bluuebunny/crossref_metadata_2025 huggingface dataset:
The Nordic States
Authors: Wrange Pål , Kjeldgaard-Pedersen Astrid
Published: November 2023

The chapter on the Nordic States—Denmark, Finland, Iceland, Norway, and Sweden—begins by outlining key aspects of domestic as well as international history that have had significant impact on the region’s predominantly positive attitude towards international law. Despite certain differences among them—due in part to geopolitical interests—the Nordics have a long-standing tradition of extensive cooperation on important questions of international law, including the nomination of common candidates to positions in core international institutions like the ICJ, the ICC, and the ILC. With the examples of international security law and human rights, the chapter illustrates the active approach of the Nordic States in international law-making when it comes to legal regimes of general importance from a governmental perspective. The chapter then discusses historic and current Nordic trends in international legal scholarship, including Scandinavian legal realism. By way of conclusion, the authors reflect on the notion of ‘a Nordic approach to international law’.
Mass Medicine, Disease Control, and Conflict
Authors: Havik Philip J.
Published: November 2023

Following the outbreak of armed conflict in Algeria, Kenya, Rhodesia/Zimbabwe, Angola, Portuguese Guinea, and Mozambique in the 1950s and 1960s, health services and disease control programmes were confronted with significant challenges. These were acutely felt by vulnerable populations in rural areas which became the targets of ethnic and nationalist insurgency as well as counter-insurgency operations. The shift in focus of colonial policies to the contested terrain of community welfare and the militarization of colonial space turned villages into laboratories for the implementation of new forms of collective (health) security. ‘Mass medicine’, which was developed from the early 1900s with planned, top-down operations, mapping, large scale screening, curative and preventive interventions, and surveillance techniques to control and eradicate diseases, showed marked similarities with securitarian COIN-related interventions in conflict zones. This chapter analyses the entanglements of mass medicine, collective health security, and COIN strategies, as the developmentalist colonial state undertook the securitization and scientization of bio-social population management during late colonialism. In the process, it explores cognitive and behavioural aspects of coercive and persuasive strategies and interventions, showing how they evolved during protracted armed conflict in former Portuguese colonies—Angola and Portuguese Guinea—until the end of empire.
The Learning Brain
Authors: Aite Ania , Altarelli Irene , Borst Grégoire , Knops André
Published: November 2023

In this chapter, the authors first present the latest findings regarding the developing and the learning brain, and in particular that such development is nonlinear and dynamic and more affected by the environment than originally conceived. The authors then provide a comprehensive review of the latest findings on the domain-specific and domain-general neurocognitive processes involved in learning to read and learning mathematics in typically developing children and children with learning disabilities. In the fourth part of the chapter, the authors focus on the role of executive functions and inhibitory control more specifically, in school learning, such as arithmetic word problem and deductive reasoning. In addition, the authors present evidence that pedagogical interventions based on teaching to inhibit a given misleading strategy can be effective in helping students overcome systematic errors in different school learning. The authors conclude this chapter by providing a note of caution and a framework to bridge the gap between educational neuroscience in the lab and pedagogical practice in the classroom. More specifically, the authors argue that translating findings from cognitive neuroscience into intervention is a complex and arduous process that takes time but is worth a try given the importance of reading, mathematical, and reasoning skills in industrialized societies and the struggles that many students experience in learning these cultural tools.
A Novel Soybean Diacylglycerol Acyltransferase 1b Variant with Three Amino Acid Substitutions Increases Seed Oil Content
Authors: Flyckt Kayla S , Roesler Keith , Haug Collet Kristin , Jaureguy Luciano , Booth Russ , Thatcher Shawn R , Everard John D , Ripp Kevin G , Liu Zhan-Bin , Shen Bo , Wayne Laura L
Published: November 2023

Improving soybean (Glycine max) seed composition by increasing the protein and oil components will add significant value to the crop and enhance environmental sustainability. Diacylglycerol acyltransferase (DGAT) catalyzes the final rate-limiting step in triacylglycerol biosynthesis and has a major impact on seed oil accumulation. We previously identified a soybean DGAT1b variant modified with 14 amino acid substitutions (GmDGAT1b-MOD) that increases total oil content by 3 percentage points when overexpressed in soybean seeds. In the present study, additional GmDGAT1b variants were generated to further increase oil with a reduced number of substitutions. Variants with one to four amino acid substitutions were screened in the model systems Saccharomyces cerevisiae and transient Nicotiana benthamiana leaf. Promising GmDGAT1b variants resulting in high oil accumulation in the model systems were selected for overexpression in soybeans. One GmDGAT1b variant with three novel amino acid substitutions (GmDGAT1b-3aa) increased total soybean oil to levels near the previously discovered GmDGAT1b-MOD variant. In a multiple location field trial, GmDGAT1b-3aa transgenic events had significantly increased oil and protein by up to 2.3 and 0.6 percentage points, respectively. The modeling of the GmDGAT1b-3aa protein structure provided insights into the potential function of the three substitutions. These findings will guide efforts to improve soybean oil content and overall seed composition by CRISPR editing.
Phytoplankton metabolism in a stratified nearshore ecosystem with recurrent harmful algal blooms (HABs)
Authors: Regaudie-de-Gioux A , Latorre L , Basterretxea G
Published: November 2023

