bluuebunny/crossref_metadata_2025 huggingface dataset:
Frailty and osteoporotic fractures represent mutual risks for each other with common physiological backgrounds
Authors: Urano Tomohiko , Kuroda Tatsuhiko , Saito Mitsuru , Shiraki Masataka
Published: January 2025

Frailty and osteoporosis are known to exacerbate each other. However, limited research is available on the shared pathophysiological factors contributing to osteoporotic fractures and frailty. This study aims to identify common factors associated with both the current frailty and the occurrence of incident vertebral fractures. A total of 912 postmenopausal Japanese women, 63.9 ± 10.0 years of age (mean ± SD), were included in the present study. Each participant’s baseline frailty status was assessed using a questionnaire about the five following items: Fatigue, Resistance, Ambulation, Inactivity, and Weight Loss. A score of 3 or above indicated the prevalence of frailty. The participants were then followed up for an average of 10.5 ± 7.5 years, during which 202 patients suffered incident vertebral fractures. The Cox proportional hazards model for incident vertebral fracture revealed that lumbar bone mineral density (HR 0.753, P<.001), adiponectin (HR 1.025, P=.021), Log IL-6 (HR 1.227, P=.029), prevalent vertebral fracture (HR 2.124, P<.001), and frailty status (HR 1.355, P=.002) were independent predictors of incident vertebral fractures. The factors associated with frailty status at baseline were assessed using logistic regression analysis, revealing that adiponectin (OR 1.063, P<.001), Log IL-6 (OR 2.94, P<.001), and prevalent vertebral fractures (OR 2.816, P<.001) were significantly associated with current frailty. Biochemical factors such as IL-6 and adiponectin were commonly associated with vertebral fractures and frailty. Additionally, frailty status was identified as an independent risk factor for vertebral fractures, while prevalent vertebral fractures were significantly associated with frailty. These findings clearly indicate that frailty and osteoporotic fractures represent mutual risks for each other, with serum levels of adiponectin and IL-6 serving as common physiological backgrounds.
Potential influence of supplemental nutrients intake by adults on the development, fecundity, and population growth of Megalurothrips usitatus (Thysanoptera: Thripidae) offspring
Authors: Li Tiantian , Liu Ying , Liang Xiao , Wu Chunling , An Xingkui , Wang Ying , Hao Guifeng , Chen Yiting , Chen Qing
Published: January 2025

Megalurothrips usitatus (Bagnall) (Thysanoptera: Thripidae), is an important pest in cowpea-growing areas of south China. To study control strategies, M. usitatus has been raised for multiple generations in the laboratory. Considering the impact of supplemental nutrients on colony fitness during laboratory rearing is crucial for achieving a significant population of uniformly developed individuals. Here, an age-stage, 2-sex life table for M. usitatus was developed to examine the impacts of F0  M. usitatus adults fed on 3 different supplemental diets (20% sucrose solution, 20% pollen solution, and 20% honey solution) on the development, fecundity, and population growth of F1  M. usitatus. The findings indicated that, compared to thrips fed on water, F0 adult thrips provided with 3 supplementary diets exhibited a reduction in the developmental duration for each instar, an increase in fecundity, and an extension of the lifespan of F1  M. usitatus, with honey yielding the best results. Similarly, the addition of supplemental nutrients resulted in a reduction in the mean generation time (T) and an enhancement of the net reproductive rate (R0), intrinsic rate of increase (r), and finite rate of increase (λ) compared to the control group. The effects were highest for honey, followed by pollen, and then sucrose. This study provides favorable evidence concerning the direct impacts of parental nutrition supplementation on the fitness of offspring in insects, and provides information to aid indoor rearing of M. usitatus.
A guide to CNN-based dense segmentation of neuronal EM images
Authors: Urakubo Hidetoshi
Published: January 2025

Large-scale reconstitution of neuronal circuits from volumetric electron microscopy images is a remarkable research goal in neuroanatomy. However, the large-scale reconstruction is a result of automatic segmentation using convolutional neural networks (CNNs), which is still challenging for general researchers to perform. This review focuses on two representative CNNs for dense neuronal segmentation: flood-filling networks (FFNs) and local shape descriptors (LSDs)-predicting U-Net (LSD network). It outlines their basic mechanisms, requirements, and output segmentation using the author’s example segmentation. The FFN excels in segmenting long axons, and the LSD network is adept at segmenting myelinated axons. The choice between FFN and LSD depends on the target, as neither is universally superior. A common limitation of FFN and LSD is the easy detachment of thin spines from parent dendrites, which is fundamentally unavoidable. The author also introduces CNNs that were proposed to mitigate this issue. As CNN-based automated segmentation can take months, researchers need to be aware of the selection of an appropriate CNN, required computer resources and fundamental limitations. This review serves as a guide for such dense neuronal segmentation.
Case presentation of a robot-assisted bilateral benign tonsillectomy using the da Vinci SP system
Authors: Seifen Christopher , Matthias Christoph , Jeyarajan Harishanker , Huppertz Tilman
Published: January 2025

