bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone Density Correlates With Depth of Subsidence After Expandable Interbody Cage Placement
Authors: Katz Austen D. , Song Junho , Duvvuri Priya , Shahsavarani Shaya , Ngan Alex , Zappia Luke , Nuckley David , Coldren Valerie , Rubin Josh , Essig David , Silber Jeff , Qureshi Sheeraz A. , Virk Sohrab
Published: November 2024

Study Design:

Biomechanical analysis.

Objective:

To evaluate the depth of subsidence resulting from an expandable interbody cage at varying bone foam densities.

Summary of Background Data:

Expandable interbody cages have been shown to be associated with increased rates of subsidence. It is critical to evaluate all variables which may influence a patient’s risk of subsidence following the placement of an expandable interbody cage.

Methods:

In the first stage of the study, subsidence depth was measured with 1 Nm of input expansion torque. In the second stage, the depth of subsidence was measured following 150 N output force exerted by an expandable interbody cage. Within each stage, different bone foam densities were analyzed, including 5, 10, 15, and 20 pounds per cubic foot (PCF). Five experimental trials were performed for each PCF material, and the mean subsidence depths were calculated. Trials which failed to reach 150 N output force were considered outliers and were excluded from the analysis.

Results:

There was an overall decrease in subsidence depth with increasing bone foam density. The mean subsidence depths at 150 N output force were 2.0±0.3 mm for 5 PCF, 1.8±0.2 mm for 10 PCF, 1.1±0.2 mm for 15 PCF, and 1.1±0.2 mm for 20 PCF bone foam. The mean subsidence depths at 1 Nm of input torque were 2.3±0.5 mm for 5 PCF, 2.3±0.5 mm for 10 PCF, 1.2±0.2 mm for 15 PCF, and 1.1±0.1 mm for 20 PCF bone foam.

Conclusions:

Depth of subsidence was negatively correlated with bone foam density at both constant input torque and constant endplate force. Because tactile feedback of cage expansion into the subsiding bone cannot be reliably distinguished from true expansion of disc space height, surgeons should take bone quality into account when deploying expandable cages.
Current Emergency Medical Service Vasoactive Use for the Management of Shock
Authors: Bloom Jason E. , Goel Vishal , Anderson David , Cartledge Susie , Nehme Ziad , Ball Jocasta , Eliakundu Amminadab , Chan William , Chew Derek P. , Kaye David M. , Stub Dion
Published: November 2024

OBJECTIVES:

We sought to describe the indications for vasoactive medication administration, hemodynamic treatment targets, and specific agents used by various international emergency medical service (EMS) providers.

DESIGN AND SETTING:

In March 2022, we sent an online survey comprising of 20 questions to Medical Directors of EMSs across Australia, the Asia Pacific region, and North America.

PATIENTS:

A total of 108 EMS directors were emailed an invitation to participate.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Twenty-five EMS medical directors responded. Local site guidelines for vasoactive agent administration were available to 77.3% of providers. Epinephrine was commonly used as first-line vasoactive agent in 52% of questionnaire respondents, followed by norepinephrine (22%), dopamine (18%), and metaraminol (4%). Epinephrine was the most commonly used vasoactive agent across all forms of shock, with a higher proportion of utilization in cases of cardiogenic shock (58%) and patients suffering shock following cardiac arrest (56%).

CONCLUSIONS:

International EMS vasoactive use in the management of shock is heterogeneous. Future randomized controlled trials should aim to elucidate optimal prehospital treatment strategies for shock, including the initiation, choice of agent, and monitoring of vasoactive medication.
An Interactive Virtual Reality Simulation Developed to Teach Oral Care Application Skills on Unconscious Patients: Effect on the Knowledge Level of Nursing Students
Authors: Çobanoğlu Asuman , İçten Tarık
Published: November 2024

A quasi-experimental one-group pretest-posttest research design was used in this study. For the purpose of the research, a computer-based and interactive virtual reality simulation for applying oral care on an unconscious patient was developed to be integrated into the existing nursing curriculum. It was concluded that the computer-based, interactive virtual reality simulation design developed for teaching oral care application on an unconscious patient had a high impact on education and the sense of presence. It was further determined that the virtual reality simulation, developed herein, improved the students’ knowledge level on the subject (P < .05). It was concluded that the computer-based, interactive virtual reality simulation prepared for applying oral care on an unconscious patient is an effective and usable method in nursing education.
Exploring the Relationship Between Nurses' Lifelong Learning Levels and Their Web-Based Information Search Strategies and Digital Literacy
Authors: Çalışkan Figen , Ay Fatma , Ozdemir Irem Nur
Published: November 2024

This study aimed to determine the relationship between nurses' levels of lifelong learning and their Web-based information search and interpretation strategies and digital literacy. This descriptive correlational study was conducted at a training and research hospital in Istanbul province. Data were obtained from 302 nurses who consented to participate in the study between April 17 and June 23, 2023. The data were collected using a questionnaire, the Lifelong Learning Scale, the Digital Literacy Scale, and the Web-Based Information Search and Interpretation Strategies Scale. The mean age of the nurses was 31.52 ± 7.4 years. A positive correlation was found between nurses' lifelong learning levels and digital literacy levels. In addition, nurses' lifelong learning levels positively affect Web-based information search and interpretation strategies. It was determined that the mean scores of the subdimensions of the Scale of Information Search and Interpretation Strategies in the Web Environment were high. Nurses with an average age of 31 years and above have a high level of lifelong learning and level of digital literacy. Nurses' willingness to learn throughout their lives has positively affected their digital literacy levels. Nurses use different sources and professional Web sites more frequently when seeking information than other strategies.
National Analysis of Preexisting Immunosuppressive Conditions and Infection-Related Readmissions Among Sepsis Survivors
Authors: Umberger Reba A. , Cao Xueyuan , Reynolds Rebecca B. , Kilgannon Andrea R. , Mayr Florian B. , Yende Sachin
Published: November 2024

Background

Recurrent episodes of infection and subsequent sepsis are a frequent cause of readmission after sepsis hospitalization. Although persistent immune dysregulation initiated during the sepsis episode may play a role, the impact of preexisting immune suppression (including HIV, organ transplantation, and cancer) and common chronic diseases associated with immune suppression (diabetes and chronic kidney disease) on the risk of recurrent infections after sepsis is unknown.

