bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive guided salp swarm algorithm with velocity clamping mechanism for solving optimization problems
Authors: Wang Zongshan , Ding Hongwei , Wang Jie , Hou Peng , Li Aishan , Yang Zhijun , Hu Xiang
Published: September 2022

Salp swarm algorithm (SSA) is a well-established population-based optimizer that exhibits strong exploration ability, but slow convergence and poor exploitation capability. In this paper, an endeavour is made to enhance the performance of the basic SSA. The new upgraded version of SSA named as ‘adaptive strategy-based SSA (ABSSA) algorithm’ is proposed in this paper. First, the exploratory scope and food source navigating commands of SSA are enriched using the inertia weight and boosted global best-guided mechanism. Next, a novel velocity clamping strategy is designed to efficiently stabilize the balance between the exploration and exploitation operations. In addition, an adaptive conversion parameter tactic is designed to modify the position update equation to effectively intensify the local exploitation competency and solution accuracy. The effectiveness of the proposed ABSSA algorithm is verified by a series of problems, including 23 classical benchmark functions, 29 complex optimization problems from CEC 2017, and five engineering design tasks. The experimental results show that the developed ABSSA approach performs significantly better than the standard SSA and other competitors. Moreover, ABSSA is implemented to handle path planning and obstacle avoidance (PPOA) tasks in autonomous mobile robots and compared with some swarm intelligent approach-based path planners. The experimental results indicate that the ABSSA-based PPOA method is a reliable path planning algorithm.
Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes
Authors: Ramanathan Swetha , Albarillo Fritzie S , Fitzpatrick Margaret A , Suda Katie J , Poggensee Linda , Vivo Amanda , Evans Martin E , Jones Makoto , Safdar Nasia , Pfeiffer Chris , Smith Bridget , Wilson Geneva , Evans Charlesnika T
Published: September 2022

Background

Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described for Pseudomonas aeruginosa (PA) bloodstream infection (BSI). Therefore, the goal of this study was to examine ID consultation of inpatients with PA BSI and factors impacting outcomes.

Methods

This was a retrospective cohort study from January 1, 2012, to December 31, 2018, of adult hospitalized veterans with PA BSI and antibiotic treatment 2 days before through 5 days after the culture date. Multidrug-resistant (MDR) cultures were defined as cultures with resistance to at least 1 agent in ≥3 antimicrobial categories tested. Multivariable logistic regression models were fit to assess the impact of ID consults and adequate treatment on mortality.

Results

A total of 3256 patients had PA BSI, of whom 367 (11.3%) were multidrug resistant (MDR). Most were male (97.5%), over 65 years old (71.2%), and White (70.9%). Nearly one-fourth (n = 784, 23.3%) died during hospitalization, and 870 (25.8%) died within 30 days of their culture. Adjusted models showed that ID consultation was associated with decreased in-hospital (odds ratio [OR], 0.47; 95% CI, 0.39–0.56) and 30-day mortality (OR, 0.51; 95% CI, 0.42–0.62).

Conclusions

Consultation with ID physicians improves clinical outcomes such as in-hospital and 30-day mortality for patients with PA BSI. ID consultation provides value and should be considered for patients with PA BSI.
Perceptions and Experiences With Evidence-based Treatments Among People Who Use Opioids
Authors: Carlberg-Racich Suzanne , Sherrod Darielle , Swope Kristin , Brown Dannielle , Afshar Majid , Salisbury-Afshar Elizabeth
Published: September 2022

Objectives

Even where treatment is available, people who use drugs (PWUD) may not seek help. Few published studies examine beliefs, experiences, and perceptions of evidence-based treatment among PWUD who are not actively engaged in care. This study aimed to explore the experiences of PWUD in considering or accessing treatment and gauge receptiveness to low-threshold treatment models.

Methods

A purposeful sample of participants actively using opioids and with previous interest in or experience with treatment was recruited from a harm reduction program in Chicago. Semistructured interviews were conducted to explore key phenomena while allowing for unanticipated themes. The instrument included questions about historical drug use, treatment experience, and perceptions of how to improve treatment access and services. Private interviews were audio recorded, transcribed, and double coded by 2 analysts. Queries of coded data were analyzed using issue-focused analysis to identify themes.

Results

The sample (N = 40) approximated groups at highest risk of fatal overdose in Chicago, with more than 80% between the ages of 45 to 64 years, 65% African American, and 62% male identified. The majority had prior treatment experience, although all resumed use after completing or leaving treatment. The most prevalent barriers to treatment included structural barriers related to social determinants, lack of readiness for abstinence, burdensome intake procedures, and regulatory/programmatic requirements. Most participants expressed interest in low-threshold treatment.

