bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroinflammation generated by HIV-infected microglia promotes dysfunction and death of neurons in human brain organoids
Authors: Kong Weili , Frouard Julie , Xie Guorui , Corley Michael J , Helmy Ekram , Zhang Gang , Schwarzer Roland , Montano Mauricio , Sohn Peter , Roan Nadia R , Ndhlovu Lishomwa C , Gan Li , Greene Warner C
Published: April 2024

Despite the success of combination antiretroviral therapy (ART) for individuals living with HIV, mild forms of HIV-associated neurocognitive disorder (HAND) continue to occur. Brain microglia form the principal target for HIV infection in the brain. It remains unknown how infection of these cells leads to neuroinflammation, neuronal dysfunction, and/or death observed in HAND. Utilizing two different inducible pluripotent stem cell-derived brain organoid models (cerebral and choroid plexus [ChP] organoids) containing microglia, we investigated the pathogenic changes associated with HIV infection. Infection of microglia was associated with a sharp increase in CCL2 and CXCL10 chemokine gene expression and the activation of many type I interferon stimulated genes (MX1, ISG15, ISG20, IFI27, IFITM3 and others). Production of the proinflammatory chemokines persisted at low levels after treatment of the cell cultures with ART, consistent with the persistence of mild HAND following clinical introduction of ART. Expression of multiple members of the S100 family of inflammatory genes sharply increased following HIV infection of microglia measured by single-cell RNA-seq. However, S100 gene expression was not limited to microglia but was also detected more broadly in uninfected stromal cells, mature and immature ChP cells, neural progenitor cells and importantly in bystander neurons suggesting propagation of the inflammatory response to bystander cells. Neurotransmitter transporter expression declined in uninfected neurons, accompanied by increased expression of genes promoting cellular senescence and cell death. Together, these studies underscore how an inflammatory response generated in HIV-infected microglia is propagated to multiple uninfected bystander cells ultimately resulting in the dysfunction and death of bystander neurons.
Dual stimulus-responsive renewable nanoadsorbent for selective adsorption of low-density lipoprotein in serum
Authors: Guo Chen , Jiang Xinbang , Guo Xiaofang , Liu Zhuang , Wang Biao , Du Yunzheng , Tian Ziying , Wang Zimeng , Ou Lailiang
Published: April 2024

Selective removal of ultra-high low-density lipoprotein (LDL) from the blood of hyperlipemia patients using hemoperfusion is considered an efficient method to prevent the deterioration of atherosclerotic cardiovascular disease. Based on the exceptional structure–function properties of multistimulus-responsive materials, we developed a magnetic photorenewable nanoadsorbent (Fe3O4@SiO2@Azo-COOH) with outstanding selectivity and regenerative characteristics, featuring functionalized azobenzene as the ligand. The dual-stimulus response endowed Fe3O4@SiO2@Azo-COOH with rapid separation and photoregenerative properties. The adsorbent demonstrated excellent removal efficiency of LDL with an adsorption capacity of 15.06 mg/g, and highly repetitive adsorption performance (≥5 cycles) under irradiation. Fe3O4@SiO2@Azo-COOH also exhibited remarkable adsorption properties and selectivity in human serum, with adsorption capacities of 10.93, 21.26 and 9.80 mg/g for LDL, total cholesterol and triglycerides and only 0.77 mg/g for high-density lipoprotein (HDL), resulting in a 93% selective adsorption difference (LDL/HDL). Complete green regeneration of the nanoadsorbent was achieved through a simple regeneration process, maintaining a recovery rate of 99.4% after five regeneration experiments. By combining dynamic perfusion experiment with micromagnetic microfluidics, the LDL content decreased by 16.6%. Due to its superior adsorption capacity and regenerative properties, the dual stimulus-responsive nanosorbent is considered a potential hemoperfusion adsorbent.
Identifying the mass—a timely reminder from Hong Kong Court
Authors: Lam Steven
Published: April 2024

In Hip Hing Construction Co Ltd v Hong Kong Airlines Ltd [2024] HKCFI 370, [2024] HKCLC 83, the Hong Kong Court of First Instance held that a clause purporting to create a trust of a sum of money over the defendant’s general assets was void for uncertainty of subject-matter. This note seeks to examine the significance of the Court’s reasoning. In particular, it argues that the Court’s express endorsement of the beneficial co-ownership analysis when analysing the question of certainty of subject-matter is to be welcomed. The Court correctly highlighted the importance of identifying the “mass”, of which the trust asset forms part. The “mass” or the “single asset” must be identified before the beneficiary could acquire an equitable interest as an equitable tenant-in-common.
Oxidative stability in meat (pectoralis major) of broiler orally supplemented with essential oils of allium sativum, Curcuma longa, Zingiber officinale, and Cinnamomum zeylanicum
Authors: Jimoh Olatunji Abubakar , Akinleye Sule Bamidele , Simon Chigozie Joy , Kayode Aderonke Opeyemi , Akande Mary Olajumoke , Ogunjobi Tolulope Emmanuel , Tijani Labeeb Taiwo , Ayileye Kehinde Tosin
Published: April 2024

