bluuebunny/crossref_metadata_2025 huggingface dataset:
P158 Cutaneous vasculitis in systemic lupus erythematosus: trends of incidence and risk factors
Authors: Saleh Ahmed , Gordon Caroline , Reynolds John
Published: April 2024

Background/Aims

Cutaneous vasculitis (CV) is the most common form of vasculitis observed in patients with SLE; however, the precise epidemiological trends and underlying risk factors remain uncertain. The aim of this study was to define the incidence, prevalence, and risk factors of CV in systemic lupus erythematosus (SLE) patients over a period of 20 years.

Methods

The Birmingham Lupus Cohort is a longitudinal observational cohort of patients with SLE. All patients fulfilled the 1997 ACR Updated Classification Criteria for SLE. Inception patients were recruited within three years of their fourth ACR criterion. Disease activity was assessed using the classic BILAG index and laboratory results recorded. The BILAG vascular domain was used to determine the incidence rate, which refers to the rate at which new cases of minor and major CV attributed to active SLE occur. Cox proportional hazards frailty models were developed to identify clinical and laboratory variables associated with development of CV.

Results

We analysed 392 patients, of whom 375 (92.5%) were females. There were 213 (55.0%) White, 72 (18.6%) African-Caribbean, 82 (21.1%) South Asian, 9 (2.3%) East Asian, and 11 (2.8%) other ethnicities. The median (IQR) age at enrolment was 33 (26 - 44) years and the median duration of follow up was 9.2 (5.1 - 14.7) years. The incidence rates of minor and major CV were reported in Table 1. In Cox proportional hazards models, there was a positive association between CV and discoid rash (hazard ratio [HR] 2.16 [95% CI: 1.01, 4.61]), Raynaud’s phenomenon (HR 5.67 [95% CI: 4.11, 7.81]), livedo reticularis (HR = 4.69 [95% CI: 1.83, 12.0]), arthritis (HR 3.02 [95% CI: 2.20, 4.15]), renal involvement (OR 2.40 [95% CI: 1.55, 3.71]), haematological involvement (HR = 2.46 [95% CI: 1.80, 3.36]), and Afro-Caribbean descent (HR 1.96 [95% CI: 1.03, 3.74]). In addition, CV was positively associated with anti-dsDNA (HR = 2.33 [95% CI: 1.67, 3.27]), low C3 or C4 (HR 2.29 [95% CI: 2.18, 4.10]), and history of anti-Ro or anti-La (HR = 1.92 [95% CI: 1.15, 3.21]).

Conclusion

The incidence rates of CV decrease over the duration of follow-up and are associated with defined clinical and serological features.

Disclosure

A. Saleh: Grants/research support; A.S. is a sponsored PhD student by the Egyptian ministry of higher education represented by The Egyptian Bureau for Cultural & Educational Affairs in London. C. Gordon: None. J. Reynolds: None.
P188 Frailty and its impact on patient-reported outcomes in polymyalgia rheumatica
Authors: Harkins Patricia , Cowley Sharon , Harrington Robert , Kane David , Conway Richard
Published: April 2024

Background/Aims

Frailty is an increasingly important construct in the field of rheumatology, aiding the identification of individuals with increased vulnerability to accelerated clinical decline, and overall worse disease outcomes. The aim of this research was to explore the prevalence of frailty and its potential associated impact on patient reported outcomes (PROs) in a cohort of patients with polymyalgia rheumatica (PMR).

Methods

Patients with a diagnosis of PMR (fulfilling the 2012 EULAR/ACR Provisional Classification Criteria), who were in clinical remission and on active treatment with glucocorticoids were recruited from two centres. Patients were >3 months and <12 months from diagnosis. Frailty was defined by the 5 criteria of the widely validated Fried Phenotypic Frailty Index. Patient-reported outcomes included anxiety, using the Generalised Anxiety Disorder Assessment (GAD-7), mood using the Patient Health Questionnaire (PHQ-9), fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), pain using the visual analogue scale (VAS) and overall health related quality of life using the Health Assessment Questionnaire-Disability Index (HAQ-DI). The associations between categorical variables were compared using the -test or Fishers exact test. The association between continuous variables and categorical variables was assessed using the Kruskal-Wallis test. Correlations were calculated using Pearson’s r. All analyses were conducted using R (R Core Team, 2022). A p-value of < 0.05 was considered as statistically significant.

