bluuebunny/crossref_metadata_2025 huggingface dataset:
Modeling and controlling the body in maladaptive ways: an active inference perspective on non-suicidal self-injury behaviors
Authors: Laura Barca , Maisto Domenico , Pezzulo Giovani
Published: November 2023

A significant number of persons engage in paradoxical behaviors, such as extreme food restriction (up to starvation) and non-suicidal self-injuries, especially during periods of rapid changes, such as adolescence. Here, we contextualize these and related paradoxical behavior within an active inference view of brain functions, which assumes that the brain forms predictive models of bodily variables, emotional experiences, and the embodied self and continuously strives to reduce the uncertainty of such models. We propose that not only in conditions of excessive or prolonged uncertainty, such as in clinical conditions, but also during pivotal periods of developmental transition, paradoxical behaviors might emerge as maladaptive strategies to reduce uncertainty—by “acting on the body”— soliciting salient perceptual and interoceptive sensations, such as pain or excessive levels of hunger. Although such strategies are maladaptive and run against our basic homeostatic imperatives, they might be functional not only to provide some short-term reward (e.g. relief from emotional distress)—as previously proposed—but also to reduce uncertainty and possibly to restore a coherent model of one’s bodily experience and the self, affording greater confidence in who we are and what course of actions we should pursue.
Histidine-containing dipeptide supplementation improves delayed recall: a systematic review and meta-analysis
Authors: Bell Simon M , Hariharan Rohit , Laud Peter J , Majid Arshad , de Courten Barbora
Published: November 2023

Context

Histidine-containing dipeptides (carnosine, anserine, beta-alanine and others) are found in human muscle tissue and other organs like the brain. Data in rodents and humans indicate that administration of exogenous carnosine improved cognitive performance. However, RCTs results vary.

Objectives

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of histidine-containing dipeptide (HCD) supplementation on cognitive performance in humans to assess its utility as a cognitive stabiliser.

Data Sources

OVID Medline, Medline, EBM Reviews, Embase, and Cumulative Index to Nursing and Allied Health Literature databases from 1/1/1965 to 1/6/2022 for all RCT of HCDs were searched.

Data Extraction

2653 abstracts were screened, identifying 94 full-text articles which were assessed for eligibility. Ten articles reporting the use of HCD supplementation were meta-analysed.

Data Analysis

The random effects model has been applied using the DerSimonian-Laird method. HCD treatment significantly increased performance on Wechsler Memory Scale (WMS) −2 Delayed recall (Weighted mean difference (WMD) (95% CI (CI)) = 1.5 (0.6, 2.5), P < .01). Treatment with HCDs had no effect on Alzheimer’s Disease Assessment Scale-Cognitive (WMD (95% CI) = −0.2 (−1.1, 0.7), P = .65, I2 = 0%), Mini-Mental State Examination (WMD (95% CI) = 0.7 (−0.2, 1.5), P = .14, I2 = 42%), The Wechsler Adult Intelligence Scale (WAIS) Digit span Backward (WMD (95% CI) = 0.1 (−0.3, 0.5), P = .51, I2 = 0%), WAIS digit span Forward (WMD (95% CI) = 0.0 (−0.3, 0.4), P = .85, I2 = 33%) and the WMS-1 Immediate recall (WMD (95% CI) = .7 (−.2, 1.5), P = .11, I2 = 0%). The effect on delayed recall remained in subgroup meta-analysis performed on studies of patients without mild cognitive impairment (MCI), and in those without MCI where average age in the study was above 65.

Conclusion

HCD, supplementation improved scores on the Delayed recall examination, a neuropsychological test affected early in Alzheimer’s disease. Further studies are needed in people with early cognitive impairment with longer follow-up duration and standardization of carnosine doses to delineate the true effect.

Systematic Review Registration

PROSPERO registration no. CRD42017075354.
SOCIÉTÉ DES PRODUITS NESTLÉ SA v CADBURY UK LTD
Authors:   Chancery Division
Published: November 2023

H1 Trade Marks — Application for registration — Opposition Proceedings — Colour marks — Purple per se — Purple “applied to the packaging of the goods” — Whether inherently unregistrable — Whether they were “signs” — Whether applications for a multitude of visual forms — Whether too vague — Appeal to High Court
Objective sleep and cardiometabolic biomarkers: results from the community of mine study
Authors: Zamora Steven , Full Kelsie M , Ambeba Erica , Savin Kimberly , Crist Katie , Natarajan Loki , Sears Dorothy D , Alismail Sarah , Letellier Noémie , Benmarhnia Tarik , Jankowska Marta M
Published: November 2023

Study Objectives

Examining multiple dimensions of sleep health may better capture associations between sleep and health risks, including cardiometabolic disease (CMD). Hispanics have elevated risk for inadequate sleep and CMD biomarkers. Few studies have explored whether associations between sleep and CMD differ by Hispanic ethnicity.

Methods

Leveraging data from the Community of Mine (CoM) study, a cross-sectional investigation of 602 ethnically diverse participants, we derived accelerometer-measured sleep duration and efficiency, and self-reported sleep quality. Accelerometer-measured sleep exposures were analyzed both as continuous and categorical variables. Multivariate and quantile regression models were used to assess associations between sleep and CMD biomarkers (insulin resistance, systolic blood pressure, and low-density-lipoprotein cholesterol), controlling for age, sex, ethnicity, education, smoking status, and body mass index. We examined the potential effect modification of Hispanic ethnicity.

