bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatially resolved properties of extraplanar diffuse ionized gas in NGC 3511 and NGC 3513
Authors: Zhu Hanjue , Boettcher Erin , Chen Hsiao-Wen
Published: July 2024

Gaseous, disc–halo interfaces are shaped by processes that are critical to galaxy evolution, including gas accretion and outflows. Extraplanar diffuse ionized gas (eDIG) layers are characterized by scale heights that largely exceed those predicted by their temperature, suggesting the presence of turbulent energy injection from star-formation feedback. However, the origin of this large-scale height remains uncertain. To explore the connection between eDIG and star-forming discs, we present a spatially resolved case study of a nearby pair of sub-$L_*$, intermediately inclined disc galaxies NGC 3511/3513. We decompose optical nebular lines observed using long-slit spectroscopy into narrow and broad velocity components. In NGC 3511, the broad component has three distinctive characteristics in comparison to the narrow component: (1) significantly higher velocity dispersions (a median $\langle \sigma \rangle _{\text{Broad}} = 24$  km s$^{-1}$compared to $\langle \sigma \rangle _{\text{Narrow}} = 13$  km s$^{-1}$), (2) elevated [N ii]$\lambda$6583/H$\alpha$ and [S ii]$\lambda$6716/H$\alpha$ line ratios, and (3) a rotational velocity lag. These characteristics support the origin of the broad component in an extraplanar, gaseous disc. In NGC 3513, the broad component reveals disc–halo circulation via localized outflows at radius $\lesssim 1$ kpc. For NGC 3511, we test a vertical hydrostatic equilibrium model with pressure support supplied by thermal and turbulent motions. Under this assumption, the eDIG velocity dispersion corresponds to a scale height $h_{z} \gtrsim 0.2 - 0.4$ kpc at $R = 3 - 5$ kpc, a factor of a few above the thermal scale height ($h_{z} \lesssim 0.1$ kpc). This highlights the importance of turbulent motions to the vertical structure of the gaseous, disc–halo interface.
Evolution and Functional Differentiation of the C-terminal Motifs of FtsZs During Plant Evolution
Authors: An Jinjie , Wang Lulu , Hong Conghao , Gao Hongbo
Published: July 2024

Filamentous temperature-sensitive Z (FtsZ) is a tubulin-like GTPase that is highly conserved in bacteria and plants. It polymerizes into a ring at the division site of bacteria and chloroplasts and serves as the scaffold protein of the division complex. While a single FtsZ is present in bacteria and cyanobacteria, there are two subfamilies, FtsZ1 and FtsZ2 in the green lineage, and FtsZA and FtsZB in red algae. In Arabidopsis thaliana, the C-terminal motifs of AtFtsZ1 (Z1C) and AtFtsZ2-1 (Z2C) display distinct functions in the regulation of chloroplast division. Z1C exhibits weak membrane-binding activity, whereas Z2C engages in the interaction with the membrane protein AtARC6. Here, we provide evidence revealing the distinct traits of the C-terminal motifs of FtsZ1 and FtsZ2 throughout the plant evolutionary process. In a range of plant species, the C-terminal motifs of FtsZ1 exhibit diverse membrane-binding properties critical for regulating chloroplast division. In chlorophytes, the C-terminal motifs of FtsZ1 and FtsZ2 exhibit both membrane-binding and protein interaction functions, which are similar to those of cyanobacterial FtsZ and red algal FtsZA. During the transition from algae to land plants, the functions of the C-terminal motifs of FtsZ1 and FtsZ2 exhibit differentiation. FtsZ1 lost the function of interacting with ARC6 in land plants, and the membrane-binding activity of FtsZ2 was lost in ferns. Our findings reveal the functional differentiation of the C-terminal motifs of FtsZs during plant evolution, which is critical for chloroplast division.
Varenicline Over-The-Counter Trial on Efficacy and Safety
Authors: Pearson Jennifer , Nides Mitchell A , Cataldo Alana , Martinez Marisol , Morales Jackie , Seltzer Ryan , Kurka Jonathan , Broussard Matthew , Leischow Scott J
Published: July 2024

Introduction

Varenicline helps people who smoke quit at rates 2–3 times greater than placebo. Currently, in the United States, varenicline is not available over the counter (OTC).

Aims and Methods

In this study, we assessed the safety and efficacy of 1 mg and 0.5 mg varenicline as an OTC medication for smoking cessation in comparison to placebo. This randomized, double-blind, placebo-controlled study was performed at two clinical sites in the United States of n = 313 people. The treatment period was 12 weeks. During the COVID pandemic, the protocol was modified to allow remote participation; verification of smoking status was via breath carbon monoxide levels for in-person visits and mailed urine cotinine kits for the remote participants.

Results

There was no difference in biologically confirmed continuous abstinence by condition between weeks 8 and 12; however, the odds of biologically confirmed point prevalence abstinence were higher for those in the 1 mg b.i.d. condition than for those in the placebo condition at week 12 (OR 3.39; 95% CI 1.49, 7.71), and were higher for those assigned to the 1.0 mg b.i.d. condition than the 0.5 mg b.i.d. condition at week 12 (OR 2.37; 95% CI 1.11, 5.05). Adverse events were modest, and as expected (vivid dreams and nausea in the medication conditions).

