bluuebunny/crossref_metadata_2025 huggingface dataset:
P06 Management challenges and treatment options of difficult-to-treat organisms in patients with complex medical devices: a case of vancomycin-resistant Enterococcus infection in a patient with a left ventricular assist device
Authors: Hrycaiczuk Joshua , Ali Bazga
Published: August 2024

Background

Medical devices are becoming increasingly sophisticated. Inserting prosthetic devices into a patient has an inherent risk of infection and as the complexity of devices increases the management of infective complications becomes more problematic. Over the last 40 years the incidence of cardiac device-related infective endocarditis has risen more than fourfold.1 This risk is compounded by the increasing prevalence of antimicrobial resistance limiting treatment options.

Clinical case

A 65-year-old man had a left ventricular assist device (LVAD) inserted for severe ischaemic cardiomyopathy. An LVAD is an electromechanical pump placed into the left ventricle; it supports it in maintaining cardiac output acting as either a bridge to recovery or transplant, or to extend the patient’s quality and duration of life.2 This insertion was complicated by vancomycin-susceptible Enterococcus faecium bacteraemia with PET scan demonstrating abnormal update within the LVAD system. He was treated with 6 weeks of IV vancomycin and was discharged to the outpatient setting to continue 6 weekly dalbavancin for the next 12 months. Nine months into treatment, bacteraemia recurred and susceptibilities demonstrated the organism had become resistant to vancomycin. Long-term, non-toxic treatment options were needed as, due to the complex nature of the LVAD device, removal was not viable. Treatment choices were limited, and because of the toxic effects associated with long-term linezolid use, daptomycin was chosen as a daily OPAT option. Subsequent daptomycin MIC testing suggested this would be ineffective (MIC=12) and his treatment was switched to minocycline plus rifampicin. Further testing demonstrated rifampicin resistance (MIC=32) and minocycline partial resistance (MIC=4). The patient remains stable and asymptomatic in the community on minocycline whilst further long-term therapeutic options are considered to suppress infection in this challenging case.

Conclusions

This case highlights the growing problem of managing chronic infections with resistant organisms in patients with irremovable devices. Treatment options specifically for vancomycin-resistant Enterococcus are limited, especially when considering a case where the patient requires prolonged outpatient antibiotics to sustain meaningful quality of life. Although new antimicrobials (contezolid and delpazolid) are in development for VRE, these do not have a novel mechanism of action.3 This case demonstrates the importance of developing novel therapeutic options to combat resistant organisms and the significance of minimizing the development and spread of antimicrobial resistance.
P11 Pharmacists’ knowledge, attitudes and perceptions towards antimicrobial stewardship and resistance during the COVID-19 pandemic at secondary care settings in the UK
Authors: Elshenawy Rasha Abdelsalam , Umaru Nkiruka , Aslanpour Zoe
Published: August 2024

Background

Addressing antimicrobial resistance (AMR) is pivotal during the COVID-19 pandemic. Inappropriate antibiotic prescribing exacerbated AMR, prompting the WHO to advocate for antimicrobial stewardship (AMS). The Royal Pharmaceutical Society (RPS) highlighted pharmacists’ role in optimizing antimicrobial use. Investigating pharmacists’ knowledge, attitudes and perceptions (KAP) regarding antibiotic prescribing, AMR and AMS contributes to global efforts to combat AMR and improve AMS practices.

Objectives

To explore pharmacists’ KAP during COVID-19.

Methods

In 2023, the study utilized a prospective cross-sectional design and employed an online survey questionnaire via Qualtrics to evaluate pharmacists’ KAP regarding antibiotic prescribing, AMR and AMS. Ethical approval was obtained, and implicit consent was assumed. The participants were registered pharmacists working at a secondary care setting, an NHS Foundation Trust within the UK, during the COVID-19 pandemic. The study involved patient and public involvement, was registered with the ISRCTN and OCTOPUS registry, and analysed data using descriptive statistics and IBM SPSS Statistics. A sample size of 125 was considered for a 5% margin of error and 95% confidence level.

Results

The results revealed that the majority of respondents were aged 25–31 (44.0%), held postgraduate degrees (70.4%), were female (71.2%) and had 6–20 years of experience (41.6%). Regarding knowledge, high percentages agreed that antimicrobial resistance is a public health concern (85.2%), actions in combating AMR affect society (91.2%) and implementing AMS promotes judicious antibiotic use (85.6%). For attitudes and perceptions, respondent pharmacists indicated agreement with updated antibiotic guidelines (56.8%), influenced antibiotic prescribing due to COVID-19 patient conditions (80%) and support from microbiologists and AMS teams for informed decisions (79.2%).

Conclusions

This study highlights pharmacists’ crucial role in fighting AMR during the COVID-19 pandemic. They demonstrated good KAP emphasizes their potential to co-lead AMS implementation, ultimately saving lives and promoting global health.
P22 How do we improve gentamicin prescribing and reviewing within colorectal wards—a quality improvement project
Authors: Smith Lauren , Palenzuela Espe , Sutherland Rebekah
Published: August 2024

Objectives

A retrospective study investigating gentamicin prescribing and reviewing, focusing on Trak short code ‘\gent’, across colorectal wards at Western General Hospital, Edinburgh.

