bluuebunny/crossref_metadata_2025 huggingface dataset:
Compositional and Functional Alterations in Intestinal Microbiota in Patients with Psychosis or Schizophrenia: A Systematic Review and Meta-analysis
Authors: Murray Nuala , Al Khalaf Sukainah , Bastiaanssen Thomaz F S , Kaulmann David , Lonergan Edgar , Cryan John F , Clarke Gerard , Khashan Ali S , O’Connor Karen
Published: May 2023

Background and Hypothesis

Intestinal microbiota is intrinsically linked to human health. Evidence suggests that the composition and function of the microbiome differs in those with schizophrenia compared with controls. It is not clear how these alterations functionally impact people with schizophrenia. We performed a systematic review and meta-analysis to combine and evaluate data on compositional and functional alterations in microbiota in patients with psychosis or schizophrenia.

Study design

Original studies involving humans and animals were included. The electronic databases PsycINFO, EMBASE, Web of Science, PubMed/MEDLINE, and Cochrane were systematically searched and quantitative analysis performed.

Study results

Sixteen original studies met inclusion criteria (1376 participants: 748 cases and 628 controls). Ten were included in the meta-analysis. Although observed species and Chao 1 show a decrease in diversity in people with schizophrenia compared with controls (SMD = −0.14 and −0.66 respectively), that did not reach statistical significance. We did not find evidence for variations in richness or evenness of microbiota between patients and controls overall. Differences in beta diversity and consistent patterns in microbial taxa were noted across studies. We found increases in Bifidobacterium, Lactobacillus, and Megasphaera in schizophrenia groups. Variations in brain structure, metabolic pathways, and symptom severity may be associated with compositional alterations in the microbiome. The heterogeneous design of studies complicates a similar evaluation of functional readouts.

Conclusions

The microbiome may play a role in the etiology and symptomatology of schizophrenia. Understanding how the implications of alterations in microbial genes for symptomatic expression and clinical outcomes may contribute to the development of microbiome targeted interventions for psychosis.
Theorizing Potential Downstream Cultural Consequences of LGBT+ Activism
Authors: Ayoub Phillip M , Page Douglas , Whitt Samuel
Published: May 2023

To what extent does local LGBT+ activism have impacts beyond its immediate surroundings? We offer a theoretical framework emphasizing how a combination of local movement visibility and LGBT+ cultural receptivity can account for disseminating influences of LGBT+ activism. We illustrate our framework in part through an analysis of the potential diffusion of LGBT+ support in Bosnia in the aftermath of the country’s first-ever Pride. Our model explains why the 2019 Sarajevo Pride increased LGBT+ support locally but had no immediate effects on attitudes in greater Bosnia. It also explains why LGBT+ support has since expanded beyond the capital to Bosnia’s surrounding regions in a follow-up 2021 study. Even when local LGBT+ visibility is low or nonexistent, underlying cultural receptivity can be conducive to the gradual diffusion of LGBT+ support. Moreover, the challenging circumstances of the pandemic did not undermine the expansion of LGBT+ tolerance across Bosnia. Our findings illustrate the persistent power as well as limitations of LGBT+ activism to usher in downstream cultural change.
Selective events at individual sites underlie the evolution of monkeypox virus clades
Authors: Molteni Cristian , Forni Diego , Cagliani Rachele , Arrigoni Federica , Pozzoli Uberto , De Gioia Luca , Sironi Manuela
Published: May 2023

In endemic regions (West Africa and the Congo Basin), the genetic diversity of monkeypox virus (MPXV) is geographically structured into two major clades (Clades I and II) that differ in virulence and host associations. Clade IIb is closely related to the B.1 lineage, which is dominating a worldwide outbreak initiated in 2022. Lineage B.1 has however accumulated mutations of unknown significance that most likely result from apolipoprotein B mRNA editing catalytic polypeptide-like 3 (APOBEC3) editing. We applied a population genetics—phylogenetics approach to investigate the evolution of MPXV during historical viral spread in Africa and to infer the distribution of fitness effects. We observed a high preponderance of codons evolving under strong purifying selection, particularly in viral genes involved in morphogenesis and replication or transcription. However, signals of positive selection were also detected and were enriched in genes involved in immunomodulation and/or virulence. In particular, several genes showing evidence of positive selection were found to hijack different steps of the cellular pathway that senses cytosolic DNA. Also, a few selected sites in genes that are not directly involved in immunomodulation are suggestive of antibody escape or other immune-mediated pressures. Because orthopoxvirus host range is primarily determined by the interaction with the host immune system, we suggest that the positive selection signals represent signatures of host adaptation and contribute to the different virulence of Clade I and II MPXVs. We also used the calculated selection coefficients to infer the effects of mutations that define the predominant human MPXV1 (hMPXV1) lineage B.1, as well as the changes that have been accumulating during the worldwide outbreak. Results indicated that a proportion of deleterious mutations were purged from the predominant outbreak lineage, whose spread was not driven by the presence of beneficial changes. Polymorphic mutations with a predicted beneficial effect on fitness are few and have a low frequency. It remains to be determined whether they have any significance for ongoing virus evolution.
Neonicotinoid Seed Treatments Influence Soil Nematode Taxonomic Composition and the Soil Microbial Cooccurrence Networks
Authors: Parizadeh Mona , Kembel Steven W. , Mimee Benjamin
Published: May 2023

