bluuebunny/crossref_metadata_2025 huggingface dataset:
Cleaning up alpha-1 antitrypsin deficiency related liver disease
Authors: Rademacher Laura , Fromme Malin , Strnad Pavel
Published: May 2023

Purpose of review

Alpha-1 antitrypsin deficiency (AATD) is one of the most common genetic disorders arising due to mutations in alpha-1 antitrypsin (AAT) gene affecting primarily the lung and the liver. This review summarizes the pathophysiology and clinical manifestation of different AATD genotypes and discusses the recent therapeutic developments. The focus is on the severe, rare homozygous Pi∗ZZ and the common heterozygous Pi∗MZ genotype.

Recent findings

Pi∗ZZ individuals harbor an up to 20 times higher risk of liver fibrosis and cirrhosis than noncarriers and liver transplantation is currently the only available therapeutic option. AATD constitutes a proteotoxic disorder arising from hepatic AAT accumulation and the currently most promising data come from a phase 2, open-label trial of fazirsiran, a hepatocyte-targeted siRNA. Pi∗MZ subjects display an increased risk of advanced liver disease and at the latter stage, a faster deterioration than individuals without AAT mutation.

Although the fazirsiran data offer a glimpse of hope to AATD patients, a consensus on appropriate study endpoint, a careful patient selection as well as monitoring of long-term safety will be essential for an approval.
Metabolic dysfunction and nonalcoholic fatty liver disease risk in individuals with a normal body mass index
Authors: DiStefano Johanna K. , Gerhard Glenn S.
Published: May 2023

Purpose of review

Nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity, but is also common in individuals with a normal body mass index (BMI), who also experience the hepatic inflammation, fibrosis, and decompensated cirrhosis associated with NAFLD progression. The clinical evaluation and treatment of NAFLD in this patient population are challenging for the gastroenterologist. A better understanding of the epidemiology, natural history, and outcomes of NAFLD in individuals with normal BMI is emerging. This review examines the relationship between metabolic dysfunction and clinical characteristics associated with NAFLD in normal-weight individuals.

Recent findings

Despite a more favorable metabolic profile, normal-weight NAFLD patients exhibit metabolic dysfunction. Visceral adiposity may be a critical risk factor for NAFLD in normal-weight individuals, and waist circumference may be better than BMI for assessing metabolic risk in these patients. Although screening for NAFLD is not presently recommended, recent guidelines may assist clinicians in the diagnosis, staging, and management of NAFLD in individuals with a normal BMI.

Individuals with a normal BMI likely develop NAFLD as a result of different etiologies. Subclinical metabolic dysfunction may be a key component of NAFLD in these patients, and efforts to better understand this relationship in this patient population are needed.
The role of artificial intelligence in hepatology research and practice
Authors: Khalifa Ali , Obeid Jihad S. , Erno Jason , Rockey Don C.
Published: May 2023

Purpose of review

The use of artificial intelligence (AI) in examining large data sets has recently gained considerable attention to evaluate disease epidemiology, management approaches, and disease outcomes. The purpose of this review is to summarize the current role of AI in contemporary hepatology practice.

Recent findings

AI was found to be diagnostically valuable in the evaluation of liver fibrosis, detection of cirrhosis, differentiation between compensated and decompensated cirrhosis, evaluation of portal hypertension, detection and differentiation of particular liver masses, preoperative evaluation of hepatocellular carcinoma as well as response to treatment and estimation of graft survival in patients undergoing liver transplantation. AI additionally holds great promise in examination of structured electronic health records data as well as in examination of clinical text (using various natural language processing approaches). Despite its contributions, AI has several limitations, including the quality of existing data, small cohorts with possible sampling bias and the lack of well validated easily reproducible models.

AI and deep learning models have extensive applicability in assessing liver disease. However, multicenter randomized controlled trials are indispensable to validate their utility.
Machine and deep learning in inflammatory bowel disease
Authors: Zulqarnain Fatima , Rhoads S. Fisher , Syed Sana
Published: May 2023

Purpose of review

The Management of inflammatory bowel disease (IBD) has evolved with the introduction and widespread adoption of biologic agents; however, the advent of artificial intelligence technologies like machine learning and deep learning presents another watershed moment in IBD treatment. Interest in these methods in IBD research has increased over the past 10 years, and they offer a promising path to better clinical outcomes for IBD patients.

Recent findings

Developing new tools to evaluate IBD and inform clinical management is challenging because of the expansive volume of data and requisite manual interpretation of data. Recently, machine and deep learning models have been used to streamline diagnosis and evaluation of IBD by automating review of data from several diagnostic modalities with high accuracy. These methods decrease the amount of time that clinicians spend manually reviewing data to formulate an assessment.

