bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical role of serum tumor markers SCC, NSE, CA 125, CA 19-9, and CYFRA 21-1 in patients with lung cancer
Authors: Sun Aiwen
Published: April 2023

Objective

The aim of the study was to assess the diagnostic value of tumor markers in discriminating between lung cancer and benign chest diseases (BCDs).

Methods

There were 322 patients enrolled in this investigation including 180 cases of lung cancer and 142 cases of BCD. Serum neuron-specific enolase (NSE), cancer antigen 125, cancer antigen 19-9, squamous cell carcinoma–related antigen, and cytokeratin fragment 19 (CYFRA 21-1) were compared between different populations, cancer stages, and before and after treatment. Logistic regression and receiver operating characteristic curves were used to evaluate the diagnostic markers.

Results

Both NSE and CYFRA 21-1 were significantly associated with lung cancer. The CYFRA 21-1 showed the best performance, as well as its combinations, for lung cancer diagnosis. It also showed significant change 6 months after radical surgery in lung cancer patients.

Conclusion

The marker CYFRA 21-1 could be developed as an adjuvant marker for the early diagnosis of lung cancer and as a prognostic marker for lung cancer treatment.
The importance of live binary evolution in numerical simulations of binaries embedded in circumbinary discs
Authors: Franchini Alessia , Lupi Alessandro , Sesana Alberto , Haiman Zoltan
Published: April 2023

The shrinking of a binary orbit driven by the interaction with a gaseous circumbinary disc, initially advocated as a potential way to catalyse the binary merger, has recently been debated in the case of geometrically thick (i.e. with H/R ≳ 0.1) discs. However, a clear consensus is still missing mainly owing to numerical limitations, such as fixed orbit binaries or lack of resolution inside the cavity carved by the binary in its circumbinary disc. In this work, we assess the importance of evolving the binary orbit by means of hydrodynamic simulations performed with the code gizmo in meshless finite mass mode. In order to model the interaction between equal mass circular binaries and their locally isothermal circumbinary discs, we enforce hyper-Lagrangian resolution inside the cavity. We find that fixing the binary orbit ultimately leads to an overestimate of the gravitational torque that the gas exerts on the binary and an underestimate of the torque due to the accretion of material on to the binary components. Furthermore, we find that the modulation of the accretion rate on the binary orbital period is strongly suppressed in the fixed orbit simulation, while it is clearly present in the live binary simulations. This has potential implications for the prediction of the observable periodicities in massive black hole binary candidates.
TIC 219006972: a compact, coplanar quadruple star system consisting of two eclipsing binaries with an outer period of 168 d
Authors: Kostov Veselin B , Borkovits Tamás , Rappaport Saul A , Powell Brian P , Pál András , Jacobs Thomas L , Gagliano Robert , Kristiansen Martti H , LaCourse Daryll M , Moe Maxwell , Omohundro Mark , Schmitt Allan R , Schwengeler Hans M , Terentev Ivan A , Vanderburg Andrew
Published: April 2023

We present the discovery of a new highly compact quadruple star system, TIC 219006972, consisting of two eclipsing binary stars with orbital periods of 8.3 and 13.7 d, and an outer orbital period of only 168 d. This period is a full factor of 2 shorter than the quadruple with the shortest outer period reported previously, VW LMi, where the two binary components orbit each other every 355 d. The target was observed by Transiting Exoplanet Survey Satellite in full-frame images in sectors 14–16, 21–23, 41, 48, and 49, and produced two sets of primary and secondary eclipses. These show strongly non-linear eclipse timing variations (ETVs) with an amplitude of ∼0.1 d, where the ETVs of the primary and secondary eclipses and of the two binaries are all largely positively correlated. This highlights the strong dynamical interactions between the two binaries and confirms the compact quadruple configuration of TIC 219006972. The two eclipsing binaries are nearly circular, whereas the quadruple system has an outer eccentricity of about 0.25. The entire system is nearly edge-on, with a mutual orbital inclination between the two eclipsing binary star systems of about 1 deg.
Short-term topiramate treatment prevents radiation-induced cytotoxic edema in preclinical models of breast-cancer brain metastasis
Authors: Contreras-Zárate Maria J , Alvarez-Eraso Karen L F , Jaramillo-Gómez Jenny A , Littrell Zachary , Tsuji Nikki , Ormond D Ryan , Karam Sana D , Kabos Peter , Cittelly Diana M
Published: April 2023

Background

Brain edema is a common complication of brain metastases (BM) and associated treatment. The extent to which cytotoxic edema, the first step in the sequence that leads to ionic edema, vasogenic edema, and brain swelling, contributes to radiation-induced brain edema during BM remains unknown. This study aimed to determine whether radiation-associated treatment of BM induces cytotoxic edema and the consequences of blocking the edema in preclinical models of breast-cancer brain metastases (BCBM).

Methods

Using in vitro and in vivo models, we measured astrocytic swelling, trans-electric resistance (TEER), and aquaporin 4 (AQP4) expression following radiation. Genetic and pharmacological inhibition of AQP4 in astrocytes and cancer cells was used to assess the role of AQP4 in astrocytic swelling and brain water intake. An anti-epileptic drug that blocks AQP4 function (topiramate) was used to prevent cytotoxic edema in models of BM.

