bluuebunny/crossref_metadata_2025 huggingface dataset:
BN SO52 - Innovative Tools for Laparoscopic Bile Duct Exploration (LCBDE) in Torbay Hospital
Authors: Manasseh Mina , Bowling Kirk
Published: November 2024

Background

Laparoscopic bile duct exploration (LCBDE) is a minimally invasive technique used to manage common bile duct (CBD) stones. The procedure has evolved significantly with the development of specialized tools that enhance efficacy and patient outcomes. This abstract aims to discuss the various tools employed for LCBDE at Torbay Hospital, highlighting their specific uses, benefits, and outcomes.

Method

We conducted a retrospective analysis of LCBDE procedures performed at Torbay Hospital. The tools used included the Pusen ‘Skinny scope’, Ambscope, Nathenson tipless basket, GB stone retrieval basket, and Rotacrusher. Data were collected on the types of tools used, procedural success rates, stone clearance rates, and any complications

Results

The Pusen ‘Skinny scope’ (3mm) was used in 60% of cases for transcystic exploration, showing high success in stone visualization and retrieval. The Ambscope (5mm) was used in 30% of cases for choledochotomy, effectively accessing larger stones. The Nathenson tipless basket retrieved up to 8mm stones in 45% of cases. The GB stone retrieval basket extracted non-disposable stones up to 2cm. The Rotacnsher, used for large stones in choledochotomy, was highly effective but needed larger port access. Laser and mechanical lithotripters fragmented stones larger than 1cm with an 85% success rate. Overall stone clearance was 90% with minimal complications.

Conclusion

The use of specialized tools in LCBDE at Torbay Hospital has significantly improved the management of CBD stones. The Pusen ‘Skinny scope’ and Ambscope provide excellent visualization and access, while the Nathenson tipless basket and GB stone retrieval basket offer reliable stone extraction capabilities. Advanced lithotripters further enhance the ability to manage larger stones. These tools collectively contribute to high success rates and favorable patient outcomes, reinforcing the value of LCBDE in modern surgical practice.
BN SO54 - Complex Management of a Gastrocutaneous Fistula Following Pancreatic Necrosectomy: A Case Report
Authors: Dionísio Daniela Venâncio , Fonseca Cláudia , Bicho Luís , Pupo Alexandra , Marques Hugo Pinto
Published: November 2024

Background

Gastrocutaneous fistulas are rare but serious complications that can arise following the surgical treatment of necrotizing pancreatitis. This post-operatory complication can be refractory to conservative management and may be further aggravated by severe skin injuries and malnutrition. This case report describes the comprehensive and multidisciplinary approach of a challenging case of gastrocutaneous fistula, ultimately requiring re-intervention.

Method

A 78-year-old female with a history of severe necrotizing pancreatitis underwent pancreatic necrosectomy by laparotomy. Postoperatively, she developed a gastric fistula, initially repaired with a double-layered suture. Recurrence led to a gastrocutaneous fistula with continuous gastric drainage and chemical burn of the surrounding skin. Initial conservative management included insertion of a nasogastric tube for gastric decompression, followed by placement of a PEG tube to redirect the drainage and prevent further skin damage and an esophagojejunal feeding tube to bypass the fistula and maintain nutrition. Nevertheless, the fistula persisted, resulting in significant skin erosion and deterioration of the patient’s condition.

Results

Given the failure of conservative measures and a concurrent diagnosis of a pancreatic fistula, a surgical approach was deemed necessary. The patient was transferred to a specialized hospital center, where she underwent fistulectomy with partial gastrectomy and wound closure. Negative pressure wound therapy (NPWT) was applied to the ulcerated skin to promote healing. This approach led to the successful closure of the gastrocutaneous fistula and healing of the skin wound. The patient showed marked clinical recovery, with no signs of infection or fistula recurrence and the nutritional status was successfully managed through enteral feeding leading to a notable functional recovery.

Conclusion

This case underlines the complexity of managing gastrocutaneous fistulas, demonstrating the efficacy of combining surgical and supportive therapies, serving as a reference for similar future cases and emphasizing the need for comprehensive management strategies for complex postoperative complications.
BN SO62 - Laparoscopic technique for right sided paraduodenal hernia repair: A clinical study and surgical insights
Authors: Pannu Arslan , Needham Paul
Published: November 2024

Background

Paraduodenal hernias can present significant diagnostic and therapeutic challenges, with up to 50% potentially leading to bowel obstruction. A minimally invasive approach to repairing these defects offers reduced morbidity and quicker recovery. This report highlights the feasibility and safety of laparoscopic repair of a right-sided paraduodenal hernia.

Method

A 19-year-old female presented with persistent postprandial bilious vomiting and a long history of forceful regurgitation 10-30 minutes after eating. The preoperative evaluation, surgical technique and operative outcomes are detailed.

Results

Preoperative evaluation included magnetic resonance imaging, computed tomography and a barium swallow, revealing an incidental finding of the duodenojejunal flexure and most jejunal loops on the right side of the abdomen.

A right paraduodenal hernia was diagnosed during laparoscopy. After delineating and reducing the hernia laparoscopically, the sac was obliterated by opening up the posterior aspect over the inferior vena cava. The repair was completed by suturing the hernia orifice and plicating the duodenum. The patient's symptoms resolved postoperatively, with no intraoperative or immediate postoperative adverse outcomes reported. Scheduled outpatient follow-up showed satisfactory resolution of symptoms.