Conclusions

The results are suggestive that varenicline is safe and effective as an OTC medication.
The Effect of the Menstrual Cycle on Energy Intake: A Systematic Review and Meta-analysis
Authors: Tucker Jessica A L , McCarthy Seth F , Bornath Derek P D , Khoja Jenna S , Hazell Tom J
Published: July 2024

Context

Energy intake may differ across the menstrual cycle, with some studies identifying greater energy intake in the luteal phase (LP) compared with the follicular phase (FP) and others finding no clear differences. To date, no study has systematically synthesized the available data to draw more definite conclusions while considering any methodological inconsistencies between studies.

Objective

The aim was to conduct a systematic review/meta-analysis in an effort to determine if there are differences in energy intake between the FP and LP.

Data Sources

A systematic search strategy was developed and the search was conducted in 5 databases for studies that investigated any changes in energy intake across menstrual phases.

Data Extraction

Using Covidence, studies were identified and included if they contained individuals between the ages of 18 and 45 years, maintained an average body mass index (BMI) of 18.5–25 kg/m2, had no history of disordered eating, and included energy intake and menstrual cycle measurements in the FP and LP.

Data Analysis

Effect sizes were calculated for each study and a random-effects model was used to pool the results of each study.

Results

Fifteen datasets were included consisting of 330 female participants with a mean age of 26 ± 4 years and mean BMI of 22.4 ± 2.3 kg/m2. Overall, there was a statistically significant difference (standardized mean difference = 0.69; P = .039) with increased energy intake in the LP compared with the FP (crude 168 kcal⋅d−1 average difference between phases).

Conclusion

Energy intake was found to be greater in the LP compared with the FP, providing insight into the effect of the menstrual cycle on energy intake. However, there were repeated methodological inconsistencies and future work should strive to utilize best practices for both energy intake measurement and menstrual phase specification.
Two listeners detect slightly more birds than a single listener when interpreting acoustic recordings
Authors: Iles David T , Francis Charles M , Smith Adam C , Weeber Russ , Friis Christian , Daly Lindsay
Published: July 2024

Acoustic recorders are increasingly important for monitoring bird populations and have potential to augment existing monitoring programs such as the North American Breeding Bird Survey (BBS). An advantage of acoustic recordings is that they can be reviewed multiple times by multiple experts, potentially yielding improved estimates of species abundance and community richness. Yet, few studies have examined how frequently successive listeners disagree on acoustic interpretations and how strongly estimates of species richness and abundance are altered when multiple experts review each recording. We assigned multiple expert listeners to interpret recordings at 690 BBS stops, and subsequently assigned second listeners to conduct a review of first listeners’ interpretations. We examined the extent to which listeners agreed with each other and quantified the effect of disagreements on resultant estimates of species occurrence, abundance, and stop-level richness. We also compared estimates from acoustic recordings to those obtained during simultaneous field surveys. Estimates were highly correlated for number of species per stop (r = 0.92) and detection probabilities of species (r = 0.97) based on first and second-listener data. Second listeners disagreed with ~9% of first listeners’ interpretations and added an average of ~15% additional species and 16% additional birds not reported by first listeners. Estimates based on acoustic recordings were also highly correlated with those obtained from field surveys, though listeners were unable to count flocks. A single expert reviewer can provide a reasonable approximation of the relative abundance and species composition of birds available for acoustic detection during BBSs. However, acoustic review by multiple listeners may still be important for species that are rare, difficult to identify, or of high conservation concern.
A new era of synthetic biology—microbial community design
Authors: Matuszyńska Anna , Ebenhöh Oliver , Zurbriggen Matias D , Ducat Daniel C , Axmann Ilka M
Published: July 2024

Synthetic biology conceptualizes biological complexity as a network of biological parts, devices, and systems with predetermined functionalities and has had a revolutionary impact on fundamental and applied research. With the unprecedented ability to synthesize and transfer any DNA and RNA across organisms, the scope of synthetic biology is expanding and being recreated in previously unimaginable ways. The field has matured to a level where highly complex networks, such as artificial communities of synthetic organisms, can be constructed. In parallel, computational biology became an integral part of biological studies, with computational models aiding the unravelling of the escalating complexity and emerging properties of biological phenomena. However, there is still a vast untapped potential for the complete integration of modelling into the synthetic design process, presenting exciting opportunities for scientific advancements. Here, we first highlight the most recent advances in computer-aided design of microbial communities. Next, we propose that such a design can benefit from an organism-free modular modelling approach that places its emphasis on modules of organismal function towards the design of multispecies communities. We argue for a shift in perspective from single organism–centred approaches to emphasizing the functional contributions of organisms within the community. By assembling synthetic biological systems using modular computational models with mathematical descriptions of parts and circuits, we can tailor organisms to fulfil specific functional roles within the community. This approach aligns with synthetic biology strategies and presents exciting possibilities for the design of artificial communities.

