bluuebunny/crossref_metadata_2025 huggingface dataset:
Implant-Based Breast Reconstruction After Nipple-Sparing and Skin-Sparing Mastectomy in Breast-Augmented Patients: Prepectoral or Submuscular Direct-to-Implant Reconstruction?
Authors: Salgarello Marzia , Fabbri Mariachiara , Visconti Giuseppe , Barone Adesi Liliana
Published: December 2023

Background

Patients with breast augmentation facing a breast cancer diagnosis pose unique challenges for both breast and plastic surgeons in terms of treatment and reconstruction. Traditional submuscular direct-to-implant (DTI) breast reconstruction is often considered the standard approach, regardless of the previous implant pocket. However, recent trends in prepectoral reconstruction provide an innovative solution for patients with previous subglandular and submuscular implants.

Objectives

In this study we aimed to share our experiences with DTI breast reconstruction in patients with a history of breast augmentation, with a specific focus on the viability of prepectoral reconstruction.

Methods

A retrospective review was conducted on 38 patients with previous breast augmentation who underwent either skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer followed by DTI reconstruction between January 2015 and July 2023. Our analysis considered various factors, including previous implant positioning, capsular and implant status, and mastectomy flap thickness (MFT), offering insights into the rationale behind choosing the new implant positioning.

Results

Patients with a history of subglandular breast augmentation and an MFT greater than 1 cm were candidates for prepectoral reconstruction. When the MFT was less than 1 cm but flap vascularity was sufficient, a prepectoral reconstruction was performed; otherwise, retropectoral reconstruction was preferred. Patients with submuscular breast augmentation were evaluated similarly, with submuscular reconstruction chosen when the MFT was less than 1 cm and prepectoral reconstruction preferred when the MFT exceeded 1 cm.

Conclusions

Immediate prepectoral DTI reconstruction represents a feasible option for specific patients with a history of breast augmentation. Decisions regarding the reconstructive approach are influenced by variables such as mastectomy flap thickness, implant status, and capsular conditions.

Level of Evidence: 3
Comment on ‘Dupilumab significantly improves sleep in adults with atopic dermatitis: results from the 12-week placebo-controlled period of the 24-week phase IV randomized double-blinded placebo-controlled DUPISTAD study’
Authors: Johnson Chandler , Smith Payton , Haran Kathryn , Kranyak Allison , Liao Wilson , Bhutani Tina
Published: December 2023

In this letter to the editor, we respond to the article by Merola et al. titled ‘Dupilumab significantly improves sleep in adults with atopic dermatitis: results from the 12-week placebo-controlled period of the 24-week phase IV randomized double-blinded placebo-controlled DUPISTAD study’. We add to the authors’ discussion on the discrepancy between objective and subjective measures of sleep in people with atopic dermatitis treated with dupilumab.
Pelvic drain placement after robot-assisted radical prostatectomy: meta-analysis
Authors: Ma Jianglei , Chang Yifan , Xu Weidong , Cao Wanli , Zhang Zongqin , Lou Yihaoyun , Li Duocai , Ma Zifang , Jiang Junhui , Ren Shancheng
Published: December 2023

Background

It is not clear whether the routine placement of a pelvic drain after robot-assisted radical prostatectomy is a necessity. The aim of this study was to investigate this through a meta-analysis of RCTs and non-randomized studies.

Methods

A search was performed in PubMed/MEDLINE, Embase, the Cochrane Library, and the Web of Science, up to 9 March 2023, for clinical trials comparing no drain with pelvic drain placement for patients with prostate cancer after robot-assisted radical prostatectomy. Two researchers independently conducted literature screening, data extraction, and quality assessment. A random-effect model was assumed for all analyses. The Cochrane Collaboration’s risk-of-bias tool was used to evaluate the methodological quality of RCTs and, for non-randomized studies, the ROBINS-I tool was used (where ROBINS-I stands for Risk Of Bias In Non-randomized Studies - of Interventions). This meta-analysis was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42023406429).

Results

A total of six studies with 1480 patients were included in the meta-analysis. Both the meta-analysis of RCTs and the meta-analysis of non-randomized studies showed that patients without drains had a similar estimated blood loss (mean difference 40.49 ml, 95% c.i. −59.75 to 140.74 ml, P = 0.430, and mean difference −14.20 ml, 95% c.i. −32.26 to 3.87 ml, P = 0.120 respectively), overall complication rate (OR 0.60, 95% c.i. 0.35 to 1.04, P = 0.070, and OR 0.90, 95% c.i. 0.59 to 1.39, P = 0.640 respectively), Clavien–Dindo grade I–II complication rate (OR 0.62, 95% c.i. 0.34 to 1.13, P = 0.120, and OR 0.83, 95% c.i. 0.28 to 2.51, P = 0.750 respectively), Clavien–Dindo grade III–V complication rate (OR 0.60, 95% c.i. 0.10 to 3.69, P = 0.590, and OR 0.92, 95% c.i. 0.25 to 3.39, P = 0.900 respectively), and duration of hospital stay (mean difference −0.08 days, 95% c.i. −0.45 to 0.29 days, P = 0.670, and mean difference −0.64 days, 95% c.i. −2.67 to 1.39 days, P = 0.540 respectively) compared with routinely drained patients. Meta-analysis of non-randomized studies revealed that the duration of operation for patients without drains was shorter than that for patients with drains (mean difference −34.88 min, 95% c.i. −43.58 to –26.18 min, P < 0.001), but the meta-analysis of RCTs indicated that there was no significant difference between the two groups (mean difference −7.64 min, 95% c.i. −15.61 to 0.32 min, P = 0.060).