Neonicotinoid insecticides are widely used to control early-season and foliar-feeding pests. Some studies have revealed their nontarget impacts on pollinators and other invertebrates but few investigated their effects on soil microbiota. Given the crucial role of soil prokaryotic and eukaryotic microbial communities in agroecosystem regulation and their contribution to soil fertility, it is critical to understand their structure and changes in response to disturbances such as pesticide application. Among these communities, free-living nematodes have the potential to indicate the ecological changes in soil caused by environmental stress and have a key role in forming and modulating soil microbial composition and function by feeding on other soil microorganisms or interacting with them. Here, we used 18S ribosomal RNA gene amplicon sequencing to characterize the effects of neonicotinoids on soil nematode communities in a 3-year soybean-corn crop rotation in Quebec, Canada. We also quantified the changes in nematode-bacteria cooccurrence networks in soil exposed to neonicotinoids. We found that neonicotinoid seed treatment significantly explained variation in nematode community composition and affected the relative abundance of some nematode families, such as a decrease in the omnivorous family Dorylaimidae in neonicotinoid-treated samples. Moreover, neonicotinoids altered the patterns of nematode-bacteria cooccurrence, including the structure and taxonomic composition of the networks. However, it is unclear whether neonicotinoids affected bacterial cooccurrence networks directly, or indirectly by affecting nematodes that feed on bacteria. Further research is needed to understand how neonicotinoids affect nematodes and the role of nematodes in microbial network variation in soil exposed to neonicotinoids.
Molecular Mapping of Yr85 and Comparison with Other Genes for Resistance to Stripe Rust on Wheat Chromosome 1B
Authors: Feng Junyan , Yao Fangjie , Wang Meinan , See Deven R. , Chen Xianming
Published: May 2023

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici, is one of the most serious plant diseases worldwide. Resistant cultivars are the most effective way to control the disease. YrTr1 is an important stripe rust resistance gene that has been used in wheat breeding programs and is represented in the host differential set to identify P. striiformis f. sp. tritici races in the United States. To map YrTr1, AvSYrTr1NIL was backcrossed to its recurrent parent Avocet S (AvS). Seedlings of BC7F2, BC7F3, and BC8F1 populations were tested with YrTr1-avirulent races under controlled conditions, and BC7F2 plants were genotyped using simple sequence repeat (SSR) and single nucleotide polymorphism (SNP) markers. YrTr1 was mapped to the short arm of chromosome 1B using four SSR and seven SNP markers. The genetic distances of YrTr1 from the nearest flanking markers IWA2583 and IWA7480 were 1.8 and 1.3 centimorgans (cM), respectively. DNA amplification of a set of 21 Chinese Spring (CS) nulli-tetrasomic lines and seven CS 1B deletion lines with three SSR markers confirmed the chromosome arm location and further placed the gene in chromosomal bin region 1BS18 (0.5). The gene was determined to be about 7.4 cM proximal to Yr10. Based on multirace response array and chromosomal location, YrTr1 was determined to be different from other permanently named stripe rust resistance genes in chromosome arm 1BS and was named Yr85.
The End of Roe v Wade and New Legal Frontiers on the Constitutional Right to Abortion
Authors: Cohen I.G. , Murray M. , Gostin L.O.
Published: May 2023

(JAMA. 2022;328:325–326)

In the case Dobbs v Jackson Women’s Health Organization in 2022, the US Supreme Court ended the right to abortion established in 1973 with Roe v Wade. The court majority argued that abortion is not referenced in the constitution, is not “implicit in the concept of ordered liberty,” and that the issue should be resolved in each state by voters.
Risk of Preterm Birth, Small for Gestational Age at Birth, and Stillbirth After COVID-19 Vaccination During Pregnancy: Population-based Retrospective Cohort Study
Authors: Fell D.B. , Dimanligh-Crez S. , Regan A.K. , Haberg S.E. , Christopher A.G. , Oakley L. , Alton G.D. , Torok E. , Dhinsa T. , Shah P.S. , Wilson K , Sprague A.E. , El-Chaar D. , Walker M.C. , Barrett J. , Okun N. , Buchan S.A. , Kwong J.C. , Wilson S.E. , Dunn S.I. , MacDonald S.E. , Dougan S.D.
Published: May 2023

(BMJ. 2022;378:e071416)

COVID-19 infection during pregnancy increases the risk of preterm birth, fetal growth restriction, postpartum hemorrhage, and stillbirth pregnancies. In addition, women of reproductive age also remain among the lowest to seek the SARS-CoV-2 vaccine since Canada’s introduction of vaccines on December 14, 2020, possibly due to pregnancy risk claims. This study retrospectively researched preterm births, small for gestational age (SGA) births, and stillbirths and the COVID-19 vaccine.
Opioid Dispensing After Cesarean Delivery in British Columbia: A Historical Cohort Analysis From 2004 to 2019
Authors: Ziafat K. , Polderman S. , Nabavi N. , Preston R. , Chau A. , Krausz M.R. , Schwarz S.K.W. , Maclure M.
Published: May 2023

(Can J Anesth/J Can Anesth. 2022;69:997–1006)

