bluuebunny/crossref_metadata_2025 huggingface dataset:
Solitons in openN= 2 string theory
Authors: Hamanaka Masashi , Huang Shan-Chi , Kanno Hiroaki
Published: April 2023

The open N = 2 string theory is defined on the 4D space-time with the split signature (+, +, −, −). The string field theory action of the open N = 2 string theory is described by the 4D Wess–Zumino–Witten (WZW4) model. The equation of motion of the WZW4 model is the Yang equation, which is equivalent to the anti-self-dual Yang–Mills equation. In this paper, we study soliton-type classical solutions of the WZW4 model in the split signature by calculating the action density of the WZW4 model. We find that the action density of the one-soliton solutions is localized on a 3D hyperplane. This shows that there would be codimension-one-solitonic objects, or equivalently some kind of three-branes in the open N = 2 string theory. We also prove that, in the asymptotic region of the space-time, the action density of the n-soliton solutions is a “non-linear superposition” of n one-solitons. This suggests the existence of n intersecting three-branes in the N = 2 strings. Finally we make a reduction to a (1 + 2)D real space-time to calculate the energy densities of the soliton solutions. We can successfully evaluate the energy distribution for the two-soliton solutions and find that there is no singularity in the interacting region. This implies the existence of smooth intersecting codimension-one branes in the whole region. Soliton solutions in the Euclidean signature are also discussed.
Application of photocrosslinkable hydrogels based on photolithography 3D bioprinting technology in bone tissue engineering
Authors: Gao Jianpeng , Liu Xiao , Cheng Junyao , Deng Junhao , Han Zhenchuan , Li Ming , Wang Xiumei , Liu Jianheng , Zhang Licheng
Published: April 2023

Bone tissue engineering (BTE) has been proven to be an effective method for the treatment of bone defects caused by different musculoskeletal disorders. Photocrosslinkable hydrogels (PCHs) with good biocompatibility and biodegradability can significantly promote the migration, proliferation and differentiation of cells and have been widely used in BTE. Moreover, photolithography 3D bioprinting technology can notably help PCHs-based scaffolds possess a biomimetic structure of natural bone, meeting the structural requirements of bone regeneration. Nanomaterials, cells, drugs and cytokines added into bioinks can enable different functionalization strategies for scaffolds to achieve the desired properties required for BTE. In this review, we demonstrate a brief introduction of the advantages of PCHs and photolithography-based 3D bioprinting technology and summarize their applications in BTE. Finally, the challenges and potential future approaches for bone defects are outlined.
P207 External validation of the Southend giant cell arteritis pre-test probability score in a Dorset fast-track clinic
Authors: Carroll James , Griffith Flynn , Fox Christine , Khurshid Muhammad
Published: April 2023

Background/Aims

Giant cell arteritis (GCA) is a common referral to rheumatology departments and timely and accurate diagnosis is important to prevent ischaemic complications. The current BSR and EULAR guidelines support the use of temporal and axillary artery ultrasound for ruling out GCA in low-probability cases or for confirming GCA in high-probability cases. The Southend GCA pre-test probability score (PTPS) is a tool that can be used to risk-stratify patients and guide the need for additional investigations. Previous publications have categorised patients as low-risk (PTPS <9), intermediate-risk (PTPS 9-12) and high-risk (PTPS >12). We aimed to provide external validation of the Southend PTPS by assessing its performance in patients attending the fast-track GCA clinic at Poole Hospital.

Methods

Between 5th January 2018 and 17th June 2022, 576 patients were seen in the GCA fast-track clinic at Poole Hospital and 506 (87.8%) had a calculated PTPS. Patients were diagnosed with ‘confirmed GCA’, ‘possible GCA’, ‘probable GCA’, ‘presumed GCA’, ‘not GCA’, or ‘large vessel vasculitis’ based on clinical, laboratory, ultrasound, biopsy or additional imaging. For the purpose of this analysis, we included only those patients who were diagnosed with ‘confirmed GCA’ (86 patients) or ‘not GCA’ (319 patients). A PTPS ≥9 was used to calculate the sensitivity, specificity, positive and negative predictive values for a diagnosis of GCA.

Results

The mean age of patients with ‘confirmed GCA’ in our cohort was 78.8 years and the percentage who were female was 72.1%. A PTPS ≥9 had a sensitivity of 97.7% and specificity of 63% for a diagnosis of GCA. The positive predictive value was 41.6% and negative predictive value was 99%.

Conclusion

Our results show that the Southend PTPS can be used to risk stratify patients into high- and low-risk groups and validates the PTPS outside the centre in which it was developed. Our results are comparable to those published by other external centres. The high negative predictive value of the test suggests it is particularly helpful in ruling out GCA and could conceivably have a role in screening referrals to the fast-track clinic; however, further work would be needed to determine the optimal cut-off score.

Disclosure

J. Carroll: None. F. Griffith: None. C. Fox: None. M. Khurshid: None.
E007 Is there an urgent need to change the methotrexate monitoring guidelines to incorporate fibroscan?
Authors: Ramalingam Satheekshan , Sayed Mostafa , Alam Syed , Makkuni Damodar
Published: April 2023

Background/Aims

Methotrexate (MTX) is a widely used DMARD for which routine blood monitoring is required to identify hepatotoxicity and bone marrow suppression. Despite routine monitoring and normal liver function tests some patients develop hepatic fibrosis. Transient elastography (fibroscan) offers an excellent non-invasive approach to measure the stiffness of the liver as a form of assessing hepatic fibrosis and would prove extremely useful to monitor the effects of MTX in our patient groups.

