bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Outcomes for Women at Risk of Preterm Delivery Given Half Dose Versus Full Dose of Antenatal Betamethasone: A Randomized, Multicenter, Double-blind, Placebo-controlled, Noninferiority Trial
Authors: Schmitz T. , Doret-Dion M. , Sentilhes L. , Parant O. , Claris O. , Renesme L. , Abbal J. , Girault A. , Torchin H. , Houllier M. , Le Saché N. , Vivanti A.J. , De Luca D. , Winer N. , Flamant C. , Thuillier C. , Boileau P. , Blanc J. , Brevaut V. , Bouet P.E. , Gascoin G. , Beucher G. , Datin-Dorriere V. , Bounan S. , Bolot P. , Poncelet C. , Alberti C. , Ursino M. , Aupiais C. , Baud O. ,   BETADOSE Trial Study Group,   Groupe de Recherche en Obstétrique et Gynécologie
Published: May 2023

(Lancet. 2022;400:592–604)

Antenatal corticosteroids are recommended worldwide to help premature fetus lung maturity. However, the current recommended dose may be too high, based on some neurological, mental, and behavioral side effects. This study compared a half-dose (12 mg) of antenatal betamethasone to the typical full dose (24 mg) to determine if a half-dose can be as effective as a full dose, as well as to ultimately determine if a half-dose should be recommended in order to lessen side effects.
The Association of Fetal Acidemia With Adverse Neonatal Outcomes at Time of Scheduled Cesarean Delivery
Authors: Bligard K.H. , Cameo T. , McCallum K.N. , Rubin A. , Rimsza R.R. , Cahill A.G. , Palanisamy A. , Odibo A.O. , Raghuraman N.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:265.e1–8)

Fetal acidemia at delivery is a predictor of neonatal morbidity and mortality. Testing fetal umbilical artery (UA) blood gases at delivery can help identify neonates with acidemia who should receive additional surveillance and interventions to prevent long-term adverse outcomes. There is debate over which levels of fetal acidemia are associated with neonatal morbidity. Fetal acidemia is caused by an interruption in placental gas exchange during contractions in labor. Fetal acidemia does not occur often during scheduled, prelabor cesarean delivery (CD), and is believed to be caused by compression of the inferior vena cava or poor uterine and placental perfusion. This study examined the association between acidemia at the time of scheduled, prelabor CD, and adverse neonatal outcomes, hypothesizing that there would be no association between fetal acidemia and neonatal morbidity in this context.
Beyond Stillbirth: Association of Intrahepatic Cholestasis of Pregnancy Severity and Adverse Outcomes
Authors: Sarker M. , Zamudio A.R. , DeBolt C. , Ferrara L.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:517.e1–517.e7)

While the incidence of intrahepatic cholestasis of pregnancy (IHCP) is infrequent (0.3% to 0.5%) in most regions, rates are elevated (15%) in certain populations and confer significant risk to the fetus. Maternal pruritus and elevated bile acids often begin in the second or third trimester, with the total bile acid (TBA) level being correlated to severity of disease and predictive of stillbirth. In addition to fetal demise, recent research has highlighted the association of IHCP with increased iatrogenic preterm birth, spontaneous preterm birth, respiratory distress syndrome and meconium-stained amniotic fluid. While severity-based analysis based on TBA levels is established for stillbirth, this study aimed to delineate an analysis of TBA correlation to other adverse outcomes beyond stillbirth.
Severity of Intrapartum Fever and Neonatal Outcomes
Authors: Hensel D. , Zhang F. , Carter E.B. , Frolova A.I. , Odibo A.O. , Kelly J.C. , Cahill A.G. , Raghuraman N.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:513.e1–513.e8)

Infection- or noninfection-mediated intrapartum maternal fever (≥38 °C) is a frequent complication of childbirth, affecting 1 in 15 deliveries. Associations with increased risk for neonatal morbidity include low Apgar score, sepsis, encephalopathy, seizures, respiratory distress, meconium aspiration, and NICU admission. Risk for maternal morbidity as defined by labor dystocia, hemorrhage, instrumental vaginal delivery, and cesarean delivery is also heightened. Studies investigating the correlation of fever severity to increased neonatal and maternal morbidity are conflicting and have been conducted in homogenous patient populations with labor management differing from the standard of care in the United States. The aim of this study was to evaluate the relationship between increased severity of intrapartum fever and maternal and neonatal morbidity in a diverse, contemporary cohort, and medical practice. The authors hypothesized that risk would be independent from the duration of the time from the maximum fever temperature (Tmax) through to delivery.
Neonatal Outcomes After Use of Buprenorphine during Pregnancy
Authors: Krans E.E.
Published: May 2023

(N Engl J Med. 2022;387:2085–2086)

Opioid use during pregnancy continues to rise and result in adverse maternal and neonatal outcomes. Buprenorphine and methadone are medications used for opioid use disorder (OUD) treatment to help prevent risks such as overdose and preterm birth. While methadone was used for decades to treat perinatal OUD, it suffers from several issues. The primary issue is that it can only be given by federally licensed drug and alcohol treatment programs, which can be a barrier for many women requiring treatment. Another issue is that it is a long-acting drug.
Fetal Reduction From Twin to Singleton Gestation: A Meta-analysis
Authors: Bardin R. , Gupta M. , Greenberg G. , Nandrajog A. , Hadar E.
Published: May 2023

