bluuebunny/crossref_metadata_2025 huggingface dataset:
Proteome and genome integration analysis of obesity
Authors: Zhao Qigang , Han Baixue , Xu Qian , Wang Tao , Fang Chen , Li Rui , Zhang Lei , Pei Yufang
Published: March 2023

The prevalence of obesity has increased worldwide in recent decades. Genetic factors are now known to play a substantial role in the predisposition to obesity and may contribute up to 70% of the risk for obesity. Technological advancements during the last decades have allowed the identification of many hundreds of genetic markers associated with obesity. However, the transformation of current genetic variant-obesity associations into biological knowledge has been proven challenging. Genomics and proteomics are complementary fields, as proteomics extends functional analyses. Integrating genomic and proteomic data can help to bridge a gap in knowledge regarding genetic variant–obesity associations and to identify new drug targets for the treatment of obesity. We provide an overview of the published papers on the integrated analysis of proteomic and genomic data in obesity and summarize four mainstream strategies: overlap, colocalization, Mendelian randomization, and proteome-wide association studies. The integrated analyses identified many obesity-associated proteins, such as leptin, follistatin, and adenylate cyclase 3. Despite great progress, integrative studies focusing on obesity are still limited. There is an increased demand for large prospective cohort studies to identify and validate findings, and further apply these findings to the prevention, intervention, and treatment of obesity. In addition, we also discuss several other potential integration methods.
Nuclear factor-Y mediates pancreatic β-cell compensation by repressing reactive oxygen species-induced apoptosis under metabolic stress
Authors: He Siyuan , Yu Xiaoqian , Cui Daxin , Liu Yin , Yang Shanshan , Zhang Hongmei , Hu Wanxin , Su Zhiguang
Published: March 2023

Background

Pancreatic β-cells elevate insulin production and secretion through a compensatory mechanism to override insulin resistance under metabolic stress conditions. Deficits in β-cell compensatory capacity result in hyperglycemia and type 2 diabetes (T2D). However, the mechanism in the regulation of β-cell compensative capacity remains elusive. Nuclear factor-Y (NF-Y) is critical for pancreatic islets' homeostasis under physiological conditions, but its role in β-cell compensatory response to insulin resistance in obesity is unclear.

Methods

In this study, using obese (ob/ob) mice with an absence of NF-Y subunit A (NF-YA) in β-cells (ob, Nf-ya βKO) as well as rat insulinoma cell line (INS1)-based models, we determined whether NF-Y-mediated apoptosis makes an essential contribution to β-cell compensation upon metabolic stress.

Results

We showed that obese animals had markedly augmented NF-Y expression in pancreatic islets. Deletion of β-cell Nf-ya in obese mice worsened glucose intolerance and resulted in β-cell dysfunction, which was attributable to augmented β-cell apoptosis and reactive oxygen species (ROS). Furthermore, we showed that primary pancreatic islets from Nf-ya βKO mice were sensitive to palmitate-induced β-cell apoptosis due to mitochondrial impairment and the attenuated antioxidant response, which resulted in the aggravation of phosphorylated c-Jun N-terminal kinase (JNK) and cleaved caspase-3. These detrimental effects were completely relieved by ROS scavenger. Ultimately, we showed that forced overexpression of NF-Y in INS1 β-cell line could rescue palmitate-induced β-cell apoptosis, dysfunction, and mitochondrial impairment.

Conclusion

Pancreatic NF-Y might be an essential regulator of β-cell compensation under metabolic stress.
Cellulite Pathophysiology and Psychosocial Implications
Authors: Bass Lawrence S. , Hibler Brian P. , Khalifian Saami , Shridharani Sachin M. , Klibanov Olga M. , Moradi Amir
Published: March 2023

BACKGROUND

Cellulite is a highly prevalent aesthetic condition in postpubertal women.

OBJECTIVE

The objective of this article was to describe the latest data on the pathophysiology of cellulite and to highlight the psychosocial aspects that should be considered when treating cellulite.

METHODS

A roundtable meeting was convened to discuss and share views on the latest data on the pathophysiology and psychosocial aspects of cellulite. The participants' experience helped guide a narrative review on this topic.

RESULTS

The pathophysiology of cellulite primarily involves fibrous septal changes. Strategies targeting the fibrous septa have shown the most consistent efficacy, while showing inconsistent or short-term results when targeting the other components of cellulite, such as decreased dermal thickness, vascular alterations, and inflammation. Female sex, increased age, and high body mass index contribute to cellulite pathophysiology.

CONCLUSION

Patients seeking treatment for cellulite are willing to endure numerous treatments, high cost, temporary and/or delayed results, and invasive procedures with potential adverse effects. Psychological discomfort has been reported among patients with cellulite, and understanding their behaviors and psychological characteristics can help clinicians provide better care to these patients seeking treatment.
Cellulite: Current Treatments, New Technology, and Clinical Management
Authors: LaTowsky Brenda , Jacob Carolyn , Hibler Brian P. , Lorenc Paul Z. , Petraki Chrysi , Palm Melanie
Published: March 2023

BACKGROUND

Cellulite is a well-known concern for many women; however, treatment can prove challenging because of the complexities of cellulite etiology, the various factors contributing to its appearance, and the multitude of therapies and procedures available.

