bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Outcomes Data Collection Instrument Scores Within Gross Motor Function Classification Scale Levels and Functional Mobility Scale Ratings in Individuals With Cerebral Palsy
Authors: Ciccodicola Eva , Liang Adriana , Kay Robert M. , Wren Tishya A.L.
Published: April 2024

Background and Objective:

The Pediatric Outcomes Data Collection Instrument (PODCI) is a patient/parent-reported outcome measure used in children with cerebral palsy (CP). PODCI score variability has not been widely examined in patients of Gross Motor Function Classification System (GMFCS) level IV or using the Functional Mobility Scale (FMS). The purpose of this study is to examine the distribution of PODCI scores within patients with CP GMFCS levels I-IV and FMS levels 1-6.

Methods:

Retrospectively identified patients with CP whose parent/caregiver had completed the PODCI at their visit were grouped based on GMFCS and FMS level. One-way ANOVA with pairwise Bonferroni-adjusted post hoc tests was performed to compare the effect of GMFCS and FMS levels (1, 2-4, 5, or 6) on PODCI scores.

Results:

Three hundred sixty-seven patients were included (128 female, 11.7 years, SD 3.6). Global, Sports, Transfer, and Upper Extremity scores differed among all GMFCS levels (P≤0.056) and were significantly lower for GMFCS IV compared with all other levels. Happiness, Expectations, and Pain scores did not differ significantly among GMFCS levels including level IV (P>0.06). Similar trends were seen at all FMS distances (5, 50, and 500âm). At 50âm, Global, Sports, Transfer, and Upper Extremity scores differed significantly among all FMS levels (P<0.001) except that Upper Extremity Scores were similar between levels 2-4 and level 5 (P=1.00). Happiness and Pain scores were not different between FMS levels (P>0.27). Expectations scores differed only between FMS 1 and FMS 6 with FMS 6 being higher at the 50-m distance only (P=0.03).

Conclusions:

Parent-reported outcome measures are important for providing patient-centered care. Providers can examine these measures alongside functional classification systems to create a more complete clinical picture of the patient. Providers should be aware of the score trends seen in our results when evaluating the PODCI for individuals with CP to improve shared decision-making and better monitor their need for future care.

Level of Evidence:

Level III—retrospective study.
Reliability of Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot
Authors: Kayondo Timothy Kiweewa , El-Adwar Khaled Loutfy , Abdullah Elsayed Abdelhalim , Mosa Mena Micheal
Published: April 2024

Background:

Talipesequinovarus is a congenital ankle/foot malformation that commonly affects newborns. In its treatment using the Ponseti method, an Achilles tenotomy is frequently needed to correct residual equinus deformity. Percutaneous (PC) tenotomy is the most commonly used technique and needs to be thoroughly evaluated. The question we needed to answer was: “Does PC Achilles tenotomy result in complete tendon sectioning”?

Methods:

This clinical study included 56 idiopathic clubfeet in 36 patients who presented during the first 6 months of life and were treated with Ponseti manipulation and casting followed by PC Achilles tenotomy. PC tenotomy was done under general anesthesia, and Thompson’s calf squeeze test was performed intraoperatively just after tenotomy. In case of a negative test (ie, ankle plantar flexion with calf squeeze), the percutaneous incision was extended to assess the cause of the negative test.

Results:

Forty-nine feet (87.5%) had a complete tenotomy, as evidenced by a positive Thompson’s calf squeeze test. While 7 feet (12.5%) showed a negative test, and therefore the percutaneous incision was extended and all were found to have an incompletely divided Achilles tendon. The tendons were then completely divided, after which Thompson’s test became positive in all.

Conclusion:

Percutaneous Achilles tenotomy is a reliable procedure, but was found to result in incomplete tendon sectioning in 12.5% of cases, affecting the range of ankle dorsiflexion. Thompson’s squeeze test is reliable in picking up cases of incomplete tenotomy after the PC technique, and in these cases the incision should be extended for complete sectioning.

Level of Evidence:

Level I.
The Significance of Parametric Mapping in Advanced Cardiac Imaging
Authors: Khachatoorian Yeraz , Fuisz Anthon , Frishman William H. , Aronow Wilbert S. , Ranjan Pragya
Published: April 2024

Cardiac magnetic resonance imaging has witnessed a transformative shift with the integration of parametric mapping techniques, such as T1 and T2 mapping and extracellular volume fraction. These techniques play a crucial role in advancing our understanding of cardiac function and structure, providing unique insights into myocardial tissue properties. Native T1 mapping is particularly valuable, correlating with histopathological fibrosis and serving as a marker for various cardiac pathologies. Extracellular volume fraction, an early indicator of myocardial remodeling, predicts adverse outcomes in heart failure. Elevated T2 relaxation time in cardiac MRI indicates myocardial edema, enabling noninvasive and early detection in conditions like myocarditis. These techniques offer precise insights into myocardial properties, enhancing the accuracy of diagnosis and prognosis across a spectrum of cardiac conditions, including myocardial infarction, autoimmune diseases, myocarditis, and sarcoidosis. Emphasizing the significance of these techniques in myocardial tissue analysis, the review provides a comprehensive overview of their applications and contributions to our understanding of cardiac diseases.
Prelaryngeal soft tissue injury of the neck caused by an accidental crossbow shot
Authors: Kotek Jiří , Žvák Ivo , Dušek Tomáš , Růžička Jaroslav , Šatanková Jana , Burešová Zuzana , Lochman Petr
Published: April 2024

