bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol
Authors: Braaten Jacob A. , Dillon Bridget S. , Wothe Jillian K. , Olson Conner P. , Lusczek Elizabeth R. , Sather Kristiana J. , Beilman Gregory J. , Brunsvold Melissa E.
Published: December 2023

OBJECTIVES:

To investigate the effect of a restrictive blood product utilization protocol on blood product utilization and clinical outcomes.

DESIGN:

We retrospectively reviewed all adult extracorporeal membrane oxygenation (ECMO) patients from January 2019 to December 2021. The restrictive protocol, implemented in March 2020, was defined as transfusion of blood products for a hemoglobin level less than 7, platelet levels less than 50, and/or fibrinogen levels less than 100. Subgroup analysis was performed based on the mode of ECMO received: venoarterial ECMO, venovenous ECMO, and ECMO support following extracorporeal cardiopulmonary resuscitation (ECPR).

SETTING:

M Health Fairview University of Minnesota Medical Center.

PATIENTS:

The study included 507 patients.

INTERVENTIONS:

One hundred fifty-one patients (29.9%) were placed on venoarterial ECMO, 70 (13.8%) on venovenous ECMO, and 286 (56.4%) on ECPR.

MEASUREMENTS AND MAIN RESULTS:

For patients on venoarterial ECMO (48 [71.6%] vs. 52 [63.4%]; p = 0.374), venovenous ECMO (23 [63.9%] vs. 15 [45.5%]; p = 0.195), and ECPR (54 [50.0%] vs. 69 [39.2%]; p = 0.097), there were no significant differences in survival on ECMO. The last recorded mean hemoglobin value was also significantly decreased for venoarterial ECMO (8.10 [7.80–8.50] vs. 7.50 [7.15–8.25]; p = 0.001) and ECPR (8.20 [7.90–8.60] vs. 7.55 [7.10–8.88]; p < 0.001) following implementation of the restrictive transfusion protocol.

CONCLUSIONS:

These data suggest that a restrictive transfusion protocol is noninferior to ECMO patient survival. Additional, prospective randomized trials are required for further investigation of the safety of a restrictive transfusion protocol.
Intraductal papillary neoplasms of the bile ducts—what can be seen with ultrasound?
Authors: Möller Kathleen , Braden Barbara , Jenssen Christian , Ignee André , Cui Xin Wu , Yamashita Yasunobu , Kitano Masayuki , Faiss Siegbert , Sun Siyu , Dietrich Christoph F.
Published: December 2023

Intraductal papillary neoplasm of the bile ducts is a rare tumor. Characteristic features include bile duct dilatation, cystic lesions with communication to the bile ducts, and intraluminal solid nodules arising from the bile duct wall. As in pancreatic intraductal papillary mucinous neoplasia, intestinal, pancreaticobiliary, gastric, and oncocytic types are described. Intraductal papillary neoplasm of the bile ducts has a high potential for malignancy, and patients should be surgically resected when possible. In this review, the complex imaging diagnosis is presented. The main focus is on contrast-enhanced ultrasound, an established method for many other indications whose potential on the biliary system should be better exploited. In the present article, typical contrast-enhanced ultrasound findings in intraductal papillary neoplasm of the bile ducts are demonstrated.
Ethics and benefits of family participation in global surgery: a review of the One World Surgery experience
Authors: Antunez Merlin O. , Bae Caroline G. , Eblovi Darren , Bae Donald S. , Daly Peter J.
Published: December 2023

Short-term experiences in global health (STEGHs) provide the opportunity to improve individual patient care and build systemic capacity in under-resourced communities. While most STEGHs are conducted by teams of clinical practitioners and/or trainees, there are some organizations in which nonclinical family members of medical/surgical volunteers participate. One World Surgery is an example of an organization that encourages family member participation in its short-term volunteer trips to Honduras. Through careful pretrip orientation, on-site supervision, and consistent educational programs, One World Surgery has developed a program which promotes safe and effective participation of family members. A recent survey of preprofessional volunteers confirmed that participants felt appropriately supervised and well prepared for their STEGH duties; as a testament to their experience, 100% of these volunteers indicated they would like to return for another One World Surgery experience. The purpose of this paper is to highlight the benefits of family member participation in STEGHs and share the experience of one organization in which family member participation has been developed to provide ethical, beneficial, and sustainable care.
Deconstructing the Excellent Plastic Surgeon: A Survey of Key Attributes
Authors: Sendek Gabriela , Blum Jessica D. , Reghunathan Meera , Chen Shirley , Luong Thanh T. , Gosman Amanda A. , Butler Paris D.
Published: December 2023

Background:

Most plastic surgeons practice in nonacademic settings, leaving a small subset of academic plastic surgeons with the responsibility of selecting the future generation of plastic surgeons without representation from a majority of our field. This raises questions as to whether the academic attributes valued during residency selection are valid predictive markers of who will become an excellent plastic surgeon. A survey was conducted of both academic and nonacademic plastic surgeons, as well as trainees, to determine what traits are considered most essential to being an excellent plastic surgeon.

Methods:

An electronic survey was distributed before the American Council of Academic Plastic Surgeons 10th Annual Winter Meeting. Demographics and information regarding the respondents’ training and academic status were collected. Respondents were asked to select five traits that they considered most important to be an excellent plastic surgeon from a list of 20 preselected traits. Chi-square and Fisher exact tests were used to perform subgroup analyses.

