bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-reported Outcomes of Revision Ankle Open Reduction Internal Fixation
Authors: Mutawakkil Muhammad Y. , Gulati Reeti K. , Zaidi Abu J. , Barrett Joshua , Patel Milap , Kadakia Anish
Published: February 2023

Ankle fractures may require revision surgery for malunion or suboptimal joint congruence results after initial surgical or nonsurgical treatment. There is limited literature on the outcomes of patients undergoing such revision surgery for ankle fracture malunion. In this retrospective case series, we determined clinical and functional outcomes of revision ankle open reduction internal fixation (ORIF) for 7 patients with ankle fracture malunion through patient-reported and radiographic outcomes. Patient-reported Outcomes Measurement Information System physical function and pain interference scores prerevision and postrevision procedure were obtained from 7 patients treated from January 2017 to October 2020. Postoperative complications including persistent pain, infection, hardware removal, hardware failure, and conversion to ankle arthrodesis were analyzed. Seven patients who underwent revision ORIF surgery for ankle fracture malunion between January 2017 and October 2020 were included. The average age was 46.3

12.2 years old; 85.7% of the patients were female; 14.3% were male. The average amount of time between revision ORIF procedure and collection of postoperative Patient-Reported Outcomes Measurement Information System scores was 19.3±5.9 months. Each of the 7 patients showed an increase in physical function after revision surgery (average preoperative physical function score: 30.7; average postoperative physical function score: 48.9). All patients showed a decrease in pain after revision surgery (average preoperative pain interference score: 64.8; average postoperative pain interference score: 55.7). Of the 7 participants who underwent revision ORIF, a majority did not experience any complications at least 1 year postprocedure, including infection, reoperation, or hardware removal. One participant underwent hardware removal for persistent pain and developed overlying cellulitis. For patients with ankle fracture malunion without significant post-traumatic degenerative changes of the ankle joint, revision ankle ORIF can be an effective method for improving physical function, decreasing pain, and preserving ankle joint motion.

Level of Evidence: Level IV—case series.
Retinal Pigment Epithelium Tear After Nonpenetrating Deep Sclerectomy
Authors: Cayzac Vincent , Sagnard Marion , Valero Bernard , Voisin Hugo , El Chehab Hussam
Published: February 2023

Retinal pigment epithelium (RPE) tear is a common complication in the context of neovascular age-related macular degeneration treated by intravitreal injections of antivascular endothelial growth factor drugs. There are some reports of such complications after trabeculectomy but none after nonpenetrating deep sclerectomy (NPDS). A 57-year-old man presented to our hospital with uncontrolled advanced glaucoma of his left eye. NPDS with adjunctive use of mitomycin C was performed with no intraoperative complication. On the seventh postoperative day clinical examination and multimodal imaging revealed a macular RPE tear in the operated eye. Subretinal fluid induced by the tear resolved within 2 months with an increase in intraocular pressure. To the best of our knowledge, this article discusses the first reported case of RPE tear occurring just after NPDS.
Subjective and Objective Measurement of Sleep Quality and Activity in Glaucoma
Authors: Stoner Ari M. , Patnaik Jennifer L. , Ertel Monica K. , Capitena-Young Cara E. , SooHoo Jeffrey R. , Pantcheva Mina B. , Kahook Malik Y. , Seibold Leonard K.
Published: February 2023

Précis:

Glaucoma patients exhibit worse indices of sleep function by both objective and subjective metrics compared with controls.

Purpose:

The purpose of this study is to characterize the sleep parameters and physical activity levels of glaucoma patients compared with controls.

Patients and Methods:

A total of 102 patients with a diagnosis of glaucoma in at least 1 eye and 31 control subjects were enrolled in the study. Participants completed the Pittsburgh Sleep Quality Index (PSQI) during enrollment and then wore wrist actigraphs for 7 consecutive days to characterize circadian rhythm, sleep quality, and physical activity. The primary outcomes of the study were subjective and objective metrics of sleep quality using the PSQI and actigraphy devices, respectively. The secondary outcome was physical activity, measured by the actigraphy device.

Results:

From the PSQI survey, glaucoma patients had higher (worse) scores compared with controls for sleep latency, sleep duration, and subjective sleep quality, whereas scores for sleep efficiency were lower (better), suggesting more time spent in bed asleep. By actigraphy, time in bed was significantly higher in glaucoma patients as was time awake after sleep onset. Interdaily stability, quantifying the synchronization to the 24-hour light-dark cycle, was lower in glaucoma patients. There were no other significant differences between glaucoma and control patients with regard to rest-activity rhythms or physical activity metrics. In contrast to the survey data, findings from the actigraphy demonstrated that there were no significant associations between the study group and controls regarding sleep efficiency, onset latency, or total sleep time.

Conclusions:

In this study, patients with glaucoma demonstrated several subjective and objective differences in sleep function when compared with controls, whereas physical activity metrics were similar.
Influence of Age, Sex, and Wait Times on Public Online Ratings of Glaucoma Physicians in the United States
Authors: Kim Joo Yeon , Francisco Raia , Wang Jiaying , Liu Jacob J. , Stephenson Nathaniel J. , Khalil Charbel bou , Kim Dong Hyeon , Nguyen Anne X. , Youn Gun Min , Sun Yang , Wu Albert Y.
Published: February 2023

Précis:

Glaucoma surgeons are highly rated by the general public. Physicians with shorter wait times and who are younger are more likely to have higher ratings. Female glaucoma physicians are less likely to have higher ratings.

