bluuebunny/crossref_metadata_2025 huggingface dataset:
Multilocus-sequence typing reveals clonality of Staphylococcus aureus in atopic dermatitis
Authors: Blicharz Leszek , Szymanek-Majchrzak Ksenia , Młynarczyk Grażyna , Czuwara Joanna , Waśkiel-Burnat Anna , Goldust Mohamad , Samochocki Zbigniew , Rudnicka Lidia
Published: August 2023

Background

Atopic dermatitis (AD) is exacerbated by Staphylococcus aureus, which is capable of displacing not only the physiological microbiota, but also other strains of its own species. Analyses of the molecular characteristics and relationships of S. aureus strains present in different microniches are lacking.

Objectives

To determine, using multilocus sequence typing (MLST), the relationship of S. aureus isolates from the lesional and nonlesional skin and anterior nares of patients with AD, and to review the characteristics of the dominant clones.

Methods

Sixty-three individuals with active AD were enrolled. Ten patients with moderate-to-severe AD (SCoring of Atopic Dermatitis score ≥ 25) colonized by S. aureus in all analysed locations were included in the MLST analysis.

Results

The most prevalent sequence types were 7 (10/30 strains; 33.3%), 15 and 97 (both 5/30 strains; 16.7%) all of which were associated with the expression of adhesins and toxins promoting chronic microbial dysbiosis, skin barrier damage and inflammation. Six patients (60%) were carriers of clonal S. aureus strains at all analysed locations, three (30%) carriers in lesional and nonlesional skin, and one (10%) was a carrier in nonlesional skin and the anterior nares.

Conclusions

The results imply that the identified S. aureus lineages are better adapted to dominate the microbiota in AD. Decontaminating the identified reservoirs of S. aureus (i.e. anterior nares and nonlesional skin) could reduce the severity of AD.
Soluble wild-type ACE2 molecules inhibit newer SARS-CoV-2 variants and are a potential antiviral strategy to mitigate disease severity in COVID-19
Authors: Ameratunga Rohan , Mears Emily , Leung Euphemia , Snell Russell , Woon See-Tarn , Kelton William , Medlicott Natalie , Jordan Anthony , Abbott William , Steele Richard , Rolleston William , Longhurst Hilary , Lehnert Klaus
Published: August 2023

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease of 2019 (COVID-19), has caused havoc around the world. While several COVID-19 vaccines and drugs have been authorized for use, these antiviral drugs remain beyond the reach of most low- and middle-income countries. Rapid viral evolution is reducing the efficacy of vaccines and monoclonal antibodies and contributing to the deaths of some fully vaccinated persons. Others with normal immunity may have chosen not to be vaccinated and remain at risk if they contract the infection. Vaccines may not protect some immunodeficient patients from SARS-CoV-2, who are also at increased risk of chronic COVID-19 infection, a dangerous stalemate between the virus and a suboptimal immune response. Intra-host viral evolution could rapidly lead to the selection and dominance of vaccine and monoclonal antibody-resistant clades of SARS-CoV-2.

There is thus an urgent need to develop new treatments for COVID-19. The NZACE2-Pātari project, comprising modified soluble angiotensin-converting enzyme 2 (ACE2) molecules, seeks to intercept and block SARS-CoV-2 infection of the respiratory mucosa. In vitro data presented here show that soluble wild-type ACE2 molecules retain the ability to effectively block the Spike (S) glycoprotein of SARS-CoV-2 variants including the ancestral Wuhan, delta (B.1.617.2) and omicron (B.1.1.529) strains. This therapeutic strategy may prove effective if implemented early during the nasal phase of the infection and may act synergistically with other antiviral drugs such as Paxlovid to further mitigate disease severity.
Prefrontal GABA and glutamate–glutamine levels affect sustained attention
Authors: Kondo Hirohito M , Terashima Hiroki , Kihara Ken , Kochiyama Takanori , Shimada Yasuhiro , Kawahara Jun I
Published: August 2023

Attention levels fluctuate during the course of daily activities. However, factors underlying sustained attention are still unknown. We investigated mechanisms of sustained attention using psychological, neuroimaging, and neurochemical approaches. Participants were scanned with functional magnetic resonance imaging (fMRI) while performing gradual-onset, continuous performance tasks (gradCPTs). In gradCPTs, narrations or visual scenes gradually changed from one to the next. Participants pressed a button for frequent Go trials as quickly as possible and withheld responses to infrequent No-go trials. Performance was better for the visual gradCPT than for the auditory gradCPT, but the 2 were correlated. The dorsal attention network was activated during intermittent responses, regardless of sensory modality. Reaction-time variability of gradCPTs was correlated with signal changes (SCs) in the left fronto-parietal regions. We also used magnetic resonance spectroscopy (MRS) to measure levels of glutamate–glutamine (Glx) and γ-aminobutyric acid (GABA) in the left prefrontal cortex (PFC). Glx levels were associated with performance under undemanding situations, whereas GABA levels were related to performance under demanding situations. Combined fMRI–MRS results demonstrated that SCs of the left PFC were positively correlated with neurometabolite levels. These findings suggest that a neural balance between excitation and inhibition is involved in attentional fluctuations and brain dynamics.
Age differentially modulates the cortical tracking of the lower and higher level linguistic structures during speech comprehension
Authors: Xu Na , Qin Xiaoxiao , Zhou Ziqi , Shan Wei , Ren Jiechuan , Yang Chunqing , Lu Lingxi , Wang Qun
Published: August 2023