Methods

A retrospective study was conducted between January 2021 and August 2022. Inflammatory arthritis patients who have been on MTX for more than five years were selected for the study. Their fibroscan results were obtained and their median value (kilopascals), if they had an ultrasound in the past showing cirrhosis, metabolic risk factors such as obesity (BMI>30), presence of type 2 diabetes and alcohol consumption (>14 units/week) were recorded from their clinic letters.

Results

Of the 56 patients, there were 18 males and 38 females. 29% of the patients had a median fibroscan value of more than 7 kpa (n = 16). Of these 16 patients, 50% of the patients had a metavir score of F2 (n = 8), 25% of the patients had a metavir score of F3 (n = 4) and 25% of the patients had a metavir score of F4 (n = 4). Of the 16 patients (11 RA and 5 PSA) with high median value, 46% had a BMI > 30 kg/m2 (n = 7), 13% had a diagnosis of type 2 diabetes mellitus (n = 2) and none of the patients had consumed more than 14 units/week of alcohol. Of the 16 patients with high median value, 12% (n = 2) had a diagnosis of cirrhosis on ultrasound. One patient had extremely high median value of 26 had underlying ILD, right heart failure and possible cardiac cirrhosis. 1 patient had developed frank cirrhosis and the high fibroscan results were noted subsequently. For all the patients with high metavir score of F4 and above, MTX therapy was discontinued.

Conclusion

A significant percentage of the cohort (29%) had a high median value above 7 of which 25% of the patients had F4 fibrosis despite having normal liver function tests. The study illustrates the need for a different modality in addition to the routine blood monitoring for the patients on MTX with metabolic risk factors. Therefore, it is vital to obtain a baseline fibroscan in high-risk patient group with preexisting metabolic risk factors prior to initiating MTX therapy and monitor every 5 years thereafter. This will help the clinician to safely continue MTX in this group of patients without the fear of worsening liver fibrosis.

Disclosure

S. Ramalingam: None. M. Sayed: None. S. Alam: None. D. Makkuni: None.
E019 A case of RS3PE triggered by immune check point inhibitor
Authors: Ramachandran Deepak , Mushtaq Warda , Makkuni Damodar
Published: April 2023

Background/Aims

Immune checkpoint inhibitors (ICIs) are increasingly being used in oncology and there is growing evidence of rheumatological problems arising in these group of patients. ICIs have been approved for the treatment of several cancers including non-small cell lung cancer, renal cell carcinoma, Hodgkin lymphoma and other malignancies. Pembrolizumab, an anti-PD1, is known to cause inflammatory arthritis in some patients, and we report a case of relapsing-remitting synovitis with pedal oedema (RS3PE) in a patient with lung cancer.

Methods

A 67-year-old lady was diagnosed with adenocarcinoma in her left lung with pleural and pulmonary metastasis. She was commenced on carboplatin, pemetrexed and pembrolizumab initially for 4 cycles followed by pembrolizumab maintenance therapy for another 2 years. However, while on pembrolizumab therapy, she started to develop intermittent pain and swelling in her small joints of the hands and feet. There was marked pitting pedal oedema extending up to the knee along with swelling of the dorsum of the hand. She had intermittent swelling in the knee joints as well.

Results

The blood tests were negative for rheumatoid factor, anti-CCP and ANA. The CRP was markedly raised (120) from her previous values since she started developing joint symptoms. The kidney and liver function tests were within normal limits. A CT chest, abdomen pelvis was done which did not reveal any metastasis or progression of lung cancer.

At the time of the review she was started on prednisolone 20mg once daily. Following this, the joint pain and swelling started to resolve, and the patient was advised to taper the steroids gradually. The pembrolizumab therapy was stopped few months later. The pedal oedema resolved within a few weeks of starting steroids and the joint inflammation settled after stopping the treatment.

Conclusion

ICI therapy has been known to trigger inflammatory arthropathy like RA. Psoriatic arthritis, undifferentiated monoarthritis and oligoarthritis, RS3PE and tenosynovitis have also been reported. Most published cases are mild to moderate in severity often responding to corticosteroids. Several patients have been treated with traditional DMARDs and biologics. RS3PE syndrome could be part of the paraneoplastic process but the onset of symptoms after starting pembrolizumab and rapid resolution after stopping the treatment indicates that this is likely a drug-induced adverse effect.

Disclosure

D. Ramachandran: None. W. Mushtaq: None. D. Makkuni: None.
E035 An evaluation of the causes and outcomes of haemophagocytic lymphohistiocytosis in Sheffield Teaching Hospitals: 2016 to 2021
Authors: Awdas Bethany , Nadin Thomas , Tattersall Rachel
Published: April 2023

Background/Aims

Haemophagocytic lymphiohistiocytosis (HLH) is a rare, underrecognised hyperinflammatory syndrome, characterised by immune dysregulation. Without treatment, the ensuing cytokine storm leads to high mortality. Secondary HLH (sHLH) is triggered by malignancy, infection, autoimmunity and medicines; treatment with immunosuppression is consensus- rather than evidence-based and extrapolated from primary HLH. Sheffield hosts a mature HLH multidisciplinary advisory group (MDAG). Here we evaluate the cause, treatment, requirement for critical care and mortality of people with HLH managed through the MDAG in a period including the coronavirus pandemic but prior to NHS England approval of anakinra (IL-1 antagonist) for HLH.

