bluuebunny/crossref_metadata_2025 huggingface dataset:
I simply have more of a role as a human being: Psychotherapists’ Experience Delivering Psychotherapy to Nursing Home Residents With Depression
Authors: Nagel Laura Carlotta , Baumeister Natalie , Müller Tanja , Stangier Ulrich
Published: September 2024

Background and Objectives

The lack of psychotherapy in nursing homes can be explained by organizational obstacles but also by practitioners’ reservations about this patient group and setting. This study aimed to inform practice by qualitatively exploring the experiences of psychotherapists delivering cognitive behavioral therapy to residents of nursing homes diagnosed with depression.

Research Design and Methods

Semistructured interviews with 6 psychotherapists, who had delivered treatment within the DAVOS project (Depression in the nursing home: a cluster-randomized stepped-wedge collaborative case management approach to improve treatment) were recorded, transcribed, and analyzed using a deductive–inductive content analysis.

Results

Therapists experienced various difficulties, including practical (e.g., multiprofessional collaboration) and existential issues (e.g., confrontation with their own mortality). Participants described correcting some stereotypical images of older people (in need of care) through their work within the DAVOS project. However, evidence of ageism was still included in their reports. In the interviews, psychotherapists more experienced with older patients addressed more existential issues, whereas more novice therapists tended to focus more on practical difficulties.

Discussion and Implications

To ensure a more effective implementation of psychotherapeutic treatment in nursing homes, it appears necessary to address important contextual factors that facilitate interdisciplinary collaboration, interference-free treatment rooms, and tele-assisted sessions. Further, more setting-specific training, targeted supervision regarding death and suicide, and interventions that address stereotypical images of age and older people in residential care are needed.

Clinical Trial Registration Number

DRKS00015686
Identification of a “Blue Zone” in the Netherlands: A Genetic, Personal, Sociocultural, and Environmental Profile
Authors: Deeg Dorly J H , van Tilburg Theo , Visser Marjolein , Braam Arjan , Stringa Najada , Timmermans Erik J
Published: September 2024

Background and Objectives

“Blue Zones” (BZs) are regions with exceptionally high numbers of longevous inhabitants. Several factors have been suggested to promote longevity in BZs, but the evidence generally does not meet scientific quality criteria. We aimed to characterize a municipality as a “relative BZ,” satisfying 3 criteria: compared to other municipalities, more exceptionally longevous inhabitants, a higher life expectancy, and a more stable population.

Research Design and Methods

The population-based Longitudinal Aging Study Amsterdam has been ongoing since 1992 in 11 municipalities across the Netherlands with 3- or 4-yearly measurement waves. Using all available waves, we included 39 genetic, personal, sociocultural, and environmental characteristics.

Results

One municipality satisfied the 3 BZ criteria. In comparison with participants in other municipalities in the same province and other provinces in the Netherlands, BZ-participants more often had a polygenic risk score linked to longevity, smoked less, consumed less alcohol and more fruit, biked more minutes, did more often paid work, practiced singing more often, attached higher importance to religion, and lived in a more walkable and livable environment. In contrast, BZ-participants had a slower walking speed, more depressive symptoms, felt less purpose in life, had a larger waist circumference, walked and did sports less often, consumed less vegetables, and exchanged less instrumental support. Other indicators of their physical and mental health and social connectedness did not substantially differ from non-BZ-participants.

Discussion and Implications

Rather than clues to healthy aging, our findings suggest factors conducive to longevity regardless of impaired health.
Counting everyone: evidence for inclusive measures of disability in federal surveys
Authors: Hall Jean P , Goddard Kelsey S , Ipsen Catherine , Myers Andrew , Kurth Noelle K
Published: September 2024

The US Census Bureau has used the American Community Survey six-question set (ACS-6) to identify disabled people since 2008. In late 2023, the Census Bureau proposed changes to these questions that would have reduced disability prevalence estimates by 42%. Because these estimates inform funding and programs that support the health and independence of people with disabilities, many disability researchers and advocates feared this change in data collection would lead to reductions in funding and services. While the Census has paused—but not ruled out—the proposed changes, it is critical that alternate, more inclusive disability questions be identified and tested. We used data from the 2023/2024 National Survey on Health and Disability to explore alternative questions to identify disabled people in national surveys. A single broad question about conditions identified 11.2% more people with disabilities, and missed significantly fewer people with psychiatric disabilities compared to the current ACS-6 questions. A combination of a broad question and the existing ACS-6 questions may be necessary to more accurately and inclusively identify people with disabilities.
‘Does God toss logistic coins?’ and other questions that motivate regression by composition
Authors: Daniel Rhian M , Farewell Daniel M , Huitfeldt Anders
Published: September 2024

Regression by composition is a new and flexible toolkit for building and understanding statistical models. Focusing here on regression models for a binary outcome conditional on a binary treatment and other covariates, we motivate the need for regression by composition. We do this first by exhibiting—using L’Abbé plots—the families of relationships between untreated and treated conditional outcome risks that emerge from generalized linear models for many different link functions. These are compared with the relationships (between untreated and treated risks) that arise from mechanistic sufficient component cause models, which are first principles causal models for binary outcomes. By considering mechanistic models that allow for non-monotone causal effects and by allowing sufficient causes to be associated, we expand upon similar discussions in the recent literature. We discuss conditions under which commonly used statistical models for binary data, such as logistic regression, arise from mechanistic models where the sufficient causes are associated in a particular way, as well as other situations in which the statistical models arising do not correspond to a generalized linear model but can be naturally expressed as a regression by composition model.
Gravitational waves from mergers of Population III binary black holes: roles played by two evolution channels
Authors: Liu Boyuan , Hartwig Tilman , Sartorio Nina S , Dvorkin Irina , Costa Guglielmo , Santoliquido Filippo , Fialkov Anastasia , Klessen Ralf S , Bromm Volker
Published: September 2024