Opioids have been overprescribed in North America, including in the field of obstetrics, over the past two decades. Cesarean delivery (CD) is the most common inpatient surgery performed in Canada and opioids are commonly prescribed at discharge to post-CD patients. In 2008, a warning was issued by Health Canada against the use of codeine in mothers who were breastfeeding. A recent study based in the United States found that opioid prescribing practices varied most by the hospital, rather than current recommendations or patient factors. This study used the Surgical Quality Outcome Reports (SQOR) study and the SQOR Extension Study to identify post-CD prescribing patterns among hospitals, hospital type, and hospital location, to inform quality improvement efforts.
Natural Language Processing of Admission Notes to Predict Severe Maternal Morbidity During the Delivery Encounter
Authors: Clapp M.A. , Kim E. , James K.E. , Perlis R.H. , Kaimal A.J. , McCoy T.H.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:511.e1–511.e8)

Natural language processing (NLP) is a machine learning technique that has been shown to enhance clinical prediction tasks with improved outcomes. This newer strategy is under investigation for its contribution to address severe maternal morbidity (SMM) beyond already in place predelivery planning, communication, and consultation. Using data inherently generated at a patient encounter, it is hypothesized that NLP may boost more accurate maternal risk stratification for SMM and allow provider alerts. NLP methods are proposed that stratify all patients into relevant risk pools to facilitate planning for appropriate care and potentially avert adverse outcomes.
A Machine-learning–based Algorithm Improves Prediction of Preeclampsia-associated Adverse Outcomes
Authors: Schmidt L.J. , Rieger O. , Nexanski M. , Hackelöer M. , Dröge L.A. , Henrich W. , Higgins D. , Verlohren S.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:77.e1–30)

Preeclampsia is associated with increased maternal morbidity and mortality. It can be difficult to estimate the severity of preeclampsia and to predict adverse outcomes caused by the disease. A number of biomarkers can be accurate positive predictors for preeclampsia. Previous studies have shown the risk of preeclampsia can be more accurately predicted using a multifactorial analysis with patients’ medical history data and current health data. The current study aimed to demonstrate that using machine-learning with this data can more accurately predict adverse outcomes compared to traditional models.
Hypertension in Pregnancy and Adverse Outcomes Among Low-risk Nulliparous Women Expectantly Managed at or After 39 weeks: A Secondary Analysis of a Randomized Controlled Trial
Authors: Bartal M.F. , Premkumar A. , Rice M.M. , Reddy U.M. , Tita A.T.N. , Silver R.M. , El-Sayed Y.Y. , Wapner R.J. , Rouse D.J. , Saade G.R. , Thorp J.M. , Constantine M.M. , Chien E.K. , Casey B.M. , Srinivas S.K. , Swamy G.K. , Simhan H.N.
Published: May 2023

(BJOG. 2022;129:1396–1403)

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality. A recent study compared low-risk patients at 39 weeks gestation who were expectantly managed versus those who were induced and found those who were induced had a lower risk of developing HDP. This study aimed to compare the prevalence of the adverse perinatal and maternal outcomes among expectantly managed low-risk patients who developed HDP with those who did not.
Antenatal Betamethasone Regimen for Women at Risk of Preterm Birth
Authors: Melamed N. , Asztalos E.
Published: May 2023

(Lancet. 2022;400:542–543)

For more than 50 years, antenatal betamethasone has been used as a treatment to reduce neonatal respiratory complications. Evaluating a more recent study examining the risk-to-benefit ratio of the treatment regimen, this article aimed to understand if the dosage of steroids should be reduced in order to minimize risk to the fetus from being exposed to corticosteroids in utero. Some recent studies have indicated correlation between treatment with betamethasone and some physical, mental, or developmental disorders.
Guidelines for Pregnant Individuals With Monkeypox Virus Exposure
Authors: Dashraath P. , Nielsen-Saines K. , Mattar C. , Musso D. , Tambyah P. , Baud D.
Published: May 2023

(Lancet. 2022;400:21–22)

Monkeypox has recently gained a lot of attention because of its sudden transmission levels in nonendemic countries. Previous interactions of pregnant patients and the monkeypox virus have been recorded. This article describes past cases and uses this information to detail the possible impact of the monkeypox virus on a fetus as well as recommended methods for testing and treating exposed and positive pregnant individuals.
Buprenorphine Versus Methadone for Opioid Use Disorder in Pregnancy
Authors: Suarez E.A. , Huybrechts K.F. , Straub L. , Bateman B.T.
Published: May 2023

(N Engl J Med. 2022;387:2033–2044)

Opioid use during pregnancy has been on the rise since 2000. The standard care for opioid use disorder during pregnancy is either buprenorphine or methadone treatment, which both have been shown to improve maternal and neonatal outcomes. Buprenorphine may have greater benefits, yet data is limited. This study aimed to analyze the risk of adverse outcomes for mother and baby with buprenorphine treatment compared to methadone treatment for opioid use during pregnancy.
Early Amino Acids in Extremely Preterm Infants and Neurodisability at 2 Years
Authors: Bloomfield F.H. , Jiang Y. , Harding J.E. , Crowther C.A. , Cormack B.E. ,   ProVIDe Trial Group
Published: May 2023

(N Engl J Med. 2022;387:1661–1672)

Adequate fetal amino acid intake is an essential part of proper growth and development in utero. Despite its importance, the optimal protein intake for extremely low birth weight (<1000 g) infants has yet to be determined. The primary aim of this study is to determine whether an additional intake of 1 g per day of amino acids in extremely low birth weight infants beginning within 24 hours of delivery through the first 5 days of life will increase 2-year survival rates of children without neurodisability, adjusting for gestational age at the time of delivery. Secondary aims are to determine what neonatal morbidity and growth outcomes are associated with the additional intake of 1 g per day of amino acids in the same patient population.
The Incidence of Breakthrough Pain Associated With Programmed Intermittent Bolus Volumes for Labor Epidural Analgesia: A Randomized Controlled Trial
Authors: Zuo R.H. , Dang J.J. , Zhuang J.W. , Chen Q.M. , Zhang J.Y. , Zheng H.W. , Wang Z.P.
Published: May 2023

