bluuebunny/crossref_metadata_2025 huggingface dataset:
392. PLANNING IS THE KEY—ESOPHAGECTOMY WITH COLONIC INTERPOSITION FOLLOWING: WHIPPLE’S, LEFT LOWER LOBECTOMY, RIGHT PLEURECTOMY AND COLONIC SURGERY
Authors: Sivarajan Sri , Kulasegaran Suheelan , Kumar Bhaskar
Published: August 2023

Link to Video: https://www.dropbox.com/s/wpr3s097g50oadl/Colonic%20interposition%20%28ISDE%20SUBMISSION%29.mp4?dl=0.

Description of Video:

We report our learnings from a complex surgical case of Ivor Lewis esophagectomy with colonic conduit in a patient who had undergone multiple previous abdominal and thoracic operations. This seventy-two-year-old man was found to have an esophageal adenocarcinoma (T4N0M0) in the distal esophagus with a significant surgical background: Whipple’s procedure for pancreatic cancer; Left lower lobectomy for lung cancer; Right pneumonectomy for recurrent pneumothoraces and a defunctioning stoma for chemotherapy associated anal fistula. To our knowledge, no such case of colonic interposition for esophagectomy has been reported in the literature for a patient with such extensive surgical history.

This presented significant surgical and anaesthetic challenges which are explored in the video. Principally the need for extensive planning to anticipate risk and modify procedural steps to account for these accordingly. For example, the operation began with a right thoracotomy, given the possibility that dense adhesions from previous surgery could obstruct safe dissection and subsequently the procedure could be aborted before any critical steps were made. Additionally, we consider the importance of involving other surgical specialities to aid with safe dissection and delineation of anatomy. Each of the key operative steps are described and paired with real-time video footage. Post-operatively we describe how the risk of anastomotic leak given a high-risk anastomosis may be reduced through pre-emptive Endoluminal Vacuum therapy. We also discuss the importance of recognising and managing feculent aspiration pneumonia which is common following this surgery.

Discussion of this case and our operative approach would serve to highlight how surgery remains a feasible option for patients despite complex anatomy and surgical history; provided risks are anticipated and appropriately managed.
Trans-catheter mitral valve-in-valve replacement in a patient on venoarterial extracorporeal membrane oxygenation: a case report
Authors: Bainiwal Jassimran Singh , Ham Jeremy-Ann , Aksoy Olcay
Published: September 2023

Background

Bioprosthetic mitral valves on average have a median durability between 8 and 10 years. After the failure of a bioprosthetic valve, surgical replacement is often indicated. However, the options for those patients at high or prohibitive surgical risks are limited. Here, we describe a case of a successful trans-catheter mitral valve-in-valve (TMViV) replacement on venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Case summary

We describe a case of a 39-year-old female with a history notable for systemic lupus erythematosus, severe pulmonary arterial hypertension (now mixed pre and post) thought to be secondary to prior substance use, and infective endocarditis complicated by severe mitral stenosis status post-bioprosthetic mitral valve replacement who presented with symptoms of acute hypoxic respiratory failure secondary to severe bioprosthetic mitral valve stenosis. The patient had a prolonged hospital course complicated by a pulseless electrical activity arrest, (continuous renal replacement therapy) for acute renal failure, and hypertonic saline due to cerebral oedema. Due to her significant co-morbidities and haemodynamic instability with acute kidney injury and recent neurologic insult, the patient was thought not to be a good surgical candidate. However, given her young age and overall improved neurologic status, it was thought the patient could benefit from a TMViV with bi-ventricular support given her right- and left-sided heart failure and was placed on VA-ECMO in anticipation of a TMViV procedure for circulatory support. The patient underwent a successful TMViV replacement using a trans-septal approach with a 26 mm SAPIEN 3 valve and atrial septal defect closure with a 14 mm Amplatzer device on hospital Day 12. The patient was successfully de-cannulated from VA-ECMO on hospital Day 13. The patient had a prolonged hospital course but eventually had renal recovery and tracheostomy de-cannulation. A trans-thoracic echocardiogram prior to discharge was notable for a well-functioning valve and normal ejection fraction. The patient was discharged to a nursing home for further rehabilitation.

Discussion

The gold standard for bioprosthetic mitral valve stenosis is surgical replacement of the valve. However, the options for those at high or prohibitive surgical risk are lacking. Recent studies have demonstrated TMViV is a safe alternative to surgical mitral valve redo cases in high-risk patients. To our knowledge, there are limited data on trans-catheter valve placement while on VA-ECMO. Successful implantation in our patient suggests that TMViV in a stenotic bioprosthesis is feasible in very high-risk patients with the use of VA-ECMO to support haemodynamics.
Adenosine sensitive left ventricular summit ventricular tachycardia in a pre-adolescent: case report
Authors: Ferns Sunita J , Scheinman Melvin
Published: September 2023

Background

Sustained forms of tachycardia especially from the left ventricular summit are rare. Adenosine sensitive outflow tachycardias, especially from the left ventricular summit, are rarer still. These arrhythmias may be exercise or stress induced as they are facilitated by catecholamines and characteristically terminate with adenosine, vagal manoeuvres, and beta-blockers. The surface 12-lead electrocardiogram can be used to localize the anatomic site of origin before catheter ablation; however, prediction of the precise origin may still be challenging due to the intimate and complex anatomy of the outflow tracts.

