bluuebunny/crossref_metadata_2025 huggingface dataset:
Nursing Practice and Care Structure for Children and Their Families in Need of Pediatric Palliative and End-of-Life Care in Japan
Authors: Nagoya Yuko , Matsuoka Mari , Takenouchi Naoko , Hirata Mika , Arita Naoko , Kawakatsu Kazuko , Furuhashi Tomoko , Ishiura Mitsuyo , Nakatani Fumi
Published: January 2023

Many nurses experience difficulties in pediatric palliative care practice. The study aimed to describe the current situation and structure of pediatric palliative and end-of-life care nursing practices for children and their families in Japan. The research subjects were nurses working in hospitals; facilities for persons with severe physical, motor, and intellectual disabilities; and home-visit nursing stations. The practice ratio was calculated using a 79-item survey form, and factor analysis was conducted. A total of 113 facilities (acceptance rate: 26.5%) and 777 nurses (response rate: 44.6%) responded. Five items had a “Practicing” ratio of ≥90%. In factor analysis, 7 domains were identified: “preparing to face the time of death with the child and family,” “ensuring child-centered care,” “managing symptoms with the child and family,” “considering and coordinating for the child's peaceful time of death,” “understanding and respecting the culture of the child and family,” “assessing the child and family as a whole person,” and “performing self-reflection on an ethical issue.” Nurses' practice of pediatric palliative care differs by practice domain. It is necessary to reflect on the educational programs under development to improve the quality of life of children and their families.
Revisiting Reduction Mammaplasty: Complications of Oncoplastic and Symptomatic Macromastia Reductions
Authors: Morrison Kerry A. , Frey Jordan D. , Karp Nolan , Choi Mihye
Published: January 2023

Background:

Oncoplastic breast reduction has been shown to be an effective and safe approach to breast conservation surgery in women with macromastia. However, there remains a paucity of data investigating the comparative outcomes. This study seeks to delineate the complication profiles for oncoplastic and symmetrizing breast reductions versus mammaplasty for benign macromastia.

Methods:

A retrospective review was conducted of all consecutively performed reduction mammaplasty cases at a single institution by two plastic surgeons over a 2-year period.

Results:

A total of 632 breasts were analyzed: 502 reduction mammaplasties, 85 symmetrizing reductions, and 45 oncoplastic reductions in 342 patients. Mean age was 43.9 ± 15.93 years, mean body mass index was 29.15 ± 5.66 kg/m2, and mean reduction weight was 610.03 ± 313.13 g. Regarding surgical technique, a medial pedicle was used in 86% of cases. There were similar postoperative complication outcomes for nipple necrosis, wound healing, scar revision, fat necrosis, seroma, hematoma, and overall complication rates for all procedures. However, the rate of postoperative revision among reduction mammaplasty (2%), oncoplastic reduction (6.7%), and symmetrizing reduction (5.9%) was significantly different (P = 0.027). In univariate analysis, diabetes (P = 0.011), smoking (P = 0.007), higher body mass index (P = 0.003), larger reduction weight (P = 0.011), longer nipple-to–inframammary fold measurement (P = 0.014), and longer sternal notch–to-nipple measurement (P = 0.039) were all significant risk factors for a surgical complication in reductions performed for any indication. Using a multivariate logistic regression model, diabetes (P = 0.047), smoking (P = 0.025), and higher body mass index (P = 0.002) were all retained as statistically significant risk factors.

Conclusion:

The complication profiles for both oncoplastic breast reductions and breast reductions for symptomatic macromastia are similar and acceptably low.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Male Face-Lift Finesse
Authors: Rohrich Rod J. , Novak Matthew
Published: January 2023

Male face lifts account for approximately 10% of the total number of face-lift procedures performed annually in the United States. Although many face-lift principles apply universally, there are certain characteristics of the male face that make the management and surgical procedure unique. A systematic and patient-specific approach to the preoperative markings, facial analysis, and surgical technique in the male face lift will ensure safe, consistent, and natural appearing results.
Paradoxical Changes of Cutaneous Microcirculation and Sympathetic Fibers of Rat Hind Limbs after Sciatic Nerve Compression
Authors: Peng Yi , Lu Junren , Lu Shunyi , Zou Jiapeng , Fu Tengfei , Jiang Libo , Wang Jiayi , Meng Dehua , Chen Zenggan , Zhang Jian
Published: January 2023

Background:

Recent studies show evidence that surgical nerve decompression could improve cutaneous blood flow (CBF), which might benefit ulcer healing. However, the change of CBF and sympathetic fibers after nerve compression is poorly understood. In the current study, a unilateral sciatic nerve compression model was created in Sprague-Dawley rats.

Methods:

A laser Doppler imaging system was applied to assess the CBF of the regions below the ankles. Immunohistochemistry and transmission electron microscopy were used to investigate the histopathologic changes of sympathetic fibers in sciatic nerve samples.

Results:

Laser Doppler imaging revealed decreased CBF of both the lesional limb and the contralesional limb, which occurred earlier in the lesional side, indicating an enhanced sympathetic tone on vasomotor function. Intraneural density of sympathetic fibers decreased on both sides and the ultrastructure of unmyelinated fibers of both sides degenerated in a nonsynchronized manner.

