bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of community mask mandates on SARS-CoV-2 transmission in Ontario after adjustment for differential testing by age and sex
Authors: Peng Amy , Bosco Savana , Simmons Alison E , Tuite Ashleigh R , Fisman David N
Published: February 2024

Mask use for prevention of respiratory infectious disease transmission is not new but has proven controversial during the SARS-CoV-2 pandemic. In Ontario, Canada, irregular regional introduction of community mask mandates in 2020 created a quasi-experiment useful for evaluating the impact of such mandates; however, Ontario SARS-CoV-2 case counts were likely biased by testing focused on long-term care facilities and healthcare workers. We developed a regression-based method that allowed us to adjust cases for under-testing by age and gender. We evaluated mask mandate effects using count-based regression models with either unadjusted cases, or testing-adjusted case counts, as dependent variables. Models were used to estimate mask mandate effectiveness, and the fraction of SARS-CoV-2 cases, severe outcomes, and costs, averted by mask mandates. Models using unadjusted cases as dependent variables identified modest protective effects of mask mandates (range 31–42%), with variable statistical significance. Mask mandate effectiveness in models predicting test-adjusted case counts was higher, ranging from 49% (95% CI 44–53%) to 76% (95% CI 57–86%). The prevented fraction associated with mask mandates was 46% (95% CI 41–51%), with 290,000 clinical cases, 3,008 deaths, and loss of 29,038 quality-adjusted life years averted from 2020 June to December, representing $CDN 610 million in economic wealth. Under-testing in younger individuals biases estimates of SARS-CoV-2 infection risk and obscures the impact of public health preventive measures. After adjustment for under-testing, mask mandates emerged as highly effective. Community masking saved substantial numbers of lives, and prevented economic costs, during the SARS-CoV-2 pandemic in Ontario, Canada.
Information synergy maximizes the growth rate of heterogeneous groups
Authors: Kemp Jordan T , Kline Adam G , Bettencourt Luís M A
Published: February 2024

Collective action and group formation are fundamental behaviors among both organisms cooperating to maximize their fitness and people forming socioeconomic organizations. Researchers have extensively explored social interaction structures via game theory and homophilic linkages, such as kin selection and scalar stress, to understand emergent cooperation in complex systems. However, we still lack a general theory capable of predicting how agents benefit from heterogeneous preferences, joint information, or skill complementarities in statistical environments. Here, we derive general statistical dynamics for the origin of cooperation based on the management of resources and pooled information. Specifically, we show how groups that optimally combine complementary agent knowledge about resources in statistical environments maximize their growth rate. We show that these advantages are quantified by the information synergy embedded in the conditional probability of environmental states given agents’ signals, such that groups with a greater diversity of signals maximize their collective information. It follows that, when constraints are placed on group formation, agents must intelligently select with whom they cooperate to maximize the synergy available to their own signal. Our results show how the general properties of information underlie the optimal collective formation and dynamics of groups of heterogeneous agents across social and biological phenomena.
Fractured columnar small-world functional network organization in volumes of L2/3 of mouse auditory cortex
Authors: Bowen Zac , Shilling-Scrivo Kelson , Losert Wolfgang , Kanold Patrick O
Published: February 2024

The sensory cortices of the brain exhibit large-scale functional topographic organization, such as the tonotopic organization of the primary auditory cortex (A1) according to sound frequency. However, at the level of individual neurons, layer 2/3 (L2/3) A1 appears functionally heterogeneous. To identify if there exists a higher-order functional organization of meso-scale neuronal networks within L2/3 that bridges order and disorder, we used in vivo two-photon calcium imaging of pyramidal neurons to identify networks in three-dimensional volumes of L2/3 A1 in awake mice. Using tonal stimuli, we found diverse receptive fields with measurable colocalization of similarly tuned neurons across depth but less so across L2/3 sublayers. These results indicate a fractured microcolumnar organization with a column radius of ∼50 µm, with a more random organization of the receptive field over larger radii. We further characterized the functional networks formed within L2/3 by analyzing the spatial distribution of signal correlations (SCs). Networks show evidence of Rentian scaling in physical space, suggesting effective spatial embedding of subnetworks. Indeed, functional networks have characteristics of small-world topology, implying that there are clusters of functionally similar neurons with sparse connections between differently tuned neurons. These results indicate that underlying the regularity of the tonotopic map on large scales in L2/3 is significant tuning diversity arranged in a hybrid organization with microcolumnar structures and efficient network topologies.
Access to inflatable penile prosthesis surgery as indicated by distances traveled among US men with Medicare
Authors: Rojanasarot Sirikan , Morris Kathryn , Nicholson Tristan , Walsh Thomas
Published: February 2024

Background

The significance of geographic barriers to receiving inflatable penile prosthesis (IPP) treatment is uncertain according to the existing medical literature.

