bluuebunny/crossref_metadata_2025 huggingface dataset:
Oropharyngeal application of colostrum or mother’s own milk in preterm infants: a systematic review and meta-analysis
Authors: Kumar Jogender , Meena Jitendra , Ranjan Ankit , Kumar Praveen
Published: January 2023

Context

Many preterm neonates often cannot be fed enterally and hence do not receive the benefits of colostrum. Oropharyngeal application of colostrum is a novel way of harnessing the immunological benefits of colostrum. Randomized controlled trials (RCTs) investigating the efficacy of this approach have shown variable results.

Objective

The aim of this systematic review was to synthesize available data on the effect of oropharyngeal application of colostrum or mother's own milk (CMOM) in preterm infants.

Data Sources

Six electronic databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library) were searched until January 13, 2022. Only RCTs comparing oral application of CMOM with placebo/routine care in preterm infants were eligible. Studies enrolling term neonates or administering enteral feeds were excluded.

Data Extraction

Two investigators independently extracted data using a structured proforma.

Data Analysis

The Cochrane Risk of Bias 2 tool was used to assess bias. Random-effects meta-analysis was undertaken using RevMan 5.4 software. From 2787 records identified, 17 RCTs enrolling 4106 preterm infants were included. There was no significant difference between groups in incidence of necrotizing enterocolitis (NEC) stage 2 or higher (RR = 0.65; 95%CI, 0.36–1.20; 1089 participants in 12 trials). Application of CMOM significantly reduced the incidence of sepsis (RR = 0.72; 95%CI, 0.56–0.92; 1511 participants in 15 studies) and any stage of NEC (RR = 0.58; 95%CI, 0.37–0.92; 1616 participants in 16 trials). The CMOM group achieved full enteral feeds 1.75 days sooner (95%CI, 0.3–3.2 days; 1580 participants in 14 studies) and had higher weight at discharge (MD = 43.9 g; 95%CI, 3–85 g; 569 participants in 3 studies). There were no statistically significant differences in other outcomes.

Conclusions

Evidence with low to very low certainty suggests CMOM has a beneficial effect on NEC (any stage), sepsis, and time to full enteral feeds. Given its low cost and minimal risk of harm, routine CMOM use may be considered in preterm neonates.

Prospero Registration Number

CRD42021262763
COVID-19 and culture
Authors: Mohanty Aatishya , Ang James B
Published: January 2023

The USA has been particularly hard hit by the COVID-19 pandemic and a wide spatial variation can be seen in its spread and mortality. This raises the question of why some regions are more resilient to the pandemic than others? We hypothesize that the individualism–collectivism cleavage explains the disparity in COVID-19 cases observed across sub-national units in the USA. Cultural disparity among different groups of people leads to differences in how they perceive health crises and thereby shapes the way they respond to pandemics. A heightened sense of obligation and responsibility increases in-group sociability and interdependence and raises the perceived vulnerability towards disease transmission among collectivistic individuals, and this leads to greater adherence to containment measures and social distancing rules. Our results provide evidence that more individualistic states tend to have more COVID-19 cases across the USA.
Differential Gene Expression Profiling in Alveolar Echinococcosis Identifies Potential Biomarkers Associated With Angiogenesis
Authors: Yimingjiang Maiweilidan , Aini Abudusalamu , Tuergan Talaiti , Zhang Wei
Published: January 2023

Background

Alveolar echinococcosis (AE) is a worldwide zoonosis caused by Echinococcus multilocularis. Alveolar echinococcosis is a severe chronic parasitic disease that exhibits a tumor-like growth, with the potential for invasion and distant metastasis; however, the molecular mechanism underlying this condition remains unclear.

Methods

Transcriptome analyses were performed to detect differentially expressed genes (DEGs) in samples from patients with AE with invasion and distant metastasis. The results were further verified by immunohistochemistry.

Results

A total of 1796 DEGs were identified, including 1742 upregulated and 54 downregulated DEGs. A subsequent functional analysis showed that the significant DEGs were involved in the angiogenesis process. Immunohistochemical analysis confirmed the reliability of the transcriptomic data.

Conclusions

These results suggest that angiogenesis is a possible mechanism underlying the tumor-like biological behavior observed during E multilocularis infection. Genes related to this process may play important roles in AE invasion and distant metastasis.
Evidence Regarding Pharmacogenetics in Pain Management and Cancer
Authors: Smith D Max , Figg William D
Published: January 2023

Patients experience interindividual variation in response to analgesics, which may be partially explained by genetics. This commentary discusses a recently published trial on COMT genotype and opioid dose requirements and describes the potential role for COMT and other genes (eg, CYP2D6) on opioid therapy and the current evidence for germline pharmacogenetics and resources for opioid pharmacogenetics.
Mutations in RZF1, a zinc-finger protein, reduce magnesium uptake in roots and translocation to shoots in rice
Authors: Kobayashi Natsuko I , Takagi Hiroki , Yang Xiaoyu , Nishizawa-Yokoi Ayako , Segawa Tenta , Hoshina Tatsuaki , Oonishi Takayuki , Suzuki Hisashi , Iwata Ren , Toki Seiichi , Nakanishi Tomoko M , Tanoi Keitaro
Published: January 2023

