bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of preconditioning hypoxia in schwann-like-cells-derived adipose mesenchymal stem cells and rat sciatic nerve-derived stem cells: experimental research
Authors: Sumarwoto Tito , Suroto Heri , Utomo Dwikora Novembri , Prakoeswa Cita Rosita Sigit , Tinduh Damayanti , Notobroto Hari Basuki , Arfian Nur , Rantam Fedik Abdul , Rhatomy Sholahuddin , Mahyudin Ferdiansyah
Published: May 2023

Background:

The preconditioning hypoxia for stem cells is a strategy to achieve effective conditions for cell therapy, indicate increased expression of regenerative genes in stem cell therapy, and enhance the secretion of bioactive factors and therapeutic potential of their cultured secretome.

Objectives:

This study aims to explore the response of Schwann-like cells derived from adipose-derived mesenchymal stem cells (SLCs) and Schwann cells rat sciatic nerve-derived stem cells (SCs) with their secretomes under normoxic and hypoxic conditions in vitro.

Material and methods:

SLCs and SCs were isolated from the adipose tissue and the sciatic nerve of the adult white male rat strain Wistar. Cells were incubated in 21% O2 (normoxic group) and 1%, 3%, and 5% O2 (hypoxic group) conditions. Concentration values of transforming growth factor-β (TGF-β), basic Fibroblast Growth factor (bFGF), brain-derived neurotrophic factor, glial-derived neurotrophic factor, vascular endothelial growth factor, and nerve growth factor were detected and calculated utilizing an enzyme-linked immunosorbent assay, and the growth curve was described.

Results:

SLCs and SCs indicated positive expression for mesenchymal markers and negative expression for hematopoietic markers. Normoxic conditions SLCs and SCs showed elongated and flattened morphology. Under hypoxic conditions, SLCs and SCs showed a classic fibroblast-like morphology. Hypoxia 1% gave the highest concentration in TGF-β and bFGF from the SLCs group and TGF-β, bFGF, brain-derived neurotrophic factor, and vascular endothelial growth factor from the SCs group. No significant differences in concentration of growth factors between the SLCs group compared to SCs group in all oxygen groups.

Conclusions:

Preconditioning hypoxia has an effect on the composing of SLCs, SCs, and their secretomes in vitro; no significant differences in concentration of growth factors between the SLCs group compared with the SCs group in all oxygen groups.
Resistance patterns of bacterial pathogens causing lower respiratory tract infections: Aleppo-Syria
Authors: Arab Ola , Al-Kayali Rawaa , Khouri Abdullah , Haj Kaddour Samer
Published: May 2023

Background:

Globally, lower respiratory tract infections (LRTIs) are one of the lead causes of death. Bacterial and susceptibility profiles are not constant over time and geographically, and different patient factors can be correlated with those infections.

Objective:

This study aimed to scan the bacterial spectrum causing LRTIs, their susceptibility profile and patient related risk factors.

Material and methods:

Two hundred sixty-eight specimens from LRTIs suspected patients attending University Hospital were collected. Specimens included bronchial washings, transtracheal aspiration samples and sputum. After appropriate culture and identification tests, susceptibility test was done using minimum inhibitory concentration method. Data were collected from patients for further analysis.

Results:

of total specimens, 150 showed positive culture results (Acinetobacter baumannii,Pseudomonas aeruginosa,Citrobacter koseri,Escherichia coli,Klebsiella pneumonia, Staphylococcus aureus, Staphylococcus epidermidis,Staphylococcus haemolyticus, Streptococcus pneumoniaandCandida spp.). The antibiogram showed high resistance among all bacterial isolates against most antibiotics. Good susceptibility rates were shown to colistin in Gram-negative group and piperacillin\tazobactam in Gram-positive group. Trimethoprim\sulfamethoxazole showed good susceptibility results in both groups. Many factors showed correlation with LRTIs such as age (P=0.004), smoking (P=0.049), residency (P=0.043), hypertension (P=0.012), lung chronic disease (P=0.007) and cancer (P=0.048).

Conclusion:

The leading cause of LRTIs in our study wereA. baumanniiandP. aeruginosawhich both are very troublesome pathogens and multidrug resistant frequency was alarming. Random empirical antibiotic using can highly lead to increased resistance. Further care must be taken after patients with risk factors, and adjustments should be done to those modifiable factors.
Exploring the relationship between insomnia and depression: a cross-sectional prospective study
Authors: Mohammed Salih Ahmed Mishaal , Madallah Zeyad Tariq , Ibrahim Radhwan H , Alseadn Mahfoodh Suliaman Hasan , Almushhadany Osama Ismael
Published: May 2023

Objectives:

This is a cross-sectional prospective study aimed to examine the association between insomnia and depression among individuals attending an outpatient psychiatric clinic.

Methods:

A total of 416 participants were recruited from the psychiatric and mental health outpatient clinic using a cross-sectional design. The participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) to measure sleep disturbances and depressive symptoms, respectively. Ethical approval was obtained from the Institutional Review Board at Ninevah University. Descriptive statistics, bivariate correlations, and multivariate regression analysis were used to analyze the data. The data collected in the study was analyzed using SPSS v0.26.

