bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetic cheiroarthropathy in uncontrolled type 2 diabetes with positive anti-nuclear antibodies: a case report from Sudan
Authors: Abdalla Elham , Gamar Abrar Mohamed , Taha Ziryab Imad , Alfatih Mohammed 
Published: March 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Study design:
Exploratory mixed methods.

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

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

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

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

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

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

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

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

Conclusions:
The surveillance for patients with IPMNs was associated with early identification of concomitant PDACs and longer survival of patients diagnosed with this malignancy.
Bayesian autoencoders for data-driven discovery of coordinates, governing equations and fundamental constants
Authors: Mars Gao L. , Nathan Kutz J. 
Published: March 2024

Recent progress in autoencoder-based sparse identification of nonlinear dynamics (SINDy) underℓ1constraints allows joint discoveries of governing equations and latent coordinate systems from spatio-temporal data, including simulated video frames. However, it is challenging forℓ1-based sparse inference to perform correct identification for real data due to the noisy measurements and often limited sample sizes. To address the data-driven discovery of physics in the low-data and high-noise regimes, we propose Bayesian SINDy autoencoders, which incorporate a hierarchical Bayesian Spike-and-slab Gaussian Lasso prior. Bayesian SINDy autoencoder enables the joint discovery of governing equations and coordinate systems with uncertainty estimate. To resolve the challenging computational tractability of the Bayesian hierarchical setting, we adapt an adaptive empirical Bayesian method with Stochastic Gradient Langevin Dynamics (SGLD) which gives a computationally tractable way of Bayesian posterior sampling within our framework. Bayesian SINDy autoencoder achieves better physics discovery with lower data and fewer training epochs, along with valid uncertainty quantification suggested by the experimental studies. The Bayesian SINDy autoencoder can be applied to real video data, withaccurate physics discovery which correctly identifies the governing equation and provides a close estimate for standard physics constants like gravityg, for example, in videos of a pendulum.
Cyborg islets: implanted flexible electronics reveal principles of human islet electrical maturation
Authors: Li Qiang , Liu Ren , Lin Zuwan , Zhang Xinhe , Silva Israeli Galicia , Pollock Samuel D. , Alvarez-Dominguez Juan R. , Liu Jia 
Published: March 2024

AbstractFlexible electronics implanted during tissue formation enable chronic studies of tissue-wide electrophysiology. Here, we integrate tissue-like stretchable electronics during organogenesis of human stem cell-derived pancreatic islets, stably tracing single-cell extracellular spike bursting dynamics over months of functional maturation. Adapting spike sorting methods from neural studies reveals maturation-dependent electrical patterns of α and β-like (SC-α and β) cells, and their stimulus-coupled dynamics. We identified two major electrical states for both SC-α and β cells, distinguished by their glucose threshold for action potential firing. We find that improved hormone stimulation capacity during extended culture reflects increasing numbers of SC-α/β cells in low basal firing states, linked to energy and hormone metabolism gene upregulation. Continuous recording during further maturation by entrainment to daily feeding cycles reveals that circadian islet-level hormone secretion rhythms reflect sustained and coordinate oscillation of cell-level SC-α and β electrical activities. We find that this correlates with cell-cell communication and exocytic network induction, indicating a role for circadian rhythms in coordinating system-level stimulus-coupled responses. Cyborg islets thus reveal principles of electrical maturation that will be useful to build fully functionalin vitroislets for research and therapeutic applications.
Cancer-associated DNA Hypermethylation of Polycomb Targets Requires DNMT3A Dual Recognition of Histone H2AK119 Ubiquitination and the Nucleosome Acidic Patch
Authors: Gretarsson Kristjan H. , Abini-Agbomson Stephen , Gloor Susan L , Weinberg Daniel N , McCuiston Jamie L , Kumary Vishnu Udayakumar Sunitha , Hickman Allison R , Sahu Varun , Lee Rachel , Xu Xinjing , Lipieta Natalie , Flashner Samuel , Adeleke Oluwatobi A. , Popova Irina K , Taylor Hailey F , Noll Kelsey , Windham Carolina Lin , Maryanski Danielle N , Venters Bryan J , Nakagawa Hiroshi , Keogh Michael-Christopher , Armache Karim-Jean , Lu Chao 
Published: March 2024

AbstractDuring tumor development, promoter CpG islands (CGIs) that are normally silenced by Polycomb repressive complexes (PRCs) become DNA hypermethylated. The molecular mechanism by whichde novoDNA methyltransferase(s) catalyze CpG methylation at PRC-regulated regions remains unclear. Here we report a cryo-EM structure of the DNMT3A long isoform (DNMT3A1) N-terminal region in complex with a nucleosome carrying PRC1-mediated histone H2A lysine 119 monoubiquitination (H2AK119Ub). We identify regions within the DNMT3A1 N-terminus that bind H2AK119Ub and the nucleosome acidic patch. This bidentate interaction is required for effective DNMT3A1 engagement with H2AK119Ub-modified chromatin in cells. Furthermore, aberrant redistribution of DNMT3A1 to Polycomb target genes inhibits their transcriptional activation during cell differentiation and recapitulates the cancer-associated DNA hypermethylation signature. This effect is rescued by disruption of the DNMT3A1-acidic patch interaction. Together, our analyses reveal a binding interface critical for countering promoter CGI DNA hypermethylation, a major molecular hallmark of cancer.
Performance of new national health insurance fund packages (Wekeza, Najali, Timiza) in Kinondoni municipal, Dar es salaam, Tanzania
Authors: Chihoma Evangelina C. , Mwangu Mughwira 
Published: March 2024