OBJECTIVE

To discuss current cellulite treatment options and effective clinical management.

METHODS

A roundtable meeting was convened to discuss and share views on current cellulite treatment options, new technologies, and clinical management. The participants' views helped guide a narrative review on this topic.

RESULTS

Advanced interventions for cellulite treatment—such as physical and acoustic subcision, radiofrequency, and injectable biostimulators—are gradually being established, with accumulating evidence showing efficacy, patient satisfaction, and potentially long-lasting outcomes. Cellulite severity rating scales are necessary for assessing treatment outcomes, but these can be complex to use in clinical practice, and the majority do not include patient or clinician perspectives.

CONCLUSION

With the advent of new treatments and technologies, cosmetic surgeons and dermatologists will need to tailor their approach to each patient's needs and manage patient expectations because multimodal methods are likely to be required to address the various factors underlying cellulite appearance.
Visual outcomes, satisfaction, and spectacle independence with a nondiffractive extended vision intraocular lens targeted for slight monovision
Authors: Solomon Kerry D. , Sandoval Helga P. , Potvin Richard
Published: March 2023

Purpose:

To evaluate vision, satisfaction, and spectacle independence of the AcrySof IQ Vivity intraocular lens when the nondominant eye is targeted for slight myopia.

Setting:

1 clinical practice in the United States.

Design:

Prospective unmasked nonrandomized clinical trial.

Methods:

Patients presenting for cataract surgery interested in reducing their dependence on spectacles were enrolled, with the dominant eye targeted for emmetropia and the nondominant eye targeted for slight monovision (−0.50 diopters [D]). Visual disturbances, satisfaction, and spectacle independence were evaluated. Visual acuity (VA) was tested at distance (4 m), intermediate (66 cm), and near (40 cm) at 3 months postoperatively when uncorrected, with both eyes corrected to emmetropia and with 1 eye adjusted for monovision. 2 binocular defocus curves were also collected under the latter 2 conditions.

Results:

Data from 31 patients were analyzed. The mean refractive spherical equivalent was 0.45 D more myopic in the nondominant eye, resulting in worse uncorrected VA at distance but better uncorrected VA at near. The binocular defocus curve with monovision showed significantly better VA from −2.0 to −3.0 D, and patients reported less need for spectacles (and better vision) at near than reported with binocular emmetropia. Glare, blurred vision, and starbursts were the most reported visual disturbances. Although not correlated with the difference in refraction, glare and blurred vision were significantly correlated with overall satisfaction.

Conclusions:

Implanting this IOL with a target of slight myopia in the nondominant eye appears to be a viable way to improve near vision, although with an increased potential for visual disturbances.
Changing trends, clinicopathological characteristics, surgical treatment patterns, and prognosis of schistosomiasis-associated versus non-schistosomiasis-associated colorectal cancer: a large retrospective cohort study of 31 153 cases in Shanghai, China (2001–2021)
Authors: Zheng Nanxin , Wang Hao , Yu Qing , Wang Chen , Bai Chen Guang , Pan An Fu , Jiang Jianjun , Lu Jian , Dai Si Min , Mei Zubing , Zhang Wei , Gao Xian Hua
Published: March 2023

Background:

With the elimination of schistosomiasis in China, its role in the pathogenesis of colorectal cancer (CRC) has decreased. However, the trends, clinicopathological features, surgical treatment patterns, and prognosis of schistosomiasis-associated CRC (SACRC) versus non-schistosomiasis-associated CRC (NSACRC) in China remain unclear.

Materials and methods:

The percentage trend of SACRC in CRC patients in China was analyzed using data retrieved from the Pathology Registry of Changhai Hospital (2001–2021). Clinicopathological characteristics, surgical treatment patterns, and prognosis-related parameters were compared between the two groups. Multivariate Cox regression analyses were performed for disease-free survival (DFS) and overall survival (OS).

Results:

A total of 31 153 CRC cases were included, with 823 (2.6%) cases of SACRC and 30 330 (97.4%) cases of NSACRC. The average percentage of SACRC cases has decreased continuously from 3.8 to 1.7% (from 2001 to 2021). Compared with the NSACRC group, the SACRC group had more men, older age at diagnosis, lower BMI, fewer symptoms; higher rates of rectal cancer, comorbidities, KRAS mutation, multiple primary CRC and concomitant polyps; less lymph node metastasis, distant metastasis, vascular invasion, and tumor budding; less preoperative radiotherapy and preoperative chemotherapy; and more positive resection margins and postoperative targeted therapy. There were no significant differences between the two groups regarding laparoscopic surgery, palliative resection, extended radical resection, or ostomy. Moreover, the SACRC group had adverse DFS and similar OS compared with the NSACRC group. In multivariate analyses, schistosomiasis was not an independent predictor of DFS or OS.

Conclusion:

The percentage of SACRC in CRC (2.6%) in our hospital was very low, and it decreased continuously over the last two decades, indicating that schistosomiasis is no longer an important risk factor for CRC in Shanghai, China. Patients with SACRC have distinct clinicopathological, molecular, and treatment-related features and survival rates similar to those with NSACRC.
Early and late recurrence patterns of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy: a multicenter study
Authors: Zhang Xiu-Ping , Xu Shuai , Gao Yuan-Xing , Zhao Zhi-Ming , Zhao Guo-Dong , Hu Ming-Gen , Tan Xiang-Long , Lau Wan Yee , Liu Rong
Published: March 2023

Background:

Survival after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains poor because of high incidences of recurrence. The risk factors, patterns, and long-term prognosis in patients with early recurrence and late recurrence (ER and LR) for PDAC after PD were studied.

