bluuebunny/crossref_metadata_2025 huggingface dataset:
A new simplified risk assessment model enhances postoperative prophylaxis of venous thromboembolism in Chinese adult patients with inguinal hernia (CHAT-3): a prospective, multicenter, randomized controlled trial
Authors: Gu Zhi-Chun , Dai Meng-Fei , Hu Meng , Yan Yi-Dan , Lin Hou-Wen , Zhang Li , Zhang Zi-Chao , Liu Chang , Ning Ning , Zhang Hui , Zhang Nan , Che Yan , Li Jian-Wen , Wang Ming-Gang , Liu Yu-Chen ,   and for the CHAT-3 investigators
Published: June 2024

Background:

Venous thromboembolism (VTE) significantly affects the prognosis of surgical patients with inguinal hernia. The complex Caprini score, commonly used for postoperative VTE risk assessment, poses practical challenges for surgeons in clinical settings.

Methods:

The CHAT-3 trial, a prospective, multicenter, randomized controlled trial, compared a simple three-factor model to assess VTE risk against routine practices in postinguinal hernia surgery (IHS) patients. The patients were randomly assigned (1:1) to the intervention or control arm. The intervention group used the three-factor model to identify patients at moderate or high risk of VTE for subsequent prophylaxis according to clinical guidelines. Both groups were followed for 4 weeks, with randomization implemented using computer-generated sequences. The primary outcome measured was the rate of VTE prophylaxis. Secondary outcomes included time spent on VTE risk assessment (surgeon self-reported), postoperative D-dimer trends, perioperative VTE occurrence, bleeding events, and the net clinical benefit.

Results:

Of the 1109 participants, 508 in the experimental group and 601 in the control group completed follow-up. The three-factor model showed higher VTE prophylaxis rates in all patients (pharmacologic prophylaxis: 26.2 vs. 6.00%, P<0.001) and particularly in those at high risk (pharmacologic prophylaxis: 57.3 vs. 9.50%, P<0.001). The experimental group significantly reduced VTE risk assessment time compared to the Caprini score (1.39±0.55 min vs. 5.73±1.35 min, P<0.001). The experimental group had lower D-dimer levels (0.26±0.73 mg/l vs. 0.35±0.55 mg/l, P=0.028). In the experimental group, the patients did not experience an increased risk of VTE (0 vs. 1.66%, P=0.268) and bleeding (1.18 vs. 0.67%, P=0.558) compared to the controls. There was no significant difference in net clinical benefit, which combined VTE and bleeding events, between the experimental and control groups (1.18 vs. 0.83%, P=0.559).

Conclusion:

Applying the simple three-factor model in perioperative VTE management could quickly identify the patient with a high risk of VTE and improve the prophylaxis rate of perioperative VTE.
Predicting Self-Reported Social Risk in Medically Complex Adults Using Electronic Health Data
Authors: Grant Richard W. , McCloskey Jodi K. , Uratsu Connie S. , Ranatunga Dilrini , Ralston James D. , Bayliss Elizabeth A. , Sofrygin Oleg
Published: June 2024

Background:

Social barriers to health care, such as food insecurity, financial distress, and housing instability, may impede effective clinical management for individuals with chronic illness. Systematic strategies are needed to more efficiently identify at-risk individuals who may benefit from proactive outreach by health care systems for screening and referral to available social resources.

Objective:

To create a predictive model to identify a higher likelihood of food insecurity, financial distress, and/or housing instability among adults with multiple chronic medical conditions.

Research Design and Subjects:

We developed and validated a predictive model in adults with 2 or more chronic conditions who were receiving care within Kaiser Permanente Northern California (KPNC) between January 2017 and February 2020. The model was developed to predict the likelihood of a “yes” response to any of 3 validated self-reported survey questions related to current concerns about food insecurity, financial distress, and/or housing instability. External model validation was conducted in a separate cohort of adult non-Medicaid KPNC members aged 35–85 who completed a survey administered to a random sample of health plan members between April and June 2021 (n = 2820).

Measures:

We examined the performance of multiple model iterations by comparing areas under the receiver operating characteristic curves (AUCs). We also assessed algorithmic bias related to race/ethnicity and calculated model performance at defined risk thresholds for screening implementation.

Results:

Patients in the primary modeling cohort (n = 11,999) had a mean age of 53.8 (±19.3) years, 64.7% were women, and 63.9% were of non-White race/ethnicity. The final, simplified model with 30 predictors (including utilization, diagnosis, behavior, insurance, neighborhood, and pharmacy-based variables) had an AUC of 0.68. The model remained robust within different race/ethnic strata.

Conclusions:

Our results demonstrated that a predictive model developed using information gleaned from the medical record and from public census tract data can be used to identify patients who may benefit from proactive social needs assessment. Depending on the prevalence of social needs in the target population, different risk output thresholds could be set to optimize positive predictive value for successful outreach. This predictive model-based strategy provides a pathway for prioritizing more intensive social risk outreach and screening efforts to the patients who may be in greatest need.
Vulvar skin disease in the pediatric population
Authors: Griffith Taylor , Hunt Madeline , Marathe Kalyani
Published: June 2024

Purpose of review

Vulvar skin disease is an underrecognized pediatric condition encompassing a wide range of conditions, from isolated vulvar disease to vulvar manifestations of systemic illnesses. This review highlights the most current research discussing clinical features, risk factors, and treatments.