(Int J Obstet Anesth. 2022;51:103571)

Previously, ideal programmed intermittent epidural bolus (PIEB) doses were unknown despite the wide belief that use of PIEB may reduce local anesthetic use, improve quality of analgesia and maternal satisfaction, and reduce motor block compared with continuous epidural infusion. This study compared 3 different dosages of a PIEB to determine impact on breakthrough pain and other labor analgesia factors.
Evaluation of a Quality Improvement Bundle Aimed to Reduce Opioid Prescriptions After Cesarean Delivery: An Interrupted Time Series Study
Authors: Laksono I. , Matelski J. , Flamer D. , Gold S. , Selk A.
Published: May 2023

(Can J Anesth/J Can Anesth. 2022;69:1007–1016)

There are efforts from the medical community and the public to reduce the prescription of opioids in the United States and Canada. Quality improvement (QI) initiatives have been successfully used to reduce opioid prescriptions in patients undergoing cesarean delivery (CD). This study assessed opioid prescribing rates following a quality improvement initiative, hypothesizing there would be a lower rate of opioid prescription in post-CD patients following implementation of the QI bundle.
A 31-Year-Old Woman With Postpartum Abdominal Pain and Fever
Authors: Little S.E. , Catalano O.A. , Edlow A.G. , Shroff S.G.
Published: May 2023

(N Engl J Med. 2022;387:2367–2375)

This case presented 15 days after the patient’s vaginal delivery of a healthy baby, when she was admitted to the hospital with abdominal pain and fever. Sixteen days prior, spontaneous labor had been augmented by artificial membrane rupture (showing clear, odorless fluid) and oxytocin infusion. An elevated white-cell count was noted (13,800/mL, 4500 to 11,000/mL reference range) and intravenous penicillin was administered. Hemoglobin was noted to be 14.0 g/dL (12.0 to 16.0 g/dL reference range). Delivery occurred 6 hours later, followed immediately by uterine atony hemorrhage with 500 mL of blood loss. Hemostasis was achieved by bimanual massage of the uterus, and administration of oxytocin and methylergonovine. A routine repair of a perineal laceration was also performed. The patient discharged from the hospital on postpartum day 1.
Effect of COVID-19 pandemic on blood transfusion service: an experience from a regional blood transfusion center
Authors: Thakur Sanjay K. , Sinha Anil K. , Negi Dinesh K. , Singh Sompal
Published: May 2023

The unforeseen and uncertain life-threatening situation of the COVID-19 pandemic dramatically affected all areas of the human daily work schedule. This study was designed to assess the impact of the COVID-19 pandemic on blood transfusion services and discuss the adopted confrontation measures for uninterrupted blood supply during the pandemic situation. The data on blood donation, blood component preparation, and issue from January 2019 to December 2022 were collected from the inventory registers of the RBTC, Delhi, India. Compared to the non-pandemic year 2019, during the year 2020, all variables decreased gradually. The observed maximum decrease in variables such as blood collection (–79.16%) in the month of October, blood issue (–71.61%) in the month of August, random donor platelets (RDP) preparation (–98.09%) in the month of October, RDP issue (–86.08%) in the month of September, fresh frozen plasma (FFP) preparation (–100%) in the month of October, and FFP issue (–96.08%) in the month of July with an annual decrease of –45.52%, –42.87%, –33.00%, –59.79%, –40.98%, and –54.48%, respectively, as compared to year 2019. Compared to year 2020, in year 2021, the annual increase in blood collection, blood issue, FFP preparation, FFP issue, RDP preparation, and RDP issue was +50.20%, +21.68%, +65.31%, +78.52%, +116.23%, and +213.30%, respectively. Our study results show that the COVID-19 pandemic has significantly affected blood transfusion services at our blood bank. The adopted coping strategies to maintain the safe and uninterrupted blood transfusion chain at our blood bank gave us lessons for future preparedness if faced with a similar situation.
Correction of Breast Ptosis in Immediate Breast Reconstruction
Authors: Bushong Elizabeth E. , Komorowska-Timek Ewa D. , Parker Jessica
Published: May 2023

Background:

Nipple-sparing mastectomy is psychologically advantageous and can result in superior cosmetic outcomes. However, nipple position adjustment is challenging, and ischemic complications may arise. For patients who require timely mastectomies and reconstructions, concurrent mastopexy may prevent nipple malposition and reduce the risk for future corrections.

Methods:

A retrospective chart review of all patients undergoing immediate prosthetic reconstruction after nipple-sparing mastectomy were analyzed. Data regarding patient characteristics; surgical indications; reconstructive modality, including presence or absence of simultaneous nipple lift; and early and late complications were examined.

