bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 6 Combined Umbilical Cord Mesenchymal Stromal/Stem Cell Application For Primary Torsion Dystonia Treatment (Case Report)
Authors: Petriv Taras , Vorodi Milan , Tsymbaliyk Yaroslav , Tsymbaliuk Yulia , Luzan Boris , Tsymbaliuk Vitaliy
Published: September 2023

Introduction

Primary torsion dystonia (PTD) is a neurological disorder characterized by sustained or intermittent muscle contractions causing abnormal movements and/or postures with severe disability of young patients. Traditional therapies for PTD include oral anti-parkinsonism drugs, botulinum neurotoxin, pallidotomy and deep brain stimulation. Stem cell therapy is another promising treatment option, due to its neuroregenerative properties.

Objectives

The objective of the study was to investigate the effect of combined (intrathecal and intravenous) administration of umbilical cord derive stromal/stem cells (UC-MCS) on PTD reduction.

Methods

Patient M, born on 25.06.2004, fell ill gradually, 8 years ago developed signs of muscle dystonia, especially in right hand. Genetic tests were carried out, which revealed mutations in the DYT-1 gene. The diagnosis of primary torsion dystonia was established. Conservative treatment was not effective. The patient was offered treatment in the frame of research scientific program "To investigate the effectiveness of regenerative cell technologies in the neurosurgical treatment of patients with demyelinating diseases of the CNS and cerebral palsy. № 0119U000112" UC-MSCs for this study were isolated from healthy human umbilical cord and prepared due to the minimal criteria established by the Mesenchymal and Tissue Stem Cell Committee of the International Society for Cellular Therapy. 3 injections of UC-MSC were performed with time interval of 6 month (intravenously and intrathecally in a dose of 6 × 107at each injection). Intrathecal administration was performed according to the typical method of performing lumbar puncture in compliance with the rules of asepsis and antiseptics in the operation room using local anesthesia.

Results

Prior to stem cells injection, the patient's Unified Dystonia Rating Scale (UDRS) dystonia movement score was 15, which progressively decreased after procedure to 13, 10, 7 and 4 after 6, 12, 18 and 24 months respectively. There was a significant improvement in the patient's quality of life.

Discussion

UC-MSC significantly reduce dystonia in patient. This result is probably achieved due to the neuroregenerative and neurotrophic effects of UC-MSCs. Study results suggest the need to provide larger multicenter randomized studies with more sophisticated methods of investigations.
Abstract 11 Monitoring Cord Blood Inventory Reliability by Key Quality Indicators At and After Release
Authors: Frenet Emeline Masson , Sung Dorothy , Watanabe Chiseko , Chowtee Bryana , Bentsen Helen , Liu WenJun , Tabar Sara , Romeo Cynthia , Lu Ling , Shi Patricia , Jimenez Alexandra
Published: September 2023

Introduction

As per FACT standards, Cord Blood Banks (CBB) have to verify that they provide a safe and effective product for transplant. Validated processing methods and storage conditions are the first steps towards this goal, but what are the final steps to monitor the quality of the cord blood units (CBU) released for transplant?

Objectives

We present here a retrospective analysis of our Program’s final verification process to meet this FACT requirement.

Methods

CBU shipped between January 2018 and December 2022 were reviewed for out of specification events. The following Quality Control (QC) parameters were measured on attached segments before shipment: total nucleated cells (TNC), viable CD34 cells (vCD34), and colony forming units (CFU). Confirmed date of infusion and engraftment data were obtained from CIBMTR.

Results

A total of 619 CBU were shipped during the study period. 550 had a segment analyzed at the time of shipment. Average post-thaw CD34 viability on the segments was 93.5% (Table 1). Average recoveries for TNC, viable CD34 and CFU were 83.3%, 64.90% and 60.86%, respectively (Table 1). 6 (1%) CBUs were found to have CD34 viability lower than FACT requirement (≥70%) (Table 1). Investigations were performed for each CBU, concluding that these were technical issues with no repercussion on the final product. No segments demonstrated absence of CFU growth. 544 CBUs had an infusion date recorded by CIBMTR (Table 1). 250 of the CBU infused had engraftment data, and 242 engrafted. 8 (3%) CBU transplants resulted in non-engraftment. All had QC results within expected range (Table 1).

Discussion

Our QC results confirm the continued stability of the CBU until shipment. The small subset of CBU with out of specification results were linked to technical issues and did not affect the outcome of transplant. Outcome data is another way of assessing the quality of the CBUs, even though it may be influenced by many factors out of the CBB’s responsibility (such as diagnosis, conditioning, multiple transplants, etc…). The combined analysis of the two datasets is a good way for a CBB to ensure processes are performing as expected over time and monitor the quality of the final product.
Abstract 32 Expanded Umbilical Cord Blood CD34+ Cells Are Immunomodulatory in a Rat Model of Neonatal Brain Injury
Authors: Penny Tayla , Watt Ashalyn , Marzan Ricki , Pham Yen , Sutherland Amy , Smith Madeleine , Jenkin Graham , Miller Suzanne , McDonald Courtney
Published: September 2023

Introduction

Hypoxic ischemic (HI) insults during pregnancy and birth can result in neurodevelopmental disorders, including cerebral palsy. We have previously shown that multiple doses of umbilical cord blood (UCB) cells are needed to effectively reduce long-term neuropathology and behavioural outcomes. Unfortunately, for multiple doses it is likely that UCB expansion will be required to increase the number of cells available for treatment.

