bluuebunny/crossref_metadata_2025 huggingface dataset:
Hematological and Other Cancers in People Using Clozapine
Authors: Dawson Jessica L. , Sluggett Janet K. , Procter Nicholas G. , Myles Nicholas , Bell J. Simon
Published: April 2023

Background

Recent observational study evidence suggests that clozapine, unlike other antipsychotics, may be associated with a small increased risk of hematological malignancy. This study described characteristics of hematological and other cancers in those taking clozapine reported to the Australian Therapeutic Goods Administration.

Methods

We analyzed public case reports for “clozapine,” “Clozaril,” or “Clopine” from January 1995 to December 2020 classified as “neoplasm benign, malignant and unspecified” by the Australian Therapeutic Goods Administration. Data on age, sex, dose, clozapine start and cessation dates, Medical Dictionary for Regulatory Activities reaction terms, and date of cancer were extracted.

Results

Overall, 384 spontaneous reports of cancers in people taking clozapine were analyzed. The mean age of patients was 53.9 years (SD, 11.4 years), and 224 (58.3%) were male. The most frequent cancers were hematological (n = 104 [27.1%]), lung (n = 50 [13.0%]), breast (n = 37 [9.6%]), and colorectal (n = 28 [7.3%]). The outcome was fatal for 33.9% of cancer reports. Lymphoma comprised 72.1% of all hematological cancers (mean patient age, 52.1 years; SD, 11.6 years). The median daily dose of clozapine at the time of hematological cancer report was 400 mg (interquartile range, 300–543.8 mg), and the median duration of clozapine use before hematological cancer diagnosis was 7.0 years (interquartile range, 2.8–13.2 years).

Conclusions

Lymphoma and other hematological cancers are overrepresented in spontaneous adverse event reports compared with other cancer types. Clinicians should be aware of the possible association with hematological cancers and monitor for and report any hematological cancers identified. Future studies should examine histology of lymphomas in people using clozapine and corresponding blood level of clozapine.
An Evaluation of the Multifactorial Model of Cancer-Related Cognitive Impairment
Authors: Oppegaard Kate R. , Mayo Samantha J. , Armstrong Terri S. , Kober Kord M. , Anguera Joaquin , Wright Fay , Levine Jon D. , Conley Yvette P. , Paul Steven , Cooper Bruce , Miaskowski Christine
Published: April 2023

Background

Up to 45% of patients report cancer-related cognitive impairment (CRCI). A variety of characteristics are associated with the occurrence and/or severity of CRCI. However, an important gap in knowledge of risk factors for CRCI is the relative contribution of each factor. The Multifactorial Model of Cancer-Related Cognitive Impairment (MMCRCI) is a conceptual model of CRCI that can be used to evaluate the strength of relationships between various factors and CRCI.

Objectives

The purpose of this study was to use structural regression methods to evaluate the MMCRCI using data from a large sample of outpatients receiving chemotherapy (n = 1,343). Specifically, the relationships between self-reported CRCI and four MMCRCI concepts (i.e., social determinants of health, patient-specific factors, treatment factors, and co-occurring symptoms) were examined. The goals were to determine how well the four concepts predicted CRCI and determine the relative contribution of each concept to deficits in perceived cognitive function.

Methods

This study is part of a larger, longitudinal study that evaluated the symptom experience of oncology outpatients receiving chemotherapy. Adult patients were diagnosed with breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding 4 weeks; were scheduled to receive at least two additional cycles of chemotherapy; were able to read, write, and understand English; and gave written informed consent. Self-reported CRCI was assessed using the Attentional Function Index. Available study data were used to define the latent variables.

Results

On average, patients were 57 years of age, college educated, with a mean Karnofsky Performance Status score of 80. Of the four concepts evaluated, while co-occurring symptoms explained the largest amount of variance in CRCI, treatment factors explained the smallest amount of variance. A simultaneous structural regression model that estimated the joint effect of the four exogenous latent variables on the CRCI latent variable was not significant.

Discussion

These findings suggest that testing individual components of the MMCRCI may provide useful information on the relationships among various risk factors, as well as refinements of the model. In terms of risk factors for CRCI, co-occurring symptoms may be more significant than treatment factors, patient-specific factors, and/or social determinants of health in patients receiving chemotherapy.
Illicit drug and alcohol use and measures of musculoskeletal function and mental health in orthopaedic trauma patients
Authors: Spratt James , Adkins Zachary , Warda Danny , Smith Michele , Bruggers Jennifer , Weiss Paul , Becher Stephen
Published: April 2023

Objectives:

The objective of this study was to describe the relationship between positive toxicology screens and measures of preinjury mental health and physical function in an orthopaedic trauma population

Design:

This was a cross-sectional study.

Setting:

Urban Level 1 trauma center.

Patients:

A total of 125 trauma patients gave written consent for this study.

Main Outcome Measurements:

Questionnaires such as, Patient Health Questionnaire-9, General Anxiety Disorder-7, PCL-5, and Short Musculoskeletal Function Assessment, were used to survey patients after surgical intervention.

Results:

Patient Health Questionnaire-9 (P = 0.05) and PCL-5 (P = 0.04) were not found to have significant differences between positive and negative toxicology screens. Both General Anxiety Disorder-7 (P = 0.004) and Short Musculoskeletal Function Assessment function (P = 0.006) were significantly higher in patients with positive toxicology screens.

