bluuebunny/crossref_metadata_2025 huggingface dataset:
Cholelithiasis, cholecystitis, cholecystectomy and the associated risk of colorectal cancer
Authors: Tsai Po-Li , Lin Yu-Wen , Chen Jian-Syun , Wu Shu-I , Chiang Mei-Feng , Chen Ming-Jen
Published: March 2023

Background

Many studies have suggested that cholelithiasis or cholecystectomy may be associated with risk of colorectal cancer [CRC]. This study aimed to verify CRC risk among cholelithiasis patients who experienced cholecystitis or cholecystectomy or both.

Methods

Data of a cholelithiasis cohort (n = 28,267) and a noncholelithiasis cohort (n = 112,948) were retrieved (1:4 ratio) from the Longitudinal Health Insurance Database for comparison of CRC risk. Confounding factors were adjusted in multivariate analysis. A hospital-based cancer registry containing 8156 CRC patients was also examined. Data were statistically analyzed using χ2 test, t test, and Cox proportional-hazards model.

Results

Univariate and multivariate analysis showed that having cholelithiasis was associated with increased risk of CRC (crude hazard ratio: 1.533 [95% confidence interval {CI}: 1.423–1.652); adjusted HR: 1.481 [95% CI: 1.375–1.597], respectively, p < 0.001) relative to not having cholelithiasis. Increased CRC incidence among patients with cholelithiasis was higher in the right-sided colon (adjusted HR: 1.452 [95% CI: 1.234–1.709], p < 0.001), and higher in female patients. The trend of higher incidence of right-sided colon cancer was also seen in the hospital-based cancer registry. Of note, cholecystitis or cholecystectomy was associated with mildly increased CRC risk among cholelithiasis patients. Cholecystitis was associated with increased risk of left-sided CRC. Cholecystitis plus cholecystectomy was associated with increased risk of rectal cancer.

Conclusions

These results support that cholelithiasis is associated with increased risk of CRC especially in the right-sided colon and among female patients. Cholecystitis and cholecystectomy may shift cancer to the distal part of the large bowel.
OUTCOMES OF SWITCHING FROM PROACTIVE TO REACTIVE TREATMENT AFTER DEVELOPING ADVANCED CENTRAL NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Cornish Elisa E. , Nguyen Vuong , Puzo Martin , O'Toole Louise , Gemmy Cheung Chui M. , Vincent Andrea , Guillaumie Tremeur , Oei Sioe Lan , Morros Helena Brosa , Barthelmes Daniel , Gillies Mark C.
Published: March 2023

Purpose:

We assessed outcomes of eyes with neovascular age-related macular degeneration (nAMD) that switched from proactive (treat-and-extend) to reactive (pro re nata) treatment regimen after developing macular atrophy (MA) or submacular fibrosis (SMFi).

Methods:

Data were collected from a retrospective analysis of a prospectively designed, multinational registry of “real-world” nAMD treatment outcomes. Eyes without MA or SMFi when starting treatment with a vascular endothelial growth factor inhibitor regimen that subsequently developed MA or SMFi were included.

Results:

Macular atrophy developed in 821 eyes and SMFi in 1,166 eyes. Seven percent of eyes that developed MA and 9% of those that developed SMFi were switched to reactive treatment. Vision was stable at 12 months for all eyes with MA and inactive SMFi. Active SMFi eyes that switched to reactive treatment had significant vision loss. No eyes that continued proactive treatment developed ≥15 letter loss, but 8% of all eyes that switched to a reactive regimen and 15% of active SMFi eyes did.

Conclusion:

Eyes that switch from proactive to reactive treatment after developing MA and inactive SMFi can have stable visual outcomes. Physicians should be aware of the risk of a significant loss of vision in eyes with active SMFi that switch to reactive treatment.
RHOMBUS DEFORMATION OF RETINAL LATERAL DISPLACEMENT AFTER EPIRETINAL MEMBRANE REMOVAL REVEALED BY DIFFEOMORPHIC IMAGE REGISTRATION
Authors: Honzawa Koki , Horiguchi Hiroshi , Terauchi Ryo , Iida Yuka , Katagiri Satoshi , Gunji Hisato , Nakano Tadashi
Published: March 2023

Purpose:

To establish an analysis method using diffeomorphic image registration and evaluate microvascular displacement through epiretinal membrane (ERM) removal.

Methods:

Medical records of eyes that underwent vitreous surgery for ERM were reviewed. Postoperative optical coherence tomography angiography (OCTA) images were converted to the corresponding preoperative images according to a configured algorithm using diffeomorphism.

Results:

Thirty-seven eyes with ERM were examined. Measured changes in the foveal avascular zone (FAZ) area showed a significant negative correlation with central foveal thickness (CFT). The average amplitude of microvascular displacement calculated for each pixel was 69 ± 27 µm in the nasal area, which was relatively smaller than that in other areas. The vector map, which included both the amplitude and the vector of microvasculature displacement, showed a unique vector flow pattern called the rhombus deformation sign in 17 eyes. Eyes with this deformation sign showed less surgery-induced changes in the FAZ area and CFT and a milder ERM stage than those without this sign.

