bluuebunny/crossref_metadata_2025 huggingface dataset:
IBC Oxford University Oral Abstract 13 - Video abstract: fistula treatment after bariatric surgery with partially covered metallic stent -laparoscopic removal
Authors: Falcão M , Neto M Galvao , de Jesus R Nascimento , Bastos F , Ramos J Renata Faria , Quadros L Gustavo , Grecco E , Felicio J Henrique , Marques L
Published: February 2025

Case Presentation 

The patient underwent Roux in Y Gastric Bypass by laparoscopy without complications, developing on postoperative day 7 with an abscess in the epigastrium at the site of the 5 mm portal, associated with local pain, fever and chills. Within 24 hours, there was spontaneous drainage of large amounts of purulent secretion, with pain improvement. The patient was advised to be hospitalized again and started on broad-spectrum antibiotic therapy.

Abdominal CT and Upper GI endoscopy were performed, which revealed leakage from the gastro-enteric anastomosis with spontaneous cutaneous drainage without compromising the cavity. The patient remained with a WallFlexTM Oesophageal 23 mm stent for 34 days, with complete remission of the infectious condition. Endoscopic removal attempts of the stent were unsuccessful due to adherence by pseudo-polyptic adhesions that fixed the uncovered area of the stent extremities, preventing endoscopic detachment and consequent removal.

We chose to perform laparoscopic access through the alimentary loop immediately below the gastro-enteric anastomosis was performed with an enterotomy with identification of the stent at its distal end, The stent was released and exteriorised to the proximal portion with laparoscopic section of the pseudo-polyps at the proximal end that fixed the Stent. We were able to free the proximal end by removing the stent without additional injuries via the enterotomy. Enterorrhaphy and cavity drainage were performed.

The patient was discharged on postoperative day 3 progressing clinically well and under endoscopic control after 9 months with maintained surgical anatomy and satisfactory surgery results.
IBC Oxford University Oral Abstract 14 - Video abstract: a rare case of lower gastric pouch necrosis post Roux-en-Y gastric bypass with leak and severe sepsis
Authors: Bhambri A , Mehra N
Published: February 2025

Case Presentation 

A 40-year-old gentleman with a weight of 120 kgs (BMI 45 kg/m2) underwent a laparoscopic Roux-en-Y gastric bypass at another centre. He was discharged on postoperative day 2 but had complaints of respiratory distress and an elevated heart rate but no contrast enhanced CT abdomen was done. The patient was discharged but his clinical status deteriorated on postoperative Day 3.

A contrast enhanced CT (CECT) abdomen showed gross pneumo-peritoneum and a leak from the gastro-jejunal anastomosis on postoperative Day 4. The patient presented to our unit on postoperative day 4 with gasping, tachycardia (155/min), tachypnoea (48/min), the arterial blood gas (ABG) showed severe metabolic acidosis with pH of 7.0. The patient was anuric and was severely dehydrated as no IV fluids or antibiotics were given at the previous tertiary hospital) The patient was resuscitated for 5 hours and taken for surgery after consent including the risk of death.

The operative findings were a septic peritoneal cavity with a gush of air on entering the abdomen The lower and medial parts of the gastric pouch were completely necrotic and sloughed off. A gastro-jejunal anastomosis leak was confirmed by an intra-operative air insufflation test. The gastric tissue was very friable. The anastomotic sutures were loose and so four interrupted sutures were taken, and the leak site was repaired. A post-gastro-jejunal anastomosis repair air insufflation test showed no leak. A feeding gastrostomy was placed and secured to the gastric remnant for post-operative feeding Thorough peritoneal toilet was performed and multiple abdominal drains were placed.

The patient had a stormy recovery post-operatively with associated metabolic acidosis and tachycardia and was intubated for 48 hours. After extubation, she was pyrexial and made slow progress. She was discharged on postoperative day 14 with her feeding gastrostomy removed after 4 weeks once patient was tolerating adequate oral intake
IBC Oxford University Oral Abstract 20 - Video abstract: dysphagia and malnutrition post LINX procedure for GERD
Authors: Damrah O , Amaireh W K
Published: February 2025

Introduction

The LINX (Magnetic sphincter augmentation) is an option for gastrooesophageal reflux disease (GERD) which has serious complications including severe dysphagia and malnutrition.

Methods

A 27-year-old male patient with long standing GERD failing to respond to PPI medication and lifestyle changes, He underwent a laparoscopic hiatal hernia repair with Toupet fundoplication but failed to respond with ongoing reflux.

An Upper GI endoscopy revealed recurrence of a hiatal hernia with Grade B reflux esophagitis. He then underwent redo-hiatal hernia repair with LINX placement which was complicated by severe dysphagia with weight loss (BMI 20 kg/m2). Following this removal of the LINX device and conversion to Roux-en-Y gastric bypass was done.

Result

The patient recovered with improvement of his reflux and dysphagia symptoms and re-gained weight (BMI 25.3 kg/m2).

Conclusion

Removal of the LINX device and Roux-en-Y gastric bypass is a viable and the preferred option for severe dysphagia and malnutrition post LINX placement.
IBC Oxford University Oral Abstract 22 - Esophagogastric cancer surgery characteristics and outcomes in bariatric patients, compared with non-bariatric patients
Authors: Lessing Y , Abu-Abeid A , Falk E , Lahat G , Nizri E , Dayan D
Published: February 2025

Background

The association between bariatric surgery and esophagogastric cancer (EGC) is debated. This study aimed to assess EGC characteristics and surgery outcomes comparing bariatric and non-bariatric patients.