Lipid oxidation is a normal process in living muscles, but is escalated postmortem due to the loss of inherent antioxidant defense, which causes quality deterioration of meat. This study investigates the effects of essential oil (EO) supplementation to the drinking water of broiler chicken on physical properties, antioxidants, and lipid oxidation in Pectoralis major during frozen storage. Two hundred day-old chicks of arbo acre were allocated to five groups; control (T1) and the groups supplemented with: Allium sativum (T2), Curcuma longa (T3), Zingiber officinale (T4) and Cinnamomum zeylanicum (T5) at the level of 300ml/L into drinking water throughout a 49-d study. Thereafter, birds were slaughtered and breast meat excised for assessments during a 28-d storage period at 4 °C using standard procedure. The results show that cooking loss of Pectoralis major from T1 birds was not significantly (P > 0.05) different from that of T4, and were significantly higher than those of T2, T3, and T5 birds. Meat from T5 birds showed the lowest drip loss. The results for total antioxidant activity are not similar among sampling days. In general, control group showed inferior values, but T2 and T4 had greater values on days 0 and 28. The rate of lipid peroxidation increased with time; however, EOs administration markedly reduced the peroxidation rates compared to controls. The catalase activity of breast meat was significantly declined from day 14, but was enhanced as an effect of EO consumption especially in group T5 at 21 and 28 d. Supplementation of garlic, turmeric, and cinnamon EOs to broiler chickens increased glutathione peroxidase in breast meat on days 21 and 28, while turmeric EO enhanced superoxide dismutase up to 7 d. In conclusion, EOs are valuable supplements for broiler chickens and potent in enhancing meat quality and prolonging the shelf life.
Relationship of length of the estrous cycle to antral follicle number in crossbred beef heifers
Authors: Cushman Robert A , Kaps Martim , Snider Alexandria P , Crouse Matthew S , Woodbury Bryan L , Keel Brittney N , McCarthy Kacie L
Published: April 2024

Length of the menstrual cycle was positively associated with antral follicle number in women. If this pattern is consistent in cattle, a value-added benefit to using automated activity monitors to determine estrous status could be the ability to predict antral follicle count (AFC). We, therefore, hypothesized that as inter-estrous interval increased ultrasonographic AFC would be greater in crossbred beef heifers. Over 3 yr, crossbred beef heifers (n = 1,394) were fitted with automated activity monitors for 81 d. From days 42 to 46, heifers were submitted for ultrasonographic examination to determine AFC. From days 60 to 81, heifers were visually observed twice daily for 45 min for signs of behavioral estrus. Heifers that had a behavioral estrus that coincided with a sensor-based estrus and had a previous sensor-based estrus between 15 and 26 d earlier were used for the analysis (n = 850). A combination of regression analyses and correlation analyses were applied to understand the association between data collected by sensors and follicle number determined by ultrasonographic examination. Antral follicle count was analyzed using the GLM procedure of SAS with estrous cycle length (15 to 26 d) as a fixed effect. Estrus was more likely to initiate in the early morning hours and peak activity was greater (P < 0.0001) when estrus initiated between 0200 and 0800 hours then when estrus initiated at other times of the day. Antral follicle count did not differ due to length of the estrous cycle (P = 0.87). Thus, length of the estrous cycle obtained from three-axis accelerometers cannot be used to predict follicle number in crossbred beef heifers; however, machine learning approaches that combine multiple features could be used to integrate parameters of activity with other relevant environmental and management data to quantify AFC and improve reproductive management in beef cows.
Osteology, phylogenetic affinities, and palaeobiogeographic significance of the bizarre ornithischian dinosaur Ajkaceratops kozmai from the Late Cretaceous European archipelago
Authors: Czepiński Łukasz , Madzia Daniel
Published: April 2024

At the climax of their evolutionary history in the latest Cretaceous, ceratopsian dinosaurs were among the most dominant components of North American and Asian land ecosystems. In other continental landmasses, however, ceratopsians were extraordinarily rare and the affinities of their proposed representatives often turned out to be inconclusive. Arguably the most significant evidence of Ceratopsia from outside North America and Asia is represented by Ajkaceratops kozmai from the Santonian (Upper Cretaceous) of Hungary. We provide a detailed osteological description of Ajkaceratops and highlight its bizarre anatomy. Ajkaceratops has been ‘traditionally’ interpreted to represent a Bagaceratops-like coronosaur, and its occurrence on the European islands was hypothesized to probably result from an early Late Cretaceous dispersal event from Asia. However, while the snout of Ajkaceratops may resemble that of some ceratopsians, closer inspection of the preserved elements indicates that these similarities are largely superficial. While it cannot be ruled out that Ajkaceratops represents a highly peculiar member of the clade, its placement is far from certain. Still, the discovery of Ajkaceratops exemplifies the importance and uniqueness of European dinosaur faunas.
Taking High-Fidelity Simulation to the Next Level
Authors: Barnes Glenn A. , Haas Barbara K.
Published: April 2024

