bluuebunny/crossref_metadata_2025 huggingface dataset:
Injection-related Visual Compromise
Authors: Santiago Díaz Alejandra , Montes José Raúl , Nieves Martinez Ileana
Published: January 2024

The global market for hyaluronic acid (HA)-based dermal fillers has experienced substantial growth, providing patients with an effective nonsurgical cosmetic option. According to the global market report, the HA dermal fillers market size is expected to grow to $8.5 billion in 2027 at an annual growth rate (CAGR) of 8.9%. However, despite their popularity, HA injections are not free of complications. Vascular occlusion, particularly involving the central retinal artery, represents a significant risk. This case report presents a 60-year-old woman who presented with binocular vertical diplopia after HA filler injection in the right tear trough area. Upon evaluation, the patient exhibited right hypertropia, suggesting right inferior rectus paresis due to vascular injury of the infraorbital artery. Prompt management with hyaluronidase and oral steroids resulted in the resolution of double vision. This case highlights the importance of recognizing potential complications during HA filler injections and emphasizes the need for early intervention to minimize adverse effects.
Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review
Authors: Guliyeva Gunel , Janis Jeffrey E.
Published: January 2024

Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: “pyoderma gangrenosum” and “surgery.” This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.
Comparison of disc position stability and condylar bone remodeling between two open disc repositioning surgeries: a retrospective single-center cohort study
Authors: Lu Chuan , Zhao Jieyun , Zhang Xiaoyu , Fan Xingda , Nie Xin , Yu Chuangqi , Yang Chi , He Dongmei
Published: January 2024

Background and Objective:

Open suturing (OSu) and Mini-screw Anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodeling (CBR) between these two surgical procedures in a single center.

Methods:

A retrospective cohort study using magnetic resonance imaging (MRI) scans (preoperation, 1 week and 12 mo postoperation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one center through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting 5 factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression.

Results:

385 patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% confidence interval [CI], 1.27 to 6.85) and better CBR (RR=1.58; 95%CI, 1.02 to 2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95%CI, 1.11 to 6.26) and overcorrected or posteriorly repositioned discs were more stable than normally-repositioned discs (RR=5.84; 95%CI, 2.58 to 13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95%CI, 0.89 to 0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95%CI, 1.76 to 3.83).

Conclusion:

OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.
Influence of the Spread of the Electric Field on Speech Recognition in Cochlear Implant Users
Authors: Kopsch Anna C. , Rahne Torsten , Plontke Stefan K. , Wagner Luise
Published: January 2024

Objective

To investigate the correlation of word recognition with cochlear implant (CI) and spread of the electric field.

Study Design

Prospective, noninterventional, experimental study.

Setting

A tertiary referral center.

Patients

Thirty-eight adult CI users with poor (n = 11), fair (n = 13), and good (n = 16) word recognition performance.

Main Outcome Measure

Transimpedances were measured after 37 μs. Word recognition score was recorded at 65 dB SPL for German monosyllables in quiet. Transimpedance half widths were calculated as a marker for spread of the electric field.

Results

Narrow and broad spread of the electric field, i.e., small and large half widths, were observed in all word recognition performance groups. Most of the transimpedance matrices showed a pattern of expansion along the diagonal toward the apical electrode contacts. Word recognition was not correlated with transimpedance half widths.

Conclusions

The half width of the spread of the electric field showed no correlation with word recognition scores in our study population.
A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases
Authors: Häußler Sophia Marie , Peichl Jonathan , Bauknecht Christian , Spierling Katja , Olze Heidi , Betz Christian , Stölzel Katharina
Published: January 2024

Background

Acute mastoiditis (AM) is a potentially life-threatening condition primarily affecting children. To date, there are no consistent criteria or valid guidelines for the diagnosis and treatment of pediatric AM. Therefore, this study evaluates the clinical course of AM in terms of clinical signs and treatment. In addition, a novel classification scheme for the disease and a treatment algorithm is being proposed.

Methods

Patient records over a 12-year period from a single center were reviewed to identify confirmed cases of AM in children. Data collected included clinical signs, body temperature, and infection parameters during the disease, as well as radiological imaging, antibiotics, and surgical as well as conservative treatment. In addition, a classification of the AM stages was established in accordance with the findings described and practical experience, consisting of four stages (1, mastoidal irritation; 2, mild AM; 3, advanced AM; 4, advanced AM and additional complications) with corresponding treatment recommendations. In the retrospective cohort, those AM cases that were treated alongside the classification were compared with the rest concerning clinical course and outcome.

