bluuebunny/crossref_metadata_2025 huggingface dataset:
Decision-making in practice
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán
Published: June 2023

Accepting all of the theory already described concerning how decisions are, should, and should not be taken, what advice can be offered on practical clinical decision-making, whether it is directed at clinical intervention or at assisting lawyers and courts, to address defined legal questions? It might be thought that all that needs to be written here is, ‘follow the rules of ordinary good clinical psychiatric practice’. However, as we have already suggested, all medical practice is subject to both heuristics and bias, as well as to the role of values, and all—but particularly the latter—is especially so in a forensic context. This chapter builds on A.1: Decision-making theories to put the background into practice. It covers clinical decision-making in both clinical and clinic-legal practice, as well as clinico-legal questions to ask yourself when coming to decisions.
Legal critiquing in general
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán
Published: June 2023

Legal critique is, for clinicians, perhaps the most feared critique paradigm. Not merely by virtue of the potential for legal sanction but also because it is in this context that they are most likely to feel in an alien world, subject to language and rules that are not of their clinical world. The two ‘territories’ of medicine and law are profoundly different in their purposes and methods, as is evident from the difficulties often experienced in clinico-legal practice, and will have been observed within many of the cases in Part B, of ‘mapping’ a medically defined mental state onto any given, or a number of different legal definitions or tests. Although some legal domains are more reflexive than others in being able to incorporate the constructs and methods of medicine, whatever legal domain one is in will contain profound differences of method and process from clinical practice because law tends ultimately towards being a closed or ‘autopoietic’ intellectual system. This chapter covers legal critique. The chapter covers how the territories of medicine and law are profoundly different in their purposes of methods.
Other specific critique paradigms
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán
Published: June 2023

Whereas the purpose of criminal negligence is to punish for criminal wrongdoing, the purpose of civil negligence is to compensate victims for the effects of negligent clinical practice and to ‘police’ practice against (i.e. discourage) such negligent practice. So, turning to the example of patient suicide, here, there can be, and often is, critiquing of clinical practice in the civil courts, in terms of negligence, and in the Coroners Court. Where counsel for a bereaved family may, for example, in the latter aim both to collect evidence and to achieve a finding that will assist in a negligence action, as wells as using critiquing within an MPTS hearing to similar intended effect (aside from also using any nonlegal internal hospital or external inquiry). And again, all these legal fora apply differing processes and critically appraise the case against differing criteria. Yet, although they are addressing apparently different questions, again there is much room for ‘cross-over’ between fora, including by data and findings originating within one forum being used within another. This chapter covers other specific critique paradigms, including civil negligence, coroner’s inquests, inquiries, root cause analysis, audit, appraisal, peer review, and self-critique.
Designing a clinical trial
Authors: Cook Jonathan A.
Published: June 2023

This chapter explains how to clarify the research question and turn it into researchable objectives using the PICOTS framework (population, intervention, control, outcome, timing, and setting). Common options for each of the components of the PICOTS framework are presented. Two in-depth examples are used to show how the original research question can inform the trial design. Also covered in this chapter are the key decisions in formulating the study objectives along with how to decide whether the research question is a sensible one. The need to build the study team, and also how to develop a good funding proposal are also considered.
Setting up a clinical trial
Authors: Cook Jonathan A.
Published: June 2023

This chapter discusses the practical considerations of setting up a clinical trial. The ethical and regulatory permissions and requirements for starting a clinical trial are covered as is the key role of the Sponsor. The additional requirements and documentation needed for trials that involve an investigational medicinal products or medical device is reviewed. The impact of legislation on approvals and the handling of data are considered. How to develop and finalize the protocol for the study is considered in terms of how the trial population, treatments, outcomes and follow-up and assessments are specified. The setting up of study centres is also reviewed.
Data collection and monitoring in a clinical trial
Authors: Cook Jonathan A.
Published: June 2023

This chapter discusses the practical considerations of collecting data for a clinical trial. The different potential data sources and the options for data collection and related decisions that need to be made are covered. The importance of the trial database is addressed, along with the critical importance of ensuring processes are put in place to minimise missing data. The need for monitoring of accumulating data and the use of audits is considered. How an interim analysis can be used to inform decision-making during a trial’s running is reviewed. The role of a data and safety monitoring committee is also addressed. Examples are used throughout.
I-Love-Q relations for a generic family of neutron star equations of state
Authors: Nath Kamal Krishna , Mallick Ritam , Chatterjee Sagnik
Published: June 2023

Neutron stars (and quark stars) have recently been found to follow certain universality, the I-Love-Q relations. These relations can provide a greater understanding of the structural and macro properties of compact astrophysical objects with knowledge of any one of the observable. The reason behind this is the lack of sensitivity to the relations with the equation of state (EoS) of matter. In this work, we have investigated the consistency of universal relations for a generic family of equations of state. These equations of state are consistent with the prescribed limits of nuclear theory (low densities) and perturbative QCD (asymptotically high densities) and respecting recent astronomical observations. At intermediate densities, the equations of states are parametrized by the adiabatic speed of sound. Although the spread in the EoS is significant, the universal nature of the I-Love-Q trio holds relatively well up to a specific tolerance limit of 5 per cent fractional percentage error. We have compared the result first with a similar set, but not respecting the recent astrophysical constraints. A deviation from universality is seen and the tolerance exceeds the 5 per cent limit. Next, we have compared our result with a family of EoS having monotonic sound speed inside a neutron star. A slight deviation from universality is seen for this case; however, the tolerance remains within the 5  per cent limit. This shows the existence of a correlation between universal relations and observational constraints.
IDPodcasts: An Online Resource for Infectious Diseases Learning
Authors: Katzman Ju Hee , Oehler Richard L
Published: June 2023

