bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Impact of Substance Use Disorder Resources on Outcomes of Persons Who Inject Drugs with Infections
Authors: Greenlee Sage B. , Kenney Rachel M. , Makowski Charles T. , Bulat Elizabeth , Brar Indira , Davis Susan L.
Published: July 2022

Objective

The aim of the study is to evaluate the impact of inpatient substance use disorder (SUD) resources on outcomes of persons who inject stimulants and/or opioids (PWIDs) with infections.

Methods

This retrospective cohort evaluated PWIDs hospitalized from July 1, 2020, to May 31, 2021, and prescribed an antimicrobial course. The patients were compared based on inpatient implementation of SUD resources, including consultation of addiction medicine/behavioral health, implementation of an opioid withdrawal treatment protocol, or continuation/initiation of medications for opioid use disorder. The primary outcome was a composite of antibiotic completion, no unplanned discharge, and no 30-day readmission. Notable secondary outcomes included length of stay and presence of stigmatizing language in the electronic medical record.

Results

A total of 119 patients were analyzed—74 (62.2%) received SUD resources. The primary outcome was met by 43 patients with SUD resources implemented (58.1%) and 19 patients without resources (42.2%, P = 0.093). After adjustment for infection type, implementation of SUD resources (adjusted odds ratio, 2.593; 95% confidence interval, 1.162–5.789) was independently associated with primary outcome success. The patients who received SUD resources had a median length of stay of 7 days (4–13.3) compared with 4 days (2–6.5) in those without resources (P < 0.001). Stigmatizing language was present in 98% of patient electronic medical records.

Conclusions

Patient care provided to PWIDs with infections is optimized when SUD resources are implemented. This study further supports the necessity of improving SUD management when PWIDs are admitted to healthcare facilities.
Examining the Role of Nonsurgical Therapy in the Treatment of Geriatric Urinary Incontinence
Authors: Parker-Autry Candace , Neiberg Rebecca , Leng X. Iris , Matthews Catherine A. , Dumoulin Chantale , Kuchel George , Kritchevsky Stephen B.
Published: July 2022

OBJECTIVE:

To examine the role of physical function impairments on the change in urinary incontinence (UI) symptoms after pelvic floor muscle training in older women.

METHODS:

This is a prospective cohort study of 70 community-dwelling participants, older than age 70 years, with at least moderate incontinence symptoms. A comprehensive pelvic floor and physical function assessment was done at baseline. Individualized pelvic floor muscle training prescriptions with behavioral management strategies to reduce incontinence episodes were provided for 12 weeks. Baseline physical function was determined using the SPPB (Short Physical Performance Battery). A total score of 9 or lower out of 12 indicated impaired physical function, and scores higher than 9 indicated normal physical function. A 3-day bladder diary established daily incontinence episodes. The between-group difference in the change in number of UI episodes, from baseline to 6 weeks, was our primary outcome. Descriptive analyses compared important demographic and clinical characteristics. Longitudinal mixed model linear regression analyses determined the change in incontinence episodes and estimates of improvement based on the presence of impaired physical function and adjusted for age, race, and body mass index (BMI).

RESULTS:

Participants' mean±SD age was 76.9±5.4 years, and 15.7% identified as African American, with no significant differences in age or race between groups. Participants with impaired physical function had higher mean±SD BMI (33.6±14.5 vs 27.4±5.8; P=.03) and more baseline incontinence episodes (4.5±2.9 vs 2.7±2.1 episodes per day; P=.005) than in women without functional impairment. After 6 weeks of pelvic floor exercises, the change in number of incontinence episodes per day was not different between participants with physical functional impairment compared with women with normal physical function (mean [95% CI] −1.2 [−2.0 to −0.5] vs −0.4 [−1.1 to 0.3], P=.31). Overall, after 12 weeks of pelvic floor muscle training, complete satisfaction with incontinence symptom improvement was low for both groups (41.8% with physical function impairments vs 44.8% with normal physical function; P=.90).

CONCLUSION:

Behavioral therapy including pelvic floor muscle training may not significantly decrease UI symptoms to a degree that is satisfactory in women who are older than 70 years and are seeking treatment for UI, regardless of the presence of physical function impairments.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03057834.
Effect of Paracervical Block Volume on Pain Control for Dilation and Aspiration
Authors: Crouthamel Bonnie , Economou Nicole , Averbach Sarah , Rible Radhika , Kully Gennifer , Meckstroth Karen , Mody Sheila K.
Published: July 2022

OBJECTIVE:

To compare pain scores during office dilation and aspiration between low-volume and high-volume paracervical block of the same dose.

METHODS:

We conducted a multi-site, randomized, single-blind, placebo-controlled trial from October 2018 to December 2020. We randomized participants presenting for office dilation and aspiration under minimal sedation stratified by procedural indication (induced abortion vs early pregnancy loss) to a 20-mL buffered 1% lidocaine paracervical block or a 40-mL buffered 0.5% lidocaine paracervical block, both with two units of vasopressin in a standardized technique. To detect a 15-mm or greater difference in pain at the time of cervical dilation with 80% power and a two-sided alpha of 0.05, a total of 104 participants was required. The study was also powered to detect a 20-mm or greater difference in pain at the time of cervical dilation within each stratum (induced abortion and early pregnancy loss). The primary outcome was pain with cervical dilation on a 100-mm visual analog scale in the overall cohort. Secondary outcomes included pain with cervical dilation within each stratum. We used a Wilcoxon rank-sum test to compare median pain scores between groups.

