bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiometabolic Parameters 3 Years After Switch to Dolutegravir/Lamivudine vs Maintenance of Tenofovir Alafenamide–Based Regimens
Authors: Batterham Rachel L , Espinosa Nuria , Katlama Christine , McKellar Mehri , Scholten Stefan , Smith Don E , Ait-Khaled Mounir , George Nisha , Wright Jonathan , Gordon Lori A , Moodley Riya , Wynne Brian , van Wyk Jean
Published: July 2023

Background

Cardiometabolic outcomes were investigated 3 years after switching to the 2-drug regimen dolutegravir/lamivudine (DTG/3TC) vs continuing 3-/4-drug tenofovir alafenamide (TAF)–based regimens in a multicenter phase 3 noninferiority study based on an open-label randomized design.

Method

Adults with virologically suppressed HIV-1 switched to once-daily DTG/3TC (n = 369) or continued TAF-based regimens (n = 372). Cardiometabolic health parameters were assessed through week 144 via mixed-model repeated measures or logistic regression analyses, adjusting for baseline variables.

Results

At week 144, 13% (42/316) of the DTG/3TC group and 12% (37/303) of the TAF-based regimen group had ≥10% weight gain from baseline (adjusted odds ratio, 1.11; 95% CI, .68–1.80). Adjusted change from baseline in serum leptin, a surrogate marker of adiposity, was similar between groups (treatment ratio, 1.00; 95% CI, .89–1.13). The lipid profile generally favored DTG/3TC in the baseline boosted subgroup. Adjusted odds revealed no clinically meaningful differences between groups: homeostatic model assessment of insulin resistance ≥2 (adjusted odds ratio, 0.79; 95% CI, .50–1.26), metabolic syndrome (International Diabetes Federation criteria, 0.99; .59–1.68), hepatic fibrosis (fibrosis-4 index score ≥1.45, 1.39; .63–3.06), and coronary artery disease risk (Framingham risk score ≥10%, 0.92; .56–1.49). Baseline variables and characteristics associated with odds of each cardiometabolic parameter outcome were consistent with known risk factors, including age, sex, race, and some disease characteristics.

Conclusions

Cardiometabolic health 3 years after switching to DTG/3TC was comparable to that for individuals continuing TAF-based regimens, further supporting DTG/3TC as a robust switch option with a stable metabolic profile.

Trial registration

ClinicalTrials.gov NCT03446573
Multidrug-Resistant Bacterial Infections Among Very Low Birthweight Infants With Late-Onset Sepsis in Johannesburg, South Africa
Authors: Licona Genesis , Ballot Daynia , Moon Troy D , Banerjee Ritu , Amorim Gustavo , Agthe Alexander G , Weitkamp Jörn-Hendrik
Published: July 2023

Background

An estimated 2.4 million babies died within the first 28 days of life in 2020. The third leading cause of neonatal death continues to be neonatal sepsis. Sepsis-causing bacterial pathogens vary temporally and geographically and, with a rise in multidrug-resistant organisms (MDROs), pose a threat to the neonatal population.

Methods

This was a single-center, retrospective study of very low birth weight (VLBW) infants with late-onset sepsis (LOS) admitted to a neonatal unit in South Africa. We aimed to calculate the prevalence of multidrug-resistant (MDR) infections in this population. The data collected included demographic and clinical characteristics, length of hospital stay, risk factors for MDRO and mortality, and microbiology results. Logistic regression was used to assess the association between prespecified risk factors with MDR infections and mortality.

Results

Of 2570 VLBW infants admitted, 34% had LOS, of which 33% was caused by MDROs. Infection with Acinetobacter spp., Pseudomonas spp., extended-spectrum beta-lactamase Klebsiella spp., or Escherichia coli was associated with the highest mortality in the LOS cohort. Infants with congenital infections (adjusted odds ratio [aOR], 5.13; 95% CI, 1.19–22.02; P = .028) or a history of necrotizing enterocolitis (aOR, 2.17; 95% CI, 1.05–4.49; P = .037) were at significantly higher risk for MDR infections.

Conclusions

More than one-third of LOS cases in VLBW infants were caused by MDROs in this study. MDR infections cause substantial neonatal mortality. Antimicrobial stewardship programs, infection control protocols, and ongoing surveillance are needed to prevent further emergence and spread of MDR infections worldwide.
Evolution of cytosolic and organellar invertases empowered the colonization and thriving of land plants
Authors: Wan Hongjian , Zhang Youjun , Wu Limin , Zhou Guozhi , Pan Luzhao , Fernie Alisdair R , Ruan Yong-Ling
Published: July 2023

