bluuebunny/crossref_metadata_2025 huggingface dataset:
VI—Four Grades of Modal Naturalism
Authors: Wilson Alastair
Published: June 2024

How, if at all, can scientific progress improve our view of the modal facts? According to rationalist approaches to modal epistemology, science has no substantive role: a priori reflection reveals the structure of modal space, and a posteriori science merely locates us within that modal space, by identifying the actual properties and structures instantiated at our world. According to modal naturalist approaches, science provides evidence about the structure of the underlying modal space. In this paper I distinguish four versions of modal naturalism, with science playing an increasingly robust evidential role, and discuss their plausibility.
Sharing sensitive data in life sciences: an overview of centralized and federated approaches
Authors: Rujano Maria A , Boiten Jan-Willem , Ohmann Christian , Canham Steve , Contrino Sergio , David Romain , Ewbank Jonathan , Filippone Claudia , Connellan Claire , Custers Ilse , van Nuland Rick , Mayrhofer Michaela Th , Holub Petr , Álvarez Eva García , Bacry Emmanuel , Hughes Nigel , Freeberg Mallory A , Schaffhauser Birgit , Wagener Harald , Sánchez-Pla Alex , Bertolini Guido , Panagiotopoulou Maria
Published: June 2024

Biomedical data are generated and collected from various sources, including medical imaging, laboratory tests and genome sequencing. Sharing these data for research can help address unmet health needs, contribute to scientific breakthroughs, accelerate the development of more effective treatments and inform public health policy. Due to the potential sensitivity of such data, however, privacy concerns have led to policies that restrict data sharing. In addition, sharing sensitive data requires a secure and robust infrastructure with appropriate storage solutions. Here, we examine and compare the centralized and federated data sharing models through the prism of five large-scale and real-world use cases of strategic significance within the European data sharing landscape: the French Health Data Hub, the BBMRI-ERIC Colorectal Cancer Cohort, the federated European Genome-phenome Archive, the Observational Medical Outcomes Partnership/OHDSI network and the EBRAINS Medical Informatics Platform. Our analysis indicates that centralized models facilitate data linkage, harmonization and interoperability, while federated models facilitate scaling up and legal compliance, as the data typically reside on the data generator’s premises, allowing for better control of how data are shared. This comparative study thus offers guidance on the selection of the most appropriate sharing strategy for sensitive datasets and provides key insights for informed decision-making in data sharing efforts.
Leriglitazone halts disease progression in adult patients with early cerebral adrenoleukodystrophy
Authors: Golse Marianne , Weinhofer Isabelle , Blanco Bernardo , Barbier Magali , Yazbeck Elise , Huiban Camille , Chaumette Boris , Pichon Bertrand , Fatemi Ali , Pascual Silvia , Martinell Marc , Berger Johannes , Perlbarg Vincent , Galanaud Damien , Mochel Fanny
Published: June 2024

Cerebral adrenoleukodystrophy (CALD) is an X-linked rapidly progressive demyelinating disease leading to death usually within a few years. The standard of care is haematopoietic stem cell transplantation (HSCT), but many men are not eligible due to age, absence of a matched donor or lesions of the corticospinal tracts (CST). Based on the ADVANCE study showing that leriglitazone decreases the occurrence of CALD, we treated 13 adult CALD patients (19–67 years of age) either not eligible for HSCT (n = 8) or awaiting HSCT (n = 5).

Patients were monitored every 3 months with standardized neurological scores, plasma biomarkers and brain MRI comprising lesion volumetrics and diffusion tensor imaging.

The disease stabilized clinically and radiologically in 10 patients with up to 2 years of follow-up. Five patients presented with gadolinium enhancing CST lesions that all turned gadolinium negative and, remarkably, regressed in four patients. Plasma neurofilament light chain levels stabilized in all 10 patients and correlated with lesion load. The two patients who continued to deteriorate were over 60 years of age with prominent cognitive impairment. One patient died rapidly from coronavirus disease 2019.

These results suggest that leriglitazone can arrest disease progression in adults with early-stage CALD and may be an alternative treatment to HSCT.
Dose-dependent LSD effects on cortical/thalamic and cerebellar activity: brain oxygen level–dependent fMRI study in awake rats
Authors: Ghaw Ashley , Chunduri Alisha , Chang Arnold , Ortiz Richard J , Kozlowska Milena , Kulkarni Praveen P , Ferris Craig F
Published: June 2024

