bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of percutaneous cholecystostomy on National Health Service (NHS) service provision and subsequent clinical as well as surgical outcomes.
Authors: Chong Li Cheng , Jatania Jignesh , Wynne Kamil
Published: December 2023

Aims

To evaluate the impact of percutaneous cholecystostomy on the NHS and clinical/surgical outcomes.

Methods

Retrospective analysis of patients who underwent percutaneous cholecystostomy between 01/01/2020 to 31/12/2022. Data collected included patient demographics, procedure (indications, mean time for insertion/removal), microbiology (bile aspirate, blood culture), imaging (endoscopic retrograde cholangio-pancreatography (ERCP) / tubogram) performed, clinical outcome, number of planned/unplanned follow-ups and difficulty of cholecystectomy.

Results

The cohort included 33 patients (20 male, 13 female) with mean age of 74 years. Top indications were (1) gallbladder empyema identified on computed tomographic imaging (76%) and (2) being unfit for surgery i.e., significant comorbidities (55%) / septic (30%). Mean time of insertion and removal was 5 and 59 days, respectively. Escherichia coli (67%) was the most common microorganism from bile aspirate. Most (52%) blood cultures showed no growth. Within the initial admission, majority (82%) did not have ERCP and one-third (36%) had a tubogram. In terms of outcome, 14 (42%) subsequently had cholecystectomy, 12 (36%) were discharged, 6 (18%) died and 1 (3%) is awaiting cholecystectomy. There was a mean of 2 follow-ups before patients were discharged from service. Of those who underwent cholecystectomy, 12/14 were done electively, 12/14 were total cholecystectomy and 13/14 were laparoscopic. Mean surgical time was 116 minutes.

Conclusions

Percutaneous cholecystostomy is an effective treatment/bridging therapy for patients unsuitable for emergency cholecystectomy. It does not reduce time/difficulty of subsequent cholecystectomy. However, it does put a strain on the NHS with regards to length of stay and planned/unplanned follow-ups.
Making the decision not to proceed to Emergency Laparotomy in the acute general surgical patient - a multi-disciplinary approach?
Authors: Bakrania Shiv , Manor Kristin , Capozzi Patrizia
Published: December 2023

Aim

To establish who was involved in making the decision not to proceed to emergency laparotomy for emergency general surgery patients with acute pathology.

Methods

Retrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Identification of and further collection of data from electronic patient records for patients that did not proceed to Emergency Laparotomy despite indicative pathology.

Results

A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023.

39 (6.3%) patients had an Emergency Laparotomy.

17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology.

Of the 17 patients without laparotomy median age of 86 years (range 42 – 91 years) and 12 were female patients.

A consultant surgeon was involved in the decision making not to proceed to laparotomy 100% of all cases.

A consultant in care of the elderly was involved in the decision making for those aged >65 years in 73% of cases (11/15).

Anaesthetic specialists were involved in the decision making in only 18% (3/17) cases.

Intensivists were involved in only one patient’s case.

The patient (when appropriate) and the patients relatives were consulted in the decision making for 88% (15/17).

Conclusion

NELA has clear standards for emergency laparotomy. We believe the decision not to operate is complex and as such advocate multi-disciplinary input and inclusion of patients and relatives wishes.
Atypical Influx: Navigating Invasive Group A Streptococcus Cases in Emergency General Surgery
Authors: Saunders Jada , Gerges Farid , Shaikh Amarah Ghani , Mumuni Quadri , Mithany Reda , Sriskandarajah Kumuthan
Published: December 2023

Aim

To highlight the rising national incidence of iGAS infections, particularly during the post emergency phase of the COVID-19 pandemic, and emphasise its significance as a differential diagnosis in acutely unwell emergency surgical patients.

Methods

Data was gathered retrospectively from December 2022 - August 2023. Inclusion criteria were emergency surgical patients testing positive for GAS isolated from sterile sites, or non-sterile sites in case of septic shock.

Results

Six cases (four females, two males), with a mean age of 55 (36-67) were identified. Four had necrotizing fasciitis, one bacterial peritonitis in the presence of a ventriculo-peritoneal shunt, and one streptococcal bacteremia. All presented in septic shock, with metabolic acidosis and multiorgan impairment. The initial diagnosis was clinical in 66% of cases. iGAS was confirmed via wound, peritoneal fluid, tissue or blood culture in five patients and via genital swab in one. 50% of cases were sensitive to clindamycin and amoxicillin. Two received IV immunoglobulins. All cases were managed according to Sepsis 6 protocols, involving multidisciplinary teams. Five patients underwent immediate surgery for debridement and washout. The mortality rate was 16.6%. Three patients were transferred to tertiary centres once stabilised (1 for neurosurgical input, and 2 for plastics grafting).

Conclusion

It is crucial for frontline doctors to consider iGAS as a differential when encountering critically ill surgical patients. Simultaneous systemic resuscitation, early surgical intervention, multidisciplinary care, tailored antibiotic therapy and immunoglobulins are essential to minimise morbidity and mortality.
The importance of accuracy in consenting in Laparoscopic Appendicectomies and Cholecystectomies in Emergency General Surgery
Authors: Johnston Magnus , Fourie Amy , Damaskos D
Published: December 2023

Background

Emergency General Surgery frequently necessitates expediting the consent due to clinic pressure often reducing the time for extensive and accurate consents. New recommendations from GIRFT, RCS and ASGBI advise the best practice for laparoscopic appendicectomy and cholecystectomies documentation to ensure that clinicians are adhering to safe practice with focus on consenting and informing patients accurately.

