bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of discoidin domain receptor 1 as a new therapeutic strategy for osteosarcoma
Authors: Wang Jinglu , Walker Robert L. , Hornicek Francis J. , Shi Huirong , Duan Zhenfeng
Published: December 2024

Osteosarcoma is the most common type of bone cancer. Some patients eventually develop recurrent or metastatic diseases and treatment options are extremely limited. Discoidin domain receptor 1 (DDR1) is a unique collagen‐activated tyrosine kinase that participates in various human diseases, including cancer. DDR1 promotes adhesion, proliferation, differentiation, migration, and metastasis of cancer cells. The purpose of this study is to assess the expression, clinical prognostic relationship and functional roles of DDR1 in osteosarcoma. The correlation between DDR1 expression in tumor tissues and clinicopathological features, and prognosis was assessed via immunohistochemical staining of a unique tissue microarray (TMA) constructed from osteosarcoma specimens. DDR1‐specific siRNA and a highly selective DDR1 inhibitor, 7rh, were applied to determine the impact of DDR1 expression on osteosarcoma cell growth and proliferation. Furthermore, the effect of DDR1 inhibition on clonogenicity was evaluated using a clonogenic assay, and a 3D cell culture model was used to mimic DDR1 effects in an in vivo environment. The results demonstrate that higher DDR1 expression significantly correlates with recurrence, metastasis, and shorter overall survival in osteosarcoma patients. The expression of DDR1 is also inversely correlated to the response to neoadjuvant chemotherapy. Therapeutically, DDR1 knockdown with siRNA or selective inhibition with 7rh decreases the proliferation and growth of osteosarcoma cells. In conclusion, our study supports DDR1 expression as an independent predictor of poor prognosis and a promising therapeutic target for osteosarcoma.
Advances in asthma and allergic disease genetics
Authors: Schoettler Nathan
Published: December 2024

Purpose of review

Asthma and allergic disease are common chronic conditions affecting individuals of all ages. The contribution of genetics to the risk of asthma and allergic diseases is well established, yet the mechanisms through which genetic variation contribute to risk continues to be investigated. This review focuses on recent advances made in genetic studies of asthma and allergic disease phenotypes.

Recent findings

Progress has been made at expanding genetic studies of asthma and allergic diseases in more diverse and non-European populations, and genetic associations have been made with loci and more refined phenotypes associated with these conditions. Among the 11 large genome-wide association studies or admixture mapping studies published recently, 52 novel associations were identified for asthma and allergic disease phenotypes. As in previous studies, variant- and genome-based heritability remains relatively low. The use of polygenic risk scores in asthma and allergic diseases has increased and reinforces the remarkable overlap of the genetic risk of these conditions. Whole genome and exome sequencing has led to associations of specific genes with these conditions, including rare STAT6 gain-of-function mutations that were identified in individuals with multiple, severe and early life allergic diseases and asthma.

Overall, we have learned that asthma and allergic diseases phenotypes are highly polygenic and have considerable overlap in their genetic landscapes.
Effectiveness of Ketamine As a Rescue Drug for Patients Experiencing Benzodiazepine-Resistant Status Epilepticus in the Prehospital Setting
Authors: Scheppke Kenneth A. , Pepe Paul E. , Garay Sebastian A. , Coyle Charles W. , Antevy Peter M. , Perlmutter Michael C. , Scheppke Eric K. , Crowe Remle P.
Published: December 2024

OBJECTIVES:

Accumulating basic science data, early clinical findings and various feasibility considerations have provided rationales for administering ketamine as a proposed rescue medication for midazolam-resistant status epilepticus (SE) in the logistically challenging prehospital environment. This report details the multiyear experience of paramedics managing midazolam-resistant SE following the introduction of a ketamine-rescue protocol.

DESIGN:

A 7-year, population-based, observational study was conducted to evaluate outcomes of patients treated with IV, intraosseous, intramuscular, or intranasal ketamine for SE despite sufficient midazolam dosings. Tracked outcomes included: 1) rapid/sustained termination of clinical seizures in adults while under paramedics’ care; 2) corresponding evaluations in children/adolescents; 3) any concerning observations regarding need for assisted ventilation, intubation, or other active interventions post-ketamine; and 4) any identifiable associations between outcomes and circumstances, demographics, or medical history.

SETTING:

Emergency response 9-1-1 system serving a large, diverse U.S. county (jurisdictional population, 961,000/1,769 sq miles).

PATIENTS:

Those receiving ketamine from paramedics for persistent seizures.

INTERVENTIONS:

Adults and adolescents: 100 mg ketamine IV/intraosseous/intramuscular/intranasal; children: 1 mg/kg intramuscular/intranasal.

MEASUREMENTS AND MAIN RESULTS:

Among 81 total cases, 57 involved adults (18–86 yr old) receiving the SE-midazolam + ketamine protocol. Ketamine rapidly terminated convulsions in 56 (98.2%) without recurrence during prehospital and hospital arrival phases. For approved reasons, paramedics administered ketamine directly (no midazolam) in eight adults and one child, terminating convulsions in every case. Among 15 childhood/adolescent cases treated per protocol, ketamine rapidly terminated SE activity in 11, but only mitigated it in four, including two retrospectively judged to involve nonseizure activity and two involving intranasal administration. Among all 81 ketamine-treated cases, there were no identifiable clinically significant complications attributable to ketamine, particularly the need for any additional active interventions.