Interest in machine and deep learning is increasing in medicine, and these methods are poised to revolutionize the way that we treat IBD. Here, we highlight the recent advances in using these technologies to evaluate IBD and discuss the ways that they can be leveraged to improve clinical outcomes.
Perceptions and priorities of perioperative staff and the public for sustainable surgery: a validated questionnaire study
Authors: Gadi Nishita , Lam Kyle , Acharya Amish , Winter Beatty Jasmine , Purkayastha Sanjay
Published: May 2023

Background:

Surgery is a substantial contributor to healthcare-related emissions. Despite a drive to improve sustainability, few interventions have been adopted. Stakeholder engagement is considered a key barrier to implementation. This study aimed to determine the attitudes and beliefs of the perioperative staff and the public regarding sustainability initiatives in surgery, and whether differences exist between the two groups.

Materials and Methods:

Separate validated healthcare professional and public questionnaires were developed using a stepwise process. A systematic review was undertaken using Medline, Embase and Cochrane to identify key domains pertaining to sustainability and ensure content validity. Initial questionnaires were developed and refined using an iterative process of feedback from focus groups. Psychometric validation was conducted to remove question ambiguity. The final validated questionnaire was distributed to perioperative staff and the public using a multimodal approach involving online tools and in person.

Results:

Only 37.1% of perioperative staff reported the implementation of sustainability initiatives in their departments. Yet, staff (45.7%) and the public (48.2%) somewhat agreed that sustainability should influence a surgeon’s procedural decision-making. Insufficient staff education regarding sustainability was a potential cause for the lack of adoption, with 71.4% reporting they had no formal training. Moreover, discrepancies in the perceived importance of sustainability may have contributed. Staff and the public agreed that outcomes (38.6 vs. 42.7%, P=0.767) and surgeon experience with a technique (28.6 vs. 40.0%, P=0.082) were more important than sustainability. However, 40.9% of the public did not consider operative time an important factor compared to sustainability, while 45.7% of staff would only tolerate procedures 25% longer.

Conclusions:

Engaging stakeholders is central to implementing long-term environmentally sustainable initiatives in surgery without compromising patient outcomes. More work is needed to understand the relative trade-offs considered by perioperative staff and the public, as well as provide both groups with more pertinent education on ecological outcomes.
Bibliometric analysis of COVID-19 research in Morocco: short communication
Authors: Zoukal Sofia , Hassoune Samira , Nani Samira
Published: May 2023

Introduction:

As a global pandemic, coronavirus disease 2019 (COVID-19) has led to a growing number of related research studies being published worldwide. However, there is no study on the bibliometric analysis of these Moroccan studies. This study aims to provide a general overview of COVID-19 studies in Morocco and may provide a direction for hot topics and future research trends.

Method:

The global literature about COVID-19 published between 2019 and 2022 was scanned in PubMed, the Web of Science collection database, Scopus, and two preprint platforms. ‘COVID-19’, ‘Novel Coronavirus’, ‘2019-nCoV’, and ‘SARS-CoV-2’ were used as the keywords to reach the relevant publications. The VOS viewer was applied to perform the bibliometric analysis of these articles.

Results:

A total of 987 Moroccan publications on the topic of COVID-19 were retrieved. Of all these publications, 166 (61.9%) were original journal articles, 10 (3.7%) were review articles, 514 (8.38%) were letters and 56 (20.9%) were others, such as case reports, notes, or book chapters. Ten original articles (3.7%) had not yet been peer-reviewed and were retrieved from the preprint servers medRxiv and bioRxiv. The highest number of COVID-19 publications was published by Mohammed V University in Rabat (n=45, 16.8%), followed by Hassan II University (n=32, 11.9%) and Mohammed VI University of Health Sciences (n=29, 10.8%). The open-access format was the predominant publishing model (43.2%) and 92.9% were written in English. The main research lines identified in COVID-19 for Morocco are related to the pandemic’s indirect effects: education (11.2%), mental health (6.3%), and the environment (6.3%).

Conclusion:

Moroccan institutions have made a profound contribution to COVID-19 research than that in other African countries, but lags behind compared to that in Arabic countries.
Laparoscopic modified fundus-down cholecystectomy technique: an alternative method for performing a safe laparoscopic cholecystectomy: how to article
Authors: Jearanai Supakool , Wangkulangkul Piyanun , Sakolprakaikit Kanittha , Cheewatanakornkul Siripong
Published: May 2023

Background:

Modified fundus-down cholecystectomy is a surgical procedure used to treat patients diagnosed with benign gallbladder disease. This technique begins with Calot’s triangle dissection and attempts to identify key structures such as the cystic artery and duct. Subsequently, fundus-down dissection is performed to separate the gallbladder from the cystic plate. The cystic artery and duct are the final structures that are clipped and cut. In this study, the authors discuss the success and complication rates of this treatment based on their 10-year experience at a tertiary hospital in southern Thailand.

Objectives:

This study aimed to compare the operative outcomes of conventional laparoscopic cholecystectomy (LC) and modified fundus-down techniques regarding postoperative complications and consequences.

Methods:

A retrospective analysis of single-centre data from 2010 to 2022 was conducted at our hospital. All patients with gallstone disease who underwent conventional LC or modified fundus-down cholecystectomy were included in the study. The primary outcomes of this study were the incidence of major bile duct injury and the need for further intervention or surgical correction.

