bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing Music Therapy in Maternity Care in Ireland: A Qualitative Study
Authors: Cheung Pui Sze , McCaffrey Triona , Tighe Sylvia Murphy , Lowther Timothy , Mohamad Mas Mahady
Published: September 2024

Music therapy can be a form of preventive or early intervention. It strengthens and utilizes women’s own resources to build resilience, aids relaxation, reduces symptoms of anxiety and depression, promotes parent–infant attachment, and adapts to physical and psychological challenges during the perinatal period. The inclusion of music therapy in Irish maternity services has the potential to improve the quality of healthcare delivery provided to parents and infants. Recent studies demonstrate that the prospect of music therapy is welcomed by parents and perinatal healthcare professionals in Ireland, but such services are yet to be formally embedded in maternity care. Building on a cross-sectional survey, this qualitative study employed 6 semi-structured interviews with women and perinatal healthcare professionals in Ireland to understand their perspectives on developing music therapy in Irish maternity care services. Four themes were identified from the thematic analysis of these interviews: (1) music has multiple functions during the perinatal period; (2) music programs contribute to holistic perspectives and approachability in perinatal care; (3) music therapy provides specialist support; and (4) further development of music therapy services is challenging. The findings offer important insights and practical considerations on the key components of the music therapy programs and strategies in developing music therapy in Irish maternity settings. This information can directly inform music therapy researchers and practitioners in designing music therapy programs and developing relevant services in collaboration with maternity care professionals and policymakers.
Retained bullets: to remove or not to remove? Lessons from two clinical scenarios with intracardiac bullet embolization
Authors: Hinton Jared B , Landwehr Hunter J , Loudon Andrew M , Moorman Matthew L
Published: September 2024

Firearm-related injuries in the USA are increasing, with over 105,000 cases annually. Gunshot wounds (GSWs), especially those involving retained bullets, present complex challenges due to bullet trajectories and embolization risks. This study reviews two cases of bullet emboli, focusing on bullet localization strategies and timing of removal. Imaging techniques such as chest X-ray, CT scan, intraoperative fluoroscopy, and transesophageal echocardiogram were employed for localization. In Case 1, a stable patient with a left-back GSW had a bullet embolism from the inferior vena cava to the right ventricle, necessitating prompt removal. In Case 2, an unstable patient with thoracoabdominal GSWs experienced a delayed embolism to the aortic root, requiring multiple surgeries. Effective management of retained bullets involves diverse imaging and timely surgical intervention, especially for stable patients, emphasizing individualized and proactive strategies to enhance outcomes in bullet embolization cases.
Artificial Intelligence in the U.S. Military Health System: Forging a New Frontier for Clinical Care and Efficiency
Authors: Adirim Terry , Madsen Cathaleen
Published: September 2024

The Military Health System (MHS) has historically been at the forefront of innovation in medicine and science, but it has also historically struggled to implement battlefield innovations or civilian technologies for wider domestic use. Artificial intelligence (AI) has emerged as a transformative force in health care with civilian health systems and institutions at the forefront of these innovations. While these tools have the potential to support resolution of military health’s most pressing issues, the MHS is behind its civilian counterparts in advancing AI. Adoption of AI could benefit the MHS in such areas as service member and beneficiary access to care; more precise allocation of medical personnel and resources; improved operations of military treatment facilities; early detection of emerging threats to health; and force multiplication of existing telehealth capabilities. This evolving and highly visible technology also presents challenges in the military context above those in the civilian context, such as additional levels of privacy and security, integration with purpose-built secure systems, and additional regulatory obligations. To address these, the MHS should engage in three lines of effort to advance AI: establishing governance, education and training of medical personnel, and engaging in research, development, testing, and piloting of AI applications. This will require dedicated personnel and resources for a substantial initial outlay to be recouped later through more effective administration and care. By leveraging lessons learned from civilian systems, the MHS can design, adopt, and implement AI solutions to improve care for service members in both domestic and operational contexts, and for their beneficiaries.
Evaluation of a Novel Needle Decompression Device Against Standard of Care: A Cadaveric Model
Authors: Myers John C , Achay Jennifer , Limon David , Gerhardus Christian , Eastridge Brian , Gelfond Jonathan , Willis Ross , Nicholson Susannah , Bynum Jim
Published: September 2024

Introduction

Pneumothorax (PTX) incidence in patients arriving to a trauma center can be as high as 20%. The severity of PTX can range from insignificant to life-threatening. Five percent of combat casualties sustaining thoracic trauma have tension PTX (tPTX) at the time of death. Rapid diagnosis and decompression, traditionally with a needle decompression in the prehospital setting, is essential. However, high iatrogenic injury rates reveal a need for a device with the potential to decrease injury rate without compromising decompression success. The Donaldson Decompression Needle (DDN) is a 10-gauge × 3.25 inch needle with a locking mechanism designed to prevent over-insertion. During insertion, a spring-loaded blunt tip retracts, releasing the lock. After penetration of the parietal pleura, the blunt tip projects forward, which in turn locks the device in place on the chest. The device also contains an integrated 1-way valve (OWV) to prevent causing iatrogenic PTX, if placed into a healthy lung cavity.

