bluuebunny/crossref_metadata_2025 huggingface dataset:
P-706. Adenovirus Type 21 Outbreak among Haematology and liver transplant patients at a large tertiary care hospital in Singapore
Authors: Foo Mabel Z Q , Chan Darius Y W , Venkatachalam Indumathi , Wong Hei Man , Ying Sim Jean Xiang , Lai Deborah C M , Cui Lin , Ling Moi Lin
Published: January 2025

Background

Human adenoviruses (HAdVs) commonly cause acute respiratory illness, with documented outbreaks in military settings. HAdV infections frequently precipitate severe pneumonia amongst immunocompromised patients, with associated mortality risk. We report a HAdV type 21 infection cluster involving immunocompromised patients at a tertiary care hospital.

Methods

Hospital-onset (HO) adenoviral infection was defined as positive HAdV polymerase chain reaction (PCR) test with corresponding respiratory symptom onset six days after admission. Positive samples were typed in the National Public Health Laboratory by sequencing hexon gene variable regions. Epidemiological investigations were carried out for potential spatiotemporal linkage between these patients for targeted infection prevention interventions.

Results

Between 1st January to 31st March 2024, 21 HAdV-positive cases were identified, with five categorised as HO HAdV. Four patients (80%) had haematological malignancies and one had received a liver transplant 23 days prior to testing positive for HAdV. The mean age of patients was 58.6 years (SD: ± 9.7), with males comprising 60% of the cohort. The median hospital length of stay (LOS) before HAdV positivity was 21 days (range: 6 – 45). Clinical manifestations included fever, shortness of breath, cough, and acute respiratory failure. All patients required Intensive Care Unit (ICU) admission, with an average ICU LOS of 10 days (SD: ± 9.2). Respiratory samples of three patients were typed as HAdV 21, and three had adenovirus DNAemia.

In the identified cluster, the four patients with haematological malignancies shared the same ward, with two overlapping in time but housed in different rooms. The liver transplant patient had overlapping stay in the critical care unit with a patient from the haematology cluster and shared the same mobile chest x-ray machine with two others from the same cluster. All four patients with haematological malignancies experienced same-admission mortality.

Conclusion

Timely symptom recognition and respiratory multiplex panel testing enabled detection of HAdV infection cluster in immunocompromised patients. Early cluster detection and reinforcement of infection prevention measures at risk locations can mitigate transmission of HAdV infections.

Disclosures

Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects
P-723. Incidence, Etiology, and Outcomes of Viral Pneumonia in Adults with Cancer at a Tertiary Care Centre in Eastern India: A One Year Prospective Cohort Study
Authors: Malik Simran , Bhattacharya Sanjay , Das Bhattacharya Sangeeta
Published: January 2025

Background

We identified pneumonia in adult cancer patients admitted to the ICU over one year, delineated viral pneumonia, assessed etiology, and studied clinical outcomes.Figure 1:Etiology of pneumonia cases where viruses were detected (n=90)

Methods

Pneumonia cases were clinically and radiologically identified from October 2022-September 2023. Pneumonia was categorized as community-acquired or healthcare-associated. Viral detection was done using Qiagen’s QIAstat-Dx Respiratory SARS-CoV-2 Panel and bioMeriéux’s BioFire® FilmArray® Pneumonia Panel. Bacterial, fungal, and mycobacterial detection involved microscopy, culture, ELISA, PCR, and CBNAATs.

All cases where bacteria, mycobacteria, and fungi were detected along with viruses were assigned “co-infection/ superadded infections". Frequency of pathogens were compared using a modified Z-test. Seasonality was assessed using the chi-square test for homogeneity. Lengths of hospital and ICU stay were compared using linear regression and mortality was compared using logistic regression and Kaplan-Meier survival analysis.Figure 2:Kaplan-Meier survival analysis for pneumonia cases where viruses were detected stratified by etiology

Results

355 cases of pneumonia were identified. Viruses were detected in 90 (25.4%). Of these 40 were viral pneumonia [incidence: 1.8% (95% CI: 1.3-2.4%)] among 2279 in-patients, and 50 were viral co-infections/ superadded infections (figure 1).

Rhinovirus/ enterovirus (27) was the commonest followed by SARS-CoV2 (15), influenza A (12), and RSV A/B (10). RSV A/B was more common in CAP cases (p=0.005). CMV was more common in HAP (p=0.042). Seasonal variation was seen in influenza A/B only with the highest frequency during monsoon (p=0.000).

Aspergillus (23) was most frequently detected alongside viruses, followed by Klebsiella pneumoniae (17), Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter (10 each).

The overall length of hospital stay in this cohort was 16.3 days, length of ICU stay was 9.6 days, and 90-day mortality was 54.4%. Length of ICU stay was higher in viral co-infections/ superadded infections (table 2, figure 2).

Conclusion

Majority of pneumonia cases with viral detection are co-infections/ superadded infections associated with prolonged ICU stay. There is a need for diagnostic stewardship to ensure rapid diagnosis, and appropriate antimicrobial prophylaxis for antibacterial and antifungal cover.

Disclosures

All Authors: No reported disclosures
P-752. Do Antibiotics Improve Wound Necrosis Following Biodegradable Temporizing Matrix (BTM) Placement in Patients with Xylazine-associated Wounds?
Authors: Schultz Sara K , Rae Lisa , Bougazzoul Oumaima
Published: January 2025

Background

Xylazine-associated wounds are a unique wound typology among patients with injection behavior in geographic areas where xylazine has infiltrated the fentanyl drug supply. The use of the dermal substitute biodegradable temporizing matrix (BTM) is being evaluated to promote wound stabilization in the presence of severe soft tissue necrosis, a well-known characteristic of xylazine wounds. The role of antibiotics in the treatment of BTM placement for xylazine wounds is unclear.