Aim

To describe the travel patterns of men with erectile dysfunction (ED) in the United States who underwent IPP surgery.

Methods

This retrospective cohort study utilized data from the 100% Medicare Standard Analytical Files. Men aged ≥65 years with an ED diagnosis who underwent IPP surgery between January 2016 and December 2021 were identified from the database. Federal Information Processing Series codes from the National Bureau of Economic Research’s County Distance Database were used to determine geographic distances from patients’ homes to the facilities at which surgery was performed.

Outcomes

Evaluations included the proportions of men who traveled outside their county of residence or state for IPP treatment and the average distances in miles traveled.

Results

Among 15 954 men with ED undergoing IPP treatment, 56.4% received care out of their county for IPP, at a mean distance of 125.6 miles (range, 3.8-4935.0). Although patients aged ≥80 years were less likely to travel outside their county as compared with men aged 65 to 69 years (48.1% vs 57.1%, P < .001), if they traveled, they were likely to travel farther (mean, 171.8 vs 117.7 miles; P < .001). South Dakota had the highest proportion of men traveling outside their county for IPP treatment (91.3%; mean, 514.2 miles), while Vermont had the highest proportion traveling outside their home state (73.7%).

Clinical Implications

By unveiling disparities in access, this study will potentially lead to tailored interventions that enhance patient care and health outcomes.

Strengths and Limitations

Strengths include the uniqueness in (1) evaluating the proportions of patients who travel out of their county of residence or home state for IPP treatment and (2) quantifying the average distances that patients traveled. An additional strength is the large sample size due to the retrospective design and database used. The analysis did not capture all Medicare enrollees; however, it did encompass all traditional Medicare enrollees, representing approximately half of all men in the US aged ≥65 years. Limitations include not being generalizable to entire population of the US, as the study examined only Medicare enrollees. In addition, the study period includes the pandemic, which could have affected travel patterns. Furthermore, the coding and accuracy of the data are limitations of using administrative claims data for research.

Conclusion

Study findings showed that many men with Medicare and ED traveled from their home geographic location for IPP treatment.
Causal associations between prostate diseases, renal diseases, renal function, and erectile dysfunction risk: a 2-sample Mendelian randomization study
Authors: Dilixiati Diliyaer , Kadier Kaisaierjiang , Lu Jian-De , Xie Shiping , Azhati Baihetiya , Xilifu Reyihan , Rexiati Mulati
Published: February 2024

Background

Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain.

Aim

The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED.

Methods

In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran’s Q statistic was employed to measure heterogeneity.

Outcomes

We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED.

Results

Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED.

Clinical Implications

The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa.

Strengths and Limitations

This study’s strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results.

Conclusion

The results of this study suggest a potential link between PCa and a higher risk of ED.
Genomic epidemiology of highly pathogenic avian influenza A (H5N1) virus in wild birds in South Korea during 2021–2022: Changes in viral epidemic patterns
Authors: Kim Ji-Yun , Jeong Sol , Kim Da-Won , Lee Dong-Wook , Lee Dong-Hun , Kim Daehun , Kwon Jung-Hoon
Published: February 2024

Clade 2.3.4.4b highly pathogenic avian influenza A (HPAI) viruses have been detected in wild birds worldwide, causing recurrent outbreaks since 2016. During the winter of 2021–2022, we detected one H5N8 and forty-three H5N1 clade 2.3.4.4b HPAI viruses from wild birds in South Korea. Phylogenetic analysis revealed that HA gene of H5N1 viruses was divided into two genetically distinct groups (N1.G1 and N1.G2). Bayesian phylodynamic analysis demonstrated that wild birds play a vital role in viral transmission and long-term maintenance. We identified five genotypes (N1.G1.1, N1.G2, N1.G2.1, N1.G2.2, and N1.G2.2.1) having distinct gene segment constellations most probably produced by reassortments with low-pathogenic avian influenza viruses. Our results suggest that clade 2.3.4.4b persists in wild birds for a long time, causing continuous outbreaks, compared with previous clades of H5 HPAI viruses. Our study emphasizes the need for enhancing control measures in response to the changing viral epidemiology.
TaqMan Real-Time PCR Assay for Specific Detection and Differentiation of Xanthomonas translucens pv. undulosa from Other Pathovars Targeting a Recombination Mediator Gene, recF
Authors: Tambong James T. , Xu Renlin , Fleitas Maria Constanza , Wang Lipu , Akuma Mercy , Chi Sylvia I. , Kutcher Hadley R.
Published: February 2024

