bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural-and-dynamical similarity predicts compensatory brain areas driving the post-lesion functional recovery mechanism
Authors: Chakraborty Priyanka , Saha Suman , Deco Gustavo , Banerjee Arpan , Roy Dipanjan
Published: July 2023

The focal lesion alters the excitation–inhibition (E–I) balance and healthy functional connectivity patterns, which may recover over time. One possible mechanism for the brain to counter the insult is global reshaping functional connectivity alterations. However, the operational principles by which this can be achieved remain unknown. We propose a novel equivalence principle based on structural and dynamic similarity analysis to predict whether specific compensatory areas initiate lost E–I regulation after lesion. We hypothesize that similar structural areas (SSAs) and dynamically similar areas (DSAs) corresponding to a lesioned site are the crucial dynamical units to restore lost homeostatic balance within the surviving cortical brain regions. SSAs and DSAs are independent measures, one based on structural similarity properties measured by Jaccard Index and the other based on post-lesion recovery time. We unravel the relationship between SSA and DSA by simulating a whole brain mean field model deployed on top of a virtually lesioned structural connectome from human neuroimaging data to characterize global brain dynamics and functional connectivity at the level of individual subjects. Our results suggest that wiring proximity and similarity are the 2 major guiding principles of compensation-related utilization of hemisphere in the post-lesion functional connectivity re-organization process.
Evaluation of Resistance Resources and Analysis of Resistance Mechanisms of Maize to Stalk Rot Caused by Fusarium graminearum
Authors: Zhang Xue , Zheng Suli , Yu Miao , Xu Chuzhen , Li Yonggang , Sun Lei , Hu Guanghi , Yang Jianfei , Qiu Xiaojing
Published: July 2023

Stalk rot is one of the most destructive and widely distributed diseases in maize plants worldwide. Research on the performance and resistance mechanisms of maize against stem rot is constantly improving. In this study, among 120 inbred maize lines infected by Fusarium graminearum using the injection method, 4 lines (3.33%) were highly resistant to stalk rot, 28 lines (23.33%) were resistant, 57 lines (47.50%) were susceptible, and 31 lines (25.84%) were highly susceptible. The inbred lines 18N10118 and 18N10370 were the most resistant and susceptible with disease indices of 7.5 and 75.6, respectively. Treatment of resistant and susceptible maize inbred seedlings with F. graminearum showed that root hair growth of the susceptible inbred lines was significantly inhibited, and a large number of hyphae attached and adsorbed multiple conidia near the root system. However, the resistant inbred lines were delayed and inconspicuous, with only a few hyphae and spores appearing near the root system. Compared with susceptible inbred lines, resistant maize inbred line seedlings treated with F. graminearum exhibited elevated activities of catalase, phenylalanine ammonia-lyase, polyphenol oxidase, and superoxide dismutase. We identified 153 genes related to disease resistance by transcriptome analysis. The mitogen-activated protein kinase signaling and peroxisome pathways mainly regulated the resistance mechanism of maize inbred lines to F. graminearum infection. These two pathways might play an important role in the disease resistance mechanism, and the function of genes in the two pathways must be further studied, which might provide a theoretical basis for further understanding the molecular resistance mechanism of stalk rot and resistance gene mining.
Diet and Injection, Important Recommendations to Characterize Clavibacter michiganensis–Tomato Interactions
Authors: Brochu Anne-Sophie , Durrivage Jeanne , Torres Dagoberto , Pérez-López Edel
Published: July 2023

Tomato ( Solanum lycopersicum L.) is one of the most important vegetables in the world. Its extensive cultivation has made this plant the target of many viral, fungal, and bacterial diseases. Among them, bacterial canker of tomato caused by Clavibacter michiganensis ( Cm) has been named one of the most devastating diseases affecting the tomato industry worldwide. It can significantly reduce the yields and profitability of this crop. One of the big challenges we found when working with Cm and trying to characterize the virulence of different isolates was the lack of a consensus methodology to inoculate tomato plants, fertilize them, and characterize Cm virulence. The aim of this research was to identify an artificial inoculation method to induce bacterial canker on tomato plants in greenhouse conditions to homogenize the results of different studies with Cm. We compared two inoculation methods, the scalpel and syringe methods, with two levels of fertilization, low and high fertilization. After evaluating several variables, such as the percentage of necrotic leaves and the height of the plants, the results showed that syringe inoculation with low fertilization was the most effective inoculation method, allowing for the development of a multilevel scale that can be used to study the interaction between tomato plants and Cm isolates.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
An Observational Study of Outcomes Associated with Virtual Pain Management Programmes Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic
Authors: Hollyfield Shakira , Travers Warren , Sondh Satwinder K , Wilczek Angelika , Jacobs Clair , McCracken Lance M , Scott Whitney
Published: July 2023

Objective:

In response to COVID-19, virtual, group-based interdisciplinary pain management programmes (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low intensity and pre-neuromodulation PMPs based on Acceptance and Commitment Therapy (ACT) as part of routine care during the pandemic.

