bluuebunny/crossref_metadata_2025 huggingface dataset:
How Often Do Patients Presenting With Severe Adolescent Idiopathic Scoliosis Have Underlying Hip Dysplasia?
Authors: Taylor Tristen N. , Bridges Callie S. , Duruewuru Anthony T. , Sher Andrew C. , Rosenfeld Scott B. , Smith Brian G. , Kan J. Herman
Published: September 2023

Introduction:

Adolescent idiopathic scoliosis radiographic screening will often include the hips. The purpose of this study is to evaluate the prevalence of hip dysplasia by lateral center edge angle (LCEA) on scoliosis radiographs in patients presenting with severe range (>45 deg) idiopathic curves.

Methods:

We reviewed 200 consecutive patients (400 hips) with idiopathic scoliosis with major coronal curves ≥45 degrees between October 2009 and October 2022. The presenting scoliosis radiograph PA were reviewed for the following variables: major coronal curve direction, coronal balance, and lateral center edge angles. An LCEA value ≤18 was considered dysplastic. To assess potential measurement variability related to parallax of the scoliosis radiographs, the intermodality intraclass correlation coefficient (ICC) was measured from a subset of 20 hip LCEA values from patients with both scoliosis and pelvis radiographs.

Results:

A total of 200 patients [mean age: 13.6 (1.8) years; Female: 79%] were reviewed. The mean major curve (SD) was 58.6 degrees (11.4 deg). Overall 19% (37/200) patients or 11% (43/400) of hips had hip dysplasia. Of the dysplastic hips, 16% (6/43, P<0.001) were bilateral and 57% (21/43, P=0.04) were right sided. There was no association between dysplastic hip laterality and ipsilateral or contralateral coronal balance (P=0.26) or curve direction (P=0.49). The interobserver ICC for assessment of LCEA on scoliosis radiographs was 0.85, and the intermodality ICC between pelvic and scoliosis radiographs was 0.78.

Conclusion:

Hip dysplasia was present in 19% of patients presenting with large major curves, and many of these patients had right sided hip dysplasia. There was no association between hip dysplasia laterality and the patient’s major curve direction or coronal balance. There was good intermodality reliability (ICC=0.78) between LCEA values in patients who had both scoliosis and pelvis radiographs, and good inter-rater reliability between raters. Radiographic interpretation of adolescent idiopathic scoliosis should focus not only on the description of the curve and ruling out underlying segmentation anomalies but should also include critical assessment of the hips to exclude co-existing hip dysplasia.

Level of Evidence:

Therapeutic study—level IV
Current and Expanded Indications for Cervical Disc Arthroplasty
Authors: Divi Srikanth N. , Plantz Mark A. , Tegethoff Jason , Su Brian W.
Published: September 2023

The widespread success of cervical disc arthroplasty (CDA) has led to an interest in expanding indications beyond those outlined in the initial Food and Drug Administration investigational device exemption studies. Some of these off-label indications currently include 3-level and 4-level CDA, hybrid constructs with adjacent segment anterior cervical discectomy and fusion or corpectomy constructs, pre-existing kyphosis, revision of a failed anterior cervical discectomy and fusion to a CDA, CDA in the setting of significant degenerative disc disease and/or facet joint arthropathy, CDA for congenital cervical stenosis, and CDA in the presence of ossification of the posterior longitudinal ligament. This review article will summarize the current literature pertaining to the aforementioned indications.
Socioeconomic Influence on Cervical Fusion Outcomes
Authors: Touponse Gavin , Theologitis Marinos , Beach Isidora , Rangwalla Taiyeb , Li Guan , Zygourakis Corinna
Published: September 2023

Study Design:

A retrospective observational study.

Objective:

The aim of this study was to compare postoperative outcomes following cervical fusion based on socioeconomic status (SES) variables including race, education, net worth, and homeownership status.

Summary of Background Data:

Previous studies have demonstrated the effects of patient race and income on outcomes following cervical fusion procedures. However, no study to date has comprehensively examined the impact of multiple SES variables. We hypothesized that race, education, net worth, and homeownership influence important outcomes following cervical fusion.

Materials and Methods:

Optum’s de-identified Clinformatics Data Mart (CDM) database was queried for patients undergoing first-time inpatient cervical fusion from 2003 to 2021. Patient demographics, SES variables, and the Charlson comorbidity index were obtained. Primary outcomes were hospital length of stay and 30-day rates of reoperation, readmission, and postoperative complications. Secondary outcomes included postoperative emergency room visits, discharge status, and total hospital charges.

Results:

A total of 111,914 patients underwent cervical spinal fusion from 2003 to 2021. Multivariate analysis revealed that after controlling for age, sex, and Charlson comorbidity index, Black race was associated with a higher rate of 30-day readmissions [odds ratio (OR): 1.11, 95% CI: 1.03–1.20]. Lower net worth (vs. >$500K) and renting (vs. owning a home) were significantly associated with both higher rates of 30-day readmissions (OR: 1.29, 95% CI: 1.17–1.41; OR: 1.34, 95% CI: 1.22–1.49), and emergency room visits (OR: 1.29, 95% CI: 1.18–1.42; OR: 1.11, 95% CI: 1.00–1.23). Lower net worth (vs. >$500K) was also associated with increased complications (OR: 1.22, 95% CI: 1.14–1.31).