Bacterial leaf streak and black chaff diseases of wheat caused by Xanthomonas translucens pv. undulosa is becoming a major constraint to growers and trade since it is seedborne. Molecular tools for specific detection/differentiation of pv. undulosa are lacking. We report the development of a TaqMan real-time PCR for specific detection/identification of pv. undulosa targeting the recombination mediator gene (recF). Analysis of the complete recF (1,117 bp) sequences identified the gene as a reliable phylogenetic marker for identification of pv. undulosa, differentiating it from the other pathovars; recF-based sequence homology values among the 11 pathovars correlated well with genome-based DNA-DNA hybridization values. The discriminatory power of recF to differentiate pv. undulosa from the other pathovars is due to nucleotide polymorphic positions. We used these nucleotide polymorphisms to develop a TaqMan PCR for specific detection of pv. undulosa. The specificity of the assay was validated using 67 bacterial and fungal/oomycete strains. The selected primers and the double-quenched FAM-labeled TaqMan probe were specific for the detection of 11 pv. undulosa/secalis strains. The 56 strains of other X. translucens pathovars (n = 39) and non-Xanthomonas spp. (n = 17) did not exhibit any detectable fluorescence. Also, greenhouse-inoculated and naturally infected wheat leaf samples showed positive reactions for the presence of pv. undulosa DNA but not healthy control plants. The TaqMan assay reliably detected as low as 1-pg DNA amount and 10 colony forming units of the target pathogen per reaction. This TaqMan assay could be useful to regulatory agencies with economic benefits to wheat growers.
The Devil's in the Depot Details: Case of Iatrogenic Opioid Intoxication After Buprenorphine Injection Requiring Surgical Excision
Authors: Vais Simone , Starr Nichole , Castro Maria , Brand Nathan , Murphy Alexander , Tesoriero Ronald , Kryzhanovskaya Irina
Published: February 2024

Monthly long-acting injectable buprenorphine (LAI-BUP) is a treatment option for moderate to severe opioid use disorder. Safe administration of LAI-BUP requires preexisting opioid tolerance to prevent sedation and respiratory depression. In the event of adverse medication effects including oversedation, LAI-BUP can be surgically excised up to 14 days after administration (https://www.sublocadehcp.com/dosing-administration). However, the manufacturer does not provide guidance on the proper procedure for excision, and no case reports have been published documenting this procedure. We report a case of a man with methamphetamine use disorder and multiple unintentional fentanyl overdoses who inadvertently received LAI-BUP for overdose protection. This resulted in significant sedation for days, ultimately necessitating excision 5 days after administration. His sedation improved moderately at 24 hours after excision and significantly by 36 hours after excision. Providers seeking to use LAI-BUP to prevent overdose among those with unintentional opioid exposure must ensure sublingual buprenorphine tolerance before injection to avoid iatrogenic harm. Although manufacturer instructions mention that LAI-BUP can be excised under local anesthesia within 14 days of insertion, ideal excision is best performed in a setting with surgical instruments and cautery—such as the operating room—as the depot can adhere strongly to the surrounding subcutaneous tissue.
Foot complaints pre-operative to primary total hip or knee arthroplasty
Authors: Malkus Joost B. , Piekaar Roderick S.M. , Benard Menno R. , Gademan Maaike G.J. , Vliet Vlieland Thea P.M. , Verdegaal Suzan H.M.
Published: February 2024

Purpose of the Study:

Aim of the study was to determine the prevalence of foot and ankle complaints and radiographic abnormalities, and their association in patients planned for total joint surgery.

Methods:

A cross-sectional cohort study of 183 patients, planned for total hip or knee arthroplasty (THA, TKA). Assessments included recording of polyneuropathy, previous trauma, foot deformities, and ankle range of motion (ROM); self-reported foot and ankle complaints; and radiographic severity of the foot and ankle joints OA.

Results:

In patients planned for THA and TKA, the proportions of patients with risk factors or using bespoke footwear ranged from 21-41%, whereas the proportions with clavus, hammertoes, and/or hallux valgus or rigidus varied between 1-17%. Although the mean foot function scores were good (median FAOS >93 and FFI-5pt 0), up to 24% of patients had a low score on one or more of the subscale scores. Prevalence of patients with signs of radiographic OA in foot and ankle were lower in THA than TKA patients, respectively. For the TKA group, we found an association between radiological scores and both self-reported measures of foot and ankle complaints.

Conclusion:

About a quarter of patients undergoing THA and TKA report some foot complaints, whereas 32-45% have signs of radiographic OA of foot and/or ankle. Since foot and ankle complaints have shown to have a negative effect on outcome of THA and TKA surgery, pre-operative optimisation concerning the foot complaints should be considered to support a more favourable outcome.
Risk Factors for Early Treatment Discontinuation Due to Toxicity Among Patients With Metastatic Castration-resistant Prostate Cancer Receiving Androgen Receptor–targeted Therapy
Authors: Chakrani Zakaria , Mellgard George , Saffran Nathaniel , McCroskery Stephen , Taylor Nicole , Patel Mann , Liaw Bobby , Galsky Matthew , Oh William K. , Tsao Che-Kai , Patel Vaibhav G.
Published: February 2024

Background:

Androgen receptor–targeted therapies (ARTs) improve survival outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC); however, a significant portion of patients discontinue treatment for various reasons including treatment-related toxicity. We aim to describe reasons for ART treatment discontinuation and identify predictors associated with increased risk of treatment discontinuation due to toxicity.