Nurse educators must prepare nursing students to be competent first responders and providers in nontraditional situations. We developed a course that provides in-depth experiential instruction in disaster nursing, remote/austere nursing, and global health. The Nursing in Nontraditional Environments course provides nursing students with the knowledge and skills to provide quality care to patients in environments outside traditional hospitals and clinics. The course merges survival skills with austere care using evidence-based practice derived from the US Military and the Wilderness Medical Society.
Does Celecoxib Prescription for Pain Management Affect Post-tonsillectomy Hemorrhage Requiring Surgery? A Retrospective Observational Cohort Study
Authors: So Vincent , Radhakrishnan Dhenuka , MacCormick Johnna , Webster Richard J. , Tsampalieros Anne , Zitikyte Gabriele , Ripley Allyson , Murto Kimmo
Published: April 2024

Background

Adenotonsillectomy and tonsillectomy (referred to as tonsillectomy hereafter) are common pediatric surgeries. Postoperative complications include hemorrhage requiring surgery (2 to 3% of cases) and pain. Although nonsteroidal anti-inflammatory drugs are commonly administered for postsurgical pain, controversy exists regarding bleeding risk with cyclooxygenase-1 inhibition and associated platelet dysfunction. Preliminary evidence suggests selective cyclooxygenase-2 inhibitors, for example celecoxib, effectively manage pain without adverse events including bleeding. Given the paucity of data for routine celecoxib use after tonsillectomy, this study was designed to investigate the association between postoperative celecoxib prescription and post-tonsillectomy hemorrhage requiring surgery using chart-review data from the Children’s Hospital of Eastern Ontario.

Methods

After ethics approval, a retrospective single-center observational cohort study was performed in children less than 18 yr of age undergoing tonsillectomy from January 2007 to December 2017. Cases of adenoidectomy alone were excluded due to low bleed rates. The primary outcome was the proportion of patients with post-tonsillectomy hemorrhage requiring surgery. The association between a celecoxib prescription and post-tonsillectomy hemorrhage requiring surgery was estimated using inverse probability of treatment weighting based on propensity scores and using generalized estimating equations to accommodate clustering by surgeon.

Results

An initial patient cohort of 6,468 was identified, and 5,846 children with complete data were included in analyses. Median (interquartile range) age was 6.10 (4.40, 9.00) yr, and 46% were female. In the cohort, 28.1% (n = 1,644) were prescribed celecoxib. Among the 4,996 tonsillectomy patients, 1.7% (n = 86) experienced post-tonsillectomy hemorrhage requiring surgery. The proportion with post-tonsillectomy hemorrhage requiring surgery among patients who had a tonsillectomy and were or were not prescribed celecoxib was 1.94% (30 of 1,548; 95% CI, 1.36 to 2.75) and 1.62% (56 of 3,448; 95% CI, 1.25 to 2.10), respectively. Modeling did not identify an association between celecoxib prescription and increased odds of post-tonsillectomy hemorrhage requiring surgery (odds ratio = 1.4; 95% CI, 0.85 to 2.31; P = 0.20).

Conclusions

Celecoxib does not significantly increase the odds of post-tonsillectomy hemorrhage requiring surgery, after adjusting for covariates. This large pediatric cohort study of celecoxib administered after tonsillectomy provides compelling evidence for safety but requires confirmation with a multisite randomized controlled trial.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Outcomes of a Novel Spine Virtual Fracture Clinic in an Australian Tertiary Hospital
Authors: Elias Patrick , Cavka Bernarda , Turner Peter , Ambikaipalan Anuruthran , Cross Emily , Kong Emily , Gibb Kirsty , Yang Yi , Anderson Nathan , Yataganbaba Alper , Cunningham John
Published: April 2024

Study design.

This was a retrospective cohort study.

Objective.

To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management.

Summary of background data.

The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population.

Methods.

A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephone-based SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications.

Results.

Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs. 2.4, P<0.001), appointments not attended (5% vs. 13%, P<0.001), referrals lost to follow-up (0% vs. 10.7%, P<0.001), and a shorter duration of care (median 48 vs. 58 d, P<0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified.

Conclusion.

This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes.
Clinical and Radiologic Predictors of Slower Improvement and Nonimprovement After Surgical Treatment of L4-L5 Degenerative Spondylolisthesis
Authors: Singh Sumedha , Shahi Pratyush , Song Junho , Subramanian Tejas , Morse Kyle , Maayan Omri , Araghi Kasra , Singh Nishtha , Tuma Olivia , Asada Tomoyuki , Korsun Maximilian , Mai Eric , Dowdell James , Sheha Evan , Sandhu Harvinder , Albert Todd , Qureshi Sheeraz , Iyer Sravisht
Published: April 2024

Study Design.