Conclusion:

Socioeconomic variables, including patient race, education, and net worth, influence postoperative metrics in cervical spinal fusion surgery. Future studies should focus on developing and implementing targeted interventions based on patient SES to reduce disparity.
Evaluating Leadership Development Competencies of Clinicians to Build Health Equity in America
Authors: Henry Ellison , Chandler Caroline , Laux Jeff , Noble Cheryl C. , Corbie Giselle , Fernandez Claudia S. P. , Dave Gaurav
Published: September 2023

Introduction:

To achieve more equitable health, health care must be grounded in an understanding of social determinants of health. Clinicians need hands-on, equity-centered training in interdisciplinary settings where they can further develop leadership skills and apply learnings in real-time. The Clinical Scholars program trained five cohorts of health care professionals in 25 leadership development competencies to contribute toward advancing health equity within the organizations and communities where they work. This study describes the self-reported ratings of three dimensions of competencies within four domains.

Methods:

Data from 169 Fellows were collected at three time-points during the three-year training program using Qualtrics and Research Electronic Data Captrue software. Analysis was conducted in R and included descriptive statistics, fitting a linear mixed-effects model using random intercepts, and paired-sample t tests to assess significance between baseline and endpoint ratings.

Results:

We found improved ratings over time for each of the three competency dimensions (knowledge, self-efficacy, use) and significant differences in ratings from baseline to endpoint, by domain (personal, interpersonal, organizational, community, and systems).

Discussion:

These findings support the effectiveness of an equity-centered leadership development curriculum in training health care professionals to address health challenges in their communities and organizations, thereby furthering the broader goal of achieving more equitable health for all.
Recent advances of artificial intelligence in melanoma clinical practice
Authors:   Naya, Lin Zijun , Shen Haoyan , Liu Xinguang , Ma Wanrui , Wang Mingfa , Ruan Jie , Yu Hongbin , Ma Sha , Sun XueRong
Published: September 2023

Skin melanoma is a lethal cancer. The incidence of melanoma is increasing rapidly in all regions of the world. Despite significant breakthroughs in melanoma treatment in recent years, precise diagnosis of melanoma is still a challenge in some cases. Even specialized physicians may need time and effort to make accurate judgments. As artificial intelligence (AI) technology advances into medical practice, it may bring new solutions to this problem based on its efficiency, accuracy, and speed. This paper summarizes the recent progress of AI in melanoma-related applications, including melanoma diagnosis and classification, the discovery of new medication, guiding treatment, and prognostic assessment. The paper also compares the effectiveness of various algorithms in melanoma application and suggests future research directions for AI in melanoma clinical practice.
Longitudinal Policy and Systems Change as a Component of Community Power
Authors: Devine Claire , Ghosal Ritu , Weller Maggie , Doren Taylor , Yu Chia Hua , Marsillo Roxanne , Kenton Natalie
Published: September 2023

Community power represents the ability of communities to develop, sustain, and grow the capacity to participate in and advance systems change that addresses health inequities but is difficult to assess because of its multifaceted, longitudinal nature. Using California's school-based Local Control Funding Formula (LCFF) as an example, this article examines the interconnectedness of longitudinal policy and systems changes as one approach to understanding and visualizing evolving community power. Data on policy and systems changes were collected during the 10-year, place-based Building Healthy Communities initiative and coded using thematic analysis. Related changes within sites and between community and state levels were linked to show how changes built and overlapped over time. Around 45% of changes were interconnected and cascaded to build momentum within sites; in addition, a substantial proportion of statewide changes (68%) overlapped with community ones. The state-level LCFF policy led to multiple community-based changes over time, involving ongoing engagement from various community groups across communities. Local implementation of the LCFF policy change was used to illustrate the usefulness of connecting community-driven policy and systems changes over time to explore the dynamics of community power and address some of the limitations of that approach.
Interpersonal Discrimination, Neighborhood Inequities, and Children's Body Mass Index
Authors: Kunin-Batson Alicia , Carr Christopher , Tate Allan , Trofholz Amanda , Troy Michael F. , Hardeman Rachel , Berge Jerica M.
Published: September 2023

Psychosocial stressors have been implicated in childhood obesity, but the role of racism-related stressors is less clear. This study explored associations between neighborhood inequities, discrimination/harassment, and child body mass index (BMI). Parents of children aged 5-9 years from diverse racial/ethnic backgrounds (n = 1307), completed surveys of their child's exposure to discrimination/harassment. Census tract data derived from addresses were used to construct an index of concentration at the extremes, a measure of neighborhood social polarization. Child's height and weight were obtained from medical records. Multiple regression and hierarchical models examined child's BMI and racism at the individual and census tract levels. Children residing in the most Black-homogenous census tracts had 8.2 percentage units higher BMI percentile (95% confidence interval, 1.5-14.9) compared with white-homogenous tracts (P = .03). Household income and home values were lower, poverty rates higher, and single parent households more common among Black-homogeneous census tracts. Almost 30% of children experienced discrimination/harassment in the past year, which was associated with a 5.28-unit higher BMI percentile (95% confidence interval, 1.72-8.84; P = .004). Discrimination and racial/economic segregation were correlated with higher child BMI. Longitudinal studies are needed to understand whether these factors may be related to weight gain trajectories and future health.
Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting
Authors: Lathan Emma C. , Haynes Tamara , Langhinrichsen-Rohling Ryan , Sonu Stan C. , Powers Abigail
Published: September 2023