Penetrating neck injury is quite a rare entity, all the more if it is caused by a shotgun. Due to lots of vital important structures, it may immediately be life-threatening, and an organized and systematic approach is highly recommended. We present a case of a young man who was accidentally hit by a crossbow arrow to the neck. An overview of diagnostic and treatment management of such an injury is also provided.
The Long Road is Never Lonely
Authors: GIMBEL LAUREN A.
Published: April 2024

An early reflection on a career just begun.
Understanding Patterns of Preserved Retinal Ganglion Cell Layer in Advanced Glaucoma as Seen With Optical Coherence Tomography
Authors: Sun Anna J. , Gomide Gabriel , Tsamis Emmanouil , Mao Grace , Leshno Ari , La Bruna Sol , Liebmann Jeffrey M. , De Moraes Carlos Gustavo , Hood Donald C.
Published: April 2024

Précis:

Using optical coherence tomography (OCT), eyes with advanced glaucoma were found to have a wide range of patterns of damage that were consistent with the natural history of progression based on a model of macular progression.

Purpose:

To understand the patterns of preserved retinal ganglion cells in eyes with advanced glaucoma using OCT and a model of progression of the central macula.

Methods:

OCT GCL thickness was measured in 94 eyes with advanced glaucoma, defined as glaucomatous eyes with a 24-2 MD (mean deviation) worse than −12 dB. A commercial report supplied the GCL thickness in 6 sectors of the thick, donut-shaped GCL region around the fovea. For each eye, the 6 sectors were coded as green (within normal limits, WNL), yellow (≤5th, ≥1st percentile), or red (<1st percentile).

Results:

In all 94 eyes, one or more of the 6 sectors of the donut were abnormal (red or yellow), while all 6 sectors were red in 52 (55%) of the eyes. On the other hand, 33 eyes had one or more sectors WNL (green). While the pattern of donut damage varied widely across these 33 eyes, 61 of the 66 hemiretinas were consistent with a temporal-to-nasal progression of damage within each hemiretina as predicted by our model.

Conclusions:

All eyes with advanced glaucoma had damage to the critically important central, donut-shaped GCL region. This region showed a wide range of patterns of damage, but these patterns were consistent with the natural history of progression based on a model of macular progression. These results have implications for the clinical identification of macular progression, as well as for inclusion criteria for clinical trials seeking to preserve central macular function.
Visual outcomes comparing emmetropia vs mini-monovision after bilateral implantation of a nondiffractive extended vision intraocular lens: randomized trial
Authors: Vasavada Vaishali , Vasavada Shail A. , Shastri Lajja , Nath Vandana , Vasavada Abhay R. , Srivastava Samaresh
Published: April 2024

Purpose:

To compare visual outcomes and patient satisfaction after bilateral implantation of a nondiffractive extended vision intraocular lens (IOL) when targeting emmetropia vs mini-monovision.

Setting:

Iladevi Cataract & IOL Research Centre, Ahmedabad, India.

Design:

Prospective, randomized controlled trial.

Methods:

Patients undergoing bilateral cataract surgery with an extended vision IOL (Vivity) randomized to group I—IOL implantation with emmetropic target in both eyes or group II—IOL implantation with mini-monovision of −0.5 diopters (D) were included in this study. Outcome measures evaluated 6 months postoperatively were unaided and corrected near visual acuity (UNVA, CNVA) at 40 cm and unaided and corrected distance (UDVA, CDVA) and intermediate (UIVA, CIVA) visual acuity at 66 cm. Mesopic contrast sensitivity, binocular defocus curve, Patient-Reported Spectacle Independence Questionnaire, and satisfaction on the McAlinden questionnaire were also assessed.

Results:

70 patients enrolled in this study. 34 and 33 patients in groups I and II, respectively, completed follow-up. Binocular UNVA was significantly better in group II (0.26 ± 0.05 vs 0.22 ± 0.08 logMAR, P = .03). Reading add required in group II was significantly lower. UIVA (0.09 ± 0.06 vs 0.07 ± 0.08 logMAR, P = .15) and UDVA (0.02 ± 0.04 vs 0.02 ± 0.05 logMAR, P = .78) were not significantly different between groups. Mesopic contrast sensitivity was not significantly different between the groups. Binocular defocus curve showed significantly better mean visual acuities between −2.0 D and −3.0 D in group II. Patients in both groups had high levels of spectacle independence, with no patient reporting dysphotopsia.