ABSTRACTBackgroundTanzania is one of the countries which has joined the UN efforts of attaining Universal health Coverage (UHC) by 2030 by ensuring that all citizens are able to access health services thereby reducing out of pocket expenditure. As a strategy to achieve UHC, the National Health Insurance Fund (NHIF) introduced new premium packages in September 2019 named TIMIZA, NAJALI and WEKEZA premium packages to accommodate private individuals and their families who are not in the formal employment sector to increase the coverage of citizens who are health insured in the country and to increase their accessibility to quality health services. Since the introduction of these packages no studies have been done to assess their performance. Therefore, this study evaluated the performance of the packages through process evaluation by exploring its level of utilization from September 2019, the acceptability of the packages by the health care providers and client satisfaction towards the services offered.MethodsA descriptive cross-sectional study was conducted in selected NHIF accredited health facilities in Kinondoni Municipal using mixed method of data collection. Secondary data was quantitatively extracted from NHIF enrollment registries using a data abstraction tool to assess the percentage of citizens enrolled from Kinondoni NHIF office from September 2019 to March 2021.In-depth interview was used to evaluate the acceptability of the packages among the health care providers and Clients (beneficiaries) satisfaction towards the quality of services offered. Qualitative data was analyzed by content analysis approach and Microsoft excel for the quantitative data.ResultsNHIF has been able to enroll 17,248 members which is only 1% of the total population of people in Kinondoni MC against their set target which was to enroll at least 50% of the total population. Beneficiaries of the packages are unsatisfied and health providers are also unhappy about the packages due to poor orientation, cumbersome referral system and uncertainties in availability of medications and investigations.Conclusion and RecommendationThis evaluation has revealed that NHIF new packages have not been performing well since their introduction in September 2019. They are far from reaching the set target due to challenges which have been brought forward by beneficiaries and health care providers. NHIF need to improve their orientation by educating their clients about every service covered in a scheme before enrollment. Also, they should perform biannual review of their list of medicines and services covered by constantly updating their medicines list according to the pharmaceutical and insurance market.
HOCl-producing Electrochemical Bandage is Active in Murine Polymicrobial Wound Infection
Authors: Fleming Derek , Bozyel Ibrahim , Koscianski Christina A. , Ozdemir Dilara , Karau Melissa J. , Cuello Luz , Anoy Md Monzurul Islam , Gelston Suzanne , Schuetz Audrey N. , Greenwood-Quaintance Kerryl E. , Mandrekar Jayawant N. , Beyenal Haluk , Patel Robin 
Published: March 2024

AbstractWound infections, exacerbated by the prevalence of antibiotic-resistant bacterial pathogens, necessitate innovative antimicrobial approaches. Polymicrobial infections, often involvingPseudomonas aeruginosaand methicillin-resistantStaphylococcus aureus(MRSA), present formidable challenges due to biofilm formation and antibiotic resistance. Hypochlorous acid (HOCl), a potent antimicrobial agent produced naturally by the immune system, holds promise as an alternative therapy. An electrochemical bandage (e-bandage) that generates HOClin situwas evaluated for treatment of murine wound biofilm infections containing both MRSA andP. aeruginosawith “difficult-to-treat” resistance. Previously, the HOCl-producing e-bandage was shown to reduce wound biofilms containingP. aeruginosaalone. Compared to non-polarized e-bandage (no HOCl production) and Tegaderm only controls, the polarized e-bandages reduced bacterial loads in wounds infected with MRSA plusP. aeruginosa(MRSA: vs Tegaderm only – 1.4 log10CFU/g, p = 0.0015, vs. non-polarized – 1.1 log10CFU/g, p = 0.026.P. aeruginosa: vs Tegaderm only – 1.6 log10CFU/g, p = 0.0015, vs non-polarized – 1.6 log10CFU/g, p = 0.0032), and MRSA alone (vs Tegaderm only – 1.3 log10CFU/g, p = 0.0048, vs. non-polarized – 1.1 log10CFU/g, p = 0.0048), without compromising wound healing or causing tissue toxicity. Addition of systemic antibiotics did not enhance the antimicrobial efficacy of e-bandages, highlighting their potential as standalone therapies. This study provides additional evidence for the HOCl-producing e-bandage as a novel antimicrobial strategy for managing wound infections, including in the context of antibiotic resistance and polymicrobial infections.
Touchstones for the development of an inclusive approach for ecotourism as a service industry
Authors: Saxena Anupam , Shanker Sugandha , Sethi Deepa , Seth Manisha , Saxena Anurag 
Published: March 2024

PurposeThis study was conducted to analyse the socio-ecological problems faced by the Suhelwa Wildlife Sanctuary and understand its potential and challenges for developing ecotourism following Triple Bottom Line (TBL) principles. The study also benchmarked best ecotourism practices across the globe to create an ecotourism plan that would provide alternative livelihood and help in sustainable management of the area by reducing poverty, dependency on forests and biodiversity protection.Design/methodology/approachSuhelwa Wildlife Sanctuary was chosen because this area has several socio-ecological crises with limited livelihood options, and there is an urgent need for alternative livelihood opportunities in the form of ecotourism. The study followed an ethnographic approach through observation, participant observation, and semi-structured interviews. Content and thematic analysis was conducted through Atlas Ti9.0 software for data analysis. Subsequently, benchmarking best ecotourism practices through a literature review was done to develop an ecotourism action plan.FindingsThe First finding was related to the study area divided into three themes: problems, potential for ecotourism development, and challenges for ecotourism development. The second finding was related to benchmarking best practices and suggesting an action plan.Originality/valueThis work studied an area not sufficiently acknowledged by academicians and policymakers concerning ecotourism development. The work also benchmarks the best practices for ecotourism and proposes a sight-specific ecotourism action plan in accordance with TBL.