bluuebunny/crossref_metadata_2025 huggingface dataset:
Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance
Authors: Schutgens Roger E.G. , Jimenez-Yuste Victor , Escobar Miguel , Falanga Anna , Gigante Bruna , Klamroth Robert , Lassila Riitta , Leebeek Frank W.G. , Makris Michael , Owaidah Tarek , Sholzberg Michelle , Tiede Andreas , Werring David J. , van der Worp H. Bart , Windyga Jerzy , Castaman Giancarlo
Published: June 2023

Cardiovascular disease is an emerging medical issue in patients with hemophilia (PWH) and its prevalence is increasing up to 15% in PWH in the United States. Atrial fibrillation, acute and chronic coronary syndromes, venous thromboembolism, and cerebral thrombosis are frequent thrombotic or prothrombotic situations, which require a careful approach to fine-tune the delicate balance between thrombosis and hemostasis in PWH when using both procoagulant and anticoagulant treatments. Generally, PWH could be considered as being naturally anticoagulated when clotting factors are <20 IU/dL, but specific recommendations in patients with very low levels according to the different clinical situations are lacking and mainly based on the anecdotal series. For PWH with baseline clotting factor levels >20 IU/dL in need for any form of antithrombotic therapy, usually treatment without additional clotting factor prophylaxis could be used, but careful monitoring for bleeding is recommended. For antiplatelet treatment, this threshold could be lower with single-antiplatelet agent, but again factor level should be at least 20 IU/dL for dual antiplatelet treatment. In this complex growing scenario, the European Hematology Association in collaboration with the International Society on Thrombosis and Haemostasis, the European Association for Hemophilia and Allied Disorders, the European Stroke Organization, and a representative of the European Society of Cardiology Working Group on Thrombosis has produced this current guidance document to provide clinical practice recommendations for health care providers who care for PWH.
Safety of office-based lens surgery: U.S. multicenter study
Authors: Kugler Lance J. , Kapeles Matthew J. , Durrie Daniel S.
Published: June 2023

Purpose:

To evaluate the rate of adverse events after office-based lens surgery performed across multiple private practices in the United States.

Setting:

36 private practices across the U.S.

Design:

Retrospective multicenter study.

Methods:

This analysis included case records of all consecutive patients who underwent office-based lens surgery for visually significant cataract, refractive lens exchange, or phakic intraocular lens implantation between August 2020 and May 2022 at 36 participating sites across the U.S. The study outcome measures included the assessment of intraoperative and postoperative complications such as the incidence of unplanned vitrectomy, iritis, corneal edema, and endophthalmitis after lens surgery. The frequency of patients requiring a return to the operating room (OR) or referral to a retina surgeon and the frequency of patients requiring hospitalization or calling emergency services (911) for any reason were also evaluated.

Results:

The study reviewed 18 005 cases of office-based cataract or refractive lens surgery performed at 36 clinical sites. The rates of postoperative endophthalmitis, toxic anterior segment syndrome, and corneal edema were 0.028%, 0.022%, and 0.027%, respectively. Unplanned anterior vitrectomy was performed in 0.177% of patients. Although 0.067% of patients needed to return to the OR, 0.011% of patients were referred to the hospital.

Conclusions:

The rate of adverse events for office-based cataract or refractive lens surgery is similar to or less than the reported adverse event rate for modern cataract surgery in the ambulatory surgery center setting.
Substance Misuse Themes Among Women Living in Transitional Housing
Authors: Lopez Alexa A. , Dressel Anne E. , Deal Emily , Krueger Emma , Graf Maria , Pittman Belinda , Schmitt Marin , Kako Peninnah , Ochoa-Nordstrum Brittany , Mkandawire-Valhmu Lucy
Published: June 2023

Traditional substance misuse treatments have not always taken women or marginalized populations into consideration. A holistic approach that addresses how drugs may be used to cope with trauma caused by violence, poverty, and neglect as well as employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. As substance misuse rates rise among African American women, characterizing how this may influence or be influenced by relationships (such as with children, intimate partners, and social relations) is especially important in the context of effective treatment. The purpose of this qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program grounded in social support. Many women discussed how the program itself was an impetus in addressing not only their own substance use but also intergenerational substance use within their families. Women also noted how relationships with their children were vastly different pretreatment compared with during and after treatment, specifically emphasizing a positive improvement. Regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professional in ensuring effective and culturally relevant treatment for African American women; nursing curricula should include evidence-based practice education and training on mental health and substance misuse specific to marginalized communities to more deeply understand the complex intersections of substance misuse, poverty, and social relationships in the lives of women.
Utilization of Nurse-Administered Screening, Brief Intervention, and Referral to Treatment in a Brief Psychiatric Inpatient Unit
Authors: Kracher Stacy , Bayette Lorrie , Young Doris , Goebert Deborah A. , Guerrero Maria , Agapoff Jame A.
Published: June 2023

Background

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use.

Objectives

The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates.

Design

Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates.

Results

Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16–31 postdischarge.