Methods

A focussed questionnaire regarding NHS Lothian gentamicin prescribing charts and Trak short code ‘\gent’ was placed around targeted wards in Western General Hospital in November 2023. A retrospective search of HEPMA data including all patients who had received gentamicin in Colorectal wards between 18 August 2023 and 18 December 2023. A total of 100 patients, 25 from each ward, were randomly selected. Trak data was analysed using the search terms; ‘gentamicin’, ‘IVOS’ and ‘\gent’. Patient data including the number of gentamicin doses received, indications for gentamicin prescribing, evidence of documentation of gentamicin reviewing and on what day of the course, and the use of the ‘\gent’ Trak short code was gathered.

Results

Questionnaire results: 33 responses, 75.8% (25) felt the NHS Lothian gentamicin charts are not well designed, 72.7% (23) did not know ‘\gent’ existed. From the HEPMA search, 100 patients were included, of which 59% were male. The median age was 67 years (19–90). The average gentamicin dose received was 3.8 doses, while 52% of patients received 5 doses. Indication of gentamicin; 58% intra-abdominal infection. Sixty-five percent had documented discussion of gentamicin reviewing, 69.2% of these only occurred on the day of dose 5. Thirty-five percent had no documentation of gentamicin reviewing; 80% of the course length prompts occurred on Day 5. There was no documented discussion on Day 3 of gentamicin, as prompted by the NHS Lothian gentamicin chart. Overall use of \gent was 2%.

Conclusions

(i) The Trak short code ‘\gent’, designed to help make prescribing easier, is not being used. (ii) A large proportion of clinical staff are unaware of ‘\gent’. (iii) Clinical teams do not routinely document their gentamicin reviewing. (iv) Delayed gentamicin doses continue to be given due to lack of communication and lack of documentation. Since completing the search, an informative poster has been placed around the same wards to highlight ‘\gent’ and its uses. Further data will be collated, and a second cycle of the project will involve another retrospective HEPMA search and study of gentamicin patients and the use of ‘\gent’ with the aim of an increase in use and discussion of the review process.
P27 Investigation of subtherapeutic vancomycin levels
Authors: Liu Alice
Published: August 2024

Background

A retrospective audit was conducted in a large UK district hospital to assess the reasons behind subtherapeutic vancomycin assay levels and make recommendations as to how to improve the quality of vancomycin prescribing.

Materials and methods

The vancomycin assay levels were extracted from biochemistry data retrospectively in a 6 month period and patients’ notes with prescription charts were examined for low assay levels as defined by the local hospital’s vancomycin protocol.

Results

Twenty-seven percent of assay results (92 out of 337) were found to be at subtherapeutic levels in 57 patients, in which the vancomycin plasma concentration was less than 10 mg/L. Only 45 patient records were able to be retrieved for data analysis, of which 7 patients (16%) received either no or under loading dose during the treatment initiation. In terms of maintenance dose, 12 patients (27%) received under dose and 18 patients (40%) started the dose at the wrong time; half of this group had severely delayed the treatment for more than 4 h. Fifty-five subtherapeutic levels were identified among the 45 patients and the reasons for this included that assay samples were sent too early, dosage was prescribed incorrectly due to misconception of renal function, body weight miscalculation (i.e. ideal body weight versus actual body weight), as well as low dose being started because of acute or chronic renal impairment.

Conclusions

The audit demonstrated there was a knowledge gap in vancomycin dosing calculation judged by patient’s body weight and renal function and the correct timing of assay. A pragmatic approach including education of junior doctors in antimicrobial prescribing, user-friendly guidelines or algorithmic chart in dosage recommendation, and pre-formatting of electronic prescriptions via EPMA should be adopted to increase the safe usage of vancomycin.
P32 Bloodstream infection following transrectal ultrasound-guided prostate biopsy: antibiotic susceptibility of isolates relative to perioperative antibiotic prophylaxis regimen
Authors: Mulrooney C , Gregg S , Leonard M , O’Loughlin M , Dowling C , Ni Riain U
Published: August 2024

Background

Transrectal ultrasound (TRUS)-guided biopsy of the prostate is a standard investigation for the diagnosis of prostate cancer.1 Perioperative antibiotic prophylaxis is standard of care, notwithstanding which, infection complications post biopsy are reported at 2%–6%.2,3 Single agent ciprofloxacin was used as perioperative antibiotic prophylaxis for TRUS-guided biopsy within our centre until 2011 when data relating increasing rates of fluoroquinolone resistance among Enterobacterales prompted a change. From 2011, prophylaxis changed to dual agent ciprofloxacin plus gentamicin. Scheduled review of the hospital’s empirical antimicrobial guidelines is undertaken every 3 years, most recently in 2024. Review of antibiograms of bloodstream infection isolates is an integral part of the antimicrobial guideline review process, to inform change in empirical regimens, if indicated, based on local antibiotic resistance rates.

Objectives

Specific to TRUS-guided biopsy guidelines, antibiotic susceptibility data for organisms associated with invasive infection post TRUS biopsy from 2021 to 2023 was reviewed.

Methods

Post-procedure surveillance database identified patients who required hospital readmission due to suspected or confirmed infection following TRUS-guided biopsy of prostate between January 2021 and December 2023. Laboratory information systems of all five hospitals in the region were accessed for blood culture results and the organism and antibiogram of any associated positive blood culture was recorded.

Results

Of 2073 patients who underwent TRUS-guided biopsy, 63 (3.04%) patients were readmitted to hospital with suspected infection. Of these readmitted patients, 13/63 had positive blood cultures. All of the isolates (13/13, 100%) were Escherichia coli and 12 of 13 (92.3%) E. coli isolates tested susceptible or susceptible increased exposure to at least one of gentamicin or ciprofloxacin: 12/13 (92.3%) susceptible to gentamicin; 8 (61.5%) susceptible/susceptible increased exposure to ciprofloxacin; 1 (7.7%) resistant to both ciprofloxacin and gentamicin.

