bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Cross-Stapling Technique in Mechanical Colorectal Anastomosis and Short-term Outcomes
Authors: Guerra Francesco , Coletta Diego , Giuliani Giuseppe , Turri Giulia , Pedrazzani Corrado , Coratti Andrea
Published: June 2024

BACKGROUND:

The double-stapled technique is the most common method of colorectal anastomosis in minimally invasive surgery. Several modifications to the conventional technique have been described to reduce the intersection between the stapled lines, as the resulting lateral dog-ears are considered possible risk factors for anastomotic leakage.

OBJECTIVE:

This study aimed to analyze the outcomes of patients receiving conventional versus modified stapled colorectal anastomosis after minimally invasive surgery.

DATA SOURCES:

A systematic review of the published literature was undertaken. PubMed/MEDLINE, Web of Science, and Embase databases were screened up to July 2023.

STUDY SELECTION:

Relevant articles were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles reporting on the outcomes of patients with modified stapled colorectal reconstruction compared with the conventional method of double-stapled anastomosis were included.

INTERVENTIONS:

Conventional double-stapling colorectal anastomosis and modified techniques with reduced intersection between the stapled lines were compared.

MAIN OUTCOME MEASURES:

The rate of anastomotic leak was the primary end point of interest. Perioperative details including postoperative morbidity were also appraised.

RESULTS:

There were 2537 patients from 12 studies included for data extraction, with no significant differences in age, BMI, or proportion of high ASA score between patients who had conventional versus modified techniques of reconstructions. The risk of anastomotic leak was 62% lower for the modified procedure than for the conventional procedure (OR = 0.38 [95% CI, 0.26–0.56]). The incidences of overall postoperative morbidity (OR = 0.57 [95% CI, 0.45–0.73]) and major morbidity (OR = 0.48 [95% CI, 0.32–0.72]) following modified stapled anastomosis were significantly lower than following conventional double-stapled anastomosis.

LIMITATIONS:

The retrospective nature of most included studies is a main limitation, essentially because of the lack of randomization and the risk of selection and detection bias.

CONCLUSIONS:

The available evidence supports the modification of the conventional double-stapled technique with the elimination of 1 of both dog-ears as it is associated with a lower incidence of anastomotic-related morbidity.
Empagliflozin: Primus Inter Pares Among Sodium–Glucose Cotransporter-2 Inhibitors?
Authors: Biondi-Zoccai Giuseppe , Frati Giacomo , Peruzzi Mariangela , Booz George W.
Published: June 2024

Sodium/glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic medications which have proved capable of providing breakthrough cardiovascular (CV) benefits in a variety of clinical scenarios, including patients with heart failure or obesity, irrespective of diabetic status. Several SGLT2 inhibitors are available, but the most prominent ones are canagliflozin, dapagliflozin, and empagliflozin. Several studies have focused on empagliflozin and its effects on the risk of heart failure incidence and recurrences. Most recently, empagliflozin has been recently tested in patients with recent myocardial infarction in the EMPAgliflozin on Hospitalization for Heart Failure and Mortality in Patients With aCuTe Myocardial Infarction randomized trial, with apparently ambiguous findings. The present viewpoint succinctly illustrates the main features of SGLT2 inhibitors as a pharmacologic class, their ever expanding role as a CV medication, and the comparative effectiveness of different individual SGLT2 inhibitors, explicitly commenting on the recent data on empagliflozin in patients with acute myocardial infarction. The reader will find in this article a poignant perspective on this novel avenue for CV prevention and treatment, which greatly expands the management armamentarium of CV practitioners. Indeed, we make the case that SGLT2 inhibitors have a clearly favorable class effect, with differences between individual agents mainly suitable for personalization of care and minimization of side effects.
Three-Dimensional Reconstruction of Subbasal Nerve Density in Eyes With Limbal Stem Cell Deficiency: A Pilot Study
Authors: Stoddard-Bennett Theo , Bonnet Clémence , Deng Sophie X.
Published: June 2024

Purpose:

Corneal subbasal nerve parameters have been previously reported using 2-dimensional scans of in vivo laser scanning confocal microscopy (IVCM) in eyes with limbal stem cell deficiency (LSCD). This study aims to develop and validate a method to better quantify corneal subbasal nerve parameters and changes from reconstructed 3-dimensional (3D) images.

Methods:

IVCM volume scans from 73 eyes with various degrees of LSCD (mild/moderate/severe) confirmed by multimodal anterior segment imaging including IVCM and 20 control subjects were included. Using ImageJ, the scans were manually aligned and compiled to generate a 3D reconstruction. Using filament-tracing semiautomated software (Imaris), subbasal nerve density (SND), corneal nerve fiber length, long nerves (>200 μm), and branch points were quantified and correlated with other biomarkers of LSCD.

Results:

3D SND decreased in eyes with LSCD when compared with control subjects. The decrease was significant for moderate and severe LSCD (P < 0.01). 3D SND was reduced by 3.7% in mild LSCD, 32.4% in moderate LSCD, and 96.5% in severe LSCD. The number of long nerves and points of branching correlated with the severity of LSCD (P < 0.0001) and with declining SND (R2 = 0.66 and 0.67, respectively). When compared with 2-dimensional scans, 3D reconstructions yielded significant increases of SND and branch points in all conditions except severe LSCD. 3D analysis showed a 46% increase in long nerves only in mild LSCD (P < 0.01).

