bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Learning and Culture in Monkeys
Authors: van de Waal Erica , Canteloup Charlotte
Published: November 2023

The first report of cultural behaviour in primates—potato-washing described in Japanese macaques—was the starter point for 70 years of investigation of social learning in wild animals and has laid the foundations of animal culture studies. This chapter reviews key findings now accumulated for many different monkey species and using a wide array of methodologies including observations in the wild, controlled experiments in captivity, and field experiments. Both observational and experimental approaches highlight the existence of technical, feeding, and social traditions in monkeys. Recent advances in modelling techniques enable a better understanding of when social learning is used and if the pathways of transmission follow specific biases such as payoff bias, conformity, or learning from specific group members like higher-ranked or successful individuals. Technologies including environmental DNA metabarcoding, GPS loggers and artificial intelligence are promising new tools in evidencing group-level differences. Combining all these examples, the chapter illustrates the diversity of cultural behaviour found in monkeys, confirming the saying ‘monkey see, monkey do’.
Paravertebral Nerve Block for Procedural Pain in Percutaneous Vertebroplasty
Authors: Kang Min-Seok , Son In-Seok , Kim Tae-Hoon , Lee Suk-Ha , You Ki-Han , Lee Woo-Myung , Hyun Jin-Tak , Park Hyun-Jin
Published: November 2023

Objectives:

This study aimed to unidimensionally measure procedural pain at each percutaneous vertebroplasty (PVP) stage and evaluate the effectiveness of paravertebral nerve block (PVNB) in reducing procedural pain.

Methods:

A retrospective study of prospectively collected data was conducted on 66 patients who underwent PVP for osteoporotic vertebral compression fractures. The subjects were divided into two groups: Group A (fluoroscopic-guided PVNB; 5 cm3of 0.75% ropivacaine on each side) and Group B (local anesthesia). To investigate procedural pain associated with PVP, the visual analog scale (VAS) score was assessed at each surgical stage: before the incision (stage 1), transpedicular approach (stage 2), and polymethylmethacrylate cement injection (stage 3). After the procedure, patients were asked about their surgical experience and satisfaction using the IOWA Satisfaction with Anesthesia Scale (ISAS). Periprocedural complications were also recorded.

Results:

A total of 63 patients (78.65 y of age) were finally enrolled: 30 from group A and 33 from group B. In both groups, a significant ≥2-point increase in procedural pain was observed during PVP compared to that during stage 1 (P<0.001). In stages 2 and 3, the pain intensity was significantly lower in Group A (P<0.001). Upon discharge, the VAS score improved in all groups; however, the ISAS score was significantly higher in Group A (P<0.001). There was no difference in periprocedural complications between the two groups (P=0.743).

Discussion:

PVP causes significant procedural pain, and PVNB is a potentially effective modality for enhancing patient satisfaction and reducing procedural pain.
A Unique Case of Intrauterine Pressure Injury
Authors: Burns Heather R. , Yim Nicolas H. , Dibbs Rami P. , Ferry Andrew M. , Belfort Michael A. , Buchanan Edward P.
Published: November 2023

The authors present a review of the literature regarding pressure injuries (PIs) in neonates and a case of a newborn who developed a PI following a prolonged labor process and fetal malposition. A girl born at 35 weeks’ gestation to a 34-year-old gravida 7 para 6 mother with a medical history of untreated gestational diabetes, preeclampsia, and COVID-19 was delivered via cesarean section after failure to progress through labor. The premature infant was found to have a 3.2 × 2.3-cm PI at the nape of the posterior neck. Premature infants have a histologically proven, age-dependent decreased thickness of their stratum corneum, epidermis, and dermis, which places them at increased risk of developing PIs that can be painful and lead to infection. In the present case, the neonate’s congenital PI was successfully treated with medical-grade honey for approximately a month.
Nursing Students’ Knowledge on Pressure Injuries Following a Blended-Learning Unit: A Quasi-experimental Study
Authors: Bobbink Paul , Gschwind Géraldine , Charbonneau Lucie , Guex Carole , Chabal Laurent , Probst Sebastian
Published: November 2023

OBJECTIVE

To assess first-year bachelor’s degree in nursing students’ knowledge about pressure injury (PI) etiology, classification, prevention, and management following blended learning and clinical practice.

METHODS

A quasi-experimental design was used. Nursing students’ PI knowledge was measured using the French version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) at three time points: baseline (before a blended-learning unit, consisting of 2 hours of e-learning and 3 hours of practical workshop), after the blended-learning unit, and after clinical practice.

RESULTS

A total of 21 students participated over the three time points. At baseline, the mean percentage of correct answers on the PUKAT was 45.8%. This score increased to 59.2% following the blended-learning unit and 65% after completing the clinical practice (F
2,58 = 19.08; P = .00). Over the three time points, students scored highest on knowledge of risk assessment and lowest on knowledge of prevention.

CONCLUSIONS

Blended-learning units combining e-learning and practical workshops are valuable tools to increase students’ knowledge about PIs. The PUKAT enables the evaluation of changes in students’ knowledge following a teaching unit on PIs. However, more research is needed to assess the long-term evolution of knowledge and the impact of this teaching on clinical practice.
Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture
Authors: Tzen Yi-Ting , Sambandam Senthil , Delmore Barbara , Wang Jijia , Chu Andy , Wukich Dane K.
Published: November 2023

OBJECTIVE

To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications.