Despite serving patients with especially high rates of trauma exposure and related sequelae, many primary care providers do not receive specialized training in the provision of trauma-informed care (TIC). This study sought to document primary care providers' baseline rates of TIC training and their knowledge, perceptions, and practice of TIC at a large, urban public hospital in the Southeastern United States. Participants (n = 67; 68.7% women; 44.8% white; M
age = 36.7 years, standard deviation [SD]age = 9.8 years) completed an online self-report survey on their TIC training status, trauma-related knowledge, perceptions, and practices, as well as burnout and secondary traumatic stress. Less than half of participants (43.3%) endorsed TIC training exposure. Participants generally had adequate levels of trauma-related knowledge (76.5% of items correct) and favorable perceptions of TIC (endorsed 89.7% of TIC-supportive statements). Most participants (86.6%) endorsed recently using trauma-informed practices, but only 47.8% reported routinely screening for trauma-related disorders. Participants who reported receiving prior TIC training scored better on knowledge items and endorsed recently using more trauma-informed practices than those who did not have training exposure. TIC training status' associations with current screening practices and perceptions of TIC were trending toward significance. TIC training status was not related to burnout, and trained participants reported greater secondary traumatic stress than those without training exposure. Results point to system-wide TIC training as a well-received, translational strategy that can enhance the trauma-informed nature of primary care provision.
Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach
Authors: Rachmiel Adi , Capucha Tal , Ginini Jiriys George , Emodi Omri , Aizenbud Dror , Shilo Dekel
Published: September 2023

Background:

Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage.

Methods:

Eighteen patients 14–25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood.

All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required.

Results:

Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months.

Conclusions:

The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14–18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants.
Sorafenib induces ferroptosis by promoting TRIM54-mediated FSP1 ubiquitination and degradation in hepatocellular carcinoma
Authors: Liu Man-ru , Shi Ce , Song Qiu-ya , Kang Meng-jie , Jiang Xin , Liu Hui , Pei Dong-sheng
Published: September 2023

Background:

Ferroptosis is a unique form of regulated cell death that provided a new opportunity for cancer therapy. Ferroptosis suppressor protein 1 (FSP1) is a key regulator in the NAD(P)H/FSP1/CoQ10 antioxidant system, which sever as an oxide redox enzyme to scavenge harmful lipid hydroperoxides and escape from ferroptosis in cells. This study aimed to investigate the role of FSP1 on sorafenib-induced ferroptosis and disclosed the underlying mechanisms.

Methods:

Cell viability, malondialdehyde (MDA), glutathione (GSH), and lipid reactive oxygen species levels were assessed using indicated assay kits. The levels of FSP1 and glutathione peroxidase 4 (GPX4) in the patients with HCC were analyzed based on the database. Western blot and quantitative real-time PCR were performed to detect the protein and mRNA expression. Co-immunoprecipitation was applied to detect the interaction between proteins. Tumor xenograft experiments were used to evaluate whether overexpression of FSP1-inhibited sorafenib-induced ferroptosis in vivo.

Results:

We verified that sorafenib-induced ferroptosis in HCC. Furthermore, we found that sorafenib decreased the protein level of FSP1, and knockdown FSP1 rendered HCC cells susceptible to sorafenib-induced ferroptosis. Co-immunoprecipitation and ubiquitination assays showed that sorafenib accelerated the TRIM54-mediated FSP1 ubiquitination and degradation. Sorafenib-induced ferroptosis was abrogated by TRIM54 suppression. Mechanically, sorafenib-promoted TRIM54 ubiquitinated and degraded FSP1 by means of the ERK pathway. Moreover, FSP1 enhanced tumor development and decreased HCC cellular susceptibility to sorafenib in vivo.

Conclusions:

Sorafenib facilitated the TRIM54-mediated FSP1 ubiquitination through the ERK pathway, thereby inducing ferroptosis in HCC cells.
MELD, MELD 3.0, versus Child score to predict mortality after acute variceal hemorrhage: A multicenter US cohort
Authors: Buckholz Adam , Wong Rochelle , Curry Michael P. , Baffy Gyorgy , Chak Eric , Rustagi Tarun , Mohanty Arpan , Fortune Brett E.
Published: September 2023

Background:

Acute variceal hemorrhage is a major decompensating event in patients with cirrhosis and is associated with high 6-week mortality risk. Many prognostic models based on clinical and laboratory parameters have been developed to risk stratify patients on index bleeding presentation, including those based on the Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP). However, consensus on model performance remains unclear.