Purpose:

Find what characteristics of glaucoma physicians are associated with higher online ratings.

Methods:

All American members of the American Glaucoma Society were queried on Healthgrades, Vitals, and Yelp. Ratings, medical school ranking, region of practice, sex, age, and wait times were recorded.

Results:

One thousand one hundred six (78.2%) of American Glaucoma Society members had at least 1 review across the 3 platforms. The average score among glaucoma surgeons was 4.160 (0.898 SD). Female physicians were associated with lower online ratings [adjusted odds ratio (aOR): 0.536; 95% CI 0.354–0.808]. Physicians with <30 minutes of wait time had higher ratings: 15–30 minutes wait time (aOR: 2.273; 95% CI: 1.430–3.636) and <15 minutes wait time (aOR: 3.102; 95% CI: 1.888–5.146). Older physicians had lower ratings (aOR: 0.384; 95% CI: 0.255–0.572).

Conclusions:

Public online ratings of glaucoma specialists in the United States seem to favor those of younger age, men, and those with shorter wait times.
Highly Active Antiretroviral Therapy in an Extremely Low Birth Weight Newborn With in Utero Transmission of HIV
Authors: Dodi Icilio , Romanini Enzo , Veronese Piero , Cangelosi Antonina Marta , Calzolari Francesca , Ruozi Maria Beatrice , Maffini Valentina
Published: February 2023

The management of perinatal HIV infection in preterm infants is hampered by the lack of evidence informing optimal antiretroviral treatment for these vulnerable newborns. We present a case of an extremely preterm infant with HIV infection treated immediately with a 3-drug antiretroviral regimen and achieving stable suppression of HIV plasma viral load.
Clinical Characteristics and Outcomes of SARS-CoV-2 Positive Neonates Born to Persons With SARS-CoV-2 Infection in Pregnancy in Los Angeles County, California, May 22, 2020–February 22, 2021
Authors: Barnes Emily , Van Groningen Karinne , Ngo Van , Nunez Denise , Mykhaylov Nina , Ryan Alison , Apichon Savij , Sontz Jordan , Lyu Caleb , Halai Umme-Aiman
Published: February 2023

Background:

It is well established that pregnant persons with SARS-CoV-2 are at an increased risk for preterm birth, however, less is known about perinatal outcomes for neonates with intrauterine exposure to SARS-CoV-2.

Methods:

Characteristics of 50 SARS-CoV-2 positive neonates born to SARS-CoV-2 pregnant persons positive between May 22, 2020, and February 22, 2021, in Los Angeles County, CA, were assessed. Pattern of neonate SARS-CoV-2 test results and time to positive test was analyzed. Objective clinical severity criteria were applied to assess neonatal disease severity.

Results:

Median gestational age was 39 weeks with 8 (16%) neonates born preterm. Most (74%) were asymptomatic, while 13 (26%) were symptomatic from any cause. Four (8%) symptomatic neonates met criteria for severe disease, of which 2 (4%) were likely secondary to COVID-19. The other 2 with severe disease had more likely alternate diagnoses, and 1 of these neonates subsequently died at 7 months of life. Among 12 (24%) that were positive within 24 hours after birth, one was persistently positive and represented likely intrauterine transmission. Sixteen (32%) were admitted to the neonatal intensive care unit.

Conclusion:

In this case series of 50 SARS-CoV-2 positive mother-neonate pairs, we found that most neonates were asymptomatic regardless of when they tested positive during the 14 days after birth, that there was relatively low risk of COVID-19 associated severe disease, and that intrauterine transmission can occur in rare cases. Although short-term outcomes are mostly promising, more research is needed to study long-term consequences of SARS-CoV-2 infection in neonates born to positive pregnant persons.
Impact of a Documented Penicillin Allergy on Antibiotic Selection in Pediatric Patients With Osteomyelitis
Authors: Naureckas Li Caitlin , Herman Katherine , Yim Ramy , Nakamura Mari M. , Chu Esther , Wilder Jayme L. , Alfieri Maria , Ethier Benjamin , Esty Brittany
Published: February 2023

Penicillin allergy labels are common in hospitalized patients, and there is a frequent misconception that these patients cannot receive cephalosporins. Through retrospective review, we found that patients with reported penicillin allergies were significantly less likely to receive first-line therapy for acute hematogenous osteomyelitis.
Distinct Clinical and Laboratory Features of COVID-19 in Children During the Pre-Delta, Delta and Omicron Wave
Authors: Han Mi Seon , Kim Kyung Min , Oh Kyung Jin , Chang Ju Young , Lee Seong Yong , Choi Ji Eun , Shin Su-Mi , Sun Jiyu
Published: February 2023

Background:

The SARS-CoV-2 variants of concern exhibit distinct features in terms of transmissibility and virulence. This study compared the clinical characteristics of COVID-19 in children during pre-Delta, Delta and Omicron waves.