(Int J Gynaecol Obstet. 2022;158:260–269)

Twin pregnancies have 2 to 3.5 times increased risk of maternal hypertensive and hyperglycemic complications and 2 to 3 times increased risk of perinatal and infant mortality. Approximately 50% of twin pregnancies result in preterm birth <37 weeks gestation, and early preterm birth at <34 weeks gestation occurs in 14%. The outcomes of multifetal reduction in triplets and quadruplets have been studied, but maternal, perinatal, and neonatal results for twins have been inconsistent. This meta-analysis helps to clarify issues around fetal reduction compared with ongoing twin pregnancies.
Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight
Authors: Clasen T.F. , Chang H.H. , Thompson L.M. , Kirby M.A. , Balakrishnan K. , Rosenthal J.P. , Checkley W. , Peel J.L. ,   HAPIN Investigators
Published: May 2023

(N Engl J Med. 2022;387:1735–1746)

Over the past few decades, 3 billion people continue to use open fires and traditional stoves to cook with using solid biomass fuels (biomass) like charcoal and wood. The resulting air pollution within the home is a concerning health risk for low- to middle-income populations and leads to millions of premature deaths and adverse health outcomes, including lower birth weight neonates. Liquefied petroleum gas (LPG) cookstoves have been shown to decrease air pollution and associated health risks. This study aimed to determine whether replacing biomass cookstoves with LPG cookstoves impacts birth weight.
Parenteral Protein in Extremely Preterm Infants: More Is Not Better
Authors: Martin C.R.
Published: May 2023

(N Engl J Med. 2022;387:1712–1713)

Adequate nutrient absorption in utero is critical for neonatal health and development. Premature delivery of a baby disrupts the accumulation of vital nutrients, so sufficient nutrient replacement is required to help prevent nutrient deficits and adverse health outcomes. The standard of preterm infant nutritional management is to closely replicate a healthy fetus’s nutrient intake and growth rates. This approach, however, does not take into consideration factors and illnesses preterm infants face in the neonatal intensive care unit such as lung injury, immature metabolism, and hypothermia that may require necessary pivots in treatment. Additional studies are required to determine the best nutrition management of preterm infants that may be different than healthy fetuses to ensure optimal outcomes.
Intrathecal 2-Chloroprocaine 3% Versus Hyperbaric Bupivacaine 0.75% for Cervical Cerclage: A Double-blind Randomized Controlled Trial
Authors: Lee A. , Shatil B. , Landau R. , Menon P. , Smiley R.
Published: May 2023

(Anesth Analg. 2022;134:634–632)

Cervical cerclage, an operation designed to reduce preterm delivery and improve perinatal outcomes, is often performed under spinal anesthesia. While the benefits of spinal anesthesia are well documented, a short-acting local anesthetic agent, such as 2-chloroprocaine, could shorten postanesthesia care unit (PACU) stay compared with longer acting agents. Currently, bupivacaine is the most used local anesthesia for cerclage because of historical concern regarding 2-chloroprocaine’s safety. This study randomly compared the outcome of 2-chloroprocaine 3% 50 mg and hyperbaric bupivacaine 0.75% 9 mg on dermatomal level, sensory block resolution, ability to ambulate and void, and motor blockade.
Obstetric Comorbidity Index and the Odds of General Versus Neuraxial Anesthesia in Women Undergoing Cesarean Delivery: A Retrospective Cohort Study
Authors: Singh S. , Farber M.K. , Bateman B.T. , Lumbreras-Marquez M.I. , Richey C.J. , Easter S.R. , Fields K.G. , Tsen L.C.
Published: May 2023

(Int J Obstet Anesth. 2022;51:103546)

General anesthesia (GA) is often related to significant anesthetic exposure, tracheal intubation, risk for pulmonary aspiration, surgical site infection, and severe postpartum depression. As cesarean deliveries (CD) are common in the United States and around the world, many countries view GA during CD as an indicator that improvements could be made. In an effort to persuade more people towards neuraxial anesthesia instead of GA, this study researched the relationship between obstetric comorbidity index (OCI) risk-assessment data, a tool used by the several countries to assess the risk of surgeries and prepare for said risk, and GA, specifically in a nonemergency setting.
Opioids for Cesarean Delivery Under General Anesthesia and Neonatal Outcome: A Historical Cohort Study
Authors: Caissie N. , Héroux J. , Lefebvre M. , Lamarche D. , Dubois M-C. , Rivard G. , D’Aragon F.
Published: May 2023

(Can J Anesth/J Can Anesth. 2022;69:1017–1024))

While general anesthesia (GA) is not the preferred technique for cesarean delivery (CD), due to the risk of gastric aspiration, it is sometimes used for emergent delivery or in the setting of contraindications to neuraxial anesthesia. Opioids are often used in nonobstetric populations during anesthesia to attenuate the hemodynamic response to laryngoscopy. In pregnant patients with hypertensive disorders of pregnancy, opioids are used to avoid exaggerated sympathetic responses to intubation. However, beta-blockers, vasodilators, or magnesium are considered just as effective in stabilizing blood pressure as opioids in this population. Since opioids are associated with an increased risk of neonatal respiratory depression, their use in GA for cesarean is not common. This study aimed to describe the current use of opioids during GA for CD, find potential predictors of opioid use in pregnant patients, and investigate the association between opioid use and neonatal outcomes.
A Multimodal Approach to Reducing Post-Cesarean Opioid Use: A Quality Improvement Initiative
Authors: Llarena N.C. , Krivanek K. , Yao M. , Kim D.D. , Devarajan J. , Ayad S. , Chiang E.
Published: May 2023

