bluuebunny/crossref_metadata_2025 huggingface dataset:
762 A Systematic Review of Surgical Simulation in Burn Surgery: Education, Assessment, and Management
Authors: Roohani Idean , Moshal Tayla , O'Brien Devon , Jimenez Christian , Collier Zachary , Kondra Katelyn , Yenikomshian Haig , Gillenwater Justin , Carey Joseph
Published: May 2023

Introduction

Proper assessment and management of burn patients requires practical knowledge and timely interventions in a high-stakes setting. Although much of burn care emphasizes critical care, nuances exist among this patient population, creating challenges for surgeons-in-training. As a result, low- and high-fidelity burn simulations have become increasingly popular means to educate burn care physicians and their teams in a safe environment without compromising care or endangering patients. The aim of this report is to systematically review the literature for existing simulations related to burn care.

Methods

A systematic review was conducted using the following databases: PubMed, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were peer-reviewed articles about surgical simulation models related to burn care and surgery. Skills and techniques taught, assessment methods, model type, fidelity, and equipment were extracted from included studies. Conference proceedings, reviews, non-English and non-burn-specific literature were excluded.

Results

Our search criteria identified 2,585 articles, 16 of which met inclusion criteria. Simulation methods included 7 simulation courses (43.8%), 6 synthetic benchtop models (37.5%), 2 augmented/virtual reality interfaces (12.5%), and 2 iOS applications (12.5%). There were no burn-specific animal or cadaveric models. Model fidelities included 9 (56.3%) high-, 3 (18.8%) medium-, and 4 (25.0%) low-fidelity. The most common topics included in the simulations were burn wound assessment/management (n=10, 62.5%), escharotomy (n=6, 37.5%), fluid management (n=2, 12.5%), electrical burns (n=1, 6.2%), skin graft harvest (n=1, 6.2%), tangential excision (n=1, 6.2%), and cricothyrotomy (n=1, 6.2%).

Conclusions

Burn management requires an expansive breadth of intensive care knowledge and surgical expertise combined with a distinct, burn-specific skill set. A paucity exists in the literature for augmented/virtual reality and animal/cadaver models unique to burn care and surgery. Our review identified a need to expand simulator options to improve training in skin grafting, burn reconstruction, and burns-specific intensive care management.

Applicability of Research to Practice

Given the rapidly expanding emphasis on remote learning in the post-COVID era, developing accessible surgical simulation infrastructure adjacent to clinical training may better prepare global burn providers for the complexity of burn care.
763 The Cardioprotective Effects of Sildenafil, PJ34, MitoTEMPO, and ZLN005 in the Early After Burn Injury
Authors: Radhakrishnan Ravi , wen Jake , DeJesus Jana , Radhakrishnan Geetha
Published: May 2023

Introduction

Cardiac function has been found to decrease within the first 24 hours after burn injury and has been documented to stay depressed for up to 72 hours. Cardioprotective drugs such as sildenafil, PJ34, MitoTEMPO, and ZLN005 have been shown to counteract this dysfunction when administered 1 hour before burn injury. However, there remains limited knowledge on the effects of cardioprotective drugs in the early phase of burn injury.

Methods

Sprague-Dawley rats were divided into 6 groups. In 5 groups, a 60% TBSA scald burn was performed. Cardioprotectors Sildenafil, PJ34, MitoTEMPO, and ZLN005 were administered to 6 rats per group. A control group of 6 unburned rats was maintained in synchrony. Burned and unburned rats were sacrificed after measurement of heart function using echocardiography (ECHO, Vevo2100 echocardiograph). Heart rate (HR), left ventricular ejection fraction (LVEF), fractional shortening (FS), cardiac output (CO), intraventricular septum (IVS), left ventricular (LV) mass, left ventricular wedge pressure (LVWP) and left ventricular internal diameter (LVID) were assessed with the Vevo2100 echocardiograph software.

Results

Compared to sham control, heart rat (HR), diastolic LVID significantly increased at 3 hours post burn. CO, EF, FS, IVS in systole and diastole decreased at 3 hours post burn. LVID after administration of Sildenafil reduced heart rate at 3 hours post burn. ZLN005 restored burn-induced IVS systolic and diastolic decrease at 3 hours post burn. All drugs improved burn-induced EF, FS. Sildenafil and TEMPO recovered CO at 3 hours post burn.

Conclusions

In this study, cardiac function was found to be reduced up to 13 days after initial injury. Sildenafil, ZLN005, and TEMPO were shown to recover cardiac function at 3 hours post-injury, showing improvements in EF and FS. Sildenafil reduced HR and CO while ZLN005 restored burn-induced IVS during systole and diastole. This suggests the cardioprotective utility of these medications if administered early after burn injury.

Applicability of Research to Practice

Will help improve critical care and understanding of cardiac function.
765 When All Hell Breaks Loose: The Need for Specialized Burn Provider Expertise During Crisis
Authors: Goff Anna , Lambrix Marcie , Neading Andrew , Kohler Casey , Maluso Patrick , Gerrek Monica
Published: May 2023

Introduction

The COVID-19 pandemic prompted health care organizations to create or revisit crisis standards of care (CSC) guidelines. The goal of these plans is to preemptively determine the most effective way to allocate resources under circumstances in which not all patients can be treated in accordance with general standards of care. In 2020, the American Burn Association (ABA) released professional recommendations for the development of CSC guidelines. Specifically, the ABA provided triage tables that could be incorporated into organizational CSC guidelines with the intention of assisting providers by predicting mortality based on a patient’s age and burn size. These tables are often misinterpreted by non-burn providers who tend to overestimate burn size and conclude that a patient has a higher predicted mortality than they actually do. Inaccurate predicted mortalities can result in inappropriate care plans and ultimately impact patient outcomes. We argue that the ABA predicted mortality tables are helpful when used by experienced burn providers, but that there are inherent ethical risks when they are utilized by providers who lack appropriate burn care experience.