Results

51 consecutive patients were recruited, of which 56.9% (n = 29) were female. Using the Fried Phenotypic Index, 64.7% (n = 33) were classified as robust, 27.5% (n = 14) as pre-frail and 7.8% (n = 4) as frail. All patients classified as frail were female and had a statistically significantly higher BMI (p = 0.040) than those in the robust and pre-frail categories. Compared to robust individuals, those who were frail had statistically significant higher median GAD-7 (p = 0.003), PHQ-9 (p = 0.001), VAS (p = <0.001) and HAQ-DI (p = <0.001) scores. FACIT-F scores were also worse in those who were frail versus robust (p = 0.001).

Conclusion

Over one third of patients with PMR in this cohort were classified as pre-frail or frail. Increased frailty status was significantly correlated with worse PROs, including mood, pain, fatigue and overall quality of life. As frailty is a potentially reversible state, accurately identifying frailty, and implementing appropriate interventions is of utmost importance to ensure improved clinical outcomes in those with PMR.

Disclosure

P. Harkins: Grants/research support; British Society for Rheumatology. S. Cowley: None. R. Harrington: None. D. Kane: None. R. Conway: None.
E007 Novel signs to predict healthcare consumption following bone fracture: a clinical audit
Authors: Mudkavi Rohan , Shenker Nicholas
Published: April 2024

Background/Aims

Recovery following fracture is variable. Previously we have identified poor outcomes based upon baseline abnormal body scheme. We now aimed to determine whether these novel bedside tests measuring finger perception abnormalities and body scheme disruption can be used to predict healthcare utilisation post fracture.

Methods

We performed two bedside tests in patients who were in cast in the plaster room. We followed up clinical records for 2+ years and gathered data on the use of healthcare resources from both hospital and primary care electronic patient records. The novel tests were a finger perception (FP) and body scan (BS) assessment. The audit was approved by Cambridge University Hospitals (PRN8899).

Results

46 patients were included. 2 had incomplete data and were excluded from the final analysis. 25 patients (group 1) had no abnormalities in their body scheme at baseline in the fracture room. 16 had a single abnormality and 3/44 (group 2, 7%) had both FP and BS. This final group consumed more analgesics, took longer to discharge and had a greater utilisation of healthcare resources (Table 1). Comparing the cost difference using NHS 2020 Reference costs between groups 1 and 2 was around £530/patient. Annually this equates to £175,000 for CUH.

Conclusion

FS and BS are easy to assess in patients with a bone fracture and predict a cohort which expressed more pain and health care consumption. Upscaling the difference between the normal and abnormal groups would incur an annual trust and primary care cost of £175,000.

Disclosure

R. Mudkavi: None. N. Shenker: None.
E028 A differential diagnosis for treatment resistant psoriatic arthritis
Authors: Jacobs Alana , Callan Margaret
Published: April 2024

Background/Aims

This case involves a 45 year old gentleman with established psoriatic arthritis with axial and peripheral joint involvement. His disease was managed with subcutaneous methotrexate and etanercept. Despite improvement in axial symptoms and resolution of symptoms at other peripheral joints, he had ongoing severe monoarthritis of his right knee with significant pain and swelling.

Methods

In spite of several joint aspirations and intra-articular steroid injections [ten in total], escalation of dose of methotrexate, addition of sulfasalazine and switch of biologic to adalimumab, the patient’s right knee symptoms persisted. Further imaging was performed. An US scan showed chronic synovial hypertrophy with fatty metaplasia and an MRI scan showed frond like synovial thickening, suggestive of lipoma arborescens.

Results

The patient was referred to the orthopaedic surgeons and underwent excision synovectomy. The histopathology reported fibrofatty tissue with areas of chronic synovitis with presence of lymphoplasmacytic aggregates. The patient’s knee symptoms persisted for five years in total after clinical improvement at other joints; post-synovectomy, his right knee symptoms were improved. Lipoma arborescens is a benign progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium; it frequently affects the knee joint suprapatellar pouch. Villous proliferation of the synovium occurs, with subsequent replacement of synovial connective tissue by adipocytes.

Conclusion

Lipoma arborescens has been described occasionally in association with psoriatic arthritis. It is felt to occur as a reactive response to chronic synovial irritation; in this case from an inflammatory affront. Given the rarity of lipoma arborescens, coupled with the patient’s known underlying diagnosis of a seronegative arthritis, there was significant delay in his diagnosis. This case highlights the need to consider other causes of persistent joint pain and swelling when maximal therapeutic options have been unsuccessful.

Disclosure

A. Jacobs: None. M. Callan: None.
E057 International survey to evaluate current options and user needs for subcutaneous injection of methotrexate to inform development of a new injection device
Authors: Müller-Ladner Ulf , Edwards Christopher , Erkens Andreas
Published: April 2024

Background/Aims

Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. To assess the needs of users and the relevance of features of a new MTX autoinjector succeeding the metoject®/metex® PEN, an international online survey was performed.

