bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical effects of Evans versus Hintermann osteotomy for treating adult acquired flatfoot deformity: a patient-specific finite element investigation
Authors: Xu Can , Liu Hua , Li Mingqing , Li Hui , Pan Chun’ang
Published: February 2024

Background

Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good clinical results. The aim of this study was to compare these two procedures in terms of corrective ability and biomechanics influence on the Chopart and subtalar joints through finite element (FE) analysis.

Methods

Twelve patient-specific FE models were established and validated. The Hintermann osteotomy was performed between the medial and posterior facets of the subtalar joint; while, the Evans osteotomy was performed on the anterior neck of the calcaneus around 10 mm from the calcaneocuboid joint surface. In each procedure, a triangular wedge of varying size was inserted at the lateral edge. The two procedures were then compared based on the measured strains of superomedial calcaneonavicular ligaments and planter facia, the talus-first metatarsal angle, and the contact characteristics of talonavicular, calcaneocuboid and subtalar joints.

Results

The Hintermann procedure achieved a greater correction of the talus-first metatarsal angle than Evans when using grafts of the same size, indicating that Hintermann had stronger corrective ability. However, its distributions of von-Mises stress in the subtalar, talonavicular and calcaneocuboid joints were less homogeneous than those of Evans. In addition, the strains of superomedial calcaneonavicular ligaments and planter facia of Hintermann were also greater than those of Evans, but both generally within the safe range (less than 6%).

Conclusion

This FE analysis study indicates that both Evans and Hintermann procedures have good corrective ability for AAFD. Compared to Evans, Hintermann procedure can provide a stronger corrective effect while causing greater disturbance to the biomechanics of Chopart joints, which may be an important mechanism of arthritis. Nevertheless, it yields a better protection to the subtalar joint than Evans osteotomy.

Clinical relevance

Both Evans and Hintermann LCL surgeries have a considerable impact on adjacent joints and ligament tissues. Such effects alongside the overcorrection problem should be cautiously considered when choosing the specific surgical method.

Level of evidence

Level III, case–control study.
Differences and similarities in muscle architecture of fibularis longus and brevis—An observational descriptive cross-sectional and feasibility study
Authors: Sprinchorn Anna E. , Eizenberg Norman , Barker Priscilla J.
Published: February 2024

Background

The fibularis longus (FL) muscle is larger in volume than fibularis brevis (FB) and is therefore claimed to be the stronger evertor of the two. Clinical observation of FL and FB tendon rupture show that injury to the FB has a serious negative effect on hindfoot eversion. This implies that the FB is the stronger and more important evertor. The strength of a muscle is not purely based on its volume, and the observed discrepancy between the FB and FL may be due to differences in muscle architecture. This study compares the muscle architecture of FL with FB.

Methods

Sixteen legs from eight formaldehyde-fixed human specimens, mean age 83 (range 72–89) years, were dissected. The volume, fibre lengths and fibre pennation angles for both muscles were measured and the physiological cross-sectional area (PCSA) was calculated.

Results

The FL was always larger than the FB, with an individual difference in volume that varied from 1.4 to 4.6 times larger with a mean difference of 17 ml (95% CI 14–20; p < 0.001). Mean fibre lengths were 9 mm (95% CI 2–16; p = 0.015) longer in FL than in FB. The mean pennation angle was 9.6 degrees in FL and 8.8 degrees in FB, this difference was not significant (p = 0.32). The mean PCSA for FL was 3 cm2 (95% CI 2–4) larger than for FB (p < 0.001).

Conclusions

With our sample set, the hypothesis that the muscle architecture can explain the clinical discrepancy between the FL and FB, was not supported. The difference in hindfoot eversion might instead depend on the different moment arms of FL and FB and the effect forefoot abduction has on hindfoot eversion.
Bushenhuoluo Decoction improves polycystic ovary syndrome by regulating exosomal miR-30a-5p/ SOCS3/mTOR/NLRP3 signaling-mediated autophagy and pyroptosis
Authors: Huang Qun , Li Yuanbin , Chen Zhuang , Ou Huiping , Tan Yanjiao , Lin Hui
Published: February 2024

Background

Polycystic ovary syndrome (PCOS) is a frequent and complicated endocrine disease that remains a major reason for infertility. Bushenhuoluo Decotion (BSHLD) has been validated to exhibit curative effects on PCOS. This study was aimed to explore the potential mechanism underlying the therapeutic action of BSHLD.

Methods

PCOS rat model was induced by dehydroepiandrosterone (DHEA). Serum hormone and cytokines levels and ovarian pathological alterations were measured to assess ovarian function. Exosomes (Exos) were identified by Transmission electron microscopy and Nanoparticle Tracking Analysis. RT-qPCR, Western blotting, immunohistochemical staining, and immunofluorescence staining were performed to detect molecule expressions. Proliferation and pyroptosis of granulosa cells (GCs) were evaluated by CCK-8 and flow cytometry, respectively. The binding relationship between miR-30a-5p and suppressor of cytokine signaling 3 (SOCS3) was verified by dual luciferase reporter and RIP assays.

Results

BSHLD treatment improved serum hormone abnormality, insulin sensitivity, and ovarian morphologic changes of PCOS rats. Moreover, BSHLD treatment restrained the excessive autophagy and pyroptosis in ovarian tissues of PCOS rats. Moreover, BSHLD reduced the expression of miR-30a-5p in serum, serum-derived Exos, and ovarian tissues, thus inhibiting autophagy and NLRP3-mediated pyroptosis in GCs. Mechanistically, SOCS3 was proved as a target of miR-30a-5p and could activate mTOR/P70S6K pathway to repress autophagy. The inhibitory effect of miR-30a-5p deficiency on autophagy and pyroptosis of GCs was attenuated by rapamycin.

