bluuebunny/crossref_metadata_2025 huggingface dataset:
Gene therapy for age-related macular degeneration: potential, feasibility, and pitfalls
Authors: Berkowitz Sean T. , Finn Avni P.
Published: March 2024

Purpose of review

The landscape for age-related macular degeneration (AMD) is rapidly changing with addition of biosimilars and now United States Food and Drug Administration (FDA) approved nonneovascular AMD (nnAMD) treatment options. These developments have inspired a burgeoning pipeline of gene therapy approaches focused on similar antivascular endothelial growth factors (VEGF) and complement related pathways. Historic and more recent setbacks in the gene therapy pipeline, including intraocular inflammatory reactions, have raised important concerns for adverse events related to AMD therapeutics both for gene and nongene approaches. The specific clinical profile of these therapeutics approaching later stage clinical trials are complex and under active investigation; however, these options hold promise to disrupt the current landscape and change management paradigms for one of the leading causes of vision loss worldwide.

Recent findings

This review covers current gene therapy approaches for neovascular AMD (nAMD) and nnAMD. Intravitreal, suprachoroidal, and subretinal delivery routes are discussed with attention to technical procedure, capabilities for transgene delivery to target tissue, immunogenicity, and collateral effects. Suprachoroidal delivery is an emerging approach which may bridge some of the practical drawbacks for intravitreal and subretinal methods, though with less elaborated immunologic profile. In parallel to delivery modification, viral vectors have been cultivated to target specific cells, with promising enhancements in adeno-associated viral (AAV) vectors and persistent interest in alternate viral and nonviral delivery vectors. Ongoing questions such as steroid or immunosuppressive regimen and economic considerations from a payer and societal perspective are discussed.

The present review discusses emerging gene therapy options which could foster new, more durable nAMD and nnAMD therapeutics. These options will need refinement with regards to route, vector, and dosage, and specialists must decipher the specific clinical risk benefit profile for individual patients. Ongoing concerns for immunogenicity or dosage related adverse events could stifle progress, while further vector development and refined delivery techniques have the potential to change the safety and efficacy of currently options in the pipeline.
Adverse Event Following Immunization Monitoring System in Japan
Authors: Okuyama Mai , Kamiya Hajime , Kamidani Satoshi , Saitoh Akihiko
Published: March 2024

Although immunization is essential for maintaining public health, adverse events following immunization (AEFI) occur at a certain rate. Therefore, it is extremely important to conduct postimmunization safety monitoring and relief systems to ensure the safe implementation of immunizations for the public. This article summarizes the monitoring system of AEFI and the unique compensation system (so-called relief system) in Japan. In addition, current problems and issues on the AEFI monitoring and relief system will be specified, and immunization-related systems planned to be built in the future in Japan will be introduced.
Evaluation of Acute and Convalescent Antibody Concentration Against Pneumococcal Capsular Polysaccharides for the Diagnosis of Pneumococcal Infection in Children with Community-Acquired Pneumonia
Authors: Carter Michael J. , Shrestha Sonu , O’Reilly Peter , Gurung Pallavi , Gurung Meeru , Thorson Stephen , Kandasamy Rama , Voysey Merryn , O’Mahony Elizabeth , Kelly Sarah , Ansari Imran , Shah Ganesh , Amatya Puja , Tcherniaeva Irina , Berbers Guy , Murdoch David R. , Pollard Andrew J. , Shrestha Shrijana , Kelly Dominic F. ,   on behalf the PneumoNepal Study Group
Published: March 2024

We evaluated whether the quantification of IgG to pneumococcal capsular polysaccharides is an accurate diagnostic test for pneumococcal infection in children with pneumonia in Nepal. Children with pneumococcal pneumonia did not have higher convalescent, or higher fold change, IgG to pneumococcal polysaccharides than children with other causes of pneumonia. Caution is needed in interpreting antibody responses in pneumococcal infections.
Characterizing high-cost healthcare users among adults with back pain in Ontario, Canada: a population-based cohort study
Authors: Wong Jessica J. , Côté Pierre , Tricco Andrea C. , Watson Tristan , Rosella Laura C.
Published: March 2024