Conclusion

The intraoperative and postoperative outcomes of patients without drains were not inferior to those of patients with drains. In selected patients, pelvic drains can be omitted after robot-assisted radical prostatectomy.
Neutrophil depletion attenuates antibody-mediated rejection in a renal transplantation mouse model
Authors: Li Xingku , Zhao Yakun , Sun Wenying , Zhang Cong , Yu Yadi , Du Bo , Jin AiShun , Liu Ye
Published: December 2023

Antibody-mediated rejection (AMR) can cause graft failure following renal transplantation. Neutrophils play a key role in AMR progression, but the exact mechanism remains unclear. We investigated the effect of neutrophils on AMR in a mouse kidney transplantation model. The mice were divided into five groups: syngeneic transplantation (Syn), allograft transplantation (Allo), and three differently treated AMR groups. The AMR mouse model was established using skin grafts to pre-sensitize recipient mice. Based on the AMR model, Ly6G-specific monoclonal antibodies were administered to deplete neutrophils (NEUT−/− + AMR) and TACI-Fc was used to block B-cell-activating factor (BAFF)/a proliferation-inducing ligand (APRIL) signaling (TACI-Fc + AMR). Pathological changes were assessed using hematoxylin–eosin and immunohistochemical staining. Banff values were evaluated using the Banff 2015 criteria. Donor-specific antibody (DSA) levels were assessed using flow cytometry, and BAFF and APRIL concentrations were measured using ELISA. Compared to the Syn and Allo groups, a significantly increased number of neutrophils and increased C4d and IgG deposition were observed in AMR mice, accompanied by elevated DSA levels. Neutrophil depletion inhibited inflammatory cell infiltration and reduced C4d and IgG deposition. Neutrophil depletion significantly decreased DSA levels after transplantation and suppressed BAFF and APRIL concentrations, suggesting a mechanism for attenuating AMR-induced graft damage. Similar results were obtained after blockading BAFF/APRIL using a TACI-Fc fusion protein. In summary, neutrophil infiltration increased in the AMR mouse renal transplantation model. Neutrophil depletion or blockading the BAFF/APRIL signaling pathway significantly alleviated AMR and may provide better options for the clinical treatment of AMR.
Comparative metatranscriptomics reveals effect of host plant on microbiota gene expression of Anastrepha obliqua (Diptera: Tephritidae) larvae
Authors: Cárdenas-Hernández Valentina , Lemos-Lucumí César Alejandro , Toro-Perea Nelson
Published: December 2023

The microbiota associated with phytophagous insects perform several functions that help insects exploit plant resources. Thus, microorganisms contribute to the dispersal of phytophagous species to new host plants, thereby promoting diversification. In this study, metatranscriptomic analysis was used to compare the gene expression of the microbiome of Anastrepha obliqua Macquart larvae feeding on 3 of its host plants: Spondias purpurea L (red mombin), Mangifera indica L (mango), and Averrhoa carambola L (starfruit). To identify differential gene expression in relation to the host plant, transcript abundance was compared. The results of the taxonomic and functional beta-diversity analysis showed that there were significant differences in the structures and activities of the microbial communities depending on the infested plant. Among the microorganisms, bacteria and fungi were active components of the microbiota. Differential expression analyses showed that the different active genes in each of the plants analyzed were mainly grouped into categories related to carbohydrate and amino acid metabolism, with some of these genes coding for cytochrome o ubiquinol oxidase, cytochrome c, and the enzyme isocitrate dehydrogenase. The microbiota of A. carambola larvae differed more at the level of community structure and gene function, possibly due to the different nutritional composition of the A. carambola and the presence of a set of secondary metabolites specific to the family Oxalidaceae. In conclusion, the transcriptional activity of the microbiota of A. obliqua larvae is influenced by diet, which is important because it could influence the performance of the insect on each of its different host plants.
Multiple generation distinct toxicant exposures induce epigenetic transgenerational inheritance of enhanced pathology and obesity
Authors: Nilsson Eric E , McBirney Margaux , De Santos Sarah , King Stephanie E , Beck Daniel , Greeley Colin , Holder Lawrence B , Skinner Michael K
Published: December 2023