Magnesium (Mg) homeostasis is critical for maintaining many biological processes, but little information is available to comprehend the molecular mechanisms regulating Mg concentration in rice (Oryza sativa). To make up for the lack of information, we aimed to identify mutants defective in Mg homeostasis through a forward genetic approach. As a result of the screening of 2,825 M2 seedlings mutated by ion-beam irradiation, we found a rice mutant that showed reduced Mg content in leaves and slightly increased Mg content in roots. Radiotracer 28Mg experiments showed that this mutant, named low-magnesium content 1 (LMGC1), has decreased Mg2+ influx in the root and Mg2+ translocation from root to shoot. Consequently, LMGC1 is sensitive to the low Mg condition and prone to develop chlorosis in the young mature leaf. The MutMap method identified a 7.4-kbp deletion in the LMGC1 genome leading to a loss of two genes. Genome editing using CRISPR-Cas9 further revealed that one of the two lost genes, a gene belonging to the RanBP2-type zinc-finger family that we named RanBP2-TYPE ZINC FINGER1 (OsRZF1), was the causal gene of the low Mg phenotype. OsRZF1 is a nuclear protein and may have a fundamental role in maintaining Mg homeostasis in rice plants.
Translation, adaptation, and clinical validation of the Premature Ejaculation Diagnostic Tool in Spanish (Colombia)
Authors: Vallejo-Medina Pablo , Saffon José Pablo , Álvarez-Muelas Ana
Published: January 2023

Background

Premature ejaculation is the most prevalent form of sexual dysfunction in men. The Premature Ejaculation Diagnostic Tool (PEDT) is an instrument used to evaluate premature ejaculation. It offers adequate psychometric properties and good reliability.

Aim

To adapt and validate a Colombian version of the PEDT in Colombian clinical and nonclinical samples.

Methods

Two samples were used in this study. The first was made up of 1110 men who were recruited to evaluate validity and reliability. Their ages ranged from 19 to 65 years (mean ± SD, 39.71 ± 12.53). The second sample included 123 men (66.7%) who did not meet diagnostic criteria for premature ejaculation per the International Statistical Classification of Diseases and Related Health Problems (ICD-10), while 33.3% met ICD-10 criteria for this dysfunction. Their ages ranged from 18 to 65 years (34.19 ± 12.65). Scores were used to calculate the cutoff.

Outcomes

A translated and adapted version of the PEDT was developed specifically for Colombia. All participants completed the Colombian version of the PEDT, a sociodemographic questionnaire, the Colombian version of the Massachusetts General Hospital–Sexual Functioning Questionnaire, and a semistructured interview based on the ICD-10.

Results

The results showed adequate psychometric properties and satisfactory internal consistency and confirmed the 1-dimensional factorization of the scale. According to ICD-10 criteria, the study also confirmed significant differences between participants who self-reported premature ejaculation and those who did not. In addition, it showed adequate evidence of convergent validity, with a moderate correlation with sexual functioning scores. As a result, the cutoff point was set to 10.5, with an area under the curve of 96.8%. Therefore, a score ≥11 points suggested the presence of premature ejaculation.

Clinical Translation

The current Colombian version of the PEDT is a useful instrument that determines the presence of premature ejaculation that is compatible with ICD-10 criteria.

Strengths and Limitations

The Colombian version of the PEDT presents evidence of reliability and validity, a confirmed 1-dimensional factorization, and a cutoff point for Hispanic populations. More in-depth evaluation of the diagnosis of premature ejaculation is required, and further research among other Spanish-speaking countries and sexual minorities is recommended.

Conclusion

The Colombian version of the PEDT is a psychometric adequacy tool for evaluating and diagnosing premature ejaculation, following the ICD-10 criteria.
Navigating the complexities of section 100A: a look at the future of trust taxation in Australia
Authors: Mak Charles Ho Wang
Published: January 2023

Section 100A of the Income Tax Assessment Act of 1936 is a provision designed to prevent arrangements in which a distribution is made to a beneficiary with a low tax rate, yet, the economic benefit is conveyed or paid to a second beneficiary with a higher tax rate. The Australian Taxation Office provided its final guidance on this provision very recently. This article provides an overview of the guidance, analyses cases regarding the application of Section 100A, and assesses the guidance’s potential future implications on trust taxation in Australia.
Changes of HIV burden globally and in China over three decades: a secondary analysis of global HIV statistics
Authors: Lu Yanqiu , Tang Shengquan , Qin Yuanyuan , Harypursat Vijay , Wu Hao , Chen Yaokai
Published: January 2023

Background:

A more comprehensive understanding of the trends of incidence, prevalence, and mortality in human immunodeficiency virus (HIV), and their complex interrelationships, may provide important evidence for decision-making related to HIV prevention and control. The variances in these indices between different population groups, genders, and ages are critical to decipher evolving patterns of the HIV epidemic in specific populations.