Conclusions

Existing treatment barriers may be addressed by shifting to lower-threshold intake processes and/or outreach-based delivery of opioid agonist treatment. Engaging PWUD in efforts to create lower-threshold treatment programs is necessary to ensure that needs are met.
Extent of Disease on Visceral Peritoneal Surfaces of Mucinous Appendiceal Neoplasms Controls Survival
Authors: Sugarbaker Paul H. , Chang David
Published: September 2022

Objective:

To determine causes of treatment failure of low-grade appendiceal mucinous neoplasms (LAMN).

Background:

For 3 decades, LAMN have been treated by cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy. This combined treatment has resulted in a large change in the survival of these patients.

Methods:

A retrospective review of a prospectively maintained database was performed. A restricted cohort of patients with only LAMN histology and complete CRS were included in the statistical analysis.

Results:

Four hundred and fifty patients were available with a median follow-up of 15.3 years (range 10–35 years). The median age was 49.7 and there were 196 males (43.6%). The mean survival was 24.5 years. Extent of parietal peritonectomy, resection of uterus, ovaries and apex of vagina had no impact on survival. Variables that indicated an increased extent of disease on visceral peritoneal surfaces had a significant impact on survival. Early postoperative intraperitoneal chemotherapy with 5-fluorouracil did not augment hyperthermic intraperitoneal chemotherapy (HIPEC). Patients who required reoperation for recurrence or patients with class 4 adverse events had a reduced prognosis.

Conclusions:

The mean survival of LAMN treated by complete CRS and perioperative chemotherapy was 24.5 years. Extent of disease quantitated on visceral peritoneal surfaces by the extent of visceral resections was the variable associated with treatment failure. Peritonectomy plus HIPEC was able to control disease on parietal peritoneal surfaces. Not only a larger extent of disease but also its location on visceral peritoneal surfaces controlled survival.
Effect of Local Antibiotic Prophylaxis on Postoperative Deep Infection in Fracture Surgery: A Systematic Review and Meta-Analysis
Authors: Kruse Colin , Axelrod Daniel , Al-Mohrej Omar A. , Daniel Ryan , Johal Herman
Published: September 2022

Objectives:

Despite the use of systemic antibiotic prophylaxis, postoperative infection after fracture surgery remains an issue. The purpose of this systematic review and meta-analysis was to evaluate the effect of locally applied antibiotics on deep infection in fracture surgery in both the open and closed fractures.

Data Sources:

A comprehensive search of MEDLINE, Embase, and PubMed was performed from the date of inception to April 15, 2021, and included studies in all languages.

Study Selection:

Cohort studies were eligible if they investigated the effect on the infection rate of local antibiotic prophylaxis on deep infection after fracture surgery.

Data Extraction:

This study was conducted according to the Cochrane Handbook for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials and the Methodological Index for Nonrandomized Studies tool where applicable.

Data Synthesis:

An inverse variance random-effects model was the primary analysis model because of the anticipated diversity in the evaluated populations. Univariate models were used when a single outcome was of interest.

Conclusions:

The risk of deep infection was significantly reduced when local antibiotics were applied compared with the control group receiving systemic prophylaxis only. This beneficial effect was observed in open fractures but failed to reach statistical significance in closed fractures. This meta-analysis suggests that there may be a significant risk reduction in deep infection rate after fracture surgery when local antibiotics are added to standard systemic prophylaxis, particularly in open fractures. Further high-powered Level I studies are needed to support these findings.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effect of a Protocol to Reduce Radiographic Imaging in Pediatric Patients With Suspected Fractures
Authors: Schlacter Jamie A. , Roussos Demetrios , Masrouha Karim , Karamitopoulos Mara , Carter Cordelia , Price Andrew , Castañeda Pablo , Litrenta Jody
Published: September 2022

Background:

Children with suspected fractures are typically evaluated with multiple x-rays. This approach can add time, discomfort, and radiation exposure without clinical benefit. The purpose of this study was to determine whether a focused radiographic protocol could reduce the number of x-rays performed without missing any fractures.

Methods:

Pediatric patients presenting at 2 sites within an academic medical center [urgent care (UC) and the emergency department(ED)] for a suspected fracture were identified. There were 495 patients (UC, 409; ED, 86) over a 3-month period. A retrospective chart review was performed to characterize the standard x-rays performed. Using this data, a simplified protocol was developed and distributed. Subsequently, 333 patients (UC, 259; ED, 74) were evaluated over the same period 1-year later. The main outcome measures included the final diagnosis, the total number of x–rays, the number of anatomic areas imaged, visit length, and the time for additional trips to radiology. Charts were reviewed to identify any missed injuries. Welch 2-sample t tests and Fisher exact tests were used for statistical analysis.

