bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging Can Predict Hamstring or Quadriceps Tendon Autograft Diameter in Pediatric or Adolescent Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Vivekanantha Prushoth , Sun Bryan , Parasu Naveen , de SA Darren
Published: October 2024

Objective:

Insufficient graft diameter is an important factor that contributes to failure rates after anterior cruciate ligament reconstruction (ACLR). Although modalities, such as magnetic resonance imaging (MRI), have been well investigated in the adult population to predict graft diameter preoperatively, it is unclear whether similar strategies can be used in the pediatric population. This review aims to evaluate the utility of MRI in the preoperative estimation of autograft parameters in pediatric or adolescent patients undergoing ACLR.

Methods:

Three databases were searched on January 31, 2024. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Revised Assessment of Multiple Systematic Reviews guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, graft characteristics, MRI imaging techniques, and statistical analyses correlating MRI parameters with graft length or diameter were recorded.

Results:

Five studies consisting of 450 patients were included in this review (48.4% females). The mean (SD) age at ACLR was 14.7 (6.8) years. Three studies using hamstring tendon (HT) autografts found that combined semitendinosus and gracilis tendon cross-sectional area (ST+GT CSA) were able to predict graft diameter. One study reported an ST+GT CSA cutoff of 31.2 mm2 to have an 80% and 74% sensitivity and specificity, respectively, in predicting HT autograft diameter above 8 mm. Two studies using quadriceps tendon (QT) autografts found that tendon thickness on sagittal MRI view was able to predict graft diameter. One study reported a QT cutoff of 6.7 mm to have 97.5% and 46.6% sensitivity and specificity, respectively, in predicting the diameter of the QT graft to be above 8 mm. Associations between MRI parameters and graft length were not reported.

Conclusion:

Although there is limited evidence, ST+GT CSA and QT thickness on sagittal view on MRI can be used to predict intraoperative HT and QT autograft diameter, respectively, in pediatric or adolescent ACLR. Future investigations should investigate correlations between imaging parameters and graft length, especially when using QT autografts in the pediatric population.

Level of Evidence:

Level III.
Doctors as Device Manufacturers? Regulation of Clinician-Generated Innovation in the ICU
Authors: Simon David A. , Young Michael J.
Published: October 2024

Critical care physicians are rich sources of innovation, developing new diagnostic, prognostic, and treatment tools they deploy in clinical practice, including novel software-based tools. Many of these tools are validated and promise to actively help patients, but physicians may be unlikely to distribute, implement, or share them with other centers noncommercially because of unsettled ethical, regulatory, or medicolegal concerns. This Viewpoint explores the potential barriers and risks critical care physicians face in disseminating device-related innovations for noncommercial purposes and proposes a framework for risk-based evaluation to foster clear pathways to safeguard equitable patient access and responsible implementation of clinician-generated technological innovations in critical care.
Evaluation of a Physiologic-Driven Closed-Loop Resuscitation Algorithm in an Animal Model of Hemorrhagic Shock
Authors: Pinsky Michael R. , Gomez Hernando , Wertz Anthony , Leonard Jim , Dubrawski Artur , Poropatich Ronald
Published: October 2024

OBJECTIVES:

Appropriate resuscitation from hemorrhagic shock is critical to restore tissue perfusion and to avoid over-resuscitation. The objective of this study was to test the ability of a closed-loop diagnosis and resuscitation algorithm called resuscitation from shock using functional hemodynamic monitoring using invasive monitoring (ReFit1) and minimally invasive monitoring (ReFit2) to identify, treat, and stabilize a porcine model of severe hemorrhagic shock.

DESIGN:

We created a ReFit algorithm using dynamic hemodynamic parameters of pulse pressure variation (PPV), stroke volume variation (SVV), dynamic arterial elastance (Eadyn = PPV/SVV), driven by mean arterial pressure (MAP), mixed venous oxygen saturation, and heart rate targets to define the need for fluids, vasopressors, and inotropes.

SETTING:

University-based animal laboratory.

SUBJECTS:

Twenty-seven female pigs.

INTERVENTIONS:

Anesthetized, intubated, and ventilated (8 mL/kg) pigs were bled at 10 mL/min until a MAP of less than 40 mm Hg, held for 30 minutes, then resuscitated. The ReFit algorithm used the above dynamic parameters to drive computer-controlled infusion pumps to deliver blood, lactated Ringer’s solution, norepinephrine, and in ReFit1 dobutamine. In four animals, after initial resuscitation from hemorrhagic shock, the ability of the ReFit1 algorithm to treat acute air embolism-induced pulmonary hypertension and right heart failure was also tested.

MAIN RESULTS:

In 10 ReFit1 and 17 ReFit2 animals, the time to stabilization from shock was not dissimilar to open controlled resuscitation performed by an expert physician (52 ± 12, 50 ± 13, and 60 ± 15 min, respectively) with similar amounts of fluids and norepinephrine needed. In four ReFit1 animals after initial stabilization, the algorithm successfully resuscitated the animals after inducing an acute air embolism right heart failure, with all animals recovering stability within 30 minutes.

