bluuebunny/crossref_metadata_2025 huggingface dataset:
A “New” Nonmesh Technique for Inguinal Hernia Repair: Revisiting E. Wyllys Andrews and His Imbricating Operation
Authors: Yerxa John , Wang Hanghang , Pappas Theodore N.
Published: June 2023

The use of prosthetic mesh to repair inguinal hernias has been common practice at surgical centers around the world for more than 30 years. Open tissue repairs are the alternative for patients who cannot have, do not want, or are not offered mesh. Open tissue repairs are troubled by inferior recurrence rates in most clinical trials. In this article, we will review a long-forgotten tissue repair described by Andrews in 1895. In addition, we report on our early experience with the Andrews technique for primary inguinal hernia tissue repair.
The importance of microvascular inflammation in ageing and age-related diseases: a position paper from the ESH working group on small arteries, section of microvascular inflammation
Authors: Mengozzi Alessandro , de Ciuceis Carolina , Dell’oro Raffaella , Georgiopoulos Georgios , Lazaridis Antonios , Nosalski Ryszard , Pavlidis George , Tual-Chalot Simon , Agabiti-Rosei Claudia , Anyfanti Panagiota , Camargo Livia L. , Dąbrowska Edyta , Quarti-Trevano Fosca , Hellmann Marcin , Masi Stefano , Mavraganis Georgios , Montezano Augusto C. , Rios Francesco J. , Winklewski Pawel J. , Wolf Jacek , Costantino Sarah , Gkaliagkousi Eugenia , Grassi Guido , Guzik Tomasz J. , Ikonomidis Ignatios , Narkiewicz Krzysztof , Paneni Francesco , Rizzoni Damiano , Stamatelopoulos Kimon , Stellos Konstantinos , Taddei Stefano , Touyz Rhian M. , Triantafyllou Areti , Virdis Agostino
Published: June 2023

Microcirculation is pervasive and orchestrates a profound regulatory cross-talk with the surrounding tissue and organs. Similarly, it is one of the earliest biological systems targeted by environmental stressors and consequently involved in the development and progression of ageing and age-related disease. Microvascular dysfunction, if not targeted, leads to a steady derangement of the phenotype, which cumulates comorbidities and eventually results in a nonrescuable, very high-cardiovascular risk. Along the broad spectrum of pathologies, both shared and distinct molecular pathways and pathophysiological alteration are involved in the disruption of microvascular homeostasis, all pointing to microvascular inflammation as the putative primary culprit. This position paper explores the presence and the detrimental contribution of microvascular inflammation across the whole spectrum of chronic age-related diseases, which characterise the 21st-century healthcare landscape. The manuscript aims to strongly affirm the centrality of microvascular inflammation by recapitulating the current evidence and providing a clear synoptic view of the whole cardiometabolic derangement. Indeed, there is an urgent need for further mechanistic exploration to identify clear, very early or disease-specific molecular targets to provide an effective therapeutic strategy against the otherwise unstoppable rising prevalence of age-related diseases.
Clinical Efficacy of an Astragalus and Atractylodes Recipe for Treating Early Diabetic Kidney Disease: A Meta-analysis of Evidence-Based Studies
Authors: Sun Panpan , Zhao Yirui , Huang Yonghao , Chen Lei , Wei Lai , Wang Yarong
Published: June 2023

Background:

In the clinical practice of different medical practitioners, the therapeutic effect of astragalus and atractylodes recipe (AAR) on early diabetic kidney disease (DKD) is obvious, but there is a lack of large sample data to support it. This study aimed to systematically evaluate the efficacy and safety of AAR for treating early DKD.

Methods:

Reports published in the following databases from inception to January 26, 2022 were retrieved: China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal Database (VIP), Sinomed, PubMed, and the Cochrane Library. Randomized controlled trials (RCTs) evaluating the use of AAR for treating early DKD were considered, with relevant data extracted and quality evaluated according to the Cochrane Collaboration System Evaluation Method. Data were analyzed using RevMan 5.4 software.

Results:

Thirteen articles that included a total of 928 patients were considered. Based on the meta-analysis, the total efficacy of the treatment group was better than that of the control group (odds ratio [OR]: 4.31; 95% confidence interval [CI]: 2.78, 6.70; P < 0.0001). The treatment group outperformed the control group in terms of blood-fat total cholesterol (TC, SMD: 0.44; 95% CI: 0.62, 0.26; P < 0.00001), triglyceride (TG, SMD: 0.83, 95% CI: 1.47, 0.19; P = 0.01), serum creatinine (Scr, SMD: 1.55; 95% CI: 2.28, 0.82; P = 0.02), blood urea nitrogen (BUN, SMD: 0.77; 95% CI: 1.47, 0.07; P = 0.03), and urinary albumin excretion rate (UAER, SMD: 1.55; 95% CI: 2.28, −0.82; P < 0.0001).

