bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to Enrollment in a Post-Stroke Neuromodulation and Walking Study: Implications for Recruiting Women
Authors: Mehta Twinkle , Cleland Brice , Madhavan Sangeetha
Published: February 2024

Background

Women have a higher risk of stroke and related disability than men but are underrepresented in stroke clinical trials. Identifying modifiable recruitment and enrollment barriers for women can improve study generalizability, statistical power, and resource utilization.

Objective

In a post-stroke neuromodulation study, we determined the impact of sex on the occurrence of exclusion criteria and compared the sex distribution of screened and enrolled individuals with a broader stroke-affected population.

Methods

A total of 335 individuals with chronic stroke were screened for a study examining how neuromodulation and high-intensity treadmill training affect walking speed and corticomotor excitability. Demographics and exclusions were retrospectively gathered as a secondary dataset. Exclusion criteria consisted of 6 categories (not target population, unable to do treadmill protocol, unable to do non-invasive brain stimulation, insufficient ankle motion and disinterest, and cognitive impairment). Incidence of each exclusion criterion was compared between women and men. The sex distribution was compared to a dataset from Chicago primary stroke centers.

Results

A total of 81 individuals were enrolled and 254 were not. The percentage of women excluded was significantly greater than that of men ( P = .04). No individual exclusion criterion or categories excluded women more frequently than men. Screened and enrolled individuals had a lower proportion of women and younger age than a representative stroke population ( P < .001).

Conclusions

We identified exclusion criteria (ie, headaches, cognitive scores, and age) that are modifiable barriers to enrollment of women in this post-stroke neuromodulation study. Addressing underrepresentation of women in stroke research is pivotal for enhancing generalizability, achieving statistical power, and optimizing resources.
Setting priorities for physical examination in pharmacy education: A Delphi study
Authors: Tremblay Marie-Laurence , Guay Marc-Antoine , Lafleur Alexandre
Published: February 2024

Background:

As the scope of pharmacy practice is expanding, a growing number of pharmacists perform physical examination (PE) to gather additional information to monitor the effectiveness and safety of their patients’ therapy. This professional activity calls for the development of comprehensive and valuable PE training. We sought to determine by consensus which PE tests should be given teaching priority in pharmacy education.

Methods:

Using existing PE literature in pharmacy, we conducted an online Delphi survey from December 2021 to April 2022 with 16 pharmacists who practise in a variety of settings and/or who are considered experts in PE.

Results:

After 2 Delphi rounds, consensus was reached to either include or exclude 27 PE tests in entry-to-practice programs. One last round allowed prioritizing the agreed-upon PE tests in terms of educational needs. Clinicians agreed that measuring blood pressure is indispensable and should be given teaching priority, followed by pulse rate, weight and blood glucose measurements. Endocrine system and head and neck examinations should be included in pharmacy programs, but their clinical usefulness was considered less important.

Discussion:

We compared our results with PE literature in other health care disciplines. We found that only a few PE tests truly influence drug therapy management, that some examinations can be quite difficult to perform accurately and that without proper training and opportunities to retrain, skill decay can lead to dangerous misinterpretations. Pharmacy programs should consider focusing on teaching PE tests supported by evidence as having an impact on drug therapy management. Can Pharm J (Ott) 2024;157:xx-xx.
New strategies for confirmatory testing of secondary hypotheses on combined data from multiple trials
Authors: Vandemeulebroecke Marc , Häring Dieter A , Hua Eva , Wei Xiaoling , Xi Dong
Published: February 2024

Background:

Pivotal evidence of efficacy of a new drug is typically generated by (at least) two clinical trials which independently provide statistically significant and mutually corroborating evidence of efficacy based on a primary endpoint. In this situation, showing drug effects on clinically important secondary objectives can be demanding in terms of sample size requirements. Statistically efficient methods to power for such endpoints while controlling the Type I error are needed.

Methods:

We review existing strategies for establishing claims on important but sample size–intense secondary endpoints. We present new strategies based on combined data from two independent, identically designed and concurrent trials, controlling the Type I error at the submission level. We explain the methodology and provide three case studies.

Results:

Different strategies have been used for establishing secondary claims. One new strategy, involving a protocol planned analysis of combined data across trials, and controlling the Type I error at the submission level, is particularly efficient. It has already been successfully used in support of label claims. Regulatory views on this strategy differ.

