bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Ceftriaxone Compared With Cefazolin or Nafcillin/Oxacillin for Outpatient Therapy for Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections: Results From a Large United States Claims Database
Authors: Hamad Yasir , Nickel Katelin B , Olsen Margaret A , George Ige A
Published: January 2024

Background

Ceftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking.

Methods

In this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models.

Results

Of 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61–64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01–2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81–3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18–2.23]), central line–associated BSI (aOR, 1.72 [95% CI, 1.33–2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18–2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI, .67–1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI, .66–1.10]) when compared with oxacillin/nafcillin/cefazolin.

Conclusions

In this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin.
You Might be an Anarchist if …
Authors: Ehrenberg Kenneth M
Published: January 2024

I show that conceptual philosophical anarchism, the claim that law cannot give reasons for action, is entailed by several popular theories about law. Reductionists about practical authority believe that all supposedly legitimate practical authority reduces to forms of theoretical authority. They tend to embrace anarchism, but some readers might not be clear why. Trigger theorists about reason-giving believe that all reason-giving merely activates pre-existing conditional reasons. Natural lawyers hold that all legal reasons are sourced in the natural law, which entails that positive law cannot provide reasons for action. If you are attracted to any of these theories and still think that positive law creates new practical reasons, you might have to give up one or the other position. If anarchism is entailed by believing the normativity in law’s directives pre-dates the directive, only a few may be able to avoid it, Hans Kelsen, Mark Greenberg, and Joseph Raz being the most likely.
Telemedicine in Peru: origin, implementation, pandemic escalation, and prospects in the new normal
Authors: Rees Gareth H , Peralta Felipe
Published: January 2024

For many countries telemedicine was speedily adopted as a result of the COVID-19 pandemic, though for some countries telemedicine may have been implemented in a context of limited regulations or few plans or strategies to scale quickly. This article recounts how telemedicine was developed in Peru as a measure to support the country's Universal Health Coverage and service access to rural and locations with low workforce numbers and its deployment. From a range of data, we find that Peru's development of telehealth began before the pandemic, which by 2020 was sufficient to be able to foster a rapid and wider deployment and while the telemedicine service volumes quickly grew from the pandemic onset, these numbers then begin to reduce suggesting that telemedicine was considered more as a pandemic emergency measure rather than a change to the mix of health provision. From these data we offer two lessons, (i) that Peru's preparedness in terms of telemedicine policy and regulation were helpful to rapidly expand telemedicine at a time of necessity and (ii) that due to this investment and with a better understanding, Peru now has a short-run window of opportunity for the Peruvian Government to continue its regulatory development and investment to further deploy telemedicine services as a UHC improvement measure and to better align the health system to the country’s health needs.
X-ray iron absorption line in Swift J1858.6−0814
Authors: Asai Kazumi , Mihara Tatehiro , Sakai Kento , Kubota Aya
Published: January 2024

We present the spectral analysis of bright steady states in an outburst of the transient neutron star low-mass X-ray binary Swift J1858.6−0814 observed with the Neutron star Interior Composition Explorer (NICER). We detected an ionized iron K absorption line (H-like Fe) at 6.97 keV in the spectrum. We estimate the photoionization parameter using the ratio of the equivalent widths of the Fe xxvi (H-like) (17 ± 5 eV) and Fe xxv (He-like) (<3 eV) and discuss the origin of the iron absorption line. The irradiated gas producing the absorption line would locate within (3–6) × 109 cm of the X-ray source. We suggest that the observed H-like Fe absorption line originates from the highly ionized gas in the inner accretion disk in Swift J1858.6−0814.
Decoding the genetic symphony: Profiling protein-coding and long noncoding RNA expression in T-acute lymphoblastic leukemia for clinical insights
Authors: Verma Deepak , Kapoor Shruti , Kumari Sarita , Sharma Disha , Singh Jay , Benjamin Mercilena , Bakhshi Sameer , Seth Rachna , Nayak Baibaswata , Sharma Atul , Pramanik Raja , Palanichamy Jayanth Kumar , Sivasubbu Sridhar , Scaria Vinod , Arora Mohit , Kumar Rajive , Chopra Anita
Published: January 2024

T-acute lymphoblastic leukemia (T-ALL) is a heterogeneous malignancy characterized by the abnormal proliferation of immature T-cell precursors. Despite advances in immunophenotypic classification, understanding the molecular landscape and its impact on patient prognosis remains challenging. In this study, we conducted comprehensive RNA sequencing in a cohort of 35 patients with T-ALL to unravel the intricate transcriptomic profile. Subsequently, we validated the prognostic relevance of 23 targets, encompassing (i) protein-coding genes—BAALC, HHEX, MEF2C, FAT1, LYL1, LMO2, LYN, and TAL1; (ii) epigenetic modifiers—DOT1L, EP300, EML4, RAG1, EZH2, and KDM6A; and (iii) long noncoding RNAs (lncRNAs)—XIST, PCAT18, PCAT14, LINC00202, LINC00461, LINC00648, ST20, MEF2C-AS1, and MALAT1 in an independent cohort of 99 patients with T-ALL. Principal component analysis revealed distinct clusters aligning with immunophenotypic subtypes, providing insights into the molecular heterogeneity of T-ALL. The identified signature genes exhibited associations with clinicopathologic features. Survival analysis uncovered several independent predictors of patient outcomes. Higher expression of MEF2C, BAALC, HHEX, and LYL1 genes emerged as robust indicators of poor overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS). Higher LMO2 expression was correlated with adverse EFS and RFS outcomes. Intriguingly, increased expression of lncRNA ST20 coupled with RAG1 demonstrated a favorable prognostic impact on OS, EFS, and RFS. Conclusively, several hitherto unreported associations of gene expression patterns with clinicopathologic features and prognosis were identified, which may help understand T-ALL's molecular pathogenesis and provide prognostic markers.
Leveraging metabolic modeling and machine learning to uncover modulators of quiescence depth
Authors: Eames Alec , Chandrasekaran Sriram
Published: January 2024