Results:

From a total of 1993 patients who were surveyed, 1612 patients underwent conventional LC and 381 underwent laparoscopic modified fundus-down cholecystectomy. In terms of conversion rate, estimated blood loss, length of hospital stay, and complication rate, there were no differences between the conventional LC and the modified fundus-down approach. However, modified fundus-down cholecystectomy reduced the operative time. The authors collected data from each patient’s sign-in to extubation time (P<0.001). The postoperative complications (P=0.120) and conversion rates (P=0.904) were similar.

Conclusion:

Laparoscopic modified fundus-down cholecystectomy can be performed in simple and complex cases, including cases of severe fibrosis of the hepatocystic triangle. The study showed that this alternative technique could reduce operative time compared to the conventional technique with no difference in complications, especially common bile duct injury, postoperative common bile duct stones, and postoperative pancreatitis.
Comprehensive overview of human monkeypox: epidemiology, clinical features, pathogenesis, diagnosis and prevention
Authors: Ali Eman , Sheikh Ayesha , Owais Rabia , Shaikh Asim , Naeem Unaiza
Published: May 2023

Monkeypox (MPX) is a zoonotic disease caused by the monkeypox virus (MPXV), belonging to the orthopoxvirus genus with a presentation resembling smallpox making it historically challenging to distinguish the disease from smallpox clinically. Since a British citizen brought MPX into the country on 6 May 2022, there have been concerns about the re-emergence of the human MPXV. Since then, the WHO has reported 92 confirmed cases and 28 suspected cases in 13 nations where MPXV was not endemic. WHO declared MPX a ‘public health emergency of international concern’ on 23 July 2022. MPXV can spread either through human-human contact or animal-human contact. Respiratory droplets, direct contact with bodily fluids, contaminated patient surroundings or objects, and skin sores from an infected person have all been linked to the disease’s transmission from one person to another. Fever, headache, lethargy, asthenia, enlargement of the lymph nodes, weariness, back pain, and myalgia are some of the symptoms that last from 2 to 5 weeks. It can be diagnosed using a range of diagnostic methods, including electron microscopy, Immunoglobulin M, enzyme-linked immunosorbent assay, polymerase chain reactions, histological analysis, immunofluorescent antibody testing, virus isolation, etc. Smallpox immunization before infection may lessen clinical symptoms and is around 85% effective in protecting from the MPXV.
First-line treatment options for advanced gastric/gastroesophageal junction cancer patients with PD-L1-positive: a systematic review and meta-analysis
Authors: Fan Ling , Lu Ning , Zhang Lingmin , Zhang Jie , Li Jie , Cui Manli , Zhang Mingxin
Published: May 2023

Background:

Lately, many trials have paid much attention on the oncological outcomes of immunotherapy combined with chemotherapy as a first-line treatment. The authors perform a systematic meta-analysis to assess the efficacy and safety of programmed death 1 inhibitor plus chemotherapy for first-line treatment in advanced gastric/gastroesophageal junction cancer.

Materials and methods:

Literature search through major databases in English and Chinese: PubMed, Embase, Cochrane library, web of Science and CNKI updated on 10 March 2023. Randomized controlled trials were selected to investigate chemotherapy plus programmed death 1 inhibitor versus chemotherapy.

Results:

A total of 7 randomised controlled trials including 5788 participants were included. The overall survival (hazard ratio=0.79;95% CI: 0.74–0.85, P<0.01), progression-free survival (hazard ratio=0.72; 95% CI: 0.67–0.77, P<0.01) and objective response rate (risk ratio=1.24,95% CI: 1.18–1.31, P<0.05) were longer than chemotherapy alone in the pooled analysis. For subgroup analyses of overall survival, programmed death 1 inhibitors plus chemotherapy had a significant advantage in patients with combined positive score greater than or equal to 5, in Asia, in men and in those younger than 65 years (P<0.01), as were immune-mediated adverse events (odds ratio=8.86;95% CI: 1.26–62.47,P<0.05) and treatment-related grade 3–5 adverse events (odds ratio=1.40,95% CI:1.20–1.62, P<0.01).

Conclusion:

Programmed death 1 inhibitors plus chemotherapy have significant antitumour activity compared to chemotherapy alone. However, it is riskier in terms of toxicity than chemotherapy. The authors recommend programmed death 1 inhibitors plus chemotherapy as the optimal treatment regimen for patients with positive programmed death ligand 1 expression, in Asia, male and less than 65 years of age. More well-designed studies are needed to investigate the efficacy and safety of different immune plus chemotherapy drug doses and regimens.
Current status and future of cardio-obstetrics-review
Authors: Khalid Humna , Karishma Fnu , Mumtaz Hassan , Saqib Muhammad , Iftikhar Muhammad , Shahab Ramsha
Published: May 2023