Methods:

We performed a single-institution retrospective review of patients with mCRPC receiving ART between 2010 and 2021. Our primary aim was to identify risk factors for treatment discontinuation due to toxicity. Our secondary aim was to describe ART discontinuation patterns among patients with mCRPC.

Results:

One hundred thirty-three patients with mCRPC started and discontinued ARTs. Fourteen patients (10.5%) discontinued treatment due to toxicity. Common reasons for treatment discontinuation include Prostate Specific Antigen test progression, radiographic progression, toxicity, and death. Significant predictors of treatment discontinuation due to toxicity on bivariate analysis and multivariate analysis included patient-reported falls (odds ratio [OR]: 7.67, CI: [1.31-40.42]; P=0.016), rash (OR: 13.4, CI: [1.35-134.81]; P=0.026), and weakness (OR: 4.16, CI: [1.15-15.0]; P=0.019).

Conclusions:

Our work presents the first description of ART treatment discontinuation and its causes in the real-world setting, as well as patient-reported side effects. Most patients with mCRPC discontinued treatment due to the progression of disease and a minority of patients discontinued secondary to treatment toxicity. Initial multivariable analysis suggests that patient-reported weakness, falls, and rash were associated with a higher likelihood of treatment discontinuation due to toxicity. Early monitoring of this population can prolong the duration of treatment and prevent unnecessary treatment burden.
Initial experience with the anaesthetic management of fetoscopic spina bifida repair at a German University Hospital
Authors: Schmitt Nicolas , Schubert Ann-Kristin , Wulf Hinnerk , Keil Corinna , Sutton Caitlin Dooley , Bedei Ivonne , Kalmus Gerald
Published: February 2024

Spina bifida aperta (SBA) is a serious neural tube defect that can lead to a range of disabilities and health complications in affected individuals. In recent years, fetoscopic surgical repair has emerged as a promising new approach to treat spina bifida prenatally, offering the potential for improved outcomes compared with traditional open surgery. As one of the few centres in Europe to offer this innovative technique, the Departments of Obstetrics and Gynaecology, Neurosurgery, and Anaesthesiology and Intensive Care Medicine at the University Medical Centre of Marburg (UKGM Marburg) have faced unique challenges in developing and establishing standards of care for the pregnant patients undergoing this complex procedure. In this publication, we aim to present details of our initial experience with the first 15 patients and propose a clinical concept for the rather complex perioperative management of these patients.
Ultrasound-guided Treatment of Polycaprolactone Granuloma
Authors: Cerón Bohórquez Jair Mauricio , Desyatnikova Stella
Published: February 2024

Foreign body granulomas associated with polycaprolactone (PCL) filler injections are rare, yet challenging to manage. Multiple management modalities have been described. Here, we present a literature review and describe a case of histologically confirmed PCL-related granuloma, treated using ultrasound-guided injections of triamcinolone, hyaluronidase, and 5-fluorouracil combined with oral prednisolone and doxycycline.
Accelerated Corneal Crosslinking to Arrest Progression of Corneal Ectasia: A Prospective Multicenter Study
Authors: Salvador-Culla Borja , Afsara Ahmmed , Roper Nicola , Mulroy Julie , Galankova Lubomira , Duncan Holly , Tabibian David , Lamarca-Mateu Jose , Figueiredo Francisco C.
Published: February 2024

Objectives:

To report the results of epithelium-off accelerated corneal collagen crosslinking (accelerated corneal crosslinking [ACXL]) in patients with progressive keratoconus.

Methods:

This prospective, nonrandomized, noncomparative, interventional, multicenter clinical study included all patients who underwent ACXL, either continuous (c-ACXL; 9 mW/cm2, 10′, 5.4 J/cm2) or pulsed (p-ACXL; 2″ON/1″OFF, 30 mW/cm2, 4.5′, 5.4 J/cm2) between January 2014 and May 2017. Best-corrected visual acuity, sphere, cylinder, spherical equivalent, and topographical keratometry data were collected preoperatively and at 1, 3, 6, 12, 18, and 24 months postoperatively.

Results:

Ninety-six eyes of 78 patients were included. The mean age was 20.8±4.4 years (14–33) for c-ACXL and 26.7±7.7 years (12–37) for p-ACXL. The mean best-corrected visual acuity was 0.4±0.4 for c-ACXL and 0.01±0.1 for p-ACXL preoperatively, and 0.3±0.3 (P=0.0014) and −0.01±0.1 (P=0.1554), respectively, at the last follow-up. The subjective sphere and spherical equivalent did not show statistically significant differences between the time points (P>0.05). The subjective cylinder showed significant differences (P=0.0013 for c-ACXL; P=0.0358 for p-ACXL). Keratometric values (Ksteep, Kflat, and SimK) remained stable, with no statistically significant differences (P>0.05). No major complications were noted.