Conclusions:

Inference on combined data across trials is a useful approach for generating pivotal evidence of efficacy for important but sample size–intense secondary endpoints. It requires careful preparation and regulatory discussion.
‘I should do what?’ Addressing research misconduct through values alignment
Authors: Chatfield Kate , Law Emma
Published: February 2024

Evidence suggests that the incidence of research misconduct is not in decline despite efforts to improve awareness, education and governance mechanisms. Two responses to this problem are favoured: first, the promotion of an agent-centred ethics approach to enhance researchers’ personal responsibility and accountability, and second, a change in research culture to relieve perceived pressures to engage in misconduct. This article discusses the challenges for both responses and explains how normative coherence through values alignment might assist. We argue that research integrity and research ethics convey mixed messages, which are likely to contribute to a form of normative confusion. For the successful adoption of an agent-centred approach, normative coherence is needed between the two. To facilitate normative coherence, we propose that research ethics and research integrity be underpinned by a shared set of moral values that can be enacted via codes and guidelines and imbue research environments. Furthermore, to facilitate culture change, the same normative coherence is necessary at all levels of an institution. Only via values alignment between institutional aims, management, institutional practices and researchers can an ethical culture become truly embedded in research institutions.
Entrepreneurs of memory: Selling history in the GDR Museum shop in Berlin
Authors: Saryusz-Wolska Magdalena , Hochmuth Hanno , Stach Sabine
Published: February 2024

The field of memory studies rarely deals with commercial enterprises, which, as we argue in this article, play just as prominent a role in shaping collective memories as state actors or nongovernmental organizations. The aim of our study is therefore to discuss the role of private entrepreneurs and their businesses in the context of GDR memory. We focus on the privately run GDR Museum in Berlin and its best-selling products. Through the lens of the museum store, we analyze the exhibition, an iconic eggcup, and a book on the history of the GDR that has enjoyed sustained sales over a lengthy period. By tracing the intertwined distribution chains of these memory goods, we emphasize the importance of private entrepreneurs and their networks in the current German memory culture. We argue that economic interests and developments are just as important as political decisions and public institutions regarding the memory of the communist past. Thus memory studies should also focus on enterprises of memory by analyzing business data. This poses an empirical challenge that is worth tackling, since it broadens our understanding of current memory culture.
Libyan deportees on the Italian island of Ustica: Remembering colonial deportations in the (peripheral) metropole
Authors: Ravelli Galadriel
Published: February 2024

In 1911, the Italian liberal government launched the colonial occupation of what is now known as Libya, which was met with unexpected local resistance. The government resorted to mass deportations to the metropole to sedate the resistance, which continued for more than two decades under both the liberal and Fascist regimes. This chapter of Europe’s and Italy’s colonial history has been almost entirely removed from collective memory. The article explores the extent to which colonial deportations are remembered on the Sicilian Island of Ustica, which witnessed the deportation from Libya of more than 2000 people. Currently, the island is home to the only cemetery in Italy that is entirely dedicated to Libyan deportees. I argue that the visits of Libyan delegations, which took place from the late 1980s to 2010, succeeded in challenging colonial aphasia at the local level. Yet, as a result of Ustica’s peripheral position within the national space, the memory work developed through the encounter between local and Libyan actors remained marginal, despite its potential to redefine the Mediterranean as a symbolic space where colonial histories are articulated and remembered. Italy’s outsourcing of the memory work in relation to colonial deportations implies a missed opportunity to interrogate the postcolonial present and thus question persistent dynamics of power in Europe that exclude the constructed Other.
The Battle of Thakhek, 21 March 1946: Traces of a colonial massacre on the Lao–Thai border
Authors: Pholsena Vatthana
Published: February 2024

This article explores the life of an event—a massacre during the First Indochina War on 21 March 1946 in Thakhek, Laos—in the border town of Nakhon Phanom in northeastern Thailand, to where most of the survivors fled. Ignored by Thai authorities and not memorialized in social practices, this event nevertheless continues to have significant impacts on local communities. This article draws on two key concepts: Paul Ricoeur’s “mnemonic act” and Avery Gordon’s notion of “haunting.” Ricoeur’s “small miracle” of memory and Gordon’s haunting as a way of awakening consciousness to past violence help to elucidate the meanings of events for the present, namely, the traces that they leave. Following Valentina Napolitano’s definition of “trace,” this article shows how the memory of the event of 21 March 1946 has become anchored in different sites in Nakhon Phanom and how the event has acquired different meanings, its life prolonged through divergent processes of (re)interpretation and narrativization in each of these sites.
Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units
Authors: Silva Thiago Lopes , dos Santos Luciano Marques , Kusahara Denise Miyuki , Burciaga Luz Verónica Berumen , Biazus Dalcin Camila , de Souza Sabrina , Bitencourt Aline de Souza , Rocha Patrícia Kuerten
Published: February 2024

Background

Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care.

Objective

To verify the association of Nursing professionals’ work shift and training time with proper disinfection of intravenous catheter devices in pediatric units.

Methods

A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤ .05 as significance level.