Results:

A total of 416 participants were recruited from the psychiatric and mental health outpatient clinic in Iraq through convenience sampling. The sample included 227 (54.6%) females and 189 (45.4%) males, with a mean age of 35.4 years (SD=9.8, range=18–65). Participants had a mean PSQI score of 11.6 (SD=3.7, range=2–21) and a mean BDI score of 21.8 (SD=11.1, range=0–54). Bivariate correlations showed a significant positive relationship between sleep disturbances (as measured by the PSQI) and depressive symptoms (as measured by the BDI) (r=0.67, P<0.001).

Conclusions:

The study provides valuable insights into the relationship between insomnia and depression in a sample of individuals from Iraq. These findings could contribute to the development of interventions to improve mental health outcomes among this population.
Hepatogastric fistula: a complication of pyogenic liver abscess in a patient with the Brugarda syndrome – A rare case report
Authors: Dev Santosh , Yadav Radheshyam , Sah Birendra , Sah Ashok Kumar , Ghimire Bikal , Shah Jayant Kumar
Published: May 2023

Introduction and Importance:

Hepatogastric fistula following pyogenic liver abscess (PLA) is a rare and fatal complication, and only a handful of cases have been reported without co-existing comorbidities of Brugarda syndrome.

Case presentation:

A 22-year-old male presented to the emergency room with a known case of Brugarda pattern ECG with chief complaints of on-and-off abdominal pain and fever for 2 weeks and shortness of breath for one day. On evaluation, echocardiography showed a clot in the inferior vena cava (IVC) and right atrium (RA), and on computed tomography scan of the abdomen revealed a liver abscess with transmural gastric perforation. During, an exploratory laparotomy where a fistula joining the left lobe of the liver and stomach was detected, and an emergency excision was done. The patient was shifted to the ICU and later developed septic shock, which was managed medically.

Clinical discussion:

Usually, thrombosis of the portal vein and the hepatic vein is a very common complication of a PLA but vascular complications like IVC, RA thrombosis, and hepatogastric fistula have been reported rarely. Our case is peculiar hepatogastric fistulization along with IVC/RA clots in a patient with Brugarda pattern ECG. The typical clinical manifestation of a patient with hepatogenic fistula is absent in our patient and presented with an on-off type of fever, epigastric pain, and shortness of breath and was managed surgically.

Conclusion:

Hepatogasric fistula, thrombosis of the IVC, and RA are a rare complications of PLA. The patient with Brugarda syndrome is at high risk as its clinical manifestation gets exaggerated during sepsis.
Kimura disease masquerading tuberculosis: a rare case presentation
Authors: Paneru Rabin , Pokhrel Madalasa , Lamichhane Saral , Basnet Subash , Poudel Saroj , Gautam Sudarshan , Sharma Nava Raj
Published: May 2023

Introduction and importance:

Kimura disease (KD) is an inflammatory disorder characterized by the development of subcutaneous lymphoid masses and regional lymphadenopathy. Due to its rarity and similarity to another disease, the diagnosis is complex.

Case presentation:

Here, the authors present a case of KD in 26-year-old male from Nepal who initially did not respond to antitubercular therapy. Later on, KD was diagnosed based on histopathology. He was followed up in medical outpatient with a good response to corticosteroid therapy.

Clinical discussion:

The diagnosis of KD is quite difficult in low-resource settings. The diagnosis is histopathological. Associated lymphadenopathy may mimic tuberculosis. Many patients respond well to the high-dose of steroid therapy; some might also require surgical excision or chemotherapy.

Conclusion:

Hence, the physician should include KD as a differential when a male in his 20s or 30s presents with a subcutaneous nodular mass in the head and neck.
Exploring potential pharmacological mechanisms of Yiqi Tuomin Decoction in the treatment of allergic rhinitis utilizing network pharmacology prediction and molecular docking-based strategies: experimental research
Authors: Zhang Weixin , Zhou Qing , Chen Xiaoning , Zhao Jingjing , Shi Jun , Chen Li
Published: May 2023

Background:

Yiqi TuominDecoction (YTD), which originated from the theory of lung deficiency and cold in Chinese medicine, is a common Chinese herbal formula used against allergic rhinitis (AR). In our otolaryngology department, this prescription has been used to treat so many AR patients with lung-deficiency-related colds for nearly 30 years. However, the mechanism of its ingredient–target is still unclear. Based on our early experiments and clinical case studies, in this paper, we explore the mechanism of YTD systematically against AR using bioinformatic methods of network pharmacology and molecular docking.

Methods:

The Traditional Chinese Medicine Systems Pharmacology (TCMSP) database was used to screen the active ingredients and targets of YTD. The AR-related targets were retrieved from OMIM, GeneCards, TTD, DisGeNET, DrugBank databases, and PharmGKB. The Venn database was used to screen the potential core targets. After that, the STRING database was used to construct the protein–protein interaction (PPI) of the core targets and then visualize it by Cytoscape. The Gene Ontology (GO)-enriched processes and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of the core targets were analyzed by the KOBAS-I database and Sangerbox. Molecular docking was used to assess interactions between potential targets and active ingredients.

Results:

A total of 169 active ingredients and 238 targets of YTD were predicted. YTD shared 115 common targets with AR from the Venn database. The GO-enriched processes and KEGG pathways indicate that genes involved in inflammation and oxidative stress, accompanying the MAPK signaling pathway, Th17 cell differentiation, IL-17 signaling pathway, and Th1 and Th2 cell differentiation, may play a mediated effect in YTD. The docking results showed good binding ability between the active ingredients and the selected targets.