Conclusions:

Both c-ACXL and p-ACXL are equally safe and effective ACXL protocols in stabilizing the progression of keratoconus and can be considered alternatives to the conventional Dresden protocol.
Enhanced durability and evolution of retreatment criteria of intravitreal antivascular endothelial growth factor agents for diabetic macular edema
Authors: Mandava Nikhil K. , Kuriyan Ajay E. , Ho Allen C. , Hsu Jason , Regillo Carl D. , Klufas Michael A.
Published: February 2024

Purpose of review

The increasing prevalence of diabetic macular edema (DME) necessitates an updated review of treatment modalities. While the shift from laser to anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed patient outcomes, benefits of these agents are not fully realized in real-world implementation relative to the setting of controlled clinical trials. This review outlines the evolution of intravitreal anti-VEGF treatment extension protocols for DME that reflect efforts to address treatment adherence challenges while optimizing visual outcomes.

Recent findings

Recent studies highlight the efficacy of extended-interval dosing with anti-VEGF agents in managing DME. Trials such as RISE/RIDE, VISTA/VIVID, and LUCIDATE have established the foundation of these regimens by demonstrating sustained visual gains with continuous treatment. However, newer trials including PROTOCOL T, KESTREL/KITE, YOSEMITE/RHINE, and PHOTON have furthered this concept, revealing that less frequent dosing of various anti-VEGF agents can maintain similar visual acuity and anatomical outcomes to traditional monthly injections.

The reviewed findings suggest a paradigm shift in DME treatment toward less frequent anti-VEGF injections. This has significant implications for clinical practice, potentially leading to greater adherence to treatment regimens and sustained visual function in patients, while minimizing treatment burden and healthcare costs. Further investigation into the long-term effects of extended dosing intervals is required.
Musculoskeletal pain in 13-year-old children: the generation R study
Authors: van Leeuwen Guido J. , van den Heuvel Marleen M. , Bindels Patrick J. E. , Bierma-Zeinstra Sita M. A. , van Middelkoop Marienke
Published: February 2024

Musculoskeletal (MSK) pain is a common reason for consultation in general practice and frequently reported in children and adolescents. This study examined the prevalence of MSK pain in 13-year-old children and assessed associations with physical and psychosocial factors. Data from the Generation R Study, a population-based birth cohort, was used. Prevalence and characteristics of MSK pain were assessed, using a pain mannequin, at 13 years of age (N = 3062). Demographics and data on physical activity, sedentary behaviors, previous reported MSK pain, and behavioral problems were extracted from questionnaires. The body mass index (BMI) SD-score was calculated from objectively measured weight and height. A prevalence of 23.3% was found for MSK pain in children of which 87.2% persisted for more than 3 months (ie, chronic), 45.5% experienced pain daily. More physically active children and children with a higher BMI reported MSK pain more frequently compared with non-MSK pain and no pain. The knee was the most often reported location. Children with MSK pain were more likely to have reported MSK pain at 6 years. Multivariable analyses showed significant associations for male sex (OR 0.74, 95% CI 0.56-0.98), high maternal educational (OR 0.69, 95% CI 0.49-0.96), higher BMI (OR 1.19, 95% CI 1.05-1.35), being physically active (OR 1.41, 95% CI 1.03-1.91), and behavioral problems (OR 1.85, 95% CI 1.33-2.59) with the presence of MSK pain. The chronic nature of MSK pain in combination with the relatively high prevalence of MSK pain in this study shows that MSK pain is already an important problem at a young age.
A Systematic Review of Variables Used in Physical Therapist Education Program Admissions Part 2: Noncognitive Variables
Authors: Bowens Andrea N.
Published: February 2024

Background and Purpose.

Physical therapist (PT) education professionals agree on promoting holistic admissions practices to increase student body diversity but lack consensus about what factors in an application should be part of this process. This systematic literature review aimed to understand the value of noncognitive variables in PT education admissions.

Methods.

The initial literature search identified 1,592 articles in databases and relevant journals. Of the 39 studies meeting the inclusion criteria, 29 reported on noncognitive variables.

Results.

Commonly used noncognitive variables (interviews, written essays, letters of recommendation, and clinical experiences) were insignificant or inconsistently associated with performance in the PT program or on the National Physical Therapy Examination. Sociodemographic variables appeared to negatively affect the academic qualifications of applicants who were older, identified with underrepresented racial/ethnic groups, and reported English as a second language. Finally, 5 studies identified personal attributes, such as emotional intelligence and grit, as having a significant relationship with successful student outcomes.