Results

There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure ( p = .376). However, longer training time was associated with a lower rate in performing such procedure ( p < .001).

Conclusion

Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time.
The Agrarian Conflicts and Food Crises Nexus in Contemporary Latin America
Authors: Zimerman Artur
Published: February 2024

This paper explores the violence stemming from food riots in Latin American countries that have been triggered by recurring food crises in the twenty-first century, particularly impacting impoverished rural populations. The marginalized sectors of emerging countries, whose demands for basic rights such as the right to food go unaddressed by the State, may resort to protests that can escalate into confrontations. The recurrent food crises exacerbate the struggle to meet the basic needs of those who are unable to subsist regularly. This research focuses on a region that has received less scholarly attention compared to Africa and Asia, and examines indicators such as land grabbing, climate change, demographic pressures, political polarization, as independent variables to elucidate the association with food riot occurrences. The collected data and statistical analysis confirm the hypotheses, although further studies are required to enhance the performance of certain indicators.
Luxury Venice: The spread of touristification processes as alpha territorialisation
Authors: Tedesco Carla , Basso Matteo , Mazzoleni Chiara , Morea Valeria
Published: February 2024

In Venice, Italy, peculiar forms of alpha territorialisation are triggered mainly by touristification and ‘tourism-led gentrification’ processes. Such dynamics, increasingly supported by real estate financialisation, are currently spreading from the old town towards the minor islands of the Venetian lagoon, as well as towards the mainland. These processes change the traditional relationship between the old town and its islands. At the same time, such drifts are somehow counteracted by social movements and grassroots cultural practices that often implement forms of actions towards the realisation of an alternative idea of the city. This paper argues that such processes can be interpreted as phenomena of alpha territorialisation and that this interpretation helps us understand the spatial and environmental consequences of urban socio-economic restructuring processes.
Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project
Authors: Ruiz Ramos Jesus , Alquézar-Arbé Aitor , Juanes Borrego Ana , Burillo Putze Guillermo , Aguiló Sira , Jacob Javier , Fernández Cesáreo , Llorens Pere , Quero Espinosa Francisco de Borja , Gordo Remartinez Susana , Hernando González Rocio , Moreno Martín Miguel , Sánchez Aroca Sara , Sara Knabe Alicia , González González Rebeca , Carrión Fernández Marina , Artieda Larrañaga Alberto , Adroher Muñoz Maria , Hong Cho Jeong-Uh , Escolar Martínez Berganza María Teresa , Gayoso Martín Sara , Sánchez Sindín Goretti , Silva Penas Martina , Gómez y Gómez Bárbara , Arenos Sambro Roser , González del Castillo Juan , Miró Òscar
Published: February 2024

Background:

Polypharmacy is a growing phenomenon among elderly individuals. However, there is little information about the frequency of polypharmacy among the elderly population treated in emergency departments (EDs) and its prognostic effect. This study aims to determine the prevalence and short-term prognostic effect of polypharmacy in elderly patients treated in EDs.

Methods:

A retrospective analysis of the Emergency Department Elderly in Needs (EDEN) project’s cohort was performed. This registry included all elderly patients who attended 52 Spanish EDs for any condition. Mild and severe polypharmacy was defined as the use of 5–9 drugs and ⩾10 drugs, respectively. The assessed outcomes were ED revisits, hospital readmissions, and mortality 30 days after discharge. Crude and adjusted logistic regression analyses, including the patient’s comorbidities, were performed.

Results:

A total of 25,557 patients were evaluated [mean age: 78 (IQR: 71–84) years]; 10,534 (41.2%) and 5678 (22.2%) patients presented with mild and severe polypharmacy, respectively. In the adjusted analysis, mild polypharmacy and severe polypharmacy were associated with an increase in ED revisits [odds ratio (OR) 1.13 (95% confidence interval (CI): 1.04–1.23) and 1.38 (95% CI: 1.24–1.51)] and hospital readmissions [OR 1.18 (95% CI: 1.04–1.35) and 1.36 (95% CI: 1.16–1.60)], respectively, compared to non-polypharmacy. Mild and severe polypharmacy were not associated with increased 30-day mortality [OR 1.05 (95% CI: 0.89–2.26) and OR 0.89 (95% CI: 0.72–1.12)], respectively.

Conclusion:

Polypharmacy was common among the elderly treated in EDs and associated with increased risks of ED revisits and hospital readmissions ⩽30 days but not with an increased risk of 30-day mortality. Patients with polypharmacy had a higher risk of ED revisits and hospital readmissions ⩽30 days after discharge.
Electrochemotherapy for the treatment of basal cell tumours of the nasal planum in three cats
Authors: Salmoral Alvaro , Penzo Chiara , Baines Stephen
Published: February 2024

Case series summary

Malignant basal cell tumours may be seen on or near the nasal planum in cats, and include basal cell carcinomas, which are common, and basosquamous carcinomas, which are rare. Reported treatments for these tumours include surgical excision, radiotherapy, photodynamic therapy and cryosurgery. This report describes the successful management of basal cell tumours with electrochemotherapy (ECT), including calcium electroporation, in three cats.