Conclusions:

Positive toxicology seems to be associated with preinjury anxiety. Patient reported preinjury function was not adversely affected by the presence of illicit substances or alcohol, nor were levels of post-traumatic stress disorder and depression found to be higher in patients with positive toxicology screens.

Level of Evidence:

Level IV Cross-Sectional Study.
Pericardial Mesotheliomas
Authors: Arrossi Andrea Valeria
Published: April 2023

Primary pericardial mesothelioma (PM) is a rare tumor arising from the mesothelial cells of the pericardium. It has an incidence of <0.05% and comprises <2% of all mesotheliomas; however, it is the most common primary malignancy of the pericardium. PM should be distinguished from secondary involvement by the spread of pleural mesothelioma or metastases, which are more common. Although data are controversial, the association between asbestos exposure and PM is less documented than that with other mesotheliomas. Late clinical presentation is common. Symptoms may be nonspecific but are usually related to pericardial constriction or cardiac tamponade, and diagnosis can be challenging usually requiring multiple imaging modalities. Echocardiography, computed tomography, and cardiac magnetic resonance demonstrate heterogeneously enhancing thickened pericardium, usually encasing the heart, with findings of constrictive physiology. Tissue sampling is essential for diagnosis. Histologically, similar to mesotheliomas elsewhere in the body, PM is classified as epithelioid, sarcomatoid, or biphasic, with the biphasic type being the most common. Combined with morphologic assessment, the use of immunohistochemistry and other ancillary studies is helpful for distinguishing mesotheliomas from benign proliferative processes and other neoplastic processes. The prognosis of PM is poor with about 22% 1-year survival. Unfortunately, the rarity of PM poses limitations for comprehensive and prospective studies to gain further insight into the pathobiology, diagnosis, and treatment of PM.
Relational empathy, holistic care and quality of life in persons with spinal cord injuries: A cross-sectional study.
Authors: Mohan Meenakshi , Singh Virendra Vikram , Deb Roumi
Published: April 2023

Introduction

High-quality health systems are built on the concept of patient-centred approach which includes holistic care and empathy. With time, this has progressively been recognized as a valuable paradigm for better health outcomes, particularly in chronic diseases.

Objectives

The study aims to determine the patient's perception during his/her consultation and to assess the relationship between CARE measure with demographic/injury variables and Quality of Life.

Methods

The present cross-sectional study was conducted among 226 SCI individuals. Data was collected via structured questionnaire, WHOQOL-BREF, and CARE measure. Independent t- test is used to compare WHOQOL-BREF domains with two groups of CARE measure. Logistic regression was used to determine the significant factors of CARE measure.

Results

In the logistic regression analysis, it was observed that higher quality of life score has significantly higher odds of getting higher CARE score with a remarkable odds ratio(O.R 1.0264, 1.0121,1.0261,95% C.I,P-value = 0.0001,0.0472, 0.0001).

Conclusion

The quality of life of the present population is closely associated with greater perceptions of holistic care and empathy in the therapeutic patient-provider relationship. Lack of coordination, poor quality of life and limited communication between patient and provider may arise when the latter focuses only on treating disease rather than treating a patient as a “Whole person”.
Potentially Preventable Readmissions after Acute Inpatient Rehabilitation
Authors: Herrmann Amanda A. , Chrenka Ella A. , Seth Srishti , Nyamao Tiffan M. , Niemioja Gretchen M. , Hanson Leah R. , Hussein Haitham M.
Published: April 2023

Objective

To identify causes and risk factors for potentially preventable readmissions (PPRs) of patients discharged from an inpatient rehabilitation facility (IRF).

Design

Our hospital billing database was used to identify patients discharged from our IRF between 2013-2018 and experienced a PPR within 90 days (n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the IRF who did not experience a PPR, a group of age- and sex-matched controls (n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses.

Results

Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a PPR if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common PPR diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection.

Conclusion

Identifying patients with the common causes for PPRs, in addition to the noted risk factors, are important considerations for inpatient rehabilitation discharge planning.
The Montreal Children’s Hospital Experience Managing the Robin Sequence Population: An Analysis of Outcomes and Algorithmic Approach for Surgical Technique Selection
Authors: Chocron Yehuda , Cote Aurore , Alabdulkarim Abdulaziz , Barone Natasha , Gilardino Mirko S.
Published: April 2023

Background:

The development of mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA) has led to significant improvements in respiratory outcomes for the Robin Sequence (RS) population. Despite such advances, there continues to be debate regarding management strategies. We present our experience managing the RS population with insights on technique selection.

Methods:

A retrospective review of RS patients treated at our institution from 2003-2021 was conducted. Baseline patient demographics and clinical parameters including feeding and respiratory status were recorded. Outcomes included the need for tracheostomy or tracheostomy decannulation rates and feeding status. Patients were evaluated through overnight oximetry and drug-induced sleep endoscopy (DISE). Outcomes were stratified according to management technique (MDO, TLA, vs. conservative) and compared through statistical analysis.