Aim

The aim of this study is to look at the accuracy of the documentation of consent in emergency general surgery laparoscopic appendicectomies and cholecystectomies to ensure and promote best practice.

Method

A retrospective analysis of 75 patients from the emergency general surgical take requiring laparoscopic appendicectomy or cholecystectomy from 08/09/23-14/9/23 in the Royal infirmary of Edinburgh, a tertiary trauma centre. The consent forms were analysed for scribed operation, legibility, abbreviations, and risks/ complications. The patients’ notes were then analysed to find out the operation carried out and any operative or immediate post operative complications. The consents forms were then compared to the post operative notes looking at the immediate operative complications to assess their accuracy.

Conclusion

The retrospective study demonstrated that there is scope for improvement within the consenting process to ensure the accuracy of the predicted operation and subsequent risks thus to improve true informed consent. The areas which could easily be improved on as such is the legibility, use of abbreviations and complete documentation of risks/complications the use of Procedure specific consent forms (PSCF) may be beneficial in creating standardisation.
From active affordance to active inference: vertical integration of cognition in the cerebral cortex through dual subcortical control systems
Authors: Luu Phan , Tucker Don M , Friston Karl
Published: December 2023

In previous papers, we proposed that the dorsal attention system’s top-down control is regulated by the dorsal division of the limbic system, providing a feedforward or impulsive form of control generating expectancies during active inference. In contrast, we proposed that the ventral attention system is regulated by the ventral limbic division, regulating feedback constraints and error-correction for active inference within the neocortical hierarchy. Here, we propose that these forms of cognitive control reflect vertical integration of subcortical arousal control systems that evolved for specific forms of behavior control. The feedforward impetus to action is regulated by phasic arousal, mediated by lemnothalamic projections from the reticular activating system of the lower brainstem, and then elaborated by the hippocampus and dorsal limbic division. In contrast, feedback constraint—based on environmental requirements—is regulated by the tonic activation furnished by collothalamic projections from the midbrain arousal control centers, and then sustained and elaborated by the amygdala, basal ganglia, and ventral limbic division. In an evolutionary-developmental analysis, understanding these differing forms of active affordance—for arousal and motor control within the subcortical vertebrate neuraxis—may help explain the evolution of active inference regulating the cognition of expectancy and error-correction within the mammalian 6-layered neocortex.
The co-activation pattern between the DMN and other brain networks affects the cognition of older adults: evidence from naturalistic stimulation fMRI data
Authors: Sun Fengzhu , Cui Dong , Jiao Qing , Niu Jinpeng , Zhang Xiaotong , Shi Yajun , Liu Haiqin , Ouyang Zhen , Yu Guanghui , Dou Ruhai , Guo Yongxin , Dong Li , Cao Weifang
Published: December 2023

Brain function changes affect cognitive functions in older adults, yet the relationship between cognition and the dynamic changes of brain networks during naturalistic stimulation is not clear. Here, we recruited the young, middle-aged and older groups from the Cambridge Center for Aging and Neuroscience to investigate the relationship between dynamic metrics of brain networks and cognition using functional magnetic resonance imaging data during movie-watching. We found six reliable co-activation pattern (CAP) states of brain networks grouped into three pairs with opposite activation patterns in three age groups. Compared with young and middle-aged adults, older adults dwelled shorter time in CAP state 4 with deactivated default mode network (DMN) and activated salience, frontoparietal and dorsal-attention networks (DAN), and longer time in state 6 with deactivated DMN and activated DAN and visual network, suggesting altered dynamic interaction between DMN and other brain networks might contribute to cognitive decline in older adults. Meanwhile, older adults showed easier transfer from state 6 to state 3 (activated DMN and deactivated sensorimotor network), suggesting that the fragile antagonism between DMN and other cognitive networks might contribute to cognitive decline in older adults. Our findings provided novel insights into aberrant brain network dynamics associated with cognitive decline.
Dietary history of click beetles and wireworms in the genus Limonius (Coleoptera: Elateridae) revealed by molecular gut content analysis
Authors: Serrano Jacqueline M , Cook Rachel , Headrick Heather , Cooper W Rodney
Published: December 2023

Wireworms, the larval stage of pest click beetle species (Coleoptera: Elateridae), are pests of many crops in North America including root vegetables and cereals. There is cause for concern amongst growers who are facing pressure from wireworms because there are a decreasing number of effective pesticides that can be used for wireworm management. Most research on pest elaterids has focused on the wireworm stage, which is the damage causing life stage. Recently, the focus in elaterid research has shifted to the adult click beetle stage, including identification of semiochemicals and development of effective traps. However, there is still a lot to be discovered about the basic biology of click beetles, including their feeding ecology. In an effort to understand the feeding ecology of click beetles, we investigated the presence of plant DNA in the digestive tracts of Limonius californicus (Mann.), L. canus (LeConte), and L. infuscatus (Mots.) beetles collected in 3 different locations within central Washington. To examine dietary histories of beetles and wireworms, specimens were collected from natural habitats and high-throughput sequencing of the plant genes trnF and ITS was used to identify their dietary history. Results revealed that click beetles do feed on a large variety of plants, which included a large quantity of brassicaceous plants commonly found in areas surrounding wireworm infested plots. The identification of the dietary history of the click beetles allowed us to infer their landscape-scale movements thus providing a means to better understand their behavior.
Postoperative ACTH-stimulated aldosterone predicts biochemical outcome in primary aldosteronism
Authors: Bruedgam Denise , Adolf Christian , Schneider Holger , Schwarzlmueller Paul , Mueller Lisa , Handgriff Laura , Bidlingmaier Martin , Kunz Sonja , Zimmermann Petra , Deniz Sinan , Williams Tracy Ann , Beuschlein Felix , Reincke Martin , Heinrich Daniel A
Published: December 2023