Objectives

In this study, we aimed to investigate the efficacy of expanded UCB derived CD34+ cells in modulating perinatal brain injury.

Methods

UCB derived CD34+ cells were expanded over a 14-day period using a previously optimised expansion protocol. HI injury was induced in postnatal day (P) 10 rats by left carotid artery ligation, followed by 90min hypoxia (8% oxygen). Pups were administered 1 million expanded UCB cells (eUCB) on P11, 13 and 20. Rats underwent extensive behavioural testing and post-mortem was performed on either P17 or P50 where tissue was collected for flow cytometry or immunohistochemistry analysis.

Results

After the 14-day expansion there was a ~800-fold increase in cell number with 70.7±2.18% CD34+ cells. Flow cytometry at P17 showed a significant increase in peripheral regulatory T-cells following eUCB administration (P=0.047). At P50, HI brain injury resulted in significant behavioural deficits and adverse neuropathologies. Multiple doses of eUCB significantly reduced microglial activation compared to HI in the cortex (P=0.02) and the hippocampus (P=0.018).

Discussion

Results from this study show for the first time that expanded UCB-derived CD34+ cells are a promising treatment option for perinatal brain injury as they have significant anti-inflammatory properties.
A Gray Future: The Role of the Anesthesiologist in Hybrid Warfare
Authors: Granholm Fredrik , Tin Derrick , Doyle Leilani , Ciottone Gregory
Published: September 2023

During the last few decades, the increasing use of asymmetric and multimodal tactics by terrorists has led anesthesiologists worldwide to analyze and discuss their role in mass casualty scenarios in more depth. Now anesthesiologists must address the new situation of hybrid threats and hybrid warfare. This will have a direct impact on anesthesiology and intensive care, and in the end, the health and well-being of critical patients of all ages. To be able to respond to a hybrid threat efficiently and effectively, it is imperative that anesthesiologists play an early and integral role in mitigation and response planning.
Synthetic Interbody Devices and Traditional Bone Graft Are Associated With a Similar Rate of Surgical Complications After 1-2 Level Anterior Cervical Discectomy and Fusions
Authors: Shukla Geet , Matur Abhijith V. , Tao Xu , Khalid Syed , Garner Rebecca , Gibson Justin , Cass Daryn , Wu Andrew , Street Seth , Garcia-Vargas Julia , Mehta Jay , Childress Kelly , Duah Henry O. , Motley Benjamin , Cheng Joseph , Adogwa Owoicho
Published: September 2023

Study Design:

Retrospective cohort.

Objective:

To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures.

Summary of Background Data:

Cervical degenerative disorders affect up to 60% of older adults in the United States. Both traditional allograft or autograft and synthetic interbody devices (polyetheretherketone or titanium) are used for decompression and arthrodesis, with increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized.

Patients and Methods:

Patients who underwent 1-2 level ACDFs for cervical radiculopathy or myelopathy between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for nondegenerative pathologies, such as tumors, trauma, or infection, were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was the development of all-cause surgical complications after 1-2 level ACDFs. The secondary outcome was all-cause medical complications.

Results:

1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications was found between the synthetic cohort and the allograft or autograft cohort after 1-2 level ACDFs (Relative Risk: 0.86, 95% confidence interval: 0.730–1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (Relative Risk: 0.73, 95% confidence interval: 0.554–0.974, P = 0.037), which was higher in the allograft/autograft cohort.

Conclusion:

After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.
DermaClose: A Case Series in the Management of Large Soft Tissue Defects in Diabetic Foot Infection
Authors: Brannigan Kathryn , Yao Susie Zhi Jie , Gee Edward
Published: September 2023

Diabetic foot infection poses a complex problem due to several interrelated issues, including rapidly spreading infection, poor vascular supply, and reduced healing ability. Management may require multiple operative procedures and prolonged treatment with a high risk of morbidity, such as amputation, and mortality.

Debridement of infection commonly creates large wounds and soft tissue defects, with limited soft tissue reconstructive options due to adverse local and systemic factors. In this setting, treatment often consists of protracted periods of secondary wound healing by granulation, de-tensioning the tissues by removing bone, and minor or major amputation. Flaps and grafts may be considered but often carry unacceptable rates of failure. We present 3 cases in which DermaClose, an automated wound management system, was employed by a joint Orthopedic and Plastic Surgery team with excellent results and rapid closure of large soft tissue defects.

Level of Evidence:

Level IV.
Prevalence and Risk Factors for Weaning Failure From Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Insufficiency*
Authors: Gerhardinger Felix , Fisser Christoph , Malfertheiner Maximilian V. , Philipp Alois , Foltan Maik , Zeman Florian , Stadlbauer Andrea , Wiest Clemens , Lunz Dirk , Müller Thomas , Lubnow Matthias
Published: September 2023

OBJECTIVE:

Analysis of the prevalence and risk factors for weaning failure from venovenous extracorporeal membrane oxygenation (VV-ECMO) in patients with severe acute respiratory insufficiency.

DESIGN:

Single-center retrospective observational study.

SETTING:

Sixteen beds medical ICU at the University Hospital Regensburg.

