bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment efficacy and safety of adalimumab versus tocilizumab in patients with active and severe Takayasu arteritis: an open-label study
Authors: Wang Jinghua , Kong Xiufang , Ma Lili , Ding Zhenqi , Chen Huiyong , Chen Rongyi , Jin Xuejuan , Chen Caizhong , Lin Jiang , Jiang Lindi
Published: August 2023

Objective

This study aimed to compare the efficacy and safety of adalimumab (ADA) vs tocilizumab (TCZ) in patients with Takayasu arteritis (TAK).

Methods

This was a randomized, controlled, open-label study. Forty patients with active and severe TAK were enrolled. They were treated with ADA (n = 21) combined with glucocorticoids (GCs) and MTX or TCZ (n = 19) combined with GCs and MTX. The planned follow-up duration was 12 months. The primary end point was the efficacy rate (ER) at 6 months. The secondary end points included ER at 9 and 12 months, relapse rate, GC tapering, adverse effects, and life quality changes during treatment.

Results

In the intention-to-treat (ITT) population, the ER at 6 months was higher in the ADA group (85.71% vs 52.63%, P = 0.02). A similar direction of effect was noted in the per-protocol set (89.47% vs 62.50%, P = 0.06). The percentages of patients who achieved a GC dose of ≤10 mg/day at 6 months were similar between the ADA and TCZ groups (47.37% vs 43.75%, P = 0.83). The ERs at 9 and 12 months were similar between the two groups (P > 0.05). During the first 12 months of treatment, the relapse rate and adverse event incidence were comparable between the two groups (ADA vs TCZ: 9.52% vs 10.53%, P = 0.96; 38.10% vs 47.37%, P = 0.55, respectively).

Conclusion

ADA combined with GCs and MTX may be more efficacious than TCZ combined with GCs and MTX among patients with active and severe TAK.

Trial registration

Clinicaltrials.gov; NCT04300686.
Cerebrospinal-fluid biomarkers for predicting phenoconversion in patients with isolated rapid-eye movement sleep behavior disorder
Authors: Fernandes Mariana , Maio Silvia , Eusebi Paolo , Placidi Fabio , Izzi Francesca , Spanetta Matteo , De Masi Claudia , Lupo Clementina , Calvello Carmen , Nuccetelli Marzia , Bernardini Sergio , Mercuri Nicola Biagio , Liguori Claudio
Published: August 2023

Study Objectives

Patients with isolated rapid-eye-movement sleep behavior disorder (iRBD) have an increased risk of developing neurodegenerative diseases. This study assessed cerebrospinal-fluid (CSF) biomarkers of neurodegeneration and blood-brain barrier (BBB) alteration in patients with iRBD compared to controls and ascertain whether these biomarkers may predict phenoconversion to alpha-synucleinopathies (Parkinson’s Disease (PD), Dementia with Lewy bodies (DLB), Multiple System Atrophy (MSA)).

Methods

Patients and controls underwent between 2012 and 2016 a neurological assessment, a lumbar puncture for CSF biomarker analysis (β-amyloid42 - Aβ42; total-tau, and phosphorylated tau), and BBB alteration (CSF/serum albumin ratio). All patients with iRBD were followed until 2021 and then classified into patients who converted to alpha-synucleinopathies (iRBD converters, cRBD) or not (iRBD non-converters, ncRBD).

Results

Thirty-four patients with iRBD (mean age 67.12 ± 8.14) and 33 controls (mean age 64.97 ± 8.91) were included. At follow-up (7.63 ± 3.40 years), eight patients were ncRBD and 33 patients were cRBD: eleven converted to PD, 10 to DLB, and two to MSA. Patients with iRBD showed lower CSF Aβ42 levels and higher CSF/serum albumin ratio than controls. Cox regression analysis showed that the phenoconversion rate increases with higher motor impairment (hazard ratio [HR] = 1.23, p = 0.032). CSF Aβ42 levels predicted phenoconversion to DLB (HR = 0.67, p = 0.038) and BBB alteration predicted phenoconversion to PD (HR = 1.20, p = 0.038).

Discussion

This study showed that low CSF Aβ42 levels and high BBB alteration may predict the phenoconversion to DLB and PD in patients with iRBD, respectively. These findings highlight the possibility to discriminate phenoconversion in iRBD patients through CSF biomarkers; however, further studies are needed.
Surgical Management of Vestibular Schwannomas: The Retrosigmoid Approach
Authors: Tiano Benjamin N. , Deep Nicholas L. , Turcotte Evelyn L. , Bendok Bernard R. , Weisskopf Peter A.
Published: August 2023

This article is written to provide the reader with a comprehensive overview of the retrosigmoid approach to resection of a tumor at the cerebellopontine angle (CPA). Vestibular schwannoma is a benign tumor arising from either the superior or inferior vestibular nerves. These slow-growing tumors are initially clinically silent but eventually result in symptoms of hearing loss and imbalance, as they grow and compress surrounding cranial nerves and the brainstem. Observation, radiosurgery, and microsurgical resection are the 3 primary management strategies, and decision-making is highly nuanced and individualized to the patient.
Cooling Down Inflammation in the Cardiovascular System via the Nicotinic Acetylcholine Receptor
Authors: Kaplan Abdullah , Lakkis Bachir , El-Samadi Lana , Karaayvaz Ekrem Bilal , Booz George W. , Zouein Fouad A.
Published: August 2023