Results:

A total of 187 responses were received from meeting attendees, representing an 89.0% response rate. Overall, the five values endorsed as most important for a plastic surgeon were being technically sound (53%), collaborative (48%), ethical (44%), compassionate (37%), and emotionally intelligent (33%). However, the emphasis placed on these different attributes differed significantly amongst different demographic groups.

Conclusion:

It is important that we use methods such as holistic review when evaluating plastic surgery applicants to ensure our selection process is congruent with the traits we value.
A SWOT Analysis of Hot Topics in Plastic Surgery Resident Education: Consensus From the ACAPS 10th Annual Winter Meeting
Authors: Reghunathan Meera , Camacho Justin M. , Blum Jessica , Sendek Gabriela , Luong Thanh T. , Chen Shirley , Bradford Perry , Llaneras Jason , Butler Paris D. , Gosman Amanda A.
Published: December 2023

Background:

With the aim of facilitating a critical self-reflection on how to align plastic surgery education with making excellent plastic surgeons, a rotating small-group session followed by live interactive audience polling was used to perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis at the 10th Annual American Council of Academic Plastic Surgeons Winter Meeting.

Methods:

The final day of the conference included a 3-hour session of rotating small groups followed by live interactive audience polls discussing the following six relevant educational topics: the Plastic Surgery Common Application and resident selection, aesthetic surgery education, leadership development and business education, embedded fellowships and focused training, mentorship, and faculty retention.

Results:

A total of 60 individuals participated in the activity. A SWOT analysis was successfully performed for each educational topic, and a minimum of four opportunities were identified per topic to help guide future endeavors. Examples of opportunities include releasing recommendations for the implementation of holistic review; developing formal guidelines for aesthetic surgery education in residency via collaboration between ACAPS, American Society of Plastic Surgeons, and The Aesthetic Society; creating extended focused elective rotations; integrating business education into formal curricula for all training levels; enforcing transparency regarding position expectations and offerings including salary, call schedule, and current challenges; and more.

Conclusion:

The results of this study will help guide future initiatives by the ACAPS to improve resident education and academic retention.
Strength in Numbers: A SWOT Analysis of Plastic Surgery
Authors: Blum Jessica D. , Reghunathan Meera , Bradford Perry S. , Camacho Justin , Sendek Gabriela , Jeffers Lynn , Cash Camille , Mackay Donald , Butler Paris D. , Gosman Amanda A.
Published: December 2023

Background:

Plastic surgeons comprise the minority of practicing surgeons, with an even smaller minority practicing in an academic setting. As the practice of medicine and the systems in which we operate continue to evolve, it is essential that plastic surgeons have a say in the changing landscape. This study conducted a strengths, weaknesses, opportunities, and threats (SWOT) analysis of plastic surgery to identify unifying strengths and common threats.

Methods:

An electronic survey was distributed to American Council of Academic Plastic Surgeons’ Winter Meeting attendees on three separate occasions preceding the meeting. Respondents were asked to provide demographic information and to identify the top three strengths, weaknesses, opportunities, and threats (SWOT analysis) for the specialty. Subgroup analyses were performed based on demographic characteristics.

Results:

A total of 187 responses were received from meeting attendees, representing an 89.0% response rate. Most respondents were non-Hispanic (78.6%), White (66.8%), women (59.5%), and faculty/independent physicians (65.8%). The most identified strength in plastic surgery was our problem-solving abilities (62.0%). The most identified weakness was poor public perception of plastic surgery (54.0%). The most identified opportunity was demonstration of value to health systems (67.9%), and the most identified threat was scope of practice creep by other specialties (78.1%). The SWOT analysis identified lack of surgeon diversity as a key weakness, improvement of surgeon diversity as a key opportunity, and lack of diversity among plastic surgeons as a key threat to the specialty.

Conclusion:

Only through a diverse but united front can we effectively use our strengths to face our threats and employ opportunities to overcome our weaknesses.
The Social, Mental, and Physical Health Impacts of the COVID-19 Pandemic on People With HIV: Protocol of an Observational International Multisite Study
Authors: Cuca Yvette P. , Horvat Davey Christine , Corless Inge B. , Phillips J. Craig , Sierra-Perez Álvaro José , Solís Báez Solymar , Iwu Emilia , Sabone Motshedisi , Mulaudzi Mercy Tshilidzi , Murphey Christina , Shaibu Sheila , Chen Wei-Ti , Santa Maria Diane , Schnall Rebecca , Palmieri Patrick , Apiruknapanond Panta , Wang Tongyao , de Jesús Tania , Huang Emily , Broussard Janessa , Dawson-Rose Carol
Published: December 2023

As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; HIV continuum of care indicators; mental and social health; COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes. Results of this study will contribute to knowledge that can inform responses to future public health crises to minimize their impacts on vulnerable populations such as PWH.
A novel skin grafting modality: prefabricated large sheet of postage-stamp autografts and allografts to repair extensive burn wounds; a prospective matched-control study
Authors: Shen Chuan’an , Zhang Bohan , Liu Xinzhu , Cai Jianhua , Sun Tianjun , Li Dongjie , Deng Huping , Yuan Huageng
Published: December 2023

Background:

The excessively long operative time has been the greatest barrier to the success of transplanting postage-stamp auto- and allografts directly and piece-by-piece onto extensive burn wounds. To solve this challenge, the authors present a novel grafting modality, that is, the prefabricated-large-sheet grafting that moves the labor-intensive and time-consuming process of grafts-positioning before grafting and thereby markedly shortens the operative time.