Conclusions

SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.
Multilevel Factors Associated With Lifetime, Current, and Binge Drinking Among Korean Adolescents Based on the Ecological Model
Authors: Kim Eun-Mi , Kim Heejung
Published: June 2023

Background

Drinking usually begins in adolescence and is a major public health concern. Few studies have identified multilevel factors considering the frequency and amount of drinking among adolescents. This study aimed to identify the multilevel factors associated with lifetime, current, and binge drinking among Korean adolescents based on the ecological model.

Methods

This cross-sectional study used data from the 2018 Korea Youth Risk Behavior Survey (N = 60,040). Hierarchal multinomial logistic regression analyses were performed using complex sample data.

Results

Overall, 15,030 (25.4%), 4,629 (8.0%), and 5,038 (8.9%) subjects were involved in lifetime, current, and binge drinking, respectively. The following multilevel factors revealed significant associations with lifetime, current, and binge drinking: boys, high school students, depression, suicidal ideation at individual level, family acceptance of alcohol use, poor household economic status at family level, poor academic achievement, not receiving education on alcohol use at school level, possible alcohol access, and harm caused by drinkers at social level (all ps < .01). The main risk factors were family acceptance of alcohol use (lifetime, current, and binge drinking vs. OR = 3.95, 6.88, and 5.46, respectively) and possible alcohol access (OR = 5.65, 19.78, and 93.62).

Discussion

This study revealed multilevel factors associated with lifetime, current, and binge drinking. School nurses and community leaders are necessary to develop customized drinking prevention programs considering drinking frequency and amount, and individual, family, school, and social factors. Especially, the implementation of a drinking prevention program that reduces family acceptance of alcohol use and access to alcohol could be an effective strategy.
Relapse Prevention and Prediction Strategies in Substance Use Disorder
Authors: Carter T'Anya , Heaton Karen , Merlo Lisa J. , Roche Bernadette T. , Puga Frank
Published: June 2023

Background

Relapse prevention for those with substance use disorder (SUD) is an evolving practice. Initiatives focused on relapse prevention from other populations may provide the foundation for future considerations and recommendations for recovering anesthesia providers in the workplace. The purpose of this scoping review was to examine what is known about return-to-use prediction and prevention strategies in various populations struggling with SUDs to inform future considerations and implications for recovering anesthesia providers with a history of SUD.

Methods

The Arksey and O'Malley framework was used to conduct a scoping review of the literature. A systematic search was conducted across three databases (PubMed, CINAHL, and PsycInfo) for relevant literature. Search terms used were “measures predicting relapse in substance use disorder” and “relapse prevention in substance use disorder AND anesthesia.” Data from articles that met the eligibility criteria were extracted and summarized by the primary author.

Results

The search identified 46 articles highlighting various relapse prediction and prevention strategies related to craving and stress, underlying biological factors, neuroimaging, and mindfulness. Relapse prediction and prevention strategies ranged from cell phone applications, monitoring biological markers, and functional neuroimaging of the brain.

Conclusions

Relapse is a concern for individuals with a history of SUD. For anesthesia providers, immediate access to powerful anesthesia medications requires return-to-use prediction and prevention strategies when anesthesia providers return to work after SUD treatment. Although some identified strategies are practical, more research is needed to predict and prevent return to use for recovering anesthesia providers.
To explore the effects of herbal medicine among cancer patients in Taiwan: A cohort study
Authors: Li Tsai-Feng , Hwang I-Hsuan , Tsai Cheng-Hung , Hwang Shinn-Jang , Wu Ta-Peng , Chen Fang-Pey
Published: June 2023

Background:

Traditional Chinese medicine (TCM) is widely used by ethnic Chinese communities. TCM is covered by Taiwan’s National Health Insurance (NHI) program. We evaluated the efficacy and outcomes of complementary Chinese herbal medicine (CHM) therapy in patients with cancer.

Methods:

This population-based cohort study was conducted using the data of patients who received a cancer diagnosis between 2005 and 2015 in Taiwan. Eligible patients were divided into standard and complementary CHM therapy groups. The complementary CHM therapy group was further divided into low cumulative dosage (LCD), medium cumulative dosage (MCD), and high cumulative dosage (HCD) subgroups. Overall survival (OS), mortality risk, cancer recurrence, and metastasis were analyzed for all cancers and five major cancers (lung, liver, breast, colorectal, and oral cancers).

Results:

We included 5707 patients with cancer (standard therapy, 4797 [84.1%]; complementary CHM therapy, 910 [15.9%]; LCD, 449 [7.9%]; MCD, 374 [6.6%], and HCD, 87 [1.5%]). For the LCD, MCD, and HCD subgroups, the mortality risk was 0.83, 0.64, and 0.45, and the 11-year OS, 5-year cumulative cancer recurrence, and 5-year cumulative cancer metastasis rates were 6.1 ± 0.2, 6.9 ± 0.2, and 8.2 ± 0.4 years; 39.2%, 31.5%, and 18.8%; and 39.5%, 32.8%, and 16.6%, respectively. The cumulative cancer recurrence and metastasis rates of the standard therapy group were 40.9% and 32.8%, respectively. The cumulative recurrence and metastasis rates of all cancers, lung cancer, and liver cancer and all cancers, colorectal cancer, and breast cancer, respectively, were significantly lower in the HCD subgroup than in the other subgroups and standard therapy group (p < 0.05).