Inflammation is a major player in many cardiovascular diseases including hypertension, atherosclerosis, myocardial infarction, and heart failure. In many individuals, these conditions coexist and mutually exacerbate each other's progression. The pathophysiology of these diseases entails the active involvement of both innate and adaptive immune cells. Immune cells that possess the α7 subunit of the nicotinic acetylcholine receptor on their surface have the potential to be targeted through both pharmacological and electrical stimulation of the cholinergic system. The cholinergic system regulates the inflammatory response to various stressors in different organ systems by systematically suppressing spleen-derived monocytes and chemokines and locally improving immune cell function. Research on the cardiovascular system has demonstrated the potential for atheroma plaque stabilization and regression as favorable outcomes. Smaller infarct size and reduced fibrosis have been associated with improved cardiac function and a decrease in adverse cardiac remodeling. Furthermore, enhanced electrical stability of the myocardium can lead to a reduction in the incidence of ventricular tachyarrhythmia. In addition, improving mitochondrial dysfunction and decreasing oxidative stress can result in less myocardial tissue damage caused by reperfusion injury. Restoring baroreflex activity and reduction in renal damage can promote blood pressure regulation and help counteract hypertension. Thus, the present review highlights the potential of nicotinic acetylcholine receptor activation as a natural approach to alleviate the adverse consequences of inflammation in the cardiovascular system.
Vomer Flaps Support Velopharyngeal Competency, Fistula Free Repair, and 3D Construction of Normal Anatomy in Patients with Cleft Palate
Authors: Schmidt Gül , Toubekis Evjenia , Koch Hubertus , Schlabe Jürgen , Hunn-Stohwasser Christa , Beck-Broichsitter Benedicta , Heiland Max , Matuschek Carsten
Published: August 2023

Background:

Cleft palate repair comprises the surgical creation of a congenitally nonexistent normal anatomy, to establish physiological function by moving tissues into their normal anatomical positions. In patients with isolated incomplete (IICP) or submucous (SMCP) cleft palate, the vomer is usually not completely attached to the palatal plate in the midline. This condition, which is visible through surgical access radiologically or via endoscope, is often disregarded during hard palate repair. This can lead to “hypernasality” despite a well-functioning velopharyngeal mechanism. The general practice of hard palate repair by suturing merely the nasal layers together separates the oral and nasal cavities. However, without incorporation of the vomer, it is impossible to build two separate nasal floors on the left and right sides. We consider that achieving normal speech and separation of the nasal cavities are mutually dependent and have to be considered equally.

Methods:

We described hard palate repair involving the vomer for construction of both nasal floors. We presented the occlusal relationship, hypernasality, and fistula rates in 37 patients operated on between January 1, 2017 and June 30, 2018.

Results:

One child presented minimal hypernasality; all others had normal resonance/voice. Fistula rate was zero, and no cross bites were observed.

Conclusions:

The implicit connection between the inner nose, resonance/voice, and prevention of fistulae has not yet been acknowledged. The correct usage of vomer flaps in IICP and SMCP creating separate nasal floors supports the velopharyngeal competency, avoids fistula formation, and should be incorporated regularly, like in other cleft forms.
Reinforced Biologic Mesh Reduces Postoperative Complications Compared to Biologic Mesh after Ventral Hernia Repair
Authors: Sivaraj Dharshan , Henn Dominic , Fischer Katharina S. , Kim Trudy S. , Black Cara K. , Lin John Q. , Barrera Janos A. , Leeolou Melissa C. , Makarewicz Nathan S. , Chen Kellen , Perrault David P. , Gurtner Geoffrey C. , Lee Gordon K. , Nazerali Rahim
Published: August 2023

Background:

The use of biologic mesh to reinforce the abdominal wall in ventral hernia repair has been proposed as a viable alternative to synthetic mesh, particularly for high-risk patients and in contaminated settings. However, a comparison of clinical outcomes between the currently available biologic mesh types has yet to be performed.

Methods:

We performed a retrospective analysis of 141 patients who had undergone ventral hernia repair with biologic mesh, including noncross-linked porcine ADM (NC-PADM) (n = 51), cross-linked porcine ADM (C-PADM) (n = 17), reinforced biologic ovine rumen (RBOR) (n = 36), and bovine ADM (BADM) (n = 37) at the Stanford University Medical Center between 2002 and 2020. Postoperative donor site complications and rates of hernia recurrence were compared between patients with different biologic mesh types.

Results:

Abdominal complications occurred in 47.1% of patients with NC-PADM, 52.9% of patients with C-PADM, 16.7% of patients with RBOR, and 43.2% of patients with BADM (P = 0.015). Relative risk for overall complications was higher in patients who had received NC-PADM (RR = 2.64, P = 0.0182), C-PADM (RR = 3.19, P = 0.0127), and BADM (RR = 2.11, P = 0.0773) compared with those who had received RBOR. Furthermore, relative risk for hernia recurrence was also higher in all other mesh types compared with RBOR.