Conclusions:

Our study systematically indicated the underlying mechanism of YTD against AR from the perspective of bioinformatics. By studying the active ingredients of YTD, we obtained molecular mechanisms and established a reliable method and molecular theoretical basis for the sensible development of Chinese medicine in the treatment of AR.
Odontogenic myxoma of the mandible: a case report
Authors: Khalil Abdulkarim , Ahmad Karam G. , Khalil Modar , Salloum Rabab
Published: May 2023

Introduction:

The odontogenic myxoma is a tumor of the jaws which arises from the mesenchymal portion of the tooth germ, either the dental papilla, the follicle, or the periodontal ligament. It is a slow-growing, painless, nonmetastasizing, central tumor of the jaws, chiefly the mandible. Radiographically, the classic presentation may vary from a unilocular radiolucency to a multilocular lesion with well-defined or diffuse margins. On histological study, it is composed of triangular or stellate connective cells, anastomosed by fine extensions, and embedded in abundant mucoid material.

Case presentation:

We present the unusual case of an odontogenic myxoma involving a 37-year-old female patient, which had acquired large dimensions and involved the right half of the mandible, including the ramus; the patient was treated with large resection surgery, with satisfying medium-term results.

Clinical discussion:

Early diagnosis of such lesions is very important, as the patient avoids extensive surgical procedures that involve losing a large part of the jawbones and their subsequent impact on the patient’s quality of life.

Conclusion:

Although there is no fixed treatment plan for the management of odontogenic myxoma, treatment includes surgical management that may range from simple enucleation and curettage to surgical excision; wide surgical resection is appropriate for cases of large size to avoid recurrence.
Postesophagectomy chylothorax: a review of the risk factors, diagnosis, and management
Authors: Zarei Mahdi , Montazer Majid , Shakeri Bavil Oliyaei Sepehr , Jahanshahlou Farid , Hosseini Mohammad-Salar
Published: May 2023

Chylothorax is a crucial postoperative complication of esophagectomy. Characterized by the leakage of chyle and lymphatic fluid through the thoracic duct, chylothorax could result in pleural effusion, respiratory distress, shortness of breath, cardiac arrhythmia, electrolyte imbalance, and malnutrition. Postesophagectomy chylothorax is associated with high morbidity and mortality, and its diagnosis and management require prompt and accurate identification of risk factors and treatment strategies. A variety of strategies are available to treat postesophagectomy chylothorax, ranging from conservative management to pharmacological, lymphangiographic, and surgical treatments. This study reviews the physio-anatomical basis, disease presentation, diagnostic methods, risk factors, and management options for postesophageal chylothorax, filling the literature gap, and highlighting the importance of early recognition and timely intervention in improving patient outcomes.
A rare case of chondrosarcoma at the posterior costovertebral junction: a case report
Authors: Abdullah Lava , Alsulaiman Sihaam Saleh , Alsalhani Obai Mustafa , Alkheder Ahmad , Al-Sulaiman Ibrahim Ali
Published: May 2023

Introduction:

Chodrosarcoma is the third most common primary malignancy of the bone, it is considered the most frequent malignancy of the chest wall. Chondrosarcoma at the costovertebral junction is rare and few cases are described in the literature.

Case Presentation:

The authors present a case of a 47-year-old female with a complaint of chronic pain in the right posterior upper chest, dyspnea, and episodes of dizziness.

The diagnosis of low-grade chondrosarcoma at the posterior costovertebral junction was made by video-assisted thoracic surgery and computed tomography.

The surgical management included resection of the tumor and parts of adjacent ribs.

Discussion:

Chondrosarcoma is chemotherapy and radiotherapy-resistant. The total surgical excision of the tumor with sufficient margins is usually curative.

Conclusion:

A follow-up is necessary because of the potential for recurrence.
Effectivity of puncture method for intervertebral disc degeneration animal models: review article
Authors: Romaniyanto FNU , Mahyudin Ferdiansyah , Utomo Dwikora N. , Suroto Heri , Sari Winda A. , Fachreza Muhammad S. , Sadewa Daffa , Dzikri Dykall N. , Nofaldi Fakhri
Published: May 2023

Intervertebral disk degeneration (IDD) is a chronic condition brought on by various factors and mechanisms that have been linked to many deaths and illnesses. The causes of IDD involve multiple processes, including genetics, stress, cellular aging, and changes in nutrition due to the limited blood supply. Animal models play a crucial role in biomedical research and the selection of these models is based on many considerations, including the need for similarities in structure and function with humans. This is important because the etiology and pathogenesis of IDD are complex. Finding the right animal model is not an easy task. In addition to having similarities to humans, these models should also be reliable, reproducible, cost-effective, and easy to maintain. One common method of inducing IDD in animal models is needle puncture. This method is less invasive and time-consuming compared to other methods and allows for precise control over the extent and location of the injury.
Using a right-angle forceps clamp to pass a suture under the coracoid base in coracoclavicular stabilization: a technical note
Authors: Klabklay Prapakorn , Maliwankul Korakot , Chuaychoosakoon Chaiwat
Published: May 2023

Introduction and importance:

A distal clavicle fracture is a common injury of the shoulder joint. Coracoclavicular (CC) stabilization is one of the recommended procedures for treating the distal clavicle fracture. However, it is difficult to pass the suture under the coracoid process with instruments normally available in the operating room (OR). Herein, the authors describe a simple technique to accomplish this suture passing quickly and easily using tools available in the OR.

