bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of county-level socioeconomic status with meningioma incidence and outcomes
Authors: Pugazenthi Sangami , Price Mackenzie , De La Vega Gomar Rodrigo , Kruchko Carol , Waite Kristin A , Barnholtz-Sloan Jill S , Walsh Kyle M , Kim Albert H , Ostrom Quinn T
Published: December 2023

Background

Prior literature suggests that individual socioeconomic status (SES) may influence incidence, treatments, and survival of brain tumor cases. We aim to conduct the first national study to evaluate the association between US county-level SES and incidence, treatment, and survival in meningioma.

Methods

The Central Brain Tumor Registry of the United States analytic dataset, which combines data from CDC’s National Program of Cancer Registries (NPCR) and National Cancer Institute's Surveillance, Epidemiology, and End Results Program, was used to identify meningioma cases from 2006 to 2019. SES quintiles were created using American Community Survey data. Logistic regression models were used to evaluate associations between SES and meningioma. Cox proportional hazard models were constructed to assess the effect of SES on survival using the NPCR analytic dataset.

Results

A total of 409 681 meningioma cases were identified. Meningioma incidence increased with higher county-level SES with Q5 (highest quintile) having a 12% higher incidence than Q1 (incidence rate ratios (IRR) = 1.12, 95%CI: 1.10–1.14; P < .0001). The Hispanic group was the only racial–ethnic group that had lower SES associated with increased meningioma incidence (Q5: age-adjusted incidence ratio (AAIR) = 9.02, 95%CI: 8.87–9.17 vs. Q1: AAIR = 9.33, 95%CI: 9.08–9.59; IRR = 0.97, 95%CI: 0.94–1.00; P = .0409). Increased likelihood of surgical treatment was associated with Asian or Pacific Islander non-Hispanic individuals (compared to White non-Hispanic (WNH)) (OR = 1.28, 95%CI: 1.23–1.33, P < .001) and males (OR = 1.31, 95%CI: 1.29–1.33, P < .001). Black non-Hispanic individuals (OR = 0.90, 95%CI: 0.88–0.92, P < .001) and those residing in metropolitan areas (OR = 0.96, 95%CI: 0.96–0.96, P < .001) were less likely to receive surgical treatment compared to WNH individuals. Overall median survival was 137 months, and survival was higher in higher SES counties (Q5 median survival = 142 months).

Conclusions

Higher county-level SES was associated with increased meningioma incidence, surgical treatment, and overall survival. Racial–ethnic stratification identified potential disparities within the meningioma population. Further work is needed to understand the underpinnings of socioeconomic and racial disparities for meningioma patients.
Menopause in the workplace; what’s everyone getting in a sweat about
Authors: Fitzgerald Louise
Published: December 2023

Menopause is associated with turbulent hormonal symptoms and this can be reflected in the workplace, negatively impacting work performance, attendance and career decisions. There has been a growing recognition among employers of the need to address menopause as an occupational health concern, particularly with an increased interest in the media and reported tribunal claims.
Least-squares analysis of the moments of the charge distribution in the mean-field models
Authors: Suzuki Toshio
Published: December 2023

The nth moment, $R^{(n)}_c$, of the charge distribution is composed of not only the m(≤ n)th moments, $R^{(m)}_p$, of the point proton distribution, but also the m(≤ (n − 2))th ones, $R^{(m)}_n$, of the point neutron distribution. The experimental value of $R^{(n)}_c(R^{(n)}_{c,{\rm exp}})$ observed through electromagnetic interaction makes it possible to investigate the point proton and neutron distributions together on the same basis. In order to estimate $R^{(m)}_\tau (\tau =p,n)$ from $R^{(n)}_{c,{\rm exp}}$, however, nuclear models are required. The structure of the least-squares analysis (LSA) between $R^{(n)}_c$ and $R^{(m)}_\tau$ is investigated within the mean-field framework. The LSA reveals constraints inherent in the model framework through the least-squares lines (LSL) and determines the value of $R^{(m)}_\tau$ of $R^{(n)}_{c,{\rm exp}}$ uniquely as a result of the sum rule with respect to the coefficients of the LSL equations. The n-dependence of the values of $R^{(m)}_\tau$ in the LSA is examined numerically by using the moments calculated up to n = 6 for 40Ca, 48Ca, and 208Pb.
Cancer Stem Cells as a Therapeutic Target: Current Clinical Development and Future Prospective
Authors: Philchenkov Alex , Dubrovska Anna
Published: December 2023