Materials and Methods

We compared the DDN against a standard-of-care (SOC) needle (E-ARS 10 gauge × 3.25”) in a cadaveric randomized crossover design study. Tension pneumothorax was created by inserting a needle adjacent to the sternum and insufflating to 15 mmHg. Data collected included participant demographics/experience, cadaver measurements, and procedure data such as intrathoracic pressures and decompression time. Participants also completed a postprocedure survey. A secondary objective was evaluation of decompression rate with the OWV on vs. off.

Results

Twenty participants were enrolled in the study. Five participants required exclusion. While there were no differences in set-up times for the 2 procedures (DDN vs. SOC, 33 seconds vs. 28 seconds, P = .63), the decompression times were significantly different between the 2 groups (DDN vs. SOC, 2:06 vs. 1:06, P = .019). Evaluation of the secondary outcome resulted in 18 repetitions. The average decompression time for the OWV on group (n = 9) vs. OWV off group (n = 9) was 44 seconds vs. 10 seconds (P=<.05).

Conclusions

Despite the similar length and gauge of the DDN compared to the standard of care (SOC), the success rate of thoracic decompression was lower for the DDN when compared to the SOC (46% vs. 87%, P = .077) although statistical noninferiority was not established. Additionally, intradevice comparisons indicated decompression with the OWV on significantly prolonged decompression time when compared to when it was removed. It could be appropriate to consider removing the OWV after placement to decrease the decompression time, followed by reattachment for transport. Further research into the ability of the DDN to decrease iatrogenic injury will follow validation of decompression capabilities.
The Potential Utility of Retinal Biomarkers to Index Central Nervous System Effects of Repetitive Blast Exposure in Military Personnel
Authors: Silverstein Steven M
Published: September 2024

Military personnel exposed to blasts receive repeated subconcussive head impacts. Although these events typically do not cause immediate symptoms and do not lead to medical evaluation, the cumulative effects of subconcussive impacts can be significant and can include postconcussive symptoms, changes in brain structure and function, long-term cognitive dysfunction, depression, and chronic traumatic encephalopathy. Retinal measures such as thickness of retinal neural layers, density of retinal microvasculature, and strength of retinal neuronal firing are associated with cognitive function and brain structure and function in healthy populations and in neurodegenerative disease cohorts, and changes over time in retinal indices predict cognitive decline and brain atrophy in longitudinal studies in a range of medical populations. This commentary highlights the potential benefits of using retinal biomarkers in the routine screening and monitoring of brain health in warfighters and veterans. Retinal measures can be rapidly acquired (often in a matter of seconds) using methods that are inexpensive and noninvasive, and they can be collected with movable and often portable equipment that uses automated scoring routines that can be used for prediction and decision-making at the individual level. To date, however, retinal biomarkers have not been included in studies of blast overpressure exposures in military personnel. Despite this, preclinical and human evidence suggests that they could be among the most effective methods for tracking central nervous system damage in people exposed to repeated blasts. Retinal biomarkers could also contribute to brief test batteries to determine who is most at risk for long-term negative effects of future exposures. In addition, the sensitivity of retinal indices to blast exposure and mild traumatic brain injury suggests that they should be incorporated into research on strategies to minimize or prevent blast-related short- and long-term central nervous system changes in blast-exposed military personnel.
Investigating the impact of COVID-19 lockdowns on fragility fracture risk and bone mineral density in a large observational cohort: a cross-sectional study
Authors: Amin Hamzah , Khan Muhammed Aqib , Bukhari Marwan
Published: September 2024

Objectives

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2 or COVID-19) led to lockdowns predisposing people to sedentary lifestyles and unhealthy behaviours which may have affected bone mineral density (BMD) and fragility fracture risk. However, limited studies describe such an association. We aimed to investigate how COVID-19 lockdowns has affected BMD and fragility fractures in a large cohort.

Methods

Patients were referred to our DXA scanner from 2004 to 2024 and were subsequently categorized as pre- or post-March 23, 2020 (pre- and post-COVID-19) to allow analysis between the groups. Demographic, BMD and compositional data were compared between the two populations. A multivariate logistic regression modelled the odds of reporting a fracture including hip and non-hip fracture. A multiple linear regression was used to model how the lockdown has affected bone density. All analyses were adjusted for confounders.

Results

Of 43 799 referrals, 6564 were post-COVID-19. Post-COVID-19 patients had higher non-hip fracture rates (42.0% vs 39.8%), were 3 kg heavier, and had lower left femoral T-scores. Patients referred post-COVID-19 had a statistically significant reduction of −0.23 to their T-score after adjusting for confounders as well as increased risk of getting diagnosed with osteoporosis [odds ratio (OR) 1.49, 95% CI 1.40–1.59]. Patients referred after the pandemic had a reduced odds of any fracture (OR 0.83, 95% CI 0.77–0.88), hip (OR 0.74, 95% CI 0.62–0.88) and non-hip fracture (OR 0.78, 95% CI 0.73–0.83).