The gravitational wave (GW) signal from binary black hole (BBH) mergers is a promising probe of Population III (Pop III) stars. To fully unleash the power of the GW probe, one important step is to understand the relative importance and features of different BBH evolution channels. We model two channels, isolated binary stellar evolution (IBSE) and nuclear star cluster-dynamical hardening (NSC-DH), in one theoretical framework based on the semi-analytical code a-sloth, under various assumptions on Pop III initial mass function (IMF), initial binary statistics and high-z nuclear star clusters (NSCs). The NSC-DH channel contributes $\sim 8\!-\!95{{\ \rm per\ cent}}$ of Pop III BBH mergers across cosmic history, with higher contributions achieved by initially wider binary stars, more top-heavy IMFs, and more abundant high-z NSCs. The dimensionless stochastic GW background (SGWB) produced by Pop III BBH mergers has peak values $\Omega ^{\rm peak}_{\rm GW}\sim 10^{-11}\!-\!8\times 10^{-11}$ around observer-frame frequencies $\nu \sim 10\!-\!100\ \rm Hz$. The Pop III contribution can be a non-negligible ($\sim 2\!-\!32{{\ \rm per\ cent}}$) component in the total SGWB at $\nu \lesssim 10\ \rm Hz$. The estimated detection rates of Pop III BBH mergers by the Einstein Telescope are $\sim 6\!-\!230$ and $\sim 30\!-\!1230\ \rm yr^{-1}$ for the NSC-DH and IBSE channels, respectively. Pop III BBH mergers in NSCs are more massive than those from IBSE, so they dominate the Pop III SGWB below 20 Hz in most cases. Besides, the detection rate of Pop III BBH mergers involving at least one intermediate-mass BH above $100\ \rm M_\odot$ by the Einstein Telescope is $\sim 0.5\!-\!200\ \rm yr^{-1}$ in NSCs but remains below $0.1\ \rm yr^{-1}$ for IBSE.
Influence of the Lense–Thirring effect on stellar orbits around a spinning supermassive black hole
Authors: Tomar Yashvardhan , Dinh Cuc , Li Gongjie , Lin Douglas
Published: September 2024

Rotating supermassive black holes drive Lense–Thirring (LT) effects, which induce orbit nodal and eccentricity vector precession in their vicinity. Typically, these relativistic effects are quite small, but for the case of close-in orbits that are additionally perturbed by an outer intermediate-mass companion (IMC), we show that the LT effects can lead to markedly different dynamical behaviour. Using REBOUND N-body simulations, we show that resonances occur considering both the LT effect and secular perturbations from the IMC, and it can excite the inclination of the orbits, an order of magnitude higher than that achieved solely due to secular three-body effects. We also examine the sensitivity of the inclination growth on the profile of the IMC and find that the excitation is highest for a companion to supermassive black hole (SMBH) mass ratio of 1:1000 and for companions that orbit the SMBH on closer-in orbits. In addition, we investigate how varying the spin direction of the SMBH affects the inclination of the orbits. We find no excitation in the eccentricity of the orbits since the resonance is on the nodal angle, and the fast precession suppresses Kozai cycles. Finally, we note how the LT effect reduces the stability of the three-body system, enhancing the scattering rate between the test particles and the IMC, and thus making disruption events more likely in the system.
Safety of a short-term infusion of fosnetupitant in patients with gastrointestinal and breast cancer: a prospective study
Authors: Nakata Akinobu , Hashimoto Naoya , Narita Yukiya , Wakabayashi Munehiro , Kodama Hiroyuki , Ogata Takatsugu , Honda Kazunori , Masuishi Toshiki , Taniguchi Hiroya , Kadowaki Shigenori , Ando Masashi , Endo Yuka , Kotani Haruru , Kataoka Ayumi , Hattori Masaya , Yoshimura Akiyo , Sawaki Masataka , Nozawa Kazuki , Oze Isao , Iwata Hiroji , Muro Kei
Published: September 2024

Background

Fosnetupitant, a neurokinin-1 receptor antagonist, is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients undergoing highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC). Previous phase III trials demonstrated the non-inferiority of its 30-minute infusion to fosaprepitant in efficacy and a favorable safety profile.

Methods

This was a single-arm, phase II study to investigate the safety of a 15-minute infusion of fosnetupitant in patients with gastrointestinal and breast cancer. Patients who had received their dose of fosnetupitant in a 30-minute infusion without developing an allergic reaction were eligible and received their next fosnetupitant dose for 15 minutes. The primary endpoint was the incidence of an allergic reaction during the first 15-minutes infusion, and the secondary endpoints were the incidence of injection site reaction (ISR), the incidence of a grade ≥ 3 treatment-related adverse event (TRAE) with fosnetupitant, and complete response (CR) rate.