PATIENTS:

Two hundred twenty-seven patients with severe acute respiratory insufficiency requiring VV-ECMO support between October 2011 and December 2017.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Patients meeting our ECMO weaning criteria (Spo
2 ≥ 90% with Fio
2 ≤ 0.4 or Pao
2/Fio
2 > 150 mm Hg, pH = 7.35–7.45, positive end-expiratory pressure ≤ 10 cm H2O, driving pressure < 15 cm H2O, respiratory rate < 30/min, tidal volume > 5 mL/kg, ECMO bloodflow ≈ 1. 5 L/min, sweep gas flow ≈ 1 L/min, heart rate < 120/min, systolic blood pressure 90–160 mm Hg, norepinephrine < 0.2 µg/[kg*min]) underwent an ECMO weaning trial (EWT) with pausing sweep gas flow. Arterial blood gas analysis, respiratory and ventilator parameters were recorded prior, during, and after EWTs. Baseline data, including demographics, vitals, respiratory, ventilator, and laboratory parameters were recorded at the time of cannulation. One hundred seventy-nine of 227 (79%) patients were successfully decannulated. Ten patients (4%) underwent prolonged weaning of at least three failed EWTs before successful decannulation. The respiratory rate (19/min vs 16/min, p = 0.002) and Paco
2 (44 mm Hg vs 40 mm Hg, p = 0.003) were higher before failed than successful EWTs. Both parameters were risk factors for ECMO weaning failure (Paco
2: odds ratio [OR] 1.05; 95% CI, 1.001–1.10; p = 0.045; respiratory rate: OR 1.10; 95% CI, 1.04–1.15; p < 0.001) in multivariable analysis. The rapid shallow breathing index [42 (1/L*min), vs 35 (1/L*min), p = 0.052) was higher before failed than successful EWTs. The decline of Sao
2 and Pao
2/Fio
2 during EWTs was higher in failed than successful trials.

CONCLUSIONS:

Seventy-nine percent of patients were successfully decannulated with only 4% needing prolonged ECMO weaning. Before EWT only parameters of impaired ventilation (insufficient decarboxylation, higher respiratory rate) but not of oxygenation were predictive for weaning failure, whereas during EWT-impaired oxygenation was associated with weaning failure.
Factors associated with the efficacy of mature oocyte production after dual-trigger controlled ovarian stimulation using a GnRH antagonist protocol
Authors: New Geok Huey , Wu Wen-Bin , Chen Hsuan-Ting , Lin Jun-Jie , Lai Tsung-Hsuan
Published: September 2023

Background:

The number of mature oocytes retrieved plays a significant role in determining embryo development and pregnancy outcomes of in vitro fertilization (IVF). However, studies investigating factors predictive of the efficacy of mature oocyte production (EMOP) after dual-trigger controlled ovarian stimulation (COS) are rare. This study aims to identify key predictors of EMOP during dual-trigger COS with a gonadotropin-releasing hormone (GnRH) antagonist protocol for IVF.

Methods:

This retrospective cohort study included 359 first-time IVF patients undergoing dual-trigger COS with a GnRH antagonist protocol. EMOP was defined as the ratio of metaphase II (MII) oocyte count to antral follicle count (AFC). Based on EMOP results, patients were divided into two groups: group A (EMOP <70%; n = 232) and group B (EMOP ≥70%; n = 127).

Results:

Multivariate logistic regression analysis revealed that day-2 follicle-stimulating hormone (FSH), stimulation duration, and total oocyte count were the most significant predictors of EMOP (p < 0.05; odds ratios: 1.637, 3.400, and 1.530, respectively). Receiver operating characteristic analysis demonstrated that total oocyte count <9.5 (area under the curve [AUC], 0.782; sensitivity, 76.2%; specificity, 69.2%; p < 0.001) and stimulation duration <9.5 days (AUC, 0.725; sensitivity, 63.5%; specificity, 66.7%; p < 0.001) significantly predicted EMOP <70%. Stimulation duration combined with total oocyte count exhibited the highest power in predicting EMOP <70% (AUC, 0.767; sensitivity, 92.3%; specificity, 42.4%).

Conclusion:

Stimulation duration combined with total oocyte count was identified as the most important factor associated with the EMOP during dual-trigger COS in IVF using a GnRH antagonist protocol.
Control Attitudes Scale-Revised–Brazilian Version
Authors: de Araujo Kaji Priscila , de Lucena Ferretti-Rebustini Renata Eloah , Bosco Aprile Daniele Cristina , de Lima Lopes Juliana , Batista Santos Vinicius , Takao Lopes Camila
Published: September 2023

Background

Heart failure demands self-care skills and behaviors that can be negatively impacted by a low level of perceived control (PC), a belief about having the necessary resources to deal with negative events. Having valid and reliable instruments to measure PC is important to support interventions that improve self-care and related outcomes. The Control Attitudes Scale-Revised (CAS-R) was developed in the United States to measure PC in cardiac conditions. In Brazil, there are no instruments available to measure this construct.

Objective

The aims of this study were to translate and adapt the CAS-R to the Brazilian population and to assess the content validity of the adapted version.

Methods

The CAS-R was translated, back-translated, and assessed by an expert committee for linguistic equivalences. An agreement > 80% was considered adequate. Content validity (clarity, theoretical relevance, and practical pertinence) was assessed by both an expert professional panel (n = 6–8) and a panel of patients with heart failure (n = 40). A content validity coefficient > 0.70 was considered acceptable.

Results

The translations to Brazilian Portuguese were considered consistent with the original CAS-R. In the third round of linguistic equivalence assessment, all items achieved acceptable agreement, except for 2 items. After modifications to the instrument to achieve adequate equivalences, the adapted version had a final content validity coefficient of 0.93. Most patients were able to understand the instrument.

