bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of traditional roughage-based or limit-fed, high-energy diets on growth performance and digestion in newly received growing cattle and subsequent implications on feedlot growth performance and carcass characteristics
Authors: Scilacci Morgan A , Titgemeyer Evan C , Duncan Zachary M , Spore Tyler J , Montgomery Sean P , O’Quinn Travis G , Tarpoff Anthony J , Hollenbeck William R , Blasi Dale A
Published: May 2024

The objective was to determine the effects of ad libitum-fed roughage-based diets or limit-fed high-energy diets on growth performance, behavior, health, and digestion in newly received growing cattle and subsequent implications on feedlot growth performance and carcass characteristics. In experiment 1, 409 crossbred heifers (initial body weight [BW] = 279 ± 24 kg) in 32 pens were used in a randomized block design. Heifers were fed one of two dietary treatments: a total mixed ration with 0.99 Mcal net energy for gain (NEg)/kg dry matter (DM) fed ad libitum (0.99AL) or 1.32 Mcal NEg/kg DM limit-fed at 85% of intake of heifers fed 0.99AL (1.32LF85%). Both diets contained 40% DM as a branded wet corn gluten feed. In experiment 2, 370 crossbred heifers (initial BW = 225 ± 20 kg) were used in a randomized block design and were fed a diet formulated to contain 0.99 Mcal of NEg/kg DM for ad libitum intake or a diet formulated to contain 1.32 Mcal of NEg/kg DM and fed at 2.2% of BW daily (DM basis; 1.32LF2.2). For experiments 1 and 2, treatment integrity was maintained through the finishing phase where cattle were fed a common diet. Cattle were sorted by BW into heavy and light groups prior to finishing, with light cattle fed longer than heavy cattle to reach similar harvest BW. In experiment 3, eight ruminally cannulated heifers (average BW = 305 ± 23 kg) were used in a 2-period cross-over design and fed treatments from experiment 1 to assess digestibility and ruminal fermentation characteristics. Gain:feed was 47% and 35% greater (P < 0.01) in experiments 1 and 2, respectively, for limit-fed heifers compared with 0.99AL heifers. Rumination time was greater (P < 0.01) for 0.99AL compared with limit-fed treatments in experiments 1 and 2. Activity was greater (P < 0.01) for 1.32LF2.2 than for 0.99AL in experiment 2. In experiment 1, more (P = 0.03) carcasses from light-sort heifers than carcasses from heavy-sort heifers had livers with large, active abscesses. In experiment 2, finishing phase morbidity was greater (P < 0.01) for 1.32LF2.2 than for 0.99AL. Light-sort groups had fewer (P < 0.01) edible livers than heavy-sort groups, suggesting that greater number of days on feed may increase the risk of liver abscess prevalence and condemnation. In experiment 3, apparent total-tract DM and organic matter digestibilities were greater (P < 0.01) for 1.32LF85% than for 0.99AL. Overall, dietary treatments during the growing phase had little carryover effect on feedlot growth performance, carcass characteristics, or liver abscesses prevalence at harvest.
Genome-Informed Trophic Classification and Functional Characterization of Virulence Proteins from the Maize Tar Spot Pathogen Phyllachora maydis
Authors: Rogers Abigail , Jaiswal Namrata , Roggenkamp Emily , Kim Hye-Seon , MacCready Joshua S. , Chilvers Martin I. , Scofield Steven R. , Iyer-Pascuzzi Anjali S. , Helm Matthew
Published: May 2024

Phyllachora maydis is an ascomycete foliar fungal pathogen and the causal agent of tar spot in maize. Although P. maydis is considered an economically important foliar pathogen of maize, our general knowledge of the trophic lifestyle and functional role of effector proteins from this fungal pathogen remains limited. Here, we utilized a genome-informed approach to predict the trophic lifestyle of P. maydis and functionally characterized a subset of candidate effectors from this fungal pathogen. Leveraging the most recent P. maydis genome annotation and the CATAStrophy pipeline, we show that this fungal pathogen encodes a predicted carbohydrate-active enzymes (CAZymes) repertoire consistent with that of biotrophs. To investigate fungal pathogenicity, we selected 18 candidate effector proteins that were previously shown to be expressed during primary disease development. We assessed whether these putative effectors share predicted structural similarity with other characterized fungal effectors and determined whether any suppress plant immune responses. Using AlphaFold2 and Foldseek, we showed that one candidate effector, PM02_g1115, adopts a predicted protein structure similar to that of an effector from Verticillium dahlia. Furthermore, transient expression of candidate effector-fluorescent protein fusions in Nicotiana benthamiana revealed two putative effectors, PM02_g378 and PM02_g2610, accumulated predominantly in the cytosol, and three candidate effectors, PM02_g1115, PM02_g7882, and PM02_g8240, consistently attenuated chitin-mediated reactive oxygen species production. Collectively, the results presented herein provide insights into the predicted trophic lifestyle and putative functions of effectors from P. maydis and will likely stimulate continued research to elucidate the molecular mechanisms used by P. maydis to induce tar spot.
Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center
Authors: Madhvani Kiran R. , Fong Angus , Clark Thomas , Eng Khemerin , Condurache Codrin , McGregor-Riley Jonathan , Shields David W.
Published: May 2024

OBJECTIVES:

The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo–Anderson 3B open tibial fractures.