Methods:

A secondary analysis of relevant data was conducted using data extracted from the Global Burden of Disease study of 2019. HIV/acquired immune deficiency syndrome (AIDS) incidence, prevalence, AIDS-related mortality, and mortality-to-prevalence ratio (MPR) for annual percentage change, average annual percentage change (AAPC), and corresponding 95% confidence intervals (CIs) were calculated using joinpoint regression statistical analysis.

Results:

The AAPC of HIV/AIDS incidence, prevalence, AIDS-related mortality rate, and MPR were –1.4 (95% CI: –1.6, –1.2), 4.1 (95% CI: 4.0, 4.3), 2.0 (95% CI: 1.7, 2.3), and –2.1 (95% CI: –2.3, –1.8) between 1990 and 2019 globally, and were 3.5 (95% CI: 2.2, 4.8), 6.9 (95% CI: 6.8, 7.0), 8.1 (95% CI: 7.1, 9.1), and 1.2 (95% CI: 0.1, 2.3) in China during the same period. In terms of differences in the preceding indicators by gender, we observed a similar pattern of trends for male and female genders both globally and in China during the entire study period. Each specific age group exhibits a distinct pattern in terms of incidence, prevalence, mortality rate, and MPR both globally and in China.

Conclusions:

Prevalence and mortality rates of HIV/AIDS have increased between 1990 and 2019 globally and in China. While the incidence rate and MPR have declined globally over the past three decades, these two indicators are observed to present an increasing trend in China. There is a high HIV burden among young and middle-aged adults globally; however, the elderly have a high HIV burden in China. HIV screening at older age should be scaled up, and patients with advanced HIV disease should be provided early with additional care and health resources.
Menopause in people with cystic fibrosis
Authors: Prochownik Katherine , Jain Raksha , Taylor-Cousar Jennifer L. , Lavage Daniel R. , Stransky Olivia M. , Thomas Holly N. , Kazmerski Traci M.
Published: January 2023

Objective

This study aimed to describe the menopause experience of people with cystic fibrosis (CF).

Methods

We conducted a computer-based cross-sectional survey of women with CF 25 years or older at 10 US CF centers exploring a range of sexual and reproductive health concerns, including menopause. We used descriptive statistics to analyze results.

Results

Of 460 participants, 5 (3%) were perimenopausal and 34 (7%) were postmenopausal. Of participants perimenopausal or menopausal (n = 39), 97% reported the following menopausal symptoms occurring at least once a week: most commonly early wake-up (83%); stiffness/soreness in joints, neck, or shoulders (65%); and night sweats (65%). Among menopausal participants, the median self-reported age at menopause was 48.5 years (interquartile range, 5.5 y). Thirty percent experienced worsened CF symptoms during menopause, and 42% experienced worsening CF symptoms after menopause. Twenty-four percent of menopausal participants were on estrogen therapy and 15% on estrogen and progesterone therapy. Three-fourths of participants using hormone therapy reported no change in their CF symptoms. One percent of the 460 survey participants reported discussing menopause with their CF provider, despite 19% wanting to discuss this topic with their CF team.

Conclusions

This is the first study to describe menopause symptoms of people with CF. People with CF experience a variety of menopausal symptoms and often report a worsening of their CF symptoms after menopause, suggesting an interplay between female sex hormones and CF. Larger studies are needed comparing the sexual and reproductive health experiences and care needs of people with CF in the menopause transition to the general population.
Trends in engagement in surrogacy by nationality 2018–2020: a survey of surrogacy agencies
Authors: Everingham Sam G. , Whittaker Andrea
Published: January 2023

Introduction:

Global reproductive destinations are constantly changing, and so is the cross-border reproductive movement of both gametes and intended parents seeking to build families. Quantifying the use of cross-border surrogacy is difficult given no reliable data exists on the global patterns of use of CBRC generally or surrogacy in particular.

Methods:

Approximately 150 surrogacy agencies in countries offering surrogacy to foreigners were invited to provide consolidated data on the number of commissioning singles and couples who signed with their agency for surrogacy services over the 2018–2020 calendar years, by nationality of the biological intended parent(s). Twenty-four agencies (16%) reported on 5968 clients.

Results:

Other than the United States, agencies were involved predominately in arrangements for foreigners. In the United States, other than the large domestic market, France, Australia, and Israel were large source countries. Australia and France were also large source countries for Canada. China was overwhelmingly the largest source country engaging in Ukraine. In Georgia, other than Georgian nationals, China, Israel, and the United States were the largest foreign source countries. In Greece, apart from locals, the largest source countries were Italy and Australia. Colombia reported a wide spread of foreign clientele with Israel, the United States, and Canada as the largest. COVID-19 had a significant impact on enrolments in Georgia and Ukraine—each experienced large declines in enrolments when comparing 2019–2020. In contrast, despite travel bans in 2020, agencies in 3 of 4 unregulated countries continued to report increases in enrolments.