The University of South Florida (USF)'s IDPodcasts features hundreds of comprehensive infectious diseases (ID)­–related lectures freely accessible for medical learners and educators at all levels. Content is free and is shared via its flagship website, YouTube channel, podcast series, and an all-new IOS app. Updated app features improve in-app navigation, content accessibility, and overall user friendliness.
Understanding palladium–tellurium cluster formation on WTe2: From a kinetically hindered distribution to thermodynamically controlled monodispersity
Authors: Evans Prescott E , Wang Yang , Sushko Peter V , Dohnálek Zdenek
Published: June 2023

A fundamental understanding of the transition metal dichalcogenide (TMDC)–metal interface is critical for their utilization in a broad range of applications. We investigate how the deposition of palladium (Pd), as a model metal, on WTe2(001), leads to the assembly of Pd into clusters and nanoparticles. Using X-ray photoemission spectroscopy, scanning tunneling microscopy imaging, and ab initio simulations, we find that Pd nucleation is driven by the interaction with and the availability of mobile excess tellurium (Te) leading to the formation of Pd-Te clusters at room temperature. Surprisingly, the nucleation of Pd-Te clusters is not affected by intrinsic surface defects, even at elevated temperatures. Upon annealing, the Pd-Te nanoclusters adopt an identical nanostructure and are stable up to ∼523 K. Density functional theory calculations provide a foundation for our understanding of the mobility of Pd and Te atoms, preferential nucleation of Pd-Te clusters, and the origin of their annealing-induced monodispersity. These results highlight the role the excess chalcogenide atoms may play in the metal deposition process. More broadly, the discoveries of synthetic pathways yielding thermally robust monodispersed nanostructures on TMDCs are critical to the manufacturing of novel quantum and microelectronics devices and catalytically active nano-alloy centers.
Brain mechanisms of mental processing: from evoked and spontaneous brain activities to enactive brain activity
Authors: Zhang Chi , Wang Yifeng , Jing Xiujuan , Yan Jin H
Published: June 2023

Within the context of the computer metaphor, evoked brain activity acts as a primary carrier for the brain mechanisms of mental processing. However, many studies have found that evoked brain activity is not the major part of brain activity. Instead, spontaneous brain activity exhibits greater intensity and coevolves with evoked brain activity through continuous interaction. Spontaneous and evoked brain activities are similar but not identical. They are not separate parts, but always dynamically interact with each other. Therefore, the enactive cognition theory further states that the brain is characterized by unified and active patterns of activity. The brain adjusts its activity pattern by minimizing the error between expectation and stimulation, adapting to the ever-changing environment. Therefore, the dynamic regulation of brain activity in response to task situations is the core brain mechanism of mental processing. Beyond the evoked brain activity and spontaneous brain activity, the enactive brain activity provides a novel framework to completely describe brain activities during mental processing. It is necessary for upcoming researchers to introduce innovative indicators and paradigms for investigating enactive brain activity during mental processing.
Employing a transitivity violation detection algorithm to assess best–worst scaling designs
Authors: Bir Courtney , Widmar Nicole Olynk , Slipchenko Natalya , Polcyn Addison , Wolf Christopher A
Published: June 2023

When choosing a partial factorial design for best–worst scaling (BWS) or other discrete choice experiment, researchers are faced with design size choices. This work investigates differences between two case 1 (object) BWS choice experiment designs that varied in choice set size and number of questions. Using a random-parameter logit model, preference shares were determined and statistically compared between models. The number of transitivity violations occurring between the experimental designs was analyzed employing a newly developed directed graph algorithm. The relative importance consumers placed on dairy milk attributes differed between the designs studied. The design presenting fewer attributes per choice set forced novel tradeoffs more often and yielded no increase in transitivity violations. In general, if one seeks to establish rank among variables and force tradeoffs, smaller designs should be considered.
Profile and clinical relevance of non-criteria antiphospholipid antibodies in patients diagnosed with or highly suspected of APS
Authors: Li Siting , Zhao Jiulang , Bai Yina , Meng Jingjing , Wang Qian , Tian Xinping , Li Mengtao , Zeng Xiaofeng , Hu Chaojun
Published: June 2023

Objective

This study investigates the positivity and relevance of non-criteria aPLs with clinical phenotypes in patients highly suspected of or diagnosed with APS.