Case summary

A 12-year-old female presented to an emergency room with frequent runs of wide complex tachycardia that terminated with adenosine but would spontaneously reinitiate. After three additional temporary terminations with adenosine and because of an inability to completely eliminate tachycardia, she was started on an esmolol infusion that resulted in an abrupt termination of tachycardia. At follow-up, she reported breakthrough episodes of tachycardia with exercise, especially associated with beta-blocker non-compliance. The rest of her cardiac testing was normal apart from an anomalous right coronary artery origin from the left coronary sinus. Given the increased frequency of symptomatic palpitations and medication non-compliance, she underwent an electrophysiology study. During the study, a ventricular tachycardia was successfully mapped to an epicardial focus at the left ventricle summit and was successfully ablated.

Discussion

The response of this patient’s ventricular tachycardia to adenosine suggests a triggered mechanism. To our knowledge, this is the first unambiguous example of left ventricular tachycardia due to cAMP-mediated triggered activity in this age group.
Metalloproteome of human-infective RNA viruses: a study towards understanding the role of metal ions in virology
Authors: Dixit Himisha , Kulharia Mahesh , Verma Shailender Kumar
Published: September 2023

Metalloproteins and metal-based inhibitors have been shown to effectively combat infectious diseases, particularly those caused by RNA viruses. In this study, a diverse set of bioinformatics methods was employed to identify metal-binding proteins of human RNA viruses. Seventy-three viral proteins with a high probability of being metal-binding proteins were identified. These proteins included 40 zinc-, 47 magnesium- and 14 manganese-binding proteins belonging to 29 viral species and eight significant viral families, including Coronaviridae, Flaviviridae and Retroviridae. Further functional characterization has revealed that these proteins play a critical role in several viral processes, including viral replication, fusion and host viral entry. They fall under the essential categories of viral proteins, including polymerase and protease enzymes. Magnesium ion is abundantly predicted to interact with these viral enzymes, followed by zinc. In addition, this study also examined the evolutionary aspects of predicted viral metalloproteins, offering essential insights into the metal utilization patterns among different viral species. The analysis indicates that the metal utilization patterns are conserved within the functional classes of the proteins. In conclusion, the findings of this study provide significant knowledge on viral metalloproteins that can serve as a valuable foundation for future research in this area.
Function analysis of CYP321A9 from Spodoptera frugiperda (Lepidoptera: Noctuidae) associated with emamectin benzoate, and a novel insecticide, cyproflanilide detoxification
Authors: Shi Yang , He Li , Ding Wenbing , Huang Hong , He Hualiang , Xue Jin , Gao Qiao , Zhang Zhixiang , Li Youzhi , Qiu Lin
Published: August 2023

The fall armyworm, Spodoptera frugiperda, is an invasive agricultural pest that is a serious threat to agricultural production and global food security. Chemical control is the most effective method for preventing outbreaks of S. frugiperda. However, insecticide resistance often develops as a result of prolonged pesticide use, and the molecular mechanisms involved in insecticide resistance remain unclear. Insect cytochrome P450 monooxygenases play an important role in the detoxification of insecticides and insecticide resistance in Lepidoptera. In our study, the LC50 of a novel insecticide (cyproflanilide) and a conventional insecticide (emamectin benzoate) for S. frugiperda second-instar larvae were 7.04 and 1.61 mg/L, respectively. Furthermore, CYP321A9 expression was upregulated in larvae exposed to these insecticides. Additionally, knockdown of CYP321A9 by feeding larvae with dsRNA for 72 h significantly increased the mortality of S. frugiperda exposed to emamectin benzoate and cyproflanilide by 23.33% and 7.78%, respectively. Our results indicate that CYP321A9 may play an important role in the detoxification of emamectin benzoate and cyproflanilide in S. frugiperda. Our findings provide a basis to better understand the mechanisms of insecticide resistance and contribute to the control of S. frugiperda.
Twentieth-century private collecting
Authors: Muskett Georgina
Published: September 2023

Dr Philip Nelson, who died in 1953, was an antiquary and collector who lived in Liverpool. One of the highlights of the collections of classical sculpture in the World Museum, part of National Museums Liverpool, is a group of statuettes and busts acquired by Nelson from the 12th Lord Kinnaird and formerly housed in Rossie Priory, near Perth in Scotland. Although Nelson bought only two sculptures from the first auction of sculptures from the Rossie Priory collection, held at Sotheby’s in London in December 1948, it is apparent that he acquired several others, either directly from Lord Kinnaird or through dealers. Details of this process can be found in the archives of the World Museum and the Walker Art Gallery, also part of National Museums Liverpool, including hitherto unpublished letters, notebooks and invoices, reproduced here in an online appendix. The correspondence provides an insight into the formation of a private collection of ancient sculpture in the first half of the twentieth century, a period often overlooked in collecting scholarship.
Massive mixed epithelial-stromal tumour of seminal vesicle requiring challenging abdominoperineal resection: a case report and review of literature
Authors: Yu Zirong , Choy Kay Tai , Ong Ferdinand , Williams Evan , Naidu Sanjeev , Smithers Bernard M , Gurung Anjan , Lutton Nicholas
Published: September 2023