Conclusion:

Our data indicate that RBOR decreases abdominal complications and recurrence rates after ventral hernia repair compared with NC-PADM, C-PADM, and BADM.
The Modified M-plasty Approach to Mastectomy: Avoiding the Lateral Dog-ear
Authors: Meybodi Farid , Pham My , Sedaghat Negin , Elder Elisabeth , French James
Published: August 2023

Postmastectomy “dog-ears” are cosmetically displeasing, can contribute to a poorly fitting bra, and may cause discomfort for patients. They occur most commonly in patients with high body mass index and/or large breasts and can be challenging to manage. To avoid the lateral dog-ear following simple mastectomy, we describe the M-plasty with the addition of a lipodermal flap. We demonstrate that the addition of a lipodermal flap not only flattens the lateral contour of the chest wall but also facilitates a tension-free closure. This helps reduce wound-healing issues in high-risk patients with multiple comorbidities, high body mass index, and large breast size.
Successful Restoration of Elbow Extension Using the Latissimus Dorsi Flap: Case Report
Authors: Ozaniak Andrej , Hladik P. , Lischke R.
Published: August 2023

The latissimus dorsi (LD) myocutaneous flap is heavily used in reconstructive plastic surgery as either a local or distant flap, and mostly for coverage of large defects. To date, only a limited number of studies have described the use of an LD flap for functional reconstruction. Restoration of the extensor mechanism remains an unexplored area, and several issues remain to be addressed. First, generally accepted recommendations for the surgical technique do not include specific steps to achieve functional qualities of the upper extremity after complete removal of the triceps brachii muscle. Second, to date, it has not been clarified whether elbow extension requires correction because the movement can be naturally compensated for by gravity. To contribute to the current knowledge base in this field, the authors describe a technique for the reconstruction of an extensor mechanism of the elbow by transferring a pedicled functional LD flap while maintaining an intact insertion. Reconstruction was performed in a patient who experienced a second recurrence of a malignant peripheral nerve sheath tumor and underwent complete excision of the triceps brachii muscle. After excision, a meshed epidermal graft was used for wound closure. The patient’s postoperative course was uneventful. His elbow was immobilized for 3 weeks using an elbow splint, followed by intensive rehabilitation. The functional result was excellent, with an Enneking limb function score of 26. During the 16-month follow-up, no signs of local recurrence or systemic spread were observed.
Use of Double Myocutaneous Flap after Extended Resection of Locally Advanced Ulcerated Breast Carcinoma
Authors: Vieira René Aloisio da Costa , Oliveira Luiz Carlos Navarro de , Ching An Wan , de Oliveira-Junior Idam
Published: August 2023

Locally advanced ulcerated breast neoplasm is a condition that frequently occurs in developing countries. Generally, it is centrally localized and submitted to neoadjuvant therapy; thereafter, upon disappearance of the ulceration, it is submitted to radical mastectomy. Presence of axillary infiltration and ulceration with incomplete response makes it necessary for the use of surgical flaps for skin closure. We report a case in which primary reconstructive surgical procedure and skin closure was necessary, where we used double myocutaneous flaps—the latissimus dorsi and VRAM (vertical rectus abdominis myocutaneous) flap. We discussed treatment of the ulcerated lesions, possible surgical solutions, and the conditions associated with the use of double flaps. For primary closure of extensive areas, double myocutaneous flaps can be used as a solution in cases where skin grafts or surgical microsurgical flaps are not able to serve as a surgical solution. Myocutaneous flaps are associated with lower rates of complication, allowing for rapid recovery without increasing the time necessary before the next adjuvant therapy.
Tongue Flap for Total Full Thickness Upper Lip with Vermillion Reconstruction: Case Report
Authors: Mrad Mohamed A. , AlMarshad Felwa A. , AlMarghoub Mohammed A. , Mahabbat Nehal , AlMubarak Sultan K.
Published: August 2023

Lips play an important role in the function of the oral stoma. Lips also have a vital aesthetic role in the face. Lips are typically reconstructed by local, regional, or free flaps. Tongue flaps have been used for reconstruction of oral and palate defects resulting from congenital disorders, trauma, infection, and surgery. Because of its versatility, rich blood supply, and position, the tongue flap is reliable for defect reconstruction. In this study, we report a case of an upper lip full thickness defect managed with a tongue flap. The results were functionally and aesthetically excellent. To the best of our knowledge, this is the first attempt to reconstruct a full upper lip defect using the tongue.
Operation-related Musculoskeletal Injuries among United States Surgeons: A Gender-stratified National Survey
Authors: Tran Maria , Kortz Michael W. , Johnson Britt , Janis Jeffrey E.
Published: August 2023

Background:

Operation-related musculoskeletal injury (ORMI) among surgeons is a well-described phenomenon. Our study aimed to determine the prevalence of self-reported ORMI among surgeons of various subspecialties and preliminarily investigate the role of gender.

Methods:

An anonymous survey, querying information pertinent to ORMIs, was distributed online through the American College of Surgeons community membership forum. Nonparametric univariate analysis and a multivariate regression model were conducted. A P value of 0.05 determined significance.

Results:

A total of 624 male and female surgeons responded to the survey, with 50.8% reporting having an injury related to operating. Among the entire cohort, the prevalence of ORMI was significantly higher among female surgeons than male surgeons (P = 0.01), although there was no significant difference among the genders in ORMI prevalence when stratifying by age group (all P > 0.05).

