bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation
Authors: Griffith Patricia B. , Mariani Bette , Kelly Michelle M.
Published: July 2023

AIM

The aim of this study was to examine the effect of structured reflection used during a simulated patient’s diagnostic workup on diagnostic reasoning competency and accuracy and explore participants’ cognitive bias experience and perceived utility of structured reflection.

BACKGROUND

Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy.

METHOD

Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection’s utility were explored.

RESULTS

Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants.

CONCLUSION

Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy’s components with the same noted benefits.
Implicit Bias in Nursing: Student Reflections
Authors: Hanks Jacquie , Van De Graaff Whitney , Hamzhie Chelsea , Koziol Dana , Williams Jacque
Published: July 2023

Implicit bias can lead to health disparities related to a patient’s race, religion, sexual identity, and mental illness. Students responded to the Implicit Association Test for race followed by a structured reflection. Student reflections were evaluated qualitatively. Results hold a key to future educational interventions/training to help nursing students become consciously aware of implicit biases and choose behaviors that are non-biased.
The Role of Specialty Certification in Career-Long Competence
Authors: Lyness Jeffrey M. , McMahon Graham T.
Published: July 2023

Across the medical profession there is broad acceptance of the critical role of continuing medical education (CME) in enabling physicians to adapt to both new information and evolving expectations within the profession. In the presence of widespread participation in CME, some have attempted to question, discredit, or marginalize the role of ongoing lifelong assessment of physician knowledge and skills through specialty continuing certification, advocating instead for a participatory standard based only on engagement with CME. This essay outlines the limitations of physician self-evaluation and clarifies the need for external assessments. Certification boards’ role is to set specialty-specific standards for competence, assess to those standards, and assure the public that certified physicians are adequately maintaining their skills and abilities; doing so credibly necessarily requires, in part, independent assessments of physician competence. In these contexts, the specialty boards are taking approaches to identify performance gaps and leverage intrinsic motivation to facilitate physician engagement in targeted learning. Specialty board continuing certification plays a unique role, distinct from and complementary to the CME enterprise. Calls to eliminate continuing certification requirements beyond self-directed CME are contradictory to the evidence and fail the profession and the public.
Evaluation of new IPSS-Molecular model and comparison of different prognostic systems in patients with myelodysplastic syndrome
Authors: Ma Jiale , Gu Yan , Wei Yanhui , Wang Xuee , Wang Peixuan , Song Chunhua , Ge Zheng
Published: July 2023

A risk-adapted treatment strategy is of crucial importance in patients with myelodysplastic syndromes (MDS). Previous risk prognostic scoring systems did not integrate molecular abnormalities. The new IPSS-Molecular (IPSS-M) model, combing genomic profiling with hematologic and cytogenetic parameters, was recently developed to evaluate the associations with leukemia-free survival (LFS), leukemic transformation, and overall survival (OS). However, it has not yet been widely validated in clinics. This study aims to further validate the prognostic power of IPSS-M based on real-world data and to compare the prognostic value of different scoring systems in patients with MDS. IPSS-M Web calculator was used to calculate a tailored IPSS-M score of the enrolled patient (N = 255), and the risk category was defined correspondingly. We next compared the IPSS-M prognostic power to that of IPSS, IPSS-R, and WPSS. We found that IPSS-M risk classification was statistically significant for 3-year OS and LFS. Compared with other tools, IPSS-M was superior in sensitivity and accuracy for 3-year OS and LFS. The mapping C-index between IPSS-R and IPSS-M categories resulted in improved discrimination across the OS, but not LFS and leukemic transformation. The result of different treatment options indicated that allogeneic hematopoietic stem cell transplantation (allo-HSCT) can result in a better OS than those without allo-HSCT. In conclusion, IPSS-M was a valuable tool for risk stratification compared with other risk prognostic scoring systems. However, more studies should be conducted to explore the appropriate treatment options for different groups stratified by IPSS-M.
MXRA7 is involved in megakaryocyte differentiation and platelet production
Authors: Sun Zhenjiang , Wang Benfang , Shen Ying , Ma Kunpeng , Wang Ting , Wang Yiqiang , Lin Dandan
Published: July 2023

Matrix remodeling is a critical process in hematopoiesis. The biology of MXRA7, as a matrix remodeling associated gene, has still not been reported in hematopoietic process. Public databases showed that MXRA7 expressed in hematopoietic stem cells, suggesting that it may be involved in hematopoiesis. We found that the amounts of megakaryocytes were lower in bone marrow and spleen from Mxra7
−/− mice compared with that from wild-type mice. Knock-out of MXRA7 also reduced the amount of platelet in peripheral blood and affected the function of platelets. Knock-out of MXRA7 inhibited hematopoietic stem/progenitor cells differentiate to megakaryocytes possibly through down-regulating the expression of GATA-1 and FOG-1. Moreover, knockdown of MXRA7 in MEG-01 cells could inhibit the cell proliferation and cell apoptosis. Knockdown of MXRA7 inhibited the differentiation of MEG-01 cells and proplatelet formation through suppressing the ERK/MAPK signaling pathway and the expression of β-tubulin. In conclusion, the current study demonstrated the potential significance of MXRA7 in megakaryocyte differentiation and platelet production. The novel findings proposed a new target for the treatment of platelet-related diseases, and much more investigations are guaranteed to dissect the mechanisms of MXRA7 in megakaryocyte differentiation and platelet production.
Myocardial Protection by Desflurane: From Basic Mechanisms to Clinical Applications
Authors: Qin Han , Zhou Jing
Published: July 2023