METHODS:

Design:

A prospectively maintained database was retrospectively interrogated.

Setting:

Single major trauma center in the United Kingdom.

Patient Selection Criteria:

All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors.

Outcome Measures and Comparisons:

The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions.

RESULTS:

Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases.

CONCLUSIONS:

Orthoplastic care including circular frame fixation for Gustilo–Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%).

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Intraoperative Hypotension Is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery
Authors: Glassman Steven D. , Carreon Leah Y. , Djurasovic Mladen , Chappell Desiree , Saasouh Wael , Daniels Christy L. , Mahoney Colleen H. , Brown Morgan E. , Gum Jeffrey L.
Published: May 2024

Study Design.

Retrospective observational cohort.

Objectives:

This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.

Summary of Background Data.

IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.

Methods.

A total of 539 thoracolumbar fusion cases, more than six surgical levels and >3 hours duration, were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1-minute intervals. Cummulative duration of MAP <65 mm Hg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI, and encephalopathy were noted. Cumulative complications were grouped as none, one to two complications, or more than three complications.

Results.

There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs. 5.6 min, P<0.001) and across the entire procedure (28.1 vs. 19.3 min, P=0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT, and postoperative cognitive dysfunction. Comparison of patients with zero versus one to two versus three or more complications demonstrated that patients with three or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had one to two or three or more complications.

Conclusion.

This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multilevel lumbar fusion surgery.

Level of Evidence.

III.
Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion
Authors: Gouzoulis Michael J. , Seddio Anthony E. , Winter Adam D. , Jabbouri Sahir S. , Zhu Justin R. , Rubio Daniel R. , Varthi Arya G. , Grauer Jonathan N.
Published: May 2024

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion.

Summary of Background data.

Navigation has become increasingly utilized for posterior lumbar fusion (PLF). More recently, robotic-assisted systems have been gaining traction. However, the incremental advantage of these systems has been unclear in the literature.

Methods.

Patients undergoing one-level to three-level PLF (with or without anterior or posterior interbody fusion) were identified from the 2015 to 2022 M161Ortho PearlDiver Database using CPT codes. Navigation assistance was identified based on CPT coding and robotic assistance was based on ICD-10 procedural coding. Navigation-assisted cases were matched 4:1 to robotic-assisted patients based on age, sex, Elixhauser Comorbidity Index, number of levels fuse, and concomitant anterior fusion. Incidence of 90-day adverse outcomes were assessed and compared with multivariable logistical regression. Bonferroni correction was applied for multiple testing. Rate of reoperation was assessed using the Kaplan-Meier survival analysis.

Results.

From 2015 to 2022, there has been a significant increase in both navigation-assisted and robotic-assisted lumbar fusions, with navigation-assisted surgery being significantly more common. After matching, there were 2401 navigation-assisted cases and 651 robotic-assisted cases. On multivariate analysis, there were no significant differences in 90-day any, severe, or minor adverse events. There was a significant increase odd of readmissions in the robotic cohort (OR: 1.77, P<0.001). There were no differences in 3-year reoperation rates between the navigation-assisted and robotic-assisted cohorts (95.8% vs. 94.0%, P=0.30).

Conclusions.

As spinal navigation has been gaining popularity and robotic assistance is starting to be further utilized, the incremental advantage of different techniques may be questioned. While further study and technique evolution are ongoing, the current study was not able to demonstrate 90-day or 3-year incremental advantages for robotics relative to navigation based on the metrics evaluated.

Level of Evidence.

Level III.
Targeting HSP47 for cancer treatment
Authors: Shi Run , Yu Ruixue , Lian Fei , Zheng Yalong , Feng Shunhang , Li Changzhi , Zheng Xinhua
Published: May 2024

Heat shock protein 47 (HSP47) serves as an endoplasmic reticulum residing collagen-specific chaperone and plays an important role in collagen biosynthesis and structural assembly. HSP47 is encoded by the SERPINH1 gene, which is located on chromosome 11q13.5, one of the most frequently amplified regions in human cancers. The expression of HSP47 is regulated by multiple cellular factors, including cytokines, transcription factors, microRNAs, and circular RNAs. HSP47 is frequently upregulated in a variety of cancers and plays an important role in tumor progression. HSP47 promotes tumor stemness, angiogenesis, growth, epithelial-mesenchymal transition, and metastatic capacity. HSP47 also regulates the efficacy of tumor therapies, such as chemotherapy, radiotherapy, and immunotherapy. Inhibition of HSP47 expression has antitumor effects, suggesting that targeting HSP47 is a feasible strategy for cancer treatment. In this review, we highlight the function and expression of regulatory mechanisms of HSP47 in cancer progression and point out the potential development of therapeutic strategies in targeting HSP47 in the future.
LONG-TERM VISUAL OUTCOMES AND OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS IN EYES WITH MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION FOLLOWING ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY
Authors: Viggiano Pasquale , Bisceglia Giulia , Bacherini Daniela , Chhablani Jay , Grassi Maria Oliva , Boscia Giacomo , Borrelli Enrico , Reibaldi Michele , Evangelista Federica , Alessio Giovanni , Boscia Francesco
Published: May 2024