Cardio-obstetrics refers to an approach to maternal care that is based upon teamwork with specialists from maternal-foetal medicine, cardiology, anaesthesiology, neonatology, nursing, social work, and pharmacy that work together to achieve appropriate outcomes for the pregnant patient. The aim of this paper is to highlight and provide a narrative review on the currently published research on the current status and future of cardio-obstetrics. A short review on the hemodynamic physiology in pregnancy has also been described in this paper. The authors have discussed the major risk factors associated with exacerbation of pregnancy and the possible remedies that are currently available in this paper in accordance to the updated research. The cardio-obstetrics team provides advice about healthy pregnancy planning before conception. Proper cardio-obstetric care is associated with better outcomes in women with a high cardiovascular risk with decreased adverse maternal and foetal outcomes. Such care should be given to underserved and marginalized communities with great care as they have largely lacked such care in the past. The authors conclude the paper by recommendations to advance this newly emerging field by way of further scientific research and public awareness. This review can serve helpful to any physician working in the healthcare as well as the public that are interested in awareness about the multidisciplinary needs of pregnant women with cardiovascular disease.
Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer
Authors: Wang Yuh-Feng , Lo Chun-Yu , Chen Li-Yu , Chang Chi-Wei , Huang Ya-Ting , Huang Ya-Yao , Huang Yi-Hsiu
Published: May 2023

Purpose

Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68Ga-PSMA-11, 18F-DCFPyL, and 18F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors.

Methods

This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools.

Results

Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83–0.86), 0.61 (95% CI, 0.39–0.79), and 0.62 (95% CI, 0.46–0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78–0.89), 0.67 (95% CI, 0.52–0.80), and 0.60 (95% CI, 0.45–0.73), respectively, without significant differences (P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03–1.17; P < 0.01).

Conclusions

This meta-analysis found that whereas 18F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.
FAPI PET Signal in Hibernoma Reflects FAP Expression in Tumor Vasculature Cells
Authors: Hotta Masatoshi , Mona Christine E. , Crompton Joseph G. , Armstrong Wesley R. , Gafita Andrei , Nelson Scott D. , Eilber Fritz C. , Dawson David W. , Calais Jeremie , Benz Matthias R.
Published: May 2023

A 43-year-old man with a growing mass in the right groin, concerned for liposarcoma, underwent MRI and 68Ga–fibroblast activation protein inhibitor (FAPI)-46 PET/CT before surgery. Fibroblast activation protein inhibitor PET/CT demonstrated increased uptake (SUVmax, 3.2) predominantly in the solid portion, where MRI showed gadolinium enhancement. The patient subsequently underwent surgery and was diagnosed with hibernoma. The immunohistochemistry of the tumor revealed the fibroblast activation protein expression in the fibrovascular network and myofibroblastic cells of the tumor. This case suggests that the FAPI uptake can be affected by the vascular cells, and thus, a careful interpretation of the FAPI PET signal may be needed.
Visual Attention, Bias, and Social Dispositions Toward People With Facial Anomalies
Authors: Villavisanis Dillan F. , Workman Clifford I. , Zapatero Zachary D. , Vu Giap H. , Humphries Stacey A. , Blum Jessica D. , Cho Daniel Y. , Swanson Jordan W. , Bartlett Scott P. , Chatterjee Anjan , Taylor Jesse A.
Published: May 2023

Background

Facial attractiveness influences our perceptions of others, with beautiful faces reaping societal rewards and anomalous faces encountering penalties. The purpose of this study was to determine associations of visual attention with bias and social dispositions toward people with facial anomalies.

Methods

Sixty subjects completed tests evaluating implicit bias, explicit bias, and social dispositions before viewing publicly available images of preoperative and postoperative patients with hemifacial microsomia. Eye-tracking was used to register visual fixations.

Results

Participants with higher implicit bias scores fixated significantly less on the cheek and ear region preoperatively (P = 0.004). Participants with higher scores in empathic concern and perspective taking fixated more on the forehead and orbit preoperatively (P = 0.045) and nose and lips (P = 0.027) preoperativel.

Conclusions

Participants with higher levels of implicit bias spent less visual attention on anomalous facial anatomy, whereas participants with higher levels of empathic concern and perspective taking spent more visual attention on normal facial anatomy. Levels of bias and social dispositions such as empathy may predict layperson gaze patterns toward those with facial anomalies and provide insights to neural mechanisms underlying the “anomalous is bad” paradigm.
Immediate Versus Delayed-Immediate Autologous Breast Reconstruction After Nipple-Sparing Mastectomy
Authors: Barnes Laura L. , Patterson Anne , Lem Melinda , Holland Michael C. , Lentz Rachel , Sbitany Hani , Piper Merisa L.
Published: May 2023

Introduction

Autologous reconstruction following nipple-sparing mastectomy (NSM) is either performed in a delayed-immediate fashion, with a tissue expander placed initially at the time of mastectomy and autologous reconstruction performed later, or immediately at the time of NSM. It has not been determined which method of reconstruction leads to more favorable patient outcomes and lower complication rates.

