bluuebunny/crossref_metadata_2025 huggingface dataset:
PEDICLE TRANSPOSITION FLAP, INVERTED FLAP, FREE FLAP, AND STANDARD PEEL FOR LARGE FULL-THICKNESS MACULAR HOLES
Authors: Macchi Iacopo , Huelin Fernando J. , Young-Zvandasara Tafadzwa , Di Simplicio Sandro , Kadhim Mustafa R. , Chawla Harshika , Hillier Roxane J.
Published: May 2024

Purpose:

To compare anatomical and functional outcomes of four different techniques for the treatment of large idiopathic full-thickness macular holes.

Methods:

This single-center retrospective study included 129 eyes of 126 patients with large (>500 µm) full-thickness macular holes who presented between January 2018 and October 2022. All patients underwent 23/25 G vitrectomy and gas with standard internal limiting membrane (ILM) peel, pedicle transposition, inverted, or free flap technique. Postoperative optical coherence tomography images were assessed by two independent masked graders.

Results:

Mean age was 73.2 years (SD 8.4) with a median F/U of 5 months (IQR 8). The overall anatomical success rate was 81%; it was significantly lower (59%) for the standard ILM peel (P < 0.0001). The pedicle transposition flap showed superior visual recovery compared with the free flap (+27 vs. +12 ETDRS letters, P = 0.02). At 3 months, restoration of the external limiting membrane was significantly better for the pedicle transposition flap compared with free flap and standard ILM peel (P = 0.008 and P = 0.03) and superior to all the other techniques at 6 months (P = 0.02, P = 0.04, and P = 0.006).

Conclusion:

Standard ILM peel alone offers inferior outcomes for the management of large full-thickness macular holes. Of the alternative ILM techniques, despite similar closure rates, foveal microstructural recovery is most complete following the pedicle transposition flap and least complete following the free flap.
THE IMPACT OF EARLY SURGICAL INTERVENTION ON ANISEIKONIA IN PATIENTS WITH EPIRETINAL MEMBRANE
Authors: Choi Jaehwan , Lim Seul Gi , Kang Se Woong , Kim Sang Jin , Son Ki Young , Hwang Sungsoon
Published: May 2024

Purpose:

To investigate the efficacy of early surgical intervention in ameliorating aniseikonia among patients with epiretinal membrane.

Methods:

This prospective cohort study enrolled patients who underwent surgery for epiretinal membrane. Patients were divided into early (symptom onset within 1 year) and late (symptom onset ≥1 year) treatment groups. Changes in aniseikonia, best-corrected visual acuity, and tangential retinal displacement were assessed and compared at 6 and 12 months postoperatively.

Results:

Of the 56 patients, 30 (53.6%) belonged to the early treatment group and 26 (46.4%) to the late treatment group. The early treatment group demonstrated a significant reduction in aniseikonia score at 6- and 12-month follow-up visits (−1.10 ± 1.50 [P = 0.002] and −1.18 ± 1.79 [P = 0.003], respectively); however, no improvement was observed in the late treatment group (0.98 ± 4.62 [P = 0.310] and 1.52 ± 4.35 [P = 0.124], respectively). The early treatment group showed larger tangential retinal displacement at the 12-month postoperative follow-up visit. In addition, the amount of tangential retinal displacement was associated with postoperative changes in aniseikonia.

Conclusion:

Early surgical intervention is helpful in improving aniseikonia in patients with epiretinal membrane. The degree of recovery in inner retinal displacement was associated with the improvement of aniseikonia.
Combined Amniotic Membrane Graft and Autologous Retinal Transplant for Repair of Refractory Chronic Myopic Macular Holes
Authors: Tauqeer Zujaja , Park Jong , Mahmoud Tamer H.
Published: May 2024

Purpose:

To report a technique for reconstruction of large, persistent, chronic, myopic macular holes using a combined human amniotic membrane graft and autologous retinal transplant (AMN-ART).

Methods:

Three patients with large, myopic macular holes that failed prior surgical attempts and underwent subretinal amniotic membrane graft with overlying autologous retinal transplant and short-term perfluorocarbon tamponade. Pre- and postoperative visual acuity (VA) and images were analyzed at 3, 6, and 9 months.

Results:

All 3 myopic macular holes remained closed at 9 months with resolution of central scotoma. The first case, a 69-year-old female, presented with a persistent macular hole whose minimum linear diameter was 1085 μm. Her pre-op VA of 20/200 improved by 9 months to 20/100. Secondly, a 72-year-old male with history of recurrent retinal detachment repair with silicone oil and persistent macular hole of 1134 μm presented with pre-op VA of 20/200, which was unchanged at 9 months. Lastly, a 76-year-old female with a persistent macular hole of 935 μm with preop VA of 20/80 improved by 9 months post-op to 20/50. No complications were encountered related to the grafts.