Conclusion:

Patients receiving complementary CHM therapy may have prolonged OS and reduced risks of mortality, recurrence, and metastasis. A dose–response relationship was noted between CHM therapy and mortality risk: increased dosage was associated with improved OS and reduced mortality risk.
The Effect of Distance Empowerment Program on Self-efficacy Among Multiple Sclerosis Patients
Authors: Arab Farzaneh , Hekmatpou Davood , Saeedi Maryam
Published: June 2023

BACKGROUND: Multiple sclerosis (MS) is the most common nontraumatic debilitating disease in young adults. This study aimed to determine the effect of distance empowerment programs on self-efficacy in MS patients. METHODS: Sixty-four MS patients participated in this quasi-experimental study. Patients were first entered into the study using the convenience sampling method and then were randomly allocated to control (32) and intervention (32) groups. The intervention group underwent a distance empowerment program (via WhatsApp, Telegram, and blog) and weekly telephone follow-up for 2 months. Self-efficacy was evaluated before, and immediately after, the empowerment program using the MS Self-Efficacy Scale. RESULTS: Data from 59 participants were analyzed. Before implementation of the empowerment program, the mean scores of self-efficacy in the intervention and control groups were not significantly different. After implementing the empowerment program, the mean score of self-efficacy in the intervention group was higher than that of the control group (P < .05). CONCLUSION: Distance empowerment has an effect on the self-efficacy of patients with MS and may lead to an increase in self-efficacy scores after implementing an empowerment program.
Gender disparities in health-related quality of life (HRQoL) in patients with cutaneous T-cell lymphoma
Authors: Chalaka Christopher W. , Mahurin Heather M. , Tarabadkar Erica , Hippe Daniel S. , Loggers Elizabeth T. , Shinohara Michi M.
Published: June 2023

Background:

Patients with cutaneous T-cell lymphoma (CTCL) often experience debilitating symptoms that impair health-related quality of life (HRQoL). Existing evidence for HRQoL differences with respect to gender is conflicting.

Objective:

To investigate potential gender differences in HRQoL for patients with CTCL.

Methods:

We performed a cross-sectional study to assess HRQoL in patients with CTCL by partnering with the Cutaneous Lymphoma Foundation to distribute an electronic survey from February to April 2019.

Results:

A total of 292 patient responses (66% women, mean age 57 years) were included in the analysis. Most of the cohort had early-stage (IA–IIA) (74%; 162/203) mycosis fungoides (MFs) (87%; 241/279), followed by Sézary syndrome (SS) (12%; 33/279). Women with CTCL experienced significantly worse HRQoL compared with men (Skindex-16: 51±26 vs. 36±26, P ≤ 0.001; FACT-G: 69±21 vs. 77±16, P = 0.005). This gender difference was present even when controlling for stage of disease. Women experienced worse HRQoL in all three of the Skindex-16 subscales (symptoms: β = 14.0, P ≤ 0.001; emotions: β = 15.1, P ≤ 0.001; functioning: β = 11.3, P = 0.006), but only two of the four FACT-G subscales (physical: β =-2.8, P ≤ 0.001; emotional: β = -2.0, P = 0.004).

Limitations:

Due to the method of distribution of the survey, we were unable to estimate a participant response rate. Participants’ diagnosis and stage were self-reported.

Conclusion:

In this cohort women with CTCL experienced significantly worse HRQoL when compared to men. Additional studies are necessary to determine what factors contribute to this gender disparity.
Use of Mitomycin-C in Laryngotracheal Stenosis
Authors: Di Felice Christopher , Machuzak Michael S. , Shepherd Ray W.
Published: June 2023

Background:

Therapeutic options for managing laryngotracheal stenosis (LTS) are limited. Endoscopy is a minimally invasive approach to treating LTS, but carries a high risk of stenosis recurrence. Mitomycin C (MMC) is often used as an adjunct therapy to delay the time to symptomatic recurrence of LTS. This review synthesizes the current literature on the topic of MMC as an adjunct treatment strategy for LTS.

Methods:

A focused literature search was carried out from PubMed on June 12, 2022 using the terms “mitomycin c AND stenosis” in all fields with no date limitations. Evidence-based recommendations relevant to the clinical application of MMC as an adjunct therapy for LTS were formulated. Three questions were addressed: 1) efficacy of MMC, 2) single versus multiple application(s) of MMC, and 3) safety of MMC. The evidence rating and recommendation strength were guided by the GRADE system.

Results:

Twenty-nine studies were reviewed. The efficacy of MMC as an adjunct therapy for LTS varied across studies. Randomized controlled trials have not shown an outcome difference with MMC use, although methodologic flaws including underpowering were noted. A meta-analysis of observational studies with a comparator arm found the unadjusted probability of remaining symptom-free for >1 year is greater with versus without MMC application (73% vs. 35%). Single versus multiple application(s) of MMC resulted in similar restenosis rates at long-term follow-up. Complications related to MMC use are rarely reported using conventional doses (0.4 mg/mL). Overall, the quality of evidence was low and the recommendation for intervention was weak.

