bluuebunny/crossref_metadata_2025 huggingface dataset:
Balancing innovation and affordability in anti-obesity medications: the role of an alternative weight-maintenance program
Authors: Kim David D , Hwang Jennifer H , Fendrick A Mark
Published: May 2024

Despite remarkable clinical advances in highly effective anti-obesity medications, their high price and potential budget impact pose a major challenge in balancing equitable access and affordability. While most attention has been focused on the amount of weight loss achieved, less consideration has been paid to interventions to sustain weight loss after an individual stops losing weight. Using a policy simulation model, we quantified the impact of a weight-maintenance program following the weight-loss plateau from the initial full-dose glucagon-like peptide 1 (GLP-1) receptor agonists or incretin mimetic use. We measured long-term health care savings and the loss of some health benefits (eg, maintenance of weight loss, improvements in cardiometabolic risk factors, and reductions in diabetes and cardiovascular events). Our model suggested that, compared with continuous long-term full-dose GLP-1 receptor agonists or incretin mimetic drugs, the alternative weight-maintenance program would generate slightly fewer clinical benefits while generating substantial savings in lifetime health care spending. Using less expensive and potentially less effective alternative weight-maintenance programs may provide additional headroom to expand access to anti-obesity medications during the active weight-loss phase without increasing total health care spending.
Patterns of collateral arteries to the spinal cord after thoraco-abdominal aortic aneurysm repair
Authors: Saitoh Daiki , Yamazaki Yuya , Tsuji Tatsunori , Sakoda Naoya , Yakuwa Kazuki , Tabayashi Azuma , Koizumi Junichi , Ohsawa Satoshi , Kin Hajime
Published: May 2024

OBJECTIVES

Our goal was to evaluate postoperative patterns of collateral arteries to the spinal cord during occlusion of the segmental arteries supplying the artery of Adamkiewicz (AKA).

METHODS

Between April 2011 and December 2022, a total of 179 patients underwent thoraco-abdominal aortic aneurysm repair; 141 had an identifiable AKA on preoperative multidetector computed tomography scans, 40 underwent thoraco-abdominal aortic aneurysm replacement (TAAR) and 101 underwent thoracic endovascular aortic repair (TEVAR). New postoperative collateral blood pathways invisible on preoperative contrast-enhanced computed tomography scans were identified in 42 patients (10 patients who had TAAR vs 32 patients who had TEVAR) who underwent preoperative and postoperative multidetector computed tomography scanning for AKA identification.

RESULTS

The thoracodorsal and segmental arteries were the main collateral pathways in both groups. Th9-initiated collaterals were the most common. Collaterals from the internal thoracic artery were observed in the TEVAR group but not in the TAAR group. One patient in the TEVAR group experienced postoperative paraparesis, which was not observed in the TAAR group. Postoperative paraplegia was more common in the non-Th9-origin group, but this difference was not significant.

CONCLUSIONS

Thoracodorsal and segmental arteries may be important collateral pathways after TEVAR and TAAR. For thoracodorsal arteries, preserving the thoracodorsal muscle during the approach would be crucial; for segmental arteries, minimizing the area to be replaced or covered would be paramount. An AKA not initiated at the Th9 level poses a high risk of postoperative paraplegia.
Multicentre experience of sutureless prostheses inside degenerated stentless aortic valves and bioroots
Authors: Bakhtiary Farhad , Silaschi Miriam , El-Sayed Ahmad Ali , Salamate Saad , Meuris Bart
Published: May 2024

OBJECTIVES

Patients with failed stentless aortic prostheses are a challenging population to treat, as reoperative procedures may be complex and catheter-based treatments are associated with a high rate of procedural events. Reoperative surgery using sutureless valves may be an alternative.

METHODS

In this multicentre experience, we assess outcomes of 17 patients who underwent reoperative surgery using the Perceval valve (Corcym UK Limited, London, UK) inside Freestyle prosthesis (Medtronic Inc., Dublin, Ireland) or bioroots from 2018 to 2023.

RESULTS

Mean age was 71.1 ±  standard deviation 15.1 years and mean EuroSCORE II was 13.5 ± 15.8%, Society of Thoracic Surgeons Score was 5.9 ± 11.7%. Mean transvalvular gradient at baseline was 25.3 ± 19.9 mmHg and left ventricular ejection fraction was 53.5 ±  standard deviation 8.5%. In 70.6% (12/17), moderate or severe aortic regurgitation was present. Implant success was 100%. Aortic cross-clamp time was 44.5 ±  standard deviation 23.6 min. No patient needed a pacemaker and no mild paravalvular regurgitation occurred. Mean gradient was 12.5 ± 4.7 mmHg; 30-day mortality was 5.9% (1/17).

