bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound-guided Genicular Nerve Block in Patients Undergoing Knee Arthroscopy: A Randomized Controlled Trial
Authors: Liu Qian , Zhong Qing , Tang Guoqiang , Yang Pingliang , Ye Ling
Published: October 2024

This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into two groups: 1. nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral and inferomedial genicular nerve, 2-ml 0.5% ropivacaine each nerve.) prior to the general anesthesia, 2. control group: no intervention prior to the general anesthesia. The measurements were pain severity at 3,6, 12, 24, 48, and 72 hours after surgery at rest and at activity(Pain severity was primary outcome at 3 hours after surgery at rest); the time for first ambulation; straight leg raise; mechanical pain threshold of the block areas; time of the surgery, anesthesia and extubation; the use of analgesics in the perioperative period and 72 hours after the surgery; the number of patients awakening from pain on the first two nights after the surgery; the length of hospital stay; postoperative adverse effects. The pain severity was performed by VAS (A 10-point visual analogue scale, 0 points painless, 10 points severe pain) and median (interquartile range; IQR). A total of 70 patients (median age: 53 y, 32 men; 35 per group) were included. Compared to the control group, the nerve block group had a lower pain VAS score at rest (2[2-2] vs. 3[2-4], P<0.01) at 3 hours, and lower pain VAS score at rest persisted for 24 hours and activity persisted for 12 hours after the surgery, also had lower intraoperative dosage of sufentanil (20±4.8 vs. 28.5±5.1 mg; P<0.001), lower requirement for analgesics for pain and lower PONV (postoperative nausea and vomiting) throughout the 72-hour observation period. There were no significant difference for the incidence of postoperative adverse effects and straight leg raise. In conclusion, ultrasound-guided genicular nerve block could reduce the pain severity after knee arthroscopy and decrease the use of intraoperative sufentanil without affecting motor function.
Rotator Cuff Tear and Associated Risk Factors. The Mutual Role of Medical Conditions
Authors: Preziosi Standoli Jacopo , Candela Vittorio , Gumina Stefano
Published: October 2024

■:

Several medical conditions (diabetes, cardio-vascular diseases, hypercholesterolemia etc.) or modifiable behavioral habits (smoking habit and alcohol assumption) capable of causing a damage to the peripheral microcirculation are considered potential risk factors for degeneration/tear of the rotator cuff. The aim of the study was to analyse and quantify how the association of multiple known risk factors is more effective than the predisposing action of a single factor. 308 consecutive patients who underwent arthroscopic repair of a full-thickness Rotator Cuff Tear (RCT) represented the case group. The control group included 388 consecutive healthy asymptomatic subjects for shoulder pathologies. A multivariable prognostic model for the prediction of rotator cuff tear has been performed to analyse the mutual effect of multiple risk factors. With a correct classification estimated at 70.6% a smoker patient (OR=2.405; CI95%=1.645-3.516) with hypercholesterolemia (OR=1.976; CI95%=1.408-2.771), diabetes (OR=2.362; CI95%=1.241-4.493) and arterial hypertension (OR=1.630; CI95%=1.156-2.300) has a higher chance of developing a rotator cuff tear surgery compared to a peer non-smoker healthy subject. Probability of a smoker patient suffering from hypercholesterolemia, diabetes, and arterial hypertension to undergo rotator cuff repair surgery is not given by the sum of the probabilities of each condition but increases drammatically. Each pathology interacts with each other; dramatically increasing the risk of developing a cuff tear.

Level of Evidence:

III Retrospective Study
Effect Analysis of Early Rehabilitation Therapy Combined with Repetitive Transcranial Magnetic Stimulation on Postoperative Rehabilitation of Sports Knee Injury
Authors: Feng Shuolei , Shi Xiaoping , Cao Xiaodong , Zhao Jinwei
Published: October 2024

Objective:

To analyze the effectiveness of combined early rehabilitation therapy and repetitive transcranial magnetic stimulation (rTMS) in the postoperative rehabilitation of patients with sports knee injuries (SKI).

Methods:

A total of 62 SKI patients from June 2021 to June 2022 were randomly selected by computer and divided into group A (31 cases, early rehabilitation therapy) and group B (31 cases, early rehabilitation therapy +rTMS) by numbered envelope method. The effects of the two groups were compared.

Results:

After treatment, the pain frequency and pain intensity in group B were lower than in group A, while the completion of knee movements without significant pain, the degree of knee swelling, and the impact of the knee on activities were higher in group B than in group A; the Lysholm score and inflammatory factor indicators in group B were superior to those in group A (all P<0.05).

Conclusion:

The combination of early rehabilitation therapy and rTMS in postoperative rehabilitation of SKI patients has better effects on knee joint function and inflammation.
Factors that Influence Recovery From Concussion in Young Children and Preadolescents
Authors: Datoc Alison E. , Mathew Abel S. , Choi Daniel M. , Price August , Lauman Samuel , Hartland Lindsey C. , Boucher Sarah J. , Ellis Christine S. , Abt John P.
Published: October 2024

Objective:

To examine differences in the presentation and management of concussion in younger children (aged 4–8 years) versus preadolescents (9–12 years) and identify factors that influence recovery time.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Pediatric sports medicine and orthopedics clinic.