Methods:

Medical records of 1163 children <19 years of age with COVID-19 admitted to a designated hospital in Seoul, South Korea, were analyzed. Clinical and laboratory findings during the pre-Delta (March 1, 2020, to June 30, 2021; 330 children), Delta (July 1, 2021, to December 31, 2021; 527 children) and Omicron (January 1, 2022, to May 10, 2022; 306 children) waves were compared.

Results:

Children during the Delta wave were older and had a higher proportion of fever ≥5 days and pneumonia than children during the pre-Delta and Omicron waves. The Omicron wave was characterized by younger age and a higher proportion of fever ≥39.0 °C, febrile seizure and croup. More children <2 years of age and adolescents aged 10 to <19 years experienced neutropenia and lymphopenia, respectively, during the Delta wave. Children aged 2 to <10 years had a higher incidence of leukopenia and lymphopenia during the Omicron wave.

Conclusions:

Distinct features of COVID-19 were observed in children during the Delta and Omicron surges. Continuous scrutiny of the manifestations of variants of concern is needed for appropriate public health response and management.
Neurological complications of sepsis
Authors: Piva Simone , Bertoni Michele , Gitti Nicola , Rasulo Francesco A. , Latronico Nicola
Published: February 2023

Purpose of review

Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of hospital and ICU admission. The central and peripheral nervous system may be the first organ system to show signs of dysfunction, leading to clinical manifestations such as sepsis-associated encephalopathy (SAE) with delirium or coma and ICU-acquired weakness (ICUAW). In the current review, we want to highlight developing insights into the epidemiology, diagnosis, prognosis, and treatment of patients with SAE and ICUAW.

Recent findings

The diagnosis of neurological complications of sepsis remains clinical, although the use of electroencephalography and electromyography can support the diagnosis, especially in noncollaborative patients, and can help in defining disease severity. Moreover, recent studies suggest new insights into the long-term effects associated with SAE and ICUAW, highlighting the need for effective prevention and treatment.

In this manuscript, we provide an overview of recent insights and developments in the prevention, diagnosis, and treatment of patients with SAE and ICUAW.
Approach to acute encephalitis in the intensive care unit
Authors: Venkatesan Arun , Habis Ralph , Geocadin Romergryko G.
Published: February 2023

Purpose of review

Recent years have seen a dramatic increase in the identification of autoimmune encephalitis (AE) and the emergence of new causes of infectious encephalitis (IE). However, management of these patients remains challenging, with many requiring care in intensive care units. Here, we describe recent advances in the diagnosis and management of acute encephalitis.

Recent findings

Advances in the identification of clinical presentations, neuroimaging biomarkers, and electroencephalogram patterns have enabled more rapid diagnosis of encephalitis. Newer modalities such as meningitis/encephalitis multiplex PCR panels, metagenomic next-generation sequencing, and phage display-based assays are being evaluated in an effort to improve detection of autoantibodies and pathogens. Specific advances in the treatment of AE include establishment of a systematic approach to first-line therapies and the development of newer second-line modalities. The role of immunomodulation and its applications in IE are actively being investigated. In the ICU, particular attention to status epilepticus, cerebral edema, and dysautonomia may improve outcomes.

Substantial diagnostic delays still occur, with many cases left without an identified etiology. Antiviral therapies remain scarce, and optimal treatment regimens for AE still need to be clarified. Nevertheless, our understanding of diagnostic and therapeutic approaches to encephalitis is rapidly evolving.
Effects of ankle-foot orthoses on different gait patterns in children with spastic cerebral palsy: A statistical parametric mapping study
Authors: Dobler Florian , Cip Johannes , Lengnick Harald , Alexander Nathalie
Published: February 2023

Background:

Ankle-foot orthoses (AFOs) are a common treatment to correct gait deviations in children with spastic cerebral palsy (SCP). Studies on the outcome of AFOs on gait often do not account for different gait patterns.

Objectives:

The aim of this study was to investigate the effects of AFOs on specific gait patterns in children with cerebral palsy.

Study Design:

Retrospective, unblinded, controlled, cross-over study.

Methods:

Twenty-seven children with SCP were assessed in the conditions walking barefoot or with shoes and AFO. AFOs were prescribed based on usual clinical practice. Gait patterns for each leg were classified as excess ankle plantarflexion in stance (equinus), excess knee extension in stance (hyperextension), or excess knee flexion in stance (crouch). Differences in spatial-temporal variables and sagittal kinematics and kinetics of the hip, knee, and ankle between the 2 conditions were determined using paired t-tests and statistical parametric mapping, respectively. The effect of AFO-footwear neutral angle on knee flexion was tested using statistical parametric mapping regression.

Results:

AFO use improved spatial-temporal variables and reduced ankle power generation in preswing. For “equinus” and “hyperextension” gait patterns, AFOs decreased ankle plantarflexion in preswing and initial swing and decreased ankle power in preswing. Ankle dorsiflexion moment increased in all gait pattern groups. Knee and hip variables did not change in any of the 3 groups. AFO-footwear neutral angle had no effect on changes in sagittal knee angle.

