bluuebunny/crossref_metadata_2025 huggingface dataset:
Sweet Syndrome as a Herpetiform Mimic: A Diagnostic Challenge
Authors: Mendez-Flores Silvia , Perales-González Alejandra , Saeb-Lima Marcela
Published: May 2024

The authors present a singular case of Sweet syndrome (acute febrile neutrophilic dermatosis) manifesting with an unusual herpetiform clinical presentation, underscoring the imperative for its inclusion in differential diagnoses of herpetic infections. A 26-year-old female patient with a systemic lupus erythematosus history presented with facial edema, hyperthermia, cephalalgia, and polyarticular pain. Dermatological examination revealed clustered, vesicle-like papules on erythematous, edematous skin, mimicking herpetic infection. Elevated acute-phase reactants and urine anomalies were noted. Histopathology confirmed Sweet syndrome, characterized by superficial and deep neutrophilic dermatitis, karyorrhexis, and papillary dermal edema. The patient responded to corticosteroid therapy and a brief antibiotic course, resolving both systemic and cutaneous symptoms. This case is remarkable for its atypical herpetiform presentation, a clinical rarity in Sweet syndrome, challenging the conventional diagnostic process. It emphasizes the necessity of considering Sweet syndrome in differential diagnoses when encountering herpetiform lesions, particularly in patients with autoimmune backgrounds. This case contributes significantly to the understanding of Sweet syndrome's clinical variability and highlights the critical role of thorough clinicopathological evaluation in achieving accurate diagnosis in complex dermatological disorders.
Rare Presentation of Melanoma Recurrences With Diffuse Subcutaneous Intravascular Lesions: A Novel In-Transit Metastases Pattern
Authors: Su Shitong , Liu Jie , Jiang Yu
Published: May 2024

In 4%–11% of cases, melanoma recurrences present as in-transit (IT) metastases, and their prognosis is quite poor. Consequently, an early diagnosis and treatment of IT metastasis assume paramount significance. Despite this, the diagnosis of cutaneous IT metastases persistently presents a formidable challenge due to the diversity in clinical and dermoscopic characteristics. We provide a novel melanoma IT metastases pattern with interesting dermoscopic features and magnetic resonance imaging via presenting an unusual case characterized by diffuse subcutaneous intravascular lesions to supplement the understanding of cutaneous melanoma IT metastases.
INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POOR VISUAL ACUITY
Authors: Song Jae Shin , Kim Min Seok , Joo Kwangsic , Park Sang Jun , Woo Se Joon , Park Kyu Hyung
Published: May 2024

Purpose:

To investigate the significance of intravitreal anti–vascular endothelial growth factor treatment in patients with neovascular age-related macular degeneration and poor visual acuity.

Methods:

Retrospective study of patients with neovascular age-related macular degeneration with baseline best-corrected visual acuity of ≤20/200. Patients were divided into regular treatment and scarce treatment groups according to whether they underwent consecutive intravitreal anti–vascular endothelial growth factor treatments at intervals of ≤4 months or not.

Results:

A total of 131 eyes were included: 87 and 44 eyes in the regular treatment and scarce treatment groups, respectively. The regular treatment group showed significantly improved preservation of lesion size at both Years 1 and 2, with significantly fewer incidences of new subretinal hemorrhage. Improvements in visual acuity, reduction in central subfield macular thickness, and maximal height of choroidal neovascularization were significantly favorable in the regular treatment group at Year 1, and central subfield macular thickness was significantly decreased at Year 2. Survival analysis revealed that the regular treatment group had significantly greater preservation of visual acuity and lesion size than that in the scarce treatment group.

Conclusion:

Maintaining intravitreal anti–vascular endothelial growth factor treatment for patients with neovascular age-related macular degeneration and poor vision showed significant advantages in visual acuity and lesion size stability and reduced the incidence of new subretinal hemorrhage, which suggests preservation of paracentral vision.
SURGICAL OUTCOMES IN CONCURRENT SICKLE CELL AND DIABETIC RETINOPATHY
Authors: Rohowetz Landon J. , Shaheen Abdulla , Magraner Maria , Flynn Harry W. , Williams Basil K. , Smiddy William E. , Sridhar Jayanth , Russell Jonathan F. , Townsend Justin H. , Berrocal Audina M. , Albini Thomas , Yannuzzi Nicolas A.
Published: May 2024

Purpose:

To report the clinical features and outcomes in eyes that underwent vitreoretinal surgery for complications of concurrent sickle cell retinopathy and diabetic retinopathy.

Methods:

Retrospective, consecutive case series of all eyes that underwent vitreoretinal surgery for complications secondary to concurrent sickle cell retinopathy and diabetic retinopathy between January 01, 2014, and December 31, 2021.

Results:

The study included 20 eyes of 14 patients. Indications for surgery included tractional retinal detachment in 12 eyes (60%), combined tractional retinal detachment/rhegmatogenous retinal detachment in 6 eyes (30%), and vitreous hemorrhage in 2 eyes (10%). Pars plana vitrectomy was performed in all eyes. One eye received a scleral buckle at the same time as pars plana vitrectomy. There was no change in mean best-corrected visual acuity at the last follow-up examination (1.5 [20/678]) when compared with mean preoperative best-corrected visual acuity (1.6 [20/762], P = 0.83). Preoperative best-corrected visual acuity correlated with postoperative best-corrected visual acuity at the last follow-up examination in eyes with retinal detachment (r = 0.49, P = 0.04). Single operation anatomic success was achieved in 11 of 17 eyes (65%) with retinal detachment.