CONCLUSIONS:

Ketamine appeared to be consistently effective in treating adults with ongoing out-of-hospital seizures that were resistant to sufficient dosings of midazolam. Similar results were observed in children/adolescents.
Shoshin Beriberi in a Child With Intestinal Failure: A Case Report
Authors: Böhrer Madeleine , Burgess Paige , Da Costa Sao Pedro Tais , Boctor Dana Liza , Boggs Samantha
Published: December 2024

Background:

Acute illness states with increased metabolic demand can precipitate severe thiamine deficiency if physiologic needs exceed endogenous stores and supplementation. Patients with preexisting risk factors such as parenteral nutrition (PN) dependence, eating disorders, gastrointestinal disorders, or surgeries are especially vulnerable.

Case Summary:

A 9-year-old girl with short bowel syndrome receiving long-term PN, including standard thiamine supplementation, presented with refractory shock following aspiration. Profound hyperlactatemia, cardiac dysfunction, and vasoactive requirements persisted despite extracorporeal membrane oxygenation and resolved only after treatment with parenteral thiamine.

CONCLUSIONS:

Hemodynamic collapse due to thiamine deficiency (Shoshin beriberi) may occur during acute illness in children with nutritional risk factors and should be considered in refractory hyperlactatemia. Timely treatment with parenteral thiamine can support dramatic hemodynamic recovery. Treatment of suspected thiamine deficiency should not be delayed for laboratory confirmation as current thiamine reference ranges correlate poorly with clinical severity, and functional testing may not be readily available.
Genetic alterations are related to clinicopathological features and risk of recurrence/metastasis of hepatocellular carcinoma
Authors: Meng Lili , Jiang Zhenjian , Shen Guangyue , Lin Shulan , Gao Feng , Guo Xinxin , Lv Bin , Hu Shuying , Ni Zheng , Chen Shanghua , Ji Yuan
Published: December 2024

Lack of efficient biomarkers and clinical translation of molecular typing impedes the implementation of targeted therapy for hepatocellular carcinoma (HCC). High-throughput sequencing techniques represented by next-generation sequencing (NGS) are tools for detecting targetable genes. The objective of this study is to explore the genetic alterations associated with clinicopathological features and the risk of recurrence/metastasis in HCC. NGS analysis was conducted on formalin-fixed paraffin-embedded tissues from 164 resected liver samples obtained from Chinese patients. Morphologic subtypes were reviewed based on hematoxylin-eosin and immunohistochemistry staining, Correlation to the acquired molecular features were analyzed with clinicopathological information. We also retrieved follow-up information of the 123 transplanted cases from 2017 to 2019 to screen recurrence/metastasis-associated factors by univariate analysis. Generally, the most frequently mutated genes include TP53 and CTNNB1 which showed a trend of mutually exclusive mutation. Copy-number variant with the highest frequency was detected in TAF1 and CCND1 in 11q13.3 loci. Correlation analysis showed that various genetic alterations were associated with morphologic subtypes and other pathologic features. While gene signatures of proliferation/nonproliferation class were correlated with differentiation, satellite foci and other invasive morphological features. Macrotrabecular-massive subtype, TSC2 (tuberous sclerosis complex 2) mutation, Ki-67 expression, and other six factors were found to be associated with recurrence/metastasis after liver transplantation. Genetic alterations detected by NGS show correlation with not only pathological and clinical features, but also with recurrence/metastasis after liver transplantation. Further gene-level molecular typing will be practical for targeted therapy and individual recurrence risk assessment in HCC patients.
Zero-count Detector
Authors: Semkow Thomas M.
Published: December 2024

We developed a statistical theory of zero-count-detector (ZCD), which is defined as a zero-class Poisson under conditions outlined in this paper. ZCD is often encountered in the studies of rare events in physics, health physics, and many other fields where counting of events occurs. We found no acceptable solution to ZCD in classical statistics and affirmed the need for the Bayesian statistics. Several uniform and reference priors were studied, and we derived Bayesian posteriors, point estimates, and upper limits. It was shown that the maximum-entropy prior, containing the most information, resulted in the smallest bias and the lowest risk, making it the most admissible and acceptable among the priors studied. We also investigated application of zero-inflated Poisson and Negative-binomial distributions to ZCD. It was shown using Bayesian marginalization that, under limited information, these distributions reduce to the Poisson distribution.
INCREASED RISK OF CYSTOID MACULAR EDEMA AFTER CATARACT SURGERY IN EYES PREVIOUSLY VITRECTOMIZED FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Iuliano Lorenzo , Maestranzi Gisella , Corbelli Eleonora , Rasore Gabriele , Bandello Francesco , Codenotti Marco
Published: December 2024

Purpose:

To assess the rate and risk factors of cystoid macular edema (CME) both after isolated vitrectomy and after subsequent phacoemulsification in eyes with primary noncomplicated rhegmatogenous retinal detachment (RRD) or idiopathic epiretinal membrane (ERM).

Methods:

Retrospective observation of institutional patients undergoing vitrectomy for RRD or vitrectomy with internal limiting membrane peeling for ERM from 2016 to 2021, further analyzing those who later underwent phacoemulsification. The CME rate was assessed within the first 6 months after both vitrectomy and cataract surgery.

