bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Vulnerability Index and Health Outcomes in the United States
Authors: Higginbotham J. Kimberly , Segovia Laura M. , Rohm Kristi L. , Anderson Cindy M. , Breitenstein Susan M.
Published: January 2025

The Centers for Disease Control and Prevention created the Social Vulnerability Index (SVI) for the purpose of allocating resources in times of emergency based on social determinants of health (SDOH). The purpose of this systematic review was to evaluate how the SVI tool has been applied in health care literature focused on health in the United States (US). A systematic literature review was conducted in 7 research databases with an 11-year time frame reflecting the launch of SVI, with the last search completed on September 29, 2022. Studies were included that involved humans, health, SVI, and conducted in the US. Articles were excluded if the SVI was used in COVID-19, disaster, pandemic, environment, or hazards. A total of 47 articles were included in the systematic review. The majority of studies analyzed individual/population health outcomes in clinical, surgical, mortality, or health promotion areas. The majority of studies showed a relationship between neighborhood-level SDOH and health outcomes. Study authors reported strengths, limitations, and recommendations of the SVI tool. A potential limitation of the study was the exclusion of studies that used the SVI related to disaster. The SVI represents a powerful tool to assess neighborhood-level SDOH and examine upstream drivers health outcomes with direct implications for research, policy, and practice.
Two Cases of Ischemic Complications in Abdominoplasty After Use of a New Biologic Migraine Medication
Authors: Tuominen Reetta , Koljonen Virve
Published: January 2025

Abdominoplasty is a common aesthetic procedure, and ischemic complications are rare, particularly in nonsmokers. We present 2 cases of ischemic complications in nonsmoking patients treated with fremanezumab, a biologic medication for severe migraines. A 55-year-old woman underwent lipoabdominoplasty on December 18, 2023. At the 16-day postoperative follow-up, demarcated necrosis was observed beneath the wound tape, and secondary direct closure was performed 6 weeks later. She had been using fremanezumab for 4 years. A 47-year-old woman underwent abdominoplasty on April 23, 2024, with moderate dissection and liposuction to the flanks. Signs of abdominal flap ischemia were evident in the operating room, and treatment for the Raynaud phenomenon was initiated immediately. The ischemia demarcated over 2 weeks, and secondary direct closure was performed 3 weeks postoperatively. She had been using fremanezumab for two months. Calcitonin gene-related peptide antagonists are potent medications for severe migraine with few contraindications. Fremanezumab may affect peripheral circulation, potentially increasing the risk of surgical complications.
Facial Fat Grafting Cannula: A Tool to Facilitate Closed Irrigation in Flexor Tenosynovitis
Authors: Kreutz-Rodrigues Lucas , Tunaboylu Mehmet Furkan , Moran Steven L.
Published: January 2025

Pyogenic flexor tenosynovitis (PFT), also known as septic or suppurative flexor tenosynovitis, is a closed-space infection of the hand’s flexor tendon sheath that necessitates timely diagnosis and treatment. The treatment consists of antibiotic therapy often combined with prompt surgical treatment. The most common surgical approach is the closed irrigation technique, which involves inserting a 16-gauge angiocatheter in the proximal aspect of the flexor tendon sheath, leaving the distal end of the Brunner incision open during the irrigation process. However, this method has its own challenges, such as catheter bending and kinking, thereby obstructing the fluid irrigation process and prolonging the operative duration. Instead, we propose the use of a rigid plastic facial fat grafting cannula, which is coupled to a 50-mL syringe with 0.9% saline solution. The cannula is placed at the level of the A1 pulley, and irrigation is easily performed. This simplifies this process by maintaining adequate fluid outflow through the flexor tendon sheath.
Downstaging of hepatocellular carcinoma before liver transplantation: Results from a national multicenter prospective cohort study
Authors: Xu Edison , Tabrizian Parissa , Gutierrez Julio , Hoteit Maarouf , Ghaziani Tara , Zhou Kali , Parikh Neehar , Ajmera Veeral , Aby Elizabeth , Shui Amy , Marino Rebecca , Martin Allison , Wong Christopher , Kao Karissa , Dave Shravan , Florman Sander , Yao Francis , Mehta Neil
Published: January 2025

Background and Aims:

Patients with HCC meeting United Network for Organ Sharing (UNOS)-downstaging (DS) criteria have excellent post-liver transplantation (LT) outcomes. Studies on HCC beyond UNOS-DS criteria (“All-Comers” [AC]) have been limited by small sample size and short follow-up time, prompting this analysis.

Approach and Results:

Three hundred twenty-six patients meeting UNOS-DS and 190 meeting AC criteria from 9 LT centers across 5 UNOS regions were enrolled from 2015 to 2023 and prospectively followed. Competing risk analysis and Kaplan-Meier method were used to evaluate DS and LT outcomes, and Fine-and-Gray and Cox models were used to identify predictors of outcomes. AC and UNOS-DS had similar median alpha-fetoprotein (15 vs. 12 ng/mL; p=0.08), MELD (9 vs. 9; p=0.52), and Child-Pugh (A vs. A; p=0.30). Two years after the first local regional therapy, 82% of UNOS-DS and 66% of AC were successfully downstaged (p<0.001). In AC, DS rates were 72% for tumor number plus diameter of largest lesion <10, 51% for sum 10–12, and 39% for sum >12 (p=0.01). Yttrium-90 achieved higher DS success than transarterial chemoembolization in AC (74% vs. 65%; p<0.001). 48% of UNOS-DS and 40% of AC underwent LT (p=0.10). Five-year post-LT survival was similar between UNOS-DS and AC (74% vs. 72%; p=0.77), although 5-year post-LT recurrence was higher in AC (30% vs. 14%; p=0.02).