Results

Radiation-induced astrocytic swelling and transient upregulation of AQP4 occurred within the first 24 hours following radiation. Topiramate decreased radiation-induced astrocytic swelling and loss of TEER in astrocytes in vitro, and acute short-term treatment (but not continuous administration), prevented radiation-induced increase in brain water content without pro-tumorigenic effects in multiple preclinical models of BCBM. AQP4 was expressed in clinical BM and breast-cancer cell lines, but AQP4 targeting had limited direct pro-tumorigenic or radioprotective effects in cancer cells that could impact its clinical translation.

Conclusions

Patients with BM could find additional benefits from acute and temporary preventive treatment of radiation-induced cytotoxic edema using anti-epileptic drugs able to block AQP4 function.
Immunogenicity, Safety, and Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infections After Coronavirus Disease 2019 Vaccination in Organ Transplant Recipients: A Prospective Multicenter Canadian Study
Authors: Kabbani Dima , Yotis Demitra M , Ferreira Victor H , Shalhoub Sarah , Belga Sara , Tyagi Varalika , Ierullo Matthew , Kulasingam Vathany , Hébert Marie-Josée , West Lori , Delisle Jean-Sébastien , Racine Normand , De Serres Sacha A , Cardinal Héloïse , Dieudé Mélanie , Humar Atul , Kumar Deepali
Published: April 2023

Background

Solid organ transplant (SOT) recipients are at risk for severe coronavirus disease 2019 (COVID-19), despite vaccination. Our study aimed to elucidate COVID-19 vaccine immunogenicity and evaluate adverse events such as hospitalization, rejection, and breakthrough infection in a SOT cohort.

Methods

We performed a prospective, observational study on 539 adult SOT recipients (age ≥18 years old) recruited from 7 Canadian transplant centers. Demographics including transplant characteristics, vaccine types, and immunosuppression and events such as hospitalization, infection, and rejection were recorded. Follow ups occurred every 4–6 weeks postvaccination and at 6 and 12 months from first dose. Serum was processed from whole blood to measure anti-receptor binding domain (RBD) antibodies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to assess immunogenicity.

Results

The COVID-19 vaccines were found to be safe in SOT recipients with low rates of rejection requiring therapy (0.7%). Immunogenicity improved after the third vaccine dose, yet 21% developed no anti-RBD response. Factors such as older age, lung transplantation, chronic kidney disease, and shorter duration from transplant were associated with decreased immunogenicity. Patients with at least 3 doses were protected from hospitalization when experiencing breakthrough infections. Significantly increased anti-RBD levels were observed in patients who received 3 doses and had breakthrough infection.

Conclusions

Three or four doses of COVID-19 vaccines were safe, increased immunogenicity, and protected against severe disease requiring hospitalization. Infection paired with multiple vaccinations significantly increased anti-RBD response. However, SOT populations should continue to practice infection prevention measures, and they should be prioritized for SARS-CoV-2 pre-exposure prophylactics and early therapeutics.
Dicer-like 3a mediates intergenerational resistance against root-knot nematodes in rice via hormone responses
Authors: Meijer Anikó , Atighi Mohammad Reza , Demeestere Kristof , De Meyer Tim , Vandepoele Klaas , Kyndt Tina
Published: April 2023

In a continuously changing and challenging environment, passing down the memory of encountered stress factors to offspring could provide an evolutionary advantage. In this study, we demonstrate the existence of “intergenerational acquired resistance” in the progeny of rice (Oryza sativa) plants attacked by the belowground parasitic nematode Meloidogyne graminicola. Transcriptome analyses revealed that genes involved in defense pathways are generally downregulated in progeny of nematode-infected plants under uninfected conditions but show a stronger induction upon nematode infection. This phenomenon was termed “spring loading” and depends on initial downregulation by the 24-nucleotide (nt) siRNA biogenesis gene dicer-like 3a (dcl3a) involved in the RNA-directed DNA methylation pathway. Knockdown of dcl3a led to increased nematode susceptibility and abolished intergenerational acquired resistance, as well as jasmonic acid/ethylene spring loading in the offspring of infected plants. The importance of ethylene signaling in intergenerational resistance was confirmed by experiments on a knockdown line of ethylene insensitive 2 (ein2b), which lacks intergenerational acquired resistance. Taken together, these data indicate a role for DCL3a in regulating plant defense pathways during both within-generation and intergenerational resistance against nematodes in rice.
Overnight declarative memory consolidation and non-rapid eye movement sleep electroencephalographic oscillations in older adults with obstructive sleep apnea
Authors: Teh Jun Z , Grummitt Lucinda , Haroutonian Carla , Cross Nathan E , Skinner Bradley , Bartlett Delwyn J , Yee Brendon , Grunstein Ronald R , Naismith Sharon L , D’Rozario Angela L
Published: April 2023

Study Objectives

To compare overnight declarative memory consolidation and non-rapid eye movement (NREM) sleep electroencephalogram (EEG) oscillations in older adults with obstructive sleep apnea (OSA) to a control group and assess slow-wave activity (SWA) and sleep spindles as correlates of memory consolidation.

Methods

Forty-six older adults (24 without OSA and 22 with OSA) completed a word-pair associate's declarative memory task before and after polysomnography. Recall and recognition were expressed as a percentage of the morning relative to evening scores. Power spectral analysis was performed on EEG recorded at frontal (F3-M2, F4-M1) and central (C3-M2, C4-M1) sites. We calculated NREM absolute slow oscillation (0.25–1 Hz) and delta (0.5–4.5 Hz) EEG power, and slow (11–13 Hz) spindle density (number of events per minute of N2 sleep) and fast (13–16 Hz) spindle density.

