bluuebunny/crossref_metadata_2025 huggingface dataset:
Does domination require unequal power?
Authors: MacRae Callum Zavos
Published: November 2024

Until recently, many theorists defined domination such that it requires unequal power, and most others held that even if domination were not defined as requiring unequal power, a requirement of unequal power would nevertheless follow from the definition of what domination is. On these views, unless there is an imbalance of power between the two parties, there can be no relation of domination. However, two prominent theorists have recently broken from this consensus, on the grounds that people can depend on one another's arbitrary or uncontrolled wills even in contexts where there is no inequality of power. In this paper, I argue that this is a mistake: domination theorists have a powerful reason to hold that domination cannot take place without a power imbalance. Consequently, we should only accept definitions of the concept on which domination requires unequal power.
The Unidroit Principles of International Commercial Contracts: potential for greater use in the Middle East and North Africa
Authors: Wehling Philine , Mahasneh Nisreen
Published: November 2024

The International Institute for the Unification of Private Law’s (Unidroit) Principles of International Commercial Contracts (UPICC) provide a uniform international instrument setting out general rules for international commercial contracts as an alternative to the State law-centred approach to contracting and dispute resolution. While the UPICC are well known among academics and frequently referred to in practice in many regions of the world including Europe, Latin America, and Asia, they are applied far less often in the Middle East and North Africa (MENA). This is in spite of the fact that their use appears to be widely permissible under MENA States’ domestic legislation, and international trade involvement provides opportunities for them to be applied productively. The reasons for less usage in the MENA region are manifold and include, among others, a judicial tendency to apply domestic law, the hierarchy between the Islamic Sharia and lex mercatoria, the limited involvement of experts from the MENA region in the elaboration of the UPICC and their subsequent promotion, and limited linguistic accessibility. Potential advantages of greater usage include the promotion of fair and harmonized contract practices and facilitating the resolution of cross-border private legal conflicts as well as the UPICC’s use as a model and reference for modernization and harmonization of contract law across the region and beyond. This article examines the use of the UPICC in MENA and the potential for facilitating their future impact in the region, focusing on Arab jurisdictions influenced by Islamic law.
Compensatory mechanisms that maintain androgen production in mice lacking key androgen biosynthetic enzymes
Authors: Lawrence Ben M. , O'Donnell Liza , Gannon Anne‐Louise , Smith Sarah , Curley Michael K. , Darbey Annalucia , Mackay Rosa , O'Shaughnessy Peter J. , Smith Lee B. , Rebourcet Diane
Published: November 2024

Testosterone and dihydrotestosterone (DHT) are essential for male development and fertility. In the canonical androgen production pathway, testosterone is produced in the testis by HSD17B3; however, adult male Hsd17b3 knockout (KO) mice continue to produce androgens and are fertile, indicating compensatory mechanisms exist. A second, alternate pathway produces DHT from precursors other than testosterone via 5α‐reductase (SRD5A) activity. We hypothesized that the alternate pathway contributes to androgen bioactivity in Hsd17b3 KO mice. To investigate contributions arising from and interactions between the canonical and alternate pathways, we pharmacologically inhibited SRD5A and ablated Srd5a1 (the predominant SRD5A in the testis) on the background of Hsd17b3 KO mice. Mice with perturbation of either the canonical or both pathways exhibited increased LH, testicular steroidogenic enzyme expression, and normal reproductive tracts and fertility. In the circulation, alternate pathway steroids were increased in the absence of HSD17B3 but were reduced by co‐inhibition of SRD5A1. Mice with perturbations of both pathways produced normal basal levels of intratesticular testosterone, suggesting the action of other unidentified hydroxysteroid dehydrogenase(s). Strikingly, testicular expression of another SRD5A enzyme, Srd5a2, was markedly increased in the absence of Hsd17b3, suggesting a compensatory increase in SRD5A2 to maintain androgen bioactivity during HSD17B3 deficiency. Finally, we observed elevated circulating concentrations of the 11‐keto‐derivative of DHT, suggesting compensatory extra‐gonadal induction of bioactive 11‐keto androgen production. Taken together, we conclude that, in the absence of the canonical pathway of androgen production, multiple intra‐ and extra‐gonadal mechanisms cooperate to maintain testosterone and DHT production, supporting male development and fertility.
Biomarkers in the diagnosis of mast cell activation
Authors: Voelker Dayne , Pongdee Thanai
Published: November 2024

Purpose of review

Mast cell activation is defined by activation of mast cells by varying stimuli with release of chemical mediators either through degranulation or release of de novo synthesized proteins or lipid mediators. Currently, tryptase measurement increase during symptomatic episodes is the most accepted biomarker measurement for mast cell activation. However, newer diagnostic tools including clinically available urinary mast cell mediators are noninvasive and can be more readily obtained compared to serum tryptase levels. This review will highlight biomarker measurement in the diagnosis of mast cell activation.