Methods

We conducted a literature review of CSC guidelines that included specific instructions for the triage of burn patients. We reviewed 15 publicly available CSC guidelines, 8 of which specifically mentioned burn patients, and examined each to see if/how they utilized ABA triage tables for predicting burn patient mortality.

Results

Of the 8 CSC plans that acknowledged burn patients, 5 utilized the mortality predictors outlined in the ABA triage tables to guide resource allocation. In the majority of plans, patients with a predicted mortality of >90% were not eligible to receive treatment and/or transfer. None of the plans specified the involvement of a specialized burn provider in assessing burns.

Conclusions

Our findings indicate that the expert evaluation of burns and thus predicted mortality can be the difference between receiving and not receiving potentially life-saving interventions under CSC guidelines. If a non-burn provider overestimates a burn size, for example, a patient may be undertreated for potentially survivable injuries under some CSC guidelines. This may further perpetuate health disparities given vulnerable populations are at higher risk of suffering burn injuries and often face a higher risk of morbidity and mortality.

Applicability of Research to Practice

This project demonstrates the need for expert input from specialized burn providers in assessing burns, especially in CSC scenarios, to ensure these assessments are reliable and accurate. Involving expert burn providers in this process will help ensure ethically appropriate clinical care decisions are being made which will improve patient outcomes and resource management in crises and decrease provider distress.
766 Evaluating the Ethics of Comfort Care in Self-Immolation Burns
Authors: Pham Theophilus , Dissanaike Sharmila , Shrestha Kripa , Dhanasekara Chathurika
Published: May 2023

Introduction

Self-Immolation injuries, although rare, incur a high mortality rate due to the high injury burden. These patients often require a long hospital stay including extended periods of time in the ICU due to the systemic burden of their burns. They often present with active suicidal ideation leaving medical decisions to be made by their next of kin who want to see everything done to preserve the life of their loved ones. Over the past several years our burn center has taken a more holistic approach to the care of these patients involving both the psychiatry team as well as the palliative care team to discuss concurrent treatment and prognosis with both patients and their families. Previous ICU dogma often discourage earlier palliative care consultation as many providers and families see such actions as the care team no longer wishing to provide care for patients

Methods

Single patient case study and review

Results

The early consultation of a supportive care team allowed the patient's family more access to resources to better make a better informed decision that was in keeping with the patient's wishes

Conclusions

Patients who commit self immolation often present with active suicidal ideations and are deemed unfit to make their own medical decisions. It is of utmost importance to not only treat their burns but also for early psychiatric treatment of their underlying condition when possible. These patients often are not coherent or are determined to not have the autonomy to make their own medical decision. Until the patient is deemed capable of making their own medical decision, it is up to the providers to determine a surrogate decision maker. The role of the surrogate decision maker is difficult as they must use substitute judgment in order to make decisions based on the subjective wishes of the patient. The difficulty in this situation arises from the fat that the decisions although made based upon the patient’s wishes can be at conflict with the patient’s best interest. When these conflicts arise it is up to medical providers to have an open dialogue and convey all revelevent information related to prognosis and outcome with the decision maker. There have been no studies that look at the ethics of palliative care among these patients and how to best honor their wishes.

Applicability of Research to Practice

This study is to help foster a discussion around the ethics of early discussion of palliative measures in regards to the treatment of self-immolation burns
773 Inhalation Injury Severity Score on Admission Predicts Overall Survival in Burn ICU Patients
Authors: Flinn Ashley , Kemp Bohan Phillip , Rauschendorfer Catherine , Le Tuan , Rizzo Julie
Published: May 2023

Introduction

Inhalation injury (II) is identified in about one-third of burn patients and is associated with increased morbidity and mortality. There are multiple scoring systems to grade II; however, no study has compared ability of these scoring systems to predict outcomes of interest such as overall survival. We hypothesized that II grades from each scoring system assessed would correlate strongly and that higher scores (representing higher grade II) would be associated with worse overall survival (OS).

Methods

This was a prospective, observational study that included intubated burn patients who underwent fiberoptic bronchoscopy within 24 hours of admission. II was graded using three scoring systems: Abbreviated Injury Score (AIS), Inhalation Injury Severity Score (I-ISS), and Mucosal Score (MS). All scoring systems use a Likert-type scale (AIS: 0-4; I-ISS and MS: 0-3) with more severe IIs given higher scores. Agreement between scoring systems was assessed with Krippendorff’s Alpha (KA) >0.80 indicating high reliability. Multivariable analyses were used to determine variables independently associated with OS. Significance was set at p< 0.05.