The key role of cancer stem cells (CSCs) in tumor development and therapy resistance makes them essential biomarkers and therapeutic targets. Numerous agents targeting CSCs, either as monotherapy or as part of combination therapy, are currently being tested in clinical trials to treat solid tumors and hematologic malignancies. Data from ongoing and future clinical trials testing novel approaches to target tumor stemness-related biomarkers and pathways may pave the way for further clinical development of CSC-targeted treatments and CSC-guided selection of therapeutic regimens. In this concise review, we discuss recent progress in developing CSC-directed treatment approaches, focusing on clinical trials testing CSC-directed therapies. We also consider the further development of CSC-assay-guided patient stratification and treatment personalization.
Lack of controlled studies on snakebite prevention: a rapid review
Authors: Rodrigo Chaturaka , Gnanathasan Ariaranee
Published: December 2023

Globally, snakebites cause an estimated 80 000–140 000 deaths annually. While there are evidence-based recommendations for managing snakebite victims, recommendations on the prevention of snakebites are limited to expert opinions. We conducted a rapid review to summarise evidence from human studies with a control group on preventing snakebites. Searching PubMed, Web of Science, Scopus, CINAHL and EMBASE with inclusive search terms without language or time limits only yielded three eligible studies (one case control study and two prospective controlled clinical studies), highlighting a knowledge gap. Two studies in Nepal by the same group showed that health education of stakeholders and sleeping under a bednet can significantly reduce snakebite incidence (p<0.05), but these observations are not confirmed elsewhere, and because of the high risk of bias the certainty of evidence was low. The third study from Sri Lanka, which assessed if sleeping above ground would prevent snakebites, had inconclusive results. This demonstrates an urgent need for studies with a control group to guide evidence-based recommendations for snakebite prevention. Potential interventions tested can range from low-cost measures such as wearing appropriate footwear in resource-limited settings to testing the efficacy of chemical, biological (e.g. rodent control) or device-based methods and community-supported platforms tracking snakebite sightings with real-time geolocation data in highly resourced settings.
The Novel Use of Magtrace in Chest Masculinizing Transgender Top Surgery
Authors: Bryan Jaimie L. , Spiguel Lisa R. , Herremans Kelly M. , Han Sabrina H. , McKean Jordan A. , Sorice-Virk Sarah
Published: December 2023

Chest masculinization is the most common surgery performed in transgender men, and although incidence of occult cancer is lower than in cis-gender women receiving mastectomy or reduction mammoplasties, the incidence of high-risk lesions is comparable. In patients with concerns for occult malignancy, Magtrace is a nonradioactive tracer available to assist management for its delayed sentinel lymph node mapping capabilities. We present the first case report using Magtrace before masculinizing mastectomies in a transgender man.
Portable hypothermic oxygenated machine perfusion for organ preservation in liver transplantation: A randomized, open-label, clinical trial
Authors: Panayotova Guergana G. , Lunsford Keri E. , Quillin R. Cutler , Rana Abbas , Agopian Vatche G. , Lee-Riddle Grace S. , Markovic Daniela , Paterno Flavio , Griesemer Adam D. , Amin Arpit , Alonso Diane , Rocca Juan P. , Borja-Cacho Daniel , Hernandez-Alejandro Roberto , Fung John J. , Pelletier Shawn J. , Shah Shimul A. , Guarrera James V.
Published: December 2023

Background and Aims:

In liver transplantation, cold preservation induces ischemia, resulting in significant reperfusion injury. Hypothermic oxygenated machine perfusion (HMP-O2) has shown benefits compared to static cold storage (SCS) by limiting ischemia-reperfusion injury. This study reports outcomes using a novel portable HMP-O2 device in the first US randomized control trial.

