bluuebunny/crossref_metadata_2025 huggingface dataset:
SIX YEARS OF NEURO-NAVIGATION ASSISTED BRAIN TUMOUR SURGERY: PROGRESS AND CHALLENGES
Authors: Ugwuanyi Ugochukwu , Salawu Morayo , Ayogu Obinna , Jubrin Paul
Published: September 2023

AIMS

To report a six-year experience with computerized neuro-navigation assistance in our neuro-oncology surgeries and services.

METHOD

Retrospective review of all consecutive cases involving computer-assisted neuro-navigation diagnostic and resective brain tumour operation over a six-year period (January 2016-December 2021). Main study parameters: Clinical diagnostic procedures, operations, histological diagnosis, adjuvant treatments. Data were analysed using simple descriptive statistics, and results were presented accordingly.

RESULTS

Total number of cases 111, Males 70 and Females 41 (M: F = 1.7:1). Age ranges from 8 months to 80 years. The commonest presentation was headache, nausea, and vomiting. Pre-op diagnosis: Intra axial tumours 70/111 (63%), Extra axial tumours 41/111 (36%). Operations: Resection/Debulking of tumour 86/111(77,4%), with complete EOR of 65/86 (75%). Diagnostic Biopsy 68/111(61%) with target precision of 100%. Common Histology were Gliomas 50/111(45%), Meningiomas 41/111 (36.9%), and Metastatic 15/111 (13.5%). Adjuvant treatments and follow-ups were advised accordingly.

CONCLUSIONS

With computerized neuro-navigation assistance, a wider spectrum of brain tumours were more confidently operated, and adjuvant treatments were easily deployed in line with a precise histological diagnosis for improved neuro-oncology services. But this success was at a huge cost of adopting measures to overcome some inevitable challenges.
What Do We Measure When We Measure Affective Polarization across Countries?
Authors: Tichelbaecker Thomas , Gidron Noam , Horne Will , Adams James
Published: September 2023

Measures of affective polarization—that is, dislike and hostility across party lines—have been developed and validated in the context of America’s two-party system. Yet increasingly, affective polarization is examined comparatively. We address this issue by introducing a novel dataset that measures aspects of partisan affect in 10 countries with diverse party systems. We detect associations between partisan affect toward out-parties versus affect toward out-parties’ supporters, but their strength varies across countries. We discuss measurement reasons for this variation and consider the implications of our findings for the emerging comparative affective polarization literature.
Old paradigms and new concepts in familial Mediterranean fever (FMF): an update 2023
Authors: Ben-Chetrit Eldad
Published: September 2023

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent attacks of fever and polyserositis. Its first description as a new entity was published by Siegal in 1945. Colchicine has been the treatment of choice for this disease since 1972. Significant progress has been made over the years in understanding FMF’s clinical features, diagnosis, mode of inheritance, pathogenesis and therapeutic approach. However, many old paradigms related to FMF have proven inaccurate, leading to the emergence of new concepts that provide more precise insights. The term ‘FMF’ is no longer appropriate as the disease is found beyond the Mediterranean basin. The concept of diagnosis based only upon clinical ground proved to be wrong. The paradigm that MEFV mutations in FMF lead to loss of function of the encoded peptide pyrin turned out to be a gain of function mutation. Finally, the concept that as a genetic disease FMF should be treated for life was found to be inaccurate for the subpopulation of the heterozygote patients. Thus, the breakthroughs of identifying the gene associated with the disease (MEFV) and the deciphering of its pathogenesis revolutionized our old paradigms and replaced them with new and more precise insights.
Patterns and determinants of response to novel therapies in juvenile and adult-onset polyarthritis
Authors: Triaille Clément , Quartier Pierre , De Somer Lien , Durez Patrick , Lauwerys Bernard R , Verschueren Patrick , Taylor Peter C , Wouters Carine
Published: September 2023

Biologic and targeted synthetic DMARDs (b/tsDMARDs) have revolutionized the management of multiple rheumatic inflammatory conditions. Among these, polyarticular JIA (pJIA) and RA display similarities in terms of disease pathophysiology and response pattern to b/tsDMARDs. Indeed, the therapeutic efficacy of novel targeted drugs is variable among individual patients, in both RA and pJIA. The mechanisms and determinants of this heterogeneous response are diverse and complex, such that the development of true ‘precision’-medicine strategies has proven highly challenging. In this review, we will discuss pathophysiological, patient-specific, drug-specific and environmental factors contributing to individual therapeutic response in pJIA in comparison with what is known in RA. Although some biomarkers have been identified that stratify with respect to the likelihood of either therapeutic response or non-response, few have proved useful in clinical practice so far, likely due to the complexity of treatment–response mechanisms. Consequently, we propose a pragmatic, patient-centred and clinically based approach, i.e. personalized instead of biomarker-based precision medicine in JIA.
Mechanisms of Alveolar Type 2 Epithelial Cell Death During Acute Lung Injury
Authors: Qi Xiaofeng , Luo Yali , Xiao Mengyong , Zhang Qiuju , Luo Jing , Ma Linna , Ruan Linfeng , Lian Nini , Liu Yongqi
Published: September 2023