Objectives

To investigate the role of preexisting immune-suppressive conditions (PISCs) and other common chronic diseases on infection-related readmissions after a sepsis admission.

Methods

Using the US 2015 Nationwide Readmissions Database, we identified a retrospective cohort of adult patients with an unplanned sepsis index admission from April to September, excluding patients with sepsis during the preceding 90 days. We followed all sepsis survivors for subsequent infection-related admissions for 90 days. We identified clinical conditions using International Classification of Diseases coding.

Results

We identified 649 029 unique unplanned sepsis admissions over 6 months; 189 604 (29.2%) had sepsis with PISC, and 459 425 (70.8%) had sepsis without PISC. Overall, sepsis survivors were older (median age, 70 years), and 145 156 (22.4%) experienced at least 1 infection-related readmission within 90 days. The incidence of infection-related readmission among sepsis survivors with PISC was 26.1%, whereas it was 20.8% for those without PISC. The excess risk of infection-related readmissions attributed to PISC was 5.3%, whereas the excess risk attributed to diabetes and chronic kidney disease was 3.7% and 4.7%, respectively. The background risk attributed to new-onset sepsis among participants with none of these conditions was 16.3%. Multivariable regression analysis adjusting for age, gender, and acute illness factors indicated that odds of infection-related readmission were strongly associated with PISC (odds ratio 1.30; 95% confidence interval, 1.29-1.32), closely followed by chronic kidney disease (1.28 [1.27-1.32]) and diabetes (1.17 [1.16-1.19]).

Conclusion

The risk of subsequent infection is higher among patients with PISC, although chronic kidney disease and diabetes are also important risk factors for subsequent infection and sepsis readmissions.
Risk Factors Contributing to the Development of Bronchopulmonary Dysplasia
Authors: Bradley Caitlin , DeGrazia Michele , Shi Ling , Aronowitz Teri
Published: November 2024

Background

Despite advances in medical care, the incidence and severity of bronchopulmonary dysplasia (BPD) among infants born at less than 32 weeks’ gestation have not decreased. Also, BPD prediction tools have been criticized for containing too few variables, not being validated beyond their initial development, and having a lack of generalizability. To develop a comprehensive prediction tool for postnatal use, a broad evaluation of BPD risk factors is needed.

Objectives

To examine risk factors for the development of BPD among a sample of preterm infants.

Method

This research was a retrospective cohort study examining preterm infants (n = 455) treated at a level IV neonatal intensive care unit. Binary logistic regression was used to examine the relationship between BPD and 15 risk factors that were identified through a comprehensive review of the literature. Multinomial regression was used to examine the relationship between risk factors and the severity of BPD.

Results

Risk factors for BPD that were identified included birth weight, surfactant administration, and mechanical ventilation. When examined by severity, other risk factors identified were gestational age, infections, and the presence of a patent ductus arteriosus.

Discussion

The variables most frequently included in contemporary BPD prediction tools include gestational age, birth weight, sex, and early respiratory status. The findings of this research demonstrate that the addition of multiple surfactant doses, infections, and patent ductus arteriosus as BPD risk factors might strengthen BPD prediction tools. Moreover, a number of blood transfusions and weights deserve further evaluation in future research as potential BPD risk factors.
Popliteal Pterygium Syndrome: A Case Report Highlighting Challenges and Surgical Interventions in a Resource-limited Setting
Authors: Shanko Nagasa Wirtu , Eshete Mekonen , Hussen Reyad Adem , Chafamo Eyob Zergaw , Keno Senayad Banti
Published: November 2024

