bluuebunny/crossref_metadata_2025_split huggingface dataset:
Avacopan in the treatment of refractory scleritis secondary to granulomatosis with polyangiitis: A case report
Authors: Bober Emilia , Sharma Bhavana , Papasavvas Ioannis , McAdoo Stephen , Petrushkin Harry 
Published: October 2024

Purpose Avacopan is a novel C5a receptor inhibitor which was recently licensed for treatment of severe granulomatosis with polyangiitis (GPA) in the European Union and the United Kingdom. To the best of our knowledge, this is the first described case on initial ophthalmic outcomes in a patient with severe GPA and concurrent refractory scleritis treated with avacopan. Case Description We present a case of de novo scleritis in a 77-year-old male with a background of retinitis pigmentosa with Argus II implant in situ. Severe scleral inflammation occurred following a suture removal from the implant site. Remission was not maintained despite orbital floor injections and high dose oral prednisolone. The diagnostic work-up revealed GPA which quickly progressed to involve vital organs. In view of his systemic deterioration, he was started on avacopan alongside rituximab, cyclophosphamide and high dose oral prednisolone. Sustained remission of scleritis was noted after 7 months of treatment with avacopan and low dose oral prednisolone with no other maintenance immunosuppression. Conclusion We observed a sustained benefit of avacopan in allowing for successful taper of systemic steroids. We report that avacopan used alongside other immunosuppressants may be a viable option in patients with GPA and concurrent refractory scleritis. Further studies are needed to establish the longer term impact of this agent on the control of scleral inflammation.
Microbial Contamination of Herbal Medicines in Africa, 2000-2024: A Systematic Review
Authors: Ahiabor Wisdom K , Darkwah Samuel , Donkor Eric S 
Published: October 2024

Introduction:Herbal medicine has been a cornerstone of healthcare for centuries, with an estimated 80% of the world’s population relying on it. In Africa, herbal medicine is the backbone of rural healthcare, serving 80% to 90% of the population. Despite its widespread use, the safety of herbal medicine raises a significant concern considering the lack of regulation and testing, particularly in Africa. Microbial contamination is a primary safety risk threatening consumer health. In this systematic review, we aimed to synthesise evidence on microbial contamination in herbal medicines across Africa, provide a clear understanding of the problem, and inform effective public health interventions regarding microbial contamination of herbal medicines in Africa.Method:The systematic review was conducted in accordance with the PRISMA guidelines. A literature search was conducted across PubMed, Web of Science, Science Direct, Scopus, and Google Scholar using appropriate search terms. Eligible studies were selected based on predetermined criteria, and data were extracted and analysed.Results:The review included fifty eligible studies in Africa, with a combined sample size of 1996, of which 1791 showed microbial contamination. Bacterial contaminants were reported in 98% of studies, with Escherichia coli (62%) being the most reported bacteria, followed by Staphylococcus aureus (57%), and Bacillus spp. (55%). Fungal contaminants were reported in 70% of studies, with Aspergillus spp. (40%) being the most reported, followed by Penicillium spp. (27%) and Candida spp. (26%). Parasitic contaminants were reported in 2% of the studies reviewed. A total of 70 bacterial species, 37 fungal species, and 6 parasite species were identified in this review.Conclusion:Herbal medicines in Africa pose significant health threats to consumers due to the high prevalence of diverse microbial contaminants and clinically significant pathogens. This emphasises the need for stricter regulations and quality control measures in the production, sale and use of herbal medicines.
Measurement of cerebral venous oxygenation with quantitative susceptibility mapping after subarachnoid hemorrhage: A pilot study
Authors: Qi Meng , Zhang Lei , Wang Ning , Jiang Lidan , Zhao Hao , Chen Wenjin , Xu Yueqiao 
Published: October 2024