Methods:

Using a large US multicenter cohort of hospitalized patients with cirrhosis who presented with acute variceal hemorrhage, this study evaluates, recalibrates, and compares liver severity index-based models, including the more recent MELD 3.0 model, to investigate their predictive performance on 6-week mortality. Models were also recalibrated and externally validated using additional external centers.

Results:

All recalibrated MELD-based and CTP-based models had excellent discrimination to identify patients at higher risk for 6-week mortality on initial presentation. The recalibrated CTP score model maintained the best calibration and performance within the validation cohort. Patients with low CTP scores (Class A, score 5–6) were strongly associated with < 5% mortality, while high CTP score (Class C, score > 9) were associated with > 20% mortality.

Conclusion:

Use of liver severity index-based models accurately predict 6-week mortality risk for patients admitted to the hospital with acute variceal hemorrhage and supports the utilization of these models in future clinical trials as well as their use in clinical practice.
Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression
Authors: Melgarejo Jesus D. , Van Eijgen Jan , Wei Dongmei , Maestre Gladys E. , Al-Aswad Lama A. , Liao Chia-Te , Mena Luis J. , Vanassche Thomas , Janssens Stefan , Verhamme Peter , Zhang Zhen-Yu , Van Keer Karel , Stalmans Ingeborg
Published: September 2023

Background:

Low ocular perfusion pressure (OPP), which depends on the mean arterial pressure (MAP) and intraocular pressure (IOP), is associated with glaucoma. We studied 24-h MAP dysregulations and OPP in relation to the progression of glaucoma damage.

Methods:

We retrospectively analyzed 155 normal-tension glaucoma (NTG) and 110 primary open-angle glaucoma (POAG) patients aged 18 years old followed at the University Hospital Leuven with repeated visual field tests (n = 7000 measures, including both eyes) who underwent 24-h ambulatory blood pressure monitoring. Twenty-four-hour MAP dysregulations were variability independent of the mean (VIM), and the five lowest dips in MAP readings over 24 h. OPP was the difference between 2/3 of the MAP and IOP. Glaucoma progression was the deterioration of the visual field, expressed as decibel (dB) changes in mean deviation analyzed by applying multivariable linear mixed regression models.

Results:

The mean age was 68 years (53% were women). High 24-h VIMmap was associated with glaucoma progression in POAG (P < 0.001) independently of the 24-h MAP level. The estimated changes in mean deviation in relation to dip MAP measures ranged from −2.84 dB [95% confidence interval (CI) −4.12 to −1.57] to −2.16 dB (95% CI −3.46 to −0.85) in POAG. Reduced OPP along with high variability and dips in MAP resulted in worse mean deviation deterioration.

Conclusion:

The progression of glaucoma damage associates with repetitive and extreme dips in MAP caused by high variability in MAP throughout 24 h. This progression exacerbates if 24-h MAP dysregulations occur along with reduced OPP.
Acquired bleeding disorders secondary to immune checkpoint inhibitors: a case report and systematic literature review
Authors: Archibald William J. , Kouides Peter A. , Refaai Majed A. , Lachant Neil A.
Published: September 2023

Acquired bleeding disorders because of an autoimmune phenomenon are rare events. Acquired von Willebrand disease (aVWD) has been estimated as having a prevalence of 400 per million in the general population. Acquired hemophilia A (AHA), the most common of the acquired hemophilias, has an estimated incidence of 1.3–1.5 cases per million per year. Immune checkpoint inhibitors (ICI) targeting PD-1, PD-L1, and CTLA-4 are being used with increasing frequency for hematologic and oncologic disorders. Acquired hemophilias and aVWD have been reported with the use of ICI therapy.

We performed a systematic review of the literature to identify cases of acquired bleeding disorders with ICI therapy and contribute our own institution's experience with a case of AHA after pembrolizumab therapy. Six cases of AHA, one case of aVWD, and one case of factor V inhibitor were identified in the literature. Inhibitors were successfully eradicated in five of the eight cases identified. We propose that a centralized registry, possibly through the Scientific and Standardization Subcommittee on Plasma Coagulation Inhibitors through the International Society on Thrombosis and Hemostasis (ISTH), be developed to record treatment and outcomes of this rare ICI complication in order to prognosticate risk and better understand optimal treatment strategies.
Multicenter validation of FIB-6 as a novel machine learning non-invasive score to rule out liver cirrhosis in biopsy-proven MAFLD
Authors: Anushiravani Amir , Alswat Khalid , Dalekos George N , Zachou Kalliopi , Örmeci Necati , Al-Busafi Said , Abdo Ayman , Sanai Faisal , Mikhail Nabiel NH , Soliman Riham , Shiha Gamal
Published: September 2023

Background and aims

We previously developed and validated a non-invasive diagnostic index based on routine laboratory parameters for predicting the stage of hepatic fibrosis in patients with chronic hepatitis C (CHC) called FIB-6 through machine learning with random forests algorithm using retrospective data of 7238 biopsy-proven CHC patients. Our aim is to validate this novel score in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).

