bluuebunny/crossref_metadata_2025 huggingface dataset:
Misogynistic Extremism: A Scoping Review
Authors: O’Hanlon Robin , Altice Frederick L. , Lee Roy Ka-Wei , LaViolette Jack , Mark Gloria , Papakyriakopoulos Orestis , Saha Koustuv , De Choudhury Munmun , Kumar Navin
Published: June 2023

In recent years, the concept of “misogynistic extremism” has emerged as a subject of interest among scholars, governments, law enforcement personnel, and the media. Yet a consistent understanding of how misogynistic extremism is defined and conceptualized has not yet emerged. Varying epistemological orientations may contribute to the current conceptual muddle of this topic, reflecting long-standing and on-going challenges with the conceptualization of its individual components. To address the potential impact of misogynistic extremism (i.e., violent attacks), a more precise understanding of what this phenomenon entails is needed. To summarize the existing knowledge base on the nature of misogynistic extremism, this scoping review analyzed publications within English-language peer-reviewed and gray literature sources. Seven electronic databases and citation indexes were systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist and charted using the 2020 PRISMA flow diagram. Inclusion criteria included English peer-reviewed articles and relevant gray literature publications, which contained the term “misogynistic extremism” and other closely related terms. No date restrictions were imposed. The search strategy initially yielded 475 publications. After exclusion of ineligible articles, 40 publications remained for synthesis. We found that misogynistic extremism is most frequently conceptualized in the context of misogynistic incels, male supremacism, far-right extremism, terrorism, and the black pill ideology. Policy recommendations include increased education among law enforcement and Countering and Preventing Violent Extremism experts on male supremacist violence and encouraging legal and educational mechanisms to bolster gender equality. Violence stemming from misogynistic worldviews must be addressed by directly acknowledging and challenging socially embedded systems of oppression such as white supremacy and cisheteropatriarchy.
Using Plan, Do, Study, Act Cycles to Improve a Maternal Self-Care Intervention With Audience Input
Authors: Hobbs Savannah , Bellows Laura L. , Coatsworth J. Douglas , Johnson Susan L.
Published: June 2023

Maternal self-care, including healthy eating, physical activity, and stress management behaviors, is influenced by environmental, social, and individual factors. Plan-Do-Study-Act (PDSA) Cycling is an effective quality improvement process using rapid cycling to refine interventions to fit audience-specific contexts and to address socioecological influences on behavior change. To refine components of the Healthy EnviROnmentS Self-Care intervention, a mindful self-care program for mothers of preschool-aged children in rural communities, PDSA cycles were used to examine: (A) acceptability of content, (B) suitability of implementation strategies, and (C) feasibility of digital supports across three stages of program development. Stage 1 included a group discussion with an expert panel ( n = 8). Stage 2 used brief interviews and group discussion with a convenience sample ( n = 5). Stage 3 included in-depth interviews with the focal population ( n = 6). In-depth interviews were transcribed and analyzed using a directed approach, and data were compiled from group discussion notes and assessed for congruence and analyzed for emergent themes. PDSA cycles relating to content led to the addition of activities to introduce mindfulness and foster social support and the revision of handouts. Implementation strategies were refined with respect to workshop duration, activity order, and meeting type. Digital supports resulted in refinement to the study website and tablet applications. Utilization of PDSA cycles allowed for input from the focus population at every point of intervention design and considered socioecological factors that can influence behavior change.
Endovascular Treatment of Superior Mesenteric Artery Pseudoaneurysm Due to Infective Endocarditis With Stent-Graft
Authors: Zhou Xiaoxiang , Pu Xibing , Li Zhengjiang , zeng Qinglong , He Yangyan , He Yunjun , Xiang Yilang , Wu Ziheng , Li Dongling , Lu Tian , Zhang Hongkun , Zhu Qianqian
Published: June 2023

Purpose:

To report a successful case of pseudoaneurysm of the superior mesenteric artery (SMA) caused by infected endocarditis treated with a covered stent.

Case Report:

A patient was diagnosed with infective endocarditis and 2 months later a proximal SMA pseudoaneurysm was identified on computed tomography. Daptomycin was started on admission and continued for approximately 4 months until the inflammatory markers normalized, and then the SMA pseudoaneurysm was successfully excluded with a stent-graft and antibiotics were continued for 1 year after the procedure. There were no associated complications or recurrences at the 3-year follow-up.

Conclusion:

Placing a covered stent with a full course of antibiotics before and after surgery may be a successful alternative to open surgery in the treatment of pseudoaneurysms of the SMA due to infective endocarditis.