Since the first use of a da Vinci system to perform a radical tonsillectomy in 2007, transoral robotic surgery (TORS) has been further developed and finally accepted as a safe surgical method. The recent introduction of the da Vinci Single-Port (SP) system has brought new innovations in the field of ears, nose and throat (ENT) medicine, e.g. to perform minimally invasive head and neck tumor surgery. In Europe, the da Vinci SP system has recently received CE Mark approval for TORS application. We present the first case of a robot-assisted bilateral benign tonsillectomy with the da Vinci SP system in Germany and demonstrate the technical feasibility of this platform.
TBX3 is Essential for Zygotic Genome Activation and Embryonic Development in Pigs
Authors: Li Xiao-Han , Lee Song-Hee , Kim Ji-Dam , Lee Gyu-Hyun , Sim Jae-min , Cui Xiang-Shun
Published: January 2025

The pluripotency-related T-box family transcription factor TBX3 maintains mESC self-renewal and plays a key role in the development of several tissues, including the heart, mammary glands, limbs, and lungs. However, the role of TBX3 during porcine preimplantation embryo development remains unclear. In our research, TBX3 was knocked down by injecting dsRNA to explore the function of TBX3. TBX3 expression gradually increases during early embryonic development. TBX3 knockdown resulted in decreased in the rate of four-cell and blastocyst. Depletion of TBX3 decreased the level of H3K9Ac/H3K27Ac and decreased ZGA gene expression at the four-cell stage. Furthermore, TBX3 knockdown led to a decrease in ZSACN4 protein level, DNMT1 and intracellular 5mc levels were increased, and then induced telomeres shorten and DNA damaged. Additionally, TBX3 knockdown significantly decreased histone acetylation and pluripotency genes NANOG/OCT4 expression in blastocysts. TBX3 knockdown induced apoptosis in blastocysts. Taken together, TBX3 regulate histone acetylation and play important roles in zygotic genome activation and early embryonic development in pigs.
In Situ Focused Ion Beam Redeposition Surface Coatings for Site-Specific, Near-Surface Characterization by Atom Probe Tomography
Authors: Guerguis Bavley , Cuduvally Ramya , Arcuri Gabriel , Pourbahari Bita , McDermid Joseph R , Pawlowicz Chris , Langelier Brian , Bassim Nabil
Published: January 2025

Atom probe tomography (APT) enables three-dimensional chemical mapping with near-atomic scale resolution. However, this method requires precise sample preparation, which is typically achieved using a focused ion beam (FIB) microscope. As the ion beam induces some degree of damage to the sample, it is necessary to apply a protective layer over the region of interest (ROI). Herein, the use of redeposition, a (frequently considered negative) side effect of FIB sputtering, is explored as a technique for targeted surface coatings in site-specific, near-surface APT investigations. In addition, the concept of “self-coating” is presented, which is the application of a capping layer using material from the same, or a similar, sample. It is shown to provide a pathway for high-quality coatings, as well as a method of minimizing the field evaporation threshold difference at the cap–sample interface, thus greatly reducing the likelihood of premature fractures. In situ redeposition surface coatings are shown to be versatile, with four materials used in the coating and analysis of two Si-based semiconductors and a Fe-Mn alloy. Several factors are discussed, such as the specimen yield, the capping layer quality, and the ease of ROI identification, all of which demonstrate its effectiveness in routine sample preparation workflows.
Preparation of Small Extracellular Vesicles Using Sequential Ultrafiltration with Regenerated Cellulose Membranes of Different Molecular Weight Cutoffs: A Study of Morphology and Size by Electron Microscopy
Authors: Ishii Noriyuki , Tateno Hiroaki
Published: January 2025

There is still room for improvement in the isolation and purification techniques for extracellular vesicles (EVs), particularly in the separation of exosomes (small EVs) from other membrane vesicles such as microvesicles and apoptotic bodies. Furthermore, it is crucial to establish preparation methods that preserve the intrinsic properties of EVs in this context. In this study, we focus on the isolation and preparation of small EVs, exosomes, from the culture supernatant of a human cell line. We discuss the sequential use of regenerated cellulose membranes with different molecular weight cutoffs, based on direct evaluation by transmission electron microscopy, and examine the challenges of characterizing biological membrane vesicles, small EVs, identified during this process.
Pulmonary Coinfection of Pneumocystis jirovecii and Aspergillus Species
Authors: Hatzl Stefan , Geiger Christina , Kriegl Lisa , Reinisch Andreas , Wölfler Albert , Apfaltrer Georg , Keldorfer Markus , Rödl Siegfried , Hoenigl Martin , Eller Philipp , Krause Robert
Published: January 2025

In this multicenter study of 387 patients who were immunocompromised, 4.5% with invasive pulmonary aspergillosis also had Pneumocystis jirovecii pneumonia. Predictors of coinfection included elevated β-D-glucan and prolonged corticosteroid use. Coinfection correlated with reduced 30-day survival (22% vs 57%), suggesting that early identification and prophylaxis may improve outcomes.
Influence of Preoperative Physical Function Scores on Outcomes After Single-level Cervical Disc Replacement
Authors: Hartman Timothy J. , Nie James W. , Zheng Eileen , MacGregor Keith R. , Oyetayo Omolabake O. , Singh Kern
Published: January 2025

Study Design:

Retrospective study.

Objective:

We aim to determine the influence of preoperative Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) scores on perioperative and postoperative outcomes, the latter determined through patient-reported outcome measures (PROMs) and the degree of achievement rates of minimum clinically important difference (MCID) following single-level cervical disc replacement (CDR).

Background:

Several studies have examined the relationship between preoperative PROMIS-PF as a prognostic factor for postoperative outcomes. Few studies have examined this relationship as it applies to CDR.