Conclusion

The laparoscopic repair of the right paraduodenal hernia was successfully performed, leading to the resolution of the patient's symptoms. This case underscores the importance of considering laparoscopic approaches for managing complex and rare hernias, especially when cross-sectional imaging modalities do not clearly identify the cause of symptoms. The laparoscopic technique offers significant advantages, including reduced pain and faster recovery.
HPB SO13 - Comparative analysis of cost and clinical benefit of Robotic Surgery (RS) vs Laparoscopic Surgery (LS) for the treatment of symptomatic liver cysts
Authors: Chin Sirr Ling , Hamady Zaed , Arshad Ali
Published: November 2024

Background

The treatment for symptomatic liver cysts involves the removal of a large portion of the cyst wall (deroofing/fenestration). Robotic surgery (RS) is now used more commonly to treat liver cysts. It is unclear whether RS or laparoscopic surgery (LS) results in superior clinical or economic outcomes. The objective of this study is to compare the cost and clinical benefit of RS vs LS in adults with liver cyst(s).

Method

Patients meeting inclusion criteria were identified from operating notes and a prospectively held hospital database between 2019 to 2024. Eligible candidates were further investigated for post-operative outcome, length of stay (LOS), subsequent in-person clinic follow-ups for review and removal of drain, and further treatment in patients with recurrence of liver cyst. Financial data for all surgical equipment in RS and LS were provided by sales representatives from the relevant industries.

Results

Forty-four LS and seven RS patients were analysed. Neither approach recorded a return to theatre. There was no mortality in either group. There was a significantly shorter LOS for RS vs LS patients (median LOS=1 vs 2 days, p<0.05). There was no significant difference in bile leak, drain duration or cyst recurrence between LS and RS. The economic analysis revealed that without taking into account reduced LOS, the costs of RS and LS was £1261.70 and £1733.61 per procedure, respectively. The increased cost in LS was primarily due to multiple stapler firings (median staplers used=5) vs zero staplers in RS.

Conclusion

Robotic liver cyst surgery is cheaper and provides better clinical outcomes in terms of shorter LOS and reduced complications. Further studies are warranted to examine the long-term cost-effectiveness of RS.
HPB SO26 - Evaluation of Theatre Database Accuracy in a Tertiary HPB Center According to NCIP Standards in the UK
Authors: Fouad Mina , Malek Sepand , Beckingham Ian
Published: November 2024

Background

The goal of creating the NCIP (National Clinical Improvement Programme) theatre data set discovery information system is to allow NHS Improvement to evaluate how theatre data can improve the attribution of surgical activities, as documented in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, to individual consultants. The success of NCIP is at risk due to the inaccurate attribution of existing activity data to consultants.

Method

The NCIP theatre database for the Hepato-Pancreato-Biliary (HPB) surgery department was compiled over a 12-month period (from April 2022 to April 2023) and analyzed based on the operating consultant recorded in the operative notes, clinical letters, and the Carfelow system (admitting office records).

Results

In Nottingham University Hospitals (NUH), 143 major liver and pancreatic resections were performed, including 38 Whipple’s procedures (both classic and Pylorus-preserving Pancreatico-Duodenectomy), 19 Distal Pancreatectomies, and 86 Liver resections. Of these, only 58 patients (40.6%) had correct entries in the NCIP database regarding the operating surgeon. The NCIP data inaccuracies for the operating consultant were 65.8% (25/38) for Whipple’s procedures, 57.9% (11/19) for Distal Pancreatectomies, and 56.97% (49/86) for Liver resections. Conversely, the NCIP data was 100% accurate concerning the assigned consultant on Careflow, which matches the clinical letters from the outpatient clinic.

Conclusion

The gap between the NCIP database and the admitting office database leads to inaccurate attributions of surgical activity. This hinders learning and improvement efforts essential for achieving program benefits and prevents providers from complying with license conditions and delivering efficient healthcare services. To ensure accurate HES data, admitting officers should request proper communication and accurate consultant codes from consultant secretaries to ensure accurate data across the different hospital systems
HPB SO30 - Evaluation of efficiency of Co-amoxiclav as an empiric antimicrobial treatment for grade II/ III acute cholecystitis
Authors: Elmetwally Ashraf , Canelo Ruben
Published: November 2024

Background

Acute cholecystitis is associated with considerable mortality. The risk of mortality ranges between 2.4% to 8.4% according to severity. The main line of managing patient presenting with grade II/ III acute cholecystitis is source control through insertion of cholecystostomy drain (if patient is not suitable for emergency cholecystectomy) and anti-microbial treatment. Tokyo 2018 guidelines recommends against use of Co-Amoxiclav as an empiric antimicrobial therapy for cases of acute cholecystitis as most common organism isolated is E. Coli. The aim of this study is to evaluate the efficiency of Co-amoxiclav as an empiric antimicrobial treatment for grade II/ III acute cholecystitis.

Method

The medical records were searched retrospectively for patient presented with acute severe cholecystitis grade II/ III who treated with cholecystostomy drain insertion as a temporary measure during 2020 and 2021.

The culture and sensitivity (C&S) of cholecystostomy drain aspirate at time of insertion of the drains were reviewed to determine the type of appropriate antimicrobial therapy. The results were analysed using both best and worst case scenario to find about the efficacy of Co-Amoxiclav as an empiric antimicrobial treatment.

