bluuebunny/crossref_metadata_2025 huggingface dataset:
Realtime polymorphic malicious behavior detection in blockchain-based smart contracts
Authors: GaliŞ Darius , PungilĂ Ciprian , Negru Viorel
Published: March 2024

This paper proposes an innovative approach to achieving real-time polymorphic behavior detection, and its direct application to blockchain-focused smart-contracts. We devise a method based on a non-deterministic finite state machine to perform approximate pattern-matching, using a look-ahead mechanism implemented through a concept similar to that of a sliding window, and using threshold-based similarity checking at every state in the automaton. We introduce and formalize our approach, discuss the challenges we faced and then test it in a real-world environment. The experimental results obtained showed a significant speed-up of our approach, as compared to the classic similarity measures used commonly in such scenarios.
Brain banking in the United States and Europe: Importance, challenges, and future trends
Authors: Danner Benjamin , Gonzalez Angelique D , Corbett William Cole , Alhneif Mohammad , Etemadmoghadam Shahroo , Parker-Garza Julie , Flanagan Margaret E
Published: March 2024

In recent years, brain banks have become valuable resources for examining the molecular underpinnings of various neurological and psychological disorders including Alzheimer disease and Parkinson disease. However, the availability of brain tissue has significantly declined. Proper collection, preparation, and preservation of postmortem autopsy tissue are essential for optimal downstream brain tissue distribution and experimentation. Collaborations between brain banks through larger networks such as NeuroBioBank with centralized sample request mechanisms promote tissue distribution where brain donations are disproportionately lower. Collaborations between brain banking networks also help to standardize the brain donation and sample preparation processes, ensuring proper distribution and experimentation. Ethical brain donation and thorough processing enhances the responsible conduct of scientific studies. Education and outreach programs that foster collaboration between hospitals, nursing homes, neuropathologists, and other research scientists help to alleviate concerns among potential brain donors. Furthermore, ensuring that biorepositories accurately reflect the true demographics of communities will result in research data that reliably represent populations. Implementing these measures will grant scientists improved access to brain tissue, facilitating a deeper understanding of the neurological diseases that impact millions.
Defective mutations in STAY-GREEN 1, PHYTOENE SYNTHASE 1, and MYB12 genes lead to formation of green ripe fruit in tomato
Authors: Cui Long , Zheng Fangyan , Li Changxing , Li Guobin , Ye Jie , Zhang Yuyang , Wang Taotao , Hong Zonglie , Ye Zhibiao , Zhang Junhong
Published: March 2024

Modern tomatoes produce colorful mature fruits, but many wild tomato ancestors form green or gray green ripe fruits. Here, tomato cultivar ‘Lvbaoshi’ (LBS) that produces green ripe fruits was found to contain three recessive loci responsible for fruit development. The colorless peel of LBS fruits was caused by a 603 bp deletion in the promoter of SlMYB12. The candidate genes of the remaining two loci were identified as STAY-GREEN 1 (SlSGR1) and PHYTOENE SYNTHASE 1 (SlPSY1). SGR1 and PSY1 co-suppression by RNAi converted the pink fruits into green ripe fruits in transgenic plants. An amino acid change in PSY1 and a deletion in the promoter of SGR1 were also identified in several wild tomatoes bearing green or gray ripe fruits. Overexpression of PSY1 from green ripe fruit wild tomatoes in LBS plants could only partially rescue the green ripe fruit phenotype of LBS, and transgenic lines expressing ProSGR1::SGR1 from Solanum pennellii also failed to convert purple-flesh into red-flesh fruits. This work uncovers a novel regulatory mechanism by which SlMYB12, SlPSY1, and SlSGR1 control fruit color in cultivated and some wild tomato species.
Bronze Age Architecture, Mainland Greece
Authors: Worsham Rebecca
Published: March 2024

Tension between conservation and dynamism marks the architecture of the mainland Greek Bronze Age, from about 3000 to 1100 bce. Material may be best known from the Peloponnese, but considered here in addition is the Greek mainland as far north as Thessaly, as well as islands that are well integrated into mainland Greek culture, including particularly Aegina and Skyros, with their well-known fortified trading settlements. In no study is architecture of the entirety of the period considered together, and in general there are few synthetic treatments of mainland Greek Bronze Age architecture of any period, particularly in contrast to the number of studies on the architecture of Crete. It is standard to discuss the material of the Early Bronze Age (EBA or, regionally, Early Helladic, or EH) independent of the following periods, based on a perceived cultural break at the end of EH II, roughly at 2250 bce. The subsequent EH III and Middle Helladic (MH) periods are grouped because of the continuity between them, though they have only recently been the topic of serious study. In contrast, there are many more studies handling Mycenaean architecture, beginning with the so-called Shaft Grave period in Late Helladic (LH) I (roughly 1650 bce). In all periods, the focus has been on elite structures, including the corridor houses of EH II and the “palaces” and elite houses of the Mycenaean period, as well as large-scale works like fortifications and tholos tombs. And there is a good amount of still extant Bronze Age architecture on the Greek mainland, though in highly variable states of preservation—most commonly, only the foundations of a structure remain, even at the palatial level. On the other hand, some of the infrastructural works at this period are enormously large-scale, changing the landscape itself. The most abundant, if not the most monumental, categories of remaining architecture are relatively modest—that is, domestic architecture and the funerary material especially as represented by cemeteries.
Seven Wonders of the World
Authors: Tobin Jennifer
Published: March 2024