Conclusions

The centre’s rate of significant infection complication is in line with published rates. The revised perioperative antibiotic prophylaxis regimen of dual therapy with gentamicin and ciprofloxacin remains appropriate. Following 2073 TRUS-guided biopsies over a 3 year period, only one patient requiring readmission with infection had a bloodstream infection with an organism resistant to both prophylactic agents, while five patients had bloodstream infection with an organism resistant to ciprofloxacin, the previous monotherapy regimen.
Elucidation of factors influencing spinal ankylosis in patients with axial spondyloarthritis
Authors: Izumiyama Takuya , Mori Yu , Kanabuchi Ryuichi , Hatakeyama Hiroshi , Aizawa Toshimi
Published: August 2024

Objectives

Spondyloarthritis encompasses conditions such as ankylosing spondylitis and psoriatic arthritis. Advanced axial spondyloarthritis causes significant spinal fusion, affecting daily activities. Recent therapeutic agents have enhanced the control of inflammation, yet they do not consistently stop the axial progression. This study aimed to identify factors influencing the progression of axial lesions over a 2-year period in Japanese patients with axial spondyloarthritis.

Methods

This retrospective and cross-sectional study included 47 axial spondyloarthritis patients. Spinal lesions were assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Patients were categorized into progressive and nonprogressive groups based on changes in their mSASSS scores. Various clinical parameters were analysed for correlation with ankylosis progression.

Results

The study found no significant correlation between ankylosis progression and traditional factors, including the level of inflammation or the use of biologics. However, modified Health Assessment Questionnaire scores were associated with disease progression. The baseline mSASSS was another significant factor, underscoring the importance of early detection and management.

Conclusions

This study showed that patient-reported outcomes and baseline mSASSS scores are crucial for assessing axial spondyloarthritis progression. This underscores the need for a comprehensive treatment strategy that addresses both clinical indicators and patient-reported outcomes.
Synthetic data generation by diffusion models
Authors: Zhu Jun
Published: August 2024

This paper provides a brief overview on diffusion models, which are extremely powerful on generating high-dimensional data, including images, 3D content, and videos, and provides insights for future work.
Methyl eugenol regulates mating behavior in oriental fruit flies by enhancing lek attractiveness
Authors: Zhang Jie , Liu Wei , Chang Hetan , Wang Qi , Yuan Jinxi , Liu Leyuan , Liu Chenhao , Zhang Yan , Ru Chuanjian , Yan Shanchun , Hansson Bill S , Wang Guirong
Published: August 2024

Plant-produced volatiles play a pivotal role as mediators in complex interactions between insects and plants. Despite the widespread recognition that these compounds serve as cues for herbivorous insects to locate their preferred host plants, their effects on insect mating behavior are less understood. Here, we show that male oriental fruit flies (Bactrocera dorsalis) are highly attracted to the host plant volatile compound methyl eugenol (ME), which enhances the attractiveness of male leks to females. To elucidate the molecular underpinnings of this phenomenon, we identify the olfactory receptor BdorOR94b1 responsible for detecting ME. Genetic disruption of BdorOR94b1 leads to a complete abolition of both physiological and behavioral responses to ME. Additionally, we confirm that, through digestion, male flies convert ME to (E)-coniferyl alcohol, a compound that enhances the attractiveness of their leks to females. This increased attractiveness allows females to select optimal mates, thereby enhancing their reproductive success. The impairment of ME detection significantly diminishes the mating advantage within the leks, as males are unable to locate and utilize ME effectively. Our findings unveil a novel mechanism through which plant volatile compounds regulate the mating behavior of the economically important oriental fruit fly and provide new insights into the general ecology of insect–plant interactions.
Systemic inflammation and changes in physical well-being in patients with breast cancer: a longitudinal study in community oncology settings
Authors: Gilmore Nikesha , Li Yue , Seplaki Christopher L , Sohn Michael , Wang Ying , Li Chin-Shang , Loh Kah Poh , Lin Po-Ju , Kleckner Amber , Mohamed Mostafa , Vertino Paula , Peppone Luke , Mustian Karen , Kadambi Sindhuja , Corso Steven W , Esparaz Benjamin , Giguere Jeffrey K , Mohile Supriya , Janelsins Michelle C
Published: August 2024

Background

Chemotherapy adversely affects physical well-being and inflammation may be related to changes in physical well-being. We evaluated the association of systemic inflammation with changes in physical well-being.

Methods

In a prospective study of 580 patients with stages I-III breast cancer we assessed immune cell counts, neutrophil:lymphocyte ratio (NLR), lymphocyte:monocyte ratio (LMR), and platelet:lymphocyte ratio (PLR) within 7 days before chemotherapy (pre-chemotherapy). Physical well-being was assessed using the Functional Assessment of Cancer Therapy: General—Physical Well-being subscale (FACT-PWB) pre-chemotherapy and 1 month and 6 months post-chemotherapy. Clinically meaningful decline in physical well-being was determined as decreasing FACT-PWB by more than one point from pre-chemotherapy level, and non-resilience defined as having decline post-chemotherapy and not returning to within one-point of pre-chemotherapy FACT-PWB by 6 months post-chemotherapy. Multivariable logistic regressions examined the association between inflammation and changes in physical well-being, adjusting for sociodemographic and clinical characteristics.

