bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyaluronan Hybrid Cooperative Complexes Injection as a Biostimulation for Postobese Skin Laxity in the Arm: A Histopathologic Study
Authors: Margara Andrea , Haykal Diala , Musella Danilo , Bellia Gilberto , Boriani Filippo
Published: December 2023

Background

The Hybrid Cooperative Complexes of high and low molecular weight hyaluronic acids (HHCC) improve skin structure and bioactivity. Massive weight loss damages cellular composition and morphological structure of skin. An injective treatment of postobese skin consisting of HHCC may have a role in counteracting these histopathological alterations.

Objectives

To analyze the histological effects of HHCC injection in the cutaneous tissues of massive weight loss patients suffering from arm laxity.

Methods

Nine ex-obese patients with postweight-loss-related arm laxity and ptosis requiring brachioplasty were prospectively recruited at the first author's department. HHCC injection was performed on only 1 arm, which included 2 injective sessions separated by 30 days. One month posttreatment, patients underwent a bilateral brachioplasty, and the surgical specimens were histologically examined, searching for any variation in the cutaneous connective tissue following injections. Histology on treated specimens showed a statistically significant increased density of elastic fibers along with a lower fragmentation of the same fibers compared to the untreated tissue. Fibroblasts demonstrated a swollen appearance as if involved in a bioactivation process.

Results

Treatment with HHCC increases the number of elastin fibers and determines a more regular elastin deposition and architecture, as well as the bioactivation of fibroblasts. The contralateral untreated area showed an irregular structure with elastosis and elastolysis.

Conclusions

More studies are necessary, but histologically proven benefits are demonstrated in the HHCC-treated skins when compared with basal controlateral skin. These data support the use of HHCC formulations for the treatment of postobese skin laxity.

Level of Evidence: 5
An improved Shorea robusta genomic DNA extraction protocol with high PCR fidelity
Authors: Mishra Garima , Meena Rajendra K , Kant Rama , Pandey Shailesh , Ginwal Harish S , Bhandari Maneesh S
Published: December 2023

Shorea robusta (Dipterocarpaceae), commonly known as Sal, is an economically and culturally important timber species, known to contain a wide spectrum of polyphenols, polysaccharides, and other secondary metabolites in the tissues, which can interfere with the extraction of high-quality genomic DNA. In order to screen simple sequence repeat (SSR) markers and carry out other DNA-based analyses for this species in our laboratory, a high-throughput DNA extraction methodology was needed. Hence, we have optimized a simple, rapid, safe, and reliable high-throughput protocol for DNA extraction suitable for both fresh and dry leaves. The standardized protocol delivered good DNA yield of ∼1500 µg from 1 g of leaf tissue, with purity indicated by a 260 nm/280 nm absorbance ratio ranging from 1.70 to 1.91, which validated the suitability of extracted DNA and revealed reduced levels of contaminants. Additionally, the protocol that we developed was found to be suitable for polymerase chain reaction (PCR) amplification using microsatellite markers. Genome-wide characterization with SSR markers has been established in S. robusta, which further validates the protocol and its usefulness in DNA-based studies across the genus and/or family.
The dynamic causality brain network reflects whether the working memory is solidified
Authors: Chen Chunli , Liang Yi , Xu Shiyun , Yi Chanlin , Li Yuqin , Chen Baodan , Yang Lei , Liu Qiang , Yao Dezhong , Li Fali , Xu Peng
Published: December 2023

Working memory, which is foundational to higher cognitive function, is the “sketchpad of volitional control.” Successful working memory is the inevitable outcome of the individual’s active control and manipulation of thoughts and turning them into internal goals during which the causal brain processes information in real time. However, little is known about the dynamic causality among distributed brain regions behind thought control that underpins successful working memory. In our present study, given that correct responses and incorrect ones did not differ in either contralateral delay activity or alpha suppression, further rooting on the high-temporal-resolution EEG time-varying directed network analysis, we revealed that successful working memory depended on both much stronger top-down connections from the frontal to the temporal lobe and bottom-up linkages from the occipital to the temporal lobe, during the early maintenance period, as well as top-down flows from the frontal lobe to the central areas as the delay behavior approached. Additionally, the correlation between behavioral performance and casual interactions increased over time, especially as memory-guided delayed behavior approached. Notably, when using the network metrics as features, time-resolved multiple linear regression of overall behavioral accuracy was exactly achieved as delayed behavior approached. These results indicate that accurate memory depends on dynamic switching of causal network connections and shifting to more task-related patterns during which the appropriate intervention may help enhance memory.
Prevalence Rates of Pneumococcal Vaccination in IBD and 30-Day Clinical Outcomes in Patients With IBD and Pneumococcal Disease Stratified by Receipt of Pneumococcal Vaccination: A Multi-Network Study
Authors: Ford Andrew , Chittajallu Vibhu , Abraham Perez Jaime , Martin Scott , Alkhayyat Motasem , Dave Maneesh , Ho Edith Y , Sinh Preetika , Nguyen Vu , Cooper Gregory , Katz Jeffry , Cominelli Fabio , Regueiro Miguel , Mansoor Emad
Published: December 2023

Lay Summary

This study sought to assess outcomes associated with pneumococcal vaccination in adult inflammatory bowel disease patients. Results found unvaccinated patients had higher adverse outcomes, including greater risk of hospitalization, ICU admission, ventilation, and mortality. These findings underscore the importance of pneumococcal vaccination.
A case report of transcatheter aortic valve replacement in a patient with Sjögren's syndrome and aortic stenosis
Authors: Yang Zhenyu , Fang Wei , Wang Qiuhe , Li Yan
Published: December 2023

Background

The co-existence of Sjögren's syndrome and aortic stenosis (AS) is infrequent, and there lack cases of transcatheter aortic valve replacement (TAVR) for these patients with detailed management decision-making.

