bluuebunny/crossref_metadata_2025 huggingface dataset:
IBC Oxford University Oral Abstract 24 - Comparison of the surgical experience between robotic OAGB/MGB/BAGUA as a primary surgery procedure versus sleeve gastrectomy conversion to robotic OAGB/MGB/BAGUA in a tertiary level hospital in Mexico City, Mexico
Authors: Gaytan Fuentes O F , Gaytan Fuentes I A , Barajas Galicia E , Barba Mendoza J A , Ceron Castillo R , Terriquez Rodríguez S , Ortíz Fernández M
Published: February 2025

Introduction

Bariatric surgery is the most effective treatment for obesity and its comorbidities. Nowadays, the robotic approach is the preferred method for superobesity and revisional surgery, mitigating the technical difﬁculty, improving the prognosis and diminishing the length of hospital stay. The objective of this study is to document our surgical experience with Robotic Bariatric Surgery and the One Anastomosis Gastric Bypass technique //MiniGastric Bypass // Bypass Gastrico de Una Sola Anastomosis (OAGB/MGB/BAGUA). The objectives of the statistical analysis were: 1.- To know the patient's demographic proﬁle in both groups. 2.- To know the prevalence of present comorbidities. 3.- To compare the operative times of both groups: primary surgery versus revisional surgery. 4.- Apply a Linear Regression Analysis in order to know the trend for operative times according to BMI as a predictor variable. Twenty-three patients were included.

Methods

Seventeen patients underwent Robotic OAGB/MGB/BAGUA as a primary surgery (Group 1) and six patients underwent revisional surgery or conversion from Sleeve Gastrectomy to Robotic OAGB/MGB/BAGUA (Group 2).

Results

Table 1. Demographic Profile. (Upload File) Table 2. Comorbidities Profile in Both Groups. (Upload File) Table 3. Operative Times. (Upload File) COMPLICATIONS No complication 22 patients (95.7%) Complications: 1 (4.3%) patient; c.i. (95%): 0.11% to 21.94% Comparative statistical analysis was carried out, based on non-parametric tests: *Mann-Whitney U Test—Kolmogorov-Smirnov Test for the three surgical times: Docking, Console and Total Time in Group 1 and Group 2. In the three comparisons made, the statistical tests applied showed the levels of statistical signiﬁcance: Docking and Console in Group 1 versus Docking Group 2, P = 0.420727 and P > 0.10; Total Time in Group 1 versus Console in Group 2, P = 0.325552 and P > 0.10 respectively.

According to the operative times, there was no statistically significant difference between groups. The correlation between operative times and the body mass index (BMI) was studied with Linear Regression Analysis, considering BMI as a predictor variable and operative times as predicted variable. Both all three times, and groups were studied. We found a trend to decrease in surgical times, meanwhile, an increase in BMI was observed in this analysis.

Conclusion

We highlight in this summary the Total Time with a decrease index of 1 min/BMI Unit (weight/m2). The analysis of variance showed that the presence of comorbidities had no inﬂuence on surgical times.
IBC Oxford University Oral Abstract 29 - Totally robotic approach to primary metabolic surgery ameliorates postoperative bleeding
Authors: Smith D , Buffington C , Lopez C , Krzyzanowski S , Santos C
Published: February 2025

Introduction

Postoperative bleeding is the most common major postoperative complication following metabolic bariatric surgery (MBS). The primary objective of the present study was to examine the incidence of postoperative bleeding among patients whose MBS procedure was performed totally robotic (ROB) and compare these rates to surgeries performed with conventional laparoscopy. Secondary endpoints of the study were peri-operative and early (30-d) postoperative surgical outcomes with the totally ROB versus laparoscopic (LAP) approach.

Methods

The study was a retrospective analysis of 809 (498 ROB, 311 LAP) primary surgeries performed by a single surgeon between 1/20–11/23, that is 351 Roux-en-Y gastric bypass (RYGB), 393 sleeve gastrectomy (SG), 65 duodenal switch (DS). All patients were under identical postoperative care and discharge protocols, and there were no significant differences in characteristics (age, BMI, total number of co-existing health issues) between patients who had a ROB or LAP approach. Outcome measures included: 1) incidence of major postoperative bleeding, 2) length of hospital stay (LOS), 3) operative (op) time, and 4) early (30-d) postoperative major complications, readmissions, and reoperations.

Results

Among surgeries performed laparoscopic, 71% of major complications were postoperative bleeds. Of these, 60% required reoperation and 30% endoscopic intervention. The incidence rate for major bleeding following surgeries performed laparoscopic averaged 2.3% for all primary procedures and 3.4%, 2.5%, and 5.6% for RYGB, SG, and DS, respectively. Conversely, with the ROB system, postoperative bleeding was rare. No postoperative bleeding occurred among patients having a ROB SG or DS and only 1 bleed occurred with the RYGB, a patient with multiple co-existing health issues and numerous adhesions prolonging surgery. Other surgical outcomes were also significantly improved with the ROB approach over conventional laparoscopy. For patients having a SG or RYGB, op times were significantly (P < 0.0001) lower when surgeries were performed ROB versus LAP. Length of hospital stay was also significantly (P < 0.0001) shorter following ROB procedures, i.e., all surgeries LOS = 1.18 d ROB versus 2.37 d LAP; RYGB = 1.19 d ROB versus 1.39 d LAP; SG = 1.14 d ROB versus 1.25 d LAP; DS = 1.25 ROB versus 1.58 d LAP. Readmission rates (30-d) were significantly less when surgeries were performed robotic (3.4% ROB versus 6.7% LAP), as were major complications (all surgeries = 1.2% ROB versus 4.0% LAP; RYGB = 1.7% ROB versus 5.1% LAP; SG = 0.85% ROB versus 3.2% LAP).

