bluuebunny/crossref_metadata_2025 huggingface dataset:
Readability of Patient Education Materials in Plastic Surgery: Assessing 14 Years of Progress
Authors: Wirth Peter J. , Warden Aleah M. , Moura Steven P. , Attaluri Pradeep K. , Larson Jeffrey D.
Published: February 2025

Background:

Current recommendations suggest that patient education materials (PEMs) be written at or below the sixth-grade reading level. In a 2010 study, the average readability of PEMs on the American Society of Plastic Surgeons (ASPS) and The Aesthetic Society (AS) websites was found to be at the 11th-grade level or higher. We sought to assess progress made toward providing accessible PEMs.

Methods:

PEMs were obtained from the ASPS and AS websites. The PEMs were entered into an online scoring tool. PEMs were scored on 3 common readability indices: Flesch–Kincaid, Simple Measure of Gobbledygook, and Flesch Reading Ease (FRE).

Results:

The average grade level of ASPS PEMs calculated using the Flesch–Kincaid, Simple Measure of Gobbledygook, and FRE readability models were 9.7 ± 1.1, 12.6 ± 0.7, and 47.6 ± 6.2, respectively. This FRE score corresponds to approximately grade 13–16 reading levels. The average of AS PEMs were 9.3 ± 0.5, 12.3 ± 0.3, and 51.3 ± 3.9, respectively; this FRE corresponds to grade 10–12 reading levels. There were no PEMs written at or below the recommended sixth-grade reading level found on ASPS and AS websites.

Conclusions:

Despite increasing awareness of the need for equitable access to healthcare, PEMs continue to be written at a reading level well above the recommendation. Over the past 14 years, we have seen only modest improvement in readability indices. In addition to advocating for more accessible PEMs, we must gather a deeper understanding of how patients seek information about plastic surgery.
Ankylosing spondylitis and the genetic correlation of extra-articular manifestations: Evidence from bidirectional Mendelian randomization and Bayesian colocalization
Authors: Pan Hong , Ye Youchen , Wang Dawei , Zheng Jie , Zhao Zhifang , Zhao Kefeng
Published: February 2025

Spondyloarthritis (SpA) encompasses a group of inflammatory joint disorders affecting the spine and joints, including ankylosing spondylitis and nonradiographic axial SpA, exhibiting diverse extra-articular manifestations. Genetic factors, beyond human leukocyte antigen B27, play a significant role in SpA development. Leveraging advanced statistical methods, this study explores bidirectional Mendelian randomization (MR) and Bayesian colocalization to unravel the genetic links between SpA and its extra-articular manifestations. Positive MR analysis indicates causal relationships between ankylosing spondylitis and various extra-articular conditions. Leave-one-out analysis suggests that these effects are not driven by individual single-nucleotide polymorphisms. In reverse MR, potential reverse causal relationships are explored, revealing uveitis, inflammatory bowel disease, and ulcerative colitis as candidates. Colocalization analysis, unfortunately, does not identify shared genetic foundations. In conclusion, seronegative spinal arthritis may lead to myocarditis, atrioventricular block, bronchiectasis, Crohn disease, and coccygeal plexus syndrome, while there is a 2-way causal relationship with uveitis, inflammatory bowel disease, and ulcerative colitis.
First case report of long-term latent infection paracoccidioidomycosis in China
Authors: Dong Haiping , Feng Jingyuan , Wu Shaoling , Liang Feng , Li Hua , Liang Xiaocheng , Liao Weixiang , Pan Yanshan , Tang Guidan , Li Donghai , Zhou Wei , Cao Zhizhong , Wang Weiyong , Hu Jinxing
Published: February 2025

Rationale:

Although paracoccidioidomycosis is one of the most prevalent endemic mycoses in Latin American countries, where at least 10 million people are infected, the prevalence of paracoccidioidomycosis in China remains unknown because no related case has been reported, and its diagnosis is extremely challenging for local clinicians because of the complexity of disease progression and lack of specific evidence.

Patient concerns:

Here, we report the first case of PCM in a male patient with a long-term latent infection in China.

Diagnosis:

The results of special staining, immunohistochemistry, lymph node biopsy pathology, and metagenomic second-generation sequencing indicated that the patient was infected with Paracoccidioides brasiliensis.

Interventions:

In this case, the patient was administered voriconazole 200 mg twice daily.

Outcomes:

After continuous treatment for 6 months, the patient’s symptoms improved significantly, and the medication was discontinued. The outpatient follow-up revealed no discomfort.

Lessons:

This case is of great value for the early diagnosis, treatment, and prevention of the spread of this emerging infectious disease in China.
A case report of epithelial adenomatoid hamartoma misdiagnosed as a nasal poly
Authors: Liu Siyu , Bai Bin , Feng Yu , Li Maocai , Li Lianqing , Gong Lili
Published: February 2025

Rationale:

Respiratory epithelial adenomatoid hamartomas (REAH) are benign tumors. The clinical presentation of REAH often resembles that of nasal polyps or inverted papillomas. Owing to the lack of specific clinical symptoms or imaging findings, the diagnosis is usually confirmed only by pathological examination after surgery and misdiagnosis is common. Therefore, we report this case of nasal REAH that was misdiagnosed as a nasal polyp. Clinical cases of nasal polyps with hamartoma are very rare. Pathological biopsy, complete removal of the lesion by surgery and postoperative follow-up are essential for the diagnosis and treatment of REAH.