Results

99 patients were included in the analysis. Median percent total body surface area burned and Injury Severity Score (ISS) were 19.5% (interquartile range [IQR] 9-39%) and 25 (13-34), respectively. At admission, median AIS, I-ISS, and MS scores were 2 (1-3) for all scoring systems. Patients who died had higher overall injury burden than those who survived (Table 1). Additionally, patients who died had similar median admission AIS and MS scores, but higher I-ISS scores than those who survived (Table 1). There was strong correlation between the grade of II at admission using the three scoring systems (KA=0.85). On regression analysis, the only II scoring system independently associated with overall survival was I-ISS (score 3 compared to scores 1-2: OR 13.16, 95% CI 1.65-105.07; p=0.02).

Conclusions

Grade of II on admission correlated well between scoring systems, but only I-ISS on admission was independently associated with OS. Progression of injury after initial assessment may contribute to the poor correlation between admission score and overall survival for IIs graded with AIS and MS. Repeated assessment and re-grading II after initial resuscitation may more accurately identify patients at increased risk for mortality.

Applicability of Research to Practice

Grading II is common practice in Burn ICUs. This study demonstrates good reliability between the three most common II scoring systems utilized and that I-ISS on admission can be used to predict risk of mortality, which is useful prognostic information for both burn care providers as well as patients and their families.
A hierarchical modeling approach to predict the distribution and density of Sierra Nevada Red Fox (Vulpes vulpes necator)
Authors: Green David S , Martin Marie E , Matthews Sean M , Akins Jocelyn R , Carlson Jennifer , Figura Pete , Hatfield Brian E , Perrine John D , Quinn Cate B , Sacks Benjamin N , Stephenson Thomas R , Stock Sarah L , Tucker Jody M
Published: May 2023

Carnivores play critical roles in ecosystems, yet many species are declining worldwide. The Sierra Nevada Red Fox (Vulpes vulpes necator; SNRF) is a rare and endangered subspecies of red fox limited to upper montane forests, subalpine, and alpine environments of California and Oregon, United States. Having experienced significant distribution contractions and population declines in the last century, the subspecies is listed as at-risk by relevant federal and state agencies. Updated information on its contemporary distribution and density is needed to guide and evaluate conservation and management actions. We combined 12 years (2009–2020) of detection and nondetection data collected throughout California and Oregon to model the potential distribution and density of SNRFs throughout their historical and contemporary ranges. We used an integrated species distribution and density modeling approach, which predicted SNRF density in sampled locations based on observed relationships between environmental covariates and detection frequencies, and then projected those predictions to unsampled locations based on the estimated correlations with environmental covariates. This approach provided predictions that serve as density estimates in sampled regions and projections in unsampled areas. Our model predicted a density of 1.06 (95% credible interval = 0.8–1.36) foxes per 100 km2 distributed throughout 22,926 km2 in three distinct regions of California and Oregon–Sierra Nevada, Lassen Peak, and Oregon Cascades. SNRFs were most likely to be found in areas with low minimum temperatures and high snow water equivalent. Our results provide a contemporary baseline to inform the development and evaluation of conservation and management actions, and guide future survey efforts.
Smart Iterative Analysis Tool for the Size Distribution of Spherical Nanoparticles
Authors: Guckel Jannik , Görke Marion , Garnweitner Georg , Park Daesung
Published: May 2023

The size of nanoparticles is a critical parameter with regard to their performance. Therefore, precise measurement of the size distribution is often required. While electron microscopy (EM) is a useful tool to image large numbers of particles at once, manual analysis of individual particles in EM images is a time-consuming and labor-intensive task. Therefore, reliable automatic detection methods have long been desired. This paper introduces a novel automatic particle analysis software package based on the circular Hough transform (CHT). Our software package includes novel features to enhance precise particle analysis capabilities. We applied the CHT algorithm in an iterative workflow, which ensures optimal detection over wide radius intervals, to deal with overlapping particles. In addition, smart intensity criteria were implemented to resolve common difficult cases that lead to false particle detection. Implementing these criteria enabled an effective and precise analysis by minimizing detection of false particles. Overall, our approach showed reliable particle analysis results by resolving common types of particle overlaps and deformation with only negligible errors.
Competition on presynaptic resources enhances the discrimination of interfering memories
Authors: Fung Chi Chung Alan , Fukai Tomoki
Published: May 2023

Evidence suggests that hippocampal adult neurogenesis is critical for discriminating considerably interfering memories. During adult neurogenesis, synaptic competition modifies the weights of synaptic connections nonlocally across neurons, thus providing a different form of unsupervised learning from Hebb’s local plasticity rule. However, how synaptic competition achieves separating similar memories largely remains unknown. Here, we aim to link synaptic competition with such pattern separation. In synaptic competition, adult-born neurons are integrated into the existing neuronal pool by competing with mature neurons for synaptic connections from the entorhinal cortex. We show that synaptic competition and neuronal maturation play distinct roles in separating interfering memory patterns. Furthermore, we demonstrate that a feedforward neural network trained by a competition-based learning rule can outperform a multilayer perceptron trained by the backpropagation algorithm when only a small number of samples are available. Our results unveil the functional implications and potential applications of synaptic competition in neural computation.
Treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs: British Society for Rheumatology guideline scope
Authors: Zhao Sizheng Steven , Harrison Stephanie R , Chan Antoni , Clarke Nick , Davis Charlotte , Eddison Joe , Gregory William J , Jones Gareth T , Marzo-Ortega Helena , Murphy Daniel J , Sandhu Virinderjit , Sengupta Raj , Siebert Stefan , Thompson Ben , Webb Dale , Yates Max , Gaffney Karl
Published: May 2023

