bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient burden and joint inflammation during development of RA from arthralgia: is it similar in ACPA-positive and ACPA-negative disease?
Authors: Khidir Sarah J H , Krijbolder Doortje I , Glas Herman K , van Mulligen Elise , van der Helm-van Mil Annette H M
Published: January 2024

Objectives

ACPA-positive and ACPA-negative RA differ in underlying risk factors but have a similar clinical presentation at RA diagnosis. It is unknown what the ACPA-associated differences or similarities are during the symptomatic at-risk stage of RA, i.e. clinically suspect arthralgia (CSA). To deepen insights into these differences/similarities, we compared the course of symptoms/impairments and subclinical joint inflammation in the CSA phase during progression to inflammatory arthritis (IA) or to CSA resolution.

Methods

A total of 845 CSA patients were followed for a median of 24 months; 136 patients developed IA and an additional 355/505 patients had resolution of CSA according to rheumatologists. Patient burden (pain, morning stiffness, fatigue, functional disabilities, presenteeism) was assessed at baseline and 4, 12 and 24 months and at IA development. Subclinical joint inflammation in the hands and feet was assessed over time with 1.5T MRI. Linear and Poisson mixed models were used.

Results

In both ACPA-positive and ACPA-negative patients, patient burden increased towards IA development and decreased towards CSA resolution. However, patient burden was lower in ACPA-positive vs ACPA-negative disease at all timepoints. Conversely, subclinical joint inflammation tended to increase more rapidly during development of ACPA-positive IA [incidence rate ratio (IRR) 1.52 (95% CI 0.94, 2.47), P = 0.089] and remained higher over time in ACPA-positive CSA patients achieving resolution compared with ACPA-negative patients [IRR 1.52 (95% CI 1.07, 2.15), P = 0.018]. Although correlation coefficients between changes in patient burden and subclinical joint inflammation during progression to IA were weak, they were consistently higher in ACPA-positive than ACPA-negative disease, e.g. ρ = 0.29 vs 0.12 for functional disabilities.

Conclusion

During RA development and CSA resolution, ACPA-positive CSA patients have lower patient burden but more subclinical joint inflammation than ACPA-negative CSA patients. These data strengthen the notion that the development of ACPA-positive and ACPA-negative RA is pathophysiologically different and encourage further research on these differences.
Heterogeneous Brain Abnormalities in Schizophrenia Converge on a Common Network Associated With Symptom Remission
Authors: Wang Yingru , Yang Yinian , Xu Wenqiang , Yao Xiaoqing , Xie Xiaohui , Zhang Long , Sun Jinmei , Wang Lu , Hua Qiang , He Kongliang , Tian Yanghua , Wang Kai , Ji Gong-Jun
Published: January 2024

Background and Hypothesis

There is a huge heterogeneity of magnetic resonance imaging findings in schizophrenia studies. Here, we hypothesized that brain regions identified by structural and functional imaging studies of schizophrenia could be reconciled in a common network.

Study Design

We systematically reviewed the case-control studies that estimated the brain morphology or resting-state local function for schizophrenia patients in the literature. Using the healthy human connectome (n = 652) and a validated technique “coordinate network mapping” to identify a common brain network affected in schizophrenia. Then, the specificity of this schizophrenia network was examined by independent data collected from 13 meta-analyses. The clinical relevance of this schizophrenia network was tested on independent data of medication, neuromodulation, and brain lesions.

Study Results

We identified 83 morphological and 60 functional studies comprising 7389 patients with schizophrenia and 7408 control subjects. The “coordinate network mapping” showed that the atrophy and dysfunction coordinates were functionally connected to a common network although they were spatially distant from each other. Taking all 143 studies together, we identified the schizophrenia network with hub regions in the bilateral anterior cingulate cortex, insula, temporal lobe, and subcortical structures. Based on independent data from 13 meta-analyses, we showed that these hub regions were specifically connected with regions of cortical thickness changes in schizophrenia. More importantly, this schizophrenia network was remarkably aligned with regions involving psychotic symptom remission.

Conclusions

Neuroimaging abnormalities in cross-sectional schizophrenia studies converged into a common brain network that provided testable targets for developing precise therapies.
Cultural Resistance to Policy Change: Welfare Privatization, Policy Feedback, and the Moral Economy of Welfare
Authors: Frederiksen Morten
Published: January 2024

Social policy research posits that people adapt to policy change by aligning their preferences and institutional expectations through habituation. At face value, this policy feedback theory conflicts with theories of moral economy, which suggests that people share durable cultural repertoires regarding the meaning of the good life and good society. Deploying a large number of qualitative interviews, this study analyzes whether and how people resist or adapt to welfare privatization polices in Sweden and Denmark. The analysis identifies and compares cultural repertoires incompatible across the state–market boundary in the contexts of health care and education. Equality and efficiency are identified as key values in the moral economy of welfare, whereas profit and selectivity are market values that interviewees resist and reject in the context of welfare. In contrast, many justify the individual right to buy welfare in the market. The findings suggest that policy changes that cross sectorial boundaries become legitimate only if multiple notions of cultural worth are involved. Attempts to justify privatization policies take place as cultural reconfiguration and interpretation, rather than changed preferences and expectations.
Uterine Immunoprivileged Cells Restore Cardiac Function of Male Recipients After Myocardial Infarction
Authors: Peng Zexu , Ludke Ana , Wu Jun , Li Shuhong , Alibhai Faisal J , Zhang Yichong , Fan Yunfei , Song Huifang , He Sheng , Xie Jun , Li Ren-Ke
Published: January 2024