Results

The study period was from February 17, 2023 to June 20, 2023. In an exploratory analysis, medical records from the end of the study period to December 31, 2023 were retrospectively evaluated to assess the time-saving effect and safety of the short-term infusion of fosnetupitant. Fifty-six patients with gastrointestinal and 14 patients with breast cancer were enrolled, one of whom with breast cancer did not receive study treatment at her own request. No allergic reactions occurred during the 15-minutes infusion. Furthermore, there were no allergic reactions across all 280 short-term injections (Table 1). Additionally, no ISR or grade 3 or higher TRAE were reported. The CR rate was 87.0%.

Conclusion

Short-term infusion of fosnetupitant, administered over 15 minutes, was demonstrated to be safe and effective for patients receiving HEC or MEC (Japan Registry of Clinical Trials Trial ID: jRCT1041220144).
Tamsulosin and Time to Spontaneous Void After Hysterectomy
Authors: Gabra Martina , Hall Christine , McCann Lelan , Shah Jeenal , Jones Ismael , Masjedi Aaron , Runke Stephanie , Hsu Chiu-Hsieh , Aguirre Andrea
Published: September 2024

OBJECTIVE:

To evaluate whether a single preoperative dose of tamsulosin reduces the time to postoperative void and time to discharge in patients who are undergoing minimally invasive hysterectomy.

METHODS:

This single-center, block-randomized, placebo-controlled, double-blind superiority trial evaluated the effect of 0.4 mg tamsulosin compared with placebo on the time to void after hysterectomy. Patients who underwent outpatient minimally invasive hysterectomy were randomized to a single dose of tamsulosin or placebo 1 hour before surgery. All participants underwent a standardized backfill void trial to eliminate discrepancies in bladder volume that would otherwise affect the time to void. For our primary aim, we planned to enroll 150 participants to show a 30-minute reduction in the time to postoperative void (80% power, α<0.05). The secondary aim was to compare the time to discharge from the postanesthesia care unit.

RESULTS:

From June 2021 through January 2023, 344 patients were screened, and 150 were included in the final data analysis: 77 in the tamsulosin group and 73 in the placebo group. The time to spontaneous void was not different between the tamsulosin and placebo groups (106 minutes vs 100 minutes, P=.5). In addition, there was no statistical difference in time to discharge from the postanesthesia care unit (144 minutes vs 156 minutes, P=.4). Demographics and surgical details were not different between each group.

CONCLUSION:

A single dose of tamsulosin preoperatively does not lead to a decrease in postoperative time to void or time to discharge in patients undergoing minimally invasive hysterectomy for benign conditions.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04859660.
Hybrid Fixation for Large Unstable Juvenile Osteochondritis Dissecans Lesions: Midterm Results in Adolescent Patients With Completely or Partially Salvageable Progeny Fragment
Authors: Masquijo Javier , Sanchez Ortiz Milca , Penafort Felipe , Marangoni Lucas
Published: September 2024

Background:

This study aimed to describe the midterm clinical and radiographic outcomes of a hybrid fixation technique (HFT) combining interfragmentary compression with screws and biological support provided by the osteochondral autograft transplantation system (OATS) for treating large unstable juvenile osteochondritis dissecans (JOCD) lesions involving the knee in patients aged ≤18 years.

Methods:

Thirteen patients (15 knees, 9 males) with unstable JOCD lesions in the knee underwent treatment. HFT was indicated for lesions that had a completely salvageable (N=10) or partially salvageable progeny fragment (N=5). Patients were evaluated at a minimum follow-up of 1 year. The mean age of the patients was 15.3 years (range, 11 to 18 y), with 10 lesions involving the medial femoral condyle and 5 involving the lateral femoral condyle. The mean lesion area were 397.7 mm2. The outcome measures included the Pedi-IKDC and Tegner activity scales. Radiographic evaluation consisted of assessing osteochondral graft integration using the MOCART score on MRI and determining the degree of osteoarthritis using the Kellgren-Lawrence system (KL).

Results:

At a mean follow-up of 51 months (range, 12 to 143 mo), the mean Pedi-IKDC and Tegner activity scale were 90.1±7.2 and 94.7±6.7 points, respectively. Patients with unilateral lesions resumed sports activities on average after 7.7 months (range, 6 to 12 mo). All patients exhibited progeny fragment integration on MRI, with a mean MOCART score of 85±6.5 (range, 75 to 95). Radiographs indicated grade 1 KL joint space in 13 knees and grade 2 in 2 knees. At the last follow-up, 12 patients were asymptomatic, whereas 1 patient experienced occasional mild discomfort during intense physical activity. Six patients required additional surgery for hardware removal, and 1 patient underwent intra-articular loose body removal.

Conclusion:

The hybrid fixation technique showed promising outcomes in terms of fragment healing and midterm results for unstable JOCD lesions. These findings suggest that HFT can be considered a valid treatment option for large unstable lesions involving the femoral condyles of the knee in adolescents.

Study Design:

Therapeutic study (level of evidence IV).
Rapidly growing ovarian dysgerminoma during pregnancy: a case report and literature review
Authors: Awada Rim , Jlailati Alaa , Ahmad Heya , Hanna Majd , Martini Nafiza , Al-Mahasna Souheb
Published: September 2024

Introduction and importance:

Ovarian dysgerminoma is a rare germ cell tumor comprising 1–2% of ovarian malignancies. It predominantly affects women aged 20–30 years old and has a favorable prognosis with nearly 100% 5-year survival for early-stage disease. However, its nonspecific symptoms often delay diagnosis, accentuating the need for timely identification and intervention to optimize outcomes.