Conclusion:

Use of an AAR for treating diabetic kidney disease improved clinical outcomes versus conventional treatment alone, without compromising patient safety.
Variability in Heart Yield From Donation After Brain Death Between Organ Procurement Organizations: An Opportunity for Improvement
Authors: Suarez-Pierre Alejandro , Iguidbashian John , Vigneshwar Navin , Breithaupt Jason , Fullerton David A. , Reece T. Brett , Hoffman Jordan R.H. , Cleveland Joseph C. , Rove Jessica Y.
Published: June 2023

Increasing the number of available hearts for transplantation is the best strategy to decrease waitlist mortality. This study examines organ procurement organizations (OPOs) and their role in the transplantation network to determine whether variability in performance exists across them. Adult deceased donors who met the criteria for brain death between 2010 and 2020 (inclusive) in the United States were examined. A regression model was fitted and internally validated using donor characteristics available at the time of organ recovery to predict the likelihood of heart transplantation. Subsequently, an expected heart yield was calculated for each donor using this model. Observed-to-expected (O/E) heart yield ratios for each OPO were calculated by dividing the number of hearts recovered for transplantation by the expected number of recoveries. There were 58 OPOs active during the study period, and on average, OPO activity grew over time. The mean O/E ratio among OPOs was 0.98 (standard deviation ± 0.18). Twenty-one OPOs consistently performed below the expected level (95% confidence intervals < 1.0) and generated a deficit of 1,088 expected transplantations during the study period. The proportion of hearts that were recovered for transplantation varied significantly by OPO categories: low tier 31.8%, mid tier 35.6%, and high tier 36.2% (p < 0.01), even as the expected yield was similar across tiers (p = 0.69). OPO performance accounts for 28% of the variability in successfully transplanting a heart after accounting for the role of referring hospitals, donor families, and transplantation centers. In conclusion, there is significant variability in volume and heart yield from brain-dead donors across OPOs.
Validation of the YuWell YE660D oscillometric upper-arm blood pressure monitor for clinic and home in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard (International Organization for Standardization 81060-2:2018) and the International Organization for Standardization Amendment 1. 2020
Authors: Zhang Hui-Jie , Peng Yue , Zhang Juan , Zhang Jin , Teng Li-Ni , Zhang Shu-Juan , Zhou De-Jun , Long Ming-Zhi
Published: June 2023

Objective

To evaluate the accuracy of the YuWell YE660D oscillometric upper-arm blood pressure (BP) monitor in general population (for clinic and home BP measurements in adults) according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020.

Methods

Subjects were recruited to fulfill the age, sex, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumferences 22–32 cm (standard) and 22–45 cm (wide range).

Results

Ninety-two subjects were recruited and 85 subjects were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.3 ± 7.2/2.2 ± 5.5 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 6.1/4.8 mmHg (systolic/diastolic).

Conclusion

The YuWell YE660D oscillometric upper-arm electronic BP monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020 in adults and hence can be recommended for home and clinical use.
Different time points, different blood pressures: complexity of blood pressure measurement in hemodialysis patients
Authors: Lan Shan , Zhang Yazhen , Wang Jing , Wu Zhibin , Chen Shanying
Published: June 2023

Objective

We used our established database to investigate predialysis blood pressure (BP) measurements at different time points.

Methods

Our study period spanned from 1 January 2019 to 31 December 2019. The different time points included: the long interdialytic interval versus the short interdialytic interval; different hemodialysis shifts. Multiple linear regression was used to explore the association between BP measurements and different time points.

Results

A total of 37 081 cases of hemodialysis therapies were included. After a long interdialytic interval, predialysis SBP and DBP were significantly elevated. Predialysis BP was 147.72/86.73 mmHg on Monday and 148.26/86.52 mmHg on Tuesday, respectively. Both predialysis SBP and DBP were higher in the a.m. shift. The mean BP in the a.m. and p.m. shifts were 147.56/87 mmHg and 144.83/84.64 mmHg, respectively. In both diabetic nephropathy and non-diabetic nephropathy patients, higher SBP measurements after a long interdialytic interval were observed; however, in diabetic nephropathy patients, we did not find significant differences in DBP among different dates. In diabetic nephropathy and non-diabetic nephropathy patients, we observed that the effect of different shifts on BP was similar. In Monday, Wednesday and Friday subgroups, the long interdialytic interval was also associated with BP; however, in Tuesday, Thursday and Saturday subgroups, different shifts but not the long interdialytic interval was associated with BP.

Conclusion

The long interdialytic interval and different hemodialysis shifts have a significant effect on predialysis BP in patients with hemodialysis. When interpreting BP in patients with hemodialysis, different time points is a confounder.
Metacognitive Beliefs and Metacognitive Capacity
Authors: Ayala Alexandra , Mickens Jessica L. , Myers Evan J. , Abel Danielle B. , Hegwood Ceouna M. , Davis Beshaun J. , Lysaker Paul H. , Minor Kyle S.
Published: June 2023

Metacognition has been defined several ways across different fields. In schizophrenia, two primary approaches to assessing metacognition focus on measuring metacognitive beliefs and metacognitive capacity. The degree of association between these two approaches is unclear. In this pilot study, schizophrenia (n = 39) and control (n = 46) groups were assessed using metacognitive beliefs (Metacognition Questionnaire-30) and metacognitive capacity (Metacognition Assessment Scale-Abbreviated) scales. We also examined how these two approaches predicted quality of life. Results showed anticipated differences for metacognitive beliefs, metacognitive capacity, and quality of life when comparing schizophrenia and healthy control groups. However, metacognitive beliefs and metacognitive capacity were not significantly related and only predicted quality of life in the healthy control group. Although preliminary, these findings suggest that these two approaches have a limited relationship with one another. Future studies should test these findings in larger samples and focus on examining associations at different levels of metacognitive functioning in those with schizophrenia.
Borderline Personality Organization as an Aid in Differential Diagnosis
Authors: Jackson Daniel , McLawhorn Donald E. , Pal Sutanaya
Published: June 2023