Patient concerns:

The patient had been experiencing bilateral anosmia for 6 years without any obvious triggers. He also experienced nasal congestion and mucopurulent nasal discharge after exposure to cold and alcohol.

Diagnosis:

Analyzing the pathological findings that the patient was diagnosed with right-sided respiratory epithelial adenomatoid pleomorphic histiocytoma and left-sided nasal polyps.

Interventions:

Nasal endoscopic surgery was performed to remove bilateral nasal lesions and send them for routine pathological examination.

Outcomes:

After surgery, the patient’s sense of smell was slightly restored to normal.

Lessons:

Our case report findings suggest that clinical attention should be paid to the possibility of nasal REAH with nasal polyps in bilateral nasal polypoid masses, particularly if the olfactory fissure is involved.
Abducens nerve palsy in patients with spontaneous intraventricular hemorrhage: A case report
Authors: Li Chenyan , Cai Yong , Zhong Xingming , Shen Lijuan
Published: February 2025

Rationale:

The purpose of this case report is to describe the process of the patient developing abductor nerve paralysis, analyze the causes of this symptom, provide new diagnostic and treatment ideas for patients with spontaneous intraventricular hemorrhage who develop abductor nerve paralysis, and be alert to the occurrence of abductor nerve paralysis in such patients.

Patient concerns:

A 49-year-old man was admitted to our hospital with a spontaneous intraventricular hemorrhage. After performing digital subtraction angiography of the whole brain under local anesthesia, his eyes were limited in abduction, accompanied by hemorrhage and exudation of the optic papilla. Edema is an extremely rare condition.

Diagnoses:

Transient intracranial hypertension was considered after reexamination with computed tomography.

Interventions:

The application of mannitol and the release of cerebrospinal fluid were used to reduce intracranial pressure and provide patient-related symptomatic treatment.

Outcomes:

After 1 month, the patient’s eyes had no abduction limitation and showed good activity.

Lessons:

Abducens nerve palsy is a common condition. Owing to its complex etiology, a careful and comprehensive examination is necessary. In particular, patients with spontaneous cerebral hemorrhage who undergo digital subtraction angiography should pay more attention to the abducens nerve.
Case report and literature review: Misdiagnoses of contrast encephalopathy as stroke
Authors: Qi Xiangjia , Gao Liqian , Qi Lifeng
Published: February 2025

Rationale:

Contrast-induced encephalopathy (CIE) is a rare complication following carotid artery stenting, often mimicking stroke symptoms such as focal neurological deficits. Its transient nature and reversibility necessitate differentiation from critical complications like cerebral hemorrhage or infarction, as management strategies differ substantially. This case underscores the diagnostic challenges and clinical implications of CIE in endovascular procedures.

Patient concerns:

A 65-year-old woman with a history of cerebral infarction and prior carotid artery stenting presented with persistent numbness in her extremities for over 1 month. Post-carotid artery stenting, she developed acute slurred speech and right-sided limb weakness within 1 hour, raising concerns for stroke or procedural complications.

Diagnoses:

Emergency cranial computed tomography revealed left cerebral hemisphere swelling and linear hyperdensities, while magnetic resonance imaging demonstrated punctate diffusion-weighted imaging hyperintensities in the left parietal lobe. Temporal correlation of symptoms with iodixanol contrast administration (150 mL) supported a diagnosis of CIE, excluding acute infarction or hemorrhage.

Interventions:

Immediate management included antiplatelet therapy (tirofiban), thrombolysis (urokinase), corticosteroids (methylprednisolone), and antiedema agents (mannitol and albumin). Supportive care emphasized hydration and neurological monitoring.

Outcomes:

The patient exhibited progressive improvement, with complete resolution of speech and motor deficits by postoperative day 3. Neuroimaging abnormalities regressed, aligning with the transient nature of CIE.

Lessons:

This case highlights the critical role of prompt neuroimaging to exclude life-threatening differentials and confirms CIE’s reversibility with supportive care. Risk factors such as contrast volume and cerebral circulation dynamics warrant attention. Clinicians should exercise caution in readministering iodinated contrast to patients with prior CIE episodes.
Ameliorating standard operating procedures could reduce the risk of needle retention after acupuncture
Authors: Hsieh Hsu-Tung , Lin Chia-Lin , Lin Shun-Ku
Published: February 2025

