bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Factors and Treatment Effect Modifiers for Physical Health, Opioid Prescription, and Health Care Utilization in Patients With Musculoskeletal Disorders in Primary Care: Exploratory Secondary Analysis of the STEMS Randomized Trial of Direct Access to Physical Therapist–Led Care
Authors: Zouch James , Bhimani Nazim , Bussières André , Ferreira Manuela L , Foster Nadine E , Ferreira Paulo
Published: May 2024

Objective

The aims of the study were to identify prognostic factors associated with health care outcomes in patients with musculoskeletal (MSK) conditions in primary care and to determine whether characteristics associated with choice of care modify treatment effects of a direct-access physical therapist–led pathway in addition to general practitioner (GP)–led care compared to GP-led care alone.

Methods

A secondary analysis of a 2-parallel-arm, cluster randomized controlled trial involving general practices in the United Kingdom was conducted. Practices were randomized to continue offering GP-led care or to also offer a direct-access physical therapist–led pathway. Data from adults with MSK conditions who completed the 6-month follow-up questionnaire were analyzed. Outcomes included physical health, opioid prescription, and self-reported health care utilization over 6 months. Treatment effect modifiers were selected a priori from associations in observational studies. Multivariable regression models identified potential prognostic factors, and interaction analysis tested for potential treatment effect modifiers.

Results

Analysis of 767 participants indicated that baseline pain self-efficacy, pain severity, and having low back pain statistically predicted outcomes at 6 months. Higher pain self-efficacy scores at baseline were associated with improved physical health scores, reduced opioid prescription, and less health care utilization. Higher bodily pain at baseline and having low back pain were associated with worse physical health scores and increased opioid prescription. Main interaction analyses did not reveal that patients’ age, level of education, duration of symptoms, or MSK presentation influenced response to treatment, but visual trends suggested those in the older age group proceeded to fewer opioid prescriptions and utilized less health care when offered direct access to physical therapy.

Conclusions

Patients with MSK conditions with lower levels of pain self-efficacy, higher pain severity, and presenting with low back pain have less favorable clinical and health care outcomes in primary care. Prespecified characteristics did not modify the treatment effect of the offer of a direct-access physical therapist–led pathway compared to GP-led care.

Impact

Patients with MSK conditions receiving primary care in the form of direct-access physical therapist–led or GP-led care who have lower levels of self-efficacy, higher pain severity, and low back pain are likely to have a less favorable prognosis. Age and duration of symptoms should be explored as potential patient characteristics that modify the treatment response to a direct-access physical therapist–led model of care.
Increased prevalence of malignancies in patients with IgG4-related disease: implications for clinical care
Authors: Keller-Sarmiento Luca , Viapiana Naomi , Lanzillotta Marco , Batani Veronica , Mahajne Jasmin , Dagna Lorenzo , Della-Torre Emanuel
Published: May 2024

Objectives

The association between cancer and IgG4-related disease (IgG4-RD) is evolving. The primary aim of this study was to investigate the prevalence of malignancies in IgG4-RD. The secondary aim was to describe the epidemiological and clinical characteristics of IgG4-RD patients with a history of cancer.

Methods

Two hundred and ten patients with IgG4-RD were included in this retrospective study. IgG4-RD phenotypes, clinical and serological variables were analysed. The prevalence of cancer in IgG4-RD was compared with that in the Italian population using the registry of the Global Cancer Observatory (GCO) of the World Health Organization. The Standardized Incidence Ratio (SIR) for cancer in IgG4-RD was obtained based on the 5-year Limited Duration Prevalence (2015–2020) of tumours in the Italian population.

Results

Thirty-seven/210 patients (18%) developed cancer before or after the diagnosis of IgG4-RD. Solid and haematologic tumours were more frequently observed in pancreato-biliary IgG4-RD. The SIR for malignancy in IgG4-RD patients was 2.54 higher than the general Italian population (P = 0.007). The SIR was 2.78 higher for males (P = 0.005) and 1.15 higher for females (P > 0.05). Thirty-two malignancies were diagnosed before and 16 after IgG4-RD diagnosis. Interval ‘from IgG4-RD to cancer’ was shorter than that ‘from cancer to IgG4-RD’. Most tumours occurring after IgG4-RD developed within 36 months from diagnosis of IgG4-RD.

Conclusions

The prevalence of cancer in patients with IgG4-RD is increased compared with the Italian population and mechanistically suggests a possible paraneoplastic association. Close surveillance is warranted for the first 36 months after IgG4-RD diagnosis.
Combination of cytoplasmic and nuclear patterns on Hep-2 antinuclear antibody is useful as a screening test for anti-synthetase syndrome
Authors: Yoshida Katsuyuki , Takahashi Soshi , Kawai Ryota , Saito Toshiharu , Hatachi Saori , Shintani Ayumi , Sugawara Hitoshi , Kumagai Shunichi
Published: May 2024

Objective

This study aimed to establish a screening model for differentiating anti-synthetase syndrome (ASS) from other ANA-associated rheumatic diseases (AARDs) using a combination of cytoplasmic and non-cytoplasmic ANA (ncANA) patterns.