Conclusions:

Despite higher HCC recurrence and lower intention-to-treat survival in AC, post-LT survival was comparable between UNOS-DS and AC. Yttrium-90 attained higher DS success than transarterial chemoembolization in AC. LT after DS is feasible in AC, though defining an upper limit in tumor burden may be necessary.
Sleep Disturbance and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury and Orthopedic Injury
Authors: Luszawski Caroline A. , Minich Nori M. , Bigler Erin D. , Taylor H. Gerry , Bacevice Ann , Cohen Daniel M. , Bangert Barbara A. , Zumberge Nicholas A. , Tomfohr-Madsen Lianne M. , Brooks Brian L. , Yeates Keith Owen
Published: January 2025

Objective: Sleep disturbance (SD) is common after pediatric mild traumatic brain injury (mTBI) and may predict increased postconcussive symptoms (PCS) and prolonged recovery. Our objective was to investigate the relation of SD with PCS in children with mTBI and those with orthopedic injury (OI). Setting: Emergency departments (EDs) at 2 children’s hospitals in the Midwestern United States. Participants: Children and adolescents aged 8 to 16 years old diagnosed with either a mTBI (n = 143) or OI (n = 74) and recruited within 24 hours postinjury. Design: Observational, prospective, concurrent cohort study with longitudinal follow-up. Main measures: Parents rated children’s preinjury sleep retrospectively shortly after injury, and postinjury sleep at 3 and 6 months postinjury, using the Sleep Disorders Inventory for Students. Parents rated children’s preinjury symptoms retrospectively in the emergency department, and parents and children rated PCS at 3 and 6 months, using the Health and Behavior Inventory and the Postconcussive Symptom Interview. Weekly ratings on the Health and Behavior Inventory were also obtained remotely. Results: Postinjury SD was modestly but not significantly higher in the mTBI group compared to the OI group (P = .060, d = 0.32). Children with mTBI who were symptomatic postacutely based on parent ratings had worse parent-rated sleep outcomes at 3 and 6 months postinjury compared to children who were not symptomatic. Greater preinjury SD also predicted more postinjury SD and more severe PCS regardless of injury type. Conclusions: The results suggest potential bidirectional associations between SD and PCS after mTBI. Studies of treatments for SD following pediatric mTBI are needed.
Optical Coherence Tomography Angiography in Patients With the Boston Keratoprosthesis Type 1
Authors: Sun Jessica A. , Johnson Grace , Saini Chhavi , Chang Aimee C. , Devlin Julia , Wang Haobing , Chung In Young , Dohlman Thomas H. , Paschalis Eleftherios I. , Chodosh James , Shen Lucy Q.
Published: January 2025

Purpose:

To report on optical coherence tomography angiography (OCTA) in patients with a type 1 Boston keratoprosthesis (KPro) and determine its feasibility through assessment of imaging artifacts.

Methods:

KPro and non-KPro subjects were matched for age, gender, and glaucoma diagnosis. OCTA images of the peripapillary optic nerve were obtained, reviewed by 2 readers masked to the diagnosis for artifacts and usability, and used for microvascular measurements.

Results:

KPro subjects (n = 18) had worse visual acuity than non-KPro (n = 36) subjects (LogMAR mean ± standard deviation 0.36 ± 0.30 vs. 0.07 ± 0.11, P < 0.001) and a greater proportion were monocular (56% vs. 3%, P < 0.001). OCTA from KPro eyes had more artifacts per scan than images from non-KPro eyes (4 ± 2 vs. 2 ± 2, P < 0.001). About 33% of KPro images were useable based on having image quality score above 40 and artifact in less than 10% of the peripapillary region. Worse visual acuity (odds ratio [OR] 0.01, 95% confidence interval [CI] 2 x 10−4-0.30, P = 0.02) and KPro (OR 0.19, 95% CI 0.05–0.63, P = 0.008) were associated with lowered likelihood of usability. Useable OCTA from 3 KPro eyes with glaucoma demonstrated microvascular defects in the inferior peripapillary region and lower vessel density and flow compared with 3 KPro eyes without glaucoma.

Conclusions:

This is the first study assessing OCTA in KPro patients and identified a higher incidence of artifacts that may be associated with the KPro optic. About 33% of KPro images were useable for microvascular measurements, supporting further OCTA research in this population to assess vascular pathology of glaucoma.
Metabolic consequences and tubular function after augmentation cystoplasty in children with neurogenic bladder
Authors: Chang Jei-Wen , Yang Hui-Hsin , Lin Tzu-Ching , Kuo Fang-Cheng , Fan Yu-Hua , Chen Hsin-Hung , Yang Ling-Yu , Liu Chin-Su , Tsai Hsin-Lin
Published: January 2025

Background:

While many studies have reported the renal outcomes and metabolic consequences of augmentation cystoplasty (AC), few have focused on changes in renal tubular function. This study investigated the prevalence of metabolic disturbances, renal tubular function, and 24-hour urine chemistry, aiming to evaluate the association between metabolic alterations and urolithiasis after AC.

Methods:

We investigated serum biochemistry, blood gas, and 24-hour urinary metabolic profile of children who underwent AC between January 2000 and December 2020. The assessed outcomes included metabolic complications, tubular function, and magnesium status. Associations between 24-hour urinary metabolic parameters and urolithiasis formation were also examined.

