bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing the efficacy and safety of thromboprophylaxis with enoxaparin versus normal saline after liver transplantation: randomized clinical trial
Authors: Xie Kunlin , Yang Hongzhao , Wang Shouping , Xiao Chenghan , Lan Tian , Jiang Hanyu , Li Sheyu , Tu Huakang , Yang Jian , Lyv Tao , Qiu Jianguo , Zhou Jing , Zhang Zhongwei , Du Chengyou , Wu Xifeng , Huang Jiwei , Elgendi Ahmed M , Kow Alfred W C , Yang Jiayin , Zeng Yong , Wu Hong
Published: February 2025

Background

Venous thrombosis represents a significant complication after deceased-donor liver transplantation, yet there are currently no established protocols for thromboprophylaxis after deceased-donor liver transplantation. The aim of this study was to evaluate the efficacy and safety of prophylactic anticoagulation in patients undergoing deceased-donor liver transplantation.

Methods

A dual-centre RCT of patients assigned to receive either enoxaparin or normal saline after liver transplantation was conducted. The primary efficacy outcome was the incidence of venous thrombosis (portal vein thrombosis and deep vein thrombosis) and the primary safety outcome was the incidence of major bleeding.

Results

A total of 462 patients were recruited. In the intention-to-treat analysis, 89 patients (19.3%) experienced venous thrombosis and 141 patients (30.5%) experienced major bleeding within 90 days after transplantation. No significant differences were observed in the incidence of venous thrombosis, portal vein thrombosis, or deep vein thrombosis between the two groups in the intention-to-treat cohort. The anticoagulant group demonstrated a markedly elevated incidence of major bleeding (35.5% versus 25.5%, P = 0.020). Subgroup analysis revealed that anticoagulation was associated with a lower risk of deep vein thrombosis in hepatocellular carcinoma patients (HR 0.44 (95% c.i. 0.23 to 0.86), P = 0.016), without a significantly higher risk of major bleeding.

Conclusion

Use of prophylactic anticoagulation with enoxaparin is associated with a significantly higher incidence of major bleeding in patients undergoing deceased-donor liver transplantation, rather than a lower likelihood of venous thrombosis.

Registration number

ChiCTR2000032441 (www.chictr.org.cn).
13 Catheter-related bloodstream infection (CRBSI) in patients undergoing abdominal surgery: a prospective cohort study
Authors: Toutouzas Konstantinos , Frountzas Maximos , Vouros Dimitrios , Mexi Anna , Matthaiou Georgia , Toutouza Orsalia , Theodorou Dimitrios
Published: February 2025

Aim

Postoperative fever is a complex clinical problem which results in prolonged hospital stay interval and increased cost worldwide. The aim of the present study was to investigate the incidence of postoperative fever which is caused by catheter-related bloodstream infection (CRBSI) in patients undergoing abdominal surgery.

Methods

Patients who underwent abdominal surgery at the 1st Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, and presented postoperative fever were prospectively enrolled from 2018 until 2023. The postoperative fever management included removal of the central catheter and tip culture, blood cultures, urine cultures and chest x-ray. In addition, the day of postoperative fever, blood cultures, urine cultures and central catheter cultures, as well as the reason of postoperative fever were reported.

Results

In total, 189 patients were included in the present study, 110 of whom were males and 79 females. The cut-off point for postoperative fever associated to CRBSI was 7 days. This point presented 57% sensitivity, 63% specificity, 33% positive predictive value and 82% negative predictive value. Univariable analysis indicated significantly higher rate of CRBSI when postoperative fever was presented after 7th postoperative day (P = 0.02). Moreover, CRBSI was significantly higher in emergent operations (P = 0.003), in patients with more than one pathogens in their blood cultures (P = 0.001) and in patients with positive urine cultures (P = 0.003). Multivariable analysis confirmed the aforementioned correlations except for CRBSI increase in patients with fever after 7 postoperative days.

Conclusions

Postoperative fever presented before the 7th day after abdominal surgery did not seem to be associated to CRBSI. Therefore, alternative reasons for postoperative fever should be investigated.
30 Prophylaxis of incisional surgical site infection with antibiotic lavage of the surgical wound. A prospective double-blind randomised multicentre study
Authors: Candela Laura Vasquez , Amillo Mireia , Amador Sara , Casal Miquel , Sarasa Nuria , Ojeda Felipe , Badia Josep M
Published: February 2025

Objective

Surgical site infection (SSI) is the most common complication of surgery. Prevention of incisional SSI (I-SSI) by topical prophylaxis is controversial. Human studies on topical antibiotic wound lavage are old and inconclusive. Current meta-analyses and WHO recommendations do not recommend it. The aim of the study was to evaluate the efficacy of wound irrigation with an antibiotic solution on the rate of I-SSI.

Methods

Prospective, multicentric, randomised, double-blind clinical trial to compare irrigation of surgical incisions with amoxicillin-clavulanate solution (ATB-Group) with saline lavage (Saline-Group). The study was conducted in three types of surgery according to their risk of SSI: clean surgery (abdominal hernia repair), and clean-contaminated (caesarean sections and colorectal surgery). The primary endpoint was the incidence of I-SSI within 30 days of surgery according to CDC criteria. Secondary endpoints were: length of stay (LOS), 30-day reoperation rate, 30-day wound complication rate (other than SSI), 30-day mortality rate, microbiology of infections, 30-day adverse event or complication rate. Surgical complications were categorised according to the Clavien-Dindo classification. The severity of wound infection was assessed according to the ASEPSIS score.