Case summary

We report a case of a female patient who had AS and Sjögren's syndrome with leukopaenia and thrombocytopaenia. To overcome co-existing hyper-coagulation and high thrombogenesis risk, difficult lifetime valve management, and high infection risk, we performed TAVR with 3D printing and formulated antithrombotic and antibiotic schemes.

Conclusion

This case provided a successful experience of TAVR in patients with Sjögren's syndrome. Long-term follow-up will be conducted, and optimization of the therapeutic regimen requires further exploration.
Foreign Competition along the Quality Ladder
Authors: Piveteau Paul , Smagghue Gabriel
Published: December 2023

We document that firms with low prices are more impacted by low-cost competition. To explain this pattern, we propose an empirical model of trade with random-coefficient demand and endogenous product quality. Unlike commonly used demand systems (e.g., constant elasticity of substitution, nested logit), this model generates rich substitution patterns and implies an ‘escape-competition’ effect: in response to low-cost competition, firms have an incentive to upgrade their product quality. The estimation of the model reveals significant heterogeneity in consumer preferences. Counterfactual experiments suggest that the ‘China shock’ was significantly more damaging to firms at the bottom of the price distribution, and that quality upgrading had a limited role at mitigating the shock.
Cauchy data for Levin’s method
Authors: Ashton Anthony
Published: December 2023

In this paper, we describe the Cauchy data that gives rise to slowly oscillating solutions to the Levin equation. We present a general result on the existence of a unique minimizer of $\|Bx\|$ subject to the constraint $Ax=y$, where $A,B$ are linear, but not necessarily bounded operators on a complex Hilbert space. This result is used to obtain the solution to the Levin equation, both in the univariate and multivariate case, which minimizes the mean-square of the derivative over the domain. The Cauchy data that generates this solution is then obtained, and this can be used to supplement the Levin equation in the computation of highly oscillatory integrals in the presence of stationary points.
Applying contrastive pre-training for depression and anxiety risk prediction in type 2 diabetes patients based on heterogeneous electronic health records: a primary healthcare case study
Authors: Feng Wei , Wu Honghan , Ma Hui , Tao Zhenhuan , Xu Mengdie , Zhang Xin , Lu Shan , Wan Cheng , Liu Yun
Published: December 2023

Objective

Due to heterogeneity and limited medical data in primary healthcare services (PHS), assessing the psychological risk of type 2 diabetes mellitus (T2DM) patients in PHS is difficult. Using unsupervised contrastive pre-training, we proposed a deep learning framework named depression and anxiety prediction (DAP) to predict depression and anxiety in T2DM patients.

Materials and Methods

The DAP model consists of two sub-models. Firstly, the pre-trained model of DAP used unlabeled discharge records of 85 085 T2DM patients from the First Affiliated Hospital of Nanjing Medical University for unsupervised contrastive learning on heterogeneous electronic health records (EHRs). Secondly, the fine-tuned model of DAP used case–control cohorts (17 491 patients) selected from 149 596 T2DM patients’ EHRs in the Nanjing Health Information Platform (NHIP). The DAP model was validated in 1028 patients from PHS in NHIP. Evaluation included receiver operating characteristic area under the curve (ROC-AUC) and precision-recall area under the curve (PR-AUC), and decision curve analysis (DCA).

Results

The pre-training step allowed the DAP model to converge at a faster rate. The fine-tuned DAP model significantly outperformed the baseline models (logistic regression, extreme gradient boosting, and random forest) with ROC-AUC of 0.91±0.028 and PR-AUC of 0.80±0.067 in 10-fold internal validation, and with ROC-AUC of 0.75 ± 0.045 and PR-AUC of 0.47 ± 0.081 in external validation. The DCA indicate the clinical potential of the DAP model.

Conclusion

The DAP model effectively predicted post-discharge depression and anxiety in T2DM patients from PHS, reducing data fragmentation and limitations. This study highlights the DAP model’s potential for early detection and intervention in depression and anxiety, improving outcomes for diabetes patients.
The post-quiescence properties of Cir X-1 at orbital phase around periastron observed by NuSTAR and NICER
Authors: Yu Z L , Zhang S , Chen Y P , Kong L D , Wang P J , Shui Q C , Peng J Q , Yan Z , Li X D , Zhang S N
Published: December 2023