Quiescence, a temporary withdrawal from the cell cycle, plays a key role in tissue homeostasis and regeneration. Quiescence is increasingly viewed as a continuum between shallow and deep quiescence, reflecting different potentials to proliferate. The depth of quiescence is altered in a range of diseases and during aging. Here, we leveraged genome-scale metabolic modeling (GEM) to define the metabolic and epigenetic changes that take place with quiescence deepening. We discovered contrasting changes in lipid catabolism and anabolism and diverging trends in histone methylation and acetylation. We then built a multi-cell type machine learning model that accurately predicts quiescence depth in diverse biological contexts. Using both machine learning and genome-scale flux simulations, we performed high-throughput screening of chemical and genetic modulators of quiescence and identified novel small molecule and genetic modulators with relevance to cancer and aging.
The Voynich Manuscript, Dr Johannes Hartlieb and the Encipherment of Women’s Secrets
Authors: Brewer Keagan , Lewis Michelle L
Published: January 2024

The Voynich manuscript is a famous European enciphered manuscript of the early fifteenth century featuring herbal, pharmaceutical, astrological and anatomical illustrations, including hundreds of naked women. Some hold objects adjacent to or unambiguously pointed towards their genitalia. This paper therefore investigates the culture of self-censorship, erasure and encipherment of women’s secrets, with a focus on Dr Johannes Hartlieb (c. 1410–68). Hartlieb had enduring apprehensions about the propagation of women’s secrets in vernacular Bavarian, which culminated in a call for ‘secret letters’ to hide recipes for abortifacients and contraceptives. Other cases of encipherment relating to sexual intercourse and genitalia will be described. On the basis of this evidence, we propose that the Rosettes, the largest and most complex illustration in the Voynich manuscript, represents coitus and conception. This hypothesis explains many of the illustration’s features and establishes a variety of future research possibilities.
The Root-Lesion Nematode, Pratylenchus penetrans, Affects Early Growth and Physiology of Grafted M.9, G.41, and G.935 Apple Rootstocks Similarly Under Field Microplot Conditions
Authors: King Lindsay , Munro Paige , Xu Hao , Jones Melanie , Forge Tom
Published: January 2024

The root-lesion nematode, Pratylenchus penetrans, is a ubiquitous parasite of roots of temperate fruit trees. It affects early growth of trees replanted into former orchard sites where populations have built up and may contribute to decline complexes of older trees. Most British Columbia, Canada, apple acreage is planted with M.9 rootstock, but growers are increasingly considering Geneva-series rootstocks such as G.41 and G.935. Among these rootstocks, responses to P. penetrans, specifically, are poorly known. To compare the resistance and tolerance to P. penetrans of G.41, G.935, and M.9 rootstocks (‘Ambrosia’ scion), a field microplot experiment was established in spring of 2020 at the Summerland Research and Development Centre. The experimental design was a two by three factorial combination of: P. penetrans inoculation (+/−) and rootstock (G.41, G.935, and M.9), with 20 replicate microplots of each of the six treatment combinations arranged in a randomized complete block design. The P. penetrans inoculum was 5,400 nematodes per microplot (54 P. penetrans liter−1 soil), which is below commonly accepted damage thresholds. Though P. penetrans population densities were lower for the G.41 rootstock by the end of the 2021 growing season, the effects of P. penetrans were similar among rootstocks. In the establishment year (2020), P. penetrans caused significant reductions in aboveground growth. In 2021, shoot growth and root weight were reduced by P. penetrans. The nematode also reduced rates of leaf gas exchange and stem water potential. These data suggest that while G.41 and G.935 may have other horticultural benefits over M.9, they are equally susceptible to P. penetrans at the early stages of tree growth.
Identifying Onion Fields at Risk of Iris Yellow Spot Virus in New York
Authors: Komondy Lidia , Hoepting Christy , Fuchs Marc , Pethybridge Sarah J. , Nault Brian A.
Published: January 2024

