bluuebunny/crossref_metadata_2025 huggingface dataset:
The involvement of oral bacteria in inflammatory bowel disease
Authors: Xiang Bingjie , Hu Jun , Zhang Min , Zhi Min
Published: August 2024

Microorganisms play an important role in the pathogenesis of inflammatory bowel disease (IBD). The oral cavity, the second-largest microbial niche, is connected to the gastro-intestinal tract. Ectopic gut colonization by oral microbes is a signature of IBD. Current studies suggest that patients with IBD often report more oral manifestations and these oral issues are closely linked with disease activity. Murine studies have indicated that several oral microbes exacerbate intestinal inflammation. Moreover, intestinal inflammation can promote oral microbial dysbiosis and the migration of oral microbes to the gastro-intestinal tract. The reciprocal consequences of oral microbial dysbiosis and IBD, specifically through metabolic alterations, have not yet been elucidated. In this review, we summarize the relationship between oral bacteria and IBD from multiple perspectives, including clinical manifestations, microbial dysbiosis, and metabolic alterations, and find that oral pathogens increase anti-inflammatory metabolites and decrease inflammation-related metabolites.
The state of health information organizations and plans to participate in the federal exchange framework
Authors: Everson Jordan , Chang Wei , Patel Vaishali , Adler-Milstein Julia
Published: August 2024

In late 2023, the Office of the National Coordinator for Health Information Technology launched the Trusted Exchange Framework and Common Agreement (TEFCA) to enable nationwide health information exchange. Regional, local, and state health information organizations (HIOs) will be key components of nationwide exchange, and TEFCA could broaden HIOs' access to information. However, HIOs can choose whether to participate. We conducted a national survey of HIOs in 2023 to assess their plans to participate in TEFCA and broader measures of maturity. We identified 76 operational HIOs, down from 89 in 2019. These HIOs operated in 47 states and contained over 600 million patient records, indicating some duplication. Sixty-three percent of HIOs planned to participate in TEFCA, up 7 percentage points from 2019, and 32% of HIOs indicated that they did not know if they would participate. Health information organizations already engaged in exchange with other networks were more likely to plan to participate. The most common barrier (44%) was having not developed a strategic plan for TEFCA participation. While TEFCA appears to have successfully engaged the majority of HIOs, achieving nationwide exchange will require policy efforts to either attract the remaining HIOs or ensure that nonparticipating HIOs' providers have another option for TEFCA participation.
Upadacitinib for Acute Severe Ulcerative Colitis: A Systematic Review
Authors: Damianos John A , Osikoya Olufemi , Brennan Gregory
Published: August 2024

Acute severe ulcerative colitis (ASUC) remains a clinical challenge associated with considerable morbidity, including colectomy. Upadacitinib (UPA), a selective Janus kinase (JAK)-1 inhibitor, is approved for moderate-to-severe ulcerative colitis in patients intolerant or not responding to tumor necrosis factor-alpha inhibitors. It has also increasingly been used off-label for ASUC. We performed a systematic review of all available literature on UPA in ASUC. We identified 11 studies, with a pooled total of 55 patients. Most patients experienced rapid and sustained improvement. Colectomy rate at 90 days was 16.3%. Among those who did not get colectomy, 80% were in steroid-free remission at follow-up. The reported adverse events were low, including 2 venous thromboembolic events. Overall, UPA appears to represent a safe and effective therapy for ASUC.
Influence of deployment method and maintenance on efficacy of sticky card traps for Halyomorpha halys (Hemiptera: Pentatomidae)
Authors: Nixon Laura J , Acebes-Doria Angelita , Kirkpatrick Danielle , Leskey Tracy C
Published: August 2024

Halyomorpha halys (Stål) (Hemiptera: Pentatomidae) is an invasive pest which feeds on numerous economically significant crops. Many integrated pest management strategies for this species rely on effective season-long monitoring for H. halys populations, including attract-and-kill and threshold-based insecticide sprays. Previous studies have shown that a black pyramid trap effectively captures all mobile life stages of H. halys, however, these bulky, ground-deployed traps can be impractical in active orchard rows. Clear sticky cards have been used as a more practical tool for monitoring when paired with the H. halys aggregation pheromone and synergist. Here, the efficacy of deploying single- or double-sided sticky cards hanging in trees or deployed on wooden stakes was compared to standard black pyramid traps over 2 years. The efficacy of single-sided sticky cards deployed on wooden stakes was also evaluated after occlusion of 25%, 50%, or 75% of the surface area by 2D inert materials and 3D organic matter. Single-sided sticky cards were also exposed to simulated sunlight and rainfall for 0, 4, 8, and 12 wk before deployment on wooden stakes. Captures of H. halys adults using sticky cards deployed on wooden stakes were comparable to pyramid traps. Occlusion of cards by 25% or more of any material type led to a decrease in H. halys captures, however, weathering did not influence capture. These data show that clear sticky cards deployed on wooden stakes are effective for season-long monitoring of H. halys in apple orchards, and card replacement should be driven by maintenance of cleanliness.
The Ongwen Case at the International Criminal Court as a Test of the Court’s Outreach Programming in Northern Uganda
Authors: Jjuuko Dennis , Opio Francis
Published: August 2024

