bluuebunny/crossref_metadata_2025 huggingface dataset:
A unified framework for the measurement of mobility in older persons
Authors: Beauchamp Marla K , Hao Qiukui , Kuspinar Ayse , Amuthavalli Thiyagarajan Jotheeswaran , Mikton Christopher , Diaz Theresa , Raina Parminder
Published: October 2023

Mobility is often referred to as a ‘sixth vital sign’ because of its ability to predict critical health outcomes in later adulthood. In the World Health Organization (WHO) World Report on Aging and Health, mobility is described as movement in all its forms whether powered by the body or a vehicle. As such, mobility encompasses basic physical actions such as getting up from a chair and walking, as well as activities such as exercising, driving and using public transportation. A plethora of measurement tools have been developed to assess various aspects of mobility; however, there is wide variability in the mobility constructs being measured which limits standardisation and meaningful comparison across studies. In this paper, we propose a comprehensive framework for measuring mobility that considers three distinct facets of mobility: perceived mobility ability (‘what can you do’), actual mobility ability (‘what you actually do’) and locomotor capacity for mobility (‘what could you do’). These three facets of mobility are rooted in the three components of healthy aging endorsed by the WHO: functional ability, intrinsic capacity and environments. By proposing a unified framework for measuring mobility based on theory and empirical evidence, we can advance the science of monitoring and managing mobility to ensure functional ability in older age.
Barriers to social inclusion and levels of urbanisation: Does it matter where you live?
Authors: Whelan Adele , Devlin Anne , McGuinness Seamus
Published: October 2023

This paper investigates the occurrence and nature of barriers to social inclusion in distinct geographical settings. Utilising a unique administrative dataset from Ireland’s dominant social inclusion programme, this study examines how location impacts the occurrence of these barriersat a small-area level. Ireland’s high growth rates have raised concerns about uneven effects, making it an interesting case study for ‘left behind’ places. The findings reveal that barriers associated with social inclusion, related to economic participation, are more prevalent in ‘independent urban towns’ compared to both more urban and more rural areas, over and above area-level deprivation. This implies that existing policies, which traditionally employs a simplistic urban/rural dichotomy, lacks effective targeting, and would benefit from adopting a more precise spatial perspective.
The association between Peyronie’s disease and depression: a scoping review
Authors: Kraglund Rune , Durukan Emil , Giraldi Annamaria , Fode Mikkel
Published: October 2023

Introduction

Peyronie’s disease (PD) can have an immense psychological impact, with depression being a reported possible, severe consequence. To date, no literature reviews have systematically and critically assessed the relationship between PD and depression.

Objectives

The study sought to identify and critically appraise the current literature on the association between PD and depression.

Methods

Studies had to address men with PD or probable PD and assess depression or depressive symptoms. Quantitative and qualitative, peer-reviewed, primary, empirical studies written in English or Danish were included. According to the guidelines for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guideline, we performed a systematic review of PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, and Web of Science. Reference lists of included studies were screened for additional sources. Gray literature was searched for in Google Scholar and Bielefeld Academic Search Engine. Data were charted using a data extraction form, and critical appraisal was performed using the QuADS (quality assessment with diverse studies) tool.

Results

Thirteen studies were included. Most studies had a cross-sectional design, and also cohort studies and longitudinal observational studies without a control group were found. Depression was assessed mainly by validated questionnaires or diagnostic codes. Questionnaire studies found a prevalences of moderate to severe depression of 24% to 48%, while studies using diagnostic codes found depression in 4% to 37% of men with PD. The quality of the included studies varied from 38% to 82% of the maximum possible score in the QuADS assessment.

Conclusion

While most studies describe an association between PD and depression, the evidence is not comprehensive. The current literature is especially at risk of selection bias and the influence of confounding factors, and a direct causality between PD and depression cannot be established. Future research calls for more methodically rigorous studies as well as qualitative studies to understand the relationship.
Traumatic acid inhibits ACSL4 associated lipid accumulation in adipocytes to attenuate high‐fat diet‐induced obesity
Authors: Gao Jianfang , Zhang Zhongxiao , Dong Xiaohua , Zhao Jing , Peng Zhou , Zhang Ling , Xu Zhongqing , Xu Liling , Wang Xingyun , Guo Xirong
Published: October 2023

Obesity is a major health concern that lacks effective intervention strategies. Traumatic acid (TA) is a potent wound‐healing agent in plants, considered an antioxidant food ingredient. This study demonstrated that TA treatment significantly reduced lipid accumulation in human adipocytes and prevented high‐fat diet induced obesity in zebrafish. Transcriptome sequencing revealed TA‐activated fatty acid (FA) degradation and FA metabolism signaling pathways. Moreover, western blotting and quantitative polymerase chain reaction showed that TA inhibited the expression of long‐chain acyl‐CoA synthetase‐4 (ACSL4). Overexpression of ACSL4 resulted in the reversal of TA beneficiary effects, indicating that the attenuated lipid accumulation of TA was regulated by ACSL4 expression. Limited proteolysis‐mass spectrometry and microscale thermophoresis were then used to confirm hexokinase 2 (HK2) as a direct molecular target of TA. Thus, we demonstrated the molecular basis of TA in regulating lipid accumulation and gave the first evidence that TA may function through the HK2‐ACSL4 axis.
Measuring Competency: Improving the validity of your procedural performance assessments
Authors: Andreatta Pamela B. , Renninger Christopher H. , Bowyer Mark W. , Gurney Jennifer M.
Published: October 2023

Objective:

The objective of the study was to compare the use of ordinal scales and interval scales for capturing surgical competency information for general surgeons performing 3 complex trauma procedures.