Since the time of its creation in the Hellenistic period, the idea of the Seven Wonders has captured the imagination of various societies up to the modern age. The “canonical” list of monuments (the Pyramids of Giza, Babylon [including the Hanging Gardens and the Walls], the Temple of Artemis at Ephesus, the Statue of Zeus at Olympia, the Mausoleum of Halicarnassus, the Lighthouse of Alexandria, and the Colossus of Rhodes) was created in the sixteenth century by Dutch artist Maerten van Heemskerck, whose highly imaginative renderings of these monuments were subsequently reproduced as etchings and disseminated across Europe. Their popularity guaranteed that Heemskerck’s list became the accepted slate of the Seven Wonders. Throughout its history, however, the list was never static, with personal taste, political agenda, or religious allegiance often dictating the inclusion or omission of certain monuments. At least twenty-five different lists of Seven Wonders are known from the Hellenistic period to the Renaissance, with some thirty different monuments appearing at one time or another. Each of these earned its status as a wonder due to its great size, beauty, wealth of materials, or miraculous engineering.
Homelessness in the United States
Authors: Colburn Gregg
Published: March 2024

Homelessness is a stubborn and persistent phenomenon in the United States. According to 2022 data from the U.S. Department of Housing and Urban Development, over a half million people experience homelessness on a given night in the United States. This single night count fails to capture the fact that over a lifetime, approximately 4 to 7 percent of the US population will experience homelessness at some point. These lifetime prevalence estimates underscore that homelessness is not a fringe issue affecting a small number of unfortunate individuals, but rather is a structural challenge that requires and demands a robust societal response. A comprehensive body of research describes the scope of the problem, the people who experience homelessness, its history, its causal drivers, the individual and societal costs of homelessness, and potential solutions to the problem. The scholarly literature also considers how broader structural changes are needed to address the systemic racism and inequality that contribute to the homelessness crisis. This bibliography includes research from scholars from a broad array of disciplines and fields, including anthropology, medicine, nursing, public health, social work, psychology, sociology, geography, economics, political science, public policy, urban planning, and real estate. The homeless population is not uniform, so understanding who experiences homelessness is essential because it tells a critical story about the nature of the crisis and its causes. Black, Brown, and Indigenous people and families are substantially overrepresented in the homeless population. This disproportionality speaks to the important role that racism and discrimination in a range of systems and institutions—such as housing, education, healthcare, and criminal justice—have played in shaping the scale and composition of this crisis. At its core, homelessness is the result of limited or restricted access to housing. As numerous studies demonstrate, housing ends homelessness. As it is for many phenomena in the social world, identifying the causal pathways into and explanations of homelessness is a complicated exercise. Individual attributes and behavior can produce a bout of homelessness, but so can the context in which people live.
Sanctuary Cities
Authors: Gonzalez O'Brien Benjamin
Published: March 2024

With sanctuary, and sanctuary-adjacent, policies now in existence worldwide, scholarship on these policies has now expanded beyond the United States and North America. In the United States, these policies prohibit the collection of immigration-related information and limit cooperation of local law enforcement with Immigration and Customs Enforcement (ICE), with the purpose of allowing local undocumented populations to access resources and benefits without fear of deportation. While this is how sanctuary is understood in the United States, the meaning of sanctuary, and content of the policies, varies internationally based on national and regional contexts. In the United Kingdom, sanctuary is primarily meant to facilitate the incorporation of asylee and refugee populations, instead of undocumented, or irregular, immigrants. In Mexico, sanctuary is applied to returned populations who find themselves displaced and without resources to restart their lives after removal from the United States. What all these policies have in common is that they seek to allow displaced and marginalized populations some level of incorporation into the local community. Sanctuary as a municipal strategy has its roots in the United States, with the Los Angeles Police Department passing Special Order Number 40 in 1979, which was the first to forbid officers from inquiring into the immigration status of residents. The number of sanctuary localities rapidly expanded in the 1980s, as the faith-based Sanctuary Movement began to offer refuge in synagogues and churches to Salvadoran and Guatemalan asylum seekers, who feared they would face persecution or death if they were deported. As the movement captured national attention, cities across the United States began declaring themselves to be cites of refuge for Central Americans and sanctuary cities were born. Since then, sanctuary policies have spread internationally, while being adapted for different contexts and needs. When the Oxford Bibliographies in Latino Studies article on “Sanctuary Cities” was originally written in 2020, the work on these policies and movements outside of the United States was limited. Today, there is a growing body of research exploring sanctuary in the rest of North America, Europe, and Latin America, as well as the religious, comparative, and normative concerns researchers should consider when assessing sanctuary policies and movements.
The Language Games of Canon Law: Strategic Ambiguity Between Law and Religion
Authors: Hahn Judith
Published: March 2024