Methods

: This retrospective observational study included patients with AARDs such as SLE, SSc, SS, MCTD and PM/DM who underwent ANA screening between April 2012 and December 2021. Variables included age, sex, ANA patterns (Cytoplasmic and ncANA) and titres. Logistic regression analysis of Cytoplasmic and ncANA patterns was performed to differentiate ASS from other AARDs.

Result

: The 981 diagnosed cases of AARDs consisted of SS (n = 451), SSc (n = 264), SLE (n = 201), PM/DM (n = 104), MCTD (n = 52) and ASS, including PM/DM (n = 64). Of these, 155 patients had ≥2 overlapping diseases; however, there was no overlap between AARDs and ASS. ASS is more likely to occur when the cytoplasmic titre is positive and the ncANA <320. Receiver operating characteristic analysis of the Cytoplasmic and ncANA range revealed an area under the receiver operating characteristic curve of 0.885 (95% CI: 0.844–0.927).

Conclusion

: It is important to detect cytoplasmic patterns as an ANA screening test for ASS diagnosis, even if the titre is low. Additionally, combining the cytoplasmic and ncANA patterns yields more accurate ASS screening results.
Educative Psychological Treatment at Edinburgh’s Royal Asylum: Unfolding The Morningside Mirror, 1845–1882
Authors: Holligan Christopher
Published: May 2024

This article examines moral therapy in relation to writing by fee-paying ‘lunatic’ asylum patients from the upper and middle classes. Their work was published in a nineteenth-century monthly periodical, The Morningside Mirror. There is an intersection of the periodical with status and the interests of gentlemanly values. Despite their psychopathological diagnoses, which included melancholia, writers for the Mirror retained their human capacity to share poignant insights into love and social injustice. Edinburgh’s reputation as a cultural and scientific centre of learning provided opportunities for the asylum to market itself as an iconic sanctuary that could maintain the materially privileged lifestyles of patients. The Morningside Mirror offered creative activity, self-esteem maintenance and public recognition. It connected the Asylum to the society outside. The expression of logic as reflective of the repair of reason signalled, from the viewpoint of psychological medicine, the Mirror’s therapeutic impact and utility to project reputation.
Association between poor sleep and mental health issues in Indigenous communities across the globe: a systematic review
Authors: Fernandez Dan Richard , Lee Rennie , Tran Nam , Jabran Dure Sameen , King Stephanie , McDaid Lisa
Published: May 2024

Study Objectives

Evidence from studies among non-Indigenous populations has established the association of poor sleep to mental health issues and supported how improving sleep could reduce the risk of mental ill health. In contrast, for Indigenous people, who experience disproportionate rates of mental ill health, the association between sleep and mental health and the potential of sleep health in reducing the risk and severity of mental health issues have never been fully reviewed. Considering the literature gap, this review assesses the association between sleep and mental health in Indigenous people.

Methods

Following PRISMA guidelines, a study was submitted to the PROSPERO database for registration (293798) prior to commencing the review. Then academic databases were searched for relevant studies published up till 19 February 2023. Studies with quantitative data on sleep and mental health association in Indigenous people were included and a narrative review/synthesis was conducted.

Results

Seven studies, using carer/self-reports (six cross-sectional, one longitudinal) among three Indigenous groups (N = 3066) met the inclusion criteria. In Indigenous Australian children, arousal problems were associated with aggression, and withdrawn behavior, while early bedtime was associated with a lower risk of behavioral problems. In Native American young people, insomnia symptoms were associated with depressive symptoms in adults, short sleep was associated with affective disorders. Clinical sleep issues, i.e. restless leg and apnea, were associated with depression. In Amerindian/Mestizo adults, restless leg syndrome was associated with depression and anxiety. Overall, findings report the prevalence of poor sleep and mental health issues among Indigenous communities across the globe. Six studies scored “moderate quality” and one study scored “high quality” in quality assessment.

Conclusions

While there is limited research available, our finding suggests an association between poor sleep and mental health issues in Indigenous people. Further investigation of the potential role of, and investing in, sleep health could help support mental health.
Authentic Behavior and Job Satisfaction among Child Welfare Caseworkers
Authors: Kim Yoon Mi , Lee Soohyoung Rain , Kovarie George M , Maxi Andrea , Hong Sunki
Published: May 2024

