bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of cefepime therapeutic drug monitoring in febrile neutropenia patients with hematologic malignancies
Authors: Lodl Emma F , Alshaer Mohammad H , Adams C. Brooke , Richards Ashley , Peloquin Charles , Venugopalan Veena
Published: November 2023

Introduction

Cefepime is a fourth-generation cephalosporin and is a workhorse for the empiric treatment of febrile neutropenia (FN). Beta-lactam therapeutic drug monitoring (TDM) has emerged as a dose optimization strategy in patient populations with altered kinetics. Prior literature has demonstrated that patients with FN exhibit augmented renal clearance which may lead to subtherapeutic drug concentrations with standard dosing regimens. The aim of this study was to evaluate pharmacokinetic/pharmacodynamic (PK/PD) target attainment and clinical outcomes in patients with hematologic malignancies and FN who were treated empirically with cefepime.

Methods

This was a prospective, single-center study of adults with hematologic malignancies and FN admitted to the inpatient unit. The primary outcome was PK/PD target attainment (defined as 100% free time greater than minimum inhibitory concentration (100% fT > MIC)). Secondary clinical outcomes were time to defervescence, time to ANC recovery, in-hospital mortality, and cefepime failure.

Results

There were 55 patients in our study. Forty-three (78%) patients achieved the primary outcome of PK/PD target attainment. The mean time to defervescence was similar between those that achieved PK/PD target attainment and those that did not (95% CI −0.75 to 1.25, p = 0.62).

Conclusions

This study showed that standard cefepime dosing in patients with hematologic malignancies and FN does not result in achievement of 100% fT > MIC in all patients. Patients in the group that did not achieve PK/PD target attainment were younger with increased creatinine clearance, indicating that cefepime TDM may be especially beneficial in these patients.
Unusual encephalopathy with Wernicke–Korsakoff syndrome-like features due to adjuvant nivolumab for malignant melanoma
Authors: Malik Saniya , White Wendy , Dasanu Constantin A
Published: November 2023

Introduction

Autoimmune encephalitis is a rare immune-related adverse event of PD-1 inhibitors, nivolumab and pembrolizumab. Autoimmune hypophysitis can also be seen with the use of these agents. The relationship between these two phenomena is currently unknown.

Case report

We describe a 79-year-old man with anterior scalp melanoma who received adjuvant nivolumab therapy. Sixteen weeks after the completion of nivolumab therapy, the patient presented to the hospital with altered mental status, anterograde amnesia, and symptoms of nausea and vomiting. The patient's encephalopathy was associated with confabulations. Workup identified increased CSF protein without increased cellularity, along with decreased serum cortisol and ACTH levels. This was consistent with encephalitis and central adrenal insufficiency.

Management and outcome

The patient had a robust clinical response to steroids, with resolution of mental status changes and normalization of blood pressure. He continues to receive maintenance steroid therapy without any further symptoms six months later.

Conclusions

We report herein a unique case of encephalopathy in the setting of nivolumab use for the treatment of melanoma. The condition resembled Korsakoff psychosis seen in the setting of alcoholism and was associated with central adrenal insufficiency. A prompt response to steroids was both diagnostic and therapeutic in our case, suggesting the resolution of autoimmune phenomena related to nivolumab.
Evaluating De-Escalation Training for Direct and Indirect Employees Caring for Residents With Huntington’s Disease
Authors: Rogers Brandon , St. Marie Barbara , Wesemann Daniel , Nopoulos Peg
Published: November 2023

INTRODUCTION:

Little is known about reducing the challenges for caregivers and patients with Huntington’s disease (HD). HD creates behavioral disturbances, cognitive decline, and motor disorder progression over the lifetime requiring some individuals to need long-term facility care.

AIMS:

There are concerns about safety and confidence of employees caring for residents with HD.

METHODS:

Nursing staff, administrators, and auxiliary employees were recruited from a long-term care (LTC) facility in rural Iowa, from July 2020 to August 2020. A de-escalation training intervention was delivered. The 1-day intervention included resident behaviors, planning and safety, teamwork, communication, and included role play and simulation. A pre- and post-survey measured confidence and competence in caring for people with HD before and after a training intervention. A resident medical record audit explored challenging behaviors before and after the training intervention.

RESULTS:

Of 25 participants, six were registered nurses/licensed practical nurses (RNs/LPNs; 24%), four administrators (16%), eight nursing assistants (32%), and seven auxiliary employees (28%). There was improvement in employees perceived safety (33.3%), co-workers enjoyment working with HD residents (54%), understanding symptoms of HD (44.4%), confidence in job abilities (21.0%), and confidence in ability to care for patients with HD (26.3%). A medical record audit showed decreased documentation of resident aggression and care refusal post-intervention.