It has been documented that the uterus plays a key cardio-protective role in pre-menopausal women, which is supported by uterine cell therapy, to preserve cardiac functioning post-myocardial infarction, being effective among females. However, whether such therapies would also be beneficial among males is still largely unknown. In this study, we aimed to fill in this gap in knowledge by examining the effects of transplanted uterine cells on infarcted male hearts. We identified, based on major histocompatibility complex class I (MHC-I) expression levels, 3 uterine reparative cell populations: MHC-I(neg), MHC-I(mix), and MHC-I(pos). In vitro, MHC-I(neg) cells showed higher levels of pro-angiogenic, pro-survival, and anti-inflammatory factors, compared to MHC-I(mix) and MHC-I(pos). Furthermore, when cocultured with allogeneic mixed leukocytes, MHC-I(neg) had lower cytotoxicity and leukocyte proliferation. In particular, CD8+ cytotoxic T cells significantly decreased, while CD4+CD25+ Tregs and CD4-CD8- double-negative T cells significantly increased when cocultured with MHC-I(neg), compared to MHC-I(mix) and MHC-I(pos) cocultures. In vivo, MHC-I(neg) as well as MHC-I(mix) were found under both syngeneic and allogeneic transplantation in infarcted male hearts, to significantly improve cardiac function and reduce the scar size, via promoting angiogenesis in the infarcted area. All of these findings thus support the view that males could also benefit from the cardio-protective effects observed among females, via cell therapy approaches involving the transplantation of immuno-privileged uterine reparative cells in infarcted hearts.
The seroprevalence of toxocariasis and related risk factors in children in Ho Chi Minh City, Vietnam: results from a school-based cross-sectional study
Authors: Ha Thieu V , Vo Tien T N , Dang Duy K H , Tran Y M L , Kim Thanh V , Le Duc H , Do Lan-Anh T , Tang Hong K
Published: January 2024

Background

Children are especially vulnerable to Toxocara infection and its severe complications; however, there have not been any published data on the disease prevalence and treatment effectiveness in the population of Vietnamese children. This study was conducted to determine the prevalence of toxocariasis and explore factors associated with Toxocara infection in children aged 3–15 y in Ho Chi Minh City, Vietnam.

Methods

We conducted a cross-sectional study using a multistage cluster sampling approach in public schools. Blood samples were collected, and toxocariasis cases were confirmed, based on a history of contact with dogs/cats and positive anti-Toxocara antibody detection via ELISA. We calculated the percentage of seropositive children across gender, grade levels, districts and caregiver education. Multiple regression models were employed to identify potential risk factors.

Results

Anti-Toxocara antibodies were found in 14.2% of the 986 children studied. Significant variations in seropositivity were observed across grade levels, districts and caregiver education levels. Multivariable analysis identified caregiver education, contact with dogs/cats and improper handling of pet feces as seropositivity risk factors.

Conclusion

This was the first community-based prevalence study of toxocariasis in a pediatric population in Vietnam. Implementation of preventive measures such as public education, routine fecal examinations and chemotherapeutic treatment of animals is highly recommended.
Detection and Characterization of Xylella fastidiosa subsp. fastidiosa in Rabbiteye Blueberry in South Carolina
Authors: Cieniewicz Elizabeth , Schnabel Elise , Powell Garner , Snipes Zachary , Schnabel Guido
Published: January 2024

Xylella fastidiosa causes bacterial leaf scorch in southern highbush (Vaccinium corymbosum interspecific hybrids) and is also associated with a distinct disease phenotype in rabbiteye blueberry (V. virgatum) cultivars in the southeastern United States. Both X. fastidiosa subsp. fastidiosa and X. fastidiosa subsp. multiplex have been reported to cause problems in southern highbush blueberry, but so far only X. fastidiosa subsp. multiplex has been reported in rabbiteye cultivars in Louisiana. In this study, we report detection of X. fastidiosa in rabbiteye blueberry plants in association with symptoms of foliar reddening and shoot dieback. High throughput sequencing of an X. fastidiosa-positive plant sample and comparative analyses identified the strain in one of these plants as being X. fastidiosa subsp. fastidiosa. We briefly discuss the implications of these findings, which may spur research into blueberry as a potential inoculum source that could enable spread to other susceptible fruit crops in South Carolina.
Treatment with sodium butyrate induces autophagy resulting in therapeutic benefits for spinocerebellar ataxia type 3
Authors: Watchon Maxinne , Robinson Katherine J. , Luu Luan , An Yousun , Yuan Kristy C. , Plenderleith Stuart K. , Cheng Flora , Don Emily K. , Nicholson Garth A. , Lee Albert , Laird Angela S.
Published: January 2024