The International Criminal Court’s outreach office remains a central pillar to the legitimacy and relevance of the Court’s activities aimed towards victims’ constituencies. However, the Court’s outreach programmes in the Ongwen case are constrained by a communication strategy used in the context of a fledgling communication infrastructure in northern Uganda. We rely on primary qualitative interviews with victims of Ongwen’s atrocities at Lukodi, Pajule, and Odek to reflect on the need for contextualized outreach activities that are responsive to the needs of victims of the Lord’s Resistance Army insurgency.
Lessons learned from the Sexual Medicine Society of North America fellowship bootcamp
Authors: Köhler Tobias S , Bonakdar Hashemi Milad , Helo Sevann , Morey Allen F , Nelson Christian J , Trost Landon , Ziegelmann Matthew J , Khera Mohit
Published: August 2024

Background

Sexual Medicine Society of North America (SMSNA) fellowships offer variable experience in sexual health domains: erectile dysfunction, Peyronie’s disease, male infertility, male hypogonadism (low testosterone), reconstruction (including male incontinence), benign prostatic hyperplasia, gender affirmation surgery, sexual mental health, and female sexual dysfunction.

Aim

To evaluate baseline and postbootcamp understanding and trust in these domains.

Methods

In 2023, 28 of 31 urologists currently enrolled in SMSNA-endorsed fellowships participated in a 3.5-day training bootcamp in Minneapolis, Minnesota. Participants were asked to complete pre- and postbootcamp surveys. The bootcamp curriculum offered American Urological Association guidelines and case-based lectures, hands-on clinical training with cadavers (penile surgery) and models (collagenase training), and interaction with industry.

Outcomes

Changes in knowledge, independence, and trust in performing the procedures, as well as billing issues and feedback for future bootcamps.

Results

Prebootcamp surveys revealed vastly varied residency experience. Reported time with an expert faculty member was greatest for benign prostatic hyperplasia and least for female sexual dysfunction, gender affirmation surgery, and low testosterone. The lowest prebootcamp confidence in performing surgery independently was for penile grafting procedures and elevating the neurovascular bundle. Postbootcamp results revealed several areas of significant improvement in confidence (P ≤ .03): intralesional injections for Peyronie’s disease, manual modeling, penile plication, penile grafting procedures, and elevating the neurovascular bundle. There was a trend for improved confidence with the insertion of inflatable (P = .05) and semirigid (P = .08) penile prostheses. Nonsignificant improvement occurred in artificial urinary sphincter surgery (P = .12). Participants graded the bootcamp very highly and requested that next year’s bootcamp have more content on female sexual dysfunction, male incontinence, and low testosterone, as well as more hands-on skills sessions and case-based lecture formats.

Clinical Implications

Offering a bootcamp with hands-on instruction could significantly improve urologists’ knowledge and confidence.

Strengths and Limitations

As the main strength, this study was the first specialized bootcamp for urologists in the subject of men’s health, taking into account hands-on and cadaver laboratories, as well as highlighting industrial and pharmaceutical products. The small sample size was the major limitation.

Conclusions

Current SMSNA fellows present with varied levels of experience and confidence across sexual health domains. Notable confidence improvements were seen with topics that combined didactic lectures with hands-on trainings.
Impact of Hepatitis B Virus Point-of-care DNA Viral Load Testing Compared With Laboratory-based Standard-of-care Approaches on Uptake of HBV Viral Load Testing, Treatment, and Turnaround Times: A Systematic Review and Meta-analysis
Authors: Gu Shuqin , Tao Yusha , Fan Chengxin , Dai Yifan , Li Feifei , Conklin Jamie L , Tucker Joseph D , Chou Roger , Moody M Anthony , Easterbrook Philippa , Tang Weiming
Published: August 2024

Background

Point-of-care (PoC) hepatitis B virus (HBV) DNA viral load (VL) assays represent an alternative to laboratory-based standard-of-care (SoC) VL assays to accelerate diagnosis and treatment. We evaluated the impact of using PoC versus SoC approaches on the uptake of VL testing, treatment, and turnaround times from testing to treatment across the HBV care cascade.

Methods

We searched 5 databases, 6 conference websites, and contacted manufacturers for unpublished reports, for articles with or without a comparator (SoC VL testing), and had data on the uptake of VL testing, treatment, or turnaround times between hepatitis B surface antigen (HBsAg) testing, VL testing, and treatment in the cascade. We performed a random-effects meta-analysis on rates of VL testing and treatment initiation.

Results

Six studies, composing 9 arms, were included. Three PoC arms reported less than 1 day between screening for HBsAg positivity and VL testing, and the other one (2 arms) reported it between 7 and 11 days. Five arms reported the time to available VL test results (<1 day). Three studies reported 1–8 days between VL testing results and treatment initiation. Two studies reported the turnaround times between a positive HBsAg screening and treatment initiation (the same day and 27 days). Overall, 84.1% of those with HBsAg positivity were tested for DNA VL and 88.3% of eligible people initiated treatment.

Conclusions

HBV PoC DNA testing appears to be associated with a turnaround time of <1 day for receipt of VL results and appears associated with high rates of DNA testing and initiation of treatment among those eligible.