METHODS

In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications.

RESULTS

Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation.

CONCLUSIONS

Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.
Incidence of Pressure Injury Among Older Adults Transitioning from Long-term Care to the ED
Authors: Tate Kaitlyn , Palfreyman Simon , Reid R. Colin , McLane Patrick , Cummings Greta G.
Published: November 2023

OBJECTIVE

To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults’ emergency transitions from long-term care (LTC) to the ED.

METHODS

Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban centers located in provinces in Canada. Binary logistic regression was used to examine the influence of sociodemographic, service use, and client health and function factors on the incidence of PIs during transitions from LTC facilities to EDs.

RESULTS

Having a mobility issue (odds ratio [OR], 4.318; 95% CI, 1.344–13.870), transitioning from a publicly owned versus a nonprofit volunteer LTC facility (OR, 4.886; 95% CI, 1.157–20.634), and time from ED arrival to return to LTC being 7 to 9 days (OR, 41.327; 95% CI, 2.691–634.574) or greater than 9 days (OR, 77.639; 95% CI, 5.727–1,052.485) significantly increased the odds of experiencing a new skin injury upon return to LTC. A higher number of reported reasons for emergency transition (up to 4) significantly decreased the odds of a new PI upon return to LTC (OR, 0.315; 95% CI, 0.113-0.880).

CONCLUSIONS

The study findings can be used to identify LTC residents at increased risk for developing new skin injuries during an emergency transition, namely, those with mobility impairment, those requiring inpatient care for 6 or more days, and those transitioning from publicly owned LTC facilities. Evaluating the uptake and effectiveness of single-pronged and multipronged interventions such as visual cues for patient turning through online monitoring, consistent risk assessments, and improved nutrition in all care settings are vital next steps in preventing skin injuries in this population.
Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient
Authors: Yen Yi-Meng , Kim Young-Jo , Ellis Henry B. , Sink Ernest L. , Millis Michael B. , Zaltz Ira , Sankar Wudbhav N. , Clohisy John C. ,   ANCHOR Group, Nepple Jeffrey J.
Published: November 2023

Background:

Surgical treatment for adolescent patients with femoroacetabular impingement (FAI) is increasing. The purpose of this study was to determine the clinical outcomes of FAI surgery in a multicenter cohort of adolescent patients and to identify predictors of suboptimal outcomes.

Methods:

One hundred twenty-six adolescent hips (114 patients < 18 years of age) undergoing surgery for symptomatic FAI were studied from a larger multicenter cohort. The group included 74 (58.7%) female and 52 male hips (41.3%) with a mean age of 16.1 (range 11.3 to 17.8). Clinical outcomes included the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (5 domains), and University of California Los Angeles activity score. Failure was defined as revision surgery or clinical failure (inability to reach minimally clinical important differences or patient acceptable symptoms state for the mHHS). Statistical analysis was used to identify factors significantly associated with failure.

Results:

There was clinically important improvement in all patient-reported outcomes for the overall group, but an 18.3% failure rate. This included a revision rate of 8.7%. Females were significantly more likely than males to be classified as a failure (25.7 vs. 7.7%, P=0.01), in part because of lower preoperative mHHS (59.1 vs. 67.0, P< 0.001). Mild cam deformity (alpha angle <55 degrees) was present in 42.5% of female hips compared with 17.3% male hips. Higher alpha angles were inversely correlated with failure. Alpha angles >63 have a failure rate of 8.3%, between 55 and 63 degrees, 12.0% failure rate, and <55 degrees (mild cam) failure rate of 37.5%. Patients who participated in athletics had a 10.3% failure rate compared with nonathletes at 25.0% (P=0.03, RR (relative risk) 2.4).

Conclusions:

Adolescent patients undergoing surgical treatment for FAI generally demonstrate significant improvement. However, female sex, mild cam deformities, and lack of sports participation are independently associated with higher failure rates. These factors should be considered in surgical decision-making and during patient counseling.

Level of Evidence:

Level III—retrospective comparative study.
Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator
Authors: Zayda Ahmed , Badr Ismail Tawfeek
Published: November 2023

Nonunion of the periarticular distal tibial fractures is a challenging issue with limited options for treatment. The study aims to evaluate the outcomes of treatment of non-united periarticular distal tibial fractures using Ilizarov external fixation. A retrospective study included 16 patients with distal tibial fracture nonunion treated with Ilizarov fixator from 2014 to 2019 with a minimum 1-year follow-up after frame removal. Fibular plating was done in 8 cases and supplementary interfragmentary screws at the nonunion site in 5 cases. Primary or delayed bone graft was used in 11 patients. The ASAMI protocol was used to assess the bone and functional results. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to assess the functional outcomes. Study included 9 males and 7 females, mean age of 47.4±14.1 years. 15 cases had previous surgeries for nonunion. 7 had active infection. duration of nonunion was 24.1±13.2 months. Mean duration of fixation was 5.7±1.0 months. Mean follow-up was 21.8±8.5 months. Mean AOFAS score improved from 52.4±3.7 preoperatively to 85.4±9.8 at the latest follow-up (P<0.001). Finally, the infection was resolved, and union was achieved in all patients. Bone results were excellent in 3 cases and good in 13, whereas functional results were excellent in 6 cases, good in 8, fair in 1, and poor in 1. Ilizarov fixator is a reliable option for treating nonunion in the periarticular distal tibial fractures. It provides secure fixation for short distal fragments, especially with history of infection, those with bad skin conditions, previous failed internal fixation, and osteopenic bone.