Results

We observed mixed results based on CMD biomarkers and sleep exposure. Increased sleep duration was significantly related to low-density lipoprotein cholesterol in adjusted models (estimate = 0.06; 95% CI: 0.02, 0.11). Poor sleep efficiency was associated with greater insulin resistance in the adjusted quantile (estimate = 0.20; 95% CI: 0.04, 0.36) model at the 90th percentile. Self-reported sleep quality was not associated with CMD outcomes. There was no evidence of effect modification by Hispanic ethnicity.

Conclusions

In this cohort, sleep health measures were found to have mixed and at times opposing effects on CMD outcomes. These effects did not demonstrate an interaction with Hispanic ethnicity.
Associations Between Provider-Assigned Apgar Score and Neonatal Race
Authors: Edwards S.E. , Wheatley C. , Sutherland M. , Class Q.A.
Published: November 2023

(Am J Obstet Gynecol. 2023;228(2):229.e1–229.e9)

Apgar scores are typically used by pediatricians and nurses to determine whether a newborn needs medical intervention. Consisting of 5 categories in which the score ranges from 0 to 2, the composite score can range from 0 to 10; low scores are predictive of poor neurologic outcomes, but the assignment of the score has an inherent amount of subjectivity as well as poor specificity. One area of subjectivity in particular concerns race, as well-perfused infants of different races could subjectively be viewed differently if expectations are inaccurate. To date, no studies have examined the relationship between Apgar score and race, nor assessed the impact this may have on neonatal care. This study aimed to assess the relationship between race and Apgar scores. The authors hypothesized that Apgar scores for Black newborns would be significantly lower than other races, but that cord gases would not significantly differ.
Maternal Sudden Death: A Nationwide Retrospective Study
Authors: Braund S. , Leviel J. , Morau E. , Deneux-Tharaux C. , Verspyck E. ,   ENCMM Study Group
Published: November 2023

(BJOG. 2023;130:257–263)

Deaths that occur suddenly, with or without witnesses, can often be reported speculatively if there is no autopsy performed or supervision by medical personnel. Maternal sudden death is no exception to this trend, but it represents a situation that is multifaceted because of the physical strain present during and after childbirth, as well as complications associated with it. This study was done to examine what role sudden maternal deaths play in total maternal mortality, and to investigate possible explanations and commonalities based on recorded causes of death.
Posterior Reversible Encephalopathy Syndrome
Authors: Geocadin R.J.
Published: November 2023

(N Engl J Med. 2023;388:2171–2178)

Posterior reversible encephalopathy syndrome (PRES) most often affects individuals with acute hypertension or elevated blood pressure or those who have been exposed to certain drugs or toxic agents. PRES often presents with acute neurological deficits, but these are often resolved relatively quickly if promptly diagnosed and treated. This review article describes the pathology, features, epidemiology, management, and implications of PRES.
Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence
Authors: Gaston I.N. , Lange E.M.S. , Farrer J.R. , Toledo P.
Published: November 2023

(Anesth Analg. 2023;136:1217–1219)

Recent advances in technology have made life-threatening airway failures in obstetric anesthesia less and less frequent occurrences. Though these events are rare, they still occur and often result in death or very poor outcomes if not treated appropriately. Sugammadex has been shown to be a rapid and effective reversal technique for aminosteroid-induced paralysis in nonpregnant patients and has been associated with a 30% reduction in major postoperative pulmonary complications. There is a lack of evidence in the obstetric population, but it could potentially be assumed that results would be similar. This article reviews the history and effectiveness of Sugammadex and its potential for effectiveness in an obstetric population.
Pregnancy and Residency: Overdue for Equity
Authors: Koven S. , Haberer J.E. , Gomez-Kwolek D.
Published: November 2023

(N Engl J Med. 2023;16;388:966–967)

Three female physicians discuss the difficulty of combining pregnancy with medical training. Some obstacles include how to balance the physical demands of growing a baby with an inflexible schedule, a lack of maternity leave options, social pressure to not burden fellow staff during the prenatal and postnatal period, the adverse effects of stress on the mother and infant’s health, deferring childbearing until after training, slow uptake of policy changes, and career disruptions to have a child. Despite the unique experiences of these physicians, there was a shared theme: a healthy pregnancy and simultaneously successfully complete residency with their peers was unattainable. A lack of gender equity in medicine is at the root of the problem.
Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal
Authors: Young L.W. , Ounpraseuth S.T. , Merhar S.L. , Hu Z. , Devlin L.A. ,   et al
Published: November 2023

(N Engl J Med. 2023; 388:2326–2337)

The diagnosis of neonatal opioid withdrawal syndrome is a frequent occurrence within US hospitals. Most often neonates are evaluated for withdrawal-related symptoms with the Finnegan Neonatal Abstinence Scoring Tool and the associated modifications, however this approach may lead to overuse of pharmacologic agents such as morphine. These authors sought to evaluate whether the Eat, Sleep, Console approach could reduce length of hospital stays experienced by neonates without compromising their safety.
Biomarkers and the Risk of Preeclampsia
Authors: Emeruwa U.N. , Gyamfi-Bannerman C. , Laurent L.C.
Published: November 2023

(JAMA. 2023;329:539–541)