RESULTS:

We enrolled 114 participants. There was no difference in median pain scores between low-volume and high-volume groups during dilation (62 mm vs 59 mm, P=.94), aspiration (69.5 mm vs 70 mm, P=.47), postprocedure (25 mm vs 25 mm, P=.76), or overall (60 mm vs 60 mm, P=.23). Stratified by indication, there were no significant differences in scores at any time point between the low-volume and high-volume paracervical block groups. There was decreased overall pain in patients with induced abortion who received the higher volume paracervical block, though this did not reach statistical significance (67.5 mm vs 60.5 mm, P=.08). Pain during paracervical block administration was similar between groups (55 mm vs 45 mm, P=.24) and there was no difference in occurrence of side effects (P=.63).

CONCLUSION:

We found no difference in pain with cervical dilation among participants who received the low-volume compared with high-volume paracervical block when studied alone.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03636451.
Common Sleep Disorders in Pregnancy
Authors: Facco Francesca L. , Chan Megan , Patel Sanjay R.
Published: July 2022

Compared with men, women have a greater risk of sleep disorders and report higher rates of sleep disturbance. Hormonal and physiologic changes throughout the life span appear to influence a woman's ability to get a good night's sleep. Sleep disturbances are commonly reported during pregnancy, affecting more than one-half of all pregnancies and increasing as gestation progresses. The pervasiveness of sleep complaints during pregnancy may lead to a belief that these symptoms are normal or to be expected. Unfortunately, this perception may impede the accurate diagnosis of sleep disorders during this crucial time. Obstructive sleep apnea, insomnia, and restless legs syndrome are the most common sleep disorders in pregnancy. Sleep disruption in pregnancy can substantially worsen maternal quality of life and may be a risk factor for adverse pregnancy outcomes. This review outlines important considerations for obstetricians taking care of pregnant patients with sleep-related complaints.
Umbilical Cord Collection and Drug Testing to Estimate Prenatal Substance Exposure in Utah
Authors: Smid Marcela C. , Allshouse Amanda A. , McMillin Gwendolyn A. , Nunez Kendyl , Cavin Tyler , Worden Joseph , Buchi Karen , Muniyappa Bhanu , Varner Michael W. , Cochran Gerald , Metz Torri D.
Published: July 2022

OBJECTIVE:

Our primary objective was to estimate statewide prenatal substance exposure based on umbilical cord sampling. Our secondary objectives were to compare prevalence of prenatal substance exposure across urban, rural, and frontier regions, and to compare contemporary findings to those previously reported.

METHODS:

We performed a cross-sectional prevalence study of prenatal substance exposure, as determined by umbilical cord positivity for 49 drugs and drug metabolites, through the use of qualitative liquid chromatography-tandem mass spectrometry. All labor and delivery units in Utah (N=45) were invited to participate. Based on a 2010 study using similar methodology, we calculated that a sample size of at least 1,600 cords would have 90% power to detect 33% higher rate of umbilical cords testing positive for any substance. Deidentified umbilical cords were collected from consecutive deliveries at participating hospitals. Prevalence of prenatal substance exposure was estimated statewide and by rurality using weighted analysis.

RESULTS:

From November 2020 to November 2021, 1,748 cords (urban n=988, rural n=384, frontier n=376) were collected from 37 hospitals, representing 92% of hospitals that conduct 91% of births in the state. More than 99% of cords (n=1,739) yielded results. Statewide, 9.9% (95% CI 8.1–11.7%) were positive for at least one substance, most commonly opioids (7.0%, 95% CI 5.5–8.5%), followed by cannabinoid (11-nor-9-carboxy-delta-9-tetrahydrocannabinol [THC-COOH]) (2.5%, 95% CI 1.6–3.4%), amphetamines (0.9%, 95% CI 0.4–1.5), benzodiazepines (0.5%, 95% CI 0.1–0.9%), alcohol (0.4%, 95% CI 0.1–0.7%), and cocaine (0.1%, 95% CI 0–0.3%). Cord positivity was similar by rurality (urban=10.3%, 95% CI 8.3–12.3%, rural=7.1%, 95% CI 3.5–10.7%, frontier=9.2%, 95% CI 6.2–12.2%, P=.31) and did not differ by substance type. Compared with a previous study, prenatal exposure to any substance (6.8 vs 9.9%, P=.01), opioids (4.7 vs 7.0% vs 4.7%, P=.03), amphetamines (0.1 vs 0.9%, P=.01) and THC-COOH (0.5 vs 2.5%, P<.001) increased.

CONCLUSION:

Prenatal substance exposure was detected in nearly 1 in 10 births statewide.
Enhancing Skin Uptake of Topical Antioxidants With 1,440-nm Nonablative Fractional Diode Laser Pretreatment
Authors: Wang Jordan V. , Friedman Paul M. , Rodeberg Deirdre , Konda Adarsh , Parker Catherine , Geronemus Roy G.
Published: July 2022

BACKGROUND

Energy-based devices, such as nonablative lasers, are a promising method to enhance the delivery and absorption of topically applied molecules.