Results:

The authors included 187 phakic eyes with ERM and 311 with RRD undergoing isolated vitrectomy. Postvitrectomy CME occurred in 12.8% of ERM cases compared with 1% in RRD cases (P < 0.0001). Stage-4 ERMs and intraoperative laser were found associated with CME. After uncomplicated phacoemulsification, the CME rate was higher in eyes vitrectomized for ERM (13.8%) compared with RRD (2%, P = 0.0055). Postvitrectomy CME was found to be associated with an increased risk of postcataract CME (odds ratio 13.588, P = 0.0187).

Conclusion:

In eyes undergoing phacoemulsification postvitrectomy, the risk of CME is higher when vitrectomy was performed for ERM compared with RRD. The ERM-related intraretinal changes, together with the required surgical stress, may play a role in making these eyes more susceptible to CME.
A Review of Contact Lens Regulations in the Asia Pacific Region
Authors: Lee Jie Rong Jerome , Yee Ting Hui , Levitz David , Lim Blanche Xiao Hong , Mehta Jodhbir Singh , Stapleton Fiona , Lim Chris Hong Long
Published: December 2024

The increased usage of nonrefractive cosmetic contact lenses in Asia and a trend toward increased online purchasing of both refractive and cosmetic contact lenses poses unique challenges in the management of contact lens–related complications. However, regulations have lagged behind this increased uptake in the community. This paper reviews regulations surrounding the manufacturing, import, and distribution of contact lenses in the Asia Pacific region and compares them with international regulations from the European Union and United States. It found a need for more specific regulations and closer surveillance targeted at new trends in contact lens purchasing and usage. This paper also found a need for more effective enforcement of current regulations.
Interactions between antidiabetes medications and heart–brain axis
Authors: Ong Leong Tung , Sia Ching-Hui
Published: December 2024

Purpose of review

The heart–brain axis (HBA) is the physiological interactions between the cardiovascular and nervous systems through autonomic nerves, hormones, and cytokines. Patients diagnosed with diabetes mellitus have an increased risk of the cardiovascular and neurological diseases. However, recent evidence demonstrated that different antidiabetic drugs may delay cognitive impairment and improve cardiovascular outcomes. This review examines the impact of antidiabetic drugs on the HBA in patients with diabetes.

Recent findings

Metformin improves the cardiovascular and cognitive outcomes through adenosine 5′-monophosphate-activated protein kinase activation. Sodium-glucose cotransporter-2 inhibitors reduce inflammation, oxidative stress by inhibiting the NLRP3 inflammasome thereby reducing the incidence of heart failure and formation of beta-amyloid and neurofibrillary tangles in the brain. Dipeptidyl peptidase-4 inhibitors exhibit neuroprotective effects in Alzheimer's disease by reducing amyloid-beta and tau pathology and inflammation but may exacerbate heart failure risk due to increased sympathetic activity and prolonged β-adrenergic stimulation. Glucagon-like peptide-1 receptor agonists exhibit neuroprotective effects in Alzheimer's and Parkinson's diseases by reducing neuroinflammation, but may increase sympathetic activity, potentially elevating heart rate and blood pressure, despite their cardioprotective benefits.

Antidiabetes medications have the potential to improve cardiovascular and cognitive outcomes; however, additional studies are required to substantiate these effects.
The State of Medical Care for Adults With Intellectual and/or Developmental Disabilities
Authors: Ervin David A.
Published: December 2024

For more than 2 decades, medical care for adults with intellectual and/or developmental disabilities (IDDs) has been difficult to access and has not substantially changed the persistently poor health status that is common in this population cohort. While there has been some progress in the development of models of care that are designed with and for adults with IDD, it has been slow and sporadic, with little data or analyses of efficacy or effectiveness. Very few medical schools and other health science professional education in the United States include curricular content on adults with IDD, resulting in health care practitioners being under or altogether unprepared to provide care to them. Public and private health care policy and financing are not responsive to the medical care needs and experiences of adults with IDD. More recently, the impact of the COVID-19 pandemic on adults with IDD was disproportionally more severe, with significantly higher rates of morbidity and mortality than on adults without IDD, having nothing to do with the presence of an IDD itself. This commentary reviews persistent barriers to accessible, responsive medical care for adults with IDD and reviews a number of health care models that have been developed since the turn of the 21st century. It also offers a brief review of Medicaid Managed Care as a potential policy and financing solution to long-standing financing and related obstacles to optimal medical care.
Atherogenic low-density lipoprotein and cardiovascular risk
Authors: Hernando-Redondo Javier , Niño Olga Castañer , Fitó Montse
Published: December 2024

Purpose of review

Despite reductions in low-density lipoprotein (LDL) cholesterol (LDLc), residual cardiovascular risk remains due to factors beyond lipoprotein levels, such as LDL particle count, size, electronegativity and modifications. Technological advances allow detailed profiling of LDL particles, offering potential biomarkers for diagnosis, prognosis, and treatment of cardiovascular disease (CVD). The aim of this review is to provide an updated overview of the state of knowledge in the field of LDL atherosclerotic role, which is evolving rapidly due to technological advances in biomarker measurement and applications.