Patients:

Three hundred seventy-five patients aged 4 to 12 years diagnosed with concussion between 2020 and 2022.

Independent Variables:

Age, gender, race/ethnicity, mechanism of injury (sport vs nonsport related), neurodevelopmental or psychiatric diagnosis, concussion history, Post-Concussion Symptom Scale (PCSS) score, and Vestibular Ocular Motor Screening (VOMS) overall change scores.

Main Outcome Measures:

Days since injury (DSI) to initial visit, total number of visits, recovery time (days).

Results:

Groups significantly differed in DSI (P = 0.01) and overall VOMS change score (P = 0.03). No differences were observed between groups on total number of visits or recovery time. Patients with fewer DSI [odds ratio (OR) = 1.15], less change in overall VOMS score (OR = 1.02), lower PCSS scores (OR = 1.02), and who were injured in sport were less likely to experience a protracted recovery.

Conclusions:

Younger children with concussion may be appropriately treated with a similar approach to preadolescent patients despite greater DSI and differences in VOMS change scores, without sacrificing overall recovery time. Consistent with research in older cohorts, protracted recovery was seen in nonsport patients, and patients seen sooner at a specialty concussion clinic were less likely to experience a protracted recovery, endorsed lower PCSS scores, and had lower overall VOMS change scores. Further research is needed to solidify a child-specific paradigm to concussion management.
Adenomatous Polyposis Coli Gene Mutations, Risk Factors, and Long-term Outcomes Associated With Desmoid Tumors in Patients With Familial Adenomatous Polyposis After Colectomy in Japan
Authors: Kojima Tadahiro , Kurachi Kiyotaka , Iwaizumi Moriya , Tatsuta Kyota , Sugiyama Kosuke , Akai Toshiya , Sakata Mayu , Morita Yoshifumi , Kikuchi Hirotoshi , Hiramatsu Yoshihiro , Takeuchi Hiroya
Published: October 2024

Goals:

To clarify the characteristics of desmoid tumors in Japanese patients with familial adenomatous polyposis after colectomy.

Background:

Few comprehensive reports have been published on desmoid tumors in Asian patients with familial adenomatous polyposis.

Study:

This retrospective study included the data of 81 patients with familial adenomatous polyposis who underwent surgery between 1978 and 2021. The adenomatous polyposis coli gene mutation sites, risk factors, and long-term outcomes associated with desmoid tumors in Japanese patients with familial adenomatous polyposis after colectomy were analyzed.

Results:

No association was observed between the gene mutation sites and desmoid tumor development in 40 patients who underwent genetic analyses. The rate of desmoid tumor development was 30.3% in 66 patients. Multivariate analysis revealed that age below 32 years at colectomy (hazard ratio = 5.491, 95% confidence interval 1.820-16.50, P < 0.001) and familial adenomatous polyposis-related malignancies other than colorectal cancer (hazard ratio = 5.574, 95% confidence interval 2.075-14.98, P < 0.001) were independent risk factors for desmoid tumor development following colectomy. The 10-year disease-specific survival and overall survival rates for desmoid tumors were 92.9% and 76.9%, respectively. The median surveillance duration was 90 months.

Conclusions:

Adenomatous polyposis coli gene mutation sites alone were not considered a factor for delaying or avoiding colectomy to prevent desmoid tumors in Japanese patients with familial adenomatous polyposis. The timing of colectomy and careful surveillance should be considered for managing patients at a high risk of developing desmoid tumors. Desmoid tumors in patients with familial adenomatous polyposis did not significantly impact prognosis, and pharmacological treatments are important for disease control.
Comparison of predictors of survival among fulminant myocarditis patients undergoing veno-arterial extracorporeal membrane oxygenation in the adult and pediatric populations
Authors: Dean Yomna E. , Doma Mohamed , Afzal Ahson , Elawady Sameh Samir , Elmezayen Rafeek W. , Bamousa Bdoor Ahmed A. , Iqbal Naila , Megiso Muluken Zeleke , Kodurum Sriharsha , Ramadan Adham , El Bahaie Mahmoud , Magdi Ahmed , Afzal Fatima , Badr Helmy , Katamesh Basant , Ismail Dina , Etman Yasser , Hazimeh Yusef , Darling Edward , Aiash Hani
Published: October 2024

Background:

Fulminant myocarditis (FM) is a potentially life-threatening disease that requires emergency care. The authors’ study aims to explore clinical outcomes and predictors of survival when using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for the treatment of FM in adult and pediatric patients to analyze differences between both populations.

Methods:

PubMed, Scopus, Web of Science, and Cochrane databases were searched for studies reporting the effect of VA-ECMO on patients diagnosed with fulminant myocarditis. Statistical analysis was performed using R version 4.2.2.

Results:

Forty-three studies were included in our analysis with a total of 1268 patients. Survival rates were 65% and 71% among adult and pediatric patients, respectively. Patients who didn’t suffer from cardiac arrest prior to VA-ECMO had better chances of survival in both populations; adults (OR 0.44; P<0.01) and pediatric (OR = 0.32; P= 0.006). Younger age was associated with higher survival among the adults (MD= −8.81; P<0.01). Additionally, pre-ECMO LVEF was higher among survivors in the pediatric group (MD= 8.23; P<0.01). Furthermore, no significant association was detected between sex, VA-ECMO duration, systolic blood pressure, lactate levels, and survival rates among both groups.