Conclusions:

Binocular UNVA was significantly better, with comparable UDVA and mesopic contrast sensitivity when targeting mini-monovision with the nondiffractive extended vision IOL as compared with targeting binocular emmetropia.
Blocking proteinase-activated receptor 2 signaling relieves pain, suppresses nerve sprouting, improves tissue repair, and enhances analgesic effect of B vitamins in rats with Achilles tendon injury
Authors: Li Lihui , Yao Hongyu , Mo Rufan , Xu Lihong , Chen Peng , Chen Yuchen , Hu Jiang-Jian , Xie Wei , Song Xue-Jun
Published: April 2024

Tendon injury produces intractable pain and disability in movement, but the medications for analgesia and restoring functional integrity of tendon are still limited. In this study, we report that proteinase-activated receptor 2 (PAR2) activation in dorsal root ganglion (DRG) neurons contributes to chronic pain and tendon histopathological changes produced by Achilles tendon partial transection injury (TTI). Tendon partial transection injury increases the expression of PAR2 protein in both somata of DRG neurons and their peripheral terminals within the injured Achilles tendon. Activation of PAR2 promotes the primary sensory neuron plasticity by activating downstream cAMP-PKA pathway, phosphorylation of PKC, CaMKII, and CREB. Blocking PAR2 signaling by PAR2 small-interference RNA or antagonistic peptide PIP delays the onset of TTI-induced pain, reverses the ongoing pain, as well as inhibits sensory nerve sprouting, and promotes structural remodeling of the injured tendon. Vitamin B complex (VBC), containing thiamine (B1), pyridoxine (B6), and cyanocobalamin (B12), is effective to ameliorate TTI-induced pain, inhibit ectopic nerve sprouting, and accelerate tendon repair, through suppressing PAR2 activation. These findings reveal a critical role of PAR2 signaling in the development of chronic pain and histopathological alterations of injured tendon following Achilles tendon injury. This study suggests that the pharmaceuticals targeting PAR2, such as VBC, may be an effective approach for the treatment of tendon injury–induced pain and promoting tendon repair.
A Cross-sectional Survey of Comprehension and Satisfaction of Spanish-Reading Adults Regarding RÁPIDO as a Stroke Awareness Acronym
Authors: Smith Fiona S. , Lai Hongyin , Tamí-Maury Irene , Cornejo Gonzalez Angelica , Stuart Susan , Denny Mary Carter , Ancer Leal Andrea , Sharrief Anjail , Maroufy Vahed , Savitz Sean I. , Beauchamp Jennifer E. S.
Published: April 2024

BACKGROUND: Delay time to hospital arrival may be influenced by lack of recognition of stroke signs and the necessity to seek emergency medical, which in turn is influenced by language barriers to, a modifiable risk factor, stroke awareness education. The objective was to determine the comprehension and satisfaction of a Spanish stroke awareness acronym, RÁPIDO, among community-living, Hispanic and Latino, Spanish-reading adults. METHODS: A 33-item survey was completed by 166 adults. Data on sociodemographics, language preferences, stroke education, and comprehension and satisfaction with RÁPIDO were collected. Descriptive characteristics were calculated. Fisher exact tests were performed to determine whether reading language (group 1, only or predominantly reads in Spanish; group 2, reads in Spanish and English equally or reads predominately in English) influenced survey responses. Responses to open-ended questions were categorized. RESULTS: Sixty-nine percent of the participants were born outside of the United States, 82% currently resided in the United States, 34% read only or predominately in Spanish, and 7% had a stroke. Most participants thought RÁPIDO was informative, eye-catching, and easily remembered. Significant differences were found between reading language preference groups for correctly identifying RÁPIDO images for facial drooping (group 1, 80%; group 2, 95%; P ≤ .001) and dizziness/loss of balance (group 1, 54%; group 2, 73%; P = .027). Eighty percent or more of all participants were able to correctly interpret RÁPIDO images for facial drooping, blurry vision, impaired speech, and call emergency services. Adding “911” to the RÁPIDO image of the clock was a common suggestion. CONCLUSIONS: RÁPIDO was well received among the participants. Modifications to RÁPIDO images representing dizziness/loss of balance and arm weakness, and the addition of “911” may improve its usefulness. Obtaining more extensive feedback across the United States and testing the effect of RÁPIDO on increasing knowledge of stroke signs and retention of that knowledge are necessary next steps.
The Use of the Acute Stroke Management Questionnaire to Measure Acute Care Nurses' Stroke Knowledge
Authors: Leach Catherine T. , Bolin Linda P. , Swanson Melvin S. , Burch Ashley E. , Woltz Patricia C.
Published: April 2024

BACKGROUND: Nurses are key in identifying and treating in-hospital strokes (IHSs). Delayed treatment times and poor patient outcomes are associated with IHSs. Information is needed on nurses' stroke knowledge and the objective measurement of stroke knowledge using a validated tool. The Acute Stroke Management Questionnaire (ASMaQ) was recently developed to test stroke knowledge of healthcare professionals but has not been used on a nursing-specific population. METHODS: Through online surveying and use of ASMaQ, we will measure stroke knowledge of nurses caring for adult, hospitalized patients in an urban, southeast US health system. RESULTS: Total N is 196. Most participants (74.5%, n = 146) never worked on a stroke floor; however, almost all (95.9%, n = 188) cared for a stroke patient in the past. Most participants (65.3%, n = 128) reported receiving prelicensure stroke education, and 98.5% (n = 193) received postlicensure stroke education. Acute Stroke Management Questionnaire total scores ranged from 93 to 133 (mean [SD], 117.35 [8.15]). Most participants scored in the good stroke knowledge range for all 3 ASMaQ domains and total ASMaQ score. CONCLUSION: The online delivery of the ASMaQ was successful in testing nurses' stroke knowledge, and nurses were shown to have good stroke knowledge. Future initiatives should focus on discerning whether certain nurse characteristics predict higher or lower levels of stroke knowledge to help inform educational initiatives to improve IHS outcomes.
Psychometric Evaluation of the “Providing Validation” Measure in Vascular Anomalies
Authors: Sisk Bryan A. , Kerr Anna M. , Newman Amy R. , Chen Dandan , Mack Jennifer W. , Reeve Bryce B.
Published: April 2024