Conclusion:

Although improvements in spatial-temporal variables were seen, gait deviations could only partially be corrected. Therefore, AFO prescriptions and design should individually address specific gait deviations and their effectiveness in children with SCP should be controlled.
Comparison of 18F-FDG and 68Ga-FAPI-04 Uptake in Postoperative Re-evaluation of Gastric, Duodenal, and Colorectal Cancers
Authors: Liu Huipan , Yang Xiao , Liu Lin , Qu Gengcuo , Chen Yue
Published: February 2023

Purpose

To compare the potential efficacy of 68Ga-FAPI-04 PET/CT with that of 18F-FDG PET/CT for detecting tumor recurrence and nodal and distant metastases in gastric, duodenal, and colorectal cancers.

Methods

This single-center retrospective clinical study was performed at the Affiliated Hospital of Southwest Medical University between January 2020 and June 2022. Participants with gastric, duodenal, and colorectal cancers after curative resection underwent both 68Ga-FAPI-04 and 18F-FDG PET/CT. Histopathologic examination, morphologic imaging, and/or follow-up imaging served as the reference standards. The SUVmax of the tumor recurrence and nodal and distant metastases between 18F-FDG and 68Ga-FAPI-04 PET/CT were compared using the paired-sample t test.

Results

Forty-one participants with gastric, duodenal, and colorectal cancers were enrolled in the study (median age, 51 years; range, 19–75 years). The sensitivity of 68Ga-FAPI-04 PET/CT was higher than that of 18F-FDG PET/CT for detecting tumor recurrence (6 of 6 [100%] vs 4 of 6 [67%]), nodal metastases (92 of 92 [100%] vs 31 of 92 [34%]), and distant metastases (28 of 30 [93%] vs 20 of 30 [67%]).

Conclusion

68Ga-FAPI-04 PET/CT for tumor re-evaluation showed potential for more accurate performance of gastric, duodenal, and colorectal cancers, thereby improving treatment decision-making.
Simulation- vs. Didactic-Based Learning for Rehabilitation Nurses Caring for Patients With Autonomic Dysreflexia
Authors: Alvarado Virginia , Stutzman Sonja E. , Nairon Emerson , Olson DaiWai M.
Published: February 2023

Purpose

Autonomic dysreflexia (AD) is associated with spinal cord injury, manifesting in symptoms of high blood pressure, bradycardia, headache, diaphoresis, and anxiety. Nurses often manage these symptoms; thus, nursing knowledge of AD is crucial. The purpose of this study was to improve AD nursing knowledge while exploring differences between simulation and didactic learning in nurse education.

Design and Methods

This prospective pilot study used two types of learning (simulation vs. didactic) to determine if one was superior to the other regarding nursing knowledge of AD. Nurses were given a pretest, randomized to simulation or didactic learning, and then given a posttest 3 months later.

Results

Thirty nurses were enrolled in this study. Seventy-seven percent of nurses held a BSN degree with an average of 15.75 years in nursing. The mean knowledge scores for AD at baseline for the control (13.9 [2.4]) and intervention (15.5 [2.9]) groups were not statistically different (p = .1118). The mean knowledge scores for AD after either didactic- or simulation-based education for the control (15.5 [4.4]) and intervention (16.5 [3.4]) groups were not statistically different (p = .5204).

Clinical Relevance

Autonomic dysreflexia is a critical clinical diagnosis that requires prompt nursing intervention to prevent threatening consequences. This study focused on how different methods of education best benefited AD knowledge acquisition and how simulation versus didactic learning impacts overall nursing education.

Conclusions

As a whole, providing nurses with AD education was helpful in improving their understanding of the syndrome. However, our data suggest that both didactic and simulation are equally effective methods to increase AD knowledge.
Noticing Acute Changes in Health in Long-Term Care Residents
Authors: Bowen Mary Elizabeth , Rowe Meredeth , Flynn Aidan , Basehore Heather , Shin Ju Young
Published: February 2023

Purpose

Early signs of acute conditions and increased fall risk often go unrecognized in patients in long-term care facilities. The aim of this study was to examine how healthcare staff identify and act on changes in health status in this patient population.

Design

A qualitative study design was used for this study.

Methods

Six focus groups across two Department of Veterans Affairs long-term care facilities were conducted with 26 interdisciplinary healthcare staff members. Using thematic content analysis, the team preliminarily coded based on interview questions, reviewed and discussed emerging themes, and agreed on the resultant coding scheme for each category with additional independent scientist review.

Results

Themes included describing and explaining how “normal” or expected behavior is identified by staff, noticing changes in a resident, determining the significance of the change, hypothesizing reasons for an observed change, response to an observed change, and resolution of the clinical change.

Conclusions

Despite limited training in formal assessment methods, long-term care staff have developed methods to conduct ongoing assessments of the residents. This technique, individual phenotyping, often identifies acute changes; however, the lack of formal methods, language, or tools to communicate the changes means that these assessments are not often formalized in a manner that informs the residents’ changing care needs.

Clinical Relevance to the Practice of Rehabilitation Nursing

More formal objective measures of health change are needed to assist long-term care staff in expressing and interpreting the subjective phenotype changes into objective, easily communicated health status changes. This is particularly important for acute health changes and impending falls, both of which are associated with acute hospitalization.
Tsugishige Kondo, The Father of Japanese Surgery
Authors: Imai Shoichi , Narushima Mitsunaga , Banda Chihena H. , Shiraishi Makoto , Shimizu Kotaro , Okada Yoshimoto , Mitsui Kohei , Danno Kanako , Ishiura Ryohei , Yuzuriha Shunsuke , Ohmori Kitaro
Published: February 2023

Hideyo Noguchi is one of the most famous scientists in Japan's history, and his portrait has adorned the ¥1,000 banknotes since 2004. He had a childhood burn injury resulting in severe hand scarring and contracture that plagued his early life and education.