Conclusions:

The global cross-border surrogacy market remains highly volatile, experiencing rapid growth and decline, especially in newer destinations. Source countries providing surrogacy clients are based partly on proximity and cultural ties, but more so on affordability. Further research is required to monitor the effects of engagement in newer destinations with fewer protections.
Gender differences in acute aortic syndromes
Authors: Bhatt Nitish , Chung Jennifer Chia-Ying
Published: January 2023

Purpose of review

Acute aortic syndromes include acute aortic dissection, intramural hematoma, and penetrating aortic ulcer, and are associated with high mortality and morbidity. This review focuses on recent findings and current understanding of gender-related and sex-related differences in acute aortic syndromes.

Recent findings

Large international and national registries, population studies, and multicentre national prospective cohort studies show evidence of sex differences in acute aortic syndromes. Recent studies of risk factors, aorta remodelling, and genetics provide possible biological basis for sex differences. The 2022 American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Aortic Disease revise recommendations for surgical management for aortic root and ascending aorta dilatation, which could impact outcome differences between the sexes.

Acute aortic syndromes affect men more frequently than women. The prevalence of acute aortic syndromes and prevalence of many risk factors rise sharply with age in women leading to higher age at presentation for women. Times from symptom onset to presentation and presentation to diagnosis are delayed in female patients. Females with type A dissection are also more commonly treated conservatively than male counterparts. These factors likely contribute to higher early mortality and complications in women.
Anticoagulation for rheumatic mitral stenosis, INVICTUS in perspective
Authors: Verma Raj , Latter David A.
Published: January 2023

Purpose of review

Rheumatic mitral stenosis (MS) while declining in high- and middle-income countries, continues to be a major cause of death and disability in low-income countries. Although the nonvitamin-K antagonist oral anticoagulants (NOACs) have essentially supplanted vitamin K antagonists (VKA) in patients with nonvalvular atrial fibrillation (AF), their efficacy for stroke prevention in patients with rheumatic MS and AF has not been widely studied until recently. The purpose of this review is to provide a succinct synopsis of the current anticoagulation recommendations for patients with native and prosthetic heart valve disease, with a specific focus on patients with rheumatic MS.

Recent findings

The INVICTUS trial was the first large randomized evaluation of a NOAC vs. VKA in approximately 4600 patients with moderate to severe rheumatic MS and AF. The primary outcome of stroke, systemic embolization, myocardial infarction, vascular and all-cause death, VKA treated patients exhibited lower event rates (including mortality) compared to rivaroxaban. We discuss and contextualize these findings as they relate to the broader use of anticoagulants in patients with valvular heart disease, with and without concomitant AF.

VKA remains the standard of care for patients with moderate to severe rheumatic MS who have concomitant AF. Rates of stroke in anticoagulated patients with rheumatic MS and AF are lower than what is traditionally held, while nonstroke related deaths remain the most common mechanism of mortality.
Update on cardiogenic shock: from detection to team management
Authors: Khariton Yevgeniy , Hassan Ossama Abou , Hernandez-Montfort Jaime A.
Published: January 2023

Purpose of review

The following review is intended to provide a summary of contemporary cardiogenic shock (CS) profiling and diagnostic strategies, including biomarker and hemodynamic-based (invasive and noninvasive) monitoring, discuss clinical differences in presentation and trajectory between acute myocardial infarction (AMI)-CS and heart failure (HF)-CS, describe transitions to native heart recovery and heart replacement therapies with a focus on tailored management and emerging real-world data, and emphasize trends in team-based initiatives and interventions for cardiogenic shock including the integration of protocol-driven care.

Recent findings

This document provides a broad overview of contemporary scientific consensus statements as well as data derived from randomized controlled clinical trials and observational registry working groups focused on cardiogenic shock management.

This review highlights the increasingly important role of pulmonary artery catheterization in AMI-CS and HF-CS cardiogenic shock and advocates for routine application of algorithmic approaches with interdisciplinary care pathways. Cardiogenic shock algorithms facilitate the integration of clinical, hemodynamic, and imaging data to determine the most appropriate patient hemodynamic support platform to achieve adequate organ perfusion and decongestion.
Donation after circulatory determination of death in heart transplant: impact on current and future allocation policy
Authors: Hendren Nicholas S. , Truby Lauren K. , Farr Maryjane
Published: January 2023

Purpose of review

Historically, the selection criteria for heart transplant candidates has prioritized posttransplant survival while contemporary allocation policy is focused on improving waitlist survival. Donor scarcity has continued to be the major influence on transplant allocation policy. This review will address the opportunity of donation after circulatory determination of death (DCDD) and potential impact on future policy revisions.

Recent findings

In 2018, changes to U.S. heart allocation policy led to several intended and unintended consequences. Beneficial changes include reduced waitlist mortality and broader geographic sharing. Additional impacts include scarcer pathways to transplant for patients with a durable left ventricular assist device, increased reliance on status exceptions, and expanded use of temporary mechanical support. DCDD is anticipated to increase national heart transplant volumes by ∼30% and will impact waitlist management. Centers that offer DCDD procurement will have reduced waitlist times, reduced waitlist mortality, and higher transplant volumes.