Methods

Single-centre retrospective analysis of prospective EGC surgery database.

Results

EGC-surgery was performed in 269 patients, classified as bariatric (n = 10, 3.3%), and non-bariatric (n = 259, 96.6%) groups. Non-bariatric group was sub-classified into body mass index (BMI) <35 kg/m2 (n = 244) and >35 kg/m2 (n = 15). BMI was 35.3 ± 5.6 versus 25.7 ± 16.1 and 37.8 ± 8.7 kg/m2 in bariatric versus non-bariatric-BMI <35 and >35, respectively (P < 0.001). Bariatric patients were significantly younger (56.75 ± 11 versus 71 ± 10 and 68.38 ± 8.2 years; P < 0.001). They tended to have lower rates of diabetes mellitus (30% versus 43.9% and 73.3%; P = 0.05) and significantly lower hypertension rates (50%, versus 86.5% and 93.3%, P < 0.004). Bariatric procedures were performed 11.3 years (IQR 5.5–16.5) prior to EGC-surgery. Tumour characteristics were statistically comparable except a significantly higher number of positive LN in the bariatric group (6.9 ± 13.6 versus 2.7 ± 4.9 and 1.9 ± 4.8;P = 0.006), and more bariatric patients received adjuvant treatment (P = 0.035). Postoperative major complication rates (0% versus 25.8%, and 33.3%; P = 0.14) and length of hospital stay (14.1 ± 15.3, versus 23 ± 28.5, and 21 ± 18 days; P = 0.59) were comparable. There was no significant difference in Disease- free survival (P = 0.42) or overall survival (P = 0.48) between patient-groups.

Conclusions

Bariatric patients were diagnosed with EGC at a younger age and tended to have worse nodal involvement. Although outcomes were comparable, clinical and endoscopic surveillance seem important as EGC can occur 10 years or earlier than in non-bariatric patients.
IBC Oxford University Oral Abstract 25 - Laparoscopic delivery of a novel enterotomy capture device between self-forming magnetic anastomosis in Roux-en-Y gastric bypass (RYGB) patients for the creation of a side-side jejunal-jejunal anastomosis
Authors: Contreras J E , Marín P , Guerra A , Mellafe M E , Darvich Í
Published: February 2025

Background

In previously bi-partition studies, a magnetic anastomosis has demonstrated the ability to reduce anastomosis complications such as leaks and bleeding, however previous delivery methods required the creation an enterotomy with delayed anastomosis creation. We report the procedure feasibility and 30-day results of a first ever use in humans of a novel surgical technique that eliminates the need to close the enterotomies via conventional methods after creating the anastomosis and facilitates an immediate lumen opening between two new coupled self-forming magnets (SFM) in RYGB patients.

Methods

Prospective non-randomized single centre trial. Surgery consisted in creating an immediate communication in a side-to-side jejunal-jejunal anastomosis intraluminally through a novel temporary enterotomy control and capture (ECC) device. All devices were deployed and delivered laparoscopically.

Results

A total of 5 patients were recruited, with a mean age of 35.8 (27–43) years, sex-ratio (60% F) and initial BMI of 44.8 ± 7.6 kg/m2. All procedures were performed laparoscopically. There was no conversion or peri-operative mortality. All ECCs and SFMs were delivered and connected with no delivery malfunctions, completed in an anastomosis creation time of 10 minutes (enterotomy to magnet coupling). All ECC and SFMs passed with no retentions. A total of 1 procedure adverse events (AE) occurred due to poor tolerance to oral intake from gastro-jejunal anastomosis inflammation. 0 AE occurred during the 30-day follow up period.

Conclusions

Preliminary and procedure feasibility data of these new surgical techniques and devices suggest the procedures are both feasible and safe in RYGB surgery. Further and longer studies are warranted.
IBC Oxford University Oral Abstract 28 - Assessment of rivaroxaban as VTE prophylaxis after gastric bypass surgery
Authors: Mohamed E
Published: February 2025

Background

Bariatric surgery is increasingly utilized to manage and prevent health issues related to obesity and the associated high incidence of venous thromboembolism (VTE). This work aimed to evaluate the effectiveness of a prophylactic dose of rivaroxaban against the development of VTE after bariatric surgery.

Methods

This prospective cohort study was carried out on 40 morbid obese patients aged 18–60 years old, both sexes, with body mass index (BMI) ≥40 or >35 kg/m2 with obesity-related co-morbidities who underwent gastric bypass surgery. Patients received rivaroxaban 10 mg once a day orally 24 h post-operation for 1 month.

Results

After 30 days, thrombosis did not occur in any patient. Intra luminal bleeding occurred in 3(7.5%) of the patients who were presented with melena, tachycardia, and hypotension and readmitted and all managed conservatively. The mean red blood cells transfused was 2.7 units, plasma transfused was 3.3 units, and the mean hospital stay was 2.3 days.

