bluuebunny/crossref_metadata_2025 huggingface dataset:
Optic Nerve Sheath Diameter Point-of-Care Ultrasonography Quality Criteria Checklist: An International Consensus Statement on Optic Nerve Sheath Diameter Imaging and Measurement*
Authors: Hirzallah Mohammad I. , Lochner Piergiorgio , Hafeez Muhammad Ubaid , Lee Andrew G. , Krogias Christos , Dongarwar Deepa , Hartman Nicholas D. , Ertl Michael , Robba Chiara , Malojcic Branko , Valaikiene Jurgita , Sarwal Aarti , Hakimi Ryan , Schlachetzki Felix ,   for the Optic Nerve Sheath Diameter Point-of-Care Ultrasonography Quality Criteria Checklist (ONSD POCUS QCC) Expert Panelists
Published: June 2024

OBJECTIVES:

To standardize optic nerve sheath diameter (ONSD) point-of-care ultrasonography (POCUS) and improve its research and clinical utility by developing the ONSD POCUS Quality Criteria Checklist (ONSD POCUS QCC).

DESIGN:

Three rounds of modified Delphi consensus process and three rounds of asynchronous discussions.

SETTING:

Online surveys and anonymous asynchronous discussion.

SUBJECTS:

Expert panelists were identified according to their expertise in ONSD research, publication records, education, and clinical use. A total of 52 panelists participated in the Delphi process.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Three Delphi rounds and three asynchronous discussion rounds generated consensus on quality criteria (QC). This started with 29 QC in addition to other QC proposed by expert panelists. The QC items were categorized into probe selection, safety, body position, imaging, measurement, and research considerations. At the conclusion of the study, 28 QC reached consensus to include in the final ONSD POCUS QCC. These QC were then reorganized, edited, and consolidated into 23 QC that were reviewed and approved by the panelists.

CONCLUSIONS:

ONSD POCUS QCC standardizes ONSD ultrasound imaging and measurement based on international consensus. This can establish ONSD ultrasound in clinical research and improve its utility in clinical practice.
Association between birth weight and risk of nonneurological childhood cancers: a systematic review and meta-analysis
Authors: Rashti Roya , Ghasemi Faezeh , Poorolajal Jalal
Published: June 2024

Objectives

This systematic review aims to synthesize the available literature to determine the association between birthweight and the risk of nonneurological childhood cancers.

Methods

We conducted a systematic search of PubMed, Web of Science, and Scopus databases up to May 2023 to identify observational studies. Heterogeneity between studies was evaluated using the I
2 statistics. Publication bias was assessed using Begg and Egger tests. We calculated the odds ratio (OR) or risk ratio (RR) with a 95% confidence interval (CI) using a random-effects model.

Results

Of 11 034 studies retrieved from the search, 56 studies (including 10 568 091 participants) were eligible. The ORs (95% CI) of low (<2500 g) versus normal birthweight (2500–4000 g) and childhood cancers were as follows: leukemia, 0.92 (0.77–1.11); acute lymphoblastic leukemia, 0.82 (0.72–0.94); acute myeloid leukemia, 0.98 (0.77–1.24); lymphoma, 0.99 (0.47–2.10); Hodgkin, 0.79 (0.61–1.03); non-Hodgkin, 0.85 (0.60–1.20); neuroblastoma, 1.34 (1.14–1.58); retinoblastoma, 0.95 (0.68–1.32); rhabdomyosarcoma, 0.86 (0.61–1.20); embryonal, 0.97 (0.66–1.43); alveolar, 1.92 (0.43–8.51); and Wilms tumor, 1.01 (0.83–1.24). The ORs (95% CI) of high (>4000 g) versus normal birthweight and childhood cancers were as follows: leukemia, 1.30 (1.18–1.42); acute lymphoblastic leukemia, 1.27 (1.16–1.39); acute myeloid leukemia, 1.13 (0.98–1.30); lymphoma, 1.69 (0.72–3.94); Hodgkin, 1.22 (1.02–1.46); non-Hodgkin, 1.22 (0.80–1.86); neuroblastoma, 1.20 (1.02–1.41); retinoblastoma, 1.17 (0.93–1.48); rhabdomyosarcoma, 1.07 (0.90–1.27); embryonal, 1.22 (1.00–1.49); alveolar, 1.02 (0.46–2.27); and Wilms tumor, 1.49 (1.34–1.67).

Conclusion

This meta-analysis identified high birth weight as a potential risk factor for some childhood cancers, while low birth weight might be protective against a few.
Open Surgical Excision of Dorsal Wrist Ganglia: Puncturing the Dome Reduces Surgery Time
Authors: Al-Qattan Mohammad M. , Altwaijri Nouf A. , Al-Mohrij Saad A. , Al-Qattan Ahmed M.
Published: June 2024

Background:

The following study is retrospective and compared the operative time and complications using two techniques of surgical resection of primary dorsal wrist ganglia in adults.