The continental tradition of modern positive law, with its attempt to formulate clear legal rules, tends to be suspicious of ambiguity and struggles with the productive power of the untranslatable. Opaque kernels that inevitably remain in laws seem risky and call for disambiguation—through legislation, the courts, or administration. Yet despite this struggle against ambiguity, laws, as texts made of language, not only remain essentially ambiguous, but often require ambiguity when regulating for plural groups. In global legal orders, such as Roman Catholic canon law, we can observe that ambiguity is used strategically to allow for the inclusion of plural legal cultures. Adding to this, canon law fosters its opaqueness by meandering between secular and religious language games, thus playing with the semantic surplus of religion for the sake of cultivating ambiguity. This ambiguity management is itself ambiguous. It is inclusive, allowing plural communities to exist under the roof of Catholicism, but it is also open to the authorities’ arbitrary decisions undermining legal certainty as a core value of modern law.
Stem Cell Derived Extracellular Vesicle Therapy for Multiple Sclerosis, A Systematic Review and Meta-Analysis of Preclinical Studies
Authors: Barabadi Mehri , Paton Madison C B , Kumar Naveen , Lim Rebecca , Payne Natalie L
Published: March 2024

Stem cell therapy holds promise for multiple sclerosis (MS), with efficacy of different stem cell types reported across a range of preclinical MS animal models. While stem cell therapy has been approved for a small number of diseases in humans, extracellular vesicles (EVs) may provide an efficacious, cost-effective, and safer alternative to stem cell therapy. To this end, we conducted a systematic review with meta-analysis to assess the effectiveness of stem cell-derived secretome (EV and conditioned media (CM)) in animal models of MS. The data were extracted to calculate standardized mean differences for primary outcome measure of disease severity, using a random effect model. Additionally, several subgroup analyses were conducted to assess the impact of various study variables such as stem cell type and source, stem cell modification, route and time of administration, number of animals and animal’s age, and EV isolation methods on secondary outcome. Publication quality and risk of bias were assessed. Overall, 19 preclinical studies were included in the meta-analysis where stem cell EV/CM was found to significantly reduce disease severity in EV-treated (SMD = 2, 95% CI: 1.18-2.83, P < .00001) and CM-treated animals (SMD = 2.58, 95% CI: 1.34-3.83, P < .00001) compared with controls. Our analysis indicated that stem cell secretome has a positive effect on reducing demyelination, systemic neuroinflammation, and disease severity in preclinical models of MS. These findings indicate a potential therapeutic effect that merits investigation and validation in clinical settings.
Effective Control of Sclerotinia Stem Rot in Canola Plants Through Application of Exogenous Hairpin RNA of Multiple Sclerotinia sclerotiorum Genes
Authors: Azizi Abdolbaset , del Río Mendoza Luis E.
Published: March 2024

Sclerotinia stem rot is a globally destructive plant disease caused by Sclerotinia sclerotiorum. Current management of Sclerotinia stem rot primarily relies on chemical fungicides and crop rotation, raising environmental concerns. In this study, we developed an eco-friendly RNA bio-fungicide targeting S. sclerotiorum. Six S. sclerotiorum genes were selected for double-stranded RNA (dsRNA) synthesis. Four genes, a chitin-binding domain, mitogen-activated protein kinase, oxaloacetate acetylhydrolase, and abhydrolase-3, were combined to express hairpin RNA in Escherichia coli HT115. The effect of application of total RNA extracted from  E. coli HT115 expressing hairpin RNA on disease progressive and necrosis lesions was evaluated. Gene expression analysis using real-time PCR showed silencing of the target genes using 5 ng/µl of dsRNA in a fungal liquid culture. A detached leaf assay and greenhouse application of dsRNA on canola stem and leaves showed variation in the reduction of necrosis symptoms by dsRNA of different genes, with abhydrolase-3 being the most effective. The dsRNA from a combination of four genes reduced disease severity significantly ( P = 0.01). Plants sprayed with hairpin RNA from four genes had lesions that were almost 30% smaller than those of plants treated with abhydrolase-3 alone, in lab and greenhouse assays. The results of this study highlight the potential of RNA interference to manage diseases caused by S. sclerotiorum; however, additional research is necessary to optimize its efficacy.
Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block and Adductor Block After Total Knee Arthroplasty
Authors: Tan Minghe , Chen Bozhou , Li Qingshu , Wang Siqi , Chen Daiyu , Zhao Maoji , Cao Jun
Published: March 2024

Objectives:

This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these three.

Methods:

Patients undergoing TKA were randomly assigned to one of three groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary endpoint was the Numeric Rating Scale (NRS) score at movement at 24 hours post-surgery. Secondary endpoints included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion (ROM), effective PCNA utilization, and opioid consumption at various post-surgery time points.

Results:

Of the 94 valid datasets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary endpoint (H=7.003, P=0.03). Post-hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2-4]) compared to the ACB group (4 [3-5], Bonferroni-adjusted P=0.03). Regarding secondary endpoints, both the FNB and FTB groups had lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other endpoints.

Discussion:

Continuous FTB provides postoperative analgesia comparable to FNB, but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.
Effects of Web-Assisted Education on Nursing Students’ Pressure Injury Knowledge Levels
Authors: Efteli Elçin , Çömez Saadet
Published: March 2024

Objective

To investigate the effect of web-assisted education on the pressure injury knowledge levels of nursing students.