The resulting hand deformity required 3 separate reconstructions with the third and most complex surgery performed by Professor Tsugishige Kondo just before Noguchi's final medical doctor license examination in 1897. In this surgery, Kondo released the contractures using the first radial forearm flap performed in Japan long before the establishment of plastic surgery in the country.

Reviewing the history of Kondo, we find that he likely learned the art of reconstructive surgery along with many other surgical techniques during his stay in Europe from 1891 to 1896 where he was mentored by 4 prominent surgeons of the era: Christian Albert Theodor Billroth, Vincenz Czerny, James Israel, and Carl Nicoladoni. During this period, Czerny reported performing the world's first breast reconstruction using lipoma transfer, and Nicoladoni performed the world's first thumb reconstruction with a chest flap and with toe-to-thumb transfer. Kondo may have watched these world's first operations and may have also been taught these innovative techniques including the forearm flap directly by these pioneers. He returned to Japan and successfully applied these reconstructive surgery methods in his practice and teaching, as evidenced by the landmark surgery of Hideyo Noguchi's hand, and laid the foundations for the development of plastic surgery in Japan.
Operating in an Opioid Crisis
Authors: Hammond Jacob B. , Hung Penny , Chang Yu-Hui H. , Rebecca Alanna M. , Howard Michael A. , Teven Chad M.
Published: February 2023

Background

In response to the opioid epidemic, the United States declared a public health emergency in 2017. We evaluated pain medication prescribing practices among plastic and reconstructive surgeons, assessing pain medication prescription rates and opioid-related mortality both nationally and regionally within the United States.

Methods

A retrospective analysis of Medicare Part D prescriber data among plastic surgeons from 2013 through 2017 was conducted. Pain medications were categorized as opioid and nonopioid medications. Trends in surgeon prescribing habits were evaluated using the Cochrane-Armitage trend test.

Results

A total of 708,817 pain medication claims were identified: 612,123 claims (86%) were for opioid pain medications and 96,694 claims (14%) were for nonopioid pain medications. Total pain medication claims decreased from 44% of all medications in 2013 to 37% in 2017 (P < 0.001). Opioid medications decreased from 37% of total medication claims to 32% (P < 0.001). The overall opioid prescription rate fell from 1.53 claims per beneficiary in 2013 to 1.32 in 2017 (P < 0.001). Nonopioid pain medications decreased from 7% in 2013 to 6% in 2017 (P < 0.001); nonsteroidal anti-inflammatory drug claims increased by 44%. The prescription rate of nonopioid medications decreased from 2.40 claims per beneficiary in 2013 to 2.32 in 2017 (P < 0.001). An overall increase in opioid-related mortality was observed. Trends in pain medication prescriptions varied significantly among US regions and divisions.

Conclusions

Plastic surgeons are prescribing less opioids and relying more on nonopioid pain medications. Increased adoption of multimodal pain treatment approaches among surgeons is a likely explanation for this trend in face of the current opioid crisis.
The genetic spectrum of febrile infection-related epilepsy syndrome (FIRES) and refractory status epilepticus
Authors: deCampo Danielle , Xian Julie , Karlin Alexis , Sullivan Katie R. , Ruggiero Sarah M. , Galer Peter D. , Ramos Mark , Abend Nicholas S. , Gonzalez Alex , Helbig Ingo
Published: February 2023

Febrile infection-related epilepsy syndrome (FIRES) is a severe childhood epilepsy with refractory status epilepticus after a typically mild febrile infection. The etiology of FIRES is largely unknown, and outcomes in most individuals with FIRES are poor. Here, we reviewed the current state-of-the art genetic testing strategies in individuals with FIRES. We performed a systematic computational analysis to identify individuals with FIRES and characterize the clinical landscape using the Electronic Medical Records (EMR). Among 25 individuals with a confirmed FIRES diagnosis over the last decade, we performed a comprehensive review of genetic testing and other diagnostic testing. Management included use of steroids and intravenous immunoglobulin (IVIG) in most individuals, followed by the ketogenic diet, and, after 2014, an increasing use of immunosuppressants, IVIG, and plasma exchange (PLEX). Genetic testing was performed on a clinical basis in almost all individuals and was non-diagnostic in all patients. We compared FIRES with both status epilepticus (SE) and refractory status epilepticus (RSE) as a broader comparison cohort and identified genetic causes in 36% of patients with RSE. In summary, despite the absence of any identifiable etiologies in FIRES, we performed an unbiased analysis of the clinical landscape, identifying a heterogeneous range of treatment strategies and characterized real-world clinical practice. FIRES remains one of the most enigmatic conditions in child neurology without any known etiologies to date despite significant efforts in the field, suggesting a clear need for further studies and novel diagnostic and treatment approaches. Furthermore, the difference in genetic signatures between FIRES and RSE suggest distinct underlying etiologies.
Faster bi-stable visual switching in psychosis
Authors: Killebrew Kyle W. , Moser Hannah R. , Grant Andrea N. , Marjańska Małgorzata , Sponheim Scott R. , Schallmo Michael-Paul
Published: February 2023