Mixed epithelial-stromal tumours (MESTs) are a rare biphasic tumour that frequently arise in women from the renal and urogenital tract. They are also seen in men but are exceptionally uncommon with only few cases reported to originate from the seminal vesicles. Malignant transformation of its epithelial or stromal components is possible; however, by in large, these tumours are benign in nature. We report the case of a 48-year-old man with no remarkable medical or surgical history who presented with a huge expanding pelvic and intra-abdominal mass that required extensive surgical management including a pelvic exenteration. Histopathological analysis concluded the diagnosis of benign MEST originating from the seminal vesicles with no malignant features. No further systemic therapy was recommended for our patient. Given the technical intricacy in the operative resection of this tumour, we aim to present our findings and surgical management of this complex MEST.
The WD40 domain-containing protein Ehd5 positively regulates flowering in rice (Oryza sativa)
Authors: Zhang Xuening , Feng Qi , Miao Jiashun , Zhu Jingjie , Zhou Congcong , Fan Danlin , Lu Yiqi , Tian Qilin , Wang Yongchun , Zhan Qilin , Wang Zi-Qun , Wang Ahong , Zhang Lei , Shangguan Yingying , Li Wenjun , Chen Jiaying , Weng Qijun , Huang Tao , Tang Shican , Si Lizhen , Huang Xuehui , Wang Zi-Xuan , Han Bin
Published: August 2023

Heading date (flowering time), which greatly influences regional and seasonal adaptability in rice (Oryza sativa), is regulated by many genes in different photoperiod pathways. Here, we characterized a heading date gene, Early heading date 5 (Ehd5), using a modified bulked segregant analysis method. The ehd5 mutant showed late flowering under both short-day and long-day conditions, as well as reduced yield, compared to the wild type. Ehd5, which encodes a WD40 domain-containing protein, is induced by light and follows a circadian rhythm expression pattern. Transcriptome analysis revealed that Ehd5 acts upstream of the flowering genes Early heading date 1 (Ehd1), RICE FLOWERING LOCUS T 1 (RFT1), and Heading date 3a (Hd3a). Functional analysis showed that Ehd5 directly interacts with Rice outermost cell-specific gene 4 (Roc4) and Grain number, plant height, and heading date 8 (Ghd8), which might affect the formation of Ghd7–Ghd8 complexes, resulting in increased expression of Ehd1, Hd3a, and RFT1. In a nutshell, these results demonstrate that Ehd5 functions as a positive regulator of rice flowering and provide insight into the molecular mechanisms underlying heading date.
MYB24 orchestrates terpene and flavonol metabolism as light responses to anthocyanin depletion in variegated grape berries
Authors: Zhang Chen , Dai Zhanwu , Ferrier Thilia , Orduña Luis , Santiago Antonio , Peris Arnau , Wong Darren C J , Kappel Christian , Savoi Stefania , Loyola Rodrigo , Amato Alessandra , Kozak Bartosz , Li Miaomiao , Liang Akun , Carrasco David , Meyer-Regueiro Carlos , Espinoza Carmen , Hilbert Ghislaine , Figueroa-Balderas Rosa , Cantu Dario , Arroyo-Garcia Rosa , Arce-Johnson Patricio , Claudel Patricia , Errandonea Daniel , Rodríguez-Concepción Manuel , Duchêne Eric , Huang Shao-shan Carol , Castellarin Simone Diego , Tornielli Giovanni Battista , Barrieu Francois , Matus José Tomás
Published: August 2023

Variegation is a rare type of mosaicism not fully studied in plants, especially fruits. We examined red and white sections of grape (Vitis vinifera cv. ‘Béquignol’) variegated berries and found that accumulation of products from branches of the phenylpropanoid and isoprenoid pathways showed an opposite tendency. Light-responsive flavonol and monoterpene levels increased in anthocyanin-depleted areas in correlation with increasing MYB24 expression. Cistrome analysis suggested that MYB24 binds to the promoters of 22 terpene synthase (TPS) genes, as well as 32 photosynthesis/light-related genes, including carotenoid pathway members, the flavonol regulator HY5 HOMOLOGUE (HYH), and other radiation response genes. Indeed, TPS35, TPS09, the carotenoid isomerase gene CRTISO2, and HYH were activated in the presence of MYB24 and MYC2. We suggest that MYB24 modulates ultraviolet and high-intensity visible light stress responses that include terpene and flavonol synthesis and potentially affects carotenoids. The MYB24 regulatory network is developmentally triggered after the onset of berry ripening, while the absence of anthocyanin sunscreens accelerates its activation, likely in a dose-dependent manner due to increased radiation exposure. Anthocyanins and flavonols in variegated berry skins act as effective sunscreens but for different wavelength ranges. The expression patterns of stress marker genes in red and white sections of ‘Béquignol’ berries strongly suggest that MYB24 promotes light stress amelioration but only partly succeeds during late ripening.
Color Flow Doppler in Spinal Ultrasound: A Novel Technique for Assessment of Catheter Position in Labor Epidurals
Authors: van den Bosch O.F.C. , Gleicher Y. , Arzola C. , Siddiqui N. , Downey K. , Carvalho J.C.A.
Published: September 2023