Methods

All patients with xylazine-associated wounds who underwent BTM placement at Temple University Hospital since August 2023 were identified. The electronic medical record was used to collect data including demographics, antibiotic course, microbiologic data, discharge disposition, and appearance of the wound. The primary outcome was evidence of less necrotic tissue on a stable wound within 60 days.

Results

A total of 37 patients were identified. 60% of patients had an infectious disease consult. 89% of patients had clinical or radiographic evidence of osteomyelitis underlying their xylazine wound. 25 patients (68%) received antibiotics during their admission for BTM. 15 (41%) of patients received at least 4 weeks of antibiotics. 12 patients (33%) did not receive any antibiotics during their admission. 25% of patients received antibiotics for an indication unrelated to their xylazine wound. Treatment regimens varied and included both oral and intravenous antibiotics. 49% of patients lacked stable housing at the time of discharge. 13 (35%) patients had evidence of less necrotic tissue on a stable wound at 60 days. Of those 13 patients, 9 received antibiotics and 4 received none. Of the patients who received at least 4 weeks of antibiotics, only 11% had evidence of less necrotic tissue at 60 days. Of the patients who received no antibiotics, 8% had evidence of less necrotic tissue at 60 days.

Conclusion

Severe tissue necrosis related to injection of xylaxine requires new treatment paradigms. Our small study questions the utility of prolonged antibiotic treatment courses for patients with xylazine wounds and BTM placement, including in the setting of osteomyelitis, as we did not see high treatment success in these patients.

Disclosures

Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
P-762. Prevalence and/or Recurrence of Non-Tubercular Mycobacterial Pulmonary Disease in Structural and Airway Lung Disease
Authors: Chowdhury Mohit , Singh Urvashi B , Ray Animesh , Sinha Sanjeev
Published: January 2025

Background

Nontuberculous mycobacterial pulmonary disease (NTM-PD) frequently remains undetected, especially among patients with preexisting respiratory conditions who are prone to develop the disease. This study aims to explore the prevalence, species diversity, and outcomes of NTM-PD in India, an uncharted topic.

Methods

We conducted a prospective observational study, enrolling 69 patients with symptomatic chronic respiratory diseases or a history of Tuberculosis (TB). These patients underwent thorough clinical assessment, chest computed tomography scans, and either a single bronchoscopic sample or three sputum samples for microbiological analysis, along with relevant biochemical investigations. Diagnosis of NTM-PD followed the ATS 2020 diagnostic criteria. The growth of the organism was compared using patented indigenous media with or without p-nitrobenzoic acid.

Results

The prevalence of NTM-PD was 17.4%, with TB affecting 31.9% of cases. Baseline clinical symptoms and their duration showed no statistically significant differences, except NTM-PD patients with hemoptysis had significantly shorter symptom durations than other groups. Isolation rates were notably higher with the patented indigenous media compared to the mycobacterial growth indicator tube for both NTM (100% vs. 33.3%, p < 0.001) and Mycobacterium tuberculosis (M.Tb) (57.1% vs. 47.6%, p < 0.001). NTM-PD patients exhibited a significantly higher proportion of fibro-cavitary disease compared to other groups when comparing radiological findings. After monitoring NTM-PD patients following treatment, one patient (20%) experienced a recurrence of symptoms within six months, rest continue to be under follow-up.

Conclusion

In a high-burden TB setting, clinical suspicion and effort to look for NTM-PD is often low. Our study highlights the high prevalence of NTM-PD in individuals with chronic lung conditions/past history of TB. Patients with NTM-PD show higher rates of fibro-cavitary disease, possibly allowing the NTM to form biofilms and hence lead to relapses. Diagnosis of NTM-PD is thus important, to ensure desired treatment for the recommended duration and a thorough and prolonged post-treatment monitoring due to higher relapse risk.

Disclosures

All Authors: No reported disclosures
P-763. Assessment of the in vitro potency of anti-mycobacterial agents against clinical Mycobacterium avium complex (MAC) pulmonary isolates: implications of intravenous and inhaled amikacin breakpoint reporting
Authors: Mark Gill Christian , Chamberland Robin R , Abate Getahun
Published: January 2025

Background

MAC pulmonary disease is associated with significant morbidity and requires multi-drug treatment for extended periods. The novel dosage form amikacin liposome inhalation suspension (ALIS) represents a much-needed treatment option and is noted to have success at MICs of ≤64mg/L, higher than the intravenous (IV) amikacin (AMK) breakpoint (≤16 mg/L) due to optimized pulmonary exposure. Herein, we assessed the in vitro potency of AMK utilizing both ALIS and IV breakpoints as well as other standard antimycobacterial agents.

Methods

MAC isolates obtained from sputum, bronchoalveolar lavage, or lung tissue culture between 1/1/2018 - 3/1/24 were assessed. The first isolate per patient per year was assessed. MICs were collected from the medical record as determined by standard methods at one of two reference laboratories. If a single sample had two MIC values reported, the more conservative was used for analysis. MICs to AMK, clarithromycin (CLR), moxifloxacin (MXF), and linezolid (LNZ) were collected. Data were assessed as MIC50/90 (mg/L) and categorized per CLSI breakpoints. Patients were classified as receiving MAC directed treatment based on documentation in the medical record. If treatment data was unknown, patients were classified as indeterminate treatment.