Methods

Outpatient cases were included from a prospectively maintained database, and patients were grouped into APS (n = 168), seronegative APS (SNAPS, n = 9), those meeting the diagnostic criteria for clinical events without laboratory results (only-event, n = 15), those that had aPL positivity without clinical manifestations (asymptomatic APA, n = 39), and healthy controls (n = 88). Criteria aPL results and APS-related clinical features were extracted. Sixteen non-criteria aPLs were tested and analysed.

Results

LA, aCL and anti-β2 glycoprotein-I were positive in 84.5%, 61.3% and 74.4% of APS patients, and 61.5%, 59.0% and 74.4% of asymptomatic APA patients, respectively. In patients negative for criteria serological tests, 23 out of 24 were positive for at least one non-criteria aPL. Triple-positive patients also had significantly higher tests of some aPLs in comparison with other groups. Stroke was associated with anti-phosphatidyl-inositol (aPI) IgG and anti-phosphatidyl-glycerol (aPG) IgG. Late embryonic loss correlated with aPI IgM, and premature birth/eclampsia was associated with aPI IgG and aPG IgG. There were also positive associations between heart valve lesions and anti-phosphatidylserine–prothrombin (aPS/PT) IgM, APS nephropathy and anti-phosphatidyl-choline IgG or aPS/PT IgG, and livedo reticularis and anti-phosphatidyl-ethanolamine IgM.

Conclusion

The prevalence of non-criteria aPLs differed from diagnostic biomarkers in patients diagnosed with or suspected of APS. Detection of aPLs provided additive value in the evaluation of APS-related clinical manifestations.
Improving our understanding of the paradoxical protective effect of obesity on radiographic damage: a large magnetic resonance imaging-study in early arthritis
Authors: den Hollander Nikolet K , van der Helm-van Mil Annette H M , van Steenbergen Hanna W
Published: June 2023

Objective

Obesity conveys a risk for RA development, while paradoxically, associating with less radiographic progression after RA diagnosis. Using MRI we can study this surprising association in detail from MRI-detected synovitis and osteitis to MRI-detected erosive progression, which precedes radiographic progression. Previous research suggested obesity associates with less osteitis and synovitis. We therefore aimed to (i) validate the previously suggested association between BMI and MRI-detected osteitis/synovitis; (ii) study whether this is specific for ACPA-positive or ACPA-negative RA or also present in other arthritides; (iii) study whether MRI-detected osteitis associates with MRI-detected erosive progression; and (iv) study whether obesity associates with MRI-detected erosive progression.

Methods

We studied 1029 early arthritis patients (454 RA, 575 other arthritides), consecutively included in Leiden Early Arthritis Clinic. At baseline patients underwent hand-and-foot MRI that were RAMRIS-scored, and 149 RA patients underwent follow-up MRIs. We studied associations between baseline BMI and MRI-detected osteitis/synovitis (using linear regression), and erosive progression (using Poisson mixed models).

Results

In RA, higher BMI associated with less osteitis at disease onset (β = 0.94; 95% CI: 0.93, 0.96) but not with synovitis. Higher BMI associated with less osteitis in ACPA-positive RA (β = 0.95; 95% CI: 0.93, 0.97), ACPA-negative RA (β = 0.97; 95% CI: 0.95, 0.99) and other arthritides (β = 0.98; 95% CI: 0.96, 0.99). Over 2 years, overweight and obesity associated with less MRI-detected erosive progression (P = 0.02 and 0.03, respectively). Osteitis also associated with erosive progression over 2 years (P < 0.001).

Conclusions

High BMI relates to less osteitis at disease onset, which is not confined to RA. Within RA, high BMI and less osteitis associated with less MRI-detected erosive progression. This suggests that the protective effect of obesity on radiographic progression is exerted via a path of less osteitis and subsequently fewer MRI-detected erosions.
Untangling the threads: phylogenetic relationships of threadfins (Percomorphacea: Perciformes: Polynemidae)
Authors: Presti Paulo , Johnson G David , Datovo Aléssio
Published: June 2023

Threadfins are primarily marine bony fishes that have part of the pectoral fin modified into specialized sensitive filaments. They compose the Polynemidae, a family with eight genera and 42 extant species. The internal relationships and phylogenetic position of Polynemidae within Percomorphacea are controversial, with highly conflicting hypotheses proposed by both molecular and phenotypic analyses. We performed a cladistic analysis of threadfins based on the most comprehensive sampling of morphological data ever done. The final dataset included 197 characters from external morphology, the laterosensory system, osteology, myology and neurology in representatives of all valid polynemid genera. More than half of the characters are reported here for the first time, notably the myological ones. A sensitivity analysis of 11 different weighting schemes (equal weighting and extended implied weighting parsimony) resulted in a fully resolved tree. Sciaenidae, not Pleuronectiformes, is recovered as sister to Polynemidae. All polynemid genera are resolved as monophyletic except Polydactylus, which is polyphyletic. Filimanus, Pentanemus and Polydactylus s.s. appear as successive sister taxa of all remaining threadfins. Leptomelanosoma, Parapolynemus and Polynemus form a monophyletic group. Eleutheronema and Galeoides appear intercalated with other species of Polydactylus in the apical portions of the polynemid tree.
CRISPR/Cas9-Mediated Mutagenesis of Carotenoid Cleavage Dioxygenase (CCD) Genes in Sorghum Alters Strigolactone Biosynthesis and Plant Biotic Interactions
Authors: Hao Jingjie , Yang Ying , Futrell Stephanie , Kelly Elizabeth A. , Lorts Claire M. , Nebie Baloua , Runo Steven , Yang Jinliang , Alvarez Sophie , Lasky Jesse R. , Schachtman Daniel P.
Published: June 2023