Retrospective cohort.

Objective.

To identify the predictors of slower and nonimprovement after surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).

Summary of Background Data.

There is limited evidence regarding clinical and radiologic predictors of slower and nonimprovement following surgery for L4-5 DLS.

Methods.

Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiologic variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.

Results.

Two hundred thirty-three patients (37% decompression and 63% fusion) were included. At less than three months, high pelvic tilt (PT) (OR: 0.92, P=0.02) and depression (OR: 0.28, P=0.02) were predictors of MCID nonachievement and GRC nonbetterment, respectively. Neither retained significance at above six months and hence, were identified as predictors of slower improvement. At above six months, low preoperative VAS leg (OR: 1.26, P=0.01) and high facet orientation (OR: 0.95, P=0.03) were predictors of MCID nonachievement, high L4-5 slip percentage (OR: 0.86, P=0.03) and L5-S1 angular motion (OR: 0.78, P=0.01) were predictors of GRC nonbetterment, and high preoperative ODI (OR: 0.96, P=0.04) was a predictor of PASS nonachievement.

Conclusions.

High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of nonimprovement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.
Impact of Preoperative Symptom Duration on Patient-Reported Outcomes Following Cervical Disc Replacement for Cervical Radiculopathy
Authors: Mai Eric , Kim Eric T. , Kaidi Austin , Subramanian Tejas , Simon Chad Z. , Asada Tomoyuki , Kwas Cole T. , Zhang Joshua , Araghi Kasra , Singh Nishtha , Tuma Olivia C. , Korsun Maximilian K. , Allen Myles R.J. , Heuer Annika , Sheha Evan D. , Dowdell James E. , Huang Russel C. , Albert Todd J. , Qureshi Sheeraz A. , Iyer Sravisht
Published: April 2024

Study design.

Retrospective review of prospectively collected data.

Objective.

To determine the impact of preoperative symptom duration on postoperative functional outcomes after cervical disc replacement (CDR) for radiculopathy.

Summary of Background Data.

CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes after CDR is not well established.

Methods.

Patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (<6 mo) and prolonged (≥6 mo) cohorts based on preoperative symptom duration. Patient-reported outcome measures (PROMs) included neck disability index (NDI), visual analog scale (VAS) neck and arm. Changes in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo–2 y) postoperative periods.

Results.

A total of 201 patients (43.6±8.7 y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared with the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%,P=0.001), VAS-Neck (87.0% vs. 56.0%,P<0.001), and VAS-Arm (90.5% vs. 70.7%,P=0.002). Prolonged preoperative symptom duration (≥6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2–6.9,P=0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7–26.0,P<0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5–22.5,P<0.001).

Conclusions.

Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability.

Level of Evidence.

Level III.
Novel variant in Nudix hydrolase 15 gene influences 6-mercaptopurine toxicity in childhood acute lymphoblastic leukemia patients
Authors: Sabirova Zarina , Mahnoor Shazia , Lasfar Dina , Gagné Vincent , Théorêt Yves , Leclerc Jean Marie , Laverdière Caroline , Sinnett Daniel , Tran Thai-Hoa , Krajinovic Maja
Published: April 2024

Acute lymphoblastic leukemia (ALL) is the most frequent pediatric cancer. 6-Mercaptopurine (6-MP) is a key component of ALL treatment. Its use, however, is also associated with adverse drug reactions, particularly myelosuppression. Thiopurine S-methyltransferase (TPMT) and, more recently, Nudix hydrolase 15 (NUDT15) deficiency, due to no-function variants in their respective genes, are well known for their role in the development of this toxicity. Two novel genetic variants, rs12199316 in TPMT and rs73189762 in the NUDT15 gene, were recently identified by targeted sequencing. The latter is particularly interesting because of its potential association with 6-MP intolerance. Here, we assessed the relationship of this variant with the risk of myelosuppression and 6-MP dose intensity in 275 patients treated with Dana Farber Cancer Institute ALL protocols at the Sainte Justine University Health Center. Carriers of the NUDT15 rs73189762 variant allele were at a higher risk of myelosuppression, as shown by absolute phagocyte count reduction during consolidation II and maintenance phases of therapy. Reduction in 6-MP dose intensity was observed in patients with both rs73189762 and known no-function variants in the NUDT15 and TPMT genes. This finding supports the initial observation and suggests that 6-MP dose reduction might be beneficial for individuals with this genotype combination.
Preclinical Performance of the Combined Application of Two Robotic Systems in Microsurgery: A Two-center Study
Authors: Wessel Kai J. , Stögner Viola A. , Yu Catherine T. , Pomahac Bohdan , Hirsch Tobias , Ayyala Haripriya S. , Kueckelhaus Maximilian
Published: April 2024

Background:

Recent advancements in the development of robotic devices increasingly draw the attention toward the concept of robotic microsurgery, as several systems tailored to open microsurgery are being introduced. This study describes the combined application of a novel microsurgical robot, the Symani, with a novel robotic microscope, the RoboticScope, for the performance of microvascular anastomoses in a two-center preclinical trial.