Results

218 samples were included from 178 patients. CLR was the most active agent with 97% of isolates testing as susceptible (MIC50/90, 0.5/2). MXF and LNZ had relatively poor activity with 82% and 66% of isolates susceptible to each agent, respectively. Considering AMK, high susceptibility to the IV breakpoint was observed with 94% of isolates meeting this criterion (MIC50/90, 8/16). Among the 14 isolates that were intermediate or resistant to IV AMK, 13 remained susceptible to ALIS (MIC range 32-64). 54%, 26%, and 20% of patients were treated, untreated, or indeterminate, respectively. The percent of isolates susceptible to each agent between treated and untreated were similar for all agents.

Conclusion

AMK and CLR remain highly active against MAC pulmonary isolates. Amongst isolates intermediate or resistant to IV AMK, most isolates remained susceptible to ALIS. These data highlight the need for laboratories to report susceptibility to both IV and ALIS to avoid clinicians erroneously disregarding a therapeutic option.

Disclosures

Christian Mark Gill, PharmD, BCIDP, Cepheid: Grant/Research Support|Entasis: Grant/Research Support|Everest Medicines: Grant/Research Support|Shionogi: Grant/Research Support
P-764. Epidemiology of Nontuberculosis Mycobacteria (NTM) in Monroe County, NY: 2021-2023
Authors: Myers christopher J , Dumyati Ghinwa
Published: January 2025

Background

Nontuberculosis mycobacteria (NTM) are opportunistic pathogens causing complex infections requiring prolonged multi-drug therapy and/or surgical interventions. The incidence rates of NTM are increasing nationally, however NTM is currently not a reportable in many states, and likely underreported. To provide a better understanding the burden of NTM, we describe the epidemiology over a 3 year surveillance period.

Methods

Active laboratory and population-based surveillance was conducted in Monroe County, NY as part of the CDC Emerging Infections Program. Demographic, clinical, and laboratory data were collected via medical record review. Cases were categorized as pulmonary (PNTM) or extrapulmonary (ENTM) based on source of isolation, with PNTM further categorized into possible or confirmed. A case was defined as incident if NTM was not isolated in the 12 months prior to the positive culture, or prevalent if NTM was present in the prior 12 months. Incidence rates were calculated for 2021-2023 using U.S. Census population estimates, and descriptive analyses were performed to describe demographic and clinical characteristics of PNTM vs ENTM cases.

Results

Incidence rates of PNTM and ENTM increased from 5.3 and 1.06 to 7.88 and 1.74 per 100,000 population between 2021-2023, respectively (Figure 1). PNTM and ENTM cases were both predominantly White (83% vs 73%), Non-Hispanic (90% vs 87%). PNTM cases were older (Median 69 yrs; IQR: 62, 77) than ENTM cases (Median 57yrs, IQR: 39, 69) and more likely to have underlying obstructive airway disease (Table 1). M. avium complex was most common in PNTM cases and rapid growing NTM species in ENTM cases (Table 2). Notably 50% of PNTM cases and 70% of ENTM cases had a clinical diagnosis of NTM disease. ENTM cases had trauma (13%), surgery (17%), medical devices (27%) or injections (13%) at the site of infection.

Conclusion

This study reveals a rising incidence of both PNTM and ENTM infections with variations in species distribution and associated risk factors for ENTM such as surgical procedures and medical devices. These results underscore the need for ongoing monitoring and targeted interventions to address the growing public health burden of NTM infections.

Disclosures

All Authors: No reported disclosures
P-772. Whole Genome Analysis of Mycobacterium intracellulare isolates from Colonic Biopsy In Inflammatory Bowel Disease Patients
Authors: Singh Urvashi B , Deb Sushanta , Kumari Lata , Mahajan Neeraj , Ahuja Vineet
Published: January 2025

Background

A long debate has prevailed over cause of Crohn's disease with published evidence for Mycobacterium paratuberculosis (MAP).Our study was designed to look for mycobacterial pathogens by culture and DNA PCR in patients with inflammatory bowel disease(IBD).

Phylogenetic Analysis of M. intracellulare isolate genomes compared with reference M. intracellular strain ATCC 13950T

Circular representation of four M. intracellulare isolate genomes compared with reference M. intracellular strain ATCC 13950T. Inner to outer four concentric rings show isolates from this study. The information is read from outer circle to inner as follows: genome size, genes on the forward strand, genes on the reverse strand, t-RNA, and r-RNA of reference strain.The percentage similarity is represented by different color codes. Zoomed portion represent absent genetic region in four isolates.

Methods

Colonic biopsy and Blood Buffy coat samples were processed for cultures and DNA detection for mycobacterial pathogens (including MAP) in 889 patients with inflammatory bowel disease; Crohn’s disease (CD)( clinical manifestations, endoscopic,radiological and histological features as per ECCO consensus guidelines), Intestinal tuberculosis,Controls (Adult patients with hemorrhoidal bleeding and no other colonic disease undergoing sigmoidoscopy).