Approach and Results:

The PILOT trial (NCT03484455) was a multicenter, randomized, open-label, noninferiority trial, with participants randomized to HMP-O2 or SCS. HMP-O2 livers were preserved using the Lifeport Liver Transporter and Vasosol perfusion solution. The primary outcome was early allograft dysfunction. Noninferiority margin was 7.5%. From April 3, 2019, to July 12, 2022, 179 patients were randomized to HMP-O2 (n=90) or SCS (n=89). The per-protocol cohort included 63 HMP-O2 and 73 SCS. Early allograft dysfunction occurred in 11.1% HMP-O2 (N=7) and 16.4% SCS (N=12). The risk difference between HMP-O2 and SCS was −5.33% (one-sided 95% upper confidence limit of 5.81%), establishing noninferiority. The risk of graft failure as predicted by Liver Graft Assessment Following Transplant score at seven days (L-GrAFT7) was lower with HMP-O2 [median (IQR) 3.4% (2.4–6.5) vs. 4.5% (2.9–9.4), p=0.024]. Primary nonfunction occurred in 2.2% of all SCS (n=3, p=0.10). Biliary strictures occurred in 16.4% SCS (n=12) and 6.3% (n=4) HMP-O2 (p=0.18). Nonanastomotic biliary strictures occurred only in SCS (n=4).

Conclusions:

HMP-O2 demonstrates safety and noninferior efficacy for liver graft preservation in comparison to SCS. Early allograft failure by L-GrAFT7 was lower in HMP-O2, suggesting improved early clinical function. Recipients of HMP-O2 livers also demonstrated a lower incidence of primary nonfunction and biliary strictures, although this difference did not reach significance.
The association of time-updated ambulatory blood pressure and renal progression in hypertensive patients with chronic kidney disease: post hoc analysis of ACCURATE study
Authors: Kim Yunmi , Kim Jayoun , Kang Eunjeong , Im Dha Woon , Kim Taehee , Huh Hyuk , Kim Yeong Hoon , Lee Hyanglim , Kim Ji Hye , Oh Kook-Hwan
Published: December 2023

Objectives

: This study aimed to evaluate the effect of time-updated ambulatory blood pressure on chronic kidney disease (CKD) progression in patients with hypertension.

Methods

: Among patients with hypertension and CKD stages 3 and 4, enrolled in a clinical trial in which hypertension was treated based on office or ambulatory blood pressure (BP), participants assigned to the ambulatory BP were included in this study. Ambulatory BP was measured at the start of the study and 3, 6, and 18 months. Renal events were defined as a decrease in the estimated glomerular filtration rate (eGFR) by at least 30%, dialysis, or transplantation.

Results

: A total of 21 cases of renal events were observed. For baseline BP, a multivariate Cox model revealed that neither office SBP nor any component of ambulatory SBP, including mean, day-time, night-time BPs was associated with the risk of renal events. For time-updated BP, a marginal structural model revealed that the office SBP was not associated with renal events [hazard ratio 1.03, 95% confidence interval (CI) 0.99–1.07, P = 0.117], but higher ambulatory SBPs, including day-time (hazard ratio 1.05, 95% CI 1.01–1.10, P = 0.014), night-time (hazard ratio 1.05, 95% CI 1.02–1.08, P = 0.001), and mean (hazard ratio 1.06, 95% CI 1.02–1.10, P = 0.002) ambulatory SBPs, were significantly associated with an increased risk of renal events.