Objective We measured cerebral venous oxygenation after aneurysmal subarachnoid hemorrhage (aSAH) using quantitative susceptibility mapping (QSM) to explore its relationship with cognitive function. Methods Twenty participants, including 10 patients with aSAH and 10 healthy volunteers as the control group, were included. Patients with aSAH were evaluated at 2 days, 3 weeks, and 6 months after aSAH. Each participant underwent magnetic resonance imaging and completed the Montreal Cognitive Assessment (MoCA) at baseline, midpoint, and endpoint. QSM was used to determine the magnetic susceptibility of the cerebral veins. Furthermore, the relationship between MoCA and oxygen saturation in the cerebral veins was examined. Results The first scans of the cerebral veins and straight sinus susceptibility were considerably more significant in the aSAH group than in the healthy control group. At the 6-month follow-up, the mean oxygen saturation steadily increased in the aSAH group. Cerebral venous oxygen saturation was moderately correlated with MoCA (r = 0.5319, P = .0025). Conclusion QSM can be used to measure changes in cerebral venous oxygenation levels in patients with aSAH. During the acute phase of aSAH, there is a reduction in the oxygen saturation in the cerebral veins, and the shift in oxygen saturation levels may correlate with cognitive outcomes in patients with aSAH.
Development and Validation of a Low-Cost, High-Fidelity Simulation Model for Robotic Internal Mammary Artery Harvest Using the da Vinci Xi Robot
Authors: Ashraf Syed Faaz , Seese Laura , Hasan Irsa S. , Babu Ashok N. , Balkhy Husam H. , Kiaii Bob B. , Guy T. Sloane , Kaczorowski David J. , Bonatti Johannes 
Published: October 2024

Objective: We created and validated a low-cost simulation model for robotic internal mammary artery (IMA) takedown. Methods: The simulation model utilized a calf fetus thorax cavity stented open internally and secured to a table. The simulation model was validated at a 2-day robotic cardiac surgery workshop. Each participant harvested one IMA using the da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA, USA). We compared participant self-reported confidence at robotic IMA harvest before and after using the simulator. Results: Our novel thorax-securing strategy resulted in a stable structure and allowed access to both IMAs from the same 3 ports. The cost to set up the first simulation model was $176 and $133 for every subsequent model. Fifty participants used the simulation model: 42 cardiothoracic surgery attendings and 8 fellows or residents. The feedback form response rate was 78% ( n = 39). On the Likert scale, participants rated realism of the calf model to simulate robotic IMA harvesting (0 = not realistic, 10 = highly realistic) with a median of 8 out of 10 (interquartile range [IQR] 7 to 9). Participant confidence (0 = not at all confident, 10 = very confident) in robotic IMA harvesting before and after using the simulator increased ( P = 0.001) from a median of 5 (IQR 1 to 7) to 9 (IQR 7 to 10). Conclusions: This robotic IMA harvest simulation model is affordable, realistic, and improved participant confidence in robotic IMA harvest. It may provide a valuable training tool for surgeons learning robotic coronary bypass surgery and allows for training frequency necessary to pass basic learning curves.
Coronary Connector Facilitated Total Endoscopic Coronary Artery Bypass: An Ex Vivo Feasibility Study
Authors: Gianoli Monica , de Jong Anne Roos , Wassink Harmen Matthijs , Gründeman Paul F. , Kiaii Bob , Balkhy Husam H. , Suyker Willem J. L. 
Published: October 2024