Lysergic acid diethylamide is a hallucinogen with complex neurobiological and behavioural effects. This is the first study to use MRI to follow functional changes in brain activity in response to different doses of lysergic acid diethylamide in fully awake, drug-naive rats. We hypothesized that lysergic acid diethylamide would show a dose-dependent increase in activity in the prefrontal cortex and thalamus while decreasing hippocampal activity. Female and male rats were given intraperitoneal injections of vehicle or lysergic acid diethylamide in doses of 10 or 100 µg/kg while fully awake during the imaging session. Changes in blood oxygen level–dependent signal were recorded over a 30-min window. Approximately 45-min post-injection data for resting-state functional connectivity were collected. All data were registered to rat 3D MRI atlas with 173 brain regions providing site-specific increases and decreases in global brain activity and changes in functional connectivity. Treatment with lysergic acid diethylamide resulted in a significant dose-dependent increase in negative blood oxygen level–dependent signal. The areas most affected were the primary olfactory system, prefrontal cortex, thalamus and hippocampus. This was observed in both the number of voxels affected in these brains regions and the changes in blood oxygen level–dependent signal over time. However, there was a significant increase in functional connectivity between the thalamus and somatosensory cortex and the cerebellar nuclei and the surrounding brainstem areas. Contrary to our hypothesis, there was an acute dose-dependent increase in negative blood oxygen level–dependent signal that can be interpreted as a decrease in brain activity, a finding that agrees with much of the behavioural data from preclinical studies. The enhanced connectivity between thalamus and sensorimotor cortices is consistent with the human literature looking at lysergic acid diethylamide treatments in healthy human volunteers. The unexpected finding that lysergic acid diethylamide enhances connectivity to the cerebellar nuclei raises an interesting question concerning the role of this brain region in the psychotomimetic effects of hallucinogens.
Assisted peritoneal dialysis in Europe: a strategy to increase and maintain home dialysis
Authors: Reyskens Margot , Abrahams Alferso C , François Karlien , van Eck van der Sluijs Anita
Published: June 2024

Peritoneal dialysis (PD) is a form of kidney replacement therapy with the major advantage that it can be performed at home. This has a positive impact on patients’ autonomy and quality of life. However, the dialysis population is ageing and physical and/or cognitive impairments are common. These limitations often form a barrier to PD and contribute to the low incidence and prevalence of PD in Europe. Assisted PD can be a solution to this problem. Assisted PD refers to a patient being assisted by a person or device in performing all or part of their dialysis-related tasks, thereby making PD more accessible to elderly but also younger frail patients. In this way, offering an assisted PD program can help lower the threshold for initiating PD. In this review, we provide an overview of the epidemiology of assisted PD in Europe, we discuss the different categories and clinical outcomes of assisted PD, and we present how assisted PD can be implemented in clinical practice as a possible strategy to increase and maintain home dialysis in Europe.
Cardiomyocyte βII spectrin plays a critical role in maintaining cardiac function by regulating mitochondrial respiratory function
Authors: Yang Rongjin , Ruan Banjun , Wang Rutao , Zhang Xiaomeng , Xing Pingping , Li Congye , Zhang Yunyun , Chang Xiaoqian , Song Haifeng , Zhang Shun , Zhao Huishou , Zhang Feiyu , Yin Tao , Qi Tingting , Yan Wenjun , Zhang Fuyang , Hu Guangyu , Wang Shan , Tao Ling
Published: June 2024

Aims

βII spectrin is a cytoskeletal protein known to be tightly linked to heart development and cardiovascular electrophysiology. However, the roles of βII spectrin in cardiac contractile function and pathological post-myocardial infarction remodelling remain unclear. Here, we investigated whether and how βII spectrin, the most common isoform of non-erythrocytic spectrin in cardiomyocytes, is involved in cardiac contractile function and ischaemia/reperfusion (I/R) injury.

Methods and results

We observed that the levels of serum βII spectrin breakdown products (βII SBDPs) were significantly increased in patients with acute myocardial infarction (AMI). Concordantly, βII spectrin was degraded into βII SBDPs by calpain in mouse hearts after I/R injury. Using tamoxifen-inducible cardiac-specific βII spectrin knockout mice, we found that deletion of βII spectrin in the adult heart resulted in spontaneous development of cardiac contractile dysfunction, cardiac hypertrophy, and fibrosis at 5 weeks after tamoxifen treatment. Moreover, at 1 week after tamoxifen treatment, although spontaneous cardiac dysfunction in cardiac-specific βII spectrin knockout mice had not developed, deletion of βII spectrin in the heart exacerbated I/R-induced cardiomyocyte death and heart failure. Furthermore, restoration of βII spectrin expression via adenoviral small activating RNA (saRNA) delivery into the heart reduced I/R injury. Immunoprecipitation coupled with mass spectrometry (IP–LC–MS/MS) analyses and functional studies revealed that βII spectrin is indispensable for mitochondrial complex I activity and respiratory function. Mechanistically, βII spectrin promotes translocation of NADH:ubiquinone oxidoreductase 75-kDa Fe-S protein 1 (NDUFS1) from the cytosol to mitochondria by crosslinking with actin filaments (F-actin) to maintain F-actin stability.

Conclusion

βII spectrin is an essential cytoskeletal element for preserving mitochondrial homeostasis and cardiac function. Defects in βII spectrin exacerbate cardiac I/R injury.
A suite of genome-engineered hepatic cells provides novel insights into the spatiotemporal metabolism of apolipoprotein B and apolipoprotein B–containing lipoprotein secretion
Authors: Meurs Amber , Ndoj Klevis , van den Berg Marlene , Marinković Goran , Tantucci Matteo , Veenendaal Tineke , Kuivenhoven Jan Albert , Klumperman Judith , Zelcer Noam
Published: June 2024

Aims

Apolipoprotein B (APOB)-containing very LDL (VLDL) production, secretion, and clearance by hepatocytes is a central determinant of hepatic and circulating lipid levels. Impairment of any of the aforementioned processes is associated with the development of multiple diseases. Despite the discovery of genes and processes that govern hepatic VLDL metabolism, our understanding of the different mechanistic steps involved is far from complete. An impediment to these studies is the lack of tractable hepatocyte-based systems to interrogate and follow APOB in cells, which the current study addresses.