Objective

Primary aldosteronism (PA) is the most common surgically curable cause of hypertension. Unilateral aldosterone-producing adenoma can be treated with adrenalectomy. Clinical and biochemical outcomes are assessed 6-12 months after adrenalectomy according to primary aldosteronism surgical outcome (PASO) consensus criteria. Earlier prediction of biochemical remission would be desirable as it could reduce cumbersome follow-up visits. We hypothesized that postoperative adrenocorticotropic hormone (ACTH) stimulated plasma aldosterone concentrations (PAC) measured shortly after adrenalectomy can predict PASO outcomes.

Design

Retrospective cohort study.

Methods

We analyzed 100 patients of the German Conn's registry who underwent adrenalectomy and postoperative ACTH stimulation tests within the first week after adrenalectomy. Six to twelve months after adrenalectomy we assessed clinical and biochemical outcomes according to PASO criteria. Serum cortisol and PAC were measured by immunoassay at baseline and 30 min after the intravenous ACTH infusion. We used receiver operating characteristics (ROC) curve analysis and matched the parameters to PASO outcomes.

Results

Eighty-one percent of patients had complete, 13% partial, and 6% absent biochemical remission. Complete clinical remission was observed in 28%. For a cut-off of 58.5 pg/mL, stimulated PAC could predict partial/absent biochemical remission with a high sensitivity (95%) and reasonable specificity (74%). Stimulated PAC's area under the curve (AUC) (0.89; confidence interval (CI) 0.82-0.96) was significantly higher than other investigated parameters.

Conclusions

Low postoperative ACTH stimulated PAC was predictive of biochemical remission. If confirmed, this approach could reduce follow-up visits to assess biochemical outcome.
Large alphabet inference
Authors: Painsky Amichai
Published: December 2023

Consider a finite sample from an unknown multinomial distribution. Inferring the underlying multinomial parameters is a basic problem in statistics and related fields. Currently known methods focus on classical regimes where the sample is large, or both the sample and the alphabet are small. In this work we study the complementary large alphabet regime, as we consider the case where the number of samples is comparable with (or even smaller than) the alphabet size. We introduce a novel inference scheme that significantly improves upon currently known methods. Our proposed scheme is robust, easy to apply and provides favourable performance guarantees.
Dietary butyrate and valerate glycerides impact diarrhea severity and immune response of weaned piglets under ETEC F4-ETEC F18 coinfection conditions
Authors: Kovanda Lauren , Park Jungjae , Park Sangwoo , Kim Kwangwook , Li Xunde , Liu Yanhong
Published: December 2023

Enterotoxigenic Escherichia coli (ETEC) causes post-weaning diarrhea in piglets, significantly impacting animal welfare and production efficiency. The two primary ETEC pathotypes associated with post-weaning diarrhea are ETEC F4 and ETEC F18. During the post-weaning period, piglets may be exposed to both ETEC F4 and ETEC F18. However, the effects of coinfection by both strains have not been studied. Short chain fatty acid feed additives, such as butyrate and valerate, are being investigated for their potential to improve animal performance and disease resistance. Therefore, this pilot experiment aimed to test the effects of butyrate glycerides or valerate glycerides on growth performance, diarrhea incidence, and immune responses of piglets under ETEC F4-ETEC F18 coinfection conditions. Twenty piglets were individually housed and assigned to one of the three dietary treatments immediately at weaning (21 to 24 d of age). The dietary treatments included control (basal diet formulation), control supplemented with 0.1% butyrate glycerides or 0.1% valerate glycerides. After a 7-d adaptation, all pigs were inoculated with ETEC F4 and ETEC F18 (0.5 × 109 CFU/1.5 mL dose for each strain) on three consecutive days. Pigs and feeders were weighed throughout the trial to measure growth performance. Fecal cultures were monitored for hemolytic coliforms, and blood samples were collected for whole blood and serum analysis. Pigs fed valerate glycerides tended (P = 0.095) to have higher final body weight compared with control. The overall severity of diarrhea was significantly (P < 0.05) lower in both treatment groups than control. Pigs fed valerate glycerides tended (P = 0.061) to have lower neutrophils and had significantly (P < 0.05) lower serum TNF-α on day 4 post-inoculation. This pilot experiment established an appropriate experimental dose for an ETEC F4-ETEC F18 coinfection disease model in weaned piglets. Results also suggest that butyrate glycerides and valerate glycerides alleviated diarrhea and regulated immune responses in piglets coinfected with ETEC F4 and ETEC F18.
The Energy Charter Treaty at a critical juncture: of knowns, unknowns, and lasting significance
Authors: Daszko Agata
Published: December 2023