Conclusions

For primary MBS, the totally robotic approach results in highly significant reduction of postoperative bleeding, along with a decreased incidence of 30-d major complications, reops, readmissions and lower duration of surgery and length of hospital stay.
IBC Oxford University Oral Abstract 41 - Efficacy and safety of laparoscopic conversion of failed vertical banded gastroplasty (VBG) to laparoscopic minigastric bypass (LMGB)
Authors: Amer Y
Published: February 2025

Background/Introduction

Obesity has become one of the most important health issues in developing and developed countries, with dramatic increase over the last decades. Morbid obesity is associated with serious comorbidities, such as type 2 diabetes, hypertension, arthritis, and sleep apnea, which cause an estimated 6 to 12 times greater mortality rate than the normal populations. Bariatric surgery is the only method for sustained weight loss in morbid obesity. However, 10–25% of patients will require re-operation for unsatisfactory weight loss or weight regain after restrictive surgery. Re-operation is associated with higher morbidity and mortality.

Objectives

The objective of the current study is to evaluate the safety and efficacy of laparoscopic mini-gastric bypass (LMGB) as convention surgery for failed vertical banded gastroplasty (VBG).

Methods

From February 2021 to November2023, 43 consecutive patients underwent LMGB for failed VBG. Average age was 32.4 years (range 21 to 49) and average BMI before re-operation was 42.6 kg/m2. There were 18 male and 25 female patients. All the patients underwent complete preoperative work-up, including blood chemistry, endocrine status, abdominal ultrasound, upper gastrointestinal barium studies, and gastroendoscopy. Visits to a psychiatrist and dietician were arranged, and explanations for a clear understanding of the benefits, risks, and long-term consequences of a malabsorptive procedure were done. The LMGBs were essentially the same as described by Rutledge technique. All patients received a quality-of-life questionnaire evaluation at their preoperative and postoperative follow-up at 6 months using the Gastrointestinal Quality of-Life Index (GIQLI).

Results

All the re-operations were completed laparoscopically. Average operative time was 164.5 minutes (range 140 to 280). All the patients were followed regularly every 3 months, and the mean BMI at 1 year after the LMGB was 31.6 kg/m2 (P < 0.001 compared with BMI before revision). Three patients (3.9%) complained of epigastralgia and marginal ulcers were diagnosed by endoscopy. A proton-pump inhibitor was prescribed, and all the ulcers healed on medical treatment

Conclusion

Based on the results of the current study, LMGB is an effective and safe revision operation for patients with failed VBG with excellent weight loss and accepted improvement in other causes of failure of VBG.
IBC Oxford University Poster Abstract 5 - Adding a preoperative dose of LMWH may decrease VTE following bariatric surgery
Authors: Abdelsalam Ahmed Mohammed , ElAnsary Ahmed Mohammed Salah Eldeen , Salman Mohammed Abdallah , Nassef Sahar Abdelrahman , Elfergany Hala Mostafa
Published: February 2025

Introduction

Bariatric procedures are the most effective management for obesity. There is no standard Venous thromboembolism (VTE) prophylaxis for both dosing and duration of anticoagulation following laparoscopic sleeve gastrectomy (LSG).

Aims

To assess the optimum regimen for VTE prophylaxis in bariatric procedures and to reduce the incidence of perioperative bleeding.

Methods

This is a prospective randomized study that involved 100 morbidly obese patients, subdivided into two groups; group A received postoperative low molecular weight heparin (LMWH) prophylaxis alone starting from day one to day 15 in dose 1 mg/kg/day in a maximum dose 120 mg/day, and group B received both pre and postoperative LMWH; at night of surgery 12 hours preoperatively and postoperative starting from day one to day 15 with the same dose. All patients underwent mesenteric and bilateral lower limbs duplex 15 days postoperative using a Philips iU machine and linear (L9-3), convex (C5-1), and sector (S5-1) probes.

Results

The purpose of this study was to evaluate if the addition of a pre-operative regimen of low molecular weight heparin to a standard post-operative regimen decreased the incidence of VTE compared to a post-operative low molecular weight heparin regimen alone.

Conclusion

Preoperative as well as a postoperative prophylactic anticoagulant as LMWH is recommended to prevent perioperative VTE. There was an insignificant increase in postoperative bleeding in patients who received preoperative prophylactic anticoagulants.
IBC Oxford University Poster Abstract 8 - Reflux after bariatric surgery, does LINX bridge the gap?
Authors: Foula M , Shomimi S
Published: February 2025

Introduction

Reflux after bariatric surgery is not uncommon and can negatively impact patients’ quality of life. Laparoscopic sleeve gastrectomy is well known to induce de-novo reflux symptoms. Barrett’s esophagitis has been widely reported after laparoscopic sleeve gastrectomy. Moreover, esophago-gastro-duodenoscopy is not routinely performed for all patient preoperatively to detect patients with silent reflux. In most cases, conversion of sleeve gastrectomy to a low-pressure procedure can solve the issue and relieve the symptoms. However, some patients still experienced these symptoms after gastric bypass. Objectives We aim to present our early experience, as a tertiary university institute, in using LINX device to manage reflux symptoms after different bariatric procedures.