Recent findings

This review will highlight biomarker measurement in mast cell activation including serum tryptase and urinary mast cell mediators including N-methylhistamine, leukotriene E4, and 2,3-dinor-11beta-prostaglandin F2 alpha.

Urine mast cell mediators obtained at baseline and during symptom exacerbation are emerging biomarkers in the diagnosis of mast cell activation. Tryptase measurement and urinary mast cell mediator measurement are currently the most accepted biomarkers for mast cell activation. Further research is needed to establish new biomarkers for mast cell activation.
Entrustment and EPAs for Artificial Intelligence (AI): A Framework to Safeguard the Use of AI in Health Professions Education
Authors: Gin Brian C. , O’Sullivan Patricia S. , Hauer Karen E. , Abdulnour Raja-Elie , Mackenzie Madelynn , ten Cate Olle , Boscardin Christy K.
Published: November 2024

In this article, the authors propose a repurposing of the concept of entrustment to help guide the use of artificial intelligence (AI) in health professions education (HPE). Entrustment can help identify and mitigate the risks of incorporating generative AI tools with limited transparency about their accuracy, source material, and disclosure of bias into HPE practice. With AI’s growing role in education-related activities, like automated medical school application screening and feedback quality and content appraisal, there is a critical need for a trust-based approach to ensure these technologies are beneficial and safe. Drawing parallels with HPE’s entrustment concept, which assesses a trainee’s readiness to perform clinical tasks—or entrustable professional activities—the authors propose assessing the trustworthiness of AI tools to perform an HPE-related task across 3 characteristics: ability (competence to perform tasks accurately), integrity (transparency and honesty), and benevolence (alignment with ethical principles). The authors draw on existing theories of entrustment decision-making to envision a structured way to decide on AI’s role and level of engagement in HPE-related tasks, including proposing an AI-specific entrustment scale. Identifying tasks that AI could be entrusted with provides a focus around which considerations of trustworthiness and entrustment decision-making may be synthesized, making explicit the risks associated with AI use and identifying strategies to mitigate these risks. Responsible, trustworthy, and ethical use of AI requires health professions educators to develop safeguards for using it in teaching, learning, and practice—guardrails that can be operationalized via applying the entrustment concept to AI. Without such safeguards, HPE practice stands to be shaped by the oncoming wave of AI innovations tied to commercial motivations, rather than modeled after HPE principles—principles rooted in the trust and transparency that are built together with trainees and patients.
Early Palliative Care Following Aborted Cancer Surgery: Results of a Prospective Feasibility Trial
Authors: Cloyd Jordan M. , Khatri Rakhsha , Sarna Angela , Stevens Lena , Heh Victor , Dillhoff Mary , Kim Alex , Pawlik Timothy M. , Ejaz Aslam , Wells-Di Gregorio Sharla , Scott Erin , Kale Sachin S.
Published: November 2024

Background:

Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable.

Methods:

This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up.

Results:

Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, P = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, P = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, P = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline.

Conclusions:

Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.
Effects of Noise Exposure on Peripheral Auditory Function, Binaural Envelope Coding, and Speech Perception in Student Musicians With Normal Hearing
Authors: Patro Chhayakanta , Singer Aviya , Monfiletto Angela , Peitsch Katherine , Bologna William J.
Published: November 2024

Objectives:

Musicians face an increased risk of hearing loss due to prolonged and repetitive exposure to high-noise levels. Detecting early signs of hearing loss, which are subtle and often elusive to traditional clinical tests like pure-tone audiometry, is essential. The objective of this study was to investigate the impact of noise exposure on the electrophysiological and perceptual aspects of subclinical hearing damage in young musicians with normal audiometric thresholds.

Design:

The study included 33 musicians and 33 nonmusicians, all aged between 21 and 35 years, with normal audiometric thresholds. Participants underwent a comprehensive test battery, which encompassed standard and extended high-frequency (EHF) pure-tone audiometry (0.25 to 16 kHz), a Noise Exposure Structured Interview, auditory brainstem responses (ABRs) to clicks at various presentation rates and levels, thresholds for detecting interaural envelope time difference, and a spatial release from masking (SRM) paradigm in which the target speech was presented in the presence of either colocated or spatially separated time-reversed two-talker babble.

Results:

The results indicated the musician group reported greater lifetime noise exposure than the nonmusician group, but the Noise Exposure Structured Interview scores were neither correlated with the ABR results nor with the speech perception outcomes. The ABR analyses indicated diminished level-dependent growth and increased rate-dependent decline in wave I amplitudes among musicians compared with nonmusicians. The student musicians exhibited better binaural envelope processing skills than nonmusicians, emphasizing their perceptual advantages in auditory processing associated with musicianship. Speech perception results indicated no significant differences in SRM between student musicians and nonmusicians. However, in both groups, individuals with poorer EHF hearing exhibited reduced SRM compared with those with normal EHF hearing, underscoring the importance of assessing and addressing EHF hearing.