Diffuse alveolar epithelial cell (AEC) death occurs extensively during acute lung injury (ALI). Due to the limited proliferative capacity of alveolar type 1 epithelial (AT1) cells, the differentiation and regenerative capacity of alveolar type 2 epithelial (AT2) cells are required to restore the barrier function of AECs. However, during lung injury, AT1 cells are particularly susceptible to injury, and ATII cells die in the presence of severe or certain types of injury. This disruption ultimately results in a hindrance to the ability of AT2 cells to proliferate and differentiate into AT1 cells in time to repair the extensively damaged AECs. Therefore, understanding the mechanism of injury death of AT2 cells may be beneficial to reverse the above situation. This article reviews the main death modes of AT2 cells, including apoptosis, necrosis, necroptosis, pyroptosis, autophagic cell death, and ferroptosis. It compares the various forms of death, showing that various cell injury death modes have unique action mechanisms and partially overlapping pathways. Studying the mechanism of AT2 cell death is helpful in screening and analyzing the target pathway of AEC barrier function recovery. It opens up new ideas and strategies for preventing and treating ALI.
The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians
Authors: Lersch Friedrich , Correia Paula Cruz , Hight Darren , Kaiser Heiko A. , Berger-Estilita Joana
Published: September 2023

Purpose of review

This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes.

Recent findings

Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain.

The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96).
Office-based anesthesia: a contemporary update on outcomes, incentives, and controversies
Authors: Young Steven , Osman Brian , Shapiro Fred E.
Published: September 2023

Purpose of review

The volume of office-based surgery (OBS) has surged over the last 25–30 years, however patients with increasing comorbidities are being considered for procedures in office locations. This review focuses on office-based surgery outcomes, financial incentives driving this change, and controversies.

Recent findings

Healthcare economics appear to drive the push towards OBS with improved reimbursements, but there are rising out-of-pocket costs impacting patients. Plastic surgery has low complications, but procedures like buttock augmentation are associated with mortality. In ophthalmology, emerging controversial literature investigates the impact of anesthesia type on and whether anesthesia providers impact ophthalmology outcomes. Dental anesthesia continues to suffer occasional wrong-sided surgeries. Vascular interventions are being driven towards offices due to reimbursements, and may be safely performed. Meta-analyses of ear, nose, and throat in-office surgeries have low complication rates.

The reported safety supports the proper selection of patients for the proper procedure in the right location. Anesthesiologists need to develop and implement safe and efficient systems to optimize patient outcomes in outpatient office settings. Further research and uniform standardized outcomes tracking are needed in the emerging specialties performing office-based surgery.
Ambulatory anesthesia: restructuring for success
Authors: Bello Corina , Romero Carolina S. , Heinimann Jonathan , Lederer Melanie , Luedi Markus M.
Published: September 2023

Purpose of review

We review current evidence about organizational structures, patient selection criteria, safety measures, economic considerations, quality management, and staffing challenges in ambulatory anesthesia. The focus is on the facilitators and barriers related to the peri-interventional period and the potential concepts and innovations for further development of ambulatory anesthesia services.

Recent findings

Recent findings shed light on organizational structures in ambulatory anesthesia, including hospital-based centers, freestanding ambulatory centers, and office-based practices. Patient selection for ambulatory anesthesia involves a two-step process, considering both surgical and anesthetic factors. Safety measures, such as standardized guidelines and scoring systems, aim to ensure patient well being during the perioperative course. Economic considerations pose challenges due to the complexities of managing operating room efficiency and the variations in reimbursement systems. Quality management in ambulatory anesthesia emphasizes the need for outcome studies and patient-centered quality indicators. Staffing requirements necessitate highly skilled professionals with both technical and nontechnical skills, and structured education and training are essential.

Ambulatory anesthesia is gaining importance due to advancements in surgical techniques and periinterventional care. The review highlights the need for addressing challenges related to organizational structures, patient selection, patient safety, economic considerations, quality management, and staffing in ambulatory anesthesia. Understanding and addressing these factors are crucial for promoting the further development and improvement of ambulatory anesthesia services.
Intraoperative Use of Phenylephrine versus Ephedrine and Postoperative Delirium: A Multicenter Retrospective Cohort Study
Authors: Ma Haobo , Ahrens Elena , Wachtendorf Luca J. , Suleiman Aiman , Shay Denys , Munoz-Acuna Ricardo , Tartler Tim M. , Teja Bijan , Wagner Soeren , Subramaniam Balachundhar , Rhee James , Schaefer Maximilian S.
Published: September 2023

Background

The treatment of intraoperative hypotension with phenylephrine may impair cerebral perfusion through vasoconstriction, which has been linked to postoperative delirium. The hypothesis was that intraoperative administration of phenylephrine, compared to ephedrine, is associated with higher odds of postoperative delirium.