Results

There were no significant differences in overnight recall and recognition between OSA (mean age 58.7 ± 7.1 years, apnea–hypopnea index (AHI) 41.9 ± 29.7 events/hour) and non-OSA (age 61.1 ± 10.3 years, AHI 6.6 ± 4.2 events/hour) groups. The OSA group had lower fast spindle density in the frontal region (p = 0.007). No between-group differences in SWA were observed. In the Control group, overnight recognition positively correlated with slow spindle density in frontal (rho = 0.555, p = 0.020) and central regions (rho = 0.490, p = 0.046). Overnight recall was not related to SWA or spindle measures in either group.

Conclusions

Older adults with OSA had deficits in fast sleep spindles but showed preserved overnight declarative memory consolidation. It is possible that compensatory mechanisms are being recruited by OSA patients to preserve declarative memory consolidation despite the presence of sleep spindle deficits.
Cultivating Sense of Belongingness Among Graduate Nursing Students: A Virtual Fitness Challenge
Authors: Stamm Robyn W. , Davis Lindsay , Gillespie Gordon L. , Lopez Rosado Juan O. , Rota Matthew J.
Published: April 2023

Sense of belongingness in the academic environment has been associated with positive student outcomes and increased student success. To cultivate belongingness, graduate nursing students were invited to participate in a virtual fitness challenge. Sense of belongingness was measured through pre- (n = 103) and post-intervention (n = 64) surveys with three subscales: other students, faculty, and the university. Students reported improved sense of belongingness following the intervention for all subscales, with statistically significant improvements related to other students (p = .007) and the university (p = .023). A virtual fitness challenge may improve sense of belongingness among graduate nursing students.
Cognitive and Noncognitive Factors Influencing Nursing Students’ Academic Success: Structural Equation Model Analysis
Authors: Hollinger-Smith Linda M. , Patterson Barbara J. , Morin Karen H. , Scott Cameron J.
Published: April 2023

AIM

The study aim was to identify and explore relationships among cognitive and noncognitive factors that may contribute to prelicensure baccalaureate nursing students’ academic success across their program of study.

BACKGROUND

Nurse educators are challenged to improve students’ academic success. With limited evidence, cognitive and noncognitive factors have been identified in the literature as potential factors that influence academic success and may support students’ readiness for practice as new graduate nurses.

METHOD

Data sets from 1,937 BSN students at multiple campuses were analyzed using an exploratory design and structural equation modeling.

CONCLUSION

Six factors were conceptualized as contributing equally to the initial cognitive model. The final noncognitive model, with deletion of two factors, yielded the best fit for the four-factor model. Cognitive and noncognitive factors were not significantly correlated. This study provides a beginning understanding of cognitive and noncognitive factors associated with academic success that may support readiness for practice.
Radiofrequency Ablation of Leiomyomas
Authors: Stewart Kelsey A. , Greenberg James A. , Kho Kimberly A. , Cohen Rassier Sarah L.
Published: April 2023

Radiofrequency ablation (RFA) of leiomyomas represents a significant advancement in the treatment of this common uterine condition. In the appropriately selected patient, both laparoscopic and transcervical options provide effective treatment for bleeding and bulk symptoms in a uterine-sparing manner. Compared with other minimally invasive leiomyoma treatment options, RFA procedures have comparable or favorable safety profiles, recovery timelines, and reintervention rates. Data on future fertility and pregnancy are limited, although early reports are promising.
Delaying the Fellowship Start Date in Obstetrics and Gynecology
Authors: Banks Erika , George Karen E. , Doulaveris George , Gressel Gregory M. , Sax Megan , Connolly AnnaMarie
Published: April 2023

OBJECTIVE:

To evaluate residents planning fellowship, their preferences for fellowship start date, and the acceptability of resultant gaps in pay and insurance coverage.

METHODS:

A survey was conducted during the 2022 in-service training examination querying obstetrics and gynecology residents about their desire to pursue fellowship, their preferred fellowship start date (understanding the salary gap), and the acceptability of a medical insurance gap.

RESULTS:

Survey analysis of respondents planning to pursue fellowship demonstrated that, acknowledging the pay gap that would occur, 93.9% preferred a fellowship start date after July 1, with the majority (65.1%, 593/911) preferring an August 1 fellowship start date. Most respondents (87.7%, 798/910) found the potential resultant gap in medical insurance coverage acceptable. Survey data showed that racial and ethnic identity was not a determining factor in either of these issues.

CONCLUSION:

The majority of current residents planning to pursue fellowship prefer a delayed fellowship start date, even if it means a gap in salary and insurance coverage. The results of this study, requested by a specialty-wide, consensus-building workgroup, informed a statement signed by the majority (88.9%) of workgroup constituents supporting an August 1 clinical fellowship start date.
Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis
Authors: Lorange Justin-Pierre , Laverdière Carl , Corban Jason , Montreuil Julien , Harvey Edward J.
Published: April 2023

Objective:

To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both.

Data Sources:

A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used “lower extremity” or “leg” or “tibia” and “compartment syndrome” and “pressure” as the subjects. A manual search of the bibliographies was performed and cross-referenced with those used to formulate the American Academy of Orthopaedic Surgeons clinical practice guidelines.