Clinical Trials Registration

PROSPERO CRD42023398440.
Clinical trial results: each patient’s participation should count
Authors: Figg William D , Bates Susan E
Published: August 2024

This editorial addresses concerns about published clinical trial results of a study on homeopathic treatment for non–small cell lung cancer.
Genotypic and Phenotypic Analyses Show Ralstonia solanacearum Cool Virulence Is a Quantitative Trait Not Restricted to “Race 3 Biovar 2”
Authors: Dewberry Ronnie J. , Sharma Parul , Prom Jessica L. , Kinscherf Noah A. , Lowe-Power Tiffany , Mazloom Reza , Zhang Xuemei , Liu Haijie , Arif Mohammad , Stulberg Michael , Heath Lenwood S. , Eversole Kellye , Beattie Gwyn A. , Vinatzer Boris A. , Allen Caitilyn
Published: August 2024

Most Ralstonia solanacearum species complex strains cause bacterial wilts in tropical or subtropical zones, but the group known as race 3 biovar 2 (R3bv2) is cool virulent and causes potato brown rot at lower temperatures. R3bv2 has invaded potato-growing regions around the world but is not established in the United States. Phylogenetically, R3bv2 corresponds to a subset of the R. solanacearum phylotype IIB clade, but little is known about the distribution of the cool virulence phenotype within phylotype IIB. Therefore, genomes of 76 potentially cool virulent phylotype IIB strains and 30 public genomes were phylogenetically analyzed. A single clonal lineage within the sequevar 1 subclade of phylotype IIB that originated in South America has caused nearly all brown rot outbreaks worldwide. To correlate genotypes with relevant phenotypes, we quantified virulence of 10 Ralstonia strains on tomato and potato at both 22 and 28°C. Cool virulence on tomato did not predict cool virulence on potato. We found that cool virulence is a quantitative trait. Strains in the sequevar 1 pandemic clonal lineage caused the most disease, whereas other R3bv2 strains were only moderately cool virulent. However, some non-R3bv2 strains were highly cool virulent and aggressively colonized potato tubers. Thus, cool virulence is not consistently correlated with strains historically classified as the R3bv2 group. To aid in the detection of sequevar 1 strains, this group was genomically delimited in the LINbase web server, and a sequevar 1 diagnostic primer pair was developed and validated. We discuss implications of these results for the R3bv2 definition.
Melatonin alleviates hyperoxia‐induced lung injury through elevating MSC exosomal miR‐18a‐5p expression to repress PUM2 signaling
Authors: Zou Dongmei , Liao Jinwen , Xiao Min , Liu Liang , Xu Mingguo
Published: August 2024

Mesenchymal stem cells (MSC)‐derived exosomes (Exo) are a possible option for hyperoxia‐induced lung injury (HLI). We wanted to see if melatonin (MT)‐pretreated MSC‐derived exosomes (MT‐Exo) were more effective against HLI, and we also tried to figure out the underlying mechanism. HLI models were established by hyperoxia exposure. HE staining was adopted to analyze lung pathological changes. MTT and flow cytometry were used to determine cell viability and apoptosis, respectively. The mitochondrial membrane potential (MMP) was analyzed using the JC‐1 probe. LDH, ROS, SOD, and GSH‐Px levels were examined by the corresponding kits. The interactions between miR‐18a‐5p, PUM2, and DUB3 were analyzed by molecular interaction experiments. MT‐Exo could effectively inhibit hyperoxia‐induced oxidative stress, inflammatory injury, and apoptosis in lung epithelial cells, while these effects of MT‐Exo were weakened by miR‐18a‐5p knockdown in MSCs. miR‐18a‐5p reduced PUM2 expression in MLE‐12 cells by directly targeting PUM2. In addition, PUM2 inactivated the Nrf2/HO‐1 signaling pathway by promoting DUB3 mRNA decay post‐transcriptionally. As expected, PUM2 overexpression or DUB3 knockdown abolished the protective effect of MT‐Exo on hyperoxia‐induced lung epithelial cell injury. MT‐Exo carrying miR‐18a‐5p reduced hyperoxia‐mediated lung injury in mice through activating Nrf2/HO‐1 pathway. MT reduced PUM2 expression and subsequently activated the DUB3/Nrf2/HO‐1 signal axis by increasing miR‐18a‐5p expression in MSC‐derived exosomes to alleviate HLI.
‘Forever Chemicals’ in Water Supply More Widespread Than Previously Thought
Authors: Roush Karen
Published: August 2024

The compounds are associated with numerous health risks.
New Report Highlights the Impact of Long COVID
Authors: Roush Karen
Published: August 2024

Debilitating symptoms, affecting multiple organ systems, can last years.
Florida Becomes the First State to Allow Cesarean Deliveries Outside of Hospitals
Authors: Roush Karen
Published: August 2024

The new law has raised alarm among maternal health experts.
Better Outcomes with Pulmonologist-Directed Care of Asthma or COPD
Authors: Rosenberg Karen
Published: August 2024

According to this study:
Two Hormonal Therapies for Endometriosis-Related Pain Have Similar Results
Authors: Rosenberg Karen
Published: August 2024

According to this study:
School refusal
Authors: Heuer Beth
Published: August 2024

School refusal refers to child- or adolescent-motivated refusal to attend school or remain in school for the duration of the school day. Importantly, the child or adolescent does not conceal their absence from school from their caregivers. Root causes for school refusal include anxiety, mood disorders, untreated learning disorders, and social difficulties. Long-term outcomes of school refusal include further social withdrawal, ongoing mental health issues, and unemployment. This article reviews the differences between school refusal and other types of chronic absenteeism, and it describes behaviors that may manifest in a child or adolescent who avoids attending school. The primary care provider's role in evaluation and treatment of this population is discussed.
NP student knowledge and perceptions of medical marijuana
Authors: Cassone Clark , Rissmiller Patricia
Published: August 2024

Objective:

This study aimed to measure NP students' knowledge and perception of medical marijuana (MM) and determine whether they need additional education on the topic.