Graphical Abstract
A Molecular Method to Assess Viability of Phytophthora in Infected Wood Following Phytosanitary Heat Treatment
Authors: Leal Isabel , Feau Nicolas , Uzunovic Adnan , Foord Brett , Hamelin Richard C.
Published: July 2024

International trade in wood products is an important component of the global economy. However, wood and wood products may have pests associated with them that could be introduced into importing countries, posing phytosanitary risks and leading to the implementation of regulatory restrictions that affect wood trade. The application of heat to kill wood-associated pests has been a successful phytosanitary method to reduce their spread. To evaluate the efficacy of wood heat treatment to kill fungal and fungus-like pathogens, the method of choice has been to grow organisms in cultures for subsequent identification. However, some plant pathogens can be difficult or impossible to grow in axenic cultures, and a molecular method can still be useful for assessing pathogen viability after heat treatment. RNA is a single-stranded molecule that is responsible for the transcription of genes. Since it becomes rapidly unstable after cell death, it provides a measure of viability. We therefore designed and tested RNA-based molecular diagnostic assays targeting essential genes and assessed their presence after heat treatment in wood colonized by four Phytophthora species of phytosanitary concern ( P. × multiformis, P. cinnamomi, P. lateralis, and P. ramorum) through reverse transcription and real-time polymerase chain reaction (RT-qPCR). Our assays differentiate between genomic and mRNA as the TaqMan probes span exon–intron junctions. We validated these RT-qPCR assays to assess heat treatment efficacy of Phytophthora-inoculated wood. These assays can be very useful tools to assess the effectiveness of current and emerging phytosanitary wood treatments.

[Formula: see text] Copyright © 2024 His Majesty the King in Right of Canada, as represented by the Minister of Natural Resources Canada. This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Innovative Learning Activities to Prepare Nursing Students for the Next Generation NCLEX
Authors: Gibbons Wanda R. , Stevenson Shannon M. , Mutic Abby D.
Published: July 2024

The purpose of this course innovation was to introduce Next Generation NCLEX (NGN)-style questions and create supplemental cooperative learning assignments (CLAs) to enhance content mastery in a prelicensure maternity course. The course itself is divided into three modules focusing on maternal, newborn, and women’s health. Three CLAs and two Canvas quizzes were developed to reinforce the course content and integrate NGN-style case studies and questions. The CLAs and quizzes aligned with the course module content. Anecdotally, students endorsed the CLAs as a positive experience, emphasizing the value of learning to set care priorities for maternity patients.
A Study of Factors Contributing to Emotional Exhaustion in Online Nursing Students
Authors: Snellgrove Susan , Gatling Lori
Published: July 2024

Emotional exhaustion in online nursing students leads to attrition in educational and professional settings. Few studies have been performed on practicing nurses enrolled in online programs. The purpose of this study was to explore factors contributing to emotional exhaustion in nursing students. Survey methodology targeted licensed practical nurses, registered nurses, and advanced practice registered nurses enrolled in online programs. Data collected from 116 students included demographics and answers to closed- and open-ended questions regarding emotional exhaustion. Participants reported high levels of emotional exhaustion related to multiple factors. Findings from this study will be used to identify at-risk students and interventions to decrease attrition and increase student success.
Improving Mental Health Literacy in Nursing Students: Integrating Mental Health Throughout the Curriculum
Authors: Gamez Vicki , Gunning Thomas
Published: July 2024

As more patients seek help for acute mental health conditions in all sectors of health care, the demand for nurses trained to care for this population is outpacing the supply. Nursing schools have not been successful in educating students with the knowledge, skills, and attitudes needed to provide care. The purpose of this study was to integrate mental health concepts throughout the entire curriculum in a two-year associate degree nursing program and examine its effects on developing mental health literacy in prelicensure students.
Trigger Warnings in Nursing Education: Psychiatric Mental Health Instructors’ Practices and Perspectives
Authors: Neathery Melissa
Published: July 2024

Psychiatric mental health (PMH) nursing education covers topics that some students find potentially distressing and anxiety-producing. Trigger warnings are commonly found in entertainment and social media venues, but there is little research to explore the use of trigger/content warnings in undergraduate nursing education. This current research surveyed PMH nursing instructors (n = 48) and found that most give trigger warnings and believe them to be helpful. However, there is no consistency on how and when warnings are provided, nor their content. Overall, results indicate that trigger warnings may be one aspect of implementing supportive and trauma-informed pedagogy.
SGLT-2 inhibitors: new horizons for rheumatologists
Authors: Chakrabarti Katherine , McCune W. Joseph
Published: July 2024

Purpose of review

Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of medications initially developed for the treatment of diabetes, although their cardiac and renal protective benefits are far reaching. There has been marked interest in the rheumatology community to adopt these medications into our clinical practice, particularly for chronic kidney disease with persistent proteinuria.

Recent findings

SGLT2 inhibitors have been approved for patients with type 2 diabetes mellitus, heart failure with reduced or preserved ejection fraction, atherosclerotic cardiovascular disease in the setting of type 2 diabetes mellitus, as well as chronic kidney disease with proteinuria. Large studies on SGLT2 inhibitors have largely excluded patients with proteinuric chronic kidney disease due to autoimmune glomerulonephritis due to concerns for confounding from immunosuppression. The Dapagliflozin and Prevention of Adverse Outcomes in CKD Trial (DAPA-CKD) showed that SGLT2 inhibition decreased progression of renal disease in patients with IgA nephropathy. Expanding this to other autoimmune glomerulonephropathies, several small studies have shown improvements in proteinuria in patients with lupus nephritis treated with SGLT2 inhibitors. A study evaluating safety of SGLT2 inhibitors in patients with lupus identified no specific concerns even with concomitant use of immunosuppression.