The coastal ocean is experiencing changes in its physical and chemical properties that strongly affect planktonic metabolism assemblages and, in some cases, favor the occurrence of harmful algal blooms (HABs). Here we analyze the variations in phytoplankton biomass, gross and net primary production (NCP) as well as community respiration (CR) at two nearshore sampling sites (P1 and P2) located at a Mediterranean beach where high biomass HABs are recurrent. At P1, the most exposed site, phytoplankton chlorophyll was generally low, whereas dinoflagellates outbreaks of the genus Gymnodinium and Alexandrium were recurrent during summer at P2 spanning for 10–20 days. During bloom episodes, NCP increased up to 10-fold (>80 mmol O2 m−3 day−1). Contrastingly, variation in CR only reached an average of 1.8-fold the rates of non-bloom conditions. Remarkably, although the enhanced NCP:CR ratio suggests net autotrophic population growth, production per unit biomass at P1 and P2 was not significantly different. Our results indicate that although summer conditions favor the necessary primary production enhancement leading to HAB occurrences, the short-term dynamics driving high biomass episodes are not driven by metabolic variations but instead are governed by subtle accumulative processes of some flagellate species in the nutrient-rich nearshore environment.
Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache
Authors: Ferch Richard D , Zhang Tyson , Bogduk Nikolai
Published: November 2023

Background

Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered.

Objective

To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability.

Design

Practice audit.

Setting

Private practice of senior author.

Subjects

Prospective series of 23 consecutive patients.

Methods

Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8–40 months), and for achieving various combinations of improvement of both neck pain and disability.

Results

Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both.

Conclusions

The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.
Civil-Military Relations in the Age of Populist Nationalism: The Case of Israel
Authors: Ziv Guy
Published: November 2023

One underplayed aspect of the current populist zeitgeist is the politicization of the military, adding to the growing list of dangers that democracies face today. Israel, which has experienced its own nationalistic populism since 2010, represents a deviant case with regard to the civil–military dimension. In contrast to the typical pattern of populist leaders enhancing the military's influence to bolster their own power, in Israel, populist politicians have sought to restrain the military top brass from the decision-making process, going as far as delegitimizing them by portraying them as part of the “leftist” out-of-touch elite. In a country in which the lines between the military and civilian spheres have traditionally been blurred and where security officials have played a significant role in decision-making, this has been a noteworthy development in the era of Benjamin Netanyahu. This article advances two causal claims pertaining to the Israeli case. First, perceived military setbacks and political-diplomatic moves associated with the military have diminished the once-hallowed reputation of the Israel Defense Forces. Second, right-wing politicians often view the military top brass as potential political rivals, given the standard practice in Israel of high-ranking generals entering politics upon retirement. The generals’ declining status in Israeli society has opened up the political space for populist nationalists to assault both active and retired security officials whose assessments often clash with the worldview of right-wing politicians.
Chimeric antigen receptor T cell therapy: a new emerging landscape in autoimmune rheumatic diseases
Authors: Lyu Xia , Gupta Latika , Tholouli Eleni , Chinoy Hector
Published: November 2023

Chimeric antigen receptor T cell (CAR-T) therapy, an innovative immune cell therapy, has revolutionized the treatment landscape of haematological malignancies. The past 2 years has witnessed the successful application of CD19-targeting CAR constructs in refractory cases of autoimmune rheumatic diseases, including systemic lupus erythematosus, systemic sclerosis and anti-synthetase syndrome. In comparison with existing B cell depletion therapies, targeting CD19 has demonstrated a more rapid and profound therapeutic effect, enabling drug-free remission with manageable adverse events. These promising results necessitate validation through long-term, large-sample randomized controlled studies. Corroborating the role of CAR-T therapy in refractory rheumatological disorders and affirming safety, efficacy and durability of responses are the aims of future clinical studies. Optimizing the engineering strategies and better patient selection are also critical to further refining the successful clinical implementation of CAR-T therapy.
Contexts of Contestation: How Competing Logics of the State Enable and Constrain Immigrant Civic and Political Participation
Authors: Vo Austin Hoang-Nam
Published: November 2023

Immigrants face substantial barriers to civic and political participation, but many nonetheless remain highly engaged. This study examines this tension by developing and applying a framework for analyzing how state policies both integrate immigrants and enforce immigration to shape participation. I find that states (1) differ in their adoption and implementation of federal immigration policy and (2) pass inclusive and exclusive legislation in cross-cutting ways, which together (3) shape group differences in immigrant engagement along race-ethnicity and citizenship. Immigrant participation is examined using multilevel data that combine individual-level characteristics with state policy and implementation measures. Models show that inclusionary public benefits policy bolsters participation and exclusionary law enforcement policy reduces participation. However, these policy effects are shown to attenuate each other in asymmetric ways. The bolstering effect of inclusionary policy is sensitive to and rendered statistically nonsignificant by exclusionary policy, but the reverse is not true. I conclude with a discussion on the implications of these results for research on civic inequality along race-ethnicity and citizenship.
Attestation and revocation: the curious world of Sangha v Sangha [2023] EWCA Civ 660
Authors: Learmonth Alexander
Published: November 2023

In Sangha, the Court of Appeal lays down some salutary lessons, not only about the risks of unthinkingly including revocation clauses in wills for testators with assets in more than one jurisdiction, but also about the importance of complying with the proper steps for due execution of a will.
Functional Walker Boots are Preferred to Synthetic Casts by Patients and Carers in the Management of Pediatric Stable Ankle Injuries
Authors: Hampton Matthew James , Hilton Camila , Nicolaou Nicolas , Flowers Mark J.
Published: November 2023

Introduction:

Traditionally children who presented with a stable ankle injury have been managed in a below-knee synthetic cast. No previous study has investigated patient and parents/carer preference between synthetic casts and walker boots.