CONCLUSIONS:

Our physiologically based functional hemodynamic monitoring-centered closed-loop resuscitation system can effectively diagnose and treat cardiovascular shock due to hemorrhage and air embolism.
Advancements in the Treatment of Diuretic Resistance in Congestive Heart Failure
Authors: Muzammil Muhammad Ali , Syed Muhammad Abbas , Riaz Sania , Anwar Mariam , Fariha FNU , Imran Laiba , Syed Abdul Rehman Shah , Zaveri Sahil
Published: October 2024

This narrative evaluates the dynamic developments that have significantly transformed treatment strategies in the constantly evolving domain of diuretic resistance (DR) management in congestive heart failure (CHF). The discourse explores historical challenges and the current state of therapeutic approaches as it investigates the crucial matter of DR in patients with CHF. An introduction provides a synopsis of the pivotal function diuretics performed in the management of fluid excess and the intricacies associated with CHF. The narrative explores the progressive exposure of the constraints that traditional treatments face, thus underscoring the persistent issue of DR and the imperative for innovative methodologies. The text underscores advancements in pharmacotherapy that demonstrate efficacy in surmounting resistance, including innovative diuretics and combination therapies. Furthermore, it outlines the pivotal shift towards personalized medicine, an approach that transforms the results of treatments through the integration of genetic knowledge and individualized strategies. Furthermore, the text delves into nonpharmacological strategies, including ultrafiltration and renal denervation, that enhance the overall comprehension of the intricate battle against diuretic resistance. In summary, this narrative exemplifies resolute perseverance in the pursuit of solutions, presenting a promising future wherein various developments converge to restore hope in regard to the control of DR and the improvement of the health status of chronic heart failure patients.
Menopausal hormone therapy for breast cancer survivors
Authors: Huguenin Annabelle
Published: October 2024

Purpose of review

The global incidence of breast cancer continues to increase and increasing efficacy of treatments has improved overall prognosis and survival with a resulting requisite focus on improving quality of life after cancer. Treatment inevitably results in symptoms of menopause and these symptoms may be more severe after cancer treatment compared to natural menopause and may pose a potential risk of early treatment discontinuation. Consequently, the global burden of successfully managing these symptoms is significant.

Recent findings

There is a discordance between randomized and observational data regarding the risk of systemic menopausal hormone therapy and breast cancer recurrence; hormone receptor status is significant to recurrence risk in this setting. The systemic absorption of local oestrogen is not a consistent surrogate marker for cancer recurrence and clinical data has not demonstrated a consistent increase in the risk of cancer recurrence with local therapy.

Nonhormonal treatments remain first-line management of menopause symptoms in breast cancer survivors to minimize the risk of cancer recurrence. However, severe symptoms not responding to nonhormonal interventions require a multidisciplinary, patient-centred approach to discuss the evidence base for hormonal treatments.
Genetic Variants Associated With a History of Glaucoma Surgery in Japanese Patients With Primary Open Angle Glaucoma
Authors: Mabuchi Fumihiko , Tanaka-Mabuchi Nakako , Sakurada Yoichi , Yoneyama Seigo , Yamagata Zentaro , Kashiwagi Kenji ,   for the Japan Glaucoma Society Omics Group (JGS-OG)
Published: October 2024

Précis:

The genetic risk score (GRS) of genetic variants associated with intraocular pressure (IOP) elevation, but not those associated with optic nerve vulnerability, was associated with a history of glaucoma surgery in Japanese patients with primary open angle glaucoma (POAG).

Objective:

To investigate genetic variants associated with a history of glaucoma surgery in Japanese patients with POAG.

Methods:

Japanese patients with POAG (n = 468), including normal tension glaucoma (n = 246) and high tension glaucoma (n = 222), and control subjects (n = 246) were genotyped for 22 genetic variants predisposing to POAG, which can be classified into those associated with IOP elevation (IOP-related genetic variants) and optic nerve vulnerability independent of IOP (optic nerve-related genetic variants). The unweighted and weighted GRSs of 17 IOP-related, 5 optic nerve-related, and all 22 genetic variants were calculated, and the association between the GRS and a history of glaucoma surgery was evaluated.

Results:

There was a significant association (odds ratio 1.13 per unweighted GRS, 95% CI: 1.03 to 1.24, P = 0.0093) between IOP-related unweighted GRS and a history of glaucoma surgery. A significant association (odds ratio 1.09 per 0.1 weighted GRS, 95% CI: 1.04 to 1.14, P = 0.00022) was also found between IOP-related weighted GRS and a history of glaucoma surgery. The IOP-related GRS was positively correlated with the need for glaucoma surgery. The mean of IOP-related unweighted and weighted GRS in patients with POAG with a history of glaucoma surgery were significantly higher (P = 0.013 and P = 0.00031, respectively) than those in patients with POAG without a history of glaucoma surgery.