Recent findings

While small dense LDL has been linked to increased CVD risk, current approaches favor a comprehensive evaluation of all lipoprotein subtypes, as this is a more feasible and standardized method. The atherogenic potential of circulating oxidized LDL (oxLDL) may be the key factor in the onset and progression of atherosclerosis. Thus, elevated oxLDL levels are recognized as a marker of increased CVD risk in both general and high-risk populations, although further research is needed to clarify some conflicting findings. The oxidized LDL receptor 1 (LOX-1) has emerged as a promising target for immunotherapy and innovative drug delivery strategies to modulate atherosclerosis.

A panel of biomarkers related to LDL atherogenicity may help predict future ischemic events. An atheroprotective diet and increased physical activity could improve LDL oxidation. OxLDL has become a target for immunomodulatory antiatherosclerosis therapy and delivering LDL-based nanocarriers holds promise for both imaging and therapeutics.
Time to Resolution of Severe Anemia in Young Children With Iron Deficiency
Authors: Leister John , Norby Faye L. , Boucher Alexander A.
Published: December 2024

Iron deficiency anemia in children remains a pervasive problem. Prolonged iron deficiency anemia (IDA) is linked to adverse neurodevelopmental outcomes, but the duration of severe IDA (hemoglobin <7 g/dL) in children is poorly studied, particularly for racial/ethnic minority groups. We reviewed the electronic medical records of 92 children (1 to 5 y old) with IDA within a major metropolitan health care system. Duration of anemia, hemoglobin at diagnosis and nadir, age, sex, race/ethnicity, and the use of intravenous interventions were analyzed by Kaplan-Meier curves, Cox regression, and logistic regression. The majority of the included children were Asian (72.8%). Anemia resolution was documented in 68% of cases, and 47% of cases received intravenous intervention. Iron repletion was only confirmed in 37% of cases (n=34), leaving many children with unclear resolution at risk for recurrence. Caucasian children had anemia resolution faster than Black or Asian children, and the latter groups were also less likely to reach hemoglobin normalization. Children with intravenous interventions were more likely to have documented resolution than those with only oral treatment. Those receiving intravenous interventions were more likely to be followed through anemia resolution, although treatment standardization was lacking, and confirmation of iron storage repletion was rarely checked. Future studies should emphasize the importance of ensuring iron storage replacement and potentially utilize time-to-anemia resolution data to determine optimal hemoglobin values for intravenous iron as a first-line intervention.
Telehealth in Gynecologic Oncology Clinical Trials
Authors: Andriani Leslie , Saikali Linda M. , Plenn Eion , Gleason Emily , Grabill Megan , Bilger Andrea , Koelper Nathanael C. , Smith Anna Jo B. , Rendle Katharine A. , Simpkins Fiona , Ko Emily M.
Published: December 2024

OBJECTIVE:

To describe patient, research staff, and clinician perspectives regarding the effects of telehealth and remote clinical trial operations on safety, quality, and experience in gynecologic oncology clinical trials.

METHODS:

This qualitative study used semistructured interviews conducted from May to June 2022 with purposively sampled clinical trial participants, research staff, and clinicians involved in gynecologic oncology clinical trials with telehealth utilization. Participants described telehealth in clinical trial experiences, including benefits and barriers to receipt and provision of care, satisfaction, and quality. Transcripts were coded and analyzed with a modified content analysis approach based on research objectives and emergent themes. An adapted version of the validated Telehealth Usability Questionnaire was administered to all invited participants.

RESULTS:

Five patients, seven clinicians, and five research staff were interviewed. Patients and clinicians reported that telehealth, remote testing, and medication delivery positively affected quality of life by reducing financial burden, wait times, and transportation needs. Interviewees did not report telehealth-related changes in treatment-related adverse effects, referrals for urgent evaluation, or compromise of privacy but expressed concerns about the lack of physical examinations. Patients reported that telehealth increased scheduling burden without negative effects on care quality, counseling comprehension, relationships with trial teams, or satisfaction. Clinicians and research staff reported improved workflows regarding remote consent, sponsor interactions, and documentation but challenges with virtual patient education and off-site testing. Clinicians highlighted disparities for patients with limited technology access and reported institutional and insurance-based telehealth policies as barriers. Survey responses supported qualitative findings.

CONCLUSION:

Despite notable limitations, patients, research staff, and clinicians recommended continued utilization of telehealth and remote clinical trial operations in clinical trials. Future clinical trial designs should consider telehealth inclusion.
Understanding Strategies to Reduce the Impact of Non-urgent Visits to the Pediatric Emergency Department
Authors: Qureshi Erica , Nguyen Kelly , Burstein Brett , Moe Jessica , Miller Steven P. , Meckler Garth , Doan Quynh
Published: December 2024

Context:

The pediatric emergency department (PED) is increasingly being used for non-urgent reasons. This impacts PED input and throughput, and contributes to overcrowding. To identify solutions, it is essential to identify and describe the approaches that have been trialed.

Objective:

We completed a scoping review to identify and then describe the design and outcomes of all initiatives undertaken to reduce the impact of non-urgent visits on the PED.

Data Sources:

We searched 4 databases (MEDLINE, EMBASE, EBM, and CINAHL) to identify research published from the database inception until March 31, 2024.

Study Selection:

Studies met our inclusion criteria if they focused on the pediatric ED, defined non-urgent visits, described an intervention (hypothesizing it would reduce the impact of non-urgent visits on the PED), and reported on the interventions impact.