Study Selection and Extraction:

Inclusion criteria were traumatic tibia injuries, presence of data to calculate the sensitivity, specificity, positive and negative predictive values of clinical findings and/or pressure monitoring, and the presence or absence of compartment syndrome as the outcome. A total of 2906 full articles were found, of which 63 were deemed relevant for a detailed review. Seven studies met all eligibility criteria.

Data Synthesis:

The likelihood ratio form of Bayes theorem was used to assess the discriminatory ability of the clinical findings and ICP monitoring as tests for compartment syndrome. The predictive value for diagnosing acute compartment syndrome was 21% and 29% for the clinical signs and ICP, respectively. When combining both, the probability reached 68%.

Conclusions:

The use of ICP monitoring may be helpful when combined with a clinical assessment to increase the sensitivity and specificity of the overall diagnosis. Previously accepted individual inference values should be revisited with new prospective studies to further characterize the statistical value of each clinical finding.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors and Characteristics of Recalcitrant Osteomyelitis After Initial Surgical and Antibiotic Treatment
Authors: Shah Nihar S. , Kanhere Arun P. , Dowell Evan , Sabbagh Ramsey S. , Bonamer John , Franklin Austin , Sanders Drew T. , Sagi H Claude
Published: April 2023

Objectives:

To evaluate the injury, patient, and microbiological characteristics that place patients at risk for recalcitrant fracture–related infection and osteomyelitis despite appropriate initial treatment.

Design:

Retrospective chart review.

Setting:

Three level I trauma centers.

Patients and Participants:

Two hundred and fifty-seven patients undergoing surgical debridement and antibiotic therapy for osteomyelitis from 2003 to 2019.

Main Outcome Measurements:

Patients were categorized as having undergone serial bone debridement if they had 2 separate procedures a minimum of 6 weeks apart with a full course of appropriate antibiotics in between. Patient records were reviewed for age, injury location, body mass index, smoking status, comorbidities, and culture results including the presence of multidrug-resistant organisms and culture-negative osteomyelitis.

Results:

A total of 257 patients were identified; 49% (n = 125) had a successful single course of treatment, and 51% (n = 132) required repeat debridement for recalcitrant osteomyelitis. At the index treatment for osteomyelitis, the most common organisms in both groups were methicillin-resistant (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). There was no significant difference in incidence of polymicrobial infection between the 2 groups (25% vs. 20%, P = 0.49). The most common organisms cultured at the time of repeat saucerization remained MRSA and MSSA; however, the same organism was cultured from both the index and repeat procedures in only 28% (n = 37) of cases. Diabetic patients, intravenous drug use status, delay to diagnosis, and open fractures of the lower leg are independent risk factors for failure of initial treatment of posttraumatic osteomyelitis.

Conclusions:

Successful eradication of fracture-related infection and posttraumatic osteomyelitis is difficult and fails 51% of the time despite standard surgical and antimicrobial therapy. Although MRSA and MSSA remain the most common organisms cultured, patients who fail initial treatment for osteomyelitis often do not culture the same organisms as those obtained at the index procedure.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Residual coronary artery tree description and lesion EvaluaTion (CatLet) score, clinical variables, and their associations with outcome predictions in patients with acute myocardial infarction
Authors: Xu Mingxing , Wang Shu , Zhang Ying , Zhang Jie , Ma Jin , Shen Junfei , Tang Yida , Jiang Tingbo , He Yongming
Published: April 2023

Background:

We have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score with respect to outcome predictions for acute myocardial infarction (AMI) patients. The current study hypothesized that the residual CatLet (rCatLet) score predicts clinical outcomes for AMI patients and that a combination with the three clinical variables (CVs)—age, creatinine, and ejection fraction, will enhance its predicting values.

Methods:

The rCatLet score was calculated retrospectively in 308 consecutively enrolled patients with AMI. Primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) including all-cause mortality, non-fatal AMI, transient ischemic attack/stroke, and ischemia-driven repeat revascularization, was stratified according to rCatLet score terciles: rCatLet_low ≤3, rCatLet_mid 4–11, and rCatLet_top ≥12, respectively. Cross-validation confirmed a reasonably good agreement between the observed and predicted risks.

Results:

Of 308 patients analyzed, the rates of MACCE, all-cause death, and cardiac death were 20.8%, 18.2%, and 15.3%, respectively. Kaplan–Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the rCatLet score, with P values <0.001 on trend test. For MACCE, all-cause death, and cardiac death, the area under the curves (AUCs) of the rCatLet score were 0.70 (95% confidence intervals [CI]: 0.63–0.78), 0.69 (95% CI: 0.61–0.77), and 0.71 (95% CI: 0.63–0.79), respectively; the AUCs of the CVs-adjusted rCatLet score models were 0.83 (95% CI: 0.78–0.89), 0.87 (95% CI: 0.82–0.92), and 0.89 (95% CI: 0.84–0.94), respectively. The performance of CVs-adjusted rCatLet score was significantly better than the stand-alone rCatLet score in terms of outcome predictions.

Conclusion:

The rCatLet score has a predicting value for clinical outcomes for AMI patients and the incorporation of the three CVs into the rCatLet score will enhance its predicting ability.