Spinocerebellar ataxia type 3 (SCA3, also known as Machado Joseph disease) is a fatal neurodegenerative disease caused by the expansion of the trinucleotide repeat region within the ATXN3/MJD gene. Mutation of ATXN3 causes formation of ataxin‐3 protein aggregates, neurodegeneration, and motor deficits. Here we investigated the therapeutic potential and mechanistic activity of sodium butyrate (SB), the sodium salt of butyric acid, a metabolite naturally produced by gut microbiota, on cultured SH‐SY5Y cells and transgenic zebrafish expressing human ataxin‐3 containing 84 glutamine (Q) residues to model SCA3. SCA3 SH‐SY5Y cells were found to contain high molecular weight ataxin‐3 species and detergent‐insoluble protein aggregates. Treatment with SB increased the activity of the autophagy protein quality control pathway in the SCA3 cells, decreased the presence of ataxin‐3 aggregates and presence of high molecular weight ataxin‐3 in an autophagy‐dependent manner. Treatment with SB was also beneficial in vivo, improving swimming performance, increasing activity of the autophagy pathway, and decreasing the presence of insoluble ataxin‐3 protein species in the transgenic SCA3 zebrafish. Co‐treating the SCA3 zebrafish with SB and chloroquine, an autophagy inhibitor, prevented the beneficial effects of SB on zebrafish swimming, indicating that the improved swimming performance was autophagy‐dependent. To understand the mechanism by which SB induces autophagy we performed proteomic analysis of protein lysates from the SB‐treated and untreated SCA3 SH‐SY5Y cells. We found that SB treatment had increased activity of Protein Kinase A and AMPK signaling, with immunoblot analysis confirming that SB treatment had increased levels of AMPK protein and its substrates. Together our findings indicate that treatment with SB can increase activity of the autophagy pathway process and that this has beneficial effects in vitro and in vivo. While our results suggested that this activity may involve activity of a PKA/AMPK‐dependent process, this requires further confirmation. We propose that treatment with sodium butyrate warrants further investigation as a potential treatment for neurodegenerative diseases underpinned by mechanisms relating to protein aggregation including SCA3.
Associations of Methadone and BUP/NX Dose Titration Patterns With Retention in Treatment and Opioid Use in Individuals With Prescription-Type Opioid Use Disorder: Secondary Analysis of the OPTIMA Study
Authors: Bakouni Hamzah , Haquet Lexie , Socias M. Eugenia , Le Foll Bernard , Lim Ron , Ahamad Keith , Jutras-Aswad Didier ,   for the OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse
Published: January 2024

Introduction

Methadone and buprenorphine/naloxone (BUP/NX) titration parameters (eg, range, duration, and rate) can vary during opioid use disorder (OUD) treatment. We describe methadone and BUP/NX titration patterns and their associations with treatment outcomes among individuals with a prescription-type OUD.

Methods

We used data from a 24-week open-label, multicenter randomized controlled trial, including N = 167 participants aged 18–64 years old with prescription-type OUD who received at least a first dose of treatment. Descriptive analyses of methadone and BUP/NX titration patterns were conducted, that is, range and duration from first to maximum dose, and rate (range/duration ratio). Outcomes included percentage of opioid-positive urine drug screens (UDS) and treatment retention. Adjusted linear and logistic regressions were used to study associations between titration patterns and percentage of opioid-positive UDS and treatment retention.

Results

Methadone doses were increased by a mean dose range of 42.4 mg over a mean duration of 42.2 days. BUP/NX doses were increased by a mean dose range of 8.4 mg over a mean duration of 28.7 days. Only methadone dose titration range (odds ratio: 1.03; 95% CI, 1.01 to 1.05) and duration (odds ratio: 1.03; 95% CI, 1.01 to 1.05) were associated with higher retention. Only methadone dose titration rate was associated with lower percentage of opioid-positive UDS at weeks 12–24 (B: −2.77; 95% CI, −4.72 to −0.81).

Conclusions

Specific parameters of methadone titration were associated with treatment outcomes and may help in personalizing treatment schedules. Sustained methadone dose titration, when indicated, may help increase retention, whereas faster dose titration for methadone may help decrease opioid use.
The Activity Management Inventory for Pain (AMI-P)
Authors: Racine Mélanie , Jensen Mark P. , Cane Douglas , Moulin Dwight E. , Vlaeyen Johan W.S. , Nielson Warren R.
Published: January 2024

Objectives:

Activity management is an important treatment component in chronic pain programs. However, there are shortcomings in measures of this construct, leading to inconsistencies in research findings. Here, we describe the development of the Activity Management Inventory for Pain (AMI-P).

Methods:

The AMI-P was developed by a group of international researchers with extensive expertise both in chronic pain and activity management. The initial evaluation of the AMI-P items included two studies that were both conducted in Canadian tertiary pain care centers.

Results:

The resulting 20-item measure has three behavior scales (Rest, Alternating Activity, Planned Activity), and four goal scales (Feel Less Pain, Get More Done, Complete the Task, Save Energy). The behavior scales evidenced marginal to good internal consistency and test-retest reliability, and a moderate positive association with an existing pacing measure. The Rest and Alternating Activity scales were associated with greater pain interference, the Alternating Activity and Planned Activity scales were associated with less satisfaction with social roles, and the Planned Activity scale was associated with fewer depressive symptoms. The Alternating Activity scale increased significantly from pre- to post-treatment. All goal scales were positively associated with all behavior scales. The Feel Less Pain goal scale was positively associated with measures of avoidance and pain interference, while the Get More Done goal scale was negatively associated with measures of depressive symptoms and overdoing.