Needle retention, where acupuncture needles are left in the patient following treatment, is a serious adverse event that can lead to infections, bleeding, and tissue damage. While rare, its potential complications render it a critical concern in acupuncture practice. Current research suggests that inadequate procedural safeguards contribute to the incidence of needle retention, yet there is limited investigation into the role of standard operating procedures (SOPs) in reducing such events. This study aimed to evaluate and compare the effects of 2 different SOPs on the incidence of needle retention in acupuncture treatment. We developed a new acupuncture procedure based on SOPs for acupuncture commonly used in hospitals in Taiwan. The main advancements included replacing paper confirmation checklists with online instant messaging systems, staff meetings before treatment, and repeated confirmations after treatment. We implemented 2 SOPs for inpatients in Taipei City Hospital from 2018 to 2021. The incidence of needle retention was calculated, and a logistic regression model was applied to estimate the odds ratio (95% confidence interval) for needle retention risk between the acupuncture SOPs. This study included 13,920 acupuncture treatments, of which 7653 followed the original SOP and 6267 followed the new SOP. The incidence of needle retention was 6.8 versus 2.2 per thousand acupuncture treatments for the original versus new SOPs, respectively. Compared with the original SOP, the new version showed a 0.41 adjusted odds ratio (95% confidence interval, 0.15–0.72; P = .032) of needle retention after adjusting for age, gender, body mass index, Barthel scale, and acupuncture treatment times. Ameliorating the SOPs could reduce the risk of needle retention after acupuncture. This study showed that a new acupuncture SOP, incorporating technology and better communication, significantly reduced needle retention incidents, enhancing patient safety and care quality.
Exploring the causal relationship between constipation and ileus: Insights from bidirectional Mendelian randomization and genomic data analysis
Authors: Xiao Zhengping , Xiao Xi , Nie Guole , Li Baosong , Jiang Hong
Published: February 2025

Constipation currently affects approximately 15% of the global population, and contemporary lifestyles are increasing its incidence every year. A significant number of individuals with constipation also experience ileus, a common surgical emergency known for its sudden onset and rapid progression. However, the intricate dynamics of the relationship between constipation and ileus are not well understood. This study aimed to elucidate the causal relationship and underlying mechanisms of constipation and ileus, thereby advancing our understanding of their interconnections. A bidirectional 2-sample Mendelian randomization (MR) analysis was performed using the IEU OpenGWAS database. Single nucleotide polymorphisms were used as instrumental variables to determine the causative association between constipation and ileus. Additionally, we utilized eQTL datasets to identify pertinent genes, conducted gene ontology and Kyoto encyclopedia of genes and genomes enrichment analyses, and constructed protein–protein interaction (PPI) networks via the GeneMANIA database to identify the possible molecular pathways involved. Bidirectional MR revealed a significantly elevated risk of ileus due to constipation (OR = 1.467, 95% CI = 1.217–1.770, P < .001). Our eQTL investigation revealed 6 genes that were co-expressed in both ailments. Enrichment analysis suggested potential roles of these genes in nucleic acid metabolism and ribosomal biosynthesis, with b-ureidopropionase 1 (UPB1) exhibiting the most pronounced enrichment. Furthermore, PPI network analysis highlighted several pivotal proteins and genes. The findings of this study indicate the existence of a causal nexus between constipation and ileus, underscoring the significant genetic susceptibility shared between these conditions. It has been postulated that constipation can perturb the incidence of ileus via biochemical pathways, including nucleic acid metabolism and ribosomal biosynthesis, with UPB1 possibly serving as a key molecular target. Our results elucidate the novel genetic basis of constipation and ileus and provide a foundation for future experimental studies and the development of customized preventive and therapeutic approaches.
Symmetrical peripheral gangrene after cardiac surgery: A case report and review of literature
Authors: Chen Xiaoliang , Shao Guofeng , Zhao Shunying , Li Ni
Published: February 2025

Rationale:

Cardiac surgery can cause arrhythmias and low cardiac output syndrome through various mechanisms, including cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest, and ischemia resulting from coronary or graft occlusion. Symmetric peripheral gangrene is a rare but serious complication that can occur after cardiac surgery. Here, we present a case of symmetric peripheral gangrene shortly after cardiac surgery for mitral valve replacement.

Patient concerns:

A 76-year-old male with rheumatic heart disease and severe mitral stenosis underwent mitral valve replacement. He experienced postoperative bleeding on the first day after the cardiac surgery. After experiencing ventricular fibrillation, cardiogenic shock, acute hepatic failure, and disseminated intravascular coagulation (DIC), he developed symmetrical peripheral gangrene on the fifth day after cardiac surgery.

Diagnoses:

The patient presented with postoperative bleeding, cardiogenic shock, and DIC complicated by symmetrical peripheral gangrene following cardiac surgery.

Interventions:

During cardiosurgery intensive care unit admission, the patient received positive inotropic agents and vasopressors, blood transfusion, and antithrombotic treatment with low -molecular-weight heparin. Because of the severe general condition of the patient, amputation was not performed.

Outcomes:

The patient died on the 80th day after cardiac surgery because of multiorgan failure and DIC.

Lessons:

Physicians should be vigilant for comorbid symmetrical peripheral gangrene in patients undergoing cardiac surgery who present with postoperative bleeding, cardiogenic shock, and DIC. Early recognition of acrocyanosis, prompt management of cardiogenic shock, correction of anemia, hemodynamic stabilization, and properly controlled use of anticoagulation may help prevent symmetrical peripheral gangrene.
Predictive value of respiratory mechanics for the risk of unilateral pulmonary edema following minimally invasive cardiac surgery: An observational study
Authors: Fan Qiaolian , Chen Feng , Chen Mingguang , Lin Fenghui , Xue Yimin
Published: February 2025

