bluuebunny/crossref_metadata_2025 huggingface dataset:
School Meals Are Evolving: Has the Evidence Kept Up?
Authors: Alderman Harold , Bundy Donald , Gelli Aulo
Published: February 2024

School meal programs are popular social programs. They are provided to 61 percent of primary students in high-income countries but to a smaller share of students in less wealthy countries. There is a body of evidence documenting their contribution to education, health and nutrition, and social protection. But in each domain, program objectives have evolved: schooling is recognized to be more about learning than grades obtained; nutrition goals include healthy diets that reduce risks of non-communicable diseases and are more environmentally responsible; social protection programs aim to respond to acute crises and address chronic poverty. In addition to assisting in these sectors, school meal programs are tasked with creating food systems that assist smallholder farmers, an endeavor that has yet to be extensively studied. This review examines the latest evidence on these evolving dimensions of school meal programs. Findings suggest that while there is a strong evidence base for school meals, there are also specific gaps in the evidence of effectiveness and a particular lack of clarity around costs. The country-led School Meals Coalition, developed in response to COVID pandemic-related school closures, has brought new momentum to national programs and new urgency for reliable evidence on effectiveness and costs.
Current concepts in postpartum anemia management
Authors: Neef Vanessa , Choorapoikayil Suma , Hof Lotta , Meybohm Patrick , Zacharowski Kai
Published: February 2024

Purpose of review

Postpartum anemia (PPA) is common in women after childbirth and affects about 50–80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment.

Recent findings

Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age.

Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.
Intraoperative EEG-based monitors: are we looking under the lamppost?
Authors: Baron Shahaf Dana , Shahaf Goded
Published: February 2024

Purpose of review

While electroencephalogram (EEG)-based depth of anesthesia monitors have been in use clinically for decades, there is still a major debate concerning their efficacy for detecting awareness under anesthesia (AUA). Further utilization of these monitors has also been discussed vividly, for example, reduction of postoperative delirium (POD).

It seems that with regard to reducing AUA and POD, these monitors might be applicable, under specific anesthetic protocols. But in other settings, such monitoring might be less contributive and may have a ‘built-it glass ceiling’.

Recent advances in other venues of electrophysiological monitoring might have a strong theoretical rationale, and early supporting results, to offer a breakthrough out of this metaphorical glass ceiling. The purpose of this review is to present this possibility.

Recent findings

Following previous findings, it might be concluded that for some anesthesia protocols, the prevailing depth of anesthesia monitors may prevent incidences of AUA and POD. However, in other settings, which may involve other anesthesia protocols, or specifically for POD – other perioperative causes, they may not. Attention-related processes measured by easy-to-use real-time electrophysiological markers are becoming feasible, also under anesthesia, and might be applicable for more comprehensive prevention of AUA, POD and possibly other perioperative complications.

Attention-related monitoring might have a strong theoretical basis for the prevention of AUA, POD, and potentially other distressing postoperative outcomes, such as stroke and postoperative neurocognitive disorder. There seems to be already some initial supporting evidence in this regard.
Guidelines in trauma-related bleeding and coagulopathy: an update
Authors: Christoffel Jannis , Maegele Marc
Published: February 2024

Purpose of review

The diagnosis and treatment of patients with severe traumatic bleeding and subsequent trauma-induced coagulopathy (TIC) is still inconsistent, although the implementation of standardized algorithms/treatment pathways was repeatedly linked to improved outcome. Various evidence-based guidelines for these patients now exist, three of which have recently been updated.

Recent findings

A synopsis of the three recently updated guidelines for diagnosis and treatment of seriously bleeding trauma patients with TIC is presented: (i) AWMF S3 guideline ‘Polytrauma/Seriously Injured Patient Treatment’ under the auspices of the German Society for Trauma Surgery; (ii) guideline of the European Society of Anesthesiology and Intensive Care (ESAIC) on the management of perioperative bleeding; and (iii) European guideline on the management of major bleeding and coagulopathy after trauma in its 6th edition (EU-Trauma).

Treatment of trauma-related bleeding begins at the scene with local compression, use of tourniquets and pelvic binders and rapid transport to a certified trauma centre. After arrival at the hospital, measures to record, monitor and support coagulation function should be initiated immediately. Surgical bleeding control is carried out according to ‘damage control’ principles. Modern coagulation management includes individualized treatment based on target values derived from point-of-care viscoelastic test procedures.
Massive transfusion in trauma
Authors: Lier Heiko , Hossfeld Björn
Published: February 2024

Purpose of review

The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion.

Recent findings

Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3–4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies.