Strigolactones are a group of small molecules that play critical roles in plant developmental processes and root biotic interactions. Strigolactones are agronomically important due to their role as a signal for the germination of a parasitic weed ( Striga spp.) that reduces yields of cereal crops worldwide. To identify the genes encoding strigolactones in sorghum and their function, we characterized two CRISPR/Cas9-mediated gene knockouts of carotenoid cleavage dioxygenase 8 ( CCD8) genes ( SbCCD8a and SbCCD8b), which have been shown in other plant species to be involved in strigolactone biosynthesis. Although strigolactones are important for the parasitization of sorghum in Africa, the functions of members of the CCD8 family have not been characterized. The impact of the knockouts on strigolactone production, plant growth and development, resistance to the parasitic weed Striga, and the root-associated microbiomes were investigated in this study. The results revealed that knockout of SbCCD8 genes in sorghum significantly reduced orobanchol production and Striga germination. Strigolactone deficiency altered the shoot and root architecture and reduced grain yield of sorghum. The knockout of the SbCCD8b gene significantly affected the rhizosphere bacterial diversity and community composition at sorghum plant grain-fill stage due to the abolition of orobanchol exudation from roots. Reduced amounts of orobanchol in root exudates also influenced root-associated fungal taxa abundance. Our findings provide new insights into potentially sustainable approaches for the recruitment of beneficial microbes and for parasitic weed control through manipulation of strigolactone production in sorghum.
Statin Therapy Induces Gut Leakage and Neuromuscular Disjunction in Patients With Chronic Heart Failure
Authors: Ahmad Firdos , Karim Asima , Khan Javaidullah , Qaisar Rizwan
Published: June 2023

Statins are commonly used to limit the risk of cardiovascular diseases, including ischemic heart attack and stroke. However, treatment often leads to myopathy and muscle weakness. Therefore, a better understanding of underlying pathomechanism is needed to improve the clinical outcomes. Here, we assessed the physical performance, including handgrip strength (HGS), gait speed (GS), and short physical performance battery, in 172 patients diagnosed with chronic heart failure (CHF) treated with (n = 50) or without (n = 122) statin and 59 controls. The plasma biomarkers, including sarcopenia marker C-terminal agrin fragment-22 (CAF22), intestinal barrier integrity marker zonulin, and C-reactive protein (CRP), were measured and correlated with the physical performance of patients. The HGS, short physical performance battery scores, and GS were significantly compromised in patients with CHF versus controls. Irrespective of etiology, significant elevation of plasma CAF22, zonulin, and CRP was observed in patients with CHF. There were strong inverse correlations of CAF22 with HGS (r2 = 0.34, P < 0.0001), short physical performance battery scores (r2 = 0.08, P = 0.0001), and GS (r2 = 0.143, P < 0.0001). Strikingly, CAF22 and zonulin were positively correlated with each other (r2 = 0.10, P = 0.0002) and with the level of CRP in patients with CHF. Further investigations revealed a significant induction of CAF22, zonulin, and CRP in patients with CHF taking statin versus nonstatin group. Consistently, HGS and GS were significantly lower in the statin versus nonstatin CHF patients' group. Collectively, statin therapy adversely affects the neuromuscular junction and intestinal barrier, which potentially induces systemic inflammation and physical disability in patients with CHF. Further prospective confirmation of the findings is required in a well-controlled study.
Isolated myeloid sarcoma of the pancreas: a case report
Authors: Jiang Lei , Miao Yi , Wei Jishu
Published: June 2023

Myeloid sarcoma (MS) is a rare solid tumor, and the diagnose is ambiguity. On account of the rarity of MS, it is often misdiagnosed. In order to promote clinicians to have a better understanding of the disease, a case of isolated myeloid sarcoma of the pancreas has been admitted by the Center for Pancreas, the First Affiliated Hospital of Nanjing Medical University. A 36-year-old male patient presented to our department with recurrent postprandial abdominal distension and pain, and weight loss. The initial radiologic diagnose of the lesion was pancreatic cancer and a pancreatectomy was performed. Eventually, the histopathology result confirmed the final diagnosis: myeloid sarcoma (MS). To date, this type of disease has hardly been reported in the literature. This case report describes the diagnostic and treatment process and discusses the better way for diagnosis, which will guide such diseases in the future.
Vaccination in kidney disease: what did we learn from COVID-19 pandemic
Authors: Khan Sana F.
Published: June 2023

Purpose of review

Patients with kidney disease were prioritized during COVID-19 vaccination efforts. Initial data on vaccine seroconversion and efficacy were confounded by heterogeneous vaccination regimens as well as response assessments. Recent data have addressed responses to evolving vaccine regimens, and addressed concerns in this high-risk population.