Conclusion

Collectively, BSHLD suppressed autophagy and pyroptosis to improve POCS by regulating exosomal miR-30a-5p/SOCS3/mTOR signaling.
Combining proteins with n-3 PUFAs (EPA + DHA) and their inflammation pro-resolution mediators for preservation of skeletal muscle mass
Authors: Blaauw Renée , Calder Philip C. , Martindale Robert G. , Berger Mette M.
Published: February 2024

The optimal feeding strategy for critically ill patients is still debated, but feeding must be adapted to individual patient needs. Critically ill patients are at risk of muscle catabolism, leading to loss of muscle mass and its consequent clinical impacts. Timing of introduction of feeding and protein targets have been explored in recent trials. These suggest that “moderate” protein provision (maximum 1.2 g/kg/day) is best during the initial stages of illness. Unresolved inflammation may be a key factor in driving muscle catabolism. The omega-3 (n-3) fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are substrates for synthesis of mediators termed specialized pro-resolving mediators or SPMs that actively resolve inflammation. There is evidence from other settings that high-dose oral EPA + DHA increases muscle protein synthesis, decreases muscle protein breakdown, and maintains muscle mass. SPMs may be responsible for some of these effects, especially upon muscle protein breakdown. Given these findings, provision of EPA and DHA as part of medical nutritional therapy in critically ill patients at risk of loss of muscle mass seems to be a strategy to prevent the persistence of inflammation and the related anabolic resistance and muscle loss.
Leptin receptor deficiency impedes metabolic surgery related-weight loss through inhibition of energy expenditure in db/db mice
Authors: Tong Dan , Xiang Jie , Liu Wei , Sun Fang , Wang Lijuan , Mou Aidi , Cao Tingbing , Zhou Qing , You Mei , Liao Yingying , Gao Peng , Liu Daoyan , Lu Zongshi , Zhu Zhiming
Published: February 2024

Background

Roux-en-Y gastric bypass (RYGB) surgery is an effective metabolic surgery against diabetes and obesity. Clinical evidence indicates that patients with severe obesity have a poor curative effect in losing weight if they suffer from leptin or its receptor deficiency, but the underlying mechanism remains elusive. Here, we investigated the effect of leptin receptor deficiency on metabolic dysfunction in db/db mice treated by RYGB surgery.

Methods

The db/db mice and their heterozygote control db/m mice were subjected to RYGB or sham surgery. Body weight, blood glucose, food intake and glucose tolerance were evaluated. Micro-PET/CT and histological analysis were performed to examine the glucose uptake of tissues and the fat changes in mice. The key factors in glucose and fatty acid metabolism were detected by western blot analysis.

Results

Compared with the sham group, the db/db mice in the RYGB group showed more significant weight regain after surgical recovery and improvement in hyperinsulinemia and glucose tolerance. However, the total body fat and multiple organ lipid deposition of RYGB-treated db/db mice was increased. The underlying mechanism studies suggested that the activation of AMPK regulated GLUT4 to increase glucose uptake, but AMPK could not promote fatty acid oxidation through the JAK2/STAT3 pathway under leptin receptor deficiency in db/db mice.

Conclusion

We conclude that leptin receptor deficiency impedes the AMPK activation-mediated fat catabolism but does not affect AMPK-related glucose utilization after metabolic surgery in db/db mice. This result helps select surgical indications for patients with obesity and diabetes.
Development and validation of the Japanese version of the Bedtime Procrastination Scale (BPS-J)
Authors: Hazumi Megumi , Kawamura Aoi , Yoshiike Takuya , Matsui Kentaro , Kitamura Shingo , Tsuru Ayumi , Nagao Kentaro , Ayabe Naoko , Utsumi Tomohiro , Izuhara Muneto , Shinozaki Mio , Takahashi Eriya , Fukumizu Michio , Fushimi Momo , Okabe Satomi , Eto Taisuke , Nishi Daisuke , Kuriyama Kenichi
Published: February 2024

Background

The average sleep duration of Japanese people is shorter than that of people from other countries, and bedtime procrastination is suspected to be one of the factors contributing to this issue. This study aimed to develop and validate the Japanese version of the Bedtime Procrastination Scale (BPS-J).

Methods

The BPS-J was developed through procedures including the translation and back-translation of the scale, cognitive interviews with 100 participants who reported having experiences of being diagnosed with insufficient sleep syndrome (ISS) or receiving treatment for ISS using open-ended online questionnaires, and expert checking. To investigate the scale’s validity and reliability, an online survey was conducted with daytime workers aged 20 − 65 years without a history of sleep disorders other than ISS. Half the participants were retested using the same survey after 14 days. Participants’ responses to the Brief Self-Control Scale (BSCS), General Procrastination Scale (GPS), and Munich ChronoType Questionnaire (MCTQ), and data on sleep-related variables such as sleep duration on workdays and the days per week of fatigue or sleep loss, sex, and age, were collected.