Results

Four cultures from CD patients grew Mycobacterium intracellulare. Whole Genome Sequencing identified deletion regions in the studied isolates, with 156 protein-coding genes absent in all four isolates compared to the reference genome (M. intracellulare Strain ATCC 13950T). Antibiotic resistance and virulence factor analyses indicated resistance to rifampicin and isoniazid and an abundance of virulence factor genes in M. Intracellulare species. Pan and core gene analyses suggested a closed pan-genome in M.intracellulare, with limited distribution of antibiotic resistance genes.

Conclusion

M. Intracellulare is reported in immune-compromised patientsin several studies. The results of the core genome phylogenetic analysis suggest that factors beyond the isolation sources of M.intracellulare strains may contribute to shape their evolutionary trajectory. Functional analysis indicated a gradual decrease in metabolic capacity across clusters, suggesting an ongoing genome streamlining process in M. Intracellulare species. Essential gene prediction identified strain specific essential genes, emphasizing the importance of energy-related processes. Homologous recombination rate analysis suggested recombination in M. intracellulare strains, with specific parameters showing variation compared to other pathogenic species. This comprehensive study contributes valuable information about the genomic characteristics, evolution, and functional profiles of M. intracellulare strains.

Disclosures

All Authors: No reported disclosures
P-776. Value Of Neutrophil/Lymphocyte Ratio In Predicting Relapse In Multifocal Tuberculosis
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir
Published: January 2025

Background

Multifocal tuberculosis remains a life-threatening disease. The involvement of two non-contiguous extrapulmonary sites makes the prognosis difficult to predict. Neutrophil-lymphocyte ratio (NLR) is a useful biomarker for predicting outcome in various clinical setting. We aimed to study the value of NLR in predicting relapse in multifocal tuberculosis.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious disease department for multifocal tuberculosis between 1998 and 2022. The NLR was defined as the number of neutrophils divided by the number of lymphocytes in whole blood. Receiver operating characteristic curves and areas under the curves (AUC) were calculated to evaluate the predictor value of NLR.

Results

We encountered 94 cases, among whom 64 were females (68.1%). Relapse was noted in 9 cases (9.6%). The NLR was significantly higher among relapsing multifocal tuberculosis cases (4.1[2.5-8.5] vs 2.4[1.6-3.7] ; p=0.031). The optimal cut-off of NLR for predicting relapse among multifocal tuberculosis cases was 3.7, with a sensitivity of 62.5% and a speciﬁcity of 75.4%. The AUC was 0.737 and the 95% conﬁdence interval ranged from 0.575 to 0.899.

Conclusion

The NLR was a useful biomarker in predicting relapse among multifocal tuberculosis cases. Such patients require a close follow-up in order to promptly diagnose relapse.

Disclosures

All Authors: No reported disclosures
P-793. Long-term Outcomes of Mycobacterium avim complex Pulmonary Disease in Kyushu, Japan: A Retrospective Multicenter Study
Authors: Ide Shotaro , Takazono Takahiro , Morimoto Shinpei , Yoshida Masataka , Takeda Kazuaki , Iwanaga Naoki , Hosogaya Naoki , Komiya Kosaku , Izumikawa Koichi , Furumoto Akitsugu , Yanagihara Katsunori , Mukae Hiroshi
Published: January 2025

Background

Recently, the number of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has increased worldwide. The most common causative organism in Japan is the Mycobacterium avium complex (MAC). The incidence of MAC pulmonary disease (MAC-PD) is higher than that in other countries, and deaths from MAC-PD are increasing. Complex cases involving radiological fibrocavitary patterns and pulmonary aspergillosis have been reported as poor prognostic factors; however, available evidence is limited. To address this gap, we initiated a retrospective, multicenter study in Kyushu, Japan, focusing on the long-term prognosis of patients five years after the diagnosis of MAC-PD. The primary objective of this study was to investigate the factors that influence the outcomes of these patients by employing data accessible at the time of their initial diagnosis.

Methods

This was a retrospective cohort study of patients aged ≥ 18 years with newly diagnosed NTM-PD who visited 18 medical centers in Kyushu, Japan, between 2010 and 2017. Patient data were collected from medical records by respiratory experts and recorded using the EDC.

Results

The study enrolled 1317 patients with NTM-PD, of whom 1214 had MAC-PD. Patients with insufficient information were excluded, and 856 patients were analyzed: 546 (63.8%) with a non-cavitary nodular bronchiectatic (NB) pattern and 194 (22.7%) with a cavitary NB or fibrocavitary pattern. 107 (12.5%) died from all-cause by 5 years after diagnosis and 137 (16.0%) by 10 years; in the group that died after 5 years, the following were detected as risk factors in multivariate analysis: male sex (OR = 2.90, 95% confidential interval 1.84-4.56), age ≥ 70 (OR = 2.20, 95%CI 1.33-3.63), lobes with cavities ≥ 2 lobes (OR = 2.16, 95%CI 1.07-4.36), albumin < 3.5 g/dL (OR = 3.68, 95%CI 2.29-5.91), and oral corticosteroids (OR 1.97, 95%CI 1.04-3.73).

Conclusion

Male sex and fibrocavitary patterns have been reported to be poor prognostic factors for MAC-PD. In our study, we found that cavitary formation in more than two lobes, lower albumin levels, and oral corticosteroids were newly considered poor prognostic factors. We believe that our findings may help determine treatment induction and predict the prognosis of MAC-PD.