Methods:

A cross-sectional, descriptive study was implemented. NP students were asked to complete a survey that assessed their knowledge of MM, including adverse reactions and medical indications. Perceptions of recreational marijuana and MM were assessed through a 5-point Likert-scale questionnaire.

Results:

Of the 230 NP students who completed all or part of the questionnaire, 115 met inclusion criteria and were included in results. Most students (94%) felt that MM should be legalized in all US states. Likewise, 97% felt that MM education should be included in NP program curricula; however, only 30% reported receiving in-depth education on the topic. Participants were asked to identify, among 18 provided medical conditions, those which were approved indications for MM use; accurate response rate was low, though cancer, pain, cachexia, nausea/vomiting, posttraumatic stress disorder, and epilepsy were identified correctly as indications by more than half of participants. Previous MM use and religious affiliation had an impact on knowledge and perceptions of MM.

Conclusion:

With an increasing number of states legalizing MM, NP programs must evaluate their current curricula and integrate content that addresses the gap in knowledge of MM mechanism of action, indications, and adverse reactions.
Factor Eight Inhibitor Bypass Activity Use in Cardiac Surgery: A Propensity-matched Analysis of Safety Outcomes
Authors: Nicholas Joshua A. , Harrison Natasha , Chakraborty Dipro , Chang Alan L. , Aghaeepour Nima , Wirtz Katherine , Nielson Elaina , Parsons Cody , Jackson Ethan , Panigrahi Anil K.
Published: August 2024

Background:

Bleeding during cardiac surgery may be refractory to standard interventions. Off-label use of factor eight inhibitor bypass activity (FEIBA) has been described to treat such bleeding. However, reports of safety, particularly thromboembolic outcomes, show mixed results, and reported cohorts have been small.

Methods:

Adult patients undergoing cardiac surgery on cardiopulmonary bypass between July 1, 2018, and June 30, 2023, at Stanford Hospital (Stanford, California) were reviewed (n = 3,335). Patients who received FEIBA to treat postcardiopulmonary bypass bleeding were matched with those who did not by propensity scores in a 1:1 ratio using nearest neighbor matching (n = 352 per group). The primary outcome was a composite outcome of thromboembolic complications including any one of deep vein thrombosis, pulmonary embolism, unplanned coronary artery intervention, ischemic stroke, and acute limb ischemia, in the postoperative period. Secondary outcomes included renal failure, reoperation, postoperative transfusion, intensive care unit length of stay, and 30-day mortality.

Results:

A total of 704 encounters was included in this propensity-matched analysis. The mean dose of FEIBA administered was 7.3 ± 5.5 U/kg. In propensity-matched multivariate logistic regression models, there was no statistically significant difference in odds ratios for thromboembolic outcomes, intensive care unit length of stay, or mortality. Patients who received more than 750 U FEIBA had an increased odds ratio for acute renal failure (odds ratio, 4.14; 95% CI, 1.61 to 10.36; P < 0.001). In multivariate linear regression, patients receiving FEIBA were transfused more plasma and cryoprecipitate postoperatively. However, only the dose range of 501 to 750 U was associated with an increase in transfusion of erythrocytes (β, 2.73; 95% CI, 0.68 to 4.78; P = 0.009) and platelets (β, 1.74; 95% CI, 0.85 to 2.63; P < 0.001).

Conclusions:

Low-dose FEIBA administration during cardiac surgery does not increase risk of thromboembolic events, intensive care unit length of stay, or mortality in a propensity-matched cohort. Higher doses were associated with increased acute renal failure and postoperative transfusion. Further studies are required to establish the efficacy of activated factor concentrates to treat refractory bleeding during cardiac surgery.
Population screening for cirrhosis
Authors: Thiele Maja , Pose Elisa , Juanola Adrià , Mellinger Jessica , Ginès Pere
Published: August 2024

In response to the growing health crisis of liver-related morbidity and mortality, screening for liver cirrhosis has emerged as a promising strategy for early detection and timely intervention. By identifying individuals with severe fibrosis or compensated cirrhosis, screening holds the promise of enhancing treatment outcomes, delaying disease progression, and ultimately improving the quality of life of affected individuals. Clinical practice guidelines from international scientific societies currently recommend targeted screening strategies, investigating high-risk populations with known risk factors of liver disease. While there is good evidence that screening increases case finding in the population, and a growing number of studies indicate that screening may motivate beneficial lifestyle changes in patients with steatotic liver disease, there are major gaps in knowledge in need of clarification before screening programs of cirrhosis are implemented. Foremost, randomized trials are needed to ensure that screening leads to improved liver-related morbidity and mortality. If not, screening for cirrhosis could be unethical due to overdiagnosis, overtreatment, increased health care costs, negative psychological consequences of screening, and futile invasive investigations. Moreover, the tests used for screening need to be optimized toward lower false positive rates than the currently used FIB-4 while retaining few false negatives. Finally, barriers to adherence to screening and implementation of screening programs need to be elucidated. This review provides a comprehensive overview of the current landscape of screening strategies for liver cirrhosis and the promises and pitfalls of current methods for early cirrhosis detection.
Impact of VO2peak on the Clinical Outcomes of Older Patients With Coronary Heart Disease in China
Authors: Zhang Ying-Yue , Liu Xiao-Li , Hu Xin , Hu Rong , Xu Yong , Ma Jing
Published: August 2024

Purpose:

The aim of this study was to explore the role of cardiopulmonary exercise test parameters, especially peak oxygen uptake (VO2peak), in predicting the incidence of adverse cardiovascular events in older Chinese patients with coronary heart disease (CHD).