Results

We analyzed data from 574 participants to assess scale validity. We then analyzed data from 280 participants to determine test–retest reliability. Confirmatory factor analyses revealed that the two-factor model without Item 2 was most suitable for the BPS-J, unlike other language versions. Regardless of the full-item model or the model with Item 2 eliminated, sufficient reliability and significant correlations with the BSCS, GPS, MCTQ, and sleep-related variables such as sleep duration per night on work days, days per week of feeling fatigued, and days per week of sleep loss were observed. Logistic and linear regressions showed that the relationships between the BPS-J, sleep-related variables, and MCTQ were maintained after adjusting for sex and age.

Conclusion

The BPS-J had sufficient validity and reliability. Further, eliminating Item 2 from the original version of the BPS strengthened the ability to survey Japanese daytime workers.
Dual channel and multi-scale adaptive morphological methods for infrared small targets
Authors: Liu Ying-Bin , Zeng Yu-Hui , Qin Jian-Hua
Published: February 2024

Infrared small target detection is a challenging task. Morphological operators with a single structural element size are easily affected by complex background noise, and the detection performance is easily affected by multi-scale background noise environments. In order to enhance the detection performance of infrared small targets, we propose a dual channel and multi-scale adaptive morphological method (DMAM), which consists of three stages. Stages 1 and 2 are mainly used to suppress background noise, while stage 3 is mainly used to enhance the small target area. The multi-scale adaptive morphological operator is used to enhance the algorithm’s adaptability to complex background environments, and in order to further eliminate background noise, we have set up a dual channel module. The experimental results indicate that this method has shown superiority in both quantitative and qualitative aspects in comparison methods, and the effectiveness of each stage and module has been demonstrated in ablation experiments. The code and data of the paper are placed in https://pan.baidu.com/s/19psdwJoh-0MpPD41g6N_rw.
An evaluation of pharmacists’ general attitudes, knowledge, and phobias regarding medications that include corticosteroids: a cross-sectional study
Authors: Barakat Muna , Thiab Samar , Farha Rana Abu , Alshweiki Anas O. , Thaher Roa’a , Alsughaier Asem , Malaeb Diana
Published: February 2024

Background

Corticosteroid-containing medications are widely accessible in various forms, including topical, injectable, and inhaled formulations. Due to uncertain safety profiles, healthcare providers, including pharmacists, often express apprehension when dispensing these drugs. This cross-sectional study assesses the knowledge, attitudes, and phobia of Jordanian pharmacists regarding corticosteroid-containing medications.

Methods

Conducted through a self-administered online questionnaire.

Results

the study reveals that dermatological conditions and respiratory disorders are the primary indications for prescribing corticosteroid-containing drugs. The most reported side effects among pharmacists’ patients include increased appetite, diabetes, and skin thinning. Pharmacists generally exhibit acceptable knowledge, with a median score of 9.0 out of 11.0 (IQR = 3.0). Over two-thirds of pharmacists (69.9%) achieve a high knowledge score (Bloom’s cut-off point ≥ 8.8). However, only 55.7% are aware that corticosteroids may induce mood changes. High phobia scores, particularly concerning increased blood pressure and osteoporosis risks, indicate pharmacist reservations in corticosteroid dispensing. Interestingly, pharmacists in rural areas display lower knowledge scores, while those working outside community pharmacies exhibit lower phobia scores compared to their counterparts in urban areas and community pharmacies, respectively.

Conclusion

Despite generally good knowledge levels, the study underscores high phobia scores among Jordanian pharmacists regarding corticosteroid dispensing, particularly due to concerns about blood pressure elevation and osteoporosis risks. This suggests a potential need for targeted educational interventions and support systems to enhance pharmacist confidence and optimize corticosteroid usage while minimizing associated risks.
Public hospital pharmacists’ knowledge, attitudes, and practices for antibiotic stewardship implementation in Limpopo Province, South Africa
Authors: Mthombeni Tiyani Comfort , Burger Johanita Riétte , Lubbe Martha Susanna , Julyan Marlene
Published: February 2024

Background

Hospital pharmacists are important in antibiotic stewardship programs (ASP), a global strategy to combat antibiotic resistance (ABR). South African public hospitals have limited ASP implementation. This study describes Limpopo Provincial Hospital pharmacists’ knowledge, attitudes, and practice toward ASP implementation.

Method

A questionnaire to explore pharmacists’ knowledge, attitudes and practices regarding ASP implementation comprised 43 questions hosted online. A link was sent by invitation e-mail to eligible respondents in November 2021. Five questions on respondents’ demographics, 15 questions on ASP knowledge, 10 Likert scale questions on attitude, and 13 on ASP practices were included. Mean (standard deviation (SD)) knowledge and attitude scores and a median (interquartile range (IQR)) practice score was calculated. Associations between categorical variables were assessed using chi-square/Fisher’s exact analysis (p < 0.05), with Cramér’s V as effect size.

Results

The survey yielded 35 responses (13.1%). Twenty (57.1%) respondents were female. Seventeen (48.6%) respondents were between the ages of 31 and 40 years. The mean knowledge score of respondents was 9.8 (2.6) (N = 34), with knowledge gaps on One Health and socioeconomic determinates of ABR. Ten (29.6%) respondents thought One Health discouraged multi-sector collaboration, and nineteen (55.9%) respondents thought ASP was the only strategic response to ABR. Sixteen (47.1%) respondents did not know that poor access to clean water accelerates ABR and seventeen (50.0%) did not know that poverty could be a determinant for antibiotic use. The mean respondent attitude score was 8.0 (1.7) (N = 28). Twenty-seven (96.4%) respondents agreed that ASP was necessary and agreed to participate in ASP respectively. All 28 (100.0%) respondents agreed to lead an ASP. The median (IQR) respondents’ practice score was − 2.0 (IQR: -6.0–5.8) (N = 16). Respondents were inconsistently (never, sometimes, every time) participating in multi-disciplinary forums (6/16, 37.5%) and expressed a desire for training (11/13, 84.6%) on ASP through in-service (7/27, 25.9%). Respondents thought ASP training should include medical officers (12/29, 41.4%) and nurses (9/29, 31.8%). Knowledge score was associated with gender (p = 0.048; V = 0.416) and attitude score (p = 0.013; V = 0.556).