Methods and results

To facilitate the cellular study of VLDL metabolism, we generated human hepatic HepG2 and Huh-7 cell lines in which CRISPR/Cas9-based genome engineering was used to introduce the fluorescent protein mNeonGreen into the APOB gene locus. This results in the production of APOB100-mNeon that localizes predominantly to the endoplasmic reticulum (ER) and Golgi by immunofluorescence and electron microscopy imaging. The production and secretion of APOB100-mNeon can be quantitatively followed in medium over time and results in the production of lipoproteins that are taken up via the LDL receptor pathway. Importantly, the production and secretion of APOB-mNeon is sensitive to established pharmacological and physiological treatments and to genetic modifiers known to influence VLDL production in humans. As a showcase, we used HepG2-APOBmNeon cells to interrogate ER-associated degradation of APOB. The use of a dedicated sgRNA library targeting all established membrane-associated ER-resident E3 ubiquitin ligases led to the identification of SYNV1 as the E3 responsible for the degradation of poorly lipidated APOB in HepG2 cells.

Conclusions

In summary, the engineered cells reported here allow the study of hepatic VLDL assembly and secretion and facilitate spatiotemporal interrogation induced by pharmacologic and genetic perturbations.
Gut Microbial Species and Endotypes Associate with Remission in Ulcerative Colitis Patients Treated with Anti-TNF or Anti-integrin Therapy
Authors: Tamburini Fiona B , Tripathi Anupriya , Gold Maxwell P , Yang Julianne C , Biancalani Tommaso , McBride Jacqueline M , Keir Mary E , GARDENIA Study Group
Published: June 2024

Background and Aims

The gut microbiota contributes to aberrant inflammation in inflammatory bowel disease, but the bacterial factors causing or exacerbating inflammation are not fully understood. Further, the predictive or prognostic value of gut microbial biomarkers for remission in response to biologic therapy is unclear.

Methods

We perform whole metagenomic sequencing of 550 stool samples from 287 ulcerative colitis patients from a large, phase 3, head-to-head study of infliximab and etrolizumab.

Results

We identify several bacterial species in baseline and/or post-treatment samples that associate with clinical remission. These include previously described associations [Faecalibacterium prausnitzii_F] as well as new associations with remission to biologic therapy [Flavonifractor plautii]. We build multivariate models and find that gut microbial species are better predictors for remission than clinical variables alone. Finally, we describe patient groups that differ in microbiome composition and remission rate after induction therapy, suggesting the potential utility of microbiome-based endotyping.

Conclusions

In this large study of ulcerative colitis patients, we show that few individual species associate strongly with clinical remission, but multivariate models including microbiome can predict clinical remission and have better predictive power compared with clinical data alone.
Rethinking weight loss treatments as cardiovascular medicine in obesity, a comprehensive review
Authors: Tuccinardi Dario , Watanabe Mikiko , Masi Davide , Monte Lavinia , Meffe Luigi Bonifazi , Cavallari Ilaria , Nusca Annunziata , Maddaloni Ernesto , Gnessi Lucio , Napoli Nicola , Manfrini Silvia , Grigioni Francesco
Published: June 2024

The global escalation of obesity has made it a worldwide health concern, notably as a leading risk factor for cardiovascular disease (CVD). Extensive evidence corroborates its association with a range of cardiac complications, including coronary artery disease, heart failure, and heightened vulnerability to sudden cardiac events. Additionally, obesity contributes to the emergence of other cardiovascular risk factors including dyslipidaemia, type 2 diabetes, hypertension, and sleep disorders, further amplifying the predisposition to CVD. To adequately address CVD in patients with obesity, it is crucial to first understand the pathophysiology underlying this link. We herein explore these intricate mechanisms, including adipose tissue dysfunction, chronic inflammation, immune system dysregulation, and alterations in the gut microbiome.Recent guidelines from the European Society of Cardiology underscore the pivotal role of diagnosing and treating obesity to prevent CVD. However, the intricate relationship between obesity and CVD poses significant challenges in clinical practice: the presence of obesity can impede accurate CVD diagnosis while optimizing the effectiveness of pharmacological treatments or cardiac procedures requires meticulous adjustment, and it is crucial that cardiologists acknowledge the implications of excessive weight while striving to enhance outcomes for the vulnerable population affected by obesity. We, therefore, sought to overcome controversial aspects in the clinical management of heart disease in patients with overweight/obesity and present evidence on cardiometabolic outcomes associated with currently available weight management interventions, with the objective of equipping clinicians with an evidence-based approach to recognize and address CVD risks associated with obesity.
Are Virtual Assistants Trustworthy for Medicare Information: An Examination of Accuracy and Reliability
Authors: Langston Emily , Charness Neil , Boot Walter
Published: June 2024

Background and Objectives

Advances in artificial intelligence (AI)-based virtual assistants provide a potential opportunity for older adults to use this technology in the context of health information-seeking. Meta-analysis on trust in AI shows that users are influenced by the accuracy and reliability of the AI trustee. We evaluated these dimensions for responses to Medicare queries.