Some patients with back pain contribute disproportionately to high healthcare costs; however, characteristics of high-cost users with back pain are not well defined. We described high-cost healthcare users based on total costs among a population-based cohort of adults with back pain within the Ontario government's single-payer health system across sociodemographic, health, and behavioural characteristics. We conducted a population-based cohort study of Ontario adult (aged 18 years or older) respondents of the Canadian Community Health Survey (CCHS) with back pain (2003-2012), linked to administrative data (n = 36,605; weighted n = 2,076,937, representative of Ontario). Respondents were ranked based on gradients of total healthcare costs (top 1%, top 2%-5%, top 6%-50%, and bottom 50%) for 1 year following the CCHS survey, with high-cost users as top 5%. We used multinomial logistic regression to investigate characteristics associated with the 4 cost groups. Top 5% of cost users accounted for 49% ($4 billion CAD) of total healthcare spending, with inpatient hospital care as the largest contributing service type (approximately 40% of costs). Top 5% high-cost users were more likely aged 65 years or older (ORtop1% = 16.6; ORtop2-5% = 44.2), with lower income (ORtop1% = 3.6; ORtop 2-5% = 1.8), chronic disease(s) (ORtop1% = 3.8; ORtop2-5% = 1.6), Aggregated Diagnosis Groups measuring comorbidities (ORtop1% = 25.4; ORtop2-5% = 13.9), and fair/poor self-rated general health (ORtop1% = 6.7; ORtop2-5% = 4.6) compared with bottom 50% users. High-cost users tended to be current/former smokers, obese, and report fair/poor mental health. High-cost users (based on total costs) among adults with back pain account for nearly half of all healthcare spending over a 1-year period and are associated with older age, lower income, comorbidities, and fair/poor general health. Findings identify characteristics associated with a high-risk group for back pain to inform healthcare and public health strategies that target upstream determinants.
Individual Patient Comorbidities and Effect on Cochlear Implant Performance
Authors: Dang Sabina , Kallogjeri Dorina , Dizdar Karmela , Lee David , Bao James W. , Varghese Jordan , Walia Amit , Zhan Kevin , Youssef Stephanie , Durakovic Nedim , Wick Cameron C. , Herzog Jacques A. , Buchman Craig A. , Piccirillo Jay F. , Shew Matthew A.
Published: March 2024

Objective

To examine the association between preoperative comorbidities and cochlear implant speech outcomes.

Study Design

Retrospective cohort.

Setting

Tertiary referral center.

Patients

A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included.

Exposure

Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes.

Main Outcome Measures

Postoperative change in consonant–nucleus–consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months.

Results

A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet (p= 0.045) and AzBio + 10 dB SNR (p= 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7–58.9) and 32.5 (24.6–40.5), respectively, for AzBio Quiet; 39.5 (33.8–45.2) and 21.2 (13.6–28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7–49.0) and 31.1 (24.8–37.4), respectively, for CNC.

Conclusions

Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.
Status epilepticus: what's new for the intensivist
Authors: Benghanem Sarah , Pruvost-Robieux Estelle , Neligan Aidan , Walker Matthew C.
Published: March 2024

Purpose of review

Status epilepticus (SE) is a common neurologic emergency affecting about 36.1/100 000 person-years that frequently requires intensive care unit (ICU) admission. There have been advances in our understanding of epidemiology, pathophysiology, and EEG monitoring of SE, and there have been large-scale treatment trials, discussed in this review.

Recent findings

Recent changes in the definitions of SE have helped guide management protocols and we have much better predictors of outcome. Observational studies have confirmed the efficacy of benzodiazepines and large treatment trials indicate that all routinely used second line treatments (i.e., levetiracetam, valproate and fosphenytoin) are equally effective. Better understanding of the pathophysiology has indicated that nonanti-seizure medications aimed at underlying pathological processes should perhaps be considered in the treatment of SE; already immunosuppressant treatments are being more widely used in particular for new onset refractory status epilepticus (NORSE) and Febrile infection-related epilepsy syndrome (FIRES) that sometimes revealed autoimmune or paraneoplastic encephalitis. Growing evidence for ICU EEG monitoring and major advances in automated analysis of the EEG could help intensivist to assess the control of electrographic seizures.

Research into the morbi-mortality of SE has highlighted the potential devastating effects of this condition, emphasizing the need for rapid and aggressive treatment, with particular attention to cardiorespiratory and neurological complications. Although we now have a good evidence-base for the initial status epilepticus management, the best treatments for the later stages are still unclear and clinical trials of potentially disease-modifying therapies are long overdue.
How to manage catatonia, Parkinson and dementia in ICU
Authors: Attali David , Calligaris Charlotte , Grabli David , Slooter Arjen J.C.
Published: March 2024

Purpose of review

The rising prevalence of neurodegenerative and mental disorders, combined with the challenges posed by their frailty, has presented intensivists with complex issues in the intensive care unit (ICU). This review article explores specific aspects of care for patients with catatonia, Parkinson's disease (PD), and dementia within the context of the ICU, shedding light on recent developments in these fields.

Recent findings

Catatonia, a neuropsychiatric syndrome with potentially life-threatening forms, remains underdiagnosed, and its etiologies are diverse. PD patients in the ICU present unique challenges related to admission criteria, dopaminergic treatment, and respiratory care. Dementia increases the risk of delirium. Delirium is associated with long-term cognitive impairment and dementia.

While evidence is lacking, further research is needed to guide treatment for ICU patients with these comorbidities.
Acute encephalopathy in the ICU: a practical approach
Authors: Kurtz Pedro , van den Boogaard Mark , Girard Timothy D. , Hermann Bertrand
Published: March 2024

Purpose of review

Acute encephalopathy (AE) – which frequently develops in critically ill patients with and without primary brain injury – is defined as an acute process that evolves rapidly and leads to changes in baseline cognitive status, ranging from delirium to coma. The diagnosis, monitoring, and management of AE is challenging. Here, we discuss advances in definitions, diagnostic approaches, therapeutic options, and implications to outcomes of the clinical spectrum of AE in ICU patients without primary brain injury.