Conclusion

COVID-19 lockdowns may have negatively affected bone; however, this has not translated to an increased fracture risk in our study. Further research is needed with prospective cohorts to corroborate this risk.
Unraveling Morphological, Physiological, and Transcriptomic Alterations Underlying the Formation of Little Leaves in Phytoplasma-Infected Sweet Cherry Trees
Authors: Tan Yue , Xu Li , Zhu Min , Zhao Yan , Wei Hairong , Wei Wei
Published: September 2024

Phytoplasmas are minute phytopathogenic bacteria that induce excessive vegetative growth, known as witches’ broom (WB), in many infected plant species during the later stages of infection. The WB structure is characterized by densely clustered little (small) leaves, which are frequently accompanied by chlorosis (yellowing). The mechanisms behind the formation of little leaves within WB structures (LL-WB) are poorly understood. To address this gap, the LL-WB formation was extensively studied using sweet cherry virescence (SCV) phytoplasma-infected sweet cherry plants. Based on morphological examinations, signs of premature leaf senescence were observed in LL-WB samples, including reduced leaf size, chlorosis, and alterations in shape. Subsequent physiological analyses indicated decreased sucrose and glucose levels and changes in hormone concentrations in LL-WB samples. Additionally, the transcriptomic analysis revealed impaired ribosome biogenesis and DNA replication. As an essential process in protein production, the compromised ribosome biogenesis and the inhibited DNA replication led to cell cycle arrest, thus affecting leaf morphogenesis and further plant development. Moreover, the expression of marker genes involved in premature leaf senescence was significantly altered. These results indicate a complicated interplay between the development of leaves, premature leaf senescence, and pathogen-induced stress responses in SCV phytoplasma-infected sweet cherry trees. The results of this study provide insight into understanding the underlying molecular mechanisms driving the formation of little leaves and interactions between plants and pathogens. The findings might help control phytoplasma diseases in sweet cherry cultivation.
The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis
Authors: Lele Abhijit V. , Moreton Elizabeth O. , Mejia-Mantilla Jorge , Blacker Samuel N.
Published: September 2024

In this review article, we explore the implementation and outcomes of enhanced recovery after spine surgery (spine ERAS) across different World Bank country-income levels. A systematic literature search was conducted through PubMed, Embase, Scopus, and CINAHL databases for articles on the implementation of spine ERAS in both adult and pediatric populations. Study characteristics, ERAS elements, and outcomes were analyzed and meta-analyses were performed for length of stay (LOS) and cost outcomes. The number of spine ERAS studies from low-middle-income countries (LMICs) increased since 2017, when the first spine ERAS implementation study was published. LMICs were more likely than high-income countries (HICs) to conduct studies on patients aged ≥18 years (odds ratio [OR], 6.00; 95% CI, 1.58-42.80), with sample sizes 51 to 100 (OR, 4.50; 95% CI, 1.21-22.90), and randomized controlled trials (OR, 7.25; 95% CI, 1.77-53.50). Preoperative optimization was more frequently implemented in LMICs than in HICs (OR, 2.14; 95% CI, 1.06-4.41), and operation time was more often studied in LMICs (OR 3.78; 95% CI, 1.77-8.35). Implementation of spine ERAS resulted in reductions in LOS in both LMIC (−2.06; 95% CI, −2.47 to −1.64 d) and HIC (−0.99; 95% CI, −1.28 to −0.70 d) hospitals. However, spine ERAS implementation did result in a significant reduction in costs. This review highlights the global landscape of ERAS implementation in spine surgery, demonstrating its effectiveness in reducing LOS across diverse settings. Further research with standardized reporting of ERAS elements and outcomes is warranted to explore the impact of spine ERAS on cost-effectiveness and other patient-centered outcomes.
Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials*
Authors: McDougall Garrett G. , Flindall Holden , Forestell Ben , Lakhanpal Devan , Spence Jessica , Cordovani Daniel , Sharif Sameer , Rochwerg Bram
Published: September 2024

OBJECTIVES:

Given the uncertainty regarding the optimal approach to laryngoscopy for the intubation of critically ill adult patients, we conducted a systematic review and meta-analysis to compare video laryngoscopy (VL) vs. direct laryngoscopy (DL) for intubation in emergency department and ICU patients.

DATA SOURCES:

We searched MEDLINE, PubMed, Embase, Cochrane Library, and unpublished sources, from inception to February 27, 2024.

STUDY SELECTION:

We included randomized controlled trials (RCTs) of critically ill adult patients randomized to VL compared with DL for endotracheal intubation.

DATA EXTRACTION:

Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023469945).

DATA SYNTHESIS:

We included 20 RCTs (n = 4569 patients). Compared with DL, VL probably increases first pass success (FPS) (relative risk [RR], 1.13; 95% CI, 1.06–1.21; moderate certainty) and probably decreases esophageal intubations (RR, 0.47; 95% CI, 0.27–0.82; moderate certainty). VL may result in fewer aspiration events (RR, 0.74; 95% CI, 0.51–1.09; low certainty) and dental injuries (RR, 0.46; 95% CI, 0.19–1.11; low certainty) and may have no effect on mortality (RR, 0.97; 95% CI, 0.88–1.07; low certainty) compared with DL.