Results:

A total of 25 patients with a mean follow-up period of 13.8 ± 5.7 years were enrolled. The mean age at AC was 7.5 ± 4.4 years, and 22 and 3 patients underwent AC using the ileum and colon, respectively. There were no abnormalities in serum levels of sodium, potassium, chloride, and calcium. Hypomagnesemia (magnesium <1.7 mg/dL) due to renal loss was observed in one patient (4.0%). Six (24.0%) patients had increased urinary β2-microglobulin levels and normal serum levels. The ratio of the maximum rate of tubular phosphate reabsorption to the glomerular filtration rate was low in three (12.0%) patients. Four (16.0%) patients had normal serum magnesium levels but urinary magnesium excretion <40 mg/d. Urolithiasis occurred in 11 patients (44.0%). The most common 24-hour urine metabolic abnormality was hypomagnesiuria (72.0%). No urinary metabolic parameters or daily protein intake were associated with urolithiasis.

Conclusion:

AC for children is safe and does not significantly impact the metabolic profile. Excretions of 24-hour urinary calcium, uric acid, magnesium, and the sodium-to-potassium ratio were not associated with urolithiasis. However, a high prevalence of 24-hour urine magnesium excretion <88 mg/1.73 m2 was noted. Further prospective studies are needed to investigate longitudinal changes in renal tubular function and 24-hour urine metabolic profiles, particularly magnesium status.
Intraoperative methods for detecting bile leakage for liver resection: Current situation
Authors: Mo Shu-Tian , Peng Tao
Published: January 2025

Bile leakage is one of the common complications after hepatectomy. Recalcitrant bile leakage not only seriously affects the quality of life of patients, but also prolongs the hospitalization time, increases hospitalization costs, and puts psychological, mental, and financial pressure on patients. The most commonly used methods for the surgical detection of bile leakage include the White test, developer injection through the gallbladder tube/gallbladder, and photodynamic imaging. A new method, Peng’s leakage test, was developed by the authors to detect bile duct leakage and was shown to be the best method available to prevent postoperative bile leakage in patients.
Physical Restraint in a Pediatric Intensive Care Unit: A Cross-Sectional, Observational Study in China
Authors: WANG Ling-Ying , HU Zi-Yi , TANG Meng-Lin , HU Xiu-Ying
Published: January 2025

Background

Research data on the extent of and protocols related to physical restraint (PR) in pediatric intensive care units (PICUs) are scarce. Most previous studies in China on this topic have focused on the prevalence, reasons, and background of PR use among adult patients.

Purpose

This study was designed to delineate the application of PR and the factors associated with PR use in PICUs in China.

Methods

A cross-sectional study was conducted in one PICU at West China Hospital, Sichuan University, from January 2020 to December 2020. A total of 1,086 pediatric patients in the PICU were included in this study. Data collection was performed over 11 months, utilizing PR observation forms and patient records. Descriptive statistical analysis was used to obtain the data, and logistic regression models were used to analyze the independent risk factors for PR.

Results

Of the 1,086 participants, 750 (69.1%) experienced being restrained, and 83.5% of the restrained participants who were pediatric patients were restrained for more than 50% of their time during their PICU stay. The results of logistic regression analysis identified age (1–6 years: OR = 2.090, 95% CI [1.508, 2.897], p < .001; 7–17 years: OR = 0.523, 95% CI [0.358, 0.765], p = .001), use of mechanical ventilation (OR = 2.126, 95% CI [1.480, 3.055], p < .001), use of drainage tubes (OR = 1.916, 95% CI [1.445, 2.541], p < .001), and sedation (OR = 1.494, 95% CI [1.101, 2.026], p = .010) as significantly correlated with the use of PR in the PICU. For the 750 patients who experienced being restrained, PR initiation was documented with a written medical order, and in 604 cases (80.5%), the restraints were removed without similar documentation.

Conclusions

The use of PR is common in PICUs in China, with more than half of pediatric patients being restrained during their stay. Age, mechanical ventilation, use of drainage tubes, and use of sedative drugs were identified as significantly associated with PR use. Developing standardized procedures/guidelines for PR use in Chinese PICUs and enhancing medical staff education on PR practices are imperative.
Comparative effectiveness of acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: a network meta-analysis of randomized trials
Authors: Zhou Ting , Hou Huaijin , Cairen Zhuoma , Wang Yun , Wang Peng , Ge Long , Wa Macuo , Xu Ziqing , Tang Feng , Wang Caihong , Liu Rongxin , Li Deyan , Xue Jianjun , Zhang Senbing
Published: January 2025

Objective:

The objective was to systematically evaluate the effectiveness of different acupoint stimulation techniques in preventing postoperative nausea and vomiting (PONV) after general anesthesia.

Methods:

The authors searched PubMed, Cochrane Library, Web of Science, and Embase for relevant papers, about the effect of acupoint stimulation for preventing PONV from their inception to 31 July 2023. Two reviewers performed study screening, data extraction, and risk of bias assessment. The authors focused on patient important outcomes, including the incidence of PONV, postoperative nausea (PON), or postoperative vomiting (POV), and the number of patients requiring antiemetic rescue. The authors conducted network meta-analyses to estimate the relative effectiveness between different acupoint stimulation using Stata 17.0 and Revman 5.3 software.

Results:

The authors included 50 randomized trials involving 7372 participants (median age: 43.5 years, female: 73.3%). The network meta-analysis revealed that compared with the control (sham acupoint stimulation or blank control), antiemetic alone could significantly reduce the incidence of POV (RR 0.49, 95% CI: 0.36–0.69), but could not significantly reduce the incidence of PONV and PON (RR 0.49, 95% CI: 0.36–0.69; RR 0.81, 95% CI: 0.59–1.10; respectively); both TEAS and electroacupuncture alone significantly reduced the incidence of PONV, PON, and POV, and combined with antiemetic was usually more effective than single acupoint stimulation.