Results

Fifty-nine percent (310/529) and 36% (178/501) of participants had physical well-being decline post-chemotherapy and 6 months post-chemotherapy, respectively. Fifty percent (147/294) were non-resilient. Low NLR and PLR were associated with 1.78 (P = .01) and 1.66 (P = .02) fold greater odds of having a decline in physical well-being 6 months post-chemotherapy compared to those with high NLR and PLR, respectively. Low NLR and PLR were associated with 1.92 (P = .02) and 2.09 (P = 0.01) fold greater odds of being non-resilient 6 months post-chemotherapy compared to those with high NLR and PLR, respectively.

Conclusion

Low NLR and PLR were associated with chemotherapy-induced changes in physical well-being independent of sociodemographic and clinical risk factors.
Race and Superfund site remediation
Authors: Topaz Chad M , Garcia Nueva Berenize , Izidro de Souza Patrick , Schumann Jesse , Shvedova Leah , Cai Xizhen , Ning Shaoyang
Published: August 2024

Superfund is a federal program established in 1980 to manage the cleanup of hazardous waste sites across the United States. Given the health and economic costs borne by people living near these sites, any demographic disparities within the Superfund program are issues of environmental justice. We investigate whether racial demographics local to a Superfund site are associated with its cleanup status, and if so, how. Our work addresses gaps in the literature by using detailed geospatial processing, comprehensive data, and a more complete set of racial/ethnic categorizations. We study 1,688 Superfund sites across the country. Under a wide variety of modeling scenarios, we consistently find that the proportion of the nearby population that is Asian is negatively associated with the probability of a Superfund site being cleaned up. This association has remained unidentified until now, possibly because earlier research on Superfund sites did not distinguish Asian populations as a separate group. Our result underscores the need for specific measurement and inclusion of diverse populations in environmental studies.
Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy
Authors: Boggess KA , Valint A , Refuerzo JS , Zork N , Battarbee AN , Eichelberger K , Ramos GA , Olson G , Durnwald C , Landon MB , Aagaard KM , Wallace K , Scifres C , Rosen T , Mulla W , Valent A , Longo S , Young L , Marquis MA , Thomas S , Britt A , Berry D
Published: August 2024

(JAMA. 2023;330(22):2182–2190. doi:10.1001/jama.2023.22949)

Higher risks are associated with pregnancies in which the mother has a diagnosis of diabetes, whether preexisting type 2 diabetes mellitus (T2DM) or gestational diabetes diagnosed before 23 weeks gestation (EgD). Management of maternal diabetes is the best way to limit adverse pregnancy and birth outcomes for both mother and child and includes blood glucose monitoring, dietary modification, and insulin therapy to optimize glycemic control. This study tested the impact of adding metformin to insulin therapy on the risk of adverse neonatal outcomes. The Medical Optimization of Management of Overt Type 2 Diabetes in Pregnancy, hereafter referred to as the MOMPOD trial, implemented at 17 clinical U.S. sites, utilized a randomized, double-blinded, placebo-controlled protocol. Participants were pregnant between June 2017 and November 2021, aged 18 to 45 years, with singleton gestation pregnancies in the 10 to 22 weeks 6 days range and a diagnosis of T2DM or EgD requiring insulin therapy.
Prenatal Enzyme-Replacement Therapy
Authors: van der Ploeg AT
Published: August 2024

(N Engl J Med. 2022;387(23):2189–2193. doi: 10.1056/NEJMe2211515)

Genetic diseases are difficult to treat, and though treatments have been developed none are curative. One still developing treatment is enzyme replacement therapy, and it is currently the standard of care for several lysosomal disorders. A recent study reported the first use of in utero enzyme replacement therapy for Pompe disease, which significantly mitigated symptoms and prolonged the life of the fetus that underwent treatment. This article is an editorial that describes the origin, development, mechanisms, and implications of enzyme replacement therapy and discusses the implications of this recently published study.
Conservative Management of Placenta Accreta Spectrum and Breast-Milk Production
Authors: Coselli Jennie , Kassir Elias , Lambert Katherine , Trotter Rylee , Sibai Baha , Berens Pamela
Published: August 2024

Conservative management of placenta accreta spectrum (PAS) includes delivery of the fetus with retention of the placenta in situ. There are insufficient data evaluating the effect of leaving the placenta in situ with PAS on the ability to establish lactation. We performed a prospective cohort study of 126 patients diagnosed with PAS. Clinical data pertaining to breastfeeding were obtained, as well as laboratory values for β-hCG and progesterone. Our objective was to assess breast-milk production measured by time of onset of stage II lactogenesis and hormone values in individuals managed with placental retention compared with those undergoing hysterectomy. We found that the average time for onset of stage II lactogenesis was 5.6 days with conservative management and 3.8 days with cesarean hysterectomy (P=.07). Although β-hCG levels did not differ between groups, postpartum progesterone levels were lower in the cesarean hysterectomy group compared with the retained placenta group (1.86 ng/mL vs 62.9 ng/mL, P<.001).
Investigation of Video Ocular Counter-Roll Findings According to Head and Body Tilt Positions in Healthy Subjects
Authors: Kartal Özcan Ahsen , Satici Sema , Akbulut Ahmet Alperen , Kiliç Mert , Çankaya Sare , Polat Zahra
Published: August 2024

Objectives:

A vestibulo-ocular reflex called the ocular counter-roll can be used to assess how well the otolith organs are functioning. The video ocular counter-roll (vOCR) test is a recent addition to the videonystagmography test battery that allows for video recording and quantitative ocular counter-roll analysis. The purpose of this study is to investigate potential discrepancies in vOCR measurements obtained from a 30° lateral head tilt in the roll plane versus measurements obtained from a 30° tilt of the head and body.