Background:

Surgical performance assessment is typically captured using nonparametric data (eg, checklists) that do not support inferential analyses. Interval scales support parametric analyses that are essential for determining competency. We compared assessment outcomes for surgeons performing 3 complex trauma procedures using ordinal and interval scales.

Methods:

All participants were board-certified or eligible general surgeons. Each participant was assessed by an experienced trauma surgeon while performing 3 trauma procedures on cadavers. All assessors completed a rigorous assessment certification process. We calculated descriptive statistics to examine the differences between interval (parametric) and ordinal (nonparametric) outcomes.

Results:

Ordinal scales overestimated competence in up to 100% of the participants and did not identify specific performance gaps. Interval scales provided more granularity and identified specific capability gaps.

Conclusions:

Imprecise instrumentation conveys a false sense of competence and deprives surgeons of opportunities to close capability gaps. Measuring discrete procedural components with interval scales provides a more precise measurement of surgical competency.
Evolution of Treatment Outcomes and Prognostic Factors in Esophageal Cancer Surgery: A Retrospective Analysis of 1500 Consecutive Esophagostomies
Authors: Kimura Yasue , Oki Eiji , Nakanoko Tomonori , Hu Qingjiang , Natsugoe Keita , Nanbara Sho , Nakanishi Ryota , Nakashima Yuichiro , Ota Mitsuhiko , Yoshizumi Tomoharu
Published: October 2023

Objective:

To clarify the surgical outcomes of esophagectomy in Japan and comprehensively evaluate trends over time. It is important to analyze data from a large number of consecutive patients from a single institution.

Methods:

We evaluated the treatment outcomes, complications, and prognosis of 1500 consecutive patients who underwent esophagectomy during 5 periods: group A (n = 284), 1964–1984; group B (n = 345), 1985–1993; group C (n = 253), 1994–2002; group D (n = 297), 2003–2012; and group E (n = 321), 2013–March 2020.

Results:

The incidences of squamous cell carcinoma and adenocarcinoma were 93.8% and 3.3%, respectively. The proportion of adenocarcinoma cases has gradually increased over time. The in-hospital mortality rates for groups A, B, C, D, and E were 12%, 4.6%, 1.2%, 2.9%, and 1.5%, respectively. Group A had a significantly higher mortality rate than the other groups (P < 0.0001). Three-year survival rates were 22.2%, 47.8%, 53.4%, 69.9%, and 72.6% in groups A–E, respectively, 5-year survival rates were 17.2%, 41.3%, 49.2%, 63.9%, and 68.4%, respectively (P < 0.0001, group A vs groups D and E). The prognosis improved over time. Multivariate analysis revealed that depth of invasion, lymph node metastasis, the extent of lymph node resection, curative resection, pulmonary complications, and anastomotic leakage were significant independent prognostic factors. However, for recent surgeries (groups D and E), only the depth of invasion, lymph node metastasis, and curative resection were significant independent prognostic factors.

Conclusions:

Valuable changes in background and prognostic factors occurred over time. These findings will help optimize esophageal cancer management and improve patient outcomes.
Medium-term Results After Femoral Head Resection and Subtrochanteric Valgus Osteotomy in Children and Adolescents With Neuromuscular Disorders
Authors: Marowsky Madeleine , Jungesblut Oliver , Strahl André , Stücker Ralf , Rupprecht Martin
Published: October 2023

Background:

Various salvage surgical procedures for painful hip dislocation in adolescent patients with cerebral palsy exist. To date, no significant differences among these surgical techniques have been described. In our institution the McHale procedure is the standard of care for painful chronically dislocated hips with or without deformity of the femoral head in patients with cerebral palsy. This study focuses on mid-term results after surgical treatment.

Methods:

Surgical reports and patient charts were analyzed retrospectively. All x-rays were evaluated and migration of the proximal femur and heterotopic ossification according to Brooker were recorded. In addition, we conducted a telephone interview with the caretakers with special reference to pain preoperatively and postoperatively and after implant removal, sitting tolerance, range of motion, mobility, quality of life, and personal hygiene.

Results:

Fifty-two patients (65 hips) with a mean age of 13.5 ± 3.6 years (range: 4 to -20 y) were included. Mean surgery time was 178.4 ± 63.4 minutes (range: 45 to 380 min) and mean follow-up was 45.17 ± 30.6 months (range: 12 to 204 mo). A significant difference between preoperative and postoperative pain levels was found, P<0.001. Personal hygiene (P=0.02) and quality of life (P=0.013) improved significantly. Eighty-five percent of the caregivers would have the surgery performed on their child again and 81% of the caregivers would recommend the surgery to others. The removal of implants leads to a significant improvement in pain (P=0.011). A total of 22 complications in 65 McHale procedures (33.9%) were related to the procedures.

Conclusions:

A significant reduction in pain and a significant improvement of hygiene as well as quality of life can be achieved with the McHale procedure in painful chronically dislocated hips in patients with cerebral palsy. Overall, the procedure is predominantly experienced as helpful by the caregivers and recommended to others. The removal of the implants improves pain significantly, but complications may occur in one third of the patients.