CONCLUSIONS:

In critically ill adult patients undergoing intubation, the use of VL, compared with DL, probably leads to higher rates of FPS and probably decreases esophageal intubations. VL may result in fewer dental injuries as well as aspiration events compared with DL with no effect on mortality.
Association Between Restricting Symptoms and Disability After Critical Illness Among Older Adults
Authors: Jain Snigdha , Han Ling , Gahbauer Evelyne A. , Leo-Summers Linda , Feder Shelli L. , Ferrante Lauren E. , Gill Thomas M.
Published: September 2024

OBJECTIVES:

Older adults who survive critical illness are at risk for increased disability, limiting their independence and quality of life. We sought to evaluate whether the occurrence of symptoms that restrict activity, that is, restricting symptoms, is associated with increased disability following an ICU hospitalization.

DESIGN:

Prospective longitudinal study of community-living adults 70 years old or older who were interviewed monthly between 1998 and 2018.

SETTING:

South Central Connecticut, United States.

PATIENTS:

Two hundred fifty-one ICU admissions from 202 participants who were discharged alive from the hospital.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Occurrence of 15 restricting symptoms (operationalized as number of symptoms and presence of ≥ 2 symptoms) and disability in activities of daily living, instrumental activities of daily living, and mobility was ascertained during monthly interviews throughout the study period. We constructed multivariable Poisson regression models to evaluate the association between post-ICU restricting symptoms and subsequent disability over the 6 months following ICU hospitalization, adjusting for known risk factors for post-ICU disability including pre-ICU disability, frailty, cognitive impairment, mechanical ventilation, and ICU length of stay. The mean age of participants was 83.5 years (sd, 5.6 yr); 57% were female. Over the 6 months following ICU hospitalization, each unit increase in the number of restricting symptoms was associated with a 5% increase in the number of disabilities (adjusted rate ratio, 1.05; 95% CI, 1.04–1.06). The presence of greater than or equal to 2 restricting symptoms was associated with a 29% greater number of disabilities over the 6 months following ICU hospitalization as compared with less than 2 symptoms (adjusted rate ratio, 1.29; 95% CI, 1.22–1.36).

CONCLUSIONS:

In this longitudinal cohort of community-living older adults, symptoms restricting activity were independently associated with increased disability after ICU hospitalization. These findings suggest that management of restricting symptoms may enhance functional recovery among older ICU survivors.
Steroid-refractory immune checkpoint inhibitor (ICI) hepatitis and ICI rechallenge: A systematic review and meta-analysis
Authors: Hwang Soo Young , Hsieh Pinghsin , Zhang Wei
Published: September 2024

Background:

In recent years, the use of immune checkpoint inhibitors (ICIs) has become a cornerstone in cancer treatment. However, this has also resulted in the emergence of immune-related adverse events, notably ICI hepatitis, posing a significant clinical challenge. While steroids are the primary treatment, there are increasing cases of steroid-refractory ICI hepatitis. Our objective is to investigate the management of ICI hepatitis and its response to steroid treatment.

Methods:

PubMed/MEDLINE, EMBASE, and CENTRAL databases were searched in July 2023 based on keywords including ICIs (anti–Programmed cell death protein 1/Programmed Death-Ligand 1, anti–CTLA–4, and anti-LAG3) and hepatitis.

Results:

A total of 4358 studies were screened, and 44 studies were included in this systematic review. One thousand eight hundred fifty-six patients with ICI hepatitis were included (grade 1-2: 31.7%, grade 3-4: 56.0%, and unknown: 12.3%) with 1184 patients who received corticosteroid treatment. The duration of treatment and dosage varied considerably across the studies. Mycophenolate mofetil was the predominant agent used in 68 out of 82 cases (82.9%), followed by infliximab and azathioprine. A summary estimate of the proportion of steroid-refractory hepatitis in a random effects model was 16% (95% CI: 11%–23%). An estimated 40% (95% CI: 30%–51%) of patients of all patients with ICI hepatitis were rechallenged with an ICI, and of those rechallenged, there was an estimated 22% (95% CI: 15%–30%) recurrence.

Conclusions:

Corticosteroids are the primary treatment for ICI hepatitis, with mycophenolate mofetil used as a secondary option for steroids-refractory cases. Current practices mostly rely on expert consensus, highlighting the need for further research to validate and optimize these treatments, particularly for steroid-resistant cases.
Prevalence of SARS-CoV-2 in Children Identified by Preprocedural Testing at 5 US Children’s Hospital Systems
Authors: Wang-Erickson Anna F. , Zhang Xueyan , Dauer Klancie , Zerr Danielle M. , Adler Amanda , Englund Janet A. , Lee Brian , Schuster Jennifer E. , Selvarangan Rangaraj , Rohlfs Chelsea , Staat Mary A. , Sahni Leila C. , Boom Julie A. , Balasubramani G. K. , Williams John V. , Michaels Marian G.
Published: September 2024

Background:

The burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic children was initially presumed to be high, which influenced hospital, school and childcare policies. Before vaccines were widely available, some hospitals implemented universal preprocedural SARS-CoV-2 polymerase chain reaction testing on asymptomatic patients. Understanding SARS-CoV-2 prevalence in asymptomatic children is needed to illuminate the diversity of viral characteristics and inform policies implemented during future pandemics.