Conclusion:

The authors calculated and visualized microvascular displacement using diffeomorphism. The authors found a unique pattern (rhombus deformation) of retinal lateral displacement through ERM removal, which was significantly associated with the severity of ERM.
PRIMARY MULTIPLE EVANESCENT WHITE DOT SYNDROME AND MULTIPLE EVANESCENT WHITE DOT SYNDROME SECONDARY TO MULTIFOCAL CHOROIDITIS/PUNCTATE INNER CHOROIDOPATHY
Authors: Meng Yang , Zhang Qi , Li Lu , Yi Zuohuizi , Xu Yishuang , Su Yu , Liang Congbi , Xiao Di , Zhang Lu , Chen Changzheng
Published: March 2023

Purpose:

To present and compare the clinical features and multimodal imaging (MMI) findings of the primary form of multiple evanescent white dot syndrome (MEWDS) and MEWDS secondary to multifocal choroiditis/punctate inner choroidopathy (MFC/PIC).

Methods:

A prospective case series. Thirty eyes of 30 MEWDS patients were included and divided into the primary MEWDS group and MEWDS secondary to MFC/PIC group. Demographic, epidemiologic, and clinical characteristics and MEWDS-related MMI findings of the two groups were compared.

Results:

Seventeen eyes from 17 patients with primary MEWDS and 13 eyes from 13 patients with MEWDS secondary to MFC/PIC were evaluated. Patients with MEWDS secondary to MFC/PIC tended to have a higher degree of myopia than those with primary MEWDS. No other significant differences in demographic, epidemiologic, and clinical characteristics and MMI findings were found between the two groups.

Conclusion:

“MEWDS-like reaction” hypothesis seems to be correct for MEWDS secondary to MFC/PIC, and the authors highlight the importance of MMI examinations in MEWDS. Further research is needed to confirm whether the hypothesis is applicable to other forms of secondary MEWDS.
Achieving Mild Therapeutic Hypothermia in the Human Cochlea
Authors: Arteaga Alberto A. , Beatrous Britton , Eby Thomas L. , Smith Jeremy , Yoder Marcus , Meritt Ryan , Molinaro Nicholas , Spankovich Christopher
Published: March 2023

Objective

To determine temperature and duration of cooling necessary for achieving cochlear mild therapeutic hypothermia (MTH) via ear canal cooling using cool water and earmold attached to a Peltier device.

Study Design and Setting

Human temporal bone lab study performed at the University of Mississippi Medical Center.

Interventions

Cochlear cooling via the ear canal using water irrigation and an earmold attached to a Peltier device. Temperature analysis through implanted thermal probes within the cochlea.

Main Outcome Measures

Temperature changes in the cochlea.

Results

Irrigation of the ear canal with water resulted in achieving MTH in approximately 4 minutes using cool water (30°C) and in approximately 2 minutes using ice-chilled water. After 20 minutes, irrigation of the ear canal using cool water plateaued at a ∆2°C while cooling with ice-chilled water results in an average ∆4.5°C. We observed MTH using a medium-length earmold attached to a Peltier device after approximately 22 minutes of cooling and achieved a maximal average ∆ of 2.3°C after 60 minutes of cooling. Finally, we observed that a longer earmold (C2L) with greater proximity to the eardrum resulted in more efficient intracochlear temperature change, achieving MTH in approximately 16 minutes.

Conclusions

MTH of the cochlea can be achieved with water-based ear canal irrigation and via a Peltier device connected to an aluminum earmold.
Cochlear Implant Adult Speech Perception Outcomes: Seniors Have Similar Good Outcomes
Authors: Birman Catherine S. , Hassarati Rachelle T.
Published: March 2023

Objective

The primary aim was to analyze the speech perception outcomes of patients with cochlear implants 65 years and older, compared with those younger than 65 years. The secondary aim was to analyze if preoperative hearing levels, severe compared with profound, had an effect on speech perception outcomes in senior citizens.

Study Design

Retrospective case review of 785 patients, between 2009 and 2016.

Setting

A large cochlear implant program.

Patients

Cochlear implant adult recipients younger than 65 years and 65 years and older at the time of surgery.

Intervention(s)

Therapeutic—cochlear implant.

Main Outcome Measure(s)

Speech perception outcomes, using City University of New York (CUNY) sentences and Consonant-Nucleus-Consonant (CNC) words. Outcomes were measured preoperatively and postoperatively at 3, 6and 12 months for cohorts younger than 65 years and 65 years and older.

Results

Adult recipients younger than 65 years compared with those 65 years and older had comparable outcomes for CUNY sentence scores outcomes (p = 0.11) and CNC word scores (p = 0.69). The preoperative four-frequency average severe hearing loss (HL) cohort was significantly better compared with the profound HL cohort, for both the CUNY sentence scores (p < 0.001) and CNC word scores (p < 0.0001). The four-frequency average severe HL cohort had better outcomes irrespective of age.

Conclusions

Senior citizens have similarly good speech perception outcomes as adults younger than 65 years. Those with preoperative severe HL have better outcomes than profound loss. These finds are reassuring and can be used when counseling older cochlear implant candidates.
Morphometric Analysis and Linear Measurements of the Scala Tympani and Implications in Cochlear Implant Electrodes
Authors: Fujiwara Rance J.T. , Ishiyama Gail , Lopez Ivan A. , Ishiyama Akira
Published: March 2023

Hypothesis

The objective of this study was to perform detailed height and cross-sectional area measurements of the scala tympani in histologic sections of nondiseased human temporal bones and correlate them with cochlear implant electrode dimensions.

Background

Previous investigations in scala tympani dimensions have used microcomputed tomography or casting modalities, which cannot be correlated directly with microanatomy visible on histologic specimens.