Coronary heart disease is an affliction that is common and has an adverse effect on patients' quality of life and survival while also raising the risk of intraoperative anesthesia. Mitochondria are the organelles most closely associated with the pathogenesis, development, and prognosis of coronary heart disease. Ion abnormalities, an acidic environment, the production of reactive oxygen species, and other changes during abnormal myocardial metabolism cause the opening of mitochondrial permeability transition pores, which disrupts electron transport, impairs mitochondrial function, and even causes cell death. Differences in reliability and cost-effectiveness between desflurane and other volatile anesthetics are minor, but desflurane has shown better myocardial protective benefits in the surgical management of patients with coronary artery disease. The results of myocardial protection by desflurane are briefly summarized in this review, and biological functions of the mitochondrial permeability transition pore, mitochondrial electron transport chain, reactive oxygen species, adenosine triphosphate-dependent potassium channels, G protein–coupled receptors, and protein kinase C are discussed in relation to the protective mechanism of desflurane. This article also discusses the effects of desflurane on patient hemodynamics, myocardial function, and postoperative parameters during coronary artery bypass grafting. Although there are limited and insufficient clinical investigations, they do highlight the possible advantages of desflurane and offer additional suggestions for patients.
Imported Malaria in Children: A Study Over an 11-Year Period in Brussels
Authors: Selimaj Kontoni Valbona , Goetghebuer Tessa , Hainaut Marc , Vanderfaeillie Anna , Nguyen Vo Thanh Phuong , Jourdain Sarah , Pace David
Published: July 2023

Background:

Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries.

Methods:

This was a retrospective case review of all laboratory-confirmed malaria cases in children 0–16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels.

Results:

A total of 160 children with a median age of 6.8 years (range 5–191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully.

Conclusions:

Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.
Epidemiologic Changes of Neonatal Early-onset Sepsis After the Implementation of Universal Maternal Screening for Group B Streptococcus in Hong Kong
Authors: Wang Xuelian , Chan Peggy Hiu Ying , Lau Hoi Ying Sharon , Tsoi Kathleen , Lam Hugh Simon
Published: July 2023

Background:

The epidemiology of neonatal early-onset sepsis (EOS) has changed with time and with changes in prevention strategy. Population-representative contemporary data provide insights on how to further improve EOS prevention and triage strategies.

Methods:

Neonates born in public hospitals in Hong Kong from January 1, 2006, to December 31, 2017 were included. The epidemiological characteristics of EOS and the use of intrapartum antibiotic prophylaxis (IAP) were compared between the 2 epochs before (January 1, 2006 to December 31, 2011) and after (January 1, 2012 to December 31, 2017) the territory-wide implementation of universal maternal group B Streptococcus (GBS) screening.

Results:

EOS developed in 1.07‰ of live births (522/490,034). After the implementation of universal GBS screening, the EOS rate decreased in neonates born ≥34 weeks (1.17‰–0.56‰, P < 0.001) and remained similar in those born <34 weeks (7.8‰–10.9‰, P = 0.15), whereas the proportions of IAP coverage increased in both groups [7.6%–23.3% (P < 0.001) and 28.5%–52.0% (P < 0.001), respectively]. The major pathogen for EOS shifted from GBS to Escherichia coli, and for early-onset meningitis from GBS to Streptococcus bovis. IAP was associated with subsequent isolation of pathogens resistant to ampicillin [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI): 1.3–4.2], and second-generation [aOR 2.0; 95% CI: 1.02–4.3] and third-generation [aOR 2.2; 95% CI: 1.1–5.0] cephalosporins.