Methods:

Data were extracted from patient records of outpatient children who were preprocedurally tested for SARS-CoV-2 from 5 US hospital systems between March 1, 2020, and February 28, 2021. Prevalence was determined from positive test results. Adjusted odds ratios (AORs) were calculated using mixed logistic regression with the site as a random effect.

Results:

This study analyzed 93,760 preprocedural SARS-CoV-2 test results from 74,382 patients and found 2693 infections (3.6%) from 2889 positive tests (3.1%). Site-specific prevalence varied across sites. Factors modestly associated with infection included being uninsured [AOR, 1.76 (95% confidence interval [CI], 1.45–2.13)], publicly insured [AOR, 1.17 (95% CI, 1.05–1.30)], Hispanic [AOR, 1.78 (95% CI, 1.59–1.99)], Black [AOR, 1.22 (95% CI, 1.06–1.39)], elementary school age [5–11 years; AOR, 1.15 (95% CI, 1.03–1.28)], or adolescent [12–17 years; AOR, 1.26 (95% CI, 1.13–1.41)].

Conclusions:

SARS-CoV-2 prevalence was low in outpatient children undergoing preprocedural testing, a population that was predominantly asymptomatic at the time of testing. This study contributes evidence that suggests that undetected infection in children likely did not play a predominant role in SARS-CoV-2 transmission during the early prevaccine pandemic period when the general population was naive to the virus.
Concomitant Rifampicin-Sensitive Pulmonary Tuberculosis With Pre-extremely Drug-resistant Neuro-Tuberculosis in Child With Steroid-Resistant Nephrotic Syndrome
Authors: Mehta Vaidehi , Ansari Ramsha , Shah Ira
Published: September 2024

Mixed tuberculosis occurs with multiple clonally distinct mycobacterium tuberculosis strains in an individual. We present a 12-year-old girl with steroid-resistant nephrotic syndrome and drug-sensitive pulmonary tuberculosis (Xpert MTB/Rif) and preextensively drug-resistant tuberculosis neuro-tuberculosis (Line Probe Assay). Mixed tuberculosis involving drug-susceptible and drug-resistant strains can hinder treatment. This case highlights the challenges in diagnosing mixed tuberculosis to ensure effective management.
Relationship between postablation fever and prognosis in initial hepatocellular carcinoma: a 15-year multicenter, retrospective cohort study
Authors: Cai Qian , Pang Chuan , Wang Zhen , Li Jianming , Dai Yuqing , Fan Fang-ying , Wang Zhong-qi , Hu Xin , Li Lijuan , Chen Xu-wei , Ji Ran , Mei Qian , Zhang Chao , Liang Ping , Yu Xiaoling , Liu Fang-yi , Cheng Zhigang , Yu Jie
Published: September 2024

Background:

Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear.

Materials and Methods:

This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and an adjusted Cox model. Survival analyses used the Kaplan–Meier method.

Results:

A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0–38.8°C for 1–2 days), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57–0.95; P=0.02) and ER (HR, 0.66; 95% CI: 0.54–0.81; P<0.001), however, PHF showed no differences in VER (HR, 0.99; 95% CI: 0.76–1.30; P=0.96) and ER (HR, 0.86; 95% CI: 0.69–1.07; P=0.17). With a median follow-up of 47 months (IQR: 26–79), the median DFS for TLF patients was 40 months, superior to afebrile (30 months, P=0.019) and PHF patients (33 months, P=0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P=0.02) and PHF patients (66.7%, P=0.03). No significant difference was found in DFS and OS between afebrile and PHF patients (P=0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation (P<0.001 vs. afebrile and P=0.01 vs. PHF).

Conclusion:

Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.
Management of velopharyngeal insufficiency by a new modification of sphincter pharyngoplasty technique in cleft palate patients, clinical and radiographical prospective study
Authors: Hamdy Jafar , Yacoub Hikmat
Published: September 2024

Background:

This study was designed to investigate the effectiveness and outcome of a new modification of the sphincter pharyngoplasty technique in the treatment of velopharyngeal insufficiency patients, with the determination of a specific dimension of velopharyngeal port and velum length of no hypernasality, snoring, and nasal regurgitation potential.

Materials and methods:

The study included 10 patients, who were suffering from consistent hypernasal speech after failure of conservative speech therapy. Clinical and radiographic measurements of the velopharyngeal port and velum length before and after surgery were done, with clinical patient follow-up to assess snoring and nasal regurgitation after surgery for 1, 6, and 12 months.