Methods:

Six novices, residents, and experienced microsurgeons (n = 18) performed five anastomoses on 1.0-mm-diameter silicone vessels with a conventional versus combined robotic approach, resulting in 180 anastomoses. Microsurgical performance was evaluated, analyzing surgical time, subjective satisfaction with the anastomosis and robotic setup, anastomosis quality using the anastomosis lapse index score, microsurgical skills using the Structured Assessment of Microsurgery Skills score, and surgical ergonomics using the Rapid Entire Body Assessment score.

Results:

All participants significantly improved their performance during the trial and quickly adapted to the novel systems. Surgical time significantly decreased, whereas satisfaction with the anastomosis and setup improved over time. The use of robotic systems was associated with fewer microsurgical errors and enhanced anastomosis quality. Especially novices demonstrated accelerated skill acquisition upon robotic assistance compared with conventional microsurgery. Moreover, upper extremity positioning was significantly improved. Overall, the robotic approach was subjectively preferred by participants.

Conclusions:

The concept of robotic microsurgery holds great potential to improve precision and ergonomics in microsurgery. This two-center trial provides promising evidence for a steep learning curve upon introduction of robotic microsurgery systems, suggesting further pursuit of their clinical integration.
Beyond the Recruitment Pipeline: A Call to Action for Centering the Success of Under-represented Minority Trainees in Obstetrics and Gynecology
Authors: Young Omar M. , DeGaia Ayana G.R. , Akingbola Oluwabukola Ajagbe , Staples Halley
Published: April 2024

Just like all aspects of the American experience, racism has had a significant presence in Obstetrics and Gynecology (OBGYN). Black physicians in OBGYN face unique challenges in training programs, having to learn a specialty while combating racial macroaggression and microaggressions constantly and, often, in isolation. We present the stories of black OBGYNs who have sustained such an experience while also offering equitable and actionable solutions to improve clinical training environments.
Waitlisting and liver transplantation for MetALD in the United States: An analysis of the UNOS national registry
Authors: Ochoa-Allemant Pedro , Serper Marina , Wang Roy X. , Tang Helen , Ghandour Bachir , Khan Sarem , Mahmud Nadim
Published: April 2024

Background and Aims:

The new steatotic liver disease (SLD) nomenclature introduced metabolic and alcohol-associated liver disease (MetALD), describing the intersection of metabolic dysfunction–associated steatotic liver disease and alcohol-associated liver disease. Waitlisting and liver transplantation for MetALD are not well defined. We aimed to develop and validate an algorithm for identifying SLD phenotypes and assessing trends in waitlisting and transplant outcomes.

Approach and Results:

We conducted a retrospective cohort study using the United Network for Organ Sharing registry, supplemented with detailed single-center data. We developed 5 candidate algorithms for SLD classification and calculated their diagnostic performance. Trends in waitlist registrations and transplants were estimated, and competing risk analyses and Cox regression models were conducted to assess waitlist removal and posttransplant outcomes among SLD phenotypes. The best-performing algorithm demonstrated substantial agreement (weighted kappa, 0.62) for SLD phenotypes, with acceptable sensitivity (73%) for MetALD. Between 2002 and 2022, waitlist registrations and transplants for MetALD increased 2.9-fold and 3.3-fold, respectively. Since 2013, there has been a significant increase in the absolute number of waitlist registrations (122 per year; 95% CI, 111–133) and transplants (107 per year; 95% CI, 94–120) for MetALD. Patients with MetALD experienced higher waitlist removal (adjusted subdistribution hazard ratio, 1.10; 95% CI, 1.03–1.17), all-cause mortality (adjusted hazard ratio, 1.13; 95% CI, 1.03–1.23), and graft failure (adjusted hazard ratio, 1.12; 95% CI, 1.03–1.21) than those with alcohol-associated liver disease.

Conclusions:

We developed and validated an algorithm for identifying SLD phenotypes in UNOS. MetALD is the third leading etiology among those waitlisted and underwent transplantation, exhibiting worse pretransplantation and posttransplantation outcomes compared to alcohol-associated liver disease. Identifying and addressing factors determining poor outcomes is crucial in this patient population.
RELIABILITY OF CLINICAL GRADING OF DIABETIC RETINOPATHY COMPARED WITH GRADING OF ULTRA-WIDEFIELD IMAGES
Authors: Castellanos-Canales Daniela , Decker Nicole L. , Fukuyama Hisashi , Duffy Brandon V. , Fawzi Amani A.
Published: April 2024

Purpose:

To evaluate the reliability of clinical grading of diabetic retinopathy (DR) severity compared with grading on ultra-widefield pseudocolor fundus (UWF-CF) and ultra-widefield fluorescein angiography (UWF-FA) images and their relative detection of sight-threatening DR and referable DR.