Methods

This retrospective evaluation (approved locally STH 10850) identified patients from MDAG records 1st October 2016 to 30th September 2021. Data from electronic/paper records was analysed using Microsoft Excel.

Results

HLH triggers were infection (viral 34%, bacterial 10%), haematological (35%), rheumatological (13%) and other (8%). Rheumatological causes were Still’s disease (n = 5); antiphospholipid syndrome (n = 2); JO1 dermatomyositis (n = 1); SLE (n = 1); and rheumatoid arthritis (n = 1). Other causes included unknown (n = 3); combined systemic JIA and sickle cell crisis (n = 1); medication (alemtuzumab) (n = 1); and primary HLH (n = 1). Overall mortality was 53% and highest in HLH with a haematological malignancy trigger (82%) Prior to the COVID19 pandemic (pre-March 2020), the commonest trigger of HLH was haematological malignancy (47%); after March 2020, the commonest trigger was infection (64%); COVID-19 explained 42% of cases. Mortality fell from 72% to 31%.

Conclusion

In this real-world series of people with HLH, mortality and critical care requirement was high. HLH triggers reflect published evidence as does poor prognosis in haematological malignancy-associated HLH. No-HLH associated with non-haematological malignancy was identified; we may need to improve MDAG reach into oncology. Seeming reduction in mortality following the COVID-19 pandemic may reflect increased recognition of COVID-19 induced hyperinflammation along with locally-agreed access to anakinra for COVID-19-induced HLH. The increase in infection related HLH cases since March 2020 is explained largely by COVID-19 cases. This has led to a relative reduction in cases related to haematological malignancy. HLH requires multidisciplinary management and better research to improve treatment.

Disclosure

B. Awdas: None. T. Nadin: None. R. Tattersall: None.
Which extra-renal flare is ‘difficult to treat’ in systemic lupus erythematosus? A one-year longitudinal study comparing traditional and machine learning approaches
Authors: Maffi Michele , Tani Chiara , Cascarano Giancarlo , Scagnellato Laura , Elefante Elena , Stagnaro Chiara , Carli Linda , Ferro Francesco , Signorini Viola , Zucchi Dina , Cardelli Chiara , Trentin Francesca , Collesei Antonio , Mosca Marta
Published: April 2023

Objectives

To describe phenotypes and outcomes of extra-renal flares in SLE, to identify clusters of extra-renal flares based on baseline features, and to develop a machine learning (ML) tool capable of predicting ‘difficult to treat’ (D2T) flares.

Methods

Extra-renal flares that occurred in our cohort over the last five years with at least one year of follow-up were included. Baseline clinical variables were described and flares assigned to clusters. Attainment of remission and low disease activity state (LLDAS) at 12 months were compared. Flares were then considered ‘D2T’ in case of non-attainment of LLDAS at 6 and 12 months. Baseline features were used to train a ML model able to predict future D2T-flares, at admission. Traditional approaches were then compared with informatic techniques.

Results

Among 420 SLE patients of the cohort, 114 flares occurred between 2015 and 2021; 79 extra-renal flares, predominantly mucocutaneous (24.1%) and musculoskeletal (45.6%), were considered. After 12 months, 79.4% and 49.4% were in LLDAS and in remission, respectively, while 17 flares were classified as D2T (21.5%); D2T flares received a higher cumulative and daily dose of glucocorticoids. Among the clusters, cluster ‘D’ (mild-moderate flares with mucocutaneous manifestations in patients with history of skin involvement) was associated with the lowest rate of remission. Among clinical data, not being on LLDAS at 3 months was the unique independent predictor of D2T flares.

Conclusions

Our clusterization well separates extra-renal flares according to their baseline features and may propose a new identification standard. D2T flares, especially refractory skin manifestations, are frequent in SLE and represent an unmet need in the management of the disease as they are associated with higher glucocorticoid (GC) dosage and risk of damage accrual. Our ML model could help in the early identification of D2T flares, flagging them to elevate the attention threshold at admission.
The diagnostic value of sST2 for myocardial fibrosis in idiopathic inflammatory myopathies in subclinical stage of cardiac involvement
Authors: Sun Jianhong , Xu Yuanwei , Wu Yang , Sun Jiayu , Yin Geng , Chen Yucheng , Xie Qibing
Published: April 2023

Objective

Myocardial fibrosis occurs in the early subclinical stage of cardiac involvement in idiopathic inflammatory myopathies (IIMs). Soluble suppression of tumorigenicity 2 (sST2) is known to have an immunomodulatory impact during autoimmune disease development. The current study investigated the diagnostic value of sST2 for myocardial fibrosis during early stage of cardiac involvement in IIM.

Methods

A total of 44 IIM patients with normal heart function and 32 age- and gender-matched healthy controls (HCs) were enrolled. Serum sST2 levels were measured by ELISA and cardiac magnetic resonance (CMR) parameters for myocardial fibrosis [native T1, extracellular volume (ECV), late-gadolinium enhancement (LGE)] and oedema (T2 values) were analysed.