Relevance and novel information

All patients had a complete response lasting at least 9 months to 1 year. The adverse effects of this treatment were minimal and were limited to nasal discharge, sneezing and scabs at the treatment site. ECT and calcium electroporation are a safe, minimally invasive and effective option for the treatment of feline basal cell carcinoma and basosquamous carcinomas.
Family Genetic-Risk Profiles Associated With Divorce
Authors: Salvatore Jessica E. , Ohlsson Henrik , Sundquist Jan , Sundquist Kristina , Kendler Kenneth S.
Published: February 2024

We used Swedish national-register data ( N = 2,828,777) to examine divorce and its associated patterns of family genetic-risk scores (FGRSs; personalized measures of genetic risk inferred from diagnoses in relatives) across 10 psychiatric disorders: major depression, anxiety disorders, obsessive compulsive disorder, bipolar disorder, schizophrenia, anorexia nervosa, alcohol use disorder, drug use disorder, attention-deficit/hyperactive disorder, and autism spectrum disorder. Individuals who divorced had elevated FGRSs across all disorders compared with individuals who were stably married or never married. FGRSs for all disorders were higher among divorced females compared with divorced males and among individuals who did not go on to have a stable second marriage compared with individuals who had a stable second marriage and increased as the cumulative number of divorces increased. In summary, genetic predispositions for psychiatric disorders are associated with the propensity to divorce and with several differences as a function of sex, remarriage, and the cumulative number of divorce transitions.
Three-in-one protocol for the management of hemodynamically unstable paediatric pelvic fracture – a level one trauma centre 15 year review
Authors: Wei Adam Yang Zhen , King Him Tim Chui , Bong Lee Kin
Published: February 2024

A three-in-one protocol comprised of pelvic external fixation, retroperitoneal pelvic packing, and angiography with or without embolization has been developed and used in our centre to improve survival outcomes of hemodynamically unstable pelvic fractures since 2008. Fourteen paediatric patients over a period of 15 years are reviewed in this case series. The mean age is 11.6 and standard deviation is 4.6. The mean injury severity score is 31.6. Sixty four percent underwent three-in-one protocol management. The overall survival rate at index hospital admission and at one year is 85.7% which is higher than the adult group (81%) from a study conducted at our centre and comparable to the rate in paediatric group. One patient had pelvic external fixator pin tract infection and two had lower limb ischemia post embolization. At 6 months follow up, one patient had pelvic pain and one had hip protrusio. We conclude that improvement in survival outcome also applies to the paediatric population. Technical differences in the paediatric group is highlighted to minimize potential complications.
Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial
Authors: Alaia Michael J. , Li Zachary I. , Chalem Isabel , Hurley Eoghan T. , Vasavada Kinjal , Gonzalez-Lomas Guillem , Rokito Andrew S. , Jazrawi Laith M. , Kaplan Kevin
Published: February 2024

Background:

Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes.

Purpose:

To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

Eligible patients had previously participated in a multicenter, placebo-controlled, randomized, double-blinded trial that evaluated the analgesic effects of CBD in the immediate postoperative period after ARCR. The experimental group received 25 mg of CBD 3 times/day if <80 kg and 50 mg of CBD 3 times/day if >80 kg for 14 days, with the control group receiving an identical placebo. The following outcomes were assessed at minimum 1-year follow-up: visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction. The rates of achievement of the Patient Acceptable Symptom State (PASS) were compared based on ASES at latest follow-up. Continuous and categorical variables were compared with the Mann-Whitney U test and Fisher exact test, respectively.

Results:

Follow-up was obtained from 83 of 99 patients (83.8%) who completed the original trial. There were no significant differences between the CBD and control groups with respect to age, sex, body mass index, rate of concomitant procedures, or number of anchors used intraoperatively. At 1-year follow-up, there were no significant differences between the CBD and control groups in VAS pain (0.8 vs 1.2, P = .38), ASES (93.0 vs 91.1, P = .71), SANE (87.6 vs 90.1, P = .24), or satisfaction (97.4 vs 95.4, P = .41). A majority of patients achieved the PASS (81.0% [CBD] vs 77.5% [control]; P = .79).

Conclusion:

Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome.