Methods

A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations of the three MTX devices currently available on the market and were informed about the new MTX autoinjector.

Results

In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories “dosing/administration” and “ease of use”. 82% of physicians, 87% of nurses, and 76% of patients stated a positive first impression of the new button-free MTX autoinjector, respectively. The features rated most relevant by the user groups were a) 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 points of a total of 100 points), b) small injection volume (9.7 to 11.7 points), c) short injection time below 5 seconds (8.5 to 11.1 points), and d) 10 different doses for dose flexibility (8.0 to 13.2 points).

Conclusion

Autoinjectors for MTX appear to be preferred over PFS in this international survey. In addition, important features of MTX autoinjectors for patients and healthcare professionals were identified including the autoinjector mechanism, volume of injection and injection time.

Disclosure

U. Müller-Ladner: Consultancies; U.M.-L. was advisor to medac GmbH. Member of speakers’ bureau; U.M.-L. was speaker to medac GmbH. C. Edwards: Member of speakers’ bureau; C.J.E. has been a speaker for medac. A. Erkens: Other; A.E. has performed strategic market research for medac GmbH.
E062 Nailfold capillaroscopy: its application in routine clinical practice
Authors: Tabassum Syeda A , Douglas Karen M J , Udeshika Erandi
Published: April 2024

Background/Aims

Nailfold capillaroscopy (NFC) is a non-invasive tool to evaluate the structural microvascular abnormalities found in systemic sclerosis (SSc). NFC allows for the visualization of the capillary bed at the nailfold, providing valuable insights into the structure and function of these capillaries. NFC helps differentiate primary from secondary Raynaud’s phenomenon (RP). Abnormal NFC is included in the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria and due to its predictive value of developing SSc is included in the Very Early Diagnosis of SSc (VEDOSS) criteria. Dudley Group NHS FT runs a consultant-led service supported by a specialty trainee where clinical review is carried out alongside NFC using video capillaroscopy. Patients can be referred to this clinic from rheumatology or respiratory colleagues.

Methods

We audited all patients who had attended a monthly NFC clinic between September 2021 and October 2023. We reviewed clinical letters and electronic patient record system and collected details of: demographics; immunology; clinical characteristics; reason for attending the clinic; NFC findings; and diagnosis. NFC findings were classified as normal or abnormal (to include scleroderma pattern and non-specific changes). Data was analysed using excel for individual variables and their comparison with nailfold capillaroscopy results.

Results

We identified 80 patients, of which 63 (79%) were females and median age was 54.5 years. ANA was positive in 64 (80%) patients, SSc and myositis immunology blots were positive in 41 (51%) and 4 (5%) respectively. Clinical characteristics included RP in 71 (89%) and interstitial lung disease (ILD) in 17 (21%). The reasons for attending the NFC clinic were categorised as: to exclude secondary causes of RP (52; 65%); to aid diagnosis of suspected SSc (23; 29%); surveillance of known SSc (5; 6%). NFC was normal in 42 patients. In the 38 patients where NFC was abnormal the clinical diagnosis was categorised as: primary RP (8; 10%); SSc spectrum of disease (17; 21%); and another CTD (20; 25%). Of patients with SSc spectrum of disease: 24% (4/17) had a diagnosis of VEDoSS; 47% (8/17) Limited Cutaneous SSc; and 29% (5/17) Diffuse SSc. The presence of RP and ANA was not significantly different in patients with abnormal NFC. There was a non-significant association between the presence of ILD and abnormal NFC. 9/17 (52%) patients with ILD had an abnormal NFC compared to 18/63 (29%) patients without ILD (p = 0.059).

Conclusion

NFC is a simple procedure in conjunction with a clinical review to enhance the early diagnosis of SSc and exclusion of secondary Raynaud’s. It supports education and training as a tool for learning as being part of the curriculum.

Disclosure

S.A. Tabassum: None. K.M.J. Douglas: None. E. Udeshika: None.
E074 Clinical features, disease activity and functional outcome of juvenile-onset, adult-onset and late-onset ankylosing spondylitis: a cross sectional study from India
Authors: Modadugu Krishna Pratheek , Thabah Molly M
Published: April 2024

Background/Aims

Ankylosing spondylitis (AS) or radiographic axial spondyloarthritis (axial SpA) is reported to present with peripheral arthritis, less spinal symptoms, and more radiographic damage in juvenile onset (age at onset ≤16 years) as compared to adult-onset AS(age at onset <45 years). Functional outcome has varied depending on the population studied. In this cross-sectional study we compared clinical features, disease activity, and functional outcome among juvenile-onset AS (JoAS), adult-onset AS(AoAS), late-onset AS (LoAS).