Results:

In total, 142 patients underwent 228 nipple-sparing mastectomies and prosthetic reconstructions. Correction of ptosis (lift) was performed in 22 patients and 34 breasts. The remaining 122 patients and 194 breasts did not receive mastopexy (no-lift). Two patients received bilateral reconstructions involving both lift and no-lift. Comparing the lift and no-lift cohorts demonstrated no differences in major complications (47.1% versus 57.7%; P = 0.25) and minor complications (76.5% versus 74.7%; P = 0.83). Control for plane of implant placement also did not show differences in major (P = 0.31) or minor (P = 0.97) complications. Similarly, control of application of acellular dermal matrix found major (P = 0.25) and minor (P = 0.83) complications uniform and not affected by lift status. Nipple lift distance was not associated with increased major (P = 0.10) complications.

Conclusion:

Simultaneous correction of nipple position in immediate prosthetic breast reconstruction seem safe with uniform complications rates that are unaffected by acellular dermal matrix use or plane of implant placement.
Fertility-sparing Scrotal Reconstruction with a Superficial Circumflex Iliac Perforator Flap
Authors: Ando Nobuhiro , Akita Shinsuke , Mitsukawa Nobuyuki
Published: May 2023

It is believed that skin flaps should not be used to reconstruct large scrotal defects because thick flaps increase testicular temperature and decrease fertility, and those skin grafts should be used to reconstruct large scrotal defects. We report a case of extensive scrotal defect reconstructed with bilateral superficial circumflex iliac perforator (SCIP) flaps in which spermatogenesis improved postoperatively over time. A 44-year-old man underwent reconstruction of an extensive scrotal defect caused by Fournier gangrene, and bilateral SCIP flaps were used for the reconstruction. In the third postoperative month, his semen volume and sperm count after centrifugation were 1.5 mL and eight, respectively. Based on these semen findings, fertility specialists diagnosed the patient with extremely low fertility. In the ninth postoperative month, the semen volume was 2.2 mL, sperm density was 2.7 × 106/mL, sperm motility was 64%, and normal sperm morphology was 54%, indicating significant improvement. Based on the sperm findings, fertility specialists considered the patient capable of causing pregnancy. There have been no reports of preservation of spermatogenesis after scrotal reconstruction with a thinned perforator flap. In the postoperative period, we observed improvement of spermatogenesis, which suggests that scrotal reconstruction with an SCIP flap may be effective for improving both cosmetic appearance and fertility.
Trends in U.S. HIV Peer Health Worker Training Strategies and Approaches: A Scoping Review of the Literature
Authors: Gormley Maurade , Loughran Claire , Conte Jill , Dunn Navarra Ann-Margaret
Published: May 2023

Peer health workers (peers) are commonly engaged interventionists in the HIV care spectrum. The objective of this scoping review was to examine the range of evidence on training strategies and approaches for peer-led HIV behavioral interventions in the United States. Four electronic databases (Medline, CINAHL, EMBASE, and PsycINFO) were searched for peer-reviewed published literature (2010–2021) of peer-led HIV behavioral interventions directed to improving antiretroviral therapy adherence and/or retention in care. Eighteen studies met the inclusion criteria. Eleven studies referenced manualized training materials, and nine used role-play as part of their curricula. Peer training content and duration varied across studies, as well as evaluation of intervention fidelity, and peer competency. Findings highlight heterogeneity in peer training strategies and approaches. The expansion and sustainability of peer engagement in the HIV care continuum will require greater consensus among members of the research community on best practices for training.
Short-term outcomes following intracorporeal versus extracorporeal anastomosis after laparoscopic right and left-sided colectomy: a propensity score-matched study
Authors: Teramura Koichi , Kitaguchi Daichi , Matsuoka Hiroya , Hasegawa Hiro , Ikeda Koji , Tsukada Yuichiro , Nishizawa Yuji , Ito Masaaki
Published: May 2023

Background:

To compare the short-term outcomes of patients undergoing intracorporeal anastomosis (IA) during laparoscopic colectomy to those undergoing extracorporeal anastomosis (EA).

Methods and Materials:

The study was a single-center retrospective propensity score-matched analysis conducted. Consecutive patients who underwent elective laparoscopic colectomy without the double stapling technique between January 2018 and June 2021 were investigated. The main outcome was overall postoperative complications within 30 days after the procedure. We also performed a sub-analysis of the postoperative results of ileocolic anastomosis and colocolic anastomosis, respectively.

Results:

A total of 283 patients were initially extracted; after propensity score matching, there were 113 patients in each of the IA and EA groups. There were no differences in patient characteristics between the two groups. The IA group had a significantly longer operative time than the EA group (208 vs. 183 min, P=0.001). The rate of overall postoperative complications was significantly lower in the IA group (n=18, 15.9%) than in the EA group (n=34, 30.1%; P=0.02), especially in colocolic anastomosis after left-sided colectomy (IA: 23.8% vs. EA: 59.1%; P=0.03). Postoperative inflammatory marker levels were significantly higher in the IA group on postoperative day 1 but not on postoperative day 7. There was no difference in the postoperative lengths of hospital stay between the two groups, and no deaths occurred.

Conclusion:

The data suggest that performing IA during laparoscopic colectomy can potentially reduce the risk of postoperative complications, especially in colocolic anastomosis after left-sided colectomy.
The Rate of Eustachian Tube Dysfunction in Adult Patients With Chronic Inflammatory Middle Ear Disease Is Low
Authors: Gey Alexandra , Reiber Julia , Honigmann Robert , Zirkler Jonas , Rahne Torsten , Plontke Stefan K.
Published: May 2023

Objective

To assess the rate of dilatory (chronic obstructive) eustachian tube dysfunction (ETD) in adult patients scheduled for surgery for chronic inflammatory middle ear disease.