The molecular innovation underpinning efficient carbon and energy metabolism during evolution of land plants remains largely unknown. Invertase-mediated sucrose cleavage into hexoses is central to fuel growth. Why some cytoplasmic invertases (CINs) function in the cytosol, whereas others operate in chloroplasts and mitochondria, is puzzling. We attempted to shed light on this question from an evolutionary perspective. Our analyses indicated that plant CINs originated from a putatively orthologous ancestral gene in cyanobacteria and formed the plastidic CIN (α1 clade) through endosymbiotic gene transfer, while its duplication in algae with a loss of its signal peptide produced the β clade CINs in the cytosol. The mitochondrial CINs (α2) were derived from duplication of the plastidic CINs and coevolved with vascular plants. Importantly, the copy number of mitochondrial and plastidic CINs increased upon the emergence of seed plants, corresponding with the rise of respiratory, photosynthetic, and growth rates. The cytosolic CIN (β subfamily) kept expanding from algae to gymnosperm, indicating its role in supporting the increase in carbon use efficiency during evolution. Affinity purification mass spectrometry identified a cohort of proteins interacting with α1 and 2 CINs, which points to their roles in plastid and mitochondrial glycolysis, oxidative stress tolerance, and the maintenance of subcellular sugar homeostasis. Collectively, the findings indicate evolutionary roles of α1 and α2 CINs in chloroplasts and mitochondria for achieving high photosynthetic and respiratory rates, respectively, which, together with the expanding of cytosolic CINs, likely underpin the colonization of land plants through fueling rapid growth and biomass production.
Genicular nerve radiofrequency ablation for the treatment of chronic knee joint pain: a real-world cohort study with evaluation of prognostic factors
Authors: Caragea Marc , Woodworth Tyler , Curtis Tim , Blatt Michael , Cheney Cole , Brown Todd , Carson Daniel , Kuo Keith T , Randall Dustin , Huang Emily Y , Carefoot Andrea , Teramoto Masaru , Mills Megan , Cooper Amanda , Burnham Taylor , Conger Aaron , McCormick Zachary L
Published: July 2023

Background

Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain. However, there has been minimal investigation of real-world, long-term outcomes and factors that predict treatment success after GNRFA.

Objectives

To evaluate the effectiveness of GNRFA for chronic knee pain in a real-world population and identify predictive factors.

Methods

Consecutive patients who underwent GNRFA at a tertiary academic center were identified. Demographic, clinical, and procedural characteristics were collected from the medical record. Outcome data were numeric rating scale (NRS) pain reduction and Patient Global Impression of Change (PGIC). Data were collected by standardized telephone survey. Predictors of success were evaluated with logistic and Poisson regression analyses.

Results

Of the 226 total patients identified, 134 (65.6 ± 12.7; 59.7% female) were successfully contacted and analyzed, with a mean follow-up time of 23.3 ± 11.0 months. Of those, 47.8% (n = 64; 95% CI: 39.5%–56.2%) and 61.2% (n = 82; 95% CI: 52.7%–69.0%) reported ≥50% NRS score reduction and ≥2-point NRS score reduction, respectively, and 59.0% (n = 79; 95% CI: 50.5%–66.9%) reported “much improved” on the PGIC questionnaire. Factors associated with a greater likelihood of treatment success (P < .05) were higher Kellgren–Lawrence osteoarthritis grade (2–4 vs 0–1); no baseline opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted.

Conclusion

In this real-world cohort, approximately half of the participants experienced clinically meaningful improvements in knee pain after GNRFA at an average follow-up time of nearly 2 years. Factors associated with higher likelihood of treatment success were more advanced osteoarthritis (Kellgren–Lawrence Grade 2–4); no opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted.
Frailty predicts knee pain trajectory over 9 years: results from the Osteoarthritis Initiative
Authors: Cai Guoqi , Zhang Youyou , Wang Yining , Li Xiaoxi , Xu Shengqian , Shuai Zongwen , Pan Faming , Peng Xiaoqing
Published: July 2023

Objective

Frailty is a multisystem syndrome and its relationship with symptomatic osteoarthritis has been reported. We aimed to identify trajectories of knee pain in a large prospective cohort and to describe the effect of frailty status at baseline on the pain trajectories over 9 years.

Methods

We included 4419 participants (mean age 61.3 years, 58% female) from the Osteoarthritis Initiative cohort. Participants were classified as “no frailty,” “pre-frailty,” or “frailty” at baseline, based on 5 characteristics (ie, unintentional weight loss, exhaustion, weak energy, slow gait speed, and low physical activity). Knee pain was evaluated annually using the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (0–20) from baseline to 9 years.

Results

Of the participants included, 38.4%, 55.4%, and 6.3% were classified as “no frailty,” “pre-frailty,” and “frailty,” respectively. Five pain trajectories were identified: “No pain” (n = 1010, 22.8%), “Mild pain” (n = 1656, 37.3%), “Moderate pain” (n = 1149, 26.0%), “Severe pain” (n = 477, 10.9%), and “Very Severe pain” (n = 127, 3.0%). Compared to participants with no frailty, those with pre-frailty and frailty were more likely to have more severe pain trajectories (pre-frailty: odds ratios [ORs] 1.5 to 2.1; frailty: ORs 1.5 to 5.0), after adjusting for potential confounders. Further analyses indicated that the associations between frailty and pain were mainly driven by exhaustion, slow gait speed, and weak energy.

