bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluorescence-guided Two-port Robotic Gastrectomy Versus Conventional Laparoscopic Gastrectomy: A Nonrandomized Controlled Trial
Authors: Choi Seohee , Kim Na Young , Kim Youn Nam , Park Sung Hyun , Kim Ki-Yoon , Cho Minah , Kim Yoo Min , Hyung Woo Jin , Kim Hyoung-Il
Published: July 2023

Objective:

To compare the number of retrieved lymph nodes between conventional laparoscopic gastrectomy (CLG) and robotic gastrectomy integrated with fluorescence guidance and a two-port system (integrated robotic gastrectomy, IRG).

Background:

The benefits of robotic surgery over laparoscopic surgery for gastric cancer have not yet been established. Using built-in features of robotic system, further benefit can be provided to the patients with effective lymphadenectomy and enhanced recovery.

Methods:

A nonrandomized controlled trial was performed by a single surgeon at single-center, tertiary referral hospital between January 2018 and October 2021. Overall, 140 patients scheduled to undergo minimally invasive subtotal gastrectomy for early gastric cancer were enrolled. The primary endpoint was the number of retrieved lymph nodes. Secondary endpoints were complications, hospital stay, pain score, body image, and operative cost.

Results:

This study analyzed 124 patients in the per-protocol group (IRG, 64; CLG, 60). The number of retrieved lymph nodes was higher in the IRG group than those in the CLG group (IRG vs CLG; 42.1 ± 17.9 vs 35.1 ± 14.6, P = 0.019). Moreover, other surgical parameters, such as hospital stay (4.1 ± 1.0 vs 5.2 ± 1.8, P < 0.001) and body image scale (better in 4 of the 10 questions), were significantly better in the IRG than in the CLG.

Conclusions:

Robotic surgical procedures integrated with fluorescence guidance and a reduced-port system yielded more retrieved lymph nodes. In addition, the IRG group showed better perioperative surgical outcomes, particularly regarding the length of hospital stay and postoperative body image.

Trial registration:

NCT03396354
Geriatric Intertrochanteric Fractures: What is the optimal follow-up period?
Authors: Green John , Watson J. Tracy , Philip Shaheen  , Kuldjanov Djoldas
Published: July 2023

Objective:

To evaluate operatively treated intertroch fracture patients in order to determine the optimal follow-up to ensure complete fracture healing and recognize complications.

Design:

This was a retrospective cohort review of patients, presenting with an intertrochanteric hip fracture, treated with a cephallomedullary nail (CMN) or sliding hip screw.(SHS).

Setting:

Patients were treated at an Academic Level 1 trauma center. The trauma database matched with CPT codes 27244 and 27245 to identify patients over the age of 60, treated with CMN or SHS. Inclusion criteria included isolated intertroch fractures (not pathologic), complete radiographic and clinical data, with at least 1 year follow-up. 497 patients were identified. 249 patients met inclusion criteria with 194 patients studied.

Intervention:

All patients underwent operative fixation for their isolated intertroch fractures with either CMN or SHS.

Main Outcome Measurements:

Radiographic parameters included time to union, neck shaft angle, tip apex distance, and femoral neck screw telescoping (shortening)for both CMS and SHS combined. Post-operative complications were recorded.

Results:

Union was achieved at a mean of 64.8+/-30.7 days. Mortality (n=12), infection (n=4), and implant failure (n=5) occurred within three months . Neck shaft angle changed prior to 3 months. Significant neck shortening for both CMN and SHS occurred within 6 weeks. (p=<0.001). Major complications occurred early, within 3 months.

Conclusion:

Radiographic parameters occurred during the first 3 months . Most fractures healed by three months, the remainder by 6 months. Routine follow up for 6 months is more than sufficient for most of these fractures.

Level of evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Surgeon Preference for Prophylactic Contralateral Fixation in Slipped Capital Femoral Epiphysis (SCFE) Patients: A Nationwide POSNA Survey Study
Authors: Donnelly Megan R. , Layne Jonathan E. , Castañeda Pablo G.
Published: July 2023

Background:

It is estimated that 11% to 60% of unilateral slipped capital femoral epiphysis (SCFE) patients will develop contralateral pathology, usually within 18 months after the first event. Despite this, prophylactic fixation remains controversial, and there is significant variability in surgeon preferences. Thus, this study aimed to determine which factors predict surgeon preferences for prophylactic contralateral pinning in SCFE patients.

Methods:

We designed a survey for pediatric orthopedic surgeons to collect data on (1) surgeon and hospital characteristics, (2) individual preference for contralateral SCFE pinning in three disparate hypothetical scenarios, and (3) personal risk-aversion traits. The questionnaire was distributed across the United States by the POSNA Evidence-Based Orthopaedics Committee. All POSNA members were eligible to respond. We performed analyses to evaluate the role of patient risk factors in hypothetical surgical decision-making and to determine if surgical training, hospital characteristics, and geographic region influenced prophylactic pinning in a surgeon’s real-life practice.