Conclusion

: A higher time-updated ambulatory BP was associated with an increased risk of renal events in patients with hypertension and CKD, whereas baseline office and ambulatory BP, and time-updated office BP were not.
Hypertension in the first blood pressure reading and the risk of cardiovascular disease mortality in the general population: findings from the prospective KORA study
Authors: Atasoy Seryan , Henningsen Peter , Johar Hamimatunnisa , Middeke Martin , Sattel Heribert , Linkohr Birgit , Rückert-Eheberg Ina-Maria , Heier Margit , Peters Annette , Ladwig Karl-Heinz
Published: December 2023

Background:

The risk of cardiovascular disease (CVD) mortality in individuals with an alerting reaction, assessed by hypertension in the first blood pressure (BP) reading but normal BP in further readings, remains unknown in the general population.

Methods and Results:

In a sample of 11 146 adults (51.5% men and 48.5% women) with a mean age of 47.1 years (SD ± 12.3) from a German population-based cohort, we analyzed risk factors and CVD mortality risk associated with an alerting reaction. An alerting reaction was prevalent in 10.2% of the population and associated with sociodemographic, lifestyle, and somatic CVD risk factors. Within a mean follow-up period of 22.7 years (SD ± 7.05 years; max: 32 years; 253 201 person years), 1420 (12.7%) CVD mortality cases were observed. The CVD mortality rate associated with an alerting reaction was significantly higher than in normotension (64 vs. 32 cases/10 000 person-years), but lower than hypertension (118 cases/10 000 person-years). Correspondingly, the alerting reaction was associated with a 23% higher hazard ratio of CVD mortality than normal blood pressure [hazard ratio 1.23 (95% confidence interval 1.02–1.49), P = 0.04]. However, adjustment for antihypertensive medication use attenuated this association [1.19 (0.99–1.44), P = 0.06].

Conclusion:

The results may warrant monitoring of an alerting reaction as a preventive measure of CVD mortality in untreated individuals with elevated first BP readings, as well as optimized treatment in treated individuals.
Early vascular damage in retinal microcirculation in arterial hypertension: the Czech post-MONICA study
Authors: Cífková Renata , Harazny Joanna M. , Bruthans Jan , Wohlfahrt Peter , Krajčoviechová Alena Hrubeš , Lánská Věra , Gelžinský Július , Mateřánková Markéta , Mareš Štěpán , Filipovský Jan , Mayer Otto , Schmieder Roland E.
Published: December 2023

Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.

Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals.

Design and method:

A total of 398 randomly selected individuals from an urban population aged 25–65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals (n = 213), treated controlled hypertensive individuals (n = 30), treated uncontrolled hypertensive individuals (n = 26), and newly detected/untreated hypertensive individuals (n = 73).

Results:

There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals.

Conclusion:

Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.
Chronic kidney disease prevalence in asymptomatic patients with risk factors—usefulness of serum cystatin C: a cross-sectional study
Authors: Avila Mariela N. , Luciardi María C. , Oldano Ana V. , Aleman Mariano N. , Pérez Aguilar Rossana C.
Published: December 2023

Background:

Chronic kidney disease is recognized as a worldwide public health problem, particularly within an increasing prevalence of obesity, diabetes mellitus, and hypertension. This disease affects more than 13% of the world's population and is increasing. Further biochemical assessment with new biomarkers, such as serum cystatin C (CysC), would improve patient care and disease control. The aim of this study was to detect chronic kidney disease (CKD) in asymptomatic subjects with risk factors and evaluate CysC as early biomarker of renal damage and accurate test to estimation glomerular filtration (GF).

Methods:

This observational analytic and cross-sectional design included 195 patients of both sexes. A full clinical evaluation included height, weight, waist circumference, body mass index (BMI), blood pressure (BP), and family history of disease. Renal function was evaluated through serum creatinine (SCrea), serum CysC, urinary albumin, and urinary creatinine. GF was calculated using CKD-EPI creatinine (CKD-EPI Crea) and CKD-EPI creatinine-cystatin C equations (CKD-EPI Crea-CysC).