Conclusions:

Pathogen profile of EOS changed with the implementation of universal GBS screening. S. bovis has emerged as a more common pathogen associated with the risk of meningitis. IAP may not be as effective in reducing EOS rate among infants born <34 weeks as compared with those ≥34 weeks, and newer strategies may be needed.
Moraxella Catarrhalis Infrequently Cultured from Middle Ear Fluid of Children with Acute Otitis Media
Authors: Conway Isabella O. , Kurs-Lasky Marcia , Shaikh Nader
Published: July 2023

We compared the distribution of organisms in the nasopharynx and the middle ear fluid in 164 episodes of acute otitis media in children 6–35 months of age. In contrast to Streptococcus pneumoniae and Haemophilus influenzae, Moraxella catarrhalis is isolated from the middle ear in only 11% of episodes with nasopharyngeal colonization with this organism.
An Orbital Manifestation of VEXAS Syndrome
Authors: Lokhande Anagha , Jarmale Spandana , Vaishnav Yash J. , Schaefer Jamie
Published: July 2023

VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an adult-onset autoinflammatory disorder characterized by systemic inflammation (vasculitis, arthritis, chondritis, dermatosis) and hematologic abnormalities (thrombosis, cytopenia, vacuolization of marrow precursors). The patient demonstrated some of the adult-onset inflammatory and hematologic features, in addition to recurrent eye pain, chemosis and orbital inflammation. This case describes an instance of VEXAS syndrome in a patient with uncommon orbital symptoms such as scleritis and myositis.
The Effect of Early Feeding of Full Liquids on Postoperative Infants
Authors: Kiolbasa Carolyn , Chaturvedi Apurva , Ryan Colleen , Johnsen Linda , Schmidt Barbara , Schroeder James W. , Birmingham Patrick K. , Manworren Renee C. B.
Published: July 2023

There is a lack of evidence-based guidance for postoperative feeding of infants after outpatient surgeries. This randomized controlled trial tested the hypothesis that infants, aged ≤12 months who are fed formula or milk at home, will have more oral intake, less pain, and less emergence delirium when fed formula/milk as compared with clear liquids in the postanesthesia care unit. Infants were randomized to receive formula/milk or clear liquids as first feeding after outpatient myringotomy and tube insertion. Pain (Faces, Legs, Activity, Cry, and Consolability) and emergence delirium (Pediatric Anesthesia Emergence Delirium) scores were recorded and compared immediately and again 15 and 30 minutes after arrival in the postanesthesia care unit. Infants randomized to the formula/milk first-feeding group had significantly more volume of oral feeding intake than infants randomized to the clear liquid first-feeding group (M = 80.5 ml, 95% CI [15, 146], p = .017). There was no significant difference in vomiting, pain scores, or emergence delirium scores between groups. These results support the practice of ad lib feeding of infants who preferred full liquids after outpatient surgical procedures.
The relationship between vitamin D and short-term blood pressure variability
Authors: Baniasad Amir , Mokhtari Ardekan Abnoos , Najafzadeh Mohammad Javad , Mousavi Mehdiabadi Fatemeh
Published: July 2023

Objectives

This study aimed to evaluate the relationships between serum levels of 25-hydroxyvitamin D (25(OH)D) and short-term blood pressure variability (BPV) in newly diagnosed hypertensive patients.

Methods

One hundred newly diagnosed patients with stage one essential hypertension were included and divided into two groups, the deficient and non-deficient groups, according to their 25(OH)D level. The blood pressure was recorded automatically by a portable ambulatory blood pressure monitor for 24 h.

Results

In the present study, there was no significant relationship between vitamin D levels and short-term BPV or other parameters derived from ambulatory blood pressure monitoring (ABPM) (P > 0.05). Age (r = 0.260, P = 0.009), serum phosphorus (r = 0.271, P = 0.007), and cholesterol levels (r = 0.310, P = 0.011) were positively correlated with 25(OH)D levels, while glomerular filtration rate (r = -0.232, P = 0.021) negatively correlated with vitamin D levels. There was no crude or adjusted relationship between the levels of 25(OH)D and any parameters of ABPM in multiple linear regression analysis.

Conclusion

Although the relationship between vitamin D levels and cardiovascular diseases has been confirmed, vitamin D deficiency does not cause an increase in cardiovascular risk by influencing the short-term BPV or other parameters derived from ABPM.
A Case of Uterine Tumor Resembling Ovarian Sex Cord Tumor With Prominent Myxoid Features
Authors: Ise Koki , Tanei Zen-ichi , Oda Yoshitaka , Tanikawa Satoshi , Sugino Hirokazu , Ishida Yusuke , Tsuda Masumi , Gotoda Yuko , Nishiwaki Kunihiko , Yanai Hiroyuki , Hasegawa Tadashi , Nagashima Kazuo , Tanaka Shinya
Published: July 2023

Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare tumor with low malignant potential that commonly occurs in middle age. Although more than 100 cases have been reported to date, myxoid morphology is not well documented. Here, we present a 75-yr-old woman with abnormal vaginal bleeding, with an 8-cm mass in the uterine corpus detected by irregular, high-intensity signaling on T2-weighted imaging. The uterine mass had a glistening mucinous appearance on gross examination. Microscopically, most of the tumor cells were floating in the myxoid stroma. The tumor cells formed clusters or nests with abundant cytoplasm, while some exhibited trabecular or rhabdoid appearances. Immunohistochemically, tumor cells were positive for pancytokeratin (AE1/AE3), α-smooth muscle actin, CD10, progesterone receptor, and some sex cord markers such as calretinin, inhibin, CD56, steroidogenic factor-1. Electron microscopy demonstrated epithelial and sex cord differentiation. This tumor was negative for JAZF1–JJAZ1 fusion gene that is frequently found in low-grade endometrial stromal sarcoma. Fusion genes related to UTROSCT, including NCOA2/3, were not detected by reverse transcription polymerase chain reaction. The present case suggests that UTROSCT should be included in the differential diagnosis of myxoid uterine tumors.
Neuroendocrine Marker Expression in Primary Non-neuroendocrine Epithelial Tumors of the Ovary: A Study of 551 Cases
Authors: Kendall Bártů Michaela , Němejcová Kristýna , Michálková Romana , Bui Quang Hiep , Drozenová Jana , Fabian Pavel , Fadare Oluwole , Hausnerová Jitka , Laco Jan , Matěj Radoslav , Méhes Gábor , Šafanda Adam , Singh Naveena , Škapa Petr , Špůrková Zuzana , Stolnicu Simona , Švajdler Marián , Lax Sigurd F. , McCluggage W. Glenn , Dundr Pavel
Published: July 2023

Expression of neuroendocrine (NE) markers in primary ovarian non-NE epithelial tumors has rarely been evaluated. The aim of our study was to evaluate the expression of the most widely used NE markers in these neoplasms and to determine any prognostic significance of NE marker expression. The cohort consisted of 551 primary ovarian tumors, including serous borderline tumors, low-grade serous carcinomas, high-grade serous carcinomas (HGSC), clear cell carcinomas, endometroid carcinomas, mucinous borderline tumors, and mucinous carcinomas. Immunohistochemical analysis was performed using antibodies against INSM1, synaptophysin, chromogranin, and CD56 on tissue microarray. Positivity for INSM1, synaptophysin, chromogranin, and CD56 was most frequently observed in mucinous tumors (48.7%, 26.0%, 41.5%, and 100%, respectively). The positivity for these NE markers was mostly restricted to nonmucinous elements distributed throughout the tumor. The mucinous borderline tumor and mucinous carcinomas groups had similar proportions of positivity (mucinous borderline tumor: 53%, mucinous carcinomas: 39%). In the other tumor types, except for HGSC, there was only focal expression (5%–10%) or negativity for NE markers. HGSC showed high CD56 expression (in 26% of cases). Survival analysis was only performed for CD56 in HGSC as this was the only group with sufficient positive cases, and it showed no prognostic significance. Except for mucinous tumors, expression of NE markers in non-NE ovarian epithelial tumors is low. CD56 expression in HGSC occurs frequently but is without diagnostic or prognostic value.
Eccrine Porocarcinoma of the Vulva With Sarcomatoid Transformation, a New Human Papillomavirus-associated Malignancy? Case Report and Review of the Literature
Authors: Campbell Katelynn , Quiroga Eleonora Fiorletta , Dunn Andrew , Zoumberos Nicholas , Quick Charles Matthew
Published: July 2023

Eccrine porocarcinoma is a rare cutaneous neoplasm, and rarer still in the anogenital region. In the vulva, the most common carcinoma by far is squamous cell carcinoma; however, eccrine porocarcinoma can arise at this site. As the distinction between porocarcinoma and squamous cell carcinoma has important prognostic implications at other cutaneous sites, it stands to reason that it may have these same implications in the vulva. We present a case of an eccrine porocarcinoma in the vulva of a 70-year-old woman that, in addition, showed sarcomatoid transformation. This tumor harbored human papillomavirus-18 DNA and mRNA, raising the question of the role of the oncogenic virus in sweat gland neoplasms of the vulva.
Liver Cancer Vascularity Driven by Extracellular Matrix Stiffness
Authors: Taiji Ryosuke , Cortes Andrea C. , Zaske Ana Maria , Williams Malea , Dupuis Crystal , Tanaka Toshihiro , Nishiofuku Hideyuki , Chintalapani Gouthami , Peterson Christine B. , Avritscher Rony
Published: July 2023

Background

Extracellular matrix stiffness represents a barrier to effective local and systemic drug delivery. Increasing stiffness disrupts newly formed vessel architecture and integrity, leading to tumor-like vasculature. The resulting vascular phenotypes are manifested through different cross-sectional imaging features. Contrast-enhanced studies can help elucidate the interplay between liver tumor stiffness and different vascular phenotypes.

Purpose

This study aims to correlate extracellular matrix stiffness, dynamic contrast-enhanced computed tomography, and dynamic contrast-enhancement ultrasound imaging features of 2 rat hepatocellular carcinoma tumor models.