Conclusions:

Student musicians exhibit peripheral neural deficits; however, no clear relation was found between these neural deficits and their perceptual skills. Notably, reduced EHF thresholds were clearly related to reduced SRM, which poses a challenge for speech perception in complex multi-talker environments, affecting both musicians and nonmusicians alike.
Injury Patterns and Surgical Approaches
Authors: Shaikh Humza S. , Haase Douglas R.
Published: November 2024

Effective management of bony and cartilaginous thoracic injury is a vital part of the care of the polytraumatized patient. Commonly because of high-energy accidents including motor vehicle collisions and falls, these patients routinely require multidisciplinary care and surgical intervention. As our understanding of unstable chest wall injuries and pulmonary sequelae of the injury grows, it is imperative that injury patterns and surgical approaches become familiar to the orthopaedic trauma-trained surgeon. Common rib fracture patterns and muscle-sparing surgical approaches are detailed, with the goal of restoring chest wall stability to improve the mechanics of respiration and pain control in these challenging patients.
Surgical Fixation of Flail Chest Injuries: Reduction and Fixation Options, Tips and Tricks
Authors: Dehghan Niloofar , Taylor Benjamin C.
Published: November 2024

Modern techniques of rib fracture fixation surgery follow the AO principles of fracture reduction, fixation, and appropriate soft tissue handling. Fixation techniques can be performed using anatomic reduction and rigid fixation, or bridge plate fixation for comminuted fractures. Anatomic and nonanatomic plates can be used, although titanium precontoured locking plates are the most commonly used. Other contemporary intra- and extramedullary fixation strategies have also been developed. Intrathoracic fixation is a novel technique, however, limited literature on clinical outcomes currently exists. This article discusses techniques of reduction, fixation, and tips and tricks for surgical fixation of rib fractures.
Rib and Sternum Nonunions: Diagnosis and Treatment and Awareness of Other Potential Posttraumatic Pathology
Authors: Cole Peter A.
Published: November 2024

As the operative management of acute, chest wall, skeletal injury escalates throughout the world, it has become commonplace for patients with posttraumatic conditions to present with clinical reconstructive challenges as well. In addition, it is becoming clear that rib nonunions are not rare, likely more than 5% of rib fractures. No subspecialty is better equipped to address such painful conditions than orthopaedic surgery. Likewise, there are a plethora of other posttraumatic problems that patients face, from intercostal neuralgia, pleural herniation, rib synostosis, and costal margin and sternal injuries that do not heal properly, which require treatment solutions. This emerging new field of surgery is optimized by an interdisciplinary approach, between general and orthopaedic trauma surgeons, and between thoracic, anesthesia, and rehabilitation specialists. This article emphasizes the workup and operative treatment of painful rib and sternal nonunions, in particular, and familiarizes the orthopaedist with other cold skeletal trauma in general. From the distinctive history and physical examination of the patient with a rib psuedoarthrosis to proper diagnostic studies, the surgeon is led through a principled approach to nonunion surgery, inclusive of autogenous graft harvest to provide both biologic and mechanical variables to bear in the successful treatment of this condition.
Comparison of Single-Stage and Dual-Stage Approaches for Nonunion Repair in the Absence of Evident Infections
Authors: Gupta Rajul , Burkhart Andrew , Barnes Tyler , Beltran Michael , Laughlin Richard , Sagi Henry Claude
Published: November 2024

OBJECTIVES:

The aim of the study was to determine if routine dual-stage nonunion repair (DSR) surgery leads to better outcomes than single-stage nonunion (SSR) repair surgery in fracture nonunions without evident clinical or laboratory signs of infection.

METHODS:

Design:

Retrospective comparison study.

Setting:

Level 1 Trauma Center affiliated with an academic teaching hospital.

Patient Selection Criteria:

Skeletally mature patients diagnosed with fracture nonunion between June 2013 and January 2022 were included. Patients with previous nonoperative treatment, definitive external fixation, previous or current diagnosis of fracture-related infection, or <12 months of follow-up were excluded.

Outcome Measures and Comparison:

Patient characteristics and details of the primary and the revision surgery were recorded. Comparison of the primary outcome measures, fracture-related infection, recalcitrant nonunion, and implant failures was performed between SSR and DSR groups.

RESULTS:

A total of 113 patients met the eligibility criteria. Eighty-six patients (mean age 44.8 years, range 17–80 years, 64% men) underwent SSR, while 27 patients (mean age 50.8 years, range 21–77 years, 52% men) underwent DSR. Seventy-six percent underwent SSR and 24% underwent DSR. Baseline characteristics were similar between groups (open fractures, P = 0.918; smoking, P = 0.86; lower limb fractures, P = 0.238; diabetes, P = 0.503; erythocyte sedimentation rate, P = 0.27; C-reactive protein, P = 0.11; age, P = 0.11; Charlson comorbidity index, P = 0.06) except for a higher rate of DSR in cases initially treated elsewhere (P = 0.015) and in obese patients (P = 0.044). Bone grafting was more frequent in DSR using plates (P = 0.030). No significant differences were observed in subsequent infections (6.97% vs. 7.41%, P = 0.939), persistent nonunion (28.2% vs. 14.81%, P = 0.169), or implant failure (19.76% vs. 22.22%, P = 0.782) between SSR and DSR.