Methods

We performed a retrospective chart review of all patients who underwent autologous abdomen-based free flap breast reconstruction after NSM between January 2004 and September 2021. Patients were stratified into 2 groups by timing of reconstruction (immediate and delayed-immediate). All surgical complications were analyzed.

Results

One hundred one patients (151 breasts) underwent NSM followed by autologous abdomen-based free flap breast reconstruction during the defined time period. Fifty-nine patients (89 breasts) underwent immediate reconstruction, whereas 42 patients (62 breasts) underwent delayed-immediate reconstruction. Considering only the autologous stage of reconstruction in both groups, the immediate reconstruction group experienced significantly more delayed wound healing, wounds requiring reoperation, mastectomy skin flap necrosis, and nipple-areolar complex necrosis. Analysis of cumulative complications from all reconstructive surgeries revealed that the immediate reconstruction group still experienced significantly greater cumulative rates of mastectomy skin flap necrosis. However, the delayed-immediate reconstruction group experienced significantly greater cumulative rates of readmission, any infection, infection requiring PO antibiotics, and infection requiring IV antibiotics.

Conclusions

Immediate autologous breast reconstruction after NSM alleviates many issues seen with tissue expanders and delayed autologous reconstruction. Although mastectomy skin flap necrosis occurs at a significantly greater rate after immediate autologous reconstruction, it can often be managed conservatively.
Microvascular Free Flap Reconstruction of Thigh Defects After Tumor Resection in the Setting of Radiation
Authors: Kuruoglu Doga , Bakri Karim , Tran Nho V. , Moran Steven L. , Vijayasekaran Aparna , Carlsen Brian T.
Published: May 2023

Background

Soft tissue reconstruction of the thigh defects can usually be achieved with local options. Free tissue transfer may be indicated in very large defects with exposed vital structures and/or a history of radiation therapy where the healing potential of local option is poor. In this study, we evaluated our experience on microsurgical reconstruction of oncological and irradiated thigh defects to assess the risk factors for complications.

Methods

Institutional review board–approved retrospective case series study using electronic medical records from 1997 to 2020 was conducted. All patients with irradiated thigh defects derived from oncological resections who underwent microsurgical reconstruction were included. Patient demographics and clinical and surgical characteristics were recorded.

Results

Twenty free flaps were transferred in 20 patients. Mean age was 60 ± 11.8 years, and median follow-up time was 24.3 months (interquartile range [IQR], 71.4–9.2 months). The most common type of cancer was liposarcoma (n = 5). Neoadjuvant radiation therapy was performed in 60%. Most commonly used free flaps were latissimus dorsi muscle/musculocutaneous flap (n = 7) and anterolateral thigh flap (n = 7) Nine flaps were transferred immediately after resection. Overall, 70% of arterial anastomoses were end-to-end, whereas 30% were end-to-side. Deep femoral artery branches were chosen as the recipient artery in the 45%. Median length of hospital stay was 11 days (IQR, 16.0–8.3 days), and median time to start weight-bearing was 20 days (IQR, 49.0–9.5 days). All were successful except for 1 patient who required additional pedicled flap coverage. The overall major-complication rate was 25% (n = 5, hematoma = 2, venous congestion requiring emergent exploration surgery = 1, wound dehiscence = 1, surgical site infection = 1). Cancer recurred in 3 patients. One required amputation due to cancer recurrence. Age (hazard ratio [HR], 1.14; P = 0.0163), tumor volume (HR, 18.8; P = 0.0006), and resection volume (HR, 2.24; P = 0.0019) were statistically significantly associated with having a major complication.

Conclusions

Based on the data, microvascular reconstruction of irradiated post–oncological resection defects shows high flap survival rate and success. Given the large size of flap required, the complex nature and size of these wounds, and history of radiation, wound healing complications are common. Despite this, free flap reconstruction should be considered in irradiated thighs with large defects. Studies with larger cohort and longer follow-up are still required.
What COVID Restrictions Have Taught Us About Visiting Subinternships
Authors: Zitkovsky Helen S. , Kuhn Natalie L. , Guo Lifei
Published: May 2023

Background

Integrated plastic surgery applicants complete among the highest number of visiting audition rotations of any specialty. In the 2021 match, we observed that the elimination of audition rotations and in-person interviews drastically increased the number of applicants who matched at their home program. We sought to evaluate the effect of applicants participating in one selective visiting subinternship rotation on home program match rates.

Methods

Top 50 plastic surgery residency programs were identified by 2021 Doximity rankings. Publicly available, online plastic surgery match spreadsheets were used to collect available information including matched applicants' medical school, the institution at which they matched, whether they matched at their home institution, and whether they had previous communication with their matched program including research year or visiting subinternship completed.

Results

Fourteen percent of applicants matched at their home institution in 2022, comparable with recent prepandemic rates of 14.1% and 16.7%, versus 24.1% in 2021. The largest effect was observed among the top 25 programs. Separately, approximately 70% of applicants provided self-reported information on whether they completed a subinternship. Among the top 50 programs, 39.0% of applicants completed an audition rotation at the institution at which they eventually matched.