Results:

Renal injury showed 24% of patients with albuminuria; 18% of them were categorized as A2 and 6% as A3. Therefore, 73% had no progression risk (baseline risk), 20% moderate risk, and 7% high risk. Among analyzed groups, significant differences were found in BMI, BP, Screa, CysC, CKD-EPI Crea, and CKD-EPI Crea-CysC. Overweight population was analyzed by assessing CysC and calculating CKD-EPI Crea-CysC, showing an important change with respect to the general population.

Conclusion:

Combined CysC and Crea measurement provides incremental improvement in predicting measured GF.
Occurrence and predictors of delirium in critically ill older patients: a prospective cohort study
Authors: Martins Rita , Martins Sónia , Correia Raquel , Pinho Elika , Paulo Cristiana , Silva Maria João , Teixeira Ana , Fontes Liliana , Lopes Luís , Paiva José Artur , Azevedo Luís Filipe , Fernandes Lia
Published: December 2023

Objectives:

This study aims to analyze the occurrence of delirium in critically ill older patients and to identify predictors of delirium.

Methods:

This prospective study included critically ill older patients admitted into level II units of Intensive Care Medicine Department of a University Hospital. Patients with Glasgow Coma Scale score ≤11, traumatic brain injury, terminal disease, history of psychosis, blindness/deafness, or inability to understanding/speaking Portuguese were excluded. The Confusion Assessment Method-Short Form (CAM-4) was used to assess the presence of delirium.

Results:

The final sample (n = 105) had a median age of 80 years, most being female (56.2%), widowed (49.5%), and with complete primary education (53%). Through CAM-4, 36.2% of the patients had delirium. The delirium group was more likely to have previous cognitive decline (48.6% vs 19.6%, P = .04) and severe dependency in instrumental activities of daily living (34.3% vs 14.8%, P = .032), comparing with patients without delirium. The final multiple logistic regression model explained that patients with previous cognitive decline presented a higher risk for delirium (odds ratio: 4.663, 95% confidence Interval: 1.055–20.599, P = .042).

Conclusions:

These findings corroborate previous studies, showing that cognitive decline is an independent predictor for delirium in older patients. This study is an important contribution for the knowledge regarding the predictors of delirium. The recognition of these factors will help to identify patients who are at high risk for this syndrome and implement early screening and prevention strategies. However, further studies with larger samples, recruited from other clinical settings as well as analyzing other potential factors for delirium, will be needed.
Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review
Authors: Patel Parth S. , Akshintala Venkata S.
Published: December 2023

Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regard to both indications for its use and improvements in technique. The most common complication is post-ERCP pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multifactorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections, and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal non-steroidal anti-inflammatory drugs (NSAIDs), aggressive intravenous (IV) fluid hydration, and pancreatic duct stents. Appropriate patient selection and the use of noninvasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related, and combination strategies for prevention and will be important as the use of ERCP continues to grow.
Endoscopic evacuation of chronic subdural hematoma with rigid and flexible endoscope: case report
Authors: Mokbul Mobin Ibne , Ghimire Sagun , Rana Md. Sumon , Bhuiyan Md. Sazzad Hossain , Islam Md. Shafiqul
Published: December 2023

Introduction:

Subdural haematoma (SDH) is a common neurosurgical condition after head trauma requiring evacuation to prevent secondary brain injury. The first choice of management in these patients is a large craniotomy or burr-hole evacuation. However, sometimes due to lack vision during drain tube insertion or irrigation the authors might land up in a complication like cortical bridging vein rupture, haemorrhage etc. Also, the management of septate chronic SDH (CSDH) with multiple neo-membranes does not have a well-defined surgical approach. Recently, endoscopic evacuation has been reported to a be a feasible method for evacuation in acute, subacute and chronic SDH patients.

Presentation of case:

A 65-years-old male patient presented with a history of recent head injury and symptoms of headache and urinary incontinence of 7 days (Glasgow Coma Scale Score 15/15). Computed tomography scan revealed CSDH at both fronto-parietal convexity more on right side.