Methods:

Depending on patients’ needs, participants completed a virtual high- or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 and 2019 for in-person residential (n=561), outpatient (n=123), and pre-neuromodulation (n=207) PMPs were also examined to provide an historical benchmark of performance.

Results:

The virtual high-intensity PMP (n=294) showed significant improvements on all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP (n=129). No statistically significant improvements were observed for the virtual low intensity PMP (n=90). The improvements associated with pre-pandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic.

Discussion:

These data provide preliminary support for the potential benefits of high, but not low, intensity virtual ACT-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.
Characterizing a Joint Reflection-Distortion OAE Profile in Humans With Endolymphatic Hydrops
Authors: Stiepan Samantha , Shera Christopher A. , Abdala Carolina
Published: July 2023

Objectives:

Endolymphatic hydrops (EH), a hallmark of Meniere disease, is an inner-ear disorder where the membranes bounding the scala media are distended outward due to an abnormally increased volume of endolymph. In this study, we characterize the joint-otoacoustic emission (OAE) profile, a results profile including both distortion- and reflection-class emissions from the same ear, in individuals with EH and speculate on its potential utility in clinical assessment and monitoring.

Design:

Subjects were 16 adults with diagnosed EH and 18 adults with normal hearing (N) matched for age. Both the cubic distortion product (DP) OAE, a distortion-type emission, and the stimulus-frequency (SF) OAE, a reflection-type emission, were measured and analyzed as a joint OAE profile. OAE level, level growth (input/output functions), and phase-gradient delays were measured at frequencies corresponding to the apical half of the human cochlea and compared between groups.

Results:

Normal hearers and individuals with EH shared some common OAE patterns, such as the reflection emissions being generally higher in level than distortion emissions and showing more linear growth than the more strongly compressed distortion emissions. However, significant differences were noted between the EH and N groups as well. OAE source strength (a metric based on OAE amplitude re: stimulus level) was significantly reduced, as was OAE level, at low frequencies in the EH group. These reductions were more marked for distortion than reflection emissions. Furthermore, two significant changes in the configuration of OAE input/output functions were observed in ears with EH: a steepened growth slope for reflection emissions and an elevated compression knee for distortion emissions. SFOAE phase-gradient delays at 40 dB forward-pressure level were slightly shorter in the group with EH compared with the normal group.

Conclusions:

The underlying pathology associated with EH impacts the generation of both emission types, reflection and distortion, as shown by significant group differences in OAE level, growth, and delay. However, hydrops impacts reflection and distortion emissions differently. Most notably, DPOAEs were more reduced by EH than were SFOAEs, suggesting that pathologies associated with the hydropic state do not act identically on the generation of nonlinear distortion at the hair bundle and intracochlear reflection emissions near the peak of the traveling wave. This differential effect underscores the value of applying a joint OAE approach to access both intracochlear generation processes concurrently.
Evaluating Surgical Cervical Arthrodesis With a Novel MRI Grading Score
Authors: Mazur-Hart David J. , Godil Jamila A. , Larson Erik W. , Nugent Joseph G. , Gerges Christina , Pettersson David R. , Ross Donald A.
Published: July 2023

Study Design:

This was a single-institution retrospective study.

Objective:

Evaluate a magnetic resonance imaging (MRI)-scoring system to differentiate arthrodesis from pseudoarthrosis following anterior cervical discectomy and fusion.

Summary of Background Data:

Diagnostic workup following fusion surgery often includes MRI to evaluate neural structures and computed tomography (CT) and/or dynamic x-rays to evaluate instrumentation and arthrodesis. The use of MRI alone for these evaluations would protect patients from harmful CT and x-ray ionizing radiation.

Methods:

Neurosurgical attending evaluated CTs for arthrodesis or pseudoarthrosis. Blinded neuroradiology attending and neurosurgery senior resident evaluated independent T1 and T2 region of interest (ROI) signal intensity over instrumented disk space. Cerebral spinal fluid (CSF) at the cisterna magnum and distal adjacent uninstrumented vertebral body (VB) were also calculated. ROIinterspace/ROICSF and ROIinterspace/ROIVB quotients were used to create T1- and T2-interspace interbody scores (IIS).

Results:

Study population (n=64 patients, 50% female) with a mean age of 51.72 years and 109 instrumented levels with 45 fused levels (41.3%) were included. T1-weighted MRI, median T1-IISCSF for arthrodesis was 176.20 versus 130.92 for pseudoarthrosis (P<0.0001), T1-IISVB for arthrodesis was 68.52 and pseudoarthrosis was 52.71 (P<0.0001). T2-weighted MRI, median T2-IISCSF for arthrodesis was 27.72 and 14.21 for pseudoarthrosis (P<0.0001), while T2-IISVB for arthrodesis was 67.90 and 41.02 for pseudoarthrosis (P<0.0001). The greatest univariable discriminative capability for arthrodesis via AUROC was T1-IISVB (0.7743).

Conclusion:

We describe a novel MRI scoring system that may help determine arthrodesis versus pseudoarthrosis following anterior cervical discectomy and fusion. Postoperative symptomatic patients may only require MRI, which would protect patients from ionizing radiation.