Methods:

A total of 184 diabetic eyes were analyzed. UWF-CF and UWF-FA images were graded based on the International Clinical Diabetic Retinopathy severity scale. Agreement between clinical and UWF-based severity grading was evaluated using Cohen's kappa coefficient. The rate of sight-threatening DR and referable DR was evaluated for each grading method.

Results:

Moderate agreement was found between clinical grading and UWF-CF (k = 0.456, P < 0.001) and between UWF-CF and UWF-FA (k = 0.443, P < 0.001). The agreement between clinical grading and UWF-FA was fair (k = 0.397, P < 0.001). UWF-based grading identified a higher DR grade in 56 eyes (30%) on UWF-CF and 85 eyes (46.2%) on UWF-FA. Compared with clinical grading, UWF-FA detected a higher rate of sight-threatening DR (44%; 81/184 vs. 22.3%; 41/184), while UWF-CF detected more referable eyes (58.1%; 107/184 vs. 45.65%; 84/184).

Conclusion:

Ultra-widefield pseudocolor fundus is a valuable tool for identifying referable eyes and can be a useful, noninvasive adjunct to clinical grading. The results suggest that UWF-FA is particularly useful for detecting unsuspected sight-threatening DR in eyes with clinically referable DR.
A NOVEL SURGICAL TECHNIQUE FOR GIANT AND REFRACTORY MACULAR HOLES: AUTOLOGOUS TENON CAPSULE PLUG
Authors: Yilmaz Sami , Yildiz Aysegul Mavi , Avci Remzi
Published: April 2024

Purpose:

To evaluate the safety and efficiency of the autologous Tenon capsule plug (ATCP) technique for the treatment of large (1000 um<) and refractory macular holes (MHs).

Methods:

This retrospective, interventional, case series included 3 patients who underwent 23-gauge vitrectomy and ATCP technique for giant or refractory MH. All patients underwent a complete ophthalmic examination including optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry (MP). The changes in retinal structure and function were evaluated.

Results:

The minimum follow-up was 6 months. The preoperative minimum hole diameters were 728 um, 422 um, and 1154 um for case 1, case 2, and case 3 respectively. Case 1 and case 2 had an idiopathic MH that failed to close after vitrectomy with (internal limiting membrane) ILM peeling, whereas case 3, who had a giant, irregular MH underwent the ATCP technique as the primary intervention. Complete hole closure was achieved in all patients at the last follow-up. However, case 1 required a second ATCP surgery due to dislodgement of the plug in the early postoperative period. The BCVA increased in all patients. The final MP analysis revealed that the percentage of fixation points at circles 4o for case 1, case 2 and case 3 were 93.5%, 99.9% and 95.6% respectively.

Conclusions:

We suggest that the ATCP technique can provide a simple, cheap, repeatable, and readily available surgical solution for the treatment of giant and refractory macular holes. Further prospective studies with a larger sample size are needed to confirm our preliminary results.
Evolution of Pentosan Polysulfate Maculopathy Following Medication Discontinuation
Authors: Ka-Lok Tao Brendan , Pereira Austin , Koushan Keyvan
Published: April 2024

Purpose:

To describe a patient receiving pentosan polysulfate (PPS) for interstitial cystitis, who developed PPS maculopathy (PPSM) that persisted and evolved for four years after medication discontinuation.

Methods:

Case report of one patient at a tertiary retina clinic.

Results:

A 48-year-old female with a history of interstitial cystitis was referred to our retina clinic with no vision complaints. She had been taking PPS for 10 years, first consuming 600mg/day for eight years, followed by 200mg/day for two years. At first presentation in 2016, examination revealed macular pigmentary clumping in both eyes. In subsequent years, pigmentary changes were confirmed by optical coherence tomography (OCT) which showed progressive macular thinning in both eyes. In 2019, the patient discontinued PPS; however, she continued to exhibit PPSM progression for years thereafter. At four-year follow-up after discontinuation of PPS, the patient returned with stable vision, but showed changes in macular lipofuscin deposits with outer retinal and retinal pigment epithelial alterations.