Discussion and Conclusion.

Cognitive variables should serve as only one of several factors considered in admissions to achieve a more diverse class of students. Physical therapist education programs may use this evidence to reevaluate their admissions practices to include a balanced consideration of cognitive and noncognitive variables.
Lipschütz ulcers due to SARS-CoV-2 infection: a neglected diagnosis in emergency room
Authors: Brambilla Ilaria , Bolcato Vittorio , Volonté Martina , Querzani Andrea , Guarracino Carmen , Tondina Enrico , Marseglia Gian Luigi , Brazzelli Valeria
Published: February 2024

Background:

Primary acute genital ulcers, or Lipschütz ulcers (LU), are nonsexually transmitted, painful, self-limiting, nonrecurrent vulvar ulcers with unclear pathogenesis, representing a challenging diagnosis in emergency setting. LU have recently been described in association with severe acute respiratory syndrome coronaVirus 2 (SARS-CoV-2) infection and vaccination.

Objective:

The aim of this study is to describe 2 cases of LU due to SARS-CoV-2 infection, highlighting the diagnostic process, differential diagnosis, disease course, and management options.

Methods:

We describe 2 young females (12 and 9 years old) who presented to pediatric emergency room with the sudden onset of well-demarcated, painful, vulvar ulcers with fibrinous necrotic center.

Results:

Both patients tested positive to SARS-CoV-2 nasal swab, and, at physical examination, no other lesions were found in other cutaneous or mucosal sites. Sexual abuse was excluded in both cases, as well as infectious and autoimmune diseases. Supportive analgesic therapy was administered, and complete remission of lesions was observed at follow-up visits without evidence of scarring.

Limitations:

The main limitation of this work is represented by the small number of cases described.

Conclusion:

Even though extremely rare, LU related to COVID-19 are an emerging entity to be considered in the diagnosis of acute genital ulcerations. Multidisciplinary diagnostic workup of genital ulcers must be established in order to exclude sexual child abuse, to ensure patient safety, and to avoid unnecessary treatment and familial anxiety.
Immune checkpoint inhibitors in liver transplantation: Current practice, challenges, and opportunities
Authors: Martin Sean P. , Mehta Neil , Emamaullee Juliet
Published: February 2024

Immune checkpoint inhibitors are becoming a mainstay of cancer treatment. While first studied and approved for patients with unresectable disease, due to their efficacy, they are becoming increasingly used in the perioperative period across many cancer types. In patients with HCC, immune checkpoint inhibitors have now become the standard of care in the advanced setting and have shown promising results in the adjuvant setting after liver resection. While these drugs continue to show promise, their role in the peritransplant setting still remains a question. In this review, we explore the current use of this class of medications in patients with HCC, as well as the immunologic role of the pathways that they inhibit. We also identify potential for future research opportunities to better understand the role of these medications.
Novel indications for referral and care for simultaneous liver kidney transplant recipients
Authors: Lum Erik L. , Bunnapradist Suphamai , Wiseman Alexander C. , Gurakar Ahmet , Ferrey Antoney , Reddy Uttam , Al Ammary Fawaz
Published: February 2024

Purpose of review

Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net.

Recent findings

The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys. Access to kidney transplantation following liver transplant alone (LTA) increased with favorable outcomes. Estimating GFR in liver transplant candidates remains challenging, and innovative methods are needed. SLK provided superior patient and graft survival compared to LTA only for patients with advanced CKD and dialysis at least 3 months. SLK can provide immunological protection against kidney rejection in highly sensitized candidates. Post-SLK transplant care is complex, with an increased risk of complications and hospitalization.

The SLK policy improved kidney access and utilization. Transplant centers are encouraged, under the safety net, to reserve SLK for liver transplant candidates with advanced CKD or dialysis at least 3 months while allowing lower thresholds for highly sensitized patients. Herein, we propose a practical approach to liver transplant candidates with kidney dysfunction.
A Predictive Strategy for Nonsurgical Management of Pancreatic Stones
Authors: Yamamoto Satoshi , Inui Kazuo , Katano Yoshiaki , Miyoshi Hironao , Kobayashi Takashi , Tachi Yoshihiko
Published: February 2024

Objectives

We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient.

Materials and Methods

We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0–239), median age was 58 years (22–83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis.

Results

Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1–61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones.

Conclusions

If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.
Cognitive flexibility training for chronic pain: a randomized clinical study
Authors: Holzer Katherine J. , Todorovic Marko S. , Wilson Elizabeth A. , Steinberg Aaron , Avidan Michael S. , Haroutounian Simon
Published: February 2024

Introduction:

Previous studies suggest an association between cognitive flexibility and development of chronic pain after surgery. It is not known whether cognitive flexibility can be improved in patients with chronic pain.