Methods:

Data from patients who underwent PD for PDAC were analyzed. Recurrence was divided into ER (ER ≤1 years) and LR (LR >1 years) using the time to recurrence after surgery. Characteristics and patterns of initial recurrence, and postrecurrence survival (PRS) were compared between patients with ER and LR.

Results:

Among the 634 patients, 281 (44.3%) and 249 (39.3%) patients developed ER and LR, respectively. In the multivariate analysis, preoperative CA19-9 levels, resection margin status, and tumor differentiation were significantly associated with both ER and LR, while lymph node metastasis and perineal invasion were associated with LR. Patients with ER, when compared with patients with LR, showed a significantly higher proportion of liver-only recurrence (P<0.05), and worse median PRS (5.2 vs. 9.3 months, P<0.001). Lung-only recurrence had a significantly longer PRS when compared with liver-only recurrence (P<0.001). Multivariate analysis demonstrated that ER and irregular postoperative recurrence surveillance were independently associated with a worse prognosis (P<0.001).

Conclusion:

The risk factors for ER and LR after PD are different for PDAC patients. Patients who developed ER had worse PRS than those who developed LR. Patients with lung-only recurrence had a significantly better prognosis than those with other recurrent sites.
Deep-learning-based semantic segmentation of autonomic nerves from laparoscopic images of colorectal surgery: an experimental pilot study
Authors: Kojima Shigehiro , Kitaguchi Daichi , Igaki Takahiro , Nakajima Kei , Ishikawa Yuto , Harai Yuriko , Yamada Atsushi , Lee Younae , Hayashi Kazuyuki , Kosugi Norihito , Hasegawa Hiro , Ito Masaaki
Published: March 2023

Background:

The preservation of autonomic nerves is the most important factor in maintaining genitourinary function in colorectal surgery; however, these nerves are not clearly recognisable, and their identification is strongly affected by the surgical ability. Therefore, this study aimed to develop a deep learning model for the semantic segmentation of autonomic nerves during laparoscopic colorectal surgery and to experimentally verify the model through intraoperative use and pathological examination.

Materials and methods:

The annotation data set comprised videos of laparoscopic colorectal surgery. The images of the hypogastric nerve (HGN) and superior hypogastric plexus (SHP) were manually annotated under a surgeon’s supervision. The Dice coefficient was used to quantify the model performance after five-fold cross-validation. The model was used in actual surgeries to compare the recognition timing of the model with that of surgeons, and pathological examination was performed to confirm whether the samples labelled by the model from the colorectal branches of the HGN and SHP were nerves.

Results:

The data set comprised 12 978 video frames of the HGN from 245 videos and 5198 frames of the SHP from 44 videos. The mean (±SD) Dice coefficients of the HGN and SHP were 0.56 (±0.03) and 0.49 (±0.07), respectively. The proposed model was used in 12 surgeries, and it recognised the right HGN earlier than the surgeons did in 50.0% of the cases, the left HGN earlier in 41.7% of the cases and the SHP earlier in 50.0% of the cases. Pathological examination confirmed that all 11 samples were nerve tissue.

Conclusion:

An approach for the deep-learning-based semantic segmentation of autonomic nerves was developed and experimentally validated. This model may facilitate intraoperative recognition during laparoscopic colorectal surgery.
Cholecystectomy and risk of liver disease: a systematic review and meta-analysis of 27 million individuals
Authors: Luo De , Chen Xin-Pei , Dai Yang , Kuang Fei , Kang Mao-Ji , Li Bo , Su Song
Published: March 2023

Background:

There is still a lack of knowledge on the association between cholecystectomy and liver disease. This study was conducted to summarize the available evidence on the association of cholecystectomy with liver disease and quantify the magnitude of the risk of liver disease after cholecystectomy.

Methods:

PubMed, Embase, Web of Science, and Cochrane Library were searched systematically from database inception to January 2023 to identify eligible studies that evaluated the association between cholecystectomy and the risk of liver disease. Meta-analysis was conducted to obtain a summary odds ratio (OR) and 95% confidence interval (CI) using a random-effects model.

Results:

We identified 20 studies with a total of 27 320 709 individuals and 282 670 liver disease cases. Cholecystectomy was associated with an increased risk of liver disease (OR: 1.63, 95% CI: 1.34–1.98). In particular, cholecystectomy was found to be significantly associated with a 54% increased risk of nonalcoholic fatty liver disease (OR: 1.54, 95% CI: 1.18–2.01), a 173% increased risk of cirrhosis (OR: 2.73, 95% CI: 1.81–4.12), and a 46% increased risk of primary liver cancer (OR: 1.46, 95% CI: 1.18–1.82).