Speech comprehension requires listeners to rapidly parse continuous speech into hierarchically-organized linguistic structures (i.e. syllable, word, phrase, and sentence) and entrain the neural activities to the rhythm of different linguistic levels. Aging is accompanied by changes in speech processing, but it remains unclear how aging affects different levels of linguistic representation. Here, we recorded magnetoencephalography signals in older and younger groups when subjects actively and passively listened to the continuous speech in which hierarchical linguistic structures of word, phrase, and sentence were tagged at 4, 2, and 1 Hz, respectively. A newly-developed parameterization algorithm was applied to separate the periodically linguistic tracking from the aperiodic component. We found enhanced lower-level (word-level) tracking, reduced higher-level (phrasal- and sentential-level) tracking, and reduced aperiodic offset in older compared with younger adults. Furthermore, we observed the attentional modulation on the sentential-level tracking being larger for younger than for older ones. Notably, the neuro-behavior analyses showed that subjects’ behavioral accuracy was positively correlated with the higher-level linguistic tracking, reversely correlated with the lower-level linguistic tracking. Overall, these results suggest that the enhanced lower-level linguistic tracking, reduced higher-level linguistic tracking and less flexibility of attentional modulation may underpin aging-related decline in speech comprehension.
Increased noise relates to abnormal excitation-inhibition balance in schizophrenia: a combined empirical and computational study
Authors: Abbasi Samira , Wolff Annemarie , Çatal Yasir , Northoff Georg
Published: August 2023

Electroencephalography studies link sensory processing issues in schizophrenia to increased noise level—noise here is background spontaneous activity—as measured by the signal-to-noise ratio. The mechanism, however, of such increased noise is unknown. We investigate if this relates to changes in cortical excitation-inhibition balance, which has been observed to be atypical in schizophrenia, by combining electroencephalography and computational modeling. Our electroencephalography task results, for which the local field potentials can be used as a proxy, show lower signal-to-noise ratio due to higher noise in schizophrenia. Both electroencephalography rest and task states exhibit higher levels of excitation in the functional excitation-inhibition (as a proxy of excitation-inhibition balance). This suggests a relationship between increased noise and atypical excitation in schizophrenia, which was addressed by using computational modeling. A Leaky Integrate-and-Fire model was used to simulate the effects of varying degrees of noise on excitation-inhibition balance, local field potential, NMDA current, and . Results show a noise-related increase in the local field potential, excitation in excitation-inhibition balance, pyramidal NMDA current, and spike rate. Mutual information and mediation analysis were used to explore a cross-level relationship, showing that the cortical local field potential plays a key role in transferring the effect of noise to the cellular population level of NMDA.
Accelerating knowledge translation to improve cardiovascular outcomes and health services: opportunities for bridging science and clinical practice
Authors: Lauck Sandra B , Saarijärvi Markus , De Sousa Ismália , Straiton Nicola , Borregaard Britt , Lewis Krystina B
Published: August 2023

Knowledge translation (KT) is the exchange between knowledge producers and users to understand, synthesize, share, and apply evidence to accelerate the benefits of research to improve health and health systems. Knowledge translation practice (activities/strategies to move evidence into practice) and KT science (study of the methodology and approaches to promote the uptake of research) benefit from the use of conceptual thinking, the meaningful inclusion of patients, and the application of intersectionality. In spite of multiple barriers, there are opportunities to develop strong partnerships and evidence to drive an impactful research agenda and increase the uptake of cardiovascular research.
Crustal and uppermost mantle structures imaged by teleseismicP-wave traveltime tomography beneath the Southeastern Korean Peninsula: implications for a hydrothermal system controlled by the thermally modified lithosphere
Authors: Lee Sungho , Song Jung-Hun , Heo Dabeen , Rhie Junkee , Kang Tae-Seob , Choi Eunseo , Kim YoungHee , Kim Kwang-Hee , Ree Jin-Han
Published: August 2023