CONCLUSIONS

Rate of mortality was lower than predicted by EuroSCORE II in these high-risk patients and haemodynamic outcomes were favourable. Heart teams should consider this treatment concept when discussing patients with failed stentless valves or bioroots.
Multidrug-Resistant Organisms: The Silent Plight of Burn Patients
Authors: Elsheikh Randa , Makram Abdelrahman M
Published: May 2024

The global increasing spread of multidrug-resistant organisms (MDROs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is patients with burns, who are prone to hyperinfection as they suffer from a hypermetabolic state and weaken immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, we discuss consensuses here. In this review, we aim to present the current knowledge on multidrug resistance with a special focus on patients with burns, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.
HSD17B13 liquid–liquid phase separation promotes leukocyte adhesion in chronic liver inflammation
Authors: Ye Jing , Huang Xiyu , Yuan Manman , Wang Jinglin , Jia Ru , Wang Tianyi , Tan Yang , Zhu Shun , Xu Qiang , Wu Xingxin
Published: May 2024

The rs72613567:TA polymorphism in 17-beta hydroxysteroid dehydrogenase 13 (HSD17B13) has been found to reduce the progression from steatosis to metabolic dysfunction-associated steatohepatitis (MASH). In this study, we sought to define the pathogenic role of HSD17B13 in triggering liver inflammation. Here, we demonstrate that HSD17B13 forms liquid–liquid phase separation (LLPS) around lipid droplets in the livers of MASH patients. The dimerization of HSD17B13 supports the LLPS formation and promotes its enzymatic function. HSD17B13 LLPS increases the biosynthesis of platelet activating factor (PAF), which in turn promotes fibrinogen synthesis and leukocyte adhesion. Blockade of the PAF receptor or STAT3 pathway inhibits the fibrinogen synthesis and leukocyte adhesion. Importantly, adeno-associated viral-mediated xeno-expression of human HSD17B13 exacerbates western diet/carbon tetrachloride-induced liver inflammation in Hsd17b13−/− mice. In conclusion, our results suggest that HSD17B13 LLPS triggers liver inflammation by promoting PAF-mediated leukocyte adhesion, and targeting HSD17B13 phase transition could be a promising therapeutic approach for treating hepatic inflammation in chronic liver disease.
Young metal-rich stars in the halo of M82: a tidal dwarf galaxy?
Authors: Suwannajak Chutipong , Sarajedini Ata
Published: May 2024

We present Hubble Space Telescope Advanced Camera for Surveys photometry of an arc structure of stars in the southern halo of M82. The structure is located at a projected height of ≈5 kpc from the disc of M82 but its stellar content exhibits a younger mean age than that of typical halo stars. We measured the distance, mean age, and peak metallicity of the stars in the arc and used them to determine the structure’s origin. The arc colour–magnitude diagram yields a tip of the red giant branch (RGB) distance of 3.63 ± 0.08 Mpc, similar to that of M82, confirming its association with the galaxy. The colour–magnitude diagram also reveals a population of predominantly young stars with a mean age of ≈100–160 Myr, which is similar to that of the young stars formed in the tidal debris between M81, M82, and NGC 3077. We derived the mean metallicity of the halo stars surrounding the arc to be [Fe/H] ≈ −1.0, similar to that of the RGB population of the halo of M81. The RGB stars in the arc, while they are slightly more metal-rich than the halo RGB, show no spatial correlation with the young stars, suggesting that the arc is consists of mainly young stellar population. Furthermore, the observed age gradient along the structure of the arc indicates that the arc began forming from the closer side to M82, then moving outward. Taken together, the results suggest that the formation of the young stars that give rise to the arc structure could have been triggered by the interactions between M82’s southern outflow and the H i gas clouds surrounding it, representing a snapshot of a tidal dwarf galaxy in the process of forming.
A brain metastasis liquid biopsy: Where are we now?
Authors: Robinson Stephen David , de Boisanger James , Pearl Frances M G , Critchley Giles , Rosenfelder Nicola , Giamas Georgios
Published: May 2024

Brain metastases remain a challenging and feared complication for patients with cancer and research in this area has lagged behind research into metastases to other organs. Due to their location and the risks associated with neurosurgical biopsies, the biology underpinning brain metastases response to treatment and evolution over time remains poorly understood. Liquid biopsies are proposed to overcome many of the limitations present with tissue biopsies, providing a better representation of tumor heterogeneity, facilitating repeated sampling, and providing a noninvasive assessment of tumor biology. Several different liquid biopsy approaches have been investigated including circulating tumor cells, circulating tumor DNA, extracellular vesicles, and tumor-educated platelets; however, these have generally been less effective in assessing brain metastases compared to metastases to other organs requiring improved techniques to investigate these approaches, studies combining different liquid biopsy approaches and/or novel liquid biopsy approaches. Through this review, we highlight the current state of the art and define key unanswered questions related to brain metastases liquid biopsies.
Trends in Daily Cigarette Consumption Among Smokers: A Population Study in England, 2008–2023
Authors: Jackson Sarah E , Tattan-Birch Harry , Buss Vera , Shahab Lion , Brown Jamie
Published: May 2024

Introduction

This study aimed to estimate time trends in cigarette consumption among smokers in England between 2008 and 2023 and to explore differences by key potential moderators.

Aims and Methods

We used data from 57 778 adult cigarette smokers participating in a nationally representative monthly cross-sectional survey between January 2008 and September 2023. We estimated monthly time trends in mean daily consumption of (1) any, (2) manufactured, and (3) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status.