Conclusions:

There is an association between cholecystectomy and the risk of liver disease. Our results suggest that strict surgical indications should be implemented to reduce unnecessary cholecystectomy. Additionally, the routine assessment of liver disease is necessary for patients with a history of cholecystectomy. More prospective large-sample studies are required for better estimates of the risk.
A model-based quantitative analysis of efficacy and associated factors of platelet rich plasma treatment for osteoarthritis
Authors: Cao Ying , Luo Jieren , Han Shun , Li Zewei , Fan Tianxiang , Zeng Muhui , Wen Xin , Peng Yongzheng , Jiang Li , Han Weiyu , Lin Lijun , Fu Siu Ngor , Hunter David J , Ding Changhai , Li Lujin , Zhu Zhaohua
Published: March 2023

Objective:

While platelet rich plasma (PRP) has been extensively studied in treating osteoarthritis (OA), there has been an ongoing debate regarding the efficacy of PRP and the optimal subpopulation for PRP treatment remains unknown. The authors hereby aim to establish a pharmacodynamic model-based meta-analysis to quantitatively evaluate PRP efficacy, comparing with hyaluronic acid (HA) and identify relevant factors that significantly affect the efficacy of PRP treatment for OA.

Methods:

The authors searched for PubMed and the Cochrane Library Central Register of Controlled Trials of PRP randomized controlled trials (RCTs) for the treatment of symptomatic or radiographic OA from the inception dates to 15 July 2022. Participants’ clinical and demographic characteristics and efficacy data, defined as Western Ontario and McMaster Universities Osteoarthritis Index and visual analog scale pain scores at each time point were extracted.

Results:

A total of 45 RCTs (3829 participants) involving 1805 participants injected with PRP were included in the analysis. PRP reached a peak efficacy at ~ 2–3 months after injection in patients with OA. Both conventional meta-analysis and pharmacodynamic maximal effect models showed that PRP was significantly more effective than HA for joint pain and function impairment (additional decrease of 1.1, 0.5, 4.3, and 1.1 scores compared to HA treatment at 12 months for Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, function, and visual analog scale pain scores, respectively). Higher baseline symptom scores, older age (≥60 years), higher BMI (≥30), lower Kellgren–Lawrence grade (≤2) and shorter OA duration (<6 months) were significantly associated with greater efficacy of PRP treatment.

Conclusion:

These findings suggest that PRP is a more effective treatment for OA than the more well-known HA treatment. The authors also determined the time when the PRP injection reaches peak efficacy and optimized the targeting subpopulation of OA. Further high-quality RCTs are required to confirm the optimal population of PRP in the treatment of OA.
Chin-tuck assistant system (CAS)—A novel method using auditory feedback for postural maintenance in a chin-tuck maneuver: A randomized trial
Authors: Oh Donghwan , Park Han Sol , Park Myung Won , Kim Ho Jeong , Choi Wan Young , Park Ji-Su
Published: March 2023

Introduction:

Chin-tuck are effective in patients with dysphagia, where aspiration can occur due to pharyngeal swallowing delays. This study aims to verify whether Chin-tuck Assistant System Maneuver (CAS-M) supplemented with Chin-Tuck Maneuver (CTM) is effective for learning and maintaining correct chin-tuck postures. In addition, we investigated the possibility of using CAS-M as a customized rehabilitation treatment program for patients with poor cognitive ability, attention issues, and general swallowing disorders.

Intervention:

To demonstrate the effectiveness of CAS, we recruited 52 healthy adults and assigned them to 2 groups. The CTM group was trained to maintain the correct chin-tuck posture using the general Chin-Tuck Maneuver, while the CAS-M group was trained using CAS. Four evaluations were conducted using CAS to investigate the degree of postural maintenance of chin-tuck before and after intervention.

Results:

The CAS-M group showed a statistically significant difference in TIME, BEEP, and change (P < .05), but the CTM group showed no statistically significant differences (P < .05). YZ evaluation showed no statistically significant differences in both groups.

Conclusion:

After examining the effects of CAS-M using CAS on healthy adults, we confirmed this to be a more effective method for correct chin-tuck posture than conventional CTM.
The impact of heat waves on the mortality of Chinese population: A systematic review and meta-analysis
Authors: Pan Ranran , Xie Ming , Chen Mengxiang , Zhang Yannan , Ma Jian , Zhou Junhua
Published: March 2023

Background:

Many studies had shown that with global warming, heat waves may increase the mortality risk of Chinese populations. However, these findings are not consistent. Therefore, we elucidated the associations by meta-analysis and quantified the magnitude of these risks, as well as the underlying factors.

Methods:

We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, EMBASE, and Web of Science for literature screening up to Nov 10, 2022, to analyze the effect of heat waves on mortality in the Chinese population. Literature screening and data extraction were performed independently by two researchers and the data were merged by meta-analysis. In addition, we conducted subgroup analysis by sex, age, years of education, region, and number of events to explore the source of heterogeneity.