Conclusions

Prophylactic oral rivaroxaban 10 mg once daily 24 h after gastric bypass surgery for 1 month is effective against VTE development.
IBC Oxford University Oral Abstract 34 - Ursodeoxycholic acid prophylaxis and the reduction of gallstone formation after bariatric surgery: an updated meta-analysis of randomized controlled trials
Authors: Alhuniti M
Published: February 2025

Introduction

Gallstone formation following bariatric surgery poses a significant clinical concern, prompting various preventive strategies, including ursodeoxycholic acid (UDCA) prophylaxis. This systematic review and meta-analysis aimed to assess the efficacy of UDCA in preventing gallstone formation after bariatric surgery.

Methods

A comprehensive literature search was conducted in major databases up to September 2023, identifying 12 randomized controlled trials (RCTs) meeting the inclusion criteria. The studies, spanning from 1993 to 2022, involved 2767 patients who underwent diverse bariatric procedures. The primary outcome was the overall incidence of cholelithiasis, with secondary outcomes encompassing gallstone occurrences at three, six, and 12 months; symptomatic cholelithiasis; and rates of cholecystectomy. The Cochrane risk-of-bias tool was utilized for evaluating study quality, and statistical analyses were conducted using the RevMan software (Cochrane Collaboration, London, UK).

Results

Patients receiving UDCA demonstrated a significantly lower overall incidence of gallstones post-bariatric surgery (risk ratio [RR] 0.13; P < 0.0001). Subgroup analyses confirmed reduced gallstone incidence at three months (P = 0.04), six months (P < 0.00001), and one year (P < 0.00001) with UDCA prophylaxis. Symptomatic cholelithiasis incidence was also lower in the UDCA group (RR 5.70; P < 0.00001), and cholecystectomy rates were significantly reduced (RR 3.05; P = 0.002).

Conclusions

This meta-analysis supports the efficacy of UDCA prophylaxis in preventing gallstone formation after bariatric surgery. The findings suggest that UDCA administration not only lowers overall gallstone incidence but also reduces the occurrence of symptomatic cholelithiasis and mitigates the need for cholecystectomy. However, caution is warranted due to heterogeneity, diverse surgical procedures, and limited long-term follow-up in the included studies. Further research with standardized protocols and extended observational periods is recommended to strengthen the evidence base and guide clinical practice.
IBC Oxford University Poster Abstract 18 - Roux-en-Y gastric bypass distalisation for insufficient weight loss or weight regain: a systematic review and meta-analysis
Authors: Dias A Silva , Amorim-Cruz F , Fernandes Lope D , Bouça-Machado R , Resende F , Preto J , Carneiro S , da-Costa E Lima , Sousa-Pinto B , Santos-Sousa H
Published: February 2025

Background

Weight Regain or Insufficient Weight Loss after primary Roux-en-Y Gastric Bypass (RYGB) poses a significant challenge for bariatric surgeons. Distalisation of RYGB serves as a revisional malabsorptive procedure, potentially offering a solution, albeit with associated complications. This review and meta-analysis aim to enhance the evidence base concerning the safety and efficacy of several distalisation variants.

Methods

Following PRISMA recommendations, we conducted a systematic review and meta-analysis across three databases (PubMed, Scopus, and Web of Science). Primary outcomes included short-term (1 year), mid-term (2–3 years), and long-term (5 years) weight loss progress. Secondary outcomes encompassed early postoperative complications, comorbidity resolution, hypoalbuminemia, Protein Energy Malnutrition (PEM), and the need for surgical revision. Subgroup analyses categorized patients based on Total Alimentary Limb Length (TALL) and Common Limb (CL) lengths, as well as by the type of Distalisation performed.

Results

Our analysis comprised 18 studies. Across all studies, %Excess Weight Loss (%EWL) was 59.4% (short-term), 58.6% (mid-term), and 67.5% (long-term). Subgroup analysis revealed that TALL <325 cm correlated with improved weight loss but increased PEM risk compared to TALL ≥325 cm. Similarly, CL <125 cm was associated with higher complication rates than CL ≥125 cm. Type I surgery yielded superior weight loss compared to Type III at short and mid-term. High heterogeneity was noted among results.

Conclusions

A TALL above 325–350 cm and a CL above 125–150 cm seem to offer a potentially safer approach, while maintaining favourable weight loss outcomes. Type I distalisation demonstrated the most promising weight loss pattern. Enhanced standardization in surgical practice and terminology is imperative for comprehensive evaluation of distalisation outcomes.
Early detection of melanoma: Evaluating the combined use of total body photography and sequential digital dermoscopic imaging in a national health service setting
Authors: Hodgkinson Tara , Vereker Ciara , Spencer Ashley
Published: February 2025

Early detection of thin, stage 1A melanoma is crucial in improving patient outcomes, but this can be clinically challenging in patients with multiple atypical naevi. We report an observational study evaluating the effectiveness of a UK based Clinical Nurse Specialist (CNS) led total body photography (TBP) and sequential digital dermoscopic imaging (SDDI) programme, for patients at high risk of developing melanoma. 1680 patients underwent 6890 TBP and SDDI sessions, with 345 excision biospsies of clinically suspcious melanocytic lesions performed (5% sessions). Twenty-one pT1a and pT1b melanomas (6.1% of biopsies), 20 melanoma-in-situ (5.8% biopsies) and 150 dysplastic naevi (43.5% biopsies) were identified. Mean Breslow Thickness (BT) was 0.52mm (range 0.2-1mm). 95.2% of melanomas had a BT of <0.8mm without ulceration (pT1a), and the number needed to biopsy (NNB) was 8.41. Our UK experience demonstrates that a nurse-led programme of TBP with SDDI can be a clinically effective strategy for detection of early melanoma and melanoma-in-situ.
Provisioning of vitellogenic follicles continues after green turtles arrive at the nesting beach
Authors: Bruno Renato Saragoça , Bolten Alan B , Bjorndal Karen A
Published: February 2025