Conclusions:

This proof-of-concept study validates the use of 3D reconstruction to better characterize the corneal subbasal nerve in eyes with LSCD. In the future, this concept could be used with machine learning to automate the measurements.
Trends in Corneal Donation From 2013 to 2022 in Aotearoa-New Zealand: Impact of Donor Age, Gender, Ethnicity, and COVID-19
Authors: Allen Natalie , Niederer Rachael , Brookes Nigel , McGhee Charles
Published: June 2024

Purpose:

To evaluate corneal donation demographics in New Zealand (NZ) and explore changes over time.

Methods:

Data were collected from all donated corneas processed by the New Zealand National Eye Bank over a 10-year period from January 2013 until December 2022. Demographic data including age, self-identified ethnicity, and gender were collected, along with location and cause of death. National death data for the corresponding period were collected online from Statistics New Zealand.

Results:

A total of 1842 donors were processed; 1414 (76.8%) were sourced from Aotearoa-New Zealand and the remainder from Australia/United States. There was a small but statistically significant median age difference between NZ donors (68 years, interquartile range 55–76) and overseas donors [66 years (interquartile range) 51–70]. Most (n = 1151 81.4%) of NZ donors died in hospital settings, with the most common cause of death being cerebrovascular (n = 444 31.4%). Individuals were less likely to donate their cornea if they were female, [incidence rate ratio (IRR) 0.746, P < 0.001] older age (IRR 0.968, P < 0.001), or if they were of Māori (IRR 0.178, P < 0.001) or Pasifika ethnicity (IRR 0.125, P < 0.001). There was also a statistically significant decrease in donation rates over time (IRR 0.945, P < 0.001).

Conclusions:

There remains a profound gap between the demand for corneal transplantation and corneal tissue donation, which is worsening with time. Donor age, gender, and ethnicity seem to influence corneal donation rates. These demographic differences may be ameliorated by increased education, cultural safety, further research into those willing to donate, and the establishment of an organ/tissue donation registry.
Criteria for premium intraocular lens patient selection
Authors: Chen Jacqueline L. , Al-Mohtaseb Zaina N. , Chen Allison J.
Published: June 2024

Purpose of review

To discuss available premium intraocular lenses (IOLs), patient selection, and important considerations for each premium IOL.

Recent findings

We review important topics and considerations for premium IOL selection: specifically, toric, extended depth of focus (EDOF), multifocal/trifocal, light adjustable lenses (LALs), and small aperture IOLs. Toric lenses are an excellent option for patients with astigmatism. However, to achieve optimal patient satisfaction, it is critical to account for the ATR astigmatism contribution from the posterior cornea and high angle alphas. Additionally, examining the ocular surface prior to placement of EDOF/multifocal IOLs is important, yet the significance of HOAs on outcomes after implantation still must be elucidated more. Finally, recent studies reveal that the small aperture lens is a good alternative for those with corneal irregularities, and second generation LALs are a great option to achieve target refractions in those with less predictable refractive outcomes, such as in Fuchs’ dystrophy or in eyes with previous refractive surgery.
Ocular manifestations of juvenile Sjögren's disease
Authors: Nguyen Robert , Gomez-Castillo Luis , Gonzales John A.
Published: June 2024

Purpose of review

This review aims to enhance understanding of juvenile Sjögren's disease (jSjD) by exploring diagnostic criteria, ocular clinical features, ancillary ophthalmic testing, and management strategies specific to this rare pediatric condition.

Recent findings

Unlike adults, children with jSjD often present with recurrent parotitis and extra-glandular symptoms before developing sicca symptoms. Adult SjD classification criteria do not consider pediatric-specific symptoms and physiological differences. Underutilization of diagnostic tests such as the ocular staining score (OSS) and Schirmer I may result in an incomplete understanding of the prevalence of keratoconjunctivitis sicca in jSjD.

Timely referral to an ophthalmologist can address perceived feasibility issues with respect to ocular features in jSjD. Management of keratoconjunctivitis sicca in jSjD includes improving ocular surface lubrication and decreasing inflammation. Recognition of pediatric-specific clinical features and development of universally accepted jSjD classification criteria will allow for better identification of potential participants for future jSjD studies.
Increased Severity of Mycoplasma pneumoniae Infections in Spanish Children
Authors: Méndez-Echevarría Ana , Calle-Miguel Laura , Miralbés Sheila , Barreiro-Pérez Sagrario , Afonso-Rodriguez Olga , Soler-Simón José Antonio , Espeleta-Fox Ana , Jiménez-Jiménez Ana Belén , Méndez-Sánchez Alejandra , Rementeria-Radigales Joseba Iñaki , Guerrero-Del-Cueto Fuensanta , Laveglia Vanessa , Ortiz-Valentín Irene , Gómez-Mera Emilio , Fernández-Puentes Verónica , Rodríguez-Noriega-Bejar Lucía , Bustillo Matilde , Retuerta Azucena , Fernàndez-Cantalejo José , Sanz-Rueda Laura , Ibáñez María Mercedes , Berzosa Arantxa , Fernández-Ledesma Berta , Álvaro Alicia , Santamaría-Barrena Teresa , Carazo-Gallego Beatriz , Moraleda Cinta , Calvo Cristina ,   on behalf of the Spanish Mycoplasma Study Group
Published: June 2024

Background:

Since the end of 2023, an elevated incidence and severity of Mycoplasma pneumoniae infections among children in Asia has been noted. Subsequently, this trend was observed in several European countries although limited data are currently available. We conducted a national study to delineate the ongoing M. pneumoniae outbreak in our country.