There are subsets of patients whose presentations elude a precise diagnosis. All diagnoses are asymptotic to nature as they are constructs imposed on the world. Nonetheless, a greater degree of accuracy and precision is possible and beneficial for most patients. This is particularly true for patients with borderline personality organization (BPO) who present with psychotic symptoms. For the purposes of avoiding a misconstrual of the meaning of psychotic experiences in these patients, a brief synopsis of borderline personality organization, in contradistinction to borderline personality disorder, may prove to be of some clinical utility. The BPO construct presciently anticipates the trend toward a dimensional model of personality disorders and has the potential to enrich and inform these developments.
Profunda Artery Perforator Flap Tongue Reconstruction: An Effective and Safe Alternative to the Anterolateral Thigh Flap
Authors: Ismail Tarek , Padilla Pablo , Kurlander David E. , Corkum Joseph P. , Hanasono Matthew M. , Garvey Patrick B. , Chang Edward I. , Yu Peirong , Largo Rene D.
Published: June 2023

Background:

The anterolateral thigh (ALT) perforator flap is a workhorse flap for tongue reconstruction. The authors present an alternative option using the profunda artery perforator (PAP) flap for glossectomy reconstruction compared with the ALT flap.

Methods:

A retrospective review was conducted of 65 patients who underwent subtotal or total glossectomy reconstruction between 2016 and 2020 (46 ALT versus 19 PAP flaps). Flap volume was assessed using computed tomography scans at two different time points. Quality of life and functional outcomes were measured using the MD Anderson Symptom Inventory for Head and Neck Cancer.

Results:

Patients receiving a PAP flap had significantly lower body mass index compared with those receiving an ALT flap (22.7 ± 5.0 versus 25.8 ± 5.1; P = 0.014). Donor-site and recipient-site complications were similar, as was the mean flap volume 7 months after surgery (30.9% for ALT versus 28.1% for PAP; P = 0.93). Radiation and chemotherapy did not appear to have a significant effect on flap volume change over time. The most frequently reported high-severity items in MD Anderson Symptom Inventory for Head and Neck Cancer were swallowing/chewing and voice/speech for both cohorts. Patients who had reconstruction with a PAP flap had significantly better swallowing function (P = 0.034).

Conclusions:

Both the PAP and ALT flaps appear to be safe and effective choices for subtotal and total tongue reconstruction. The PAP flap can serve as an alternative donor site, especially in patients with low body mass index and thin lateral-thigh thickness undergoing reconstruction of extensive glossectomy defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Avoiding Pretarsal Denervation in Lower Blepharoplasty Incisions: Refined Pretarsal Motor Nerve Anatomy
Authors: Choi Yeop , Kim In-Beom
Published: June 2023

Background:

Pretarsal atrophy is not uncommonly found in patients who have undergone a transcutaneous or transconjunctival lower blepharoplasty because of intraoperative denervation of the pretarsal orbicularis oculi. The motor-supplying concept to the lower eyelid was recently updated; however, there have not yet been any guidelines to preserve motor nerves in lower blepharoplasty incisions based on the refined knowledge.

Methods:

Forty-six fresh cadaveric hemifaces were examined to find a safe zone for a lower blepharoplasty muscle incision and a danger zone for an infraorbital incision in the transblepharoplasty midface approach. In addition, practical anatomy about the pretarsal motor supply was also investigated in detail.

Results:

The medial, lateral, superior, and inferior borders of the safe zone for a lower blepharoplasty muscle incision were 9.4 mm from the medial canthus line, 3 mm from the lateral canthal crease, and 6.0 and 6.5 mm from the eyelid margin, respectively. The danger zone for an infraorbital incision ranged from 9.4 mm medial to the midpupillary line to 9.7 mm lateral to the midpupillary line. The motor nerve in the danger zone abutted the distal roof of the preseptal pocket, making it vulnerable to electrocautery heat. Motor nerve distribution of the lower pretarsal orbicularis oculi was fully identified.

Conclusions:

There is a safe zone for the lower blepharoplasty muscle incision which, if adhered to, will preserve the pretarsal motor supply and prevent muscle atrophy. There is an infraorbital danger zone, where surgeons should pay special attention to avoid electrocautery heat injury.
Neurectomy of the Nerve of Henle Associated with Periarterial Sympathectomy for Management of Intractable Raynaud Phenomenon
Authors: Chen Shih-Heng , Lien Po-Hao , Lee Che-Hsiung , Huang Ren-Wen , Hsu Chung-Cheng , Lin Cheng-Hung , Lin Yu-Te , Tsai Chia-Hsuan , Tsai Hsin-I , Liu Yuan-Chang
Published: June 2023

Background:

In periarterial sympathectomy for intractable Raynaud phenomenon, the extent of adventitectomy and postoperative outcomes and hand perfusion assessment tools remain debatable. The authors evaluated the outcome of neurectomy of the nerve of Henle combined with ulnar tunnel release and periarterial adventitectomy in the treatment of refractory Raynaud phenomenon using objective measurements and patient-reported outcomes.