Results

A total of 109 patients (mean age, 3.8 ± 3.8 years) were included. The main symptoms at hospital admission were auricular protrusion (n = 73; 67.0%), fever (n = 56; 51.4%) with a mean temperature of 38.3 ± 1.1°C, and otalgia (n = 28; 25.7%). The mean laboratory-tested levels of leukocytes and C-reactive protein at the time of hospital admission were 15.96 ± 8.7/nl and 59.6 ± 54.0 mg/L, respectively. During winter, there was a higher prevalence of AM, with peak hospital admissions in April (n = 22). The most common pathogen was Streptococcus pyogenes (32 cases). Treatment was purely conservative in four cases, whereas the remaining cases underwent surgery (41× grommet insertion, 64× plus mastoidectomy). The outcome was generally good, but in eight patients a second surgical procedure had to be performed as they showed signs of clinical deterioration. A total of 101 patients were treated according to the proposed algorithm, and all of which had a good outcome without the need for further interventions.

Conclusion

Based on clinical experience in a large cohort of pediatric AM patients, a novel diagnostic and treatment algorithm has been developed and successfully tested in a retrospective cohort for AM in children to prevent further complications and to ease its management by pediatricians and otorhinolaryngologists in the emergency setting.
Localization of Low- and High-Frequency Sounds in Cochlear Implant Recipients Using a Contralateral Hearing Aid
Authors: Zelger Philipp , Zorowka Patrick , Schmutzhard Joachim , Galvan Oliver , Rossi Sonja , Stephan Kurt , Seebacher Josef
Published: January 2024

Background and Objectives

The ability to localize sounds is partly recovered in patients using a cochlear implant (CI) in one ear and a hearing aid (HA) on the contralateral side. Binaural processing seems effective at least to some extent, despite the difference between electric and acoustic stimulation in each ear. To obtain further insights into the mechanisms of binaural hearing in these listeners, localization of low- and high-frequency sounds was tested.

Study Design

The study used a within-subject design, where participants were tasked with localizing sound sources in the horizontal plane. The experiment was conducted in an anechoic chamber, where an array of seven loudspeakers was mounted along the 24 azimuthal angle span from −90° to +90°. Stimuli were applied with different frequencies: broadband noise and high- and low-frequency noise.

Subjects

Ten CI recipients participated in the study. All had an asymmetric hearing loss with a CI in the poorer ear and an HA on the contralateral side.

Main Outcome Measures

Accuracy of sound localization in terms of angular error and percentage of correct localization scores.

Results

The median angular error was 40° in bimodal conditions for both broadband noise and high-frequency noise stimuli. The angular error increased to 47° for low-frequency noise stimuli. In the unilaterally aided condition with an HA, only a median angular error of 78° was observed.

Conclusions

Irrespective of the frequency composition of the stimuli, this group of bimodal listeners showed some ability to localize sounds. Angular errors were larger than those reported in the literature for bilateral CI users or single-sided deaf listeners with a CI. In the unilateral listening condition with HA, only localization of sounds was not possible for most subjects.
Expression of Brain-Derived Neurotrophic Factor in Human Spiral Ganglia Neurons after Cochlear Implantation
Authors: Wong Emily C. , Lopez Ivan A. , Ishiyama Akira , Ishiyama Gail
Published: January 2024

Background

Brain-derived neurotrophic factor (BDNF) is an important factor in the development and neuroprotection of afferent auditory pathways. In this study, we investigated the expression of BDNF in the afferent auditory pathway after cochlear implantation (CI), hypothesizing that electrical stimulation after CI stimulates BDNF expression in the afferent auditory pathway.

Methods

Archival human temporal bones from eight patients with a history of CI and five patients with normal hearing (ages 65–93 years old) were studied. Temporal bone specimens were immunoreacted with rabbit polyclonal antibodies against BDNF and mouse monoclonal antibodies against pan-neurofilaments. In cases of unilateral CI, the BDNF expression was compared with the contralateral unimplanted ear and normal temporal bones without hearing loss.

Results

BDNF immunoreactivity (IR) localized to the spiral ganglion neurons (SGNs) somata and the surrounding satellite cells. BDNF-IR in the spiral ganglia was similar in the apical, middle, and basal hook regions. Neurofilament IR localized to SGN nerve fibers in both implanted and unimplanted cochleae. BDNF-IR in the SGN and satellite cells was significantly increased in the implanted specimens compared with the unimplanted specimens (p < 0.05) and the normal hearing specimens (p < 0.05). BDNF-IR expression was similar in the unimplanted cochlea and in the normal cochlea. BDNF protein expression was increased despite complete loss of the organ of Corti hair cells and supporting cells. Even in the cases of CI with a 6-mm first-generation electrode, BDNF expression was upregulated throughout the cochlea.