Methods

Consenting patients fulfilling either the ASAS classification for axial SpA or 1984 modified New York criteria attending SpA clinic were included between May and June 2022. Data was collected by direct patient interview and clinical examination. Data collected: Clinical features, treatment, current disease activity by Bath AS disease activity index (BASDAI), current functional outcome by the Bath Ankylosing Spondylitis Functional Index (BASFI). Disease activity, functional outcome were compared among JoAS, AoAS, and LoAS. Study protocol was approved by the IEC.

Results

Of 73 patients (61 male), mean age 39.1±12.8 years, 10 (13.7%) were JoAS, 56 (76.7%) and 7 (9.6%) were AoAS and LoAS respectively. Only 30%, 59%, and 57% patients in JoAS, AoAS, and LoAS respectively were employed. There were no differences in the clinical presentation, namely back pain, neck pain, hip involvement, uveitis, and enthesitis among the three groups (Table 1). Majority received conventional-synthetic-DMARDs; only 2(20)%, 8(14.3), and 1(14.3) in the JoAS, AoAS, and LoAS group respectively had ever received TNF-inhibitors. Majority patients in all the groups had active disease (BASDAI>4 and ASDAS>1.3) and there was also no difference in the disease activity (at enrolment) between the groups. All patients with JoAS were positive for HLA-B27. Mean BASFI was not different between the groups, but poor functional outcome (BASFI >6) was observed in 5/10 (50%), 28/56 (50%), 5/9 (71.4%) patients of JoAS, AoAS, and LoAS respectively.

Conclusion

In a study involving a homogeneous cohort of Indian AS, there were no marked differences in clinical features, disease activity between JoAS, AoAS, and LoAS. Majority patients have poor functional outcomes which could be a direct effect of poor disease control due to lack of access to TNF inhibitors.

Disclosure

K. Modadugu: None. M.M. Thabah: None.
Efficacy of a Telemonitoring System as a Complementary Strategy in the Treatment of Patients With Heart Failure
Authors: Achury-Saldaña Diana M. , Gonzalez Rafael A. , Garcia Angel , Mariño Alejandro , Bohorquez Wilson R.
Published: April 2024

Episodes of decompensation are the main cause of hospital admissions in patients with heart failure. For this reason, the use of mobile apps emerges as an excellent strategy to improve coverage, real-time monitoring, and timeliness of care. ControlVit is an electronic application for early detection of complications studied within the context of a tertiary university hospital. Patients were randomized to the use of ControlVit versus placebo, during a 6-month follow-up. The primary outcome was the difference in numbers of readmissions and deaths for heart failure between both groups. One hundred forty patients were included (intervention = 71, placebo = 69), with an average age of 66 years old; 71% were men. The main etiology of heart failure was ischemic (60%), whereas the main comorbidities were arterial hypertension (44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus (27%). The primary outcome occurred more frequently in the control group: readmission due to decompensation for heart failure (control group n = 14 vs intervention group n = 3; P = .0081), and death (control group n = 11 vs intervention group n = 3; P = .024). In heart failure patients, ControlVit is a useful and supplementary tool, which reduces hospital admissions due to episodes of decompensation.
Spock2 Functions as a Key Time-Series Gene of Endothelial Cells in Sepsis-Induced Cardiomyopathy
Authors: Zhang Jian , Lu Yao , Shen Yihui , Zhang Hui , Xu Yuchen , Wang Xuejun , Chen Yifan , He Xiaozhen , Lu Hao , Cheng Leilei
Published: April 2024

The study aimed to investigate the pathogenesis of sepsis-induced cardiomyopathy, a leading cause of mortality in septic patients. Transcriptome data from cecal ligation and puncture–induced septic mice were analyzed at different time points (24, 48, and 72 hours) using GSE171546 data. Through weighted gene co-expression network analysis, time series, and differential expression analyses, key time-series differentially expressed genes were identified. In addition, single-cell sequencing data (GSE207363) were used for both differential and pseudotime analyses to pinpoint differentially expressed genes specific to endothelial cells. The study highlighted Spock2, S100a9, S100a8, and Xdh as differential genes specific to endothelial cells in a time-dependent manner. Immunofluorescence validation confirmed the increased expression of SPOCK2 in the endothelial cells of cecal ligation and puncture–induced septic mice. Furthermore, in vitrostudies showed that deletion of Spock2 significantly increased LPS-induced apoptosis and necrosis in human umbilical vein endothelial cells. In conclusion, SPOCK2 expression was increased in septic cardiac endothelial cells and LPS-induced human umbilical vein endothelial cells and may play a protective role.
Evaluating fluid overload in critically ill children
Authors: Bem Reinout A. , Lemson Joris
Published: April 2024

Purpose of review

To review the evaluation and management of fluid overload in critically ill children.