Methods

A total of 103,094 hospitalized adults undergoing general anesthesia for noncardiac, non-neurosurgical procedures between 2008 and 2020 at two tertiary academic healthcare networks in Massachusetts were included in this multicenter hospital registry study. The primary exposure was the administration of phenylephrine versus ephedrine during surgery, and the primary outcome was postoperative delirium within 7 days. Multivariable logistic regression analyses adjusted for a priori defined confounding variables including patient demographics, comorbidities, and procedural factors including magnitude of intraoperative hypotension were applied.

Results

Between the two healthcare networks, 78,982 (76.6%) patients received phenylephrine, and 24,112 (23.4%) patients received ephedrine during surgery; 770 patients (0.8%) developed delirium within 7 days. The median (interquartile range) total intraoperative dose of phenylephrine was 1.0 (0.2 to 3.3) mg and 10.0 (10.0 to 20.0) mg for ephedrine. In adjusted analyses, the administration of phenylephrine, compared to ephedrine, was associated with higher odds of developing postoperative delirium within 7 days (adjusted odds ratio, 1.35; 95% CI, 1.06 to 1.71; and adjusted absolute risk difference, 0.2%; 95% CI, 0.1 to 0.3%; P = 0.015). A keyword and manual chart review–based approach in a subset of 45,465 patients further validated these findings (delirium incidence, 3.2%; adjusted odds ratio, 1.88; 95% CI, 1.49 to 2.37; P < 0.001). Fractional polynomial regression analysis further indicated a dose-dependent effect of phenylephrine (adjusted coefficient, 0.08; 95% CI, 0.02 to 0.14; P = 0.013, per each μg/kg increase in the cumulative phenylephrine dose).

Conclusions

The administration of phenylephrine compared to ephedrine during general anesthesia was associated with higher odds of developing postoperative delirium. Based on these data, clinical trials are warranted to determine whether favoring ephedrine over phenylephrine for treatment of intraoperative hypotension can reduce delirium after surgery.

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Oral Squamous Cell Carcinoma Metastasis to Anterolateral Thigh Flap Donor Site: A Case Report
Authors: Chiang Liang-Jui , Lee Yao-Chou
Published: September 2023

In the realm of oncologic reconstructive surgery, local or distant autologous tissue is frequently used to improve function and appearance. Due to advances in microsurgery and intensive care, reconstructive free flap surgery has become the standard treatment for head and neck cancer. However, the complexity of interdisciplinary intervention and prolonged surgical time inevitably increase the risk of cross-contamination, potentially leading to donor site metastasis. According to the literature, tumor transmission to the donor site of free flaps is extremely rare. We present the case of a 54-year-old man with left tongue squamous cell carcinoma. Three months after tumor ablation and reconstruction with a free anterolateral thigh flap, the patient presented with a mass on the donor site of the left thigh, which was proven to be a metastasis. A systemic workup revealed multiple metastases. Six months after reconstruction, the patient died of COVID-19 pneumonia. The incidence and risk factors of donor site metastasis are not well known. The primary causes are direct implantation or hematogenous spread. Cross-contamination is primarily prevented by the surgeon’s awareness and avoidance. The development of new-onset lesions at the donor site warrants additional testing to detect systemic disease progression during follow-up.
Tube-in-Tube Phalloplasty with Tailor-made Bilateral Superficial Circumflex Iliac Artery Perforator Flaps Using Preoperative High-resolution Ultrasound
Authors: Yoshimatsu Hidehiko , Karakawa Ryo , Fuse Yuma , Yano Tomoyuki
Published: September 2023

In phalloplasty, the radial forearm free flap is the most commonly used flap, followed by the anterolateral thigh flap. Superficial circumflex iliac artery perforator (SCIP) flaps have been used in phalloplasty, but bulkiness and unstable perfusion have precluded their common use. In this report, we present a case in which tube-in-tube phalloplasty was performed using bilateral SCIP flaps assisted by preoperative high-resolution ultrasonography. A 67-year-old man underwent resection of his penis for treatment of carcinoma. A year later, phalloplasty using bilateral SCIP flaps was planned. After mapping out the superficial circumflex iliac artery and the superficial circumflex iliac vein to their terminal portions using preoperative high-resolution ultrasonography, a 12 cm × 8 cm rectangular flap was designed on the right groin for reconstruction of the phallus, and a 10 cm × 4 cm rectangular flap was designed on the left groin for reconstruction of the urethra. Both flaps were harvested above the superficial fascia, and the thickness of both flaps was 4 mm. The Foley catheter was removed three weeks after the operation, and the patient began urinating in the standing position. No fistula or urethral stenosis had occurred as of 12 months after the reconstruction, and the patient was satisfied with the cosmesis. The use of preoperative high-resolution ultrasonography played a decisive role in ensuring the perfusion of the flap, resulting in prevention of postoperative complications such as fistula and/or urethral stenosis caused by malperfusion of the flap.
Obesity management for the hepatologist—What to do, how to do it and why?
Authors: Watt Kymberly D. , Paul Sonali , Khan Mohammad Qasim , Siddiqui Mohammad , Lam Jenny , Diwan Tayyab S. , Camilleri Michael
Published: September 2023