Conclusion:

Using VA-ECMO in patients with fulminant myocarditis can significantly improve survival outcomes, with improved prognosis observed with younger age among adults and absence of prior history of cardiac arrest in both groups.
Anterior communicating artery aneurysm with concomitant A2 segment triplication and anterior communicating artery fenestration, A rare case series on microsurgical treatment
Authors: Hosseini Ehsan Mohammad , Aghamiri Seyed Hossein , Haridas Abilash , Natarajan Sabareesh , Peyvandi Maryam , Sourani Arman
Published: October 2024

Introduction and importance:

There are few cases of multiple simultaneous anterior communicating artery (AComA) aneurysms with A2 triplication and AComA duplication.

Cases presentation:

(1) A fenestrated AComA with a saccular aneurysm (neck diameter 9 mm; dome height 8 mm) projecting superiorly from the distal AComA branch, as well as an anomalous artery arising from the posterior surface of the same AComA. (2) A duplicate AComA with a saccular aneurysm (neck diameter of 5 mm; dome height of 9 mm) projecting superioposteriorly from the distal AComA branch, as well as an anomalous artery arising from the anterior surface of the same AComA was diagnosed. Both were treated by microsurgical titanium clip occlusion.

Clinical discussion:

Anatomical variations are believed to enhance the risk of anterior communicating artery (AComA) aneurysms, accounting for ~30% of all intracranial aneurysms. In such circumstances, the goal is to occlude the aneurysmal lesions safely while preserving the patency of other branches.

Conclusion:

AComA aneurysms accompanied by anomalous triplicated A2 and fenestrated AComA are rare and challenging. Such complex cases response best using microsurgery using titanium clip occlusion with durable favorable outcomes.
Clinical diagnosis and management of spinocerebellar ataxia in a resource-constrained setting: a case report from Eastern Nepal
Authors: Adhikari Nabin , Pokhrel Popular , KC Priyanka , Kumar Sah Navin , Shah Bhupendra
Published: October 2024

Introduction:

Spinocerebellar ataxias (SCA) are a diverse group of neurodegenerative disorders with autosomal dominant inheritance, primarily affecting the cerebellum and its connections. Diagnosis typically involves genetic testing, but in resource-limited settings, clinical and neuroimaging assessments become critical. This case report highlights the role of nongenetic methods in diagnosing SCA and outlines management strategies in such settings.

Case Presentation:

A 41-year-old male presented with a 2-year history of progressive gait imbalance, headache, and abnormal speech. He had a family history of similar symptoms in two siblings, but no significant past medical history. Clinical examination revealed scanning speech, dysmetria, and a broad-based gait. Clinical and neuroimaging findings, including cerebellar atrophy, led to a diagnosis of SCA in the absence of genetic testing. Patient management with speech, occupational, and physical therapies, showed gradual improvement.

Discussion:

SCA, characterized by cerebellar atrophy and a range of clinical symptoms, is typically diagnosed through genetic testing, but clinical and imaging assessments are crucial when genetic resources are limited. This case illustrates that a comprehensive clinical evaluation, including neuroimaging, can support the diagnosis of SCA even without genetic testing. Strategic management emphasizing symptomatic relief and functional improvement through a multidisciplinary approach, including regular follow-up and personalized therapy, are crucial, as evidenced by the timely improvement observed in our case.

Conclusion:

In resource-limited settings, a comprehensive clinical and neuroimaging assessment is essential for diagnosing spinocerebellar ataxia when genetic testing is not feasible. Effective management through multidisciplinary therapies can improve patient outcomes, underscoring the need for innovative strategies to enhance diagnostic and treatment capabilities in such environments.
Eyebrow bleeding as a rare migraine symptom: a case report
Authors: Tavasoli Azita , Rezazadeh Mohammad , Kachuei Maryam
Published: October 2024

This case report documents a rare presentation of eyebrow bleeding occurring during migraine episodes in a 10-year-old girl, highlighting atypical signs associated with the disorder. Despite her normal neurological examinations and imaging studies, the patient experienced recurrent, severe headaches accompanied by localized bleeding and red spots on the forehead. This unusual symptomatology suggests potential underlying neurovascular and neuroinflammatory mechanisms, necessitating heightened awareness among healthcare providers. Following treatment with Coenzyme Q10, Vitamin B2, and Cyproheptadine, both headache frequency and symptom intensity significantly improved. This case underscores the importance of comprehensive evaluation and recognition of uncommon migraine manifestations in clinical practice.
Hoyeraal–Hreidarsson syndrome: a case report of dyskeratosis congenita with a novel PARN gene mutation
Authors: Çalişkan Kamiş Şule , Çil Metin , Yağci-Küpeli Begül
Published: October 2024

Introduction and importance:

Dyskeratosis congenita (DC) is a rare multisystem disorder primarily characterized by bone marrow failure due to telomere shortening. Typical clinical features include oral leukoplakia, skin hyperpigmentation, and nail dystrophy, along with an increased risk of malignancies. Hoyeraal–Hreidarsson syndrome (HH), a severe variant of DC, is associated with profound neurological and immunological complications, emphasizing the importance of early diagnosis and genetic evaluation to guide appropriate management.