Popliteal pterygium syndrome is a rare congenital disorder characterized by facial, genitourinary, and musculoskeletal anomalies, with popliteal webbing being notably challenging. A 4-year-old boy presented with progressive limping, cleft palate, and genital malformations. He had no follow-up care after an intraoral band excision at 15 days old. The boy underwent surgery for left-sided popliteal webbing, followed by genital and cleft palate repair. A modified jumping man Z-plasty flap was used for the popliteal webbing, followed by splinting. Subsequent follow-ups showed no complications. Enhancing care in resource-constrained settings requires addressing challenges such as delayed interventions due to late follow-up, limited awareness between communities and healthcare professionals, social stigma, and inadequate healthcare understanding. These obstacles hinder timely diagnosis and intervention, underscoring the need for increased awareness and effective early intervention strategies. Early detection and parental counseling are critical in managing popliteal pterygium syndrome. Timely surgical planning, including addressing orofacial and genital deformities and using Z-plasty for webbing release, is essential. Postoperative splinting significantly improves outcomes.
Outcome and management of patients with hepatocellular carcinoma who achieved a complete response to immunotherapy-based systemic therapy
Authors: Scheiner Bernhard , Kang Beodeul , Balcar Lorenz , Radu Iuliana-Pompilia , Reiter Florian P. , Adžić Gordan , Guo Jiang , Gao Xu , Yuan Xiao , Cheng Long , Gorgulho Joao , Schultheiss Michael , Peeters Frederik , Hucke Florian , Ben Khaled Najib , Piseddu Ignazio , Philipp Alexander , Sinner Friedrich , D’Alessio Antonio , Pomej Katharina , Saborowski Anna , Bathon Melanie , Schwacha-Eipper Birgit , Zarka Valentina , Lampichler Katharina , Nishida Naoshi , Lee Pei-Chang , Krall Anja , Saeed Anwaar , Himmelsbach Vera , Tesini Giulia , Huang Yi-Hsiang , Vivaldi Caterina , Masi Gianluca , Vogel Arndt , Schulze Kornelius , Trauner Michael , Djanani Angela , Stauber Rudolf , Kudo Masatoshi , Parikh Neehar D. , Dufour Jean-François , Prejac Juraj , Geier Andreas , Bengsch Bertram , von Felden Johann , Venerito Marino , Weinmann Arndt , Peck-Radosavljevic Markus , Finkelmeier Fabian , Dekervel Jeroen , Ji Fanpu , Wang Hung-Wei , Rimassa Lorenza , Pinato David J. , Bouattour Mohamed , Chon Hong Jae , Pinter Matthias
Published: November 2024

Background and Aims:

The outcome of patients with HCC who achieved complete response (CR) to immune-checkpoint inhibitor (ICI)–based systemic therapies is unclear.

Approach and Results:

Retrospective study of patients with HCC who had CR according to modified Response Evaluation Criteria in Solid Tumors (CR-mRECIST) to ICI-based systemic therapies from 28 centers in Asia, Europe, and the United States. Of 3933 patients with HCC treated with ICI-based noncurative systemic therapies, 174 (4.4%) achieved CR-mRECIST, and 97 (2.5%) had CR according to RECISTv1.1 (CR-RECISTv1.1) as well. The mean age of the total cohort (male, 85%; Barcelona-Clinic Liver Cancer-C, 70%) was 65.9±9.8 years. The majority (83%) received ICI-based combination therapies. Median follow-up was 32.2 (95% CI: 29.9–34.4) months. One- and 3-year overall survival rates were 98% and 86%. One- and 3-year recurrence-free survival rates were excellent in patients with CR-mRECIST-only and CR-RECISTv1.1 (78% and 55%; 70% and 42%). Among patients who discontinued ICIs for reasons other than recurrence, those who received immunotherapy for ≥6 months after the first mRECIST CR had a longer recurrence-free survival than those who discontinued immunotherapy earlier (p=0.008). Of 9 patients who underwent curative surgical conversion therapy, 8 (89%) had pathological CR (CR-RECISTv1.1, n= 2/2; CR-mRECIST-only, n= 6/7).

Conclusions:

Overall survival and recurrence-free survival of patients with CR-mRECIST-only and CR-RECISTv1.1 were excellent, and 6 of 7 patients with CR-mRECIST-only who underwent surgical conversion therapy had pathological CR. Despite potential limitations, these findings support the use of mRECIST in the context of immunotherapy for clinical decision-making. When considering ICI discontinuation, treatment for at least 6 months beyond CR seems advisable.
History of Lens Care Products in Japan: Insights From Advertisements in the Journal of the Japan Contact Lens Society for 65 Years
Authors: Toshida Hiroshi , Matsuzawa Akiko , Koh Shizuka , Hori Yuichi
Published: November 2024

This review examines the history of contact lens (CL) care products, particularly focusing on hard contact lenses (HCLs) like those made from polymethyl methacrylate and rigid gas permeable (RGP) materials. Although literature on CL history is extensive, there is limited information on the history of CL care products, especially in Japan. This review uses advertisements from the Journal of the Japan Contact Lens Society from 1959 to 2023 to trace the evolution of these products. The early HCL care primarily involved simple cleaning with dishwashing liquids because of the robust nature of polymethyl methacrylate lenses. Advertisements for care products became more prevalent with the introduction of RGP lenses that are more prone to dirt and deposit buildup. The first significant advertisements for HCL care products appeared in 1968, with notable products highlighting advancements in cleaning, rinsing, and storing solutions. The introduction of soft contact lenses in Japan in 1972 necessitated new care methods, such as boiling disinfection. Over the years, the market saw the introduction of various multipurpose solutions and specialized cleaning agents, although the number of advertisements for these products has declined since the late 1990s. Economic factors and changes in the CL industry have influenced the advertising trends observed in the journal. Despite the decline in market share for RGP lenses, they remain essential for specific conditions like keratoconus, some corneal disorders with irregular astigmatism, and moderate to high astigmatism. This review underscores the ongoing need for effective CL care products and the role of advertisements in documenting their history.
Quality Assurance of Depression Ratings in Psychiatric Clinical Trials
Authors: Sapko Michael T. , Kolesar Cortney , Sharp Ian R. , Javitt Jonathan C.
Published: November 2024

Background

Extensive experience with antidepressant clinical trials indicates that interrater reliability (IRR) must be maintained to achieve reliable clinical trial results. Contract research organizations have generally accepted 6 points of rating disparity between study site raters and central “master raters” as concordant, in part because of the personnel turnover and variability within many contract research organizations. We developed and tested an “insourced” model using a small, dedicated team of rater program managers (RPMs), to determine whether 3 points of disparity could successfully be demonstrated as a feasible standard for rating concordance.