Small studies have shown that SGLT2 inhibitors can been utilized safely and efficaciously in patients with lupus nephritis. Additional research is needed to identify where these medications fit into the rheumatology treatment armamentarium.
Antimelanoma differentiation antigen 5-positive dermatomyositis: an update
Authors: Lu Xin , Peng Qinglin , Wang Guochun
Published: July 2024

Purpose of review

Antimelanoma differentiation antigen 5-dermatomyositis (MDA5-DM) is a complex and serious systemic autoimmune disease that primarily affects the skin and lungs. In this review, we aimed to provide new insights into the clinical features, pathogenesis, and practical management approach for this disease.

Recent findings

Although lung lesions are prominent in most patients with MDA5-DM, they are now recognized as heterogeneous diseases. Peripheral blood lymphocyte count can serve as a simple and reliable laboratory parameter for categorizing MDA5-DM into three subgroups: mild, medium, and severe. Recent studies have implicated viral infection, genetic factors, autoimmunity against MDA5, multiple immune cells, and interferons as significant contributors to MDA5-DM pathogenesis. In addition to traditional treatments with glucocorticoids and immunosuppressants, many new approaches, including new biologics and targeted agents, have been explored. Additionally, infection is a common complication of MDA5-DM, and prophylaxis or treatment of the infection is as important as treating the primary disease.

Knowledge of clinical characteristics and pathogenesis of MDA5-DM has grown in recent years. Although many new therapeutic approaches have been explored, further studies are required to confirm their efficacy.
Knee Arthrodesis Surgical Technique
Authors: Couso Megan , Sherman Nathan , Lowe Jason
Published: July 2024

Knee arthrodesis is a procedure seldomly performed. One surgical approach involves employing a nonmodular intramedullary nail in conjunction with a total knee arthroplasty cutting guide to prepare the bone for knee arthrodesis.

Video available at:

https://ota.org/education/ota-online-resources/video-library-procedures-techniques/knee-arthrodesis-surgical
Assessment of Gross Motor Skills in Ponseti-treated Children With Idiopathic Clubfoot at 3 Years Old: Insights from the Peabody Developmental Motor Scale 2
Authors: Rice Samuel W. , Moisan Alice , Rhodes Leslie , Locke Lindsey L. , Nolan Vikki G. , Wells Aristea , Kelly Derek M.
Published: July 2024

Background:

Congenital talipes equinovarus, or clubfoot, can lead to lifelong functional impairments, including diminished gross motor skills (GMS), if left untreated. The Ponseti method corrects idiopathic clubfoot through casting and bracing. Given the importance of GMS in childhood development, this technique must be optimized to support childhood and long-term health outcomes. This study examined immediate posttreatment GMS in 3-year-old children treated with Ponseti, hypothesizing that they would perform on par with their nonclubfoot peers.

Methods:

Data from 45 children (33 to 46 mo of age) treated for idiopathic clubfoot were analyzed. The Peabody Developmental Motor Scales, 2nd edition, was used to assess GMS, and logistic regression identified factors influencing Gross Motor Quotient (GMQ) scores.

Results:

Approximately half (n=22) of the patients exhibited below-average GMS (11th to 25th percentile), with 11 scoring below the 10th percentile. Initial deformity severity, gender, and cast numbers did not impact GMQ. Repeat percutaneous tenotomy was associated with lower GMQs. Brace compliance significantly reduced odds of low GMQs by up to 80%. Age at testing and additional surgery were also linked to below-average and poor GMQs.

Conclusions:

GMS appeared to be impaired in almost half of the 3-year-old patients treated for idiopathic clubfoot, so our hypothesis was disproven. Repeat percutaneous tenotomy was associated with lower GMS, necessitating future recognition of patients who might be at risk of relapse. Brace noncompliance emerged as a significant risk factor, emphasizing early identification of these patients and education for their parents. This study offers a benchmark for clinicians and parents, but research on long-term outcomes is needed.

Level of Evidence:

Level II, prospective cohort study.
Dermatological toxicity associated with the use of gilteritinib in relapsed acute myeloid leukemia with FLT3 mutation: a case report
Authors: Martín Roldán Alicia , Alarcón-Payer Carolina , Sánchez Suárez María Del Mar , Jiménez Morales Alberto
Published: July 2024

We present a case of a patient diagnosed with FLT3 mut+ acute myeloid leukemia with FLT3 and NMP1 mutations who did not respond to standard induction and consolidation treatment with chemotherapy. Due to the FLT3mut+ gene mutation and intermediate cytogenetic risk, treatment with gilteritinib is requested. After treatment she experienced a neutrophilic dermatosis and granuloma annulare that was resolved with gilteritinib dose reduction and specific treatment in coordination with the dermatology department.
Complete and durable regression of leptomeningeal involvement during lorlatinib treatment in a patient with lung cancer
Authors: Guaitoli Giorgia , Martinelli Enrica , Trudu Lucia , Desideri Isacco , Mortini Pietro , Greco Stefano , Bruni Alessio , Greto Daniela , Pecchioli Guido , Chiavelli Chiara , Dominici Massimo , Bertolini Federica
Published: July 2024