Methods

Three-dimensional reconstructions of 10 archival human temporal bone specimens with no history of middle or inner ear disease were generated using hematoxylin and eosin histopathologic slides. At 90-degree intervals, the heights of the scala tympani at lateral wall, midscala, and perimodiolar locations were measured, along with cross-sectional area.

Results

The vertical height of the scala tympani at its lateral wall significantly decreased from 1.28 to 0.88 mm from 0 to 180 degrees, and the perimodiolar height decreased from 1.20 to 0.85 mm. The cross-sectional area decreased from 2.29 (standard deviation, 0.60) mm2 to 1.38 (standard deviation, 0.13) mm2 from 0 to 180 degrees (p = 0.001). After 360 degrees, the scala tympani shape transitioned from an ovoid to triangular shape, corresponding with a significantly decreased lateral height relative to perimodiolar height. Wide variability was observed among the cochlear implant electrode sizes relative to scala tympani measurements.

Conclusion

The present study is the first to conduct detailed measurements of heights and cross-sectional area of the scala tympani and the first to statistically characterize the change in its shape after the basal turn. These measurements have important implications in understanding locations of intracochlear trauma during insertion and electrode design.
Ammonia and nutritional therapy in the critically ill: when to worry, when to test and how to treat?
Authors: Redant Sebastien , Warrillow Stephen , Honoré Patrick M.
Published: March 2023

Purpose of review

Hyperammonaemia is almost always develops in patients with severe liver failure and this remains the commonest cause of elevated ammonia concentrations in the ICU. Nonhepatic hyperammonaemia in ICU presents diagnostic and management challenges for treating clinicians. Nutritional and metabolic factors play an important role in the cause and management of these complex disorders.

Recent findings

Nonhepatic hyperammonaemia causes such as drugs, infection and inborn errors of metabolism may be unfamiliar to clinicians and risk being overlooked. Although cirrhotic patients may tolerate marked elevations in ammonia, other causes of acute severe hyperammonaemia may result in fatal cerebral oedema. Any coma of unclear cause should prompt urgent measurement of ammonia and severe elevations warrant immediate protective measures as well as treatments such as renal replacement therapy to avoid life-threatening neurological injury.

The current review explores important clinical considerations, the approach to testing and key treatment principles that may prevent progressive neurological damage and improve outcomes for patients with hyperammonaemia, especially from nonhepatic causes.
Patient Factors Associated With Use of Adult Primary Care and Virtual Visits During the COVID-19 Pandemic
Authors: Ritzwoller Debra P. , Goodrich Glenn W. , Tavel Heather M. , Odelberg Michelle R. , Davis Teaniese L. , Gander Jennifer C. , McCracken Courtney E. , Weinfield Nancy S. , Roblin Douglas W.
Published: March 2023

Background:

The delivery of adult primary care (APC) shifted from predominately in-person to modes of virtual care during the COVID-19 pandemic. It is unclear how these shifts impacted the likelihood of APC use during the pandemic, or how patient characteristics may be associated with the use of virtual care.

Methods:

A retrospective cohort study using person-month level datasets from 3 geographically disparate integrated health care systems was conducted for the observation period of January 1, 2020, through June 30, 2021. We estimated a 2-stage model, first adjusting for patient-level sociodemographic, clinical, and cost-sharing factors, using generalized estimating equations with a logit distribution, along with a second-stage multinomial generalized estimating equations model that included an inverse propensity score treatment weight to adjust for the likelihood of APC use. Factors associated with APC use and virtual care use were separately assessed for the 3 sites.

Results:

Included in the first-stage models were datasets with total person-months of 7,055,549, 11,014,430, and 4,176,934, respectively. Older age, female sex, greater comorbidity, and Black race and Hispanic ethnicity were associated with higher likelihood of any APC use in any month; measures of greater patient cost-sharing were associated with a lower likelihood. Conditional on APC use, older age, and adults identifying as Black, Asian, or Hispanic were less likely to use virtual care.

Conclusions:

As the transition in health care continues to evolve, our findings suggest that to ensure vulnerable patient groups receive high quality health care, outreach interventions to reduce barriers to virtual care use may be warranted.
Impact of COVID-19 on Trends in Outpatient Clinic Utilization
Authors: McCracken Courtney E. , Gander Jennifer C. , McDonald Bennett , Goodrich Glenn K. , Tavel Heather M. , Basra Sundeep , Weinfield Nancy S. , Ritzwoller Debra P. , Roblin Douglas W. , Davis Teaniese L.
Published: March 2023

Background:

The COVID-19 pandemic forced many US health care organizations to shift from mostly in-person care to a hybrid of virtual visits (VV) and in-person visits (IPV). While there was an expected and immediate shift to virtual care (VC) early in the pandemic, little is known about trends in VC use after restrictions eased.

Methods:

This is a retrospective study using data from 3 health care systems. All completed visits from adult primary care (APC) and behavioral health (BH) were extracted from the electronic health record of adults aged 19 years and older from January 1, 2019 to June 30, 2021. Standardized weekly visit rates were calculated by department and site and analyzed using time series analysis.

Results:

There was an immediate decrease in APC visits following the onset of the pandemic. IPV were quickly replaced by VV such that VV accounted for most APC visits early in the pandemic. By 2021, VV rates declined, and VC visits accounted for <50% of all APC visits. By Spring 2021, all 3 health care systems saw a resumption of APC visits as rates neared or returned to prepandemic levels. In contrast, BH visit rates remained constant or slightly increased. By April 2020, almost all BH visits were being delivered virtually at each of the 3 sites and continue to do so without changes to utilization.