Bi-stable stimuli evoke two distinct perceptual interpretations that alternate and compete for dominance. Bi-stable perception is thought to be driven at least in part by mutual suppression between distinct neural populations that represent each percept. Abnormal visual perception is observed among people with psychotic psychopathology (PwPP), and there is evidence to suggest that these visual deficits may depend on impaired neural suppression in visual cortex. However, it is not yet clear whether bi-stable visual perception is abnormal among PwPP. Here, we examined bi-stable perception in a visual structure-from-motion task using a rotating cylinder illusion in a group of 65 PwPP, 44 first-degree biological relatives, and 43 healthy controls. Data from a ‘real switch’ task, in which physical depth cues signaled real switches in rotation direction were used to exclude individuals who did not show adequate task performance. In addition, we measured concentrations of neurochemicals, including glutamate, glutamine, and γ-amino butyric acid (GABA), involved in excitatory and inhibitory neurotransmission. These neurochemicals were measured non-invasively in visual cortex using 7 tesla MR spectroscopy. We found that PwPP and their relatives showed faster bi-stable switch rates than healthy controls. Faster switch rates also correlated with significantly higher psychiatric symptom levels across all participants. However, we did not observe any significant relationships across individuals between neurochemical concentrations and SFM switch rates. Our results are consistent with a reduction in suppressive neural processes during structure-from-motion perception in PwPP, and suggest that genetic liability for psychosis is associated with disrupted bi-stable perception.
Sex differences in risk factors, burden, and outcomes of cerebrovascular disease in Alzheimer’s disease populations
Authors: Morrison Cassandra , Dadar Mahsa , Collins D. Louis ,   the Alzheimer’s Disease Neuroimaging Initiative
Published: February 2023

Background

White matter hyperintensity (WMH) accumulation is associated with vascular risk factors such as hypertension, diabetes, smoking, and obesity. Increased WMH burden results in increased cognitive decline and progression to mild cognitive impairment (MCI) and dementia. However, research has been inconsistent when examining whether sex differences influence the relationship between vascular risk factors, WMH accumulation, and cognition.

Methods

A total of 2119 participants (987 females) with 9847 follow-ups from the Alzheimer’s Disease Neuroimaging Initiative met inclusion criteria for this study. Linear regressions were used to examine the association between vascular risk factors (individually and as a composite score) and WMH burden in males and females. When controlling for vascular risk factors, linear mixed models were also used to investigate whether the relationship between WMHs and longitudinal cognitive scores differed between males and females.

Results

Males had overall increased occipital (p<.001), but lower frontal (p<.001), total (p=.01), and deep (p<.001) WMH burden compared to females. For males, history of hypertension was the strongest contributor to WMH burden. On the other hand, the vascular composite score was the strongest factor for WMH in females. Greater increase in WMH accumulation was observed in males with a history of hypertension in the frontal region (p=.014) and males with high systolic blood pressure in the occipital region (p=.029) compared to females. With respect to cognition, WMH burden was more strongly associated with longitudinal decreases in global cognition, executive functioning, and functional activities of daily living in females compared to males.

Discussion

These findings show that controlling hypertension is important to reduce WMH burden in males. Conversely, minimizing WMH burden through vascular risk factors requires controlling many factors for females (e.g., hypertension, diabetes, smoking, alcohol abuse, etc.). The results have implications for therapies and interventions designed to target cerebrovascular pathology and the subsequent cognitive decline.
Infection prevention and control measures to reduce the transmission of mpox: a systematic review
Authors: Kuehn Rebecca , Fox Tilly , Guyatt Gordon , Lutje Vittoria , Gould Susan
Published: February 2023

Objectives

To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox on the basis of synthesis of available literature.

Methods

The WHO Clinical Management and Infection Prevention and Control guideline 2022 development group developed three structured research questions concerning respiratory and isolation infection prevention control measures for mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies.

Results

No studies were identified that directly addressed respiratory and isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%)cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There proved to be no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 (0.0%) cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air.

Conclusions

Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of respiratory infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients.
Ethnomedicinal health seeking practices and their associated treatment outcomes in managing diarrheal diseases among under-five-year-old children in Korogwe and Handeni Districts, Tanzania: Protocol for a cross-sectional mixed method study
Authors: Liheluka Edwin , Gibore Sophia Nyasiro , Lusingu John P. A. , Gesase Samwel , Minja Daniel T. R. , Lamshöft Maike , Dekker Denise , Bali Theodora
Published: February 2023

Background

Ethnomedicinal remedies relevant for treating a range of ailments including diarrheal diseases among children aged less than five years is an integral component of the long-standing culture that communities have inherited from previous generations. The treatment also has mutual impact on the practice of health seeking behavior built within the family and clan level.