To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.
The importance of simulation-based multi professional training in obstetric anesthesia: an update
Authors: Abrams Jordan , Mahoney Bryan
Published: February 2024

Purpose of review

Simulation-based training remains an integral component of medical education by providing a well tolerated, controlled, and replicable environment for healthcare professionals to enhance their skills and improve patient outcomes. Simulation technology applied to obstetric anesthesiology continues to evolve as a valuable tool for the training and assessment of the multidisciplinary obstetric care team.

Recent findings

Simulation-based technology has continued to play a role in training and assessment, including recent work on interdisciplinary communication, recognition, and management of obstetric hemorrhage, and support in the low or strained resource setting. The COVID-19 pandemic has accelerated the evolution of simulation-based training away from a reliance on in-situ or high-fidelity manikin-based approaches toward an increasing utilization of modalities that allow for remote or asynchronous training.

The evolution of simulation for interdisciplinary training and assessment in obstetric anesthesia has accelerated, playing a greater role in aspects of communication, management of hemorrhage and supporting low or strained resource settings. Augmented reality, virtual reality and mixed reality have advanced dramatically, spurred on by the need for remote and asynchronous simulation-based training during the pandemic.
Direct oral anticoagulants in trauma patients
Authors: Schöchl Herbert , Grottke Oliver , Schmitt Felix C.F.
Published: February 2024

Purpose of review

Direct oral anticoagulants (DOACs) are increasingly prescribed for prevention of thromboembolic events. Thus, trauma care providers are facing a steadily raising number of injured patients on DOACs.

Recent findings

Despite a predictable pharmacokinetic profile, the resulting plasma levels of trauma patients upon admission and bleeding risks remain uncertain. Therefore, recent guidelines recommend the measurement of DOAC plasma concentrations in injured patients. Alternatively, DOAC specific visco-elastic tests assays can be applied to identify DOAC patients at bleeding risk.

Bleeding complications in trauma patients on DOACs are generally higher compared to nonanticoagulated subjects, but comparable to vitamin K antagonists (VKAs). In particular, a traumatic brain injury does not carry an increased risk of intracranial bleeding due to a DOAK intake compared to VKAs. Current studies demonstrated that up to 14% of patients with a hip fracture are on DOACs prior to surgery. However, the majority can be operated safely within a 24h time window without an increased bleeding rate.

Specific antagonists facilitate rapid reversal of patients on DOACs. Idarucizumab for dabigatran, and andexanet alfa for apixaban and rivaroxaban have been approved for life threatening bleeding. Alternatively, prothrombin complex concentrate can be used. Dialysis is a potential treatment option for dabigatran and haemoabsorption with special filters can be applied in patients on FXa-inhibitors.

Current guidelines recommend the measurement of DOAC plasma levels in trauma patients. Compared to VKAs, DOACs do not carry a higher bleeding risk. DOAC specific antagonists facilitate the individual bleeding management.
How much does it cost to be fit for operation? The economics of prehabilitation
Authors: Crişan Iulia , Slankamenac Ksenija , Bilotta Federico
Published: February 2024

Purpose of review

Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs.

Recent findings

The current literature regarding the economics of prehabilitation is limited. However, such programs have been mainly associated with either a reduction in total healthcare related costs or no increase.

Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.
Anesthetic recommendations for maternal and fetal safety in nonobstetric surgery: a balancing act
Authors: Obiyo Leziga T. , Tobes Daniel , Cole Naida M.
Published: February 2024

Purpose of review

Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery.

Recent findings

Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety.

These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.
Long-term effects of neuraxial analgesia
Authors: Kearns Rachel J. , Broom Malcolm A. , Lucas Dominique N.
Published: February 2024

Purpose of review

This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child.

Recent findings

Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve.

For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority.

Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.
Anesthesia for gender-affirming surgery: a practical review
Authors: Sanchez Kyle , Tollinche Luis , Reece-Nguyen Travis
Published: February 2024

Purpose of review

Gender-affirming surgery (GAS) is an effective, well studied, and often necessary component of gender-affirming care and mitigation of gender dysphoria for transgender and gender-diverse (TGD) individuals. GAS is categorized as chest surgeries, genitourinary surgeries, facial feminization/masculinization, and vocal phonosurgery. Despite increased incidence of GAS during recent years, there is a gap in knowledge and training on perioperative care for TGD patients.

Recent findings

Our review discusses the relevant anesthetic considerations for the most common GAS, which often involve highly specialized surgical techniques that have unique implications for the anesthesia professional.