Results:

A total of 126 POSNA members responded to the survey. In the last year, a median of 6.5 SCFE patients was seen per surgeon (1243 patients total). A median of 10% of those patients underwent prophylactic contralateral fixation. In multiple analyses, surgeons were influenced by body mass index, open triradiate cartilage, patient race, various endocrine abnormalities, and specific radiographic measurements when deciding to fix the contralateral side prophylactically. Moreover, in multivariate regression, more years in practice and a hospital size of 500+ beds predicted fewer prophylactic fixation procedures (all P<0.05). Surgeons practicing in the South Atlantic, New England, and Mountain regions of the United States estimated the highest rate of contralateral pinning.

Conclusions:

This study’s findings suggest that multiple factors influence surgeons’ decisions to prophylactically fix the contralateral side in SCFE patients. Surgical training, hospital characteristics, and geographical regions played a role in decision-making.

Level of Evidence:

N/A
The Difference in Tibial Tuberosity to Trochlear Groove Distance Between CT and MRI Arises From the Degree of Knee Flexion During Imaging
Authors: Bae Kunhyung , Aldosari Amaal Mohammed , Kang Michael Seungcheol
Published: July 2023

Background:

Tibial tuberosity to trochlear groove distance (TT-TG) has been reported to have different values according to imaging modalities, usually higher in computed tomography (CT) than in magnetic resonance imaging (MRI). This difference is thought to be caused by the degree of knee flexion during imaging, but few studies have aimed to elucidate the cause.

Methods:

Five hundred eight patients with knee CT or MRI performed between ages of 6 to 16 years without underlying diseases affecting the musculoskeletal system were included. This study was conducted in 2 statistical ways. (1) Propensity score matching was performed for the imaging modality, and the bony TT-TG was compared between the 2 matched groups. (2) A regression model was fitted with 484 patients with either CT or MRI (a training set), and validation of the fitted model was performed with 24 patients with both CT and MRI simultaneously taken within a week (a test set). The predicted TT-TG values were compared with the measured values.

Results:

(1) Eighty-one patients were successfully matched by propensity score (all the standardized mean differences < 0.1) for each modality. In the matched patients, there was no significant difference in TT-TG according to the imaging modality (11.3 ± 3.7 mm for CT, 10.4 ± 3.8 mm for MRI, P = 0.126). (2) For the model fitting, different linear models were fitted before and after 10 degrees of knee flexion angle because there was a sharp change in TT-TG when the knee flexion angle was <10 degrees. The predicted TT-TG values did not significantly differ from the measured values (10.2 ± 4.3 mm vs. 9.0 ± 5.1 mm, P = 0.124).

Conclusions:

This study is the first to statistically prove that the difference between TT-TG in MRI and CT originates from the different degrees of knee flexion. In addition, although more studies are needed, authors recommend imaging to be performed with the knee flexed at least 10 degrees for more reliable measurements because TT-TG changes sharply if the knee flexion angle is <10 degrees.

Level of Evidence:

III.
Moving from Interest to Engagement—Understanding the Research Capacity Building Needs of Rehabilitation Doctors
Authors: Geraghty Timothy J. , Foster Michele M. , Burridge Letitia H.
Published: July 2023

Introduction:

Doctors working in rehabilitation settings have specialized clinical skills and experience, but research activity may be constrained by time pressures and inadequate current skills. This means missed opportunities to contribute to the evidence-base for better clinical practice and outcomes for people living with disabling, chronic complex conditions. This research aimed to understand rehabilitation doctors' research needs, experience, and aspirations to enable future training initiatives that are tailored to their practice context.

Methods:

This exploratory sequential mixed-method study comprised a survey followed by focus groups. Rehabilitation doctors from three health services in south-east Queensland, Australia completed an online survey incorporating the Research Spider to explore their research experience, confidence, interest, opportunity, and intent. Focus groups explored the survey results and participants' views regarding strategies to build research capacity.

Results:

The major findings were the gap between high research interest and low experience, confidence and opportunity; and fundamental research skills were identified as priority training topics. These findings support previous research. However, rehabilitation doctors may also have a self-expectation that, as competent clinicians, they should necessarily also be research-competent, and hold misperceptions regarding the shared nature of health services research.

Discussion:

Protected time and funding may enhance engagement with research to generate specialty-relevant evidence for practice. To this end, a research capacity building initiative in the form of a series of self-directed learning packages has been developed and implemented. A tailored workshop to strengthen rehabilitation doctors' research skills and engagement has also been developed for implementation.
Is Education Enough to Change the Practice of Monitoring of Blood Pressure in Outpatient Clinics? Case Report
Authors: Smith Leslie M. , Muralidharan Sindhuja , Stanek Diana , Yorke Amy M.
Published: July 2023

Purpose:

Hypertension (HTN) is a prevalent and preventable risk factor for several medical conditions that can lead to death. The purpose of this study was to investigate the frequency of physical and occupational therapists taking blood pressure (BP) in outpatient clinics before and after education focused on the clinical importance of monitoring BP.

Methods:

This pre/posttest model consists of 2 phases. In phase 1, physical and occupational therapists were surveyed regarding attitudes, behaviors, and barriers toward monitoring BP; and electronic medical records (EMR) were audited to determine frequency of BP documentation. For phase 2, educational webinars were developed highlighting the importance of BP monitoring and followed by another EMR audit.