Level of Evidence:

Level IV.
Effectiveness of Halo-Pelvic Traction and Thoracoplasty for Pulmonary Artery Pressure and Cardiopulmonary Function in Patients With Severe Spinal Deformity
Authors: Tan Kunyue , Liu Chunxia , Zhao Zhengkai , Wang Shuzhen , Liang Yijian , Yu Bin , Xiong Feng
Published: July 2023

Study Design:

Retrospective review.

Objective:

To evaluate the effectiveness of halo-pelvic traction and thoracoplasty for pulmonary artery pressure (PAP) and cardiopulmonary function in patients with severe spinal deformity.

Summary of Background Data:

The effect of severe spinal deformity on pulmonary arterial hypertension, cardiac structure, and function has received little attention before.

Patients and Methods:

A total of 21 patients with severe spinal deformity were included in our study; all patients were examined by echocardiography and pulmonary function test before and after treatment. The correlations between PAP and pulmonary function were examined using Pearson correlation analysis.

Results:

The PAP decreased from 58.67 ± 20.24 to 39.00 ± 12.51 mm Hg, and the PAP of 42.86% of the patients returned to normal after treatment. Right cardiac enlargement, left ventricular diastolic function, and pulmonary function were improved at the same time. The ratio of left ventricular to right ventricular diameter returned to normal. Moderate correlations (correlation coefficient: −0.513 to −0.559) between PAP and forced vital capacity and forced expiratory volume in the first second were identified.

Conclusions:

Pulmonary arterial hypertension, ventricular diastolic function, and pulmonary function were improved after halo-pelvic traction and thoracoplasty. A moderate negative correlation was identified between PAP and pulmonary function: the more pulmonary function improved, the more PAP decreased.
Successful treatment of severe lung cancer caused by third-generation EGFR-TKI resistance due to EGFR genotype conversion with afatinib plus anlotinib
Authors: Li Qing , Xu Nengluan , Lin Ming , Chen Yusheng , Li Hongru
Published: July 2023

Third-generation EGFR-TKIs can be used to treat advanced non-small cell lung cancer patients with T790M resistance mutation induced by first- or second-generation EGFR-TKIs. However, it will also result in drug resistance, and the resistance mechanisms of third-generation EGFR-TKIs are complex. Here we reported a patient diagnosed with advanced lung adenocarcinoma and EGFR positive in September 2016. Following first-line targeted therapy with gefitinib, genetic testing showed EGFR T790M positive, which resulted in a change to osimertinib targeted therapy. In May 2021, troponin and creatinine levels were elevated, and the tumor hyperprogressed to severe lung cancer. Repeated genetic testing revealed that EGFR genotype converted to a non-classical mutation and EGFR T790M turned negative, which caused third-generation EGFR-TKI resistance. As a result, afatinib combined with anlotinib was selected to stabilize the patient’s condition. We were inspired by the case that it reflects the significance and necessity of exploring the resistance mechanism and dynamically detecting genetic status throughout the course of treatment, which may help realize individualized precision therapy, and maximize the potential of patient.
Non-small cell lung cancer patient with a rare UGP2-ALK fusion protein responded well to alectinib: a case report
Authors: Chen Liulin , Chu Daifang , Li Wangping , Zhang Haitao
Published: July 2023

Several rare anaplastic lymphoma kinase (ALK) fusions have been identified in patients with non-small cell lung cancer (NSCLC); however, their treatment is not currently uniform. alectinib has been commonly used to treat rare ALK fusions in patients with NSCLC. This is the first study to report the occurrence of a uridine diphosphate-glucose pyrophosphorylase 2 (UGP2)-ALK fusion in a patient with NSCLC. The patient, who was hospitalized because of shortness of breath lasting 20 days, showed hydrothorax of the left lung under a computerized tomography chest scan. Pathological histology revealed lung adenocarcinoma in the patient. The UGP2-ALK mutation was found by next-generation sequencing. Subsequently, the patient was administered alectinib, and thereafter, the tumor lesion was observed to gradually shrink over the follow-up period. Progression-free survival reached 10 months as of the follow-up date, with no adverse events detected. This case report provides valuable insights into the clinical management of NSCLC patients with UGP2-ALK fusions. Moreover, alectinib is confirmed to be an appropriate therapeutic agent for such patients.
AZD7762 induces CRBN dependent BAG3 degradation through ubiquitin-proteasome pathway
Authors: Liao Yanli , Yuan Chao , Huang Mi , Si WenXia , Li Duanzhuo , Wu Weibin , Zhang Shifa , Wu Runkun , Quan Yi , Yu Xin , Liao Shengjie
Published: July 2023