Discussion:

The authors reported our initial experience on a typical case of an older patient with chronic subdural haematoma and its evacuation with the assistance of both rigid and flexible endoscope. The authors could visualize cortical bridging veins and neo-membranes intraoperatively and guided our drainage tube accordingly to avoid inadvertent haemorrhage. There was no recurrence of symptoms postoperatively. Thus we achieved apparent successful evacuation of the CSDH in this patient in a 6-month follow-up.

Conclusion:

Endoscopic evacuation of CSDH proves to be an effective minimally invasive modality and more studies are required on larger patient groups with long-term follow-up imaging to confirm its superiority.
Preservation versus dissection of the intercostobrachial nerve for breast cancer surgeries: a systematic review and meta-analysis
Authors: Al-dardery Nada M. , Khaity Abdulrhman M. , Albakri Khaled A. , Abdelsattar Ahmed T. , Benmelouka Amira Y. , Lee Theodore , Foppiani Jose A. , Lin Samuel J.
Published: December 2023

Introduction:

This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery.

Methods:

The authors searched Web of Science, PubMed, Cochrane CENTRAL, and Scopus from inception until March 2023. Records were screened for eligible studies, and all relevant outcomes were pooled as an odds ratio (OR) with the corresponding 95% CI in the meta-analysis models using RevMan version 5.4.

Results:

These results from 11 studies (1021 patients) favored preservation of the ICBN over its dissection in terms of anaesthesia and hypaesthesia [OR 0.50, (95% CI, 0.31–0.82); P = 0.006] and [OR 0.33, (95% CI, 0.16–0.68); P = 0.003], respectively. Whereas the overall effect favored ICBN dissection over preservation in the case of hyperaesthesia [OR 4.34, (95% CI, 1.43–13.15); P = 0.01]. Conversely, no significant variance was detected between the two groups in terms of pain [OR 0.68, (95% CI, 0.28–1.61) P = 0.38], paraesthesia [OR 0.88, (95% CI, 0.49–1.60); P = 0.68], and analgesia [OR 1.46, (95% CI, 0.05–45.69); P = 0.83].

Conclusion:

This meta-analysis revealed that the preservation of the ICBN has a significant effect on the disturbance of sensory parameters of hypaesthesia and anaesthesia when compared to its dissection. Further studies with larger sample sizes are recommended to precisely compare both techniques on a wider range of parameters.
Emotional Dysregulation and Temperament-Character Traits in Adolescents With Functional Neurological Symptom Disorder (Conversion Disorder)
Authors: Ucuz Ilknur , Uzun Cicek Ayla , Komurcu Celik Merve , Akan Mustafa , Kesriklioglu Esma , Gungor Serdal , Ozel Ozcan Ozlem
Published: December 2023

The purpose of this study was to evaluate emotion dysregulation and temperament-character traits in adolescents with functional neurological symptom disorder (FNSD). Forty adolescents with FNSD and 40 healthy adolescents were evaluated by a semiconstructed diagnosis interview, Temperament and Character Inventory (TCI), Difficulties in Emotion Regulation Scale (DERS), Regulation of Emotions Questionnaire (REQ), and Children's Somatization Inventory-24 (CSI-24). The external and internal dysfunctional emotion regulation scores of REQ, all subscales of DERS, except the awareness subscale, and CSI-24 scores were significantly higher in FNSD patients compared with healthy controls. There were significant differences between the groups in terms of harm avoidance and reward dependence subscale scores of TCI. Multiple logistic regression analysis showed that the external dysfunctional emotion regulation strategy, somatization, and reward dependence are significant predictors of FNSD. Our results provide evidence that adolescents with FNSD experience emotional dysregulation and that the differential value of some temperament-character traits in the diagnosis of FNSD.
Neurologic Outcomes and Quality of Life in Children After Extracorporeal Membrane Oxygenation
Authors: Michel Alizée , Vedrenne-Cloquet Meryl , Kossorotoff Manoëlle , Thy Michaël , Levy Raphaël , Pouletty Marie , De Marcellus Charles , Grimaud Marion , Moulin Florence , Hully Marie , Simonnet Hina , Desguerre Isabelle , Renolleau Sylvain , Oualha Mehdi , Chareyre Judith
Published: December 2023

RATIONALE:

Use of life support with extracorporeal membrane oxygenation (ECMO) is associated with brain injury. However, the consequences of these injuries on subsequent neurologic development and health-related quality of life (HRQoL) are poorly described in children.