Results:

Before surgery, the mean clinical anteroposterior distance/velopharyngeal depth was 16.40±1.7 mm, and the mediolateral distance was 20.20±3.4 mm. After surgery, the mean anteroposterior distance decreased to 8±0.9 mm, and the mean mediolateral distance decreased to 12.60±2.06 mm. Both measurements showed statistically significant (P=0.0001). After 12 months postoperatively, the radiographic CT axial anteroposterior distance was 12.09±1.4 mm, and the mean mediolateral distance was 19.82±5.6 mm, compared to the mean CT anterioposterior before surgery 15.60±2 mm and mediolaterally 21.28±2.7 mm. The anteroposterior measurement showed a statistically significant (P=0.002), while the mediolateral measurement did not (P=0.3). The mean velum length before surgery was 25.80±1.5 mm and 27.03±0.6 mm after 12 months postoperatively. Snoring and nasal regurgitation occurrence were assessed at 1, 6, and 12 months postoperatively, with all reports being negative.

Conclusion:

Sphincter pharyngoplasty using posterior tonsillar pillars for treating VPI patients results in improved speech outcomes without snoring or nasal regurgitation.
Odontogenic Myxomas Harbor Recurrent Copy Number Alterations and a Distinct Methylation Signature
Authors: Kleijn Tony G. , Ameline Baptiste , Schreuder Willem H. , Kooistra Wierd , Doff Jan J. , Witjes Max , Pichardo Sarina E.C. , Lausová Tereza , Koppes Sjors A. , van den Hout Mari F.C.M. , van Engen-van Grunsven Ilse C.H. , Flucke Uta E. , de Lange Jan , Szuhai Karoly , Briaire-de Bruijn Inge H. , Savci-Heijink Dilara C. , Suurmeijer Albert J.H. , Bovée Judith V.M.G. , von Deimling Andreas , Baumhoer Daniel , Cleven Arjen H.G.
Published: September 2024

Odontogenic myxoma is a rare, benign, and locally aggressive tumor that develops in the tooth-bearing areas of the jaw. The molecular mechanisms underlying odontogenic myxomas are unknown and no diagnostic markers are available to date. The aim of this study was to analyze DNA methylation and copy number variations in odontogenic myxomas to identify new molecular signatures for diagnostic decision-making. We collected a cohort of 16 odontogenic myxomas from 2006 to 2021 located in the mandible (n = 10) and maxilla (n = 6) with available formalin-fixed paraffin-embedded or fresh frozen tumor tissue from a biopsy or resection material. Genome-wide DNA methylation and copy number variation data were generated from 12 odontogenic myxomas using the Illumina Infinium Methylation EPIC array, interrogating >850,000 CpG sites. Unsupervised clustering and dimensionality reduction (Uniform Manifold Approximation and Projection) revealed that odontogenic myxomas formed a distinct DNA methylation class. Copy number profiling showed recurrent whole-chromosome gains (trisomies) of chromosomes 5, 8, and 20 in all cases, and of chromosomes 10, 12, and 17 in all except one case. In conclusion, odontogenic myxomas harbor recurrent copy number patterns and a distinct DNA methylation profile, which can be used as an additional diagnostic tool in the appropriate clinical and radiologic context. Further research is needed to explain the genetic mechanisms caused by these alterations that drive these locally aggressive neoplasms.
Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in PICU: Single-Center Retrospective Study in North India, 2018–2021
Authors: Sachdev Anil , Kumar Anil , Mehra Bharat , Gupta Neeraj , Gupta Dhiren , Gupta Suresh , Chugh Parul
Published: September 2024

Objectives:

In this study, we have reviewed the association between esophageal pressure-guided positive end-expiratory pressure (PEEP) setting and oxygenation and lung mechanics with a conventional mechanical ventilation (MV) strategy in patient with moderate to severe pediatric acute respiratory distress syndrome (PARDS).

Design:

Retrospective cohort, 2018–2021.

Setting:

Tertiary PICU.

Patients:

Moderate to severe PARDS patients who required MV with PEEP of greater than or equal to 8 cm H2O.

Interventions:

Esophageal pressure (i.e., transpulmonary pressure [PTP]) guided MV vs. not.

Measurements and Main Results:

We identified 26 PARDS cases who were divided into those who had been managed with PTP-guided MV (PTP group) and those managed with conventional ventilation strategy (non-PTP). Oxygenation and lung mechanics were compared between groups at baseline (0 hr) and 24, 48, and 72 hours of MV. There were 13 patients in each group in the first 24 hours. At 48 and 72 hours, there were 11 in PTP group and 12 in non-PTP group. On comparing these groups, first, use of PTP monitoring was associated with higher median (interquartile range) mean airway pressure at 24 hours (18 hr [18–20 hr] vs. 15 hr [13–18 hr]; p = 0.01) and 48 hours (19 hr [17–19 hr] vs. 15 hr [13–17 hr]; p = 0.01). Second, use of PTP was associated with higher PEEP at 24, 48, and 72 hours (all p < 0.05). Third, use of PTP was associated with lower Fio
2 and greater Pao
2 to Fio
2 ratio at 72 hours. Last, there were 18 of 26 survivors, and we failed to identify an association between use of PTP monitoring and survival.