Methods:

Twenty-one operations using the novel modality were performed on 11 patients with extensive deep burns. The grafting time using the novel modality was recorded and compared with that of the conventional piece-by-piece grafting. Eventually, the take rates of the two modalities were compared.

Results:

All patients were healed and discharged. The average grafting time per unit area (100 cm2) of prefabricated-large-sheet grafting and piece-by-piece grafting were (0.41±0.09) min and (7.46±1.07) min, respectively, and the difference is statistically significant(P<0.001). The average take rate of the prefabricated sheets was (85.43±6.14)% and that of the piece-by-piece transplanted grafts was (87.29±5.23)% and there is no significant difference(P>0.05).

Conclusions:

The prefabricated-large-sheet grafting significantly reduces the intraoperative grafting time while ensures uniformity of the skin grafts and secures good outcomes, thereby making the intermingled transplantation of postage-stamp auto- and allografts, which has been an excellent modality per se but limited to repair small residual wounds, now feasible to repair extensive deep burn wounds. It is worth wider understanding and application in the treatment of extensive deep burns.
Association of systemic inflammatory markers and tertiary lymphoid structure with pathological complete response in gastric cancer patients receiving preoperative treatment: a retrospective cohort study
Authors: Wu Yingying , Zhao Junjie , Wang Zhaoming , Liu Dan , Tian Chenyu , Ye Botian , Sun Yihong , Li Haojie , Wang Xuefei
Published: December 2023

Background:

Assessment of systemic and local immune responses is crucial in determining the efficacy of cancer interventions. The identification of specific factors that correlate with pathological complete response (pCR) is essential for optimizing treatment decisions.

Methods:

In this retrospective study, a total of 521 patients diagnosed with gastric adenocarcinoma who underwent curative gastrectomy following preoperative treatment were reviewed. Of these patients, 463 did not achieve pCR (non-pCR) and 58 achieved pCR. Clinicopathological factors were evaluated to identify predictors for pCR using a logistic regression model. Additionally, a smaller cohort (n=76) was derived using propensity score matching to investigate local immune response, specifically the features of tertiary lymphoid structure (TLS) using H&E staining, immunohistochemistry, and multiplex immunofluorescence.

Results:

The multivariate regression analysis demonstrated a significant association between low systemic inflammatory status and pCR, as evidenced by reduced levels of the combined systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) (SII+NLR) (odds ratio: 3.33, 95% CI: 1.79–6.17, P<0.001). In the smaller cohort analysis, distinct TLS characteristics were correlated with the presence of pCR. Specifically, a higher density of TLS and a lower proportion of PD1+ cells and CD8+ cells within TLS in the tumor bed were strongly associated with pCR.

Conclusion:

Both systemic and local immune profile were associated with pCR. A low level of SII+NLR served as an independent predictor of pCR, while distinct TLS features were associated with the presence of pCR. Focusing on the immune profile was crucial for optimal management of gastric cancer patients receiving preoperative treatment.
Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis
Authors: Xue Kang , Huang Xing , Zhao Pengcheng , Zhang Yi , Tian Bole
Published: December 2023

Background:

Pancreatic cancer frequently involves the surrounding major arteries, preventing surgeons from making a radical excision. Neoadjuvant therapy (NAT) can lessen the size of local tumors and eliminate potential micrommetastases. However, systematic and evidence-based recommendations for the treatment of arterial resection (AR) after NAT in pancreatic cancer are scarce.

Method:

A computerized search of the Medline, Embase, Cochrane Library databases, and Clinicaltrials was performed to identify studies reporting the outcomes of patients who underwent pancreatectomy with AR and NAT for pancreatic cancer. Studies that reported perioperative and/or long-term results after pancreatectomy with AR and NAT were eligible for inclusion. The quality of the evidence was assessed with Newcastle–Ottawa Quality Assessment Form of bias tool. Data were pooled and analyzed by Stata 14.0 software.

Result:

Nine studies with an overall sample size of 215 met our eligibility criteria and were included in the meta-analysis. All studies were retrospective studies, and the methodological quality was moderate. The pooled morbidity and mortality rates were 51% (95% CI: 41–61%; I²= 0.0%) and 2% (95% CI: 0–0.08; I²=33.3%), respectively. Meta-analysis showed that the overall R0 resection rate was 79% (CI: 70–86%, I²=15.5%). Comparative data on R0 rates of patients who underwent pancreatectomy with and without NAT showed a significant difference in favor of the former group with moderate statistical heterogeneity (Relative risk=1.21; 95% CI: 0.776–1.915; I²=48.0%). The median 1-, 2-, 3-, and 5-year survival rates of patients who had AR were 92.3% (range: 72.7–100%), 64.8% (range: 25–78.8%), 51.6% (range: 16.7–63.6%), and 14% (range: 0–41.1%), respectively. Data on median progression-free survival ranged from 5.25 to 36.3 months, and the median overall survival ranged from 17 to 44.9 months.