Case presentation:

A 28-year-old pregnant woman presented with a complaint of a heavy sensation during her third month of pregnancy. An ultrasound scan detected a mass that was suspected to be a uterine fibroid tumor. The mass grew to a size of 20×20 cm, completely covering the fetus and causing significant discomfort. A cesarean section was performed at 37 weeks, delivering a healthy fetus. Intraoperatively, a necrotic dysgerminoma was unexpectedly discovered, leading to treatment with the BEP regimen, resulting in a complete response. The patient is currently under observation with favorable tumor marker levels and no abnormalities on imaging.

Clinical discussion:

The review of literature on 13 pregnant cases showed dysgerminoma can manifest with abdominal pain or distension, or incidentally. Unilateral tumors occurred more frequently on the right side. Imaging aids diagnosis but definitive classification requires immunohistochemistry. Treatment involves surgery with chemotherapy for advanced disease. Prognosis is favorable with appropriate management.

Conclusion:

Dysgerminoma during pregnancy poses diagnostic challenges due to nonspecific symptoms and physiological changes. A synergistic approach of imaging, histopathology, surgery, and chemotherapy enables accurate diagnosis and treatment. Further research on surgical strategies and patient-centered care is warranted for continued improvement.
Ramon syndrome: a rare case report of cherubism with gingival fibromatosis in an adult female
Authors: Assimi Sihame , Cherkaoui Amine
Published: September 2024

Introduction and Importance:

Cherubism is a rare genetic disorder characterized by painless bilateral expansion of the mandible and maxilla.

Case Presentation:

The authors present an unusual case of a 50-year-old female patient with Ramon syndrome, a rare variant of cherubism accompanied by gingival fibromatosis. The patient exhibited symptoms such as short stature, mental retardation, rheumatoid arthritis, epilepsy, hirsutism, and gingival enlargement. Clinical examination revealed generalized gingival inflammation, plaque formation, and a loss of attachment. Radiographically, bilateral multilocular radiolucencies were observed in the mandibular body and the ramus. The patient underwent a nonsurgical phase, including oral hygiene motivation and periodontal debridement, followed by a surgical phase involving gingivoplasty and internal bevel gingivectomy with open flap debridement. Histopathological analysis confirmed the presence of fibroblasts, multinucleated giant cells, and fibrous connective tissues. The patient’s son also presented with bilateral facial swelling and similar radiographic findings, indicating familial inheritance of cherubism.

Clinical Discussion:

This case demonstrates the clinical, radiographic, and histopathological features of cherubism associated with gingival fibromatosis and highlights the challenges in its diagnosis and management. Regular follow-up and maintenance are essential for long-term stability and prevention of recurrence.

Conclusion:

This report contributes to the limited literature on cherubism in older patients and emphasizes the importance of early identification and intervention in affected individuals.
The sitting versus lateral position during induction of spinal anesthesia for elective cesarean delivery on block characteristics and severity of hypotension: a prospective randomized clinical trial, 2023
Authors: Befkadu Aynalem , Timerga Sara , Mihretu Fasil , Seyoum Fetene , Alimawu Agmuas A.
Published: September 2024

Background:

Spinal anesthesia (SA) is the most preferred technique for cesarean delivery but is challenged by many adverse effects, mostly by maternal hypotension and bradycardia. Due to the high adversity effects of hypotension to mother and baby, prevention at any cost is much more advice. SA inductional positioning could be one of the preventive methods.

Objective:

To assess the effect of sitting and lateral SA induction positions on hemodynamic changes, severity of hypotension, and block characteristics in elective cesarean section.

Methodology:

A prospective double-blinded randomized control trial was conducted by recruiting 132 patients using a systematic random sampling technique. Patients were randomized into lateral position (n=66) and control group (sitting position) (n=66). Isobaric bupivacaine (0.5%) was injected into the spinal space at L3–L4 level in the lateral position for group 1 and in the sitting position for group 2. Afterward, the patient’s blood pressure was measured at first and third minute, then every 5 min until the 20th minute, and then every 10 min until the end of cesarean section. Data analysis was performed using SPSS (version 21) software, and continuous variables were analyzed by independent sample t test while categorical by Fisher exact and χ
2 test. An intention-to-treat analysis was applied for those who lost follow-up and P value <0.05 was considered statically significant.

Result:

There was a statistically significant difference in the incidence of hypotension between lateral and supine positions [50 (75.8%) in sitting and 31 (47.0% lateral), dep=0.002)]. The frequency of hypotension was more in the sitting position, and there were no significant differences in heart rate. Vasopressor consumption was 14.98±20.50 in the lateral group and 30.89±22.259 in the sitting group, P value <0.001. The onset of sensory block was faster in the lateral group (1.92±0.56 vs. 3.8±0.01, P<0.001), but it requires more time for identification of subarachnoid space (2.95±2.0 vs. 1.5±1.0, P=0.002).

Conclusion:

Lateral positioning was superior in view of better hemodynamic stability, early onset, low vasopressor consumption, and low incidence of hypotension for parturients undergoing elective cesarean section.
Endoscopic endonasal surgery for the complete removal of tuberculum sellae meningioma coexisting with craniopharyngioma: case report and literature review
Authors: Chen Yu Xing , Wan Xi Chen , Pan Lai Sheng , Peng Hao Yang , Hong Tao , Wu Xiao
Published: September 2024

Introduction and importance:

Meningioma (MNG) is a common intracranial tumor, whereas craniopharyngioma (CPG) is relatively uncommon, and the combination of the two is extremely rare according to the currently published literature. Moreover, to date, most cases of CPG combined with MNG have been treated via surgical resection, particularly by craniotomy.

