bluuebunny/crossref_metadata_2025 huggingface dataset:
Eosinophilic granuloma of the clavicle in an 11-year-old Chinese girl: A case report
Authors: Chen Qian-Dui , Lin Shuang-Zhu , Zhou Jie , Chen Xiao-Xiao , Yang Rui-Tong , Wang Xinyao , Li Jia-Yi , Feng Xiao-Chun , Liu Yu-Shu , Jiang Kai , Feng Jin-Hua
Published: June 2023

Rationale:

Eosinophilic granuloma (EG) – the most common form of Langerhans cell histiocytosis – occurs rarely, and manifestations with only rib and clavicle involvement are extremely rare. EG symptoms often include pain, swelling, and soft tissue mass. The clinical diagnosis of bone EG is complex, and the differential diagnosis includes Ewing sarcoma, tuberculosis, multiple myeloma, lymphoma, primary bone malignancy, and other osteolytic lesions.

Patient’s concern:

The patient was an 11-year-old female who found a subcutaneous mass at the junction of the right clavicle and sternum 2 days before presenting at the clinic without apparent triggers. Initially, we considered a subcutaneous cyst or inflammatory mass. Color ultrasound and computed tomography examination revealed osteomyelitis. Finally, the patient was diagnosed with EG after a pathological tissue biopsy, and the child recovered after surgery and anti-infective treatment.

Diagnosis:

The patient underwent surgery to remove the tumor at a specialist hospital and was diagnosed with EG by pathological examination.

Intervention:

The patient went to a specialist hospital for surgery to remove the mass and underwent anti-infective treatment.

Outcomes:

The patient recovered after surgical resection and antibiotic treatment.

Lessons:

In this report, we emphasize that the clinical presentation of EG in children is not specific. Furthermore, examining age, history, presence of symptoms, and the number of sites is essential to make a correct diagnosis, and a histological examination is necessary to confirm the diagnosis.
Repeatedly next-generation sequencing during treatment follow-up of patients with small cell lung cancer
Authors: JiaXin Yin , XiaoFeng Cong , PengFei Cui , Songchen Zhao , Ziling Liu
Published: June 2023

Somatic alterations in tumors are a frequent occurrence. In small cell lung cancer (SCLC), these include mutations in the tumor suppressors TP53 and retinoblastoma (RB1). We used next generation sequencing (NGS) to study specific genetic variants and compare genetic and clinicopathological features of SCLC with healthy control genome. Ten SCLC patients receiving standard chemotherapy, between 2018 and 2019, from the First Hospital of Jilin University were included in this study. Prior patient treatment, NGS was performed using DNA isolated from blood plasma. New NGS analyses were performed after 2 and 4 treatment cycles. Four patients presented with different metastases at diagnosis. Overall, most genes tested presented missense or frameshift variants. TP53, RB1, CREBBP, FAT1 genes presented gain of stop codons. At the single-gene level, the most frequently altered genes were TP53 (8/10 patients, 80%) and RB1 (4/10 patients, 40%), followed by bromodomain containing 4 (BRD4), CREBBP, FAT1, FMS-like tyrosine kinase 3 (FLT3), KDR, poly ADP-ribose polymerase (PARP1), PIK3R2, ROS1, and splicing factor 3b subunit 1 (SF3B1) (2/10 patients, 20%). We identified 5 genes, which have not been previously reported to bear mutations in the context of SCLC. These genes include BRD4, PARP1, FLT3, KDR, and SF3B1. We observed that among the studied individuals, patients with a high number of genetic events, and in which such mutations were not eradicated after treatment, showed a worse prognosis. There has not yet been given enough attention to the above-mentioned genes in SCLC, which will have great clinical prospects for treatment.
Verum versus Sham brain-computer interface on upper limb function recovery after stroke: A systematic review and meta-analysis of randomized controlled trials
Authors: Shou Yi-zhou , Wang Xin-hua , Yang Gui-fen
Published: June 2023

Background:

Previous clinical trials have reported that the brain-computer interface (BCI) is a useful management tool for upper limb function recovery (ULFR) in stroke. However, there is insufficient evidence regarding this topic. Thus, this study aimed to investigate the effectiveness of verum versus sham BCI on the ULFR in stroke patients.

Methods:

We comprehensively searched the Cochrane Library, PUBMED, EMBASE, Web of Science, and China National Knowledge Infrastructure databases from their inception to January 1, 2023. Randomized clinical trials (RCTs) assessing the effectiveness and safety of BCI for ULFR after stroke were included. The outcomes were the Fugl-Meyer Assessment for Upper Extremity, Wolf Motor Function Test, Modified Barthel Index, motor activity log, and Action Research Arm Test. The methodological quality of all the included randomized controlled trials was evaluated using the Cochrane risk-of-bias tool. Statistical analysis was performed using RevMan 5.4 software.

Results:

Eleven eligible studies involving 334 patients were included. The results of the meta-analysis showed significant differences in the Fugl-Meyer Assessment for Upper Extremity (mean difference [MD] = 4.78, 95% confidence interval [CI] [1.90, 7.65], I
2 = 0%, P = .001) and Modified Barthel Index (MD = 7.37, 95% CI [1.89, 12.84], I
2 = 19%, P = .008). However, no significant differences were found on motor activity log (MD = −0.70, 95% CI [−3.17, 1.77]), Action Research Arm Test (MD = 3.05, 95% CI [−8.33, 14.44], I
2 = 0%, P = .60), and Wolf Motor Function Test (MD = 4.23, 95% CI [−0.55, 9.01], P = .08).