Results:

After implementing the radiographic protocol, there was a significant reduction in the number of x-ray views, 3.4 versus 5.1 (P<0.001). There was a decrease in imaging of multiple anatomic areas with the largest reduction occurring in patients presenting with elbow injuries (9% vs. 44%, P<0.001). No difference was found in the rate of patients sent back to radiology (6% vs. 7%, P=0.67). However, among patients presenting with outside imaging, significantly fewer were sent to radiology for additional x-rays (29% vs. 50%, P<0.01).

Conclusion:

A simple radiographic protocol for evaluating pediatric patients with suspected fractures safely led to a decrease in the overall number of x-rays without missing any injuries.

Level of Evidence:

Level III, retrospective comparative study.
Comparing Clinical and Radiographic Outcomes Between the Self-locking Stand-Alone Cage and Conventional Cage-Plate Construct: a 5-year Retrospective Cohort Study
Authors: Li Pan , Lei Runbo , Gan Lu , Shangguan Lei , Liang Zhuowen , Chang Le , Cao Xiongfei , Ye Zhengxu , Li Mo , Luo Zhuojing
Published: September 2022

Study Design/Setting.

A retrospective cohort study.

Objective.

To evaluate the clinical efficacy of the self-locking stand-alone cage (SA) and conventional cage-plate construct (CPC) in treating degenerative cervical spondylosis with a 5-year follow-up.

Summary of Background Data.

The stand-alone approach was designed to reduce complications associated with traditional anterior cervical discectomy and fusion (ACDF). These techniques have been shown to have satisfactory short-term clinical outcomes. Literature describing the mid-term clinical outcomes of stand-alone cage is limited.

Methods.

We retrospectively analyzed patients with cervical spondylosis who had received an SA device or CPC between 2014 and 2016 at the Xijing Hospital. Participants were matched for sex, age, and operative level. Differences in clinical and radiographic outcomes and the occurrence of postoperative complications between the two groups were analyzed.

Results.

In total, 207 patients were included (101 with SA and 106 with CPC), the median follow-up for both groups were 60.2 months and 60.9 months. Both groups exhibited significant improvements in all measured values compared to the preoperative values. The SA group had a shorter operation time, less intraoperative blood loss, and a significantly lower incidence of dysphagia after surgery than the CPC group (P<0.05). At the last visit, cage subsidence was 6.9% and 3.8% in the SA and CPC groups, respectively (P=0.365). The radiographic ASD was significantly lower in the SA group than in the CPC group (6.9% vs. 27.4%, P<0.01). No symptomatic ASD was observed in the SA group, and 6 (5.7%) cases occurred in the CPC group (P=0.029).

Conclusion.

In this study of the Asian population, the stand-alone cage showed similar efficacy to that of the conventional cage-plate construct in treating cervical spondylosis with ACDF, with a significant reduction in the incidence of immediate postoperative dysphagia and mid-term ASD.
Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: 5-year Long-term Results of a Randomized Controlled Trial
Authors: Chen Zihao , Zhang Liangming , Dong Jianwen , Xie Peigen , Liu Bin , Chen Ruiqiang , Li Shangfu , Liu Zhongyu , Yang Bu , Feng Feng , He Lei , Yang Yang , Pang Mao , Rong Limin
Published: September 2022

Study Design.

Prospective randomized controlled study.

Objective.

To compare the efficacy and safety between percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED).

Summary of Background Data.

Two kinds of minimally invasive discectomy, PTED and MED, are now widely used for treating lumbar disc herniation (LDH). The long-term comparative results of these two techniques still remained uncertain.

Methods.

In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH, and were randomly allocated to PTED or MED group. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP) and physical function (SF36-PF), European Quality of Life-5 Dimensions (EQ-5D), Visual Analogue Scales for back pain (VAS-back) and leg pain (VAS-leg).

Results.

A total of 241 patients were accepted to enrolled in our RCT, of which 119 were randomly assigned to the PTED group, and the rest 122 were assigned to the MED group. 194 out of 241 patients (80.5%) completed the 5-year follow-up. PTED group was associated with shorter postoperative in-bed time and length of hospital stay. Both primary and secondary outcomes did not differ significantly between the two treatment groups at each follow-up time point. During the 5-year follow-up, 7 recurrent cases occurred in PTED group and MED group respectively.

Conclusion.