Results

105 sample of cholecystostomy drain aspirate sent for culture and sensitivity, 27 samples were resistant to co-amoxiclav (25%), while 22 samples were sensitive to co-amoxiclav(20.9%) . 56 of samples (53.1%) showed no mention of testing of Co-Amoxiclav. On further analysis on best case scenario basis, the sensitivity to co-amoxiclav will be 74% considering all the 56 non-tested samples are sensitive to co-amoxiclav. While on worst case scenario, the sensitivity to co-amoxiclav will be 74% considering all the 56 non-tested samples are resistant to co-amoxiclav.

Conclusion

Use of co-amoxiclav as an empirical antimicrobial treatment for cases of grade II/ III acute cholecystitis is associated with considerable antimicrobial resistance ranges from 25% in the best case scenario and 79% in worst case scenario. The most common organism isolated from these samples was E.coli.

These results are in complete agreement with Tokyo 2018 guidelines, which states that Co-amoxiclav is associated with more than 20% resistance.
HPB SO45 - Level 1 evidence comparing aggressive versus non-aggressive intravenous fluid therapy in acute pancreatitis
Authors: Evans Daisy , Hajibandeh Shahin , Hajibandeh Shahab , Athwal Tejinderjit , Satyadas Thomas
Published: November 2024

Background

Fluid balance in the management of acute pancreatitis (AP) is challenging and has been described as a “double-edged sword” whereby adequate fluids are required to counteract systemic hypovolaemia whilst excessive fluids may exacerbate systemic oedema. Given that data generated from randomised studies are conflicting, the optimal rate and type of fluid resuscitation for AP are yet to be determined. We aimed to perform a comprehensive meta-analysis of all existing randomized controlled trials (RCTs) to evaluate comparative outcomes of aggressive versus non-aggressive intravenous fluid (IVF) therapy in patients with AP.

Method

A systematic search of electronic data sources and bibliographic reference lists were conducted. All RCTs reporting outcomes of aggressive versus non-aggressive IVF therapy in AP were included and their risk of bias were assessed. Effect sizes were determined for overall mortality, systemic inflammatory response syndrome (SIRS), sepsis, respiratory failure, pancreatic necrosis, severe pancreatitis, clinical improvement, AKI, and length of stay using random-effects modelling. Trial sequential analysis was conducted to determine risk of types 1 or 2 errors.

Results

Ten RCTs enrolling 993 patients with AP who received aggressive (n = 475) or non-aggressive (n = 518) IVF therapy were included. Aggressive IVF therapy was associated with significantly higher rate of sepsis (OR:2.68, P=0.0005) and longer length of stay (MD:0.94, P<0.00001). There was no statistically significant difference in mortality (RD:0.02, P=0.31), SIRS (OR:0.93, P=0.89), respiratory failure (OR:2.81, P=0.07), pancreatic necrosis (OR:1.98, P = 0.06), clinical improvement (OR:1.12, P=0.83), severe pancreatitis (OR:1.31, P=0.38) or AKI (OR:1.06, P=0.91). Subgroup analysis demonstrated higher morbidity and mortality with aggressive fluids in severe AP. Trial sequential analysis detected risk of type 2 error.

Conclusion

Aggressive IVF therapy may be associated with higher morbidity in patients with acute pancreatitis compared with the non-aggressive approach, particularly in patients with more severe disease. It may also prolong length of hospital stay. The available evidence is subject to type 2 error indicating the need for adequately powered RCTs.
HPB SO53 - Implementation of High Volume-Low Complexity 'GIRFT' lists for laparoscopic cholecystectomy
Authors: Mohammed Musab , Basu Soutrik , Abdel-Galil Noor , Saha Arin
Published: November 2024

Background

Waiting times for elective surgery have risen steadily since 2010, with particularly sharp increases after the Covid pandemic. There have been several initiatives to improve theatre productivity and increase operative numbers and these are broadly encompassed within GIRFT standards and the development of the concept of a High Volume-Low Complexity list. Current GIRFT standards recommend six laparoscopic cholecystectomies on an all-day operating list. This study aimed to describe the development and implementation of these lists within out district general hospital setting and outline the key barriers and solutions for other units to learn from.

Method

All patients on the waiting list for laparoscopic cholecystectomy were assessed and screened by a panel of consultant surgeons to assess suitability for a HVLC list. Theatre staff, anaesthetists and surgeons were widely consulted within local focus groups and a novel method of remuneration for additional work was developed: a 'cost-per-case (CPC)' remuneration structure was introduced (in contrast to standard remuneration by session time) to ensure productivity and high quality surgery. Operations were carried out on weekend lists in a dedicated accredited Elective Surgical Hub and staff were able to finish the day when all operations were completed.

Results

CPC lists took place from August 2023 to May 2024. All lists had six laparoscopic cholecystectomies or eight hernia repairs (or a combination) in line with GIRFT standards. Overall 124 cholecystectomies were performed and 119 were completed on a day case basis. The remaining 5 patients had a single night stay. There were no returns-to-theatre or major morbidity.

All lists had started by 830AM and the latest finish time throughout the study period was 1525PM. The utilisation of CPC lists contributed to waiting times falling dramatically from over 52 weeks to 28 weeks by the end of the study period.