Conclusions:

VC use peaked during the early pandemic period. While rates of VC are higher than prepandemic levels, IPV are the predominant visit type in APC. In contrast, VC use has sustained in BH, even after restrictions eased.
Gaps and Disparities in Chronic Hepatitis B Monitoring and Treatment in the United States, 2016-2019
Authors: Pham Thi T. Hang , Toy Mehlika , Hutton David , Thompson William , Conners Erin E. , Nelson Noele P. , Salomon Joshua A. , So Samuel
Published: March 2023

Background:

Chronic hepatitis B (CHB) carries an increased risk of death from cirrhosis and hepatocellular carcinoma (HCC). The American Association for the Study of Liver Diseases recommends patients with CHB receive monitoring of disease activity, including ALT, hepatitis B virus (HBV) DNA, hepatitis B e-antigen (HBeAg), and liver imaging for patients who experience an increased risk for HCC. HBV antiviral therapy is recommended for patients with active hepatitis and cirrhosis.

Methods:

Monitoring and treatment of adults with new CHB diagnoses were analyzed using Optum Clinformatics Data Mart Database claims data from January 1, 2016, to December 31, 2019.

Results:

Among 5978 patients with new CHB diagnosis, only 56% with cirrhosis and 50% without cirrhosis had claims for≥1 ALT and either HBV DNA or HBeAg test, and among patients recommended for HCC surveillance, 82% with cirrhosis and 57% without cirrhosis had claims for≥1 liver imaging within 12 months of diagnosis. Although antiviral treatment is recommended for patients with cirrhosis, only 29% of patients with cirrhosis had≥1 claim for HBV antiviral therapy within 12 months of CHB diagnosis. Multivariable analysis showed patients who were male, Asian, privately insured, or had cirrhosis were more likely (P<0.05) to receive ALT and either HBV DNA or HBeAg tests and HBV antiviral therapy within 12 months of diagnosis.

Conclusion:

Many patients diagnosed with CHB are not receiving the clinical assessment and treatment recommended. A comprehensive initiative is needed to address the patient, provider, and system-related barriers to improve the clinical management of CHB.
Risk Factors for Return to the Emergency Department and Readmission in Patients With Hospital-Diagnosed Advanced Lung Cancer
Authors: Ray Emily M. , Hinton Sharon P. , Reeder-Hayes Katherine E.
Published: March 2023

Background:

Advanced lung cancer (ALC) is a symptomatic disease often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve care delivery.

Objectives:

We examined the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed ALC.

Research Design, Subjects, and Measures:

In Surveillance, Epidemiology, and End Results-Medicare, we identified patients with incident ALC (stage IIIB–IV small cell or non–small cell) from 2007 to 2013 and an index hospitalization within 7 days of diagnosis. We used a time-to-event model with multivariable regression to identify risk factors for 30-day acute care utilization (emergency department use or readmission).

Results:

More than half of incident ALC patients were hospitalized around the time of diagnosis. Among 25,627 patients with hospital-diagnosed ALC who survived to discharge, only 37% ever received systemic cancer treatment. Within 6 months, 53% had been readmitted, 50% had enrolled in hospice, and 70% had died. The 30-day acute care utilization was 38%.

Small cell histology, greater comorbidity, precancer acute care use, length of index stay >8 days, and prescription of a wheelchair were associated with higher risk of 30-day acute care utilization. Age >85 years, female sex, residence in South or West regions, palliative care consultation, and discharge to hospice or a facility were associated with lower risk.

Conclusions:

Many patients with hospital-diagnosed ALC experience an early return to the hospital and most die within 6 months. These patients may benefit from increased access to palliative and other supportive care during index hospitalization to prevent subsequent health care utilization.
MRI Screening in Vestibular Schwannoma: A Deep Learning-based Analysis of Clinical and Audiometric Data
Authors: Kortebein Sarah , Gu Shoujun , Dai Kathy , Zhao Elizabeth , Riska Kristal , Kaylie David , Hoa Michael
Published: March 2023

Objective:

To find a more objective method of assessing which patients should be screened for a vestibular schwannoma (VS) with magnetic resonance imaging (MRI) using a deep-learning algorithm to assess clinical and audiometric data.

Materials and Methods:

Clinical and audiometric data were collected for 592 patients who received an audiogram between January 2015 and 2020 at Duke University Health Center with and without VS confirmed by MRI. These data were analyzed using a deep learning-based analysis to determine if the need for MRI screening could be assessed more objectively with adequate sensitivity and specificity.

Results:

Patients with VS showed slightly elevated, but not statistically significant, mean thresholds compared to those without. Tinnitus, gradual hearing loss, and aural fullness were more common in patients with VS. Of these, only the presence of tinnitus was statistically significant. Several machine learning algorithms were used to incorporate and model the collected clinical and audiometric data, but none were able to distinguish ears with and without confirmed VS. When tumor size was taken into account the analysis was still unable to distinguish a difference.