Conclusions:

Pancreatectomy with major AR following NAT has the potential to enhance the survival rate of patients with unresectable pancreatic cancer involving the arteries by achieving R0 resection, despite a significant risk of postoperative complications. However, to validate the feasibility and effectiveness of this procedure, prospective controlled studies are necessary to address limitations arising from small sample sizes and potential biases inherent in retrospective studies.
Capitalizing on the Value of the Clinical Nurse Specialist in Palliative Care
Authors: Haskamp Amy Corey , Whitehead Phyllis
Published: December 2023

The clinical nurse specialist (CNS) is 1 of the 4 advanced practice registered nurse roles and a vital component in palliative and hospice nursing care. The CNS is a specialty expert clinician capable of practicing in a variety of health care settings including acute care, primary care, and specialty ambulatory care. The CNS integrates palliative care standards across the 3 spheres of impact (patient, nurse, and system) to improve care patients receive at end of life, mentoring and coaching nurses in the unique aspects of palliative and hospice care (HPC), and serving as a clinical expert for the organization to ensure best practices and quality outcomes. Clinical nurse specialists are trained to diagnose, treat, and prescribe to provide holistic care to their patients. However, challenges exist for the CNS role due to variations in state regulations regarding title protection and scope of practice leading to inconsistency in and misperception of the CNS role. Clinical nurse specialists have a wealth of expertise that can lead to systematic improvement in patient outcomes, advances in hospice and palliative nursing practice, and management of HPC patients and their families. Clinical nurse specialists are a hidden treasure that should be integrated into HPC practice.
Xiao-Ping Chen: the “Master of the Scalpel” who saves lives by entering the forbidden territory of hepatopancreatobiliary surgery
Authors:   Editorial Office of Oncology and Translational Medicine
Published: December 2023

In his 50 years of practice, he has performed more than 20,000 hepatopancreatobiliary surgeries, being the first one to propose the concept of the “auxiliary partial orthotopic liver transplantation” internationally. Furthermore, he developed the “Chen's inserting biliary-enteric anastomosis and pancreato-enteric anastomosis,” “Chen's hepatic vascular occlusion,” “Chen's liver double-hanging maneuver,” and “Chen's hepatic vascular occlusion without liver portal dissection.” He also popularized these theories and techniques both in China and worldwide. His name is Xiao-Ping Chen, an academician of the Chinese Academy of Sciences and honorary president of the Tongji Medical College of Huazhong University of Science and Technology.
Role of tumor necrosis factor alpha-induced protein 6 (TNFAIP6) in tumors: a pan-cancer analysis
Authors: Yang Yang , Liu Zhi-Gang , Yang Yan-Qi , Zhang Zhi-Gang , Wang Xiao-Li , Li Yu-Long , Sun Rui-Fang
Published: December 2023

Background

There is growing evidence that the gene named tumor necrosis factor α–induced protein 6 (TNFAIP6) has an important role in various tumors. However, a systematic pan-cancer analysis of TNFAIP6 is lacking. Here we aimed to analyze the expression of TNFAIP6 across multiple cancers and verify its expression during the progression of colon cancer.

Methods

We performed a comprehensive bioinformatics analysis to examine the expression of TNFAIP6 across 27 tumor types. GEPIA2 was used to evaluate the effect of TNFAIP6 on clinical cancer prognosis. cBioportal was used to assess TNFAIP6 mutations. The correlation between TNFAIP6 and cancer immune infiltrates was explored using TIMER2.0. The CancerSEA database was used to perform functional analysis of TNFAIP6. Metascape was used to identify TNFAIP6-related gene enrichment pathways. Immunohistochemistry was performed to detect TNFAIP6 protein expression in the colon cancer. In addition, the Comparative Toxicogenomics Database was searched for known and possible antitumor drugs that may be associated with TNFAIP6.

Results

We found that, in most of the cancers included in this analysis, TNFAIP6 was highly expressed, and there is a distinct relationship between TNFAIP6 expression and cancer prognosis. TNFAIP6 expression is associated with cancer-associated fibroblasts, neutrophils, and endothelial cells. TNFAIP6 and similar genes may also be involved in the PID_VEGF_VEGFR_ pathway. Immunohistochemistry revealed an increasing trend of TNFAIP6 protein expression in normal, adenoma, and colon cancer tissues. Several known and possible antitumor drugs that may be associated with TNFAIP6 were identified in the Comparative Toxicogenomics Database. These results suggest that a number of drugs may target TNFAIP6 during cancer treatment, including cisplatin, irinotecan, resveratrol, U 0126, NSC689534, genistein, NSC668394, oxaliplatin, plerixafor, topotecan, vincristine, flutamide, doxorubicin, MRK 003, folic acid, demecolcine, tunicamycin, zoledronic acid, and schizandrin B.

Conclusions

TNFAIP6 may function as an oncogene in certain cancers. Furthermore, this study provides evidence that TNFAIP6 is an important factor in colon cancer progression.
The relationship between alcohol consumption and risk of HIV in married men in Sub-Saharan Africa
Authors: König Lukas , Petersen Williams Petal , Shuper Paul A. , Probst Charlotte
Published: December 2023

Objective:

A key factor for incidence of HIV is alcohol consumption. It impacts judgment and the probability to overlook risk-relevant information, which creates a pathway to reduced adherence to biomedical prevention and engagement in condomless sex. We strengthen the understanding of the link between alcohol consumption and risk of HIV among married men in sub-Saharan Africa (SSA), as we use comprehensive population-level data to provide robust evidence with high external validity.