This study was designed to investigate the relationship between authentic behavior and job satisfaction among child welfare caseworkers in Pennsylvania. Confirmatory factor analysis was conducted to validate the domains of the Authentic Behavior Scale (balanced processing, relational transparency, and internalized morality) and Job Satisfaction Scale, and the results provided consistent support for the factorial structure of the scales across child welfare caseworkers. The findings of this study revealed a positive correlation between authentic behavior and job satisfaction. To further explore this relationship, a path model was developed that included the elements of authentic behavior, job satisfaction, and demographic variables. The results indicated an association between the type of agency and internalized morality, impacting job satisfaction. Private workers showed a higher level of authentic behavior compared with public workers, with authentic behavior associated with greater job satisfaction. The findings suggest that authentic behavior can play a crucial role in social work practice and warrants considerable attention.
Phylogenomic Discordance is Driven by Wide-Spread Introgression and Incomplete Lineage Sorting During Rapid Species Diversification Within Rattlesnakes (Viperidae: Crotalus and Sistrurus)
Authors: Myers Edward A , Rautsaw Rhett M , Borja Miguel , Jones Jason , Grünwald Christoph I , Holding Matthew L , Grazziotin Felipe G , Parkinson Christopher L
Published: May 2024

Abstract.—Phylogenomics allows us to uncover the historical signal of evolutionary processes through time and estimate phylogenetic networks accounting for these signals. Insight from genome-wide data further allows us to pinpoint the contributions to phylogenetic signal from hybridization, introgression, and ancestral polymorphism across the genome. Here, we focus on how these processes have contributed to phylogenetic discordance among rattlesnakes (genera Crotalus and Sistrurus), a group for which there are numerous conflicting phylogenetic hypotheses based on a diverse array of molecular datasets and analytical methods. We address the instability of the rattlesnake phylogeny using genomic data generated from transcriptomes sampled from nearly all known species. These genomic data, analyzed with coalescent and network-based approaches, reveal numerous instances of rapid speciation where individual gene trees conflict with the species tree. Moreover, the evolutionary history of rattlesnakes is dominated by incomplete speciation and frequent hybridization, both of which have likely influenced past interpretations of phylogeny. We present a new framework in which the evolutionary relationships of this group can only be understood in light of genome-wide data and network-based analytical methods. Our data suggest that network radiations, like those seen within the rattlesnakes, can only be understood in a phylogenomic context, necessitating similar approaches in our attempts to understand evolutionary history in other rapidly radiating species.
Determining muscle plasticity and meat quality development of low-input extended fed market-ready steers
Authors: Wicks Jordan C , Wivell Alexis L , Beline Mariane , Zumbaugh Morgan D , Bodmer Jocelyn S , Yen Con-Ning , Johnson-Schuster Chantal , Wilson Thomas B , Greiner Scott P , Johnson Sally E , Shi Tim H , Silva Saulo Luz , Gerrard David E
Published: May 2024

In March 2020, the World Health Organization declared COVID-19 a pandemic, which ultimately led to many meat processors temporarily shutting down or reducing processing capacity. This backlog in processing capacity forced many feedlots to retain cattle for longer periods of time and assume the risk of major market fluctuations. The aim of this study was to understand how a dietary insult affects meat quality and muscle metabolism in market-ready steers (590 kg). Sixteen market-ready (590 kg) commercial Angus crossbred steers were subjected to a maintenance diet of either forage or grain for 60 d. Longissimus lumborum (LL) muscle samples were collected immediately postmortem and processed for characteristics reflecting the underlying muscle fiber type and energy state of the tissue. Despite cattle being subjected to a 60-d feeding period, there were no detectable differences (P > 0.05) in carcass characteristics, color of lean, or ultimate pH (pHu). Moreover, our data show that muscle plasticity is rather resilient, as reflected by lack of significance (P > 0.05) in oxidative and glycolytic enzymes, myosin heavy chain isoforms (MyHC), myoglobin, and mitochondrial DNA (mtDNA) contents. These data show that market-ready steers are capable of withstanding a low-input feeding strategy up to 60 d without dramatically impacting underlying muscle characteristics and meat quality development.
Addition of Liposomal Bupivacaine to Standard Bupivacaine versus Standard Bupivacaine Alone in the Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial
Authors: Chan Timmy Chi Wing , Wong Janus Siu Him , Wang Fengfeng , Fang Christian Xinshuo , Yung Colin Shing-yat , Chan Manson Tak Hei , Chan Will Shing Him , Wong Stanley Sau Ching
Published: May 2024

Background

The analgesic effect of adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus block is not known. The authors hypothesized that addition of liposomal bupivacaine would reduce acute postoperative pain compared to standard bupivacaine alone.

Methods

A randomized controlled trial was conducted. Patients and outcome assessors were blinded. Eighty patients undergoing distal radial fracture fixation during regional anesthesia with supraclavicular brachial plexus block were randomized into two groups. The liposomal bupivacaine group received 10 ml 0.5% plain bupivacaine immediately followed by 10 ml 1.33% liposomal bupivacaine (n = 40). The standard bupivacaine group received 20 ml 0.5% plain bupivacaine (n = 40). The primary outcome was weighted area under curve (AUC) numerical rating scale pain score at rest during the first 48 h after surgery. Secondary outcomes included weighted AUC scores for pain with movement, overall benefit with analgesia score, and other functional scores.

