bluuebunny/crossref_metadata_2025 huggingface dataset:
Modernisation of will-making formalities requires a fulsome embrace of technology
Authors: Johnson Mark
Published: December 2024

Reform to enable electronic wills in England and Wales is on the horizon as the Law Commission reviews responses to its supplementary consultation with a view to reporting in early 2025. This article considers will-making in England and Wales and the potential impact of Wills Act 1837 formalities as a drag on the propensity for will-making. The article advocates a whole adoption of technology to enable electronic wills, supported by an electronic wills registry, to increase the accessibility and propensity of will-making. Methods for electronic signatures, asynchronous witnessing, and electronic storage are evaluated together with a comparison to nascent electronic will regimes in the US and Australia.
Description of tissue profiles, thalamic location, and recommended penetrating captive bolt placement in cadaver heads from domesticated 24- to 48-mo-old male yaks (Bos grunnians)
Authors: Hamilton Emma M , Vogel Kurt D , Kirk Ashlynn A , Rossi Michael , Anderson Karly N
Published: December 2024

Yaks are a domesticated species utilized for meat, fiber, and transportation in many countries. In the United States, yak meat is growing in popularity due to its classification as a “healthy” meat. Penetrating captive bolt (PCB) is an approved method of preslaughter stunning and euthanasia for cattle. At the time of our study, peer-reviewed literature or industry guidelines for PCB stunning or euthanasia did not appear to exist for yaks. This study aimed to identify and describe an ideal placement based on the location of the thalamus, part of the brain that is important for sensibility, and to describe the tissue depths at this placement. To do this, 10 hide-on cadaver heads from yaks were sourced from a population of 30 yaks aged 24 to 48 mo, which had a mean hot carcass weight of 180.1 ± 52.0 kg (±SD). Source animals were stunned in a frontal location with a handheld PCB during normal slaughter procedures at the collaborating slaughter establishment. Cadaver heads were stored in a walk-in freezer for 96 d before head processing. Head weight, total head length, horn tip spread, and horn base circumference were measured. Heads were split down the midline using a band saw. Heads were imaged and tissue thicknesses of the exposed surface of each head were measured. Thalamic depth and measurements to describe the location of the thalamus relative to external head anatomy were recorded from these images. Results are reported as mean ± SD. On average, the total length of the head from the poll to the nose was 37.74 ± 2.83 cm. The center of the thalamus was located 11.86 ± 1.32 cm below the poll: 23.88 ± 1.56% down the frontal plane of the head. The exposed diameter of the thalamus on the frontal plane of the head was 3.43 ± 0.31%. Thus, an ideal PCB placement for yaks is located approximately 25% of the way down the frontal plane of the face of the animal. Tissue depth measurements are reported as mean ± SD followed by a 97.5% one-sided upper reference limit (URL). Soft tissue thickness was 16.03 ± 3.26 mm (URL: 23.77 mm), cranial thickness was 30.69 ± 4.34 mm (URL: 40.97 mm), and total tissue thickness was 46.71 ± 7.15 mm (URL: 63.68 mm). Thalamic depth was 92.22 ± 11.60 mm (URL: 119.74 mm). These results show that an ideal PCB placement for yaks is located at 23.88 ± 1.56% of the distance from the poll to the nose down the frontal plane of the head and a penetration depth of 92.22 ± 11.60 mm is required to reach the thalamus.
A New Mobility Field and Gradient-Based Traffic Signal Control Approach Applicable to Large-Scale Road Networks
Authors: Yang Hu , Guo Bao , Yan Changxin , Chen Zhiqiang , Wang Pu
Published: December 2024

Previous traffic control models were usually developed on small or medium size road networks. The traffic control models applicable to large-scale road networks have received growing interest. In this study, we develop a new mobility field and gradient-based traffic signal control approach applicable to large road networks. First, we introduce an emerging analytical technique, the mobility field approach, to generate the mobility field of urban travels and measure the gradients of the mobility field. Next, a gradient-based approach is proposed to identify the signalized intersections for implementing traffic control. Finally, a gradient-based traffic control model is developed to alleviate traffic congestion during mass events. A new solution algorithm, termed as DBSCAN-FW-GA, is proposed to solve the developed traffic control model. The developed mobility field and gradient-based traffic signal control approach is validated using actual road network data and travel demand data. Results indicate that the proposed new traffic control approach can reduce 17.97% more travel time compared with the widely used perimeter control approach.
A meta-analysis highlights the idiosyncratic nature of tradeoffs in laboratory models of virus evolution
Authors: Kabengele Ketty , Turner Wendy C , Turner Paul E , Ogbunugafor C. Brandon
Published: December 2024