Conclusions

The allowance of medical students to perform only one visiting subinternship in the 2022 match cycle normalized home match rates to the prepandemic baseline, possibly driven by a large proportion of students matching at their visiting rotation institution. Perhaps from both a program and applicant standpoint, 1 away rotation may provide sufficient exposure for eventual match success.
A Prospective Evaluation of the Quality of Life and Mental Health Implications of Mastectomy Alone on Women in sub-Saharan Africa
Authors: Kennedy Sarah H. , Bekele Mahteme , Berlin Nicholas L. , Ranganathan Kavitha , Hamill Jennifer B. , Haileselassie Etsehiwot , Oppong Joseph , Newman Lisa A. , Momoh Adeyiza O.
Published: May 2023

Objective:

Assess quality of life and mental health implications of mastectomy for breast cancer on sub-Saharan African women.

Background:

Mortality rates amongst women diagnosed with breast cancer in sub-Saharan Africa (SSA) are high, with disparities in survival relative to women in high income countries partly attributed to advanced disease at presentation. Fears of the sequelae of mastectomy are a prominent reason for presentation delays. There is a critical need to better understand the effects of mastectomy on women in SSA to inform preoperative counseling and education for women with breast cancer.

Methods:

Women with breast cancer in Ghana and Ethiopia undergoing mastectomy were followed prospectively. Breast related quality-of-life and mental health measures were evaluated preoperatively, three and six months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Bivariate and logistic regression analyses evaluated changes in these measures for the total cohort and between sites.

Results:

A total of 133 women from Ghana and Ethiopia were recruited. The majority of women presented with unilateral disease (99%) and underwent unilateral mastectomy (98%) with axillary lymph node dissection. Radiation was more common in Ghana (P<0.001). Across most BREAST-Q subscales, women from both countries reported significantly decreased scores at three months postoperative. At six months, the combined cohort reported decreased scores for breast satisfaction (mean difference, -3.4). Women in both countries reported similar improvements in anxiety and depression scores postoperatively.

Conclusions:

Women from Ghana and Ethiopia who underwent mastectomy experienced a decline in breast-related body image while also experiencing decreased levels of depression and anxiety.
Safety and Efficacy of Iltamiocel Cellular Therapy for the Treatment of Fecal Incontinence. Results of a Phase 1/2 Study
Authors: Knowles Charles , Canestrari Emanuele , Jankowski Ron , Cardello Kelly , Raval Manoj J.
Published: May 2023

Objective:

To examine the safety and efficacy of iltamiocel, an investigational cellular therapy of autologous muscle-derived cells, as a treatment for fecal incontinence (FI) in adults.

Background:

Limited therapeutic options are available for patients with FI refractory to conservative treatments. Cell therapy using autologous muscle-derived cells represents a promising, minimally invasive approach for restoring anal sphincter function.

Methods:

In this multicenter, prospective, non-randomized study, 48 participants were treated with a single iltamiocel dose of 250×106 cells. The primary outcome was the incidence of product or procedure-related adverse events (AEs) and serious adverse events (SAEs). Secondary outcomes were changes in number of FI episodes, Cleveland Clinic Incontinence Score (CCIS), Fecal Incontinence Quality of Life (FIQL), and anorectal manometry at 3, 6, and 12 months compared to baseline.

Results:

No SAEs and only one product-related AE of inflammation at the injection site were reported. At 12 months, there was a reduction in median FI episodes (-6.0; 95% CI: −10.0, −1.0) and days with episodes (−4.0; 95% CI: −8.0, −1.0). A ≥50% reduction in FI episodes was observed in 53.7% of participants, and 24.4% had complete restoration of continence. Symptom severity and quality of life improved with mean CCIS reduction (-2.9; 95% CI: - 3.7, −2.1), and FIQL increased (2.2; 95% CI:1.4, 2.9). No significant changes were detected in anorectal manometry measurements. A history of episiotomy was significantly associated with treatment response in multivariate analysis.

Conclusion:

The administration of iltamiocel cellular therapy is safe. Iltamiocel shows promise for significantly improving fecal incontinence symptoms and quality of life.
Ostomy-Related Quality of Life in Puerto Ricans Living With Inflammatory Bowel Disease
Authors: Lojo Juan J. , de la Villa Ricardo , Vega-Torres Mayte M. , Torres Esther A.
Published: May 2023

PURPOSE:

The aim of this study was to determine ostomy-related quality of life (QOL) in Hispanic Puerto Ricans living with an enteral stoma and inflammatory bowel disease (IBD). We analyzed possible associations between QOL and sex, diagnosis, and type and duration of stoma.

DESIGN:

Prospective cohort study.

SUBJECTS AND SETTINGS:

The sample comprised 102 adults living with IBD and an ostomy; 60 of 101 (59.4%) were males, 44 of 102 (43.1%) had Crohn's disease, and 60 of 102 (58.9%) had an ileostomy. Participants were receiving care at the Center for IBD of the University of Puerto Rico in San Juan, Puerto Rico, between January 2012 and December 2014.