This article envisions the future of international investment law and arbitration amidst the need to accelerate the shift towards renewable energy. Recognizing the risks of predicting the unknown, the article charts the delicate balance between forecasting a future legal framework and respecting past complexities. Focusing on the Energy Charter Treaty (ECT), the article analyses ‘known-knowns’ rooted in positive law and ‘known-unknowns’ in the ECT’s future. The article examines the ECT’s design and scope in the first part, showing its pivotal role in organizing the renewable energy market through fair and equitable treatment and expropriation provisions. Against this backdrop, the article explores potential continuation, modernization, or abandonment scenarios and argues for a nuanced and anticipatory approach to the Treaty’s evolving dynamics. It underscores the variety of pending cases, the potential resurgence of State contracts, and the shift to contract-based arbitration influenced by ECT decisions. Given the impasse over the ECT’s modernization and the paradoxical nature of the ongoing energy transition, the ECT will continue to shape international investment law and international energy governance for the foreseeable future.
Association of hearing loss with patient-reported functional outcomes in adult survivors of childhood cancer
Authors: Bass Johnnie K , Wang Fang , Thaxton Mackenzie E , Warren Sarah E , Srivastava Deo Kumar , Hudson Melissa M , Ness Kirsten K , Brinkman Tara M
Published: December 2023

Background

Hearing loss is prevalent following ototoxic therapy for childhood cancer. Associations between hearing loss, self-perceived hearing handicap, and functional outcomes have not been examined in survivors.

Methods

Adult survivors treated with platinum or head and neck radiotherapy with hearing loss were recruited. A total of 237 survivors (median age at survey = 37.0 years [range = 30.0-45.0 years]; median = 29.1 years [range = 22.4-35.0 years] since diagnosis; median = 4.0 years [range = 2.9-7.7 years] from last audiogram to survey) completed the Hearing Handicap Inventory for Adults and questionnaires on social and emotional functioning and hearing aid use. Hearing loss severity was defined according to Chang criteria. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between hearing loss, hearing handicap, functional outcomes, and hearing aid use with adjustment for sex, race, age at hearing loss diagnosis, and age at survey.

Results

Two-thirds of survivors had severe hearing loss, which was associated with increased likelihood of hearing handicap (mild-moderate handicap: OR = 2.72, 95% CI = 1.35 to 5.47; severe handicap: OR = 5.99, 95% CI = 2.72 to 13.18). Survivors with severe hearing handicap had an increased likelihood of social isolation (OR = 8.76, 95% CI = 3.62 to 21.20), depression (OR = 9.11, 95% CI = 3.46 to 24.02), anxiety (OR = 17.57, 95% CI = 3.77 to 81.84), reduced personal income (OR = 2.82, 95% CI = 1.46 to 5.43), and less than full-time employment (OR = 2.47, 95% CI = 1.30 to 4.70). Survivors who did not use a recommended hearing aid were twice as likely to have less than full-time employment (OR = 2.26, 95% CI = 1.10 to 4.61) and reduced personal income (OR = 2.24, 95% CI = 1.08 to 4.63) compared with survivors who wore a hearing aid.

Conclusion

Self-perceived hearing handicap beyond measured hearing loss is associated with reduced functional outcomes. Assessment of hearing handicap may facilitate targeted interventions in adult survivors with hearing loss.
Randomized trial of dyadic-report vs proxy-report and self-report symptom assessment for pediatric patients receiving cancer treatments
Authors: Tomlinson Deborah , Tardif-Theriault Cassandra , Schechter Tal , Dupuis L Lee , Sung Lillian
Published: December 2023

Background

We validated different approaches to symptom assessment for pediatric cancer patients based on the Symptom Screening in Pediatrics Tool (SSPedi) for self-report (SSPedi and mini-SSPedi), proxy-report (proxy-SSPedi), and structured dyadic-report (co-SSPedi). The objective was to compare co-SSPedi scores vs proxy-report (proxy-SSPedi) and self-report (SSPedi or mini-SSPedi) scores for pediatric patients receiving cancer treatments.

Methods

This was a single-center, randomized crossover study enrolling English-speaking dyads of pediatric patients with cancer or hematopoietic cell transplant recipients 4-18 years old and their guardians. Dyads were randomized to first complete the dyadic-report (co-SSPedi) or self-report (patients: SSPedi or mini-SSPedi) and proxy-report (guardians: proxy-SSPedi). Dyads then crossed over to the alternate approach. Primary analysis compared total SSPedi scores between randomized groups.

Results

We enrolled 420 dyads that were randomized to co-SSPedi first (n = 213) or proxy-SSPedi and self-report SSPedi first (n = 207). Mean total SSPedi scores (± standard deviation) were co-SSPedi (9.6 ± 7.1), proxy-SSPedi (9.7 ± 7.5; P = .950 for comparison vs co-SSPedi), and self-report SSPedi (9.7 ± 8.2; P = .981 for comparison vs co-SSPedi). Co-SSPedi scores were significantly different from proxy-SSPedi for feeling disappointed or sad, feeling cranky or angry, feeling tired, mouth sores, and changes in taste. Co-SSPedi scores were significantly different from self-report SSPedi scores for problems with thinking or remembering things, feeling tired, mouth sores, tingly or numb hands or feet, and diarrhea.