Methods:

Patients undergoing single-level CDR with preoperative PROMIS-PF scores were identified retrospectively using a single-surgeon database. Patients undergoing surgery for infection/fracture/malignancy were excluded. Patients were divided by mean preoperative PROMIS-PF score: lower-functioning (PROMIS-PF <40) and higher-functioning (PROMIS-PF ≥40). Patient-Reported Outcomes Measurement Information System (PROMIS-PF), 12-item Short Form Physical Component Score (SF-12 PCS), Visual Acuity Scale (VAS) scores for neck and arm, and Neck Disability Index scores, collected at preoperative, 6-week, 12-week, 6-month, and 1-year time points.

Results:

Fifty-seven patients were included with 33 considered higher functioning. Operative times were increased in the higher-functioning group (P = 0.003). The lower-functioning cohort saw improvement in all 6-week/12-week/6-month PROMs. The higher-functioning cohort saw improvement in all PROMs except SF-12 PCS. Between groups, the higher-functioning cohort reported greater postoperative PROMIS-PF at multiple time points, preoperative SF-12 PCS, 12-week/preoperative VAS-neck, and preoperative VAS-arm (P ≤ 0.036, all). The lower-functioning group had greater preoperative/6-week Neck Disability Index (P ≤ 0.027, all) and had greater MCID achievement at 6-month SF-12 PCS/12-week VAS arm (P ≤ 0.026, all).

Conclusion:

Independent of preoperative function, both groups reported improvement in all outcomes except for SF-12 PCS in the higher-functioning cohort. Between groups, the higher-functioning cohort had significantly better outcomes; however, this significance was not seen past 12 weeks for any PROM. MCID achievement rates were significantly greater in the lower-functioning group in the SF-12 PCS and VAS arm. Patients with lower preoperative PROMIS-PF scores may experience greater rates of clinically noticeable improvements in function/arm pain postoperatively.
The Modified Frailty 5-Factor Index Predicts Adverse Outcomes After Ventral Hernia Repair in a National Database
Authors: Diaz Allison L. , Lee Wen-Yu , Oh Cheongeun , Kimberly Laura L.
Published: January 2025

Background:

Ventral hernia repair (VHR) is a common procedure performed on a comorbid patient population at risk for complications, necessitating effective preoperative risk assessment. Previous research suggests that frailty better predicts adverse outcomes compared with historical risk proxies including age. We examined the association between frailty as measured by the 5-factor modified frailty index and postoperative complications following VHR as reported in the National Surgical Quality Improvement Program database.

Methods:

A retrospective review of the National Surgical Quality Improvement Program database from 2015 to 2020 was performed for patients who underwent VHR with the component separation technique. Descriptive analyses were performed on demographics, comorbidities, American Society of Anesthesiologists class, and the modified frailty index score. Multivariable regression was conducted for frailty, age, other comorbidities, and hernia characteristics to determine the relationship to all-cause and surgical site complications, complication severity, complications with Clavien-Dindo score above 3, length of stay, readmission, and reoperation. All analyses were performed using R software. A P value less than 0.05 was considered statistically significant.

Results:

A total of 14,575 patients were identified. Frailty was a significant predictor of all-cause complications, readmission, reoperation, and increasing length of stay. Increased age was a significant predictor for length of stay and severe systemic complications. Smoking status and American Society of Anesthesiologists class of 4 were associated with all outcomes. Body mass index predicted surgical site complications and reoperation.

Conclusions:

Frailty can predict many postoperative complications of VHR with component separation technique and is an important element of risk prediction for potential surgical candidates.
Versatility of the Anterolateral Thigh Flap for Abdominal Wall Reconstruction
Authors: Pedrazzi Nadine E. , Schweizer Riccardo , Klein Holger J. , Steiner Stephan , Vonlanthen René , Hermanns Thomas , Schneiter Didier , Giovanoli Pietro , Plock Jan A.
Published: January 2025

Background:

Abdominal wall reconstruction represents an ambitious and demanding challenge. This study aimed to illustrate the versatility of the anterolateral thigh (ALT) flap in its different designs for the reconstruction of complex defects of the abdominal wall.

Methods:

Charts of patients with complex abdominal wall defects who underwent a reconstruction with an ALT flap at the University Hospital of Zurich (2018–2020) were reviewed retrospectively. Patient characteristics and ALT flaps used were analyzed in detail.

Results:

Ten patients received a total of 12 ALT flaps. Free flaps were applied to defects in the upper third of the abdomen. All flaps were harvested with a fascial component. An iliotibial tract reinforcement was incorporated in 4 (33%) cases, and 1 case included a muscular component and motor nerve, to provide functional reconstructive potential. A total of 30% of cases experienced complications requiring surgical revision during a mean follow-up of 5 months.

Conclusions:

The ALT flap represents a workhorse in abdominal wall reconstruction due to its versatility and anatomical proximity. Depending on the localization of the defect, this flap can be used in a pedicled or free microsurgical manner. The fascial component of the ALT fasciocutaneous flap and of the extended iliotibial tract provides stable fascia for reinforcement or fascial reconstruction of the abdominal wall. Raised as a chimeric flap with vastus lateralis muscle and motor branch of the femoral nerve, it is a viable option for functional reconstructions.
Efficacy of Split-Thickness Thin Amniotic Membrane Graft for Closure of Refractory or Large Macular Holes
Authors: Trivedi Vichar , You Qisheng , Lee Patrick SY , Im Jacob , Tran David V , Me Rao , Benenati Brian , Gregory Andrew , Le Kim , Lin Xihui
Published: January 2025

Purpose:

To assess the effectiveness of split-thickness amniotic membrane (SAM) grafts in achieving closure of refractory or large macular holes (MH).