Conclusion

Our study found pharmacists had good knowledge and a positive attitude toward ASP implementation but poor ASP practices. A multi-disciplinary in-service training could address identified knowledge and practice gaps.
Navigating the myriad of corporate quality standards: a CSR and stakeholder perspective
Authors: Ritchie William J. , Gallagher Scott , Melnyk Steven A. , Shahzad Ali
Published: February 2024

Quality standards (QS) (e.g., ISO 9001) play an important role in assuring the quality of goods and services for organizational stakeholders on a global scale. Recent work has highlighted the role of QS in communicating corporate social responsibility (CSR) practices to a firm’s stakeholders making both the QS adoption decision and the timing of adoption of immense strategic importance to top managers. However, the types of QS and their intended and unintended beneficiaries vary widely, making it difficult for managers to choose QS that are in accord with their CSR goals. Further, current economic (cost/benefit) and institutionally-based theoretical approaches do not provide managers with adequate guidance in making strategic adoption decisions. Rapid developments in QS practices have also made it difficult for researchers to incorporate them into CSR theory. Drawing upon a literature review of QSs and stakeholder theory, this study presents a QS framework and taxonomy that integrates QS adoption timing and beneficiaries. The framework also presents four configurations of QS adopters and their associated beneficiary stakeholder groups, enabling both researchers and practitioners to more completely understand the complex nature of stakeholder pressures on organizations.
Exploring the efficacy of a Trichoderma asperellum-based seed treatment for controlling Fusarium equiseti in chickpea
Authors: Adnani Manal , El Hazzat Naila , Msairi Soukaina , El Alaoui Moulay Abdelaziz , Mouden Najoua , Selmaoui Karima , Benkirane Rachid , Ouazzani Touhami Amina , Douira Allal
Published: February 2024

Background

Chickpea plant (Cicer arietinumL.) is an important legume crop that is vulnerable to various fungal pathogens causing significant yield losses. Among them,Fusarium equisetiis a pathogen that has started to raise concern. In contrast,Trichodermaspecies have been explored for their ability to control such pathogens. In this study, the efficacy of a novel seed treatment formulation was explored for controllingF. equisetiin chickpea plants. The formulation was designated to enhance growth in chickpea plants as well as the ability to protect plants from infection. In addition, this formulation was tested for its effectiveness in maintaining the conidia of the antagonist in the soil after sowing.

Results

Applying theTrichoderma asperellum-based formulation promoted growth, as well as root and aerial biomass. In seedlings derived from treated seeds, the shoot length increased by 36.8%, and the average number of leaves also increased than the control. Following evaluation of disease severity and the foliar alteration index (FAI), a protective effect was noted, as the symptoms ofFusariumwere significantly reduced in treated plants than the infected control. Re-isolation from plants infected withF. equisetiwas successful in the roots (72.7%), root crown (84.5%), stem (64.4%), and even in petioles (36.1%).

Conclusions

Due to both direct antagonist activity and indirect growth promotion ability, the findings suggested that tested formulation can be a sustainable and eco-friendly alternative to chemical fungicides for managingF. equisetiin chickpea seeds.
Key transcription factors required for outburst of rice blast disease in Magnaporthe oryzae
Authors: Wang Qing , Huang Zhicheng , Khan Irshad Ali , Li Yan , Wang Jing , Wang Jiaoyu , Liu Xiao-Hong , Lin Fucheng , Lu Jianping
Published: February 2024

Rice blast is a serious threat to the safe production of grain crops such as rice and wheat. Sporulation, appressorium formation, and invasive growth of Magnaporthe oryzae are the key stages of the development and spread of rice blast epidemics. M. oryzae is a hemibiotrophic fungus that undergoes changes in available carbon sources during the infection cycle. Lipid is a major storage for M. oryzae spores and a major carbon source used in glycerol synthesis and turgor pressure generation in appressoria. The formation of a dense cell wall melanin layer is necessary for an appressorium to produce turgor and to be pathogenic. The plant cell wall is an important carbon source during the infection stage of M. oryzae. Transcription factors regulate gene expression in fungi and are key intermediates between the reception of external environmental signals and the control of development and pathogenicity in M. oryzae. The disease cycle of M. oryzae is controlled by some key transcription factors, such as sporulation by Cos1 and Hox2, appressorium formation by Sfl1, Hox7, and Vrf1, invasive growth by Mst12 and Mig1, and resistance to host basal immunity by Ap1 and Atf1. This review focuses on describing the key transcription factors of M. oryzae that regulate sporulation, appressorium formation, invasive growth, lipid metabolism, carbohydrate metabolism, melanin synthesis, oxidative response, and host basal immunity, as well as the working mechanism of the transcription factors.
A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty
Authors: Quaye Aurora , McAllister Brian , Garcia Joseph R. , Nohr Orion , Laduzenski Sarah J. , Mack Lucy , Kerr Christine R. , Kerr Danielle A. , Razafindralay Charonne N. , Richard Janelle M. , Craig Wendy Y. , Rodrigue Stephen
Published: February 2024

Background

Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA.