Clinical Impact

This case report reports a rare case of pseudoaneurysm of the superior mesenteric artery due to infective endocarditis, which was successfully treated with an overlapping stent and confirmed by complete imaging data at a three-year follow-up. This report suggests that endovascular treatment may be an alternative to open surgery in the treatment of pseudoaneurysms of the superior mesenteric artery caused by infective endocarditis.
Autonomous Control of Music to Retrain Walking After Stroke
Authors: Collimore Ashley N. , Roto Cataldo Anna V. , Aiello Ashlyn J. , Sloutsky Regina , Hutchinson Karen J. , Harris Brian , Ellis Terry , Awad Louis N.
Published: June 2023

Background

Post-stroke care guidelines highlight continued rehabilitation as essential; however, many stroke survivors cannot participate in outpatient rehabilitation. Technological advances in wearable sensing, treatment algorithms, and care delivery interfaces have created new opportunities for high-efficacy rehabilitation interventions to be delivered autonomously in any setting (ie, clinic, community, or home).

Methods

We developed an autonomous rehabilitation system that combines the closed-loop control of music with real-time gait analysis to fully automate patient-tailored walking rehabilitation. Specifically, the mechanism-of-action of auditory-motor entrainment is applied to induce targeted changes in the post-stroke gait pattern by way of targeted changes in music. Using speed-controlled biomechanical and physiological assessments, we evaluate in 10 individuals with chronic post-stroke hemiparesis the effects of a fully-automated gait training session on gait asymmetry and the energetic cost of walking.

Results

Post-treatment reductions in step time (Δ: −12 ± 26%, P = .027), stance time (Δ: −22 ± 10%, P = .004), and swing time (Δ: −15 ± 10%, P = .006) asymmetries were observed together with a 9 ± 5% reduction ( P = .027) in the energetic cost of walking. Changes in the energetic cost of walking were highly dependent on the degree of baseline energetic impairment ( r =− .90, P < .001). Among the 7 individuals with a baseline energetic cost of walking larger than the normative value of healthy older adults, a 13 ± 4% reduction was observed after training.

Conclusions

The closed-loop control of music can fully automate walking rehabilitation that markedly improves walking after stroke. Autonomous rehabilitation delivery systems that can safely provide high-efficacy rehabilitation in any setting have the potential to alleviate access-related care gaps and improve long-term outcomes after stroke.
The Impact of Physical Activity in Patients With Type 2 Diabetes
Authors: Bassin Sandhya Rao , Srinath Reshmi
Published: June 2023

Most patients with type 2 diabetes (T2DM) do not meet guideline-driven exercise recommendations. Physical activity (PA) is any form of bodily movement via skeletal muscle contraction. It can include walking, gardening, leisure activity, exercise, or movement for transportation or an occupation. Aerobic and resistance exercise have been well studied and are known to improve glycemic control in patients with T2DM. While data is less substantial, low-intensity PA such as walking, yoga, tai-chi, qigong, and activity for household tasks have also been shown to be effective methods of reducing hyperglycemia. Additionally, PA to break up sedentary behaviors can also have glycemic benefits. Healthcare providers should encourage patients to increase their PA as a more sustainable means of meeting guideline-directed exercise and activity recommendations. Discussing these changes with patients involves identifying motivators, setting goals, removing barriers, monitoring progress, and understanding the patient’s social support and environment.
An Empirical Review of Key Glucose Monitoring Devices: Product Iterations and Patent Protection
Authors: Darrow Jonathan J. , Van de Wiele Victor , Beran David , Kesselheim Aaron S.
Published: June 2023

Introduction:

Each year, people with diabetes and their insurers or governments spend billions of dollars on blood glucose monitors and their associated components. These monitors have evolved substantially since their introduction in the 1970s, and manufacturers frequently protect original medical devices and their modifications by applying for and obtaining patent protection.

Research Design and Methods:

We tracked the product iterations of five widely used blood glucose monitors—manufactured by LifeScan, Dexcom, Abbott, Roche, and Trividia—from information published by the U.S. Food and Drug Administration (FDA), and extracted relevant U.S. patents.

Results:

We found 384 products made by the five manufacturers of interest, including 130 devices cleared through the 510(k) pathway, 251 approved via the premarket approval (PMA) pathway or via PMA supplements, and three for which de novo requests were granted. We identified 8095 patents potentially relevant to these devices, 2469 (31%) of which were likely to have expired by July 2021.

