Long-term outcomes after the arterial switch operation.

OBJECTIVES: The aims of this study were to evaluate the 16-year experience with  arterial switch operation at Beijing Children's Hospital and to determine early and late mortality and late morbidity, to explore risk factors for late complications and reintervention, and finally to evaluate whether the neoaortic sinotubular junction reconstruction technique reduces late complications of arterial switch operation. METHODS: The clinical data of 185 patients with transposition of the great arteries who underwent arterial switch operation in Beijing Children's Hospital from January 2006 to January 2022 and 30 patients who underwent modified arterial switch operation with neoaortic sinotubular junction reconstruction technique in Fuwai Hospital during the same period were retrospectively analysed. Propensity score matching was also used to match the neoaortic sinotubular junction reconstruction patients in Fuwai Hospital with 30 non-neoaortic sinotubular junction reconstruction patients in Beijing Children's Hospital. RESULTS: There were 13 early deaths (7.03%) and five late deaths (3.01%). Nineteen patients (11.45%) developed new aortic valve regurgitation and 28 patients (16.87%) developed aortic root dilation. Late right ventricular outflow tract obstruction occurred in 33 patients (19.88%). Late reintervention occurred in 18 cases (10.84%). Multivariate analysis showed that aorto-pulmonary diameter mismatch, previous pulmonary artery banding, and mild moderate or above new aortic valve regurgitation at discharge were independent risk factors for late new aortic valve regurgitation and aortic root dilation. Low surgical weight was an independent risk factor specific to new aortic valve regurgitation, and bicuspid native pulmonary valve was an independent risk factor specific to aortic root dilation. Older surgical age and aortic root dilation were independent risk factors for late right ventricular outflow tract obstruction. Older surgical age, operation before 2014, late right ventricular outflow tract obstruction, and late aortic root dilation were independent risk factors for late intervention. Propensity score matching showed that new aortic valve regurgitation and aortic root dilation were not followed up in the neoaortic sinotubular junction reconstruction group, while seven cases of aortic root dilation and five cases of new aortic valve regurgitation occurred in the non-neoaortic sinotubular junction reconstruction group, respectively, and the differences were statistically significant (P = 0.003; P = 0.015). CONCLUSIONS: The increased incidence of new aortic valve regurgitation, aortic root dilation, and right ventricular outflow tract obstruction as children age is a major concern outcome in the future and may mean more late reintervention. neoaortic sinotubular junction reconstruction technique may reduce the incidence of new aortic valve regurgitation and aortic root dilation, and improve the late prognosis of arterial switch operation. Careful follow-up of neo-aortic valve and root function is imperative, especially in patients with aorto-pulmonary diameter mismatch, previous pulmonary artery banding, mild new aortic valve regurgitation at discharge, low surgical weight, and bicuspid native pulmonary valve structures.

Researcher engagement in policy deemed societally beneficial yet unrewarded.

Maintaining the continued flow of benefits from science, as well as societal support for science, requires sustained engagement between the research community and the general public. On the basis of data from an international survey of 1092 participants (634 established researchers and 458 students) in 55 countries and 315 research institutions, we found that institutional recognition of engagement activities is perceived to be undervalued relative to the societal benefit of those activities. Many researchers report that their institutions do not reward engagement activities despite institutions' mission statements promoting such engagement. Furthermore, institutions that actually measure engagement activities do so only to a limited extent. Most researchers are strongly motivated to engage with the public for selfless reasons, which suggests that incentives focused on monetary benefits or career progress may not align with researchers' values. If institutions encourage researchers' engagement activities in a more appropriate way - by moving beyond incentives - they might better achieve their institutional missions and bolster the crucial contributions of researchers to society.

Single-Center Experience of 500 Cases of Laparoscopic Sleeve Gastrectomy: Surgical Techniques and Perioperative Management Strategies.