Methods:

This retrospective study reviewed data from patients who underwent surgical repair of MHs using SAM grafts between January 2019 and December 2023. Key parameters, including best-corrected visual acuity (BCVA) and MH size, were evaluated both preoperatively and postoperatively.

Results:

The study included 13 patients (9 females; mean age 63.5 years). Before surgery, the median BCVA was 1.30 ± 0.56 LogMAR (approximate Snellen equivalent: 20/400), and the median MH size measured 717 ± 246.6 µm. After an average follow-up period of 28 months, the median BCVA improved significantly to 1.00 ± 0.52 LogMAR (p < 0.05) (approximate Snellen equivalent: 20/200). All MHs were successfully closed, and no intraoperative complications were observed.

Conclusion:

SAM grafting is a safe and reliable option for closing refractory or large MHs, resulting in significant improvements in BCVA and successful hole closure. Compared to full-thickness grafts, SAM grafts offer advantages such as increased flexibility in placement and ease of removal post-closure, due to their thinner and more pliable nature, which facilitates easier handling and positioning within the MH.
A 5-Year Review of Characteristics and Outcomes of Trauma Surgery Patients Leaving Against Medical Advice
Authors: Quick Joseph D. , Powell Lauren E. , Bien Erica , Adams Nellie R. , Miotke Sam A. , Barta Ruth J.
Published: January 2025

Objectives:

The objective of this study was to characterize the demographic, social, economic, and clinical factors of trauma surgery patients leaving against medical advice (AMA).

Methods:

Data were retroactively obtained from a level-one trauma center in a medium-sized metropolitan area from January 2017 to December 2021. The sample population consisted of patients admitted or treated by the trauma surgical service.

Results:

In the 5-year study period, 130 surgical patients left AMA and met the inclusion criteria for this study. The average patient was 38.8 years old. The majority were male (77.7%) and White (47.7%). It was found that 74.6% of patients had insurance, 23.6% were experiencing homelessness, and 6.2% required an interpreter. A large percentage of patients had a past medical history significant for depression (31.5%), anxiety disorders (25.4%), and substance use disorder (68.5%). Analysis of the hospital time course of this patient population indicated that patients were most often admitted to trauma surgery (70.0%) and most often required consults by neurosurgery (28.5%). Procedures were performed for 81.5% of patients and social services were consulted for 60.8% of patients. Only 50.8% of patients who left AMA were noted to receive discharge instructions. Nearly half (44.6%) of the patients returned to a hospital to receive additional care within 1 month of their initial AMA discharge date.

Conclusions:

A concerning number of trauma surgery patients left without discharge instructions, possibly leading to a high rate of 30-day hospital readmission. Future studies are needed to examine and further characterize the relationship between discharge protocol and outcomes of patients leaving AMA.
A Comprehensive Approach to Reducing Patient Safety Indicators (PSI-90)
Authors: Duncan Anthony , Leyk Rachel , Mannuru Devendranath , Briggs Steven , Zreik Khaled
Published: January 2025

Background:

PSI-90, a composite measure comprising ten indicators, reflects the quality of care during hospital stays. The Hospital-Acquired Condition Reduction Program (HACRP), a Centers for Medicare and Medical Services (CMS) program, assesses hospital performance based on quality measures, including PSI-90, with financial implications for poor performers.

Objectives:

To evaluate PSI events, establish workflows for accurate documentation, and foster collaboration across clinical and administrative teams, with the ultimate objective of reducing PSI events.

Methods:

Essential actions involved designating a PSI nurse reviewer and a quality physician advisor, securing the involvement of executive leadership, adopting computer-assisted coding technology, and promoting teamwork among Clinical Documentation Improvement (CDI), coding, and Health Information Management (HIM) teams.

Results:

The collaborative efforts yielded a 45% reduction in PSI events, leading to estimated cost avoidance of $1.4 million, and exemption from HACRP penalties. Lessons learned encompassed the importance of executive leadership support, data-driven decision-making, and ongoing education.

Conclusion:

This study shows the significance of collaboration, leadership support, and data utilization in PSI reduction efforts. Furthermore, it shows benefit of a surgical quality officer in advancing patient safety, aligning with ACS recommendations.
Needs Assessment for Home Modification and Risk Factors for Home Unintentional Injuries in Post-total Knee Arthroplasty Patients
Authors: Tongta Saowalak , Woratanarat Patarawan , Wongsak Siwadol , Phonakhae Rossarin , Arunwilai Nartanong , Woratanarat Thira
Published: January 2025

Objectives:

Home assessment and modification are crucial to prevent fall and fall-related injuries, especially in vulnerable subjects. This study assessed the need for home modifications and investigated risk factors associated with home injuries in post-total knee arthroplasty (TKA) patients.

Methods:

This study was conducted at the university hospital from July 2022 to July 2023. The patients who had undergone TKA without perioperative complications were recruited. The demographics, clinical data, home environmental factors, needs for home modification, and factors related to home unintentional injury were collected at 2 weeks postoperatively. The analysis was done by using descriptive statistics, and logistic regression.