Methods

It is a case series representing our early experience in preforming LINX procedure for patients with intractable reflux after different bariatric procedures.

Results

Ten cases with intractable symptomatic reflux were managed in our hospital using LINX device. Five of them had their reflux after laparoscopic sleeve gastrectomy, three cases had intractable reflux after gastric bypass and two cases after one-anastomosis gastric bypass. All cases were managed successfully using LINX device. All patients were followed up for 9–18 months with good results in terms of reflux symptoms and quality of life.

Conclusion

Reflux after bariatric surgery remains a common cause of patients’ morbidity that negatively impact their quality of life. LINX procedure can present a valid option to tackle postoperative reflux with promising results.
IBC Oxford University Poster Abstract 13 - Single anastomosis duodeno-ileal bypass with gastric plication
Authors: Andraos Y , Saliba K
Published: February 2025

Background

Gastric plications and SADI. are new procedures for which authors describe benefits, results, and complications throughout their studies for patients with high BMI.

Objectives

The aim is to demonstrate the technique we are performing (SADI—P) and to describe its standardization implemented at our bariatric unit and to evaluate safety, efficacy, as well as complications.

Methods

From May 2016 until January 2019, 118 patients underwent Single Anastomosis Duodeno-Ileal Bypass (SADI) of which 84 with primary gastric plication. The procedure was first described by Youssef Andraos M.D. FACS. (the author) and presented as a video presentation at the 24th IFSO WORLD CONGRESS 2019 (V-123). Technical steps presented consist of 1. Gastric Greater Curvature Plication (GGCP) is performed using two rows of running non-absorbable 2/0 sutures starting at the GE Junction to 4 cm from the pylorus, in multiple bites (standard steps of this procedure were presented at the Clinical Congress 2019 of the American College of Surgeons in San Francisco, CA by the author (Session Code: VE303)) 2. GGCP is calibrated over a 40 French Faucher tube. 3. SADI is performed at 3.5 meters from the ileocecal valve. 4. Terminal-lateral hand-sewn duodenal-ileal anastomosis is performed by two anterior and two posterior running absorbable 3/0 sutures. 5. Patent and leak test are performed at the end of the surgery. Data was prospectively collected and analysed.

Results

52 patients were males, mean age being 39.4 ± 11 years, mean operative time duration being 80 ± 13.2 minutes, mean pre-operative BMI. being 46.5 ± 9.75 kg/m2 (36.75 kg/m2–56.25 kg/m2), mean pre-operative weight being 134 ± 26.75 kg (107.25 kg–160.75 kg). Among the 84 patients who underwent SADI—P, there were 21 with type 2 diabetes and 20 with arterial blood hypertension. The mean excess weight loss percentages (%EWL) at 1, 3, 6, 18, 32 months were 24.4 ± 14.07%, 71.1 ± 22.8%, 84.5 ± 23.3%, 85 ± 18.4% , 88 ± 19.52% respectively with a total weight loss (TWL) 11.17 ± 1.9%, 19.65 ± 4%, 30.2 ± 8.3%, 35.2 ± 10.9%, 38.4 ± 10.2% respectively. Obesity-related comorbidities showed favourable resolution: 18 of the diabetic patients as well as 14 of the hypertensive patients became off-treatment. All patients were discharged 56 hours post-operatively. There were no deaths, transfusion, or leak. 2 cases of severe hypo-albuminemia were reversed to normal anatomy at 6 and 26 post-operatively.

Conclusion

SADI-P is a standardized, safe, and efficient procedure at our bariatric unit for high BMI. patients with severe comorbidities. Nevertheless, severe hypo-albuminemia is still an issue to be considered. Longer follow-up and deeper studies are necessary to assess the long-term effect of this procedure.
Vulnerability of fault-tolerant topological quantum error correction to quantum deviations in code space
Authors: Zhao Yuanchen , Liu Dong E
Published: February 2025

Quantum computers face significant challenges from quantum deviations or coherent noise, particularly during gate operations, which pose a complex threat to the efficacy of quantum error correction (QEC) protocols. In this study, we scrutinize the performance of the topological toric code in 2 dimension (2D) under the dual influence of stochastic noise and quantum deviations, especially during the critical phases of initial state preparation and error detection facilitated by multi-qubit entanglement gates. By mapping the protocol for multi-round error detection--from the inception of an imperfectly prepared code state via imperfect stabilizer measurements--to a statistical mechanical model characterized by a 3-dimensional ℤ2 gauge theory coupled with a 2-dimensional ℤ2 gauge theory, we establish a novel link between the error threshold and the model's phase transition point. Specifically, we find two distinct error thresholds that demarcate varying efficacies in error correction. The empirical threshold that signifies the operational success of QEC aligns with the theoretical ideal of flawless state preparation operations. Contrarily, below another finite theoretical threshold, a phenomenon absent in purely stochastic error models emerges: unidentifiable measurement errors precipitate QEC failure in scenarios with large code distances. For codes of finite or modest distance d, it is revealed that maintaining the preparation error rate beneath a crossover scale, proportional to 1/log d, allows for the suppression of logical errors. Considering that fault-tolerant quantum computation is valuable only in systems with large scale and exceptionally low logical error rates, this investigation explicitly demonstrates the serious vulnerability of fault tolerant QEC based on 2D toric codes to quantum deviations in code space, highlighting the imperative to address inherent preparation noise.
Learning Through Teaching: How Physicians Learn Medicine in Authentic Clinical Contexts
Authors: Frija-Gruman Nissim Maxim , Steinert Yvonne , Macdonald Mary Ellen , Sun Ning-Zi
Published: February 2025

Purpose

Little is known about the clinical knowledge and skills that are acquired by physicians through teaching, how such learning occurs, or the factors that influence this process. This study explored how physicians acquire clinical knowledge and skills through clinical teaching and examined the contextual elements that influence this learning.