Case presentation:

A 59-year-old woman who presented with headache and vomiting and who was initially diagnosed with CPG combined with MNG underwent single-stage endoscopic endonasal surgery. The patient’s recovery was uneventful.

Clinical discussion:

A case of CPG combined with MNG was reported, and previously reported cases of CPG combined with MNG were systematically reviewed. Finally, the indications for and limitations of treatment with an endoscopic endonasal approach for CPG combined with MNG are discussed.

Conclusion:

The combination of CPG and MNG is rare. After comprehensive assessment, one-stage resection using endoscopic endonasal surgery is feasible. This approach can potentially reduce the duration of treatment and the risk of postoperative complications associated with multiple surgeries.
Interleukin-10: Genetic and biochemical prediction of sepsis-induced acute kidney injury in critically ill patients in intensive care unit: A cross-sectional study
Authors: Amin Amr A. , Ghonaim Aseel M. , Al-Amodi Hiba S. , Mukhtar Mohammed H. , Allam Reem M. , Dannoun Anas , Eldein Mohamed N. , Bogari Neda M.
Published: September 2024

Background:

Sepsis is a potentially life-threatening condition that eventually causes multiorgan dysfunction in critically ill patients. Acute kidney injury (AKI) is a severe life-threatening complication of sepsis, a condition termed sepsis-induced AKI (S-AKI), with poor clinical outcomes and high mortality rates. Inflammatory and immunological responses are important variables in S-AKI. This study aimed to examine the relationship of rs1518111 polymorphism in the interleukin-10 (IL-10) gene and serum/urine IL-10 levels with sepsis-induced AKI in critically ill patients in the intensive care unit (ICU).

Methods:

In this cross-sectional study, 310 critically ill adult patients were recruited, of whom, 197 developed S-AKI. Real-time polymerase chain reaction was performed to detect the rs1518111 polymorphism. Circulating blood and urine IL-10 levels of IL-10 were measured.

Results:

For rs1518111 SNP, the presence of at least one T allele increased the risk of occurrence of S-AKI (odds ratio [OR]: 1.34, 95% CI: 1.07-3.17; p < 0.001), regardless of the type of infection and severity of sepsis. Blood and urine IL-10 levels were an excellent prediction of S-AKI (area under the receiver operating characteristic curve [AUC]: 0.881 and 0.953 and sensitivity: 90.2% and 97.6% at cutoff of 133.5 and 5.67 pg/mL, respectively). Regression analysis showed that white blood cell count and increased blood and urine IL-10 levels, in addition to the presence of TT genotype, are independent risk factors for S-AKI.

Conclusion:

rs1518111 polymorphism in the IL-10 gene is a risk factor for sepsis-induced AKI in the ICU. Serum/urine IL-10 levels may be used as predictors of S-AKI in critically ill patients with sepsis, thereby improving early management.
Primary Care Provider and Staff Wellness and Burnout Levels and Suggestions to Improve Wellness: Analysis of Survey Findings
Authors: Cunningham Amy T. , Waters Alexa , Shah Dhruvi , Arefi Pouya , Sifri Randa D.
Published: September 2024

Primary care provider and staff burnout is high, although less research exists comparing burnout by role. The objectives of this study were to characterize primary care provider and staff wellness and burnout and provide suggestions to improve wellness in a large network. Survey items included demographics, the Perceived Stress Reactivity Subscale, abbreviated Maslach Burnout Inventory, Mini-Z burnout survey, self-reported wellness, and one open-ended question asking what would improve their work-related wellness. Surveys were disseminated in February 2021, October 2021, and June 2022. Responses were analyzed by demographic categories. Open-ended responses were coded. In total 1015 responses were recorded (29.5% response rate). Burnout varied by role and campus. The 677 open-ended comments had six main themes for improving wellness: Staffing, Health System, Practice, Training, Incentives, and Miscellaneous. Primary care providers/staff reported varying, consistent levels of burnout. They suggested practice and system-level changes including increased staffing, schedule changes and improved communication.
Diurnal variation of postoperative delirium in elderly patients undergoing esketamine anesthesia for elective noncardiac surgery: a randomized clinical trial
Authors: Zhang Yuan , Chen Rong , Tang Shan , Sun Tao , Yu Yanli , Shi Ruoshi , Wang Kai , Zeng Zi , Liu Xinhang , Meng Qingtao , Xia Zhongyuan
Published: September 2024

Background:

Postoperative delirium (POD) is a serious and common complication. The aim of present study is to investigate the diurnal variation of POD and the effects of esketamine in elderly patients.

Methods:

A randomized, double-blind, placebo-controlled clinical trial with factorial design was conducted. Patients (aged 65 to 85 years) with normal Mini-Mental State Examination (MMSE) score were stratified by age (≤70 vs. >70) and American Society of Anesthesiologists physical status classification (Ⅱ vs. Ⅲ), then randomly assigned to either morning (08:00–12:00) or afternoon (14:00–18:00) noncardiac operation under general anesthesia with or without esketamine administration (0.2 mg/kg). The primary outcome was the incidence of POD (3-Minute Diagnostic Interview for Confusion Assessment Method-defined Delirium, 3D-CAM) on postoperative days 1, 3, and 7. The secondary outcomes were the scores of MMSE and Hospital Anxiety and Depression Scale. The intention-to-treat analysis of the outcomes were performed by generalized estimating equation.