Conclusion:

Functional and anatomic outcomes after surgery in eyes with concurrent sickle cell retinopathy and diabetic retinopathy are relatively poor.
The Impact of Infant Bacille Calmette-Guérin Vaccination on the Immunogenicity of Other Vaccines: A Randomized Exploratory Study
Authors: Maytum Alexander , Porter David , de Whalley Philip , Thompson Amber , Plested Emma , Kerridge Simon , Liu Xinxue , Smits Gaby , van der Klis Fiona , Snape Matthew D. , Clutterbuck Elizabeth , Pollard Andrew J.
Published: May 2024

The effect of the Bacille Calmette-Guérin (BCG) vaccine on the immunogenicity of separately administered serogroup C meningococcal vaccine and other vaccinations was examined in 28 infants randomized to receive BCG at age ≤7 days, at 3 months or after study completion. Immunogenicity of the serogroup C meningococcal vaccine and other routine vaccines might be improved when BCG is administered in early infancy.
Bronchial Valves for Persistent Air Leak
Authors: Damaraju Vikram , Sehgal Inderpaul Singh , Muthu Valliappan , Prasad Kuruswamy Thurai , Dhooria Sahajal , Aggarwal Ashutosh Nath , Agarwal Ritesh
Published: May 2024

Background:

Patients with persistent air leak (PAL) pose a therapeutic challenge to physicians, with prolonged hospital stays and high morbidity. There is little evidence on the efficacy and safety of bronchial valves (BV) for PAL.

Methods:

We systematically searched the PubMed and Embase databases to identify studies evaluating the efficacy and safety of BV for PAL. We calculated the success rate (complete resolution of air leak or removal of intercostal chest drain after bronchial valve placement and requiring no further procedures) of BV for PAL in individual studies. We pooled the data using a random-effects model and examined the factors influencing the success rate using multivariable meta-regression.

Results:

We analyzed 28 observational studies (2472 participants). The pooled success rate of bronchial valves in PAL was 82% (95% confidence intervals, 75 to 88; 95% prediction intervals, 64 to 92). We found a higher success rate in studies using intrabronchial valves versus endobronchial valves (84% vs. 72%) and in studies with more than 50 subjects (93% vs. 77%). However, none of the factors influenced the success rate of multivariable meta-regression. The overall complication rate was 9.1% (48/527). Granulation tissue was the most common complication reported followed by valve migration or expectoration and hypoxemia.

Conclusion:

Bronchial valves are an effective and safe option for treating PAL. However, the analysis is limited by the availability of only observational data.
Sedoanalgesia With Ketamine in the Emergency Department
Authors: Molina Gutiérrez Miguel Angel , Fernández Camuñas María , Ruíz Domínguez Jose Antonio , Bueno Barriocanal Marta , De Miguel Lavisier Begoña , López López Rosario , de Ceano-Vivas La Calle María
Published: May 2024

Objective

Ketamine is a safe and widely used sedative and analgesic in children. The purpose of this study is to evaluate the response to sedoanalgesia for painful procedures in the pediatric emergency department.

Methods

A retrospective study was conducted in children younger than 16 years who underwent painful procedures with intravenous/intranasal ketamine between January 2016 and December 2022. We collected demographic variables, effectiveness, route of administration, indication, dose, sedation strategy, duration of procedure, and associated adverse effects.

Results

A total of 671 ketamine sedation procedures (411 males/260 females) were included, with a mean age of 7.2 years. Closed reduction was the most common painful procedure (53.8%), followed by burn healing (24.6%). Ketamine was administered intravenously in 93.4% of procedures and intranasally in 6.6%. The result of sedoanalgesia was satisfactory in 84.9% and unsatisfactory in 15.1%. The percentage of cases with unsatisfactory analgesia was higher with intranasal administration (36.4%; P < 0.001). In the intravenous group, the percentage of cases with unsatisfactory effectiveness (28.7%) was higher for patients younger than 2 years of age (P < 0.001). Arthrocentesis procedures were associated with the highest percentage of unsatisfactory sedoanalgesia failures among patients receiving intravenous ketamine (39.3%; P < 0.001). Intranasal ketamine patients who received a dose between 3.6 and 4 mg/kg had a significantly higher percentage of unsatisfactory sedoanalgesia (66.7%; P = 0.048). Patients receiving intravenous ketamine had significantly higher rates of unsatisfactory sedoanalgesia when the initial dose interval was 1.6 to 2 mg/kg (11.8%; P = 0.002) and when the final total dose was also 1.6 to 2 mg/kg (17.6%; P = 0.002).