Results:

Fifty-nine RS patients were included. Twenty-eight were managed conservatively, 19 underwent MDO, 10 underwent TLA, one underwent both TLA and MDO and one underwent tracheostomy primarily. Overall, 1.7% of the cohort required a tracheostomy and 86% achieved oral feeding post-procedure. The MDO cohort had lower APGAR scores and mean birth weight compared to the conservative and TLA cohorts (p<0.05). There were no statistical differences in respiratory and feeding outcomes across all three cohorts.

Conclusion:

A therapeutic algorithm was developed with insight on the use of DISE and risk stratification with overnight oximetry to guide procedural selection. Using this approach, safe and satisfactory respiratory outcomes were achieved with a low tracheostomy rate. Risk stratification is possible without polysomnography and DISE is a promising tool (that requires further validation) for procedural selection in this population.
Facial palsy after orthognathic surgery: Incidence, causative mechanism, management, and outcome
Authors: Hattori Yoshitsugu , Huang Po-Cheng , Chang Chun-Shin , Chen Yu-Ray , Lo Lun-Jou
Published: April 2023

Background:

Facial palsy after orthognathic surgery is an uncommon but serious complication causing dissatisfaction and affecting quality of life. The occurrence could be under-reported. Surgeons need to recognize this issue regarding the incidence, causative mechanism, managements, and outcome.

Methods:

A retrospective review of orthognathic surgery records between January 1981 and May 2022 was conducted in our craniofacial center. Patients who developed facial palsy after the surgery were identified, and demographics, surgical methods, radiological images and photographs were collected.

Results:

A total of 20,953 sagittal split ramus osteotomy (SSRO) was performed in 10,478 patients. Twenty-seven patients developed facial palsy, resulting in an incidence of 0.13% per SSRO. In a comparison of SSRO technique, Obwegeser-Dal Pont technique using osteotome for splitting had higher risk of facial palsy than Hunsuck technique using the manual twist splitting (p<0.05). The severity of facial palsy was complete in 55.6% of patients and incomplete in 44.4%. All patients were treated conservatively, and 88.9% attained full recovery in a median (interquartile range) duration of 3 (2.75 - 6) months after surgery, whereas 11.1% remained partial recovery. Initial severity of facial palsy predicted the timing of recovery, with incomplete palsy patients having faster recovery period than the complete palsy patients (median (interquartile range); 3 (2 - 3) months versus 6 (4 - 6.25) months, respectively, p = 0.02).

Conclusion:

The incidence of facial palsy after orthognathic surgery was 0.13%. Intraoperative nerve compression was the most likely causative mechanism. Conservative treatment is the mainstay of therapeutic strategy, and full functional recovery was anticipated.
“Free chimeric SCIAP flap in reconstructing the distal complex extensor tendon injury.”
Authors: Chu Tinggang , Xiao Jian , Zhou Xijie , Lin Kang , Tao Zhenyu
Published: April 2023

The distal complex extensor tendon injury, presented as traumatic skin, zone Ⅰ-Ⅱ of EPL/EHL, and its bony insertion loss, still represents a challenging issue and requires well-vascularized skin paddle, tendinous graft and insertional reconstruction. Guided by the “all-in-one-step-reconstruction” rule, the chimeric superficial circumflex iliac artery perforator (SCIAP) flap, generally considered as a promising multiple-type tissue provider (vascularized skin paddle, fascia, or iliac flap), can fulfill the reconstructive demands and has an edge over the two-staged countermeasure. Here, we adopted the tripartite SCIAP flaps to reconstruct the distal complex thumb or toe injuries for 8 cases (6 thumbs and 2 halluces), all of which were re-attached with vascularized fascia lata-iliac crest conjunctions using the “pull-out” technique. All SCIAP flaps survived uneventfully without donor site complications. The remodeled interphalangeal joints regained near-normal radiologic manifestation. The chimeric SCIAP may be a promising technique for distal complex extensor tendon injury, providing vascularized skin paddle and fascia lata-iliac crest graft, it also qualifies for the “all-in-one-stage” reconstruction concept.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV
The Impact of Orbital Volume on Post-traumatic Enophthalmos: A Systematic Review and Meta-analysis
Authors: Murray-Douglass Alexander , Peters Matthew C. , Johnson Nigel R. , Harris Richard
Published: April 2023

Purpose:

Orbital volume increase has been previously linked with post-traumatic enophthalmos. However, this varies and some studies show no correlation. This systematic review and meta-analysis aimed to synthesize the correlation between orbital volume and enophthalmos and to determine if surgical intervention, enophthalmos measurement method, fracture location, or timing affect this correlation.

Methods:

Automation tools were used to assist in this review of 6 databases. Searches were performed across all dates. Included studies quantitatively reported orbital volume and enophthalmos following traumatic orbital wall fractures in at least 5 adult subjects. Correlational data were extracted or calculated. Random-effects meta-analysis was used with subgroup analyses for each of the secondary aims.

Results:

Twenty-five articles describing 648 patients were included. The pooled correlation between orbital volume and enophthalmos was r=0.71 (R
2=0.50, P<0.001). Operative status, enophthalmos measurement method, and fracture location did not affect pooled correlation. The delay between trauma or surgery and enophthalmos measurement was not shown to modulate correlation for unoperated patients (R
2=0.05, P=0.22) but showed a negative relationship for postoperative patients (z=−0.0281, SE=0.0128, R
2=0.63, P=0.03), but this was heavily influenced by a single article. All results had high residual heterogeneity. Studies were rated as moderate, low, or very low quality with few stating explicit hypotheses or limitations.

