bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Zhuzi contentious? A rhetorical investigation of speech/word radicals in ancient Chinese texts
Authors: Liu Jiao , Li Ke
Published: October 2023

In communication, rhetors are inclined to employ contentious rhetorical modes designed to win or compete. Consequently, noncontentious rhetorical modes, such as invitational rhetoric, are underappreciated. This study fosters a better understanding of the rationale and possibility of noncontentious rhetorical modes rooted in texts by traditional Chinese intellectuals. We identify, classify, and interpret indigenous terms identified with speech/word radicals in nine Chinese philosophical classics across five major schools of thought in ancient China using a corpus-driven approach and key concepts of rhetorical studies to delineate the pattern, components, and modes of ancient Chinese rhetoric. The results show that (1) characters with speech/word radicals in ancient Chinese texts follow a pattern between rank and frequency; (2) basic components of rhetorical acts in ancient China can be described based on these terms, and characteristic rhetorical components are identified upon similarities and differences among five schools of thought; and (3) studying rhetorical modes of ancient Chinese rhetoric with speech/word radicals reveals that intellectuals in ancient China adopted both the contentious modes and the noncontentious modes of rhetoric. This study also demonstrates the possibility of studying semantic radicals in texts through digital methods to delineate ancient Chinese rhetoric.
Horizontally Transferred Salivary Protein Promotes Insect Feeding by Suppressing Ferredoxin-Mediated Plant Defenses
Authors: Wang Yi-Zhe , Ye Yu-Xuan , Lu Jia-Bao , Wang Xin , Lu Hai-Bin , Zhang Ze-Long , Ye Zhuang-Xin , Lu Yu-Wen , Sun Zong-Tao , Chen Jian-Ping , Li Jun-Min , Zhang Chuan-Xi , Huang Hai-Jian
Published: October 2023

Herbivorous insects such as whiteflies, planthoppers, and aphids secrete abundant orphan proteins to facilitate feeding. Yet, how these genes are recruited and evolve to mediate plant–insect interaction remains unknown. In this study, we report a horizontal gene transfer (HGT) event from fungi to an ancestor of Aleyrodidae insects approximately 42 to 190 million years ago. BtFTSP1 is a salivary protein that is secreted into host plants during Bemisia tabaci feeding. It targets a defensive ferredoxin 1 in Nicotiana tabacum (NtFD1) and disrupts the NtFD1–NtFD1 interaction in plant cytosol, leading to the degradation of NtFD1 in a ubiquitin-dependent manner. Silencing BtFTSP1 has negative effects on B. tabaci feeding while overexpressing BtFTSP1 in N. tabacum benefits insects and rescues the adverse effect caused by NtFD1 overexpression. The association between BtFTSP1 and NtFD1 is newly evolved after HGT, with the homologous FTSP in its fungal donor failing to interact and destabilize NtFD1. Our study illustrates the important roles of horizontally transferred genes in plant–insect interactions and suggests the potential origin of orphan salivary genes.
Optimal dose of intravenous cyclophosphamide during remission induction therapy in ANCA-associated vasculitis: A retrospective cohort study of J-CANVAS
Authors: Sofue Hideaki , Kida Takashi , Hirano Aiko , Omura Satoshi , Kadoya Masatoshi , Nakagomi Daiki , Abe Yoshiyuki , Takizawa Naoho , Nomura Atsushi , Kukida Yuji , Kondo Naoya , Yamano Yasuhiko , Yanagida Takuya , Endo Koji , Hirata Shintaro , Matsui Kiyoshi , Takeuchi Tohru , Ichinose Kunihiro , Kato Masaru , Yanai Ryo , Matsuo Yusuke , Shimojima Yasuhiro , Nishioka Ryo , Okazaki Ryota , Takata Tomoaki , Ito Takafumi , Moriyama Mayuko , Takatani Ayuko , Miyawaki Yoshia , Ito-Ihara Toshiko , Yajima Nobuyuki , Kawaguchi Takashi , Fujioka Kazuki , Fujii Wataru , Seno Takahiro , Wada Makoto , Kohno Masataka , Kawahito Yutaka
Published: October 2023

Objectives

To identify the optimal dose of intravenous cyclophosphamide (IVCY) for induction therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis.