Conclusion

By utilising a novel form of remuneration, based on volume of work completed rather than time, we were able to maximise productivity without compromising safety whilst developing employment conditions that encouraged colleagues to perform additional work. Key facets to successful implementation include appropriate screening of cases, allowing staff to leave when the work is completed (rather than have to wait till the end of the day) and standardising equipment and kit to reduce wastage and turnaround time between cases. These lessons can be implemented in any surgical unit to improve productivity and increase volume of cases performed.
HPB SO55 - Utilisation of Telephone Assessment Clinic for booking Laparoscopic Cholecystectomy: Analysis of outcomes and cancellations
Authors: Mohammed Musab , Khan Saadia , Boalot Ahmed , Hasan Mahmudul , Saha Arin
Published: November 2024

Background

Despite extensive efforts to increase productivity after the Covid pandemic, there still remain areas of limited capacity. Face-to-face outpatient clinic provision is yet to return to normal levels, despite significant increases in referrals. Telephone assessment clinics are attractive solutions as they can be performed outside 'standard' operating hours of the hospital and require fewer support staff, giving increased flexibility to consultant and trainee surgeons who perform them. However, it is unclear whether telephone assessment alone is sufficient to book patients onto operating lists. This study aimed to assess the effectiveness of telephone assessment alone when booking patients for laparoscopic cholecystectomy.

Method

A standardised telephone assessment process was developed which included mandatory information about symptoms, past medical and surgical history and body weight. All patients referred for consideration of cholecystectomy from January 2023 to January 2024 received either a telephone or face-to-face clinic appointment; those who received a telephone appointment were not routinely offered face-to-face assessment unless clinically indicated. Patients were listed for laparoscopic cholecystectomy from either clinic and all operations took place on pooled operating lists.

Operative and clinical outcomes were recorded, including cancellations on the day and unexpected anatomy or procedures. Outcomes between telephone and face-to-face appointments were compared.

Results

Over the study period, 189 patients had a laparoscopic cholecystectomy from an elective clinic source. Other sources included those patients who had presented acutely and were discharged and those on semi-acute lists. 106 patients had a telephone assessment as their only prior engagement with surgical services prior to surgery. Of these patients, there was one cancellation on the day (due to absence of symptoms between clinic assessment and date of surgery). Nine patients required cholangiography which had not been initially booked. In contrast, three patients who had had face-to-face assessment were cancelled on the day.

Conclusion

Telephone assessment alone is sufficient to book patients onto an elective theatre list for laparoscopic cholecystectomy, with no adverse impact on cancellations and theatre utilisation. To ensure low cancellation rates and safe surgery, senior decision making is required for telephone assessment clinics (in this study, all appointments were carried out by consultant surgeons) and a standardised proforma to ensure all relevant information is recorded. The low rate of cancellations was maintained even though a 'pooled' operating list is utilised in our hospital.

Telephone assessment clinics for first appointments are safe and effective and could help in reducing overall waiting times.
HPB SO59 - How do Previous Biliary Interventions Affect the Operative and Postoperative Outcomes Of Patients Undergoing Laparoscopic Cholecystectomy (LC) and Bile Duct Exploration (LCBDE)?
Authors: Hayyawi Israa , Omran Asmaa , Khan Khurram S , Nassar Ahmad
Published: November 2024

Background

Laparoscopic biliary surgery is perceived to be difficult in patients who had undergone previous biliary interventions; ERCP, cholecystostomy or cholecystectomy. Our objective was to evaluate the referral pattern, the preoperative characteristics and operative and postoperative outcomes in such patients.

Method

Analysis of prospectively collected data from patients treated by a specialist biliary unit dedicated to index admission LC and single session laparoscopic management of bile duct stones. In spite of a policy of no preoperative endoscopic clearance of bile duct stones the unit inevitably received some patients who had had previous ERCP at other hospitals prior to referral or were initially unfit when admitted to the base hospital and required ERCP. In a series of 6140 LC and LCBDE 158 patients (2.57%) had already undergone ERCP and 31 (0.5%) had undergone cholecystectomies (18), cholecystostomies (9) or attempted cholecystectomy.

Results

Of 158 pre-referral ERCPs, 130 (82.3%) were referred from other hospitals, 36 (22.8%) having had more than one ERCP. 83.5% had suspected CBD stones. LC difficulty grade was IV to V in 48.7%. 112 patients (70.9%) required LCBDE. There were 10.1% biliary related complications, 3 re-operations, one conversion and one mortality. of 31 patients with previous biliary interventions, 58% came from other units or hospitals. A third had already undergone ERCP. 61.3% had LC difficulty grades IV or V. The 18 un-cholecystectomised patients needed LCBDE with no conversions or bile duct injuries. There were only 2 (6.5%) biliary related complications.