Results

The trial included 685 patients (200 hernia repairs, 218 caesarean sections and 272 elective colorectal procedures), 351 in the ATB-Group and 334 in the Saline-Group. Both groups were comparable in age, sex, BMI, comorbidities, ASA score, and operative time. The overall rate of SSI for the entire cohort was 5.9%, being 2.5% in the Saline-group and 3.4% in the ATB-group, P = 0.51. No differences were detected when SSI was subdivided by surgical site level. There were also no differences in secondary outcomes such as: time to onset of SSI, postoperative complications, other infectious complications or microbiology of the infecting flora. LOS was 3.8 days in both groups. Mortality was 0.4% in the ATB-Group and 0.3% in the Saline-Group. Analysis of primary or secondary endpoints by subgroups of type of surgery also showed no differences between the two study groups.

Conclusions

Wound irrigation with antibiotic solution was not superior to saline lavage for I-SSI prophylaxis in clean and clean-contaminated surgery. Probably, the low rate of SSI obtained in the two arms of this study did not allow to find differences between the two study groups. The study was registered with ClinicalTrials.gov (NCT04476212), was authorised by the Spanish Medicine Agency (EUDRA CT:2017-002669-23), and received grant PI19/01294 for Health Research Projects from the Ministry of Science, Innovation and Universities of Spain.
15 Negative pressure wound therapy (NPWT) in the management of complicated surgical infections
Authors: Frountzas Maximos , Theodorou Panagiotis , Mexi Anna , Chamzin Alexandros , Theodoropoulos George , Theodorou Dimitrios , Toutouzas Konstantinos
Published: February 2025

Aim

Complicated surgical infections have been associated to high mortality rates and prolonged hospital stay interval worldwide. The aim of the present study was to investigate the safety and effectiveness of negative pressure wound therapy (NPWT) in the management of complicated surgical infections.

Methods

Patients who presented complicated surgical infections (enteroatmospheric fistulas, dehiscence in wounds with previous synthetic mesh placement, soft tissue necrotic infections) at the 1st Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, and presented postoperative fever were prospectively enrolled from 2021 until 2023. Patients’ demographics, perioperative parameters and indications for NPWT utilization were reported.

Results

In total, 16 patients were included in the present study and their age range was 42–82 years old. The range of hospital stay interval was 5–23 days and the range of NPWT utilization was 9–84 days. Seven patients presented enteroatmospheric fistula, 6 patients had dehiscence in wounds with previous synthetic mesh placement and 3 patients presented soft tissue necrotic infections that were managed using NPWT. In 4 of 16 patients, an extraperitoneal synthetic mesh had been placed. Two patients died due to multiorgan failure which was not associated to the local management of complicated surgical infection.

Conclusions

NPWT seemed to be a safe and effective option in the management of complicated surgical infections achieving local wound control and successful wound healing with synthetic mesh preservation.
44 Gram stain and intraabdominal infection: narrative revision
Authors: Vázquez Alba Manuel , Pérez Inés Rubio , Badía Pérez Josep María , Sánchez Carmen González , Garriga Xavier Guirao
Published: February 2025

Aim

Our aim is to determine whether Gram staining can confirm the presence of pathogens in an intra-abdominal infection (IAI), identify filamentous forms or provide information for the initiation of antibiotic treatment and/or drainage of a collection. It also intended to assess whether the Gram stain result may support the diagnosis of primary or secondary peritonitis.

Methods

A narrative literature review was conducted. Articles published in English or Spanish since 1990 were included. Experimental studies, peritoneal dialysis and liver cirrhosis were excluded. SINTAXIS: ‘Intraabdominal Infections’ (diverticulitis, colonic; Appendicitis; cholecystitis, acute; Peptic Ulcer Perforation; Intestinal Perforation; secondary peritonitis; Abdominal Abscess; Postoperative complications) AND (‘Gentian Violet’ OR ‘Gram's stain).

Results

Forty papers were found and eight were selected for review (7 retrospective and 1 prospective observational studies). The usefulness of Gram staining was discussed in acute cholecystitis, liver abscess, secondary peritonitis, blood stream infections and soft tissue infections, but no uniform criteria were found in the patients included. According to studies, we cannot conclude that Gram stain is useful in IAI. It does not seem to predict the outcome of cultures or influence the duration and selection of antimicrobial therapy, whereas it may be slightly more useful for fungi due to its higher negative predictive value. Gram stain positivity seems to mean an increased risk of SSI in certain pathologies and closer outpatient monitoring could be applied in these cases. Microbiological characterization of the Gram stain in certain pathologies (soft tissue infection, blood stream infection) may point to an intra-abdominal origin of the primary infection.