Methods:

Children aged between 6 and 16 years who presented with stable ankle injuries (ankle sprains, small fragment avulsions, and fibular Salter-Harris 1 injuries) were randomized to receive treatment with either a synthetic cast or a walker boot. A tailored, study-specific questionnaire was designed and completed at 4 weeks from injury to evaluate both patient and parents/carer preference. An analysis of costs associated with both treatments was performed.

Results:

Ninety-one patients were available for final analysis. Forty-seven received synthetic cast treatment and 44 walker boot treatment. Patient demographics and injury types were matched between groups.

Statistical significance was found in favor of the walker boot with regard to comfort, reduction in activity during treatment, and patient-reported problems at the end of treatment. There was a strong and significant preference toward treatment with the walker boot, both from patients and parents/carers. There was no difference between groups with regard to walking ability, analgesia requirement, and patient-reported pain scores.

Unplanned attendances to the hospital during the treatment period were higher in the synthetic cast group. The overall treatment cost per patient was lower with the walker boot.

Conclusions:

In children who present with stable ankle injuries, treatment in a walker boot is preferred by both patients and parents/carers. It results in fewer unplanned attendances to the hospital, is less expensive, and we recommend it as the treatment of choice in stable pediatric ankle injuries.

Level of Evidence:

Level II.
Reapplication of the Pavlik Harness for Treatment of Developmental Dysplasia of the Hip After Initial Pavlik Harness Failure
Authors: Tomaru Yohei , Kamegaya Makoto , Saisu Takashi , Murakami Reiko , Sakuma Akitoshi , Oikawa Yasuhiro , Kakizaki Jun , Segawa Yuko , Tsukagoshi Yuta , Kamada Hiroshi , Yamazaki Masashi
Published: November 2023

Objective:

The Pavlik harness (PH) has been widely used as the standard treatment for infants with developmental dysplasia of the hip (DDH). When the initial application of the PH fails, alternative treatments, such as closed reduction, open reduction, and reapplication of the PH will be considered. Compared with other treatments, reapplication of the PH offers certain advantages, including simplicity and reduced physical, and psychological stress, on both infants and caregivers. This study aims to investigate the effectiveness of reapplying the PH in patients with DDH.

Methods:

This study included patients with DDH (complete dislocation) who were treated by reapplication of PH between 1988 and 2012. Patients who were able to follow-up for more than 5 years were included. We examined the reduction rate and several factors to identify indicators associated with successful reduction during reapplication, including age, sex, side of hip dislocation, and the presence of the Ortolani sign. At the final follow-up, hip development was assessed using the Severin classification, whereas avascular necrosis (AVN) was evaluated using the Kalamchi classification and the Salter criteria.

Results:

A total of 56 patients (48 females and 8 males) and 57 hips were included in this study. The mean age at first and second application of PH was 4.2 months old (range: 0.12 to 6.4), and 5.8 months old (3.0 to 11.4), respectively. The reduction rate was 49% (28 out of 57 hips). Among the successfully reduced hips, the AVN rate was 3.6% (1 out of 28 hips). The Severin classification revealed 27 hips in class I and 1 hip in class III. Statistical analysis indicated a significantly higher proportion of left hip involvement in the reduction group (85% vs 41%, χ2 test, P < 0.001). Although not statistically significant, the rate of positive Ortolani sign tended to be higher in the reduction group (61% vs 38%, χ2 test, P = 0.06).

Conclusion:

The reapplication method demonstrated a 49% reduction rate and a low AVN rate of 3.6% in our study. It is worth considering for patients who fail the initial PH treatment, particularly in cases of left-side dislocation and a positive Ortolani sign during the initial application.
Melanocytic Neoplasm With KIT and APC Mutations: A New Subtype of Melanocytoma?
Authors: Donati Michele , Grossmann Petr , Mansour Boulos , Kazakov Dmitry V.
Published: November 2023