We assessed the psychometric properties of the “providing validation” subscale of PedCOM measures for parents of children with vascular anomalies and adult patients. A total of 139 adult patients and 78 parents completed surveys. The mean score for patients was 3.7 (standard deviation 1.0), and for parents was 4.0 (standard deviation 0.9). “Providing validation” measures demonstrated high internal consistency and good model fit to a unidimensional model for both patients and parents using confirmatory factor analysis. The measures also demonstrated convergent validity with co-administered measures. This study demonstrated the validity of “providing validation” measures for parents and adult patients with vascular anomalies.
The safety, feasibility, and oncological outcomes of laparoscopic completion total gastrectomy for remnant gastric cancer: a prospective study with 3-year follow-up (FUGES-004 study)
Authors: Zhong Qing , Wu Dong , Jiang Yi-ming , He Qing-Liang , Dang Xue-Yi , Xu Dong-Bo , Sun Yu-Qin , Su Guo-Qiang , Guo Kai-Qing , Cai Li-Sheng , Zhang Hao-xiang , Ye Wen , Lin Guang-tan , Li Ping , Xie Jian-Wei , Chen Qi-Yue , Zheng Chao-Hui , Lu Jun , Huang Chang-Ming , Lin Jian-Xian
Published: April 2024

Background:

The efficacy of laparoscopic completion total gastrectomy (LCTG) for remnant gastric cancer (RGC) remains controversial.

Methods:

The primary outcome was postoperative morbidity within 30 days after surgery. Secondary outcomes included 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence. Inverse probability treatment weighted (IPTW) was used to balance the baseline between LCTG and OCTG.

Results:

Final analysis included 46 patients with RGC who underwent LCTG at the FJMUUH between June 2016 and June 2020. The historical control group comprised of 160 patients who underwent open completion total gastrectomy (OCTG) in the six tertiary teaching hospitals from CRGC-01 study. After IPTW, no significant difference was observed between the LCTG and OCTG groups in terms of incidence (LCTG vs. OCTG: 28.0 vs. 35.0%, P=0.379) or severity of complications within 30 days after surgery. Compared with OCTG, LCTG resulted in better short-term outcomes and faster postoperative recovery. However, the textbook outcome rate was comparable between the two groups (45.9 vs. 32.8%, P=0.107). Additionally, the 3-year DFS and 3-year OS of LCTG were comparable to those of OCTG (DFS: log-rank P=0.173; OS: log-rank P=0.319). No significant differences in recurrence type, mean recurrence time, or 3-year cumulative hazard of recurrence were observed between the two groups (all P>0.05). Subgroup analyses and concurrent comparisons demonstrated similar trends.

Conclusions:

This prospective study suggested that LCTG was noninferior to OCTG in both short-term and long-term outcomes. In experienced centers, LCTG may be considered as a viable treatment option for RGC.
The role of hypoxia in chronic kidney disease: a nuanced perspective
Authors: Faivre Anna , de Seigneux Sophie
Published: April 2024

Purpose of review

This review critically examines the role of hypoxia in chronic kidney disease (CKD). While traditionally viewed as detrimental, recent insights suggest a more nuanced understanding of hypoxia's role during renal disease.

Recent findings

Emerging evidence challenges the traditional view that hypoxia is universally harmful in CKD context. We review here the recent evidence about hypoxia and HIF activation in CKD. We also discuss the effect of hypoxia on the renal tissue, and the relative inhibition of different HIF isoforms. Recent advancements in therapies, such as HIF prolyl hydroxylase inhibitors (HIF-PHIs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors seem to target the HIF pathway. These drugs impact anemia associated with CKD

but also renoprotection, hinting at a more complex interplay between hypoxia, HIF activation, and renal health.

A certain level of hypoxia and specific HIF pathway activation, especially HIF-α, can be beneficial in CKD progression. Therapeutic strategies targeting HIF stabilization, such as with HIF-PHIs and SGLT2 inhibitors, offer promising avenues for enhancing renal protection. Future investigations should aim at better understanding the precise effects on HIF pathway and optimize their clinical application to improve outcomes for CKD patients.
Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function
Authors: Lopategui Diana M. , Shah Hemendra N. , Herrmann Thomas R.W.
Published: April 2024

Purpose of review

Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies.

Recent findings

Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation.

Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.
Definitions and unmet needs in the management of oligomestatic renal cell carcinoma in the modern era
Authors: Francolini Giulio , Campi Riccardo , Ciccarese Chiara ,   the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer working group
Published: April 2024

Purpose of review

Oligometastatic renal cell carcinoma (RCC) is a complex entity, potentially leading to a specific clinical management of these patients. Recent and ongoing trials have raised several unresolved questions that could impact clinical routine practice, advocating for the integration of novel treatment options (systemic treatment, cytoreductive surgery, or stereotactic body radiotherapy - SBRT) with varied modalities and objectives.

Recent findings

Immunotherapy represents a breakthrough in the systemic treatment of mRCC. However, many questions are still unsolved regarding the perfect timing for starting systemic and whether the systemic treatment could improve the activity of metastases-directed strategies. Moreover, the widespread use of adjuvant immunotherapy will challenge the treatment paradigm in the oligorecurrent scenario. Radical surgery of metastases and more recently SBRT – both eventually associated with systemic treatment – actually rep

resent two important approaches to be considered in oligometastatic patients.