Results

Overall cigarette consumption fell from 13.6 [95% CI = 13.3 to 13.9] to 10.6 [10.5 to 10.8] per day between January 2008 and October 2019 (a 22% decrease), then remained stable up to September 2023. Over this period, the proportion mainly or exclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1%–32.1%] in 2008 to 52.1% [49.7%–54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2–9.8] per day in January 2008 to 5.0 [4.7–5.3] in September 2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9–4.4] to 5.6 [5.3–5.9], respectively. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped.

Conclusions

Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October 2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco.

Implications

While average cigarette consumption in England has fallen over the past 15 years, this declining trend has stalled (and reversed in some population groups) since 2019. The availability of cheap, hand-rolled tobacco appears to be undermining policies that aim to reduce smoking by raising the price of tobacco (eg, through taxation) and could be targeted to reignite the decline in cigarette consumption.
Development and Psychometric Evaluation of a Novel Measure of Nicotine E-cigarette Withdrawal for Use With Adolescents and Young Adults
Authors: Morean Meghan E , Rajeshkumar Lavanya , Krishnan-Sarin Suchitra
Published: May 2024

Introduction

Nicotine withdrawal is a well-established construct that prompts continued nicotine product use and contributes to failed cessation efforts. Despite ongoing public health concerns about nicotine e-cigarette use in adolescents and young adults (AYAs), no psychometrically sound measure of nicotine e-cigarette withdrawal exists for this population.

Aims and Methods

A mixed methods approach comprising a literature review to identify existing nicotine withdrawal items; subject matter expert feedback on existing items and novel item generation; cognitive interviews assessing the measure’s instructions, items, and response options; and a large quantitative validation survey (N = 997) was employed to develop the novel retrospective measure of nicotine e-cigarette withdrawal.

Results

A 25-item solution comprising four subscales—negative affect, negative physical symptoms, craving, and appetite/food—and an overall withdrawal score was supported. Internal reliability was excellent (mean alpha = 0.91), and scalar measurement invariance was reached for all subgroups tested (eg, sex, age, exclusive e-cigarette use vs. dual tobacco product use, and daily vs. non-daily nicotine vaping). Overall withdrawal and its subscales evidenced concurrent validity with time to first vape in the morning, e-cigarette dependence, and previous vaping cessation attempts, although not each subscale was associated with each outcome. Importantly, cross-sectional incremental validity analyses indicated that retrospective withdrawal accounted for variance in each outcome above and beyond e-cigarette dependence.

Conclusions

The novel retrospective AYA Nicotine E-cigarette Withdrawal Scale (AYA NEWS) evidenced strong psychometric properties for use in this population. Future research can determine whether the AYA NEWS can be used to assess acute e-cigarette nicotine withdrawal.

Implications

While e-cigarette use remains the most prevalent form of nicotine product use among AYAs, there are limited options for psychometrically sound measures of e-cigarette-related constructs in this population. Withdrawal from nicotine is associated with failed cessation attempts and continued use of nicotine-containing products, making it a critical construct within tobacco-related research. This study outlines the development and preliminary psychometric evaluation of a novel, retrospective measure of nicotine e-cigarette withdrawal. Study findings support using the Adolescent and Young Adult Nicotine E-cigarette Withdrawal Scale (NEWS) to assess retrospective withdrawal from nicotine e-cigarettes in young people.
Epidemiological anomaly detection in Philippine public health surveillance data through Newcomb-Benford analysis
Authors: Parreño Samuel John E
Published: May 2024

Background

Public health surveillance is vital for monitoring and controlling disease spread. In the Philippines, an effective surveillance system is crucial for managing diverse infectious diseases. The Newcomb-Benford Law (NBL) is a statistical tool known for anomaly detection in various datasets, including those in public health.

Methods

Using Philippine epidemiological data from 2019 to 2023, this study applied NBL analysis. Diseases included acute flaccid paralysis, diphtheria, measles, rubella, neonatal tetanus, pertussis, chikungunya, dengue, leptospirosis and others. The analysis involved Chi-square tests, Mantissa Arc tests, Mean Absolute Deviation (MAD) and Distortion Factor calculations.

Results

Most diseases exhibited nonconformity to NBL, except for measles. MAD consistently indicated nonconformity, highlighting potential anomalies. Rabies consistently showed substantial deviations, while leptospirosis exhibited closer alignment, especially in 2021. Annual variations in disease deviations were notable, with acute meningitis encephalitis syndrome in 2019 and influenza-like illness in 2023 having the highest deviations.