Conclusions:

Both TEAS and electroacupuncture, with or without antiemetic, could significantly reduce the incidences of postoperative nausea and vomiting after general anesthesia.
Human or Machine? A Comparative Analysis of Artificial Intelligence–Generated Writing Detection in Personal Statements
Authors: Goodman Margaret A. , Lee Anthony M. , Schreck Zachary , Hollman John H.
Published: January 2025

Introduction.

This study examines the ability of human readers, recurrence quantification analysis (RQA), and an online artificial intelligence (AI) detection tool (GPTZero) to distinguish between AI-generated and human-written personal statements in physical therapist education program applications.

Review of Literature.

The emergence of large language models such as ChatGPT and Google Gemini has raised concerns about the authenticity of personal statements. Previous studies have reported varying degrees of success in detecting AI-generated text.

Subjects.

Data were collected from 50 randomly selected nonmatriculated individuals who applied to the Mayo Clinic School of Health Sciences Doctor of Physical Therapy Program during the 2021–2022 application cycle.

Methods.

Fifty personal statements from applicants were pooled with 50 Google Gemini–generated statements, then analyzed by 2 individuals, RQA, and GPTZero. RQA provided quantitative measures of lexical sophistication, whereas GPTZero used advanced machine learning algorithms to quantify AI-specific text characteristics.

Results.

Human raters demonstrated high agreement (κ = 0.92) and accuracy (97% and 99%). RQA parameters, particularly recurrence and max line, differentiated human- from AI-generated statements (areas under receiver operating characteristic [ROC] curve = 0.768 and 0.859, respectively). GPTZero parameters including simplicity, perplexity, and readability also differentiated human- from AI-generated statements (areas under ROC curve > 0.875).

Discussion and Conclusion.

The study reveals that human raters, RQA, and GPTZero offer varying levels of accuracy in differentiating human-written from AI-generated personal statements. The findings could have important implications in academic admissions processes, where distinguishing between human- and AI-generated submissions is becoming increasingly important. Future research should explore integrating these methods to enhance the robustness and reliability of personal statement content evaluation across various domains. Three strategies for managing AI's role in applications—for applicants, governing organizations, and academic institutions—are provided to promote integrity and accountability in admission processes.
Timely delivery of care in neurological emergencies: can standardized management protocols help?
Authors: Ouyang Menglu , Allende Ma. Ignacia , Anderson Craig S.
Published: January 2025

Purpose of review

To review the evidence that supports the implementation of goal-directed care bundle protocols to improve outcomes from neurocritical conditions, and of the possible advantage of specific over generalized protocols.

Recent findings

Articles from January 1, 2023 to July 31, 2024 were searched to evaluate the effectiveness of standardized management in neurological emergencies. The use of care bundles and standardized protocols with time- and target-related metrics has shown benefit in patients with acute stroke and traumatic brain injury.

A goal-directed care protocol to guide standard management implemented by a multidisciplinary team can improve outcomes from neurological emergencies. However, implementation challenges need to be addressed before wide adoption of protocolized care for maximum benefit to populations.
Timing of neuroprognostication in the ICU
Authors: Faiver Laura , Steinberg Alexis
Published: January 2025

Purpose of review

Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies to mitigate the self-fulfilling prophecy, and how to approach the indeterminate prognosis.

Recent findings

The goal of neuroprognostication is to provide a timely and accurate prediction of a patient's neurologic outcome so treatment can proceed in accordance with a patient's values and preferences. Neuroprognostication should be delayed until at least 72 h after injury and/or only when the necessary prognostic data is available to avoid early withdraw life-sustaining treatment on patients who may otherwise survive with a good outcome. Clinicians should be aware of the limitations of available predictors and prognostic models, the role of flawed heuristics and the self-fulfilling prophecy, and the influence of surrogate decision-maker bias on end-of-life decisions.

The approach to neuroprognostication after ABI should be systematic, use highly reliable multimodal data, and involve experts to minimize the risk of erroneous prediction and perpetuating the self-fulfilling prophecy. Even when such standards are rigorously upheld, the prognosis may be indeterminate. In such cases, clinicians should engage in shared decision-making with surrogates and consider the use of a time-limited trial.
A Hospital Resource for Nurses Navigating Doctoral Education and Beyond
Authors: Feetham Suzanne , Patterson Kelly Katherine , Colson Cindy D. , Engh Eileen P. , Frame Shaun Christopher , Giordano Nicholas A. , King Simmy , Ojini Deborah , Ryan Schultz Theresa , Speller-Brown Barbara , Walsh Heather
Published: January 2025

Advancing nursing practice to improve care and system outcomes requires doctoral-prepared nurses to conduct programs of research and translate science to practice. The authors describe a Doctoral support group (DSG) at one hospital designed to support nurses considering and navigating doctoral education while continuing as hospital employees. Strategies from 18 years' experience are provided for others to develop and sustain a DSG as part of an environment to support and retain nurses with doctoral degrees.
Repetitive transcranial magnetic stimulation for fibromyalgia: are we there yet?
Authors: Lapa Jorge Dornellys da Silva , da Silva Valquíria Aparecida , Ciampi de Andrade Daniel
Published: January 2025