Patients

We included adult patients with chronic inflammatory middle ear disease (chronic suppurative otitis media, adhesive otitis media [middle ear atelectasis], cholesteatoma). We excluded patients with pathologies that do not stem from ETD (e.g., noninflammatory chronic middle ear disease [e.g., otosclerosis], tumors, solely external auditory canal conditions), patients scheduled for implantable electronic hearing devices independent of disease, patients with otitis media with effusion and scheduled paracentesis or ventilation tubes only, patients with previous radiotherapy or previous balloon eustachian tuboplasty, and children and patients unable to complete questionnaires.

Intervention(s)

We evaluated ETD with Valsalva maneuver and in case of negative or unclear Valsalva with the eustachian tube score (ETS). A negative Valsalva maneuver and an ETS score of 5 or lower were used to define dilatory (chronic obstructive) ETD.

Main Outcome Measure(s)

Rate of ETD in the included patients.

Results

From a total of 482 consecutive patients, 350 patients had positive Valsalva maneuver or ETS score higher than 5. From the 193 patients with negative or unclear Valsalva maneuver, 77 patients had an ETS score of 5 or lower, and 55 rejected further diagnostics with ETS.

Conclusions

Based on a large cohort of adult patients with chronic inflammatory middle ear disease scheduled for middle ear surgery, the majority (82%) seems to have no dilatory (chronic obstructive) ETD that can be detected with current routine clinical methods and tubomanometry. Common pathophysiological explanations should be questioned critically, especially in the context of communication with patients.
Using Stapes Velocity to Estimate the Efficacy of Mechanical Stimulation of the Round Window With an Active Middle Ear Implant
Authors: Tollin Daniel J. , Koka Kanthaiah , Peacock John
Published: May 2023

Objective

To test a method to measure the efficacy of active middle ear implants when coupled to the round window.

Methods

Data previously published in Koka et al. (Hear Res 2010;263:128–137) were used in this study. Simultaneous measurements of cochlear microphonics (CM) and stapes velocity in response to both acoustic stimulation (forward direction) and round window (RW) stimulation (reverse direction) with an active middle ear implant (AMEI) were made in seven ears in five chinchillas. For each stimulus frequency, the amplitude of the CM was measured separately as a function of intensity (dB SPL or dB mV). Equivalent vibrational input to the cochlea was determined by equating the acoustic and AMEI-generated CM amplitudes for a given intensity. In the condition of equivalent CM amplitude between acoustic and RW stimulation-generated output, we assume that the same vibrational input to the cochlea was present regardless of the route of stimulation.

Results

The measured stapes velocities for equivalent CM output from the two types of input were not significantly different for low and medium frequencies (0.25–4 kHz); however, the velocities for AMEI-RW drive were significantly lower for higher frequencies (4–14 kHz). Thus, for RM stimulation with an AMEI, stapes velocities can underestimate the mechanical input to the cochlea by ~20 dB for frequencies greater than ~4 kHz.

Conclusions

This study confirms that stapes velocity (with the assumption of equivalent stapes velocity for forward and reverse stimulation) cannot be used as a proxy for effective input to the cochlea when it is stimulated in the reverse direction. Future research on application of intraoperative electrophysiological measurements during surgery (CM, compound action potential, or auditory brainstem response) for estimating efficacy and optimizing device coupling and performance is warranted.
Cochlear Implantation for Rudimentary Otocysts: Two Case Reports
Authors: Lu Simeng , Wei Xingmei , Kong Ying , Yang Bentao , Dhanasingh Anandhan , Li Yongxin
Published: May 2023

Objective

Rudimentary otocyst (RO) is characterized by an otic capsule without an internal auditory canal, which is considered a contraindication to cochlear implantation (CI). In this study, we were the first to report two patients with ROs who underwent CI.

Patient

Two patients (18 months old and 2 years old) presenting with bilateral congenital hearing loss were diagnosed with ROs.

Intervention

CI was performed. The transmastoid slotted labyrinthotomy approach was used with customized MED-EL electrode arrays.

Main Outcome Measures

Categorical auditory performance, infant-toddler meaningful auditory integration of sound, the speech intelligibility rating, and meaningful use of speech scale.

Results

Both children could understand common phrases and had intelligible, connected speech 2 years after CI.

Conclusion

With proper indication, surgical approach and postoperative training, a child with an RO may benefit from CI.
An overview of hydrocephalus and shunts used in the clinical management of hydrocephalus
Authors: Jakiela Julia , Billavara Minaal , Kaliaperumal Chandrasekaran , Kumar Arun
Published: May 2023

As hydrocephalus is a complex neurological condition with significant clinical implications, we believe that this review article is timely to provide a comprehensive overview of shunts used in neurosurgery. This article delves into the etiology, clinical presentation, and challenges associated with hydrocephalus, while focusing primarily on the surgical placement of shunt systems as a key management strategy. We believe that this review will offer valuable insights to clinicians and researchers involved in the management of hydrocephalus. It will provide an in-depth understanding of different shunt systems, their specific characteristics, and associated advantages and limitations, thus empowering clinicians to make informed decisions tailored to individual patients.
Ultrasonographic Identification of Shell Surface Types in Commercially Available Silicone Gel-Filled Breast Implants
Authors: Herrera-Mora Giovanni , Solis-Chaves Pablo , Hernandez-Aviles Georgina , Graham Emma-Jane M. , Clausen-Oreamuno Christine , Castro-Cespedes Jose Andres , Haupt Jennifer , Jamiel Morgan , Veiseh Omid , Sforza Marcos , Hancock John , Kinney Brian , De Mezerville Roberto , Langer Robert , Doloff Joshua C. , Chacon-Quiros Manuel
Published: May 2023

Background

Breast implant safety issues have resulted in the need for global product recalls and medical device tracing. Conventional methods of breast implant tracing, have to date proven to be unsuccessful. This study aims to evaluate the effectiveness of HRUS screening in identifying implanted breast devices.