Recent findings

Understanding and definitions of delirium and coma have evolved. Delirium is a neurocognitive disorder involving impairment of attention and cognition, usually fluctuating, and developing over hours to days. Coma is a state of unresponsiveness, with absence of command following, intelligible speech, or visual pursuit, with no imaging or neurophysiological evidence of cognitive motor dissociation. The CAM-ICU(−7) and the ICDSC are validated, guideline-recommended tools for clinical delirium assessment, with identification of clinical subtypes and stratification of severity. In comatose patients, the roles of continuous EEG monitoring and neuroimaging have grown for the early detection of secondary brain injury and treatment of reversible causes.

Evidence-based pharmacologic treatments for delirium are limited. Dexmedetomidine is effective for mechanically ventilated patients with delirium, while haloperidol has minimal effect of delirium but may have other benefits. Specific treatments for coma in nonprimary brain injury are still lacking.
The therapeutic effect of alcoholic extract of Fumaria parviflora on high-fat diet-induced nonalcoholic fatty liver in rats: an animal experiment
Authors: Eghdami Shayan , Afrashteh Fatemeh , Shojaii Asie , Abolhasani Maryam , Motevalian Manijeh
Published: March 2024

Background and purpose:

Nonalcoholic fatty liver disease (NAFLD) is a growing problem with a significant burden. Lifestyle modification is the recommended treatment, but researchers are exploring other options. This study focused on the effects of Fumaria parviflora (FP) extracts on NAFLD induced by a high-fat diet in rats.

Experimental approach:

Thirty-five 10-week-old male Wister-Albino rats were divided into seven groups: normal diet control, high fat diet control, high fat diet with oral normal saline gavage, high fat diet with oral Atorvastatin gavage, and three groups receiving high fat diet with FP extract in 200 mg/kg, 400 mg/kg, and 700 mg/kg.

Blood samples of rats were used for the measurement of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP).

1×1 cm Liver biopsies were taken, stained with Trichrome Stain (Masson) and Hematoxylin and eosin (H&E) stain for evaluation by a pathologist.

Findings/results:

Lab results showed that FP extract inhibits weight gain, has positive effects on triglyceride and alkaline phosphatase levels, and reduces hepatocyte ballooning and inflammation in rats.

Conclusion:

FP extract may lower liver enzymes and have a positive impact on triglyceride, LDL, and HDL levels in rats with NAFLD.
Pancytopenia as a first presentation of late-onset systemic lupus erythematosus: a case report
Authors: Haidar Ghina , Khalayli Naram , Drie Tasneem , Safiah Mhd Homam , Kudsi Maysoun
Published: March 2024

Introduction:

Systemic lupus erythematosus (SLE) is a systemic immune disease that classically occurs in young to middle-aged women and may present with cutaneous, renal, haematologic, neurological, and/or other symptoms at the time of diagnosis. Late-onset SLE or SLE in the elderly is a subtype that differs from classic SLE in terms of age group, clinical symptoms, organ involvement and severity.

Case presentation:

A 63-year-old female noted to have pancytopenia. The patient was diagnosed with lupus upon obtaining clinical presentations and serological marker, along with high titres of the antinuclear antibody and/or anti-double-stranded DNA antibody. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid response.

Discussion:

Late-onset SLE accounts for 2–12% of SLE patients with a minimum age of onset of 50 years and older, leading to significant delays in diagnosis. Late-onset SLE differs from early-onset SLE in terms of sex and ethnicity prevalence, clinical symptoms and signs, development of organ damage, disease activity and severity, and prognosis. Some studies have also shown that late-stage SLE patients have higher rates of RF and anti-Ro/anti-La antibody positivity, lower complement titre, and higher incidence of elevated creatinine and decreased creatinine clearance. First-line treatment of pancytopenia is glucocorticoid. In refractory cases, rituximab and immunosuppressants can be used.

Conclusion:

It is important to assess any unusual presentation of SLEs when clinical suspicion remains high and conducting further laboratory and imaging investigation.
Ventricular tachycardia storm after accidental poisoning of delphinium species: a rare case report
Authors: Shrestha Swikriti , Thapa Shovit , Hussain Asraf , Lamichhane Sandesh , Subedi Subash , KC Sujata , Kandel Narayan , Pant Kailash
Published: March 2024

Introduction:

Delphinium species are commonly used as medicinal herbs, with a wide range of implications for medical conditions. The injudicious use of this plant has been known to cause devastating side effects, including cardiac arrhythmias.

Case presentation:

Here, the authors present an 80-year-old male with incessant ventricular tachycardia after ingestion of this herb. The sinus rhythm was restored after electrical cardioversion and aggressive intravenous antiarrhythmics.

Clinical discussion:

To the best knowledge of the authors, no case of a ventricular storm following ingestion of Delphinium has been reported till now, probably rendering this case the first one.