Results:

Fifteen related studies on the impact on heat waves of the death of Chinese people were included in this study. The results of the meta-analysis showed that heat waves were significantly associated with increased mortality from non-accidental deaths, cardiovascular diseases, stroke, respiratory diseases, and circulatory diseases in the Chinese population: non-accidental mortality (RR = 1.19, 95% CI: 1.13–1.27, P < .01), cardiovascular diseases (RR = 1.25, 95% CI: 1.14–1.38), stroke (RR = 1.11, 95% CI: 1.03–1.20), respiratory diseases (RR = 1.18, 95% CI: 1.09–1.28), and circulatory diseases (RR = 1.11, 95% CI: 1.06–1.17). Subgroup analyses showed that heat waves had a higher risk of non-accidental death for those with <6 years of education than for those with ≥6 years of education. Meta-regression analysis showed that the contribution of the study year to the inter studied heterogeneity was 50.57%. The sensitivity analysis showed that the exclusion of any single study did not materially alter the overall combined effect. The meta-analysis method indicated no obvious evidence of publication bias.

Conclusions:

The results of the review indicated that heat waves were associated with increased mortality in the Chinese population, that attention should be paid to high-risk groups, and that public health policies and strategies should be implemented to more effectively respond to and adapt to climate change.
Multiple bioinformatics analysis identifies IGFBP1 as associated with the prognosis of stomach adenocarcinoma
Authors: Luo Xiao-Ye , Zhang Yan-Ping , Zheng Feng , Zhou Liang
Published: March 2023

This study aimed to screen the hub gene for predicting the prognosis of patients with stomach adenocarcinoma (STAD). The RNA-sequencing expression data and clinical data of STAD were collected from the cancer genome atlas. The R package “limma” was performed to ascertain the differentially expressed genes (DEGs) between the relapse group and non-relapse group, and the DEGs between the survival dead status group and survival alive status group were screened. The overlapping genes between 2 DEGs sets were identified by the Venn diagram. Many different bioinformatics analysis methods were performed to analyze the importance of hub genes. One gene signature, IGFBP1, was extracted. The KM plot indicated that STAD patients with low IGFBP1 mRNA expression have a shorter overall survival time. The top 100 co-expression genes of IGFBP1 were mainly enriched in complement and coagulation cascades, epithelial cell signaling in Helicobacter pylori infection, and Wnt signaling pathway. Immune infiltration analysis indicated IGFBP1 may inhibit immune cell infiltration in tumors by infiltration and immune escape, leading to tumor metastasis and progression. The bioinformatics analysis results indicate that IGFBP1 can be used as a tool to evaluate the mortality risk of patients with STAD.
Acute benzyl alcohol intoxication: An autopsy case report
Authors: Ichimata Shojiro , Hata Yukiko , Zaimoku Ryosuke , Nishida Naoki
Published: March 2023

Introduction:

The main mechanism of death and the pathological appearance of cases of benzyl alcohol intoxication has not been fully investigated. Autopsy reports of cases of benzyl alcohol intoxication have not been published.

Case presentation:

A 24-year-old man was found in the state of cardiopulmonary arrest at a construction site. He had been performing paint stripping. He was immediately transferred to the hospital, but he did not recover. An autopsy showed focal coloring of the skin without any major caustic injury. A histopathological investigation showed vacuolar degeneration in the epidermis and dermo-epidermal junction, and severe erosion of the tracheal and bronchial mucosa. No pathological changes in the kidney were evident. A neuropathological investigation showed central chromatolysis of neuronal cells in pontine nuclei and grumose degeneration in the cerebellar dentate nucleus. The blood content of benzyl alcohol was 780.0 μg/mL.

Lessons:

Present case suggest that multiple pathways of exposure may be associated with more rapid progression in acute benzyl alcohol intoxication, and that early and/or severe involvement of the central nervous system rather than renal dysfunction may be associated with an early death.
Vaseline gauze packing for the treatment of acute hemorrhagic rectal ulcer: Two case reports
Authors: Yim Sung Kyun , Lee Chang Hun , Kim Seong-Hun , Kim Sang Wook , Seo Seung Young
Published: March 2023

Rationale:

Acute hemorrhagic rectal ulcer (AHRU) is a relatively rare condition characterized by sudden onset, painlessness, and massive hematochezia in patients with severe underlying conditions. When AHRU is encountered, they can often be successfully controlled endoscopically, though recurrent bleeding is common and an alternative treatment must be sought if initial endoscopic treatment fails. We report 2 cases of AHRU which were successfully treated with Vaseline gauze packing after the failure of endoscopic hemostasis.

Patient concerns:

The first patient was an 88-year-old female that visited our emergency department with hematochezia. She was immobilized because of a left pelvic bone fracture resulting from a slip-down. The initial endoscopy showed fresh blood in her rectum with diffuse ulceration near the dentate line but no active bleeding. However, Massive hematochezia has recurred during conservation. A second patient, an 86-year-old female, debilitated because of schizophrenia, dementia, and past subdural hemorrhage, visited our emergency department, also with massive hematochezia. Her initial endoscopy showed deep ulceration near the dentate line. After admission, she experienced massive hematochezia from an AHRU with an exposed vessel but endoscopic hemostasis failed to control bleeding.

Diagnoses:

Both patients were diagnosed as AHRU based on the endoscopic findings.

Interventions:

In both cases, Vaseline gauze packing was performed for bleeding control.

Outcomes:

After Vaseline gauze packing, no further bleeding occurred and follow-up endoscopy showed definitive improvement of ulcers.