Conclusions

The CAS-R–Brazilian version is equivalent to the original CAS-R and has satisfactory evidence of content validity. Additional psychometric testing will be performed to allow for the assessment of PC in individuals with heart failure in Brazil.
Evaluation of stroke volume estimation during orthostatic stress: the utility of Modelflow
Authors: Lucci Vera-Ellen M. , Parsons Iain T. , Hockin Brooke C.D. , Claydon Victoria E.
Published: September 2023

Advanced blood pressure monitoring devices contain algorithms that permit estimation of stroke volume (SV). Modelflow (Finapres Medical Systems) is one common method to non-invasively estimate beat-to-beat SV. However, Modelflow accuracy during profound reductions in SV is unclear. We aimed to compare SV estimation by Modelflow and echocardiography, at rest and during orthostatic challenge. We tested 13 individuals (age 24 ± 2 years; 7 female) using combined head-up tilt and graded lower body negative pressure, continued until presyncope. SV was derived by both Modelflow and echocardiography on multiple occasions while supine, during orthostatic stress, and at presyncope. SV index (SVI) was determined by normalising SV for body surface area. Bias and limits of agreement were determined using Bland-Altman analyses. Two one-sided tests (TOST) examined equivalency. Across all timepoints, Modelflow estimates of SV (73.2 ± 1.6 ml) were strongly correlated with echocardiography estimates (66.1 ± 1.3 ml) (r = 0.56, P < 0.001) with a bias of +7.1 ± 21.1 ml. Bias across all timepoints was further improved when SV was indexed (+3.6 ± 12.0 ml.m-2). Likewise, when assessing responses relative to baseline, Modelflow estimates of SV (−23.4 ± 1.4%) were strongly correlated with echocardiography estimates (−19.2 ± 1.3%) (r = 0.76, P < 0.001), with minimal bias (−4.2 ± 13.1%). TOST testing revealed equivalency to within 15% of the clinical standard for SV and SVI, both expressed as absolute values and relative to baseline. Modelflow can be used to track changes in SV during profound orthostatic stress, with accuracy enhanced with correction relative to baseline values or body size. These data support the use of Modelflow estimates of SV for autonomic function testing.
How we can improve the appropriateness of ambulatory gastrointestinal endoscopy: the lesson of the COVID-19 outbreak
Authors: Tursi Antonio , Palieri Antonio Pio , Lattarulo Vincenzo , Elefante Antonio , Gigliobianco Andrea , Spinazzola Domenico , Elisei Walter , Papa Alfredo
Published: September 2023

Background

The coronavirus disease 2019 (COVID-19) outbreak has significantly modified hospital and outpatient activities.

Aims

To assess the pandemic’s impact on the appropriateness of outpatient gastrointestinal (G.I.) endoscopy in a southern Italy Region.

Methods

Between 1 January 2019 and 31 December 2022, we compared the number, the type of activities, and the appropriateness of the G.I. endoscopy procedures in the four territorial gastroenterology and digestive endoscopy services of the Apulia region.

Results

In 2019, 11 173 outpatient procedures were provided, which dropped by about 44% (P < 0.05) during 2020. The endoscopic activity was slightly reduced during 2020 (−18.77%), while every other activity dropped significantly. During 2021–2022, the overall activities slightly increased but remained below the number of activities provided before the pandemic (P < 0.05). However, the endoscopic activity increased by +6.86% from 2019 to 2022, mainly due to more colonoscopies. During the 4 years analysed, the overall appropriateness rate of the endoscopic examinations increased during 2020 (2019: 67%; 2020: 81%) while dropping again in the following years (2021: 75%; 2022; 69%).

Conclusion

The appropriateness of the G.I. endoscopic procedures in the territorial gastroenterology services in the Apulia Region has improved during the acute phase of the COVID-19 pandemic, dropping again in the following years. Overall, the appropriateness of endoscopic procedures remains suboptimal; thus, educational activities are needed to improve the appropriateness rate to optimise the limited resources.
Predictive value of SUVmax in visceral pleural invasive lung adenocarcinoma with different diameters
Authors: Sun Xiaoyan , Chang Cheng , Xie Chun , Zhu Jiahao , Ni Xuping , Xie Wenhui , Wang Yuetao
Published: September 2023

Objectives

This study aimed to investigate predictive visceral pleural invasion (VPI) occurrence value of the maximum standardized uptake value (SUVmax) in patients with lung adenocarcinoma (LA).

Patients and methods

A total of 388 LA patients were divided into D1ab, D1c, D1, D2, D2a, D2b, D3, and all patient groups based on their tumor diameter (D). Patients were also classified into negative VPI (VPI-n) and positive VPI (VPI-p) groups according to VPI presence. SUVmax of patients was measured with 18F-fluorodeoxyglucose (FDG) by PET/computed tomography (18F-PET/CT). Receiver operating characteristic (ROC) analysis and the area under curve (AUC) of SUVmax were applied to determine optimal cut-off value for predicting VPI occurrence.

Results

There were significant differences in SUVmax between VPI-n and VPI-p groups (P < 0.05) at the same tumor diameter. SUVmax cut-off value and sensitivity (Se,%) of VPI occurrence in each group were following: D1ab was 3.79 [AUC = 0.764, P < 0.001], Se86.11%; D1c was 5.47 (AUC = 0.706, P < 0.001), Se 93.75%; D1 was 5.49 (AUC = 0.731, P < 0.001), Se 79.76%; D2 was 7.36 (AUC = 0.726, P < 0.001), Se81.67%. All patient group was 7.26 (AUC = 0.735, P < 0.001), Se74.19%.