Results

For the primary outcome, the liposomal bupivacaine group was associated with statistically significantly lower weighted AUC pain score at rest (0.6 vs. 1.4; P < 0.001) in the first 48 h. Of the secondary outcomes, no difference between treatment groups reached statistical significance with the exception of weighted AUC score for pain with movement (2.3 vs. 3.7; adjusted P < 0.001) and overall benefit with analgesia score (1.1 vs. 1.7; adjusted P = 0.020) in the first 48 h, as well as numerical rating scale pain score at rest (0.5 vs. 1.9; adjusted P < 0.001) and with movement (2.7 vs. 4.9; adjusted P < 0.001) on postoperative day 1. Differences in numerical rating scale pain scores on postoperative days 2, 3, and 4 did not reach the level of statistical significance. There were no statistically significant differences in sensory function.

Conclusions

Liposomal bupivacaine given via supraclavicular brachial plexus block reduced pain at rest in the early postoperative period.

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Recruiting and cultivating future leaders in laboratory science
Authors: Bartolucci Alison , Alouf Charlene , Angle Marlane , Jindal Sangita
Published: May 2024

Purpose of review

Technological in-vitro fertilization (IVF) advancements originate in the embryology laboratory, and are accompanied by increased regulatory oversight and risk management. Stakes have never been higher or the need greater for the recruitment and cultivation of leaders in laboratory science to navigate the direction of IVF. Current thought leaders in state-of-the-art laboratories must prioritize this mission to optimize and preserve the future of IVF.

Recent findings

Leaders in laboratory science must be able to speak to patients, the lay public, business leaders, scientific colleagues and clinical embryologists. While technically gifted, laboratory leaders may benefit from leadership training. Recruitment of scientists into IVF is currently challenging due to a lack of branding and no clear pipeline for new scientists to enter the field. Once recruited however, cultivation of new leaders requires coaching and skill acquisition over time, in order to create multifaceted laboratory leadership.

Laboratory leaders are typically recruited based on education and experience to lead teams of embryologists. These leaders will adopt new technologies in the laboratory. Therefore, laboratory leaders play a powerful role in IVF requiring leadership skills ultimately driving patient outcomes. These laboratory directors must possess innate leadership abilities or learn how to lead their teams.
Climate change and human health: a primer on what women's health physicians can do on behalf of their patients and communities
Authors: Alvero Ruben
Published: May 2024

Purpose of review

To describe the current state of knowledge on the impact on climate change on women's health and to highlight opportunities for healthcare providers to serve as advocates and subject matter experts.

Recent findings

Healthcare providers are a uniquely respected voice in society but have not used this advantage to advocate for their communities and participate in mitigation, adaptation, and resiliency efforts on behalf of their patients and communities.

Healthcare providers feel that climate change is real, is human caused, and is currently or will shortly negatively impact their patients. They feel unprepared to serve as leaders and advocates due to time limitations and a knowledge gap. Resources in the current climate movement can help close this gap.
Liver-specific mitochondrial amidoxime–reducing component 1 (Mtarc1) knockdown protects the liver from diet-induced MASH in multiple mouse models
Authors: Guo Yuanjun , Gao Zhengyu , LaGory Edward L. , Kristin Lewis Wilson , Gupte Jamila , Gong Yan , Rardin Matthew J. , Liu Tongyu , Nguyen Thong T. , Long Jason , Hsu Yi-Hsiang , Murray Justin K. , Lade Julie , Jackson Simon , Zhang Jun
Published: May 2024

Background:

Human genetic studies have identified several mitochondrial amidoxime–reducing component 1 (MTARC1) variants as protective against metabolic dysfunction–associated steatotic liver disease. The MTARC1 variants are associated with decreased plasma lipids and liver enzymes and reduced liver-related mortality. However, the role of mARC1 in fatty liver disease is still unclear.

Methods:

Given that mARC1 is mainly expressed in hepatocytes, we developed an N-acetylgalactosamine–conjugated mouse Mtarc1 siRNA, applying it in multiple in vivo models to investigate the role of mARC1 using multiomic techniques.

Results:

In ob/ob mice, knockdown of Mtarc1 in mouse hepatocytes resulted in decreased serum liver enzymes, LDL-cholesterol, and liver triglycerides. Reduction of mARC1 also reduced liver weight, improved lipid profiles, and attenuated liver pathological changes in 2 diet-induced metabolic dysfunction–associated steatohepatitis mouse models. A comprehensive analysis of mARC1-deficient liver from a metabolic dysfunction–associated steatohepatitis mouse model by metabolomics, proteomics, and lipidomics showed that Mtarc1 knockdown partially restored metabolites and lipids altered by diet.