Level of Evidence:

IV.
Reconstruction of the Anterior Tibialis Tendon Using In-phase Tendon Transfers
Authors: Fernández Augusto Roca , Gupta Rajul , Johnson Brian , Smith Richard M. , Laughlin Richard T.
Published: October 2023

Anterior tibialis tendon ruptures or lacerations are rare conditions that do not have a universally accepted treatment. Previously reported methods have described end-to-end repair, transfer of the extensor hallucis longus, and allograft interposition graft. The purpose of this paper is to describe a technique for reconstruction of the anterior tibialis tendon with a transfer of the medial 2 tendons of the extensor digitorum longus (EDL) to span any gaps or diseased tendon. In addition, the lateral 2 tendons of the EDL are transferred to the peroneus tertius to balance dorsiflexion and prevent overpull on the fourth and fifth toes if the EDL tendons are left in place. Using the EDL to reconstruct the anterior tibialis provides an in-phase tendon transfer resulting in symmetric dorsiflexion at the ankle. In addition, the EDL is a normal muscle with the capacity for hypertrophy, which supplements the muscle power of the injured anterior tibialis which often atrophies in the interim between injury and repair.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Kickstand Technique for Treatment of Valgus-Impacted Proximal Humerus Fractures
Authors: Wright Logan , Struk Aimee , Wright Thomas
Published: October 2023

Purpose:

Describe a new technique using a minimally invasive surgical intervention for the treatment of valgus-impacted proximal humerus fractures. The Kickstand technique is a novel approach that offers reliable fixation and union without the need for additional hardware.

Materials and Methods:

A retrospective case series of 3 patients with valgus-impacted proximal humerus fractures was treated with this Kickstand technique using an intramedullary fibular allograft. Postoperative x-rays and outcomes are presented.

Results:

The Kickstand technique was used to address valgus-impacted fractures in 3 patients. Postoperative range of motion and shoulder outcome scores were reported at 2 years for patients A and B, and at 1 year for patient C (Active range of motion external rotation: 28 degrees; Active range of motion elevation: 140 degrees; Simple Shoulder Test-12: 11; American Shoulder and Elbow Standardized Shoulder Assessment: 78). Postoperative Grashey and lateral x-rays for each patient show union of the valgus-impacted humerus.

Conclusions:

The Kickstand technique using intramedullary fibular allograft is an alternative fixation technique for displaced valgus proximal humerus fracture. It has the advantage of avoiding additional metallic hardware and allowing early motion but requires the use of intramedullary fibular allograft which can interfere with future use of stemmed humeral prosthesis.
Tissue amount and diagnostic yield of a novel franseen EUS-FNB and a standard EUS-FNA needle—A randomized controlled study in solid pancreatic lesions
Authors: Kovacevic Bojan , Toxværd Anders , Klausen Pia , Larsen Michael H. , Grützmeier Simon , Detlefsen Sönke , Karstensen John Gásdal , Brink Lene , Hassan Hazem , Høgdall Estrid , Vilmann Peter
Published: October 2023

Background and Objectives

Several types of needles are available for EUS–guided tissue sampling of pancreatic lesions. Whereas fine-needle aspiration (FNA) needles typically provide cytological samples, fine-needle biopsy (FNB) needles are designed to obtain microcores with preserved tissue architecture. The aim of this study was to compare tissue amount and diagnostic yield between a modified Franseen-type FNB needle (TopGain; Medi-Globe GmbH, Grassau, Germany) and a standard FNA needle.

Methods

We performed a prospective, multicenter randomized controlled study between June 2020 and September 2021, including patients with a solid pancreatic lesion referred for EUS-guided tissue sampling at 3 centers in Denmark. The patients were randomized 1:1 to either FNA needle or the novel FNB needle. Primary outcomes included the number of obtained tissue microcores and total and diagnostic tissue area.

Results

Sixty-four patients were included. The median number of tissue microcores procured per pass was significantly higher in the FNB group compared with FNA (3 vs. 2, P < 0.001). Similarly, the mean total tissue area (2.74 vs. 0.44 mm2, P < 0.001) and mean diagnostic tissue area (1.74 vs. 0.28 mm2, P < 0.001) were more than 6-fold larger in the FNB samples compared with FNA. The median number of passes needed for a diagnostic sample was 1 for the FNB needle and 2 for FNA needle (P = 0.12). The novel FNB needle provided a higher percentage of samples of excellent quality (P = 0.002).

Conclusions

The novel Franseen-type FNB needle seems to be significantly superior to a conventional FNA needle. The results of this study underline excellent performance of crown-cut needles.
Hepatobiliary surgery in Taiwan: The past, present, and future. Part I; biliary surgery
Authors: Ker Chen-Guo
Published: October 2023

In Taiwan, most surgical services were mainly provided by Japanese or Western surgeons before World War II. Tsuchiya Kunita first reported surgical treatment of gallstone diseases in 1915 in Taiwan. After World War II, experienced Japanese surgeons returned to Japan, and well-trained surgeons moved to Taiwan from different hospitals in Mainland China after 1949. In 1954, Liao had reported surgical gallstone diseases treated by cholecytostomy, cholecystectomy, and cholecystogastrostomy or cholecystoduodenostomy from National Taiwan University Hospital (Formos J Surg. 1954;53:833–4). By using of operative cholangiography, diagnosis and removal of intrahepatic stones could be done through choledochostomy reported first by Lee HC from National Defense Medical Center in 1966 and 1968 (Chin Med J ROC. 1966;13:301–8; Chin Med J ROC. 1968;15:124–34). Wei from the National Taiwan University Hospital reported the first left hepatectomy for treating hepatolithiasis on one patient among his series in 1971 (Formos J Surg. 1971;4:178–96). Treatments of hepatolithiasis were well analyzed by Wen and Lee from Triservice General Hospital and Veterans General Hospital in 1972 (Ann Surg. 1972;175:166–77). Hwang was the first to use choledochofiberscope for removing retained stones since 1974 reported from Show Chwan Memorial Hospital in 1978 (Am J Surg. 1978;139:860–4). The first laparoscopic cholecystectomy was performed by Huang from Taipei Cathay General Hospital in 1990 in Taiwan (J Formos Med Assoc. 1991;90:893–9). Nowadays, Taiwan hepatobiliary surgeons were extensively using either laparoscopic or robotic surgery for treatment of hepatobiliary diseases.