Understanding the energetic demands of reproduction on female sea turtles is crucial for devising effective conservation strategies aimed at supporting the reproductive health and resilience of populations at nesting habitats. We studied the ovaries of 69 green turtles (Chelonia mydas) preyed upon by jaguars (Panthera onca) during three nesting seasons at Tortuguero, Costa Rica, the main green turtle Atlantic nesting beach. Our findings revealed a bimodal distribution of vitellogenic follicles, with ‘dominant’ follicles destined for ovulation and ‘non-dominant’ follicles to be resorbed. Female green turtles lay, on average, six clutches with ~110 eggs each per nesting season, and a size hierarchy was also found within dominant follicles. During the nesting season, the diameter of small dominant follicles increased by 66% prior to ovulation. Analysis of yolk composition showed that small dominant follicles had higher percent water content than large dominant follicles, which indicates dry matter deposition rather than hydration is responsible for the pre-ovulatory increase in diameter of green turtle dominant follicles during the nesting season. Furthermore, percentages of lipid, nitrogen (N) and phosphorus (P) in the yolk dry matter were constant across green turtle vitellogenic follicles, which underscores that the increase in follicle size results from provisioning with yolk containing similar proportions of these nutrients. Atretic follicles had higher water and lower P percentages than dominant follicles, indicating an accelerated resorption of phosphorus over lipids and N, which could be due to the importance of this nutrient for eggshell production. Finally, >49% of the energy required for egg production was still to be invested during the nesting season, and yolk from non-dominant follicles would not have provided sufficient energy for most females to complete yolk deposition. These insights into follicular dynamics and nutrient provisioning clarify the ongoing reproductive investments made by female green turtles at Tortuguero.
Provocation: Is there an assumed need for participatory design with children?
Authors: Sim Gavin
Published: February 2025

This paper reflects on participatory design practices within the child–computer interaction (CCI) community, which has a long tradition of advocating the inclusion of children in the design process. The benefits of involving children are widely cited in the CCI literature. However, through a critical analysis of children’s current technology usage, research and industry practice, this paper offers three provocations relating to participatory design and children. The first focuses on what constitutes participatory design, suggesting that the use of children in a single design activity to generate ideas is very distant from traditional participatory design (PD) and thus should not be referred to as PD. the second is that there needs to be a shift toward researching and developing methods to enable children to participate in design activities that align with industry timelines. The final provocation suggests that unless there are some tangible benefits of including children in PD of technology or impact can be demonstrated from the work, then an ethical debate is needed about their role and inclusion. These three provocations are designed to question and stimulate the debate around the benefits and values of including children in the design process. Without a critical reflection on current practices and processes, current trends may continue and design practices within the industry may not evolve.
Unlocking the agro-physiological potential of wheat rhizoplane fungi using a niche-conserved consortium construction approach with low P conditions
Authors: Benbrik Brahim , Reid Tessa E , Nkir Dounia , Chaouki Hicham , Aallam Yassine , Clark Ian M , Mauchline Tim H , Harris Jim , Pawlett Mark , Barakat Abdellatif , Rchiad Zineb , Bargaz Adnane
Published: February 2025

Plant Growth Promoting Fungi (PGPF) hold promises for enhancing crop yield. This study delves into fungal diversity of the wheat rhizoplane across seven Moroccan agricultural regions, employing a niche-conserved strategy to construct fungal consortia (FC) exhibiting higher phosphorus (P) acquisition and plant growth promotion. This study combined culture-independent and culture-dependent methods exploring taxonomic and functional diversity in the rhizoplane of wheat plants obtained from twenty-eight zones. Twenty fungal species from eight genera were isolated and confirmed through ITS Sanger sequencing. P solubilization (PS) capacity was assessed for individual species, with Talaromyces sp. (F11) and Rhizopus arrhizus CMRC 585 (F12) exhibiting notable PS rates, potentially due to organic acid production like gluconic acid. PGP traits and antagonism activities were considered when constructing twenty-eight niche-conserved FC (using isolates from the same zone), seven intra-region FC (different zones within a region), and one inter-regions FC. Under low P conditions, in-planta inoculation with niche-conserved FC (notably FC14 and FC17) enhanced growth, physiological parameters and P uptake of wheat, in both vegetative and reproductive stages. FC14 and FC17, composed of potent fungi such as F11 and F12, demonstrated superior plant growth benefits compared to intra- and inter-regions constructed FC. Our study underscores the efficacy of the niche-conserved strategy in constructing FC from isolates within the same niche, proving significant agro-physiological potential to enhance P uptake and plant growth of wheat.
Improved robustness to gene tree incompleteness, estimation errors, and systematic homology errors with weighted TREE-QMC
Authors: Han Yunheng , Molloy Erin K
Published: February 2025