Conclusions

Approximately two-thirds of middle-aged and older adults were frail or pre-frail. The role of frailty in predicting pain trajectories suggests that frailty may be an important treatment target for knee pain.
The (moral) language of hate
Authors: Kennedy Brendan , Golazizian Preni , Trager Jackson , Atari Mohammad , Hoover Joe , Mostafazadeh Davani Aida , Dehghani Morteza
Published: July 2023

Humans use language toward hateful ends, inciting violence and genocide, intimidating and denigrating others based on their identity. Despite efforts to better address the language of hate in the public sphere, the psychological processes involved in hateful language remain unclear. In this work, we hypothesize that morality and hate are concomitant in language. In a series of studies, we find evidence in support of this hypothesis using language from a diverse array of contexts, including the use of hateful language in propaganda to inspire genocide (Study 1), hateful slurs as they occur in large text corpora across a multitude of languages (Study 2), and hate speech on social-media platforms (Study 3). In post hoc analyses focusing on particular moral concerns, we found that the type of moral content invoked through hate speech varied by context, with Purity language prominent in hateful propaganda and online hate speech and Loyalty language invoked in hateful slurs across languages. Our findings provide a new psychological lens for understanding hateful language and points to further research into the intersection of morality and hate, with practical implications for mitigating hateful rhetoric online.
Surgeon Experience Matters: An Exact Matched Analysis of TLIF Outcomes Demonstrates No Difference in Surgical Outcomes Between Experienced Neurosurgeons and Orthopedic Surgeons
Authors: Shukla Geet G. , Matur Abhijith V. , Childress Kelly , Tao Xu , Garcia-Vargas Julia , Mehta Jay , Garner Rebecca M. , Gibson Justin , Cass Daryn , Vorster Phillip , Wu Andrew , Street Seth , Duah Henry O. , Motley Benjamin , Cheng Joseph , Adogwa Owoicho
Published: July 2023

Study Design:

Retrospective cohort study.

Objective:

To compare surgical and medical complications profile between neurosurgeons and orthopedic surgeons after transforaminal lumbar interbody fusion (TLIF) procedures.

Background:

Studies comparing the impact of spine surgeon specialty (neurosurgery vs. orthopedic spine) on TLIF outcomes have been inconclusive and failed to control for operative learning curves and surgical maturity. Orthopedic spine surgeons perform fewer spine procedures in residency, although these differences may be attenuated by mandatory fellowship before starting practice. Any observed differences are likely attenuated with increasing surgeon experience.

Materials and Methods:

Using an all-payer claims database, PearlDiver Mariner, 120 million patient records were analyzed between 2010 and 2022, to identify individuals with lumbar stenosis or spondylolisthesis who underwent index one- to three-level TLIF procedures. International Classification of Diseases—Ninth Edition (ICD-9), International Classification of Diseases—10th Edition (ICD-10) and Current Procedural Terminology (CPT) codes were used to query the database. Only Neurosurgeons and Orthopedic spine surgeons who had performed at least 250 procedures were included in the study. Patients undergoing surgery for tumor, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with all-cause surgical or medical complications in a linear regression model.

Results:

1:1 exact matching created two equal groups of 18,195 patients without baseline differences who underwent TLIF procedures by neurosurgeons or orthopedic surgeons. There was no difference in all-cause surgical complications between neurosurgeons and orthopedic spine surgeons (relative risk=1.008, 95% CI: 0.850–1.195, P=0.965). All-cause medical complication rate was higher in the neurosurgery cohort (relative risk=1.144, 95% CI: 1.042–1.258, P=0.005).

Conclusion:

The results of this study suggest that after accounting for surgical maturity, neurosurgeons and orthopedic spine surgeons have similar surgical outcomes. However, neurosurgeons have higher all-cause medical complication rates compared with orthopedic spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes.
In-person, Hybrid, and Virtual Grand Rounds in Plastic Surgery: Impact and Participant Perceptions
Authors: Hyland Colby J. , Xiang David H. , Yang Alan Z. , Helliwell Lydia A. , Broyles Justin M.
Published: July 2023

Background:

Many plastic surgery residency programs adapted to the COVID-19 pandemic by implementing virtual grand rounds. This study aimed to assess the impact of virtual grand rounds and how attendees perceived virtual grand rounds to inform future programmatic planning.

Methods:

This was a quality improvement initiative involving a cross-sectional survey and retrospective review of administrative records for the 2017–2018 (in-person) and 2021–2022 (virtual) academic years for two academic plastic surgery training programs in Boston, MA. Respondents were residents, fellows, and faculty within the two multisite plastic surgery residency training programs.

Results:

There were 39 respondents (51% faculty, 41% residents, and 8% fellows). There was no evidence of different preferences for the format of future grand rounds (P = 0.08), with most preferring hybrid, defined as in person for speakers and others who could attend. Most respondents indicated a more accessible learning environment (86.8%) and lack of in-person interaction (82.1%) as reasons for liking and not liking virtual grand rounds, respectively. Excluding outliers, attendance in 2021–2022 was on average 7.4% points greater than that in 2017–2018 (P < 0.001), or six to seven more individuals at each session. There were significantly more out-of-state speakers in 2021–2022 (84%) as compared to 2017–2018 (28%) (P = 0.0008).