The southeastern Korean Peninsula (SeKP) has experienced intense deformation owing to subduction and backarc extension at the eastern continental margin of the Eurasian Plate, leading to the formation of complex tectonic structures. Abnormally high surface heat flux, Cenozoic volcanism, signatures of mantle degassing and hydrothermal alteration, and several active fault systems with extensional sedimentary basins have been identified; however, the major driving forces that promote local seismic events and hydrothermal activities remain enigmatic. Here, we constructed 3-D P-wave velocity of the crust and upper mantle in the SeKP for the first time using a teleseismic traveltime tomography method and an extensive data set obtained from a dense seismic network. Our model revealed three distinct velocity patterns at different depths: (1) in the upper crust (depth ∼0–10 km), a low-velocity anomaly beneath the Cenozoic sedimentary basin exhibiting a prominent lateral velocity contrasts with higher velocities in the Cretaceous sedimentary and plutonic rocks; (2) a N–S trending low-velocity anomaly extending from the lower crust to the uppermost mantle (depth ∼20–35 km) beneath the major active fault systems interpreted as a thermally or mechanically weakened structure that could transfer high surface heat flux and transport mantle-driven gases and (3) a low-velocity anomaly adjacent to the Cenozoic basin in the upper mantle at depths of 35–55 km interpreted as the higher temperature upper mantle. Via a series of geodynamic simulations, we demonstrated that the extensional deformation at the eastern continental margin during the Early to Middle Miocene locally enhanced the temperature of the crust and upper mantle beneath the SeKP. We propose that a hydrothermal system, resulting from the thermally modified lithosphere of the continental margin, has contributed to the enhanced local seismicity and geothermal activities observed in the SeKP region.
Differential Severe Acute Respiratory Syndrome Coronavirus 2–Specific Humoral Response in Inactivated Virus–Vaccinated, Convalescent, and Breakthrough-Infected Subjects
Authors: Duarte Luisa F , Vázquez Yaneisi , Diethelm-Varela Benjamín , Pavez Valentina , Berríos-Rojas Roslye , Méndez Constanza , Riedel Claudia A , White Jessica A , Kalergis Alexis M , Bueno Susan M , González Pablo A
Published: August 2023

Background

We sought to identify potential antigens for discerning between humoral responses elicited after vaccination with CoronaVac (a severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] inactivated vaccine), natural infection, or breakthrough infection.

Methods

Serum samples obtained from volunteers immunized with CoronaVac (2 and 3 doses), breakthrough case patients, and from convalescent individuals were analyzed to determine the immunoglobulin (Ig) G responses against 3 structural and 8 nonstructural SARS-CoV-2 antigens.

Results

Immunization with CoronaVac induced higher levels of antibodies against the viral membrane (M) protein compared with convalescent subjects both after primary vaccination and after a booster dose. Individuals receiving a booster dose displayed equivalent levels of IgG antibodies against the nucleocapsid (N) protein, similar to convalescent subjects. Breakthrough case patients produced the highest antibody levels against the N and M proteins. Antibodies against nonstructural viral proteins were present in >50% of the convalescent subjects.

Conclusions

Vaccinated individuals elicited a different humoral response compared to convalescent subjects. The analysis of particular SARS-CoV-2 antigens could be used as biomarkers for determining infection in subjects previously vaccinated with CoronaVac.
Molecular Surveillance Detects High Prevalence of the Neglected Parasite Mansonella ozzardi in the Colombian Amazon
Authors: Dahmer Kendra J , Palma-Cuero Monica , Ciuoderis Karl , Patiño Claudia , Roitman Sofia , Li Zhiru , Sinha Amit , Hite Jessica L , Cuellar Olga Bellido , Hernandez-Ortiz Juan P , Osorio Jorge E , Christensen Bruce M , Carlow Clotilde K S , Zamanian Mostafa
Published: August 2023

Background

Mansonellosis is an undermapped insect-transmitted disease caused by filarial nematodes that are estimated to infect hundreds of millions of people. Despite their prevalence, there are many outstanding questions regarding the general biology and health impacts of the responsible parasites. Historical reports suggest that the Colombian Amazon is endemic for mansonellosis and may serve as an ideal location to pursue these questions.

Methods

We deployed molecular and classical approaches to survey Mansonella prevalence among adults belonging to indigenous communities along the Amazon River and its tributaries near Leticia, Colombia.

Results

Loop-mediated isothermal amplification (LAMP) assays on whole-blood samples detected a much higher prevalence of Mansonella ozzardi infection (approximately 40%) compared to blood smear microscopy or LAMP performed using plasma, likely reflecting greater sensitivity and the ability to detect low microfilaremias and occult infections. Mansonella infection rates increased with age and were higher among men. Genomic analysis confirmed the presence of M. ozzardi that clusters closely with strains sequenced in neighboring countries. We successfully cryopreserved M. ozzardi microfilariae, advancing the prospects of rearing infective larvae in controlled settings.

Conclusion

These data suggest an underestimation of true mansonellosis prevalence, and we expect that these methods will help facilitate the study of mansonellosis in endemic and laboratory settings.
Use of information communication technologies by older people and telemedicine adoption during COVID-19: a longitudinal study
Authors: Mao Likun , Mohan Gretta , Normand Charles
Published: August 2023

Objectives

To investigate how information communication technology (ICT) factors relate to the use of telemedicine by older people in Ireland during the pandemic in 2020. Furthermore, the paper tested whether the supply of primary care, measured by General Practitioner’s (GP) accessibility, influenced people’s telemedicine options.

Method

Based on 2 waves from The Irish Longitudinal Study on Ageing, a nationally representative sample, multivariate logistic models were applied to examine the association between pre-pandemic use of ICTs and telemedicine usage (GP, pharmacist, hospital doctor), controlling for a series of demographic, health, and socioeconomic characteristics.