Methods

We retrospectively assessed patients with antibody-associated vasculitis who received IVCY every 2–3 weeks during the remission induction phase. The associations of the IVCY dose with infection-free survival and relapse-free survival were analysed using a Cox regression model. We compared patients in three categories: very low-dose (VLD), low-dose (LD), and conventional dose (CD) (<7.5 mg/kg, 7.5–12.5 mg/kg, and >12.5 mg/kg, respectively). The non-linear association between IVCY dose and the outcomes was also evaluated.

Results

Of the 80 patients (median age 72 years), 12, 42, and 26 underwent the VLD, LD, and CD regimens, respectively, of whom 4, 3, and 7 developed infection or died. The adjusted hazard ratios for infection or death were 4.3 (95% confidence interval (CI) 0.94–19.8) for VLD and 5.1 (95% CI 1.21–21.3) for CD, compared with LD. We found the hazard ratio for infection or death increased when the initial IVCY dose exceeded 9 mg/kg. Relapse-free survival did not differ clearly.

Conclusion

Low-dose IVCY (7.5–12.5 mg/kg) may result in fewer infections and similar relapse rates compared with the conventional regimen (>12.5 mg/kg).
Empirical Antibiotic Therapy in Diabetic Foot Ulcer Infection Increases Hospitalization
Authors: Schmidt Brian M , Kaye Keith S , Armstrong David G , Pop-Busui Rodica
Published: October 2023

Background

We evaluated the outcomes associated with initial antibiotic management strategies for infected diabetic foot ulcers (DFUs) diagnosed in an outpatient multidisciplinary center.

Methods

Consecutive outpatient individuals with infected DFUs, stratified according to Infectious Diseases Society of America infection severity, were followed for 1 year from the initial antibiotic administration to treat acute infection. The main outcomes were hospitalization rates for a diabetes-related foot complication within 30 days of diagnosis and requiring an amputation or death during follow-up. Outcomes were analyzed by regression analysis, accounting for demographics, clinical characteristics, and antibiotic therapy.

Results

Among 147 outpatients with infected DFUs, 116 were included. Infections were categorized as mild (68%), moderate (26%), and severe (6%). Empirical antibiotics (not culture-guided) were prescribed as initial treatment in 39 individuals, while 77 received culture-based antibiotics. There were no differences in demographic or clinical characteristics between the antibiotic administration groups, except for a higher body mass index and prevalence of chronic kidney disease in the empirical cohort. Forty-two infected DFU patients required hospitalization within 30 days of diagnosis for the same reason. The relative risk for hospitalizations was 1.87 greater in those with mild infections when treated with empirical antibiotics compared with culture-directed antibiotics. There were no differences in amputations and/or death at 1 year follow-up.

Conclusions

These data support obtaining tissue culture to guide antibiotic therapy, regardless of DFU infection severity, to decrease hospitalizations.
Hospital admissions and emergency department visits for people with dementia
Authors: Zafeiridi E , McMichael A , O’Hara L , Passmore P , McGuinness B
Published: October 2023

Background

Previous studies have suggested that people with dementia (PwD) are more likely to be admitted to hospital, have prolonged hospital stay, or visit an emergency department (ED), compared to people without dementia.

Aim

This study assessed the rates of hospital admissions and ED visits in PwD and investigated the causes and factors predicting this healthcare use. Further, this study assessed survival following hospital admissions and ED visits.

Design

This was a retrospective study with data from 26 875 PwD and 23 961 controls.

Methods

Data from national datasets were extracted for demographic characteristics, transitions to care homes, hospital and ED use and were linked through the Honest Broker Service. PwD were identified through dementia medication and through causes for hospital admissions and death.

Results

Dementia was associated with increased risk of hospital admissions and ED visits, and with lower odds of hospital readmission. Significant predictors for hospital admissions and readmissions in PwD were transitioning to a care home, living in urban areas and being widowed, while female gender and living in less deprived areas reduced the odds of admissions. Older age and living in less deprived areas were associated with lower odds of an ED visit for PwD. In contrast to predictions, mortality rates were lower for PwD following a hospital admission or ED visit.

Conclusions

These findings result in a better understanding of hospital and ED use for PwD. Surprisingly, survival for PwD was prolonged following hospital admissions and ED visits and thus, policies and services enabling these visits are necessary, especially for people who live alone or in rural areas; however, increased primary care and other methods, such as eHealth, could provide equally effective care in order to avoid distress and costs for hospital admissions and ED visits.
Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review
Authors: Magnan Elizabeth , Weyrich Meghan , Miller Marykate , Melnikow Joy , Moulin Aimee , Servis Mark , Chadha Puja , Spivack Sarah , Henry Stephen G.
Published: October 2023

Purpose

In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma.