Registration:

NCT04672252 (ClinicalTrials.gov identifier).
How Does a Junior Faculty Development Program Affect Burnout? A Mixed Methods Assessment
Authors: Riley Timothy D , Parascando Jessica A , VanDyke Erika , Stuckey Heather L , Dong Huamei , Pasha-Razzak Omrana , Kass Lawrence E , McCall-Hosenfeld Jennifer , Bronson Sarah K
Published: February 2024

OBJECTIVES

Burnout is common among junior faculty. Professional development has been proposed as a method to improve engagement and reduce burnout among academic physicians. The Penn State College of Medicine Junior Faculty Development Program (JFDP) is a well-established, interdisciplinary program. However, an increase in burnout was noted among participants during the program. The authors sought to quantify the change in burnout seen among JFDP participants across 3 cohorts, and to explore sources of well-being and burnout among participants.

METHODS

Through a sequential explanatory mixed methods approach, participants in the 2018/19, 2019/20, and 2020/21 cohorts took a survey assessing burnout (Copenhagen Burnout Inventory), quality of life (QoL), job satisfaction, and work–home conflict at the start and end of the course. Descriptive statistics were generated as well as Pearson χ2 test/Fisher exact test for categorical variables and Wilcoxon rank sum tests for continuous variables for group comparisons. To better understand the outcome, past participants were invited to interviews regarding their experience of burnout during the course. Inductive thematic analysis (kappa = 0.86) was used to derive themes.

RESULTS

Start- and end-of-course surveys were completed by 84 and 75 participants, respectively (response rates: 95.5% and 85.2%). Burnout associated with patient/learner/client/colleague increased ( P = .005) and QoL decreased ( P = .02) at the end compared with the start. Nonsignificant trends toward worsening in other burnout categories, work–home conflict, and job satisfaction were also observed. Nineteen interviews yielded themes related to risks and protective factors for burnout including competing demands, benefits of networking, professional growth, and challenges related to diverse faculty roles.

CONCLUSION

Junior Faculty Development Program participants demonstrated worsening of burnout and QoL during the program while benefiting from opportunities including skill building and networking. The impact of Junior Faculty Development Programs on the well-being of participants should be considered as an element of their design, evaluation, and refinement over time.
Teaming in Graduate Medical Education: Ward Rounds and Beyond
Authors: Nataraj Neela , Tome June , Ratelle John T.
Published: February 2024

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.
Mixed convection flow of radiated Sutterby nanofluid by stretchable cylinder with irreversibility and heat generation
Authors: Rahman Mujeeb Ur , Haq Fazal , Abduvalieva Dilsora
Published: February 2024

Entropy generation has gained consideration of researchers due to its applications. Applications of entropy occur in chillers, desert collars, refrigerators, and all type of heat transfer devices. Due to vast range of applications of entropy, in this study irreversibility in Sutterby nanofluid flow by stretchable cylinder is discussed. While reporting momentum equation magnetic field and mixed convection effects are considered. Influences of radiation, Joule heating, and heat source are deliberated in the expression for thermal energy. Chemical reaction impact is taken in the modeling of concentration equation. Irreversibility for the considered flow is obtained by utilizing thermodynamics second law. Dimensional partial differential equations (PDEs) representing the flow are transformed to dimensionless ordinary differential equations(ODEs) through similarity transformations. Solution of ODEs is obtained via NDSolve code of Mathematica. Impact of flow parameters on velocity, entropy, temperature, Bejan number, and concentration are studied graphically. Engineering quantities are analyzed numerically. It is noticed through achieved results that velocity drops for higher magnetic variable while upsurges for higher curvature variable. Thermal field boosts for higher magnetic and heat source parameter. For rising diffusion and radiation variables entropy improves.
Effect of suprachoroidal triamcinolone on intraocular pressure: a systematic review and meta-analysis
Authors: Ghazanfar Altamash Shahriyar , Khowaja Aly Hamza , Tayyab Haroon
Published: February 2024

Background:

Triamcinolone acetonide is a synthetic corticosteroid with multiple ocular uses. Like other corticosteroids, it too is associated with ocular side effects such as increased intraocular pressure (IOP), glaucoma and cataracts. Suprachoroidal administration of triamcinolone is hoped to reduce the ocular side effects of the drug, especially rises in IOP. Our systematic review and meta-analysis aims to study this phenomenon.

Objectives:

The purpose of this study was to evaluate the effect of suprachoroidal triamcinolone injections on IOP.

Design:

Systematic review and meta-analysis

Methods:

We utilized the Medline, Scopus and Cochrane databases for this review. Studies published till June 2023, which fulfilled the eligibility criteria, were included. Studies in the English language with adult participants who were administered suprachoroidal triamcinolone without any concurrent intervention were included, whereas studies that did not report the mean and standard deviation for IOP were excluded. The outcome of interest was IOP at 1, 3 and 6 months post-suprachoroidal triamcinolone injection. IOP values from included studies were extracted onto Review Manager version 5.4 for analysis.