In conclusion, we should never forget the great contributions from many clinics in rural villages hosted by Christian or Catholicism organizations in Taiwan hundred years ago. We should express our appreciations to the history of the evolutions of biliary surgical skills. In Taiwan, a great surgeon today is always standing on the shoulders of our ancient giants, our surgical teachers.
Botulinum Toxin A Injection for Hemihypertrophy-related Unilateral Gastrocnemius Hypertrophy
Authors: Zhang Ziming , Wei Qingqian , Li Yingzi , Zhuang Jun , Su Xueshang , Liu Tun , Hu Jintian
Published: October 2023

Hemihypertrophy is a rare congenital disorder that causes unequal growth of the extremities, trunk, face, or half of the body. We report a case of a 32-year-old woman with hemihypertrophy-related gastrocnemius hypertrophy treated with botulinum toxin A injection. The patient has received two botulinum toxin A injections, and we measured the thickness of the gastrocnemius muscle using ultrasound and measured the maximum circumference around the calf with the patient in the prone position. The patient’s maximum calf circumference was reduced by 1 cm. The thickness of the medial head of the gastrocnemius was reduced by 0.3 cm, and the thickness of the lateral head of the gastrocnemius was reduced by 0.6 cm. Botulinum toxin A injection therapy was effective in treating hemihypertrophy-related gastrocnemius hypertrophy.
Combined, elobixibat, and colestyramine reduced cholesterol toxicity in a mouse model of metabolic dysfunction-associated steatotic liver disease
Authors: Iwaki Michihiro , Kessoku Takaomi , Tanaka Kosuke , Ozaki Anna , Kasai Yuki , Kobayashi Takashi , Nogami Asako , Honda Yasushi , Ogawa Yuji , Imajo Kento , Usuda Haruki , Wada Koichiro , Kobayashi Noritoshi , Saito Satoru , Nakajima Atsushi , Yoneda Masato
Published: October 2023

Background:

Cholesterol levels and bile acid metabolism are important drivers of metabolic dysfunction-associated steatohepatitis (MASH) progression. Using a mouse model, we investigated the mechanism by which cholesterol exacerbates MASH and the effect of colestyramine (a bile acid adsorption resin) and elobixibat (an apical sodium-dependent bile acid transporter inhibitor) concomitant administration on bile acid adsorption and MASH status.

Methods:

Mice were fed a high-fat high-fructose diet with varying concentrations of cholesterol to determine changes in fatty liver according to liver status, water intake, defecation status, insulin resistance, bile acid levels, intestinal permeability, atherosclerosis (in apolipoprotein E knockout mice), and carcinogenesis (in diethylnitrosamine mice). Using small interfering ribonucleic acid (siRNA), we evaluated the effect of sterol regulatory element binding protein 1c (SREBP1c) knockdown on triglyceride synthesis and fatty liver status following the administration of elobixibat (group E), colestyramine (group C), or both (group EC).

Results:

We found greater reductions in serum alanine aminotransferase levels, serum lipid parameters, serum primary bile acid concentrations, hepatic lipid levels, and fibrosis area in EC group than in the monotherapy groups. Increased intestinal permeability and watery diarrhea caused by elobixibat were completely ameliorated in group EC. Group EC showed reduced plaque formation rates in the entire aorta and aortic valve of the atherosclerosis model, and reduced tumor counts and tumor burden in the carcinogenesis model.

Conclusions:

Excessive free cholesterol in the liver can promote fatty liver disease. Herein, combination therapy with EC effectively reduced free cholesterol levels in MASH model mice. Our study provides strong evidence for combination therapy as an effective treatment for MASH.
Serum 25-hydroxyvitamin D, type 2 diabetes, and liver-related outcomes: Secondary data analysis of a prospective recruited cohort
Authors: Wang Yu , Dan Lintao , Fu Tian , Sun Yuhao , Chen Jie , Mao Ren
Published: October 2023

Background:

The association of vitamin D deficiency, which is prevalent in type 2 diabetes mellitus (T2DM), with liver disease and related mortality has not been quantified. Our study aimed to (1) investigate whether there is a synergistic association of vitamin D deficiency and T2DM with liver-related outcomes and (2) explore whether high 25-hydroxyvitamin D [25(OH)D] concentrations are associated with a lower risk of liver-related outcomes in T2DM.

Method:

Leveraging the data from UK Biobank, we conducted 2 studies: study I assessed the joint associations of vitamin D deficiency [25(OH)D <50 nmol/L] and T2DM with liver-related outcomes among 439,276 participants, and study II explored the associations of vitamin D status with liver-related outcomes among 21,519 individuals with T2DM. Baseline T2DM was identified through medication, laboratory test, and electronic health-related records. Serum 25(OH)D was measured by direct competitive chemiluminescent immunoassay. Liver-related outcomes included 6 liver disease end points and mortality by overall liver disease, chronic liver disease, and severe liver disease.