Conclusion:

BCI may be an effective management strategy for ULFR in stroke patients. Future studies with larger sample size and strict design are still needed to warrant the current findings.
Analysis of the outcome of bi-vertebral transpedicular wedge osteotomy for correcting severe kyphotic deformity in ankylosing spondylitis
Authors: Li Wei , Tong Guojun , Cai Binbin , Quan Renfu
Published: June 2023

To study the outcomes of bi-vertebral transpedicular wedge osteotomy in correcting severe kyphotic deformity in ankylosing spondylitis (AS). This retrospective study focused on all the patients who underwent thoracic and lumbar bi-vertebra transpedicular wedge osteotomy with pedicle screw internal fixation to treat their severe thoracolumbar kyphotic deformity of AS in our hospital from January 2014 to January 2020. The perioperative and operative data of each patient were collected and analyzed. A total of 21 male AS patients with severe kyphotic deformity were studied with a mean age of 42.2 ± 9.2 years. Intraoperatively, the mean operating time is 5.8 ± 1.6 hour with a mean blood loss of 725.5 ± 140.6 mL. The average postoperative correction of kyphosis reached 60.8o at 1 week after the surgery, which is significantly improved from preoperative presentation (P < .05), and stayed no significant change over the time during longer period of follow-ups (12–24 months) with the overall correction rate of 72.2%. Moreover, the postoperative changes in thoracic kyphosis (TK) angle, thoracolumbar kyphosis (TLK) angle, lumbar lordosis (LL) angle, maxilla-brow angle, as well as C2SVA and C7SVA sagittal balance were also significant, all of which enabled the patients to walk in upright position and sleep in the supine position with the improvements in other clinical symptoms. Bi-vertebral transpedicular wedge osteotomy of thoracic and lumbar vertebrae is a safe and effective method to restore the physiological curvature of the sagittal position of the spine and correct severe ankylosing deformity.
Analyzing fulminant myocarditis research trends and characteristics using the follower-leading clustering algorithm (FLCA): A bibliometric study
Authors: Yen Pei-Chun , Chou Willy , Chien Tsair-Wei , Jen Tung-Hui
Published: June 2023

Background:

Myocarditis can be classified into 2 categories: fulminant myocarditis (FM) and nonfulminant myocarditis. FM is the most severe type, characterized by its acute and explosive nature, posing a sudden and life-threatening risk with a high fatality rate. Limited research has been conducted on FM characteristics using cluster analysis. This study introduces the following-leading clustering algorithm (`) as a unique method and utilizes it to generate a dual map and timeline view of FM themes, aiming to gain a better understanding of FM.

Methods:

The metadata were obtained from the Web of Science (WoS) database using an advanced search strategy based on the topic (TS= ((“Fulminant”) AND (“Myocarditis”))). The analysis comprised 3 main components: descriptive analytics, which involved identifying the most influential entities using CJAL scores and analyzing publication trends, author collaborations using the FLCA algorithm, and generating a dual map and timeline view of FM themes using the FLCA algorithm. The visualizations included radar plots divided into 4 quadrants, stacked bar and line charts, network charts, chord diagrams, a dual map overlay, and a timeline view.

Results:

The findings reveal that the prominent entities in terms of countries, institutes, departments, and authors were the United States, Huazhong University of Science and Technology (China), Cardiology, and Enrico Ammirati from Italy. A dual map, based on the research category, was created to analyze the relationship between citing and cited articles. It showed that articles related to cells and clinical medicine/surgery were frequently cited by articles in the fields of general health/public/nursing and clinical medicine/surgery. Additionally, a visual timeline view was presented on Google Maps, showcasing the themes extracted from the top 100 cited articles. These visualizations were successfully and reliably generated using the FLCA algorithm, offering insights from various perspectives.

Conclusion:

A new FLCA algorithm was utilized to examine bibliometric data from 1989 to 2022, specifically focusing on FM. The results of this analysis can serve as a valuable guide for researchers, offering insights into the thematic trends and characteristics of FM research development. This, in turn, can facilitate and promote future research endeavors in this field.
Testing the impact of occupational intervention on professional ethics and values of Staff in University Medical Centers
Authors: Areji Anthony Chukwudi , Ede Moses Onyemaechi , Agbo Christian Onuorah , Eze Hillary Oguejiofor , Ogbodo Ignatius Ifeanyichukwu , Eze Chima Fidelis , Nyakuwa Robert , Chinweuba Ngozi H. , Agbigwe Ifeanyichukwu B.
Published: June 2023

Background:

The level of commitment to jobs is the driver of how much a worker could offer to those that need the services. People become poised to deliver services when they hold the job in high esteem. Evidence abounds that some workers in public services barely value their professional responsibilities and conduct. This motivated the present researchers to test the impacts of rational emotive behavioral occupational intervention (REBOI) on the professional ethics and values of Staff in University Medical Centers.