Protein degraders are currently under rapid development as a promising modality for drug discovery. They are compounds that orchestrate interactions between a target protein and an E3 ubiquitin ligase, prompting intracellular protein degradation through proteasomal pathway. More protein degraders identification will greatly promote the development of this field. BAG3 is widely recognized as an excellent therapeutic target in cancer treatments. Exploring protein degraders that target BAG3 degradation has profound implications. Herein, molecular docking was applied to assess binding energy between 81 clinical phase I kinase inhibitors and BAG3. BAG3 protein and mRNA level were detected by western blot and quantitative real-time PCR. CCK8 assay and colony formation assay were applied to detect the cell viability and proliferation rate. Cell death was accessed using flow cytometry combined with PI and Annexin V double staining. AZD7762, a Chk1 kinase inhibitor, was identified to induce BAG3 degradation in a ubiquitin-proteasome pathway. AZD7762-induced BAG3 degradation was not dependent on Chk1 expression or activity. CRBN, an E3 ligase, was identified to bind to BAG3 and mediated BAG3 ubiquitination in the presence of AZD7762. By targeting Chk1 and BAG3, two ideal therapeutic targets in cancer treatment, AZD7762 would be a powerful chemotherapy agent in the future.
Role of adipokines in sarcopenia
Authors: Lu Wenhao , Feng Wenjie , Lai Jieyu , Yuan Dongliang , Xiao Wenfeng , Li Yusheng
Published: July 2023

Sarcopenia is an age-related disease that mainly involves decreases in muscle mass, muscle strength and muscle function. At the same time, the body fat content increases with aging, especially the visceral fat content. Adipose tissue is an endocrine organ that secretes biologically active factors called adipokines, which act on local and distant tissues. Studies have revealed that some adipokines exert regulatory effects on muscle, such as higher serum leptin levels will cause a decrease in muscle function and adiponectin inhibits the transcriptional activity of Forkhead box O3 (FoxO3) by activating peroxisome proliferators-activated receptor-γ coactivator -1α (PGC-1α) and sensitizing cells to insulin, thereby repressing atrophy-related genes (atrogin-1 and muscle RING finger 1 [MuRF1]) to prevent the loss of muscle mass. Here, we describe the effects on muscle of adipokines produced by adipose tissue, such as leptin, adiponectin, resistin, mucin and lipocalin-2, and discuss the importance of these adipokines for understanding the development of sarcopenia.
Effects of radiation therapy on tumor microenvironment: an updated review
Authors: Zhang Zewen , Peng Yuanhao , Peng Xin , Xiao Desheng , Shi Ying , Tao Yongguang
Published: July 2023

Cancer is a major threat to human health and causes death worldwide. Research on the role of radiotherapy (RT) in the treatment of cancer is progressing; however, RT not only causes fatal DNA damage to tumor cells, but also affects the interactions between tumor cells and different components of the tumor microenvironment (TME), including immune cells, fibroblasts, macrophages, extracellular matrix, and some soluble products. Some cancer cells can survive radiation and have shown strong resistance to radiation through interaction with the TME. Currently, the complex relationships between the tumor cells and cellular components that play major roles in various TMEs are poorly understood. This review explores the relationship between RT and cell–cell communication in the TME from the perspective of immunity and hypoxia and aims to identify new RT biomarkers and treatment methods in lung cancer to improve the current status of unstable RT effect and provide a theoretical basis for further lung cancer RT sensitization research in the future.
Incidental Detection of Malignancies With Cell-Free DNA Screening
Authors: RINK BRITTON D. , STEVENS BLAIR K.
Published: July 2023

Cell-free circulating DNA is an evolving technology with important clinical applications in both obstetric care and oncology. In the challenging patient with pregnancy and co-existing malignancy, the utility of cell-free DNA both for aneuploidy screening and cancer identification is an area of active research. Understanding the physiology associated with circulating cell-free DNA and subsequent laboratory evaluation is critical for clinicians caring for the obstetric patient with cell-free fetal DNA screening results suggestive of malignancy. Ongoing research is necessary to determine best practices for the evaluation and management of these patients with promising applications in the advancement of precision medicine.
The Use of the Pericranial Periosteal Flap in Children for Treating Severe Lower Eyelid Retraction
Authors: Lim Christina S. , Malhotra Raman
Published: July 2023

Purpose:

To describe a surgical technique that can achieve significant lower eyelid elevation in severe retraction in children using a pericranial periosteal flap with skin graft.

Methods:

A retrospective, single-center, case series of 3 consecutive pediatric cases are performed where a pericranial periosteal flap was used with a skin graft to manage severe lower eyelid retraction. Outcome measures include the extent of lower eyelid elevation (mm) and complications in the follow-up visits.

Results:

Three children with severe lower eyelid retraction underwent the surgery. There were 2 boys and 1 girl with the mean age of 6.7 years (range, 5–8 years). The improvement of lower eyelid retraction was 3, 3, and 7 mm at 28, 24, and 6 months, respectively. No perioperative or postoperative complications occurred.

Conclusions:

Children with severe lower eyelid retraction often have a complex craniofacial and surgical history, and its surgical correction can be challenging. This case series present the successful use of pericranial flaps in treating severe lower eyelid retraction in children. The authors recommend this flap in children where traditional options have either failed or are not applicable.
Early pigment dispersion and raised intraocular pressure after uneventful central-hole implantable collamer lens surgery
Authors: Chaudhary Sanjay , Mehra Hema , Mittal Shanu Kumar , Pandey Alka
Published: July 2023

Introduction:

With ever-increasing cases of myopia worldwide, there has been a quantum jump in the number of refractive procedures. 3 cases who had an uncomplicated implantable collamer lens (ICL) surgery in both eyes, but had a new complication, are presented here. This is not yet described in the literature to the authors' knowledge.