Design:

Cross-sectional data analysis.

Methods:

Based on data from Demographic and Health Surveys (DHS) from 20 countries and over 30 000 observations, a minimally and a fully adjusted model with country fixed effects examined the relationship between the men's alcohol consumption (observed by wife) and HIV status (blood test) while accounting for survey weights and controlling for potential confounders.

Results:

The data comprised a total of 35 108 men. Minimally adjusted [risk ratio (RR) 1.25; 95% confidence interval (CI) 1.14–1.37; P < 0.001] and fully adjusted (RR 1.26; 95% CI 1.15–1.38; P < 0.001) models showed a positive association between the men's alcohol consumption and HIV status. Two sensitivity analyses confirmed the association.

Conclusion:

In line with previous experimental studies and theoretical framework, this study confirms a risk relationship between alcohol consumption and HIV. Thus, modern HIV/AIDS programs must continue to address the relationship in implementation of prevention and treatment programs.
Chest Computed Tomography Findings in Unilateral Pulmonary Fibrosis Secondary to Chronic Hypoperfusion
Authors: Marrocchio Cristina , Humphries Stephen M. , Lynch David A.
Published: December 2023

Purpose:

Unilateral lung fibrosis is uncommon and few cases secondary to parenchymal hypoperfusion have been reported, requiring further understanding of this entity. This study aims to report the chest computed tomography (CT) findings of patients with unilateral lung fibrosis related to parenchymal hypoperfusion observed in our institution.

Patients and Methods:

Patients with a chest CT between 2004 and 2022 showing a condition causing hypoperfusion of either lung and ipsilateral unilateral lung fibrosis were retrospectively identified. Clinical and scintigraphic data were collected. Pattern and distribution of fibrosis were recorded, and its progression was evaluated when follow-up was available. In adequate CTs, fibrosis was quantified using data-driven textural analysis (DTA). Affected and contralateral lungs and baseline and follow-up data were compared using the Wilcoxon signed-rank test.

Results:

Thirteen patients (male: 7, female: 6, median age: 61 y) were included; 5 with congenital unilateral absence of a pulmonary artery and 8 with fibrosing mediastinitis. The mean scintigraphic perfusion of affected lungs was 3.3% ± 1.1 compared with 96.7% ± 1.1 contralaterally (n = 7, P = 0.017). Fibrosis had a UIP pattern in one case, indeterminate in the others, and was most commonly diffuse craniocaudally and peripheral or central axially. DTA in 12 patients showed a mean fibrotic score of 32% ± 24.6 compared with 0.5% ± 0.4 in the contralateral lungs (P = 0.002). Median follow-up was 4.5 years (minimum to maximum: 1 to 13 y). Of 10 patients, fibrosis was progressive in 60%. DTA of 5 follow-up CTs showed increased reticulations (P = 0.043).

Conclusion:

In patients with lung hypoperfusion, the possible complication of lung fibrosis should be considered.
The Efficacy of Acupressure for Nausea and Vomiting After Laparoscopic Cholecystectomy: A Meta-analysis Study
Authors: Zhao Bufei , Zhao Tianshi , Yang Hua , Fu Xiaojuan
Published: December 2023

Objectives:

This meta-analysis aims to explore the impact of acupressure on nausea and vomiting for patients undergoing laparoscopic cholecystectomy (LC).

Background:

Acupressure may have some potential in managing nausea and vomiting after LC.

Patients and Methods:

PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of acupressure on nausea and vomiting for LC.

Results:

Six randomized controlled trials were finally included in the meta-analysis. Overall, compared with control intervention for LC, acupressure was associated with significantly reduced incidence of nausea at 2 hours [odds ratio (OR) = 0.37; 95% CI = 0.21-0.67; P = 0.001] and nausea at 6 hours (OR = 0.38; 95% CI = 0.22-0.66; P = 0.0006; Fig. 4), and decreased need of rescue antiemetic (OR = 0.41; 95% CI = 0.20-0.85; P = 0.02; Fig. 8), but demonstrated no obvious impact on vomiting at 2 hours (OR = 0.76; 95% CI = 0.28-2.10; P = 0.60), vomiting at 6 hours (OR = 0.49, 95% CI = 0.20-1.20; P = 0.12), nausea at 24 hours (OR = 0.71; 95% CI = 0.37-1.35; P = 0.30), or vomiting at 24 hours (OR = 0.81; 95% CI = 0.28-2.35; P = 0.69).

Conclusions:

Acupressure is effective in controlling nausea and decreasing rescue antiemetics for LC.
Breaking the Status Quo in Heart Failure: Leveraging Remote Patient Monitoring to Effectively Put the Heart Failure Guidelines to Practice
Authors: Feldman David I. , Campbell Marcus L , Feldman Theodore , Curnow Randall , Fudim Marat
Published: December 2023

Background

Despite guideline directed medical therapy (GDMT) being recognized to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF), optimization has been limited resulting in worse outcomes and exorbitant costs. Although remote patient monitoring (RPM) has proven to help improve patient care, implementation of RPM at scale leading to healthcare cost savings has not been demonstrated.