Oligometastatic RCC represents a status including a wide spectrum of clinical conditions that requires a tailored treatment approach. The correct management integrates local approaches (either metastasectomy or SRBT) and systemic (immune)-therapy. Several unmet needs have to be investigated, mainly regarding the lack of prospective randomized trials that directly compare modern therapies and different integration strategies.
Clinical and Economic Implications of Interventions in Pancreatic Fluid Collections
Authors: Varadarajulu Shyam , Cangelosi Michael J. , Cramer Geri R. , Kuipers Kevin , Reimer Stacey , Roy Ann K.
Published: April 2024

Objective

To compare clinical and economic implications of percutaneous and endoscopic treatment approaches in patients with pancreatic fluid collections (PFCs).

Materials and Methods

This is a retrospective claims analysis of Medicare beneficiaries who underwent inpatient endoscopic or percutaneous PFC drainage procedures (2016–2020). We performed longitudinal analysis of claims for all-cause mortality and rehospitalization during 180-day follow-up. Main outcome was mortality. Other outcomes were rehospitalization and direct costs.

Results

A total of 1311 patients underwent endoscopic (n = 727) or percutaneous (n = 584) drainage. Percutaneous as compared with endoscopic approach was associated with higher mortality (23.08% vs 16.7%, P = 0.004), rehospitalization (58.9% vs 53.3%, P = 0.04), and mean direct hospital costs ($37,107 [SD = $67,833] vs $27,800 [SD = $43,854], P = 0.004). On multivariable analysis, percutaneous drainage (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.02–1.86; P = 0.039), older age (hazard ratio [HR], 1.04; 95% CI, 1.01–1.04; P < 0.001), intensive care unit stay (HR, 1.02; 95% CI, 1.01–1.03; P < 0.001), and multiple comorbidities (HR, 1.07; 95% CI, 1.05–1.09; P < 0.001) were significantly associated with mortality. Percutaneous drainage (adjusted odds ratio [OR], 1.30; 95% CI, 1.04–1.63; P = 0.027) and older age (OR, 0.98; 95% CI, 0.97–0.99; P < 0.001) were significantly associated with rehospitalizations.

Conclusions

As percutaneous drainage may be associated with higher mortality, rehospitalization, and costs, when requisite expertise is available, endoscopy should be preferred for treatment of PFC amenable to such an approach. Randomized trials are required to validate these findings.
Oncology’s Silent Caregivers
Authors: Hendricks Bailey A. , Kupzyk Kevin , Poppert Cordts Katrina M. , Lally Robin M.
Published: April 2024

Background

Cancer affects the whole family system causing reorganization of functioning and responsibilities where children may take on a caregiving role. In the United States, an estimated 204 000 to 475 000 caregiving youth provide multifaceted, extended care in oncology. This results in both positive and negative outcomes for youth—spanning multiple domains of health.

Objective

The aim of this study was to explore the caregiving experiences, outcomes, and unmet needs of caregiving youth (aged 12-24 years) in oncology.

Methods

An explanatory sequential mixed-methods study design was used. Fifty-two adults who lived with a parent with cancer as a child were recruited via social media and asked to complete an online survey. A subsample of 18 individuals reporting high to very high amounts of caregiving were subsequently interviewed.

Results

The mean reported caregiving youth age was 16.13 (±4.86) years. They provided care approximately 22.43 h/wk for approximately 3.04 years. Most (71.2%) reported high to very high amounts of caregiving activity. The highest reported categories of unmet needs were information, family, feelings, friends, and time out/recreation. Qualitative findings included 4 themes: stepping into the role, family communication, dealing with feelings, and a new separateness.

Conclusions

Identified needs included a desire for more information to aid in uncertainty, better communication within the family, needing someone to help them process their feelings, and peer-to-peer support.

Implications for Practice

It is important for nurses and researchers to be aware of and acknowledge the needs of families dealing with cancer and aid in the development and implementation of tailored interventions to support caregiving youth.
Virtually Supervised Exercise Programs for People With Cancer
Authors: Smith Gillian V. H. , Myers Samantha A. , Fujita Rafael A. , Yu Christy , Campbell Kristin L.
Published: April 2024

Background

Exercise has been shown to improve physical function and quality of life for individuals with cancer. However, low rates of exercise adoption and commonly reported barriers to accessing exercise programming have demonstrated a need for virtual exercise programming in lieu of traditional in-person formats.

Objective

The aim of this study was to summarize the existing research on supervised exercise interventions delivered virtually for individuals living with and beyond cancer.

Methods

We conducted a scoping review of randomized controlled trials, pilot studies, or feasibility studies investigating virtually supervised exercise interventions for adults either during or after treatment of cancer. The search included EMBASE, MEDLINE, CINAHL, SPORTDiscus, Cochrane Library, and conference abstracts.

Results

Fifteen studies were included. The interventions were delivered mostly over Zoom in a group format, with various combinations of aerobic and resistance exercises. Attendance ranged from 78% to 100%, attrition ranged from 0% to 29%, and satisfaction ranged from 94% to 100%. No major adverse events were reported, and only 3 studies reported minor adverse events. Significant improvements were seen in upper and lower body strength, endurance, pain, fatigue, and emotional well-being.