Conclusions

Total co-SSPedi scores were not significantly different compared with proxy-report or self-report scores, although there were differences in specific symptom scores. If different reporter types are used during clinical implementation, specifying reporter type will be important. The study was registered at clinicaltrials.gov (NCT #05012917). Symptoms are common and frequently severely bothersome in pediatric patients with cancer and hematopoietic cell transplant (HCT) recipients (1). To measure the extent of bothersome symptoms, the Symptom Screening in Pediatrics Tool (SSPedi) suite of symptom assessment tools was developed for pediatric patients receiving cancer treatments and currently consists of multiple validated instruments. SSPedi was developed for self-report by patients 8-18 years of age (2,3). Mini-SSPedi was developed for self-report by patients 4 to 7 years of age (4). Proxy-SSPedi was developed for proxy-report by guardians of pediatric patients 2-18 years of age (5). These 3 instruments can be categorized as either self-report (SSPedi or mini-SSPedi) or proxy-report (proxy-SSPedi).
Hamilton’s cumular conception of quantifying particles: an exercise in third-order logic
Authors: Makinson David
Published: December 2023

Sir William Hamilton is remembered for his proposal to extend the four traditional categoricals to eight by quantifying predicate as well as subject terms. He intended the quantifying particles to be understood in a ‘collective’ or ‘cumular’ manner rather than in a ‘distributive’ or ‘exemplar’ one, but commentators from De Morgan onwards have worked primarily from the latter perspective, comforted in the 20th century by the fact that it translates readily into the language of first-order logic with identity. Formal representation of the cumular approach needs more sophisticated resources, and the paper shows how it may be carried out using selection functions in the language of third-order logic. It also reviews a number of variants, some equivalent and others not so, as well as their reductions to second-order logic, and situates historical sources, both before and after Hamilton, with respect to the web of formal constructions.
Dynamic action of an intrinsically disordered protein in DNA compaction that induces mycobacterial dormancy
Authors: Nishiyama Akihito , Shimizu Masahiro , Narita Tomoyuki , Kodera Noriyuki , Ozeki Yuriko , Yokoyama Akira , Mayanagi Kouta , Yamaguchi Takehiro , Hakamata Mariko , Shaban Amina Kaboso , Tateishi Yoshitaka , Ito Kosuke , Matsumoto Sohkichi
Published: December 2023

Mycobacteria are the major human pathogens with the capacity to become dormant persisters. Mycobacterial DNA-binding protein 1 (MDP1), an abundant histone-like protein in dormant mycobacteria, induces dormancy phenotypes, e.g. chromosome compaction and growth suppression. For these functions, the polycationic intrinsically disordered region (IDR) is essential. However, the disordered property of IDR stands in the way of clarifying the molecular mechanism. Here we clarified the molecular and structural mechanism of DNA compaction by MDP1. Using high-speed atomic force microscopy, we observed that monomeric MDP1 bundles two adjacent DNA duplexes side-by-side via IDR. Combined with coarse-grained molecular dynamics simulation, we revealed the novel dynamic DNA cross-linking model of MDP1 in which a stretched IDR cross-links two DNA duplexes like double-sided tape. IDR is able to hijack HU function, resulting in the induction of strong mycobacterial growth arrest. This IDR-mediated reversible DNA cross-linking is a reasonable model for MDP1 suppression of the genomic function in the resuscitable non-replicating dormant mycobacteria.
Enzymic recognition of amino acids drove the evolution of primordial genetic codes
Authors: Douglas Jordan , Bouckaert Remco , Carter Charles W , Wills Peter R
Published: December 2023

How genetic information gained its exquisite control over chemical processes needed to build living cells remains an enigma. Today, the aminoacyl-tRNA synthetases (AARS) execute the genetic codes in all living systems. But how did the AARS that emerged over three billion years ago as low-specificity, protozymic forms then spawn the full range of highly-specific enzymes that distinguish between 22 diverse amino acids? A phylogenetic reconstruction of extant AARS genes, enhanced by analysing modular acquisitions, reveals six AARS with distinct bacterial, archaeal, eukaryotic, or organellar clades, resulting in a total of 36 families of AARS catalytic domains. Small structural modules that differentiate one AARS family from another played pivotal roles in discriminating between amino acid side chains, thereby expanding the genetic code and refining its precision. The resulting model shows a tendency for less elaborate enzymes, with simpler catalytic domains, to activate amino acids that were not synthesised until later in the evolution of the code. The most probable evolutionary route for an emergent amino acid type to establish a place in the code was by recruiting older, less specific AARS, rather than adapting contemporary lineages. This process, retrofunctionalisation, differs from previously described mechanisms through which amino acids would enter the code.
Complications, Treatment, and Outcomes of Self-Injecting Substances Into the Face: A Systematic Review
Authors: Tripathi Nitika V. , Hakimi Amir A. , Parsa Keon M. , Bartholomew Isabella Y. , Reilly Michael J. , Chu Eugenia
Published: December 2023

BACKGROUND

The increased demand for minimally invasive facial cosmetic procedures in tandem with the ease of acquiring injectable cosmetics through direct-to-consumer retailers has led to a rise in self-injecting cosmetics among untrained individuals.

OBJECTIVE

To analyze complications, treatments, and outcomes associated with self-injecting fillers into the face.

METHODS

A systematic review of the literature from PubMed and Embase databases was performed from inception to September 10, 2022, to identify studies pertaining to self-injection of facial fillers.

RESULTS

A total of 15 articles describing 38 complications among 18 patients were included in the data collection. The most commonly injected substance was hyaluronic acid (76.4%). The lips were the most common site of injection (33%). The most reported complication was edema (61%). Severe complications included acute vascular compromise (11%) and acute hearing loss (5%). The most common intervention was use of hyaluronidase and/or antibiotics (87.5%). Patients generally healed after treatment although residual localized hyperpigmentation was noted among 11% of patients.