Design:

Thirty otologically, and neurologically healthy subjects aged 18 to 30 (M = 23.32 years, SD = 2.66 years; 8 men, 22 women) participated in this study. Pure-tone audiometry, oculomotor tests, and vOCR evaluation were performed for all participants. The vOCR assessment was performed in 2 positions, 30° lateral head tilt, and 30° body tilt position. The degree of static vOCR eye position and vOCR asymmetry in both positions were calculated and compared.

Results:

There was no statistically significant difference between the vOCR findings obtained in the right and left 30° lateral head tilt (p = 0.546) and body tilt (p = 0.114). vOCR asymmetry was determined as median (interquartile range) 0.08 (0.07) in lateral head tilt position and 0.09 (0.06) in body tilt position. The degree of static vOCR (8.75° [1.91]) detected during body tilt was statistically greater than the static vOCR (6.62 [1.69]) detected during head tilt (p < 0.001). There was no statistically significant difference in terms of ocular counter-roll asymmetry detected between head tilt and body tilt (p = 0.918).

Conclusions:

Our study shows a significant difference in the vOCR responses during head tilt and body tilt, a finding that should be considered during clinical evaluation of vestibular function. There was no significant asymmetry between the responses with either head or body tilt.
Clinical endpoints in myositis: challenges and ways forward
Authors: Ricco Cristina , Stone Caroline J. , Werth Victoria P.
Published: August 2024

Purpose of review

This review addresses the challenges and advances in clinical endpoints for myositis, with a particular focus on ensuring comprehensive assessment of both muscle and skin disease activity. The relevance of this review stems from recent developments in outcome measures and their implications for clinical trial design and patient inclusivity. While quality of life (QoL) and lung involvement are also important aspects of myositis, they are beyond the scope of this review and need to be addressed in future studies.

Recent findings

Traditional outcome measures like the Total Improvement Score (TIS) have limitations, especially for patients with skin-predominant dermatomyositis (DM). Recent studies highlight the importance of incorporating skin-specific measures such as the Cutaneous Disease Area and Severity Index (CDASI) and the novel composite measure, Dermatomyositis Outcomes for Muscle and Skin (DMOMS). These measures provide a more balanced assessment of disease activity. Clinical trial data analyzed using these measures have demonstrated significant benefits for patients with both classic and amyopathic DM, emphasizing the need for their broader adoption.

Advancements in outcome measures are crucial for inclusive and effective myositis clinical trials. Incorporating comprehensive tools like the DMOMS can enhance the assessment of both muscle and skin disease activities, potentially leading to better therapeutic strategies and improved patient outcomes. This shift is essential for addressing the needs of all Idiopathic inflammatory myopathy patients, including those with skin-predominant DM.
Interfacility Transfer of Pediatric Supracondylar Elbow Fractures: Transfer by Ambulance Shows No Advantage in Speed of Transfer or Prevention of Complications
Authors: Richardson Spencer M. , Levey Sarah T. , Suryavanshi Joash R. , Parihar Amrit S. , Vrabec Curtis , Tysklind R. Gunnar , Bielski Robert J.
Published: August 2024

Background:

The treatment of supracondylar humerus (SCH) fractures is increasingly centralized in tertiary centers. Interfacility transfer from other facilities may occur by ground ambulance or privately owned vehicle (POV). The objective of this study was to determine if interfacility transfer by POV is equivalent in transfer time and perioperative complications compared with ground ambulance.

Methods:

This was a single-institution, retrospective study of SCH fractures with an intact pulse transferred by POV or ground ambulance. Transfer time points were collected to determine transfer time and speed. Associated injuries of ipsilateral fracture, skin at risk, and motor nerve palsy were recorded from orthopaedic documentation at the presentation. Insurance status and the Area Deprivation Index (ADI) were used as measures of socioeconomic disparity.

Results:

676 “urgent” Type III, IV, and flexion type SCH fractures and 167 “nonurgent” Type II SCH fractures were transferred by ambulance or POV. Open reduction was similar between urgent transfers transported by ambulance or POV (10% vs. 9%, P=0.344). There was no difference in transfer time (P=0.391) or transfer speed (P=0.416) between transfer groups. POV transfers were independently associated with no skin at risk (OR 2.1; 95% CI: 1.3-3.3, P=0.003), neurovascularly intact (OR 2.5; 95% CI: 1.4-4.4, P=0.001), and patients in the low (OR 1.9; 95% CI: 1.3-2.5, P=0.041) and moderate deprivation (OR 1.9; 95% CI: 1.1-3.5, P=0.034) compared with the high deprivation group. Medicaid insurance was associated with a lower odds ratio of private transport compared with commercial insurance (OR 0.54; 95% CI: 0.38-0.76, P=<0.001).

Conclusions:

Interfacility transfer of nonemergent SCH fractures by privately owned vehicles has a similar speed of transfer and perioperative complication rate to transfer by ground ambulance. Our findings allow the triaging of nonemergent SCH fractures for potential interfacility transfer by privately owned vehicles and bring attention to disparities in interfacility transfer methods.

Level of Evidence:

Level III- Retrospective cohort study.
Corner Osteotomy as the more Advanced Approach to Deformity Correction in Adult Spinal Deformity
Authors: Lee Ki Young , Lee Jung-Hee , Kang Kyung-Chung , Lee Won-Young , Kim Jin-Hyung
Published: August 2024

Study Design.

A retrospective study

Objective.