Case presentation:

A 59-year-old Thai female presented with right shoulder pain after a fall. The physical examination showed a prominent bulge and tenderness at the right distal clavicle. A radiograph of both clavicles showed a right displaced distal clavicle fracture. After discussing the possible treatments with her, she decided to have CC stabilization as we recommended.

Clinical discussion:

In CC stabilization, the most important but difficult step is passing a suture under the coracoid base. There are some specialized commercial instruments which are matched to the shape of the coracoid process to make it easy to perform this step, but all are highly expensive (~$1400–1500 per piece) and thus often not available in ORs in resource-limited settings.

Conclusion:

The authors devised a technique using standard surgical instruments and materials available in all ORs to enable them to pass a suture easily and quickly under the coracoid base.
Adaption of the Casey-Fink Survey Tool for Nurse Residency Programs
Authors: Godzik Cassandra M. , Hurley Susan Lysaght , Buck Harleah G. , Yacinthus Blandine A. , Brennan Caitlin W.
Published: May 2023

OBJECTIVE

This evaluation project focused on assessing the content validity of an adapted version of the Casey-Fink (CF) Graduate Nurse Experience Survey, which is aimed at measuring role transitions in nursing.

BACKGROUND

Registered nurses in the hospice and palliative care field need training and confidence to be proficient in core skills including communication, interprofessional competence, and clinical skills required to care for the dying patient. However, a review of the literature revealed a gap in the availability of survey instruments to measure the confidence of nurses entering the field of hospice and palliative care.

METHODS

Ten items from the CF survey were revised by the project team and then evaluated for relevance by a group of 7 national hospice and palliative experts. The content validity index (CVI) was used to determine item relevance.

RESULTS

Item-level CVI (I-CVI) calculations ranged from 0.57 to 1.0. The 8 items scored between 0.80 and 1.0 were retained as written. One item required further revision (I-CVI, 0.71), and 1 item revision was eliminated (I-CVI, 0.57). Experts also suggested 5 additional items in the original CF-survey need modification.

CONCLUSION

The adapted CF-survey tool is ready for further psychometric testing, and next steps include administration to a new sample of nurse residents to determine construct validity.
Thinking, Feeling, Behaving
Authors: Price Deborah M. , Figueroa Nicole , Macera-DiClemente Linda , Wintermeyer-Pingel Sue , Riley Penny , Tschannen Dana
Published: May 2023

OBJECTIVE

This study examined the impact of the MINDBODYSTRONG® program on mental health and lifestyle behaviors among a sample of staff nurses, clinical nurse leaders, and faculty, when offered after the onset of the COVID-19 pandemic.

BACKGROUND

Previous studies have demonstrated the MINDBODYSTRONG program decreased anxiety and depressive symptoms, improved job satisfaction, and sustained healthy lifestyle behaviors in newly licensed RNs. This program has not been studied with experienced nurses. In addition, the use of a virtual format is unique.

METHODS

A pre-post design was used for this pilot study. Subjects were recruited from a large Midwestern medical center and affiliated school of nursing. Registered participants of the MINDBODYSTRONG program attended 7 weekly sessions virtually.

RESULTS

The MINDBODYSTRONG intervention suggests sustained improvement in perceived stress, anxiety, depression, and use of healthy behaviors.

CONCLUSION

This pilot study supports that the MINDBODYSTRONG program may be effective in addressing mental health and healthy lifestyle beliefs for staff nurses, clinical nurse leaders, and nursing faculty.
Developing a Quantitative Staffing to Workload Tool in an Ambulatory Setting
Authors: Hennek Lindsay R. , Bhandari Pawan , Ashley Kelly , McConnell Lisa A. , Renneke Cassondra D. , Stransky Angela M. , Mathew Bijoy M. , Runge Jessica M. , Pederson Michael D. , Slama Heather J.
Published: May 2023

Ambulatory staffing to workload based on visit volume in an outpatient setting is an elusive formula, and the literature describing such processes is limited. One health system tasked a multidisciplinary team with developing an ambulatory staffing to workload tool to meet the needs of staff, management, and leadership. The resultant tool includes an automated dashboard for determining staffing needs on the basis of quantified workload, prospective modeling, and historical dashboards to demonstrate actual staffing (full-time equivalents) to workload (outpatient volumes) compared with budget.
Diagnostic Yield and Utility of Radiographic Imaging in the Evaluation of Pulsatile Tinnitus: A Systematic Review
Authors: Cao Austin C. , Hwa Tiffany P. , Cavarocchi Caitlin , Quimby Alexandra , Eliades Steven J. , Ruckenstein Michael J. , Bigelow Douglas C. , Choudhri Omar A. , Brant Jason A.
Published: May 2023

Objective:

The objective of this study is to assess diagnostic yield of imaging modalities used to evaluate patients presenting with pulsatile tinnitus (PT).

Databases Reviewed:

PubMed, Embase, and Scopus were queried using the search terms “pulsatile tinnitus,” “pulse-synchronous tinnitus,” and “pulse synchronous tinnitus” with no date limitations.

Methods:

Studies that reported diagnostic imaging for patients presenting with PT were included. Data were reviewed for sample size, gender, age, imaging study, indications, and diagnoses. The primary outcome measure from aggregated data was the yield of positive diagnoses made with each imaging modality. The quality of evidence was assessed for risk of bias.