Objective: Totally endoscopic coronary artery bypass (TECAB) procedures pose significant challenges, motivating the development of Octocon, an automated endoscopic connector designed for coronary anastomoses in off-pump and endoscopic settings. This feasibility study aimed to assess Octocon’s functionality and maneuverability in closed-chest conditions during robot-assisted TECAB simulations. Methods: The Octocon deployment comprises a 3-step procedure. Initially, delicate self-aligning microstapling technology is used to attach connector halves to individual blood vessels. Subsequently, the connector halves are joined to accomplish the anastomosis process. TECAB conditions were simulated using a dedicated box housing ex vivo porcine hearts. The study, conducted by 3 experienced surgeons, investigated the feasibility and standardization potential of a robot-assisted procedure employing Octocon. It evaluated maneuverability in closed-chest conditions and assessed the effectiveness of grafting internal mammary artery segments to different heart regions using single graft, jump graft, and Y-graft constructions. Results: The robot-assisted procedure, using 4 standard instruments, successfully completed all 3 steps in 18 anastomotic procedures. In 96% of cases, the procedural steps were accomplished on the first attempt. The feasibility of constructing jump graft and Y-graft geometries on both anterior and posterior heart walls was demonstrated. Furthermore, experiences affirmed the device’s endoscopic user-friendliness, ease of teachability, reproducibility, and potential to achieve expedient, leak-free anastomoses. Conclusions: This ex vivo study confirmed Octocon’s potential suitability and functionality for TECAB. The device can create diverse grafting strategies and achieve wide-open vascular connections on various heart regions, highlighting its potential in advancing minimally invasive, robot-assisted coronary procedures. These promising results justify further exploration for integration into clinical practice.
Decrease of Prolylcarboxypeptidase Dose of Aqueous Humor is Involved in the Pathogenesis of Primary Open-Angle Glaucoma via Finetuning of the Local Ocular Renin-Angiotensin System
Authors: Ren Jing , Xiao Yuanyuan , Wang Di , Cui Huiling , Zhao Rumeng , Guo Zilu , Wang Yuhao , Zhu Shichao , Tang Bo , Wang Jing , Wang Gang , Wang Huaying , Hu Xinyuan , Thorne Rick F. , Duan Shichao , Li Haijun 
Published: October 2024

Objective In this study, we investigated the cause of the AngII dose elevation in aqueous humor of primary open-angle glaucoma (POAG) patients. Methods Enzyme-linked immunosorbent assay (ELISA), western blotting were used to detect concentration of Angiotensin Converting Enzyme 2 (ACE2) and Prolylcarboxypeptidase (PRCP). AngII and AngII + Recombinant PRCP were injected into anterior chamber of mouse eye. Mouse Intraocular pressure (IOP) was measured every week, mouse eye sections were conducted Hematoxylin-and-Eosin (H&E) staining, Masson’ staining and Immunofluorescence staining. Western blotting and Immunofluorescence staining assays to detected fibrosis of trabecular meshwork cells. Mass spectrometry was used to identify proteins of aqueous humor. Results PRCP dose are decreased in aqueous humor of POAG patients. There is a negative correlation between PRCP and AngII levels in aqueous humor and between PRCP levels and the IOP. PRCP treatment reverses fibrosis of trabecular meshwork (TM) and prevents IOP elevation induced by AngII. Exogenous PRCP rescues fibrosis induced by AngII in HTMCs. Proteome profiling detected 502 differentially expressed proteins. Conclusion Our study found PRCP dose was decreased in POAG patients’ aqueous humor, and it might cause high level of AngII. Restoration of PRCP rescued fibrosis of TM cells and ameliorated IOP in AngII treatment mouse.
Playing the game of selectivity: The normalisation of merit and invisibilisation of advantage in students’ admission into competitive schools
Authors: Tham Melissa , Walsh Lucas 
Published: October 2024

Students’ beliefs in schooling to achieve opportunity have been well documented in the school choice literature. How students make sense of successful entry into competitive and high-demand schools via high-stakes entrance exams is less researched. High-demand schools, including both public and private schools, can utilise entrance exams to enrol their students. This paper aims to contribute empirical and conceptual insights into school selectivity by tracing the experiences of students as they navigate exams into selective and high-fee private schools, to broaden understandings of how competitive school admissions processes can impact students. Interviews reveal that many students are motivated to achieve occupational opportunities through admission into competitive schools. Influenced by their families, all participants undergo private tutoring and exam coaching to prepare for entrance exams, from a few months to 8 years. Long-term tutoring, repetitive test-taking and applying for multiple high-demand schools both simultaneously and consecutively constitute ‘playing the game of selectivity’, an experience from which students develop conceptions of merit that normalises these processes. Such conceptions of merit include individualistic strategies that render invisible their own sense of economic advantage relative to others.
Most Common Pathogens Causing Rhinosinusitis in Patients Who Underwent Endoscopic Sinus Surgery Before, During, and After the COVID-19 Pandemic
Authors: Almhanedi Hamad , Aldajani Ahmad , Steinberg Emily , Tewfik Marc 
Published: October 2024