Cir X-1 is an unusual X-ray binary, which has resumed periodic outbursts since August 2019. We investigate the post-quiescence spectral properties of Cir X-1 at orbital phase around the periastron using NICER and NuSTAR X-ray observatories after the resumption of outbursts. We identify two distinct classes of spectral properties. The first class exhibits highly ionized absorption, whereas the second class does not. We suggest that the ionized absorption originates from the shelter of the disc wind, while the low-ionized/neutral absorption arises from the companion’s stellar wind. We also suggest that the disc wind may be always present in both classes, and a warped precession disc could alter the visibility of the disc wind.
Demographics of three-body binary black holes in star clusters: implications for gravitational waves
Authors: Marín Pina Daniel , Gieles Mark
Published: December 2023

To explain both the dynamics of a globular cluster and its production of gravitational waves from coalescing binary black holes, it is necessary to understand its population of dynamically formed (or, ‘three-body’) binaries. We provide a theoretical understanding of this population, benchmarked by direct N-body models. We find that N-body models of clusters on average have only one three-body binary at any given time. This is different from theoretical expectations and models of binary populations, which predict a larger number of binaries (∼5), especially for low-N clusters (∼100), or in the case of two-mass models, low number of black holes. We argue that the presence of multiple binaries is suppressed by a high rate of binary–binary interactions, which efficiently ionize one of the binaries involved. These also lead to triple formation and potentially gravitational wave captures, which may provide an explanation for the recently reported high efficiency of in-cluster mergers in models of low-mass clusters ($\lesssim 10^5\, {\rm M}_\odot)$.
An observationally driven multifield approach for probing the circum-galactic medium with convolutional neural networks
Authors: Gluck Naomi , Oppenheimer Benjamin D , Nagai Daisuke , Villaescusa-Navarro Francisco , Anglés-Alcázar Daniel
Published: December 2023

The circum-galactic medium (CGM) can feasibly be mapped by multiwavelength surveys covering broad swaths of the sky. With multiple large data sets becoming available in the near future, we develop a likelihood-free Deep Learning technique using convolutional neural networks (CNNs) to infer broad-scale physical properties of a galaxy’s CGM and its halo mass for the first time. Using CAMELS (Cosmology and Astrophysics with MachinE Learning Simulations) data, including IllustrisTNG, SIMBA, and Astrid models, we train CNNs on Soft X-ray and 21-cm (H i) radio two-dimensional maps to trace hot and cool gas, respectively, around galaxies, groups, and clusters. Our CNNs offer the unique ability to train and test on ‘multifield’ data sets comprised of both H i and X-ray maps, providing complementary information about physical CGM properties and improved inferences. Applying eRASS:4 survey limits shows that X-ray is not powerful enough to infer individual haloes with masses log (Mhalo/M⊙) < 12.5. The multifield improves the inference for all halo masses. Generally, the CNN trained and tested on Astrid (SIMBA) can most (least) accurately infer CGM properties. Cross-simulation analysis – training on one galaxy formation model and testing on another – highlights the challenges of developing CNNs trained on a single model to marginalize over astrophysical uncertainties and perform robust inferences on real data. The next crucial step in improving the resulting inferences on the physical properties of CGM depends on our ability to interpret these deep-learning models.
Functional Prokaryotic-Like Deoxycytidine Triphosphate Deaminases and Thymidylate Synthase in Eukaryotic Social Amoebae: Vertical, Endosymbiotic, or Horizontal Gene Transfer?
Authors: Liang Heng , Mower Jeffrey P , Chia Catherine P
Published: December 2023

The de novo synthesis of deoxythymidine triphosphate uses several pathways: gram-negative bacteria use deoxycytidine triphosphate deaminase to convert deoxycytidine triphosphate into deoxyuridine triphosphate, whereas eukaryotes and gram-positive bacteria instead use deoxycytidine monophosphate deaminase to transform deoxycytidine monophosphate to deoxyuridine monophosphate. It is then unusual that in addition to deoxycytidine monophosphate deaminases, the eukaryote Dictyostelium discoideum has 2 deoxycytidine triphosphate deaminases (Dcd1Dicty and Dcd2Dicty). Expression of either DcdDicty can fully rescue the slow growth of an Escherichia coli dcd knockout. Both DcdDicty mitigate the hydroxyurea sensitivity of a Schizosaccharomyces pombe deoxycytidine monophosphate deaminase knockout. Phylogenies show that Dcd1Dicty homologs may have entered the common ancestor of the eukaryotic groups of Amoebozoa, Obazoa, Metamonada, and Discoba through an ancient horizontal gene transfer from a prokaryote or an ancient endosymbiotic gene transfer from a mitochondrion, followed by horizontal gene transfer from Amoebozoa to several other unrelated groups of eukaryotes. In contrast, the Dcd2Dicty homologs were a separate horizontal gene transfer from a prokaryote or a virus into either Amoebozoa or Rhizaria, followed by a horizontal gene transfer between them. ThyXDicty, the D. discoideum thymidylate synthase, another enzyme of the deoxythymidine triphosphate biosynthesis pathway, was suggested previously to be acquired from the ancestral mitochondria or by horizontal gene transfer from alpha-proteobacteria. ThyXDicty can fully rescue the E. coli thymidylate synthase knockout, and we establish that it was obtained by the common ancestor of social amoebae not from mitochondria but from a bacterium. We propose horizontal gene transfer and endosymbiotic gene transfer contributed to the enzyme diversity of the deoxythymidine triphosphate synthesis pathway in most social amoebae, many Amoebozoa, and other eukaryotes.
Topologically nontrivial three-body contact interaction in one dimension
Authors: Ohya Satoshi
Published: December 2023