Methods:

Surgery was performed by the senior author (M.M.A.) through a transverse skin incision. The dome of the ganglion is dissected in both techniques. In the first technique (group A patients, n = 20 patients), dissection is continued to the base of the ganglion to reach the stalk near the scapho-lunate ligament. The stalk is transected and cauterized near the ligament. This surgical technique has been practiced by the senior author for 25 years. Over the last 5 years, the author has modified the technique (group B patients, n = 20 patients) by puncturing the dome of the ganglion following dome dissection. About two-thirds of the content of the ganglion is removed, and a mosquito is then used to close the puncture site. Dissection of the base of the ganglion to the stalk becomes easier and quicker, and the stalk is transected and cauterized near the scapho-lunate ligament.

Results:

There was one recurrence in each group. Other complications were not seen in either group. The mean operative time (SD) was 30.75 (SD = 2.98) minutes for group A; and 20.75 (SD = 2.25) minutes for group B. An independent-samples t test was used to compare the operative time of both groups, which showed the difference was statistically significant (P < 0.001).

Conclusions:

Our study showed that intentionally puncturing the dome of the ganglion makes the dissection of the base quicker, without increasing the risk of complications.
Lymphovenous Anastomosis for the External and Internal Types of Head and Neck Lymphedema: A Case Series and Preliminary Clinical Results
Authors: Lin Ying-Sheng , Liu Chia-Ju , Chou Chen-Han
Published: June 2024

Background:

Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL.

Methods:

Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. Lymphedema Symptom Intensity and Distress Surveys—Head and Neck (LSIDS-H&N) were used for evaluation. In addition, for the external type, MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNL) rating scale was used for evaluation. For the internal type, Swallowing Quality of Life was used for evaluation.

Results:

With an average follow-up period of 15.4 ± 15.9 months, LSIDS-H&N improved from 1.11 ± 0.54 to 0.44 ± 0.66 (P = 0.02). For patients with the external type, within an average follow-up period of 15 ± 16.1 months, the MDACC HNL rating scale improved from level 2 to 0 or 1a (P = 0.008). For patients with the internal type, within an average follow-up period of 21 ± 17.3 months, Swallowing Quality of Life improved from 130.5 ± 9.2 to 151 ± 19.8 (P = 0.5).

Conclusions:

Based on our preliminary results, LVA could be a potential solution to both external and internal HNL.
Nicotine aggravates liver fibrosis via α7 nicotinic acetylcholine receptor expressed on activated hepatic stellate cells in mice
Authors: Mihara Taiki , Hori Masatoshi
Published: June 2024

Background:

Smoking is a risk factor for liver cirrhosis; however, the underlying mechanisms remain largely unexplored. The α7 nicotinic acetylcholine receptor (α7nAChR) has recently been detected in nonimmune cells possessing immunoregulatory functions. We aimed to verify whether nicotine promotes liver fibrosis via α7nAChR.

Methods:

We used osmotic pumps to administer nicotine and carbon tetrachloride to induce liver fibrosis in wild-type and α7nAChR-deficient mice. The severity of fibrosis was evaluated using Masson trichrome staining, hydroxyproline assays, and real-time PCR for profibrotic genes. Furthermore, we evaluated the cell proliferative capacity and COL1A1 mRNA expression in human HSCs line LX-2 and primary rat HSCs treated with nicotine and an α7nAChR antagonist, methyllycaconitine citrate.

Results:

Nicotine exacerbated carbon tetrachloride–induced liver fibrosis in mice (+42.4% in hydroxyproline assay). This effect of nicotine was abolished in α7nAChR-deficient mice, indicating nicotine promotes liver fibrosis via α7nAChR. To confirm the direct involvement of α7nAChRs in liver fibrosis, we investigated the effects of genetic suppression of α7nAChR expression on carbon tetrachloride–induced liver fibrosis without nicotine treatment. Profibrotic gene expression at 1.5 weeks was significantly suppressed in α7nAChR-deficient mice (−83.8% in Acta2, −80.6% in Col1a1, −66.8% in Tgfb1), and collagen content was decreased at 4 weeks (−22.3% in hydroxyproline assay). The in vitro analysis showed α7nAChR expression in activated but not in quiescent HSCs. Treatment of LX-2 cells with nicotine increased COL1A1 expression (+116%) and cell proliferation (+10.9%). These effects were attenuated by methyllycaconitine citrate, indicating the profibrotic effects of nicotine via α7nAChR.

Conclusions:

Nicotine aggravates liver fibrosis induced by other factors by activating α7nAChR on HSCs, thereby increasing their collagen-producing capacity. We suggest the profibrotic effect of nicotine is mediated through α7nAChRs.
Enhancing Cardiorespiratory Fitness Through Sauna Bathing
Authors: Kunutsor Setor K. , Isiozor Nzechukwu M. , Kurl Sudhir , Laukkanen Jari A.
Published: June 2024

Purpose:

The physiological adaptations stimulated by a sauna bath (SB) are similar to those produced by moderate- or high-intensity physical activity (PA), but the relationship between SB and cardiorespiratory fitness (CRF) is not clear. The objective of this study was to evaluate the cross-sectional and longitudinal associations between frequency and duration of SB with CRF.