Results:

Our search yielded 104 results, from which 22 papers were shortlisted for full-text screening. Finally, 12 studies were included in the analysis. Our analysis suggests a statistically significant increase in IOP in the first month after suprachoroidal triamcinolone injection but no significant differences at 3 and 6 months post-injection as compared to baseline.

Conclusion:

Elevated IOP at 1 month post-injection must be considered when using suprachoroidal triamcinolone and adequate safety measures must be taken. However, the absence of a significant rise at 3 and 6 months post-injection indicates that this modality is safer than other existing drug delivery methods.

Trial registration:

Registered with the Research Registry with the unique identifying number ‘reviewregistry1656.’ https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/648eefe65b6523002995eb21/
The Impact of Participating in Surgical Trips to Low Income, Low Resource Countries on Professional Development of Plastic Surgery Trainees
Authors: Le Lamvy T. , Borad Vedant , Schubert Mia M. , Quillopa Naomi , Mahajan Ashish Y. , Heinrich Cherrie A. , Barta Ruth J. , Schubert Warren
Published: February 2024

Title: The impact of participating in surgical trips to low income, low resource countries on professional development of plastic surgery trainees. Objective: Global health initiatives have increased in popularity in recent years, yet international surgical volunteerism remains controversial. Though many U.S. residencies incorporate global health initiatives, there is no standardization of the role that surgical volunteerism plays in resident education. Our goal was to evaluate the impact of surgical volunteerism on former plastic surgery trainees during and after residency. Methods: An electronic survey was distributed to 35 graduates of the plastic surgery residency program at the University of Minnesota between 1991 and 2019. The survey included 28 yes/no questions and free responses. The response rate was 100% (n = 35). Results: 34 of 35 former graduates (97.1%) participated in at least one international surgical trip during residency. All participants had exposure to cleft surgery, and 82.4% reported a predominance of cleft cases. 23.5% of graduates have continued to perform cleft surgery as part of their practice, and 47.1% have continued to embark on surgical trips post-residency. Participants reported that volunteering on international surgical trips have made them more adaptable in the operating room (91.2%), gave them a better understanding of the challenges of poverty (97.1%), and helped them to provide better care for marginalized patients in low resource settings (70.6%). One hundred percent of participants reported that international surgical trips were an important part of their residency training (n = 34). Conclusions: International surgical volunteer work can provide an invaluable experience during training, and they should be offered by plastic surgery residency programs. Supporting resident involvement in surgical trips can have long term ramifications in their careers and commitment to helping the underserved.
Centrilobular emphysema and airway dysanapsis: factors associated with low respiratory function in younger smokers
Authors: Mochizuki Fumi , Tanabe Naoya , Shimada Takafumi , Iijima Hiroaki , Sakamoto Ryo , Shiraishi Yusuke , Maetani Tomoki , Shimizu Kaoruko , Suzuki Masaru , Chubachi Shotaro , Ishikawa Hiroichi , Naito Takashi , Kanasaki Megumi , Masuda Izuru , Oguma Tsuyoshi , Sato Susumu , Hizawa Nobuyuki , Hirai Toyohiro
Published: February 2024

Background

Low respiratory function in young adulthood is one of the important factors in the trajectory leading to the future development of COPD, but its morphological characteristics are not well characterised.

Methods

We retrospectively enrolled 172 subjects aged 40–49 years with ≥10 pack-years smoking history who underwent lung cancer screening by computed tomography (CT) and spirometry at two Japanese hospitals. Emphysema was visually assessed according to the Fleischner Society guidelines and classified into two types: centrilobular emphysema (CLE) and paraseptal emphysema (PSE). Airway dysanapsis was assessed with the airway/lung ratio (ALR), which was calculated by the geometric mean of the lumen diameters of the 14 branching segments divided by the cube root of total lung volume on a CT scan.

Results

Among the subjects, CLE and PSE were observed in 20.9% and 30.8%, respectively. The mean ALR was 0.04 and did not differ between those with and without each type of emphysema. Multivariable regression analysis models adjusted for age, sex, body mass index and smoking status indicated that CLE and a low ALR were independently associated with lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (estimate −1.64 (95% CI −2.68– −0.60) and 6.73 (95% CI 4.24–9.24), respectively) and FEV1% pred (estimate −2.81 (95% CI −5.10– −0.52) and 10.9 (95% CI 5.36–16.4), respectively).