CONCLUSIONS:

No difference was found in infection, recalcitrant nonunion, and implant failure between SSR and DSR for nonunions without overt signs of infection. The study challenges the routine use of DSR, questions the necessity of subjecting patients to 2 surgical procedures, and advocates for a more judicious approach in the absence of overt fracture-related infection in a fracture nonunion.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Impact of Low-density Lipoprotein Levels on Rates of Pseudarthrosis After Anterior Cervical Discectomy and Fusion
Authors: Hirpara Ankit , Ackert-Bicknell Cheryl L. , Patel Vikas V.
Published: November 2024

Study Design.

Retrospective cohort study.

Objective.

To understand how preoperative LDL levels, statin intake, and fish oil intake affect rates of pseudarthrosis after single-level and multilevel ACDF.

Summary of Background Data.

Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical degenerative diseases or injuries causing neck pain, myelopathy, and radiculopathy. Pseudarthrosis following ACDF can lead to persistent symptoms and may require revision surgery. No studies have explored the link between low-density lipoprotein (LDL) levels and statin or fish oil intake on pseudarthrosis in ACDF.

Materials and Methods.

Patients undergoing ACDF were identified using TriNetX, a health care database with over 100 million patients. Pseudarthrosis rates following single-level and multilevel ACDF were compared between patients with high versus low LDL within one year before surgery. Pseudarthrosis rates were also compared between patients taking or not taking a statin as well as patients taking or not taking fish oil within six months before surgery. For all analyses, patients underwent propensity score matching in a 1:1 ratio based on relevant demographic factors and comorbidities.

Results.

Patients with an LDL above 142 mg/dL, compared with below 66 mg/dL, had significantly higher rates of pseudarthrosis at six months, one year, and two years after single-level and multilevel ACDF. Patients not taking a statin or fish oil, compared with those taking a statin or fish oil, respectively, also had significantly higher rates of pseudarthrosis at all time points after multilevel ACDF, but not single-level ACDF.

Conclusion.

Low LDL levels are associated with reduced rates of pseudarthrosis after single-level and multilevel ACDF. Statin and fish oil intake before surgery are also associated with reduced rates of pseudarthrosis after multilevel, but not single-level ACDF. These associations may be used for preoperative planning, patient optimization, and risk stratification.
Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery
Authors: Ghali Abdullah , Lawand Jad , Singh Aaron , Mihas Alexander , Jami Meghana , Farhat Anthony , Deveza Lorenzo
Published: November 2024

Study Design:

Retrospective cohort study of national database.

Objective:

This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery.

Summary of Background Data:

Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery.

Methods:

Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months.

Results:

In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24 mo) were also significantly higher in the ADP group.

Conclusions:

Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications.

Level of Evidence:

III
Small-Vessel Vasculitis or Perifolliculitis in Small-Fiber Neuropathy With TS-HDS, FGFR-3, or Plexin D1 Antibodies
Authors: Zeidman Lawrence A. , Levine Todd , Cangelosi John
Published: November 2024

Introduction:

Small-fiber neuropathy (SFN) is highly prevalent but often idiopathic. TS-HDS, FGFR-3, and Plexin D1 autoantibodies (seropositive) may be present in more than 40% of idiopathic cases. Another autoimmune biomarker is a non–length-dependent (NLD) skin biopsy pattern. Our goal was to demonstrate that small-vessel vasculitis and perifolliculitis (inflammation) on skin biopsies are additional biomarkers.

Methods:

All pure SFN skin biopsy reports were reviewed for inflammation, and their charts were examined for other relevant history.

Results:

Seven of 80 patients with pure SFN had inflammation (8.8%); 5 patients were female (71%) and 2 were male (29%); average age was 45 (16–67). All 7 patients with inflammation were seropositive (100%, P = 0.0495), and 6 patients (86%) had either NLD inflammation or NLD pathology (P = 0.0003).

Discussion:

Inflammation is present only in a small portion of punch biopsies, but may be another autoimmune SFN biomarker. It is strongly associated with seropositivity and NLD-pathology. Further studies are likely indicated to assess inflammation pathophysiology and immunotherapy responsiveness.
A cross-sectional geospatial analysis of access to cesarean delivery in Uganda by facility functionality
Authors: Garba Deen L. , Buda Alexandra M. , Okolo Isioma , Tindiweegi Praise , Babweteera Alan , Tibaijuka Leevan , Ngonzi Joseph , Kayondo Musa , Byamukama Onesmus , Adu-Bonsaffoh Kwame , Juran Sabrina , Lugobe Henry M. , Boatin Adeline A.
Published: November 2024

Introduction:

There is minimal data on spatial access to surgical maternal care in Uganda. We aimed to determine geospatial access to facilities performing cesarean delivery in Uganda at differing facility functional levels.