Methods:

Baseline SB habits were assessed in 2012 men aged 42 -61 yr. CRF was directly measured using a respiratory gas exchange analyzer during cardiopulmonary exercise testing at baseline and 11 yr later. The associations of SB frequency and duration with baseline and 11-yr levels of CRF were examined using robust regression analyses adjusted for several confounders, including lifestyle factors such as PA.

Results:

In baseline analysis, a unit increase in sauna sessions/wk was associated with an increase in CRF 0.30 mL/kg/min (standard error [SE]: 0.14; P = .034). Alternatively, compared with a single sauna sessions/wk, 2-3 and 4-7 sauna sessions/wk was each associated with significant increases in levels of CRF: 0.84 mL/kg/min (SE: 0.32; P = .008) and 1.17 mL/kg/min (SE: 0.57; P = .041), respectively. In longitudinal analysis, frequent SB was associated with increases in 11-yr CRF levels, but this was only significant for 2-3 sauna sessions/wk compared with a single sauna sessions/wk: 1.22 mL/kg/min (SE: 0.59; P = .038). Duration of SB was not significantly associated with CRF levels in cross-sectional and longitudinal analyses.

Conclusions:

Frequent SB may improve levels of CRF independently of PA. These results warrant replication in robust definitive randomized controlled trials.
RELATIONSHIP BETWEEN OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS AND NUMBER OF INTRAVITREAL RANIBIZUMAB INJECTIONS IN EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN THE HARBOR STUDY
Authors: Tong Nianting , Fan Wenying , Su Li , Ebraheem Adel , Uji Akihito , Marion Kenneth , Sadda Srinivas
Published: June 2024

Purpose:

To correlate baseline spectral-domain optical coherence tomography characteristics with the number of as-needed intravitreal injections of ranibizumab over a 24-month follow-up period in eyes with neovascular age-related macular degeneration.

Methods:

Two hundred thirty-six eyes of 236 subjects with neovascular age-related macular degeneration treated with ranibizumab 0.5 mg pro re nata in the HARBOR study were enrolled. Baseline spectral-domain optical coherence tomography images were evaluated by certified reading center graders for specific morphologic features of the macular neovascularization lesion and surrounding retina. Baseline optical coherence tomography features and patient demographics correlated with the number of injections over the next 2 years.

Results:

The mean number of injections in the 0.5 mg pro re nata group was 8.07 (median 8, 3–12) after 12 months and 14.25 (median 14, 3–24) after 24 months of treatment. After multivariate, linear, regression analysis, the only baseline parameter that was independently associated with a higher injection frequency at both 12 and 24 months was a greater baseline subretinal fluid thickness.

Conclusion:

A greater subretinal fluid thickness at baseline was associated with a higher frequency of pro re nata injections over 12 and 24 months in eyes treated with ranibizumab for neovascular age-related macular degeneration. These findings may be of value in counseling patients who are about to initiate therapy for macular neovascularization.
Examining Opportunities Offered Outside of Home Country in Physical Therapy Education: Considering the Colonial History of Global Health
Authors: Dholakia Kripa , Audette Jennifer , Gamble April , Hartman Jeff
Published: June 2024

Background and Purpose.

Increasingly, PT programs in the United States are providing educational experiences outside of the home country (OHC) where faculty and students engage in global health initiatives. It is important to consider that the field of global health has its historical roots in colonialism, which has led to inequities and injustice. Those who are engaged in this work must assist in reversing this colonial legacy. The purpose of this position paper is to present the colonial history of global health, to provide context, and to spark critical reflection among PT educators about how OHC experiences are developed and configured.

Position and Rationale.

As a profession, we must educate ourselves about the history of global health and critically reflect on OHC engagements to ensure that we support equity and justice.

Discussion and Conclusion.

We must start by grounding our OHC experiences in health equity and justice. This should be done by considering the colonial history of global health and the privileges we hold as members of academic institutions in the United States. Why we offer OHC experiences in PT education should be investigated and clear to both faculty and students. Excluding this colonial history and its impacts risks perpetuating the historical harms to the health and well-being of the populations we claim to be serving.
Retrieval Practice Improves Exam Performance as a Function of Review Question Number and Format
Authors: Pitt Jason , Huebner Bethany
Published: June 2024

Introduction.

Although retrieval practice is a well-established method of improving learning, it is unclear whether review question format matters or how many review questions are needed to maximize the effects of retrieval practice.

Review of Literature.

Inconsistent findings are reported regarding review question format, and no studies were conducted in physical therapy education programs. A positive relationship is reported between review question number and exam performance, but no studies estimate the number of review questions needed to maximize retention of specific learning objectives.

Subjects.

Eighty-eight second-year Doctor of Physical Therapy students (baseline cohort = 42 students, intervention cohort = 46 students).

Methods.