Conclusion:

Female surgeons are more likely to report an ORMI, although the impact of confounding variables such as age, operative case volume, and surgical subspecialty remain to be fully elucidated.
Trends, Gaps, and Collaboration in Facial Transplantation: A Bibliometric Study
Authors: Hoffman Alexandra F. , Rodriguez Colon Ricardo , Diep Gustave K. , Berman Zoe P. , Kimberly Laura L. , Trilles Jorge , Boczar Daniel , Chaya Bachar F. , Rodriguez Eduardo D.
Published: August 2023

Background:

Facial transplantation (FT) has advanced extensively over the past two decades, with over 40 transplants performed to date. Over this time, the FT literature has evolved as well, from early discussions on ethics and feasibility of FT to functional outcomes reports more recently. We aimed to evaluate the entire body of FT literature to identify trends in publications over time in addition to current existing gaps in the field.

Methods:

We conducted a comprehensive bibliometric analysis of the published FT literature from 1994, the first year FT was mentioned in the literature, through July 2020. Co-authorship and keyword information were analyzed using VOSviewer. Articles were manually categorized based on keywords and their aim to provide insight on trends.

Results:

A total of 2182 articles were identified. Analysis identified the top 50 publishing authors in the field and demonstrated co-authorship linkage between 84.8% of the top 1000 authors. Clinical surgical techniques, protocols, and experiments were the most frequently published category. Within clinical outcomes, immunologic outcomes were most frequent, while psychosocial were the lowest. Gaps were identified in long-term outcomes reporting and patient-reported outcomes, with physician-reported outcomes heavily outweighing patient-reported outcomes.

Conclusions:

As the field continues to evolve, rigorous tracking of publication patterns over time will encourage development of a more robust evidence base, identify gaps in the published literature, and highlight opportunities to enhance collaboration in the field. This data will provide surgeons and research institutions with information to further improve this life-changing procedure.
Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting
Authors: Gfrerer Lisa , Winograd Jonathan M. , Austen William G. , Valerio Ian L.
Published: August 2023

Background:

Restoration of breast sensation has become an important goal in autologous and implant-based breast reconstruction after cancer-related mastectomy. Although gender-affirming mastectomy with free nipple grafting (FNG) results in similar sensory deficits, chest reinnervation concepts have not been applied to this procedure.

Methods:

This article describes a novel technique to reinnervate the FNG in patients undergoing double incision gender mastectomy.

Results:

Our technique differs from previously described reinnervation techniques in several aspects: (1) the donor axon count is maximized by preserving the third to fifth lateral cutaneous nerves for coaptation to the nipple areola complex, (2) the reinnervation approach varies and is based on patient anatomy, (3) the distal graft or donor nerve is split into fascicles to increase the reinnervation zone, and (4) the split fascicles are coapted to the dermatosensory peripheral nerve elements of the dermis.

Conclusion:

Chest reinnervation is technically feasible in patients undergoing double incision gender mastectomy with FNG (please also see the video abstract).
The Application of Medical Tattooing in Cosmetic Breast Surgery
Authors: Becker Stacie , Proctor Miranda , Cassisi Jeffrey E.
Published: August 2023

Historically, medical tattooing has mainly been applied to correct or simulate the nipple areola complex among breast cancer survivors postmastectomy. Our purpose was to extend the application of medical tattooing to other cosmetic breast surgeries in a complimentary fashion and to improve aesthetic outcomes through scar blending, areola extension, and/or decorative appliques. Two case studies in which medical tattooing was applied following breast augmentation or reduction are presented. Our clinical procedures are described, including assessment, treatment planning, equipment, inks, and considerations for topical anesthesia. The two cases illustrate the range of applications of medical tattooing in cosmetic breast surgery from minor touch-up, to using elaborate decorative appliques for camouflage. Preoperative photographs, and postoperative patient photographs illustrating good aesthetic outcomes are presented. The field of medical tattooing is effective and is expanding rapidly but needs professional direction. We suggest plastic and cosmetic surgery practices develop active and intentional relationships with professional tattoo artists. Professional medical organizations should lead the development of medical tattoo assistant training and credentialling. Priorities for future research are described.
An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care
Authors: Miller Angela , Skoranski Allen K. , Prior Barbara , Fitzpatrick Rebecca , Morgan Cindy , Hepschmidt Philynn , Smith Beth A. , Cella Michael , Brown McGlotten Dawn , Pitt Kenya , Polomano Rosemary C.
Published: August 2023

In ambulatory care, monitoring process performance measures (PPMs) is essential to meet regulatory requirements, establish targets for care, seek reimbursement, and evaluate patient care responsibilities. We implemented a comprehensive program, “Engage to Sustain,” for licensed practical nurses (LPNs) and certified medical assistants (CMAs) to practice at the top of their licensure/certification. Screening rates for 4 key PPMs (depression screening, fall risk screening, and tobacco use and counseling) markedly increased following this intervention across 18 ambulatory departments with more than 2 million patient visits. Shifting responsibilities for patient screening from physicians and advanced practitioners to LPNs and CMAs improves screening rates.
What is new with irritable bowel syndrome
Authors: Kamal Hebat Y. , Morneault-Gill Kayla , Chadwick Christina B.
Published: August 2023

Purpose of review

This review aims to summarize the most up-to-date criteria for diagnosis of pediatric irritable bowel syndrome (IBS) and treatment options. It also explores recent research that has been performed evaluating risk factors, pathophysiology, and treatment designed to improve quality of life for those who suffer from IBS. IBS is a common disorder in pediatrics and one of the most common causes of abdominal pain for children; thus, it can be quite debilitating for individuals to achieve a satisfactory quality of life on a routine basis. Reliable, available treatment is needed but can be challenging to find, given the variety of symptoms and triggers involved and lack of a clear understanding of how IBS develops.