Results:

Six patients who did not receive an intervention because of canceled operation were excluded after randomization. The datasets containing 426 cases were analyzed following the intention-to-treat principle after handling missing data via multiple imputation method. The incidence of POD declined from about 55% on postoperative day 1 to 31 and 18% on postoperative days 3 and 7, respectively. Afternoon operation [B=−0.583, OR (95% CI) 0.558 (0.319–0.976); P=0.041], but not esketamine, significantly decreased the incidence of POD. Both esketamine and operation time failed to significantly affect MMSE, HAD, and NRS score. There was no interaction among operation time, esketamine, and follow up time.

Conclusion:

Elderly patients undergoing elective noncardiac surgery in the afternoon displayed lower POD incidence than those operated in the morning. A single low-dose of esketamine before general anesthesia induction failed to significantly decrease the risk of POD but decrease the risk of intraoperative hypotension and emergence agitation.
Normal Saline Versus Hypertonic Saline for Airway STENT Maintenance
Authors: Salguero Bertin D. , Joy Greta , Lo Cascio Christian M. , Agrawal Abhinav , Chaddha Udit
Published: September 2024

Background:

Mucus plugging is a common complication of airway stenting. There is no data or guidance on the best airway hygiene regimen and consequently wide practice variation exists.

Methods:

This single-center, nonblinded, randomized, pilot study aims to evaluate the effectiveness and safety of nebulized 3% saline (3%S) versus normal saline (NS) in reducing the incidence of mucus plugging in adult patients that undergo central airway stent placement. Patients were enrolled immediately after stent placement and randomized to nebulized 3%S or NS (3 mL) 3 times a day. Patients were scheduled for surveillance bronchoscopy in 4 to 6 weeks. Unscheduled bronchoscopies due to symptomatic mucus plugging were recorded.

Results:

From December 2022 to March 2024, 37 patients were screened, and 35 were enrolled. Four in the 3%S and 8 in the NS group did not undergo a surveillance bronchoscopy and were excluded from the final analysis. During surveillance bronchoscopy for the 3%S (n=13) and NS (n=10) groups, obstructive mucus plugging was noted in 7.7% versus 40%, granulation requiring intervention in 7.7% versus 10%, and >25% circumferential biofilm in 0% versus 30%, respectively. In the 3%S versus NS groups, 0% versus 20% of patients required an unscheduled bronchoscopy due to mucus plugging. There were no side effects reported with the daily use of 3%S or NS.

Conclusion:

Nebulized 3%S is safe and may be equally or more effective than NS in preventing obstructive mucus plugging in patients who undergo airway stenting. A larger blinded randomized controlled trial is necessary to confirm this finding.
A Reduced Resistance, Concentric-Gated Artificial Membrane Lung for Pediatric End-Stage Lung Failure
Authors: Wich Lauren A. , Gudex Leah M. , Dann Tyler M. , Matich Hannah J. , Thompson Alex J. , Atie Michael , Johnson Matthew D. , Bartlett Robert H. , Rojas-Peña Alvaro , Hirschl Ronald B. , Potkay Joseph A.
Published: September 2024

The goal of the low-resistance pediatric artificial lung (PAL-LR) is to serve as a pumpless bridge-to-transplant device for children with end-stage lung failure. The PAL-LR doubles the exposed fiber length of the previous PAL design. In vitro and in vivo studies tested hemocompatibility, device flow, gas exchange and pressure drop performance. For in vitro tests, average rated blood flow (outlet SO2 of 95%) was 2.56 ± 0.93 L/min with a pressure drop of 25.88 ± 0.90 mm Hg. At the targeted pediatric flow rate of 1 L/min, the pressure drop was 8.6 mm Hg compared with 25 mm Hg of the PAL. At rated flow, the average O2 and CO2 transfer rates were 101.75 ± 10.81 and 77.93 ± 8.40 mL/min, respectively. The average maximum O2 and CO2 exchange efficiencies were 215.75 ± 22.93 and 176.99 ± 8.40 mL/(min m2), respectively. In vivo tests revealed an average outlet SO2 of 100%, and average pressure drop of 2 ± 0 mm Hg for a blood flow of 1.07 ± 0.02 L/min. Having a lower resistance, the PAL-LR is a promising step closer to a pumpless artificial membrane lung that alleviates right ventricular strain associated with idiopathic pulmonary hypertension.
Sclerosing Epithelioid Fibrosarcoma Harboring the EWSR1–CREB3L1 Gene Fusion: The Importance of Molecular Classification in Pediatric Sarcomas
Authors: Offenbacher Rachel , Kaswan Sara , Fabish Lara , Barron Carly , Fox Jana , Chin Steven , Snuderl Matija , Lee Alice , Loeb David M. , Baker Alissa
Published: September 2024

Background:

Sclerosing epithelioid fibrosarcoma (SEF) is a very rare soft tissue sarcoma that most commonly presents in middle-aged and elderly adults but has been rarely seen in children. SEF is a very aggressive tumor with over 50% of patients experiencing local recurrence and 40% to 80% of patients experiencing distant metastatic spread. This disease has been shown to be resistant to chemotherapy and is classically treated with surgical excision.