Data Extraction:

The title and abstract of each study were independently screened for inclusion by 2 reviewers (E.Q., K.N.), and disagreements were resolved by deliberation until consensus was achieved. This process was then repeated for the full text of all articles.

Results:

In total, we screened 11,600 articles and 20 were included. Nine interventions focused on PED input, 10 on PED throughput, and 1 on both PED input and throughput. Definitions of non-urgent visits and outcomes measures used to assess the effectiveness of an intervention differed between studies. Three types of strategies employed to reduce the impact of non-urgent visits on the PED were identified, these include (1) engaging nonpediatric emergency medicine clinicians by including them into the PED or connecting non-urgent patients to community locations for care, (2) reorganizing PED operations in anticipation of non-urgent visits, and (3) providing education to prevent future non-urgent visits.

Conclusions:

Consistent definitions of non-urgent visits and standardized outcome measures may allow for more precise comparisons between studies. We identify 3 commonly employed strategies that may help reduce the impact of non-urgent visits on the PED.
Children and Restraints Study in Emergency Ambulance Transport-Cardiopulmonary Resuscitation (CARSEAT-CPR)
Authors: Cochran-Caggiano Nicholas , Tse Whitney , Swinburne Cecily , Lang Nicholas , Till Sara , Donovan Sean , Woodson Mary Clare C. , Dailey Michael W.
Published: December 2024

Objectives

To compare the ability to perform basic life support (BLS) skills on children and infants in a moving ambulance whether or not they are properly secured to the stretcher.

Methods

Emergency Medicine Services provider ability to perform BLS skills was measured in moving ambulances on a closed course using an analog for child and infant cardiac arrest. Data were compared for child and infant manikins secured to the stretcher via different methods in simulated patient resuscitations performed by 24 participants.

Results

We found that there was no significant difference in mean rate (P = 0.104), depth (P = 0.21), or chest compression fraction (P = 0.92) between tests on restrained and unrestrained pediatric manikins. For infants, there was a 4-mm difference in compression depth (P = 0.0018). The clinical significance of this difference is not readily apparent. Infant tests did not show a difference in compression rate (P = 0.35) or compression fraction (P = 0.26). Across all tests, the rate and depth of compressions were adequate, but compression fraction was not adequate in the infant simulations. There were no differences in ventilations between restrained and unrestrained simulations (child P = 0.15; infant P = 0.13) but both were less than the American Heart Association recommendation.

Conclusions

In this simulation study, it was found that there was no significant difference noted in BLS adequacy between unrestrained pediatric patients and those restrained with commercial devices. Overall, the ability to perform appropriate BLS on children was equivocal and our simulations suggested BLS could not be adequately performed on infants regardless of restraint type/status.
The Effect of Graded Motor Imagery on Pain and Function in Individuals with Knee Osteoarthritis
Authors: Yıldız Kızkın Zeynep , Oğuz Semra , Ak Semih
Published: December 2024

Objective

To examine whether graded motor imagery (GMI) was as effective as transcutaneous electrical nerve stimulation (TENS) in improving pain and functionality in patients with knee osteoarthritis (PwKOA).

Design

Forty-six PwKOA were randomized (1:1) into the GMI and the TENS groups. Both groups participated in home-based and functional exercises. A visual analog scale (VAS), the pressure pain threshold, range of motion (ROM), muscle strength, the Timed Up and Go Test, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline, after 8 weeks of treatment, and after a 6-week follow-up period.

Results

The within-group comparisons showed significant improvements in outcomes for both treatments. However, the difference between the groups was significant in favor of the GMI group in knee flexion ROM, knee extensor muscle strength, and WOMAC-pain and WOMAC-function parameters at the end of the treatment, and VAS-activity, knee flexor muscle strength, and WOMAC-stiffness values showed greater improvement in the GMI group compared with the TENS group at the end of the 6-week follow-up (for all, p < 0.05).

Conclusions

GMI seems to be a more effective adjuvant than TENS. If applied in PwKOA, pain and functional recovery improved, and results were maintained for up to 6 weeks.
Fostering Inclusivity in PM&R: A National Survey
Authors: Adeniyi Adedeji , Fuentes Shane , Farah Raysha , Lawani Sahadah , Sosa Oliver , Puckerine Mikaili , Stein Joel , von Rickenbach Kristian J
Published: December 2024

There is a persistent underrepresentation of women and multiple ethnic minority groups among medical school and residency applicants and trainees, particularly in Physical Medicine and Rehabilitation (PM&R). There is limited information on what causes these demographic disparities in PM&R and on strategies to increase interest in the field. To address this gap and improve early recruitment efforts, the authors conducted the first-ever national survey to gather information on pre-medical students’ perceived barriers to medical school admissions, career interests, perceptions of PM&R, and strategies to increase interest in PM&R. The survey received 1093 responses from 236 colleges with a diverse representation of participants, including 53.3% (n = 583) from historically underrepresented groups such as those Underrepresented in Medicine (URiM), and those from rural communities, and/or low socioeconomic backgrounds. Only 31.2% (n = 313) knew the existence of PM&R. However, 60.0% (n = 568) of respondents were interested in learning more about PM&R through shadowing a PM&R physician (82.2%, n = 780), attending workshops (75.9%, n = 720), and mentorship (58.9%, n = 559). The national survey revealed limited exposure to PM&R at the pre-medical level but a strong interest in dedicated mentorship and workshops, suggesting effective strategies to address underrepresentation.
Epidemiological, clinical and mortality trends in people living with HIV over 60 years in the PISCIS population-based cohort from Catalonia and Balearic Islands
Authors: Bruguera Andreu , Nomah Daniel K. , Moreno-Fornés Sergio , Martinez Esteban , Negredo Eugènia , Tiraboschi Juan , Navarro Jordi , Domingo Pere , Fanjul Francisco , Villoslada Aroa , Peraire Joaquim , Jaen Angeles , Miró José M. , Casabona Jordi , Reyes-Urueña Juliana
Published: December 2024