Repetitive transcranial magnetic stimulation (rTMS) has increasingly been used to modify cortical maladaptive plastic changes shown to occur in fibromyalgia (FM) and to correlate with symptoms. Evidence for its efficacy is currently inconclusive, mainly due to heterogeneity of stimulation parameters used in trials available to date. Here, we reviewed the current evidence on the use of rTMS for FM control in the format of a narrative review, in which a systematic dissection of the different stimulation parameters would be possible. We conducted a search in Medline and Embase for controlled trials on rTMS in people with FM with at least 10 participants in each treatment arm, and treatment/follow-up of at least 3 weeks. The search identified 482 abstracts, of which 45 were screened to full review, and 11 met inclusion criteria. Six out of 11 trials were positive. The dorsolateral prefrontal cortex was the target in 218 patients (49.2%), and the primary motor cortex (M1) in 225 (50.8%). Studies targeting M1 at 10 Hz, with stimulation current delivered in the posterior-anterior, were systematically positive, frequently showing that maintenance sessions delivered weekly, and biweekly were able to maintain the analgesic effects seen after daily induction sessions. Studies assessing the effects of rTMS for FM are still marked by heterogeneity in stimulation petameters, choice of primary outcomes, and inclusion criteria. The selection of the stimulation parameters associated with significant analgesic effects is likely to benefit following larger multicenter trials and improve the overall management of pain and associated symptoms in people with FM.
Fibromyalgia: do I tackle you with pharmacological treatments?
Authors: Perrot Serge
Published: January 2025

Pharmacological approaches are frequently proposed in fibromyalgia, based on different rationale. Some treatments are proposed to alleviate symptoms, mainly pain, fatigue, and sleep disorder. Other treatments are proposed according to pathophysiological mechanisms, especially central sensitization and abnormal pain modulation. Globally, pharmacological approaches are weakly effective but market authorization differs between Europe and United States. Food and Drug Administration–approved medications for fibromyalgia treatment include serotonin and noradrenaline reuptake inhibitors, such as duloxetine, and pregabalin (an anticonvulsant), which target neurotransmitter modulation and central sensitization. Effect of analgesics, especially tramadol, on pain is weak, mainly on short term. Low-dose naltrexone and ketamine are gaining attention due their action on neuroinflammation and depression modulation, but treatment protocols have not been validated. Moreover, some treatments should be avoided due to the high risk of abuse and severe side effects, especially opioids, steroids, and hormonal replacement.
Spatiotemporal gait parameters influencing functional mobility of people with lower limb amputation
Authors: Kristal Anat , Gaunaurd Ignacio , Kirk-Sanchez Neva , Gard Steven , Clark Natali , Da Silva Emika , Stieg Forrest , Gailey Robert
Published: January 2025

Background:

Walking speed is a measure of functional mobility that is relatively easy to quantify. In people with lower limb amputation, reduced walking speed has been linked with specific atypical spatiotemporal gait parameters. However, the influence of atypical spatiotemporal gait parameters on the walking speed of people with unilateral transtibial amputation (TTA) and transfemoral amputation (TFA) remains unclear.

Objectives:

To identify spatiotemporal gait parameters influencing walking speed of people with unilateral TTA or TFA.

Study design:

Cross-sectional.

Methods:

The 10-meter walk test (10mWT) was used to measure walking speed, and an instrumented walkway was used to record spatiotemporal gait parameters. Regression analyses were used to determine the best subset of spatiotemporal gait parameters that influence the walking speed of people with TTA and TFA.

Results:

The study included 43 people with TTA and 49 with TFA. In the TTA group, spatiotemporal gait parameters accounted for 65.5% of the variance in walking speed, with prosthetic single limb support accounting for 52.2%, prosthetic terminal double limb support accounting for 8.9%, and stride width accounting for 4.4%. In the TFA group, intact swing accounted for 46.7% of the variance in walking speed. There was no significant difference in walking speed between the TTA and the TFA groups (p > 0.05).

Conclusions:

The study's results highlight specific spatiotemporal gait parameters that affect the walking speed of people with unilateral TTA and TFA. In addition, results suggest that walking speed over short distances is not confounded by amputation level (i.e., TTA and TFA).
The Value of Multidisciplinary Neuro-oncological Tumor Boards to Increase the Accuracy of FET PET for Identifying Brain Tumor Relapse
Authors: Ceccon Garry S. , Werner Jan-Michael , Ruge Maximilian I. , Goldbrunner Roland , Celik Eren , Baues Christian , Deckert Martina , Brunn Anna , Rongen Manuel Montesinos , Büttner Reinhard , Dunkl Veronika , Nogova Lucia , Schlamann Marc , Kabbasch Christoph , Rueß Daniel , Hampl Jürgen , Wollring Michael M. , Rosen Elena K. , Tscherpel Caroline , Stoffels Gabriele , Lohmann Philipp , Mottaghy Felix M. , Fink Gereon R. , Langen Karl-Josef , Galldiks Norbert
Published: January 2025

Purpose

Especially in Europe, amino acid PET is increasingly integrated into multidisciplinary neuro-oncological tumor boards (MNTBs) to overcome diagnostic uncertainties such as treatment-related changes. We evaluated the accuracy of MNTB decisions that included the O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET information compared with FET PET results alone to differentiate tumor relapse from treatment-related changes.

Patients and Methods

In a single academic center, we retrospectively evaluated 180 MNTB decisions of 151 patients with CNS WHO grade 3 or 4 gliomas (n = 122) or brain metastases (n = 29) presenting equivocal MRI findings following anticancer treatment. All patients underwent FET PET imaging besides MRI before MNTB discussion. Additionally, the patient’s clinical status and pretreatment were considered for decision-making. The diagnostic performance was calculated for FET PET findings alone and MNTB decisions that included FET PET results using 2 × 2 contingency tables. MNTB decisions were validated using the neuropathological result in 43% (n = 78) or clinicoradiologically in 57% (n = 102).