Methods

This single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes.

Results

A total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups.

Conclusion

The study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research.

Trial registration

This project was retrospectively registered with clinicaltrials.gov (NCT05635916) on 2 December 2022.
Commentary: raised c-troponin levels as a sign of myocardial injury after COVID-19 vaccination in healthy individuals are worrying
Authors: Klement Rainer Johannes , Walach Harald
Published: February 2024

Background

Recently, Buergin et al. (Eur J Heart Fail 25(10):1871–1881, 2023 doi:10.1002/ejhf.2978) thoroughly measured a frequency of 2.8% elevated high-sensitivity cardiac troponin T levels, a sign of myocardial damage, after mRNA-1273 (Moderna) booster vaccinations. In their discussion, they claim that before vaccinations were available, the incidence and extent of myocardial damage associated with COVID-19 infection would have been much higher. We here scrutinize this claim based on empirical data.

Main body

Burgin et al. have only cited papers in support of their claim which considered hospitalized COVID-19 patients. After extracting COVID-19 infection data from Germany and Switzerland and the expected frequency of elevated troponin levels after COVID-19 infection in both hospitalized and non-hospitalized individuals, we find that the extent of myocardial damage after vaccinating a considerable proportion of the general population is expected to be much higher than after natural infections.

Conclusions

The claim that the extent of myocardial injury after COVID-19 infection would be higher than after vaccination is not supported by empirical evidence and therefore wrong. We conclude that cross-national systematic observational studies should be conducted that allow a more precise estimation of the risk–benefit ratio of COVID-19 mRNA vaccinations.
Successful healing of aneurysmal false lumen using a second-generation drug-eluting stent in spontaneous coronary artery dissection: a case report
Authors: Niida Tomiharu , Isoda Kikuo , Tada Miho , Kitahara Satoshi , Fujino Yusuke
Published: February 2024

Background

According to 2023 ESC Guideline, conservative medical management is generally recommended for the treatment of spontaneous coronary artery dissection (SCAD) except for patients with signs of ongoing myocardial ischemia. However, in some cases, invasive treatment (coronary artery bypass graft surgery or percutaneous coronary intervention (PCI)) is performed because of the progression of aneurysm in SCAD. Although there is no established strategy for the management of coronary aneurysm in SCAD, we report a case of successful healing of aneurysmal false lumen (AFL) using a second-generation drug-eluting stent (DES) in SCAD.

Case presentation

A 44-year-old woman without any cardiovascular risk factors was transferred to our hospital due to inferior myocardial infarction. Coronary angiography (CAG) showed multiple SCADs in the coronary artery. We performed PCI to the distal right coronary artery (RCA) because the RCA showed severe stenosis (99%) with bradycardia. Six days after the first PCI, SCAD relapsed in the mid left anterior descending artery (LAD). Furthermore, AFL was observed by intravascular ultrasound imaging. To avoid enlargement of the AFL and progression of the dissection toward the proximal site of the LAD, we performed PCI to the mid LAD to seal the entry tear of the dissection using a second-generation DES. CAG revealed that the AFL in the mid LAD completely diminished at 1 year after PCI.

Conclusions

The implantation of a second-generation DES might be one of therapeutic options for sealing AFL in SCAD patients.
‘Am I really the priority here?’: help-seeking experiences of university students who self-harmed
Authors: Tickell Alice , Fonagy Peter , Hajdú Katalin , Obradović Sandra , Pilling Stephen
Published: February 2024

Background

Self-harm is a significant problem in university students because of its association with emotional distress, physical harm, broader mental health issues and potential suicidality. Research suggests that fewer than half of students who have self-harmed seek professional help when at university.

Aims

This study aimed to explore the help-seeking journeys of university students who had engaged in self-harm, to identify perceived facilitators and barriers to securing both formal and informal support.

Method

Participants comprised 12 students who had self-harmed during their university tenure. Engaging in two semi-structured interviews over the academic year, they shared insights into their help-seeking behaviours and proposed enhancements to local services. Data underwent reflexive thematic analysis within a critical realist framework.

Results

The analysis identified four themes: ‘The initial university phase poses the greatest challenge’, ‘Perceived criteria for “valid” mental health problems’, ‘Evading external judgements, concerns and consequences’ and ‘The pivotal role of treatment options and flexibility in recovery’.

Conclusions

Students felt isolated and misunderstood, which amplified self-harming tendencies and diminished inclinations for help-seeking. A prevalent belief was that for self-harm to be deemed ‘valid’, it must manifest with a certain severity; however, concurrent fears existed around the ramifications of perceived excessive severity. Participants expressed a desire for streamlined pathways to mental health resources, encompassing both university and external mental health services. Insights from this study could guide future research and inform current service paradigms within academic and healthcare systems.
Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines
Authors: Valencia Fernando , Gómez Henry L. , Neciosup Silvia P. , Limón Ronald , Torrico María del Carmen , Morillas Lena , Torres Roberto , Sánchez Cesar , Araya Ingiborg , Gómez Rodolfo , Bruges Ricardo , Vargas Carlos , Soria Tannia , Muñoz René , Riofrío Mauricio , Gálvez Marco , Ruiz Rossana , Benites Pilar , Cardoso Fatima
Published: February 2024

PURPOSE

As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access.