Exam questions were randomly assigned into different review categories. Some exam questions received no review, whereas other exam questions were reviewed with open-ended review questions or varying numbers of multiple-choice review questions. Performance on 160 multiple-choice exam questions was compared between review question categories using mixed-effects logistic regression models.

Results.

Both open-ended and multiple-choice review questions significantly improved exam question performance. Performance on exam questions improved most when more than one multiple-choice review question was provided. After controlling for exam question difficulty, multiple-choice review questions were superior to open-ended review questions.

Discussion and Conclusion.

On multiple-choice exams, multiple-choice review questions are at least as effective as open-ended review questions. Given their ease of implementation, multiple-choice review questions are an efficient means to improve multiple-choice exam question performance.
The impact of slowly digestible and resistant starch on glucose homeostasis and insulin resistance
Authors: Chisbert Maëliss , Castell Anne-Laure , Vinoy Sophie , Nazare Julie-Anne
Published: June 2024

Purpose of review

This review will summarize recent studies assessing the effect of slowly digestible starch (SDS) and resistant starch (RS) on glucose metabolism in healthy, prediabetic or type 2 diabetic adults.

Recent findings

Currently, a particular interest in starch and its digestibility has arisen, with data showing a positive effect of SDS and RS on the glucose homeostasis of healthy, at-risk, prediabetic and type 2 diabetic patients but research is ongoing.

Carbohydrates (CHO) and especially starch play a major role in the prevention and management of metabolic diseases such as type 2 diabetes (T2D). This largely depends on the quality and the digestibility (rate and extent) of the ingested starchy products, beyond their quantity. SDS have been poorly studied but display a beneficial effect on reducing glucose excursions in healthy and insulin-resistant subjects and a relevant potential to improve glucose control in type 2 diabetic individuals. As for RS, the results appear to be encouraging but remain heterogeneous, depending the nature of the RS and its role on microbiota modulation. Further studies are needed to confirm the present results and investigate the potential complementary beneficial effects of SDS and RS on long-term glucose homeostasis to prevent cardiometabolic diseases.
Micronutrient (iron, selenium, vitamin D) supplementation and the gut microbiome
Authors: Faradina Amelia , Tinkov Alexey A. , Skalny Anatoly V. , Chang Jung-Su
Published: June 2024

Purpose of review

Deficiencies in micronutrients persist as widespread global challenges, where supplementation remains a crucial therapeutic approach. This review aims to elucidate the intricate relationships between micronutrient supplementation – specifically iron, selenium (Se), and vitamin D (Vit D) – and gut microbiota composition, investigating their collective impact on host health and disease susceptibility.

Recent findings

Maintaining balanced iron levels is essential for gut microbiota equilibrium and host health, as both iron deficiency and excess disrupt gut bacterial balance, affecting colon health. Se supplementation can restore and improve the gut microbial balance, influencing health outcomes not only in the gut but also in areas such as neuroprotection in the brain, testicular health, and metabolic syndrome. Clinical and experimental models demonstrate that Vit D modulates the gut microbiome, enhancing anti-inflammatory effects, supporting metabolic health, and potentially reducing the risk of gut-related behavioral changes and diseases.

Findings of this review emphasize that balanced iron levels are essential for maintaining a healthy gut microbiota composition and underscore the beneficial effects of Se and Vit D in modulating the gut microbiome. The interactions between micronutrients and the gut microbiome are complex but may have a broad spectrum of health outcomes.
Role of dietary fibres in cardiometabolic diseases
Authors: Dahm Christina C. , Langmann Fie , Nannsen Anne Østergaard , Ibsen Daniel B.
Published: June 2024

Purpose of review

This review highlights recent developments in understanding the role of dietary fibre and specific fibre types on risk and management of cardiometabolic disease with a focus on the causal pathways leading to cardiometabolic diseases, namely weight management, glycaemic control, and lipid levels, as well as the latest findings for cardiovascular disease outcomes such as coronary heart disease, stroke, and mortality. Evidence for mechanisms through gut microbiota are also briefly reviewed.

Recent findings

Dietary fibre intake is associated with improved weight management, the extent of which may depend on the subtype of dietary fibre. Overall dietary fibre intake reduces blood glucose and HbA1c, however soluble fibres may be particularly effective in reducing HbA1c, fasting blood glucose and blood lipids. Individual meta-analyses and umbrella reviews of observational studies on dietary fibre, as well as major fibre types, observed inverse associations with incident coronary heart disease, stroke, and mortality due to cardiovascular disease. As different types of fibres exerted different health benefits, fibre diversity (i.e. combinations of fibres) should be further investigated.

Dietary fibres improve both short-term and long-term cardiometabolic disease risk factors and outcomes, and thus should be on every menu.
Performance of the Elixhauser Comorbidity Index in Predicting Mortality Among a National US Sample of Hospitalized Homeless Adults
Authors: Tsai Jack , Kim Youngran
Published: June 2024

Background:

The Elixhauser Comorbidity Index (ECI) is widely used, but its performance in homeless populations has not been evaluated.