Conclusions:

IOP-related, but not optic nerve-related, genetic variants were associated with a history of glaucoma surgery in Japanese patients with POAG. These results indicate that IOP elevation induced by IOP-related genetic variants rather than optic nerve vulnerability induced by optic nerve-related genetic variants may play an important role in requiring glaucoma surgery.
Acupuncture in the Treatment of Male Infertility: A Review
Authors: Zhang Lei , Bao Binghao , Wang Xueyan , Tong Suyan , Wen Haolang , Liu Baoxing
Published: October 2024

In recent years, there has been a global decline in the quality of human semen, leading to a gradual increase in the incidence of infertility, which significantly impacts men’s health. Due to the complex etiology of male infertility, clinical treatment is predominantly confined to drugs, surgery, and assisted reproductive technology. However, the efficacy of these approaches often falls short of meeting clinical needs, prompting the exploration of new treatment methods. Acupuncture, a crucial component of traditional Chinese medicine (TCM), has gained increasing prominence in the treatment of male infertility, yielding noteworthy results. This article offers an overview of TCM’s perspective on male infertility, explores the clinical efficacy of acupuncture in treating male infertility and the corresponding mechanisms, and summarizes the existing challenges in the current acupuncture-based treatment of male infertility. It also clarifies the validity of acupuncture and provides references for the future development of acupuncture in the treatment of male infertility.
Analysis of Factors and Clinical Outcomes of Planned Tracheal Extubation Failure in Neurosurgical Intensive Care Unit Patients
Authors: Wu Haotian , Shen Jinsong , Xu Yan
Published: October 2024

BACKGROUND: Planned tracheal extubation failure is a common occurrence among patients in the neurosurgical intensive care unit (NICU) because of the complex nature of neurocritical injuries, and the failure could result in a poor prognosis. METHODS: We observed and recorded the patients with tracheal intubation in the NICU of a hospital in Shanghai from June 2021 to December 2022 and analyzed data from planned tracheal extubation, categorizing patients by success or failure, and compared outcomes between the two groups while investigating contributing factors. RESULTS: A total of 156 patients were included, 133 (85.3%) of whom were successfully extubated and 23 (14.7%) were not. The results of logistic regression analysis demonstrated that the Glasgow Coma Scale score before extubation (OR, 0.643; 95% CI, 0.444–0.931; P = .020) and the frequency of respiratory secretions suctioning before tracheal extubation (OR, 0.098; 95% CI, 0.027–0.354; P < .001) were independent risk factors for extubation failure. We also found that the extubation failure group experienced a significantly longer ICU stay and incurred higher hospitalization costs. CONCLUSIONS: Poor Glasgow Coma Scale scores and a high frequency of respiratory secretions suctioning before tracheal extubation were the main factors contributing to tracheal extubation failure in NICU patients. To avoid tracheal extubation failure and adverse outcomes, these two factors should be carefully assessed before tracheal extubation.
Indocyanine green fluorescence angiography in the management of intestinal injuries following penetrating abdominal trauma: a case-control study comparing postoperative outcomes
Authors: Patel Mohamed Q. , Osterkamp Jens TF , Buitendag Johan JP , Forgan Timothy R. , Steyn Elmin
Published: October 2024

Background:

The surgical management of penetrating hollow visceral injuries includes primary repair or exteriorization. Tissue perfusion at the site of gastrointestinal suture repair may be challenging to assess and is vulnerable to local energy transfer-related injury, micro- or macro-circulatory insufficiency, or splanchnic vasoconstriction for various reasons. Breakdown of suture lines can lead to potentially life-threatening complications. The intraoperative use of indocyanine green fluorescence angiography (ICG-FA) may reduce the risk of postoperative morbidity and mortality by ensuring optimal tissue perfusion at the chosen site of suture repair.

Materials and methods:

The authors conducted a retrospective review of the postoperative complications, length of ICU stay, and length of hospital stay in patients undergoing laparotomy, with and without ICG-FA for penetrating abdominal trauma at a Level One Trauma Center in Cape Town, South Africa.

Results:

One hundred patients were included in the study, of which 20 underwent laparotomy with ICG-FA, and 80 did not. The overall complication rate was significantly lower in the ICG-FA group (OR 0.336, p=0.0412). The anastomotic leak rates in the ICG-FA and control groups were 0% and 6.25%, respectively (p=0.5799). Revision surgery was required in 2 and 14 patients in the ICG-FA and control groups, respectively (OR 0.524, p=0.516). The mean length of stay in the hospital showed no statistical difference, 8.6 and 5.3 days for the ICG-FA and control groups, respectively (p=0.092). The mean length of ICU stay was 6.3 and 2.3 days for the ICG-FA and control groups, respectively (p=0.1642).

Conclusion:

Lower levels of overall postoperative complications and lower rates of revision surgery in patients undergoing laparotomy with ICG-FA are promising. Non-significant findings regarding the relationship between the usage of ICG-FA and anastomotic leak rates suggest the need for larger randomized studies.
METTL16 inhibits pancreatic cancer proliferation and metastasis by promoting MROH8 RNA stability and inhibiting CAPN2 expression – experimental studies
Authors: Yi Tingzhuang , Wang Chunming , Ye Xia , Lin Jie , Lin Cheng , Qin Fengzhen , Yang Wanlin , Ye Yulu , Ning Dengchong , Lan Jinyan , Li Huafu , Luo Chunying , Ma Jian , Wei Zhongheng
Published: October 2024

Background:

N6-methyladenosine (m6A) modification plays a crucial role in the progression of various cancers, including pancreatic cancer, by regulating gene expression. However, the specific mechanisms by which m6A affects pancreatic cancer metastasis remain unclear. This study aims to elucidate the role of METTL16, an m6A writer gene, in regulating core genes such as CAPN2 and MROH8, influencing tumor growth and metastasis.