Summary methods are widely used to reconstruct species trees from gene tres while accommodating discordance from incomplete lineage sorting; however, it is increasingly recognized that their accuracy can be negatively impacted by incomplete and/or error-ridden gene trees. To address the latter, Zhang and Mirarab (2022) updated the popular summary method ASTRAL so that it weights quartets based on gene tree branch lengths and support values. The implementation of these weighting schemes presented computational challenges, leading Zhang and Mirarab (2022) to replace ASTRAL’s original algorithm (i.e., computing an exact solution within a constrained search space) in favor of search heuristics based on phylogenetic placement. Here, we show that these weighting schemes can be effectively leveraged within the Quartet Max Cut framework of Snir and Rao (2010), introducing weighted TREE-QMC. The incorporation of weighting schemes into TREE-QMC required only a small increase in time complexity compared to the unweighted algorithm; fortunately, the increase in runtime was also small, behaving more like a constant factor in our simulation study. Moreover, weighted TREE-QMC was fast and highly competitive with weighted ASTRAL, even outperforming it in terms of species tree accuracy on some challenging simulation conditions, such as large numbers of taxa. In reanalyzing two avian data sets, we found that weighting quartets by gene tree branch lengths can improve robustness to systematic homology errors and can be as effective as removing the impacted taxa from individual gene trees or removing the impacted gene trees entirely. Lastly, our study revealed that TREE-QMC was robust to extreme rates of missing taxa, suggesting its utility as a supertree method. Source code for weighted TREE-QMC is available on Github: (https://github.com/molloy-lab/TREE-QMC)
Population Dynamics, Route of Infection, and Velocity of Systemic Spread of Erwinia amylovora in Infected Apple Branches
Authors: Dougherty Katherine Olive , Outwater Cory A. , Sundin George W.
Published: February 2025

Fire blight, caused by Erwinia amylovora, is one of the most devastating diseases of apple and pear worldwide. Young trees are particularly susceptible to the shoot blight phase of the disease, and the rapid downward spread of E. amylovora from infected shoot tips throughout trees to the rootstock often results in the formation of girdling cankers that kill trees. We quantified and tracked the systemic migration of E. amylovora cells in field studies through infected shoot tissues to gain insight into the systemic movement of the pathogen. In 2021 and 2022, bacterial populations were monitored over a 20-day period in defined sections of ‘Gala’ apple shoots in replicated field experiments. E. amylovora reached populations >109 cfu g-1 and maintained high populations in shoot tissue throughout the 20-day sampling period under conducive environmental conditions. E. amylovora cells migrated through shoot tissue at a maximum of 49.5 cm at 5 days after inoculation (9.9 cm day-1) and exhibited an average velocity of 4.2 cm day-1. The rate of migration through the new growth was 5.4 cm day-1 and further investigations using scanning electron microscopy did not reveal major obstructions at the bud scar. Microscopic examination of infected shoot tissue enabled us to detect prolific colonization and bacterial ooze formation in the cortical parenchyma. Our study refines the fundamental knowledge of E. amylovora systemic colonization during shoot blight and contextualizes previously divergent studies of colonization from the past 50 years.
Two-Phase Individual Assessments: A Second-Chance Assessment Strategy With Individualized Feedback to Promote Assessment for Learning
Authors: Zagaar Munder , Haudek Sandra B. , Boedeker Peter
Published: February 2025

Problem

High-stakes multiple-choice question (MCQ) exams in medical education typically focus on assessment of learning at a single point without providing feedback for improvement. Educators can achieve a more balanced approach to MCQ exams by combining efficient assessment of learning with the feedback and improvement opportunities of assessment for learning.

Approach

As part of a curriculum renewal at Baylor College of Medicine’s MD program, the Two-Phase Individual Assessment (TPIA) model was launched within a 4-week preclinical Foundations of Medicine course in August 2023. The TPIA model featured weekly assessments, each consisting of 2 MCQ exams given on the same day with a 4-hour study period in between. Exams were paired, consisting of an equal number of items that addressed the same learning objectives. After the initial exam, students received an individualized feedback report indicating correctly and incorrectly answered objectives. Students applied individualized feedback reports to self-identify and remediate deficiencies in preparation for the second-chance exam. Only the highest score counted toward the final grade.

Outcomes

Among 230 medical student participants, significant performance improvements between morning and afternoon exams were observed across the first 3 weekly TPIAs, with mean score increases of 4.93, 5.06, and 10.86. Mean change in performance in week 4 was not significant. Student end-of-course survey responses indicated a strong preference for the TPIA format. Responses highlighted the value of offering individualized feedback, unstructured time to address knowledge gaps, and a corresponding opportunity for improvement.

Next Steps

Future research will extend TPIA’s implementation in more clinical-oriented courses to validate TPIA’s effectiveness and explore its effect on long-term knowledge retention through more cumulative examinations. Integrating TPIA-based approaches may advance educational systems toward developing a culture of feedback literacy and embracing second chances to support learning and professional growth.
Quantifying Oculomotor Fatigability for Early Detection of Myasthenia Gravis
Authors: Kim Ye Lin , Nguyen Thanh Tin , Hwang Seung-Bae , Kang Jin-Ju , Chae Juhee , Oh Sun-Young
Published: February 2025

Objectives:

The aim of this prospective, longitudinal study was to validate video-oculography (VOG) for early detection of myasthenia gravis (MG) in patients with clinical suspicion of MG but lacking confirmatory laboratory results.

Methods:

Thirteen individuals suspected of having MG were studied using a 3-dimensional VOG system. Oculomotor fatigability, defined as the decrement (%) between the second and the last 5 average measures, was calculated.