Methods:

to achieve the above aim, a randomized control design was used. A total of 114 staff were recruited, assessed 3 times using 3 instruments, and coached by therapists. The coaching last for 12 sessions. The data collected were subjected to a multivariate statistical analysis to test how effective the intervention was in changing negative perceptions about values and ethics in workplaces.

Results:

It was found that REBOI changes negative perceptions about professional ethics and values among staff of medical centers. The effectiveness of the REBOI is not statistically influenced by gender and group interaction. Gender does not moderate the impact of the intervention.

Conclusion:

This study finally suggests that REBOI effectively changes negative perceptions about values and ethics among health workers. Thus, recommends for the advancement of Ellis’ principles in other workplaces and across populations.
Neutrophil to high-density lipoprotein cholesterol ratio, a novel risk factor associated with acute ischemic stroke
Authors: Yu Lina , Ma Ke , Hao Jian , Zhang Bin
Published: June 2023

To investigate the relationship between neutrophil to high-density lipoprotein cholesterol ratio (NHR) and Acute Ischemic Stroke (AIS), and provide a new direction for the diagnosis and prevention of AIS. A total of 158 patients with AIS and 162 healthy individuals were recruited. Demographic, clinical, and laboratory data of participants were obtained and the multivariable logistic regression analysis was employed to assess risk factors for AIS. The receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of NHR for AIS. The spearman correlation analysis was used to estimate the correlation between NHR and national institute of health stroke scale (NIHSS) score. The age, White blood cell, MONO (monocyte), NEUT (neutrophil), creatinine, TG (triglyceride), NHR, neutrophil to lymphocyte ratio and MONO to high-density lipoprotein cholesterol ratio were remarkably greater and HDL-C (high-density lipoprotein cholesterol) was dramatically lower in the case group compared with in the control group (P < .05). The multivariable logistic regression analysis revealed that age [OR = 1.095, 95% CI (1.056, 1.135)], TG [OR = 6.188, 95% CI (2.900, 13.206)] and NHR [OR = 11.394, 95% CI (1.196, 108.585)] were independent risk factors for AIS (P < .05). The areas under the curve (AUCs) for the prediction of AIS by the age, TG and NHR were 0.694, 0.686, 0.782, respectively, the specificity were 56.8%, 88.3%, 87.0%, and the sensitivity were 75.3%, 44.3%, 56.3%, respectively (P < .05). In addition, spearman correlation analysis indicated that there was a positive correlation between NHR and NIHSS score (R = 0.558, P < .05). The level of NHR was higher in patients with a NIHSS score of above 5 points compared with those with a NIHSS score of 5 points or lower (P < .0001). The age, TG, and NHR were independent risk factors for AIS, and the level of NHR was positively correlated with severity of AIS.
Mechanism of Yiqi Huoxue Huatan recipe in the treatment of coronary atherosclerotic disease through network pharmacology and experiments
Authors: Huang Hong-Tao , Lv Wen-Qing , Xu Fei-Yue , Wang Xiao-Long , Yao Yi-Li , Su Li-Jie , Zhao Han-Jun , Huang Yu
Published: June 2023

In recent years, with population aging and economic development, morbidity and mortality of atherosclerotic cardiovascular disease associated with atherosclerosis (AS) have gradually increased. In this study, a combination of network pharmacology and experimental verification was used to systematically explore the action mechanism of Yiqi Huoxue Huatan Recipe (YHHR) in the treatment of coronary atherosclerotic heart disease (CAD). We searched and screened the active ingredients of Coptis chinensis, Astragalus membranaceus, Salvia miltiorrhiza, and Hirudo. We also searched multiple databases for related target genes corresponding to the compounds and CAD. STRING was used to construct the protein-protein interaction (PPI) network of genes. Metascape was used to perform gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis for common targets to analyze the main pathways, and finally, the molecular docking and main possible pathways were verified by experimental studies. Firstly, a total of 1480 predicted target points were obtained through the Swiss Target Prediction database. After screening, merging, and deleting duplicate values, a total of 768 targets were obtained. Secondly, “Coronary atherosclerotic heart disease” was searched in databases such as the OMIM, GeneCards, and TTD. 1844 disease-related targets were obtained. Among PPI network diagram of YHHR-CAD, SRC had the highest degree value, followed by AKT1, TP53, hsp90aa1 and mapk3. The KEGG pathway bubble diagram was drawn using Chiplot, the Signal pathways such as NF kappa B signaling pathway, Lipid and AS, and Apelin signaling pathway are closely related to the occurrence of CAD. The PCR and Western blot methods were used to detect the expression of NF-κB p65. When compared with that in the model group, the expression of NF-κB p65mRNA decreased in the low-concentration YHHR group, with P < .05, while the expression of NF-κB p65mRNA decreased significantly in the high-concentration YHHR group, with P < .01. On the other hand, when compared with that in the model group, the expression of NF-κB p65 decreased in the low-concentration YHHR group, but was not statistically significant, while the expression of NF-κB p65 was significant in the high-concentration YHHR group, and has statistical significance with P < .05. YHHR has been shown to resist inflammation and AS through the SRC/NF-κB signaling pathway.
Soft tissue pseudotumors of the hand and wrist mimicking malignancy: Two case reports
Authors: Kim Jong Ok , Lee Yeon Soo , Park Sangeun
Published: June 2023

Rationale:

Most soft-tissue lesions in the hand and wrist have a benign etiology, and malignant tumors, such as soft-tissue sarcomas, are rare. Mimickers of soft tissue tumors in the hand and wrist are more common than true neoplastic lesions; however, soft tissue pseudotumors that mimic malignancy are very rare.