METHODS

Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote. In addition to this, the level of access to each of the recommendations presented, according to the country and health system, was exposed.

RESULTS

Latin American experts had a high level of agreement with the ABC5 consensus recommendations (range, 83%-100%). Twelve of 61 statements are not available for all patients in LA. Among the limitations to access, the following ones are described: limited access to certain technologies (stereotactic body radiotherapy, positron emission tomography-computed tomography), the high costs of drugs that limits access to treatment with CDK4/6 inhibitors, pertuzumab, or poly(ADP-ribose) polymerase inhibitors, and the lack of molecular tests for access to therapeutic targets, as well as the difficult geography and cultural diversity of our continent.

CONCLUSION

Despite the great relevance of the recommendations of the ABC5 consensus guidelines, we highlight that we still need to improve access for all patients, regardless of the country or health system they are in, for which we call to action to policy makers and patient groups to improve clinical outcomes of patients with advanced breast cancer in our region.
Bacterial Isolates and Characteristics of Children With Febrile Neutropenia on Treatment for Cancer at a Tertiary Hospital in Western Kenya
Authors: Kipchumba Samuel Kipkemoi , Njuguna Festus Muigai , Nyandiko Winstone Mokaya
Published: February 2024

PURPOSE

This study aimed to identify the patient characteristics of children with febrile neutropenia, the associated bacterial organisms, and their sensitivity patterns.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted at the Moi Teaching and Referral Hospital (MTRH) pediatric oncology ward, from June 2021 to April 2022. A total of 110 children who developed fever and neutropenia during chemotherapy were enrolled. Blood samples for culture were collected aseptically. Patient characteristics were presented in frequency tables. Antimicrobial sensitivity patterns were plotted in tables against the bacterial isolates cultured. Chi-square/Fisher's exact test was used to determine any association between patient characteristics, bacterial growth, and antimicrobial sensitivity.

RESULTS

The majority (n = 66; 60%) were males. The median age was 6.3 years (standard deviation, 3.7). The majority of patients 71 (64.5%) had hematologic malignancies, the most common being AML. There was a significant association between severity of neutropenia and hematologic malignancies ( P = .028). In total, 31/110 (28.2%) blood cultures were positive for bacterial growth. Gram-positive bacteria were more frequent (n = 20; 58.1%). The most common organism was Escherichia coli (n = 6; 18.2%), followed by Staphylococcus aureus (n = 5; 15.2%). All the isolates were sensitive to linezolid and vancomycin and also showed good sensitivity toward meropenem (n = 10/11; 90.9%). High resistance to cephalosporins was noted with ceftriaxone (n = 5/6; 83.3%), cefepime (n = 4/7; 57.1%), and ceftazidime (n = 3/4; 75%).

CONCLUSION

The most common malignancy associated with febrile neutropenia was AML. Gram-positive bacteria were the most common isolates. There was high resistance to cephalosporins.
Central Precocious Puberty in Italian Boys: Data From a Large Nationwide Cohort
Authors: Cassio Alessandra , Marescotti Gloria , Aversa Tommaso , Salerno Mariacarolina , Tornese Gianluca , Stancampiano Marianna , Tuli Gerdi , Faienza Maria Felicia , Cavarzere Paolo , Fava Daniela , Parpagnoli Maria , Bruzzi Patrizia , Ibba Anastasia , Calcaterra Valeria , Mameli Chiara , Grandone Anna , Cherubini Valentino , Assirelli Valentina , Franchina Francesca , Capalbo Donatella , Di Mase Raffaella , Tamaro Gianluca , Cavasin Julia , Munarin Jessica , Russo Gianni , Wasniewska Malgorzata ,   the Physiopathology of Growth Processes and Puberty Study Group of the Italian Society for Pediatric Endocrinology and Diabetology, Di Iorgi Natascia , Iughetti Lorenzo , Antoniazzi Franco , Loche Sandro , Gaudino Rossella , Matarazzo Patrizia , Varriale Gaia , Curatola Selenia , Aiello Francesca
Published: February 2024

Context

There are only a few nationwide studies on boys with central precocious puberty (CPP) and the last Italian study is a case series of 45 boys that dates back to 2000.

Objective

We aimed to evaluate the causes of CPP in boys diagnosed during the last 2 decades in Italy and the relative frequency of forms with associated central nervous system (CNS) abnormalities on magnetic resonance imaging (MRI) compared to idiopathic ones.

Methods

We performed a national multicenter retrospective study collecting data from 193 otherwise normal healthy boys with a diagnosis of CPP. Based on MRI findings, the patients were divided into: Group 1, no CNS abnormalities; Group 2, mild abnormalities (incidental findings) unrelated to CPP; and Group 3, causal pathological CNS abnormalities.

Results

The MRI findings show normal findings in 86%, mild abnormalities (incidental findings) in 8.3%, and causal pathological CNS abnormalities in 5.7% of the cases. In Group 3, we found a higher proportion of patients with chronological age at diagnosis < 7 years (P = .00001) and body mass index greater than +2 SDS (P < .01). Gonadotropin-releasing hormone analogue therapy was started in 183/193 subjects. The final height appeared in the range of the target height in all groups and in 9 patients in whom the therapy was not started.