Conclusion:

This report aims to present the rare case using theoretical concepts from the discipline and to share our approach in the hope of achieving a better understanding of similar cases.
Diagnosis and management of intraspinal tuberculoma with osseous involvement: A case report
Authors: Wu Song , Hu Fei , Sun Bing , Yang Yuting , Zhang Wenxin , Ma Yuan , Ouyang Qing
Published: March 2024

Introduction and Importance:

Intraspinal tuberculoma is rare and challenging situation, which results in serious neurological dysfunctions.

Case Presentation:

This case report shows an intraspinal tuberculoma with osseous involvement in a 31-year-old male patient with subacute progressing neurologic deficit. His medical history included tuberculosis of pulmonary and intestinal 8 years previously, at which time he had been treated with intestinal obstruction operation and antituberculosis treatment. A quadruple antituberculosis treatment was carried out after admission, however, his neurological condition was steadily worsening. He underwent debulking of mass for decompression and pathological analysis revealed intraspinal tuberculoma. The patient was prescribed a 12-month course of antituberculosis therapy, and a good clinical outcome was obtained subsequently.

Clinical Discussion:

This case was treated by microsurgical resection and antituberculosis therapy, and the outcome was favorable.

Conclusion:

Intraspinal tuberculoma should be considered when an intraspinal mass is found with a history of tuberculosis, it can be effectively diagnosed by MRI and treated by the combination of medical and surgical treatments.
Prevalence, types, and characteristics of headache in Behcets disease without involvement of the central nervous system in the Syrian population: a case-cohort study
Authors: Rabah Karam , Rabah Nour , Deeb Haya , Haidar Ghina , Kudsi Maysoun
Published: March 2024

Introduction:

Oral ulcers, genital ulcers, and uveitis represent the typical trial of Behcet’s disease (BD). It is well common on the Old Silk Road. The mucocutaneous lesions are the hallmark of BD, but neurological involvement is one of the severe symptoms. Headaches may be an early sign of BD neurological involvement. This study aims to investigate the headache prevalence and its types, and characteristics in a Syrian sample of BD patients.

Methods:

BD patients were clinically interviewed and examined to collect their information, symptoms, and signs. the International Study Group for Behcet’s Disease diagnosis criteria was used to confirm the BD diagnosis. The International Classification of headaches was used when classifying the headaches.

Results:

One hundred twenty participants were included in the study. half of them were BD patients and the control group was also 60 participants. Among Syrian BD patients, 36.7% suffer from primary headaches and 36.7% suffer from secondary headaches. These findings were not significantly different between the BD patients and the healthy population. Our results showed that there was no statistically significant difference between the two groups.

Conclusion:

Headache should not be considered a predictor for neurological involvement among BD patients. Additional attention to BD patients or the specific treatment for headaches is not required and does not differ from the general population.
Paraneoplastic pemphigus in a patient with T-cell lymphoma, a case report
Authors: Molla Yohannis Derbew , Answar Isak Omer , Worku Biruk Mulat , Tadesse Amanuel Kassa , tefera Elias manaye , Alemu Bewketu Abebe , Legese Gebrehiwot Lema , Abera Samuel Addisu
Published: March 2024

Introduction and importance:

Paraneoplastic pemphigus is an uncommon autoimmune mucocutaneous disease characterized by severe stomatitis, polymorphous skin eruptions, and the presence of underlying neoplasms. Unique histopathological features include suprabasal acantholysis and clefts with scattered necrotic keratinocytes.

Case presentation:

A 27-year-old female patient presented with a three-month history of a painless swelling, approximately the size of a pea, on the left lateral aspect of her neck and axillary area. This swelling progressively increased in size and number. Additionally, she had reddish, itchy, raised skin lesions over her elbows bilaterally, which gradually spread to involve most of her body, including her lips, tongue, and buccal mucosa. These skin lesions were associated with difficulty swallowing both liquid and solid foods. A diagnostic test, including a biopsy, confirmed the diagnosis of paraneoplastic pemphigus. Subsequently, the patient was managed with chemotherapy and other supportive measures, leading to improvement and eventual discharge.

Clinical discussion:

Paraneoplastic pemphigus is a rare blistering disorder associated with neoplasms, often presenting diagnostic and treatment challenges. Patients with PNP may develop a diverse range of lesions. It is crucial to promptly recognize and manage the underlying malignancy for improved patient outcomes.

Conclusion:

This case highlights the rare association between T-cell lymphoma and paraneoplastic pemphigus. Clinicians should also remain vigilant for the possibility of paraneoplastic pemphigus in lymphomas that are not of B-cell lineage.
Treatment of resistant paecilomyces lilacinus keratitis with topical voriconazole and oral itraconazole: A rare case report from somalia
Authors: Mohamed Hassan Muhumed , Hassan Ibrahim Ali , Yussuf Aisha Abdirahman , Nor Yahye Abshir , Ahmed Abdirisak Abdikarin , Roble Abdullahi Ali
Published: March 2024

Introduction and importance:

Paecilomyces species are rare fungi that are resistant to standard treatment and have increasing clinical relevance. The Purpureocillium lilac-inum, formerly known as Paecilomyces lilacinus, has a unique sensitivity for the corneal surface. However, only a few cases have been documented globally. This case report presents the successful management of a patient with Paecilomyces lilacinus keratitis with topical voriconazole and oral itraconazole.