Objectives:

Using a national sample of inpatients, this study compared homeless and nonhomeless inpatients on common clinical diagnoses and evaluated ECI performance in predicting mortality among homeless inpatients.

Research Design:

A retrospective study was conducted using 2019 National Inpatient Sample (NIS) data, the largest publicly available all-payer inpatient health care database in the United States.

Subjects:

Among 4,347,959 hospitalizations, 78,819 (weighted 1.8%) were identified as homeless.

Measures:

The ECI consists of 38 medical conditions; homelessness was defined using the International Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM) diagnostic code, and clinical conditions were based on the Clinical Classifications Software Refined (CCSR) for ICD-10-CM.

Results:

Leading clinical diagnoses for homeless inpatients included schizophrenia and other psychotic disorders (13.3%), depressive disorders (9.4%), and alcohol-related disorders (7.2%); leading diagnoses for nonhomeless inpatients were septicemia (10.2%), heart failure (5.2%), and acute myocardial infarction (3.0%). Metastatic cancer and liver disease were the most common ECI diagnoses for both homeless and nonhomeless inpatients. ECI indicators and summary scores were predictive of in-hospital mortality for homeless and nonhomeless inpatients, with all models yielding concordance statistics above 0.80, with better performance found among homeless inpatients.

Conclusions:

These findings underlie the high rates of behavioral health conditions among homeless inpatients and the strong performance of the ECI in predicting in-hospital mortality among homeless inpatients, supporting its continued use as a case-mix control method and predictor of hospital readmissions.
Prevention and treatment of osteomyelitis after open tibia fractures
Authors: Mehta Devan D. , Leucht Philipp
Published: June 2024

Infection and chronic post-traumatic osteomyelitis of the tibia after open fracture are complex problems that cause significant morbidity and threaten the viability of a limb. Therefore, it is of utmost importance for the orthopaedic surgeon to understand both patient and treatment factors that modify the risk of developing these disastrous complications. Infection risk is largely based on severity of open injury in addition to inherent patient factors. Orthopaedic surgeons can work to mitigate this risk with prompt antibiotic administration, thorough and complete debridement, expedient fracture stabilization, and early wound closure. In the case osteomyelitis does occur, the surgeon should use a systematic multidisciplinary approach for eradication.
Visual midline gauge validity and repeatability: Comparison to a current clinical method
Authors: Stalin Amritha , Ding Ran , Leat Susan J. , Binhilabi Ohwod , Labreche Tammy
Published: June 2024

Significance

Visual midline shifts are thought to occur post-stroke and be a risk factor for falls. This study investigates a new method for quantifying visual midline shifts, a first step toward developing greater understanding of visual midline shift.

Purpose

This study standardized the parameters of a novel visual midline gauge, compared the results with the current clinical method, and presents normative data and repeatability of both methods.

Methods

Ninety-three participants without neurological or ocular problems were recruited in Canada and Hong Kong. In experiment 1, horizontal and vertical visual midlines were measured using the gauge for two speeds and two repositioning methods. In experiment 2, visual midline was measured for three distances using a target speed and repositioning method chosen based on the first experiment. Visual midlines were also measured using the current clinical method during both visits.

Results

There were no significant effects of age, speed, study location, or repositioning method on visual midline positions (all p>0.05). For the horizontal direction, measurements at 25 cm were different from those at 50 (p=0.03) and 100 cm (p=0.001). For the vertical direction, there was no such effect. The measurements were found to be repeatable to within approximately 3°. In both visits, there were significant correlations between measurements using the visual midline gauge and the clinical method for the vertical direction (all p<.001) but not for the horizontal direction (all p>0.05).

Conclusions

The measurement of visual midline is tolerant of differences in target speed, testing method, and age of the participants, and the visual midline gauge measurements are repeatable.
A National Survey of Pediatric Post-Acute Care Facilities*
Authors: Straka Nadine , França Urbano L. , Franks Jennifer D. , McManus Michael L.
Published: June 2024

OBJECTIVES:

To identify and geolocate pediatric post-acute care (PAC) facilities in the United States.

DESIGN:

Cross-sectional survey using both online resources and telephone inquiry.

SETTING:

All 50 U.S. states surveyed from June 2022 to May 2023. Care sites identified via state regulatory agencies and the Centers for Medicare & Medicaid Services.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Number, size, and type of facility, scope of practice, and type of care provided. One thousand three hundred fifty-five facilities were surveyed; of these, 18.6% (252/1355) were pediatric-specific units or adult facilities accepting some pediatric patients. There were 109 pediatric-specific facilities identified within 39 U.S. states. Of these, 38 were freestanding with all accepting children with tracheostomies, 97.4% (37/38) accepting those requiring mechanical ventilation via tracheostomy, and 81.6% (31/38) accepting those requiring parenteral nutrition. The remaining 71 facilities were adult facilities with embedded pediatric units or children’s hospitals with 88.7% (63/71), 54.9% (39/71), and 54.9% (39/71), accepting tracheostomies, mechanical ventilation via tracheostomy, and parenteral nutrition, respectively. Eleven states lacked any pediatric-specific PAC units or facilities.