Results:

A total of 140 patients were included. The occurrence of falls within 2 weeks after TKA was 33.57%. The location of falls was the home entrance (29.09%), living room (23.64%), and bathroom (18.18%). About 38.5% of the patients explicitly needed home modifications. Falls were associated with inefficient grab bars [adjusted odds ratio=3.26, 95% CI=1.37-7.81, P=0.008] and lighting (adjusted odds ratio=12.83, 95% CI=1.36-121.34, P=0.026).

Conclusions:

Falls among post-TKA patients were frequently occurred. Preoperative home assessment and home modifications should be done in order to minimize risks of falls, particularly in common locations.
Audiovisual Breathing Guidance for Improved Image Quality and Scan Efficiency of T2- and Diffusion-Weighted Liver MRI
Authors: Mesropyan Narine , Katemann Christoph , Heuvelink-Marck Annerieke , Yüksel Can , Isaak Alexander , Lakghomi Asadeh , Bischoff Leon , Dell Tatjana , Kravchenko Dmitrij , Kuetting Daniel , Pieper Claus C. , Luetkens Julian A.
Published: January 2025

Objectives

Impaired image quality and long scan times frequently occur in respiratory-triggered sequences in liver magnetic resonance imaging (MRI). We evaluated the impact of an in-bore active breathing guidance (BG) application on image quality and scan time of respiratory-triggered T2-weighted (T2) and diffusion-weighted imaging (DWI) by comparing sequences with standard triggering (T2S and DWIS) and with BG (T2BG and DWIBG).

Materials and Methods

In this prospective study, random patients with clinical indications for liver MRI underwent 3 T MRI with standard and BG acquisitions. The audiovisual BG application received the respiratory signal from the scanner, and animated breathing instructions were displayed using a mirror and screen behind the MRI bore. Prior to the DWIBG and T2BG acquisition, patients received a short video instruction about MRI with BG. Suitable parameters for desired breathing pattern for T2BG and DWIBG were set individually for each patient based on the patient's physical respiratory ability (ie, 4 seconds breathing followed by 4.5 seconds breath holding). Artifacts, sharpness, lesion conspicuity, and overall image quality were assessed using a Likert scale from 1 (nondiagnostic) to 5 (excellent). Scan time, apparent contrast-to-noise ratio, and apparent signal-to-noise ratio (aSNR) for all sequences were analyzed. Paired t test and Wilcoxon test were used for statistical analysis.

Results

Thirty-two patients (mean age: 55 ± 13 years, 13 female) were included. T2BG showed less artifacts (4.5 ± 0.7 vs 4.1 ± 0.8, P < 0.001) and better sharpness, lesion conspicuity, and overall image quality (eg, overall image quality 4.6 ± 0.7 vs 4.4 ± 0.7, P = 0.004) compared with T2S. DWIBG demonstrated improved image quality in all categories compared with DWIS (eg, overall image quality 4.5 ± 0.5 vs 4.3 ± 0.5, P = 0.005) and less artifacts (4.1 ± 0.5 vs 3.8 ± 0.7, P = 0.007). Scan times of T2BG (286 ± 23 vs 345 ± 68 seconds, P < 0.001) and DWIBG (160 ± 4 vs 252 ± 70 seconds, P < 0.001) were reduced by 17% and 37%, respectively. aSNR and apparent contrast-to-noise ratio (eg, aSNR: 23.45 ± 11.31 [T2BG] vs 25.84 ± 10.76 [T2S]; P = 0.079) were similar for both sequences for both approaches.

Conclusions

Active BG for respiratory-triggered liver T2w and DWI sequences led to significant reduction of breathing artifacts, improved image quality, and shorter scan time compared with standard acquisitions.
Optimal Timing and Approaches for First Tangential Excision in Patients with ≥70% TBSA Burns
Authors: Huang Runzhi , Yao Yuntao , Xie Sujie , Li Junqiang , Zhang Wei , Liu Yifan , Xian Shuyuan , Sun Hanlin , Wu Guosheng , He Heng , Li Linhui , Wu Xinru , Li Yuanan , Zhang Haoyu , Lu Bingnan , Zhou Jiajie , Zhou Yibin , Xu Dayuan , Xia Zhaofan , Ji Shizhao
Published: January 2025

Objective:

We aim to determine the optimal timing and approaches for first tangential excision of severely burned patients ≥70% total body surface area (TBSA).

Background:

Early tangential excision is the gold-standard surgical therapy for full-thickness burns. However, there are debates about its optimal timing and approaches for severely burned patients ≥70%TBSA.

Materials and Methods:

This study included 185 patients in the Kunshan factory explosion. We focused on surgical timing, surgical area, and main wound covering method for first tangential excision. We determined the optimal cut-off values for surgical timing and area using R language “surv_cutpoint” and “surv_categorize” functions, and utilized the Kaplan-Meier survival analysis to investigate their influences on patients’ overall survival. Then, we utilized multi-variate Cox regression analysis to identify independent factors, and performed subgroup analyses to find confounding factors. Finally, we employed a 10-year single-center cohort of 144 patients with burn injury ≥70% TBSA for external validation.