Methods and Materials

Buffalo-McA-RH7777 and Sprague Dawley (SD)–N1S1 tumor models were used to evaluate tumor stiffness by 2-dimensional shear wave elastography, along with tumor perfusion by dynamic contrast-enhanced ultrasonography and contrast-enhanced computed tomography. Atomic force microscopy was used to calculate tumor stiffness at a submicron scale. Computer-aided image analyses were performed to evaluate tumor necrosis, as well as the percentage, distribution, and thickness of CD34+ blood vessels.

Results

Distinct tissue signatures between models were observed according to the distribution of the stiffness values by 2-dimensional shear wave elastography and atomic force microscopy (P < 0.05). Higher stiffness values were attributed to SD-N1S1 tumors, also associated with a scant microvascular network (P ≤ 0.001). Opposite results were observed in the Buffalo-McA-RH7777 model, exhibiting lower stiffness values and richer tumor vasculature with predominantly peripheral distribution (P = 0.03). Consistent with these findings, tumor enhancement was significantly greater in the Buffalo-McA-RH7777 tumor model than in the SD-N1S1 on both dynamic contrast-enhanced ultrasonography and contrast-enhanced computed tomography (P < 0.005). A statistically significant positive correlation was observed between tumor perfusion on dynamic contrast-enhanced ultrasonography and contrast-enhanced computed tomography in terms of the total area under the curve and % microvessel tumor coverage (P < 0.05).

Conclusions

The stiffness signatures translated into different tumor vascular phenotypes. Two-dimensional shear wave elastography and dynamic contrast-enhanced ultrasonography adequately depicted different stromal patterns, which resulted in unique imaging perfusion parameters with significantly greater contrast enhancement observed in softer tumors.
Construction of Sensitive Labia Minora–Clitoris–Clitoral Hood Complex in Sex Reassignment Surgery in Circumcised Populations
Authors: Balik Ozan
Published: July 2023

Introduction

The construction of the labia minora from preputial tissues in uncircumcised patients and the preservation of the sensitivity of the labia minora are not new ideas. However, evidently, this technique is designed for uncircumcised cases.

There is no preputial tissue in the circumcised population. However, this tissue, whose inner and outer layers have different structures and appearances, is critical in the construction of the labia minora. Instead, there is an area of reepithelialization and reinnervation that heals secondarily or is closed primarily, depending on the circumcision. Also, this new skin area is devoid of the natural oily secretions of the prepuce. In addition, the removal of preputial tissue in circumcised individuals may cause uncertainty in terms of vascularity or sensitivity. In this study, we share our clinical experience regarding large labia minora creation (with preserved flap circulation without vaginal reconstruction concerns) and the use of most of the urethra as a mesh graft in the circumcised population.

Materials and Methods

Between 2010 and 2022, 19 cases were operated on with this technique. All cases were primary interventions for male-to-female sex reassignment. Because this design of the sensitive inner surface of the labia minora, which ensured vascular safety, was not found in the literature, the design was named “butterfly flap” because of its shape.

Evaluation of Sensation

The area corresponding to both wings of the butterfly flap was evaluated with the Semmes Weinstein Monofilament test, with the patient's eyes closed, in the preoperative period. Likewise, the sensitivity of the inner surface of the labia minora in the first year of 10 patients who were able to attend follow-up clinical examination was evaluated with the same method.

Results

In our study, a clitoris and a labia minora with sensory innervation were obtained by elevating the superior 180-degree area of the neurovascular bundle surrounding the penis and using the butterfly flap we prepared in the area fed by this bundle. Fourteen cases stated that the sensation of the newly formed labia minora was erogenous and different from the tactile sensation on the body of the penis.
Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery
Authors: Parmeshwar Nisha , Mehta Shayna R. , Piper Merisa
Published: July 2023

Background

Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery.

Methods

A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output.

Results

Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003).

Conclusions

This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.
Modified Preauricular Transparotid Approach for Treating Mandibular Condylar Fractures
Authors: Arcuri Francesco , Ferri Andrea , Bianchi Bernardo , Laganà Francesco
Published: July 2023

Aim of the Study:

We introduce a technical variant of the standard preauricular approach to treat intracapsular and condylar neck fractures: the modified preauricular transparotid approach (MPTA). The main modification, when compared with the conventional submandibular approach, is that the incision of the superficial musculoaponeurotic system is performed directly above the parotid gland, and the buccal branch of the facial nerve is dissected in a retrograde way within the parotid gland.

Case Series:

Between January 2019 and December 2020 at the Maxillofacial Departments of “Ospedale Maggiore” of Parma and “Policlinico San Martino” of Genoa 6 patients affected by intracapsular and condylar neck fractures underwent open reduction and internal with MPTA. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 85 minutes, ranging from 75 to 115 minutes. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible.

Conclusion:

MPTA is particularly suited for intracapsular and condylar neck fractures. Morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and esthetic deformity.
Diverticulitis Familiality: A Statewide Case-Control Study
Authors: Cohan Jessica N , Horns Joshua J , Ramsay Joemy M , Huang Lyen C , Allen-Brady Kristina
Published: July 2023

BACKGROUND:

The etiology of diverticulitis is multifactorial and poorly understood. We estimated the familiality of diverticulitis using the Utah Population Database, a statewide database linking medical records with genealogy data.