CONCLUSIONS:

These findings suggest de-escalation training in LTC facilities increased perception of job safety, co-workers’ enjoyment, understanding HD symptoms, confidence in ability to care for patients with HD, and decreased resident agitation and care refusal.
Prenatal Coffin-Siris Syndrome: Expanding the Phenotypic and Genotypic Spectrum of the Disease
Authors: Keskinen Sini , Paakkola Teija , Mattila Mirjami , Hietala Marja , Koillinen Hannele , Laine Jukka , Haanpää Maria K.
Published: November 2023

Coffin-Siris syndrome is an autosomal dominant disorder with neurological, cardiovascular, and gastrointestinal symptoms. Patients with Coffin-Siris syndrome typically have variable degree of developmental delay or intellectual disability, muscular hypotonia, dysmorphic facial features, sparse scalp hair, but otherwise hirsutism and fifth digit nail or distal phalanx hypoplasia or aplasia. Coffin-Siris syndrome is caused by pathogenic variants in 12 different genes including SMARCB1 and ARID1A. Pathogenic SMARCB1 gene variants cause Coffin-Siris syndrome 3 whereas pathogenic ARID1A gene variants cause Coffin-Siris syndrome 2. Here, we present two prenatal Coffin-Siris syndrome cases with autosomal dominant pathogenic variants: SMARCB1 gene c.1066_1067del, p.(Leu356AspfsTer4) variant, and a novel ARID1A gene c.1920+3_1920+6del variant. The prenatal phenotype in Coffin-Siris syndrome has been rarely described. This article widens the phenotypic spectrum of prenatal Coffin-Siris syndrome with severely hypoplastic right ventricle with VSD and truncus arteriosus type III, persisting left superior and inferior caval vein, bilateral olfactory nerve aplasia, and hypoplastic thymus. A detailed clinical description of the patients with ultrasound, MRI, and post mortem pictures of the affected fetuses showing the wide phenotypic spectrum of the disease is presented.
Peri-firing compression in prevention of pancreatic fistula after distal pancreatectomy: A systematic review and a cohort study
Authors: Kjeseth Trond , Yaqub Sheraz , Edwin Bjørn , Kleive Dyre , Sahakyan Mushegh A.
Published: November 2023

Background/Aims:

Clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) occurs in 20%–40% of patients and remains a leading cause of morbidity and increased healthcare cost in this patient group. Recently, several studies suggested decreased risk of CR-POPF with the use of peri-firing compression (PFC) technique. The aim of this report was to conduct a systematic review to get an overview of the current knowledge on the use of PFC in DP. In addition, our experience with PFC was presented.

Methods:

The systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Also, 19 patients undergoing DP with the use of PFC at Oslo University Hospital were studied. The primary endpoint was incidence of CR-POPF.

Results:

Seven articles reporting a total of 771 patients were ultimately included in the systematic review. Only two of these were case–control studies examining outcomes in patients with and without PFC, while the rest were case series. These were heterogeneous in terms of staplers used, cartridge selection policy, and PFC technique. Both case–control studies reported significantly reduced CR- POPF incidence with PFC. Eight (21%) of our patients developed CR-POPF after DP with PFC. Only one patient developed CR-POPF among those with pancreatic transection site thickness ⩽1.5 cm.

Conclusion:

Evidence on potential benefits of PFC in DP is limited in quantity and quality. Our findings suggest that the use of PFC does not lead to reduction in the incidence of CR-POPF. Yet, there might be a benefit from PFC when dealing with a thin pancreas.
The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review
Authors: Sprang Ginny , Gusler Stephanie , Eslinger Jessica , Gottfried Ruth
Published: November 2023

This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.
Mixed Methods Evaluation of the Impact of the COVID-19 Pandemic on Immigrant Families
Authors: Tyler Sydney , Abuogi Lisa , Vannoni Valentina , Silveira Lori , Lang Sean , Smith Christiana , DeCamp Lisa Ross
Published: November 2023

Introduction: Little is known about the experiences of immigrant families with COVID-19 illness. This mixed methods study compared child and household experiences at the time of a child's COVID-19 diagnosis between immigrant and US-born parents and explored immigrant Latino perspectives on underlying causes of COVID-19 disparities between immigrant and US-born families. Methods: Study data includes surveys of parents of a child with a positive SARS-CoV2 test resulting at Children's Hospital Colorado and focus groups with Latino immigrant adults. We compared household COVID-19 experiences, use of mitigation measures, vaccine intention and sociodemographic information between survey participants stratified by nativity and completed thematic qualitative data analysis. Results: Findings from quantitative data were reinforced by qualitative data including: lower socio-economic status and higher employment in essential services increased infections and spread in immigrant families and higher risk of limited information access related to language barriers and prevalent misinformation. Survey results showed no difference in COVID-19 vaccine intention by nativity. Focus group participants reported limited access to non-English language culturally-tailored vaccine information and competing work demands decreased uptake. Conclusion: Avoiding exacerbating disparities in the face of another public health emergency requires focused investments in policies and approaches specifically directed at immigrant communities.
Activation of cyclin-dependent kinase 5 broadens action potentials in human sensory neurons
Authors: Tiwari Manindra Nath , Hall Bradford E , Ton Anh-Tuan , Ghetti Re , Terse Anita , Amin Niranjana , Chung Man-Kyo , Kulkarni Ashok B
Published: November 2023