Level of Evidence:

Level IV.
Treatment of Hallux Valgus with Metatarsus Adductus
Authors: Tung Wei Shao , Eftekhari Mani , Miller Christopher P.
Published: November 2023

Metatarsus adductus is a common congenital foot deformity with an inward deviation of the forefoot occurring in the transverse plane of the foot. This article describes a minimally invasive approach using proximal metatarsal metaphyseal osteotomies to address the adduction of metatarsals at the tarsometatarsal joint complex. This approach offers possible advantages of minimally invasive surgery over open procedures in terms of outcomes, including lowered incidences of sagittal malunion, nonunion of the arthrodesis or metatarsal osteotomy, wound healing complications, and joint stiffness. Further research is warranted for the long-term outcomes of the procedure and how much of the deformity can be corrected.

Level of Evidence:

Level IV.
Antineoplastic activity of GP-2250 in-vitro and in mouse xenograft models
Authors: Sofia R. Duane , Martin Kathryn M. , Costin James C.
Published: November 2023

This study examined the antineoplastic effects of GP-2250 (misetionamide), an oxathiazine derivative with broad activity, in multiple cancer cell lines and mouse xenograft models. Antineoplastic activity of GP-2250 was tested in >300 cancer cell lines using the OncoPanel cytotoxicity assay. GP-2250 activity was further tested in mouse xenograft models, in which GP-2250 or vehicle (10 ml/kg) was administered daily for 28 days by intraperitoneal injection in the lower right abdomen of CrTac:NCR-Foxn1nu mice with tumor volumes of 100 to 200 mm3. In the in-vitro models, GP-2250 increased cytotoxicity readings with IC50 and EC50 as well as indications of cell cycle blockage in pancreatic and ovarian cell lines. In mouse xenograft models, a reduction of 30–40% in tumor volume occurred in the GP-2250 group versus the vehicle group. On the final day of the study, tumor progression was significantly reduced in 4 tumor types: HT-29 in the GP-2250 500 and 1000 mg/kg groups, SKOV-3 in all GP-2250 treatment groups, Cal-27 in the GP-2250 1000 mg/kg group, and Hs-695T in the GP-2250 250 and 1000 mg/kg groups. Tumor regression in Cal-27 tumors was dose-dependent. GP-2250 demonstrated cytotoxic activity in vitro and reduced the tumor volume in a variety of human cancer cell lines in a xenograft mouse model. Given these results, as well as evidence of synergism with other anticancer drugs, GP-2250 shows promise as a new therapeutic agent for treating human cancers and is being evaluated in a phase 1 dose-escalation study (NCT03854100).
Antibiotics, Sedatives, and Catecholamines Further Compromise Sepsis-Induced Immune Suppression in Peripheral Blood Mononuclear Cells
Authors: Miller Muska , Melis Miranda J. , Miller James R.C. , Kleyman Anna , Shankar-Hari Manu , Singer Mervyn
Published: November 2023

OBJECTIVES:

We hypothesized that the immunosuppressive effects associated with antibiotics, sedatives, and catecholamines amplify sepsis-associated immune suppression through mitochondrial dysfunction, and there is a cumulative effect when used in combination. We thus sought to determine the impact of the exemplar drugs ciprofloxacin, propofol, and norepinephrine, used alone and in combination, at clinically relevant concentrations, on the ex vivo functionality of peripheral blood mononuclear cells (PBMCs) drawn from healthy, infected, and septic individuals.

DESIGN:

In vitro/ex vivo investigation.

SETTING:

University laboratory.

SUBJECTS:

Healthy volunteers, infected (nonseptic) patients in the emergency department, and septic ICU patients.

INTERVENTIONS:

PBMCs were isolated from these subjects and treated with ciprofloxacin (100 µg/mL), propofol (50 µg/mL), norepinephrine (10 µg/mL), or all three drugs combined, with and without lipopolysaccharide (100 ng/mL) for 6 or 24 hours. Comparison was made between study groups and against untreated cells. Measurements were made of cell viability, cytokine production, phagocytosis, human leukocyte antigen-DR (HLA-DR) status, mitochondrial membrane potential, mitochondrial reactive oxygen species production, and oxygen consumption. Gene expression in immune and metabolic pathways was investigated in PBMCs sampled from healthy volunteers coincubated with septic serum.

MEASUREMENTS AND RESULTS:

Coincubation with each of the drugs reduced cytokine production and phagocytosis in PBMCs isolated from septic patients, and healthy volunteers coincubated with septic serum. No effect was seen on HLA-DR surface expression. No cumulative effects were seen with the drug combination. Sepsis-induced changes in gene expression and mitochondrial functionality were not further affected by addition of any of the drugs.

