjects. Catheter choice is dependent on resuscitation requirements, monitoring indications, parenteral therapeutic needs, need for inpatient versus outpatient care, and anticipated duration of use.

Conclusions and Relevance

All pregnant patients require vascular access. A subset requires more invasive catheters for management of specific conditions such as trauma in pregnancy, postpartum hemorrhage, and puerperal sepsis. In addition, vascular access plays an important role in operative planning for patients with placenta accreta spectrum disorder and fetal disorders requiring intrauterine surgery. Gaining an understanding of the types of catheters and their associated complications will allow obstetricians, family medicine physicians, midwives, nurses, intensivists, and anesthesiologists to make informed decisions regarding catheter selection and management.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner will be better able to discuss indications and contraindications, approach to placement, and associated complications for PICC lines, arterial catheters, centrally inserted central catheters, and peripheral intravenous catheters; describe available data regarding complications associated with these catheters in pregnancy; and propose an evidence-based approach to clinical decision making regarding vascular access in 2 clinical scenarios among pregnant patients.
Children Born After Assisted Reproduction More Commonly Carry a Mitochondrial Genotype Associating With Low Birthweight
Authors: Mertens Joke , Belva Florence , van Montfoort Aafke P.A. , Regin Marius , Zambelli Filippo , Seneca Sara , de Deckersberg Edouard Couvreu , Bonduelle Maryse , Tournaye Herman , Stouffs Katrien , Barbé Kurt , Smeets Hubert J.M. , Van de Velde Hilde , Sermon Karen , Blockeel Christophe , Spits Claudia
Published: January 2025

(Abstracted from Nat Commun 2024;15:1232

Assisted reproductive technology (ART) has enabled many couples before considered untreatably infertile to have children, though there have been concerns that children born using these technologies are at risk for adverse outcomes. These adverse outcomes vary, and many of them stem from unknown causes.
Future Directions in the Treatment of Low-Grade Gliomas
Authors: Kinslow Connor J. , Mehta Minesh P.
Published: January 2025

There is major interest in deintensifying therapy for isocitrate dehydrogenase–mutant low-grade gliomas, including with single-agent cytostatic isocitrate dehydrogenase inhibitors. These efforts need head-to-head comparisons with proven modalities, such as chemoradiotherapy. Ongoing clinical trials now group tumors by intrinsic molecular subtype, rather than classic clinical risk factors. Advances in imaging, surgery, and radiotherapy have improved outcomes in low-grade gliomas. Emerging biomarkers, targeted therapies, immunotherapy, radionuclides, and novel medical devices are a promising frontier for future treatment. Diverse representation in glioma research and clinical trials will help to ensure that advancements in care are realized by all groups.
Effect of age, harvest site and body mass index on the cell composition of the stromal vascular fraction
Authors: Yang Zi-Han , Zhang Tian-Yu , Chen Fang-Zhou , Xie Yun , Tan Poh-Ching , Li Qing-Feng , Zhou Shuang-Bai
Published: January 2025

Background:

The stromal vascular fraction (SVF) of adipose tissue has now been widely used in plastic surgeries, clinical trials and therapies. However, the cell composition of SVF undergoes dynamic changes during aging and obesity, which may influence the efficacy of the SVF. This study analyzed the effects of age, harvest site and body mass index on the cell composition of the SVF.

Methods:

A study was performed on 162 patients. The age ranged from 13 to 88 years old, with body mass index (BMI) <25kg/m2 or ≥ 25kg/m2. Fat tissue was harvested from the abdominal region, hips, thighs or arms, and the SVF was isolated for flow cytometry.

Results:

Our results demonstrated that the declines of adipose derived stem cells (ADSCs) and endothelial cells (ECs) first occurred in donors aged 40-49 years old. Subsequently, the percentages of endothelial progenitor cells (EPCs), preadipocytes, and M2 macrophages started to decrease in donors aged 50-69 years old. Lower percentages of ECs and M2 macrophages were found in donors with higher BMI.