Chronic pain is one of the most devastating and unpleasant conditions, associated with many pathological states. Tissue or nerve injuries induce extensive neurobiological plasticity in nociceptive neurons, which leads to chronic pain. Recent studies suggest that cyclin-dependent kinase 5 (CDK5) in primary afferents is a key neuronal kinase that modulates nociception through phosphorylation under pathological conditions. However, the impact of the CDK5 on nociceptor activity especially in human sensory neurons is not known. To determine the CDK5-mediated regulation of human dorsal root ganglia (hDRG) neuronal properties, we have performed the whole-cell patch clamp recordings in neurons dissociated from hDRG. CDK5 activation induced by overexpression of p35 depolarized the resting membrane potential (RMP) and reduced the rheobase currents as compared to the control neurons. CDK5 activation changed the shape of the action potential (AP) by increasing AP -rise time, -fall time, and -half width. The application of a prostaglandin E2 (PG) and bradykinin (BK) cocktail in control hDRG neurons induced the depolarization of RMP and the reduction of rheobase currents along with increased AP rise time. However, PG and BK applications failed to induce any significant changes in the p35-overexpressing group. We conclude that, in dissociated hDRGs neurons, CDK5 activation through the overexpression of p35 broadens the AP and that CDK5 may play important roles in the modulation of AP properties in human primary afferents under the condition in which CDK5 is upregulated, contributing to chronic pain.
Convergence and divergence: Depictions of indigenous peoples in secondary school history textbooks from Brazil and Norway
Authors: Lennert da Silva Ana Lucia , Wieberg Klausen Siri
Published: November 2023

This study explores and compares the ways in which indigenous peoples are depicted in current secondary school history textbooks in Brazil and Norway. This study seeks to show both convergence and divergence in narrative patterns by employing qualitative data analysis. Convergence is found, in particular, in: the mandatory inclusion of the topic of indigenous peoples in national curricula; school textbooks describe these groups as homogeneous groups and ethnic minorities that still suffer discrimination and exclusion. Regarding divergence, we highlight that: the definition of indigenous peoples is context dependent. In Brazil, textbooks are explicit regarding violence, while the Norwegian ones provide minimal descriptions of it; in Brazilian textbooks, indigenous peoples are depicted as part of the Brazilian society, both victims and agents of their destiny, while the Norwegian ones depicted them as “the other” and focused on their victimization. The article reflects on the social implications of these narrative patterns for these groups.
Are latent working memory items retrieved from long-term memory?
Authors: Mao Chao Chang , Xu Chenlingxi , Loaiza Vanessa , Rose Nathan S
Published: November 2023

Switching one’s focus of attention between to-be-remembered items in working memory (WM) is critical for cognition, but the mechanisms by which this is accomplished are unclear. A long-term memory (LTM) account suggests that switching attention away from an item, and passively retaining and reactivating such “latent” items back into the focus of attention involves episodic LTM retrieval processes, even for delays of only a few seconds. We tested this hypothesis using a two-item, double-retrocue WM task that requires participants to switch attention away from and reactivate items followed by subsequent LTM tests for reactivated items from the initial WM task (vs. continuously retained or untested control items). We compared performance on these tests between older adults (a population with LTM deficits) and young adults with either full (Experiment 1) or divided (Experiment 2) attention during the WM delay periods. The effects of reactivating latent items, as well as ageing and divided attention, had significant effects on WM performance, but did not interact with or systematically affect subsequent LTM for reactivated versus control items on item-, location-, or associative-recognition memory judgements made with either high or low confidence. Experiment 3 confirmed that these effects did not depend on whether or not young participants were warned about the subsequent LTM tests before performing the WM task. These dissociations between WM and LTM are inconsistent with the LTM account of latent WM; they are more consistent with the dynamic processing model of WM ( Current Directions in Psychological Science).
Understanding reform discourses in complex times of change: Positions and practices of early childhood professionals from Victorian kindergarten settings
Authors: Armstrong Lauren
Published: November 2023