(Reg Anesth Pain Med 2022;47:775–779)

Epidural analgesia is one of the most common pain relief treatments during labor and delivery and is usually very effective. In a small percentage of epidurals, misplacement of the epidural catheter can cause inadequate anesthetic effects. To reduce instances of insufficient pain relief, it would be beneficial to be able to assess the position and flow of the catheter before administering medication. This study was designed to visualize flow in the epidural space using a structured color flow Doppler assessment, and to describe the location of the flow relative to the catheter insertion site. The primary outcome was the visualization of flow in the epidural space by color flow Doppler ultrasound. Secondary outcomes were visualization of catheter flow at the interspace of insertion, and at the interspaces above and below insertion, as well as visibility from unilateral or bilateral view, and visibility of flow on injection of saline only or an injection of a saline and air mixture.
Preparing for Obstetric Anesthesia: An Educational Randomised Controlled Trial Comparing E-learning to Written Course Material
Authors: Andersson M.L. , Duch P. , Bessmann E.L. , Lundstrøm L.H. , Ekelund K.
Published: September 2023

(Acta Anaesthesiol Scand. 2023;67:36–43)

E-learning is becoming more common in postgraduate continual medical education. While there many studies that have shown the benefits of e-learning and its effectiveness has similarity to traditional teaching methods, the studies vary in quality. This study aimed to determine whether e-learning better prepares obstetric anesthesia course participants compared with written course material by assessing precourse knowledge, anxiety level, group performance, and postcourse knowledge.
Association of Texas’ 2021 Ban on Abortion in Early Pregnancy With the Number of Facility-based Abortions in Texas and Surrounding States
Authors: White K. , Sierra G. , Lerma K. , Beasley A. , Hofler L.G. , Tocce K. , Goyal V. , Ogburn T. , Potter J.E. , Dickman S.L.
Published: September 2023

(JAMA. 2022;328:2048–2055)

In 2021, the state of Texas implemented a strict abortion law (SB 8) that banned abortion after the detection of fetal cardiac activity. Previously, abortions could be performed in the state of Texas up to 22 weeks of gestation. In June 2022, the US Supreme Court overturned its decision on Roe v Wade, making it possible to enforce the new legislation banning nearly all abortions. Primary outcomes for this study included the change in the number of facility-based, out-of-state, and total documented abortions for Texas residents after the implementation of SB 8. The secondary outcome was the change in the percentage of out-of-state abortions for Texas residents that were provided at or after 12 weeks of gestation.
Delivering Evidence to Prevent Recurrent Venous Thromboembolism in Pregnancy
Authors: van Lennep J.E.R. , Nerenberg K.A.
Published: September 2023

(Lancet. 2022;400:1743–1745)

Pregnant and postpartum women have an increased risk for venous thromboembolism (VTE) (0 to 1%) with a history of VTE increasing the likelihood (2% to 10%). Hypercoagulability, endothelial damage, and venous stasis are contributing factors. Low–molecular-weight heparin (LMWH) thromboprophylaxis during pregnancy to 6 weeks postpartum is the recommended treatment for women with history of VTE, yet evidence-based dosage recommendations are lacking, causing dosage variation between countries and practices.
Put Your Weight Behind It—Effect of Body Mass Index on the Active Second Stage of Labor: A Retrospective Cohort Study
Authors: Østborg T.B. , Sande R.K. , Kessler J. , Tappert C. , von Brandis P. , Eggebø T.M.
Published: September 2023

(BJOG. 2022;129:2166–2174)

Recent studies have indicated rising rates of obesity throughout the world, with larger percentages of women in developed countries being classified as overweight or obese. Obesity in pregnancy has been associated with complications such as pre-eclampsia, gestational diabetes, preterm delivery, and others. Obesity is also associated with delivery complications and increases risk of surgical intervention. Previous research has shown an association between obesity and slow labor progress, and awareness of the risks associated with obesity may bias both the mother and the birth attendant, affecting both labor experience and potentially outcome. The purpose of this study was to examine differences in the active second stage of labor in groups based on body mass index (BMI), with the primary outcome the median duration of the second stage.
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
Authors: Hundscheid T. , Onland W. , Kooi E.M.W. , Vijlbrief D.C. , de Vries W.B. , de Boode W.P. ,   BeNeDuctus Trial Investigators
Published: September 2023

(N Engl J Med. 2023;388:980–990)

Patent ductus arteriosus (PDA), where the vessel connecting the pulmonary artery and aorta does not properly close, is a common adverse outcome for preterm birth. Cyclooxygenase inhibitors are used to help treat PDA but the evidence and clinical outcome benefits are lacking. This study aimed to answer the question whether expectant management or ibuprofen treatment in extremely preterm infants with PDA are a superior treatment.
Interventions for the Prevention or Treatment of Epidural-related Maternal Fever: A Systematic Review and Meta-analysis
Authors: Cartledge A. , Hind D. , Bradburn M. , Martyn-St James M. , Davenport S. , Tung W.S. , Yung H. , Wong J. , Wilson M.
Published: September 2023

(British Journal of Anaesthesia. 2022;129:567e580)