We report a very unusual case of melanocytic neoplasm appearing clinically as a 0.5-cm dome-shaped pigmented papule on the chest of a 63-year-old man. Microscopically, it was an asymmetric, entirely dermally based neoplasm characterized by a multinodular, vaguely plexiform architecture composed of moderately pleomorphic spindled melanocytes with ample, dusty pigmented cytoplasm and scattered multinucleated cells. The tumor cells were strongly positive for Melan-A, HMB45, S100, and PRAME, whereas p16 showed diffuse nuclear loss. β-catenin presented a strong and diffuse cytoplasmic staining, while nuclei were negative. Despite an increased cellularity, mitotic count was low (1/mm2). Fluorescence in situ hybridization revealed no copy number alteration in melanoma-related genes (CDKN2A, MYB, MYC, CCND1 and RREB1). DNA and RNA sequencing identified KIT c.2458G>T and APC c.6709C>T mutations. No further genetic alteration was detected including TERT-promoter (TERT-p) hot-spot mutation. A re-excision was performed. A sentinel lymph node biopsy was negative. Clinical investigations revealed no extracutaneous involvement. The patient is disease-free after a follow-up period of 8 months. Given the peculiar morphologic and molecular findings, we hypothesize the lesion may represent a novel subtype of an intermediate grade melanocytic tumor (melanocytoma).
Connexin 43 in Dermatofibroma and Dermatofibrosarcoma Protuberans: Diagnostic, Pathogenic, and Therapeutic Implications
Authors: Fernandez-Flores Angel , Varela-Vazquez Adrian , Mayan Maria D. , Fonseca Eduardo
Published: November 2023

Connexins play a crucial role in the formation of gap junctions that connect cells to each other, as well as cells to the surrounding environment. In recent years, connexin 43 has been extensively studied in various human tumors. In this study, we conducted an immunohistochemical analysis to evaluate the expression of connexin in 16 dermatofibromas (DFs) and 13 dermatofibrosarcoma protuberans (DFSP). Connexin was diffusely expressed in the cytoplasm of all DFs with moderate or strong intensity, whereas all DFSPs showed negative staining. In addition to its diagnostic implications, the loss of Cx43 may elucidate the invasive capacity of DFSP and offer a potential avenue for future therapeutic interventions.
Melanoma Mimicker: Pigmented Mammary Paget Disease in a Man
Authors: Kenny Mary Grace , Nguyen Mai , Modi Mitul , Eilers David , Souchik Adam
Published: November 2023

Male breast cancer comprises less than 1% of all breast cancer cases. Mammary Paget disease (MPD) represents a subset of breast cancer that presents with skin changes of the nipple and areola, and is frequently misdiagnosed clinically due to similarities with other disease states, leading to an average delay in diagnosis of 1 month to 2 years. Pigmented mammary Paget disease (PMPD) is an uncommon variant of MPD that clinically and histologically resembles malignant melanoma. Due to variable immunohistochemical staining patterns, analysis can be challenging and often requires interpretation of panels for accurate diagnosis. We present a rare case of PMPD in a male, originally diagnosed both clinically and histologically as malignant melanoma, to highlight the diagnostic challenges that this entity presents, and to review staining patterns which may be useful in its diagnosis.
Nodular-Type Lichen Myxedematosus: A Rare Variant With Exclusive Involvement of the Hands—Report of Two Cases With a Comprehensive Review of the Literature
Authors: Cerroni Lorenzo , Rongioletti Franco
Published: November 2023

Lichen myxedematosus (LM) is an uncommon cutaneous mucinosis characterized by the deposition of mucin and fibroblast proliferation in the dermis. This condition can be classified into 2 forms: a diffuse/generalized LM, also known as scleromyxedema, associated with monoclonal gammopathy and systemic implications, and a localized form, primarily affecting the skin. Within the localized form, nodular-type LM is a rare variant presenting as firm, skin-colored to pinkish mucinous nodules. In this article, we report 2 new cases of nodular-type LM with exclusive involvement of the hands and provide a comprehensive review of the diagnosis, histopathological aspects, and therapeutic considerations of this rare condition.
Artificial Intelligence in Melanoma Dermatopathology: A Review of Literature
Authors: Neimy Hannah , Helmy John Elia , Snyder Alan , Valdebran Manuel
Published: November 2023

Pathology serves as a promising field to integrate artificial intelligence into clinical practice as a powerful screening tool. Melanoma is a common skin cancer with high mortality and morbidity, requiring timely and accurate histopathologic diagnosis. This review explores applications of artificial intelligence in melanoma dermatopathology, including differential diagnostics, prognosis prediction, and personalized medicine decision-making.
Squamous Carcinoma of the Oral Cavity in Patient with Fanconi Anemia: A Challenging Reconstruction with Double-barrel Free Fibula Flap Case Report
Authors: Gargiulo Maurizio , Petroccione Carlo , Razzano Sergio , La Torre Francesca , Manfellotto Vincenzo , D’Aniello Giuseppe , Barbieri Gerarda , d’Alessio Matteo , Nicoletti Giovanni Francesco , Ferraro Giuseppe Andrea
Published: November 2023

Fanconi anemia (FA) is a very rare form of aplastic anemia. Patients with FA have a higher risk of developing solid tumors such as head and neck squamous cell carcinoma, higher risk of local recurrence, and impaired resistance to chemotherapy and radiotherapy treatments than the normal population. In this article, we describe the challenging clinical case of a patient with FA who underwent surgery for the removal of a large squamous cell carcinoma in the oral cavity. Mandibular reconstruction was performed using a biaxial double-barrel fibular flap, with excellent functional aesthetic outcomes.
Lumbar Osteomyelitis and Epidural Abscess Caused by Cardiobacterium hominis—First Reported Case in the Pediatric Population: The Role of Universal 16S rRNA Gene PCR and Sequencing
Authors: Al Zoubi Moamen , Khan Huma M. , Najafi Sona
Published: November 2023