(BJOG: Int J Obstet Gynaecol. 2022;129:1583–1590)

Opioid administration following cesarean delivery is common in the United States, but the number of opioids prescribed is often higher than needed to control pain. Opioid overdose deaths among reproductive-age women have increased since 1999. Opioids also are associated with adverse effects and outcomes for mothers and neonates. A multi-modal approach using acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) is recommended by American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists. These methods have been shown to reduce opioid use and adequately manage pain but have not been widely adopted by clinicians. This study evaluated a four-part quality improvement initiative, including nursing education, designed to reduce inpatient and outpatient opioid use and prescribing patterns.
Healing Exposed Calvarial Hardware Using Negative-Pressure Wound Therapy and Vashe Wound Solution: Case Report
Authors: Ockerman Kyle M. , Cox Elizabeth A. , Wiesemann Gayle , Nichols D. Spencer , Murad Gregory J. A. , Ching Jessica , Sorice-Virk Sarah
Published: May 2023

OBJECTIVE

The management of cranioplasty infections has historically been explantation followed by delayed reimplantation/reconstruction. This treatment algorithm necessitates surgery, tissue expansion, and prolonged disfigurement. In this report, the authors describe a treatment approach consisting of serial vacuum-assisted closure (VAC) with hypochlorous acid (HOCl) solution (Vashe Wound Solution; URGO Medical) as a salvage strategy.

METHODS

A 35-year-old man who sustained head trauma, neurosurgical complications, and severe syndrome of the trephined (SOT; devastating neurologic decline treated by cranioplasty) underwent titanium cranioplasty with free flap. Three weeks postoperation, he presented with pressure-related wound dehiscence/partial flap necrosis, exposed hardware, and bacterial infection. Given the severity of his precranioplasty SOT, hardware salvage was critical. He was treated with serial VAC with HOCl solution for 11 days followed by VAC for 18 days and definitive split-thickness skin graft placement over resulting granulation tissue. Authors also conducted a literature review of cranial reconstruction infection management.

RESULTS

The patient remained healed 7 months postoperatively without recurrent infection. Importantly, his original hardware was retained, and his SOT remained resolved. Findings from the literature review support the use of conservative modalities to salvage cranial reconstructions without hardware removal.

CONCLUSIONS

This study investigates a new strategy for managing cranioplasty infections. The VAC with HOCl solution regimen was effective in treating the infection and salvaging the cranioplasty, thus obviating the complications associated with explantation, new cranioplasty, and recurrence of SOT. There is limited literature on the management of cranioplasty infections using conservative treatments. A larger study to better determine the efficacy of VAC with HOCl solution is underway.
Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review
Authors: Reynolds F. Hall , Tusa Mark G. , Banks Samuel L.
Published: May 2023

OBJECTIVE

To present the toe web space as an anatomically, physiologically, and pathologically unique part of the human body; characterize toe web infections and discuss why they occur; and highlight toe web psoriasis as an uncommon condition that providers should consider if toe web intertrigo does not respond to treatment.

DATA SOURCE

This review encompassed many years of clinical observation and photographs; medical textbooks; and a literature search of MEDLINE, PubMed, and Google Scholar.

STUDY SELECTION

Primary research keywords included intertrigo, toe web intertrigo, toe web infection, tinea pedis, microbiome, skin microbiome, toe web microbiome, ecology, psoriasis, psoriasis microbiome, intertriginous psoriasis, and Wood’s lamp. More than 190 journal articles met the search criteria.

DATA EXTRACTION

The authors sought data relating to what makes for a healthy toe web space and what makes for disease. They extracted and collated relevant information to compare and contrast among sources.

DATA SYNTHESIS

After understanding the normal toe web space and the microorganisms that normally reside there, the authors investigated why infections occur, how they should be treated, what complications may result, and what other diseases occur in the toe web area.

CONCLUSIONS

This review of toe web infection illustrates the effect of the microbiome and reports a rare form of psoriasis that is usually misdiagnosed as athlete’s foot. The toe web space is a unique part of the human body that can be affected by a variety of both common and unusual conditions.
Educational needs of self-care in cachectic cancer patients and caregivers
Authors: Hopkinson Jane B.
Published: May 2023

Purpose of review

To give an overview of what is known about the educational component of supportive care for people with cancer cachexia and their family caregivers.

Recent findings

The educational needs for self-care by people with cancer cachexia are largely unmet. There is potential for education to enable self-care that mitigates cachexia-related distress with benefit to quality of life and mitigates malnutrition/malnutrition risk with implications for treatment tolerance and outcomes. Theoretically informed approaches to cancer cachexia education for patients and their family members are needed if optimal methods for support of self-care are to be identified. The cancer workforce also needs education to have the confidence and knowledge to play a role in the cancer cachexia education of their patients.

To address the educational needs of self-care in cachectic cancer patients and their caregivers, there is much work to do. Healthcare professionals need to know the best educational process and methods for cachexia for supporting quality of life and to facilitate improving cancer treatment outcomes including survival.
How to become a Multinational Association of Supportive Care in Cancer-designated center of excellence in supportive care in cancer
Authors: Antonuzzo Andrea , Lucchesi Maurizio , Ripamonti Carla Ida
Published: May 2023

Purpose of review

Aim of this review is to encourage and involve more doctors to take care of supportive care in cancer patients and to become centers of excellence.