Epidural-related maternal fever (ERMF) occurs in 15% to 25% of laboring women who receive analgesia. ERMF is not seen in non-pregnant or pregnant women who are not in labor. The cause behind ERMF is not yet understood. There have been studies on a number of preventative interventions for ERMF. This systematic review aimed to compare the effectiveness of proposed interventions, primarily in terms of the incidence of ERMF, and secondarily, by comparing the incidence of neonatal sepsis evaluation and neonatal admission to level 2 care.
Individualized Music Interventions for Dementia-Related Behavior Management
Authors: Simpson Jeannie
Published: September 2023

Dementia presents many challenges for the person diagnosed, as well as for caregivers. The use of psychotropic medications for dementia-related behaviors has been linked to adverse reactions and increased mortality. Alternative approaches such as the use of personalized music playlists and musically-related spiritual care have had promising results including improved quality of life for persons with dementia and reduced stress for caregivers. Implementing an individualized music program is relatively simple and avoids deleterious side effects that may accompany medication use.
Robotic Anterior Resection for Rectosigmoid Colon Cancer using Single Port Access
Authors: Bae Sung Uk , Jeong Woon Kyung , Baek Seong Kyu
Published: September 2023

Single-port laparoscopic surgery (SPLS) and a robotic surgical system have recently been included in contemporary colorectal surgical practice. 1–4 SPLS may result in better cosmetic outcomes, reduced postoperative incisional pain, fewer incisional hernias, minimal organ damage, and fewer wound complications. 2,5 However, SPLS for left-sided colorectal cancer is a challenging technique, even for experienced laparoscopic colorectal surgeons, owing to the difficulty of constructing instrument triangulation and using endo-staplers in the pelvic cavity from a single umbilical port with adequate distal margins. The Da Vinci Si Single-Site ® system (Intuitive Surgical, Sunnyvale, CA) was specifically developed to overcome SPLS limitations. Since the robotic instruments are crossed at the port site, but the software "reassigns" them to the surgeon's hand on the robotic console, the platform can easily create instrument triangulation while minimizing external robotic arm collisions. 6–8 Due to the lack of wrist articulation, the limited range of motion of the semi-rigid robotic instruments, and the limited choice of instruments, the Single-Site ® platform has not yet been widely utilized for colorectal diseases. A novel robotic technique, the da Vinci SP ® system (Intuitive Surgical, Sunnyvale, CA, USA), was designed for single-site surgery. This platform has a robotic arm with a high degree of freedom that is introduced directly into the peritoneal cavity through a single incision. The benefits of the single-port da Vinci robot platform include a holographic display of the instrument location, wristed articulation and flexible elbows, a console-controlled camera, and three-dimensional optics. This robotic system for single-port access can perform lymph node dissection around the inferior mesenteric artery using 4-arm wrist articulation while preserving the autonomic nerves during left-sided colorectal cancer surgery.
Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum
Authors: Boesing Christoph , Schaefer Laura , Schoettler Jochen Johannes , Quentin Alena , Beck Grietje , Thiel Manfred , Honeck Patrick , Kowalewski Karl-Friedrich , Pelosi Paolo , Rocco Patricia R.M. , Luecke Thomas , Krebs Joerg
Published: August 2023

BACKGROUND

The Trendelenburg position with pneumoperitoneum during surgery promotes dorsobasal atelectasis formation, which impairs respiratory mechanics and increases lung stress and strain. Positive end-expiratory pressure (PEEP) can reduce pulmonary inhomogeneities and preserve end-expiratory lung volume (EELV), resulting in decreased inspiratory strain and improved gas-exchange. The optimal intraoperative PEEP strategy is unclear.

OBJECTIVE(S)

To compare the effects of individualised PEEP titration strategies on set PEEP levels and resulting transpulmonary pressures, respiratory mechanics, gas-exchange and haemodynamics during Trendelenburg position with pneumoperitoneum.

DESIGN

Prospective, randomised, crossover single-centre physiologic trial.

SETTING

University hospital.

PATIENTS

Thirty-six patients receiving robot-assisted laparoscopic radical prostatectomy.

INTERVENTION(S)

Randomised sequence of three different PEEP strategies: standard PEEP level of 5 cmH2O (PEEP5), PEEP titration targeting a minimal driving pressure (PEEP
Δ
P
) and oesophageal pressure-guided PEEP titration (PEEPPoeso) targeting an end-expiratory transpulmonary pressure (P
TP) of 0 cmH2O.

MAIN OUTCOME MEASURES

The primary endpoint was the PEEP level when set according to PEEP
Δ
P
and PEEPPoeso compared with PEEP of 5 cmH2O. Secondary endpoints were respiratory mechanics, lung volumes, gas-exchange and haemodynamic parameters.

RESULTS

PEEP levels differed between PEEP
Δ
P
, PEEPPoeso and PEEP5 (18.0 [16.0 to 18.0] vs. 20.0 [18.0 to 24.0]vs. 5.0 [5.0 to 5.0] cmH2O; P < 0.001 each). End-expiratory P
TP and lung volume were lower in PEEP
Δ
P
compared with PEEPPoeso (P = 0.014 and P < 0.001, respectively), but driving pressure, lung stress, as well as respiratory system and dynamic elastic power were minimised using PEEP
Δ
P
(P < 0.001 each). PEEP
Δ
P
and PEEPPoeso improved gas-exchange, but PEEPPoeso resulted in lower cardiac output compared with PEEP5 and PEEP
Δ
P
.