Discussion:

The findings support the reliability and validity of the AMI-P scales, while also highlighting the complexity and multidimensional aspects of activity management.
Comparison of Short-term Results: Robotic-assisted vs. Conventional Bilateral Total Knee Arthroplasty
Authors: Kang Louis , Lee Ji Won , Mistretta Katherine , Pianka Mark , Chou Jiling , Macaraeg Crisanto , Boucher Henry R.
Published: January 2024

Introduction:

Robotic-assisted total knee arthroplasty is becoming widely accepted as a method to improve intra-operative measures and post-operative functional outcomes. While there is a large body of evidence supporting robotic-assisted unilateral total knee arthroplasty (TKA), few studies have examined the outcomes of this technology in simultaneous bilateral TKA procedures. Thus, the purpose of the study is to compare the clinical outcomes between patients undergoing simultaneous robot-assisted bilateral total knee arthroplasty (raTKA) versus conventional bilateral total knee arthroplasty (convTKA).

Methods:

We retrospectively reviewed 140 simultaneous bilateral TKA cases (61 conventional, 79 robot-assisted) performed by a single surgeon in a single institution from January 1, 2015 to December 11, 2020. The institution’s electronic medical records were reviewed for patient demographic information, operative data, and post-operative complications. Outcomes Based Electronic Research Database (OBERD) records were reviewed for patient-reported outcomes (Oxford Knee Score and SF-12 Version 1) preoperatively and postoperatively at 6 months, 1 year, and 2 years.

Results:

Both raTKA and convTKA groups exhibited clinically relevant improvements beyond the minimally clinically important difference (MCID) in SF-12 physical and Oxford Knee Scores at 6 months, 1 year, and 2 years post-surgery. There were no statistically significant differences found between the two groups in terms of postoperative SF-12 scores, Oxford Knee Scores, complications, or revision rates. The raTKA group had a longer length of stay (2.6 versus 2.2 days, P=0.001) and a significantly different discharge disposition with more patients entering acute rehab compared to the convTKA group (20 versus 7 patients respectively, P=0.031).

Conclusion:

Robotic-assisted total knee arthroplasty has a non-inferior impact on short-term patient outcomes compared to conventional methods in patients undergoing simultaneous bilateral total knee arthroplasty.

Level of evidence:

III
Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis
Authors: Pitre Tyler , Drover Katherine , Chaudhuri Dipayan , Zeraaktkar Dena , Menon Kusum , Gershengorn Hayley B. , Jayaprakash Namita , Spencer-Segal Joanna L. , Pastores Stephen M. , Nei Andrea M. , Annane Djillali , Rochwerg Bram
Published: January 2024

OBJECTIVES:

To perform a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with sepsis.

DATA SOURCES:

We searched PubMed, Embase, and the Cochrane Library, up to January 10, 2023.

STUDY SELECTION:

We included randomized controlled trials (RCTs) comparing corticosteroids with placebo or standard care with sepsis.

DATA EXTRACTION:

The critical outcomes of interest included mortality, shock reversal, length of stay in the ICU, and adverse events.

DATA ANALYSIS:

We performed both a pairwise and dose-response meta-analysis to evaluate the effect of different corticosteroid doses on outcomes. We used Grading of Recommendations Assessment, Development and Evaluation to assess certainty in pooled estimates.

DATA SYNTHESIS:

We included 45 RCTs involving 9563 patients. Corticosteroids probably reduce short-term mortality (risk ratio [RR], 0.93; 95% CI, 0.88–0.99; moderate certainty) and increase shock reversal at 7 days (RR, 1.24; 95% CI, 1.11–1.38; high certainty). Corticosteroids may have no important effect on duration of ICU stay (mean difference, –0.6 fewer days; 95% CI, 1.48 fewer to 0.27 more; low certainty); however, probably increase the risk of hyperglycemia (RR, 1.13; 95% CI, 1.08–1.18; moderate certainty) and hypernatremia (RR, 1.64; 95% CI, 1.32–2.03; moderate certainty) and may increase the risk of neuromuscular weakness (RR, 1.21; 95% CI, 1.01–1.45; low certainty). The dose-response analysis showed a reduction in mortality with corticosteroids with optimal dosing of approximately 260 mg/d of hydrocortisone (RR, 0.90; 95% CI, 0.83–0.98) or equivalent.

CONCLUSIONS:

We found that corticosteroids may reduce mortality and increase shock reversal but they may also increase the risk of hyperglycemia, hypernatremia, and neuromuscular weakness. The dose-response analysis indicates optimal dosing is around 260 mg/d of hydrocortisone or equivalent.
Non-occlusive mesenteric ischemia in critically ill patients: does bedside laparoscopy offer any real benefit?
Authors: Barone Mirko , Frontera Regina , Liouras Rita Vaia , Ippoliti Massimo , Serano Luca , Iovino Carmine Giovanni , Dell’Atti Ivan , Vetrugno Luigi , Mucilli Felice , Maggiore Salvatore Maurizio
Published: January 2024

Non-occlusive mesenteric ischemia in critically ill patients still has a poor prognosis. Despite several established risk factors, the interaction between clinical conditions and perfusion mismatch often leads to progressive organ failure. Workup is challenging because of the absence of typical abdominal signs and symptoms due to sedation, poor reactivity, need for ventilation, and confounding comorbidities. Moreover, imaging has poor specificity with findings often inconclusive. A bedside exploratory laparoscopy, as a complementary strategy, would allow for early and prompt diagnosis. Limits of a minimally invasive surgical rationale lie upon the effects of pneumoperitoneum induction, surgical stress, logistical resources, expertise, and costs.
Routine screening for gestational diabetes: a review
Authors: Sarker Minhazur R. , Ramos Gladys A.
Published: January 2024

Purpose of Review

Rates of gestational diabetes mellitus (GDM) throughout the world continue to increase associated with the increasing rates of obesity. Given this epidemiologic burden, the importance of proper screening, diagnosis, and management cannot be understated. This review focuses on the current screening guidelines utilized throughout the world and new data recently published regarding the most optimal screening techniques and future directions for research.

Recent Findings

Despite unanimous opinion that GDM warrants screening, the optimal screening regimen remains controversial. Notably, in the United States per the consensus recommendation by the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine, a 2-step screening approach is often used. Recently, there have been multiple studies published that have compared the 1-step and 2-step screening process with respect to GDM incidence and perinatal outcomes. These new findings are summarized below.

Utilization of the 1-step screening as opposed to the 2-step screening results in an increased diagnosis of GDM without significant population level benefit in outcomes. However, these studies remain underpowered to allow for meaningful comparison of outcomes in those diagnosed with GDM.
Tranexamic Acid in Tumescence for Cervicofacial Rhytidectomies
Authors: Trimas Gracen E. , Frost Morgan D.T. , Trimas Scott J.
Published: January 2024

Background:

Cervicofacial rhytidectomies are one of the most common procedures in the United States. There are many different methods and techniques involved, but all aim to minimize blood loss and procedure time. In our study, we investigated the addition of tranexamic acid (TXA) to tumescent anesthesia during rhytidectomy procedures. Our objective was to analyze the difference in mean procedure time and estimated blood loss in patients undergoing both general and other anesthesia types, with and without the addition of TXA, while maintaining patient safety.

Methods:

Seventy-four patients underwent a standard superficial musculoaponeurotic system plication technique rhytidectomy, with 60 patients undergoing general anesthesia and the remaining 14 undergoing other anesthesia types. Forty patients were treated without TXA, whereas the remaining 34 were treated with TXA.

Results:

Although the difference was not statistically significant, the addition of TXA resulted in a lower procedure time and estimated blood loss. Within anesthesia type, there was also a slight difference that TXA decreased blood loss and procedure time. We did find that general anesthesia type does significantly impact procedure time and estimated blood loss, when compared with other anesthesia types, independent of TXA use.

Conclusion:

The use of tumescent TXA may allow for a faster procedure with less blood loss, although further studies with a larger sample size are needed.
A Rare Case of Dermatofibrosarcoma in a Pediatric Patient
Authors: Martinez Paul F. , Richardson Skyler , Bakovic Melanie , Manrique Monica , Mantilla-Rivas Esperanza , Oh Albert K. , Rogers Gary F.
Published: January 2024

Dermatofibrosarcoma protuberans (DFSP) is a rare malignant fibroblastic tumor. DFSP has an insidious onset, slow growth, and heterogeneous presentation that can create a delay in diagnosis and increase morbidity. In this case report, we present a child with DFSP that presented as a large, slow-growing mass over the dorsum of the left foot. She underwent successful surgical excision with no functional sequelae.
Compression Dressing versus Noncompressive Transparent Eye Shield after Ptosis Surgery
Authors: Schuh Anna , Reischmann Lilian , Hintschich Christoph R.
Published: January 2024

Background:

We aimed to investigate the effect of compression dressing on edema, ecchymosis, pain, and ocular surface irritation after ptosis surgery.

Methods:

After ptosis correction [anterior levator reinsertion (and resection) (ALR), if necessary additional blepharoplasty], the eye was randomized for compression dressing or transparent eye shield. Edema and ecchymosis were scored on a four-point rating scale by a blinded observer 1 day (D1), 1 week (D7), and 8 weeks (D56) after surgery; the same was done for scar formation regarding redness and bulging at D7 and D56. Aesthetic outcome was ranked by patient and blinded observer using the Global Aesthetic Improvement Score at D1, D7, and D56. Postoperative pain was scored using a visual analogue scale (0 to 10) at D1. Impairment after surgery by dressing or eye shield was evaluated at D1.

Results:

Ecchymosis, edema, scar formation, and aesthetic outcome ranked by the patient and blinded observer did not differ between the groups with compression dressing and eye shield at any day of follow-up (P > 0.05). Postoperative pain and impairment were the same in both groups (P > 0.05). One case of corneal erosion occurred in the group with compression dressing at D1 (P = 0.342). At D7, corneal staining was increased in the group without compression dressing (P = 0.930).

Conclusions:

Compression dressing after ALR does not reduce ecchymosis, edema, or postoperative pain and has no effect on early scar formation or aesthetic results. To prevent corneal erosion caused by the dressing, it can be omitted after ALR without inferiority for the early postoperative results.
A Retrospective Review of Patient-reported Outcomes after Postaxial Polydactyly Ligation and Surgical Excision
Authors: Ganju Nakul , Mantilla-Rivas Esperanza , Martinez Paul F. , Manrique Monica , Escandón Joseph M. , Shah Samay , Rogers Ashley E. , Boyajian Michael J. , Oh Albert K. , Rogers Gary F.
Published: January 2024

Background:

Interventions for type B postaxial polydactyly include suture ligation and surgical excision, yet there is a paucity of literature comparing the outcomes of these procedures. This study sought to compare patient-reported long-term outcomes of postaxial digit excision.

Methods:

A six-question survey was distributed from January 2021 to March 2022 to patients who underwent treatment for type B postaxial polydactyly at a single pediatric institution from 2010 to 2016. Patients were queried about the incidence of pain sensitivity, keloid healing, and/or persistent presence of bump (“nubbin”) at the treatment site.

Results:

A total of 158 responses accounting for 258 digits were attained for a 53% response rate. The majority of digits (67.4%, n = 174) were surgically excised. Median age at procedure was 49 days: 13.0 days for ligation, 63.0 days for surgical excision. Median age at survey was 8 [IQR 5.4–10.2] years. Short-term (<30 days after procedure) complications rate was 1.6%. The rate of a raised or sensitive scar was 39.5% (ligation 51.5% versus surgery 35.4%, P < 0.05). The likelihood of postoperative sensitivity (P = 0.80) was similar among groups. However, the odds of a residual bump or raised scar at the surgical site was significantly higher in the ligation group (P = 0.001). These findings remained significant in the adjusted analysis.

Conclusion:

This study suggests that suture ligation can be used in select cases without increasing the prevalence of long-term pain or sensitivity, albeit with greater risk of a bump or raised scar at the excision site compared with surgical excision.
Greater use of antihypertensive medications explains lower blood pressures and better control in statin-treated than statin-eligible untreated adults
Authors: Egan Brent M. , Li Jiexiang , Sutherland Susan E. , Rakotz Michael K.
Published: January 2024

Objective:

Statins appear to have greater antihypertensive effects in observational studies than in randomized controlled trials. This study assessed whether more frequent treatment of hypertension contributed to better blood pressure (BP, mmHg) control in statin-treated than statin-eligible untreated adults in observational studies.

Methods:

National Health and Nutrition Examination Surveys 2009–2020 data were analyzed for adults 21–75 years (N = 3814) with hypertension (BP ≥140/≥90 or treatment). The 2013 American College of Cardiology/American Heart Association Cholesterol Guideline defined statin eligibility. The main analysis compared BP values and hypertension awareness, treatment, and control in statin-treated and statin-eligible but untreated adults. Multivariable logistic regression was used to assess the association of statin therapy to hypertension control and the contribution of antihypertensive therapy to that relationship.

Results:

Among adults with hypertension in 2009–2020, 30.3% were not statin-eligible, 36.9% were on statins, and 32.8% were statin-eligible but not on statins. Statin-treated adults were more likely to be aware of (93.4 vs. 80.6%) and treated (91.4 vs. 70.7%) for hypertension than statin-eligible adults not on statins. The statin-treated group had 8.3 mmHg lower SBP (130.3 vs. 138.6), and 22.8% greater control (<140/<90: 69.0 vs. 46.2%; all P values <0.001). The association between statin therapy and hypertension control [odds ratio 1.94 (95% confidence interval 1.53–2.47)] in multivariable logistic regression was not significant after also controlling for antihypertensive therapy [1.29 (0.96–1.73)].

Conclusion:

Among adults with hypertension, statin-treated adults have lower BP and better control than statin-eligible untreated adults, which largely reflects differences in antihypertensive therapy.
Methylation-associated pathways in Macular Telangiectasia Type 2 and ophthalmologic findings in patients with genetic methylation disorders
Authors: Pauleikhoff Laurenz , Wingert Victoria , Grünert Sarah C. , Lange Clemens , Hannibal Luciana , Bucher Felicitas
Published: January 2024

Purpose:

Serine (Ser) and glycine (Gly) levels were reported to differ between Macular telangiectasia type 2 (MacTel) patients compared to healthy controls. Since they are closely related to methylation metabolism, this report investigates methylation-associated metabolite (MAM) levels in MacTel patients and retinal changes in monogenetic methylation disorders.

Methods:

Prospective, monocentric study on MacTel patients and healthy controls the underwent a standardized protocol including a blood draw. MAM levels in plasma were determined using targeted quantitative metabolomics. Furthermore, patient records of cystathionine beta-synthase (CBS), methylenetetrahydrofolate reductase (MTHFR), and cobalamin C (MMACHC) deficiency were screened for reported retinal changes.

Results:

In total, 29 MacTel patients and 27 healthy controls were included. MacTel patients showed lower plasma Ser (p = 0.02 and p = 0.01) and Gly (p= 0.11 and p = 0.11) levels than controls. Principal component analyses revealed that MAM, especially homocysteine, contributed to a distinct clustering of MacTel patients. No retinal changes were seen in CBS (n=1) and MTHFR (n=2) deficiency, while two patients with MMACHC (n=4) deficiency displayed extensive macular dystrophy.

Conclusions:

MacTel patients show distinct clustering of MAM compared to controls. Of the three homocystinurias, only MMACHC resulted in macular dystrophy, possibly due to distinct compensatory pathways.
Pneumatic Retinopexy: Analysis of Risk Factors and Complications in 850 Cases
Authors: Erdoğdu Erdem , Kayıkçı Gülce , Aksoy Funda Ebru , Uygur Abdulkerim , Artunay Özgür
Published: January 2024

Background:

To study out types and incidence of the complications and reveal the risk factors that affect anatomical and visual success of pneumatic retinopexy (PR) with a high number of rhegmatogenous retinal detachment (RRD) cases.