Research Design and Methods

During the summer of 2023, we assessed the accuracy and reliability of Alexa, Google Assistant, Bard, and ChatGPT-4 on Medicare terminology and general content from a large, standardized question set. We compared the accuracy of these AI systems to that of a large representative sample of Medicare beneficiaries who were queried twenty years prior.

Results

Alexa and Google Assistant were found to be highly inaccurate when compared to beneficiaries’ mean accuracy of 68.4% on terminology queries and 53.0% on general Medicare content. Bard and ChatGPT-4 answered Medicare terminology queries perfectly and performed much better on general Medicare content queries (Bard = 96.3%, ChatGPT-4 = 92.6%) than the average Medicare beneficiary. About one month to a month-and-a-half later, we found that Bard and Alexa’s accuracy stayed the same, whereas ChatGPT-4’s performance nominally decreased, and Google Assistant’s performance nominally increased.

Discussion and Implications

LLM-based assistants generate trustworthy information in response to carefully phrased queries about Medicare, in contrast to Alexa and Google Assistant. Further studies will be needed to determine what factors beyond accuracy and reliability influence the adoption and use of such technology for Medicare decision-making.
Temporal dynamism and the persisting stable self
Authors: Latham Andrew J , Miller Kristie , Yechimovitz Shira
Published: June 2024

Empirical evidence suggests that a majority of people believe that time robustly passes and that many also report that it seems to them, in experience, as though time robustly passes. Non-dynamists deny that time robustly passes, and many contemporary non-dynamists—deflationists—even deny that it seems to us as though time robustly passes. Non-dynamists, then, face the dual challenge of explaining why people have such beliefs and make such reports about their experiences. Several philosophers have suggested the stable-self explanation, according to which what partly explains one or both of the explananda is that people believe themselves to have a stable persisting self that is imagined either as moving through time or as being stationary with time moving around it. This paper empirically investigates this explanation. We found, however, no evidential support for the stable-self explanation, leaving the non-dynamist but also, we will argue, the dynamist with an extant explanatory challenge.
How Effective are the Monin–Lundgren Hierarchy and the Karman–Howarth Equation for Low-Reynolds-Number Decaying Isotropic Turbulence?
Authors: Hosokawa Iwao
Published: June 2024

The study of decaying homogeneous isotropic turbulence (HIT) in a series of the author's recent works is extended here to present new aspects of its nearly final period of decay and the time-dependent Loitsyanskii integral. The works contain a Gaussian family of exact solutions for a velocity probability density function (PDF) of the first equation of the Monin–Lundgren hierarchy and time-dependence of many physical quantities for a wide range of Taylor-scale Reynolds numbers (${{{\mathop{{R}}\nolimits} }_\lambda } = 40 \sim 100000$ or more). In this Letter, the case with ${{{\mathop{{R}}\nolimits} }_\lambda } = 40$ is taken up in particular, and it is revealed to be almost the lower limit for the application of our method to treat decaying HIT.
Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case–Control Study
Authors: Cancela-Cilleruelo Ignacio , Rodríguez-Jiménez Jorge , Fernández-de-las-Peñas César , Cleland Joshua A , Arias-Buría José L
Published: June 2024

Objective

The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE).

Methods

Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5–C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, and width) of the common wrist extensor tendon and extensor carpi radialis brevis muscle as well as the thickness of the supinator muscle were assessed.

Results

Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space on the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123–0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268–0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side.

Conclusions

This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE.

Impact

Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE.
Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl
Authors: Liu Patricia , Chan Brian , Sokolski Eleasa , Patten Alisa , Englander Honora
Published: June 2024

Objectives

Treating acute opioid withdrawal and offering medications for opioid use disorder (OUD) is critical. Hospitalization offers a unique opportunity to rapidly initiate methadone for OUD; however, little clinical guidance exists. This report describes our experience during the first 9 months following introduction of a hospital-based rapid methadone initiation protocol.

Methods

We conducted a retrospective chart review of hospitalized patients with OUD seen by our interprofessional addiction medicine consult service at an urban academic center between December 2022 and August 2023. We identified patients who initiated methadone using the rapid methadone initiation protocol, which includes dose recommendations (maximum 60 mg day 1, 70 mg day 2, 80 mg day 3, 100 mg days 4–7) and strict inclusion and exclusion criteria (end organ failure, arrhythmia, concurrent benzodiazepine or alcohol use, age >65).

Results

There were 171 patients that received methadone for OUD during the study period. Of those, 25 patients (15%) received rapid methadone initiation. The average total daily dose of methadone on days 1–7 was 53.0 mg, 69.2 mg, 75.4 mg, 79.5 mg, 87.1 mg, 92.2 mg, and 96.6 mg, respectively. There were no adverse events requiring holding a dose of scheduled methadone, naloxone administration, or transfer to higher level of care.