Methods:

Older patients with CHD who underwent cycle ergometer cardiopulmonary exercise test at the Cardiac Rehabilitation Clinic of Chinese PLA General Hospital from July 1, 2015 to January 31, 2020 were enrolled. The follow-up intervals were 6 mo. Cox regression was used to analyze the relationship between VO2peak and adverse cardiovascular events. Restricted cubic splines and subgroup analyses were used to observe the relationship between VO2peak and the hazard ratio (HR) of the primary end point event (PEE), which included a composite of all-cause death, nonfatal recurrent myocardial infarction, unscheduled revascularization, and stroke. The composite end point event was the PEE combined with cardiac rehospitalization.

Results:

A total of 1223 participants (mean age 68 ± 5 yr) were included. Median follow-up was 68 mo. Mean VO2peak was 16.5 ± 4.0 mL/kg/min, and VO2peak was an independent predictor of the PEE (HR = 0.929; 95% CI, 0.891-0.970; P = .001). This association was further validated by restricted cubic spline and subgroup analyses. Peak oxygen uptake was also an independent risk factor for the composite end point event (HR = 0.968; 95% CI, 0.941-0.996; P = .025).

Conclusion:

In conclusion, VO2peak is an independent risk factor for adverse cardiovascular events in older Chinese patients with CHD, and more optimal therapy should be recommended to patients with lower VO2peak.
Emergency Surgery in a Large Urban Area Community Hospital During SARS-CoV-2 Pandemic: An Analysis on Acute Appendicitis
Authors: Mazzoni Gianluca , Liotta Gianluca , Lepre Luca , Leonardo Giacomo , Tognoni Valeria , Campa Rossella D. , Fransvea Pietro , Costa Gianluca
Published: August 2024

Background:

The literature highlights a decrease in surgical treated appendicitis with an increased severity during the COVID-19 pandemic. The aim of this study was to analyze the effect of COVID lockdown on the population with appendicitis comparing clinical-pathologic data and outcome in two matching period (prepandemic and pandemic era).

Methods:

A retrospective analysis of patients admitted to two community urban hospital in Rome with diagnosis of acute appendicitis (AA) before and after the COVID-19 pandemic was performed. We compared patients patients with acute appendicitis in three groups named A (pre-COVID), B (early pandemic), and C (late pandemic). We evaluate the differences between the three groups in terms of onset of symptoms and severity, procedure difficulty, conversion rate, and short-term outcome.

Results:

A total of 310 patients were identified. The time interval from onset of symptoms to arrival in the emergency department was significantly longer in both pandemic group; there was also a significantly longer time to surgery comparing to group A. The risk of complicated AA was higher in both pandemic groups. A significantly higher grade of difficulty was detected in both COVID-groups. However, no differences were observed in conversion rate. Postoperative complications rate showed no significant difference among all three groups. No patients was tested positive for SARS-CoV-2 postoperatively.

Conclusion:

AA treatment was comparable to pre-COVID period in-hospital presurgery stay and early postoperative outcome. With an accurate respect of pandemic protocol is possible to maintain a high and safe standard of care for patients with acute appendicitis.
Laparoscopic treatment of small bowel incarceration and perforated appendix within right-sided spigelian hernia: case report and review of the literature
Authors: Tufo Andrea , Marte Gianpaolo , Guida Francesco , Travaglino Angela , Fortunato Armellino Mariano
Published: August 2024

Spigelian hernia is a rare disease and a quarter of the patients present with incarceration or strangulation of the hernia content and require emergency surgery. We report a case of an elderly obese woman with comorbidity presented with abdominal pain and right flank palpable mass. The contrast enhanced computer tomography showed bowel incarceration within right side spigelian hernia. Only at laparoscopic exploration a diagnosis of appendicitis within spigelian hernia was made and the patient underwent laparoscopic appendicectomy and open debridement of the abscess with primary closure of the defect. The postoperative stay was uneventful. Few cases of appendicitis within spigelian hernia have been reported in literature and, as in our case, the diagnosis is usually difficult and laparoscopy has a key role in the diagnosis and treatment of those patients also in emergency setting. Early repair decreases the rate of morbidity related to this condition.
SPARING VERSUS REMOVAL OF EPIRETINAL PROLIFERATION IN THE SURGICAL REPAIR OF FULL-THICKNESS MACULAR HOLES
Authors: Fukushima Masaki , Tsuboi Kotaro , Akai Ryota , Ishida Yuichiro , Kusaka Shunji , Kamei Motohiro , Hayashi Atsushi , Wakabayashi Taku
Published: August 2024

Purpose:

To evaluate the efficacy of vitrectomy with epiretinal proliferation (EP) sparing for full-thickness macular hole accompanied by EP.