Though maternal and fetal deaths due to preeclampsia and other hypertensive disorders of pregnancy have decreased in recent years, the incidence of preeclampsia has risen. Current clinical practice for preventing preeclampsia includes initiating a low-dose aspirin treatment at the end of the first trimester of pregnancy; it has been shown to largely mitigate the effects of preeclampsia and reduce incidence. One recent study by Mendoza et al examined the effect of discontinuation of aspirin treatment between 24 and 28 weeks of gestation and found discontinuation is non-inferior to continuation of treatment to 36 weeks. This study had some important findings and implications, but is hard to generalize to the United States, as there are some fundamental differences in the aspirin treatment regimen; the dosage in the United States is 81 mg rather than 150 mg, and there is no recommendation to stop treatment at 36 weeks of gestation. Diagnostically, the United States also does not use molecular biomarkers (the sFlt-1:PlGF ratio) but rather clinical factors to determine risk of preeclampsia. Implementing the methods proposed in this recent study would be a major overhaul of current clinical practice in the United States.
Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth
Authors: Tita A.T.N. , Carlo W.A. , McClure E.M. , Mwenechanya M. , Koso-Thomas E. M. ,   et al,   of the A-PLUS Trial Group
Published: November 2023

(N Engl J Med. 2023;388:1161–1170)

Sepsis and other maternal infections are responsible for 10% of maternal deaths. Sepsis is among the top 3 most common maternal deaths globally. Preeclampsia and hemorrhage are the 2 leading causes of maternal death above infection; however, the rates of preeclampsia and hemorrhage have remained stable over the years while the rates of infection and sepsis have increased. This study aimed to determine whether maternal and neonatal mortality and sepsis could be reduced using the Azithromycin Prevention in Labor Use Study (A-PLUS).
Nitrous Oxide: Primum Non Nocere
Authors: Seiler F.A.
Published: November 2023

(Anesth Analg. 2023;136:613–615)

The use of nitrous oxide (N2O) for labor analgesia is increasing across the world. N2O is being commonly used as an analgesic in Europe, Australia, New Zealand, Canada, the United Kingdom, Finland, and Sweden. Although its use is common in many areas N2O has not been proven effective and is harmful to the environment. The use of N2O for labor analgesia has increased in hundreds of health care facilities across the United States since 2012.
Randomized Assessment of the Optimal Time Interval Between Programmed Intermittent Epidural Boluses When Combined With the Dural Puncture Epidural Technique for Labor Analgesia
Authors: Yao H.Q. , Huang J.Y. , Deng J.L. , Liu L. , Ai L. , Kee W.D.N. , Xiao F.
Published: November 2023

(Anesth Analg. 2023;136:532–539)

Neuraxial labor analgesia has advanced to include the dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques. This study aimed to test the appropriate interval for effective analgesia when the DPE technique is followed by the PIEB technique. This study used fixed volumes of PIEB at 10 mL of ropivacaine 0.1% and 0.5 mg/mL of sufentanil.
Direct Comparison of Peak Bulk Flow Rate of Programmable Intermittent Epidural Bolus and Manual Epidural Bolus Using a Closed-End Multiorifice Catheter: An Experimental Study
Authors: Younger J.D. , Faryami A. , Prasad M. , Viar D. , Menkara A. , Tang A. , Harris C.A.
Published: November 2023

(Anesth Analg. 2023;136:1198–1205)

Labor analgesia is a popular and widespread technique for pain management during labor and delivery, with many facilities adopting an administration method of programmable intermittent epidural bolus (PIEB). Previous research has studied both advantages and disadvantages of PIEB, with a consensus that advantages outweigh disadvantages. Many institutions also give access to a manual epidural bolus for breakthrough pain and/or for underperforming epidural analgesia, and studies have shown that this combination tends to lead to greater patient satisfaction, greater sensory blockade and improved pain control. Though studies have analyzed the effects of these methods, knowledge is lacking for the comparison of flow rate between PIEB and manual bolus. Understanding any differences could be beneficial to current understanding of mechanisms of pain management during labor and delivery.
General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry
Authors: Seymour L.M. , Fernandes N.L. , Dyer R.A. , Smit M.I. , van Dyk D. , Hofmeyr R.
Published: November 2023

(Anesth Analg. 2023;136:992–998)

In Africa, maternal morality following cesarean delivery is 50× more likely compared to morality rates in high-income countries, and spinal anesthesia (SA) is the preferred anesthetic method during cesarean delivery. For parturient patients with hypertensive disorders (ie, preeclampsia, eclampsia, or gestational hypertension), there is an increased risk for adverse outcomes, including spinal epidural hematoma following SA, so thrombocytopenia should be excluded before neuraxial blockade. An accurate platelet count is necessary before SA in emergent situations of fetal distress, which can be complicated when laboratory services are unavailable or off-site. The primary aim of this study was to determine which patients received general anesthesia (GA) when the presence of thrombocytopenia was known versus suspected. The secondary aim was perioperative platelet counts of patients with suspected thrombocytopenia to determine how often GA may have been avoided in favor of SA if platelet count was known.
A Newborn Girl With Hypoglycemia
Authors: Sen S. , Westra S.J. , Matute J.D. , Sherwood J.S. , High F.A. , Kwan M.C.
Published: November 2023

(N Engl J Med. 2022;387:1218–1226)

A newborn female patient was admitted to the neonatal intensive care unit (ICU) due to hypoglycemia.
Trends in NP and RN enrollment, graduation, and practice
Authors: Fitzgerald Margaret
Published: November 2023