CONCLUSION

Injecting commercially available substances into the face is associated with potentially irreversible aesthetic, infectious, and vascular complications, especially in the hands of untrained consumers. Patients and providers should be aware of this dangerous trend.
Topical Treatment of Cutaneous Squamous Cell Carcinoma in Situ and the Impact of Clinical Risk Factors and Positive Histologic Margins at the Time of Diagnosis
Authors: Calley Brandon J. , Fazio Justin , Banerjee Anjishnu , Clark Melanie A.
Published: December 2023

BACKGROUND

Limited data exist for the efficacy of topical 5-fluorouracil (5-FU) and imiquimod for cutaneous squamous cell carcinoma (cSCC) in situ (cSCCis) with positive histologic margins at the time of diagnosis.

OBJECTIVE

Identify the efficacy of topical 5-FU and imiquimod in the treatment of cSCCis with positive histologic margins at the time of diagnosis in relation to clinical risk factors.

MATERIALS AND METHODS

Pathology records were screened at a single institution from 2014 to 2021 for cSCCis with positive histologic margins. Patients were included if they were treated with curative intent with topical 5-FU or imiquimod. Recurrences were evaluated in relation to multiple clinical risk factors.

RESULTS

Of 215 patients treated with 5-FU or imiquimod after biopsy-proven cSCCis, 19 patients had recurrent cSCCis and 1 patient had upstaging to invasive cSCC. Recurrence was more likely in larger lesions at the time of initial biopsy (p = .033) and in patients treated with topical imiquimod compared with topical 5-FU (p < .01).

CONCLUSION

Topical 5-FU is an appropriate therapy for cSCCis in the correct clinical scenario. Extra consideration should be taken for use of 5-FU in larger diameter cSCCis lesions. Although limited by sample size, our study does not support the use of imiquimod for cSCCis.
Massive neoplastic ascites
Authors: Guadagni Stefano
Published: December 2023

Peritoneal metastases frequently occur in primary or recurrent abdominal malignancy and are often associated with massive ascites, which determines severe abdominal bloating, respiratory distress, and poor quality of life in patients with few months of life. After the failure of traditional medical therapies, simple drainage is effective in providing temporary symptom relief but does not provide a durable solution. Several treatment options are available, but no standard treatment strategy has been established, and none of the treatments consistently showed the ability to extend life expectancy. This review focuses on outcomes and adverse events of simple drainage, catheter placement, intraperitoneal therapy, peritoneovenous shunting, hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy, pressurized intraperitoneal aerosol chemotherapy, and cell-free and concentrated ascites reinfusion therapy. The choice between the available options for durable symptom management requires both care and caution in weighing risks and benefits according to the patient’s life expectancy.
Photorefractive keratectomy in flat, normal, and steep corneas
Authors: Levinger Eliya , Arnon Roee , Pikkel Joseph , Yahalomi Tal , Sela Tzahi , Munzer Gur , Mimouni Michael
Published: December 2023

Purpose:

To compare photorefractive keratectomy (PRK) outcomes in patients with different corneal steepness.

Setting:

Care-Vision Laser Center, Tel-Aviv, Israel.

Design:

Retrospective comparative chart review.

Methods:

Patients included in this study underwent wavefront optimized myopic PRK between January 2013 and December 2019. Patients were divided into 3 groups based on the steepness of the cornea (steep keratometry) (flat: <42 diopters [D], normal: 42 to 46 D and steep: >46 D). One to one matching was performed to verify that baseline parameters (age, preoperative visual acuity and refractive error) were similar between groups. Primary outcome measures were: postoperative corrected/uncorrected distance visual acuity (CDVA/UDVA), efficacy index (postoperative UDVA/preoperative CDVA), safety index (postoperative CDVA/preoperative CDVA), spherical equivalence (SEQ) and cylinder.

Results:

After matching, 650 eyes were included in each group, which were similar in baseline parameters. There were no significant postoperative differences between flat, normal, and steep corneas in terms of safety index (1.02 vs 1.03 vs 1.03, P = .28), efficacy index (1.01 vs 1.01 vs 1.02, P = .57), logMAR CDVA (0.01 vs 0.02 vs 0.01, P = .76), logMAR UDVA (0.02 vs 0.03 vs 0.02, P = .68), %SEQ within 0.50 D (73.9% vs 74.2% vs 74.6%, P = .95) or 1.00 D of target (91.9% vs 92.5% vs 92.2%, P = .92), %cylinder within 0.50 D (82.8% vs 82.2% vs 81.4%, P = .81) or 1.00 D of target (96.9% vs 97.1% vs 97.2%, P = .95).

Conclusions:

No significant differences were found between flat, normal and steep corneas following wavefront-optimized myopic PRK. Thus, this procedure may be safely and effectively performed in both flat and steep corneas.
Diagnostic challenges and updated therapeutic strategies of Kimura’s disease: A case report successfully treated by dupilumab and review
Authors: Cordeil Stephanie , Hermine Olivier , Hot Arnaud
Published: December 2023

Rationale:

Kimura's disease (KD) is a rare and chronic eosinophilic related-disease, characterized by subcutaneous tissue masses, regional enlarged lymph nodes, hypereosinophilia and elevated serum IgE. KD usually affects young adults in the Asian population. In Western countries, the clinical and biological presentation of KD is often unknown, delaying the diagnosis. Therapeutic management is not standardized and despite recent advances, remission from KD can be difficult to achieve, especially in relapse situations.