Conclusions

The study provides practical insights for improving Philippine public health surveillance. Despite some diseases showing conformity, deviations suggest data quality issues. Enhancing the PIDSR, especially in diseases with consistent nonconformity, is crucial for accurate monitoring and response. The NBL’s versatility across diverse domains emphasizes its utility for ensuring data integrity and quality assurance.
Interstitial fibrosis increases the risk of end-stage kidney disease in patients with lupus nephritis
Authors: Sun Yi-Syuan , Huang De-Feng , Chang Fu-Pang , Chen Wei-Sheng , Liao Hsien-Tzung , Chen Ming-Han , Tsai Hung-Cheng , Tsai Ming-Tsun , Tsai Chang-Youh , Lai Chien-Chih , Yang Chih-Yu
Published: May 2024

Objective

To evaluate the risk of end-stage kidney disease (ESKD) in LN patients using tubulointerstitial lesion scores.

Methods

Clinical profiles and histopathological presentations of 151 biopsy-proven LN patients were retrospectively examined. Risk factors of ESKD based on characteristics and scoring of their tubulointerstitial lesions [e.g. interstitial inflammation (II), tubular atrophy (TA) and interstitial fibrosis (IF)] were analysed.

Results

The mean age of 151 LN patients was 36 years old, and 136 (90.1%) were female. The LN cases examined included: class I/II (n = 3, 2%), class III/IV (n = 119, 78.8%), class V (n = 23, 15.2%) and class VI (n = 6, 4.0%). The mean serum creatinine level was 1.4 mg/dl. Tubulointerstitial lesions were recorded in 120 (79.5%) patients. Prior to receiving renal biopsy, nine (6.0%) patients developed ESKD. During the follow-up period (mean, 58 months), an additional 47 patients (31.1%) progressed to ESKD. Multivariate analyses identified serum creatinine [hazard ratio (HR): 1.7, 95% CI: 1.42–2.03, P < 0.001] and IF (HR: 3.2, 95% CI: 1.58–6.49, P = 0.001) as independent risk factors of ESKD. Kaplan–Meier analysis further confirmed a heightened risk of ESKD associated with IF.

Conclusion

Tubulointerstitial involvement is commonly observed in the histopathological presentation of LN. However, IF, rather than II or TA, was found to increase the risk of ESKD in our cohort. Therefore, to predict renal outcome in LN patients prior to adjusting immunosuppressive treatment, the degree of IF should be reviewed.
Transformational Leadership, Secondary Traumatic Stress, and Burnout of Child Welfare Workers: Multilevel Moderation Effects
Authors: Park Tae Kyung , Kim Jangmin , Pierce Barbara , Lee Hyunji
Published: May 2024

This study examines the moderating effects of distant leader’s practice of transformational leadership on the relationship between secondary traumatic stress (STS) and burnout among child welfare workers. Caseworkers and supervisors in a Midwest U.S. state (N = 210) rated their regional director’s use of transformational leadership skills using a survey. Given the nature of the clustered data, multilevel modeling was employed to examine the main effects of transformational leadership on worker burnout and its cross-level interaction effect on the association between worker STS and burnout. Multilevel modeling demonstrated that worker burnout was positively associated with STS and negatively associated with organizational-level transformational leadership. The cross-level interaction between transformational leadership and STS was significant. Specifically, the positive association between workers’ STS and burnout decreased as transformational leadership increased. These findings suggest that organizational approaches such as transformational leadership can influence workforce results. Further research will guide child welfare policymakers to develop more sophisticated training programs in leadership skills and strategies.
Effects of zinc supplementation and implant abscess on the immune system and growth performance of growing beef steers
Authors: Rients Emma , Franco Carlos , Diaz Fabian , McGill Jodi , Hansen Stephanie
Published: May 2024

Seventy-two Angus-cross steers (261 ± 14 kg) were utilized to determine the effects of supplemental Zn sulfate on growth, trace mineral status, circulating immune cells, and functional innate immune responses. Steers were stratified by weight and implanted with a Component E-S with Tylan implant (Elanco Animal Health, Greenfield, IN) on day 0. Dietary treatments included: control (CON; no supplemental Zn), Zn100 (100 mg supplemental Zn/kg DM), and Zn150 (150 mg supplemental Zn/kg DM). Analyzed dietary concentrations of Zn were 58, 160, and 207 mg Zn/kg DM, respectively. On days 13 and 57, blood from nine steers per treatment was collected for immune analyses (cell phenotyping and response to stimulus). On day 16, implant abscesses were evaluated by palpation and visual appraisal. Sixty percent of steers had abscesses; however, there were no differences in abscess prevalence due to treatment (P = 0.67). Data were analyzed as a split-plot design using the Mixed procedure of SAS 9.4 (Cary, NC) with effects of dietary treatment, abscess, and their interaction. There was a tendency (treatment × abscess; P ≤ 0.09) for steers without abscesses to have greater average daily gain (ADG; treatment × abscess P = 0.06) and gain:feed (G:F; treatment × abscess P = 0.09) from d 14 to 27 in CON and Zn100 while within Zn150 steers without abscesses tended to have lesser ADG and G:F than abscessed steers. There were no other treatment × abscess effects for growth performance, but steers with abscesses tended to have decreased final body weight (P = 0.10) and overall G:F (days 0 to 57; P = 0.08). There was no interaction of treatment and abscess on immune cell populations on days 13 or 58 (treatment × abscess P ≥ 0.11). On day 13, Zn150 steers had increased CD45RO + gamma delta (P = 0.04) T cells. Abscessed steers had increased CD21 + B cells (P = 0.03) and tended to have increased CD21 + (P = 0.07) and CD21 + MHCIIhi (P = 0.07) B cells in circulation. This study shows zinc supplementation and implant abscesses can alter the immune system and growth performance of growing beef steers.
Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship
Authors: Alex Capri P. , Fromme H. Barrett , Greenberg Larrie , Ryan Michael S. , Gustafson Sarah , Neeley Maya K. , Nunez Shaughn , Rideout Molly E. , VanNostrand Jessica , Orlov Nicola M.
Published: May 2024

Purpose

Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions.