Conclusions

Considering the heterogeneity of the studies reviewed, no clear conclusions can be drawn about the usefulness of Gram staining in IAI.
36 Retro-hepatic abscess as a complication following laparoscopic cholecystectomy
Authors: Kucera Adam , Gergel Michal , Lancz-Klikáčová Anita , Brychta Ivan
Published: February 2025

Laparoscopic cholecystectomy is a common, safe and effective procedure as a surgical solution of gallbladder stones. Throughout multiple studies, it has proven as a procedure with a generally low frequency of associated complications, varying from 0,5% to 6%, from which 13% of the complications were intraoperative, spilling of the gallbladder stones represented only an approximate 2% of intraoperative complications. The authors report a rare case of a 41-year-old female patient with fever and elevated inflammatory markers, leading to a diagnosis of retro-hepatic abscess of the right hepatic lobe. The patient was suffering from fever, fatigue and chronic abdominal pain in right hypochondrium. She was treated by a general practitioner by empiric oral antibiotics, however septic signs remained. Due to her recent travel history, she was examined by a infectious disease specialist. She underwent a series of diagnostics, including an ultrasound, which has shown an abscess-like formation with calcifications, sized approximately 9 × 8 × 7 cm, suspected as a right lobe liver abscess. CT scan showed an atypical abscess like collection in segment 6 of the liver, with presence of calcified dense areas, assuming echinococcosis. However, immunology and serology showed no signs of parasite infection. At this point. information on previous (2 years) laparoscopic cholecystectomy was obtained. Considering location of the abscess, gallstones like finding on CT and previous cholecystectomy, abscess around spilled gallstones was suspected and surgery recommended. The method of mini-invasive extraperitoneal video assisted approach was agreed upon. With ultrasound guidance, punction and subsequent miniincision was performed, in the 10th right intercostal space. Pus was evacuated and the cavity was investigated with standard laparoscope, locating 4 gallstones and extracting them with laparoscopic grasper. Lavage and insertion of two drains followed. Drains were regularly flushed with normal saline and left in place for 7 days. Further course was uneventful. Standard therapy of liver and subhepatic abscesses is percutaneous drainage, however retained gallstones as a permanent bacterial nidus need to be removed in order to heal the abscess completely. Miniinvasive extraperitoneal approach is an effective option. Spilled gallstones should be taken into consideration in cases of atypical intraabdominal abscesses ant information on previous gallbladder surgery.
State-of-the-Art Review: Data and Trust to Improve Care for Transgender and Gender-Diverse Patients
Authors: Van Sickels Nicholas , Wong Jennifer W H , Villacorta-Cari Evelyn , Lee Steph E , Fallin-Bennett Keisa
Published: February 2025

Healthcare for transgender and gender-diverse (TGD) patients is evolving. With 1.6 million people in the United States identifying as transgender, clinicians have significant opportunity to learn, build trust, and offer thoughtful preventive and therapeutic care. Gender-affirming care starts by using chosen names and pronouns and creating welcoming environments. Medical and surgical care for TGD persons is endorsed by multiple medical societies and is associated with reduced symptoms of dysphoria and improved quality of life. Barriers accessing this care include a lack of provider knowledge and availability, socioeconomic factors, discrimination, ongoing anti-LGBTQ+ legislation, and mistreatment from the medical system. Complications of gender-affirming surgical procedures are uncommon when performed by qualified and well-trained surgeons, though often patients must travel significant distances to attain surgical care, limiting postoperative follow-up. Complications of non-medical-grade procedures, such as fillers, are common and can present many years after the initial procedure. With respect to sexual wellness, social and biomedical interventions addressing disproportionate effects of human immunodeficiency virus and sexually transmitted infections on TGD people show promise in clinical trials. Further education for providers and patients, advocacy for affirming spaces and policies promoting evidence-based care, and building trust are crucial for holistic care of TGD patients.
FlashFox: a secret-sharing approach to securing data deletion for Flash-based SSD
Authors: Cheng Wen , Tu Shengxia , Liu Yi , Zeng Lingfang , Wang Yang , Brinkmann André
Published: February 2025

The ‘out-of-place’ update nature of Solid State Drives (SSDs) introduces a security risk. Scrubbing, a secure deletion method, mitigates this issue but negatively affects SSD endurance and requires redundant data for recovery due to page errors. Previously, the RAID-5 based scheme was used to manage redundant data. While effective for reading, it causes significant write latency due to the channel blocking issue. In response, we propose FlashFox, which integrates secret sharing and Reed-Solomon coding into SSDs, enabling the application of scrubbing within an encrypted storage environment. This innovation ensures secure deletion by cleaning up sensitive data, thereby reducing wear on SSD endurance. Furthermore, we have developed a RAID-4-based scheme for implementing FlashFox on SSDs. This scheme, by assigning specific channels to manage redundant data, successfully avoids the channel blocking issue prevalent in RAID-5. Experimental results show FlashFox reduces endurance wear by at least 15% compared to traditional scrubbing methods and writing response delay by at least 8$\times $ compared to RAID-5 based scheme.
Can Winegrowing Cause Rural Development? Evidence from Baden-Württemberg
Authors: Huning Thilo R , Wahl Fabian
Published: February 2025

Historical winegrowing shaped modern rural development, even in areas in which its cultivation was given up after the early modern period. We provide evidence for this idea from municipality level data on Southwestern German viticulture over the last 1,300 years, and find a significant link between historical winegrowing and modern economic development. We rely on cross-sectional regressions and on an instrumental variable strategy using precipitation seasonality. Our findings highlight two mechanisms through which historical viticulture affected modern development: by leaving behind a more egalitarian inheritance norm, and a more collectivist society.
A deficiency screen of the X chromosome for Rap1 GTPase dominant interacting genes in Drosophila border cell migration
Authors: Messer C Luke , Burghardt Emily , McDonald Jocelyn A
Published: February 2025