Materials and Methods:

Transcriptomic data from pancreatic cancer patients in The Cancer Genome Atlas (TCGA) were analyzed to identify m6A-related genes. We performed correlation and survival analyses to uncover core genes influenced by m6A expression. Functional assays, including METTL16 knockdown and overexpression experiments, were conducted in pancreatic cancer cell lines, patient-derived organoids, and animal models. Immunofluorescence, co-immunoprecipitation (Co-IP), and m6A-specific quantitative PCR were used to validate protein interactions and m6A modifications. Chromatin immunoprecipitation (ChIP) analysis was utilized to investigate transcription factor binding at gene promoter regions.

Results:

METTL16 and METTL3 were identified as key m6A regulators associated with improved prognosis in pancreatic cancer patients (P<0.05). CAPN2, CHMP2B, ITGA3, ITGA6, ITPR1, and RAC1 were identified as core genes linked to m6A expression, all significantly correlated with patient prognosis (P<0.05). METTL16 overexpression significantly inhibited tumor growth and metastasis (P<0.001) by downregulating CAPN2 through an indirect mechanism involving the transcription factor TBP and the gene MROH8. MROH8 negatively regulated CAPN2 by promoting TBP degradation, with METTL16 enhancing MROH8 mRNA stability through m6A modifications (P<0.01). Functional assays demonstrated that METTL16 and YTHDC2 (an m6A reader) collaboratively enhanced MROH8 mRNA stability, thereby inhibiting CAPN2 expression and reducing tumor proliferation and metastasis (P<0.001).

Conclusion:

This study reveals a novel regulatory axis involving METTL16, MROH8, and TBP that modulates CAPN2 expression, contributing to the suppression of pancreatic cancer progression. The METTL16–MROH8–TBP–CAPN2 pathway offers potential therapeutic targets for pancreatic cancer treatment, highlighting the significance of m6A modifications in tumor regulation. Further clinical validation is needed to confirm these findings in human patients.
Guiding treatment decisions in renal cell carcinoma: the role of biomarkers and clinical factors
Authors: Huebner-Resch Irene , Schmidinger Manuela
Published: October 2024

Purpose of review

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for metastatic renal cell carcinoma (mRCC), significantly improving overall survival and achieving durable responses. This review is timely due to the increasing number of ICI-based regimens now considered standard care for RCC. There is an urgent need to identify reliable biomarkers that can predict therapeutic responses and resistance, a key challenge in current research.

Recent findings

While tumor-specific factors such as pathological characteristics, genomic mutations, and transcriptional profiles have been extensively studied, no definitive predictive biomarker has yet emerged. Additionally, advanced technologies are being explored to address tumor heterogeneity. Recent research has focused on novel areas such as the microbiome, radiomics, and spatial transcriptomics, which show promise as potential biomarkers.

The translation of these emerging biomarker findings into clinical practice is essential to improving personalized treatment strategies for RCC. Until reliable biomarkers are clinically available, clinical factors may play a pivotal role in guiding individualized treatment decisions to optimize patient outcomes.
Necrotizing enterocolitis in term infants with congenital heart disease and preterm infants after surgery
Authors: Hadian Hooman , Esparham Ali , Sheikhbahaei Erfan , Zefreh Hamidreza , Hosseinpour Mehrdad
Published: October 2024

Background:

The purpose of this study was to report and compare the surgical outcomes of preterm-related necrotizing enterocolitis (PNEC) and congenital heart disease (CHD)-related necrotizing enterocolitis (CDNEC).

Materials and Methods:

Preterm infants without CHD and term infants with CHD who developed NEC and needed surgery were included in this cohort study between 2018 and 2021 at our university-affiliated hospital. A board-certified pediatric cardiologist examined all the patients with echocardiographic and cardiac examinations to diagnose CHD, and a pediatric surgeon evaluated the neonates for surgical indications. Patient characteristics, pregnancy history, and surgical and mortality outcomes were collected from the infants’ medical records.

Results:

Forty infants with NEC were included. The CDNEC and PNEC groups consisted of 18 and 22 infants, respectively. Although the disease-specific mortality rate was higher in the CDNEC group than in the PNEC group, the difference was insignificant (55.5% and 40.9%, respectively, P=0.36). There was no statistically significant difference in the time of NEC occurrence, location, type of surgery, or indications for surgery between the two groups.

Conclusion:

Despite the pathophysiologies of CDNEC and PNEC being different, the characteristics, pregnancy history, surgical, and mortality outcomes of these two types are similar in infants who undergo surgical treatment.
Epispadic accessory urethra in an 8-month-old female with urethral duplication: a case report
Authors: Askar Ayed S. , Altarraf Tarraf A. , Mohamed Shrouk F.
Published: October 2024

Introduction and importance:

Urethral duplication is an uncommon urogenital congenital disability that presents as an accessory urethra in an atypical location. This condition is often coupled with other congenital anomalies like bladder exstrophy, pseudohermaphroditism, and renal disorders.