CONCLUSION:

Drugs commonly used in critical care lead to significant immune dysfunction ex vivo and enhance sepsis-associated immunosuppression. Further studies are required to identify underlying mechanisms and potential impact on patient outcomes.
The International Awareness of Breast Reconstruction
Authors: Alsubhi Fatema S. , Alothman Mohammed A. , Alhadlaq Abdulrahman I.
Published: November 2023

Background:

To our knowledge, this is the first and largest study conducted to collect data among surgeons worldwide about breast reconstruction. We have aimed to collect data about breast reconstruction worldwide, the most popular breast reconstruction techniques, and the barriers behind the low rate of breast reconstruction according to surgeons.

Methodology:

A comparative cross-sectional design was used in this study. A prepared questionnaire, which was developed after reviewing the literature review conducted for this study, was used to collect data. The questionnaire is multiple choice. It was distributed among surgeons online.

Results:

The study includes 812 participants who live all over the world, representing 79 countries. More than a third of surgeons perform less than 10 breast reconstructions per year (33.38%), and 45.86% of them think that immediate surgery is the most frequent practice. A higher percentage of participants prefer implants over autologous reconstruction as a technique for breast reconstruction (54.9%). Moreover, 39.02% of participants shared that a lack of knowledge about the availability of breast reconstruction was a reason for refusing the surgery.

Conclusions:

This study demonstrates that the breast reconstruction rate is still low and that most surgeons prefer implants that are performed immediately. The lack of knowledge among patients about the availability of breast reconstruction is the most common reason for refusing reconstruction. Therefore, there is a need to increase patient awareness about the availability of this surgery.
The Use of Three Iliac Crest Muscles for Head and Neck Soft Tissue Reconstruction: Technical Note
Authors: Crêvecoeur Hervé , Nsimba-Bimwala Francis , Shimwa-Karengera Stéphane
Published: November 2023

This technical note describes a novel approach to reconstructing soft tissue in the head and neck region by diverting a flap originally intended for hard tissue reconstruction. We present a case of a 79-year-old woman with a large tumor on the left side of the mobile tongue, where the use of a radial free flap was challenging. Instead, we used the muscular portion of the iliac crest as a reliable alternative for reconstruction, offering a suitable oral lining. Using a muscular free flap, we achieved effective tongue reconstruction while minimizing donor site morbidity. The deep circumflex iliac artery muscular free flap demonstrates promising outcomes for large defects in the oral cavity and facial regions. However, a comprehensive case series with functional assessments and long-term follow-up is necessary to evaluate potential complications, such as hernia formation.
Extended Superior Dermoglandular Pedicle Approach: A Versatile Technique for a Variety of Breast Deformities
Authors: Aboul Wafa Ahmed Mabrouk
Published: November 2023

Background:

Although the selected pedicle is important in how it maintains nipple viability and is of equal importance, it can be utilized with the remaining breast tissue to reshape the breast mound. It is ideally used as an extended pedicle, as it allows us to use the tissue in the lower pole of the breast. The purpose of this article was to evaluate additional indications and outcomes using the extended superior pedicle approach along with conventional techniques.

Methods:

This is a retrospective study over 5 years of using an extended superior dermoglandular pedicle approach for managing a variety of breast deformities. Postoperative complications, along with patient and surgeon satisfaction, were assessed.

Results:

All 68 patients expressed that the results were either excellent (85.3%) or very good (14.7%) according to the evaluation parameters. Among the 68 patients, there were 62 very good outcomes (91.2%) and six good outcomes (8.8%) according to surgeon evaluation. Only one reduction experienced a superficial partial loss, which was improved with no intervention. There was minor asymmetry in three patients (4.4%), which was not experienced by the patients, and poor scar quality in one dark-skinned patent.

Conclusions:

The author was able to expand the utility of extended superior pedicle for various breast deformities, such as reduction mammoplasty; mastopexy; augmentation mastopexy, either autoaugmentation or prosthetic; tuberous breast; after lumpectomy resection; and even in secondary breast deformities with reproducible and reliable outcomes across a wide patient population.
Immortalized Human Conjunctival Epithelial Cells Produce Functional Complement C3 and C4 Proteins
Authors: Ziemanski Jillian F. , Szalai Alexander J.
Published: November 2023

Purpose:

The aim of this study was to assess whether complement proteins C3 and C4 are produced by immortalized human conjunctival epithelial (HCjE) cells.

Methods:

Supernatants and cell lysates from undifferentiated and differentiated HCjE cells were assayed for C3 and C4 by enzyme-linked immunosorbent assay. To measure complement protein function, supernatants and lysates were treated with heat-aggregated IgG, and soluble C5b-9 was measured.

Results:

C3 was upregulated in supernatants from differentiated HCjE cells compared with undifferentiated HCjE cells (556.55 ± 91.75 vs. 56.95 ± 12.09 ng/mL, P <0.001). C4 was also increased in supernatants but to a much lesser extent (0.599 ± 0.476 vs. 0.172 ± 0.0133 ng/mL, P = 0.03). From HCjE cell lysates, total C3 production was 9.03 times higher in differentiated HCjE cells (P <0.001), whereas total C4 remained relatively unchanged. After activation with heat-aggregated IgG, sC5b-9 could be detected from both undifferentiated and differentiated HCjE cell lysates, but not in the HCjE supernatants.