Conclusion:

Combined AMN-ART may provide a surgical option for repair of refractory, large, chronic myopic macular holes with underlying atrophy.
Decellularized Descemet Membrane Anterior Keratoplasty With Allogeneic Simple Limbal Epithelial Transplantation for Partial Limbal Stem Cell Deficiency Following Partial Keratolimbal Allograft Failure
Authors: Cheung Albert Y. , Reinisch Cameron B. , Hou Joshua H.
Published: May 2024

Purpose:

The purpose of this study was to describe the use of Descemet membrane anterior keratoplasty (DMAK) with modified allogeneic simple limbal epithelial transplantation to treat a case of partial limbal stem cell deficiency (LSCD) following keratolimbal allograft failure.

Methods:

Case report.

Results:

A 21-year-old woman with autoimmune polyglandular syndrome–related LSCD presented with pain and decreased vision. There was partial failure and recurrence of LSCD after a severe/acute keratolimbal allograft rejection that led to persistent epithelial defects refractory to conservative therapy. This was treated with a superficial keratectomy and placement of a DMAK. A modified allogeneic simple limbal epithelial transplantation was performed with an overlying amniotic membrane and temporary tarsorrhaphy. There was epithelialization of the corneal surface by 3 to 4 weeks with an improved ocular surface. Despite partial recurrence of late staining, the cornea has remained epithelized, vision has improved, and the patient has remained pain-free more than 1.5 years following the procedure.

Conclusions:

DMAK may be a long-term substrate to help improve and maintain epithelization of the cornea up to 1.5 years. DMAK may be a viable alternative to using amniotic membrane as a scaffold in allogeneic simple limbal epithelial transplantation for treatment of partial LSCD. While late epithelial staining recurred in our patient, DMAK appears to prevent recurrent epithelial defects and reduce ocular surface pain, conveying an improvement in quality of life in patients at high risk of rejection/failure.
Comparison of Weaning Strategies in Patients Receiving Venovenous Extracorporeal Membrane Oxygenation: An Exploratory Retrospective Study
Authors: Nagler Bernhard , Buchtele Nina , Hermann Alexander , Robak Oliver , Bojic Andja , Schellongowski Peter , Staudinger Thomas
Published: May 2024

Venovenous extracorporeal membrane oxygenation (VV ECMO) facilitates the reduction of mechanical ventilation (MV) support in acute respiratory failure. Contrary to increasing evidence regarding its initiation, the optimal timing of VV ECMO weaning in interaction with MV weaning is undetermined. In this retrospective study, 47 patients who received VV ECMO between 2013 and 2021 and survived ≥1 day after ECMO cessation were divided according to their MV status before ECMO removal: 28 patients were classified into an “ECMO weaning during assisted MV/spontaneous breathing” group and 19 into an “ECMO weaning during controlled MV” group. Extracorporeal membrane oxygenation duration was longer in the “assisted MV/spontaneous breathing” group (17 [Interquartile range (IQR) = 11–35] vs. 6 [5–11] days, p < 0.001). These patients had a longer intensive care unit (ICU) stay after ECMO start (48 [29–66] vs. 31 [15–40] days, p = 0.01). No significant differences were found for MV duration after ECMO start (30 [19–45] vs. 19 [12–30] days, p = 0.06) and further ICU survival (86% vs. 89%, p ≥ 0.9). There was a trend toward more patients with mechanical ECMO complications in the “assisted MV/spontaneous breathing” group (57% vs. 32%, p = 0.08). Thus, our results suggest a possible benefit of early ECMO weaning during controlled MV.
Association of apolipoprotein B and apolipoprotein A1 levels with social determinants of health and coronary artery disease mortality in the United Kingdom Biobank – is there a need for consideration?
Authors: Füller David , Liu Chang , Desai Shivang R. , Vatsa Nishant , Sun Yan V. , Quyyumi Arshed A.
Published: May 2024

Background

A higher prevalence of cardiovascular risk factors has previously been shown to be associated with adverse social determinants of health (SDoH) and to explain some of their impact on cardiovascular risk. Whether there is a relationship between lipid parameters, specifically apolipoprotein B (apoB), apolipoprotein A1 (apoA1), their ratio (apoB/apoA1), and SDoH, and whether coronary artery disease (CAD) mortality risk associated with circulating apoB and apoA1 is modified by SDoH was unclear.

Methods

We investigated associations of apoA1, apoB, and apoB/apoA1 with the level of education and household income and their joint impact on CAD mortality in participants of the UK Biobank (UKB) with and without prevalent CAD at enrollment. Hazard ratios for CAD mortality were estimated after adjusting for SDoH and clinical covariates.