Methods:

Nineteen patients with 20 affected hands were prospectively enrolled and underwent the proposed procedures from 2015 to 2021. Relevant data, including Michigan Hand Outcomes Questionnaire and 36-Item Short Form health questionnaire scores, were documented for analysis during a 3-year follow-up.

Results:

The average ingress value of the three measured fingers (index, long, and ring) on indocyanine green angiography increased after surgery (P = 0.02). The median number of ulcers decreased (P < 0.001), and the median digital skin temperature increased (P < 0.001). Questionnaire scores showed improvement in physical aspects, such as overall hand function (P ≤ 0.001), activities of daily living (P = 0.001), work performance (P = 0.02), pain (P < 0.001), physical function (P = 0.053), and general health (P = 0.048), and mental aspects, such as patient satisfaction (P < 0.001) and mental health (P = 0.001). The average indocyanine green ingress value of the three measured fingers significantly correlated with the patient-reported outcomes, including overall hand function (r = 0.46, P = 0.04), work performance (r = 0.68, P = 0.001), physical function (r = 0.51, P = 0.02), and patient satisfaction (r = 0.35, P=0.03).

Conclusions:

The proposed surgical procedures provided satisfactory outcomes, both subjectively and objectively, over a follow-up period of up to 3 years. Indocyanine green angiography may provide rapid and quantitative measurements for perioperative hand perfusion assessment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
18F-FDG PET/CT Imaging Findings of a Case of Primary Cardiac Chondrosarcoma and Pulmonary Inflammation
Authors: Liu Yi-Ting , Cheng You , Shao Dan
Published: June 2023

Primary cardiac chondrosarcoma invading the right pulmonary vein is very rare, whereas secondary cardiac chondrosarcoma is relatively common. We reported the 18F-FDG PET/CT findings of primary cardiac chondrosarcoma and pulmonary inflammation misdiagnosed as cardiac malignancy and pulmonary metastasis in a 27-year-old man.
Aberrant Vascular Anatomy Associated With Artifactual Focal Avidity in the Liver on PSMA PET
Authors: Lawal Ismaheel O. , Pectasides Melina , Parihar Ashwin Singh , Shah Hardik U. , Halkar Raghuveer K. , Jani Ashesh B. , Schuster David M.
Published: June 2023

68Ga–prostate-specific membrane antigen (PSMA) PET/CT is a valuable tool for staging and restaging of prostate cancer. Prostate-specific membrane antigen expression is not specific to prostate cancer, as it is expressed in normal tissues as well as in neoplastic and nonneoplastic processes. Awareness of the broad possibility of lesions with PSMA avidity is necessary to recognize normal variants and avoid potential pitfalls in image interpretation. We present a series of cases showing physiologic focal PSMA avidity in hepatic segment IVb. We correlate this uptake with aberrant hepatic vasculature. The awareness of this variant is important for accurate image interpretation to prevent additional invasive procedures, undue treatment escalation, and denial of curative treatment to patients.
Comparison of major abdominal emergency surgery outcomes across organizational models of emergency surgical care: Analysis of the UK NELA national database
Authors: Anand Easan , Rahman Saqib A. , Tomlinson Christopher , Mercer Stuart J. , Pucher Philip H.
Published: June 2023

BACKGROUND

Emergency general surgery (EGS) admissions account for a large proportion of surgical care and represent the majority of surgical patients who suffer in-hospital mortality. Health care systems continue to experience growing demand for emergency services: one way in which this is being increasingly addressed is dedicated subspecialty teams for emergency surgical admissions, most commonly termed “emergency general surgery” in the United Kingdom. This study aims to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies.

METHODS

Data was obtained from the National Emergency Laparotomy Audit database. Patients were dichotomized into EGS hospital or non-EGS hospital. Emergency general surgery hospital is defined as a hospital where >50% of in-hours emergency laparotomy operating is performed by an emergency general surgeon. The primary outcome was in-hospital mortality. Secondary outcomes were intensive therapy unit (ITU) length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias.

RESULTS

There were 115,509 patients from 175 hospitals included in the final analysis. The EGS hospital care group included 5,789 patients versus 109,720 patients in the non-EGS group. Following propensity score weighting, mean standardized mean difference reduced from 0.055 to <0.001. In-hospital mortality was similar (10.8% vs. 11.1%,p= 0.094), with mean length of stay (16.7 days vs. 16.1 days,p< 0.001) and ITU stay (2.8 days vs. 2.6 days,p< 0.001) persistently longer in patients treated in EGS systems.

CONCLUSION

No significant association between the emergency surgery hospital model of care and in-hospital mortality in emergency laparotomy patients was seen. There is a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the United Kingdom.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy are associated with similar outcomes in traumatic cardiac arrest
Authors: Koh Ezra Y. , Fox Erin E. , Wade Charles E. , Scalea Thomas M. , Fox Charles J. , Moore Ernest E. , Morse Bryan C. , Inaba Kenji , Bulger Eileen M. , Meyer David E.
Published: June 2023

BACKGROUND

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive alternative to resuscitative thoracotomy (RT) for patients with hemorrhagic shock. However, the potential benefits of this approach remain subject of debate. The aim of this study was to compare the outcomes of REBOA and RT for traumatic cardiac arrest.