Case presentation:

A 40-year-old woman came to our ophthalmology clinic complaining of right eye pain due to a severe corneal infection in her right eye. Corneal scraping and identification of the cultured pathogen were performed, which revealed Paecilomyces lilacinus. The corneal infection improved after being treated with hourly topical voriconazole (10 mg/mL) and oral traconozole.

Clinical discussion:

Paecilomyces/Purpureocillium keratitis, which accounts for 5% of keratomycosis cases in tropical and subtropical areas, is extremely rare. It does not respond well to conventional antifungal treatment and frequently requires therapeutic surgery. Risk factors include wearing contact lenses, ocular trauma, ocular surgery, corticosteroids, and IOL implantation.

Conclusion:

For the treatment of Paecilomyces lilacinus keratitis that is unresponsive to conventional antifungal medications, voriconazole may be helpful. Early organism detection and the appropriate therapy are necessary for the management of keratitis.
Factors Related to Person-Centered Care for Older Patients With Cancer and Dementia in Designated Cancer Hospitals
Authors: Ikeda Setsuka , Aoyanagi Michiko , Nakaya Ryota , Yoshimura Mai , Sumi Naomi
Published: March 2024

Background

Person-centered care (PCC) should be promoted for patients with cancer and dementia who are likely to be hindered from pursuing a meaningful life owing to their will not being reflected in the cancer treatment process.

Objective

This study aimed to clarify the factors related to nurses’ practice of PCC for older patients with cancer and dementia in designated cancer hospitals.

Methods

An online cross-sectional survey was administered to nurses working at designated cancer hospitals in Japan. The survey items included demographic data and factors assumed to be related to nursing practice and practice of PCC.

Results

A multiple regression analysis indicated that the factors related to the practice of PCC were attitude toward patients with dementia (β = 0.264, P < .001), holding conferences (β = 0.255, P < .001), knowledge about cancer nursing (β = 0.168, P < .001), knowledge about dementia (β = 0.128, P = .003), and participation in dementia care training (β = 0.088, P = .032).

Conclusions

Nurses’ practice of PCC may not be sufficient to provide personalized care tailored to patients’ cognitive function. The factors related to PCC are attitude toward patients with dementia, holding conferences, knowledge about cancer and dementia, and dementia care training.

Implications for Practice

To promote PCC for patients with cancer and dementia, nurses should learn about these conditions with an interest in patients and collaborate with other professionals. Future studies should use cluster sampling and focus on the extent of cancer or dementia symptoms.
Risk Factors for Tissue Expander–Related Infections in Pediatric Scar Reconstruction: A 10-Year Retrospective Study
Authors: Fan Chunjie , Li Peilong , Yan Ning , Huang Guobao
Published: March 2024

Background:

Tissue expansion addresses limited soft-tissue availability and provides natural-looking skin for scar reconstruction. However, infection is a common complication in expander surgery. This 10-year retrospective cohort study was performed to investigate the infection risk factors in pediatric scar reconstruction.

Methods:

This single-center observational cohort study was conducted at the Central Hospital Affiliated with Shandong First Medical University, China, and analyzed data from pediatric patients undergoing tissue expander surgery for scar reconstruction from January of 2012 to June of 2022. Patients were selected, were divided into groups with or without infection, and their demographic and clinical data were analyzed. Propensity score matching ensured balanced comparisons, and logistic regression identified infection risk factors.

Results:

Among the 4539 patient records, 1756 eligible pediatric patients were included (142 with infections; 1614 without infections). Multivariate analysis revealed that factors increasing infection risk included having 3 or more expanders (OR, 2.39, P < 0.05), a total expander volume of 300 cc or more (OR, 2.33, P < 0.05), back or gluteal implants (OR, 1.33, P < 0.05), lack of antibiotic prophylaxis (OR, 0.65, P < 0.05), and absence of hematoma evacuation (OR, 3.29, P < 0.05). Microbiological analysis found no significant bacterial differences among antibiotic prophylaxis groups, with Staphylococcus aureus being the predominant bacterium in infections.

Conclusions:

Patients with multiple expanders, larger expander volumes, back or gluteal implants, lack of antibiotic prophylaxis, and hematoma evacuation absence have higher infection risks. Short-term (<24 hours) use of S. aureus–sensitive antibiotics after surgery may benefit pediatric infection risk reduction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Liver Imaging in Gastroenteropancreatic Neuroendocrine Neoplasms
Authors: Jeph Sunil , Gupta Shiva , Yedururi Sireesha , Daoud Taher E. , Stanietzky Nir , Morani Ajaykumar C.
Published: March 2024