While DCDD will provide more transplant opportunities, donor organ scarcity will persist and influence allocation policies. Differential patient selection, waitlist strategy, and outcome expectations may indicate that allocation is adjusted based on the procurement options at individual centers. Future policy, which will consider posttransplant outcomes, may reflect that different procurement strategies may yield different outcomes.
Device-based therapies for decompensated heart failure
Authors: Brooksbank Jeremy A. , Albert Chonyang
Published: January 2023

Purpose of review

Despite improvements in medical therapies, patients with heart failure continue to suffer significant morbidity and mortality. Acute decompensated heart failure (ADHF) remains a common and serious medical condition with a myriad of implications on patient survival and quality of life, and heart failure related readmissions persist [1–3].

Recent findings

From the detection of prehospitalization decompensation and inpatient management of ADHF to stabilization of cardiogenic shock and durable mechanical circulatory support, device-based therapies are utilized across the spectrum of heart failure management. At present, there are numerous device-based therapies commonly used in clinical practice and many more devices in the early clinical-trial phase aimed at attenuation of ADHF.

In this review, we examine recent updates in the breadth and use of devices-based therapies in these three main domains: ambulatory heart failure, acute decompensated heart failure, and cardiogenic shock. Device-based therapies for decompensated heart failure will continue to grow in number, indication, and complexity, making recognition and familiarity with available technologies of increased importance for research and clinical practice.
The emerging role of the branched chain aminotransferases, BCATc and BCATm, for anti-tumor T-cell immunity
Authors: Wetzel Tanner J. , Erfan Sheila C. , Ananieva Elitsa A.
Published: January 2023

Challenges regarding successful immunotherapy are associated with the heterogeneity of tumors and the complex interactions within the surrounding tumor microenvironment (TME), particularly those between immune and tumor cells. Of interest, T cells receive a myriad of environmental signals to elicit differentiation to effector subtypes, which is accompanied by metabolic reprogramming needed to satisfy the high energy and biosynthetic demands of their activated state. However, T cells are subjected to immunosuppressive signals and areas of oxygen and nutrient depletion in the TME, which causes T-cell exhaustion and helps tumor cells escape immune detection. The cytosolic and mitochondrial branched chain amino transferases, BCATc and BCATm, respectively, are responsible for the first step of the branched chain amino acid (BCAA) degradation, of which, metabolites are shunted into various metabolic processes. In recent years, BCAT isoenzymes have been investigated for their role in a variety of cancers found throughout the body; however, a gap of knowledge exists regarding the role BCAT isoenzymes play within immune cells of the TME. The aim of this review is to summarize recent findings about BCAAs and their catabolism at the BCAT step during T-cell metabolic reprogramming and to discuss the BCAT putative role in the anti-tumor immunity of T cells. Not only does this review acknowledges gaps pertaining to BCAA metabolism in the TME but it also identifies the practical application of BCAA metabolism in T cells in response to cancer and spotlights a potential target for pharmacological intervention.
Recent insights into the role of Akt in CD4 T-cell activation and differentiation: alternative splicing and beyond
Authors: White Tristan L. A. , Jin Ye , Gable Matthew J. , Morel Penelope A.
Published: January 2023

The activation and differentiation of CD4+ T cells is a complex process that is controlled by many factors. A critical component of the signaling pathway triggered following T-cell receptor (TCR) engagement is the serine threonine kinase Akt. Akt is involved in the control of many cellular processes including proliferation, metabolism, and differentiation of specific TH-cell subsets. Recent work has shown that, depending on the nature or strength of the TCR activation, Akt may activate different sets of substrates which then lead to differential cellular outcomes. Akt plays an important role in controlling the strength of the TCR signal and several recent studies have identified novel mechanisms including control of the expression of negative regulators of TCR signaling, and the influence on regulatory T cells (Treg) and TH17 differentiation. Many of these functions are mediated via control of the FoxO family of transcription factors, that play an important role in metabolism and Th cell differentiation. A theme that is emerging is that Akt does not function in the same way in all T-cell types. We highlight differences between CD4 and CD8 T cells as well as between Treg, TH17, and TFH cells. While Akt activity has been implicated in the control of alternative splicing in tumor cells, recent studies are emerging that indicate that similar functions may exist in CD4 T cells. In this mini review, we highlight some of the recent advances in these areas of Akt function that demonstrate the varied role that Akt plays in the function of CD4 T cells.
Revisiting the “starved gut” hypothesis in inflammatory bowel disease
Authors: Colgan Sean P. , Wang Ruth X. , Hall Caroline H.T. , Bhagavatula Geetha , Lee J. Scott
Published: January 2023