Patient and Clinical Findings:

2 weeks after uneventful bilateral ICL surgery, the patients presented with slight blurring of vision in 1 eye only. On examination, there was excessive pigment dispersion in the anterior chamber both in front of and behind the ICL. They also had raised intraocular pressure (IOP) a few days later, possibly due to blockage of the trabecular meshwork by iris pigments.

Diagnosis, Intervention, and Outcomes:

All the patients were managed conservatively on anti-inflammatory and IOP-lowering eyedrops. The dispersed pigments decreased with normalization of IOP after 2 to 4 weeks of conservative management with no blurring of vision. However, the pupil remained slightly dilated and irregular in all these cases.

Conclusions:

The excessive pigment dispersion seen after ICL surgery is not commonly encountered after ICL surgery and can be managed conservatively.
Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage
Authors: Lindquist Nathan R. , Dietrich Mary S. , Patro Ankita , Henry Melissa R. , DeFreese Andrea J. , Freeman Michael H. , Perkins Elizabeth L. , Gifford René H. , Haynes David S. , Holder Jourdan T.
Published: July 2023

Objective

To quantify the effect of datalogging on speech recognition scores and time to achievement for a “benchmark” level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes.

Study Design

Retrospective cohort.

Setting

Tertiary referral center.

Patients

Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020.

Main Outcome Measures

Processor datalogging, speech recognition scores, achievement of “benchmark speech recognition performance” defined as 80% of the median score for speech recognition outcomes at our institution.

Results

The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant–nucleus–consonant and AzBio scores within the first year (odds ratio = 1.21,p< 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day.

Conclusions

Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.
Bed Rest After Acute Myocardial Infarction: A Century of Expert Opinions in Cecil Textbook of Medicine
Authors: Manu Peter , Dinu Eleonora-Antoaneta , Rogozea Liliana M.
Published: July 2023

Background:

Complete bed rest has been a component of the management of acute myocardial infarction, which was first diagnosed in the United States in 1912. The prescribed duration of bed rest has been progressively shortened in the past century.

Study Question:

What are the milestones of the changes in the expert approach to the duration of bed rest for patients with acute myocardial infarction?

Study Design:

To determine the changes in the experts' approach to the duration of bed rest after a diagnosis of acute myocardial infarction, as presented in a widely used textbook in the United States.

Data Sources:

The chapters presenting the management of myocardial infarction in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results:

Complete rest for 2–6 weeks was recommended by the Cecil's experts from 1927 through 1967. The practice was questioned since the early 1950s, but the recommended duration of bed rest was decreased to 3–4 days only in 1971, after most US hospitals opened coronary care units. The required time in bed was further decreased to 1 day in 1992 and to 12 hours in 2004. By 2007, the literature contained data from 15 trials with a total of 1471 patients kept in bed “longer” and 1487 patients who had been prescribed bed rest for “shorter” periods after an acute uncomplicate myocardial infarction and there was no difference between the groups regarding reinfarction, cardiac mortality, or all-cause mortality.

Conclusions:

The duration of bed rest after acute myocardial infarction recommended by experts in the United States has had a downward trend with an inflection point in the early 1970s. The change reflected experts' opinion, rather than evidence produced by randomized controlled trials.
High-deductible Health Plans and Nonfatal Opioid Overdose
Authors: Eddelbuettel Julia C.P. , Barry Colleen L. , Kennedy-Hendricks Alene , Busch Alisa B. , Hollander Mara A.G. , Huskamp Haiden A. , Meiselbach Mark K. , Schilling Cameron , Stuart Elizabeth A. , Eisenberg Matthew D.
Published: July 2023

Objectives:

Opioid-related overdose is a public health emergency in the United States. Meanwhile, high-deductible health plans (HDHPs) have become more prevalent in the United States over the last 2 decades, raising concern about their potential for discouraging high-need populations, like those with opioid use disorder (OUD), from engaging in care that may mitigate the probability of overdose. This study assesses the impact of an employer offering an HDHP on nonfatal opioid overdose among commercially insured individuals with OUD in the United States.

Research Design:

We used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. We used an intent-to-treat, difference-in-differences regression framework to estimate the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. We also used an event-study model to account for dynamic time-varying treatment effects.

Results:

Across both comparison and treatment groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. Our primary model and robustness checks revealed no impact of HDHP offer on the probability of a nonfatal overdose.