Obesity is highly prevalent in hepatology clinics and has a significant impact on chronic liver disease and patient management. Hepatologists and gastroenterologists need to be actively engaged in the management of obesity. This review provides a detailed approach to this challenging comorbidity.
Hypoxia-driven tumor stromal remodeling and immunosuppressive microenvironment in scirrhous HCC
Authors: Chen Shuling , Liao Changyi , Hu Huanjing , Liao Junbin , Chen Zebin , Li Shuang , Zeng Xuezhen , Peng Bo , Shen Shunli , Li Dongming , Li Shaoqiang , Lai Jiaming , Peng Sui , Xie Yubin , Kuang Ming
Published: September 2023

Background and Aims:

Scirrhous HCC (SHCC) is one of the unique subtypes of HCC, characterized by abundant fibrous stroma in the tumor microenvironment. However, the molecular traits of SHCC remain unclear, which is essential to develop specialized therapeutic approaches for SHCC.

Approach and Results:

We presented an integrative analysis containing single-cell RNA-sequencing, whole-exome sequencing, and bulk RNA-sequencing in SHCC and usual HCC samples from 134 patients to delineate genomic features, transcriptomic profiles, and stromal immune microenvironment of SHCC. Multiplexed immunofluorescence staining, flow cytometry, and functional experiments were performed for validation. Here, we identified SHCC presented with less genomic heterogeneity while possessing a unique transcriptomic profile different from usual HCC. Insulin-like growth factor 2 was significantly upregulated in SHCC tumor cells compared to usual HCC, and could serve as a potential diagnostic biomarker for SHCC. Significant tumor stromal remodeling and hypoxia were observed in SHCC with enrichment of matrix cancer–associated fibroblasts and upregulation of hypoxic pathways. Insulin-like growth factor 2 was identified as a key mediator in shaping the hypoxic stromal microenvironment of SHCC. Under this microenvironment, SHCC exhibited an immunosuppressive niche correlated to enhanced VEGFA signaling activity, where CD4+ T cells and CD8+ T cells were dysfunctional. Furthermore, we found that another hypoxic-related molecule SPP1 from SHCC tumor cells suppressed the function of dendritic cells via the SPP1-CD44 axis, which also probably hindered the activation of T cells.

Conclusion:

We uncovered the genomic characteristics of SHCC, and revealed a hypoxia-driven tumor stroma remodeling and immunosuppressive microenvironment in SHCC.
Spatial proximity of tumor-immune interactions predicts patient outcome in hepatocellular carcinoma
Authors: Maestri Evan , Kedei Noemi , Khatib Subreen , Forgues Marshonna , Ylaya Kris , Hewitt Stephen M. , Wang Limin , Chaisaingmongkol Jittiporn , Ruchirawat Mathuros , Ma Lichun , Wang Xin Wei
Published: September 2023

Background and Aims:

The fitness and viability of a tumor ecosystem are influenced by the spatial organization of its cells. We aimed to study the structure, architecture, and cell-cell dynamics of the heterogeneous liver cancer tumor microenvironment using spatially resolved multiplexed imaging.

Approach and Results:

We performed co-detection by indexing multiplexed immunofluorescence imaging on 68 HCC biopsies from Thai patients [(Thailand Initiative in Genomics and Expression Research for Liver Cancer (TIGER-LC)] as a discovery cohort, and then validated the results in an additional 190 HCC biopsies from Chinese patients [Liver Cancer Institute (LCI)]. We segmented and annotated 117,270 and 465,632 cells from the TIGER-LC and LCI cohorts, respectively. We observed 4 patient groups of TIGER-LC (IC1, IC2, IC3, and IC4) with distinct tumor-immune cellular interaction patterns. In addition, patients from IC2 and IC4 had much better overall survival than those from IC1 and IC3. Noticeably, tumor and CD8+ T-cell interactions were strongly enriched in IC2, the group with the best patient outcomes. The close proximity between the tumor and CD8+ T cells was a strong predictor of patient outcome in both the TIGER-LC and the LCI cohorts. Bulk transcriptomic data from 51 of the 68 HCC cases were used to determine tumor-specific gene expression features of our classified subtypes. Moreover, we observed that the presence of immune spatial neighborhoods in HCC as a measure of overall immune infiltration is linked to better patient prognosis.

Conclusions:

Highly multiplexed imaging analysis of liver cancer reveals tumor-immune cellular heterogeneity within spatial contexts, such as tumor and CD8+ T-cell interactions, which may predict patient survival.
Higher need for polycystic liver disease therapy in female patients: Sex-specific association between liver volume and need for therapy
Authors: Barten Thijs R.M. , Atsma Femke , van der Meer Adriaan J. , Gansevoort Ron , Nevens Frederik , Drenth Joost P.H. , Gevers Tom J.G.
Published: September 2023

Background and Aims:

Prognostic tools or biomarkers are urgently needed in polycystic liver disease (PLD) to monitor disease progression and evaluate treatment outcomes. Total liver volume (TLV) is currently used to assess cross-sectional disease severity, and female patients typically have larger livers than males. Therefore, this study explores the sex-specific association between TLV and volume-reducing therapy (VRT).