OBJECTIVE

To characterize ex vivo uptake of common antioxidant topicals after pretreatment with a nonablative laser wavelength.

MATERIALS AND METHODS

Using donor human skin tissue, uptake of 3 topical antioxidants was analyzed (C E Ferulic with 15% l-ascorbic acid [15% vitamin C serum], Phloretin CF with ferulic acid [10% vitamin C serum], and Phyto+ [botanical serum]; SkinCeuticals, Dallas, TX; 2010 formulations) after pretreatment with a 1,440-nm nonablative fractional diode laser.

RESULTS

Pretreatment with the 1,440-nm laser enhanced uptake of 15% and 10% vitamin C serums by approximately 10 and 21 times, respectively, compared to controls. Laser pretreatment also enhanced uptake of botanical serum by approximately 6 times relative to controls. Permeation of vitamin C and botanical serums was also enhanced through laser pretreatment.

CONCLUSION

Nonablative laser pretreatment increased uptake and permeation of topical antioxidants. Optimizing treatment requires consideration of the device and treatment parameters as well as the properties of the topical formulation.
Effects of adjuvant Chinese patent medicine therapy on major adverse cardiovascular events in patients with coronary heart disease angina pectoris: a population-based retrospective cohort study
Authors: Liu Yijia , Li Zhu , Wang Xu , Ni Tongyao , Ma Mei , He Yuanyuan , Yang Rongrong , Luo Mingchi
Published: July 2022

Objective:

This study aimed to explore the effects of Chinese patent medicine (CPM) in reducing the incidence of major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD) angina pectoris and improving clinical effectiveness and provide evidence for its use as clinical adjuvant therapy.

Methods:

Twenty-eight thousand five hundred and seventeen patients hospitalized with CHD angina pectoris from 6 hospitals were divided into CPM group (n = 11,374) and non-CPM group (n = 17,143) to evaluate the incidence of MACE, including myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting.

Results:

The incidence of MACE in the CPM group was lower than that in the non-CPM group. CPM therapy was an independent protective factor that reduced the overall risk of MACE [adjusted hazard ratio = 0.40, 95% confidence interval (0.33; 0.49)]. Patients in the CPM group who received one, two, or three types of CPM could benefit from adjuvant treatment with CPM, and taking more types of CPM was associated with a lower risk of MACE. In addition, the male population was better than the female population in taking CPM, and middle-aged people aged 55 to 64 were more suited to take CPM based on Western medicine.

Conclusions:

The use of CPM as adjuvant therapy can decrease the occurrence of MACE in patients with CHD angina pectoris, especially in men and middle-aged people, and the drug treatment plan should be optimized accordingly. However, this conclusion needs further verification by prospective cohort studies in the future.
In-situ Field Gamma Spectrometry in a Radionuclide Air Sampler
Authors: Lebel Luke , Barlow Kyle , Boulianne Diana , Clouthier Tony
Published: July 2022

The work being presented is on the development of a system to measure the speciation of airborne radionuclide emissions from the environment during a nuclear emergency. On-site air sampling measurements that were conducted during the Fukushima Daiichi accident were limited because field teams had to be sent out to run the sampling systems and retrieve the filters for gamma spectrometry analysis in a separate laboratory. The start of air sampling was delayed, and it was impossible for emergency responders to use the information about the airborne radionuclide composition in a timely way. The goal of the current study is to develop a system that could provide live, near real-time information about the concentrations of different radionuclides in the air without having to rely on human intervention. The development of the prototype in the current work is largely being enabled by Cd-Zn-Te spectrometers, which provide reasonably high-resolution spectrometry given that it is a room temperature sensor, and allow the measurements to be conducted in the field. A custom filter cartridge has been designed to hold a pair of aerosol and iodine filters in place while keeping the gamma spectrometers as close as possible in order to obtain high count rate efficiencies. A single cartridge holds both filters and has an internal flow channel directing the air flow between them. The cartridge design also facilitates replacing the filters as the accumulated radioactivity on the filters becomes too high. An automation system can move a filter cartridge from the fresh cartridge storage bank to the sampling location (filtration and gamma spectrometry) and return the used filter cartridge to the used cartridge storage bank. The radionuclide air sampling system prototype has been designed and constructed. It has been tested with fixed sources located on the respective aerosol and iodine filters. The real-time data capture aspects of the system were also demonstrated with a live 131I capture experiment. The projected performance of the system during a reactor accident was also simulated, emulating the characteristic detector efficiencies and projecting how the airborne concentrations could be reconstructed. The study has designed and constructed a radionuclide air sampler that could be used for measuring airborne radioactivity in emissions from a nuclear accident. Because the gamma spectrometry measurements are done in situ with good resolution and the system is automated, it would allow data to be transmitted back to an emergency operations center immediately rather than having to wait for additional laboratory analysis.
Nuclear Radiation Knowledge and Anxiety Levels among Residents around a Nuclear Power Plant in Liaoning Province, China
Authors: Sun Lu , Qiao Baojun , Chen Zhongxing , Yao Shuang , Liu Baochen , Li Di , Zhang Zhuo , Cui Yong
Published: July 2022