Method

The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality.

Results

A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention.

Conclusions

SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.
Integrating Public and Population Health Into Medical Education Curricula: Opportunities and Challenges for Reform
Authors: Mehta Shobha H. , Shah Nirav R.
Published: October 2023

In a review of U.S. medical education curricular guidance, from premedical studies through to continuing medical education, Maeshiro and colleagues found limited examples of public and population health topics. In this Commentary, the authors emphasize the importance of including public and population health in the curriculum, pointing to curricular reform efforts to integrate these topics into teaching of basic sciences and clinical studies. In addition, they consider the expectations placed on physicians to meet the needs of the population and argue that policies that support public health funding, infrastructure, and workers are also critical to improving the health of communities.
Epidemiology of systemic vasculitis
Authors: Ozguler Yesim , Esatoglu Sinem Nihal , Hatemi Gulen
Published: October 2023

Purpose of review

Epidemiology of vasculitides exhibit geographic variation and data from some parts of the world are still scarce. Increased recognition of these rare diseases and improvement in diagnosis and patient care may lead to changes in their epidemiology. In this review, we aimed to highlight the most recent work on the epidemiology of systemic vasculitis.

Recent findings

New data from countries where information on the epidemiology of giant cell arteritis, Takayasu arteritis and Behçet syndrome were limited have revealed that these conditions are not as rare as previously believed. The incidence rates during the coronavirus disease 2019 pandemic highlight the link between Kawasaki disease and respiratory pathogens. The use of different classification criteria hampers the comparison of true incidence and prevalence rates in antineutophil cytoplasmic antibody (ANCA)-associated vasculitis and its subtypes between geographies and over time.

Recent studies have highlighted the epidemiology of vasculitides in different parts of the world and changing trends. Standardization of study design and disease definitions is needed to improve the reliability and comparability of the results.
Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis
Authors: Huffman William H. , Gupta Radhika , Ayotte Steven R. , Lawrence J. Todd R.
Published: October 2023

Background:

Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth.

Methods:

The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs).

Results:

A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period (R
2=0.899; P<0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%).

Conclusions:

Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males.

Level of Evidence:

Level III—prognostic.
Preoperative Cervical Range of Motion in Flexion as a Risk Factor for Postoperative Cervical Sagittal Imbalance After Laminoplasty
Authors: Liu Chengxin , Wang Wei , Li Xiangyu , Shi Bin , Lu Shibao
Published: October 2023

Study Design.

Retrospective study.

Objective.

To investigate factors associated with cervical sagittal imbalance (CSI) after cervical laminoplasty (LMP).

Summary of Background Data.

Preoperative dynamic cervical sagittal alignment is an important predictor for changes in cervical sagittal alignment and clinical outcomes after LMP. However, the impact of preoperative dynamic cervical sagittal alignment on postoperative changes in the cervical sagittal vertical axis (cSVA) after LMP remains unclear. We hypothesized that preoperative cervical flexion and extension function are associated with the changes in cSVA and clinical outcomes and found potential risk factors for post-LMP CSI.

Patients and Methods.

Patients undergoing LMP at a single institution between January 2019 and December 2021 were retrospectively reviewed. The average follow-up period was 19 months. The parameters were collected before the surgery and at the final follow-up. We defined the changes in cSVA (△cSVA) ≤ −10 mm as the improvement group, −10 mm < △cSVA ≤ 10 mm as the stable group, and △cSVA > 10 mm as the deterioration group. Multivariate logistic regression was used to evaluate factors associated with postoperative CSI. The χ2 test was used to compare categorical data between groups. T tests, analysis of variance, Kruskal-Wallis tests, and Mann-Whitney Wilcoxon tests were used to assess the differences between radiographic and clinical parameters among groups. A receiver operating characteristic curve analysis was used to identify optimal cutoff values.

Results.

The study comprised 102 patients with cervical spondylotic myelopathy. The Japanese Orthopedic Association recovery rate was better in the improvement group and a significant aggravation in neck pain was observed in the deterioration group after surgery. Cervical Flex range of motion (ROM; spine range of flexion) was significantly higher in the deterioration group. The multivariate logistic regression model suggested that greater Flex ROM and starting LMP at C3 were significant risk factors for postoperative deterioration of cervical sagittal balance. Receiver operating characteristic curves showed that the cutoff value for preoperative Flex ROM was 34.10°.