Recent findings

In 2019, MASCC initiated a certification program to recognize oncology centers that demonstrate best practices in supportive cancer care but literature on how to become MASCC-designated center of Excellence in Supportive Care in Cancer is scarce and will be bulleted.

Becoming centers of excellence means not only the recognition of the clinical and managerial requirements to provide good supportive care but also the creation of a network of centers to participate in multicenter scientific projects and thus improve knowledge in the field of supportive care in cancer patients.
Neoadjuvant and adjuvant approaches in gastroesophageal cancers
Authors: Scheck Magdalena K. , Masetti Michael , Lorenzen Sylvie
Published: May 2023

Purpose of review

Despite advances in the perioperative treatment of locally advanced (T2-4 and/or N+) gastroesophageal cancer with evolving chemoradiotherapy and chemotherapy regimens, prognosis remains poor. Biomarker-based approaches with targeted therapies and immune checkpoint inhibition present a new opportunity to improve response rate and overall survival. This review aims to shed light on the current treatment strategies and therapy options that are under investigation for the curatively intended perioperative treatment of gastroesophageal cancer.

Recent findings

A major step for patients with advanced esophageal cancer and insufficient response to chemoradiotherapy was the implementation of immune checkpoint inhibition in the adjuvant treatment with positive effects on survival duration and quality of life (CheckMate577). Various studies that seek to further integrate immunotherapy or targeted therapy into (neo-) adjuvant treatment are on their way and show promising results.

Ongoing clinical research tries to increase the effectivity of standard of care approaches for the perioperative treatment of gastroesophageal cancer. Biomarker based immunotherapy and targeted therapy bear the opportunity to further improve the outcome.
Following your gut: the emerging role of the gut microbiota in predicting and treating immune-related adverse events
Authors: Desilets Antoine , Elkrief Arielle
Published: May 2023

Purpose of review

Although immune checkpoint inhibition has reshaped the therapeutic landscape leading to improved outcomes across an array of both solid and hematologic malignancies, a significant source of morbidity is caused by immune-related adverse events (irAEs) caused by these agents.

Recent findings

The gut microbiota has emerged as a biomarker of response to these agents, and more recently, also as a key determinant of development of irAEs. Emerging data have revealed that enrichment of certain bacterial genera is associated with an increased risk of irAEs, with the most robust evidence pointing to an intimate connection with the development of immune-related diarrhea and colitis. These bacteria include Bacteroides, Enterobacteriaceae, and Proteobacteria (such as Klebsiella and Proteus). Lachnospiraceae spp. and Streptococcus spp. have been implicated irAE-wide in the context of ipilimumab.

We review recent lines of evidence pointing to the role of baseline gut microbiota on the development of irAE, and the potentials for therapeutic manipulation of the gut microbiota in order to reduce irAE severity. The connections between gut microbiome signatures of response and toxicity will need to be untangled in further studies.
Treatment of radiation-associated angiosarcoma
Authors: Dufresne Armelle , Meeus Pierre , Sunyach Marie-Pierre
Published: May 2023

Purpose of review

Radiation-associated angiosarcoma is a cutaneous aggressive tumor that is very rare and it represents a specific entity poorly studied in literature. It requires new therapeutic opportunity.

Recent findings

The complete surgical resection with negative margins is the mainstay treatment of localized treatment, even though it is difficult to reach in case of diffuse cutaneous infiltration. Adjuvant re-irradiation may improve local control with no benefit demonstrated on survival. Many systemic treatments can be efficient not only in metastatic setting but also in neoadjuvant setting in case of diffuse presentation. These treatments have never been compared to each other; the most efficient regimen remains to be determined, and a high heterogeneity of treatment is observed, even between sarcoma reference centers.

Immune therapy represents the most promising treatment under development. At the time of building clinical trial to assess the efficacy of immune therapy, the lack of randomized studies prevents the identification of a strong and consensual reference arm treatment. Given the rarity of the disease, only international collaborative clinical trials may have a chance to include enough patients to draw any conclusion and so will have to counteract the heterogeneity of management.
Doxorubicin combined with Trabectedin in systemic first-line M+/recurrent leiomyosarcoma patients
Authors: Turinetto Margherita , Meeus Pierre , Ray-Coquard Isabelle
Published: May 2023

Purpose of review

Currently, the only systemic therapy approved for advanced leiomyosarcoma is Doxorubicin-based monotherapy. Despite disappointing progression-free survival (PFS) and overall survival (OS), no combination therapy has formally ever proven to be more effective. In this clinical setting, selecting the most efficient therapy is key, as most patients become quickly symptomatic with poor performance status.

This review aims to describe the current emerging role of Doxorubicin and Trabectedin in first-line setting, compared with doxorubicin alone the current standard of treatment.

Recent findings

Previous randomized trials focusing on combination therapies (Doxorubicin + ifosfamide, doxorubicin + evofosfamide, doxorubicin + Olaratumab, or Gemcitabine + Docetaxel) never reported positive results on the primary endpoint (OS or PFS). For the first time, the randomized phase III LMS-04 demonstrated that Doxorubicin and Trabectedin have a better PFS and disease control rate (DCR) compared with Doxorubicin, with higher but still manageable toxicities.