Purpose:

To evaluate the structural characteristics and long-term visual outcomes in eyes impacted by macular edema as a consequence of retinal vein occlusion that has undergone effective treatment with anti–vascular endothelial growth factor therapy.

Methods:

Inclusion criteria comprised 42 eyes of 41 patients, subjected to long-term follow-up, displaying resolved macular edema after a minimum of 5 years since the commencement of anti–vascular endothelial growth factor therapy. During the final visit, two experienced observers evaluated several qualitative parameters using spectral-domain optical coherence tomography, such as the integrity of the external limiting membrane, the state of the ellipsoid zone and retinal pigment epithelium, and the presence of disorganization of the retinal inner layers. In addition, a quantitative evaluation of the inner and outer retinal thicknesses was conducted for the purpose of topographical analysis.

Results:

The most prominent qualitative correlation identified with best-corrected visual acuity during the final visit was connected to the presence of disorganization of the retinal inner layers (P = 0.004) and the integrity of the external limiting membrane (P = 0.015). In relation to quantitative aspects, a noteworthy correlation was noted between the visual acuity during the last visit and the parafoveal thickness in both the inner (P = 0.003) and outer retina (P = 0.018).

Conclusion:

In eyes where macular edema resulting from retinal vein occlusion has been successfully resolved with anti–vascular endothelial growth factor therapy, changes in the status of the external limiting membrane and the presence of disorganization of the retinal inner layers serve as valuable optical coherence tomography biomarkers, indicating prolonged visual outcomes.
Launch of Board Certification in Pediatric Infectious Diseases in Japan
Authors: Saitoh Akihiko , Nishiya Katsumi , Miyairi Isao , Shoji Kensuke , Ishiwada Naruhiko , Katayose Masahiko , Hoshino Tadashi , Ohga Shouichi , Moriuchi Hiroyuki , Ouchi Kazunobu
Published: May 2024

To cultivate specialists in pediatric infectious diseases (ID) in Japan, the Japanese Society for Pediatric Infectious Diseases initiated board certification for pediatric ID in 2017. Previously, in 2014, we had formed a committee for board certification in pediatric ID and discussed the fundamentals of the board certification system, including the goals, requirements for designated training institutions, provisional certification of pediatric ID specialists and eligibility for and content of the board certification examination. After approval from 31 programs, the pediatric ID programs started in 2017 with 8 fellows in 7 programs. The first 6 graduates received board certification in 2020. To date, 61 pediatricians have been board certified as pediatric ID specialists. In parallel, we introduced board certification for pediatricians who work mainly in primary care settings and have a special interest in pediatric ID. This system has certified 338 pediatricians. During and after the development of the programs, we achieved substantial progress in highlighting the pivotal role of pediatric ID specialists, including the establishment and maintenance of antimicrobial stewardship programs, pediatric ID consultations and introduction of viral diagnosis by polymerase chain reaction at institutions. However, several issues need to be addressed, including the establishment of independent pediatric ID departments in institutions, payment of consultation fees, program site visits, maintenance of certification and cultivation of physician-scientists. These challenges will be the focus of future efforts.
Recent trends of stem cell therapies in the management of orthopedic surgical challenges
Authors: Pal Debajyoti , Das Pratik , Roy Subhasis , Mukherjee Prasenjit , Halder Samar , Ghosh Debaki , Nandi Samit Kumar
Published: May 2024