Awareness of radiation-related knowledge (RRK) and nuclear energy-related knowledge (NERK) among residents around a nuclear power plant (NPP), as well as their concerns about a NPP, were investigated. A face-to-face survey was conducted among 1,775 residents within 30 km around the NPP in Liaoning Province, China. A single-item Likert scale, Spearman’s/Pearson’s correlation coefficients, Student’s t-test, ANOVA, and multiple-linear regression analysis were employed. Awareness of RRK and NERK among residents around the NPP was 27.7% and 36.6%, respectively. The anxiety level of respondents was negatively corelated with the distance from their residence to the NPP and age. Also, 55.6% of respondents thought that the publicity about nuclear energy/NPPs was insufficient, and 82.7% of respondents wanted to know relevant information about NPPs. Awareness of RRK and NERK among residents around the NPP was relatively low, which was related to education, occupation, and income. The anxiety level among residents was related to distance and age. The public was eager to know about RRK and NERK. These findings indicate that the publicity and education of RRK and NERK among residents around the NPP should be strengthened.
Gene Co-Expression Network Analysis Identifies Hubs in Hepatitis B Virus-Associated Hepatocellular Carcinoma
Authors: Wang Shen-Yung , Huang Yen-Hua , Liang Yuh-Jin , Wu Jaw-Ching
Published: July 2022

Background:

Hepatocellular carcinoma (HCC) is among the leading causes of cancer-related death worldwide. The molecular pathogenesis of HCC involves multiple signaling pathways. This study utilizes systems and bioinformatic approaches to investigate the pathogenesis of HCC.

Methods:

Gene expression microarray data were obtained from 50 patients with chronic hepatitis B and HCC. The 1649 differentially expressed genes were inferred from tumorous and nontumorous datasets. Weighted gene co-expression network analysis (WGCNA) was performed to construct clustered co-expressed gene modules. Statistical analysis was used to study the correlation between gene co-expression networks and demographic features of patients. Functional annotation and pathway inference were explored for each co-expression network. Network analysis identified hub genes of the prognostic gene co-expression network. The hub genes were further validated with a public database.

Result:

Five distinct gene co-expression networks were identified by WGCNA. A distinct co-expressed gene network was significantly correlated with HCC prognosis. Pathway analysis of this network revealed extensive integration with cell cycle regulation. Ten hub genes of this gene network were inferred from protein-protein interaction network analysis and further validated in an external validation dataset. Survival analysis showed that lower expression of the 10-gene signature had better overall survival and recurrence-free survival.

Conclusion:

This study identified a crucial gene co-expression network associated with the prognosis of HBV-related HCC. The identified hub genes may provide insights for HCC pathogenesis and may be potential prognostic markers or therapeutic targets.
Achievements of the Compendium Bencao Tujing (Illustrated Classic of Materia Medica): A Preliminary Study
Authors: Xiu Lin-Lin , Xu Shi-Chun , Wang Qi-Xuan , Chen Shao-Hong , Liu Hai-Yan , Zhong Gan-Sheng
Published: July 2022

Bencao Tujing (Illustrated Classic of Materia Medica) is a brilliant and monumental compendium of materia medica by Su Song, which was published in 1061 and gathered ancestral knowledge from the Song dynasty as a legacy for posterity. The compendium emphasized the clinical applications of medicinal materials collected nationwide, which used illustrated atlases as references. The descriptions for each medicinal material subsumed the prescriptions containing it and were supplemented with relevant medical cases. Medical prescriptions predating the Song dynasty were included, which enhanced the clinical usefulness of the pharmacopoeia. The ancestral knowledge of materia medica was extensively merged with natural history throughout the compendium, which also made extensive reference to more than 200 Chinese classics, local gazetteers, and published works from the social and natural sciences. The inclusion of natural history and literature works changed the convention used in earlier pharmacopoeias to present medicines based solely on pharmacological analyses. The compendium also pioneered the inclusion of natural history in pharmacopoeia. Bencao Tujing helped establish China's leading position in the field of materia medica. Su Song's meticulous nature, truth-seeking attitude, and adherence to scientific thinking are truly worthy of emulation and promotion.
Global research on vitamin D and coronavirus disease 2019: A bibliometric and visualized study
Authors: Shah Muhammad Waseem , Ahmad Tauseef , Khan Muhammad , Muhammad Shafi , Sun Guiju
Published: July 2022

Background and aim:

Vitamin D play a substantial role in immune function, but little is known about its prevention in coronavirus disease 2019 (COVID-19). A detail bibliometric analysis of the published scientific literature indexed in Web of Science on vitamin D as a therapeutic option for the COVID-19 patients’ treatment is lacking. Thus, the current study was conducted to determine the key bibliometric indices and plot the global research on vitamin D and COVID-19.

Methods:

The Web of Science Core Collection database was utilized to retrieve publications on vitamin D and COVID-19. A Boolean search strategy was applied and the obtained data were exported to Microsoft Excel to generate relevant graphs. Furthermore, VOSviewer software version 1.6.17 for Windows was used to generate co-authorship countries, bibliographic coupling sources and co-occurrence keyword network visualization mapping. In addition, RStudio and Bibliometric online tool were used to generate WordCloud and thematic map, and intercountries relation map, respectively.