Results:

Performing first tangential excision in >3 days (hazard ratio=2.37, 95% confidence interval=1.05-5.40, P=0.039) and surgical area > 48% TBSA (hazard ratio=2.41, 95% confidence interval=1.46-4.00, P<0.001) were independent risk factors in the Kunshan cohort for overall survival of patients ≥70% TBSA, and were associated with higher rate of complications. Subgroup analysis revealed that the timing and TBSA of first tangential excision were influenced by several treatment and complications factors (hemodynamic status and types of hospitals). Main wound covering methods was a significant confounding factor. Patients with more autograft showed better overall survival than those with more extensive use of temporary skin substitutes in the Kaplan-Meier survival analysis (P<0.001). However, main wound covering methods influenced by the severity of injury, availability of autologous skin source, as well as the medical resources. Additionally, external validation demonstrated consistent results and acceptable calibration.

Conclusion:

This study identified the optimal timing and approaches for first tangential excision, validating them as independent prognostic factors for patients with ≥70% TBSA. However, considering the various confounding factors, treatment for each patient should be tailored.
Textbook Neoadjuvant Experience: Defining a Novel Composite Outcomes Measure for Patients with Pancreatic Cancer Undergoing Neoadjuvant Therapy
Authors: Underwood Patrick W , Leuschner Thomas , Ejaz Aslam , Dillhoff Mary , Tsai Susan , Pawlik Timothy M , Manne Ashish , Krishna Somashekar G , Miller Eric D , Ahmad Syed , Cloyd Jordan M
Published: January 2025

Background:

Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC). Disease progression, toxicity, and failure to undergo surgical resection are common during NT, yet little research has focused on efforts to optimize care delivery. We sought to define and validate a novel composite outcomes metric that characterizes the successful delivery of NT.

Study Design:

All patients with localized PDAC receiving NT in intention-to-treat fashion between 2018-2023 were retrospectively evaluated. A textbook neoadjuvant experience (TNE) was defined as the absence of mortality, disease progression, or hospital admission during NT as well as the completion of all intended NT and successful surgical resection.

Results:

Among 306 patients with localized PDAC, median age was 66 and 58.5% were male. Overall, only 85 (28%) experienced a TNE which was more common among patients with potentially resectable (45/96, 47%) than borderline resectable (33/112, 29%) or locally advanced (7/98, 7%) disease. Patients with a TNE experienced greater overall survival (OS) than those individuals without a TNE (median not reached vs 16.4 months (95%CI: 14.9-17.9 months), p<0.001). On multivariable Cox regression analysis, a TNE was the strongest predictor of improved OS (HR 0.33; 95%CI: 0.20-0.54, p<0.001).

Conclusion:

A TNE is infrequently achieved among patients with PDAC undergoing NT but is significantly associated with improved long-term outcomes. Future research aimed at optimizing outcomes of NT delivery should incorporate this novel composite metric that may more accurately reflect patient and provider expectations of treatment.
Time to standardize educational competencies on EBP: the benefits of a common core framework
Authors: Cardoso Ana Filipa , Lockwood Craig
Published: January 2025

Principles, theories, and models of education for health professionals have not evolved in parallel with advanced requirements for evidence-based practice (EBP). We propose that groups such as JBI, with a global network of clinical and academic centers, are well placed to reignite the debate and advance evidence-based curriculum development. This can be achieved by operationalizing the JBI Model for Evidence-Based Healthcare within the Sicily statement's pedagogical framework. We propose that JBI establish a global methodological group to advance this work, including the implementation and evaluation of evidence-based curriculum for cross-professional teaching of evidence-based health care principles and practices, as well as facilitating resource-sharing capability.
Immunogenicity of bivalent versus monovalent mRNA booster vaccination among adult paramedics in Canada who had received three prior mRNA wild-type doses
Authors: Asamoah-Boaheng Michael , Goldfarb David M. , Kayda Iryna , Yap Justin , Kirkham Tracy , Karim Mohammad Ehsanul , Demers Paul , Copp Jeffrey M. , Grunau Brian
Published: January 2025

Introduction. Comparative immunogenicity from different mRNA booster vaccines (directed at WT, BA.1 or BA.4/5 antigens) remains unclear.

Methods. We included blood samples from adult paramedics who received three mRNA WT-directed vaccines plus a fourth dose of the following: (1) WT monovalent, (2) Moderna BA.1-WT bivalent or (3) Pfizer BA.4/5 WT bivalent vaccine. The primary outcome was angiotensin-converting enzyme 2 (ACE2) inhibition to BA.4/5 antigen. We used optimal pair matching (using age, sex-at-birth, preceding SARS-CoV-2 infection and fourth vaccine-to-blood collection interval) to create balanced groups to individually compare each vaccine type to each other vaccine (overall, within subgroups defined by SARS-CoV-2 infection and after combining BA.1 and BA.4/5 cases). We compared outcomes with the Wilcoxon matched-pairs signed rank test.

Results. Overall, 158 paramedics (mean age 45 years) were included. ACE2 inhibition was higher for BA.1 compared to WT (P=0.002); however, no difference was detected between BA.4/5 vs. WT or BA.1 vs. BA.4/5. Among cases with preceding SARS-CoV-2, there were no detected between-group differences. Among cases without preceding SARS-CoV-2, the only detected difference was BA.1>WT (P=0.003). BA.1 and BA.4/5 cases combined had higher ACE2 inhibition than WT (P=0.003).