Results:

From an initial search of 1145 articles, 17 manuscripts met inclusion criteria, of which 12 studies evaluated individual imaging modalities. The number of unique patients included was 1232. The diagnostic yield varied between modalities: carotid ultrasound (21%, 95% confidence interval [CI]: 12%–35%), CT temporal bone (65%, CI: 20%–93%), computed tomographic angiography (86%, CI: 80%–90%), and MRI/magnetic resonance angiography (58%, CI: 43%–72%).

Conclusion:

Studies on the diagnostic approach to PT are limited by heterogeneity in both inclusion criteria and reporting standards. A wide range of imaging modalities are used in practice during the initial evaluation of PT, and the diagnostic yield for imaging can be improved by utilizing more specific clinical indications.
Bilateral Buccal Flap Revision Palatoplasty to Correct Velopharyngeal Dysfunction in Patients with Repaired Cleft Palate: Perceptual Speech, Acoustic, and Aerodynamic Outcomes
Authors: Napoli Joseph A. , Kalmar Christopher L. , Low David W. , Buckley James , Bunnell H. Timothy , Vallino Linda D.
Published: May 2023

Background:

The purpose of this study was to analyze perceptual, acoustic, and aerodynamic changes in speech and velopharyngeal function after bilateral buccal flap revision palatoplasty (BBFRP). in patients with repaired cleft palate.

Methods:

Ten consecutive patients, aged 4-18 years with velopharyngeal dysfunction (VPD) treated with BBFRP by a single surgeon, were evaluated. Using a visual analog scale (VAS), nine blinded speech-language pathologists independently rated hypernasality, hyponasality, audible nasal emission (ANE) and speech acceptability. Measurements of the acoustic speech signal were used to quantify changes in hypernasality and nasal emission. The pressure-flow technique was used to determine changes in velopharyngeal gap size.

Results:

Complete records were available for 8 patients. After surgery, hypernasality significantly decreased (p<.001) and speech acceptability increased (p<.001). ANE was significantly reduced (p<.001). Postoperative acoustic measures showed a reduction of nasal emission and improved nasalization. VP gap size significantly decreased after BBFRP (p<.001), correlating with lower VAS ratings of hypernasality (p=.015). Hyponasality did not significantly change after surgery (p=.964). No patient developed sleep disordered breathing.

Conclusions:

BBFRP resulted in a measurable improvement in hypernasal speech, audible nasal emission, and speech acceptability without significant changes in hyponasality or risk of obstructive sleep apnea.
The Natural History of Fibrous Dysplasia of the Orbit
Authors: Blum Jessica D. , Cho Daniel Y , Villavisanis Dillan F. , Goncalves Fabricio G. , Swanson Jordan W. , Storm Philip B. , Taylor Jesse A. , Bartlett Scott P.
Published: May 2023

Background:

Orbital fibrous dysplasia (FD) is a disease of disordered fibro-osseous proliferation secondary to altered osteogenesis, with potential sequelae including compressive neuropathy and irreversible vision loss. The purpose of this study was to evaluate the natural history and longitudinal outcomes of 37 patients with orbital FD who underwent stratified surgical management.

Methods:

All patients treated for FD from 2015-2021 were identified, yielding 185 patients, 39 with orbital involvement. Impressions from head CTs were analyzed by a craniofacial radiologist to evaluate location and timing of tumor growth. Operative records were reviewed to determine surgical approach (partial excision/contouring, complete excision, or partial excision with optic nerve decompression).

Results:

Average age at diagnosis was 10.7±4.5 years, with average follow up of 5.2±4.7 years. Of the 37 patients with orbital involvement, 28 (75.7%) had optic canal involvement. Of those with optic canal involvement, 13 (46.4%) required partial excision with optic nerve decompression while 15 (53.6%) did not. Of those without optic canal involvement, two patients (22.2%) underwent partial excision/contouring of the anterior orbit to correct dystopia and/or proptosis and four patients (44.4%) underwent complete excision of the orbital component and reconstruction with bone graft or mesh. Younger age at diagnosis was associated with an increased number of surgical interventions (p=.011), younger age at first optic canal decompression (p=.003) and worse visual outcomes (p=.009).

Conclusions:

In our cohort, patients diagnosed at a younger age required more surgeries, underwent decompression earlier, and had worse visual outcomes.
3D-printable Open-source Cleft Lip and Palate Impression Trays – A Single-Impression-Workflow
Authors: Meyer Simon , Benitez Benito K. , Thieringer Florian M. , Mueller Andreas A.
Published: May 2023

Documenting the complex three-dimensional cleft lip and palate malformation by plaster casts based on maxillary impressions is standard care. Presurgical orthopedic treatment also requires an impression. Digital impression-taking in patients with cleft lip and palate becomes feasible, but procurement costs still hinder clinical implementation. Individualized impression trays allow for a precise impression, limiting the airway risk. We present an open-source impression tray library with scalable impression trays not requiring 3D modeling knowledge. The cleft lip and palate impression tray library is accessible on Open Science Framework. Different shapes are available, and the tray size is selected based on the tuber distance. This allows 3D printing with biocompatible material at the point-of-care complying with local regulations. Our presented open-source cleft tray library offers a hybrid solution for cleft centers, pending the implementation of digital impression.
Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the “voluntary faculty” model
Authors: Yonge John , Schaetzel Shaina , Paull Jessie , Jensen Guy , Wallace James , O'Brien Brendan , Pak Grace , Schreiber Martin , Glaser Jacob
Published: May 2023

BACKGROUND

Appropriate operative volume remains a critical component in mitigating surgical atrophy and maintaining clinical competency. The initiation of military-civilian surgical partnerships (MCPs) has been proposed for addressing knowledge, skills, and abilities (KSA) metrics to address concerns over operational readiness and the low acuity experienced by military surgeons. This study investigates the first partnership for Navy surgical staff at a nonacademic Military Treatment Facility (MTF) with a regional academic Army Military Treatment Facility (AMTF) and a civilian, nonacademic level II trauma center devised to improve operational readiness for attending surgeons. We hypothesize that a skill sustainment MCP will allow military surgeons to meet combat readiness standards as measured by the KSA metric.