Trial Registration:

http://www.chictr.org.cn, ChiCTR-POC-17013536.
Effect of head and neck positions on tracheal intubation using a McGRATH MAC video laryngoscope
Authors: Kim Hyerim , Chang Jee-Eun , Won Dongwook , Lee Jung-Man , Kim Tae Kyong , Kim Min Jong , Min Seong-Won , Hwang Jin-Young
Published: April 2023

BACKGROUND

Different head and neck positions may affect video laryngoscopy in terms of laryngeal exposure, intubation difficulty, advancement of the tracheal tube into the glottis and the occurrence of palatopharyngeal mucosal injury.

OBJECTIVE

We investigated the effects of simple head extension, head elevation without head extension and the sniffing position on tracheal intubation using a McGRATH MAC video laryngoscope.

DESIGN

A randomised, prospective study.

SETTING

Medical centre governed by a university tertiary hospital.

PATIENTS

A total of 174 patients undergoing general anaesthesia.

METHODS

Patients were randomly allocated to one of three groups: simple head extension (neck extension without a pillow), head elevation only (head elevation with a pillow of 7 cm and no neck extension) and sniffing position (head elevation with a pillow of 7 cm and neck extension).

MAIN OUTCOMES

During tracheal intubation using a McGRATH MAC video laryngoscope in three different head and neck positions, we assessed intubation difficulty by several methods: a modified intubation difficulty scale score, time taken for tracheal intubation, glottic opening, number of intubation attempts, requirements for other manoeuvres (lifting force or laryngeal pressure) for laryngeal exposure and advancement of the tracheal tube into the glottis. The occurrence of palatopharyngeal mucosal injury was evaluated after tracheal intubation.

RESULTS

Tracheal intubation was significantly easier in the head elevation group than in the simple head extension (P = 0.001) and sniffing positions (P = 0.011). Intubation difficulty did not differ significantly between the simple head extension and sniffing positions (P = 0.252). The time taken for intubation in the head elevation group was significantly shorter than that in the simple head extension group (P < 0.001). A lifting force or laryngeal pressure was required less frequently for tube advancement into the glottis in the head elevation group than in the simple head extension (P = 0.002) and sniffing position groups (P = 0.012). The need for a lifting force or laryngeal pressure for tube advancement into the glottis was not significantly different between the simple head extension and sniffing positions (P = 0.498). Palatopharyngeal mucosal injury occurred less frequently in the head elevation group than in the simple head extension group (P = 0.009).

CONCLUSION

The head elevation position facilitated tracheal intubation using a McGRATH MAC video laryngoscope compared with a simple head extension or sniffing position.

TRIAL REGISTRY NUMBER

ClinicalTrials.gov (NCT05128968)
Male Pectoralis Major Muscle Augmentation with Autologous Fat Transplantation Using VASER Lipoaspirate: Evaluation with MRI
Authors: Kandulu Hüseyin , Terzibasioglu Ali Ege
Published: April 2023

Background:

The popularity of autologous fat grafts has increased for the reshaping, contouring, and augmentation of the male breast tissue. However, long-term maintenance of tissue viability and the ways for assessment serve as hot-spot topics in the field. This study was designed to evaluate the viability of fat grafts obtained by a vibration amplification of sound energy at resonance (VASER)-assisted lipoaspiration procedure using a magnetic resonance imaging–based approach.

Methods:

This is a prospective examination of 20 male patients (40 breasts) who underwent VASER-assisted liposuction and fat grafting surgery, and long-term fat graft viability was evaluated by magnetic resonance imaging scans.

Results:

Participants had an average age of 34.85 ± 7.37 years with a mean BMI of 26.73 ± 2.63 kg/m2. The mean fat graft volume injected was 542.63 ± 144.78 mL on the right, and 548.95 ± 140.36 mL on the left side. On the magnetic resonance imaging follow-up, the mean intrapectoral adipose tissue thickness was 20.34 ± 6.31 mm on the right, and 18.94 ± 8.27 mm on the left sides and tissue viability was preserved in all cases. The mean follow-up duration was 22 ± 9.8 (range 14-44) months.

Conclusion:

VASER-assisted lipoaspiration and autologous fat grafting of the major pectoralis muscle provide a satisfactory outcome and long-term maintenance of the grafted adipose tissue.
Treatment and Management of Ectrodactyly–Ectodermal Dysplasia–Clefting Syndrome With Scleral Prosthetic Devices
Authors: Labunski Andrea , Carrasquillo Karen G. , Brocks Daniel
Published: April 2023

This case report highlights the unique application and long-term benefits of customized scleral devices in a patient with ocular complications from ectrodactyly–ectodermal dysplasia–clefting (EEC) syndrome over the span of 10 years. A 13-year-old girl with a history of EEC syndrome and ocular manifestations, including severe bilateral dry eye disease, corneal neovascularization and scarring, progressive fibrous pannus, and limbal stem cell deficiency, was examined and fitted with scleral devices. The goal of treatment was to stabilize the ocular surface, enhance vision, and improve ocular comfort. Throughout the course of treatment, there was minimal progression in ocular signs, despite interruptions in scleral device wear from application and removal challenges secondary to ectrodactyly. Customized scleral devices provided an optimal environment to support the ocular surface, improve comfort, and improve visual acuity. Further studies are required to demonstrate the benefits of scleral devices in larger populations of patients with EEC syndrome.
Visco-Circumferential-Suture-Trabeculotomy Versus Rigid-Probe Viscotrabeculotomy in Neonatal-Onset Primary Congenital Glaucoma
Authors: Elwehidy Ahmed S. , Bayoumi Nader H.L. , Elzeini Rasha M. , Abdelkader Amr
Published: April 2023

Précis:

Angle procedures are safe and relatively effective for neonatal onset PCG. Watchful delay in intervention to close to the second month of life is helpful in ensuring diagnosis and making surgery more successful and easier.