Different theoretical frameworks have been invoked to guide the study of virus evolution. Three of the more prominent ones are (i) the evolution of virulence, (ii) life history theory, and (iii) the generalism–specialism dichotomy. All involve purported tradeoffs between traits that define the evolvability and constraint of virus-associated phenotypes. However, as popular as these frameworks are, there is a surprising paucity of direct laboratory tests of the frameworks that support their utility as broadly applicable theoretical pillars that can guide our understanding of disease evolution. In this study, we conduct a meta-analysis of direct experimental evidence for these three frameworks across several widely studied virus–host systems: plant viruses, fungal viruses, animal viruses, and bacteriophages. We extracted 60 datasets from 28 studies and found a range of relationships between traits in different analysis categories (e.g., frameworks, virus–host systems). Our work demonstrates that direct evidence for relationships between traits is highly idiosyncratic and specific to the host–virus system and theoretical framework. Consequently, scientists researching viral pathogens from different taxonomic groups might reconsider their allegiance to these canons as the basis for expectation, explanation, or prediction. Future efforts could benefit from consistent definitions, and from developing frameworks that are compatible with the evidence and apply to particular biological and ecological contexts.
Unveiling hidden Bathynellidae (Crustacea: Bathynellacea) diversity in Australia: an integrated study reveals remarkable diversity and a new subfamily from Queensland
Authors: Perina Giulia , Camacho Ana I , White Nicole E , Morgan Liesel , Lawrie Angus , Floeckner Stephanie , Guzik Michelle T
Published: December 2024

Awareness of pressures on subterranean habitats and their associated groundwater-dependent ecosystems has increased recently. Subterranean fauna provide critical services and can act as bioindicators; however, a significant portion of this diversity is unknown. The family Bathynellidae are neglected taxa of tiny subterranean crustaceans, with only 112 species described in 36 genera and three subfamilies worldwide. Their conservative morphology, small size, and delicate exoskeleton make their dissection, observation, and study very difficult. However, in recent years, molecular tools have been used to support morphology and reconstruct phylogenies to analyse the relationships among taxa and understand their origins. In this paper, using molecular and morphological data, we recognize 37–41 new Bathynellidae putative species from Australia, including a new genus and species (Queenslandbathynella gen. nov. spinosa sp. nov.), here described, belonging to a new subfamily (Queenslandbathynellinae subfam. nov.), expanding the morphological knowledge of the family. We present a multigene phylogeny inclusive of many described and undescribed taxa from Australia and worldwide, with four genes (cytochrome c oxidase subunit I and 16S, 28S, and 18S ribosomal RNA), that supports the erection of a new genus and subfamily, which provides a new molecular framework for Bathynellidae.
Inflammatory mediator contributes to leptin resistance and obesity in craniopharyngioma
Authors: Xiao Youchao , Wu Wentao , Liu Fangzheng , Jin Lu , Jia Yanfei , Qiao Ning , Cai Kefan , Ru Siming , Cao Lei , Gui Songbai
Published: December 2024

Obesity presents a significant challenge in managing patients with craniopharyngioma (CP). Cyst fluid (CF), rich in inflammatory mediators, is implicated in CP‐related obesity, though the precise mechanism remains unclear. This study investigated the impact of CF or C‐X‐C motif chemokine ligand‐1 (CXCL1) injections on body weight, Lee index, plasma lipid profiles, hepatic lipid accumulation, leptin levels, NF‐κB pathway, the suppressor of cytokine signaling 3 (SOCS3) expression, and leptin sensitivity in rats. Bioinformatics was employed to identify differentially expressed genes (DEGs) between CF/CXCL1‐treated and control SY5Y cells, as well as to confirm enriched pathways. Western blotting was used for experimental validation, including the effects of sodium salicylate (SS) on leptin sensitivity in SY5Y cells. Injecting CF or CXCL1 into the brain, without hypothalamic damage, led to increased body weight, Lee index, and hepatic lipid accumulation in rats, alongside elevated fasting blood glucose, triglycerides, and total cholesterol, while high‐density lipoprotein cholesterol levels decreased. Additionally, CF and CXCL1 could induce elevated leptin levels, a higher leptin‐to‐body weight ratio, and resistance to exogenous leptin by activating the NF‐κB pathway and upregulating the expression of SOCS3 in rats. Further validation confirmed that CF and CXCL1 suppress leptin signaling by activating the NF‐κB pathway and upregulating SOCS3. Moreover, SS mitigated the inhibitory effects of CF or CXCL1 on leptin signaling, preserving leptin sensitivity in SY5Y cells. These results highlight the obesogenic role of CF and CXCL1, offering insights into the development of morbid obesity through inflammatory factor‐mediated leptin resistance, independent of hypothalamic damage. SS may serve as a promising therapeutic approach for CP‐associated obesity, though additional clinical studies are necessary to confirm its efficacy.
Anesthesia Quality Improvement: Current State and Future Opportunities
Authors: Tung Avery , Dutton Richard P.
Published: December 2024

Continuous improvement of quality and safety is a professional obligation of anesthesiologists and an ongoing activity of all academic departments and private practices. Quality improvement is an infinite process that is never fully complete but that instead evolves over time in response to emerging threats to patient safety from new medications, new surgical procedures, and increased recognition of systematic threats. This review discusses current definitions and thinking in anesthesia quality improvement, outlines recommended efforts at the local department level, and makes suggestions for the projects and activities most likely to benefit the anesthesia patients and clinicians of the future.
Epidemiology of myositis
Authors: Duremala Fnu , Tiniakou Eleni , Andrews James
Published: December 2024

Purpose of review

This review aims to synthesize recent developments in the epidemiology of idiopathic inflammatory myopathies (IIMs), focusing on incidence, prevalence, disease classification, and clinical outcomes.