Conclusions

BDNF expression in the SGN appears to be upregulated by the electrical stimulation from CI. This study provides evidence that the electrical stimulation from CI may stimulate the expression of BDNF, playing a neuroprotective role in the rehabilitation of hearing in the deafened ear.
Assessment of Nutritional Risk Scores (the Nutritional Risk Screening 2002 and Modified Nutrition Risk in Critically Ill Scores) as Predictors of Mortality in Critically Ill Patients on Extracorporeal Membrane Oxygenation
Authors: Zhu Manyi , Zha Yutao , Cui Liangwen , Huang Rui , Wei Zhengxiang , Fang Ming , Liu Nian , Shao Min
Published: January 2024

Nutritional risk is associated with intensive care unit (ICU) stay and mortality, the Nutritional Risk Screening 2002 (NRS 2002) and the modified Nutritional Risk in the Critically Ill (mNUTRIC) score are assessment instruments and useful in predicting the risk regarding mortality in ICU patients. Our aim was to assess the effects of mNUTRIC and NRS 2002 on mortality in patients on extracorporeal membrane oxygenation (ECMO). A retrospective cohort study was performed and 78 patients were included for final analysis. In the current study, the NRS 2002 and the mNUTRIC score within 24 hours before starting ECMO were applied to assess patients’ nutritional status on ECMO and explore the relationship between nutritional status and patient outcomes. This study suggests that both mNUTRIC and NRS 2002 scores were found to be significant independent risk and prognostic factors for in-hospital and 90 day morality among ECMO patients based on multivariable logistic regression analysis (p < 0.05), with those in the high-risk group having higher in-hospital and 90 day mortality rates than those identified as being at low risk (p < 0.001). In comparison to the NRS 2002 score, the mNUTRIC score demonstrated a superior prognostic ability in ECMO patients.
The genetics of cystinuria – an update and critical reevaluation
Authors: Abad Baucells Clàudia , Schönauer Ria , Halbritter Jan
Published: January 2024

Purpose of review

We aimed to critically evaluate how the establishment of genotype-based treatment for cystinuria has been hampered due to the large number of variants of unknown significance (VUS) within the disease causing genes as well as challenges in accessing a large enough sample size for systematic analysis of endpoint parameters that truly reflect disease severity. This review further discusses how to overcome these hurdles with the establishment of a cystinuria-specific refinement of the current American College of Medical Genetics and Genomics (ACMG)-criteria of variant interpretation.

Recent findings

Novel tools such as AlphaMissense combined with the establishment of a refined ACMG criterion will play a significant role in classifying VUS within the responsible disease genes SLC3A1 (rBAT) and SLC7A9 (BAT1). This will also be essential in elucidating the role of promising candidate genes, such as SLC7A13 (AGT1), which have been derived from murine model systems and still need further research to determine if they are involved in human cystinuria.

Cystinuria was one of the first disorders to receive a gene-based classification, nonetheless, the clinically actionable implications of genetic diagnostics is still minor. This is due to poorly characterized genotype-phenotype correlations which results in a lack of individualized (genotype-) based management and metaphylaxis.
A case report of postcardioversion device-related thrombus in a patient with left atrial appendage occlusion device on apixaban
Authors: Ahmed Hasaan , Ismayl Mahmoud , Palicherla Anirudh , Heppler Miranda , Petraskova Terezia , Kousa Omar , Vargha Jalal
Published: January 2024

Background:

Current guidelines recommend proceeding with cardioversion, without the explicit need for preprocedural transesophageal echocardiography (TEE), in patients compliant with oral anticoagulation for at least 3 weeks. The relevance of these guidelines remains unclear in those undergoing repeat cardioversion.

Case summary:

A 66-year-old male with a history of atrial fibrillation (AF) and a left atrial appendage occlusion (LAAO) device, compliant with apixaban, presented with dyspnea and lightheadedness. He was cardioverted into sinus rhythm, 10 days before symptom onset, with TEE unremarkable at the time. An ECG revealed that the patient converted back into AF and a repeat cardioversion was scheduled. At the patient’s request, a TEE was obtained, revealing a new 2 cm×1 cm thrombus in the left atrium above the WATCHMAN device. Cardioversion was canceled and the patient was hospitalized for AF management.

Discussion:

Cardioverted patients are at risk for thrombus formation due to atrial stunning, a transitory dysfunction of the atrial appendage and atrium, which occurs immediately after cardioversion and can persist for several weeks. The likelihood of a thrombus is further propagated by individual risk factors for stroke.

Conclusion:

Anticoagulation does not eliminate the risk of thrombus formation in those with increased risk factors for stroke. Further studies are warranted to assess the need for routine TEE, after cardioversion, in those with stroke risk factors on anticoagulation or who have LAAO.
Compassionate Care
Authors: Segre Lisa S. , Davila Rebecca Chuffo , Banks Erika , Hohmann Kayla , Vlasich Maureen , Hein Maria L. , Beck Cheryl Tatano
Published: January 2024

Purpose:

Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences.

Study Design and Methods:

This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity.

Results:

Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU.