Objective:

With HIV now a chronic condition and an aging population, understanding the evolving profiles of older people living with HIV (PWH) is crucial. In this longitudinal study we examined changes in epidemiological and mortality trends among aging PWH aged 60 and above from 1998 to 2021.

Design:

The study constructed four retrospective cohorts based on our calendar periods, reflecting the changing epidemiology of HIV - 1998-2003, 2004-2008, 2009-2014, and 2015-2021. Each calendar period included patients on follow-up that turned 60 during that period in PISCIS, the Populational HIV Cohort from Catalonia and Balearic Islands.

Methods:

Sociodemographic and clinical characteristics were analysed and compared between periods, and 5-year mortality-associated factors were assessed.

Results:

Results indicate the proportion of those infected through intravenous drug use in older PWH has increased (4.7% in 1998-2003 vs 24.7% in 2015-2021), as well as those born outside Spain (7.5% vs 21.8%), alongside a lesser percentage of late HIV diagnoses (59.9% vs 46.8%), reflecting a change in older PWH epidemiological profile. The presence of ≥3 comorbidities emerged as a significant predictor of 5-year mortality in the latest cohort, while CD4 cell count of <200 cells/μL at the age of 60 lost significance [1998-2008: HR:3.19 (CI:1.18-8.63) – 2015-2021: HR:1.38 (CI:0.74-2.59)], underscoring the transition to the chronic disease era of the HIV pandemic.

Conclusion:

Despite advanced treatment strategies have improved HIV health indicators, new challenges have emerged among the older PWH. Tailored interventions addressing the unique difficulties faced by this population are essential to optimize HIV care outcomes.
Pregnancy Outcomes and All-Cause Mortality Following Pregnancy among U.S.-Born Women with Perinatally Acquired HIV
Authors: Abraham Bisrat K. , Vogler Mary , Talati Achala , Suresh Prapitha , Gill Balwant , Ravikumar Saiganesh , Shepard Colin , Gulick Roy , Nash Denis , Peters Vicki
Published: December 2024

Background:

Maternal and pregnancy outcomes among women with perinatally acquired HIV (PHIV) versus women with HIV acquired through other routes (NPHIV), are not fully understood.

Setting:

U.S.-born women during 2005–2015 in New York City (NYC)

Methods:

We utilized data from the NYC HIV surveillance registry, Expanded Perinatal Surveillance (EPS) database, and Vital Statistics, to compare pregnancy and all-cause mortality outcomes among women with PHIV versus NPHIV delivering infants during 2005–2015.

Results:

There were 186 deliveries among 137 women with PHIV and 1188 deliveries among 910 women with NPHIV. Women with PHIV were younger at delivery, more likely to be aware of their HIV status, and less likely to use substances or be incarcerated. At the time of delivery, women with PHIV were more likely to have HIV RNA>1,000 copies/mL (34% vs. 19%), CD4<200 cells/µL (18% vs. 7%; median CD4 300 cells/µL vs. 435 cells/µL), to have adequate prenatal care (43% vs. 35%), and to deliver by elective C-section (63% vs. 49%). There were no differences in intrapartum and neonatal antiretroviral therapy use, perinatal transmission, gestational age and birth weight of the infants, nor infant mortality. Women with NPHIV had higher survival compared to women with PHIV (RR=2.29, P=0.004; age-adjusted aRR=3.23, P<0.001; age and CD4 adjusted aRR=2.09, P=0.046).

Conclusions:

Women with PHIV had lower long-term survival after delivery likely due to limited HIV treatment options in childhood and a longer duration of HIV infection, underscoring the importance of close follow-up and tailored support services beyond the post-partum period.
Update on syphilis diagnostics
Authors: Sweitzer Stephanie , Duncan Joseph A. , Seña Arlene C.
Published: December 2024

Purpose of review

Syphilis is rising globally, with resultant increases in morbidity and mortality that disproportionately impact underserved populations. Appropriate screening and testing for syphilis with accurate, reliable, affordable, and timely assays is crucial for combating this epidemic. This review provides a brief overview of laboratory methods for syphilis diagnosis, with a focus on recent updates in diagnostics and directions for future research.

Recent findings

Syphilis can be complex and time-consuming to diagnose and stage appropriately. The historic use of darkfield microscopy for diagnosis has been eclipsed by algorithms that include both nontreponemal and treponemal antibody tests for screening and confirmation of active Treponema pallidum infection. Newer diagnostic modalities include nucleic acid amplification assays (NAATs) and point-of-care testing (POCT), which hold promise for increasing identification of active syphilis but have notable limitations. More work is needed to develop accurate, reliable, affordable, and expeditious tests to optimize syphilis diagnosis.