Results:

A total of 818 publications on vitamin D and COVID-19 were included in the final analysis. These publications were cited 10,713 times, with an H-index of 50. The number of publications and citations score from 2020 to November 2021 increased from 317 (2423 citations) to 501 (8290 citations). Delanghe JR and Speeckaert MM were the most prolific authors with 13 publications each. The most productive journal was Nutrients (n = 63). The most studied research area is nutrition dietetics. The most widely used author keywords were COVID-19 (n = 444), Vitamin D (n = 312), and SARS-CoV-2 (n = 190). The National Institute of Health and US Department of Health and Human Services were the leading funding agencies. Harvard University was the most active institution with 25 publications. The United States of America was the highly contributing and influential country in terms of publications (n = 203) and total link strength (n = 185).

Conclusion:

It was concluded that an increasing trend in the number of publications on vitamin D and COVID-19 has been observed. Significantly, the majority of the research has been conducted in developed countries. Most importantly, over the time, the direction of research has been changed and the recent trend topics are vitamin D deficiency, risk and infection, and vitamin D supplementation based on KeyWords Plus. The use of vitamin D supplement is one of the promising therapeutic options for COVID-19 treatment. Therefore, the current study not only highlight the global research trends but also provide standard bibliographic information for future studies.
Total failure of spinal anesthesia for cesarean delivery, associated factors, and outcomes: A retrospective case–control study
Authors: Punchuklang Wiruntri , Nivatpumin Patchareya , Jintadawong Thatchanan
Published: July 2022

Spinal anesthesia is the anesthetic technique of choice for patients undergoing cesarean delivery. In the present study, total spinal anesthesia failure was defined as a case when an absent blockade or inadequate surgery required general anesthesia administration with an endotracheal tube. This study aimed to investigate factors related to this condition and report its maternal and neonatal outcomes.

This retrospective matched case–control study was conducted by recruiting 110 patients with failed spinal anesthesia and 330 control patients from September 1, 2016, to April 30, 2020, in the largest university hospital, Thailand.

Of 12,914 cesarean deliveries, 12,001 patients received single-shot spinal anesthesia (92.9%) during the study period. Total spinal anesthesia failure was experienced by 110/12,001 patients, giving an incidence of 0.9%. Factors related to the failures were a patient body mass index (BMI) ≤29.5 kg/m2 (adjusted odds ratio 1.9; 95% confidence interval 1.2–3.1; P = .010) and a third-year resident (the most senior trainee) performing the spinal block (adjusted odds ratio 2.4; 95% confidence interval 1.5–3.7; P < .001). In the group with failed spinal anesthesia, neonatal Apgar scores at 1 and 5 minutes were lower than those of the control group (both P < .001). Two patients in the failed spinal anesthesia group (2/110; 1.8%) had difficult airways and desaturation.

Independent factors associated with total spinal anesthesia failure were a BMI of ≤29.5 kg/m2 and a third-year resident performing the spinal block. Although the incidence of total failure was infrequent, there were negative consequences for the mothers and neonates. Adjusting the dose of bupivacaine according to the weight and height of a patient is recommended, with a higher dose appropriate for patients with a lower BMI.
Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent
Authors: Lucocq James , Scollay John , Patil Pradeep
Published: July 2022

Objective:

The present study defines prolonged length of stay (PLOS) following elective laparoscopic cholecystectomy (LC) and its relationship with perioperative morbidity. A preoperative risk tool to predict PLOS is derived to inform resource utilization, risk stratification and patient consent.

Background:

Surgical candidates for elective LC are a heterogeneous group at risk of various perioperative adverse outcomes. Preoperative recognition of high-risk patients for PLOS has implications on feasibility for day surgery, resource utilization, preoperative risk stratification, and patient consent.

Methods:

Data for all patients who underwent elective LC between January 2015 and January 2020 across 3 surgical centers (1 tertiary referral center and 2 satellite units) in 1 health board were collected retrospectively (n=2166). The optimal cut-off of PLOS as a proxy for operation-related adverse outcomes was found using receiver operating characteristic curves. Multivariate logistic regression was conducted on a derivation subcohort to derive a preoperative model predicting PLOS. Receiver operating characteristic curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined.

Results:

A LOS of ≥3 days following elective LC demonstrated the best diagnostic ability for operation-related adverse outcomes [area under curve (AUC)=0.87] and defined the PLOS cut-off. The rate of PLOS was 6.6% (144/2166), 86.1% of which had a perioperative adverse outcome. PLOS was strongly associated with all adverse outcomes (subtotal, conversion-to-open, intraoperative complications, postoperative complication/imaging/intervention) (P<0.001). The preoperative model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.80) and stratified patients appropriately.

Conclusions:

Morbidity in PLOS patients is significant and pragmatic patient selection in accordance with the risk tool may help centers improve resource utilization, risk stratification, and their consent process. The risk tool may help select candidates for cholecystectomy in a strictly ambulatory/outpatient center.
Learning Curve of Laparoscopic Gastrectomy: A Multicenter Study
Authors: Brenkman Hylke J.F. , Claassen Linda , Hannink Gerjon , van der Werf Leonie R. , Ruurda Jelle P.-H. , Nieuwenhuizen Grard A.P. , Luyer Misha D.P. , Kouwenhoven Ewout A. , van Det Marc J. , van Berge Henegouwen Mark I. , Gisbertz Suzanne S. , Stoot Jan H.M.B. , Hulsewé Karel W.E. , van Workum Frans , van Hillegersberg Richard , Rosman Camiel
Published: July 2022

Objective:

To evaluate the learning curve of laparoscopic gastrectomy (LG) after an implementation program.