Conclusion. Omicron-directed vaccines appear to improve Omicron-specific immunogenicity; however, this appears limited to SARS-CoV-2-naive individuals.
Pancreatic tuberculosis revealed by a mass with neoplastic appearance: a case report
Authors: Hachimi Idrissi Mariam , Benass Jihane , Zegmout Adil , Tazi Imane , Ben Lahlou Yassine , Benaissa Elmostafa , Hassan Seddik , Chadli Mariama
Published: January 2025

Introduction. Pancreatic tuberculosis is an extremely rare form of extrapulmonary tuberculosis. This condition can be challenging to diagnose due to its rarity, nonspecific symptoms and radiological features that may mimic a neoplastic origin.

Case report. A 46-year-old immunocompetent patient with no past history of tuberculosis exposure presented with spontaneously resolving jaundice over the past month, accompanied by nonspecific fever episodes and general fatigue with no other associated digestive symptoms. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a poorly defined, partially necrotic mass in the pancreatic head with heterogeneous hypodensity and enhancement after contrast injection. Additionally, there were nodal and hilar macro-nodal lesions with necrotic appearances, as well as peripancreatic lymphadenopathy. The patient was scheduled for an endoscopic ultrasound (EUS) examination, which revealed the presence of a heterogeneous lesion with areas of necrosis in the posterosuperior aspect of the head and isthmus of the pancreas, accompanied by perilesional and coeliac lymphadenopathies with necrotic centres. EUS-guided tissue sampling allowed the diagnosis of pancreatic tuberculosis, with both histological examination and GeneXpert MTB/RIF testing rapidly positive for Mycobacterium tuberculosis, followed by culture on solid Loewenstein–Jensen medium. The patient responded well to antitubercular chemotherapy.

Conclusion. Pancreatic tuberculosis, though rare, should be considered in cases of pancreatic masses, especially in endemic regions. Tissue samples with necrosis should be tested for M. tuberculosis using GeneXpert and Loewenstein–Jensen culture. This work highlights the GeneXpert MTB/RIF test as highly sensitive, specific and fast, making it ideal for diagnosing extrapulmonary tuberculosis, particularly when smear results are negative.
Monte Carlo simulations predict distinct real EEG patterns in individuals with high and low IQs
Authors: Tozzi Arturo
Published: January 2025

The neural mechanisms underlying individual differences in intelligence are a central focus in neuroscience. We investigated the effectiveness of Monte Carlo simulations in predicting real EEG patterns and uncovering potential neural differences between individuals with high and low intelligence. EEG data were collected from two groups of volunteers categorized by IQ, namely, a high-IQ group and a low-IQ group. A univariate normal distribution was fitted to each EEG channel using Maximum Likelihood Estimation, after which synthetic datasets were generated based on the estimated parameters. Statistical analyses including Root Mean Square Error (RMSE) calculations assessed the alignment between real and simulated data. We showed that Monte Carlo simulations effectively replicated the statistical properties of the EEG data from both the groups, closely matching the real central tendencies, variability and overall distribution shapes. Specific EEG channels, particularly in the frontal and temporal bilateral regions, exhibited significant differences between the two groups, pointing to potential neural markers of cognitive abilities. Further, the low-IQ group exhibited higher predictability and more consistent neural patterns, reflected by lower RMSE values and smaller standard deviations across several EEG channels. Conversely, the high-IQ group displayed greater variability and larger RMSE values, reflecting complex neural dynamics that are less predictable by Monte Carlo simulations. Our findings underscore the utility of Monte Carlo simulations as a robust tool for replicating EEG patterns, identifying cognitive differences and predicting EEG activity associated with intelligence levels. These insights can inform predictive modeling, neurocognitive research, educational strategies and clinical interventions of targeted cognitive enhancement.
Integration of mathematical modeling and economics approaches to evaluate strategies for control ofSalmonellaDublin in a heifer-raising operation
Authors: Llanos-Soto Sebastian , Wiedmann Martin , Adalja Aaron , Henry Christopher , Moroni Paolo , Frye Elisha , Yepes Francisco A. Leal , Ivanek Renata
Published: January 2025

SalmonellaDublin infections in heifer-raising operations (HROs) cause animal health and economic losses for these operations and represent a pathogen source for dairy farms obtaining replacement heifers from HROs. To improve control ofS. Dublin, we (i) developed a mathematical model ofS.Dublin transmission on a HRO, (ii) evaluated the vaccine effectiveness and cleaning improvements for controlling the infection, and (iii) evaluated the influence of infection and control strategies on the HRO’s operating income. We developed a modified Susceptible-Infected-Recovered-Susceptible model ofS.Dublin spread in a batch-stocking HRO post-introduction of an index case, with stochasticity introduced through Monte Carlo simulations. Epidemiological outcomes (S.Dublin-induced deaths and abortions during raising andS.Dublin carriers and asymptomatic infections among raised replacement heifers) and operating income per 100-head raised on a HRO over a 2-year simulation were compared between control scenarios. We validated our model againstS.Dublin infection data in cattle. Partial rank correlation coefficient and classification trees were used to determine parameter influence on model outcomes. Our model predicts a median of 37 carriers and 92 asymptomatic infections among raised replacement heifers out of 2,330 heifers that departed the operation by the end of the 2-year simulation period, highlighting the critical role of HROs in spreadingS. Dublin. Increasing barn floor cleaning frequency (to a maximum of 12x per day) meaningfully reduced theS.Dublin epidemiological outcomes and improved the HRO’s operating income. Depending on the cost of cleaning, the median operating income increased between 1.2% to 10.6% in the first year when cleaning 12x per day compared to baseline (cleaning 1x per week). In most cost scenarios, predictions do not support the use of vaccination, even when paired with stringent cleaning measures. The developed model is expected to aid efforts to controlS.Dublin in HROs.
A new skin supplement Purasomes XCELL: an integrative approach in regenerative aesthetics
Authors: Salvaggio Antonio , Coppa Federica , Brundo Maria Violetta
Published: January 2025