To investigate the usefulness of corner osteotomy (CO) in patients with adult spinal deformity (ASD) by comparing with pedicle subtraction osteotomy (PSO) for lordosis correction.

Summary of Background Data.

PSO remains a valuable procedure for patients with ASD, but it has a limit to obtaining correction angles exceeding 45° in patients with a large pelvic incidence or with previous spinal fusion surgeries. Theoretically, CO can exceed the limitation of PSO and can achieve a wide range of correction angles. However, no study has analyzed the clinical data and usefulness of CO.

Methods.

This study included 115 patients (mean age 71.1 y, mean follow-up period 78.9 mo) with ASD who underwent deformity correction using PSO or CO. Comparative analysis was performed on spinopelvic parameters including segmental angle (SA) around the osteotomy site, and clinical and surgical assessment between the PSO and corner groups.

Results.

In the corner group, the postoperative SA (35° vs. −39.3°, P=0.004) and the degree of SA correction (34.8° vs. 39.7°, P=0.004) were greater, and a broader range of SA correction was also possible (18-51° vs. 18-61°). Although the operative time was longer in the corner group (316.8 min vs. 342.3 min, P=0.014), the estimated blood loss (EBL) was lower (2841.3 mL vs. 2465.4 mL, P=0.032). There was no difference in major complication rates, but the frequency of rod fracture (RF) was lower in the corner group (36/27 vs. 1/51, P<0.05).

Conclusion.

CO showed a greater SA correction and achieved a broader range of SA correction angles than PSO with no difference in the incidence of major complications. In addition, the EBL and the frequency of RF were lower. Based on these results, we expect that CO can serve as a promising surgical alternative to PSO for spinal deformity correction among patients with ASD.
Long-term Efficacy of Pulmonary Artery Desnervation Treatment in Heart Failure With Preserved Ejection Fraction: A Subgroup Analysis of 3-year Results From the PADN-5 Study
Authors: Zhang Hang , Yu Wande , Zhang Mengyu , Li Wei , Kan Jing , Xie Dujiang , Zhang Juan , Chen Shaoliang
Published: August 2024

Objective:

The Pulmonary Arterial Denervation in Patients With Pulmonary Hypertension Associated With the Left Heart Failure (PADN-5) study proved that pulmonary artery denervation (PADN) is associated with significant improvements in hemodynamic and clinical outcomes in patients with combined pre- and post-capillary pulmonary hypertension (CpcPH). This study aimed to assess the 3-year clinical results of PADN in patients who had heart failure with preserved ejection fraction (HFpEF) developing into CpcPH (HFpEF-CpcPH).

Methods:

In this post hoc analysis of the PADN-5 trial, 38 patients with HFpEF were included in screening out of 98 patients with CpcPH who were randomly assigned to treatment with sildenafil and sham PADN (sham PADN (plus sildenafil) group, abbreviated as sham group) or PADN (PADN group). HFpEF in the PADN-5 trial was defined as a left ventricular ejection fraction ≥50%, and CpcPH was defined as a mean pulmonary arterial pressure ≥25 mmHg, a pulmonary arterial wedge pressure >15 mmHg, and a pulmonary vascular resistance >3.0 WU. The changes in the 6-minute walk distance (6-MWD) and the plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) at 6-month and 3-year follow-up, as well as the clinical endpoint of the occurrence of clinical worsening, defined as cardiopulmonary-related death, rehospitalization, or heart or lung transplantation at 3-year follow-up were examined.

Results:

Thirty-eight patients with HFpEF-CpcPH were assigned to the PADN group (n = 19) or the sham group (n = 19). At the 6-month follow-up, 6-MWD (433 (275, 580)m vs. 342 (161, 552)m), and reductions in NT-proBNP (−47% (−99%, 331%) vs. −12% (−82%, 54%)) were significantly improved in the PADN group (all P < 0.05). Over the 3-year follow-up period, PADN treatment resulted in marked increases in 6-MWD (450 (186, 510)m vs. 348 (135, 435)m) and reductions in NT-proBNP (−55% (−99%, 38%) vs. −10% (−80%, 95%)) (all P < 0.05). Clinical worsening was experienced by 12 patients (63%) in the sham group, but by only 5 patients (26%) in the PADN group (hazard ratio = 0.149, 95% confidence interval: 0.038–0.584, P = 0.006). The 6-MWD and PADN treatments were independent predictors of clinical deterioration in patients with HFpEF-CpcPH.

Conclusions:

PADN therapy is associated with improvements in exercise capacity and clinical outcomes. PADN therapy may have a potential role in patients with HFpEF-CpcPH for whom current treatment options are limited.
Preliminary clinical practice of radical prostatectomy without preoperative biopsy
Authors: Liu Ranlu , Yin Lu , Ma Shenfei , Yang Feiya , Lian Zhenpeng , Wang Mingshuai , Lei Ye , Dong Xiying , Liu Chen , Chen Dong , Han Sujun , Xu Yong , Xing Nianzeng
Published: August 2024

Background:

At present, biopsy is essential for the diagnosis of prostate cancer (PCa) before radical prostatectomy (RP). However, with the development of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI), it might be feasible to avoid biopsy before RP. Herein, we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.

Methods:

Between December 2017 and April 2022, 56 patients with maximum standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals. The consistency between clinical and pathological diagnoses was evaluated. Preoperative characteristics were compared among patients with different pathological types, T stages, International Society of Urological Pathology (ISUP) grades, and European Association of Urology (EAU) risk groups.