Recent findings

There are multiple pharmacologic and nonpharmacologic treatment options being explored and studied globally but further, larger, and well controlled studies are needed to confirm these outcomes.

Because pediatric IBS is one of the most common functional disorders associated with abdominal pain and can be brought on by multiple factors, management often involves addressing these individual triggers with a multifaceted treatment plan, which could include dietary changes, probiotics, medication, or psychotherapy and should be tailored to each affected individual.
The Modified Clinical Progression Scale for Pediatric Patients: Evaluation as a Severity Metric and Outcome Measure in Severe Acute Viral Respiratory Illness
Authors: Leland Shannon B. , Staffa Steven J. , Newhams Margaret M. , Khemani Robinder G. , Marshall John C. , Young Cameron C. , Maddux Aline B. , Hall Mark W. , Weiss Scott L. , Schwarz Adam J. , Coates Bria M. , Sanders Ronald C. , Kong Michele , Thomas Neal J. , Nofziger Ryan A. , Cullimore Melissa L. , Halasa Natasha B. , Loftis Laura L. , Cvijanovich Natalie Z. , Schuster Jennifer E. , Flori Heidi , Gertz Shira J. , Hume Janet R. , Olson Samantha M. , Patel Manish M. , Zurakowski David , Randolph Adrienne G. ,   on behalf of the Pediatric Acute Lung and Sepsis Investigator’s Network Pediatric Intensive Care Influenza Study Group (PALISI PICFLU) Investigators and Overcoming COVID-19 Investigators
Published: August 2023

OBJECTIVES:

To develop, evaluate, and explore the use of a pediatric ordinal score as a potential clinical trial outcome metric in children hospitalized with acute hypoxic respiratory failure caused by viral respiratory infections.

DESIGN:

We modified the World Health Organization Clinical Progression Scale for pediatric patients (CPS-Ped) and assigned CPS-Ped at admission, days 2–4, 7, and 14. We identified predictors of clinical improvement (day 14 CPS-Ped ≤ 2 or a three-point decrease) using competing risks regression and compared clinical improvement to hospital length of stay (LOS) and ventilator-free days. We estimated sample sizes (80% power) to detect a 15% clinical improvement.

SETTING:

North American pediatric hospitals.

PATIENTS:

Three cohorts of pediatric patients with acute hypoxic respiratory failure receiving intensive care: two influenza (pediatric intensive care influenza [PICFLU], n = 263, 31 sites; PICFLU vaccine effectiveness [PICFLU-VE], n = 143, 17 sites) and one COVID-19 (n = 237, 47 sites).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Invasive mechanical ventilation rates were 71.4%, 32.9%, and 37.1% for PICFLU, PICFLU-VE, and COVID-19 with less than 5% mortality for all three cohorts. Maximum CPS-Ped (0 = home at respiratory baseline to 8 = death) was positively associated with hospital LOS (p < 0.001, all cohorts). Across the three cohorts, many patients’ CPS-Ped worsened after admission (39%, 18%, and 49%), with some patients progressing to invasive mechanical ventilation or death (19%, 11%, and 17%). Despite this, greater than 76% of patients across cohorts clinically improved by day 14. Estimated sample sizes per group using CPS-Ped to detect a percentage increase in clinical improvement were feasible (influenza 15%, n = 142; 10%, n = 225; COVID-19, 15% n = 208) compared with mortality (n > 21,000, all), and ventilator-free days (influenza 15%, n = 167).

CONCLUSIONS:

The CPS-Ped can be used to describe the time course of illness and threshold for clinical improvement in hospitalized children and adolescents with acute respiratory failure from viral infections. This outcome measure could feasibly be used in clinical trials to evaluate in-hospital recovery.
Pulmonary Hemorrhage in Pediatric Hematopoietic Stem Cell Transplant Recipients: A Single-Center Retrospective Study
Authors: Chopra Yogi , Alsabahi Amal , Schechter Tal , Mtaweh Haifa , Sweezey Neil , Balit Corinne , Ali Muhammad , Chiang Kuang-Yueh , Gassas Adam , Krueger Joerg
Published: August 2023

OBJECTIVES:

Pulmonary hemorrhage (PH) is a serious complication posthematopoietic stem cell transplant (HSCT). In view of limited available pediatric data, we performed a retrospective study to describe epidemiology, management, and outcomes of PH post-HSCT in children in our national center.

DESIGN:

Retrospective study.

SETTING:

Academic children’s hospital (2000–2015).