Active episodes of inflammatory bowel disease (IBD), which include ulcerative colitis and Crohn’s disease, coincide with profound shifts in the composition of the microbiota and host metabolic energy demand. Intestinal epithelial cells (IEC) that line the small intestine and colon serve as an initial point for contact for the microbiota and play a central role in innate immunity. In the 1980s, Roediger et al proposed the hypothesis that IBD represented a disease of diminished mucosal nutrition and energy deficiency (“starved gut”) that strongly coincided with the degree of inflammation. These studies informed the scientific community about the important contribution of microbial-derived metabolites, particularly short-chain fatty acids (SCFA) such as butyrate, to overall energy homeostasis. Decades later, it is appreciated that disease-associated shifts in the microbiota, termed dysbiosis, places inordinate demands on energy acquisition within the mucosa, particularly during active inflammation. Here, we review the topic of tissue energetics in mucosal health and disease from the original perspective of that proposed by the starved gut hypothesis.
Surgical decisions in the setting of zonulopathy
Authors: Fram Nicole R. , McKee Yuri , Chang David F. , Chee Soon-Phaik , Donaldson Kendall E. , Crandall David A. , Al-Mohtaseb Zaina , Chen Allison J.
Published: January 2023

An 85-year-old man with a history of type 2 diabetes, pseudoexfoliation (PXF) in both eyes, and tamsulosin use was referred for the evaluation of a dense cataract in the right eye and a subluxated intraocular lens (IOL) in the left eye. Unfortunately, his surgery in the left eye was complicated by diffuse zonulopathy. The referring surgeon placed a 3-piece IOL in the sulcus. However, the passively fixated 3-piece IOL moved inferiorly causing monocular diplopia for over a year. Because the patient was pleased with the IOL immediately postoperatively, a refixation procedure was performed in the form of sulcus placement with iris suture fixation in the left eye. Fortunately, the iris-fixated IOL in the left eye has remained well centered and stable without cystoid macular edema (CME) or chronic inflammation for over 8 months. The patient is on no ocular medications and has no family history of glaucoma. He now needs cataract surgery in the right eye and is extremely apprehensive because of his difficult course in the left eye.

The corrected distance visual acuity is 20/70 in the right eye and 20/25 in the left eye. Intraocular pressures (IOPs) measure 20 mm Hg in the right eye and 14 mm Hg in the left eye by Goldmann tonometry. Pachymetry is 536 µm in the right eye and 543 µm in the left eye. Pupils are round with minimal reactivity and without a relative afferent pupillary defect. Extraocular motility is normal in both eyes, and confrontation visual fields is full in both eyes. Gonioscopy reveals an angle open to the pigmented trabecular meshwork (PTM) in the right eye and the ciliary body in the left eye with 1+ PTM and without peripheral anterior synechia in both eyes. The retinal nerve fiber layer and macular optical coherence tomography are normal in both eyes.

On slitlamp examination, pertinent findings include pseudoexfoliative changes at the pupillary margin with poor dilation of 3.5 mm in both eyes; the anterior chamber (AC) is shallow but adequate in the right eye and deep and quiet with rare pigmented cells in the left eye. There is a 5+ nuclear sclerotic cataract with pseudoexfoliative changes on the anterior capsule and no obvious phacodonesis in the right eye and a 3-piece posterior chamber IOL in the sulcus fixated to the iris with 10-0 polypropylene sutures at 6 and 12 o'clock without pseudophacodonesis in the left eye. Dilated fundus examination reveals a cup-to-disc ratio of 0.4 with healthy neuroretinal rims in both eyes, posterior vitreous detachments in both eyes, and no evidence of diabetic retinopathy in both eyes. All other findings are unremarkable.

How would you counsel this patient regarding his risk factors for surgery in the right eye? What surgical maneuvers would you use to remove the cataract safely? How would you stabilize the IOL if the capsule bag becomes compromised due to zonulopathy?
Attention to diseases that re-emerge due to refusal of vitamin K: an infant case
Authors: Öztürk Betül , Yaradılmış Raziye Merve , Azapağası Ebru , Öztürk Zeynelabidin , Fettah Ali , Tuygun Nilden
Published: January 2023

Intramuscular vitamin K injection is recommended for all newborns to prevent bleeding. However, the number of parents who reject vitamin K is at an increase. We present a 1-month girl who presented with haemorrhagic shock due to extraordinary intra-thoracic bleeding. The patient was treated with thoracentesis and blood transfusion. Parents were informed the about the benefits of Vitamin K and they were convinced to continue a routine immunization programme.
Prevalence of Exocrine Pancreatic Dysfunction Based on Direct Function Testing in Pediatric Inflammatory Bowel Disease
Authors: Fernandez Jenelle , Hopson Puanani , Patel Samit B. , Horvath Karoly , Pandey Akash
Published: January 2023

Objectives:

Patients with inflammatory bowel disease (IBD) frequently have extraintestinal manifestations. The goal of this pilot study was to assess exocrine pancreatic function in cases with suspicion for or an established diagnosis of IBD.

Methods:

Direct stimulated endoscopic pancreatic function test (ePFT) was performed in 74 children with IBD, in both newly diagnosed and established cases. Demographic, clinical, and laboratory parameters were entered into a database and analyzed.