Recent findings

Recent studies confirm that labial adhesions resolve more quickly with estrogen treatment. Topical corticosteroids remain first-line for treatment of vulvar lichen sclerosus, and some procedural interventions are showing promising results. Latest evidence shows efficacy of biologic agents in hidradenitis suppurativa and vulvar Crohn's. Vaginal voiding remains an underrecognized cause of irritant vulvovaginitis. Lately vulvar aphthae have been associated with coronavirus disease 2019. Distinguishing between infantile perianal pyramidal protrusion, molluscum, and condyloma can be aided by differences in morphologic features.

Vulvar dermatoses have a high impact on children's health and wellbeing. Clinician familiarity with recognition and latest advancements in vulvar dermatoses can aid in prompt diagnosis, management, and appropriate referrals. Vulvar biopsy and vaginal cultures should be used prudently. Treatments include topicals, behavioral modification, systemic medications, and procedures.
Isolated Optic Nerve Relapse in a Pediatric Patient With T-Cell Lymphoblastic Leukemia: A Brief Report
Authors: Shenkar Rakefet , Kahwash Samir B. , Rodriguez Diana P. , Abu Arja Rolla , Reed Suzanne M. , Rangarajan Hemalatha G.
Published: June 2024

Isolated optic nerve (ON) relapse is a rare occurrence in lymphoblastic leukemia (LBL). A 10-year-old boy with T-LBL presented 8 months after diagnosis with blurred vision and thickening of right ON on magnetic resonance imaging consistent with relapse. Cerebrospinal fluid and bone marrow were negative for leukemia. He received reinduction chemotherapy (including nelarabine and craniospinal radiation) followed by a myeloablative matched sibling donor bone marrow transplant. He remains in remission 2 years post-transplant with normal vision. We also review the literature for reports of isolated ON relapse in patients with LBL. Our patient’s clinical course demonstrates that disease control can be achieved with early detection of ON relapse before disease progression.
Mayer–Rokitansky–Küster–Hauser syndrome managed with McIndoe’s vaginoplasty: a case series and literature review
Authors: Chaudhary Aashutosh , Acharya Suyash , Dahal Amartya , Basnet Rahul , Basnet Aniket , Chaudhary Ashlesha , Basnyat Rupesh Singh , Dongol Anjana
Published: June 2024

Introduction:

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a congenital anomaly characterized by the absence of the uterus and the upper two-thirds of the vagina. It is a rare congenital anomaly with an incidence of 1 in 5000 female live births.

Case series:

The authors describe three cases of females presenting with primary amenorrhoea who were diagnosed with MRKH syndrome. The patients were managed with McIndoe’s vaginoplasty with neovagina creation with an amnion graft.

Discussion:

Management of MRKH syndrome involves vaginoplasty with neovagina creation. The approach to neovagina creation can be done surgically or non-surgically. Non-surgical creation of the vaginal cavity involves serial use of vaginal dilators, while there are several ways for surgical creation of neovagina. The modified Abbe-McIndoe procedure using amnion to create neovagina is a minimally invasive, rapid, and simple procedure with no risk of immune rejection because the amnion membrane lacks histocompatibility antigens. In addition, the graft is also readily available, storable, and inexpensive.

Conclusion:

Diagnosis of MRKH syndrome can be made when a young female with primary amenorrhoea and normal secondary sexual characteristics has agenesis of the uterus, and upper two-thirds of the vagina revealed on ultrasonography or magnetic resonance imaging. The patient can be offered treatment with vaginoplasty with neovagina creation.
Efficacy and safety of albumin for the treatment of hepatic encephalopathy: an updated systematic review and meta-analysis of randomized controlled trials
Authors: Murtaza Farhan , Mathew Midhun , Fagbamila Oluwaseun , Subramani Sachin , Nimal Simran , Nyshita Veeramachaneni Naga , Priya Vishnu , Sany Abu Talha , Kumar Yamanth , Cicani Laura , Ehsan Muhammad , Kandel Kamal
Published: June 2024

Background:

Albumin acts as a scavenger of reactive oxygen species and an inhibitor of inflammatory processes that underlie hepatic encephalopathy (HE). However, the role of albumin in hepatic encephalopathy is not well-established. The authors performed this meta-analysis to evaluate the efficacy and safety of albumin in the management of hepatic encephalopathy.

Methods:

The authors carried out an extensive search across multiple databases, including MEDLINE (via PubMed), Embase, CENTRAL, and various trial registries, to identify randomized controlled trials (RCTs) evaluating the impact of albumin administration in HE. The authors used a random-effects model for analyses and presented dichotomous outcomes and continuous outcomes as relative risk and mean difference, along with corresponding 95% CIs, respectively. Heterogeneity was assessed using both the I2 index and χ2 test.

Results:

Our meta-analysis included 4 RCTs involving 306 patients. Our primary outcomes, mortality, and persistence of HE were reported by all four studies. Albumin was found to significantly decrease mortality in patients with HE [risk ratio (RR) 0.52, 95% CI 0.32–0.83; I2
=0%]. Persistence of HE was found to be comparable between the two groups (RR 0.83, 95% CI 0.68–1.00; I2
=24%). There was no significant difference between the albumin and control groups regarding length of hospital stay (MD −1.55, 95% CI −3.5 to 0.14; I2
=41%), adverse events (RR 1.00, 95% CI 0.87–1.16; I2
=0%), and severe adverse events (RR 0.89, 95% CI 0.59–1.35).