This report presents a case of a 14-year-old female patient diagnosed with lumbar (L2–L3) epidural abscess and vertebral osteomyelitis caused byCardiobacterium hominis. The diagnosis was made using universal 16S rRNA polymerase chain reaction. To the best of our knowledge, this is the first reported case ofC. hominislumbar epidural abscess and vertebral osteomyelitis in pediatric population. This case serves to illustrate the potential value of polymerase chain reaction and DNA sequencing in diagnosing culture-negative vertebral osteomyelitis and the potential role ofC. hominisin causing this infection.
Effect of intrastromal corneal ring segments on in vivo corneal biomechanics in keratoconus: 1-year results
Authors: Vinciguerra Riccardo , Fernández-Vega-Cueto Luis , Roberts Cynthia J. , Poo-Lopez Arancha , Eliasy Ashkan , Merayo-Lloves Jesús , Elsheikh Ahmed , Madrid-Costa David , Lisa Carlos , Alfonso José F.
Published: November 2023

Purpose:

To evaluate the 1-year effects of the implantation of intrastromal corneal ring segments (ICRS) in keratoconus (KC) on the dynamic corneal response (DCR) parameters obtained with the Corvis.

Setting:

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

Design:

Prospective, single-center, clinical study.

Methods:

Included were patients who underwent ICRS implantation for KC over a period of 1 year. On the day of the surgery and at least 6 months after ICRS implantation, the following measurements were made: corrected distance and uncorrected distance visual acuity, corneal tomography indices with the Pentacam, biomechanically corrected intraocular pressure and the Corvis DCRs (integrated inverse concave radius, deformation amplitude ratio, stiffness parameter at first applanation, stress–strain index [SSI] and the highest concavity radius).

Results:

30 eyes were included with a mean follow-up time of 15 months. Statistical analysis showed that ICRS implantation induced significant improvements in corneal biomechanics measurements between preoperative and long-term follow-up as demonstrated by a significant increase in SSI (P = .003). To confirm that this difference was actually induced due to a stiffening between early postoperative (previously published) and long-term an additional t-test was done between month 1 and late follow-up which confirmed a significant stiffening in the value of SSI (P = .01).

Conclusions:

Patients implanted with ICRS alone for KC showed a significantly stiffer response due to increased structural support compared with preoperative values and 1 month postoperative.
Prosthetic Curricular Threads: Pilot Survey of Clinical Practice and Physical Therapy Education
Authors: Corio Frances M. , Troiano Robert , Lee Daniel J.
Published: November 2023

Introduction

Physical therapists play a critical role in the rehabilitation of persons with limb loss/limb difference. The introduction to the skills and knowledge necessary to provide skilled care occurs during the physical therapist’s education in an accredited physical therapy program. Although clinical practice evolves as technological changes manifest and the evidence base progresses, it is unclear whether physical therapy education is adapting to stay current with clinical practice.

Purpose

The aim of this study was to explore the alignment of clinical practice with physical therapy education as it relates to prosthetic-specific curriculum.

Methods

Surveys were sent to inpatient rehabilitation hospitals, prosthetic service clinics, and accredited physical therapy programs. Each survey was designed to assess both limb loss/limb difference rehabilitation and prosthetic specific-content germane to the setting being surveyed.

Results

Sixty-eight physical therapy programs, 48 prosthetic-service providers, and 14 rehabilitation hospitals responded. Just over one third of physical therapy education programs reported having a course dedicated solely to prosthetic-related content.

There was general alignment between what is being taught and what is being practiced in the clinics; however, there was variation in specific content and time devoted to prosthetic-related curriculum across programs.

Conclusions

Further alignment of prosthetic-related content and clinical practice is needed in physical therapy programs.

Clinical Relevance Statement

More careful alignment of prosthetic curricular content with clinical practice in physical therapy programs will increase the effectiveness of rehabilitation programs and help persons with amputations regain more function and quality of life.
Effect of carotid corrected flow time combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients: A prospective cohort study
Authors: Huang Shishi , Liao Zhenqi , Chen Andi , Wang Jiali , Xu Xiaodong , Zhang Liangcheng
Published: November 2023

Background:

Hypotension often occurs following the induction of general anesthesia in elderly patients undergoing surgery and can lead to severe complications. This study assessed the effect of carotid corrected flow time (FTc) combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients.

Materials and methods:

The prospective cohort study was divided into two parts. The first part (Part Ⅰ) consisted of 112 elderly patients. Carotid FTc was measured using Color Doppler Ultrasound 5 minutes before anesthesia induction. Hypotension was defined as a decrease of greater than 30% decrease in systolic blood pressure (SBP) or a decrease of greater than 20% decrease in mean arterial pressure (MAP) from baseline, or an absolute SBP below 90 mmHg and MAP below 60 mmHg within 3 minutes after induction of general anesthesia. The predictive value of carotid FTc were determined using Receiver Operating Characteristic (ROC) curve. The second part (Part Ⅱ) consisted of 65 elderly patients. Based on the results in Part Ⅰ, elderly patients with carotid FTc below the optimal cut-off value received perioperative fluid therapy at a volume of 8 ml/kg balanced crystalloids (lactated Ringer solution) in 30 minutes before induction. The effect of carotid FTc combined with perioperative fluid therapy was assessed by comparing observed incidence of hypotension after induction.