Clinical Implications:

For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.
Barriers and Facilitators of Parent Presence in the Neonatal Intensive Care Unit
Authors: Nist Marliese Dion , Spurlock Elizabeth J. , Pickler Rita H.
Published: January 2024

Purpose:

The purpose of this study was to describe system-level and personal factors influencing parent presence in the neonatal intensive care unit (NICU) and identify differences in factors by sociodemographic characteristics.

Study Design and Methods:

In a cross-sectional national survey study using social media recruitment, participants rated the frequency of 13 potential barriers and 12 potential facilitators using a 5-point Likert scale. Experiences of discrimination and parent–staff engagement were also measured.

Results:

Valid responses were analyzed from 152 participants. Uncomfortable facilities and home responsibilities were the most highly reported system-level and personal barriers, respectively. Encouragement to participate in caregiving and social support were the most highly reported system-level and personal facilitators, respectively. Participants reported low to moderate levels of discrimination and moderate levels of parent–staff engagement. Latent class analysis revealed three sociodemographic clusters. Differences in barriers, facilitators, discrimination, and engagement were found among clusters.

Clinical Implications:

NICU facilities are uncomfortable and may discourage parent presence. Allowing support persons to accompany parents, providing comfortable facilities, and engaging parents in caregiving may promote greater parent presence and improved parent and child outcomes. Studies of potential bias toward parents with lower education and income and effects on parent presence and infant outcomes are needed.
Expedited surgery does not increase transfusion rates for patients with geriatric hip fracture taking factor Xa inhibitors
Authors: Wang Juntian , Nilssen Paal , Stone Julia , Breda Kathleen , Little Milton , Moon Charles , Lin Carol
Published: January 2024

Objectives:

Geriatric patients who sustain hip fractures and are taking factor Xa inhibitors (Xa-I) experience surgical delay. Our institution developed a pharmacokinetic protocol to formally guide and expedite surgical timing for these patients. The protocol is based on the patient's renal function and timing of last Xa-I dose. For patients with impaired renal function, longer wait times are recommended. The purpose of this study was to determine the effects of this protocol for patients with geriatric hip fracture taking Xa-I.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center.

Patients/Participants:

A total of 164 patients aged 65 and older who were taking Xa-I before admission and underwent hip fracture surgery; 68 patients in the Standard group (2014–2018) and 96 patients in the Expedited group (2020–2022, after protocol implementation).

Intervention:

Hip fracture surgery.

Main Outcome Measurements:

Time to surgery (TTS), transfusion rate, blood loss, 90-day complication rates.

Results:

The median TTS was significantly shorter in the Expedited group (28.6 hours, interquartile range 21.3 hours) than in the Standard group (44.8 hours, interquartile range 21.1 hours) (P < .001). There were no differences in overall transfusion rates. Multivariable regression analysis demonstrated that time to surgery was not predictive of transfusion rate in all patients (OR 1.00, 95% CI 0.99–1.02, P = .652). There were no differences in blood loss or rates of 90-day complications.

Conclusion:

Geriatric patients with hip fractures and taking factor Xa inhibitors may warrant earlier surgery without an increased risk of transfusion or bleeding.

Level of Evidence:

Therapeutic Level III.
Prognostic Value of BAP1 Protein Expression in Uveal Melanoma
Authors: Kennedy Susan , Owens Sally , Ivers Laura , Hegarty Ciara , O’Neill Valerie , Berenguer-Pina Jose J. , Horgan Noel , Crown John , Walsh Naomi
Published: January 2024

The prognostic value of the traditional pathologic parameters that form part of the American Joint Committee on Cancer staging system and genetic classifications using monosomy chromosome 3 and structural alterations in chromosome 8 are well established and are part of the diagnostic workup of uveal melanoma (UM). However, it has not been fully clarified whether nuclear protein expression of the tumor suppressor gene BAP1 (nBAP1) by immunohistochemistry alone is as powerful a predictor of overall survival (OS) and/or disease-specific survival (DSS) as chromosome analysis. The protein expression of nBAP1 was evaluated in a retrospective cohort study of 308 consecutive patients treated by primary enucleation between January 1974 and December 2022. We correlated clinical, pathologic, and cytogenetic characteristics to identify the best prognostic indicators for OS and DSS. Loss of nBAP1 was detected in 144/308 (47%) of patients. Loss of nBAP1 expression was significantly associated with poor survival. In patients with disomy chromosome 3, nBAP1 negative is significantly associated with poorer OS but not DSS. We observed that older age (>63 years), presence of metastasis, and nBAP1 negative remained independent prognostic factors in multivariate analysis. nBAP1 protein expression proved to be a more reliable prognostic indicator for OS than the American Joint Committee on Cancer staging, M3 status, or The Cancer Genome Atlas classification in this cohort. This study provides support for accurate prognostication of UM patients in routine histology laboratories by immunohistochemistry for nBAP1 alone.
Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma
Authors: Kmeid Michel , Lee Goo , Yang Zhaohai , Pacheco Richard , Lin Jingmei , Patil Deepa T. , Youssef Mariam , Zhang Qingzhao , Alkashash Ahmad Mahmoud , Li Jingwei , Lee Hwajeong
Published: January 2024