Disclosures

Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees
P-794. An eight-year experience of active case-finding for tuberculosis cases using mass chest radiography among prisoners in Songkhla Province, Thailand
Authors: Ruangchan Sujinda , Saengsanga Pornthip , Kiamkan Nongnuch
Published: January 2025

Background

Thailand is classified by the World Health Organization (WHO) as a high tuberculosis-burden country with an expected that there are 120,000 TB incidences per year in 2016. Reported cases of tuberculosis among prisoners may account for 30% of tuberculosis with an incidence of 880-5,803 cases per 100,000 inmates in low- to middle-income countries. Beginning in 2017, an active case–finding strategy for tuberculosis was implemented in all prisons in Thailand. Mass chest radiograph screening is performed on all prisoners to identify and bring into treatment tuberculosis cases as soon as possible.

Incidence of pulmonary tuberculosis among prisoners in Songkhla Province in the South of Thailand 2016-2023

Methods

A retrospective descriptive study was conducted at Songkhla Provincial Hospital between 2016 and 2023. Inmates from four prisons in Songkhla Province were assessed by tuberculosis screening using mass chest radiographs yearly from 2017. If abnormal chest radiography revealed compatibility with tuberculosis, sputum microscopy and sputum GeneXpert were performed. Data were analyzed using descriptive statistics

Results

After implementing the active case-finding strategy in 2017, the incidence of pulmonary tuberculosis in prisons rose from 584 cases per 100,000 inmates in 2016 to 3,483 per 100,000 inmates in 2019. Then the trend declined to 2,264 per 100,000 inmates in 2021 and 1,982 per 100,000 inmates in 2023. Tuberculosis cases in the prisons accounted for 15% in 2016 and continued to rise to 60% in 2019 then decline to 41% in 2023 of all tuberculosis cases in Songkhla Province. Furthermore, sputum microscopy or GeneXpert detected tuberculosis positive between 10% and 16% of all tuberculosis cases in the four prisons. The rates of treatment success were 90%-94% and the case fatality rates were 11-58 cases per 100,000 inmates at the four prisons.

Conclusion

The active case-finding strategy using mass chest radiography increases the early detection of tuberculosis cases and early treatment in prisons. After 3 years of implementing strategies, the incidence of pulmonary tuberculosis has declined

Disclosures

All Authors: No reported disclosures
Anatomical Location of the Bowel in Different Surgical Positions
Authors: Farber S. Harrison , Rudy Robert F. , Zhou James J. , Alan Nima , DiDomenico Joseph D. , O’Neill Luke K. , Williams Gabriella P. , Alhilali Lea M. , Turner Jay D. , Uribe Juan S.
Published: January 2025

Study Design.

Radiographic analysis.

Objective.

Evaluate the anatomical relationships of the bowel to the lateral surgical corridor and the spine in various surgical positions.

Summary of Background Data.

Retroperitoneal transpsoas lateral lumbar interbody fusion (LLIF) may be performed with patients in the prone position, allowing for lateral and posterior approaches to the spine without repositioning the patient. Few, if any, studies discuss changes of the bowel position during these procedures.

Methods.

Ten healthy volunteers underwent MRI in 3 positions: supine, prone with hips extended (prone-extension), and right lateral decubitus (left side up) with hips flexed (lateral decubitus-flexion). Anatomical relationships of the bowel to fixed spinal landmarks were assessed at L1-5, and the changes among participants’ positions were compared.

Results.

Anterior bowel movement was noted with prone-extension (range: 0.32-1.39 cm) and lateral decubitus-flexion (range: 0.97-2.18 cm) positioning compared with supine positioning. Significant anterior movement of the bowel was observed at L1-2 (P=0.03) and L2-3 (P=0.04) disc levels in participants in the prone position and at L2-3 (P=0.002) and L3-4 (P=0.01) in those in the lateral position when compared with those in the supine position. No differences in bowel movement were found for prone and lateral positioning. The percentages of participants with bowels located in the operative corridor were similar among the surgical positions (all P>0.07). 3D volumetric analysis showed that the magnitude of these changes was greatest for the upper left colon.

Conclusions.

The results showed that the bowel was positioned anteriorly at L1-5 disc levels when participants were in prone-extension and lateral decubitus-flexion positions compared with the supine position. Overall, the magnitude of bowel positional change was small and variable. These findings suggest that the bowel does not fall away from the surgical corridor when performing retroperitoneal access for single-position prone surgery compared with the lateral decubitus-flexion position.
Metabolic effects of heterocyclic amines on insulin‑induced AKT phosphorylation and gluconeogenic gene expression are modified by N-acetyltransferase 2 genetic polymorphism
Authors: Walls Kennedy M. , Joh Jonathan Y. , Martinez Madeline M. , Hong Kyung U. , Hein David W.
Published: January 2025

Objective

Heterocyclic amines (HCAs) are mutagens and carcinogens primarily generated when cooking meat at high temperatures or until well-done, and their major metabolic pathway includes hepatic N-hydroxylation via CYP1A2 followed by O-acetylation via N-acetyltransferase 2 (NAT2). NAT2 expresses a well-defined genetic polymorphism in humans resulting in rapid and slow acetylators. Recent epidemiological studies reported significant associations between dietary HCA exposure and insulin resistance and type II diabetes.

Methods

We assessed the effect of some of the most common HCAs found in cooked meat, 2-amino-3,4-dimethylimidazo[4,5-f]quinoline, 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline, and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine, on insulin signaling and gluconeogenic gene expression in cryopreserved human hepatocytes characterized by their NAT2 genotype and phenotype to investigate the role of NAT2 genetic polymorphism in HCA-induced metabolic dysregulation.

Results

HCA treatment significantly reduced insulin-induced protein kinase B phosphorylation and significantly increased expression of genes involved in gluconeogenesis (G6PC, PCK1, FOXO1, and PPARA) in cryopreserved human hepatocytes from rapid but not from slow acetylators.

Conclusion

The findings suggest that NAT2 genetic polymorphism modifies HCA-induced insulin resistance and gluconeogenic gene expression, implying that individuals with rapid acetylator phenotype may be at greater risk of dysregulated glucose homeostasis following exposure to HCAs.
Plastic Surgeon Well-being, Mindfulness, and the Art of Letting Go
Authors: Kim David H. , Chandawarkar Simran K. , Krajewski Aleksandra , DeLuca-Pytell Danielle , Akiki Ronald K. , Asanbe Opeyemi A. , Patel Sameer A.
Published: January 2025

As plastic surgeons, we strive to achieve the best possible outcomes for our patients. However, despite being a good surgeon with a sound plan that was thoughtfully crafted and well executed, complications still happen. As a result, surgeons involved in the care of patients who have complications can experience mental and emotional suffering, including feelings of guilt, sadness, anxiety, and stress. It is important to be aware of these emotions and to acknowledge them. Through recognition and self-acceptance, we can let go of that which no longer serves us and focus on the present. In fact, there are definitive benefits to letting go of negative thoughts, emotions, and maladaptive behaviors by implementing mindfulness-based practices and seeking individualized treatment if needed.
Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces
Authors: Dai Zhang-Yi , Shen Cheng , Wang Xinwei , Wang Fu-Qiang , Wang Yun
Published: January 2025

Background:

While recent randomized controlled trials have demonstrated that sublobar resection is non-inferior to lobectomy, the comparative efficacy of these procedures remains uncertain for early-stage non-small cell lung cancer (NSCLC; ≤ 3 cm) exhibiting invasive features postoperatively, such as visceral pleural invasion (VPI) or spread through air spaces (STAS).

Materials and Methods:

To identify eligible studies, a comprehensive search of PubMed, Embase, MEDLINE, the Cochrane Library, and Web of Science was conducted through 25 July 2024. Studies were screened according to predefined criteria in accordance with PRISMA guidelines. The primary endpoints were 5-year overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) and 95% confidence intervals (CI) were used to perform a meta-analysis.

Results:

The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8,054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. The meta-analysis revealed that sublobar resection was associated with impaired 5-year OS (HR: 1.25; 95% CI: 1.10-1.41) and slightly inferior RFS (HR: 1.25; 95% CI: 0.99-1.58) compared to lobectomy for pT2a (VPI) NSCLC patients with tumor ≤3 cm. Similarly, sublobar resection was associated with significantly worse 5-year OS (HR: 2.58; 95% CI: 1.92-3.45) and 5-year RFS (HR: 2.42; 95% CI: 1.69-3.46) compared to lobectomy for stage IA NSCLC patients with STAS. Subgroup analysis revealed that statistically significant differences in 5-year OS (HR: 1.13; 95% CI: 0.92-1.38) and 5-year RFS (HR: 0.87; 95% CI: 0.56-1.36) were not observed between the sublobar resection and lobectomy groups for pT2a (VPI) NSCLC patients with tumor ≤2 cm. Additionally, no statistically significant survival difference was observed between the segmentectomy and lobectomy groups for NSCLC patients (≤3 cm) with VPI (5-year OS: HR: 1.16; 95% CI: 0.89-1.52; 5-year RFS: HR: 1.07; 95% CI: 0.88-1.30) or STAS (5-year OS: HR: 3.88; 95% CI: 0.82-18.31; 5-year RFS: HR: 1.64; 95% CI: 0.70-3.80).

Conclusion:

For early-stage (≤3 cm) NSCLC with VPI or STAS, sublobar resection was associated with worse survival outcomes compared to lobectomy. However, segmentectomy achieved survival outcomes comparable to those of lobectomy. For pT2a (VPI) NSCLC patients with tumor ≤2 cm, the differences in survival outcomes between sublobar resection and lobectomy were not statistically significant.
The effects of extracorporeal shock wave therapy in children with cerebral palsy: a systematic review
Authors: de Roo Eline G. , Koopman Sanne B. , Janssen Thijs W. , Aertssen Wendy F.M.
Published: January 2025

Introduction:

Spastic Cerebral Palsy (CP) is a major cause of movement disorders in pediatric rehabilitation. Current treatments are often invasive and may lead to substantial discomfort. Extracorporeal shockwave therapy (ESWT) presents a potential alternative, offering a less invasive approach with a reduced side effect profile. However, the impact of ESWT on children with CP remains unclear. This systematic review aims to summarize the current evidence on ESWT’s impact in children with spastic CP across various domains of the International Classification of Functioning, Disability, and Health for Children and Youth.

Method:

To answer the main question, a systematic literature study is used. The studies, collected from four databases, were screened and data on outcome measures and methodological quality were extracted. Effect sizes were calculated to facilitate study comparison.

Results:

In total, twelve randomized controlled trials met inclusion criteria, with PEDro scores ranging from three to eight. The combined study population included 421 children. Positive effects were observed on resistance to passive movements, passive range of motion, and gross motor skills, with effect sizes ranging from moderate (0.65) to very large (7.69).