Importance Chronic rhinosinusitis (CRS) significantly impacts patients’ quality of life and incurs substantial healthcare costs. Understanding pathogen trends before, during, and after the COVID-19 pandemic can inform better management and treatment strategies. Objective To identify the common pathogens associated with CRS and compare them across pre-pandemic, during-pandemic, and post-pandemic periods. Design Retrospective chart review. Setting McGill University Health Centre, Montreal, Canada. Participants Around 147 patients were 18 years and older, diagnosed with CRS, underwent endoscopic sinus surgery within the specified timeframe (January 2017 to September 2023), and whose charts contained relevant microbiology information. Patients were categorized into 3 groups based on surgery dates: pre- (January 2018 to November 2019), during- (January 2020 to December 2021), and post-pandemic (February 2022 to September 2023). Main Outcome Measures Distribution and prevalence of pathogens associated with CRS across the 3 time periods. Microbiology results from nasal cultures were analyzed to identify predominant pathogens. Results Among the 147 patients, 46 distinct organisms were identified. Staphylococcus aureus was the most prevalent pathogen, increasing during the COVID-19 period (24.7%) compared to pre-pandemic (17.9%) and post-pandemic (21.5%) periods. Significant increases during the COVID-19 period were noted for Aspergillus fumigatus (6.8%, P < .001), Enterobacter cloacae (6.8%, P = .01), and Cutibacterium acnes (6.8%, P = .03). Post-pandemic, significant rises were observed in Serratia marcescens ( P < .001) and Achromobacter denitrificans ( P = .03). Conclusions and Relevance Significant shifts in CRS-associated pathogens occurred during the COVID-19 pandemic. Notable changes in the prevalence of S. aureus, A. fumigatus, E. cloacae, and C. acnes were observed during the pandemic, with increases in S. marcescens and A. denitrificans post-pandemic. These findings suggest that the pandemic’s impact on healthcare practices and environmental factors influenced the microbial etiologies of CRS. Future research may explore the mechanisms driving these changes and their long-term implications for CRS management.
Soluble Guanylate Cyclase Dysfunction and Nitric Oxide Pathway in Chronic Rhinosinusitis With Nasal Polyps: Predictive Markers for Postoperative Recurrence
Authors: Jiang, MD Sijie , Zhang, MD Caixia , Tong, MD Zongjing , Xie, PhD Shaobing , Xie, MD Zhihai , Zhang, MD Hua , Jiang, MD Weihong 
Published: October 2024

Background Elevated nitric oxide (NO) levels have been linked to a heightened risk of recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the precise influence of NO on CRSwNP recurrence remains unclear. Objective This study seeks to elucidate the relationship between NO levels and the risk of CRSwNP recurrence. Methods A protein chip array analysis was conducted to identify differentially expressed inflammatory mediators in the nasal tissues between patients with CRSwNP and healthy controls (HC). Differentially expressed proteins were analyzed, and bioinformatics analysis was used to predict the potential functions and pathways of these proteins. Western blotting (WB) and immunohistochemistry were employed to validate the candidate proteins in 2 independent cohorts. Receiver-operating characteristic (ROC) curves were employed to assess the abilities of target proteins for predicting the postoperative recurrence of CRSwNP. Results Twelve differentially expressed proteins were identified between the CRSwNP and HC groups. Notably, differentially expressed proteins exhibited high expression of the biological process term “positive regulation of nitric oxide-mediated signal transduction” ( P < .05). WB and immunohistochemistry results demonstrated that guanylate cyclase 1 soluble subunit alpha 1 (GUCY1A1), GUCY1A2, nitric oxide synthase 1 adaptor protein, epidermal growth factor receptor, and insulin were found to be upregulated in the CRSwNP group compared to the HC group ( P < .05). Moreover, elevated levels of GUCY1A2 and GUCY1A1 were observed to be associated with an increased risk of CRSwNP recurrence ( P < .05), and ROC curve analysis confirmed their effectiveness as predictors for postoperative recurrence ( P < .05). Conclusion Our findings revealed that CRSwNP exhibited a distinct tissue protein profile, with soluble guanylate cyclase dysfunction and the nitric oxide pathway implicated in the underlying pathological mechanisms. The discovery-validation results suggested that GUCY1A1 and GUCY1A2 were promising predictors for postoperative recurrence in patients with CRSwNP.
Implementation of an Optimized Preoperative Checklist for Endoscopic Sinus Surgery Within a Multiinstitutional Resident Education Curriculum
Authors: Leong Stephen , Scharfenberger Thomas , Yang Nathan , Ray Amrita , Akbar Nadeem , Colley Patrick M. , Signore Anthony Del , Eloy Jean Anderson , Govindaraj Satish , Gudis David , Helman Samuel , Hsueh Wayne , Iloreta Alfred-Marc , Kacker Ashutosh , Lieberman Seth M. , Pearlman Aaron N. , Schaberg Madeleine R. , Tabaee Abtin A. , Overdevest Jonathan B. 
Published: October 2024