The employment outlook for NPs is expected to continue its growth trend in the coming years. This article summarizes graduation and employment trends for nursing students and provides a synopsis of data from the Bureau of Labor Statistics about the growing demand for NPs and nurses. A brief overview of the history of recent workforce trends is also provided.
Five-Year Follow-Up of a Slowly Resorbable Biosynthetic P4HB Mesh (Phasix) in VHWG Grade 3 Incisional Hernia Repair
Authors: Van den Dop L. M. , Van Rooijen M. M. J. , Tollens T. , Jørgensen L. N. , De Vries-Reilingh T. S. , Piessen G. , Köckerling F. , Miserez M. , Dean M. , Berrevoet F. , Dousset B. , Van Westreenen H. L. , Gossetti F. , Tetteroo G. W. M. , Koch A. , Boomsma M. F. , Lange J. F. , Jeekel J.
Published: November 2023

Objective:

To assess the 5-year recurrence rate of incisional hernia repair in Ventral Hernia Working Group (VHWG) 3 hernia with a slowly resorbable mesh.

Summary Background Data:

Incisional hernia recurs frequently after initial repair. In potentially contaminated hernia, recurrences rise to 40%. Recently, the biosynthetic Phasix mesh has been developed that is resorbed in 12–18 months. Resorbable meshes might be a solution for incisional hernia repair to decrease short- and long-term (mesh) complications. However, long-term outcomes after resorption are scarce.

Methods:

Patients with VHWG grade 3 incisional midline hernia, who participated in the Phasix trial (Clinilcaltrials.gov: NCT02720042) were included by means of physical examination and computed tomography (CT). Primary outcome was hernia recurrence; secondary outcomes comprised of long-term mesh complications, reoperations, and abdominal wall pain [visual analogue score (VAS): 0–10].

Results:

In total, 61/84 (72.6%) patients were seen. Median follow-up time was 60.0 [interquartile range (IQR): 55–64] months. CT scan was made in 39 patients (68.4%). A recurrence rate of 15.9% (95% confidence interval: 6.9–24.8) was calculated after 5 years. Four new recurrences (6.6%) were found between 2 and 5 years. Two were asymptomatic. In total, 13/84 recurrences were found. No long-term mesh complications and/or interventions occurred. VAS scores were 0 (IQR: 0–2).

Conclusions:

Hernia repair with Phasix mesh in high-risk patients (VHWG 3, body mass index >28) demonstrated a recurrence rate of 15.9%, low pain scores, no mesh-related complications or reoperations for chronic pain between the 2- and 5-year follow-up. Four new recurrences occurred, 2 were asymptomatic. The poly-4-hydroxybutyrate mesh is a safe mesh for hernia repair in VHWG 3 patients, which avoids long-term mesh complications like pain and mesh infection.
Clinical and Radiographic Outcomes of Repair of Spondylolitic Spondylolisthesis Through Direct Pars Repair
Authors: Nagata Kosei , Dimar John R. , Smith Nolan Sledge , Puno Rolando M. , Glassman Steven D. , Djurasovic Mladen , Carreon Leah Y.
Published: November 2023

Study Design.

A retrospective chart review.

Objective.

The objective of this study is to investigate whether direct pars repair achieves bone healing and symptom relief in patients with spondylolitic spondylolisthesis.

Summary of Background Data.

While most cases of spondylolysis can be managed nonoperatively, a small percentage of patients require surgical intervention. The outcome of direct pars repair through a standard pedicle-screw with wiring technique is controversial in patients with lumbar spondylolitic spondylolisthesis.

Materials and Methods.

Medical records of patients who had undergone an open surgical pars repair were retrospectively reviewed. Standard demographic and surgical parameters were collected. All patients underwent a primary repair of the pars with an autograft or bone morphogenetic protein and instrumentation using a pedicle-screw with spinous process wiring. At 6 to 12 months after the surgery, patient’s pain symptoms, and postoperative computed tomography (CT) scans were independently reviewed to assess healing; which was graded as nonunion, partial union, or solid union.

Results.

There were 68 patients identified (33 male and 35 female), with an average age of 18.6 years. The mean estimated blood loss was 139 ml, and the mean length of hospital stay was 3.7 days. CT evaluation revealed 35 (52%) solid unions, 21 (31%) partial unions, and 12 (18%) nonunions requiring revisions. Thirty-four (50%) patients had no postoperative pain, 24 (35%) had mild pain, and 10 (15%) had persistent pain. The majority of patients with nonunions on CT had mild or persistent pain. Patients with no or mild pain tended to be younger than those with persistent pain (17.5 vs. 24.6 yr, P=0.163).

Conclusion.

This study demonstrated a partial or complete union rate of 82% and a postoperative persistent pain rate of 15%. These figures are comparable to the previous study, and this pedicle-screw with wiring technique can be worth trying before interbody fusion for spondylolytic spondylolisthesis to preserve anatomical lumbar motion.
Learning from patients
Authors: Nembhard Ingrid M. , Matta Sasmira , Shaller Dale , Lee Yuna S. H. , Grob Rachel , Schlesinger Mark
Published: November 2023

Background

Enthusiasm has grown about using patients’ narratives—stories about care experiences in patients’ own words—to advance organizations’ learning about the care that they deliver and how to improve it, but studies confirming association have not been published.

Purpose

We assessed whether primary care clinics that frequently share patients’ narratives with their staff have higher patient experience survey scores.