Emerged health-related problems especially with increasing population and with the wider occurrence of these issues have always put the utmost concern and led medicine to outgrow its usual mode of treatment, to achieve better outcomes. Orthopedic interventions are one of the most concerning hitches, requiring advancement in several issues, that show complications with conventional approaches. Advanced studies have been undertaken to address the issue, among which stem cell therapy emerged as a better area of growth. The capacity of the stem cells to renovate themselves and adapt into different cell types made it possible to implement its use as a regenerative slant. Harvesting the stem cells, particularly mesenchymal stem cells (MSCs) is easier and can be further grown in vitro. In this review, we have discussed orthopedic-related issues including bone defects and fractures, nonunions, ligament and tendon injuries, degenerative changes, and associated conditions, which require further approaches to execute better outcomes, and the advanced strategies that can be tagged along with various ways of application of MSCs. It aims to objectify the idea of stem cells, with a major focus on the application of MSCs from different sources in various orthopedic interventions. It also discusses the limitations, and future scopes for further approaches in the field of regenerative medicine. The involvement of MSCs may transition the procedures in orthopedic interventions from predominantly surgical substitution and reconstruction to bio-regeneration and prevention. Nevertheless, additional improvements and evaluations are required to explore the effectiveness and safety of mesenchymal stem cell treatment in orthopedic regenerative medicine.
Endovascular treatment versus standard medical treatment in patients with established large infarct: a cohort study
Authors: Guo Changwei , Li Linyu , Huang Jiandi , Yang Jie , Song Jiaxing , Huang Jiacheng , Peng Zhouzhou , Yu Nizhen , Liu Chang , Kong Weilin , Hu Jinrong , Chen Li , Guo Meng , Yue Chengsong , Yang Dahong , Liu Xiang , Miao Jian , Wang Mengmeng , Luo Xiangyun , Tang Zhaoyin , Bai Xiubing , Wang Duolao , Li Fengli , Yang Qingwu , Zi Wenjie
Published: May 2024

Background:

Previous trials confirmed the benefit of endovascular treatment (EVT) in acute large core stroke, but the effect of EVT on outcomes in these patients based on noncontrast computed tomography (NCCT) in real-world clinical practice was unclear. The aim of this study was to explore the effect of EVT versus standard medical treatment (SMT) in patients with large ischemic core stroke defined as Alberta Stroke Program Early CT Score (ASPECTS) ≤5 based on NCCT alone.

Materials and methods:

Patients with acute large core stroke at 38 Chinese centers between November 2021 and February 2023 were reviewed from a prospectively maintained database. The primary outcome was favorable functional outcome [modified Rankin Scale score (mRS), 0–3] at 90 days. Safety outcomes included 48 h symptomatic intracerebral hemorrhage (sICH) and 90-day mortality.

Results:

Of 745 eligible patients recruited at 38 stroke centers between November 2021 and February 2023, 490 were treated with EVT+SMT and 255 with SMT alone. One hundred and eighty-one (36.9%) in the EVT group achieved favorable functional independence versus 48 (18.8%) treated with SMT only [adjusted risk ratio (RR), 1.86; 95% CI: 1.43–2.42, P<0.001; adjusted risk difference (RD), 13.77; 95% CI: 7.40–20.15, P<0.001]. The proportion of sICH was significantly higher in patients undergoing EVT (13.3 vs. 2.4%; adjusted RR, 5.17; 95% CI: 2.17–12.32, P<0.001; adjusted RD, 10.10; 95% CI: 6.12–14.09, P<0.001). No significant difference of mortality between the groups was observed (41.8 vs. 49.0%; adjusted RR, 0.91; 95% CI: 0.77–1.07, P=0.24; adjusted RD, −5.91; 95% CI: −12.91–1.09, P=0.1).

Conclusion:

Among patients with acute large core stroke based on NCCT in real-world, EVT is associated with better functional outcomes at 90 days despite of higher risk of sICH. Rates of procedure-related complications were relatively higher in the EVT+SMT group.
Totally laparoscopic versus laparoscopy-assisted distal gastrectomy: the KLASS-07: a randomized controlled trial
Authors: Park Shin-Hoo , Lee Chang-Min , Hur Hoon , Min Jae-Seok , Ryu Seung Wan , Son Young-Gil , Chae Hyun Dong , Jeong Oh , Jung Mi Ran , Choi Chang In , Song Kyo Young , Lee Han Hong , Kim Ho Goon , Jee Ye Seob , Hwang Sun-Hwi , Lee Moon-Soo , Kim Kwang Hee , Seo Sang Hyuk , Jeong In Ho , Son Myoung Won , Kim Chang Hyun , Yoo Moon-Won , Oh Sung Jin , Kim Jeong Goo , Hwang Seong Ho , Choi Sung IL , Yang Kyung Sook , Huang Hua , Park Sungsoo
Published: May 2024

JOURNAL/ijos/04.03/01279778-202408000-00031/figure1/v/2024-08-13T152924Z/r/image-jpeg

Backgrounds:

Strong evidence is lacking as no confirmatory randomized controlled trials (RCTs) have compared the efficacy of totally laparoscopic distal gastrectomy (TLDG) with laparoscopy-assisted distal gastrectomy (LADG). The authors performed an RCT to confirm if TLDG is different from LADG.

Methods:

The KLASS-07 trial is a multi-centre, open-label, parallel-group, phase III, RCT of 442 patients with clinical stage I gastric cancer. Patients were enroled from 21 cancer care centres in South Korea between January 2018 and September 2020 and randomized to undergo TLDG or LADG using blocked randomization with a 1:1 allocation ratio, stratified by the participating investigators. Patients were treated through R0 resections by TLDG or LADG as the full analysis set of the KLASS-07 trial. The primary endpoint was morbidity within postoperative day 30, and the secondary endpoint was quality of life (QoL) for 1 year. This trial is registered at ClinicalTrials.gov (NCT 03393182).