Pharmacological management has advanced considerably since the 2015 British Society for Rheumatology axial spondyloarthritis (axSpA) guideline to incorporate new classes of biologic DMARDs (bDMARDs, including biosimilars), targeted synthetic DMARDs (tsDMARDs) and treatment strategies such as drug tapering. The aim of this guideline is to provide an evidence-based update on pharmacological management of adults with axSpA (including AS and non-radiographic axSpA) using b/tsDMARDs. This guideline is aimed at health-care professionals in the UK who care directly for people with axSpA, including rheumatologists, rheumatology specialist nurses, allied health professionals, rheumatology specialty trainees and pharmacists; people living with axSpA; and other stakeholders, such as patient organizations and charities.
Impact of Corporate Subsidies on Borrowing Costs of Local Governments: Evidence from Municipal Bonds
Authors: Chava Sudheer , Malakar Baridhi , Singh Manpreet
Published: May 2023

We analyze the impact of $40 billion of corporate subsidies given by US local governments on their borrowing costs. We find that winning counties experience a 15.2 basis points (bps) increase in bond yield spread as compared to the losing counties. The increase in yields is higher (18–26 bps) when the subsidy deal is associated with a lower jobs multiplier or when the winning county has a lower debt capacity. However, a high jobs multiplier does not seem to alleviate the debt capacity constraints of local governments. Our results highlight the potential costs of corporate subsidies for local governments.
Vitamin D Status Is Associated With Immune Checkpoint Inhibitor Efficacy and Immune-related Adverse Event Severity in Lung Cancer Patients: A Prospective Cohort Study
Authors: You Wen , Liu Xinyu , Tang Hao , Lu Bo , Zhou Qingyang , Li Yue , Chen Minjiang , Zhao Jing , Xu Yan , Wang Mengzhao , Qian Jiaming , Tan Bei
Published: May 2023

Vitamin D (VitD) is potentially immunomodulatory, so here we aimed to explore the relationships between serum VitD levels, immune checkpoint inhibitor (ICI) efficacy, and immune-related adverse events (irAEs). Serum 25-hydroxyvitamin D [25(OH)D] levels were quantified before and after ICI treatment in prospectively enrolled patients with advanced lung cancers. Of 77 enrolled patients, 29 developed 42 irAEs. Baseline 25(OH)D levels of partial response (PRs) patients were significantly higher than non-PR patients (19.39±7.16 vs. 16.28±5.99 ng/mL, P=0.04). The area under the curve of 25(OH)D >15.73 ng/mL to identify PR was 0.63 (95% CI, 0.51–0.76, P=0.047), and baseline 25(OH)D levels >15.73 ng/mL (odds ratio: 2.93, 95% CI, 1.10–7.79, P=0.03) and prior targeted therapy (odds ratio: 0.30, 95% CI, 0.10–0.92, P=0.04) were independent predictors of PR as best efficacy by multivariable logistic regression. With respect to irAEs, baseline 25(OH)D levels were higher in grade 1 irAE patients than in grade 2/3/4 irAE patients (20.07±8.64 vs. 15.22±2.30 ng/mL, P=0.02). However, the area under the curve was only 0.56 (95% CI, 0.42–0.70, P=0.39) for a baseline 25(OH)D of 20.99 ng/mL for predicting irAE occurrence. There was a direct monotonic relationship and U-shaped relationship between baseline 25(OH)D levels and ICI efficacy and irAE occurrence, respectively. Overall survival was significantly different between VitD sufficient, insufficient, and deficient patients (log-rank P=0.01), which remained after adjustment in Cox proportional hazards regression models. Baseline 25(OH)D levels seem to be associated with ICI efficacy and prognosis, it might be helpful to assess the baseline VitD status, and supplementation with VitD might bring some benefit to enhance ICI efficacy and reduce moderate-severe irAEs.
Cartilage Tissue Engineering for Nasal Alar and Auricular Reconstruction: A Critical Review of the Literature and Implications for Practice in Dermatologic Surgery
Authors: Himeles Jaclyn R. , Ratner Désirée
Published: May 2023

BACKGROUND

Reconstructing defects requiring replacement of nasal or auricular cartilage after Mohs micrographic surgery can at times be challenging. While autologous cartilage grafting is considered the mainstay for repair, it may be limited by cartilage quality/quantity, donor site availability/morbidity, and surgical complications. Tissue-engineered cartilage has recently shown promise for repairing properly selected facial defects.

OBJECTIVE

To (1) provide a comprehensive overview of the literature on the use of tissue-engineered cartilage for nasal alar and auricular defects, and (2) discuss this technology's advantages and future implications for dermatologic surgery.

MATERIALS AND METHODS

A literature search was performed using PubMed/MEDLINE and Google Scholar databases. Studies discussing nasal alar or auricular cartilage tissue engineering were included.

RESULTS

Twenty-seven studies were included. Using minimal donor tissue, tissue-engineered cartilage can create patient-specific, three-dimensional constructs that are biomechanically and histologically similar to human cartilage. The constructs maintain their shape and structural integrity after implantation into animal and human models.

CONCLUSION

Tissue-engineered cartilage may be able to replace native cartilage in reconstructing nasal alar and auricular defects given its ability to overcome several limitations of autologous cartilage grafting. Although further research is necessary, dermatologic surgeons should be aware of this innovative technique and its future implications.
Using Google Trends for Evaluation of Public Interest in Female Genital Aesthetic Procedures
Authors: Ergul Aslıhan , Caglar Ufuk , Yuksel Bahar , Ozgor Faruk
Published: May 2023

BACKGROUND

Genital aesthetics is a treatment that is increasing in popularity.