Recent findings

IIM is a rare group of autoimmune diseases characterized by muscle weakness and systemic involvement, with incidence rates ranging from 0.2 to 2 cases per 100 000 person-years. The role of myositis-specific autoantibodies (MSAs) in stratifying disease risk and prognosis is increasingly recognized, such as in anti-MDA5 positive DM, which is associated with a high risk of rapidly progressive interstitial lung disease. Furthermore, patients with IIM exhibit elevated risks of comorbidities, including cardiovascular disease and malignancy.

IIM diseases are complex disorders with significant health impacts, necessitating enhanced awareness and research. Improved classification and understanding of MSAs are crucial for earlier diagnosis and tailored therapeutic strategies. Continued epidemiological research is essential to elucidate underlying mechanisms and inform future interventions, ultimately aiming to enhance the quality of life and clinical outcomes for affected patients.
Can We Predict 30-day Readmission Following Hip Fracture?
Authors: Pettit Christopher J. , Herbosa Carolyn F. , Ganta Abhishek , Rivero Steven , Tejwani Nirmal , Leucht Philipp , Konda Sanjit R. , Egol Kenneth A.
Published: December 2024

OBJECTIVES:

To determine the most common reason for 30-day readmission following hospitalization for hip fractures.

METHODS:

Design: A retrospective review.

Setting:

Single academic medical center that includes a Level 1 Trauma Center.

Patient Selection Criteria:

Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients that died during their initial admission were excluded.

Outcome Measures and Comparisons:

Patient demographics, hospital quality measures, outcomes and readmission within 30-days following discharge for each patient were reviewed. 30-day readmission reason was recorded and correlation analysis was performed.

RESULTS:

A total of 3,032 patients were identified with a mean age of 82.1 years and 70.5% of patients being female. The 30-day readmission cohort was 2.6 years older (p<0.001) and 8.8% more male patients (p=0.027), had 0.5 higher CCI (p<0.001), 0.3 higher ASA class (p<0.001) and were 9.2% less independent at the time of admission (p= 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared to closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, p<0.001). Those readmitted by 30-days developed more major (16.7% vs. 8.0%) (p<0.001) and minor (50.5% vs. 36.4%) (p<0.001) complications during their initial hospitalization and had a 1.5 day longer LOS during their first admission (p<0.001). Those discharged home were less likely to be readmitted within 30-days (20.7% vs. 27.6%, (p=0.008). Multivariate regression revealed increasing ASA class (O.R. 1.47, p=0.002) and pre-injury ambulatory status (O.R. 1.42, p=0.007) were most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, COPD exacerbation and pneumonia.

CONCLUSION:

Thirty-day readmission following hip fracture was associated with older, sicker patients with decreased pre-injury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission following hip fracture was pulmonary complications.

LEVEL OF EVIDENCE:

Prognostic Level III
Bartonella quintana Endocarditis Associated With Head Lice in a Canadian Indigenous Youth
Authors: Petel Dara , Power Alyssa , Tadros Manal , Waters Valerie
Published: December 2024

Bartonella quintana is a rare but important cause of culture-negative endocarditis, classically associated with body lice infestation. We report the first known pediatric case of Bartonella quintana endocarditis associated with head lice. The importance of sending targeted testing for this organism in at-risk patients, ideally on tissue specimens, is emphasized.
Insular Infraorbital Neurovascular Pedicle Labial Salivary Gland Transplantation for Severe Dry Eye: Anatomy Study and Case Report
Authors: Zuo Er-Dong , Zhou Jing , Lu Han , Li Yue , Wang Ying-Hui , Jin Yong-Gang , Jie Ying , Chen Xiao-Hong
Published: December 2024

Background:

Severe dry eyes often require surgical intervention. Submandibular salivary and minor salivary gland transplantation are options for refractory dry eyes but have limitations. We innovatively designed an insular infraorbital neurovascular pedicle labial salivary gland transplantation (IINPLSGT) and validated its feasibility and safety through anatomical studies.

Methods:

An anatomical study was conducted on 13 red-colored latex arterial-perfused cadavers (24 sides). Two specimens (4 sides) simulated IINPLSGT. We recorded the branching patterns and courses of the infraorbital artery, infraorbital nerve, and angular artery, as well as the distribution of nerves, vessels, and salivary glands in the upper lip. Infraorbital artery and angular artery were anatomically classified. The feasibility of the IINPLSGT was validated. Otolaryngologists and ophthalmologists performed IINPLSGT, transferring the labial mucosal flap to the lower eyelid conjunctival fornix to treat severe dry eye in 1 patient.

Results:

Infraorbital artery exhibited 5 potential branches, classified into 5 types based on developmental patterns. Angular artery was classified into 3 types based on the courses. Patient symptoms significantly improved postoperatively, with Schirmer I increasing from 0 mm to 6 mm, noninvasive breakup time from 0 seconds to 6 seconds, and SPEED (Standard Patient Evaluation of Eye Dryness questionnaire) score decreasing from 10.5 to 3 in the OD 1 year after surgery. No severe complications were observed.