Results:

Significant reductions in oculomotor ranges were found, exceeding previous cutoff values for horizontal saccades (16.4 ± 9.8%), vertical saccades (18.7 ± 12.6%), horizontal smooth pursuit (15.7 ± 6.0%), and vertical smooth pursuit (27.2 ± 17.4%). Despite initially negative laboratory tests, many participants later tested positive on the neostigmine test (92.3%) and repetitive nerve stimulation tests (69.2%).

Conclusions:

VOG is a reliable diagnostic tool for MG, particularly useful for seronegative patients, allowing for earlier and more accurate diagnosis than conventional methods.
Effect of Nurse Residency Programs on New Graduate Nurses Entering the Critical Care Setting
Authors: Chung Jae , Lim Fidelindo
Published: February 2025

The transition period from undergraduate nursing education to professional practice is a time of uncertainty and great difficulty for new graduate nurses (NGNs). Nurse residency programs (NRPs) provide structured education, simulation-based learning, and preceptorship to ease the transition. Although its effect on improving retention of NGNs is well established in the literature, the effect on clinical competency has not been documented as well. The purpose of this integrative review is to appraise the available literature and synthesize the evidence that demonstrates the effect of NRPs on clinical competency of NGNs entering the critical care setting. Inclusion criteria were quantitative and qualitative studies, peer-reviewed studies published after 2004 and in English, identified through a systematic literature search using the CINAHL database. Critical appraisal of the articles was completed using Law et al’s Critical Review Form. Eight articles (4 quantitative, 3 mixed method, and 1 qualitative study) met the inclusion criteria. The themes identified were common tools used to assess the efficacy of NRPs, improved clinical competency of NGNs, improved self-confidence, improved retention rates, and peer support among NGNs. Implications for nursing education and practice include applying evidence-based NRPs, incorporating simulation, enhancing sustainability, and reducing NRP variability through accreditation.
Pathophysiology of Sepsis
Authors: Marshall Tanya , Dysert Karen , Young Meilin , DuMont Tiffany
Published: February 2025

Sepsis is a condition of life-threatening organ dysfunction caused by a dysregulated host response to infection. It is the result of a series of exaggerated physiologic responses that lead to simultaneous hyper- and hypoinflammatory states. In the hyperinflammatory phase, there is an exuberant release of cytokines, commonly referred to as a cytokine storm. The immune-suppressive phase is characterized by counterregulatory attempts to achieve homeostasis that sometimes “overshoot”, leaving the host in a state of immunosuppression, thus predisposing to recurrent nosocomial and secondary infections. The aging population with comorbidities faces higher risks of immune dysfunction and inflammation. Thus, the number of sepsis survivors that develop subsequent infections is predicted to rise substantially in the next few decades. Understanding sepsis-induced immune dysregulation may enhance surveillance and outcomes. This review is intended to describe the pathophysiology of sepsis and its effects on the immune system.
Renal Involvement in Sepsis
Authors: Rane Rahul Prakash , Soundranayagam Sheahahn , Shade Daniel A. , Nauer Kevin , DuMont Tiffany , Nashar Khaled , Balaan Marvin R.
Published: February 2025

Acute kidney injury (AKI) is a common complication of sepsis due to a myriad of contributing factors and leads to significant morbidity and mortality in critically ill patients. Prompt identification and management are vital to reverse and/or prevent the worsening of AKI. When renal function is severely compromised, there may be a need for dialytic therapy to meet the metabolic needs of patients. This article will review the definition of AKI, epidemiology, risk factors, and pathophysiology of AKI in sepsis, along with both non-dialytic and dialytic treatment strategies. We will also review landmark trials in fluid resuscitation in sepsis.
Caregiver Satisfaction During the Transition From Inpatient Cancer Care to Home-Based End-of-Life Care
Authors: Benn Katharine , Wood Kathleen , Strauss Shiela M. , Davis Mary Elizabeth , Barton-Burke Margaret
Published: February 2025

Background:

People with advanced cancer often cite home as their preferred place of death, yet a preponderance of deaths occurs in hospitals. Hospice care improves outcomes at end of life (EOL). Hospital-to-home transitional care is a critical area of care delivery, but the caregiver’s experience during this transition is a gap in the literature.

Objective:

This mixed-methods study explored informal caregiver perceptions of the transition from inpatient cancer care to home-based EOL care.

Methods:

A cross-sectional survey measured caregiver satisfaction with advanced cancer and palliative care. A qualitative content analysis of additional free-text comments from respondents was also conducted.

Results:

A total of 53 (27%) of caregivers completed the survey. Responses were positive overall, with higher satisfaction noted for Hispanic/Latino caregivers (P = .033) and caregivers with greater self-reported support at home (P = .006), and trending toward higher satisfaction for caregivers aged 65 years and older (P = .075). Qualitative findings indicate effective communication and care coordination are critical components of positive experiences.

Conclusions:

Results suggest that early identification and support for caregivers with lower self-reported outside support at EOL may increase satisfaction.

Implications for Practice:

Previous work demonstrated a gap in the understanding of caregiver experience in the transition from hospital-based to home hospice care. Assessment of outside caregiver support should be performed before discharge.