METHODS:

One-hundred two adults Puerto Ricans with IBD completed the Stoma Quality of Life (Stoma-QOL) questionnaire. Data were analyzed using frequency distributions for categorical variables and summary statistics for continuous variables. Independent-group t test and one-way analysis of variance, with the post hoc Tukey test, were used to determine group differences for the variables of age, sex, civil status, time living with an ostomy, type of ostomy, and IBD diagnosis. Results were analyzed according to the number of responses to each variable; the denominator varied for some variables.

RESULTS:

Having an ostomy for more than 40 months was significantly associated with a higher QOL score (59.0 vs 50.7; P = .05). Males had significantly higher scores than females (59.94 vs 50.23; P = .0019). Age, IBD diagnosis, and type of ostomy were not associated with the Stoma-QOL scores.

CONCLUSIONS:

The achievement (over 40 months) to attain improved ostomy-related QOL suggests that early training in the care of the ostomy and advanced planning when leaving home may enhance ostomy-related QOL. Lower QOL in women may represent an opportunity for a sex-specific educational intervention.
Frequency of Minor Shifts in Body Position and Pressure Injury Development
Authors: Efteli Elçin
Published: May 2023

PURPOSE:

The purpose of this study was to evaluate the influence of minor shifts in body position on the development of pressure injuries.

DESIGN:

A prospective, comparative, descriptive study.

SUBJECTS AND SETTING:

The sample comprised 78 bedridden patients aged 18 years or older, free of pressure injuries, and hospitalized in the Neurology and Internal Medicine clinics and intensive care units. The study setting was a state hospital in Burdur Province, Southwest Turkey; data were collected between March and September 2018.

METHODS:

Patients were monitored once weekly until the end of their stay or until pressure injury development. Data were collected using a researcher-designed data collection form. Patients' ability to make minor shifts in body position was categorized between 0 and 3 per movement group.

RESULTS:

Twenty-one (26.9%) of 78 participants developed a pressure injury; 90.4% (n = 19) were stage 1 pressure injuries. Pressure injuries occurred in 94.1% of the patients who did not make shifts in body position versus 80% of the patients who performed shifts every 4 hours. No pressure injuries developed in those patients who moved every hour (P = .00).

CONCLUSIONS:

Study findings support the importance of making minor shifts in body position for prevention of pressure injury in bedridden patients.
Monitoring of Schools and Colleges of Pharmacy Based on NAPLEX Passage Rate
Authors: Shcherbakova Natalia , Pezzuto John M.
Published: May 2023

Introduction

We have evaluated two approaches of monitoring schools and colleges of pharmacy based on North American Pharmacist Licensure Examination® (NAPLEX®) passage rates. Historically, the Accreditation Council for Pharmacy Education (ACPE) has cited programs based on achieving a passage rate ≥2 SD standard deviations (SD) below the national average. Since the National Association of Boards of Pharmacy (NABP) no longer reports scores, this procedure is currently being reconsidered. Our supposition is that the failure rate of ≥2 SD below the average passage rate should be retained, but now, based on the national average passage rate. However, we further suggest this is not adequate, due to major variations in class size.

Commentary

We suggest the establishment of a ‘maximum acceptable failure count’, likely in the range of 20-25 failing graduates per class. Analyses of data from 2017-2019 indicate that this approach would lead to monitoring approximately 15% of existing programs that graduate approximately 40% of individuals failing NAPLEX, versus monitoring approximately 5% of programs that graduate approximately 9% of individuals failing NAPLEX.

Implications

The historical method of monitoring pharmacy programs with NAPLEX passage based on the national average ≥2 SD is not adequate, primarily due large variations in class size. In that accreditation standards are currently being revised (“Standards 2025”), this would be an ideal time to reconsider methods for selecting programs that warrant monitoring based on inadequate NAPLEX passage rates. We suggest the concept of ‘maximum acceptable failure count’ should be taken into account when identifying programs to be cited.
Retinoblastoma Detection via Image Processing and Interpretable Artificial Intelligence Techniques
Authors: Duraivenkatesh Surya , Narayan Aditya , Srikanth Vishak , Made Adamou Fode
Published: May 2023

Retinoblastoma (RB) is a treatable ocular melanoma that is diagnosed early and subsequently cured in the United States but has a poor prognosis in low- and middle-income countries (LMICs). This study outlines an approach to aid health-care professionals in identifying RB in LMICs. Transfer learning methods were utilized for detection from fundus imaging. One hundred and forty RB+ and 140 RB-images were acquired from a previous deep-learning study. Next, five models were tested: VGG16, VGG19, Xception, Inception v3, and ResNet50, which were trained on the two-hundred-and-eighty image dataset. To evaluate these models, the Dice Similarity Coefficient (DSC) and Intersection-over-Union (IoU) were used. Explainable AI techniques such as SHAP and LIME were implemented into the best-performing models to increase the transparency of their decision-making frameworks, which is critical for the use of AI in medicine. We present that VGG16 is the best at identifying RB, though the other models achieved great levels of prediction. Transfer learning methods were effective at identifying RB, and explainable AI increased viability in clinical settings.
Intermuscular Adiposity is Associated with Coronary Microvascular Dysfunction Independently of Body Mass Index and Modifies its Effect on Adverse Cardiovascular Outcomes
Authors: Souza Ana C. , Amelie S. Troschel , Jan P. Marquardt , Filipe A. Moura , Sanjay Divakaran , Jon Hainer , Ron Blankstein , Sharmila Dorbala , Marcelo F. Di Carli , Florian J. Fintelmann , Viviany R. Taqueti
Published: May 2023