Collective cell migration is critical to embryonic development, wound healing, and the immune response, but also drives tumor dissemination. Understanding how cell collectives coordinate migration in vivo has been a challenge, with potential therapeutic benefits that range from addressing developmental defects to designing targeted cancer treatments. The small GTPase Rap1 has emerged as a regulator of both embryogenesis and cancer cell migration. How active Rap1 coordinates downstream signaling functions required for coordinated collective migration is poorly understood. Drosophila border cells undergo a stereotyped and genetically tractable in vivo migration within the developing egg chamber of the ovary. This group of 6-8 cells migrates through a densely packed tissue microenvironment and serves as an excellent model for collective cell migration during development and disease. Rap1, like all small GTPases, has distinct activity state switches that link extracellular signals to organized cell behaviors. Proper regulation of Rap1 activity is essential for successful border cell migration yet the signaling partners and other downstream effectors are poorly characterized. Using the known requirement for Rap1 in border cell migration, we conducted a dominant suppressor screen for genes whose heterozygous loss modifies the migration defects observed upon constitutively active Rap1V12 expression. Here we identified seven genomic regions on the X chromosome that interact with Rap1V12. We mapped three genomic regions to single Rap1-interacting genes, frizzled 4, Ubiquitin specific protease 16/45, and strawberry notch. Thus, this unbiased screening approach identified multiple new candidate regulators of Rap1 activity with roles in collective border cell migration.
Bridging language barriers: Access to primary care for Medicaid Managed Care patients with limited English proficiency in three metropolitan areas
Authors: Bustamante Arturo Vargas , Melgoza Esmeralda , Ismail Ahmad , Majano Rosario , Félix Beltrán Lucía
Published: February 2025

This secret shopper study compares the wait times for scheduling a first-time primary-care appointment among adults enrolled in Medicaid Managed Care who speak English, Spanish, or Mandarin in the Los Angeles, Houston, and New York Metropolitan Statistical Areas. Primary-care practices in Medicaid Managed Care Organization directories were randomized by language. The objective of the secret shoppers was to schedule first-time primary-care appointments, either in person or via telehealth. We found that the average wait times for Spanish and Mandarin speakers were greater than for English speakers by 3.73 and 14 days in Los Angeles and 7.29 and 2.55 days in Houston, respectively. The average wait time among Spanish and Mandarin speakers was 2.22 and 1.76 days less compared with English speakers in New York. We discuss the importance of policies and provide recommendations to address disparities in health access and use among adults with limited English proficiency.
A Uniform Estimate for the Quaternionic Gauduchon Metric With Prescribed Volume Form
Authors: Zhang Jiaogen
Published: February 2025

The quaternionic Calabi conjecture, posed by Alesker and Verbitsky [1], predicts that the quaternionic Monge–Ampère equation can always be solved on any compact HKT manifold. Motivated by this conjecture, we will introduce a quaternionic version of the Gauduchon conjecture on any compact $SL(n,\mathbb{H})$-manifold, specifically addressing the existence of quaternionic Gauduchon metrics with prescribed volume form. We reframe this question as a special case of fully nonlinear elliptic equations of second order and subsequently establish a uniform estimate for the potential function.
Iranian Madrasa Historiographies on the Fate of Falsafa after Averroes: The Structure, Scope, and History of ‘Islamic Philosophy’ from Mīr Dāmād to ṬabāṬabāʾī and Āshtiyānī
Authors: Amin Beidokhti Hanif
Published: February 2025

Iranian philosophers train in a living tradition of falsafa that gives them a different perspective from that of modern European scholars. They call their profession philosophy, and philosophy for them is not a historical phenomenon, though it has a past. Contemporary falsafa has a narrative of its past, which I outline in this article, calling it the madrasa narrative. It is presented in the form of historiographies of falsafa, which, though less than a century old, form an extensive body of texts. After introducing this narrative, I focus on Mīr Dāmād’s (d. 1631) conception of the course of falsafa and his relation to his predecessors. I argue that he should be credited as the initiator of ‘Islamic philosophy’, both conceptually and terminologically. I emphasize the continuous line he draws linking himself to Fārābī (d. ca. 950-1) through Avicenna (d. 1037). Thereafter, I outline the formative contributions of Muḥammad Ḥusayn Ṭabāṭabāʾī (1904–81) in the contemporary practice of falsafa, and in historiography of Jalāl al-Dīn Āshtiyānī (1925–2005) who, together with Henry Corbin (1903–78), shaped the modern madrasa narrative. I show that Āshtiyānī’s historiographical effort was a reaction to what he considered Europeans’ unawareness of the continuity and vitality of falsafa in the Islamic East. I conclude with some observations on the scope, structure, and historiography of contemporary falsafa in Iran.
Challenges to and considerations of designing cancer prevention trials
Authors: Enserro Danielle M , Gunn Heather J , Elsaid Mohamed I , Duan Fenghai , Pugh Stephanie L
Published: February 2025