Results

Previously reported having Internet access was a statistically positive predictor for telemedicine usage. The availability of high-speed broadband Internet did not exhibit a statistical association. The association was more prominent among those under 70 years old and non-Dublin urban areas. People with more chronic conditions, poorer mental health, and private health insurance had higher odds of using telemedicine during the period of study. No clear pattern between telemedicine use and differential geographic access to GP was found.

Discussion

The important role of ICT access and frequent engagement with the Internet in encouraging telemedicine usage among older adults was evidenced.

Conclusion

Internet access was a strong predictor for telemedicine usage. We found no evidence of a substitution or complementary relationship between telemedicine and in-person primary care access.
Biofilm formation in drug-resistant Acinetobacter baumannii and Acinetobacter nosocomialis isolates obtained from a university hospital in Pelotas, RS, Brazil
Authors: Amaral Suélen Cavalheiro , Pruski Beatriz Bohns , de Freitas Stella Buchhorn , dos Santos Lucas Moreira , Hartwig Daiane Drawanz
Published: August 2023

This study aimed to investigate the antibiotic resistance and biofilm formation of Acinetobacter calcoaceticus—A. baumannii (ACB) complex isolates recovered from a university hospital in Pelotas, RS, Brazil. The species were confirmed using gyrB multiplex and blaOXA-51-like genes PCR. The presence of the bfmRS virulence gene was evaluated by the PCR, and the isolates were classified based on their biofilm-forming ability on polystyrene (PO) and glass surfaces (TM). Out of 50 ACB complex isolates evaluated, 41 were identified as A. baumannii and nine as A. nosocomialis. The bfmRS gene was detected in 97.6% (40/41) of A. baumannii and 33.3% (3/9) of A. nosocomialis species. Forty-nine isolates exhibited a multidrug-resistant (MDR) profile, while one A. nosocomialis isolate presented an extensively drug-resistant (XDR) profile. All isolates were able of forming biofilms on PO surfaces and 98% (49/50) on TM surfaces. A significant correlation was observed between biofilm production on PO and TM surfaces (P < 0.05). However, no correlation was found between biofilms forming and the presence of the bfmRS gene or displaying a certain antibiotic resistance profile. In conclusion, A. baumannii and A. nosocomialis are frequent species causing nosocomial infections in a hospital in Pelotas, RS, Brazil, and both are capable of forming biofilms.
Social deprivation and kidney failure due to an undiagnosed nephropathy
Authors: Sakhi Hamza , Beaumier Mathilde , Couchoud Cécile , Prezelin-Reydit Mathilde , Radenac Jennifer , Lobbedez Thierry , Morin Denis , Audard Vincent , Chatelet Valérie
Published: August 2023

Background

In France, kidney diseases of undetermined origin account for 5%–20% of all causes of end-stage kidney disease. We investigated the impact of social disadvantage on the lack of aetiological diagnosis of nephropathies.

Methods

Data from patients who started dialysis in France between 1 January 2017 and 30 June 2018 were extracted from the French Renal Epidemiology and Information Network registry. The social deprivation of each individual was estimated by the European Deprivation Index (EDI) defined by the patient's address. Logistic regression was used to perform mediation analysis to study the potential association between social deprivation and unknown nephropathy.

Results

Of the 7218 patients included, 1263 (17.5%) had unknown kidney disease. A total of 394 (31.4%) patients in the unknown kidney disease belonged to the most deprived quintile of the EDI [fifth quintile (Q5)], vs 1636 (27.5%) patients in the known kidney disease group. In the multivariate analysis, unknown kidney disease was associated with Q5 (odds ratio 1.40, 95% confidence interval 1.12–1.74, P = .003). Mediation analysis did not identify any variables (e.g. obesity, initiation of dialysis in emergency, number of visits to the general practitioner and nephrologist before initiation of dialysis, date of first nephrology consultation) that mediated the association between social deprivation and nephropathy of unknown origin.

Conclusions

Our results show that, compared with nondeprived subjects, individuals experiencing social deprivation have a higher risk of unknown nephropathy at dialysis initiation. However, mediation analysis did not identify any variables that explained the association between social deprivation and nephropathy of unknown origin.
A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for the treatment of lumbar facet syndrome: 12 month outcomes
Authors: McCormick Zachary L , Conger Aaron , Kendall Richard , Wagner Graham , Henrie A Michael , Littell Madelaine , Sperry Beau P , Petersen Russel , Cooper Amanda N , Teramoto Masaru , Burnham Taylor R
Published: August 2023

Background

Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold.

Objective

Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements.

Design

Prospective randomized comparative trial.

Methods

Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models.

Results

Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48–85), 55% (95% CI 34–74), and 45% (95% CI 26–66) of participants met the NPRS responder definition, compared to 25% (95%CI 9–53), 25% (95% CI 9–53), and 17% (95% CI 5–45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05).

Conclusions

C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains.