Methods:

We defined three levels of facility functionality: level 1 – functional by designation, i.e., health system level; level 2 – performed at least one cesarean delivery in the past year; and level 3 – performed at least 20 cesarean deliveries in the past year. We mapped facilities in ArcGIS Pro using GPS coordinates, calculated Manhattan distances, and using transportation network data, identified the area indicating 30-minute, 1-hour, and 2-hour geographic walking and driving access to facilities. The population estimate raster was overlain with drive time analysis areas to calculate the total population catchment within each travel time.

Results:

Of 6937 total facilities, 339 (4.9%) met level 1 functionality, 287 (4.1%) met level 2 functionality, and 241 (3.5%) met level 3 functionality. The percentages of women within 30-minute, 1-hour, and 2-hour walking times from level 1 facilities were 9.7%, 19.8%, and 34.8%, respectively. These percentages decreased to 9.2%, 19%, and 33% for level 2 functionality and 8.1%, 17.4%, and 30.5% for level 3 functionality, respectively. Access varied regionally, with the poorest access in the Northern region (20% within 2 hours walking) compared to the Central region (55.2% within 2 hours walking).

Conclusion:

We demonstrate a substantial proportion of the Ugandan population does not have timely access to cesarean delivery, with substantial subnational variation. This inequity in access to surgical obstetric care is vital information that can assist policymakers in achieving universal maternal health access.
Radiographic Enhancement of Lymph Nodes 9 Months after Omental Lymph Node Transfer
Authors: Shrout Max A. , Plonkowski Alexander T. , Morris Bryn E. , Flug Jonathan A. , Rebecca Alanna M.
Published: November 2024

Lymphedema is a frequent complication of breast cancer treatment. As the survival rates of breast cancer continue to increase, the number of women with lymphedema will also increase. Surgical treatment of lymphedema has made significant advances during the past 20 years, and our understanding of these procedures continues to evolve. Vascularized lymph node transfer is an increasingly popular option for surgical treatment of lymphedema; however, the mechanism behind symptomatic relief is not fully understood. A proposed theory for improvement in lymphedema symptoms is lymphangiogenesis and spontaneous regeneration of lymphatic vessels, the timing and degree of which are not well defined. We present the case of a 40-year-old woman with a 10-year history of right upper extremity lymphedema secondary to bilateral mastectomy and right axillary lymph node dissection, who subsequently underwent vascularized omental lymph node transfer and lymphovenous bypass with radiographic evidence of spontaneous lymphatic reconnection within 9 months. To our knowledge, this is the earliest reported radiographic evidence of lymphatic regeneration in a human subject to date, adding to the growing body of evidence to support the therapeutic benefits of vascularized lymph node transfers.
Placental Abruption: Pathophysiology, Diagnosis, and Management
Authors: Schneider Emily , Kinzler Wendy L.
Published: November 2024

Placental abruption is a complete or partial separation of the placenta from the uterine decidua. Clinical manifestations include vaginal bleeding, abdominal pain, uterine contractions, and abnormalities in the fetal heart rate tracing. Placental abruption occurs in 0.4% to 1.0% of all pregnancies. However, the pathophysiology remains incompletely understood. We present a review of the pathophysiology, diagnosis, and management of placental abruption, exploring overlapping processes which contribute to premature placental separation. Classic findings and limitations of ultrasound in evaluating placental abruption are explained. Finally, we discuss the management of placental abruption based on gestational age, fetal status, and maternal hemodynamic stability.
Streamlining outpatient prepectoral breast reconstruction: The role of polyurethane oxygen-enriched bra cups from pandemic innovation to standardized cost analysis
Authors: Sordi Silvia , Kaciulyte Juste , Marzouk El Araby Mohamed , Luridiana Gianluigi , Marchesi Andrea , Gatto Arianna , Seth Ishith , Rozen Warren Matthew , Casella Donato , Cuomo Roberto
Published: November 2024

Background:

The COVID-19 pandemic necessitated a reassessment of healthcare delivery, emphasizing on strategies to reduce hospital visits without compromising patient care. In response, plastic surgery units explored innovative approaches to ensure high-quality care and enhanced protection for vulnerable groups, such as oncologic patients undergoing mastectomy and breast reconstruction. This study evaluates the implementation of a polyurethane-polyester bra cup enriched with oxygen to diminish the need for postoperative outpatient visits.