CONCLUSION

PEEP
Δ
P
ameliorated the effects of Trendelenburg position with pneumoperitoneum during surgery on end-expiratory P
TP and lung volume, decreased driving pressure and dynamic elastic power, as well as improved gas-exchange while preserving cardiac output.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00028559, date of registration 2022/04/27). https://drks.de/search/en/trial/DRKS00028559
An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents
Authors: Pudney Ellen V. , Puhl Rebecca M. , Halgunseth Linda C. , Schwartz Marlene B.
Published: September 2023

Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.
Alpha-lipoic Acid Protects Against Chronic Alcohol Consumption-induced Cardiac Damage by the Aldehyde Dehydrogenase 2–associated PINK/Parkin Pathway
Authors: Shen Cheng , Chen Xueheng , Cao Yong , Du Yanyan , Xu Xuan , Wu Qingjing , Lin Lizhi , Qin Yiran , Meng Runqi , Gan Lijun , Zhang Jinguo
Published: September 2023

Chronic alcohol intake contributes to high mortality rates due to ethanol-induced cardiac hypertrophy and contractile dysfunction, which are accompanied by increased oxidative stress and disrupted mitophagy. Alpha-lipoic acid (α-LA), a well-known antioxidant, has been shown to protect against cardiac hypertrophy and inflammation. However, little is known about its role and mechanism in the treatment of alcoholic cardiomyopathy. Here, we evaluated the role of α-LA in alcohol-induced cardiac damage by feeding mice a 4.8% (v/v) alcohol diet with or without α-LA for 6 w. Our results suggested that chronic alcohol consumption increased mortality, blood alcohol concentrations, and serum aldehyde levels, but a-LA attenuated the elevations in mortality and aldehydes. Chronic alcohol intake also induced cardiac dysfunction, including enlarged left ventricles, reduced left ventricular ejection fraction, enhanced cardiomyocyte size, and increased serum levels of brain natriuretic peptide, lactate dehydrogenase, and creatine kinase myocardial isoenzyme. Moreover, alcohol intake led to the accumulation of collagen fiber and mitochondrial dysfunction, the effects of which were alleviated by α-LA. In addition, α-LA intake also prevented the increase in reactive oxygen species production and the decrease in mitochondrial number that were observed after alcohol consumption. Chronic alcohol exposure activated PINK1/Parkin-mediated mitophagy. These effects were diminished by α-LA intake by the activation of aldehyde dehydrogenase 2. Our data indicated that α-LA helps protect cardiac cells against the effects of chronic alcohol intake, likely by inhibiting PINK1/Parkin-related mitophagy through the activation of aldehyde dehydrogenase 2.
Use of Nile tilapia fish skin in treatment for burn victims
Authors: Ghosh Bikona , Sánchez-Velazco Diana F. , Prem Parvati , Ali Anam Sayed Mushir , Dominique Olivia , Shah Shahtaj Adil , Ojeda Luis Morales , Obeysekera Dinali
Published: September 2023

Burn injuries in the United States result in 1.1 million hospital admissions, with around 4500 deaths annually, according to the CDC. Although skin grafts have been the standard treatment since 1869, recent research suggests that tilapia skin could offer a safer and more effective alternative. This review aims to assess the strengths and knowledge gaps related to the usage of fish skin in burn patients. A systematic search was conducted on electronic databases, such as PubMed, Scopus, Web of Science, Clinicaltrials.gov, and Google Scholar, using relevant MESH keywords from 2018 to 2022. The search and analysis followed the “Preferred Reporting Items for Systematic Reviews and Meta-analysis” methodology. Data extraction utilized a template based on the Cochrane Consumers and Communication Review group’s extraction guidelines. Out of 166 studies identified, 12 relevant studies were extensively analyzed. The trials consistently demonstrated accelerated reepithelialization, improved patient compliance in managing burn-related pain, no immunologic or allergic reactions, reduced infection rates, shorter hospital stays, and decreased treatment costs when using fish skin. These findings suggest that fish skin is comparable to traditional treatments in terms of effectiveness and safety. Considering the discussed advantages, Nile tilapia fish skin emerges as a promising xenograft option for burn victims. However, further large-scale trials and studies are needed before its widespread and official implementation in burn centers. More research is required to establish the efficacy and safety of fish skin as a viable treatment modality.
The S100 calcium-binding protein A6 plays a crucial role in hepatic steatosis by mediating lipophagy
Authors: Du Qian , Zhu Tingting , Wen Guorong , Jin Hai , An Jiaxing , Xu Jingyu , Xie Rui , Zhu Jiaxing , Yang Xiaoxu , Zhang Ting , Liu Qi , Yao Shun , Yang Xingyue , Tuo Biguang , Ma Xiong
Published: September 2023

Background:

S100 calcium-binding protein A6 (S100A6) is a calcium-binding protein that is involved in a variety of cellular processes, such as proliferation, apoptosis, and the cellular response to various stress stimuli. However, its role in NAFLD and associated metabolic diseases remains uncertain.