This study aimed to investigate the predictive effect of static lung compliance (SLC) and airway resistance (AR) in patients undergoing minimally invasive cardiac surgery (MICS) with unilateral pulmonary edema (UPE). A total of 245 patients who underwent MICS via cardiopulmonary bypass and minimal right lateral thoracic incision port access were enrolled, with immediate postoperative SLC and AR data collected upon intensive care unit (ICU) admission. Cutoff values for grouping patients into high (H-) and low (L-) compliance/resistance categories were determined using receiver-operating characteristic curves and Youden indexes. The primary outcome was the incidence of radiographically and clinically defined UPE within the first 24 hours postoperatively, while the secondary outcomes included duration of mechanical ventilation, length of ICU stay, total hospitalization days, in-hospital mortality, and the highest sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE-II) scores within the first 24 hours post-surgery. Results showed that patients in the L-compliance group (SLC < 40 mL/cmH2O) had longer durations of mechanical ventilation, length of ICU stay, and total hospitalization days, along with higher SOFA and APACHE-II scores compared to those in the H-compliance group (SLC ≥ 40 mL/cmH2O) (P < .05), although there was no significant difference in in-hospital mortality. Conversely, patients in the H-resistance group (AR ≥ 11 cm H2O/[L·s]) exhibited longer durations of mechanical ventilation, length of ICU stay, and total hospitalization days, as well as significantly higher SOFA, APACHE-II scores, but lower in-hospital mortality rates than those in the L-resistance group (AR < 11 cm H2O/[L·s]) (P < .05). In summary, immediate postoperative SLC < 40 mL/cm H2O and AR > 11 cm H2O/(L·s) are potentially valuable indicators for predicting postoperative UPE in patients undergoing MICS.
Primary small cell neuroendocrine carcinoma of the larynx: A detailed case report
Authors: Mu Siqi , Wu Xiaosong
Published: February 2025

Rationale:

Small cell neuroendocrine carcinoma (SCNEC) of the larynx is a rare and aggressive malignancy, notorious for its rapid progression and poor prognosis. Early diagnosis and effective management are crucial, particularly for high-risk populations such as long-term smokers.

Patient concerns:

A young male smoker presented with progressive laryngeal symptoms, which prompted further investigation due to the severity and progression of his symptoms.

Diagnoses:

The patient was diagnosed with SCNEC of the larynx after presenting with symptoms. Diagnostic procedures confirmed the presence of a localized tumor without distant metastasis.

Interventions:

In response to the diagnosis, the patient underwent a surgical intervention that achieved clear margins, chosen based on the tumor’s localized nature at diagnosis. This approach emphasized comprehensive initial surgical management.

Outcomes:

The absence of immediate postoperative recurrence highlights the potential effectiveness of the surgical approach as a standalone treatment in selected cases of SCNEC.

Lessons:

This case underscores the importance of considering SCNEC in the differential diagnosis when young smokers present with laryngeal symptoms. It highlights the need for proactive surgical strategies to manage this aggressive cancer effectively. Additionally, it emphasizes that despite the favorable initial outcome, the high risk of recurrence necessitates rigorous long-term follow-up and a structured surveillance strategy to enhance early detection and potentially improve long-term outcomes. This report offers significant insights into the rapid progression and nuanced management of SCNEC, providing valuable lessons for clinical practice.
Examining the Sequential Relationships Between Voice Changes, Symptom Experiences, Fear of Cancer Recurrence, and Voice-Related Quality of Life in Patients With Thyroid Cancer
Authors: Lee Myung Kyung , Oh Jihyun
Published: February 2025

Background

Thyroid cancer is considered lower-grade cancer with a high survival rate; however, the voice changes, and the presence of other diverse symptoms following a thyroidectomy can impact a patient’s voice-related quality of life (VRQOL).

Objective

This study aimed to examine the serial multiple mediating effects of voice changes, symptom experiences, and fear of cancer recurrence on the VRQOL among patients diagnosed with thyroid cancer postthyroidectomy.

Methods

This cross-sectional study used a descriptive, structured self-report questionnaire. A total of 225 individuals participated who were 20 years and older, had been diagnosed with thyroid cancer and had undergone thyroidectomy surgery at comprehensive university hospitals in Daegu, Daejeon, Sejong, and Anyang in South Korea before data collection.

Results

The study’s findings revealed a statistically significant direct impact between patients’ voice changes and their VRQOL. Moreover, the serial mediation model highlighted that as the severity of patients’ voice changes escalated, the intensity of their other symptom experiences and fear of cancer recurrence increased, resulting in a deterioration in their VRQOL. The study’s findings identified partial mediating effects of symptom experiences and the fear of cancer recurrence in the association between voice changes and the VRQOL.

Conclusions

These findings underscore the importance of adopting a modeling approach that considers the simultaneous sequential relationships among 4 pivotal variables, namely, voice changes, symptom experiences, fear of cancer recurrence, and VRQOL.

Implications for Practice

The findings highlight the crucial impact of voice changes on patients’ VRQOL, which is closely linked to various psychological aspects of the disease.
Management of Maternal Genetic Conditions in Pregnancy, Part 1: Disorders of the Connective Tissue, Muscle, Vascular, and Skeletal Systems
Authors: Mardy Anne , Whitney Madeline
Published: February 2025

Importance

The number of patients with various genetic syndromes who are or seek to become pregnant is increasing due to advances in medical care and assisted reproductive technologies. Management of these patients requires multidisciplinary care teams and knowledge of the risks of increased morbidity and mortality. In addition, many of these inheritance patterns are autosomal dominant, with a 50% risk of an offspring inheriting the disorder with each pregnancy.

Objective

In this first of a 2-part series, common syndromes with connective tissue, muscle, vascular, or skeletal involvement will be discussed regarding surveillance and management of mother and fetus.