METHODS

A memorandum of understanding was initiated between the Navy Military Treatment Facility (NMTF), the AMTF, and the level II civilian trauma center (CTC). The single military surgeon in this study was classified as “voluntary faculty” at the CTC. Total case volume and acuity were recorded over an 11-month period. Knowledge, skills, and abilities metrics were calculated using the standard national provider identifier number and the novel case-log based method.

RESULTS

A total of 156 cases were completed by a single surgeon over the study period, averaging 52 cases per institution. Significantly more KSAs were obtained at the CTC compared with NMTF (5,954 vs. 2,707; p < 0.001). Significantly more emergent cases were observed at the CTC compared with the MTFs (χ2 = 7.1, n = 96, p < 0.05). At a single site, AMTF, a significant difference in the calculated KSA score, was observed between the national provider identifier and case-log methods (5,278 vs. 3,297; p = 0.04).

CONCLUSION

The skill sustainment MCP between NMTF and CTC increased surgical readiness and exposed surgeons to increased operative acuity. The voluntary faculty model reduces direct litigation exposure and encourages clinical competency for military surgeons while remaining a deployable asset to the global military effort.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Craniodental anatomy in Permian–Jurassic Cynodontia and Mammaliaformes (Synapsida, Therapsida) as a gateway to defining mammalian soft tissue and behavioural traits
Authors: Norton Luke A. , Abdala Fernando , Benoit Julien
Published: May 2023

Mammals are diagnosed by more than 30 osteological characters (e.g. squamosal-dentary jaw joint, three inner ear ossicles, etc.) that are readily preserved in the fossil record. However, it is the suite of physiological, soft tissue and behavioural characters (e.g. endothermy, hair, lactation, isocortex and parental care), the evolutionary origins of which have eluded scholars for decades, that most prominently distinguishes living mammals from other amniotes. Here, we review recent works that illustrate how evolutionary changes concentrated in the cranial and dental morphology of mammalian ancestors, the Permian–Jurassic Cynodontia and Mammaliaformes, can potentially be used to document the origin of some of the most crucial defining features of mammals. We discuss how these soft tissue and behavioural traits are highly integrated, and how their evolution is intermingled with that of craniodental traits, thus enabling the tracing of their previously out-of-reach phylogenetic history. Most of these osteological and dental proxies, such as the maxillary canal, bony labyrinth and dental replacement only recently became more easily accessible—thanks, in large part, to the widespread use of X-ray microtomography scanning in palaeontology—because they are linked to internal cranial characters.

This article is part of the theme issue ‘The mammalian skull: development, structure and function’.
Purpura fulminans secondary to Capnocytophaga canimorsus bacteraemia following a dog bite: A case report and review of literature.

Authors: Killington Kieran , Lee Nathaniel , Asher Radha , Farrant Olivia , Stone Neil
Published: May 2023

Introduction. Infection due to Capnocytophaga canimorsus may result in a wide variety of clinical presentations. We present a case of life-threatening Capnocytophaga canimorsus infection with evolution of ecchymosis to purpura fulminans.
Case description. We present a case of a 43-year-old male with a significant history of alcohol use who presented with features of sepsis following a dog bite. This was associated with a striking, widespread purpuric rash.  A causative pathogen, C. canimorsus was identified through blood culture and 16S RNA sequencing. His initially purpuric rash underwent bullous change and was diagnosed clinically as purpura fulminans, confirmed on skin biopsy. He made a full recovery with prompt antimicrobial therapy, initially with amoxiclav/clavulanic acid but escalated to clindamycin and meropenem due to clinical deterioration and concerns of beta-lactamase resistance.
Discussion . b-lactamase producing Capnocytophaga strains are of increasing concern. This particular concern is reflected in our case as five days into treatment with b-lactamase inhibitor combination therapy the patients clinical condition deteriorated but demonstrably improved on switching to a carbapenem.
The development of biopsy proven purpura fulminans in this immunocompetent case is a rare severe manifestation of the previously reported manifestation of DIC in Capnocytophaga septicaemia. The case reported describes characteristics common with other DIC presentations such as the presence of clinical risk factors (history of alcohol excess) and symmetrical involvement. However, an unusual feature in that initial purpuric lesions were followed by the development of a bullous appearance and peripheral necrotic features concerning for purpura fulminans and confirmed with skin biopsy.
Incidence, antifungal resistance properties, and virulence traits of candida species isolated from HIV/AIDS Patients from the hospital system in Kenya.
Authors: miruka haron nyaboga , Eric Omwenga O. , Musyoki Stanslaus , Awuor Silas O.
Published: May 2023