Results

In 292 804 participants without established CAD, apoB, and the apoB/apoA1 ratio were inversely associated with level of education and household income, whereas apoA1 was positively associated with household income. Adjustment for education level and household income coupled with the number of people living in the household did not attenuate the association between the apolipoprotein levels and incident CAD mortality rates. In a cohort of 13 826 participants with prevalent CAD, apoA1 levels were inversely associated with level of education. Higher apoB levels were only associated with greater CAD mortality risk after adjustment for risk factors. Risk estimation for CAD death through circulating apoA1 levels requires accounting for significant differences by sex.

Conclusion

Circulating lipid parameters are associated with SDoH in individuals without CAD. CAD mortality risk estimation through apoA1 and apoB levels does not require accounting for SDoH.
Nutrition support, carbohydrate feeding and insulin sensitivity in the critically ill patient: a complex relationship
Authors: Doola Ra’eesa , Dupuis Claire , Preiser Jean-Charles
Published: May 2024

Purpose of review

This review aims to summarize recent studies that highlight the complex relationship between nutrition, carbohydrate, insulin provision and glycaemic control in the critically ill patient population.

Recent findings

Results of observational studies concur to support early hypoglycaemia and persisting hyperglycaemia as life-threatening events. In contrast, interventional studies indicate that early macronutrient restriction appears to reduce the benefits related to insulin therapy. This restriction is however associated with improved outcomes in itself. The potential role of modified enteral solutions as an adjunctive treatment to attenuate hyperglycaemia warrants further research. The selection of a therapeutic modality may also differ according to the characteristics of the setting, such as the nurse-to-patient ratio, the type and accuracy of meters, including near-continuous glucose monitoring and the availability of computer-guided protocols.

There appears to be significant interplay between nutrition, including carbohydrate provision, blood glucose control and clinical outcomes. Individualized care is probably needed to define the optimal glucose target and nutritional intervention. This can differ according to the preexistence of chronic hyperglycaemia, the timing from the onset of critical illness and the clinical condition itself.
The role of telehealth in the delivery of oral and maxillofacial surgery services at a level 6 hospital in New South Wales Australia during COVID-19 – the John Hunter Hospital experience: a commentary, review and cautionary tale for the future
Authors: Welham Annabelle , Tan-Gore Eileen , Taylor Rebekah
Published: May 2024

Purpose of review

The objective of this article is to understand the uptake in use of Telehealth services during the COVID-19 pandemic as a way to provide compelling impetus for further research and promotion of Telehealth in general. A data review of Outpatient Department data from 2020 to 2023, as compiled by the Surgical Outcomes improvement Unit.

Recent findings

Telehealth was widely adopted during the COVID-19 pandemic for clinicians to provide healthcare to patients whilst adhering to strict lockdown guidelines aimed at limiting exposure and spread of the respiratory virus. There has been minimal analysis, however, of the ethical and legal implications of telemedicine. Whilst it seems that access to care is improved via telehealth, there are subtle, inherent barriers intrinsic to it.

There was a significant increase in the use of audio and audiovisual aids in the delivery of Oral and Maxillofacial Outpatient care during the COVID-19 period. Further analysis and improvements need to be made to the system before it can be considered as sufficient and adequate. Where there is rapid adoption of Telehealth in the delivery of Oral and Maxillofacial Surgery Services, there must be concurrent rigorous review and update of systems in order to address the key areas of patient safety and accuracy of treatment.
From Institution to Community
Authors: Granek Barry , Barberio Angelo , Mattel Pamela
Published: May 2024

Purpose/Objective:

Coordinated Behavioral Care began using its Pathway Home program to serve a subset of New York State Adult Home Settlement class members. Through its multidisciplinary team approach, Pathway Home is utilizing its multiphase model in assisting individuals with Serious Mental Illness leaving an Adult Home to successfully transition and remain in the community.

Primary Practice Setting:

The Pathway Home program is a community-based service and serves class members wherever is needed to assist in their recovery and transition from an Adult Home. This includes meeting class members in Adult Homes and various settings in the community.

Findings/Conclusions:

The New York State Adult Home Settlement presents a variety of systemic, care management, and individual member challenges. Adding the Pathway Home approach to an already existing, yet insufficient care management model strengthens the initiative's goal to transition and retain members safely into the community. Through the approach's adaptability and flexibility in providing community-based care, Pathway Home's successful cross-system collaboration is worthy of replication for other high need populations.