The significance of discontinuous growth (DG) of the tumor to include tumor deposits and intramural metastasis in esophageal adenocarcinoma (EAC) is unclear. Esophagectomy specimens from 151 treatment-naïve and 121 treated patients with EAC were reviewed. DG was defined as discrete (≥2 mm away) tumor foci identified at the periphery of the main tumor in the submucosa, muscularis propria, and/or periadventitial tissue. Patients’ demographics, clinicopathologic parameters, and oncologic outcomes were compared between tumors with DG versus without DG. DGs were identified in 16% of treatment-naïve and 29% of treated cases (P=0.01). Age, gender, and tumor location were comparable in DG+ and DG– groups. For the treatment-naïve group, DG+ tumors were larger with higher tumor grade and stage and more frequent extranodal extension, lymphovascular/perineural invasion, and positive margin. Patients with treated tumors presented at higher disease stages with higher rates of recurrence and metastasis compared with treatment-naïve patients. In this group, DG was also associated with TNM stage and more frequent lymphovascular/perineural spread and positive margin, but not with tumor size, grade, or extranodal extension. In multivariate analysis, in all patients adjusted for tumor size, lymphovascular involvement, margin, T and N stage, metastasis, neoadjuvant therapy status, treatment year, and DG, DG was found to be an independent adverse predictor of survival outcomes in EAC. DG in EAC is associated with adverse clinicopathologic features and worse patient outcomes. DG should be considered throughout the entire clinicopathologic evaluation of treatment-naïve and treated tumors as well as in future staging systems.
Resuscitation With Vitamin C, Hydrocortisone, and Thiamin in Children With Septic Shock: A Multicenter Randomized Pilot Study
Authors: Schlapbach Luregn J. , Raman Sainath , Buckley David , George Shane , King Megan , Ridolfi Roberta , Harley Amanda , Cree Michele , Long Debbie , Erickson Simon , Singh Puneet , Festa Marino , Gibbons Kristen , Bellomo Rinaldo ,   on behalf of the Resuscitation in Paediatric Sepsis Randomized Controlled Pilot Platform in the Paediatric Intensive Care Unit (RESPOND PICU) Study Investigators and the Australian and New Zealand Intensive Care Society Paediatric Study Group
Published: January 2024

OBJECTIVES:

Adjunctive therapy with vitamin C, hydrocortisone, and thiamin has been evaluated in adults, but randomized controlled trial (RCT) data in children are lacking. We aimed to test the feasibility of vitamin C, hydrocortisone, and thiamin in PICU patients with septic shock; and to explore whether the intervention is associated with increased survival free of organ dysfunction.

DESIGN:

Open-label parallel, pilot RCT multicenter study. The primary endpoint was feasibility. Clinical endpoints included survival free of organ dysfunction censored at 28 days and nine secondary outcomes, shock reversal, and two proxy measures of intervention efficacy.

SETTING:

Six PICUs in Australia and New Zealand.

PATIENTS:

Children of age between 28 days and 18 years requiring vasoactive drugs for septic shock between August 2019 and March 2021.

INTERVENTIONS:

Patients were assigned 1:1 to receive 1 mg/kg hydrocortisone every 6 hours (q6h), 30 mg/kg ascorbic acid q6h, and 4 mg/kg thiamin every 12 hours (n = 27), or standard septic shock management (n = 33).

MEASUREMENTS AND MAIN RESULTS:

Sixty of 77 (78%) eligible patients consented with 91% of approached parents providing consent. The median time from randomization to intervention was 44 (interquartile range [IQR] 29–120) min. Seventy of seventy-seven (28%) patients had received IV steroids before randomization. Median survival alive and free of organ dysfunction was 20.0 (0.0–26.0) days in the intervention and 21.0 (0.0–25.0) days in the standard care group. Median PICU length of stay was 5.3 (2.5–11.3) days in the intervention group versus 6.9 (3.0–11.5) days in the control group. Shock reversal occurred at a median of 35.2 (14.6–101.2) hours in the intervention group versus 47.3 (22.4–106.8) hours in the standard care group (median difference –12 hr; 95% CI, –56.8 to 32.7 hr).