Results:

Nine clinicians participated in our survey. Survey results indicated that one-third agreed that BP should be monitored during evaluations, but 100% responded that they rarely take BP. An audit of 488 EMR charts pre-education showed there was no BP documented. Three months after education, another 237 EMR charts were audited, with a 12.7% improvement in the frequency of BP documented. A chi-square analysis showed that this improvement was statistically significant (P < .001).

Conclusions:

Therapists did not monitor and document BP. After the webinar series, there was a significant increase, however still below recommendations for monitoring BP.
Local Regrowth and the Risk of Distant Metastases Among Patients Undergoing Watch-and-Wait for Rectal Cancer: What Is the Best Control Group? Muticenter Retrospective Study
Authors: São Julião Guilherme Pagin , Fernández Laura M. , Vailati Bruna Borba , Habr-Gama Angelita , Azevedo José , Santiago Inês , Parés Oriol , Parvaiz Amjad , Vendrely Véronique , Rullier Anne , Rullier Eric , Denost Quentin , Perez Rodrigo Oliva
Published: July 2023

BACKGROUND:

A proportion of patients that achieve a clinical complete response may develop local regrowth. While salvage appears to provide appropriate local control, the risk of distant metastases is less known.

OBJECTIVE:

Compare the risk of distant metastases between patients that achieve a complete clinical response (watch-and-wait strategy) and subsequent local regrowth to patients managed by surgery after chemoradiation.

DESIGN:

Retrospective multicenter cohort study.

SETTINGS:

This study used data of patients from 3 institutions that were treated between 1993 and 2019.

PATIENTS:

Patients with initial clinical complete response (after neoadjuvant therapy) followed by local regrowth and patients with near-complete pathological response (≤10%) after straightforward surgery after chemoradiation.

MAIN OUTCOME MEASURES:

Univariate/multivariate analysis was performed to identify risk factors for distant metastases. Kaplan-Meier curves were created (log-rank test) to compare survival outcomes. Analysis were performed using time-zero as last day of radiation therapy (1) or as date of salvage resection (2) in the local regrowth group.

RESULTS:

Twenty-one of 79 patients with local regrowth developed distant metastases while only 10 out of 74 after straightforward surgery (p = 0.04). Local regrowth and final pathology (ypT3-4) were the only independent risk factors associated with distant metastases. When using date of salvage resection as time-zero, distant-metastases-free survival rates was significantly inferior for patients with local regrowth (70 vs. 86%; p = 0.01).

LIMITATIONS:

Small number of patients, many neoadjuvant therapies, selection bias.

CONCLUSIONS:

Patients undergoing watch-and-wait who develop local regrowth are at higher risk for development of distant metastases compared to patients with near-complete pathological response managed by surgery upfront after chemoradiation.
A Descriptive Analysis of Access to Assistive Technology in Children With Acquired Brain Injury: The Right to Assistive Devices
Authors: Fins Joseph J. , Knitter Julie , Mukherjee Debjani , Conti Karen , Donleavy-Hiller Barbara , Gerber Linda M. , Hersh Jennifer E. , Kotorac-Erlbaum Rita , Milch Barbara , Klein Scott M.
Published: July 2023

Objective:

Pediatric clinicians caring for children with acquired brain injury have noted that many individuals requiring assistive technology (AT) go unserved or face delays until devices are obtained, with potential adverse implications for recovery and development. In this article we map the pathways by which AT is prescribed and assess delays and barriers to access.

Methods:

We conducted a retrospective chart review of patients with moderate to severe brain injury admitted to Blythedale Children's Hospital over a 2-year period using a database drawn from the medical record.

Results:

We identified 72 children diagnosed with brain injury requiring at least 1 device. Devices were used to improve mobility and positioning, self-care, safety, and communication, and enable access to other technologies and foster social integration. We found that 55% of devices were delivered, with most deliveries to home or the hospital's outpatient department for fitting, training, and instruction. Time to delivery ranged from 12 to 250 days with an average of 69.4 days. Twenty percent of nondeliveries were attributable to change in medical status, transfer to a skilled nursing facility, or continued inpatient status, while 31% were canceled by the family. Other nondeliveries were attributed to insurance coverage. We also found that the medical record is not designed for the longitudinal tracking of devices, indicating the need for a prospective process to document the AT trajectory.