OBJECTIVES:

The aim of this preliminary study was to describe short- and long-term neurologic outcomes in survivors of ECMO, as well as their HRQoL.

DESIGN:

Retrospective identified cohort with contemporary evaluations.

SETTING:

Necker Children’s Hospital academic PICU.

PATIENTS:

Forty survivors who underwent ECMO (October 2014 to January 2020) were included in follow-up assessments in May 2021.

INTERVENTIONS:

None.

MEASUREMENT AND MAIN RESULTS:

We first reviewed the outcomes of ECMO at the time of PICU discharge, which included a summary of neurology, radiology, and Pediatric Overall/Cerebral Performance Category (POPC/PCPC) scores. Then, in May 2021, we interviewed parents and patients to assess HRQoL (Pediatric Quality of Life Inventory [PedsQL]) and POPC/PCPC for children 3 years old or older, and Denver II test (DTII) for younger children. An evaluation of DTII in the youngest patients 1 year after ECMO decannulation was also added. Median age at ECMO was 1.4 years (interquartile range [IQR], 0.4–6 yr). Thirty-five children (88%) underwent a venoarterial ECMO. At PICU discharge, 15 of 40 patients (38%) had neurologic impairment. Assessment of HRQoL was carried out at median of 1.6 years (IQR, 0.7–3.3 yr) after PICU discharge. PedsQL scores were over 70 of 100 for all patients (healthy peers mean results: 80/100), and scores were like those published in patients suffering with chronic diseases. In May 2021, seven of 15 patients had a normal DTII, and 36 of 40 patients had a POPC/PCPC score less than or equal to 3.

CONCLUSIONS:

None of our patients presented severe disability at long term, and HRQoL evaluation was reassuring. Considering the risk of neurologic impairment after ECMO support, a systematic follow-up of these high-risk survivor patients would be advisable.
Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States*
Authors: McCrory Michael C. , Akande Manzilat , Slain Katherine N. , Kennedy Curtis E. , Winter Meredith C. , Stottlemyre Morgan G. , Wakeham Martin K. , Barnack Kyle A. , Huang Jia Xin , Sharma Meesha , Zurca Adrian D. , Pinto Neethi P. , Dziorny Adam C. , Maddux Aline B. , Garg Anjali , Woodruff Alan G. , Hartman Mary E. , Timmons Otwell D. , Heidersbach R. Scott , Cisco Michael J. , Sochet Anthony A. , Wells Brian J. , Halvorson Elizabeth E. , Saha Amit K. ,   for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Social Determinants of Health Subgroup
Published: December 2023

OBJECTIVES:

To evaluate for associations between a child’s neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS).

DESIGN:

Retrospective cohort study.

SETTING:

Fifteen PICUs in the United States.

PATIENTS:

Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2–19.5%,p< 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) (p< 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) (p= 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94–1.79;p= 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993–1.00;p= 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46–5.20;p< 0.0001) as compared with those with commercial insurance.

CONCLUSIONS:

Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.
Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020–2021*
Authors: Stevens Paige E. , Rassbach Caroline E. , Qin FeiFei , Kuo Kevin W.
Published: December 2023

OBJECTIVES:

To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care.

DESIGN:

Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties.

SETTING:

Online survey open from April to May 2021.

SUBJECTS:

A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We assessed fellows’ survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history (p < 0.001) and increased knowledge of spiritual practices that could influence medical care (p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history (p < 0.001) and comfort in referring families to spiritual care resources (p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care.