Conclusion:

The role for MMC as an adjunct therapy in LTS is uncertain. While safe in its application, the efficacy of MMC in reducing stenosis recurrence remains a matter of debate. Large, prospective studies are needed to inform future recommendations.
Choosing Wisely in Gastroenterology: five new recommendations from the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO)
Authors: Venezia Ludovica , Buonocore Matteo Rossano , Barbuscio Ilenia , Bortoluzzi Francesco , Monica Fabio , Manfredi Guido , Anderloni Andrea , Stasi Elisa ,   on behalf of Association of Hospital Gastroenterologists and Endoscopists (AIGO) Young Committee
Published: June 2023

Background

‘Choosing Wisely’ is an international campaign against inappropriateness in medical practices that aims to promote a rational and evidence-based use of resources. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) joined the Campaign in 2017 releasing five recommendations.

Aims

To identify five new recommendations for a correct, evidence-based approach to the management of gastrointestinal diseases.

Methods

All AIGO members were asked to identify practices or interventions that, even though diffuse in clinical practice, do not provide benefit for patients. The proposed items were then revised, divided by topic and ranked. After a systematic review of the literature for each item, five new recommendations were identified.

Results

The five recommendations are: do not request surveillance investigations for patients with pancreatic cysts who are poor surgical candidates, irrespective of cysts nature and characteristics; do not request esophagogastroduodenoscopy in patients with recent onset of upper gastrointestinal symptoms younger than 50 years, without alarm features; do not request surveillance colonoscopy for asymptomatic colonic diverticular disease without changes in symptoms; do not perform food intolerance tests except for those scientifically validated; do not prescribe proton pump inhibitors to patients with liver cirrhosis, outside of established indications.

Conclusion

The Choosing Wisely recommendations will reduce unnecessary testing and treatments, increasing patient safety and overall healthcare quality.
Application of the birthrate plus (BR+) methodology to identify midwifery workforce shortages in China: a retrospective multisite study
Authors: He Hongxiao , Lu Hong , Wang Yan , Pang Ruyan , Qiu Liqian , Yao Jiasi , Zhou Hong , Zhu Xiu
Published: June 2023

Objective:

The goal of this study is to apply Birthrate Plus (BR+) methodology in Chinese midwifery settings to assess the midwifery workforce status and to calculate the potential demand for more midwives.

Methods:

This was a retrospective multisite study using 12,443 maternal medical records from 49 midwifery settings in Zhejiang Province, China. Data needed in the BR+, including the types of childbearing women and the number of midwifery service hours, were extracted and then calculated to assess the estimated demand and shortage of midwives.

Results:

The study included 599 midwives across 49 settings, with a range of 1–35 full-time equivalent midwives per setting, totaling 465 full-time equivalent midwives. Using BR+ methodology, the analysis revealed a shortage of midwives in 61.2% of the surveyed settings and a surplus in 22.4%. The shortage varied significantly across different levels of settings (H=6.505, P<0.05).

Conclusions:

Overall, the midwifery services provided were significantly insufficient in the surveyed regions, and workforce allocation was unbalanced among different areas.
A Systematic Review of Multisensory Stimulation on Procedural Pain Among Preterm Neonates
Authors: Sharma Neha , Samuel Asir John
Published: June 2023

Purpose:

This systematic review aims to evaluate the quality of studies and synthesize the literature on multisensory stimulation (MSS) on procedural pain among hospitalized preterm neonates.

Summary of Key Points:

Search strategies were applied to PubMed/Medline, CINAHL, SCOPUS, and PEDro. A total of 414 studies were identified, 104 were screened, and 4 were included. Two independent reviewers extracted data from identified studies that were synthesized qualitatively and quantitatively.

Conclusion and Recommendations for Clinical Practice:

There is strong evidence of MSS in decreasing procedural pain, but additional research is needed to identify the beneficial effects of MSS with a standardized protocol to promote good clinical practice in neonatal intensive care settings.

What This Adds to the Evidence:

High-quality evidence supports beneficial effects of MSS, but standardization of the MSS protocol and its administration needs to be established.
High Specificity of HPV Cell-Free DNA Tests in Persons With HIV for the Detection of HPV-Related Cancer
Authors: Ellsworth Grant , Shen Roger , Marcelin Kinge-Ann , Majumdar Rahul , Bazil Maximillian , Moore Grace , Nelson Meredith , Alland Isabel , Sepulveda Gustavo , Wilkin Timothy , Higginson Daniel S.
Published: June 2023

Introduction:

Persons with HIV (PWH) experience high rates of human papillomavirus (HPV)–associated cancers compared with the general population. Plasma HPV cell-free DNA (cfDNA) tests are sensitive in patients with known HPV-associated cancers. It is not known whether these tests can screen for invasive cancers in populations with high burdens of nonmalignant HPV disease such as PWH. It was not known whether HPV infection and/or noninvasive anal high-grade squamous intraepithelial lesions (HSIL) alone in this population would result in detectable HPV cfDNA, which would result in a high number of false positives if HPV cfDNA is used to screen for invasive cancers.