Conclusion:

Instead of tolerating delays and denials, there should be a normative expectation that children have a right to medically necessary devices, consistent with disability law. This analysis was undertaken as a step toward formulating a prospective means of tracking AT recommendations, approvals, denials, and/or deliveries. Our findings should be understood as a promissory note toward structural reforms that are reflective of society's responsibility to better meet the needs of vulnerable children and their families.
The role of extracellular vesicle-derived miRNAs in adipose tissue function and metabolic health
Authors: Paneru Bam D. , Hill David A.
Published: July 2023

Extracellular vesicles (EVs) are nanometer size lipid particles that are released from virtually every cell type. Recent studies have shown that miRNAs carried by EVs play important roles in intercellular and interorgan communication. In the context of obesity and insulin resistance, EV-derived miRNAs functionally bridge major metabolic organs, including the adipose tissue, skeletal muscle, liver, and pancreas, to regulate insulin secretion and signaling. As a result, many of these EV-derived miRNAs have been proposed as potential disease biomarkers and/or therapeutic agents. However, the field’s knowledge of EV miRNA-mediated regulation of mammalian metabolism is still in its infancy. Here, we review the evidence indicating that EV-derived miRNAs provide cell-to-cell and organ-to-organ communication to support metabolic health, highlight the potential medical relevance of these discoveries, and discuss the most important knowledge gaps and future directions for this field.
Impact of Interprofessional Communication on Safety in the Neonatal Intensive Care Unit
Authors: Thomas Tyler S. , Chance Kasey , Spurlock Amy
Published: July 2023

Background:

In light of the complex advances in neonatal intensive care units (NICU), it is essential that healthcare providers (HCPs) are equipped with the appropriate skills to effectively communicate between disciplines to provide safe, quality care. However, many HCPs acknowledge that they are not confident in their ability to communicate effectively with peers.

Purpose and Design:

This study aimed to identify perceived barriers and facilitators of communication among HCPs in a NICU setting. This study took place in a 60-bed NICU that utilized multiple disciplines of HCPs. Using a qualitative, cross-sectional design, 2 surveys were administered, namely, a demographic survey with open-ended questions and the Safety Attitudes Questionnaire (SAQ).

Results:

Findings indicated inverse relationships in age/experience and perceptions of management. Total SAQ scores ranged from 45 to 77 (N = 28, M = 62.47, SD = 9.40). The SAQ highlight that total scores above 75 correspond with positive perceptions of safety in the NICU.

Conclusion:

The statistical evidence derived from this study contributes to the evaluation of HCP-perceived communication barriers and facilitators. The identification of perceived barriers and facilitators of communication in an ICU setting may serve as a distinct, evidence-based foundation to develop interventions that emphasize the value of communication.
Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit
Authors: McDonald Rebecca , Moloney Willoughby
Published: July 2023

Background:

Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families.

Objective:

This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care.

Participants:

Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals.

Methods:

A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents.

Results:

Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes.

Conclusion:

The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.
One Year Into Dupilumab: Physician and Patient Experiences in Initiating Dupilumab for Pediatric Eosinophilic Esophagitis
Authors: Nguyen Nathalie , Burger Cassandra , Skirka Stephanie , White Shannon , Smith Melanie , Menard-Katcher Calies , Furuta Glenn T. , Mehta Pooja
Published: July 2023

In 2022, the US Food and Drug Administration approved dupilumab for treatment of eosinophilic esophagitis (EoE). The aims of this study were to report physician and patient perspectives on initiating dupilumab. A 2-pronged approach was used: (1) data on physician prescribing practices was gathered via retrospective chart review of EoE patients prescribed dupilumab and (2) pediatric patients on dupilumab were approached to complete a questionnaire regarding reasons for initiation. During this time, 42 patients were prescribed dupilumab. From the physician’s perspective, the primary reasons for dupilumab included nonresponse to topical corticosteroids (TCS) (52%), nonadherence (28%), adverse effects (10%), or to treat multiple atopic diseases (5%). The median dupilumab initiation time, from day prescribed to first injection, was 37 days [interquartile range (IQR) 37]. Almost all required prior authorization (PA) (98%), while 17% required letter of appeal and 2% required peer-to-peer. Fifteen patients (36%) completed the questionnaire portion of the study. From the patient’s perspective, the primary reasons for dupilumab initiation included nonresponse to TCS (27%), nonadherence to TCS (27%), concern about adverse effects of TCS (7%), and treatment of multiple atopic diseases (33%). In conclusion, physicians are prescribing dupilumab primarily for nonresponse to TCS and almost all required PA with a long delay to starting dupilumab.
Establishment of a t(11;19), KMT2A Rearranged B-ALL Cell Line for Preclinical Evaluation and Novel Therapeutics Development for Refractory Infant Leukemia
Authors: Sharma Ritul , Incoronato Andrea , Zhang Chunfen , Jayanthan Aarthi , Shah Ravi , Narendran Aru
Published: July 2023

Leukemia, diagnosed in children less than 12 months of age, is a rare condition with an aggressive disease presentation and poor response to conventional chemotherapeutic agents. In addition, the unique vulnerability of the affected population does not always permit the use of markedly intense regimens with higher doses of cytotoxic agents. However, the unique biology of these leukemic cells also provides opportunities for the identification of effective and potentially well-tolerated targeted therapeutic strategies. In this report, we describe the establishment and characterization of a cell line from the blasts of an infant diagnosed with refractory B-cell acute lymphoblastic leukemia (ALL) carrying the characteristic histone lysine methyltransferase 2A (KMT2A) gene rearrangement. This cell line consists of rapidly proliferating clones of cells with chemosensitivity patterns previously described for KMT2A rearranged leukemia cells, including relative resistance to glucocorticoids and sensitivity to cytarabine. We also show effective targetability with menin inhibitors, indicating the activity of abnormal KMT2A-related pathways and the potential utility of this cell line in comprehensive drug library screens. Overall, our findings report the establishment and in vitro validation of a cell line for research into key aspects of infant leukemia biology and targeted therapeutics development.
Barriers and Facilitators of Premarital Genetic Counseling for Sickle Cell Disease in Northern Nigeria
Authors: Galadanci Aisha A. , Estepp Jeremie H. , Khan Hamda , Farouk Zubaida L. , Caroll Yvonne , Hodges Jason , Yarima Sabiu , Ibrahim Umma A. , Idris Ibrahim M. , Gambo Awwal , Hussaini Nafiu , Mukaddas Aisha , DeBaun Michael R. , Galadanci Najibah A.
Published: July 2023