Implications for Case Management Practice:

A programmatic review for Pathway Home Adult Home+ teams gleaned the following key points for the field to consider in future care management practices. Class member self-efficacy and cross-system collaboration are essential in facilitating a class member's move into the community. Member choice and educating class members on their rights to move and options as well as community exposure prior to transition are important in assessing how a member fares outside of the Adult Home. Members determining their own care can reduce the risk of adverse outcomes and reinstitutionalization. Current low-touch care management programs are insufficient for members with complex needs living in institutions. These care management programs need to be augmented with a whole person approach, delivered by a multidisciplinary team.
Nurses’ knowledge, Practice, and Associated Factors Towards Adult Palliative Care
Authors: Agena Ayele , Atinafu Ataro Bizuayehu , Endrias Eshetu Elfios , Birhan Belete , Borie Yacob Abriham , Bekele Gezahegn , Molla Ezedin , Samuel Tinbete , Yeheyis Tomas , Melesse Ayantu , Banga Debora
Published: May 2024

The demand for palliative care is increasing rapidly, but inadequate knowledge and practice remain a significant issue. This study aimed to assess nurses' knowledge, practice, and associated factors toward adult palliative care. A cross-sectional study was conducted including 277 randomly selected nurses from May through September 2021. The data related to knowledge were gathered using the Palliative Care Quiz for Nursing, and an observational checklist to assess the practice was used. EpiData and SPSS software were used for data entry and analysis, respectively. Descriptive statistics and bivariable and multivariable analyses were also applied. Depending on the value of the adjusted odds ratio with a 95% confidence level, statistical significance was declared at a P value of .05. Findings showed that 43.2% and 47% of nurses had good knowledge and practice in palliative care, respectively. The odds of trained nurses having good knowledge were 9.65 times higher than those who did not. There were 2.7 times more odds of practicing palliative care among nurses with good knowledge than those with poor knowledge. Overall, over half of the nurses have poor knowledge and practice in palliative care. To enhance their knowledge and practice, formal palliative care education and training will be beneficial.
Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit
Authors: Lim Czer Anthoney Enriquez , Bailey Jennifer , Oh Julie , Ibia Imikomobong , Eiting Erick , Barnett Barbara , Calderon Yvette , Cowan Ethan
Published: May 2024

Objectives

Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated.

Methods

In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model.

Results

One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7–27.1) for observation and 43.2 hours (95% CI, 37.8–48.6) for inpatient (P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0–38.6) for observation and 48.1 hours (95% CI, 42.2–54.0) for inpatient (P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07–2.42) fold shorter time to discharge among children admitted to observation compared with inpatient (P = 0.02) and a 1.70 (95% CI, 1.07–2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses (P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department.

Conclusions

These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.
Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns
Authors: Fortin Kristine , Wood Joanne N. , Udell Sean M. , Christian Cindy W.
Published: May 2024

Objectives

The aims of this study were to describe chief complaints provided at emergency department triage for young children ultimately given a diagnosed with injuries concerning for physical abuse and compare chief complaints by hospital child protection team assessment (abuse most likely, accident most likely, undetermined) among children younger than 2 years who were the subject of a report to child protective services.

Methods

This is a retrospective review of children evaluated by the child protection team at an urban children's hospital over a 5-year period. Children younger than 2 years who were the subject of a report to child protective services for suspected physical abuse were included. Chief complaints noted in emergency department triage notes were categorized as follows: 1, medical sign or symptom; 2, accidental trauma incident; 3, identified injury; 4, concern for abuse; or 5, multiple unrelated complaints. Child protection team assessments were categorized as follows: 1, abuse most likely; 2, accident most likely; or 3, undetermined. We used descriptive statistics and tests of association (χ2, Fisher exact, Kruskal-Wallis).

Results

Median age of the 422 children included was 4.9 months. Child protection team assessment was abuse most likely in 44%, accident most likely in 23%, and undetermined in 34%. Chief complaints in the overall sample were 39% medical, 29% trauma incident, 16% injury, 10% abuse concern, and 6% multiple unrelated. When the abuse most likely and accident most likely groups were compared, medical chief complaints were more common in the former (47% vs 19%, P < 0.001), whereas trauma incident chief complaints were more common in the latter (19% vs 64%, P < 0.001). Most common medical complaints in the abuse most likely group were altered mental status, abnormal limb use, swelling, pain, apnea, and vomiting.

Conclusion

Many children found to have injuries concerning for abuse (47%) present without mention of trauma, injury, or abuse concern as part of the chief complaint. Our findings suggest important topics to include in training physicians about recognition of abuse.
Characterizing Point-of-Care Ultrasound Credentialing in Pediatric Emergency Departments
Authors: Brant Julia Aogaichi , D'Amico Beth , Orsborn Jonathan , Toney Amanda G. , Lam Samuel H.F. , Mickley Megan , Ambroggio Lilliam
Published: May 2024

Objective

It is unclear which pediatric emergency departments (PEDs) have a point-of-care ultrasound (POCUS) credentialing process or if this process is consistent per expert guidelines. Our objective was to describe formalized POCUS credentialing processes across PEDs that are active in the pediatric emergency medicine POCUS (P2) Network.

Methods

A survey was developed from nationally recommended credentialing guidelines. This anonymous survey was sent out to the P2 Network comprising more than 230 members involved in pediatric POCUS. The survey was analyzed using descriptive analysis with counts and percentages.