In the first-line setting, the results of this trial were pivotal for numerous reasons; Doxorubicin-Trabectedin is the first combination that has been proven to be more effective in terms of PFS, ORR and trend of OS compared with doxorubicin alone; moreover, it is clear that trials regarding soft tissue sarcoma should strive to be histology-driven.
A Practical Review of the Management of Xanthelasma palpebrarum
Authors: Malekzadeh Hamid , Ormseth Benjamin , Janis Jeffrey E.
Published: May 2023

Background:

Xanthelasma palpebrarum is the most common type of xanthomatous lesion. Various methods for treating Xanthelasma palpebrarum have been reported. We conducted a systematic review to evaluate the efficacy and associated complications of different treatment methods, and we summarized these findings as a practical review designed to be clinically useful, accessible, and impactful.

Methods:

The PubMed and Embase databases were searched to identify clinical studies that reported on outcomes and complications of different methods of Xanthelasma treatment. The electronic databases were searched from January 1990 to October 2022. Data on study characteristics, lesion clearance, complications, and recurrences were collected.

Results:

Forty-nine articles (including 1329 patients) were reviewed. The studies reported on surgical excision, laser modalities, electrosurgical techniques, chemical peeling, cryotherapy, and intralesional injection. The majority of studies were retrospective (69%) and single-arm (84%). Surgical excision combined with blepharoplasty and skin grafts showed excellent outcomes for large Xanthelasma. CO2 and erbium yttrium aluminum garnet (Er:YAG) were the most commonly studied lasers and showed more than 75% improvement in over 90% and 80% of patients, respectively. Comparative studies reported better efficacy for CO2 laser than both Er:YAG laser and 30%–50% trichloroacetic acid. Dyspigmentation was the most encountered complication.

Conclusions:

Different methods for the treatment of Xanthelasma palpebrarum have been reported in the literature, with moderate to excellent efficacy and safety profiles depending on the size and location of the lesion. Surgery is more appropriate for larger and deeper lesions, whereas laser and electrosurgical techniques can be used in smaller and more superficial contexts. Only a limited number of comparative studies have been conducted, and novel clinical trials are necessary to further augment appropriate treatment selection.
When All Else Fails: Transformational Strategies to Put Not-for-Profit Healthcare on a Sustainable Path
Authors: Majka Dan , Samaris Dawn
Published: May 2023

Changes in underlying cost structure, intensifying competition for nonacute healthcare services, heightened costs of capital, and lower investment returns have put many health systems on an unsustainable path forward. Traditional performance improvement efforts remain important but cannot fully remedy the underlying causes that have disrupted operational and financial performance. Health systems must consider a fundamental transformation of their business model. Transformation requires a disciplined assessment of the health system's current portfolio of businesses, services, and markets. The goal of transformative change is to concentrate efforts and resources on ways that can sustain the organization's long-term relevance while supporting its mission. Decisions resulting from this assessment will define new opportunities to optimize lines of business, identify partnerships to fulfill mission, and free up resources for areas where the organization can truly excel.
UChicago Medicine Grows Through Partnership Synergies
Authors: Jackiewicz Thomas E.
Published: May 2023

University of Chicago Health System—UChicago Medicine—recently joined forces with AdventHealth's Great Lakes Region to expand access to services, treatment options, and clinical trials to residents in Chicago's western suburbs. Other organizations may want to follow that approach in developing and maintaining a high-quality and integrated healthcare ecosystem—one that not only increases access to care for underserved populations but also responds to changing consumer preferences and behavior. Building partnerships with other systems that possess similar values and complementary strengths is an effective way to provide patients with convenient, high-quality care closer to home. Early results of the joint venture show promising synergies and benefits.
A retrospective cohort study of differential attainment, COVID and Chaos: taking the difference out of a terrible trinity
Authors: James Osian P. , Mellor Katie , Luton Oliver , Robinson David , Walsh Leona , Hemington-Gorse Sarah , Egan Richard J. , Lewis Wyn G.
Published: May 2023

Background:

This study aimed to evaluate Core Surgical Training (CST) differential attainment related to COVID-19, gender, and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes.

Methods:

A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were: Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass, and Higher Surgical Training National Training Number (NTN) appointment. Data was collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS®.

Results:

CSTs numbering 138 completed training pre- and 133 peri-COVID. ARCPO 1,2&6 were 71.9% pre- vs. 74.4% peri-COVID (P=0.844). MRCS pass rates were 69.6% pre- versus 71.1% peri-COVID (P=0.968) but NTN appointment rates diminished (pre- 47.4% vs. peri- 36.9%, P=0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender (m: f 1:0.87, OR 0.53, P=0.043) and CST theme (Plastics vs. General OR 16.82, P=0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P=0.004); NTN with the Improving Surgical Training run-through program (OR 5.00, P<0.001). Program retention improved peri-COVID (OR 0.20, P=0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P=0.018).

Conclusion:

Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat.
Analysis of prognostic factors and establishment of prognostic model for primary mediastinal germ cell tumors: a case controlled study
Authors: Leng Changsen , Cui Yingying , Mai Zihang , Chen Rui , Yuan Jianye , Wang Kexi , Wen Jing , Fu Jianhua , Liu Qianwen
Published: May 2023

Background:

The overall prognosis of primary mediastinal germ cell tumors (PMGCTs) is poor and the associated prognostic factors are not fully understood. Our goal was to investigate the prognostic factors of PMGCTs and to develop a validated prognostic prediction model.