Methods:

A multicenter retrospective observational study was conducted across 32 hospitals in Spain, encompassing patients under 18 years old hospitalized for M. pneumoniae infection from January 2023 to March 2024. Infection was confirmed by positive polymerase chain reaction and/or by 2 serological tests.

Results:

A total of 623 children were included, with 79% of cases diagnosed in the final 3 months of the study period. Pneumonia was the most common diagnosis (87%). Respiratory symptoms were present in 97% of cases, with 62% requiring oxygen supplementation and 14% requiring admission to the pediatric intensive care unit (PICU). Risk factors for PICU admission included the presence of neurological symptoms, hypoxemia and a history of prematurity. Children admitted to the PICU exhibited significantly higher neutrophil counts upon admission.

Conclusions:

We have observed a notable increase in hospital admissions, including PICU support by up to 14%, due to M. pneumoniae infection in our country since November 2023, indicative of a more severe clinical course associated with this pathogen.
Self-Assessment of Cochlear Health by New Cochlear Implant Recipients: Daily Impedance, Electrically Evoked Compound Action Potential and Electrocochleography Measurements Over the First Three Postoperative Months
Authors: Mushtaq Faizah , Soulby Andrew , Boyle Patrick , Papoutselou Efstratia , Nunn Terry , Hartley Douglas E.H.
Published: June 2024

Hypotheses

In newly implanted cochlear implant (CI) users, electrically evoked compound action (eCAPs) and electrocochleography (ECochGs) will remain stable over time. Electrode impedances will increase immediately postimplantation due to the initial inflammatory response, before decreasing after CI switch-on and stabilizing thereafter.

Background

The study of cochlear health (CH) has several applications, including explaining variation in CI outcomes, informing CI programming strategies, and evaluating the safety and efficacy of novel biological treatments for hearing loss. Very early postoperative CH patterns have not previously been intensively explored through longitudinal daily testing. Thanks to technological advances, electrode impedances, eCAPs, and ECochGs can be independently performed by CI users at home to monitor CH over time.

Methods

A group of newly implanted CI users performed daily impedances, eCAPs, and ECochGs for 3 months at home, starting from the first day postsurgery (N = 7) using the Active Insertion Monitoring system by Advanced Bionics.

Results

Measurement validity of 93.5, 93.0, and 81.6% for impedances, eCAPs, and ECochGs, respectively, revealed high participant compliance. Impedances increased postsurgery before dropping and stabilizing after switch-on. eCAPs showed good stability, though statistical analyses revealed a very small but significant increase in thresholds over time. Most ECochG thresholds did not reach the liberal signal-to-noise criterion of 2:1, with low threshold stability over time.

Conclusion

Newly implanted CI recipients can confidently and successfully perform CH recordings at home, highlighting the valuable role of patients in longitudinal data collection. Electrode impedances and eCAPs are promising objective measurements for evaluating CH in newly implanted CI users.
Sudden Sensorineural Hearing Loss Before COVID-19, During COVID-19, and After Inactivated Vaccination: Experience From a Tertiary Referral Center in China
Authors: Cao Xin , Yi Haijin
Published: June 2024

Objective

The purpose of this study was to investigate the incidence rate and audiological characteristics of sudden sensorineural hearing loss (SSHL) before the COVID-19 pandemic, during the COVID-19 pandemic, and after inactivated vaccination, and to analyze whether the novel coronavirus or inactivated vaccination have an impact on hearing loss.

Materials and Methods

The clinical data of all patients who visited the hospital in July 2019 (before pandemic), July 2020 (during pandemic) and July 2021 (after the inactivated vaccination at least the first basic dose of COVID-19 vaccination) were retrospective analyzed. All patients diagnosed with sudden sensorineural hearing loss in these three periods were screened, and their incidence rate, hearing characteristics, and prognosis were compared.

Results

Overall, the incidence rates of sudden hearing loss in July 2019, July 2020, and July 2021 were 0.59, 0.60, and 0.52% (25 of 4225, 20 of 3322, 28 of 5432), respectively, without significant difference (χ
2 = 0.372, p = 0.830). A significant difference was noted in the incidence of hypertension (p = 0.02), whereas no significant difference was noted in age (p = 0.591, p = 0.66), sex (p = 0.19, p = 0.08), main symptoms (p = 0.18, p = 0.15), side (p = 0.483, p = 0.89), audiogram shape (p = 0.56, p = 0.989), average hearing threshold of affected frequency (p = 0.81, p = 0.89), average hearing threshold of normal ear affected frequency (p = 0.65, p = 0.68), average hearing threshold of affected frequency after treatment (p = 0.49, p = 0.38), days between symptoms onset and hospital visit (p = 0.62, p = 0.85), treatment plan (p = 0.551, p = 0.474), and effectiveness (p = 0.104, p = 0.050).

Conclusion

Our study failed to find a correlation between the novel coronavirus pandemic and inactivated vaccination and SSHL, and there was no direct evidence supporting that COVID-19 or inactivated vaccination had an impact on the incidence rate and prognosis of SSHL patients.
Effect of carnitine supplementation on energy utilization in patients with type 2 diabetes and long-term tube feeding: A CARE-compliant case report
Authors: Asai Shingo , Tai Yuki , Fujimura Masaki , Yamamoto Masakazu , Makabu Yasuhiro , Shimizu Yuki , Kido Yasuhiro , Hara Hiroto , Kokubo Eri , Chen Wun-Bill
Published: June 2024

Introduction:

Carnitine is essential for the energy utilization of long-chain fatty acids. However, the effects of carnitine supplementation on patients undergoing tube feeding remain unclear, and some enteral formula products do not contain carnitine. In order to gain insights into the role of carnitine supplementation on energy utilization in patients with long-term tube feeding, we observed the changes in respiratory quotient (RQ) of patients before and after the addition of carnitine due to the renewal of an enteral formula product.