Conclusions:

Manufacturers of blood glucose monitoring systems frequently modified their devices and obtained patent protection related to these device modifications. The therapeutic value of these new modifications should be critically evaluated and balanced against their additional cost. Older glucose monitoring devices that were marketed in decades past are now in the public domain and no longer protected by patents. Newer devices will join them as their patents expire. Increased demand from people with diabetes and the health care system for older, off-patent devices would provide an incentive for the medical device industry to make these devices more widely available, enabling good care at lower cost when such devices are substantially equivalent in effectiveness and safety. In turn, availability and awareness of older, off-patent devices could help stimulate such demand.
A machine learning approach on chest X-rays for pediatric pneumonia detection
Authors: Barakat Natali , Awad Mahmoud , Abu-Nabah Bassam A
Published: June 2023

Background

According to the World Health Organization (WHO), pneumonia is the leading infectious cause of death in children below 5 years old. Hence, the early detection of pediatric pneumonia is crucial to reduce its morbidity and mortality rates. Even though chest radiography is the most commonly employed modality for pneumonia detection, recent studies highlight the existence of poor interobserver agreement in the chest X-ray interpretation of healthcare practitioners when it comes to diagnosing pediatric pneumonia. Thus, there is a significant need for automating the detection process to minimize the potential human error. Since Artificial Intelligence tools such as Deep Learning (DL) and Machine Learning (ML) have the potential to automate disease detection, many researchers explored how such tools can be implemented to detect pneumonia in chest X-rays. Notably, the majority of efforts tackled this problem from a DL point of view. However, ML has shown a higher potential for medical interpretability while being less computationally demanding than DL.

Objective

The aim of this paper is to automate the early detection process of pediatric pneumonia using ML as it is less computationally demanding than DL.

Methods

The proposed approach entails performing data augmentation to balance the classes of the utilized dataset, optimizing the feature extraction scheme, and evaluating the performance of several ML models. Moreover, the performance of this approach is compared to a TL benchmark to evaluate its candidacy.

Results

Using the proposed approach, the Quadratic SVM model yielded an accuracy of 97.58%, surpassing the accuracies reported in the current ML literature. In addition, this model classification time was significantly smaller than that of the TL benchmark.

Conclusion

The results strongly support the candidacy of the proposed approach in reliably detecting pediatric pneumonia.
Effects of Lateral Opening-Wedge Distal Femoral Osteotomy on Meniscal Allograft Transplantation: A Biomechanical Evaluation
Authors: Lee Simon , Brown Justin R. , Bartolomei Christopher , Turnbull Travis , Miles Jon W. , Dornan Grant J. , Frank Rachel M. , Vidal Armando F.
Published: June 2023

Background:

Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically.

Purpose/Hypothesis:

The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus.

Study Design:

Controlled laboratory study.

Methods:

Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation.

Results:

Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (–41%) (all P < .05 vs intact), while LMAT restored all outcome measures (all P > .05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (–0.0479 N/mm2), 5.9% (–0.154 N/mm2), and 1.4% (–6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively.

Conclusion:

Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile.

Clinical Relevance

Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient.
Can Hip Passive Range of Motion Predict Hip Microinstability? A Comparative Study
Authors: Curtis Daniel M. , Pullen W. Michael , Hopkins Justin N. , Murray Iain R. , Money Adam , Segovia Nicole A. , Safran Marc R.
Published: June 2023

Background:

Hip microinstability is an increasingly recognized cause of pain and disability in young adults. It is unknown whether differences in passive hip range of motion (ROM) exist between patients with versus without hip microinstability.

Hypothesis:

Underlying ligamentous and capsular laxity will result in differences in clinically detectable passive ROM between patients with femoroacetabular impingement (FAI), patients with microinstability, and asymptomatic controls.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A retrospective review of all patients undergoing hip arthroscopy between 2012 and 2018 was conducted. Patients with a diagnosis of isolated microinstability based on intraoperative findings were identified and classified as having isolated FAI, instability, or FAI + instability. Patients without a history of hip injury were included as controls. Range of motion was recorded in the supine position for flexion, internal rotation, and external rotation. Univariate and multivariate analysis was performed on each measurement in isolation as well as combinations of motion to include total rotation arc, flexion + rotation arc, and flexion + 2× rotation arc Models were then created and tested to predict instability status.

Results:

In total, 263 hips were included: 69 with isolated instability, 50 with FAI, 50 with FAI + instability, and 94 control hips. A higher proportion of patients in the instability and FAI + instability groups were female compared with the FAI and control groups ( P < .001). On univariate analysis, differences were found in all groups in all planes of motion ( P < .001). Multivariable analysis demonstrated differences in all groups in flexion and flexion + rotation arc. In symptomatic patients, the best performing predictive model for hip microinstability was flexion + rotation arc ≥200° (Akaike information criterion, 132.3; P < .001) with a sensitivity of 68.9%, specificity of 80.0%, positive predictive value of 89.1%, and negative predictive value of 51.9%.

Conclusion:

Patients with hip microinstability had significantly greater ROM than symptomatic and asymptomatic cohorts without hip microinstability. Symptomatic patients with hip flexion + rotation arc ≥200° were highly likely to have positive intraoperative findings for hip microinstability, whereas instability status was difficult to predict in patients with a flexion + rotation arc of <200°.
Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis
Authors: Nutarelli Sebastiano , Lodi Camilla Mondini Trissino da , Cook Jill L. , Deabate Luca , Filardo Giuseppe
Published: June 2023

Background:

Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes’ careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures.