Iris yellow spot virus (IYSV) poses a significant threat to dry bulb onion, Allium cepa L., production and can lead to substantial yield reductions. IYSV is transmitted by onion thrips, Thrips tabaci (Lindeman), but not via seed. Transplanted onion fields have been major early season sources of IYSV epidemics. As onion thrips tend to disperse short distances, seeded onion fields bordering transplanted onion fields may be at greater risk of IYSV infection than seeded fields isolated from transplanted ones. Additionally, seeded onion fields planted early may be at greater risk of IYSV infection than those seeded later. In a 2-year study in New York, we compared IYSV incidence and onion thrips populations in seeded onion fields relative to their proximity to transplanted onion fields. In a second study, we compared IYSV incidence in onion fields with either small or large plants during midseason. Results showed similar IYSV incidence and onion thrips populations in seeded onion fields regardless of their proximity to transplanted onion fields, while IYSV incidence was over four times greater in large onion plants than in small ones during midseason. These findings suggest a greater risk of onion thrips-mediated IYSV infection in onion fields with large plants compared with small ones during midseason and that proximity of seeded fields to transplanted ones is a poor indicator of IYSV risk. Our findings on IYSV spread dynamics provided valuable insights for developing integrated pest and disease management strategies for New York onion growers.
Mathematical modeling of fluid dynamics in in vitro gut fermentation systems: A new tool to improve the interpretation of microbial metabolism
Authors: Lessard‐Lord Jacob , Lupien‐Meilleur Joseph , Roussel Charlène , Gosselin‐Cliche Benjamin , Silvestri Cristoforo , Di Marzo Vincenzo , Roy Denis , Rousseau Elsa , Desjardins Yves
Published: January 2024

In vitro systems are widely employed to assess the impact of dietary compounds on the gut microbiota and their conversion into beneficial bacterial metabolites. However, the complex fluid dynamics and multi‐segmented nature of these systems can complicate the comprehensive analysis of dietary compound fate, potentially confounding physical dilution or washout with microbial catabolism. In this study, we developed fluid dynamics models based on sets of ordinary differential equations to simulate the behavior of an inert compound within two commonly used in vitro systems: the continuous two‐stage PolyFermS system and the semi‐continuous multi‐segmented SHIME® system as well as into various declinations of those systems. The models were validated by investigating the fate of blue dextran, demonstrating excellent agreement between experimental and modeling data (with r2 values ranging from 0.996 to 0.86 for different approaches). As a proof of concept for the utility of fluid dynamics models in in vitro system, we applied generated models to interpret metabolomic data of procyanidin A2 (ProA2) generated from the addition of proanthocyanidin (PAC)‐rich cranberry extract to both the PolyFermS and SHIME® systems. The results suggested ProA2 degradation by the gut microbiota when compared to the modeling of an inert compound. Models of fluid dynamics developed in this study provide a foundation for comprehensive analysis of gut metabolic data in commonly utilized in vitro PolyFermS and SHIME® bioreactor systems and can enable a more accurate understanding of the contribution of bacterial metabolism to the variability in the concentration of target metabolites.
Cervical Kyphosis
Authors: Lee Yu-Po , Liang Jason
Published: January 2024

Kyphosis of the cervical spine can have many causes. The most common causes include degeneration of the cervical spine, infection, trauma, inflammatory diseases, tumors, and iatrogenic causes. Cervical kyphosis can be associated with myelopathy and radiculopathy, so it is important to look for signs and symptoms of spinal cord and nerve root compression as well. As the kyphosis worsens, patients can experience problems with horizontal gaze, swallowing, and even breathing. The first line of treatment for cervical kyphosis is rest and lifestyle modifications. Cervical kyphosis can cause muscular strain best treated with rest and avoidance of re-injuring the muscles and tendons. Nonsurgical treatments for cervical kyphosis also includes physical therapy and pain management procedures, and is attempted if there are no findings of sensory loss, motor weakness, bowel or bladder dysfunction, or spinal cord impingement signs. Many factors play a role in the decision-making process for surgical intervention, which include level of pain, degree of physical impairment, and the amount of cervical kyphosis present. The optimal surgical approach is not always clear but can include an anterior, posterior, or combined anterior and posterior approach.
CE: Our Journey to Pass a Surgical Plume Evacuation Law
Authors: Vortman Rebecca K. , Smalley Penny J.
Published: January 2024

Surgical plume is produced when heat-generating instruments are used to cut, cauterize, or vaporize tissue during surgery. Surgical plume can rapidly diffuse, and without the use of plume evacuators to ensure it is captured, filtered, and removed, health care workers and patients are at risk for inhalation exposure to airborne contaminants, including smoke and biological hazards. The use of surgical plume evacuators in health care facilities is inconsistent across the United States. This article describes the experience of two nurses who led a grassroots coalition to pass a surgical plume evacuation law in Illinois. It also outlines strategies they used in the legislative process that nurses can apply to their own efforts to advocate for health policy change at the state level.
Association of metformin and statin uses with the prognosis of colon cancer: a meta-analysis
Authors: Xu Yanyan , Che Hao , Liu Jiang , Ye Pingjiang
Published: January 2024

Background

Metformin and statins are commonly used globally for the treatment of type 2 diabetes mellitus and dyslipidemia, respectively. Recently, multiple novel pathways have been discovered, which may contribute to the treatment of various types of cancer. Several meta-analysis studies have reported that the use of metformin or statins is associated with a lower risk of colon cancer compared to nonusers. In this study, our aim was to perform a meta-analysis and investigate the prognostic roles of these two medications in colon cancer.