Case presentation:

We observed 6 patients who continued tube feeding with the same enteral formula product scheduled for renewal. All 6 participants had diabetes, and indirect calorimetry data were available for 4 patients. Participants were observed for 3 months after switching to the new formulation. After the switching, a carnitine supplementation of 120 to 180 mg/day was provided, depending on the intake amount. One month after switching, blood free carnitine and total carnitine levels in all 6 patients increased from below the lower limit to within the range of the Japanese reference standard. In 3 of the 4 patients for whom indirect calorimetry was possible, the fasting RQ at baseline was >0.90, suggesting impaired lipid utilization. The mean fasting RQ significantly decreased 2 months after the switch. The 1- and 2-hour postprandial RQ also showed a significant decrease after switching.

Conclusion:

Carnitine supplementation of enteral formulas may be important for normal energy utilization of lipids in patients receiving long-term tube feeding. An evaluation using randomized controlled trials with a larger number of patients is required.
Canakinumab is effective for refractory Entero-Behçet’s disease with compound heterozygous variants of the MEFV gene: A case report
Authors: Umeda Masataka , Tsukamoto Yutaka , Sugimoto Takashi , Ozasa Souichiroh , Akabame Shogo , Fukui Shoichi , Mohamed Lamiaa Yaser Helmy , Tsuji Yoshika , Koga Tomohiro , Matsuoka Yuki , Kato Takeharu , Tominaga Tetsuro , Furuse Yuki , Maeda Takahiro , Ariyoshi Koya , Kawakami Atsushi
Published: June 2024

Rationale:

Behçet’s disease (BD) is characterized by recurrent oral ulcers, skin lesions, genital ulcers, and ocular inflammation, with uncontrolled gastrointestinal manifestations potentially leading to fatal complications. Human leukocyte antigen (HLA) class I alleles such as HLA-B51 and HLA-A26 are genetic risk factors for BD, and interleukin-1β activation plays a key role in BD pathogenesis. Familial Mediterranean fever, another autoinflammatory disease caused by MEFV gene mutations, shares similarities with BD, including enhanced interleukin-1β production.

Patient concerns:

We present a case of BD with severe gastrointestinal ulcers and MEFV variants treated with canakinumab.

Diagnoses:

A 69-year-old Japanese woman with a history of malignant lymphomas and nontuberculous mycobacterial arthritis developed BD symptoms, including oral and gastrointestinal ulcers.

Interventions:

Despite after treatments with 2 tumor necrosis factor inhibitors, her oral and gastrointestinal ulcers persisted. Genetic analysis revealed L110P/E148Q MEFV variants, prompting the administration of canakinumab and granulocyte and monocyte adsorption apheresis.

Outcomes:

Continuous treatment with canakinumab improved the oral and gastrointestinal ulcers.

Lessons:

This case highlights the potential efficacy of canakinumab in treating severe gastrointestinal ulcers in BD patients with MEFV variants.
Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps
Authors: Tanna Neil , Sultan Darren L. , Minasian Raquel A. , Clappier Mona , Haddock Nicholas T. , Chrysopoulo Minas T. , Nahabedian Maurice Y. , Serletti Joseph M. , Allen Robert J.
Published: June 2024

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand the types of abdominally based flaps, their anatomy, and their drawbacks. 2. Understand important aspects of the history and physical examination of patients wishing to undergo these procedures. 3. Understand the benefits of preoperative planning and its role in avoiding complication. 4. Understand the operative steps of the procedures and tips to increase efficiency. 5. Understand the postoperative care of these patients and the role of enhanced recovery pathways.

In this article, the authors review the history, current state, and future directions related to abdominally based microsurgical breast reconstruction. This article covers preoperative, intraoperative, and postoperative considerations intended to improve patient outcomes and prevent complications. Evidence-based findings are reported when available to comprehensively review important aspects of these procedures.
The Role of Local Flaps in Foot and Ankle Reconstruction: An Assessment of Outcomes across 206 Patients with Chronic Wounds
Authors: Berger Lauren E. , Spoer Daisy L. , Huffman Samuel S. , Garrett Richard W. , Khayat Elias , DiBello John R. , Zolper Elizabeth G. , Akbari Cameron M. , Evans Karen K. , Attinger Christopher E.
Published: June 2024

Background:

Reconstructive surgery has experienced a paradigm shift in favor of free flaps. Yet local flaps may be of particular use in foot and ankle reconstruction among comorbid patient populations. Thus, the authors sought to better characterize long-term outcomes in this setting.

Methods:

A single-center, retrospective cohort study of patients undergoing local muscle and fasciocutaneous flaps of the foot and ankle from January of 2010 through November of 2022 was performed. Flaps were performed on wounds measuring 3 × 6 cm or smaller; flap selection depended on preoperative vascular assessment, Doppler findings, comorbidity profile, and wound location, depth, and geometry.