Results

FET PET results alone yielded an accuracy of 87% (sensitivity, 90%; specificity, 65%; positive predictive value, 95%). When integrating FET PET results for decision-making in the MNTB setting, the accuracy increased to 95% (sensitivity, 99%; specificity, 70%; positive predictive value, 96%; P = 0.002). In MNTB decisions concerning glioblastoma patients, the median survival was 2.4 times longer when FET PET suggested treatment-related changes (15.6 vs 6.4 months; P = 0.009).

Conclusions

Our results suggest that MNTB discussion further enhances the FET PET value for identifying brain tumor relapse. A prospective evaluation of FET PET results with and without integration in an MNTB is warranted.
Effect of Older Age on Postoperative Urinary Retention After Prolapse Surgery
Authors: McLarty Kristiana B. , Zuo Stephanie W. , Warner Kristina J. , Orris Steven R. , Nguyen Tien C. , Meckes Nicole A. , Mumford Brigid S. , Bellam Kavya , Rayen Richael , Ackenbom Mary F.
Published: January 2025

Importance

Postoperative urinary retention (POUR) is common after reconstructive pelvic surgery. Little is known about the relationship between older age (≥70 years) and POUR after pelvic organ prolapse surgery.

Objectives

We aimed to investigate the relationship between age ≥70 years and POUR. Secondarily, we aimed to determine if duration of urinary catheterization differed by age in women with POUR.

Study Design

This was a secondary analysis of a dual-center retrospective study on perioperative adverse events in biologic females aged ≥61 years undergoing prolapse surgery. The primary outcome was POUR, defined as a failed retrograde voiding trial requiring bladder catheterization. The secondary outcome was duration of temporary bladder catheterization. We developed a stepwise multivariable logistic regression model, which included relevant variables with P < 0.10 on univariate analyses and a forced age variable.

Results

In this cohort of 2,665 women, mean ± standard deviation age was 71.2 ± 6.7 years, and 54.6% were ≥70 years, POUR occurred in 830 (31.1%) patients. Women with POUR had a lower body mass index and were more likely to have undergone a vaginal prolapse surgery and concomitant hysterectomy/incontinence procedure (P < 0.05). They had higher estimated blood loss (75 vs 50 mL, P < 0.001). On multivariable logistic regression, age ≥70 years was not associated with POUR (adjusted odds ratio 1.02, 95% CI [0.83–1.26]). Age ≥70 years was associated with longer duration of catheterization (5 vs 4 days, P < 0.01).

Conclusion

Age was not associated with POUR when controlling for other clinical factors (body mass index, surgical approach, concomitant hysterectomy/incontinence surgery, and estimated blood loss). These factors may affect POUR in older women and should be considered in perioperative management.
Phenotypes of Pelvic Organ Prolapse
Authors: Sayler Zoe , Weston Katie , Johnson Colin M. , Cunningham Victoria , Bradley Catherine S. , Kenne Kimberly A. , Wendt Linder , Ten Eyck Patrick , Kowalski Joseph T.
Published: January 2025

Importance

The Pelvic Organ Prolapse Quantification (POP-Q) stages do not correlate with symptoms or characterize important prolapse subtypes.

Objectives

We hypothesize that clinically meaningful prolapse “phenotypes” utilizing POP-Q measurements can be defined. The primary aim was to define the phenotypes and their frequency. Secondary aims were to compare demographics, medical characteristics, and symptoms between phenotypes.

Study Design

Patients who previously underwent prolapse surgery were retrospectively categorized into 1 of 8 phenotypes based on 2 principles: (1) prolapse exists when the anterior or posterior vaginal wall descend to the hymen or the apex descends half total vaginal length, and (2) prolapse may exist in anterior, posterior, and/or apical compartments. Demographics, medical characteristics, and Pelvic Floor Distress Inventory-20 (PFDI-20) responses were compared. Linear and logistic regression models were used for comparisons.

Results

The AC (anterior-predominant and apical) phenotype was most common (231 of 501 patients, 46.1%) and served as the reference for comparisons. The no prolapse, P (isolated posterior), C (isolated apical), and PC (posterior-predominant and apical) phenotypes were younger. The A (isolated anterior) phenotype was older. P, PC, and APC (anterior and posterior and apical) phenotypes had greater body mass index. The P phenotype Colorectal-Anal Distress Inventory scores were higher. Similarly, the PC phenotype had higher scores for bowel splinting and rectal prolapse. Conversely, the C phenotype total PFDI-20 scores were lower (P = 0.01). Only the APC phenotype had no significant differences in any PFDI-20 question compared with the AC phenotype.

Conclusion

These phenotypes may allow for improved understanding, communication, and counseling about prolapse and prolapse treatment.
Impact of Non-Hepatectomy Opioid Reduction Efforts on Post-Hepatectomy Opioid Prescriptions: Analysis of 2,005 Patients
Authors: Fields Brittany C , Newhook Timothy E , Prakash Laura R , Arvide Elsa M , Li Zhouxuan , Tran Cao Hop S , Maxwell Jessica E , Perrier Nancy D , Katz Matthew HG , Vauthey Jean-Nicolas , Tzeng Ching-Wei D
Published: January 2025

Introduction:

Pathway-driven, post-pancreatectomy opioid reduction interventions have proven effective and sustainable and may have a “halo effect” on other major abdominal cancer operations. This study’s aim was to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy.