Conclusions:

Bony orbital volume expansion accounts for around 50% of post-traumatic enophthalmos. The other half is probably explained by soft tissue or geometric bony, rather than volumetric, changes.
An Esthetic Scoring System for Scaphocephaly Assessment and Outcomes: A Pilot Study
Authors: Van Carlen Martin , Dawes William , Hennedige Anusha , Sinha Ajay , Bordbar Patrishia , Parks Chris , Vaiude Partha , Nayar Rakhee , Quirk Debbie , Richardson David , Duncan Christian
Published: April 2023

Scaphocephaly is the commonest form of craniosynostosis with a varied presentation consisting of many morphological components and a range of possible surgical interventions. However, with regard to esthetic assessment, there is no universally applied assessment system.

The aim was to develop a simple assessment tool encompassing multiple phenotypic components of scaphocephaly. This was done by piloting a red/amber/green (RAG) scoring system to judge esthetic outcomes following scaphocephaly surgery using photographs and experienced observers.

Standard photographic views of 20 patients who had undergone either passive or anterior 2/3 vault remodelling were scored by 5 experienced assessors. Using a RAG scoring system before and after scaphocephaly correction according to 6 morphological characteristics: visual impression of cephalic index, calvarial height, bitemporal pinching, frontal bossing, posterior bullet, and displacement of the vertex. All 5 assessors were asked to score the preoperative and postoperative views independently. The RAG scores were each assigned a number (1–3) and added to give a composite score (range 6–18) and these were averaged between the 5 assessors.

There was a highly statistically significant difference between both preoperative and postoperative composite scores (P<0.0001). A subgroup analysis of the postoperative composite score between the 2 surgical techniques showed no significant difference (P=0.759).

The RAG scoring system can be used to assess esthetic change following scaphocephaly correction and it provides both a visual analogue and a numerical indicator of change. This assessment method needs further validation but is a potentially reproducible way to score and compare esthetic outcomes in scaphocephaly correction.
Prkra Mutation Alters mRNA Expression During Embryonic External Ear Development
Authors: Liu Wei , Lin Lin , Yang Qinghua , Jin Shengyang , Jiang Haiyue
Published: April 2023

To understand the changes in mRNA expression during the embryonic development of the external mouse ear after the point mutation of the Prkra gene, Prkra short ear mouse model was used to study the development of the embryonic external ear. The tissues of the embryonic external ear were obtained when mouse embryos developed to E15.5 and E17.5. The changes in the mRNA expression profile were detected and analyzed. Find_circ and CIRI2 softwares were used to identify the upregulated and down-regulated expression of mRNA in the experimental and control groups. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functional annotations were conducted on the differentially expressed mRNA, and the related signal pathways were analyzed after the upregulation and down-regulation of mRNA expression. This study aimed to understand the regulation of mRNA expression in Prkra short-ear mice during the external ear development in embryos. The results showed a correlation between abnormally expressed mRNA and signal pathways and the regulation of the development of the external ear of Prkra short-ear mice, and there were differences in some key regulatory mRNA changes after the Prkra gene point mutation. This study will provide a new clue for the mechanism of mRNA regulating the development of the external mouse ear. The change in mRNA expression profile can also provide clues for studying the biological regulation mechanism of external ear embryonic development.
Flap Necrosis Associated With Furlow’s Palatoplasty
Authors: Rossell-Perry Percy
Published: April 2023

Background:

Numerous authors have reported their outcomes after using Furlow’s palatoplasty for cleft palate repair. However, little attention has been given to the operative complications associated with this technique. The present study was carried out to present cases and analyze the various factors influencing the development of this complication accompanying Furlow’s palatoplasty.

Materials and Methods:

This is a case report study of patients with cleft palate admitted to our center due to sequelae after primary cleft palate repair using Furlow palatoplasty between 2003 and 2021. Patient information was identified from the Smile Train cleft charity organization, parents’ reports, and hospital records (intake forms and operating room registries).

Results:

Five patients were identified as having secondary cleft palate with palatal flap necrosis and associated with Furlow palatoplasty during patient evaluation at our center between 2003 and 2021. The observed prevalence was 1.54%.

Conclusions:

Palatal flap necrosis is a rare but serious complication after primary Furlow’s palatoplasty. The occurrence of this complication can be reduced by careful preoperative planning, and prevention is possible.
Anatomical Study and Clinical Application of Optic Canal Decompression Via Transethmoid-sphenoid Approach Under Endoscope
Authors: Wang Xingdong , Zhang Hengzhu , She Lei , Wang Xiaodong , Yan Zhengcun , Wei Min , Tang Can
Published: April 2023