Purpose:

To determine the prevalence and incidence of PT in athletes and the general population.

Design:

Systematic review; Level of evidence, 3.

Methods:

A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population.

Results:

A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes’ populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men ( P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years ( P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations ( P = .004).

Conclusion:

This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.
Open Versus Arthroscopic Latarjet for Recurrent Anterior Shoulder Instability: A Systematic Review and Meta-analysis
Authors: Deng Zhenhan , Zheng Yizi , Su Jingyue , Chen Siyu , Deng Zhiqin , Zhu Weimin , Li Yusheng , Lu Wei
Published: June 2023

Background:

The open Latarjet (OL) procedure and arthroscopic Latarjet (AL) procedure are able to treat recurrent anterior shoulder instability (RASI) with high success rates.

Purpose:

To evaluate the clinical efficacy and postoperative revisions and complications between the OL and AL procedures in the treatment of RASI.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

MEDLINE, Embase, and the Cochrane Library were searched to retrieve and include cohort studies comparing the OL and AL procedures for RASI. Clinical outcomes were compared, and results were reported as odds ratios (ORs) or mean differences (MDs) with 95% CIs.

Results:

Eleven clinical trials with 1217 patients were included. There were no differences between the procedures in pain score, Rowe score, Walch-Duplay score, external rotation, persistent apprehension, instability, recurrence, revisions attributed to recurrent instability, overall complications, wound infection, hematoma, graft complications, screw-related complications, or osteoarthritis. When compared with the OL procedure, the AL procedure had a significantly lower nonunion rate (OR, 9.92; 95% CI, 1.71 to 57.71; P = .01); however, the AL procedure had a longer operation time (MD, –24.49; 95% CI, –48.44 to –0.54; P = .05), lower Western Ontario Shoulder Instability Index score (MD, 97.27; 95% CI, 21.91 to 172.63; P = .01), higher revision rate (OR, 0.39; 95% CI, 0.16 to 0.95; P = .04), and greater screw deviation (MD, –6.41; 95% CI, –10.25 to –2.57; P = .001).

Conclusion:

For most outcome measures, no difference was seen between the OL and AL procedures. The AL procedure had a lower Western Ontario Shoulder Instability Index score and a higher revision rate and appeared to have a significant learning curve. However, the AL procedure resulted in a lower nonunion rate.
Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial
Authors: Götschi Tobias , Hodel Sandro , Kühne Nathalie , Bachmann Elias , Li Xiang , Zimmermann Stefan M. , Snedeker Jess G. , Fucentese Sandro F.
Published: June 2023

Background:

Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery.

Hypothesis:

Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively.

Results:

The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient’s recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698).

Conclusion:

Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year.

Registration:

NCT03462823 ( ClinicalTrials.gov identifier).
Primary Autologous Stem Cell Transplantation for Unilateral Primary Central Nervous System Lymphoma–Ophthalmic Variant (Primary Vitreoretinal Lymphoma)
Authors: Lee Brian , de Vos Sven , McCannel Colin A.
Published: June 2023

Purpose: To describe the long-term outcomes of 2 cases of primary autologous stem cell transplantation (ASCT) for the treatment of primary central nervous system lymphoma–ophthalmic variant (PCNSL-O) or primary vitreoretinal lymphoma (PVRL). Methods: Two cases and their findings were analyzed. A review of the histopathology, systemic treatment, and multimodal ocular imaging was performed. Results: A 52-year-old woman and 56-year-old woman were referred for vitritis and retinal lesions suspicious for PCNSL-O. The initial vitreous biopsies were inconclusive. Both patients had subsequent chorioretinal biopsies that confirmed the diagnosis of diffuse large B-cell lymphoma. No systemic or central nervous system involvement was found on systemic workup. Both patients received intravitreal and systemic chemotherapy followed by ASCT, and both remained in complete remission 7 and 8 years later. Conclusions: These cases show the long-term survival of patients diagnosed with PVRL when primary ASCT, the primary treatment for PCNSL, is performed.
Clinical and Anatomic Outcomes of 3-Piece Poly(methyl methacrylate) Intraocular Lens Rescue and Needle-Assisted Transconjunctival Intrascleral Lens Fixation
Authors: Curran Christian , Adam Murtaza K.
Published: June 2023