METHODS

A planned secondary analysis of the United States Department of Defense-funded Emergent Truncal Hemorrhage Control study was performed. Between 2017 and 2018, a prospective observational study of noncompressible torso hemorrhage was conducted at six Level I trauma centers. Patients were dichotomized by REBOA or RT, and baseline characteristics and outcomes were compared between groups.

RESULTS

A total of 454 patients were enrolled in the primary study, of which 72 patients were included in the secondary analysis (26 underwent REBOA and 46 underwent resuscitative thoracotomy). Resuscitative endovascular balloon occlusion of the aorta patients were older, had a greater body mass index, and were less likely to be the victims of penetrating trauma. Resuscitative endovascular balloon occlusion of the aorta patients also had less severe abdominal injuries and more severe extremity injuries, although the overall injury severity scores were similar. There was no difference in mortality between groups (88% vs. 93%, p = 0.767). However, time to aortic occlusion was longer in REBOA patients (7 vs. 4 minutes, p = 0.001) and they required more transfusions of red blood cells (4.5 vs. 2.5 units, p = 0.007) and plasma (3 vs. 1 unit, p = 0.032) in the emergency department. After adjusted analysis, mortality remained similar between groups (RR, 0.89; 95% confidence interval, 0.71–1.12, p = 0.304).

CONCLUSION

Resuscitative endovascular balloon occlusion of the aorta and RT were associated with similar survival after traumatic cardiac arrest, although time to successful aortic occlusion was longer in the REBOA group. Further research is needed to better define the role of REBOA in trauma.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Progressive supranuclear palsy: current approach and challenges to diagnosis and treatment
Authors: Veilleux Carpentier Ariane , McFarland Nikolaus R.
Published: June 2023

Purpose of review

Since the original description of progressive supranuclear palsy (PSP) by Steele, Richardson and Olszewski, the clinical spectrum of PSP has expanded and now includes multiple phenotypic variants linked by a common disease. In this review, we discuss the evolution of the PSP syndrome and clinical criteria, with a particular focus on the 2017 Movement Disorders Society PSP criteria, its application and limitations. We also discuss our current approach to diagnosis and treatment.

Recent findings

There is a significant overlap between the different variants of PSP and multiple phenotypes that may be applied to the same patient simultaneously. Variant severity and predominance also evolve throughout the course of the disease. Each variant and level of certainty is associated with different specificity and sensitivity for underlying disease. The differential diagnosis of PSP is continuously evolving and includes other tauopathies, neurodegenerative, genetic, autoimmune and infectious disorders. MRI measurements can aid in the diagnosis. The first guidelines to help with clinical management of those patients have been recently published.

Although much improved, clinical PSP criteria alone remain insufficient and emphasize the need for improved biomarkers to identify patients at early stages to direct appropriate therapeutic strategies and target potential research.
MRI in the new era of antiamyloid mAbs for the treatment of Alzheimer's disease
Authors: Filippi Massimo , Cecchetti Giordano , Agosta Federica
Published: June 2023

Purpose of review

Currently, three antibeta amyloid (Aβ) mAbs are approved or under examination in USA and in Europe for the treatment of patients with early Alzheimer's disease. The aim of this review is to summarize the role of MRI in the mandatory redefinition of dementia care.

Recent findings

Disease-modifying therapies require a reliable biological diagnosis of Alzheimer's disease. Structural MRI should be acquired at the beginning of the diagnostic process as a gateway before subsequent etiological biomarkers. MRI findings, indeed, may support a diagnosis of Alzheimer's disease or suggest alternative non-Alzheimer's disease conditions. Given the high risk/benefit ratio of mAbs and the impact of amyloid-related imaging abnormalities (ARIA), moreover, MRI will be crucial for the appropriate patient selection and safety monitoring. Ad-hoc neuroimaging classification systems of ARIA have been developed and continuous education of prescribers and imaging raters is prompted. MRI measures have been also assessed in clinical trials as potential markers of therapeutic efficacy; results, though, are controversial and still need clarification.

Structural MRI will play a crucial role in the upcoming era of amyloid-lowering mAbs against Alzheimer's disease, from the correct patient selection to the monitoring of adverse events and of disease progression.
Altered amygdala functional connectivity after real-time functional MRI emotion self-regulation training
Authors: Gao Hui , Zhang Huan , Wang Linyuan , Zhang Chi , Feng Zhiyuan , Li Zhonglin , Tong Li , Yan Bin , Hu Guoen
Published: June 2023