Conclusions:

Using audiometric and clinical data, deep learning-based analyses failed to produce an adequately sensitive and specific model for the detection of patients with VS. This suggests that a specific pattern of audiometric asymmetry and clinical symptoms may not necessarily be predictive of the presence/absence of VS to a level that clinicians would be comfortable forgoing an MRI.
Mechanism of Injury and Age Predict Operative Intervention in Pediatric Perineal Injury
Authors: McLaughlin Christopher J. , Martin Kathryn L.
Published: March 2023

Objectives

Literature characterizing pediatric perineal trauma is sparse and generally limited to females. The purpose of this study was to characterize pediatric perineal injuries with specific focus on patient demographics, mechanisms of injury, and care patterns at a regional level 1 pediatric trauma center.

Methods

Retrospective review of children aged younger than 18 years evaluated at a level 1 pediatric trauma center from 2006 to 2017. Patients were identified by International Classification of Diseases-9 and 10 codes. Extracted data included demographics, injury mechanism, diagnostic studies, hospital course, and structures injured. The χ2 and t tests were used to examine differences between subgroups. Machine learning was used to predict variable importance in determining the need for operative interventions.

Results

One hundred ninety-seven patients met inclusion criteria. Mean age was 8.5 years. A total of 50.8% were girls. Blunt trauma accounted for 83.8% of injuries. Motor vehicle collisions and foreign bodies were more common in patients aged 12 years and older, whereas falls and bicycle-related injuries were more common in those younger than 12 years (P < 0.01). Patients younger than 12 years were more likely to sustain blunt trauma with isolated external genital injuries (P < 0.01). Patients aged 12 and older had a higher incidence of pelvic fractures, bladder/urethral injuries, and colorectal injuries, suggesting more severe injury patterns (P < 0.01). Half of patients required operative intervention. Children aged 3 years or younger and older than 12 years had longer mean hospital stays compared with children aged 4 to 11 years (P < 0.01). Mechanism of injury and age constituted more than 75% of the variable importance in predicting operative intervention.

Conclusions

Perineal trauma in children varies by age, sex, and mechanism. Blunt mechanisms are the most common, with patients frequently requiring surgical intervention. Mechanism of injury and age may be important in deciding which patients will require operative intervention. This study describes injury patterns in pediatric perineal trauma that can be used to guide future practice and inform injury prevention efforts.
Feeding Problems in Young Children: A Cross-Sectional Study in Sweden
Authors: Lamm Kajsa , Landgren Kajsa , Vilhjálmsson Runar , Kristensson Hallström Inger
Published: March 2023

Objectives:

To describe the prevalence of feeding problems (FPs) in children aged 10, 18, and 36 months who visited Swedish Child Health Services.

Methods:

Parents of children attending regular 10-, 18-, and 36-month visits at the child health care centers (CHCCs) in Sweden answered a questionnaire including a Swedish version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) as well as demographic questions. CHCCs were stratified according to a sociodemographic index.

Results:

Parents of 238 girls (115) and boys (123) completed the questionnaire. Using international thresholds for FP detection, 8.4% of the children had a total frequency score (TFS) indicating FP. Based on the total problem score (TPS), the result was 9.3%. The mean score for all children was 62.7 for TFS (median 60; range 41–100), and 2.2 for TPS (median 0; range 0–22). Children aged 36 months had a significantly higher average TPS score than younger children, but TFS scores did not differ by age. There were no significant difference in gender, parents’ education, or sociodemographic index.

Conclusion:

Prevalence numbers found in this study are similar to those found in studies with BPFAS in other countries. Children 36 months of age had a significantly higher prevalence of FP than children aged 10 and 18 months. Young children with FP should be referred to health care specializing in FP and PFD. Creating awareness of FP and PFD in primary care facilities and child health services may facilitate early detection and intervention for children with FP.
Segmental Arterial Mediolysis Presenting as a Pancreatic Mass in a Pediatric Patient: A Case Report
Authors: Bhesania Natalie , Patil Deepa T. , McCleary Brendan , Selvakumar Praveen Kumar Conjeevaram , Radhakrishnan Kadakkal
Published: March 2023

We describe a case of segmental arterial mediolysis (SAM) in a 2-year-old male who presented with symptoms of acute pancreatitis. SAM is a vascular entity of unknown etiology that involves medium-sized arteries in which the integrity of the vessel wall is compromised, resulting in increased susceptibility to ischemia, hemorrhage, and dissection. The clinical presentation is variable and can range from abdominal pain to more ominous findings of abdominal hemorrhage or organ infarction. This entity should be considered in the correct clinical setting and after other vasculopathies have been excluded. We aim to bring awareness to pediatric providers given this is a rare entity with variable presentation, which could be potentially life threatening.
Construction and Evaluation of a Realistic Low-Cost Model for Training in Chest-Tube Insertion
Authors: López-Baamonde Manuel , Perdomo Juan Manuel , Ibáñez Cristina , Angelès-Fité Gerard , Magaldi Marta , Panzeri Miriam Fiore , Bergé Raquel , Gómez-López Lidia , Guirao Montes Ángela , Gomar-Sancho Carmen ,   on behalf of SIMCLÍNIC-ANESTHESIOLOGY
Published: March 2023

Introduction

Emergency thoracostomy is applied in life-threatening situations. Simulation plays a pivotal role in training in invasive techniques used mainly in stressful situations. Currently available commercial simulation models for thoracostomy have various drawbacks.

Methods

We designed a thoracostomy phantom from discarded hospital materials and pigskin with underlying flesh. The phantom can be used alone for developing technical skills or mounted on an actor in simulation scenarios. Medical students, intensive care unit (ICU) and emergency department teams, and thoracostomy experts evaluated its technical fidelity and usefulness for achieving learning objectives in workshops.