Food supplements are taking on an increasingly important role as potential support tools for well-being and health. Supplements that offer essential nutrients and bioactive compounds can help fill nutritional gaps and provide specific benefits to complement health and wellness promotion strategies. Many supplements contain bioactive compounds used to enhance skin health and appearance, but only few biomolecules influence telomere lengths. Aims of this study was evaluatedin vitroeffectiveness of a new supplement Purasomes XCELL that contains natural compounds extracted from bovine colostrum andAstragalus, on skin aging using telomere length as an aging biomarker. Our results suggest that Purasomes XCELL has protective effect that is manifested already 4 weeks of treatment, but the telomere shortening rates on human fibroblasts were even more pronounced at 8 weeks. This new supplement could be highly effective on skin aging.
Treg cell epitopes fromα-tubulin: discovery and immunomodulatory features
Authors: Fiyouzi Tara , Subiza Jose L. , Lafuente Esther M. , Reche Pedro A
Published: January 2025

Regulatory T (Treg) cells are pivotal in maintaining self-tolerance and controlling immune responses. In this study, we investigated potential Treg cell epitopes in human α-tubulin that were selectedin silicofor their promiscuous binding to class II human leukocyte antigens and full identity with antigens from enteric nematodes present in excretory-secretory products. We identified five Treg cell epitopes in α-tubulin that were capable of stimulating and expanding IL-10 and TGF-β-producing Foxp3+Treg cells in peripheral blood mononuclear cells. We also proved that a peptide pool containing the identified Treg cell epitopes (αTBL pool) suppressed the T cell responses elicited by different stimuli, including LPS, and class I and class II restricted T cell epitopes, as determined by intracellular cytokine staining assays. Similarly, this same peptide pool was able to suppress T cell responses in mixed lymphocyte reactions. Finally, we found that stimulation of naive CD4+T cells with autologous monocyte-derived dendritic cells in the presence of the αTBL pool promoted the differentiation of functional CD4+CD25highFoxP3+T cells capable of suppressing the proliferation of CD3/CD28-activated T cells. α-tubulin Treg cell epitopes could be useful for treating autoimmune and chronic inflammatory diseases by inducing Treg cells and, given the ubiquitous and copious expression of α-tubulin, enable a general mechanism of immune homeostasis.
SELECTION OF ANTI-NUCLEAR ANTIGEN (ANA) REACTIVE B CELLS IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Atisha-Fregoso Yemil , Meng Wenzhao , Rosenfeld Aaron M. , Liu Fang , MacCarthy Thomas , Feltman Scott , Aranow Cynthia , Mackay Meggan , Terestchenko Chloe , Dunn Moriah , Scharff Matthew , Luning Prak Eline T. , Diamond Betty
Published: January 2025

Objective

Autoreactive B cells that recognize nuclear antigens are normally present in healthy individuals and patients with systemic lupus erythematosus (SLE), yet their activation and the production of IgG autoantibodies is a hallmark of SLE. The selection process and regulation of these cells in patients with SLE has not been completely understood. To gain insights into tolerance checkpoints and the developmental trajectories of autoreactive clones, we studied the BCR sequences from thousands of anti-nuclear antigen binding (ANA)+ and ANA-B cells from patients with SLE.

Methods

From a cohort of 13 patients with SLE, we identified and isolated ANA+ and ANA-B cells by flow cytometry using a method based on their binding to nuclear extracts. We sequenced B cell receptor (BCR) heavy chain variable regions and investigated the features of the IgH repertoire of ANA+ and ANA-B cells from naïve, memory and age-associated B cells (ABCs), and from total plasmablasts.

Results

The frequency of ANA+ B cells was similar in ABCs and naive B cells and higher in both than in memory B cells. We observed preferential usage of some VH (IGHV1-18, IGHV3-21, IGHV3-23|3-23D, IGHV4-34, IGHV4-39 and IGHV4-59) and VJ genes (IGHJ4 and IGHJ6) in B cells from these patients. ANA+ naïve and ANA+ ABCs used different gene segments and have longer CDR3 sequences than ANA+ memory B cells and ANA-subsets. ANA+ ABCs and memory B cells have a lower frequency of somatic hypermutation (SHM) and less activation induced deaminase (AID) targeting to WRC hotspots compared with their ANA-counterparts. Patients with active disease have a lower frequency of SHM in ANA+ ABCs and memory B cells and in ANA-ABCs.

Conclusion

Compared to memory B cells, ABCs are enriched in autoreactivity. Our results suggest that there is an immune checkpoint that restricts the differentiation of ANA+ naïve B cells into memory B cells and that ANA+ ABCs originate from ANA+ naïve B cells. Lower frequencies of SHM in antigen experienced ANA+ B cells, and particularly ANA+ ABCs, suggest that these cells might be generated through an extrafollicular (EF) pathway, and that in patients with active SLE there is more EF activation.