Conclusions:

HCjE cells produce C3 and C4 in sufficient quantities to support the formation of sC5b-9, confirming their biological activity and suggesting that HCjE cells likely produce all complement proteins C1 through C9.
Central Venous Catheter-related Bloodstream Infections Caused by Enterobacterales in Pediatric Oncology Patients: Catheter Salvage or Removal
Authors: van den Bosch Ceder H. , Kops Aranka L. , Loeffen Yvette G. T. , van der Steeg Alida F. W. , van de Wetering Marianne D. , Fiocco Marta F. , Ekkelenkamp Miquel B. , Wolfs Tom F. W.
Published: November 2023

Background:

The aim was to determine whether salvage treatment with systemic antibiotics is a safe and effective strategy for Enterobacterales bloodstream infections (BSI) in pediatric oncology patients with a central venous catheter (CVC).

Methods:

A retrospective study was performed on oncology and stem cell recipient patients with a CVC and blood culture with Enterobacterales, at the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands. Analyses were performed for all BSI and for episodes meeting central line-associated bloodstream infection (CLABSI) criteria. The cumulative incidence of an event (ie, removal, intensive care admission or death) was estimated after blood culture collection for episodes primarily treated with antibiotics. The effect of prognostic factors on the hazard of the event of interest was assessed by estimating a Cox proportional hazard regression model.

Results:

In total, 95 CVC-related Enterobacterales BSIs in 82 patients were included; 12 (13%) BSIs required immediate CVC removal and for 83 (87%) BSIs CVC salvage was attempted. The cumulative incidence of events at 60 days was 53.0% [95% confidence interval (CI): 41.7–63.1] for BSIs (n = 83), and 64.4% (95% CI: 48.3–76.7) for CLABSIs (n = 45). The events occurred after a median of 6 (Q1–Q3: 2–15) and 6 (Q1–Q3: 2–20) days for BSIs and CLABSIs, respectively. Intensive care admission after salvage treatment was required in 16% of the BSIs and CLABSIs, resulting in death in 5% and 2% of cases, respectively. No significant association between risk factors and events was found.

Conclusions:

The cumulative incidence of an event at 60 days after salvage treatment for Enterobacterales CLABSIs and BSIs in pediatric oncology patients is high. Immediate CVC removal appears recommendable for this patient group.
Comparison of toric intraocular lens calculation with the integrated K method and three single biometric devices
Authors: Shah Yachana , Jacques Angela , Or Lior , Barrett Graham
Published: November 2023

Purpose:

To compare astigmatic outcomes using the Integrated K method and anterior surface keratometry from 3 different biometric devices.

Setting:

Lions Eye Institute, Perth, Australia.

Design:

Retrospective case series.

Methods:

Eyes of patients who underwent uneventful cataract surgery were analyzed. Predicted postoperative astigmatism was calculated for Integrated K method, IOLMaster 700, Lenstar and Pentacam. The mean centroid error in predicted postoperative refractive astigmatism (PE), mean absolute PE and percentage of eyes within 0.5 diopter (D), 0.75 D and 1 D of absolute magnitude of PE were compared. A subset analysis was done where the difference in cylinder magnitude between the 2 methods was more than 0.25 D. Spherical prediction outcomes were also analyzed.

Results:

241 eyes of 139 patients were included in the study. The mean centroid PE of Integrated K method (−0.07 @ 69) was significantly different from IOLMaster and Pentacam. The mean absolute PE with Integrated K method (0.33 ± 0.17) was significantly lower than all 3 devices. The percentage of eyes within 0.5 D and 0.75 D of absolute magnitude of PE was 82% and 99% for Integrated K method, 76% and 95% for IOLMaster and Lenstar, and 60% and 86% for Pentacam. In the subset analysis, the improvement in accuracy of the Integrated K method compared with a single device was greater in terms of the percentage of eyes predicted within 0.5 D. The Integrated K method did not impact the spherical prediction outcomes.

Conclusions:

The integrated K method is more accurate and precise than anterior surface keratometry from a single biometric device.
The “Hitch-Stitch” for Preventing High Tracheal Stent Migration
Authors: Bansal Sameer , Kumar Samiksha S. , Loknath Chakravarthi , Kalpakam Hariprasad , Singla Abhinav , Mehta Ravindra M.
Published: November 2023

Background:

Airway stenting is a standard treatment option for tracheo-bronchial obstruction and other conditions like tracheo-esophageal fistula (TEF).

Methods:

To prevent stent migration, a percutaneous fixation strategy called the “hitch-stitch” was described in 2016 as an efficient technique. We describe an extended experience of the “hitch-stitch” for silicone stents in high tracheal stenting situations and expanding indications to metal stents.

Results:

Seventy-four percutaneous stitches were placed in 54 patients (36 males and 18 females). The mean age of the patients was 42 (±19) years. The indication for stenting was tracheal stenosis in 63/74 (85%) cases and TEF in 11/74 (15%) cases. Silicone stents were used in 56/74 (75.5%) cases while self-expanding metal stents (SEMS) were used in 18/74 (24.5%) cases. The majority of the stents (62/74, 85%) were high tracheal stents. The “hitch-stitch” as an anti-migration strategy had a high success rate, with distal stent migration in only 2 cases (2.7%) as the stitch had given way—these were repositioned and hitched with double stitches. Minor complications included delayed skin healing (2.8%) and suture site infection (1.4%), which was successfully managed with oral antibiotics. Stitch removal was easy with no complications.