CONCLUSIONS:

In children requiring vasopressors for septic shock, a protocol comparing adjunctive treatment with high-dose vitamin C, hydrocortisone, and thiamin versus standard care was feasible. These findings assist in making modifications to the trial protocol to enable a better-designed larger RCT.
Perinatal outcomes of frozen-thawed embryo transfer following blastocyst-stage embryo transfer compared to those of cleavage-stage embryo transfer: analysis of 9408 singleton newborns using propensity score analysis
Authors: Zhong Hu-Cen , Wan Qi , Hu Yu-Ling , Li Tian , Huang Li-Juan , Wang Mao , Hu Xin-Yue , Wang Meng-Di , Zhong Zhao-Hui
Published: January 2024

Objective:

Regarding frozen-thawed embryo transfer (FET), there is limited consensus on whether extending embryo culture from the cleavage stage to the blastocyst stage affects perinatal outcomes. This study aimed to compare perinatal outcomes of singletons between blastocyst-stage embryo transfer (BT) and cleavage-stage embryo transfer (CT) in FET.

Methods:

A total of 9408 FET cycles that met the inclusion criteria were included in this retrospective cohort study between 2019 and 2022. Blastocyst-stage embryo transfers were performed in the BT group, and cleavage-stage embryo transfers were performed in the CT group. Multivariate logistic regression analyses were performed, as well as propensity score matching (PSM) to adjust for confounders.

Results:

After PSM, a higher risk of pre-term birth (PTB; odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.00–1.50, P = 0.048) and being large for gestational age (LGA; OR: 1.16, 95% CI: 1.00–1.35, P = 0.050) was observed in the BT group compared to that in the CT group. After stratified PSM, in the subgroup under 35 years of age, only an increased risk of LGA was observed in the BT group compared to the CT group. Perinatal outcomes in the double-embryo transfer subgroup were similar to those in the unstratified group. However, in the subgroup beyond 35 years of age and the single embryo transfer subgroup, perinatal outcomes were not statistically different between the BT and CT groups (P >0.05).

Conclusions:

In FET, prolonged embryo culture to the blastocyst stage increased the risk of PTB and LGA in single fetuses. However, stratified analysis based on age and the number of transferred embryos yielded different results, necessitating further mechanistic studies.
Effects of Simulation Fidelity on Health Care Providers on Team Training—A Systematic Review
Authors: Mitchell Sally , Blanchard Erin , Curran Vernon , Hoadley Theresa , Donoghue Aaron , Lockey Andrew ,   on behalf of the Society for Simulation in Healthcare
Published: January 2024

This systematic review, following PRISMA standards, aimed to assess the effectiveness of higher versus lower fidelity simulation on health care providers engaged in team training. A comprehensive search from January 1, 2011 to January 24, 2023 identified 1390 studies of which 14 randomized (n = 1530) and 5 case controlled (n = 257) studies met the inclusion criteria. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity prevented any metaanalysis. Limited evidence showed benefit for confidence, technical skills, and nontechnical skills. No significant difference was found in knowledge outcomes and teamwork abilities between lower and higher fidelity simulation. Participants reported higher satisfaction but also higher stress with higher fidelity materials. Both higher and lower fidelity simulation can be beneficial for team training, with higher fidelity simulation preferred by participants if resources allow. Standardizing definitions and outcomes, as well as conducting robust cost-comparative analyses, are important for future research.
Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?
Authors: Woodall William J. , Chang Eugene H. , Toy Serkan , Lee Deborah R. , Sherman Jonathan H.
Published: January 2024

Introduction

The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods.

Methods

As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible.

Results

Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I–III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge.

Conclusions

Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.
Educational and Patient Care Impacts of In Situ Simulation in Healthcare
Authors: Calhoun Aaron W. , Cook David A. , Genova Gina , Motamedi Seyed Mohammad Kalantar , Waseem Muhammad , Carey Rob , Hanson Amy , Chan Jacky C.K. , Camacho Cheryl , Harwayne-Gidansky Ilana , Walsh Barbara , White Marjorie , Geis Gary , Monachino Anne Marie , Maa Tensing , Posner Glenn , Li David Li , Lin Yiqun
Published: January 2024

This systematic review was performed to assess the effectiveness of in situ simulation education. We searched databases including MEDLINE and Embase for studies comparing in situ simulation with other educational approaches. Two reviewers screened articles and extracted information. Sixty-two articles met inclusion criteria, of which 24 were synthesized quantitatively using random effects meta-analysis. When compared with current educational practices alone, the addition of in situ simulation to these practices was associated with small improvements in clinical outcomes, including mortality [odds ratio, 0.66; 95% confidence interval (CI), 0.55 to 0.78], care metrics (standardized mean difference, −0.34; 95% CI, −0.45 to −0.21), and nontechnical skills (standardized mean difference, −0.52; 95% CI, −0.99 to −0.05). Comparisons between in situ and traditional simulation showed mixed learner preference and knowledge improvement between groups, while technical skills showed improvement attributable to in situ simulation. In summary, available evidence suggests that adding in situ simulation to current educational practices may improve patient mortality and morbidity.
Evaluation of Forward Head Posture, Balance, and Risk for Falls in Community-Dwelling Older Adults
Authors: Migliarese Sara , Wendt Christopher , Anastopoulos John , Anastopoulos Jessica , White Emma
Published: January 2024

Objective:

This study investigated the influence of fear of falling, forward head posture (FHP), cervical proprioception, dynamic balance, and sensory integration on fall risk in older adults.