Conclusions:

In this cohort of moderate to severe PARDS cases undergoing MV with PEEP greater than or equal to 8 cm H2O, we have identified some favorable associations of oxygenation status when PTP-guided MV was used vs. not. Larger studies are required.
Integrating Emotional Health Assessments into Pediatric Care: Initial Learnings from an MOC Part 4 Activity
Authors: Lannon Carole M. , Schuler Christine L. , Thomas LaCrecia , Gehring Emily , Mann Keith J. , Leslie Laurel K.
Published: September 2024

Introduction:

Living with a chronic condition often impacts the emotional health of children. Pediatricians frequently feel unprepared to address these concerns. The American Board of Pediatrics Roadmap Project aims to support these clinicians. We describe the results from the initial cohort of pediatricians who completed the American Board of Pediatrics Maintenance of Certification (MOC) Roadmap Part 4 activity.

Methods:

The Roadmap MOC activity uses a standardized improvement template with accompanying resources to guide participants. Physicians self-assess their ability to provide emotional health support by completing a Roadmap Readiness Checklist and creating a personal project relevant to their practice. They collect data at three time points: baseline, midpoint, and completion for two measures (the Readiness Checklist and a participant-selected measure). Physicians also reflect on their experience.

Results:

Of the initial cohort of 29 physicians, 22 submitted three sequential checklist assessments. Scores increased for “developing a family resource list” (by 90%), “confidence to address emotional health” (79%), “having a family crisis plan” (78%), and “staff awareness” (34%). Twenty-four physicians who measured whether clinical encounters addressed emotional health documented an increase from 21% to 77%. Physician feedback was positive, for example, “This project has had a profound impact on our care of children.”

Conclusions:

This initial cohort of participants improved on the Readiness Checklist and emotional health assessment. Both generalist and subspecialty pediatricians found the activity useful and relevant, suggesting that this MOC Part 4 activity is a feasible resource for supporting physicians in addressing emotional health.
Effectiveness of bracing combined with exercise-based treatment of adolescent idiopathic scoliosis: Assessing the synergistic benefits: A systematic review
Authors: Aktan-Ilgaz Deniz , Sahiner Hande , Eraslan Leyla , Gursen Ceren , Guney-Deniz Hande
Published: September 2024

The purpose of this study was to evaluate evidence on the effectiveness of combined bracing and exercise on adolescent idiopathic scoliosis (AIS). From inception to April 28, 2022, PubMed and Web of Science searched for randomized clinical and nonrandomized prospective studies reporting Cobb angle (CA), angle of trunk rotation (ATR), quality of life (QoL), and pulmonary function (PF) in AIS patients treated with exercise and braces (10 years-skeletal maturity). Two authors analyzed and extracted data for this review. The PEDro scale was used to assess the risk of bias (RoB). Therapy protocols and basic data have been collected. Each CA, ATR, QoL, and PF study’s evidence and strength were also included. A total of 12 studies with 714 patients with AIS were included. Five studies used a control group with exercises and 7 with braces. The results showed that exercise-brace can decrease CA and ATR and increase QoL and PF with AIS; however, the strength of conclusion for all outcomes was moderate. In this review, 4 studies were categorized as low RoB, 3 as moderate RoB, and 5 as high RoB. Level of evidence analysis revealed that 12 studies were classified as level of evidence B. The current studies do not sufficiently support the effects of exercise and brace therapy on CA, ATR, QoL, and PF in patients with AIS.
Glucagon-Like Peptide-1 Agonists
Authors: Stanton Eloise W. , Manasyan Artur , Banerjee Rakhi , Hong Kurt , Koesters Emma , Daar David A.
Published: September 2024

Background

Glucagon-like peptide-1 (GLP-1) agonists, such as exenatide, liraglutide, dulaglutide, semaglutide, and tirzepatide, effectively manage type 2 diabetes by promoting insulin release, suppressing glucagon secretion, and enhancing glucose metabolism. They also aid weight reduction and cardiovascular health, potentially broadening their therapeutic scope. In plastic surgery, they hold promise for perioperative weight management and glycemic control, potentially impacting surgical outcomes.

Methods

A comprehensive review was conducted to assess GLP-1 agonists' utilization in plastic surgery. We analyzed relevant studies, meta-analyses, and trials to evaluate their benefits and limitations across surgical contexts, focusing on weight reduction, glycemic control, cardiovascular risk factors, and potential complications.

Results

Studies demonstrate GLP-1 agonists' versatility, spanning weight management, cardiovascular health, neurological disorders, and metabolic dysfunction-associated liver diseases. Comparative analyses highlight variations in glycemic control, weight loss, and cardiometabolic risk. Meta-analyses reveal significant reductions in hemoglobin A1C levels, especially with high-dose semaglutide (2 mg) and tirzepatide (15 mg). However, increased dosing may lead to gastrointestinal side effects and serious complications like pancreatitis and bowel obstruction. Notably, GLP-1 agonists' efficacy in weight reduction and glycemic control may impact perioperative management in plastic surgery, potentially expanding surgical candidacy for procedures like autologous flap-based breast reconstruction and influencing outcomes related to lymphedema. Concerns persist regarding venous thromboembolism and delayed gastric emptying, necessitating further investigation into bleeding and aspiration risk with anesthesia.