Conclusion.

Preoperative dynamic cervical sagittal alignment influences postoperative cervical sagittal balance after LMP. Cervical LMP should be carefully considered for patients with a preoperative high Flex ROM, as CSI is likely to occur after surgery.

Level of Evidence:

Level 3.
Early Compensatory Segmental Angle Changes at L3-L4 and L4-L5 After a L5-S1 Interbody Fusion for a Grade 1 Spondylolisthesis
Authors: O’Connor Bailey , Bansal Aiyush , Leveque Jean-Christophe , Drolet Caroline E. , Shen Jesse , Nemani Venu , Canlas Gina , Louie Philip K.
Published: October 2023

Study Design.

The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022.

Objective.

To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1.

Background.

Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1. This can lead to lordotic overcompensation at adjacent levels to maintain spinopelvic balance. However, the fate of adjacent angles after interbody fusion is not well understood.

Patients and Methods.

Preoperative and 6-month postoperative measurements of SL (L3-L4, L4-L5, and L5-S1), lumbar lordosis, and pelvic incidence (PI) were obtained from sagittal standing radiographs. Preliminary t tests were performed for descriptive purposes, and multiple regression was used for hypothesis testing.

Results.

Ninety-eight patients met the inclusion criteria (50 ALIF and 48 TLIF). A greater amount of lordosis achieved at L5-S1 was significantly associated with a greater reduction of SL at L4-L5 (r = −0.65, P < 0.001) or L3-L4 (r = −0.46, P < 0.001). A greater preoperative PI was associated with a greater reduction of SL at L4-L5 (r = −0.42, P < 0.001) and at L3-L4 (r = −0.44, P < 0.001)

Conclusion.

At 6 months after a lumbar interbody fusion at L5-S1, greater compensatory changes with lordosis reduction are observed at the supra-adjacent L4-L5 and L3-L4 levels in patients achieving greater L5-S1 SL. In addition, preoperative PI played a role in influencing lordotic correction.
Access to Care Limitations: When Distance and Lack of Evidence Meet
Authors: Olsen Darren , Patel Lina , Spinazzi Noemi Alice , Nyp Sarah S.
Published: October 2023

CASE:

Jimmy is a 13-year-old adolescent boy who was diagnosed with Down syndrome (trisomy 21) prenatally. Jimmy is the only individual with Down syndrome in the small, rural community where he lives with his parents. He has mild sleep apnea, and his gross and fine motor developmental milestones were generally consistent with those expected among children with Down syndrome. At age 4, his parents raised concerns about his limited language, strong preference to be alone, and refusal to leave the house. Parents had observed his marked startle response to loud laughter and adult male voices. At age 7, his preferred activities consisted of dangling necklaces or shoelaces in front of his face and rocking his body forward and backward when seated. After limited progress in special education, speech, and occupational therapies, he was referred, at age 8, to a specialty center 3 hours from his home for a multidisciplinary evaluation. There, he received a diagnosis of co-occurring autism spectrum disorder (ASD).

Over the last year, his repetitive behaviors have become more intense. He hits the side of his head with his fist and presses his thumbs into his eyes, causing bruising. Any attempts to remove his dangle objects are met with aggressive behaviors, including hitting, kicking, scratching, and elopement. At school, he refuses to complete work and sometimes hits his teacher. Aggression stops in the absence of educational demands. School staff informed parents they are not equipped to handle Jimmy's behaviors.

Jimmy recently presented to the specialty center for developmental-behavioral pediatric and psychology support at the request of his primary care clinician. The developmental pediatrician discussed with Jimmy's parents the possibility of a trial of medication to address disruptive/aggressive behavior if there is not improvement with initiation of behavioral strategies. The psychologist began weekly behavioral parent training visits through telehealth, including prevention strategies, reinforcement, and functional communication training. The strategies have helped decrease the frequency of elopement and aggressive behaviors. Self-injurious behaviors and refusal at school have remained constant.