Results:

A total of 206 patients met inclusion criteria. Their median age was 61.0 years (interquartile range, 16.8), and comorbidities included diabetes mellitus (n = 149 [72.3%]) and peripheral arterial disease (n = 105 [51.0%]). Presentations included chronic, nonhealing wounds (n = 77 [39.1%]) or osteomyelitis (n = 45 [22.8%]) and most frequently extended to the bone (n = 128 [62.1%]). Eighty-seven patients (42.2%) received muscle flaps; 119 (57.8%) received fasciocutaneous flaps. Six patients (2.9%) needed return to the operating room, with thrombosis occurring in 2 cases (1.0%). The flap success rate was 98.1%. By a median follow-up duration of 21.7 months (interquartile range, 39.0), 21.8% of patients (n = 45) required ipsilateral amputation, 73% (n = 145 of 199) were ambulatory, and 2 deaths related to the surgical wound occurred (2 of 49 [4.1%]). Multivariate analysis revealed that positive predictors of complications included diabetes mellitus, end-stage renal disease, and history of venous thromboembolism or smoking.

Conclusion:

Local flaps remain a reliable option to reconstruct smaller defects of the foot and ankle in a highly comorbid population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Antithrombotic Questionnaire Tool for Evaluation of Combined Antithrombotic Therapy in Community Pharmacies
Authors: van Uden Renate C.A.E. , Sulaiman Barzo , Pols Patricia A.M. , Meijer Karina , van den Bemt Patricia M.L.A. , Becker Matthijs L.
Published: June 2024

Objective

The objective of this paper is to assess the diagnostic value of an antithrombotic questionnaire tool compared with the hospital’s medical record information tool. The hypothesis of this study was that the antithrombotic questionnaire tool could identify patients with potentially incorrect antithrombotic therapy.

Methods

This cross-sectional study was conducted in eight community pharmacies in the Netherlands. A standardized questionnaire was developed as antithrombotic questionnaire tool. The pharmacist assessed whether the antithrombotic therapy was correct or potentially incorrect based on answers given by patients and based on the medical record. The primary outcome of the study was the sensitivity and specificity of the antithrombotic questionnaire tool to identify patients with potentially incorrect antithrombotic therapy.

Results

For 95 patients, the pharmacist assessed that in 81 (85%) the antithrombotic therapy was correct and in 14 (15%) potentially incorrect. Based on the medical record, 86 patients (91%) were assessed as correct and 9 (9%) as potentially incorrect. The sensitivity of the tool was 100% and the specificity 94%.

Conclusions

This study demonstrated that the antithrombotic questionnaire tool is a suitable tool to assess whether the patient’s antithrombotic therapy is potentially incorrect. It can be applied to identify patients with potentially incorrect antithrombotic therapy.
Cost-effectiveness of different intervention strategies of HIV in Zhejiang, China
Authors: Wu Chensi , Xu Xiaolan , Peng Chunting , Dong Yin , Lou Zhuoqi , Pan Liya , Chen Lin , Zeng Yifan , Ruan Bing
Published: June 2024

Objective:

Mass screening for HIV and preexposure prophylaxis (PrEP) may be effective measures for reducing the probability of HIV transmission. Our study aimed to determine the cost-effectiveness of preliminary screening in the general population, PrEP for HIV-negative spouses in serodiscordant couples, or both approaches in Zhejiang Province.

Design:

From a policy-maker's perspective, a Markov model was constructed to compare four strategies over a 30-year horizon.

Methods:

In the Markov model, the implementation intensities of the strategies varied from 50 to 100%. Different strategies were evaluated by the reduction of unfavorable clinical outcomes, saved life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs).

Results:

The PrEP-screening strategy reduced the most unfavorable clinical outcomes and saved the most life-years and QALYs from 2023 to 2052. It always gained the maximum QALYs and NMB, while its ICER was always lower than the willingness-to-pay (WTP). The NMB of the PrEP-screening strategy gradually increased as the implementation intensity increased.

Conclusion:

With adequate manpower and policies, we suggest implementing the PrEP-screening strategy in Zhejiang Province, suggesting that the broader the population coverage of the strategy, the better. In addition, the PrEP strategy is an alternative.
Dedicated Photon-Counting CT for Detection and Classification of Microcalcifications
Authors: Huck Luisa Charlotte , Bode Maike , Zanderigo Eloisa , Wilpert Caroline , Raaff Vanessa , Dethlefsen Ebba , Wenkel Evelyn , Kuhl Christiane Katharina
Published: June 2024

Objectives

Clinical experience regarding the use of dedicated photon-counting breast CT (PC-BCT) for diagnosis of breast microcalcifications is scarce. This study systematically compares the detection and classification of breast microcalcifications using a dedicated breast photon-counting CT, especially designed for examining the breast, in comparison with digital breast tomosynthesis (DBT).

Materials and Methods

This is a prospective intraindividual study on women with DBT screening–detected BI-RADS-4/-5 microcalcifications who underwent PC-BCT before biopsy. PC-BCT images were reconstructed with a noninterpolated spatial resolution of 0.15 × 0.15 × 0.15 mm (reconstruction mode 1 [RM-1]) and with 0.3 × 0.3 × 0.3 mm (reconstruction mode 2 [RM-2]), plus thin-slab maximum intensity projection (MIP) reconstructions. Two radiologists independently rated the detection of microcalcifications in direct comparison with DBT on a 5-point scale. The distribution and morphology of microcalcifications were then rated according to BI-RADS. The size of the smallest discernible microcalcification particle was measured. For PC-BCT, the average glandular dose was determined by Monte Carlo simulations; for DBT, the information provided by the DBT system was used.