Prevention trials in oncology are some of the most important cancer clinical trials that can be designed, implemented, analyzed, and interpreted. They are pivotal in the goal of stopping the development of cancer before it starts. Prevention trials are unique in that they not only have some of the same requirements and challenges as treatment trials but also have challenges that may make their design more complex. This paper aims to discuss some types of prevention trials and highlight their most common design challenges, including large sample size requirements, slow accrual rates with long accrual duration, extended follow-up periods with trial adherence issues and missing data, endpoints that require extended follow-up or have a high level of confounding, and problems with optimizing study design. This article provides real study examples and suggestions for designing prevention clinical trials while mitigating the known issues they face.
Parental autonomy and children’s health: a patriarchal dilemma in the Middle East, with particular emphasis on Kuwait
Authors: Al Majed Bashayer
Published: February 2025

In 2020, Kuwaiti mothers won legal medical guardianship over their children, enabling them to authorize medical treatment, this despite still not having autonomy for their own medical care, yet being vicariously liable for potential tort caused by their child. This dichotomy raises questions over the implementation of the new legislation, if the mother and the male guardian had opposing views over the child’s health. Recent years have seen the UK cases of Charlie Gard and Alfie Evans initiate passionate ethical debate when courts invoked Parens Patriae, superseding parental autonomy and supporting clinicians’ decisions to withdraw life support. Middle Eastern courts tend to support parental decisions; however, strict civil laws exist regarding the continuation and cessation of life support. This article examines the patriarchal culture in the Middle East and explores whether a Kuwaiti mother’s medical autonomy would be upheld in the event of a parental dispute over their child’s treatment and end-of-life care, within the framework of the Kuwaiti Civil Code No. 67 of 1980. The article concludes that matriarchal guardianship would likely be undermined; however, legislative changes are the first step and advances in palliative care across the Middle East are introducing a changing culture towards open parental discussions and shared decision-making, slowly making the mother’s decisive voice a part of the norm.
Levofloxacin to prevent bacterial infection in patients with acute myeloid leukemia treated by venetoclax and azacitidine: a Toulouse-Bordeaux DATAML registry study
Authors: Brousse Xavier , Rasandisona Nicolas , Bérard Emilie , Leroy Harmony , Delavigne Karen , Mottal Nathan , Tavitian Suzanne , Leguay Thibaut , Lapierre Léopoldine , Delabesse Eric , Bidet Audrey , Gauthier Martin , Lara Diane , Banos Anne , Guiraud Jennifer , Floch Pauline , Ghenim Leila , Sarry Audrey , de Grande Anne-Charlotte , Béranger Clémentine , Récher Christian , Pigneux Arnaud , Bertoli Sarah , Dumas Pierre-Yves
Published: February 2025

Objectives

Antibiotic prophylaxis for patients with cancer remains a controversial issue and is not broadly recommended for hematological malignancies. The venetoclax (VEN) and azacitidine (AZA) combination allows for high rates of complete remission in acute myeloid leukemia (AML) but enhances the incidence of febrile neutropenia (FN) compared to AZA alone, making primary antibiotic prophylaxis a relevant question.

Patients and Methods

Patients with AML who received VEN-AZA were selected from the DATAML registry to investigate the use of levofloxacin (LEVO) prophylaxis, administered at 500 mg/day from day 10 following the first course of VEN-AZA, until neutrophil recovery (>0.5x109/L).

Results

A cohort of 258 patients was identified (median age 69.8 years, IQR 20.4-87.4), 72 of them having received LEVO and 186 treated with standard of care (SOC). VEN-AZA was used for newly diagnosed AML in 52.7% of cases. FN occurred in 33.3% of LEVO patients vs. 37.1% of SOC patients (p=0.572). Time from day 10 VEN-AZA to FN was significantly delayed in LEVO patients (12.5 days vs 8 in SOC; p=0.037). Pulmonary infections were considerably reduced by LEVO (10.2% vs 1.4%, p=0.018) as well as those involving enterobacterales (9.1% vs 1.4%; p=0.029). No early increase in fluoroquinolone resistance was detected (p=0.142).

Conclusion

Levofloxacin as primary prophylaxis in patients with AML treated with VEN-AZA seems to decrease the rate of documented infections even if the incidence of FN was not significantly decreased. This prophylaxis shaped a different clinical and microbiological landscape without significant increase of antibiotic resistance.
A Cross-National Analysis of Trust and Support for Pandemic Response Measures
Authors: Bryan James D , LeVan A Carl
Published: February 2025

Even as COVID-19 threatened millions of lives, people in many countries resisted public health recommendations. In a cross-national study of pandemic response, we demonstrate that political trust across different institutions predicts support for policies to manage the health risks. We disaggregate political trust, creating separate measures for “partisan” and “nonpartisan” controlled institutions. Our empirical strategy utilizes data from Eurobarometer, Afrobarometer, and Arab Barometer surveys across 57 countries. Tests of a “vertical trust” hypothesis demonstrate that trust in partisan and nonpartisan institutions predict support for pandemic restrictions and willingness to get vaccinated. Interestingly, the strength of the relationships varies across and within countries. Tests of a “contingent solidarity” hypothesis reveal widespread politicization of the pandemic by democratic and autocratic incumbents alike. We conclude by exploring how infusing neutral, nonpartisan institutions with subjective political narratives stokes mistrust in “scientific authority” and harms democracy.
Abatacept and the risk of malignancy: a meta-analysis across disease indications
Authors: Zuckerman Benjamin P , Gibson Mark , Roy Ritika , Hughes Mark , Mehta Daksh , Yang Zijing , Adas Maryam , Ng Kenrick , Russell Mark D , Cope Andrew , Norton Sam , Galloway James
Published: February 2025

Objectives

To estimate the association between abatacept use and the incidence of malignancy excluding non-melanomatous skin cancers (NMSCs).