Recent findings

Emerging evidence associates fluid overload, i.e. having a positive cumulative fluid balance, with adverse outcome in critically ill children. This is most likely the result of impaired organ function due to increased extravascular water content. The combination of a number of parameters, including physical, laboratory and radiographic markers, may aid the clinician in monitoring and quantifying fluid status, but all have important limitations, in particular to discriminate between intra- and extravascular water volume. Current guidelines advocate a restrictive fluid management, initiated early during the disease course, but are hampered by the lack of high quality evidence.

Recent advances in early evaluation of fluid status and (tailored) restrictive fluid management in critically ill children may decrease complications of fluid overload, potentially improving outcome. Further clinical trials are necessary to provide the clinician with solid recommendations.
Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care
Authors: Calihan Jessica B. , Matson Pamela
Published: April 2024

Purpose of review

Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use.

Recent findings

There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use.

Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.
Update on Total Auricular Construction
Authors: Yamada Akira , Chwa Emily S. , Boctor Michael J.
Published: April 2024

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management.

Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors’ focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.
Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center
Authors: House Sherita , Naim Ali Hebatallah A. , Stucky Christopher
Published: April 2024

Background and Objectives:

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center.

Methods:

We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other.

Results:

Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = −.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = −.01, P = .00), and participants with graduate degrees reported lower RC (β = −.62, P = .00).

Conclusions:

We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.
Predicting Microwave Ablation Early Efficacy in Pulmonary Malignancies via Δ Radiomics Models
Authors: Yang Jing , Yang Chen , Feng Jianju , Zhu Fandong , Zhao Zhenhua
Published: April 2024

Objective

This study aimed to explore the value of preoperative and postoperative computed tomography (CT)–based radiomic signatures and Δ radiomic signatures for evaluating the early efficacy of microwave ablation (MWA) for pulmonary malignancies.

Methods

In total, 115 patients with pulmonary malignancies who underwent MWA treatment were categorized into response and nonresponse groups according to relevant guidelines and consensus. Quantitative image features of the largest pulmonary malignancies were extracted from CT noncontrast scan images preoperatively (time point 0, TP0) and immediately postoperatively (time point 1, TP1). Critical features were selected from TP0 and TP1 and as Δ radiomics signatures for building radiomics models. In addition, a combined radiomics model (C-RO) was developed by integrating radiomics parameters with clinical risk factors. Prediction performance was assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).

Results

The radiomics model using Δ features outperformed the radiomics model using TP0 and TP1 features, with training and validation AUCs of 0.892, 0.808, and 0.787, and 0.705, 0.825, and 0.778, respectively. By combining the TP0, TP1, and Δ features, the logistic regression model exhibited the best performance, with training and validation AUCs of 0.945 and 0.744, respectively. The DCA confirmed the clinical utility of the Δ radiomics model.

Conclusions

A combined prediction model, including TP0, TP1, and Δ radiometric features, can be used to evaluate the early efficacy of MWA in pulmonary malignancies.
An Enhanced Recovery After Surgery (ERAS) Protocol for Orthognathic Surgery Reduces Rates of Postoperative Nausea
Authors: Alvarez Gerardo A. , Hebert Kelsey J. , Britt Michael C. , Resnick Cory M. , Padwa Bonnie L. , Green Mark A.
Published: April 2024

For many surgical procedures, enhanced recovery after surgery (ERAS) protocols have improved patient outcomes, particularly postoperative nausea and vomiting. The purpose of this study was to evaluate postoperative nausea following orthognathic surgery after the implementation of an ERAS protocol. This retrospective cohort study included patients between 12 and 35 years old who underwent orthognathic surgery at Boston Children’s Hospital from April 2018 to December 2022. Patients with syndromes or a hospital stay greater than 48 hours were excluded from the study. The primary predictor was enrollment in our institutional ERAS protocol. The main outcome variable was postoperative nausea. Intraoperative and postoperative covariates were compared between groups using unpaired t tests and chi squared analysis. Univariate and multivariate regression models with 95% confidence intervals were performed to identify predictors for nausea. A P value<0.05 was considered significant. There were 128 patients (68 non-ERAS, 60 ERAS) included in this study (51.6% female, mean age 19.02±3.25 years). The ERAS group received less intraoperative fluid (937.0±462.3 versus 1583.6±847.6 mL, P≤0.001) and experienced less postoperative nausea (38.3% versus 63.2%, P=0.005). Enhanced recovery after surgery status (P=0.005) was a predictor for less postoperative nausea, whereas bilateral sagittal split osteotomy (P=0.045) and length of stay (P=0.007) were positive predictors for postoperative nausea in multivariate logistic regression analysis. Implementing an ERAS protocol for orthognathic surgery reduces postoperative nausea.