Australian early childhood education and care [ECEC] has faced a series of change and reform since 2009, including the introduction and later revisions of key curriculum and qualify frameworks, increased qualifications, shifting theoretical knowledge and pedagogies, and challenges from the COVID-19 pandemic. Consequently, early childhood professionals [ECPs] have been confronted with a succession of substantial changes impacting their professional practice. This paper reports on a qualitative, post-structural study identifying workplace and learning discourses as key influences for the reform engagement of eleven ECPs from kindergarten settings in Victoria, Australia. Foucauldian Discourse Analysis [FDA] revealed specific subjective positions and discursive practices among participants. Recommendations are offered to address issues related to the uptake of reform initiatives. It is anticipated that these findings may generate greater opportunities to support our existing, emerging and future generations of ECPs as they lead the transformation of ECEC and transition through complex times of uncertainty.
CXX-3, a Norditerpene Lactones From Podocarpus nakaii, Inhibits Cancer Cell Viability by Suppressing the NRF2/KEAP1 Antioxidant Pathway
Authors: Yuan Jingtao , Gao Hang , Zhou Daotang , Wang Yifan , Shen Feiyan , Chen Yueru , Zhu Rui
Published: November 2023

Objective: The role of Nuclear factor E2-related factor 2 (NRF2) in cells is a double-edged sword, as it can maintain the stability of the inner environment for normal cells by resisting oxidation, but can also confer drug adaptability to cancer cells. Recent reports suggest that inhibiting NRF2 can weaken the drug resistance of cells, making it a potential target for cancer therapy. Our research on CXX-3, a norditerpenoid isolated from Podocarpus nakaii, demonstrated its ability to combat cancer cells. Methods: We observe for the first time that an active ingredient from P. nakaii induces cancer cell death accompanied by the accumulation of reactive oxygen species (ROS) and arrests the cell cycle in the S phase. The ROS inhibitor NAC(N-acetyl-l-cysteine) can partially rescue cell death. Additionally, we identified the NRF2/KEAP1 (Kelch-like ECH-associated protein 1, KEAP1) complex as the critical site conquered by CXX-3. Dysfunction of this complex ruined the antioxidation ability of glioma and colon carcinoma. Interestingly, CXX-3 seems to disable the KEAP1/NRF2 complex through a separate mechanism. Results: In conclusion, CXX-3 can disrupt the antioxidation ability of cancer cells, leading to the accumulation of ROS, thereby arresting the cell cycle, and inducing cell death. Conclusion: As such, CXX-3 holds promise as a prospective compound for cancer therapy.
The Presentation to Publication Pipeline
Authors: Carr-Chellman Davin J. , Rogers-Shaw Carol , Kroth Michael , Yelich-Biniecki Susan , Schmidt Steven
Published: November 2023

Using the metaphor of a publication “pipeline,” this article offers practical tips for early-career scholars to take their ideas from concept to publication. Too often, conference presentations do not continue to publication, limiting the potential for dissemination of research work throughout the field and impeding professional scholarly growth. Here, experienced scholars share what they have found helpful to maximize publication productivity.
Name, Image, and Likeness and the Health of the Young Athlete: A Call to Action for Sports Medicine Providers and the Athletic Healthcare Network
Authors: Hollabaugh William L. , Jeckell Aaron S. , Diamond Alex B.
Published: November 2023

Context:

In June 2021, the National Collegiate Athletic Association (NCAA) adopted a new policy allowing NCAA athletes the opportunity to benefit and profit from their name, image, and likeness (NIL). Several state high-school associations have established policies to guide their members and students through the new era of NIL. While the potential benefits cannot be ignored, NIL presents novel responsibilities and stressors to athletes. This paper will review the paucity of literature on the effect of NIL on youth athletes and bring attention to mental health, well-being, or academic performance impacted by NIL.

Evidence Acquisition:

Articles were identified through Google and PubMed search starting from NIL policy approval (June 30, 2021). Search terms included “name, image and likeness” and “NIL.”

Study Design:

Clinical commentary.

Level of Evidence:

Level 5.

Results:

Although 1 article was identified through PubMed search and numerous articles were identified through Google search, no articles directly evaluated the effects of NIL on the mental health, well-being, or academic performance of youth athletes.

Conclusion:

It is critical for sports medicine providers and other members of the athletic healthcare network to familiarize themselves with these emerging topics to best serve their patients and communities. The athletic healthcare network must be prepared to address possible NIL-related health ramifications for our patients and their families and help them navigate a confusing and predatory landscape. We must provide resources to youth athletes to minimize the risks associated with NIL involvement and related activities, and to ensure that athletes with NIL contracts are able to balance their academic and athletic responsibilities. Fostering strong relationships between stakeholders and sports medicine staff is paramount to creating an environment that permits honest discussions about NIL and the health of athletes from youth to adulthood.