Methods

The study was conducted with 106 first-year students in the Nursing Department. Those who received both web-assisted education and conventional education were assigned to the experimental group, and those who received only conventional education were assigned to the control group. The authors used arithmetic mean, percentages, Student t test, and χ
2 test to analyze the data.

Results

The rate of the correct responses given to the questions by the students was 97.55% in the experimental group and 85.15% in the control group. The comparison of the mean number of correct answers revealed a statistically significant difference between the two groups.

Conclusions

The authors conclude that the web-supported education given to nursing students in addition to the conventional education positively contributed to their learning level.
Mechanical and Architectural Changes in Animal Bone Following Fast Neutron Irradiation
Authors: Galiano Eduardo , Liu Jinlu , Ren Beide , Xu Penghao
Published: March 2024

Damage to healthy bone following exposure to ionizing radiation has been well documented for at least seven decades. Among the reported effects are a transient increase in stiffness and a reduction in breaking strength. These changes have been linked to a decrease in osteoblast proliferation and differentiation, inducing cell cycle arrest, reducing collagen production, and increasing sensitivity to apoptotic agents. In this work, we analyzed some mechanical and structural changes in compact costal bovine bone (Hereford breed, n = 9) subjected to escalating doses of fast neutrons from a 7Li(p,n)7Be reaction. The mean neutron energy was 233 keV with calculated absorbed doses ranging from 0 to 4.05 ± 10% Gy. Samples were subjected to Young’s Modulus (YM) and breaking strength testing with a Universal Testing Machine (UTM). We found an increase in Young’s Modulus and a decrease in breaking strength as functions of increasing dose equivalent. Optical coherence tomography (OCT) revealed trabecular displacement into compact bone in an irradiated sample (D = 4.05 ± 10% Gy), with breaching of the endosteal wall. OCT further revealed a “crack-like” structure across the irradiated sample, potentially consistent with damage from a proton track resulting from an elastic (n,p) reaction. No previous report has been found on mechanical changes in large mammalian bones following fast neutron doses, nor of the OCT imaging of such samples.
Iris Cerclage To Treat Persistent Mydriasis Following Acute Angle Closure Glaucoma Improves Visual Quality
Authors: Wang Xianhuai , Li Tianhui , Guo Xinyu , Feng Qing , Sun Xincheng
Published: March 2024

Précis:

We developed a modified iris cerclage technique that improves best corrected visual acuity, pupillary parameters, self-assessed photophobia, and visual function index-14 questionnaire scores in patients with acute primary angle closure and permanent mydriasis after cataract surgery.

Purpose:

To evaluate the efficacy of a modified iris cerclage technique in patients with acute primary angle closure (PAC) and permanent mydriasis after cataract surgery.

Patients and Methods:

Twelve eyes of 12 patients with acute PAC and permanent mydriasis at more than 3 months after phacoemulsification combined with intraocular lens (IOL) implantation underwent modified iris cerclage. Best corrected visual acuity (BCVA), intraocular pressure (IOP), pupil diameter, and visual function index-14 (VF-14) questionnaire and self-assessed photophobia scores before surgery and at 1 week, 1 month, and 3 months postoperatively were compared. Further, the postoperative pupil position morphology and complications were evaluated.

Results:

BCVA improved from 0.48±0.23 preoperatively to 0.28±0.15, 0.27±0.15, and 0.26±0.14 at 1 week, 1 month, and 3 months postoperatively, respectively (P=0.008). No significant difference was observed between the preoperative and postoperative IOP (P=0.974). Pupil diameter improved from 6.34±0.51 mm preoperatively to 3.59±0.33, 3.59±0.34, and 3.58±0.32 mm at 1 week, 1 month, and 3 months postoperatively, respectively (P<0.001). Self-assessed photophobia scores improved from 3.33±0.78 preoperatively to 0.83±0.72, 0.51±0.15, and 0.45±0.14 at 1 week, 1 month, and 3 months postoperatively, respectively (P<0.001). VF-14 scores improved from 47.6±6.1 points preoperatively to 67.9±6.2, 72.1±6.1, and 73.5±6.0 points at 1 week, 1 month, and 3 months postoperatively, respectively (P<0.001). Postoperatively, all pupils were centered and round. No postoperative complications, such as iris-suture slippage, iridodialysis, or exposure of the IOL’s optical zone edge, were observed.