Metastatic spread to the central nervous system (CNS) is frequent in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) and has an important impact on patient prognosis and quality of life. Leptomeningeal involvement may occur in up to 10% of cases of ALK-positive NSCLC. Lorlatinib is a third-generation ALK inhibitor that has excellent CNS penetrability and demonstrated its efficacy both in pretreated and treatment-naive patients. Herein, we present the case of a 34-year-old patient diagnosed with stage IV ALK-rearranged NSCLC who received two lines of ALK inhibitors (crizotinib followed by alectinib) and several courses of brain stereotactic ablative radiotherapy until leptomeningeal involvement was detected. Third-line lorlatinib was then administered, and 2 months later encephalic MRI documented complete regression of the leptomeningeal involvement that is still maintained after 36 months while treatment with lorlatinib is still ongoing with good tolerability. To the best of our knowledge, this is the longer intracranial response reported in the literature, underlining the importance of the most appropriate choice of systemic treatments and their integration with loco-regional approaches to improve outcomes.
Society of Critical Care Medicine and American Society of Health-System Pharmacists Guideline for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults
Authors: MacLaren Robert , Dionne Joanna C. , Granholm Anders , Alhazzani Waleed , Szumita Paul M. , Olsen Keith , Barletta Jeffrey F. , Møller Morten Hylander , Karvellas Constantine J. , Wischmeyer Paul , DePriest Ashley , Carlos Victor , Argetsinger Debora , Carothers John J. , Lee Rosemary , Napolitano Lena , Perri Dan , Naylor Douglas F.
Published: July 2024

RATIONALE:

Critically ill adults can develop stress-related mucosal damage from gastrointestinal hypoperfusion and reperfusion injury, predisposing them to clinically important stress-related upper gastrointestinal bleeding (UGIB).

OBJECTIVES:

The objective of this guideline was to develop evidence-based recommendations for the prevention of UGIB in adults in the ICU.

DESIGN:

A multiprofessional panel of 18 international experts from dietetics, critical care medicine, nursing, and pharmacy, and two methodologists developed evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guideline development including task force selection and voting.

METHODS:

The panel members identified and formulated 13 Population, Intervention, Comparison, and Outcome questions. We conducted a systematic review for each question to identify the best available evidence, statistically analyzed the evidence, and then assessed the certainty of the evidence using the GRADE approach. We used the evidence-to-decision framework to formulate the recommendations. Good practice statements were included to provide additional guidance.

RESULTS:

The panel generated nine conditional recommendations and made four good practice statements. Factors that likely increase the risk for clinically important stress-related UGIB in critically ill adults include coagulopathy, shock, and chronic liver disease. There is no firm evidence for mechanical ventilation alone being a risk factor. Enteral nutrition probably reduces UGIB risk. All critically ill adults with factors that likely increase the risk for stress-related UGIB should receive either proton pump inhibitors or histamine-2 receptor antagonists, at low dosage regimens, to prevent UGIB. Prophylaxis should be discontinued when critical illness is no longer evident or the risk factor(s) is no longer present despite ongoing critical illness. Discontinuation of stress ulcer prophylaxis before transfer out of the ICU is necessary to prevent inappropriate prescribing.

CONCLUSIONS:

The guideline panel achieved consensus regarding the recommendations for the prevention of stress-related UGIB. These recommendations are intended for consideration along with the patient’s existing clinical status.
From Traditional Typing to Intelligent Insights: A Narrative Review of Directions Toward Targeted Therapies in Delirium
Authors: Potter Kelly M. , Prendergast Niall T. , Boyd J. Gordon
Published: July 2024

Delirium is a heterogeneous syndrome characterized by an acute change in level of consciousness that is associated with inattention and disorganized thinking. Delirium affects most critically ill patients and is associated with poor patient-oriented outcomes such as increased mortality, longer ICU and hospital length of stay, and worse long-term cognitive outcomes. The concept of delirium and its subtypes has existed since nearly the beginning of recorded medical literature, yet robust therapies have yet to be identified. Analogous to other critical illness syndromes, we suspect the lack of identified therapies stems from patient heterogeneity and prior subtyping efforts that do not capture the underlying etiology of delirium. The time has come to leverage machine learning approaches, such as supervised and unsupervised clustering, to identify clinical and pathophysiological distinct clusters of delirium that will likely respond differently to various interventions. We use sedation in the ICU as an example of how precision therapies can be applied to critically ill patients, highlighting the fact that while for some patients a sedative drug may cause delirium, in another cohort sedation is the specific treatment. Finally, we conclude with a proposition to move away from the term delirium, and rather focus on the treatable traits that may allow precision therapies to be tested.
Implementation of sentinel node biopsy in high-risk endometrial cancer
Authors: Occhiali Tommaso , Vizzielli Giuseppe , Mariani Andrea
Published: July 2024

Purpose of review

Endometrial cancer is the most common gynecologic malignancy and sentinel lymphnode biopsy is accepted as a valid alternative to lymphadenectomy for staging purposes. Recently, sentinel node biopsy has been also extended to high-risk disease where risk of nodal involvement is higher.