Conclusion:

IINPLSGT is a safe and feasible method for treating severe dry eyes. The procedure is simple, with a high postoperative gland survival rate, stable secretion, and minimal complications.
Tibial Spine Fractures
Authors: Perkins Crystal A.
Published: December 2024

Tibial spine fractures (TSFs) are a relatively uncommon knee injury that most commonly occurs in skeletally immature pediatric patients following a sports or bicycle-related injury. Treatment of TSFs is guided based on fracture displacement on radiographs and associated injuries. Surgical treatment is recommended for displaced TSFs with arthroscopic or open reduction and fixation. Arthroscopic reduction and suture fixation can be utilized for all tibial spine fractures, regardless of comminution, and allows for treatment of both the TSF and concomitant meniscal and/or chondral injuries. Stable fixation and early motion are important to minimize the risk of arthrofibrosis.
Radionuclide treatments of cancer: molecular mechanisms, biological responses, histopathological changes, and role of PET imaging
Authors: Sarikaya Ismet
Published: December 2024

Radiation treatments [radiotherapy and radionuclide treatments (RNTs)] are one of the main and effective treatment modalities of cancer. Globally, the number of cancer patients treated with radionuclides are much less as compared to number of radiotherapy cases but with the development of new radiotracers, most notably 177Lu and 225Ac-labeled prostate-specific membrane antigen ligands, and 223Ra-dichloride for prostate cancer and 177Lu-somatostatin analogs for neuroendocrine tumors, there is a significant rise in RNTs in the last decade. As therapeutic applications of nuclear medicine is on the rise, the aim of this review is to summarize biological responses to radiation treatments and molecular mechanisms of radiation-induced cell death (e.g. ionization, DNA damages such as double-strand breaks, DNA repair mechanisms, types of cell deaths such as apoptosis, necrosis, and immunogenic cell death), histopathological changes with radiation treatments, and role of PET imaging in RNTs as part of radionuclide theranostics for selecting and planning patients for RNTs, dosimetry, predicting and assessing response to RNTs, predicting toxicities, and other possible PET findings which may be seen after RNTs such as activation of immune system.
Efficacy of Auricular Acupressure Combined With Positive Psychological Techniques on Sleep Quality in Cancer Patients Undergoing Radiotherapy
Authors: Bi Liuna , Gao Wenjuan , Zhang Qian , Li Na , Zhang Xian , Han Jing
Published: December 2024

Background

Auricular acupressure (AA) and positive psychological intervention (PPI) are promising sleep improvement methods.

Objective

To assess and compare the efficacies of combined intervention (CI [AA + PPI]), AA, and PPI in sleep quality enhancement and their potential effects in alleviating negative psychological states in radiotherapy-treated patients with cancer.

Methods

This study was a 4-arm, placebo-controlled randomized trial. We randomly assigned 120 eligible patients into 4 groups (30 patients per group). The main outcomes included subjective sleep quality, psychological distress, and fear of cancer recurrence, which were measured at baseline, immediate postintervention, and 4 weeks postintervention. Objective sleep quality was measured using Fitbit Charge 3 at baseline and immediate postintervention. The intervention effects were estimated using the linear mixed model.

Results

The 4 groups demonstrated significant differences in subjective sleep quality (P < .001), psychological distress (P = .004), and fear of cancer recurrence (P < .001). CI, AA, and PPI had different degrees of positive effects on subjective sleep quality compared with sham control; CI was more effective than AA and PPI, whereas AA was more effective than PPI. CI and PPI showed significant and comparable effects on psychological distress and fear of cancer recurrence reduction. Only CI and AA significantly improved the objective sleep quality.

Conclusions

CI, AA, and PPI are recommended as complementary therapies to improve the sleep quality of patients with cancer.

Implications for Practice

In future clinical practice, healthcare workers should assess patients’ sleep quality and psychological status and select appropriate interventions.
Effects of Diabetes and Attentional Focus on Learning of a Novel Balance Task
Authors: Lee Szu-Ping , Shih Hui-Ting , Wu Fu-Lien , Armagnac Rebeca , Lee Yinny , Letkiewicz Alicia , Mamauag Mieko , Hooyman Andrew , Winstein Carolee
Published: December 2024

Background and Purpose:

Chronic diabetes is a prevalent systemic disease that impairs neuromotor functioning and often leads to increased risk of falls. Adopting an external focus of attention during motor skill practice has been shown to improve learning outcomes; however, it has not been examined in this population. We examined how attentional focus instructions (internal vs external) affect balance performance and learning in older adults with and without diabetes.

Methods:

Fifty-three older adults (27 with diabetes, 63.7 ± 7.0 years) participated in the randomized, pre-post intervention study. The balance training involved 50 practice trials of a stabilometer task that was novel to all participants. Participants were randomized to receive either internal or external focus task instruction. Task performance was assessed at baseline, during training, and during a retention test. Primary outcomes were changes in balance task performance before and after training.

Results:

Participants who received external focus instruction showed a significantly greater increase in balance performance than individuals who received internal focus instruction (95% confidence interval, 0.02-4.05; P = 0.048). While participants with diabetes exhibited poorer baseline task performance (P = 0.02), both groups improved their relative task performance after training (95% confidence interval, 5.25-18.14; P < 0.0001).