Method

Performance of the new score was externally validated in cohorts from one site in Egypt (n = 674) and in 5 different countries (n = 1798) in Iran, KSA, Greece, Turkey and Oman. Experienced pathologists using METAVIR scoring system scored the biopsy samples. Results were compared with FIB-4, APRI, and AAR.

Results

A total of 2472 and their liver biopsy results were included, using the optimal cutoffs of FIB-6 indicated a reliable performance in diagnosing cirrhosis, severe fibrosis, and significant fibrosis with sensitivity = 70.5%, specificity = 62.9%. PPV = 15.0% and NPV = 95.8% for diagnosis of cirrhosis. For diagnosis of severe fibrosis (F3 and F4), the results were 86.5%, 24.0%, 15.1% and 91.9% respectively, while for diagnosis of significant fibrosis (F2, F3 and F4), the results were 87.0%, 16.4%, 24.8% and 80.0%). Comparing the results of FIB-6 rule-out cutoffs with those of FIB-4, APRI, and AAR, FIB-6 had the highest sensitivity and NPV (97.0% and 94.7%), as compared to FIB-4 (71.6% and 94.7%), APRI (36.4% and 90.7%), and AAR (61.2% and 90.9%).

Conclusion

FIB-6 score is an accurate, simple, NIT for ruling out advanced fibrosis and liver cirrhosis in patients with MAFLD.
Predictors of 30-day mortality in patients diagnosed with hepatic encephalopathy on admission to the emergency department
Authors: Yuksek Ali , Acehan Selen , Satar Salim , Gulen Muge , Balcik Muhammet , Sevdimbas Sarper , Ince Cagdas , Koca Ahmet Naci , Tas Adnan
Published: September 2023

Background

The aim of this study is to compare the laboratory findings and disease severity scores of patients diagnosed with hepatic encephalopathy (HE) in the emergency department (ED) to predict 30-day mortality.

Method

The patients over 18 years old and diagnosed HE in the ED of a tertiary hospital were included in the study. Demographic and clinical characteristics, laboratory parameters, predisposing causes and outcomes of the patients included in the study were recorded in the data form. Severity of liver disease was assessed by Child Pugh Score (CPS), End-stage liver disease model (MELD), MELD-Na and MELD-Lactate scores.

Results

Two hundred fifty-four patients diagnosed with HE were included in the study. 59.1% of the patients were male. The mean age of the patients was 65.2 ± 12.6 years. The mortality rate of the patients was 47.2%. When the receiver operating characteristic (ROC) analysis, which determines the predictive properties of laboratory parameters and disease severity scores, was examined, the area under curve value of the MELD-Lactate score (0.858 95% CI 0.812–0.904, P < 0.001) was the highest. Binary logistic regression analysis for the estimation of patients’ 30-day mortality showed that CPS and MELD-Lactate scores and blood ammonia and B-type natriuretic peptide levels were independent predictors of mortality.

Conclusion

According to the study data, MELD-Lactate and BNP levels in patients diagnosed with HE in the ED may help the clinician in the prediction of 30-day mortality in the early period.
Mixed donor chimerism following stem cell transplantation for sickle cell disease
Authors: Shah Niketa C. , Rangarajan Hemalatha G. , Ngwube Alexander , Shenoy Shalini
Published: September 2023

Sickle cell disease is a debilitating hemoglobinopathy with high morbidity and mortality. Hematopoietic stem cell transplantation (HCT) is curative, but the presence of mixed donor/recipient chimerism post-HCT raises concerns about disease control long-term. Mixed donor/recipient chimerism is reported in significant numbers even after aggressive HCT conditioning regimens. Post-HCT, adequacy of donor erythropoiesis is crucial for disease control. This review explores the relationship between mixed donor/recipient chimerism and outcomes post-HCT.

Serial chimerism analysis in lineage specific manner in erythroid or myeloid cells post-HCT predicts for disease control and HCT success. Adequate and stable donor-derived erythropoiesis is essential for reversing SCD manifestations. Myeloid lineage chimerism mirrors erythropoiesis is commercially available, and a reliable indicator of adequacy. Using this tool, the minimum threshold of donor chimerism is required to prevent SCD-related complications and maintain sickle hemoglobin less than 50% is approximately 20–25% even when a donor has Hb S trait. Curative interventions should, at a minimum, meet this goal long-term.

Achieving a balance between successful engraftment while minimizing toxicity is important in patients vulnerable because of age or preexisting morbidity and is the objective of recent clinical trials. As HCT and gene therapies evolve, efficient long-term follow-up that includes durability assessment of mixed donor/recipient chimerism will be crucial.
Results of laminoplasty versus laminectomy and posterior fusion for multilevel cervical spondylotic myelopathy
Authors: Nguyen Trong Yen , Nguyen Khac Hieu , Tran Quang Dung , Pham Quang Anh , Lam Viet Anh
Published: September 2023

Background:

The authors compared the clinical, MR, and clinical outcomes for patients with multilevel cervical spondylotic myelopathy (MCSM) who underwent laminoplasty (LP) versus laminectomy with fusion (LPSF).