Three successive multiple generations of rats were exposed to different toxicants and then bred to the transgenerational F5 generation to assess the impacts of multiple generation different exposures. The current study examines the actions of the agricultural fungicide vinclozolin on the F0 generation, followed by jet fuel hydrocarbon mixture exposure of the F1 generation, and then pesticide dichlorodiphenyltrichloroethane on the F2 generation gestating females. The subsequent F3 and F4 generations and F5 transgenerational generation were obtained and F1–F5 generations examined for male sperm epigenetic alterations and pathology in males and females. Significant impacts on the male sperm differential DNA methylation regions were observed. The F3–F5 generations were similar in ∼50% of the DNA methylation regions. The pathology of each generation was assessed in the testis, ovary, kidney, and prostate, as well as the presence of obesity and tumors. The pathology used a newly developed Deep Learning, artificial intelligence-based histopathology analysis. Observations demonstrated compounded disease impacts in obesity and metabolic parameters, but other pathologies plateaued with smaller increases at the F5 transgenerational generation. Observations demonstrate that multiple generational exposures, which occur in human populations, appear to increase epigenetic impacts and disease susceptibility.
Impact of participation as a peer change agent on peer change agents themselves: a quantitative study of a peer-led, social media-based PrEP promotion intervention
Authors: Cooper Spring C , Santella Anthony J , Caines Matthew , Rojanaworarit Chanapong , Hernandez Alex
Published: December 2023

Despite the adoption of pre-exposure prophylaxis (PrEP) as a crucial HIV intervention, uptake remains suboptimal among men who have sex with men, a sexual minority group, due to barriers like cost and stigma. Peer change agents (PCAs) disseminate PrEP information within their social networks. This study explores the reciprocal effects of an online community-based participatory intervention on PCAs, focusing on their transformed PrEP uptake perceptions—leadership efficacy, social network dynamics, attitudes, perceived benefits and barriers and self-efficacy. Leveraging insights from the PrEP Chicago Study, our research addresses a key gap in community-based participatory interventions for PrEP uptake: the transformative experiences and perception shifts of PCAs involved in these interventions. We engaged 20 men who have sex with men, aged 18–45, as PCAs in a one-group pretest–posttest design intervention, which disseminated PrEP communications within their preferred online networks. We utilized the PrEP Chicago Study’s 45 Likert items, tailored to reveal the PCAs’ transformative potential. Data on PrEP uptake perceptions, sociodemographics and social media use were captured and analyzed using the Wilcoxon matched-pairs signed-rank test, a nonparametric method. PCAs demonstrated significant changes in their PrEP uptake perceptions, including leadership capacity, social network dynamics, attitudes toward PrEP, perceived benefits, barriers and self-efficacy. Our intervention highlights the reciprocal transformation PCAs undergo when disseminating PrEP information. This study adds a new dimension to community-based PrEP interventions and underscores the need for continued refinement of peer-led strategies to optimize the transformative potential of PCAs.
Vaccination Shapes Within-Host SARS-CoV-2 Diversity of Omicron BA.2.2 Breakthrough Infection
Authors: Zhang Yi , Zhou Yang , Chen Jiazhen , Wu Jing , Wang Xun , Zhang Yumeng , Wang Shiyong , Cui Peng , Xu Yuanyuan , Li Yang , Shen Zhongliang , Xu Tao , Zhang Qiran , Cai Jianpeng , Zhang Haocheng , Wang Pengfei , Ai Jingwen , Jiang Ning , Qiu Chao , Zhang Wenhong
Published: December 2023

Background

Low-frequency intrahost single-nucleotide variants of SARS-CoV-2 have been recognized as predictive indicators of selection. However, the impact of vaccination on the intrahost evolution of SARS-CoV-2 remains uncertain at present.

Methods

We investigated the genetic variation of SARS-CoV-2 in individuals who were unvaccinated, partially vaccinated, or fully vaccinated during Shanghai's Omicron BA.2.2 wave. We substantiated the connection between particular amino acid substitutions and immune-mediated selection through a pseudovirus neutralization assay or by cross-verification with the human leukocyte antigen–associated T-cell epitopes.

Results

In contrast to those with immunologic naivety or partial vaccination, participants who were fully vaccinated had intrahost variant spectra characterized by reduced diversity. Nevertheless, the distribution of mutations in the fully vaccinated group was enriched in the spike protein. The distribution of intrahost single-nucleotide variants in individuals who were immunocompetent did not demonstrate notable signs of positive selection, in contrast to the observed adaptation in 2 participants who were immunocompromised who had an extended period of viral shedding.

Conclusions

In SARS-CoV-2 infections, vaccine-induced immunity was associated with decreased diversity of within-host variant spectra, with milder inflammatory pathophysiology. The enrichment of mutations in the spike protein gene indicates selection pressure exerted by vaccination on the evolution of SARS-CoV-2.
Impact of possible errors in natural language processing-derived data on downstream epidemiologic analysis
Authors: Lan Zhou , Turchin Alexander
Published: December 2023

Objective

To assess the impact of potential errors in natural language processing (NLP) on the results of epidemiologic studies.

Materials and Methods

We utilized data from three outcomes research studies where the primary predictor variable was generated using NLP. For each of these studies, Monte Carlo simulations were applied to generate datasets simulating potential errors in NLP-derived variables. We subsequently fit the original regression models to these partially simulated datasets and compared the distribution of coefficient estimates to the original study results.

Results

Among the four models evaluated, the mean change in the point estimate of the relationship between the predictor variable and the outcome ranged from −21.9% to 4.12%. In three of the four models, significance of this relationship was not eliminated in a single of the 500 simulations, and in one model it was eliminated in 12% of simulations. Mean changes in the estimates for confounder variables ranged from 0.27% to 2.27% and significance of the relationship was eliminated between 0% and 9.25% of the time. No variables underwent a shift in the direction of its interpretation.