Methods and Results:

In this study, we revealed a new function and mechanism of S100A6 in NAFLD. S100A6 expression was upregulated in human and mouse livers with hepatic steatosis, and the depletion of hepatic S100A6 remarkably inhibited lipid accumulation, insulin resistance, inflammation, and obesity in a high-fat, high-cholesterol (HFHC) diet-induced murine hepatic steatosis model. In vitro mechanistic investigations showed that the depletion of S100A6 in hepatocytes restored lipophagy, suggesting S100A6 inhibition could alleviate HFHC-induced NAFLD. Moreover, S100A6 liver-specific ablation mediated by AAV9 alleviated NAFLD in obese mice.

Conclusions:

Our study demonstrates that S100A6 functions as a positive regulator of NAFLD, targeting the S100A6-lipophagy axis may be a promising treatment option for NAFLD and associated metabolic diseases.
Teprotumumab-related Cutaneous Hypersensitivity Reactions
Authors: Dallalzadeh Liane O. , Ting Michelle , Topilow Nicole , Robbins Shira L. , Liu Catherine Y. , Burkat Cat N. , Korn Bobby S. , Kikkawa Don O.
Published: September 2023

The authors report 4 cases of cutaneous hypersensitivity reactions developing in the course of teprotumumab treatment for thyroid eye disease. The onset of the cutaneous hypersensitivity reaction was also observed during the treatment course in all cases, between the second and fifth infusions. Teprotumumab-related cutaneous reactions suggest a possible immunogenic component of the monoclonal antibody and highlight the importance of close monitoring during treatment.
Efficacy of local infiltration of tranexamic acid in subcutaneous surgery: A protocol from a single medical center
Authors: Chang Yao-Jen , Lin Yu-Hsien , Wang Pao-Lo , Lin Hwang-Chi
Published: September 2023

Background:

The purpose of this study was to explore efficacy of locally injected tranexamic acid (TXA) at a concentration of 1 mg/mL for reduction perioperative bleeding and postoperative complications in subcutaneous tumor excisions. We present the protocol and also compare results between the group of use antithrombotic group and not used.

Methods:

This is a retrospective study. Fifty-three patients were divided into 3 groups. Group 1 (n = 14): using antithrombotic drugs (antiplatelet or anticoagulants) with locally injected TXA. Group 2 (n = 17): using antithrombotic drugs without locally injected TXA. Group 3 (n = 22): not using antithrombotic drugs but with locally injected TXA. TXA was diluted to 1 mg/mL for use based on our experience. All patients were operated by 1 surgeon in 1 single medical center in Taipei from March 1st, 2020, to March 31st 2022. Outcomes such as the quality of perioperative surgical field and postoperative surgical complications were evaluated and compared. The quality of field was intraoperatively recorded by an assessment and photos from the surgeon. The statistical relationships between the complication rates were analyzed using χ2 test and a 1-way ANOVA by SPSS 25.

Results:

From Groups 1 and 3, a total of 36 patients, 29 patients had a clear surgical field during procedure. When comparing Groups 1 and 2, use of locally injected TXA had greater positive advantage in terms of a clearer vision whilst surgery (P = .031). Group 2 had more minor complications such as hematoma, severe ecchymosis, wound dehiscence, wound infection. By postoperatively reducing hematomas for 24 hours, it significantly reduce the incidence of abovementioned minor complications (P = .036). With the help of locally injected TXA, shorter time was required to remove drain, hence reducing duration of in-hospital stay.

Conclusion:

The use of locally injected TXA whilst performing subcutaneous surgery on patients taking antithrombotic drugs is cost-effective. It could reduce bleeding and provide a more effective surgical field. In our study, favorable results were obtained from the use of diluted tranexamic acid (1 mg/mL) mixed with lidocaine, namely in clearing the surgical field as well as reducing postoperative surgical complications.
Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are early predictors of bronchopulmonary dysplasia
Authors: Jiang Junsheng , Mao Yueyan , Zhou Qian , Wu Jiabo
Published: September 2023

To determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are correlated with bronchopulmonary dysplasia (BPD) on the first day of prematurity and to help with early warning, identification, and intervention in the development of BPD. From January 2017 to June 2022, newborns who were diagnosed with BPD conducted a retrospective cohort study. Complete blood cells were measured within the first 24 hours of life in preterm neonates of 32 gestational weeks with BPD as the observation group and non-BPD infants as the control group. In all groups, the NLR and PLR levels were measured. Both univariate and multivariate logistic regression analyses were used to evaluate the data. In this research 76 cases of non-BPD and 48 cases of BPD were used as controls. Compared with the non-BPD group, the NLR and PLR levels were considerably higher in the BPD group. Logistic regression analysis suggested that NLR and PLR were independent risk factors for BPD (OR [odds ratio]: 3.786; 95% CI [confidence interval]: 1.75–8.16; P < .05; OR: 3.391; 95% CI: 1.85–28.78; P < .05). The findings may demonstrate that higher NLR and PLR are independently and significantly associated with the development of BPD.
Small intestinal obstruction due to a giant gallstone: a rare case report from Syria
Authors: Suleiman Farah , Suleiman Ghazal , Shbani Abdulrahman , Hasan Ahmad , Hussein Al-janabi Moatasem
Published: September 2023

Introduction and importance:

Gallstone ileus is a rare and potentially life-threatening condition characterized by the obstruction of the small intestine due to a gallstone. It occurs as a complication of gallstone disease, where a large gallstone erodes through the gallbladder into the gastrointestinal tract, creating a fistula.