STUDY DESIGN:

We identified patients with diverticulitis diagnosed between 1998 and 2018 and age- and sex-matched controls in the Utah Population Database. Risk of diverticulitis in family members of patients and controls was calculated using multivariable Poisson models. We performed exploratory analyses to determine the association of familial diverticulitis with severity of disease and age of onset.

RESULTS:

The study population included 9,563 diverticulitis patients (with 229,647 relatives) and 10,588 controls (with 265,693 relatives). Relatives of patients were more likely to develop diverticulitis (incidence rate ratio [IRR] 1.5, 95% CI 1.4 to 1.6) compared with relatives of controls. There was an elevated risk of diverticulitis among first-degree (IRR 2.6, 95% CI 2.3 to 3.0), second-degree (IRR 1.5, 95% CI 1.3 to 1.6), and third-degree relatives of patients (IRR 1.3, 95% CI 1.2 to 1.4). Complicated diverticulitis was more common among relatives of patients compared with relatives of controls (IRR 1.6, 95% CI 1.4 to 1.8). Age at diverticulitis diagnosis was similar between groups (relatives of patients 0.2 years older than relatives of controls, 95% CI –0.5 to 0.9).

CONCLUSIONS:

Our results indicate that the first-, second-, and third-degree relatives of diverticulitis patients are at elevated risk of developing diverticulitis. This information may aid surgeons in counseling patients and family members about diverticulitis risk and can inform the development of future risk-stratification tools. Further work is needed to clarify the causal role and relative contribution of various genetic, lifestyle, and environmental factors in the development of diverticulitis.
Foraging history of individual elephants using DNA metabarcoding
Authors: Gill Brian A. , Wittemyer George , Cerling Thure E. , Musili Paul M. , Kartzinel Tyler R.
Published: July 2023

Individual animals should adjust diets according to food availability. We used DNA metabarcoding to construct individual-level dietary timeseries for elephants from two family groups in Kenya varying in habitat use, social position and reproductive status. We detected at least 367 dietary plant taxa, with up to 137 unique plant sequences in one fecal sample. Results matched well-established trends: elephants tended to eat more grass when it rained and other plants when dry. Nested within these switches from ‘grazing’ to ‘browsing’ strategies, dietary DNA revealed seasonal shifts in food richness, composition and overlap between individuals. Elephants of both families converged on relatively cohesive diets in dry seasons but varied in their maintenance of cohesion during wet seasons. Dietary cohesion throughout the timeseries of the subdominant ‘Artists’ family was stronger and more consistently positive compared to the dominant ‘Royals’ family. The greater degree of individuality within the dominant family's timeseries could reflect more divergent nutritional requirements associated with calf dependency and/or priority access to preferred habitats. Whereas theory predicts that individuals should specialize on different foods under resource scarcity, our data suggest family bonds may promote cohesion and foster the emergence of diverse feeding cultures reflecting links between social behaviour and nutrition.
Domestication effect of reduced brain size is reverted when mink become feral
Authors: Pohle Ann-Kathrin , Zalewski Andrzej , Muturi Marion , Dullin Christian , Farková Lucie , Keicher Lara , Dechmann Dina K. N.
Published: July 2023

A typical consequence of breeding animal species for domestication is a reduction in relative brain size. When domesticated animals escape from captivity and establish feral populations, the larger brain of the wild phenotype is usually not regained. In the American mink (
Neovison vison
), we found an exception to this rule. We confirmed the previously described reduction in relative braincase size and volume compared to their wild North American ancestors in mink bred for their fur in Poland, in a dataset of 292 skulls. We then also found a significant regrowth of these measures in well-established feral populations in Poland. Closely related, small mustelids are known for seasonal reversible changes in skull and brain size. It seems that these small mustelids are able to regain the brain size, which is adaptive for living in the wild, and flexibly respond to selection accordingly.
Fault diagnosis for wind turbines with graph neural network model based on one-shot learning
Authors: Yang Shuai , Zhou Yifei , Chen Xu , Li Chuan , Song Heng
Published: July 2023

Because of the harsh working environment, there is usually a lack of effective data from the gearboxes of wind turbines for fault classification. In this paper, a fault-diagnosis model based on graph neural networks and one-shot learning is proposed to solve the problem of fault classification with limited data. In the proposed method, the short-time Fourier transform is used to convert one-dimensional vibration signals into two-dimensional data, then feature vectors are extracted from the two-dimensional data, and small-sample learning is achieved. An experimental rig was built to simulate the real working scenario of a wind turbine, and the results indicate the high classification accuracy of the proposed method. Furthermore, its effectiveness is verified in comparisons with Siamese, matching and prototypical networks, with the proposed method outperforming all of them.
Sea stars resist wasting through active immune and collagen systems
Authors: Pespeni Melissa H. , Lloyd Melanie M.
Published: July 2023