Conclusions:

This study demonstrated that the percentages of ADSCs and ECs of SVF, decreased significantly starting from donors over age 40, followed by changes in other cell subpopulations. Furthermore, donors with BMI ≥ 25kg/m2 had lower percentages of ECs and M2 macrophages.
Benefits and durability of an affordable prosthetic silicone cushion liner locally manufactured in a resource-limited environment: Enabling adoption of total surface bearing sockets and silicone cushion liners
Authors: Ghidini Claudia , Sharma Shova Kanta , Shrestha Saloman , Prasad Dhan , Favier Clément D. , Erenstone Jeffrey , Bull Anthony M. J. , Maharjan Suraj
Published: January 2025

Introduction:

Prosthetic silicone liners improve comfort and skin protection and allow the use of total surface bearing (TSB) sockets, which provide enhanced proprioception and comfort. Unfortunately, silicone liners are cost-prohibitive in resource-limited environments (RLEs) where patellar tendon bearing (PTB) sockets with PE-lite liners remain standard, leading to patient discomfort and skin issues.

Objective:

This study evaluates the benefits and durability of an affordable silicone liner locally manufactured in an RLE to promote TSB socket adoption, aiming to enhance prosthetic care and patient outcomes.

Methods:

Ethical approval was granted by the Nepal Health Research Council. Twelve people with a unilateral transtibial amputation who were using a PTB socket with PE-lite participated in the study and received a new prosthesis (TSB socket with an affordable silicone liner). Participants performed mobility tests (2-Minute Walking Test, Timed Up and Go Test) and completed self-reported questionnaires for both prostheses. Liner durability was assessed.

Results:

Participant mobility improved while wearing the TSB socket and silicone liner. The new prosthesis was found to be comfortable, and there were no major problems identified although excessive sweating, typical with silicone liners, was reported. Liners were replaced after 6.1 (±3.1) months.

Conclusion:

A locally manufactured liner provided increased mobility and high levels of satisfaction. This affordable liner may be suitable for use in RLEs, enabling adoption of TSB sockets and improving rehabilitation outcomes of people with a transtibial amputation. However, durability concerns and excessive sweating would suggest that improvements can still be made.
Interprogram Differences in Core General, Core Plastic, and Plastic Surgery-Adjacent Training
Authors: Akhavan Arya A. , Atayeva Rena , Tiongco Rafael F. P. , Puthumana Joseph S. , Redett Richard J. , Lifchez Scott D. , Cooney Damon S. , Cooney Carisa M.
Published: January 2025

Background

Plastic surgery training continues to evolve with integrated residents spending more time in plastic versus general surgery. Herein, we provide an updated description of interprogram differences in core general, core plastic, and plastic surgery-adjacent training curricula.

Methods

We obtained rotation schedules from US plastic surgery residency websites or program coordinators for AY2021–2022. Rotation months were recorded and categorized into Core General Surgery, Core Plastic Surgery, and Plastic Surgery-Adjacent. Rotations were compared to American Board of Plastic Surgery (ABPS) and Accreditation Council for Graduate Medical Education (ACGME) standards. Data were analyzed using descriptive statistics (SPSS, IBM Corp., v27.0, Armonk, NY).

Results

Of 84 programs, we obtained schedules for 63 (75%). Most offered 2 years of Core General Surgery followed by 4 years of Core Plastic Surgery training (n = 32, 50.8%). From postgraduate years 1–6, programs offered median 52 months [interquartile range (IQR): 47.5, 55] of Core Plastic Surgery, 12 months (IQR: 9, 14) of Core General Surgery, and 8 months (IQR: 6, 10) of Plastic Surgery-Adjacent rotations. Six (9.5%) programs' schedules included rotations specifically addressing all ABPS competency requirements; 1 (1.6%) included rotations addressing all ACGME Core General Surgery competency requirements. Departmental status was not associated with differences in training time.

Conclusions

Our results demonstrate that in AY2021–2022, integrated plastic surgery training programs offered 6 months less Core General Surgery, 3 months less Plastic Surgery-Adjacent, and 9 months more Core Plastic Surgery Rotations than in 2012. Very few program schedules include named rotations that specifically addressed all ABPS or ACGME competency requirements.
Purported Bladder Irritant Intake in Women With Urgency Urinary Incontinence
Authors: Ha Barbara , Yanek Lisa R. , Harrington Bryna J. , Blomquist Joan L. , Chen Chi Chiung Grace , Patterson Danielle , Handa Victoria L.
Published: January 2025

Importance

Patients with urgency urinary incontinence are often recommended to avoid bladder irritants, but there is a lack of evidence for this.

Objective

The aim of the study was to compare consumption of purported bladder irritants between women with and without urgency urinary incontinence.