Objectives:

This study tested whether a neurocognitive training program results in improved cognitive flexibility and pain in patients with chronic pain.

Methods:

We conducted a single-center, prospective, randomized study investigating 5-week daily neurocognitive training in patients with chronic pain. Participants (n = 145) were randomized into neurocognitive training or care as usual, and they completed assessments at baseline, posttreatment, and 3 months. The treatment group was asked to spend 35 minutes daily completing a program with tasks on cognitive flexibility, memory, attention, and speed. The primary outcome was performance on the neurocognitive performance test (NCPT). Secondary outcomes included levels of pain interference and severity.

Results:

At 5 weeks, the treatment group showed greater improvements on NCPT compared with the control group (d = 0.37); effect size was smaller at 3 months (d = 0.18). The treatment group reported lower pain severity at 5 weeks (d = 0.16) and 3 months (d = 0.39) than the control group, but pain interference was only lower at 3 months (d = 0.20).

Conclusions:

Outcomes suggest that using neurocognitive training to modify cognitive flexibility in patients with chronic pain may improve pain severity. This study provided effect size estimates to inform sample size calculations for randomized controlled trials to test the effectiveness of neurocognitive interventions for the prevention and treatment of chronic pain.
The role of cytokines and chemokines in the maintenance of chronic pain—a pilot study
Authors: Lassen Josephine , Leypoldt Frank , Hüllemann Philipp , Janssen Maren , Baron Ralf , Gierthmühlen Janne
Published: February 2024

Introduction:

The immune system is believed to be important in the initiation and maintenance of chronic pain.

Objectives:

The aim was to investigate whether patients with chronic painful polyneuropathy (PP) differ in cytokine profiles of serum and/or cerebrospinal fluid (CSF) compared with pain-free controls.

Methods:

Thirty-nine patients (16 women and 23 men, mean age, 69.2 ± 12.7 years, range 41–92 years) with PP (mean duration 43 ± 48.3 months) were phenotyped with quantitative sensory testing and electroneurography, and serum and CSF samples were analyzed by 40-multiplexed, bead-based cytokine immunoassays. Results were compared with 36 age- and gender-matched patients with normal pressure hydrocephalus and absence of abnormal CSF findings.

Results:

Compared with controls, patients with PP had lower concentrations of several proinflammatory and anti-inflammatory chemokines and cytokines in CSF, and others showed the same tendency, among these were tumor necrosis factor-α (14.1 ± 10.0 vs 23.9 ± 16.4 pg/mL, P < 0.005), interleukin (IL)-2 (0.6 ± 0.4 vs 1.2 ± 0.6 pg/mL, P < 0.0001), IL-6 (4.7 ± 6.8 vs 7.3 ± 9 pg/mL, P = 0.001), and IL-10 (7.5 ± 6.8 vs 16.8 ± 19.2 pg/mL, P < 0.01), whereas no differences were observed in serum.

Conclusion:

Results suggest that (1) inflammatory mediators play a minor role in the maintenance of chronic pain in contrast to initiation of acute pain, (2) chemokines/cytokines are downregulated in chronic pain, or (3) chemokines/cytokines have a protective role for nerve regeneration that is disturbed in patients with chronic pain.
Long-Term Orbito-Ocular Outcomes following Le Fort III and Monobloc Distraction Osteogenesis in Patients with Syndromic Craniosynostosis
Authors: Pontell Matthew E. , Wagner Connor S. , Reddy Neil , Salinero Lauren K. , Barrero Carlos E. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: February 2024

Background:

Exorbitism in patients with syndromic craniosynostosis is often managed by Le Fort III (LF3) or monobloc (MB) distraction osteogenesis (DO). This study compared short- and long-term orbital craniometrics after LF3DO/MBDO and related these findings to symptom relief.

Methods:

Patients undergoing LF3DO or MBDO from 2000 to 2021 with preoperative and postoperative imaging were included. Postoperative computed tomographic (CT) scans were categorized as early (<1 year) or late (>1 year), and age-matched control CT scans were compared with late postoperative scans. Superoinferior orbital rim position, relative globe position, and orbital volume were analyzed. Symptoms were assessed by a patient-reported outcome analysis.

Results:

Thirty-four patients (LF3DO, n = 16; MBDO, n = 18) were matched by age at surgery, sex, syndrome, and age at imaging. Time to late CT scan was 6.2 years (LF3DO) and 7.5 years (MBDO). Between early and late postoperative time points, LF3DO patients experienced no change in inferior rim position. MBDO patients experienced a decrease in inferior orbital rim position of 4.7 mm (P = 0.005), but superior orbital rim distance remained stable. Comparison of late scans and age-matched controls revealed no difference in inferior or superior orbital rim position in LF3DO patients, but the superior orbital rim distance was longer in MBDO patients (P = 0.015). Patient-reported outcome response rate was 76% with a median follow-up of 13.7 years. Most (81%) symptomatic patients improved, 19% remained symptomatic, and no patients worsened.