Results:

Among the 74 children, 49 were newly diagnosed and 25 had an established diagnosis of IBD. A majority had the diagnosis of Crohn disease (CD) (n = 48; 32 new and 16 established cases) with male predominance (64.6%). Altogether, 42 (56.7%) children had either generalized or partial exocrine pancreatic insufficiency (EPI). Twenty-four of the 48 CD children (50%) had abnormal ePFT. In those with ulcerative colitis (UC), 18 of the 26 (62.9%) had abnormal ePFT. The highest abnormality rate was in lipase enzyme activity. Weight z scores were significantly lower in those with abnormal ePFT (Crohn cases: P = 0.008; UC cases: P = 0.046). Peak protein concentration in collected pancreatic fluid was significantly lower in children with CD who had abnormal ePFT (P = 0.013).

Conclusions:

This pilot study revealed a relatively high prevalence of EPI in children with IBD through use of ePFT. EPI can result in maldigestion, with decreased capacity to digest fat. Further prospective studies are needed to assess need and efficacy of pancreatic enzyme replacement therapy in children with IBD and abnormal ePFT.
The Role of Ultrasound in Pediatric Skull Fractures
Authors: Şık Nihan , Öztürk Ali , Yılmaz Durgül , Duman Murat
Published: January 2023

Background

The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma.

Methods

Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images.

Results

There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8–98.6) and 96.8% (95% CI, 89.1–99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1–98.8), and the negative predictive value was 95.3% (95% CI, 87.3–98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs.

Conclusions

When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.
SARS-COV-2 Infection in Children in Emergency Departments in Spain
Authors: Hernández-Bou Susanna , Rivas-García Arístides , Lera Esther , Valle-T-Figueras José María , Bonvehí Aida , Gomez Borja ,   on behalf of the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies (SEUP)
Published: January 2023

Objectives

The first cases of infection by SARS-CoV-2 in the Spanish pediatric population were reported on early March 2020. Although most were mild or asymptomatic, new forms of clinical presentation and severity were reported with the evolution of the pandemic. We aimed to describe demographics, clinical features, and management of children with COVID-19 treated in Spanish emergency departments (EDs).

Methods

A multicenter registry including 15 pediatric EDs was carried out. Patients younger than 18 years with confirmed acute SARS-CoV2 infection diagnosed between March and August 2020 were included.

Results

Three hundred ninety-five patients were analyzed (median age, 4.3 years). Fifty-five (13.9%) had comorbidities, and 141 (35.7%) a household contact with confirmed COVID-19. The most reported symptoms were fever (85.2%) and cough (41.7%). Fifty (12.5%) were asymptomatic. Seventeen (4.9%) were not well-appearing at presentation. Children underwent a blood test in 26.7% and a chest X-ray in 21.4%; findings were often unremarkable. Symptomatic treatment was prescribed to 80%; 6 (1.7%) received antiviral treatment. Seventy-one (20.6%) were hospitalized, and 3 (0.9%) were admitted to the intensive care unit; no patient died. The main clinical diagnoses were fever without a source (38%) and upper respiratory tract infection (32.2%); 4 (1.1%) presented a multisystem inflammatory syndrome.

Conclusions

Most pediatric COVID-19 cases in EDs during the first months of the pandemic were healthy, well-appearing children, presenting with fever +/− respiratory symptoms. In a significant number of cases, there was household transmission. Most children were managed as outpatients with symptomatic treatment, being exceptional the evolution to a serious illness.
Poor HIV-Related Outcomes in Older Adults Newly Diagnosed With HIV: A 4-Year Retrospective Analysis From a Single Site in Asia
Authors: Wong Hoi Yee , Wong Pui Li , Bador Maria Kahar , Chong Meng Li , Shenoi Sheela , Rozanova Julia , Syed Omar Sharifah Faridah , Neelamegam Malinee , Lee Yew Kong , Rajasuriar Reena
Published: January 2023

Background:

In resource-limited settings, HIV-related services are often targeted to younger key populations, although increasing reports have found that adults ≥50 years now account for among the highest increase in new HIV diagnosis. We assessed the proportion of new HIV infections among older adults (≥50 years) and compared their sociodemographics, risk behaviors, and HIV-related outcomes to newly diagnosed younger adults (<50 years).

Methods:

This retrospective analysis included all new HIV diagnosis from 2016 to 2019 at the University of Malaya Medical Centre, Malaysia. Trends of HIV diagnosis was assessed using join point regression analysis, and characteristics between the older and younger adults were compared using χ2test or Mann–WhitneyUtest. Kaplan–Meier analysis and log-rank test were used to compare the survival probability in both age groups.

Results:

From a total of 594 new HIV diagnosis between 2016 and 2019, 11.5% (N = 68) were among older adults with an annual percent increase of 5.50%. Older adults were more likely ethnic Indians (P< 0.001), acquired HIV through heterosexual contact (P= 0.001), had late presentation to care (P= 0.003), and multimorbidity (P< 0.001). Immunological responses after 12 months on antiretroviral therapy were comparable in both the groups. Older adults had a higher probability of death compared with younger adults (adjusted hazard ratio 1.81, 95% confidence interval: 1.02 to 3.23,P= 0.043) after adjusting for sex, mode of HIV transmission, late presentation to care, antiretroviral therapy initiation, and multimorbidity.