Results

Between September 2022 and July 2023, 22 participants (mean age, 61; range, 42–85 years) with microcalcifications (16 malignant; 6 benign) were included. In 2/22 with microcalcifications in the posterior region, microcalcifications were not detectable on PC-BCT, likely because they were not included in the PC-BCT volume. In the remaining 20 participants, microcalcifications were detectable. With high between-reader agreement (κ > 0.8), conspicuity of microcalcifications was rated similar for DBT and MIPs of RM-1 (mean, 4.83 ± 0.38 vs 4.86 ± 0.35) (P = 0.66), but was significantly lower (P < 0.05) for the remaining PC-BCT reconstructions: 2.11 ± 0.92 (RM-2), 2.64 ± 0.80 (MIPs of RM-2), and 3.50 ± 1.23 (RM-1). Identical distribution qualifiers were assigned for PC-BCT and DBT in 18/20 participants, with excellent agreement (κ = 0.91), whereas identical morphologic qualifiers were assigned in only 5/20, with poor agreement (κ = 0.44). The median size of smallest discernible microcalcification particle was 0.2 versus 0.6 versus 1.1 mm in DBT versus RM-1 versus RM-2 (P < 0.001), likely due to blooming effects. Average glandular dose was 7.04 mGy (PC-BCT) versus 6.88 mGy (DBT) (P = 0.67).

Conclusions

PC-BCT allows reliable detection of in-breast microcalcifications as long as they are not located in the posterior part of the breast and allows assessment of their distribution, but not of their individual morphology.
Primary Lymphovenous Anastomosis After Extended Soft Tissue Resection in the Medial Thigh for Reduction of Lymphocele and Lymphedema
Authors: Uyulmaz Semra , Grünherz Lisanne , Giovanoli Pietro , Fuchs Bruno , Lindenblatt Nicole
Published: June 2024

Introduction

Postoperative chronic lymphocele and lymphedema represent severe burdens for soft tissue sarcoma patients who are already physically handicapped after an extensive surgery and a long recovery time. Incidences are high in the upper medial thigh. We have shifted our focus to lymphedema and lymphocele risk reduction with immediate lymphovenous anastomosis (LVA) after sarcoma resection.

Methods

We performed immediate lymphatic reconstruction in 11 patients after soft tissue sarcoma resection in the upper medial thigh. The postoperative course was followed up closely, and postoperative occurrence of lymphocele and lymphedema was clinically assessed. A literature search outlining the latest clinical data, current treatment strategy landscape, and their application into clinical practice was added to the investigation.

Results

A total of 19 LVA and 2 lympho-lymphatic anastomoses were performed in 11 patients immediately after tumor resection in an end-to-end manner. We found a postoperative lymphedema rate of 36% and a postoperative lymphocele rate of 27%. Mean follow-up time was 17 months. Average tumor volume was 749 cc. Our literature search yielded 27 articles reporting on immediate LVA in cancer patients. Incidences of secondary lymphedema after LVA for lymphedema prevention vary between 0% and 31.1%. Lymphocele prevention with LVA is poorly studied in sarcoma patients.

Conclusion

Immediate lymphatic reconstruction improved the overall postoperative course of our patients. The current literature does not serve with high-quality studies about primary LVA preventing lymphedema and lymphocele formation. We conclude that this technique should be seen as an additional concept to achieve overall better postoperative outcomes in these challenging surgical settings. We strongly recommend to either anastomose or ligate severed lymphatics under the microscope primarily after sarcoma resection in the upper medial thigh area.
Individualized Digital Nasoalveolar Molding: A Proof of Concept
Authors: Parakarn Hathaichanok , Pisek Poonsak , Wangsrimongkol Buddhathida
Published: June 2024

Nasoalveolar molding (NAM) is a recognized adjunctive therapy to primary cheiloplasty in patients with complete cleft lip and palate (CLP). The conventional technique can be time-consuming, costly, and requires experienced clinicians. Over the past decade, CAD/CAM technology has been employed to facilitate NAM therapy, showing promising results. This study introduces an individualized Digital NAM (iDNAM), a digital approach revolutionizing NAM treatment using CAD/CAM technology, and evaluates treatment outcomes. A 57-day-old infant with complete UCLP underwent intraoral and nasolabial scans, along with 3D photogrammetry. Open-source software was utilized for virtual alveolar segmentation and NAM plate design. iDNAM incorporates a nasal molding extension, introducing an innovative nasal stent activation protocol. Changes in alveolar and nasal morphology were compared between the initial and presurgery stages. After treatment with iDNAM, the alveolar cleft gap was reduced to 4.22 mm. Nostril height on the cleft side, columellar length, and nose projection increased by 0.98, 2.40, and 1.90 mm, respectively. The nasal base-columellar angle improved by 29.50 degrees. The results demonstrate a significant reduction in the alveolar cleft gap and improved nasal morphology, making iDNAM as an alternative to NAM therapy.
TRAUMA-INDUCED COAGULOPATHY: PREVALENCE AND ASSOCIATION WITH MORTALITY PERSIST 20 YEARS LATER
Authors: Teeter William , Neal Matthew D. , Brown Joshua B. , MacLeod Jana B. A. , Vesselinov Roumen , Kozar Rosemary A.
Published: June 2024