Methods

Patients from 11 states were enrolled from August 2021 to April 2023 in a virtual heart failure (HF) program offered by Cadence. Eligible patients were Medicare beneficiaries with a history of an ejection fraction (EF) <40%. A clinical team monitored patient daily vitals measured on a cellular enabled blood pressure (BP) cuff, heart rate monitor and weight scale. Clinical visits using technology enabled clinical protocols were also conducted on a regular basis to facilitate guideline directed clinical interventions including symptom, vital and medication optimization. Cost analysis used 5 years of de-identified healthcare claims data from an Accountable Care Organization (ACO) and calculated average monthly healthcare costs using the 4-month period of January-April for each year. We then used a Differences-in-Differences analysis to estimate the effect of Cadence on average monthly healthcare costs compared to ACO patients who were ordered for Cadence but did not enroll.

Results

Total of 367 patients (mean [SD]: age 74 [11] years; EF 45 [2] %; systolic BP (SBP) 131 [19] mmHg; n [%]: 122 women [33%]; 260 white (71%)) were followed for a median of 294 days. There was a significant decrease in patients’ BP (SBP -6.9, Diastolic BP -4.9 mmHg; p<0.001) and weight (−2.1 lbs; p=0.010) but not heart rate. Patients experienced significant increases in the use of sodium glucose co-transporter 2 inhibitors (92 [26%] to 165 [45%]; p<0.001) and mineralocorticoid receptor antagonists (120 [33%] to 144 [39%]; p=0.002) but not β-blockers or renin-angiotensin system antagonists. The percentage of patients on ≥50% target dose significantly increased for all pillars of GDMT. There was also a significant increase in the percentage of patients on all 4 pillars of GDMT at follow (84 [23%] vs. 26 [7%]; p<0.001). A total of 70 enrolled and 42 ordered but not enrolled HF patients were included in the ACO analysis. Compared to ordered but not enrolled patients, enrollment in Cadence resulted in a 52% (-$1,076.64 per HF patient per month) cost reduction, with the most significant reductions related to hospitalizations and hospital associated spending.

Conclusions

We present the first evidence to support the use of a remote patient intervention program that leverages RPM and technology supported clinical interventions to not only improve the use and dose of GDMT for HFrEF patients but also reduce total and hospital associated costs.
Factors associated with knowledge, attitudes, and behaviors regarding antiviral medications for COVID-19 among US adults
Authors: Oyegun E. Ivy , Ategbole Muyiwa , Jorgensen Cynthia , Fisher Allison , Briggs Hagen Melissa , Gutekunst Lindsay , Roberts Eric , Koumans Emilia H.
Published: December 2023

Background

Little is known about public perceptions of antivirals for the treatment of mild-to-moderate COVID-19 in the United States (US). Our objective was to explore adult perceptions toward COVID-19 antivirals with the goal of improving outreach communications about antivirals for COVID-19.

Methods

During July 2022, potential respondents 18 years and older were randomly sampled from a national opt-in, non-representative, cross-sectional internet panel, with oversampling of African Americans, Hispanics, and adults 65 years and older. Respondents were asked about sociodemographic factors, and knowledge, attitudes, and perceptions regarding COVID-19 antivirals. Results were weighted to represent the non-institutionalized US adult population.

Results

Among 1,155 respondents, 51% were female, 60% were 18-49 years, 21% were 50-64 years, and 19% were 65 years or older. Compared to those aged 18-49 years and 50-64 years, a greater proportion of adults 65 years and older were knowledgeable about COVID-19 antivirals and would take them if they tested positive or their doctor recommended them. Adults 65 years and over and those reporting immunosuppression or disability had the highest rates of willingness to take antivirals. For all groups, the proportion of people willing to take antivirals increased by >20% if recommended by their doctor. Respondents in the 50-64 and 65+ groups who were sure they would take COVID-19 antivirals were more likely to be fully vaccinated and less likely to be living in isolation.

Conclusion

Groups that are less likely to have been vaccinated, those living in isolation, and those not sure about whether they would take an antiviral or not may be at risk for not receiving treatment to prevent severe COVID-19 outcomes. However, trust in doctor recommendations may be enough to overcome individual patient concerns about COVID-19 antivirals. Targeted initiatives to educate those at risk for severe COVID-19 outcomes about the effectiveness of antivirals, including those who are unvaccinated given their increased risk of severe disease, may be needed to further lower this population’s risk of severe COVID-19.
Circulating inflammatory proteins may be potential drug targets for Idiopathic Membranous Nephropathy: proteome-wide Mendelian Randomization and colocalization analysis
Authors: Su Zhihang , Rao Qingqing , Wu Di , Yin Zheng , Liu Wen , Wan Qijun
Published: December 2023

Background

Idiopathic membranous nephropathy (IMN) is a predominant cause of nephrotic syndrome among adults. Existing drugs are ineffective in about one-third of IMN patients, and the high recurrence rate makes them far from satisfactory. Therefore, it is imperative to find new therapeutic targets for membranous nephropathy. Circulating inflammatory proteins in plasma have been found to be related to the disease and prognosis of IMN patients, yet the causal relationship between them still remains unclear. A better understanding of the inflammatory response of IMN can help us better understand the occurrence of IMN, as well as a good way to find new therapeutic targets. In this study, we aim to use proteome-wide Mendelian Randomization and colocalization analysis to identify plasma inflammatory proteins as potential therapeutic targets for IMN.