Conclusion

Supervised exercise interventions delivered virtually are feasible and may improve physical function for individuals with cancer. The supervision included in these virtual programs promoted similar safety as seen with in-person programming. More randomized controlled trials with large cohorts are needed to validate these findings.

Implications for Practice

Individuals living with and beyond cancer can be encouraged to join virtually supervised exercise programs because they are safe, well enjoyed, and may improve physical function and quality of life.
LGBTI Healthcare in Medical Education
Authors: Elboga Gulcin , Kocamer Sahin Sengul , Demir Bahadır , Ozdamar Unal Gulin , Alparslan Beyza , Altıntaş Ezel , Marangoz Talip Kerem , Guneyligil Kazaz Tanyeli , Altindag Abdurrahman
Published: April 2024

Our aim is to reveal the interaction of cultural and religious influences with professional equipment by determining the level of knowledge, sexual attitudes, and homophobia of medical students about LGBTI+ individuals. The study included 324 students from our faculty of medicine. The Hudson and Ricketts Homophobia scale, the Attitudes Towards Lesbians and Gay Men scale, and the Hendrick Sexual Attitudes scale were used with the sociodemograpic data form. Data were collected and analyzed using descriptive and inferential statistical tests. The mean score of the students from the Hudson and Ricketts Homophobia scale was 58.50. The findings of our study support that medical students consider that the education they receive in this regard is inadequate. One of the goals of undergraduate medical education is the provision of health services to all segments of society; therefore, it is recommended to make improvements in the curriculum in this regard.
Combining Artificial Intelligence and Simplified Image Processing for the Automatic Detection of Mycobacterium tuberculosis in Acid-fast Stain
Authors: Wang Hsiang Sheng , Liang Wen-Yih
Published: April 2024

Tuberculosis (TB) poses a significant health threat in Taiwan, necessitating efficient detection methods. Traditional screening for acid-fast positive bacilli in acid-fast stain is time-consuming and prone to human error due to staining artifacts. To address this, we present an automated TB detection platform leveraging deep learning and image processing. Whole slide images from 2 hospitals were collected and processed on a high-performance system. The system utilizes an image processing technique to highlight red, rod-like regions and a modified EfficientNet model for binary classification of TB-positive regions. Our approach achieves a 97% accuracy in tile-based TB image classification, with minimal loss during the image processing step. By setting a 0.99 threshold, false positives are significantly reduced, resulting in a 94% detection rate when assisting pathologists, compared with 68% without artificial intelligence assistance. Notably, our system efficiently identifies artifacts and contaminants, addressing challenges in digital slide interpretation. Cross-hospital validation demonstrates the system’s adaptability. The proposed artificial intelligence–assisted pipeline improves both detection rates and time efficiency, making it a promising tool for routine pathology work in TB detection.
Negative impact of a health insurer-mandated de-simplification from a single-tablet regimen to a two-tablet regimen
Authors: Oosterhof Piter , Van Luin Matthijs , Brinkman Kees , Burger David M.
Published: April 2024

Objectives:

Antiretroviral therapy (ART) accounts for a considerable proportion of HIV care expenses. In June 2021, a Dutch healthcare insurer implemented a mandatory policy to de-simplify branded RPV/TDF/FTC (Eviplera) into a two-tablet regimen containing rilpivirine (Edurant) and generic TDF/FTC as part of cost-saving measures. The objectives of this study were to evaluate the acceptance of this policy, the trends in ART dispensation, and cost developments.

Design:

A retrospective database study.

Methods:

In this study, medication dispensation data were obtained from the Dutch Foundation for Pharmaceutical Statistics (SFK). This database covers 98% of all medication dispensations from Dutch pharmacies including people with HIV who receive ART. We received pseudonymized data exclusively from individuals insured by the insurer for the years 2020–2022. Costs were calculated using Dutch drug prices for each year.

Results:

In June 2021, 128 people with HIV were on branded RPV/TDF/FTC. Following the policy implementation, 59 (46%) had switched to RPV + generic TDF/FTC, but after 1.5 years, only 17 of 128 individuals (13%) used the proposed two-tablet regimen. The other 111/128 used RPV/TDF/FTC with prescriptions for ’medical necessity’ (n = 29), switched to RPV/TAF/FTC (n = 51), or other ART (n = 31). Despite expectations of cost-savings, costs increased from €72 988 in May 2021 to €75 649 in May 2022.

Conclusion:

A mandatory switch from an STR to a TTR in people with HIV proved unsuccessful, marked by low acceptance, and increased costs after 1 year. This underscores the necessity of incorporating patient and prescriber involvement in changing medication policies.
Spectrum of Imaging Findings and Complications After Hepatic Transarterial Chemoembolization for Liver Tumors
Authors: Zandieh Ghazal , Yazdaninia Iman , Afyouni Shadi , Shaghaghi Mohamadreza , Borhani Ali , Mohseni Alireza , Shaghaghi Shiva , Liddell Robert , Kamel Ihab R.
Published: April 2024

This study reviews the spectrum of imaging findings and complications after transarterial chemoembolization (TACE) for the treatment of primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma) and liver metastases. The review encompasses a spectrum of imaging criteria for assessing treatment response, including the modified Response Evaluation Criteria in Solid Tumors guidelines, tumor enhancement, and apparent diffusion coefficient alterations.