This study aimed to evaluate the safety and accuracy of the endoscopic transethmoid-sphenoid approach for optic canal decompression. Twelve sides of 6 adult cadaveric heads fixed in formalin were selected to simulate optic canal decompression using the endoscopic transethmoid-sphenoid approach. Furthermore, this approach was used for optic canal decompression in 10 patients (11 eyes) with optic nerve canal injury. Related anatomical structures were observed using a 0-degree endoscope, and the anatomical characteristics as well as the surgical data were collected. The maximum effective widths of the cranial opening, orbital opening, and middle segment of the canal that could be drilled open endoscopically were 7.82±2.63, 8.05±2.77, and 6.92±2.01 mm, respectively. The angle between the line linking the center point of the tubercular recess with the midpoint of the cranial opening of the optic canal and the horizontal coordinate was 17.23±1.34 degrees. At the orbital opening of the optic canal, the ophthalmic artery was located directly inferior to the optic nerve in 2 cases (16.7%) and laterally inferior to the optic nerve in 10 cases (83.3%). Six of the operational eyes were effective while the remaining 5 were ineffective. No postoperative complications such as bleeding, infection, or cerebrospinal fluid leakage were observed during the follow-up period (6–12 mo). In conclusion, optic canal decompression positively impacts the prognosis of partial traumatic optic neuropathy. Furthermore, the endoscopic transethmoid-sphenoid approach for optic canal decompression is a minimally invasive procedure that provides direct access and adequate decompression. This technique is easy to master and suitable for clinical applications.
Analysis of Survival Quality of Peroneal Artery Perforator Flap in Immediate Repairment and Reconstruction of Oral and Maxillofacial Malignancies
Authors: Song Peijun , Liang Qiu , Qian Yunzhu , Li Jiancheng
Published: April 2023

Objective:

This study aimed to investigate the survival quality of peroneal artery perforator flap in the reconstruction of oral and maxillofacial malignant tumors.

Methods:

Thirty-two cases with a diagnosis of oral and maxillofacial malignant tumors admitted to our hospital from January 2019 to December 2019 were randomly divided into 2 groups. The observation group was reconstructed with free open artery perforator flaps, and the control group was repaired with free forearm flaps.

Results:

The observation group had significantly lower scores in terms of postoperative pain, appearance, and anxiety, compared with the control group (P<0.05). Both groups had high scores on taste, saliva, and shoulder function although there was no significant difference (P>0.05). The scores of the observation group were significantly higher than those in the control group in terms of chewing, swallowing, speech, activity, mood, and entertainment (P<0.05). There was 1 case accompanied by postoperative wound dehiscence and 2 cases with wound infection in the observation group while there were 3 cases with wound dehiscence and 2 cases with wound infection in the control group (P>0.05).

Conclusion:

Compared with the forearm flap, the peroneal artery perforator flap can improve the survival quality of patients, especially in postoperative function with the fibula joint to repair the oral and maxillofacial defects. It has a wide application prospect as one of the ideal flaps in oral and maxillofacial postoperative repair and reconstruction.
Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis
Authors: Sayegh Aref S. , Eppler Michael , Sholklapper Tamir , Goldenberg Mitchell G. , Perez Laura C. , La Riva Anibal , Medina Luis G. , Sotelo Rene , Desai Mihir M. , Gill Inderbir , Jung James J. , Kazaryan Airazat M. , Edwin Bjørn , Biyani Chandra Shekhar , Francis Nader , Kaafarani Haytham MA , Cacciamani Giovanni E.
Published: April 2023

Introduction:

The accurate assessment and grading of adverse events (AE) is essential to ensure comparisons between surgical procedures and outcomes. The current lack of a standardized severity grading system may limit our understanding of the true morbidity attributed to AEs in surgery. The aim of this study is to review the prevalence in which intraoperative adverse event (iAE) severity grading systems are used in the literature, evaluate the strengths and limitations of these systems, and appraise their applicability in clinical studies.

Methods:

A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Scopus were queried to yield all clinical studies reporting the proposal and/or the validation of iAE severity grading systems. Google Scholar, Web of Science, and Scopus were searched separately to identify the articles citing the systems to grade iAEs identified in the first search.

Results:

Our search yielded 2957 studies, with 7 studies considered for the qualitative synthesis. Five studies considered only surgical/interventional iAEs, while two considered both surgical/interventional and anesthesiologic iAEs. Two included studies validated the iAE severity grading system prospectively. A total of 357 citations were retrieved, with an overall self/non-self-citation ratio of 0.17 (53/304). The majority of citing articles were clinical studies (44.1%). The average number of citations per year was 6.7 citations for each classification/severity system, with only 2.05 citations/year for clinical studies. Of the 158 clinical studies citing the severity grading systems, only 90 (56.9%) used them to grade the iAEs. The appraisal of applicability (mean%/median%) was below the 70% threshold in 3 domains: stakeholder involvement (46/47), clarity of presentation (65/67), and applicability (57/56).

Conclusion:

Seven severity grading systems for iAEs have been published in the last decade. Despite the importance of collecting and grading the iAEs, these systems are poorly adopted, with only a few studies per year using them. A uniform globally implemented severity grading system is needed to produce comparable data across studies and develop strategies to decrease iAEs further improving patient safety.
Liver Transplantation vs Partial Hepatectomy for Stage T2 Multifocal Hepatocellular Carcinoma <3 cm Without Vascular Invasion: A Propensity Score-Matched Survival Analysis
Authors: Wong Linda L , Landsittel Douglas P , Kwee Sandi A
Published: April 2023

BACKGROUND:

Multifocal hepatocellular carcinoma (HCC) differs biologically and immunologically from single-nodule HCC. Asian and European guidelines consider liver transplantation (LT) and partial hepatectomy (PH) as effective for T2 multifocal HCC, with preference toward LT, but few US studies compare these treatments directly. This propensity score–based observational study uses an established national cancer outcomes registry to compare overall survival in patients undergoing PH and LT for multifocal HCC.