Recent findings

Our review focuses on the definition of high-risk disease and how there are different concepts of high-risk in the scientific community. While the sensitivity of sentinel node biopsy has been established and accepted in lower risk endometrial cancers, only in recent years retrospective and prospective evidence has been published. Ultrastaging allows to identify more nodal disease that would normally be overlooked by traditional staging, allowing proper adjuvant therapy to be administered. The longstanding question of whether lymphadenectomy in high-risk settings is a therapeutic or a staging procedure remains open. Retrospective data, however, show that oncologic outcomes are not compromised by sentinel node biopsy.

Sentinel node biopsy is a valid alternative to traditional, more extensive nodal staging: with the addition of ultrastaging, it has more sensitivity than lymphadenectomy with less surgical morbidity. Ongoing trials will definitively establish if oncological outcomes are affected by sentinel node biopsy, but retrospective data are encouraging.
How to treat advanced Hodgkin lymphoma?
Authors: Rossi Cédric , Casasnovas René-Olivier
Published: July 2024

Purpose of review

In this review, we analyzed the different therapy options in patients with advanced Hodgkin lymphoma (HL).

Recent findings

The treatment of advanced HL has greatly evolved during the last decade even still based on polychemotherapy. Mature data established that the better strategies require Positron emission tomography (PET)-driven treatments which allow to optimize the balance between disease control and both immediate and late treatment adverse effects, leading to cure most patients while minimizing the risk of toxicity. Indeed, PET-driven deescalated strategies offer the better treatment option. The recent incorporation of targeted therapies, anti-CD30 or anti-programmed cell death protein 1 (PD1) in combination with chemotherapy should quickly change the game and be a step forward to still decrease the risk of treatment toxicity and improve the cure rate.

The standard of care for advanced HL remains currently PET-driven chemotherapy and should rapidly evolve with the addition of targeted therapy combined with chemotherapy.
Cutaneous Deciduosis: A Rare Cutaneous Lesion Mimicking Malignancy
Authors: Tinguria Mukund , Chorneyko Katherine , Boutross-Tadross Odette
Published: July 2024

Cutaneous deciduosis is an extremely rare condition that clinically presents as a nodular lesion in the skin as a scar or neoplasm. Histologically, this may pose a diagnostic challenge simulating malignant epithelioid neoplasms including sarcoma. Histologically, a nodular growth pattern of large monomorphic epithelioid cells is observed. The epithelioid cells in deciduosis can appear atypical with considerable nuclear pleomorphism, mimicking a malignancy. These features can be misinterpreted as a primary cutaneous or metastatic malignancy by dermatopathologists who are not familiar with gynecologic pathology. Failure to correctly diagnose this condition may result in unnecessary diagnostic studies for the patient. In this article, we report a case of cutaneous deciduosis in a 35-year-old woman with a cesarean scar. Histological examination revealed nodular proliferation of large epithelioid cells with pale eosinophilic cytoplasm and large nuclei with prominent nucleoli. Compressed atrophic slit-like glands resembling endometrial glands were present in some areas. Histopathological features of decidual cells, along with appropriate immunohistochemical studies, help establish the diagnosis and rule out other neoplastic mimics of deciduosis.
Local Cutaneous Scrotal Involvement of Paratesticular Mesothelioma
Authors: Maniam Ganesh , Tekin Burak , Gupta Sounak , Nguyen Giang , Agrawal Shruti
Published: July 2024

Paratesticular mesothelioma (malignant mesothelioma arising from the tunica vaginalis of the testis) represents a small proportion of mesothelial neoplasms, and cutaneous involvement by paratesticular mesothelioma is very rare. Cutaneous involvement can manifest as scrotal subcutaneous nodules from regional spread, distant metastasis, or direct extension through surgical scars. Mesothelioma has 3 histopathologic classifications that include epithelioid, biphasic, and sarcomatoid, which is rarely seen in paratesticular mesothelioma. Given the rarity of this condition, cutaneous mesothelioma may be misdiagnosed as histologic mimics, such as metastatic adenocarcinoma or adnexal neoplasms; thus, appropriate immunohistochemical workup and clinical correlation are required to make an accurate diagnosis. In this case, a 75-year-old man with a history of paratesticular mesothelioma, status postorchiectomy, presented with right-sided scrotal swelling, erythema, and subcutaneous nodules. These nodules were identified as local recurrence with cutaneous involvement by paratesticular mesothelioma on histopathologic examination. This case highlights the clinical and histopathologic features of this diagnosis and underscores the importance of dermatopathologists being aware of this condition to ensure accurate diagnosis.
Evaluating Access and Outcomes in Gender-affirming Breast Augmentation: A Comparative Study of a County Hospital and an Academic Center
Authors: McLaughlin Matthew F. , Rosser Mica , Song Siyou , Mehta Nina , Terry Michael J. , Kim Esther A.
Published: July 2024

Background:

Research on the diverse patient population undergoing gender-affirming breast augmentation remains scarce. We compared patients undergoing this procedure at San Francisco General Hospital (ZSFG), a county hospital, and the University of California, San Francisco (UCSF), an academic medical center.

Methods:

This was a retrospective cohort study of patients who underwent primary gender-affirming breast augmentation at ZSFG (August 2019 to June 2023) and UCSF (March 2015 to June 2023). Differences in sociodemographic characteristics, surgical access, and outcomes between sites were assessed.