Conclusions:

The study revealed nonsynchronized reduced CBF of bilateral hind limbs with paradoxically degenerated and diminished sympathetic fibers in bilateral sciatic nerves after unilateral sciatic nerve compression. These results may validate the importance of and broaden the indications for surgical nerve decompression in preventing or treating foot ulcers.
Quantifying the Severity of Metopic Craniosynostosis Using Unsupervised Machine Learning
Authors: Anstadt Erin E. , Tao Wenzheng , Guo Ejay , Dvoracek Lucas , Bruce Madeleine K. , Grosse Philip J. , Wang Li , Kavan Ladislav , Whitaker Ross , Goldstein Jesse A.
Published: January 2023

Background:

Quantifying the severity of head shape deformity and establishing a threshold for operative intervention remains challenging in patients with metopic craniosynostosis (MCS). This study combines three-dimensional skull shape analysis with an unsupervised machine-learning algorithm to generate a quantitative shape severity score (cranial morphology deviation) and provide an operative threshold score.

Methods:

Head computed tomography scans from subjects with MCS and normal controls (5 to 15 months of age) were used for objective three-dimensional shape analysis using ShapeWorks software and in a survey for craniofacial surgeons to rate head-shape deformity and report whether they would offer surgical correction based on head shape alone. An unsupervised machine-learning algorithm was developed to quantify the degree of shape abnormality of MCS skulls compared to controls.

Results:

One hundred twenty-four computed tomography scans were used to develop the model; 50 (24% MCS, 76% controls) were rated by 36 craniofacial surgeons, with an average of 20.8 ratings per skull. The interrater reliability was high (intraclass correlation coefficient, 0.988). The algorithm performed accurately and correlates closely with the surgeons assigned severity ratings (Spearman correlation coefficient, r = 0.817). The median cranial morphology deviation for affected skulls was 155.0 (interquartile range, 136.4 to 194.6; maximum, 231.3). Skulls with ratings of 150.2 or higher were very likely to be offered surgery by the experts in this study.

Conclusions:

This study describes a novel metric to quantify the head shape deformity associated with MCS and contextualizes the results using clinical assessments of head shapes by craniofacial experts. This metric may be useful in supporting clinical decision making around operative intervention and in describing outcomes and comparing patient population across centers.
Long-Term Clinical Results of Two-Stage Total Ear Reconstruction of Microtia Using Autologous Cell-Engineered Chondrocytes
Authors: Sakahara Daisuke , Yanaga Hiroko , Noto Mariko , Fujimoto Takuya , Imai Keisuke
Published: January 2023

Background:

Microtia repair requires a large volume of reconstruction material.

In pediatric patients, the collectable volume of autologous cartilage is limited, and the impact of surgical invasion and donor-site morbidity can be particularly severe. The authors developed a new treatment method using cultured autologous human auricular chondrocytes that provides a sufficiently large volume of reconstruction material.

Methods:

Approximately 1 cm2 of auricular cartilage was collected from the affected site. Chondrocytes were isolated and cultured with autologous serum to accelerate cell proliferation. The cells were subcultured and formed a gel-form mass without a scaffold. In our two-stage implantation, the cultured chondrocytes were first injected into the patient’s lower abdomen, where the cells grew into a large, newly generated cartilage in 6 months. Thereafter, this cartilage was sculpted into an ear framework and subcutaneously reimplanted into the new ear location. Clinical outcomes were assessed over a long-term follow-up.

Results:

Eight patients underwent surgery using cultured autologous auricular chondrocytes from 2002 to 2008. The patients’ ages ranged from 6 to 10 years. The follow-up period ranged from 11 to 18 years. None of the patients experienced absorption of cultured chondrocytes after the second stage. Complications included one case of absorption and one case of allergic reaction in the first stage.

Conclusions:

The authors’ patients represent the first successful cases of regenerative surgery for microtia using cultured chondrocytes. No malignant transformation, change in size, deformation, or other abnormalities were observed during the long-term follow-up, demonstrating the safety of cultured cartilage. No major complications occurred.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Personalized Opioid Prescription Model for Predicting Postoperative Discharge Opioid Needs
Authors: Zhang Kevin K. , Blum Kevin M. , Chu Jacqueline J. , Zewdu Abeba , Janse Sarah , Skoracki Roman , Janis Jeffrey E. , Barker Jenny C.
Published: January 2023

Background:

Opioid overprescribing after surgery is common. There is currently no universal predictive tool available to accurately anticipate postdischarge opioid need in a patient-specific manner. This study examined the efficacy of a patient-specific opioid prescribing framework for estimating postdischarge opioid consumption.

Methods:

A total of 149 patients were evaluated for a single-center retrospective cohort study of plastic and reconstructive surgery patients. Patients with length of stay of 2 to 8 days and quantifiable inpatient opioid consumption (n = 116) were included. Each patient’s daily postoperative inpatient opioid consumption was used to generate a personalized logarithmic regression model to estimate postdischarge opioid need. The validity of the personalized opioid prescription (POP) model was tested through comparison with actual postdischarge opioid consumption reported by patients 4 weeks after surgery. The accuracy of the POP model was compared with two other opioid prescribing models.

Results:

The POP model had the strongest association (R
2 = 0.899; P < 0.0001) between model output and postdischarge opioid consumption when compared to a procedure-based (R
2 = 0.226; P = 0.025) or a 24-hour (R
2 = 0.152; P = 0.007) model. Accuracy of the POP model was unaffected by age, gender identity, procedure type, or length of stay. Odds of persistent use at 4 weeks increased, with a postdischarge estimated opioid need at a rate of 1.16 per 37.5 oral morphine equivalents (P = 0.010; 95% CI, 1.04 to 1.30).