OBJECTIVE

To clarify public interest in genital aesthetic procedures among women between 2004 and 2022.

MATERIALS AND METHODS

In total, 12 terms including labiaplasty, vaginoplasty, perineoplasty, laser vaginal rejuvenation, labia cosmetic surgery, vaginal cosmetic surgery, vaginal tightening, genital bleaching, hymenoplasty, clitoroplasty, labiaplasty cost, and vaginal laser were reviewed. To evaluate public attention to female genital aesthetic procedures between January 1, 2004, and January 1, 2022, three 6-year periods were compared about the abovementioned 12 terms.

RESULTS

Public attention to labiaplasty and hymenoplasty was significantly higher in 2010 to 2016 than in 2004 to 2010 and 2016 to 2022. Vaginoplasty, laser vaginal rejuvenation, and labia cosmetic surgery terms were researched significantly less in 2010 to 2016 and 2016 to 2022 than in 2004 to 2010 (p = .001). Public interest in vaginal tightening and labiaplasty cost significantly increased from 2004 to 2022. Finally, the term vaginal laser was researched most between 2016 and 2022 (p = .001).

CONCLUSION

This study found that public attention to labiaplasty cost and vaginal tightening continuously increased between 2004 and 2022. In addition, public interest in the term vaginal laser significantly increased after 2016. By contrast, vaginoplasty, laser vaginal rejuvenation, and labia cosmetic surgery terms were researched significantly less after 2010.
Current challenges and future perspectives in treating patients with NAFLD-related cirrhosis
Authors: Mallet Maxime , Silaghi Cristina Alina , Sultanik Philippe , Conti Filomena , Rudler Marika , Ratziu Vlad , Thabut Dominique , Pais Raluca
Published: May 2023

Despite the slow, progressive nature of NAFLD, the number of patients with NAFLD-related cirrhosis has significantly increased. Although the management of patients with cirrhosis is constantly evolving, improving the prognosis of patients with NAFLD-related cirrhosis is a challenge because it is situated at the crossroads between the liver, the metabolic, and the cardiovascular diseases. Therefore, the therapeutic interventions should not only target the liver but also the associated cardiometabolic conditions and should be adapted accordingly. The objective of the current review is to critically discuss the particularities in the management of patients with NAFLD-related cirrhosis. We relied on the recommendations of scientific societies and discussed them in the specific context of NAFLD cirrhosis and the surrounding cardiometabolic milieu. Herein, we covered the following aspects: (1) the weight loss strategies through lifestyle interventions to avoid sarcopenia and improve portal hypertension; (2) the optimal control of metabolic comorbidities in particular type 2 diabetes aimed not only to improve cardiovascular morbidity/mortality but also to lower the incidence of cirrhosis-related complications (we discussed various aspects related to the safety of oral antidiabetic drugs in cirrhosis); (3) the challenges in performing bariatric surgery in patients with cirrhosis related to the portal hypertension and the risk of cirrhosis decompensation; (4) the particularities in the diagnosis and management of the portal hypertension and the difficulties in managing patients awaiting for liver transplantation; and (5) the difficulties in developing drugs and conducting clinical trials in patients with NAFLD-related cirrhosis. Moreover, we discussed the emerging options to overcome these obstacles.
Antiviral therapy substantially reduces HCC risk in patients with chronic hepatitis B infection in the indeterminate phase
Authors: Huang Daniel Q. , Tran Andrew , Yeh Ming-Lun , Yasuda Satoshi , Tsai Pei-Chien , Huang Chung-Feng , Dai Chia Yen , Ogawa Eiichi , Ishigami Masatoshi , Ito Takanori , Kozuka Ritsuzo , Enomoto Masaru , Suzuki Takanori , Yoshimaru Yoko , Preda Carmen M. , Marin Raluca I. , Sandra Irina , Tran Sally , Quek Sabrina X.Z. , Khine Htet Htet Toe Wai , Itokawa Norio , Atsukawa Masanori , Uojima Haruki , Watanabe Tsunamasa , Takahashi Hirokazu , Inoue Kaori , Maeda Mayumi , Hoang Joseph K. , Trinh Lindsey , Barnett Scott , Cheung Ramsey , Lim Seng Gee , Trinh Huy N. , Chuang Wan-Long , Tanaka Yasuhito , Toyoda Hidenori , Yu Ming-Lung , Nguyen Mindie H.
Published: May 2023

Background and Aims:

HCC risk in chronic hepatitis B (CHB) is higher in the indeterminate phase compared with the inactive phase. However, it is unclear if antiviral therapy reduces HCC risk in this population. We aimed to evaluate the association between antiviral therapy and HCC risk in the indeterminate phase.