Strength-of-Recommendation Taxonomy:

N/A.
Regulating driving automation in the European Union – criminal liability on the road ahead?
Authors: Gless Sabine , Ligeti Katalin
Published: November 2023

Technological developments enable modern cars to drive autonomously. The EU has embraced this phenomenon in the hope that such technology can ameliorate mobility and environmental problems and has therefore engaged in tailoring technical solutions to driving automation in Europe. But driving automation, like other uses of AI, raises novel legal issues, including in criminal law – for instance when such vehicles malfunction and cause serious harm. By only pushing for a technological standard for self-driving cars, are EU lawmakers missing necessary regulatory aspects? In this article, we argue that criminal law ought to be reflected in EU strategy and offer a proposal to fill the current gap, suggesting an approach to allocate criminal liability when humans put AI systems in the driver’s seat.
Comprehensive Diabetes Assessment Instrument for Patients With Type 2 Diabetes
Authors: Segal Jodi , DeGrazia Robert , Pitts Samantha , Brown Kristal , Taualii Maile
Published: November 2023

Aims:

There is a paucity of efficient processes for collecting information in a primary care setting to connect patients afflicted with type 2 diabetes to valuable resources. The objective of this research project was to develop a Comprehensive Diabetes Assessment (CDA) instrument which could be used to assess patients’ barriers to best outcomes.

Methods:

We reviewed published literature and online compilations for validated tools assessing threats to optimal diabetes self-management. We conducted focus groups with patients, clinicians, and service providers who provided feedback on the tools’ appropriateness and feasibility. We aggregated the favored tools and did cognitive testing with patients to assess understanding and affective response to the instrument.

Results:

Five focus groups involved varied stakeholders in Baltimore, MD and Honolulu, HI. We presented 2 tools assessing knowledge barriers, 3 tools assessing psychological barriers, 4 tools assessing literacy, and 1 numeracy. The final instrument included 6 multi-part items and takes 3 minutes to complete. Cognitive interviewing with 8 patients in Baltimore and 8 in Hawaii confirmed that the instrument is understandable, quick to complete, and is acceptable to patients.

Conclusions:

Because of the complexity of self-management of diabetes, we suggest that this CDA instrument, plus a social needs assessment, should be administered at least annually and at times of clinical deterioration. We anticipate the instrument will be proven valuable in connecting patients to services from which they will benefit.
Association Between History of Psychiatric Disorder and Degree of Physical Injury Among Suicide Attempters: Secondary Data Analysis in a Japanese Rural Area
Authors: Tanji Fumiya , Miyamoto Syohei , Iwasawa Atsushi , Ohta Hidenobu , Ono Kyoichi
Published: November 2023

Introduction:

While there may be differences in the choice of suicide methods between attempters with and those without a history of psychiatric disorders, it is not clear whether these differences predict the actual degree of physical injury. The present study aimed to investigate the association between the history of psychiatric disorder and the degree of physical injury among suicide attempters in a Japanese rural area.

Methods:

We conducted a cross-sectional study analyzing secondary data of 806 suicide attempters from April 2012 to March 2022 obtained from a Japanese rural city. The exposure variable was a history of psychiatric disorders. The primary outcome was the degree of physical injury of suicide attempters: moderate and severe. We conducted a multivariate Poisson regression analysis to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results:

Among 806 suicide attempters, a significant negative association between the history of psychiatric disorder and the degree of physical injury was observed (PR = 0.40; 95% CI, 0.28-0.59). Those with and without psychiatric disorders were more likely to choose low- and severe-lethality suicide methods such as drug or psychotropic overdoses and hanging or deep wrist injuries, respectively ( P < .001).

Conclusions:

The present study highlights the importance of considering suicide attempters, both with and without psychiatric disorders, while formulating targeted suicide prevention strategies.
Clinical Variables Specific to Timing of Tracheal Extubation Following Pediatric Cardiac Surgery
Authors: Maddali Madan Mohan , Al-Mamari Asiya Hilal , Raju Sowmiya , Sathiya Panchatcharam Murthi
Published: November 2023

Background

The primary objective of this study was to identify specific factors in pediatric cardiac surgical patients when tracheal extubation was performed on the operating table after completion of open-heart surgery (Group-1), postoperatively in the intensive care unit within 6 h (Group-II) or after 6 h (Group-III). The causes of failed extubation, the presence of chromosomal disorders in addition to arterial blood gas analysis parameters at the time of tracheal extubation, and the duration of intensive care unit stay were also evaluated in each group.

Methods

In addition to the three groups, Groups I and II were combined as a “fast-track” extubation group. The demographic data, Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, the Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Category (STAT Mortality Category), cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, and vasoactive-inotropic score (VIS) at the time of tracheal extubation along with data related to secondary objectives were recorded for each patient.

Results

A significant association was found by bivariate analysis between clinical variables and for both operating table and fast-track extubation in terms of age, weight, RACHS-1 score, STAT category, CPB and ACC time, and VIS. A multivariate-adjusted analysis showed weight, lower STAT category, CPB time, and VIS were independent predictors for operating table and fast-track extubation.

Conclusions

Younger age, lower weight, higher RACHS-1, STAT category, and VIS, along with longer CPB and ACC, are associated with delay in the timing of tracheal extubation in pediatric cardiac surgical patients.
The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study
Authors: Keorochana Gun , Tantrakansakun Chakkraphan , Suriyonplengsaeng Chinnawut , Jaipanya Pilan , Lertudomphonwanit Thamrong , Leelapattana Pittavat , Chanplakorn Pongsthorn , Kraiwattanapong Chaiwat
Published: November 2023

Study Design

Cadaveric anatomical studies.