Method

This multimethod study was performed at 6 U.S.-based institutions from March to October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses.

Results

Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]).

Conclusions

This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.
Academic Medicine and Rural Health System Partnerships: Enhancing Education While Advancing Physician Workforce Priorities
Authors: Hawes Emily M. , Rodefeld Lori , Weinstein Debra F.
Published: May 2024

A worsening shortage of rural physicians paralleling increasing health disparities demands attention. Past and ongoing efforts to address this shortage have had positive effects and can inform new strategies to achieve even greater impact. Interventions have included the development of regional medical school campuses and rural-focused tracks to recruit medical students from rural areas, expansion of rural-based graduate medical education (GME) programs and tracks, and use of institutional and individual financial incentives for rural-based training and/or practice. National policy has also taken aim at this challenge with provisions aimed at expanding rural GME in the Medicare, Medicaid, and State Children’s Health Insurance Program Balanced Budget Refinement Act of 1999 and the Consolidated Appropriations Act of 2021. Additionally, several states have funded growth in GME, and supportive pathways for Medicare reimbursement and for Veterans Administration funding have been implemented. The authors recommend a new strategy for bolstering the rural physician workforce, focused on using academic-rural partnerships to incorporate rural rotations as a routine part of GME. They explain how the current health care landscape supports this approach and outline additional steps toward implementation. Centralized data collection and analysis are noted as essential to guide future efforts.
Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease
Authors: Brahmania Mayur , Rogal Shari , Serper Marina , Patel Arpan , Goldberg David , Mathur Amit , Wilder Julius , Vittorio Jennifer , Yeoman Andrew , Rich Nicole E. , Lazo Mariana , Kardashian Ani , Asrani Sumeet , Spann Ashley , Ufere Nneka , Verma Manisha , Verna Elizabeth , Simpson Dinee , Schold Jesse D. , Rosenblatt Russell , McElroy Lisa , Wadhwani Sharad I. , Lee Tzu-Hao , Strauss Alexandra T. , Chung Raymond T. , Aiza Ignacio , Carr Rotonya , Yang Jin Mo , Brady Carla , Fortune Brett E.
Published: May 2024

Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.
Remote Topography-Guided Transepithelial Photorefractive Combined Phototherapeutic Keratectomy Telesurgery
Authors: Alessio Giovanni , Puzo Pasquale , Di Pardo Camilla , Sborgia Alessandra , D'Oria Francesco
Published: May 2024

Purpose.

The purpose of this study was to report the first remote telesurgery in a case of epithelial basement membrane disease with recurrent corneal erosions.

Methods.

Topography-guided transepithelial photorefractive combined phototherapeutic keratectomy (PRK-PTK) is a surgical option that treats corneal irregularities and prevents the recurrences of erosions while treating the refractive error.

Results.

We performed for the first time a remote transepithelial topography-guided combined PRK-PTK using the iRes®2 excimer laser platform (iVIS Technologies, Taranto, Italy), with the surgeon sitting in his own room and controlling the excimer laser in remote with 5G connection through the Remote Control Station and the patient in the operating room. At one-month post-operative, visual acuity was 20/20 and the patient's symptoms subsided.

Conclusions.

Our surgery opens the era of telesurgery in the corneal panorama.
Improving First Case Operating Room Efficiency
Authors: Afford Rebecca , Chan Megan , Garelnabi Rana , Ali Akbari Fariba Haji , Wiseman Sam M.
Published: May 2024

Introduction:

Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR.

Methods:

A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB.

Results:

After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results.

Conclusions:

Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR.
Rotator Cuff Tendinopathy: Pathways of Apoptosis
Authors: Worsfold Sophie I. , Carter Kristyn , Akbar Moeed , Hackett Lisa , Millar Neal L. , Murrell George A.C.
Published: May 2024