In high-income countries, premarital genetic counseling for Sickle Cell Disease (SCD) is a standard practice. However, in Nigeria, there is no formal premarital genetic counseling program available for SCD. We conducted a series of focus group discussions with health care professionals, patients with SCD, and parents of the patients with or without SCD to gain an understanding of their attitudes and beliefs towards SCD/Sickle Cell Trait and premarital genetic counseling for SCD. Data were analyzed using Charmaz’s constructivist grounded theory approach. Two themes were highlighted in the analysis as follows: (1) the difference between the perception of premarital sickle cell screening among individuals with SCD versus the general population, and (2) the personal beliefs and physical challenges that could lead to the avoidance of premarital screening within the general community. Lack of disease-related knowledge, testing facilities, transportation, and stigma associated with the disease were the most commonly perceived barriers to premarital testing. Also, a willingness to receive premarital testing for SCD exists within our community to reduce the spread of the disease and advocate for improved health-related quality of life of patients with SCD. The content and structure of a premarital genetic counseling program in Kano, Northern Nigeria, needs to be developed.
The Pursuing Excellence Collaborative: Engaging First-Year Residents and Fellows in Patient Safety Event Investigations
Authors: Paull Douglas E. , Newton Robin C. , Tess Anjala V. , Bagian James P. , Kelz Rachel R. , Weiss Kevin B.
Published: July 2023

Objectives

Resident and fellow engagement in patient safety event investigations (PSEIs) can benefit both the clinical learning environment’s ability to improve patient care and learners’ problem-solving skills. The goals of this collaborative were to increase resident and fellow participation in these investigations and improve PSEI quality.

Methods

This collaborative involved 18 sites—8 sites that had participated in a similar previous collaborative (cohort I) and 10 “new” sites (cohort II). The 18-month collaborative included face-to-face and virtual learning sessions, check-ins, and coaching calls. A validated assessment tool measured PSEI quality, and sites tracked the percentage of first-year residents and fellows included in a PSEI.

Results

Sixteen of the 18 sites completed the 18-month collaborative. Baseline was no first-year resident or fellow participation in a PSEI. Among these 16 clinical learning environments, 1237 early learners participated in a PSEI by the end of the collaborative. Six of these 16 sites (38%) reached the goal of 100% participation of first-year residents and fellows. As a percentage of total first-year residents and fellows, larger institutions had less resident and fellow participation. Six of the 9 cohort II sites submitted PSEIs for independent review at 6 months and again at the end of the collaborative. The PSEI quality scores increased from 5.9 ± 1.8 to 8.2 ± 0.8 (P ≤ 0.05).

Conclusions

It is possible to include all residents and fellows in PSEIs. Patient safety event investigation quality can improve through resident and fellow participation, use of standardized processes during training and investigations, and review of PSEI quality scores with a validated tool.
Artificial Intelligence-Enhanced Breast MRI
Authors: Lo Gullo Roberto , Marcus Eric , Huayanay Jorge , Eskreis-Winkler Sarah , Thakur Sunitha , Teuwen Jonas , Pinker Katja
Published: July 2023

Primary systemic therapy (PST) is the treatment of choice in patients with locally advanced breast cancer and is nowadays also often used in patients with early-stage breast cancer. Although imaging remains pivotal to assess response to PST accurately, the use of imaging to predict response to PST has the potential to not only better prognostication but also allow the de-escalation or omission of potentially toxic treatment with undesirable adverse effects, the accelerated implementation of new targeted therapies, and the mitigation of surgical delays in selected patients. In response to the limited ability of radiologists to predict response to PST via qualitative, subjective assessments of tumors on magnetic resonance imaging (MRI), artificial intelligence–enhanced MRI with classical machine learning, and in more recent times, deep learning, have been used with promising results to predict response, both before the start of PST and in the early stages of treatment. This review provides an overview of the current applications of artificial intelligence to MRI in assessing and predicting response to PST, and discusses the challenges and limitations of their clinical implementation.
Tips and Tricks to Avoid Complications With Scapula Tip-Free Flap
Authors: Imanol Zubiate Illarramendi , Paolo Cariati , Ángel Martínez-Sahuquillo , Fernando Monsalve , Jose Fernández Solís , Ildefonso Martínez Lara
Published: July 2023

Purpose:

Create a practical step-by-step guide to harvesting this flap, highlighting the critical points that can create problems during surgery and the postoperative period.