Case presentation:

The authors present a case of a 2-year-old girl diagnosed with Hoyeraal–Hreidarsson syndrome, linked to a newly discovered mutation in the poly (A)-specific ribonuclease (PARN) gene. The patient exhibited intrauterine growth retardation (IUGR), congenital cytomegalovirus (CMV) infection, immunodeficiency, microcephaly, and cerebellar hypoplasia. Whole-exome sequencing (WES) identified a novel mutation in the PARN gene.

Clinical discussion:

Hoyeraal–Hreidarsson syndrome, a severe form of DC, manifests with multisystem involvement and is genetically heterogeneous. Early genetic testing through techniques such as WES can aid in diagnosing rare syndromes like HH and guide treatment strategies, including bone marrow transplantation.

Conclusion:

This case underscores the importance of genetic evaluation in complex, rare syndromes like HH. Whole-exome sequencing plays a crucial role in identifying pathogenic mutations and tailoring management. The patient’s prognosis is being closely monitored following bone marrow transplantation.
Burnout among Nurses, Midwives, and Physicians in Maternity Care Exposed to Traumatic Childbirth Events
Authors: Robinson Keisha A. , Atlas Robert O. , Storr Carla L. , Gaitens Joanna M. , Blanchard May , Ogbolu Yolanda
Published: October 2024

Purpose:

To describe the relationship between experiencing traumatic childbirth events and burnout.

Study Designs and Methods:

This descriptive cross-sectional study used an anonymous online survey to assess traumatic childbirth event exposure and the three independent constructs of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Participants were a convenience sample of registered nurses, obstetric residents, family medicine residents, and attending obstetricians across five hospitals from December 2020 through June 2021. The traumatic childbirth event questionnaire measured the frequency of traumatic childbirth event exposure, perception of severity, and perceived influence on the participant's professional practice and personal life.

Results:

Data were analyzed from 150 participants. Registered nurses represented the largest percentage of participants (66%). Components of burnout varied according to race and occupation. Asian/Pacific Islanders had significantly higher mean depersonalization scores at 10.1 (SD = 6.0). Resident physicians had the highest emotional exhaustion scores (M = 34.6, SD = 8.8). Traumatic childbirth events perceived influence on practice correlates with personal accomplishments. Yet, no relationship was observed between traumatic childbirth events, emotional exhaustion, and depersonalization. Linear mixed analysis revealed that hospitals account for 7.5% of the variance in emotional exhaustion scores, 11.1% in depersonalization scores, and 1.3% in personal accomplishments scores.

Clinical Implications:

Maternity clinicians experience burnout at similar rates to those in other specialties. Although traumatic childbirth events are infrequent and not strongly correlated with emotional exhaustion and depersonalization, hospitals should implement effective strategies to support clinicians after such events. Educational interventions can enhance knowledge and resilience, whereas specialized training effectively alleviates burnout. Development of evidence-based strategies that prioritize the wellbeing of clinicians and patients is crucial.
Labor Nurses' Experiences During the COVID-19 Pandemic
Authors: Eanes Linda , Mathew Liji , Philips Betty , Paul Dalia , Mathews Moncy
Published: October 2024

Purpose:

The purpose of this study was to describe labor and delivery nurses' experiences in caring for patients during the COVID-19 pandemic.

Methods:

We used a descriptive phenomenological design and purposeful sampling to recruit experienced labor and delivery nurses for flexible semi-structured face-to-face audiotaped interviews. Constant comparison was used to analyze data.

Results:

Ten nurses employed in a labor and delivery unit in two acute care hospitals in southern Texas participated and were interviewed from June through August 2022. The mean age of nurse participants was 36.5 years. Seven had over 5 years' experience as a labor and delivery nurse before the pandemic. Five distinct themes were identified: Psychological stress during COVID-19; Feelings of satisfaction and gratitude; Resilience and readiness for positive change; Patient-centered care; and Interprofessional collaboration.

Clinical Implications:

These findings build on our understanding of key determinants contributing to labor and delivery nurses' ability to adjust to the unprecedented and chaotic working conditions during the COVID-19 pandemic and highlighted several factors that could influence nurses' resilience and job satisfaction.
A Systematic Review of Worldwide Female Enrollment in Randomized Controlled Trials of Post-Stroke Lower Extremity Rehabilitation
Authors: Safaei-Qomi Mohammad R. , Mehrabi Sarvenaz , Fleet Jamie L , Peters Sue , Viana Ricardo , Payne Michael W. , Tang Ada , Teasell Robert
Published: October 2024