Results:

The areas under the ROC for carotid FTc to predict the hypotension after induction were 0.876 [95% confidence interval (CI) 0.800-0.952, P<0.001]. The optimal cut-off value was 334.95 ms (sensitivity of 87.20%; specificity of 82.20%). The logistic regression analysis revealed that carotid FTc is an independent predictor for post-induction hypotension in elderly patients. The incidence of post-induction hypotension was significantly lower (P<0.001) in patients with Carotid FTc<334.95 ms who received perioperative fluid therapy (35.71%) compared to those who did not (92.31%).

Conclusions:

Carotid FTc combined with the perioperative fluid therapy could significantly reduce the incidence of hypotension after the induction of general anesthesia in elderly patients.
Short- and long-term outcomes after robotic versus open hepatectomy in patients with large hepatocellular carcinoma: a multicenter study
Authors: Zhang Xiu-Ping , Jiang Nan , Zhu Lin , Lin Zhao-Yi , Guo Wei-Xing , Chen Xiong , Ma Yun-Tao , Zhang Fan , Tang Yu-Fu , Chen Zi-Li , Yan Mao-Lin , Zhao Zhi-Ming , Li Cheng-Gang , Lau Wan Yee , Cheng Shu-Qun , Hu Ming-Gen , Liu Rong
Published: November 2023

Background:

Robotic hepatectomy (RH) is currently widely accepted and it is associated with some benefits when compared to open hepatectomy (OH). However, whether such benefits can still be achieved for patients with large hepatocellular carcinoma (HCC) remain unclear. This study aimed to evaluate the short- and long-term outcomes of patients undergoing RH or OH.

Methods:

Perioperative and survival data from patients with large HCC who underwent RH or OH between January 2010 and December 2020 were collected from eight centers. Propensity score matching (PSM) was performed to minimize potential biases.

Results:

Using predefined inclusion criteria, 797 patients who underwent OH and 309 patients who underwent RH were enrolled in this study. After PSM, 280 patients in the robotic group had shorter operative time (median 181 vs. 201 min, P<0.001), lower estimated blood loss (EBL) (median 200 vs. 400 mL, P<0.001), and shorter postoperative length of stay (LOS) (median 6 vs. 9 d, P<0.001) than 465 patients in the open group. There were no significant differences between the two groups in overall survival (OS) and recurrence-free survival (RFS). Cox analysis showed AFP >400 ng/mL, tumour size >10 cm, and microvascular invasion were independent risk factors for OS and RFS. After PSM, subgroup analysis showed that patients with a huge HCC (diameter >10 cm) who underwent RH had significantly lower EBL (median 200.0 vs. 500.0 minutes, P<0.001), and shorter LOS (median 7 vs. 10 d, P<0.001) than those who underwent OH.

Conclusion:

Safety and feasibility of RH and OH for patients with large HCC were comparable. RH resulted in similar long-term survival outcomes as OH.
Predictive factors for persistent hypercalcemia following parathyroidectomy in patients with persistent hyperparathyroidism after kidney transplantation: A retrospective cohort study
Authors: Kim Byung-Chang , Kim Hyosang , Baek Chung Hee , Kim Young Hoon , Pak Shin Jeong , Kwon Douk , Cho Jae Won , Lee Yu-mi , Sung Tae-Yon , Chung Ki-Wook , Kim Won Woong
Published: November 2023

Background:

Surgery for irreversible hyperparathyroidism is the preferred management for kidney transplant patients. We analyzed the factors associated with persistent hypercalcemia after parathyroidectomy in kidney transplant patients and evaluated the appropriate extent of surgery.

Materials and Methods:

We retrospectively analyzed 100 patients who underwent parathyroidectomy because of persistent hyperparathyroidism after kidney transplantation at a tertiary medical center between June 2011 and February 2022. Patients were divided into two groups: 22 with persistent hypercalcemia after parathyroidectomy and 78 who achieved normocalcemia after parathyroidectomy. Persistent hypercalcemia was defined as having sustained hypercalcemia (≥10.3 mg/dL) 6 months after kidney transplantation. We compared the biochemical and clinicopathological features between the two groups. Multivariate logistic regression analysis was used to identify potential risk factors associated with persistent hypercalcemia following parathyroidectomy.

Results:

The proportion of patients with serum intact parathyroid hormone (PTH) level >65 pg/mL was significantly high in the hypercalcemia group (40.9% vs. 7.7%). The proportion of patients who underwent less than subtotal parathyroidectomy was significantly high in the persistent hypercalcemia group (19.2% vs. 50%). Patients with a large remaining size of the preserved parathyroid gland (≥0.8 cm) had a high incidence of persistent hypercalcemia (29.7% vs. 52.6%). In the multivariate logistic regression analysis, the drop rate of intact PTH <88% on postoperative day (POD) 1 (odds ratio [OR] 10.3, 95% confidence interval [CI]: 2.7–39.1, P=0.001) and the removal of≤2 parathyroid glands (OR 6.8, 95% CI: 1.8–26.7, P=0.001) were identified as risk factors for persistent hypercalcemia.