Results:

During an average follow-up duration of 11.6 years, we observed a significant positive additive interaction effect (all synergy index>1.0) of T2DM and vitamin D deficiency on the risk of liver-related outcomes. Compared with participants without either T2DM or vitamin D deficiency, the multivariable-adjusted HRs of overall liver diseases were 1.29 for participants without T2DM but with vitamin D deficiency, 1.73 for participants with T2DM but without vitamin D deficiency, and 2.19 for participants with both T2DM and vitamin D deficiency. In individuals with T2DM, we observed that participants without vitamin D deficiency were inversely associated with incident liver disease and related mortality (multivariable-adjusted HRs 0.41–0.81) when compared with individuals with vitamin D deficiency.

Conclusions:

There are positive synergistic associations of vitamin D deficiency and T2DM with liver-related outcomes. Inverse associations between serum 25(OH)D concentrations and liver-related outcomes were observed in individuals with T2DM.
Short-term Changes in Epithelial and Optical Redistribution Induced by Different Orthokeratology Designs
Authors: Meng Ziqi , Chen Siping , Zhe Nan , Cao Tongxin , Li Zhangliang , Zhang Yunjie , Wei Ruihua
Published: October 2023

Objectives:

This study aimed to investigate corneal epithelial and topographic changes caused by two commercial myopia orthokeratology (ortho-k) designs.

Methods:

Twenty-six subjects fitted with vision shape treatment (VST) lenses and 30 subjects fitted with corneal reshaping therapy (CRT) lenses were reviewed 1 day, 1 week, and 1 month after lens initiation. A spectral-domain optical coherence tomography system was used to create epithelial maps that were in turn used to determine the average epithelial thickness of each zone and the diameter of treatment zone. By measuring the topographic tangential differential map, the treatment zone diameter and the power and width of the high convex zone (HCZ) were obtained. All epithelial thicknesses and topographic corneal variations recorded were analyzed.

Results:

At the central zone, the epithelial thickness changes (△ET) decreased significantly after 1 day of ortho-k in two groups. At 2- to 9-mm peripheral zone, ortho-k increased △ET until 1 week in the VST group, whereas it kept increasing in the CRT group after 1 week. At 1 month, the central △ET is −9.51±2.38 mm in the VST group, which was comparable to −8.72±3.43 mm in the CRT group. The nasal HCZ power and the △ET of nasal and inferior nasal were significantly larger in the CRT group. A positive correlation was found between the HCZ power and △ET generated by VST-type lenses inferiorly and temporally. For the CRT group, a positive correlation was found between inferior HCZ power and △ET.

Conclusions:

At the early stage of ortho-k, epithelial thickness and topography change quickly and simultaneously. Epithelial changes were in line with corneal topography reshaping. Epithelial and optical remodelling were affected by different lens types.
Early Endophthalmitis Rates and Risk Factors After Corneal Transplant Surgeries in Medicare Beneficiaries From 2016 to 2019
Authors: Ali Muhammad , Dun Chen , Chen Ariel , Saeed Safa , Prescott Christina R. , Makary Martin A. , Srikumaran Divya , Woreta Fasika A.
Published: October 2023

Purpose:

The aims of this study were to determine rates of early postkeratoplasty endophthalmitis and identify sociodemographic and medical risk factors in the Medicare population.

Methods:

Using a retrospective cohort design, patients aged 65 years and older undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) from 2016 to 2019 among 100% Medicare Fee-or-Service database were included. Rates of early endophthalmitis within 42 days of keratoplasty were determined using the International Classification of Diseases, 10th Revision-Clinical Modification diagnostic codes. Patient and physician characteristics were compared using x2 tests, and a multivariable logistic regression model was used to evaluate factors associated with endophthalmitis.

Results:

The overall early endophthalmitis rate after keratoplasty was 0.39% (n = 216/54,822) with a median time to diagnosis of 14 (interquartile range: 5–25) days. Rates by keratoplasty types were 1.31% for cataract surgery combined with PK, 1.13% for PK, and 0.22% for EK. On multivariable analysis, the odds of endophthalmitis were higher for PK [odds ratio (OR): 5.46, 95% confidence interval (CI), 3.98–7.49] and ALK (OR: 5.45, 95% CI, 2.59–11.49) relative to EK. Patients with a Charlson Comorbidity Index (CCI) ≥3 had higher odds of endophthalmitis (OR: 1.82; 95% CI, 1.28–2.58) relative to patients with a CCI of 0. Practices located in the Midwest (OR: 0.59, 95% CI, 0.36–0.96), West (OR 0.57; 95% CI, 0.35–0.93), and Northeast (OR: 0.59 95% CI, 0.35–0.99) had lower odds of reporting endophthalmitis when compared to the South.

Conclusions:

Patients undergoing PK and ALK and those with a CCI ≥3 had higher odds of endophthalmitis relative to EK and patients without comorbidities, respectively. Practices in the West, Midwest, and Northeast had lower odds of endophthalmitis relative to the South.
A Modified liver donor risk index for pediatric liver transplant recipients
Authors: Guhan Maya , Montgomery Ashley , Varghese Ron , Rana Abbas
Published: October 2023