STUDY DESIGN:

Data from the 2020 National Cancer Database were obtained on patients who underwent LT or PH for multifocal stage 2 HCC within Milan criteria and without vascular invasion. Propensity score matching and Cox regression analysis was applied to evaluate overall survival in an observational cohort balanced by age, sex, treatment facility type, treatment year, prothrombin time, α-fetoprotein, comorbidity burden, liver fibrosis severity, and pretreatment creatinine and bilirubin levels.

RESULTS:

Of 21,248 T2 HCC patients identified, 6,744 had multifocal tumors with largest tumor diameter <3 cm without major vascular invasion, with 1,267 and 181 having undergone LT and PH, respectively. Propensity score–matched Cox regression analysis associated LT with a hazard ratio of 0.39 (95% CI 0.30 to 0.50) relative to PH. Landmark analyses to account for a longer interval to LT demonstrated survival benefits of similar magnitude.

CONCLUSIONS:

Although early-stage HCC can be effectively treated with either LT or PH, propensity score–matched analysis comparatively shows a survival benefit for LT in patients with multifocal HCC who are within the Milan criteria.
Pseudoaneurysm after High-Grade Penetrating Solid Organ Injury and Utility of Delayed CT Angiography
Authors: Schellenberg Morgan , Owattanapanich Natthida , Emigh Brent , Nichols Chance , Dilday Joshua , Ugarte Chaiss , Onogawa Atsushi , Matsushima Kazuhide , Martin Matthew J , Inaba Kenji
Published: April 2023

BACKGROUND:

Leaving an injured solid organ in situ allows preservation of structure function but invites complications from the damaged parenchyma, including pseudoaneurysms (PSAs). Empiric PSA screening after solid organ injury is not yet established, particularly following penetrating trauma. The study objective was definition of delayed CT angiography (dCTA) yield in triggering intervention for PSA after penetrating solid organ injury.

METHODS:

Penetrating trauma patients at our American College of Surgeons–verified level 1 center with American Association for the Surgery of Trauma grade ≥3 abdominal solid organ injury (liver, spleen, kidney) were retrospectively screened (January 2017 to October 2021). Exclusions were age <18 y, transfers, death within <48 h, and nephrectomy/splenectomy within <4 h. Primary outcome was intervention triggered by dCTA. Statistical testing with ANOVA/chi-square compared outcomes between screened vs unscreened patients.

RESULTS:

A total of 136 penetrating trauma patients met study criteria: 57 patients (42%) screened for PSA with dCTA and 79 (58%) unscreened. Liver injuries were most common (n = 41, 64% vs n = 55, 66%), followed by kidney (n = 21, 33% vs n = 23, 27%) and spleen (n = 2, 3% vs n = 6, 7%) (p = 0.48). Median American Association for the Surgery of Trauma grade of solid organ injury was 3 (3 to 4) across groups (p = 0.75). dCTA diagnosed 10 PSAs (18%) at a median of hospital day 5 (3 to 9). Among screened patients, dCTA triggered intervention in 17% of liver patients, 29% of kidney patients, and 0% of spleen-injured patients, for an overall yield of 23%.

CONCLUSIONS:

Half of eligible penetrating high-grade solid organ injuries were screened for PSA with dCTA. dCTA identified a significant number of PSAs and triggered intervention in 23% of screened patients. dCTA did not diagnose any PSAs after splenic injury, although sample size hinders interpretation. To avoid missing PSAs and incurring their risk of rupture, universal screening of high-grade penetrating solid organ injuries may be prudent.
Genome analysis-based union of the genera Youhaiella and Paradevosia, and proposal that Methyloterrigena soli Kim et al. 2016 is a later heterotypic synonym of Paradevosia shaoguanensis Geng et al. 2015
Authors: Li Wei , Zi Zhi-Da , Ma Fu , Xie Bing , Lv Jie
Published: April 2023

Phylogenetic tree analysis of

Youhaiella tibetensis

F4T,

Paradevosia shaoguanensis

J5-3T and

Methyloterrigena soli

M48T based on 16S rRNA gene sequences revealed that the three genera did not form distinct and independent monophyletic clusters. The 16S rRNA gene sequence similarities were all higher than 99 % between each pair of the three type strains. Average nucleotide identity, digital DNA–DNA hybridization, average amino acid identity and 16S rRNA gene sequence similarity between

Paradevosia shaoguanensis

J5-3T and

Methyloterrigena soli

M48T showed that they represented the same species. Physiological and biochemical characteristics of these three strains were similar, such as motility by polar flagella, major respiratory quinone, polar lipids, and fatty acids. Polygenetic trees and other characteristic comparative analysis revealed the need to merge the genera