It is known that three-body contact interactions in one-dimensional (1D) n(≥3)-body problems of nonidentical particles can be topologically nontrivial: they are all classified by unitary irreducible representations of the pure twin group PTn. It was, however, unknown how such interactions are described in the Hamiltonian formalism. In this paper, we study topologically nontrivial three-body contact interactions from the viewpoint of the path integral. Focusing on spinless particles, we construct an n(n − 1)(n − 2)/3!-parameter family of n-body Hamiltonians that corresponds to one particular 1D unitary representation of PTn. These Hamiltonians are written in terms of background Abelian gauge fields that describe infinitely thin magnetic fluxes in the n-body configuration space.
Frequency and types of errors in clinician-composed death certificates for patients with or without autopsy in a hospital population
Authors: Pape Ariana , Scherpelz Kathryn P
Published: December 2023

Background

Death certificate (DC) errors are common. At our institution, all deaths have a preliminary death certificate (PDC) written by a clinician and then revised by a pathologist prior to the clinician signing the final death certificate (FDC). In autopsy cases, the FDC is signed by the pathologist who performs the autopsy.

Methods

A total of 100 in-hospital deaths (50 with autopsy and 50 without) occurred in 2020 were arbitrarily selected from a tertiary care center. All PDCs and FDCs were compared to identify/classify errors as major (incorrect cause of death (COD) or significant contributing factors) or minor (abbreviations, inappropriate non-essential contributing factors, immediate/intermediate COD errors). Frequency of PDC errors was compared by autopsy status, duration of hospital stay and PDC author.

Results

Ninety percent of cases had at least one PDC error and 39% had a major error. Major errors were more common in autopsy cases (50% versus 28%, P = 0.035), although minor/overall errors were not. Error rates did not significantly differ for the other variables assessed.

Conclusions

There is significance of having a pathologist review and revise DCs before they are signed. The increased frequency in major errors in cases with autopsy suggests that autopsy findings provided additional information to elucidate COD.
Decomposing Duration Dependence in a Stopping Time Model
Authors: Alvarez Fernando , Borovičková Katarína , Shimer Robert
Published: December 2023

We develop an economic model of transitions in and out of employment. Heterogeneous workers switch employment status when the net benefit from working, a Brownian motion with drift, hits optimally chosen barriers. This implies that the duration of jobless spells for each worker has an inverse Gaussian distribution. We allow for arbitrary heterogeneity across workers and prove that the distribution of inverse Gaussian distributions is partially identified from the duration of two non-employment spells for each worker. We estimate the model using Austrian social security data and find that dynamic selection is a critical source of duration dependence.
The Chinese Zodiac-in-Noise Test: An Internet-Based Speech-in-Noise Test for Large-Scale Hearing Screening
Authors: Zhou Huali , Meng Qinglin , Liu Xiaohong , Wu Peina , Shang Shidong , Xiao Wei , Kang Yuyong , Li Jiawen , Wang Yamin , Zheng Nengheng
Published: December 2023

Objectives:

Motivated by the growing need for hearing screening in China, the present study has two objectives. First, to develop and validate a new test, called the Chinese Zodiac-in-noise (ZIN) test, for large-scale hearing screening in China. Second, to conduct a large-scale remote hearing screening in China, using the ZIN test developed.

Design:

The ZIN test was developed following a similar procedure as the digits-in-noise test but emphasizes the importance of consonant recognition by employing the 12 zodiac animals in traditional Chinese culture as speech materials. It measures the speech reception threshold (SRT) using triplets of Chinese zodiac animals in speech-shaped noise with an adaptive procedure.

Results:

Normative data of the test were obtained in a group of 140 normal-hearing listeners, and the performance of the test was validated by comparisons with pure-tone audiometry in 116 listeners with various hearing abilities. The ZIN test has a reference SRT of −11.0 ± 1.6 dB in normal-hearing listeners with a test-retest variability of 1.7 dB and can be completed in 3 minutes. The ZIN SRT is highly correlated with the better-ear pure-tone threshold (r = 0.82). With a cutoff value of −7.7 dB, the ZIN test has a sensitivity of 0.85 and a specificity of 0.94 for detecting a hearing loss of 25 dB HL or more at the better ear.

A large-scale remote hearing screening involving 30,552 participants was performed using the ZIN test. The large-scale study found a hearing loss proportion of 21.0% across the study sample, with a high proportion of 57.1% in the elderly study sample aged over 60 years. Age and gender were also observed to have associations with hearing loss, with older individuals and males being more likely to have hearing loss.

Conclusions:

The Chinese ZIN test is a valid and efficient solution for large-scale hearing screening in China. Its remote applications may improve access to hearing screening and enhance public awareness of hearing health.
Machine learning review of hand surgery literature
Authors: Rowley M. Andrew , Allen J. Ryan , Newton William , Daly Charles
Published: December 2023

Background:

Latent Dirichlet Allocation is an artificial intelligence model which processes text into topics, and has had broad application in medicine, political science, and engineering. As the orthopedic hand literature continues to grow, such technology may have value in efficiently conducting identifying trends and conducting systematic reviews. The purpose of this study is to demonstrate the use of Latent Dirichlet Allocation and machine learning to review literature and summarize the past 21 yr of hand surgery research.