Methods

To identify relevant articles, literature searches were performed in the PubMed and Web of Science databases using a combination of keywords related to metformin, statins and colon cancer prognosis until August 2023. The study utilized STATA 12.0 software (Stata Corporation, College Station, Texas, USA) to compute all the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between metformin or statin uses and prognostic-related outcomes.

Results

Our analysis revealed that the use of metformin was associated with a significantly lower overall mortality of colon cancer (HR = 0.63; 95% CI = 0.51–0.77; I
2 = 94.9%; P < 0.001), as well as lower cancer-specific mortality of colon cancer (HR = 0.68; 95% CI = 0.50–0.94; I
2 = 91.9%; P < 0.001). Similarly, the use of statins was also associated with a lower overall mortality of colon cancer (HR = 0.68; 95% CI = 0.60–0.78; I
2 = 93.8%; P < 0.001), as well as a lower cancer-specific mortality of colon cancer (HR = 0.74; 95% CI = 0.67–0.81; I
2 = 82.2%; P < 0.001).

Conclusion

Our meta-analysis study suggests that statins and metformin may have potential as adjuvant agents with significant benefits in the prognosis of colon cancer.
Applying a multistate survival model to explore the role of fine particles in promoting frailty in the Medicare cohort
Authors: Fann Neal , Zanobetti Antonella , Mork Daniel , Steinhardt William , Rappold Ana G.
Published: January 2024

Fine particle pollution is a well-established risk to human health. Observational epidemiology generally treats events as though they are independent of one another and so do not examine the role air pollution may play in promoting the progression of disease. Multistate survival models account for the complex pathway of disease to death. We employ a multistate survival model to characterize the role of chronic exposure to PM2.5 in affecting the rate at which Medicare beneficiaries transition to first hospitalization for cardiovascular disease and then subsequently death. We use an open cohort of Medicare beneficiaries and PM2.5 concentrations estimated with photochemical model predictions, satellite-based observations, land-use data, and meteorological variables. The multistate model included three transitions: (1) entry to cardiovascular hospital admission; (2) entry to death; and (3) cardiovascular hospital admission to death. The transition intensity was modeled using a Cox proportional hazards model. For a 1 µg/m3 increase in annual mean PM2.5, we estimate a nationally pooled hazard ratio of 1.022 (95% confidence interval [CI] = 1.018, 1.025) for the transition from entry to first cardiovascular hospital admission; 1.054 (95% CI = 1.039, 1.068) for the transition from entry to death; 1.036 (95% CI = 1.027, 1.044) for the transition from first cardiovascular hospital admission to death. The hazard ratios exhibited some heterogeneity within each of nine climatological regions and for each of the three transitions. We find evidence for the role of PM in both promoting chronic illness and increasing the subsequent risk of death.
Evaluating the association between longitudinal exposure to a PFAS mixture and adolescent cardiometabolic risk in the HOME Study
Authors: Fleury Elvira S. , Kuiper Jordan R. , Buckley Jessie P. , Papandonatos George D. , Cecil Kim M. , Chen Aimin , Eaton Charles B. , Kalkwarf Heidi J. , Lanphear Bruce P. , Yolton Kimberly , Braun Joseph M.
Published: January 2024

Background:

Exposure to per- and polyfluoroalkyl substances (PFAS) throughout gestation and childhood may impact cardiometabolic risk.

Methods:

In 179 HOME Study participants (Cincinnati, OH; recruited 2003–2006), we used latent profile analysis to identify two distinct patterns of PFAS exposure from serum concentrations of four PFAS measured at birth and ages 3, 8, and 12 years. We assessed the homeostatic model of insulin resistance, triglycerides-to-high-density lipoprotein cholesterol ratio, leptin-to-adiponectin ratio, systolic blood pressure, visceral fat, and hemoglobin A1c levels at age 12 years. We used multivariable linear regression to assess the association of membership in the longitudinal PFAS mixture exposure group with a summary measure of overall cardiometabolic risk and individual components.

Results:

One PFAS exposure profile (n = 66, 39%) had higher geometric means of all PFAS across all visits than the other. Although adjusted associations were null in the full sample, child sex modified the association of longitudinal PFAS mixture exposure group with overall cardiometabolic risk, leptin-to-adiponectin ratio, systolic blood pressure, and visceral fat (interaction term P values: 0.02–0.08). Females in the higher exposure group had higher cardiometabolic risk scores (ß = 0.43; 95% CI = −0.08, 0.94), systolic blood pressures (ß = 0.6; 95% CI = 0.1, 1.1), and visceral fat (ß = 0.44; 95% CI = −0.13, 1.01); males had lower cardiometabolic risk scores (ß = −0.52; 95% CI = −1.06, −0.06), leptin-to-adiponectin ratios (ß = −0.7; 95% CI = −1.29, −0.1), systolic blood pressures (ß = −0.14; 95% CI = −0.7, 0.41), and visceral fat (ß = −0.52; 95% CI = −0.84, −0.19).