Despite some stabilization, limited local resources as well as the lack of evidence-based guidelines for people with both Down syndrome and ASD have impeded improvements in Jimmy's significant behavioral and developmental challenges. His parents have become increasingly isolated from critical family and community support as well. In what ways could the clinicians and community support this child and his family and prevent others from experiencing similar hardships?
Optimal surgical techniques for curative resection of the rectal cancer
Authors: Bae Hyeon Woo , Kim Nam Kyu
Published: October 2023

The aim of rectal cancer surgery is to achieve a curative resection by completely removing the rectum involved with cancer surrounding the mesorectum, obtaining a safe adequate resection margin, and preserving important structures crucial for the patient's quality of life. Optimal dissection along the avascular embryological fusion line and among deep invisible structures is essential. Whereas a minimally invasive surgical approach allows for better visibility of deep pelvic structures compared with the open surgery period, the sequence of dissection and anatomical knowledge about pelvic fascia and relevant nerve structures are crucial for safe pelvic dissection in terms of oncologic and functional outcomes. In this review, we represent practical technical tips based on personal experience and previous studies to achieve the mentioned goals.
A Prospective Multicenter Study of a Weekly Application Regimen of Viable Human Amnion Membrane Allograft in the Management of Nonhealing Diabetic Foot Ulcers
Authors: Galiano Robert D. , Orgill Dennis P. , Armstrong David G. , Glat Paul M. , Carter Marissa J. , Zelen Charles M.
Published: October 2023

Background:

Diabetic foot ulcers (DFUs) pose a significant clinical challenge for providers and patients, and often precede devastating complications such as infection, hospitalization, and amputation. Therefore, advanced treatment options are needed to facilitate the healing of chronic DFUs and improve outcomes in this high-risk population. Cryopreserved viable human amnion membrane allograft (vHAMA) has shown great promise in the treatment of recalcitrant DFUs as a supplement to standard of care (SOC). Placental grafts are rich in extracellular matrix proteins, growth factors, and cytokines, which can induce angiogenesis and dermal fibroblast proliferation, resulting in accelerated healing.

Methods:

In this prospective, multicenter single arm trial, 20 patients with nonhealing DFUs received weekly application of vHAMA, in addition to SOC, for up to 12 weeks. The primary study endpoint was proportion of healed wounds at 12 weeks. Secondary endpoints included proportion of wounds healed at 6 weeks, time to heal, and percentage area wound reduction. Subjects were evaluated for ulcer healing and assessed for adverse events at every treatment visit.

Results:

At study conclusion, 85% of patients receiving vHAMA healed. Ten wounds healed (50%) by 6 weeks, and 17 wounds (85%) healed by 12 weeks. The mean time to heal was 46.6 days (95% CI: 35.1–58.0), and the average number of vHAMAs used was 5.4 (SD: 3.25). The mean PAR was 86.3% (SD: 40.51).

Conclusions:

Aseptically processed, cryopreserved vHAMA should be considered as a safe and effective option for DFUs refractory to SOC therapy.
Recent advances in the diagnosis and management of acute myocardial infarction
Authors: Hsieh Yi-Keng , Wang Mei-Tzu , Wang Chien-Ying , Chen Cheng-Fong , Ko Yu-Ling , Huang Wei-Chun
Published: October 2023

With the discovery of new biomarkers for the early detection of acute myocardial infarction (AMI), advancements in valid medication, and percutaneous coronary intervention (PCI), the overall prognosis of AMI has improved remarkably. Nevertheless, challenges remain which require more difficult work to overcome. Novel diagnostic and therapeutic techniques include new AMI biomarkers, hypothermia therapy, supersaturated oxygen (SSO2) therapy, targeted anti-inflammatory therapy, targeted angiogenesis therapy, and stem cell therapy. With these novel methods, we believe that the infarction size after AMI will decrease, and myocardial injury–associated ventricular remodeling may be avoided. This review focuses on novel advances in the diagnosis and management of AMI.
Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey
Authors: Crizzle Alexander M. , Wawzonek Peter A. , Bigelow Philip L.
Published: October 2023

Background

This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population.

Methods

This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population.

Results

Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population.

Conclusions

Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.
The Nutritional Characteristics of Usual Lunches Consumed Among Japanese Workers
Authors: Sugimoto Minami , Asakura Keiko , Mori Sachie , Shinozaki Nana , Murakami Kentaro , Imamura Haruhiko , Nishiwaki Yuji
Published: October 2023

Objective

This study investigated whether the nutritional characteristics of lunches consumed by Japanese workers differ by where the meal is usually prepared or eaten.

Methods

This cross-sectional study included 620 employees (aged 20 to 75 years) from eight business offices in Tokyo, Japan. Dietary data were collected using the validated Meal-based Diet History Questionnaire. The Healthy Eating Index 2015 and dietary intakes from lunch were compared between workers classified by usual lunch type: homemade (n = 190), staff canteen (n = 77), restaurant (n = 109), and takeaway (n = 244).