Purpose: To report the clinical and anatomic outcomes of a single-stage rescue and sutureless 30-gauge needle-assisted transconjunctival intrascleral fixation of dislocated 3-piece rigid poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs). Methods: This retrospective noncomparative single-surgeon interventional study comprised eyes that had concurrent 23- or 25-gauge pars plana vitrectomy and IOL rescue with sutureless transconjunctival needle-assisted flanged haptic intrascleral fixation. Lamellar scleral dissection for haptic fixation was performed 3 mm posterior to the surgical limbus with 30-gauge needles. Primary endpoints included visual acuity (VA), IOL tilt measured with ultrasound biomicroscopy (UBM), and postoperative complications. Results: The study evaluated 25 eyes of 24 patients. The IOL was successfully refixated in 24 of the 25 eyes. The mean preoperative logMAR VA of 1.21 ± 0.79 SD (median 1.3; Snellen equivalent 20/400) improved to 0.28 ± 0.35 (median 0.14; Snellen equivalent 20/30) postoperatively ( P < .0001). The mean IOL tilt measured by UBM (n = 7) was 3.79 ± 3.60 degrees. The mean postoperative follow-up was 348 ± 284 days (range, 7-979 days). Postoperative complications included self-clearing vitreous hemorrhage (n = 9), retinal detachment (RD) (n = 1), cystoid macular edema (n = 3), and corneal edema (n = 3). Three eyes (13%) required additional surgery, 1 for RD and 2 for delayed haptic slippage and secondary IOL tilt causing irregular astigmatism. Conclusions: Intrascleral needle-assisted fixation of dislocated or mobile 3-piece PMMA IOLs is an effective, safe method to restore VA.
Sometimes It Really Is the Zebra: A Rare Case of Infantile Giant Cell Fibroblastoma
Authors: Alessio-Bilowus Dominic , Sacks Gina N. , Luby Alexandra O. , Heider Amer , Vercler Christian J.
Published: June 2023

Plastic surgeons often perform surgical excision of soft tissue lesions and masses on the head and neck. In the pediatric population, these are most commonly benign lesions; however, malignant lesions must always remain on the differential. In this case report, we describe a case of a scalp giant cell fibroblastoma in infancy. Once the diagnosis was confirmed, a multidisciplinary tumor board including pediatric hematology-oncology was consulted for management recommendations. Surgical re-excision with additional 1 cm margins was performed and wound closure was accomplished without any undermining of surrounding skin and ultimately covered with a skin graft. While extremely rare, giant cell fibroblastoma is a locally aggressive soft tissue tumor that plastic surgeons may encounter in clinic practice and requires multi-disciplinary care.
Examining the Effectiveness of Financial Protection Schemes in Reducing Health Inequality
Authors: Ahmed Shakeel , Mahapatro Sandhya R.
Published: June 2023

Health protection schemes such as health insurance and financial assistance provide immense help and support to access health care services, especially to the poor and marginalized section of society. India is witness to low health-related expenditure, and the society's socioeconomic and demographic structure further drops health care access to the new bottom. Consequently, inequality in health care access is highly observed across many socioeconomic attributes. The condition of Bihar, the poorest state of India, is more alarming. The analysis suggests that financial support in terms of universal health insurance coverage considerably reduces out-of-pocket expenditure and thus health inequality. Further, the low health insurance coverage is not solely due to a lack of institutional commitment and implementation process; the cognitive behavior and attitude of people are equally responsible for low health care access. An intensive awareness program to show the benefit of the health insurance scheme and sensitization of people against the social stigma is important to provide better health care access and reduce health inequality.
Treating relapsed/refractory mature T- and NK-cell neoplasms with tislelizumab: a multicenter open-label phase 2 study
Authors: Bachy Emmanuel , Savage Kerry J. , Huang Huiqiang , Kwong Yok-Lam , Gritti Giuseppe , Zhang Qingyuan , Liberati Anna Marina , Cao Junning , Yang Haiyan , Hao Siguo , Hu Jianda , Zhou Keshu , Petrini Mario , Russo Filomena , Zhang Huilai , Sang Wei , Ji Jie , Ferreri Andrés José María , Damaj Gandhi Laurent , Liu Hui , Zhang Wei , Ke Xiaoyan , Ghiggi Chiara , Huang Sha , Li Xiaotong , Yao Hui , Paik Jason , Novotny William , Zhou Wenxiao , Zhu Hongjie , Zinzani Pier Luigi
Published: June 2023