Results:

Four hundred forty-two patients were randomized (222 to TLDG, 220 to LADG), and 422 patients were included in the pure analysis (213 and 209, respectively). The overall complication rate did not differ between the two groups (TLDG vs. LADG: 12.2% vs. 17.2%). However, TLDG provided less postoperative ileus and pulmonary complications than LADG (0.9% vs. 5.7%, P=0.006; and 0.5% vs. 4.3%, P=0.035, respectively). The QoL was better after TLDG than after LADG regarding emotional functioning at 6 months, pain at 3 months, anxiety at 3 and 6 months, and body image at 3 and 6 months (all P<0.05). However, these QoL differences were resolved at 1 year.

Conclusions:

The KLASS-07 trial confirmed that TLDG is not different from LADG in terms of postoperative complications but has the advantages to reduce ileus and pulmonary complications. TLDG can be a good option to offer better QoL in terms of pain, body image, emotion, and anxiety at 3–6 months.
Association between postoperative radiotherapy for young-onset nonsmall cell lung cancer and risk of second primary malignancies: comparative study
Authors: Li Zuwei , Guo Minzhang , Liu Lunxu , Deng Senyi
Published: May 2024

Background:

The most common form of therapy for nonsmall cell lung cancer (NSCLC) in early stage is surgery-based combination therapy, including radiotherapy and immunotherapy. However, postoperative radiotherapy (PORT) of cancer is correlated with increasing risk of second primary malignancy (SPM), especially young-onset cancer cases. The authors aimed to quantify the risks of SPM associated with PORT treatment for young‑onset NSCLC in early stage.

Methods:

The authors screened for SPM that developed over 5 years since the diagnosis of NSCLC. Using the data from the Surveillance, Epidemiology, and End Results database, PORT-correlated risks were estimated with multivariate Logistic regression analysis. Moreover, Fine-Gray’s competing risk regression analysis was used to calculate the cumulative incidence of SPMs.

Results:

Among the 30 308 young-onset NSCLC patients in early stage undergoing surgery, a total of 3728 patients have received PORT. Logistic regression analyses showed that PORT showed substantial correlation with elevated risks of second solid malignancies [relative risks (RR)=1.31; 95% CI: 1.17–1.46], lung cancer (RR=1.23; 95% CI: 1.07–1.42), breast cancer (RR=1.74; 95% CI: 1.16–2.74), and colon and rectum cancers (RR=1.37; 95% CI: 1.07–2.06) as well as a negligible risk of second hematologic malignancies (RR=1.15; 95% CI: 0.82–1.67). The cumulative incidence of SPMs revealed similar findings. Higher RR was obtained in NSCLC patients aged 60–69 years (RR=1.33), in white race (RR=1.36), diagnosed in 1975–2000 (RR=1.23) and 2001–2015 (RR=1.40), or diagnosed with lung adenocarcinoma (RR=1.55).

Conclusion:

PORT for young-onset NSCLC in early stage was correlated with elevated risks of SPMs (lung cancer, breast cancer, as well as colon and rectum cancers), supporting the need for long-term surveillance of these patients.
Clinical Practice Patterns in Sickle Cell Disease Treatment: Disease-modifying and Potentially Curative Therapies
Authors: Sánchez Luisanna M. , Morrone Kerry , Frei-Jones Melissa , Fasipe Titilope A.
Published: May 2024

Therapeutic options for sickle cell disease (SCD) have increased recently as well as the development of updated national guidelines. It is not known how these options are being offered or to what degree guidelines are incorporated into clinical practice. This study aimed to describe practice patterns for pediatric hematologists regarding the use of disease-modifying and potentially curative therapies for SCD. A 9-section, cross-sectional electronic survey was disseminated during a 3-month period via SurveyMonkey, to members of the American Society of Pediatric Hematology/Oncology Hemoglobinopathy Special Interest Group (ASPHO HSIG). A total of 88 physician members of the ASPHO HSIG were surveyed. Ninety percent of respondents (72/80) start hydroxyurea routinely in patients with HbSS and HbSβ0thalassemia, regardless of disease severity. Laboratory monitoring was recommended every 3 months for stable dosing in 63.8% (51/80). New therapies were recommended for patients on hydroxyurea who were still experiencing SCD complications: L-glutamine 68.5% (37/54) or crizanlizumab 93.1% (54/58). Voxelotor was recommended for patients on hydroxyurea with low hemoglobin in 65.1% (43/66) of cases. Matched sibling transplant was considered for any disease severity by 55.1% (38/69). Gene therapy trials are offered on-site by 29% (20/69). Our study demonstrated the enhanced utilization of hydroxyurea while revealing the unexplored potential of other disease-modifying therapies in SCD. These findings underscore the importance of continued knowledge acquisition about the long-term efficacy of new medical therapies and addressing barriers to the use of proven therapies and guide the development of future studies of optimal SCD management.
From Morphology to Molecules: Advances in the Distinction of Multiple Primary Lung Cancers From Intrapulmonary Metastases in Non–Small Cell Lung Cancer
Authors: Olteanu Gheorghe-Emilian , Kern Izidor , Kalson Lipika , Brcic Luka
Published: May 2024