Methods:

Patients who underwent mastectomy and prepectoral breast reconstruction between February 2020 and March 2021 were selected. A novel postoperative management protocol with a polyurethane-polyester bra cup was adopted, and a cost-benefit analysis evaluated the economic impact of integrating this medical device into postoperative care.

Results:

The polyurethane-polyester bra cup wound dressing significantly reduced the frequency of outpatient visits, enhancing patient autonomy in postoperative care. Patients reported high satisfaction levels, particularly appreciating the ability to manage the device independently, which contributed to the substantial reduction of hospital accesses. Economic analysis revealed that the devices’ utilized resulted in a notable reduction of 333.5 working hours, translating to a financial saving, ranging between €9990 and €40,020 for nursing and medical staff, respectively. The device cost was established at €20 per unit, demonstrating an effective cost-saving strategy in postoperative care.

Conclusions:

The adoption of polyurethane-polyester bra cup in postsurgical care for mastectomy patients undergoing implant-based prepectoral breast reconstruction proved to be a strategic measure in reducing hospital visits and maintaining high levels of patient satisfaction.
Intermittent Bleeding from the Iridocorneal Angle and Subsequent Ghost Cell Glaucoma Following Gonioscopy-Assisted Transluminal Trabeculotomy: A Case Report
Authors: Sozen-Delil Fatma Isil , Donmez Gun Raziye , Akçay Güzide , Kanar Hatice Selen , Şimşek Şaban
Published: November 2024

Purpose:

This study aims to present a case involving intermittent bleeding from the iridocorneal angle following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery, followed by the development of ghost cell glaucoma (GCG).

Methods:

A 25-year-old man with a history of post-traumatic angle recession glaucoma underwent uneventful 360° GATT surgery.

Results:

Two weeks after the surgery, while the reason for the incomplete resolution of hyphema remained unclear, intermittent bleeding from the iridocorneal angle and hemorrhage in the inferior vitreous were observed during the patient’s follow-up examination. Although bleeding was controlled with intravenous tranexamic acid therapy, the patient required pars plana vitrectomy due to the development of GCG. Despite medical treatment, the patient’s intraocular pressure (IOP) remained elevated during follow-ups, leading to the decision to perform Ahmed Glaucoma Valve implantation surgery as a final intervention. At the latest evaluation, the patient’s IOP was under control without medication.

Conclusion:

Following GATT surgery, the possibility of intermittent bleeding from the iridocorneal angle should be considered if the hyphema persists beyond the expected duration. Hospitalization and closer patient monitoring may be necessary to detect intermittent bleeding.
Erythema Multiforme
Authors: Bennett Copp Lauren
Published: November 2024

Erythema multiforme is an acute, immune-mediated, mucocutaneous disorder that is frequently associated with herpes simplex virus. This condition is subdivided into two classifications: erythema multiforme minor and erythema multiforme major. It is important to recognize that erythema multiforme major is its own entity and should not be confused for Stevens–Johnson syndrome. This review will discuss the epidemiology, pathophysiology, diagnosis, and management of erythema multiforme so that dermatology nurses and providers are better able to identify and manage this disease.
Pachydermodactyly Associated With Repetitive Body-Focused Behaviors in an Adolescent Male
Authors: Patrick Bailey , Casterline Benjamin Warren , Braudis Kara , Martin Kari
Published: November 2024

An 18-year-old male presented to outpatient orthopedics with asymptomatic, slowly progressive swelling of his fingers over the course of 2 weeks. Radiographs were unremarkable, which prompted a referral to dermatology. Examination revealed firm fusiform swelling of the proximal phalanges, sparing the thumb and interphalangeal joints. The overlying skin appeared normal. A skin biopsy was performed by the punch technique. Dermatopathology revealed excessive dermal mucin without fibrosis or inflammation to establish the diagnosis of pachydermodactyly, a disorder most common in adolescent males and associated with repetitive rubbing of the fingers or cracking of the knuckles. The patient's mother reported that he had a habit of cracking the finger joints. The patient was advised to discontinue this behavior; however, no improvement was reported on follow-up.
Development and Impact of a Cognitive Reserve Enhancement Program for Climacteric Korean Women
Authors: KIM Ji Hyun , PARK Seungmi
Published: November 2024

Background

In light of the rising incidence of mild cognitive impairment in women, an appropriate cognitive reserve enhancement program is urgently needed for women experiencing climacteric symptoms.

Purpose

The purpose of this study was to develop a cognitive reserve enhancement program for climacteric women based on cognitive reserve theory (CRT) and to verify its effectiveness.

Methods

A nonequivalence control group, pre- and post-quasi-experimental design was used. The 58 climacteric women with subjective memory deterioration enrolled as participants were divided into the experimental group (28 women), which received a 24-session CRT-based cognitive reserve enhance program, and the control group (30 women), the members of which received the cognitive training via a mobile application after completion of the study. Valid data from 24 experimental and 26 control participants were available for analysis. Objective cognitive functions, including overall cognitive, memory, attention, and language, were measured pretest and posttest using the following tools: Everyday Cognition Scale (subjective cognitive function), Center for Epidemiologic Studies Depression Scale (depression), and World Health Organization Quality of Life-Brief Version (quality of life).