Conclusions:

Exposure to this PFAS mixture throughout childhood may have sex-specific effects on adolescent cardiometabolic risk.
Concerted synergy between viral-specific IgG and CD8+ T cells is critical for clearance of an HCV-related rodent hepacivirus
Authors: Gridley John , Holland Brantley , Salinas Eduardo , Trivedi Sheetal , Dravid Piyush , Elrod Elizabeth , Jin Fengzhi , Kumari Anuradha , Batista Mariana N. , Thapa Manoj , Rice Charles M. , Marcotrigiano Joseph , Kapoor Amit , Grakoui Arash
Published: January 2024

Background and Aims:

Evidence assessing the role of B cells and their antibodies, or lack thereof, in the spontaneous resolution of acute HCV infection is conflicting. Utilization of a strictly hepatotropic, HCV-related rodent hepacivirus (RHV) model circumvents many of the challenges facing the field in characterizing the immunological correlates of dichotomous infection outcomes. This study seeks to elucidate the importance of B cells in the clearance of acute RHV infection.

Approach and Results:

µMT mice were infected i.v. with RHV and found to develop chronic infection for over a year. Wild-type (WT) mice depleted of B cells also exhibited persistent viremia that resolved only upon B cell resurgence. The persistent infection developed by B1-8i and AIDcre/cre mice revealed that antigen-specific, class-switched B cells or their antibodies were crucial for viral resolution. Virus-specific CD8+ and CD4+ T cells were characterized in these mice using newly developed major histocompatibility complex class I and II tetramers and ex vivo peptide stimulation. Immunoglobulin G (IgG) was purified from the serum of RHV- or lymphocytic choriomeningitis virus Armstrong-infected mice after viral clearance and passively transferred to AIDcre/cre recipients, revealing viral clearance only in αRHV IgG recipients. Further, the transfer of αRHV IgG into B cell–depleted recipients also induced viral resolution. This ability of RHV-specific IgG to induce viral clearance was found to require the concomitant presence of CD8+ T cells.

Conclusions:

Our findings demonstrate a cooperative interdependence between immunoglobulins and the T cell compartment that is required for RHV resolution. Thus, HCV vaccine regimens should aim to simultaneously elicit robust HCV-specific antibody and T cell responses for optimal protective efficacy.
Reappraisal of the conventional hemostasis tests as predictors of perioperative bleeding in the era of rebalanced hemostasis in cirrhosis
Authors: Tripodi Armando , Primignani Massimo , D’Ambrosio Roberta , Tosetti Giulia , La Mura Vincenzo , Lampertico Pietro , Peyvandi Flora
Published: January 2024

New global laboratory procedures mimicking the in vivo hemostasis process led to the changing paradigm of cirrhosis from the prototype of hemorrhagic diseases to a condition in which hemostasis is normal but fragile, thus justifying the hemorrhagic/thrombotic tendencies that affect these patients. The new paradigm was instrumental to change the management of cirrhosis. For example, international guidelines warn against the entrenched practice of testing patients with conventional hemostasis tests and infusing those with abnormalities with fresh-frozen plasma, coagulation factor concentrates, or platelets, prior to surgery/invasive procedures. These recommendations are, however, largely disattended. The practice of testing patients with the prothrombin time or viscoelastometry and using arbitrary cutoffs to make decisions on perioperative prophylaxis is still common and probably driven by medicolegal issues. There is no doubt that prothrombin time and congeners tests are unable to predict bleeding in cirrhosis. However, it cannot be excluded that some tests may be useful in patients who are severely decompensated. Large prospective collaborative studies are warranted. Enrolled patients should be randomized to receive perioperative prophylaxis based on laboratory testing (eg, viscoelastometry, thrombomodulin-modified thrombin generation) or to usual care. However, for these trials to be useful, a third group of patients who do not receive prophylaxis should be included. In conclusion, until results from these studies are available, physicians attending cirrhosis should refrain from using laboratory tests with arbitrary cutoffs to make decision on perioperative prophylaxis. Decision should be made by considering the clinical history of individual patients and the risk of hemorrhage of specific procedures.
The ability of artificial intelligence chatbots ChatGPT and Google Bard to accurately convey pre-operative information for patients undergoing ophthalmological surgeries
Authors: Patil Nikhil S. , Huang Ryan , Mihalache Andrew , Kisilevsky Eli , Kwok Jason , Popovic Marko M. , Nassrallah Georges , Chan Clara , Mallipatna Ashwin , Kertes Peter J. , Muni Rajeev H.
Published: January 2024

Introduction:

To determine whether the two popular artificial intelligence (AI) chatbots, ChatGPT and Bard, provide high-quality information concerning procedure description, risks, benefits, and alternatives of various ophthalmological surgeries.

Methods:

ChatGPT and Bard were prompted with questions pertaining to the description, potential risks, benefits, alternatives, and implications of not proceeding with various surgeries in different subspecialties of ophthalmology. Six common ophthalmic procedures were included in our analysis. Two comprehensive ophthalmologists and one sub-specialist graded each response independently using a five-point Likert scale.

Results:

Likert grading for accuracy was significantly higher for ChatGPT in comparison to Bard (4.5±0.6 vs 3.8±0.8, p<0.0001). Generally, ChatGPT performed better than Bard even when questions were stratified by type of ophthalmological surgery. There was no significant difference between ChatGPT and Bard for response length (2104.7±271.4 characters vs 2441.0±633.9 characters, p=0.12). ChatGPT responded significantly slower than Bard (46.0±3.0 seconds vs 6.6±1.2 seconds, p<0.0001).