Conclusions:

Taken together, reducing mARC1 expression in hepatocytes protects against metabolic dysfunction–associated steatohepatitis in multiple murine models, suggesting a potential therapeutic approach for this chronic liver disease.
An overview of the cholesterol metabolism and its proinflammatory role in the development of MASLD
Authors: Zhang Linqiang , Shi Yongqiong , Liang Bin , Li Xi
Published: May 2024

Cholesterol is an essential lipid molecule in mammalian cells. It is not only involved in the formation of cell membranes but also serves as a raw material for the synthesis of bile acids, vitamin D, and steroid hormones. Additionally, it acts as a covalent modifier of proteins and plays a crucial role in numerous life processes. Generally, the metabolic processes of cholesterol absorption, synthesis, conversion, and efflux are strictly regulated. Excessive accumulation of cholesterol in the body is a risk factor for metabolic diseases such as cardiovascular disease, type 2 diabetes, and metabolic dysfunction–associated steatotic liver disease (MASLD). In this review, we first provide an overview of the discovery of cholesterol and the fundamental process of cholesterol metabolism. We then summarize the relationship between dietary cholesterol intake and the risk of developing MASLD, and also the animal models of MASLD specifically established with a cholesterol-containing diet. In the end, the role of cholesterol-induced inflammation in the initiation and development of MASLD is discussed.
The importance of optimal medical therapy in patients undergoing lower extremity bypass
Authors: Gomez-Sanchez Clara M. , Conte Michael S.
Published: May 2024

Purpose of review

The prevalence of peripheral artery disease is growing, with millions of people globally suffering its end-stage manifestation, chronic limb-threatening ischemia (CLTI). Revascularization procedures like lower extremity bypass play a vital role in limb salvage but optimal medical therapy is essential for maximizing the benefit of these procedures and reducing long-term risks of cardiovascular and limb-related events.

Recent findings

Patients with PAD who undergo lower extremity bypass warrant a comprehensive approach to risk factor modification for both primary and secondary prevention of cardiovascular and limb-related complications. This includes appropriate use of high-intensity statins, smoking cessation, and management of hypertension and diabetes. Additionally, antiplatelet therapy is indicated for all patients with CLTI and additional treatment with low-dose anticoagulation may also be beneficial.

Optimal medical therapy is essential for optimizing outcomes in patients with PAD undergoing lower extremity bypass.
A Novel Custom Bent 27-Gauge Needle–Guided Suture Snare Technique for Scleral Fixation of Posterior Chamber Intraocular Lenses
Authors: Chen Chunming , Shao Yan , Zhong Hong , Qin Chengyao , Liu Zehao , Sun Wenxiu , Li Min
Published: May 2024

Purpose:

To describe a custom bent 27-gauge needle–guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL).

Methods:

An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27-gauge needle, and the needle tip was advanced into the eye from the intraocular lens (IOL) fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera.

Results:

The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle-corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up.

Conclusion:

The curved needle-guided suture snare technique provides a simple minimally invasive method of scleral suture fixation of PCIOL.
Ocular Cicatricial Pemphigoid in Young Patients
Authors: Jinagal Jitender , Gupta Barkha , Hanumanthu Vinodh , Chatterjee Debajyoti , Limbu Sraddha , Malhotra Chintan , Gupta Amit , Jain Arun K. , Yangzes Sonam , Mahajan Rahul , Handa Sanjeev , Pandav Surinder Singh , De Dipankar
Published: May 2024

Purpose:

The purpose of this study is to report ocular cicatricial pemphigoid (OCP) occurring in young patients. Relevant literature is also reviewed.

Methods:

Medical records of patients aged 30 years or younger who were treated for OCP between August 2021 and May 2023 at a tertiary care eye institute were reviewed. The most common differential diagnoses of cicatrizing conjunctivitis, such as Stevens-Johnson syndrome sequelae, chemical injury, chronic topical/systemic drug use, autoimmune connective tissue disorders, or allergic eye diseases, were ruled out based on clinical history, examination, and the Cicatrizing Conjunctivitis Score described by Shanbhag et al. The diagnosis of OCP was confirmed by positive direct immunofluorescence of oral mucosal and/or conjunctival biopsy in a majority of the patients.

Results:

Seven patients fulfilled the criteria for a diagnosis of OCP. The mean age at presentation was 21.86 ± 5.25 years (13–28 years). Some of the patients presented with relatively atypical features for OCP such as corneal immune ring infiltrate and bilateral corneal perforation. Six patients exhibited systemic mucosal lesions, and the direct immunofluorescence yield was 85.71%. All patients required aggressive immunosuppressive treatment.

Conclusions:

OCP is classically described as a rare disease that occurs in old age. This case series highlights the importance of a higher index of suspicion for diagnosing OCP at a younger age. Early administration of immunosuppressive agents can potentially control severe ocular surface inflammation and its sequelae.
Endothelial Involvement in Monocular Mpox Keratitis: In Vivo Confocal Microscopy Approach
Authors: Corbella-Baselga Inés , Bruix Anna , Larena Raquel , Julio Gemma , Barraquer Rafael I.
Published: May 2024

Purpose:

The aim of this study was to describe the clinical features and endothelial involvement in a case of Mpox virus keratitis by in vivo confocal microscopy (IVCM).

Methods:

This is a case report.