Conclusions:

LF3DO and MBDO achieved stable orbital craniometric changes, with improved stability at the inferior orbital rim after LF3DO. Craniometric changes were associated with long-term exorbitism symptom relief.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Cumulative Stress Across the Life Course and Biological Aging in Adulthood
Authors: Suglia Shakira F. , Clausing Elizabeth S. , Shelton Rachel C. , Conneely Karen , Prada-Ortega Diddier , DeVivo Immaculata , Factor-Litvak Pam , Cirillo Piera , Baccarelli Andrea A. , Cohn Barbara , Link Bruce G.
Published: February 2024

Objective

Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging.

Methods

In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth–age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction–based methods.

Results

In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length.

Conclusions

We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.
Which factors may influence medium-term quality of life of patients with lower-limb loss? A systematic review of the literature
Authors: Pelzer Doriane , Beaudart Charlotte , Thibaut Aurore , Bornheim Stephen , Kaux Jean-François
Published: February 2024

Objectives:

The aim of this study was to systematically review the literature to identify factors that may influence quality of life in people with lower-limb amputation (all etiologies). Our primary focus was on identifying factors that can be modified, enabling a more concentrated integration of these aspects into the care and treatment of amputated patients.

Data source:

Medline (via Ovid) and Scopus were searched in January 2023 for studies assessing quality of life for people with lower-limb loss. Studies were included if they reported on factors that could influence quality of life. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

Study selection:

Studies were identified and assessed independently by 2 reviewers.

Data extraction:

Data were extracted by 2 independent reviewers.

Data synthesis:

After removing duplicates, the search yielded 2616 studies, of which 24 met our inclusion criteria (cross-sectional n = 13; prospective n = 9; retrospective n = 2). The most commonly used quality-of-life instruments were the Short Form 36, followed by the World Health Organization Quality of Life-BREF and the EuroQoL 5 dimension. Younger age, traumatic etiology, unilateral or below-knee amputation, presence of comorbidities, and social integration were found to influence quality of life in people with lower-limb amputation, whereas sex and socioeconomic context do not seem to have a clear influence.

Conclusions:

This systematic review of the literature identified several factors that influence quality of life in patients with lower-limb amputation. However, the results are not always consistent across studies and there is still no consensus on some factors. Conclusive findings regarding sex and socioeconomic status remain elusive, primarily because of substantial disparities observed across the literature. Future prospective longitudinal studies with clear a priori inclusion of a wide range of potential factors are needed to clarify the impact of the identified factors. Factors such as age, type of amputation, comorbidities and social integration should be considered in the management of patients with amputation.
Effect of Prophylactic Placement of Percutaneous Endoscopic Gastrostomy on the Surgical Prognosis in Patients With Oral Cancer: A Pilot Study
Authors: Li Chen-Xi , Pataer Parekejiang , Gong Zhong-Cheng
Published: February 2024

This study assessed the application of prophylactic percutaneous endoscopic gastrostomy (pPEG) in patients with newly diagnosed oral cancer (OC) who underwent surgery and were ready for subsequential chemoradiation. In total, 113 patients who underwent OC surgical treatment were divided into pPEG (n = 26), nasogastric tube (n = 54), and oral feeding (n = 33) groups. Their baseline characteristics, surgery-related outcomes, and nutritional data were analyzed using the Wilcoxon rank-sum test and χ2 test. No statistical significance was shown among the 3 groups using different flaps for reconstructing OC-related defects (P > 0.05). Patients of the pPEG group had the lowest incidence of surgical site infection (SSI; 23.1%, P = 0.006), but the longest hospital stay (24.1 ± 7.9 d, P < 0.001). Prophylactic percutaneous endoscopic gastrostomy may decrease the frequency of SSI but increase the length of hospitalization in SSI OC. However, multicentric prospective clinical controlled trials with large sample sizes are needed to further validate our findings.
Forced Esthetic Position: A Diagnostic Strategy for Anteroposterior Repositioning in Orthognathic Surgeries
Authors: León Nelson , Martínez Alejandro , Spinella Almeida Matheus , Claus Jonathas Daniel Paggi
Published: February 2024

Considering the esthetic goals involved in orthognathic surgeries, one of the challenges is to define the horizontal projection of the jaws. Most of the cephalometric analyses are focused on the position of the upper incisor and upper lip. Planning the correction of a mandibular retrognathism can be simplified by clinical simulation asking the patient to project their mandible. A forced esthetic position protocol is presented as a starting point for the planning in orthognathic cases.
Editorial introductions
Authors: Domolo Anna
Published: February 2024

Current Opinion in Supportive and Palliative Care was launched in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of supportive and palliative care are divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal’s Section Editors for this issue.