Conclusion:

Albumin administration in patients with hepatic encephalopathy decreases mortality but does not significantly impact the persistence of HE. Further high-quality, large-scale randomized controlled trials are needed to provide conclusive evidence.
Ryzumvi: pioneering advances in countering drug-induced mydriasis
Authors: Azhar Ayesha , Riaz Rumaisa , Khan Afsheen , Kumari Varsha , Habib Ashna , Akilimali Aymar
Published: June 2024

This article discusses the prevalence and impact of pharmacologically-induced mydriasis, a condition where the pupil becomes excessively dilated due to certain drugs. It highlights the challenges faced by medical professionals in dealing with this condition and the limitations of current treatments, like pilocarpine and dapiprazole, which come with systemic side effects and specific contraindications, limiting their regular use. The article introduces Ryzumvi, a novel ophthalmic solution approved by the US FDA, which effectively reverses mydriasis caused by adrenergic agonists and antimuscarinic drugs. The article provides insights into its mechanism of action, clinical efficacy, pharmacokinetics, safety, and tolerance based on extensive clinical trials. It emphasizes its rapid onset of action and effectiveness in restoring pupils to their initial size. It also underlines the potential for expanded applications, including in pediatric patients, solidifying its importance in the field of ophthalmology. Furthermore, Ryzumvi represents a promising advancement in managing pharmacologically-induced mydriasis, offering swift and effective relief while highlighting the importance of adhering to safety precautions and the continuous research and development efforts in ophthalmology to comprehensively address vision-related disorders and enhance patient outcomes.
Statin use in total joint arthroplasty: a systematic review
Authors: Baghdadi Soroush , Babagoli Mazyar , Soleimani Mohammad , Ramezani Akam , Ghaseminejad-Raeini Amirhossein , Siavashi Babak , Sheikhvatan Mehrdad , Fallah Yousef , Shafiei Seyyed H.
Published: June 2024

Introduction:

There has been increased interest in the use of Statins in total hip and knee arthroplasty (THA and TKA) patients to improve outcomes and reduce postoperative complications. This study was performed to systematically review the evidence on Statin use in total joint arthroplasty, specifically its benefits and complications.

Methods:

Adhering to the PRISMA guidelines, a systematic review of PubMed, Embase, Scopus, Web of Science, and the Cochrane database was performed to find studies reporting on the effects of Statin use on outcomes of THA and TKA. Two authors independently selected relevant papers to include.

Results:

A total of 18 papers were included in the final analysis. Most were retrospective studies, with heterogeneous patient selection and outcome measures. The evidence on the risks and benefits of Statin use on outcomes of total joint arthroplasty was very limited and heterogeneous. Studies were focusing on perioperative cardiac outcomes, clinical outcomes and complications, renal, pulmonary, and gastrointestinal outcomes. Due to the heterogeneity of reported data, a formal meta-analysis was not possible.

Conclusions:

There is some evidence in the literature suggesting that perioperative use of Statins, especially in Statin-naïve patients, may reduce cardiac (e.g. atrial fibrillation) and noncardiac (e.g. delirium) complications, while not increasing the risk of muscle or liver toxicity. The authors also found low levels of evidence that Statin use may reduce the long-term risk for revision surgery and osteolysis.
MicroRNAs as promising biomarkers and potential therapeutic agents in breast cancer management: a comprehensive review
Authors: Mohan Lal Priyanka , Hamza Siddiqui Muhammad , Soulat Amna , Mohan Anmol , Tanush Dev , Tirath Komal , Raja Sandesh , Khuzzaim Khan Muhammad , Raja Adarsh , Chaulagain Aayush , Tejwaney Usha
Published: June 2024

Breast cancer (BC), a complex and varied ailment, poses a significant global health burden. MicroRNAs (miRNAs) have emerged as vital regulators in BC progression, with potential implications for diagnosis and treatment. This review aims to synthesize current insights into miRNA dysregulation in BC. MiRNAs, small RNA molecules, govern gene expression post-transcriptionally and are implicated in BC initiation, metastasis, and therapy resistance. Differential expression of specific miRNAs in BC tissues versus normal breast tissue sheds light on underlying molecular mechanisms. MiRNAs also offer promise as diagnostic biomarkers due to their stable nature, accessibility in bodily fluids, and altered expression patterns in early-stage disease, augmenting conventional diagnostic methods. Beyond diagnosis, miRNAs also hold promise as therapeutic targets in BC. By modulating the expression of specific dysregulated miRNAs, it may be possible to restore normal cellular functions and overcome treatment resistance. However, several challenges need to be addressed before miRNA-based therapies can be translated into clinical practice, including the development of efficient delivery systems and rigorous evaluation through preclinical and clinical trials. MiRNAs represent a promising avenue in BC research, offering potential applications in diagnosis, prognosis, and therapeutic interventions. As our understanding of miRNA biology deepens and technology advances, further research and collaborative efforts are needed to fully exploit the diagnostic and therapeutic potential of miRNAs in BC management. Ultimately, the integration of miRNA-based approaches into clinical practice may lead to more personalized and effective strategies for combating this devastating disease.
Burkitt lymphoma in a scalp region: a case report of it’s recurrence in a 13-year-old child
Authors: Baniya Aashish , Koirala Diwakar , Dahal Alok , Khadka Grishma
Published: June 2024

Introduction:

Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma characterized by chromosome 8 MYC gene translocation. It manifests in three clinical types: immunodeficiency-related, sporadic (nonendemic), and endemic (African), each differing in epidemiology and clinical behavior. Treatment typically involves enrollment in clinical trials or intensive chemotherapy regimens like R-CODOX-M/IVAC. The authors present a case of recurrent BL following treatment.