Methods

Site raters recorded and scored all Montgomery-Åsberg Depression Rating Scale (MADRS) interviews. Audio files were independently reviewed and scored by RPMs within 24 to 48 hours. Concordance was defined as the absolute difference in MADRS total score of 3 points or less. A MADRS total score that differed by 4 or more points triggered a discussion with the site rater and additional training, as needed.

Results

In a sample of 236 ratings (58 patients), IRR between site ratings and blinded independent RPM ratings was 94.49% (223/236). The lowest concordance, 87.93%, occurred at visit 2, which was the baseline visit in the clinical trial. Concordance rates at visits 3, 4, 5, and 6 were 93.75%, 96.08%, 97.30%, and 100.00%, respectively. The absolute mean difference in MADRS rating pairs was 1.77 points (95% confidence interval: 1.58–1.95). The intraclass correlation was 0.984 and an η2 = 0.992 (F = 124.35, P < 0.0001).

Conclusions

Rigorous rater training together with real-time monitoring of site raters by RPMs can achieve a high degree of IRR on the MADRS.
Potential of Klotho as a Biomarker for Overwork
Authors: Zhu Ling-Na , Xiang Dong-Lin , Zuo Jiang-Cheng , Wang Guang-Yong , Xiao Ning
Published: November 2024

Objective

This study evaluates the utility of serum s-αKlotho levels as a quantifiable biomarker for overwork.

Methods

Frontline medical workers aged 20–55 years from Yiling People's Hospital of Yichang were recruited. Criteria included nonsmokers, non-heavy drinkers, no chronic medication use, and no acute illnesses recently. Participants worked over 10 hours per day, 60 hours weekly, and had at least 3 years of experience. A control group was matched except for work conditions. Data were collected through surveys, and serum levels were measured.

Results

Significant differences in serum Klotho were found between overwork and control groups. The overwork group had higher median s-αKlotho levels (49.99 pg/mL) compared to controls (27.88 pg/mL).

Conclusion

Overworked medical workers exhibited elevated serum s-αKlotho, suggesting s-αKlotho as a potential biomarker for overwork. Future research should use multicenter designs with larger samples to validate findings.
Evaluating Injury and Illness Trends in Federal and Postal Service Employees Using Workers’ Compensation Claims Data 2007–2022
Authors: Wurzelbacher Steven J. , Krieg Edward F. , Meyers Alysha R. , Bushnell Paul T. , Van Nguyen Nhut , Tseng Chih-Yu
Published: November 2024

Objective

The purpose of this study was to understand federal workplace injury/illness trends.

Methods

Over 1.5 million federal and Postal Service employee workers’ compensation (WC) claims from 2007 to 2022 were linked to employment data and analyzed.

Results

From 2007 to 2019, falls, slips, trips represented the highest proportion of claims (30.7%), followed by overexertion and bodily reaction (24.4%), unclassified (16.4%), contact with objects and equipment (13.1%), violence and other injuries by persons or animals (8.8%), transportation incidents (4.0%), exposure to harmful substances or environments (2.5%), and fires and explosions (0.24%). From 2020 to 2022, COVID-19 drove a major shift to exposure to harmful substances or environments representing the highest proportion of claims (44.3%).

Conclusions

Claims data represent a potentially rich data source that employing agencies can use to focus prevention and treatment of injury/illness.
Prospective Associations Between Organizational Changes and Health Outcomes Among French Employees Who Remained in Employment
Authors: Niedhammer Isabelle , Bertrais Sandrine
Published: November 2024

Objective

This study aimed to explore the prospective associations of organizational changes with health outcomes among employees who remained in employment.

Methods

The study relied on the prospective data of the national French working conditions survey collected from employees and their employers in 2013, 2016, and 2019. The study sample included 4480 private sector employees. Organizational changes were assessed by the employers. The two health outcomes, collected from the employees, were psychological well-being and self-reported health. The prospective associations between organizational changes and health outcomes were studied using multilevel mixed-effects linear and robust Poisson regression models.

Results

No association was found between organizational changes and well-being and self-reported health.

Conclusions

Our study did not find significant prospective associations between organizational changes and two health outcomes among employees who remained in employment. More high-quality research is needed.
Intraoperative Electrical Stapedius Reflex Testing to Monitor Cochlear Nerve Integrity during Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation
Authors: Carlson Matthew L. , Daher Ghazal S. , Khandalavala Karl R. , Lohse Christine M. , Neff Brian A. , Driscoll Colin L. W. , Peris-Celda Maria , Van Gompel Jamie J. , Link Michael J. , Saoji Aniket A.
Published: November 2024

Objective

To compare the utility of intraoperative electrically evoked auditory brainstem response (eABR) and electrically evoked stapedial reflex testing (eSRT) for cochlear nerve integrity monitoring during simultaneous translabyrinthine resection of vestibular schwannoma (VS) and cochlear implantation.

Study design

Historical cohort study.

Setting

Tertiary academic referral center.

Patients

Eleven patients (12 cases) who underwent translabyrinthine tumor resection with simultaneous placement of a standard, unmodified cochlear implant (CI).

Intervention

A CI placed at the beginning of the operation before tumor resection to facilitate intraoperative cochlear nerve monitoring through a CI-delivered electrical stimulus.

Main outcome measure

Correlation of intraoperative monitoring outcomes with postoperative CI performance.

Results

Among the 12 cases (median age, 47 years), eABR waveforms were present at the conclusion of tumor resection in 10, including 6 that achieved open set speech perception. Of the 2 cases with negative eABR, 1 achieved open set speech perception. By contrast, of the 8 cases with a positive eSRT response, 7 achieved open set speech perception. Of the 4 cases with a negative eSRT response, none achieved open set speech perception. The 3 cases that did not receive auditory stimulation included 2 with positive and 1 with negative eABR; all 3 had a negative eSRT response.