Methods:

The tips and tricks to harvesting the scapula tip-free flap are described in different points, describing the patient preparation and skin incision, identification of the anterior border of the latissimus dorsi, dissection of the pedicle, bone osteotomy, flap inset, and closure.

Results:

As the scapula tip-free flap provides skin, muscle, and bone tissue, it is a valid option for the reconstruction of the defects maxillary and mandibular region for facial reconstruction. The complications are minimal, with some cases of seroma and postoperative shoulder pain.

Conclusion:

Thanks to the surgical technique described, harvesting the scapula tip-free flap with the patient in the supine position makes it a valid option for working in 2 fields, shortening surgical time and being a very interesting option for maxillofacial reconstruction.
KNOCKDOWN OF CIRC_0001379 ATTENUATES HYPOXIA/REOXYGENATION-INDUCED CARDIOMYOCYTE APOPTOSIS AND INFLAMMATORY RESPONSE BY MIR-98-5P/SOX6 AXIS
Authors: Wang Kun , Wang Huifeng , Zhang Qiang , Liu Feijun
Published: July 2023

Background: Aberrant expression of circular RNAs (circRNAs) has been revealed to have crucial roles in the pathological processes of cardiovascular disease. Here, this study aimed to investigate the role and mechanism of circ_0001379 in hypoxia/reoxygenation (H/R)-induced cardiomyocyte injury to explore the potential action of circ_0001379 in acute myocardial infarction (AMI). Methods: Levels of genes and proteins were examined by quantitative real-time polymerase chain reaction and western blot. Cell counting kit-8 assay, 5-ethynyl-2′-deoxyuridine assay, and flow cytometry were used to detect cardiomyocyte proliferation and apoptosis, respectively. The activity of IL-1β, IL-6, and TNF-α was determined by ELISA analysis. The target relationship between miR-98-5p and circ_0001379 or SOX6 (SRY-Box Transcription Factor 6) was verified by dual-luciferase reporter and RNA immunoprecipitation assays. Results: Circ_0001379 was highly expressed in AMI mouse model and H/R-induced cardiomyocytes. Functionally, circ_0001379 silencing attenuated H/R-evoked cardiomyocyte apoptosis and inflammatory response. Mechanistically, circ_0001379 functioned as a sponge for miR-98-5p, which directly targeted SOX6. Moreover, circ_0001379 could regulate SOX6 expression via sponging miR-98-5p. Further rescue experiments showed that inhibition of miR-98-5p reversed the protective effects of circ_0001379 silencing on H/R-induced cardiomyocytes. Besides that, miR-98-5p overexpression abolished H/R-evoked cardiomyocyte apoptosis and inflammatory response, while this condition was abated by SOX6. Conclusion: Circ_0001379 silencing protects cardiomyocytes from H/R-induced apoptosis and inflammatory response by miR-98-5p/SOX6 axis, suggesting a novel therapeutic strategy for AMI prevention.
Splenic invariant Natural Killer T-cells (iNKT-cells) play a significant role in the response to polymicrobial sepsis
Authors: Heffernan Daithi S. , Chung Chun-Shiang , Ayala Alfred
Published: July 2023

Background

Sepsis is marked by a dysregulated immune response to an infection. Invariant Natural Killer T-cells (iNKT-cells) are a pluripotent lymphocyte subpopulation capable of affecting and coordinating the immune response to sepsis. The spleen is an important site of immune interactions in response to an infection. Splenic iNKT-cells have emerged as important potential front-line mediators of chronic immune response. There is little data addressing the role splenic of iNKT-cells in response to intra-abdominal polymicrobial sepsis.

Methods

The Cecal Ligation and Puncture (CLP) model was used to create intraabdominal sepsis in 8-12 week old WT, iNKT-/-, or PD-1-/- mice. 24 hours later spleens were harvested. Flow cytometry was used for phenotyping using monoclonal antibodies. Cell sort was used to isolate iNKT-cells. A macrophage cell line was used to assess iNKT-cell:phagocyte interactions. ELISA was used for cytokine analysis.

Results

Splenic iNKT-cell populations rapidly declined following induction of sepsis.

Within iNKT-cell-/- mice, a distinct baseline hyper-inflammatory environment was noted. Within WT, sepsis induced an increase in splenic IL-6 and IL-10, whereas in iNKT-/- mice, there was no change in elevated IL-6 levels and a noted decrease in IL-10 expression. Further, following sepsis, PD-1 expression was increased upon spleen iNKT-cells. With respect to PD-1 ligands upon phagocytes, PD-L1 expression was unaffected whereas PD-L2 expression was significantly affected by the presence of PD-1.

Conclusions

Invariant Natural Killer T-cells play a distinct role in the spleen response to sepsis, an effect mediated by the checkpoint protein PD-1. Given that modulators are available in clinical trials, this offers a potential therapeutic target in the setting of sepsis induced immune dysfunction.
Women’s Experiences of Urinary Tract Infections and Impact on Life: An Exploratory Qualitative Study
Authors: Krishnaswamy Priyanka H. , Middleton Eilidh , Hagen Suzanne , Guerrero Karen Lesley , Booth Jo
Published: July 2023

Importance

Despite high incidences of urinary tract infections (UTIs), little is known about how bothersome symptoms are and the effects on women's life and sexual activity, leaving a gap in our understanding of the physical and emotional effects of UTIs on women.