Patients with relapsed/refractory (R/R) mature T- and natural killer (NK)–cell neoplasms lack effective treatments after failure of standard therapies. This phase 2 study evaluated the efficacy and safety of the programmed cell death protein 1 inhibitor tislelizumab in these patients. Seventy-seven patients were treated with 200 mg tislelizumab every 3 weeks. Twenty-two patients with extranodal NK-/T-cell lymphomas were enrolled in cohort 1; 44 patients with peripheral T-cell lymphoma (PTCL) were enrolled in cohort 2 (21 patients had PTCL not otherwise specified, 11 patients had angioimmunoblastic T-cell lymphoma, and 12 patients had anaplastic large-cell lymphoma). Cohort 3 comprised 11 patients with cutaneous T-cell lymphoma, of which 8 patients had mycosis fungoides (MF) and 3 had Sézary syndrome. Of the 77 patients, 76.6% had advanced-stage disease, 51.9% had refractory disease, and 49.4% received ≥3 prior systemic regimens. Promising efficacy was observed in cohort 3 (median follow-up [FU], 16.6 months; overall response rate [ORR], 45.5%; complete response [CR], 9.1%; median duration of response [DOR], 11.3 months; median progression-free survival, 16.8 months; median overall survival, not reached). Modest efficacy was observed in cohort 1 (median FU, 8.4 months; ORR, 31.8%; CR, 18.2%; median DOR, not reached) and cohort 2 (median FU, 9.3 months; ORR, 20.5%; CR, 9.1%; median DOR, 8.2 months). Most treatment-related adverse events were grade 1 or 2, and the safety profile was consistent with the known safety profile of tislelizumab. In conclusion, tislelizumab was well tolerated, achieving modest efficacy in R/R mature T- and NK-cell neoplasms, with some long-lasting remissions. This trial was registered at www.clinicaltrials.gov as #NCT03493451.
Uptake of long-chain fatty acids from the bone marrow suppresses CD8+ T-cell metabolism and function in multiple myeloma
Authors: Gudgeon Nancy , Giles Hannah , Bishop Emma L. , Fulton-Ward Taylor , Escribano-Gonzalez Cristina , Munford Haydn , James-Bott Anna , Foster Kane , Karim Farheen , Jayawardana Dedunu , Mahmood Ansar , Cribbs Adam P. , Tennant Daniel A. , Basu Supratik , Pratt Guy , Dimeloe Sarah
Published: June 2023

T cells demonstrate impaired function in multiple myeloma (MM) but suppressive mechanisms in the bone marrow microenvironment remain poorly defined. We observe that bone marrow CD8+ T-cell function is decreased in MM compared with controls, and is also consistently lower within bone marrow samples than in matched peripheral blood samples. These changes are accompanied by decreased mitochondrial mass and markedly elevated long-chain fatty acid uptake. In vitro modeling confirmed that uptake of bone marrow lipids suppresses CD8+ T function, which is impaired in autologous bone marrow plasma but rescued by lipid removal. Analysis of single-cell RNA-sequencing data identified expression of fatty acid transport protein 1 (FATP1) in bone marrow CD8+ T cells in MM, and FATP1 blockade also rescued CD8+ T-cell function, thereby identifying this as a novel target to augment T-cell activity in MM. Finally, analysis of samples from cohorts of patients who had received treatment identified that CD8+ T-cell metabolic dysfunction resolves in patients with MM who are responsive to treatment but not in patients with relapsed MM, and is associated with substantial T-cell functional restoration.
Role of small airway dysfunction in unexplained exertional dyspnoea
Authors: Sharpe Alexis L. , Reibman Joan , Oppenheimer Beno W. , Goldring Roberta M. , Liu Mengling , Shao Yongzhao , Bohart Isaac , Kwok Benjamin , Weinstein Tatiana , Addrizzo-Harris Doreen , Sterman Daniel H. , Berger Kenneth I.
Published: June 2023

Background

Isolated small airway abnormalities may be demonstrable at rest in patients with normal spirometry; however, the relationship of these abnormalities to exertional symptoms remains uncertain. This study uses an augmented cardiopulmonary exercise test (CPET) to include evaluation of small airway function during and following exercise to unmask abnormalities not evident with standard testing in individuals with dyspnoea and normal spirometry.

Methods

Three groups of subjects were studied: 1) World Trade Center (WTC) dust exposure (n=20); 2) Clinical Referral (n=15); and Control (n=13). Baseline evaluation included respiratory oscillometry. Airway function during an incremental workload CPET was assessed by: 1) tidal flowversusvolume curves during exercise to assess for dynamic hyperinflation and expiratory flow limitation; and 2) post-exercise spirometry and oscillometry to evaluate for airway hyperreactivity.

Results

All subjects demonstrated normal baseline forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Dyspnoea was reproduced during CPET in WTC and Clinical Referral groupsversusControl without abnormality in respiratory pattern and minute ventilation. Tidal flow–volume curves uncovered expiratory flow limitation and/or dynamic hyperinflation with increased prevalence in WTC and Clinical ReferralversusControl (55%, 87%versus15%; p<0.001). Post-exercise oscillometry uncovered small airway hyperreactivity with increased prevalence in WTC and Clinical ReferralversusControl (40%, 47%versus0%, p<0.05).

Conclusions

We uncovered mechanisms for exertional dyspnoea in subject with normal spirometry that was attributable to either small airway dysfunction during exercise and/or small airway hyperreactivity following exercise. The similarity of findings in WTC environmentally exposed and clinically referred cohorts suggests broad relevance for these evaluations.
Biotite: new tools for a versatile Python bioinformatics library
Authors: Kunzmann Patrick , Müller Tom David , Greil Maximilian , Krumbach Jan Hendrik , Anter Jacob Marcel , Bauer Daniel , Islam Faisal , Hamacher Kay
Published: June 2023

Background

Biotite is a program library for sequence and structural bioinformatics written for the Python programming language. It implements widely used computational methods into a consistent and accessible package. This allows for easy combination of various data analysis, modeling and simulation methods.