Results

Healthy Eating Index 2015 for lunch was highest in the staff canteen group, followed by the homemade group. The staff canteen group had higher intakes of total vegetables, potatoes, fish, and several vitamins from lunch than the restaurant or takeaway groups.

Conclusions

Homemade and canteen lunches are relatively healthy options for lunch for Japanese workers.
Comparing the safety and efficacy of sleeve gastrectomy vs. Roux-en Y gastric bypass in elderly (>60 Years) with severe obesity; An umbrella systematic review and meta-analysis
Authors: Kermansaravi Mohammad , Vitiello Antonio , Valizadeh Rohollah , Shahmir Shahab Shahabi , Musella Mario
Published: October 2023

Background:

Today, bariatric surgeons face the challenge of treating older adults with class III obesity. The indications and outcomes of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) also constitute a controversy.

Methods:

PubMed, Web of Science and Scopus were searched to retrieve systematic reviews/meta-analyses published by March 1, 2022. The selected articles were qualitatively evaluated using A Measurement Tool to Assess systematic Reviews (AMSTAR).

Results:

An umbrella review included six meta-analyses retrieved from the literature. The risk of early- and late-emerging complications decreased by 55% and 41% in the patients underwent SG than in those receiving RYGB, respectively. The chance of the remission of hypertension and obstructive sleep apnea, respectively increased by 43% and 6%, but type-2 diabetes mellitus (T2DM) decreased by 4% in the patients underwent RYGB than in those receiving SG. RYGB also increased excess weight loss (EWL) by 15.23% in the patients underwent RYGB than in those receiving SG.

Conclusion:

Lower levels of mortality and early- and late-emerging complications were observed in the older adults undergoing SG than in those receiving RYGB, which was, however, more efficient in term of weight loss outcomes and recurrence of obesity-related diseases
Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study
Authors: Raptis Dimitri Aristotle , Salinas Camila Hidlago , Malagò Massimo ,   The LiverGroup.org Collaborative (Appendix)
Published: October 2023

Background:

The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.

Methods:

LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrolment within January to December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country- and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141)

Results:

A total of 2,159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among higher and lower HDI groups, respectively.

Conclusions:

This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. We identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index (HDI) countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.
Artificial intelligence assisted endoscopic ultrasound for detection of pancreatic space occupying lesion: A systematic review and meta-analysis
Authors: Dhali Arkadeep , Kipkorir Vincent , Srichawla Bahadar S. , Kumar Harendra , Rathna Roger B. , Ongidi Ibsen , Chaudhry Talha , Morara Gisore , Nurani Khulud , Cheruto Doreen , Biswas Jyotirmoy , Chieng Leonard R. , Dhali Gopal Krishna
Published: October 2023

Background:

Diagnosing pancreatic lesions, including chronic pancreatitis, autoimmune pancreatitis, and pancreatic cancer, poses a challenge and, as a result, is time-consuming. To tackle this issue, artificial intelligence (AI) has been increasingly utilized over the years. AI can analyze large data sets with heightened accuracy, reduce inter-observer variability, and can standardize the interpretation of radiologic and histopathologic lesions. Therefore, this study aims to review the use of AI in the detection and differentiation of pancreatic space-occupying lesions and to compare AI-assisted endoscopic ultrasound (EUS) with conventional EUS in terms of their detection capabilities.

Methods:

Literature searches were conducted through PubMed/Medline, SCOPUS, and Embase to identify studies eligible for inclusion. Original articles, including observational studies, randomized control trials, systematic reviews, meta-analyses, and case series specifically focused on AI-assisted EUS in adults, were included. Data were extracted and pooled, and a meta-analysis was conducted using Meta-xl. For results exhibiting significant heterogeneity, a random-effects model was employed; otherwise, a fixed-effects model was utilized.

Results:

A total of 21 studies were included in the review with 4 studies pooled for a meta-analysis. A pooled accuracy of 93.6% (CI 90.4-96.8%) was found using the random-effects model on four studies that showed significant heterogeneity (P<0.05) in the Cochrane’s Q test. Further, a pooled sensitivity of 93.9% (CI 92.4-95.3%) was found using a fixed-effects model on seven studies that showed no significant heterogeneity in the Cochrane’s Q test. When it came to pooled specificity, a fixed-effects model was utilized in six studies that showed no significant heterogeneity in the Cochrane’s Q test and determined as 93.1% (CI 90.7-95.4%). The pooled positive predictive value which was done using the random-effects model on six studies that showed significant heterogeneity was 91.6% (CI 87.3-95.8%). The pooled negative predictive value which was done using the random-effects model on six studies that showed significant heterogeneity was 93.6% (CI 90.4-96.8%).