Case:

We describe the case of a 10-year-old girl with Graves’ disease who presented with protruding eyes (to a greater extent on the left side) and was found to have a large mass in her left inferior rectus muscle that was diagnosed as SEF. After treatment with incomplete resection, due to the benign-appearing nature of the tumor on imaging, and proton radiation therapy, she remains disease-free at 18 months post-therapy.

Discussion:

SEF is typically identified via genetic testing and recognition of the EWSR1–CREB3L1 gene fusion as well as MUC4 expression via immunohistochemistry. DNA methylation profiling, which has traditionally been used in brain tumors, can also efficiently identify this tumor, and we recommend expanding the use of this technology for difficult to classify pediatric sarcomas.
Histologic and Molecular Type Changes in Endometrial Cancer Recurrences in Comparison With Their Corresponding Primary Tumors
Authors: Moreno-Moreno Esther , Caniego-Casas Tamara , Carretero-Barrio Irene , Cortés Alfonso , Muriel Alfonso , Domínguez-Rullán José Antonio , Martín-Gromaz Carmen , Moreno-Bueno Gema , Matías-Guiu Xavier , Palacios José , Pérez-Mies Belén
Published: September 2024

In this study, molecular alterations in endometrial carcinoma (EC) recurrences were analyzed. We aimed to identify genes implicated in tumor progression and to evaluate whether histologic and molecular type shifting occurs in recurrences. Thus, we analyzed 50 samples corresponding to 24 primary ECs (15 low-grade endometrioid endometrial carcinomas [LG-EECs] and 9 high-grade endometrial carcinomas) and their corresponding 26 recurrences. These were studied by immunohistochemistry, next-generation sequencing, and MLH1 promoter methylation. We observed shared mutations in all primary tumors and their recurrences, indicating a clonal relationship between both lesions. Most morphologic and molecular changes associated with progression were found in LG-EEC. In this group, 6 patients (40%) presented additional mutations in the recurrence. These mutations more frequently affected genes of the PI3K/AKT/PTEN pathway, implicating this pathway not only in tumor initiation but also in progression. In addition, 2 patients (13%) in which the primary tumor belonged to the nonspecific molecular profile subtype, shifted to the mismatch repair deficient (MMRd) subtype after the acquisition of MLH1 promoter methylation in the recurrence lesions. In 3 patients (20%) with MMRd, there was a change from LG-EEC to G3-EEC. One TP53-mutated LG-EEC transformed into an undifferentiated carcinoma in a mediastinal lymph node metastasis after losing the expression of SMARCA2 while preserving SMARCA4 and SMARCB1. Morphologic and molecular changes in EC recurrences, especially dedifferentiation and the acquisition of MMRd, should be considered for a correct diagnosis and treatment. MMRd should be tested in metastatic lesions, if available, in patients with primary tumors reported to be of a molecular subtype different from MMRd.
Recent advances in acupuncture for pain relief
Authors: Niruthisard Supranee , Ma Qiufu , Napadow Vitaly
Published: September 2024

Introduction:

Acupuncture therapy has achieved global expansion and shown promise for health promotion and treatment of acute/chronic pain.

Objectives:

To present an update on the existing evidence base for research and clinical practice supporting acupuncture analgesia.

Methods:

This Clinical Update elaborates on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care “Factsheet Acupuncture for Pain Relief” and reviews best evidence and practice.

Results:

Acupuncture is supported by a large research evidence base and growing utilization. Mechanisms of acupuncture analgesia include local physiological response at the needling site, suppression of nociceptive signaling at spinal and supraspinal levels, and peripheral/central release of endogenous opioids and other biochemical mediators. Acupuncture also produces pain relief by modulating specific brain networks, integral for sensory, affective, and cognitive processing, as demonstrated by neuroimaging research. Importantly, acupuncture does not just manage pain symptoms but may target the sources that drive pain, such as inflammation, partially by modulating autonomic pathways. Contextual factors are important for acupuncture analgesia, which is a complex multifaceted intervention. In clinical practice, historical records and many providers believe that acupuncture efficacy depends on specific acupoints used, the technique of needle placement and stimulation, and the person who delivers the procedure. Clinical research has supported the safety and effectiveness of acupuncture for various pain disorders, including acupuncture as a complementary/integrative therapy with other pain interventions.

Conclusion:

Although the quality of supportive evidence is heterogeneous, acupuncture's potential cost-effectiveness and low risk profile under standardized techniques suggest consideration as a neuromodulatory and practical nonpharmacological pain therapy.
Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees Part 2: Speech Fundamentals and Perceptual Speech Assessment
Authors: Wright Joshua M. , MacIsaac Molly F. , Vieux Jamilla , Rottgers S. Alex , Halsey Jordan N.
Published: September 2024

Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. The gold standard for diagnosis is auditory-perceptual speech evaluation by a specialized speech-language pathologist. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism, (2) fundamental speech terminology and principles of perceptual speech assessment for VPD, and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 2, the authros begin with the concepts and terminology required to understand the perceptual speech assessment of VPD, including resonance, articulation, and the differentiation between consonants and vowels. We review the types of speech samples used for evaluation such as single-word articulation tests, syllable repetition, sentence repetition, and spontaneous connected speech. Finally, we discuss the auditory-perceptual speech assessment for VPD, including the assessment of resonance, nasal air emission, articulation, and voice quality. The use of rating scales like the Pittsburgh Weighted Speech Scale (PWSS) and the Cleft Audit Protocol for Speech-Augmented-Americleft Modification (CAPS-A-AM) is highlighted. In addition, the significance of intraoral examinations, visual-tactile-auditory evaluations, and the assessment of voice quality are covered. Most textbook chapters discussing this topic assume a foundational knowledge of speech-language pathology, which a surgical trainee may lack. This study aimed to bridge the gap between surgical training and speech pathology, providing a comprehensive resource to enhance the understanding and management of VPD.
Species of Chinese materia medica resources based on the fourth national survey of Chinese materia medica resources
Authors: Huang Luqi , Guo Lanping , Zhang Xiaobo , Yu Liying , Sun Jiahui
Published: September 2024