Epidemics are becoming more common and severe, however, pinpointing the causes can be challenging, particularly in marine environments. The cause of sea star wasting (SSW) disease, the ongoing, largest known panzootic of marine wildlife, is unresolved. Here, we measured gene expression longitudinally of 24 adult
Pisaster ochraceus
sea stars, collected from a recovered site, as they remained asymptomatic (8 individuals) or naturally progressed through SSW (16 individuals) in individual aquaria. Immune, tissue integrity and pro-collagen genes were more highly expressed in asymptomatic relative to wasting individuals, while hypoxia-inducible factor 1-α and RNA processing genes were more highly expressed in wasting relative to asymptomatic individuals. Integrating microbiome data from the same tissue samples, we identified genes and microbes whose abundance/growth was associated with disease status. Importantly, sea stars that remained visibly healthy showed that laboratory conditions had little effect on microbiome composition. Lastly, considering genotypes at 98 145 single-nucleotide polymorphism, we found no variants associated with final health status. These findings suggest that animals exposed to the cause(s) of SSW remain asymptomatic with an active immune response and sustained control of their collagen system while animals that succumb to wasting show evidence of responding to hypoxia and dysregulation of RNA processing systems.
Colonization–persistence trade-offs in natural bacterial communities
Authors: Ontiveros Vicente J. , Capitán José A. , Casamayor Emilio O. , Alonso David
Published: July 2023

Fitness equalizing mechanisms, such as trade-offs, are recognized as one of the main factors promoting species coexistence in community ecology. However, they have rarely been explored in microbial communities. Although microbial communities are highly diverse, the coexistence of their multiple taxa is largely attributed to niche differences and high dispersal rates, following the principle ‘everything is everywhere, but the environment selects’. We use a dynamical stochastic model based on the theory of island biogeography to study highly diverse bacterial communities over time across three different systems (soils, alpine lakes and shallow saline lakes). Assuming fitness equalization mechanisms, here we newly analytically derive colonization–persistence trade-offs, and report a signal of such trade-offs in natural bacterial communities. Moreover, we show that different subsets of species in the community drive this trade-off. Rare taxa, which are occasional and more likely to follow independent colonization/extinction dynamics, drive this trade-off in the aquatic communities, while the core sub-community did it in the soils. We conclude that equalizing mechanisms may be more important than previously recognized in bacterial communities. Our work also emphasizes the fundamental value of dynamical models for understanding temporal patterns and processes in highly diverse communities.
The Impact of Internet Addiction on Academic Performance among Medical Students in Bangladesh: A Cross-Sectional Study and the Potential Role of Yoga
Authors: Afrin Sumaiya , Rahman Nur-A-Safrina , Tabassum Tahsin Tasneem , Abdullah Faisal , Rahman Md. Istiakur , Simu Sumona Haque , Kumar Lakshya , Noor Khutaija , Vishal FNU , Podder Vivek
Published: July 2023

Background

Excessive internet use is a growing concern globally, and internet addiction negatively impacts academic performance. Limited research has been conducted on this topic among undergraduate medical students in Bangladesh.

Purpose

This study aimed to determine the prevalence of internet addiction and its impact on academic performance among medical students in Bangladesh, with a focus on the role of Yoga in reducing internet addiction.

Methods

A cross-sectional study was conducted among third-year medical students in four colleges in Dhaka, Bangladesh. Simple random sampling techniques were used to select participants, and data were collected using pre-tested questionnaires and a checklist for office records through face-to-face interviews. SPSS version 25 was used for data processing and analysis.

Results

Out of 312 students, 84% were addicted to the internet, and only 16% were normal. 64.4% had good results in the first professional examination, while 35.6% had poor results. 85.9% had good attendance, while 14.1% had poor attendance. The association between internet addiction level and first professional examination results and class attendance was highly significant.

Conclusion

This study highlights the high prevalence and negative impacts of internet addiction among medical students in Bangladesh. The study suggests that promoting awareness about healthy technology use, establishing a better balance between internet usage and academic study, and encouraging the practice of Yoga can help alleviate this problem. Further research and interventions are needed to tackle this emerging public health issue. Encouraging students to use the internet for academic purposes and providing education and resources can help promote healthy technology use. Healthcare professionals should also be aware of the risks and encourage seeking help if needed.
Using radio jingles to promote use of a family planning call center: A comparative interruptive time series analysis
Authors: Meekers Dominique , Olutola Olaniyi , Turk Lynn Abu
Published: July 2023

Introduction

This paper measures the effect of a radio jingle campaign promoting a toll-free family planning call center (Honey&Banana) in Nigeria on the number of information requests received.