Recent findings

mRNA vaccines BNT162b2 (Pfizer/BioNTech), mRNA1273 (Moderna) were the predominant vaccines used in two and three-dose regimens. Although population-based studies show reduced rates of seroconversion in kidney disease cohorts, there continues to be evolving efficacy largely due to emerging variants, and utilization of ongoing vaccine development. Recommendations on vaccination regimens now exclude use of monovalent mRNA vaccines, with bivalent vaccines are now the preferred effective vaccination. Individualization and adjustment of immunosuppressive drugs is recommended for maximal serological response in transplant recipients and patient with autoimmune kidney diseases.

Waning responses to initial vaccination regimen, as well as emerging variants of concern have resulted in multiple dose regimens being investigated in patient with kidney disease. Use of bivalent mRNA vaccine is now recommended for initial as well as subsequent vaccine doses.
Biomarker guided management of hypertension
Authors: Kotta Prasanti Alekhya , Nambi Vijay
Published: June 2023

Purpose of review

Approximately 1.28 billion people are affected by hypertension globally and the incidence of hypertension is on an upward trajectory with an aging population and increasing burden of risk factors including obesity. Despite low-cost, highly-effectively, easy-to-treat strategies, it is estimated that ∼720 million people are not receiving the treatment they need for optimal hypertension management. Several factors contribute to this including an unwillingness to be treated for an asymptomatic condition.

Recent findings

Biomarkers such as troponin, B-type Natriuretic Peptide (BNP), N-terminal-pro hormone BNP (NT-proBNP), uric acid, microalbuminuria have been found to be associated with adverse clinical outcomes among individuals with hypertension. Biomarkers also allow for identification of asymptomatic organ damage.

Biomarkers have the ability to identify higher risk individuals in whom risk-benefit for therapies may be most favorable, helping optimize the net benefit of therapy. Whether biomarkers can help guide therapy intensity and choice remains to be tested.
Why Are Individuals Who Have Not Disclosed Self-Injury Comfortable Discussing Their Experiences in Research?
Authors: Mirichlis Sylvanna , Boyes Mark , Hasking Penelope , Lewis Stephen P.
Published: June 2023

Not everyone who shares their lived experience of nonsuicidal self-injury (NSSI) in research has disclosed this previously outside of a research context. Our objective was to identify reasons people who have not previously disclosed their NSSI felt comfortable discussing their self-injury in research contexts. The sample consisted of 70 individuals with lived experience of self-injury who had not previously disclosed this experience outside of research (M
age = 23.04 years, SD = 5.90; 75.70% women). Using content analysis of open-ended responses, we identified three reasons participants felt comfortable discussing their NSSI in research. Most commonly, participants did not anticipate negative consequences discussing their NSSI due to the way the research was conducted (e.g., confidentiality). Second, participants valued NSSI research and wanted to contribute to such work. Third, participants referenced feeling mentally and emotionally prepared to discuss their NSSI. The findings indicate that individuals who have not previously disclosed their NSSI may wish to discuss their experience in research for a variety of reasons. Such findings highlight implications for how we foster safe spaces in research for people with lived experience of NSSI.
Integrating Psychiatric Services in the Emergency Room to Improve Patient Care by Using Quality Improvement Methods
Authors: Reinfeld Samuel , Gill Poonamdeep , Cáceda Ricardo , Batra Jaskanwar
Published: June 2023

Prolonged length of stay in emergency departments (EDs) for patients with a psychiatric chief complaint is a widespread problem. Prolonged stays can lead to adverse outcomes and poor quality of care. We sought to improve quality of care for patients in the medical ED who needed psychiatric care. To identify the areas of weakness, we queried the ED staff via an online survey about the perception of the challenges working with our Comprehensive Psychiatric Emergency Program (CPEP), which is located adjacent to and works closely with the medical ED providing psychiatric consultation. We identified several action steps and used the Plan-Do-Study-Act methodology for implementation. We reported a reduction in time to complete consultations and improved communication between CPEP and the medical ED staff.
A review of clinical practice guidelines for preventing chlamydial and gonococcal ophthalmia neonatorum
Authors: Sun Ruiyang , Zhu Xiu , Zhang Ting , Lu Hong
Published: June 2023

Background:

Ophthalmia neonatorum poses a significant risk of severe damage to neonatal eyes, including corneal perforation and blindness, if preventive measures are not implemented after birth. While the World Health Organization (WHO) has recommended universal topical ocular prophylaxis, limited evaluations have been conducted regarding the consistency of international and national clinical practice guidelines concerning the prevention of neonatal ophthalmia.

Objective:

The objective of this study is to evaluate and analyze clinical practice guidelines pertinent to the prevention of ophthalmia neonatorum in newborns following delivery. The aim is to offer guidance to medical and nursing staff regarding newborn eye care within the clinical context.