Conclusions:

The POP model accurately estimates postdischarge opioid consumption and risk of developing persistent use in plastic surgery patients. Use of the POP model in clinical practice may lead to more appropriate and personalized opioid prescribing.
The Vicious Circle of Stasis, Inflammation, and Fibrosis in Lymphedema
Authors: Brown Stav , Dayan Joseph H. , Kataru Raghu P. , Mehrara Babak J.
Published: January 2023

Lymphedema is a progressive disease of the lymphatic system arising from impaired lymphatic drainage, accumulation of interstitial fluid, and fibroadipose deposition. Secondary lymphedema resulting from cancer treatment is the most common form of the disease in developed countries, affecting 15% to 40% of patients with breast cancer after lymph node dissection. Despite recent advances in microsurgery, outcomes remain variable and, in some cases, inadequate. Thus, development of novel treatment strategies is an important goal. Research over the past decade suggests that lymphatic injury initiates a chronic inflammatory response that regulates the pathophysiology of lymphedema. T-cell inflammation plays a key role in this response. In this review, the authors highlight the cellular and molecular mechanisms of lymphedema and discuss promising preclinical therapies.
Cosmetic Rhinoplasty
Authors: Boustany Ashley N. , Grover Ritwik , Alnaeem Hassan , Seyidova Nargiz , Rohrich Rod J. , Lin Samuel J.
Published: January 2023

Learning Objectives:

After studying this article, the participant should be able to: 1. Perform a systematic nasofacial analysis. 2. Identify the underlying anatomical cause of specific external nasal findings. 3. Recognize the interrelated effects of operative maneuvers. 4. Develop an appropriate operative plan to address patient concerns.

The rhinoplasty operation is one of the most challenging procedures in plastic surgery, and requires a combination of surgical judgment, knowledge of anatomy, technical skill, and lifelong study. A foundation must be built on clearly defined patient goals and an accurate diagnosis, based on known ideals and their anatomical correlation. It is important to recognize the definitive impact of each operative maneuver to achieve predictable outcomes. This article provides a problem-based approach to common cosmetic nasal deformities.
Hypertrophic Scars of the Hand: The Role of Electrophotobiomodulation Theory as a Recent Line of Treatment
Authors: Elmelegy Nader Gomaa
Published: January 2023

Background:

A more enduring strategy for the treatment of hypertrophic scars of the hand is still a challenge facing restorative dermatologists and plastic surgeons. Nonetheless, with the use of nonablative devices, intense pulsed light and different types of lasers have started to yield promising outcomes and are close to becoming an effective and dependable technique. The advances in radiofrequency energy have brought new life to optical-based frameworks. Radiofrequency current delivers an unadulterated heat effect according to the electrical response characteristics of each tissue. The purpose of this study was to assess the patient satisfaction, safety, and clinical efficacy of the use of electrophotobiomodulation (combined intense pulsed light and radiofrequency energy) in the treatment of postburn hypertrophic scars of the hand.

Methods:

This was a prospective clinical study that was performed on 56 patients who presented with postburn hypertrophic scars on the hands between March of 2013 and January of 2020.

Results:

The clinical appraisal showed excellent results in 33 patients (58.9%), good results in 18 patients (32.2%), fair results in five patients (8.9%), and no poor results.

Conclusion:

The use of radiofrequency energy combined with intense pulsed light was effective for the treatment of hand scars on people with various skin tones.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Host variation in type I interferon signaling genes (MX1), C–C chemokine receptor type 5 gene, and major histocompatibility complex class I alleles in treated HIV+ noncontrollers predict viral reservoir size
Authors: Siegel David A. , Thanh Cassandra , Wan Eunice , Hoh Rebecca , Hobbs Kristen , Pan Tony , Gibson Erica A. , Kroetz Deanna L. , Martin Jeffrey , Hecht Frederick , Pilcher Christopher , Martin Maureen , Carrington Mary , Pillai Satish , Busch Michael P. , Stone Mars , Levy Claire N. , Huang Meei-Li , Roychoudhury Pavitra , Hladik Florian , Jerome Keith R. , Kiem Hans-Peter , Henrich Timothy J. , Deeks Steven G. , Lee Sulggi A.
Published: January 2023

Objective:

Prior genomewide association studies have identified variation in major histocompatibility complex (MHC) class I alleles and C–C chemokine receptor type 5 gene (CCR5Δ32) as genetic predictors of viral control, especially in ‘elite’ controllers, individuals who remain virally suppressed in the absence of therapy.

Design:

Cross-sectional genomewide association study.

Methods:

We analyzed custom whole exome sequencing and direct human leukocyte antigen (HLA) typing from 202 antiretroviral therapy (ART)-suppressed HIV+ noncontrollers in relation to four measures of the peripheral CD4+ T-cell reservoir: HIV intact DNA, total (t)DNA, unspliced (us)RNA, and RNA/DNA. Linear mixed models were adjusted for potential covariates including age, sex, nadir CD4+ T-cell count, pre-ART HIV RNA, timing of ART initiation, and duration of ART suppression.

Results:

Previously reported ‘protective’ host genetic mutations related to viral setpoint (e.g. among elite controllers) were found to predict smaller HIV reservoir size. The HLA ‘protective’ B∗57:01 was associated with significantly lower HIV usRNA (q = 3.3 × 10−3), and among the largest subgroup, European ancestry individuals, the CCR5Δ32 deletion was associated with smaller HIV tDNA (P = 4.3 × 10−3) and usRNA (P = 8.7 × 10−3). In addition, genomewide analysis identified several single nucleotide polymorphisms in MX1 (an interferon stimulated gene) that were significantly associated with HIV tDNA (q = 0.02), and the direction of these associations paralleled MX1 gene eQTL expression.