Methods

Systematic database searches were performed, to April 2024, to identify phase II/III/IV randomised clinical trials (RCTs), long-term extension (LTE) and observational cohort studies of abatacept in people with rheumatoid arthritis and psoriatic arthritis. Network and pairwise meta-analyses were performed to estimate incidence rate ratios (IRRs) for malignancy excluding NMSC, comparing abatacept with placebo and tumour necrosis factor inhibitors (TNFi) in RCT/LTE studies. Pairwise meta-analyses evaluated the same outcome in observational studies, comparing abatacept with conventional synthetic DMARDs (csDMARDs) and biologic/targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs).

Results

In 18 eligible RCTs and 10 LTE studies, there were 15 535 person-years of exposure to abatacept, 1495 to placebo, and 733 to TNFi. In network meta-analyses of combined RCT/LTE data, the incidence of all malignancies excluding NMSCs was not significantly different between abatacept and placebo (IRR 0.58; 95% CI 0.32–1.09) or TNFi (IRR 0.72; 95% 0.27–1.87). In observational data, the incidence of malignancy was higher with abatacept, relative to other b/tsDMARDs (IRR 1.21; 95% CI 1.15–1.28), but not significantly different compared with csDMARDs (IRR 0.97; 95% CI 0.90–1.06).

Conclusions

Abatacept was associated with a higher incidence of malignancy compared with other b/tsDMARDs in observational studies, but not when compared with placebo or TNFi in RCT/LTE data. Further pharmacovigilance data is essential to help elucidate whether abatacept modifies cancer risk.

PROSPERO registration number

CRD42023382314
Evaluation of watermelon cultivars for susceptibility to anthracnose, Painter, VA, 2024
Authors: Nieland Emma , Higgins Douglas S. , Langston David , Adams Calyn
Published: February 2025

Watermelon anthracnose, caused by Colletotrichum orbiculare, occurs annually on watermelon (Citrullus lanatus) throughout the Mid-Atlantic region of the United States, impacting both yield and fruit quality. Symptoms of the disease include brown, rounded lesions on the leaves, stems, and fruit that can coalesce into regions of dead tissue. This report evaluates various cultivars for their susceptibility to the disease in a trial conducted in 2024 at the Virginia Tech Eastern Shore Agriculture Research and Extension Center. The results from this trial will help growers choose the appropriate cultivar for their production system in the Mid-Atlantic region.
Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality—A Predefined Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial
Authors: Thevathasan Tharusan , Claus Julia , Roßberg Michelle , Skurk Carsten , Fichtlscherer Stephan , Akin Ibrahim , Fuernau Georg , Hassager Christian , Zeymer Uwe , Preusch Michael R. , Graf Tobias , Feistritzer Hans-Josef , Jobs Alexander , de Waha Suzanne , Thiele Holger , Desch Steffen , Pöss Janine , Freund Anne ,   on behalf of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators
Published: February 2025

Objectives:

The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).

Design:

Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.

Setting:

Multicenter, international randomized controlled trial across 31 centers.

Patients:

Adult patients with successfully resuscitated OHCA and no ST-segment elevations.

Interventions:

The first recorded electrocardiogram after the return of spontaneous circulation (ROSC) at hospital admission was analyzed by experienced physicians.

Measurements and Main Results:

Significant coronary lesions and 30-day mortality. In total, 412 patients with a coronary angiography were included, of which 163 (40%) had significant coronary lesions. No electrocardiogram pattern was identified as a predictor of significant coronary lesions. In the total cohort of patients with and without coronary angiography, right bundle branch blocks (BBBs), prolonged intrinsicoid deflection times, and intrinsicoid deflections in right BBB were strong, independent predictors of 30-day mortality. The “intrinsicoid deflection” is the sharp upward deflection in the QRS complex of an electrocardiogram. The “intrinsicoid deflection time” is the interval from the start of the QRS complex to the peak of the R wave. The predictive performance for significant coronary lesions was poor across all electrocardiogram patterns and better for 30-day mortality.

Conclusions:

Standardized 12-lead electrocardiogram patterns after ROSC at hospital admission in patients with successfully resuscitated OHCA without ST-segment elevations have poor predictive performance for the presence of significant coronary lesions. Different QRS-related patterns might identify patients with higher risk of short-term mortality.
Phenotypes of Functional Decline or Recovery in Sepsis ICU Survivors: Insights From a 1-Year Follow-Up Multicenter Cohort Analysis
Authors: Liu Keibun , Nakashima Takaya , Goto Tadahiro , Nakamura Kensuke , Nakano Hidehiko , Motoki Maiko , Kamijo Hiroshi , Ayaka Matsuoka , Ishii Kenzo , Morita Yasunari , Hongo Takashi , Shimojo Nobutake , Tanaka Yukiko , Hanazawa Manabu , Hamagami Tomohiro , Oike Kenji , Kasugai Daisuke , Sakuda Yutaka , Irie Yuhei , Nitta Masakazu , Akieda Kazuki , Shimakura Daigo , Katsukawa Hajime , Kotani Toru , Nydahl Peter , Schaller Stefan J. , Ogura Takayuki ,   on behalf of the Investigating Long term Outcomes of ICU patients with Sepsis or Septic shock (ILOSS) Study Group
Published: February 2025