Algorithms utilizing a combination of serological treponemal and nontreponemal assays remain standard of care for the diagnosis of syphilis, but recently developed NAATs and POCT assays present opportunities to increase syphilis detection. Further research is warranted to improve upon these testing modalities and explore other markers that could aid in syphilis diagnosis.
Climate change and extreme weather events and linkages with HIV outcomes: recent advances and ways forward
Authors: Logie Carmen H. , MacNeil Andie
Published: December 2024

Purpose of review

Discuss the recent evidence on climate change and related extreme weather events (EWE) and linkages with HIV prevention and care outcomes.

Recent findings

We identified 22 studies exploring HIV prevention and care in the context of EWE. HIV prevention studies examined sexual practices that increase HIV exposure (e.g., condomless sex, transactional sex), HIV testing, and HIV recent infections and prevalence. HIV care-related outcomes among people with HIV included clinical outcomes (e.g., viral load), antiretroviral therapy adherence and access, HIV care engagement and retention, and mental and physical wellbeing. Pathways from EWE to HIV prevention and care included: structural impacts (e.g., health infrastructure damage); resource insecurities (e.g., food insecurity-related ART adherence barriers); migration and displacement (e.g., reduced access to HIV services); and intrapersonal and interpersonal impacts (e.g., mental health challenges, reduced social support).

Studies recommended multilevel strategies for HIV care in the context of EWE, including at the structural-level (e.g. food security programs), health institution-level (e.g., long-lasting ART), community-level (e.g. collective water management), and individual-level (e.g., coping skills). Climate-informed HIV prevention research is needed. Integration of EWE emergency and disaster preparedness and HIV services offers new opportunities for optimizing HIV prevention and care.
Extending Amyloidosis Diagnosis
Authors: Arslan Dilsat Fırat , Inal Ekin , Isik Emine Göknur , Sanli Yasemin
Published: December 2024

We present a case with systemic amyloidosis secondary to immunoglobulin light-chain amyloidosis (AL amyloidosis), which 18F-FDG PET/CT and 99mTc-PYP scintigraphy revealed amyloid deposition in the peritoneum, omentum, and mesentery. AL amyloidosis is characterized by the proliferation of clonal plasma cells and increased production and extracellular accumulation of immunoglobulin light chains, leading to organ malfunction. Even though AL amyloidosis can affect the gastrointestinal system, peritoneal involvement is rarely observed. PET/CT and SPECT/CT images showed moderate to slightly increased tracer uptake in affected organs.
Long Terms Results of Temporal Facelift: 6 Years of Experience in 250 Cases
Authors: Şirinoglu Hakan , Ergün Tatar Burak , Güvercin Emre
Published: December 2024

Background:

Temporal facelift (TFL) is an innovative technique for lifting the upper and mid-face. It is characterized by a unique dissection plane above the subgaleal fascia, which seamlessly transitions into the sub-superficial muscular aponeurotic system (SMAS) layer in the mid-face. This approach enables comprehensive mid-face elevation, robust canthopexy, and a significant brow lift in various vectors.

Objectives:

The authors present their experience with 250 TFL procedures over a period of 6 years.

Patients and Methods:

This retrospective study analyzed 250 of 441 patients who underwent TFL surgery. The surgical procedures, conducted under general anesthesia by a senior surgeon following the TFL method, involved a vertical-vector deep-plane mid-face lift, canthopexy, and brow-lift triad. Close monitoring of complications and detailed photographic documentation of the outcomes were performed. Postoperative care included taping the operation area to reduce swelling, with subsequent follow-up examinations and interventions such as lymphatic massage and botulinum toxin injections for asymmetric brow movements or steroid injections for excessive mid-face swelling.

Results:

Among 250 patients (248 female, 2 male; mean age, 37 y), unilateral neuropraxia of the frontal branch of the facial nerve occurred in 5.6% and resolved spontaneously within 2.8 months. Persistent dimples (2.8%) resolved by the fifth postoperative month. Six patients (2.4%) underwent revision surgery with no observed complications like hematoma, necrosis, infection, or seroma.

Conclusions:

The TFL technique represents a significant advancement in upper and mid-face lifting procedures and offers several advantages over the traditional methods.
Yearning for Youth and Vitality: A Plastic Surgeon’s View of “The House of the Sleeping Beauties” by Yasunari Kawabata
Authors: Hwang Kun
Published: December 2024