Methods:

A multicenter, retrospective study. Eyes were divided into two groups: the sparing group (Group S) included eyes in which the EP around the hole was peeled and preserved, whereas the removal group (Group R) included eyes in which the EP was partially or completely removed. The internal limiting membrane was peeling in all eyes.

Results:

Forty-six eyes were included. Twenty-five eyes were in Group S, and 21 eyes were in Group R, with no difference in preoperative best-corrected visual acuity (BCVA) (P = 0.96). After primary surgery, macular holes were closed in all eyes, and there were no complications in either group. Postoperative 12-month BCVA significantly improved in both groups (both P < 0.01), while Group S had better 12-month BCVA than Group R (P = 0.016). In the multivariable analysis, EP sparing was associated with better BCVA at 12 months (P = 0.006) after accounting for the minimal macular hole size and preoperative BCVA.

Conclusion:

Epiretinal proliferation sparing and removal were both safe and effective techniques, while EP sparing may provide a favorable outcome for eyes with full-thickness macular hole and EP.
Regional Summed Corneal Refractive Power Changes in Myopic Orthokeratology and Their Relationships With Axial Elongation
Authors: Zhang Hening , Li Hui , Zou Zongyin , Yang Jing , Zhou Sheng
Published: August 2024

Purpose:

To determine the relationship between regional summed corneal refractive power changes (CRPCs) in myopic orthokeratology and axial elongation.

Design:

This retrospective study included 70 eyes of 70 patients aged 8 years to 13 years who underwent orthokeratology lens (OK lens) treatment, and all patients underwent regular follow-ups at 1 week, 1 month, 6 months, and 12 months at Zhongshan Ophthalmic Center between January 2019 and May 2021.

Methods:

Axial length (AL) was measured at baseline and 12 months by an IOLmaster 5.0. Refractive error power was measured using cycloplegia. Regional summed CRPCs were calculated by MATLAB software using difference tangential power maps at the sixth month acquired by corneal topography measurements (Medmont E300 Corneal Topographer; Medmont Pty, Victoria, Australia) and defined as changes in corneal refractive power at the sixth month from baseline. The regional summed CRPCs were then subdivided into 4-mm diameter circles, 4- to 5-mm diameter chords, and 5- to 6-mm diameter chords according to the distance from the central of the pupil and into negative, positive, and total according to the values. Pearson correlation, multiple linear regression analysis, and stepwise multiple linear regression analysis were performed to analyze the relationships among these parameters.

Results:

Axial elongation had a negative relationship with positive regional summed corneal refractive power in the central 4-mm diameter circle and age (r=−0.282, P=0.018; r=−0.473, P<0.001, respectively) and a positive relationship with negative regional summed corneal refractive power in the 5- to 6-mm diameter chord (r=0.361, P=0.002). Stepwise multiple linear regression analysis identified age (standardized β=−0.434, P<0.001) and negative regional summed corneal refractive power in the 5- to 6-mm diameter chord (standardized β=0.305, P=0.004) as factors influencing AL elongation.

Conclusion:

Negative regional summed corneal refractive power in a 5- to 6-mm diameter chord after OK lens treatment may be an important index for evaluating the control effects of axial elongation.
Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert III esophagogastric junction cancer and upper and middle third gastric cancer
Authors: Wang Juan , Liu Shushang , Chen Haixiang , Luo Jialin , Xu Guanghui , Feng Xiangying , Yang Xuewen , Yang Jianjun , Gang Ji
Published: August 2024

Background:

This study aimed to compare the efficacy and safety of TLTG with the overlap technique to LATG in patients with advanced Siewert III Esophagogastric Junction Cancer and upper and middle third gastric cancer.

Methods:

This single-center RCT enrolled 292 patients with the mentioned cancers, randomly assigned to TLTG overlap (n=146) or LATG (n=146) groups. Data on demographics, pathology, intraoperative variables, postoperative complications, recovery parameters, and 3-year survival were collected. Main outcome: postoperative complications within 30 days. Secondary outcomes: 3-year disease-free and overall survival.

Results:

TLTG versus LATG: TLTG had shorter incision, faster flatus/defecation, reduced analgesia, less opioid use, and shorter hospital stay. Similar operation time, anastomosis time, blood loss, and lymph node harvest. TLTG had a lower overall post-op complication rate (P=0.047) and no significant difference in serious complications (P=0.310). Variances in anastomotic stenosis occurrence at 3 months. No rehospitalization or mortality at 30 days. No significant differences in 3-month disease-free survival (P=0.058) or overall survival (P=0.236).

Conclusion:

The overlap method for anastomosis in TLTG is safe and feasible for advanced middle-upper-third gastric cancer, with positive short-term outcomes. This technique has the potential to be the preferred esophagojejunostomy approach in TLTG.

Trial registration:

This trial has been registered at Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: 4 September 2019).
Exploring Colorectal Cancer Screening Reach Among United States Veterans: Analyzing Clinical, Sociodemographic, and Social Determinants of Health-Based Patient Factors Across Screening Methods
Authors: Malani Kanika , Loscalzo Kirsten , Elfanagely Yousef , Promrat Kittichai
Published: August 2024

Introduction:

Mailed fecal immunochemical testing (mFIT), in-clinic FIT (cFIT), and colonoscopy are believed to reach distinct patient populations. This study aims to evaluate this belief.