Anesthesiology professionals must attend to the surgical and anesthetic nuances of various GAS procedures. However, as many considerations are based on common practice, research is warranted on anesthetic implications and outcomes of GAS.
Administration of the GSK Respiratory Syncytial Virus Vaccine to Pregnant Persons in Error
Authors: Moro Pedro L. , Gallego Ruth , Scheffey Anne , Fleming-Dutra Katherine E. , Hall Elisha , Zhang Bicheng , Marquez Paige , Jones Jefferson M. , Nair Narayan , Broder Karen R.
Published: February 2024

The GSK and Pfizer respiratory syncytial virus (RSV) vaccines are both indicated for adults aged 60 years and older, but only the Pfizer product is approved for use in pregnancy to prevent RSV-associated lower respiratory tract disease in infants aged younger than 6 months. To assess for vaccine administration errors (ie, administration of the GSK RSV vaccine to pregnant persons) VAERS (Vaccine Adverse Event Reporting System), a U.S. passive reporting system, was searched for the time period from August 2023 to January 2024. A total of 113 reports of these administration errors were identified. Most reports (103, 91.2%) did not describe an adverse event. These administration errors are preventable with proper education and training and other preventive measures.
Comparison of Occupational Noise Exposure Assessment Methods: A Systematic Review
Authors: Makaruse Nyasha , Maslin Mike , Shai-Campbell Ziva
Published: February 2024

Objectives:

The purpose of this systematic review of publications was to evaluate existing evidence on the accuracy and precision of alternative occupational noise assessment methods, with personal noise dosimetry as the reference.

Design:

A structured literature search was performed in Ovid MEDLINE(R) and Embase in July 2021 and 2022. The Covidence software was used for importing articles, screening titles and abstracts, full-text review, and study selection. Two reviewers independently conducted the title, abstract, and full-text screening of eligible studies. The reporting of this systematic review was guided by the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of selected articles was assessed using the Joanna Briggs Institute checklist for analytical cross-sectional studies.

Results:

In total, 11 studies consistent with the study selection criteria were identified out of 327 articles from the initial search. The noise-measurement methods identified in the selected studies included subjective rating through a questionnaire, expert opinion, smartwatch, sound level meter, sound level meter combined with a radio-frequency identification system, smart devices, workgroup dosimetry sampling, task-based measurement (TBM), and hybrid TBM. The hybrid method (a combination of task-based, subjective rating, and trade mean measurements) was the best alternative to full-shift personal noise-dosimetry with a negligible bias of 0.1 dB, precision of 2.4 dBA, and accuracy of 2.4 dBA.

Conclusion:

A variety of lower-cost TBM methods had relatively high accuracy and precision levels comparable to personal dosimetry. These findings are particularly relevant for low-income countries where occupational noise measurements should be obtained with minimal work disruptions and costs. However, it should also be noted that TBMs are greatly affected by job variation, multiple tasks, or mobile tasks.
Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study
Authors: Chalkias Athanasios , Huang Yiyuan , Ismail Anis , Pantazopoulos Ioannis , Papagiannakis Nikolaos , Bitterman Brayden , Anderson Elizabeth , Catalan Tonimarie , Erne Grace K. , Tilley Caroline R. , Alaka Abiola , Amadi Kingsley M. , Presswalla Feriel , Blakely Pennelope , Bernal-Morell Enrique , Cebreiros López Iria , Eugen-Olsen Jesper , García de Guadiana Romualdo Luis , Giamarellos-Bourboulis Evangelos J. , Loosen Sven H. , Reiser Jochen , Tacke Frank , Skoulakis Anargyros , Laou Eleni , Banerjee Mousumi , Pop-Busui Rodica , Hayek Salim S. ,   on behalf of the International Study of Inflammation in COVID-19 (ISIC) Investigator Group
Published: February 2024

Objectives:

To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.

Design:

Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.

Setting:

Ten academic institutions in the United States and Europe.

Patients:

Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.

Interventions:

Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao
2/Fio
2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao
2/Fio
2 ratio less than or equal to 250.

Measurements and Main Results:

The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group (p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52–0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51–0.90; p = 0.006).