This review systematically examined the reporting of sex and female participation in post-stroke lower extremity (LE) motor rehabilitation randomized controlled trials (RCTs) over time and identified differences in female participation across RCTs conducted in low-and-middle-income countries (LMICs), high-income-countries (HICs), and HIC-regions. Systematic searches were conducted of MEDLINE, Embase, CINAHL and PsycINFO from 1970 to May 2022. RCTs in English were included if they examined post-stroke LE motor rehabilitation interventions in adults diagnosed with stroke. A total of 1,285 RCTs were analyzed; 4.5% of RCTs did not report sex, and the overall female participation was 39.4%. The percentage of female participants did not significantly differ between HICs and LMICs. Within HICs, the percentage of female participants was significantly higher in European RCTs than RCTs in Asia & Oceania (P = 0.008). No significant changes in female participation were found for any of the countries or regions over the last two decades. Female participation was significantly higher in RCTs conducted in the acute phase compared to those in the chronic phase (p < 0.001). More research is needed to understand the reasons behind female under-enrollment and further efforts are required to ensure adequate enrollment of males and females.
Cytokine trajectory over time in men and women with HIV on long-term ART
Authors: Vanpouille Christophe , Wells Alan , DeGruttola Victor , Lynch Miranda , Zhang Xinlian , Fitzgerald Wendy , Tu Xin , Chaillon Antoine , Landay Alan , Weber Kathleen , Scully Eileen , Karn Jonathan , Gianella Sara
Published: October 2024

Objective:

Although antiretroviral therapy (ART) suppresses viral replication and reduces inflammation, it does not lead to the normalization of cytokines. The long-term effects of ART beyond viral suppression have not been studied and are mostly limited to cross-sectional research.

Design:

The impact of long-term ART on the trajectory of 40 cytokines/chemokines in 31 men and 59 women who maintained viral suppression over a median period of 6 years (317 visits ranging 24 to 384 weeks post ART initiation) were measured by Luminex.

Methods:

We used a generalized additive model with a Gaussian distribution and identity link function to model concentrations over time and investigate sex and race differences.

Results:

While most cytokine/chemokine trajectories remained stable, the trajectory of 9 markers of monocyte/macrophage activation (IP-10, I-TAC, MIG, sCD163, sCD14, MCP-1, MIP-3β, CXCL13, TNF-α) decreased over time (adj. p < 0.05). Despite continuous viral suppression, M-CSF, IL-15, and LBP increased over time (adj. p < 0.05). sCD14 was the only cytokine whose trajectory differed by sex (adj. p = 0.033). Overall, women had lower mean levels of IL-18 but higher levels of sCD14 than did men (adj. p < 0.05). GROα, LBP and sCD14 showed significant differences between races (adj. p < 0.05). No association between cytokines and cellular HIV DNA/RNA was found.

Conclusions:

Our study reveals a continuous decline in markers of monocyte/macrophage activation over six years of suppressive ART, indicating that long-term treatment may mitigate inflammaging and cardiovascular-related outcomes. The higher levels of sCD14 observed in women are consistent with them having greater innate immune activation than men do.
Evaluation of the Effect of Pre-bent Z-shaped Titanium Plate on Narrowing of Zygomatic Arch in L-shaped Reduction Malarplasty
Authors: Shu Kai-yi , Li Xi-yuan , Zhao Jiu-li , Zhang Zhi-yong
Published: October 2024

Objective:

Pre-bent titanium plates are widely used for internal fixation in L-shaped zygomatic reduction. The aim is to evaluate the effect of pre-bent Z-shaped titanium plate on the narrowing of the zygomatic arch in L-shaped reduction malarplasty.

Methods:

Thirty cosmetic female patients were selected and scanned using computed tomography (CT). The CT images of pre-operation (T1) and post-operation(T2) were re-established through MIMICS26.0 (Materialise). After the 2 images were registered based on the skull base, the narrowing distance (ZRN) at the posterior end of the free zygomatic arch, as well as the preoperative and postoperative cross-sectional dimensions of the zygomatic arch, were measured. The ZRN and the altitude of the pre-bent titanium plate (TA) were compared using an independent t test, and their correlation was also analyzed using the Pearson coefficient. The preoperative and postoperative longest diameter (L1) and shortest diameter (L2) of the posterior zygomatic arch were compared using a paired t test.

Results:

The TA was 3.80±0.82 mm and the ZRN was 3.21±0.82 mm. The difference value was 0.59±0.41 mm, which was statistically significant. TA showed a strong correlation with ZRN (r=0.916, P=0.002). The L1 and L2 of the zygomatic arch root were slightly reduced postoperatively.

Conclusion:

The pre-bent Z-shaped titanium plate does not completely correspond to the zygomatic arch narrowing distance in the actual application of L-shaped reduction malarplasty. However, it can control the narrowing distance of the zygomatic arch predictably, and achieve satisfactory surgical outcomes.
Morphologic Characterization of Pancreatic Ductal Adenocarcinoma following Post-neoadjuvant Pancreatectomy and Clinical value of Intratumor Heterogeneity
Authors: Lionetto Gabriella , Mattiolo Paola , Ciulla Calogero , Savegnago Giulia , Casciani Fabio , De Pastena Matteo , Paiella Salvatore , Pea Antonio , Esposito Alessandro , Crovetto Anna , Donadelli Massimo , Franzina Carlotta , Fassan Matteo , Scarpa Aldo , Salvia Roberto , Malleo Giuseppe , Luchini Claudio
Published: October 2024

Objective:

To evaluate the morphologic landscape of pancreatic ductal adenocarcinoma (PDAC), intratumor spatial heterogeneity, and the resulting clinical impact following post-neoadjuvant pancreatectomy.

Summary Background Data:

The clinical value of PDAC morphologic subtypes and intratumor spatial heterogeneity post-treatment remains an open issue.