The Liver Donor Risk Index (LDRI) was developed by Feng et. al. to predict the quality of donor liver allografts. However, there is currently no literature documenting the application and efficacy of Feng’s LDRI specifically for the pediatric population. The goal of our study is to apply Feng’s LDRI to our study population as well as develop a pediatric-specific LDRI. De-identified data from the United Network for Organ Sharing for 7,836 pediatric transplant recipients, was retrospectively analyzed from January 1, 2000, to July 1, 2022. We performed a univariate and multivariate Cox regression analysis to determine the significant recipient and transplant factors impacting pediatric liver allograft survival. These significant factors were used to construct the pediatric-specific LDRI index. Receiver operator characteristic curve analysis was utilized to compare the pediatric-specific and Feng LDRI indexes at 1, 5, and 10 years.​​ Our pediatric-specific LDRI includes 4 variables found to be significant in pediatric populations: donor age: 35-50, ≥ 50; cold ischemia time ≤ 6, AST level >1000. In addition, our pediatric-specific LDRI had a higher ROC c-statistic compared to Feng’s LDRI at 1 year (0.57 vs. 0.55), 5 years (0.57 vs. 0.50), and 10 years (0.58 vs. 0.47). Our findings indicate that there is a need to create a pediatric-specific LDRI as the Feng LDRI has not been shown to be efficacious in pediatric populations. Our index may serve as a starting point for the development of a comprehensive pediatric LDRI.
Burden, clinical features, and outcomes of post-tuberculosis chronic obstructive lung diseases
Authors: Sehgal Inderpaul Singh , Dhooria Sahajal , Muthu Valliappan , Salzer Helmut J.F. , Agarwal Ritesh
Published: October 2023

Purpose of review

Post-tuberculosis lung disease (PTLD) is an increasingly recognized and debilitating consequence of pulmonary tuberculosis (PTB). In this review, we provide a comprehensive overview of PTLD with airflow obstruction (PTLD-AFO), focusing on its burden, pathophysiology, clinical manifestations, diagnostic methods, and management strategies.

Recent findings

The relationship between PTLD and airflow obstruction is complex and multifactorial. Approximately 60% of the patients with PTLD have some spirometric abnormality. Obstruction is documented in 18–22% of PTLD patients. The host susceptibility and host response to mycobacterium drive the pathogenic mechanism of PTLD. A balance between inflammatory, anti-inflammatory, and fibrotic pathways decides whether an individual with PTB would have PTLD after microbiological cure. An obstructive abnormality in PTLD-AFO is primarily due to destruction of bronchial walls, aberrant healing, and reduction of mucosal glands. The most common finding on computed tomography (CT) of thorax in patients with PTLD-AFO is bronchiectasis and cavitation. Therefore, the ‘Cole's vicious vortex’ described in bronchiectasis applies to PTLD. A multidisciplinary approach is required for diagnosis and treatment. The disability-adjusted life-years (DALYs) attributed to PTLD represent about 50% of the total estimated burden of DALYs due to tuberculosis (TB). Patients with PTLD require comprehensive care that includes psychosocial support, pulmonary rehabilitation, and vaccination against respiratory pathogens. In the absence of trials evaluating different treatments for PTLD-AFO, therapy is primarily symptomatic.

PTLD with airflow obstruction has considerable burden and causes a significant morbidity and mortality. However, many aspects of PTLD-AFO still need to be answered. Studies are required to evaluate different phenotypes, especially concerning Aspergillus-related complications. The treatment should be personalized based on the predominant phenotype of airflow obstruction. Extensive studies to understand the exact burden, pathogenesis, and treatment of PTBLD-AFO are needed.
Review of artificial intelligence clinical applications in Nuclear Medicine
Authors: Panagiotidis Emmanouil , Papachristou Konstantinos , Makridou Anna , Zoglopitou Lydia-Aggeliki , Paschali Anna , Kalathas Theodoros , Chatzimarkou Michael , Chatzipavlidou Vasiliki
Published: October 2023

This paper provides an in-depth analysis of the clinical applications of artificial intelligence (AI) in Nuclear Medicine, focusing on three key areas: neurology, cardiology, and oncology. Beginning with neurology, specifically Alzheimer’s disease and Parkinson’s disease, the paper examines reviews on diagnosis and treatment planning. The same pattern is followed in cardiology studies. In the final section on oncology, the paper explores the various AI applications in multiple cancer types, including lung, head and neck, lymphoma, and pancreatic cancer.
Effects of intracerebroventricular administration of calcitonin gene-related peptide (CGRP) on sex hormones and sperm quality in rats
Authors: Rahimi Kaveh , Riyahi Moslem , Sajedianfard Javad , Nazifi Saeed
Published: October 2023

Background:

Therapeutic strategies with calcitonin gene-related peptide (CGRP) or its receptor have been investigated, but there are few studies regarding the possible harmful effects of CGRP in other body organs.

Objective:

This study aimed to investigate the effect of intracerebroventricular (ICV) injection of CGRP on sex hormones and sperm quality in rats.

Methods:

Twelve male rats were divided into two groups (n=6 per group). The first group (control) rats were injected with 5 µl artificial cerebrospinal fluid intra-ICV; the second group rats, 5 µl (1.5 nmol) CGRP. The levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone were measured. Epididymal sperms were used to determine the sperm parameters.

Results:

The levels of testosterone, LH and FSH in CGRP group was significantly lower than in artificial cerebrospinal fluid (ACSF) group (P<0.05). The concentration and motility of sperm in CGRP group was significantly lower than in ACSF group (P<0.05). In CGRP group live spermatozoa and intact acrosome significantly reduced compared to the ACSF group (P<0.05). In addition, in CGRP group dead spermatozoa and lose acrosome significantly increased compared to the ACSF group (P<0.05).