Objective:

Sepsis often leads to heterogeneous symptoms of post-intensive care syndrome (PICS) composing physical, cognitive, and psychiatric disabilities, resulting in deteriorated quality of life (QoL), with limited interventions. This study aimed to identify phenotypes of sepsis-associated PICS by physical, cognitive, and psychiatric function and QoL at hospital discharge.

Design:

A prospective observational study.

Setting:

Twenty-one mixed ICUs.

Patients:

All consecutive adult patients between November 2020 and April 2022, diagnosed with sepsis at ICU admissions and survived discharge, were enrolled.

Interventions:

None.

Measurements and Main Results:

Phenotyping with clusters determined by three approaches was performed with following variables at hospital discharge: Barthel Index (≤ 90 defined physical PICS), Short Memory Questionnaire (< 40 defined cognitive PICS), Hospital Anxiety and Depression Scale (≥ 8 defined psychiatric PICS), Impact of Event Scale-Revised (≥ 25 defined psychiatric PICS), EuroQoL 5-dimension 5-level, Clinical Frailty Scale hand-grip strength, and Medical Research Council. Each disability, employment, destination, and survival, were followed over the first year of hospital discharge. In total, 220 ICU patients were included (median age: 72.5 yr, 129 males (59%), 166 septic shocks (75%), and median Sequential Organ Failure Assessment Score: 8). Four phenotypes were identified: group 1 (n = 62) with no PICS, group 2 (n = 55) with mild PICS (physical and cognitive), group 3 (n = 53) with moderate PICS (all domains), and group 4 (n = 50) with severe PICS (all domains). Functional decline and recovery significantly varied among the phenotypes. Physical and cognitive PICS in group 2 improved by the 3-month follow-up, whereas the disabilities in groups 3 and 4 remained over the year. Psychiatric PICS in groups 3 and 4 ameliorated, whereas depression symptoms in group 4 were still evident at the 12-month follow-up. All groups showed persistent moderate to severe reduced QoL and low employment (0–50%). The survival in group 4 continuously decreased.

Conclusions:

Four clinical phenotypes of ICU sepsis survivors might contribute to a deeper understanding of post-sepsis trajectories and an individualized treatment approach.
The impact of genetic variations in FPGS, MTHFR, and ATIC on methotrexate response among pediatric patients with acute lymphoblastic leukemia
Authors: Wang Shu-Mei , Zhao Dan-Qi , Kong Xiao-Yan , Li Miao
Published: February 2025

Objectives

Genetic polymorphisms in FPGS, MTHFR, and ATIC have emerged as important modulators of methotrexate (MTX) metabolism and toxicity. We investigated the distribution of FPGS rs10106, MTHFR rs1801131, and ATIC rs2372536 polymorphisms in children with acute lymphoblastic leukemia (ALL) and assessed their influence on MTX concentrations, toxicity profiles, and clinical outcomes.

Methods

Genotyping of FPGS rs10106 G > A, MTHFR rs1801131 A > C, and ATIC rs2372536 C > G polymorphisms was conducted using the Sequenom MassARRAY iPLEX platform in 145 pediatric ALL patients.

Results

Significant ethnic differences were observed in the allelic and genotypic distributions of the three single nucleotide polymorphisms (SNPs) investigated. None of these three SNPs had a significant effect on MTX levels or toxicities. The frequencies of the ATIC rs2372536 CC genotype and C allele in ALL patients (44.8% and 68.6%, respectively) were significantly lower than those in Han Chinese in Beijing, China (58.3% and 78.2%, respectively; P = 0.036 and 0.019, respectively). Patients carrying the ATIC rs2372536 GG genotype (36.4%, 4/11) had a significantly higher relapse rate than the CC genotype carriers (6.2%, 4/65, P = 0.013). There, however, were no significant effects on relapse-free survival in Kaplan–Meier and Cox regression analyses for all three candidate SNPs.

Conclusion

Our findings offer valuable insights into the intricate interplay between genetic polymorphisms, MTX exposure, toxicities, and clinical outcomes in patients with ALL and have the potential to inform precision medicine strategies.
The Rate of Secondary Speech Surgery After Cleft Palate Repair: A Systematic Review
Authors: Plonkowski Alexander T. , Choi Dylan G. , Naidu Priyanka , Turk Marvee , Yao Caroline A. , Magee William P.
Published: February 2025

Background:

Reported rates of velopharyngeal insufficiency (VPI) after primary palatoplasty for cleft palate (CP) range from 5% to 30%. Although some cases are managed with speech therapy, many patients with VPI require surgical intervention. In this study, we investigate the rate of VPI surgery in patients with CP.

Methods:

A systematic review was undertaken following PRISMA guidelines. PubMed, Scopus, and Cochrane databases were used. Studies reporting the rate of VPI surgery in patients with CP were included. Studies containing patients with submucous clefts and/or lacking 6 months follow-up were excluded. Rates of VPI surgery were calculated through weighted means.