Methods:

We conducted a prospective study of PWH in 2 cohorts: 20 without anal HSIL and 20 with anal HSIL. We tested anal and vaginal swabs for HPV infection, and HPV genotyped the biopsies of anal HSIL. Finally, we performed HPV cfDNA droplet digital polymerase chain reaction to test for HPV16/18/33 from plasma samples.

Results:

In the combined cohorts, the median age was 56 years, 12.5% were cisgender women, and none had detectable HIV. In total, 84.6% had prevalent anovaginal HPV infection, including 10 participants with HPV16, 13 with HPV18, and 2 with HPV33 infections. Five and 2 participants had HPV16 and HPV33 detected in anal HSIL, respectively. Despite the high prevalence of HPV infection and anal HSIL, no participant had HPV16/18/33 detectable cfDNA by droplet digital polymerase chain reaction.

Conclusions:

These results provide a strong rationale for investigating the use of HPV cfDNA in a screening setting for suspected HPV-related invasive cancers in PWH.
A Case of Pancreatic Cancer With Rare Cutaneous and Muscle Metastases on 18F-FDG PET/CT Imaging
Authors: Zhang Zeyu , Guo Shiwei , Zuo Changjing , Cheng Chao
Published: June 2023

A 46-year-old man underwent PET/CT for metastatic survey 6 years after radical resection of pancreatic cancer. In addition to the increased uptake observed in the operative area, increased FDG uptake was also observed in the left external abdominal oblique muscle and the left frontal scalp. Both intramuscular and subcutaneous lesions were surgically excised and diagnosed as metastases from pancreatic cancer.
Pneumatic Compression–Assisted Lymphoscintigraphy for Quantitative Evaluation of Breast Cancer–Related Lymphedema
Authors: Min Ingi , Lim Sung Joon , Cheon Gi Jeong , Suh Minseok , Seo Kwan Sik
Published: June 2023

Objectives

Acquired lymphedema of upper extremity is a chronic pathologic status that frequently occurs after breast cancer treatment. Reliable and quantitative evaluation of lymphedema is crucial for successful management of patients. Although lymphoscintigraphy is the primary investigation for the confirmation and evaluation of lymphedema, the specific protocol of stress intervention is not well established. This study aims to introduce intermittent pneumatic compression (IPC) as a part of stress lymphoscintigraphy and compare the effectiveness of conventional stress lymphoscintigraphy (CSL) and pneumatic compression–assisted lymphoscintigraphy (PCAL).

Methods

Our study was designed as a retrospective analysis of 85 breast cancer patients with lymphedema who underwent lymphoscintigraphy utilizing either IPC device or conventional stress maneuver and received complex decongestive therapy. The flow extent of the lymphatic fluid (FE) was evaluated using a 0- to 4-point scale based on lymphoscintigraphic images. The visualization of lymph nodes was also assessed. The clinical outcomes were evaluated by changes in side-to-side circumferential and volume differences of upper extremities and compared between groups.

Results

Of 85 patients, 47 underwent CSL, and 38 underwent PCAL. Participants with relatively preserved flow extent of the lymphatic fluid (FE 3) showed a significant difference in percentage reduction of volume (PRV) between CSL and PCAL groups (P = 0.036). In the other groups, CSL and PCAL demonstrated comparable differences in PRV without statistical significance.

Conclusion

Our study suggests that participants in the PCAL group with relatively preserved lymphatic flow extent (FE 3) had better PRV compared with those in the CSL group. The use of IPC devices in lymphoscintigraphy with the novel stress maneuver can help in the quantitative description of lymphedema status and the selection of an appropriate treatment method.
Robot-Guided Stereotactic Puncture and Drainage in the Treatment of Thalamic Abscess
Authors: Chen Xiaoshuai , Cao Xuemin , Nie Quanmin , Li Sen , Wang Zengwu , Fan Danjie
Published: June 2023

Brain abscess is rare in clinic, the reported incidence is only 0.4 to 0.90 per 100,000 population, and most of them have a history of prodromal infection. Headache and fever are the most common clinical symptoms, and only a few are accompanied by neurological disorders. For the treatment of brain abscess, the most commonly used treatment is stereotactic puncture drainage and antibacterial therapy. A patient with a left thalamic abscess with no history of prodromal infection was reported. Stereotactic puncture and drainage were performed under the guidance of the Ruimi robot. The bacterial culture of the abscess was Streptococcus constellation (Streptococcus constellatus). The patient was discharged after 4 weeks of antibacterial treatment with vancomycin. The patients were followed up half a year after the operation, the prognosis was good and there was no recurrence.
Correction of Cryptotia With Double Z-plasty:Modified Large Z-plasty Technique
Authors: Yotsuyanagi Takatoshi , Yamashita Ken , Sugai Asuka , Gonda Ayako , Kitada Ayaka , Onuma Masahiro , Ueda Naohiro , Harada Jiro
Published: June 2023