Background Preoperative review of computed tomography (CT) imaging assists with endoscopic sinus surgery (ESS) planning, where trainees may benefit from a systematic approach. We have previously developed an optimized preoperative checklist for sinus CT imaging using an iterative modified Delphi method. Objective In this study, we assess the utility of an optimized preoperative checklist for residents performing ESS. Methods Resident sinus CT scan education consisted of a preintervention questionnaire, an 18-min video outlining the optimized preoperative checklist, and a delayed postintervention questionnaire; these were distributed via Qualtrics to otolaryngology residents across 5 training programs in the NY metro area. The preintervention questionnaire contained 25 survey questions and a 225-point quiz on sinus CT anatomy; the delayed postintervention questionnaire contained the same 25 survey questions and a second, distinct 225-point quiz. Results In total, 74 residents completed the preintervention questionnaire, 47 completed the postintervention questionnaire, and 36 completed both. Among residents completing both questionnaires, the average preintervention quiz score was 136.8 ± 24.0 and the average postintervention quiz score was 156.0 ± 23.5 ( P < .001). Resident habitual utilization of a systematic preoperative CT imaging checklist increased significantly from 21.6% to 72.9% as a result of the curriculum intervention. Conclusion We find that an educational program centered on an iteratively optimized preoperative checklist for ESS improves the ability of trainees to identify critical sinus CT structures. Further integration of checklists and educational curricula may enhance rhinology education efforts and improve surgical anatomy competency.
Shared leadership – vertical leadership dynamics in teams
Authors: van Knippenberg Daan , Pearce Craig L. , van Ginkel Wendy P. 
Published: October 2024

Shared leadership, team members collectively leading the team, has developed from a new perspective on team leadership to an established area of research. As the evidence of the effectiveness of shared leadership accumulates, it comes increasingly into focus that we lack theory about the dynamic interplay of shared leadership and vertical leadership – the leadership by the individual formally assigned to lead the team. The absence of such theory is problematic because vertical leadership is a continuing presence in the shared leadership process and, to be effective, vertical leadership should arguably both influence and be influenced by shared leadership. Linear models in which vertical leadership is treated as a predictor of shared leadership without taking this dynamic into account fall short of capturing how vertical and shared leadership work in conjunction. We propose theory to address this, outlining how vertical leadership can develop, maintain, and complement shared leadership in a process in which shared and vertical leadership coevolve as they influence each other. We identify an internal role for vertical leadership in stimulating the development and maintenance of team cognition for shared leadership, guiding the team in shared leadership, and engendering team reflexivity to learn from the experience with shared leadership, and an external role in complementing shared leadership through boundary spanning to connect the team to its external environment. As shared leadership develops over time, it influences these vertical leadership behaviors, such that vertical leadership evolves as shared leadership evolves. Plain Language Summary Title Shared leadership in teams: the role of the formal team leader.