Conclusion:

In this large series of percutaneous “hitch-stitch” as a stent migration prevention strategy, long-term data shows it is safe and effective in an expanded cohort of silicone stents. Its extended utility is the successful application to metal stents, especially in TEF, where the consequences can be deleterious. It is simple to do, with minimal extra requirements and not associated with any significant complications.
FIB-4 Reliability in Patients With Severe Obesity
Authors: Green Victoria , Lin Joanne , McGrath Morgan , Lloyd Aaron , Ma Pearl , Higa Kelvin , Roytman Marina
Published: November 2023

Background:

Liver biopsy is the gold standard to evaluate hepatic fibrosis; however, it has many drawbacks, especially in patients with severe obesity. Noninvasive testing such as the FIB-4 score is increasingly being used as the initial screening tool to identify patients at risk for advanced fibrosis. The broader applicability of FIB-4 and the precision of its cutoff values remain uncertain in metabolic dysfunction-associated steatotic liver disease and patients with severe obesity. Our study explored the correlation between FIB-4 scores and intraoperative liver biopsy in patients with severe obesity undergoing bariatric surgery.

Methods:

A total of 632 patients with severe obesity underwent preoperative vibration-controlled transient elastography and intraoperative liver biopsy during bariatric surgery from January 2020 to August 2021. Variables collected included patient demographics, laboratory values, abdominal ultrasound, vibration-controlled transient elastography, and liver biopsy results. ANOVA 1-way test, χ2 tests, and Fisher exact tests were used for quantitative and qualitative variables, respectively. The 95% CIs for the mean FIB-4 scores were used to generate surrogate cutoff values. The proposed FIB-4 cutoffs for F0-1, F2, F3, and F4 were 0.62 (CI: 0.59, 0.64), 0.88 (0.74, 1.01), 1.24 (0.94, 1.54), and 1.53 (0.82, 2.24), respectively. Area under the curve (AUC) methods were used to compare traditional to proposed cutoff values.

Results:

Applying the traditional FIB-4 cutoffs to approximate advanced fibrosis yielded an AUC of 0.5748. Use of the proposed FIB-4 cutoffs increased the AUC to 0.6899. The proposed FIB-4 cutoffs correctly identified 40 patients with biopsy-proven advanced fibrosis (F3-F4), all of which would have been missed using traditional cutoffs.

Conclusion:

Our study revealed that the use of the currently accepted FIB-4 cutoffs as the screening modality for identifying patients with advanced fibrosis due to metabolic dysfunction-associated steatotic liver disease is insufficient and will result in missing patients with histologically confirmed advanced fibrosis. Use of the revised FIB-4 scores should be considered to diagnose patients with severe obesity at high risk of liver disease progression.
Role of FDG PET/CT in definitive and presumed autoimmune encephalitis
Authors: Kalra Simran , Tripathi Madhavi , Tripathi Manjari , Sonar Roopal Sarraf , Pandey Anil Kumar , Jaleel Jasim , Singh Rajesh Kumar , Kumar Praveen , Damle Nishikant Avinash , Bal Chandrasekhar
Published: November 2023

Objective

F-18 Fluorodeoxyglucose PET/CT (FDG-PET) is emerging as a useful imaging adjunct to MRI in the initial diagnostic evaluation of autoimmune encephalitis (AIE)-though presently it is not included in the diagnostic criteria.

Materials and methods

In this prospective study we enrolled a total of 52 patients with clinically diagnosed and treated AIE. MRI evaluation was done in each case along with CSF and EEG where feasible. FDG-PET was done for all and images were interpreted visually and using SPM.

Results

The mean age group of patients included was 38.5 ± 22.6 years with 31 females and 21 males. 23 antibody-positive cases underwent PET, the most common antibody detected was anti-NMDAR type followed by anti-LGI 1. Most common metabolic pattern in NMDARE was hypermetabolism in basal ganglia and hypometabolism in parieto-occipital cortices and ovarian teratoma was detected in two of these patients on whole-body PET. A metabolic pattern consistent with AIE was demonstrated in 22/29 (75.8%) antibody-negative patients with hypermetabolism in basal ganglia and mesial temporal cortices. The overall sensitivity of FDG PET was 86% (45/52). MRI abnormalities were detected in 22/52 (42%) cases, 10/23 antibody positive and 12/29 antibody negative cases. PET was positive in 23/30 (76%) MRI negative cases.

Conclusion

Sensitivity of FDG PET for supporting a diagnosis of AIE was higher compared to MRI in both antibody-positive (definitive) and antibody-negative (presumed) AIE. Specific metabolic patterns can be demonstrated on FDG PET in AIE, prompting an early diagnosis so that timely treatment can be instituted.
18F-FDG PET/MRI for restaging esophageal cancer after neoadjuvant chemoradiotherapy
Authors: Valkema Maria J. , de Lussanet de la Sablonière Quido G. , Valkema Roelf , Thomeer Maarten G.J. , Dwarkasing Roy S. , Harteveld Anita A. , Doukas Michail , Mostert Bianca , van der Zijden Charlène J. , van der Sluis Pieter C. , Lagarde Sjoerd M. , Wijnhoven Bas P.L. , Verburg Frederik A. , van Lanschot J. Jan B.
Published: November 2023

Purpose

The purpose of this study was to investigate whether 18F-fluorodeoxyglucose (18F-FDG) PET/MRI may potentially improve tumor detection after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer.