Approach

We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system. We used multilevel models to analyze survey data from patients about their experiences and from staff about exposure to useful narratives. We examined staff confidence in own knowledge as a moderator because confidence can influence use of new information sources.

Results

Frequency of sharing useful narratives with staff was associated with patient experience scores for all measures, conditional on staff confidence in own knowledge (p < .01). For operational measures (e.g., care coordination), increased sharing correlated with subsequently higher performance for more confident staff and lower performance or no difference for less confident staff, depending on measure. For relational measures (e.g., patient–provider communication), increased sharing correlated with higher scores for less confident staff and lower scores for more confident staff.

Conclusion

Sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge.

Practice Implications

Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organizations need to address how narrative feedback interacts with their staff’s confidence to realize higher experience scores across domains.
IATROGENIC MACULAR HOLE BECAUSE OF NEODYMIUM:YTTRIUM-ALUMINUM-GARNET-SELECTIVE LASER TRABECULOPLASTY LASER: CASE REPORT AND MANAGEMENT
Authors: Saleem Zara , Scoles Drew , Capone Antonio , Mahmoud Tamer H.
Published: November 2023

Purpose:

To report a case of a patient who suffered a full-thickness macular hole because of the accidental utilization of the selective laser trabeculoplasty mode of a dual mode laser.

Method:

Case report.

Results:

A 69-year-old woman experienced vision loss in her left eye immediately after undergoing attempted neodymium:yttrium-aluminum-garnet capsulotomy using a neodymium:yttrium-aluminum-garnet-selective laser trabeculoplasty laser system. Postinjury visual acuity was 20/25 and 20/800 in the right and left eyes, respectively. Ophthalmic examination and multimodal imaging revealed multiple macular hemorrhages and an irregular full-thickness macular hole. The patient required multiple surgeries including an autologous retinal transplant to achieve hole closure.

Conclusion:

Macular hole formation is a devastating consequence of inadvertent use of the selective laser trabeculoplasty mode when performing a neodymium:yttrium-aluminum-garnet laser capsulotomy with a neodymium:yttrium-aluminum-garnet-selective laser trabeculoplasty laser system. The authors emphasize the importance of ensuring the correct mode is selected for treatment to minimize the risk of retinal damage and permanent vision loss.
Effect of Silica in the Manufacture of Autologous Serum Eye Drops on Corneal Stromal Cells
Authors: Kim Sangyoon , Lee Ji Eun
Published: November 2023

Purpose:

The aim of this study was to evaluate the effect of serum clot activator, silica (SiO2), which may be used for making autologous serum eye drops, on human corneal fibroblasts.

Methods:

Cultured human corneal fibroblasts were exposed to 10%, 20%, and 30% silica for 1, 6, and 24 hours; methyl thiazolyl tetrazolium–based colorimetric assay was performed to determine the survival rate of fibroblasts and lactate dehydrogenase leakage assay to assess the cytotoxicity. The apoptotic response was evaluated by flow cytometric analysis and fluorescence staining with Annexin V and propidium iodide. Cellular morphology was evaluated by inverted phase-contrast light microscopy and electron microscopy.

Results:

The survival rate of human corneal fibroblasts and cytotoxicity showed both dose-dependent and time-dependent responses. The fluorescent micrograph and flow cytometry showed that as the exposure time increased, more cells underwent apoptosis or necrosis after treatment with 30% silica. When observed with light and electron microscopy, the number of corneal fibroblasts decreased and they were more detached from the dish. In addition, damaged corneal fibroblasts showed degenerative changes after exposure to 30% silica.

Conclusions:

Silica showed dose-dependent and time-dependent toxicity in human corneal fibroblasts. It is safer to keep the blood in tubes without a clot activator when manufacturing autologous serum eye drops to prevent possible corneal cytotoxicity.
Central Toxic Keratopathy After Collagen Cross-Linking: A Case Series
Authors: Dongre Pankaj , Bevara Akhil , Deshmukh Rashmi , Vaddavalli Pravin K.
Published: November 2023

Purpose:

The aim of this study was to report a case series of central toxic keratopathy (CTK) after collagen cross-linking (CXL) in keratoconus.

Methods:

This is a retrospective case series between January 2020 and September 2021. In this period, CXL was performed for progressive keratoconus in 964 eyes. CXL was performed using the epithelium-off accelerated protocol in all patients with a riboflavin soak time of 20 minutes and a UVA light exposure of 9 mW for 10 minutes using the Avedro KXL (Glaukos Inc, Aliso Viejo, CA) cross-linking system.

Results:

Twelve of 964 eyes (1.2%) developed CTK within 1 week of CXL. All patients presented with well-circumscribed, central disciform haze that was broader in the anterior stroma and narrower in the posterior stroma. We noted initial flattening in keratometry up to 3 months post-CXL in these patients, which gradually steepened over 12 months, but did not reach preoperative levels. We also noted exuberant flattening in pachymetry in the first 3 months, which improved over 12 months. There was a statistically significant decrease in pachymetry in patients who developed CTK at 3 and 12 months postoperatively when compared to patients who underwent CXL but did not develop CTK.