Introduction: A 2003 landmark study identified the prevalence of early trauma-induced coagulopathy (eTIC) at 28% with a strong association with mortality of 8.9%. Over the last 20 years, there have been significant advances in both the fundamental understanding of eTIC and therapeutic interventions. Methods: A retrospective cohort study was performed from 2018 to 2022 on patients ≥18 using prospectively collected data from two level 1 trauma centers and compared to data from 2003. Demographics, laboratory data, and clinical outcomes were obtained. Results: There were 20,107 patients meeting criteria: 65% male, 85% blunt, mean age 54 ± 21 years, median Injury Severity Score 10 (10, 18), 8% of patients were hypotensive on arrival, with an all-cause mortality 6.0%. The prevalence of eTIC remained high at 32% in patients with an abnormal prothrombin time and 10% with an abnormal partial thromboplastin time, for an overall combined prevalence of 33.4%. Coagulopathy had a major impact on mortality over all injury severity ranges, with the greatest impact with lower Injury Severity Score. In a hybrid logistic regression/Classification and Regression Trees analysis, coagulopathy was independently associated with a 2.1-fold increased risk of mortality (95% confidence interval 1.5–2.9); the predictive quality of the model was excellent [area under the receiver operating characteristic curve (AUROC) 0.932]. Conclusion: The presence of eTIC conferred a higher risk of death across all disease severities and was independently associated with a greater risk of death. Biomarkers of coagulopathy associated with eTIC remain strongly predictive of poor outcome despite advances in trauma care.
Advanced Preoperative Clinical Stage Is Associated With More Lymph Node Harvest in Patients With Right Colon Cancer
Authors: Kim Hyeon Kyeong , Oh Bo-Young , Noh Gyoung Tae , Chung Soon Sup , Lee Ryung-Ah , Kim Ho Seung
Published: June 2024

Purpose:

The adequacy of lymph node (LN) harvest is important in oncological colon cancer resections. While several studies have suggested factors influencing LN yield in colon cancer, limited data are available only regarding right hemicolectomies with complete mesocolic excision (CME) and central vessel ligation (CVL).

Methods:

A retrospective analysis was conducted on 169 patients who underwent right hemicolectomies with CME and CVL for right-sided colon cancer between February 2019 and March 2023. The patients were divided into 2 groups: groups with ≤24 LN yield and >24 LN yield, and the patient, surgical, and pathologic factors, which could potentially influence the LN yield, were analyzed.

Results:

Younger age, lower American Society of Anesthesiologists (ASA) classification, and advanced clinical TNM (cTNM) stage among patient factors, the presence of obstructions regarding the surgical factors, and the presence of desmoplastic tumor reaction in the pathologic factors were more likely to harvest >24 LNs. In a multivariate analysis, younger age, lower ASA classification, advanced cTNM stage, and an ileocolic artery (ICA) crossing pattern posterior to the superior mesenteric vein (SMV) were independently associated with a >24 LN harvest. Patients with cTNM 3,4 showed the tendency of > 24 LN yield consistently within each subgroup, irrespective of the age, ASA classification, and ileocolic artery crossing pattern.

Conclusions:

Our investigation revealed a significant correlation between the advanced preoperative clinical stage and an increased number of harvested lymph nodes (LNs) in patients undergoing right hemicolectomies with CME a CVL. The observed association is potentially influenced by tumor aggressiveness and the extent of surgical resection performed by the surgeon. To elucidate the intricate relationship between surgical outcomes and the quantity of LN harvest in patients subjected to standardized CME and CVL for right-sided colon cancer, further dedicated research is warranted.
The Effect of the Single-Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (SADI-S) on Circulating Concentrations of 25-OH Vitamin D and B12 at 1 Year Postsurgery
Authors: Sylvestre Jane , Newkirk Melanie , Samavat Hamed , Parker Anna
Published: June 2024

More than 650 million adults in the world are obese. Bariatric surgery has proven to be an effective treatment; however, it is underutilized. A relatively new procedure, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), has shown greater weight loss success than leading procedures but little is known about its effects on nutrient deficiencies. The present review aims to explore the effects of the SADI-S on blood concentrations of 25-OH vitamin D and vitamin B12 up to 1 year postsurgery. Findings suggest that vitamin D deficiency is more prevalent than vitamin B12 deficiency in patients who have undergone the SADI-S; however, there was no clear cause and effect relationship.
The Risk of Microbial Transmission in Recipients of Donor Livers That Underwent Hypothermic or Normothermic Machine Perfusion
Authors: Endo Chikako , Lascaris Bianca , Brüggenwirth Isabel M. A. , Roggeveld Jan , Blokzijl Hans , de Meijer Vincent E. , Doting M. H. Edwina , Porte Robert J.
Published: June 2024

Background.

Ex situ machine perfusion is increasingly used to preserve and assess donor livers before transplantation. Compared with traditional static cold storage (SCS), machine perfusion exposes livers to an additional risk of microbial contamination. However, information on the risk of microbial transmission during machine perfusion is lacking.

Methods.

All livers that underwent either hypothermic oxygenated machine perfusion (HOPE) or normothermic machine perfusion (NMP) in our center between September 2021 and September 2023, and during which samples were taken from SCS fluid and/or machine perfusion solution for microbiological examination, were included in this retrospective, observational clinical study. Microbial transmission was examined from SCS fluid to machine perfusion solution fluid and, subsequently, to recipients of these livers.

Results.