Conclusions:

Both ChatGPT and Bard may offer accessible and high-quality information relevant to the informed consent process for various ophthalmic procedures. Nonetheless, both AI chatbots overlooked probability of adverse events, hence limiting their potential and introducing patients to information that may be difficult to interpret.
Evaluating the Accuracy of ChatGPT and Google BARD in Fielding Oculoplastic Patient Queries: A Comparative Study on Artificial versus Human Intelligence
Authors: Al-Sharif Eman M. , Penteado Rafaella C. , Dib El Jalbout Nahia , Topilow Nicole J. , Shoji Marissa K. , Kikkawa Don O. , Liu Catherine Y. , Korn Bobby S.
Published: January 2024

Purpose:

This study evaluates and compares the accuracy of responses from 2 artificial intelligence platforms to patients’ oculoplastics-related questions.

Methods:

Questions directed toward oculoplastic surgeons were collected, rephrased, and input independently into ChatGPT-3.5 and BARD chatbots, using the prompt: “As an oculoplastic surgeon, how can I respond to my patient’s question?.” Responses were independently evaluated by 4 experienced oculoplastic specialists as comprehensive, correct but inadequate, mixed correct and incorrect/outdated data, and completely incorrect. Additionally, the empathy level, length, and automated readability index of the responses were assessed.

Results:

A total of 112 patient questions underwent evaluation. The rates of comprehensive, correct but inadequate, mixed, and completely incorrect answers for ChatGPT were 71.4%, 12.9%, 10.5%, and 5.1%, respectively, compared with 53.1%, 18.3%, 18.1%, and 10.5%, respectively, for BARD. ChatGPT showed more empathy (48.9%) than BARD (13.2%). All graders found that ChatGPT outperformed BARD in question categories of postoperative healing, medical eye conditions, and medications. Categorizing questions by anatomy, ChatGPT excelled in answering lacrimal questions (83.8%), while BARD performed best in the eyelid group (60.4%). ChatGPT’s answers were longer and potentially more challenging to comprehend than BARD’s.

Conclusion:

This study emphasizes the promising role of artificial intelligence-powered chatbots in oculoplastic patient education and support. With continued development, these chatbots may potentially assist physicians and offer patients accurate information, ultimately contributing to improved patient care while alleviating surgeon burnout. However, it is crucial to highlight that artificial intelligence may be good at answering questions, but physician oversight remains essential to ensure the highest standard of care and address complex medical cases.
Inferior Oblique Flap: An Approach for Improved Vascular Supply in Complex Ocular Surface Reconstruction
Authors: Gundlach Bradley S. , Roelofs Kelsey A. , Rootman Daniel B.
Published: January 2024

This case report describes a novel surgical technique using an inferior oblique muscle flap for a patient requiring complex ocular surface reconstruction. A 63-year-old female with Stevens-Johnson syndrome and complex ocular history including multiple penetrating keratoplasties and keratoprostheses presented with recurrent keratoprosthesis implant plate necrosis. In conjunction with revision keratoplasty, a custom inferior oblique muscle flap was designed to provide improved support and vascularity to the corneal tissue bed; at 12 months postoperation, the graft remained well attached and free of graft failure. Here, we present this technique along with operative photos, describing how this technique may provide surgeons an additional option for complex ocular surface reconstruction.
Outcome Comparison of Transconjunctival Müller’s Muscle Recession With Levator Disinsertion (TMRLD) to Gold Weight Implantation in the Treatment of Paralytic Lagophthalmos
Authors: Park Ji Kwan , Campbell Benjamin , Shipchandler Taha , Lee Hui Bae Harold
Published: January 2024

Purpose:

To compare clinical outcomes of transconjunctival Müller’s muscle recession with levator disinsertion (TMRLD) to the traditional gold weight implantation in patients with paralytic lagophthalmos.

Methods:

A retrospective nonrandomized comparative review of patients who had gold weight implantation and TMRLD surgeries for paralytic lagophthalmos from January 2016 to January 2023 was performed. The main outcome comparisons were measurement changes in lagophthalmos, marginal reflex distance 1, visual acuity, and corneal examination. Complication and reoperation rates were also compared.

Results:

Twenty-six cases of gold weight implantation and 20 cases of TMRLD surgeries were identified. The changes in logMAR visual acuity between gold weight implantation and TMRLD groups were not statistically significant (−0.10 ± 0.48 vs. +0.05 ± 0.14, p > 0.05). The percent improvement in lagophthalmos (62.2% ± 51.8% vs. 58.4% ± 21.1%) and final marginal reflex distance 1 (2.22 ± 1.42 vs. 2.25 ± 1.41 mm) were also comparable between groups (p > 0.05). Both groups showed similar changes in marginal reflex distance 1 (1.75 ± 1.31 vs. 2.83 ± 1.37 mm) and lagophthalmos (3.77 ± 3.92 vs. 3.36 ± 1.36 mm) (p > 0.05). The overall complication (15.4% vs. 15.0%) and reoperation rates (15.4% vs. 15.0%) were comparable over the follow-up duration (291.6 ± 437.3 vs. 121.0 ± 177.8 days) (p > 0.05).