Case presentation:

A type 2 diabetic woman in her 50s presented to the emergency department complaining of abdominal pain and vomiting. She has not emptied her bowels since 3 days ago. A clinical examination showed tenderness in the abdomen associated with fecal vomiting. A computed tomography (CT) scan was performed and showed a dilated gallbladder with gas. A giant gallstone in a small intestinal loop was observed. The diagnosis was a small intestinal obstruction due to a giant gallstone and a duodenal-biliary fistula.

Clinical discussion:

Gallstone ileus is an occasional complication of cholelithiasis, occurring in less than 0.5% of patients. Gallstone ileus frequently occurs in the terminal ileum and the ileocecal valve. Regarding the clinical presentation, abdominal pain is the most common symptom, followed by vomiting and constipation. CT scan is the gold standard utilized to diagnose gallstone ileus. Surgical intervention is the mainstay treatment for giant gallstone ileus, with enterolithotomy being the most commonly performed procedure.

Conclusion:

Gallstone ileus is an uncommon but potentially life-threatening condition that can emerge in elderly patients with a history of cholelithiasis. It is crucial for clinicians to maintain a high index of suspicion when encountering older patients with risk factors for cholelithiasis and intestinal obstruction.
Unraveling recurrent urinary tract infection in adulthood: a rare case report of unilateral partial duplex collecting system with ureterocele
Authors: Katwal Shailendra , Ghimire Aastha , Shrestha Kusum , Kansakar Rochak , Amatya Suban
Published: September 2023

Introduction:

Duplication of the renal collecting system, known as the duplex collecting system, is a common congenital anomaly of the urinary tract. It can be partial or complete and affects 0.7–4% of the population, with a higher incidence in females. Ureteroceles are cystic dilations of the distal ureter and are often asymptomatic, particularly in adults.

Case presentation:

The authors present a case of a newly diagnosed partial duplex collecting system of the left kidney and left intravesical ureterocele, which was diagnosed for the first time at the age of 47 years, along with a history of symptoms suggestive of recurrent urinary tract infection and a urethral calculus which was surgically managed 5 years ago.

Clinical discussion:

The presence of a duplex collecting system can be observed even in males, with the possibility of recurrent urinary tract infection and the rare occurrence of an intravesical ureterocele. While ureteroceles are typically considered a congenital condition, they can also be diagnosed in adults.

Conclusion:

A partial duplex collecting system of the left kidney with left intravesical ureterocele in the age of 47 years in a male is a rare occurrence. Diagnosis and management of such urological cases can be challenging especially in a resource limited setting, which can be mitigated by awareness of unusual presentations, proper antenatal care, and access to proper diagnostic tools.
Adult-onset acute disseminated encephalomyelitis: a rare case report in a 26-year-old female and review of literature
Authors: Marsool Mohammed D.M. , Prajjwal Priyadarshi , Inban Pugazhendi , Marsool Ali D.M. , Tariq Halla , Hussin Omniat A.
Published: September 2023

Acute disseminated encephalomyelitis is a demyelinating autoimmune condition that mostly affects the central nervous system. We present a case of a woman who presented with paralysis and speech deficits following an episode of upper respiratory tract infection. Brain and spinal cord imaging were used to confirm the diagnosis.
Novel putative biomarkers for infective endocarditis by serum proteomic analysis: a comprehensive review of literature
Authors: Begum Afreen , Modumudi Sravani , Subramani Sachin , Khoont Dhruvi , Vanaparti Ankitha , Master Mahima , Khan Javeria , Botticelli Ana L. , Botticelli Ricardo W. , Mian Hafsa S. , Saad Muhammad , Abbas Kiran
Published: September 2023

Infective endocarditis (IE) is a challenging condition with high mortality. Prompt detection of IE has become essential for early and immediate management. The authors aimed to comprehensively review the existing literature on novel putative biomarkers for IE through serum proteomic analysis. The literature reveals high levels of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels in IE with staphylococcal etiology, valvular lesions, and when combined with cardiac troponin I (cTnI), had a more significant value for risk stratification. A higher pro-ADM level, copeptin, NT-proBNP, and the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) all impacted mortality during the hospital stay. The biomarker matrix metalloproteinase-9 was utilized to predict new-onset embolic events in patients, thus serving as a predictive marker. Procalcitonin was an important diagnostic marker in IE complicated with severe infection. Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interferon-γ, cTnI, and NT-proBNP were also discovered to be useful as prognostic indicators. Early diagnosis and appropriate treatment are possible using antiphospholipid antibodies as a diagnostic test for definite IE. It is also concluded that antineutrophilic cytoplasmic antibody positive individuals with IE had a lengthier hospital stay. These noninvasive biomarkers can identify patients at risk and provide appropriate and early clinical management. NT-proBNP, Cystatin C, troponins, IL-6, IL-8, S100A11, and AQP9 are examples of possible markers that appear promising for further research. In conclusion, large-scale validation studies should study these biomarkers further to establish their use in clinical settings.