Results

A total of 36 PEDs responded to the survey. All departments had a faculty member in charge of maintaining the credentialing process, and all faculty members had POCUS education available; 88.6% of education was scheduled didactics or bedside teaching. There were 80.6% of PEDs that had a process for internally credentialing faculty. Some PEDs offered protected education for POCUS, however, 44.8% had <50% of their faculty credentialed. There were 4 PEDs that offered incentives for completion of POCUS credentialing including salary bonuses; only 1 offered shift buy down as incentive. That PED had 100% of its faculty credentialed. All PEDs performed quality assurance on POCUS scans done in the ED, most done weekly. Billing for scans occurred in 26 PEDs. Skin/soft tissue and focused assessment with sonography for trauma were the 2 most common applications credentialed.

Conclusions

Among PEDs surveyed, there was a lack of standardization of POCUS resources and components of credentialing. Incentives may be beneficial in improving credentialing faculty and standardizing the credentialing process.
Impact of a Strategy for Improving Early Management of Acute Pain in the Pediatric Emergency Department
Authors: Storch-De-Gracia Pilar , Salido Débora , Molina Alberto , Notario Javier , Tubal Perez-Perez Jose
Published: May 2024

Objectives

The objective of this study was to measure the impact of an intervention on pain treatment in a pediatric emergency department (ED). The application of interventions to improve pain management in DE has demonstrated diverse effects so far, most of them successful.

Methods

This is a quasi-experimental before-and-after, longitudinal, prospective study.

Patients were collected between January 2020 and December 2021. Principal outcome was the number of patients with moderate or severe pain who received analgesia before 30 minutes to the ED arrival. The intervention consisted of several training sessions for nursing staff, pediatricians, and trauma physicians.

Results

A total of 515 patients were enrolled, 230 during preintervention period and 285 during postintervention period. The percentage of patients receiving analgesia before 30 minutes increased from 24% to 29% and before 60 minutes increased from 31% to 42%. Time to analgesia administration decreased from 43 to 39 minutes.

Only 254 patients (49%) received analgesia at some point during their stay in the ED, 137 (26.6%) before 30 minutes and 193 (37.5%) before 60 minutes. The probability of receiving analgesia was greater in patients seen by a pediatrician rather than an orthopedist (59%–37%). Metamizole was the most commonly used drug (48%), followed by ibuprofen and acetaminophen.

Conclusions

The application strategies to enhance early pain treatment in the ED can improve analgesia administration. Training strategies aimed at healthcare personnel working in the ED can change the way they work and achieve clear benefits for the patient. The treatment of pain in the ED should begin as soon as possible, and in this objective, the involvement of the nursing staff is a priority, because they are the professional who has the best opportunity for the detection and treatment of pain from the moment of triage.
Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency
Authors: Shahi Niti , Meier Maxene , Reppucci Marina L. , Pickett Kaci L. , Phillips Ryan , McLean Marissa , Moulton Steven L. , Lindberg Daniel M.
Published: May 2024

Objectives

Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs.

Methods

A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019–10/2/2019 vs 10/3/2019–3/31/2020). The main outcome was ED length of stay in minutes.

Results

There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, −1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods.

Conclusions

Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
Is Serratus Posterior Superior Intercostal Plane Block a Novel Indication for the Management of Pain in Thoracic Acute Herpes Zoster? A Case Report
Authors: Balcı Fatih , Tekcan Muhammed Nail , Gündoğdu Oğuz , Avcı Onur
Published: May 2024

Postherpetic neuralgia results from varicella-zoster virus reactivation post–chickenpox infection, manifesting as persistent and severe pain lasting a minimum of 3-mo post–herpes zoster onset. Traditional postherpetic neuralgia management comprises antiviral, analgesic medications, corticosteroids, and various agents. Ultrasound-guided nerve blocks have recently emerged as a promising postherpetic neuralgia treatment. In a case involving a 58-year-old man with severe thoracic herpes zoster lesions, the serratus posterior superior intercostal plane block was employed under ultrasound guidance, significantly reducing pain scores and enhancing quality of recovery. This study underscores serratus posterior superior intercostal plane block’s secure, effective role in managing thoracic herpes zoster, and mitigating postherpetic neuralgia risk. This case report represents the pioneering application of serratus posterior superior intercostal plane block for postherpetic neuralgia, offering a promising avenue for relieving patients suffering from this condition.
Predictors of Spasticity 3–6 Mos After Stroke
Authors: McIntyre Amanda , Teasell Robert , Saikaley Marcus , Miller Thomas
Published: May 2024

Objective

The aim of the study is to identify predictors of poststroke spasticity (modified Ashworth Scale scores, ≥1) at 3–6 mos after stroke.

Design

A 5-yr (2015–2020) retrospective cohort of patients who attended inpatient stroke rehabilitation in Southwestern Ontario, Canada, were included. Sociodemographic, clinical, stroke-related, rehabilitation-related, and outcome measure data were extracted from paper charts and electronic databases.