Methods:

Sociodemographic, clinical, and social determinants of health (SDOH) characteristics of 201 patients completing mFIT, 203 patients completing cFIT, and 74 patients completing colonoscopy at a Northeastern United States Veterans Affairs center from August 2023 to January 2024 were compared using descriptive statistics, χ2, and ANOVA tests.

Results:

Patients completing mFIT (P=0.003) and cFIT (P=0.001) were older than those completing colonoscopy. mFIT patients had more private health insurance as compared with cFIT (P<0.0001) patients. Patients completing colonoscopy had higher average disability ratings as compared with cFIT patients (P<0.0001). mFIT (P<0.0001) and colonoscopy (P<0.0001) patients had more time elapsed since their last primary care visit as compared with cFIT patients. mFIT patients had lower rates of mental health disorders as compared with colonoscopy (P<0.0001) and cFIT (P<0.0001) patients. cFIT patients had higher rates of past stool test use as compared with mFIT (P<0.0001) and colonoscopy (P<0.0001) patients. mFIT patients had lower rates of past colonoscopy completion as compared with cFIT (P<0.0001) and colonoscopy (P<0.0001) patients. There were no significant differences in SDOH domains among patients completing each of the screening methods.

Conclusion:

While each of the screening methods reaches a different patient population, mFIT does not reach a substantially more vulnerable population compared with cFIT and colonoscopy, highlighting the need for improvements in mFIT outreach.
Patterns of Growth of Tumors in Li-Fraumeni Syndrome by Imaging: A Case Series
Authors: Azma Roxana , Arenos-Abril Jesus , Junhasavasdiku Thitiporn , Tewattanarat Nipaporn , Nourmohammad Armin , Abadeh Armin , Panwar Sanuj , Villani Anita , Malkin David , Doria Andrea S.
Published: August 2024

Although tumors of Li-Fraumeni syndrome (LFS) have a premalignant or dormant phase that could be exploited by early imaging detection, this has been underevaluated in the literature. We present a case series of patients with LFS followed by imaging over time to highlight patterns of growth of tumors and hotspots of missed tumors in this population. Clinical and imaging features were available for 29 tumors of 24 carriers of a germline TP53 pathogenic variant, developed between 1999 and 2023 were retrospectively reviewed in a single tertiary pediatric center. Imaging characteristics of tumors were evaluated with MRI, CT, and radiographs. Local invasion, time interval for developing primary cancer, and/or recurrent disease and metastasis, and factors that delayed the tumor diagnosis were assessed. In patients with multiple tumors the median time intervals for development of first, second, and third primary cancers were 45.9, 79.8, and 28.1 months, respectively. Hotspots of missed tumors included superficial soft tissues, areas close to bones, on the scalp, in tissues around the adrenal region and in small hypodense lesions on brain CT. In conclusion, the pattern of growth of tumors is variable and erratic in LFS patients with some tumors presenting with a dormant pattern.
STEP–organizing a major project to tackle significant uncertainty
Authors: Methven P.
Published: August 2024

This article describes why Spherical Tokamak for Energy Production (STEP) has been launched, what it aims to achieve (benefits) and, principally, how the whole programme will be delivered (strategy). The article draws on the work of major project delivery and organization design (OD) and applies this to the context of STEP, which is dominated by significant uncertainty in all dimensions (technical, financial, commercial and programmatic), where there is embryonic delivery capability, but where there are also global-scale opportunities. This leads to an approach based on securing and organizing the correct capability from both public and private sectors to work in a collaborative arrangement with a single purpose and, critically, in an operating model designed to manage uncertainty and emerging risks and to exploit opportunities. Placing adaptability at the core of the OD, particularly the ability to deliver emergent strategy through guided empowerment in pursuit of an ambitious aim, is a further development beyond much of the current thinking in major projects. The article concludes with an appendix that translates that programme approach into principles for managing the engineering design work.

This article is part of the theme issue ‘Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)’.
Plasma burn—mind the gap
Authors: Meyer Hendrik ,   on behalf of the STEP Plasma Team
Published: August 2024

The programme to design plasma scenarios for the Spherical Tokamak for Energy Production (STEP), a reactor concept aiming at net electricity production, seeks to exploit the inherent advantages of the spherical tokamak (ST) while making conservative assumptions about plasma performance. This approach is motivated by the large gap between present-day STs and future burning plasmas based on this concept. It is concluded that plasma exhaust in such a device is most likely to be manageable in a double null (DN) configuration, and that high core performance is favoured by positive triangularity (PT) plasmas with an elevated central safety factor. Based on a full technical and physics assessment of external heating and current drive (CD) systems, it was decided that the external CD is provided most effectively by microwaves. Operation with active resistive wall mode (RWM) stabilization as well as high elongation is needed for the most compact solution. The gap between existing devices and STEP is most pronounced in the area of core transport, owing to high normalized plasma pressure in the latter which changes qualitatively the nature of the turbulence controlling transport. Plugging this gap will require dedicated experiments, particularly on high-performance STs, and the development of reduced models that faithfully represent turbulent transport at high normalized pressure. Plasma scenarios in STEP will also need to be such that edge localized modes (ELMs) either do not occur or are small enough to be compatible with material lifetime limits. The high current needed for a power plant-relevant plasma leads to the unavoidable generation of high runaway electron beam current during a disruption, where novel mitigation techniques may be needed.