Conclusions:

Several reports of CTK postrefractive surgery have been described previously. However, the association of CXL in the development of CTK has not been described previously. Here, we elucidated the clinical features of CTK after CXL and how it differs from corneal scarring or haze that occurs post-CXL.
Robotic and laparoscopic right lobe living donation compared to the open approach: A multicenter study on 1194 donor hepatectomies
Authors: Troisi Roberto Ivan , Cho Hwui-Dong , Giglio Mariano Cesare , Rhu Jinsoo , Cho Jai Young , Sasaki Kazuanri , Han Dai Hoon , Kwon Choon Hyuck David , Han Ho-Seong , Chen Po-Da , Wu Yao-Ming , Choi Gi Hong , Choi Gyu Sung , Kim Ki-Hun
Published: November 2023

Due to the success of minimally invasive liver surgery, laparoscopic and robotic minimally invasive donor hepatectomies (MIDH) are increasingly performed worldwide. We conducted a retrospective, multicentre, propensity score–matched analysis on right lobe MIDH by comparing the robotic, laparoscopic, and open approaches to assess the feasibility, safety, and early outcomes of MIDHs. From January 2016 until December 2020, 1194 donors underwent a right donor hepatectomy performed with a robotic (n = 92), laparoscopic (n = 306), and open approach (n = 796) at 6 high-volume centers. Donor and recipients were matched for different variables using propensity score matching (1:1:2). Donor outcomes were recorded, and postoperative pain was measured through a visual analog scale. Recipients’ outcomes were also analyzed. Ninety-two donors undergoing robotic surgery were matched and compared to 92 and 184 donors undergoing laparoscopic and open surgery, respectively. Conversions to open surgery occurred during 1 (1.1%) robotic and 2 (2.2%) laparoscopic procedures. Robotic procedures had a longer operative time (493 ± 96 min) compared to laparoscopic and open procedures (347 ± 120 and 358 ± 95 min; p < 0.001) but were associated with reduced donor blood losses (p < 0.001). No differences were observed in overall and major complications (≥ IIIa). Robotic hepatectomy donors had significantly less pain compared to the 2 other groups (p < 0.001). Fifty recipients of robotic-procured grafts were matched to 50 and 100 recipients of laparoscopic and open surgery procured grafts, respectively. No differences were observed in terms of postoperative complications, and recipients’ survival was similar (p=0.455). In very few high-volume centers, robotic right lobe procurement has shown to be a safe procedure. Despite an increased operative and the first warm ischemia times, this approach is associated with reduced intraoperative blood losses and pain compared to the laparoscopic and open approaches. Further data are needed to confirm it as a valuable option for the laparoscopic approach in MIDH.
Systematic Review of Intracochlear Measurements and Effect on Postoperative Auditory Outcomes after Cochlear Implant Surgery
Authors: Hasan Zubair , Key Seraphina , Lee Michael , Da Cruz Melville
Published: November 2023

Objective

Quality and adequacy of the electrode neuron interface (ENI) is postulated to be a determining factor in affecting auditory outcomes after cochlear implantation. This study aims to review radiological parameters affecting ENI, including angular insertion (AngI), wrapping factor (WF), scalar translocation (ScaT), and electrode–modiolar distance (EMD) and their effect on auditory outcomes.

Databases Reviewed

PubMed, MEDLINE, Embase, Scopus, OpenGrey, and Google Scholar from inception to 01 September 2022.

Methods

Inclusion criteria were (i) all humans with any cochlear implant (CI); (ii) postoperative cross-sectional imaging with electrode position factors of AngI, ScaT, EMD, and/or WF; and (iii) associated auditory outcomes. Search was restricted to English-language literature. Two independent reviewers performed title and abstract screening, data extraction, and ROBINS-I risk of bias assessment. Formal statistical analysis not performed due to data heterogeneity. PROSPERO (CRD42022359198).

Results

Thirty-one studies (n = 2,887 patients, 3,091 electrodes) underwent qualitative synthesis. Higher AngI (n = 1921 patients) demonstrated positive correlation in 11 studies, no correlation in eight studies, and negative correlation in four studies. ScaT (n = 2,115 patients) demonstrated negative correlation in 12 studies, none in six studies, and one unclear correlation. Larger EMD (n = 240 patients) showed negative correlation in two studies, no correlation in one, and unclear correlation in one study. Smaller WF (n = 369 patients) demonstrated no correlation in three studies and positive correlation in one study.

Conclusions

Our study finds variable reported relationship between AngI and auditory outcomes. CI electrodes with a ScaT or larger EMD are more likely to exhibit poorer outcomes, and WF does not correlate with outcomes.
Facial-onset sensory and motor neuronopathy with myasthenia gravis: A case report
Authors: Pan Chengyu , Yang Xiangrong , Tai Zhenzhen , Zhou Zhiwei , Hao Renfang , Wang Jin , Liang Tao
Published: November 2023

Rationale:

Facial-onset sensory and motor neuronopathy (FOSMN) is a greatly rare disease, so far, autopsy evidence that is associated with neurodegenerative. Myasthenia gravis (MG) is an antibody-mediated and complement-involved acquired autoimmune disorder of the post-synaptic neuromuscular junction. There have been few reports about if there is related between the 2. In this study, we present the case of a man who was diagnosed as FOSMN with MG in continuity.

Patient concerns:

The patient chief complaints were right-side facial numbness and right-eyelid incomplete closure, followed by slurred speech and dysphagia, and the symptoms gradually progressed. The patient serum was positive for anti-AchR and anti-Titin antibodies.

Diagnoses:

The patient was diagnosed FOSMN with MG.

Interventions:

The patient symptoms were relieved after pyridostigmine bromide and prednisolone treatment.

Outcomes:

Symptoms have improved.