Conclusion

While previous biliary interventions understandably increased the difficulty of LC they did not adversely affect operative and postoperative outcomes. Such surgery should be undertaken in the specialist setting as 70.9% of those with previous endoscopic and 58.1% of those with previous surgical or radiologically guided biliary interventions require LCBDE. Implementing definitive surgical interventions during the index admission can achieve a substantial reduction in re-admission rates, and overall decrease in hospital episodes without significant morbidity, re-interventions or mortality. This enhances the quality of life for patients who would otherwise be subjected to multiple repeat ERCPs and yields significant cost benefits.
Bridging the gaps between JCV infection models and human disease
Authors: Cortese Irene , Tan C Sabrina
Published: November 2024

This scientific commentary refers to ‘JC virus spread is potentiated by glial replication and demyelination-linked glial proliferation’ by Li et al. (https://doi.org/10.1093/brain/awae252).
The strategy of using heme proteins and synthetic porphyrins as injectable antidotes for fire gas poisoning
Authors: Mao Qiyue , Nakagami Atsuki , Kodera Masahito , Kitagishi Hiroaki
Published: November 2024

During fire accidents, 2 highly toxic components of fire smoke, carbon monoxide (CO) and hydrogen cyanide (HCN), are produced simultaneously, and more than 50% of fire-related deaths can be attributed to the inhalation of these toxic gases. Despite the different CO and HCN detoxification mechanisms, oxygen (O2) ventilation is currently the primary clinical treatment, and no alternative methods are available at present. In this review, the toxicological mechanisms of CO and HCN are investigated with an emphasis on the toxic effects of their combination. On the basis of these toxic mechanisms, the advantages and disadvantages of the current clinical detoxification methods are analyzed and discussed. We also summarize the latest advancements in the development of CO- and HCN-scavenging antidotes, highlighting the strategy of using synthetic iron porphyrins that have been synthesized mainly in our laboratory as water-soluble synthetic hemoglobin biomimetics.
‘They Never had a Chance’: Unequal Opportunities and Fair Redistributions
Authors: Dong Lu , Huang Lingbo , Lien Jaimie W
Published: November 2024

A meritocratic fairness ideal typically asserts that income inequality is justifiable if it arises from differences in performance rather than mere luck. In this study, we present experimental evidence that reveals how merit judgements are influenced by the sources of performance differentials, while holding fixed the underlying impact on incentives to perform. Drawing inspiration from real-world factors that create inequality, we investigate unequal opportunities in education and employment that impact performance. Contrary to some earlier findings suggesting that merit judgements are unaffected by unequal circumstances, our study demonstrates that individuals’ redistributive behaviour is responsive to both the nature and extent of these unequal opportunities. This research thus provides fresh insights into the nuanced factors that motivate people to endorse income redistribution.
The pangenome analysis of the environmental source Salmonella enterica highlights a diverse accessory genome and a distinct serotype clustering
Authors: Aguirre-Sánchez José Roberto , Chaidez Cristóbal , Castro-del Campo Nohelia
Published: November 2024

Salmonella remains the leading cause of foodborne infections globally. Environmental reservoirs, particularly aquatic bodies, serve as conduits for the fecal–oral transmission of this pathogen. While the gastrointestinal tract is traditionally considered the primary habitat of Salmonella, mounting evidence suggests the bacterium’s capacity for survival in external environments. The application of advanced technological platforms, such as next-generation sequencing, facilitates a comprehensive analysis of Salmonella’s genomic features. This study aims to characterize the genomic composition of Salmonella isolates from river water, contributing to a potential paradigm shift and advancing public health protection. A total of 25 river water samples were collected and processed, followed by microbiological isolation of Salmonella strains, which were then sequenced. Genomic characterization revealed adaptive mechanisms, including gene duplication. Furthermore, an open pangenome, predisposed to incorporating foreign genetic material, was identified. Notably, antibiotic resistance genes were found to be part of the core genome, challenging previous reports that placed them in the accessory genome.
Toward a National Profile of Loneliness in Old-Age China: Prevalence and Lonely Life Expectancy
Authors: Wang Xueqing
Published: November 2024

Objectives

Loneliness presents a significant challenge for many older adults in China. Understanding the national scale and patterns of loneliness is critical to inform and guide policy interventions. This study builds a national profile of loneliness among Chinese adults aged 55 and above, illustrating the prevalence of loneliness and the average years expected to feel lonely, and examining how these measures vary by urban/rural residence and gender.

Methods

This study uses the China Health and Retirement Longitudinal Study (2011–2018, N = 25,563) to estimate the loneliness prevalence across different gender and urban/rural residences. Drawing on Sullivan’s method for calculating Healthy Life Expectancy, the author estimate the Lonely Life Expectancy (LLE), which quantifies the expected years an individual will live with loneliness.

Results

Approximately 30% of older Chinese aged 55 and above reported experiencing loneliness during 2011–2018. At age 55, Chinese adults anticipate spending about 7–10 years feeling lonely, representing over one-third of their remaining lifespan. By age 75, this proportion may increase to more than half. Estimates of prevalence and LLE exhibit marked disparities with respect to gender and urban/rural residency. Rural women emerged as the most disadvantaged, facing the highest prevalence and largest proportion of remaining lifetime feeling lonely.

Discussion

Older adults in China spend a significant proportion of their remaining lives feeling lonely. Marked disparities in LLEs underscore the potential role of loneliness in perpetuating health inequalities across different gender and urban/rural residences. These results highlight the urgent need for targeted interventions to mitigate the consequences of prolonged loneliness.
The Bidirectional Relationship Between Sleep and Pain in Crohn’s Disease: A Daily Diary Study
Authors: Salwen-Deremer Jessica K , Westvold Sarah J , Siegel Corey A , Smith Michael T
Published: November 2024

Background

Pain is common in Crohn’s disease (CD) even after endoscopic healing is achieved. Depression, sleep disturbances, fatigue, and worry about pain impact the pain experience. There is a bidirectional relationship between sleep and pain, though it has received minimal attention in CD. Herein, we sought to comprehensively assess this relationship in CD using daily diaries.