Conclusions

Intraoperative eSRT using an unmodified CI is a promising new method for monitoring the integrity of the cochlear nerve during simultaneous VS resection. eSRT response at the conclusion of tumor resection strongly correlated with CI open set speech capacity. Although still useful, eABR was less reliable at predicting postoperative hearing outcomes in this series.
Whole lung and sequential bronchoscopic lavage for pulmonary alveolar proteinosis
Authors: Tay Chee Kiang , Kumar Anupam , Hsu Anne Ann Ling , Lee Pyng
Published: November 2024

Purpose of review

Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease that results from the accumulation of lipoproteinaceous material in the alveoli due to abnormal surfactant homeostasis. Since its introduction in the 1960s, whole lung lavage (WLL) has been the primary treatment for PAP. This review focuses on WLL, including its technique modifications, and sequential bronchoscopic lavage.

Recent findings

Autoimmune PAP, which accounts for the majority of cases, occurs when antigranulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies lead to the deficiency of bioavailable GM-CSF. At present, there are no international guidelines or consensus statements for PAP treatment. Traditionally, therapeutic decisions are made based on the severity and type of PAP. Despite emerging data on GM-CSF-based therapies, WLL remains a central component in the therapeutic strategy for PAP.

Although the technique of WLL has evolved over time, there is still no universally adopted, standardized protocol. However, key periprocedural aspects – such as preprocedural planning, patient evaluation, anesthetic technique, lavage protocol, and postprocedural care – remain essential to ensuring the safety and success of WLL.
Using Z Codes to Document Social Risk Factors in the Electronic Health Record
Authors: Baker Kelley M. , Hill Mary A. , Goldberg Debora G. , Kitsantas Panagiota , Miller Kristen E. , Smith Kelly M. , Hong Alicia
Published: November 2024

Introduction:

Individual-level social risk factors have a significant impact on health. Social risks can be documented in the electronic health record using ICD-10 diagnosis codes (the “Z codes”). This study aims to summarize the literature on using Z codes to document social risks.

Methods:

A scoping review was conducted using the PubMed, Medline, CINAHL, and Web of Science databases for papers published before June 2024. Studies were included if they were published in English in peer-reviewed journals and reported a Z code utilization rate with data from the United States.

Results:

Thirty-two articles were included in the review. In studies based on patient-level data, patient counts ranged from 558 patients to 204 million, and the Z code utilization rate ranged from 0.4% to 17.6%, with a median of 1.2%. In studies that examined encounter-level data, sample sizes ranged from 19,000 to 2.1 billion encounters, and the Z code utilization rate ranged from 0.1% to 3.7%, with a median of 1.4%. The most reported Z codes were Z59 (housing and economic circumstances), Z63 (primary support group), and Z62 (upbringing). Patients with Z codes were more likely to be younger, male, non-White, seeking care in an urban teaching facility, and have higher health care costs and utilizations.

Discussion:

The use of Z codes to document social risks is low. However, the research interest in Z codes is growing, and a better understanding of Z code use is beneficial for developing strategies to increase social risk documentation, with the goal of improving health outcomes.
Using nutrition to help recovery from infections
Authors: Moura Ines B. , Buckley Anthony M.
Published: November 2024

Purpose of review

Antibiotics are a cornerstone of modern medicine, but antibiotic consumption can have depleting effects on the gut microbiota, potentially leading to gastrointestinal symptoms and other diseases, namely Clostridioides difficile infection. Because nutrition is a major driver of gut microbiota diversity and function, here we explore the current evidence on the potential of diets in alleviate the deleterious effects of antibiotics consumed during infections.

Recent findings

Beneficial nutrients can enhance the symbiotic effect of the gut microbiota with the host, supporting anti-inflammatory responses and maintaining tight junction integrity. Short-chain fatty acids have been shown to positively affect the immune response, reducing the severity of C. difficile infection, whereas high-fibre diets have been shown to promote faster recovery of the gut microbiota after antibiotic therapy.

The role of nutrition during infection is gaining momentum, with key findings exploring the effect of some nutrients in limiting the severity of infections and helping the microbiota recover from antibiotic-induced dysbiosis. Although this field is in its infancy, these findings open the possibility of personalised nutrition as a way of restoring microbiome diversity. But more work is needed to identify the most effective types and combinations of nutrients to achieve this.
I Wish the World Were More Like Case Managers
Authors: Powell Suzanne K.
Published: November 2024

The CMSA Standards of Practice are a timeless compass for the treatment of others. Case managers know that when individuals reach an optimal level of functional capability, everyone benefits.
Evaluating Bias and Racism in a Risk-Factor–Based Drug Testing Policy in the Labor and Delivery Department
Authors: Malekmadani Arienne , Puglisi Leah , Starikov Roman , Terplan Mishka
Published: November 2024

OBJECTIVE:

To assess bias in and consent before drug testing during prenatal care and birth in a hospital system with a risk-factor–based drug testing policy.

METHODS:

This retrospective cohort study included all patients who delivered in a regional hospital system from January 1, 2020, to June 1, 2022. Chart abstraction identified whether urine drug testing was performed and age, race, marital status, insurance status, ZIP code, gestational age, body mass index (BMI), and delivery mode. Propensity score matching through a pregnancy risk model was used to assess the association of race, insurance status, marital status, and median income with likelihood of testing. Data were analyzed with logistic regression. Charts of 200 randomly selected patients were also evaluated for documentation of consent, testing indication, test result, and child welfare reports.