Approach and Results:

In this prospective cohort study, we included patients with PLD from European treatment centers. We explored sex-specific differences in the association between baseline TLV and initiation of volume-reducing therapy and determined the cumulative incidence rates of volume-reducing therapy in our cohort.

We included 358 patients, of whom 157 (43.9%) received treatment. Treated patients had a higher baseline TLV (median TLV 2.16 vs. 4.34 liter, p < 0.001), were more frequently female (69.7% vs. 89.8%, p < 0.001), and had a higher risk of liver events (HR 4.381, p < 0.001). The cumulative volume-reducing therapy rate at 1 year of follow-up was 21.0% for females compared to 9.1% for males. Baseline TLV was associated with volume-reducing therapy, and there was an interaction with sex (HR females 1.202, p < 0.001; HR males 1.790, p < 0.001; at 1.5 l).

Conclusion:

Baseline TLV is strongly associated with volume-reducing therapy initiation at follow-up in patients with PLD, with sex-specific differences in this association. Disease staging systems should use TLV to predict the need for future volume-reducing therapy in PLD separately for males and females.
Regional Vessel Density Reduction in the Macula and Optic Nerve Head of Patients With Pre-Perimetric Primary Open Angle Glaucoma
Authors: Verticchio Vercellin Alice , Siesky Brent , Antman Gal , Oddone Francesco , Chang Michael , Eckert George , Arciero Julia , Kellner Rebecca L. , Fry Brendan , Coleman-Belin Janet , Carnevale Carmela , Harris Alon
Published: September 2023

Précis:

Capillary and neuronal tissue loss occur both globally and with regional specificity in pre-perimetric glaucoma patients at the level of the optic nerve and macula, with perifovea regions affected earlier than parafovea areas.

Purpose:

To investigate optic nerve head (ONH) and macular vessel densities (VD) and structural parameters assessed by optical coherence tomography angiography in pre-perimetric open angle glaucoma (ppOAG) patients and healthy controls.

Materials and Methods:

In all, 113 healthy and 79 ppOAG patients underwent global and regional (hemispheric/quadrants) assessments of retinal, ONH, and macular vascularity and structure, including ONH parameters, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness. Comparisons between outcomes in ppOAG and controls were adjusted for age, sex, race, BMI, diabetes, and hypertension, with P<0.05 considered statistically significant.

Results:

In ppOAG compared with healthy controls: RNFL thicknesses were statistically significantly lower for all hemispheres, quadrants, and sectors (P<0.001–0.041); whole image peripapillary all and small blood vessels VD were statistically significantly lower for all the quadrants (P<0.001–0.002), except for the peripapillary small vessels in the temporal quadrant (ppOAG: 49.66 (8.40), healthy: 53.45 (4.04); P=0.843); GCC and inner and full macular thicknesses in the parafoveal and perifoveal regions were significantly lower in all the quadrants (P=0.000–P=0.033); several macular VD were significantly lower (P=0.006–0.034), with the exceptions of macular center, parafoveal superior and inferior quadrant, and perifoveal superior quadrant (P>0.05).

Conclusions:

In ppOAG patients, VD biomarkers in both the macula and ONH, alongside RNFL, GCC, and macular thickness, were significantly reduced before detectable visual field loss with regional specificity. The most significant VD reduction detected was in the peripheric (perifovea) regions. Macular and ONH decrease in VD may serve as early biomarkers of glaucomatous disease.
Association of Yersinia Infection With Kawasaki Disease: A Prospective Multicenter Cohort Study
Authors: Hayashi Hiroshi , Uda Kazuhiro , Araki Yumi , Akahoshi Shogo , Tanaka Miki , Miyata Koichi , Hataya Hiroshi , Miura Masaru
Published: September 2023

Background:

Yersinia infection is known to present with Kawasaki disease (KD)-like symptoms although differentiating the 2 has been a challenge. The present study aimed to describe the clinical characteristics and prevalence of Yersinia infection presenting with KD-like symptoms.

Methods:

The present, prospective, multicenter study enrolled patients who received a diagnosis of KD between January 2021 and January 2022 at 2 hospitals in Tokyo. Stool samples were collected within 3 days of the start of KD treatment, and cultures were performed for Yersinia. Clinical history and symptoms suggestive of Yersinia infection were also evaluated.

Results:

During the study period, 141 KD patients were screened and 117 patients with evaluable stool samples were registered. Only 1 patient was positive for Yersinia pseudotuberculosis, which was detected from both stool and blood cultures. The patient was refractory to KD treatment but improved after initiation of appropriate antibiotic therapy.

Conclusions:

Routine screening for Yersinia is not appropriate for patients with KD and should be limited to certain patients in high-risk areas and those who are refractory to the standard KD treatment.
Infections in Asymptomatic Unaccompanied Asylum-seeking Children in London 2016–2022
Authors: Eisen Sarah , Williams Bhanu , Cohen Jonathan
Published: September 2023

Background:

Unaccompanied asylum-seeking children are at increased risk of infections and experience barriers to healthcare access. There is a lack of evidence to underpin existing national and international guidance regarding asymptomatic infection screening in this population. We describe the results from routine infection screening of 1104 unaccompanied asylum-seeking children attending for testing at 3 London centers.