Background:Skeletal muscle (SM) fat infiltration, or intermuscular adipose tissue (IMAT), reflects muscle quality and is associated with inflammation, a key determinant in cardiometabolic disease. Coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD), is independently associated with BMI, inflammation and risk of heart failure, myocardial infarction and death. We sought to investigate the relationship between skeletal muscle quality, CMD and cardiovascular outcomes.

Methods:Consecutive patients (N=669) undergoing evaluation for CAD with cardiac stress PET demonstrating normal perfusion and preserved left ventricular ejection fraction were followed over median 6 years for major adverse cardiovascular events (MACE), including death and hospitalization for myocardial infarction or heart failure. CFR was calculated as stress/rest myocardial blood flow and CMD defined as CFR<2. Subcutaneous adipose tissue (SAT), SM and IMAT areas (cm2) were obtained from simultaneous PET attenuation correction CTs using semi-automated segmentation at the twelfth thoracic vertebra (T12) level.

Results:Median age was 63 years, 70% were female and 46% nonwhite. Nearly half of patients were obese (46%, BMI 30-61) and BMI correlated highly with SAT and IMAT (r=0.84 and 0.71, respectively, p<0.001) and moderately with SM (r=0.52, p<0.001). Decreased SM and increased IMAT, but not BMI or SAT, remained independently associated with decreased CFR (adjusted p=0.03 and p=0.04, respectively). In adjusted analyses, both lower CFR and higher IMAT were associated with increased MACE [HR 1.78 (1.23-2.58) per -1U CFR and 1.53 (1.30-1.80) per +10 cm2IMAT, adjusted p=0.002 and p<0.0001, respectively], while higher SM and SAT were protective [HR 0.89 (0.81-0.97) per +10 cm2SM and 0.94 (0.91-0.98) per +10 cm2SAT, adjusted p=0.01 and 0.003, respectively]. Every 1% increase in fatty muscle fraction [IMAT/(SM+IMAT)] conferred an independent 2% increased odds of CMD [CFR<2, OR 1.02 (1.01-1.04), adjusted p=0.04] and a 7% increased risk of MACE [HR 1.07 (1.04-1.09), adjusted p<0.001]. There was a significant interaction between CFR and IMAT, not BMI, such that patients with both CMD and fatty muscle demonstrated highest MACE risk (adjusted p=0.02).

Conclusion:Increased intermuscular fat is associated with CMD and adverse cardiovascular outcomes independently of BMI and conventional risk factors. The presence of CMD and skeletal muscle fat infiltration identified a novel at-risk cardiometabolic phenotype.
How does ChatGPT4 preform on Non-English National Medical Licensing Examination? An Evaluation in Chinese Language
Authors: Fang Changchang , Ling Jitao , Zhou Jing , Wang Yue , Liu Xiaolin , Jiang Yuan , Wu Yifan , Chen Yixuan , Zhu Zhichen , Ma Jianyong , Yan Ziwei , Yu Peng , Liu Xiao
Published: May 2023

Background

ChatGPT, an artificial intelligence (AI) system powered by large-scale language models, has garnered significant interest in the healthcare. Its performance dependent on the quality and amount of training data available for specific language. This study aims to assess the of ChatGPT’s ability in medical education and clinical decision-making within the Chinese context.

Methods

We utilized a dataset from the Chinese National Medical Licensing Examination (NMLE) to assess ChatGPT-4’s proficiency in medical knowledge within the Chinese language. Performance indicators, including score, accuracy, and concordance (confirmation of answers through explanation), were employed to evaluate ChatGPT’s effectiveness in both original and encoded medical questions. Additionally, we translated the original Chinese questions into English to explore potential avenues for improvement.

Results

ChatGPT scored 442/600 for original questions in Chinese, surpassing the passing threshold of 360/600. However, ChatGPT demonstrated reduced accuracy in addressing open-ended questions, with an overall accuracy rate of 47.7%. Despite this, ChatGPT displayed commendable consistency, achieving a 75% concordance rate across all case analysis questions. Moreover, translating Chinese case analysis questions into English yielded only marginal improvements in ChatGPT’s performance (P =0.728).

Conclusion

ChatGPT exhibits remarkable precision and reliability when handling the NMLE in Chinese language. Translation of NMLE questions from Chinese to English does not yield an improvement in ChatGPT’s performance.