Study Objective

To assess ethnomedicinal health seeking practices and their associated treatment outcomes for managing diarrheal diseases among children aged below five years children in Korogwe and Handeni Districts, Tanzania

Methods

A mixed method approach will be employed whereby both qualitative and quantitative research approaches will be utilized. Narrative and cross-sectional research designs will be used for qualitative and quantitative research, respectively. The study population will include caretakers of under-five-year-old children, pediatric health care workers and traditional healers. Purposive sampling method will be used to select participants for qualitative research while a systematic random sampling will be used to select participants for quantitative research. Social Ecological Model (SEM) theory will be employed to elicit the target population perceptions and context-specific factors, which will explain the ethnomedicinal health seeking practices and their associated treatment outcomes in managing diarrheal diseases among under-five-year-old children in Korogwe and Handeni Districts, Tanzania.
Network Pharmacology and Bioinformatics Methods Reveal the Mechanism of Sishenwan in the Treatment of diabetic nephropathy
Authors: Deng Yuanyuan , Ma Yu , Zhang Sai , Zhang Mianzhi
Published: February 2023

Objective. In order to decipher the bioactive components and potential mechanisms of the traditional Chinese medicine (TCM) formula Sishenwan (SSW) for diabetic nephropathy (DN), we integrated network pharmacology and bioinformatics.Methods. The candidate compounds of SSW and relative targets were obtained from the TCMSP, BATMAN-TCM, SiwssTartgetPrediction, STITCH, and ChEMBL web servers. The UniProt database was used to translate the target names into gene names, and then constructed the herbal-compound-target network. DN-related targets were ascertained based on OMIM, CTD, GeneCards, DisGeNET, and GEO. Furthermore, there was a protein-protein interaction (PPI) network to explore the overlapping targets between SSW and DN, which focused on screening the pivotal targets by topology. GO and KEGG enrichment analyses were carried out to further understand the potential functions associated with the effect of SSW against DN. Eventually, molecular docking simulations were performed to validate the binding affinity between major bioactive components and hub genes.Results.A total of 120 candidate active compounds and 542 corresponding drug targets were derived, in which 195 targets intersected with DN. Then, KEGG pathway analysis showed that several signaling pathways were closely related to the process of SSW against DN, including the AGE-RAGE signaling pathway in diabetic complications, the TNF signaling pathway, and IL-17 signaling pathway, ect. The PPI network analysis identifiedPTGS2, CREB1, ESR1, TNF, IL1B, INS, AKT1, PPARG, andJUNwere the top 9 hub targets. The molecular docking confirmed that the bioactive compounds of SSW had a firm binding affinity with hub targets.Conclusions. As a whole, the present study revealed that SSW exerted therapeutic effects on DN via modulating multi-targets with multi-compounds through multi-pathways.
Diffuse myocardial fibrosis associates with incident ventricular arrhythmia in implantable cardioverter defibrillator recipients
Authors: Olausson Eric , Wertz Jonathon , Fridman Yaron , Bering Patrick , Maanja Maren , Niklasson Louise , Wong Timothy C , Fukui Miho , Cavalcante João L. , Cater George , Kellman Peter , Bukhari Syed , Miller Christopher A. , Saba Samir , Ugander Martin , Schelbert Erik B.
Published: February 2023

Background

Diffuse myocardial fibrosis (DMF) quantified by extracellular volume (ECV) may represent a vulnerable phenotype and associate with life threatening ventricular arrhythmias more than focal myocardial fibrosis. This principle remains important because 1) risk stratification for implantable cardioverter defibrillators (ICD) remains challenging, and 2) DMF may respond to current or emerging medical therapies (reversible substrate).

Objectives

To evaluate the association between quantified by ECV in myocardium without focal fibrosis by late gadolinium enhancement (LGE) with time from ICD implantation to 1) appropriate shock, or 2) shock or anti-tachycardia pacing.

Methods

Among patients referred for cardiovascular magnetic resonance (CMR) without congenital disease, hypertrophic cardiomyopathy, or amyloidosis who received ICDs (n=215), we used Cox regression to associate ECV with incident ICD therapy.

Results

After a median of 2.9 (IQR 1.5-4.2) years, 25 surviving patients experienced ICD shock and 44 experienced shock or anti-tachycardia pacing. ECV ranged from 20.2% to 39.4%. No patient with ECV<25% experienced an ICD shock. ECV associated with both endpoints, e.g., hazard ratio 2.17 (95%CI 1.17-4.00) for every 5% increase in ECV, p=0.014 in a stepwise model for ICD shock adjusting for ICD indication, age, smoking, atrial fibrillation, and myocardial infarction, whereas focal fibrosis by LGE and global longitudinal strain (GLS) did not.

Conclusions

DMF measured by ECV associates with ventricular arrhythmias requiring ICD therapy in a dose-response fashion, even adjusting for potential confounding variables, focal fibrosis by LGE, and GLS. ECV-based risk stratification and DMF representing a therapeutic target to prevent ventricular arrhythmia warrant further investigation.