Results:

Of 195 patients, 122 patients had surgery at UCSF and 73 patients at ZSFG. ZSFG patients were more likely to be unstably housed (P < 0.001), Spanish-speaking (P = 0.001), and to have obesity (P = 0.011) and HIV (P = 0.004). Patients at ZSFG took hormones for longer before surgical consultation (P < 0.001) but had shorter referral-to-surgery intervals (P = 0.024). Patients at ZSFG more frequently underwent a subglandular approach (P = 0.003) with longer operative times (P < 0.001). Major surgical complications were uncommon (2.1%) with no differences between sites. Aesthetically, implant malposition/rotation occurred more often in patients at UCSF (P = 0.031), but revision rates were similar at both sites. Patients at UCSF had longer follow-up periods (P = 0.008).

Conclusions:

County hospital patients seeking gender-affirming breast augmentation have distinct sociodemographic profiles and more comorbidities than academic medical center patients. County patients might experience greater barriers that delay surgical eligibility, such as stable housing. Nevertheless, this procedure can be safely and effectively performed in both patient populations.
Electrophysiological Changes in Patients with Postoperative Cross-facial Nerve Graft in a Tertiary Care Center
Authors: González-Woge Osmar R. , Salazar Trujillo Bruno A. , Elnecavé Olaiz Alejandro , González-Woge Miguel Á. , Aragón Luna Victoria , Loreto Francisca S. , González-Navarro Mauricio
Published: July 2024

Background:

Facial nerve palsy is a multifaceted pathology that causes facial disfigurement, affecting eye closure, speech articulation, oral competence, and emotional expression, with functional, aesthetic, and psychological consequences. Standardized electrophysiological tests, such as electroneurography and electromyography, allow an objective evaluation of the functional state of the nerve. Here, we aimed to compare and correlate clinical findings with electromyography in patients with facial nerve palsy, before and after facial nerve reanimation with cross-facial nerve grafts.

Methods:

Eight patients with traumatic or nontraumatic facial paralysis with complete clinical records who underwent surgical reanimation of facial nerve with cross nerve grafts.

Results:

The median time from diagnosis to treatment was 173 days (interquartile range = 222). Outcomes were evaluated using standard clinical scales (House-Brackmann, Sunnybrook, and eFACE) and electromyography. The median time for postoperative outcome evaluation was 768 days (interquartile range = 1053). A statistically significant difference was found between pre- and postoperative outcomes according to eFACE (Δ median = 13, P = 0.003), House-Brackmann (Δ median = −2, P = 0.008), and electromyography (Δ mean = 855, P = 0.005). A positive correlation between electromyography and clinical evaluation with eFACE was observed (r = 0.751, 95% confidence interval = 0.174–0.944, P = 0.019).

Conclusions:

Our results suggest that cross nerve grafts are associated with clinical and electromyographic improvement of the paralyzed face. Electromyography and eFACE scores validate the reliability of eFACE scale for measuring postoperative outcomes. We suggest postoperative electromyography as an objective measure of postoperative evaluation in patients with a delay in improvement at 6–9 months.
Reconstruction of Total Hand Degloving Injury with Combined Free and Pedicled Flaps and Ilizarov Minifixator
Authors: Hayashi Kota , Hattori Yasunori , Sakamoto Sotetsu , Gour Vijayendrasingh , Sasaki Jun , Doi Kazuteru
Published: July 2024

Total hand degloving injuries present a significant challenge in treatment, with no consensus yet on the optimal choice of flap for coverage. Functional reconstruction necessitates careful consideration of syndactyly release, particularly after flap coverage. A 64-year-old woman sustained a total hand degloving injury and underwent extensive reconstructive surgery. Initially, a free superficial circumflex iliac perforator flap was applied to the thumb, whereas pedicled groin and superficial inferior epigastric artery flaps were used for the remaining fingers. However, partial necrosis at the edges of the pedicled flaps necessitated the adduction of the fingers, followed by suturing the skin flaps closed. This led to the formation of adduction contractures, requiring careful release and skin flap extension for effective syndactyly release. Subsequently, the innovative use of an Ilizarov minifixator was used for the dual purpose of interdigital widening and elongation of the flap. At the 27-month follow-up, the patient demonstrated significant functional recovery of the hand and fingers, showing the effectiveness of this multifaceted surgical approach. Despite some residual flexion contractures, the patient regained the ability to write and perform pinching motions with the thumb and middle finger, expressing satisfaction with the surgical outcome. In conclusion, for a functional reconstruction of the thumb and fingers, the thumb and other fingers should be covered separately. When the fingers are in adduction and there is insufficient skin stock for syndactyly release, using an external fixator to expand the interdigital spaces before the syndactyly release proved to be effective.
Ocular dominance shift in refractive cataract surgery: prospective, observational study
Authors: Song Tingting , Nie Fen , Zhao Yang , Liao Menglian , He Lian , Tang Qiongyan , Duan Xuanchu
Published: July 2024

Purpose:

To explore the features of the dominant and nondominant eyes in patients with cataracts and predict ocular dominance shift (ODS) based on preoperative indicators.

Setting:

Changsha Aier Eye Hospital, Changsha, Hunan, China.