Patient concerns:

This study describes 2 patients with soft tissue pseudotumors of the hand and wrist. Both patients presented with rapidly growing soft-tissue masses. Magnetic resonance imaging (MRI) revealed ill-defined margins and an aggressive appearance in both cases, leading to a strong suspicion of malignant soft tissue tumors.

Diagnosis:

Both patients underwent incisional biopsies, and the final diagnoses were inflammation due to IgG4-related disease in the first case and chronic granulomatous inflammation in the second case.

Interventions:

The first patient was administered oral steroids, while the second patient was treated with anti-inflammatory drugs.

Outcomes:

Both patients showed a reduction in swelling of the hand and wrist.

Lessons:

Although the imaging approach for pseudotumorous lesions is similar to that for true soft tissue tumors, the management of these lesions is different. Biopsies should only be performed when the diagnosis is unclear.
Endoscopic approaches to small intestinal strictures
Authors: Ashat Munish , El-Abiad Rami , Khashab Mouen A.
Published: June 2023

Purpose of review

Gastric outlet obstruction (GOO) occurs from benign or malignant causes. Historically, the treatment of benign strictures revolved around endoscopic balloon dilation, whereas, in the case of malignant strictures, the placement of self-expandable metallic stents was the focus. The advent of lumen-apposing metal stent has opened new horizons in addressing shortcomings of enteral stenting and surgical gastroenterostomies. The purpose of the review is to discuss the endoscopic approaches to small bowel strictures and to examine the supporting data behind each practice.

Recent findings

Given the risk and futility of balloon dilation for malignant strictures, enteral stenting is pursued in patients who are poor surgical candidates and with life expectancy less than 6 months. For patients with longer survival, surgical gastroenterostomy (S-GE) should be considered. Recent data have shown comparable technical and clinical success rates between EUS-gastroenterostomy and S-GE but with lower adverse event rate and hospital length of stay.

In recurrent benign strictures and malignant GOO, EUS-GE has recently gained momentum in providing an effective and a well tolerated alternative. Individualized therapy centered around the patient's prognosis and preference while factoring in the local expertise for the specific indication is vital.
Update on injection augmentation pharyngoplasty in the treatment of velopharyngeal insufficiency
Authors: Kelly Zachary , Nassar Michel
Published: June 2023

Purpose of review

Velopharyngeal insufficiency (VPI) refers to a structural defect resulting in incomplete closure between the soft palate and posterior pharyngeal wall, leading to inadequate speech and deglutition. Traditional surgical options for VPI include sphincter pharyngoplasty, pharyngeal flaps and palatoplasty. Although these procedures have been successfully used over the past several decades, they are associated with complications such as pain, bleeding, infection and obstructive sleep apnoea. They also require postoperative admission. Injection augmentation pharyngoplasty (IAP) is increasingly being viewed as a viable, less invasive surgical option for patients with mild to moderate VPI.

Recent findings

Both autologous fat and alloplastic synthetics have been used as injectable materials, with low morbidity and good speech outcomes. However, given the overall lack of standardization across studies, no single material has shown clear superiority.

IAP is a promising alternative to more invasive surgeries in the treatment of patients with mild to moderate VPI. The purpose of this review is to provide an overview of this approach, with an emphasis on its safety and efficacy.
Facilitating a Culture of Evidence-Based Practice and Quality Improvement Excellence
Authors: Barnsteiner Jane , Beebe Scott , Dicker Rachel , Halm Margo , Hirsch Malka , Taulbee Rebecca , Troy David
Published: June 2023

This article defines evidence-based practice (EBP) and quality improvement (QI) and examines the positive impact on patient care when they are in place, as well as the barriers to their implementation. An effective tool, Ovid Synthesis, was created to enable clinicians and administrators to streamline the processes for EBP and QI, provide oversight on the initiatives underway, and enable clinical educators to help nursing staff develop the necessary competencies and successfully execute their EBP and/or QI projects.
Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy - Propensity Score-matched Analysis
Authors: Nickel Felix , Wise Philipp , Müller Philip C. , Kuemmerli Christoph , Cizmic Amila , Salg Gabriel , Steinle Verena , Niessen Anna , Mayer Philipp , Mehrabi Arianeb , Loos Martin , Müller-Stich Beat P. , Kulu Yakup , Büchler Markus W. , Hackert Thilo
Published: June 2023

Objective:

The goal of the current study was to investigate the perioperative outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) in a high-volume center.

Summary Background Data:

Despite RPD’s prospective advantages over OPD, current evidence comparing the two has been limited.and has prompted further investigation. The aim of this study was to compare both approaches while including the learning curve phase for RPD.

Methods:

A 1:1 propensity score-matched (PSM) analysis of a prospective database of RPD with OPD (2017-2022) at a high-volume center was performed. Main outcomes were overall- and pancreas specific complications.