Discussion and Conclusions:

Adopting an external focus of attention benefits performance during short-term training of a novel balance task in older adults with and without diabetes. Participants with diabetes were capable of learning the challenging balance task with practice, at a relative rate similar to those without diabetes. This information may be useful for designing interventional strategies to improve physical function and mitigate fall risks in older adults with diabetes.
How a Dream Led Me to Psychoanalysis
Authors: Plakun Eric M.
Published: December 2024

This column addresses the role of dreams in psychoanalysis and psychodynamic therapy. It includes an autobiographical perspective on how a dream led this psychiatrist to become a psychoanalyst and an introduction to social dreaming.
Misdiagnosis of Primary Eating Disorder in an Individual With Major Depressive Disorder and Comorbid Catatonic Syndrome
Authors: Howard Adam , Robbins-Welty Gregg , Schindler Nicole J. , Kincaid Brian , Komisar Jonathan
Published: December 2024

Catatonia is a neuropsychiatric syndrome affecting movement, emotion, speech, and behavior, which commonly occurs secondary to medical or psychiatric disorders and with comorbid illnesses. We report the case of an 18-year-old male with a history of depression, anxiety, attention-deficit/hyperactivity disorder, polysubstance use, and previous suicide attempts who presented to the hospital from a residential eating disorders treatment facility, due to psychomotor slowing. The patient scored 3 or lower on the Bush-Francis Catatonia Rating Scale (BFCRS), but he showed marked improvement following 2 mg of intravenous lorazepam. The patient was referred for ECT, experienced dramatic improvement, and was discharged at his baseline functioning. His discharge diagnosis was catatonic syndrome secondary to severe melancholic depression. Catatonia may present a diagnostic challenge as no single catatonia screener captures all possible phenotypes. The patient consistently scored low on the BFCRS but he had a clear response to standard-of-care catatonia treatment. Psychomotor slowing is common in catatonia but is not designated as a catatonic feature in either the DSM-5 or the BFCRS. This case also presented diagnostic complexity as the patient initially presented with malnutrition and concern about a possible eating disorder. This report highlights that diagnosing catatonia is challenging, particularly in the context of medical complexity, and that there are discrepancies between diagnostic tools. When suspicion of catatonia is high, despite low individual screening scores, clinicians may consider alternative screening instruments or empiric treatment.
Imaging Yield, Surgical Findings, and Outcomes Following Surgical Excision of Lateral Brow Dermoid Cysts
Authors: Gates-Tanzer Lauren , Pazelli Alexandre Meira , Wang Leda , Cofer Shelagh , Davis Dawn M R , Lehman Julia , Bradley Elizabeth , Mardini Samir , Gibreel Waleed
Published: December 2024

Purpose:

To review cases of lateral brow dermoid cysts and gain insight into the utility of preoperative imaging, incidence of intraorbital extension, and recurrence rate.

Methods:

This is a retrospective study of all patients who underwent excision of lateral brow dermoid cysts at the authors' academic center over a 37-year period.

Results:

A total of 136 patients were included. The median age at presentation was 5.6 months [interquartile range (IQR) 3–16.5], and the median age at removal was 1.5 years (IQR 0.9–3.4). Preoperative imaging was performed in 44 patients. Intraorbital communication was predicted in 4 patients who underwent imaging and confirmed in 6 patients (4.4%) intraoperatively. Superficial dermoids were the most common depth (n=79, 58.1%), followed by periosteal (n=37, 27.2%) and intraosseous (n=14, 10.3%). Two patients (1.4%) presented with postoperative hematoma that required surgical evacuation. Recurrence was seen in 2 patients (1.4%). Among those who completed a follow-up, the median follow-up time was 1 month (IQR 0.44–5.8 months).

Conclusion:

The authors' study revealed that the majority of lateral brow dermoid cysts are either superficial or involve the periosteum, with orbital involvement being rare. None of our patients demonstrated intracranial communication. Imaging did not seem to add clinical value in patients for whom there was no clinical suspicion for the involvement of the deeper tissues, so careful consideration of ordering preoperative imaging would help decrease health care costs and avoid radiation exposure, which is particularly concerning for pediatric patients. The recurrence rate of lateral brow dermoid cyst seems to be low but studies with longer follow-ups are needed.
Assessing Diversity, Equity and Inclusion Statements of Urogynecology Fellowships
Authors: Jenkins Nicole , Cao Qilin , Vurture Gregory , Smilen Scott W.
Published: December 2024

Importance

The Accreditation Council for Graduate Medical Education (ACGME) has aimed to increase diversity among the physician workforce. Prospective applicants utilize websites to identify programs that share a commitment to equity and inclusion. Published statements of Diversity, Equity, and Inclusion (DEI) demonstrate a fellowship program’s recognition of the importance of improving diversity in health care and medical education.

Objective

The aim of the study was to assess the utilization of DEI statements published on urogynecology and reconstructive pelvic surgery (URPS) fellowship program websites.

Study Design

All ACGME accredited URPS fellowship websites in July 2023 were reviewed for presence of a DEI statement as a primary outcome. Website content was then compared across geographical regions (Northeast, Mid-Atlantic, Midwest, South, and West).

Results

Seventy-two URPS programs had a dedicated website for review. Nine (12.5%) URPS programs had a published diversity statement. There were no statistical differences in the presence of a statement in URPS fellowships based on core-surgical speciality or geographic region.

Conclusions

A majority of URPS programs lack a DEI statement (87.5%) demonstrating an area for improvement. With an increasingly diverse patient population, the recruitment of a diverse pool of physician applicants is more crucial than ever. By advocating for transparency, URPS fellowship programs can foster an environment that nurtures a physician workforce better equipped to provide culturally inclusive health care.
Role of Minimally Invasive Reoperation for Postoperatively Diagnosed T2 Gallbladder Cancer: Multicenter Retrospective Cohort Study
Authors: Park Yeshong , Choi Sae Byeol , Lee Boram , Han Ho-Seong , Jeong Chi-Young , Kang Chang Moo , Hwang Dae Wook , Kim Wan-Joon , Yoon Yoo-Seok
Published: December 2024

BACKGROUND:

Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC.