Study Design

We performed a case-control study of nonpregnant females aged ≥20 years using the National Health and Nutrition Examination Survey, 2007–2020. Cases were defined as participants with moderate, severe, or very severe urgency urinary incontinence without stress urinary incontinence, measured with the Sandvik Incontinence Severity Index. Controls were defined as those without urgency urinary incontinence. The exposures of interest were 6 bladder irritants listed by the National Institute of Diabetes and Digestive and Kidney Diseases: (1) alcohol; (2) spicy foods; (3) chocolate; (4) artificial sweeteners; (5) caffeinated, carbonated, and citrus beverages; and (6) high-acid foods. Weighted multivariable logistic regression analysis was used to determine independent associations between each irritant and urgency urinary incontinence.

Results

Overall, this study included 651 cases with urgency urinary incontinence (6.8%) and 8,890 controls (93.2%). More cases reported consuming caffeinated, carbonated, and citrus beverages (53.8% vs 47.1%, P = 0.01) and high-acid foods (50.3% vs 44.3%, P = 0.02). In multivariable analysis, the odds of urgency urinary incontinence were increased significantly with intake of caffeinated, carbonated, and citrus beverages (odds ratio 1.37, 95% confidence interval 1.09–1.73) and high-acid foods (odds ratio 1.29, 95% confidence interval 1.03–1.62).

Conclusions

In this case-control study of community-dwelling adult females, urgency urinary incontinence was associated with consumption of caffeinated, carbonated, and citrus beverages and high-acid foods. Adequately powered prospective trials are needed to further investigate the effects of these foods and beverages on urgency urinary incontinence to guide clinical practice.
Irreversible Electroporation and β-Glucan Induced Trained Innate Immunity for the Treatment of Pancreatic Ductal Adenocarcinoma: A Phase II Study
Authors: Martin Robert CG , Li Yan , Shore Emily A , Malik Danial A , Li Hong , Hu Xiaoling , Hayat Traci , Tan Min , McMasters Kelly M , Yan Jun
Published: January 2025

Introduction:

Irreversible electroporation(IRE) has augmented the effects of certain immunotherapies in pancreatic cancer(PDA). Yeast-derived particulate beta-glucan induces trained innate immunity and has successfully reduces murine PC tumor burden. This is a Phase II study to test the hypothesis that IRE may augment beta-glucan induced trained immunity in patients with PDA.

Methods:

Phase II clinical trial (NCT03080974), surgical ablative IRE was performed on clinical stage-III PDA followed by oral beta-Glucan administration for 12-months or until disease recurrence. Peripheral blood was taken pre-op, 14-days, and every 3-months and was evaluated by mass cytometry and compared to patients who received IRE alone.

Results:

Thirty consecutive patients with pre-operative clinical stage-III PDA were treated with IRE and then initiated on oral beta-glucan post-operatively was compared to 20 patients treated with IRE alone. There were no dose limiting toxicities with oral beta-glucan and compliance with therapy was 96% in all patients. Seven(23%) patients developed grade 3/4 treatment related adverse events(AEs) at 90-days; none required a dose modification of oral beta-glucan. Median disease-free interval of 18 months (range 6-48), with a median overall survival of 32.5 months(range 4-53). At 12-months post IRE, immunophenotyping was demonstrated a significant effect with improvement in the IRE-Beta-Glucan treated group. This also resulted in a significant decrease on naïve CD4 and CD8 T cells with increased CD4 and CD8 terminal effector cells in the IRE-Beta glucan treated group, which correlated with a significant improvement in disease free interval (DFI) and overall survival (OS)(P=0.001).

Conclusions:

Combined beta-glucan with IRE ablated PDA tumor cells elicited a potent trained response and augmented anti-tumor functionality at 12 months post IRE, which translated into an improved DFI and OS.
Long-Term Islet Graft Functional Assessments in More than 500 Patients Undergoing Total Pancreatectomy with Intraportal Islet Autotransplantation
Authors: Bellin Melena D , Eaton Anne , Ramanathan Karthik , Beilman Gregory , Downs Elissa , Schwarzenberg Sarah J , Trikudanathan Guru , Freeman Martin , Sutherland David , Chinnakotla Srinath
Published: January 2025

Background:

Total pancreatectomy and intraportal islet cell auto transplantation (TPIAT) is increasingly being offered to patients with refractory chronic pancreatitis. Understanding factors that impact islet function over time is critical.

Study Design:

We evaluated factors associated with islet function over 12 years post TPIAT using mixed meal tolerance testing (MMTT). Insulin independence and HbA1c were assessed at each time. We compared AUC C-peptide, AUC glucose, insulin independent and HbA1c patterns over time by patient characteristics using generalized linear mixed models.