Conclusions:

We observed a significant association between previously reported ‘protective’ MHC class I alleles and CCR5Δ32 with the HIV reservoir size in noncontrollers. We also found a novel association between MX1 and HIV total DNA (in addition to other interferon signaling relevant genes, PPP1CB, DDX3X). These findings warrant further investigation in future validation studies.
Perinatal outcomes associated with combination antiretroviral therapy compared with monotherapy
Authors: Portwood Clara , Sexton Harriet , Kumarendran Mary , Brandon Zoe , Johnson Bradley , Kirtley Shona , Hemelaar Joris
Published: January 2023

Objectives:

Increasing numbers of women living with HIV (WLHIV) worldwide receive combination antiretroviral therapy (cART) during pregnancy. We aimed to assess the risk of adverse perinatal outcomes in pregnant WLHIV receiving cART compared with pregnant WLHIV receiving zidovudine monotherapy.

Design:

Systematic review and meta-analysis.

Methods:

We searched four electronic literature databases (PubMed, CINAHL, Global Health, EMBASE) for studies published between 1 January 1980 and 20 April 2020 using a comprehensive search strategy. Studies reporting data on WLHIV receiving cART compared with WLHIV receiving monotherapy for 11 adverse perinatal outcomes were sought: preterm birth (PTB), very PTB, spontaneous PTB, low birthweight (LBW), very LBW, preterm and term LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted to calculate relative risk (RR) and 95% confidence intervals (95% CI).

Results:

We included 30 studies reporting on 317 101 pregnant women in 27 countries. WLHIV receiving cART were at increased risk of PTB (RR 1.32, 95% CI 1.18–1.46), LBW (1.35, 1.19–1.53), SGA (1.32, 1.13–1.53), VSGA (1.64, 1.34–2.02), and stillbirth (2.41, 1.83–3.17) compared to WLHIV receiving monotherapy. The significance of these results was maintained in subgroup analyses for studies conducted in low and middle-income countries and average quality studies. Additionally, WLHIV receiving nonnucleoside reverse transcriptase inhibitor-based cART were associated with increased risk of PTB, LBW, and stillbirth, while WLHIV receiving protease inhibitor-based cART were associated with increased risk of PTB, compared with WLHIV receiving monotherapy.

Conclusion:

Pregnant WLHIV receiving cART are associated with increased risk of adverse perinatal outcomes, compared with WLHIV receiving monotherapy.
Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa
Authors: Cluver Lucie D. , Zhou Siyanai , Orkin Mark , Rudgard William , Meinck Franziska , Langwenya Nontokozo , Vicari Marissa , Edun Olanrewaju , Sherr Lorraine , Toska Elona
Published: January 2023

Objective:

We are failing to reach 95–95–95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally.

Design:

A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015–2016, 2017–2018).

Methods:

A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex.

Results:

Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21–0.72, P = 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P = 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70–74%) compared with 38% (95% CI 20–56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex.

Conclusion:

Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.
Advanced HIV disease and engagement in care among patients on antiretroviral therapy in South Africa: results from a multi-state model
Authors: Patten Gabriela E. , Euvrard Jonathan , Anderegg Nanina , Boulle Andrew , Arendse Kirsten D. , von der Heyden Erin , Ford Nathan , Davies Mary-Ann
Published: January 2023

Objective:

Despite improved access to antiretroviral therapy (ART) for people with HIV (PWH), HIV continues to contribute considerably to morbidity and mortality. Increasingly, advanced HIV disease (AHD) is found among PWH who are ART-experienced.

Design:

Using a multi-state model we examined associations between engagement with care and AHD on ART in South Africa.

Methods:

Using data from IeDEA Southern Africa, we included PWH from South Africa, initiating ART from 2004 to 2017 aged more than 5 years with a CD4+ cell count at ART start and at least one subsequent measure. We defined a gap as no visit for at least 18 months. Five states were defined: ‘AHD on ART’ (CD4+ cell count <200 cells/μl), ‘Clinically Stable on ART’ (CD4+ cell count ≥200 or if no CD4+ cell count, viral load <1000 copies/ml), ‘Early Gap’ (commencing ≤18 months from ART start), ‘Late Gap’ (commencing >18 months from ART start) and ‘Death’.

Results:

Among 32 452 PWH, men and those aged 15–25 years were more likely to progress to unfavourable states. Later years of ART start were associated with a lower probability of transitioning from AHD to clinically stable, increasing the risk of death following AHD. In stratified analyses, those starting ART with AHD in later years were more likely to re-engage in care with AHD following a gap and to die following AHD on ART.