Conclusions:

In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.
Global trends in cutaneous malignant melanoma incidence and mortality
Authors: De Pinto Giuseppe , Mignozzi Silvia , La Vecchia Carlo , Levi Fabio , Negri Eva , Santucci Claudia
Published: February 2024

Mortality from cutaneous malignant melanoma (CMM) increased in the past, but trends have been favorable in more recent years in several high-income countries. However, incidence has been increasing in several countries. We provided an up-to-date overview of mortality trends from CMM. We analyzed death certification data from the WHO in selected countries worldwide from 1980 to the most recent available calendar years. We also reported incidence data derived from Cancer Incidence in Five Continents from 1990 to 2012. Separate analyses were performed for young adults aged 20–44 and middle-aged adults aged 45–64 years. Mortality from CMM in all age groups showed a favorable pattern in the majority of the countries considered. Mortality trends declined by 40 to 50% in Australia over the last decades, confirming the importance of prevention measures. Considering young adults aged 20–44, Australia, New Zealand and Northern Europe reported the highest death rates for both sexes (>0.90/100 000 in men and >0.60/100 000 in women) while Japan, the Philippines, and Latin America the lowest ones (<0.50/100 000 and <0.35/100 000 in men and women, respectively). Incidence trends were stable or upward in most countries, with higher rates among women. Our study highlights a global reduction of CMM mortality over the last three decades. The increasing awareness of risk factors, mainly related to UV exposure, along with early diagnosis and progress in treatment for advanced disease played pivotal roles in reducing CMM mortality, particularly in Australia.
Radiotherapy Results in Locally Advanced Sinonasal Cancer
Authors: Duru Birgi Sümerya , Özkaya Akagündüz Özlem , Dagdelen Meltem , Yazici Gözde , Canyilmaz Emine , Ceylaner Biçakçi Beyhan , Çetinayak Hasan O. , Baltalarli Papatya B. , Demiröz Abakay Candan , Kaydihan Nuri , Delikgöz Soykut Ela , Erdiş Eda , Akyürek Serap , Esassolak Mustafa , Uzel Ömer E. , Bakirarar Batuhan , Cengiz Mustafa
Published: February 2024

Objective:

This study aims to examine the treatment outcomes and related factors in locally advanced sinonasal cancer across Turkiye.

Methods:

Twelve centers participants of the Turkish Society for Radiation Oncology Head and Neck Study Group attended the study. One hundred and ninety-four patients treated with intensity-modulated radiation therapy between 2001 and 2021 were analyzed retrospectively. The survival analysis was performed using the Kaplan-Meier method. Acute and late toxicity were recorded per Common Toxicity Criteria for Adverse Events V4.0.

Results:

The median age was 58 years and 70% were male. The majority of tumors were located in maxillary sinus (59%). Most of the patients (%83) had T3 and T4A disease. Fifty-three percent of patients were in stage 4A. Radiotherapy was administered to 80% of the patients in the adjuvant settings. Median 66 Gy dose was administered in median 31 fractions. Chemotherapy was administered concomitantly with radiotherapy in 45% of the patients mostly with weekly cisplatin. No grade ≥4 acute and late toxicity was observed. The median follow-up was 43 months. The 5-year and 10-year overall survival (OS); locoregional recurrence-free survival (LRFS); distant metastasis-free survival (DMFS), and progression-free survival (PFS) rates were 61% and 47%; 69% and 61%; 72%, and 69%, and 56% and 49%, respectively. In the multivariate analysis, several factors demonstrated significant influence on OS, such as performance status, surgery, and lymph node involvement. Moreover, surgery was the key prognostic factor for LRFS. For DMFS, lymph node involvement and surgical margin were found to be influential factors. In addition, performance status and lymph node involvement were identified as significantly affecting PFS.

Conclusions:

In our study, the authors obtained promising results with IMRT. Performance status, lymph node involvement, and surgery emerged as the primary factors significantly influencing OS.
The impact of leader member exchange quality and differentiation on counterproductive and citizenship behavior in health care teams
Authors: Mitchell Rebecca , Gu Jun , Boyle Brendan
Published: February 2024

Background

Organizational citizenship behavior (OCB) may increase service quality. In contrast, counterproductive work behavior (CWB) may undermine patient safety. Efforts to increase OCB and reduce CWB rely on a good understanding of their antecedents, yet there is a lack of research in health care to inform such endeavors.

Purpose

The aim of this study was to investigate the role of leadership, specifically leader–member exchange (LMX), in reducing CWB and increasing OCB in health care teams.

Methodology/Approach

Team survey data were collected from 75 teams in U.S. health services organizations. Polynomial regression and response surface analysis was used to investigate our hypotheses.

Results

For OCB, the response surface along the line of incongruence (a
3) was positive and significant, and for CWB, a
3 was negative and significant.

Conclusion

The results of polynomial regression and response surface analysis indicate that OCB increases when LMX quality is high and that LMX differentiation is comparatively lower. In contrast, CWB increases when LMX differentiation is high, whereas LMX quality is lower.

Practice Implications

These findings provide useful suggestions to promote valuable extra-role behaviors in health care teams. Health care team leaders should aim to develop strong exchange relationships with all members if they wish to increase citizenship behavior and decrease counterproductive behavior. Building positive exchange relationships with only a few team members is likely to undermine citizenship behavior and increase counterproductive behavior.
Risk Assessment for Workers with Wearable Medical Devices Exposed to Electromagnetic Fields
Authors: Vivarelli Cecilia , Censi Federica , Calcagnini Giovanni , Falsaperla Rosaria , Mattei Eugenio
Published: February 2024

The exponential diffusion of wearable medical devices (WMD) in recent years has involved people of all ages, including workers. Workers who use WMDs should be considered at a particular risk from electromagnetic fields, and in accordance with EU Directive 2013/35/EU, they require an individual risk assessment. Currently, there is no international standard that provides specific guidance on how to perform such a risk assessment. This paper focuses on the effects of electromagnetic fields on WMDs and does not consider the direct effects on human body tissues. It aims to offer practical recommendations to employers and/or health physicists for the risk assessment of workers with WMDs. Focusing on EU countries, we first describe the requirements outlined by the technical standard for the electromagnetic compatibility (EMC) of medical electrical equipment EN 60601-1-2. Then, some general guidelines on how to perform the risk assessment are provided. The assessment can be conducted by comparing the field values measured in the workplace with the immunity test levels specified in the technical standards of medical electrical equipment. If the measured values are lower than the immunity test levels indicated in the standard and the distance from the electromagnetic source is greater than the distance used by the manufacturer during the EMC (electromagnetic compatibility) tests (typically 30 cm), the risk for the worker may be considered acceptable. However, if the measured values exceed the immunity test levels or the distance criteria, a specific evaluation based on a case-by-case analysis is required.
Decommissioning of a Medical Cyclotron Vault: The Case Study of the National Cancer Institute of Milano
Authors: Pola Andrea , Bortot Davide , Pasquato Stefano , Mazzucconi Davide , Chiesa Carlo , Zanellati Fabio , Brusa Anna
Published: February 2024

In the widespread use of medical cyclotrons for isotope production, radiological and economic consequences related to the decommissioning of particle accelerators are often neglected. However, decommissioning regulation and its related procedures always demand efforts and costs that can unexpectedly impact on budgets. The magnitude of this impact depends strongly on the residual radioactivity of the accelerator and of the vault, and more specifically on the kind and activity concentration of residual radionuclides. This work reports and discusses a case study that analyzes in detail the characterization activities needed for optimized management of the decommissioning of a medical cyclotron vault. In particular, this paper presents the activities carried out for assessing the activity concentrations and for guiding the disposal of the cyclotron vault of the Italian National Cancer Institute of Milano (INT). An unshielded 17 MeV cyclotron vault was characterized by high resolution gamma-ray spectrometry both in-situ and in-laboratory on extracted samples. Monte Carlo simulations were also carried out to assess the overall distribution of activation in the vault. After a few months from the final shutdown of the accelerator, activity concentrations in the concrete walls due to neutron activation exceeded the clearance levels in many regions, especially close to the cyclotron target. Due to the relatively long half-lives of some radionuclides, a time interval of about 20 y after the end of bombardment is necessary for achieving clearance in some critical positions. Far from the target or in positions shielded by the cyclotron, activation levels were below the clearance level. The comparison between Monte Carlo simulations and experimental results shows a good agreement. The in-situ measurements, simpler and economically advantageous, cannot completely replace the destructive measurements, but they may limit the number of required samples and consequently the decommissioning costs. The methodology described and the results obtained demonstrated that it is possible to obtain accurate estimations of activity concentrations with cheap and quick in-situ measurements if the concentration profile in-depth inside the wall is well known. This profile can be obtained either experimentally or numerically through suitably validated Monte Carlo simulations.
Complex breast reconstruction using bilateral profunda artery perforator-free-flaps in a resource-limited setting: a case report
Authors: Otieno Daniel O. , Njoroge Ruth W. , Moki Josiah , Okello Alex , Dahir Mohamed
Published: February 2024