Results:

Fifty-five (98%) patients were confirmed with PCa by pathology, including 49 (89%) with clinically significant prostate cancer (csPCa, defined as ISUP grade ≥2 malignancy). One patient was diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). CsPCa patients, compared with clinically insignificant prostate cancer (cisPCa) and HGPIN patients, were associated with a higher level of prostate-specific antigen (22.9 ng/mL vs. 10.0 ng/mL, P = 0.032), a lower median prostate volume (32.2 mL vs. 65.0 mL, P = 0.001), and a higher median SUVmax (13.3 vs. 5.6, P <0.001).

Conclusions:

It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI. However, the diagnostic efficacy of csPCa with PI-RADS ≥4 and SUVmax of ≥4 is inadequate for performing a procedure such as RP. Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.
Impact of UGT1A4 and UGT2B7 polymorphisms on lamotrigine plasma concentration in patients with bipolar disorder
Authors: Zhao Ting , Zhang Hui-lan , Feng Jie , Cui Long , Sun Li , Li Hong-jian , Yu Lu-hai
Published: August 2024

Purpose

The purpose of this study was to evaluate the effect of UGT1A4 and UGT2B7 polymorphisms on the plasma concentration of lamotrigine in Chinese patients with bipolar disorder.

Methods

A total of 104 patients were included in this study. Steady-state plasma lamotrigine concentrations were determined in each patient after at least 21 days of continuous treatment with a set dose of the drug. Lamotrigine plasma concentrations were ascertained using ultra-performance liquid chromatography. Simultaneously, plasma samples were used for patient genotyping.

Results

The age, sex, BMI, daily lamotrigine dose, plasma lamotrigine concentration, and lamotrigine concentration/dose ratio of patients exhibited significant differences, and these were associated with differences in the genotype [UGT1A4 −142T>G and UGT2B7 −161C>T (P < 0.05)]. Patients with the GG and GT genotypes in UGT1A4 −142T>G had significantly higher lamotrigine concentration/dose values (1.6 ± 1.1 and 1.7 ± 0.5 μg/ml per mg/kg) than those with the TT genotype (1.4 ± 1.1 μg/ml per mg/kg). Likewise, patients with the UGT2B7 −161C>T TT genotype had significantly higher lamotrigine concentration/dose values (1.6 ± 1.1 μg/ml per mg/kg) than those with the CC genotype (1.3 ± 1.3 μg/ml per mg/kg). Multiple linear regression analysis showed that sex, lamotrigine dose, UGT1A4 −142T>G, and UGT2B7 −161C>T were the most important factors influencing lamotrigine pharmacokinetics (P < 0.001).

Conclusion

The study results suggest that the UGT1A4 −142T>G and UGT2B7 −161C>T polymorphisms affect lamotrigine plasma concentrations in patients with bipolar disorder.
THE EFFICACY OF INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR FOR RADIATION MACULOPATHY
Authors: Chi Sheng-Chu , Chang Hsin-Ho
Published: August 2024

Background:

Antivascular endothelial growth factor (VEGF) therapy is the primary approach for managing radiation maculopathy. However, a noticeable gap exists in meta-analyses evaluating the efficacy of anti-VEGF therapy specifically in the context of radiation maculopathy.

Methods:

We conducted a review of comparative studies on anti-VEGF treatment up to October 2023. References were sourced from PubMed, EMBASE, and the Cochrane Library. The Cochrane Risk of Bias tool assessed the quality of randomized controlled trials, while the Risk Of Bias In Nonrandomized Studies of Interventions tool evaluated nonrandomized controlled trials.

Results:

Thirteen articles originating from 11 trials involving 2,525 eyes of 2,408 patients were included. Four trials with 2,226 eyes examined the effect of preventive anti-VEGF. Four trials with 189 eyes assessed the effect of anti-VEGF for preexisting maculopathy, and three trials with 110 eyes compared different anti-VEGF treatment modalities. In the preventive anti-VEGF treatment meta-analysis over a 24-month follow-up, the anti-VEGF group exhibited significantly fewer cases of radiation maculopathy (odds ratio: 0.40; 95% confidence interval: 0.25, 0.66, P= 0.0003, I2 = 45%). For the meta-analysis of anti-VEGF treatment for preexisting radiation maculopathy over a 6-month follow-up, the anti-VEGF group showed improved visual acuity (SMD: −1.13, 95% confidence interval, −1.69 to −0.56, P < 0.0000, I2 = 47%) and decreased central macular thickness (SMD: −0.59, 95% confidence interval, −1.13 to −0.05, P = 0.03, I2 = 62%).

Conclusion:

Prophylactic anti-VEGF effectively prevents radiation maculopathy and is also beneficial in treating preexisting radiation maculopathy. Intensive treatment initially provides early benefits, but the efficacy diminishes after transitioning to a treat-and-extend regimen.
OUTCOMES OF PRO RE NATA VERSUS TREAT-AND-EXTEND ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS FOR MYOPIC MACULAR NEOVASCULARIZATION IN MULTIETHNIC PATIENTS IN THE UNITED STATES
Authors: Swaminathan Shreya , Mahmoudzadeh Raziyeh , Wakabayashi Taku , Bowers Mallory , Momenaei Bita , Abishek Robert M. , Salabati Mirataollah , Hsu Jason , Dunn James P.
Published: August 2024

Purpose:

To compare visual outcomes and recurrence rates between pro re nata (PRN), treat-and-extend and stop (TES), and treat-and-extend with chronic maintenance dosing (TEM) regimens of anti–vascular endothelial growth factor (vascular endothelial growth factor) injections for myopic macular neovascularization (MNV) in multiethnic patients.