Case presentation:

The authors report a case of a female infant aged 8 months with urethral duplication, showing an unusual urinary opening in the prepubic area and urinary discharge. A comprehensive diagnostic assessment, consisting of a clinical exam, imaging tests, and cystoscopy, verified the existence of an accessory urethra and the normal one in epispadias. The patient had a successful surgery to remove the accessory tract with primary closure.

Clinical discussion:

Urethral duplication is associated with diverse clinical signs and symptoms. Accurate diagnosis needs thorough imaging studies, and treatment should be tailored according to the type and anatomical location of the accessory tract.

Conclusion:

The histological confirmation of urethral duplication was obtained following the surgical excision of the additional tract. This case underscores the significance of accurate diagnosis and treatment approaches to manage this case.
Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study
Authors: Kilpatrick Kelley , Tewah Ruth , Tchouaket Eric , Jokiniemi Krista , Bouabdillah Naima , Biron Alain , Emed Jessica , Martel Brigitte , Atallah Renée , Jabbour Mira , Bryant-Lukosius Denise
Published: October 2024

Purpose/Aims

To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes.

Design

Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022).

Methods

Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants’ feedback informed the dashboard’s development. Analysis: Descriptive statistics, with content analysis for qualitative data.

Results

The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified.

Conclusions

Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.
Impact of smoking habits on cardiovascular and neoplastic events and all-cause death in people with HIV from the STOPSHIV cohort
Authors: De Socio Giuseppe Vittorio , Ricci Elena , Piconi Stefania , Squillace Nicola , Maggi Paolo , Orofino Giancarlo , Altobelli Debora , Santoro Carmen , Guastavigna Marta , Menzaghi Barbara , Salomoni Elena , Di Biagio Antonio , dell’Omo Marco , Francisci Daniela , Bonfanti Paolo ,   for CISAI study group (Italian coordination group for the study of allergies, HIV infection)
Published: October 2024

Objective:

The study aimed to assess the impact of smoking exposure on major clinical events (MCEs) in a real-life setting of people with HIV (PWH).

Design:

An observational, longitudinal, multicenter cohort study from Italy.

Methods:

Consecutive 983 PWH were enrolled in “STOP Smoking in HIV people” (STOPSHIV) projects and followed from July 2014 until September 2023. The observed MCE defined as cardiovascular events, neoplastic diseases, or death for any reason was assessed according to smoking status and related variables (number of cigarettes smoked daily, pack-years, Fagerström test) in participants. The association between exposure variables and the event was evaluated using the Cox proportional hazard model [hazard ratios, and 95% confidence interval (95% CI)].

Results:

Over 6997.6 person-years of follow-up (PYFU), we found a total of 49 cardiovascular events, 61 neoplastic events, and 47 deaths. The overall incidence rate of MCE was 17.6 /1000 PYFU (95% CI 14.7–21.0). All-cause death rate was 6.7 (95% CI 5.0–8.9)/1000 PYFU. In a multivariate analysis, older age (hazard ratio 1.07, CI 1.05–1.09), high Fagerström Test for Nicotine Dependence (hazard ratio 1.09, CI 1.03–1.15), a low nadir CD4+ cell count less than 200 cells/μl (hazard ratio 1.63, CI 1.10–1.41), history of previous neoplasm (hazard ratio 2.41; CI 1.34–4.43), and IDU as a risk factor for HIV infection (hazard ratio 2.36; CI 1.52–3.68) were independent predictors of any MCE.

Conclusion:

Non-AIDS clinical conditions are the most observed clinical events in PWH from Italy. Smoking exposure significantly increases the risk of MCE in PWH, and a high Fagerström Test for Nicotine Dependence is a predictor of MCE.
Surgical Options for Retained Gallstones After Cholecystectomy
Authors: Mohtashami Ali , Ziaziaris William A. , Lim Chris S.H. , Bhimani Nazim , Leibman Steven , Hugh Thomas J.
Published: October 2024

Background:

Retained gallstones are the most common cause of postcholecystectomy pain. They may be in a long remnant cystic duct (CD), the common bile duct (CBD), or within a remnant gallbladder (GB) post subtotal cholecystectomy. Although endoscopic management is often attempted, occasionally surgical clearance is required. Rates of preoperative surgery to remove stones in a remnant GB are rising due to the increased practice of subtotal cholecystectomy during a problematic laparoscopic cholecystectomy. This study aims to review the surgical management of symptomatic retained stones at a tertiary hepatobiliary referral center in Sydney, Australia.

Patients and Methods:

This retrospective analysis of prospectively collected data was performed on patients who underwent an operation for retained stones after a previous cholecystectomy over 18 years (2004-2022). All of the patients with residual CBD stones had failed endoscopic retrograde cholangiopancreatogram (ERCP) attempts or could not have an ERCP because of prior foregut surgery. All patients underwent a systematic preoperative workup confirming the biliary anatomy and pathology.