Candidiasis is the most common fungal infection in hospitalized patients with acquired immune deficiency syndrome resulting to morbidity and mortality. This study is aimed at characterizing, incidence, susceptibility, resistance genes, antibiofilm activity, and virulence traits of Candida species isolated from HIV-Infected patients. One hundred and eighty-one samples were collected and cultured on Sabouraud Dextrose Agar, biochemical tests and confirmed using automated Vitek-2 ® Compact bioMérieux followed by susceptibility tests, done by use of various conventional antifungals against the isolates using standard procedures. Virulence factors, biofilm formations and resistance genes of Candida strains were determined. Out of the 181 samples, 46 were identified as Candida spp., 20 C. albicans (43.5%), 6 C. tropicalis (13.0%), 8 C. krusei (17.4%), 4 C. glabrata (8.7%), 3 C. famata (6.5%), 3 C. parapsilosis (6.5%), and 2 C. guilliermondii (4.3%). All the Candida albicans isolated were both Gram positive and Germ test tube test positive. Eighteen (90%) of the isolates were susceptible to Clotrimazole at a concentration of 5 μg/mL – 10μg/mL followed by 17 (85%) isolates to Panosoconazole at a concentration of 0.002 μg/mL – 5μg/mL. Eight (40.0%) of the Candida albicans isolates possessed the gene (cdr1) that was observed at 286 bp. Virulence enzymes was determined in which 100% produced Haemolysin, followed by proteinase (75.0%), phospholipase (50%), coagulase at (50%) and lastly capsulase (25.0%). Fluconazole and Clotrimazole did not inhibit growth of C. albicans at high concentrations but from our study, it was deduced that they inhibit biofilm formation at lower concentrations. C. albicans isolates were resistant to multiple antifungal including those commonly used in the management on HIV/AIDs patient. This attributed to resistant genes and produced various virulence factors that were found to be present in the isolates. Therefore, there is a need to carry out regular surveillance on antifungal drug resistance.
Shimia ponticola sp. nov., an aerobic anoxygenic photoheterotrophic bacterium, isolated from surface seawater in the South China Sea
Authors: Chen Qi , He Bowen , Lin Ta-Hui , Jiao Nianzhi , Zheng Qiang
Published: May 2023

A Gram-stain-negative marine bacterium, designated as WX04T, was isolated from the South China Sea. The genome of strain WX04T contained a complete photosynthetic gene cluster and is the first identified photoheterotroph of the genus

Shimia

with high photochemical efficiency (Fv/Fm=0.705±0.010), indicating its diverse metabolic and growth strategies, and unique evolution in the genus

Shimia

. The genome size of strain WX04T is 3.78 Mbp, and the G+C content is 58.8 %. Its isolate formed pink colonies and the cells were non-flagellated and rod-shaped. Growth was observed at 15–35 °C (optimum, 30 °C), at pH 5.0–11.0 (optimum, pH 7.0) and in the presence of 3–5 % (w/v) NaCl (optimum, 3 %). Both catalase activity and oxidase activity were found to be negative. The 16S rRNA gene sequence analyses revealed that this isolate represents a novel species within the genus

Shimia

, sharing 96.8 and 95.6% sequence identities with

Shimia aestuarii

DSM 15283T and

Shimia marina

DSM 26895T, respectively. The respiratory quinone was ubiquinone-10 (100 %). The primary cellular fatty acids (>5 %) were summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c), C18 : 0,C18 : 1
 ω7c 11-methyl and C10 : 0 3-OH. The dominant polar lipids of strain WX04T comprised phosphatidylcholine, phosphatidylethanolamine and phosphatidylglycerol. The combined polyphasic data shows that strain WX04T is a novel species within the genus

Shimia

, which is proposed as Shimia ponticola sp. nov., and the type strain is WX04T (=KCTC 62628T=MCCC 1K02295T).
Emergence of biased hypermutation in a heterologous additional transcription unit in recombinant lentogenic Newcastle disease virus
Authors: de Buhr Hendrik , de Leeuw Olav S. , Harders Frank , Peeters Ben P. , de Swart Rik L.
Published: May 2023

Recombinant Newcastle disease virus (rNDV) strains engineered to express foreign genes from an additional transcription unit (ATU) are considered as candidate live-attenuated vector vaccines for human and veterinary use. Early during the COVID-19 pandemic we and others generated COVID-19 vaccine candidates based on rNDV expressing a partial or complete SARS-CoV-2 spike (S) protein. In our studies, a number of the rNDV constructs did not show high S expression levels in cell culture or seroconversion in immunized hamsters. Sanger sequencing showed the presence of frequent A-to-G transitions characteristic of adenosine deaminase acting on RNA (ADAR). Subsequent whole genome rNDV sequencing revealed that this biased hypermutation was exclusively localized in the ATU expressing the spike gene, and was related to deamination of adenosines in the negative strand viral genome RNA. The biased hypermutation was found both after virus rescue in chicken cell line DF-1 followed by passaging in embryonated chicken eggs, and after direct virus rescue and subsequent passaging in Vero E6 cells. Levels of biased hypermutation were higher in constructs containing codon-optimized as compared to native S gene sequences, suggesting potential association with increased GC content. These data show that deep sequencing of candidate recombinant vector vaccine constructs in different phases of development is of crucial importance in the development of NDV-based vaccines.
Delineating the effect of sex hormone intake on immunity in cis and trans women with HIV
Authors: Pasin Chloé , Nuñez David Garcia , Kusejko Katharina , Hachfeld Anna , Buvelot Hélène , Cavassini Matthias , Damonti Lauro , Fux Christoph , Martinez de Tejada Begoña , Notter Julia , Trkola Alexandra , Günthard Huldrych F. , Aebi-Popp Karoline , Kouyos Roger D. , Abela Irene A. ,   the Swiss HIV Cohort Study
Published: May 2023

Background

Although sex hormones are recognized to induce immune variations, little is known on the effect of exogenous sex hormone intake on immune responses in cis and trans women. Here, we aimed at quantifying how sex hormone intake affects HIV-1 immune markers in cis women (CW) and trans women (TW) with HIV.