Methods

Data from 113 female patients undergoing pre-operative ultrasound screening for secondary breast surgery between 2019 and 2022 was prospectively reviewed to evaluate the effectiveness of HRUS imaging with the aid of a Sonographic Surface Catalog to identify the surface and brand type of implanted breast devices.

To corroborate the findings and assess the reproducibility of the approach, further evaluations were replicated in New Zealand white rabbits and compared to the results found in humans.

Results:

In the human recipients, implant surface and brand types were correctly identified by ultrasound imaging in 99% (112/113) and 96% (69/72) of the cases, either consultation-only or revision, respectively. This constituted an overall success rate of 98% (181/185). Further, in a corroborating New Zealand White rabbit model where full-scale commercial implants were introduced and monitored over many months, from the total 28 analyzed, the surface was accurately identified in a total of 27 cases (the one failure being prior to generation of an SSC), demonstrating an overall success rate of 96.4%.

Conclusions

HRUS is, therefore, a valid and first-hand tool for breast implant imaging that can correctly evaluate both surface type and brand type alongside other variables such as implant placement, positioning, flipping, or rupture.

Clinical Relevance Statement:

High-resolution ultrasound is a valid and first-hand tool for the identification and traceability of breast implants that evaluates surface type and brand type. These low-cost, accessible, and reproducible practice provides patients with peace of mind and surgeons with a promising diagnostic tool.
Outcomes of Primary Furlow Double-Opposing Z-plasty for the Treatment of Symptomatic Submucous Cleft Palate
Authors: Pitkänen Veera , Szwedyc Anika , Alaluusua Suvi , Geneid Ahmed , Vuola Pia , Saarikko Anne
Published: May 2023

Background:

Submucous cleft palate (SMCP) requires surgical repair if symptomatic. The Furlow double-opposing Z-plasty is the preferred method in Helsinki cleft center.

Aims:

To assess the efficacy and complications of Furlow Z-plasty in the treatment of symptomatic SMCP.

Methods:

This retrospective study reviewed documentation of 40 consecutive patients with symptomatic SMCP who underwent primary Furlow Z-plasty by 2 high-volume cleft surgeons at a single center between 2008 and 2017. Patients underwent perceptual and instrumental evaluation of velopharyngeal function (VPF) by speech pathologists preoperatively and postoperatively.

Results:

The median age at Furlow Z-plasty was 4.8 years (SD 2.6, range 3.1–13.6). The overall success rate, including postoperative competent or borderline competent VPF, was 83%, and 10% required secondary surgery for residual velopharyngeal insufficiency. The success rate was 85% in nonsyndromic, and 67% in syndromic patients with no significant difference (P=0.279). Complications arose in only 2 (5%) patients. No children were found to have obstructive sleep apnea postoperatively.

Conclusion:

Furlow primary Z-plasty is a safe and effective operation for symptomatic SMCP with a success rate of 83% with only 5% rate of complications.
Viral Hepatitis Necessitating Liver Transplantation in Children
Authors: Valamparampil Joseph , Kelly Deirdre
Published: May 2023

Viral hepatitis accounts for a significant global disease burden and mortality, both in children and adults. There are significant differences in the viral etiology, epidemiology, and complications in children worldwide. Children of all ages may have devastating complications with a significant risk of mortality and long-term morbidity because of viral hepatitis. Liver transplantation is the only curative option for pediatric patients with end-stage liver disease, hepatocellular carcinoma, or acute liver failure because of viral hepatitis. The introduction of universal vaccination for hepatitis B across the world and hepatitis A in some countries had led to significant changes in the incidence of disease and the need for liver transplantation for the complications of viral hepatitis in children. The development of effective treatment with directly acting antiviral agents for hepatitis C has already transformed outcomes in adults and children and reduced the need for liver transplantation. Although newer therapy for hepatitis B is being evaluated in adults, current therapy for children is not curative, indicating the need for lifelong therapy and potential necessity for liver transplantation. The recent epidemic of acute hepatitis in children across the world has highlighted the importance of understanding the etiology of unusual causes for acute liver failure and the urgent need for liver transplantation.
Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
Authors: Halle-Smith James M. , Hall Lewis , Hann Angus , Arshad Asif , Armstrong Matthew J. , Bangash Mansoor N. , Murphy Nick , Cuell James , Isaac John L. , Ferguson James , Roberts Keith J. , Mirza Darius F. , Perera M. Thamara P. R.
Published: May 2023

Background.

Primary nonfunction (PNF) is a life-threatening complication of liver transplantation (LT), but in the early postoperative period, it can be difficult to differentiate from early allograft dysfunction (EAD). The aim of this study was to determine if serum biomarkers can distinguish PNF from EAD in the initial 48 h following LT.

Materials and Methods.