Results:

Fourteen patients had surgical intervention for retained stones. All cases were attempted laparoscopically and were successful in 11/14 patients (78%). Retained stones were found within a remnant GB (29%, n=4), a remnant CD (36%, n=5), or the CBD (36%, n=5). Conversion to an open procedure in 3 patients was for dense fibrosis associated with a long low-insertion of the CD, necessitating a hepatico-jejunostomy, failure to delineate the biliary anatomy, and inability to clear CBD stones, respectively. One patient developed a minor postoperative complication (superficial wound infection), and all patients were free of symptoms at a median follow-up of 33.5 months.

Conclusion:

This study demonstrates favorable outcomes in patients undergoing laparoscopic intervention for retained gallstones. A systematic approach to the workup and surgical management of patients with retained stones is essential.
Associations Between Intertemporal Food Choice and BMI in Adult Women: An fMRI Study Using a Quasi-realistic Design
Authors: Sommerfeld Anne , Herrmann Manfred , Heldmann Marcus , Erhard Peter , Münte Thomas F.
Published: October 2024

Background:

Impulsivity resulting in unrestrained eating has been implicated as a contributing factor for obesity. Delay discounting (DD) tasks where individuals choose between a smaller immediate reward and a larger delayed reward provide useful data to describe impulsive decision-making and to determine the extent to which delayed rewards are discounted.

Objective:

To study the association between body mass index(BMI) and delay discounting for food and money in adult women.

Methods:

We used a DD task with real food rewards to investigate impulsive decision-making as related to BMI in participants who self-identified as women. Participants in group A had a mean BMI of 21.4 (n = 14), and participants in group B had a mean BMI of 32.2 (n = 14). Each group was tested in a hungry state during a single session. We performed fMRI during a DD task requiring participants to choose between a food item (one sandwich) constituting a smaller immediate reward and multiple food items (two, three, or four sandwiches) constituting a series of larger delayed rewards available at different intervals. The steepness of the discounting curve for food was determined from these decisions. Participants then completed a monetary discounting task to facilitate a comparison of the discounting of food and monetary rewards.

Results:

Participants in group B discounted food rewards more steeply than monetary rewards. Decisions for delayed rewards led to increased activations of brain areas related to executive control on fMRI, such as the head of the caudate nucleus and the anterior cingulate cortex (ACC) in group A, but not group B participants.

Conclusion:

Our findings suggest that group B had difficulty deciding against the immediate food rewards due to insufficient recruitment of cortical control areas. Therefore, impulsivity is an important target for behavioral interventions in individuals with obesity.
Trajectory Analysis of Healthcare Use Before and after Gastrointestinal Cancer Surgery
Authors: Munir Muhammad Musaab , Woldesenbet Selamawit , Pawlik Timothy M
Published: October 2024

BACKGROUND:

Frailty correlates with worse postoperative outcomes and higher surgical cost, but the long-term impact on healthcare use remains ill-defined. We sought to evaluate patterns of healthcare use pre- and postsurgery among patients with gastrointestinal cancer and characterize the association with frailty.

STUDY DESIGN:

Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the SEER-Medicare database from 2005 to 2020. Frailty was assessed using the claims-based frailty index. Group-based trajectory modeling identified clusters of patients with discrete patterns of healthcare use. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty.

RESULTS:

Among 66,684 beneficiaries, 4 distinct use trajectories based on data from 12 months before and after surgical resection were identified. After a surge in use during the month of surgical resection, most patients reverted to presurgery baseline use (low: 6,588, 9.9%; moderate: 17,627, 26.4%; and high: 29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgical resection precipitated a transition from a “low” presurgery use state to a “high” use state postsurgery. Frail patients were more likely to be among those individuals who transitioned to high users (low: 4.2% vs transition: 12.6% vs high: 7.5%; p < 0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: odds ratio 4.90, 95% CI 4.49 to 5.35; p < 0.001).

CONCLUSIONS:

Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare use after surgical resection. Preoperative predictive models may help differentiate different healthcare use trajectories to help tailor care for patients in the postoperative period.
Surgical Management of Penetrating Carotid Artery Injury: Preoperative Level of Consciousness Does Matter
Authors: Katsura Morihiro , Jakob Dominik A , Kelly Boyle , Ikenoue Tatsuyoshi , Matsushima Kazuhide , Demetriades Demetrios
Published: October 2024

BACKGROUND:

The optimal surgical management of penetrating carotid artery injuries (PCAIs) remains controversial. This study aimed to examine the association between operative techniques for PCAI and the incidence of stroke.

STUDY DESIGN:

This retrospective cohort study used the American College of Surgeons TQIP (2016 to 2021) database. We included patients (age 16 years or older) with severe penetrating injuries to the common or internal carotid arteries (CCA/ICA) who underwent one of the following operative procedures: primary suture repair, ligation, and arterial reconstruction with a graft. Multivariate logistic regression analysis with cluster-adjusted-robust SEs was performed to estimate the adjusted odds ratio (AOR) for postoperative stroke stratified by the initial Glasgow Coma Scale (GCS).