Materials and Methods:

The study cohort included patients who underwent post-neoadjuvant pancreatectomy for PDAC at the University of Verona Hospital Trust between 2013 and 2019. All hematoxylin and eosin-stained slides were reviewed to assess PDAC histomorphology and intratumor heterogeneity. The relationship with other clinicopathological variables, overall survival (OS), and recurrence-free (RFS) survival was evaluated using standard statistics.

Results:

The study cohort included 400 patients. Histological revision identified ten different morphologic subtypes. Gland-forming PDAC with a conventional pattern was the most frequently identified subtype (41.8%). Overall, 247 tumors (61.7%) showed only one histological pattern and were classified as homogeneous, whereas 153 (38.3%) showed different morphologies and were classified as heterogeneous tumors. The median post-resection survival was 30.1 months (95%CI 26.6-33.5). There was a substantial survival variability according to the morphologic subtype, ranging from 19.1 months in the gyriform subtype to 47.0 months in the papillary subtype. Tumors with a heterogeneous morphology displayed a higher rate of nodal metastases, worse tumor regression metrics, and worse oncologic outcomes relative to spatially homogeneous tumors.

Discussion:

This paper provided a morphological taxonomy of residual tumors following post-neoadjuvant pancreatectomy for PDAC. The morphologic subtype and intratumor spatial heterogeneity have relevant prognostic implications and could be included in the pathology report to complement regression metrics.
Outcomes among Patients with End-Stage Kidney Disease and Chronic Limb-Threatening Ischemia
Authors: Shah Samir K. , Neal Dan , Vasilopoulos Terrie , Segal Mark , Berceli Scott , Weissman Joel S.
Published: October 2024

Objective:

To understand mortality and secondary outcomes in patients with both end-stage kidney disease (ESKD) and chronic limb-threatening ischemia (CLTI) after no procedural treatment, primary amputation, endovascular treatment, and open surgery.

Summary Background Data:

ESKD and CLTI commonly cooccur and limited prior work has demonstrated poor outcomes including one-year survival despite treatment.

Methods:

We conducted a retrospective national cohort study of United States Renal Data System data from January 1, 2016 to December 31, 2019 to determine mortality, major postoperative complications, and other outcomes. We performed an exploratory analysis comparing two-year survival by treatment using propensity matching.

Results:

Of 1,876,652 records with a CLTI diagnosis, we identified 3,908 patients with ESKD and an incident CLTI diagnosis. Mean age at CLTI diagnosis was 65.7 years and 2,405 (61.5%) were male. 2,696 (69.0%) had no procedural treatment, 609 (15.6%) had major limb amputation, 439 (11.2%) had endovascular treatment, and 164 (4.2%) had open surgery. There was 44.9% mortality at one year, along with 41.8% major postoperative complications and 52.6% readmissions at 90 days. Comparing two-year survival, we found no differences between the amputation and endovascular cohorts (P=0.08) and between endovascular and open (P=.06). There was superior two-year survival in the open surgery cohort compared to the amputation cohort (P=0.002)

Conclusions:

Patients living with both ESKD and CLTI experience poor outcomes irrespective of treatment. Exploratory analyses demonstrated that two-year survival among the three principal procedural treatments was similar except for superior survival among patients undergoing open therapy compared to primary amputation.
Health care impact of lower extremity amputations in diabetes mellitus derived from Dutch insurance claims; design of the retrospective cohort study; Dutch diabetes estimate—amputation initiative (DUDE-8)
Authors: Rosien Leonie , Geurten Rose J. , Bilo Henk J. G. , Ruwaard Dirk , Gans Rijk O. B. , Oskam Jacques , van Tilburg Chantal , Elissen Arianne M. J. , van Dijk Peter R.
Published: October 2024

Introduction:

Many individuals with diabetes mellitus (DM) experience complications that significantly impact their quality of life and life expectancy. Foot complications, arising from neuropathy, macroangiopathy, and metabolic derangements, or a combination of these factors, are a major concern. The combination of these disorders increases the risk of developing diabetic foot ulcers (DFUs), which in turn can lead to lower extremity amputations (LEAs) if not promptly and adequately treated. Globally, 80% of all nontraumatic LEAs are due to DM, and most of these were preceded by a nonhealing DFU. Studies in the Netherlands have explored the incidence of LEA in the diabetic population, reporting a range from 78 to 704 per 100 000 person-years. The current design focuses on utilizing the available all-claims data to gain valuable insights into amputation rates among individuals with DM in the Netherlands during the years 2013–2019 and develop a more comprehensive understanding of the current Dutch situation.

Methods and analyses:

In the Netherlands, all amputations are performed in hospitals, allowing for comprehensive financial claims data. The current project focuses on utilizing the available all-claims data to gain insights into yearly LEA rates among individuals with and without DM in the Netherlands. Over the period 2013–2019, various predefined analyses will be performed, including costs and outcomes. Individuals will be matched based on age, gender, and, where applicable, socioeconomic status. Depending on the research questions, additional analyses will take place on epidemiology, healthcare use, costs, and mortality rates.
Is infracolic omentectomy necessary for early-stage (FIGO I–II) borderline ovarian tumors? A protocol for systematic review and meta-analysis
Authors: Reis Rosilene J. , Medeiros Lidia R. , Reis Ricardo , Zanon Jeferson R. , Avila Renata , Souza Mileide M.
Published: October 2024

Background:

Borderline ovarian tumors (BOTs) are reported to account for 10%–20% of all ovarian tumors. Guidelines for the surgical management of BOTs include hysterectomy with bilateral salpingo-oophorectomy, peritoneal washings, omentectomy, and multiple peritoneal biopsies. However, when omentectomy is recommended, it is unclear whether removal of a normal-appearing omentum has a therapeutic benefit.