Purpose:

The purpose of this study was to compare the surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) to rigid-probe double-entry viscotrabeculotomy (DEVT) and rigid-probe single-entry viscotrabeculotomy (SEVT) in infants with neonatal-onset primary congenital glaucoma (PCG).

Design:

This was a retrospective chart review.

Patients and Methods:

Retrospective chart review of 64 eyes of 64 infants with neonatal-onset PCG referred to Mansoura Ophthalmic Center in Mansoura, Egypt between February 2008 and November 2018. Study groups included VCST, DEVT, and SEVT, and follow-up covered 4 postoperative years. Complete (qualified) success was defined as intraocular pressure (IOP) ≤18 mm Hg and with 35% IOP reduction from baseline without (with) IOP-lowering medications or further surgical interventions, and without any sign of progression in corneal diameter, axial length, or optic disc cupping and without visual devastating complications.

Results:

The mean±SD age at presentation and at the surgery of the study children was 3.63±1.74 and 55.23±1.60 days, respectively. The mean±SD IOP and cup/disc ratio of all study eyes at presentation and at final follow-up were 34.91±0.82 mm Hg and 0.70±0.09 and 17.04±0.74 mm Hg and 0.63±0.08, respectively. Complete success was achieved in 54.5%, 43.5%, and 31.6% in the VCST, DEVT, and SEVT groups, respectively. A self-limited hyphema was the commonest complication in all groups.

Conclusions:

Angle procedures are safe and marginally effective for the surgical treatment of neonatal-onset PCG, bringing IOP under control for at least 4 years of follow-up. Circumferential trabeculotomy as a first-line treatment has more favorable outcomes than rigid-probe SEVT. Rigid-probe viscotrabeculotomy offers an alternative to the noncompleted circumferential procedure.
The Infection Profile and Survival of Children and Adolescents With COVID-19 Undergoing Cancer Treatment: A Cohort Study
Authors: de Andrade-Lima Ana Luiza Magalhães , Lins Mecneide Mendes , Borborema Maria do Céu Diniz , Matos Ana Paula Rodrigues , de Oliveira Kaline Maria Maciel , Gonçalves Mello Maria Júlia
Published: April 2023

Objective:

The objective of this study was to evaluate the clinical evolution of coronavirus disease 2019 (COVID-19) in children and adolescents with cancer.

Methods:

Cohort involving patients undergoing cancer treatment, 19 years old and under, with the diagnosis of COVID-19 by real-time polymerase chain reaction, in a reference hospital, between March 2020 and November 2021. Data were collected from medical records and interviews with patients and/or guardians. The primary outcomes studied were severe/critical COVID-19 presentation, deaths from any cause and overall survival. The Cox proportional hazards multivariate regression analysis was performed to determine the risk of death.

Results:

Sixty-two participants were included, most (67.7%) were male, with a median age of 6.8 years. Severe/critical forms of COVID-19, observed in 24.2%, seemed to indicate that the pediatric population undergoing cancer treatment has a higher morbidity rate than the general pediatric population (8–9.2%). During follow-up (4.5–18 months), 20 patients (32.3%) completed their cancer treatment and 18 died (29%)—6 during hospitalization and 12 after discharge. In total 61.1% of deaths occurred within 63 days of a detectable real-time polymerase chain reaction. Patients with a higher risk of death presented with severe/critical COVID-19 [adjusted hazard risk (aHR): 8.51; 95% confidence interval (CI): 2.91–24.80; P < 0.00] solid tumors (aHR: 3.99; 95% CI: 1.43–11.12; P = 0.008) and diarrhea as a symptom of COVID-19 (aHR: 3.9; 95% CI: 1.23–12.73; P = 0.021).

Conclusions:

These findings support the impact that severe acute respiratory syndrome-associated coronavirus 2 infection has on the population of children and adolescents with cancer, not only regarding immediate severity but also in their survival rate. Further studies evaluating long-term outcomes of COVID-19 in children and adolescents with cancer should be encouraged.
Stridor in Tuberculosis and COVID-19 Coinfection
Authors: Moya-Smith TlalliAztlan , St. Louis Joshua
Published: April 2023

As the SARS-CoV-2 pandemic continues to affect millions across the globe, the risk of coinfection with tuberculosis (TB) threatens patients' health and challenges our diagnostic capabilities. Here, we present a case of TB with pulmonary and laryngeal involvement complicated by coinfection with COVID-19. This case illustrates the importance of laboratory and imaging findings to differentiate between COVID-19 and TB and explores the potential for steroid use in laryngeal TB.
The effect of repetitive topical applications of local anesthetics (EMLA) on experimental pain and itch (histaminergic and nonhistaminergic)
Authors: Aliotta Giulia Erica , Vecchio Silvia Lo , Elberling Jesper , Arendt-Nielsen Lars
Published: April 2023

Background:

The effects of repeated topical applications of local anesthetics are poorly investigated as they may, in addition to analgesia, impact peripheral nerve endings in a cumulative manner. In the present study, the effects of 6 repetitive applications of eutectic mixture of lidocaine (EMLA 2.5% and prilocaine 2.5%) were investigated on experimentally induced pain, histaminergic and nonhistaminergic itch, and neurogenic inflammation.