Condensed Abstract

Analogous to heart failure and mortality outcomes, diffuse myocardial fibrosis (DMF) quantified by extracellular volume (ECV) may represent a more vulnerable phenotype for life-threatening ventricular arrhythmia than focal myocardial fibrosis. In patients referred for cardiovascular magnetic resonance, we identified 215 subsequently receiving implantable cardioverter defibrillators (ICD). After a median of 2.9 (IQR 1.5-4.2) years, 25 patients experienced ICD shock and 44 experienced shock or anti-tachycardia pacing. ECV associated with ICD therapy in Cox regression models. Focal fibrosis variables or global longitudinal strain did not. ECV-based risk stratification and DMF representing a therapeutic target to prevent ventricular arrhythmia warrant further investigation.
A Stakeholder-Led Understanding of the Implementation of Digital Technologies Within Heart Disease Diagnosis: A Qualitative Study Protocol
Authors: Abdullayev K , Chico TJA , Manktelow M , Buckley O , Condell J , Van Arkel RJ , Diaz-Zuccarini V , Matcham Faith
Published: February 2023

Introduction

Cardiovascular diseases are highly prevalent amongst the UK population, and the quality of care is being reduced due to accessibility and resource issues. Increased implementation of digital technologies into the cardiovascular care pathway has enormous potential to lighten the load on the NHS, however, it is not possible to adopt this shift without embedding the perspectives of service users and clinicians.

Methods and Analysis

A series of qualitative studies will be carried out with the aim of developing a stakeholder-led perspective on the implementation of digital technologies to improve holistic diagnosis of heart disease. Focus groups will be carried out with 20 people with lived experience of heart disease, and interviews will be carried out with 10 clinicians with experience of diagnosing heart diseases. The data will be analysed using an inductive thematic analysis approach.

Ethics and Dissemination

This study received ethical approval from the Sciences and Technology Cross Research Council at the University of Sussex. The findings will be disseminated through conference presentations, peer-reviewed publications and to the study participants.

Strengths and Limitations

The study materials have been informed by patient advisory boards, meaning they are sensitive to the experiences of the participants and the clinicians that will be recruited.

The study will allow an in-depth understanding of the attitudes and experience of people with lived experience of heart disease and clinicians with experience of diagnosing heart disease.

The use of an online research platform for participant recruitment will disadvantage those less comfortable using online resources. This may include those living in deprived areas without access to high quality technologies (which disproportionately excludes ethnic minority groups) and clinical populations with comorbidities that prevent the use of certain technologies, such as visual, auditory, physical, or learning impairments.

The use of thematic analysis will not be free from the influence of the researcher’s personal experience and knowledge
The straight and narrow: a game theory model of broad- and narrow-spectrum empiric antibiotic therapy
Authors: Diamant Maya , Obolski Uri
Published: February 2023

Physicians prescribe empiric antibiotic treatment when definitive knowledge of the pathogen causing an infection is lacking. The options of empiric treatment can be largely divided into broad- and narrow-spectrum antibiotics. Prescribing a broad-spectrum antibiotic increases the chances of covering the causative pathogen, and hence benefits the current patient’s recovery. However, prescription of broad-spectrum antibiotics also accelerates the expansion of antibiotic resistance, potentially harming future patients. We analyze the social dilemma using game theory. In our game model, physicians choose between prescribing broad and narrow-spectrum antibiotics to their patients. Their decisions rely on the probability of an infection by a resistant pathogen before definitive laboratory results are available. We prove that whenever the equilibrium strategies differ from the socially optimal policy, the deviation is always towards a more excessive use of the broad-spectrum antibiotic. We further show that if prescribing broad-spectrum antibiotics only to patients with a high probability of resistant infection is the socially optimal policy, then decentralization of the decision making may make this policy individually irrational, and thus sabotage its implementation. We discuss the importance of improving the probabilistic information available to the physician and promoting centralized decision making.
Impact of online health information-seeking behavior on shared decision-making in patients with systemic lupus erythematosus: the TRUMP2-SLE project
Authors: Ichikawa Takanori , Kishida Dai , Shimojima Yasuhiro , Yajima Nobuyuki , Oguro Nao , Yoshimi Ryusuke , Sakurai Natsuki , Hidekawa Chiharu , Sada Ken-ei , Miyawaki Yoshia , Hayashi Keigo , Shidahara Kenta , Ishikawa Yuichi , Sekijima Yoshiki , Kurita Noriaki
Published: February 2023

Objective

Providing appropriate health information to patients with systemic lupus erythematosus (SLE) is advantageous in the treatment decision-making process. We aimed to investigate how online health information-seeking behavior affects shared decision-making (SDM) in patients with SLE.

Methods

This cross-sectional study included 464 patients with SLE from five institutions. The main exposure was time spent on the Internet per day, which was divided into four categories (none, <1 h, 1–<2 h, and ≥2 h). Participants categorized their preferred first source of health information as physicians, the Internet, or other media. The outcome was the degree of SDM measured via the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). A general linear model was applied.

Results

Compared with no Internet use, longer internet use was associated with a higher SDM-Q-9 score: <1 h, 6.9 points (95% confidence interval [CI] 0.32 to 13.6) and ≥2 h, 8.75 points, (95% CI 0.61 to 16.9). The SDM-Q-9 did not differ between those who chose physicians and those who chose the Internet as their preferred first source of health information (-2.1 points [95% CI -6.7 to 2.6]). Those who chose other media had significantly lower SDM-Q-9 scores than those who chose physicians (-7.6 points [95% CI -13.2 to -1.9]).

Conclusions

The present study suggests that SDM between physicians and patients is positively (rather than adversely) associated with online information-seeking behavior, with no negative influence associated with accessing the Internet prior to visits to a rheumatologist. Rheumatologists may need to introduce their patients to websites offering high-quality health information to establish a productive physician–patient relationship for SDM.