Methods:

All original research articles published in the Journal of Hand Surgery (American), Journal of Hand Surgery (European), Hand, Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Journal of the American Academy of Orthopaedic Surgeons (JAAOS) and Plastic and Reconstructive Surgery (PRS) from 2000-2021 were analyzed using Latent Dirichlet Allocation, generating 50 topics which were then ranked by popularity and trended over the previous 21 yr.

Results:

Research article abstracts totaling 11,501 from 2000-2020 were extracted and analyzed to create 50 topics.

Conclusion:

This is the first study of its kind to utilize machine learning models for reviewing the hand surgery literature. Machine learning possesses the ability to rapidly process a large body of test and assess the current state of research and trends or research topics, which can aid clinicians and researchers in time-intensive tasks to provide clues that will promote areas of further study.
Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice
Authors: Sloss Elizabeth Ann , Jones Terry L. , Baker Kathy , Robins Jo Lynne W. , Thacker Leroy R.
Published: December 2023

The aim of this study was to describe medication administration and alert patterns among a cohort of new graduate nurses over the first year of practice. Medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. To better understand nursing workflow and documentation workload in today's clinical environment, it is important to understand patterns of medication administration and alert generation during barcode-assisted medication administration. Study objectives were addressed through a descriptive, longitudinal, observational cohort design using secondary data analysis. Set in a large, urban medical center in the United States, the study sample included 132 new graduate nurses who worked on adult, inpatient units and administered medication using barcode-assisted medication administration. Data were collected through electronic health record and administration sources. New graduate nurses in the sample experienced a total of 587 879 alert and medication administration encounters, administering 772 unique medications to 17 388 unique patients. Nurses experienced an average medication workload of 28.09 medications per shift, 3.98% of which were associated with alerts, over their first year of practice. In addition to high volume of medication administration, new graduate nurses administer many different types of medications and are exposed to numerous alerts while using barcode-assisted medication administration.
PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland
Authors: Gartrell Kyungsook , Warren Joan Insalaco , Fontelo Paul
Published: December 2023

Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the “Patient, Intervention, Comparison, Outcome” or “askMEDLINE” search engines. The results retrieved were presented as journal article abstracts or short summaries called “the bottom line,” designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of “the bottom line” or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.
Risk of Proctectomy After Ileorectal Anastomosis in Familial Adenomatous Polyposis in the Modern Era
Authors: Banerjee Sudeep , Burke Carol A. , Sommovilla Joshua , Anderson Cristan , O’Malley Margaret , LaGuardia Lisa , Vazquez Villasenor Ana , Macaron Carole , Liska David
Published: December 2023

BACKGROUND:

Prophylactic surgery for familial adenomatous polyposis has evolved over several decades. Restorative proctocolectomy with ileal pouch anal anastomosis provides an alternative to total abdominal colectomy with ileorectal anastomosis. We have previously shown the rate of proctectomy and rectal cancer after total abdominal colectomy with ileorectal anastomosis in the “pre-pouch” era was 32% and 13%, respectively.

OBJECTIVE:

To determine the rate of proctectomy and rectal cancer among familial adenomatous polyposis patients and relative-rectal sparing (< 20 rectal polyps) selected for total abdominal colectomy with ileorectal anastomosis in the modern era.

DESIGN:

Retrospective cohort study.

SETTING:

Single tertiary care institution with a hereditary colorectal cancer registry.

PATIENTS:

Familial adenomatous polyposis patients who underwent total abdominal colectomy with ileorectal anastomosis between 1993 and 2020.

MAIN OUTCOME MEASURES:

Incidence of proctectomy for any indication and rectal cancer.

RESULTS:

A total of 197 patients with median age of 24 years (range, 10-67) were included. Median follow-up after total abdominal colectomy with ileorectal anastomosis was 13 years (IQR 6-17). Sixteen patients (8%) underwent proctectomy. Indications included rectal cancer in 6 (3%) (2 Stage I and 4 Stage III); polyps with high grade dysplasia in 4 (2%); progressive polyp burden in 3 (1.5%), defecatory dysfunction in 2 (1%); and anastomotic leak in 1 (0.5%). Among 30 patients (18%) with ≥ 20 rectal polyps at the time of total abdominal colectomy with ileorectal anastomosis, 8 patients (26%) underwent proctectomy and 3 patients developed rectal cancer (10%). Among 134 patients (82%) with < 20 polyps, 8 patients (6%) underwent proctectomy and 3 patients developed rectal cancer (2%). Number of rectal polyps at the time of total abdominal colectomy with ileorectal anastomosis was associated with the likelihood of proctectomy (OR 1.1, p < 0.001) but not incident rectal cancer (p = 0.3).

LIMITATION:

Retrospective data collection.