Conclusion

In LA patients with the same diameter, SUVmax of the VPI-p group was significantly higher than that of the VPI-n group. The cut-off value of SUVmax for predicting VPI of T1 stage, T1 substages, and T2 stage LA could be determined through ROC curve. SUVmax measurement by PET/CT scan in stratified tumor size is helpful for predicting VPI occurrences of the physician.
Retrospective Evaluation of Poisoning Cases Followed Up in Pediatric Intensive Care Unit—A 12-Year Experience in a Single Center
Authors: Boyraz Merve , Botan Edin , Yuce Servet , Erdem Torun Şeyma
Published: September 2023

Objectives

Poisonings constitute an important part of preventable morbidity and mortality in pediatric intensive care units (PICUs) and hospitalizations. However, information on poisoning requiring intensive care is limited. This study aimed epidemiological evaluation of poisoning cases treated in the PICU in a single center.

Methods

The records of 504 patients admitted to the PICU due to acute poisoning between 2010 and 2022 were retrospectively reviewed. Data were evaluated using descriptive methods and the χ2 test, and statistical differences with P value <0.05 were considered significant.

Results

The age range of the patients ranged from 1 month to 216 months (18 years), and the rate of girls was 53.2% (n = 268), whereas the rate of boys was 46.8% (n = 236). The mean age was 4.4 ± 4.3 years for boys, 6.7 ± 5.8 years for girls, and 5.6 ± 5.3 years for all patients. It was determined that 79.6% of the cases were poisoned by accident and 20.4% by suicide. A total of 76.7% of the patients who were poisoned for suicide were girls and 23.3% were boys. The mean age of these patients was 14.3 ± 3.0 years. On the other hand, 47.1% of the children who were accidentally poisoned were girls and 52.9% were boys, and the mean age of these children was 3.4 ± 2.9 years. Although 79.9% of poisonings occurred at home, the causative agent was oral poisoning in 97.4% of the cases. Approximately two thirds (69.2%) of the cases were drug-related, whereas 30.8% were related to nondrug substances. In drug-related poisonings, central nervous system drugs (35.8%) were the most common agent, followed by analgesic/antipyretic (20.9%) agents, whereas among the nonpharmaceutical factors, insecticides (agricultural pesticides, rat poison, pesticides, etc) were the most common, followed by poisonous herbs (beetleweed, widow's weed, cannabis, etc). The mean admission time of the patients to the hospital was 6.3 ± 8.4 hours, and the mean length of stay in the intensive care unit was 1.6 ± 1.3 days. In the 12 years of our study, only 3 patients died due to poisoning, and our mortality rate was 0.5%. Four patients (0.7%) were referred to the Alcohol and Drug Addicts Treatment and Research Center.

Conclusions

In this study, in which we retrospectively analyzed the profiles of poisoning cases hospitalized in the PICU for 12 years, we determined that poisonous weeds were the major factor in accidental poisonings, and suicidal poisonings were above the expected rates even at the young age group such as 8–12 years old. These results show the importance of determining the poisoning profile of the health care service area.
Mandibular Canal Branching Assessed With Cone-Beam Computed Tomography
Authors: Khojastepour Leila , Nasiri Mohammad Mehdi , Hashemi Khadijeh , Ahrari Farzaneh
Published: September 2023

This study aimed to evaluate the prevalence and type of mandibular canal branching in a sample of the Iranian population through cone-beam computed tomography (CBCT) images.

This cross-sectional study was performed on CBCT records of 300 patients (112 males and 188 females; mean age 30.14 ± 10.96 y). The presence of mandibular canal branch (MCB) was evaluated by reconstructing multiple panoramic views and buccolingual cross-sections, according to Naitoh’s classification. The prevalence of MCB, the type of MCB, and the demographic information of all patients were recorded. The maximum number of branching and the maximum type of branching were also registered for each patient.

Mandibular canal branching was observed in 131(43.7%) of 300 CBCT images without side or sex differences (P > 0.05). The most frequent type was dental, followed by the retromolar, forward, and buccolingual types, respectively. There was a statistically higher frequency of retromolar canal in females than in males (odds ratio: 1.14 ± 4.25; P = 0.013). About 46% of patients with MCB had more than one accessory canal and 29% displayed more than one type of MCB. The coincidence of dental and retromolar canals in a patient was the most prevalent combination.

Considering the relatively high prevalence of MCB (43.7%), it is recommended to keep in mind the possibility of anatomical variations of the inferior alveolar nerve during dental procedures to avoid postsurgical complications. The high possibility of observing multiple numbers and types of branching in the patients should also be considered during preoperative assessments.
Biomechanical Performance of Biodegradable Screw Fixation in Mandibular Distraction Osteogenesis
Authors: Firriolo Joseph Mark , Xue Yunfeng , Weyerbacher Jonathan S. , Saldana Golddy M. , Garfinkel Alec , Garcia Tanya C. , Arzi Boaz , Wong Granger B.
Published: September 2023