RESULTS:

Among 20,084 patients, 1,251 (6.2%) were tested, of whom 142 (11.3%) tested positive. White patients had a higher rate of positive test results (16.6%) compared with patients of other racial groups (overall rate 11.3%). None of the patients had consent documented. The most common indication for testing was limited prenatal care (48.7%). Fewer than a third of tests (28.5%) were obtained for a medical indication. The majority (67.9%) of positive results were reported to child welfare services.

CONCLUSION:

Risk-factor–based toxicology policies disproportionately target Black, low-income, single, publicly insured, and uninsured patients. Patients are typically not consented; testing is infrequently obtained for medical indications; and reports to child welfare services based on positive test results are common.
Midluteal Serum Estradiol Levels Are Associated With Live Birth Rates in Hormone Replacement Therapy Frozen Embryo Transfer Cycles: A Cohort Study
Authors: Alsbjerg Birgit , Jensen Mette Brix , Elbaek Helle Olesen , Laursen Rita , Povlsen Betina Boel , Anderson Richard , Yarali Harkan , Humaidan Peter
Published: November 2024

(Abstracted from Fertil Steril 2024;121:1000–1009)

In hormone replacement therapy frozen embryo transfer cycles used in fertility treatment, estradiol is used to stimulate the development of the endometrium to prepare for implantation. Ideal estradiol levels before implantation have yet to be determined, but recent studies have shown that live birth rates are higher when estradiol levels peak between 300 and 500 pg/mL.
Extubation Failure in the PICU: A Virtual Pediatric Systems Database Study, 2017–2021
Authors: Kim Francis Y. , Soto-Campos Gerardo , Palumbo Jamie , Newth Christopher J.L. , Rice Tom B.
Published: November 2024

Objectives:

Extubation failure (EF) in PICU patients is reintubation within 48, 72, or 96 hours of planned extubation (EF48, EF72, and EF96, respectively). Standardized sedation protocols, extubation readiness testing, and noninvasive respiratory support are used to improve efficient liberation from mechanical ventilation (MV). We therefore aimed to review EF rates, time to failure, and the use of noninvasive respiratory support after extubation, 2017–2021.

Design:

Retrospective analysis of patients admitted to PICUs contributing to the Virtual Pediatric Systems (VPS, LLC) database, 2017–2021.

Setting:

One hundred thirty-six participating PICUs.

Patients:

All patients admitted to participating PICUs between January 1, 2017, and December 31, 2021, who had MV and met inclusion criteria for planned extubation.

Interventions:

None.

Measurements and Main Results:

There were 111,229 planned extubations with 5,143 reintubations within 48 hours. The EF48, EF72, and EF96 rates were 4.6%, 5.3%, and 5.8%, respectively. Higher rates of EF were associated with age younger than 6 months, underlying genetic conditions, medical comorbidities, or cardiac surgery. Failed extubation was also associated with higher Pediatric Risk of Mortality III scores, longer duration of MV, and longer PICU and hospital lengths of stay. From 2017 to 2021, there was an increase in the use of high-flow nasal cannula oxygen therapy after extubation from 16.6% to 20.2%.

Conclusions:

In the VPS 2017–2021 dataset, we have found that the overall EF rates (EF48–EF96) have improved over this 5-year period. We are not able to assess the clinical benefit of this change, but it is evident that over the same period, there has been a concomitant increase in the use of postextubation noninvasive respiratory support. Further work is needed to look at the interaction of these effects in contemporary PICU practice.
Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Lower Limb Trauma
Authors: Asran Yacer , Mutungi Thomas , Shirodkar Kapil , Hegde Ganesh , Shamshuddin Sameer , Proctor Robin , Naqvi Jawad , Knowles David , Ali Imran
Published: November 2024

Computed tomography plays an ever-increasing role in the management of fractures and dislocations due to its capability in efficiently providing multiplanar reformats and 3-dimensional volume rendered images. It can reveal findings that are occult on plain radiography and therefore allow for more accurate decision making with regard to fracture classification and management. Clinical radiologists play a critical role in facilitating the processing of imaging to provide adequate image reformats in the desired planes, producing 3 dimensional images but most crucially identifying pertinent findings, which will contribute between the selection of nonoperative and operative management and potentially influence surgical technique. In an earlier article we have outlined the key findings that the radiologist should search for in major upper limb fractures and dislocations. In this second article we focus on the pelvis, acetabulum, femur, tibia, ankle, and foot and through a case-based approach provide a succinct overview of radiological findings that can play an important role in determining patient management.
Reconstruction Kernel Optimization for Ultra-High-Resolution Photon-Counting Detector Computed Tomography of the Lung
Authors: Tóth Adrienn , Chamberlin Jordan H. , Smith Carter D. , Maisuria Dhruw , McGuire Aaron M. , Schoepf U. Joseph , O'Doherty Jim , Munden Reginald F. , Burt Jeremy , Baruah Dhiraj , Kabakus Ismail M.
Published: November 2024

Background

The latest generation of computed tomography (CT) systems based on photon-counting detector promises significant improvements in several clinical applications, including chest imaging.

Purpose

The aim of the study is to evaluate the image quality of ultra-high-resolution (UHR) photon-counting detector CT (PCD-CT) of the lung using four sharp reconstruction kernels.