CONCLUSIONS:

The distribution of pediatric PAC is sparse and uneven across the United States. We present an interactive map and database describing these facilities. These data offer a starting point for exploring the consequences of pediatric PAC supply.
A Qualitative Study of Strategies to Improve Occupational Well-being in Physical Medicine and Rehabilitation Physicians
Authors: Amano Alexis , Makowski Maryam S. , Trockel Mickey T. , Menon Nikitha K. , Wang Hanhan , Sliwa James , Weinstein Stuart , Kinney Carolyn , Paganoni Sabrina , Verduzco–Gutierrez Monica , Kennedy David J. , Knowlton Tiffany , Stautzenbach Thomas , Shanafelt Tait D.
Published: June 2024

Background

Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout.

Objective

The aim of the study is to identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-mo period.

Design

We employed two quantitative surveys spaced 6-9 mos apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey time points. These physiatrists were subsequently recruited to participate in a qualitative study using semistructured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment.

Setting

Online surveys and interviews.

Participants

Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile.

Main Outcome Measure

Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.

Results

One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges.

Conclusions

Our findings illustrate that in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.
Nothing About Us Without Us
Authors: Waters John , Siegel Charles , O’Connell David , Sacris Joel , Mallow Michael , Ziring Deborah , Ankam Nethra
Published: June 2024

Medical school curricula across the United States fail to adequately prepare students to provide high-quality care to and advocate for patients with disabilities. To address this shortcoming at one large, urban medical school, the Curriculum Committee at Sidney Kimmel Medical College formed a taskforce of students and faculty to evaluate the degree and quality of disability representation in its undergraduate medical education curriculum. Taskforce members solicited input from five community members in various fields of disability advocacy to craft recommendations that reflected this community’s vision for disability education in undergraduate medical education. Community partners suggested areas of focus including clinical skills, accessibility of healthcare facilities, awareness of intersectionality with other identities, acknowledgment of bias, and respect for the patient’s autonomy via their “right to risk.” The taskforce report to the curriculum committee included nine recommendations for curricular revision based on community partner suggestions, six of which were accepted and are being implemented into the curricular content for the class of 2026 and beyond. This novel approach to implementing curricular change could encourage other medical schools to evaluate their own curricula through the lens of disability and prompt curricular revision with the input of community partners with disabilities, students, and, faculty.
Lower Neutrophil Count Without Clinical Consequence Among Children of African Ancestry Living With HIV in Canada
Authors: Bernard Isabelle , Ransy Doris G. , Brophy Jason , Kakkar Fatima , Bitnun Ari , Sauvé Laura , Samson Lindy , Read Stanley , Soudeyns Hugo , Hawkes Michael T. ,   EPIC4 Study Group
Published: June 2024

Objective:

To investigate the association between African ancestry and neutrophil counts among children living with HIV (CLWH). We also examined whether medications, clinical conditions, hospitalization, or HIV virologic control were associated with low neutrophil counts or African ancestry.

Design:

We conducted a secondary analysis of the Early Pediatric Initiation Canada Child Cure Cohort (EPIC4) Study, a multicenter prospective cohort study of CLWH across 8 Canadian pediatric HIV care centers.

Methods:

We classified CLWH according to African ancestry, defined as “African,” “Caribbean,” or “Black” maternal race. Longitudinal laboratory data (white blood cells, neutrophils, lymphocytes, viral load, and CD4 count) and clinical data (hospitalizations, AIDS-defining conditions, and treatments) were abstracted from medical records.

Results:

Among 217 CLWH (median age 14, 55% female), 145 were of African ancestry and 72 were of non-African ancestry. African ancestry was associated with lower neutrophil counts, white blood cell counts, and neutrophil–lymphocyte ratios. Neutrophil count <1.5 × 109/L was detected in 60% of CLWH of African ancestry, compared with 31% of CLWH of non-African ancestry (P < 0.0001), representing a 2.0-fold higher relative frequency (95% CI: 1.4–2.9). Neutrophil count was on average 0.74 × 109/L (95% CI: 0.45 to 1.0) lower in CLWH of African ancestry (P < 0.0001). Neither neutrophil count<1.5 × 109/L nor African ancestry was associated with medications, hospitalizations, AIDS-defining conditions, or markers of virologic control (viral load, sustained viral suppression, and lifetime nadir CD4).