Some cases of moderate or severe cryptotia are accompanied by a shortage of the helix. Although various operative techniques for correcting cryptotia have been reported, elongation of the helix is not considered in most of those techniques. In cases of a shortage of the helix, a drooped wide helix like a constricted ear or a cranially and posteriorly hypoplastic ear, which is characteristic of cryptotia, can appear after surgery if the helix has not been elongated. We previously reported a large Z-plasty technique that has become one of the popular techniques for correcting cryptotia. However, satisfactory results are not always achieved by using this technique in cases with a shortage of the helix. We developed a new technique (double Z-plasty) in which a small Z-plasty in the helical rim is added to the usual large Z-plasty technique. An improved helical shape and enlargement of the ear can be achieved by using this technique. Almost all types of cryptotia can be treated by appropriately using the large Z-plasty and double Z-plasty techniques.
Oroantral Communications: Clinical Efficacy of a Double-layered Technique With/Without the Palatal Connective Tissue Flap: A Superiority, Single-center, University-based Randomized Clinical Trial
Authors: Baldini Nicola , Giammarinaro Enrica , Ferrari Cagidiaco Edoardo , Viviano Massimo , Discepoli Nicola , Parrini Stefano
Published: June 2023

The aim of this study was to compare the clinical results of combining a pedicle connective palatal flap coupled with the trapezoid buccal flap against the buccal flap alone in the closure of the oroantral fistula. Individuals with oroantral communication were consecutively included and eventually randomly allocated into 2 groups. In the group test, oroantral fistula was treated with the association of a buccal flap with a pedicle palatal connective tissue flap; in group control, a classic buccal sliding flap was performed. Patients’ outcomes were recorded at 48 hours, 1 week, 2 weeks, and 1 month after surgery for assessment of primary (success rate) and secondary endpoints, such as experienced pain, discomfort, and complications. The success rate was 96.6% for the test group and 86.6% for the control group. No significant difference between the 2 groups could be observed regarding discomfort and pain. More pronounced pain was detected in the test group during the early healing period. This surgical procedure was demonstrated to be successful, with a high success rate and low patient discomfort.
Comparison of the Efficacy of Subosseous Window Neuro-Endoscopy and Minimally Invasive Craniotomy in the Treatment of Basal Ganglia Hypertensive Intracerebral Hemorrhage
Authors: Lv Kun , Wang Yuhang , Chao Honglu , Cao Shengwu , Cao Wenping
Published: June 2023

Objective:

To compare the perioperative indexes and long-term effects of craniotomy and neuro-endoscopic hematoma removal in patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region.

Methods:

This study involved 128 patients with HICH in the basal ganglia region who were admitted to our hospital from February 2020 to June 2022. They were divided into 2 groups according to the random number table method. The craniotomy group (n = 70) underwent microsurgery with small bone window craniotomy with a side cleft, and the neuro-endoscopy group (n = 58) underwent small bone window neuro-endoscopic surgery. A 3-dimensional Slicer was used to calculate the hematoma volume and clearance rate and the postoperative brain tissue edema volume. The operation time, intraoperative blood loss, postoperative intracranial pressure, complications, mortality, and improvement in the modified Rankin scale score at 6 months postoperatively were compared between the two groups.

Results:

The clearance rate was significantly higher in the neuro-endoscopy group than in the craniotomy group (94.16% ± 1.86% versus 90.87% ± 1.89%, P < 0.0001). The operation time was significantly lower in the neuro-endoscopy group than in the craniotomy group (89.9 ± 11.7 versus 203.7 ± 57.6 min, P < 0.0001). Intraoperative blood loss was significantly higher in the craniotomy group (248.31 ± 94.65 versus 78.66 ± 28.96 mL, P < 0.0001). The postoperative length of stay in the intensive care unit was 12.6 days in the neuro-endoscopy group and 14.0 days in the craniotomy group with no significant difference (P = 0.196). Intracranial pressure monitoring showed no significant difference between the two groups on postoperative days 1 and 7. Intracranial pressure was significantly higher in the craniotomy group than in the neuro-endoscopy group on postoperative day 3 (15.1 ± 6.8 versus 12.5 ± 6.8 mm Hg, P = 0.029). There was no significant difference in the mortality or outcome rate at 6 months postoperatively between the two groups.

Conclusions:

In patients with HICH in the basal ganglia region, neuro-endoscopy can significantly improve the hematoma clearance rate, reduce intraoperative hemorrhage and postoperative cerebral tissue edema, and improve surgical efficiency. However, the long-term prognosis of patients who undergo craniotomy through the lateral fissure is similar to that of patients who undergo neuro-endoscopic surgery.
Vitamin D is a potential treatment for the management of gastrointestinal mucositis
Authors: Munem Fizza , Thianhlun Phir C.K. , Anderson Paul H. , Stringer Andrea M.
Published: June 2023

Purpose of the review

Gastrointestinal mucositis (GM) is a severe side effect of cancer treatments, negatively impacting the patient’s quality of life, and has limited treatment. GM consists of complex biological processes involving apoptosis and inflammation, leading to damage and ulceration of the gastrointestinal system. Recently, vitamin D has been shown to have multiple roles in the gut, including immunomodulation, epithelial barrier regulation and microbiome regulation. Hence, this review aims to put forth vitamin D as a potential therapeutic due to its protective role in the intestine.