Methods:

WHO, Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Queensland Clinical Guideline (QCG), Joanna Briggs Institute (JBI), Canada Registered Nurses’ Association of Ontario (RNAO), New Zealand Guidelines Group (NZGG) and Chinese Medlive, professional societies focusing on newborn care, and bibliographic databases such as PubMed, Embase, Web of Science, CNKI, WanFang Database, VIP, and SinoMed were systematically searched. The International Guidelines Evaluation Screening Tool (IGEST) and AGREE II were utilized to assess the quality of the guidelines. Content analysis methodology was employed for summarization, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to determine the quality of evidence and the strength of recommendations.

Results:

A total of eight guidelines pertaining to neonatal ophthalmia were included in the analysis. Among them, guidelines from the National Institute for Health and Care Excellence (NICE) and WHO obtained higher scores (≥80%). Seven guidelines recommended universal topical ocular prophylaxis. Additionally, two guidelines recommended prescreening and pretreatment of pregnant women at risk of exposure to chlamydia and gonococcus. In total, 17 recommendations were summarized. While the quality of specific evidence ranged from “very low” to “low,” the majority (12/17) of the recommendation strengths were classified as “strong”.

Conclusion:

In the clinical context, both universal topical ocular prophylaxis for neonates and screening and treatment of pregnant women and their partners for sexually transmitted diseases (STDs) are recommended.
Comparison of 16 Pediatric Acute Respiratory Distress Syndrome-Associated Plasma Biomarkers With Changing Lung Injury Severity*
Authors: Williams James G. , Jones Rhonda L. , Yunger Toni L. , Lahni Patrick M. , Yehya Nadir , Varisco Brian M.
Published: June 2023

OBJECTIVES:

Pediatric acute respiratory distress syndrome (PARDS) is a source of substantial morbidity and mortality in the PICU, and different plasma biomarkers have identified different PARDS and ARDS subgroups. We have a poor understanding of how these biomarkers change over time and with changing lung injuries. We sought to determine how biomarker levels change over PARDS course, whether they are correlated, and whether they are different in critically ill non-PARDS patients.

DESIGN:

Two-center prospective observational study.

SETTING:

Two quaternary care academic children’s hospitals

PATIENTS:

Subjects under 18 years of age admitted to the PICU who were intubated and met the Second Pediatric Acute Lung Injury Consensus Conference-2 PARDS diagnostic criteria and nonintubated critically ill subjects without apparent lung disease.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Plasma samples were obtained on study days 1, 3, 7, and 14. The levels of 16 biomarkers were measured using a fluorometric bead-based assay. Compared with non-PARDS subjects, on day 1 PARDS subjects had increased concentrations of tumor necrosis factor-alpha, interleukin (IL)-8, interferon-γ, IL17, granzyme B, soluble intercellular adhesion molecule-1 (sICAM1), surfactant protein D, and IL18 but reduced matrix metalloproteinase 9 (MMP-9) concentrations (all p < 0.05). Day 1 biomarker concentrations and PARDS severity were not correlated. Over PARDS course, changes in 11 of the 16 biomarkers positively correlated with changing lung injury with sICAM1 (R = 0.69, p = 2.2 × 10–16) having the strongest correlation. By Spearman rank correlation of biomarker concentrations in PARDS subjects, we identified two patterns. One had elevations of plasminogen activator inhibitor-1, MMP-9, and myeloperoxidase, and the other had higher inflammatory cytokines.

CONCLUSIONS:

sICAM1 had the strongest positive correlation with worsening lung injury across all study time points suggesting that it is perhaps the most biologically relevant of the 16 analytes. There was no correlation between biomarker concentration on day 1 and day 1 PARDS severity; however, changes in most biomarkers over time positively correlated with changing lung injury. Finally, in day 1 samples, 7 of the 16 biomarkers were not significantly different between PARDS and critically ill non-PARDS subjects. These data highlight the difficulty of using plasma biomarkers to identify organ-specific pathology in critically ill patients.
Robotics in Plastic Surgery: It’s Here
Authors: Henn Dominic , Trotsyuk Artem A. , Barrera Janos A. , Sivaraj Dharshan , Chen Kellen , Mittal Smiti , Mermin-Bunnell Alana M. , Chattopadhyay Arhana , Larson Madelyn R. , Kinney Brian M. , Nachbar James , TerKonda Sarvam P. , Reddy Sashank , Jeffers Lynn , Sacks Justin M. , Gurtner Geoffrey C.
Published: June 2023

Although robotic surgery has been routinely established in other surgical disciplines, robotic technologies have been less readily adopted in plastic surgery. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, most reconstructive procedures, including microsurgery, have continued to necessitate an open approach. Recent advances in robotics and artificial intelligence, however, are gaining momentum and have shown significant promise to improve patient care in plastic surgery. These next-generation surgical robots have the potential to enable surgeons to perform complex procedures with greater precision, flexibility, and control than previously possible with conventional techniques. Successful integration of robotic technologies into clinical practice in plastic surgery requires achieving key milestones, including implementing appropriate surgical education and garnering patient trust.
Functional Outcome of Dual Reinnervation with Cross-Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis
Authors: Kollar Branislav , Weiss Jakob B. W. , Kiefer Jurij , Eisenhardt Steffen U.
Published: June 2023

Background:

The combination of cross-facial nerve graft (CFNG) and masseteric nerve transfer (MNT) for reinnervation of facial paralysis may provide advantages of both neural sources. However, quantitative functional outcome reports with a larger number of patients are lacking in the literature. Here, the authors describe their 8-year experience with this surgical technique.