Case report:

A 13-year-old female presented with a gradually progressive swelling in the left parieto-occipital region. Examination revealed normal vital signs and a Glasgow coma scale, with seronegative findings on investigations. An excision of a subganglion soft tissue tumor was performed, revealing histopathological features suggestive of a small round blue cell tumor. After chemotherapy, the patient experienced a recurrence in the scalp region, diagnosed as BL.

Discussion:

While scarce reports exist on BL in the scalp region, cases have been documented in various body locations. Treatment strategies, including chemotherapy and surgery, have shown promising results in managing the disease and improving symptoms.

Conclusion:

The recurrence of BL is rare, highlighting the importance of vigilance in monitoring patients post-treatment. The authors report a case of recurrent BL in a 13-year-old female, emphasizing the need for continued research and surveillance in managing this aggressive malignancy.
Complex mitochondrial disease caused by the mutation of COX10 in a toddler: a case-report study
Authors: Tavasoli Azita , Kachuei Maryam , Talebi Saeed , Eghdami Shayan
Published: June 2024

Introduction and importance:

Cytochrome C oxidase (COX) deficiency is an uncommon inherited metabolic disorder. It is identified by a lack of the COX, also known as Complex IV. This enzyme plays a crucial role in the rate-limiting and oxygen-accepting step of the respiratory chain within the subcellular structures called mitochondria. The deficiency of COX can either be restricted to skeletal muscle tissues or can impact multiple tissues throughout the body.

Case presentation:

A 3-year-old girl was admitted due to muscle weakness and a decline in developmental milestones 7 days after a significant stressor. Leukodystrophy was observed in the brain magnetic resonance imaging, and genome sequencing identified a homozygous mutation in exon 1 and 7 of chromosome 17. This mutation led to a deficiency in COX10, which is a component of mitochondrial complex IV.

Clinical discussion:

In the medical field, inherited metabolic disorders can be complex to diagnose due to overlapping symptoms with other conditions. Mitochondria’s oxidative phosphorylation system, including the COX enzyme complex, plays a crucial role in energy production. Mitochondrial disorders, including COX deficiency, can present at various stages of life with diverse symptoms. Treatment options focus on supportive care and potential benefits from supplements like coenzyme-Q10 and small-molecule therapies targeting mitochondrial function. Identifying genetic mutations is key for advancing treatments in this area.

Conclusion:

This report presents a unique case of developmental regression and muscle weakness in a paediatric patient, which can be attributed to a rare occurrence of type 3 nuclear mitochondrial complex IV deficiency.
Takayasu arteritis presenting with large cerebral infarction in a 39-year-old Syrian woman: a case report
Authors: Muhammad Tareq , Hamdan Zulfiqar , Ebrahim Mohanad , Ali Basel , Hamdan Jafar
Published: June 2024

Introduction and importance:

Takayasu Arteritis (TA) is a rare chronic inflammatory disease of unknown etiology that primarily affects large vessels, such as the aorta and its major branches. The disease typically presents with diverse symptoms, depending on the site and degree of arterial lesions. Delayed diagnosis is common, especially in younger populations.

Case presentation:

A 39-year-old Syrian female presented with an initial stroke. She had no prior medical history and was otherwise healthy. On examination, she had an absent left radial pulse, a carotid bruit, and muscle weakness. Blood tests showed an elevated ESR and CRP. Computed tomography of the brain revealed a right large cerebral infarction. Multislice computed tomography angiography showed diffuse arterial wall thickening, stenosis, and occlusion of several major vessels, including the left internal carotid artery, right internal carotid artery, and left subclavian artery.

Clinical discussion:

The patient was diagnosed with TA based on the American College of Rheumatology criteria. She was treated with prednisolone, methotrexate, and aspirin, and her symptoms improved significantly.

Conclusion:

This case highlights the importance of considering TA in the differential diagnosis of ischemic stroke, especially in young patients with atypical presentations. Early identification and management are essential to preclude critical sequelae.
Innovative techniques in the treatment of penile strangulation: a case report
Authors: Gazzah Wael , Mzoughi Mahdy , Lahouar Rayen , Najjai Yassine , Naouar Sahbi , Salem Braiek
Published: June 2024

Introduction and importance:

Penile strangulation is a medical emergency characterized by the encirclement of the penis by an external object, resulting in circulatory compromise.

Case presentation:

A 35-year-old male presented with penile pain and urinary obstruction due to the inability to remove the ring. Upon examination, the ring was firmly lodged at the base of the penis, causing significant swelling and discoloration in the distal region.

Interventions and outcomes:

Initial attempts to cut the ring using standard tools were unsuccessful, leading to the engagement of a rescue team equipped with an air cutter. The cutting procedure, complicated by the ring’s thickness and hardness and the significant edema, took ~90 min. Safety measures, including the use of a surgical brain spatula and forceps, were employed to protect the penile skin from damage during the operation.