Conclusions:

Virtual grand rounds improved attendance and the geographic diversity of speakers. Attendees preferred a hybrid format for future grand rounds, citing advantages and disadvantages to both in-person and virtual formats.
Consensus-based Recommendations for Vibration Amplification of Sound Energy at Resonance Ultrasound-assisted Liposuction
Authors: Ruff Paul G. , Garcia Onelio , Nykiel Matthew J. , Galanis Charles J.
Published: July 2023

Background:

Ultrasound-assisted liposuction (UAL) is a popular and minimally invasive cosmetic procedure. Third-generation devices such as the vibration amplification of sound energy at resonance (VASER)lipo system are used for body contouring with enhanced tissue specificity. Despite the widespread use of VASER UAL, published guidelines and recent expert consensus recommendations are lacking. The objective of this study is to develop an expert consensus on the recommendations for use of VASER UAL.

Methods:

In a modified Delphi process, a panel of five US-based, expert plastic surgeons participated in three rounds of consensus building that spanned 4 months to align on guidance statements for the use of VASER as an adjunct to liposuction.

Results:

After the experts responded to an online questionnaire that assessed device settings, postoperative instructions, side effects or complications, and best practices, 32 initial consensus statements were developed. By round 3, these consensus statements for VASER UAL had been reduced and refined to a total of 18.

Conclusions:

To improve patient outcomes, clinicians must understand key factors and best practices when using VASER UAL, including device settings, provider technique, managing side effects, potential complications, and postoperative care. The consensus statements developed herein aim to provide clinicians with expert-backed recommendations for the use of VASER UAL.
Point-of-Care Tissue Oxygenation Assessment with SnapshotNIR for Alloplastic and Autologous Breast Reconstruction
Authors: Moritz William R. , Daines John , Christensen Joani M. , Myckatyn Terence , Sacks Justin M. , Westman Amanda M.
Published: July 2023

Background:

In breast reconstruction, mastectomy and free flaps are susceptible to vascular compromise and tissue necrosis. The SnapshotNIR device (Kent Imaging, Calgary, AB, Canada) utilizes near-infrared spectroscopy to measure tissue oxygen saturation (StO2) and hemoglobin concentration. Here, we report on the use of this device for StO2 monitoring among patients receiving alloplastic or autologous breast reconstruction.

Methods:

Patients receiving immediate alloplastic reconstruction after mastectomy or autologous reconstruction were enrolled. Preoperative, intraoperative, and postoperative images were taken of the flaps. StO2 and hemoglobin were measured at the following locations: superior and inferior breast, free flap skin paddle (when applicable), and un-operated control skin. Linear mixed effects model for repeated measurements was used to model measurements to estimate the area effect difference across time, time effect difference across area, and pairwise comparisons between two areas at each time point.

Results:

Thirty-two breasts underwent alloplastic reconstruction; 38 breasts underwent autologous reconstruction. No enrollees developed skin necrosis. StO2 was highest after mastectomy and closure in alloplastic reconstructions. StO2 was observed to decline at follow-up in autologous reconstructions. Mean preoperative StO2 was highest in breasts that had previously undergone mastectomy and alloplastic reconstruction.

Conclusions:

The SnapshotNIR device detected normal spatial and temporal differences in tissue oxygenation over the operative course of alloplastic and autologous breast reconstruction. A multi-institutional, prospective clinical trial is needed to determine the sensitivity and specificity of this device for detecting skin flap necrosis.
Acute effect of various dosages of sugar ingestion on vascular function in offspring of hypertensive and normotensive parents
Authors: Kositanurit Weerapat , Korakot Manta , Burana Chuti , Varachotisate Pachara , Kerr Stephen J. , Boonla Chanchai , Kulaputana Onanong
Published: July 2023

Objectives:

We aimed to study vascular function in healthy men with a parental history of hypertension compared to those without. Acute effect of various dosages of sugar ingestion on vascular function was also investigated in both groups.

Methods:

Thirty-two healthy men were recruited and divided into two groups, offspring of hypertensive parents (OHT) and offspring of normotensive parents (ONT). Participants were orally given 15, 30, and 60 g of sucrose solution compared to water. Peak forearm blood flow (FBF), forearm vascular resistance (FVR), pulse wave velocity (PWV), and oxidative stress markers were measured at baseline and after sucrose intake at 30, 60, 90, and 120 min.

Results:

At baseline, peak FBF was significantly lower (22.40 ± 1.18 vs. 25.24 ± 0.63 ml × dl−1 × min−1, P < 0.001), FVR was significantly higher (3.73 ± 0.42 vs. 3.30 ± 0.26 mmHg × ml−1 × dl × min, P = 0.002), and PWV was significantly faster (6.31 ± 0.59 vs. 5.78 ± 0.61 m/s, P = 0.017) in OHT than ONT. After each sucrose intake, peak FBF significantly declined and was lowest at 30 min in both groups. The reduction in peak FBF was seen in all doses of sucrose and the higher dose of sucrose intervened, the longer reduction in peak FBF observed.