This article is part of the theme issue ‘Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)’.
The magnetic cage
Authors: Nasr E. , Wimbush S. C. , Noonan P. , Harris P. , Gowland R. , Petrov A.
Published: August 2024

The Spherical Tokamak for Energy Production (STEP) requires high-field magnet designs and has therefore adopted the REBCO-based high-temperature superconductor (HTS) as its current carrier. The HTS enables the toroidal field (TF) coils to be remountable, which unlocks STEP’s vertical maintenance approach; however, remountable joints, approximately 18 GJ of stored energy and limited space down the centre of a spherical tokamak, make the TF coils the most challenging. STEP has pursued a passive approach to TF coil quench protection in order to limit coil terminal voltage. Initial results suggest that a solution may rely on tuning internal coil resistance coupled with actively powered heaters. The pre-conceptual inter-coil structure demonstrates acceptable stresses and deflections under steady-state operating conditions and preliminary fault scenarios, and loads are distributed to limit the tensile force on the TF centre rod. Finally, the HTS must operate reliably in a high radiation environment and endure high neutron fluences, ensuring commercially relevant magnet lifetimes. Initial experiments indicate that instantaneous gamma irradiation of HTS has no negative impact on current carrying capacity. Experimental programmes are underway to cold irradiate HTS to fusion-relevant fluences and to develop a method of assuring tape irradiation tolerance using oxygen ions as an analogue for neutrons.

This article is part of the theme issue ‘Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)’.
Optimizing the cost of the STEP programme
Authors: Lux Hanni , Brown Chris , Butcher Matthew , Chapman Rhian , Foster Jack , Nawal Nousheen
Published: August 2024

The Spherical Tokamak for Energy Production (STEP) programme is a world-leading fusion power plant programme that has embedded a cost conscience in its design from the early phases. This firmly addresses the attitude of cost complacency of which many major infrastructure projects have historically been accused. While a detailed and highly accurate whole life cycle cost analysis is not possible, or even valuable, during the conceptual design stage, this early design phase is still the most critical programme phase where a focus on costs can drive longer term reductions and impact whole life cycle costs at the high level. Consequently, appropriate estimating methods for these early-stage designs and lessons learned from other industries are used to inform design decisions and ensure cost is part of the overall option analysis. Hence, while the overall programme cost estimate is too immature to be a reliable indicator for the final programme costs, significant effort has been undertaken to understand the major cost drivers and take action to make the STEP design as cost-effective as possible.

This article is part of the theme issue ‘Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)’.
Genetics of posttraumatic stress disorder and cardiovascular conditions using Life’s Essential 8, Electronic Health Records, and Heart Imaging
Authors: Shen Jie , Valentim Wander , Friligkou Eleni , Overstreet Cassie , Choi Karmel , Koller Dora , O’Donnell Christopher J. , Stein Murray B. , Gelernter Joel ,   Posttraumatic Stress Disorder Working Group of the Psychiatric Genomics Consortium, Lv Haitao , Sun Ling , Falcone Guido J. , Polimanti Renato , Pathak Gita A.
Published: August 2024

BACKGROUND

Patients with post-traumatic stress disorder (PTSD) experience higher risk of adverse cardiovascular (CV) outcomes. This study explores shared loci, and genes between PTSD and CV conditions from three major domains: CV diagnoses from electronic health records (CV-EHR), cardiac and aortic imaging, and CV health behaviors defined in Life’s Essential 8 (LE8).

METHODS

We used genome-wide association study (GWAS) of PTSD (N=1,222,882), 246 CV diagnoses based on EHR data from Million Veteran Program (MVP; N=458,061), UK Biobank (UKBB; N=420,531), 82 cardiac and aortic imaging traits (N=26,893), and GWAS of traits defined in the LE8 (N = 282,271 ∼ 1,320,016). Shared loci between PTSD and CV conditions were identified using local genetic correlations (rg), and colocalization (shared causal variants). Overlapping genes between PTSD and CV conditions were identified from genetically regulated proteome expression in brain and blood tissues, and subsequently tested to identify functional pathways and gene-drug targets. Epidemiological replication of EHR-CV diagnoses was performed in AllofUS cohort (AoU; N=249,906).

RESULTS

Among the 76 PTSD-susceptibility risk loci, 33 loci exhibited local rg with 45 CV-EHR traits (|rg|≥0.4), four loci with eight heart imaging traits(|rg|≥0.5), and 44 loci with LE8 factors (|rg|≥0.36) in MVP. Among significantly correlated loci, we found shared causal variants (colocalization probability > 80%) between PTSD and 17 CV-EHR (in MVP) at 11 loci in MVP, that also replicated in UKBB and/or other cohorts. Of the 17 traits, the observational analysis in the AoU showed PTSD was associated with 13 CV-EHR traits after accounting for socioeconomic factors and depression diagnosis. PTSD colocalized with eight heart imaging traits on 2 loci and with LE8 factors on 31 loci. Leveraging blood and brain proteome expression, we found 33 and 122 genes, respectively, shared between PTSD and CVD. Blood proteome genes were related to neuronal and immune processes, while the brain proteome genes converged on metabolic and calcium-modulating pathways (FDR p <0.05). Drug repurposing analysis highlightedDRD2, NOS1, GFAP, and PORas common targets of psychiatric and CV drugs.

CONCLUSION

PTSD-CV comorbidities exhibit shared risk loci, and genes involved in tissue-specific regulatory mechanisms.