STUDY DESIGN:

Patients who underwent open (110) and laparoscopic (38) reoperation for T2 GBC between November 2004 and October 2022 at 5 tertiary referral centers were included in this multicenter retrospective cohort study. The short- and long-term outcomes were compared between the 2 groups.

RESULTS:

There were no differences in clinicopathologic characteristics between the open and laparoscopic groups. Liver resection was more frequent in the open group (101 [91.8%] vs 21 [55.3%], p < 0.001). Compared with open operation, laparoscopic reoperation was associated with shorter postoperative hospital stay (9.0 [8.0 to 10.0] vs 6.0 [3.8 to 8.3] days, p < 0.001) and a lower postoperative complication rate (24 [21.8%] vs 1 [2.6%], p = 0.013). Among patients who underwent liver resection, the postoperative hospital stay was shorter in the laparoscopic group (9.0 [8.0 to 10.0] vs 6.0 [4.0 to 9.0] days, p = 0.004). The 5-year disease-free survival (66.7% vs 76.1%, p = 0.749) and overall survival (75.2% vs 73.7%, p = 0.789) rates were not significantly different between the 2 groups.

CONCLUSIONS:

The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open operation.
Conservation implications of dietary strategies in the critically endangered Acacia gazelle (Gazella arabica acacia)
Authors: Lavie Noa , Levinson Yael , Rothman Jessica M , Hawlena Dror
Published: December 2024

Animals consume different foods in specific quantities and ratios to meet a multi-dimensional nutrient target that maximizes their fitness. Attempts to reach this target in an ever-changing nutritional landscape often influence animal foraging behavior, habitat choice, and food-web interactions. Consequently, understanding the nutritional ecology of a species is instrumental in developing efficient management plans for its conservation. We quantified the dietary considerations of a critically endangered population of Acacia gazelles (Gazella arabica acacia) in Southern Arava, Israel, and compared their diet and nutrition to that of the sympatric Dorcas gazelle (Gazella dorcas), using behavioral observations coupled by nutritional and secondary metabolite quantification, and morphological measurements of trees. Acacia gazelles mainly consumed resources from two umbrella-thorn acacia (Vachellia tortilis) subspecies that differed in morphology, nutritional composition, and phenology. Gazelles maintained a rather narrow nutritional intake target year-round despite the dynamic dietary landscape, tightly regulated their protein intake, and prioritized consumption of non-structural carbohydrates. They did so by adjusting the consumption of leaves, pods, and flowers, following the differential phenology of the twoVachelliatrees. The sympatric Dorcas gazelles generally avoided the thornyVachelliasubspecies and consumed more halophytic shrubs and less tree foliage than Acacia gazelles. Despite these dietary differences, the two gazelle species converged to a similar intake target. We conclude that suitable habitats for Acacia gazelle reintroduction must include sympatric populations of the twoV. tortilissubspecies, that nutritional deficiency is unlikely to play a major role in explaining the slow rate of population recovery, and that attempts to limit Dorcas gazelle's population size may be redundant due to the seemingly low competition between the two gazelle species.
A subset of human choroid plexus epithelial cells exhibit mitochondrial eccentricity and distinct expression of the pigmentation-associated enzyme TYRP1
Authors: Groh Adam M.R. , Premachandran Shobina , Creeggan Finn , Yaqubi Moein , Zandee Stephanie , Prat Alexandre , Antel Jack P. , Moore G.R. Wayne , Stratton Jo Anne
Published: December 2024

For decades, ultrastructural evaluation of epithelial cells in diverse organ systems has demonstrated the existence of two subtypes identified by stark differences in cytoplasmic electron density – so-called light and dark epithelial cells. Choroid plexus (CP) epithelial cells are key regulators of CSF homeostasis and are one of many specialized epithelial linings that exhibit this bimodal phenotype. Despite longstanding acknowledgement, it has been difficult to assess the potential significance of adult human light and dark CP epithelial cells due to a lack of characterization beyond electron microscopy (EM). We present the first transcriptomic analysis of adult human CP epithelial cells and denote the existence of four epithelial subpopulations, one of which is defined by elevated expression ofTYRP1– a melanocyte-associated tyrosine-related protein involved in cellular pigmentation and proliferation.TYRP1-high cells also downregulate genes related to cilia function (which is consistent with observations of dark cell identity in organoids) and upregulate genes associated with pathways related to cell cycling, stress, and iron regulation. Our data provide an explanation of the molecular underpinning of adult human light and dark cell identity and serve as a resource for investigations of epithelial heterogeneity in the CP and other organs where dark cells are found.
DRUGSYNC: Prediction of Synergistic Drug Combinations Using GCN Graph Convolutional Network based and Pre-learned Drug-induced Gene Expression Profiles
Authors: Zhao Longfei , Luo Jie
Published: December 2024