Conclusions

A rapid methadone initiation protocol for OUD can be implemented in the inpatient setting. Patients up-titrated their methadone doses quicker than with traditional induction methods, and there were no serious adverse events. Appropriate patient selection may be important to avoid harms.
Guided Growth to Treat Anterolateral Tibial Bowing Associated with Congenital Pseudarthrosis of the Tibia
Authors: Todderud Julia E. , Carlson Samuel W. , Larson A. Noelle
Published: June 2024

Background:

Anterolateral tibial bowing associated with congenital tibial pseudarthrosis occurs often in patients with neurofibromatosis type 1 and results from the inability of the fractured bone to unite, leading to persistent nonunion, abnormal bone growth, and further bowing of the tibia. Current surgical and nonsurgical approaches demonstrate persistent nonunion or refracture, often resulting in amputation.

Methods:

This report describes the management of 3 patients with anterolateral tibial bowing and NF1 who underwent distal tibia-guided growth.

Results:

The patients had an average age of 1.6 years at initial operation, with a total of 3 to 4 surgeries over an average of 2.1 years. The latest follow-up on all patients is included, at a mean of 5.1 years after the initial operation. All 3 patients experienced substantial functional improvement and improved alignment of the mechanical axis of the tibia. One patient has experienced refracture.

Conclusions:

Our study indicates that guided growth can serve as an additional surgical option to improve ALTB and potentially reduce the risk of fracture and pseudarthrosis by restoring normal mechanical alignment.

Level of Evidence:

Level—IV, Case Series.
The Evolution of Curve Patterns in Adolescent Idiopathic Scoliosis During Chêneau Brace Treatment
Authors: Hou Hao , Guo Dong , Liu Haonan , Luo Yanzhong , Yao Ziming , Feng Lei , Cao Jun , Gao Rongxuan , Zhang Xuejun
Published: June 2024

Study Design/Setting.

This retrospective study analyzed bracing outcomes in patients with adolescent idiopathic scoliosis (AIS), focusing on curve pattern changes and brace efficacy.

Objective.

To analyze the effectiveness of the Chêneau brace across different curve patterns and to evaluate the tendencies in curve evolution during treatment.

Background.

AIS presents diverse curve patterns, each responding differently to bracing. Understanding these variations is crucial for optimizing treatment strategies.

Patients and Methods.

The study included 177 patients with AIS treated with Chêneau orthoses, categorized based on curve patterns as per the main curve and modified Lenke (mLenke) classifications. We compared patients according to curve patterns and assessed changes in curve magnitude and pattern before and after treatment.

Results.

Over an average follow-up of 28.1 ± 10.7 months, the primary curve magnitude decreased from 28.8 ± 6.6° to 25.9 ± 10.5°. Significant reductions were observed in mLenke V and VI patients (P < 0.05). Patients with main lumbar curves showed better initial in-brace correction and curve control compared with those with main thoracic curves (P < 0.05). In single-curve patterns, binary logistic regression indicated that mLenke V patients demonstrated higher rates of curve control compared with mLenke I patients (P < 0.05). No significant differences were found in double-curve patterns between mLenke III and VI (P > 0.05). At the final follow-up, thoracolumbar/lumbar curves improved significantly in mLenke III and VI patients (P < 0.05), whereas thoracic curves did not (P > 0.05). Furthermore, at the last follow-up, the proportions of mLenke I, II, and IV increased, whereas mLenke III, V, and VI decreased.

Conclusions.

Bracing outcomes were more favorable in patients with main lumbar curves than those with main thoracic curves. However, no significant differences were found in patients with double-curve patterns. Thoracic curves exhibited a higher progression risk compared with thoracolumbar/lumbar curves within the same curve pattern. During bracing, a tendency for primary curves to shift proximally was noted.

Level of Evidence.

Level III.
Quality Evaluation of Guidelines for the Diagnosis and Treatment of Liver Failure
Authors: Wang Xia , Zheng Meng-Yao , He Hai-Yu , Zhu Hui-Ling , Zhao Ya-Fang , Chen Yu-Hang , Xu Zhi-Yuan , Yang Jin-Hui , Sun Da-Li
Published: June 2024

OBJECTIVES:

This study aimed to systematically assess the methodological quality and key recommendations of the guidelines for the diagnosis and treatment of liver failure (LF), furnishing constructive insights for guideline developers and equipping clinicians with evidence-based information to facilitate informed decision-making.

DATA SOURCES:

Electronic databases and manual searches from January 2011 to August 2023.

STUDY SELECTION:

Two reviewers independently screened titles and abstracts, then full texts for eligibility. Fourteen guidelines were included.

DATA EXTRACTION AND SYNTHESIS:

Two reviewers extracted data and checked by two others. Methodological quality of the guidelines was appraised using the Appraisal of Guidelines for Research and Evaluation II tool. Of the 14 guidelines, only the guidelines established by the Society of Critical Care Medicine and the American College of Gastroenterology (2023) achieved an aggregate quality score exceeding 60%, thereby meriting clinical recommendations. It emerged that there remains ample room for enhancement in the quality of the guidelines, particularly within the domains of stakeholder engagement, rigor, and applicability. Furthermore, an in-depth scrutiny of common recommendations and supporting evidence drawn from the 10 adult LF guidelines unveiled several key issues: controversy exists in the recommendation, the absence of supporting evidence and confusing use of evidence for recommendations, and a preference in evidence selection.