Results

IIM patients had significantly higher sST2 levels than HCs [67.5 ng/ml (s.d. 30.4)] vs 14.4 (5.5), P < 0.001] and levels correlated positively with diffuse myocardial fibrosis parameters, native T1 (r = 0.531, P = 0.000), ECV (r = 0.371, P = 0.013) and focal myocardial fibrosis index and LGE (r = 0.339, P = 0.024) by Spearman’s correlation analysis. sST2 was an independent predictive factor for diffuse and focal myocardial fibrosis after adjustment for age, gender, BMI and ESR. Risk increased ≈15.4% for diffuse [odds ratio (OR) 1.154 (95% CI 1.021, 1.305), P = 0.022] and 3.8% for focal [OR 1.038 (95% CI 1.006, 1.072), P = 0.020] myocardial fibrosis per unit increase of sST2. Cut-off values for diagnosing diffuse and focal myocardial fibrosis were sST2 ≥51.3 ng/ml [area under the curve (AUC) = 0.942, sensitivity = 85.7%, specificity = 98.9%, P < 0.001] and 53.3 ng/ml (AUC = 0.753, sensitivity = 87.5%, specificity = 58.3%, P < 0.01), respectively.

Conclusion

sST2 showed a marked elevation during the subclinical stage of cardiac involvement in IIM and has potential as a biomarker for predicting diffuse and focal myocardial fibrosis in IIM.
Meta-Analytic Modeling of the Severity–Yield Relationships in Soybean Frogeye Leaf Spot Epidemics
Authors: Barro Jhonatan P. , Del Ponte Emerson M. , Allen Tom , Bond Jason P. , Faske Travis R. , Hollier Clayton A. , Kandel Yuba R. , Mueller Daren S. , Kelly Heather M. , Kleczewski Nathan M. , Ames Keith A. , Price Paul , Sikora Edward J. , Bradley Carl A.
Published: April 2023

Frogeye leaf spot (FLS), caused by Cercospora sojina, is an important foliar disease affecting soybean in the United States. A meta-analytic approach including 39 fungicide trials conducted from 2012 to 2021 across eight states (Alabama, Arkansas, Illinois, Iowa, Kentucky, Louisiana, Mississippi, Tennessee) was used to assess the relationship between FLS severity and soybean yield. Correlation and regression analyses were performed separately to determine Fisher’s transformation of correlation coefficients (Zr), intercept (β0) and slope (β1). Disease pressure (low severity, ≤34.5; high severity, >34.5%) and yield class (low, ≤3,352; high, >3,352 kg/ha) were included as categorical moderators. Pearson’s [Formula: see text], obtained from back-transforming the [Formula: see text]r estimated by an overall random-effects model, showed a significant negative linear relationship between FLS severity and yield ([Formula: see text] = −0.60). The [Formula: see text]r was affected by disease pressure (P = 0.0003) but not by yield class (P = 0.8141). A random-coefficient model estimated a slope of −19 kg/ha for each percent severity for a mean attainable yield of 3,719.9 kg/ha. Based on the overall mean (95% CI) of the intercept and slope estimated by the random-coefficients model, the estimated overall relative damage coefficient was 0.51% (0.36 to 0.69), indicating that a percent increase in FLS severity reduced yield by 0.51%. The best model included yield class as a covariate, and population-average intercepts differed significantly between low (3,455.1 kg/ha) and high (3,842.7 kg/ha) yield classes. This highlights the potential impact of FLS on soybean yield if not managed and may help in disease management decisions.
Ten Questions to Guide Learners Seeking Equitable Global Health Experiences Abroad
Authors: Reynolds Christopher W. , Kolars Joseph C. , Bekele Abebe
Published: April 2023

“Global health experiences,” clinical and research learning opportunities where learners from high-income country (HIC) institutions travel to low- and middle-income countries (LMICs), are becoming increasingly popular and prolific in the health sciences. Increased interest has been well documented among medical, pharmacy, and nursing learners who are driving these agendas at their institutions. Although such opportunities have potential to mutually benefit the learner and host, in practice they can be exploitative, benefiting HIC learners without reciprocity for LMIC hosts. Given these and other pervasive ethical concerns in global health, efforts to decolonize global health and emphasize equity are being made at the institutional level. Despite progress toward global health equity from institutions, most learners lack the resources and education needed to critically evaluate the numerous global health opportunities or equitably codesign these experiences for themselves.

This article offers 10 guiding questions that learners should answer before selecting or codesigning a global health opportunity through a lens of global health equity. These prompts encompass values including motivations, reciprocity, accountability, sustainability, financial implications, self-reflection, bidirectional communication, and mitigating burden and power dynamics. The authors provide tips, pitfalls to avoid, and pragmatic examples for learners working to actualize partnerships and opportunities aligned with the movement of global health equity. With these guiding questions and accompanying reflection tool, learners, faculty members, and their LMIC partners should be better equipped to engage in mutually beneficial partnership through the framework of global health equity.
Vasopressin Use in the Support of Organ Donors: Physiological Rationale and Review of the Literature
Authors: Ouerd Sofiane , Frenette Anne Julie , Williamson David , Serri Karim , D’Aragon Frederick , Bichet Daniel G. , Charbonney Emmanuel
Published: April 2023

OBJECTIVES:

The objective of this review was to depict the physiological and clinical rationale for the use of vasopressin in hemodynamic support of organ donors. After summarizing the physiological, pharmacological concepts and preclinical findings, regarding vasopressin’s pathophysiological impacts, we will present the available clinical data.