Conclusion:

TMRLD is as safe and effective as the gold weight implantation in addressing paralytic lagophthalmos in patients with facial nerve palsy.
The Delivery Model of Perceived Medical Service Quality Based on Donabedian's Framework
Authors: Chen Chun-Cheng , Hsiao Chih-Tung , Chang Dong-Shang , Lai Wei-Chen
Published: January 2024

The implementation of the National Health Insurance has transformed the medical care landscape in Taiwan, rendering perceived medical service quality (PMSQ) and patient satisfaction significant focal points in medical care management. Past studies mostly focused on the technical aspects of medical care services, while overlooking the patients' perception of services and the delivery process of PMSQ in the medical care experience. This study integrated the theoretical framework of the Donabedian SPO model and the SERVQUAL questionnaire. The survey was conducted among the outpatients of three types of medical institutions in northern Taiwan: academic medical centers, metropolitan hospitals, and local community hospitals. A total of 400 questionnaires were collected, and 315 valid questionnaires remained after eliminating the incomplete ones. This study established a PMSQ delivery model to explore patients' perceptions of medical service quality. It was found that the variable, Assurance, could deliver the PMSQ and enhance the Medical outcome (MO), while improving the variable, Tangible, in medical institutions could not significantly enhance the MO. These findings emphasize the importance of healthcare institutions prioritizing the professional background, demeanor of their healthcare staff, treatment methods, and processes over tangible elements.
A Qualitative Study of Factors Influencing Hospital Participation in the Healthcare Equality Index
Authors: Abdow V. Peter , Marable Julian K. , Moore Eileen S.
Published: January 2024

Gender and sexual minority individuals experience higher rates of mistreatment and discrimination in healthcare compared with their non–lesbian, gay, bisexual, transgender, queer, and other nonheterosexual (LGBTQ+) peers. The Healthcare Equality Index (HEI) aims to create more inclusive environments and to provide metrics for quality improvement. Currently, only one adult hospital in the District of Columbia has earned the highest recognition from the HEI. Our institution is part of the same regional health system as this hospital, yet has never been evaluated by the HEI. This study explores the knowledge, attitudes, and perceptions surrounding the HEI at our institution to assess the feasibility of its participation. During the study period of July 2021 to June 2022, a total of 12 physicians, administrators, and educators from both hospitals and our affiliated school of medicine were interviewed. All participants expressed support after HEI requirements and improving inclusivity for LGBTQ+ patients. Participants at the other hospital cited unanimous support amongst hospital administrators as key for successful HEI implementation. Participants also mentioned cost, staff shortages, and the school of medicine's religious affiliation as potential barriers to this goal. Ultimately, hospital implementation of HEI guidelines is feasible despite shifting institutional priorities and resource limitations through greater stakeholder buy-in and streamlining a systemwide approach.
A radiogenomic multimodal and whole-transcriptome sequencing for preoperative prediction of axillary lymph node metastasis and drug therapeutic response in breast cancer: a retrospective, machine learning and international multicohort study
Authors: Lai Jianguo , Chen Zijun , Liu Jie , Zhu Chao , Huang Haoxuan , Yi Ying , Cai Gengxi , Liao Ning
Published: January 2024

Background:

Axillary lymph nodes (ALN) status serves as a crucial prognostic indicator in breast cancer (BC). The aim of this study was to construct a radiogenomic multimodal model, based on machine learning and whole-transcriptome sequencing (WTS), to accurately evaluate the risk of ALN metastasis (ALNM), drug therapeutic response and avoid unnecessary axillary surgery in BC patients.

Methods:

In this study, conducted a retrospective analysis of 1078 BC patients from The Cancer Genome Atlas (TCGA), The Cancer Imaging Archive (TCIA), and Foshan cohort. These patients were divided into the TCIA cohort (N=103), TCIA validation cohort (N=51), Duke cohort (N=138), Foshan cohort (N=106), and TCGA cohort (N=680). Radiological features were extracted from BC radiological images and differentially expressed gene expression was calibrated using technology. A support vector machine model was employed to screen radiological and genetic features, and a multimodal model was established based on radiogenomic and clinical pathological features to predict ALNM. The accuracy of the model predictions was assessed using the area under the curve (AUC) and the clinical benefit was measured using decision curve analysis. Risk stratification analysis of BC patients was performed by gene set enrichment analysis, differential comparison of immune checkpoint gene expression, and drug sensitivity testing.

Results:

For the prediction of ALNM, rad-score was able to significantly differentiate between ALN- and ALN+ patients in both the Duke and Foshan cohorts (P<0.05). Similarly, the gene-score was able to significantly differentiate between ALN- and ALN+ patients in the TCGA cohort (P<0.05). The radiogenomic multimodal nomogram demonstrated satisfactory performance in the TCIA cohort (AUC 0.82, 95% CI: 0.74–0.91) and the TCIA validation cohort (AUC 0.77, 95% CI: 0.63–0.91). In the risk sub-stratification analysis, there were significant differences in gene pathway enrichment between high and low-risk groups (P<0.05). Additionally, different risk groups may exhibit varying treatment responses (P<0.05).