Conclusion:

ICV injection of CGRP may reduce sperm quality, probably through induction of an imbalance in FSH and LH production as well as testosterone.
Giant sacrococcygeal teratoma in an infant: a case report with a literature review
Authors: Sabir Wirya N. , Ahmed Sasan M. , Hasan Karzan M. , Mohammed Bilal A. , Kareem Honar Othman , Najmadden Zana B. , Abdalla Berun A. , Salih Rawezh Q. , Mohammed Shvan H. , Kakamad Fahmi H. , Azaldeen Hevar A.
Published: October 2023

Introduction and importance:

A sacrococcygeal teratoma (SCT) is a rare embryonal tumor that emerges in the sacrococcygeal area. It affects one in every 35 000–40 000 live births. Herein, we report a case of a substantial SCT in a neonate.

Case presentation:

A neonate girl from consanguineous parents was delivered by cesarean section with a large mass (18×17 cm) in the sacrococcygeal area. The baby’s birth weight was 5 kg, of which 2.5 belonged to the mass. The vital signs were within normal ranges and she had weak movement with bluish peripheral limbs. Oxygen saturation was around 85% for a short period after birth. According to the American Academy of Pediatric Surgical Section, the tumor was type I. After the fifth day of delivery, a complete resection was done through a chevron incision. The patient was put on ‘nil by mouth’ for about 24 h and given intravenous fluid.

Clinical discussion:

The histopathological examination of the surgical specimen confirmed extragonadal immature teratoma. The histological classification of SCT is divided into three types: malignant teratomas (consisting of malignant germ cells); immature teratomas (incompletely differentiated structures with a high risk of malignancy or embryonal components); and mature teratomas (fully differentiated tissues).

Conclusion:

SCT has rarely been reported as a giant mass. Radiologic examinations in the early stages of pregnancy may be essential to the early diagnosis of the condition.
A case report of sarcoidosis overlapped with Sjogren’s syndrome
Authors: Kudsi Maysoun , Drie Tasneem , Khalayli Naram , Obaid hassnah Hashem Ammar , alghawe Fatima alzahraa , alhham Leen
Published: October 2023

Introduction and importance:

The diagnosis of sarcoidosis and Sjögren’s syndrome (SS) in the same patient is a challenge since sarcoidosis is considered an exclusion criterion for SS.

Case presentation:

The authors described a 62-year-old woman, who had SS for 8 years and presented with dry mouth, dry eyes, dyspnoea, and erythema nodosum. High resolution computed tomography of the chest showed symmetrical pulmonary micronodules, interstitial changes, and enlarged mediastinal lymph nodes. Anti-nuclear antibodies and anti-SSA antibodies were positive. Schermer’s test was also positive. A biopsy of lung nodules revealed non-caseous granuloma. Salivary gland biopsy showed focal lymphocyte infiltration. Diagnosis of sarcoidosis and SS were done according to the classification criteria in this patient.

Clinical discussion:

Although the diagnosis of Sjogren requires the exclusion of conditions that cause dry eyes and mouth, such as sarcoidosis, Few studies have reported the coexistence of sarcoidosis and SS such as this case report.

Conclusion:

This case extends our understanding of overlapped SS with sarcoidosis and provides a referential value for clinical diagnosis.
Anxiety, Depressive Symptoms, Health-Related Quality of Life, and Their Associated Factors Among Caregivers of Children With Cancer
Authors: Phiri Lophina , Li William H. C. , Phiri Patrick G. M. C. , Cheung Ankie T. , Wanda-Kalizang’oma Watipaso
Published: October 2023

Background

A child’s cancer diagnosis and treatment are stressful for family caregivers, who may experience anxiety, depressive symptoms, and poor health-related quality of life (HRQoL) related to the care they provide.

Objective

This study assessed the prevalence of anxiety, depressive symptoms, HRQoL, and associated factors among caregivers of children with cancer.

Methods

A cross-sectional study was conducted on 167 caregivers of children with cancer in Malawi. A multivariate analysis was conducted to identify the determinants of anxiety, depressive symptoms, and HRQoL.

Results

All 167 caregivers who consented to participate in this study completed all the questionnaires. Severe anxiety and severe depressive symptoms accounted for 17.5% and 10.2%, respectively. Being Muslim (B = 7.800, P < .001) and Pentecostal (B = 3.067, P = .023) by religious denominations was more likely to be anxious, whereas Catholic caregivers (B = 3.702, P = .033) were more likely to be depressed. Being unemployed was more likely to result in lower anxiety (B = −4.080, P = .016). Furthermore, caregivers demonstrated a lower mental health component (mean, 39.33 [SD, 6.35]), whereas being a female and aged between 31 and 40 years was more likely to result in better physical health (B = 3.962 [P = .031] and B = 3.415 [P = .020], respectively).

Conclusion

This study supports evidence that caregivers of children experience moderate and severe anxiety and depressive symptoms and poor HRQoL in Malawi.

Implication for Practice

Nurses need to include psychological interventions for caregivers of children with cancer during childcare.
SPARC Is a Novel Positive Immunohistochemical Marker of Epithelioid Mesothelioma to Differentiate It From Lung Adenocarcinoma and/or Squamous Cell Carcinoma
Authors: Nakagiri Tetsuya , Amatya Vishwa J. , Kushitani Kei , Kambara Takahiro , Aoe Kohei , Endo Ihiro , Miyata Yoshihiro , Okada Morihito , Takeshima Yukio
Published: October 2023