Materials and methods:

The authors evaluated 65 patients with MCSM (2019–2021) with 31 undergoing LP versus 34 having LPSF. Variables studied included JOA scores, T2W MR hyperintense cord signals, preoperative lordosis, number of stenotic levels, and neurological outcomes.

Results:

Both groups showed similar preoperative JOA scores, number of stenotic levels, T2-weighted MR hyperintense cord signals, and nearly identifcal 12-month postoperative outcomes (good for 83.9 in the LP group vs. 85.3% in the LPSF group). Differences included: higher preoperative visual analog scale in the LPSF versus LP group, plus the LPSF patients significantly less preoperative cervical lordosis versus LP patients.

Conclusion:

LP and LPSF used to treat MCSM resulted in similar clinical improvement and 1-year postoperative outcomes. However, our recommendation would be for patients with neck pain, instability, and/or cervical kyphosis to undergo LPSF.
Recurrent uveitis in a patient with CREST syndrome: a case report
Authors: Khalayli Naram , Hodifa Yara , Tarcha Raghad , Hodaifa Amr , Kudsi Maysoun
Published: September 2023

Introduction:

Systemic sclerosis is a connective tissue condition presented with clinical manifestations, including ocular involvement in a small percentage. A few cases of uveitis were described in the literature, especially in CREST syndrome.

Case presentation:

The authors reported a case of a 48-year-old male with a blurred vision in his left eye that diagnosed with recurrent uveitis in the setting of CREST syndrome, treated with prednisolone, methotrexate, and golimumab, with improvement.

Discussion:

Ocular manifestations of systemic sclerosis include palpebral alterations, keratoconjunctivitis, sicca syndrome, cataracts, pinguecula, and blepharitis. To our knowledge, this is the fifth case of uveitis in a setting of CREST syndrome in the literature, and the first one in sex involvement, as the previous cases were females, and in its treatment by golimumab, an anti-tumor necrosis factor inhibitor.

Conclusion:

Although this association is low, we believe that it should be taken into consideration when treating these situations to obtain better treatment results. Collaboration between rheumatologists and ophthalmologists is necessary in deciding on treatment.
Misdiagnosed periappendiceal and intestinal tuberculosis during the COVID-19 pandemic
Authors: Cui Zhaoyang , Le Yi , Liu Hu , Feng Linjing , Zhang Shaogeng
Published: September 2023

Introduction and importance:

The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China. It mainly involves the respiratory system, causing fever, cough, chest tightness, and other symptoms. However, when combined with other common or rare diseases, such as appendicitis and intestinal tuberculosis (TB), it can cause other systemic lesions, thus making the original disease lose its specific clinical manifestations. This case highlights the importance of early identification and clinical precision medicine diagnosis and treatment.

Case presentation:

A young woman presented with intermittent pain and discomfort in the right lower quadrant. Ultrasonography suggested appendicitis with a peripheral abscess. The nucleic acid test of COVID-19 was positive, and the chest computed tomography scan showed pulmonary involvement. She was sent for surgery. Postoperative body temperature increased regularly, and the TB T-cell test was positive.

Clinical discussion:

Multiple infections caused by common bacteria, pandemic virus, and specific mycobacterium TB cause a series of nonspecific clinical manifestations, which brings challenges to clinical diagnosis and treatment. Therefore, when facing a complex infection case, the authors should consider the possibility of multiple infections and give targeted treatment for the pathogens.

Conclusions:

During the epidemic of COVID-19, the incidence of intestinal TB is relatively low, which is easy to be overlooked and misdiagnosed, especially in the case of appendicitis. Therefore, clinicians must be highly vigilant in the diagnosis process to avoid missed diagnosis or misdiagnosis, so as to provide the best diagnosis and treatment plan.
Veterans Affairs Nurses' Perception of a Dignified Death
Authors: Fowler Susan B.
Published: September 2023

A dignified death is described as a good death or dying with dignity. Nurses caring for veterans are aware of the honor veterans can receive at the time of death. The purpose of this study was to describe and compare perceptions of a dignified death in nurses who care for veterans in Veterans Affairs settings. This descriptive, exploratory design used an online survey including scales of dying with dignity and a good death. Subjects were nurses who worked at Veterans Affairs facilities. Dying with dignity scores were high and moderately high for a good death. Good death items of wishes, peace, spirituality, and pain free were considered essential by most nurses. There was no difference in scores based on age or end-of-life experiences. Veterans Affairs nurses had a good perception of a dignified death providing a foundation for veteran support before, during, and after death.
An Innovative Assistant Nurse Manager Residency Program Focused on Participation, Satisfaction, Promotion, and Retention
Authors: Krivanek Mary Johanna , Colbert Colleen Y. , Mau Kathleen , Distelhorst Karen
Published: September 2023

Assistant nurse managers (ANMs) were asked what they needed to be successful, fully engaged, and equipped to perform in their roles. The ANM Residency Program was created to support development of new ANMs through resources, education, and mentoring. Evaluations were used to guide curriculum enhancements and improve course facilitation. Participation, satisfaction, promotion, and retention were measured. Similar programs may be used to support development for all levels of nurse leaders.
Home-based HIV testing strategies for middle-aged and older adults in rural South Africa
Authors: Marcus Maja E. , Mahlalela Nomsa , Drame Ndeye D. , Rohr Julia K. , Vollmer Sebastian , Tollman Stephen , Berkman Lisa , Kahn Kathleen , Gómez-Olivé Francesc Xavier , Manne-Goehler Jennifer , Bärnighausen Till
Published: September 2023

Objective:

More than one in four adults over 40 years with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa.