The increasing incidence of multiple lung nodules underscores the need for precise differentiation between multiple primary lung cancers (MPLCs) and intrapulmonary metastases (IPMs). This distinction impacts patient prognosis and treatment strategies. The prevalence of multiple lung nodules, ranging from 19.7% to 55.5%, highlights the clinical significance of this challenge. Historically, the role of histopathology, particularly comprehensive histology assessment (CHA), has been pivotal in differentiating MPLCs and IPMs. However, CHA has significant limitations, resulting in a constant search for a better way to distinguish those lesions. The best strategy for delineating MPLCs from IPMs is a multidisciplinary approach combining clinical data, radiology, histology, and molecular methods. Histology provides architectural and cellular characteristics, radiology contributes anatomic context and lesion characterization, and molecular methods reveal molecular features critical for accurate differentiation. Incorporating clinical data further enhances diagnostic precision. This review presents current knowledge and current approaches to multiple lung tumors. It is clear that even with a combination of pathology, radiology, and molecular data, definitive classification of multifocal lung tumors is not always possible.
The Current State of Advanced Pediatric Emergency Medicine Point-of-Care Ultrasound (POCUS) Training
Authors: Moake Matthew M. , Klekowski Nicole , Kusulas Matthew P. , Kharasch Sigmund J. , Teng David , Constantine Erika ,   on behalf of the P2Network
Published: May 2024

Objectives

This study aims to assess the current state of advanced pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) training in North America, including trends in dedicated PEM POCUS fellowships and alternative advanced POCUS training pathways, to better guide future educational efforts within the field.

Methods

We identified and surveyed 22 PEM POCUS fellowship directors across the United States and Canada regarding PEM POCUS fellowship application trends, potential barriers to pursuing additional POCUS training, and novel training models that meet the needs of the PEM POCUS workforce.

Results

The past 5 years have seen a growth in both PEM POCUS fellowship program number and trainee positions available, with a general impression by fellowship directors of a high demand for faculty who have these training credentials. However, there was a discordant drop in fellowship applicants and corresponding match rate in 2022, the cause of which is not clear. A number of programs are offering alternative advanced training options including combined PEM/POCUS fellowships and POCUS tracks within PEM fellowship.

Conclusion

As POCUS use within PEM evolves, a growing number of advanced training options are being developed. Understanding the motivations and barriers for pursuing advanced POCUS training can help to shape these options going forward, to ensure the experience incorporated within each model meets the needs of trainees, the needs of PEM divisions, and the future needs of our field.
Urinalysis in Suspected Child Abuse Evaluation in the Emergency Department
Authors: Singh Nidhi V. , Lichtsinn Katrin , Ray Molly , Lawson Karla A. , Piper Karen , Wilkinson Matthew H.
Published: May 2024

Background

Intra-abdominal injury (IAI) is the second leading cause of mortality in abused children. It is challenging to identify in young patients due to their limited verbal skills, delayed symptoms, less muscular abdominal wall, and limited bruising.

Methods

We conducted a retrospective cohort study of children aged 0 to 12 months who were evaluated in the emergency department for suspected child abuse with a skeletal survey and urinalysis between January 1, 2015, and December 31, 2017. Our primary objective was to identify the proportion of IAI cases identified by urinalysis alone (>10 RBC/HPF) and not by examination findings or other laboratory results. A secondary objective was to quantify potential delay in disposition while waiting for urinalysis results, calculated as the length of time between receiving skeletal survey and laboratory results and receiving urinalysis results.

Results

Six hundred thirteen subjects met our inclusion criteria; two subjects had hematuria, one of whom had a urinary tract infection. The other was determined to have blood from a catheterized urine specimen. One subject was found to have an IAI. We further found that urinalysis was delayed for 78% of subjects and took a median of 93 [interquartile range, 46–153] minutes longer than imaging and/or laboratories.

Conclusions

No subjects were diagnosed with abdominal trauma based on urinalysis during evaluation in the emergency department who would not have been identified by other standard testing. In addition, patients' disposition was delayed while waiting for urinalysis.
Catching Suicide Before It Harms
Authors: Wadih Esper G. , Caperell Kerry
Published: May 2024

Objectives

Suicide is the second leading cause of death in people aged 10 to 24 years. We aim to assess the effectiveness of universal suicide screening in a pediatric ED.