Internal distraction devices are commonly used in congenital micrognathia. The eventual need for device and screw removal can be challenging, requiring extensive dissection and disturbance of bone regenerate. Bioabsorbable poly-L-lactide (PLLA) screws, compared to traditional titanium screws, simplify device removal. Previous in vivo studies have found that the maximal compressive force generated by mandibular distraction is 69.4N. We hypothesized that PLLA screws could support these compressive/distraction forces. Ten mandibles were obtained from 5 canine cadavers. Paired mandibles from the same cadaver were each fixated to a mandibular distractor with eight screws (either titanium or PLLA). Devices were each set to 15 and 30 mm of distraction distance. Compression force of 80 N was then generated parallel to the axis of the distraction device. Distractor displacement was measured to detect any mechanical failure during this pre-set load. Finally, if no failure was observed at 80 N, a load-to-failure compression test was done in the PLLA group to determine the mechanical failure point. All distractors in both the titanium and PLLA screw groups withstood 80 N of compression without failure. When the load-to-failure test was performed in the PLLA group, the average device failure point was 172.8 N (range 148–196 N). Review of high-frame-rate video demonstrated that all failures occurred due to the PLLA screws breaking or falling out. Bioabsorbable PLLA screws can withstand compressive forces more than double that of the maximal in vivo forces needed during mandibular distraction. These screws may be an acceptable alternative for the fixation of internal mandibular distractors.
Perceived Age and Gender Perception Using Facial Recognition Software Following Facial Feminization Surgery
Authors: Alper David P. , Almeida Mariana N. , Hosseini Helia , De Baun Heloise M. , Moscarelli Jake , Hu Kevin G. , Parikh Neil , Ihnat Jacqueline M.H. , Alperovich Michael
Published: September 2023

Measures of success for facial feminization surgery (FFS) have previously included improved rates of external gender perception as female and patient-reported outcome measures. In this study, we used artificial intelligence facial recognition software to objectively evaluate the effects of FFS on both perceived gender and age among male-to-female transgender patients, as well as their relationship with patient facial satisfaction. Standardized frontal preoperative and postoperative images of 27 transgender women undergoing FFS were analyzed by Amazon’s AI facial recognition software to determine gender, femininity confidence score, and perceived age. Female gender-typing, improvement in gender-typing (preoperatively to postoperatively), and femininity confidence scores were analyzed. To assess patient satisfaction, FACE-Q modules were completed postoperatively. Preoperatively, FFS images were perceived as female 48.1% of the time, and postoperatively, this improved to 74.1% (P=0.05). Femininity confidence scores improved from a mean score of 0.04 preoperatively to 0.39 postoperatively (P=0.003). FFS was associated with a decrease in perceived age relative to the patient’s true age (−2.4 y, P<0.001), with older patients experiencing greater reductions. Pearson correlation matrix found no significant relationship between improved female gender typing and patient facial satisfaction. Undergoing surgery at a younger age was associated with higher overall facial satisfaction (r=−0.6, P=0.01). Transfeminine patients experienced improvements in satisfaction with facial appearance, perceived gender, and decreases in perceived age following FFS. Notably, patient satisfaction was not directly associated with improved AI-gender typing, suggesting that other factors may influence patient satisfaction.
Rhinoplasty for Sinonasal Deformities in Granulomatosis with Polyangiitis: A Systematic Review and Meta-Analysis
Authors: Alanazi Farhan , Alenezi Mazyad , Alanazy Sultan , Yahya Buthaina
Published: September 2023

Background:

Granulomatosis with polyangiitis (GPA) is a vasculitis that affects respiratory and kidney vessels. It primarily involves the nose and sinuses but can progress systemically. Granulomatosis with polyangiitis causes severe nasal deformities, impacting aesthetics and breathing. Literature focuses on rhinoplasty for saddle nose deformities in non-GPA patients, but its suitability for GPA patients remains uncertain.

Aim:

Our study aims to assess the effectiveness and safety of rhinoplasty in GPA patients by analyzing the existing literature.

Methods:

Four databases were searched; 2 reviewers independently screened the retrieved references, then relevant data for our study were extracted. Categorical outcomes were analyzed using pooled proportions and 95% CI. Statistical heterogeneity was assessed using the I
2 statistics χ2 test with a P-value lower than 0.1 indicating heterogeneity.

Results:

In our systematic review and meta-analysis, we incorporated 16 studies encompassing 136 patients who underwent nasal reconstruction as part of their treatment for GPA. The collective findings indicate a favorable success rate for rhinoplasty, with a pooled ratio of 89% (95% CI: 84%, 95%). The rate of revision surgeries was relatively low, with a pooled rate of 19% (95% CI: 12%, 26%). Furthermore, rhinoplasty demonstrated comparatively lower rates of recurrence (pooled rate: 22%, 95% CI: 3%, 42%) and complications (pooled rate: 12%, 95% CI: 7%, 18%).

Conclusion:

Rhinoplasty benefits GPA patients with saddle nose deformity and septal perforation with high success rates and low recurrence, revision, and complication outcomes. However, more research is needed for validation and refinement.
What are the differences between the three most used classifications for acute colonic diverticulitis? A comparative multicenter study
Authors: Cremonini Camilla , Biloslavo Alan , Robustelli Virna , Giannessi Sandro , Rossi Del Monte Simone , Mastronardi Manuela , Musetti Serena , Strambi Silvia , Coccolini Federico , Chiarugi Massimo , Tartaglia Dario
Published: September 2023

BACKGROUND

Acute left-sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. Currently, the most popular classifications, based on radiological findings, are the modified Hinchey, AAST, and WSES classifications. We hypothesize that all classifications are equivalent in predicting outcomes.