Over the 5-year follow-up period, PTED and MED were both efficacious in the treatment of LDH. The long-term clinical outcomes and recurrent rates were comparable between the treatment groups. PTED represents a more minimally invasive technique with the advantages of rapid recovery.
Circulating tumour DNA dynamics for assessment of molecular residual disease and for intercepting resistance in breast cancer
Authors: Valenza Carmine , Trapani Dario , Curigliano Giuseppe
Published: September 2022

Purpose of review

Longitudinal evaluation of circulating tumour DNA (ctDNA) represents a promising tool for monitoring tumour evolution. In patients with breast cancer, ctDNA dynamics for the assessment of molecular residual disease (MRD) and resistances may, respectively, help clinicians in treatment modulation of adjuvant treatments, and in anticipating resistance to ongoing treatments and switch treatments before clinical progression, to improve disease control. Anyway, the introduction of this dynamic biomarker into clinical practice requires the demonstration of analytical validity, clinical validity and clinical utility.

Recent findings

In early breast cancer setting, several observational studies demonstrated the clinical validity of MRD monitoring through ctDNA in identifying patients at a higher risk of relapse, but many clinical trials evaluating the clinical utility are still ongoing, and few data resulted in inconclusive results.

Instead, ctDNA dynamics for intercepting resistance have not been fully evaluated in terms of clinical validity, because monitoring schedules of most observational studies are not intensive. The only trial assessing their clinical utility (PADA-1) demonstrated a benefit in terms of progression-free survival, portraying a new landscape for clinical trials in this space.

Rigorous clinical trials with adequate assays and patient-relevant endpoints are paramount to demonstrate the clinical utility of ctDNA dynamics and eventually increase clinical outcomes.
Breast surgery after neoadjuvant therapy
Authors: Gnant Michael
Published: September 2022

Purpose of review

The standard of care in breast surgery has changed, from mastectomy to breast conserving surgery whenever possible, and from axillary dissection to sentinel node biopsy. Neoadjuvant systemic approaches have broadened the indications for organ-conserving and less mutilating surgery, but also raise important questions of balancing locoregional treatment de-escalation and protecting excellent long-term outcomes.

Recent findings

Recent studies have aimed at investigating the safety of de-escalating surgical approaches not only in the upfront breast surgery situation but also after neoadjuvant systemic therapy. This pertains to both the safety of breast conserving surgery – including more complex oncoplastic approaches – within the new (posttherapeutic) anatomical extent of the residual disease, but more controversially to de-escalating surgical treatment of the axilla. While sentinel node biopsy appears to be the standard of care for node-negative disease also after primary systemic therapy, the optimal procedure in situations of posttherapeutic node-positive disease remains highly controversial.

Both breast and axillary surgery after neoadjuvant systemic therapy for women with breast cancer has undergone multiple paradigm changes in recent years. For the primary tumor in the breast, breast-conserving surgery constitutes the standard of care, and unnecessary mastectomies should be strongly discouraged. For axillary surgery, sentinel-node biopsy should be aimed at, and completion axillary dissections minimized for situations of extensive disease and or poor neoadjuvant treatment response. Additional techniques such as targeted axillary dissection are currently under evaluation in clinical trials.
Long-term Locoregional Control With Unilateral Radiation for AJCC-7 T1-2N2b Tonsillar Cancer
Authors: Frankart Andrew J. , Abana Chike O. , Geier Natalie , Bahig Houda , Manzar Gohar Shahwar , Garden Adam S. , Phan Jack , Takiar Vinita
Published: September 2022

Objectives:

Unilateral radiation to cervical nodes has been used as a de-escalation strategy in well-lateralized tonsil cancers. The efficacy of this approach with multiple ipsilateral nodes is not established. The study hypothesis was that unilateral radiation for American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar cancer results in a low rate of contralateral nodal failure.

Materials and Methods:

This study was a retrospective chart review of patients with AJCC-7 T1-2N2b tonsillar cancer from 2 academic institutions who were treated with unilateral radiation. The primary endpoint was the contralateral nodal failure rate. Locoregional control, overall survival, and the need for gastrostomy tube placement were additional endpoints.

Results:

The study cohort included 66 patients treated between 2005 and 2016. The median follow-up time was 80.9 months; contralateral nodal failure occurred in 2/66 (3.0%) patients at 4.1 and 20.9 months, respectively. Both patients underwent salvage treatment with long-term subsequent survival. Overall locoregional control at both 2 and 5 years was 93.9% and the median duration of control was not reached. Overall survival at 5 years was 92.4%.