Conclusion:

The drop rate of intact PTH <88% on POD 1 and appropriate extent of surgery for controlling the autonomic function were independently associated with persistent hypercalcemia. Confirmation of parathyroid lesions through frozen section biopsy or intraoperative PTH monitoring can be helpful in preventing the inadvertent removal of a parathyroid gland and achieving normocalcemia after parathyroidectomy.
Efficacy of Antiobesity Medications in Patients With Celiac Disease on a Gluten-free Diet
Authors: Anazco Diego , Fansa Sima , Ghusn Wissam , Gala Khushboo , Nicolalde Bryan , Tama Elif , Calderon Gerardo , Bledsoe Adam C. , Hurtado Maria D. , Murray Joseph A. , Acosta Andres
Published: November 2023

Goals:

We aim to describe the weight loss outcomes of patients with celiac disease (CeD) taking antiobesity medications (AOMs) and compare it with the weight loss outcomes of patients without CeD taking AOMs.

Background:

Increasing rates of obesity and obesity-associated comorbidities have been previously reported in patients with CeD on a gluten-free diet. The effectiveness of AOMs in this population has not been previously described.

Methods:

In our retrospective cohort study, we matched 39 patients with treated CeD to 78 patients without CeD based on sex and AOM. We assessed the weight loss outcomes at 3, 6, and 12 months after starting the AOM in both cohorts and analyzed if there was a differential response when comparing by type of AOM [injectable glucagon-like peptide 1 (GLP-1) receptor agonists vs. oral non-GLP-1 AOMs].

Results:

Both cohorts had similar baseline demographic and anthropometric characteristics. At 12 months, the CeD cohort had a nonsignificantly inferior total body weight loss percentage compared with the cohort without CeD (6.5% vs. 9.5%, P=0.13). The CeD cohort had a similar proportion of patients achieving a total body weight loss percentage of ≥5% than the cohort without CeD (72.7% vs. 72.1%, P=1.00). No significant difference was observed when comparing the weight loss outcomes of injectables (GLP-1 receptor agonists) to oral AOMs. The proportion of patients reporting side effects was similar for both groups, regardless of the type of AOM.

Conclusion:

Patients with CeD taking AOMs had similar weight loss outcomes to patients without CeD. Hence, AOMs can be a safe and effective therapy for weight management in patients with CeD.
Impact of Slim Linear Echoendoscope on the Practice of EUS
Authors: Bang Ji Young , Willems Philippe , Navaneethan Udayakumar , Hawes Robert , Varadarajulu Shyam
Published: November 2023

Background:

Standard linear echoendoscopes have a large distal tip and bending radius, which can preclude adequate examination in some patients.

Objective:

We examined the impact of having available slim linear echoendoscopes (SLE) on our endoscopic ultrasound (EUS) practice.

Materials and Methods:

As a quality improvement measure, data on the need for the use of SLE were documented in 2000 consecutive procedures performed over a 10-month period from February to November 2022. When examination using a standard size echoendoscope failed due to technical limitations, the procedure was reattempted in the same session using a SLE. The main outcome was the impact of SLE, which was defined as the establishment of a new diagnosis or if findings altered treatment plan.

Results:

A complete EUS examination failed in 23 of 2000 procedures (1.15%, 95% CI, 0.73-1.72%) performed using standard size echoendoscope (14 male, median age 73 y [IQR 66 to 79]). The examination was technically successful when using SLE in 22 of 23 (95.6%) patients. SLE impacted clinical management in all 22 patients (100%) by establishing tissue diagnosis in 19 and/or altering subsequent treatment plan in 5. Adverse event of transient hypoxia was observed in one patient (4.3%).

Conclusions:

A very experienced EUS team required SLE in 1.1% of consecutive examinations. Our findings suggest that when used, 95% of patients benefitted as it had a significant impact on their clinical management.
The Rosetta Stone of interactions of mucosa and associated bacteria in the gastrointestinal tract
Authors: Berberolli Serena , Wu Mengqi , Goycoolea Francisco M.
Published: November 2023

Purpose of review

Gut microbiota–mucosa–epithelial cells co-exist in an intricate three-way relationship that underpins gut homeostasis, and ultimately influences health and disease conditions. The O-glycans of mucin glycoproteins have been uncovered as a centrepiece of this system, although understanding the phenomena at play at the molecular level has been challenging and subject to significant traction over the last years. The purpose of this review is to discuss the recent advances in the phenomena that mediate microbiota and mucus multidirectional interactions in the human gut.

Recent findings

The mucus biosynthesis and degradation by both commensal and pathogenic bacteria is under tight regulation and involves hundreds of carbohydrate-active enzymes (CAZy) and transporters. The fucosylation of O-glycans from mucin-2 seems to dictate binding by pathogenic species and to influence their virulence. Less clear is the influence of O-glycans in quorum sensing and biofilm formation. We have reviewed the advances in the in vitro models available to recreate the phenomena that capture the physiological context of the intestinal environment, emphasising models that include mucus and other aspects relevant to the physiological context.