Trial registration details

ClinicalTrials.gov (NCT03614793); August 3, 2018.
Estimation of natural methane emissions from the largest oil sand deposits on earth
Authors: Wei Cao , Jafari Raad Seyed Mostafa , Hassanzadeh Hassan
Published: August 2023

Worldwide methane emission by various industrial sources is one of the important human concerns due to its serious climate and air-quality implications. This study investigates less-considered diffusive natural methane emissions from the world's largest oil sand deposits. An analytical model, considering the first-order methane degradation, in combination with Monte Carlo simulations, is used to quantitatively characterize diffusive methane emissions from Alberta's oil sands formations. The results show that the average diffusive methane emissions from Alberta's oil sands formations is 1.56 × 10−4 kg/m2/year at the 90th percentile of cumulative probability. The results also indicate an annual diffusive methane emissions rate of 0.857 ± 0.013 Million tons of CO2e/year (MtCO2e/year) from Alberta's oil sands formations. This finding suggests that natural diffusive leakages from the oil sands contribute an additional 1.659 ± 0.025 and 5.194 ± 0.079% to recent Canada's 2019 and Alberta's 2020 methane emission estimates from the upstream oil and gas sector, respectively. The developed model combined with Monte Carlo simulations can be used as a tool for assessing methane emissions and current inventories.
Grapevine Leaf Epiphytic Fungal and Bacterial Communities Are Influenced More by Spatial and Temporal Factors than by Powdery Mildew Fungicide Spray Programs
Authors: Yang Hui-Ching , Rodriguez-Ramos Jean C. , Hale Lauren , Naegele Rachel P.
Published: August 2023

Synthetic fungicide treatments for managing grapevine powdery mildew have been widely applied in vineyards for decades, yet their ecological impacts on microorganisms in the phyllosphere have not been sufficiently studied. To investigate the impact of fungicide sprays on the grapevine leaf microbiota, grapevine leaf epiphytes were collected throughout the growing season from two California vineyards, each treated with identical spray programs. Each spray program was designed to control grapevine powdery mildew and contained five rotating synthetic fungicides. Leaf samples were collected before the first spray and between subsequent spray applications. Amplicon sequencing of ITS2 and 16S rRNA V4 regions was used to compare leaf epiphytic fungal and bacterial/archaeal diversities, taxonomic compositions, and differential abundances of taxa among treatments, locations, and sampling time points. Location (vineyard) and time significantly affected bacterial and fungal community compositions, whereas spray treatment did not. Plant-pathogenic fungi were the dominant fungal guild in both locations, and, in one location, their dominance increased significantly as the season progressed. Botrytis, an important postharvest pathogen in grapes, was significantly higher in relative abundance in one of the locations in the late season and acted as a hub genus in a co-occurrence network. In summary, the overall impact of the different spray programs on microbial community compositions was not significant, suggesting that the shifts of grapevine foliar microbial communities may be driven mainly by spatial and temporal factors rather than specific fungicide applications.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Learning Curve of Wrist-level Tendon Repairs Using a Novel Tendon Stapler versus Traditional Suture Methods
Authors: Hendrycks Russell J. , Reed Evelyn R. , Graham Emily M. , Patel Niki K. , Rosales Megan , Mendenhall Shaun D.
Published: August 2023

Numerous effective techniques for primary tendon coaptations exist. However, these techniques are complex and require a substantial amount of training to become proficient. Recently, a novel tendon stapler device (TSD) was developed that could potentially diminish the discrepancies among surgeons of varying levels of training. We hypothesized that the TSD would be easier to learn and would demonstrate improved learning curve efficiencies across participants of differing tendon repair experience compared with traditional suture methods. Participants included a novice, intermediate, and expert in tendon repairs. Comparisons were performed on wrist-level flexors and extensors from human donor arms. The suture repairs were performed with a modified Kessler with a horizontal mattress and were performed in one session on two donor arms by each participant. In a second session, each participant performed the TSD repairs on the matched, contralateral donor arms. Scatterplots fitted with Loess curves, one-way analysis of variance, Tukey pairwise comparisons, two-sided independent samples t test, and Fisher exact test were used to analyze findings. Results of our study showed that TSD repair times did not vary significantly by experience level. Suture repairs reached a stable “learned” level around repair #30, whereas the TSD repairs showed a more efficient curve that stabilized around repair #23. The TSD required less educational time, demonstrated a more efficient learning curve, and showed less variability across participants and repair order. Overall, the TSD is easy to adopt and may carry positive implications for surgeons and patients.
Aesthetic Units and Zones of Adherence: Relevance to Surgical Planning in the Head and Neck
Authors: Kirwan Laurence
Published: August 2023

Background:

Aesthetic units (AUs) and zones of adherence (ZA) have been previously described in the face; however, a systematic classification of AUs and ZAs together with a unified approach to planning surgery has not been previously described for head and neck surgery. The five principles of surgical planning necessitate respect for AUs, ZAs, and flexion creases; correct scar orientation; and replacing tissue “like for like” by adhering to the four “Ts” of reconstruction (tone, texture, type, and thickness of skin and subcutaneous tissue).

Methods:

Images of male and female patients and stock images (from iStock) were reviewed and analyzed.

Results:

AUs and ZAs were described and tabulated.