Conclusions:

The use of unilateral radiation for AJCC-7 T1-2N2b tonsillar cancer resulted in low rates of contralateral nodal failure. This outcome demonstrates the safety of considering unilateral radiation treatment in patients with a relatively high ipsilateral nodal burden.
Clinical value of bacterial culture in sinus tract in the diagnosis of fracture-related infection
Authors: Ma Xianzhi , Huang Kunkun , Ma Sichao , Lv Ruiqiang , Qi Wanle , Wang Kai , Chao Shilan
Published: September 2022

Objectives:

This study compared the results of bacterial culture from operation versus sinus tract samples in patients with fracture-related infection (FRI), and examined the ability of bacterial culture in sinus tract to identify pathogenic bacteria.

Methods:

A retrospective analysis of 53 patients with FRI from June 2016 to June 2021 was done. Common infection sites were femur, tibiofibular, hip joint, and ankle. Samples collected in sinus tract and during the operation were sent for bacterial culture. Results were summarized and compared, respectively, with pathogenic bacteria.

Results:

In sinus tract bacterial culture, bacteria were found in 75.6% of culture samples. The top 3 bacteria presented were: Staphylococcus aureus (32.26%), Staphylococcus epidermis (12.90%), and Pseudomonas aeruginosa (8.06%). Bacterial culture from the sinus tract matched the result of intraoperative samples 67.30% of the time, while 51.50% matched the pathogenic bacteria.

Conclusion:

Bacterial culture of sinus tract samples is not recommended as the basis for identifying pathogenic bacteria. Stopping antibiotic 2 weeks before operation, taking multiple samples at different sites, and sending multiple samples for bacterial culture are good ways to improve pathogen detection rate.
CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP FOR SMALL-TO-MEDIUM IDIOPATHIC MACULAR HOLE
Authors: Ventre Luca , Fallico Matteo , Longo Antonio , Parisi Guglielmo , Russo Andrea , Bonfiglio Vincenza , Marolo Paola , Caselgrandi Paolo , Avitabile Teresio , Borrelli Enrico , Reibaldi Michele
Published: September 2022

Purpose:

To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small-to-medium idiopathic macular hole.

Methods:

Eyes with ≤400 μm idiopathic macular holes were randomized into the conventional ILM peeling group (25 eyes) and inverted flap group (25 eyes). A 12-month follow-up was considered. Macular sensitivity (MS) change detected with MP-1 microperimetry was the primary outcome. Secondary outcomes included best-corrected visual acuity change, closure rate, anatomical findings on optical coherence tomography such as U-shape foveal contour, restoration of external limiting membrane, and ellipsoid zone.

Results:

In both groups, MS improved throughout the follow-up. Final MS was greater in the conventional ILM peeling group compared with the inverted flap group, being 16.6 ± 2.3 dB versus 14.9 ± 2.9 dB, respectively (P = 0.026). In both groups best-corrected visual acuity improved throughout the follow-up, with a final best-corrected visual acuity of 0.19 ± 0.14 logMar (20/31 Snellen) in the conventional ILM group and 0.22 ± 0.11 logMar (20/33 Snellen) in the inverted flap group (P = 0.398). Anatomical hole closure was achieved in all cases. No difference in optical coherence tomography findings was shown between the two groups.

Conclusion:

A better final MS was found in eyes undergoing conventional ILM peeling. Inverted flap technique has disadvantages compared with conventional peeling for the treatment of small-to-medium idiopathic macular holes.
Outcomes of a Data-Driven Physician Practice Redesign
Authors: McVeigh Kimberly , Martinez Dayana , Fazio Jacey , Rizzo Thomas D. , Munoz Juan Irias
Published: September 2022

This study evaluated a practice redesign to improve access into a specialty practice. The secondary goal was to improve financial performance, while avoiding an increase in physician burnout. Historical demand was utilized to calculate capacity. Next, data-driven schedules were developed for this practice. We also transitioned schedules from five 8-hour to four 10-hour workdays. Access was improved for news (100% increase), consultations (16% increase), and procedures (70% increase). Gross revenue increased by 10.62% and physician burnout reduced by 25%. This project offers insights into improving the efficiency of a resource-constrained practice, while improving financial performance and reducing burnout.
Liberation from Mechanical Ventilation Before Decannulation from Venovenous Extracorporeal Life Support in Severe COVID-19 Acute Respiratory Distress Syndrome
Authors: Al-Mumin Ahmed , Tarakemeh Halla , Buabbas Sarah , Murad Anwar , Al-Mutawa Abdulaziz , Abdulmalek Kefaya , Al-Fares Abdulrahman
Published: September 2022