The aim of this study was to analyze “The House of the Sleeping Beauties” (眠れる美女) by Yasunari Kawabata from the perspectives of plastic surgery, and psychiatry/psychology. The central theme of the novel focuses on aging, desire, and the human connection to beauty and mortality. The protagonist, Eguchi, frequents a brothel where elderly men lie next to young women who are drugged and remain unconscious. This setting highlights the longing for youth and vitality, themes that are prevalent in plastic surgery. From this perspective, the novel offers a somber reflection on the extremes to which individuals might go in an effort to reconnect with their youth, even if it is only symbolic or temporary. Eguchi’s journey serves as a metaphor for aging individuals who turn to beauty treatments or cosmetic enhancements in an attempt to regain their lost youth. Unlike the temporary illusion of rejuvenation provided by plastic surgery or anti-aging treatments, the novel highlights the futility and inherent sadness of attempting to recapture what is irretrievably lost. From a psychiatric perspective, the novel may be seen as an exploration of escapism, sexual repression, or unresolved trauma. The setting, characterized by the objectification and infantilization of women, could represent a dissociative mechanism. In this scenario, elderly men project their fantasies and desires onto unconscious women, thereby sidestepping the harsh realities of aging, intimacy, and rejection. In the anti-aging surgery of male patients, it is crucial to recognize their longing for youth and vitality, a sentiment shared by both Kawabata and Eguchi.
Post-discharge telephone follow-up calls to patients with chronic obstructive pulmonary disease by primary care nurses: a best practice implementation project
Authors: Molina-Vázquez Iris , Rodríguez-León María Ángeles , Montes-Alamilla Desiré , Suárez-Sánchez Juan José , Albornos-Muñóz Laura
Published: December 2024

Introduction:

Chronic obstructive pulmonary disease (COPD) is a complex health problem, with important repercussions for patients and their families. Interventions need to be improved to prevent exacerbations and reduce high readmission and mortality rates. Evidence suggests that including a telephone follow-up (TFU) call in discharge plans could improve outcomes in patients with a chronic disease.

Objectives:

This project aimed to improve how primary care nurses in Gran Canaria, Spain, followed up COPD patients after hospital discharge.

Methods:

This project was guided by the JBI Evidence Implementation Framework, which includes the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) method. The JBI approach uses audit, feedback, and re-audit to promote evidence-based health care.

Results:

A baseline audit was conducted to compare current practices against best practices. Five barriers to best practices were identified and improvement strategies were developed. The follow-up audit revealed 100% compliance for Criteria 1 and 2, which related to COPD patients having a discharge plan and that plan including TFU. There was a 4.88% improvement for both Criteria 3 and 4, which involved the TFU being prompt and using a validated clinical questionnaire. Following project implementation, the 30-day readmission rate increased from 2.78% to 4.88% but the 30-day emergency room presentation rate decreased from 25% to 9.76%.

Conclusions:

The practice changes were partly achieved, but further strategies are needed to achieve full compliance. Educational programs are necessary when conducting improvement projects. Chances of success increase when decisions about hospital discharge involve both the hospital and the primary care service.

Spanish abstract:

http://links.lww.com/IJEBH/A296
Model-driven exploration of poro-viscoelasticity in human brain tissue: be careful with the parameters!
Authors: Greiner Alexander , Reiter Nina , Hinrichsen Jan , Kainz Manuel P. , Sommer Gerhard , Holzapfel Gerhard A. , Steinmann Paul , Comellas Ester , Budday Silvia
Published: December 2024

The brain is arguably the most complex human organ and modelling its mechanical behaviour has challenged researchers for decades. There is still a lack of understanding on how this multiphase tissue responds to mechanical loading and how material parameters can be reliably calibrated. While previous viscoelastic models with two relaxation times have successfully captured the response of brain tissue, the Theory of Porous Media provides a continuum mechanical framework to explore the underlying physical mechanisms, including interactions between solid matrix and free-flowing interstitial fluid. Following our previously published experimental testing protocol, here we perform finite element simulations of cyclic compression–tension loading and compression–relaxation experiments on human brain white and gray matter specimens. The solid volumetric stress proves to be a crucial factor for the overall biphasic tissue behaviour as it strongly interferes with porous effects controlled by the permeability. An inverse parameter identification reveals that poroelasticity alone is insufficient to capture the time-dependent material behaviour, but a poro-viscoelastic formulation captures the response of brain tissue well. We provide valuable insights into the individual contributions of viscous and porous effects. However, due to the strong coupling between porous, viscous, and volumetric effects, additional experiments are required to reliably determine all material parameters.
Inferring
in vivo
murine cerebrospinal fluid flow using artificial intelligence velocimetry with moving boundaries and uncertainty quantification
Authors: Toscano Juan Diego , Wu Chenxi , Ladrón-de-Guevara Antonio , Du Ting , Nedergaard Maiken , Kelley Douglas H. , Karniadakis George Em , Boster Kimberly A. S.
Published: December 2024

Cerebrospinal fluid (CSF) flow is crucial for clearing metabolic waste from the brain, a process whose dysregulation is linked to neurodegenerative diseases like Alzheimer’s. Traditional approaches like particle tracking velocimetry (PTV) are limited by their reliance on single-plane two-dimensional measurements, which fail to capture the complex dynamics of CSF flow fully. To overcome these limitations, we employ artificial intelligence velocimetry (AIV) to reconstruct three-dimensional velocities, infer pressure and wall shear stress and quantify flow rates. Given the experimental nature of the data and inherent variability in biological systems, robust uncertainty quantification (UQ) is essential. Towards this end, we have modified the baseline AIV architecture to address aleatoric uncertainty caused by noisy experimental data, enhancing our measurement refinement capabilities. We also implement UQ for the model and epistemic uncertainties arising from the governing equations and network representation. Towards this end, we test multiple governing laws, representation models and initializations. Our approach not only advances the accuracy of CSF flow quantification but also can be adapted to other applications that use physics-informed machine learning to reconstruct fields from experimental data, providing a versatile tool for inverse problems.