Drug-drug synergy (DDS) is crucial for identifying novel and effective drug combinations. With the accumulation of experimental data (DrugCombDB) and the uprising of deep learning approaches, many efforts have been made to computationally predict effective drug pairs. However, most models had limited success, with the highest ROC AUC of 0.65 for predicting pairs of unseen drugs. Drug-induced gene expressions profiles (DGEP) from datasets like LINCS L1000 offer a robust proxy to describe drug effects. However, overlap between DrugCombDB and experimental DGEP data is sparse only ∼2%. To address these limitations, we propose the DRUGSYNC (DrugResponse andUtilization forGraph-basedSYNergyClassification) prediction framework that leverages pre-learned drug-target interaction (DTI) and pre-learned DGEP as features. Graph Convolutional Network (GCN) was used to represent the inherent network of genetic interactions. Our pre-learned DGEP achieved 0.877 Pearson correlation coefficients (PCC). Furthermore, our framework excels by integrating pre-learned DGEP and DTI of paired drugs for DDS prediction, achieving superior performance over benchmark technologies. Notably, it demonstrates exceptional accuracy in predicting interactions between unseen drugs, with an ROC AUC score of 0.854. The analysis further emphasized the importance of accurate DGEP predictions. This method can be extended to any cell lines.
A six-plex digital PCR assay for monitoring respiratory viruses in wastewater
Authors: Pitton Melissa , McLeod Rachel E. , Caduff Lea , Dauletova Ayazhan , de Korne-Elenbaas Jolinda , Gan Charles , Hablützel Camille , Holschneider Aurélie , Kang Seju , Loustalot Guy , Schmidhalter Patrick , Schneider Linda , Wettlauffer Anna , Yordanova Daniela , Julian Timothy R. , Ort Christoph
Published: December 2024

Wastewater-based surveillance systems can track trends in multiple pathogens simultaneously by leveraging efficient, streamlined laboratory processing. In Switzerland, wastewater surveillance is conducted for fourteen locations representing 2.3 million people, or 26% of the national population, with simultaneous surveillance of four respiratory pathogens. Trends in respiratory diseases are tracked using a novel, six-plex digital PCR assay targeting Influenza A, Influenza B, Respiratory Syncytial Virus, and SARS-CoV-2 N1 and N2 genes, as well as Murine Hepatitis Virus for recovery efficiency control. The multiplex assay was developed to ensure sensitivity and accurate quantification for all targets simultaneously. Wastewater data is also integrated with disease data obtained through both a mandatory disease reporting system and the Swiss Sentinel System (Sentinella), a voluntary reporting system for general practitioners. Comparisons between wastewater data and case data from July 2023 through July 2024 demonstrate a high level of agreement, specifically for Influenza A, SARS-CoV-2, and Respiratory Syncytial Virus. Lower correspondence is observed for Influenza B, which highlights challenges in tracking disease dynamics during seasons without pronounced outbreak periods. Wastewater monitoring further revealed that targeting the N1 or N2 gene led to divergent estimates of SARS-Cov-2 viral loads, highlighting the impact of mutations in the target region of the assay on tracking trends. The study emphasizes the importance of an integrated wastewater monitoring program as a complementary tool for public health surveillance by demonstrating clear concordance with clinical data for respiratory pathogens beyond SARS-CoV-2.
Empirical evidence that diversionary feeding increases productivity in ground-nesting birds
Authors: Bamber Jack A. , Kortland Kenny , Sutherland Chris , Lambin Xavier
Published: December 2024

The recovery of predator populations can negatively impact other species of conservation concern, leading to conservation conflicts. Evidence-based solutions are needed to resolve such conflicts without sacrificing hard-won gains for recovering species. Well-designed, large-scale field experiments provide the most rigorous evidence to justify new forms of intervention, but they are notoriously hard to implement. Further, monitoring scarce species without negative impacts is challenging, calling for indirect and non-invasive monitoring methods. Uncertainties remain about whether observational monitoring adequately reflects the true processes of interest.

Having conducted a well-designed, large-scale, diversionary feeding field experiment that reduced artificial nest depredation, we evaluated whether this translated to capercaillie productivity in the same area. Using camera traps aimed at dust baths, we non-invasively monitored capercaillie hen productivity over 3 years and in 30 1km2grid cells under a randomised control (un-fed) and treatment (fed) design. Diversionary feeding significantly increased the probability that a detected hen would have a brood. The impact of diversionary feeding did not change over the brooding season, indicating that hens without a brood had failed due to nest depredation rather than predation of chicks. The probability of detecting a hen with a brood was 0.85 (0.65-0.94) in fed locations, more than double that in unfed locations, which was 0.37 (CI 0.2-0.57). The average brood size was reduced over time, but the change did not differ between fed and unfed sites. This is in line with natural mortality occurring independently of diversionary feeding. Importantly, the increased chance of having a brood in the fed areas and the predicted brood size leads to a substantial increase in overall productivity – the expected number of chicks per hen – at the end of the sampling season. This was just 0.82 (0.35 – 1.29) chicks per hen in the unfed sites and more than double 1.90 (1.24 – 2.55) chicks in fed sites.

This study provides compelling empirical evidence that diversionary feeding positively affects productivity, offering an effective non-lethal solution to the increasingly common conservation conflict where both predator and prey are afforded protection.
Genetic risk impacts stroke mortality and pathogenesis in patients with ischemic stroke: cohort study of BioBank Japan
Authors: Shimoyama Takashi , Kamatani Yoichiro , Matsuda Koichi , Yamaguchi Hiroki , Kimura Kazumi
Published: December 2024

Background

Previous multi-ancestry genome-wide association studies (GWAS) of stroke reported 32 stroke risk loci in the MEGASTROKE study. Most studies on the genetic risk score (GRS) of stroke have reported a predominance in the European general population. We aimed to explore the association among GRS, clinical characteristics, and mortality in patients with ischemic stroke registered in the BioBank Japan (BBJ) database.