Conclusion:

In more recent years, those with AHD on ART were more likely to die, and AHD at re-engagement in care increased. To further reduce HIV-related mortality, efforts to address the challenges facing these more vulnerable patients are needed.
Neutrophil heterogeneity and emergence of a distinct population of CD11b/CD18-activated low-density neutrophils after trauma
Authors: Goretti Riça Ingred , Joughin Brian A. , Teke Martha E. , Emmons Tiffany R. , Griffith Alec M. , Cahill Laura A. , Banner-Goodspeed Valerie M. , Robson Simon C. , Hernandez Jonathan M. , Segal Brahm H. , Otterbein Leo E. , Hauser Carl J. , Lederer James A. , Yaffe Michael B.
Published: January 2023

INTRODUCTION

Multiple large clinical trauma trials have documented an increased susceptibility to infection after injury. Although neutrophils (polymorphonuclear leukocytes [PMNs]) were historically considered a homogeneous cell type, we hypothesized that injury could alter neutrophil heterogeneity and predispose to dysfunction. To explore whether trauma modifies PMN heterogeneity, we performed an observational mass-spectrometry–based cytometry study on total leukocytes and low-density PMNs found in the peripheral blood mononuclear cell fraction of leukocytes from healthy controls and trauma patients.

METHODS

A total of 74 samples from 12 trauma patients, each sampled at 1 or more time points, and matched controls were fractionated and profiled by mass-spectrometry–based cytometry using a panel of 44 distinct markers. After deconvolution and conservative gating on neutrophils, data were analyzed using Seurat, followed by clustering of principal components.

RESULTS

Eleven distinct neutrophil populations were resolved in control and trauma neutrophils based on differential protein surface marker expression. Trauma markedly altered the basal heterogeneity of neutrophil subgroups seen in the control samples, with loss of a dominant population of resting neutrophils marked by high expression of C3AR and low levels of CD63, CD64, and CD177 (cluster 1), and expansion of two alternative neutrophil populations, one of which is marked by high expression of CD177 with suppression of CD10, CD16, C3AR, CD63, and CD64 (cluster 6). Remarkably, following trauma, a substantially larger percentage of neutrophils sediment in the monocyte fraction. These low-density neutrophils bear markers of functional exhaustion and form a unique trauma-induced population (cluster 9) with markedly upregulated expression of active surface adhesion molecules (activated CD11b/CD18), with suppression of nearly all other surface markers, including receptors for formyl peptides, leukotrienes, chemokines, and complement.

CONCLUSION

Circulating neutrophils demonstrate considerable evidence of functional heterogeneity that is markedly altered by trauma. Trauma induces evolution of a novel, exhausted, low-density neutrophil population with immunosuppressive features.
Recent trends in the management of isolated high-grade splenic injuries: A nationwide analysis
Authors: Aoki Makoto , Onogawa Atsushi , Matsumoto Shokei , Matsushima Kazuhide
Published: January 2023

BACKGROUND

The feasibility of nonoperative management for high-grade blunt splenic injuries (BSIs) has been suggested in recent studies. The purpose of this study was to assess nationwide trends in the management of isolated high-grade BSIs. We hypothesized that isolated high-grade BSIs are more frequently being managed nonoperatively.

METHODS

The American College of Surgeons Trauma Quality Improvement Program database was queried to identify patients (16 years or older) with isolated high-grade BSIs (Abbreviated Injury Scale, ≥3) between 2013 and 2019. Patients were divided into two groups based on their hemodynamic status (hemodynamically stable [HS] and hemodynamically unstable [HU]). The primary outcome was the rate of total splenectomy each year, and the secondary outcome was the use of splenic angioembolization (SAE). Multiple regression models were created to estimate annual trends in splenectomy and SAE.

RESULTS

A total of 6,747 patients with isolated high-grade BSIs were included: 5,714 (84.7%) and 1,033 (15.3%) in HS and HU groups, respectively. In the HS group, the rate of overall splenectomy was significantly decreased (from 22.9% in 2013 to 12.6% in 2019; odds ratio [OR] for 1-year increment, 0.850; 95% confidence interval [CI], 0.815–0.886; p < 0.001), and the use of SAE was significantly increased (from 12.5% in 2013 to 20.9% in 2019; OR, 1.107; 95% CI, 1.065–1.150; p < 0.001). In the HU group, the overall splenectomy rate was unchanged (from 69.8% in 2013 to 50.8% in 2019; OR, 0.931; 95% CI, 0.865–1.002; p = 0.071), whereas SAE was significantly increased (from 12.7% in 2013 to 28.8% in 2019; OR, 1.176; 95% CI, 1.079–1.284; p < 0.001).

CONCLUSION

We observed significant trends toward more frequent use of nonoperative management in high-grade BSIs with hemodynamic stability. Further studies are warranted to define the role of SAE, especially in patients with hemodynamic instability.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
When is enough enough? Odds of survival by unit transfused
Authors: Loudon Andrew M. , Rushing Amy P. , Hue Jonathan J. , Ziemak Alison , Sarode Anuja L. , Moorman Matthew L.
Published: January 2023

BACKGROUND

Balanced transfusion is lifesaving for hemorrhagic shock. The American Red Cross critical blood shortage in 2022 threatened the immediate availability of blood. To eliminate waste, we reviewed the utility of transfusions per unit to define expected mortality at various levels of balanced transfusion.

METHODS

A retrospective study of 296 patients receiving massive transfusion on presentation at a level 1 trauma center was performed from January 2018 to December 2021. Units of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets received in the first 4 hours were recorded. Patients were excluded if they died in the emergency department, died on arrival, received <2 U PRBCs or FFP, or received PRBC/FFP >2:1. Primary outcomes were mortality and odds of survival to discharge. Subgroups were defined as transfused if receiving 2 to 9 U PRBCs, massive transfusion for 10 to 19 U PRBCs, and ultramassive transfusion for ≥20 U PRBCs.