Conclusions:

Vascular function was attenuated in healthy men with a family history of hypertension and became worse after sucrose ingestion even at the low dose. Our findings suggest that the ones, especially those with a parental history of hypertension, should reduce sugar consumption as low as possible.
Using plasma aldosterone concentrations at 1 h of saline infusion test for the diagnosis of primary aldosteronism
Authors: Phonanuwong Ratikorn , Jannoo Sirirat , Chanthanuwat Surawadee , Soonthornpun Supamai
Published: July 2023

Objective:

Saline infusion test (SIT) requires 2 l of isotonic saline for intravenous infusion over 4 h to suppress plasma aldosterone concentration (PAC). To shorten the procedure time and minimize the volume load, we study the performance of SIT at 1, 2 and 4 h for diagnosing primary aldosteronism.

Methods:

This is a cross-sectional study. PAC was measured before and 1, 2 and 4 h after saline infusion at a rate of 500 ml/h in patients suspected to have primary aldosteronism. Primary aldosteronism was diagnosed based on 4 h PAC, adrenal imaging and/or adrenal venous sampling (AVS).

Results:

Of the 93 patients, 32 had primary aldosteronism. The area under the receiver operating characteristic (ROC) curve of the 1, 2 and 4 h PAC were not statistically different. All of the nonprimary aldosteronism group had a 1 h PAC lower than 15 ng/dl and all of the primary aldosteronism group had a 1 h PAC higher than 5 ng/dl. Nearly 30% of the nonprimary aldosteronism and primary aldosteronism groups had a 1 h PAC between 5 and 15 ng/dl (equivocal range) and could be discriminated by using percentage suppression of 1 h PAC from baseline. Using 1 h PAC of more than 15 ng/dl together with percentage suppression of 1 h PAC from baseline of less than 60 when 1 h PAC was 5–15 ng/dl, primary aldosteronism could be detected with a sensitivity of 93.7% and specificity of 96.7%.

Conclusion:

The 1 h SIT has a similar diagnostic performance to the standard SIT. Using 1 h PAC together with percentage suppression from baseline when 1 h PAC is equivocal, primary aldosteronism can be diagnosed with good accuracy.
Outpatient Runners Clinic Visit Trends and Injury Characteristics Among 392 Child and Adolescent Patients: A 10-year Chart Review
Authors: DeJong Lempke Alexandra F. , Whitney Kristin E. , Stracciolini Andrea , Ackerman Kathryn E. , d’Hemecourt Pierre A. , Willwerth Sarah B. , Meehan William P.
Published: July 2023

Objective:

To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame.

Design:

Retrospective chart review.

Setting:

Outpatient hospital-affiliated Injured Runners Clinic.

Patients:

Children and adolescent runners (6-17 years) with RRIs.

Independent Variables:

We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors.

Main Outcome Measures:

We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis.

Results:

There were 392 patients (sex: 277 F; mean age: 16.1 ± 1.3 years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ2 = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ2 = 1940, P < 0 .001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ2 = 9271, P < 0 .001; N = 591; 25.4% of all visits).

Conclusion:

We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden.
Financial Toxicity Among Breast Cancer Patients
Authors: Kuang Yi , Yuan Xiaoyi , Zhu Zheng , Xing Weijie
Published: July 2023

Background

Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.

Objectives

The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.

Methods

We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.

Results

A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.

Conclusion

Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.

Implications for Practice

More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.
Experiences of Using Patient Decision Aids for Decisions About Cancer Treatment
Authors: Longcoy Li-Ting Huang , Mathew Asha , Jang Min Kyeong , Mayahara Masako , Doorenbos Ardith Z.
Published: July 2023

Background

Inconsistent results have been found regarding the effects of patient decision aids (PtDAs) in supporting patients’ decision-making for cancer treatment.

Objective

This qualitative meta-aggregation presents the experiences of using PtDAs, as perceived by adult patients with cancer, and highlights the components they perceived as important.

Methods

We used the 3-phase process for meta-aggregation suggested by Joanna Briggs Institute to identify published studies with qualitative evidence from CINAHL, Ovid-MEDLINE, APA PsycINFO, and EMBASE databases. The selected studies involved adults with various cancer diagnoses. The phenomenon of interest and the context for this review were people’s experiences of using PtDAs for decisions about first-line cancer treatment.

Results

A total of 16 studies were included. The authors achieved consensus on 5 synthesized findings about PtDAs: (1) improved understanding of treatment options and patient values and preferences; (2) served as platforms for expressing concerns, obtaining support, and having meaningful conversations with healthcare providers; (3) facilitated active personal and family engagement in decision-making; (4) enabled recall of information and evaluation of satisfaction with decisions; and (5) presented potential structural barriers.