Results:

Of 375 patients who underwent PD (OPD n=276, RPD n=99), 180 were included in PSM analysis (90 per group). RPD was associated with less blood loss (500 (300-800) vs. 750 (400-1000)ml; P=0.006) and less total complications (50% vs. 19%; P<0.001). Operative time was longer (453 (408-529) vs. 306 (247-362)min; P<0.001); in patients with ductal adenocarcinoma, fewer lymph nodes were harvested (24 (18-27) vs. 33 (27-39); P<0.001) with RPD versus OPD. There were no significant differences for major complications (38 vs. 47%; P=0.291), reoperation rate (14% vs. 10%; P=0.495), postoperative pancreatic fistula (21% vs. 23%; P=0.858) and patients with textbook outcome (62% vs. 55%; P=0.452).

Conclusions:

Including the learning phase, RPD can be safely implemented in high-volume settings and shows potential for improved perioperative outcomes versus OPD. Pancreas-specific morbidity was unaffected by the robotic approach. Randomized trials with specifically trained pancreatic surgeons and expanded indication for the robotic approach are needed.
Prophylactic Antibiotic Duration and Infectious Complications in Pancreatoduodenectomy Patients with Biliary Stents
Authors: Boyev Artem , Arvide Elsa M. , Newhook Timothy E. , Prakash Laura R. , Bruno Morgan L. , Dewhurst Whitney L. , Kim Michael P. , Maxwell Jessica E. , Ikoma Naruhiko , Snyder Rebecca A. , Lee Jeffrey E. , Katz Matthew H.G. , Tzeng Ching-Wei D.
Published: June 2023

Objective:

This study’s aim was to compare infectious complications in pancreatoduodenectomy (PD) patients with biliary stents treated with short, medium, or long durations of prophylactic antibiotics.

Summary/Background Data:

Pre-existing biliary stents have historically been associated with higher infection risk after PD. Patients are administered prophylactic antibiotics, but the optimal duration remains unknown.

Methods:

This single-institution retrospective cohort study included consecutive PD patients from October 2016 to April 2022. Antibiotics were continued past the operative dose per surgeon discretion. Infection rates were compared by short (≤24 h), medium (>24 but ≤96 h) and long (>96 h) duration antibiotics. Multivariable regression analysis was performed to evaluate associations with a primary composite outcome of wound infection, organ-space infection, sepsis, or cholangitis.

Results:

Among 542 PD patients, 310 (57%) had biliary stents. The composite outcome occurred in 28% (34/122) short, 25% (27/108) medium, and 29% (23/80) long duration (P=0.824) antibiotic patients. There were no differences in other infection rates or mortality. On multivariable analysis, antibiotic duration was not associated with infection rate. Only postoperative pancreatic fistula (OR 33.1, P<0.001) and male sex (OR 1.9, P=0.028) were associated with the composite outcome.

Conclusions:

Among 310 PD patients with biliary stents, long duration prophylactic antibiotics were associated with similar composite infection rates to short and medium durations but were used almost twice as often in high-risk patients. These findings may represent an opportunity to de-escalate antibiotic coverage and promote risk-stratified antibiotic stewardship in stented patients by aligning antibiotic duration with risk-stratified pancreatectomy clinical pathways.
Detecting Variation in Clinical Practice Patterns for Geriatric Trauma Care Using Social Network Analysis
Authors: Jarman Molly P. , Ruan Mengyuan , Tabata-Kelly Masami , Perry Brea L. , Lee Byungkyu , Boustani Malaz , Cooper Zara
Published: June 2023

Objective:

To characterize hospital-level professional networks of physicians caring for older trauma patients as a function of trauma patient age distribution.

Summary Background Data:

The causal factors associated with between-hospital variation in geriatric trauma outcomes are poorly understood. Variation in physician practice patterns reflected by differences in professional networks might contribute to hospital-level differences in outcomes for older trauma patients.

Methods:

This is a population-based, cross-sectional study of injured older adults (age ≥65) and their physicians from January 1, 2014-December 31, 2015, using Healthcare Cost and Utilization Project inpatient data and Medicare claims from 158 hospitals in Florida. We used social network analyses to characterize hospitals in terms of network density, cohesion, small-worldness, and heterogeneity, then used bivariate statistics to assess the relationship between network characteristics and hospital-level proportion of trauma patients who were age ≥65.

Results:

We identified 107,713 older trauma patients and 169,282 patient-physician dyads. The hospital-level proportion of trauma patients who were age ≥65 ranged from 21.5% to 89.1%. Network density, cohesion, and small-worldness in physician networks were positively correlated with hospital geriatric trauma proportions (R=0.29, P<0.001; R =0.16, P=0.048; and R =0.19, P<0.001, respectively). Network heterogeneity was negatively correlated with geriatric trauma proportion (R=0.40, P<0.001).

Conclusions:

Characteristics of professional networks among physicians caring for injured older adults are associated with the hospital-level proportion of trauma patients who are older, indicating differences in practice patterns at hospitals with older trauma populations. Associations between inter-specialty collaboration and patient outcomes should be explored as an opportunity to improve treatment of injured older adults.
Does the Use of Probe-based Near-infrared Autofluorescence Parathyroid Detection Benefit Parathyroidectomy?
Authors: Kiernan Colleen M. , Thomas Giju , Patel Anuradha , Fan Run , Ye Fei , Willmon Parker A. , Solórzano Carmen C.
Published: June 2023

Objective:

To evaluate the benefits of probe-based near-infrared autofluorescence (NIRAF) parathyroid identification during parathyroidectomy.