Level of Evidence: Level III—therapeutic.
Suture-Needle Management Device and Novel Port Configuration for Robotic Sacrocolpopexy
Authors: Das Deepanjana , Squires Natalie , Mueller Margaret , Collins Sarah , Lewicky-Gaupp Christina , Bretschneider C. Emi , Geynisman-Tan Julia , Kenton Kimberly
Published: April 2024

Importance

Robot-assisted sacrocolpopexy (SCP) is a commonly performed procedure for the repair of apical pelvic organ prolapse; therefore, novel devices and techniques to improve safety and efficacy of this procedure should be explored.

Objective

The objective of this study was to assess safety and efficacy of 8-mm trocar site for use of a disposable suture/needle management device (StitchKit; Origami Surgical, Madison, NJ) for robot-assisted SCP with a 4-arm configuration and no assistant port.

Study Design

This is a retrospective case series of patients undergoing robot-assisted SCP at a tertiary center from 2018 to 2021. All surgical procedures were performed using four 8-mm robotic trocars and StitchKit device. Our objective was to review all cases in which this technique was used to determine whether the approach resulted in a safely completed procedure and any complications or adverse events. Secondary objectives were to describe patient and operative characteristics.

Results

In total, 422 patients underwent robot-assisted SCP for pelvic organ prolapse. The mean age was 60 ± 10 years, and mean body mass index was 27 ± 6 (calculated as weight in kilograms divided by height in meters squared). Most patients had stage 3 prolapse (73%) and underwent concomitant hysterectomy (70%). Ninety-nine percent (n = 416) of cases were completed robotically. StitchKit was successfully inserted and removed in all robotic cases with correct needle counts. All patients had postoperative visits, and 80% followed up at 3 months. No umbilical/port site hernias, operative site infections, or adverse events were reported.

Conclusions

Robot-assisted SCP can be performed safely using a 4-arm robotic configuration and suture kit device. This setup eliminates incisions greater than 8 mm and an assistant port, allowing for surgical efficiency without compromising patient outcomes.
A simple and fast method for estimating bat roost locations
Authors: Henley Lucy , Finch Domhnall , Mathews Fiona , Jones Owen , Woolley Thomas E.
Published: April 2024

Bats play a pivotal role in pest control, pollination and seed dispersal. Despite their ecological significance, locating bat roosts remains a challenging task for ecologists. Traditional field surveys are time-consuming, expensive and may disturb sensitive bat populations. In this article, we combine data from static audio detectors with a bat movement model to facilitate the detection of bat roosts. Crucially, our technique not only provides a point prediction for the most likely location of a bat roost, but because of the algorithm’s speed, it can be applied over an entire landscape, resulting in a likelihood map, which provides optimal searching regions. To illustrate the success of the algorithm and highlight limitations, we apply our technique to greater horseshoe bat (
Rhinolophus ferrumequinum
) acoustic data acquired from six surveys from four different UK locations and over six different times in the year. Furthermore, we investigate what happens to the accuracy of our predictions in the case that the roost is not contained within the area spanned by the detectors. This innovative approach to searching rural environments holds the potential to greatly reduce the labour required for roost finding, and, hence, enhance the conservation efforts of bat populations and their habitats.
A future food boom rescues the negative effects of early-life adversity on adult lifespan in a small mammal
Authors: Petrullo Lauren , Delaney David , Boutin Stan , Lane Jeffrey E. , McAdam Andrew G. , Dantzer Ben
Published: April 2024

Early-life adversity, even when transient, can have lasting effects on individual phenotypes and reduce lifespan across species. If these effects can be mitigated by a high-quality later-life environment, then differences in future resources may explain variable resilience to early-life adversity. Using data from over 1000 wild North American red squirrels, we tested the hypothesis that the costs of early-life adversity for adult lifespan could be offset by later-life food abundance. We identified six adversities that reduced juvenile survival in the first year of life, though only one—birth date—had continued independent effects on adult lifespan. We then built a weighted early-life adversity (wELA) index integrating the sum of adversities and their effect sizes. Greater weighted early-life adversity predicted shorter adult lifespans in males and females, but a naturally occurring food boom in the second year of life ameliorated this effect. Experimental food supplementation did not replicate this pattern, despite increasing lifespan, indicating that the buffering effect of a future food boom may hinge on more than an increase in available calories. Our results suggest a non-deterministic role of early-life conditions for later-life phenotype, highlighting the importance of evaluating the consequences of early-life adversity in the context of an animal's entire life course.
Hierarchically embedded scales of movement shape the social networks of vampire bats
Authors: Hartman C. Raven A. , Wilkinson Gerald S. , Razik Imran , Hamilton Ian M. , Hobson Elizabeth A. , Carter Gerald G.
Published: April 2024