CONCLUSION:

Patients with familial adenomatous polyposis selected for total abdominal colectomy with ileorectal anastomosis by rectal polyp number have low rates of proctectomy and rectal cancer compared to historical controls. With appropriate selection criteria and surveillance, total abdominal colectomy with ileorectal anastomosis remains an important and safe treatment option for patients with familial adenomatous polyposis.
Unscheduled Healthcare Contact after Outpatient Surgical Fixation of Distal Radius Fractures: A Retrospective Cohort Study
Authors: Menon Ambika , Payne Samuel H. , Woodard Evan D. , Williams Rachel E. , Emefiele Jesse I. , Knaus William J. , Ghareeb Paul A.
Published: December 2023

Background:

Distal radius fractures (DRFs) commonly require surgical fixation. Unscheduled healthcare contact (UHC) after surgery represents an area of quality improvement in surgical care. We hypothesize that UHC after outpatient surgical fixation of DRFs is more common in patients undergoing treatment at a safety-net hospital versus those treated at a university-affiliated facility.

Methods:

An IRB-approved retrospective review studied patients who underwent outpatient surgical treatment of DRFs from January 2017 to May 2021. Surgery was performed either at a local safety-net hospital or at a university-affiliated hospital. UHC was defined as telephone calls, emergency room visits, and/or readmissions to the hospital within 30 days of surgery. Demographic factors, medical comorbidities, and injury and surgery details were analyzed.

Results:

In total, 442 patients met inclusion criteria. An estimated 257 patients (58.1%) were treated at a university-affiliated facility, whereas 185 patients (41.9%) had surgery at the safety-net hospital. The overall rate of UHC within thirty-days of surgery was 14.0%, with the most common reason being uncontrolled pain. Rates of UHC were higher at the safety-net hospital compared with those at a university-affiliated facility (26.5% versus 5.1%, P < 0.05).

Conclusions:

UHC was significantly greater for patients undergoing surgery in a safety-net hospital setting compared with those in a university setting. UHC after surgery is often related to inadequate postoperative pain control. Improved pain control and patient education may alleviate unnecessary healthcare contact.
Plastic Surgery Clinical Trials: A Systematic Review of Characteristics, Research Themes, and Predictors of Publication and Discontinuation
Authors: Sinha Sarthak , Arora Rohit , Chockalingam Keerthana , van der Vyver Marieta , Ponich Brett , Ambikkumar Athithan , Verly Myriam , Turk Madison , Bharadia Shyla , Biernaskie Jeff , Temple-Oberle Claire , Harrop Alan Robertson , Gabriel Vincent
Published: December 2023

Clinical trials (CTs) are crucial for evidence-based surgical care. Despite growing interest in plastic and reconstructive surgery (PRS) research, the status of PRS CTs remains unknown. We obtained PRS CTs from ClinicalTrials.gov and WHO’s International Clinical Trials Registry Platform (November 2022). Topic modeling identified research themes and machine learning models generated CT-publication pairs. Kaplan-Meier curves visualized CT discontinuation and nonpublication. Of the 4685 PRS CTs identified, 79% were interventional and 81% recruited adults. Most were single-center-led (67%) and academic-funded (77%). Male investigators led 77% of CTs. Female-only patient CTs outnumbered male-only (31% versus 1%). The United States led with 41% of CTs, followed by France, Canada, and China. Industry-funded CTs were higher in the USA, Germany, and Belgium, and academic-funded in France, Canada, and China. PRS CTs clustered into aesthetics (43%), reconstructive (20%), wound healing (8%), peripheral nerve (6%), tumor excision (5%), craniofacial (5%), perioperative pain (5%), and burns (4%). Industry preferred funding aesthetics, whereas academia and industry co-funded wound healing. Publication rates of completed (24%) and terminated (10%) CTs varied by cluster, with perioperative pain CTs exhibiting higher rates. Industry-funded CTs had lower publication rates (hazard ratio: 0.64, 95% confidence interval: 0.5–0.81) and higher discontinuation (hazard ratio: 1.34, confidence interval: 1.06–1.68) driven by sponsors’ decision to terminate prematurely. Global growth in PRS trialome reflects rising interest in evidence-based plastic surgery. Yet, imbalances in participant age, geography, funding source, and trial design influence likelihood of CT discontinuation and publication. Key research gaps include pediatric CTs, accountability in industry-funded research, and multicenter collaborations with underrepresented regions.
Usefulness of Peripheral Blood Cultures in Children With Cancer and Episodes of Fever and Neutropenia
Authors: Sarquis Teresita , Ibáñez Carolina , De La Maza Verónica , Valenzuela Romina , Zubieta Marcela , Labraña Yenis , Gutiérrez Valentina , Greppi Claudia , Martínez Daniela , Díaz Paulina , Santolaya María Elena
Published: December 2023

Background:

The collection of blood cultures (BC) is key for guiding antimicrobial therapy in children with febrile neutropenia (FN), more than 90% have central venous catheters (CVC). There is no consensus on the need for peripheral BC over central BC in this population. The aim of this study was to determine the contribution of peripheral BC over central BC in the diagnosis of bloodstream infections in children with FN.

Methods:

Descriptive, retrospective study, episodes of FN recorded prospectively in 6 hospitals in Santiago, Chile, from 2016 to 2021. Central and peripheral BC were drawn upon admission. All episodes with at least one (+) BC were allocated to one of these groups: consistent (+) BC, inconsistent (+) BC, only CVC (+) BC and only peripheral (+) BC. The volume of the samples was recorded.