Objectives

This initial exploratory and descriptive study analyzes women's experiences of UTI and their perceived impact on quality of life.

Study Design

Qualitative interviews were undertaken with 23 women who had experienced at least 1 UTI, recruited from different settings—primary care, general gynecology clinics, urogynecology clinics, and online via social media. Data were analyzed thematically.

Results

Three themes described women's experiences of UTI: Women in all groups reported a wide range of physical symptoms and described the financial and psychological effects of UTIs. These effects seemed worse in women recruited via social media who also reported experiencing strong emotions and worries about close family members. Urinary tract infection support groups were considered useful, with women being grateful for consultations with alternative health practitioners and presuming safety of natural products.

Conclusions

Having a UTI appeared to affect women in a variety of ways, ranging from having different physical symptoms to being psychologically affected by these symptoms, which affected their quality of life in different ways. This research contributes to the growing evidence on how UTIs affect women, specifically further expanding on the impact on women in a range of settings—in the community and different health care settings.
MHC Tetramers Specifically Identify High- and Low-avidity Donor-specific B Cells in Transplantation Tolerance and Rejection
Authors: Durgam Samarth S. , Khiew Stella H.W. , Sayin Ismail , Jain Dharmendra , Yin Dengping , Cavazzoni Cecilia B. , Sage Peter T. , King R. Glenn , Chong Anita S.
Published: July 2023

Background.

Although donor-specific antibody pre- and posttransplantation is routinely assessed, accurate quantification of memory alloreactive B cells that mediate recall antibody response remains challenging. Major histocompatibility complex (MHC) tetramers have been used to identify alloreactive B cells in mice and humans, but the specificity of this approach has not been rigorously assessed.

Methods.

B-cell receptors from MHC tetramer-binding single B cells were expressed as mouse recombinant immunoglobulin G1 (rIgG1) monoclonal antibodies, and the specificity was assessed with a multiplex bead assay. Relative binding avidity of rIgG1 was measured by modified dilution series technique and surface plasmon resonance. Additionally, immunoglobulin heavy chain variable regions of 50 individual B-cell receptors were sequenced to analyze the rate of somatic hypermutation.

Results.

The multiplex bead assay confirmed that expressed rIgG1 monoclonal antibodies were preferentially bound to bait MHC class II I-Ed over control I-Ad and I-Ab tetramers. Furthermore, the dissociation constant 50 binding avidities of the rIgG1 ranged from 10 mM to 7 nM. The majority of tetramer-binding B cells were low avidity, and ~12.8% to 15.2% from naive and tolerant mice and 30.9% from acute rejecting mice were higher avidity (dissociation constant 50 <1 mM).

Conclusions.

Collectively, these studies demonstrate that donor MHC tetramers, under stringent binding conditions with decoy self-MHC tetramers, can specifically identify a broad repertoire of donor-specific B cells under conditions of rejection and tolerance.
Hugh Allen Oliver Hill. 23 May 1937—30 July 2021
Authors: Sadler FRS Peter J.
Published: July 2023

Allen Hill was one of the pioneers who established bioinorganic chemistry as an academic discipline. His transition from early research in organic chemistry to the biocoordination chemistry of metals led to the invention of the glucose electrode, which provided for the first time an electronic (amperometric) determination of glucose levels in blood. He guided its commercialization and subsequent use by millions of diabetics worldwide. He and his co-workers made crucial discoveries of how small molecules, especially ferrocene derivatives, can mediate electron transfer from enzymes such as glucose oxidase to electrode surfaces. He used scanning probe microscopy to reveal molecular interactions between proteins and electrode surfaces, and even resolve bound metals at near-atomic resolution. His studies of the biological redox properties and interactions of metals involved not only electrochemical methods, but also nuclear magnetic resonance, electron paramagnetic resonance and Mössbauer spectroscopies. He enjoyed the power of creativity and discovery, and was an exceptional mentor for early career researchers, with an ability to think broadly across the sciences and medicine. He gave devoted service to his college and the University of Oxford, was highly respected internationally and valued greatly the support and encouragement of his own family.
The influence of minority stress-related experiences on mental wellbeing for trans/gender-diverse and cisgender youth: a comparative longitudinal analysis
Authors: Black Louise , Humphrey Neil , Marquez Jose
Published: July 2023