Evidence Acquisition

A literature search was performed for important updates in the literature regarding management of patients with genetic connective tissue disorders, aortopathies, muscular dystrophies, vascular disorders, and skeletal dysplasias.

Results

Updates have been incorporated since the last publication in 2011, including updated diagnostic criteria for several conditions (such as Marfan syndrome), international guidelines in management of aortopathies and achondroplasia, an expanded section on hypermobile Ehlers-Danlos syndrome, and a new section on familial cerebral cavernous malformation.

Conclusions

Since the last publication, many guidelines have been published or updated regarding management of pregnancies in patients with genetic disorders and are reviewed in this article.

Relevance

Clinicians who care for pregnant patients with genetic disorders should be aware of updated guidelines and recommendations in order to optimize their care during pregnancy.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, physicians should be better able to (1) describe how to manage patients with genetic disorders that place them at high risk for aortic dissection, uterine rupture, and cerebral hemorrhage during pregnancy; (2) formulate delivery plans for patients with skeletal dysplasias; (3) interpret ultrasound findings in the context of parental genetic disorders; and (4) explain how to counsel patients with genetic disorders regarding inheritance pattern and options for preimplantation and prenatal testing.
Ovarian Cancer Risk Among Older Patients With Stable Adnexal Masses
Authors: Suh-Burgmann Elizabeth J. , Hung Yun-Yi , Schmittdiel Julie A.
Published: February 2025

(Abstracted from Am J Obstet Gynecol 2024;231(4):440.e1–440.e7)

Adnexal masses represent a clinical challenge in the field of gynecology; the only way to rule out cancer in these cases is through surgical intervention, but most masses are benign, so surgical intervention in many cases could cause more harm than good. The risk of delay in cancer diagnosis must be weighed against the potential harms of unneeded surgical intervention.
Pediatric Drowning and Prehospital Predictors of Critical Illness in the United States
Authors: Greenshields Molly , Monuteaux Michael C. , Dorney Kate , Garcia Angelica , Lee Lois K. , Farrell Caitlin A.
Published: February 2025

Objective:

Drowning is a leading cause of injury-related death for US children. The study objectives are to describe the characteristics of pediatric drowning patients receiving emergency medical services (EMS) care in the United States and to identify patient-specific and incident-specific variables associated with critical illness after drowning.

Methods:

This is a cross-sectional study using the 2019 National Emergency Medical Services Information System database. Children below 19 years old with international classification of diseases 10 external cause of injury (E-codes) for drowning were included. Critical illness was defined as a recorded Glasgow Coma Scale score <9 at any time during EMS care. We performed multivariable logistic regression reporting odds ratios (OR) and 95% CI for the outcome of critical illness controlling for demographic and incident characteristics.

Results:

Our study sample included 1052 patients, and 57% were below 5 years. Critical illness after drowning was identified in 23.9% (n=251). Most drowning patients were transported via advanced life support (88.4% for noncritically ill, 87.3% for critically ill patients). Resuscitation procedures performed by EMS for these patients included the following: 12.7% with assisted ventilation, 6.7% with advanced airway management, and 17.8% with cardiopulmonary resuscitation. There were increased odds of critical illness in males (OR 1.41, 95% CI: 1.03, 1.93) and in children below 1 year (OR 2.54, 95% CI: 1.26, 5.10) and 1 to 4 years (OR 1.61, 95% CI: 1.01, 2.56) compared with 13 to 19 years and decreased odds for urban location (OR 0.60, 95% CI: 0.39, 0.91).

Conclusions:

Among children receiving EMS care after drowning, 23.9% were critically ill, and predictors of critical illness included male sex, young age, and nonurban locations. Using national EMS data is a novel approach to inform prehospital and emergency department preparedness to improve care for pediatric patients after drowning including pediatric resuscitation procedures by EMS personnel.
A 6-Week Modified Physical Therapy Intensive Program for a Child With Cerebral Palsy
Authors: Flowers Meredith
Published: February 2025

Purpose:

This case report assesses the outcomes of a 6-week modified intensive program for a 4-year-old boy with cerebral palsy (CP), Gross Motor Function Classification System Level IV.

Summary of Key Points:

The modified intensive program included the practice of developmental gross motor skills, standing/gait training in adaptive equipment, constraint-induced movement therapy, and whole body vibration.

Conclusions:

The child improved in 4 of the 5 outcomes, including timed sitting balance and modified versions of the 5 Times Sit-to-Stand Test and 9-Hole Peg Test. His ability to assist with transfers, sit independently, and use both hands for play and self-help skills also improved.

Recommendations for Clinical Practice:

This case report adds to the body of evidence supporting the use of intensive program models of physical therapy for children with CP and highlights the need for additional research in this emerging area of clinical practice.
Comparing the Quality of Life and Patient Satisfaction After Unilateral Alveolar Cleft Repair With 2 Different Materials—An Innovative Questionnaire Study
Authors: Wu Qian , Wang Yongqian
Published: February 2025

Background:

Bone marrow concentrate (BMC) combined with β-tricalcium phosphate (β-TCP) granules show ideal osteogenic effects compared with autologous iliac crest bone graft (ICBG) in repairing the alveolar bone defect. This study aimed to investigate the quality of life and satisfaction after different treatments and analyze their potential correlation.