Rotator cuff repair is usually successful, but retear is not uncommon. It has been previously identified that there is a higher incidence of apoptosis in the edges of the torn supraspinatus tendon. A prospective cohort study was conducted with 28 patients—14 rotator cuff tear patients, 5 instability patients, and 9 Anterior cruciate ligament reconstruction patients to determine whether there was any increase in several genes implicated in apoptosis, including Fas receptor (FasR), Fas ligand, Aifm-1, Bcl-2, Fadd, Bax, and caspase-3. There was a significant expression of Bax (P=0.2) and FasR (P=0.005) in the edges of torn supraspinatus tendons, and in intact subscapularis tendons, there was a significant expression of caspase-3 (P=0.02) compared with samples from the torn supraspinatus tendon (P=0.04). The cytochrome c pathway, with its subsequent activation of caspase-3, as well as the TRAIL-receptor signaling pathway involving FasR have both been implicated. The elevated expression of Bax supported the model that the Bax to Bcl-2 expression ratio represents a cell death switch. The elevated expression of Bax in the intact subscapularis tissue from rotator cuff tear patients also may confirm that tendinopathy is an ongoing molecular process.
Herpes simplex (HSV-1) encephalitis in an infant: a case report study
Authors: Hosseini Parmis Sadat , Golfiroozi Saeed , Hosseini Parnian Sadat , Ghelichi-Ghojogh Mousa , Delavari Sahar , Hosseini Seyed Ahmad
Published: May 2024

Introduction and importance:

The herpes simplex virus (HSV) is the most common cause of acute sporadic encephalitis, a severe and often fatal disease in humans. It is associated with high mortality and morbidity rates in untreated patients.

Case presentation:

An 11-month-old child was admitted to the hospital presenting with acute fever and seizures characterized by staring episodes and spastic movements affecting the left side of the body. Diagnostic workup revealed abnormal T2 flair hyperintense foci in bi-temporoparietal lobes and right thalamus, and bilateral otomastoiditis were detected. A positive result for HSV-1 was obtained through HSV type 1/2 polymerase chain reaction (PCR) testing, leading to a diagnosis of herpes encephalitis.

Clinical discussion:

While acyclovir has proven to be an effective therapeutic option, mortality and neurological sequelae continue to be reported in a notable fraction of patients. HSV encephalitis is mainly caused by two strains of the herpes simplex virus: HSV-1, more frequently observed in children and adults, and HSV-2, commonly seen in neonates and those with compromised immune systems. MRI scans often reveal that the brain lesions are localized to certain areas, although temporal involvement may not always be evident. The symptoms of herpetic encephalitis can greatly vary, making early diagnosis and treatment vital for improving patient outcomes.

Conclusion:

This case report highlights the clinical presentation, diagnostic challenges, and treatment strategies for HSV-1 encephalitis and underscores the importance of early recognition and prompt initiation of antiviral therapy in suspected cases of HSV-1 encephalitis.
Supported Privacy: An Essential Principle for End-of-Life Care for Children and Families in the PICU
Authors: Butler Ashleigh E. , Pasek Tracy A. , Clark Tara-Jane , Broden Elizabeth G.
Published: May 2024

Caring for children and their families at the end-of-life is an essential but challenging aspect of care in the PICU. During and following a child’s death, families often report a simultaneous need for protected privacy and ongoing supportive presence from staff. Balancing these seemingly paradoxical needs can be difficult for PICU staff and can often lead to the family feeling intruded upon or abandoned during their end-of-life experience. In this “Pediatric Critical Care Medicine Perspectives” piece, we reframe provision of privacy at the end-of-life in the PICU and describe an essential principle that aims to help the interprofessional PICU team simultaneously meet these two opposing family needs: “Supported Privacy.” In addition, we offer concrete recommendations to actualize “Supported Privacy” in the PICU, focusing on environmental considerations, practical needs, and emotional responses. By incorporating the principles of “Supported Privacy” into end-of-life care practices, clinicians can support the delivery of high-quality care that meets the needs of children and families navigating the challenges and supports of end-of-life in the PICU.
Automated Calculator for the Pediatric Sequential Organ Failure Assessment Score: Development and External Validation in a Single-Center 7-Year Cohort, 2015–2021
Authors: Akhondi-Asl Alireza , Luchette Matthew , Mehta Nilesh M. , Geva Alon
Published: May 2024

OBJECTIVES:

The pediatric Sequential Organ Failure Assessment (pSOFA) score summarizes severity of organ dysfunction and can be used to predict in-hospital mortality. Manual calculation of the pSOFA score is time-consuming and prone to human error. An automated method that is open-source, flexible, and scalable for calculating the pSOFA score directly from electronic health record data is desirable.

DESIGN:

Single-center, retrospective cohort study.

SETTING:

Quaternary 40-bed PICU.

PATIENTS:

All patients admitted to the PICU between 2015 and 2021 with ICU stay of at least 24 hours.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We used 77 records to evaluate the automated score. The automated algorithm had an overall accuracy of 97%. The algorithm calculated the respiratory component of two cases incorrectly. An expert human annotator had an initial accuracy of 75% at the patient level and 95% at the component level. An untrained human annotator with general clinical research experience had an overall accuracy of 16% and component-wise accuracy of 67%. Weighted kappa for agreement between the automated method and the expert annotator’s initial score was 0.92 (95% CI, 0.88–0.95), and between the untrained human annotator and the automated score was 0.50 (95% CI, 0.36–0.61). Data from 9146 patients (in-hospital mortality 3.6%) were included to validate externally the discriminability of the automated pSOFA score. The admission-day pSOFA score had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77–0.82).