Discussion

Impact of simulated NLP errors on the results of epidemiologic studies was modest, with only small changes in effect estimates and no changes in the interpretation of the findings (direction and significance of association with the outcome) for either the NLP-generated variables or other variables in the models.

Conclusion

NLP errors are unlikely to affect the results of studies that use NLP as the source of data.
Localized effects of confiscated and re-allocated real estate mafia assets
Authors: Boeri Filippo , Di Cataldo Marco , Pietrostefani Elisabetta
Published: December 2023

Asset confiscation regimes are present throughout Europe. The Italian State implements a policy stipulating the confiscation of real estate assets from individuals convicted of mafia-related crimes and the re-allocation of these assets to new uses. The policy of confiscation (confisca) and re-allocation (destinazione) is meant to act as both an anti-mafia measure and a way to compensate local communities by converting real estate assets into public amenities. We evaluate the effects of this programme on local areas by estimating its impact on property values in the proximity of confiscations and re-allocations. The findings reveal a negative effect of confiscations and a positive effect of re-allocations on housing prices, mainly visible in mafia strongholds. Both of these trends can be observed in the time periods that directly follow instances of confiscation and re-allocation and appear to be highly localized. A drop in organized crime activity in the streets where re-allocations have occurred could account for some of the gain in property values caused by re-allocations. These findings have implications for the effectiveness of anti-mafia initiatives aimed at improving the quality of life in areas where criminal activity is more prevalent.
Poetry and Sufi commentary: a case of/for religious reading in premodern Sufism
Authors: Nair Arjun
Published: December 2023

One of the obstacles in the study of post-classical Sufi literatures has been the sceptical attitude toward Sufi commentary on Arabic and Persian lyrical poetry (specifically ‘mystical’ or ‘Sufi allegorical’ readings of the lyric). This attitude has prevented a wider appreciation of Sufi interpretations of such poetry. While there are signs of a shift in attitudes as scholars grapple with different Sufi commentators and their discussions of notable verses, many still hold to their scepticism. Although studies of individual commentaries will be necessary to reform these attitudes, a general response to the sceptical views may help to orient those studies, particularly one that draws its evidence and arguments from representative Sufi commentators and theorists of the lyric. This paper attempts such a response. Following a brief outline of critiques of Sufi commentary, and the reasons for continued scepticism toward commentators, I suggest how shifting understandings around the ambiguity present in the lyric should help to make allegorical interpretations seem more plausible as a collection of meanings in the archive that was persuasive to many readers, the figurative language of the lyric being able to support both literary-historical and allegorical interpretations of words, phrases, or images in particular verses. Sufi commentators used this ambiguity as a means by which to explore the meanings of the allegory according to the principle ‘The figurative is the bridge to the Truth–Reality’. Sufi theorists, moreover, discussed how the figurative language of the lyric and its allegoresis by way of commentary could serve distinct functions for different kinds of readers in Sufi knowledge–practice. If the figurative form of the lyric was more suitable for non-Sufi readers or novices in Sufism to encounter its ‘specific meanings’, commentary, expressed in the technical language of Sufism, could assist more advanced Sufi readers to verify its ‘general meanings’. Far from diminishing the lyric, Sufi commentary only enhanced its value, showing it to possess both literary beauty as well as profound depth of meaning. I invoke Paul Griffiths’s ‘religious reading’ to suggest that an approach to the lyric that privileges the views of Sufi commentators is not only feasible, it can even be valuable for specialists of the lyric in the contemporary academy.
Identification of soil-dwelling predators of tick nymphs (Acari: Ixodidae) by stable isotope labeling
Authors: Vinogradov Dmitry D , Smagin Alexander S , Belova Oxana A , Tsurikov Sergey M , Karganova Galina G , Tiunov Alexei V
Published: December 2023

Ticks (Family Ixodidae) spend most of their life cycle as immature stages in the soil and litter, and as any other soil invertebrates, are likely to be controlled top-down by soil-dwelling predators. To date, the ability of soil invertebrate predators to control ixodid tick population remains little known, partly due to methodological difficulties. In the current study, we developed and successfully tested a novel method of labeling live Ixodes ricinus (L., 1758) (Ixodida: Ixodidae) nymphs with a 15N isotope label. Labeled ticks were used in a small-scale 8-day-long microcosm experiment to reveal soil predators attacking nymphs. Only a small fraction (4.1% of all samples) of soil generalist predators preyed upon nymphs. A strong 15N label was found in 5 predator species, namely 2 spiders (Pachygnatha listeri Sundevall, 1830, Tetragnathidae and Ozyptila sp., Theridiidae), 2 gamasid mites (Pergamasus beklemischevi Sellnick, 1929 and Pergamasus quisquiliarum [Canestrini, 1882], Parasitidae), and 1 staphylinid beetle (Geostiba circellaris [Gravenhorst, 1806], Staphylinidae). The isotopic labeling can be a useful tool in revealing a range of invertebrate predators that can control tick populations in soil.
The energetics of cellular life transitions
Authors: Monzel Anna S , Levin Michael , Picard Martin
Published: December 2023