Method

Two theoretical frameworks informed this interpretive description study: situated learning and cognitive apprenticeship. From March to November 2021, semistructured interviews and follow-up discussions were conducted at McGill University with clinician-teachers who regularly supervise internal medicine residents. Participants were asked to describe how they learned clinical medicine through spontaneous clinical teaching, guided by questions relating to what they learned, memorable teaching moments, and factors influencing this learning. Data were analyzed iteratively, using both a deductive and inductive approach.

Results

Of the 87 contacted physicians, 45 responded, expressing interest (n = 22) or declining participation (n = 23), and 42 did not respond. All 22 clinicians who responded positively were interviewed, with 7 follow-up discussions. Results suggested that clinician-teachers encountered myriad opportunities to learn clinical medicine during spontaneous interactions with trainees. These interactions, embedded in authentic patient care, were influenced by clinician-teacher characteristics, trainee characteristics, and contextual affordances. Clinician-teachers were stimulated to learn by trainee presence and through discrete interactions with trainees. These stimuli often led to feelings of “performative pressure” to role model and teach effectively or “slowing down” in thinking, prompting clinician-teachers to engage in learning processes (e.g., reflection, collaboration, and articulation), which resulted in knowledge acquisition, reinforcement, and refinement.

Conclusions

Learning through teaching is an underappreciated strategy that can help clinician-teachers improve their clinical knowledge and skills. This study uncovered some of the processes through which clinicians learn during spontaneous clinical teaching and the factors that modulate this learning.
Effect of Grifola frondosa polysaccharide on immune function and gut microbiota in mice
Authors: Lin Xiaoliang , Ma Linlin , Liang Ming , Qu Xian , Yu Yi , Zhou Yifa , Cheng Hairong
Published: February 2025

Objective:

Grifola frondosa, a medicinal mushroom, is widely used to enhance immunity and treat cancer. Polysaccharides are its primary active components. We aimed to investigate the effects of the alkaloid G. frondosa polysaccharide (GFP) extract on immunity and gut microbiota.

Methods:

Alkaloid GFP was extracted using an alkaline extraction method, followed by hollow-fiber microfiltration. The molecular weight of alkaloid GFP was determined by high-performance gel permeation chromatography (HPGPC). Monosaccharide composition was analyzed by pre-column derivatization combined with high-performance liquid chromatography (HPLC). Methylation analysis was performed to characterize glycosidic linkages in alkaloid GFP. The immune function of alkaloid GFP was assessed in a cyclophosphamide (CTX)-induced immunosuppressive mouse model. Splenic lymphocyte proliferation, macrophage phagocytic capacity, and natural killer (NK) cell cytotoxicity were evaluated. The effect of alkaloid GFP on gut microbiota was assessed by 16S rRNA sequencing.

Results:

The molecular weight distribution of alkaloid GFP ranged from 17 to 18 kDa. The alkaloid GFP contained a β-(1→6)-glucan backbone branched at O-3 by β-1,3-D-Glcp. Oral administration of alkaloid GFP mitigated the effects of CTX on spleen index, splenic lymphocyte proliferation, and peritoneal macrophage phagocytosis. Additionally, alkaloid GFP improved the gut microbiota composition of immunosuppressed mice, increasing the relative abundances of Ligilactobacillus and Lactobacillus.

Conclusions:

Alkaloid GFP demonstrated immune-enhancing effects and gut microbiota regulatory activity, providing a basis for developing related health food ingredients.

Graphical abstract: http://links.lww.com/AHM/A156.
PKA signaling-mediated inhibition of the AIM2 inflammasome is involved in the radioprotective effect of Eleutheroside E
Authors: Zhang Liangliang , Hu Changkun , Wu Zekun , Yan Ziqiao , Xiao Chengrong , Tang Xianglin , Liao Zebin , Gao Yue
Published: February 2025

Objective:

To investigate the protective effect and underlying mechanism of Eleutheroside E (EE), derived from Acanthopanax senticosus, against γ-ray radiation-induced splenic injury.

Methods:

The Cell Counting Kit-8 assay was used to determine the toxicity of the drug. Hematoxylin and eosin, terminal deoxynucleotidyl transferase dUTP nick end-labeling, and live/dead cell double staining assays were used to evaluate the protective effects of EE on the spleen. Immunofluorescence, immunohistochemical, and enzyme-linked immunosorbent (ELISA) assays were used to investigate the underlying mechanisms of EE. Cross-talk between the AIM2 inflammasome and the PKA signaling pathway was clarified using selective inhibitors.