Results:

The analysis included 241 episodes of FN with at least one (+) BC. The median age was 7.2 years, 51% were female, 84% had hematological cancer and 98% had episodes of high-risk FN. Of a total of 241 episodes, 135 (56%) had consistent (+) BC, 13 (5%) had inconsistent (+) BC, 35 (15%) had only CVC (+) BC and 58 (24%) had only peripheral (+) BC. There were no significant differences in the volume of the samples between central and peripheral BC.

Conclusions:

The proportion of bloodstream infections detected only through peripheral BC was 24%, higher than previously reported, not due to sample volume. We recommend obtaining peripheral as well CVC BC in children with FN.
Fever, Hyperglycemia, and Swallowing Management in Stroke Unit and Non–Stroke-Unit European Hospitals: A Quality in Acute Stroke Care (QASC) Europe Substudy
Authors: Ding Ranran , Betihavas Vasiliki , McElduff Benjamin , Dale Simeon , Coughlan Kelly , McInnes Elizabeth , Middleton Sandy , Fasugba Oyebola ,   On behalf of the QASC Europe Investigators
Published: December 2023

BACKGROUND: Stroke unit care reduces patient morbidity and mortality. The Quality in Acute Stroke Care Europe Study achieved significant large-scale translation of nurse-initiated protocols to manage Fever, hyperglycemia (Sugar), and Swallowing (FeSS) in 64 hospitals across 17 European countries. However, not all hospitals had stroke units. Our study aimed to compare FeSS protocol adherence in stroke unit versus non–stroke-unit hospitals. METHODS: An observational study using Quality in Acute Stroke Care Europe Study postimplementation data was undertaken. Hospitals were categorized using 4 evidence-based characteristics for defining a stroke unit, collected from an organizational survey of participating hospitals. Differences in FeSS Protocol adherence between stroke unit and non–stroke-unit hospitals were investigated using mixed-effects logistic regression, adjusting for age, sex, and National Institutes of Health Stroke Scale. RESULTS: Of the 56 hospitals from 16 countries providing organizational data, 34 (61%) met all 4 stroke unit characteristics, contributing data for 1825 of 2871 patients (64%) (stroke unit hospitals). Of the remaining 22 hospitals (39%), 17 (77%) met 3 of the 4 stroke unit characteristics (non–stroke-unit hospitals). There were no differences between hospitals with a stroke unit and those without for postimplementation adherence to fever (49% stroke unit vs 57% non–stroke unit; odds ratio [OR], 0.400; 95% confidence interval [CI], 0.087-1.844; P = .240), hyperglycemia (50% stroke unit vs 57% non–stroke unit; OR, 0.403; 95% CI, 0.087–1.856; P = .243), swallowing (75% stroke unit vs 60% non–stroke unit; OR, 1.702; 95% CI, 0.643–4.502; P = .284), or overall FeSS Protocol adherence (36% stroke unit vs 36% non–stroke unit; OR, 0.466; 95% CI, 0.106–2.043; P = .311). CONCLUSION: Our results demonstrate that the nurse-initiated FeSS Protocols can be implemented by hospitals regardless of stroke unit status. This is noteworthy because hospitals without stroke unit resources that care for acute stroke patients can potentially implement these protocols. Further effort is needed to ensure better adherence to the FeSS Protocols.
The enhanced recovery after surgery (ERAS) protocol implementation in a national tertiary-level hospital: a prospective cohort study
Authors: Mazni Yarman , Syaiful Ridho Ardhi , Ibrahim Febiansyah , Jeo Wifanto S , Putranto Agi Satria , Sihardo Lam , Marbun Vania , Lalisang Arnetta Naomi , Putranto Rudi , Natadisastra Raden Muharam , Sumariyono Sumariyono , Nugroho Alfan Mahdi , Manikam Nurul Ratna Mutu , Karimah Nurrul , Hastuty Vyanty , Sutisna Enung Nana , Widiati Eka , Mutiara Rina , Wardhani Rizky Kusuma , Liastuti Lies Dina , Lalisang Toar Jean Maurice
Published: December 2023

Introduction:

Successful colorectal surgery is determined based on postoperative mortality and morbidity rates, complication rates, and cost-effectiveness. One of the methods to obtain an excellent postoperative outcome is the enhanced recovery after surgery (ERAS) protocol. This study aims to see the effects of implementing an ERAS protocol in colorectal surgery patients.

Methods:

Eighty-four patients who underwent elective colorectal surgery at National Tertiary-level Hospital were included between January 2021 and July 2022. Patients were then placed into ERAS (42) and control groups (42) according to the criteria. The Patients in the ERAS group underwent a customized 18-component ERAS protocol and were assessed for adherence. Postoperatively, both groups were monitored for up to 30 days and assessed for complications and readmission. The authors then analyzed the length of stay and total patient costs in both groups.