Material and Methods

This retrospective study included 25 patients (11 women and 14 men; median age, 71 years) who underwent unenhanced chest CT from April to May 2023. Images were acquired in UHR mode on a clinical dual-source PCD-CT scanner and reconstructed with four sharp kernels (Bl64, Br76, Br84, Br96). Quantitative image analysis included the measurement of image noise, and the calculation of signal-to-noise ratio, and contrast-to-noise ratio. Two radiologists independently rated the images on a 5-point Likert scale for image sharpness, image noise, overall image quality, and airway details. The 4 image sets were compared pairwise in the statistical analysis.

Results

Image noise was lowest for Br76 (74.16 ± 22.05, P < 0.001). Signal-to-noise ratio was significantly higher in the Br76 images (13.34 ± 3.47), than in the other 3 image sets (all P < 0.001). The Br76 images demonstrated the highest contrast-to-noise ratio among all reconstructions (1.54 ± 0.86, all P < 0.001). Subjective image sharpness, image noise, overall image quality, and airway detail were best in the Br76 images (all P < 0.001 to P < 0.01, for both readers).

Conclusions

The use of the Br76 reconstruction kernel provided the best quantitative and qualitative image quality for UHR PCD-CT of the lungs.
Chartering Patient Flights for Surgery in a Road Inaccessible Nation: The Samaritan’s Purse Cleft Lip Missions Model in South Sudan
Authors: Rhodes Isaiah J. , Rohde Christine C. , Rhodes William R. , Ng Jinggang J. , Lumaya Justin R.
Published: November 2024

Introduction:

Few patients in South Sudan have access to cleft lip repair due to limitations in health care facilities, personnel and road infrastructure. Samaritan’s Purse is a non-governmental organization that provides chartered flights from road inaccessible regions to a single central hospital in this nation’s capital. This study’s purpose was to describe the chartered flight model for conducting nationwide cleft lip mission trips.

Methods:

The authors performed a retrospective chart review of all patients who received cleft lip surgery at Juba Teaching Hospital during mission trips from 2011 to 2023. Patient sex, age, cleft characteristics, and home location were retrieved. Disability-adjusted life years (DALYs) were calculated and compared with the GDP/capita to assess cost-effectiveness using World Health Organization (WHO) standards.

Results:

Chart review identified 1085 patients who received cleft lip surgery. The average age of patients decreased from a high of 14.0 years in 2013 to a low of 8.2 years in 2023 (P<0.001). Patients were flown to Juba from all 10 states of South Sudan. The number of patients treated correlated with the state population (P<0.001). Each mission utilized an average of 14 flight paths. The cost of intervention per DALY averted was less than the GDP/capita of South Sudan, indicating the procedure was very cost-effective by WHO standards.

Conclusions:

Flight chartered mission trips in South Sudan have significantly decreased the backlog of patients with cleft lip in that country and are very cost-effective according to WHO standards. Investigating this model’s utility for other surgical missions while continuing to build local surgical capacity is warranted.
Erector Spinae Plane Block for Pain Management in Hepatocellular Carcinoma Patients Undergoing Laparoscopic Left Hemihepatectomy: A Retrospective Propensity Score-matched Study
Authors: Lu Heng , Zhao Xin , Lu Wen-Jiang , Yang Jie , Zhou Zhao-Hua , Lei Ze-Hua , Xie Qing-Yun
Published: November 2024

Objective:

The objective of this investigation was to ascertain the effectiveness of an ultrasound-guided erector spinae plane block (ESPB) administered to patients diagnosed with hepatocellular carcinoma who were subjected to laparoscopic left hemihepatectomy.

Methods:

A retrospective analysis was conducted on 172 patients, comparing 2 groups: one comprising 90 individuals who were administered intravenous patient-controlled analgesia (PCA) simultaneously with ESPB, and a second group of 82 patients who received PCA monotherapy. To equilibrate covariates across the groups, propensity score matching was executed, yielding 25 matched pairs as a result.

Results:

At 12 and 24 hours postprocedure, visual analog scale (VAS) pain scores, both at rest and during movement, were significantly reduced in the group receiving PCA in conjunction with ESPB. Furthermore, this group exhibited a substantially lower incidence of rescue analgesia utilization, a significantly abbreviated duration to ambulation, a reduced hospitalization period, and a significantly elevated level of patient satisfaction.

Conclusion:

ESPB serves as an efficacious ancillary analgesic for laparoscopic left hemihepatectomy, offering superior pain management and recuperation relative to the administration of intravenous analgesia in isolation. The implementation of ESPB as an adjunct to PCA in patients with hepatocellular carcinoma undergoing laparoscopic left hemihepatectomy proved to be both safe and efficacious. Notably, PCA augmented with ESPB demonstrated greater efficacy in mitigating postoperative pain compared with PCA as a standalone therapy.
Blastococcus montanus sp. nov., a multi-stress-resistant and bacteriostatic-producing bacterium isolated from the Flaming Mountain, Xinjiang,China
Authors: Wang Kexin , Liu Yang , Cui Xiaowen , Chen Tuo , Liu Guangxiu , Zhang Wei , Han Zhiyong , Zhang Gaosen
Published: November 2024