Design:

Two thousand nine hundred and sixty-three individuals in the ‘Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)’ cohort study were randomized 1 : 1 : 1 to one of three types of home-based and home-delivered HIV testing modalities: rapid testing with counseling; self-testing, and both rapid testing with counselling and self-testing.

Method:

In OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about 1 year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior.

Results:

There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility [self-testing (HIVST), −8 percentage points (pp); 95% confidence interval (CI) −14 to −2 pp; self-testing plus rapid testing and counselling (ST+RT+C); −9 pp, 95% CI −15 to −3 pp] to testing only at home (HIVST 5 pp; 95% CI 2 to 9 pp; ST+RT+C: 5 pp, 95% CI 1 to 9 pp) – suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI −1.16 to −0.01).

Conclusion:

We find HIV self-testing to be a well tolerated and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95–95–95 targets.
Urine point-of-care tenofovir test demonstrates strong predictive clinical and research utility
Authors: Mustanski Brian , Ryan Daniel T. , Spinelli Matthew A. , Gandhi Monica , Newcomb Michael E.
Published: September 2023

Background:

Preexposure prophylaxis (PrEP) significantly reduces HIV infection risk but is dependent on adherence. Available approaches to measuring adherence have limitations related to accuracy, cost, practicality, and timeliness. This study compared the performance of two methods implementable in clinics and research studies [interview and urine point of care (POC) assay] to the gold-standard for measuring recent and longer term adherence in dried blood spots (DBS).

Methods:

Participants were recruited from RADAR, a cohort study of young MSM, or via online advertisements. At 3 monthly visits, an interviewer administered 7-day timeline follow-back (TLFB) questionnaire, DBS samples were tested for tenofovir-diphosphate (TFV-DP) to estimate average dosing over the prior month and emtricitabine-triphosphate (FTC-TP) to assess recent dosing (past 2–3 days), and a urine POC TFV test to qualitatively assess recent adherence (past 4 days).

Results:

Eighty-three PrEP users contributed 163 observations. At visit 1, self-reported adherence was 86% (4+ doses in last 7 days), versus urine TFV (74%), DBS FTC-TP (76%), and DBS TFV-DP (69%). The objective measures of short-term adherence performed similarly well in predicting longer term adherence. In multivariable logistic regression analyses, the urine assay was a significant predictor of DBS TFV-DP (adjusted OR = 19.4, P < 0.0001); self-report did not add significantly.

Conclusion:

The urine POC TFV assay had excellent predictive values for adherence and self-report did not add significantly to prediction. The POC assay provides results in several minutes to enable same-visit counseling, requires no specialized training, and is projected to be low-cost.
Free Superficial Circumflex Iliac Artery/Superficial Inferior Epigastric Artery Adipofascial Flaps for Facial Reconstruction of Linear Scleroderma
Authors: Xie Jiangmiao , Zhang Wenchao , Yang Elan , Zeng Ang
Published: September 2023

Background

Linear scleroderma is an autoimmune connective disorder characterized by a saber-shaped facial deformity. The superficial circumflex iliac artery/superficial inferior epigastric artery (SCIA/SIEA) adipofascial flap is versatile for facial reconstruction, providing excellent aesthetic outcomes and minimal donor-site morbidity. Thus, this study aimed to share our experience of successfully treating linear scleroderma using single-stage SCIA/SIEA adipofascial flap microsurgery transplantation.

Methods

To correct asymmetric facial malformations, the SCIA/SIEA adipofascial flap transplantation was performed on 5 individuals with linear scleroderma. The flap was harvested based on SCIA or SIEA patterns and diameters. Donor and recipient vessels, postoperative complications, aesthetic outcomes, and patient satisfaction were recorded.

Results

All flaps survived with zero necrosis. Regarding the donor artery, SIEA was performed on 1 patient (1 of 5) and SCIA on 2 patients (2 of 5), and the remaining 2 patients (2 of 5) used the common trunk. Patients maintained a satisfactory facial counter-correction 6 to 10 years postoperatively. The complications included localized desquamate and hypotrichosis.

Conclusions

Free SCIA/SIEA adipofascial flaps improved facial linear scleroderma's long-term functional and morphological outcomes. This SCIA/SIEA adipofascial flap offers low mortality, invisible scars, and stable aesthetic outcomes compared with anterolateral thigh flap, parascapular flaps, and fat transplantation.
The Role of Antibiotic Prophylaxis in Primary and Secondary Implant-Based Breast Augmentation
Authors: Villanueva Karie G. , Barr Meaghan L. , Klingbeil Kyle D. , Tranfield Wynn , Festekjian Jaco
Published: September 2023

Background

The administration of antibiotic prophylaxis for implant-based breast augmentation (IBBA) is commonplace among many plastic surgeons. However, the current literature lacks evidence-based recommendations to support this practice. Although few studies have demonstrated a reduction in surgical site infection (SSI) and capsular contracture (CC) with antibiotics, these studies were underpowered and poorly designed. The aim of this study was to provide an updated comprehensive analysis of the literature to revisit the benefit of antibiotic prophylaxis.