Methods:

We will search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), the latest issue in the Cochrane Library, PubMed, EMBASE, LILACS, SCOPUS, Web of Science and Grey literature. Randomized controlled trials (RCTs) and non-randomized studies will be included if the patients are adults (≥18 years) with BOTs in stages I–II according to International Federation of Gynaecology and Obstetrics (FIGO). The methodological assessment will be carried out by two reviewers independently of each other using Cochrane risk-of-bias tool for randomized controlled trials (RoB 2), and the risk of bias in non-randomized studies (ROBINS-I) tool for non-randomized. The search strategy is constructed using the Boolean operators “OR” and “AND,” thorough search, a combination of medical subject heading and free-text terms will be employed. The Review Manager 5.4 will be used for the meta-analysis. For time‐to‐event data, we will use the hazard ratio with a 95% confidence interval (CI). For dichotomous outcomes, we will be used to calculate the risk ratio with a 95% CI. Continuous outcomes will be presented as the weighted mean difference or standardized mean difference with 95% CI.

Results:

This review will evaluate the effects of non-infracolic omentectomy on overall survival, progression-free survival, quality of life, recurrence index and adverse events in patients with BOTs.

Conclusion:

Our results will provide clear evidence to determine whether non-infracolic omentectomy is an effective and safe intervention for early stage (FIGO I–II) BOTs, thus benefiting patients, practitioners, and policy makers.
Plasma treatment is associated with decreased brain lesion and resuscitation requirements after traumatic brain injury in a swine model of prolonged damage-control resuscitation
Authors: Jin Guang , Liggett Marjorie R. , Ho Jessie W. , Dawood Zaiba Shafik , Chtraklin Kiril , Diaz Dariel , Alam Hasan B.
Published: October 2024

BACKGROUND

Hemorrhage and traumatic brain injury (TBI) are the leading causes of death in trauma. Future military conflicts are likely to be in austere environments, where prolonged damage-control resuscitation (p-DCR) may be required for 72 hours before evacuation. Previous studies showed that early administration of fresh frozen plasma (FFP) during p-DCR can significantly decrease the volume of resuscitation required in models of hemorrhagic shock and also provide neuroprotection after TBI. In the current study, we hypothesized that the addition of FFP to p-DCR would decrease the resuscitation requirements and improve neurological outcomes in a large animal model of combined hemorrhagic shock and TBI.

METHODS

Yorkshire swine (40–45 kg; n = 10) were subjected to TBI (controlled cortical impact) and 40% blood volume hemorrhage. After 2 hours of shock, they were randomized to either: (1) p-DCR–normal saline or (2) p-DCR–FFP (250 mL). Prolonged damage-control resuscitation targeted a systolic blood pressure of 90% of baseline, in line with Tactical Combat Casualty Care principles. At 72 hours, animals were transfused 1 U of packed red blood cells, simulating evacuation to higher echelons of care. Brain lesion size, physiologic parameters, resuscitation fluid requirements, and neurological severity score were used to compare the clinical outcomes.

RESULTS

The p-DCR–FFP group required significantly less total volume (4,540.0 ± 151.7 mL vs. 974.0 ± 167.0 mL, p < 0.01) of resuscitation to maintain the target systolic blood pressure. Fresh frozen plasma–treated animals had significantly reduced brain lesion size (4,517.0 ± 180.0 mm3 vs. 2,477.0 ± 1,191.0 mm3, p < 0.01) and showed significantly decreased functional neurologic impairment.

CONCLUSION

In this exploratory study, treatment with FFP decreased resuscitation requirements, reduced brain lesion size, and improved neurological outcomes when added to prolonged DCR in a porcine model of combined hemorrhagic shock and TBI.
The Path to Certification for Emergency Nurse Practitioners
Authors: Carman Margaret J. , Jordan Kathleen S.
Published: October 2024

Certification serves to validate the knowledge, skills, and experience required for clinical practice. Availability of a certification for emergency nurse practitioners (ENPs) has had an arduous path. This article examines the history of ENP certification in the United States, its territories and Canada, and how the certification examination has arrived at its current state.
Modelling cultural responses to disease spread in Neolithic Trypillia mega-settlements
Authors: Bentley R. Alexander , Carrignon Simon , Gaydarska Bisserka , Chapman John , Buchanan Brian , O'Brien Michael J.
Published: October 2024