Results

The experimental group showed a statistically significant increase in overall cognitive function (t = 3.82, p = .001), memory (t = 2.63, p = .012), attention: number of correct answers (t = 2.12, p = .040), language high-frequency response speed (Z = −2.49, p = .013), and language low-frequency response speed (Z = −2.77, p = .006) in objective cognitive function after 8 weeks in comparison to the control group.

Conclusions/Implications for Practice

The intervention program tested in this study to enhance cognitive reserve in climacteric women includes cognitive training, emotional and social support, and group physical activity components was found to be effective in enhancing cognitive function.
Endocervical Brush Cytology After Cervical Conization as a Predictor of Treatment Failure: A Prospective Cohort Study
Authors: Carreras-Dieguez Núria , Torras Ines , Martí Cristina , Matas Isabel , Glickman Ariel , Fusté Pere , Mula Cristina , Alos Silvia , Hoya Sandra , Rakislova Natalia , Saco Adela , Marimon Lorena , Ordi Jaume , Torné Aureli , del Pino Marta
Published: November 2024

Objective

Endocervical curettage (ECC) is the gold standard for predicting the persistence of high-grade squamous intraepithelial lesions (HSIL) after cervical conization. However, ECC has a high rate of unsatisfactory samples and may be uncomfortable for women. Endocervical sampling with brush (ECB) has been proposed as an alternative to ECC, which, in addition to the cytological evaluation, allows performing HPV testing using the same sample. We compared ECC and ECB performed immediately after conization to identify women with persistent HSIL.

Materials and Methods

This is a prospective single-center study, including 518 patients who underwent conization over a 10-year period (2012–2021). Immediately after treatment conization, we performed ECB sampling followed by ECC to all patients. We evaluated the accuracy of the 2 techniques for diagnosing persistent HSIL during follow-up.

Results

Persistent HSIL was identified in 8.9% of women. Eighteen percent of the ECC samples and only 7% of ECB cytology were unsatisfactory (p < .001). The accuracy of detecting persistent HSIL was similar for ECB and ECC (89.0%, 95% CI = 85.9–91.5 vs 90.8%, 95% CI = 87.7–93.2; p = .797). Adding HPV testing to ECB cytological evaluation increased the accuracy to 91.5% (95% CI = 88.8–93.6).

Conclusions

ECB can be reliably used to identify women with persistent HSIL after conization, as its accuracy is similar to ECC, with a lower rate of unsatisfactory results. The technique allows adding HPV testing to cytological evaluation, improving the accuracy of the test.
A Nomogram for Predicting the Transition From Recurrent Acute Pancreatitis to Chronic Pancreatitis
Authors: Wei Wanzhen , Ma Yifei , Zeng Jiahui , Song Yiqun , Han Yimin , Qian Weikun , Yang Xue , Wu Zheng , Ma Zhenhua , Wang Zheng , Duan Wanxing
Published: November 2024

Objectives

Acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis are recognized as a continuum of pancreatic diseases. Recurrence increases the risk of progression to chronic pancreatitis. The aim of this study was to search for clinical features that may promote the progression of chronic pancreatitis in patients with recurrent acute pancreatitis

Materials and Methods

We retrospectively reviewed patients with recurrent acute pancreatitis from Medical Information Mart for Intensive Care-IV database. They were divided into a training cohort and a validation cohort. A nomogram was constructed based on clinical features during the second hospitalization. The discrimination and calibration of the nomogram were evaluated using the concordance index, area under the time-dependent receiver operating characteristic curve, and calibration plots.

Results

A total of 432 recurrent acute pancreatitis patients were evaluated, of which 93 (21.53%) were diagnosed with chronic pancreatitis later. Age, biliary pancreatitis, admission interval, alcohol dependence, lipase, and platelet were selected. The concordance index was 0.717 (95% confidence interval: 0.691–0.743) for the training cohort and 0.718 (95% confidence interval: 0.662–0.774) for the validation cohort. The area under the time-dependent receiver operating characteristic curve was >0.7 over 1000 days.

Conclusions

A nomogram was developed and validated to evaluate the transition from recurrent acute pancreatitis to chronic pancreatitis.
GATA6 amplification is associated with improved survival in TP53-mutated unresectable pancreatic cancer
Authors: Zhou Edward , Yang Jung-In , Habowski Amber N , Deschênes Astrid , Belleau Pascal , Ha Taehoon , Tzanavaris Chris J. , Boyd Jeff , Hollweg Christopher A. , Zhu Xinhua , Tuveson David A. , King Daniel A.
Published: November 2024

Objectives:

GATA6 expression has been recently recognized as a favorable prognostic marker of pancreatic cancer whereas TP53 is recognized as a poor prognostic marker. We evaluated treatment outcomes by genetic alterations in TP53 and GATA6 to determine the prognostic and predictive impact of co-alterations.