Youhaiella

and

Paradevosia

into one genus.
Comparative genomic analysis of the genus Weissella and taxonomic study of Weissella fangxianensis sp. nov., isolated from Chinese rice wine starter
Authors: Xiang Fanshu , Dong Yun , Cai Wenchao , Zhao Huijun , Liu Huijie , Shan Chunhui , Guo Zhuang
Published: April 2023

In this study, three lactic acid bacteria, namely, HBUAS51963T, HBUAS51964 and HBUAS51965, were isolated from Chinese rice wine starter sampled in Fangxian County, PR China. All were non-motile, non-spore-forming and Gram-positive spherical cells. Their taxonomic status was characterized using a polyphasic approach. Genome-based analysis revealed that all three strains were phylogenomically related to

Weissella thailandensis

KCTC 3751T and

Weissella paramesenteroides

ATCC 33313T. The digital DNA–DNA hybridization (dDDH) and average nucleotide identity (ANI) values between the three strains and the phylogenetically related type strains were less than 54.8 and 93.8 %, respectively, and thus, they were below the thresholds of dDDH and ANI for species definition. The genomic DNA G+C content was 38.6 mol %. The predominant fatty acid methyl esters (>10 %) were C16 : 0, C19 : 0 cyc11 and summed feature 10 (C18 : 1 cyc11 and/or ECL 17.834). The polar lipids in the cells of strain HBUAS51963T were mainly phosphatidylglycerol, diphosphatidylglycerol, unidentified glycolipids, phospholipids and lipids. Finally, the three strains were capable of producing d-lactic acid (4.29 g l–1) and various organic acids such as tartaric, acetic, lactic and succinic acids. Overall, the results of genotypic, phenotypic and genomic analyses suggest that the three strains represent a new species of the genus

Weissella

, for which the name Weissella fangxianis sp. nov. is proposed. The type strain is HBUAS51963T (=GDMCC 1.3506T= JCM 35803T).
Genomic characterization of enterohaemolysin-encoding haemolytic Escherichia coli of animal and human origin
Authors: Sidorczuk Katarzyna , Aleksandrowicz Adrianna , Burdukiewicz Michał , Kingsley Robert A. , Kolenda Rafał
Published: April 2023

Enterohaemolysin (Ehx) and alpha-haemolysin are virulence-associated factors (VAFs) causing the haemolytic phenotype in

Escherichia coli

. It has been shown that chromosomally and plasmid-encoded alpha-haemolysin are characteristic of specific pathotypes, virulence-associated factors and hosts. However, the prevalence of alpha- and enterohaemolysin does not overlap in the majority of pathotypes. Therefore, this study focuses on the characterization of the haemolytic

E. coli

population associated with multiple pathotypes in human and animal infectious diseases. Using a genomics approach, we investigated characteristic features of the enterohaemolysin-encoding strains to identify factors differentiating enterohaemolysin-positive from alpha-haemolysin-positive

E. coli

populations. To shed light on the functionality of Ehx subtypes, we analysed Ehx-coding genes and inferred EhxA phylogeny. The two haemolysins are associated with a different repertoire of adhesins, iron acquisition or toxin systems. Alpha-haemolysin is predominantly found in uropathogenic

E. coli

(UPEC) and predicted to be chromosomally encoded, or nonpathogenic and undetermined

E. coli

pathotypes and typically predicted to be plasmid-encoded. Enterohaemolysin is mainly associated with Shiga toxin-producing

E. coli

(STEC) and enterohaemorrhagic

E. coli

(EHEC) and predicted to be plasmid-encoded. Both types of haemolysin are found in atypical enteropathogenic

E. coli

(aEPEC). Moreover, we identified a new EhxA subtype present exclusively in genomes with VAFs characteristic of nonpathogenic

E. coli

. This study reveals a complex relationship between haemolytic

E. coli

of diverse pathotypes, providing a framework for understanding the potential role of haemolysin in pathogenesis.
Structural and functional investigation of a fungal member of carbohydrate esterase family 15 with potential specificity for rare xylans
Authors: Mazurkewich Scott , Scholzen Karoline C. , Brusch Rikke H. , Poulsen Jens-Christian N. , Theibich Yusuf , Hüttner Silvia , Olsson Lisbeth , Larsbrink Johan , Lo Leggio Leila
Published: April 2023

In plant cell walls, covalent bonds between polysaccharides and lignin increase recalcitrance to degradation. Ester bonds are known to exist between glucuronic acid moieties on glucuronoxylan and lignin, and these can be cleaved by glucuronoyl esterases (GEs) from carbohydrate esterase family 15 (CE15). GEs are found in both bacteria and fungi, and some microorganisms also encode multiple GEs, although the reason for this is still not fully clear. The fungus Lentithecium fluviatile encodes three CE15 enzymes, of which two have previously been heterologously produced, although neither was active on the tested model substrate. Here, one of these, LfCE15C, has been investigated in detail using a range of model and natural substrates and its structure has been solved using X-ray crystallography. No activity could be verified on any tested substrate, but biophysical assays indicate an ability to bind to complex carbohydrate ligands. The structure further suggests that this enzyme, which possesses an intact catalytic triad, might be able to bind and act on more extensively decorated xylan chains than has been reported for other CE15 members. It is speculated that rare glucuronoxylans decorated at the glucuronic acid moiety may be the true targets of LfCE15C and other CE15 family members with similar sequence characteristics.
Risk analysis of public-private partnership waste-to-energy incineration projects in China: a hybrid fuzzy DEMATEL-ISM approach
Authors: Cheng Min , Liu Lin , Cheng Xiaotong , Tao Li
Published: April 2023

Purpose

Many waste-to-energy (WTE) plants are constructed and operated using the public-private partnership (PPP) mode in China. However, risk events of PPP WTE incineration projects sometimes occur. This study aims to clarify the relationship of risks in China's PPP WTE incineration projects and identify the key risks accordingly and risk transmission paths.