Background:

Although LG is increasingly being performed worldwide, little is known about the learning curve.

Methods:

Consecutive patients who underwent elective LG for gastric adenocarcinoma with curative intent in each of the 5 highest-volume centers in the Netherlands were enrolled. Generalized additive models and a 2-piece model with a break point were used to determine the learning curve length. Analyses were corrected for casemix and were performed for LG and for the subgroups distal gastrectomy (LDG) and total gastrectomy (LTG). The learning curve effect was assessed for (1) anastomotic leakage; and (2) the occurrence of postoperative complications, conversions to open surgery, and short-term oncological parameters.

Results:

In total 540 patients were included for analysis, 108 patients from each center; 268 patients underwent LDG and 272 underwent LTG. First, for LG, no learning effect regarding anastomotic leakage could be identified: the rate of anastomotic leakage initially increased, then reached a plateau after 36 cases at 10% anastomotic leakage. Second, the level of overall complications reached a plateau after 20 cases, at 38% overall complications, and at 5% conversions. For both LDG and LTG, each considered separately, fluctuations in secondary outcomes and anastomotic leakage followed fluctuations in casemix.

Conclusion:

On the basis of our study of the first 108 procedures of LG in 5 high-volume centers with well-trained surgeons, no learning curve effect could be identified regarding anastomotic leakage. A learning curve effect was found with respect to overall complications and conversion rate.
Optic Disc Drusen in Patients With Ocular Hypertension: A Case Series and Review of the Literature
Authors: Kohli Darrell , Chen John J. , Bhatti M. Tariq , Moore-Weiss Jodi M. , Roddy Gavin W.
Published: July 2022

Background:

The identification of glaucomatous optic neuropathy in the setting of optic disc drusen (ODD) is a challenge, and the decision of whether to offer treatment in the form of intraocular pressure (IOP) reduction is controversial. Here, we present a series of patients with coexisting ocular hypertension and ODD to evaluate clinical features, treatment options, and progression of optic neuropathy. In addition, a review of the literature on ODD with elevated IOP is provided.

Methods:

Six patients with ODD and a history of ocular hypertension are presented. Components of the examination and imaging modalities used to establish the diagnosis of ODD were recorded and a description of ocular hypertension history, glaucoma testing, and the potential treatment of IOP were also provided.

Results:

In this series, 4 of 6 patients with concurrent ocular hypertension and ODD showed progression of optic neuropathy as assessed by visual field or retinal nerve fiber layer thickness. Of the 2 patients who did not show evidence of progression, 1 was treated with IOP-lowering medications and 1 was observed off treatment. Of the 4 patients who showed evidence of progression, all 4 were initially treated with IOP-lowering medications and 2 ultimately went on to have trabeculectomy surgery. In the patients with progressive optic neuropathy, lowering the IOP seemed to halt the progression suggesting there was a pressure‐sensitive component.

Conclusions:

Distinguishing changes to the optic nerve, particularly the structural changes at the lamina cribrosa of true glaucomatous optic neuropathy in the setting of ODD, is a challenge. Careful consideration of risk factors including age, presenting features, progression indicators, and management goals is to be accounted for in the decision to offer treatment. We see the presence ODD in the patients with ocular hypertension as an additional risk for progressive changes to the nerve fiber layer and visual field that needs to be considered when determining whether to initiate therapy. Our data suggest that treatment of IOP in the patients with ocular hypertension with ODD and evidence of progression reduces the risk of further progression. Further work is needed to determine whether progression of optic neuropathy in the setting of coexisting ODD and ocular hypertension is related mechanistically to predominantly an ODD-type process, a glaucomatous process, or a combination thereof.
A Tale of Progressive Painless Vision Loss in a 64-Year-Old Man Due to Leber Hereditary Optic Neuropathy
Authors: Aung Moe H. , Volpe Nicholas J. , Choi Daniel J. , Stein Joel M. , Goldstein Amy , Liu Grant T.
Published: July 2022

A 64-year-old man presented with painless sequential bilateral vision loss, consistent with optic neuropathy, over the span of months. The significant decline in his visual function was out of proportion to the appearance of the optic nerves (which were not pale) or changes in his retinal nerve fiber layer thickness on optical coherence tomography. Neuroimaging revealed only mild T2 signal abnormality and faint enhancement in the left optic nerve. Extensive workup for potential infectious, metabolic, inflammatory, and ischemic etiologies was unremarkable. Empiric treatment with intravenous steroids did not slow or ameliorate the vision loss. Ultimately, genetic analysis revealed a missense m.11778G>A mutation in mitochondrial MT-ND4 gene, consistent with Leber hereditary optic neuropathy. Initiation of multivitamin supplements and idebenone unfortunately did not result in recovery of vision.
FLUORESCE: A Pilot Randomized Clinical Trial of Fluoxetine for Vision Recovery After Acute Ischemic Stroke
Authors: Schneider Colleen L. , Prentiss Emily K. , Busza Ania , Williams Zoë R. , Mahon Bradford Z. , Sahin Bogachan
Published: July 2022

Background:

Poststroke homonymous hemianopia is disabling, and complete spontaneous recovery is rare. In this randomized, placebo-controlled, double-blind, pilot clinical trial, we tested whether fluoxetine enhances vision recovery after stroke.