Conclusions:

Our study suggests that HDHP offer was not associated with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD. However, given the strong evidence that medications for OUD (MOUD) can reduce the risk of overdose, research should explore which facets of insurance design may impact MOUD use.
The potential role of 68Ga-FAPI-04 PET/CT for screening malignancy in suspected colonic lesions
Authors: Erol Fenercioğlu Özge , Beyhan Ediz , Şahin Rahime , Baloğlu Mehmet Can , Arslan Esra , Çermik Tevfik Fikret , Ergül Nurhan
Published: July 2023

Aim

Benign colonic lesions like tubular adenoma may show intense uptake on F-18-FDG PET/CT and can be mistaken for malignancy. In this study, we evaluated the role of 68Ga-FAPI-04 PET/CT for discriminating the benign and malignant colonic lesions.

Methods

Forty patients with diagnosis of colorectal cancer who had undergone 18F-FDG-PET/CT and 68Ga-FAPI-04 PET/CT for initial staging were retrospectively analyzed. The unexpected foci of uptake in colon on 18F-FDG PET/CT were compared with 68Ga-FAPI-04 PET/CT with lesion and background SUVmax.

Results

The primary colorectal lesion SUVmax on both PET/CTs was similar. A total of 9 incidental colon lesions in 7 patients were detected showing intense 18F-FDG uptake and no 68Ga-FAPI-04 uptake. All of the lesions were consistent with tubular adenoma histopathologically.

Conclusion

68Ga-FAPI PET/CT may have a crucial role for discrimination of benign and malignant colonic lesions and avoid the unnecessary interventions and extended surgeries in patients with colorectal cancer.
Mood Disorder or Psychotic Disorder? Yes: A Case Report on Cycloid Psychosis
Authors: Hsiung Kimberly , Skikic Maja
Published: July 2023

Cycloid psychosis is a disorder defined by episodic, acute psychoses involving thought, affect, and motor disturbances with polymorphous symptomatology followed by periods of full remission. Antipsychotics, benzodiazepines, and electroconvulsive therapy have been used empirically in acute treatment. This disorder has faced nosologic challenges and is not yet identified as a diagnostic entity by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Questions remain as to whether cycloid psychosis is a primary psychotic or primary affective disorder, given that its course and episodicity are like that of affective disorders, while its clinical manifestations include prominent psychotic symptoms. This report describes the case of a 38-year-old male with classic features of cycloid psychosis and highlights the unique characteristics that distinguish cycloid psychosis from other similar diagnoses.
Studying the Feasibility and Acceptability of an Interactive Web-based Lethal Means Safety Decision Aid for Hospitalized Adults With Suicide Risk (Lock to Live)
Authors: Singh Mandeep , Levins Brian , McCall William V. , Anderson Michael , Olsen Erik , Yee Victoria , Cushing Michaela , Spearman-McCarthy E. VANESSA
Published: July 2023

Objective:

Lock to Live is an interactive web-based lethal means safety decision aid that promotes temporary storage of firearms and medications. It has primarily been provided to suicidal patients in emergency department settings. The goal of this study was to evaluate the feasibility and acceptability of the Lock to Live decision aid with hospitalized adults at increased risk of suicide.

Methods:

Subjects provided demographic information and completed the Columbia-Suicide Severity Rating Scale after which they completed the Lock to Live program followed by a survey.

Results:

Twenty participants were recruited for this study, 5 of whom had access to firearms and 19 of whom had access to medications. Lock to Live was feasible to use as the mean length of time to complete the program was 10.0±5.3 minutes. It was acceptable to most participants as 75% of participants found it to be easy to use, and 65% of participants agreed that Lock to Live was helpful in making a decision about changing access to firearms/medications.

Conclusion:

Lock 2 Live decision aid appears to be a feasible and acceptable tool for hospitalized patients at risk for suicide.
Reduction in Cognitive Symptoms Following Intranasal Esketamine Administration in Patients With Chronic Treatment-resistant Depression: A 12-Week Case Series
Authors: Pepe Maria , Bartolucci Giovanni , Marcelli Ilaria , Simonetti Alessio , Camardese Giovanni , Di Nicola Marco , Sani Gabriele
Published: July 2023

Background:

Cognitive symptoms are a core feature of depressive disorders, interfere with full functional recovery and are prominent in patients with treatment-resistant depression (TRD), particularly in severe chronic cases. Intranasal (IN) esketamine was recently approved for the treatment of TRD; however, its effects on cognitive symptoms are unclear. In this article, we describe cognitive changes in 8 patients with chronic TRD who were treated with IN administration of esketamine.

Methods:

Eight outpatients with chronic TRD received IN esketamine over 3 months and were assessed at baseline and after 4, 8, and 12 weeks of treatment using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Digit Symbol Substitution Test (DSST), the Trail Making Test-B (TMT-B), the Patient Deficits Questionnaire for Depression 5-item (PDQ-D5), the Hamilton Anxiety Rating Scale (HARS), and the Clinical Global Impressions Scale (CGI).

Findings:

We observed reductions in cognitive symptoms according to DSST, TMT-B, and PDQ-D5 scores within the first 2 months of treatment with IN esketamine. These improvements were observed before patients achieved clinical response (≥50% decrease in baseline MADRS scores), and they also occurred earlier than reductions in HARS scores.