The recent findings highlight the importance of merging advances in analytical (glycans analysis) and omics techniques along with original robust in vitro models that enable to deconstruct part of the high complexity of the living gut and expand our understanding of the microbes-mucosa relationships and their significance in health and disease.
Cavernous hemangioma of the breast: a case report
Authors: Adhikari Shankar , Bhatta Om Prakash , Bhetwal Prashant
Published: November 2023

Background:

Hemangioma is a common benign tumor resulting from abnormal blood vessel growth but is infrequent in the breast. Preoperatively, it is challenging to diagnose breast hemangioma using clinical and conventional imaging modalities because of their lack of pathognomonic characteristics. An excisional biopsy can be used for tissue diagnosis in cases of diagnostic uncertainty.

Case presentation:

The authors report a case of cavernous hemangioma of the breast in a 15-year-old adolescent female complaining of a rapidly enlarging firm and mobile lump in the right breast. Breast ultrasonography revealed a well-circumscribed, encapsulated, heteroechoic mass with smooth margins in the retroareolar region of the right breast. Subsequent excision of the lump revealed features of a cavernous hemangioma, and the follow-up was uneventful.

Discussion:

Cavernous hemangioma of the breast is a rare entity, and its diagnosis poses a significant challenge for clinicians, as the lump may not be noticeable. The clinical diagnosis is challenging; therefore, imaging is required. Breast ultrasonography typically shows a hypoechoic lobulated mass with clear borders, although isoechoic and hyperechoic appearances are also possible. Breast mammography revealed a well-defined mass with areas of calcification. Surgical excision is often necessary when there is a discordance between imaging and histopathological findings, lesions greater than 2 cm, and atypical/malignant features.

Conclusion:

Breast hemangiomas are rare benign tumors with nonspecific imaging features that require tissue sampling for diagnosis. Clinicians should be familiar with these characteristics to ensure proper management.
Understanding the Impact of Deviant Peer Association on Dual Systems Model Development
Authors: Wojciechowski Thomas
Published: November 2023

Recent research has indicated that deviant peers may play a role in cognitive development. This is particularly the case for the dual systems model, a key framework for understanding engagement in antisocial behavior during adolescence and emerging adulthood. However, limited research has examined how preexisting mental health concerns may moderate these relationships. This study used the Pathways to Desistance data to examine attention deficit hyperactivity disorder (ADHD) as a moderator of the relationships between deviant peer association and dual systems model constructs. Generalized estimating equations were used to test these relationships. Results indicated that deviant peer association and the presence of ADHD both predicted increased sensation-seeking and lower impulse control. ADHD significantly moderated the relationship between deviant peer association and impulse control, indicating a weaker impact of deviant peer association on impulse control among participants with ADHD. No significant interaction was observed for the relationship between deviant peer association and sensation-seeking.
Recommendations From a Systematic Review of Leadership Development to Support a New Nursing Practice Model
Authors: Foots Lozay , Swiger Pauline A. , Orina Judy , Campbell Caitlin Marley , Javed Mariyam , Hodson Patricia , Patrician Patricia A.
Published: November 2023

OBJECTIVE

To develop a new nursing practice model for use within the US military, researchers aimed to create evidence-based recommendations for nursing leadership development based on current literature.

BACKGROUND

The role of nursing leadership has many implications, including better nurse and patient outcomes. Therefore, an actionable compilation of recommendations informing how to develop effective nurse leaders could be helpful for current and aspiring nurse leaders.

METHODS

Researchers conducted a systematic literature review of 5 databases searching for relevant articles published from 2001 to 2020.

RESULTS

Seventy-eight articles were synthesized to develop a list of 5 broad yet actionable recommendations for leadership development.

CONCLUSIONS

Leadership development is essential for current and future nurse leaders. The recommendations identified from this review can assist in developing leaders. Leaders can use these recommendations to guide leadership training initiatives, engage in self-development, or begin succession planning.
New Graduate Nurses' Competencies, Organizational Socialization, and Turnover Intention
Authors: Song Youngkwan , Kim Jung A
Published: November 2023

OBJECTIVE

This study aimed to identify core competencies in new-graduate nurses (NGNs) by determining which competencies affected their organizational socialization (OS) and turnover intention (TI) in their 1st year of employment.

BACKGROUND

NGNs face stressful transitions with expanded nursing responsibilities that motivate them to leave their jobs. Therefore, NGN turnover in the 1st year of practice is higher than the overall nurse turnover rate. Previous research suggested that NGNs' competency levels affect their OS and TI. However, little research has been done to determine which competencies affect these variables.

METHODS

Multiple linear regression analysis was performed on cross-sectional survey data to determine the effects of NGN work competencies on OS and TI.

RESULTS

Health promotion, supervision, interpersonal communication, and direct care competencies significantly predicted NGNs' OS, and computer technology competency significantly predicted NGNs' TI.

CONCLUSIONS

NGNs should be given early opportunities for expanded hands-on clinical experiences along with clear awareness of the organization's goals and values. Moreover, they should be offered roles that take advantage of their computer technology skills and that challenge them to contribute to their organization and nursing care in new ways.