DATA SOURCES:

Detailed search strategies in PubMed, OVID Medline, and EMBASE were undertaken using Medical Subject Headings and Key Words.

STUDY SELECTION:

Physiological articles regarding brain death, and preclinical animal and human studies about the use of vasopressin or analogs, as an intervention in organ support for donation, were considered.

DATA EXTRACTION:

Two authors independently screened titles, abstracts, and full text of articles to determine eligibility. Data encompassing models, population, methodology, outcomes, and relevant concepts were extracted.

DATA SYNTHESIS:

Following brain death, profound reduction in sympathetic outflow is associated with reduced cardiac output, vascular tone, and hemodynamic instability in donors. In addition to reducing catecholamine needs and reversing diabetes insipidus, vasopressin has been shown to limit pulmonary injury and decrease systemic inflammatory response in animals. Several observational studies show the benefit of vasopressin on hemodynamic parameters and catecholamine sparing in donors. Small trials suggest that vasopressin increase organ procurement and have some survival benefit for recipients. However, the risk of bias is overall concerning, and therefore the quality of the evidence is deemed low.

CONCLUSIONS:

Despite potential impact on graft outcome and a protective effect through catecholamine support sparing, the benefit of vasopressin use in organ donors is based on low evidence. Well-designed observational and randomized controlled trials are warranted.
From Theory to Practice: The Enacted Curriculum of a Successful Master's Program in Quality Improvement and Leadership
Authors: Stevenson Katherine , Thor Johan , D'Eon Marcel , Headrick Linda , Andersson Gäre Boel
Published: April 2023

Introduction:

Blended learning has taken on new prominence in the fields of higher and continuing education, especially as programs have shifted in response to teaching in a global pandemic. The faculty at the Jönköping Academy's Masters in Quality Improvement and Leadership program has been offering a blended learning curriculum, based on four core design principles, since 2009. We studied key features of the enacted curriculum to understand conditions that can support an effective blended learning model.

Methods:

We used a case study approach underpinned by interactive research. Document analysis, a focus group, individual interviews, and stimulated recall interviews were used for data collection. Themes were identified through qualitative content analysis and data reduction, data display, and conclusion drawing.

Results:

We grouped data into six emergent themes that clarify the enacted curriculum of an established Master's program: focusing on a common purpose, developing technical and relational knowledge and skills, linking theory and practice in the workplace, leveraging collaboration for mutual benefit, concentrating on leadership and coaching, and applying a blended and interprofessional learning model.

Conclusion:

Educators faced with increased demands to be flexible and to offer opportunities for distance education can learn from this case example of effective teaching of quality improvement and leadership in a blended format.
Fractional CO2 Laser versus Fractional CO2 Laser Plus Betamethasone/Calcipotriol Ointment in the Treatment of Nail Psoriasis
Authors: El Sharkawy Dina A. , EL-Komy Mohamed H.M. , Sobhi Rehab M. , Abdel Raouf Noura M. , Fahim Aya
Published: April 2023

BACKGROUND

Nail psoriasis has a major negative impact on the physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of the difficult penetration of the drug into the nail.

OBJECTIVE

To compare the efficacy of fractional CO2 laser monotherapy versus combined fractional CO2 laser and calcipotriol/betamethasone ointment preparation in treatment of nail psoriasis.

PATIENTS AND METHODS

Thirty patients with nail psoriasis with at least 2 affected fingernails were recruited for this study. Target NAPSI (tNAPSI) score was calculated at the start of the study and at 3 months after the last laser session. One affected fingernail of each patient received 6 sessions of fractional CO2 laser with 4-week intervals. Another affected fingernail of each patient received topical betamethasone/calcipotriol ointment once daily in addition to the 6 fractional CO2 laser sessions.

RESULTS

In the monotherapy group, there was significant improvement in the nail matrix score, nail bed score, and tNAPSI score. In the combined therapy group, there was significant improvement in nail bed score and tNAPSI score, but nail matrix score showed no statistically significant improvement. Overall, there was no statistically significant difference between the 2 studied groups.

CONCLUSION

Fractional CO2 laser can be an effective and promising new treatment for nail psoriasis.
Columellar Reconstruction in Patients with Philtrum Scars: Kalender (Fasciocutaneous Philtrum) Flap
Authors: Kalender (Galandarov) Vagif , Guliyeva Gunel , Galandarova Aysuna
Published: April 2023

Multiple techniques have been proposed for columellar reconstruction. However, in our patients with philtrum scars, none of them were promising a satisfactory outcome in one stage. Therefore, to achieve the best results in a single-stage surgery, we used a modification of the philtrum flap to repair the columella, named the Kalender (fasciocutaneous philtrum island) flap. Nine patients were operated on using this technique. The male-to-female ratio was 2:1, with a mean age of 22. The mean follow-up period was 12 months. Patient satisfaction and postoperative complications were assessed postoperatively and at all follow-ups using a five-point Likert scale. In addition, patients were satisfied with the aesthetic outcome with a mean score of 4.4. We did not observe any complications. Our experience shows that this method is a safe and technically simple alternative for columellar reconstruction in a select group of patients with philtrum scars.
Effects of Orthokeratology Lens Decentration Induced by Paracentral Corneal Asymmetry on Axial Length Elongation
Authors: Ding Wenzhi , Lu Weicong , Ji Rongyuan , Tian Yuyin , Huang Shenghai , Zhao Chenpei , Leng Lin
Published: April 2023

Background:

To determine the influence of the magnitude of treatment zone decentration on axial length (AL) elongation and to investigate the association between paracentral corneal asymmetry and orthokeratology (OK) lens decentration.