Methods

Since April 7, 2019, all patients 10 years and older who presented to the pediatric ED of our freestanding children's hospital were screened with the validated Columbia Suicide Severity Rating Scale and categorized as mild, moderate, or severe risk for suicide. Screenings from 2019 were reviewed by investigators. All children aged 10 to 18 years who were screened were included. Data collected included demographic information, previous ED visits, past chief complaints), suicidal ideation, suicide attempt, and disposition.

Results

A total of 11,469 subjects were screened for suicide risk. Of those screened, 340 were positive on Columbia Suicide Severity Rating Scale, and 5 were excluded for being outside of the age range. Of the remaining 335 subjects who screened positive, 116 (34.5%) of them presented with a primarily medical chief complaint. A total of 120 subjects screened mild risk (35.8%), 46 were moderate (13.7%), and 169 were severe (50.4%). Overall, 141 positive subjects were admitted for mental health concerns.

Conclusions

Several patients who screened positive for suicide risk did not present with a mental health concern. Nearly half of screen-positive children who were admitted for mental health concerns had been seen in the ED in the year before their visit. Initiation of universal suicide screening in the pediatric ED identified a significant number of children with unrecognized suicide risk.
Obesity as a Risk Factor for Adverse Outcomes After Pedestrian Trauma Accidents in the Pediatric Population
Authors: Mulvihill Hannah , Roster Katie , Lakhi Nisha
Published: May 2024

Objective

The aim of the study is to determine whether overweight or obese children are at an increased risk for injury and adverse outcomes following pedestrian motor vehicle accidents.

Methods

We performed a retrospective study of patients between the ages of 2 and 17 who were pedestrians injured in a collision with a motorized vehicle, presenting to a level 1 trauma center, between January 1, 2010, to December 31, 2021. Patients with admission weights falling above the 90th percentile of the Centers for Disease Control and Prevention's sex-specific growth charts were identified as overweight/obese, those below the cutoff were categorized as nonobese. Groups were compared regarding demographics, mechanism of injury, Injury Severity Score, and Abbreviated Injury Scale by body region of injury. Outcome measures included hospital admission, length of hospital stay, intensive care unit (ICU) admission, ICU length of stay, and mortality.

Results

Of the 306 patients included, 72 (23.5%) were overweight/obese and 234 (76.5%) were nonobese. The mean Injury Severity Score scores were higher among overweight/obese patients (5.37 vs 8.74, P = 0.008). Overweight/obese children were more likely to sustain severe abdominal injuries (Abbreviated Injury Scale ≥ 3) (12.2% vs 5.1%; odds ratio [OR], 2.64; 95% CI, 1.07–6.56; P = 0.030), be admitted to the hospital (94.5% vs 74.3%; OR, 12.07; 95% CI, 2.87–50.72; P < 0.001), require ICU admission (31.0% vs 20.0%, OR, 1.87; 95% CI, 1.03–3.36; P = 0.036), and require a longer ICU stay (0.9 vs 0.4 days, P = 0.014) compared with nonobese patients.

Conclusions

Obese and overweight children are at increased risk for higher injury severity scores, severe abdominal injuries, and ICU admission after pedestrian motor vehicle accidents.
Impact of a Mental Health Screening Process in a Pediatric Emergency Department
Authors: Stocker Bryan , Jain Shobhit , Patel Lina , Tarantino Celeste , Sullivant Shayla , Worland Kathryn
Published: May 2024

Objective

The aim of this study was to describe how specific mental health–trained social workers can assist in the evaluations and follow-up of patients presenting with mental health concerns in the pediatric emergency department (ED).

Methods

Work was performed at a quaternary children's hospital ED with 95,000 annual ED visits across 2 locations. Patients requiring mental health services identified based on presenting complaint or from universal suicide screen were included. Emergency department team first evaluates the patients for medical screening and then consults a team of social workers specialized in acute mental health screening (AMHS). The team evaluates and provides recommendation for disposition and assists in plan completion. For patients not admitted, AMHS team makes 24- and 48-hour calls to ensure safety. We collected and analyzed the data on all eligible patients from September 2015 through June 2019 for (1) demographic information, (2) trends in number of consults to AMHS, (3) disposition plans and trends by year, and (4) frequency of follow-up phone calls.

Results

A total of 5950 patient visits were reviewed, for 4454 distinct patients. Most patients were 12 to 17 years of age, female, and White, with Medicaid being the predominant insurance. The most common chief complaint was suicidal ideation/plan/attempt. Self-referrals were the majority of assessments, and 59% of patients were already receiving mental health services. Median team response time was 19 minutes. There was an upward trend in consults. Psychiatric hospitalization was the most common disposition; more than 95% of the other visits had timely follow-up phone calls.