Major life transitions are always difficult because change costs energy. Recent findings have demonstrated how mitochondrial oxidative phosphorylation (OxPhos) defects increase the energetic cost of living and that excessive integrated stress response (ISR) signaling may prevent cellular identity transitions during development. In this perspective, we discuss general bioenergetic principles of life transitions and the costly molecular processes involved in reprograming the cellular hardware/software as cells shift identity. The energetic cost of cellular differentiation has not been directly quantified, representing a gap in knowledge. We propose that the ISR is an energetic checkpoint evolved to (i) prevent OxPhos-deficient cells from engaging in excessively costly transitions and (ii) allow ISR-positive cells to recruit systemic energetic resources by signaling via GDF15 and the brain.
The dog as a sentinel and animal model for coccidioidomycosis
Authors: Ferguson Adam J , Thompson George R , Bruyette David , Sykes Jane E
Published: December 2023

Coccidioidomycosis is a potentially fatal fungal disease of humans and animals that follows inhalation of Coccidioides spp. arthroconidia in the environment. The disease in dogs resembles that in people, and because dogs may be at increased risk of exposure due to their proximity to the ground and digging behavior, they are valuable models for the disease in humans. Dogs have been sentinels for identification of new regions of endemicity in Washington and Texas. Canine serosurveillance has also been used to predict variables associated with environmental presence of Coccidioides spp. Expansion of the endemic region of coccidioidomycosis with climate change—along with predicted population increases and increased development in the southwest United States—may result in 45.4 million additional people at risk of infection by 2090. Here we provide an overview of the value of dogs as sentinels for the disease and encourage the routine reporting of coccidioidomycosis cases in dogs to public health agencies. We also highlight the value of dogs as naturally occurring models for studying novel treatment options and preventatives, such as a novel live avirulent coccidioidomycosis vaccine.
Usefulness of the DN4, S-LANSS, and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: a cross-sectional study
Authors: Ríos-León Marta , Taylor Julian , Segura-Fragoso Antonio , Barriga-Martín Andrés
Published: December 2023

Objective

Although the presence of neuropathic pain (NP) components has been reported in whiplash-associated disorders (WAD), no studies have analyzed the usefulness of NP screening questionnaires to detect NP components in WAD. This study aimed to assess the usefulness of 3 NP screening tools (Douleur Neuropathique 4 [DN4], self-administered Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS], and painDETECT questionnaire [PDQ]) to detect the presence of NP components in acute WAD.

Design

A cross-sectional study.

Setting

Hospital.

Subjects

Of 188 eligible individuals, 50 people (68% women, mean age = 40.3 ± 12.5 years) with acute WAD (52% Grade III) were included.

Methods

Specialized physicians initially screened participants for the presence of NP components according to clinical practice and international recommendations. After physician assessment, blinded investigators used NP screening questionnaires (DN4, S-LANSS, and PDQ) to assess participants within 2 weeks of their accident. The diagnostic accuracy of these tools was analyzed and compared with the reference standard (physicians’ assessments).

Results

The 3 screening questionnaires showed excellent discriminant validity (area under the curve: ≥0.8), especially S-LANSS (area under the curve: 0.9; P < .001). DN4 demonstrated the highest sensitivity (87%), followed by S-LANSS (75%), while S-LANSS and PDQ showed the highest specificity (85% and 82%, respectively). These tools demonstrated a strong correlation with the reference standard (S-LANSS: rho = 0.7; PDQ: rho = 0.62; DN4: rho = 0.7; all, P < .001).

Conclusions

The DN4, S-LANSS, and PDQ show excellent discriminant validity to detect the presence of NP components in acute WAD, especially S-LANSS. Initial screening with these tools might improve management of WAD.
Prostitution, renamed? Police perceptions of human trafficking
Authors: Gibbs Jennifer C , Strohacker Emily R
Published: December 2023

Often, human trafficking is only thought of as sex trafficking, and many perceive it as a new term for prostitution; yet, human trafficking includes much more. Police understanding of human trafficking is especially important as police are first responders and serve as gatekeepers to service access for victims or punishment for offenders. Thus, how police define human trafficking and whether they recognize it in their area is an important area of inquiry. Surveying 495 police officers serving at a large agency in the northeastern USA, this study explored police conceptualizations of human trafficking, finding that most officers define human trafficking as sex trafficking. Further, logistic regression analyses show that myths surrounding human trafficking (especially that human trafficking is prostitution) affect officers’ perceptions of whether human trafficking is a problem in their area. Additionally, officer characteristics, such as training, tenure, type of area served, and experience with human trafficking cases, affect officers’ perceptions of human trafficking. These and other findings are discussed in light of the literature.
Clinical Presentation Differences Among Four Subtypes of Femoroacetabular Impingement: A Case–Control Study
Authors: González-de-la-Flor Ángel , Valera-Calero Juan Antonio , García-Fernández Pablo , López-de-Uralde-Villanueva Ibai , Fernández-de-las-Peñas César , Plaza-Manzano Gustavo
Published: December 2023

Objective

The aims of this study were to assess the psychological, functional, and physical differences between patients with femoroacetabular impingement (FAI) syndrome and individuals who were asymptomatic (controls) to analyze clinical differences among 4 subtypes of FAI (cam type, cam type with labral tear, pincer type, and pincer type with labral tear), to calculate the correlations among the variables described, and to identify risk factors contributing to the hip function variance.