Introduction: Reported results and techniques of laparoscopic sleeve gastrectomy (LSG) are variable. Our objective was to assess results of weight loss, complications, and reflux in a large consecutive series of LSG, describing technical detail which contributed to outcomes. Methods: Retrospective review of prospectively collected data of 500 consecutive patients undergoing LSG. Patient demographics, weight loss, complications, and functional outcomes were analyzed and operative technique described. Results: Five hundred patients underwent LSG over 3 years (2 revisional). Mean (range) preoperative body mass index was 40 kg/m2 (32-75 kg/m2). Mean follow-up and length of hospital stay were 12 months (1-36) and 7.2 days (5-12), respectively. All-cause 30-day readmission rate was 0.3%. Mean excess weight loss was 22.3% (1 month), 42.2% (3 month), 57.2% (6 month), and 73.1% (1 year). There was no mortality and intraoperative complications occurred in our 500 cases. Early surgical complications in 2 (0.2%) patients (postoperative bleeds). Gastro-oesophageal reflux symptoms decreased about 10%. Conclusion: With attention to detail, LSG can lead to good excess weight loss with minimal complications. Tenants to success include repair of hiatal laxity, generous width at angula incisura, and complete resection of posterior fundus.

External validation of a deep learning detection system for glaucomatous optic neuropathy: a real-world multicentre study.

OBJECTIVES: To conduct an external validation of an automated artificial intelligence (AI) diagnostic system using fundus photographs from a real-life multicentre cohort. METHODS: We designed external validation in multiple scenarios, consisting of 3049 images from Qilu Hospital of Shandong University in China (QHSDU, validation dataset 1), 7495 images from three other hospitals in China (validation dataset 2), and 516 images from high myopia (HM) population of QHSDU (validation dataset 3). The corresponding sensitivity, specificity and accuracy of this AI diagnostic system to identify glaucomatous optic neuropathy (GON) were calculated. RESULTS: In validation datasets 1 and 2, the algorithm yielded accuracy of 93.18% and 91.40%, area under the receiver operating curves (AUC) of 95.17% and 96.64%, and significantly higher sensitivity of 91.75% and 91.41%, respectively, compared to manual graders. On the subsets complicated with retinal comorbidities, such as diabetic retinopathy or age-related macular degeneration, in validation datasets 1 and 2, the algorithm achieved accuracy of 87.54% and 93.81%, and AUC of 97.02% and 97.46%, respectively. In validation dataset 3, the algorithm achieved comparable accuracy of 81.98% and AUC of 87.49%, with a sensitivity of 83.61% and specificity of 81.76% on GON recognition specifically in the HM population. CONCLUSIONS: With acceptable generalization capability across varying levels of image quality, different clinical centres, or certain retinal comorbidities, such as HM, the automatic AI diagnostic system had the potential to provide expert-level glaucoma detection.

The effectiveness of artificial intelligence-based automated grading and training system in education of manual detection of diabetic retinopathy.

Background: The purpose of this study is to develop an artificial intelligence (AI)-based automated diabetic retinopathy (DR) grading and training system from a real-world diabetic dataset of China, and in particular, to investigate its effectiveness as a learning tool of DR manual grading for medical students. Methods: We developed an automated DR grading and training system equipped with an AI-driven diagnosis algorithm to highlight highly prognostic related regions in the input image. Less experienced prospective physicians received pre- and post-training tests by the AI diagnosis platform. Then, changes in the diagnostic accuracy of the participants were evaluated. Results: We randomly selected 8,063 cases diagnosed with DR and 7,925 with non-DR fundus images from type 2 diabetes patients. The automated DR grading system we developed achieved accuracy, sensitivity/specificity, and AUC values of 0.965, 0.965/0.966, and 0.980 for moderate or worse DR (95 percent CI: 0.976-0.984). When the graders received assistance from the output of the AI system, the metrics were enhanced in varying degrees. The automated DR grading system helped to improve the accuracy of human graders, i.e., junior residents and medical students, from 0.947 and 0.915 to 0.978 and 0.954, respectively. Conclusion: The AI-based systemdemonstrated high diagnostic accuracy for the detection of DR on fundus images from real-world diabetics, and could be utilized as a training aid system for trainees lacking formal instruction on DR management.