CONCLUSIONS:

There are high differences in methodological quality and recommendations among LF guidelines. Improving these existing problems and controversies will benefit existing clinical practice and will be an effective way for developers to upgrade the guidelines.
Impact of Cutaneous Squamous Cell Carcinoma Histologic Features on Percent Interrater Agreement Regarding Tumor Differentiation
Authors: Shahwan Kathryn T. , Varra Vamsi , Nash Jessica , Chung Catherine G. , Buckley Kaila A. , McIlwee Bridget E. , Carr David R.
Published: June 2024

BACKGROUND

Poor differentiation predicts adverse outcomes in cutaneous squamous cell carcinoma (CSCC), but there is no standardized, reliable grading system.

OBJECTIVE

To explore which histologic features have the greatest impact on CSCC differentiation interrater agreement.

MATERIALS AND METHODS

In a prior study, 40 raters graded differentiation for 45 squamous cell carcinomas, and percent interrater agreements were calculated. Cases graded as well/moderately differentiated with 100% agreement (10), those graded as poorly differentiated with ≥80% agreement (5), and those that received a variety of grades with ≤60% agreement (7) were pulled for the current study. Three raters graded individual histologic features for each case, and percent interrater agreements were calculated using both the well/moderately/poorly differentiated grading system and a dichotomized system.

RESULTS

The percent interrater agreements were 34.8% for mitoses, 53% for pleomorphism, 59.1% for keratinization, 66.7% for cellular cohesion/intercellular bridges, and 78.8% for tumor edges. Percent agreements improved with dichotomous grading; the largest improvement was seen within the group of cases that had been graded as well/moderately differentiated with 100% agreement in the prior study.

CONCLUSION

Future squamous cell carcinoma differentiation grading systems would benefit from eliminating mitotic rate, clearly defining how to grade other features, and dichotomous grading.
Review of sustainable practices for the gynecology operating room
Authors: Trieu Elissa , Ramirez-Caban Laura C. , Shockley Marie E.
Published: June 2024

Purpose of review

Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement.

Recent findings

From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an ‘off’ setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals.

This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.
Facial Rejuvenation: A Global Trend of Dermatological Procedures in the Last Decade
Authors: Liu Yin , Mao Rui , Xiao Minqin , Zhu Weidong , Liu Yang , Xiao Hong
Published: June 2024

Background:

We aimed to track the global trend of cosmetic treatment outcomes for facial rejuvenation and the differences in modalities used in East Asian and Western populations.

Methods:

Articles reporting on facial rejuvenation procedures (invasive/noninvasive) were identified in PubMed from 2013 to March 2023 and bibliometrically analyzed for type of published document, citation frequency, authors with most articles, author’s affiliation, and frequency distribution of keywords.

Results:

From 553 articles, most were published in 2021 (n = 86, 15.6%). Western countries (n = 323, 58.4%) contributed more than East Asian (n = 230, 41.6%), with more invasive interventions (n = 355, 64.2%) than noninvasive techniques (n = 198, 35.8%). Numbers of invasive techniques in West versus East Asian countries were 225 (40.7%) versus 135 (24.4%). Main indications were the reduction of facial wrinkles and antiageing treatments. Hyaluronic acid, fillers, and botulinum toxin were the main hotspots for invasive treatments, whereas laser, platelet-rich plasma, and radiofrequency were for noninvasive treatments. Nasolabial folds (13.4%) and glabellar lines (12.4%) were the top research hotspots in the East Asian and Western regions. Common adverse events were pain, erythema, swelling, and bruising. Approximately, 89.3% of publications were from single countries, whereas 10.7% of publications were from international collaborations. Most articles (n = 387; 69.95%) presented their findings using level II evidence. Dermatological surgery (IF = 2.914) had the greatest number of publications (n = 109; 19.71%).

Conclusions:

The main hotspots were antiaging and youthfulness. This study provides a trend and a new perspective on the future research directions in the field of facial rejuvenation.
New Kid on the Block: A Systematic Review of the Quadratus Lumborum Block in Plastic and Reconstructive Surgery
Authors: Ihnat Jacqueline M.H. , Evans Brogan G.A. , Zhao K. Lynn , Yu Catherine T. , Ayyala Haripriya S.
Published: June 2024

Background:

Although the transversus abdominal plane (TAP) block is commonly used in abdominal surgery as part of enhanced recovery after surgery pathways, the quadratus lumborum (QL) block has been hypothesized as an effective alternative to the TAP block in some areas. This review evaluates the current literature, as it relates to the QL block in plastic and reconstructive surgery.

Methods:

A systematic review using PubMed searched for all original, peer-reviewed articles, including the term “quadratus lumborum block.” In total, 509 articles were identified for review by two independent reviewers. Original articles evaluating the use of a QL block in any plastic surgery operation were included. Articles evaluating pediatric patients, animal trials, and the use of a QL block in any nonplastic surgery operation were excluded.

Results:

Three articles met inclusion criteria. One trial demonstrated decreased subjective pain scores and total opioid use, whereas the second found no statistically significant difference. A case study described the use of a QL block for unilateral breast reconstruction with minimal opiate use and reduced pain scores postoperatively. Limitations include the limited number of studies and the heterogeneity in study type and design, making analysis difficult.