Conclusions

This study concludes that intravenous/intranasal ketamine can provide safe and successful analgesia in pediatric patients in the ED. At intravenous doses of 1–1.5 mg/kg, good effectiveness was achieved in almost 90% of cases. Arthrocentesis had the highest percentage of unsatisfactory results. Repeat dosing should be considered for procedures longer than 20 minutes.
Point-of-Care Ultrasound for Pediatric Vaginal Obstruction in the Emergency Department
Authors: Sosa Philip , Tsung James W. , Firnberg Maytal
Published: May 2024

Point-of-care ultrasound can be an effective tool to facilitate the evaluation of abdominal and pelvic pain in children. We present a series of 3 pediatric patients with nonspecific abdominal and pelvic symptoms in whom point-of-care ultrasound expedited diagnosis, guided decision-making, prompted subspecialist consultation, and led to definitive management of vaginal obstruction.
The Development of a Combined Pediatric Emergency Medicine and Point-of-Care Ultrasound Curriculum
Authors: Budnik Elizabeth , Klekowski Nicole , Carney Michele , Tucker Ryan
Published: May 2024

Point-of-care ultrasound (POCUS) use has grown rapidly in the field of pediatric emergency medicine (PEM). Despite its growth, there continues to be a need for leaders in PEM POCUS to support ongoing education and advancement of providers within this field. We have developed a novel combined PEM POCUS fellowship that has successfully produced one graduate and a second will graduate in June 2023. We describe the implementation of this model as a potential option that institutions could use as a framework to support other trainees. This could alleviate some barriers for future trainees who seek advanced POCUS training and advance this growing field.
A Nomogram Prediction Model for Persistent Pulmonary Hypertension of the Newborn in Neonates Hospitalized for the First Time After Birth
Authors: Zhang Yan , Wen Juan , Zeng Min , Zhang Limei , Pang Yusheng
Published: May 2024

Objective

Persistent pulmonary hypertension of the newborn (PPHN) is one of the critical neonatal diseases associated with high morbidity and mortality. This study attempted to conduct a nomogram prediction model for performing early identification of PPHN and providing effective information for clinical practice.

Methods

A total of 456 newborns who first admitted to the hospital after birth were included in the analysis, including 138 newborns with PPHN and 318 newborns without PPHN (as controls). The optimal predictive variables selection was performed based on LASSO (least absolute shrinkage and selection operator) regression and multivariate logistic regression. Using the selected variables, a nomogram prediction model was developed. To validate the model, the model was assessed using the receiver operating characteristic curve, calibration plot, and clinical impact curve.

Results

Six predictors, namely, gestational age, neonatal respiratory distress syndrome, the levels of hemoglobin and creatine kinase-MB, gestational thyroid dysfunction, and Pao
2, were identified by LASSO and multivariate logistic regression analysis from the original 30 variables studied. The constructed model, using these predictors, exhibited favorable predictive ability for PPHN, with an area under the receiver operating characteristic of 0.897 (sensitivity = 0.876, specificity = 0.785) in the training set and 0.871 (sensitivity = 0.902, specificity = 0.695) in the validation set, and was well calibrated, as indicated by the P
Hosmer-Lemeshow test values of 0.233 and 0.876 for the training and validation sets, respectively.

Conclusions

The model included gestational age, neonatal respiratory distress syndrome, the levels of hemoglobin and creatine kinase-MB, gestational thyroid dysfunction, and Pao
2 had good prediction performance for predicting PPHN among newborns first admitted to the hospital after birth.
Unveiling the Dark Side of Datura in Pediatric Poisoning With Insights From Jordanian Experience
Authors: Tarawneh Amjad , Nafi Omar , Abdelfattah Abedulrhman S. , Al-Tawarah Nafe M.
Published: May 2024

Objectives

Datura stramonium, jimsonweed, is a toxic plant with hallucinogenic properties. Although there are many studies on Datura poisoning, none reported cases in Jordan. This study offers a comprehensive review on D. stramonium ingestion, covering its epidemiology, clinical presentation, and treatment. We aimed to provide better understanding of the factors for Datura ingestion, identify prevention and management strategies, and address research challenges.

Methods

This study adopted a retrospective review design to evaluate the cases of Datura poisoning in Al Karak, province of Jordan during the spring of 2022. Data collected from medical records, toxicology databases, and consultation records were analyzed using descriptive statistics.

Results

The common symptoms of Datura poisoning included agitation, mydriasis, and tachycardia. The management approaches comprised supportive care, administration of Diazepam for agitation, and, in some cases, neostigmine to counteract anticholinergic effects.

Conclusions

Understanding the risks associated with D. stramonium poisoning and implementing effective prevention and management strategies are crucial. This study highlights the importance of recognizing Datura poisoning as a potential diagnosis in children presenting with unexplained anticholinergic symptoms or agitation to the emergency room.
The Association Between Early Initiation of Systemic Corticosteroids and the Hospital Length of Stay in Patients With Multisystem Inflammatory Syndrome in Children
Authors: Reynolds-Herbst Torrie , Lowe David , Lozano Juan M. , Maniaci Vincenzo
Published: May 2024

Objective

Patients with multisystem inflammatory syndrome in children (MIS-C) often require hospital admission. Treatment of MIS-C has included intravenous immunoglobulin, systemic corticosteroids, and/or immunomodulators. There is no standardized approach to when steroids should be initiated during treatment. The study objective was to determine whether early initiation of steroids in patients with MIS-C is associated with the duration of hospital length of stay (LOS).