Methods

A single institution retrospective analysis was performed on patients diagnosed with PDAC between 2014 to 2023. TP53 genotype and GATA6 amplification status were included in an analysis of overall survival (OS) and progression free survival (PFS). Previously published patient-derived organoids were used to investigate correlation between genetic status and drug sensitivity.

Results

Patients with TP53 mutations had worse OS compared to the wild type TP53 population. In general, patients with GATA6 amplification had better OS and a trend towards better PFS than the non-amplified population. Among patients with a TP53 mutation, patients with GATA6 co-alteration had longer OS compared to those who were not GATA6 amplified. In contrast, among patients who were TP53 wild type, the presence or absence of a GATA6 amplification did not impact OS or PFS. GATA6 genotype was not associated chemotherapy drug response in an organoid pharmacotyping model.

Conclusions

We found that GATA6 amplification appeared to attenuate poor prognosis observed in TP53-mutant patients regardless of the type of standard chemotherapy received, suggesting the GATA6 amplification is a prognostic biomarker but not a predictive biomarker of standard-of-care chemotherapy.
Low Expression of Mitochondrial Ribosomal Protein S5 is Associated With Poor Prognosis in Patients With Clear Cell Renal Cell Carcinoma
Authors: Yang Xiaoxiao , Han Bo , Xie Qian , Li Yi , Li Qixuan , Hu Xuelian , Zhao Hongwen , Xu Xiaosong
Published: November 2024

Mitochondrial ribosomal protein S5 (MRPS5) is abnormally expressed in various tumor tissues and may be a key molecule for the regulation of tumors. Our aim is to investigate the relationship between the expression of MRPS5 in clear cell renal cell carcinoma (ccRCC) and the prognosis of patients. MRPS5 expression in fresh tumoral tissues and peritumoral tissues of patients with ccRCC was examined by quantitative reverse transcription polymerase chain reaction, western blotting, and immunohistochemical staining, respectively. MRPS5 expression level in paraffin-embedded tumoral tissue samples with ccRCC was evaluated by immunohistochemical scoring criteria. The relationship between the expression of MRPS5 and the clinicopathological parameters and prognosis of patients with ccRCC was analyzed statistically. The expression of MRPS5 mRNA and protein in fresh tumoral tissues was lower than that in peritumoral tissues. Among 160 paraffin-embedded tumoral tissue samples, 99 cases (61.9%) showed high expression and 61 cases (38.1%) showed low expression of MRPS5. The expression level of MRPS5 was significantly correlated with T classification, TNM stage, and Fuhrman grade. Kaplan-Meier method and log-rank test indicated that patients with low MRPS5 expression had significantly poorer overall survival and recurrence-free survival than high MRPS5 expression. Multivariate analysis revealed that MRPS5 expression was an independent predictor of overall survival and recurrence-free survival, respectively. MRPS5 low expression was a risk factor for the prognosis of patients. The expression level of MRPS5 is significantly correlated with the postoperative survival status, which has the potential to be used as a novel prognostic biomarker for patients with ccRCC.
Clinical effectiveness of a standardized community-based supervised post-acute rehabilitation model after total knee arthropathy: A pilot study
Authors: Tay Matthew Rong Jie , Neoh Eng Chuan , Wong Jiayen , Tan Xee Vern , Lim Chien Joo , Tan Kelvin Guoping
Published: November 2024

Background:

Hospital-based outpatient physiotherapy is the standard of care for subacute rehabilitation after total knee arthroplasty (TKA) in Singapore. This study explores the clinical effectiveness of a standardized rehabilitation model at community-based rehabilitation centers to align the appropriate utilization of tertiary and community rehabilitative resources.

Methods:

In this pilot study, patients who had undergone TKA were assigned to either control group (n=30) or to intervention group (n=29). The control group received usual hospital-based outpatient physiotherapy, while the intervention group received rehabilitation at a community-based rehabilitation center based on standardized institution protocol. Primary and secondary outcomes were assessed at baseline and at 3 months post TKA.

Results:

Baseline characteristics in both groups were not significantly different. All patients completed the study. At 3 months, there were no significant differences in the Time Up and Go test (P<0.853), median 30 s chair rise (P=0.347), knee flexion passive range of motion (P=0.933), knee extension passive range of motion (P=0.409), and presence of knee extension lag (P=0.360). There was a lower pain intensity in the intervention group compared with the control group (P=0.003).

Conclusions:

A community-based post-acute TKA rehabilitative model demonstrated improvements in functional outcomes, and reduced pain intensity in study participants, with these findings being similar to that of standard of care hospital-based outpatient physiotherapy. This model of care warrants further evaluation in larger clinical trials.