A retrospective study of adult patients that underwent LT between January 2010 and April 2020 was performed. Clinical parameters, absolute values and trends of C-reactive protein (CRP), blood urea, creatinine, liver function tests, platelets, and international normalized ratio in the initial 48 h after LT were compared between the EAD and PNF groups.

Results.

There were 1937 eligible LTs, with PNF and EAD occurring in 38 (2%) and 503 (26%) patients, respectively. A low serum CRP and urea were associated with PNF. CRP was able to differentiate between the PNF and EAD on postoperative day (POD)1 (20 versus 43 mg/L; P < 0.001) and POD2 (24 versus 77; P < 0.001). The area under the receiver operating characteristic curve (AUROC) of POD2 CRP was 0.770 (95% confidence interval [CI] 0.645-0.895). The urea value on POD2 (5.05 versus 9.0 mmol/L; P = 0.002) and trend of POD2:1 ratio (0.71 versus 1.32 mmol/L; P < 0.001) were significantly different between the groups. The AUROC of the change in urea from POD1 to 2 was 0.765 (95% CI 0.645-0.885). Aspartate transaminase was significantly different between the groups, with an AUROC of 0.884 (95% CI 0.753-1.00) on POD2.

Discussion.

The biochemical profile immediately following LT can distinguish PNF from EAD; CRP, urea, and aspartate transaminase are more effective than ALT and bilirubin in distinguishing PNF from EAD in the initial postoperative 48 h. Clinicians should consider the values of these markers when making treatment decisions.
Steroid Avoidance After Adult Living Donor Liver Transplant: A Cohort Analysis
Authors: Nunez Miguel , Praglin Claudia R. , Torres Ana M. , Agudelo Eliana Z. , Braun Hillary J. , Huang Chiung-Yu , Syed Shareef , Roberts John P. , Roll Garrett R.
Published: May 2023

Background.

Although steroid avoidance (SA) has been studied in deceased donor liver transplant, little is known about SA in living donor liver transplant (LDLT). We report the characteristics and outcomes, including the incidence of early acute rejection (AR) and complications of steroid use, in 2 cohorts of LDLT recipients.

Methods.

Routine steroid maintenance (SM) after LDLT was stopped in December 2017. Our single-center retrospective cohort study spans 2 eras. Two hundred forty-two adult recipients underwent LDLT with SM (January 2000–December 2017), and 83 adult recipients (December 2017–August 2021) underwent LDLT with SA. Early AR was defined as a biopsy showing pathologic characteristics within 6 mo after LDLT. Univariate and multivariate logistic regressions were performed to evaluate the effects of relevant recipient and donor characteristics on the incidence of early AR in our cohort.

Results.

Neither the difference in early AR rate between cohorts (SA 19/83 [22.9%] versus SM 41/242 [17%]; P = 0.46) nor a subset analysis of patients with autoimmune disease (SA 5/17 [29.4%] versus SM 19/58 [22.4%]; P = 0.71) reached statistical significance. Univariate and multivariate logistic regressions for early AR identified recipient age to be a statistically significant risk factor (P < 0.001). Of the patients without diabetes before LDLT, 3 of 56 (5.4%) on SA versus 26 of 200 (13%) on SM needed medications prescribed for glucose control at the time of discharge (P = 0.11). Patient survival was similar between SA and SM cohorts (SA 94% versus SM 91%, P = 0.34) 3 y after transplant.

Conclusions.

LDLT recipients treated with SA do not exhibit significantly higher rates of rejection or increased mortality than patients treated with SM. Notably, this result is similar for recipients with autoimmune disease.
The Trend of Serum Creatinine Does Not Predict Follow-Up Biopsy Findings Among Kidney Transplant Recipients With Antibody-Mediated Rejection
Authors: Parajuli Sandesh , Zhong Weixiong , Pantha Monika , Sokup Megan , Aziz Fahad , Garg Neetika , Mohamed Maha , Mandelbrot Didier
Published: May 2023

Background.

Traditionally, antibody-mediated rejection (AMR) has been suspected mainly by a rise in serum creatinine (Scr) and confirmed by allograft biopsy. There is limited literature describing the trend of Scr after treatment, and how that trend might differ between patients with histological response and with no response to treatment.

Methods.

We included all cases of AMR at our program between March 2016 and July 2020 who had a follow-up biopsy after the index biopsy, with initial diagnosis of AMR. We trended the Scr and change in Scr (delta Scr) and its association with being a responder (microvascular inflammation, MVI ≤1) or nonresponder (MVI >1), as well as graft failure.

Results.

A total of 183 kidney transplant recipients were included, 66 in the responder group and 177 in the nonresponder group. The MVI scores and sum chronicity scores, along with transplant glomerulopathy scores, were higher in the nonresponder group. However, Scr at index biopsy was similar in responders (1.74 ± 0.70) versus nonresponders (1.83 ± 0.65; P = 0.39), as were the delta Scr at various time points. After adjustment for multiple variables, delta Scr was not associated with being a nonresponder. Also, delta Scr value at follow-up biopsy compared with index biopsy among responders was 0 ± 0.67 (P = 0.99) and among nonresponders was –0.01 ± 0.61 (P = 0.89). Being a nonresponder was significantly associated with an increased risk of graft failure at the last follow-up in univariate analysis but was not in multivariate analysis (hazard ratio 1.35; 95% confidence interval, 0.58-3.17; P = 0.49).

Conclusions.

We found that Scr is not a good predictor of the resolution of MVI, supporting the utility of follow-up biopsies after treatment of AMR.