Methods

This is a single-center retrospective cohort study of patients younger than 21 years who were hospitalized with MIS-C between March 2020 and September 2021 and received steroids. Cases were obtained from an institutional MIS-C log. Patients with culture proven sepsis and/or those who received intravenous immunoglobulin or steroids within the previous 30 days were excluded. We used a multivariable linear regression model, controlling for potential confounders, to assess the association between early steroids and LOS.

Results

A total of 56 patients hospitalized with MIS-C were identified; 38 received systemic corticosteroids and were included in the study. The mean time from admission to steroid administration was 9.8 hours (SD = 7.7) in the early group and 44.6 hours (SD = 14.2) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early versus late steroids in initial C-reactive peptide, procalcitonin, brain natriuretic peptide, and cardiac dysfunction. After controlling for confounders, initiating steroids within 24 hours of admission for MIS-C was associated with a decreased hospital LOS: in patients treated with early steroids, LOS was 58.3 hours less (95% confidence interval, −100.0 to −16.6; P = 0.007) than in those who received late steroids.

Conclusions

Among patients with MIS-C, initiating systemic corticosteroids within 24 hours of admission was associated with decreased hospital LOS.
Diphenhydramine and Migraine Treatment Failure in Pediatric Patients Receiving Prochlorperazine
Authors: Naeem Sobia , Lozano Juan M. , Ruiz Castaneda Ana Maria , Lowe David
Published: May 2024

Objectives

The objectives are to determine whether diphenhydramine coadministered with prochlorperazine versus prochlorperazine only is associated with a difference in the risk of migraine treatment failure, as measured by the need for additional therapy, hospitalization rates, and 72-hour return rates, and to compare extrapyramidal adverse effects between groups.

Methods

Retrospective cohort of patients aged 7 to 18 years treated in the emergency department for migraines using prochlorperazine with or without diphenhydramine between 2013 and 2019. Patients were included if they had International Classification of Diseases, Ninth or Tenth Revision, codes for migraine or unspecified headache and were treated with prochlorperazine as part of their initial migraine therapy. Data collected included demographics, medications administered, pain scores, neuroimaging, disposition, return visits, and documentation of extrapyramidal adverse effects. Multivariable logistic regression was used to estimate the association between diphenhydramine coadministration and each of the outcomes.

Results

A total of 1683 patients were included. Overall, 13% required additional therapy with a 16.7% admission rate and a 72-hour return rate of 5.3%. There was no association between initial treatment with diphenhydramine and the odds of additional therapy (adjusted odds ratio [aOR], 0.74 [95% confidence interval {CI}, 0.53–1.03]), admission rates (aOR, 1.22 [95% CI, 0.89–1.67]), or return visit rates (aOR, 0.91 [95% CI, 0.55–1.51]). Extrapyramidal adverse effects occurred in 2.4% of patients in the prochlorperazine group and 0% in the prochlorperazine with diphenhydramine group.

Conclusions

There was no association between diphenhydramine coadministration and the need for additional therapy, 72-hour return visit rates or admission rates. Extrapyramidal effects did not occur in patients treated with diphenhydramine.
Primary Care Enhanced Access Services and the Association With Nonurgent Pediatric Emergency Department Utilization and Child Opportunity Index
Authors: Hincapie Mark Ryan , Corbera-Hincapie Montserrat A. , Suresh Srinivasan , Alston Kaila , Butler Gabriella , Fabio Anthony , Ray Kristin N.
Published: May 2024

Objectives

This study aims to examine the association between primary care practice characteristics (enhanced access services) and practice-level rates of nonurgent emergency department (ED) visits using ED and practice-level data. Survey data suggest that enhanced access services within a child's primary care practice may be associated with reduced nonurgent ED visits.

Methods

We performed a cross-sectional analysis of nonurgent ED visits to a tertiary pediatric hospital in Western Pennsylvania with nearly 85,000 annual ED visits. We obtained patient encounter data of all nonurgent pediatric ED (PED) visits between January 2018 and December 2019. We identified the primary care provider at the time of the study period. For each of the 42 included offices, we determined the number of unique children in the office with a nonurgent PED visit, allowing us to determine the percentage of children in the practice with such a visit during the study period. We then stratified the 42 offices into low, intermediate, and high tertiles of nonurgent PED use. Using Kruskal-Wallis tests, logistic regression, and Pearson χ2 tests, we compared practice characteristics, enhanced access services, practice location Child Opportunity Index 2.0, and PED visit diagnoses across tertiles.

Results

We examined 52,459 nonurgent PED encounters by 33,209 unique patients across 42 outpatient offices. Primary care practices in the lowest ED visit tertile were more likely to have 4 or more evenings with office hours (36% vs 14%, P = 0.04), 4 or more evenings of weekday extended hours (43% vs 14%, P = 0.05), and at least 1 day of any weekend hours (86% vs 29%, P = 0.01), compared with practices in other tertiles. High PED use tertile offices were also associated with lower Child Opportunity Index scores.