Interestingly, the current shift in mastectomy patterns and advances in reconstruction techniques have contributed to an increasing number of patients requesting breast reconstruction postmastectomy every year. Depending on available expertise, patients can access breast reconstruction options (immediate or delayed), autologous, or implant-based. We present a case of a 36-year-old female patient 5 years into remission, having undergone mastectomy for invasive ductal carcinoma of the right breast and now preferred risk reduction surgery (prophylactic mastectomy) of her left unaffected breast with immediate reconstruction. The microsurgical technique utilized bilateral profunda artery perforator flaps from both thighs for (immediate and delayed) breast reconstruction. In our scenario, the authors had an unfavorable outcome on the side of delayed breast reconstruction (right) with a venous insufficiency diagnosis leading to unilateral complete flap loss, which was subsequently debrided and reconstructed with an obliquely-oriented pedicled Latissimus dorsi flap. In contrast, following risk reduction surgery and immediate reconstruction on the left side, the buried flap was a complete success, with the free nipple graft doing well postoperatively.
Success in managing a giant hepatic hydatid cyst: a case report of successful conservative surgical intervention in an endemic setting
Authors: Touati Dheker M. , Khefacha Fahd , Ben Othmane Mohamed R. , Khlifi Nadhem , Jaouad Firas , Idani Marwa , Belhadj Anis , Saidani Ahmed , Chebbi Faouzi
Published: February 2024

Introduction and importance:

Echinococcosis, also known as a hydatid cyst, arises from a parasitic infection caused by the larval form of the tapeworm Echinococcus granulosus in humans. This endemic disease in Tunisia presents a significant public health challenge. The case highlights the enormous size of the liver hydatid cyst, emphasizing the importance and success of conservative surgical treatment.

Case Presentation:

A 45-year-old female shepherdess presented with abdominal pain and a mass, diagnosed as a giant hepatic hydatid cyst. A computed tomography scan revealed a dysmorphic liver with a large multivesicular cyst. Surgical intervention included the resection and closure of multiple cystic fistulas. Postoperative recovery was uneventful and at the 6-month follow-up, the patient displayed no indications of recurrence.

Clinical discussion:

Echinococcosis, prevalent in livestock-farming regions, primarily affects the liver and lungs. It often remains asymptomatic, detected incidentally. Diagnosis relies on imaging, with surgical excision as the primary treatment. Percutaneous options exist but are less effective. Serologies are underused. Management challenges include complications and recurrence. Conservative surgery is common but faces complications. Radical surgery is more effective, albeit complex. Albendazole preoperatively proves promising, reducing cyst viability. Regular follow-up is crucial for recurrence detection.

Conclusion:

Managing giant hepatic hydatid cysts requires tailored approaches, especially in endemic regions. Our success with conservative surgical treatment highlights its effectiveness in confronting formidable cyst sizes, informing clinical practice, and contributing to the medical literature.
Accuracy of the KOROT P3 Accurate automated auscultatory blood pressure measuring device for professional use in people with extra-large arms
Authors: Fania Claudio , Giletto Antonella , Niero Alice , Palatini Paolo
Published: February 2024

Objective

To determine the accuracy of the KOROT P3 Accurate (previously InBody BPBIO480KV) monitor, an automated auscultatory blood pressure (BP) measuring device developed for professional use, in people with extra-large arms according to the ISO81060-2 2018 protocol.

Methods

The KOROT P3 Accurate was tested in 37 subjects with upper-arm circumference ranging from >42 to 53 cm using a mercury sphygmomanometer coupled to a 20 × 40 cm tronco-conical cuff as the reference standard.

Results

The mean BP difference between the device and the observers’ reference measurements was 1.2 ± 2.0 mmHg for systolic BP and 1.0 ± 2.0 mmHg for diastolic BP. These data were in agreement with criterion 1 of the protocol standard requirements (≤5 ± 8 mmHg). Also criterion 2 was satisfied being the standard deviations ± 1.7 mmHg for systolic BP and ± 1.6 for diastolic BP, well below the maximum values required by the protocol (±6.84/6.87 mmHg). Scatterplots of device-reference systolic and diastolic BP differences showed similar accuracy across the range of participants’ BP, arm circumference and upper-arm slant angle.

Conclusions

These data show that the KOROT P3 Accurate monitor satisfied the ISO 81060-2:2018 standard requirements in a special population of people with extra-large arms ranging from >42 to 53 cm.
Time-series analysis of hematopoietic stem cells
Authors: Han Jingjing , Duan Shuangshuang , Li Ya , Xin Chunlei
Published: February 2024