Methods

We considered measurements of key HIV-1 immune markers (CD4, CD8, lymphocyte counts, and CD4:CD8 ratio) from cis men (CM), CW, and TW enrolled in the Swiss HIV Cohort Study. We modeled immune markers using linear mixed-effects models with an interaction between the variables “group” (CW, TW) and “with sex hormone intake” (yes/no). We conducted serum proteomics measurements of 92 inflammation markers on samples from 31 TW before and after sex hormone intake to assess the inflammation environment.

Results

We included 54’141 measurements from 3’092 CW and 83 TW sampled between 2015 and 2022, and 147’298 from 8’611 CM. Sex hormone intake was associated with significant distinct effects on CD4 and CD4:CD8 ratio between the different groups of women (p=0.0025 and 0.015). TW with sex hormone intake had significantly higher CD4 counts (median = 772 (1Q-3Q=520-1’006)) than without (median = 617 (1Q-3Q=426-892)). This increase was similar in magnitude to the difference in CD4 counts between CW and CM. None of the serum inflammation proteins showed significant concentration difference before and after sex hormone intake in TW.

Conclusion

This study highlights the need to consider the potential role of sex hormone intake in modulating the immune system among other biological and social factors, especially in TW in HIV.
NGLY1 Deficiency: A Prospective Natural History Study (NHS)
Authors: Tong Sandra , Ventola Pamela , Frater Christina H. , Klotz Jenna , Phillips Jennifer M. , Muppidi Srikanth , Dwight Selina S. , Mueller William F. , Beahm Brendan J. , Wilsey Matt , Lee Kevin J.
Published: May 2023

N-glycanase 1 (NGLY1) Deficiency is a debilitating, ultra-rare autosomal recessive disorder caused by loss of function of NGLY1, a cytosolic enzyme that deglycosylates other proteins. It is characterized by severe global developmental delay and/or intellectual disability, hyperkinetic movement disorder, transient elevation of transaminases, (hypo)alacrima, and progressive, diffuse, length-dependent sensorimotor polyneuropathy. A prospective natural history study (NHS) was conducted to elucidate clinical features and disease course. Twenty-nine participants were enrolled (15 onsite, 14 remotely) and followed for up to 32 months, representing ∼29% of the ∼100 patients identified worldwide. Participants exhibited profound developmental delays, with almost all developmental quotients below 20 on the Mullen Scales of Early Learning, well below the normative score of 100. Increased difficulties with sitting and standing suggested decline in motor function over time. Most patients presented with (hypo)alacrima and reduced sweat response. Pediatric quality of life was poor except for emotional function. Language/communication and motor skill problems including hand use were reported by caregivers as the most bothersome symptoms. Levels of the substrate biomarker, GlcNAc-Asn (aspartylglucosamine; GNA), were consistently elevated in all participants over time, independent of age. Liver enzymes were elevated for some participants but improved especially in younger patients and did not reach levels indicating severe liver disease. Three participants died during the study period. Data from this NHS informs selection of endpoints and assessments for future clinical trials for NGLY1 Deficiency interventions. Potential endpoints include GNA biomarker levels, neurocognitive assessments, autonomic and motor function (particularly hand use), (hypo)alacrima, and quality of life.
Aggregatibacter actinomycetemcomitans(Aa) cytolethal distending toxin (Cdt) modulates host phagocytic function
Authors: Kim Taewan J. , Shenker Bruce J. , Macelroy Andrew , Pankoski Lisa , Boesze-Battaglia Kathleen
Published: May 2023

Cytolethal distending toxins (Cdt) are a family of toxins produced by several human pathogens which infect mucocutaneous tissue and induce inflammatory disease. Human macrophages exposed toAggregatibacter actinomycetemcomitans(Aa) Cdt respond through canonical and non-canonical inflammasome activation to stimulate cytokine release. The inflammatory response is dependent on PI3K signaling blockade via the toxin’s phosphatidylinositol-3,4,5-triphosphate (PIP3) phosphatase activity; converting PIP3 to phosphatidylinsoitol-3,4-diphosphate (PI3,4P2) thereby depleting PIP3 pools. Phosphoinositides, also play a critical role in phagosome trafficking, serving as binding domains for effector proteins during phagosome maturation and subsequent fusion with lysosomes. We now demonstrate thatAaCdt manipulates the phosphoinositide (PI) pools of phagosome membranes and alters Rab5 association. Exposure of macrophages toAaCdt slowed phagosome maturation and decreased phago-lysosome formation, thereby compromising macrophage phagocytic function. Moreover, macrophages exposed to Cdt showed decreased bactericidal capacity leading to increase inAggregatibacter actinomycetemcomitanssurvival. Thus, Cdt may contribute to increased susceptibility to bacterial infection. These studies uncover an underexplored aspect of Cdt function and provide new insight into the virulence potential of Cdt in mediating the pathogenesis of disease caused by Cdt-producing organisms such asAa.