Conclusions

Primary care offices with higher nonurgent PED utilization had fewer enhanced access services and were located in neighborhood with fewer child-focused resources.
Reliability and Safety of the Superthin Anterolateral Thigh Flap: Evaluating Perfusion-Related Complications and Donor Morbidity
Authors: Yoo Kyung-Eun , Kim Da Eun , Lee Kyeong-Tae
Published: May 2024

Background:

With an increasing need for thin flaps, the use of superthin anterolateral thigh (ALT) flaps, raised above the supra-superficial fascia, has drawn great attention. Controversy remains regarding whether such thin-flap elevation could affect postoperative outcomes, encompassing perfusion-related complications (PRCs) and donor-site morbidity. This study aimed to evaluate the outcomes of superthin ALT flap–based reconstruction compared with those of suprafascially elevated flaps.

Methods:

Patients who underwent free ALT flap–based reconstruction between March of 2017 and June of 2023 were reviewed and categorized into 2 groups based on flap elevation plane: superthin or suprafascial. Development of PRC and donor-site morbidity, including paresthesia, was compared. Independent associations of the elevation plane with complication profiles were evaluated. Further analyses were conducted using propensity score matching.

Results:

In total, 208 cases were analyzed: 80 superthin and 128 suprafascial ALT flaps. Nineteen cases (9.1%) experienced PRC, including 4 total and 14 partial necrosis. The incidence of overall and each type of PRC did not differ based on flap elevation plane even after adjusting for other variables. The superthin group exhibited significantly lower donor-site complications compared with the others, which was upheld in multivariable analyses. Elevating the flaps in a superthin fashion allowed for a higher rate of preservation of the lateral femoral cutaneous nerve, resulting in a significantly lower rate of postoperative paresthesia. Similar associations were observed in the propensity score matching analysis.

Conclusion:

Superthin ALT flap elevation does not appear to increase PRC risk and reduces donor-site complications, compared with suprafascial elevation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Long-Term Outcomes of Regional Morphology in Spring-Assisted Surgery and Cranial Vault Remodeling
Authors: Dunson Blake T. , Bins Griffin P. , Layton Ryan G. , Zhou Larry , Kogan Samuel , Zeng Eric , Couture Daniel E. , David Lisa R. , Runyan Christopher M.
Published: May 2024

Background:

Spring-assisted surgery (SAS) and cranial vault remodeling (CVR) are widely used surgical techniques to correct sagittal craniosynostosis (SC). The authors evaluated changes in regional morphology of patients with SC who had undergone SAS or CVR, using the frontal bossing index (FBI), occipital bulleting index, vertex narrowing index (VNI), and scaphocephalic severity index (SCI) to capture differences in anterior protrusion, posterior protrusion, width restriction, and global dysmorphology, respectively.

Methods:

Indices were measured on computed tomography and 3-dimensional photographs (n = 788) of 257 patients with SC from 2001 through 2022 who underwent SAS (n = 177) or CVR (n = 80). Short-term and long-term outcomes were evaluated.

Results:

Mean age at time of surgery was older in the CVR cohort (CVR, 22.55 ± 16.00 years; SAS, 4.56 ± 2.24 years) (P < 0.05). Before surgery, the SAS cohort had more severe regional dysmorphology in FBI, VNI, and SCI (P < 0.05) relative to the CVR cohort. Frontal bossing consistently improved over time in both cohorts. Head width improved as soon as 0 to 6 months postoperatively (P < 0.05), but it consistently regressed after the initial improvement in both cohorts. Global head shape initially improved in the CVR cohort but regressed over time. In contrast, patients in the SAS group maintained improvements in SCI over time, with significantly better percentage change in every age interval (P < 0.05).

Conclusions:

The FBI, occipital bulleting index, VNI, and SCI are useful tools for monitoring head shape and growth. SAS and CVR achieve similar morphologic outcomes, despite more severe preoperative morphology in the SAS group. Trending index changes with growth between the 2 cohorts suggest improved longevity of correction in the SAS group.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
An Interdisciplinary Multimodal Integrative Healthcare Program for Chronic Spinal Pain and Comorbid Mental Disorders
Authors: Wijnen Jaap , Geijselaers Marciano Wilhelmina Henricus , Pont Marc Lucas , van‘t Hullenaar Geert , Van Oosterwijck Jessica , de Jong Jeroen
Published: May 2024

Objective

Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders.

Methods

Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time.

Results

The 20-week treatment period yielded significant improvements in both mental (B = 0.44, t(943) = 19.42, p < .001) and physical component summary scores (B = 0.45, t(943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score (B = −0.77, t(943) = −26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program.

Conclusions

An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders.
Paucity of Online Information About Gender-Affirming Surgery Fellowships in the United States
Authors: Lin Elaine , Tian William M. , Harris Raiven , Patel Ashit , Rezak Kristen M.
Published: May 2024

Background

Despite growing demand for gender-affirming surgery (GAS), there are few formal GAS fellowships in the United States. Paucity of online information about GAS fellowships may discourage potential applicants and decrease the visibility of the field. Thus, it is important to analyze the existing online information about GAS fellowships to improve fellow recruitment and patient outcomes.

Objective

To identify the number of GAS fellowship websites (GASFWs) and evaluate their robustness. Second, to report the social media presence of GAS fellowships.

Methods

To identify GASFWs, existing databases sponsored by plastic surgery associations and Google query were used between April and May 2023. Thirty-five independent variables based on previously published data were evaluated for presence in a bivariate fashion on GASFWs. Accounts on popular social media websites were also identified by Google query. Website and social media analysis were also done for GAS fellowships that were offered by departments/specialties other than plastic surgery.