Method

Patients with active symptoms of insomnia and CD were recruited as part of an ongoing clinical trial. Participants completed 14-day diaries on sleep patterns and CD symptoms. Temporal associations between sleep and pain were assessed using cross-lagged path analysis and controlled for age, sex, and menstrual cycle.

Results

Overall, 26 participants completed 14-day diaries. All assessed aspects of sleep continuity disturbance were associated with worse next-day abdominal pain (Ps < 0.01). When assessed microlongitudinally, sleep onset latency predicted next-day pain (P = 0.07) and vice versa (P = 0.03). Similarly, nightly awakenings predicted next day pain (P = 0.02) and vice versa (P = 0.04). Sleep efficiency (P = 0.003), sleep quality (P < 0.001), and total sleep time (P = 0.04) predicted next-day pain whereas models with pain as the predictor were not significant.

Conclusions

Sleep continuity and abdominal pain are closely related, with sleep efficiency, total sleep time, and sleep quality potentially driving next-day abdominal pain. As interventions for pain in IBD are limited, it may be important to capitalize on the impact of sleep disturbances on pain to optimize overall wellbeing in people with CD.
Epidemiologic and Genomic Characterization of an Outbreak of Rift Valley Fever Among Humans and Dairy Cattle in Northern Tanzania
Authors: Madut Deng B , Rubach Matthew P , Allan Kathryn J , Thomas Kate M , de Glanville William A , Halliday Jo E B , Costales Cristina , Carugati Manuela , Rolfe Robert J , Bonnewell John P , Maze Michael J , Mremi Alex R , Amsi Patrick T , Kalengo Nathaniel H , Lyamuya Furaha , Kinabo Grace D , Mbwasi Ronald , Kilonzo Kajiru G , Maro Venance P , Mmbaga Blandina T , Lwezaula Bingileki , Mosha Calvin , Marandu Annette , Kibona Tito J , Zhu Feng , Chawla Tanu , Chia Wan Ni , Anderson Danielle E , Wang Lin-Fa , Liu Jie , Houpt Eric R , Martines Roosecelis B , Zaki Sherif R , Leach Austin , Gibbons Aridth , Chiang Cheng-Feng , Patel Ketan , Klena John D , Cleaveland Sarah , Crump John A
Published: November 2024

Background

A periurban outbreak of Rift Valley fever virus (RVFV) among dairy cattle from May through August 2018 in northern Tanzania was detected through testing samples from prospective livestock abortion surveillance. We sought to identify concurrent human infections, their phylogeny, and epidemiologic characteristics in a cohort of febrile patients enrolled from 2016 to 2019 at hospitals serving the epizootic area.

Methods

From September 2016 through May 2019, we conducted a prospective cohort study that enrolled febrile patients hospitalized at 2 hospitals in Moshi, Tanzania. Archived serum, plasma, or whole blood samples were retrospectively tested for RVFV by PCR. Human samples positive for RVFV were sequenced and compared to RVFV sequences obtained from cattle through a prospective livestock abortion study. Phylogenetic analysis was performed on complete RVFV genomes.

Results

Among 656 human participants, we detected RVFV RNA in 4 (0.6%), including 1 death with hepatic necrosis and other end-organ damage at autopsy. Humans infected with RVFV were enrolled from June through August 2018, and all resided in or near urban areas. Phylogenetic analysis of human and cattle RVFV sequences demonstrated that most clustered to lineage B, a lineage previously described in East Africa. A lineage E strain clustering with lineages in Angola was also identified in cattle.

Conclusions

We provide evidence that an apparently small RVFV outbreak among dairy cattle in northern Tanzania was associated with concurrent severe and fatal infections among humans. Our findings highlight the unidentified scale and diversity of interepizootic RVFV transmission, including near and within an urban area.
Emission line velocity, metallicity, and extinction maps of the Small Magellanic Cloud
Authors: Lah Philip , Colless Matthew , D’Eugenio Francesco , Groves Brent , Gelfand Joseph D
Published: November 2024

Optical emission lines across the Small Magellanic Cloud (SMC) have been measured from multiple fields using the Australian National University 2.3m telescope with the wide-field spectrograph. Interpolated maps of the gas-phase metallicity, extinction, H $\alpha$ radial velocity, and H $\alpha$ velocity dispersion have been made from these measurements. There is a metallicity gradient from the centre to the north of the galaxy of $\sim$−0.095 dex kpc−1 with a shallower metallicity gradient from the centre to the south of the galaxy of $\sim$−0.013 dex kpc−1. There is an extinction gradient of $\sim$−0.086 E(B − V)/kpc from the centre going north and shallower going from the centre to the south of $\sim$−0.0089 E(B − V)/kpc. The SMC eastern arm has lower extinction than the main body. The radial velocity of the gas from the H $\alpha$ line and the H i line have been compared across the SMC. In general there is good agreement between the two measurements, though there are a few notable exceptions. Both show a region that has different radial velocity to the bulk motion of the SMC in the southern western corner by at least 16 km s$^{-1}$. The velocity dispersion from H $\alpha$ and H i across the SMC have also been compared, with the H $\alpha$ velocity dispersion usually the higher of the two. The eastern arm of the SMC generally has lower velocity dispersion than the SMC’s main body. These measurements enable a detailed examination of the SMC, highlighting its nature as a disrupted satellite galaxy.
JWST/NIRSpec WIDE survey: a z = 4.6 low-mass star-forming galaxy hosting a jet-driven shock with low ionization and solar metallicity
Authors: D’Eugenio Francesco , Maiolino Roberto , Mahatma Vijay H , Mazzolari Giovanni , Carniani Stefano , de Graaff Anna , Maseda Michael V , Parlanti Eleonora , Bunker Andrew J , Ji Xihan , Jones Gareth C , Helton Jakob M , Morganti Raffaella , Scholtz Jan , Tacchella Sandro , Tadhunter Clive , Übler Hannah , Venturi Giacomo
Published: November 2024