Methods:

Twenty patients who presented with complete facial paralysis (duration, <12 months) received dual reinnervation with CFNG and MNT. The functional outcome of the procedure was evaluated with the physician-graded outcome metric eFACE scale. The objective artificial intelligence–driven software Emotrics and FaceReader were used for oral commissure measurements and emotional expression assessment, respectively.

Results:

The mean follow-up was 31.75 ± 23.32 months. In the eFACE score, the nasolabial fold depth and oral commissure at rest improved significantly (P < 0.05) toward a more balanced state after surgery. Postoperatively, there was a significant decrease in oral commissure asymmetry while smiling (from 19.22 ± 6.1 mm to 12.19 ± 7.52 mm). For emotional expression, the median intensity score of happiness, as measured by the FaceReader software, increased significantly while smiling (0.28; interquartile range, 0.13 to 0.64). In five patients (25%), a secondary static midface suspension with fascia lata strip had to be performed because of unsatisfactory resting symmetry. Older patients and patients with greater preoperative resting asymmetry were more likely to receive static midface suspension.

Conclusion:

The authors’ results suggest that the combination of MNT and CFNG for reinnervation of facial paralysis provides good voluntary motion and may lessen the use of static midface suspension in the majority of patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Dolutegravir induced neural tube defects in mice are folate responsive
Authors: Tukeman Gabriel L. , Wei Hui , Finnell Richard H. , Cabrera Robert M.
Published: June 2023

Objectives

In 2018, the Botswana Tsepamo Study reported a nine-fold increased risk of neural tube defects in infants whose mothers were treated with dolutegravir (DTG) from the time of conception. As maternal folate supplementation and status is a well-known modifier of neural tube defect (NTD) risk, we sought to evaluate birth outcomes in mice fed normal and low folic acid diets treated with DTG during pregnancy.

Design

DTG was evaluated for developmental toxicity using pregnant mice fed normal or low folic acid diet.

Methods

CD-1 mice were provided diet with normal (3 mg per kg) or low (0.3 mg per kg) folic acid. They were treated with water, a human therapeutic-equivalent dose, or supratherapeutic dose of DTG from mouse embryonic day E6.5 to E12.5. Pregnant dams were sacrificed at term (E18.5) and fetuses were inspected for gross, internal, and skeletal defects.

Results

Fetuses with exencephaly, an NTD, were present in both therapeutic human equivalent and supratherapeutic exposures in dams fed low folic acid diet. Palate clefts were also found under both folate conditions.

Conclusions

Recommended dietary folic acid levels during mouse pregnancy ameliorate developmental defects that arise from DTG exposure. Since low folate status in mice exposed to DTG increases the risk for NTDs, it is possible that DTG exposures in people living with HIV with low folate status during pregnancy may explain, at least in part, the elevated NTD risk signal observed in Botswana. Based on these results, future studies should consider folate status as a modifier for DTG-associated NTD risk.
High Spatial-Resolution Skull Base Imaging With Photon-Counting Computed Tomography and Energy-Integrating Computed Tomography: A Comparative Phantom Study
Authors: Rajagopal Jayasai R. , Schwartz Fides R. , Solomon Justin B. , Enterline David S. , Samei Ehsan
Published: June 2023

Photon-counting computed tomography (PCCT) offers better high-resolution and noise performance than energy integrating detector (EID) CT. In this work, we compared both technologies for imaging of the temporal bone and skull base. A clinical PCCT system and 3 clinical EID CT scanners were used to image the American College of Radiology image quality phantom using a clinical imaging protocol with matched CTDIvol (CT dose index-volume) of 25 mGy. Images were used to characterize the image quality of each system across a series of high-resolution reconstruction options. Noise was calculated from the noise power spectrum, whereas resolution was quantified with a bone insert by calculating a task transfer function. Images of an anthropomorphic skull phantom and 2 patient cases were examined for visualization of small anatomical structures. Across measured conditions, PCCT had a comparable or smaller average noise magnitude (120 Hounsfield units [HU]) to the EID systems (144–326 HU). Photon-counting CT also had comparable resolution (task transfer function f
25: 1.60 mm−1) to the EID systems (1.34–1.77 mm−1). Imaging results supported quantitative findings as PCCT more clearly showed the 12-lp/cm bars from the fourth section of the American College of Radiology phantom and better represented the vestibular aqueduct and oval and round windows when compared with the EID scanners. A clinical PCCT system was able to image the temporal bone and skull base with improved spatial resolution and lower noise than clinical EID CT systems at matched dose.
FDG Localization in Acellular Dermal Matrix, a Potential Cause of Nonpernicious Uptake Following Breast Reconstruction Surgery
Authors: Nemzow Gabriel , Zuckier Lionel S.
Published: June 2023