Methods

A case–control study was conducted at a hospital rehabilitation unit with a cohort of individuals who were asymptomatic (controls) and a cohort of patients with FAI. Sociodemographic characteristics, pain intensity, psychological health status, hip range of motion (RoM), hip isometric strength, and hip function were assessed.

Results

A total of 69 controls and 69 patients with FAI were analyzed. Although sociodemographic characteristics were comparable between samples, poorer hip RoM, strength, and psychological health were found for the cases. FAI subtypes showed no significant pain intensity, psychological health, or RoM differences (except for hip adduction), but hip strength differed among FAI subtypes. Multiple significant correlations between psychological health, pain intensity, RoM, strength, and hip function were found. The variance values of the International Hip Outcome Tool, Hip Outcome Score (HOS) for daily living activities, and HOS for sports activities were partially explained (47.6%, 36.0%, and 21.6%, respectively) on the basis of kinesiophobia, hip strength, self-efficacy, and anxiety.

Conclusion

Patients with FAI showed poorer psychological health, hip RoM, and strength than individuals who were asymptomatic and had similar sociodemographic characteristics. FAI subtype influenced the patients’ clinical presentations. Hip strength, kinesiophobia, anxiety, and self-efficacy should be targeted for improving hip function, as they have been demonstrated to be important contributors to hip disability.

Impact

This study demonstrated that pain catastrophizing, hip strength, and hip adduction differed among FAI subtypes. However, hip function and pain intensity were comparable between FAI subtypes.
Risk assessment from radon in domestic water for the Greek population
Authors: Omirou Michalakis , Clouvas Alexandros , Leontaris Fokion , Kaissas Ioannis
Published: December 2023

This study focused on assessing the risk from the exposure to radon contained in domestic water for a significant part (~20%) of the Greek population. Also, the variation of radon in domestic water was monitored from 2017 to 2023 in certain villages that showed relatively high radon levels and relied on boreholes for their water supply. The radon in domestic water activity concentrations measured in the investigated Greek places ranged from lower than the minimum detection limit (2 Bq L−1) levels up to 187 Bq L−1 with an average value of 9.1 Bq L−1. Overall, higher radon in domestic water activity concentrations were observed in places supplied from boreholes located inside granitic and metamorphic rock areas. Only one out of the 487 examined places, which accounts for 0.015% of the examined Greek population, showed an average radon-in-water activity concentration higher than the parametric value of 100 Bq L−1 adopted by Greece following the EURATOM Directive (2013/51/EURATOM). Therefore, radon-in-water does not pose a health concern (risk) for the investigated Greek population. The total (inhalation and ingestion) annual effective doses to adults, corresponding to the measured radon-in-water activity concentrations, ranged from nearly 0 to 1.20 mSv y−1 with an average value of 0.059 mSv y−1, while for children, they ranged from almost 0 to 1.26 mSv y−1 with an average value of 0.061 mSv y−1. Regarding the variation of radon in domestic water monitoring, places supplied with water from one borehole showed no significant fluctuations from their average radon-in-water activity concentration, with standard deviations of ~20% at a coverage factor of k = 1. Even though some places supplied from three to four boreholes showed no significant fluctuations (standard deviation <= 30% at k = 1) from their average radon level, special attention is needed for places supplied from many boreholes when one measurement over the year is to be performed for the annual effective dose assessment. This is because the prevailing during-year borehole combination may not exist on the measurement day, resulting in an underestimated or overestimated dose assessment. Radon removal from domestic water supplies in the Arnea village (due to elevated radon-in-water activity concentrations) did not affect the inhalation risk for the residents of an examined house in Arnea. However, radon removal from the water supply was essential to reduce the ingestion risk for the house occupants. There is a possibility of radiation overexposure (>20 mSv y−1) for the workers in a thermal spa on Ikaria Island, and further investigation needs to be conducted with extended measurement periods.
Gender and Sex Differences in Health-related Quality of Life, Clinical Outcomes and Survival after Treatment of Metastatic Spine Disease
Authors: Goodwin C. Rory , Price Meghan , Goodwin Andrea N. , Dalton Tara , Versteeg Anne L. , Sahgal Arjun , Rhines Laurence D. , Schuster James M. , Weber Michael H. , Lazary Aron , Boriani Stefano , Bettegowda Chetan , Fehlings Michael G. , Arnold Paul M. , Dea Nicolas , Charest-Morin Raphaele , Shin John , Laufer Ilya , Chou Dean , Gokaslan Ziya L. , Clarke Michelle J. , Fisher Charles G. , Sciubba Daniel M. ,   on behalf of the AO Spine Knowledge Forum Tumor
Published: December 2023

Study Design.

Retrospective review of prospective, multicenter and international cohort study.

Objective.

To describe the effect of gender on HRQoL, clinical outcomes and survival for patients with spinal metastases treated with either surgery and/or radiation.

Summary of Background Data.