Materials and Methods:

A total of 114 PMGCTs with specific pathological types were included in this study. Clinicopathological characteristics of non-seminomatous PMGCTs and mediastinal seminomas were compared using Chi-square or Fisher’s exact test. Independent prognostic factors of non-seminomatous PMGCTs screened using the univariate and multivariate Cox regression analysis were then used to generate a nomogram. The predictive performance of the nomogram was evaluated using the concordance index, decision curve and the area under the receiver operating characteristic curve (AUC) and validated by bootstrap resampling. The Kaplan-Meier curves of independent prognostic factors were analyzed.

Results:

This study included 71 cases of non-seminomatous PMGCTs and 43 cases of mediastinal seminomas. The 3-year overall survival rates for non-seminomatous PMGCTs and mediastinal seminomas patients were 54.5% and 97.4%, respectively. The overall survival prognostic nomogram for non-seminomatous PMGCTs was established by integrating independent prognostic factors, including the Moran-Suster stage, white blood cell, hemoglobin, and platelet-lymphocyte ratio. The nomogram demonstrated good performance with a concordance index of 0.760 and the 1-year and 3-year AUC values of 0.821 and 0.833, respectively. These values were better than those of the Moran-Suster stage system. The bootstrap validation had an AUC of 0.820 (0.724–0.915) and showed a well-fitting calibration curve. Besides, patients with mediastinal seminomas showed favorable clinical outcomes and all the 9 patients received neoadjuvant therapy and postoperative surgery achieved pathological complete response.

Conclusion:

A nomogram based on staging and blood routine examination results was established to accurately and consistently predict the prognosis of patients with non-seminomatous PMGCTs.
White blood cell count combined with LDL cholesterol as a valuable biomarker for coronary artery disease
Authors: Liu Zhiyun , Yan Yongjin , Gu Shunzhong , Lu Yang , He Hao , Ding Hongsheng
Published: May 2023

Objective

Inflammation and dyslipidemia are important pathophysiological bases for the occurrence and development of coronary artery disease (CAD); however, combination of these two entities is rarely used to diagnose CAD and its severity. Our aim was to determine whether the combination of white blood cell count (WBCC) and LDL cholesterol (LDL-C) can serve as a biomarker for CAD.

Methods

We enrolled 518 registered patients and measured serum WBCC and LDL-C on admission. The clinical data were collected, and the Gensini score was used to assess the severity of coronary atherosclerosis.

Results

WBCC and LDL-C levels in the CAD group were higher than in the control group (P < 0.01). Spearman correlation analysis showed that WBCC combined with LDL-C was positively correlated with the Gensini score (r = 0.708, P < 0.01) and the number of coronary artery lesions (r = 0.721, P < 0.01). Receiver operating characteristic curve analysis revealed that WBCC combined with LDL-C had a higher predictive value for CAD, severe CAD, and three-vessel CAD [area under the curve (AUC) values were 0.909, 0.867, and 0.811, respectively] than WBCC (AUC values were 0.814, 0.753, 0.716, respectively) and LDL-C (AUC values were 0.779, 0.806, 0.715, respectively) alone (all P < 0.05).

Conclusion

WBCC combined with LDL-C is correlated with the degree of coronary artery lesion. It had high sensitivity and specificity in the diagnosis of CAD, severe CAD, and three-vessel CAD.
Impact of Direct-acting Antivirals on Hepatocellular Carcinoma and Mortality Among Medicaid Beneficiaries With Hepatitis C
Authors: Jiang Xinyi , Song Hyun Jin , Chang Ching-Yuan , Wilson Debbie L. , Lo-Ciganic Wei-Hsuan , Park Haesuk
Published: May 2023

Objective:

The effects of all-oral direct-acting antivirals (DAAs) on hepatocellular carcinoma (HCC) and liver-related and all-cause mortality were assessed among Medicaid beneficiaries with hepatitis C virus (HCV).

Subjects:

This cohort study used 2013–2019 Arizona Medicaid data from beneficiaries with HCV aged 18–64 years.

Methods:

Risks of HCC and liver-related and all-cause mortality were compared between patients with or without DAA treatment, stratified by liver disease severity, using inverse probability of treatment weighted multivariable Cox proportional hazards regression models.

Results:

Of 29,289 patients, 13.3% received DAAs. Among patients with compensated cirrhosis (CC), DAA treatment was associated with a lower risk of HCC [adjusted hazard ratio (aHR), 0.57; 95% CI, 0.37–0.88] compared with untreated patients although this association was not statistically significant for patients without cirrhosis or with decompensated cirrhosis (DCC). Compared with untreated patients, DAA treatment was associated with decreased risk of liver-related mortality for patients without cirrhosis (aHR: 0.02; 95% CI: 0.004–0.11), with CC (aHR: 0.09; 95% CI: 0.06–0.13), or with DCC (aHR: 0.20; 95% CI: 0.14–0.27). Similarly, compared with untreated patients, DAA treatment was associated with lower all-cause mortality for patients without cirrhosis (aHR: 0.10; 95% CI: 0.08–0.14), with CC (aHR: 0.07; 95% CI: 0.05–0.10), or with DCC (aHR: 0.15; 95% CI: 0.11–0.20).