Gender Differences in Health Protective Behaviors During the COVID-19 Pandemic in Taiwan: An Empirical Study.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces more severe symptoms and a higher mortality in men than in women. The role of biological sex in the immune response to SARS-CoV-2 is believed to explain this sex disparity. However, the contribution of gender factors that influence health protective behaviors and therefore health outcomes, remains poorly explored. METHODS: We assessed the contributions of gender in attitudes towards the COVID-19 pandemic, using a hypothetical influenza pandemic data from the 2014 Taiwan Social Change Survey. Participants were selected through a stratified, three-stage probability proportional-to-size sampling from across the nation, to fill in questionnaires that asked about their perception of the hypothetical pandemic, and intention to adopt health protective behaviors. RESULTS: A total of 1,990 participants (median age 45.92 years, 49% women) were included. Significant gender disparities (p<0.001) were observed. The risk perception of pandemic (OR=1.28, 95% CI=1.21-1.35, p<0.001), older age (1.06, 95%=1.05-1.07, p<0.001), female gender (OR = 1.18, 95% CI = 1.09□1.27, p<0.001), higher education (OR=1.10, 95% CI=1.06-1.13, p<0.001), and larger family size (OR=1.09, 95% CI=1.06-1.15, p<0.001) were positively associated with health protective behaviors. The risk perception of pandemic (OR=1.25, 95% CI=1.15-1.36), higher education (OR=1.07, 95% CI=1.02-1.13, p<0.05), being married (OR=1.17, 95% CI=1.01-1.36, p<0.05), and larger family size (OR=1.33, 95% CI=1.25-1.42, p<0.001), were positively associated with intention to receive a vaccine. However, female gender was negatively associated with intention to receive a vaccine (OR=0.85, 95% CI=0.75-0.90, p<0.01) and to comply with contact-tracing (OR=0.95, 95% CI=0.90-1.00, p<0.05) compared to men. Living with children was also negatively associated with intention to receive vaccines (OR=0.77, 95% CI=0.66-0.90, p<0.001). CONCLUSION: This study unveils gender differences in risk perception, health protective behaviors, vaccine hesitancy, and compliance with contact-tracing using a hypothetical viral pandemic. Gender-specific health education raising awareness of health protective behaviors may be beneficial to prevent future pandemics.

Clinical Features and Surgical Management of Cerebellopontine Angle Cholesteatoma That Presented as Trigeminal Neuralgia.

BACKGROUND: It is difficult to differentiate patients with cerebellopontine angle (CPA) cholesteatoma and patients with primary trigeminal neuralgia just according to early symptoms. We aimed to explore the clinical characteristics, early diagnosis, and microneurosurgical techniques for CPA cholesteatoma that presented as trigeminal neuralgia. METHODS: The data of 26 patients who complained trigeminal neuralgia with CPA cholesteatoma between January 2009 and December 2015 were collected and studied retrospectively, they were diagnosed by magnetic resonance imaging preoperatively and confirmed by pathology postoperatively. All the tumors were resected through a retrosigmoidal approach. In 26 cases, 14 patients who underwent cholesteatoma resection and microvascular decompression were assigned to group A and 12 patients who underwent only cholesteatoma resection were assigned to group B. The clinical features and surgical results between groups A and B were compared. The complications and surgical results were followed up, and surgical techniques were summarized. RESULTS: All patients presented as trigeminal neuralgia at the same side of the cholesteatoma. There was no statistical difference between the 2 groups in clinical features and surgical results between groups A and B. All patients with cholesteatoma showed clear and significant imaging characteristics. The tumors were totally removed in 18 patients and subtotally removed in 8 patients. Pain relief was satisfactory in all patients. Surgical complications included transient aseptic meningitis in 2 patients, facial numbness in 2 patients, mild tinnitus in 2 patients, mild and facial weakness in 1 patient. No death, hematoma, or acute hydrocephalus were reported in this series. During the follow-up of 12-80 months, no patient experienced recurrence of pain or tumor. CONCLUSIONS: Cholesteatoma of the cerebellopontine angle often presented as trigeminal neuralgia. Magnetic resonance imaging is helpful for early diagnosis according to its distinct signal. Surgical treatment is often the first choice, the neuralgia relief was satisfactory after operation. Microvascular decompression is recommended simultaneously if some offending vessels were founded during the surgical resection of the tumor.

Long-term results of selective dorsal rhizotomy for hereditary spastic paraparesis.