The incidence of neuroendocrine neoplasms (NENs) has gradually increased over the past few decades with the majority of patients presenting with metastases on initial presentation. The liver is the most common site of initial metastatic disease, and the presence of liver metastasis is an independent prognostic factor associated with a negative outcome. Because NENs are heterogenous neoplasms with variable differentiation, grading, and risk of grade transformation over time, accurate diagnosis and management of neuroendocrine liver lesions are both important and challenging. This is particularly so with the multiple liver-directed treatment options available. In this review article, we discuss the diagnosis, treatment, and response evaluation of NEN liver metastases.
Prognostic Value of a Combined Nomogram Model Integrating 3-Dimensional Deep Learning and Radiomics for Head and Neck Cancer
Authors: Li Shuyan , Xie Jiayi , Liu Jinghua , Wu Yanjun , Wang Zhongxiao , Cao Zhendong , Wen Dong , Zhang Xiaolei , Wang Bingzhen , Yang Yifan , Lu Lijun , Dong Xianling
Published: March 2024

Objective

The preoperative prediction of the overall survival (OS) status of patients with head and neck cancer (HNC) is significant value for their individualized treatment and prognosis. This study aims to evaluate the impact of adding 3D deep learning features to radiomics models for predicting 5-year OS status.

Methods

Two hundred twenty cases from The Cancer Imaging Archive public dataset were included in this study; 2212 radiomics features and 304 deep features were extracted from each case. The features were selected by univariate analysis and the least absolute shrinkage and selection operator, and then grouped into a radiomics model containing Positron Emission Tomography /Computed Tomography (PET/CT) radiomics features score, a deep model containing deep features score, and a combined model containing PET/CT radiomics features score +3D deep features score. TumorStage model was also constructed using initial patient tumor node metastasis stage to compare the performance of the combined model. A nomogram was constructed to analyze the influence of deep features on the performance of the model. The 10-fold cross-validation of the average area under the receiver operating characteristic curve and calibration curve were used to evaluate performance, and Shapley Additive exPlanations (SHAP) was developed for interpretation.

Results

The TumorStage model, radiomics model, deep model, and the combined model achieved areas under the receiver operating characteristic curve of 0.604, 0.851, 0.840, and 0.895 on the train set and 0.571, 0.849, 0.832, and 0.900 on the test set. The combined model showed better performance of predicting the 5-year OS status of HNC patients than the radiomics model and deep model. The combined model was shown to provide a favorable fit in calibration curves and be clinically useful in decision curve analysis. SHAP summary plot and SHAP The SHAP summary plot and SHAP force plot visually interpreted the influence of deep features and radiomics features on the model results.

Conclusions

In predicting 5-year OS status in patients with HNC, 3D deep features could provide richer features for combined model, which showed outperformance compared with the radiomics model and deep model.
Estimating Body Weight From Measurements From Different Single-Slice Computed Tomography Levels: An Evaluation of Total Cross-Sectional Body Area Measurements and Deep Learning
Authors: Ichikawa Shota , Sugimori Hiroyuki
Published: March 2024

Objective

This study aimed to evaluate the correlation between the estimated body weight obtained from 2 easy-to-perform methods and the actual body weight at different computed tomography (CT) levels and determine the best reference site for estimating body weight.

Methods

A total of 862 patients from a public database of whole-body positron emission tomography/CT studies were retrospectively analyzed. Two methods for estimating body weight at 10 single-slice CT levels were evaluated: a linear regression model using total cross-sectional body area and a deep learning–based model. The accuracy of body weight estimation was evaluated using the mean absolute error (MAE), root mean square error (RMSE), and Spearman rank correlation coefficient (ρ).

Results

In the linear regression models, the estimated body weight at the T5 level correlated best with the actual body weight (MAE, 5.39 kg; RMSE, 7.01 kg; ρ = 0.912). The deep learning–based models showed the best accuracy at the L5 level (MAE, 6.72 kg; RMSE, 8.82 kg; ρ = 0.865).

Conclusions

Although both methods were feasible for estimating body weight at different single-slice CT levels, the linear regression model using total cross-sectional body area at the T5 level as an input variable was the most favorable method for single-slice CT analysis for estimating body weight.
Tissue Engineering Auricular Cartilage: A Review of Auricular Cartilage Characteristics and Current Techniques for Auricular Reconstruction
Authors: Khan Nawal , Zaki Daniel P. , Brown Wendy E. , Halaseh Faris F. , Willette Dominique , Ziegler Mary , Athanasiou Kyriacos A. , Widgerow Alan D.
Published: March 2024

Microtia and anotia are congenital auricular anomalies that negatively impact the psychosocial development of those affected. Because auricular cartilage is a type of elastic cartilage that lacks regenerative capacity, any notable defect in its structure requires a surgical approach to reconstructing the auricle. While there are several reconstructive options available between alloplastic and prosthetic implants, autologous rib cartilage grafts remain the most commonly used treatment modality. Still, this widely used technique is accompanied by significant patient discomfort in a young child and carries additional risks secondary to the traumatic process of rib cartilage extraction, such as pneumothorax and chest wall deformities, and the final esthetic results may not be ideal. To circumvent these limitations, tissue engineering approaches have been used to create a realistic-looking ear that mirrors the complex anatomy of the normal ear. This article reviews the biochemical and biomechanical properties of human auricular cartilage as they relate to design criteria. In addition, a variety of cell sources, biocompatible scaffolds, scaffold-free techniques, and mechanical and biological stimuli are discussed. This review aims to identify knowledge gaps in the literature related to auricular cartilage characteristics and make recommendations to drive the field of auricular tissue engineering.
Coaching Program to Address Burnout, Well-being, and Professional Development in Pediatric Surgery Trainees
Authors: Huang Eunice Y. , Saberi Rebecca A. , Palamara Kerri , Katz Danielle , Chen Heidi , Neville Holly L.
Published: March 2024

Objective:

To assess impact of participation in a positive psychology coaching program on trainee burnout and well-being.