RESULTS:

A total of 492 patients were included (329 underwent primary suture repair, 82 underwent ligation, and 81 underwent arterial reconstruction with a graft). The median age was 31 years (interquartile range 24 to 43) and median GCS on arrival was 11 (interquartile range 3 to 15). On multivariate analysis after adjusting for potential confounders, ligation of CCA/ICA was significantly associated with increased odds of stroke in patients with initial GCS ≥9 (AOR: 4.40, 95% CI 1.16 to 16.58, p = 0.029), whereas there was no significant association in patients with GCS <9 (AOR 0.77, 95% CI 0.28 to 2.11, p = 0.37). No significant association was identified between arterial reconstruction with a graft and stroke, irrespective of the initial GCS.

CONCLUSIONS:

The study findings suggest that the preoperative level of consciousness may help in planning operative strategies for PCAI. In patients with an initial GCS ≥9, definitive repair of the CCA/ICA, including arterial reconstruction with a graft, should be pursued instead of ligation.
Towards universal models for collective interactions in biomolecular condensates
Authors: Milanetti Edoardo , Manjunatha Karan KH , Ruocco Giancarlo , Maritan Amos , Fuxreiter Monika
Published: October 2024

A wide-range of higher-order structures, including dense, liquid-like assemblies, serve as key components of cellular matter. The molecular language of how protein sequences encode the formation and biophysical properties of biomolecular condensates, however, is not completely understood. Recent notion on the scale invariance of the cluster sizes below the critical concentration for phase separation suggests a universal mechanism, which can operate from oligomers to non-stoichiometric assemblies. Here we propose a model for collective interactions in condensates, based on context-dependent, variable interactions. We provide the mathematical formalism, which is capable describing growing dynamic clusters as well as changes in their material properties. Furthermore, we discuss the consequences of the model to maximise sensitivity to the environmental signals and to increase correlation lengths.
Histopathological features of hepatocellular carcinoma in patients with hepatitis B and hepatitis D viruses infection: A single-institution study from Mongolia
Authors: Jargalsaikhan Orgil , Shao Wenhua , Ichimura-Shimizu Mayuko , Ishimaru Soichiro , Koma Takaaki , Nomaguchi Masako , Chimeddorj Battogtokh , Batchuluun Khongorzul , Tseveenjav Anujin , Magvan Battur , Lhagvadorj Sayamaa , Mendjargal Adilsaikhan , Ganbaatar Lhagvadulam , Irahara Minoru , Akaike Masashi , Boldbaatar Damdindorj , Tsuneyama Koichi
Published: October 2024

Viral hepatitis, particularly hepatitis B (HBV) and hepatitis C (HCV), is highly prevalent in Mongolia. Moreover, Mongolia has the highest prevalence of hepatitis delta virus (HDV) globally, with over 60% of HBV-infected individuals also co-infected with HDV. Since HBV/HDV infections accelerate liver disease progression more compared to HBV infection alone, urgent national health measures are required. This study presents a clinicopathological analysis of 49 hepatocellular carcinoma cases surgically resected at the Mongolia-Japan Hospital of the Mongolian National University of Medical Sciences. HBV infection was found in 27 (55.1%) cases of all HCC cases. Immunohistochemical staining of the liver revealed that 14 (28.6%) among the HBV infected tissues were HDV antigen-positive in the HCC cases. HDV-positive cases exhibited significantly higher inflammatory activity compared to HDV-negative cases, with lymphocytic infiltrates predominantly composed of CD4-positive cells. Furthermore, HDV-positive cells were spatially distinct from HBs antigen-positive cells, suggesting that HDV-infected cells may interfere with HBV replication. No significant differences in fibrosis or in tumor characteristics were observed between the HDV-positive and -negative cases.

Early diagnosis of HBV/HDV infections is essential for appropriate treatment and to prevent further domestic transmission of the virus. However, routine testing for HDV infection is rarely conducted in Mongolia. Since HDV-positive cells are morphologically indistinguishable from surrounding HDV-negative cells, routine histopathological analysis may not be sufficient to detect HDV infection. Based on this clinicopathological study, CD4 and CD8 immunostaining can be considered as an adjunctive diagnostic tool in cases with significant lymphocytic infiltration and hepatocellular damage. Additionally, HDV screening using blood and tissue samples may be recommended to ensure accurate diagnosis.
Integrating genetic and gene expression data in network-based stratification analysis of cancers
Authors: Liou Kenny , Wang Ji-Ping
Published: October 2024

Cancers are complex diseases that have heterogeneous genetic drivers and varying clinical outcomes. A critical area of cancer research is organizing patient cohorts into subtypes and associating subtypes with clinical and biological outcomes for more effective prognosis and treatment. Large-scale studies have collected a plethora of omics data across multiple tumor types. These studies provide an extensive dataset for stratifying patient cohorts. Network-based stratification (NBS) approaches have been presented to classify cancer tumors using somatic mutation data. A challenge in cancer stratification is integrating omics data to yield clinically meaningful subtypes. In this study, we integrate somatic mutation data with RNA sequencing data within the NBS framework and investigate the effectiveness of integrated NBS on three cancers: ovarian, bladder, and uterine cancer. We show that integrated NBS subtypes are more significantly associated with overall survival or histology. Integrated NBS networks also reveal highly influential genes that drive cancer initiation and progression. This comprehensive approach underscores the significance of integrating genomic data types in cancer subtyping, offering profound implications for personalized prognosis and treatment strategies.
Submaximal eccentric training during immobilization does not prevent serial sarcomere loss or impairments in mechanical function in old or young rats
Authors: Hinks Avery , Vlemmix Ethan , Power Geoffrey A.
Published: October 2024