The coronavirus disease 2019 (COVID-19) pandemic has been associated with the significant use of venovenous extracorporeal membrane oxygenation (VVECMO) globally. Identifying strategies to optimize care is essential to improving patient important outcomes. By liberation from mechanical ventilation (MV) before VVECMO to provide awake-ECMO, complications related to MV could be minimized, leading to improved outcomes. Between March 2020 and October 2021, we conducted a prospective observational study at the Kuwait Extracorporeal Life Support Program, of patients admitted for COVID-19 acute respiratory distress syndrome (ARDS), with recording baseline characteristics, respiratory support, and ECMO parameters. Of the 207 patients who underwent VVECMO for COVID-19 ARDS during this period, only 5 patients were successfully liberated from MV before decannulation to provide awake-ECMO. Four were female with a median age of 38. Before VVECMO, all patients received corticosteroids and lung-protective ventilation with four receiving prone positioning. The median duration of MV use was 4 days, whereas the median duration of VVECMO use was 12 days, with early mobility, and all survived until hospital discharge. The safety and feasibility of liberation from MV before ECMO decannulation to provide awake-ECMO were demonstrated, but further studies are warranted to identify factors associated with this success.
The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects
Authors: Coşarcan Sami Kaan , Erçelen Ömür
Published: September 2022

Introduction:

Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries.

Patient concerns, diagnosis and interventions:

Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes).

Outcomes:

All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia.

Conclusion:

We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.
Association of venous thromboembolism between hydrophilic and lipophilic statin users among diabetic subjects
Authors: Hu Wei-Syun , Lin Cheng-Li
Published: September 2022

This retrospective analysis aimed to compare the risk of venous thromboembolism (VTE) between patients with diabetes mellitus who received hydrophilic statin treatment to those who receive lipophilic statin. There were 6639 patients receiving hydrophilic statin therapy and 10,854 patients receiving lipophilic statin therapy in the study. The hazard ratios and 95% confidence intervals for VTE were estimated using univariate and multivariate Cox proportional hazards models when the study cohorts were compared. Among all patients, the incidence rate of VTE was 4.27 per 1000 person-years in the control cohort, 4.18 per 1000 person-years in the hydrophilic statin use cohort, and 3.91 per 1000 person-years in the lipophilic statin use cohort. After adjusting for age, sex, and comorbidities, the risk of VTE in the hydrophilic statin use cohort was 0.90 (0.72, 1.12) lower than that in the control cohort, the risk of VTE in the lipophilic statin use cohort was 0.87 (0.72, 1.05) lower than that in the control cohort, and the risk of VTE in the lipophilic statin use cohort was 0.97 (0.78, 1.21) lower than that in the hydrophilic statin use cohort. However, all were not statistically significant. Our result showed that there was no significant difference among the study cohorts regarding the outcome of VTE.
Better care for women with polycystic ovary syndrome – a proposal for an international evidence based best practice framework to improve care
Authors: Tay Chau Thien , Joham Anju E. , Moran Lisa J. , Teede Helena
Published: September 2022

Purpose of review

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive-age women and has reproductive, pregnancy, metabolic, dermatologic, and psychologic complications. Here we summarize current challenges and gaps in PCOS care, and propose a pathway forward to implement high quality international guideline recommendations and resources, through development of a best practice framework and benchmarking for evidence-based, patient-centric models of care (MoC).

Recent findings

The majority of women with PCOS are unsatisfied with their healthcare experience due to delayed diagnosis, inadequate information provision and inconsistent advice from diverse healthcare providers. The 2018 International Evidence-based PCOS Guideline recommended co-development of evidence-based, patient centric MoC. High-quality guidelines and resources are now available to help women understand and manage PCOS and to assist healthcare professionals to partner in their care. Leveraging these and developing a best practice framework for patient centric PCOS MoC is now a vital to optimise care and outcomes in this common and neglected condition.

Collaborative interdisciplinary efforts from academic leads, healthcare professionals and consumers are now needed to co-develop a framework and benchmarking performance indicators to guide evidence-based, patient centric PCOS MOC to improve experience and outcomes.
What factors influence the R value in data-driven respiratory gating technique? A phantom study
Authors: Hayashi Naoya , Ogasawara Daisuke , Tokorodani Ryotaro , Kirizume Rikito , Kenda Shuji , Yabe Fumika , Itoh Kenji
Published: September 2022

Objective

The R value is adopted as a metric for the effectiveness of the respiratory waveform in the Advanced Motion Free implemented in the PET scanner as the data-driven respiratory gating (DDG) algorithm. The effects of changes in various factors on R values were evaluated by phantom analysis.

Methods

We used a programmable respiratory motion phantom QUASAR with a sphere filled with an 18F solution. Respiratory motion simulation was performed by changing the sphere diameter, radioactivity concentration, amplitude, respiratory cycle, and respiratory waveform shape. Three evaluations were performed. (1) The power spectra calculated from the input waveforms were evaluated. (2) The effects of changes in the factors on the R value were evaluated. (3) DDG waveforms and inspiratory peak intervals were compared with the input waveform data set.