RESULTS

A total of 207 patients were included (median age, 32 years; median Injury Severity Score, 25; 67% with penetrating mechanism). Mortality was 29% (61 of 207 patients). Odds of survival is equal to odds of mortality at 11 U PRBCs (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.50–1.79). Beyond 16 U PRBCs, odds of mortality exceed survival (OR, 0.36; 95% CI, 0.16–0.82). Survival approaches zero >36 U PRBCs (OR, 0.09; 95% CI, 0.00–0.56). Subgroup mortality rates increased with unit transfused (16% transfused vs. 36% massive transfusion, p = 0.003; 36% massive transfusion vs. 67% ultramassive transfusion, p = 0.006).

CONCLUSION

Mortality increases with each unit balanced transfusion. Surgeons should view efforts heroic beyond 16 U PRBCs/4 hours and near futile beyond 36 U PRBCs/4 hours. While extreme outliers can survive, consider cessation of resuscitation beyond 36 U PRBCs. This is especially true if hemostasis has not been achieved or blood supplies are limited.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level IV.
Rapid evolution of diet choice in an introduced population of Trinidadian guppies
Authors: Smith Shawna , Mohamed Amina , Amaral Jeferson Ribeiro , Kusi Nana , Smith Alexander , Gordon Swanne P. , López-Sepulcre Andrés
Published: January 2023

Eco-evolutionary theory has brought an interest in the rapid evolution of functional traits. Among them, diet is an important determinant of ecosystem structure, affecting food web dynamics and nutrient cycling. However, it is largely unknown whether diet, or diet preference, has a hereditary basis and can evolve on contemporary timescales. Here, we study the diet preferences of Trinidadian guppies
Poecilia reticulata
collected from directly below an introduction site of fish transplanted from a high-predation environment into a low predation site where their densities and competition increased. Behavioural assays on F2 common garden descendants of the ancestral and derived populations showed that diet preference has rapidly evolved in the introduced population in only 12 years (approx. 36 generations). Specifically, we show that the preference for high-quality food generally found in high-predation guppies is lost in the newly derived low-predation population, who show an inertia toward the first encountered food. This result is predicted by theory stating that organisms should evolve less selective diets under higher competition. Demonstrating that diet preference can show rapid and adaptive evolution is important to our understanding of eco-evolutionary feedbacks and the role of evolution in ecosystem dynamics.
Quantitative biomechanical assessment of locomotor capabilities of the stem archosaur
Euparkeria capensis
Authors: Demuth Oliver E. , Wiseman Ashleigh L. A. , Hutchinson John R.
Published: January 2023

Birds and crocodylians are the only remaining members of Archosauria (ruling reptiles) and they exhibit major differences in posture and gait, which are polar opposites in terms of locomotor strategies. Their broader lineages (Avemetatarsalia and Pseudosuchia) evolved a multitude of locomotor modes in the Triassic and Jurassic periods, including several occurrences of bipedalism. The exact timings and frequencies of bipedal origins within archosaurs, and thus their ancestral capabilities, are contentious. It is often suggested that archosaurs ancestrally exhibited some form of bipedalism.
Euparkeria capensis
is a central taxon for the investigation of locomotion in archosaurs due to its phylogenetic position and intermediate skeletal morphology, and is argued to be representative of facultative bipedalism in this group. However, no studies to date have biomechanically tested if bipedality was feasible in
Eupakeria
. Here, we use musculoskeletal models and static simulations in its hindlimb to test the influences of body posture and muscle parameter estimation methods on locomotor potential. Our analyses show that the resulting negative pitching moments around the centre of mass were prohibitive to sustainable bipedality. We conclude that it is unlikely that
Euparkeria
was facultatively bipedal, and was probably quadrupedal, rendering the inference of ancestral bipedal abilities in Archosauria unlikely.
Lateral line morphology, sensory perception and collective behaviour in African cichlid fish
Authors: Scott Elliott , Edgley Duncan E. , Smith Alan , Joyce Domino A. , Genner Martin J. , Ioannou Christos C. , Hauert Sabine
Published: January 2023

The lateral line system of fishes provides cues for collective behaviour, such as shoaling, but it remains unclear how anatomical lateral line variation leads to behavioural differences among species. Here we studied associations between lateral line morphology and collective behaviour using two morphologically divergent species and their second-generation hybrids. We identify collective behaviours associated with variation in canal and superficial lateral line morphology, with closer proximities to neighbouring fish associated with larger canal pore sizes and fewer superficial neuromasts. A mechanistic understanding of the observed associations was provided by hydrodynamic modelling of an artificial lateral line sensor, which showed that simulated canal-based neuromasts were less susceptible to saturation during unidirectional movement than simulated superficial neuromasts, while increasing the canal pore size of the simulated lateral line sensor elevated sensitivity to vortices shed by neighbouring fish. Our results propose a mechanism behind lateral line flow sensing during collective behaviour in fishes.
Education-based grant programmes for bottom-up distance learning and project catalysis: Antimicrobial Resistance in Sub-Saharan Africa
Authors: Graham Chris LB , Akligoh Harry , Ori Joy King , Adzaho Gameli , Salekwa Linda , Campbell Patrick , Saba Courage KS , Landrain Thomas E. , Santolini Marc
Published: January 2023