What Is Foundational:

As institutions consider satisfaction of care as an important metric of quality, caregivers need to be included, particularly within transitions of care. Clear communication between the medical team and the primary caregiver is an essential component of care.
Genital Herpes Simplex Virus Infections in Women—A Clinical Update
Authors: Meller Nir
Published: February 2025

Genital herpes is a relatively common chronic lower genital tract sexually transmitted infection caused by herpes simplex virus types 1 and 2 (HSV-1 and HSV-2). It is characterized by recurrent, self-limited genital ulcers, and it is the leading cause of genital ulcer disease worldwide (1). The impact of genital herpes on sexual and reproductive health, including the risk of perinatal infection, necessitates a profound understanding of its clinical presentation, diagnosis, treatment, and prevention. This chapter aims to review the critical clinical aspects of HSV in women, emphasizing relevant evidence-based data.
Cordycepin mediates pyroptosis in HCC through the upregulation of TXNIP and synergizes with anti–PD-L1 immunotherapy
Authors: Liang Bu-Gang , Zheng Yi-Min , Shen Hong-Ye , Yang Guo-Huan , Xu Wen-Xin , Tan Chang-Jun , Ke Ai-Wu , Qin Wen-Zheng
Published: February 2025

Background:

Immune checkpoint inhibitors are effective treatments for HCC; however, their therapeutic efficacy is often limited by the development of drug resistance. Therefore, investigating new combination therapeutics involving immune checkpoint inhibitors is critical to improving patient prognosis. In this study, we investigated the therapeutic effect of cordycepin (COR) in HCC and its synergistic effect with anti–programmed cell death ligand 1 (anti–PD-L1) immunotherapy.

Methods:

We selected 2 HCC cell lines to investigate the effects of COR on HCC growth using in vivo and in vitro experiments. We performed RNA sequencing of the MHCC97H cell line treated with or without COR to understand the underlying mechanism and identify the key regulatory genes. Through in vivo and in vitro experiments on gene knockdown cells, we identified thioredoxin-interacting protein as a key molecule involved in the role of COR. Next, we used mouse subcutaneous and orthotopic tumor models to evaluate the therapeutic effects of COR, atezolizumab (a programmed death-ligand 1 [PD-L1] inhibitor), or their combination. Multiple immunofluorescence staining revealed that the combination of atezolizumab and COR therapy greatly increased the number of tumor-infiltrating CD8+ T cells and PD-L1 expression in HCC compared to monotherapy.

Results:

Our study revealed that COR significantly inhibited HCC growth both in vitro and in vivo. Mechanistically, we showed that COR induces endoplasmic reticulum stress, which upregulates thioredoxin-interacting protein expression and leads to HCC cell pyroptosis. In addition, the combination treatment with COR and PD-L1 inhibitors profoundly inhibited HCC.

Conclusions:

Overall, our study successfully established a combined therapeutic strategy using COR and PD-L1 inhibitors. This strategy has significant synergistic effects on cancer cells, highlighting its importance in cancer therapy.
Neurophysiology of resilience in juvenile fibromyalgia
Authors: Suñol Maria , Pascual-Diaz Saül , Dudley Jon , Payne Michael F. , Jackson Catherine , Tong Han , Ting Tracy V. , Kashikar-Zuck Susmita , Coghill Robert C. , López-Solà Marina
Published: February 2025

Juvenile fibromyalgia (JFM) is a chronic pain syndrome predominantly affecting adolescent girls. Resilience may be a protective factor in coping with pain, reducing affective burden, and promoting positive outlooks. Brain regions affected in JFM overlap with those linked to resilience, particularly in the default-mode network (DMN). We investigate the role of resilience on core somatic and affective symptoms in JFM and assess the neurophysiological substrates for the first time. Forty-one girls with JFM and 40 pain-free adolescents completed a resting-state functional magnetic resonance imaging assessment and self-report questionnaires. We used clustering analyses to group JFM participants based on resilience, and principal component analyses to summarize core somatic and affective symptoms. We estimated whole-brain and within-DMN connectivity and assessed differences between higher and lower resilience JFM groups and compared their connectivity patterns to pain-free participants. The higher resilience JFM group had less affective (T = 4.03; P < 0.001) but similar core somatic symptoms (T = 1.05; P = 0.302) than the lower resilience JFM group. They had increased whole-brain (Ts > 4, false discovery rate cluster-level corrected P-value < 0.03) and within-DMN (T = 2.20, P = 0.03) connectivity strength, and higher connectivity between DMN nodes and self-referential and regulatory regions. Conversely, higher DMN-premotor connectivity was observed in the lower resilience group. Juvenile fibromyalgia participants with higher resilience were protected affectively but not in core somatic symptoms. Greater resilience was accompanied by higher signal integration within the DMN, a network central to internally oriented attention and flexible attention shifting. Crucially, the connectivity pattern in highly resilient patients resembled that of pain-free adolescents, which was not the case for the lower resilience group.
How is 3D modeling in metabolic surgery utilized and what is its clinical benefit: a systematic review and meta-analysis
Authors: Robb Henry Douglas , Arif Aksaan , Narendranath Rithvik Mahadev , Das Bibek , Alyaqout Khaled , Lynn William , Aal Yasser Abul , Ashrafian Hutan , Fehervari Matyas
Published: February 2025

Background:

Three-dimensional (3D) modeling is an emerging technology in surgery, with applications in operative planning, surgical education, and patient engagement. Metabolic surgery, the most effective treatment for obesity, is increasingly prevalent leading to new complex clinical challenges. This systematic review aims to understand the use of 3D modeling in metabolic surgery and its impact on clinical outcomes.