Conclusion:

Modified iris cerclage creates a centered, precisely sized, round pupil. It improves visual quality in patients with acute PAC and permanent mydriasis after cataract surgery.
Skin Cancer: Back to Basics, Mycosis Fungoides
Authors: Lippincott Trevor
Published: March 2024

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma occurring when T-cell lymphocytes become malignant and proliferate as well as manifest in the skin. Most commonly, the disease affects the elderly population but has been seen in all ages. Presentations of MF include erythematous patches and plaques with fine scale anatomically favoring the buttocks, trunk, and extremities with complaints of significant pruritus. MF can mimic other benign inflammatory diseases such as atopic dermatitis or psoriasis. Skin biopsy of the rash for simple histology and immunophenotyping will aid in the differentiation from other diseases and confirm accurate diagnosis. Repeat biopsy is often required. A wide range of treatment options exist based on the extent of the disease and patient compliance. The prognosis is good with early detection and treatment. No cure currently exists for the disease, but a deeper understanding of triggers can guide prevention techniques and help develop targeted treatment modalities.
The Importance of Three-Dimensional Total Body Photography and the Role of the Dermatology Nurse in the Prevention of Melanoma in High-Risk Patients
Authors: Foster Theresa
Published: March 2024

Three-dimensional total body photography is a recent advance in melanoma early detection that can aid clinicians in monitoring and identifying new and changing skin lesions over time. It is a beneficial screening tool for high-risk patients to have a history of melanoma or dysplastic nevi. According to the American Cancer Society, melanoma cases are increasing each year. Melanoma is one of the most aggressive skin cancers in the United States and is the fifth most common cancer cause in both men and women. Prompt diagnosis is critical to reducing the morbidity and mortality caused by melanoma. Survival outcomes worsen with increasing tumor thickness, and thicker melanomas require more invasive and intensive treatment. However, if detected early, the 10-year survival rate of patients with thin melanomas is almost 98%, compared with as low as 48% in thick melanomas. Three-dimensional total body photography along with education provided by dermatology nurses on how this system aids in the identification of new and changing nevi is vital in the prevention of melanoma. As a Dermatology nurse, one of the most crucial roles is educating patients with evidence-based knowledge. This includes following a distinct schedule of follow up appointments to monitor moles, using sunscreen, avoiding excessive sun exposure, encouraging self-skin examinations, and ensuring patients maintain their follow-up appointments. These measures can help to prevent Melanoma.
What's Old Is New Again
Authors: Davis Kyleen E.
Published: March 2024

In recent years, multiple novel and improved therapies have become available to treat alopecia disorders. Whereas many therapeutics are entirely new, some medications, such as oral minoxidil, have been available for years and are just now being revisited as potentially valuable hair loss treatments. This article discusses the risks, benefits, and potential side effects of the off-label use of low-dose oral minoxidil. It compares low-dose oral minoxidil with topical minoxidil, a well-established and FDA-approved treatment for androgenetic alopecia, but one that is often associated with poor overall adherence. Finally, nursing considerations in the education and care of patients with alopecia disorders and associated medications are discussed.
Can we improve therapeutic compliance in cancer patients? Report of a cross-sectional case series study in Morocco
Authors: Khadija Mokhtari , Bekkay Hajji , Hanane El oualy , Hamid Madani
Published: March 2024

Therapeutic compliance (TC) refers to the patient's compliance with the prescriptions and recommendations of a doctor. Patients with cancer often exhibit unsatisfactory TC. The objective of our study was to assess TC levels in cancer patients and identify predictors of poor compliance. The authors conducted a cross-sectional study in March 2023 at the oncology centre, where the vast majority of medical activity is performed in the day hospital. TC was measured using a questionnaire or survey. Various parameters were analyzed to identify predictive factors of poor therapeutic compliance. The authors’ study included 175 cancer patients with a mean age of 55 years. The study revealed that 85% exhibited good compliance (GC) as indicated by the CI [8.500 ± 0.075], signifying patients who consistently adhered to their medication schedule. Conversely, 15% demonstrated poor compliance (PC), as indicated by the confidence interval [0.825 ± 0.750]. Compliance status was assessed by considering patients who adhered to the prescribed medication timing as good compliance (GC) and those who did not adhere as poor compliance (PC). The analysis of our study results indicated that poor therapeutic compliance was associated with low socio-economic and educational levels. Therefore, it is important to utilize all available resources to improve therapeutic compliance. The majority of factors contributing to poor compliance can be mitigated through effective coordination between the patient and their support network.
Effect of needles distance of arteriovenous fistula cannulation on hemodialysis adequacy based on KT/V: a randomized controlled trial
Authors: Karkhah Samad , Pourshaikhian Majid , Maroufizadeh Saman , Ghorbani Vajargah Pooyan , Aghajanzadeh Pegah , Osuji Joseph , Moghadamnia Mohammad Taghi
Published: March 2024

Background:

This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on haemodialysis adequacy based on KT/V.

Materials and methods:

This study was a parallel-group, randomized controlled trial. Patients who met the inclusion criteria were divided into two groups with 3 and 6 cm needle distances using block randomization. Data acquisition transpired through a comprehensive checklist encompassing demographic variables such as age and sex, alongside clinical metrics comprising actual weight, dry weight, average dialysis duration, fistula longevity, and KT/V rate.

Results:

A total of 42 haemodialysis patients were enroled in this investigation, with 21 allocated to the 3 cm needle distance group and another 21 to the 6 cm needle distance group. The mean post-haemodialysis KT/V values for the 3 cm and 6 cm needle distance groups were 1.25 (SD=0.25) and 1.42 (SD=0.24), respectively, demonstrating a statistically significant difference (P<0.001). While there was no significant difference in the average pre-haemodialysis and post-haemodialysis KT/V values within the 3 cm needle distance group (t=1.93, P=0.068), the corresponding values for the 6 cm needle distance group exhibited a notable discrepancy (t=9.66, P<0.001).