Methods:

Four skin areas on the forearms of 24 subjects were randomized to receive 3 hours of application of EMLA or placebo twice a day for 3 consecutive days. After each application, superficial blood perfusion (SBP), mechanical (mechanically evoked itch, mechanical pain threshold, and mechanical pain sensitivity), and thermal sensitivity (warm detection threshold, heat pain threshold, and suprathreshold heat sensitivity) were assessed. After the last application of EMLA/placebo, histamine and cowhage was applied (2 areas each) and itch and pain intensity and SBP were assessed.

Results:

After 3 hours of EMLA application, significant mechanical and thermal hypoalgesia were found with no cumulative efficacy over the 3 days. EMLA alone had no effect on SBP. Significantly increased SBP, reduced cowhage-induced itch, but the unaffected histamine-induced itch was found when applying EMLA ahead of histamine and cowhage.

Conclusions:

EMLA induced a reduction of mechanical and thermal sensitivity without a cumulative-dose effect. EMLA reduced nonhistaminergic itch and pain but not the experimentally provoked histaminergic itch. Selective action of EMLA on polymodal C-fibers could explain these effects.
Development of a screening tool for assessment of climate change–related heat illness in the clinical setting
Authors: Bernhardt Jean M. , Breakey Suellen , Cox Rachel , Olayinka Oluwatomisin , Quinn Lisa , Simmonds Katherine , Atkin Kathryn , Sipe Margie , Nicholas Patrice K.
Published: April 2023

Extreme heat contributes to heat-related illnesses resulting from heat intolerance, which is the inability to maintain a thermal balance to tolerate heat stress. In the United States, heat-related mortality for older persons has almost doubled in the past 20 years. Other populations at risk for heat-related illness (HRI) include children, pregnant people, those who work outside, young people participating in outdoor sports, and at-risk populations such as Black, indigenous, and populations of color. The classic heat tolerance test used for decades monitoring physiological responses to repetitive motions is impractical across large and potentially health challenged populations and does not identify environmental or social factors or specific vulnerable populations. To address this issue, we developed a heat-related illness screening tool (HIST) to identify individuals at risk for HRI morbidity and mortality based on their physical, environmental, and social vulnerabilities with an emphasis on populations of concern. The HIST has the potential to be used as routine clinical screening in the same way as other commonly used screening tools. Heat intolerance affects patient outcomes and quality of life; therefore, early screening with a simple, easy-to-administer screening tool such as the HIST can identify people at risk and refer them to services that address heat exposure and/or create safety nets to prevent heat-related illnesses.
Understanding and targeting erythroid progenitor cells for effective cancer therapy
Authors: Wang Qingfei , Poole Rylee A. , Opyrchal Mateusz
Published: April 2023

Purpose of review

It is well described that tumor-directed aberrant myelopoiesis contributes to the generation of various myeloid populations with tumor-promoting properties. A growing number of recent studies have revealed the importance of the previously unappreciated roles of erythroid progenitor cells (EPCs) in the context of cancer, bringing the updated concept that altered erythropoiesis also facilitates tumor growth and progression. Better characterization of EPCs may provide attractive therapeutic opportunities.

Recent findings

EPCs represent a heterogeneous population. They exhibit crucial pro-tumor activities by secreting growth factors and modulating the immune response. Cancers induce potent EPC expansion and suppress their differentiation. Recent single-cell transcriptome and lineage tracking analyses have provided novel insight that tumor-induced EPCs are able to be transdifferentiated into immunosuppressive myeloid cells to limit T-cell function and immunotherapy. Therapeutic strategies targeting key factors of EPC-driven immunosuppression, reducing the amount of EPCs, and promoting EPC differentiation and maturation have been extensively investigated.

This review summarizes the current state of knowledge as to the fascinating biology of EPCs, highlights mechanisms by which they exert the tumor promoting activities, as well as the perspectives on future directions and strategies to target these cells for potential therapeutic benefit.
Long-term Outcomes After Pediatric Mandibular Reconstruction Using Vascularized FreeFibula Flap
Authors: Liu Shuo , Zhang Wen-Bo , Wang Yang , Mao Chi , Yu Guang-Yan , Peng Xin
Published: April 2023

Background:

To evaluate the long-term outcomes of mandibular reconstruction with vascularized free fibula flap in pediatric patients.

Methods:

Consecutive cases of mandibular reconstruction with vascularized free fibula flaps in pediatric patients at Peking University School and Hospital of Stomatology between 1999 and 2019 were reviewed. Postoperative computed tomography (CT) data of all patients were collected at each postoperative follow-up point, and after the age of 18 years. The length and height of the grafted fibula and the length of the remaining mandible were evaluated by measuring the three-dimensional CT data using ProPlan CMF 3.0 software. Lower limb function was evaluated using the Enneking evaluation scale. Facial symmetry was self-evaluated and scored. Statistical analysis was performed on the data obtained.