Results:

EE reduced IR-induced splenic injury—the increased apoptosis rates and the levels of γ-H2AX and inflammatory factors in splenic cells were significantly alleviated. ELISA showed that EE reduced the level of IFN-γ, IL-1β, IL-6, IL-18, and TNF-α in irradiated tissues. The radioprotective effects of EE were mediated by inhibition of the AIM2 inflammasome and stimulation of PKA signaling, in which EE inhibited the increased levels of AIM2, ASC, and cleaved caspase-1 proteins upon ionizing radiation damage but rescued the decreased protein levels in PKA signaling. Suppression of AIM2 signaling was dependent on the activation of PKA signaling by EE treatment.

Conclusion:

EE exerts a significant radioprotective effect on the spleen in vitro and in vivo. Activation of the PKA signaling pathway leads to AIM2 inflammasome inhibition, thereby attenuating radiation-induced DNA damage. This was demonstrated to be the mechanism involved in the radioprotective effects of EE. Thus, EE can be used as a potential radioprotective drug in clinical practice.

Graphical abstract: http://links.lww.com/AHM/A157.
Exudative retinal detachment in a pediatric patient with Rubinstein-Taybi syndrome
Authors: Mendoza Sergio , Kozek Lindsay Klofas , Meng Da , Hoyek Sandra , Gonzalez Efren , Patel Nimesh A.
Published: February 2025

Purpose:

To highlight findings of retinal exudation with exudative retinal detachment in a patient with Rubinstein-Taybi syndrome (RSTS) due to CREBBP mutation, successfully treated with laser, with the goal of adding to the known phenotypic spectrum of ophthalmic manifestations of RSTS.

Methods:

A case report of a pediatric patient evaluated with multimodal imaging including fundus photography and fluorescein angiography.

Results:

A 15-year-old female with RSTS caused by a frameshift mutation in CREBBP was referred for retinal examination under anesthesia. In additional to typical features of RSTS, including developmental delay, microcephaly, and broad thumbs and toes, she had an ocular history of bilateral nasolacrimal duct obstructions and intermittent exotropia. Dilated fundus examination revealed left iris coloboma, bilateral optic nerve colobomas, and exudation of the left temporal retina with associated exudative retinal detachment and inferotemporal hemorrhage. Fluorescein angiography demonstrated leakage and avascularity of both eyes, with diffuse leakage and nonperfusion noted in the left eye. The avascular areas of the right eye were treated prophylactically with laser as well as sub-Tenon’s triamcinolone. The left retinal exudation initially improved with several rounds of laser treatment, however vitreoretinal membranes eventually developed, resulting in a focal tractional detachment requiring vitrectomy and lensectomy.

Conclusion:

Patients with RSTS have a wide spectrum of ophthalmic manifestations. Our patient demonstrated marked peripheral retinal avascularity and vascular leakage, ultimately resulting in a novel finding of sub-retinal exudation. Laser to the avascular retina led to initial regression of the exudation, however the patient ultimately developed a focal tractional detachment requiring surgery.
A series of hydroxychloroquine-associated cardiotoxicity presenting with heart failure
Authors: Nazarenko Natalia , Maliha Maisha , Parker Matthew , Borkowski Pawel , Csecs Ibolya , Tauras James M. , Julia Shin Jooyoung , Pullman James , Sims Daniel , Rochlani Yogita M.
Published: February 2025

Background:

Hydroxychloroquine (HCQ) is widely used to manage autoimmune conditions such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjogren’s syndrome. However, HCQ can cause cardiotoxicity, a dose-dependent complication linked to the accumulation of metabolites in lysosomes that alters cellular pH. HCQ-induced cardiotoxicity can lead to various cardiac abnormalities, including conduction defects, hypertrophy, and heart failure (HF). Importantly, this toxicity may be reversible with early detection and prompt discontinuation of HCQ.

Case Summary:

Three cases of SLE patients with prolonged HCQ use are presented, all of whom exhibited signs of cardiomyopathy and HF. The first case involved a 70-year-old male with a 30-year history of HCQ use, who presented with Mobitz II A-V block and other cardiac abnormalities. The second case was a 45-year-old female with a 26-year history of HCQ therapy who developed sinus tachycardia and biatrial enlargement. The third case involved a 75-year-old woman with 30 years of HCQ use, presenting with shortness of breath and pulmonary hypertension. In all cases, HCQ was discontinued, and supportive HF therapy was initiated, leading to improved ejection fraction and resolution of symptoms within months.

Discussion:

HCQ cardiotoxicity, although rare, is an important consideration in patients on long-term therapy, particularly as it is potentially reversible. The diagnosis can be challenging due to the nonspecific nature of cardiac symptoms and overlaps with other conditions. Imaging, particularly cardiac magnetic resonance imaging, plays a crucial role in early detection, while endomyocardial biopsy provides a definitive diagnosis. These cases underscore the need for clinicians to be aware of HCQ cardiotoxicity, as early intervention can improve patient outcomes.
Convenient but concerning: patients' experiences of metronomic chemotherapy in metastatic breast cancer
Authors: Larsson Karolina , Linderholm Barbro Kristina , Wärnberg Fredrik , Berbuyk Lindström Nataliya , Ekholm Maria , Liljedahl Matilda
Published: February 2025

Background:

Metronomic chemotherapy (MCT) is an available treatment option in patients with metastatic breast cancer. Since patients' perspectives concerning treatment selection may differ from those of the oncologists, increased knowledge on the patient perspective is needed to facilitate shared decision making. The aim was to explore patients' experiences of metronomic chemotherapy with capecitabine and cyclophosphamide (MCT-CX) with focus on the perceived benefits and drawbacks on everyday life.