Results

Of the 922 individuals attending inpatient stroke rehabilitation, 606 (55.8% males; mean age = 70.9 ± 14.2 yrs) returned for an outpatient visit. Most patients had a first ever (n = 518; 85.5%), ischemic (n = 470; 77.6%) stroke with hemiplegia (n = 449, 74.1%). A total of 20.3% (n = 122) of patients had developed poststroke spasticity by 4 mos after stroke. A binary logistic regression significantly predicted poststroke spasticity (χ2(6) = 111.696, P < 0.0001) with good model fit (χ2(8) = 12.181, P = 0.143). There were six significant poststroke spasticity predictors: hemorrhagic stroke (P = 0.049), younger age (P < 0.001), family history of stroke (P = 0.015), Functional Independence Measure admission score (P < 0.001), use of selective serotonin reuptake inhibitors (P = 0.044), and hemiplegia (P < 0.001).

Conclusions

Patients should be monitored closely for poststroke spasticity after discharge from stroke rehabilitation and throughout the care continuum.
Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study
Authors: Sobrero Federica , Roccia Fabio , Omedè Michela , Merlo Francesca , Dubron Kathia , Politis Constantinus , Rabufetti Alessandro , Scolozzi Paolo , Ramieri Guglielmo , Birk Anže , Vesnaver Aleš , Rizvi Ali O. , Laverick Sean , Jelovac Drago , Konstantinovic Vitomir S. , Vilaplana Valentines , Roig Antonio Mari , Goetzinger Maximilian , Bottini Gian Battista , Knežević Predrag , Dediol Emil , Kordić Mario , Sivrić Anamaria , Derkuş Fatma Eriş , Yilmaz Utku Nezih , Ganasouli Dimitra , Zanakis Stylianos N.
Published: May 2024

Purpose:

The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF).

Material and Methods:

This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded.

Results:

Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced (P=0.01) and comminuted (P=0.03) fractures and with the number of nonsurgically treated fracture sites (P=0.002). The angle was the only site associated with nonrigid osteosynthesis (P<0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type.

Conclusion:

Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.
Central venous-to-arterial carbon dioxide partial pressure difference as a guiding parameter for cardiotonic drug administration in patients with early-stage septic shock
Authors: Qu Ya-Qian , Shen Xiao-Hui , Zhao Qian , Guo Hui , Li Xu-Rui , Li Jian-Guo , Zang Hui-Ling , Qin Jing
Published: May 2024

Objective

This study aimed to investigate the effect of the central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO2) on the administration of cardiotonic drugs in patients with early-stage septic shock.

Methods

A retrospective study was conducted on 120 patients suffering from septic shock. At admission, the left ventricular ejection fraction (LVEF) and Pcv-aCO2 of the patients were obtained. On the premise of mean arterial pressure (MAP) ≥ 65 mmHg, the patients were divided into two groups according to the treatment approaches adopted by different doctors—Control group: LVEF ≤50%; Observation group: Pcv-aCO2 ≥ 6. Both groups received cardiotonic therapy.

Results

The two groups of patients had similar general conditions and pre-resuscitation conditions (P > 0.05). Compared to the Control group, the Observation group had a higher MAP, Lac clearance rate, and urine output after six hours of resuscitation (P < 0.05), but a lower absolute value of Lac, total fluid intake in 24 hours, and a lower number of patients receiving renal replacement therapy during hospitalization (P < 0.05). After six hours of resuscitation, the percentages of patients meeting central venous oxygen saturation and central venous pressure targets were not significantly different between the Control and Observation groups (P > 0.05). There was no difference in the 28-day mortality rate between the two groups (P > 0.05).

Conclusion

Pcv-aCO2 is more effective than LVEF in guiding the administration of cardiotonic drugs in the treatment of patients with septic shock.
A formal model accounting for measurement reliability shows attenuated effect of higher education on intelligence in longitudinal data
Authors: Eriksson Kimmo , Sorjonen Kimmo , Falkstedt Daniel , Melin Bo , Nilsonne Gustav
Published: May 2024

The effect of higher education on intelligence has been examined using longitudinal data. Typically, these studies reveal a positive effect, approximately 1 IQ point per year of higher education, particularly when pre-education intelligence is considered as a covariate in the analyses. However, such covariate adjustment is known to yield positively biased results if the covariate has measurement errors and is correlated with the predictor. Simultaneously, a negative bias may emerge if the intelligence measure after higher education has non-classical measurement errors as in data from the 1970 British Cohort Study that were used in a previous study of the effect of higher education. In response, we have devised an estimation method that used iterated simulations to account for both classical measurement errors in the covariate and non-classical errors in the dependent variable. Upon applying this method in a reanalysis of the data from the 1970 British Cohort Study, we find that the estimated effect of higher education diminishes to 0.4 IQ points per year. Additionally, our findings suggest that the impact of higher education is somewhat more pronounced in the initial 2 years of higher education, aligning with the notion of diminishing marginal cognitive benefits.
High-order homogenization of the time-modulated wave equation: non-reciprocity for a single varying parameter
Authors: Touboul Marie , Lombard Bruno , Assier Raphael C. , Guenneau Sebastien , Craster Richard V.
Published: May 2024