Recent findings

Recent studies have shown that vitamin D can reduce intestinal inflammation by reducing NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) activation. Vitamin D also targets and maintains the intestinal epithelial barrier via the tight junction protein expression and the inhibition of microbiome translocation. Significant evidence also suggests that vitamin D exerts multiple therapeutic effects through binding to vitamin D receptors (VDRs), and the downregulation of VDR has been associated with the severity of the disease. Additionally, vitamin D deficiency is reported in cancer patients.

There is a dire need for effective treatment for GM, and recent animal and human studies show that vitamin D may be a potential therapy to prevent or treat GM.
Clinical practice guideline recommendations for pediatric solid organ injury care: A Systematic Review
Authors: Yanchar Natalie , Tardif Pier-Alexandre , Freire Gabrielle , Bérubé Mélanie , Stelfox Henry T. , Beaudin Marianne , Stang Antonia , Beno Suzanne , Weiss Matthew , Labrosse Melanie , Zemek Roger , Gagnon Isabelle J. , Beaulieu Emilie , Berthelot Simon , Turgeon Alexis F. , Lauzier François , Gabbe Belinda , Moore Lynne
Published: June 2023

BACKGROUND

Observed variations in the management of pediatric solid organ injuries (SOIs) may be due to difficulty in finding and integrating recommendations from multiple clinical practice guidelines (CPGs) with heterogeneous methodological approaches. We aimed to systematically review CPG recommendations for pediatric SOIs.

METHODS

We conducted a systematic review of CPGs including at least one recommendation targeting pediatric SOI populations, using Medical Analysis and Retrieval System Online, Excerpta Medica dataBASE, Web of Science, and websites of clinical organizations. Pairs of reviewers independently assessed eligibility, extracted data, and evaluated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation II tool. We synthesized recommendations from moderate to high-quality CPGs using a recommendations matrix based on Grades of Recommendation, Assessment, Development, and Evaluation criteria.

RESULTS

We identified eight CPGs, including three rated moderate or high quality. Methodological weaknesses included lack of stakeholder involvement beyond surgeons, consideration of applicability (e.g., implementation tools), and clarity around the definition of pediatric populations. Five of the 15 recommendations from moderate to high-quality CPGs were based on moderate quality evidence or were rated as strong; these reflected nonoperative management and angioembolization for renal injuries and required length of stay for liver and spleen injuries.

CONCLUSION

We identified 15 recommendations on pediatric SOI management from 3 moderate or high-quality CPGs, but only one third were based on at least moderate-quality evidence or were rated as strong. Our results prompt the following recommendations for future CPG development or updates: (1) include all types of clinicians involved in the care of pediatric SOIs and patient and family representatives in the process, (2) develop clear definitions of the target population, and (3) provide advice and tools to promote implementation. Results also underline the urgent need for more rigorous research to support strong evidence-based recommendations in this population.

LEVEL OF EVIDENCE

Systematic Review/Meta-analysis; Level III.
The Entangled World of Memory T Cells and Implications in Transplantation
Authors: Alexander Katie L. , Ford Mandy L.
Published: June 2023

Memory T cells that are specific for alloantigen can arise from a variety of stimuli, ranging from direct allogeneic sensitization from prior transplantation, blood transfusion, or pregnancy to the elicitation of pathogen-specific T cells that are cross-reactive with alloantigen. Regardless of the mechanism by which they arise, alloreactive memory T cells possess key metabolic, phenotypic, and functional properties that render them distinct from naive T cells. These properties affect the immune response to transplantation in 2 important ways: first, they can alter the speed, location, and effector mechanisms with which alloreactive T cells mediate allograft rejection, and second, they can alter T-cell susceptibility to immunosuppression. In this review, we discuss recent developments in understanding these properties of memory T cells and their implications for transplantation.
Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b
Authors: Yan Qi , Guerrero Rafael F. , Khan Raiyan R. , Surujnarine Andy A. , Wapner Ronald J. , Hahn Matthew W. , Raja Anita , SallebAouissi Ansaf , Grobman William A. , Simhan Hyagriv , Blue Nathan R. , Silver Robert , Chung Judith H. , Reddy Uma M. , Radivojac Predrag , Pe’er Itsik , Haas David M.
Published: June 2023

Adverse pregnancy outcomes (APOs) are major risk factors for women’s health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWAS) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display the extensive results, we developed a web-based tool GnuMoM2b (https://gnumom2b.cumcobgyn.org/) for searching, visualizing, and sharing results from GWAS of 479 pregnancy traits as well as phenome-wide association studies (PheWAS) of more than 17 million single nucleotide polymorphisms (SNPs). The genetic results from three ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.
Dexamethasone modulate TWIST mediated EndMT changes in venous EC under acute shear stress. Implications for vein grafts disease
Authors: Ladak Shameem , McQueen Liam W , Tomkova Kristina , Adebayo Adewale , Suleiman Saadeh , George Sarah J , Murphy Gavin J , Zakkar Mustafa
Published: June 2023

Background

The use of vein grafts in coronary artery surgery is complicated by a high late restenosis rate resulting from the development of intimal hyperplasia, and accelerated atherosclerosis. TGFβ has been implicated in the process of intimal hyperplasia but the role of TGFβ driven Endothelial to mesenchymal is not fully understood. Here, we have investigated the hypothesis that arterial shear stress (flow) can trigger Endothelial to mesenchymal changes in venous ECs mediated by TGFβ / SMAD pathwayin-vitroandex-vivoand that a brief pretreatment of vein with Dexamethasone can suppress such changes.