Objective

This study aims to investigate the anatomical relationship between bony landmark “V point”, dural sac, nerve roots, and intervertebral disc for improving operative outcomes and decreasing post-operative complications in posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD).

Methods

10 soft adult cadavers were studied. We measured the distance of the V point to the lateral margin of dural sac, V point to the inferior border of intervertebral disc, and the inferior border of cervical nerve root to the inferior border of intervertebral disc. Then we calculated the mean of distance from V point to the inferior border of cervical nerve root.

Results

The mean distance from the V point to the lateral margin of dural sac from C3/4 to C7/T1 ranged from 3.1 ± 1.38 mm to 3.37 ± 1.46 mm. The mean distances from V point to the inferior border of intervertebral disc from C3/4 to C7/T1 were .19 ± 1.16 mm at C3/4, .45 ± 1.23 mm at C4/5, .43 ± 1.01 at C5/6, −.43 ± 1.86 mm at C6/7 and −1.5 ± 1.2 mm at C7/T1. The mean distance between V point and the inferior border of cervical nerve root from C3/4 to C7/T1 showed all positive value, ranging from .06 ± 1.18 mm to 4.45 ± 2.57 mm, increasing caudally.

Conclusion

In performing PECF or PECD, a 3-4 mm radius of bone removal should be enough for exposure and neural decompression at C3/4 to C5/6. At C6/7 and C7/T1 a more extensive bone cut of more than 4 mm is recommended, especially in cranial direction.
The Risk of Iatrogenic Posterior Neurovascular Injuries in Lateral Meniscal Repair Based on the Standard Arthroscopic Knee Position: A Magnetic Resonance Imaging Study
Authors: Boonsri Pattira , Wiriyanukhroh Tunlada , Parinyakhup Wachiraphan , Boonriong Tanarat , Chuaychoosakoon Chaiwat
Published: November 2023

Background:

Repair of the posterior horn of the lateral meniscus using an all-inside meniscal repair device involves the risk of iatrogenic posterior neurovascular injuries. Previous studies that have evaluated this risk were based on preoperative magnetic resonance imaging (MRI) with the knee in 30° of flexion and used landmarks that are impractical in the actual operative situation.

Purpose:

To use an MRI model simulating actual knee arthroscopic conditions to (1) compare the potential risk of injuries related to the lateral border of the posterior lateral meniscus root (LMR) through the anterolateral versus anteromedial portal and (2) establish “safe” and “danger” zones to reduce the possibility of injuries to posterior neurovascular structures when performing lateral meniscal repair in relation to the lateral border of the posterior LMR.

Study Design:

Descriptive laboratory study.

Methods:

Using 29 axial MRI scans of knees in the figure-of-4 position with joint fluid dilatation at the level of the lateral meniscus, direct lines were drawn to simulate a straight all-inside meniscal repair device deployed from the anterolateral and anteromedial portals to the lateral border of the posterior LMR, extending 14 mm beyond the joint capsule. If the line passed through or touched a posterior neurovascular structure, a risk of iatrogenic injuries was noted, and measurements were made to determine the safe zone in relation to the lateral border of the posterior LMR.

Results:

Repairing the lateral meniscus through the anterolateral portal in relation to the lateral border of the posterior LMR resulted in a significantly greater risk of posterior neurovascular injuries compared with repairing through the anteromedial portal, with injury incidences of 68.97% and 10.35%, respectively ( P = .001). The safe zones of lateral meniscal repair through the anterolateral and anteromedial portals were 4.15 ± 1.87 and 6.57 ± 0.98 mm, respectively, beyond the lateral border of the posterior LMR.

Conclusion:

The risk of posterior neurovascular injuries when repairing posterior lateral meniscal tissue was found to be significantly greater through the anterolateral portal compared with the anteromedial portal.

Clinical Relevance:

Surgeons can use the safe zones as defined in this study to decrease the risk of iatrogenic posterior neurovascular injuries during arthroscopic lateral meniscal repair.
Comparing Perceived Disruptiveness and Effectiveness of Protest Tactics
Authors: Furl Katherine , Lu Todd , Vo Austin Hoang-Nam , Caren Neal
Published: November 2023

How do U.S. voters view the disruptiveness and effectiveness of social movement tactics? Strategically-used assertive tactics can enable movement success, though tactics considered too disruptive or violent may reduce public support. The authors investigate how U.S. voters perceive the disruptiveness and effectiveness of various protest tactics. In a representative survey experiment, 497 U.S. voters ranked the disruptiveness and effectiveness of 65 tactics. The authors find that tactics’ perceived disruptiveness and effectiveness exhibit an inverse relationship and a continuous character. The findings suggest that multiple, contextual factors influence public perceptions of protests.
Global containments and local leakages: Structural violence and the toxic flows of shipbreaking
Authors: Dewan Camelia , Sibilia Elizabeth A.
Published: November 2023