Methods:

This is a qualitative descriptive study using individual semistructured interviews for data collection. Ten women in Sweden aged 43–83 years currently or previously treated with MCT were included. Interviews were analyzed using inductive content analysis.

Results:

In general, participants experienced MCT-CX as a convenient and easily manageable treatment with modest side effects. They emphasized that MCT-CX enabled them to live a life as close to normal as possible and valued doing so despite noncurable cancer. Participants valued the freedom of having a treatment at home. Participants raised concerns regarding the potential weaker effect of MCT-CX compared with other treatments but viewed the treatment as their lifeline that may keep them alive for just a little bit longer.

Conclusions and Interpretations:

Our results reveal an ambivalence between participants' satisfaction with the minimal intrusion of MCT-CX on everyday life and the fear of taking a potentially weak and insufficient treatment, something that needs to be addressed in future research and in patient–oncologist communication. From the patients' perspective, MCT-CX is as a feasible treatment option.
Using Computed Tomography Coronary Angiography to Differentiate Atypical Cardiac Myxoma From Thrombus
Authors: Zhang Nannan , Lan Chuanqiang , Du Zeliu , Lin Guihan , Zhong Yi , Fei Jingle , Liu Kan , Ji Jiansong , Lu Chenying
Published: February 2025

Objective:

Atypical cardiac myxoma usually presents as an isolated mass attached to the atrial septum on imaging, with no movement and a wider attachment base. It is difficult to distinguish it from cardiac thrombus through conventional echocardiography or computed tomography (CT). The purpose of this study is to evaluate the value of CT coronary angiography imaging features in distinguishing atypical cardiac myxoma from cardiac thrombus.

Materials and Methods:

This retrospective study included patients with atypical myxoma of the heart confirmed by histopathology (n = 18) and with thrombus disappearance after anticoagulation treatment (n = 23). All patients underwent a third-generation dual-source CT coronary angiography. We compared the clinical features and CT coronary angiography image characteristics of the 2 groups and used maximum-intensity projection and multiplanar reconstruction to show neovascularization of atypical cardiac myxoma.

Results:

There are significant differences in the origin, surface, and enhancement patterns between atypical cardiac myxoma and thrombus (P < 0.05, respectively). Specifically, supplied vessels were observed in the atypical cardiac myxoma group, while no neovascularization was detected in the thrombus group (83.33% vs. 0%, P < 0.001).

Conclusions:

Noninvasive CT coronary angiography can help distinguish atypical cardiac myxoma and cardiac thrombus through imaging features, especially by detecting the supplying vessels. However, supplementary examinations such as cardiac magnetic resonance imaging are still needed to identify different cardiac tumors.
Management of Zygomaticomaxillary Complex Fractures in Children
Authors: Zhang Difei , Lv Kun
Published: February 2025

Objective:

Zygomaticomaxillary complex (ZMC) fractures in children can lead to severe aesthetic and functional complications, including pronounced facial asymmetry, visual impairment, associated ophthalmic injuries. The management of ZMC fractures in pediatric patients presents unique challenges. This article verified the feasibility of using absorbable plate through intraoral approach in the reduction and fixation of ZMC fractures in children.

Methods:

The operation was performed through the intraoral maxillary sulcus incisions. The 3D printed prototype and repaired models were used intraoperatively. The tooth germs in the maxilla were revealed by fenestration on the models. Collapsed fracture segments were reduced and fixed with absorbable plates at the infraorbital margin and upper end of the zygomatic alveolar ridge.

Results:

The patient's facial appearance was restored after the surgery. The postoperative CT showed good alignment of the fracture segments. The drilling holes at the zygomatic alveolar ridge were located outside the tooth germs region.

Conclusion:

The intraoral maxillary sulcus incision is suitable for treating ZMC fractures in children with Knight and North Group Ⅲ zygomatic fractures. Stable reduction can be achieved by using absorbable plates at the inferior orbital margin and the upper end of the zygomatic alveolar ridge. The 3D printed model with tooth germs revealed can provide practical reference value.
Sleep Induction in Pediatric EEG Recordings: Chloral Hydrate Versus Melatonin and Hydoxyzine
Authors: Güzin Yiğithan , Erdoğan Irmak , Baykan Mügen , Taşkırdı Elif D. , Yaman Özlem A. , Gençpınar Pınar , Baydan Figen , Dündar Nihal O.
Published: February 2025

Purpose:

Electroencephalography (EEG) recording in pediatric patients is difficult because of patient compliance, and children who are unsuitable for behavioral training usually require sedation for EEG recordings. The aim of this study was to examine the effects of agents commonly used in daily practice for sleep induction on sleep transition, sleep architecture, and frequency of movement artifacts on EEG recordings.

Methods:

A retrospective analysis was made of the demographic data and sleep EEG recordings of patients who underwent sleep EEG because of suspected seizure between 2021 and 2022. The study included patients aged 4 to 18 years, and patients with a new or previous diagnosis of epilepsy were excluded from the study.

Results:

Evaluation was made of 88 patients, comprising 35 (39.8%) girls and 53 (60.2%) boys with a mean age of 10.6 ± 4.3 years. In the analysis of the patients who did not sleep at all during the EEG recording, the drugs administered to the patients for sedation were observed to be hydroxyzine in 4 (14.8%) patients, chloral hydrate in 1 (2.8%) patient, and melatonin in 5 (20%) patients. Sleep duration was seen to be longer and the rates of motion artifacts and awakening during filming were lower in the patients treated with chloral hydrate.