Relevance and impact:

This case underscores the necessity for timely intervention in penile strangulation cases and highlights the effectiveness of collaboration with specialized rescue teams equipped with appropriate cutting tools. It also emphasizes the importance of safety considerations when employing nonmedical devices in medical emergencies. The patient experienced a favorable outcome, with significant improvement in swelling and discoloration postprocedure, and no complications during follow-up. This report contributes to the limited but crucial literature on managing penile strangulation, particularly regarding the methods and timeframes for safely removing constricting objects.
Evaluating postoperative outcome assessment tools in hepato-pancreato-biliary surgery: A comparative analysis of the comprehensive complication index and Clavien–Dindo classification in a cohort of 1240 patients at a tertiary care center
Authors: Limbu Yugal , Acharya Bidur P. , Mishra Aakash , Regmee Sujan , Ghimire Roshan , Maharjan Dhiresh K. , Shrestha Suman K. , Thapa Prabin B.
Published: June 2024

Introduction:

The comprehensive complication index (CCI) has emerged as a new tool for reporting postoperative complications. The aim of this study is to evaluate and compare the efficacy of CCI and Clavien–Dindo Classification (CDC) in measuring postoperative outcomes in patients undergoing hepato-pancreato-biliary (HPB) surgery.

Materials and methods:

In this single-centered, prospective, comparative study conducted between January 2022 and March 2023, 1240 patients underwent HPB surgery, including laparoscopic cholecystectomies and complex HPB surgery. Postoperative complications were evaluated utilizing the CCI and CDC indices, and their relationships with length of ICU stay, hospital stay, and return to activity were compared.

Results:

A total of 117 patients (9.44%) experienced complications of varying grades. There was a strong correlation between CCI and CDC (r=0.982, P <0.001). Both CCI and CDC demonstrated a strong correlation with the length of hospital stay, ICU stay, and return to normal activity. While CCI showed a better correlation with the length of hospital stay (r=0.706 vs. 0.695) and return to normal activity (r=0.620 vs. 0.611) than CDC, the difference was not statistically significant.

Conclusion:

CCI exhibited a stronger correlation with the length of stay and return to activity; however, no statistically significant advantage was observed over CDC.
Novel Androgen Receptor Splice Variant 7 in Gynecologic Tumors
Authors: Wang Lucy , Vasudevaraja Varshini , Tran Ivy , Sukhadia Purvil , Reuter Victor E. , Abu-Rustum Nadeem R. , Rubinstein Maria M. , Gopalan Anuradha , Ross Dara , Snuderl Matija , Chiang Sarah
Published: June 2024

Androgen receptor splicing variant 7 (AR-V7) is a truncated variant of the AR mRNA that may be a predictive biomarker for AR-targeted therapy. AR-V7 has been described in prostate, breast, salivary duct, and hepatocellular carcinomas as well as mammary and extra-mammary Paget disease. We report 2 gynecologic cancers occurring in the lower uterine segment and ovary and both harboring AR-V7 by targeted RNA sequencing. The uterine tumor was an undifferentiated carcinoma consisting of epithelioid cells and focally spindled cells arranged in sheets, nests, and cords associated with brisk mitotic activity and tumor necrosis. The ovarian tumor consisted of glands with cribriform and solid architecture and uniform cytologic atypia. ER and PR were positive in the ovarian tumor and negative in the uterine tumor. Both were positive for AR and negative for HER2, GATA3, and NKX3.1. DNA methylation profiling showed epigenetic similarity of the AR-V7-positive gynecologic cancers to AR-V7-positive breast cancers rather than to prostate cancers. AR-V7 may underpin rare gynecologic carcinomas with undifferentiated histology or cribriform growth reminiscent of prostatic adenocarcinoma and breast invasive ductal carcinoma.
POLE-mutated Endometrial “Carcinosarcoma”
Authors: De Boeck Astrid , Nohr Erik , El-Hallani Soufiane , Ghatage Prafull , Lee Cheng Han , Köbel Martin
Published: June 2024

The molecular subtype classification of endometrial carcinomas has conceptually changed our approach to this disease. However, open questions remain about how to integrate certain histotype diagnoses with the molecular subtype. We report 2 cases with morphologic suspicion for endometrial carcinosarcoma, that still fell short of the essential criteria for diagnosing carcinosarcoma. On subsequent molecular testing pathogenic POLE mutations were detected and a descriptive diagnosis of endometrial endometrioid carcinomas, low-grade with a homologous sarcoma component was rendered. This challenges the existence of POLE-mutated “carcinosarcoma.”
Factors Affecting the Choice to Forgo Nipple Grafts in Gender-Affirming Chest Surgery
Authors: Ferrin Peter C. , Pua Ezra , Isbester Kelsey , Peters Blair R.
Published: June 2024

Introduction

Some patients pursuing gender-affirming mastectomy prefer to forgo autologous nipple and areolar reconstruction, instead choosing a “no nipple” option. The objective of this study is to evaluate the motives and influences contributing to this decision.

Methods

A retrospective survey-based study of patients undergoing gender-affirming mastectomy over a 4.6-year period was conducted. All patients were offered nipple and areolar reconstruction. A survey was distributed to those who elected to forgo nipple and areolar reconstruction exploring the factors influencing that choice and postoperative satisfaction.

Results

Five hundred thirty-six patients underwent gender-affirming mastectomy and 13% chose to forgo nipple and areolar reconstruction. The survey response rate was 72%. Most respondents identified as nonbinary (48%) or transmasculine (42%). Body image, defined in the context of this study as an improvement in body image satisfaction due to achievement of a more gender-congruent appearance, was the most highly cited and most heavily weighted decision-making factor. Concerns about nipple graft outcomes were frequently cited as important but carried less weight. There were no differences between transmasculine and nonbinary patients in terms of motivations for choosing this surgical option. Fifty-eight percent of respondents pursued or planned to pursue chest tattoos, whereas 42% preferred no further chest modifications. Patient satisfaction was high postoperatively (98%), and 82% of respondents would choose to forgo nipple and areolar reconstruction again even if surgical outcomes of free nipple grafts were improved.