Conclusion

Despite an increasing number of patients presenting to the ED with mental health crisis, safe and efficient management is possible with ED staff–social worker partnership. This approach can ensure that eligible patients receive consistent and evidence-based evaluations and can allow ED clinicians to respond to medical emergencies that require their attention.
Nondiagnostic 99mTc-MAG3 Diuresis Renography Studies Caused by Propofol Sedation
Authors: Singh Karan Bir , Daley Kurt , Christian Caryl , Wegner Eva A. , Rossleigh Monica A.
Published: May 2024

99mTc-MAG3 diuresis renography is a noninvasive functional imaging technique used to assess clearance of radiotracer in a dilated urinary tract under high diuresis. It is commonly performed in patients to diagnose functionally significant urinary tract obstruction. In some pediatric patients, sedation is required to enable imaging. However, propofol, a commonly used IV sedative agent, is associated with altered renal hemodynamics. We report a case series of 3 pediatric patients at our institution who received propofol sedation to enable 99mTc-MAG3 diuresis renography using a F+0 protocol, outlining that some “abnormal” studies were in fact assessed to be nondiagnostic.
The Application of “Table Tennis Racquet” Random Skin Flap in the Treatment of Facial Skin Carcinoma
Authors: Tian Kai , Jia Zou , Xu Wushuang , Wang Xiaoyun , Xie Xiaoming , Gu Yifei , Cao Shikun , Gao Suyue , Li Ke , Wu Lijun
Published: May 2024

Background

The repair of facial skin and soft tissue defects remains a clinical challenge. The author introduced a novel “table tennis racquet” random skin flap for wound repair after facial skin cancer excision and discussed its survival mechanisms.

Methods

A lateral mandibular neck skin flap shaped like a table tennis racquet with no well-known blood vessels at the narrow pedicle was designed in 31 cases to repair tissue defects. Among them, there were 8 cases of skin carcinoma in the frontotemporal area and 23 cases of skin carcinoma in the cheek. The flap area was 8.0 × 7.0 cm at maximum and 3.0 × 2.5 cm at minimum, with a pedicle width of 1.0–2.0 cm and a pedicle length of 2.0–6.0 cm.

Results

All 31 “table tennis racquet” random skin flaps survived, although there were 3 cases with delayed healing of distal flap bruising. All of them had an ideal local shape after repair with a concealed donor area and inconspicuous scars.

Conclusions

This flap has a “table tennis racquet” shape with a pedicle without well-known blood vessels and has a length-to-width ratio that exceeds that of conventional random flaps, making it unconventional. Because of its long and narrow pedicle, it not only has a large rotation and coverage area but also can be designed away from the defect area, avoiding the defect of no donor tissue being localized near the defect. Overall, this approach is an ideal option for repairing tissue defects after enlarged excision of facial skin carcinoma.
A 10-Year Review of Collagenase Versus Fasciectomy in the Treatment of Dupuytren Contracture
Authors: Steppe Cyrus , Cinclair Richard , Lies Shelby
Published: May 2024

Background

Dupuytren disease (DD) is one of the most common disorders of the hand, affecting 5.7% to 11.7% of the global population. This study seeks to evaluate the 10-year efficacy of the 2 most prominent treatment modalities for DD in Veterans Affairs hospitals, injectable collagenaseClostridium histolyticumversus open fasciectomy.

Methods

A retrospective review was conducted of all electronic medical records of patients who underwent open fasciectomy or collagenase injection to treat their persistent Dupuytren contracture between April 2011 and April 2021. All procedures were performed by 1 of 5 senior surgeons at the same Veterans Affairs Hospital.

Results

A total of 232 patients were treated for DD, with 247 collagenase injections and 44 open fasciectomies performed in this sample. Collagenase patients were, on average, 6.51 years after intervention at the time of review. Open fasciectomy patients were, on average, 4.56 years after operation at the time of review. Collagenase decreased contractures, on average, by 29.40 degrees, whereas open fasciectomy decreased contractures, on average, by 38.59 degrees. Of the contractures that were initially classified as resolved, 50 of 155 (32.2%) treated with collagenase and 6 of 56 (10.7%) treated with open fasciectomy recurred. The use of open fasciectomy compared with collagenase injections to treat contracture was associated with a 74.2% decrease in the likelihood of recurrence.

Conclusions

This study found that treatment of DD with collagenase injection is associated with a significantly lower degree of deformity correction, lower rate of resolution, and increased rate of recurrence when compared with open fasciectomy.
Thirty- and 90-Day Morbidity and Mortality by Clavien-Dindo after Surgery for Antireflux and Hiatal Hernia
Authors: Ivy Megan L , Baison George , Griffin Cassandra , Welch Allison C , White Peter T , Farivar Alexander S , Bograd Adam J , Aye Ralph W , Louie Brian E
Published: May 2024

BACKGROUND:

The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset.

STUDY DESIGN:

We retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days. All complications were graded using the Clavien-Dindo (CD) grading system. The highest grade of complication was used per patient during 30- and 31- to 90-day intervals.

RESULTS:

Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were CD less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338).

CONCLUSIONS:

Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent.