bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Growth in Consumer Welfare with Income-Dependent Preferences: Nonparametric Methods and Estimates for the United States
Authors: Jaravel Xavier , Lashkari Danial
Published: September 2023

How should we measure changes in consumer welfare given observed data on prices and expenditures? This article proposes a nonparametric approach that holds under arbitrary preferences that may depend on observable consumer characteristics, for example, when expenditure shares vary with income. Using total expenditures under a constant set of prices as our money metric for real consumption (welfare), we derive a principled measure of real consumption growth featuring a correction term relative to conventional measures. We show that the correction can be nonparametrically estimated with an algorithm leveraging the observed, cross-sectional relationship between household-level price indices and household characteristics such as income. We demonstrate the accuracy of our algorithm in simulations. Applying our approach to data from the United States, we find that the magnitude of the correction can be large because of the combination of fast growth and lower inflation for income-elastic products. Setting reference prices in 2019, we find that (i) the uncorrected measure underestimates average real consumption per household in 1955 by 11.5%, and (ii) the correction reduces the annual growth rate from 1955 to 2019 by 18 basis points, which is larger than the well-known “expenditure-switching bias” over the same time horizon.
Big broad banks: how does cross-selling affect lending?
Authors: Qi Yingjie
Published: September 2023

This article investigates how cross-selling affects relationship lending using internal data from a large bank and the Swedish credit registry. I show that within a bank–firm relationship, profit earned from non-loan products cross-subsidizes loans and increases (1) credit supply and (2) the likelihood of the bank’s pausing or waiving interest payments for delinquent loans (lenience in delinquency). For identification, I exploit the Basel II-induced exogenous variation in products’ profitability while holding constant the firm’s creditworthiness and relationship informativeness. I find that the average affected firm experienced a decrease of 6 percent ($400,000) in credit supply and 30 percent (9.8 pp) in lenience in delinquency. The results highlight the importance of cross-subsidization as a mechanism through which cross-selling affects bank–firm relationships and inform optimal regulatory design for lenders who multi-produce.
A comparison of different detection techniques for 137Cs measurements of cattle in vivo
Authors: Bartusková Miluše , Selivanova Anna , Malátová Irena , Hůlka Jiří , Škrkal Jan , Rosmus Jan , Kapyltsova Alena , Rulík Petr
Published: September 2023

Agricultural lands with farm animals (e.g. cattle) can be significantly affected by radioactive contamination following nuclear or radiation accidents. In order to optimise the techniques for measuring 137Cs in contaminated cattle, selected radiation detectors have been tested and calibrated using volumetric radiation sources. In addition, a mathematical phantom of a cow was created within Monte Carlo simulations. The main aim of the research was to propose a method for making rapid measurements of 137Cs in cattle in vivo/in situ and to select the most suitable measurement set-up. Measurements of contaminated cattle in vivo were carried out in Belarus with one selected detector, and were then compared with measurements of meat in a laboratory and with measurements of a control group of cows. The proposed measurement method was also tested on measurements of 137Cs in wild boars in Czechia with higher levels of the 137Cs activity.
Relation of resting brain signal variability to cognitive and socioemotional measures in an adult lifespan sample
Authors: Grady Cheryl L , Rieck Jenny R , Baracchini Giulia , DeSouza Brennan
Published: September 2023

Temporal variability of the fMRI-derived blood-oxygen-level-dependent (BOLD) signal during cognitive tasks shows important associations with individual differences in age and performance. Less is known about relations between spontaneous BOLD variability measured at rest and relatively stable cognitive measures, such as IQ or socioemotional function. Here, we examined associations among resting BOLD variability, cognitive/socioemotional scores from the NIH Toolbox and optimal time of day for alertness (chronotype) in a sample of 157 adults from 20 to 86 years of age. To investigate individual differences in these associations independently of age, we regressed age out from both behavioral and BOLD variability scores. We hypothesized that greater BOLD variability would be related to higher fluid cognition scores, more positive scores on socioemotional scales and a morningness chronotype. Consistent with this idea, we found positive correlations between resting BOLD variability, positive socioemotional scores (e.g. self-efficacy) and morning chronotype, as well as negative correlations between variability and negative emotional scores (e.g. loneliness). Unexpectedly, we found negative correlations between BOLD variability and fluid cognition. These results suggest that greater resting brain signal variability facilitates optimal socioemotional function and characterizes those with morning-type circadian rhythms, but individuals with greater fluid cognition may be more likely to show less temporal variability in spontaneous measures of BOLD activity.
Partner similarity and social cognitive traits predict social interaction success among strangers
Authors: Dziura Sarah L , Hosangadi Aditi , Shariq Deena , Merchant Junaid S , Redcay Elizabeth
Published: September 2023

Social interactions are a ubiquitous part of engaging in the world around us, and determining what makes an interaction successful is necessary for social well-being. This study examined the separate contributions of individual social cognitive ability and partner similarity to social interaction success among strangers, measured by a cooperative communication task and self-reported interaction quality. Sixty participants engaged in a 1-h virtual social interaction with an unfamiliar partner (a laboratory confederate) including a 30-min cooperative ‘mind-reading’ game and then completed several individual tasks and surveys. They then underwent a separate functional MRI session in which they passively viewed video clips that varied in content. The neural responses to these videos were correlated with those of their confederate interaction partners to yield a measure of pairwise neural similarity. We found that trait empathy (assessed by the interpersonal reactivity index) and neural similarity to partner both predicted communication success in the mind-reading game. In contrast, perceived similarity to partner and (to a much lesser extent) trait mind-reading motivation predicted self-reported interaction quality. These results highlight the importance of sharing perspectives in successful communication as well as differences between neurobiological similarity and perceived similarity in supporting different types of interaction success.
Summary Tests of Introgression Are Highly Sensitive to Rate Variation Across Lineages
Authors: Frankel Lauren E , Ané Cécile
Published: September 2023

The evolutionary implications and frequency of hybridization and introgression are increasingly being recognized across the tree of life. To detect hybridization from multi-locus and genome-wide sequence data, a popular class of methods are based on summary statistics from subsets of 3 or 4 taxa. However, these methods often carry the assumption of a constant substitution rate across lineages and genes, which is commonly violated in many groups. In this work, we quantify the effects of rate variation on the D test (also known as ABBA–BABA test), the D3 test, and HyDe. All 3 tests are used widely across a range of taxonomic groups, in part because they are very fast to compute. We consider rate variation across species lineages, across genes, their lineage-by-gene interaction, and rate variation across gene-tree edges. We simulated species networks according to a birth–death-hybridization process, so as to capture a range of realistic species phylogenies. For all 3 methods tested, we found a marked increase in the false discovery of reticulation (type-1 error rate) when there is rate variation across species lineages. The D3 test was the most sensitive, with around 80% type-1 error, such that D3 appears to more sensitive to a departure from the clock than to the presence of reticulation. For all 3 tests, the power to detect hybridization events decreased as the number of hybridization events increased, indicating that multiple hybridization events can obscure one another if they occur within a small subset of taxa. Our study highlights the need to consider rate variation when using site-based summary statistics, and points to the advantages of methods that do not require assumptions on evolutionary rates across lineages or across genes.
Differentiating between metabolic health statuses in Simmental cows and describing related milk fatty acids and relevant associated factors
Authors: Reus Anne M , Hajek Franziska E , Gruber Simone M , Plattner Stefan , Hachenberg Sabrina , Walleser Emil A , Aravamuthan Srikanth R , Mansfeld Rolf , Döpfer Dörte
Published: September 2023

The aim of this observational study was to examine differences in milk fatty acid (FA) concentrations for different metabolic health statuses and for associated factors—specifically to examine with which FA concentrations an increased risk for developing a poor metabolic adaptation syndrome (PMAS) was associated. During weekly visits over 51 wk, blood samples were collected from cows between 5 and 50 days in milk. The farmer collected corresponding milk samples from all voluntary milkings. The analysis was performed on n = 2,432 samples from n = 553 Simmental cows. The observations were assigned to five different cow types (healthy, clever, athletic, hyperketonemic, and PMAS, representing five metabolic health statuses), based on the thresholds of 0.7 mmol/L, 1.2 mmol/L, and 1.4 for the concentrations of β-hydroxybutyrate and nonesterified fatty acids and for the milk fat-to-protein ratio, respectively. Linear regression models using the predictor variables cow type, parity, week of lactation, and milk yield as fixed effects were developed using a stepwise forward selection to test for significant associations of predictor variables regarding FA concentrations in milk. There was a significant interaction term found between PMAS cows and parity compared to healthy cows for C18:1 (P < 0.001) and for C18:0 (P < 0.01). It revealed higher concentrations for PMAS in primiparous and multiparous cows compared to healthy cows, the slope being steeper for primiparous cows. Further, an interaction term was found between PMAS cows and milk yield compared to healthy cows and milk yield for C16:0 (P < 0.05), revealing a steeper slope for the decrease of C16:0 concentrations with increasing milk yield for PMAS compared to healthy cows. The significant associations and interaction terms between cow type, parity, week of lactation, and milk yield as predictor variables and C16:0, C18:0, and C18:1 concentrations suggest excellent opportunities for cow herd health screening during the early postpartum period.
Pediatric sepsis profile in a tertiary-care hospital in Indonesia: a 4-year retrospective study
Authors: Pudjiadi Antonius Hocky , Putri Nina Dwi , Wijaya Stephanie , Alatas Fatima Safira
Published: September 2023

Aim

This study aimed to explore the factors contributing to mortality and its management among pediatric sepsis patients at a single center in Indonesia.

Method

We conducted a retrospective study of children admitted due to sepsis from January 2015 to December 2019 in an Indonesian tertiary hospital.

Results

The mortality rate of pediatric sepsis in our study was 76.1% among 176 records with outcome identified. Mortality was significantly associated with septic shock at triage, number of organ failure, intensive care unit admission, inotropic use, septic shock and severe sepsis during hospitalization. Timing of antibiotic use did not affect mortality. Death within the first 24 h occurred in 41.8% of subjects, mostly due to septic shock.

Conclusion

This study illuminates the current state of pediatric sepsis management in our Indonesian hospital, revealing it as inadequate. Findings highlight the need for improved pre-hospital systems and sepsis recognition tools, and wider use of mechanical ventilators and advanced monitoring due to limited pediatric intensive care unit beds. Future research should focus on hospital-specific sepsis protocols to reduce pediatric sepsis mortality rates.
Integrative taxonomy of theIphisa elegansspecies complex (Squamata: Gymnophthalmidae) leads to the description of five new species
Authors: Albano de Mello Anna V , Recoder Renato S , Fouquet Antoine , Rodrigues Miguel T , Nunes Pedro M S
Published: September 2023

We reassessed the taxonomic status of lizards of the Iphisa elegans complex, a monotypic genus of Gymnophthalmidae, based on the congruence between mitochondrial DNA (Cytb) and nuclear DNA (c-mos and prlr) and characters of internal and external morphology, both quantitative and qualitative (meristic, morphometric and hemipenial), throughout its wide Amazonian distribution. The congruence of three species delimitation analyses (mPTP, bGMYC and ASAP), nuclear DNA topology and morphological evidence resulted in nine operational taxonomic units in the genus Iphisa. Besides being recovered as monophyletic groups in mitochondrial and nuclear phylogenetic trees, these nine operational taxonomic units can be distinguished by external and hemipenial morphology. Finally, we propose a new taxonomic rearrangement of the genus, whereby we: (i) restrict I. elegans to north-east Amazonia in the Guiana Shield and southwards, west from the Purus–Madeira interfluvium, on the right bank of the Amazon River; (ii) elevate Iphisa elegans soinii Dixon, 1974 to the specific level Iphisa soinii Dixon, 1974 comb. nov.; and (iii) name and describe five new species.
Antiplatelet and Wound Healing Implications of Immunotherapy and Targeted Cancer Therapies in the Perioperative Period
Authors: Sindt Jill E. , Fitzgerald Lindsey A. , Kuznicki Joanne , Prelewicz Stacy , Odell Daniel W. , Brogan Shane E.
Published: September 2023

The traditional paradigm of oncologic treatment centered on cytotoxic chemotherapy has undergone tremendous advancement during the last 15 yr with the advent of immunotherapy and targeted cancer therapies. These agents, including small molecule inhibitors, monoclonal antibodies, and immune-checkpoint inhibitors, are highly specific to individual tumor characteristics and can prevent cell growth and tumorigenesis by inhibiting specific molecular targets or single oncogenes. While generally better tolerated than traditional chemotherapy, these therapies are associated with unique constellations of adverse effects. Of particular importance in the perioperative and periprocedural settings are hematologic abnormalities, particularly antiplatelet effects with increased risk of bleeding, and implications for wound healing. This narrative review discusses targeted cancer therapies and provides recommendations for physicians managing these patients’ care as it relates to procedural or surgical interventions.
Functional Alignment Within the Fusion in Adult Spinal Deformity (ASD) Improves Outcomes and Minimizes Mechanical Failures
Authors: Ani Fares , Ayres Ethan W. , Soroceanu Alex , Mundis Gregory M. , Smith Justin S. , Gum Jeffrey L. , Daniels Alan H. , Klineberg Eric O. , Ames Christopher P. , Bess Shay , Shaffrey Christopher I. , Schwab Frank J. , Lafage Virginie , Protopsaltis Themistocles S. ,   International Spine Study Group
Published: September 2023

Study Design.

Retrospective review of an adult deformity database.

Objective.

To identify pelvic incidence (PI) and age-appropriate physical function alignment targets using a component angle of T1-pelvic angle within the fusion to define correction and their relationship to proximal junctional kyphosis (PJK) and clinical outcomes.

Summary of Background Data.

In preoperative planning, a patient’s PI is often utilized to determine the alignment target. In a trend toward more patient-specific planning, age-specific alignment has been shown to reduce the risk of mechanical failures. PI and age have not been analyzed with respect to defining a functional alignment.

Methods.

A database of patients with operative adult spinal deformity was analyzed. Patients fused to the pelvis and upper-instrumented vertebrae above T11 were included. Alignment within the fusion correlated with clinical outcomes and PI. Short form 36-Physical Component Score (SF36-PCS) normative data and PI were used to compute functional alignment for each patient. Overcorrected, under-corrected, and functionally corrected groups were determined using T10-pelvic angle (T10PA).

Results.

In all, 1052 patients met the inclusion criteria. T10PA correlated with SF36-PCS and PI (R=0.601). At six weeks, 40.7% were functionally corrected, 39.4% were overcorrected, and 20.9% were under-corrected. The PJK incidence rate was 13.6%. Overcorrected patients had the highest PJK rate (18.1%) compared with functionally (11.3%) and under-corrected (9.5%) patients (P<0.05). Overcorrected patients had a trend toward more PJK revisions. All groups improved in HRQL; however, under-corrected patients had the worst 1-year SF36-PCS offset relative to normative patients of equivalent age (−8.1) versus functional (−6.1) and overcorrected (−4.5), P<0.05.

Conclusions.

T10PA was used to determine functional alignment, an alignment based on PI and age-appropriate physical function. Correcting patients to functional alignment produced improvements in clinical outcomes, with the lowest rates of PJK. This patient-specific approach to spinal alignment provides adult spinal deformity correction targets that can be used intraoperatively.
Utilization of Synthetic Human Angiotensin II for Catecholamine-Resistant Vasodilatory Shock in Critically Ill Children: A Single-Center Retrospective Case Series
Authors: Tezel Oguzhan , Hutson Tamara K. , Gist Katja M. , Chima Ranjit S. , Goldstein Stuart L. , Stanski Natalja L.
Published: September 2023

OBJECTIVES:

To describe our institutional experience utilizing adjunctive synthetic angiotensin II in critically ill children with catecholamine-resistant vasodilatory shock (CRVS).

DESIGN:

Single-center, retrospective case series.

SETTING:

PICU and cardiac ICU (CICU) at a large, quaternary children’s hospital in the United States.

PATIENTS:

Twenty-three pediatric patients with CRVS who were prescribed synthetic angiotensin II at the discretion of bedside clinicians from January 2018 to April 2023.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Twenty-three patients (20 in PICU, 3 in CICU) with a median age of 10.4 years (interquartile range [IQR] 1.5–18.5) received angiotensin II over the study period, 70% of whom died. At the time of angiotensin II initiation, 17 patients (74%) were receiving one or more forms of extracorporeal therapy, and median Pediatric Logistic Organ Dysfunction-2 Score-2 in the prior 24 hours was 9 (IQR 7–11). The median time between initiation of the first vasoactive agent and angiotensin II was 127 hours (IQR 13–289), and the median total norepinephrine equivalent (NED) at initiation was 0.65 μg/kg/min (IQR 0.36–0.78). The median duration of therapy was 27 hours (IQR 4–68), and at each timepoint assessed, patients had median improvement in NED and mean arterial pressure (MAP) with treatment. Survivors initiated angiotensin II nearly 3 days earlier in vasoactive course (91.5 hr vs 161 hr, p = 0.23), and had both greater reduction in NED (–75% [IQR –96 to –50] vs +2.1% [IQR –55 to 33], p = 0.008) and greater increase in MAP (+15 mm Hg [IQR 10–27] vs –1.5 mm Hg [IQR –27 to 18], p = 0.052) at angiotensin II discontinuation.

CONCLUSIONS:

We demonstrate reduction in NED and improved MAP following initiation of angiotensin II in critically ill children with CRVS. Further prospective work is needed to examine optimal timing of angiotensin II initiation, appropriate patient selection, and safety in this population.
Threshold effect of systemic immune inflammatory index on hypertension in American adults (NHANES 2017–2020)
Authors: Shi Yumeng , Zhou Wei
Published: September 2023

Background and aims:

Research reports on the relationship between systemic immune-inflammation index (SII) and hypertension are limited. We aim to evaluate the possible relationship between SII and hypertension.

Methods and results:

We conducted a cross-sectional analysis of adults from the National Nutrition and Health Database from 2017 to 2020. In this study, 13 742 participants were included. The exposure variable in this study was the systemic inflammatory state as defined by SII and an outcome was hypertension. There is a nonlinear association between SII and hypertension. Two piecewise logistic regression models were used to analyze the relationship between them and calculated the cut-off point of SII to be 501.2. We found that SII on the left side of the cut-off point has nothing to do with the prevalence of hypertension. However, in patients with SII at least 501.2, the prevalence of hypertension increased with the increase of SII (odds ratio, 3.13; 95% confidence interval, 2.04–4.81). The nonlinear association between LgSII and hypertension still existed stably in the subgroups of sex, age, BMI, diabetes, and cardiovascular disease (P for interaction > 0.05).

Conclusion:

A cross-sectional analysis reported the threshold effect of SII on and hypertension and calculated the turning point of SII to be 501.2.
Hypertension with hidden causes: the cognitive and behavioral profile of an adult female with chronic stress and 16p11.2 microdeletion
Authors: Bos-Roubos Anja G. , Wingbermühle Ellen , Giesen Mareike , Kersseboom Rogier , De Graaff Laura C.G. , Egger Jos I.M.
Published: September 2023

This case report aims to alert physicians to neuropsychological features and chromosomal variants that may underly resistant hypertension. We present a 35-year-old female patient with hypertensive crisis (BP 260/160 mmHg), initially treated with a combination of calcium antagonists, beta blockers, diuretics and angiotensin-converting enzyme (ACE)-inhibitors, though with little improvement. Cushing's syndrome, Conn's syndrome, and glucocorticoid receptor deficiency were ruled out. Multidisciplinary examination of medical history and (hetero)anamneses including psychosocial factors revealed mild dysmorphic body features, developmental delay, early diagnosis of autism spectrum disorder, a history of being bullied at school, little peer contact, learning disabilities, and special education. Neuropsychological assessment demonstrated below average to low average intelligence quotient, cognitive impairments, and psychopathology. Parallel genetic analyses revealed a rare 16p11.2 microdeletion syndrome. These concurrent examinations explained the patient's life-long high stress levels. After psychological treatment, with additional support at home, her blood pressure lowered to normal levels and antihypertensive drugs were no longer needed.
Recurrent Vascularizing Keratitis in Infants With Hereditary Mucoepithelial Dysplasia Related to SREBF1 Mutation
Authors: Kim Seonghwan , Jeong Hyunchul , Ko Jung Min , Kwon Ohsang , Oh Joo Youn
Published: September 2023

Purpose:

This study aims to present ophthalmic manifestations of 2 infants with hereditary mucoepithelial dysplasia (HMD) related to SREBF1 mutation over a 5-year period.

Methods:

Two female infants with an unremarkable perinatal history were evaluated for photophobia that had been manifest since 3 months after birth and diffuse scalp alopecia. Complete ocular examinations under anesthesia were performed, as well as genetic and systemic workup.

Results:

Both patients had vascularizing keratitis in both eyes, characterized by the growth of corneal new vessels from the 360 degrees periphery to the center and the formation of stromal leucomatous opacity at the leading edge. The keratitis partially regressed in response to topical corticosteroids and waxed and waned during the 5 years of follow-up. In addition, the loss of scalp hair developed in a cyclical pattern, causing diffuse scalp alopecia in the patients. Rheumatologic, nutritional, and developmental evaluations were within normal ranges. Whole-exome sequencing identified a heterozygous c.1669C>T (p.Arg557Cys) pathogenic variant in the SREBF1 gene associated with HMD in both patients.

Conclusions:

In pediatric patients with recurrent vascularizing keratitis and diffuse scalp alopecia starting early in life, HMD should be considered, and genetic tests and collaboration with dermatologists and pediatricians on the diagnosis should be provided.
Successful Management of Fungal Keratitis Caused by Multidrug-Resistant Cladosporium Species Using Povidone-Iodine
Authors: Ramatchandirane Balamurugan , Chandrika Yarra Mano , Najeeb Shaista
Published: September 2023

We report a unique case of fungal keratitis, caused by the Cladosporium species, which is found to be resistant to multiple drugs, including voriconazole. Cladosporium belongs to the dematiaceous group of fungus, which is present ubiquitous in air, water, food etc. There are only few case reports available about Cladosporium keratitis which shows the successful management with voriconaozle. But in our case, the Cladosporium species was found to be resistant to multiple drugs, including voriconazole, and was successfully managed by topical povidone iodine (PVI) 5%.
Donor lymphocyte infusion for prophylaxis and treatment of relapse in pediatric hematologic malignancies after allogeneic hematopoietic stem cell transplant
Authors: Hou Ming-Hsin , Lee Chih-Ying , Ho Cheng-Yin , Yu Ting-Yen , Hung Giun-Yi , Huang Fang-Liang , Chiou Tzeon-Jye , Liu Chun-Yu , Yen Hsiu-Ju
Published: September 2023

Background:

Donor lymphocyte infusion (DLI) is effective for managing patients with hematologic malignancies after allogeneic hematopoietic stem cell transplant (HSCT). However, few studies have explored its optimal use in pediatric populations. Herein, we report our single-center experiences of DLI and factors for predicting its outcomes.

Methods:

This retrospective study included pediatric patients who had received DLI (between June 1998 and December 2022) after allogeneic HSCT. Data regarding patient characteristics, preemptive DLI disease status, and DLI characteristics were collected. The primary outcomes were overall survival (OS), event-free survival (EFS), and graft-vs-host-disease (GVHD) development.

Results:

The study cohort comprised 17 patients with acute leukemia, 3 with chronic leukemia, and 3 with lymphoma. Prophylactic, preemptive, and therapeutic DLI were used in seven, seven, and nine patients, respectively. Patients’ median age and DLI dose were 9 years and 4.6 × 107 CD3+ cells/kg, respectively. The 5-year OS, EFS, and nonrelapse mortality were 43.5%, 38.3%, and 13.3%, respectively. Approximately 39% of the patients developed grade III or IV acute GVHD, whereas moderate/severe chronic GVHD (cGVHD) occurred in 30% of the evaluable patients. Patients’ disease status before HSCT (p = 0.009) and DLI (p = 0.018) were the key factors influencing EFS. The implementation of a dose escalation schedule was associated with a marginal reduction in the risk of moderate/severe cGVHD (p = 0.051). A DLI dose of ≥5 × 107 CD3+ cells/kg was significantly associated with a high moderate to severe cGVHD risk (p = 0.002) and reduced OS (p = 0.089).

Conclusion:

Patients’ disease status before HSCT and DLI may help predict EFS. The use of DLI as a prophylactic and preemptive modality leads to a favorable 5-year EFS. To safely deliver DLI in children, clinicians must maintain vigilant monitoring and prepare patients in advance when escalating the dose to ≥5 × 107 CD3+ cells/kg.
Translabyrinthine Craniotomy Is Associated with Higher Risk of Asymptomatic Dural Venous Sinus Thrombosis in Vestibular Schwannoma Resection
Authors: Elms Hunter L. , Straka David M. , Abouelella Dina K. , Francis Howard W. , Kaylie David M. , Cunningham Calhoun D.
Published: September 2023

Objective

Characterize the incidence, risk factors, and patient outcomes of dural venous sinus thrombosis identified on postoperative imaging after retrosigmoid or translabyrinthine craniotomy for vestibular schwannoma resection.

Study Design

Retrospective cohort study.

Setting

Single tertiary academic referral center.

Patients

Eighty-one patients 19 to 82 years of age with vestibular schwannomas, 58% female.

Interventions

Retrosigmoid or translabyrinthine craniotomy with postoperative magnetic resonance imaging/magnetic resonance venography.

Main Outcome Measures

Association between operative approach, age, sex, body mass index, tumor size, dominant sinus, operative time, laterality, and perioperative cerebrospinal fluid (CSF) leaks with rate of thrombosis.

Results

Translabyrinthine craniotomy was associated with the highest relative risk of thrombosis (odds ratios [OR] = 19.82, 95% confidence interval [CI] = 1.75–224, p = 0.007), followed by male sex (OR = 5.53, 95% CI = 1.63–18.8, p = 0.035). Other patient and demographic risk factors were not associated with increased rates of dural venous thrombosis, nor was there an association with postoperative CSF leak. 81% (25/31) of thrombi had resolved within 3 years of surgery.

Conclusions

Translabyrinthine approach and male sex most strongly predicted postoperative dural venous thrombosis after postauricular craniotomy for vestibular schwannoma resection.

Professional Practice Gap and Educational Need

Better understanding of risk factors and management of dural venous thrombosis after vestibular schwannoma surgery.

Learning Objective

Characterize clinically significant risk factors for dural venous thrombosis in vestibular schwannoma surgery.

Desired Result

Identification of patient and operative risk factors for dural venous thrombosis.

Level of Evidence

III.

Indicate IRB or IACUC

Exempt.
Feeding Tube Placement, Complications, and Treatment Responses in a Large Eosinophilic Esophagitis Patient Population
Authors: Borinsky Stephanie A. , Cameron Brenderia A. , Xue Zeyun , LaFata Sean , Kiran Akshatha , Ocampo Adolfo A. , McCallen Justin , Lee Christopher J. , Redd Walker D. , Cotton Cary C. , Eluri Swathi , Reed Craig C. , Dellon Evan S.
Published: September 2023

Objectives:

Feeding tubes can provide a temporary or long-term solution for nutritional therapy. Little is known regarding the use of feeding tubes in patients with eosinophilic esophagitis (EoE). We sought to describe the characteristics and outcomes in EoE patients requiring tube feeding.

Methods:

This was a retrospective cohort study of EoE patients at a large tertiary care health system. Demographics, clinical characteristics, and endoscopic findings were extracted from medical records, and patients who had a feeding tube were identified. Patients with and without a feeding tube were compared. Details about the tube, complications, and treatment were extracted. Growth, global symptomatic, endoscopic, and histopathologic (<15 eos/hpf) responses were compared before and after the initiation of feeding tube therapy.

Results:

We identified 39 of 1216 EoE patients who had a feeding tube (3%). Feeding tube patients were younger (mean age 6.3 years), reported more vomiting, and had a lower total endoscopic reference score than non-feeding tube patients (P < 0.01 for all). Tubes were used for therapy for an average of 6.8 years, with most patients (95%) receiving both pharmacologic and formula treatment for EoE. An emergency department visit for a tube complication was required in 26%. Tube feeding improved body mass index z score (P < 0.01), symptomatic response (42%), endoscopic response (53%), and histologic response (71%).

Conclusions:

Among EoE patients, only a small subset required a feeding tube and predominantly were young children with failure to thrive. Feeding tubes significantly improved growth and, when used in combination with other treatments, led to reduced esophageal eosinophilic inflammation.
Expedited Laparoscopic Cholangiogram and Liver Biopsy in the Workup of Biliary Atresia
Authors: Lai Krista , Eldredge R. , Notrica David M. , Wadera Sheetal , Jamshidi Ramin , Lee Justin , Padilla Benjamin , Garvey Erin M.
Published: September 2023

Purpose:

Recent studies demonstrate the success of Kasai portoenterostomy for biliary atresia (BA) is linearly related to infant age at time of Kasai. We sought to review the feasibility and safety of laparoscopic needle micropuncture cholangiogram with concurrent core liver biopsy (if needed) for expedited exclusion of BA in patients with direct conjugated hyperbilirubinemia.

Methods:

Expedited laparoscopic cholangiogram and liver biopsy were instituted at our facility for infants with direct hyperbilirubinemia for whom clinical exam and laboratory workup failed to diagnose. A retrospective chart review was performed in infants <1 year with hyperbilirubinemia from 2016 to 2021. Demographics, preoperative evaluation, procedure details, and complications were reviewed.

Results:

Two hundred ninety-seven infants with unspecified jaundice were identified, of which, 86 (29%) required liver biopsy. Forty-seven percutaneous liver biopsies were obtained including 8 (17%) in whom BA could not be excluded. Laparoscopic cholangiogram was attempted in 47 infants following basic workup; BA was diagnosed in 22 infants (47%) of which 3 were <18 days old. Biliary patency was demonstrated laparoscopically in 22 of 25 (88%); 3 (12%) required conversion to open cholangiogram. Infants with percutaneous liver biopsy had an average delay of 3 days (range: 2–36) to cholangiogram. Preoperative studies and liver biopsy alone did not reliably exclude the diagnosis of BA.

Conclusion:

Laparoscopic cholangiogram with liver biopsy is a safe procedure resulting in the confirmation or exclusion of BA in infants. Forty-seven percent of infants who underwent laparoscopic cholangiogram were found to have BA; those who were surgical candidates underwent Kasai during the same operation.
Supratentorial extra-axial anaplastic ependymoma: a rare case report
Authors: Osman Abukar Mahamed , Çiftçi Ulvi , Sever Nurten
Published: September 2023

Introduction and importance:

Ependymomas are central nervous system tumors arising from the ependymal lining of the ventricle and spinal cord. Supratentorial extra-axial ependymomas are very rare, most commonly affecting the pediatric population and rarely in adults.

Case presentation:

The authors report a case of a 71-year-old female with a headache and blurred vision. An MRI scan revealed a lesion at the parafalcine region of the occipital lobe. A parieto-occipital craniotomy was performed. When the dura was opened during the operation, the extra-axially located, well-circumscribed, dirty yellow-white tumor dissected from the surrounding tissue was excised entirely by microdissection. Histopathological examination revealed supratentorial extra-axial anaplastic ependymoma. The patient received postoperative radiation therapy (54 Gray over 30 fractions). No recurrence of the tumor was observed during the 4-year follow-up.

Discussion:

Supratentorial ependymomas at the extra-axial region are uncommon; extra-axial anaplastic ependymoma and meningiomas have similar radiological findings, such as a dural tail, subarachnoid plane, and diffuse enhancement after contrast injection. This close similarity might cause misdiagnoses. Total surgical resection was followed by adjuvant radiotherapy and close follow-up in the gold standard of the treatment.

Conclusion:

The authors report a rare case of anaplastic ependymomas located at the extra-axial region. Anaplastic tumors are prone to recurrence despite total resection and radiation therapy; hence, a close follow-up is warranted.
Melatonin versus chloral hydrate on sleep induction for recording electroencephalography in children: a randomized clinical trial
Authors: Fazli Bahareh , Hosseini Seyed-Ahmad , Behnampour Nasser , Langari Alale , Habibi-koolaee Mahdi
Published: September 2023

Background:

Electroencephalography (EEG) plays an essential role in the diagnosis of seizures. EEG recording in children is done with partial sleep deprivation and sedative drugs. To compare the effectiveness of melatonin and chloral hydrate on sleep induction and EEG recording in children.

Materials and methods:

In a parallel blinded randomized clinical trial study, 78 patients (6 months–5 years) were included to record EEG. Patients were randomly divided into two groups to receive melatonin (0.4 mg/kg) or chloral hydrate (0.5 ml/kg). After receiving the sedative drug, the start and duration of sedation, recovery time, side effects, and epileptiform waves in the EEG were recorded. The data was analyzed using SPSS version 16, and the significance level was determined to be less than 0.05.

Results:

A total of 78 children, including 34 girls (43.6%) and 44 boys (56.4%) (average age of 27.15±17.15 months), were examined. Success in the induction of sedation was reported by melatonin in 36 patients (92%) and chloral hydrate in 37 patients (95%), which was similar between the two drugs (P=0.5). The start time (P=0.134) and the duration of sedation (P=0.408) were alike between the two drugs. However, compared to the chloral hydrate, the recovery time in the melatonin group was significantly shorter (P<0.001). Side effects were not seen in melatonin, while six children (15%) using chloral hydrate had mild side effects (P=0.013). Epileptiform waves in EEGs were reported to be similar and positive for melatonin in 18 children (50%) and chloral hydrate in 16 children (43%) (P=0.410).

Conclusion:

The findings show that using melatonin in the dose prescribed in this study had similar effects to success in inducing sedation with the minimum quantity of chloral hydrate. Regardless of the start time and duration of sedation, the shorter recovery time and the absence of side effects are the advantages of using melatonin.
Preoperative echocardiography in patients with hip fracture: a prospective cohort study
Authors: Rostagno Carlo , Tozzetti Camilla
Published: September 2023

Introduction:

Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the present investigation was to assess whether preoperative echocardiography affects time to surgery, length of hospital stay (LOS), and in hospital mortality in high-risk patients who need surgery for a hip fracture.

Material and methods:

In the study entered 255 consecutive patients with hip fracture referred to a multidisciplinary hip fracture unit. Seven hundred seventeen patients referred before the implementation of routine echocardiographic examination were considered as control group. Echocardiography was performed in patients with systolic murmurs, unstable clinical conditions, recent decompensation of heart failure or hospital admission for coronary disease. Time to surgery, LOS, and in hospital mortality in patients who underwent preoperative echocardiography (high-risk group) were compared with patients who did not undergo echo (low-risk group) and with the control group.

Results:

122/255 patients underwent echocardiography. The two groups did not differ for age, sex, type or fracture, and notably time to surgery and LOS. Coronary heart disease, atrial fibrillation, and two or more comorbidities were more frequent in the echo group. Overall clinical characteristics were not different from group of patients referred before the implementation of the echocardiographic protocol but in these last patients time to surgery and LOS were significantly longer. As well in hospital mortality was not significantly different in the two groups (1.9 in echo vs. 1.7% in nonecho) but lower than in the control group (4.1% ).

Conclusions:

An echocardiographic guide may be useful in a high-risk group with a hip fracture to choose the proper anesthetic setting, referral for intensive care observation after surgery and, optimal medical treatment, including fluid management without delay in time to surgery.
Lansoprazole plus levosulpiride versus esomeprazole in participants with gastroesophageal reflux disease and erosive esophagitis: a double blinded randomized control trial
Authors: Umer Muhammad Rizwan , Mejia Crespo Wendy E. , Dugan Sana , Javed Hamna , Suleman Muhammad , Afzal Muhammad Waqas , Mumtaz Hassan , Saqib Muhammad , Malik Haris Mumtaz , Iftikhar Muhammad
Published: September 2023

Aim:

The aim was to compare the efficacy and safety of lansoprazole plus levosulpiride over esomeprazole.

Methodology:

This randomized control trial recruited 1000 participants having symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis and they were blindly randomized into two groups in a 1:1 ratio with appropriate concealment. Group 1 was given lansoprazole plus levosulpiride combination twice daily whereas group 2 was prescribed only esomeprazole twice daily. The primary efficacy endpoint was the healing of erosive esophagitis and GERD at week 49. Secondary assessments included improvement in quality of life. Participants’ quality of life was assessed before starting the treatment and post-treatment using a short-form health survey questionnaire (SF-36).

Results:

The lansoprazole plus levosulpiride group had significantly lower rates of positive postintervention GERD and erosive esophagitis status, and higher rates of sustained resolution of heartburn compared to the esomeprazole alone group. However, the lansoprazole plus levosulpiride group also had a higher risk of nausea.

Conclusion:

Lansoprazole plus levosulpiride is a more effective and safe treatment for GERD than esomeprazole alone. Participants in the lansoprazole plus levosulpiride group showed a significantly higher rate of sustained resolution of GERD, lower rates of postintervention GERD and erosive esophagitis status, and a higher incidence of nausea compared to the esomeprazole alone group. Although quality of life worsened in both groups, adverse effects did not significantly differ. These findings strongly support the use of lansoprazole plus levosulpiride as a preferred treatment option for GERD and erosive esophagitis, which could have significant clinical implications for managing this common condition.
Continuous vs. intermittent terlipressin infusion for portal hypertension: a systematic review and meta-analysis
Authors: Hassan Mona , Merza Nooraldin , Nawras Yusuf , Bahbah Eshak I. , Al-Hillan Alsadiq , Ahmed Zohaib , ElSheref Saad El D. M. , Dahiya Dushyant S. , Dar Sophia , Al Azzawi Mohammed , Kobeissy Abdallah
Published: September 2023

Background:

Portal hypertension, a major complication of chronic liver disease, often leads to life-threatening variceal bleeding, managed effectively with vasoactive drugs like terlipressin. However, the most optimal method of terlipressin administration, continuous versus intermittent infusion, remains a subject of debate, necessitating this systematic review and meta-analysis for evidence-based decision-making in managing this critical condition.

Methods:

This systematic review and meta-analysis adhered to the PRISMA standards and explored multiple databases until 6 April 2023, such as MEDLINE through PubMed, Scopus, Web of Science, and CENTRAL. Independent reviewers selected randomized controlled trials (RCTs) that met specific inclusion criteria. After assessing study quality and extracting necessary data, statistical analysis was performed using Review Manager (RevMan), with results presented as risk ratios (RR) or mean differences.

Results:

Five RCTs (n=395 patients) were included. The continuous terlipressin group had a significantly lower risk of rebleeding (RR=0.43, P=0.0004) and treatment failure (RR=0.22, P=0.02) and fewer total adverse effects (RR=0.52, P<0.00001) compared to the intermittent group. However, there were no significant differences between the two groups in mean arterial pressure (P=0.26), length of hospital stays (P=0.78), and mortality rates (P=0.65).

Conclusion:

This study provides robust evidence suggesting that continuous terlipressin infusion may be superior to intermittent infusions in reducing the risk of rebleeding, treatment failure, and adverse effects in patients with portal hypertension. However, further large-scale, high-quality RCTs are required to confirm these findings and to investigate the potential benefits of continuous terlipressin infusion on mortality and hospital stays.
The clinical and genotypic–phenotypic findings of mucopolysaccharidosis VI patients: an Iraqi single-study descriptive study
Authors: Baheer Abdul Wahhab Saja , Farhan Thejeal Rabab , Swed Sarya
Published: September 2023

Background:

Maroteaux–Lamy syndrome (mucopolysaccharidosis type VI; MPS VI) is a chronic illness that causes progressive enlargement, inflammation, or scarring of several tissues and organs until their collapse. In most cases, an infant with MPS VI shows no symptoms. The early signs and symptoms of MPS VI in children often develop in the first few months of life. MPS VI affects various systems in the body, including the skeletal, cardiac, and respiratory systems. The authors aim in our study to describe the clinical and genotypic–phenotypic findings of MPS VI patients in ‘children Welfare Teaching Hospital, Medical City Complex.’

Methods:

The single-center study was conducted at the ‘children Welfare Teaching Hospital, Medical City Complex’ from November 2016 to May 2022. The research recruited 72 MPS VI patients from Iraq, all under 20. The authors investigated the sociodemographic characteristics, hematological lab results, gene-phenotype findings, and clinical features and evaluated the severity and progression of the MPS 6 disease.

Results:

Seventy-two Iraqi MPS VI patients were involved in the study, and the average age of the study sample was 6.38±3.4 (0.3–19). The consanguinity rate was 94.4%. In the research, females comprised 56.9% of the patients, and theZ-scores for body mass index and occipital-frontal head circumference were −2.66 and 1.2. The fascial features at diagnosis, ‘coarse facies’ (90.3%), dysostosis multiplex (93%), short stature (94.4%), and recurrent respiratory infections (91.6%), were the most common clinical features among the enrolled patients. The most frequent mutation was (complementary DNA: c.753C>G, protein effect: p.(Tyr2*) or p.(Tyr251Term), and the codon cross-tabulation: premature stop codon, or homozygous stop nonsense mutation/exon N.3) (33/69 (47.82%)). Furthermore, a statistically significant correlation existed between lower weight and height readings and the progressed and severe stages of the MPS VI illness.

Conclusion:

As the first research in Iraq with a sufficient sample size of MPS VI patients, the investigation presented important clinical and gene-phenotype findings and revealed the necessity for enhancing the diagnosis of MPS VI, including the updated molecular analysis and monitoring the multisystem parameters, aberrant comorbidities, and the progression and severity.