Methods:

Fifty-two patients undergoing alveolar cleft repair in our center from 2019 to 2023 were investigated using a questionnaire developed by our team. SPSS and AMOS software were used for reliability and validity tests to determine the final structure of the scale. The descriptive analysis, correlation analysis, and difference analysis were conducted based on the questionnaire data.

Results:

The final version of the questionnaire includes 3 parts with a total of 14 questions: alveolar repair-related quality of life scale, iliac crest-related quality of life scale, and postoperative satisfaction scale. In this study, the mean values of iliac crest-related quality of life after BMC combined with β-TCP granules repair and ICBG repair were 4.67 and 3.06, and the mean values of overall satisfaction were 4.31 and 3.79, respectively.

Conclusion:

The innovative questionnaire can be used as a reliable and valid tool for alveolar cleft repair postoperative evaluation. In this study, the quality of life and satisfaction of patients after alveolar cleft repair with both materials were good and positively correlated. Patients repaired by BMC combined with β-TCP had significantly better iliac crest-related quality of life, iliac donor site satisfaction, and overall satisfaction than patients repaired with ICBG.
Nonsurgical Correction of Deviated Nose Using Hyaluronic Acid Fillers
Authors: Yi Kyu-Ho , Wan Jovian , Yoon Song Eun , Jitaree Benrita , Kim﻿ Soo-Bin﻿
Published: February 2025

Background:

Nonsurgical correction of a deviated nose using hyaluronic acid (HA) fillers offers a minimally invasive alternative to traditional rhinoplasty. This study presents a series of cases demonstrating the efficacy of HA fillers in achieving improved nasal symmetry and alignment.

Methods:

Five female patients, aged 23 to 44, with varying degrees of nasal deviation, were treated with HA fillers. The filler was strategically injected into the deep subcutaneous or supraperiosteal planes to correct the nasal contour.

Results:

All patients showed significant improvement in nasal alignment and symmetry. The corrections were maintained during follow-up, and patients reported high satisfaction with minimal complications. HA fillers effectively camouflaged nasal deviations, providing a straighter appearance without invasive surgery.

Conclusion:

HA fillers offer a viable, nonsurgical option for correcting mild to moderate nasal deviations, providing satisfactory esthetic results with reduced downtime. However, limitations exist in addressing structural issues like septal deviation, and the results are temporary, necessitating periodic retreatment.

Evidence-based Level:

Level IV.
Maintenance Electroconvulsive Therapy for Treatment-Resistant Irritability in Autism Due to Depression in an Adolescent
Authors: Altunkilic Enes Faruk , Karacetin Gul , Gurel Ficicioglu Ipek Ege , Gurtay Ezgi , Kayan Ocakoglu Binay , Tonyali Aysegul
Published: February 2025

Irritability may be seen in patients with autism spectrum disorder, and it may be treated medically. The core features of the ASD diagnosis may confound presumed treatment resistance of irritability in ASD. Mood disorders should be in differential diagnosis if irritability is treatment-resistant in patients with autism. Electroconvulsive therapy (ECT) may be an effective treatment of choice in such patients. In this case report, we present a 16-year-old, 10-month-old male adolescent with autism spectrum disorder who was admitted to our inpatient service due to his self-harming and aggressive behavior with the possibility of severe harm resulting to others. His irritability was resistant to medical treatment; therefore, an underlying mood disorder was considered in the differential diagnosis. This case report presents a patient with treatment-resistant irritability in autism who was treated with fluoxetine and ECT. ECT is being continued as maintenance ECT. While this case is being written, he has received 36th maintenance ECT at a frequency of twice a week. This patient has benefited from a combination of fluoxetine and ECT. In conclusion, in the presence of irritability unresponsive to pharmacological and behavioral treatment in a patient with nonverbal autism spectrum disorder, an underlying mood disorder should be considered, and treatment should be arranged accordingly; ECT and maintenance ECT may be an effective treatment option.
Impact of Anesthesia on Electroconvulsive Therapy–Related Impairments in Global Cognitive Function in Patients With Treatment-Resistant Depression
Authors: Bernardoff Léo , Blay Martin , Thellier Dimitri , D'Amato Thierry , Galvao Filipe , Poulet Emmanuel
Published: February 2025

Introduction

Electroconvulsive therapy (ECT) in patients with treatment-resistant depression frequently leads to impairments in global cognitive function. Propofol and etomidate are the 2 most frequently used drugs for anesthetic induction during ECT. However, only few studies compared their differential impact on ECT-related impairments in global cognitive function.

Methods

We studied retrospectively 75 patients hospitalized at Centre Hospitalier Le Vinatier (Bron, France) who met the DSM-V criteria for major depressive disorder and were treated with bilateral ECT to compare the effects of propofol and etomidate on ECT-related cognitive impairment. Global cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), and symptom severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), both before and after treatment. The primary endpoint of the study was the change in MoCA score.

Results

We found no significant difference in MoCA score variation between the etomidate and propofol groups. There were also no significant differences in MADRS score variation, responder, remission rate or ECT parameters between the 2 groups (except duration of electroencephalogram crisis).