Methods:

This retrospective study included patients treated with PRN, TES, or TEM for myopic MNV using intravitreal bevacizumab or ranibizumab. The primary outcome measure was visual improvement at 12 months.

Results:

Overall, 127 eyes of 117 patients (75 women and 42 men) were included. The mean follow-up duration was 37.9 months. The outcomes of PRN (47 eyes [37%]), TES (52 eyes [41%]), and TEM (28 eyes [22%]) were compared. All groups showed significant visual improvement at 12 months and at the final follow-up (all P < 0.05). Visual outcomes did not differ significantly between the three groups at 12 months and the final follow-up (all P > 0.05). However, the number of eyes with recurrences was significantly higher in the PRN group and significantly lower in the TEM group during the follow-up (38%, 21%, and 11% in the PRN, TES, and TEM groups, respectively; P = 0.020). The PRN group received the fewest injections during follow-up (5.3, 10.9, and 19.9 injections in the PRN, TES, and TEM groups, respectively; P < 0.001).

Conclusion:

Comparing myopic MNV treatment regimens, anti-VEGF injections with PRN, TES, or TEM are effective for myopic MNV and have comparable visual outcomes. Because PRN provides favorable outcomes with fewer injections, it should be the first-line approach. However, a treat-and-extend approach with TES and TEM may be an option given individual patient factors.
VASCULAR CHANGES AND IRREVERSIBLE COMPLICATIONS IN 120° FUNDUS USING WIDEFIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN VOGT–KOYANAGI–HARADA DISEASE
Authors: Guo Suo , Xia Lan , Hu Rong , Wang Jing , Yang Peizeng
Published: August 2024

Purpose:

To characterize the changes in fundus corresponding to 120° field of view in chronic Vogt–Koyanagi–Harada disease in the quiescent phase and explore the associations with irreversible complications in the fundus using widefield swept-source optical coherence tomography angiography.

Methods:

Prospective cross-sectional study. Sixty-nine patients with chronic Vogt–Koyanagi–Harada disease (115 eyes) and 55 healthy control subjects (110 eyes) were included and underwent widefield swept-source optical coherence tomography angiography. Univariate analyses of variations in retinal and choroidal vessel density (VD), choroidal volume, and choroidal vascularity index in patients with Vogt–Koyanagi–Harada with different disease durations and the control subjects were conducted. Logistic regression analysis was used to identify the associations with irreversible complications, including choroidal neovascularization, vasoproliferative tumor of the retina, and chorioretinal atrophy.

Results:

The Welch analysis of variance showed lower VD of superficial retina, deep retina, choriocapillaris, and large-sized and medium-sized vessels of the choroid, and choroidal volume and choroidal vascularity index in the patients with disease duration of >24 months compared with those with disease duration of ≤24 months (all P ≤ 0.011). The regression analysis revealed that the disease duration (P = 0.008; OR = 1.02, 95% CI, 1.005–1.035) and VD of large-sized and medium-sized vessels of the choroid (P = 0.001; OR = 0.707, 95% CI, 0.575–0.87) were significantly correlated with the irreversible complications.

Conclusion:

Patients with chronic Vogt–Koyanagi–Harada in the quiescent phase with disease duration of >24 months exhibit more severe decreased VD in each layer of the retina and choroid, reduced choroidal volume, and sparse choroidal vascularity compared with those with disease duration ≤24 months. Prolonged duration and decreased VD of large-sized and medium-sized vessels of the choroid were associated with irreversible complications in the fundus.
Optical Coherence Tomography Angiography Assessment of Optic Nerve Head and Macula Across the Primary Angle Closure Disease Spectrum
Authors: Tun Tin A. , Atalay Eray , Liu Arthur , Liu Chang , Aung Tin , Nongpiur Monisha E.
Published: August 2024

Précis:

The microvasculature of the optic disc and macula in eyes with acute primary angle closure and primary angle closure glaucoma was lower across the disease spectrum, but the significant difference was only observed in primary angle closure glaucoma.

Purpose:

To assess the microvasculature in the optic nerve head (ONH) and macula across the primary angle closure disease (PACD) spectrum using optical coherence tomography angiography (OCTA).

Materials and Methods:

OCTA (AngioVue, Fremont, CA) imaging was performed on 122 PACD subjects. Flow area (FA) and vessel density (VD) in the ONH, radial peripapillary capillary (RPC) network, and superficial and deep capillary plexuses of the macula were calculated and compared across the PACD spectrum using linear regression models with generalized estimating equations adjusted for inter-eye correlation.

Results:

A total of 234 eyes including 44 primary angle closure suspects (PACS), 93 primary angle closure (PAC), 79 primary angle closure glaucoma (PACG), and 18 PAC with a history of previous acute primary angle closure (APAC) were included in the analysis. Compared with other groups, PACG eyes showed smaller FA in the ONH (1.35±0.02 mm2), RPC (0.78±0.03 mm2), and the superficial retinal layer (1.08±0.03 mm2) (all P<0.05). Lower VD was also observed in the “whole image,” “inside disc,” and “peripapillary” regions of the ONH and RPC, and the “whole image” and “parafoveal” regions of the retinal layer in the PACG group when compared with other groups (all P<0.05). No significant differences were found for the other groups (all P>0.05). Lower VD in the ONH, RPC, and superficial retinal layer significantly correlated with worse visual field loss in PACG eyes (all P<0.05).

Conclusions:

Significant reduction in the microvasculature of the optic disc and macula in PACG suggests that glaucoma development may contribute to lower VD in these regions.