Laminated media with material properties modulated in space and time in the form of travelling waves have long been known to exhibit non-reciprocity. However, when using the method of low-frequency homogenization, it was so far only possible to obtain non-reciprocal effective media when both material properties are modulated in time, in the form of a Willis-coupling (or bi-anisotropy in electromagnetism) model. If only one of the two properties is modulated in time, while the other is kept constant, it was thought impossible for the method of homogenization to recover the expected non-reciprocity since this Willis-coupling coefficient then vanishes. Contrary to this belief, we show that effective media with a single time-modulated parameter are non-reciprocal, provided homogenization is pushed to the second order. This is illustrated by numerical experiments (dispersion diagrams and time-domain simulations) for a bilayered modulated medium.
Institutional complexity emerges from socioecological complexity in small-scale human societies
Authors: Hamilton Marcus J. , Walker Robert S. , Buchanan Briggs
Published: May 2024

Human lifestyles vary enormously over time and space and so understanding the origins of this diversity has always been a central focus of anthropology. A major source of this cultural variation is the variation in institutional complexity: the cultural packages of rules, norms, ontologies and expectations passed down through societies across generations. In this article, we study the emergence of institutions in small-scale societies. There are two primary schools of thought. The first is that institutions emerge top-down as rules are imposed by elites on their societies in order to gain asymmetrical access to power, resources and influence over others through coercion. The second is that institutions emerge bottom-up to facilitate interactions within populations as they seek collective solutions to adaptive problems. Here, we use Bayesian networks to infer the causal structure of institutional complexity in 172 small-scale societies across ethnohistoric western North America reflecting the wide diversity of indigenous lifestyles across this vast region immediately prior to European colonization. Our results suggest that institutional complexity emerges from underlying socioecological complexity because institutions are solutions to coordination problems in more complex environments where human–environment interactions require increased management.
Harnessing Internet Search Data as a Potential Tool for Medical Diagnosis
Authors: Downing Gregory J. , Tramontozzi Lucas M. , Garcia Jackson , Villanueva Emma
Published: May 2024

Objectives

To explore the potential and challenges of utilizing internet search data in medical diagnosis, focusing on ethical, technical, and policy considerations by assessing the current state of research, identifying gaps and limitations, and proposing future research directions to advance this emerging field.

Methods

A comprehensive analysis of peer-reviewed literature and informational interviews with subject matter experts was conducted to examine the landscape of internet search data utilization in medical research. Searchers were performed for published peer-reviewed literature in PubMed (October to December 2023).

Results

Systematic selection according to predefined criteria resulted in the inclusion of 43 articles of the 2,499 identified citations. The analysis revealed a nascent domain of internet search data research in medical diagnosis, characterized by advancements in analytics and data integration. Although significant challenges such as bias, data privacy, and infrastructure limitations hinder widespread adoption, emerging initiatives could reshape data collection methodologies and privacy safeguards.

Conclusions

Signals correlating with diagnostic considerations have been identified in certain diseases and conditions, indicating the potential for such data to enhance clinical diagnostic capabilities. However, leveraging internet search data for improved early diagnosis and healthcare outcomes requires effectively addressing ethical, technical, and policy challenges. By fostering interdisciplinary collaboration, advancing infrastructure development, and prioritizing patient engagement and consent, researchers can unlock the transformative potential of internet search data in medical diagnosis to ultimately enhance patient care and advance healthcare practice and policy.
A 360º View for Large Language Models: Early Detection of Amblyopia in Children using Multi-View Eye Movement Recordings
Authors: Upadhyaya Dipak P. , Shaikh Aasef G. , Cakir Gokce Busra , Prantzalos Katrina , Golnari Pedram , Ghasia Fatema F. , Sahoo Satya S.
Published: May 2024