Methods:

This retrospective study involved 268 subjects (7–14 years) who wore OK lenses for one year. The parameters that reflected the paracentral corneal asymmetry were recorded: corneal toricity; Q value; anterior corneal curvature; and elevation values at the 6-, 7-, and 8-mm chords along the horizontal meridian. The relationships between these data and the amount of treatment zone decentration were analyzed. The relationship of the decentration magnitude and AL elongation was also analyzed.

Results:

AL elongation was significantly associated with initial age, baseline spherical equivalent, AL, and the decentration magnitude. The subjects with large decentration magnitude showed less AL elongation. The decentration was affected by corneal morphology at the 8-mm chord on the nasal side. In the low curvature group (≤41.0D), the decentration magnitude had a stronger correlation with AL elongation than in all subjects. In the high curvature group (>41.0D), the decentration magnitude was no longer correlated with the AL elongation.

Conclusion:

The decentration of the OK lens effectively slowed the elongation of the eyeball. When the nasal curvature was less than 41.0 D at the 8-mm chord, the magnitude of decentration was predetermined by the flatter curve.
Midterm Outcomes of Autologous Glueless Simple Limbal Epithelial Transplantation for Unilateral Limbal Stem Cell Deficiency
Authors: Malyugin Boris E. , Kalinnikova Svetlana Y. , Knyazer Boris , Gerasimov Maxim Y.
Published: April 2023

Purpose:

The aim of this study was to report the midterm outcomes of glueless simple limbal epithelial transplantation (G-SLET) as a novel modification of limbal stem cell transplantation in patients with unilateral limbal stem cell deficiency (LSCD).

Methods:

This was a single-center, retrospective, interventional case series. Analysis of the 6 months interim outcomes was performed for 11 patients with unilateral LSCD who underwent G-SLET without simultaneous keratoplasty. The primary outcome measure was clinical success, which was defined as a completely epithelialized, avascular, and stable corneal surface. Secondary outcome measures included LSCD staging, improvement in visual acuity, and corneal grading of the recipient eye before and after the intervention. Adverse events were monitored throughout the study period.

Results:

At 6-month follow-up, clinical success was achieved in 9 of the 11 cases (81.8%) and partial success was observed in 2 cases (18.2%). Among the patients in the cohort, 54.5% improved to stage 0 LSCD. Seven patients experienced enhancement in visual acuity. All corneal grading parameters improved significantly. Six adverse events were registered in 5 cases and were successfully managed. An extended scar in the donor eye was observed in 1 patient.

Conclusions:

This study demonstrated the high efficacy and safety of the G-SLET technique in the management of unilateral LSCD. G-SLET should be considered as a viable alternative to the“classic” SLET technique, specifically in the geographic areas where the availability of the fibrin glue is limited due to regulatory, economical, or any other reasons.
Postmortem Nasopharyngeal Microbiome Analysis of Zambian Infants With and Without Respiratory Syncytial Virus Disease: A Nested Case Control Study
Authors: McClintock Jessica , Odom-Mabey Aubrey R. , Kebere Nitsueh , Ismail Arshad , Mwananyanda Lawrence , Gill Christopher J. , MacLeod William B. , Pieciak Rachel C. , Lapidot Rotem , Johnson W. Evan
Published: April 2023

Background:

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and lower respiratory tract infections in children in their first year of life, disproportionately affecting infants in developing countries. Previous studies have found that the nasopharyngeal (NP) microbiome of infants with RSV infection has specific characteristics that correlate with disease severity, including lower biodiversity, perturbations of the microbiota and differences in relative abundance. These studies have focused on infants seen in clinical or hospital settings, predominantly in developed countries.

Methods:

We conducted a nested case control study within a random sample of 50 deceased RSV+ infants with age at death ranging from 4 days to 6 months and 50 matched deceased RSV− infants who were all previously enrolled in the Zambia Pertussis and RSV Infant Mortality Estimation (ZPRIME) study. All infants died within the community or within 48 hours of facility admittance. As part of the ZPRIME study procedures, all decedents underwent one-time, postmortem NP sampling. The current analysis explored the differences between the NP microbiome profiles of RSV+ and RSV− decedents using the 16S ribosomal DNA sequencing.

Results:

We found that Moraxella was more abundant in the NP microbiome of RSV+ decedents than in the RSV− decedents. Additionally, Gemella and Staphylococcus were less abundant in RSV+ decedents than in the RSV− decedents.

Conclusions:

These results support previously reported findings of the association between the NP microbiome and RSV and suggest that changes in the abundance of these microbes are likely specific to RSV and may correlate with mortality associated with the disease.
Female authorship trends and the effect of COVID-19 on cataract and refractive surgery literature
Authors: Choudhry Hassaam S. , Burton Carter , Garcia Daniel J. , Kumarapuram Siddhant , Parikh Aayushi , Eraky Fareeda , Choudhury Tasnova , Shaikh Amina , Sadek Hadeel S. , Dastjerdi Mohammad H.
Published: April 2023

Purpose:

To evaluate whether gender barriers persist specifically in the cataract and refractive surgery (CRS) literature. In addition, no literature exists investigating the long-term effect of COVID-19 on female authorship in ophthalmology past 2020.