Approach and Results:

We analyzed 855 adult (59% male), treatment-naïve patients with CHB infection without advanced fibrosis in the indeterminate phase at 14 centers (USA, Europe, and Asia). Inverse probability of treatment weighting (IPTW) was used to balance the treated (n = 405) and untreated (n = 450) groups. The primary outcome was HCC development. The mean age was 46±13 years, the median alanine transaminase was 38 (interquartile range, 24–52) U/L, the mean HBV DNA was 4.5±2.1 log10 IU/mL, and 20% were HBeAg positive. The 2 groups were similar after IPTW. After IPTW (n = 819), the 5-, 10-, and 15-year cumulative HCC incidence was 3%, 4%, and 9% among treated patients (n = 394) versus 3%, 15%, and 19%, among untreated patients (n = 425), respectively (p = 0.02), with consistent findings in subgroup analyses for age >35 years, males, HBeAg positive, HBV DNA>1000 IU/mL, and alanine transaminase<upper limit of normal. In multivariable Cox proportional hazards analysis adjusted for age, sex, HBeAg, HBV DNA, alanine transaminase, diabetes, and platelets, antiviral therapy remained an independent predictor of reduced HCC risk (adjusted HR = 0.3, 95% CI: 0.1–0.6, p = 0.001).

Conclusions:

Antiviral therapy reduces HCC risk by 70% among patients with indeterminate-phase CHB. These data have important implications for the potential expansion of CHB treatment criteria.
Tacrolimus for immunosuppression in patients with non-infectious intermediate, posterior, or panuveitides
Authors: Jabs Douglas A. , Thorne Jennifer E. , Wilkins Carl S. , Habbu Karishma A. , Berkenstock Meghan K. , Burkholder Bryn M. , Chaon Benjamin C. , Deobhakta Avnish
Published: May 2023

Purpose:

To evaluate the effectiveness of tacrolimus in patients with non-infectious intermediate, posterior, or panuveitis needing a two-immunosuppressive-agent regimen.

Methods:

Design: Retrospective cohort study. Setting: Two tertiary-care uveitis practices at academic medical centers. Patient population: 32 patients with non-infectious intermediate, posterior, or pan-uveitides in whom single agent immunosuppression was inadequate to effect successful corticosteroid sparing. Intervention: tacrolimus, added as the second immunosuppressive agent. Main outcome measure: successful corticosteroid sparing, defined as inactive uveitis at a dose of prednisone <7.5 mg/day.

Results:

Active uveitis was present in 65.6% of patients at initiation of tacrolimus, and the median time to inactive uveitis was 1.5 months (95% confidence interval [CI] 1.2, 4.08). The median time to successful corticosteroid sparing was 3.9 months (95% CI 1.41, 6.67), and by 6 months of follow-up successful corticosteroid sparing was achieved in 75% of patients. Tacrolimus was discontinued for side effects in 5 patients, 3 for tremor and 2 for hyperglycemia. All side effects were reversible with tacrolimus discontinuation.

Conclusions:

Tacrolimus appears to have efficacy as a second immunosuppressive agent in two-immunosuppressive drug regimens, when a single agent does not permit successful corticosteroid sparing. Side effects were reversible with tacrolimus discontinuation.
New exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification
Authors: Liu Xiaomin , Dai Yuhai , Huang Yusen , Zheng Simeng , Wei Yufen , Teng Yingli , Wu Xiaoming
Published: May 2023

Purpose:

To conduct a new exploration and analysis of the ion and fatty acid levels of a medium in which calcified hydrophilic intraocular lenses (IOLs) are present.

Setting:

Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.

Design:

Retrospective, laboratory observational case series.

Methods:

11 patients (11 eyes) who had implantation of foldable hydrophilic acrylic posterior IOLs were found to have opacification of the IOLs. In vivo and in vitro analyses included the evaluation of patients' clinical characteristics, microscopy, histological staining, energy dispersive X-ray spectroscopy (EDS), the ion level of the aqueous humor (AH) and preserving fluid (PF), and the fatty acid content of AH.

Results:

10 of 11 cases were female with unilateral opacification, and 7 cases had both-eye cataract surgery, including 1 first eye and 6 second eyes with IOL opacification. 4 types of similar serial numbers were counted. The analysis of AH showed that the concentrations of phosphorus and silicon were elevated but that of calcium decreased, and an increased level of silicon was detected in 3 random PFs. The palmitic (C16:0) and stearic (C18:0) fatty acids were higher than the others in the AH. The EDS confirmed that the IOL surface deposits were composed of calcium, phosphate, and a small amount of silicon.

Conclusions:

More silicon and higher C16:0 and C18:0 were found in the AH of patients with IOL opacification. New ideas and avenues have been proposed in the study of IOL opacification.
Lower urinary tract symptoms as an independent predictor of aortic regurgitation in women with cardiac symptoms
Authors: Fan Yu-Hua , Cheng Wei-Ming , Huang Yen-Chang
Published: May 2023

Background:

Very few studies have focused on the correlation between structural heart disease and lower urinary tract symptoms. In this study, we applied echocardiography to explore the correlation between lower urinary tract symptoms and structural heart disease.

Methods:

In this single-center, prospective, cross-sectional study, we enrolled adult women undergoing echocardiography for suspected cardiac abnormalities causing cardiac symptoms between February 1, 2021, and March 31, 2021. All participants completed a questionnaire regarding demographic information and lower urinary tract symptoms, which were assessed according to the International Prostate Symptom Score.

Results:

A total of 165 women aged 69.96 ± 10.20 years were enrolled. The prevalence of moderate-to-severe aortic regurgitation in patients with moderate-to-severe lower urinary tract symptoms was significantly higher than that in patients with mild lower urinary tract symptoms (33.3% vs 13.6%, p = 0.008). The prevalence of other echocardiographic abnormalities was not associated with severity of lower urinary tract symptoms. Multivariable logistic regression analyses revealed that moderate-to-severe lower urinary tract symptoms predicted moderate-to-severe aortic regurgitation (p = 0.007; odds ratio: 3.560; 95% confidence interval: 1.409-8.993). Furthermore, the International Prostate Symptom Score storage subscore (p = 0.001; odds ratio: 1.285; 95% confidence interval: 1.111–1.486), except the voiding subscore, was an independent predictor of moderate-to-severe aortic regurgitation.