Methods:

We randomized 17 consecutive adults 1:1 to 90 days of fluoxetine 20 mg daily vs placebo within 10 days of an ischemic stroke causing isolated homonymous hemianopia. The primary end point was percent improvement in 24-2 automated perimetry at 6 months. Twelve participants completed the study. Clinical trial registration NCT02737930.

Results:

Intention-to-treat analysis of the primary end point, percent improvement in perimetric mean deviation, showed a nonsignificant benefit of fluoxetine (64.4%, n = 5) compared with placebo (26.0%, n = 7, one-tailed 95% confidence interval (CI) = (−2.13, ∞), P = 0.06). The original blind field completely recovered in 60% receiving fluoxetine and 14% receiving placebo (odds ratio = 7.22, one-tailed 95% CI = (0.50, ∞)).

Conclusion:

These results suggest a trend in favor of fluoxetine for vision recovery after stroke and have the potential to inform the design of a larger multicenter trial.
Anemia and Idiopathic Intracranial Hypertension: A Case–Control Study
Authors: Sverdlichenko Irina , Yu Caberry W. , Margolin Edward , Micieli Jonathan A.
Published: July 2022

Background:

Idiopathic intracranial hypertension (IIH) is a condition that mostly affects obese women of childbearing age but has been reported to be temporally related to new diagnoses of anemia. Despite these reports, the association between anemia and IIH remains controversial. The present study aimed to understand the strength of association between anemia and IIH through a case–control design.

Methods:

Consecutive IIH patients were recruited from neuro-ophthalmology clinics and matched by age and sex to consecutive patients attending neuro-ophthalmology clinics with diagnoses other than IIH. Complete blood counts (CBCs) were reviewed within 6 months of neuro-ophthalmology presentation, and anemia was diagnosed by hemoglobin of <120 g/L in women and <130 g/L in men. Anemia was classified as microcytic (mean corpuscular volume (MCV) < 80 fL), normocytic (MCV 80-100 fL), and macrocytic (MCV > 100 fL) as well as mild (hemoglobin >110 g/L), moderate (hemoglobin 80–109 g/L), and severe (hemoglobin <80 g/L).

Results:

One hundred twenty-three IIH patients and 113 controls were included in the study. More IIH patients than controls had anemia (22.8%, 28/123 vs 10.6%, 12/113, P = 0.01) with an odds ratio of 2.48 (95% CI: 1.19, 5.16). There were no differences in severity of anemia or MCV between IIH patients and controls, with anemia most often being mild (57.1%, 16/28 vs 75%, 9/12) and normocytic (50.0%, 14/28 vs 50.0%, 6/12). However, 17.9% (5/28) of IIH patients had severe anemia compared with zero in the control group. IIH patients had a higher mean platelet count than controls (P < 0.001), and there were no differences on leukocyte counts.

Conclusion:

Idiopathic intracranial hypertension patients have a higher prevalence of anemia compared with non-IIH neuro-ophthalmology patients. The anemia was mostly mild and may be explained by other factors related to worse health status and obesity, including low socioeconomic status, poor nutrition, and polycystic ovary syndrome. However, as a CBC is a widely available test and anemia may influence the IIH disease course, we propose that this test be obtained in all patients with new papilledema.
Characterization of the intrahippocampal kainic acid model in female mice with a special focus on seizure suppression by antiseizure drugs and DMSO
Authors: Widmann Melanie , Lieb Andreas , Steck Angela , Fogli Barbara , Mutti Anna , Schwarzer Christoph
Published: July 2022

Objectives

Affecting around 50 million people, men and women likewise, epilepsies are among the most common neurological diseases worldwide. Despite special challenges in the medical treatment of women with epilepsy, previous research has mainly focused on males, in particular preclinical animal studies, leaving a gap that needs to be urgently addressed. The intrahippocampal kainic acid (IHKA) mouse model of temporal lobe epilepsy (TLE) as one of the most frequently studied models in males is used for screening of novel antiepileptic therapies. In this study we investigate the IHKA model of TLE in female mice, in particular drug-resistance of hippocampal paroxysmal discharges. Furthermore, we provide evidence for anti-seizure effects of dimethyl sulfoxide (DMSO) in epileptic, but not naÏve mice.

Methods

After injecting KA unilaterally into the hippocampus of female mice, we monitored the development of epileptiform activity in in-vivo EEG recordings, evaluated responsiveness to the commonly prescribed antiseizure drugs (ASDs) lamotrigine (LTG), oxcarbazepine (OXC) and levetiracetam (LEV) and assessed typical neuropathological alterations of the hippocampus. Moreover, the effect of different doses of DMSO was tested in the IHKA chronic epilepsy model as well as on the PTZ-induced acute seizure threshold in both female and male mice.

Results

In the IHKA model, female mice replicated the key features of human TLE (EEG and neuropathological changes). Importantly, hippocampal paroxysmal discharges (HPDs) in female mice did not respond to commonly prescribed ASDs, thus representing a suitable model of drug-resistant seizures. The solvent DMSO caused a significant short-term reduction of HPDs, but did not affect the threshold of acute seizures.