Results:

A 35-year-old man presented with redness, photophobia, pain, tearing, and a low visual acuity of 0.09 (decimal) in the left eye with a 6-week history of Mpox and corneal trauma. Previous testing of blood, interdigital skin lesions, and conjunctival and eyelid margin swabs confirmed the presence of Mpox by polymerase chain reaction. Biomicroscopy displayed superficial stromal infiltrates with a continuous but irregular epithelium. IVCM revealed the presence of pseudoguttata, loss of defined cell boundaries, infiltration of inflammatory cells in the endothelial layer, endothelial ridges, and precipitated pigmented granules, consistent with endotheliitis. After this episode, the patient had 4 reactivations, also treated with topical corticoids and oral tecovirimat 600 mg twice a day for 2 weeks. On the fourth reactivation, this treatment was extended to 4 weeks. On the last visit, the patient presented a visual acuity of 0.5 with disciform keratitis and reduced endotheliitis signs. The endothelial cell density remained normal during the follow-up (2763 ± 376 cell/mm2 at baseline and 2795 ± 238 cell/mm2 at the last visit). Polymegathism and pleomorphism showed altered values during the follow-up.

Conclusions:

Patients with an altered corneal epithelial barrier could suffer Mpox endotheliitis, like other DNA viruses, before disciform keratitis appears. IVCM is a useful tool for the early detection of endotheliitis and for describing its evolution, improving patient care.
Causality between Gut Microbiota and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization Study
Authors: Zheng Qi , Li Yuetong , Ni Jiali , Huang Yong , Wu Jiajun , Xu Xiang , Sheng Guoping , Li Lanjuan
Published: May 2024

The exact relationship between inflammatory bowel disease (IBD) and gut microbiota (GM) is still unclear. This study aimed to explore the cause-and-effect relationship between IBD and GM by Mendelian randomization (MR) analysis. The IBD data used in this study were obtained from Genome-Wide Association Studies (GWAS). The GM data were from the Dutch Microbiome Project and included 207 taxa and 205 microbiota-associated pathways. Multivariate Mendelian randomization (MVMR) analysis was performed to investigate the relationship between GM and IBD. The results demonstrated that susceptibility to developing IBD is negatively correlated with class Clostridia (OR = 0.80, P = 0.003), family Sutterellacea (OR = 0.87, P = 0.014), genus Coprobacter (OR = 0.90, P = 0.009), order Clostridiales (OR = 0.80, P = 0.003), phylum Firmicutes (OR = 0.82, P = 0.002) and Coprobacter fastidiosus (OR = 0.90, P = 0.009). Conversely, the risk of developing IBD is positively correlated with the phosphopantothenate biosynthesis I pathway (OR = 1.17, P = 0.006), Bacteroides caccae (OR = 1.14, P = 0.021) and Bacteroides uniformis (OR = 1.26, P = 0.003). Reverse causality was found between the phosphopantothenate biosynthesis I pathway and IBD (OR = 1.03, P = 0.04), but not for the remaining specific GM taxa. In conclusion, our study demonstrated a causal relationship between specific GM features and IBD.
Implementation of a Patient-Reported Outcome Measure: A Quality Improvement Project
Authors: McGrath Shana , Howard Mequeil , Webber Kristen , Juckett Lisa
Published: May 2024

Patient-reported outcome measures (PROMs) are seen as increasingly beneficial to patient-centered clinical practice, but implementation of routine collection and utilization into clinical care can be challenging. Our interdisciplinary quality improvement (QI) team used the Institute for Health Care Improvement Model for Improvement methodology to address this problem in our outpatient neurorehabilitation program. We used a participatory approach to identify the PROM rehabilitation stakeholders found to be most appropriate to implement in the outpatient settings; chart audits were conducted to determine the extent to which clinicians implemented the PROM and documented a PROM-related goal. Opportunistic clinician feedback was collected to determine single PROM usefulness and acceptability. Our 4-month initiative demonstrated increased collection of a PROM, the Patient-Specific Functional Scale (PSFS), and incorporation into patient-centered goal. Use of QI methodology was beneficial when planning and executing our initiative. Future work is needed to examine factors to sustain PSFS use, incorporation into patient-centered goal setting, and maximize meaningful patient outcomes.
Translational Research on Orthobiologics in the Treatment of Rotator Cuff Disease: From the Laboratory to the Operating Room
Authors: Eliasberg Claire D. , Trinh Paula M.P. , Rodeo Scott A.
Published: May 2024