A bacterial strain designated HT6-4T was isolated from soil samples collected from the Flaming Mountain, Xinjiang, PR China. The purpose of this study was to describe a novel species and its characteristics, through genome sequencing and analysis of the relationship between the members of the genus Blastococcus, and explore the antiradiation, antioxidation and antibacterial capabilities of strain HT6-4T. The polyphasic study confirmed the affiliation of strain HT6-4T with the genus Blastococcus. Strain HT6-4T was aerobic, Gram-stain-positive, non-budding, non-motile, catalase-positive and oxidase-negative. It grew at 10–37 °C, pH 5.0–8.0 and 0–4% (w/v) NaCl. Colonies were circular, smooth and bright orange in colour. In addition, strain HT6-4T was drought tolerant. The predominant menaquinone was MK-9, with MK-8 as the minor component. The polar lipids of strain HT6-4T were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylcholine, phosphatidylinositol, phospholipids, an unidentified aminolipid and two unidentified phospholipids. Whole-cell hydrolysates contain meso-diaminopimelic acid as the diagnostic diamino acid and ribose and galactose as diagnostic sugars. Its major fatty acids were iso-C16 :  0, C17 :  1
ω8c and C18 :  1
ω9c. The genome of strain HT6-4T was 4.30 Mb in the whole-genome shotgun project. The G+C content was 73.9 mol%. The phylogenetic analysis based on the 16S rRNA gene sequence showed that strain HT6-4T was closely related to Blastococcus jejuensis KST3-10T(97.9%), Blastococcus capsensis BMG 804T(97.8%), Blastococcus aggregatus DSM 4725T(97.5%), Blastococcus saxobsidens BC 444T(97.5%), Blastococcus xanthinilyticus BMG 862T(97.5%) and Blastococcus litoris GP-S2-8T(97.5%). The average nucleotide identity (OrthoANI) and digital DNA–DNA hybridization (dDDH) values among strain HT6-4T and B. jejuensis KST3-10T, B. capsensis BMG 804T, B. aggregatus DSM 4725T, B. saxobsidens BC 444T, B. xanthinilyticus BMG 862T and B. litoris GP-S2-8T were below the species delimitation thresholds. The genome of strain HT6-4T contained antiradiation genes, antioxidant genes and antibacterial genes. Based on its morphological, physiological and chemical taxonomic characteristics, strain HT6-4T (=KCTC 59234T =GDMCC 1.4386T) should be classified as a novel species of the genus Blastococcus with the proposed name Blastococcus montanus sp. nov.
Alterisphingorhabdus coralli gen. nov. sp. nov., a novel aerobic anoxygenic phototrophic bacteria isolated from reef-building coral
Authors: Yan Chang , Zhang Kun , Shi Songbiao , Jian Lili , Chen Beilin , Quadri Syed Raziuddin , Tian Xinpeng
Published: November 2024

The photosynthetic microorganisms within the coral holobiont produce energy and organic compounds through photosynthesis, which are vital for the biocalcification and heat tolerance of coral hosts. However, aerobic anoxygenic phototrophic bacteria (AAPB), which are one of the most important photosynthetic microorganisms, have not been thoroughly investigated in this environment. In this study, a novel AAPB, SCSIO 66989T, was isolated from the reef-building coral Favia sp. and considered a beneficial microorganism for corals (BMC). The polyphasic taxonomic analysis showed that it had the highest similarities with Parasphingorhabdus litoris DSM 22379T (95.9%) and Altererythrobacter ishigakiensis ATCC BAA-2084T (95.7%). Phylogenetic analysis showed that it formed an independent clade, distinguishing it from other genera within the family Sphingomonadaceae. The predominant fatty acids were C18 : 1
 ω7c and/or C18 : 1
 ω6c and C16 : 0. The major respiratory quinone was ubiquinone-10 (Q-10). Sphingolipid, phosphatidylethanolamine, phosphatidylglycerol and phosphatidylcholine were the diagnostic polar lipids. The average nucleotide identity, average amino acid identity and digital DNA–DNA hybridization values between SCSIO 66989T and the type strains of P. litoris DSM 22379T and A. ishigakiensis ATCC BAA-2084T were 69.2–70.0%, 58.6–61.2% and 19.2–19.7%, respectively. These results indicate that strain SCSIO 66989T represents a new species of a novel genus in the family Sphingomonadaceae, for which the name Alterisphingorhabdus coralli gen. nov. sp. nov. is proposed.
ICTV Virus Taxonomy Profile: Botourmiaviridae 2024
Authors: Donaire Livia , Xie Jiatao , Nerva Luca , Jiang Daohong , Marzano Shin-Yi Lee , Sabanadzovic Sead , Turina Massimo , Ayllón María A.
Published: November 2024

The family Botourmiaviridae includes viruses with a mono- or multi-segmented positive-sense RNA genome that infect plants and filamentous fungi. The family includes the genera Ourmiavirus (plant viruses), Botoulivirus, Betabotoulivirus, Magoulivirus, Scleroulivirus, Betascleroulivirus, Gammascleroulivirus, Deltascleroulivirus, Epsilonscleroulivirus, Penoulivirus, Rhizoulivirus and Betarhizoulivirus (fungal viruses). This summary is based on the International Committee on Taxonomy of Viruses (ICTV) Report on the family Botourmiaviridae, which is available at ictv.global/report/botourmiaviridae.
Why is next-generation sequencing essential in modern virology?
Authors: Lefèvre Charlotte , Irigoyen Nerea
Published: November 2024

A contaminated viral stock results in considerable loss of time, resources and financial means and is generally discovered only by chance after years of research. Thus, it is necessary to implement a technique that can detect contamination without prior knowledge or assumptions, such as next-generation sequencing (NGS). Here, we describe the discovery of a cross-contaminated viral stock from a biological repository of an African Zika virus isolate with Toscana virus after performing NGS on infected cells. In addition, we also describe the consequences that we faced using this contaminated stock. These included the economic and time loss to the lab that needed to repeat all previously performed experiments, the generation of biologically flawed results with a subsequent potential retraction and the severe risk of infection of lab members who manipulated the contaminated stock.