Conclusions:

Among Arizona Medicaid beneficiaries with HCV, DAA treatment was associated with decreased risk of HCC for patients with CC but not for patients without cirrhosis or with DCC. However, DAA treatment was associated with decreased risk of liver-related and all-cause mortality.
Soft Tissue Filler for Secondary Nasal Deformities
Authors: Rohrich Rod J. , Novak Matthew , Cason Roger , Trost Jeffrey
Published: May 2023

One common indication for soft tissue filler in the nose, or “liquid rhinoplasty,” is the temporary treatment of secondary nasal deformities after rhinoplasty. When applied in this manner, there are multiple aspects of the patient evaluation, timing with respect to the prior rhinoplasty and planned revision, and procedural principles and steps that must be carefully considered. Ultimately, when appropriately implemented, the procedure can help avoid unnecessary patient angst and displeasure preceding a formal revision rhinoplasty. The following article reviews the principles and application of soft tissue filler for secondary nasal deformities.
Graft Survival and Acute Rejection in Cross-Sex Solid Organ Transplants: A Systematic Review and Meta-Analysis to Inform Vascularized Composite Allotransplantation Practice
Authors: Barrow Brooke , Diep Gustave K. , Berman Zoe P. , Boczar Daniel , Lee Olive , Salinero Lauren , Howard Rachel , Trilles Jorge , Rodriguez Colon Ricardo , Rodriguez Eduardo D.
Published: May 2023

Background:

Out of nearly 90 hand and 50 face transplant recipients, only 5 have received a cross-sex vascularized composite allotransplantation (CS-VCA) to date. CS-VCA has the potential to expand the donor pool and has been shown to be anatomically feasible and ethically acceptable in previous cadaveric and survey studies. However, there is a lack of immunologic data. This study aims to evaluate the immunologic feasibility of CS-VCA through analysis of the solid organ transplant (SOT) literature, given the paucity of CS-VCA data. We hypothesize the rates of acute rejection (AR) and graft survival (GS) in CS vs. same-sex (SS)-SOT to be similar.

Methods:

A systematic review and meta-analysis of the PubMed, EMBASE, and Cochrane databases were performed in accordance with PRISMA guidelines. Studies comparing GS or AR episodes in CS- and SS- adult kidney (KT) and liver transplant (LT) populations were included. Odds ratios were calculated for overall GS and AR for all SS and CS transplant combinations (male-to-female (MTF), female-to-male (FTM) and overall).

Results:

A total of 693 articles were initially identified and 25 studies were included in the meta-analysis. No significant difference in GS was noted between SS-KT vs. CS-KT (OR 1.04 [1.00, 1.07]; P=0.07), SS-KT vs. MTF-KT (OR 0.97 [0.90, 1.04]; P=0.41) and SS-LT vs. MTF-LT (OR 0.95 [0.91, 1.00]; P=0.05). No significant difference in AR was noted between SS-KT vs. MTF-KT (OR 0.99 [0.96, 1.02]; P=0.57), SS-LT vs. CS-LT (OR 0.78 [0.53, 1.16]; P=0.22) and SS-LT vs. FTM-LT (OR 1.03 [0.95, 1.12]; P=0.47). For the remaining pairings, GS was significantly increased and AR was significantly decreased in the SS transplants.

Conclusions:

Published data suggest immunologic feasibility of CS-KT and CS-LT, with the potential for generalization to the VCA population. In theory, CS-VCA could expand the potential donor pool, leading to decreased wait times for recipients.
Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy
Authors: Yang Jing , Hu Xiuyu , Li Qingfeng , Huang Ru-Lin
Published: May 2023

Upper lid retraction (ULR) is the most common and earliest symptom in thyroid-associated ophthalmopathy (TAO) patients. Surgical correction is effective for ULR in stable diseases. However, non-invasive treatment is also required for the TAO patient in active phase. Here, we reported a complex case with TAO and unilateral ULR simultaneously. The patient had a history of progressive ptosis in the left eyelid and underwent anterior levator aponeurotic-Muller muscle resection to correct the ptosis. However, the patient gradually developed bilateral proptosis and ULR, mainly in the left eyelid. The patient was finally diagnosed with TAO with left ULR. Then, the patient was treated with botulinum toxin type A (BTX-A) injection in the left eyelid. The effect of BTX-A treatment started 7 days after injection, peaked at one month, and lasted for approximately 3 months. This study highlighted the therapeutic effect of BTX-A injection for the treatment of ULR-related TAO.
Safely Implementing a Program of Pure Laparoscopic Donor Right Hepatectomy: The Experience From a Southeast Asian Center
Authors: Law Jia-Hao , Tan Chun Han Nigel , Tan Kah Hwee Jarrod , Gao Yujia , Pang Ning Qi , Bonney Glenn Kunnath , Iyer Shridhar Ganpathi , Soubrane Olivier , Kow Wei Chieh Alfred
Published: May 2023

Background:

Laparoscopic donor right hepatectomy (LDRH) is a technically challenging procedure. There is increasing evidence demonstrating the safety of LDRH in high-volume expert centers. We report our center’s experience in implementing an LDRH program in a small- to medium-sized transplantation program.

Methods:

Our center systematically introduced a laparoscopic hepatectomy program in 2006. We started with minor wedge resections followed by major hepatectomies with increasing complexities. In 2017, we performed our first laparoscopic living donor left lateral sectionectomy. Since 2018, we have performed 8 cases of right lobe living donor hepatectomy (laparoscopy-assisted: 4 and pure laparoscopic: 4).