Social structure can emerge from
hierarchically embedded scales of movement
, where movement at one scale is constrained within a larger scale (e.g. among branches, trees, forests). In most studies of animal social networks, some scales of movement are not observed, and the relative importance of the observed scales of movement is unclear. Here, we asked: how does individual variation in movement, at multiple nested spatial scales, influence each individual's social connectedness? Using existing data from common vampire bats (
Desmodus rotundus
), we created an agent-based model of how three nested scales of movement—among roosts, clusters and grooming partners—each influence a bat's grooming network centrality. In each of 10 simulations, virtual bats lacking social and spatial preferences moved at each scale at empirically derived rates that were either fixed or individually variable and either independent or correlated across scales. We found that numbers of partners groomed per bat were driven more by within-roost movements than by roost switching, highlighting that co-roosting networks do not fully capture bat social structure. Simulations revealed how individual variation in movement at nested spatial scales can cause false discovery and misidentification of preferred social relationships. Our model provides several insights into how nonsocial factors shape social networks.
Squid male alternative reproductive tactics are determined by birth date
Authors: Hosono Shota , Masuda Yoshio , Tokioka Shun , Kawamura Tomohiko , Iwata Yoko
Published: April 2024

Alternative reproductive tactics (ARTs) are discontinuous phenotypes associated with reproduction, observed in males of many species. Typically, large males adopt a tactic of competing with rivals for mating, while small males adopt a tactic of stealing fertilization opportunities from the large males. The ‘birth date hypothesis', proposing that the date of birth influences the determination of each male's reproductive tactic, has been tested only in teleost fish to date. Here, the birth date hypothesis was tested in ARTs of Japanese spear squid
Heterololigo bleekeri
(consort/sneaker) by analysing statolith growth increments. The birth date significantly differed between consorts (early-hatched) and sneakers (late-hatched). However, no differences were detected in growth history up to 100 days from hatching. Most immature males caught during the reproductive season were larger than sneakers, and their hatch date was similar to that of consorts, suggesting that these immature males had already been following a life-history pathway as a consort. These results indicate that ARTs of
H. bleekeri
are determined based on their hatch date in early life. This study firstly suggests that the birth date hypothesis applies to aquatic invertebrates, suggesting that the mechanism by which birth date determines the individual phenotype is a phenomenon more common than previously believed.
Foraging-induced craniofacial plasticity is associated with an early, robust and dynamic transcriptional response
Authors: Tetrault Emily , Aaronson Ben , Gilbert Michelle C. , Albertson R. Craig
Published: April 2024

Phenotypic plasticity is the ability of a single genotype to vary its phenotype in response to the environment. Plasticity of the skeletal system in response to mechanical input is widely studied, but the timing of its transcriptional regulation is not well understood. Here, we used the cichlid feeding apparatus to examine the transcriptional dynamics of skeletal plasticity over time. Using three closely related species that vary in their ability to remodel bone and a panel of 11 genes, including well-studied skeletal differentiation markers and newly characterized environmentally sensitive genes, we examined plasticity at one, two, four and eight weeks following the onset of alternate foraging challenges. We found that the plastic species exhibited environment-specific bursts in gene expression beginning at one week, followed by a sharp decline in levels, while the species with more limited plasticity exhibited consistently low levels of gene expression. This trend held across nearly all genes, suggesting that it is a hallmark of the larger plasticity regulatory network. We conclude that plasticity of the cichlid feeding apparatus is not the result of slowly accumulating gene expression difference over time, but rather is stimulated by early bursts of environment-specific gene expression followed by a return to homeostatic levels.
Body size shapes song in honeyeaters
Authors: Hay Eleanor M. , McGee Matthew D. , White Craig R. , Chown Steven L.
Published: April 2024