Amblyopia is a neurodevelopmental visual disorder that affects approximately 3-5% of children globally and it can lead to vision loss if it is not diagnosed and treated early. Traditional diagnostic methods, which rely on subjective assessments and expert interpretation of eye movement recordings presents challenges in resource-limited eye care centers. This study introduces a new approach that integrates the Gemini large language model (LLM) with eye-tracking data to develop a classification tool for diagnosis of patients with amblyopia. The study demonstrates: (1) LLMs can be successfully applied to the analysis of fixation eye movement data to diagnose patients with amblyopia; and (2) Input of medical subject matter expertise, introduced in this study in the form of medical expert augmented generation (MEAG), is an effective adaption of the generic retrieval augmented generation (RAG) approach for medical applications using LLMs. This study introduces a new multi-view prompting framework for ophthalmology applications that incorporates fine granularity feedback from pediatric ophthalmologist together with in-context learning to report an accuracy of 80% in diagnosing patients with amblyopia. In addition to the binary classification task, the classification tool is generalizable to specific subpopulations of amblyopic patients based on severity of amblyopia, type of amblyopia, and with or without nystagmus. The model reports an accuracy of: (1) 83% in classifying patients with moderate or severe amblyopia, (2) 81% in classifying patients with mild or treated amblyopia; and (3) 85% accuracy in classifying patients with nystagmus. To the best of our knowledge, this is the first study that defines a multiview prompting framework with MEAG to analyze eye tracking data for the diagnosis of amblyopic patients.
The combination ofSPP1knockdown and gemcitabine treatment enhances apoptosis and reduces invasiveness of pancreatic cancer cells
Authors: Xelwa Ntombikayise , Naicker Previn , Omoshoro-Jones Jones , Devar John , Smith Martin , Candy Geoffrey , Augustine Tanya Nadine , Nweke Ekene Emmanuel
Published: May 2024

Background

Pancreatic ductal adenocarcinoma (PDAC) is poised to be a leading cause of cancer-related deaths. Despite developing new treatment strategies, patient outcomes have not significantly improved. Chemoresistance has been implicated as a major contributor to ineffective treatments observed with studies suggesting combination therapy targeting multiple pathways. This study explored dysregulated genes in tumours of PDAC patients to identify targets which could be used effectively in combination with conventional therapy against cancer cells.

Methods

In this study, PCR arrays were used for gene expression profiling of tumours obtained from South African PDAC patients to identify key differentially expressed pathways and potentially new therapeutic target genes.SPP1was selected and RNA interference was used to knock the gene down. Migration and apoptosis assays were used to evaluate the effect of the knockdown, alone and in combination with gemcitabine, on a pancreatic cancer cell line, MIA PaCa-2. Proteomic analysis using SWATH-MS was used to demonstrate potential molecular mechanisms linked to the morphological and phenotypical effects observed with treatment.

Results

We demonstrated several genes linked to the growth factor and signal transduction signalling pathways, and identifiedSPP1as a target. We observed that by combiningSPP1knockdown with conventional chemotherapy, gemcitabine, resulted in a synergistic effect, leading to an enhanced early apoptotic response. A decline of migratory and invasive capabilities of MIA PaCa-2 cells was observed upon subjecting the cancer cells toSPP1reduction and gemcitabine treatment. Furthermore, proteomic analyses uncovered several pathways that were dysregulated by the combination therapy including both pro-and anti-tumorigenic ones.

Conclusion

The study findings indicate thatSPP1could be a potential therapeutic target for PDAC, and the possible synergistic effects observed whenSPP1knockdown was combined with gemcitabine treatment suggest a potential avenue for developing more effective treatments for PDAC while exploring tumour cell adaptation for survival.
Dietary preference and susceptibility to type 2 diabetes mellitus: a wide-angle Mendelian randomization study
Authors: Lee Mia D. , Voight Benjamin F.
Published: May 2024

Background

Susceptibility to type 2 diabetes mellitus (T2D) is driven by genetic and environmental risk factors. Dietary preferences are a modifiable and largely environmental risk factor for T2D. The role of diet in disease liability has been limited to observational and epidemiologic studies with mixed findings.

Objective

To clarify the role of diet on susceptibility to T2D using genetic variants associated dietary preferences.

Methods

We collected genome-wide association data for 38 dietary preference traits plus T2D and 21 related cardiometabolic traits. We performed Mendelian randomization (MR) using genetic variants to test causal hypotheses between diet as the exposure and T2D or cardiometabolic traits as outcomes using univariable and multivariable methods along with the MR Robust Adjusted Profile Score (MR-RAPS) approach to increase power. We performed mediation analyses to evaluate the effects of dietary preferences on T2D to elucidate potential causal graphs and estimate the effects of dietary preferences mediated by potential mediators.

Results

We report 17 significant relationships between dietary preferences and T2D or a cardiometabolic risk factor (Bonferroni-corrected P < 5.99 x 10-5), including that higher intake of cheese, dried fruit, muesli, or fat-based spreads protected against T2D. We detected 7 additional associations (Bonferroni-corrected P < 1 x 10-4), with inclusion of additional genetic variants in MR-RAPS analysis. In multivariable MR, we discovered that body mass index (BMI) was a common, shared mediator for many of these observed associations. In mediation analysis, we confirmed that substantial proportions of the protective effects of cheese, dried fruit and muesli intakes on T2D were mediated by BMI. We further observed that educational attainment was an additional mediator exclusively for muesli intake-T2D association.

Conclusions

Our results provide genetic evidence supporting a link between diet and body weight, and are in line with observation of obesity and T2D in individuals and their specific preferences for food.