Conclusions

This study used qualitative evidence to demonstrate the usefulness of PtDAs and identify aspects patients with cancer find particularly beneficial.

Implications for Practice

Nurses play a crucial role in supporting patients and family caregivers throughout the decision-making process for cancer treatment. Patient decision aids that balance complex treatment information with simple language and illustrations or graphs can enhance patients’ comprehension. The integration of values clarification exercises into care can further improve patients’ decisional outcomes.
Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project
Authors: Pattnaik Priyam , Nafday Suhas , Angert Robert
Published: July 2023

Introduction:

Neonatal intensive care unit (NICU) graduates require complex services after discharge. The NICU discharge process at Children’s Hospital at Montefiore-Weiler, Bronx, NY (CHAM-Weiler) lacked a system for routine primary care provider (PCP) notification. Here, we describe a quality improvement project to improve communication with PCPs to ensure communication of critical information and plans.

Methods:

We assembled a multidisciplinary team and collected baseline data on discharge communication frequency and quality. We used quality improvement tools to implement a higher-quality system. The outcome measure was the successful delivery of a standardized notification and discharge summary to a PCP. We collected qualitative data through multidisciplinary meetings and direct feedback. The balancing measures comprised additional time spent during the discharge process and relaying erroneous information. We used a run chart to track progress and drive change.

Results:

Baseline data indicated that 67% of PCPs did not receive notifications before discharge, and when PCPs did receive notifications, the discharge plans were unclear. PCP feedback led to proactive electronic communication and a standardized notification. The key driver diagram allowed the team to design interventions that led to sustainable change. After multiple Plan-Do-Study-Act cycles, delivery of electronic PCP notifications occurred more than 90% of the time. Surveys of pediatricians who received notifications indicated that the notifications were highly valued and aided in the transition of care for these at-risk patients.

Conclusion:

A multidisciplinary team, including community pediatricians, was key to improving the rate of PCP notification of NICU discharge to more than 90% and transmitting higher-quality information.
Hydrogen-Generating Silicon-Based Agent Improves Fat Graft Survival in Rats
Authors: Otani Naoya , Tomita Koichi , Kobayashi Yuki , Kuroda Kazuya , Kobayashi Hikaru , Kubo Tateki
Published: July 2023

Background:

Regulating excessive inflammation and oxidative stress in fat grafting may improve retention rates. Hydrogen effectively combats oxidative stress and inflammation and reportedly inhibits ischemia–reperfusion injury in various organs. However, with conventional methods of hydrogen administration, incorporating hydrogen continuously into the body over a long period of time is difficult. The authors hypothesized that a silicon (Si)-based agent they recently developed would aid in fat grafting, as it can generate large amounts of hydrogen continuously in the body.

Methods:

Fat grafting was performed on the backs of rats fed either a normal or 1.0 wt% Si-based agent-containing diet. To investigate synergistic effects with adipose-derived stromal cells (ASCs), which improve retention rates of fat grafting, fat grafting with ASCs (1.0 × 105/400 mg fat) was also performed in each rat. Postoperative retention rates of grafted fat over time, inflammatory indices, apoptosis, oxidative stress markers, histologic findings, and expression levels of inflammation-related cytokines and growth factors were compared among the 4 groups.

Results:

Intake of Si-based agent and addition of ASCs significantly reduced inflammatory indices, oxidative stress, and apoptosis of grafted fat, and improved long-term retention rates, histologic measures, and grafted fat quality. Under the experimental conditions, intake of the Si-based agent and addition of ASCs yielded comparable improvements in fat graft retention. Combining the 2 enhanced these effects.

Conclusions:

Oral administration of a hydrogen-generating Si-based agent may improve grafted fat retention by regulating the inflammatory response and oxidative stress in grafted fat.

Clinical Relevance Statement:

This study demonstrates improved grafted fat retention rates using a Si-based agent. This Si-based agent has the potential to expand the range of therapeutic indications of hydrogen-based therapy to conditions for which hydrogen has yet to be found effective, such as fat grafting.
Diagnostic stewardship: what impacts antibiotics use?
Authors: Coffey KC , Morgan Daniel J , Claeys Kimberly C
Published: July 2023

Purpose of review

The aim of this study was to review recently published diagnostic stewardship studies of common clinical infectious syndromes and the impact on antibiotic prescribing.

Recent findings

Diagnostic stewardship can be implemented within healthcare systems and tailored to infectious syndromes, including urinary tract, gastrointestinal, respiratory and bloodstream infections. In urinary syndromes, diagnostic stewardship can decrease unnecessary urine culturing and associated antibiotic prescribing. Diagnostic stewardship of Clostridium difficile testing can decrease antibiotics and test ordering with a reduction in healthcare-associated C. difficile infections. Respiratory syndrome multiplex arrays can decrease time to results and increase detection of clinically relevant pathogens but may not decrease antibiotics use, or worse, could increase over-prescribing if diagnostic stewardship of ordering practices is not exercised. Lastly, blood culturing practices can be improved by clinical decision support to safely decrease collection and broad-spectrum antibiotic use.

Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship in patient care activities to leverage integration into systems-based interventions.
Neutropenia and antibiotics: when, what, how and why?
Authors: Dickter Jana , Logan Cathy , Taplitz Randy
Published: July 2023

Purpose of review

Our aim is to review recent literature on antibiotic use in patients with neutropenia.

Recent findings

Prophylactic antibiotics are associated with risks and have limited mortality benefit. While early antibiotic use in febrile neutropenia (FN) is critical, early de-escalation or discontinuation may be safe in many patients.

With an increasing understanding of potential risks and benefits of use and improved risk assessment, paradigms of antibiotic use in neutropenic patients are changing.
Mpox exposure and transmission in healthcare settings during the 2022 global outbreak
Authors: Zachary Kimon C , Philpotts Lisa L , Shenoy Erica S
Published: July 2023

Purpose of review

The risk of nosocomial transmission of mpox during the 2022 global outbreak is not well described. We evaluated reports of exposures to healthcare personnel (HCP) and patients in healthcare settings and risk of transmission.

Recent findings

Reported nosocomial transmission of mpox has been rare and associated primarily with sharps injuries and breaches in transmission-based precautions.

Currently recommended infection control practices, including the use of standard and transmission-based precautions in the care of patients with known or suspected mpox are highly effective. Diagnostic sampling should not involve the use of needles or other sharp instruments.
Sequence-based diagnostics and precision medicine in bacterial and viral infections: from bench to bedside
Authors: Pham Jonathan , Su LingHui David , Hanson Kimberly E , Hogan Catherine A
Published: July 2023

Purpose of review

Nucleic acid sequence-based organism identification plays an important role in the diagnosis and management of transplant and cancer-associated infectious diseases. Here, we provide a high-level overview of advanced sequencing technologies, discuss test performance, and highlight unmet research needs with a focus on immunocompromised hosts.

Recent findings

Next-generation sequencing (NGS) technologies are powerful tools with a growing role in managing immunocompromised patients with suspected infection. Targeted NGS (tNGS) can identify pathogens directly from patient specimens, especially for mixed samples, and has been used to detect resistance mutations in transplant-related viruses (e.g. CMV). Whole-genome sequencing (WGS) is increasingly used for outbreak investigations and infection control. Metagenomic NGS (mNGS) is useful for hypothesis-free testing and can simultaneously assess pathogens and host response to infection.

NGS testing increases diagnostic yield relative to standard culture and Sanger sequencing but may be limited by high cost, turnaround times, and detection of unexpected organisms or commensals of uncertain significance. Close collaboration with the clinical microbiology laboratory and infectious diseases is recommended when NGS testing is considered. Additional research is required to understand which immunocompromised patients are most likely to benefit from NGS testing, and when testing should ideally be performed.
Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: are we making progress?
Authors: Lewis Russell E , Stanzani Marta , Morana Giovanni , Sassi Claudia
Published: July 2023

Purpose of review

In patients with hematological malignancies, high-resolution computed tomography (CT) is the recommended imaging approach for diagnosis, staging and monitoring of invasive fungal disease (IFD) but lacks specificity. We examined the status of current imaging modalities for IFD and possibilities for more effective applications of current technology for improving the specificity of IFD diagnosis.

Recent findings

Although CT imaging recommendations for IFD are largely unchanged in the last 20 years, improvements in CT scanner technology and image processing algorithms now allow for technically adequate examinations at much lower radiation doses. CT pulmonary angiography can improve both the sensitivity and specificity of CT imaging for angioinvasive molds in both neutropenic and nonneutropenic patients, through detection of the vessel occlusion sign (VOS). MRI-based approaches also show promise not only for early detection of small nodules and alveolar hemorrhage but can also be used to detect pulmonary vascular occlusion without radiation and iodinated contrast media. 18F-fluorodeoxyglucose (FDG) PET/computed tomography (FDG-PET/CT) is increasingly used to monitor long-term treatment response for IFD, but could become a more powerful diagnostic tool with the development of fungal-specific antibody imaging tracers.

High-risk hematology patients have a considerable medical need for more sensitive and specific imaging approaches for IFD. This need may be addressable, in part, by better exploiting recent progress in CT/MRI imaging technology and algorithms to improve the specificity of radiological diagnosis for IFD.
Impact of Low-Dose Computed Tomography and Physician Education on Referral for Head Shape
Authors: Nielsen Alyssa , Moor Rachel , Neal Daniel , Governale Lance S. , Ching Jessica A.
Published: July 2023