Conclusions:

In CLWH, African ancestry is associated with lower neutrophil counts, without clinical consequences. A flexible evaluation of neutrophil counts in CLWH of African ancestry may avoid unnecessary interventions.
Imaging Review of Different Subchondral Insufficiency Fractures
Authors: Alidina Sameer , Luxenburg Dylan , Castro Athena , Subhawong Ty K. , Ferreira de Souza Felipe
Published: June 2024

Subchondral fractures are a common cause of joint pain that may ultimately lead to articular collapse and the need for arthroplasty. This type of fracture has been reported at multiple joints throughout the body. While clinical and radiographic resolution can be achieved, progressive bone collapse can occur and lead to a variety of complications. Understanding the pertinent imaging findings can aid in the early evaluation of subchondral fractures and in the prevention of their associated complications.
Aggressive Late Recurrence of a Calcifying Epithelial Odontogenic Tumor: Surgical Refinements Based on New Technologies
Authors: Tousidonis Manuel , Ochandiano Santiago , Navarro-Cuellar Carlos
Published: June 2024

A calcifying epithelial odontogenic tumor is a rare, benign odontogenic neoplasm. Surgical treatment is the option, and late recurrence is very rare. Radiologically, the lesions are commonly present scattered calcifications. This case report details a 64-year-old female patient with a recurrence of a right mandibular calcifying epithelial odontogenic tumor 2 decades after successful initial surgical removal. A segmental mandibulectomy and immediate reconstruction were performed using a planned vascularized free fibula flap with virtual surgery, custom reconstruction plate, and intraoperative computed tomography. Modifications were made to the design of the reconstruction plate to improve the cervicofacial profile and subsequent rehabilitation with dental implants. Fully guided implant surgery with point-of-care manufacturing protocol was done to improve prosthetically driven implant planning. The case presented highlights the usefulness of new technologies for mandibular reconstruction with the free fibula flap and the concept of point-of-care with technical notes that increase precision and reduce morbidity in implant-supported rehabilitation.
The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps
Authors: Rhodes Isaiah J. , Alston Chase C. , Zhang Ashley , Arbuiso Sophia , Medina Samuel J. , Liao Matthew , Ng Jinggang J. , Romeo Dominic , Dahir Shugri , Rhodes William R. , Otterburn David M.
Published: June 2024

Introduction:

Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world’s fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation.

Methods:

The authors performed a retrospective chart review on all patients who received cleft lip and palate repair by a single surgeon in 40 separate surgical camps at Edna Adan University Hospital in Hargeisa, Somaliland, between 2011 and 2024. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. Descriptive statistical analysis was performed.

Results:

A total of 767 patients (495 male, 64.5%) received 787 surgical procedures. The average age of primary surgery was 73.7 months. The most common chief complaint was left cleft lip with cleft palate (316, 41.2%). Males received primary surgery 19.2 months later than did females (73.7 and 54.6 mo, respectively, P<0.001). Patients residing in Hargeisa received their initial procedure an average of 17.8 months younger than those who lived elsewhere in Somaliland (62.9 and 80.7 mo, respectively, P=0.004).

Conclusions:

In this severely economically depressed region, patients received treatment at ages that lagged far beyond recommended guidelines. Our finding of earlier treatment for females than males is rare in the literature and likely relates to cultural sex expectations. Patients from rural locations were especially vulnerable to receiving delayed treatment. Further efforts to decrease the burden of craniofacial deformities in Somaliland should be pursued in earnest.
Long-Term Outcomes of Enucleation and Secondary Orbital Implantation Surgeries Using Polyester Mesh-Wrapped Acrylic Orbital Implants
Authors: Şendül Yekta , Alkan Abdurrahman Alpaslan
Published: June 2024

Objective:

To reveal the long-term outcomes of enucleation and secondary orbital implantation surgeries employing nonabsorbable surgical mesh-wrapped acrylic orbital implants for various reasons.

Methods:

A retrospective interventional study of 48 eyes that underwent primary or late primary enucleation and secondary orbital implantation using polyester mesh-wrapped acrylic orbital implants, between 2012 and 2021. Patient demographics, diagnosis, prior ophthalmic surgery, implant size, follow-up periods, and implant-associated complications were evaluated.

Results:

The records of 36 patients who underwent primary or late primary enucleation and 12 who underwent secondary orbital implantation due to sphere extrusion were evaluated. Patients’ mean age was 38.7 (range: 2–75) and the mean follow-up period was 48.3 months (range: 24–72 mo). Major causes for surgeries were trauma and malignancies (54.1% and 33.3%, respectively). No complications, such as conjunctival dehiscence, implant exposure or extrusion, contracted socket, or fornix insufficiency were observed in any patient during the long-term follow-up period postsurgeries.

Conclusion:

Using polyester mesh-wrapped acrylic orbital implants in enucleation and secondary orbital implantation surgeries proves to be a successful, safe, and cost-effective option.
M2 Macrophage Polarization and Tissue Remodeling in Autologous Fat Grafting for Diabetic Skin Defects
Authors: Wang Yu , Guo Xiaoshuang , Zeng Han , Chen Zong , Yue Yingying , Jin Xiaolei
Published: June 2024