Significance

By characterizing the drug-resistance of HPDs in the IHKA model of TLE in female mice we have laid a foundation for future research addressing sex-specific aspects. Considering the special issues complicating the therapeutic management of women, inclusion of females in the quest for novel treatment strategies is imperative. The observed effect of DMSO on epileptiform activity underlines that its application in epilepsy research is problematic and that the choice of solvent and appropriate vehicle control is crucial.
Pattern of Thyrocardiac Disease among Patients with Hyperthyroidism in Hong Kong
Authors: Lau Daniel Kwun-Hung , Mok Ka-Ho , Ng Cheuk-Wing , Lam Cho-Pui , Liu Zhiwei , Li Bai-Lin , Lao Jian-Hua , Ma Shing-Fung
Published: July 2022

This research aims to investigate the association between hyperthyroidism and age, sex, and infraction of the myocardium in the Hong Kong population in order to detect hyperthyroidism-induced infraction earlier (e.g., thyrocardiac disease) through chemiluminescent microparticle immunoassay (CMIA). A total of 7616 random blood specimens from males and females were collected and examined by Architect i immunoassay platform to obtain quantitative laboratory values of Free FT4, TSH, and hs-cTnI in samples serum differentiating into overt and subclinical hyperthyroidism cases. The age was between 19 and 81 years old. In this research, for population characteristics, 57 cases confirmed as hyperthyroidism (e.g. FT4 > 1.48 ng/dL, according to Abbott’s suggested reference interval) were used for analysis and 22 cases were examined in the laboratory. The highest number of hyperthyroidisms including overt and subclinical cases in female was 43 (75.44%), rather than males. For prevalence data of hyperthyroidism between September 2019 to January 2020 in Hong Kong, the range was from 0.62% to 0.93% (Median percentage = 0.75%). The research will explore the in-depth impact of gender difference on thyrocardiac disease, risk of thyrocardiac disease by age group, and the possible relationship between FT4 and hs-cTnI.
Advanced MRI scan acquisition metrics improve baseline disease severity predictions compared to traditional community MRI scan metrics
Authors: Al-Shawwa Abdul , Ost Kalum , Cadotte David , Anderson David , Evaniew Nathan , Jacobs Bradley , Cohen-Adad Julien
Published: July 2022

Degenerative Cervical Myelopathy (DCM) is the functional derangement of the spinal cord and acts as one of the most common atraumatic spinal cord injuries. Magnetic resonance imaging (MRI) are key in confirming the diagnosis of DCM in patients, though the utilization of higher fidelity magnetic resonance imaging scans and their integration into machine learning models remains largely unexplored. This study looks at the predictive ability of common community MRI scans in comparison to high fidelity scans in disease diagnosis. We hypothesize that the utilization of higher fidelity “advanced” MRI scans will increase the effectiveness of machine learning models predicting DCM severity. Through the utilization of Random Forest Classifiers, we have been able to predict disease severity with 41.8% accuracy in current community MRI scans and 63.9% in the advanced MRI scans. Furthermore, across the different predictive model variations tested, the advanced MRI scans consistently produced higher prediction accuracies compared to the community MRI counterparts. These results support our hypothesis and indicate that machine learning models have the potential to predict disease severity. However, neither performed well enough to be considered for use in clinical practice, indicating that the utilization of more sophisticated machine models may be required for these purposes.
Dynamics of sleep, feeding, and metabolic homeostasis inDrosophilaensheathing glia, astrocytes, and neurons
Authors: Flores-Valle Andres , Vishniakou Ivan , Seelig Johannes D.
Published: July 2022

Sleep is critical for homeostatic processes in the brain, including metabolism and waste removal. Here, we identify brain-wide, locally acting sleep homeostats for the short, naturally occurring sleep bouts ofDrosophilain the two major classes of glia that arborize inside the brain, astrocytes and ensheathing glia. We show that glia surround respiratory tracheal tubes, that the metabolic gas carbon dioxide, changes in pH, or behavioral activity, all induce long lasting calcium responses, and that astrocytes and glia show circadian calcium modulations. Glia describe sleep homeostasis in behaving flies more faithfully than previously identified sleep circuits in the central complex, but a subset of neurons in the fan-shaped body is important for feeding homeostasis. Local optogenetic activation of astrocytes or ensheathing glia is sufficient to induce sleep. Together, glia calcium levels can be modeled as homeostatic controllers of metabolic activity, thus establishing a link between metabolism and sleep.
The decagonal AlCuRh quasicrystal modelled with five atomic surfaces – high-temperature X-ray diffraction data analysis
Authors: Buganski Ireneusz , Strzalka Radoslaw , Wolny Janusz
Published: July 2022

Five datasets of high-temperature X-ray diffraction performed upon the decagonal phase of AlCuRh are used to derive the temperature-related structural changes. Two sets of atomic structure refinements are conducted, with four and five atomic surfaces, respectively. The fifth atomic surface emerges as a consequence either of the transition to a tiling with different local isomorphism than the Penrose tiling or of the structure being phason disordered. The correlation of the occupancy of the fifth atomic surface with the thermal dependence of the lattice constants is 80%. In addition, the structural refinement with five atomic surfaces allowed a better agreement with the experimental data to be obtained, compared with the model with four atomic surfaces.