We present NIRSpec/micro-shutter assembly observations from the JWST large-area survey WIDE, targeting the rest-frame UV–optical spectrum of Ulema, a radio-active galactic nucleus host at redshift $z=4.6348$. The low-resolution prism spectrum displays high equivalent width nebular emission, with remarkably high ratios of low-ionization species of oxygen, nitrogen, and sulphur, relative to hydrogen; auroral O$^+$ emission is clearly detected, possibly also C$^+$. From the high-resolution grating spectrum, we measure a gas velocity dispersion of $\sigma \sim 400$$\mathrm{km\, s^{-1}}$, broad enough to rule out star-forming gas in equilibrium in the gravitational potential of the galaxy. Diagnostics based on emission-line ratios suggest that the nebular emission is due to a shock which ran out of pre-shock gas. To infer the physical properties of the system, we model simultaneously the galaxy spectral energy distribution and shock-driven line emission under a Bayesian framework. We find a relatively low-mass, star-forming system ($M_\star = 1.4 \times 10^{10}~{\rm M}_\odot$, $\mathrm{SFR} = 70~{\rm M}_\odot ~{\rm yr^{-1}}$), where shock-driven emission contributes 50 per cent to the total H β luminosity. The nebular metallicity is near solar – three times higher than that predicted by the mass–metallicity relation at $z=4.6$, possibly related to fast-paced chemical evolution near the galaxy nucleus. We find no evidence for a recent decline in the star-formation rate of the galaxy, meaning that, already at this early epoch, fast radio-mode active galactic nucleus feedback was poorly coupled with the bulk of the star-forming gas; therefore, most of the feedback energy must end up in the galaxy halo, setting the stage for future quenching.
The conformation of FOXM1 homodimers in vivo is crucial for regulating transcriptional activities
Authors: Hsu Chia-Chan , Yao Xiang , Chen Shang-Yao , Tsuo Tsui-Chun , Wang I-Ching
Published: November 2024

Conformational changes in a transcription factor can significantly affect its transcriptional activity. The activated form of the FOXM1 transcription factor regulates the transcriptional network of genes essential for cell cycle progression and carcinogenesis. However, the mechanism and impact of FOXM1 conformational change on its transcriptional activity in vivo throughout the cell cycle progression remain unexplored. Here, we demonstrate that FOXM1 proteins form novel intermolecular homodimerizations in vivo, and these conformational changes in FOXM1 homodimers impact activity during the cell cycle. Specifically, during the G1 phase, FOXM1 undergoes autorepressive homodimerization, wherein the αβα motif in the C-terminal transcriptional activation domain interacts with the ββαβ motif in the N-terminal repression domain, as evidenced by FRET imaging. Phosphorylation of the αβα motif by PLK1 at S715/S724 disrupts ββαβ–αβα hydrophobic interactions, thereby facilitating a conserved αβα motif switch binding partner to the novel intrinsically disordered regions, leading to FOXM1 autostimulatory homodimerization persisting from the S phase to the G2/M phase in vivo. Furthermore, we identified a minimal ββαβ motif peptide that effectively inhibits cancer cell proliferation both in cell culture and in a mouse tumor model, suggesting a promising autorepression approach for targeting FOXM1 in cancer therapy.
Immunotherapy-related neurotoxicity in the central nervous system of children with cancer
Authors: He Jiasen , Connors Jeremy , Meador Andrew , Xu Shuo , Meador Heather , Jiang Hong , Fueyo Juan , Gomez-Manzano Candelaria , Friedman Gregory K , Zaky Wafik , Sadighi Zsila , Slopis John M , Ahmad Ali H
Published: November 2024

Significant gaps remain in our understanding of immunotherapy-related neurotoxicity in pediatric patients, largely because much of our knowledge comes from studies in adults. Accurately identifying the adverse effects of immunotherapy in children is also challenging, owing to variations in terminology and grading systems. Moreover, the manifestation of immunotherapy-related neurotoxicity differs greatly across different diseases, various modalities, dosages, and delivery methods. Combining immunotherapy with other treatments might improve outcomes but introduces new complexities and potential for increased toxicities. Additionally, pediatric patients with intracranial malignancy have unique responses to immunotherapies and distinct neurotoxicity compared to those with extracranial malignancy. Consequently, we must enhance our understanding of the pathophysiology, prevalence, severity, and management of immunotherapy’s neurotoxic effects in this vulnerable group. This review consolidates the current knowledge of immunotherapy-related neurotoxicity in pediatric oncology, highlighting various types of neurotoxicity including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and tumor inflammation-associated neurotoxicity (TIAN), among others. Furthermore, we examine the unique features of neurotoxicity associated with adoptive cellular therapy (ACT), antibody-based therapies, immune checkpoint inhibitors (ICIs), oncolytic viruses (OV), and cancer vaccines.
From Detached Concern to Love: Reconsidering Physician-Patient Boundaries
Authors: Onadipe Anjola , Curlin Farr
Published: November 2024