Trans and gender-diverse (TGD) adolescents are likely to experience poorer mental health and wellbeing than their cisgender peers. Minority stress theory has developed as a possible explanation for some of this disadvantage: factors such as increased bullying and discrimination lead to excess stress and reduced wellbeing. However, the evidence base remains limited. This study drew on secondary data analysis of the #BeeWell longitudinal cohort over 2 years (N= 26 042, aged 12–13 at time one, T1). We report two unregistered hypotheses relating to T1 (autumn 2021) data which was available at the time of stage-one submission: H1, mean differences in T1 wellbeing; H2, mean differences in T1 minority-related stressors. These are followed by two registered hypotheses relating to T2 (autumn 2022) data: H3, replication of T1 mean differences in T2 wellbeing; H4, predictions were made about the strength of the association between T1 minority-related stressors, controlling for sexuality and T2 wellbeing across T1 gender identity groups. At both time points cis-females, TGD and those who preferred not to say their gender had lower wellbeing than cis-males (CM), with the largest effect evident for the TGD group. TGD adolescents also showed the largest disadvantage (mean difference) compared with CM for minority stressors. Counter to H4 and minority stress theory, gender was not found to moderate the effect of minority stressors on later wellbeing. Our findings highlight the vulnerability of the TGD group in terms of wellbeing and minority stressors and are discussed with relevance for policy and future research.
COVID-19 transmission dynamics and the impact of vaccination: modelling, analysis and simulations
Authors: Malinzi Joseph , Juma Victor Ogesa , Madubueze Chinwendu Emilian , Mwaonanji John , Nkem Godwin Nwachukwu , Mwakilama Elias , Mupedza Tinashe Victor , Chiteri Vincent Nandwa , Bakare Emmanuel Afolabi , Moyo Isabel Linda-Zulu , Campillo-Funollet Eduard , Nyabadza Farai , Madzvamuse Anotida
Published: July 2023

Despite the lifting of COVID-19 restrictions, the COVID-19 pandemic and its effects remain a global challenge including the sub-Saharan Africa (SSA) region. Knowledge of the COVID-19 dynamics and its potential trends amidst variations in COVID-19 vaccine coverage is therefore crucial for policy makers in the SSA region where vaccine uptake is generally lower than in high-income countries. Using a compartmental epidemiological model, this study aims to forecast the potential COVID-19 trends and determine how long a wave could be, taking into consideration the current vaccination rates. The model is calibrated using South African reported data for the first four waves of COVID-19, and the data for the fifth wave are used to test the validity of the model forecast. The model is qualitatively analysed by determining equilibria and their stability, calculating the basic reproduction number

R

0

and investigating the local and global sensitivity analysis with respect to

R

0

. The impact of vaccination and control interventions are investigated via a series of numerical simulations. Based on the fitted data and simulations, we observed that massive vaccination would only be beneficial (deaths averting) if a highly effective vaccine is used, particularly in combination with non-pharmaceutical interventions. Furthermore, our forecasts demonstrate that increased vaccination coverage in SSA increases population immunity leading to low daily infection numbers in potential future waves. Our findings could be helpful in guiding policy makers and governments in designing vaccination strategies and the implementation of other COVID-19 mitigation strategies.
How time-discretization can break the asymptotics of inverse scattering
Authors: Snieder Roel
Published: July 2023

Inverse scattering by the Marchenko or Gelfand–Levitan equations consists of two steps. The first step consists of solving an integral equation to retrieve the wavefield in the interior of a scattering medium from waves recorded outside of the scattering region. The second step consists of estimating the scattering potential from this wavefield. The estimation of the potential can be justified either by taking a high-frequency limit, or by evaluating the wavefield an infinitesimal time before or after the direct wave. Waveforms obtained in experiments are discretized in time with a sampling interval

d

t

. We show an example that this time discretization precludes the extraction of the potential. The reason is that the frequencies of discretized waveforms are below the Nyquist frequency. This limitation precludes taking the high-frequency limit that is used for estimating the potential from the waveforms in the interior of the scattering region. We present an alternative method to estimate the potential from wavefields in the interior of the scattering region. This method can be used even when the waves are in the strong scattering regime.
Phylogenomics and historical biogeography of Hydrangeeae (Hydrangeaceae) elucidate the effects of geologic and climatic dynamics on diversification
Authors: Yang Xudong , Zhang Xu , Xue Tiantian , Zhang Xiaoxia , Yang Fusheng , Yu Jianghong , Janssens Steven B. , Bussmann Rainer W. , Yu Shengxiang
Published: July 2023

Demonstrating the process of transregional biogeography and mechanisms underlying evolutionary radiations is crucial to understanding biological evolution. Here, we use Hydrangeeae (Hydrangeaceae), a tribe with a unique disjunct distribution and complex trait variations, using a solid phylogenetic framework, to investigate how geographical and climatic factors interact with functional traits to trigger plant evolutionary radiations. We constructed the first highly supported and dated phylogenetic framework using 79 protein-coding genes obtained from 81 plastomes, representing 63 species and all major clades, and found that most extant species originated from asynchronous diversification of two lineages undergoing repeated expansion and retraction, at middle and high latitudes of the Northern Hemisphere between East Asia and North America, during the Eocene to Pleistocene (driven by geologic and climatic dynamics). In accordance with these drivers, interactions of flora between central-eastern China and Japan occurred frequently after the Late Tertiary. We found that resource limitation and range fragmentation probably accelerated the diversification of Hydrangeeae, which supports the resource-use hypothesis. Our study sheds light on the evolutionary radiation and assembly of flora within East Asia, and the East Asian–North American disjunction, through integration of phylogenomic and biogeographic data with functional trait and ecological data.