Rotator cuff disease is one of the most common human tendinopathies and can lead to significant shoulder dysfunction. Despite efforts to improve symptoms in patients with rotator cuff tears and healing rates after rotator cuff repair, high rates of failed healing and persistent shoulder morbidity exist. Increasing interest has been placed on the utilization of orthobiologics—scaffolds, cell-based augmentation, platelet right plasma (platelet-rich plasma), and small molecule-based strategies—in the management of rotator cuff disease and the augmentation of rotator cuff repairs. This is a complex topic that involves novel treatment strategies, including patches/scaffolds, small molecule-based, cellular-based, and tissue-derived augmentation techniques. Ultimately, translational research, with a particular focus on preclinical models, has allowed us to gain some insights into the utility of orthobiologics in the treatment of rotator cuff disease and will continue to be critical to our further understanding of the underlying cellular mechanisms moving forward.
Very Early Loading of a Bone-Anchored Hearing System Is Safe
Authors: Møller Marie Louise , Foghsgaard Søren , Hougaard Dan Dupont
Published: May 2024

Objective

To investigate the feasibility of early sound processor loading with two separate bone-anchored hearing aid implants 1 to 2 weeks after implantation. Secondary endpoints included registration of any postoperative complications, skin reactions, and any adverse events.

Study Design

Prospective, nonrandomized, noncontrolled, multicenter clinical trial.

Setting

Tertiary referral center.

Patients

Sixty adult patients, eligible for bone-anchored hearing aid surgery, were enrolled.

Intervention

Implantation of the bone-anchored hearing aid implants were done using minimally invasive surgery with tissue preservation.

Main Outcome Measure

Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Follow-ups were scheduled 5 to 12 days, 4 to 8 weeks, 6 months, and 12 months postoperatively. Differences between the lowest ISQ values (ISQ low) over time were analyzed by paired-samples t test with a significance level of 0.05. Skin and soft tissue reactions were assessed according to Holger's classification.

Results

Loading time of the Ponto Wide implant was 11.6 ± 1.4 days (SD) in average (median, 12 d; range, 7–19 d). Loading of the Ponto BHX implant was done 9.7 ± 3.5 days (SD) postoperatively (median, 9 d; range, 5–19 d). The implant stability increased significantly during the 12-month study period with both implants. One Ponto BHX implant was lost. Skin and soft tissue reactions were few in both groups. Across all planned follow-up visits, no skin and soft tissue reactions were observed in 86% (Ponto BHX implant) and 85% (Ponto Wide implant).

Conclusion

Very early loading of sound processors after percutaneous bone-anchored hearing system surgery is safe already 1 to 2 weeks postoperatively.
Seven-Year Revision Rates for Cochlear Implants in Pediatric and Adult Populations of an Integrated Healthcare System
Authors: Connell Sarah S. , Chang Richard N. , Royse Kathryn E. , Benson Nicholas J. , Tran LenhAnh P. , Fasig Brian H. , Paxton Liz W. , Balough Ben J.
Published: May 2024

Objective

We assessed three cochlear implant (CI) suppliers: Advanced Bionics, Cochlear Limited, and MED-EL, for implant revision requiring reoperation after CI placement.

Study Design

Retrospective cohort study of integrated-health-system database between 2010 and 2021. Separate models were created for pediatric (age <18) and adult (age ≥18) cohorts.

Patients

Pediatric (age <18) and adult (age ≥18) patients undergoing cochlear implantation within our integrated healthcare system.

Main Outcome Measure

Revision after CI placement. Cox proportional hazard regression was used to evaluate revision risk and adjust for confounding factors. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented.

Results

A total of 2,347 patients underwent a primary CI placement, and Cochlear Limited was most implanted (51.5%), followed by Advanced Bionics (35.2%) and MED-EL (13.3%). In the pediatric cohort, the 7-year crude revision rate was 10.9% for Advanced Bionics and 4.8% for Cochlear Limited, whereas MED-EL had insufficient cases. In adults, the rates were 9.1%, 4.5%, and 3.3% for Advanced Bionics, MED-EL, and Cochlear Limited, respectively. After 2 years of postoperative follow-up, Advanced Bionics had a significantly higher revision risk (HR = 8.25, 95% CI = 2.91–23.46); MED-EL had no difference (HR = 2.07, 95% CI = 0.46–9.25).

Conclusion

We found an increased revision risk after 2 years of follow-up for adults with Advanced Bionics CI devices. Although we found no statistical difference between manufacturers in the pediatric cohort, after 2 years of follow-up, there were increasing trends in the revision probability for Advanced Bionics. Further research may determine whether patients are better suited for some CI devices.
Management of facial nerve trauma
Authors: Greiner Rachel C. , Kohlberg Gavriel D. , Lu G. Nina
Published: May 2024

Purpose of review

To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting.

Recent findings

Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment.

The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72 h. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.
Ergonomics in facial plastic and reconstructive surgery
Authors: Kamrava Brandon , Derakhshan Adeeb , Gadkaree Shekhar K.
Published: May 2024

Purpose of review

Understanding effective ergonomic interventions is crucial for enhancing occupational health and career longevity. There is a paucity of clear ergonomics guidelines in facial plastic and reconstructive surgery (FPRS), placing practitioners at high risk of work-related musculoskeletal disorders (WMSDs) and their consequences.