Methods:

Thirty-one participants were evaluated using tests designed to detect fall risk. FHP was assessed using a cervical range of motion device and craniovertebral angle (CVA) measurement.

Results:

Independent t tests were significant for Sensory Organization Test conditions 2 (P = .031) and 5 (P = .043) for FHP versus non-FHP groups. Regression analysis revealed that CVA could predict 16.7% variance in fall risk.

Conclusion:

CVA is a practical measure for measuring FHP and identifying fall risk in older adults.
Otago Exercise Program Improves Physical Functional Performance and Reduces Falling Risk in Elderly Korean Women
Authors: Kang Minjeong , Kang Hyunsik
Published: January 2024

Aims:

To determine the effects of the Otago exercise program (OEP) on physical functional capacity and fear of falling.

Methods:

Elderly Korean women aged 75 to 84 years (n = 40) were nonrandomly assigned to the control (n = 12) or exercise (n = 36) group. The exercise group underwent a 6-month group-based OEP.

Results:

The exercise group had significant pre- to postintervention improvements in muscle quality index, walking speed, handgrip strength, 30-second chair stand test, 8-ft Timed Up and Go test, and short physical performance battery in conjunction with reduced fear of falling compared with the control group.

Conclusion:

The OEP is an effective fall prevention tool for elderly Korean women who are afraid of falling.
Antimicrobial resistance and molecular characteristics of N. gonorrhoea isolates in Ghana
Authors: Musah Haris Sualah , Addy Francis , Dufailu Osman Adamu
Published: January 2024

Introduction: Gonorrhoea is a disease associated with humans and caused by N. gonorrhoea. N. gonorrhoea’s ability to evolve and evade various treatment regimens can lead to untreatable gonorrhoea. In the absence of a viable vaccine, a national database on antimicrobial resistance (AMR) and molecular characteristics of N. gonorrhoea, and the reliance on a syndromic management regime, continuous national antimicrobial resistance surveillance and molecular characterisation of N. gonorrhoea remain imperative. Only two gonococcal studies have described its molecular characteristics linked to AMR in Ghana.
Methods: Secondary N. gonorrhoea isolates (n=4) were collected from two metropolises in Ghana: Tamale in the northern sector (n=1) and Accra in the southern sector (n=3). The isolates were confirmed and characterised using polymerase chain reaction (PCR) targeting the porB and tbpB genes, and the disk diffusion method was used to evaluate antimicrobial resistance (AMR). N. gonorrhoea Multi-Antigen Sequence Typing (NG-MAST) and porin B (porB) gene sequence analyses were used to reveal molecular epidemiology and evolutionary trajectory, respectively.
Results: All four isolates showed resistance to at least four of the tested antibiotics. One isolate showed resistance to all seven antibiotics, i.e. Ceftriaxone, Azithromycin, Ciprofloxacin, Tetracycline, Erythromycin, Togamycin and Penicillin.  NG-MAST typing revealed isolates S3 (MZ313864) as ST211. The locus of S2 (MZ313863) (transferrin binding protein B; tbpB) was identified as tbpB1844, and its porin, porB locus, as porB6412 with only four closely related variants but with 15 nucleotide differences. However, its sequence type does not exist. The PorB analysis identified isolate S3 (MZ313864) to be found globally, while S2 (MZ313863) is unique to this study.
Discussion: Despite the small number of isolates tested, this study recorded multidrug resistance and previously unknown gonococcal variants. Additionally, the molecular typing schemes revealed a disparity between NG-MAST and NCBI. There is a need for continuous gonococcal AMR and molecular surveillance in Ghana to contribute to the global efforts of describing circulating strains and to support a proper application of the syndromic management regime to gonorrhoea.
Evaporation of bacteria-laden surrogate respiratory fluid droplets: On a hydrophilic substrate versus contact-free environment confers differential bacterial infectivity
Authors: Agharkar Amey Nitin , Hajra Dipasree , Roy Durbar , Jaiswal Vivek , Kabi Prasenjit , Chakravortty Dipshikha , Basu Saptarshi
Published: January 2024