Conclusion:

This case demonstrates sustained and evolving PPSM even after drug discontinuation, suggesting that active PPS may have a prolonged half-life in the retina and retinal pigment epithelium.
Anti-dementia drugs: what is the evidence in advanced stages?
Authors: Ferreira Daniel , Nogueira Noémi , Guimarães Joana , Araújo Rui
Published: April 2024

Dementia is a major public health concern due to its increasing prevalence, substantial caregiver burden, and high financial costs. Currently, the anti-dementia drugs aim only at a symptomatic effect. The subject of prescribing these drugs in advanced stages is a matter of considerable debate, with different countries making distinct recommendations. In this review article, we analyzed the evidence regarding cognitive and functional outcomes, adverse events, health-related costs, and caregiver burden in patients with advanced Alzheimer disease (AD) and mixed dementia. We included 35 studies. Most studies are heterogeneous, focus exclusively on AD, and show small benefits in terms of cognitive and functional scales. The overall evidence seems to suggest a benefit in introducing or maintaining anti-dementia drugs in patients with advanced dementia, but clinical meaningfulness is difficult to ascertain. The issue of costs and caregiver burden is significantly underexplored in this field but also seems to favor treatment continuation, despite a reduced overall effect. The decision of introducing or withdrawing anti-dementia drugs in advanced stages of dementia should be individualized. Future studies with homogeneous designs and outcomes are warranted.
Psychometric Analysis of an Integrated Clinical Education Tool for Physical Therapists
Authors: Becker Marcie , Shields Richard K. , Sass Kelly J.
Published: April 2024

Introduction.

Integrated clinical education (ICE) courses require opportunities for practice, assessment of performance, and specific feedback. The purposes of this study were to 1) analyze the internal consistency of a tool for evaluating students during ICE courses, 2) examine the responsiveness of the tool between midterm and final assessments, and 3) develop a model to predict the final score from midterm assessments and explore relationships among the 6 domains.

Review of Literature.

Several clinical education assessment tools have been developed for terminal clinical experiences, but few have focused on the needs of learners during the ICE.

Subjects.

Eighty-five student assessments were collected from 2 consecutive cohorts of physical therapist students in a first full-time ICE course.

Methods.

The tool contained 29 items within 6 domains. Items were rated on a 5-point scale from dependent to indirect supervision. Cronbach's alpha was used to analyze the internal consistency of the tool, whereas responsiveness was examined with paired t-test and Cohen's d. A best subsets regression model was used to determine the best combination of midterm variables that predicted the final total scores. Coefficients of determination (R
2) were calculated to explore the relationships among domains.

Results.

The tool was found to have high internal consistency at midterm and final assessment (α = 0.97 and 0.98, respectively). Mean scores increased over time for each domain score and for the total score (P < .001; d = 1.5). Scores in 3 midterm domains predicted more than 57% of the variance in the final total score.

Discussion and Conclusion.

Results support the use of this tool to measure student performance and growth in a first full-time ICE course. Targeted measurement of students' abilities in ICE courses assists with differentiating formative and summative learning needed to achieve academic success.
Prevalence of smoking and its associated factors among students of the University of Dongola, Northern State, Sudan: a cross-sectional study
Authors: Abdelraouf May M.F. , Abdalla Rofida A.M. , Mohamed Douaa M.S. , Ahmed Abubaker K.A. , Abuzaid Mohamed A.M. , Issak Mohamed A. , Eljack Ibrahim A. , Saeed Elshazaly , Abdelaziz Mohamed O.
Published: April 2024

Background:

Smoking is one of the leading causes of morbidity and mortality worldwide, and its prevalence has increased globally, particularly among university students.

Objective:

The study aimed to assess the smoking prevalence and its associated factors among students at University of Dongola, Northern State, Sudan.

Methods:

A multi-centred cross-sectional study was conducted among students of University of Dongola. Data was collected via an online Google form questionnaire. Descriptive and comparative analyses were performed using SPSS, version 26. Statistical significance was considered at p less than or equal to 0.05.

Results:

A total of 642 students participated in the study, of which 51.9% were females. Most of the students (73.6%) were aged 20–25 years and came from health & medical faculties (60.7%). The overall prevalence of smoking was 11.7%. The determined risk factors for smoking included male gender (P≤0.001), older age (P≤0.001), non-health and non-medical faculties (P≤0.001), uneducated fathers (P=0.032), and low socio-economic status (P=0.001). The most common reason for smoking was stress (36%), with cigarettes being the most commonly used type (88%). Personal savings were the main source of smoking expenses (73.3%). Most smokers (88%) were aware of the harmful effects of smoking.

Conclusion:

The overall smoking prevalence was relatively low among students at University of Dongola. Male gender, older age, non-health and non-medical faculties, uneducated fathers, and low socio-economic status were significant risk factors for smoking. The majority of smokers were aware of the harmful effects of smoking.
Implementation of Listening Visits with Parents of Preterm Infants in an Italian Neonatal Intensive Care Unit
Authors: Scabia Aurora , Chorna Olena , Rocchitelli Lucia , Festante Fabrizia , Del Secco Sabrina , Costagli Ginevra , Riparbelli Cristina , Controzzi Tiziana , Tuoni Cristina , Filippi Luca , Guzzetta Andrea
Published: April 2024

Purpose:

To assess the feasibility of implementing Listening Visits (LV) in an Italian neonatal intensive care unit (NICU).