Methods

This was a prospective, single-center feasibility study. At 6–12 weeks after nCRT, patients underwent standard 18F-FDG PET/computed tomography (CT) followed by PET/MRI, and completed a questionnaire to evaluate burden. Two teams of readers either assessed the 18F-FDG PET/CT or the 18F-FDG PET/MRI first; the other scan was assessed 1 month later. Maximum standardized uptake value corrected for lean body mass (SULmax) and mean apparent diffusion coefficient (ADCmean) were measured at the primary tumor location. Histopathology of the surgical resection specimen served as the reference standard for diagnostic accuracy calculations. When patients had a clinically complete response and continued active surveillance, response evaluations until 9 months after nCRT served as a proxy for ypT and ypN (i.e. ‘ycT’ and ‘ycN’).

Results

In the 21 included patients [median age 70 (IQR 62–75), 16 males], disease recurrence was found in the primary tumor in 14 (67%) patients (of whom one ypM+, detected on both scans) and in locoregional lymph nodes in six patients (29%). Accuracy (team 1/team 2) to detect yp/ycT+ with 18F-FDG PET/MRI vs. 18F-FDG PET/CT was 38/57% vs. 76/61%. For ypN+, accuracy was 63/53% vs. 63/42%, resp. Neither SULmax (both scans) nor ADCmean were discriminatory for yp/ycT+ . Fourteen of 21 (67%) patients were willing to undergo a similar 18F-FDG PET/MRI examination in the future.

Conclusion

18F-FDG PET/MRI currently performs comparably to 18F-FDG PET/CT. Improvements in the scanning protocol, increasing reader experience and performing serial scans might contribute to enhancing the accuracy of tumor detection after nCRT using 18F-FDG PET/MRI.

Trial registration

Netherlands Trial Register NL9352.
Transfusion avoidance in myelodysplastic neoplasms
Authors: Griffiths Elizabeth A.
Published: November 2023

Purpose of review

Myelodysplastic neoplasms (MDS) are diseases of stem cell aging associated with complications from inadequate hematopoiesis (red cells, neutrophils and platelets) and variable risk for transformation to acute myeloid leukemia. Those with low-risk disease also suffer and die from MDS-related complications. Among the most challenging is development of anemia and transfusion dependence, which impacts quality of life and is associated with reduced survival. Appreciating and measuring the quality-of-life impact, preventing (if possible), treating, and managing the complications from anemia in MDS are of critical importance.

Recent findings

Recent developments in basic science highlight the potential deleterious impact of iron overload within the developing red cell niche. Iron overload can compromise red cell maturation from healthy as well as malignant clones and produces an environment favoring expansion of mutant clonal cells, potentially driving disease progression. Observational studies in nontransfusion dependent MDS highlight that iron overload occurs even in the nontransfusion dependent. The newly approved (and established) therapies for management of MDS-related anemia work best when begun before patients become heavily transfusion-dependent.

Iron overload is detrimental to hematopoiesis. Understanding the benefit afforded by transfusion is critical to optimal application and patient reported outcomes can inform this. Recently developed therapies are active and optimized application may improve response.
Pediatric acute myeloid leukemia – novel approaches
Authors: Karol Seth E. , Gueguen Gwenaelle
Published: November 2023

Purpose of review

Despite higher remission and survival rates than observed in adults, children with acute myeloid leukemia (AML) still suffer unacceptably high rates of treatment failure and late toxicities. Ongoing work aims to improve these long-term outcomes through improvements in the utilization of current therapies, the incorporation of novel chemotherapy agents, and improved use of current or novel cellular and immunotherapeutic approaches. In this review, we highlight recent advances and contextualize them within this evolving landscape.

Recent findings

Novel agents such as the B-cell lymphoma 2 inhibitor venetoclax and the menin inhibitors have shown promising results with implications for large portions of the pediatric AML population. Older agents are being used in novel combinations (e.g. gemtuzumab ozogamicin) or are expanding into pediatrics after longer use in adults (e.g. Fms-like tyrosine kinase 3 inhibitors). Finally, immunotherapeutic approaches offer new options for patients with high-risk or relapsed disease.

Recent findings have altered the landscape of pediatric AML therapy with exciting immediate and long-term implications. Ongoing studies may soon define this as standard as well. After many years in which few new therapies have become available for children with AML, recent and upcoming advances may soon dramatically alter the therapeutic landscape.
Epilepsy in Africa: a multifaceted perspective on diagnosis, treatment, and community support
Authors: Kassahun Bekele Bezawit , Nebieridze Anano , Moses Daniel Itopa , Byiringiro Clever , Nazir Abubakar , Algawork Kibru Ermias , Wojtara Magda , Uwishema Olivier
Published: November 2023

Epilepsy is the most widespread neurological disorder in Africa, affecting an estimated 25 million people. The disorder is characterized by recurrent seizures, which can be caused by a variety of factors, including past trauma, central nervous system infections, and genetic disorders. Diagnosis and treatment of epilepsy are challenging in African patients due to several factors, including the low socioeconomic status of the residents and limited access to appropriate medication. Phenobarbital remains the only drug widely available to patients, but it is not always effective and can have significant side effects. In addition to the medical challenges, individuals with epilepsy also face a lot of social stigmas in Africa. Widespread superstitions and false beliefs lead to prejudices against these people, making it difficult for them to live fulfilling social lives. With the development of new treatment modalities, such as gene therapy, stem cell therapy, and P-glycoprotein inhibitors, it is more important now than ever to increase the research output for the African region to create the best possible treatment and maximize patient outcomes.
Effects of Daily Posttraumatic Stress Disorder Symptoms on Heart Rate Variability
Authors: Slavish Danica C. , Ruggero Camilo J. , Schuler Keke , Schwartz Joseph E. , Luft Benjamin , Kotov Roman
Published: November 2023