Methods

This is a cohort study of BBJ participants. The project participants were recruited between June 2003 and March 2018. We conducted a GWAS for stroke in 19,702 Japanese patients with ischemic stroke (controls, n=159,610). GRS was generated using 29 stroke risk single nucleotide polymorphisms (SNPs) from 32 stroke-related loci identified in the MEGASTROKE. A multivariate logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for comorbidities and stroke etiology across the GRS. The Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% CIs for mortality associated with GRS.

Results

The ORs for atrial fibrillation were significantly higher in those at Intermediate GRS [20–80thpercentile of GRS; ORs 1.59 (1.25-1.90)] and High GRS [top 20thpercentile of GRS; ORs 2.12 (1.69-2.67)] after a full adjustment than in those at Low GRS (bottom 20thpercentile of GRS). Regarding stroke etiology, the ORs for cardioembolism were significantly higher in those at Intermediate GRS [ORs 1.31 (1.04-1.61)] and High GRS [ORs 1.44 (1.13-1.89)] than in those at Low GRS. During a median follow-up of 10.0 years, the risk of stroke mortality was significantly higher in those at High GRS [HRs 1.27 (1.04-1.56)] than in those at Low GRS in a fully adjusted model.

Conclusions

In Japanese, a higher GRS was significantly associated with atrial fibrillation, cardioembolism, and stroke mortality. Our findings suggest that the GRS may predict the risk of stroke mortality and provide insights into the pathogenesis of stroke.
Early Life Predictors of Obesity and Hypertension Comorbidity at Midlife: Findings from the 1958 National Child Development Study (NCDS)
Authors: Stannard S , Owen RK , Berrington A , Ziauddeen N , Fraser SDS , Paranjothy S , Hoyle RB , Alwan N A
Published: December 2024

Background

Early life exposures can increase the risk of both obesity and hypertension in adulthood. In this paper we identify exposures across five pre-hypothesised childhood domains, explore them as predictors of obesity and hypertension comorbidity using the 1958 National Child Development Study (NCDS), and discuss these results in comparison to a similar approach using another birth cohort (the 1970 British Cohort Study (BCS70)).

Methods

The analytical sample included 9150 participants. The outcome was obesity (BMI of ≥30) and hypertension (blood pressure>140/90mm Hg) comorbidity at age 44. Domains included: ‘prenatal, antenatal, neonatal and birth’, ‘developmental attributes and behaviour’, ‘child education and academic ability’, ‘socioeconomic factors’ and ‘parental and family environment’. Stepwise backward elimination selected variables for inclusion for each domain, and predicted risk scores of obesity-hypertension for each cohort member within each domain were calculated. We performed multivariable logistic regression analysis including domain-specific risk scores, sex and ethnicity to assess how well the outcome could be predicted taking all domains into account. In additional analysis we included potential adult factors.

Results

Including all domain-specific risk scores, sex, and ethnicity in the same prediction model the area under the curve was 0.70 (95%CI 0.67-0.72). The strongest domain predictor for obesity-hypertension comorbidity was for the socioeconomic factors domain (OR 1.28 95%CI 1.18-1.38), similar to the BCS70 results. However, the parental and family environment domain was not a significant predictor for obesity-hypertension comorbidity (OR 1.08 95%CI 0.94-1.24) unlike the BCS70 results. After considering adult predictors, robust associations remained to the socioeconomic, education and academic abilities, development and behaviour, and prenatal, antenatal, neonatal and birth domains.

Conclusions

In the NCDS some early life course domains were found to be significant predictors of obesity-hypertension comorbidity, supporting previous findings. Shared early-life characteristics could have a role in predicting obesity-hypertension comorbidity, particularly for those who faced socioeconomic disadvantage.
A stretchable and biomimetic polyurethane membrane for lung alveolarin vitromodelling
Authors: Mitta Emmanouela , Gilmore Andrew P. , Malliri Angeliki , Cartmell Sarah H.
Published: December 2024

The lung alveolus constitutes a morphologically and mechanistically complex tissue that is constantly subjected to cyclic tension and exhibits unique elastic properties. Available materials used to mimic alveolar tissue often lack biomimicry and the mechanical properties required for cyclic tension. Here, we report a fully synthetic fibrous polyurethane scaffold that approximates tissue stiffness, is elastic under breathing simulations and supports long-term culture of alveolar epithelial-like cells. Using electrospinning a fibrous membrane of tuneable thickness, set fibre diameter and small pore size is prepared. When subjected to cyclic uniaxial tension the material retains its elasticity at both low and high frequency mimicking human and mouse breathing. Thanks to the small pore size, lung alveolar cells can be cultured on its apical surface forming an epithelial monolayer. This monolayer can be maintained long term (at least 15 days) and in an air-liquid interface. In the latter conditions, cells differentiate and exhibit expression of surfactant protein A, a constituent of the surfactant layer that plays a key role in lung physiology. Owing to its lung-mimicking characteristics, the electrospun membrane holds the potential to be adapted for breathing lung models.