Conclusions

GLP-1 agonists offer advantages in perioperative weight management and glycemic control in plastic surgery patients. They may broaden surgical candidacy and mitigate lymphedema risk but require careful consideration of complications, particularly perioperative aspiration risk. Future research should focus on their specific impacts on surgical outcomes to optimize their integration into perioperative protocols effectively. Despite challenges, GLP-1 agonists promise to enhance surgical outcomes and patient care in plastic surgery.
Protein folding, protein dynamics and the topology of self-motions
Authors: Hayward Steven
Published: September 2024

It has long been recognized that segments of the protein main chain are like robotic manipulators and inverse kinematics methods from robotics have been applied to model loops to bridge gaps in protein comparative modelling. The complex internal motion of a redundant manipulator with fixed ends is called a self-motion and its character is determined by the relative position of its ends. Self-motions that are topologically equivalent (homotopic) occupy the same continous region of the configuration space. Topologically inequivalent (non-homotopic) regions are separated by co-regular surfaces and crossing a co-regular surface can result in a sudden dramatic change in the character of the self-motion. It is shown, using a five-residue type I β-turn, that these concepts apply to protein segments and that as the ends of the five-residue segment come closer together, a co-regular surface is crossed, and the structure is locked in to becoming either a type I or type I′ turn. It is also shown that the type II turn is topologically equivalent to the type I′ turn, not the type I turn. These results have implications for both native-state protein dynamics and protein folding.
The microbiome at the interface between environmental stress and animal health: an example from the most threatened vertebrate group
Authors: Eterovick Paula Cabral , Schmidt Robin , Sabino-Pinto Joana , Yang Chen , Künzel Sven , Ruthsatz Katharina
Published: September 2024

Nitrate pollution and global warming are ubiquitous stressors likely to interact and affect the health and survival of wildlife, particularly aquatic ectotherms. Animal health is largely influenced by its microbiome (commensal/symbiotic microorganisms), which responds to such stressors. We used a crossed experimental design including three nitrate levels and five temperature regimes to investigate their interactive and individual effects on an aquatic ectotherm, the European common frog. We associated health biomarkers in larvae with changes in gut bacteria diversity and composition. Larvae experienced higher stress levels and lower body condition under high temperatures and nitrate exposure. Developmental rate increased with temperature but decreased with nitrate pollution. Alterations in bacteria composition but not diversity are likely to correlate with the observed outcomes in larvae health. Leucine degradation decreased at higher temperatures corroborating accelerated development, nitrate degradation increased with nitrate level corroborating reduced body condition and an increase in lysine biosynthesis may have helped larvae deal with the combined effects of both stressors. These results reinforce the importance of associating traditional health biomarkers with underlying microbiome changes. Therefore, we urge studies to investigate the effects of environmental stressors on microbiome composition and consequences for host health in a world threatened by biodiversity loss.
The impact of agar depth on antimicrobial susceptibility testing by disc diffusion
Authors: Olaru Ioana D. , Schoeler Sarah , Schaumburg Frieder
Published: September 2024

Introduction. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) specifies the agar depth (4±0.5 mm) when performing antimicrobial susceptibility testing (AST). Since the infrastructure to produce standardized agar may be lacking in settings with limited resources, we wanted to examine to what extent variation in agar depth affects the inhibition zone diameters of quality control (QC) strains and AST of clinical isolates.

Methods. The inhibition zone diameters on Mueller–Hinton II agar with different depths (2–6 mm) were tested for various QC strain–antimicrobial agent combinations using Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 and Staphylococcus aureus ATCC 29213. The relationship between zone diameters at different agar depths and MICs was investigated for 35 clinical isolates (E. coli, Klebsiella pneumoniae, S. aureus and P. aeruginosa) from Sierra Leone using MICs as the reference.

Results. The inhibition zone diameters were within the acceptance ranges as defined by the EUCAST for the majority of QC strains and antimicrobials, independent of the agar depth. At extreme agar depths, inhibition zones were more frequently out of range. The accuracy of AST varied for clinical isolates at different agar depths for categorical agreement (85.8–94.6%), major error rate (0.4–2.1%) and very major error rate (VME: 3.3–12.5%).

Conclusions. Even if the QC strains were in the acceptance range at different agar depths, this does not rule out unacceptably high VME rates (>3%) in clinical isolates.
A Guide for Active Learning in Synergistic Drug Discovery
Authors: Wang Shuhui , Allauzen Alexandre , Nghe Philippe , Opuu Vaitea
Published: September 2024

Synergistic drug combination screening is a promising strategy in drug discovery, but it involves navigating a costly and complex search space. While AI, particularly deep learning, has advanced synergy predictions, its effectiveness is limited by the low occurrence of synergistic drug pairs. Active learning, which integrates experimental testing into the learning process, has been proposed to address this challenge. In this work, we explore the key components of active learning to provide recommendations for its implementation. We find that molecular encoding has a limited impact on performance, while the cellular environment features significantly enhance predictions. Additionally, active learning can discover 60% of synergistic drug pairs with only exploring 10% of combinatorial space. The synergy yield ratio is observed to be even higher with smaller batch sizes, where dynamic tuning of the exploration-exploitation strategy can further enhance performance.