Conclusion:

In general, a needle distance of 6 cm between arteriovenous points yielded superior enhancements in dialysis adequacy compared to a 3 cm needle distance following haemodialysis. Consequently, health administrators and policymakers may consider instituting efficacious interventions to scrutinize the care and therapeutic protocols for haemodialysis patients, involving the development of policies and applications.
A challenging diagnosis of chronic osteomyelitis in a child with congenital insensitivity to pain: a case report
Authors: Kamil Hazem , Alassri Riffa , Albelal Douaa , Alassri Abu Baker , Martini Nafiza , Mahmod Jaber
Published: March 2024

Introduction:

Congenital insensitivity to pain (CIP) is a rare condition where individuals are born with an inability to perceive pain. This can lead to various complications in the skin, skeletal system, and other bodily systems. Chronic osteomyelitis is one of the possible manifestations of CIP, which can be difficult to diagnose and treat due to the lack of pain as a diagnostic criterion.

Presentation:

A 5-year-old boy with CIP developed chronic osteomyelitis in his right leg, presented with fever, claudication, swelling, and local heat for 2 months. He had a history of CIP since birth, diagnosed at 18 months of age. He also had a family history of CIP. He had previously suffered a shoulder fracture and had taken asthma medication for 1 year. He had experienced tonsillitis 2 months ago. On examination, he had hepatomegaly, enlarged lymph nodes in the groin, and a minor swelling on the right knee. He had an audible snapping sound during knee flexion. Blood tests showed increased inflammatory markers. Imaging studies confirmed presence of osteomyelitis, and bone biopsy revealed infection with Staphylococcus aureus. Treatment included vancomycin and cefotaxime.

Clinical discussion:

Genetic factors behind CIP were discussed, highlighting challenges in diagnosis. Manifestations of CIP, diverse and age-related, include orthopaedic issues, ophthalmological effects, and thermoregulation disturbances. The patient’s case is presented with unique features, necessitating a comprehensive diagnostic approach.

Conclusion:

This case highlights the challenges faced in diagnosing osteomyelitis among CIP patients and emphasizes the need for other diagnostic criteria apart from pain.
Diabetic cheiroarthropathy in uncontrolled type 2 diabetes with positive anti-nuclear antibodies: a case report from Sudan
Authors: Abdalla Elham , Gamar Abrar Mohamed , Taha Ziryab Imad , Alfatih Mohammed
Published: March 2024

Background:

Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 diabetes mellitus (DM). It affects 8–50% of patients with type 1 diabetes and is also seen in type 2 diabetic patients. Consequently, it can mimic many rheumatological diseases and is often underdiagnosed. The authors present a case of a long-standing poorly controlled diabetes with diabetic cheiroarthropathy and diabetic neuropathy, along with positive ANA in the absence of any correlated autoimmune or rheumatological diseases.

Case presentation:

A 52-year-old female patient with poorly controlled diabetes (her last HbA1c reading was 9.5%) presented to the Rheumatology clinic with flexion deformities of the fingers. The patient has impaired vibration, two-point discrimination, and pinprick sensation in gloves and stock distribution, indicating peripheral neuropathy, entrapment neuropathy in the forms of bilateral carpal tunnel syndrome, and the diagnosis of diabetic cheiroarthropathy was made. Additionally, she has a positive prayer sign and a tabletop sign. Despite the absence of symptoms and signs of autoimmune disorders, this patient has positive anti-nuclear antibodies global (ANA positive by indirect immuno-fluorescence (IIF) 1\320 nucleolar pattern) with a negative: ANA profile, rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (ACPA).

Conclusion:

Regular and careful hand examination should be part of clinical assessment for diabetic patients as it could be a very simple and useful screening tool for diabetic cheiroarthropathy. Physicians can use this condition as a mirror for microvascular complications of diabetes. This allows for early detection and appropriate interventions to prevent further progression of diabetes-related complications. It is also essential to consider the presence of positive ANA in diabetic cheiroarthropathy despite the absence of any rheumatological and autoimmune diseases.
The 7-Step Neck-Lift Z-Plasty
Authors: Borab Zachary M. , Fisher Sean , Rohrich Rod J.
Published: March 2024

Patients with large amounts of neck skin redundancy who do not desire or are not candidates for traditional face and neck lifts can be managed with direct neck lifts. There are many surgical techniques to address central neck laxity. In this article, the authors present their surgical technique to address central neck laxity. The authors’ clear video format showcases the 7 steps of their neck-lift Z-plasty.
DIEP Flap versus PAP Flap versus LAP Flap: A Propensity-Matched Analysis of Aesthetic Outcomes, Complications, and Satisfaction
Authors: Haddock Nicholas T. , Lakatta Alexis C. , Steppe Cyrus , Teotia Sumeet S.
Published: March 2024

Background:

As free breast reconstruction options evolve, a patient- and body-centric approach can distinguish refined aesthetic outcomes. Although deep inferior epigastric perforator (DIEP), profunda artery perforator (PAP), and lumbar artery perforator (LAP) flaps are all safe and effective options for breast reconstruction, a head-to-head analysis of these 3 flaps has not been performed. The authors aim to compare these 3 flaps based on outcomes, BREAST-Q scores, and aesthetic results.