Methods:

We performed a retrospective analysis of routinely collected data from all unaccompanied asylum-seeking children seen in 3 services in London, United Kingdom, between 2016 and 2022.

Results:

A total of 1104 unaccompanied asylum-seeking children attended clinic; all accepted screening. The median age was 16 years (range 11–18 years) and 987 (89%) were male. 407 (37%) had at least 1 infection; 116 (11%) had multiple infections. Tuberculosis infection and schistosomiasis were common (found in 18% and 17%, respectively). Hepatitis B infection was identified with a prevalence of 3.9%. Giardia 7.7%, tapeworm 3.3% and Strongyloides 2.8% were also commonly identified.

Conclusions:

We report the largest known dataset to our knowledge of infection screening in asymptomatic unaccompanied asylum-seeking children in Europe to date. This data supports recommendations for routine asymptomatic screening in this high-risk cohort, based on the significant prevalence identified of infections of both personal and public health significance.
Kawasaki Disease Before and During the COVID-19 Pandemic: A Nationwide Population-based Study in the United States
Authors: Sakai-Bizmark Rie , Estevez Dennys , Wu Frank , Marr Emily H. , BenDavid Eyal , Mena Laurie A. , Chang Ruey-Kang R.
Published: September 2023

Background:

A decrease in the incidence of Kawasaki disease during the COVID-19 pandemic has been reported globally. Yet, previous US studies utilized patient populations of limited size and geographic scope, leaving a knowledge gap regarding the national trend. Employing a large sample size will increase the generalizability of the results and allow for more detailed analyses.

Methods:

The observational study using the 2016–2020 National (Nationwide) Inpatient Sample examined changes in the Kawasaki disease hospitalization rate in pediatric patients during the COVID-19 pandemic. Sensitivity analyses examined hospitalizations between October and December each year, as the code for multisystem inflammatory syndrome in children was implemented in October 2020.

Results:

In total, 24,505 hospitalizations with Kawasaki disease diagnoses were examined. Hospitalization rates were 65.1 and 53.8 per 1,000,000 pediatric population during the prepandemic and pandemic periods, respectively. Sensitivity analyses showed an overall decrease of 36.1%, with larger decreases for patients 1–4 years old (49.6%), males (40.0%), Asians or Pacific Islanders (57.9%) and patients in the South (47.5%), compared with their counterparts. Associations of the pandemic period with longer lengths of stay and higher daily costs were detected (adjusted mean ratio 1.11; P < 0.01 for length of stay, and adjusted mean ratio 1.33, P < 0.01 for costs).

Conclusions:

A decrease in the incidence of Kawasaki disease during the COVID-19 pandemic was observed nationwide in the United States. Contrary to a report from Japan, we did not observe a relationship between population density and a decrease in Kawasaki disease hospitalization. More detailed analyses in targeted geographical areas may provide further insights.
Pooling Saliva Sample as an Effective Strategy for the Systematic CMV Screening of Newborns—A Multicentric Prospective Study
Authors: Chasqueira Maria-Jesus , Fernandez Catarina , Marques Augusta , Rodrigues Lucia , Marçal Mónica , Tuna Madalena , Braz Monica , S Neto Ana , Mendes Candida , Lito David , Vasconcellos Gabriela , Rocha Paula , Cassiano Gonçalo , Silva Pedro , Monteiro Luísa , Sequeira Ana , Favila Menezes Maria , Albuquerque Margarida , Rego de Sousa Maria José , Paixão Paulo
Published: September 2023

Background:

Cytomegalovirus is the most common cause of congenital infections worldwide. Screening all newborns in the first 2 weeks of life is the only way to detect all cases of congenital infection, allowing the monitoring of children with asymptomatic infection at birth and early intervention.

Aim:

In this multicenter study, we aimed to evaluate the feasibility of using a saliva pool strategy for mass screening in 7 Portuguese hospitals, and to estimate the current prevalence of this congenital infection in these hospitals.

Methods:

A total of 7033 newborns were screened between June 2020 and June 2022, and 704 pools of 10 saliva samples were analyzed by polymerase chain reaction (PCR).

Results:

Of the 704 pools analyzed, 685 were negative and 19 had positive PCR results for cytomegalovirus. After individual PCR testing, 26 newborns had positive saliva results, of which 15 were confirmed by urine testing. Thus, this study’s prevalence of congenital infection was 0.21% (95% confidence interval: 0.12%–0.35%).

Conclusions:

In this study, the pooling strategy proved to be effective for the systematic screening of newborns, although this low prevalence raises questions regarding the cost-effectiveness of implementing universal screening. However, this prevalence is probably the result of the control measures taken during the pandemic; therefore, the rates are expected to return to prepandemic values, but only a new study after the pandemic will be able to confirm this.
Comparing the Clinical Courses of Children With Human Rhinovirus/Enterovirus to Children With Other Respiratory Viruses in the Outpatient Setting
Authors: Jones Milissa U. , Montgomery Agnes S. , Coskun Jennifer D. , Marcelo Raymundo Z. , Sutton Alyssa B. , Raiciulescu Sorana
Published: September 2023

Background:

While infections caused by rhinoviruses and enteroviruses are common among children, the entirety of their clinical impact remains elusive. We compared the clinical outcomes of children with rhinovirus/enterovirus infections to other common respiratory viruses in outpatient settings.