A total of 90 cases of liver machine perfusion were included: 59 HOPE and 31 NMP. SCS preservation fluid cultures before HOPE or NMP were positive for at least 1 microorganism in 52% of the cases. After HOPE, there were no cases of positive machine perfusion fluid or evidence of microbial transmission to the recipients. After NMP, in 1 (3%) patient Escherichia coli was grown from abdominal drain fluid, the same bacterial strain that was also grown from the SCS preservation fluid before NMP. This E coli was resistant to the antibiotics that are routinely added to the NMP perfusion fluid.

Conclusions.

The risk of microbial transmission after machine perfusion is very low but not absent. We recommend routine sampling of machine perfusion fluid at the end of the procedure for microbiological analysis.
Baseline Lung Allograft Dysfunction After Bilateral Lung Transplantation Is Associated With an Increased Risk of Death: Results From a Multicenter Cohort Study
Authors: Keller Michael B. , Sun Junfeng , Alnababteh Muhtadi , Ponor Lucia , D. Shah Pali , Mathew Joby , Kong Hyesik , Charya Ananth , Luikart Helen , Aryal Shambhu , Nathan Steven D. , Orens Jonathan B. , Khush Kiran K. , Kyoo Jang Moon , Agbor-Enoh Sean
Published: June 2024

Background.

A prior single-center, retrospective cohort study identified baseline lung allograft dysfunction (BLAD) as a risk factor for death in bilateral lung transplant recipients. In this multicenter prospective cohort study, we test the association of BLAD with death in bilateral lung transplant recipients, identify clinical risk factors for BLAD, and assess its association with allograft injury on the molecular level.

Methods.

This multicenter, prospective cohort study included 173 bilateral lung transplant recipients that underwent serial pulmonary function testing and plasma collection for donor-derived cell-free DNA at prespecified time points. BLAD was defined as failure to achieve ≥80% predicted for both forced expiratory volume in 1 s and forced vital capacity after lung transplant, on 2 consecutive measurements at least 3 mo apart.

Results.

BLAD was associated with increased risk of death (hazard ratio, 1.97; 95% confidence interval [CI], 1.05-3.69; P = 0.03) but not chronic lung allograft dysfunction alone (hazard ratio, 1.60; 95% CI, 0.87-2.95; P = 0.13). Recipient obesity (odds ratio, 1.69; 95% CI, 1.15-2.80; P = 0.04) and donor age (odds ratio, 1.03; 95% CI, 1.02-1.05; P = 0.004) increased the risk of developing BLAD. Patients with BLAD did not demonstrate higher log10(donor-derived cell-free DNA) levels compared with no BLAD (slope [SE]: –0.0095 [0.0007] versus –0.0109 [0.0007]; P = 0.15).

Conclusions.

BLAD is associated with an increased risk of death following lung transplantation, representing an important posttransplant outcome with valuable prognostic significance; however, early allograft specific injury on the molecular level does not increase the risk of BLAD, supporting further mechanistic insight into disease pathophysiology.
Innate and learned components of egg recognition in the ant
Camponotus floridanus
Authors: Moore Dani , Liebig Juergen
Published: June 2024

Insect societies discriminate against foreigners to avoid exploitation. In ants, helper workers only accept individuals with the familiar chemical cues of their colony. Similarly, unfamiliar eggs may get rejected at their first appearance in the nest. We investigated egg acceptance mechanisms by introducing different types of foreign eggs into worker groups of the ant
Camponotus floridanus
. Workers from established colonies familiar with queen-laid eggs always accepted eggs from highly fecund queens, but worker-laid eggs only after exposure for several weeks. Workers naive to eggs only rejected worker-laid eggs once they had prior exposure to eggs laid by highly fecund queens, suggesting that prior exposure to such eggs is necessary for discrimination. The general acceptance of eggs from highly fecund queens, irrespective of previous worker egg exposure, suggests an innate response to the queen pheromone these eggs carry. Workers learned to accept queen-laid eggs from different species, indicating high flexibility in learning egg-recognition cues. In incipient colonies with queen-laid eggs that carry a weak queen pheromone, worker-laid eggs were more likely to get accepted than queen-laid eggs from a different species, suggesting that the similarity of egg-recognition cues between the two types of
C. floridanus
eggs increases acceptance.
The relationship between ‘school readiness’ and later persistent absenteeism
Authors: Wood Megan L. , Gunning Lydia , Mon-Williams Mark
Published: June 2024

Post-pandemic school absence is an increasing concern for governments worldwide. Absence is associated with poor academic outcomes and long-term illness (physical and mental). Absenteeism increases the risk of financial difficulties in adulthood and involvement in the criminal justice system. We hypothesized that early childhood problems might be an antecedent of absenteeism. We tested this hypothesis by investigating the pre-pandemic association between school readiness and persistent absenteeism using a population-linked dataset. Analyses included 62,598 children aged 5–13 years from the Connected Bradford database (spanning academic years 2012/13 to 2019/20). Special educational needs status, English as an Additional Language status, socioeconomic status, sex and ethnicity were covariates significantly associated with persistent absenteeism. Children who were not ‘school ready’ had increased odds of being persistently absent later in their education journey after controlling for these covariates. School readiness was associated with even greater odds of being persistently absent over two or more years. These findings show (i) the seeds of absenteeism are sown early in childhood; (ii) absenteeism shows the hallmark of structural inequities; and (iii) the potential of ‘school readiness’ measures to identify children at risk of long-term disengagement from the education system.