We discuss the expected posttreatment changes and imaging responses to TACE, describing favorable and poor responses. Moreover, we present cases that demonstrate potential complications post-TACE, including biloma formation, acute cholecystitis, abscesses, duodenal perforation, arterial injury, and nontarget embolization. Each complication is described in detail, considering its causes, risk factors, clinical presentation, and imaging characteristics.

To illustrate these findings, a series of clinical cases is presented, featuring diverse imaging modalities including computed tomography, magnetic resonance imaging, and digital subtraction angiography.
Loss of Mickey Mouse Ears’ Sign in Progressive Supranuclear Palsy
Authors: Chow Tsz-Kit , Ma Kwok-Man
Published: April 2024

Progressive supranuclear palsy (PSP) is the most prevalent form of degenerative atypical parkinsonism. Clinical manifestations of PSP commonly encompass deficits in vertical gaze, postural stability, akinesia, and cognitive impairment. The characteristic metabolic pattern observed in PSP through FDG PET displays hypometabolism in the midbrain, striatum, thalamus, and frontal lobe. However, visual interpretation of midbrain hypometabolism poses challenges. In this report, we aim to elucidate a novel observation termed the “loss of Mickey Mouse ears’ sign,” which signifies midbrain hypometabolism as detected through visual assessment of FDG PET images.
An Analysis of Medical Malpractice Litigation Involving Orbital Fractures
Authors: Brozynski Martina , Seyidova Nargiz , Oleru Olachi , Rew Curtis , loschpe Anais Di Via , Taub Peter J.
Published: April 2024

Background:

Orbital fractures frequently require operative management by a plastic and reconstructive surgeon. Due to the proximity to the globe and complexity of the reconstruction, orbital fractures, and related procedures have the potential to be a source of medical litigation. The aim of the present study was to review orbital fracture malpractice litigation, including case outcomes and compensatory damages.

Methods:

The Westlaw and Lexis Nexis databases were queried for jury verdicts and settlements related to orbital fracture malpractice lawsuits. The Boolean terms included “orbit! /10 fracture,” “orbit! & fracture,” and “ocular & fracture” for both databases. Cases were included if they were state or federal cases related to both orbital fracture and medical malpractice involving surgical or medical mismanagement or misdiagnosis of orbital fracture.

Results:

A total of 49 cases from 1994 to 2018 met inclusion criteria between the databases. The most common legal complaint was the defendant’s failure to make a diagnosis either by not ordering the proper radiological tests or by not interpreting radiological tests correctly, seen in 35% of cases. In 57% of the cases, the defendant was a surgeon, 46% of which involved a plastic surgeon specifically. Cases were resolved in favor of the defendant 49% of the time. Most cases (57%) resulted in a monetary outcome of $0. However, cases that were decided in favor of the plaintiff had significant compensatory damages with the majority being over $100,000, and 1 case as high as $8 million.

Conclusion:

Although almost half of the orbital fracture malpractice cases resulted in an outcome favoring the defendant, significant monetary consequences against the defendant were possible in cases when the plaintiff prevailed.
Yard Work and Gardening: A Pastime with Potential for Craniofacial Injury
Authors: Prasad Soumil , Treger Dylan , Mangal Rohan , Gompels Matthew T. , Thaller Seth R.
Published: April 2024

Introduction:

Yard and garden tools are increasingly used by Americans. Despite the growing popularity of gardening as a leisure activity, the rate of injury associated with these tools remains remarkedly high. Previous research has highlighted the risks associated with improper handling of tools and associated potential long-term consequences. This retrospective study aims to provide a comprehensive analysis of the craniofacial injuries caused by yard and garden equipment. The investigation will emphasize the need for improved safety measures and regulations.

Methods and Materials:

Publicly available data from the National Electronic Injury Surveillance System (NEISS) database were utilized to identify craniofacial injuries related to yard and garden tool handling during a 10-year period (2013–2022). Study population included patients aged 1 to 85+ years who visited emergency departments secondary to these injuries. Data analysis involved queries for specific products and diagnostic codes related to craniofacial injuries.

Results:

Over the study period, a total of 588,384 craniofacial injuries associated with yard and garden tools were recorded, averaging 58,838 injuries annually. Men accounted for a significantly higher proportion of injuries (69.2%) compared to women (30.8%). Elderly population, particularly those aged 60 to 64 years, experienced the highest incidence of craniofacial injuries. Cranium was the most commonly affected anatomical location, comprising 34% of all injuries. Lacerations and contusions were the most frequent injury diagnoses. Greenhouse or gardening supplies and lawnmowers are the most common causative agents, respectively.