Conclusion

In our study on a large nationwide cohort of boys referred for precocious puberty signs, the percentage of forms associated with CNS abnormalities was one of the lowest reported in the literature.
Altered Static and Dynamic Brain Functional Topological Organization in Patients With Dysthyroid Optic Neuropathy
Authors: Zhou Jiang , Chen Wen , Jiang Wen-Hao , Wu Qian , Lu Jin-Ling , Chen Huan-Huan , Liu Hu , Xu Xiao-Quan , Wu Fei-Yun , Hu Hao
Published: February 2024

Context

Dysthyroid optic neuropathy (DON) is a serious vision-threatening complication of thyroid-associated ophthalmopathy (TAO). Exploration of the underlying mechanisms of DON is critical for its timely clinical diagnosis.

Objective

We hypothesized that TAO patients with DON may have altered brain functional networks. We aimed to explore the alterations of static and dynamic functional connectomes in patients with and without DON using resting-state functional magnetic resonance imaging with the graph theory method.

Methods

A cross-sectional study was conducted at a grade A tertiary hospital with 66 TAO patients (28 DON and 38 non-DON) and 30 healthy controls (HCs). Main outcome measures included topological properties of functional networks.

Results

For static properties, DON patients exhibited lower global efficiency (Eg), local efficiency, normalized clustering coefficient, small-worldness (σ), and higher characteristic path length (Lp) than HCs. DON and non-DON patients both exhibited varying degrees of abnormalities in nodal properties. Meanwhile, compared with non-DON, DON patients exhibited abnormalities in nodal properties in the orbitofrontal cortex and visual network (VN). For dynamic properties, the DON group exhibited higher variance in Eg and Lp than non-DON and HC groups. A strengthened subnetwork with VN as the core was identified in the DON cohort. Significant correlations were found between network properties and clinical variables. For distinguishing DON, the combination of static and dynamic network properties exhibited optimal diagnostic performance.

Conclusion

Functional network alterations were observed both in DON and non-DON patients, providing novel insights into the underlying neural mechanisms of disease. Functional network properties may be potential biomarkers for reflecting the progression of TAO from non-DON to DON.
Lifespan Effects of Muscle-Specific Androgen Receptor Overexpression on Body Composition of Male and Female Rats
Authors: Barsky Sabrina Tzivia , Monks Douglas Ashley
Published: February 2024

Androgenic actions of gonadal testosterone are thought to be a major mechanism promoting sex differences in body composition across the lifespan. However, this inference is based on studies of androgen receptor (AR) function in late adolescent or emerging adult rodents. Here we assess body composition and AR expression in skeletal muscle of rats at defined ages, comparing wild-type (WT) to transgenic human skeletal actin–driven AR overexpression (HSAAR) rats which overexpress AR in skeletal muscle. Male and female HSAAR and WT Sprague Dawley rats (N = 288) underwent dual-energy x-ray absorptiometry (DXA) scanning and tissue collection at postnatal day (PND) 1, 10, 21, 42, 70, 183, 243, and 365. Expected sex differences in body composition and muscle mass largely onset with puberty (PND-21), with no associated changes to skeletal muscle AR protein. In adulthood, HSAAR increased tibialis anterior (TA) and extensor digitorum longus mass in males, and reduced the expected gain in gonadal fat mass in both sexes. In WT rats, AR protein was reduced in soleus, but not TA, throughout life. Nonetheless, soleus AR protein expression was greater in male rats than female rats at all ages of sexual development, yet only at PND-70 in TA. Overall, despite muscle AR overexpression effects, results are inconsistent with major sex differences in body composition during sexual development being driven by changes in muscle AR, rather suggesting that changes in ligand promote sexual differentiation of body composition during pubertal timing. Nonetheless, increased skeletal muscle AR in adulthood can be sufficient to increase muscle mass in males, and reduce adipose in both sexes.
Disruption of placental ACKR3 impairs growth and hematopoietic development of offspring
Authors: Fukuoka Ayumi , Wilson Gillian J. , Pitmon Elise , Koumbas Foley Lily , Johnsson Hanna , Pingen Marieke , Graham Gerard J.
Published: February 2024

ACKR3 scavenges and degrades the stem cell recruiting chemokine CXCL12, which is essential for proper embryonic and, in particular, haematopoietic development. Here, we demonstrate strong expression of ACKR3 on trophoblasts. Using a maternally administered pharmacological blocker and Cre-mediated genetic approaches, we demonstrate that trophoblast ACKR3 is essential for preventing movement of CXCL12 from the mother to the embryo, with elevated plasma CXCL12 levels being detected in embryos from ACKR3-blocker-treated mothers. Mice born to mothers treated with the blocker are lighter and shorter than those born to vehicle-treated mothers and, in addition, display profound anaemia associated with a markedly reduced bone marrow haematopoietic stem cell population. Importantly, although the haematopoietic abnormalities are corrected as mice age, our studies reveal a postnatal window during which offspring of ACKR3-blocker-treated mice are unable to mount effective inflammatory responses to inflammatory/infectious stimuli. Overall, these data demonstrate that ACKR3 is essential for preventing CXCL12 transfer from mother to embryo and for ensuring properly regulated CXCL12 control over the development of the haematopoietic system.
Paradigm Shifting Research: Key Studies in Urologic Oncology
Authors: Dason Shawn , Lee Cheryl T.
Published: February 2024

Background

Genitourinary malignancies have a substantial impact on men and women in the USA as they include three of the ten most common cancers (prostate, renal, and bladder). Other urinary tract cancers are less common (testis and penile) but still have profound treatment implications related to potential deficits in sexual, urinary, and reproductive function. Evidenced-based practice remains the cornerstone of treatment for urologic malignancies.