International development and aid are often conducted through the allocation of funding determined by decisions of non-locals, especially in the west for those in the global south. In addition, such funding is often disassociated from local expertise, therefore providing little long-term developmental impact and generating distrust. This is particularly true for conservation, as well as environmental and educational programmes. We hypothesise that by granting local people the educational tools and the necessary funding to develop their own projects through the use of an applicant driven peer-review approach, it is possible to relocalize the decision-making process to the programme participants, with the potential to generate and select more relevant projects with developmental outcomes of higher quality. Here we created an online curriculum for antimicrobial resistance (AMR) education that was followed by 89 participants across Ghana, Tanzania, Nigeria, and Uganda. We then created an open research programme that facilitated the creation of eight de novo projects on AMR. Finally, we organised an applicant-driven grant round to allocate funding to the “Neonatal Sepsis in Nigeria” project to conduct a pilot study and awareness campaign. This work opens perspectives for the design of frugal educational programmes and the funding of context-specific, community-driven projects aimed at empowering local stakeholders in the global South.
Nitrite reductase activity in F420-dependent sulfite reductase (Fsr) from Methanocaldococcus jannaschii
Authors: Heryakusuma Christian , Johnson Eric F. , Purwantini Endang , Mukhopadhyay Biswarup
Published: January 2023

Methanocaldococcus jannaschii (Mj), a hyperthermophilic and evolutionarily deeply rooted methanogenic archaeon from a deep-sea hydrothermal vent, produces F420-dependent sulfite reductase (Fsr) in response to exposure to sulfite. This enzyme allows Mj to detoxify sulfite, a potent inhibitor of methyl coenzyme-M reductase (Mcr), by reducing it to sulfide with reduced coenzyme F420 (F420H2) as electron donor; Mcr is essential for energy production for a methanogen. Fsr allows Mj to utilize sulfite as a sulfur source. Nitrite is another potent inhibitor of Mcr and toxic to methanogens. It is reduced by most sulfite reductases. In this study, we report that MjFsr reduced nitrite to ammonia with F420H2 with physiologically relevant Km values (nitrite, 8.9 μM; F420H2, 9.7 μM). The enzyme also reduced hydroxylamine with a Km value of 112.4 μM, indicating that it was an intermediate in the reduction of nitrite to ammonia. These results open the possibility that Mj could use nitrite as a nitrogen source if it is provided at a low concentration of the type that occurs in its habitat.
Actinomadura terrae sp. nov. and Actinomadura litoris OS3-89, isolated from rhizosphere soil of cactus
Authors: Lee Soon Dong , Yang Hong Lim , Kim In Seop , Choe Hanna , Kim Ji-Sun
Published: January 2023

Two mycelium-forming actinobacterial strains, designated OS3-83 T and OS3-89, were isolated from rhizosphere soil of a cactus (Opuntia ficus-indica) sampled on Mara Island, Jeju, Republic of Korea. Both of the isolates were found to grow at 20–37 °C, pH 6.0–10.0 and with 0–2 % (w/v) NaCl. Their taxonomic positions were investigated by a polyphasic approach. Strains OS3-83T and OS3-89 were most closely related to the type strain of

Actinomadura litoris

(99.5 % and 98.9 % 16S rRNA gene sequence similarity, respectively). Both of the isolates shared 99.2 % sequence similarity to each other. Morphological and chemotaxonomic characteristics supported the affiliation of the two isolates to the genus

Actinomadura

. 16S rRNA gene phylogeny exhibited that strain OS3-83T formed a tight cluster with

A. litoris

, while strain OS3-89 occupied a position located remotely from

A. litoris

. Nevertheless, phylogenomic analysis based on 92 core gene sequences showed that both of the isolates formed a tight clade with

A. litoris

. The values of average nucleotide identity and digital DNA–DNA hybridization between strain OS3-83T and the closest relative,

A. litoris

, were 92.2 and 46.2 %, respectively, whereas strain OS3-89 shared an average nucleotide identity value of 97.5 % and a digital DNA–DNA hybridization value of 76.9 % with

A. litoris

. These results strongly suggested that strain OS3-83T (=KACC 19752T=NBRC 114688T) represents a novel species and strain OS3-89 (=KACC 19753=NBRC 114400) is a strain of

A. litoris

. On the basis of the data obtained here, strain OS3-83T is considered to represent a new species of the genus

Actinomadura

, for which the name Actinomadura terrae sp. nov. is proposed.
Proposal of Holzapfeliella gen. nov. and Litorivicinus gen. nov. as replacement names for the illegitimate prokaryotic generic names Holzapfelia Zheng et al. 2020 and Litoricola Kim et al. 2007, respectively
Authors: Deshmukh Umakant Bhoopati , Oren Aharon
Published: January 2023

The prokaryotic generic names

Holzapfelia

Zheng et al. 2020 and

Litoricola

Kim et al. 2007 are illegitimate because they are later homonyms of the names

Holzapfelia

Cossmann 1901, an extinct genus of molluscs (Neogastropoda) and

Litoricola

Woodward 1873, an extinct genus of crustaceans (Arthropoda), respectively (Principle 2 and Rule 51b(4) of the International Code of Nomenclature of Prokaryotes). We therefore propose the replacement generic name Holzapfeliella with type species Holzapfeliella floricola comb. nov. and the replacement generic name Litorivicinus with replacement name Litorivicinus lipolyticus for the type species, the replacement name Litorivicinus marinus, and the family name Litorivicinaceae to replace the illegitimate name