Methods:

Eight hundred and fifty eyes of the 837 patients who admitted at a tertiary center, between January 2015 and January 2022 for the diagnosis of RRD, then underwent PR and had at least 6th month follow-up, were included in the study. The multivariate logistic regression model was created to investigate the factors affecting anatomical and visual success.

Results:

The anatomical success rate was 53.4% with the first PR and 99.8% after subsequent procedures. Visual acuity of >0.4 LogMAR (<20/50 Snellen), proliferative vitreoretinopathy (PVR) and macular involvement were determined as significant preoperative risk factors for single operation and visual success in all univariate and multivariate analyses. In addition, pseudophakic/aphakic lens status was associated with single operation failure in all analyses. Besides, in all analyzes for single operation and visual success, new or missed tears, PVR, delayed subretinal fluid, macular hole and subretinal gas were identified as significant postoperative risk factors. Among these, new or missed tears was determined as the most common complication with a rate of 24%.

Conclusion:

There are many risk factors influencing the success of PR. These factors and complications should always be considered, before applying this rapid, effective, inexpensive and minimally invasive method.
Intraoperative complications and visual outcomes of cataract surgery in neovascular age-related macular degeneration
Authors: Siddiqui Mohammad Z. , Elhusseiny Abdelrahman M. , Soliman Mohamed K. , Chauhan Muhammad Z. , Neuhouser Adam J. , Yang Yit C. , Sallam Ahmed B.
Published: January 2024

Purpose:

To compare the rate of intraoperative complications and visual outcomes in patients with neovascular age-related macular degeneration (NvAMD) and control eyes without NvAMD undergoing phacoemulsification.

Setting:

Multicenter study.

Design:

Retrospective, nonrandomized comparative study.

Methods:

Eyes were classified based on the presence or absence of an NvAMD diagnosis. The main outcomes were (1) the rate of intraoperative complications, (2) the logMAR visual acuity (VA) at 4 to 12 weeks postoperatively in both groups, and (3) the reinjection rate of intravitreal antivascular endothelial growth factor after phacoemulsification.

Results:

Preoperative VA was worse in the NvAMD group (0.9 ± 0.5) compared with the reference group (0.6 ± 0.5). We observed no difference in the rate of posterior capsule rupture (PCR) (2.90% vs 2.77%; P = .889), dropped lens fragments (0.46% vs 0.29%; P = .618), or zonular dialysis (0.46% vs 0.58%, P = .749) between the 2 groups. Receiving ≥10 intravitreal injections before cataract surgery predicted the likelihood of PCR with an odds ratio of 2.86 (P = .027). Proportions of eyes achieving a visual gain of ≥0.3 logMAR (∼3 Snellen lines equivalent) was lower in NvAMD eyes (39.2% vs 63.7%; P < .0001). We observed 203 eyes (73%) in the active treatment group and 139 eyes (36%) in the inactive treatment group received >1 intravitreal injection after phacoemulsification (P < .0001).

Conclusions:

The risk for PCR was higher for eyes receiving ≥10 intravitreal injections before phacoemulsification. Only 39% of eyes with NvAMD had visual improvement by ≥3 Snellen lines.
Group-Based Trajectory Modeling to Identify Patterns of Antipsychotic-Associated Weight Gain Among Children and Adolescents
Authors: Lyu Ning , Abughosh Susan , Varisco Tyler J. , Lin Ying , Rowan Paul J. , Chen Hua
Published: January 2024

Purpose/Background

Antipsychotic-associated weight gain (AAWG) is a common adverse effect of second-generation antipsychotic (SGA) medications among children and adolescents. This study applied group-based trajectory modeling to identify latent trajectories of AAWG among children and adolescents and associated risk factors.

Procedures

This was a retrospective analysis of the IQVIA Ambulatory EMR-US database from 2016 to 2021. The cohort consisted of patients aged 6 to 19 years who were SGA naive and received at least 90 days of continuous SGA prescriptions. Group-based trajectory modeling was used to identify latent trajectories of AAWG development during a 24-month period since SGA initiation, and multinomial logistic regression analysis was conducted to examine the risk factors associated with the identified AAWG trajectories.

Findings/Results

A total of 16,262 patients were included. Group-based trajectory modeling identified the following 4 distinctive AAWG trajectories: persistent severe weight gain (4.2%), persistent moderate weight gain (20.1%), minor weight change (69.6%), and gradual weight loss (6.1%). Compared with the minor weight change group, younger age (12–17 vs 5–11: odds ratio [OR], 0.634; 95% confidence interval [CI], 0.521–0.771), lower baseline body mass index z-score (OR, 0.216; 95% CI, 0.198–0.236), and receiving olanzapine as the initial SGA (olanzapine vs aripiprazole: OR, 1.686; 95% CI, 1.673–1.699) were more likely to follow severe weight gain trajectories. The area under the receiver operating characteristic curves for comparing severe weight gain versus minor weight change groups and moderate weight vs minor weight change groups in the multinomial regression model were 0.91 and 0.8, respectively.