Lessons:

Based on these cases, we suggest that Vaseline gauze packing may be the alternative treatment for the AHRU which is located near the dentate line when endoscopic hemostasis is difficult or failed. Although further research is needed, Vaseline gauze packing has several potential advantages for the treatment of AHRU, especially in cases involving critically ill elderly patients.
A case report: An unusual presentation of adenoid cystic carcinoma of the lacrimal gland
Authors: Liang Meiqin , Yu Zhirui , Wang Feng
Published: March 2023

Rationale:

Adenoid cystic carcinoma (ACC) is the most common malignant epithelial tumor of the lacrimal gland with the highest malignant degree. ACC of the lacrimal gland is characterized by symptoms of <1 years duration. We present a 38-year-old male patient who complained of an enlarging mass in the left lacrimal fossa for almost 10 years previous to the diagnosis of ACC.

Patient concerns:

A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of a mass in his left upper lid, which had enlarged significantly over the previous months.

Diagnoses:

Magnetic resonance imaging with intravenous Gadobutrol showed moderate and homogenous mass enhancement. Bone destruction is found. The periosteum is not eroded. The magnetic resonance imaging finding was supportive for malignancy. Histopathological examination of the specimen revealed solid tumor showing a cribriform pattern mixed small amount of basaloid cell proliferation. Therefore, the final diagnose was Adenoid cystic carcinoma of the lacrimal gland.

Interventions:

The treatment included en bloc resection of the mass and adjacent bone and radiotherapy.

Outcomes:

In 1 year follow-up after operation, there is no recurrence. Visual acuity is 30/30. The left eye shows limitation on abduction.

Lessons:

The present case demonstrates an unusual progression of ACC of the Lacrimal Gland.
A fetus of partial urorectal septum malformation sequence characterized by complete septate uterus: A case report
Authors: Zhai Jingfang , Cao Shenghan , Wang Xuezhen , Liu Ying , Zhang Bei
Published: March 2023

Rationale:

Urorectal septum malformation sequence (URSMS) is an extremely uncommon anomaly characterized by imperforate anus accompanied by multiple genitourinary malformations. Here, we report a case of URSMS identified by the autopsy and classified into partial URSMS. Prenatal diagnosis is challenging for clinicians due to the difficulty of early identification of URSMS and the relative lack of specific features in ultrasound. We intend to share our experiences.

Patient concerns:

One fetus was indicated abdominal cystic structure, abdominal effusion and right renal pelvis separation (7 mm) by ultrasound at 28 + 1 week’s gestation. After the pregnancy was terminated, the fetal tissues were performed to be tested by autopsy, copy number variation sequencing and whole exon sequencing.

Diagnoses:

Based on the clinical characteristics, ultrasound, autopsy, and genetic test findings, the fetus was diagnosed with URSMS.

Interventions:

After genetic counseling, the couple opted to terminate her pregnancy.

Outcomes:

The copy number variation results of the fetus showed a 0.48-MB duplication fragment of uncertain significance on chromosome 8p23.3, while the whole-exome sequencing revealed a SAL-LIKE 1 gene mutation. The autopsy of the fetus showed imperforate anusa, the abdominal cyst was further confirmed with complete septate uterus and the lower urethra and vagina converge formed a lumen.

Lessons:

Individuals with URSMS during the fetal period might be misdiagnosed due to atypical features of URSMS. Once structural abnormalities especially cystic mass of the futuses in the lower abdomen, URSMS should be considered.
Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department
Authors: Mallett-Smith Sheila , Jadalla Ahlam , Hardan-Khalil Kholoud , Sarff Laura , Brady Margaret
Published: March 2023

Background:

Emergency department (ED) health care workers experience high rates of workplace violence (WPV).

Local Problem:

Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits.

Methods:

A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED.

Interventions:

Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies.

Results:

Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits.

Conclusions:

Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.
Special anatomy series: understanding fascicular anatomy of the brachial plexus: reverse mouse in maze game
Authors: Chiou-Tan Faye Y.
Published: March 2023

Background:

The objective of this paper is to teach the physician fascicular anatomy of the brachial plexus.

Method:

To achieve this, we will reach back to historical references that researched brachial plexus fascicular anatomy.

Results:

An applied anatomy system was created by which the lesion in the brachial plexus can rapidly be localized. This system is called the “reverse mouse in maze” game, which is a teaching tool created at this institution for resident physicians. Color coding helps localize the lesion rapidly. Black indicates where the lesion is not. Overlap of other colors points to where the lesion likely is. Finally, if the colors do not overlap, there could be 2 lesions. Example hypothetical cases are reviewed as part of this manuscript. Fascicular anatomy can be dizzying to learn and difficult to memorize for the novice physician. To localize the lesion rapidly in the clinical setting and for real-time oral board exams, we found this technique to be useful.

Conclusion:

Awareness that fascicular anatomy of the brachial plexus exists helps localize and explain needle findings on electromyography that may be confusing. The “reverse mouse in maze” localization strategy helps rapidly localize the lesion(s) and also hopefully prevents unnecessary needle testing sampling during the electromyography test.
Investigating burnout of Rehabilitation Medicine trainees: an Australian cross-sectional study
Authors: Ponsford Michael W. , Bilszta Justin L. , McKenzie Dean , Fedele Bianca , Olver John
Published: March 2023

Background:

In Rehabilitation Medicine, there is an increased incidence of burnout compared with other specialties, with burnout affecting over 50% of rehabilitation physicians. There remains limited research investigating burnout in Rehabilitation Medicine trainees.