Conclusions

In this retrospective study, choice of etomidate or propofol as anesthetic agent had no impact on the adverse effects associated with ECT on global cognitive function in patients with treatment-resistant depression.
Immunogenicity of virus-like particle vaccine candidates against SARS-CoV-2 infection
Authors: Nguyen Hai Trong , Garg Ravendra , Kroeker Andrea , Gerdts Volker , Falzarano Darryl , Liu Qiang , Baconawa Amelia
Published: February 2025

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve, potentially leading to variants of concern that could become more transmissible, resist treatment, evade host immunity and reduce the effectiveness of currently available vaccines. Improved vaccines are still required as vaccination remains the most effective strategy against this virus. We have produced two SARS-CoV-2 virus-like particles (VLPs) using a baculovirus BacMam expression platform and examined their immunogenicity in mice. VLP1 contains the spike protein from the Wuhan strain, whereas VLP2 contains that of an Omicron variant. Mice immunized with VLP1 and boosted with VLP2 developed significantly higher antibodies in the sera, as well as higher numbers of IFN-γ secreting cells than the control group. Furthermore, both VLPs induced virus-neutralizing antibodies against Wuhan and Omicron variants. In conclusion, VLPs have the potential for the development of a safe and effective vaccine against SARS-CoV-2 variants.
Comparative Modeling of Antibiotic Resistance, Tolerance, and Persistence in Mycobacterium tuberculosis and Staphylococcus aureus
Authors: Piranfar Vahhab
Published: February 2025

Antibiotic resistance, tolerance, and persistence represent key bacterial survival strategies that impact treatment outcomes and global health. WhileStaphylococcus aureusis a rapidly growing pathogen associated with acute infections,Mycobacterium tuberculosisexhibits slow growth and chronic persistence, necessitating prolonged antibiotic regimens. In this study, we developed mathematical models and computational simulations to compare bacterial survival under antibiotic exposure, quantifying differences in resistance, tolerance, and persistence. Using logistic growth equations and biphasic killing models, we simulated bacterial population dynamics under antibiotic pressure. Our results indicate thatS. aureusexhibits rapid initial tolerance with a killing rate of 0.2/hour, followed by a sharp decline, whereasM. tuberculosisdisplays a prolonged persistence phase with a slow killing rate of 0.001/hour, allowing it to survive extended antibiotic exposure. The transition from fast to slow killing occurs significantly earlier inS. aureus(80 hours). These findings highlight the necessity of prolonged therapy for tuberculosis and suggest that alternative persister-targeting interventions are needed for persistentS. aureusinfections.
UB-MBX-46 is a potent and selective antagonist of the human P2X7 receptor developed by structure-based drug design
Authors: Oken Adam C. , Turcu Andreea L. , Tzortzini Eva , Georgiou Kyriakos , Nagel Jessica , Barniol-Xicota Marta , Kim Ga-Ram , Lee So-Deok , Nicke Annette , Kim Yong-Chul , Müller Christa E. , Kolocouris Antonios , Vázquez Santiago , Mansoor Steven E.
Published: February 2025

The P2X7 receptor is an ATP-gated ion channel that activates inflammatory pathways involved in diseases such as cancer, atherosclerosis, and neurodegeneration. However, despite the potential benefits of blocking overactive signaling, no P2X7 receptor antagonists have been approved for clinical use. Interspecies variation among existing antagonists has proven challenging, in part due to the dearth of molecular information on different receptor orthologs. Here, to identify distinct molecular features in the human receptor, we determine high-resolution cryo-EM structures of the full-length wild-type human P2X7 receptor in apo closed and ATP-bound open state conformations and draw comparisons with new and existing structures of other orthologs. We also report a cryo-EM structure of the human receptor in complex with an adamantane-based inhibitor, which we leverage, in conjunction with functional data and molecular dynamics simulations, to design a potent and selective antagonist with a unique polycyclic scaffold. Functional and structural analysis reveal how this optimized ligand, UB-MBX-46, interacts with the classical allosteric pocket of the human P2X7 receptor with picomolar potency and high selectivity, revealing its significant therapeutic potential.
Postoperative glycemic variability as a predictor for one-year mortality following coronary artery bypass grafting: A retrospective cohort study
Authors: Ma Jiasen , Qin Junjun , Mao Fengkai , He Changlin , Ma Daqing , Zhu Jinpiao
Published: February 2025

Background

Increased postoperative glycemic variability (GV) has been shown to be associated with an increased risk for adverse outcomes. However, the impact of postoperative GV on the long-term mortality after cardiac surgery, particularly with regarding other associated interactive factors, remains unknown. In this study, we sought to investigate whether postoperative GV is associated with one-year mortality, and to determine whether preoperative hemoglobin A1C (HbA1C) levels or diabetes status contribute to the risk of GV-related one-year mortality following coronary artery bypass grafting (CABG).

Methods

Data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database derived from 3,598 patients, who underwent their CABG surgery and subsequently admitted to the ICU between 2008 and 2019, were retrospectively analysed. Patients were categorized into two groups based on the postoperative GV levels: the GV-Low group (GV < 0.219, n=2,399) and the GV-High group (GV ≥ 0.219, n=1,199). Cox proportional hazards models were used to examine the association between postoperative GV and one-year mortality. Kaplan-Meier curves assessed cumulative survival, while restricted cubic splines (RCS) evaluated potential non-linear relationships. Cox regression was carried out to determine the impact of postoperative GV changes on one-year mortality.