Conclusions:

Despite its demonstrated efficacy in other surgical subspecialties, there are limited data evaluating the use of the QL block in plastic and reconstructive surgery. Additional research is needed to evaluate the role of the QL block in plastic surgery and how it compares to the more widely utilized TAP block.
Surgical Correction of Low-positioned Umbilicus after Mini-abdominoplasty
Authors: Borille Giuliano B. , Pereira Filho Gustavo A. , Zancanaro Mariana , Ribeiro Vinicius W. , Giannini Renato , Proto Ricardo
Published: June 2024

Background:

The umbilicus detachment and reinsertion in umbilical float mini-abdominoplasty results in its lower position with or without shape distortion. This event creates a stigmatizing look, elongating the upper abdomen and creating variable grades of infra umbilical/pubis bulging. This lack of proportion causes an unpleasant, artificial look, and is very difficult to fix. The study aimed to describe a sequence of abdominoplasty and combined upper abdomen horizontal muscle plications to correct umbilicus malposition after a mini-abdominoplasty.

Methods:

Over a period of 24 months, 12 patients underwent a liposuction (suction-assisted liposuction) and abdominoplasty with horizontal supraumbilical muscle plication. All patients underwent objective measurements before and after the procedure, using digital image measurements by Mirror Image software, version 6.0 (Fairfield, N.J.). The follow-up evaluation was performed 12 months postoperatively. Statistical analysis was performed using IBM SPSS Statistics V26.

Results:

Over 24 months, 12 patients (100%), who underwent abdominoplasty combined with horizontal plication in the upper abdominal wall, have shown adequate umbilicus elevation (2.98 ± 0.242 cm; 95% confidence level), restoring the abdominal muscle wall proportion at 12 months follow-up. One patient (8%) had a seroma, and one (8%) had a small muscular hernia (1.5 cm) in the lower abdomen.

Conclusions:

The combination of abdominoplasty and upper horizontal muscle plication can fix the malpositioned umbilicus, restoring the aesthetic and anatomic proportions in those patients who underwent an umbilical float mini-abdominoplasty.
Enhancing competency-based assessment: Implementing oral boards in nursing education
Authors: Owen Regina D. , Moret Nicole
Published: June 2024

Competency-based education, pivotal in nursing programs, emphasizes learning methods over knowledge accumulation, integrating ongoing assessments for performance and outcomes. The American Association College of Nursing introduced competency-based education, urging educators to explore diverse assessment methods. This article explores the implementation of mock oral boards as an assessment method to synchronize performance standards with competencies in nursing education, specifically in preparing nurse practitioner students for clinical rotations.
Towards improved diagnosis: radiomics and quantitative biomarkers in 18F-PSMA-1007 and 18F-fluorocholine PET/CT for prostate cancer recurrence
Authors: Panagiotidis Emmanouil , Andreou Sotiria , Paschali Anna , Angeioplasti Kyra , Vlontzou Evaggelia , Kalathas Theodore , Pipintakou Angeliki , Fothiadaki Athina , Makridou Anna , Chatzimarkou Michael , Papanastasiou Emmanouil , Datseris Ioannis , Chatzipavlidou Vasiliki
Published: June 2024

Objective

This study compared the radiomic features and quantitative biomarkers of18F-PSMA-1007 [prostate-specific membrane antigen (PSMA)] and18F-fluorocholine (FCH) PET/computed tomography (CT) in prostate cancer patients with biochemical recurrence (BCR) enrolled in the phase 3, prospective, multicenter BIO-CT-001 trial.

Methods

A total of 106 patients with BCR, who had undergone primary definitive treatment for prostate cancer, were recruited to this prospective study. All patients underwent one PSMA and one FCH PET/CT examination in randomized order within 10 days. They were followed up for a minimum of 6 months. Pathology, prostate-specific antigen (PSA), PSA doubling time, PSA velocity, and previous or ongoing treatment were analyzed. Using LifeX software, standardized uptake value (SUV) maximum, SUVmean, PSMA and choline total volume (PSMA-TV/FCH-TV), and total lesion PSMA and choline (TL-PSMA/TL-FCH) of all identified metastatic lesions in both tracers were calculated.

Results

Of the 286 lesions identified, the majority 140 (49%) were lymph node metastases, 118 (41.2%) were bone metastases and 28 lesions (9.8%) were locoregional recurrences of prostate cancer. The median SUVmaxvalue was significantly higher for18F-PSMA compared with FCH for all 286 lesions (8.26 vs. 4.99, respectively,P < 0.001). There were statistically significant differences in median SUVmean, TL-PSMA/FCH, and PSMA/FCH-TV between the two radiotracers (4.29 vs. 2.92, 1.97 vs. 1.53, and 7.31 vs. 4.37, respectively,P < 0.001). The correlation between SUVmean/SUVmaxand PSA level was moderate, both for18F-PSMA (r = 0.44,P < 0.001;r = 0.44,P < 0.001) and FCH (r = 0.35,P < 0.001;r = 0.41,P < 0.001). TL-PSMA/FCH demonstrated statistically significant positive correlations with both PSA level and PSA velocity for both18F-PSMA (r = 0.56,P < 0.001;r = 0.57,P < 0.001) and FCH (r = 0.49,P < 0.001;r = 0.51,P < 0.001). While patients who received hormone therapy showed higher median SUVmaxvalues for both radiotracers compared with those who did not, the difference was statistically significant only for18F-PSMA (P < 0.05).