Conclusions:

The results of this study showed that chloral hydrate was the most effective drug for inducing sleep. There is a need for further similar prospective studies to be performed on patients diagnosed with epilepsy and those aged <4 years. Possible complications should be considered before using each agent for sleep induction.
Prevalence of psychological symptoms among Chinese land-lost farmers: a systematic review and meta-analysis of cross-sectional studies by using the SCL-90-R
Authors: Wu Rui-Yao , Ge Lin-Feng , Zhong Bao-Liang
Published: February 2025

Purpose of this review

Land-expropriated farmers have become a large and rapidly growing subpopulation in recent decades due to China's unprecedented industrialization and urbanization. Land appropriation has detrimental effects on the mental health of land-lost farmers. However, existing studies have conflicting findings on the severity and types of psychological symptoms among land-lost farmers compared to the general population. This review presents a meta-analysis of cross-sectional studies that assessed the psychological symptoms of land-lost farmers using the Symptom Checklist-90-Revised (SCL-90-R).

Recent findings

Major Chinese- and English-language databases were searched and eight eligible studies reporting the SCL-90-R subscale scores and standard deviations among Chinese land-lost farmers were included. Meta-analysis results showed that, among land-lost farmers, phobia was the most prominent psychological symptom (Cohen's d = 0.55), followed by depression (d = 0.42), somatization (d = 0.38), anxiety (d = 0.35), interpersonal sensitivity (d = 0.29), and hostility (d = 0.25).

Chinese land-lost farmers exhibit several significant psychological symptoms, including phobia, depression, somatization, anxiety, interpersonal sensitivity, and hostility. These data suggest a pressing need to integrate mental health support into existing social services and policies aimed at assisting land-lost farmers.
Cognitive impairment in schizophrenia: when, what, and is it remediable?
Authors: Guzman Ashlee , Harvey Philip D.
Published: February 2025

Purpose of review

Cognitive impairment in schizophrenia (SCZ) is very common and functionally relevant, being a consistent predictor of the ability to perform critical functional skills and real-world activities, such as residential independence, self-care, productive, and social activities. These impairments are not exclusive to individuals with SCZ; they are also observed in people with bipolar disorder and other mood disorders. Here, we review recent findings in the nature, determinants, and treatment of cognitive impairments with a focus on SCZ and linkage to other closely related conditions.

Recent findings

Recent studies have identified multiple levels of similarity in cognitive functioning across psychiatric conditions and identified a number of efficacious treatments. So much successful work has taken place in training-focused treatment domains that multiple meta-analyses have catalogued the level of gains, the predictors of gains, the optimal strategies, and the durability of improvement. There is also convincing evidence for the first time of pharmacological cognitive enhancement with a mechanism that is plausible for cross-diagnostic impact.

Clinicians need to consider cognitive functioning and not just in people with SCZ. Available treatments should be considered, including suggesting computerized cognitive and skills training across the full spectrum of conditions and the lifespan. Attending to new developments in pharmacological interventions will be critical, as there is at least one very promising candidate compound approved for the general treatment of SCZ with evidence of wide-ranging benefits. Other medications are in phase 2 and 3 trials and may be approved.
Molecular epidemiology of Eimeria spp. parasites and the faecal microbiome of Indiana bats (Myotis sodalis): a non-invasive, multiplex metabarcode survey of an endangered species
Authors: Bennett Andrew J. , Suski Cory D. , O’Keefe Joy M.
Published: February 2025

Assessing individual and population health in endangered wildlife poses unique challenges due to the lack of an adequate baseline and ethical constraints on invasive sampling. For endangered bats, minimally invasive samples like guano can often be the ethical and technical limit for studies of pathogens and the microbiome. In this study, we use multiplex metabarcode sequencing to describe the faecal microbiome and parasites of 56 Indiana bats (Myotis sodalis). We show evidence of a high prevalence of Eimeria spp. protozoan parasite and characterize associations between infection and changes to the faecal microbiome. We identify a strong and significant enrichment of Clostridium species in Eimeria-positive bats, including isolates related to Clostridium perfringens.
The complete genome sequence of Penaeus vannamei nudivirus (previously Baculovirus penaei or P. vannamei singly enveloped nuclear polyhedrosis virus)
Authors: Mai Hung N. , Dhar Arun K.
Published: February 2025

Penaeus vannamei singly enveloped nuclear polyhedrosis virus (PvSNPV), also known as Baculovirus penaei (BP), is the first viral pathogen of penaeid shrimp described in 1974. Although PvSNPV was discovered almost 50 years ago, the complete genome sequence has not been elucidated until now. We detected the virus in a quarantine stock of P. vannamei shrimp by light microscopy of faecal samples and by PCR screening of broodstock. Subsequently, next-generation sequencing was deployed to determine the complete genome sequence of PvSNPV. The PvSNPV genome is a circular, double-stranded DNA molecule of 119 883 bp in length encoding 101 ORFs. The deduced aa sequences from 28 ORFs were homologous to 28 core proteins from all identified nudiviruses. Phylogenetic analyses based on deduced aa sequences of the core genes and orthologous genes revealed that PvSNPV clusters with Penaeus monodon nudivirus. Therefore, we propose to rename BP/PvSNPV as P. vannamei nudivirus and re-assign the virus to the family Nudiviridae instead of Baculoviridae.
Reflecting on Fleming’s caveat: the impact of stakeholder decision-making on antimicrobial resistance evolution
Authors: Ashfield Tom , Cooray Mineli , Jimenez-Acha Isabel , Riaz Zeshan , Gifford Danna R. , Lagator Mato
Published: February 2025