Aim:

To investigate the frequency of burnout, and associations between burnout and workplace and demographic factors, among Australian registered Rehabilitation Medicine trainees.

Methods

This cross-sectional study administered the Mini-Z Burnout Survey via the Qualtrics survey platform. The presence of burnout was determined on responses to Survey Item 3. Binary logistic regression evaluated associations between burnout presence and workplace and demographic (age, sex, and stage of training) variables. An open-ended question addressing workplace stresses underwent qualitative content analysis.

Results:

Of the potential 220 registered trainees, 18.2% (39) consented to participate. Burnout was reported by 54.6% (18/33) of respondents with complete data. Logistic regression analyses revealed 2 Mini-Z items were significantly associated with burnout; job stress (odds ratio=22.9; 95% CI=3.5–145.8, P<0.001) and a hectic/chaotic work atmosphere (odds ratio=5.0; 95% CI=1.01–24, P=0.045). There was no significant association between burnout and the remaining Mini-Z items or between burnout and the demographic variables. Content analysis of responses to the open-ended question identified 3 themes: training issues; work place demands; personal health/work-life balance concerns.

Conclusion:

This Australian-first study identified significant burnout in a cohort of Rehabilitation Medicine trainees. The sources of stress identified can be used to modify workplace environments and education requirements and promote well-being among trainees.
How Nutrition and Supplements Impact Aesthetic Outcomes
Authors: Wicklund Anna Katherine
Published: March 2023

Nutraceuticals, nutritional supplements, and the diet industry often provide misleading information, make faulty promises, and may also support profit over consumer safety. Furthermore, the U.S. Food and Drug Administration regulates dietary supplements as a food, not as a drug. As health care providers, we must be aware of current trends in supplements and nutrition programs so that we can screen our patients for contraindications to aesthetic treatments and educate and promote specific supplements/programs that are safe and evidence-based. Oxidative stress, chronic inflammation, and increased glycation can accelerate the aging process. The combination of an anti-inflammatory diet and pharmaceutical-grade nutritional supplements can impact the multiple forces involved in skin aging and help balance skin homeostasis. Using specific nutritional interventions and supplements can help repair damaged skin, improve skin health, and reduce skin senescence. Aesthetic providers can enhance healing and clinical results by educating patients and providing high-quality supplements that promote good aesthetic outcomes.
Case Volume and Readiness to Deploy: Clinical Opportunities for Active-Duty Surgeons Outside of Military Hospitals
Authors: Sheldon MAJ Rowan R , Bozzay MAJ Joseph D , Brown LTC Shaun R
Published: March 2023

Background:

The Military Health System (MHS) utilizes a readiness program that identifies the knowledge, skills, and abilities (KSAs) necessary for surgeons to provide combat casualty care. Operative productivity is assigned an objective score based upon case type and complexity and totaled to assess overall readiness. As of 2019, only 10.1% of surgeons met goal readiness threshold. At one tertiary Military Treatment Facility (MTF), leadership has taken an aggressive approach towards increasing readiness by forming Military Training Agreements (MTAs) and allowing Off Duty Employment (ODE). We sought to quantify the efficacy of this approach.

Study Design

Operative logs from 2021 were obtained from surgeons assigned to the MTF. Cases were assigned CPT codes and processed through the KSA calculator (Deloitte; London, UK). Each surgeon was then surveyed to identify time away from clinical duties for deployment or military training.

Results:

Nine surgeons were present in 2021 and spent an average of 10.1 weeks (19.5%) abroad. Surgeons performed 2348 cases (Avg 261 ± 95) including 1575 (Avg 175; 67.1%) at the MTF, 606 (Avg 67.3; 25.8%) at MTAs, and 167 (Avg 18.6, 7.1%) during ODE. Adding MTA and ODE caseloads increased KSA scores by 56% (17,765 ± 7,889 v 11,391 ± 8,355). Using the MHS threshold of 14,000, three of nine (33.3%) surgeons met the readiness threshold from MTF productivity alone. Including all cases, seven of nine (77.8%) surgeons met threshold.

Conclusions:

Increased utilization of MTAs and ODE significantly augment average caseloads. These cases provide considerable benefit and result in surgeon readiness far exceeding the MHS average. Military leadership can maximize the chances of meeting readiness goals by encouraging clinical opportunities outside the MTF.
Trends in Coagulase negative Staphylococci (CoNS), England, 2010-2021
Authors: Paranthaman Karthik , Wilson Allegra , Verlander Neville , Rooney Graeme , Macdonald Neil , Nsonwu Olisaeloka , Hope Russell , Fleming Paul , Hatcher James , Ogundipe Enitan , Ratnaraja Natasha , Wan Yu , Pichon Bruno , Westrop Samantha J , Brown Colin S , Demirjian Alicia
Published: March 2023