Results

The materials used to construct the phantom cost €47. A total of 12 experts in chest-tube placement and 73 workshop participants (12 ICU physicians and nurses, 20 emergency physicians and nurses, and 41 fourth-year medical students) evaluated the model. All groups rated the model's usefulness and the sensation of perforating the pleura highly. Experts rated the air release after pleura perforation lower than other groups. Lung reexpansion was the lowest rated item in all groups. Ratings of the appearance and feel of the model correlated strongly among all groups and experts. The ICU professionals rated the resistance encountered in introducing the chest drain lower than the other groups.

Conclusions

This low-cost, reusable, transportable, and highly realistic model is an attractive alternative to commercial models for training in chest-tube insertion skills.
Outpatient EEG in Routine Clinical Care of Patients With Stroke-Related Acute Symptomatic Seizure Concerns
Authors: Chandan Pradeep , Byrnes Marie E. , Newey Christopher , Hantus Stephen , Punia Vineet
Published: March 2023

Purpose:

Acute symptomatic seizures (ASyS) after stroke contribute the highest risk to poststroke epilepsy (PSE) development. We investigated the use of outpatient EEG (oEEG) among stroke patients with ASyS concerns.

Methods:

Adults with acute stroke, ASyS concerns (underwent cEEG), and outpatient clinical follow-up were included (study population). Patients with oEEG (oEEG cohort) were analyzed for electrographic findings. Univariable and multivariable analyses helped identify predictors of oEEG use in routine clinical care.

Results:

Among 507 patients, 83 (16.4%) underwent oEEG. The independent predictors of oEEG utilization included age (OR = 1.03 [1.01 to 1.05, P = 0.01]), electrographic ASyS on cEEG (OR 3.9 [1.77 to 8.9], P < 0.001), ASMs at discharge (OR 3.6 [1.9 to 6.6], P < 0.001), PSE development (OR 6.6 [3.5 to 12.6], P < 0.001), and follow-up duration (OR = 1.01 [1.002 to 1.02], P = 0.016). Almost 40% of oEEG cohort developed PSE, but only 12% had epileptiform abnormalities. Close to a quarter (23%) of oEEGs were within normal limits.

Conclusions:

One in six patients with ASyS concern after stroke undergoes oEEG. Electrographic ASyS, PSE development, and ASM at discharge are primary drivers of oEEG use. While PSE drives oEEG use, we need systematic, prospective investigation of outpatient EEG's role as prognostic tool for PSE development.
Assessment of the Performance of Expired and Unexpired BinaxNOW COVID Rapid Antigen Test Kits Using Positive and Negative Controls
Authors: Vaeth Mary Jane E. , Mitchell Asia , Sun Kristie , Foyez Maisha , Byrd Lourdes , Elhabashy Maryam , Cheema Minahil , Gupta Ishaan , Purekal Sophia , Locke Charles , Kantsiper Melinda , Siddiqui Zishan
Published: March 2023

Rapid antigen tests are widely used to diagnose infection with SARS-CoV-2, and millions of kits have been distributed for free by government agencies. However, unused and expired kits beyond their final expiration dates remain prevalent in people’s homes. This study aimed to determine the accuracy of expired BinaxNOW COVID rapid antigen test kits. 100 expired and 100 unexpired test kits were checked for sensitivity and specificity using positive and negative controls, respectively. The results showed that there was no change in the sensitivity and specificity of BinaxNOW COVID rapid antigen test kits four months beyond the manufacturer-extended expiration date when using manufacturer-provided positive controls. The findings provide confidence in the accuracy of expired test kits, which could potentially reduce waste and strengthen supply chain resilience for pandemic preparedness. Further research utilizing actual human specimens can help determine the true accuracy of expired rapid antigen test kits in clinical use.
Multiomics machine learning identifies inflammation molecular pathways in prodromal Alzheimer’s Disease
Authors: Gómez-Pascual Alicia , Naccache Talel , Xu Jin , Hooshmand Kourosh , Wretlind Asger , Gabrielli Martina , Lombardo Marta Tiffany , Shi Liu , Buckley Noel J. , Tijms Betty M. , Vos Stephanie J. B. , ten Kate Mara , Engelborghs Sebastiaan , Sleegers Kristel , Frisoni Giovanni B. , Wallin Anders , Lleó Alberto , Popp Julius , Martinez-Lage Pablo , Streffer Johannes , Barkhof Frederik , Zetterberg Henrik , Visser Pieter Jelle , Lovestone Simon , Bertram Lars , Nevado-Holgado Alejo J. , Gualerzi Alice , Picciolini Silvia , Proitsi Petroula , Verderio Claudia , Botía Juan A. , Legido-Quigley Cristina
Published: March 2023

Mild Cognitive Impairment (MCI) is a phase that can precede Alzheimer’s Disease (AD). To better understand the molecular mechanisms underlying conversion from MCI to AD, we applied a battery of machine learning algorithms on 800 samples from the EMIF-AD MBD study. The cohort comprised participants diagnosed as 230 normal cognition (NC), 386 MCI (with longitudinal data on AD conversion or remaining stable) and 184 AD-type dementia. Data consisted of metabolites (n=540) and proteins (n=3630) measured in plasma coupled to clinical data (n=26). Multiclass models selected oleamide, MMSE and the priority language as the most confident features while MCI conversion models selected pTau, tTau and JPH3, CFP, SNCA and PI15 proteins. These proteins selected for MCI conversion have been previously associated with AD-related phenotype. Oleamide, a possible anti-inflammatory, prompted in-vitro experiments in rodent microglia. The results demonstrated that disease-associated microglia synthesize oleamide which were excreted in vesicles. In addition, plasma vesicles extracted from participants with AD showed elevated oleamide levels compared to controls (P<0.05). This study uncovered MCI conversion pathways that involve inflammation, neuronal regulation and protein degradation.