Lessons:

Facial-onset sensory and motor neuronopathy and MG have disparate clinical features. Therefore, we reported a rare case in which the 2 conditions concurrently existed. Immune dysfunction might be the pathogenesis of this association, while there is no definite evidence to support it, further studies are needed.
A neonatal case report of branchiooculofacial syndrome caused by a novel mutation in the TFAP2A gene and literature review
Authors: Luo Fangmei , Lu Meiling , Zhao Lu , Zhou Ping
Published: November 2023

Rationale:

Branchiooculofacial syndrome (BOFS) is a rare autosomal dominant disorder with a diverse clinical phenotype. To summarise the clinical characteristics and genetic variations of neonatal-onset BOFS through a case study and literature review.

Patient concerns:

A preterm neonate with a very low birth weight, born at a gestational age of 29+3 weeks, exhibited cosmetic abnormalities at a postmenstrual age of 34+6 weeks, including microcleft lip, high arched palate, curved upper lip, low ear position, and ocular hypertelorism. Hence, a genetic test on peripheral blood was carried out.

Diagnoses:

The genetic testing showed a heterozygous variant of c.724G > A (p.Glu242Lys) in the exon 4 region of the TFAP2A (transcription factor AP-2-α) gene in the short arm of chromosome 6. BOFS was confirmed based on clinical appearance and the genetic result.

Interventions:

The patient underwent solely cleft lip repair at the age of 6 months with no further intervention.

Outcomes:

The infant shows normal growth and development at 1 year of age and subsequent follow-up.

Lessons:

The characteristic facial features, branchial skin defects, and ocular anomalies are the main clinical manifestations of BOFS with neonatal onset, but the diverse clinical phenotype and variable genetic variants pose certain challenges for clinical diagnosis.
Evidence quality assessment of sodium tanshinone IIA sulfonate injection intervention coronary heart disease angina pectoris: An overview of systematic reviews and meta-analyses
Authors: Peng Lufeng , Fan Maoxia , Li Junhai , Chen Wenqiang
Published: November 2023

Background:

Sodium tanshinone IIA sulfonate injection (STS) is widely used in the clinical treatment of coronary heart disease angina pectoris (CHDAP). This article systematically summarizes and evaluates the available evidence for STS in the treatment of AP, and assess its quality.

Methods:

Two researchers searched and extracted 8 databases for systematic reviews (SRs)/meta-analyses (MAs), and independently assessed the methodological quality, risk of bias, reporting quality, and quality of evidence of SRs/MAs included in randomized controlled trials (RCTs). Tools used included the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the risk of bias in systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results:

This overview includes 11 SRs/MAs that use quantitative calculations to comprehensively evaluate various efficacies of STS in AP intervention. The methodological quality, reporting quality, risk of bias, and quality of evidence for outcome measures of SRs/MAs were all unsatisfactory. All SRs/MAs are of low quality according to the results of the AMSTAR-2 assessment, and only a small number of SRs/MAs were assessed as low risk of bias based on the results of the ROBIS assessment, and none of the SRs/MAs has been fully reported on the checklist. According to GRADE system, 33 outcomes were extracted from the included SRs/MAs for evaluation, of which 12 were rated as moderate-quality evidence, 7 as low-quality evidence, and 14 as very low-quality evidence. Limitations included the lack of essential items such as protocol registration, screening of duplicate studies, provision of a list of excluded studies and assessment of publication bias.

Conclusion:

Tanshinone IIA Sulfonate Sodium Injection may be an effective and safe treatment method. However, further standardized, comprehensive SRs/MAs and RCTs are needed to provide evidence-based medical support.
The epidemiology of food allergy in primary care clinic: A cross-sectional study
Authors: Al Hasan Dalal , Al Hasan Sara
Published: November 2023

Food allergy (FA) is an increasing global public health concern. Little is known about FA counsel in primary care clinics. The objective of this study is to describe the characteristics of FA in primary care clinics. It also aims to report the national primary care physicians’ current knowledge and practices. An electronic cross-sectional questionnaire was distributed to primary care physicians working at the Ministry of Health primary care clinics, across Kuwait’s’ 6 health districts, between May and June 2023. The questionnaire was made of 3 sections: participants’ demographic, FA counsel characteristics, participants’ knowledge and practices during FA counsel, and 37 variable tools. Eight-seven percent of primary care physicians counseled a patient with FA within the last 12 months. Most FA patients were children and infants. Approximately 2 out of 10 primary physicians counseled > 1 FA case/week. Prevalence of clinical presentation was: angioedema (23%), many skin hives (21%), few skin hives (19%), and mouth itch (9.4%). Prevalence of allergens was; peanuts (46%), shellfish (37%), eggs (36%), and tree nuts (36%), respectively. The mean of primary care physicians’ correct answers about FA was 58% and only 26% of primary care physicians acquired a sufficient amount of knowledge about FA, scoring above 67%. Their Knowledge scores about FA: clinical presentation 7 ± 1.6, diagnostic tests 2 ± 1, treatment 2.6 ± 1, and prevention 3 ± 1. In practice, correct treatment was offered by 30% of physicians, and 55% made the right referrals 86% are longing for training about FA. FA is a common counsel in primary care clinics. The most common FA presentation is a severe allergic reaction in the pediatric population. The current primary care physicians have insufficient knowledge about counseling FA and long for further training. Collectively, protocols and training for FA counseling should be launched in primary care.
Sucking lollipop after awakening from sevoflurane anesthesia reduces the degree of emergence agitation in children undergoing ambulatory surgery: A prospective randomized controlled trial
Authors: Mo Xiaofei , Zeng Jiequn , Wu Xiaoying , Huang Fa , Zhang Kunling
Published: November 2023

Background:

Emergence agitation (EA) is a common complication in pediatric anesthesia, especially in preschool children maintained by sevoflurane, with incidence ranging up to 80%. The purpose of the study was to determine whether sucking lollipop after awakening from sevoflurane anesthesia reduced the degree of EA in children undergoing ambulatory surgery.