Objective To review the epidemiology of Coagulase-negative staphylococci (CoNS) in England over the recent 12-year period. Methods Laboratory confirmed CoNS reported from sterile sites in patients in England to the UK Health Security Agency (UKHSA) between 2010 and 2021 were extracted from the national laboratory database and analysed. Results Overall, 668,857 episodes of CoNS were reported. Unspeciated CoNS accounted for 56% (374,228) of episodes, followed by Staphylococcus epidermidis (26%; 174,050), S. hominis (6.5%; 43,501) and S. capitis (3.9%; 25,773). Unspeciated CoNS increased by 8.2% (95% CI, 7.1-9.3) annually between 2010 and 2016, then decreased annually by 6.4% (95% CI: -4.8 to -7.9) until 2021. Speciated CoNS increased by 47.6% (95% CI, 44.5-50.9) annually between 2010 and 2016 and increased annually by 8.9% (95% CI: 5.1 to 12.8) until 2021. Antimicrobial susceptibility profiles differed by species. Conclusions Reports of CoNS from normally sterile body sites in patients in England increased between 2010 and 2016 and remained stable between 2017 and 2021. There has been a striking improvement in species-level identification of CoNS in recent years. Monitoring trends in CoNS epidemiology is crucial for development of observational and clinical intervention studies on individual species.
B. trematum Bacteraemia Secondary to an Empyema in an Immunocompromised Host: A Case Report and Review of the Literature.
Authors: Wong Crystal S L , Calungsud Lynna Grace , La My-Van
Published: March 2023

Introduction:
Bordetella trematum infection remains uncommon. More cases of bacteraemia are reported in recent years with the primary infection largely originating from skin and soft tissue sites. Yet, our understanding of its virulence, antibiotic susceptibility profile and treatment is still limited. 
Case presentation:
We report the first case of B. trematum bacteraemia from a left-sided empyema. An 87-year old lady with a past medical history of ischemic heart disease, diabetes mellitus complicated by nephropathy and locally advanced left breast adenocarcinoma presented with fever, productive cough and shortness of breath. The B. trematum isolates from blood and pleural fluid were identified by MALDI-TOF and 16S rRNA sequencing. Ceftriaxone and azithromycin commenced empirically on admission were switched to piperacillin-tazobactam after 2 days due to lack of clinical improvement. Despite a pleurocentesis and one week of piperacillin-tazobactam with microbiological clearance in blood, she continued to deteriorate. Decision to withdraw treatment was made in view of her prognosis, and she succumbed on the 14th day of admission. The isolate was susceptible to piperacillin-tazobactam, imipenem and meropenem but had reduced susceptibility or was non-susceptible to cefuroxime, cefotaxime, ceftazidime, cefepime, the aminoglycosides and fluoroquinolones.
Conclusion:
Invasive B. trematum infection is associated with significant mortality. Consensus for antibiotic treatment remains unclear, with limited susceptibility data to support specific antibiotic use. We expect more clinical cases will surface with improved microbial identification systems, as well as enhanced clinical awareness. Standardised and more robust susceptibility work are needed to provide clear recommendations and establish consensus in treating invasive infections.
Stenotrophomonas maltophilianatural history and evolution in the airways of adults with cystic fibrosis
Authors: Izydorczyk Conrad , Waddell Barbara J. , Thornton Christina S. , Conly John M. , Rabin Harvey R. , Somayaji Ranjani , Surette Michael G. , Church Deirdre L. , Parkins Michael D.
Published: March 2023

Stenotrophomonas maltophiliais an opportunistic pathogen infecting person with cystic fibrosis (pwCF) and portends a worse prognosis. Studies ofS. maltophiliainfection dynamics have been limited by cohort size and follow-up. We investigated the natural history, transmission potential, and evolution ofS. maltophiliain a large Canadian cohort of pwCF over a thirty-seven year period.S. maltophiliawas recovered at least once in 25.5% of the cohort. Yearly isolates from 74 pwCF (23%) were typed by pulsed-field gel electrophoresis, and shared pulsotypes underwent whole-genome sequencing. Most pwCF were infected by unique strains, but serial infections with different strains, and strains shared between patients, were observed. In chronic carriage, longer time periods between positive collection dates increased the likelihood that subsequent isolates were unrelated. Isolates from individual pwCF were largely clonal, with genetic diversity driven by gene content differences. Disproportionate progression of CF lung disease was not observed amongst those infected with multiple strains over time (versus a single) or amongst those with shared clones (versus strains only infecting one patient). We did not observe evidence of patient-to-patient transmission despite relatedness between isolates. Instead, genomic analyses suggested common, indirect sources as their origins. Sixteen multi-mutated genes were identified as having a potential role in adaptation ofS. maltophiliato CF, including in a regulator of an efflux pump and in an iron acquisition gene cluster. The information derived from a genomics-based understanding of the natural history ofS. maltophiliainfection within CF provides unique insight into its potential for in-host evolution.

IMPORTANCE

In this largest and longest single center study ofS. maltophiliacausing infections in persons with cystic fibrosis, we concluded that patient-to-patient infection transmission had not occurred. We determined that infection by a newS. maltophiliastrain was more likely the longer the time between its recovery in sputum, suggesting infection by individual strains is generally short-lived. Amongst bacterial isolates belonging to the same clonal complex, isolates could be better differentiated by their gene content than mutations, suggesting gene gain/loss may contribute more to the genetic diversity of these strains than mutation. Infection by multiple strains, or a shared strain found in at least one other person, was not associated with progression to end-stage lung disease.