Background:

Coaching using principles of positive psychology can improve well-being and reduce physician burnout. We hypothesized that participation in a coaching program would improve pediatric surgery trainee well-being.

Methods:

With IRB approval, a coaching program was implemented during the COVID-19 pandemic (September 2020 to July 2021) in the American Pediatric Surgical Association. Volunteer pediatric surgery trainees (n=43) were randomized to receive either one-on-one quarterly virtual coaching (n=22) from a pediatric surgeon trained in coaching skills or wellness reading materials (n=21). Participants completed prestudy and poststudy surveys containing validated measures, including positive emotion, engagement, relationships, meaning, accomplishment, professional fulfillment, burnout, self-valuation, gratitude, coping skills, and workplace experiences. Results were analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, or χ2 test.

Results:

Forty trainees (93%) completed both the baseline and year-end surveys and were included in the analysis. Twenty-five (64%) were female, mean age 35.7 (SD 2.3), and 65% were first-year fellows. Coached trainees showed an improved change in positive emotion, engagement, relationships, meaning, accomplishment (P=0.034), burnout (P=0.024), and gratitude (P=0.03) scores from precoaching to postcoaching compared with noncoached trainees. Coping skills also improved. More coaching sessions were associated with higher self-valuation scores (P=0.042), and more opportunities to reflect were associated with improved burnout and self-valuation.

Conclusions:

Despite the stress and challenges of medicine during COVID-19, a virtual positive psychology coaching program provided benefits in well-being and burnout to pediatric surgery trainees. Coaching should be integrated into existing wellness programs to support the acquisition of coping skills that help trainees cope with the stressors they will face during their careers.
Social determinants of health, the microbiome, and surgical injury
Authors: Alverdy John C. , Polcari Ann , Benjamin Andrew
Published: March 2024

Postinjury infection continues to plague trauma and emergency surgery patients fortunate enough to survive the initial injury. Rapid response systems, massive transfusion protocols, and the development of level 1 trauma centers, among others, have improved the outcome for millions of patients worldwide. Nonetheless, despite this excellent initial care, patients still remain vulnerable to postinjury infections that can result in organ failure, prolonged critical illness, and even death. While risk factors have been identified (degree of injury, blood loss, time to definitive care, immunocompromise, etc.), they remain probabilistic, not deterministic, and do not explain outcome variability at the individual case level. Here, we assert that analysis of the social determinants of health, as reflected in the patient's microbiome composition (i.e., community structure, membership) and function (metabolomic output), may offer a “window” with which to define individual variability following traumatic injury. Given emerging knowledge in the field, a more comprehensive evaluation of biomarkers within the patient's microbiome, from stool-based microbial metabolites to those in plasma and those present in exhaled breath, when coupled with clinical metadata and machine learning, could lead to a more deterministic assessment of an individual's risk for a poor outcome and those factors that are modifiable. The aim of this piece is to examine how measurable elements of the social determinants of health and the life history of the patient may be buried within the ecologic memory of the gut microbiome. Here we posit that interrogation of the gut microbiome in this manner may be used to inform novel approaches to drive recovery following a surgical injury.
Eastern Association for the Surgery of Trauma system wellness white paper: An evaluation of wellness from a systems perspective
Authors: Appelbaum Rachel D. , Butler Dale , Stirparo Joseph J. , Coleman Jamie , Hartwell Jennifer L. , Cunningham Kyle ,   EAST Quality, Safety, and Outcomes Committee
Published: March 2024

Providers are charged with responsibility to maintain their own health and wellness; however, well-being is multifactorial and the construct lacks clarity. In the current state of health care, burnout is on the rise with increasing demands for clinical productivity and strained system resources. The health care industry has recognized wellness’s patient safety and financial impact, recently applying research and resources to identify sustainable solutions. We reviewed the wellness literature with a focus on systems to provide a framework for consensus building for a quality acute care surgery system. Our review revealed several areas within system wellness for consideration: (1) provider wellness, (2) culture of safety, (3) learning health systems, and (4) organizational perspectives. We provide specific system recommendations for the acute care surgery practice to preserve our workforce by creating a system that works for its providers.
Urbanization and psychosis: an update of recent evidence
Authors: Grover Sandeep , Varadharajan Natarajan , Venu Sandesh
Published: March 2024

Purpose of review

Urbanization, a complex global phenomenon, has a significant bearing on schizophrenia/psychosis burden through various socioeconomic and environmental factors. This review focuses on recent evidence (2019–2023) linking urbanization, schizophrenia, and the role of green space.