Methods

We selected the genetic instrumental variables (IVs) of 91 plasma inflammatory protein quantitative trait locus (pQTL) data obtained from 14824 European population samples by Zhao JH et al. in 2023 as exposure factors. The outcome variable was obtained from the Genome-Wide Association Study (GWAS) data on IMN, which involved 2150 cases and 5829 controls across five European cohorts. To investigate the associations between inflammatory proteins and IMN risk, we conducted a two-sample bi-directional MR analysis, sensitivity analysis, Bayesian colocalization, phenotype scanning, and analysis of the Protein-Protein Interaction (PPI) network.

Results

The MR analysis uncovered 2 inflammatory factors associated with IMN. TNF-beta [(Tumor Necrosis Factor-beta) (IVW, OR=1.483, 95%CI=1.186-1.853, P=0.0005, PFDR=0.046)] was associated with an increased risk of IMN. IL-5 [(Interleukin-5) (IVW, OR=0.482, 95%CI=0.302-0.770, P=0.002, PFDR=0.097)] was associated with protective effects against IMN. After False Discovery Rate multiple correction and sensitivity analysis, they remain significant. None of these proteins exhibited a reverse causal relationship. Bayesian colocalization analysis provided evidence that TNF-beta share variants with IMN [posterior probability of hypothesis 4 (PPH4) = 0.88]. Utilizing the PPI network, we identified several proteins associated with the previously mentioned inflammatory proteins. Notably, TNF-beta and IL-5 were found to be linked to Nuclear Factor Kappa B Subunit 1 (NFKB1).

Conclusions

Our exhaustive analysis suggests a causative impact of TNF-beta and IL-5 levels on the genetically predisposed risk of IMN. These proteins hold potential as promising therapeutic targets for IMN treatment, thus necessitating further clinical investigation.
A probabilistic graphical model for estimating selection coefficient of missense variants from human population sequence data
Authors: Zhao Yige , Zhong Guojie , Hagen Jake , Pan Hongbing , Chung Wendy K. , Shen Yufeng
Published: December 2023

Accurately predicting the effect of missense variants is a central problem in interpretation of genomic variation. Commonly used computational methods does not capture the quantitative impact on fitness in populations. We developedMisFitto estimate missense fitness effect using biobank-scale human population genome data.MisFitjointly models the effect at molecular level (d) and population level (selection coefficient,s), assuming that in the same gene, missense variants with similardhave similars. MisFitis a probabilistic graphical model that integrates deep neural network components and population genetics models efficiently with inductive bias based on biological causality of variant effect. We trained it by maximizing probability of observed allele counts in 236,017 European individuals. We show thatsis informative in predicting frequency across ancestries and consistent with the fraction of de novo mutations givens. Finally,MisFitoutperforms previous methods in prioritizing missense variants in individuals with neurodevelopmental disorders.
Combined Effect of Inflammation and Malnutrition for Long-term Prognosis in Patients with Acute Coronary Syndrome: A Cohort Study
Authors: Yuxiu Yang , Ma Xiaoteng , Gao Fei , Liu Tao , Deng Jianping , Li Qiuxuan , Liu Zaiqiang , Wang Yufei , Zheng Yang , Yang Jingyao , Wang Zhijian
Published: December 2023

Background

Dysregulated inflammation with superimposed malnutrition may constitute a significant threat in acute coronary syndrome (ACS), which needs to be elucidated. We aimed to explore the prevalence and combined predictive value of inflammation and malnutrition in ACS patients.

Methods

Patients presenting with ACS undergoing percutaneous coronary intervention (PCI) were retrospectively included and stratified into four groups: nourished without elevated high-sensitivity C-reactive protein (hs-CRP), nourished with elevated hs-CRP, malnourished without elevated hs-CRP, and malnourished with elevated hs-CRP. Elevated hs-CRP was determined as over 2.2mg/L, and malnutrition was defined according to the nutritional risk index (NRI). The primary outcome was major adverse cardiovascular events (MACEs), the composite of cardiac mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization.

Results

A total of 1,743 patients were ultimately included; 646 (37%) presented elevated hs-CRP, and 119 (7%) were considered malnourished. During a median follow-up of 30 months, 351 (20.1%) MACEs occurred. The coexistence of malnutrition and elevated hs-CRP correlated with the worst outcomes among the four phenotypes, with a significantly increased risk of MACEs (adjusted hazard ratio: 2.446; 95% confidence interval: 1.464 - 4.089; p <0.001). In the subgroup analysis, NRI displayed MACEs-predicting value merely among patients with elevated hs-CRP rather than those without (p for interaction = 0.005), suggesting the modifying effect of inflammation; simultaneously, the prognostic implications of hs-CRP were influenced by patients’ baseline nutritional status, as it only existed in malnourished patients (p for interaction < 0.001).