Conclusions:

Surgical planning necessitates respect for AUs and ZAs and avoidance of maneuvers that will transgress aesthetic unit interfaces or eliminate AUs. An aesthetic atlas of AUs and ZAs is useful for planning surgery, preventing errors, and optimizing aesthetic results.
Survival benefit of living-donor liver transplantation in patients with a model for end-stage liver disease over 30 in a region with severe organ shortage: a retrospective cohort study
Authors: Yim Seung Hyuk , Kim Deok-Gie , Kang Minyu , Koh Hwa-Hee , Choi Mun Chae , Min Eun-Ki , Lee Jae Geun , Kim Myoung Soo , Joo Dong Jin
Published: August 2023

Background:

The benefits of living-donor liver transplantation (LDLT) in patients with a high Model for End-stage Liver Disease (MELD) score (who have high waitlist mortality) are unclear. Regional availability of deceased-donor organs must be considered when evaluating LDLT benefits. We aimed to compare the survival benefit of intended-LDLT to awaiting deceased-donor liver transplantation (DDLT) in patients with a MELD score ≥30 in a region with severe organ shortage.

Materials and Methods:

This retrospective review included 649 patients with a MELD score ≥30 placed on the liver transplantation waitlist. They were divided into Intended-LDLT (n=205) or Waiting-DDLT (n=444) groups based on living-donor eligibility and compared for patient survival from time of waitlisting. Post-transplantation outcomes of transplant recipients and living donors were analyzed.

Results:

Intended-LDLT patients had higher 1-year survival than Waiting-DDLT patients (53.7% vs. 28.8%, P<0.001). LDLT was independently associated with lower mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.48–0.79; P<0.001). During follow-up, 25 patients were de-listed, 120 underwent LDLT, 170 underwent DDLT, and 334 remained on the waitlist. Among patients undergoing transplantation, the risk of post-transplantation mortality was similar for LDLT and DDLT after adjusting for pre-transplantation MELD score (HR, 1.86; 95% CI, 0.73–4.75; P=0.193), despite increased surgical complications after LDLT (33.1% vs. 19.4%, P=0.013). There was no mortality among living-donors, but 4.2% experienced complications of grade 3 or higher.

Conclusions:

Compared to awaiting DDLT, LDLT offers survival benefits for patients with a MELD score ≥30, while maintaining acceptable donor outcomes. LDLT is a feasible treatment for patients with a MELD score ≥30 in regions with severe organ shortage.
Probiotics for the management of irritable bowel syndrome: a systematic review and three-level meta-analysis
Authors: Chen Min , Yuan Lu , Xie Chao-Rong , Wang Xiao-Ying , Feng Si-Jia , Xiao Xin-Yu , Zheng Hui
Published: August 2023

Objective:

Previous systematic reviews demonstrated a potentially beneficial effect of probiotics on irritable bowel syndrome (IBS). However, these studies are either affected by the inclusion of insufficient trials or by the problem of dependent data across multiple outcomes, and an overall effect size has not been provided. We aimed to determine the effect of probiotics on IBS through a three-level meta-analysis and clarify potential effect moderators.

Methods:

We searched Medline, Embase, and Web of Science, screening for randomized controlled trials (RCTs) that examine the effect of probiotics on IBS. The primary outcome was the improvement in the severity of global IBS symptoms at the end of treatment. The secondary outcomes were the improvement in abdominal pain and the quality of life. The effect sizes of the probiotics were measured by using the standardized mean difference (SMD) and pooled by a three-level meta-analysis model.

Results:

We included 72 RCTs in the analysis. The meta-analysis showed significantly better overall effect of probiotics than placebo on the global IBS symptoms (SMD -0.55, 95%CI -0.76 to -0.34, P<0.001), abdominal pain (SMD -0.89, 95%CI -1.29 to -0.5, P<0.001) and quality of life (SMD 0.99, 95%CI 0.45 to 1.54, P<0.001), respectively. Moderator analysis found that a treatment duration shorter than 4 weeks was associated with a larger effect size in all the outcomes, and Bacillus probiotics had better improvement on the abdominal pain.

Conclusions:

Probiotics had a short-term effect and a medium effect size on the global IBS symptoms. Treatment duration and types of probiotics affected the effect size of probiotics, and shorter durations and Bacillus probiotics were associated with better treatment effects.

Registration:

Open Science Framework.
Assessment of knowledge, attitude, and behavior related to children’s oral health in pediatricians and students in the pediatric field in Iran: a cross-sectional study
Authors: Jafari Saba , Memarpour Mahtab , Pakniyat Jahromi Maryam , Vossoughi Mehrdad , Hamidi Seyed Ahmadreza
Published: August 2023

Background:

Pediatricians have an important role to play in motivating and instructing parents on oral health in children. The aim of this study was to assess knowledge of, attitude to, and behavior regarding oral health care in children among pediatricians and students in the pediatric field in Iran.

Methods:

This cross-sectional study included all students in the pediatric field (those who had started a residency or fellowship) and practicing pediatricians in provincial centers and universities (61 setting centers) throughout Iran in the course of 2021. Participants completed an online questionnaire assessing details of the parameters of knowledge of, attitude to, and behavior toward oral health for each individual. A convenience sampling technique was used to gather the study sample. All data were coded for each of the parameters. The data were analyzed by one-way ANOVA (Analysis of Variance)/Tukey and Pearson’s correlation tests and path analysis.