This study aimed to investigate the molecular mechanisms underlying the aging of hematopoietic stem cells (HSCs). Gene expression profile GSE32719 was downloaded from the Gene Expression Omnibus database, including 14 young, 5 middle, and 8 old HSCs. Differential expression analysis, short time-series expression miner analysis, and weighted co-expression network analysis were conducted to screen for hub genes whose expression changed over time during HSC aging. Subsequently, functional enrichment and multiple regulatory network analyses of the hub genes were performed. A total of 124 intersecting time-dependent differentially expressed and module genes were obtained, which were considered hub genes whose expression changed over time during HSC aging. Hub genes were significantly enriched in pathways such as the Hippo and AMP-activated protein kinase (AMPK) signaling pathways. Moreover, AP-1 Transcription Factor Subunit (FOS) and sirtuin 1 (SIRT1) had higher degrees in the protein-protein interaction network, were regulated by more transcription factors (TFs), such as Sp1 transcription factor (SP1) and BRCA1 DNA repair-associated (BRCA1), in the TF-mRNA-miRNA network, were associated with more diseases in the disease-gene network, and could be targeted by more drugs in the drug-gene network. Furthermore, SIRT1 was targeted by miR-9-5p in the TF-mRNA-miRNA network. Hub genes such as FOS and SIRT1 and key pathways such as the Hippo and AMPK signaling pathways may play crucial roles in HSC aging. Moreover, FOS and SIRT1 were regulated by SP1 and BRCA1, respectively, during HSC aging. Furthermore, miR-9-5p may modulate HSC aging by targeting SIRT1. Thus, FOS and SIRT1 may be potential therapeutic targets for age-related hematopoietic dysfunction.
Status epilepticus resulted in rhabdomyolysis-induced AKI associated with hepatotoxicity induced by synergistic carbamazepine and diazepam: A case report
Authors: Soliman Nawwar , Alsultan Mohammad , Alhusseini Ayham , Alsamarrai Omar , Basha Kassem
Published: February 2024

Rationale:

Rhabdomyolysis is a serious complication of status epilepticus (SE) caused by muscle cell damage and can lead to a life-threatening acute kidney injury (AKI).

Patient concerns:

A 35-year-old man with a history of seizures treated with 3 different antiepileptic drugs (carbamazepine, lamotrigine, and levetiracetam) presented with SE. The patient received 5 doses of diazepam to control the SE in another hospital and was transferred to our emergency due to AKI.

Diagnoses:

Laboratory tests corresponded with rhabdomyolysis-induced AKI and disseminated intravascular coagulation. Thereafter, the decrease in renal excretion of both drugs (diazepam and carbamazepine) caused acute liver injury and neurotoxicity. The carbamazepine concentration was 16.39 mcg/mL, which considered in toxic level, despite using the usual dose.

Interventions:

The patient was treated with hydration and sodium bicarbonate, however; severe AKI mandated a hemodialysis session.

Outcomes:

The diuresis started to increase, kidney and liver functions improved, and altered mental status reversed.

Lessons:

This case alerts physicians to consider the synergistic drug side effects and interactions, especially when patients present with impaired liver or kidney functions. The reduction in metabolism or excretion of drugs can cause an increase in serum concentrations and induce toxicity, even when the drug intake at the usual dose.
Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis
Authors: Mughal Hamdah Bashir , Majeed Ayesha Isani , Aftab Maria , Ubaid Muhammad Furqan , Zahra Sabahat , Abbasi Muhammad Sajid Rafiq , Qadir Mamoon , Ahmad Mumtaz , Akbar Amna , Tasneem Sabahat , Jadoon Sarosh Khan , Tariq Maham , Hussain Saddam , Khandker Shahad Saif , Alvi Sarosh
Published: February 2024

Background:

Acute heart failure (AHF) is one of the most common cardiovascular diseases. Early diagnosis and prognosis are essential, as they can eventually lead to a fatal condition. Recently, brain natriuretic peptide (BNP) has been recognized as one of the most popular biomarkers for AHF. Changes in glomerular filtration rate (GFR) are often observed in AHF.

Methods:

We searched PubMed, Google Scholar, and ScienceDirect between March and June 2023. Original case control studies written in English that assessed levels oh BNP in AHF were included. Systematic reviews, letters to editor, correspondence, comprehensive reviews, and duplicated studies were excluded. Funnel plots were constructed to assess publication bias.

Results:

A total of 9 studies were selected and we obtained the mean difference (MD) of BNP level to be 2.57 (95% CI: 1.35, 3.78), and GFR to be −15.52, (95% CI: −23.35, −7.70) in AHF patients. Sensitivity analyses supported the robustness of the outcome.

Conclusion:

Results indicated that BNP was a promising prognostic biomarker of AHF, whereas GFR was found to be negatively correlated with AHF.
The investigation of cytotoxic and apoptotic activity of Cl-amidine on the human U-87 MG glioma cell line
Authors: Öğüten Pinar Naile , Engür Öztürk Selin , Dikmen Miriş
Published: February 2024

Background:

Peptidyl (protein) arginine deiminases (PADs) provide the transformation of peptidyl arginine to peptidyl citrulline in the presence of calcium with posttranslational modification. The dysregulated PAD activity plays an important role on too many diseases including also the cancer. In this study, it has been aimed to determine the potential cytotoxic and apoptotic activity of chlorine-amidine (Cl-amidine) which is a PAD inhibitor and whose effectiveness has been shown in vitro and in vivo studies recently on human glioblastoma cell line Uppsala 87 malignant glioma (U-87 MG) forming an in vitro model for the glioblastoma multiforme (GBM) which is the most aggressive and has the highest mortality among the brain tumors.