Patient concerns:

We report the case of an non-Asian man with KD, initially misdiagnosed as lymphoma. We focus on his long-lasting clinical course with 20 years of recurrence despite several therapeutic lines.

Diagnoses and interventions:

We have emphasized the key points of the KD diagnostic challenge. We chose to focus on hemopathies as diagnostic traps to illustrate several overlapping features that blur frontiers with KD. With regard to treatments, lessons can be learned from the use of the therapeutic backbone, which relies on excision surgery, radiotherapy and corticosteroids.

Outcomes:

Advancements in KD pathogenesis have highlighted the pivotal role of Th2 lymphocytes driving eosinophil activation. Directly inspired by eosinophilic and allergic field practices, targeted therapies, such as dupilumab, provide hope for potential curative options.

Lessons:

Finally, we propose a therapeutic plan to treat newly diagnosed KD and discuss options for relapsing entities.
Bibliometric analysis of global endometriosis research, 2002 to 2021: A review
Authors: Deng Siyao , Yang Dongxia , Li Qiyao , Dai Haoran , Tang Weikang , Lu Lihuang , Liu Jing , Wu Xiuhong
Published: December 2023

Endometriosis is a common disease of reproductive-age women and an important cause of dysmenorrhea and infertility. Information on endometriosis is complex and there is a lack of summarization of available results. The study aims to evaluate the overall distribution of publications related to endometriosis to provide a foundation for further research. The Web of Science Core Collection was searched for articles published in the field of endometriosis. Our survey revealed the structure, hotspots, and development trends of endometriosis-related research and publications.
A giant head and neck hemangioma of the fetus: A case report
Authors: Wang Xueying , Zhang Hongwei , Zhang Maochun , Guo Yuanyuan
Published: December 2023

Rationale:

Hemangioma is a common benign disease in clinical practice, but it is rare to find a giant hemangioma in the fetal period.

Patient concerns:

Here, we report a case of a giant hemangioma of the fetal head and neck measuring approximately 10.1 × 6.5 cm.

Diagnoses:

At first, only ultrasonography was used to diagnose the suspected hemangioma. The pregnant woman refused to undergo further testing and requested induction of labor, after which the tumor was finally sent for pathological examination to confirm hemangioma.

Interventions and outcomes:

Additionally, the fetus developed severe edema (fluid accumulation in the thoracic, abdominal, and pericardial cavities), which can be fatal to the fetus. Finally, the mother refused to continue the pregnancy and underwent induction of labor with rivanol.

Lessons:

Most hemangiomas are small and asymptomatic. Giant hemangiomas are rare and associated with a variety of maternal and fetal complications. Therefore, this article aims to summarize the knowledge related to hemangioma through this case, strengthen doctors’ understanding of this disease, and bring the attention of pregnant women to this disease to ensure early diagnosis and treatment and prevent a poor prognosis.
Characterization of lncRNA-associated ceRNA network to uncover novel potential biomarkers in coronary artery disease
Authors: Yang Ning , Song Yanqiu , Li Yang , Dong Bo , Yang Jingyu , Guo Zhigang
Published: December 2023

The purpose of this study was to construct a competitive endogenous RNA (ceRNA) network related to long non-coding RNA (lncRNAs) via the bioinformatics analysis, reveal the pathogenesis of coronary heart disease (CAD) and develop new biomarkers for CAD. The gene expression datasets of peripheral blood of CAD were downloaded from the Gene Expression Omnibus (GEO) database. The differentially expressed mRNAs, miRNAs and lncRNAs (DEmRNAs, DEmiRNAs and DElncRNAs) were identified. Subsequently, a ceRNA network involving lncRNAs, miRNAs, and mRNAs was built. Moreover, DElncRNAs in the cytoplasm were screened and a DElncRNA-associated ceRNA network was established. In total, 1860 DEmRNAs, 393 DElncRNAs and 20 DEmiRNAs were filtrated in patients with CAD compared with normal controls. Functional analysis suggested that DEmRNAs significantly enriched in CAD-related pathways, such as PI3K-Akt signaling pathways and MAPK signaling pathway. The ceRNA network contained 12 DEmiRNAs, 30 DElncRNAs and 537 DEmRNAs. Afterwards, the cytoplasm ceRNA network was consisted of 537 DEmRNAs, 12 DEmiRNAs and 12 DElncRNAs. Such as, up-regulated LncRNA-HOX transcript antisense RNA (HOTAIR) was interacted with down-regulated has-miR-326 and has-miR-1. The successful construction of lncRNA-associated ceRNA network is helpful to better clarify the pathogenesis of CAD and provide potential peripheral blood biomarkers for CAD.
Coronavirus disease pandemic impact on emergency department visits for cardiovascular disease in Korea: A review
Authors: Cho Yeonjoo , Yeo In Hwan , Lee Dong Eun , Kim Jong Kun
Published: December 2023

The coronavirus disease (COVID-19) pandemic has affected patient visits to the hospital, including visits to the emergency department (ED). This study aimed to analyze the impact of the COVID-19 pandemic on the patterns of ED visits and treatment in hospitals for diseases requiring urgent diagnosis and treatment. We analyzed entries from the South Korea National Emergency Department Information System claims database between January 1, 2018 and December 31, 2020. We analyzed data of patients who visited the ED with acute myocardial infarction (AMI), acute ischemic stroke (AIS), and acute hemorrhagic stroke (AHS). We found that the COVID-19 pandemic had impacted ED utilization and fatality in patients with AMI, AIS, and AHS.
Effect of probiotic supplementation on cognition and depressive symptoms in patients with depression: A systematic review and meta-analysis
Authors: He Jiang , Chang Lemei , Zhang Lange , Wu Wenkai , Zhuo Dongyan
Published: December 2023

Background:

Depression affects millions globally and often coexists with cognitive deficits. This study explored the potential of probiotics in enhancing cognition and ameliorating depressive symptoms in major depressive disorder patients.