Gender differences in health-related outcomes are demonstrated in numerous studies, with women experiencing worse outcomes and receiving lower standards of care than men, however, the influence that gender has on low health-related quality of life (HRQoL) and clinical outcomes after spine surgery remains unclear.

Methods.

Patient demographic data, overall survival, treatment details, perioperative complications, and HRQoL measures including EQ-5D, pain NRS, the short form 36 version 2 (SF-36v2) and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) were reviewed. Patients were stratified by sex, and a separate sensitivity analysis that excluded gender-specific cancers (i.e., breast, prostate, etc.) was performed.

Results.

The study cohort included 207 female and 183 male patients, with age, smoking status, and site of primary cancer being significantly different between the two cohorts (P<0.001). Both males and females experienced significantly improved SOSGOQ2.0, EQ-5D, and pain NRS scores at all study time points from baseline (P<0.001). Upon sensitivity analysis, (gender-specific cancers removed from analysis), the significant improvement in SOSGOQ physical, mental, and social subdomains and on SF-36 domains disappeared for females. Males experienced higher rates of postoperative complications. Kaplan-Meier survival analysis of both the overall and sensitivity analysis cohorts showed females lived longer than males after treatment (P=0.001 and 0.043, respectively).

Conclusion.

Both males and females experienced significantly improved HRQoL scores after treatment, but females demonstrated longer survival and a lower complication rate. This study suggests that gender may be a prognostic factor in survival and clinical outcomes for patients undergoing treatment for spine metastases and should be taken into consideration when counseling patients accordingly.
Prognostic factors for recurrence-free survival in resected pathologic N2-stage III non-small cell lung cancer treated with upfront surgery
Authors: Tsai Ping-Chung , Liu Chia , Yeh Yi-Chen , Hsu Po-Kuei , Huang Chien-Sheng , Hsieh Chih-Cheng , Hsu Han-Shui
Published: December 2023

Background:

The standard treatment for pathological N2 (pN2) non-small-cell lung cancer (NSCLC) patients is definitive chemoradiation. Surgery might be beneficial for resectable pN2 disease, so we investigated the recurrence-free interval of upfront surgery for selected patients with resectable pN2 disease.

Methods:

The clinicopathologic characteristics of patients with pN2 NSCLC who underwent upfront anatomical resection at Taipei Veterans General Hospital from 2011 January to 2019 December were retrospectively reviewed. A Cox regression model was used to identify prognostic factors of recurrence-free survival (RFS).

Results:

In total, 84 patients after curative lung anatomic resection were analyzed, with a 44-month median survival. The 1-, 3-, and 5-year RFS rates were 63.1%, 31.3%, and 19.9%, respectively, with a median RFS of 18.9 months. Multivariable cox regression analysis identified that the significant predictor for RFS was a tumor size of more than 3 cm (hazard ratio [HR] = 1.74, 95% CI, 1.07-2.83, p = 0.027). Visceral pleural invasion, LN harvest number, tumor stage, and N2 status including single zone (N2a) or multiple zones (N2b) were not prognostic factors in this study.

Conclusion:

Upfront surgery for resectable N2 disease achieved favorable outcomes in selected patients, especially better recurrence control with limited tumor size. Therapeutic advances might encourage surgeons to aggressive intervention.
Effect of Repetitive Head Impacts on Saccade Performance in Canadian University Football Players
Authors: Brooks Jeffrey S. , Dickey James P.
Published: December 2023

Objective:

Investigate the effect of cumulative head impacts on saccade latency and errors, measured across two successive football seasons.

Design:

Participants were acquired from a sample of convenience—one Canadian university football team. Head impacts were collected during training camp, practices, eight regular season games, and four playoff games in each season. Saccade measurements were collected at five time points—before and after training camp, at midseason, after regular season, and after playoffs.

Setting:

Two seasons following players from a single USports football team during practices and games.

Participants:

Players who completed a baseline saccade measurement and a minimum of one follow-up measurement were included in the study. A total of 127 players were monitored across two competitive seasons, including 61 players who participated in both seasons.

Independent Variables:

Head impact measurements were collected using helmet-mounted sensors.

Main Outcome Measures:

Saccade latency and number of errors were measured using high-speed video or electro-oculography.

Results:

On average, each head impact increased prosaccade latency by 5.16 × 10−3 ms (95% confidence interval [CI], 2.26 × 10−4-1.00 × 10−2, P = 0.03) and antisaccade latency by 5.74 × 10−3 ms (95% CI, 7.18 × 10−4-1.06 × 10−2, P = 0.02). These latency increases did not decrease between the two seasons; in fact, prosaccade latencies were 23.20 ms longer (95% CI, 19.40-27.14, P < 0.001) at the second season's baseline measurement than the first. The number of saccade errors was not affected by cumulative head impacts.

Conclusions:

Repetitive head impacts in Canadian university football result in cumulative declines in brain function as measured by saccade performance.

Clinical Relevance:

Football organizations should consider implementing policies focused on reducing head impacts to improve player safety.
Does Immobilization of Distal Radius Torus Fractures Affect Treatment Outcome?
Authors: Kazez Muhammed , Key Sefa , Agar Anıl
Published: December 2023

Objective

The aim of this study is to compare the clinical results of splint, short arm circular plaster, and soft bandage immobilization methods applied in the treatment of wrist torus fractures in a single center.