Results

The R values were increased and converged to a certain value as sphere diameter, radioactivity concentration, and amplitude gradually increased. The respiratory cycle showed the highest R value at 7.5 s, and the graph showed an upward convex pattern. The R value of the sinusoid waveform was higher than that of the typical waveform. There was a relationship between the power spectrum of the input waveform and R value. The visual score was also lower in the condition with a lower R value. In cases of no sphere, radioactivity, or motion, and a fast respiratory cycle, peak intervals were not accurately acquired.

Conclusions

Factors affecting the R value were sphere diameter, radioactivity concentration, amplitude, respiratory cycle, and respiratory waveform shape.
Correlation between MAMMI-PET findings and anatomopathological outcomes in breast cancer patients
Authors: de Andrés Gómez Alejandra , Villalba Ferrer Francisco , Ferrer Rebolleda Jose , Sánchez Jurado Raúl , García García Jose Ángel , García-Vilanova Comas Andrés , Fuster Diana Carlos A.
Published: September 2022

Objective

Imaging tests are a key element in the preoperative diagnosis of patients with breast cancer. Whole-body PET-computed tomography (PET/CT) breast studies have a limited spatial resolution, although dedicated breast PET (dbPET) devices such as the Mammography with Molecular Imaging PET (MAMMI-PET), have an increased sensitivity to detect tumor foci, especially those smaller than 2 cm. The purpose of this study is to define the validity and reliability of this new device.

Methods

A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. The anatomopathological study findings for the surgical pieces were used as gold standards and we calculated their concordance with the findings from the MAMMI-PET as well as the validity and reliability parameters for this test.

Results

Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. The mean patient age was 51.50 ± 11.68 years. Twenty patients had received neoadjuvant chemotherapy (NACT). The technique concordance rate was weak (K = 0.349, P = 0.001) and was 84.3% for benign lesions and 62.6% for malignant ones. The MAMMI-PET sensitivity was 75%, whereas its specificity was 57.1%; the positive predictive value was 81.8% and the negative predictive value was 47.1%, with an overall precision of 70%. The MAMMI-PET sensitivity was higher in patients who had not undergone NACT and was significantly higher in patients with luminal B breast cancer compared to the luminal A subtype.

Conclusion

The MAMMI-PET device had acceptable sensitivity and a high positive predictive value for the preoperative evaluation of patients with breast cancer; it was especially useful for lesions whose diagnosis with other imaging tests had been doubtful.
What should be the goal of cholesterol-lowering treatment? A quantitative evaluation dispelling guideline myths
Authors: Durrington Paul N. , Bashir Bilal , Soran Handrean
Published: September 2022

Purpose of review

Guidelines for cholesterol-lowering treatment generally include extensive review of epidemiological and clinical trial evidence. However, the next logical step, the translation of evidence into clinical advice, occurs not entirely by reasoning, but by a form of consensus in which the prejudices and established beliefs of the societies with interests in cardiovascular disease convened to interpret the evidence are prominent. Methods, which are the subject of this review, have, however, been developed by which clinical trial evidence can be translated objectively into best practice.

Recent findings

Guidelines differ in their recommended goals for cholesterol-lowering treatment in the prevention of atherosclerotic cardiovascular disease (ASCVD). Proposed goals are LDL-cholesterol 2.6 mmol/l (100 mg/dl) or less in lower risk, LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less in higher risk, non-HDL-cholesterol decrease of at least 40% or LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less or decreased by at least 50% whichever is lower. Evidence from clinical trials of statins, ezetimibe and proprotein convertase subtilisin/kexin type 9-inhibitors can be expressed in simple mathematical terms to compare the efficacy on ASCVD incidence of clinical guidance for the use of cholesterol-lowering medication. The target LDL-cholesterol of 2.6 mmol/l (100 mg/dl) is ineffective and lacks credibility. Cholesterol-lowering medication is most effective in high-risk people with raised LDL-cholesterol. The best overall therapeutic target is LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less or decreased by at least 50% whichever is lower. The use of non-HDL-cholesterol as a therapeutic goal is less efficacious. Aiming for LDL-cholesterol 1.4 mmol/l (55 mg/dl) or less as opposed to 1.8 mmol/l produces only a small additional benefit. Evidence for apolipoprotein B targets in hypertriglyceridaemia and in very high ASCVD risk should be more prominent in future guidelines.