Results

This article presents major functionalities introduced into Biotite since its original publication. The fields of application are shown using concrete examples. We show that the computational performance of Biotite for bioinformatics tasks is comparable to individual, special purpose software systems specifically developed for the respective single task.

Conclusions

The results show that Biotite can be used as program library to either answer specific bioinformatics questions and simultaneously allow the user to write entire, self-contained software applications with sufficient performance for general application.
LAPIS is a fast web API for massive open virus sequencing data
Authors: Chen Chaoran , Taepper Alexander , Engelniederhammer Fabian , Kellerer Jonas , Roemer Cornelius , Stadler Tanja
Published: June 2023

Background

Recent epidemic outbreaks such as the SARS-CoV-2 pandemic and the mpox outbreak in 2022 have demonstrated the value of genomic sequencing data for tracking the origin and spread of pathogens. Laboratories around the globe generated new sequences at unprecedented speed and volume and bioinformaticians developed new tools and dashboards to analyze this wealth of data. However, a major challenge that remains is the lack of simple and efficient approaches for accessing and processing sequencing data.

Results

The Lightweight API for Sequences (LAPIS) facilitates rapid retrieval and analysis of genomic sequencing data through a REST API. It supports complex mutation- and metadata-based queries and can perform aggregation operations on massive datasets. LAPIS is optimized for typical questions relevant to genomic epidemiology. Using a newly-developed in-memory database engine, it has a high speed and throughput: between 25 January and 4 February 2023, the SARS-CoV-2 instance of LAPIS, which contains 14.5 million sequences, processed over 20 million requests with a mean response time of 411 ms and a median response time of 1 ms. LAPIS is the core engine behind our dashboards on genspectrum.org and we currently maintain public LAPIS instances for SARS-CoV-2 and mpox.

Conclusions

Powered by an optimized database engine and available through a web API, LAPIS enhances the accessibility of genomic sequencing data. It is designed to serve as a common backend for dashboards and analyses with the potential to be integrated into common database platforms such as GenBank.
Systematically identifying genetic signatures including novel SNP-clusters, nonsense variants, frame-shift INDELs, and long STR expansions that potentially link to unknown phenotypes existing in dog breeds
Authors: Li Zicheng , Wang Zuoheng , Chen Zhiyuan , Voegeli Heidi , Lichtman Judith H. , Smith Peter , Liu Ju , DeWan Andrew T. , Hoh Josephine
Published: June 2023

Background

In light of previous studies that profiled breed-specific traits or used genome-wide association studies to refine loci associated with characteristic morphological features in dogs, the field has gained tremendous genetic insights for known dog traits observed among breeds. Here we aim to address the question from a reserve perspective: whether there are breed-specific genotypes that may underlie currently unknown phenotypes. This study provides a complete set of breed-specific genetic signatures (BSGS). Several novel BSGS with significant protein-altering effects were highlighted and validated.

Results

Using the next generation whole-genome sequencing technology coupled with unsupervised machine learning for pattern recognitions, we constructed and analyzed a high-resolution sequence map for 76 breeds of 412 dogs. Genomic structures including novel single nucleotide polymorphisms (SNPs), SNP clusters, insertions, deletions (INDELs) and short tandem repeats (STRs) were uncovered mutually exclusively among breeds. We also partially validated some novel nonsense variants by Sanger sequencing with additional dogs.

Four novel nonsense BSGS were found in the Bernese Mountain Dog, Samoyed, Bull Terrier, and Basset Hound, respectively. Four INDELs resulting in either frame-shift or codon disruptions were found in the Norwich Terrier, Airedale Terrier, Chow Chow and Bernese Mountain Dog, respectively. A total of 15 genomic regions containing three types of BSGS (SNP-clusters, INDELs and STRs) were identified in the Akita, Alaskan Malamute, Chow Chow, Field Spaniel, Keeshond, Shetland Sheepdog and Sussex Spaniel, in which Keeshond and Sussex Spaniel each carried one amino-acid changing BSGS in such regions.

Conclusion

Given the strong relationship between human and dog breed-specific traits, this study might be of considerable interest to researchers and all. Novel genetic signatures that can differentiate dog breeds were uncovered. Several functional genetic signatures might indicate potentially breed-specific unknown phenotypic traits or disease predispositions. These results open the door for further investigations. Importantly, the computational tools we developed can be applied to any dog breeds as well as other species. This study will stimulate new thinking, as the results of breed-specific genetic signatures may offer an overarching relevance of the animal models to human health and disease.
The effect of erector spinae plane block on fentanyl consumption during open abdominal hysterectomy: a randomised controlled study
Authors: Hamed Mohamed Ahmed , Boules Maged Labib , Mahmoud Mohamed Abd El Moniem , Abdelghaffar Rana Ahmed
Published: June 2023

Background

Perioperative analgesia is very important during an abdominal hysterectomy. Determining the impact of the erector spinae plane block (ESPB) on patients undergoing an open abdominal hysterectomy while under general anesthesia was our aim.