Methods

The authors reviewed the literature in consideration of the four top articles influencing clinical practice in the prior calendar year, 2022.

Results

The PROTECT trial demonstrates favorable 15-years outcomes for active monitoring of localized prostate cancer. The SEMS trial establishes retroperitoneal lymph node dissection as a viable option for patients with seminoma of the testis with limited retroperitoneal lymph node metastases. CheckMate 274 supports adjuvant immunotherapy following radical cystectomy for muscle-invasive bladder cancer with a high risk of recurrence. Data reported from the IROCK consortium reinforce stereotactic ablative radiotherapy as an option for localized renal cell carcinoma.

Conclusion

The care for patients with urologic cancers has been greatly improved through advances in surgical, medical, and radiation oncologic treatments realized through prospective randomized clinical trials and large multicenter collaborative groups.
Πολιτικές ανώτατης εκπαίδευσης, διά βίου μάθηση και απασχολησιμότητα
Authors: Χουρδάκης Μαρίνος
Published: February 2024

Σε ένα παγκοσμιοποιημένο περιβάλλον που χαρακτηρίζεται από συνεχείς μεταβολές, η εκπαίδευση καλείται να παίξει πρωταγωνιστικό ρόλο στην προσπάθεια της Ευρωπαϊκής Ένωσης να ανταποκριθεί στις προκλήσεις που δημιούργησαν η πολυδιάστατη κρίση και ακολούθως η ύφεση. Η παρούσα εργασία επιδιώκει να αποτυπώσει την εξέλιξη της ευρωπαϊκής εκπαιδευτικής πολιτικής και δη της πολιτικής για την ανώτατη εκπαίδευση, εξετάζοντας παράλληλα τόσο το ρόλο του κράτους, το οποίο βρίσκεται σε συνεχή «πίεση», όσο και των διεθνών οργανισμών, οι οποίοι αναλαμβάνουν ενεργό ρόλο στη διαμόρφωσή της. Κεντρικό σημείο της διατριβής αποτελεί η εξέλιξη των πολιτικών ανώτατης εκπαίδευσης και η σχέση τους με τη δια βίου μάθηση και την απασχολησιμότητα, όπως αποτυπώνονται στην εικοσαετή πορεία της Διαδικασίας της Μπολόνια (ΔτΜ). Παράλληλα, εξετάζεται ο βαθμός εφαρμογής των μέτρων που ελήφθησαν για την ανώτατη εκπαίδευση στην ελληνική περίπτωση, στην προσπάθεια επίτευξης των στόχων που τέθηκαν στη ΔτΜ. Επιπρόσθετα, επιχειρείται η σύνδεση των στόχων που τέθηκαν στην ευρωπαϊκή στρατηγική “Europe 2020” για την εκπαίδευση, την κατάρτιση και την απασχόληση με τις πολιτικές ανώτατης εκπαίδευσης, όπως εκφράστηκαν μέσα από τη ΔτΜ. Τέλος, εξετάζονται επιμέρους ζητήματα όπως η ανεργία, οι NEETs και το “brain drain”.
Η ρητορική εκπαίδευση μέσα από σύμμεικτα χειρόγραφα της περιόδου από τον 10ο μέχρι τον 12ο αιώνα
Authors: Σκουντάκης Μίνως
Published: February 2024

Ένα από τα τρία εκπαιδευτικά πεδία της Τριττύος της βυζαντινής παιδείας ήταν η ρητορική. Λόγω της σημασίας που είχε η διδασκόμενη ρητορική θεωρία στη συγγραφή των βυζαντινών λογοτεχνικών έργων, η κατανόησή της καθίσταται ιδιαίτερα σημαντική για την φιλολογική μελέτη των έργων αυτών. Κατά κύριο λόγο οι διδάσκαλοι του Βυζαντίου, οι λεγόμενοι γραμματικοί, εκπαίδευαν τους μαθητές τους στη ρητορική χρησιμοποιώντας εγχειρίδια της Αρχαιότητας, όπως και εκτεταμένα σχόλια πάνω σε αυτά. Η παρούσα διατριβή μελετά τους χειρόγραφους κώδικες της περιόδου από τον 10ο έως τον 12ο αι., στους οποίους περιέχονται τα ρητορικά εγχειρίδια, τα σχόλια και εν γένει η διδασκόμενη ρητορική θεωρία. Οι χειρόγραφοι κώδικες μελετήθηκαν ως ιστορικά τεκμήρια για την εκπαίδευση της περιόδου από τον 10ο έως τον 12ο αι., εφόσον οι γραμματικοί αντέγραψαν σε αυτά τα εκπαιδευτικά έργα, αλλά κυρίως μελετήθηκαν ως χρηστικά εργαλεία των γραμματικών, τα οποία χρησιμοποιούσαν κατά την διδασκαλία τους. Μέσα από τη φιλολογική και παλαιογραφική ανάλυση των κωδίκων προέκυψαν συμπεράσματα για τη διδακτική μεθοδολογία των γραμματικών, για το περιεχόμενο της διδασκόμενης θεωρίας, για την επιρροή της ρητορικής θεωρίας στη λογοτεχνική παραγωγή του Βυζαντίου και γενικότερα για τις εκπαιδευτικές συνήθειες των υπό μελέτη αιώνων.