Litoricolaceae

Kim et al. 2007.
Thermospira aquatica gen. nov., sp. nov., a novel thermophilic spirochete isolated from a Tunisian hot spring, and description of the novel family Thermospiraceae.
Authors: Gam Zouhaier Ben Ali , Thioye Abdoulaye , Cayol Jean-Luc , Postec Anne , Bartoli-Joseph Manon , Vandecasteele Céline , Erauso Gaël , Labat Marc
Published: January 2023

A novel thermophilic, anaerobic bacterium, strain F1F22T, was isolated from hot spring water collected in northern Tunisia. The cells were non-motile, Gram-negative and helical with hooked ends, 0.5×10–32 µm in size. Growth of the strain was observed at 45–70 °C (optimum, 55 °C), in 0.0–1.0 % (w/v) NaCl (optimum without NaCl) and at pH 6.5–8.5 (optimum, pH 7.5). Yeast extract was required for growth, and the strain grew on glucose, sucrose and maltose. The major fatty acids were C16:0 (40.2 %), iso-C16: 0 (30.2 %) and C16 :0 DMA (14.5 %). The genome consisted of a circular chromosome (2.5 Mb) containing 2672 predicted protein-encoding genes with a G+C content of 43.15 mol %. Based on a comparative 16S rRNA gene sequence analysis, strain F1F22T formed a deeply branching lineage within the phylum

Spirochaetota

, class

Spirochaetia

, order

Brevinematales

, and had only low sequence similarity to other species of the phylum (lower than 83 %). Genome-based analysis of average nucleotide identity and digital DNA–DNA hybridization of strain F1F22T with

Treponema caldarium

DSM 7334T,

Brevinema andersonii

ATCC 43811T and

Spirochaeta thermophila

DSM 6578T showed values between 63.26 and 63.52 %, and between 20 and 25 %. Hence, we propose strain F1F22T as a representative of a novel family (Thermospiraceae fam. nov.), genus and species of

Brevinematales

: Thermospira aquatica gen. nov., sp. nov. (type strain F1F22T=JCM 31314T=DSM 101182T).
A putative xanthine dehydrogenase is critical for Borrelia burgdorferi survival in ticks and mice
Authors: Phelan James P. , Bourgeois Jeffrey S. , McCarthy Julie E. , Hu Linden T.
Published: January 2023

Borrelia burgdorferi

is a pathogenic bacterium and the causative agent of Lyme disease. It is exposed to reactive oxygen species (ROS) in both the vertebrate and tick hosts. While some mechanisms by which

B. burgdorferi

ameliorates the effects of ROS exposure have been studied, there are likely other unknown mechanisms of ROS neutralization that contribute to virulence. Here, we follow up on a three gene cluster of unknown function, bb_0554, bb_0555, and bb_0556, that our prior unbiased transposon insertional sequencing studies implicated in both ROS survival and survival in Ixodes scapularis. We confirmed these findings through genetic knockout and provide evidence that these genes are co-transcribed as an operon to produce a xanthine dehydrogenase. In agreement with these results, we found that

B. burgdorferi

exposure to either uric acid (a product of xanthine dehydrogenase) or allopurinol (an inhibitor of xanthine dehydrogenase) could modulate sensitivity to ROS in a bb_0554-bb_0556 dependent manner. Together, this study identifies a previously uncharacterized three gene operon in

B. burgdorferi

as encoding a putative xanthine dehydrogenase critical for virulence. We propose renaming this locus xdhACB.
Evaluating the Performance of ChatGPT in Ophthalmology: An Analysis of its Successes and Shortcomings
Authors: Antaki Fares , Touma Samir , Milad Daniel , El-Khoury Jonathan , Duval Renaud
Published: January 2023

We tested the accuracy of ChatGPT, a large language model (LLM), in the ophthalmology question-answering space using two popular multiple choice question banks used for the high-stakes Ophthalmic Knowledge Assessment Program (OKAP) exam. The testing sets were of easy-to-moderate difficulty and were diversified, including recall, interpretation, practical and clinical decision-making problems. ChatGPT achieved 55.8% and 42.7% accuracy in the two 260-question simulated exams. Its performance varied across subspecialties, with the best results in general medicine and the worst in neuro-ophthalmology and ophthalmic pathology and intraocular tumors. These results are encouraging but suggest that specialising LLMs through domain-specific pre-training may be necessary to improve their performance in ophthalmic subspecialties.
Cluster Analysis to Find Temporal Physical Activity Patterns Among US Adults
Authors: Guo Jiaqi , Aqeel Marah M. , Lin Luotao , Gelfand Saul B. , Eicher-Miller Heather A. , Bhadra Anindya , Hennessy Erin , Richards Elizabeth A. , Delp Edward J.
Published: January 2023

Physical activity (PA) is known to be a risk factor for obesity and chronic diseases such as diabetes and metabolic syndrome. Few attempts have been made to pattern the time of physical activity while incorporating intensity and duration in order to determine the relationship of this multi-faceted behavior with health. In this paper, we explore a distance-based approach for clustering daily physical activity time series to estimate temporal physical activity patterns among U.S. adults (ages 20-65) from the National Health and Nutrition Examination Survey 2003-2006 (NHANES). A number of distance measures and distance-based clustering methods were investigated and compared using various metrics. These metrics include the Silhouette and the Dunn Index (internal criteria), and the associations of the clusters with health status indicators (external criteria). Our experiments indicate that using a distance-based cluster analysis approach to estimate temporal physical activity patterns through the day, has the potential to describe the complexity of behavior rather than characterizing physical activity patterns solely by sums or labels of maximum activity levels.