Methods

Campaign effect is measured using a comparative interrupted time series design. The design assumes that without the radio campaign, the trend in the number of calls from the intervention group would have been parallel to that observed in the control group. The effect of the radio campaign is estimated as the difference between the actual and projected number of calls received.

Results

Before the radio campaign, the trend in the monthly number of requests for family planning information was nearly flat, typically averaging below 500 calls per month. After the start of the campaign, the number of calls immediately increased substantially. The analysis predicted a gain of 360 calls per month during the campaign period. However, the results show that the campaign effect was temporary, which minimal gain after the end of the campaign.

Discussion

Results from the comparative interrupted time series make a convincing case that the radio campaign substantially increased the demand for family planning information from the call center. However, there is no solid evidence that the radio jingle campaign had a longer-term effect on use of the call center after the radio broadcasts ended. Although short-term effects could be important if they benefited disadvantaged groups that cannot easily be reached through other means, we recommend that future campaigns be re-designed to facilitate permanent increases in call center use.
Early oral switch in low-riskStaphylococcus aureusbloodstream infection
Authors: Kaasch Achim J. , López-Cortés Luis Eduard , Rodríguez-Baño Jesús , Cisneros José Miguel , Navarro M. Dolores , Fätkenheuer Gerd , Jung Norma , Rieg Siegbert , Lepeule Raphaël , Coutte Laetitia , Bernard Louis , Lemaignen Adrien , Kösters Katrin , MacKenzie Colin R. , Soriano Alex , Hagel Stefan , Fantin Bruno , Lafaurie Matthieu , Talarmin Jean-Philippe , Dinh Aurélien , Guimard Thomas , Boutoille David , Welte Tobias , Reuter Stefan , Kluytmans Jan , Martin Maria Luisa , Forestier Emmanuel , Stocker Hartmut , Vitrat Virginie , Tattevin Pierre , Rommerskirchen Anna , Noret Marion , Adams Anne , Kern Winfried V. , Hellmich Martin , Seifert Harald ,   SABATO study group (members and affiliations listed in Acknowledgement record)
Published: July 2023

Background

Staphylococcus aureusbloodstream infection (SAB) is treated with at least 14 days of intravenously administered antimicrobials. We assessed the efficacy and safety of an early oral switch therapy in patients at low risk for SAB-related complications.

Methods

In an international non-inferiority trial, we randomized patients with SAB after 5 to 7 days of intravenous antimicrobial therapy to either switch to an oral antimicrobial or to continue with intravenous standard therapy. Main exclusion criteria were signs and symptoms of complicated SAB, non-removable foreign devices, and severe comorbidity. Composite primary endpoint was the occurrence of any SAB-related complication (relapsing SAB, deep-seated infection, and mortality attributable to SAB) within 90 days.

Results

213 patients were randomized into the intention-to-treat population. In the oral switch group, 14/108 (13%) participants reached the primary endpoint versus 13/105 (12%) in the standard therapy group (adjusted difference 0.7%, 95% confidence interval [CI] -7.8% to 9.1%). Participants in the oral switch group were discharged earlier (median hospital stay from SAB onset of 12 days versus 16 days; adjusted difference -3.1 days [95% CI -7.5 to 1.4]). There was no statistical difference in 30-day survival and complications of intravenous administration. More participants in the oral group experienced at least one serious adverse event (34% versus 26%, p=0.292).

Conclusion

Oral switch was non-inferior to intravenous standard therapy in participants with low-risk SAB. However, a careful assessment of patients for signs and symptoms of complicated SAB at time of presentation and thereafter is necessary before considering early oral switch therapy.

The trial was registered asNCT01792804in ClinicalTrials.gov, as DRKS00004741 in the German Clinical trials register, and as EudraCT 2013-000577-77.
The kinetic Ising model encapsulates essential dynamics of land pattern change
Authors: Stepinski Tomasz F. , Nowosad Jakub
Published: July 2023

A land pattern change represents a globally significant trend with implications for the environment, climate, and societal well-being. While various methods have been developed to predict land change, our understanding of the underlying change processes remains inadequate. To address this issue, we investigate the suitability of the 2D kinetic Ising model (IM), an idealized model from statistical mechanics, for simulating land change dynamics. We test the IM on a variety of diverse thematic contexts. Specifically, we investigate four sites characterized by distinct patterns, presumably driven by different physical processes. Each site is observed on eight occasions between 2001 and 2019. Given the observed pattern at timesti,i= 1, …, 7, we find two parameters of the IM such that the model-evolved land pattern atti+1resembles the observed land pattern at that time. Our findings indicate that the IM produces approximate matches to the observed patterns in terms of layout, composition, texture, and patch size distributions. Notably, the IM simulations even achieve a high degree of cell-scale pattern accuracy in two of the sites. Nevertheless, the IM has certain limitations, including its inability to model linear features, account for the formation of new large patches, and handle pattern shifts.