Background:

Intraoperative parathyroid gland identification during parathyroidectomy can be challenging, while additionally requiring costly frozen sections. Earlier studies have established NIRAF detection as a reliable intraoperative adjunct for parathyroid identification.

Methods:

Patients undergoing parathyroidectomy for primary hyperparathyroidism were prospectively enrolled by a senior surgeon (>20 years experience) and a junior surgeon (<5 years experience), while being randomly allocated to the probe-based NIRAF or control group. Data collected included procedure type, number of parathyroids identified with high confidence by the surgeon and the resident, number of frozen sections performed, parathyroidectomy duration, and number of patients with persistent disease at the first postoperative visit.

Results:

One hundred sixty patients were randomly enrolled under both surgeons to the probe group (n=80) versus control (n=80). In the probe group, parathyroid identification rate of the senior surgeon improved significantly from 3.2 to 3.6 parathyroids per patient (P<0.001), while that of the junior surgeon also rose significantly from 2.2 to 2.5 parathyroids per patient (P=0.001). Parathyroid identification was even more prominent for residents increasing significantly from 0.9 to 2.9 parathyroids per patient (P<0.001). Furthermore, there was a significant reduction in frozen sections utilized in the probe group versus control (17 vs 47, P=0.005).

Conclusion:

Probe-based NIRAF detection can be a valuable intraoperative adjunct and educational tool for improving confidence in parathyroid gland identification, while potentially reducing the number of frozen sections required.
Anamorelin in Japanese patients with cancer cachexia: an update
Authors: Wakabayashi Hidetaka , Arai Hidenori , Inui Akio
Published: June 2023

Purpose of review

Anamorelin was approved for production and marketing in Japan on 22 January 2021 for cancer cachexia in non-small-cell lung cancer, gastric cancer, pancreatic cancer, and colorectal cancer. The authors describe the updates of anamorelin for cancer cachexia in Japan.

Recent findings

Recent evidence showed that anamorelin improved lean body mass, body weight, and appetite in patients with cancer cachexia in clinical practice. Anamorelin does not increase body weight in the severe-weight-loss group in cachectic patients with pancreatic cancer. Several case reports showed that anamorelin can cause cardiac adverse drug reactions. Among the cardiac adverse reactions, fatal arrhythmias should be monitored carefully even if it is the first dose. Anamorelin combined with nutrition, physical activity, and exercise may be more useful than anamorelin alone for treating cancer cachexia. An interim analysis from post-marketing all-case surveillance was performed; however, details have not yet been published. When anamorelin cannot be used for cancer cachexia, Kampo medicines can be considered as an option.

Anamorelin has changed the clinical practice of cancer cachexia in Japan. The authors hope that anamorelin is available for other disease-related cachexia along with appropriate multidisciplinary interventions.
Radiomics in Kidney Transplantation: A Scoping Review of Current Applications, Limitations, and Future Directions
Authors: Lim Ee Jean , Yen Jie , Fong Khi Yung , Tiong Ho Yee , Aslim Edwin Jonathan , Ng Lay Guat , Castellani Daniele , Borgheresi Alessandra , Agostini Andrea , Somani Bhaskar Kumar , Gauhar Vineet , Gan Valerie Huei Li
Published: June 2023

Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in kidney transplantation, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of transplantation was conducted on PubMed, EMBASE, and Scopus from inception to September 23, 2022. A total of 16 studies were included. The most widely studied clinical utility of radiomics in kidney transplantation is its use as an adjunct to diagnose rejection, potentially reducing the need for unnecessary biopsies or guiding decisions for earlier biopsies to optimize graft survival. Technology such as optical coherence tomography is a noninvasive procedure to build high-resolution optical cross-section images of the kidney cortex in situ and in real time, which can provide histopathological information of donor kidney candidates for transplantation, and to predict posttransplant function. This review shows that, although radiomics in kidney transplants is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic evaluation for living donors and potential in predicting and detecting rejection postoperatively.
Non-coding variants are a rare cause of recessive developmental disordersin transwith coding variants
Authors: Lord Jenny , Oquendo Carolina J , Martin-Geary Alexandra , Blakes Alexander JM , Arciero Elena , Domcke Silvia , Childs Anne-Marie , Low Karen , Rankin Julia ,   Genomics England Research Consortium, Baralle Diana , Martin Hilary C. , Whiffin Nicola
Published: June 2023

Purpose

Identifying pathogenic non-coding variants in individuals with developmental disorders (DD) is challenging due to the large search space. It is common to find a single protein-altering variant in a recessive gene in DD patients, but the prevalence of pathogenic non-coding ;second hits;in transwith these is unknown.

Methods

In 4,073 genetically undiagnosed rare disease trio probands from the 100,000 Genomes project, we identified rare heterozygous loss-of-function (LoF) or ClinVar pathogenic variants in recessive DD-associated genes. Using stringent region-specific filtering, we identified rare non-coding variants on the other haplotype. Identified genes were clinically evaluated for phenotypic fit, and where possible, we performed functional testing using RNA-sequencing.