Recent findings

There is mounting evidence that FPRS specialists are at increased risk of WMSDs as compared with the public and other surgical specialties. Numerous studies have demonstrated that implementation of ergonomics principles in surgery decreases WMSDs. Furthermore, WMSDs are reported as early as the first year of surgical residency, marking the importance of early intervention.

Fatigue and physical injuries among surgeons occur more often than expected, particularly during complex, extended procedures that necessitate maintaining a constant posture. FPRS procedure often place surgeons into procrustean positions. Thus, integrating ergonomic practices into the practice of FPRS is essential for reducing WMSDs.
Perspectives on the state of cleft lip and cleft palate patient care in Africa
Authors: Liu Rui Han , Manana Wayne , Tollefson Travis T. , Ntirenganya Faustin , Shaye David A.
Published: May 2024

Purpose of review

Patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa.

Recent findings

To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources.

The replacement of CLP ‘missions’ with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.
Clinical Significance of MUC4 and Associated Proteins in Pancreatic and Periampullary Cancers
Authors: Rashid Sumaira , Singh Nidhi , Rashid Safoora , Das Prasenjit , Gupta Surabhi , Chauhan Shyam S. , Sati Hem Chandra , Dash Nihar Ranjan , Sharma Atul , Dey Sharmistha , Saraya Anoop
Published: May 2024

Objective

This study primarily aimed to assess the expression of MUC4 in patients with pancreatic ductal adenocarcinoma (PDAC) as compared with controls and assess its clinical relevance.

Materials and Methods

Serum MUC4 levels and MUC4 gene expression in snap-frozen tissue were analyzed through surface plasmon resonance and quantitative polymerase chain reaction, respectively. Tumor tissues and control tissues were analyzed for MUC4 and other mucins through immunohistochemistry.

Result

MUC4 expression in tumor tissue was found to be significantly elevated in PDAC patients as compared with chronic pancreatitis tissues and normal pancreatic tissues. Periampullary carcinoma and cholangiocarcinoma tissue also showed increased expression of MUC4 and other mucins.

Conclusions

Differential expression of MUC4 in pancreatic tumor tissues can help to differentiate PDAC from benign conditions.
Research Progress on the Mechanism of Acute Hypertriglyceridemic Pancreatitis
Authors: Meng Yiteng , Han Peiyu , Ma Xiaoyu , He Yiting , Chen Hetian , Ren Hongbo
Published: May 2024

The incidence rate of hypertriglyceridemia pancreatitis (HTGP) has experienced a notable increase in recent years, with eclipsing alcohol as the second leading cause of acute pancreatitis (AP). HTGP is often associated with more severe local and systemic complications. Recognized as a metabolic disorder hypertriglyceridemia (HTG), it holds significant relevance in the pathogenesis of HTGP, yet its mechanisms are not fully understood. Both primary (genetic) and secondary (acquired) factors contribute to elevated triglyceride (TG) levels, which concurrently influence the progression of HTGP. This article presents a comprehensive review of the evolving research on HTGP pathogenesis, encompassing lipid synthesis and metabolism, calcium signal transduction, inflammatory mediators, endoplasmic reticulum stress, autophagy, mitochondrial injury by fatty acids, oxidative stress response, genetic factors, and gene mutations. By unraveling the intricate mechanisms underlying HTGP, this article aims to enhance physicians' understanding of the disease and facilitate the development of potential targeted pharmacological interventions for patients.
Bicycling for Rehabilitation of Persons With Parkinson Disease: A Scoping Review
Authors: Palmieri John L. , Jones Lesley , Schenkman Margaret , Deutsch Judith E.
Published: May 2024

Background and Purpose:

Exercise is beneficial for persons with Parkinson disease (PwPD). The overarching purpose of this scoping review was to provide guidance to clinicians and scientists regarding current evidence for bicycling exercise for PwPD. A scoping review was conducted to examine the heterogeneous literature on stationary bicycling for PwPD to reduce motor symptoms and body function structure impairments, improve activities and motor performance, and reduce disease severity.

Methods:

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. PubMed, CINAHL, and PEDro were searched from inception to January 23, 2023. Articles reporting original data on relevant outcome measures were included. Search results were screened and articles were extracted. Data were analyzed quantitatively with percentages of significant and clinically meaningful findings and qualitatively to extract themes.

Results:

Bicycling was categorized using bicycle types (assisted, nonassisted) and training modes (speed, aerobic, force). A high percentage of the 34 studies showed statistical significance for reducing motor symptoms (83%), body function structure impairments (78%), disease severity (82%), and improving activities (gait 72%, balance 60%). Clinically meaningful findings were achieved in 71% of the studies for reduction in disease severity and in 50% for improving gait.

Discussion and Conclusions:

The literature on bicycling for PwPD has evolved from speed to aerobic studies. The terminology describing types of bicycling was simplified. Of all the outcomes reported, reduction of disease severity achieved the highest frequency of clinical meaningful improvements. Bicycling was comparable with other forms of aerobic training for walking speed and endurance. Opportunities for translation to practice and research are presented.

Video Abstract available

for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A462).