CONCLUSIONS:

The developed automated algorithm calculates pSOFA score with high accuracy and is more accurate than a trained expert rater and nontrained data abstracter. pSOFA’s performance for predicting in-hospital mortality was lower in our cohort than it was for the originally derived score.
Respiratory Displacement of the Right Adrenal Vein: Comparison of Inspiratory and Expiratory Computed Tomography With Catheter Venography
Authors: Hara Junko , Ishii Shiro , Tanabe Hayato , Yamakuni Ryo , Suenaga Hiroki , Kono Teruyuki , Kuroiwa Daichi , Sekino Hirofumi , Shimabukuro Michio , Ito Hiroshi
Published: May 2024

Objective

The aim of the study is to reveal the respiratory displacement of the right adrenal vein (RAV) to predict the exact location of the RAV during adrenal venous sampling (AVS).

Methods

Computed tomography (CT) scans obtained 45 seconds (breath-hold at inhalation) and 70 seconds (breath-hold at exhalation) after contrast material injection were compared to venograms of the RAV of patients with primary aldosteronism who underwent AVS between January 2016 and December 2020. The craniocaudal distance between the center of the Th11/12 disc and the RAV orifice was measured; the craniocaudal location of the RAV orifice was also specified relative to vertebral bodies and intervertebral discs on inspiratory phase CT (In-CT), expiratory phase CT (Ex-CT), and catheter venography. The transverse and vertical angles of the RAV and the position of the RAV orifice on the inferior vena cava (IVC) circumference were measured on In-CT and Ex-CT.

Results

In total, 51 patients (30 males, 21 females; mean age, 54.9 ± 11.1 years) were included. Craniocaudal distances between the center of the Th11/12 disc and RAV orifice were significantly different among the following 3 acquisitions: catheter venography versus In-CT (15.2 ± 8.4 mm); venography versus Ex-CT (5.6 ± 4.1 mm); and In-CT versus Ex-CT (19.6 ± 8.0 mm) (all, P < 0.001). The craniocaudal location of the RAV orifice on venography was significantly closer to that on Ex-CT than on In-CT (P < 0.001); measurements using venograms compared with In-CT and Ex-CT scans were within 1 level difference in 18 (35.3%) and 47 (92.2%) patients, respectively (P < 0.001). The vertical angle of the RAV was significantly more likely to be smaller on In-CT than on Ex-CT (P < 0.001).

Conclusions

RAV locations and angles change with respiratory motion. It is crucial to consider the respiratory phase of CT because it can enable a more accurate prediction of the location of the RAV during AVS.
Cortical Lesions as an Early Hallmark of Multiple Sclerosis: Visualization by 7 T MRI
Authors: Durozard Pierre , Maarouf Adil , Zaaraoui Wafaa , Stellmann Jan-Patrick , Boutière Clémence , Rico Audrey , Demortière Sarah , Guye Maxime , Le Troter Arnaud , Dary Hugo , Ranjeva Jean-Philippe , Audoin Bertrand , Pelletier Jean
Published: May 2024

Objectives

Compelling evidence indicates a significant involvement of cortical lesions in the progressive phase of multiple sclerosis (MS), significantly contributing to late-stage disability. Despite the promise of ultra-high-field magnetic resonance imaging (MRI) in detecting cortical lesions, current evidence falls short in providing insights into the existence of such lesions during the early stages of MS or their underlying cause. This study delineated, at the early stage of MS, (1) the prevalence and spatial distribution of cortical lesions identified by 7 T MRI, (2) their relationship with white matter lesions, and (3) their clinical implications.

Materials and Methods

Twenty individuals with early-stage relapsing-remitting MS (disease duration <1 year) underwent a 7 T MRI session involving T1-weighted MP2RAGE, T2*-weighted multiGRE, and T2-weighted FLAIR sequences for cortical and white matter segmentation. Disability assessments included the Expanded Disability Status Scale, the Multiple Sclerosis Functional Composite, and an extensive evaluation of cognitive function.

Results

Cortical lesions were detected in 15 of 20 patients (75%). MP2RAGE revealed a total of 190 intracortical lesions (median, 4 lesions/case [range, 0–44]) and 216 leukocortical lesions (median, 2 lesions/case [range, 0–75]). Although the number of white matter lesions correlated with the total number of leukocortical lesions (r = 0.91, P < 0.001), no correlation was observed between the number of white matter or leukocortical lesions and the number of intracortical lesions. Furthermore, the number of leukocortical lesions but not intracortical or white-matter lesions was significantly correlated with cognitive impairment (r = 0.63, P = 0.04, corrected for multiple comparisons).