Methods:

In this prospective study, 40 children aged 2 to 6 years scheduled for ambulatory surgery with sevoflurane were enrolled. They were randomly allocated to 1 of 2 groups after evaluating baseline EA levels using the pediatric anesthesia emergence delirium (PAED) scale immediately after awakening from general anesthesia: group L (sucking lollipop) or group C (control group, without sucking lollipop). The primary outcome was the overall PAED score after intervention. Pain score, parental satisfaction, the incidence of propofol rescue and negative postoperative behavioral changes (NPOBCs) were assessed.

Results:

The overall PAED score after intervention was significantly lower in Group L compared with Group C, with an estimated difference of −1.857 (95% CI, −2.884 to −0.831; P < .001) using generalized estimating equations. However, no significant intergroup differences were observed in the pain score, parental satisfaction, the incidence of propofol rescue and NPOBCs.

Conclusions:

Sucking lollipop after awakening from sevoflurane anesthesia reduced the degree EA in children undergoing ambulatory surgery.
Effects of insomnia on symptomatic dry eye during COVID-19 in China: An online survey
Authors: Qin Guanghao , Luan Xiaoying , Chen Jiayan , Li Liangzhe , He Wei , Eric Pazo Emmanuel , He Xingru , Yu Sile
Published: November 2023

Sleep is an essential determinant of health and quality of life. This study aimed to evaluate sleep disorders and symptomatic dry eye (DE) occurrence. This study was a cross-sectional survey of 1393 participants in China. The insomnia severity index (ISI) Questionnaire was used to evaluate sleep quality, and the ocular surface disease index (OSDI) questionnaire was used to assess DE symptoms. Subjects were divided into 2 groups based on subjects with and without symptomatic DE. The patients who had DE (10.48 ± 7.27) had substantially lower ISI scores compared to those without DE (3.57 ± 5.10) (P = .003). Furthermore, each ISI item and total ISI score was significantly correlated with OSDI dry eye severity and total OSDI dry eye score. Higher prevalence of insomnia was found in participants with symptomatic DE, and insomnia correlated significantly with DE symptoms. The present results suggest that clinicians and healthcare workers need to remember that DE and insomnia are highly co-existing health issues.
Potential infection foci in the oral cavity and their impact on the formation of central nervous system abscesses: A literature review
Authors: Abed Kamil , Paciorek Marcin , Bursa Dominik
Published: November 2023

Despite advancements in preventive, diagnostic, and therapeutic activities in medicine, inflammatory processes of the central nervous system remain a significant problem, posing a serious threat to life and health. Purulent central nervous system infections are unique, including abscesses of the brain and spine, which are severe infections occurring in 0.4% to 0.9% of 1000 patients worldwide. Central nervous system abscesses have varying etiology. For example, organized, encapsulated abscesses of the brain are a unique group of inflammatory processes in the central nervous system caused by inflammation around the teeth in 3% to 10% of cases. Sometimes, the condition of patients with brain abscesses is severe and life-threatening. Therefore, detecting and eliminating all causes early, including those potentially resulting from odontogenic infections, is important; accurate and early diagnosis enables appropriate treatment. This paper presents a review of the information available in the literature on brain abscesses and their relationship with odontogenic foci of infection in the oral cavity.
Revolutionizing stroke care in Africa: A mini review of the transformative potential of mobile stroke units
Authors: Olatunji Gbolahan , Kokori Emmanuel , Isarinade Timilehin , Yusuf Ismail , Udojike Chidinma I. , Abimbola Oluwaseun , Owolabi Samuel , Abdulbasit Muili Opeyemi , Aderinto Nicholas
Published: November 2023

Stroke is a major health concern worldwide, and its impact is particularly pronounced across Africa. This paper delves into the challenges faced in African stroke care and explores the significant potential benefits of mobile stroke units (MSUs) in mitigating these issues. Key challenges include the limited healthcare infrastructure, funding constraints, difficulties reaching remote and rural areas, and shortages of qualified healthcare professionals, especially neurologists and stroke specialists. To address these challenges, recommendations are provided, emphasizing the importance of infrastructure development, sustainable funding mechanisms, solutions for rural accessibility, and healthcare workforce development through training programs and incentives. Additionally, the paper discusses prospects for MSUs in Africa, highlighting the potential for technology advancements to yield more cost-effective and compact MSU models. The integration of telemedicine capabilities within MSUs is examined to enhance communication with specialist physicians at remote hospitals, ultimately improving stroke care outcomes. Furthermore, data collection on MSU outcomes and their impact on stroke care is emphasized to inform evidence-based policies and enhance MSU operations. Collaboration and partnerships between governments, healthcare organizations, and international stakeholders are critical for facilitating MSU expansion. These partnerships can provide essential funding, expertise, and support for the implementation and sustainable operation of MSUs in Africa.