Setting:

Scopus 2015 to 2022.

Design:

Retrospective data review.

Methods:

Articles published in the Journal of Refractive Surgery and the Journal of Cataract & Refractive Surgery were recorded from January 2015 to February 2022 from Scopus. Articles with only 1 author or where gender could not be identified were excluded. The first author (FA) gender, senior author (SA) gender, affiliated country, type of literature, and number of citations were collected. Pearson chi-squared tests with phi coefficients and multivariate logistic regression were performed.

Results:

3153 articles were included in analysis. There were 910 works with female FAs and 648 with female SAs. Gender did not predict publishing in one journal over the other (P > .050). Women made up less than 30% of authorship of all types of literature, except for prospective/observational studies as FA (31.3%). Compared with before 2020, female FAs from 2020 onward were associated with increased retrospective analysis (phi = 0.072, P = .030) and letters/editorials (phi = 0.134, P < .001) but decreased case reports (phi = 0.087, P = .009) and “others” (phi = −0.164, P < .001). Similar associations were observed for female SAs. Females were more likely to publish in Asian countries. Female SAs predicted an increased likelihood of female FAs (odds ratio, 1.401, 95% CI, 1.165-1.684, P < .001).

Conclusions:

Gender disparities exist in authorship of the CRS literature. COVID-19 has altered the types of literature published by women, but men still publish most of all types of CRS research.
A Meta-analysis of the Clinical Efficacy of the Head-of-Bed Elevation for Patients With Acquired Brain Injury
Authors: Che Ying , Lu Tingting , Wang Tianming , Zhao Hairong , Song Xulin , Zhan Qing , Zhang Chengzu , Pan Haibang , Yang Kehu , Wang Bo
Published: April 2023

BACKGROUND: Acquired brain injury is caused by traumatic or nontraumatic factors and causes changes in cognition. Several reviews have described the influence of the head-of-bed (HOB) elevation on clinical indexes such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP). However, the conclusions were inconsistent. Therefore, we aimed to evaluate the effects of HOB elevation in the care of the patients with ABI. METHODS: Two researchers independently screened the literature and extracted data. We searched PubMed, EMBASE, the Cochrane Library, Web of Science, and the Chinese Biological Literature Database to collect eligible randomized controlled trials published after September 2021. Reporting quality and methodological quality of the included studies were assessed by using the Preferred Reporting Items for Systematic Reviews and Meta-analysis and the Cochrane risk-of-bias tool. RESULTS: Eight studies were included in the meta-analysis. The results showed that, compared with the flat position, HOB elevation of 30° or 45° can significantly reduce ICP (mean difference [MD], −2.40 mm Hg; 95% confidence interval [CI], −3.19 to −1.61; P < .00001). However, there were no statistical differences in CPP (MD, −1.09; 95% CI, −3.93 to 1.75; P = .45), degree of disability at 90 days (relative risk, 1.01; 95% CI, 0.94-1.08; P = .83), and mean arterial pressure (MD, −0.44; 95% CI, −10.27 to 9.93; P = .93). CONCLUSION: Head-of-bed elevation of 30° can reduce ICP and maintain CPP, and may be an effective noninvasive nursing practice for the prognosis and rehabilitation of ABI patients. Owing to the lack of high-quality, large-sample randomized controlled trials, more rigorous trials are needed to support this conclusion.
Family Presence May Reduce Postoperative Delirium After Spinal Surgery
Authors: Welsch Emily , Vashisht Ayushi , Stutzman Sonja E. , Olson DaiWai M.
Published: April 2023

BACKGROUND: Delirium is associated with worse outcomes, but there is a gap in literature identifying nurse-led interventions to reduce delirium in postoperative (postop) surgical spine patients. Because family presence has been associated with a variety of beneficial effects, we aimed to examine whether family presence in the spine intensive care unit (ICU) during the night after surgery was associated with less confusion or delirium on postop day 1. METHODS: This is a prospective nonrandomized pilot clinical trial with pragmatic sampling. Group designation was assigned by natural history. The family-present group was designated as patients for whom a family member remained present during the first night after surgery. The unaccompanied group was designated as patients who did not have a family member stay the night. Data include the Richmond Agitation Sedation Scale, the Confusion Assessment Method for the ICU, the 4AT (Alertness, Attention, Abbreviated mental test, and Acute change) score, and confusion measured with the orientation item on the Glasgow Coma Scale. Baseline data were collected after admission to the spine ICU and compared with the same data collected in the morning of postop day 1. RESULTS: At baseline, 5 of 16 patients in the family-present group (31.3%) had at least 1 incidence of delirium or confusion. Similarly, 6 of 14 patients in the unaccompanied group (42.9%) had at least 1 incidence of delirium or confusion. There was a clinically relevant, but not statistically significant, reduction in postop day 1 delirium or confusion comparing the family-present (6.3%) and unaccompanied (21.4%) groups (P = .23). CONCLUSION: Family presence may reduce delirium and confusion for patients after spine surgery. The results support continued research into examining nurse-led interventions to reduce delirium and improve outcomes for this population.
Effects of Lifestyle Interventions on Health and Life Quality of Colorectal Cancer Survivors
Authors: Zhou Ting , Cai Wenjie , Wang Weiqiong , Wang Lina
Published: April 2023

Background

The results of previous studies on the effects of lifestyle interventions on the quality of life (QoL) in colorectal cancer (CRC) survivors remain controversial, and there have been several new publications in this area in recent years.