Results

The one-year mortality rate was 4.92% following CABG. Multivariate Cox proportional hazards analysis revealed a significant association between postoperative GV and one-year mortality, with harzard ratio of 10.372 (95% CI, 3.973–27.077) in the unadjusted model, 9.065 (95% CI, 3.387–24.263) in the partially adjusted model, and 4.599 (95% CI, 1.662–12.726) in the fully adjusted model. This association followed a linear pattern (p-non-linearity = 0.962). In addition, the association was stronger in patients without diabetes millutes (DM) (odds ratio [OR], 2.781; 95% CI, 1.709–4.526) or in patients with preoperative HbA1c levels ≤ 7.0% (OR, 2.225; 95% CI, 1.537–3.221).

Conclusion

Increased postoperative GV is associated with higher one-year mortality following CABG, particularly in patients without DM. These findings may offer valuable guidance for targeted strategies to reduce mortality after cardiac surgery.
Antero-posterior patterning in the brittle starAmphipholis squamataand the evolution of body plans across echinoderms
Authors: Formery L. , Peluso P. , Rank D. R. , Rokhsar D. S. , Lowe C. J.
Published: February 2025

Although the adult pentaradial body plan of echinoderms evolved from a bilateral ancestor, identifying axial homologies between the morphologically divergent echinoderms and their bilaterian relatives has been an enduring problem in zoology. The expression of conserved bilaterian patterning genes in echinoderms provides a molecular framework for resolving this puzzle. Recent studies in juvenile asteroids suggest that the bilaterian antero-posterior axis maps onto the medio-lateral axis that is perpendicular to each of the five rays of the pentaradial body plan. Here we test this hypothesis in another echinoderm class, the ophiuroids, using the cosmopolitan brittle starAmphipholis squamata. Our results show that the general principles of axial patterning are similar to those described in asteroids, and comparisons with existing molecular data from other echinoderm taxa support the idea that medio-lateral deployment of the AP patterning program across the rays predates the evolution of the asterozoan and likely the echinoderm crown-groups. Our data also reveal expression differences betweenA. squamataand asteroids, which we attribute to secondary modifications specific to ophiuroids. Together, this work provides important comparative data to reconstruct the evolution of axial properties in echinoderm body plans.
Optimal management of isolated left vertebral artery in total arch replacement with frozen elephant trunk for aortic dissection
Authors: Zhou Sangyu , Liu Yanxiang , Zhang Bowen , Wang Luchen , Zhao Ruojin , Xie Mingxing , Chen Xuyang , Yu Cuntao , Dun Yaojun , Sun Xiaogang
Published: February 2025

Background

The presence of an isolated left vertebral artery (ILVA) in patients with aortic dissection (AD) is a rare and challenging condition. This study aims to determine the optimal management of ILVA in patients with AD undergoing total arch replacement with frozen elephant trunk (TAR with FET).

Methods and Results

This retrospective study enrolled 94 patients with ILVA and AD who underwent TAR with FET. Patients were divided into three groups: 18 patients underwent ligation of ILVA, 52 underwent ILVA- left subclavian artery (LSCA) transposition, and 24 underwent ILVA- left common carotid artery (LCCA) transposition. Vertebral artery dominance was left-dominant in 10.6%, symmetric in 33.0%, and right-dominant in 56.4% of patients. Notably, patients who underwent ligation of ILVA had either symmetric or right-dominant vertebral arteries, with no left-dominant cases. No strokes were observed. Paraplegia/paraparesis, mechanical ventilation time, and long-term survival were comparable among the three groups. Follow-up computed tomographic angiography (CTA) confirmed patency of the left vertebral artery in all patients who underwent ILVA transposition.

Conclusions

Ligation of ILVA, ILVA-LSCA transposition, and ILVA-LCCA transposition are all feasible and safe strategies for managing ILVA in patients with AD undergoing TAR with FET. However, ligation of ILVA is not recommended for patients with left-dominant vertebral arteries.
Both composition and configuration of forests and urban development shape bat activity and diversity in North American temperate forests
Authors: Chen Sihao , Li Han
Published: February 2025

Temperate forest ecosystems are important habitats for many bat species. However, these habitats are increasingly affected by anthropogenic disturbances, particularly urban development, leading to landscapes with varying land cover composition and configuration. Limited research has examined how forest and urban landscape composition and configuration influence bat activity and diversity. Using a multi-year statewide bat acoustic monitoring dataset from North Carolina, United States, we investigated the effects of forest and urban composition and configuration at multiple spatial scales on bat activity and diversity. First, we constructed single-variable landscape index regression models and found that both composition and configuration of forests and urban developments influenced bat activity and diversity in a species-specific manner. Next, we applied a hierarchical partitioning approach to compare the relative contributions of composition and configuration indices in explaining variance in bat activity. For big brown bats and hoary bats, evergreen forest and urban development composition indices contributed the most to explaining activity variance. In contrast, for eastern red bats, evening bats, and tricolored bats, deciduous forest fragmentation indices describing landscape configuration were the most influential factors. Silver-haired bat activity variance was primarily explained by an evergreen forest fragmentation index. Lastly, urban development configuration indices were the strongest predictors of Mexican free-tailed bat activity and total bat activity. These results suggest that forest and urban landscape configuration should be considered in conservation and management planning for North American temperate forest ecosystems, particularly in regions that have not experienced drastic deforestation in recent decades.