Results:

555 patients (median age 32 (IQR 17,45) years, 25% pediatric; 70% female, 41% overweight/obese) undergoing TPIAT were studied. Median islet equivalents/kg (IEQ/kg) transplanted was 3,696 (IQR 2,449, 5,494) with 26% receiving low (<2500 IEQ/kg), 43% moderate (2500-5000 IEQ/kg), and 31% high islet mass (>5000 IEQ/kg). AUC C-peptide immediately post TPIAT was lowest in those with low islet mass and remained low over time. AUC C-peptide showed a modest increase in islet function over 3-4 years in moderate/high islet mass, followed by decline (p<0.0001 for difference in post-TPIAT trajectory by group). Children have better long-term islet function particularly beyond 5 years post-TPIAT, although the difference did not reach statistical significance (p=0.0608); and overweight individuals have declining islet function long-term while those with normal/low BMI have gains in the first 3-5 years (p<0.0001). Mean hemoglobin A1c was sustained at <7% for 8 years in high islet-mass.

Conclusions:

In patients with high islet mass transplanted, islet function improves in the first several years after IAT. Islet function is sustained longer in children than in adults. Overweight/obese body habitus may be detrimental to long-term islet function, highlighting the importance of maintaining a healthy body weight for TPIAT recipients.
Holzapfeliella saturejae sp. nov. isolated from flowers of winter savoury Satureja montana L.
Authors: Alcántara Cristina , Peirotén ngela , Ramón-Núñez Luís Andrés , Landete José María , Monedero Vicente , Zúñiga Manuel
Published: January 2025

A novel strain of the genus Holzapfeliella, named He02T, was isolated from flowers of Satureja montana L. in a survey for lactic acid bacteria associated with wild and cultivated plants in the metropolitan area of Valencia, Spain. Partial 16S rRNA gene sequencing revealed a similarity of 99% to Holzapfeliella floricola DSM 23037T=Ryu1-2T. Strain He02T cells are Gram-stain-positive, catalase-negative non-motile rods, usually occurring in pairs. Cells show a pale yellow pigmentation when pelleted. As H. floricola, strain He02T utilized a narrow range of carbohydrates, namely, glucose and fructose, homofermentatively. However, genome sequencing and estimation of average nucleotide identity (ANI) revealed an ANI value of 87.44 with H. floricola DSM 23037T, the only H. floricola strain sequenced to date. A value of 30.5% for digital DNA–DNA hybridization was estimated with the Type Strain Genome Server tool when He02T was compared with strain DSM 23037T. These results indicate that strain He02T constitutes a novel species, for which the name Holzapfeliella saturejae sp. nov. with He02T (=CECT 31001T=DSM 117324T=CCM 9395T) as type strain is proposed.
Potent synthetic lethality between PLK1 and EYA-family inhibitors in tumours of the central and peripheral nervous system
Authors: Nelson Christopher B. , Wells Jadon K. , Kesarwani Ekaagra , Sobinoff Alexander P. , Gao Jixuan , MacKenzie Karen L. , Poulos Rebecca C. , Nawaz Urwah , Wang Xiang , Ford Heide L. , Pickett Hilda A.
Published: January 2025

The Eyes Absent family of protein phosphatases (EYA1-4) are aberrantly expressed and tumour-promoting across many devastating cancers of neurological origin affecting both children and adults. It has recently been demonstrated that EYA1 and EYA4 promote tumour cell survival by increasing the active pool of Polo-like kinase 1 (PLK1) molecules. This discovery provides a rationale for the therapeutic combination of EYA inhibitors with direct, ATP-competitive, PLK1 inhibitors. Here, we demonstrate potent and synergistic effects of EYA and PLK1 inhibition in cancer cell lines that overexpress EYA1 and/or EYA4, including in neuroblastoma and glioblastoma models. We identify decreases in PLK1 activity and RAD51 foci formation, and increases in mitotic arrest and cell death, as mechanistic contributors to combination sensitivity. Combined EYA and PLK1 inhibition is also effective in glioblastoma stem cell models that overexpress EYA1/EYA4 and specifically targets the cancer stem cell state. Finally, through multi-omic correlational analysis, we identify high levels of the NuRD complex and SOX9 as contributors to combination treatment sensitivity. Overall, this work identifies a novel synthetic lethal combination therapy with potential utility across a wide range of neurological cancers.