Conclusions:

A clinical response to IN esketamine was detected in severely ill patients with chronic TRD after 3 months of treatment. Interestingly, improvements on measures of cognitive symptoms were observed before patients achieved antidepressant response. These preliminary observations suggest an additional value to the antidepressant properties of IN esketamine. Clinical studies specifically investigating cognition as a primary outcome measure of IN esketamine in TRD are warranted.
“Psychotherapy in the Pressure Cooker”: A Systematic Review of Single Session Psychosocial Interventions in Emergency Departments for Suicide-related Thoughts or Behaviors
Authors: Bossé Chartier Gabrielle , Lam Frederick , Bergmans Yvonne , Lofchy Jodi , Bolton James M. , Klonsky E. David , Zaheer Juveria , Kealy David
Published: July 2023

Objectives:

Up to 20% of individuals who die by suicide have visited an emergency department (ED) within 4 weeks of their death. Limited guidance is available regarding the modification of clinical outcomes following a psychosocial intervention in the ED for pediatric and adult populations.

Methods:

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify studies focused on single-session psychosocial interventions for pediatric and adult patients experiencing suicide-related thoughts or behaviors (SRTB) in the ED. Two reviewers independently screened articles identified using the key terms suicide/self-harm, emergency department, and interview. Medline, PubMed, Embase, PsycINFO, CINAHL, and CENTRAL were searched from inception to August 2018.

Results:

After screening 3234 abstracts, 29 articles were selected for full-text review and 14 articles, representing 8 distinct studies (N=782), were included. A high level of heterogeneity was present in the included articles, with 7 randomized-controlled trials, 2 nonrandomized-controlled trials, 2 cohort studies, 2 observational studies, and 1 feasibility study. Most of the included studies focused on adolescents (6 articles) or military veterans (7 articles). Strong statistical evidence of ED interventions improving outpatient service linkage was supported (χ2: 81.80, P<0.0001, 7 studies).

Conclusions:

The findings of this study suggested promising outcomes for patients presenting to the ED with SRTB who receive a single-session psychosocial intervention. All of the studies that measured such outcomes found significantly increased follow-up care in the intervention arm. Further research is needed to strengthen the evidence base, provide better patient representation, and improve our understanding of the mechanisms by which the psychosocial intervention for SRTB in the ED ameliorates patient outcomes (CRD42020156496).
Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol
Authors: Araya Sthefano , Webster Theresa K. , Egleston Brian , Amadio Grace M. , Panichella Juliet C. , Elmer Nicholas A. , Patel Sameer A.
Published: July 2023

Background

Enhanced Recovery After Surgery (ERAS) implementation achieves earlier recovery, reduced hospital length of stay (LOS) and improved outcomes in patients undergoing deep inferior epigastric perforator (DIEP) free flaps. We sought to review our ERAS protocols and their impact on our patients' LOS compared with the literature.

Methods

This was a retrospective review of a single surgeon's experience from 2017 to 2021 of patients undergoing DIEP free-flap breast reconstruction with LOS as the primary outcome. Complication rates and patient demographics are described as secondary outcomes.

Results

One hundred twenty-one patients underwent DIEP free-flap breast reconstruction. After adapting ERAS protocols, there has been a 0.98 [SD, 0.17; confidence interval [CI], −1.3 to −0.64; P < 0.001) day decrease in length of stay comparing pre-ERAS to post-ERAS implementation. Length of stay has routinely decreased from an average discharge on day 4.17 (SD, 1.1; range, 3–8 days) in 2017 to discharge on day 2.91 (SD, 1.1; range, 1–5 days) in 2021. Seventy-five percent of patients in 2021 were hospitalized for 3 or fewer days compared with 75% of patients in 2017 hospitalized for 4 or more days. One patient experienced a flap failure. Our study supports successful discharge on postoperative days 2–3 compared with postoperative days 3–4 in the current literature.

Conclusions

The implementation of our ERAS protocol for DIEP free-flap breast reconstruction has resulted in a shorter LOS compared with contemporary literature. The ERAS protocols can be efficiently adopted in microsurgical DIEP breast reconstruction to achieve a shorter LOS without jeopardizing patient outcomes.
Adipose-Derived Stem Cells Enhance Graft Incorporation and Mineralization in a Murine Model of Irradiated Mandibular Nonvascularized Bone Grafting
Authors: Lynn Jeremy V. , Lalchandani Keshav B. , Daniel Melissa , Urlaub Kevin M. , Ettinger Russell E. , Nelson Noah S. , Donneys Alexis , Buchman Steven R.
Published: July 2023

Background

Nonvascularized bone grafting represents a practical method of mandibular reconstruction. However, the destructive effects of radiotherapy on native bone preclude the use of nonvascularized bone grafts in head and neck cancer patients. Adipose-derived stem cells have been shown to enhance bone healing and regeneration in numerous experimental models. The purpose of this study was to determine the impact of adipose-derived stem cells on nonvascularized bone graft incorporation in a murine model of irradiated mandibular reconstruction.