Results:

The length of stay in the ERAS group was shorter than the control group [median (interquartile range) 6 (5–7) vs. 13 (11–19), P<0.001], with a lower total cost of [USD 1875 (1234–3722) vs. USD 3063 (2251–4907), P<0.001]. Patients in the ERAS group had a lower incidence of complications, 10% vs. 21%, and readmission 5% vs. 10%, within 30 days after discharge than patients in the control group; however, the differences were not statistically significant. The adherence to the ERAS protocol within the ERAS group was 97%.

Conclusion:

Implementing the ERAS protocol in colorectal patients reduces the length of stay and total costs.
Media Interview Tips and Techniques for the Registered Nurse
Authors: Manning Jennifer
Published: December 2023

Background

As the largest segment of the healthcare workforce, nurses have a unique opportunity to increase the visibility of the nursing profession's contributions to healthcare services and clinical outcomes across population groups by participating in media interviews. Although a media interview can be intimidating, there are steps one can take to ensure optimal media engagement. Nurses should collaborate with the media by becoming familiar with the elements of good reporting.

Objective

This article describes several tips and techniques all nurses can implement before, during, and after a media interview to ensure the audience receives a clear message.

Procedure

Techniques include thorough preparation before the interview, careful self-management during the interview, and follow-up after the interview.

Conclusion

Nurses can conduct a successful media interview and pave the way for future nurse interviews using media training tips and techniques.
Noteworthy performance of muscle injured para-athletes: A study of MRI-detected muscle injuries at the Tokyo 2020 Summer Paralympic Games
Authors: Katagiri Hiroki , Forster Bruce B. , Koga Hideyuki , An Jae-Sung , Adachi Takuya , Derman Wayne
Published: December 2023

Background

To the best of our knowledge, no studies have attempted to correlate athletic performance with muscle injuries sustained during Paralympic Games.

Aim

This study reports the incidence, anatomical location, anatomical site classification, and relationship between competition results and anatomical site classification in athletes who participated in the Paralympic Games.

Methods

All MRI images collected at the IPC polyclinic at the Tokyo 2020 Paralympic Games were reviewed to identify the presence and anatomical site of muscle injuries. The athletes’ competition results were reviewed using IPC data sources.

Results

Twenty-six MRI-detected muscle injuries were observed in 16 male and 10 female athletes. Muscle injuries were most commonly observed during track and field events (n = 20) and in athletes with visual impairment (n = 12). Ten of the injuries involved the tendon. Twenty-one of injured athletes (81%) completed their competition, whereas 5 athletes did not. Eight athletes won medals in the Games. The anatomical site of muscle injury did not significantly impact the proportion of athletes who did not finish competition.

Conclusion

Many athletes who sustained muscle injuries completed their competitions. No association was found between anatomical site classification and Paralympic athletes’ performance in this study.
Part II: Blood Transfusion and Donor Exposure in the Surgical Management of Trigonocephaly Patients: A Protocol From Alder Hey Craniofacial Unit
Authors: Rapaport Benjamin , Burnside Girvan , Parks Chris , Duncan Christian , Richardson David , Ellenbogen Jonathan , Sinha Ajay , Craig Richard , Diwan Rishi , Hennedige Anusha
Published: December 2023

Trigonocephaly is a craniofacial malformation caused by premature fusion of the metopic suture. Surgical correction frequently results in the need for blood transfusion. Transfusion complications include transfusion-transmitted infections (TTIs), immune-mediated reactions, and volume overload. Donor exposure (DE) describes the number of blood products from unique donors with increasing DE equating to an increased risk of TTI. We evaluate data on 204 trigonocephaly patients covering 20 years of practice with respect to blood transfusions and DE. This represents the largest series from a single unit to date. A protocol based on our experiences has been devised that summarizes the key interventions we recommend to minimize blood transfusions and DE in craniofacial surgery. Patients operated on between 2000 and 2020 were included. DE and a range of values were calculated including estimated red cell loss (ERCL) and estimated red cell volume transfused (ERCVT). Groups were established by relevant interventions and compared using the Mann–Whitney U test. Mean DE fell from 1.46 at baseline to 0.85 (P<0.05). Median allogenic transfusion volume fell from 350 mL at baseline to 250 mL (P<0.05). Median ERCL fell from 15.05 mL/kg at baseline to 12.39 mL/kg and median ERCVT fell from 20.85 to 15.98 mL/kg. Changes in ERCL and ERCVT did not reach statistical significance. DE can be minimized with the introduction of key interventions such as a restrictive transfusion policy, preoperative iron, cell saver, tranexamic acid, and use of a matchstick burr for osteotomies.
Listeria innocua infection in an old case of Total Knee Replacement-an unusual case report
Authors: Gupta Minakshi , Saha Uma Shankar , Kumar Ritesh , Laik Jayanta , Mishra Minakshi
Published: December 2023

Prosthetic implant associated arthritis due to Listeria, is mostly reported due to Listeria monocytogenes. Here, we describe a patient , who underwent Total Knee Replacement, 12 years ago, presented with pain, tenderness, redness, and local rise in temperature in right knee.  Purulent fluid was aspirated. Upon microbiological analysis, culture yielded Listeria innocua.
Listeria innocua was a rare incidence. Listeria is not reported as a contaminant and routine cultures may be negative. Because of long interval between surgery and onset of symptoms, clinical suspicion, radiological investigations and analysing multiple samples are of immense help