Conclusions

CLE and airway dysanapsis on CT were independently associated with low respiratory function in younger smokers.
Ubiquitous protein lactylation in health and diseases
Authors: Wang Junyong , Wang Ziyi , Wang Qixu , Li Xiao , Guo Yaping
Published: February 2024

For decades, lactate has been considered a byproduct of glycolysis. The lactate shuttle hypothesis shifted the lactate paradigm, demonstrating that lactate not only plays important roles in cellular metabolism but also cellular communications, which can transcend compartment barriers and can occur within and among different cells, tissues and organs. Recently, the discovery that lactate can induce a novel post-translational modification, named lysine lactylation (Kla), brings forth a new avenue to study nonmetabolic functions for lactate, which has inspired a ‘gold rush’ of academic and commercial interest. Zhang et al. first showed that Kla is manifested in histones as epigenetic marks, and then mounting evidences demonstrated that Kla also occurs in diverse non-histone proteins. The widespread Kla faithfully orchestrates numerous biological processes, such as transcription, metabolism and inflammatory responses. Notably, dysregulation of Kla touches a myriad of pathological processes. In this review, we comprehensively reviewed and curated the existing literature to retrieve the new identified Kla sites on both histones and non-histone proteins and summarized recent major advances toward its regulatory mechanism. We also thoroughly investigated the function and underlying signaling pathway of Kla and comprehensively summarize how Kla regulates various biological processes in normal physiological states. In addition, we also further highlight the effects of Kla in the development of human diseases including inflammation response, tumorigenesis, cardiovascular and nervous system diseases and other complex diseases, which might potentially contribute to deeply understanding and interpreting the mechanism of its pathogenicity.

Graphical Abstract
Long-term follow-up of a healthy man with endogenous Streptococcus anginosus endophthalmitis
Authors: Sanchez Juan Martin , Davila Mauricio , Halpert Michael , Amer Radgonde
Published: February 2024

We report the long-term follow-up of an immunocompetent patient who presented with slowly progressive endogenous endophthalmitis secondary to Streptococcus anginosus. A 46-year-old healthy man presented with a two-month history of right eye iritis. On examination, visual acuity was 20/60 with intraocular pressure of 6 mm Hg. There was a small layer of hypopyon with non-granulomatous anterior uveitis and vitritis. On funduscopy, fluffy white peripheral retinal and pre-retinal lesions were noted in superonasal periphery. The patient denied any present or past illness. Diagnostic pars plana vitrectomy was performed. Culture and polymerase chain reaction of the vitreous sample were positive for Streptococcus anginosus. Intravitreal vancomycin and ceftazidime and systemic ceftriaxone were administered. Work-up which included blood and urine cultures, chest x-ray, echocardiography and abdominal ultrasound was unyielding. Subsequently and because of persistent post-infectious inflammatory reaction, intravitreal and oral steroids were administered in addition to oral azathioprine later on. After one year of follow-up, visual acuity was 20/20 with near vision of Jaeger 3 + and no signs of active uveitis were seen. Therefore, Streptococcus anginosus should be considered in the differential diagnosis of a slowly progressive endophthalmitis also in immunocompetent individuals.
The effects of short-term, progressive exercise training on disease activity in smouldering multiple myeloma and monoclonal gammopathy of undetermined significance: a single-arm pilot study
Authors: Emery A , Moore S , Crowe J , Murray J , Peacock O , Thompson D , Betts F , Rapps S , Ross L , Rothschild-Rodriguez D , Arana Echarri A , Davies R , Lewis R , Augustine DX , Whiteway A , Afzal Z , Heaney JLJ , Drayson MT , Turner JE , Campbell JP
Published: February 2024

Background

High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly investigated the effects on MGUS/SMM disease activity.

Methods

In this single-arm pilot study, N = 20 participants diagnosed with MGUS or SMM were allocated to receive a 16-week progressive exercise programme. Primary outcome measures were feasibility and safety. Secondary outcomes were pre- to post-exercise training changes to blood biomarkers of MGUS and SMM disease activity– monoclonal (M)-protein and free light chains (FLC)– plus cardiorespiratory and functional fitness, body composition, quality of life, blood immunophenotype, and blood biomarkers of inflammation.

Results

Fifteen (3 MGUS and 12 SMM) participants completed the exercise programme. Adherence was 91 ± 11%. Compliance was 75 ± 25% overall, with a notable decline in compliance at intensities > 70% V̇O2PEAK. There were no serious adverse events. There were no changes to M-protein (0.0 ± 1.0 g/L, P =.903), involved FLC (+ 1.8 ± 16.8 mg/L, P =.839), or FLC difference (+ 0.2 ± 15.6 mg/L, P =.946) from pre- to post-exercise training. There were pre- to post-exercise training improvements to diastolic blood pressure (− 3 ± 5 mmHg, P =.033), sit-to-stand test performance (+ 5 ± 5 repetitions, P =.002), and energy/fatigue scores (+ 10 ± 15%, P =.026). Other secondary outcomes were unchanged.