Real-time functional MRI neurofeedback (rtfMRI-NF) is a noninvasive technique that extracts concurrent brain states and provides feedback to subjects in an online method. Our study aims to investigate the effect of rtfMRI-NF on amygdala-based emotion self-regulation by analyzing resting-state functional connectivity. We conducted a task experiment to train subjects in self-regulating amygdala activity in response to emotional stimuli. Twenty subjects were divided into two groups. The up-regulate group (URG) viewed positive stimulus, while the down-regulate group (DRG) viewed negative stimulus. The rtfMRI-NF experiment paradigm consisted of three conditions. The URG’s percent amplitude fluctuation (PerAF) scores are significant, indicating that positive emotions may be a partial side effect, with increased activity in the left hemisphere. Resting-state functional connectivity was analyzed via a paired-sample t-test before and after neurofeedback training. Brain network properties and functional connectivity analysis showed a significant difference between the default mode network (DMN) and the brain region associated with the limbic system. These results reveal to some extent the mechanism of neurofeedback training to improve individuals’ emotional regulate regulation ability. Our study has shown that rtfMRI-neurofeedback training can effectively enhance the ability to voluntarily control brain responses. Furthermore, the results of the functional analysis have revealed distinct changes in the amygdala functional connectivity circuits following rtfMRI-neurofeedback training. These findings may suggest the potential clinical applications of rtfMRI-neurofeedback as a new therapy for emotionally related mental disorders.
Serotonin and dopamine depletion in distinct brain regions may cause anxiety in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated mice as a model of early Parkinson’s disease
Authors: Yang Ruixi , Ye Suzhen , Zhang Shuping , Huang Hanjin , Zhang Yun , Yang Yao , Xie Shu , He Lin , Yang Yuwei , Shi Jian
Published: June 2023

In this study, we aimed to evaluate the association of early anxious behavior with serotonin, dopamine, and their metabolites in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) murine model of Parkinson’s disease. Forty C57BL/6 male mice were randomly divided into the control group (n = 20) and the model group (n = 20). Mice in the model group were injected intraperitoneally with MPTP. The light-dark box (LDB) and elevated plus-maze were used to monitor anxious behavior. The association of early anxious behavior with neurotransmitters in the prefrontal cortex, hippocampus, and striatum was evaluated. In our murine model, MPTP induced a decreased level of 5-hydroxytryptamine and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the prefrontal cortex, hippocampus, and striatum (all P < 0.05); however, it only induced a decreased level of dopamine and its metabolite homovanillic acid (HVA) in the striatum (both P < 0.001), with a negative correlation in the hippocampus and a positive correlation in the cortex and striatum. In the LDB, 5-hydroxytryptamine levels in the cortex and dopamine and HVA levels in the striatum were negatively correlated with anxious behavior. Moreover, in the elevate plus-maze, 5-hydroxytryptamine and 5-HIAA in the cortex and dopamine and HVA in the striatum were positively correlated with the ratio of the time spent in open arms. In the murine model of early Parkinson’s disease, the balance between dopamine and 5-hydroxytryptamine systems varied among brain regions. The depletion of 5-hydroxytryptamine in the cortex and dopamine in the striatum may be associated with anxiety behaviors in MPTP-treated mice.
Relationship between the tau protein and choroid plexus volume in Alzheimer’s disease
Authors: Ota Miho , Sato Noriko , Nakaya Moto , Shigemoto Yoko , Kimura Yukio , Chiba Emiko , Yokoi Yuma , Tsukamoto Tadashi , Matsuda Hiroshi
Published: June 2023

Tau protein accumulation in the brain is thought to be one of the causes of Alzheimer’s disease (AD). Recent studies found that the choroid plexus (CP) has a role in β-amyloid and tau protein clearance in the brain. We evaluated the relationships between CP volume and the ß-amyloid and tau protein depositions. Participants were 20 patients with AD and 35 healthy subjects who underwent MRI and PET scanning using the ß-amyloid tracer 11C-PiB and the tau/inflammatory tracer 18F-THK5351. We computed the volume of the CP and estimated the relationships between the CP volume and ß-amyloid and tau protein/inflammatory deposition by Spearman’s correlation test. The CP volume was significantly positively correlated with both the standardized uptake value ratio (SUVR) of 11C-PiB and the SUVR of 18F-THK5351 in all participants. The CP volume was also significantly positively correlated with the SUVR of 18F-THK5351in patients with AD. Our data suggested that the volume of the CP was a good biomarker for the evaluation of tau deposition and neuroinflammation.
Visual recognition of identical cognates involves sublexical inhibition and lexical facilitation
Authors: Botezatu Mona Roxana
Published: June 2023

The study investigated the consequences of cross-language activation on the time course of bilingual word recognition. Twenty-two Spanish-English bilinguals and 21 English monolingual controls decided whether visually presented letter strings were English words, while behavioral and event-related potential responses were recorded. The language status of words was manipulated experimentally, such that words were either identical cognates between English and Spanish (e.g. CLUB) or noncognates (e.g. CLOCK). Participants were equally fast in responding to cognate and noncognate words. Bilinguals were more accurate in responding to cognates, whereas monolinguals exhibited higher accuracy in response to noncognates. Critically, bilinguals produced larger P200 followed by smaller N400 responses to cognates than noncognates, whereas monolinguals showed a pattern of reduced N400 responses to cognates. The results of the current study indicate that cross-language activation may not only result in lexical facilitation (indexed by a reduction of the N400 response to cognates) as a result of shared form-meaning associations across languages but also in sublexical inhibition (indexed by a larger P200 response to cognates) as a consequence of cross-language competition among phonological forms. Results support the language-nonselective view of bilingual lexical access and suggest that while lexical facilitation for identical cognates may be observed at most levels of second language proficiency, sublexical inhibition in response to identical cognates may be a marker of advanced levels of proficiency.
Ginsenoside Rg1 alleviates sleep deprivation-induced learning and memory impairment by inhibiting excessive neuronal apoptosis in zebrafish
Authors: Lu Haifei , Zhang Yini , Ran Simiao , Chen Yumeng , Ye Zijing , Huang Mengying , Wang Ping
Published: June 2023