A 47-year-old woman with invasive lobular carcinoma of the left breast underwent prophylactic double mastectomy which also incidentally revealed follicular lymphoma of the right breast. Reconstruction was achieved with bilateral silicone implants and acellular dermal matrix (ADM), a biological scaffold material providing mechanical support. Twelve days thereafter, staging PET/CT demonstrated symmetric moderate FDG uptake corresponding to location of the ADM slings, suspected to reflect cellular engraftment onto the ADM and confirmed by near-complete resolution at 3-month follow-up study. FDG uptake related to ADM should be recognized as reflecting expected cellular incorporation into the matrix, rather than recurrent tumor or infection.
Defining the emergency general surgery patient population in the era of ICD-10: Evaluating an established crosswalk from ICD-9 to ICD-10 diagnosis codes
Authors: Dalton Michael K. , Sokas Claire M. , Castillo-Angeles Manuel , Semco Robert S. , Scott John W. , Cooper Zara , Salim Ali , Havens Joaquim M. , Jarman Molly P.
Published: June 2023

INTRODUCTION

In 2015, the United States moved from the International Classification of Diseases, Ninth Revision (ICD-9), to the International Classification of Diseases, Tenth Revision (ICD-10), coding system. The American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes previously established a list of ICD-9 diagnoses to define the field of emergency general surgery (EGS). This study evaluates the general equivalence mapping (GEM) crosswalk to generate an equivalent list of ICD-10–coded EGS diagnoses.

METHODS

The GEM was used to generate a list of ICD-10 codes corresponding to the American Association for the Surgery of Trauma ICD-9 EGS diagnosis codes. These individual ICD-9 and ICD-10 codes were aggregated by surgical area and diagnosis groups. The volume of patients admitted with these diagnoses in the National Inpatient Sample in the ICD-9 era (2013–2014) was compared with the ICD-10 volumes to generate observed to expected ratios. The crosswalk was manually reviewed to identify the causes of discrepancies between the ICD-9 and ICD-10 lists.

RESULTS

There were 485 ICD-9 codes, across 89 diagnosis categories and 11 surgical areas, which mapped to 1,206 unique ICD-10 codes. A total of 196 (40%) ICD-9 codes have an exact one-to-one match with an ICD-10 code. The median observed to expected ratio among the diagnosis groups for a primary diagnosis was 0.98 (interquartile range, 0.82–1.12). There were five key issues identified with the ability of the GEM to crosswalk ICD-9 EGS diagnoses to ICD-10: (1) changes in admission volumes, (2) loss of necessary modifiers, (3) lack of specific ICD-10 code, (4) mapping to a different condition, and (5) change in coding nomenclature.

CONCLUSION

The GEM provides a reasonable crosswalk for researchers and others to use when attempting to identify EGS patients in with ICD-10 diagnosis codes. However, we identify key issues and deficiencies, which must be accounted for to create an accurate patient cohort. This is essential for ensuring the validity of policy, quality improvement, and clinical research work anchored in ICD-10 coded data.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level III.
The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration
Authors: Horne Kristina S. , Ceslis Amelia , Mosley Philip , Adam Robert , Robinson Gail A.
Published: June 2023

Background:

Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases.

Objective:

To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response).

Method:

We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks.

Results:

The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task’s construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring.

Conclusion:

Our work presents a novel experimental task for measuring spontaneous action initiation—a key symptom of apathy—and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.
The genome of a steinernematid-associated Pseudomonas piscis bacterium encodes the biosynthesis of insect toxins
Authors: Awori Ryan Musumba , Hendre Prasad Suresh , Amugune Nelson O.
Published: June 2023

Steinernema soil nematodes are a solution to the scourge of crop pests, due to their natural capacity to kill insects. Although this insect killing nature is established to stem from the nematodes’ Xenorhabdus bacterial endosymbionts, the role of other steinernematid-associated bacteria in the nematode lifecycle remains unclear. Thus, this genome study aimed to determine the potential of Pseudomonas piscis to contribute to the entomopathogenicity of its Steinernema host. Insect larvae were infected with one of three Steinernema cultures. From each of the three treatments, the prevalent bacteria in the haemocoel of cadavers, four days post infection were isolated, morphologically characterised, and their genomes sequenced and assembled. Assemblies were used for species delineation and identification of genes that encode production of secondary metabolites and antibiotic resistance. All genomes had at least 98% of their bases on a contig. Through digital DNA-DNA hybridisation analyses, we ascertained that the haemocoels of insect cadavers previously infected with Steinernema sp. Kalro, Steinernema sp. 75, and Steinernema sp. 97 were dominated with Xenorhabdus griffiniae Kalro, Pseudomonas piscis 75 and X. griffiniae 75, respectively. P. piscis 75 clustered with pseudomonads that are characterised by high insecticidal activity. The P. piscis 75 genome encoded the production of insect toxins such as hydrogen cyanide, orfamides and rhizoxins, antifungals such as pyrrolnitrin and pyoluteorin and a broad-spectrum antimicrobial. Its genome encoded resistance to over ten classes of antibiotics, including cationic lipopeptides. Thus, steinernematid-associated P. piscis bacteria have the biosynthetic potential to contribute to nematode entomopathogenicity.