Objectives

To assess whether lifestyle interventions can lead to favorable health outcomes and improved QoL in CRC survivors, we performed a meta-analysis.

Methods

PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched to obtain relevant literature published from January 1, 1990, to November 1, 2021. The required data were extracted and summarized to compare the physical activity levels, QoL, mental health assessment, and anthropometric data between lifestyle interventions and routine nursing.

Results

Twelve studies were included. Compared with the control group, lifestyle interventions could significantly increase the physical activity time (weighted mean difference [WMD], 9.84; 95% confidence interval [CI], 1.20–18.48; P = .026), metabolic equivalent task levels (WMD, 10.40; 95% CI, 5.30–15.49; P < .001), and Functional Assessment of Cancer Therapy Scale—Colorectal scores (WMD, 3.12; 95% CI, 0.24–5.99; P = .034). However, lifestyle interventions were not noticeably able to improve the fatigue, depression levels, anxiety levels, waist circumference, or body mass index in CRC survivors.

Conclusion

Lifestyle interventions could generate an increase in physical activity time, metabolic equivalent task levels, and QoL in CRC survivors.

Implications for Practice

Lifestyle interventions in the future that include physical activity, diet, or comprehensive programs are needed to increase physical activity levels and improve QoL in CRC survivors.
Long-term Recovery After Colorectal Cancer Surgery Among the Old
Authors: Eriksen Kristina Sundt , Husebø Sissel I. E. , Kørner Hartwig , Lode Kirsten
Published: April 2023

Background

Colorectal cancer is the third most frequently diagnosed cancer worldwide, disproportionally affecting older people. With modern treatment, older people are surviving cancer treatment and recovery. However, only a limited number of studies on the older person’s experience of recovery exist. Knowledge of the experience of recovery among people 80 years or older is essential to optimize recovery and follow-up care.

Objective

The aim of this study was to explore the experiences of persons 80 years or older during recovery up to 2 years after curative colorectal cancer surgery.

Methods

This exploratory inductive qualitative study was conducted through 18 individual in-depth interviews between July 2020 and June 2021. Content analysis was used to analyze the data.

Results

The main theme identified was Recovery among the old is a complex process. It indicated that older people operated on for colorectal cancer may have intricate health challenges that affect recovery in addition to their cancer and treatment. The main theme is built upon the subthemes Individual factors affect colorectal cancer recovery and External support systems facilitate and impede colorectal recovery.

Conclusion

Important resources for recovery among old patients included their own coping ability and support from social networks and healthcare services. The identified barriers to recovery included other health problems and issues with healthcare services delivery.

Implications for Practice

It is essential for healthcare personnel in contact with older patients to be aware of factors that influence their recovery to identify and preserve the older person’s resources and implement health-promoting initiatives to optimize recovery when needed.
The Effectiveness of Remote Video Monitoring on Fall Prevention and Nurses' Acceptance
Authors: Ergai Awatef , Spiva LeeAnna , Thurman Susan , Hatfield Marianne , McCollum Meriel , Holmes Mona
Published: April 2023

Background:

The use of remote visual monitoring (RVM) technology as a “telesitter” in hospitals can reduce falls and increase the efficiency of patient observation.

Purpose:

This study aimed to examine RVM effectiveness as a strategy to decrease patient falls and investigate nurses' acceptance and perceived usefulness of RVM technology.

Methods:

Remote visual monitoring was implemented within a health system in the Southeastern United States. Falls data 6 months prior to and postimplementation were analyzed, and 106 nurses completed a survey evaluating their acceptance of the RVM technology.

Results:

There was a significant 39.15% reduction in falls with injury (P = .006), and 70.6% of the RVM redirections were successful. Nurses' acceptance and perceived usefulness of RVM were moderate.

Conclusion:

Implementing RVM has the potential to enhance patient safety by reducing falls with injuries and is considered acceptable and useful by nurses.
Purpose in Life
Authors: Yager Joel , Kay Jerald
Published: April 2023

Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.
Quality of Life During the First Three Waves of the COVID-19 Pandemic and Two Earthquakes in Croatia
Authors: Kovačić Petrović Zrnka , Peraica Tina , Blažev Mirta , Tomašić Lea , Kozarić-Kovačić Dragica
Published: April 2023

In a cross-sectional study, we measured the impact of the first three COVID-19 pandemic waves and two earthquakes, occurring during the same period in Croatia, on the quality of life (QoL) of the general adult population. An online survey consisting of sociodemographic questions, questions related to COVID-19 and earthquake stressors, the World Health Organization Quality of Life (WHOQoL)-BREF scale, Impact of Event Scale, and Patient Health Questionnaire 4 was completed by 220 men and 898 women (mean age, 35.1 ± 12.3 years). In a series of regressions, we examined the association among five blocks of predictors and six dependent QoL variables, four domain scores, and two global scores. Both WHOQoL-BREF global and domain scores after the prolonged stress were significantly predicted by anxiety, depression, stress symptoms, and sociodemographic characteristics. COVID-19-related stressors predicted significantly physical and psychological health, social relationships, and environmental QoL, whereas earthquake-related stressors predicted health satisfaction, physical and psychological health, and environmental QoL.