Conclusion:

ESWT demonstrated positive effects across multiple domains in children with spastic CP.
A Novel Technique for rapid localization of pulmonary nodules on-site in Operating Room Followed by Lung Resection: a Case Series
Authors: Huang Wei , Zhang Chengcheng , Zeng Weibiao , Lin Dong , Fan Jiang , Wu Liang
Published: January 2025

Background:

The localization of pulmonary nodules is crucial for surgical intervention. However, a safe, simple, and efficient method remains elusive. This study aims to evaluate the safety and feasibility of a newly developed preoperative localization method for pulmonary nodules called Rapid Localization of Pulmonary Nodules On-Site (RLPN-OS).

Methods:

This study is a single-center, single-arm prospective investigation that collects and analyses the clinical data of patients who underwent RLPN-OS and lung resection, primarily evaluating the safety and feasibility of this technique.

Results:

A total of 200 lung nodules from 190 patients who underwent RLPN-OS and partial lobectomy were included in this study. The success rate of localization was 98.0%, and minor intercostal bleeding was observed in 3 cases (1.5%). All targeted lesions were located and resected successfully. No patients reported experiencing anxiety or pain during or after the procedure.

Conclusions:

This novel RLPN-OS technology represents a safe, feasible, patient-friendly, and cost-effective method for lung nodule localization. It has the potential to serve as an alternative to traditional CT-guided percutaneous localization techniques.
Motorcycle and Equestrian Trauma: An ACS TQIP Comparative Study
Authors: Ross Daniel E. , Ghodasara Satyam K. , Roskam Justin S. , Gaccione Amanda G. , DiFazio Louis T. , Bilaniuk Jaroslaw W. , Nemeth Zoltan H.
Published: January 2025

BACKGROUND:

Motorcycle and equestrian accidents can share similar trauma mechanisms and can result in serious injuries.

OBJECTIVE:

This study aims to analyze variations in injuries and safety standards through types, severity, and outcomes of traumatic injuries in both motorcycle and equestrian riders.

METHODS:

Using the 2020 ACS TQIP database, we split patients into two groups based on their primary injury. We chose codes V28 and V80.0 to identify non-collision fall or throw injuries for motorcycle and equestrian accidents respectively. A total of 17,730 motorcycle and 5,461 equestrian patients were identified.

RESULTS:

Motorcyclists were more likely to experience external/superficial injuries (41.34% vs. 29.08%, p < .001) and chest trauma (5.15% vs. 3.18%, p < .001), while equestrian trauma resulted in more injuries to the abdomen and pelvic content (24.07% vs. 15.75%, p < .001), extremities and pelvic girdle (9.85% vs. 4.98%, p < .001), and head/neck (15.57% vs. 12.16%, p < .001) comparatively. Motorcyclists also had a higher average length of inpatient stay (6.06 (8.03) vs. 4.32 (4.23) days, p < .001). Helmet use was more common among motorcyclists than horseback riders (57.79% vs. 24.24%, p < .001). The average injury severity score between the two groups was not significantly different.

CONCLUSION:

These data show the different injuries observed between both activities and the need for increased safety equipment, especially in the case of hip and pelvic injuries among equestrians. The low rate of helmet, especially among equestrian riders, is concerning despite broad education regarding their benefits.
Experiences of Nurse Managers in the 2023 Kahramanmaras, Turkey Earthquakes: A Qualitative Study
Authors: Koroglu Kaba Nagihan , Bal Betul , Ozturk Havva
Published: January 2025

BACKGROUND:

Nurse managers play a critical role in disaster response and management; yet research on their experiences in earthquakes remains limited.

OBJECTIVE:

This study aimed to explore the experiences of nurse managers in the Kahramanmaras, Turkey, earthquakes.

METHODS:

A phenomenological approach was used to guide this study, exploring the lived experiences of nurse managers who worked during the 2023 earthquakes in Kahramanmaras, Turkey. Purposive sampling identified participants, and data were collected 2–3 months postearthquake, from April to May 2023, via semi-structured interviews conducted via social media. Thematic analysis was applied to analyze the interview data.

RESULTS:

A total of 11 nurse managers were interviewed for the study. Fifty-five percent were between the ages of 35 and 44, 64% were female and had a bachelor’s degree. Five themes emerged from the data: “being unprepared” (predisaster phase), “emotional difficulties,” “communication and coordination issues,” “resource shortages” (disaster event phase), and “evaluation and professional satisfaction” (postdisaster phase).

CONCLUSION:

The study found that most nurse managers reported feeling unprepared for the earthquake despite institutional disaster management practices. They struggled with managing their emotions, resource shortages, and communication–coordination issues. These experiences underscore the need for enhanced disaster training and preparedness for nurses. Collaboration among international health organizations, nongovernmental organizations, and governments is essential to develop disaster management plans to optimize nurses as early responders.
Coronary artery dominance influences the distribution of calcified plaques in the coronary tree
Authors: Pourafkari Leili , Ansari Salman , Kinninger April , Budoff Matthew J.
Published: January 2025

Background

Coronary artery dominance is determined by the coronary artery emitting the posterior descending artery. In the left dominant system, a greater proportion of coronary flow enters the left coronary artery, potentially influencing calcified plaque development in the left anterior descending artery (LAD).

Methods

This retrospective single-center cohort study analyzed patients who underwent computed tomography angiography from September 2006 to December 2022 at Harbor-UCLA in Los Angeles, California. Coronary artery calcium (CAC) was quantified for the three coronary vessels. The LAD calcium score was divided by the total calcium score to calculate the LAD calcium percentage, which was compared between left and right dominant coronary systems. Multivariable linear regression assessed the association between LAD calcium percentage and coronary dominance, adjusting for age, gender, BMI, hyperlipidemia, hypertension, family history of cardiovascular disease, and past smoking.