Design:

Prospective, observational study.

Methods:

Patients with age-related cataracts who underwent unilateral cataract surgery were enrolled in this study. Before the procedure, uncorrected distance visual acuity (UDVA) was assessed and noncycloplegic subjective refraction evaluations were conducted to determine corrected distance visual acuity. Total astigmatism, corneal astigmatism, and intraocular astigmatism were measured using OPD-Scan III. Cataract type was assessed using slitlamp biomicroscopy based on the Lens Opacities Classification System III. Ocular dominance (OD) was determined under corrected conditions using the hole-in-card test. Follow-up visits occurred at 1 day, 1 week, and 1 month postoperatively. After 1 month, OD was re-evaluated, and participants completed the 9-item Short-Form Cataract Questionnaire.

Results:

94 patients (188 eyes) were enrolled in the study. The analysis showed that the ODS rate of unilateral cataract surgery was 40.4%. In addition, age, UDVA of the nondominant eye, posterior subcapsular cataract, and total astigmatism were risk factors for ODS. No difference in vision-related quality of life was detected between patients who had ODS and those who did not.

Conclusions:

Several preoperative parameters as potential risk factors of ODS after cataract surgery were identified. These findings provide guidance for predicting changes in the dominant eye and may improve the precise selection of intraocular lenses and implementation of monovision strategies.
Atrial Fibrillation and Older Age Predict Serum Brain-Derived Neurotrophic Factor Levels Among Patients With Heart Failure
Authors: Pressler Susan J. , Jung Miyeon , Dorsey Susan G. , Giordani Bruno , Titler Marita G. , Wierenga Kelly L. , Clark David G. , Smith Dean G. , Smith Asa B. , Gradus-Pizlo Irmina , Pressler Milton L.
Published: July 2024

Background

Predictors have not been determined of serum brain-derived neurotrophic factor (BDNF) levels among patients with heart failure (HF).

Objective

The primary purpose was to evaluate history of atrial fibrillation, age, gender, and left ventricular ejection fraction as predictors of serum BDNF levels at baseline, 10 weeks, and 4 and 8 months after baseline among patients with HF.

Methods

This study was a retrospective cohort analyses of 241 patients with HF. Data were retrieved from the patients' health records (coded history of atrial fibrillation, left ventricular ejection fraction), self-report (age, gender), and serum BDNF. Linear multiple regression analyses were conducted.

Results

One hundred three patients (42.7%) had a history of atrial fibrillation. History of atrial fibrillation was a significant predictor of serum BDNF levels at baseline (β = −0.16, P = .016), 4 months (β = −0.21, P = .005), and 8 months (β = −0.19, P = .015). Older age was a significant predictor at 10 weeks (β = −0.17, P = .017) and 4 months (β = −0.15, P = .046).

Conclusions

Prospective studies are needed to validate these results. Clinicians need to assess patients with HF for atrial fibrillation and include treatment of it in management plans.
Patient-Perceived Disability Following Transtibial Amputation and Prosthetic Limb Fitting
Authors: Ferdowsian Ryan , Pinzur Michael S. , Adams William , Angelico John
Published: July 2024

Introduction

Patients’ perception of their disability following lower-limb amputation is currently measured using patient-reported outcomes (PROs) instruments. The validity is determined by comparing instruments designed to measure patient-perceived impact on amputation-specific health-related quality of life. The goal of this investigation was to compare patient-perceived disability from an outcomes instrument specific to individuals with amputation to a well-accepted outcomes instrument used to measure disability and response to treatment in generic musculoskeletal disease.

Materials and Methods

Twenty-one patients completed the Prosthesis Evaluation Questionnaire (PEQ) and the Short Musculoskeletal Functional Assessment (SMFA) at a minimum of 3 months following transtibial amputation while undergoing prosthetic limb fitting and gait training. A functional measure of their walking ability based on Medicare ambulatory function (Amputee Mobility Predictor [AMP]) was scored by a trained rehabilitation professional.

Results

The results of the outcomes scores provided initial evidence that the PEQ and SMFA assessments are correlated (i.e., provide some evidence of convergent validity). For every 100-point improvement in patients’ PEQ score, their SMFA Bother score declined by approximately 7 points (b = −6.94; P = 0.001) and Dysfunction score declined by approximately 7 points (b = −6.74; P < 0.001). Conversely, the SMFA and PEQ subscores were not associated with the AMP K-level (all P's > 0.05).

Conclusions

The findings suggested that the PEQ and SMFA PRO instruments are correlated in their ability to measure impact on health-related quality of life. Additionally, we found that PROs (PEQ and SMFA) did not predict physical ability as measured by the AMP K-level. The value of this investigation suggests that the easy-to-administer SMFA correlates well with the accepted PEQ, making testing both less cumbersome and time-consuming. Neither measure correlated with eventual ambulatory function. Rehabilitation following lower-limb amputation demands patient-specific goals. Available tools appear valuable in assisting the rehabilitation team in developing realistic objective tools for rehabilitation following lower-limb amputation.

Clinical Relevance

The simple-to-use SMFA appears to be comparable to the more cumbersome PEQ in assessing patient outcomes following transtibial amputations. Neither outcome instrument is correlated with functional task performance in this patient population.