As zoonotic diseases coevolved with early agriculture, social distancing within dense human settlements could have conferred a selective advantage in terms of infection risk. Here, we consider the case of Trypillia mega-settlements after 4000 BC, as virulent diseases began affecting humans in the Black Sea region. Through epidemiological susceptible-infected-recovered-susceptible (SIRS) models situated on clustered networks and on a site plan of a Trypillia mega-settlement, we show the adaptive benefits of decreasing either occupation density or the frequency of interactions with other communities across the settlement. We explore critical thresholds in these parameters that may shed light on the fluctuations of population densities at Trypillia mega-settlements before and after approximately 3600 BCE. Our findings suggest that disease was probably a significant driver of human settlement patterns by late Neolithic times.
Snap-through and indirect reduced-order modelling
Authors: de Bono Max , Hill Thomas Lewis , Groh Rainer Maria Johannes , Neild Simon A.
Published: October 2024

Snap-through is a nonlinear jump phenomenon that is increasingly being designed into engineering structures. The rich and varied dynamics of snap-through present a significant bottleneck in the design process as costly dynamic simulations are required to ensure predictable behaviour. The purpose of this research is to investigate the use of a recent projection-based, reduced-order modelling technique, namely, implicit condensation and expansion with inertial compensation, to reproduce the snap-through behaviours found in bistable finite element systems in analogous models with minimal degrees of freedom. In this work, the free response of a simple mass-spring oscillator is used to differentiate different types of snap-through. This provides a framework for discussing the dynamics of a family of buckled beams. The ability of the reduced-order models to faithfully reproduce these dynamics is investigated by testing the existence and stability of predicted periodic orbits. It is shown that the minimum projection basis required to capture snap-through accurately can be found through considering the minimum energy required for different types of snap-through. For bistable beams, this can be further simplified to just requiring an eigenvalue analysis at the most unstable equilibrium.
Ultra-soft cellular solids inspired by marine mussel plaques: scaling of the mechanical properties
Authors: Pang Yong , Busfield James , Liu Tao
Published: October 2024

The porous core of the marine mussel provides mechanical advantages of achieving substantial deformation and high toughness. Inspired by the unique mechanical behaviours of mussel plaque cores, the present study develops ultra-soft, stretchable and tough cellular solids by bio-mimicking their porosity and properties. Although scaling laws to correlate the mechanical properties of cellular solids with bulk materials have been established, they are primarily based on experimental data from stiff cellular solids. In this article, the scaling law for soft cellular solids is studied to relate tensile properties and toughness with volume fractions. Unlike conventional stiff cellular solids, the scaling law shows that soft lattices experience bending-dominated deformation at the elastic state and fail under stretching-dominated deformation. Uniaxial and planar tensile tests demonstrate that the proposed soft lattices achieved Young’s modulus of

0.04
∼
0.17

MPa, failure strain of

135.5
∼
213.9
%

and toughness of

582
∼
941

J m
−2
by manipulating the volume fraction (

0.2
∼
0.5

), positioning them as softer, more stretchable and tougher than the majority of engineering foams in the Ashby diagram. In addition, the toughness of soft lattices is found to be sensitive to volume fraction but insensitive to initial crack length, thickness and height (

≥
20

m
m

). Two distinct failure modes, truss failure and joint failure, are correlated with volume fraction. The soft lattice with a volume fraction (around 0.4) similar to mussel plaque fails at the transition of these two failure modes and achieves the highest toughness. This study contributes new insights to the materials science community and lays the foundation for the development of lightweight, damage-tolerant and high-performance metamaterials.
Weak overcomes strong in sensory integration: shading warps the disparity field
Authors: Aubuchon Celine , Kemp Jovan , Vishwanath Dhanraj , Domini Fulvio
Published: October 2024

Human perception is often based on the integration of multiple sensory cues, where more statistically reliable cues are considered to have stronger influence on the percept. For example, in three-dimensional shape perception, binocular disparity is considered the most reliable cue at close distances, while pictorial cues like shading are considered less reliable. In three within-subject experiments, we instead show that shading can override disparity, a result that cannot be explained by its measured reliability, cue vetoing or cue promotion. Observers judged the shape of a disparity surface that was combined with different shading patterns. In all tests, shading altered the perceived shape specified by a strong disparity signal in a way that could not be predicted by standard accounts of three-dimensional perception. We find an example of unaccounted for cue cooperation, where shading becomes strong when it interacts with disparity.
In search of the genetic variants of human sex ratio at birth: was Fisher wrong about sex ratio evolution?
Authors: Song Siliang , Zhang Jianzhi
Published: October 2024

The human sex ratio (fraction of males) at birth is close to 0.5 at the population level, an observation commonly explained by Fisher’s principle. However, past human studies yielded conflicting results regarding the existence of sex ratio-influencing mutations—a prerequisite to Fisher’s principle, raising the question of whether the nearly even population sex ratio is instead dictated by the random X/Y chromosome segregation in male meiosis. Here we show that, because a person’s offspring sex ratio (OSR) has an enormous measurement error, a gigantic sample is required to detect OSR-influencing genetic variants. Conducting a UK Biobank-based genome-wide association study that is more powerful than previous studies, we detect an OSR-associated genetic variant, which awaits verification in independent samples. Given the abysmal precision in measuring OSR, it is unsurprising that the estimated heritability of OSR is effectively zero. We further show that OSR’s estimated heritability would remain virtually zero even if OSR is as genetically variable as the highly heritable human standing height. These analyses, along with simulations of human sex ratio evolution under selection, demonstrate the compatibility of the observed genetic architecture of human OSR with Fisher’s principle and render it plausible that multiple OSR-influencing genetic variants segregate among humans.