Graphical abstract
Reference values of Complete blood count in healthy adult Eritrean
Authors: Noury Ahmed O , Musa Omer A. , Gasmalbari Elmuiz , Bakhit Barakat M , Tesfamariam Eyasu H , Abraha Daniel M , Ghebre Zekarias B , Suleman Omer , Tesfay Efrem G , Hailezghi Filmon G
Published: March 2023

Background

Blood count is the most commonly prescribed biological examination in general medical practice. The reference intervals of the hematological parameters of this examination are critical for clinical orientations and therapeutic decisions. Because there are racial, ethnic, and geographical differences in complete blood count (CBC) reference intervals (RIs), population-specific RIs must be established. The goals of this study were to identify hematological reference ranges in healthy adult Eritreans.

Method

942 healthy Eritreans between 18 and 60 years old were included,331 males and 611 females by use of a DXH500 analyzer, age ranging between 18-60 years. The venous blood sample was collected in a tube containing EDTA anticoagulant for the blood tests. SPSS version 25 statistical software was used for data analysis, P value < 0.05 was considered significant A non-parametric test was used for the determination of upper (97.5th percentile) and lower (2.5th percentile) reference interval limits with 95% CI. The Harris and Boyd Rule is used to determine the need for partitioning of reference intervals based on gender.

Results

The established 95% reference intervals combined median (2.5th–97.5th percentile) for both males and females were: WBCs: 6.37 (3.02-13.55×103/µL), Lymph%:39.34 (21.39-60.54 %), Mono %:8.98 (5.18-14.54%), Neut%: 49.13(16.90-81.98 %), Baso%: 0.22 (0.00-0.63%), MCV: 87.67 (76.58-97.29fl), MCH: 27.53 (20.46-32.70 pg), MCHC: 31.38 (25.20-35.30 g/dl, RDW: 14.65 (12.70-18.60 %), PLT: 286.83 (131.62-453.13 ×103/µL) and MPV: 8.92 (7.28-11.01fl). The parameters that demand separate RI and Their respective median (2.5th – 97.5th percentile) for males versus females were: Eosin: 3.86 (0.29-16.68 %) versus 1.80 (0.20-6.73 %), RBCs: 5.57 (4.47-7.69×106/µL) versus 4.97 (3.98-6.38×106/µL), Hb: 15.28 (11.48-17.99 g/dl) versus 13.50 (10.74-16.54 g/dl), and HCT: 48.75 (38.96-61.17 %) versus 43.19 (34.86-58.60 %).

The median of WBCs was significantly higher in females than males, the mean WBCs were lower in people residing at high altitudes compared to those leaving at low altitudes, The WBC is significantly higher among obese participants. The median Platelet count is significantly higher in females than in males.

Conclusion

The reference intervals established in this study differ from the international one and thus should be used for the interpretation of laboratory results in diagnosis and follow-up in Eritrea. The study showed significant variations in Hb levels, RBCs count, WBCs count, and platelet according to gender, Age, BMI, and physical activity.
Cost-Effectiveness of a Pediatric Operating Room Installation in Sub-Saharan Africa
Authors: Yap Ava , Halid Salamatu I. , Ukwu Nancy , Laverde Ruth , Park Paul , Klazura Greg , Bryce Emma , Cheung Maija , Marseille Elliot , Ozgediz Doruk , Ameh Emmanuel A.
Published: March 2023

The unmet need for pediatric surgery incurs enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of economic impact data on improving pediatric surgical infrastructure in SSA precludes informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and maintaining a pediatric operating room in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of two dedicated pediatric operating rooms (ORs), which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital’s operative registry and prior literature. A societal perspective included costs incurred by the hospital system, charity, and patients’ families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation were presented from charity and societal perspectives. One-way and probabilistic sensitivity analyses were performed. We found that the installation and maintenance of two pediatric operating rooms averted 1145 DALYs and cost $155,509 annually. Annualized OR installation cost was $87,728 (56% of the overall cost). The ICER of the OR installation was $152 per DALY averted (95% uncertainty interval [UI] 147-156) from the societal perspective, and $77 per DALY averted (95% UI 75-81) from the charity perspective. These ICERs were well under the cost-effectiveness threshold of the country’s half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional pediatric operating rooms in SSA with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children’s global surgical infrastructure as an economically sound intervention.
Whole-Body Photobiomodulation Therapy for Fibromyalgia: A Feasibility Trial
Authors: Fitzmaurice Bethany C , Heneghan Nicola R , Rayen Asius TA , Grenfell Rebecca L , Soundy Andrew A
Published: March 2023