Methods:

After institutional review board approval, a retrospective review in a Research Electronic Data Capture database–guided analysis was conducted of patients who underwent simultaneous bilateral DIEP, PAP, or LAP flaps at a single academic institution. Propensity matching was performed to match 50 patients (100 flaps) in each group. Postoperative complications and BREAST-Q satisfaction survey scores were documented, and crowdsourcing was carried out to determine aesthetic preference in the general population.

Results:

Overall patient postoperative breast satisfaction was insignificantly different across the 3 flap groups (P > 0.05). Associations were seen with LAP flap donor-site seromas, PAP flap donor-site infections and wounds, and DIEP flap breast wounds and flap necrosis (P < 0.05). DIEP flaps had a higher raw score average on crowdsourcing survey, although LAP flaps were rated significantly higher aesthetically than DIEP and PAP flaps when undergoing a matched head-to-head analysis (P < 0.05).

Conclusions:

DIEP, PAP, and LAP flaps all have favorable outcomes with insignificantly different long-term satisfaction, with comparable complication profiles. Although DIEP flaps may initially score higher, LAP flaps score higher frequently when analyzed in a head-to-head analysis. For these reasons, tailoring breast reconstruction to the patient’s anatomy and morphology provides optimal outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Loop-Neurorrhaphy Technique for Preventing Bone Resorption and Preserving Sensation in Mandibular Reconstruction
Authors: Shi Jingcun , Zhang Yuhan , Zhang Bingqing , Wu Ziqian , Gupta Anand , Wang Jieyu , Sun Qi , Li Siyi , Dong Minjun , Wang Lei
Published: March 2024

Background:

The aim of this study was to investigate whether using an innervated vascularized iliac bone flap could effectively prevent bone resorption and maintain sensory function in the lower lip.

Methods:

In the innervated group, the deep circumflex iliac artery and recipient vessels were anastomosed, with simultaneous microanastomosis of ilioinguinal nerve, mental nerve, and inferior alveolar nerve. Conversely, the control group underwent solely vascular anastomosis. Computed tomography was used to assess bone quality. Sensory recovery of the lower lip was recorded using 2-point discrimination and current perception threshold testing.

Results:

The study comprised a total of 40 subjects, with each group accounting for 20 participants, equally distributed in terms of gender. Hounsfield unit loss was significantly lower in the innervated group (13.26% ± 8.65%) as compared with the control group (37.98% ± 8.60%) (P < 0.001). Moreover, 2-point discrimination values were lower in the innervated group (15.11 ± 8.39 mm) when compared with the control group (21.44 ± 7.24 mm) (P = 0.02). The current perception threshold values for the innervated group were 176.19 ± 31.89, 64.21 ± 19.23, and 42.29 ± 18.96 at 2 kHz, 250 Hz, and 5 Hz, respectively, whereas in the control group, the current perception threshold values were 204.47 ± 36.99, 82.26 ± 27.29, and 58.89 ± 25.38 at 2 kHz, 250 Hz, and 5 Hz (P = 0.02, P = 0.02, and P = 0.03, respectively).

Conclusion:

The innervated vascularized iliac bone flap represents a safe and effective novel approach to preserving lower lip sensation and preventing bone resorption through functional mandibular reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Development and alpha testing of a patient shared decision aid for prosthesis design for new lower limb prosthesis users
Authors: Anderson Chelsey B. , Fatone Stefania , Mañago Mark M. , Swink Laura A. , Kittelson Andrew J. , Magnusson Dawn M. , Christiansen Cory L.
Published: March 2024

Background:

After lower limb amputation, several prosthesis design options exist. However, prosthesis design decisions do not always reflect a prosthesis user’s needs, values, and preferences.

Objective:

To develop a patient decision aid (PDA) prototype for prosthetists and new prosthesis users facing prosthesis design decisions after lower limb amputation, and to assess its usability, accuracy, and comprehensibility.

Study design:

Exploratory mixed methods.

Methods:

PDA development was informed by a qualitative needs assessment and guided by the International Patient Decision Aid Standards. The PDA was evaluated by steering groups of experienced prosthesis users and prosthetic professionals (prosthetists and researchers) to test usability, accuracy, and comprehensibility through focus groups, individual interviews, and rating on a Likert scale ranging from 1 to 10.

Results:

The resulting PDA included 6 sections: (1) Amputation and Early Recovery, (2) Communication, (3) Values, (4) Prosthesis Design, (5) Preferences, and (6) Prosthetic Journey. Usability, accuracy, and comprehensibility were rated as 9.2, 9.6, and 9.6, respectively, by prosthetic professionals, and 9.4, 9.6, and 9.6, respectively, by prosthesis users.

Discussion:

The PDA incorporated guidance by relevant stakeholders and was rated favorably, emphasizing a need for shared decision-making support in prosthesis design. One challenge was determining the amount of information in the PDA, highlighting the diversity in end users’ informational needs. Future iterations of the PDA should undergo beta testing in clinical settings.