Conclusions

This study highlights the notable prevalence of cortical lesions at the early stage of MS identified by 7 T MRI. There may be a potential divergence in the underlying pathophysiological mechanisms driving distinct lesion types, notably between intracortical lesions and white matter/leukocortical lesions. Moreover, during the early disease phase, leukocortical lesions more effectively accounted for cognitive deficits.
Contemporary diagnosis and management of mild TBI (concussions): What you need to know
Authors: Panzera Joseph C. , Podolak Olivia E. , Master Christina L.
Published: May 2024

Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on the importance of timely identification and diagnosis, as well as the early initiation of active management of pediatric concussion immediately after injury through recovery. This approach involves the application of targeted therapies for specific deficits identified after concussion, addressing the individual pattern of symptoms experienced by patients following concussion. We will review what is known about the underlying pathophysiology that drives the clinical manifestations of concussion, the targeted clinical assessments that can both aid in the diagnosis of concussion, as well as drive the active rehabilitation of deficits seen after concussion. The standardized approach to the return to activities will also be described, including return to learning and sports.
A deep phenotyping study in mouse and iPSC models to understand the role of oligodendroglia in optic neuropathy in Wolfram syndrome
Authors: Ahuja K. , Vandenabeele M. , Nami F. , Lefevere E. , Van hoecke J. , Bergmans S. , Claes M. , Vervliet T. , Neyrincki K. , Burg T. , De Herdt D. , Bhaskar P. , Zhu Y. , Looser Z. J. , Loncke J. , Gsell W. , Plaas M. , Agostinis P. , Swinnen J.V. , Van Den Bosch L. , Bultynck G. , Saab A. S. , Wolfs E. , Chai Y.C. , Himmelreich U. , Verfaillie C. , Moons L. , De Groef L.
Published: May 2024

Wolfram syndrome (WS) is a rare childhood disease characterized by diabetes mellitus, diabetes insipidus, blindness, deafness, neurodegeneration and eventually early death, due to autosomal recessive mutations in theWFS1(andWFS2) gene. While it is categorized as a neurodegenerative disease, it is increasingly becoming clear that other cell types besides neurons may be affected and contribute to the pathogenesis. MRI studies in patients and phenotyping studies in WS rodent models indicate white matter/myelin loss, implicating a role for oligodendroglia in WS-associated neurodegeneration. In this study, we sought to determine if oligodendroglia are affected in WS and whether their dysfunction may be the primary cause of the observed optic neuropathy and brain neurodegeneration. We demonstrate that 7.5-month-oldWfs1Δexon8mice display signs of abnormal myelination and a reduced number of oligodendrocyte precursor cells (OPCs) as well as abnormal axonal conduction in the optic nerve. An MRI study of the brain furthermore revealed grey and white matter loss in the cerebellum, brainstem, and superior colliculus, as is seen in WS patients. To further dissect the role of oligodendroglia in WS, we performed a transcriptomics study of WS patient iPSC-derived OPCs and pre-myelinating oligodendrocytes. Transcriptional changes compared to isogenic control cells were found for genes with a role in ER function. However, a deep phenotyping study of these WS patient iPSC-derived oligodendroglia unveiled normal differentiation, mitochondria-associated endoplasmic reticulum (ER) membrane interactions and mitochondrial function, and no overt signs of ER stress. Overall, the current study indicates that oligodendroglia functions are largely preserved in the WS mouse and patient iPSC-derived models used in this study. These findings do not support a major defect in oligodendroglia function as the primary cause of WS, and warrant further investigation of neurons and neuron-oligodendroglia interactions as a target for future neuroprotective or -restorative treatments for WS.
Heterogeneous Cardiac- and Neural Crest-Derived Aortic Smooth Muscle Cells have Similar Transcriptional Changes after TGFβ Signaling Disruption
Authors: Ren Pengwei , Jiang Bo , Hassab Abdulrahman , Li Guangxin , Li Wei , Assi Roland , Tellides George
Published: May 2024

Smooth muscle cells (SMCs) of cardiac and neural crest origin contribute to the developing proximal aorta and are linked to disease propensity in adults. We analyzed single-cell transcriptomes of SMCs from mature thoracic aortas in mice to determine basal states and changes after disrupting transforming growth factor-β (TGFβ) signaling necessary for aortic homeostasis. A minority of Myh11 lineage-marked SMCs differentially expressed genes suggestive of embryological origin. Additional analyses in Nkx2-5 and Wnt1 lineage-marked SMCs derived from cardiac and neural crest progenitors, respectively, showed both lineages contributed to a major common cluster and each lineage to a minor distinct cluster. Common cluster SMCs extended from root to arch, cardiac subset cluster SMCs from root to mid-ascending, while neural crest subset cluster SMCs were restricted to the arch. The neural crest subset cluster had greater expression of a subgroup of TGFβ-dependent genes suggesting specific responsiveness or skewed extracellular matrix synthesis. Nonetheless, deletion of TGFβ receptors in SMCs resulted in similar transcriptional changes among all clusters, primarily decreased extracellular matrix molecules and modulators of TGFβ signaling. Many embryological markers of murine aortic SMCs were not confirmed in adult human aortas. We conclude: (i) there are multiple subtypes of cardiac- and neural crest-derived SMCs with shared or distinctive transcriptional profiles, (ii) neural crest subset SMCs with increased expression of certain TGFβ-inducible genes are not spatially linked to the aortic root predisposed to aneurysms from aberrant TGFβ signaling, and (iii) loss of TGFβ responses after receptor deletion is uniform among SMCs of different embryological origins.