Conclusion:

Moderate-to-severe lower urinary tract symptoms, especially storage symptoms, are an independent predictor of the co-existence of moderate-to-severe aortic regurgitation in women with cardiac symptoms. Early cardiological referral of patients with moderate-to-severe lower urinary tract symptoms and cardiac symptoms may improve their general health.
Computed tomography-guided interstitial implantation of I (125) radioactive seeds in the treatment of hilar airway stenosis caused by non-small cell lung cancer
Authors: Li Guo , Zhou Xia , Huang Chao-Jiao , Zuo Zhi-Wei , Wu Fa , Zhang Jun-Feng , Jiang Rui , Du Fei-Zhou
Published: May 2023

Background

Airway stenosis secondary to non-small cell lung cancer (NSCLC) is one of the severe complications that can lead to life-threatening outcomes.

Objective

To investigate the clinical utility of computed tomography (CT)-guided interstitial implantation of radioactive I-125 seeds in the treatment of hilar airway stenosis caused by NSCLC.

Methods

The cases of hilar airway stenosis caused by NSCLC in our hospital from 2017 to 2022 were collected and divided into observation and control groups. Both groups underwent conventional lung cancer treatment, and the observation group was treated with CT-guided interstitial implantation of radioactive I-125 seeds. The mean tumor diameter, hilar airway stenosis, and obstructive pneumonia scores at 3 months after treatment were compared between the two groups.

Results

After 3 months of treatment, the mean tumor diameter (28.8 ± 9.3 mm vs 49.33 ± 16.75 mm, P < 0.001), hilar airway stenosis (20.55 ± 30.36% vs 84.85 ± 26.19%, P < 0.001), and obstructive pneumonia score (2.19 ± 1.41 vs 3.48 ± 1.12, P < 0.001) of the observation group were significantly lower than those of the control group.

Conclusion

CT-guided interstitial implantation of I (125) radioactive seeds in the treatment of hilar airway stenosis caused by NSCLC can effectively reduce the tumor volume, relieve airway stenosis, and alleviate the associated obstructive pneumonia and has a certain value of application in the clinic.
Anti-inflammatory potential of 1-O-methyl chrysophanol from Amycolatopsis thermoflava ICTA 103: an exploratory study
Authors: Batchu Uma Rajeswari , Surapaneni Joshna Rani , Cheemalamarri Chandrasekhar , Mandava Kiranmai , Puvvada Nagaprasad , Shetty Prakasham Reddy , MV Surekha
Published: May 2023

The present study was designed to investigate the anti-inflammatory potential of Amycolatopsis thermoflava producing 1-O-methyl chrysophanol (OMC), a member of the hydroxyanthraquinone family. The anti-inflammatory potential was evaluated initially through in silico analysis against tumor necrosis factor- α and cyclooxygenase-2. The same activity was further confirmed based on the in vitro protein denaturation method as well as in vivo by a carrageenan-induced paw edema model in rats. The OMC compound was isolated, purified, and characterized from the fermentation broth of Amycoloptosis thermoflava. In vitro data revealed that the OMC possesses significant protein denaturation properties with an IC50 of 63.50±2.19 µg/ml higher than the standard drug, with an IC50 value of 71.42±0.715 µg/ml. The percentage of inhibition in paw swelling was observed to be 40.03±5.5 in OMC-treated group, which is comparable to the standard group (52.8±4.7). The histopathological evaluation and immunohistochemistry revealed the anti-inflammatory potential of OMC.
Frequency of low birth weight and its relationship with maternal serum zinc: a cross-sectional study
Authors: Karim Saira , Fazal Shabana , Naeem Muhammad , Ali Hikmat , Fazal Rozina , Karim Ambreen , Hashmi Saira , Baloch Yasir , khan Mehmand , Mumtaz Hassan
Published: May 2023

Introduction:

Fetal and neonatal mortality and morbidity are connected to low birth weight (LBW), which is also associated with slow growth and cognitive development. Several factors, such as maternal nutrition, LBW deliveries, and additional dietary intake, contribute to pregnancy outcomes. This study aimed to compare the maternal serum zinc levels between the LBW and normal birth weight neonates. Moreover, we will also determine the frequency of LBW in the local population.

Material and method:

This cross-sectional study was conducted at a tertiary care hospital from June 2021 to June 2022. Three hundred eighty-two gravid females with active labor (≥2 uterine contractions in 10 min) were enrolled in the study. Neonates at birth were weighed and divided into two groups: LBW and average or normal birth weight. Maternal serum zinc levels were performed by serum multi-element spectrometry (ICP-DRC-MS method). The data were analyzed using SPSS software.

Results:

Three hundred eighty-two patients enrolled in this study. The results showed the mean age of patients was 24.04±3.49 years, and the mean maternal zinc levels were found to be 75.32±13.80 μg/dl, respectively. Babies delivered at LBW had low maternal mean serum zinc levels (63.88±10.95 mg/dl) compared to babies with normal birth weight whose levels were comparatively high (83.83±8.57 mg/dl).