Conclusions

Gender-affirming mastectomy without nipple and areolar reconstruction was requested by 13% of patients presenting for gender-affirming chest surgery over the study period and had high postoperative satisfaction among patients who chose this option. This modification of gender-affirming mastectomy is a variation that surgical teams should be aware of. Many reasons to forgo nipple preservation were cited, most of which related to body image. Secondary factors were easier recovery and/or concern about outcomes of free nipple grafts. Many patients wished information about this surgical option was more widely available.
Ethical Challenges for Plastic Surgery in Treating Internationally Adopted Children With Cleft Lip and Palate
Authors: Sahlsten Schölin Johnna , Hansson Emma , Rizell Sara , Lindberg Jenny , Sandman Lars
Published: June 2024

A large number of children with cleft lip and palate (CLP) were adopted to Sweden in the last decade, mainly from China. Most of the children arrived with unoperated palates and at later ages than earlier years. This article aims to present an overview of ethical challenges within the practice of international adoption of children with CLP from the perspective of plastic surgery in a welfare health care system. An overview of CLP treatment is presented, followed by a normative discussion and ethical analysis using the 4 principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. The following themes and subthemes were analyzed: the search for normality and the potential challenge of being adopted and having CLP—treatment autonomy of the child and future preferences, adoptive parents’ expectations of plastic surgery, the journey of the adoptee and the adoptive parents; and general issues—reconstructive possibilities and consequences of CLP in the country of origin, information to the adoptive parents, health care needs, and reconstructive possibilities for children with CLP in the receiving country. Clinical implications are discussed, and suggestions for future research are provided.
Comparison of eGFR Equations to Guide Dosing of Medications for Kidney Transplant Recipients
Authors: Akbari Ayub , El Wadia Hajar , Knoll Greg A. , White Christine A. , Sood Manish M. , Massicotte-Azarniouch David , McCudden Christopher , Deschenes Marie-Josee , Salman Maria , Ramsay Tim , Hundemer Gregory L.
Published: June 2024

Background.

Clinicians caring for kidney transplant recipients (KTRs) most commonly use estimated glomerular filtration rate (eGFR) to guide medication dosing as it is the most readily available measure of kidney function. Which eGFR equations provide the most accurate medication dosing guidance for KTRs remains uncertain.

Methods.

We studied 415 stable KTRs in Canada and New Zealand. Participants completed same-day measurements of creatinine and cystatin C and measured GFR (diethylenetriaminepentaacetic acid). Chronic Kidney Disease Epidemiology Collaboration, European Kidney Function Consortium, and transplant-specific eGFR equations were compared with both Cockcroft-Gault creatinine clearance (CrCl) and measured GFR. eGFR equations were assessed both indexed to a standardized body surface area (BSA) of 1.73 m2 (milliliter per minute per 1.73 m2, as is conventional reporting from most clinical laboratories) and nonindexed (milliliter per minute) accounting for actual BSA. The primary outcome was the proportion of medication dosing discordance relative to Cockcroft-Gault CrCl or measured GFR for 8 commonly prescribed medications. Stratified analyses were performed on the basis of obesity status.

Results.

Nonindexed eGFR equations (milliliter per minute) resulted in substantially lower medication dosing discordance compared with indexed eGFR equations (milliliter per minute per 1.73 m2). These findings were most pronounced among KTRs with obesity, in whom underdosing was frequent. When compared with Cockcroft-Gault CrCl, the lowest proportion of discordance was found with the nonindexed 2023 transplant-specific equation. When compared with measured GFR, the lowest proportion of discordance was found with the nonindexed 2021 Chronic Kidney Disease Epidemiology CollaborationCr/CysC equation.

Conclusions.

Nonindexed eGFR values accounting for actual BSA should be used by clinicians for medication dosing in KTRs. These findings may inform KT providers about which eGFR equations provide the safest, most accurate medication dosing guidance for KTRs.
A protein kinase A-regulated centrosomal actin pool sets the threshold for T cell polarization
Authors: Simao Morgane , Régnier Fabienne , Randriamampita Clotilde
Published: June 2024

T lymphocyte migration triggered by chemokine stimulation is preceded by cell polarization. The acquisition of this asymmetry requires a profound cell rearrangement, particularly of the cytoskeleton. The mechanism by which a uniform signal triggered by chemokine receptors rapidly leads to this asymmetry is largely elusive. Using cell imaging, we emphasize that the centrosome dictates the position of the polarization axis in T lymphocytes. Mechanistically, we highlight that the T cell shape is controlled by the amount of actin filaments surrounding the centrosome. In resting conditions as well as after chemokine stimulation, the activity of a specific pool of protein kinase A regulates this cytoskeleton compartment. Once the centrosomal actin is reduced below a certain threshold, the symmetry breaking is catalyzed. This study points to a critical protein kinase A signaling pathway in the establishment of the immune response.
A microcontroller-based approach to control oxygen and establish flexible acclimation regimes
Authors: Mucha Stefan
Published: June 2024