The transmission of viruses/ bacteria cause infection predominantly via aerosols. The transmission mechanism of respiratory diseases is complex, including direct or indirect contact, large droplet, and airborne routes apart from close contact transmission. With this pretext, we have investigated two modes of droplet evaporation to understand its significance in airborne disease transmission; a droplet in a contact-free environment, which evaporates and forms droplet nuclei, and a droplet on a hydrophilic substrate (fomite). The study examines mass transport, the deposition pattern of bacteria in the precipitates, and their survival and virulence. The osmotic pressure increases with the salt concentration, inactivating the bacteria embedded in the precipitates with accelerated evaporation. Further, the bacteria’s degree of survival and enhanced pathogenicity are compared for both evaporation modes. The striking differences in pathogenicity are attributed to the evaporation rate, oxygen availability, and reactive oxygen species (ROS) generation.
Low-order planar pressure reconstruction of stalled airfoils using particle image velocimetry data
Authors: Carter D. W. , Ganapathisubramani B.
Published: January 2024

We present planar time-resolved particle image velocimetry (PIV) measurements of flow in the streamwise surface-normal plane of a NACA 0012 airfoil at chord-based Reynolds number Rec=7×104. The angles of attack α=13∘ and 15∘ correspond to transient stall and deep stall flow regimes, respectively. A Poisson solver is utilized to reconstruct the instantaneous planar pressure fields from the PIV with satisfactory comparison in the mean pressure compared with dynamically matched Reynolds-averaged Navier-Stokes (RANS) simulations. Using the proper orthogonal decomposition (POD), a systematic reduced-order reconstruction of the velocity fields and subsequent pressure fields is used to quantify the required number of velocity modes to achieve a desired accuracy in the instantaneous pressure. Further, a Galerkin projection of the Poisson equation onto the POD subspace is used as a framework to identify the relative contribution of each velocity mode on the resulting pressure field via quadratic stochastic estimation (QSE). In both cases, the zeroth mode (corresponding to the mean) is of leading-order importance. In addition, a tendency of the zeroth mode to interact with vortex-shedding modes is identified.

Published by the American Physical Society
2024
Photon-Noise-Tolerant Dispersive Readout of a Superconducting Qubit Using a Nonlinear Purcell Filter
Authors: Sunada Yoshiki , Yuki Kenshi , Wang Zhiling , Miyamura Takeaki , Ilves Jesper , Matsuura Kohei , Spring Peter A. , Tamate Shuhei , Kono Shingo , Nakamura Yasunobu
Published: January 2024

Residual noise photons in a readout resonator become a major source of dephasing for a superconducting qubit when the resonator is optimized for a fast, high-fidelity dispersive readout. Here, we propose and demonstrate a nonlinear Purcell filter that suppresses such an undesirable dephasing process without sacrificing the readout performance. When a readout pulse is applied, the filter automatically reduces the effective linewidth of the readout resonator, increasing the sensitivity of the qubit to the input field. The noise tolerance of the device we have fabricated is shown to be enhanced by a factor of 3 relative to a device with a linear filter. The measurement rate is enhanced by another factor of 3 by utilizing the bifurcation of the nonlinear filter. A readout fidelity of 99.4% and a quantum nondemolition fidelity of 99.2% are achieved using a 40-ns readout pulse. The nonlinear Purcell filter will be an effective tool for realizing a fast, high-fidelity readout without compromising the coherence time of the qubit.

Published by the American Physical Society
2024
Combination of XEOL, TR-XEOL and HB-T interferometer at the TPS 23A X-ray nanoprobe for exploring quantum materials
Authors: Huang Tzu-Chi , Ke Shang-Wei , Wu Yu-Hao , Wang En-Rui , Wei Wei-Lon , Lee Chien-Yu , Chen Bo-Yi , Yin Gung-Chian , Chang Han-Wei , Tang Mau-Tsu , Lin Bi-Hsuan
Published: January 2024

In this study, a combination of X-ray excited optical luminescence (XEOL), time-resolved XEOL (TR-XEOL) and the Hanbury-Brown and Twiss (HB-T) interferometer at the Taiwan Photon Source (TPS) 23A X-ray nanoprobe beamline for exploring quantum materials is demonstrated. On the basis of the excellent spatial resolution rendered using a nano-focused beam, emission distributions of artificial micro-diamonds can be obtained by XEOL maps, and featured emission peaks of a selected local area can be obtained by XEOL spectra. The hybrid bunch mode of the TPS not only provides a sufficiently high peak power density for experiments at each beamline but also permits high-quality temporal domain (∼200 ns) measurements for investigating luminescence dynamics. From TR-XEOL measurements, the decay lifetime of micro-diamonds is determined to be approximately 16 ns. Furthermore, the XEOL spectra of artificial micro-diamonds can be investigated by the HB-T interferometer to identify properties of single-photon sources. The unprecedented strategy of combining XEOL, TR-XEOL and the HB-T interferometer at the X-ray nanoprobe beamline will open new avenues with significant characterization abilities for unraveling the emission mechanisms of single-photon sources for quantum materials.