Antimicrobial resistance poses one of the greatest and most imminent threats to global health, environment and food security, for which an urgent response is mandated. Evolutionary approaches to tackling the crisis tend to focus on proximate issues including the mechanisms and pathways to resistance, with associated calls to action for infection control and antimicrobial stewardship. This is of clear benefit but overlooks the fundamental influence of policy and stakeholder decision-making on resistance evolution. In 1945, Fleming issued a stark warning on the irresponsible use of penicillin and its potential to cause death due to penicillin-resistant infections. Attention to resistance evolution theory and heeding Fleming’s advice could have allowed for a vastly different reality. Embedding evolutionary theory within policy, industry and regulatory bodies is not only essential but is now a race against time. Hence, critical appraisal of historical behaviour and attitudes at a global scale can inform a paradigm of anticipatory and adaptive policy. To undertake this exercise, we focused on the largest group of antibiotics with the greatest clinical and economic footprint, the beta-lactams. We examined historical case studies that affected how beta-lactams were developed, produced, approved and utilized, in order to relate stakeholder decision-making to resistance evolution. We derive lessons from these observations and propose sustainable approaches to curb resistance evolution. We set a position that actively incorporates an evolutionary theory of antimicrobial resistance into decision-making within antimicrobial development, production and stewardship.
Balancing preferences and constraints around nurses shift scheduling across healthcare organisations: a qualitative study
Authors: Barker Hannah Ruth , Griffiths Peter , Dall’ora Chiara
Published: February 2025

Aim

To understand how preferences and constraints of nursing staff, nurse managers and hospital directors interact and influence decisions around nurse shift patterns

Background

Globally, many nursing staff have expressed intention to leave the profession and high levels of stress and burnout. Shift patterns are often cited as a key driver of negative nurse outcomes. How preferences and constraints of staff groups involved in nurse shift scheduling interact to shape decisions remains unexplored.

Design

Qualitative study. We interviewed 17 nursing staff, 5 nurse managers and 6 hospital directors.

Methods

Staff were recruited through 5 NHS Trusts based in the North, Midlands, East and South of England. The results were analysed using inductive and deductive framework analysis.

Results

Three themes were identified that influenced nurses’ decisions for shift scheduling: 1/ Balancing Choice with Consistency, Predictability and Flexibility; 2/Adequate Rest and Recovery Between Shifts; and 3/Enjoyment and Engagement at Work. There was a meta-theme of conflicting priorities for shift scheduling between nursing staff, nurse managers and hospital directors across these three themes.

Conclusions

Different priorities for shift scheduling of nursing staff, nurse managers and hospital directors created potential or actual conflict. Solutions appeared to consist of compromises where priorities of different staff groups were simultaneously upheld to an acceptable level. This occurred through collaborative interactions across staff groups.

Implications for Practice

Nursing staff, nurse managers and hospital directors can facilitate choice and flexibility and navigate conflicts in nurse shift scheduling through collaborative approaches that enhance awareness and effective communication.

Reporting Method

Qualitative data was reported using the EQUATOR checklist COREQ. No Patient or Public Contribution

What does this paper contribute to the wider global clinical community?

Collaborative approaches can influence conflicting priorities of staff groups in relation to nurse shift scheduling.

Staff understanding other staff priorities for nurse shift scheduling enhances awareness.
Phylo-Plex: A phylogenetically informed, low-cost amplicon sequencing platform for deployable high-resolution genomic epidemiology
Authors: Beale Mathew A , Shetty Vignesh , Ambridge Kirsty E , Lacey George , Dougan Sam , Roberts-Sengier William , Sampher Beth , Lassalle Florent , Dorman Matthew J , Mahlangu Mahlape P , Venter Johanna ME , Da Costa Dias Bianca , Chipinduro Martha , Washaya Tendai M. , Rodgers Luanne , Makamure Beauty , Dauya Ethel , Marks Michael , Müller Etienne E. , Ferrand Rashida A , Thomson Nicholas R
Published: February 2025

Genomic pathogen surveillance is a powerful tool for public health and research, but is costly and unachievable in low-resource settings. Most sub-genomic typing methods sacrifice resolution whilst remaining costly. We developed “Phylo-Plex”, a novel approach that identifies information-rich genomic regions to maximise phylogenetic information whilst minimising the number of regions. Applied toTreponema pallidum, we designed a high-resolution multiplex PCR sequencing scheme for lineage tracking. Using MinION Flongle cells, we sequenced 72 clinical samples. OurT. pallidumscheme comprising 59 multiplex amplicons achieved high discrimination of fine-scale sublineages comparable to those defined using whole genomes, and demonstrating a qPCR detection limit ≤Ct 32. Variant calls from MinION amplicon sequencing were highly correlated with Illumina whole genome sequencing. We successfully deployed the method in a low-resource laboratory in Zimbabwe, costed at <£300/24 samples (£12.47/sample). Phylo-Plex enables low-cost tracking of priority pathogenic lineages in low resource settings and at scale.