Methods:

In the study, the antiproliferative and apoptotic effects of Cl-amidine on GBM cancer model were investigated. The antiproliferative effects of Cl-amidine on U-87 MG cells were determined by 4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate method at the 24th and 48th hours. The apoptotic effects were analyzed by Annexin V and Propidium iodide staining, caspase-3 activation, and mitochondrial membrane polarization (5,5’, 6,6’-tetrachloro-1,1’, 3,3’ tetraethyl benzimidazolyl carbocyanine iodide) methods in the flow cytometry.

Results:

It has been determined that Cl-amidine exhibits notable antiproliferative properties on U-87 MG cell line in a time and concentration-dependent manner, as determined through the 4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate assay. Assessment of apoptotic effects via Annexin V and Propidium iodide staining and 5,5’, 6,6’-tetrachloro-1,1’, 3,3’ tetraethyl benzimidazolyl carbocyanine iodide methods has revealed significant efficacy, particularly following a 24-hour exposure period. It has been observed that Cl-amidine induces apoptosis in cells by enhancing mitochondrial depolarization, independently of caspase-3 activation. Furthermore, regarding its impact on healthy cells, it has been demonstrated that Cl-amidine shows lower cytotoxic effects when compared to carmustine, an important therapeutic agent for glioblastoma.

Conclusion:

The findings of this study have shown that Cl-amidine exhibits significant potential as an anticancer agent in the treatment of GBM. This conclusion is based on its noteworthy antiproliferative and apoptotic effects observed in U-87 MG cells, as well as its reduced cytotoxicity toward healthy cells in comparison to existing treatments. We propose that the antineoplastic properties of Cl-amidine should be further investigated through a broader spectrum of cancer cell types. Moreover, we believe that investigating the synergistic interactions of Cl-amidine with single or combination therapies holds promise for the discovery of novel anticancer agents.
External treatment of traditional Chinese medicine for cancer pain: A systematic review and network meta-analysis
Authors: Jin Hong , Liang Ji , Zhang Siqi , Ma Shuai , Qin Hongyu , Zhang Dongxu , Pang Xueying , Zhang Miao
Published: February 2024

Background:

Cancer pain is one of the most intolerable and frightening symptoms of cancer patients. However, the clinical effect of the three-step analgesic ladder method (TSAL) is not satisfactory. The combination of external treatment of traditional Chinese medicine (TCM) can improve the clinical effect.

Objective:

This study used network meta-analysis to compare the effects of different external treatment methods of TCM combined with TSAL on cancer pain.

Methods:

Databases searched by our team included Google Scholar, Web of Science, Scopus, Embase, PubMed, and Cochrane Library. Randomized controlled trials related to the external treatment of TCM combined with TSAL for cancer pain were screened from the establishment of the database till now. The above literature extracted clinical efficacy, NRS score, KPS score, analgesic onset time, and duration as the main results after the screening. The 95% confidence interval (95% CI) of OR value and SMD value was used as the effect index to compare the difference in efficacy of different interventions, and the ranking was conducted. STATA 17.0 software was used for the statistical analysis of the above data.

Results:

A total of 78 studies were included, including 8 interventions and 5742 participants. Based on ranking probability, the clinical effective rate of manual acupuncture combined with TSAL was the best when the intervention time was set at 4 weeks [OR = 5.42, 95% CI (1.99,14.81)], and the improvement effect on KPS score was also the best [SMD = 0.97, 95% CI (0.61, 1.33)]. Acupoint external application was the best intervention in reducing NRS score [SMD = −1.14, 95% CI (−1.90, −0.93)]. Acupoint moxibustion combined with TSAL was considered to be the most effective intervention to prolong the duration of analgesia [SMD = 1.69, 95% CI (0.84, 2.54)] and shortening the onset time of analgesia [SMD = −3.00, 95% CI (−4.54, −1.47)].

Conclusions:

TSAL combined with manual acupuncture is the best in terms of clinical efficacy and improvement of patients’ functional activity status. With the extension of treatment time, the intervention of this kind of treatment on the clinical effect is more pronounced. Acupoint external application also has a unique advantage in reducing the pain level of patients. From the point of view of analgesic duration and duration of analgesia, combined acupoint moxibustion has the best effect.