Implications/Conclusions

A quarter of pediatric SGA recipients experienced persistent weight gain during the SGA treatment. The risk of having persistent AAWG can be predicted using patient characteristics collected before SGA initiation and the initial SGA agent.
Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO
Authors: Salazar-Rojas Leonardo Alberto , García Gómez Dafna Isvevia , Pinzon Martinez Yuri Valentina , Lasso Perdomo Julie Pauline , Soto Ramirez Juan Carlos , Gorgadze Tamar , Mendoza Monsalve Mary Alejandra , Vasquez Rincon Raul Fernando , Castillo Blanco Mario Alberto , Pizarro Gomez Camilo Ernesto , Bermon Angarita Anderson
Published: January 2024

Refractory hypoxemia (RH) during venovenous extracorporeal membrane oxygenation (VV ECMO) support is a complex problem that limits the benefit of this therapy. The need for sustained deep sedation and delays in active rehabilitation are considered as a direct consequence of RH. Changing from VV ECMO to a configuration that returns the flow to pulmonary artery, such as venopulmonary extracorporeal membrane oxygenation (VPa ECMO) may decrease recirculation and improve systemic oxygen delivery. We present a retrospective report that describes the impact of VPa ECMO on oxygenation during sedation withdrawal in 41 patients who received VV ECMO for coronavirus disease 2019 (COVID-19). We evidenced that arterial oxygen pressure (PaO2) increased from 68 to 112.3 mm Hg (p = 0.001) with a reduction of ECMO flow (5.7–4.8 L/m; p = 0.001). Other findings included lower rates of depth sedation (Richmond Agitation Sedation Scale [RASS] ≤3, 37–63%; p = 0.007) and lower requirement inotropic support assessed by LVIS score (4.7–1.1; p = 0.005). Discharge survival was 54% with a sustained benefit until day 79. This cannulation strategy improved effectively PaO2 in this cohort, it may be an alternative in patients with RH in VV ECMO.
Metabolic management of accidental intoxication
Authors: Khatib Khalid , Dixit Subhal , Telang Madhavi
Published: January 2024

Purpose of review

Unintentional intoxication comprises a major chunk of all intoxications. Most patients are in the pediatric age group with another set of patients being the elderly. Substances found to cause accidental intoxication vary from country to country and even within different regions of a country. Frequent reviews of current literature are needed to be abreast of trends.

Recent findings

Prescription drugs and household chemicals are major culprits when it comes to accidental intoxication. Acetaminophen, digoxin and metformin are some of the prominent prescription drugs frequently associated with unintentional intoxications. Increasingly alcohol based hand sanitizers are becoming an important etiology of these events, following their increased usage during the COVID-19 pandemic. Pattern recognition to identify class of intoxicant and supportive care including prevention of further absorption and increased excretion are cornerstones of therapy. Antidote when available should be used promptly.

Knowledge about current epidemiology of accidental intoxications, toxidrome pattern recognition and appropriate antidote usage beside adequate and timely supportive care help in successful management of the unfortunate victim of accidental intoxication.
Liver transplantation for intrahepatic cholangiocarcinoma: who, when and how
Authors: Achurra Pablo , Fernandes Eduardo , O’Kane Grainne , Grant Robert , Cattral Mark , Sapisochin Gonzalo
Published: January 2024

Purpose of review

Using transplant oncology principles, selected patients with intrahepatic cholangiocarcinoma (iCCA) may achieve long-term survival after liver transplantation. Strategies for identifying and managing these patients are discussed in this review.

Recent findings

Unlike initial reports, several modern series have reported positive outcomes after liver transplantation for iCCA. The main challenges are in identifying the appropriate candidates and graft scarcity. Tumor burden and response to neoadjuvant therapies have been successfully used to identify favorable biology in unresectable cases. New molecular biomarkers will probably predict this response in the future. Also, new technologies and better strategies have been used to increase graft availability for these patients without affecting the liver waitlist.

Liver transplantation for the management of patients with unresectable iCCA is currently a reality under strict research protocols. Who is a candidate for transplantation, when to use neoadjuvant and locoregional therapies, and how to increase graft availability are the main topics of this review.
Maximizing longevity: erythropoietin’s impact on sickle cell anaemia survival rates
Authors: Obeagu Emmanuel Ifeanyi
Published: January 2024

Sickle cell anaemia (SCA) stands as a hereditary blood disorder characterized by mutated haemoglobin, causing red blood cells to adopt a sickle shape, leading to complications like vaso-occlusive crises, anaemia, and organ damage. Despite advancements in treatment, managing SCA remains challenging, with limited options to increase life expectancy and improve quality of life for affected individuals. This paper reviews the potential impact of erythropoietin (EPO) therapy in enhancing life expectancy and ameliorating complications in individuals with SCA. EPO, primarily recognized for its role in stimulating red blood cell production, holds promise in mitigating anaemia, reducing transfusion dependence, and possibly diminishing the frequency and severity of vaso-occlusive crises in SCA patients. Moreover, by stimulating red blood cell production, EPO therapy might alleviate the vaso-occlusive process, thus reducing the frequency of painful crises and associated complications. Additionally, considering the potential side effects and the need for continuous monitoring, the use of EPO in SCA treatment requires cautious consideration. The potential of EPO therapy in SCA offers a glimpse into novel strategies aimed at improving the quality of life and extending the life expectancy of affected individuals. In conclusion, while the application of EPO in SCA treatment holds promise, additional research is indispensable to comprehend its precise role, optimize dosing strategies, and ensure safety, thereby paving the way for enhanced life expectancy and improved outcomes for individuals living with SCA.