Methods:

Following a registered protocol (PROSPERO: XXX), a comprehensive search using MEDLINE, Embase, and CENTRAL Cochrane Library was conducted. Eligible papers underwent screening and full-text review. A qualitative thematic analysis was performed alongside meta-analyses on available volumetric data. Results were reported as directed by the PRISMA guidelines.

Results:

Twenty-nine studies were included, with most at Level II evidence (n = 19, 66%). Studies focused on operative planning and surgical practice (90%, n = 26) and were subdivided into preoperative planning (14%, n = 4), postoperative diagnosis (31%, n = 9), and postoperative assessment and prediction (45%, n = 13). Only three papers addressed surgical education (10%). 3D modeling for patient education was unexplored. To assess 3D modeling’s cross-study consistency, pooled meta-analyses on preoperative and postoperative 3D gastric volumetry and abdominal circumference were performed. Average preoperative stomach volume was 794.93 mL (95% confidence interval [CI]: 518.61–1071.26 mL). Postoperative LSG and RYGB/OAGB gastric volumes were 171.71 mL (95% CI: 113.37–288.58 mL) and 35.73 mL (95% CI: 29.32–42.14 mL) respectively. Average abdominal circumference was 120.04 cm (95% CI: 100.72–139.35 cm). All volumes were consistent with published data.

Conclusions:

This systematic review highlighted the accuracy of 3D modeling for volumetric assessments and its developing role in surgical planning and training. However, its potential benefits in AR or 3DP models, in patient education or for answering bariatric surgical debates using 3D volumetric studies remain underutilized.
The role of indocyanine green in fluorescence-guided pancreatic surgery: a comprehensive review
Authors: Tufo Andrea , Milanetto Anna Caterina , Valente Roberto , Spalice Enrico , Sodano Loredana , Pasquali Claudio , Scandavini Maria Chiara , Coppola Alessandro
Published: February 2025

Pancreatic surgery is a complex and challenging field, with patients facing a high risk of postoperative complications. In recent years, indocyanine green (ICG) has gained prominence as a valuable tool used in various aspects of pancreatic surgery. ICG is a fluorescent dye thatoffers real-time imaging capabilities that enhance the surgeon’s ability to accurately localise tumours and critical anatomical structures, thereby improving surgical precision and potentially reducing operative time and complications. One of the most significant advantages of ICG is its ability to provide enhanced visualisation of the biliary tract and vascular structures, which is particularly beneficial in complex pancreatic resections, in which the anatomy can be highly variable and challenging to navigate. Furthermore, ICG can be instrumental in ensuring the adequate perfusion of anastomoses, thereby reducing the risk of postoperative leaks and associated morbidity. This comprehensive review aims to provide an in-depth analysis of the current applications, advantages, and limitations of ICG in pancreatic surgery.
Seroprevalence of Celiac Disease in Mexican Mestizo Patients With Autoimmune Thyroid Disease
Authors: Tapia-Calderón Diana Karen , Hernández-Flores Karina Guadalupe , Velarde Ruiz-Velasco José Antonio , García-Jiménez Edgar Santino , Barrientos-Ávalos José Roberto , Aldana-Ledesma Juan Manuel , Tornel-Avelar Ana Isabel , Mercado-Jáuregui Lydia Aurora , Gómez-Quiroz Adolfo , Cerda-Camacho Felipe , Felix-Tellez Francisco Alejandro , Vivanco-Cid Héctor , Domínguez-Alemán Carlos Alonso , Ugarte Álvarez Omar , Remes-Troche José María
Published: February 2025

Goals:

This study aimed to assess the seroprevalence of celiac disease in Mexican patients with autoimmune thyroid diseases, hypothesizing that prevalence would align with rates observed in other populations.

Background:

The association between celiac disease and autoimmune thyroid diseases has been documented globally, with varying seroprevalence rates. Historically, Mexican Mestizos were considered at low risk for celiac disease, yet recent findings suggest similar prevalence to other regions. However, data regarding Hispanic patients with autoimmune thyroid diseases are limited.

Study:

This observational, descriptive, cross-sectional study involved 170 Mexican Mestizo patients diagnosed with autoimmune thyroid diseases, specifically Hashimoto thyroiditis or Graves’ disease. Data on demographics, disease history, and symptoms were collected. Celiac disease seroprevalence was assessed using immunoglobulin A anti-tissue transglutaminase, immunoglobulin A deamidated gliadin peptide, and immunoglobulin G deamidated gliadin peptide antibodies, with values above a specified threshold considered positive.

Results:

Among the participants, 92.4% were female, with a mean age of 45.4 years. Hashimoto thyroiditis was present in 80.6% of cases, whereas Graves disease accounted for 19.4%. The overall celiac disease seroprevalence was 8.8% (95% CI; 5.4-14.1). All individuals with positive serology had Hashimoto thyroiditis, and although no gastrointestinal symptoms were linked to seropositivity, anemia was more common in celiac-positive subjects.

Conclusions:

Celiac disease seroprevalence among Mexican Mestizo patients with autoimmune thyroid diseases aligns with other populations. Serological screening for celiac disease is recommended, even in the absence of gastrointestinal symptoms. Further biopsy-confirmed studies are necessary.