Conclusion:

AI-assisted EUS shows a high degree of accuracy in the detection and differentiation of pancreatic space-occupying lesions over conventional EUS. Its application may promote prompt and accurate diagnosis of pancreatic pathologies.
Safety outcomes of bariatric surgery iN patients with advanced oRgan disease: the ONWARD study - a prospective cohort study
Authors: Singhal Rishi , Cardoso Victor Roth , Wiggins Tom , Yashasvi Rajeev MBBS , Ludwig Christian , Gkoutos Georgios V. , Hanif Wasim , Mahawar Kamal ,   On behalf of the ONWARD & GENEVA collaborators
Published: October 2023

Introduction:

Increasing numbers of patients with advanced organ disease are being considered for Bariatric and Metabolic Surgery (BMS). There is no prospective study on the safety of BMS in these patients. This study aimed to capture outcomes for patients with advanced cardiac, renal, or liver disease undergoing BMS.

Materials and Methods:

This was a multinational, prospective cohort study on the safety of elective BMS in adults (≥18 y) with advanced disease of the heart, liver, or kidney.

Results:

Data on 177 patients with advanced diseases of heart, liver, or kidney were submitted by 75 centres in 33 countries. Mean age and Body Mass Index was 48.56±11.23 years and 45.55±7.35 kg/m 2 respectively. Laparoscopic sleeve gastrectomy was performed in 124 patients (70%). The 30-day morbidity and mortality were 15.9% (n=28) and 1.1% (n=2) respectively. 30-day morbidity was 16.4%, 11.7%, 20.5%, and 50.0% in patients with advanced heart (n=11/61), liver (n=8/68), kidney (n=9/44), and multi-organ disease (n=2/4) respectively. Cardiac patients with left ventricular ejection fraction ≤35% and New York Heart Association classification 3 or 4, liver patients with Model for End-Stage Liver Disease score ≥12, and patients with advanced renal disease not on dialysis were at increased risk of complications. Comparison with a propensity score matched cohort found advanced disease of the heart, liver, or kidney to be significantly associated with higher 30-day morbidity.

Conclusion:

Patients with advanced organ disease are at increased risk of 30-day morbidity following BMS. This prospective study quantifies that risk and identifies patients at the highest risk.
Insights into the history and tendency of liver transplantation for liver cancer: A bibliometric-based visual analysis
Authors: He Xinyu , Xu Shengjun , Tang Linsong , Ling Sunbin , Wei Xuyong , Xu Xiao
Published: October 2023

Research on liver transplantation (LT) for liver cancer has gained increasing attention. This paper has comprehensively described the current status, hotspots and trends in this field. A total of 2991 relevant articles from January 1, 1963 to February 28, 2023 were obtained from the Web of Science Core Collection. VOSviewer and CiteSpace software were utilized as bibliometric tools to analyze and visualize knowledge mapping. Between 1963 and 2023, the number of papers in the area of LT for liver cancer increased continuously. A total of 70 countries/regions, 2303 institutions and 14840 researchers have published research articles, with the United States and China being the two most productive countries. Our bibliometric-based visual analysis revealed the expansion of LT indications for liver cancer and prevention/treatment of cancer recurrence as ongoing research hotspots over the past decades. Meanwhile, emerging studies also focus on downstaging/bridging treatments before LT and long-term survival of LT recipient, in particular the precise application of immunosuppressants.
Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study
Authors: Yang Yiyu , Zhang Xufei , Zhang Jinpeng , Zhu Jianwei , Wang Peige , Li Xuemin , Mai Wei , Jin Weidong , Liu Wenjing , Wu Xiuwen , Ren Jianan
Published: October 2023

Objective:

This study aimed to construct and validat a clinical prediction model for Surgical site infection (SSI) risk 30 days after gastrointestinal surgery.