Methods:

We conducted a retrospective analysis of nasopharyngeal samples singly positive for human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU) or respiratory syncytial virus (RSV) from patients ≤17 years submitted for clinical testing via multiplex polymerase chain reaction between 2016 and 2019. We evaluated the following outpatient outcomes: days of respiratory symptoms before testing; visits for respiratory symptoms; receipt of a breathing treatment; receipt of antibiotics and hospital admission. Statistical analyses were conducted controlling for age and comorbid conditions.

Results:

There were 1355 positive samples included in this analysis (HRV/ENT: n = 743, FLU: n = 303 and RSV: n = 309). Compared to HRV/ENT, children with FLU had 28% fewer days of respiratory symptoms (β: −0.32; 95% confidence interval: −0.46 to −0.18; P < 0.001), fewer visits for respiratory symptoms, and significantly decreased odds of receiving a breathing treatment or antibiotics, and admission to the hospital. Children with RSV had a similar number of days of respiratory symptoms, outpatient visits and odds of hospital admission, but significantly increased odds of receiving a breathing treatment and antibiotics compared to those with HRV/ENT.

Conclusion:

Clinicians should have a high level of vigilance when managing children with positive respiratory viral testing for HRV/ENT given the potential for clinical outcomes similar to and, in some instances, worse than known highly pathogenic viruses.
The impact and utility of very low-calorie diets: the role of exercise and protein in preserving skeletal muscle mass
Authors: Janssen Tom Anthonius Hubertus , Van Every Derrick W. , Phillips Stuart M.
Published: September 2023

Purpose of review

Very low-calorie diets (VLCD) are used as a weight loss intervention, but concerns have been raised about their potential negative impact on lean mass. Here, we review the available evidence regarding the effects of VLCD on lean mass and explore their utility and strategies to mitigate reductions in skeletal muscle.

Recent findings

We observed that VLCD, despite their effects on lean mass, may be suitable in certain populations but have a risk in reducing lean mass. The extent of the reduction in lean mass may depend on various factors, such as the duration and degree of energy deficit of the diet, as well as the individual's starting weight and overall health.

VLCD may be a viable option in certain populations; however, priority needs to be given to resistance exercise training, and secondarily to adequate protein intake should be part of this dietary regime to mitigate losing muscle mass.
Sex differences in serum pigment epithelium-derived factor in healthy individuals
Authors: Li Cuiliu , Zhang Yunna , Gao Fang , Zhao Nairui , Wang Guangya , Xu Jinxiu , Zhao Xiaopeng
Published: September 2023

To investigate sexual dimorphism of serum pigment epithelium-derived factor (PEDF) and its influencing factors in healthy individuals. A total of 162 healthy people (69 males, 93 females) who underwent health examinations in our department were selected. Serum PEDF, estradiol and other metabolic indices were measured, and homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were calculated to evaluate insulin resistance and β-cell function, respectively. Subjects were divided into < 50 years and ≥ 50 years groups to explore the sexual dimorphism of serum PEDF in different age groups. We found no statistically significant difference in serum PEDF levels between men and women in total. However, in the group of subjects under 50 years old, men had significantly higher PEDF levels than women (9.32 ± 2.07 μg/mL vs 8.24 ± 2.29 μg/mL, P < .05), and no sex difference was found in the ≥ 50 years group. In women, serum PEDF levels were significantly higher in subjects aged 50 years and over than in those younger than 50 years of age (9.56 ± 3.05 μg/mL vs 8.25 ± 2.30 μg/mL, P < .05). In men, there was no significant difference in serum PEDF levels between the 2 age groups. In women, correlation analysis showed that serum PEDF levels were significantly correlated with body mass index, waist circumference, diastolic blood pressure (DBP), 2-h postprandial glucose, fasting and 2-h postprandial insulin, HOMA-β, HOMA-IR, aminotransferase, triacylglycerol, and estradiol. Elevated triacylglycerol and aminotransferase and decreased estradiol were significant predictors of increased PEDF concentrations in women. There is sexual dimorphism in circulating PEDF levels, which may be related to estrogen status.
Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review
Authors: Sakellariou Evangelos , Benetos Ioannis S. , Evangelopoulos Dimitrios-Stergios , Galanis Athanasios , Alevrogianni Fani , Vavourakis Michail , Marougklianis Vasilios , Tsalimas Georgios , Pneumaticos Spiros
Published: September 2023

Spinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient’s safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction.
Using mindfulness-based stress reduction to relieve loneliness, anxiety, and depression in cancer patients: A systematic review and meta-analysis
Authors: Yu Junye , Han Mingyue , Miao Fengru , Hua Dan
Published: September 2023

Background:

Mindfulness-based stress reduction (MBSR) has been suggested as an effective mind-body approach for relieving stress in patients with chronic diseases. As of yet, there is no conclusive research on MBSR’s role in reducing affective disorders among cancer patients. A systematic review and meta-analysis was conducted to determine whether MBSR has an impact on loneliness, anxiety, and depression in cancer patients.