Methods

In order to create equal groups, 100 patients who underwent elective open abdominal hysterectomies under general anesthesia were enlisted. The preoperative bilateral ESPB with 20 ml of bupivacaine 0.25% was administered to the ESPB group (n = 50). The same procedure was performed on the control group (n = 50), but they received a 20-ml saline injection instead. The primary outcome is the total amount of fentanyl consumed during surgery.

Results

We found that the mean (SD) intraoperative fentanyl consumption was significantly lower in the ESPB group than in the control group (82.9 (27.4) g vs. 148.5 (44.8) g, with a 95% CI = -80.3 to -50.8; p 0.001). Likewise, mean (SD) postoperative fentanyl consumption was significantly lower in the ESPB group than in the control group (442.4 (17.8) g vs. 477.9 (10.4) g, with a 95% CI = -41.3 to -29.7; p 0.001). On the other hand, there is no statistically significant difference between the two study groups regarding sevoflurane consumption (89.2 (19.5) ml vs. 92.4 (15.3) ml, with a 95% CI = -10.1 to 3.8; p 0.4).

We documented that during the post-operative period (0–24 h), VAS scores at rest were, on average, 1.03 units lower in the ESPB group (estimate = -1.03, 95% CI = -1.16-(-0.86), t = -14.9, p-value 0.001), and VAS scores during cough were, on average, 1.07 units lower in the ESPB group (estimate = -1.07, 95% CI = -1.21-(-0.93), t = -14.8, p-value 0.001).

Conclusion

Bilateral ESPB can be utilized as an adjuvant method to reduce intraoperative fentanyl consumption and enhance postoperative pain control in patients undergoing open total abdominal hysterectomy under general anesthesia. It is effective, secure, and little obtrusive.

Trial registration

No protocol revisions or study amendments have been made since the trial's inception, according to the information on ClinicalTrials.gov (NCT05072184; principal investigator: Mohamed Ahmed Hamed; date of registration: October 28, 2021).
Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe acute pancreatitis: a retrospective cohort study
Authors: Xu Huiting , Wan Jianhua , He Wenhua , Zhu Yong , Zeng Hao , Liu Pi , Liu Jing , Xia Liang , Liu Fen , Zhu Yin , Chen Youxiang , Lu Nonghua
Published: June 2023

Background

At present, the relationship between severe acute pancreatitis (SAP) and albumin infusion is not clear. We aimed to identify the impact of serum albumin on the prognosis of SAP and the association between albumin infusions and mortality for hypoalbuminemia patients.

Methods

This was a retrospective cohort study that analyzed 1000 patients with SAP who were admitted to the First Affiliated Hospital of Nanchang University between January 2010 and December 2021 using data from a prospectively maintained database. Multivariate logistic regression analysis was conducted to reveal the relationship between serum albumin within 1 week after admission and poor prognosis of SAP. Propensity score matching (PSM) analysis was adopted to evaluate the effect of albumin infusion for hypoalbuminemia patients with SAP.

Results

The prevalence of hypoalbuminemia (≤ 30 g/L) was 56.9% within 1 week after admission. Multivariate logistic regression identified that age (OR: 1.02; 95% CI: 1.00-1.04; P = 0.012), serum urea (OR: 1.08; 95% CI: 1.04–1.12; P < 0.001), serum calcium (OR: 0.27; 95% CI: 0.14–0.50; P < 0.001), lowest albumin level within 1 week after admission (OR: 0.93; 95% CI: 0.89–0.97; P = 0.002), and APACHE II score ≥ 15 (OR: 1.73; 95% CI: 1.19–2.51; P = 0.004) were independently associated with mortality. The PSM analysis demonstrated that mortality (OR: 0.52, 95% CI: 0.29–0.92, P = 0.023) was less common in albumin-infused than non-albumin-infused hypoalbuminemia patients. In subgroup analyses, doses > 100 g within 1 week after admission for hypoalbuminemia patients with albumin infusions was associated with lower mortality than doses ≤ 100 g (OR: 0.51, 95% CI: 0.28–0.90, P = 0.020).

Conclusions

Hypoalbuminemia in early-stage SAP is significantly related to poor prognosis. However, albumin infusions could significantly decrease mortality in hypoalbuminemia patients with SAP. Additionally, infusing sufficient albumin within a week after admission may decrease mortality in hypoalbuminemia patients.