Conclusions

Among patients with ACS undergoing PCI, the double burden of inflammation and malnutrition signifies poorer outcomes, and their prognostic implications may be amplified by each other, which would provide implications to facilitate more individualized ACS care.
Early COVID-19 vaccine effectiveness of XBB.1.5 vaccine against hospitalization and ICU admission, the Netherlands, 9 October - 5 December 2023
Authors: van Werkhoven C. Henri , Valk Anne-Wil , Smagge Bente , de Melker Hester E. , Knol Mirjam J. , Hahné Susan J.M. , van den Hof Susan , de Gier Brechje
Published: December 2023

We present early vaccine effectiveness (VE) estimates of the 2023 seasonal COVID-19 vaccination campaign using XBB.1.5 vaccine against COVID-19 hospitalization and ICU admission in previously vaccinated adults ≥60 years old in the Netherlands. We compared vaccination status of 2050 hospitalizations including 92 ICU admissions with age group-, sex-, region- and date-specific population vaccination coverage between 9 October and 5 December 2023. VE against hospitalization was 70.7% (95% CI: 66.6; 74.3), VE against ICU admission was 73.3% (95% CI: 42.2; 87.6).
Cervical Cancer Screening Outcomes for HIV-positive Women in the Lubombo and Manzini regions of Eswatini – Prevalence and Predictors of a Positive Visual Inspection with Acetic Acid (VIA) Screen
Authors: Mapaona Rufaro , Williams Victor , Musarapasi Normusa , Kibwana Sharon , Maseko Thokozani , Chekenyere Rhinos , Gumbo Sidumo , Mdluli Phetsile , Byarugaba Hugben , Galagedera Dileepa , Mafukidze Arnold , de Mendoza Alejandra , Adsul Prajakta , Bongomin Pido , Loffredo Christopher , Dlamini Xolisile , Bazira Deus , Ojoo Sylvia , Haumba Samson
Published: December 2023

This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system. VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n=14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n=7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p=0.096). Screening at mission-owned (OR 1.40; p=0.001), NGO-owned (OR 3.08; p<0.001) and industrial/workplace-owned health facilities (OR 2.37; p=0.044) were associated with positive test results compared to government-owned health facilities, and being within the 35–44 age group (OR 1.26; p=0.017) compared to 25-34 years age group was a positive predictor of a positive VIA screen. Negative predictors of positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (OR 0.76; p=0.004) and ≥10 years (OR 0.66; p=0.002) compared to <5 years; and having an undetectable viral load (OR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.
The somato-cognitive action network links diverse neuromodulatory targets for Parkinson’s disease
Authors: Ren Jianxun , Zhang Wei , Dahmani Louisa , Hu Qingyu , Jiang Changqing , Bai Yan , Ji Gong-Jun , Zhou Ying , Zhang Ping , Wang Weiwei , Wang Kai , Wang Meiyun , Li Luming , Wang Danhong , Liu Hesheng
Published: December 2023

The newly-recognized somato-cognitive action network (SCAN) is posited to be important in movement coordination. Functional disruptions in Parkinson’s disease (PD) correspond with complex, non-effector-specific motor symptoms, indicating that SCAN dysfunction may underlie these symptoms. Along the same lines, the SCAN may link multiple neuromodulatory targets used for PD treatment. To investigate the role of the SCAN in PD, we leveraged resting-state precision functional mapping, analyzing data from 673 individuals across 6 independent datasets and 5 types of neuromodulation. Our findings revealed functional abnormalities within the SCAN in PD patients and the selective involvement of the SCAN in diverse neuromodulatory targets. Moreover, our data suggests causal links between SCAN connectivity changes and motor symptom alleviation following both invasive and non-invasive neuromodulation. Collectively, these findings underscore the critical role of the SCAN in the pathophysiology of PD and its brain stimulation treatments, and suggest the SCAN as a promising candidate target for neuromodulation.
Near chromosome-level and highly repetitive genome assembly of the snake pipefishEntelurus aequoreus(Syngnathiformes: Syngnathidae)
Authors: Wolf Magnus , Ferrette Bruno Lopes da Silva , Coimbra Raphael T. F. , de Jong Menno , Nebenfuehr Marcel , Prochotta David , Schöneberg Yannis , Zapf Konstantin , Rosenbaum Jessica , Mc Intyre Hannah A. , Maier Julia , de Souza Clara C.S. , Gehlhaar Lucas M. , Werner Melina J. , Oechler Henrik , Wittekind Marie , Sonnewald Moritz , Nilsson Maria A. , Janke Axel , Winter Sven
Published: December 2023

The snake pipefish,Entelurus aequoreus(Linnaeus, 1758), is a slender, up to 60 cm long, northern Atlantic fish that dwells in open seagrass habitats and has recently expanded its distribution range. The snake pipefish is part of the family Syngnathidae (seahorses and pipefish) that has undergone several characteristic morphological changes, such as loss of pelvic fins and elongated snout. Here, we present a highly contiguous, near chromosome-scale genome of the snake pipefish assembled as part of a university master’s course. The final assembly has a length of 1.6 Gbp in 7,391 scaffolds, a scaffold and contig N50 of 62.3 Mbp and 45.0 Mbp and L50 of 12 and 14, respectively. The largest 28 scaffolds (>21 Mbp) span 89.7% of the assembly length. A BUSCO completeness score of 94.1% and a mapping rate above 98% suggest a high assembly completeness. Repetitive elements cover 74.93% of the genome, one of the highest proportions so far identified in vertebrate genomes. Demographic modeling using the PSMC framework indicates a peak in effective population size (50 – 100 kya) during the last interglacial period and suggests that the species might largely benefit from warmer water conditions, as seen today. Our updated snake pipefish assembly forms an important foundation for further analysis of the morphological and molecular changes unique to the family Syngnathidae.