Developing appropriate professional boundaries is part of becoming a mature clinician. Boundaries help physicians fulfill their duties in relationally complex and emotionally fraught situations. The concept of “detached concern” has been used to characterize physician-patient relationships in which physicians show empathy and concern while maintaining due emotional distance. However, if the default tendency of trainees and clinicians is toward detachment, then emphasis on professional boundaries may do less to promote proper detachment than to diminish human connections with patients, thereby leading to clinician disenchantment and patient dissatisfaction. The authors propose that the physician-patient relationship is better characterized by love—specifically the kind of ordered love described by the fourth- and fifth-century bishop and philosopher Augustine of Hippo. Augustine’s vision of love has influenced many social reformers through the centuries, including, notably, Martin Luther King Jr. Importantly, such love is consistent with safeguards for which professional boundaries in the clinical context are corollaries, including guarding against forms of compassion that interfere with reasonable judgment, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that prevent human connection and concern to walls that create spaces for and encourage any human connection that does not hinder healing and the patient’s good. By shifting their emphasis from detached concern to love, medical educators can re-enchant medicine for trainees by encouraging the human connections that make the practice of medicine its own reward.
A Comparison of Clinical and Laboratory Features in Neonatal Proven Sepsis and COVID-19
Authors: Sangsari Razieh , Saeedi Maryam , Mirnia Kayvan , Eshaghi Hamid , Sareh Shiva , Afkhaminia Ali
Published: November 2024

Background:

The clinical manifestations of COVID-19 in neonates are generally mild and commonly require only supportive treatment. However, it is important to note that they can sometimes present with symptoms like bacterial sepsis, which can lead to confusion in diagnosis. In this study, our objective was to compare laboratory data and clinical manifestations between 2 groups to identify opportunities for reducing the unnecessary use of antibiotics.

Methods:

The study was conducted as a cross-sectional study between January 2020 and 2023 on neonates who were admitted to the neonatal intensive care unit or the neonatal ward of Children’s Medical Center in Tehran, Iran. We specifically compared the laboratory data and clinical characteristics of neonates who tested positive for either a blood culture or a reverse transcription polymerase chain reaction for COVID-19.

Results:

Sixty-seven neonates in COVID-19 group and 68 neonates in the bacterial sepsis group entered. Prominent symptoms in the bacterial sepsis group include vomiting, seizure, apnea, mottling, increased need for ventilation and laboratory findings showing elevated levels of C-reactive protein and thrombocytopenia. In the COVID-19 group, patient exhibit symptoms such as cough, diarrhea, fever and laboratory findings that indicate neutropenia and leukopenia. Symptoms of nervous involvement were rare in this group.

Conclusion:

It is crucial to carefully assess the symptoms, laboratory results and overall condition of the patient before deciding on antibiotic initiation. By combining rapid COVID-19 testing and clinical variables, it is possible to identify low-risk infants who are unlikely to have bacterial infections.
Respiratory Viral Co-infection in SARS-CoV-2-Infected Children During the Early and Late Pandemic Periods
Authors: Xie Jianling , Florin Todd A. , Funk Anna L. , Tancredi Daniel J. , Kuppermann Nathan , Freedman Stephen B. ,   on behalf of the Pediatric Emergency Research Network (PERN)-COVID-19 and Pediatric Emergency Research Canada (PERC) Study Teams
Published: November 2024

Background:

Knowledge regarding the impact of respiratory pathogen co-infection in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children seeking emergency department care is limited, specifically as it relates to the association between SARS-CoV-2 viral co-infection and disease severity and factors associated with co-infection.

Methods:

This secondary analysis included data from 2 prospective cohort studies conducted between March 2020 and February 2022 that included children <18 years of age tested for SARS-CoV-2 infection along with additional respiratory viruses in a participating emergency department. Outcomes included the detection rate of other respiratory viruses and the occurrence of severe outcomes (ie, intensive interventions, severe organ impairment and death).

Results:

We included 2520 participants, of whom 388 (15.4%) were SARS-CoV-2-positive. Detection of additional respiratory viruses occurred in 18.3% (71/388) of SARS-CoV-2-positive children, with rhinovirus/enterovirus being most frequently detected (42/388; 10.8%). In multivariable analyses (adjusted odds ratio and 95% confidence interval), among SARS-CoV-2-positive children, detection of another respiratory virus was not associated with severe outcomes [1.74 (0.80–3.79)], but detection of rhinovirus/enterovirus [vs. isolated SARS-CoV-2 detection 3.56 (1.49–8.51)] and having any preexisting chronic medical condition [2.15 (1.06–4.36)] were associated with severe outcomes. Among SARS-CoV-2-positive children, characteristics independently associated with an increased odds of any other viral co-infection included: age and delta variant infection.

Conclusions:

Approximately 1 in 5 children infected with SARS-CoV-2 had co-infection with another respiratory virus, and co-infection with rhinovirus/enterovirus was associated with severe outcomes. When public health restrictions were relaxed, co-infections increased.