Methods

Thirty isogenic rats were randomly divided into 3 groups: nonvascularized bone graft (control), radiation with nonvascularized bone graft (XRT), and radiation with nonvascularized bone graft and adipose-derived stem cells (ASC). Excluding the control group, all rats received a human-equivalent dose of radiation. All groups underwent mandibular reconstruction of a critical-sized defect with a nonvascularized bone graft from the contralateral hemimandible. After a 60-day recovery period, graft incorporation and bone mineralization were compared between groups.

Results

Compared with the control group, the XRT group demonstrated significantly decreased graft incorporation (P = 0.011), bone mineral density (P = 0.005), and bone volume fraction (P = 0.001). Compared with the XRT group, the ASC group achieved a significantly increased graft incorporation (P = 0.006), bone mineral density (P = 0.005), and bone volume fraction (P = 0.013). No significant differences were identified between the control and ASC groups.

Conclusions

Adipose-derived stem cells enhance nonvascularized bone graft incorporation in the setting of human-equivalent radiation.
The Utility of Flap Coverage for Limb Salvage in Patients With Severe Prosthetic Joint Infections of the Knee Requiring Implant Exchange
Authors: Kahramangil Bora , Pires Giovanna , Montorfano Lisandro , Riesgo Aldo M. , Ghaznavi Amir M.
Published: July 2023

Background

Prosthetic joint infection (PJI) is a challenging complication of knee arthroplasty, which can require amputation in severe cases. This study analyzes the utility of flap reconstruction in PJIs requiring hardware removal and extensive soft tissue debridement.

Methods

This was a retrospective analysis of patients who were treated according to a multistage extremity salvage protocol between 2018 and 2022. The protocol involved at least 3 planned surgeries including (1) hardware removal with antibiotic spacer placement and soft tissue debridement, (2) spacer exchange with flap coverage, and (3) hardware reimplantation with simultaneous or delayed extensor mechanism reconstruction. All patients had large periprosthetic tissue defects that would necessitate an amputation if not reconstructed. Primary outcomes were extremity salvage and successful defect coverage.

Results

Fifty-two patients (25 female) underwent 62 reconstructions (52 primary, 10 salvage). Flap techniques included pedicled muscular (n = 32), fasciocutaneous (n = 4), combined muscular and fasciocutaneous (n = 2), and free flaps (n = 24). Overall rate of successful defect coverage was 95% (98% in primary and 80% in salvage reconstructions). At a median follow-up of 11 months, 41 patients completed the treatment protocol with a 68% (n = 28) extremity salvage rate (reimplantation arthroplasty, n = 15; permanent knee fusion, n = 13). On the multivariate model including demographic factors, defect size, and flap type, no single factor independently predicted limb salvage.

Conclusions

Alongside intensive orthopedic surgical treatment, flap coverage may aid in extremity salvage in severe knee PJIs by reestablishing healthy soft tissue coverage and allowing reimplantation arthroplasty. We recommend a multispecialty approach including plastic surgeons for this challenging condition.
The Use of Botulinum Toxin in Raynaud Phenomenon
Authors: Lawson Olivia , Sisti Andrea , Konofaos Petros
Published: July 2023

Background

Raynaud phenomenon (RP) is a vasospastic condition of the digits that can be primary or secondary to systemic disease. Symptoms are triggered by cold or stress and can cause pain and skin color changes. The chronic ischemia may lead to necrosis, ulceration, and amputation. There are no Food and Drug Administration–approved treatments and cases refractory to pharmacologic and surgical treatments are difficult to control. Local botulinum toxin injections have been increasingly used in the treatment of Raynaud disease and have shown promising results.

Aim of the study

To examine the outcomes, techniques, and complications of botulinum toxin use for the treatment of Raynaud disease.

Methods

The PubMed database was queried using “botulinum toxin” AND “Raynaud phenomenon” as title key words. Preferred reporting items for systematic reviews and meta-analysis criteria were used. Additional articles were selected while reviewing the references of the articles from PubMed. No time restrictions were followed. Articles of all languages were included. Articles were analyzed for study type, demographics, diagnosis/inclusion criteria, treatment methods, outcome measures, length of follow-up, results, and complications. A positive outcome was defined as subjective improvement in symptoms and/or improvement in the outcome measures. A poor outcome was defined as harm done to the patient by the injection that would not have occurred otherwise.

Results

Forty-two clinical studies describing the use of botulinum toxin for Raynaud's phenomenon were found. A total of 425 patients with primary or secondary Raynaud's were treated, with ages ranging from 14 to 91 years. There were 342 women and 81 men, with a female-to-male ratio of 38:9. Outcomes were positive in 96.2% of patients. There were 14.2% of the studies that reported 3.5% of all patients showing no subjective improvement. A single study reported a poor outcome for 1 patient. There were 40.5% of the studies that reported complications, affecting 20.2% of all patients. The most frequently reported complication was transient hand weakness, affecting 44.2% of patients with complications and 8.9% of total patients. Weakness resolved in hours to months after injection. Pain at the injection site lasting minutes to days was reported in 40.7% of patients with complications, and 8.2% of total patients.

Conclusions

Botulinum toxin treatment for RP is effective. Complications are minor and self-limiting.