Discussion:

Our study highlights the persistent incidence of craniofacial injuries associated with yard and garden tool handling emphasizing the need for standardized safety regulations and guidelines. Sociological and demographic factors, such as differences in gardening habits and behavioral patterns between genders, contribute to the observed disparities in injury rates. Understanding the underlying factors contributing to these craniofacial injuries is crucial to promoting safer practices and reducing the overall burden associated with yard and garden tools.
Should soldiers take oral tranexamic acid before going into battle?
Authors: Cazes Nicolas , Corcostegui Simon-Pierre , Lovi Steven , Romary Emeric , Desrobert Vincent , Lidzborski Lionel , Derkenne Clément
Published: April 2024

Tranexamic acid is an inexpensive antifibrinolytic treatment that reduces morbidity and mortality in civilian and military trauma patients. It must be administered within 3 hours of the injury, and its efficacy is greater the earlier it is given. It is already used preventively in the civilian environment in a number of indications to reduce bleeding and bleeding-related mortality. We wondered about the potential benefits of preventive oral administration of tranexamic acid prior to an assault for military personnel with a potential risk of injury.
The association between glymphatic system dysfunction and alterations in cerebral function and structure in patients with white matter hyperintensities
Authors: Zhi Zhang , Liang Xiao , Huang Muhua , Wu Lin , Zhou Fuqing
Published: April 2024

The objective of this study is to explore the relationship between the glymphatic system and alterations in the structure and function of the brain in white matter hyperintensity (WMH) patients. MRI data were collected from 27 WMH patients and 23 healthy controls. We calculated the along perivascular space (ALPS) indices, the anterior corner distance of the lateral ventricle, and the width of the third ventricle for each subject. The DPABISurf tool was used to calculate the cortical thickness and cortical area. In addition, data processing assistant for resting-state fMRI was used to calculate regional homogeneity, degree centrality, amplitude low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), and voxel-mirrored homotopic connectivity (VMHC). In addition, each WMH patient was evaluated on the Fazekas scale. Finally, the correlation analysis of structural indicators and functional indicators with bilateral ALPS indices was investigated using Spearman correlation analysis. The ALPS indices of WMH patients were lower than those of healthy controls (left: t = -4.949, P < 0.001; right: t = -3.840, P < 0.001). This study found that ALFF, fALFF, regional homogeneity, degree centrality, and VMHC values in some brain regions of WMH patients were alternated (AlphaSim corrected, P < 0.005, cluster size > 26 voxel, rmm value = 5), and the cortical thickness and cortical area of WMH patients showed trend changes (P < 0.01, cluster size > 20 mm2, uncorrected). Interestingly, we found significantly positive correlations between the left ALPS indices and degree centrality values in the superior temporal gyrus (r = 0.494, P = 0.009, P × 5 < 0.05, Bonferroni correction). Our results suggest that glymphatic system impairment is related to the functional centrality of local connections in patients with WMH. This provides a new perspective for understanding the pathological mechanisms of cognitive impairment in the WMH population.
Differential changes in Wnt7 and Dkk1 levels in astrocytes exposed to glutamate or TNFα
Authors: García-Velázquez Lizbeth , Alobayan Reem , Morales-Moreno Denisse , Ávila-Muñoz Evangelina , Arias Clorinda
Published: April 2024

Wnt signaling plays an important role in adult brain function, and its dysregulation has been implicated in the loss of neuronal homeostasis. Despite the existence of many studies on the participation of the Wnt pathway in adult neurons, its regulation in astrocytes has been scarcely explored. Several reports point to the presence of Wnt ligands in astrocytes and their possible impact on neuronal plasticity or neuronal death. We aimed to analyze the effect of the neurotransmitter glutamate and the inflammatory cytokine TNFα on the mRNA and protein levels of the canonical Wnt agonist Wnt7a and the antagonist Dkk1 in cultured astrocytes. Primary astrocyte cultures from rat cerebral cortices were exposed to glutamate or TNFα. Wnt7a and Dkk1 expression was analyzed by RT-qPCR and its protein abundance and distribution was assessed by immunofluorescence. We found high basal expression and protein levels of Wnt7a and Dkk1 in unstimulated astrocytes and overproduction of Dkk1 mRNA induced by the two stimuli. These results reveal the astrocytic source of the canonical Wnt ligands Wnt7a and Dkk1, whose levels are differentially regulated by glutamate and TNFα. Astrocytes are a significant source of Wnt ligands, the production of which can be differentially regulated under excitatory or proinflammatory conditions, thereby impacting neuronal function.
Spatial connectivity of reef manta rays across the Raja Ampat archipelago, Indonesia
Authors: Setyawan Edy , Erdmann Mark V. , Mambrasar Ronald , Ambafen Orgenes , Hasan Abdi W. , Izuan Muhamad , Mofu Imanuel , Putra Mochamad I. H. , Sianipar Abraham B. , Constantine Rochelle , Stevenson Ben C. , Jaine Fabrice R. A.
Published: April 2024

The reef manta ray
Mobula alfredi
is present throughout most island groups that form the Raja Ampat archipelago, Indonesia. The species is protected regionally and nationally and is currently managed as a single homogeneous population within the 6.7 million ha archipelago. However, scientific evidence is currently lacking regarding the spatial connectivity and population structure of
M. alfredi
within this archipelago. Using network analysis and an array of 34 acoustic receivers deployed throughout Raja Ampat between February 2016 and September 2021, we examined the movements of 72 subadult and adult
M. alfredi
tagged in seven regions of Raja Ampat. A total of 1094
M. alfredi
movements were recorded and were primarily concentrated between nearby receiver stations, highlighting frequent local movements within, and limited long-distance movements between regional acoustic receiver arrays. Network analysis revealed highly connected nodes acting as hubs important for
M. alfredi
movements. A community detection algorithm further indicated clusters within the network. Our results suggest the existence of a metapopulation comprising three demographically and geographically distinct subpopulations within the archipelago. They also reveal the importance of Eagle Rock as a critical node in the
M. alfredi
movement network, justifying the urgent inclusion of this site within the Raja Ampat marine protected area network.