Subjects:

Children (< 18 yr) with PH and requiring PICU care post-HSCT.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The historical prevalence of PH in our center was 2.7% (31/1,148). Twenty patients had a concomitant infection, 15 had bacterial infection, 8 had viral infection, and 3 patients had a fungal infection. With a median follow-up time of 60 months, 7 of 31 patients were alive. Early PH (< 40 d post-HSCT) was associated with improved survival (6/15 vs 1/16, p = 0.035). Patients who received high-dose pulsed corticosteroid had improved survival when compared with those who did not (7/22 vs 0/9, p = 0.0012); this also applied to the subgroup of patients with a concomitant infection (5/15 vs 0, p = 0.001). None of the patients who survived had measurable respiratory sequelae.

CONCLUSIONS:

PH is a rare but serious complication after HSCT. Corticosteroids were associated with improved survival even in patients with a concomitant infection.
Defining A Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships
Authors: Binda Catherine J. , Adams Jayd , Livergant Rachel , Lam Sheila , Panchendrabose Kapilan , Joharifard Shahrzad , Haji Faizal , Joos Emilie
Published: August 2023

Objective:

To use expert consensus to build a concrete and realistic framework and checklist to evaluate sustainability in Global Surgery Partnerships (GSPs).

Summary Background Data:

Partnerships between high- and low-resourced settings are often created to address the burden of unmet surgical need. Reflecting on the negative, unintended consequences of asymmetrical partnerships, global surgery community members have proposed frameworks and best practices to promote sustainable engagement between partners, though these frameworks lack consensus. This project proposes a cohesive, consensus-driven framework with accompanying evaluation metrics to guide sustainability in GSPs.

Methods:

A modified Delphi technique with purposive sampling was used to build consensus on the definitions and associated evaluation metrics of previously proposed pillars (Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, Outcome Measurement) of sustainable GSPs.

Results:

Fifty global surgery experts from 34 countries with a median of 9.5 years of experience in the field of global surgery participated in three Delphi rounds. Consensus was achieved on the identity, definitions, and a 47-item checklist for the evaluation of the six pillars of sustainability in GSPs. 29% of items achieved consensus in the first round, whereas 100% achieved consensus in the second and third rounds.

Conclusion:

We present the first framework for building sustainable GSPs using the input of experts from all World Health Organization regions. We hope this tool will help the global surgery community to find non-colonial solutions to addressing the gap in access to quality surgical care in low-resource settings.
Haliovirga abyssi gen. nov., sp. nov., a mesophilic fermentative bacterium isolated from the Iheya North hydrothermal field, and proposal of Haliovirgaceae fam. nov.
Authors: Miyazaki Urara , Tame Akihiro , Miyazaki Junichi , Takai Ken , Sawayama Shigeki , Kitajima Masaaki , Okamoto Akihiro , Nakagawa Satoshi
Published: August 2023

A novel mesophilic, obligately anaerobic, facultatively sulphur-reducing bacterium, designated strain IC12T, was isolated from a deep-sea hydrothermal field in the Mid-Okinawa Trough, Japan. The cells were Gram-negative, motile, short rods with a single polar flagellum. The ranges and optima of the growth temperature, NaCl concentration and pH of strain IC12T were 15–40 °C (optimum, 30–35 °C), 10–60 g l−1 (optimum, 20–30 g l−1) and pH 4.9–6.7 (optimum, pH 5.8), respectively. Yeast extract was utilized as a sole carbon and energy source for fermentative growth. Major fatty acids of strain IC12T were C14 : 0, C16 : 0 and C16 : 1 ω7. Results of phylogenetic analysis based on 16S rRNA gene sequences indicated that strain IC12T was affiliated to the phylum

Fusobacteriota

and was most closely related to

Ilyobacter insuetus

VenChi2T (86.5 % sequence similarity). Strain IC12T contained a chromosome of 2.43 Mbp and a large plasmid of 0.30 Mbp. The G+C content of the genomic DNA was 26.4 mol%. The maximum values for average nucleotide identity and in silico DNA–DNA hybridization between strain IC12T and related strains of the phylum

Fusobacteriota

were 71.4 and 26.4 %, respectively. Phylogenomic, physiological and chemotaxonomic analyses indicate that strain IC12T represents a novel genus and species within the phylum

Fusobacteriota

, for which the name Haliovirga abyssi gen. nov., sp. nov. is proposed, with strain IC12T (= DSM 112164T=JCM 39166T) as the type strain. We also propose the family Haliovirgaceae fam. nov. to accommodate this novel genus.
Role of the gut microbiota in nutrient competition and protection against intestinal pathogen colonization
Authors: Horrocks Victoria , King Olivia G. , Yip Alexander Y. G. , Marques Inês Melo , McDonald Julie A. K.
Published: August 2023

The human gut microbiota can restrict the growth of pathogens to prevent them from colonizing the intestine (‘colonization resistance’). However, antibiotic treatment can kill members of the gut microbiota (‘gut commensals’) and reduce competition for nutrients, making these nutrients available to support the growth of pathogens. This disturbance can lead to the growth and expansion of pathogens within the intestine (including antibiotic-resistant pathogens), where these pathogens can exploit the absence of competitors and the nutrient-enriched gut environment. In this review, we discuss nutrient competition between the gut microbiota and pathogens. We also provide an overview of how nutrient competition can be harnessed to support the design of next-generation microbiome therapeutics to restrict the growth of pathogens and prevent the development of invasive infections.
FiTMuSiC: Leveraging structural and (co)evolutionary data for protein fitness prediction
Authors: Tsishyn Matsvei , Cia Gabriel , Hermans Pauline , Kwasigroch Jean , Rooman Marianne , Pucci Fabrizio
Published: August 2023