Methods:

Systematic searches were conducted in PubMed, Embase, and the Cochrane Library from the start of these databases to January 2nd, 2022 to identify relevant randomized controlled trials. Two authors independently conducted the literature search, collected the data, and performed the statistical analysis. In order to account for potential between-study heterogeneity, a random-effect model was used in the meta-analysis.

Results:

The meta-analysis included 16 studies with 2072 cancer patients. Among the 16 studies, 13 included patients with breast cancer, and the follow-up duration ranged from 6 to 53 weeks. Compared to controls receiving standard cancer care, interventions of MBSR with sessions for 6 to 8 weeks significantly improved loneliness (standard mean difference [SMD]: −0.35, 95% confidence interval [CI]: −0.59 to −0.12, P = .003, I
2 = 46%), anxiety (SMD: −0.51, 95% CI: −0.73 to −0.30, P < .001, I
2 = 77%), and depression (SMD: −0.61, 95% CI: −1.02 to −0.20, P = .004, I
2 = 94%) in patients with cancer.

Conclusion:

According to recent research, MBSR may be beneficial to patients diagnosed with cancer who are feeling lonely, anxious, or depressed.
Effect of auricular acupressure combined with acupuncture for juvenile pseudomyopia
Authors: Zhu Yan-Ni , Chen Yuan-Yuan , Zou Ting , Cao Ping
Published: September 2023

This retrospective study investigated the effect of auricular acupressure combined with acupuncture for juvenile pseudomyopia (JPM). In this retrospective study, we collected and analyzed a total of 66 eligible records of subjects with JPM. They were allocated into a treatment group (n = 33) and a control group (n = 33). All participants in both groups received auricular acupressure. Additionally, children in the treatment group also underwent acupuncture. The primary outcome was naked visual acuity (VA). It was performed using a standard E visual acuity chart. The secondary outcome was visual fatigue symptoms, as assessed by the College of Optometrists in Vision Development Quality of Life (COVD-QoL) questionnaire. All outcomes were analyzed before and after treatment. There were no significant differences regarding the naked VA and COVD-QoL scores before and after treatment between the 2 groups. However, there were significant differences regarding on naked VA (P < .01) and COVD-QoL scores (P < .01) within 2 groups compared before and after treatment. The findings of this study showed that both APP plus acupuncture and APP alone benefit children with JPM.
FCGR2B as a prognostic and immune microenvironmental marker for gliomas based on transcriptomic analysis
Authors: Sun Zhimin , Sun Xiaoli , Yuan Yaqin , Li Hongsheng , Li Xiaona , Yao Zhigang
Published: September 2023

To explore the expression and prognosis of Fc fragment of IgG low affinity IIb receptor (FCGR2B) in glioma and its relationship with immune microenvironment, so as to provide potential molecular targets for the treatment of glioma. We analyzed the gene expression of FCGR2B using the Cancer Genome Atlas database, Chinese Glioma Genome Atlas, Gene Expression Omnibus database and other glioma related databases. Moreover, we generated survival receiver operating characteristic curve, carried out univariate and multivariate Cox analysis and nomograph construction, and analyzed the relationship between FCGR2B and prognosis. According to the median of FCGR2B gene expression value, the differential expression analysis was carried out by high and low grouping method, and the gene ontology, Kyoto encyclopedia of genes and genomes, and gene set enrichment analysis enrichment analysis were carried out to explore the possible mechanism. Then, the correlation between immune score of glioma and prognosis, World Health Organization grade and FCGR2B expression was analyzed. Finally, the correlation between FCGR2B expression and the proportion of tumor infiltrating immune cells, immune checkpoints, tumor mutation load and immune function was analyzed. The expression of FCGR2B in gliomas was higher than that in normal tissues and was associated with poor prognosis. Independent prognostic analysis showed that FCGR2B was an independent prognostic factor for glioma. The analysis of gene ontology and gene set enrichment analysis showed that FCGR2B was closely related to immune-related functions. The analysis of immune scores and prognosis, World Health Organization grade and FCGR2B expression in gliomas indicated that patients with high immune scores had significantly poorer overall survival and higher tumor pathological grade. In addition, immune scores were significantly positively correlated with the expression of FCGR2B. The analysis of tumor infiltrating immune cells suggested that the expression level of FCGR2B affected the immune activity of TME. In addition, the expression of FCGR2B was positively correlated with almost all immune checkpoint molecules including CD28, CD44, TNFSF14, PDCD1LG2, LAIR1, and CD48 and was significantly positively correlated with tumor mutation load. All immunobiological functions of the high expression group of FCGR2B were significantly inhibited. FCGR2B may play an important role in the occurrence, development and invasion of tumor by influencing the tumor microenvironment of immunosuppression. FCGR2B may be an important target for the treatment of glioma.