Results:

Out of 582 participants who visited the website, a total of 217 completed the entire questionnaire (participation rate of 37.2%). On the attitude parameter, 84.8% of participants scored above 75% of the possible attainable score, while only 37.9% and 48.1% of them had adequate knowledge and behavior for the possible score, respectively. Specialists had a higher mean score on behavior and knowledge than residents (P=0.001). There was a significant correlation between the scores on attitude and behavior (r=0.42, P<0.001), attitude and knowledge (r=0.19, P=0.005), and behavior and knowledge (r=0.25, P<0.001). Nearly all of the participants, 216 (99.5%), felt the need for the principles of dentistry to be included in the curriculum.

Conclusions:

Pediatricians showed a favorable attitude to oral health, but their knowledge of and behavior in the field was inadequate. Improvement of pediatricians’ interest and performance in oral health in children should be encouraged through the inclusion of these parameters in the curriculum for students of the pediatric field. Implementing training programs for practical pediatricians or incorporating independent theoretical and clinical courses offered by pediatric dentists in dental school departments into the field curriculum of the students in the pediatric field is recommended.
Prediction of negative axillary node clearance by sentinel node-positive to total node ratio: a retrospective cohort study
Authors: Rosen Jemima , Manley Lara R. , Patel Arun , Gandamihardja Tasha , Rao Ahsan
Published: August 2023

Introduction:

Increasing evidence suggests that de-escalation of axillary surgery is safe, without significantly impacting patient outcome. Obtaining positive lymph nodes at a sentinel lymph node biopsy (SNB) can guide decisions toward the requirement of axillary nodal clearance (ANC). However, methods to predict how many further nodes will be positive are not available. This study investigates the feasibility of predicting the likelihood of a negative ANC based on the ratio between positive nodes and the total number of lymph nodes excised at SNB.

Methods:

Retrospective data from January 2017 to March 2022 was collected from electronic medical records. Patients with oestrogen receptor (ER) positive and HER2 negative receptor disease were included in the study. ER-negative and HER2-positive disease was excluded, alongside patients who had chemotherapy before ANC.

Results:

Of 102 patients, 58.8% (n=60) had no macrometastasis at ANC. On average, 2.76 lymph nodes were removed at SNB. A higher SNB ratio of positive to total nodes [OR 11.09 (CI 95% 2.33–52.72), P=0.002] had a significant association with positive nodes during ANC. SNB ratio less than or equal to 0.33 (1/3) had a specificity of 79.2% in identifying cases that later had a negative completion ANC, with a 95.8% specificity of no further upgrade of nodal staging.

Conclusion:

A low SNB ratio of less than 0.33 (1/3) has a high specificity in excluding the upgradation of nodal staging on completion of ANC, with a false-negative rate of less than 5%. This may be used to identify patients with a low risk of axillary metastasis, who can avoid ANC.
Assessment of manual operation note documentation practice: a cross-sectional study
Authors: Tegegne Nega Getachew , Fentie Demeke Yilkal , Tegegne Biresaw Ayen , Admassie Belete Muluadam
Published: August 2023

Background:

Operation note documentation captures the key findings and subtle elements of a surgical strategy and is crucial for patient safety. Poor operation note documentation can negatively influence postoperative patient care. This study aimed to assess manual operation note documentation practice.

Methods:

An institutional-based, cross-sectional study was conducted from 30 March to 30 April 2022, on 240 operation notes of patient data. Data were entered and analyzed by SPSS version 20. According to the RCSE, the Royal College of Surgeons of England, the practice of operation note documentation was rated excellent for each variable when it met 100%, good if it met more than 50%, and poor if it met less than 50% of the operation notes of patient data.

Results:

All operation notes (n=240) were handwritten. The practice of manual operation note documentation was deemed excellent in two (7.69%), good in 18 (69.2%), and poor in six (23.1%). Residents wrote 84.2% of the operation notes and surgeons and assistants were identified in greater than 94% of the notes, while anesthesia team members were identified in 90.8%. Estimated blood loss was documented in 4.2% of the notes, and the closure technique was described in 64.2%. The operation note templates did not include antibiotic prophylaxis, runner nurse name, or gauze and instrument counts. The urgency of the surgery and time of documentation had a negative relationship, and the seniority of the operation note writer had a positive relationship with manual operative note documentation practice.

Conclusions and recommendations:

Compared to the standard, all operation note documentation was incomplete and below the standard. We recommend that this comprehensive and specialized hospital administrator implement a new format for operation notes that incorporates RCSE requirements.
A cerebral lymphoma mimicking a meningioma: case report
Authors: Joudar Imane , Nasri Siham , Aichouni Narjisse , Kamaoui Imane , Skiker Imane
Published: August 2023

Introduction:

Cerebral lymphoma is a rare and aggressive brain tumor. It accounts for 1% of all non-Hodgkin’s lymphomas (NHL) and 2% of all brain tumors. Untreated brain lymphoma has a very poor prognosis, with an overall life expectancy of around 1.5 months.