Results

In total, only 6 GASFWs associated with plastic surgery departments were identified and analyzed. Eight nonplastic surgery GASFWs were included for analysis. Overall, both categories of GASFWs were not robust; key information such as previous fellow listing and selection criteria was often missing. Furthermore, important topics specifically related to GAS such as community engagement and programmatic building are often not found on GASFWs either. In addition, none of the fellowships had any independent Facebook, Instagram, or Twitter.

Conclusions

To ensure patient safety and quality outcomes, it is important to promote GAS by recruiting more applicants for specialized training beyond residency. With increased Internet use, improving GASFWs and social media presence as well as considering the use of a centralized database or match system can foster the growth of the field.
Timing of Autologous Tissue Breast Reconstruction Does Not Affect Free Flap Failure
Authors: Kalmar Christopher L. , Montorfano Lisandro , Thayer Wesley P. , Kassis Salam , Higdon Kent K. , Perdikis Galen
Published: May 2024

This study aimed to determine whether there is a difference in free flap failure based on the decision to undergo immediate versus delayed autologous tissue breast reconstruction after mastectomy. The National Surgical Quality Improvement Program database was queried for breast free flap procedures performed between 2015 and 2020. This study demonstrates that the decision to undergo immediate versus delayed autologous tissue breast reconstruction does not have a significant association with free flap failure. This remains true regardless of whether patients undergo unilateral mastectomy with reconstruction or whether patients choose to also undergo contralateral prophylactic mastectomy with reconstruction.
The Impact of Socioeconomic Status on the Incidence and Stage of Melanoma in China
Authors: Zheng Shaoluan , Feng Jia , Chen Zhiwei , Wei Chuanyuan , Pan Yuyan , Liu Jiaqi
Published: May 2024

Background

The role of high socioeconomic status (SES) as an established risk factor for melanoma has been well documented in Western countries and regions. However, research on the association between melanoma and SES in China remains limited. This study aimed to investigate the association between SES and melanoma incidence and stage in China.

Methods

Five measures of SES were accessed, including education level, ethnic background, per capita household income, occupation, and medical insurance coverage. A scoring system based on the Kuppuswamy Socio-Economic Scale was used to create a quantitative assessment of SES. To improve clarity and precision, we refined the language in the original text. Clinical stage at diagnosis was classified according to the Chinese Society Oncology Melanoma Guidelines.

Results

A total of 122 patients with pathologic melanoma were enrolled in this study from January 2013 to December 2017. Of these patients, 58 (48%) were male and 64 (52%) were female, with a mean age of 59.23 ± 9.91 years. Patients in the age groups of 45–59 and 60–73 had a higher incidence of melanoma compared to other age groups. Acral lentiginous melanoma was the most commonly observed subtype, accounting for 48% of cases. Patients with a low level of education (middle school and below) and a low level of monthly household income (<3000 CNY) had a higher risk of developing melanoma, as did those who were unemployed. Interestingly, a higher proportion of melanoma diagnoses were made in patients with medical insurance than those without. However, no significant differences in melanoma staging were found based on education level (P = 0.153), monthly household income (P = 0.507), occupation (P = 0.687), or insurance status (P = 0.537). According to the Kuppuswamy Socio-Economic Scale, there were 0 in upper class, 50 in upper middle class, 44 in lower middle class, 28 in upper lower class, 0 in lower class. The mean K-score was 13.85. No statistically significant interaction was observed between K-score and tumor stage.

Conclusions

Patients with lower SES have a higher risk of developing melanoma. However, no significant differences were found in melanoma staging based on SES.
Central African dwarf crocodiles found in syntopy are comparably divergent to South American dwarf caimans
Authors: Gvoždík Václav , Dolinay Matej , Zassi-Boulou Ange-Ghislain , Lemmon Alan R. , Lemmon Emily M. , Procházka Miroslav
Published: May 2024

Recent molecular taxonomic advancements have expanded our understanding of crocodylian diversity, revealing the existence of previously overlooked species, including the Congo dwarf crocodile (Osteolaemus osborni) in the central Congo Basin rainforests. This study explores the genomic divergence betweenO. osborniand its better-known relative, the true dwarf crocodile (Osteolaemus tetraspis), shedding light on their evolutionary history. Field research conducted in the northwestern Republic of the Congo uncovered a locality where both species coexist in sympatry/syntopy. Genomic analysis of sympatric individuals reveals a level of divergence comparable to that between ecologically similar South American dwarf caimans (Paleosuchus palpebrosusandPaleosuchus trigonatus), suggesting parallel speciation in the Afrotropics and Neotropics during the Middle to Late Miocene, 10–12 Ma. Comparison of the sympatric and allopatric dwarf crocodiles indicates no gene flow between the analysed sympatric individuals ofO. osborniandO. tetraspis. However, a larger sample will be required to answer the question of whether or to what extent these species hybridize. This study emphasizes the need for further research on the biology and conservation status of the Congo dwarf crocodile, highlighting its significance in the unique biodiversity of the Congolian rainforests and thus its potential as a flagship species.
Synergistic effects of musking and autohaemorrhaging on the duration of death feigning in dice snakes (
Natrix tessellata
)
Authors: Bjelica Vukašin , Golubović Ana
Published: May 2024