Design/methodology/approach

A risk list of PPP WTE incineration projects was obtained based on literature analysis. Moreover, a hybrid approach combining fuzzy sets, decision-making trial and evaluation laboratory (DEMATEL) and interpretive structural modeling (ISM) was developed to analyze the causality of risks, explore critical risks and reveal the risk transmission paths. The quantitative analysis process was implemented in MATLAB.

Findings

The results show that government decision-making risk, government credit risk, government supervision behavior risk, legal and policy risk, revenue and cost risk and management capacity risk are the critical risks of PPP WTE incineration projects in China. These critical risks are at different levels in the risk hierarchy and often trigger other risks.

Originality/value

Currently, there is a lack of exploration on the interaction between the risks of PPP WTE incineration projects. This study fills this gap by examining the key risks and risk transfer pathways of PPP WTE incineration projects from the perspective of risk interactions. The findings can help the public and private sectors to systematically understand the risks in PPP WTE incineration projects, thus enabling them to identify the risks that need to be focused on when making decisions and to optimize risk prevention strategies. The proposed hybrid approach can offer methodological ideas for risk analysis of other types of PPP projects.
The Anthropocene and the sustainable development goals: key elements in geography higher education?
Authors: Martínez-Hernández Carlos , Mínguez Carmen
Published: April 2023

Purpose

The current “Anthropocene” epoch has witnessed an imbalanced global change, but it is an opportunity to design a better and sustainable future. Sustainability criteria need to be fully implemented in political institutions, companies and universities. Moreover, sustainable pedagogies must accompany the process in terms of students’ professional competences to overcome crisis situations. This paper aims to evaluate geography degrees in Spain to corroborate whether students and teachers consider that students are prepared to address the challenges of global change.

Design/methodology/approach

The research is focused on the sustainable development goals (SDGs), a clear and easily identifiable framework for society that reflects the principles of the UN 2030 Agenda. A statistically validated questionnaire answered by 319 respondents has been used. Data analysis with descriptive and inferential techniques was performed.

Findings

The results show that geography degrees do not meet the needs of students, for whom career opportunities will be related to the implementation of the 2030 Agenda; there are significant gaps between the perception of teachers and students; some geographical topics are undervalued; SDGs are more present in optional subjects; and there is a need to “sustain” the curriculum, following this highly valued framework.

Originality/value

Geography educative programs had scarcely been empirically evaluated to check a sustainability framework implementation. This research provides innovative and unprecedented self-assessment results from higher education agents, in an empirical and statistically validated way.
COVID‐19 vaccine–associated vitiligo: A cross‐sectional study in a tertiary referral center and systematic review
Authors: Tsai Tsung‐Fu , Ng Chau Yee
Published: April 2023

As the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus continues to infect patients globally, vaccination remains one of the primary methods to combat this prolonged pandemic. However, there are growing reports of coronavirus disease 2019 (COVID‐19) vaccines possibly triggering autoimmunity, irrespective of the vaccine's design. This phenomenon has been observed in patients with vitiligo, with a rising number of cases reporting new‐onset or worsening vitiligo following COVID‐19 vaccinations. In this study, the authors present the most extensive case series of COVID‐19 vaccine–associated vitiligo to date, along with a systematic review of the literature. The aim is to assist physicians in the clinical evaluation of patients with vitiligo with regard to future vaccinations.
Clean energy, clean water, and quality education: Prospects of achieving Sustainable Development Goals (SDGs) in Sri Lanka
Authors: Wijayarathne J. M. D. Sandamali , Hassan Gazi M. , Holmes Mark J.
Published: April 2023

The Sustainable Development Goal (SDG) 7 targets universal access to affordable, reliable, and modern energy services by 2030. Modern or clean energy is perceived to be the golden thread that connects economic growth, human development, and environmental sustainability. However, one third of the world's population still uses solid fuels for cooking, endangering human health, and the environment. This paper, therefore, analyses demographic, socio‐economic, and housing characteristics that affect the fuel choice for cooking. Further, it identifies how SDG 4 (quality education) and SDG 6 (clean water) create synergies with SDG 7 (clean energy). The data are obtained from the four waves of the Sri Lankan Households Income and Expenditure Survey, covering more than 79,000 households. The random‐effects panel multinomial logit results reveal that household income, wealth, marital status and education of the head, age and education of the spouse, household size, number of children, housing characteristics, and residential sector are vital in selecting clean fuel for cooking. Furthermore, advanced sustainability analysis shows SDG 4 and 6 have a strong synergistic effect on SDG 7. Policymakers can use the findings to prioritise educational, water, and sanitation programmes in national policies aimed at enhancing the use of clean cooking fuel and technologies to meet SDG 7 by 2030.