Sleep deprivation impairs learning and memory. The neuroprotective function of ginsenoside Rg1 (Rg1) has been reported. This study aimed to investigate the alleviative effect and underlying mechanism of action of Rg1 on learning and memory deficits induced by sleep deprivation. Using 72 h of LED light to establish sleep deprivation model and treatment with Rg1-L (0.5 mg/ml), Rg1-H (1 mg/ml), and melatonin (positive control, 0.25 mg/ml), we investigated the behavioral performance of sleep deprivation zebrafish through 24 h autonomous movement tracking, a novel tank diving test, and a T-maze test. Brain injuries and ultrastructural changes were observed, brain water content was measured, and apoptotic events were analyzed using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling staining. The oxidation-associated biomarkers superoxide dismutase, catalase, and glutathione peroxidase activity and lipid peroxidation product malondialdehyde content were detected. Real-time PCR and western blotting were performed to detect the levels of apoptotic molecules (Bax, caspase-3, and Bcl-2). Rg1-treatment was observed to improve the behavioral performance of sleep-deprivation fish, alleviate brain impairment, and increase oxidative stress-related enzyme activity. Rg1 can effectively exhibit neuroprotective functions and improve learning and memory impairments caused by sleep deprivation, which could be mediated by the Bcl-2/Bax/caspase-3 apoptotic signaling pathway (see Supplementary Video Abstract, Supplemental digital content, http://links.lww.com/WNR/A702 which demonstrates our research objectives, introduction overview of Rg1, and main direction of future research).
Pathophysiological aspects of neonatal anoxia and temporal expression of S100β in different brain regions
Authors: Hamasaki Mike Yoshio , Mendes Caroline , Batagello Daniella Sabino , Hirata Mario Hiroyuki , Britto Luiz Roberto Giorgetti de , Nogueira Maria Inês
Published: June 2023

The aim of this study was to investigate the temporal variations of S100β in the hippocampus, cerebellum and cerebral cortex of neonatal rats (Wistar strain) under anoxic conditions. Real-time PCR and western blotting techniques were used for gene expression and protein analysis. Animals were divided into two groups, a control group and an anoxic group, and further separated at different time points for analysis. After anoxia, S100β gene expression showed a significant peak in the hippocampus and cerebellum after 2 h, followed by a decline compared to the control group at other time points. The increased gene expression in these regions was also accompanied by an increase in S100β protein levels in the anoxia group, observable 4 h after injury. In contrast, S100β mRNA content in the cerebral cortex never exceeded control values at any time point. Similarly, the protein content of S100β in the cerebral cortex did not show statistically significant differences compared to control animals at any assessment time point. These results suggest that the production profile of S100β differs by brain region and developmental stage. The observed differences in vulnerability between the hippocampus, cerebellum and cerebral cortex may be attributed to their distinct developmental periods. The hippocampus and cerebellum, which develop earlier than the cerebral cortex, showed more pronounced effects in response to anoxia, which is supported by the gene expression and protein content in this study. This result reveals the brain region-dependent nature of S100β as a biomarker of brain injury.
Inhibition of inflammatory factor TNF-α by ferrostatin-1 in microglia regulates necroptosis of oligodendrocyte precursor cells
Authors: Chai Zhi , Ma Teng , Li Yunhong , Chen Qiuyuan , Kang Yali , Sun Jinping , Peng Tao , Wang Nina , Yu Chengjun , Wang Lijuan , Hou Xiaolin , Wang Wei , Wang Yin
Published: June 2023

Objective

Inflammation of the surrounding environment is a major reason causing loss or injury of oligodendrocyte precursor cells (OPCs) in myelin-associated diseases. Lipopolysaccharide-activated microglia can release various inflammatory factors such as tumor necrosis factor-α (TNF-α). One of the ways of OPC death is necroptosis, which can be triggered by TNF-α, a death receptor ligand, by activating receptor-interacting protein kinase 1 (RIPK1)/RIPK3/mixed lineage kinase domain-like protein (MLKL) signaling pathway. This study investigated whether inhibiting microglia ferroptosis can decrease TNF-α release to alleviate OPC necroptosis.

Methods

Lipopolysaccharide and Fer-1 stimulate BV2 cells. The expressions of GPX4 and TNF-α were detected by western blot and quantitative real-time PCR; malondialdehyde, glutathione, iron, and reactive oxygen species were measured by the assay kits. After lipopolysaccharide stimulation of BV2 cells, the supernatant was taken to culture OPC. The protein expression levels of RIPK1, p-RIPK1, RIPK3, p-RIPK3, MLKL, and p-MLKL were detected by western blot.