Results

We found 2,430 probands with one or more rare heterozygous pLoF or ClinVar pathogenic variants in recessive DD-associated genes, for a total of 3,761 proband-variant pairs. For 1,366 (36.3%) of these pairs, we identified at least one rare non-coding variantin trans. After stringent bioinformatic filtering and clinical review, five were determined to be a good clinical fit (inALMS1, NPHP3, LAMA2, IGHMBP2andGAA).

Conclusion

We developed a pipeline to systematically identify and annotate compound heterozygous coding/non-coding genotypes. Using this approach we uncovered new diagnoses and conclude that this mechanism is a rare cause of DDs.
The influence of movement speed on reward-based motor learning
Authors: van Mastrigt Nina M. , van der Kooij Katinka , Smeets Jeroen B. J.
Published: June 2023

Human movement is inevitably variable. This variability can be seen as a constraint to overcome, but it may also be a feature: being variable may result in the discovery of better movement solutions. Especially when feedback is limited to binary information on movement success or failure, variability is key for discovering which movements lead to success. Since moving faster increases variability, we aimed to answer the question whether movement speed can be harnessed to improve such reward-based motor learning. Subjects performed a stepping task in a slow and a fast session. They had to learn the gain between their step lengths and visual target distances on screen based on binary reward feedback. We successfully manipulated movement speed between sessions and participants could learn the gain in both sessions. We found no difference in learning between speed sessions, despite the fact that variability in gain increased in the fast relative to the slow session. To distinguish between different sources of variability, we estimated inevitable motor noise from the variability following successful trials. We estimated exploration as the additional variability following non-successful trials relative to following successful trials. We found no relation between variability sources and learning. In conclusion, reward-based motor learning is possible in a gain-learning task. In this task, moving faster did not lead to higher learning. Since the role of variability may differ between experimental tasks, whether movement speed can be harnessed to improve motor learning needs to be tested in other experimental tasks.
Genetic influences on motor learning and superperformance mutants revealed by random mutational survey of mouse locomotion
Authors: Jakkamsetti Vikram , Ma Qian , Angulo Gustavo , Scudder William , Beutler Bruce , Pascual Juan M.
Published: June 2023

Evolution depends upon genetic variations that influence physiology. As defined in a genetic screen, phenotypic performance may be enhanced or degraded by such mutations. We set out to detect mutations that influence motor function, including motor learning. Thus, we tested the motor effects of 36,444 non-synonymous coding/splicing mutations induced in the germline of C57BL/6J mice with N-ethyl-N-nitrosourea by measuring changes in the performance of repetitive rotarod trials while blinded to genotype. Automated meiotic mapping was used to implicate individual mutations in causation. 32,726 mice bearing all the variant alleles were screened. This was complemented with the simultaneous testing of 1,408 normal mice for reference. 16.3% of autosomal genes were thus rendered detectably hypomorphic or nullified by mutations in homozygosity and motor tested in at least 3 mice. This approach allowed us to identify superperformance mutations inRif1,Tk1,Fan1andMn1. These genes are primarily related, among other less well characterized functions, to nucleic acid biology. We also associated distinct motor learning patterns with groups of functionally related genes. These functional sets included preferentially histone H3 methyltransferase activity for mice that learnt at an accelerated rate relative to the rest of mutant mice. The results allow for an estimation of the fraction of mutations that can modify a behavior influential for evolution such as locomotion. They may also enable, once the loci are further validated and the mechanisms elucidated, the harnessing of the activity of the newly identified genes to enhance motor ability or to counterbalance disability or disease.
Discovery of New Broad-Spectrum Anti-Infectives for Eukaryotic Pathogens Using Bioorganometallic Chemistry
Authors: Lin Yan , Jung Hyeim , Bulman Christina A. , Ng James , Vinck Robin , O’Beirne Cillian , Moser Matthew S. , Tricoche Nancy , Peguero Ricardo , Li Robert W. , Urban Joseph F. , Pape Patrice Le , Pagniez Fabrice , Moretto Marco , Weil Tobias , Lustigman Sara , Cariou Kevin , Mitreva Makedonka , Sakanari Judy A. , Gasser Gilles
Published: June 2023

Drug resistance observed with many anti-infectives clearly highlights the need for new broad-spectrum agents to treat especially neglected tropical diseases (NTDs) caused by eukaryotic parasitic pathogens including fungal infections. Since these diseases target the most vulnerable communities who are disadvantaged by health and socio-economic factors, new agents should be, if possible, easy-to-prepare to allow for commercialization based on their low cost. In this study, we show that simple modification of one of the most well-known antifungal drugs, fluconazole, with organometallic moieties not only improves the activity of the parent drug but also broadens the scope of application of the new derivatives. These compounds were highly effectivein vivoagainst pathogenic fungal infections and potent against parasitic worms such asBrugia,which causes lymphatic filariasis andTrichuris,one of the soil-transmitted helminths that infects millions of people globally. Notably, the identified molecular targets indicate a mechanism of action that differs greatly from the parental antifungal drug, including targets involved in biosynthetic pathways that are absent in humans, offering great potential to expand our armamentarium against drug-resistant fungal infections and NTDs targeted for elimination by 2030. Overall, the discovery of these new compounds with broad-spectrum activity opens new avenues for the development of treatments for several current human infections, either caused by fungi or by parasites, including other NTDs, as well as newly emerging diseases.