Systematically predicting the effects of mutations on protein fitness is essential for the understanding of genetic diseases. Indeed, predictions complement experimental efforts in analyzing how variants lead to dysfunctional proteins that in turn can cause diseases. Here we present our new fitness predictor, FiTMuSiC, which leverages structural, evolutionary and coevolutionary information. We show that FiTMuSiC predicts fitness with high accuracy despite the simplicity of its underlying model: it was one of the top predictors on the hydroxymethylbilane synthase (HMBS) target of the sixth round of the Critical Assessment of Genome Interpretation challenge (CAGI6). To further demonstrate FiTMuSiC’s robustness, we compared its predictions within vitroactivity data on HMBS, variant fitness data on human glucokinase (GCK), and variant deleteriousness data on HMBS and GCK. These analyses further confirm FiTMuSiC’s qualities and accuracy, which compare favorably with those of other predictors. Additionally, FiTMuSiC returns two scores that separately describe the functional and structural effects of the variant, thus providing mechanistic insight into why the variant leads to fitness loss or gain. We also provide an easy-to-use webserver athttp://babylone.ulb.ac.be/FiTMuSiC/, which is freely available for academic use and does not require any bioinformatics expertise, which simplifies the accessibility of our tool for the entire scientific community.
Optogenetic control of lysosome function
Authors: Ilyinsky Nikolay S. , Bukhalovich Sergey M. , Bagaeva Diana F. , Alekseev Alexey A. , Nesterov Semen V. , Tsybrov Fedor M. , Bogorodskiy Andrey O. , Nazarova Sofia F. , Alekhin Vadim A. , Moiseeva Olga V. , Vlasova Anastasiya D. , Kovalev Kirill V. , Mikhailov Anatoliy E. , Rogachev Andrey V. , Bamberg Ernst , Borshchevskiy Valentin I. , Gordeliy Valentin
Published: August 2023

Lysosome protective, metabolic, signaling functions are highly dependent on their pH. A lack of tools of high spatial and temporal resolution for pH control is a bottleneck of lysosome related cell research. Light-driven inward proton pumpNsXeR, targeted to the lysosomes of mammalian cells, produces lysosome alkalization simply by light. Complementary use of outward proton pumping Arch3 rhodopsins in lysosomes offers an approach to vary pH in a range from around 5 to 6.5 in both directions (de-acidification and acidification). Lyso-NsXeR optogenetics efficiency was demonstrated, in particular, by its ability to inhibit lysosome proteolytic enzymes. Thus, optogenetic monitoring and regulation of the lysosome function, through pH control over a wide range, could serve as an approach to studying fundamental cell processes, and rational drug design.
Liquid–liquid phase separation of α-synuclein is highly sensitive to sequence complexity
Authors: Mahapatra Anindita , Newberry Robert W.
Published: August 2023

The Parkinson’s-associated protein α-synuclein (α-syn) can undergo liquid–liquid phase separation (LLPS), which typically leads to the formation of amyloid fibrils. The coincidence of LLPS and amyloid formation has complicated the identification of the molecular determinants unique to LLPS of α-syn. Moreover, the lack of strategies to selectively perturb LLPS makes it difficult to dissect the biological roles specific to α-syn LLPS, independent of fibrillation. Herein, using a combination of subtle missense mutations, we show that LLPS of α-syn is highly sensitive to its sequence complexity. In fact, we find that even a highly conservative mutation (V16I) that increases sequence complexity without perturbing physicochemical and structural properties, is sufficient to reduce LLPS by 75%; this effect can be reversed by an adjacent V-to-I mutation (V15I) that restores the original sequence complexity. A18T, a complexity-enhancing PD-associated mutation, was likewise found to reduce LLPS, implicating sequence complexity in α-syn pathogenicity. Furthermore, leveraging the differences in LLPS propensities among different α-syn variants, we demonstrate that fibrillation of α-syn does not necessarily correlate with its LLPS. In fact, we identify mutations that selectively perturb LLPSorfibrillation of α-syn, unlike previously studied mutations. The variants and design principles reported herein should therefore empower future studies to disentangle these two phenomena and distinguish their (patho)biological roles.
Corporate governance and the choice between bank debt and public debt
Authors: Ahmed Irfan , Mehmood Owais , Ghafoor Zeshan , Jamil Syed Hassan , Majeed Afkar
Published: August 2023

Purpose

This study aims to examine the impact of board characteristics on debt choice.

Design/methodology/approach

The sample comprises of unique nonfinancial firms listed in the FTSE 350 over the period 2011–2018. This study uses Tobit and OLS regressions to check the impact of board characteristics on debt choice. The results are robust to the battery of robust checks.

Findings

This study finds that board size and board independence are positively associated with public debt. However, CEO duality and board meetings frequency are inversely associated with public debt. Overall, the findings are consistent with the “financial intermediation theory” that the firms with weak governance rely on bank financing, and firms with better corporate governance go for public debt.

Research limitations/implications

This study offers significant insights for investors and policymakers.