Methods

A comprehensive literature search of PubMed, Embase, Web of Science, and Cochrane was performed from January 1989 to January 2022. Observational studies and randomized controlled trials (RCTs) involving primary and secondary IBBA and use of antibiotic prophylaxis were included. Primary outcomes included SSI and CC. Study quality and risk of bias were evaluated using standardized tools. A meta-analysis was performed for eligible studies. Trial Sequential Analysis was used to assess the need for future RCTs.

Results

A total of 5 studies (3 observational and 2 RCTs) with 2383 patients were included in this study. Rates of SSI ranged from 0% to 2.3%, whereas CC ranged from 0% to 53%. Antibiotic prophylaxis showed no benefit for both SSI (odds ratio, 1.77; 95% confidence interval, 0.76–4.13) and CC (odds ratio, 0.46; 95% confidence interval, 0.00–45.72). Trial Sequential Analysis demonstrated that further high-quality RCTs are needed.

Conclusions

Antibiotic prophylaxis for IBBA failed to demonstrate improvements in SSI and CC in this comprehensive review. Current evidence was shown to be of low quality because of heterogeneity and high risk for bias. Further high-quality multicentered RCTs are warranted to fully evaluate the role of antibiotic prophylaxis for IBBA.
Mechanisms inherent in acute-to-chronic pain after surgery – risk, diagnostic, predictive, and prognostic factors
Authors: Rosenberger Daniela C. , Segelcke Daniel , Pogatzki-Zahn Esther M.
Published: September 2023

Purpose of review

Pain is an expected consequence of a surgery, but it is far from being well controlled. One major complication of acute pain is its risk of persistency beyond healing. This so-called chronic post-surgical pain (CPSP) is defined as new or increased pain due to surgery that lasts for at least 3 months after surgery. CPSP is frequent, underlies a complex bio-psycho-social process and constitutes an important socioeconomic challenge with significant impact on patients’ quality of life. Its importance has been recognized by its inclusion in the eleventh version of the ICD (International Classification of Diseases).

Recent findings

Evidence for most pharmacological and non-pharmacological interventions preventing CPSP is inconsistent. Identification of associated patient-related factors, such as psychosocial aspects, comorbidities, surgical factors, pain trajectories, or biomarkers may allow stratification and selection of treatment options based on underlying individual mechanisms. Consequently, the identification of patients at risk and implementation of individually tailored, preventive, multimodal treatment to reduce the risk of transition from acute to chronic pain is facilitated.

This review will give an update on current knowledge on mechanism-based risk, prognostic and predictive factors for CPSP in adults, and preventive and therapeutic approaches, and how to use them for patient stratification in the future.
Thermochemistry of hybrid materials
Authors: Navrotsky Alexandra , Leonel Gerson J.
Published: September 2023

This paper is based on a lecture Navrotsky gave honouring the memory of Paul McMillan. It summarizes our recent findings in the thermodynamics of hybrid materials including metal organic frameworks (MOFs), polymer-derived ceramics (PDCs) and ionic organic–inorganic compounds. This work describes the main structure types and their corresponding thermodynamic stability, obtained from calorimetric measurements in our laboratory. The effects of linker substituent and framework topology on the thermodynamic stability of isostructural zeolitic imidazolate frameworks and other MOFs are discussed. The paper documents the effects of interdomain interaction and bonding speciation on the thermodynamic stability of various PDC compositions, including SiC, SiOC and SiCN systems. The paper further describes effects of different cations on the thermodynamic stability of selected ionic organic–inorganic compounds. Similarities and differences among these materials are emphasized.

This article is part of the theme issue 'Exploring the length scales, timescales and chemistry of challenging materials (Part 2)'.
Recent developments in X-ray diffraction/scattering computed tomography for materials science
Authors: Omori Naomi E. , Bobitan Antonia D. , Vamvakeros Antonis , Beale Andrew M. , Jacques Simon D. M.
Published: September 2023

X-ray diffraction/scattering computed tomography (XDS-CT) methods are a non-destructive class of chemical imaging techniques that have the capacity to provide reconstructions of sample cross-sections with spatially resolved chemical information. While X-ray diffraction CT (XRD-CT) is the most well-established method, recent advances in instrumentation and data reconstruction have seen greater use of related techniques like small angle X-ray scattering CT and pair distribution function CT. Additionally, the adoption of machine learning techniques for tomographic reconstruction and data analysis are fundamentally disrupting how XDS-CT data is processed. The following narrative review highlights recent developments and applications of XDS-CT with a focus on studies in the last five years.

This article is part of the theme issue 'Exploring the length scales, timescales and chemistry of challenging materials (Part 2)'.