Methods:

This is a retrospective cohort study utilizing data from the electronic health record and a prospective quality improvement database for consecutive hepatectomy patients (09/2016-02/2024). Cohorts were based on 5 distinct eras (E) of opioid-related protocol updates (E1/pre-intervention historical baseline: 09/2016-03/2017, E2/introduction of 5x-multiplier: 04/2017-09/2018, E3/departmental opioid education program: 10/2018-12/2019, E4/initial post-hepatectomy pathways: 01/2020-06/2022, E5/updated pancreatectomy pathways influencing hepatectomy care: 07/2022-02/2024).

Results:

Of 2005 patients, 31% underwent major hepatectomy, 14% intermediate, 46% minor, and 9% combination surgery/other. Most (79%) were performed via open approach. Median hospital stay decreased from 5 to 4 days between E1-E5. Both intraoperative (E1:80mg, E5:37mg; p<0.001) and total inpatient (E1:181mg, E5:86mg; p<0.001) median oral morphine equivalents (OME) were reduced >50%. A 73% reduction in discharge OME was observed between E1 (225mg) and E5 (60mg; p<0.001), with clinically similar median pain scores at discharge (score 1-2 of 10). Concurrent universal adoption of routine 3-drug non-opioid discharge prescriptions (E1:70%, E5:98%) correlated with proportion of patients discharged opioid-free (E1:8%, E5:43%; p<0.001).

Conclusions:

Directed opioid reduction efforts for pancreatectomy influenced clinically meaningful post-hepatectomy reductions in inpatient and discharge opioid volumes. A “halo effect” of intradepartmental opioid reduction efforts is attainable and corresponds to measurable increases in opioid-free or nearly opioid-free discharges after major abdominal cancer surgery.
Impact of Disease Etiology and Indication for Colectomy on Postoperative Outcomes: A NSQIP Colectomy-Targeted Database Study
Authors: Podder Sourav K , Doermann Allison , Ibrahim George , Bowen Matthew , Koeneman Scott H , Schleider Christine , Shindle Kathleen , Cowan Scott W , Yeo Charles J , Hanna Nader
Published: January 2025

Background:

The ACS-NSQIP Colectomy-Targeted database provides valuable metrics on surgical outcomes by utilizing clinical data to enhance quality improvement efforts. However, the quality measures offered in the ACS-NSQIP semiannual report do not stratify for the indication for colectomy. We aim to compare postoperative outcomes in patients undergoing colectomy for colon cancer, infectious causes, and inflammatory bowel disease (IBD).

Study Design:

A retrospective review of patients undergoing colectomy was performed using the ACS-NSQIP Colectomy-Targeted database from 2012-2022. Logistic regression models were used to compare the 30-day postoperative outcomes of patients who underwent colectomy for colon cancer, infectious causes, and IBD while adjusting for pre-operative risk factors.

Results:

There were 158,560 patients who underwent colectomy for colon cancer, 90,827 patients for infectious causes, and 30,548 patients for IBD. In unadjusted analysis, patients undergoing colectomy for infectious causes had the highest rates of mortality (2.6%) and morbidity (27.6%). After adjusting for covariates, IBD patients undergoing colectomy had significantly higher odds of morbidity compared to those undergoing colectomy for colon cancer (OR 1.3, 95% CI [1.1, 1.4]) and infectious causes (OR 1.3, [1.2, 1.4]). Furthermore, IBD patients had significantly higher odds of experiencing venous thromboembolism, surgical site infections, prolonged ileus, and readmission within 30 days compared to both colon cancer and infectious causes patients.

Conclusions:

This study demonstrates that the indication for colectomy impacts postoperative outcomes. Reporting risk-adjusted outcomes based on the underlying disease etiology could lead to identifying high-risk patients, improving benchmarking outcomes, and developing targeted quality initiatives.
Breast Conservation Surgery for Breast Cancer in Men
Authors: Den Jennifer , Nelson Nicole , Khanipov Kamil , Klimberg V Suzanne
Published: January 2025

Background:

Male breast cancer (MBC) is a rare disease, accounting for 1% of all breast cancers diagnosed in the United States. The rarity of MBC has limited the development of treatment algorithms specific to men. Thus, the standard of care has been mastectomy. The safety and feasibility of breast-conserving surgery (BCS) in MBC are unclear. This study assessed whether overall survival outcomes, local recurrence, and postoperative complications differed between MBC patients who underwent conservative surgery or mastectomy.

Study Design:

A retrospective search for men aged ≥18 years diagnosed with breast cancer was conducted using the TriNetX network. Cohort 1 included patients who underwent BCS. Cohort 2 included patients who underwent mastectomy. Propensity score matching was conducted using age, BMI, tobacco use, cancer stage and tumor size (T1-T4), radiation, chemotherapy, hormonal therapy, genetics, and comorbidities. Outcomes of interest were 5-year overall survival (OS), local recurrence (LR), and postoperative complications.

Results:

423 patients underwent BCS, and 1,101 patients underwent mastectomy. After matching, 401 patients per cohort were identified. There was no difference in 5-year OS with the Kaplan-Meier analysis (Cohort 1: 84% vs Cohort 2: 86%, log-rank test p=0.412) or with LR (11% vs 13%, p=0.384). The mastectomy cohort was more likely to have postoperative complications, with a risk of 24% compared with 17% in the BCS cohort (p=0.011).