METHODS

This is a retrospective study of 597 patients from four medical centers between 2014 and 2021. Based on clinical, radiological, and intraoperative findings, patients were graded according to the three classifications. Regression analysis and receiver operating characteristic curve analysis were used to compare six outcomes: need for intervention, complications, major complications (Clavien–Dindo >2), reintervention, hospital length of stay, and mortality.

RESULTS

A total of 597 patients were included. Need for intervention, morbidity, and reintervention rates significantly increased with increasing AAST, modified Hinchey, and WSES grades. The area under the curve (AUC) for the need for intervention was 0.84 for AAST and 0.81 for modified Hinchey (p = 0.039). The AUC for major complications was 0.75 for modified Hinchey and 0.70 for WSES (p = 0.009). No differences were found between the three classifications when comparing AUCs for mortality, complications, and reintervention rates.

CONCLUSION

The AAST, WSES, and modified Hinchey classifications are similar in predicting complications, reintervention, and mortality rates. AAST and modified Hinchey scores result the most adequate for predicting the need for surgery and the occurrence of major complications.

Level of Evidence

Prognostic and epidemiological study, level III.
Myopathy and Ophthalmologic Abnormalities in Association With Multiple Skeletal Muscle Mitochondrial DNA Deletions
Authors: Carey Andrew R. , Miller Neil R. , Cui Hong , Allis Katrina , Balog Amanda , Bai Renkui , Vernon Hilary J.
Published: September 2023

Background:

Establishing a molecular diagnosis of mitochondrial diseases due to pathogenic mitochondrial DNA (mtDNA) variants can be difficult because of varying levels of tissue heteroplasmy, and identifying these variants is important for clinical management. Here, we present clinical and molecular findings in 8 adult patients with classical features of mitochondrial ophthalmologic and/or muscle disease and multiple mtDNA deletions isolated to muscle.

Methods:

The patients were identified via a retrospective review of patients seen in both a tertiary ophthalmology center and a genetics clinic with a clinical diagnosis of chronic progressive external ophthalmoplegia, optic nerve abnormalities, and/or mitochondrial myopathy. Age at onset of symptoms ranged from 18 to 61 years. Ocular manifestations included bilateral optic neuropathy in one patient, bilateral optic disc cupping without optic neuropathy in 2 patients, ptosis in 4 patients, and ocular motility deficits in 2 patients. Five patients had generalized weakness.

Results:

Pathogenic variants in mtDNA were not found in the blood or buccal sample from any patient, but 7 of 8 patients had multiple mtDNA deletions identified in muscle tissue. One patient had a single mtDNA deletion identified in the muscle. Heteroplasmy was less than 15% for all of the identified deletions, with the exception of one deletion that had a heteroplasmy of 50%–60%. None of the patients were found to have a nuclear gene variant known to be associated with mitochondrial DNA maintenance.

Conclusions:

mtDNA deletions were identified in adult patients with ophthalmologic and/or musle abnormalities and may underlie their clinical presentations.
Obesity and thinness: insights from genetics
Authors: Farooqi Sadaf
Published: September 2023

Genetic disruption of key molecular components of the hypothalamic leptin–melanocortin pathway causes severe obesity in mice and humans. Physiological studies in people who carry these mutations have shown that the adipose tissue-derived hormone leptin primarily acts to defend against starvation. A lack of leptin causes an intense drive to eat and increases the rewarding properties of food, demonstrating that human appetite has a strong biological basis. Genetic studies in clinical- and population-based cohorts of people with obesity or thinness continue to provide new insights into the physiological mechanisms involved in weight regulation and identify molecular targets for weight loss therapy.

This article is part of a discussion meeting issue ‘Causes of obesity: theories, conjectures and evidence (Part II)’.
The dual hypothesis of homeostatic body weight regulation, including gravity-dependent and leptin-dependent actions
Authors: Jansson John-Olov , Anesten Frederik , Hägg Daniel , Zlatkovic Jovana , Dickson Suzanne L. , Jansson Per-Anders , Schéle Erik , Bellman Jakob , Ohlsson Claes
Published: September 2023

Body weight is tightly regulated when outside the normal range. It has been proposed that there are individual-specific lower and upper intervention points for when the homeostatic regulation of body weight is initiated. The nature of the homeostatic mechanisms regulating body weight at the lower and upper ends of the body weight spectrum might differ. Previous studies demonstrate that leptin is the main regulator of body weight at the lower end of the body weight spectrum. We have proposed that land-living animals use gravity to regulate their body weight. We named this homeostatic system the
gravitostat
and proposed that there are two components of the gravitostat. First, an obvious mechanism involves increased energy consumption in relation to body weight when working against gravity on land. In addition, we propose that there exists a component, involving sensing of the body weight by osteocytes in the weight-bearing bones, resulting in a feedback regulation of energy metabolism and body weight. The gravity-dependent homeostatic regulation is mainly active in obese mice. We, herein, propose the
dual hypothesis of body weight regulation
, including gravity-dependent actions (= gravitostat) at the upper end and leptin-dependent actions at the lower end of the body weight spectrum.