Results:

Fifty-eight articles were included. The overall rate of VPI surgery was 17.5% ± 9.2% (range, 0%–59%). When stratified by phenotype, the rate of VPI surgery was 20.0% ± 13.1% for unilateral cleft lip and palate (range, 0%–39.6%), 27.1% ± 17.2% for bilateral cleft lip and palate (range, 0%–59%), and 14.4% ± 7.2% for isolated CP (range, 0%–47.4%, P > 0.05). When segregated by the palatoplasty technique, the surgical rate was 7.2% ± 3.7% for Furlow, 20.3% ± 19.8% for 2-flap, 5.0% ± 2.8% for Sommerlad, and 23.4% ± 8.0% for 2-stage (P > 0.05). Of studies reporting VPI assessment criteria, speech pathology assessment alone (n = 11, 34.4%) was the most common.

Conclusions:

Significant variability exists in reported rates of VPI surgery after CP repair. Initial results suggest a higher rate of VPI surgery in association with certain phenotypes and repair techniques, but data are insufficient for robust conclusions.
Adapting an Internet-Based Parenting Intervention for Parents With Intellectual Disabilities
Authors: Guinness Kendra E. , Diercks Catherine , Vaughn Kelly , Davis Betsy , Landry Susan , Feil Edward G.
Published: February 2025

Parents with intellectual and developmental disabilities (IDD) experience a unique set of contextual challenges that may limit the effectiveness of traditional parenting interventions. Identifying effective adaptations to existing evidence-based parenting interventions to address the needs of this vulnerable population is critical for maximizing positive outcomes for parents and children. The current study describes an iterative process of adaptation and revision of the digitally delivered Play and Learning Strategies (ePALS) program. Input from previously conducted focus groups, interviews, and a consultant parent with IDD informed preliminary adaptations to the original ePALS intervention, the efficacy of which was then evaluated with three parent–child dyads via a single-case experimental design. Preliminary data were promising but also illuminated additional implementation barriers related to recruitment and retention, assessment, and skill acquisition within the ePALS program. We discuss our approach for addressing these challenges through additional procedural revisions in preparation for a larger scale randomized controlled trial.
Timing of neurosurgical interventions for intracranial hypertension: the intensivists’ and neurosurgeons’ view
Authors: Lin Victor , Hutchinson Peter John , Kolias Angelos , Robba Chiara , Wahlster Sarah
Published: February 2025

Purpose of review

The aim of this study was to highlight clinical considerations regarding medical versus surgical management of elevated intracranial pressure (ICP), describe limitations of medical management, and summarize evidence regarding timing of neurosurgical interventions.

Recent findings

The optimal ICP management strategy remains elusive, and substantial practice variations exist. Common risks of medical treatments include hypotension/shock, cardiac arrhythmias and heart failure, acute renal failure, volume overload, hypoxemia, and prolonged mechanical ventilation.

In traumatic brain injury (TBI), recent randomized controlled trials (RCT) did not demonstrate outcome benefits for early, prophylactic decompressive craniectomy, but indicate a role for secondary decompressive craniectomy in patients with refractory elevated ICP. A recent meta-analysis suggested that when an extraventricular drain is required, insertion 24 h or less post-TBI may result in better outcomes.

In large ischemic middle cerebral artery strokes, pooled analyses of three RCTs showed functional outcome benefits in patients less than 60 years who underwent prophylactic DC within less than 48 h. In intracranial hemorrhage, a recent RCT suggested outcome benefits for minimally invasive hematoma evacuation within less than 24 h.

More data are needed to guide ICP targets, treatment modalities, predictors of herniation, and surgical triggers; clinical decisions should consider individual patient characteristics, and account for risks of medical and surgical treatments.
Gastrointestinal dysmotility in the ICU
Authors: Pachisia Anant Vikram , Pal Divya , Govil Deepak
Published: February 2025

Purpose of review

This review aims to provide a comprehensive overview of gastrointestinal dysmotility, particularly in critically ill patients within the ICU. It highlights the pathophysiology, prevalence, and clinical implications of conditions, such as oesophageal dysmotility, gastroparesis, ileus, and Ogilvie's syndrome. By examining current diagnostic and treatment approaches, the review emphasizes the importance of recognizing and managing gastrointestinal dysmotility to improve patient outcomes.

Recent finding

Recent literature indicates that up to 60% of ICU patients experience some form of gastrointestinal dysmotility, with those on mechanical ventilation being particularly at risk. The review identifies key contributors to gastrointestinal dysmotility, including inflammatory states, electrolyte imbalances, and the effects of certain medications. Nonpharmacological strategies, such as early enteral feeding, correcting electrolyte abnormalities, and mobilization are critical. Prokinetic agents have shown promise in alleviating feeding intolerance and improving gastric emptying, though their effects on overall mortality remain inconclusive.

Gastrointestinal dysmotility presents a significant challenge in critically ill patients, leading to various complications that hinder recovery. Understanding the underlying pathophysiology, coupled with effective diagnostic and treatment strategies, is essential for enhancing patient care. This review underscores the need for continued research and clinical focus on gastrointestinal motility disorders in the ICU to improve health outcomes for this vulnerable population.