Environmental control systems are important tools for experimental researchers studying animal-environment interactions. Commercial systems for measurement and regulation of environmental oxygen conditions are relatively expensive and can not always be adapted to varying experimental applications. Here, we present a low-cost and highly flexible oxygen control system using Arduino microcontrollers in combination with a commercial optical oxygen sensor. We show dissolved oxygen (DO) measurements from three experiments that were conducted with mormyrid fish with different DO regimes: 1) acute challenge with defined rates of DO change from normoxia (> 90% air saturation) to hypoxia (10% air saturation), 2) acute stepwise hypoxia in a shuttle-box setup, and 3) long-term hypoxia (15 % air saturation) that was maintained for eight weeks in the home tank of the fish. Overall, the microcontroller-based DO control systems produced the desired experimental conditions with a high and inter-trial correlation (Pearson’s R ≥ 0.987) and sufficient precision, except for the shuttle-box setup, where the lowest DO step of 10% air saturation could not be reached.
Engineered bacteria that self-assemble “bioglass” polysilicate coatings display enhanced light focusing
Authors: Sidor Lynn M. , Beaulieu Michelle M. , Rasskazov Ilia , Acarturk B. Cansu , Ren Jie , Kamoen Lycka , Vitali María Vázquez , Carney P. Scott , Schmidt Greg R. , Srubar Wil V. , Abbondanzieri Elio A. , Meyer Anne S.
Published: June 2024

Photonic devices are cutting-edge optical materials that produce narrow, intense beams of light, but their synthesis typically requires toxic, complex methodology. Here we employ a synthetic biology approach to produce environmentally-friendly, living microlenses with tunable structural properties. We engineeredEscherichia colibacteria to display the silica biomineralization enzyme silicatein from aquatic sea sponges. Our silicatein-expressing bacteria can self-assemble a shell of polysilicate “bioglass” around themselves. Remarkably, the polysilicate-encapsulated bacteria can focus light into intense nanojets that are nearly an order of magnitude brighter than unmodified bacteria. Polysilicate-encapsulated bacteria are metabolically active for up to four months, potentially allowing them to sense and respond to stimuli over time. Our data demonstrate that engineered bacterial particles have the potential to revolutionize the development of multiple optical and photonic technologies.

Significance Statement

In this work, we apply the principles of synthetic biology to create living optical devices. Utilizing the ability of sea sponges to polymerize bioglass from silica precursors in the ocean water using only a single enzyme, silicatein, we have fused this same enzyme to the surface ofEscherichia colibacterial cells. The modified bacteria can polymerize a layer of bioglass at their surface. This bioglass shell allows the bacteria to act as engineered optical devices that are able to scatter high intensity, focused light while also surviving for several months, opening the door to a wide range of sense-and-respond applications.

Classification

Biological Sciences, Applied Biological Sciences
TRIM32 inhibits Venezuelan Equine Encephalitis Virus Infection by targeting a late step in viral entry
Authors: Xie Yifan , Cao Jie , Gan Shuyi , Xu Lingdong , Zhang Dongjie , Qian Suhong , Xu Feng , Ding Qiang , Schoggins John W. , Fan Wenchun
Published: June 2024

Alphaviruses are mosquito borne RNA viruses that are a reemerging public health threat. Alphaviruses have a broad host range, and can cause diverse disease outcomes like arthritis, and encephalitis. The host ubiquitin proteasome system (UPS) plays critical roles in regulating cellular processes to control the infections with various viruses, including alphaviruses. Previous studies suggest alphaviruses hijack UPS for virus infection, but the molecular mechanisms remain poorly characterized. In addition, whether certain E3 ubiquitin ligases or deubiquitinases act as alphavirus restriction factors remains poorly understood. Here, we employed a cDNA expression screen to identify E3 ubiquitin ligase TRIM32 as a novel intrinsic restriction factor against alphavirus infection, including VEEV-TC83, SINV, and ONNV. Ectopic expression of TRIM32 reduces alphavirus infection, whereas depletion of TRIM32 with CRISPR-Cas9 increases infection. We demonstrate that TRIM32 inhibits alphaviruses through a mechanism that is independent of the TRIM32-STING-IFN axis. Combining reverse genetics and biochemical assays, we found that TRIM32 interferes with genome translation after membrane fusion, prior to replication of the incoming viral genome. Furthermore, our data indicate that the monoubiquitination of TRIM32 is important for its antiviral activity. Notably, we also show two TRIM32 pathogenic mutants R394H and D487N, related to Limb-girdle muscular dystrophy (LGMD), have a loss of antiviral activity against VEEV-TC83. Collectively, these results reveal that TRIM32 acts as a novel intrinsic restriction factor suppressing alphavirus infection and provides insights into the interaction between alphaviruses and the host UPS.