Epithelioid mesothelioma with a solid histologic pattern (solid epithelioid mesothelioma) is difficult to distinguish from a poorly differentiated squamous cell lung carcinoma and/or solid lung adenocarcinoma. Thus, immunohistochemical markers are essential for diagnosis; however, the sensitivity and specificity of pre-existing mesothelial markers are suboptimal, particularly for differentiation from squamous cell carcinoma. Using a cancer-dependency map, we analyzed gene expression data of pleural mesothelioma and non–small cell lung cancer cell lines (squamous cell carcinoma and adenocarcinoma) and identified secreted protein acidic and cysteine-rich (SPARC) as a promising candidate for the differential diagnosis of epithelioid mesothelioma from lung squamous cell carcinoma and/or lung adenocarcinoma. SPARC expression in mesothelioma and lung cancer cell lines was validated using reverse-transcription polymerase chain reaction, western blotting, and immunohistochemistry. Immunohistochemical staining was performed using anti-SPARC antibodies against solid epithelioid mesothelioma, solid lung adenocarcinoma, and poorly differentiated lung squamous cell carcinoma. SPARC positivity was seen in 42/45 (93.3%) of solid epithelioid mesothelioma, 2/40 (5%) solid lung adenocarcinoma, and 2/45 (4.5%) of lung squamous cell carcinomas. The sensitivity, specificity, and diagnostic accuracy for differentiating solid epithelioid mesothelioma from lung cancer (solid lung adenocarcinoma and poorly differentiated lung squamous cell carcinoma) were 93.3, 95.2, and 94.6%, respectively. In conclusion, SPARC is a novel mesothelial marker that can be used to differentiate epithelioid mesothelioma from squamous cell carcinoma and lung adenocarcinoma.
Approach to the Febrile Infant (<3 Months)
Authors: Grief Mari M. , Yamamoto Loren G.
Published: October 2023

Evaluation and management of the febrile infant has long been an area of variability. Recent guidelines were released by the American Academy of Pediatrics in August 2021 to help provide evidence-based clinical guidelines to decrease variability and improve outcomes.
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These guidelines largely focus on management and treatment guidelines for 3 age groups: 8 to 21 days, 22 to 28 days, and 29 to 60 days. The inclusion criteria for these guidelines are previously healthy, term infants born at 37 weeks gestation or later, with a temperature of 100.4°F (38°C) or higher. The most significant changes to historical practice are in the 22- to 28-day and 29- to 60-day age groups. If initial laboratory work is reassuring, patients may not need cerebrospinal fluid studies, and patients may be monitored at home or at the hospital using shared decision-making with the family.
Orbital Fractures: A New CT-Based Protocol to Guide the Surgical Approach and Reconstruction Material Decision-Making
Authors: Consorti Giuseppe , Betti Enrico , Catarzi Lisa
Published: October 2023

Preoperative computer-assisted planning and intraoperative navigation are becoming popular for orbital fracture treatment. However, not all institutions currently have access to these computer-aided applications. The authors present a simple and intuitive operative algorithm to guide orbital fracture reconstructions. The operative algorithm was based on linear measurements of orbital defects on high-resolution Computer tomography (CT) scans using specific axial, coronal, and sagittal plane images. The fractures were then divided into 3 types based on site and defect-size area. For each type, the authors suggested a surgical approach and material reconstruction.

Between February 2022 and January 2023, 57 patients were treated according to the described CT-based protocol. The quality of reconstruction was classified as ideal, satisfactory, acceptable, and poor based on postoperative CT. Diplopia, enophthalmos, and postoperative complications were assessed. Fifty-seven patients were included. Forty-four (77.2%) patients were included in the type 1 group, 4 (7.01%) in the type 2 group, and 9 (15.79%) in the type 3 group. The reconstruction was considered ideal in 54 (94.7%) cases, satisfactory in 2 (3.5%), and acceptable in 1 (1.8%). No revision surgery was required. In all cases, preoperative diplopia was settled out, and only 1 patient reported postoperative enophthalmos. No complications occurred, with good clinical results and orbital symmetry. The linear CT measurement-based protocol is a simple and reliable workflow to guide the surgeon’s choice of reconstruction material and surgical approach for primary orbital reconstruction. It allows good management of orbital trauma and could help standardize treatment decisions with an imaging technique available in all institutions.
Anatomical Study and Clinical Application of Neuroendoscopic Transfarlateral Supracerebellar Infratentorial Approach
Authors: Yan Zhengcun , Zhang Hengzhu , Wang Xiaodong , Wei Min , Wang Xingdong , Wang Guangjie
Published: October 2023

Background:

Tumors in the petroclival region have challenged neurosurgeons. However, neuroendoscopy has been increasingly applied internationally. This study simulated a pure neuroendoscopic transfarlateral supracerebellar infratentorial approach for petroclival tumor resection from the cadaveric head and discussed the advantages and safety of this approach.

Methods:

The anatomical structure for petroclival tumor resection was visualized using a pure neuroendoscopic transfarlateral supracerebellar infratentorial approach in 5 cadaveric heads. Ten cases with petroclival tumors were retrospectively analyzed and summarized between January 2020 and June 2021. All the cases had undergone surgery using a pure neuroendoscopic supracerebellar infratentorial approach.

Results:

The anatomical structure of the petroclival region was exposed using the pure neuroendoscopic supracerebellar infratentorial approach, and the partial anatomical structure of the middle skull base was further exposed by incision of the tentorium in the cadaveric head. Among the 10 cases, the tumors of 6 cases were totally removed, and those of 4 cases were subtotally removed; no cases of intracranial infection or death occurred after surgery.

Conclusion:

The neuroendoscopic transfarlateral supracerebellar infratentorial keyhole approach is a safe and effective surgical method to treat petroclival lesions and invasive middle cranial fossa lesions.