This article outlines the composition and species characteristics of Chinese materia medica (CMM) resources identified in the fourth national survey of CMM resources. The survey was conducted based on field investigations and office collation, adhering to the “four principles” emphasizing the existence of survey records, voucher specimens, actual photographs, and evidence of medicinal use, to summarize the species of CMM resources and ensure the scientific integrity and accuracy of the results. According to the findings, China has 18,817 CMM resources, including 15,321 medicinal plants, 826 medicinal fungi, 2517 medicinal animals, and 153 medicinal minerals. Additionally, in the fourth national survey of CMM resources, 3151 species of unique medicinal plants, 464 species of rare and endangered medicinal plants, and 196 new species in China underwent specialized investigations. These latest statistics are expected to provide the most up-to-date foundational data for the protection, management, development, and utilization of these CMM resources over an extended period, offering scientific guidance for the development of the traditional Chinese medicine industry.
Whole blood to total transfusion volume ratio in injured children: A national database analysis
Authors: Campwala Insiyah , Dorken-Gallastegi Ander , Spinella Philip C. , Brown Joshua B. , Leeper Christine M.
Published: September 2024

BACKGROUND

Whole blood (WB) resuscitation is increasingly common in adult trauma centers and some pediatric trauma centers, as studies have noted its safety and potential superiority to component therapy (CT). Previous analyses have evaluated WB as a binary variable (any versus none), and little is known regarding the “dose response” of WB in relation to total transfusion volume (TTV) (WB/TTV ratio).

METHODS

Injured children younger than 18 years who received any blood transfusion within 4 hours of hospital arrival across 456 US trauma centers were included from the American College of Surgeons Trauma Quality Improvement Program database. The primary outcome was 24-hour mortality, and the secondary outcome was 4-hour mortality. Multivariate analysis was used to evaluate associations between WB administration and mortality and WB/TTV ratio and mortality.

RESULTS

Of 4,323 pediatric patients included in final analysis, 88% (3,786) received CT only, and 12% (537) received WB with or without CT. Compared with the CT group, WB recipients were more likely to be in shock, according to pediatric age-adjusted shock index (71% vs. 60%) and had higher median (interquartile range) Injury Severity Score (26 [17–35] vs. 25 [16–24], p = 0.007). Any WB transfusion was associated with 42% decreased odds of mortality at 4 hours (adjusted odds ratio [aOR], 0.58 [95% confidence interval, 0.35–0.97]; p = 0.038) and 54% decreased odds of mortality at 24 hours (aOR, 0.46 [0.33–0.66]; p < 0.001). Each 10% increase in WB/TTV ratio was associated with a 9% decrease in 24-hour mortality (aOR, 0.91 [0.85–0.97]; p = 0.006). Subgroup analyses for age younger than 14 years and receipt of massive transfusion (>40 mL/kg) also showed statistically significant survival benefit for 24-hour mortality.

CONCLUSION

In this retrospective American College of Surgeons Trauma Quality Improvement Program analysis, use of WB was independently associated with reduced 24-hour mortality in children; further, higher proportions of WB used over the total resuscitation (WB/TTV ratio) were associated with a stepwise increase in survival.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Bleeding control methods for kids: A pediatric approach to the national education campaign—a pilot program
Authors: Anderson Melissa , Williams Renaldo
Published: September 2024

BACKGROUND

The project purpose was to design and test an age-appropriate curriculum to train children aged 5 through 13 years on bleeding control methods based on the national Stop the Bleed initiative. Studies have shown that children as young as 5 years are able to perform first aid and cardiopulmonary resuscitation. The project aimed to demonstrate that children as young as 5 years can be taught bleeding control methods. Our hypothesis was that there would be a 60% retention rate on retesting of the children within 1 year across all age groups.

METHODS

The study design was an observational cohort study from February 2018 to January 2020. Participants (aged 5 through 13 years) were trained on bleeding control methods but using an age-based curriculum. The initial training included 500 children. The participants were taught tourniquet applications, wound packing, and direct pressure skills. The curriculum consisted of a 30-minute didactic portion with participant involvement and engagement followed by 30 minutes of hands-on skill training and demonstration. In addition, participants were required to be able to recite the “5 Rules” to helping hurt people. Descriptive statistics were performed.

RESULTS

Participants were retested approximately 1 year after the initial training. The retest group only consisted of 227 participants because of a multitude of reasons for the decrease in children. Children were tested in comprehension and application of each skill. Results indicated a greater than 70% retention for all skills across all participants for the retesting after 1 year.

CONCLUSION

The findings indicated that children as young as 5 years can be taught to perform bleeding control methods of tourniquet application, wound packing, and direct pressure. While the results indicate that the older the child, the better the retention, if children were provided multiple trainings over a 1-year period, the retention could be higher.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.