Methods and Results

Comparative reverse-transcriptase polymerase chain reaction, immunostaining and Western blotting revealed that arterial shear stress induced TGFβ / SMAD dependent in HUVEC which was regulated by TWIST 1&2 as the selective inhibition of TWIST 1 or 2 using specific siRNA suppressed EndMT in response to shear stress. We also noted that brief pretreatment of HUVECs with Dexamethasone can modulate EndMT changes in response to shear stress. Using spatial cell sequencing in human long saphenous vein segments exposed to acute arterial flow identified a cluster of cells that had both EC and SMC phenotypes where TWIST2 was significantly upregulated. We validated the untargeted spatial findings in segments of veins under acute arterial flowex-vivousing comparative reverse-transcriptase polymerase chain reaction, immunostaining and RNAscope and observed that Dexamethasone can suppress EndMT changes in vein segments by suppressing TGFβ / SMAD/ TWIST1 &2.

Conclusion

Dexamethasone brief pretreatment can suppress EndMT changes triggered by acute exposure of long saphenous vein segments to arterial haemodynamics by modulating TGFβ / SMAD / TWIST1 &2 pathway.
Value of information dynamics in Disease X vaccine clinical trials
Authors: Houy Nicolas , Flaig Julien
Published: June 2023

Background

Solutions have been proposed to accelerate the development and rollout of vaccines against a hypothetical disease with epidemic or pandemic potential called Disease X. This may involve resolving uncertainties regarding the disease and the new vaccine. However the value for public health of collecting this information will depend on the time needed to perform research, but also on the time needed to produce vaccine doses. We explore this interplay, and its effect on the decision on whether or not to perform research.

Method

We simulate numerically the emergence and transmission of a disease in a population using a susceptible-infected-recovered (SIR) compartmental model with vaccination. Uncertainties regarding the disease and the vaccine are represented by parameter prior distributions. We vary the date at which vaccine doses are available, and the date at which information about parameters becomes available. We use the expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) to measure the value of information.

Results

As expected, information has less or no value if it comes too late, or (equivalently) if it can only be used too late. However we also find non trivial dynamics for shorter durations of vaccine development. In this parameter area, it can be optimal to implement vaccination without waiting for information depending on the respective durations of dose production and of clinical research.

Conclusion

We illustrate the value of information dynamics in a Disease X out-break scenario, and present a general approach to properly take into account uncertainties and transmission dynamics when planning clinical research in this scenario. Our method is based on numerical simulation and allows us to highlight non trivial effects that cannot otherwise be investigated.
Feature Selection for an Explainability Analysis in Detection of COVID-19 Active Cases from Facebook User-Based Online Surveys
Authors: Rufino Jesús , Ramírez Juan Marcos , Aguilar Jose , Baquero Carlos , Champati Jaya , Frey Davide , Lillo Rosa Elvira , Fernández-Anta Antonio
Published: June 2023

In this paper, we introduce a machine-learning approach to detecting COVID-19-positive cases from self-reported information. Specifically, the proposed method builds a tree-based binary classification model that includes a recursive feature elimination step. Based on Shapley values, the recursive feature elimination method preserves the most relevant features without compromising the detection performance. In contrast to previous approaches that use a limited set of selected features, the machine learning approach constructs a detection engine that considers the full set of features reported by respondents. Various versions of the proposed approach were implemented using three different binary classifiers: random forest (RF), light gradient boosting (LGB), and extreme gradient boosting (XGB). We consistently evaluate the performance of the implemented versions of the proposed detection approach on data extracted from the University of Maryland Global COVID-19 Trends and Impact Survey (UMD-CTIS) for four different countries: Brazil, Canada, Japan, and South Africa, and two periods: 2020 and 2021. We also compare the performance of the proposed approach to those obtained by state-of-the-art methods under various quality metrics: F1-score, sensitivity, specificity, precision, receiver operating characteristic (ROC), and area under ROC curve (AUC). It should be noted that the proposed machine learning approach outperformed state-of-the-art detection techniques in terms of the F1-score metric. In addition, this work shows the normalized daily case curves obtained by the proposed approach for the four countries. It should note that the estimated curves are compared to those reported in official reports. Finally, we perform an explainability analysis, using Shapley and relevance ranking of the classification models, to identify the most significant variables contributing to detecting COVID-19-positive cases. This analysis allowed us to determine the relevance of each feature and the corresponding contribution to the detection task.