This article explores how ship recycling—an essential part of the shipping economy—results in breaking up toxic vessels that leak hazardous materials into coastal communities and wetlands ecologies of South Asia. Drawing on multi-scaled and multisited ethnographic fieldwork with shipbreaking workers and local fishing communities in Chattogram, Bangladesh as well as with shipbreaking yard owners, maritime consultants, and government officials, we conceptualize toxic flows as a method to trace the lived experiences of those who are exposed to industrial pollution from shipbreaking. First, we propose that shipbreaking with its local toxic leakages constitutes a form of “structural violence” where violence is built into the logic of accumulation strategies in the maritime economy and shows up as unequal power relations that produce the conditions for unequal life chances. Second, we discuss Bangladesh’s recent efforts towards ratifying the Hong Kong Convention for the Safe and Environmentally Sound Recycling of Ships and its potential to contain these toxic flows. Lastly, we explore how ethnographically tracing ‘toxic flows’ i.e., the movement of these toxic substances, allows us to shift scales of analysis and make visible the different ways shipbreaking is perceived to negatively affect health and social reproduction beyond the boundary of shipbreaking yards. We conclude that structural violence such as reduced life expectancies due to poisonous exposure risks becoming embedded in the logic of oceanic forms of accumulation without state regulatory enforcement and supervision.
(Auto) Ethnographic notes about DIY ethos in lofi hip hop
Authors: Landarini Sidarta
Published: November 2023

This article explores the do-it-yourself (DIY) ethos within the realm of lofi hip hop, highlighting its significance in the aesthetic and modes of listening, production, and curation. This phenomenon is particularly prevalent among urban youth who are connected to the internet but face the harsh realities of work and study. Through digital ethnography, I delve into the personal narratives of individuals who actively contribute in lofi hip hop community. Initially, I examine the DIY esthetic characteristics that manifest in the sound, visuality, and textuality of lofi hip hop. Subsequently, I analyze the DIY performativity and affectivity exhibited by listeners, bedroom producers (artists), and DJs (YouTube channel owners and playlist curators). Finally, I provide a concise autoethnographic narrative to contextualize the hypothesis that the DIY culture observed in lofi hip hop is related to the recent dynamics of capitalist realism.
Genome analysis of haloalkaline isolates from the soda saline crater lake of Isabel Island; comparative genomics and potential metabolic analysis within the genus Halomonas
Authors: Hernández-Soto Luis Mario , Martínez-Abarca Francisco , Ramírez-Saad Hugo , López-Pérez Marcos , Aguirre-Garrido José Félix
Published: November 2023

Background

Isabel Island is a Mexican volcanic island primarily composed of basaltic stones. It features a maar known as Laguna Fragatas, which is classified as a meromictic thalassohaline lake. The constant deposition of guano in this maar results in increased levels of phosphorus, nitrogen, and carbon. The aim of this study was to utilize high-quality genomes from the genus Halomonas found in specialized databases as a reference for genome mining of moderately halophilic bacteria isolated from Laguna Fragatas. This research involved genomic comparisons employing phylogenetic, pangenomic, and metabolic-inference approaches.

Results

The Halomonas genus exhibited a large open pangenome, but several genes associated with salt metabolism and homeostatic regulation (ectABC and betABC), nitrogen intake through nitrate and nitrite transporters (nasA, and narGI), and phosphorus uptake (pstABCS) were shared among the Halomonas isolates.

Conclusions

The isolated bacteria demonstrate consistent adaptation to high salt concentrations, and their nitrogen and phosphorus uptake mechanisms are highly optimized. This optimization is expected in an extremophile environment characterized by minimal disturbances or abrupt seasonal variations. The primary significance of this study lies in the dearth of genomic information available for this saline and low-disturbance environment. This makes it important for ecosystem conservation and enabling an exploration of its biotechnological potential. Additionally, the study presents the first two draft genomes of H. janggokensis.
Risks and benefits of TIPS in HCC and other liver malignancies: a literature review
Authors: Fichtl Anna , Seufferlein Thomas , Zizer Eugen
Published: November 2023

Background

Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated treatment option for clinically significant portal hypertension (CSPH) in the context of liver cirrhosis. Its high efficacy and safety in the management of treatment-refractory ascites and variceal bleeding have been extensively proven. Contraindications for TIPS include severe right heart failure, hepatic encephalopathy, and sepsis. However, the role of liver malignancy in TIPS is debatable. Mostly, primary liver malignancies such as hepatocellular carcinoma (HCC) emerge from advanced liver diseases. Coexisting portal hypertension in HCC often results in limited treatment options and a poor prognosis.