Conclusion:

Older adults diagnosed with HIV were associated with late care presentation and increased mortality. There is an urgent need to enhance uptake of HIV testing and linkage to care among older individuals in our setting.
Skin and soft tissue infections due to rapidly growing mycobacteria
Authors: Sepulcri Chiara , Vena Antonio , Bassetti Matteo
Published: January 2023

Purpose of review

The aim of this article is to review skin and soft tissue infections due to rapidly growing mycobacteria (RGM), with a particular focus on recently published literature (2021–2022).

Recent findings

RGM are increasingly reported as a cause of skin and soft tissue infections, both in the community setting and as a cause of nosocomial outbreaks. Recent advances in molecular methods have expanded the number of species of RGM and resulted in increased diagnosis. New treatment options are under evaluation particularly for Mycobacterium abscessus, the most difficult-to-treat among RGM.

RGM are an uncommon cause of skin and soft tissue infections and a high clinical suspicion together with advanced laboratory facilities are required for diagnosis. Species identification and antimicrobial susceptibility testing are essential to drive appropriate treatment, which combines surgical debridement with prolonged antimycobacterial combination therapy.
Skeletal “Superscan” With 11C-Methionine PET/CT in Polycythemia Vera
Authors: Jochumsen Mads Ryø , Madsen Michael Alle , Arveschoug Anne Kirstine
Published: January 2023

11C-methionine PET/CT for parathyroid adenoma localization on a 60-year-old woman known with polycythemia vera revealed highly methionine-avid red bone marrow, an uptake pattern that has previously been described in hematological disease such as multiple myeloma. An equivalent skeletal “superscan” pattern in polycythemia vera has been described with other PET tracers, but this case illustrates that this pattern can be seen with 11C-methionine PET/CT as well and can be added to the list of potential pitfalls.
Microscopic observation of morphological changes in cerebral arteries and veins in hyperacute phase after experimental subarachnoid hemorrhage: an in-vivo analysis
Authors: Fujimori Kana , Kajiwara Sosho , Hasegawa Yu , Uchikawa Hiroki , Morioka Motohiro
Published: January 2023

This observational study examined morphological changes in superficial cerebral arteries and veins, which were correlated with increased intracranial pressure (ICP)-dependent and -independent hypoperfusion in hyperacute phase after subarachnoid hemorrhage (SAH). The prechiasmatic injection model was used, and 32 male Sprague–Dawley rats were divided into the sham-operated, saline-injected (V group, ICP increase), and arterial blood-injected (SAH group, subarachnoid blood and plus increase) groups. Morphological changes in cortical arteries and veins were observed through the cranial window with a microscope before and up to 10 min after the injection. At 24 h, the stenotic and obstructive cortical arteries and veins were counted. After 6 min, 60% of rats in the V group showed vasodilatation, whereas all rats in the SAH group demonstrated vasodilation and vasoconstriction (arterial instability) within 10 min. Similar acute venous congestive changes were observed within 10 min in the V and SAH groups. At 24 h, stenotic and obstructive arteries and veins were observed in the SAH group. Neurological deteriorations were observed at 1 h in the V and SAH groups, and at 23 h in the SAH group. The sham-operated group showed no evident vascular changes and neurological deterioration. The same phenomena, including arterial changes after 6 min and immediate venous changes in the V and SAH groups, may have resulted from ICP increase, whereas subarachnoid blood-related factors produced arterial instability within 5 min after blood injection. Subarachnoid blood plays a significant role in hyperacute SAH pathophysiology in addition to ICP increase.
Restoration of aquaporin-4 polarization in the spinal glymphatic system by metformin in rats with painful diabetic neuropathy
Authors: Xu Chiliang , Wang Feixiang , Su Can , Guo Xiao , Li Jiang , Lin Jingyan
Published: January 2023

Painful diabetic neuropathy (PDN) is a common complication in patients with diabetes, and its underlying mechanism remains unclear. Aquaporin-4 (AQP4) plays a crucial role in removing metabolic waste in the glymphatic system. In this study, we aimed to explore the relationship between the spinal glymphatic system and the effect of metformin on PDN. Male Sprague–Dawley rats were randomly allocated into the control group (n = 10), the PDN group (n = 10), and the metformin group (n = 10). A high-fat and high-glucose diet combined with low-dose streptozotocin was used to induce PDN rats. We detected the clearance rate of the contrast agent in the spinal cord of each rat by MRI to reflect the function of the glymphatic system. Immunofluorescence was used to detect the localization of perivascular AQP4 in astrocyte endfeet. Furthermore, we measured the expression of AQP4 in the spinal cord by Western blot. Compared with the rats in the control group, PDN rats exhibited enhanced mechanical allodynia, decreased clearance rate of the contrast agent in the spinal glymphatic system, reversed AQP4 polarization, and increased expression of AQP4. After being treated with metformin, the rats showed opposite changes in the above characteristics. The analgesic effect of metformin on PDN may be related to its ability to restore spinal AQP4 polarization, thus promoting the function of the spinal glymphatic system.