Conclusions:

A standardized, iterative method was used to develop a PDA for new lower limb prosthesis users and prosthetists when considering prosthesis design decisions. The PDA was considered useable, accurate, and comprehensible.
Intraductal Papillary Mucinous Neoplasm Surveillance Leads to Early Diagnosis and Better Outcomes of Concomitant Cancer
Authors: Oyama Hiroki , Hamada Tsuyoshi , Nakai Yousuke , Tanaka Mariko , Takagi Kaoru , Fukuda Rintaro , Hakuta Ryunosuke , Ishigaki Kazunaga , Kanai Sachiko , Kawaguchi Yoshikuni , Kurihara Kohei , Nishio Hiroto , Noguchi Kensaku , Saito Tomotaka , Sato Tatsuya , Suzuki Tatsunori , Suzuki Yukari , Takaoka Shinya , Tange Shuichi , Takahara Naminatsu , Hasegawa Kiyoshi , Ushiku Tetsuo , Fujishiro Mitsuhiro
Published: March 2024

Objective:

To examine whether long-term surveillance of intraductal papillary mucinous neoplasms (IPMNs) leads to early diagnosis and better clinical outcomes of pancreatic ductal adenocarcinomas (PDACs) developing concomitantly with IPMNs.

Summary Background Data:

Long-term image-based surveillance is recommended for patients with low-risk IPMNs. However, it is unknown whether the surveillance can improve surgical and survival outcomes of patients with concomitant PDACs.

Methods:

Using a prospective single-institutional cohort of 4,620 patients with pancreatic cysts including 3,638 IPMN patients, we identified 63 patients who developed concomitant PDAC during long-term surveillance. We compared overall survival (OS) of 46 cases with concomitant PDAC to that of 460 matched cases diagnosed with non-IPMN-associated PDAC at the same institution. Multivariable hazard ratios and 95% confidence intervals (CIs) for overall mortality were computed using the Cox regression model with adjustment for potential confounders.

Results:

Concomitant PDACs were identified at an earlier cancer stage compared to non-IPMN-associated PDACs with 67% and 38% cases identified at stage 2 or earlier, respectively (P<0.001) and 57% and 21% cases with R0 resection, respectively (P<0.001). Compared to non-IPMN-associated PDACs, concomitant PDACs were associated with longer OS (P=0.034) with a multivariable hazard ratio of 0.61 (95% CI, 0.39-0.96). The 5-year survival rate of patients with concomitant PDAC was higher compared to patients with non-IPMN-associated PDAC (34% vs. 18%, respectively; P=0.018).

Conclusions:

The surveillance for patients with IPMNs was associated with early identification of concomitant PDACs and longer survival of patients diagnosed with this malignancy.
How the kidney regulates magnesium: a modelling study
Authors: Dutta Pritha , Hakimi Shervin , Layton Anita T.
Published: March 2024

The kidneys are crucial for maintaining Mg
2+
homeostasis. Along the proximal tubule and thick ascending limb, Mg
2+
is reabsorbed paracellularly, while along the distal convoluted tubule (DCT), Mg
2+
is reabsorbed transcellularly via transient receptor potential melastatin 6 (TRPM6). TRPM6 and other renal transporter expressions are regulated by sex hormones. To investigate renal Mg
2
handling, we have developed sex-specific computational models of electrolyte transport along rat superficial nephron. Model simulations indicated that along the proximal tubule and thick ascending limb, Mg
2+
and Na
+
transport occur parallelly, but they are dissociated along the DCT. In addition, our models predicted higher paracellular Mg
2+
permeability in females to attain similar cortical thick ascending limb fractional Mg
2+
reabsorption in both sexes. Furthermore, DCT fractional Mg
2+
reabsorption is higher in females than in males, allowing females to better fine-tune Mg
2+
excretion. We validated our models by simulating the administration of three classes of diuretics. The model predicted significantly increased, marginally increased and significantly decreased Mg
2+
excretions for loop, thiazide and K-sparing diuretics, respectively, aligning with experimental findings. The models can be used to conduct
in silico
studies on kidney adaptations to Mg
2+
homeostasis alterations during conditions such as pregnancy, diabetes and chronic kidney disease.
Nitrodiazene oxides: a unique nitrogen- and oxygen-containing functional group
Authors: Scherschel Nicholas F. , Piercey Davin G.
Published: March 2024

Nitrogen-/oxygen-containing functional groups (N/O groups) may be found in a wide variety of areas such as agriculture, drug design and energetic materials. Exploring the chemistry and synthesis of N/O groups is desirable as compounds containing their functionality may prove to be invaluable in a variety of fields. A unique N/O functional group which may offer additional insight into the design of high-heteroatom content systems is the 2-nitrodiazene-1-
N
-oxide group (NDO group). While unique on their own, NDOs combine the well-known azoxy (N(O)=N) and nitro (–NO
2
) groups into a single unique N/O functional group. Although NDOs may offer superior densities and enthalpies of formations relative to their nitro counterparts, NDOs have been significantly less investigated than their nitro-bearing counterparts. This work will discuss NDOs in chemical literature from their initial discovery to modern synthesis techniques, energetic properties and chemical stability.