Predation exerts a significant selection pressure on prey, shaping a multitude of traits that serve as antipredator defences. In turn, natural selection could favour combinations of antipredator defences with synergistic effects that enhance prey survival. An especially interesting antipredator defence is death feigning (DF), present in a wide variety of taxa and usually characterized by the prey lying motionless often along with defaecation, musking and autohaemorrhaging (AH). All these aspects of the DF display should work in conjunction with one another, intensifying the overall effect of the display and in turn facilitating quicker escape. To confirm this hypothesis, we tested 263 dice snakes (
Natrix tessellata
) directly in the field. We noted the occurrence of smearing faeces, musk and AH, and we measured the duration of DF, expecting to see a negative association between the occurrence of these behaviours and the duration of DF. Our results affirm our hypothesis: dice snakes that smeared themselves in musk and faeces prior to DF and had AH during DF spent significantly less time in DF. Our results highlight the functional integration of antipredator behaviours across different phases of predator–prey interactions, emphasizing the need for future research to prioritize studying the sequential display of behaviours.
Systems Immunology Approaches to Understanding Immune Responses in Acute Infection of Yellow Fever Patients
Authors: Gonçalves André N. A. , Costa Priscilla R. , Thomazella Mateus V. , Correia Carolina A. , Marmorato Mariana P. , Dias Juliana Z. C. , Silveira Cassia G. T. , Maestri Alvino , Cerqueira Natalia B. , Moreira Carlos H. V. , Buccheri Renata , Félix Alvina C. , Martins Felipe M. , Maso Vanessa E. , Ferreira Frederico M. , Araújo José D. A. , Vasconcelos Amanda P. , Gonzalez-Dias Patrícia , Sékaly Rafick-Pierre , Cabral-Marques Otavio , Coelho-dos-Reis Jordana G. A. , Ferreira Daniela M. , Kallas Esper G. , Nakaya Helder I.
Published: May 2024

In the 2018 yellow fever (YF) outbreak in Brazil, we generated new transcriptomic data and combined it with clinical and immunological data to decode the pathogenesis of YF. Our analysis of 79 patients highlighted distinct gene expression patterns between acute YF infections, other viral infections, and the milder infection induced by the live-attenuated YF-17D vaccine. We identified a critical role for low-density, immature neutrophils in severe outcomes, marked by the downregulation of genes such as PADI4, CSF3R, and ICAM1 in deceased patients. These genes are essential for neutrophil migration and maturation, suggesting their pivotal role in disease progression. Furthermore, our study revealed a complex interaction among inflammation-related genes: increased expression of CXCL10 in the acute phase was accompanied by decreased expression of IL-1b and an increase in IL1R2, a decoy receptor that binds to IL-1 to inhibit its activity. The diminished expression of HLA class II genes suggests an impairment in antigen presentation. These insights underscore the delicate balance of immune responses in YF pathogenesis and provide a foundation for future therapeutic and diagnostic advancements in managing YF.

Highlights

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PBMC transcriptome analysis in acute YFV highlights different immune responses between survivors and deceased patients.

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Decreased expression of HLA class II genes in dendritic cells of deceased YFV patients indicates a critical impairment in antigen presentation and innate immunity.

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Elevated B cell activation markers, such as BLNK and TNFRSF13B, in fatal YFV cases suggest an overactive, potentially dysregulated B cell response.

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Increased expression of neutrophil-related genes, including DEFA1B and MMP9, in deceased YFV patients highlights neutrophils’ role in aggravating inflammation and tissue damage.

Graphical Abstract
Spatial risk of disease transmission between wild bovids and livestock in Thailand
Authors: Horpiencharoen Wantida , Marshall Jonathan C. , Muylaert Renata L. , John Reju Sam , Hayman David T. S.
Published: May 2024

The livestock-wildlife interface is one of the most essential issues threatening wildlife conservation and public health. Identifying interface areas can help to prioritise disease surveillance and implement mitigation measures and control programs for targeting threatened wildlife. We predicted interface areas which were assumed to be areas at risk of infectious disease transmission based on the spatial overlap between three Thai wild bovids (including gaur, banteng and wild water buffalo) habitat suitability and domestic cattle. We assumed that domestic cattle are the reservoir of bovine infectious disease, and that high cattle density is a proxy for a higher risk of disease transmission. Our study indicated that the highest risk areas for the native species are at the forest edges where overlap exists between high habitat suitability and high cattle density. Wild water buffalo showed the largest proportion of high-risk areas (8%), while gaur and banteng showed similar risk areas (4%) in Thailand. The largest proportion of risk areas overlapping with protected areas was Namtok Sam Lan PAs at 89% for gaur, 84% for banteng and 65% for wild water buffalo. Kuiburi NP has the largest risk area around 274 km2(around 28% of the total protected area) for gaur and banteng, whereas wild water buffalo has the largest risk area overlapping with Huai Thabthan-Had Samran around 126 km2(10% of the PA). Kaengkrachan Forest Complex showed the second largest risk area from 249 km2for gaur and 273 km2for banteng (8-9% of the PA). Our results address how habitat suitability might be helpful for infectious disease prevention and control strategies focused on native fauna and One Health. Furthermore, this work may also support the wild bovid habitat conservation initiatives and land use planning by informing decision-making about balancing wildlife habitats and livestock farming.
LUKB: Preparing Local UK Biobank Data for Analysis
Authors: Li Xiangnan , Wang Shuming , Zhang Hui , Hu Zixin
Published: May 2024

Background

While UK Biobank data holds immense potential for human health research, its complex pre-processing steps involving decryption, extraction, and code mapping often act as a barrier for researchers, diverting them from their core research questions. A freely available tool for preparing UK Biobank data would reduce the workload of researchers and the costs produced by alternatively using UK Biobank Research Analysis Platform (RAP).