Previous studies have shown that TIPS implantation in patients with HCC is technically feasible and is usually not associated with major adverse events. Furthermore, TIPS may help in bridging the time to liver transplantation in early HCC and allow for locoregional treatment in advanced HCC. However, several studies suggest that seeding tumour cells to the lungs by TIPS placement might worsen the prognosis.

Conclusions

TIPS placement in patients with coexisting liver malignancy remains a case-by-case decision, and there is no profound evidence allowing general recommendations. This review aims to provide a state-of-the-art overview of the potential risks and benefits of TIPS placement in patients with liver malignancies.
Long-term outcomes after enterostomy for very early-onset inflammatory bowel disease with interleukin-10 signaling deficiency
Authors: Tang Zifei , Sun Song , Ji Min , Shi Peng , Wang Yuhuan , Huang Zhiheng , Huang Ying
Published: November 2023

Background

Very early-onset inflammatory bowel disease (VEOIBD) with interleukin-10 (IL10R) signaling deficiency usually requires enterostomy in patients who are refractory to traditional treatment. This study aimed to evaluate long-term outcomes after enterostomy for VEOIBD patients with IL10R signaling deficiency.

Methods

The medical records of all patients undergoing enterostomy for signaling deficiency were retrospectively assessed during 2012.1–2022.7 in a tertiary teaching hospital, Children’s Hospital of Fudan University, Shanghai, China. Data on disease history, diagnosis and details of enterostomy and stoma closure and follow-up were collected. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors associated with the long-term outcome of delayed stoma closure.

Results

A total of 46 patients underwent an enterostomy, 19 who required emergency enterostomy and 27 with selective enterostomy. After ten years of follow-up, 35 patients underwent hematopoietic stem cell transplantation (HSCT), and 25 patients were alive after HSCT. The median timeframe between HSCT and stoma closure was 19.6 [15.9,26.2] months. Nineteen patients underwent stoma closure and had an average age of 3.9 ± 1.5 years; 6 patients were waiting for stoma closure. Based on a univariate logistic model, risk factors significantly associated with late stoma closure were age at enterostomy and age at HSCT. However, multivariate logistic regression showed no statistically significant factor associated with late stoma closure. There was no significant difference between the stoma closure group and delay closure group in the z scores of weight for age at follow up.

Conclusions

This study determined the long-term outcomes after enterostomy for VEOIBD with interleukin-10 signaling deficiency. The appropriate time point of enterostomy and HSCT may improve quality of life in the long term.
Behavioral model-guided nutritional counseling could improve the dietary practice and nutritional status of elders in Ethiopia: a quasi-experimental study
Authors: Seid Ahmed Muhye , Babbel Netsanet Fentahun
Published: November 2023

Background

Physiological, pathological, and socioeconomic changes occurring in older people negatively influence food intake, utilization, nutritional status, and health. These problems are deeply rooted in low socio-economic settings and could partly be addressed through systematic behavioral change approaches. Hence, this study was to evaluate the effect of behavioral model-guided nutritional counseling on the dietary intake and nutritional status of elders.

Methods

A one-armed pre- and post-test quasi-experimental design was conducted on 293 community-dwelling older adults aged above 60 years from January to May 2022. A health education tool was developed and validated using health beliefs and the theory of behavioral change. The sessions were delivered by trained nurses through home-to-home visits every week lasting 45–60 min for up to two months. Data on nutritional knowledge, dietary intake, and body weight were captured using standardized questionnaires and measurements. The primary outcome was captured using the validated mini-nutritional assessment (MNA) tool and classified accordingly. The data was analyzed using Stata software, where it is presented in tables, graphs, and summary statistics. A paired t-test and the p-value were used to identify statistically significant effects of the intervention.

Results

A total of 263 elders were involved in the experiment, and modeled nutritional counseling significantly improved the knowledge score from 7.58 (± 1.05) to 11.6 (± 1.37) (P < 0.001) at the pre- and post-intervention periods. A significant improvement has been shown in the consumption of dairy products, fruits, and animal-source foods and, importantly, in the mean dietary diversity score (p < 0.001). As a result, the burden of malnutrition was significantly lower in the post-intervention period (9.6%: 7.9–11.3) compared to baseline (12.5%: 11.4–13.8). There is a significant increase in the mini-nutrition assessment score (MD = 0.30;p = 0.007). The mean body weight and the body mass index did not change significantly after the intervention (p > 0.05).

Conclusion

Targeted behavioral model-guided nutritional counseling could help promote perception, diversify dietary consumption, and reduce the risk of undernutrition among elders. Particular attention to older people with the use of participant-centered nutritional behavioral change interventions coupled with livelihood support could help reduce undernutrition among older people.

Trial registration

Clinical Trial Registration-URL:www.clinicaltrials.gov, identifier number: NCT04746664, first released 10/02/2021.