Results

Lipopolysaccharide administration could induce ferroptosis in microglia by decreasing ferroptosis marker GPX4, while ferroptosis inhibitor Fer-1 could significantly increase GPX4 level. Fer-1 prevented oxidative stress and iron concentration elevation and alleviated mitochondrial damage in lipopolysaccharide-induced BV2 cells. The results revealed that Fer-1 downregulated the release of lipopolysaccharide-induced TNF-α in microglia and attenuated OPC necroptosis by significantly decreasing the expression levels of RIPK1, p-RIPK1, MLKL, p-MLKL, RIPK3, and p-RIPK3.

Conclusion

Fer-1 may be a potential agent for inhibiting inflammation and treating myelin-related diseases.
Low-Impact Laparoscopy vs Conventional Laparoscopy for Appendectomy: A Prospective Randomized Trial
Authors: Etienne Jean-Hubert , Salucki Benjamin , Gridel Victor , Orban Jean-Christophe , Baqué Patrick , Massalou Damien
Published: June 2023

Background:

Low-impact laparoscopy, or LIL, combining low-pressure insufflation and micro-laparoscopy, is a surgical technique that is still not widely used and that has never been evaluated for the management of acute appendicitis. The aim of this study is to assess the feasibility of an LIL protocol, to compare post-operative pain, average length of stay (LOS), and in-hospital use of analgesics by patients who underwent appendectomy according to a conventional laparoscopy or a LIL protocol.

Study design:

Patients presenting with acute uncomplicated appendicitis who were operated between January 1, 2021 and July 10, 2022 were included in this double-blind, single-centre, prospective study. They were pre-operatively randomized to a group undergoing conventional laparoscopy, i.e. with an insufflation pressure of 12 mmHg and conventional instrumentation, and an LIL group, with an insufflation pressure of 7 mmHg and micro-laparoscopic instrumentation.

Results:

Fifty patients were included in this study, 24 in the LIL group and 26 in the conventional group. There were no statistically significant differences between the two patient groups, including weight and surgical history. The post-operative complication rate was comparable between the two groups (p=0.81). Pain was reported as significantly lower according to the visual analog pain scale (VAS) 2 hours after surgery among the LIL group (p=0.019). For patients who underwent surgery according to the LIL protocol, the study confirms a statistically significant difference for theoretical and actual LOS, i.e. -0.77 days and -0.59 days, respectively (p<0.001 and p=0.03). In-hospital use of analgesics was comparable between both groups.

Conclusion:

In uncomplicated acute appendicitis, the LIL protocol could reduce post-operative pain and average LOS compared to conventional laparoscopic appendectomy.
Streptococcus parasanguinis: An emerging pathogen causing neonatal endocarditis: A case report
Authors: Shrimali Twishi , Malhotra Shikhir , Relhan Nidhi , Tak Vibhor , Choudhary Sushil Kumar , Gupta Neeraj , Singh Arun Kumarendu
Published: June 2023

Background. The microbial infection of the endocardium, popularly known as Infective Endocarditis (IE), is typically classified on the basis of anatomy, valve nativity and its associated microbiology. As per the associated microbiology,

Staphylococcus aureus

is the most common microorganism responsible for the cause of IE. Even though, the Streptococcus group accounts for a smaller percentage of IE, however this doesn’t give us the liberty of ignoring the high mortality and morbidity associated with this pathogen.

Case presentation. We report an unusual case of neonatal sepsis, complicated with endocarditis, caused by penicillin resistant

Streptococcus parasanguinis

. The neonate however died of the same despite all efforts. The said baby was given birth by a mother with gestational diabetes mellitus.

Conclusion. High index of clinical suspicion and prompt diagnosis are the most important factors of patient management, especially in cases of life threatening neonatal infections. In such conditions a coordinated interdepartmental approach is very much needed.
EVALUATION OF MYCOTOXINS IN GRAINS SOLD IN IDAH AND ITS ENVIRONS
Authors: Ukwuru Michael Ukwuru , Muritala Abdullahi
Published: June 2023

Mycotoxin contamination in grains is a significant concern due to its adverse effects on human and animal health. Understanding the levels and patterns of mycotoxin contamination in different regions and storage conditions is crucial for developing effective control strategies. This study aimed to assess mycotoxin levels in stored and recently harvested grains in three regions (Idah, Ajaka, and Ogbogbo) and investigate the implications for food safety. The study involved the analysis of mycotoxin levels in maize, rice, sorghum, and millet using appropriate analytical techniques. The findings revealed the presence of mycotoxins such as aflatoxins (1-5 µg/Kg), deoxynivalenol (520-700 µg/Kg) zearalenone (250-350 µg/Kg), ochratoxins (3-4 µg/Kg) and fumonisin in both recently harvested and stored grains. Variations in mycotoxin levels were observed among different grains and regions, highlighting the need for targeted interventions. This study demonstrates the persistence of mycotoxin contamination in stored grains and the importance of considering specific crop types and geographical locations when addressing mycotoxin contamination. The findings underscore the significance of implementing effective control measures to mitigate mycotoxin contamination and enhance food safety. The study provides valuable insights into mycotoxin contamination and emphasizes the need for comprehensive risk assessment studies and appropriate regulatory measures.