Results:

The median operative time was 418 (298–540) min, whereas the median blood loss was 300 (150–900) mL. Two patients (25%) had surgical drain placed intraoperatively. The median length of stay was 5 (3–8) d, and the median time to return to work was 55 (24–90) d. None of the donors sustained any long-term morbidity or mortality.

Conclusions:

Small- to medium-sized transplant programs face unique challenges in adopting LDRH. Progressive introduction of complex laparoscopic surgery, a mature living donor liver transplantation program, appropriate patient selection, and the invitation of an expert to proctor the LDRH are necessary to ensure success.
Differential effect of panic on the DNA methylation of the glucocorticoid receptor gene exon 1F in chronic subjective tinnitus with distress
Authors: Fransen Erik , Cassiers Laura L.M. , Chubar Viktoriia , Gilles Annick , Van Rompaey Vincent , van der Werf Ilse , Van de Heyning Paul , Claes Stephan , Sabbe Bernard , Kooy Frank R. , Van Den Eede Filip
Published: May 2023

Objective

Tinnitus can be regarded as a chronic stressor, leading to dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. There is important comorbidity with anxiety, particularly panic, potentially associated with differences in HPA axis functioning and methylation patterns of HPA axis-related genes. This study examines DNA methylation of the glucocorticoid receptor gene (NR3C1) exon 1F in adults with chronic subjective tinnitus and the possible differential effect of panic.

Methods

In a well characterized tinnitus sample (n = 22, half of which had co-occurring panic attacks), and unaffected controls (n = 31) methylation patterns of the CpG sites were determined using pyrosequencing and compared between groups through linear mixed models. Gene expression was determined using quantitative PCR on mRNA.

Results

Comparing the combined tinnitus groups to the control group, no DNA methylation differences were observed; however, the tinnitus group with panic attacks showed consistently higher mean methylation values across all CpGs compared to the tinnitus-only and the control group (P = 0.03 following Tukey correction), which became even more pronounced when accounting for childhood trauma (P = 0.012). Moreover, a significant positive correlation was found between methylation of the CpG7 site and the Beck Anxiety Inventory total score (P = 0.001) in the total population. NR3C1-1F expression was not significantly different between the three groups.

Conclusion

Panic is associated with higher DNA methylation of the NR3C1 exon 1F in adults with chronic subjective tinnitus, consistent with the reduced negative glucocorticoid feedback and HPA axis hyperfunction observed in individuals with panic disorder.
Integrated multi-omics analysis identifies epigenetic alteration related to neurodegeneration development in post-traumatic stress disorder patients
Authors: Bolouki Ayeh , Rahimi Moosa , Azarpira Negar , Baghban Fatemeh
Published: May 2023

Introduction

Post-traumatic stress disorder (PTSD), is associated with an elevated risk of neurodegenerative disorders, but the molecular mechanism was not wholly identified. Aberrant methylation status and miRNA expression pattern have been identified to be associated with PTSD, but their complex regulatory networks remain largely unexplored.

Methods

The purpose of this study was to identify the key genes/pathways related to neurodegenerative disorder development in PTSD by evaluating epigenetic regulatory signature (DNA methylation and miRNA) using an integrative bioinformatic analysis. We integrated DNA expression array data with miRNA and DNA methylation array data - obtained from the GEO database- to evaluate the epigenetic regulatory mechanisms.

Results

Our results indicated that target genes of dysregulated miRNAs were significantly related to several neurodegenerative diseases. Several dysregulated genes in the neurodegeneration pathways interacted with some members of the miR-17 and miR-15/107 families. Our analysis indicated that APP/CaN/NFATs signaling pathway was dysregulated in the peripheral blood samples of PTSD. Besides, the DNMT3a and KMT2D genes, as the encoding DNA and histone methyltransferase enzymes, were upregulated, and DNA methylation and miRNA regulators were proposed as critical molecular mechanisms. Our study found dysregulation of circadian rhythm as the CLOCK gene was upregulated and hypomethylated at TSS1500 CpGs S_shores and was also a target of several dysregulated miRNAs.

Conclusion

In conclusion, we found evidence of a negative feedback loop between stress oxidative, circadian rhythm dysregulation, miR-17 and miR-15/107 families, some essential genes involved in neuronal and brain cell health, and KMT2D/DNMT3a in the peripheral blood samples of PTSD.
The therapygenetics of anxiety disorders
Authors: Vashishtha Srishti , Kloiber Stefan , Zai Gwyneth
Published: May 2023

Treatment of anxiety disorders primarily includes pharmacological treatment and psychotherapy, yet a substantial portion of patients do not experience sufficient clinical response. Given the significant impact of anxiety disorders on well-being and quality of life, it is pertinent to strive to ensure available treatments are of paramount efficacy. This review aimed to identify genetic variants and genes that may moderate the outcome of psychotherapy in patients with anxiety disorders, termed ‘therapygenetics.’ A comprehensive search of the current literature following relevant guidelines was conducted. Eighteen records were included in the review. Seven studies reported significant associations between genetic variants and response to psychotherapy. The most investigated polymorphisms were the serotonin transporter-linked polymorphic region (5-HTTLPR), nerve growth factor rs6330, catechol-O-methyltransferase Val158Met, and brain-derived neurotrophic factor Val166Met. However, current findings are inconsistent and thus do not support the use of genetic variants for the prediction of psychotherapy response in anxiety disorders.