Study Design and Methods:

This feasibility implementation of LV included empathic listening and problem-solving sessions provided by a psychologist to 26 parents of hospitalized preterm newborns. Using the RE-AIM implementation framework, three facets of feasibility were assessed: reach, adoption, and implementation.

Results:

It is feasible to integrate LV into the NICU: 76% of families were willing to try LV (reach). Listening Visits recipients reported high satisfaction. Twelve of the 16 families (75%) received six or more LV sessions (adoption), with mothers attending more sessions. Implementation fidelity, defined here as the percentage of LV recipients that received at least four sessions, was 94% among mothers and 30% among fathers.

Clinical Implications:

The LV intervention for parental support during the NICU stay is feasible and deemed helpful by parents. Parents were motivated to participate even though their levels of depression, stress, and anxiety were not high. In addition to the use of standardized screening questionnaires, parental requests and clinical team indications should be included in the decision-making for the provision of parental support services.
Wearable apparatus for correction of visual alignment under torsional strabismus
Authors: Malleson Charles , Guillemaut Jean-Yves
Published: April 2024

SIGNIFICANCE

A wearable optical apparatus that compensates for eye misalignment (strabismus) to correct for double vision (diplopia) is proposed. In contrast to prism lenses, commonly used to compensate for horizontal and/or vertical misalignment, the proposed approach is able to compensate for any combination of horizontal, vertical, and torsional misalignment.

PURPOSE

If the action of the extraocular muscles is compromised (e.g., by nerve damage), a patient may lose their ability to maintain visual alignment, negatively affecting their binocular fusion and stereo depth perception capability. Torsional misalignment cannot be mitigated by standard Fresnel prism lenses. Surgical procedures intended to correct torsional misalignment may be unpredictable. A wearable device able to rectify visual alignment and restore stereo depth perception without surgical intervention could potentially be of great value to people with strabismus.

METHODS

We propose a novel lightweight wearable optical device for visual alignment correction. The device comprises two mirrors and a Fresnel prism, arranged in such a way that together they rotationally shift the view seen by the affected eye horizontally, vertically, and torsionally. The extent of the alignment correction on each axis can be arbitrarily adjusted according to the patient's particular misalignment characteristics.

RESULTS

The proposed approach was tested by computer simulation, and a prototype device was manufactured. The prototype device was tested by a strabismus patient exhibiting horizontal and torsional misalignment. In these tests, the device was found to function as intended, allowing the patient to enjoy binocular fusion and stereo depth perception while wearing the device for daily activities over a period of several months.

CONCLUSIONS

The proposed device is effective in correcting arbitrary horizontal, vertical, and torsional misalignment of the eyes. The results of the initial testing performed are highly encouraging. Future study is warranted to formally assess the effectiveness of the device on multiple test patients.
Parent strategies for improving compliance with eyeglass wear in young children
Authors: Harvey Erin M. , Ramesh Divya , Marshall Maria Sandra , Martin Jenifer A. , McGrath Eileen R. , Yescas Selenne , Miller Joseph M.
Published: April 2024

SIGNIFICANCE

Results of this study provide preliminary data on parent strategies for improving compliance with eyeglass treatment in young children, an age group for which previous data are limited. Parent responses provide important insights to support parents of young children who wear eyeglasses and provide preliminary data to guide additional research.

PURPOSE

The goal of this exploratory study was to learn more about parents' strategies to improve compliance with eyeglass treatment of young children.

METHODS

An online survey of parents of 1-year-old to less than 5-year-old children who wear eyeglasses was conducted. Parents indicated whether they used various strategies to encourage wear and were asked to provide advice for parents of young children recently prescribed eyeglasses. Use of various strategies by age was determined. Open-ended responses regarding advice for other parents were analyzed using qualitative content analysis.

RESULTS

The final sample included 104 parents who were predominantly White (81%), non-Hispanic (76%), and college graduates (68%). During the 2 weeks prior to survey completion, 74% of parents reported their child wore their eyeglasses ≥8 hours/day. Use of strategies for improving eyeglass wear varied by child age. The most frequent recommendations that parents provided for other parents were to be consistent in encouraging wear, use social modeling, provide positive reinforcement when the eyeglasses are worn, and ensure that the eyeglasses fit well and were comfortable.

CONCLUSIONS

Parents provided many useful insights into their experiences. However, results may not be broadly generalizable, because of the limited diversity and high rate of compliance in the study sample. Further research with more diverse populations and research on effectiveness of various strategies to increase compliance in this age group are recommended to support eyeglass treatment compliance in young children.
Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study
Authors: Mutti Donald O. , Sinnott Loraine T. , Cotter Susan A. , Jones-Jordan Lisa A. , Kleinstein Robert N. , Manny Ruth E. , Twelker J. Daniel , Zadnik Karla
Published: April 2024

SIGNIFICANCE

Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States.

PURPOSE

This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children.

METHODS

Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least −0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics.

RESULTS

The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J
0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J
0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years.

CONCLUSIONS

The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.