Methods

Patients treated for torus fractures at a tertiary trauma hospital between January 2018 and January 2022 were analyzed retrospectively. According to the physician’s preference, a splint, short arm circular plaster, or soft bandage was applied to each patient. The treatment modalities, the number of hospital admissions during the treatment, the number of radiological imaging procedures used during the treatment, immobilization time, and the follow-up periods of the patients were checked and noted on the hospital data processing system.

Results

Six hundred ten patients were included in the study. It was determined that 351 patients were treated with a short arm splint, 155 with a short arm circular cast, and 104 with soft bandaging. The number of radiological imaging procedures, the number of hospital admissions during the treatment, the duration of the pain complaint, and the complication rate of the patients treated with splint were significantly lower than the groups treated with short arm circular plaster and soft bandage (P < 0.001).

Conclusions

It was observed that patients who were immobilized with a short arm splint required less follow-up time and fewer imaging procedures and hospital admissions and experienced earlier pain relief and lower complication rates. We think that the use of short arm splints in the treatment of torus fractures is sufficient, safe, and advantageous.
Work-Life Integration for Women in Pediatric Emergency Medicine
Authors: Skotnicki Brielle Stanton , Wilson Paria M. , Kazmerski Traci M. , Prideaux Jonelle , Manole Mioara D. , Kinnane Janet M. , Lunoe Maren M.
Published: December 2023

Objective

Women in medicine generally have higher burnout and lower career satisfaction and work-life integration compared with men. This study identifies factors that contribute to burnout, career satisfaction, and work-life integration in women pediatric emergency medicine (PEM) physicians.

Methods

Self-identified women PEM physicians in the United States participated in a virtual focus group using Group Level Assessment methodology. Participants completed Group Level Assessment process steps of climate setting, generating, appreciating, reflecting, understanding, selecting, and action to (1) identify themes that contribute to burnout, career satisfaction, and work-life integration and (2) determine actionable factors based on these themes. Data were collected and thematically analyzed in real time through iterative processing. The group prioritized identified themes through rounds of distillation.

Results

Seventeen women participated, representing 10 institutions (ages 30s–70s, 69% employed full-time). Participants identified 3 main themes contributing to burnout, career satisfaction, and work-life integration: (1) gender inequities, (2) supportive leadership, and (3) balance with family life. Actionable items identified were as follows: (1) development of initiatives to equalize pay, opportunity, and career advancement among genders; (2) implementation of an institutional focus on supportive and collaborative leadership; and (3) improvement of resources and supports for physicians with family responsibilities.

Conclusions

Women PEM physicians identified gender inequities, leadership, and balance with family life as major themes affecting their burnout, career satisfaction, and work-life integration. Several action steps were identified and can be used by individuals and institutions to improve work-life integration for women PEM physicians.
The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer
Authors: Tenbergen Carlijn J.A. , Fortuin Ansje S. , van Asten Jack J.A. , Veltien Andor , Philips Bart W.J. , Hambrock Thomas , Orzada Stephan , Quick Harald H. , Barentsz Jelle O. , Maas Marnix C. , Scheenen Tom W.J.
Published: December 2023

Background

Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)–enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs.

Purpose

The aim of this study was to explore USPIO-enhanced MRI at 7 T in comparison to 3 T for the detection of small suspicious LNs in the same cohort of patients with PCa.

Materials and Methods

Twenty PCa patients with high-risk primary or recurrent disease were referred to our hospital for an investigational USPIO-enhanced 3 T MRI examination with ferumoxtran-10. With consent, they underwent a 7 T MRI on the same day. Three-dimensional anatomical and T2*-weighted images of both examinations were evaluated blinded, with an interval, by 2 readers who annotated LNs suspicious for metastases. Number, size, and level of suspicion (LoS) of LNs were paired within patients and compared between field strengths.

Results

At 7 T, both readers annotated significantly more LNs compared with 3 T (474 and 284 vs 344 and 162), with 116 suspicious LNs on 7 T (range, 1–34 per patient) and 79 suspicious LNs on 3 T (range, 1–14 per patient) in 17 patients. For suspicious LNs, the median short axis diameter was 2.6 mm on 7 T (1.3–9.5 mm) and 2.8 mm for 3 T (1.7–10.4 mm, P = 0.05), with large overlap in short axis of annotated LNs between LoS groups. At 7 T, significantly more suspicious LNs had a short axis <2.5 mm compared with 3 T (44% vs 27%). Magnetic resonance imaging at 7 T provided better image quality and structure delineation and a higher LoS score for suspicious nodes.

Conclusions

In the same cohort of patients with PCa, more and more small LNs were detected on 7 T USPIO-enhanced MRI compared with 3 T MRI. Suspicious LNs are generally very small, and increased nodal size was not a good indication of suspicion for the presence of metastases. The high spatial resolution of USPIO-enhanced MRI at 7 T improves structure delineation and the visibility of very small suspicious LNs, potentially expanding the in vivo detection limits of pelvic LN metastases in PCa patients.