Originality/value

This study offers new insights regarding the role of board characteristics in firms’ debt choice by showing the significant impact of board characteristics on debt choice. The findings indicate that the board’s efficient internal monitoring may substitute external monitoring by the bank.
Study on the functional relationship between pressure and displacement with time for waist of elastic legwear using FEM
Authors: Dan Rui , Zheng Yujie , Liu ZhiQin , Shi Zhen
Published: August 2023

Purpose

The inward displacement perpendicular to the body surface produced by compression garment is an important index to evaluate pressure comfort and optimal design of tight clothing products. The purpose of this study is to explore the pressure distribution state at waist position of elastic legwear and then to solve the common problem of excessive pressure or easy slippage for waist of elastic legwear.

Design/methodology/approach

In this paper, the authors obtained the waist cross-section model of human body using CT scanning and mimics modeling and then simulated the pressure and displacement distribution after wearing sample four elastic legwear using finite element method. The dressing process of elastic legwear was divided into six periods (instantaneous, 1, 2, 4, 8 and 12 h) in this study, and the finite element software ANSYS was used to simulate the displacement and deformation of the waist cross section. The authors finally obtained the functional relationship between pressure/displacement ratio and angle using curve fitting.

Findings

In this paper, the authors obtained the functional relationship between pressure/displacement ratio and angle using curve fitting. Comparison found that the “pressure/displacement–angle” function curve showed an almost consistent trend at any time. That was to say, when the human body was in the state of clothing pressure, the corresponding displacement value of the human body can be calculated by the curve equation under the premise of known pressure value.

Originality/value

This study solves the difficult problem which hard to measure displacement values by conventional methods due to the small deformation of the human body after dressing the compression garment. Conclusions also provide a theoretical reference for evaluating pressure comfort and optimizing clothing structure for the elastic legwear, and this method is also applicable to other types of compression garment.
Ethical leadership and interpersonal citizenship behavior in the public sector
Authors: Nguyen Long Le Hoang
Published: August 2023

Purpose

This study aims to examine the impact of ethical leadership on the extra-role behavior toward individuals of employees in the public sector. In addition, the study examines the mediating roles of supervisor-subordinate guanxi and public service motivation.

Design/methodology/approach

Research data were collected from 222 public servants in local government, Vietnam. Study using partial least square SEM (PLS-SEM) method performed by SmartPLS 3.2.9.

Findings

Ethical leadership has a direct impact on OCBI. In turn, supervisor-subordinate guanxi holds mediating role in linking the relationship between ethical leadership and OCBI. Public service motivation mediates nexuses between ethical leadership, supervisor-subordinate guanxi and OCBI.

Research limitations/implications

To encourage public servants to engage in interpersonal citizenship behaviors, leaders must focus on fostering an ethical climate in the workplace by acting as an ethical model and encouraging ethical standards in daily work.

Originality/value

The study provides new insights on the mediating role of public service motivation, guanxi from the perspective of the leader's ethical aspect.
The service sector in the classical world: focus on entertainment and well-being
Authors: Bröchner Jan
Published: August 2023

Purpose

Predicting effects of artificial intelligence on service occupations can be supported by a long historical perspective. Historical databases and archaeology help reconstructing the service sector in ancient societies. Here, the purpose of this paper is to analyse occupational specialization within services in cities of ancient Greece and the Roman Empire, as well as how the service sector is reflected in architectural remains, to identify differences and similarities with today’s Europe.

Design/methodology/approach

Occupational titles are traced in epigraphical and literary sources, sorted according to ISCO-08. Secondary sources are used for the architectural evidence of service activities, as well as for the role of contests and entertainment in antiquity.

Findings

Compared to current European service employment, professionals were fewer in classical Athens and imperial Rome, which had a greater proportion of specialized salespersons. There were few office buildings and no civic hospitals, but heavy investment in facilities for entertainment and well-being. Quality assessments for goods were little developed; contests for cultural and sports activities assessed entertainment service quality.

Research limitations/implications

This study covers two periods in classical antiquity and is restricted to Mediterranean cultures, although findings may help understanding the service sector in poor countries with informal employment.

Originality/value

While particular services provided in ancient cities have been studied, there has been no broad comparative overview of their service occupations. Services in earlier societies with primitive information and communication technologies can provide clues for current developments.
Historic development of policies and regulations concerning residential heritage in the Old City of Aleppo
Authors: Kousa Christine , Lubelli Barbara , Pottgiesser Uta
Published: August 2023

Purpose

Housing interventions carried out in accordance with current regulations in the Old City of Aleppo, both before and after the Syrian war, are minor in comparison to those carried out without a license and illegally. This suggests current policies are inadequate and needs upgrading.

Design/methodology/approach

This article critically reviews current Syrian policies and their implementation on residential heritage in the Old City of Aleppo with the aim to identify gaps and propose directions for modifications. Next to a review of the text of official policies and implementation documents, the archive of the Directorate of the Old City has been consulted and license applications, presented in the period 2018–2022, have been examined. Moreover, interviews with decision-makers from academics and practice were conducted.

Findings

Major limitations of these policies and relative application procedures have been identified: these involve: legal/administrative, economic and social aspects.

Originality/value

The specific needs have been highlighted and some proposals for improvement made.