Case presentation:

The authors report the case of a 35-year-old patient, with no previous pathological history, who presented for 3 weeks with deafness and recently aggravated otalgia. In MRI, brain imaging revealed a formation initially suggestive of an aggressive meningioma, and the histological study of the operative specimen was in favor of a diffuse large-cell non-germ-center B NHL.

Clinical discussion:

Primary central nervous system lymphoma is an extra-nodal NHL localized to the brain, meninges, spinal cord, and eyes. In 90% of cases, these are diffuse large B-cell lymphomas, the other types being poorly characterized low-grade lymphomas, T-cell lymphomas, and Burkitt’s lymphomas. MRI with gadolinium contrast is the gold standard for diagnosis which enhancement is homogeneous and well-limited, frequently associated with perilesional vascular edema. In T2-weighted sequences, there is a weak signal with restricted diffusion on diffusion-weighted imaging. The management of brain lymphoma is currently based on chemotherapy with high-dose methotrexate combined with the other agents, mainly rituximab.

Conclusion:

Cerebral lymphoma remains a non-negligible entity of central nervous system tumors, which can be confused with several other tumors, mainly glial and meningioma.
Gastric lipoma in the pyloric antrum: a rare case report
Authors: Hussein Al-janabi Moatasem A. , Mohammad Jollanar G. , Mohsen Aya Y. , Alabbas Zeina , Rasheed Omeed , Kannan Samir , Daoud Ali K.
Published: August 2023

Introduction and importance:

Gastric lipoma (GI) is a rare benign tumor of the stomach that arises from adipose tissue. It is often asymptomatic and is incidentally diagnosed on endoscopy or imaging studies.

Case presentation:

A 66-year-old male presented with epigastric pain and acid reflux. Upper gastrointestinal endoscopy revealed a 3-cm submucosal lesion in the pyloric antrum. The patient underwent a subtotal gastrectomy. The specimen was sent to the pathology department. Based on the microscopic findings, the diagnosis was a submucosal GI.

Discussion:

The diagnosis of GIs is usually made incidentally during imaging studies. Treatment options include endoscopic or surgical resection; however, conservative management can be considered in asymptomatic patients. Periodic radiological surveillance is recommended to monitor growth and assess for any malignant transformation.

Conclusion:

GI is a rare tumor that is usually asymptomatic but can present with nonspecific gastrointestinal symptoms. The diagnosis is confirmed through histological examination, and imaging techniques such as computed tomography or MRI can be useful in preoperative evaluation. Surgical resection remains the primary treatment, while endoscopic resection may be considered in certain cases.
Assessment of functional and cosmetic outcomes of Extended-Tubularized incised plate for mid-shaft and distal hypospadias as a modification of Snodgrass repair: a cross-sectional study
Authors: Alwaeli Hayder H. , Hasan Al-Timimi Hasanain F. , Ismail Mohammed B.
Published: August 2023

Background:

Hypospadias is a congenital abnormality of anterior urethral and penile development where the urethral meatus is ectopically located on the ventral aspect of the penis. It is a relatively common condition affecting ~1 in 250 male birth. Extended-Tubularized Incised Plate (E-TIP) is a modification of Snodgrass repair by extending the midline incision to the apical part of the glans resulting in a more normal appearing location of the meatus and straight urinary stream without increasing the risk of complications.

Aim of study:

To evaluate functional and cosmetic outcomes of E-TIP repair for mid-shaft and distal hypospadias as a modification of Snodgrass repair.

Patient and method:

A prospective cross-sectional study including 53 cases of mid-to-distal hypospadias repaired with the E-TIP technique between November 2019 and February 2022 in Baghdad. The authors start with the standard technique described by Snodgrass, but the midline incision of the urethral plate extended up to the apical part of the glans tip, and tabularization started distally creating a slit-like a neomeatus. Outcome assessment depended on an objective evaluation of the following parameters: maximum flow rate, post-void residual, Hypospadias Objective Score Evaluation (HOSE) score, and direction of the urinary stream.

Results:

The mean age was 3.4±2.1 years, ranging from 0.6 to 9 years. The mean duration of follow-up was 14.4±6.9 months, and the location of the meatus was coronal in 16 patients (30%), subcoronal in 25 (47%), and mid-distal shaft in 12 (23%). The glans width was greater than or equal to 14 mm in 46 patients (87%) and less than 14 mm in 7 (13%). Q.max was above the fifth percentile of age-related uroflowmetry nomograms for healthy children 5–15 years old in 29 boys (93.5%) and below the fifth percentile in 2 (6.5%). Post-void residual urine was less than 10% of voided volume in 28 out of 31 boys (90%) and greater than 10% in 3 (10%). Regarding cosmetic outcomes, 50 boys (94%) had good penile appearance and their HOSE score greater than or equal to 14 with a slit-like meatus located at the tip of the glans, while 3 (6%) of them their score was less than 14. The overall mean HOSE score postoperatively for all patients was 15±0.9. Six patients (11%) had a deviated urinary stream and 47 (89%) had a straight stream.

Conclusion:

E-TIP repair is a good alternative to standard Snodgrass repair for mid-shaft to distal hypospadias with a good functional and cosmetic outcome, particularly the neomeatus position at the tip of the glans, which is similar to the normal one without increasing the risk of meatal stenosis.