Imaging before specialist evaluation of abnormal head shape is associated with a delay in evaluation and an increase in radiation exposure. A retrospective cohort study was performed to identify referral patterns before and after the implementation of a low-dose computed tomography (LDCT) protocol and physician education to examine the intervention’s impact on time to evaluation and radiation exposure. Six hundred sixty-nine patients with an abnormal head shape diagnosis at a single academic medical center between July 1, 2014 and December 1, 2019 were reviewed. Demographics, referral information, diagnostic testing, diagnoses, and timeline of clinical evaluation were recorded. Before and after the LDCT and physician education intervention, the average ages at initial specialist appointments were 8.82 and 7.75 months, respectively (P = 0.125). Children referred after our intervention were less likely to have prereferral imaging than children referred prior (odds ratio: 0.59, CI: 0.39–0.91, P = 0.015). Average radiation exposure per patient before referral decreased from 14.66 mGy to 8.17 mGy (P = 0.021). Prereferral imaging, referral by a non-pediatrician, and non-Caucasian race were associated with older age at the initial specialist appointment. Widespread craniofacial center adoption of an LDCT protocol and improved clinician knowledge may lead to a reduction in late referrals and radiation exposure in pediatric patients with an abnormal head shape diagnosis.
Modified Lacrimal Gland Suspension Technique in Patients Who Underwent Upper Eyelid Blepharoplasty
Authors: Vatansever Mustafa
Published: July 2023

Aim:

The aim of the present study was to evaluate the efficacy of modified lacrimal gland suspension surgery combined with upper lid blepharoplasty.

Methods:

Between December 2020 and December 2021, 365 patients admitted to our clinic for ptosis were included in the study. The data of 89 patients who underwent upper lid blepharoplasty with lacrimal gland repositioning for dermatochalasis were analyzed.

Results:

Combined surgery was performed in 24.38% of the patients included in the study; 16 (17.9%) of these patients were males and 73 (82.1%) were females, and the mean age of the patients was 47.34 ± 8.13 years. The mean follow-up period was 16.42 ± 2.63 months. In patients who underwent lacrimal gland suspension, 72 (85%) of the patients complained of swelling on the outer part of the upper lid before surgery. However, 9 (10.11%) of the patients did not have lacrimal gland prolapse, and only fat prolapse was present in these patients. No complication or recurrence was observed in any patient during the follow-up period.

Discussion:

With the new modified technique, the lacrimal gland can be suspended close to the anatomical position, and satisfactory results can be obtained for both the patient and the surgeon.
Trait-dependent associations between early- and late-life reproduction in a wild mammal
Authors: McKenna-Ell Chris , Ravindran Sanjana , Pilkington Jill G. , Pemberton Josephine M. , Nussey Daniel H. , Froy Hannah
Published: July 2023

Early- versus late-life trade-offs are a central prediction of life-history theory that are expected to shape the evolution of ageing. While ageing is widely observed in wild vertebrates, evidence that early–late trade-offs influence ageing rates remains limited. Vertebrate reproduction is a complex, multi-stage process, yet few studies have examined how different aspects of early-life reproductive allocation shape late-life performance and ageing. Here, we use longitudinal data from a 36-year study of wild Soay sheep to show that early-life reproduction predicts late-life reproductive performance in a trait-dependent manner. Females that started breeding earlier showed more rapid declines in annual breeding probability with age, consistent with a trade-off. However, age-related declines in offspring first-year survival and birth weight were not associated with early-life reproduction. Selective disappearance was evident in all three late-life reproductive measures, with longer-lived females having higher average performance. Our results provide mixed support for early–late reproductive trade-offs and show that the way early-life reproduction shapes late-life performance and ageing can differ among reproductive traits.
Evolution and assembly of
Anopheles aquasalis
's immune genes: primary malaria vector of coastal Central and South America and the Caribbean Islands
Authors: Prado Sepulveda Cesar Camilo , Alencar Rodrigo Maciel , Santana Rosa Amélia , Belém de Souza Igor , D'Elia Gigliola Mayra Ayres , Godoy Raquel Soares Maia , Duarte Ana Paula , Lopes Stefanie Costa Pinto , de Lacerda Marcus Vinicius Guimarães , Monteiro Wuelton Marcelo , Nacif-Pimenta Rafael , Secundino Nágila Francinete Costa , Koerich Leonardo Barbosa , Pimenta Paulo Filemon Paolucci
Published: July 2023

Anophelines are vectors of malaria, the deadliest disease worldwide transmitted by mosquitoes. The availability of genomic data from various
Anopheles
species allowed evolutionary comparisons of the immune response genes in search of alternative vector control of the malarial parasites. Now, with the
Anopheles aquasalis
genome, it was possible to obtain more information about the evolution of the immune response genes.
Anopheles aquasalis
has 278 immune genes in 24 families or groups. Comparatively, the American anophelines possess fewer genes than
Anopheles gambiae
s
.
s
., the most dangerous African vector. The most remarkable differences were found in the pathogen recognition and modulation families like FREPs, CLIP and C-type lectins. Even so, genes related to the modulation of the expression of effectors in response to pathogens and gene families that control the production of reactive oxygen species were more conserved. Overall, the results show a variable pattern of evolution in the immune response genes in the anopheline species. Environmental factors, such as exposure to different pathogens and differences in the microbiota composition, could shape the expression of this group of genes. The results presented here will contribute to a better knowledge of the Neotropical vector and open opportunities for malaria control in the endemic-affected areas of the New World.