This article is part of a discussion meeting issue ‘Causes of obesity: theories, conjectures and evidence (Part II)’.
Diet composition and energy intake in humans
Authors: James Stubbs R. , Horgan Graham , Robinson Eric , Hopkins Mark , Dakin Clarissa , Finlayson Graham
Published: September 2023

Absolute energy from fats and carbohydrates and the proportion of carbohydrates in the food supply have increased over 50 years. Dietary energy density (ED) is primarily decreased by the water and increased by the fat content of foods. Protein, carbohydrates and fat exert different effects on satiety or energy intake (EI) in the order protein > carbohydrates > fat. When the ED of different foods is equalized the differences between fat and carbohydrates are modest. Covertly increasing dietary ED with fat, carbohydrate or mixed macronutrients elevates EI, producing weight gain and vice versa. In more naturalistic situations where learning cues are intact, there appears to be greater compensation for the different ED of foods. There is considerable individual variability in response. Macronutrient-specific negative feedback models of EI regulation have limited capacity to explain how availability of cheap, highly palatable, readily assimilated, energy-dense foods lead to obesity in modern environments. Neuropsychological constructs including food reward (liking, wanting and learning), reactive and reflective decision making, in the context of asymmetric energy balance regulation, give more comprehensive explanations of how environmental superabundance of foods containing mixtures of readily assimilated fats and carbohydrates and caloric beverages elevate EI through combined hedonic, affective, cognitive and physiological mechanisms.

This article is part of a discussion meeting issue ‘Causes of obesity: theories, conjectures and evidence (Part II)’.
Host interactions of novel Crassvirales species belonging to multiple families infecting bacterial host, Bacteroides cellulosilyticus WH2
Authors: Papudeshi Bhavya , Vega Alejandro A. , Souza Cole , Giles Sarah K. , Mallawaarachchi Vijini , Roach Michael J. , An Michelle , Jacobson Nicole , McNair Katelyn , Fernanda Mora Maria , Pastrana Karina , Boling Lance , Leigh Christopher , Harker Clarice , Plewa Will S. , Grigson Susanna R. , Bouras George , Decewicz Przemysław , Luque Antoni , Droit Lindsay , Handley Scott A. , Wang David , Segall Anca M. , Dinsdale Elizabeth A. , Edwards Robert A.
Published: September 2023

Bacteroides, the prominent bacteria in the human gut, play a crucial role in degrading complex polysaccharides. Their abundance is influenced by phages belonging to the Crassvirales order. Despite identifying over 600 Crassvirales genomes computationally, only few have been successfully isolated. Continued efforts in isolation of more Crassvirales genomes can provide insights into phage-host-evolution and infection mechanisms. We focused on wastewater samples, as potential sources of phages infecting various

Bacteroides

hosts. Sequencing, assembly, and characterization of isolated phages revealed 14 complete genomes belonging to three novel Crassvirales species infecting

Bacteroides cellulosilyticus

WH2. These species, Kehishuvirus sp. ‘tikkala’ strain Bc01, Kolpuevirus sp. ‘frurule’ strain Bc03, and ‘Rudgehvirus jaberico’ strain Bc11, spanned two families, and three genera, displaying a broad range of virion productions. Upon testing all successfully cultured Crassvirales species and their respective bacterial hosts, we discovered that they do not exhibit co-evolutionary patterns with their bacterial hosts. Furthermore, we observed variations in gene similarity, with greater shared similarity observed within genera. However, despite belonging to different genera, the three novel species shared a unique structural gene that encodes the tail spike protein. When investigating the relationship between this gene and host interaction, we discovered evidence of purifying selection, indicating its functional importance. Moreover, our analysis demonstrated that this tail spike protein binds to the TonB-dependent receptors present on the bacterial host surface. Combining these observations, our findings provide insights into phage-host interactions and present three Crassvirales species as an ideal system for controlled infectivity experiments on one of the most dominant members of the human enteric virome.
Reference materials for SARS-CoV-2 molecular diagnostic quality control: validation of encapsulated synthetic RNAs for room temperature storage and shipping
Authors: Colotte Marthe , Luis Aurélie , Coudy Delphine , Tuffet Sophie , Robene Isabelle , Fenelon Babbitha , Jouen Emmanuel , Leveque Nicolas , Deroche Luc , Alain Sophie , Plumelle Dorian , Tumiotto Camille , Busson Laurent , Lafon Marie-Edith , Bonnet Jacques
Published: September 2023

The Coronavirus pandemic unveiled the unprecedented need for diagnostic tests to rapidly detect the presence of pathogens in the population. Real-time RT-PCR and other nucleic acid amplification techniques are accurate and sensitive molecular techniques that necessitate positive controls. To meet this need, Twist Bioscience has developed and released synthetic RNA controls. However, RNA is an inherently unstable molecule needing cold storage, costly shipping, and resource-intensive logistics. Imagene provides a solution to this problem by encapsulating dehydrated RNA inside metallic capsules filled with anhydrous argon, allowing room temperature and eco-friendly storage and shipping. Here, RNA controls produced by Twist were encapsulated (RNAshells) and distributed to several laboratories that used them for COVID-19 detection tests by amplification. One RT-LAMP procedure, four different RT-PCR devices and 6 different PCR kits were used. The amplification targets were genes E, N; RdRp, Sarbeco-E and Orf1a/b. RNA retrieval was satisfactory, and the detection was reproducible. RNA stability was checked by accelerated aging. The results for a 10-year equivalent storage time at 25 °C were not significantly different from those for unaged samples. This room temperature RNA stability allows the preparation and distribution of large strategic batches which can be stored for a long time and used for standardization processes between detection sites. Moreover, it makes it also possible to use these controls for single use and in the field where large temperature differences can occur. Consequently, this type of encapsulated RNA controls, processed at room temperature, can be used as reference materials for the SARS-Cov-2 virus as well as for other pathogens detection.