Conclusions:

There is no difference in the 5-year OS and LR rate between MBC patients who undergo BCS or mastectomy. The postoperative complication rate was higher with mastectomies. We conclude that BCS for unicentric male breast cancer is feasible and preferred for T1 and T2 cancers.
Novel Use of Objective Sensor Technology: Creation of Individualized Education Plans to Develop Operative Mastery
Authors: Korndorffer James R , Schultz Cameron , Perumalla Calvin , Perrone Kenneth , Pugh Carla
Published: January 2025

Background:

Motion-tracking has been shown to correlate with expert and novice performance but has not been used for skill development. For skill development, performance goals must be defined. We hypothesize that using wearable sensor technology, motion tracking outcomes can be identified in those deemed practice-ready and used as benchmarks for precision learning.

Study Design:

At the ACS Clinical Congress, surgeons and surgeons in-training volunteered to wear motion-tracking sensors while performing intracorporeal suturing and knot-tying, laparoscopic pattern-cutting and simulated laparoscopic cholecystectomy. Coach raters evaluated the subjects using a modified SIMPL scale. Subjects were divided into two groups based on coach ratings, practice-ready and not practice-ready. Motion results were compared. Benchmark performance for each motion-tracking outcome of the simulated laparoscopic cholecystectomy was set at the median(+/-MAD) of the practice-ready cohort. For all subjects, each motion-tracking outcome was compared to the benchmark.

Results:

94 subjects were recruited. 53 were rated at practice-ready. Differences between groups were identified in 2 of 10 metrics for intracorporeal suturing and knot-tying, 4 of 10 metrics for pattern-cutting, and 5 of 10 metrics for the laparoscopic cholecystectomy. Set benchmarks for the metrics were compared to each subjects’ score for all individual metrics. A not practice-ready individual was less likely to achieve the benchmarks.(χ2 = 55.48 p <.00001).

Conclusion:

Wearable sensor technology can identify differences between surgeons rated practice-ready and not practice-ready. More importantly, motion metric results can be used to develop benchmarks for training endpoints. This will allow for development of an individualized report card and training protocol focused on areas in need of improvement instead of the current model of generalized training. Implementing such focused training may expedite competency and mastery of surgical skills.
Bimanual upper limb task practice and Transcutaneous electrical stimulation enhance spinal plasticity and hand function after chronic cervical spinal cord injury
Authors: Capozio Antonio , Chowdhury Samma T , Chakrabarty Samit , Delis Ioannis , Horne Maria , Sivan Manoj , Gad Parag , Holt Raymond , Ichiyama Ronaldo , Astill Sarah L
Published: January 2025

Injuries to the spinal cord at the cervical level can lead to loss of upper limb function. Recent work suggests that combining functional task practice with Transcutaneous electrical stimulation of the spinal cord (TCES) can increase strength and upper limb function in people living with chronic cervical spinal cord injury (cSCI). Participants (n= 5) were randomly assigned to: Group_1 (n= 3) receiving one month of upper limb task practice (ULTP) followed by one month of upper limb task practice paired with spinal stimulation (ULTP+TCES); Group_2 (n= 2) receiving one month of ULTP+TCES followed by one month of ULTP. Changes in hand function (assessed via the Graded Redefined Assessment of Strength, Sensibility), independence and quality of life were investigated after each intervention and at three-months follow-up. In addition, we assessed cortical (via Transcranial Magnetic Stimulation) and spinal (via single-pulse TCES) excitability at those same time points. For Group_1: improvements in hand function from baseline were observed after ULTP+TCES (p<0.001) and at follow-up (p=0.017); quality of life increased between baseline and after ULTP (p=0.002), ULTP+TCES (p<0.001) and at follow-up (p=0.013); spinal excitability increased from baseline to after ULTP+TCES (p<0.001). For Group_2: improvements in hand function from baseline were observed after ULTP+TCES (p<0.001), ULTP (p<0.001) and at follow-up (p<0.001); corticospinal excitability increased from baseline to after ULTP (p=0.013); spinal excitability increased from baseline to after ULTP+TCES (p<0.001) and the increase persisted 3 months later at follow-up (p=0.04). Our findings demonstrate that non-invasive spinal stimulation paired with task practice can improve hand function more than task practice alone in people living with a cSCI. In addition, we suggest that spinal plasticity induced by spinal stimulation is a potential neural substrate for the attained improvements in hand function.
Cell-autonomous and non-cell-autonomous effect of TRIM72 on ALS disease progression
Authors: Zhang Xue , He Ji , Song Ning , Li Xipeng , Wang Weizhe , Hu Yueting , Li Qing , Hu Yiqing , Yin Chunmu , Zhao Peng , Jiang Xinyi , Piao Xuejiao , Meng Dawei , Cheng Hongmei , Chen Zhaohui , Huang Xusheng , Yu Pan , Qi Xinming , Ren Jin , Luo Li , Peng Lin , Guo Wei , Wang Tong , Gong Haipeng , Fan Dongsheng , Jia Yichang
Published: January 2025

Dysfunction of RNA-binding proteins, including TDP-43 and FUS, has been associated with amyotrophic lateral sclerosis (ALS); however, the underlying mechanisms are largely unknown. Here, we reported that a neuronal upregulation of TRIM72 (Tripartite Motif Containing 72) in FUS mutation knockin ALS models slows disease progression. TRIM72 interacts with Commander, a protein complex for recycling of membrane proteins, facilitating membrane repair and antioxidation. Exosomal TRIM72 is detected in ALS patient cerebrospinal fluid (CSF) and extracellular application of exosomal TRIM72 protects cell from membrane damage. In a sporadic ALS cohort, CSF TRIM72 level associates ALS disease progression. AAV-mediated neuronal expression of TRIM72 slows down the disease progressions in ALS models and in an ALS patient without adverse effects over a year treatment course. Taken together, our results suggest a universal neuronal protection of a TRIM family protein in cell-autonomous and non-cell-autonomous manners in ALS.