Results

We developed LUKB, an R Shiny-based web tool that simplifies UK Biobank data preparation by automating pre-processing tasks. Through simple actions, researchers can add downloaded UK Biobank data to LUKB, achieving rapid data decryption, efficient extraction, and accurate code mapping effortlessly.

Conclusion

LUKB reduces pre-processing time, allowing researchers to dedicate more time to their scientific endeavors, and provide an alternative to UK Biobank RAP to minimize costs. LUKB is freely available at Github (https://github.com/HaiGenBuShang/LUKB).
Genetic variants associated with cell-type-specific intra-individual gene expression variability reveal new mechanisms of genome regulation
Authors: Xue Angli , Yazar Seyhan , Alquicira-Hernández José , Cuomo Anna S E , Senabouth Anne , Gordon Gracie , Kathail Pooja , Ye Chun Jimme , Hewitt Alex W. , Powell Joseph E.
Published: May 2024

Gene expression levels can vary substantially across cells, even in a seemingly homogeneous cell population. Identifying the relationships between genetic variation and gene expression is critical for understanding the mechanisms of genome regulation. However, the genetic control of gene expression variability among the cellswithinindividuals has yet to be extensively examined. This is primarily due to the statistical challenges, such as the need for sufficiently powered cohorts and adjusting mean-variance dependence. Here, we introduce MEOTIVE (Mapping genetic Effects On inTra-Individual Variability of gene Expression), a novel statistical framework to identify genetic effects on the gene expression variability (sc-veQTL) accounting for the mean-variance dependence. Using single-cell RNA-seq data of 1.2 million peripheral blood mononuclear cells from 980 human donors, we identified 14 – 3,488 genes with significant sc-veQTLs (study-wideq-value < 0.05) across different blood cell types, 2,103 of which were shared across more than one cell type. We further detected 55 SNP-gene pairs (in 34 unique genes) by directly linking genetic variations with gene expression dispersion (sc-deQTL) regardless of mean-variance dependence, and these genes were enriched in biological processes relevant to immune response and viral infection. An example is rs1131017 (p<9.08×10−52), a sc-veQTL in the 5’UTR ofRPS26, which shows a ubiquitous dispersion effect across cell types, with higher dispersion levels associated with lower auto-immune disease risk, including rheumatoid arthritis and type 1 diabetes. Another example isLYZ, which is associated with antibacterial activity against bacterial species and was only detected with a monocyte-specific deQTL (rs1384) located at the 3’ UTR region (p=1.48×10−11) and replicated in an independent cohort. Our results demonstrate an efficient and robust statistical method to identify genetic effects on gene expression variability and how these associations and their involved pathways confer auto-immune disease risk. This analytical framework provides a new approach to unravelling the genetic regulation of gene expression at the single-cell resolution, advancing our understanding of complex biological processes.
An in-depth analysis and exploreation with focus on the biofilm inStaphylococcus aureus
Authors: Zhang Zhiyuan , Chen Guozhong , Pan Yuanyuan , Yang Zhu , Liu Yin , Li Erguang
Published: May 2024

Research into the biolfilm formation inStaphylococcus aureushas benefited greatly from the generation of high-throughput sequencing data to drive molecular analyses. The accumulation of these data, particularly transcriptomic data, offers a unique opportunity to unearth the network and constituent genes involved in the biofilm formation ofStaphylococcus aureusthrough machine learning strategies and co-expression analyses. Herein, we harnessed all available RNA sequencing data related toStaphylococcus aureusbiofilm studies and identified influenced functional pathways and corresponding genes in the process of the transition of bacteria from planktonic to biofilm state via employing machine learning and differential expression analyses. By weighted gene co-expression analysis and our previously developed predictor, important functional modules, potential biofilm-associated proteins and subnetwork of biofilm formation pathway were found. By constructing a protein-protein interaction (PPI) network, we discovered several hitherto unreported novel protein interactions within these functional modules. To make these data more straightforward to experimental biologists, an online database named SAdb was developed (http://sadb.biownmcli.info/).

IMPORTANCE

In this work, we conducted a comprehensive and in-depth exploration of RNA sequencing data in biofilm research through differential expression analysis, machine learning, WGCNA, and biofilm-associated protein predictive analysis, which has also illuminated novel analytical perspective for other research into bacterial phenotypes. And, to provide researchers with unimpeded access to these data, we developed a database name SAdb for the storage and analysis ofStaphylococcus aureusomics data. We believe that this study will captivate the interest of researchers in the field of bacteriology, particularly those studying biofilms, which play a crucial role in bacterial growth, pathogenicity, and drug resistance.