Autologous adipose tissue was recognized as a promising therapeutic option for soft tissue defects owing to its regenerative potential and ability to facilitate tissue reconstruction. However, the mechanisms by which autologous fat grafting (AFG) promotes healing remain unclear, hindering its potential applications. This study aimed to investigate the distribution and phenotypic transition of infiltrating macrophages in transplanted adipose tissue, as well as their correlation with diabetic skin defect remodeling. Streptozotocin-induced diabetic rats with full-thickness dorsal skin defects were included in this study. The transplanted adipose tissue at the skin defects was collected and analyzed using flow cytometry to determine macrophage proportion and phenotype. The healing of skin defects was evaluated, and treatment was continued until day 14 as the designated endpoint of healing, followed by histopathologic examinations. Immunostaining with CD31 and lymphatic vessel endothelial receptor-1 was performed on wound tissues to analyze angiogenesis and lymphangiogenesis, respectively. Western blot and quantitative polymerase chain reaction analyses were used to assess the expression of the representative genes involved in the healing process. The results showed early polarization of M2 macrophages in the transplanted adipose tissue, concomitant with the upregulation of growth factors and downregulation of inflammatory factors. In vivo experiments revealed that AFG significantly promoted macrophage infiltration and M2 transformation in diabetic skin defects compared to the control groups, thereby promoting tissue extracellular matrix remodeling and lymphatic and vascular regeneration. However, the beneficial effects of AFG were inhibited by macrophage depletion. This study further demonstrated the potential of AFG for treating diabetic skin defects.
Recommendations of the SUFU/AUGS/ICS Female Stress Urinary Incontinence Surgical Publication Working Group: A Common Standard Minimum Data Set for the Literature
Authors: Rovner Eric , Chermansky Christopher , Costantini Elisabetta , Dmochowski Roger , Enemchukwu Ekene , Ginsberg David A. , Heesakkers John , Menefee Shawn , Nadeau Geneviève , Rardin Charles R. , Zimmern Philippe
Published: June 2024

Introduction and Objectives

Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal. The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery.

Methods

The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance.

Results

The WG outlined standardization in four major areas: 1) study design, 2) pretreatment demographics and characterization of the study population, 3) intraoperative events, and 4) post-treatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD - must be included; ADDITIONAL - may be included for a specific study and is inclusive of the Standard items; OPTIMAL - may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY - not relevant.

Conclusions

A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.
Patients with atrial fibrillation and diabetes mellitus affected by nonalcoholic fatty liver disease have a greater risk of mortality and worse clinical outcomes
Authors: Khokhlov Leonid , Siraw Bekure , Ali Mehnaaz , Hussain Fatima , Brown Amanda , Shemisa Kamal
Published: June 2024

Background

Nonalcoholic fatty liver disease (NAFLD) is associated with several adverse clinical outcomes. In this study, we assessed the association between NAFLD and several clinical outcome measures in patients with diabetes mellitus (DM) and atrial fibrillation (AF).

Methods

We queried the National Inpatient Sample (NIS) between 2016 and 2019 for adult patients who were hospitalized with DM and AF. NAFLD was the independent variable. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay, and total hospital charges. A multivariable logistic regression model was used to estimate odds ratios with a 95% confidence interval (CI) and a P value of less than 0.05 was considered significant.

Results

There were 6 723 293 hospitalizations with AF and DM and 253 639 (3.7%) had NAFLD. NAFLD and non-NAFLD cohorts had a mean age of 70.4 vs. 73.8 years, respectively. Overall, 55.6% were male and 73.8% were White. NAFLD was found to be significantly associated with in-hospital mortality [adjusted odds ratio (AOR), 4.2; 95% CI, 4.08–4.32], cardiogenic shock (AOR, 4.78; 95% CI, 4.59–4.98), cardiac arrest (AOR, 3.43; 95% CI, 3.27–3.59), GIB (AOR, 1.92; 95% CI, 1.86–1.98), length of stay, and total hospital charges.

Conclusion

In patients with AF and DM patients, the presence of NAFLD was associated with significantly worse clinical outcomes and higher resource utilization. Adverse cardiovascular events were common as well as GIB. Screening and prevention strategies modifying the risk and disease severity of NAFLD are needed.
Digital twinning of cardiac electrophysiology for congenital heart disease
Authors: Salvador Matteo , Kong Fanwei , Peirlinck Mathias , Parker David W. , Chubb Henry , Dubin Anne M. , Marsden Alison L.
Published: June 2024

In recent years, blending mechanistic knowledge with machine learning has had a major impact in digital healthcare. In this work, we introduce a computational pipeline to build certified digital replicas of cardiac electrophysiology in paediatric patients with congenital heart disease. We construct the patient-specific geometry by means of semi-automatic segmentation and meshing tools. We generate a dataset of electrophysiology simulations covering cell-to-organ level model parameters and using rigorous mathematical models based on differential equations. We previously proposed Branched Latent Neural Maps (BLNMs) as an accurate and efficient means to recapitulate complex physical processes in a neural network. Here, we employ BLNMs to encode the parametrized temporal dynamics of
in silico
12-lead electrocardiograms (ECGs). BLNMs act as a geometry-specific surrogate model of cardiac function for fast and robust parameter estimation to match clinical ECGs in paediatric patients. Identifiability and trustworthiness of calibrated model parameters are assessed by sensitivity analysis and uncertainty quantification.