The age-related loss of muscle mass is partly driven by a reduction in serial sarcomere number (SSN), and further SSN loss occurs during immobilization. SSN is associated with optimal force and power production and muscle passive tension, thus immobilization-induced SSN loss is especially a concern for older individuals who are often subjected to forced muscle disuse with illness and injury. We previously showed that submaximal eccentric resistance training increased SSN and improved muscle function in old rats. The present study investigated whether this training could prevent the losses of SSN and function when performed intermittently during immobilization. 10 old (32 months) and 10 young (8 months) rats underwent unilateral casting of the plantar flexors in a shortened position for 2 weeks. Thrice weekly, casts were removed for isokinetic eccentric resistance training. Pre- and post-training we assessedin-vivomaximum isometric torque at ankle angles corresponding to stretched and neutral muscle lengths, the passive torque-angle relationship, and isotonic power. The soleus and medial gastrocnemius were harvested for SSN measurements, with the untrained leg as a control. In old and young rats, muscles of the casted leg had lower muscle wet weights (−20-40%), physiological cross-sectional area (−16-20%), and SSN (−7-29%) than the control leg. Furthermore, maximum isometric torque (−37-46%) and isotonic power (−≈70%) decreased, and passive torque increased (+≈400%) from pre- to post-training for both age groups. Thus, irrespective of age, submaximal eccentric resistance training 3 days/week was ineffective for preventing the losses of muscle contractile tissue and mechanical function during casting.
SPATIAL TRANSCRIPTOMIC PROFILING OF ADVANCED OVARIAN CLEAR CELL CARCINOMA REVEALS INTRA-TUMOR HETEROGENEITY IN EPITHELIAL-MESENCHYMAL GRADIENT
Authors: Truong Le Thang , Yi-Te Wang Duncan , Chen Ko-Chen , Yan Sebastian Rui-Gu , Chu Pei-Yu , Tan Tuan Zea , Chiu Yi-Chia , Sheu Jia-Yuh , Huang Chen-Hao , Ye Jieru , Tai Ya-Ting , Juan Hsueh-Fen , Tsai Feng-Chiao , Lin Wei-Chou , Wei Lin-Hung , Huang Ruby Yun-Ju
Published: October 2024

Intratumoral heterogeneity is intrinsically comprised of molecular alterations of tumor cells and extrinsically from interconnections with microenvironments. This study explores the spatial heterogeneity of ovarian clear cell carcinoma (OCCC), a rare cancer with significance to East Asian women. We profiled 21 tumors from matched ovarian and metastatic sites with spatial transcriptomic (ST) platforms including GeoMx and Visium CytAssist. Three subclusters of OCCC tumor cells enriched in oxidative phosphorylation, epithelial-mesenchymal transition, and inflammation pathways were identified with preferential geospatial localizations in tumor centers and invasive margins/tumor-stromal interfaces. These ST subclusters correlated with epithelial-mesenchymal gradients and prognostic features in larger cohorts. Single-cell ST in CosMx identified 9 cancer cell populations with organ-specific tropism. Trajectory analysis indicated a NEAT1-high subclone having founder characteristics, progressively dominating the metastatic niche, displaying mesenchymal traits. This founder feature correlated with clinical outcomes in PanCancer datasets. Our findings highlight the adaptive and context-specific interactions between cancer cells and microenvironments within spatial complexities.
Animal Model for Pericardium Patch Thoracoabdominal Aortic Aneurysm: Step by Step
Authors: Tobita Allana , Ponte Bruno Jeronimo , Portugal Maria Fernanda Cassino , Baptista Anna Paula Weinhardt , Sincos Igor Rafael , Wolosker Nelson
Published: October 2024

2.

Objectives

We aimed to improve previously described methods for confection of thoracoabdominal aortic aneurysms (TAAA) in porcine animal models, reducing surgical procedure time and specimen mortality.

Methods

A total of 18 swine underwent a surgical procedure in order to confect a TAAA. All anesthetic precautions were taken. All the procedures were carried out via laparotomy and retroperitoneal access. An autologous peritoneum patch was used to make the aneurysm in 2 animals, and a bovine pericardium patch in 16. All the animals were followed up post-operatively, and were re-approached after 4 weeks for analysis of the aneurysm sac. The models that did not die in the post-operative period were euthanized under institutional recommendations

Results

All the animals underwent laparotomy with retroperitoneal access. Two were submitted to an autologous peritoneum patch and 16 to a bovine pericardium patch. Three models underwent single suprarenal clamping; while 15 underwent sequential clamping. There were no differences in surgical time(p 0.207)or total clamping time(p 0.276)between groups. There was a higher mortality rate after 4 weeks in models submitted to single clamping (100%) compared to sequential clamping (26.7%)(p 0.0017).

Conclusion

The experimental model of a thoracoabdominal bovine pericardium aneurysm which uses a sequential clamping technique, provides a stable and reliable platform with consistent anatomy and patency for up to four weeks. This model can be extremely valuable for assessing new endovascular therapy options in living organisms