Materials and methods:

This multi-centre study involving 57 units conducted a 30-day postoperative follow-up of 17,353 patients who underwent gastrointestinal surgery at the unit from 1 March 2021 to 28 February 2022. We collected a series of hospitalisation data, including demographic data, preoperative preparation, intraoperative procedures, and postoperative care. The main outcome variable was SSI, defined according to the Centres for Disease Control and Prevention guidelines. This study used the least absolute shrinkage and selection operator (LASSO) algorithm to screen predictive variables and construct a prediction model. The receiver operating characteristic curve, calibration, and clinical decision curves were used to evaluate the prediction performance of the prediction model.

Results:

Overall, 17,353 patients were included in this study, and the incidence of SSI was 1.6%. The univariate analysis combined with LASSO analysis showed that 20 variables, namely, chronic liver disease, chronic kidney disease, steroid use, smoking history, C-reactive protein, blood urea nitrogen, creatinine, albumin, blood glucose, bowel preparation, surgical antibiotic prophylaxis, appendix surgery, colon surgery, approach, incision type, colostomy/ileostomy at the start of the surgery, colostomy/ileostomy at the end of the surgery, length of incision, surgical duration, and blood loss were identified as predictors of SSI occurrence (P<0.05). The area under the curve values of the model in the train and test groups were 0.7778 and 0.7868, respectively. The calibration curve and Hosmer–Lemeshow test results demonstrated that the model-predicted and actual risks were in good agreement, and the model forecast accuracy was high.

Conclusions:

The risk assessment system constructed in this study has good differentiation, calibration, and clinical benefits and can be used as a reference tool for predicting SSI risk in patients.
Cholecystectomy and ERCP in pregnancy: A nationwide register-based study
Authors: Hedström Jonas , Nilson Johan , Anderson Bodil
Published: October 2023

Objective:

To examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age.

Summary Background Data:

Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients.

Methods:

Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed.

Results:

A total of 21,328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up.

Conclusion:

Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.
Preemptive infiltration with betamethasone and ropivacaine for postoperative pain in laminoplasty and laminectomy (PRE-EASE): A prospective randomized controlled trial
Authors: Shrestha Niti , Han Bo , Zhao Chunmei , Jia Wenqing , Luo Fang
Published: October 2023

Background:

Postoperative pain after laminoplasty and laminectomy occurs partially from local trauma of the paraspinal tissue. Finding a multimodal analgesic cocktail to enhance the duration and effect of local infiltration analgesia is crucial. Because of rapid onset and long duration of action of betamethasone, we hypothesized that, a preemptive multimodal infiltration regimen of betamethasone and ropivacaine reduces pain scores and opioid demand, and improves patient satisfaction following laminoplasty and laminectomy.

Materials and methods:

This prospective, randomized, open-label, blinded endpoint study was conducted between September 1, 2021 and June 3, 2022, and included patients between the ages of 18 to 64 scheduled for elective laminoplasty or laminectomy under general anesthesia, with American Society of Anesthesiologists classification I/II. 116 patients were randomly assigned to either the BR (Betamethasone-Ropivacaine) group or the R (Ropivacaine) group in a 1:1 ratio. Each group received preemptive infiltration of a total of 10 ml study solution into each level. Every 30 ml of study solution composed of 0.5 ml of Betamethasone plus 14.5 ml of saline and 15 ml of 1% ropivacaine for the BR group, and 15 ml of 1% ropivacaine added to 15 ml of saline for the R group. Infiltration of epidural space and intrathecal space were avoided and spinous process, transverse process, facet joints and lamina were injected, along with paravertebral muscles and subcutaneous tissue. Cumulative 48 hours postoperative butorphanol consumption via PCA (Patient-controlled analgesia) was the primary outcome. Intention-to-treat (ITT) principle was used for primary analysis.

Results:

Baseline characteristics were identical in both groups (P>0.05). The cumulative 48 hours postoperative butorphanol consumption via PCA was 3.0

1.4 mg in the BR group (n=58), and 7.1

1.2 mg in the R group (n=58) (P<0.001). Overall cumulative opioid demand was lower at different time intervals in the BR group (P<0.001), along with the estimated median time of first analgesia demand via PCA (3.3 hours in the BR group and 1.6 hours in the R group). Visual Analogue Scale (VAS) score at movement and rest were also significantly lower until 3 months and 6 weeks, respectively. No side effects or adverse events associated with the intervention were observed in this study.

Conclusions:

Preemptive analgesia with betamethasone and ropivacaine provides better postoperative pain management following laminoplasty and laminectomy, compared to ropivacaine alone. This is an effective technique worthy of further evaluation.