ONE-SENTENCE SUMMARY

Simple derivatives of the well-known antifungal drug fluconazole were found to be highly effectivein vivoagainst fungal infections, and also potent against the parasitic nematodeBrugia,which causes lymphatic filariasis and againstTrichuris,one of the soil-transmitted helminths that infects millions of people globally.
Visual shape discrimination in goldfish, modelled with the neural circuitry of optic tectum and torus longitudinalis
Authors: Northmore David
Published: June 2023

The ability of fish to discriminate shapes visually is well documented. What is not understood are the neural mechanisms employed by fish and other vertebrates that lack a cerebral cortex to distinguish even simple geometric patterns. All the behavioral and anatomical data in fishes point to the midbrain optic tectum as the essential structure, but physiological studies of it have shown only circular contrast-detecting receptive fields and oriented edge detectors with nothing more elaborate that is reliable. Attempting to solve this conundrum, I built a model of tectum with neuron-like elements. When shown objects moving in space, the model forms an attentional locus that tracks one object on a retinotopic layer of simulated tectal pyramidal neurons. The object’s elementary features, when binned together, allow it to be distinguished from other objects to some extent; it fails when objects differ only in the features’ spatial relationships, which fish can use for discrimination. The model’s solution is to bias the attentional locus to the edges of a shape in imitation of goldfish that naturally attend to the top of shapes. Redirection of the attentional locus from a shape’s center is achieved by spatially offsetting synaptic inputs to the pyramidal neurons, effected by the torus longitudinalis (an elongated nucleus at the medial rim of each tectal lobe) and its prolific axonal projections to the pyramidal neurons. The model’s shape discrimination was compared to goldfish in the extensive behavioral data of Bowman & Sutherland (1969) who used shapes with points and projections. One test series showed that fish were sensitive to the relative number of points on the tops of shapes. In another, fish could be trained to discriminate points on the sides. By using different offset connections and only one elementary feature detector for small dark spots, the model successfully emulated the two sets of goldfish data, as judged by significant correlations between model response and fish discrimination over 21 pairs of shapes in each series.
Cell autonomous regulation of the activation of AgRP neurons by the melanocortin-3 receptor
Authors: Gui Yijun , Dahir Naima S. , Downing Griffin , Sweeney Patrick , Cone Roger D.
Published: June 2023

The melanocortin-3 receptor (MC3R) is a negative regulator of the central melanocortin circuitry via presynaptic expression on AgRP nerve terminals, from where it regulates GABA release onto secondary MC4R-expressing neurons. Hence, animals lacking MC3R (MC3R KO) exhibit hypersensitivity to MC4R agonists. However, MC3R KO mice also exhibit defective behavioral and neuroendocrine responses to fasting. Here, we demonstrate that MC3R KO mice exhibit defective activation of AgRP neurons in response to fasting and cold exposure, while exhibiting normal inhibition of AgRP neurons by sensory detection of food. Further, using an AgRP-specific MC3R knockout model, we show that the control of AgRP neuron activation by MC3R is cell-autonomous. One mechanism underlying this involves the response to ghrelin, which is also blunted in mice with AgRP-specific deletion of the MC3R. Thus, MC3R is a crucial player in the control of energy homeostasis by the central melanocortin system, not only acting presynaptically on AgRP neurons, but via AgRP cell-autonomous regulation of fasting- and cold-induced neuronal activation as well.
Natural dispersal is better than translocation for reducing risks of inbreeding depression in eastern black rhinoceros (Diceros bicornis michaeli)
Authors: Mellya Ronald V. K. , Hopcraft J. Grant C. , Mwakilema William , Eblate Ernest M. , Mduma Simon , Mnaya Bakari , Chuma Idrissa , Macha Emmanuel S. , Wambura Dickson , Fyumagwa Robert , Kilbride Elizabeth , Mable Barbara K. , Khan Anubhab
Published: June 2023

Due to ever increasing anthropogenic impacts, many species survive only in small and isolated populations. Active conservation management to reduce extinction risk includes: increasing habitat connectivity; translocations from captive populations; or intense surveillance of highly protected closed populations. The fitness of individuals born under these scenarios may vary due to differences in selection pressures. However, the genetic impacts of such strategies are rarely assessed. Using whole genome sequences from cohorts of the critically endangered eastern black rhinoceros as a model, we compare the consequences of past conservation efforts. We find that offspring of individuals that had either dispersed from native populations (FROH>100Kb= 0.13) or translocated from captive populations (FROH>100Kb= 0.08) showed lower inbreeding compared to closed populations (FROH>100Kb= 0.17). However, the frequency of highly deleterious mutations was higher for offspring resulting from translocation compared to the other groups and this load was sheltered by higher heterozygosity. This could increase risks of inbreeding depression if captive founders subsequently inbreed after translocation. In contrast, native dispersers reduced the negative effects of inbreeding without compromising the benefits of past purging of deleterious mutations. Our study highlights the importance of natural dispersal and reiterates the importance of maintaining habitat corridors between populations.