Author summary

Due to climate change, wildlife habitat loss, and human activities, alphavirus infections are a growing threat to public health. The host UPS has critical role in virus-host interaction, but how the UPS impact alphavirus infection is not completely understood. In this study, we found that the E3 ubiquitin ligase TRIM32 inhibits diverse alphaviruses in multiple cell types. Mechanistically, TRIM32 impairs primary translation of incoming viral genome in a manner that depends on. monoubiquitination of TRIM32. Additionally, disease-associated alleles of TRIM32 have a loss-of-function with respect to viral inhibition. Together, these findings uncover a novel biological function of TRIM32 in regulating alphavirus infection and provide important insights into the interplay between alphaviruses and the host USP.
Measurement of the
e+e−→π+π−
cross section from threshold to 1.2 GeV with the CMD-3 detector
Authors: Ignatov F. V. , Akhmetshin R. R. , Amirkhanov A. N. , Anisenkov A. V. , Aulchenko V. M. , Bashtovoy N. S. , Berkaev D. E. , Bondar A. E. , Bragin A. V. , Eidelman S. I. , Epifanov D. A. , Epshteyn L. B. , Erofeev A. L. , Fedotovich G. V. , Gorkovenko A. O. , Grancagnolo F. J. , Grebenuk A. A. , Gribanov S. S. , Grigoriev D. N. , Ivanov V. L. , Karpov S. V. , Kasaev A. S. , Kazanin V. F. , Khazin B. I. , Kirpotin A. N. , Koop I. A. , Korobov A. A. , Kozyrev A. N. , Kozyrev E. A. , Krokovny P. P. , Kuzmenko A. E. , Kuzmin A. S. , Logashenko I. B. , Lukin P. A. , Lysenko A. P. , Mikhailov K. Yu. , Obraztsov I. V. , Okhapkin V. S. , Otboev A. V. , Perevedentsev E. A. , Pestov Yu. N. , Popov A. S. , Razuvaev G. P. , Rogovsky Yu. A. , Ruban A. A. , Ryskulov N. M. , Ryzhenenkov A. E. , Semenov A. V. , Senchenko A. I. , Shatunov P. Yu. , Shatunov Yu. M. , Shebalin V. E. , Shemyakin D. N. , Shwartz B. A. , Shwartz D. B. , Sibidanov A. L. , Solodov E. P. , Talyshev A. A. , Timoshenko M. V. , Titov V. M. , Tolmachev S. S. , Vorobiov A. I. , Zemlyansky I. M. , Zhadan D. S. , Zharinov Yu. M. , Zubakin A. S. , Yudin Yu. V. ,   CMD-3 Collaboration
Published: June 2024

The cross section of the process e+e−→π+π− has been measured in the center of mass energy range from 0.32 to 1.2 GeV with the CMD-3 detector at the electron-positron collider VEPP-2000. The measurement is based on a full dataset collected below 1 GeV during three data taking seasons, corresponding to an integrated luminosity of about 62  pb−1. In the dominant ρ-resonance region, a systematic uncertainty of 0.7% has been reached. At energies around ϕ-resonance the π+π− production cross section was measured for the first time with high beam energy resolution. The forward-backward charge asymmetry in the π+π− production has also been measured. It shows a strong deviation from the theoretical prediction based on the conventional scalar quantum electrodynamics framework, and it is in good agreement with the generalized vector-meson-dominance and dispersive-based predictions. The impact of the presented results on the evaluation of the hadronic contribution to the anomalous magnetic moment of muon is discussed.

Published by the American Physical Society
2024
Flying-cat parity checks for quantum error correction
Authors: McIntyre Z. M. , Coish W. A.
Published: June 2024

Long range, multiqubit parity checks have applications in both quantum error correction and measurement-based entanglement generation. Such parity checks could be performed using qubit-state-dependent phase shifts on propagating pulses of light described by coherent states |α〉 of the electromagnetic field. We consider “flying-cat” parity checks based on an entangling operation that is quantum nondemolition for Schrödinger's cat states |α〉±|−α〉. This operation encodes parity information in the phase of maximally distinguishable coherent states |±α〉, which can be read out using a phase-sensitive measurement of the electromagnetic field. In contrast to many implementations, where single-qubit errors and measurement errors can be treated as independent, photon loss during flying-cat parity checks introduces errors on physical qubits at a rate that is anticorrelated with the probability for measurement errors. We analyze this trade-off for three-qubit parity checks, which are a requirement for universal fault-tolerant quantum computing with the subsystem surface code. We further show how a six-qubit entangled “tetrahedron” state can be prepared using these three-qubit parity checks. The tetrahedron state can be used as a resource for controlled quantum teleportation of a two-qubit state or as a source of shared randomness with potential applications in three-party quantum key distribution. Finally, we provide conditions for performing high-quality flying-cat parity checks in a state-of-the-art circuit QED architecture, accounting for qubit decoherence, internal cavity losses, and finite-duration pulses, in addition to transmission losses.

Published by the American Physical Society
2024
Public perceived efficacy of emergency infrastructure project: antecedents in a triadic reciprocal determinism
Authors: Cui Caiyun , Xie Tingyu , Liu Yong , Liu Meng , Cao Huan , Li Huilian
Published: June 2024

Purpose

This paper aims to explore the influencing factors of public perceived efficacy of emergency infrastructure projects based on the triadic interactive determinism, and analyze the relationship among these factors.

Design/methodology/approach

Based on the triadic interactive determinism, we explored the factors influencing public perceived efficacy of emergency infrastructure project and empirically verified the relationship among these factors and perceived efficacy by using data drawn from a questionnaire survey of 491 residents near Leishenshan Hospital, Jiangxia District, Wuhan, China.

Findings

Prior experience, emotional response, personal expectation, public trust, context message and interactivity level, namely behavior, individual and environment, affect the perceived efficacy of public emergency infrastructure projects.

Practical implications

The results offer an insight into public perceived efficacy of emergency infrastructure project from the perspective of antecedents in a triadic reciprocal determinism, which provides a reference basis for the sustainable development of the emergency infrastructure projects. This study also suggests valuable practical implications to government departments to improve the quality of administrative decision-making effectively.

Originality/value

Although existing studies have found some influencing factors of public perceived efficacy in general infrastructure, there is still a lack of systematic carding and quantitative description of influencing factors of public perceived efficacy of emergency infrastructure projects. This study bridges this gap by exploring the determinants and their influencing relationship of public perceived efficacy especially for emergency infrastructure projects.