Effective treatment for fibromyalgia (FM) is lacking and further treatment options are needed. Photobiomodulation therapy (PBMT) represents one potential treatment option. Whilst favourable findings have been reported using localised PBMT, no investigations have established the value of whole-body PBMT for the complete set of symptom domains in FM. A single-arm feasibility study was conducted in accordance to CONSORT guidelines. A non- probability sampling method was used to access individuals with FM. The primary outcome measure was identified as the Revised Fibromyalgia Impact Questionnaire (FIQR). Forty-nine participants were screened and 21 trial participants entered the trial. Nineteen participants completed the intervention (18 whole-body PBMT sessions over approximately six weeks). Descriptive statistics and qualitative analysis was undertaken to represent feasibility outcomes. Acceptability of the trial device and processes were established. Outcome measures towards efficacy data were guided by core and peripheral OMERACT domains, utilising a combination of participant-reported and performance-based outcome measures. Positive changes were observed for FM-specific quality of life, pain, tenderness, stiffness, fatigue, sleep disturbance, anxiety, depression and cognitive impairment. Patient global assessment revealed improvements at 6 weeks, with continued effect at 24 weeks. FM- specific quality of life at 24 weeks remained improved compared with baseline scores. Data for the embedded qualitative component of the trial were captured by participant-reported experience measures and audio-recorded semi-structured interviews. Findings provide evidence to support a full-scale trial and shows promise regarding potential efficacy of this novel non-invasive treatment in an FM population.
Cross-ancestry, cell-type-informed atlas of gene, isoform, and splicing regulation in the developing human brain
Authors: Wen Cindy , Margolis Michael , Dai Rujia , Zhang Pan , Przytycki Pawel F , Vo Daniel D , Bhattacharya Arujun , Kim Minsoo , Matoba Nana , Tsai Ellen , Hoh Celine , Jiao Chuan , Aygun Nil , Walker Rebecca L , Chatzinakos Christos , Clarke Declan , Pratt Henry ,   PsychENCODE Consortium, Peters Mette A , Gerstein Mark , Daskalakis Nikolaos P , Weng Zhiping , Jaffe Andrew E , Kleinman Joel E , Hyde Thomas M , Weinberger Daniel R , Bray Nicholas J , Sestan Nenad , Geschwind Daniel H , Roeder Kathryn , Gusev Alexander , Pasaniuc Bogdan , Stein Jason L , Love Michael I , Pollard Katherine S , Liu Chunyu , Gandal Michael J
Published: March 2023

Genomic regulatory elements active in the developing human brain are notably enriched in genetic risk for neuropsychiatric disorders, including autism spectrum disorder (ASD), schizophrenia, and bipolar disorder. However, prioritizing the specific risk genes and candidate molecular mechanisms underlying these genetic enrichments has been hindered by the lack of a single unified large-scale gene regulatory atlas of human brain development. Here, we uniformly process and systematically characterize gene, isoform, and splicing quantitative trait loci (xQTLs) in 672 fetal brain samples from unique subjects across multiple ancestral populations. We identify 15,752 genes harboring a significant xQTL and map 3,739 eQTLs to a specific cellular context. We observe a striking drop in gene expression and splicing heritability as the human brain develops. Isoform-level regulation, particularly in the second trimester, mediates the greatest proportion of heritability across multiple psychiatric GWAS, compared with eQTLs. Via colocalization and TWAS, we prioritize biological mechanisms for ~60% of GWAS loci across five neuropsychiatric disorders, nearly two-fold that observed in the adult brain. Finally, we build a comprehensive set of developmentally regulated gene and isoform co-expression networks capturing unique genetic enrichments across disorders. Together, this work provides a comprehensive view of genetic regulation across human brain development as well as the stage- and cell type-informed mechanistic underpinnings of neuropsychiatric disorders.
The prevalence of bleeding disorders in women with proven endometriosis: results of a screening study.
Authors: Heynemann Sarah , Accadia Emma Rachel , Cameron Melissa , Dauer Ray , Barnes Christopher , Grover Sonia R
Published: March 2023

Objective: To establish the rate of bleeding disorders amongst women with confirmed endometriosis and clarify predictive features on history. Methods: Eight-two women with confirmed diagnosis of endometriosis were recruited from a tertiary womens hospital. General bleeding tendency was evaluated with a modified internationally standardised questionnaire, and a bleeding score was calculated. Menstrual loss was evaluated by obtaining current and heaviest-ever menses profile using Pictorial Blood loss Assessment Chart(PBAC). Forty-one women satisfied criteria for a significant bleeding tendency and underwent coagulation tests including Prothrombin time(PT), activated partial thromboplastin time(aPTT), Platelet Function Analyser-100(PFA-100) and von Willebrand factor(vWF)/Factor VIII(FVIII) studies. Results : The prevalence of abnormal screening haemostasis tests for the population was 17.72% (95% CI 10.04-27.94) for all tests, 8.54%(95% CI 3.50-16.80) for vWF tests, and 12.99%( 95% CI 6.41-22.59) for PFA-100. Receiver Operator Characteristic curve analysis demonstrated a very good performance of the bleeding score as a diagnostic test for haemostatic abnormalities for nulliparous women with endometriosis. Bleeding symptoms individually were not predictive. Logistic regression suggested the combination of mittleschmerz, cutaneous bleeding symptoms, heavy menstrual bleeding and prolonged bleeding from minor wounds as predictive for haemostatic abnormalities (p=0.0197). Conclusion: The prevalence of abnormal bleeding tests in women with endometriosis on preliminary testing was higher than the population rate of bleeding abnormalities and thus people with histologically proven endometriosis warrant a higher index of suspicion with respect to testing for mild bleeding disorders.