Results

Among 9560 subjects, 6766 with CAC greater than zero were enrolled. The average age was 64.8 ± 10.7 years: 68% were male, and 9% had left dominant coronary systems. The median CAC was 51 [0–352] in the right dominant and 49 [0–358] in the left dominant system (P = 0.73). Adjusted analysis revealed that individuals with left dominant coronary systems had a 10.1% higher (CI 7.5–12.8%, P < 0.001) LAD calcium percentage than those with right dominant systems.

Conclusion

Although coronary dominance does not influence overall plaque burden of atherosclerosis, it affects calcified plaque distribution. The left dominant system is associated with a higher proportion of calcified plaque in the LAD, potentially heightening the risk of adverse cardiovascular events.
Lack of effect of renal function on uptake of 99mTc-sestamibi in renal masses
Authors: Amindarolzarbi Alireza , Satcowitz Kendall , Khalil Adham , Osman Sena , Murtazaliev Salikh , Al-Zubaidi Anas , Viglianti Benjamin L. , Solnes Lilja B. , Kaufmann Basil , Sheikhbahaei Sara , Pavlovich Christian P. , Oldan Jorge D. , Benefield Thad , Singla Nirmish , Gorin Michael A. , Rowe Steven P.
Published: January 2025

Objective:

The appropriate clinical management of indeterminate small renal masses can be improved based on accurate risk stratification. This study aimed to investigate the impact of renal function on the uptake of technetium-99m (99mTc)-sestamibi, a widely available imaging agent that can be utilized to identify oncocytomas and other benign/indolent renal masses.

Methods:

A retrospective cohort study was conducted, involving 100 consecutive patients who underwent 99mTc-sestamibi single-photon emission computed tomography/computed tomography. Renal function was evaluated based on creatinine levels and glomerular filtration rate (GFR). Statistical analyses, including correlation and regression analyses, were performed to explore the relationship between renal function and 99mTc-sestamibi uptake.

Results:

The results revealed that discrepancies can occur between imaging and pathology results, emphasizing the need for careful interpretation of imaging findings. Correlation analysis demonstrated no significant correlation between relative tumor uptake of 99mTc-sestamibi and GFR or serum creatinine levels. These findings highlight the relative independence of renal function and 99mTc-sestamibi uptake and suggest sestamibi may be of use even in patients with relatively poor renal function.

Conclusions:

However, further research with larger sample sizes is required to validate and generalize these findings. Ultimately, understanding the broad variety of applicability of 99mTc-sestamibi uptake for risk stratification of renal malignancy could aid in appropriate clinical decision-making.
Quantitative Plaque Characteristics/Pericoronary Fat Attenuation Index and Acute Coronary Syndrome in Patients With Stable Angina Pectoris
Authors: Li Defu , Wang Yujin , Zhu Tingting
Published: January 2025

Objective:

Vascular inflammation affects acute coronary syndrome (ACS) occurrence in patients with stable angina. Coronary inflammation can be represented by the pericoronary fat attenuation index (FAI).

This study investigated the quantitative prognostic value of plaque characteristics and FAI in patients with stable angina.

Methods:

Risk factors for ACS occurrence in patients with stable angina pectoris were retrospectively analyzed. The diagnostic value of FAI and plaque characteristics for ACS occurrence in these patients were determined; Kaplan-Meier curves were used to predict ACS event incidence.

Results:

After postpropensity score matching, data of 60 and 130 patients with and without ACS, respectively, were analyzed. Pericoronary FAI, lipid volume, and lipid percentage in the narrowest segment significantly improved ACS diagnosis in patients with stable angina. Luminal stenosis ≥50% and FAI >−88 Hounsfield units (HU) were independent risk factors for ACS occurrence in patients with stable angina. Perileft anterior descending artery (LAD) FAI >−88 HU better predicted ACS occurrence in patients with stable angina than did peri-LAD FAI ≤−88 HU.

Conclusions:

In patients with stable angina, lipid volume and percentage and pericoronary FAI improved the diagnostic ability of luminal stenosis for ACS occurrence. Furthermore, peri-LAD FAI >−88 HU could predict ACS occurrence.
Headache in infections
Authors: Ramesh Rithvik , Ranganathan Lakshmi Narasimhan
Published: January 2025

Purpose of review

This review explores the phenomenology, pathogenesis, and nosology of headaches associated with infections, an often-overlooked yet clinically significant symptom. With the increasing recognition of secondary headaches in infections, understanding their clinical patterns, mechanisms, and classifications is crucial for accurate diagnosis and management.

Recent findings

Headaches in infections are ubiquitous but vary in presentation, severity, and underlying mechanisms depending on the causative pathogen. Elevated intracranial pressure, meningeal irritation, and activation of the trigeminovascular system are key contributors to headache generation, which varies depending on each pathogen. Pathogen-specific predilection for one of these mechanisms may subtly alter the clinical phenotype of the headache, which can be used to guide management. Emerging evidence highlights postinfectious headache syndromes, particularly following bacterial meningitis and SARS-CoV-2 infection, underscoring the need for long-term follow-up in these patients.

The diverse presentations of infection-related headaches necessitate a systematic approach to evaluation and management. While the pathophysiology is complex and multifaceted, understanding these mechanisms aids in differentiating primary headaches from those secondary to infections.