Recent findings

This review analyzed 43 articles that examined the correlation between urban birth or upbringing, urban living (urbanicity), and various schizophrenia/psychosis-related outcomes such as incidence, psychotic experiences, etc. The studies showed differing results across geographical locations. Socioeconomic factors like area deprivation, migrant status (ethnic density) and social fragmentation were independently associated with the risk of schizophrenia/psychosis irrespective of urbanicity. More recently, environmental factors such as green space reduction and air pollution have been explored in urban living conditions and were positively associated with an increased risk of schizophrenia/psychosis.

There is a need for further investigation in low and middle-income countries. The impact of urbanization-related factors and green space on the risk of schizophrenia/psychosis calls for appropriate governmental commitments toward structured and healthy urban planning.
Causal link between gut microbiome and schizophrenia: a Mendelian randomization study
Authors: Zeng Qi , Zhang Min , Wang Renxi
Published: March 2024

Objective

Some observational studies have shown that gut microbiome is significantly changed in patients with schizophrenia. We aim to identify the genetic causal link between gut microbiome and schizophrenia.

Methods

A two-sample Mendelian randomization (MR) study was used to evaluate the causal link between gut microbiome and schizophrenia with 28 gut microbiome-associated genetic instrumental variants chosen from recent MR reports and the largest schizophrenia genome-wide association studies (8-Apr-22 release).

Results

Inverse variance weighted method showed that genetically increased Bacteroidales_S24-7 (per SD) resulted in increased risk of schizophrenia (OR = 1.110, 95% CI: [1.012–1.217], P = 0.027). Similarly, genetically increased Prevotellaceae promoted schizophrenia risk (OR = 1.124, 95% CI: [1.030–1.228], P = 0.009). However, genetically increased Lachnospiraceae reduced schizophrenia risk (OR = 0.878, 95% CI: [0.785–0.983], P = 0.023). In addition, schizophrenia risk was also suppressed by genetically increased Lactobacillaceae (OR = 0.878, 95% CI: [0.776–0.994], P = 0.040) and Verrucomicrobiaceae (OR = 0.860, 95% CI: [0.749–0.987], P = 0.032). Finally, we did not find any significant results in the causal association of other 23 gut microbiome with schizophrenia.

Conclusion

Our analysis suggests that genetically increased Bacteroidales_S24-7 and Prevotellaceae promotes schizophrenia risk, whereas genetically increased Lachnospiraceae, Lactobacillaceae, and Verrucomicrobiaceae reduces schizophrenia risk. Thus, regulation of the disturbed intestinal microbiota may represent a new therapeutic strategy for patients with schizophrenia.
Novel automated antifungal susceptibility testing system for yeasts based on dual-detection algorithm of turbidimetry and colorimetry
Authors: Shen Tingting , Liu Piao , Chen Dongmiao , Liu Duoduo , Fang Juan , Wang Qian , Xu Yinjuan , Tan Chunjuan , Wang Congrong
Published: March 2024

Introduction. The increasing prevalence and growing resistance of fungi present a significant peril to public health. There are only four classes of antifungal medicines available today, and few candidates are in clinical trials.

Hypothesis/Gap Statement. Rapid and sensitive diagnostic techniques are lacking for most fungal pathogens, and those that do exist are expensive or hard to obtain.

Aim. This study aimed to evaluate the feasibility of a novel automated antifungal susceptibility testing system, Fungus AST, in comparison to the broth microdilution method (BMD) recommended by the Clinical and Laboratory Standards Institute (CLSI).

Methodology. A total of 101 clinical Candida spp. isolates were collected from the Zengcheng Branch of Nanfang Hospital and subjected to antifungal susceptibility testing. Antifungal susceptibility was assessed using the Fungus AST method and the BMD.

Results. In this study, we introduce a novel automated antifungal susceptibility testing system, Fungus AST, which detects the turbidity and/or colour intensity of microdilution wells using a four-wavelength detection technology in real time and is designed to match the growth characteristics of strains over time. Based on our analysis, all reportable ranges of Fungus AST were suitable for clinical fungal isolates in PR China. Within ±twofold dilutions, reproducibility was 100 %. Considering the BMD as a referenced method, ten antifungal agents (anidulafungin, caspofungin, micafungin, fluconazole, voriconazole, posaconazole, itraconazole, amphotericin B, 5-flucytosine and nystatin) showed an essential agreement of >95 %. The category agreement of five antifungal agents (anidulafungin, caspofungin, micafungin, fluconazole and voriconazole) was excellent at >90 %. One Candida albicans isolate and voriconazole showed a major error (ME) (1.7 %), and no other ME or very ME agents were found.

Conclusion. Given the above, it can be argued that the utilization of Fungus AST is a discretionary automated approach. More improvements are needed in Fungus AST compared to the BMD system for a wider range of clinical isolates, including different types of fungi.