Objective

Posttraumatic stress disorder (PTSD) is common, debilitating, and associated with an increased risk of health problems, including cardiovascular disease. PTSD is related to poor autonomic function indicated by reduced heart rate variability (HRV). However, very little work has tested the timescale or direction of these effects, given that most evidence comes from cross-sectional studies. Documentation of when effects occur and in what direction can shed light on mechanisms of cardiovascular disease risk and inform treatment. The present study of 169 World Trade Center responders, oversampled for PTSD, tested how daily PTSD symptoms were associated with autonomic function as reflected through HRV.

Methods

Participants (N = 169) completed surveys of PTSD symptoms three times a day at 5-hour intervals for 4 days while also wearing ambulatory monitors to record electrocardiograms to derive HRV (i.e., mean absolute value of successive differences between beat-to-beat intervals).

Results

HRV did not predict PTSD symptoms. However, PTSD symptoms during a 5-hour interval predicted reduced HRV at the next 5-hour interval (β = −0.09, 95% confidence interval = −0.16 to −0.02, p = .008). Results held adjusting for baseline age, current heart problems, and current PTSD diagnosis.

Conclusions

Findings underscore growing awareness that PTSD symptoms are not static. Even their short-term fluctuations may affect cardiovascular functioning, which could have more severe impacts if disruption accumulates over time. Research is needed to determine if momentary interventions can halt increases in PTSD symptoms or mitigate their impact on cardiovascular health.
Lifespan Socioeconomic Context Is Associated With Cytomegalovirus and Late-Differentiated CD8+ T and Natural Killer Cells: Initial Results in Older Adults
Authors: Reed Rebecca G. , Hillmann Abby R. , Presnell Steven R. , Al-Attar Ahmad , Lutz Charles T. , Segerstrom Suzanne C.
Published: November 2023

Objective

Lower socioeconomic status (SES) can accelerate immune aging; however, it is unknown whether and how lifespan socioeconomic context (SEC)—the relative wealth and quality of the communities an individual lives in across their lifespan—impacts immune aging. We examined the effects of childhood and adulthood SEC on late-differentiated immune cells and investigated the mediating and moderating role of cytomegalovirus (CMV), a key driver of immune aging.

Methods

Adults 60 years and older (N = 109) reported their addresses from birth to age 60 years, which were coded for county-level employment, education, and income to construct a latent SEC variable, averaged across ages 0 to 18 years (childhood SEC) and 19 to 60 years (adulthood SEC). Blood was drawn semiannually for 5 years for CMV serostatus and flow cytometry estimates of late-differentiated CD8+ T and natural killer cells. Models were adjusted for chronological age, time, sex, and individual SES (current income and education).

Results

Lower childhood SEC was associated with higher percentages of late-differentiated CD8+ T and natural killer cells via CMV seropositivity (indirect effects, p values = .015–.028). In addition, an interaction between CMV serostatus and SEC on CD8+ T-cell aging (p = .049) demonstrated that adulthood SEC was negatively associated with immune aging among CMV− but not CMV+ adults.

Conclusions

Beyond current SES, SEC related to immune aging in distinct patterns by lifespan phase. Lower childhood SEC importantly may influence who acquires CMV, which in turn predicts higher levels of immune aging, whereas higher adulthood SEC was protective against immune aging among CMV− older adults. These initial results need to be explored in larger samples.
Health technology assessments and their roles in public health policy
Authors: Khalil Hanan
Published: November 2023

Purpose of review

Health Technology Assessment (HTA) is a multidisciplinary practice that summarizes information about the medical, social, economic, and ethical issues related to the use of a health technology in a systematic, transparent, and balanced manner. Health technologies include drugs, medical devices, procedures, and systems used in healthcare. The aim of this review is to present a snapshot on its uses, methods and current challenges to inform future research.

Recent findings

HTA has been instrumental in identifying health priorities, monitor trends, resource allocation, policy development, program planning and evaluation, health disparities, emergency preparedness, advocacy and community engagement. It can also be used in research and health systems comparisons. Several countries have set up specific agencies for HTA to inform their decision making and adjusting the current tools to address their needs by developing specific methods suitable for their context.

The advantages and disadvantages of health assessment technology are interconnected, and many of the disadvantages can be mitigated with proper planning, training, and effective technology implementation. The use of health assessment technology should be guided by a commitment to patient safety, data security, and equitable healthcare access.
Potential of Three-Dimensional Portable Document Format for Article Publication in Craniofacial Surgery
Authors: Takatsume Yoshifumi , Sakamoto Yoshiaki
Published: November 2023

The portable document format (PDF) is a globally recognized standard file format of Word documents. The PDF supports the embedding of three-dimensional objects. This three-dimensional PDF can contribute to new ways of presenting and disseminating medical information in future medical journals.