Birdsongs are among the most distinctive animal signals. Their evolution is thought to be shaped simultaneously by habitat structure and by the constraints of morphology. Habitat structure affects song transmission and detectability, thus influencing song (the acoustic adaptation hypothesis), while body size and beak size and shape necessarily constrain song characteristics (the morphological constraint hypothesis). Yet, support for the acoustic adaptation and morphological constraint hypotheses remains equivocal, and their simultaneous examination is infrequent. Using a phenotypically diverse Australasian bird clade, the honeyeaters (Aves: Meliphagidae), we compile a dataset consisting of song, environmental, and morphological variables for 163 species and jointly examine predictions of these two hypotheses. Overall, we find that body size constrains song frequency and pace in honeyeaters. Although habitat type and environmental temperature influence aspects of song, that influence is indirect, likely via effects of environmental variation on body size, with some evidence that elevation constrains the evolution of song peak frequency. Our results demonstrate that morphology has an overwhelming influence on birdsong, in support of the morphological constraint hypothesis, with the environment playing a secondary role generally via body size rather than habitat structure. These results suggest that changing body size (a consequence of both global effects such as climate change and local effects such as habitat transformation) will substantially influence the nature of birdsong.
Allele-specific targeting of mutant TOR1A by the compact CRISPR/NmCas9 system in DYT1 dystonia with high fidelity
Authors: Wu Junjiao , Tang Yu
Published: April 2024

DYT1 is an autosomal dominant form of isolated dystonia, which is basically caused by an in-frame 3-bp GAG deletion in theTOR1Agene, leading to loss of a single glutamic acid residue (ΔE) at the C-terminus. TOR1A has been strongly implicated in various biological processes, such as protein quality control and regulation of ER stress. Many of these functions involve as protein multimers between TOR1A and its partners, whereas the ΔE mutant leads to destabilization of their binding, thereby reducing ATPase activation. Despite controversy over its functional model, the dominant-negative nature of TOR1AΔEhas been demonstrated in a number of ways. Therefore, it is promising to develop an allele-specific intervention strategy that specifically silences the pathogenic TOR1A allele while preserving the wild-type allele to perform its normal function. In this study, we systematically evaluated the allele-specific targeting of TOR1AΔEusing over 20 Cas endonucleases. We found that NmCas9, one of the compact Cas endonucleases yet with high-fidelity, selectively targeted the TOR1AΔEallele, with a 3-nt deletion located in the spacer region of sgRNAs. The discriminatory Nm-sgRNAs were verified both exogenously and endogenously that showed high specificity in disrupting the TOR1AΔEallele but not the wild-type one. Functionally, this strategy efficiently ameliorated the ubiquitin accumulation in DYT1 fibroblasts. Overall, our study demonstrates that the allele-specific targeting of mutant TOR1A with NmCas9 is a promising alternative approach for the treatment of DYT1.
“We have been so patient because we know where we are coming from” Exploring the acceptability and feasibility of a mobile electronic medical record system designed for community-based antiretroviral therapy in Lilongwe, Malawi
Authors: Kiruthu-Kamamia Christine , Berner-Rodoreda Astrid , O’Bryan Gillian , Sande Odala , Huwa Jacqueline , Thawani Agnes , Tweya Hannock , Groot Wim , Pavlova Milena , Feldacker Caryl
Published: April 2024

Background

Mobile health (mHealth) is reshaping healthcare delivery, especially in HIV management. The World Health Organization advocates for mHealth to provide healthcare workers (HCWs) with real-time data, enhancing patient care. However, in Malawi’s Lighthouse Trust antiretroviral therapy (ART) clinic, the nurse-led community-based ART (NCAP) program faces hurdles with data management due to lack of access to electronic medical records systems (EMRS) in the community setting. EMRS is not typically available in differentiated service delivery settings where reliable power and internet are often unavailable. We used human-centered design (HCD) processes to create a mobile EMRS prototype, the Community-based ART Retention and Suppression (CARES) app. We explore progress to simplify workflow for HCWs and improve client care.

Methods

To evaluate the CARES app’s feasibility and acceptability among NCAP HCWs, we conducted in-depth interviews among 15 NCAP HCWs. We used a rapid qualitative analysis approach guided by the extended Technology Acceptance Model. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results

As a likely result of HCD, HCWs demonstrated high expectations for the CARES app to improve healthcare delivery and data management. However, challenges such as app performance, data integration, and system navigation were significant barriers to acceptance or feasibility. Despite challenges, HCWs remained optimistic about the potential for CARES to enhance NCAP clinical decision-making and data flow. HCWs emphasized the need for continuous training and stakeholder engagement, improved infrastructure, data security protections, and establishing the CARES app and EMRS integration to facilitate CARES’ long-term success at scale.

Conclusion

The study’s findings underscore the importance of HCD for mHealth buy-in. As HCWs were invested in CARES success, they remained optimistic that the app could enhance NCAP services if user experience and app performance improved. Incorporation of HCW feedback would help deliver beyond the promise of CARES.