Conclusion:

It can be concluded that maternal dietary factors and nutrition are essential during fetal development and have an important association with birth weight.Zinc supplementation and other minerals should be prioritized because they may increase these infants’ birth weight. Increasing maternal zinc consumption has a significant positive linear relationship with infant birth weight.
Management of an accidental mass in a monorchidic patient discovered during infertility: a case report
Authors: Elmoudane Anouar , Boukhannous Ibrahim , Elalaoui Anass , haloui Anass , Bennani Amal , Barki Ali
Published: May 2023

Introduction and importance:

Testicular cancer is the most frequent type of cancer in the young adult men, it is relatively rare. Infertility is an important risk factor for testicular cancer, with a doubled risk of developing cancer compared to the general population. The standard treatment for testicular cancer is the radical orchiectomy, but partial orchiectomy or testicular sparing surgery (TSS) is indicated for small masses, as many experiences, have shown that many small masses found incidentally turn out to be benign.

Case presentation:

The authors report the case of a patient presented for primary infertility, a clinical examination for left-sided gynecomastia without inflammatory signs. A testicular MRI revealed a 7 mm suspicious nodule in the posterior-inferior aspect of the right testicle, with contrast enhancement in the juxta-tumoral area corresponding to a heterogeneous area on ultrasound. Due to the lesion described on MRI, monorchidism, and azoospermia, a TSS combined with testicular biopsy and testicular sperm extraction was indicated.

Clinical discussion:

The reference treatment for testicular cancer is the radical orchiectomy, but in some selected situations, partial orchiectomy or TSS is indicated, as many experiences have shown that many small masses found incidentally turn out to be benign.

Conclusion:

This case suggests that TSS or partial orchiectomy for small nonpalpable testicular masses in monorchidic patients can provide an excellent outcome for the patient.
Stealth invaders: unraveling the mystery of neurotropic viruses and their elusive presence in cerebrospinal fluid – a comprehensive review
Authors: Srichawla Bahadar S. , Kipkorir Vincent , Manan Muhammad Romail , Dhali Arkadeep , Diebel Sebastian , Sawant Tirtha , Zia Subtain , Carrion-Alvarez Diego , Suteja Richard C. , Nurani Khulud , Găman Mihnea-Alexandru
Published: May 2023

Neurotropic viruses are a threat to human populations due to ongoing zoonosis. A wide array of neurological manifestations can occur most often including parkinsonism, encephalitis/encephalopathy, flaccid myelitis, and Guillain-Barré syndrome. Neuroinvasion occurs through: transneural transmission, blood brain barrier (BBB) dysfunction, and ‘trojan horse’ mechanism or infected immune cell trafficking into the central nervous system (CNS). Transneural transmission occurs through virus mediated hijacking of intracellular transport proteins allowing retrograde viral transport. BBB dysfunction occurs through cytokine storm increasing membrane permissibility. Increased chemokine expression allows leukocyte trafficking to the BBB. Virally infected leukocytes may successfully pass through the BBB allowing the pathogen to infect microglia and other CNS cell types. We define cerebrospinal fluid (CSF) nondetection as a virus’ ability to evade direct CSF detection but still causing significant neurological symptoms and disease. Mechanisms of CSF nondetection include: transneuronal propagation through trans-synaptic transmission, and synaptic microfusion, as well as intrathecal antibody synthesis and virus neutralization. Direct virus detection in CSF is associated with an increased neurological disease burden. However, the lack of CSF detection does not exclude CNS involvement due to possible neuroevasive mechanisms.
Prospects of evolution-based artificial intelligence models in genome-wide studies to stratify genetic risk variants in nonalcoholic fatty liver disease
Authors: Huang Helen , Awuah Wireko A. , Garg Tulika , Ng Jyi Cheng , Mehta Aashna , Ramamoorthy Krishna , Kalmanovich Jacob , Hasan Mohammad M.
Published: May 2023

The emergence of genome-wide association studies (GWAS) has identified genetic traits and polymorphisms that are associated with the progression of nonalcoholic fatty liver disease (NAFLD). Phospholipase domain-containing 3 and transmembrane 6 superfamily member 2 are genes commonly associated with NAFLD phenotypes. However, there are fewer studies and replicability in lesser-known genes such as LYPLAL1 and glucokinase regulator (GCKR). With the advent of artificial intelligence (AI) in clinical genetics, studies have utilized AI algorithms to identify phenotypes through electronic health records and utilize convolution neural networks to improve the accuracy of variant identification, predict the deleterious effects of variants, and conduct phenotype-to-genotype mapping. Natural language processing (NLP) and machine-learning (ML) algorithms are popular tools in GWAS studies and connect electronic health record phenotypes to genetic diagnoses using a combination of international classification disease (ICD)-based approaches. However, there are still limitations to machine-learning - and NLP-based models, such as the lack of replicability in larger cohorts and underpowered sample sizes, which prevent the accurate prediction of genetic variants that may increase the risk of NAFLD and its progression to advanced-stage liver fibrosis. This may be largely due to the lack of understanding of the clinical consequence in the majority of pathogenic variants. Though the concept of evolution-based AI models and evolutionary algorithms is relatively new, combining current international classification disease -based NLP models with phylogenetic and evolutionary data can improve prediction accuracy and create valuable connections between variants and their pathogenicity in NAFLD. Such developments can improve risk stratification within clinical genetics and research while overcoming limitations in GWAS studies that prevent community-wide interpretations.