Conclusion:

Overall, the radiogenomic multimodal model employs multimodal data, including radiological images, genetic, and clinicopathological typing. The radiogenomic multimodal nomogram can precisely predict ALNM and drug therapeutic response in BC patients.
Can Double J stent encrustation be predicted by risk analysis and nomogram?: A retrospective case–control study
Authors: Liu Zicheng , Yan Minbo , Naji Yaser , Qiu Junliang , Wang Haojie , Lin Yuteng , Dai Yingbo
Published: January 2024

To explore the risk factors and develop a nomogram to predict Double J stent encrustation incidence. The general demographic characteristics and underlying risk factors of 248 patients with upper urinary tract calculus who underwent endoscopic lithotripsy and Double J stenting at the Fifth Affiliated Hospital of Sun Yat-Sen University between January 1st, 2018 and January 1st, 2023 were retrospectively analyzed. Among them,173 patients were randomly selected to form the development cohort. A multivariate logistic regression model was employed to identify the independent risk factors associated with Double J stent encrustation, and a nomogram was developed for predicting its occurrence. Additionally, 75 patients were randomly selected to form the validation cohort to validate the nomogram. Multivariate logistic regression analysis revealed that several factors were significantly associated with Double J stent encrustation: indwelling time (odds ratio [OR]1.051; 95% confidence interval [CI] 1.030–1.073, P < .001), urine PH (OR 2.198; 95% CI 1.061–4.539, P = .033), fasting blood glucose (OR 1.590; 95% CI 1.300–1.943, P < .001), and total cholesterol (OR 2.676; 95% CI 1.551–4618, P < .001).Based on these findings, A nomogram was developed to predict the occurrence of Double J stent encrustation. The nomogram demonstrated good performance with an area under the curve of 0.870 and 0.862 in the development and validation cohorts, respectively. Furthermore, the calibration curve indicated a well-fitted model. We constructed and validated an accessible nomogram to assist urologists in evaluating the risk factors associated with Double J stent encrustation and predicting its likelihood.
Risk assessment and prevention of urolithiasis in urban areas of Baoding, China
Authors: Li Meng-Lin , Song Shi-Chao , Yang Fan , Gao Chao , Zhou Bin , Wang Qian
Published: January 2024

Urolithiasis, or the formation of calculi in the urinary system, represents a prevalent urological condition frequently encountered among individuals aged 30 to 55 years. An in-depth analysis of the composition of these calculi holds significant promise in shedding light on the underlying etiological and pathogenic factors contributing to this ailment. The primary objective of this study was to delineate the principal components comprising urinary system calculi within a cohort of patients who sought medical intervention at a tertiary grade A hospital located in Baoding City. Furthermore, our investigation entailed a comprehensive examination of the physical and morphological characteristics exhibited by these calculi. In this study, a total of 2307 individuals afflicted with urinary system calculi were recruited as participants, and a corresponding number of 2307 calculous specimens were subjected to thorough examination. The specimens were examined using infrared spectroscopy. We collected and examined patient data including gender, age, location of the calculi, employment status, residential area, and other factors. The middle-aged demographic exhibited a conspicuous predilection for urinary system calculi, wherein a notable gender disparity was observed, with a male-to-female ratio of 1.63 to 1. Among the enrolled patients, kidney calculi were prevalent in 1270 cases, ureteral calculi were documented in 983 cases, and bladder calculi were encountered in 46 instances. Notably, the principal components comprising these calculi were identified as calcium oxalate and apatite, while uric acid and ammonium magnesium phosphate were comparatively less frequently encountered. Furthermore, the analysis of calculus composition across patients residing in distinct geographical regions did not reveal any statistically significant variations. The identification of components within upper urinary tract calculi plays a pivotal role in elucidating the root causes of calculus formation. This valuable information empowers healthcare professionals, particularly nursing staff, to provide personalized dietary and health guidance to patients, thereby enhancing the quality of care and promoting more effective management of this condition.
Autogenous fibula head transplantation for aneurysmal bone cyst of distal radius: A case report followed up for 7 years
Authors: Wen Zhi , Kuang Gaoyan , Jiang Yong , Wu Yuyuan , Liu Enxu , Qiu Liguo , Xu Xiaotong , Lu Min
Published: January 2024

Rationale:

Aneurysmal bone cyst (ABC) is a rare primary or secondary tumor that usually occurs in young women aged between 10 and 20 years, mostly in the long tubular bone and spine. However, there are no definite standards for its clinical treatment. To our knowledge, this is the first report of a young female patient with distal radius ABC who was successfully treated with tumor resection and autogenous fibular head transplantation.

Patient concerns:

A 28-year-old married Chinese young woman presented to our hospital with swelling and pain in her right wrist for 2 years and aggravation of wrist movement restriction for 1 week.

Diagnoses:

Pathological biopsy confirmed ABC.

Interventions:

We performed a pathological examination of the tumor on the right wrist and preliminarily confirmed the diagnosis of ABC. The right wrist joint was reconstructed by total surgical resection of the ABC tumor in the right wrist joint and autogenous fibular head transplantation.

Outcomes:

During follow-up within 7 years, good right wrist function was confirmed. The tumor did not recur, the swelling of the right wrist disappeared, the joint pain and limitation of movement significantly improved, and the function of the right wrist was not impaired in daily activities. Radiography showed that the fracture had healed.

Lessons:

Our results suggest that autofibular head transplantation is an effective treatment for reconstruction of wrist function in adult patients with ABC of the distal radius.