Methods:

Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and the Population, Intervention, Comparator, Outcome, and Study design framework, we systematically reviewed randomized controlled trials examining probiotic effects on cognition and depressive symptoms. Searches spanned 7 databases from January 2010 to May 2022. Risk of bias was assessed using Revised Cochrane Risk of Bias 2.0, and meta-analysis was conducted with RevMan 5.4.1. Publication bias was evaluated via Egger test.

Results:

In a systematic review on the effects of probiotic supplementation on cognition and depressive symptoms in depression patients, 635 records were initially identified, with 4 studies ultimately included. These randomized controlled trials were conducted across diverse regions, primarily involving females, with assessment periods ranging from 1 to 2 months. Concerning cognitive outcomes, a statistically significant moderate improvement was found with probiotic supplementation, based on the mean difference and its 95% confidence interval. However, for depressive symptoms, the overall effect was negligible and not statistically significant. A heterogeneity test indicated consistent findings across studies for both cognitive and depressive outcomes (I² = 0% for both). The potential for publication bias was evaluated using the Egger linear regression test, suggesting no significant bias, though caution is advised due to the limited number of studies.

Conclusion:

Probiotics may enhance cognitive domains and mitigate depressive symptoms, emphasizing the gut-brain axis role. However, methodological variations and brief intervention durations call for more standardized, extensive research.
Prolonged misdiagnosis of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome: A case report
Authors: Wang Yun , Zhang Weimin , Jiang Xuandong
Published: December 2023

Rationale:

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a subset of rare mitochondrial diseases characterized by diverse clinical manifestations, which often complicates its diagnosis.

Patient concerns:

This report chronicles the experiences of a 14-year-old female patient who underwent multiple misdiagnoses before the eventual identification of MELAS syndrome. Her journey began with symptoms that included growth retardation, hypertrophic cardiomyopathy, and epilepsy.

Diagnosis:

The definitive diagnosis of MELAS syndrome was established through genetic confirmation, revealing a mutation in the MT-TL1 gene (m.3242A > G).

Interventions:

Upon diagnosis, the patient received targeted symptomatic treatment, which led to pronounced improvements in her symptoms.

Outcomes:

The patient’s condition stabilized with the administered treatments, and she exhibited significant symptom relief, emphasizing the importance of accurate diagnosis and timely intervention.

Lessons:

This case underscores the imperative for heightened clinical vigilance and thorough differential diagnosis in the face of complex clinical presentations, such as those seen in MELAS syndrome, to ensure timely and appropriate interventions.
Degenerative lumbar changes have a statistically significant but small effect on trabecular bone score (TBS)-adjusted fracture risk (FRAX)
Authors: Juweid Malik E. , Alselaibi Dana , Abandeh Hiba , Al-Ibraheem Akram , Al-Qasem Soud , Albtoush Omar , Al-Hawajreh Laith , Doudeen Rahma , Abujbara Mousa , Hyassat Dana , Khawaja Nahla , Hadadin Hiba , Hijazein Yazan , Alduraidi Hamza , Ajlouni Kamel
Published: December 2023

Trabecular bone score (TBS) assesses trabecular microarchitecture at the lumbar spine and was shown to improve fracture risk prediction compared to bone mineral density (BMD) alone. We investigated whether lumbar degenerative changes (DC) affect TBS and TBS-adjusted 10-year fracture risk assessment (tool) (FRAX) estimates. All patients who underwent BMD and TBS measurements via dual-energy X-ray absorptiometry at our institution between 1/7/2020 and 1/10/2020 were retrospectively evaluated. We identified all patients who had DC in 1 or 2 vertebrae (out of L1–L4) with a BMD T score > 1 unit higher than the remaining 2 to 3 adjacent vertebrae. TBS and BMD were compared between the vertebrae with and without DC. Change in TBS as well as FRAX estimates for major osteoporotic (MOP) and hip fractures after exclusion of the degenerative vertebrae were also determined. Of the 356 eligible patients, 94 met the inclusion criteria. The mean TBS of vertebrae without DC was not significantly different from that of L1 to L4 (1.31 ± 0.12 vs 1.32 ± 0.12, respectively, P = .11). The FRAX estimates after exclusion of the degenerative vertebrae were statistically significantly higher than for L1 to L4 for both MOP and hip fractures (P = .04 and P = .01, respectively). However, the differences were very small. The mean 10-year MOP FRAX estimate after exclusion of degenerative vertebrae was 7.67% ± 4.50% versus 7.55% ± 4.36% for L1 to L4 and the mean 10-year hip FRAX estimate after exclusion of degenerative vertebrae was 2.06% ± 2.01% versus 2.02% ± 1.98% for L1 to L4. Lumbar DC have a statistically significant but only small effect on TBS-adjusted FRAX making it unnecessary to exclude the degenerative vertebrae when computing TBS.