Pure hereditary spastic paraparesis usually presents with progressive weakness and spasticity of the legs, which is similar to spastic cerebral palsy. In this study selective dorsal rhizotomy (SDR) was performed to improve the spasticity of pure hereditary spastic paraparesis and the long-term results were followed. A series of four patients with pure hereditary spastic paraparesis diagnosed by a multidisciplinary team received SDR. The dorsal rootlets from the L2 to S1 levels were selectively resected under electrophysiological monitoring. The patients were followed up for more than 2 years to evaluate the outcome of surgery. There was a significant reduction in muscular spasm after SDR. Standing and walking stability were improved in all patients which led to improvement in walking posture and longer walking distance without assistance. No urinary retention, cerebrospinal fluid leak, surgical infection or kyphosis occurred. For severe pure hereditary spastic paraparesis, SDR can reduce muscle spasm and improve standing and walking stability. These results were stable throughout follow-up. SDR performed at the level of the conus medullaris through a laminectomy from T12 to L1 or L1 to L2 requires a shorter incision, laminectomy of fewer segments, and has a shorter operation time than the usual method (laminectomy from L2 to S1). Intraoperative electrophysiological monitoring is helpful to discriminate abnormal rootlets and protect sphincter function.

Trading green backs for green crabs: evaluating the commercial shellfish harvest at risk from European green crab invasion.

Nonnative species pose a threat to native biodiversity and can have immense impacts on biological communities, altering the function of ecosystems. How much value is at risk from high-impact invasive species, and which parameters determine variation in that value, constitutes critical knowledge for directing both management and research, but it is rarely available. We evaluated the value of the commercial shellfish harvest that is at risk in nearshore ecosystems of Puget Sound, Washington State, USA, from the invasive European green crab, Carcinus maenas. We assessed this value using a simple static ecological model combined with an economic model using data from Puget Sound's shellfish harvest and revenue and the relationship between C. maenas abundance and the consumption rate of shellfish. The model incorporates a range in C. maenas diet preference, calories consumed per year, and crab densities. C. maenas is likely to prey on commercially harvested hardshell clams, oysters, and mussels, which would likely reduce additional revenue from processing and distribution, and the number of jobs associated with these fisheries. The model results suggest possible revenue losses of these shellfish ranging from $1.03-23.8 million USD (2.8-64% losses), with harvesting and processing losses up to $44 million USD (40%) and 303 job positions each year associated with a range of plausible parameter values. The broad range of values reflects the uncertainty in key factors underlying impacts, factors that are highly variable across invaded regions and so not knowable a priori. However, future research evaluating species invasions can reduce the uncertainty of impacts by characterizing several key parameters: density of individuals, number of arrivals, predation and competition interactions, and economic impacts. This study therefore provides direction for research to inform more accurate estimates of value-at-risk, and suggests substantial motivation for strong measures to prevent, monitor, and manage the possible invasion of C. maenas.

Identifying spatial priorities for protecting ecosystem services.

Priorities for protecting ecosystem services must be identified to ensure future human well-being. Approaches to broad-scale spatial prioritization of ecosystem services are becoming increasingly popular and are a vital precursor to identifying locations where further detailed analyses of the management of ecosystem services is required (e.g., examining trade-offs among management actions). Prioritization approaches often examine the spatial congruence between priorities for protecting ecosystem services and priorities for protecting biodiversity; therefore, the spatial prioritization method used is crucial because it will influence the alignment of service protection and conservation goals. While spatial prioritization of ecosystem services and prioritization for conservation share similarities, such as the need to document threats and costs, the former differs substantially from the latter owing to the requirement to measure the following components: supply of services; availability of human-derived alternatives to service provision; capacity to meet beneficiary demand; and site dependency in and scale of service delivery. We review studies that identify broad-scale spatial priorities for managing ecosystem services and demonstrate that researchers have used different approaches and included various measures for identifying priorities, and most studies do not consider all of the components listed above. We describe a conceptual framework for integrating each of these components into spatial prioritization of ecosystem services and illustrate our approach using a worked example for water provision. A fuller characterization of the biophysical and social context for ecosystem services that we call for should improve future prioritization and the identification of locations where ecosystem-service management is especially important or cost effective.

Characterizing changes in marine ecosystem services.

The benefits of marine ecosystems for people are increasingly being characterized through the concept of ecosystem services, with the promise to aid decision making from marine spatial planning to ecosystem-based management. The characterization of changes in marine ecosystem services is central to the application of ecological science to policy contexts, and this field is quickly evolving with innovations in frameworks for integrating science, understanding of ecosystems and human benefits, and innovations in tools for the modeling of services. In this article, we review efforts to characterize changes in marine ecosystem services, including recent advances, and we propose five key future directions for research: cultural values, qualitative or semi-quantitative modeling approaches, cumulative impacts, model evaluation, and markets.