Conclusion

Our analysis using both radiomic features and quantitative biomarkers demonstrated the improved performance of18F-PSMA-1007 compared with FCH in identifying metastatic lesions in prostate cancer patients with BCR.
Quantitative lobar Tc99m-MAA SPECT/CT of the lung in pre-and post-procedural guidance for bronchoscopic lung volume reduction
Authors: Ide Bolet Sean , Sisti Joseph , Cheng Ke , Dadparvar Simin
Published: June 2024

Objective

This study investigates the role of single photon emission computed tomography (SPECT) with computed tomography (CT) in treating chronic obstructive pulmonary disease (COPD) through bronchoscopic lung volume reduction (BLVR). BLVR, a minimally invasive treatment

for emphysema and hyperinflation of the lobes allows healthier lung regions to expand more efficiently by blocking the most diseased lobe(s).

It is a viable option for patients with end-stage COPD who have limited treatments available.

Methods

This prospective study included 92 patients who underwent BLVR with quantitative SPECT/CT study pre- and post

-procedure between November 2018 and June 2023. The mean age was 70 years (range 56-85). with 51 males and 41 females

. SPECT/CT quantified perfusion for each lobe, and the lowest counts/volume ratio determined the procedural target. Postprocedure SPECT/CT assessed total atelectasis and perfusion shifts. The 6-minute walk test and pulmonary function tests were compared pre- and post-BLVR.

Results

SPECT/CT-guided BLVR showed clinical benefits (decreased oxygen requirements) and physiological improvements in total lung capacity, forced expiratory volume, and forced vital capacity (P < 0.05). Significant perfusion shifts were observed away from the target lobe, with unique patterns noted for ipsilateral and contralateral nontarget lobes (P < 0.05).

Conclusion

Quantitative lobar SPECT/CT in preprocedural guidance for BLVR proved useful in identifying suitable targets in multi-lobe homogeneous emphysema, resulting in physiological and clinical improvements for this patient group. The perfusion shift information provided by SPECT/CT offers valuable insights for pulmonologists.
Update on using buccal myomucosal flaps for patients with cleft palate and velopharyngeal insufficiency: primary and secondary interventions
Authors: Marston Alexander P. , Tollefson Travis T.
Published: June 2024

Purpose of review

This review aims to examine the indications and anatomical circumstances for when to optimally incorporate buccal myomucosal flaps (BMFs) into palatal surgical reconstruction.

Recent findings

Studies examining outcomes following primary cleft palate repair with incorporation of BMF have demonstrated excellent speech outcomes and low rates of fistula. Furthermore, some reports cite an association of buccal flap use with reduced midface hypoplasia and the need for later orthognathic surgery. When used for secondary speech surgery, BMFs have been shown to lead to speech improvements across multiple outcome measures. Advantages of BMF techniques over conventionally described pharyngeal flap and pharyngoplasty procedures include significant lengthening of the velum, favorable repositioning of the levator muscular sling, and lower rates of obstructive sleep apnea.

Although the published data demonstrate excellent outcomes with use of BMFs for primary and secondary palatal surgery, there are limited data to conclude superiority over the traditional, more extensively investigated surgical techniques. The authors of this review agree with the evidence that BMF techniques can be useful in primary palatoplasty for congenitally wide clefts, secondary speech surgery for large velopharyngeal gaps, and/or in individuals with a predisposition for airway obstruction from traditional approaches.
The Liver Frailty Index: a model for establishing organ-specific frailty metrics across all solid organ transplantation
Authors: Jutras Gabrielle , Lai Jennifer C.
Published: June 2024

Purpose of review

In this review, we discuss the development of the Liver Frailty Index (LFI) and how it may serve as a model for developing other organ-specific frailty indices.

Recent findings

As the demand for solid organ transplants continues to increase, the transplantation community is enhancing its strategies for organ allocation to gain deeper insights into patient risk profiles and anticipated outcomes. Frailty has emerged as a critical concept in transplant care, offering valuable insights into adverse health outcomes. Standardizing frailty assessment across transplant programs could enhance prognostic accuracy and inform pretransplant interventions.

The LFI comprises of three performance-based tests that each represents essential components of the multidimensional frailty construct. This composite metric provides insights beyond liver function and considers nonhepatic comorbid factors. Identifying common frailty principles among all transplant candidates and adopting the LFI methodology, which assesses fundamental frailty principles using liver-specific tools, could establish a foundational pool of shared core frailty principles. From this pool, organ-specific frailty indices could be derived, each equipped with the clinically relevant organ-specific tools to evaluate common core principles.

Creating a standardized framework across all solid-organ transplants, with common principles and organ-specific measurements, would facilitate consistent frailty assessment, standardize the integration of the frailty construct into transplant decision-making, and enable center-level interventions to improve outcomes for patients with end-stage organ disease.