Results:

Fourteen patients were included in this study. All flaps were successful. The CT measurement results showed growth in the length of the grafted fibula which reconstructed the mandibular ramus and the residual mandible (P < 0.05). The height of the grafted fibula remained stable (P > 0.05). Eight patients were followed-up until > 18 years of age, and the CT measurement results after 18 years showed an essentially symmetrical mandible profile (P > 0.05). All patients were satisfied with their postoperative facial symmetry. Enneking evaluation scores showed good recovery of lower limb functions.

Conclusion:

Vascularized free fibula flap for mandibular reconstruction in pediatric patients is safe and reliable while also providing good cosmetic and functional outcomes as it demonstrated positive growth.
Reconstruction of Concha-type Microtia Using A Delayed Postauricular Skin Flap
Authors: Li Gaofeng , Zhang Bo , Ding Wei , Ouyang Huawei , Long Xiren , Fu Anqi , Liu Xiaojia
Published: April 2023

How to remove and retain the relatively large residual auricle is important for concha-type microtia reconstruction. The authors present a method for concha-type microtia reconstruction using a delayed postauricular skin flap. A total of 40 patients with concha-type microtia who underwent ear reconstruction using a delayed postauricular skin flap were retrospectively examined. Reconstruction was performed in three stages. The first stage consisted of preparation of a delayed postauricular skin flap,and dealing with the residual auricle including removal of the upper residual auricular cartilage. In the second stage, an autogenous rib cartilage framework was placed and covered with a delayed postauricular skin flap, postauricular fascia flap, and autologous medium-thickness skin graft. The ear framework was carefully articulated and secured with the retained residual auricular cartilage in order to achieve a smooth junction between the two.The third stage involved modification of the reconstructed ear. Patients were followed for 12 months after ear reconstruction. All reconstructed auricles had a good appearance, and there was a smooth connection between the reconstructed auricle and the residual ear with similar color as well as a flat and thin scar. All patients were satisfied with the results.
Which Types of Stress Are Associated With Accelerated Biological Aging? Comparing Perceived Stress, Stressful Life Events, Childhood Adversity, and Posttraumatic Stress Disorder
Authors: Bourassa Kyle J. , Caspi Avshalom , Brennan Grace M. , Hall Katherine S. , Harrington HonaLee , Houts Renate , Kimbrel Nathan A. , Poulton Richie , Ramrakha Sandhya , Taylor Gregory A. , Moffitt Terrie E.
Published: April 2023

Objective

Stress and stressful events are associated with poorer health; however, there are multiple ways to conceptualize and measure stress and stress responses. One physiological mechanism through which stress could result in poorer health is accelerated biological aging. This study tested which types of stress were associated with accelerated biological aging in adulthood.

Methods

Studying 955 participants from the Dunedin Longitudinal Study, we tested whether four types of stress assessed from ages 32 to 45 years—perceived stress, number of stressful life events, adverse childhood experiences, and posttraumatic stress disorder—were associated with accelerated biological aging.

Results

Higher levels of all four measures of stress were significantly associated with accelerated aging in separate models. In a combined model, more perceived stress and more stressful life events remained associated with faster aging, and the stress measures explained 6.9% of the variance in aging. The magnitudes of the associations between the four measures of stress and biological aging were comparable to associations for smoking and low education, two established risk factors for accelerated aging. People with high levels of perceived stress, numerous adverse childhood experiences (4+), high stressful life event counts, or posttraumatic stress disorder were aging an additional estimated 2.4 months, 1.1 additional months, 1.4 months, and 1.4 months per year, respectively.

Conclusions

Assessing stress, particularly perceived stress, could help identify people at risk of accelerated aging. Intervening to treat stress or the health-relevant sequelae of stress could potentially slow the rate at which people are aging, improving their health as they age.
Immune Phenotype and Postoperative Complications After Elective Surgery
Authors: Moris Dimitrios , Barfield Richard , Chan Cliburn , Chasse Scott , Stempora Linda , Xie Jichun , Plichta Jennifer K. , Thacker Julie , Harpole David H. , Purves Todd , Lagoo-Deenadayalan Sandhya , Hwang Eun-Sil Shelley , Kirk Allan D.
Published: April 2023

Objectives:

To characterize and quantify accumulating immunologic alterations, pre and postoperatively in patients undergoing elective surgical procedures.

Background:

Elective surgery is an anticipatable, controlled human injury. Although the human response to injury is generally stereotyped, individual variability exists. This makes surgical outcomes less predictable, even after standardized procedures, and may provoke complications in patients unable to compensate for their injury. One potential source of variation is found in immune cell maturation, with phenotypic changes dependent on an individual’s unique, lifelong response to environmental antigens.

Methods:

We enrolled 248 patients in a prospective trial facilitating comprehensive biospecimen and clinical data collection in patients scheduled to undergo elective surgery. Peripheral blood was collected preoperatively, and immediately on return to the postanesthesia care unit. Postoperative complications that occurred within 30 days after surgery were captured.

Results:

As this was an elective surgical cohort, outcomes were generally favorable. With a median follow-up of 6 months, the overall survival at 30 days was 100%. However, 20.5% of the cohort experienced a postoperative complication (infection, readmission, or system dysfunction). We identified substantial heterogeneity of immune senescence and terminal differentiation phenotypes in surgical patients. More importantly, phenotypes indicating increased T-cell maturation and senescence were associated with postoperative complications and were evident preoperatively.

Conclusions:

The baseline immune repertoire may define an immune signature of resilience to surgical injury and help predict risk for surgical complications.