The LDL-cholesterol goal of 2.6 mmol/l or less should be abandoned. Percentage decreases in LDL-cholesterol or non-HDL-cholesterol concentration are better in people with initial concentrations of less than 3.6 mmol/l. The LDL-cholesterol target of 1.8 mmol/l is most effective when initial LDL-cholesterol is more than 3.6 mmol/l in both primary and secondary prevention.
The role of surgery for locally advanced urothelial cancers
Authors: Ibilibor Christine , Kennady Emmett H. , Greene Kirsten L.
Published: September 2022

Purpose of review

Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy.

Recent findings

Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy.

Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations.
Testosterone therapy in prostate cancer: is it still a controversy?
Authors: Bart Alex S. , Van Hoof Alexander , Badre-Hume Ryan , Selvarajah Joshua , Robillard Kristian , Albala David M.
Published: September 2022

Purpose of review

The benefits of testosterone therapy (TTh) in the hypogonadal male can be dramatic. Historically, TTh has been contraindicated in prostate cancer (PCa). Current evidence has redefined our understanding of the influence serum testosterone has on prostatic androgen activity. Increasing numbers of hypogonadal men with coexisting PCa emphasizes the importance of describing those who may safely receive TTh. This review aims to present literature that evaluates the efficacy and safety of TTh in men with coexisting PCa.

Recent findings

Our study, a comprehensive review of published literature regarding TTh in men with a history of PCa, consisted of studies conducted from the 1940s to 2022. Our review discusses evidence in accordance with previous studies that TTh has a role in patients with localized PCa as it has not been reported to increase rates of recurrence or progression of PCa.

The use of TTh in hypongonadal men with a localized PCa has been shown to have positive clinical outcomes without increasing the rate of disease progression or recurrence. Further research, in a randomized controlled setting, is warranted.
The rs12532734 Polymorphism Near the Solute Carrier 26A3 Gene Locus Is Associated With Gallstone Disease in Children
Authors: Krawczyk Marcin , Niewiadomska Olga , Jankowska Irena , Jankowski Krzysztof , Świderska Jolanta , Lebensztejn Dariusz , Więcek Sabina , Gozdowska Jolanta , Kułaga Zbigniew , Weber Susanne N. , Lammert Frank , Socha Piotr
Published: September 2022

Gallstones are increasingly frequent in children. In this candidate gene study, we genotyped 5 gene variants (ANO1, SPTLC3, TMEM147, TNRC6B, rs12532734) from a recent gallstone genome-wide association study (GWAS) in a cohort of 214 children with gallstones and 172 gallstone-free adult controls. In total, 138 genotyped children presented with symptomatic gallstone disease, 47 underwent cholecystectomy, and 126 received ursodeoxycholic acid (UDCA) as therapy for stones. Among 5 tested variants, the rs12532734 polymorphism modulated the gallstone risk in the studied cohort. Its genotype distribution significantly (P = 0.025) departed from the Hardy-Weinberg equilibrium among cases, and the common allele was associated with increased odds of developing gallstones at young age (OR = 1.69, P = 0.014). SLC26A3 is the nearest gene to rs12532734 and is involved in the transepithelial bicarbonate and chloride transport. The association of rs12532734 with pediatric gallstones is a novel finding warranting further investigations also with regard to biliary bicarbonate flux and bile composition.
Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team
Authors: Rodrigues Caroline Donini , Lorenzini Elisiane , Onwuegbuzie Anthony J. , Oelke Nelly D. , Garcia Cledir França , Malkiewiez Michelle Mariah , Kolankiewicz Adriane Cristina Bernat
Published: September 2022

Background

Integration into the health system is essential for safe care and efficient use of resources.

Objectives

The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site.

Methods

The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out.

Results

The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care.

Conclusion

The low score for the care plan factor indicates weakness in the care transition.

Implications for Practice

The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.
Social Determinants of Comfort
Authors: Mooney-Doyle Kim , Mendola Annette , Naumann Wendy C. , Svynarenko Radion , Lindley Lisa C.
Published: September 2022

The social determinants of comfort describe structural conditions that influence whether, to what degree, and in what forms comfort measures are offered to and accepted by people living with serious illness and their families. The notion of social determinants of comfort builds on the well-accepted concept of social determinants of health. Although some guiding palliative care documents begin to address this intersection, deeper understanding and exploration are needed. The goals of this article are to (1) describe and articulate the impact of structural and ecological factors on the comfort children and families can attain near the end of life; (2) describe how to address these factors to support children and families in attaining comfort, and maybe even flourish, at end of life; and (3) provide an agenda for research that addresses how palliative care research can advance health equity and how a focus on equity can advance palliative care science. A variety of inequities reinforce social vulnerability and disadvantage throughout the life span and can have profound effects on children, particularly children with serious illness or at the end of life. Ethical care for these children requires recognition of the social determinants of comfort.