Conclusions

A 16-week progressive exercise programme was feasible and safe, but did not reverse MGUS/SMM disease activity, contrasting a prior case study showing that five years of exercise training reversed SMM in a 44-year-old former athlete. Longer exercise interventions should be explored in a group of MGUS/SMM patients, with measurements of disease biomarkers, along with rates of disease progression (i.e., MGUS/SMM to MM).

Registration

https://www.isrctn.com/ISRCTN65527208 (14/05/2018).
Maternal-fetal-neonatal microbiome and outcomes associated with prematurity
Authors: Silveira Rita C , Ting Joseph Y
Published: February 2024

Our understanding of the premature gut microbiome has increased rapidly in recent years. However, to advance this important topic we must further explore various aspects of the maternal microbiome, neonatal microbiota, and the opportunities for microbiome modulation. We invite authors to contribute research and clinical papers to the Collection “Maternal-fetal-neonatal microbiome and outcomes associated with prematurity”.
Noncommunicable diseases behavioural risk factors among secondary school adolescents in Urban Cameroon
Authors: Changoh Changoh Marvel , Tatah Lambed , Aroke Desmond , Nsagha Dickson , Choukem Simeon-Pierre
Published: February 2024

Adolescence is a crucial period for noncommunicable disease (NCD) risk factors, and interventions to reduce the NCD burden must target this age group. This study aimed to evaluate the NCD behavioural risk factors in adolescents attending state secondary schools in an urban setting in Cameroon. We conducted a cross-sectional survey using adapted structured questionnaires to assess the prevalence and correlates of NCD behavioural risk factors among adolescents attending selected urban state secondary schools in Douala IV, one of the six subdivisions in Douala, Cameroon. Of the 645 students who completed the study questionnaires, half of them did not have adequate knowledge about NCDs and their risk factors. Only 20% met recommended physical activity levels, nearly half lived sedentary lifestyles, and only 7% ate a healthy diet. Almost half of all participants reported drinking alcohol during the month, while 3% reported cigarette smoking. Participants with inadequate knowledge of NCDs were more likely to have elevated blood pressure values, and males had increased odds of high blood pressure. Contrarily, being male appeared to be protective against overweight and obesity. The odds of being sedentary decreased with age, and the odds of alcohol drinking seemed to grow with a higher maternal level of education. Our survey shows inadequate knowledge about NCDs and a high prevalence of NCD behavioural risk factors in adolescents in urban state secondary schools in Cameroon. These findings predict a higher NCD burden in future adults in the country, reinforcing the need for urgent public health interventions, especially regarding knowledge and sedentary living. Further research is needed to establish the transition of adolescent risk factors to adult disease through life course approaches in these settings.
Clinical application of combination [11C]C-methionine and [13N]N-ammonia PET/CT in recurrent functional pituitary adenomas with negative MRI or [18F]F-FDG PET/CT
Authors: Wang Zongming , Feng Zize , Zhu Dimin , Wang Xin , Chen Jinping , Zhu Yonghong , Wang Haijun
Published: February 2024

Background

We assessed the value of positron emission tomography/computed tomography (PET/CT) with [13N]N-ammonia ([13N]N-NH3) and [11C]C-methionine ([11C]C-MET) for the evaluation and management of recurrent secreting pituitary adenoma, which could not be detected by magnetic resonance imaging (MRI) or fluorine-18 fluorodeoxyglucose ([18F]F-FDG) PET.

Methods

Nine consecutive patients with biochemical and clinical evidence of active recurrent tumor not detected by MRI and [18F]F-FDG PET were enrolled in this study. All of the patients underwent [13N]N-NH3 and [11C]C-MET PET/CT, after which the pattern of tracer uptake was studied, the tumor position was located, and a clinical decision was made.

Results

In general, [11C]C-MET had a higher uptake in pituitary adenomas (PAs) than that in pituitary tissues, while [13N]N-NH3 had a higher uptake in pituitary tissue than in pituitary adenomas. Increased [11C]C-MET uptake was observed in all nine PAs and three pituitary tissues, while all pituitary tissues and only one pituitary adenoma showed increased [13N]N-NH3 uptake. Four patients had concordant imaging and surgical findings indicative of biochemical remission without hypopituitarism after treatment. Radiotherapy was adopted in two patients, medication in another two, and follow-up observation in one case.

Conclusion

Combined [11C]C-MET and [13N]N-NH3 PET/CT is effective in the differentiation of PAs from pituitary tissue in recurrent functional PAs with negative MRI or [18F]F-FDG PET. These results provide a valuable reference for further disease management.