CONCLUSIONS:

Providing spiritual care for families is important in critical care settings. In 2020–2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.
Investigation of the validity and reliability of the 3-meter backward walk test in high functional level adults with lower limb amputation
Authors: Yıldırım Şahan Tezel , Aydoğan Arslan Saniye , Söyler Osman
Published: December 2023

Background:

Backward walk training has an important place in the rehabilitation programs of lower extremity amputees.

Objective:

This study aimed to investigate the test-retest validity and reliability of the 3-meter backward walk test (3MBWT), minimal detectable change, and the cutoff time in high functional level adults with lower limb amputations (LLAs). Adults with LLA (n = 30) and healthy adults (n = 29) were included in the study.

Study design:

This is a randomized cross-sectional study.

Methods:

The Modified Fall Efficacy Score, Rivermead Mobility Index, and Timed Up and Go test with the 3MBWT were used to evaluate the concurrent validity of the test. The second evaluation (retest) was performed by the same physiotherapist 1 week following the first evaluation (test). The validity was assessed by correlating the 3MBWT times with the scores of other measures and by comparing the 3MBWT times between adults with LLA and healthy adults.

Results:

Test-retest reliability of the 3MBWT was excellent. The intraclass correlation coefficient for the 3MBWT was 0.950. The standard error of measurement and minimal detectable change values were 0.38 and 0.53, respectively. A moderate correlation was found between the 3MBWT, Modified Fall Efficacy Score, Timed Up and Go test, and Rivermead Mobility Index (p < 0.001). Significant differences in the 3MBWT times were found between adults with LLA and healthy controls (p < 0.001). The cutoff time of 3.11 s discriminates healthy adults from high functional level adults with LLA.

Conclusions:

The 3MBWT was determined to be valid, reliable, and easy-to-apply tool in high functional level adults with LLA. This assessment is a useful and practical measurement for dynamic balance in high functional level adults with LLA.
Intestinal Autotransplantation for Locally Advanced or Locally Recurrent Colon Cancer Invading Superior Mesenteric Artery
Authors: Wu Guosheng , Zhao Long , Jiang Weiqin , Liu Chaoxu , Zhou Xile , Zhang Wentong , Wang Jinhai , Liang Tingbo
Published: December 2023

Objective:

To examine the outcomes of intestinal autotransplantation (IATx) in patients with locally advanced (LACC) or locally recurrent (LRCC) colon cancer invading the superior mesenteric artery (SMA).

Background:

SMA involvement in LACC or LRCC is deemed unresectable and is associated with a poor prognosis. Combined extended resections of multiple organs together with SMA, followed by IATx may offer favorable clinical outcomes. However, data on its safety and efficacy are scarce.

Methods:

This retrospective cohort study included patients undergoing IATx between May 2018 and December 2022 in intestinal transplant programs at 2 university-affiliated hospitals in China. Patients with LACC or LRCC concomitantly with SMA contact of more than 180 degrees were included. Patients with a locoregional peritoneal, pelvic, or distal metastasis were excluded.

Results:

Ten patients underwent either IATx combined with pancreaticoduodenectomy (n = 8) or IATx alone (n = 2). Eight patients (80%) were males, and the median age was 55 years (range, 32–71 years). The Kaplan-Meier estimates for recurrence-free survival and overall survival at 3 years after IATx were 68% and 80%, respectively. No perioperative deaths occurred. All 10 patients experienced postoperative complications, including Clavien-Dindo grade I (n = 1), grade II (n = 4), grade IIIa (n = 1), grade IIIb (n = 3), and grade IVa (n = 1), which comprised acute venous thromboses, upper gastrointestinal hemorrhage, anastomotic leak, gastropareses, and significant pleural effusions. With an average follow-up of 23.9 months, 8 patients (80%) were currently alive without evidence of disease.

Conclusion:

Extended resection for LACC or LRCC invading SMA can be performed safely and is associated with prolonged survival.
A Novel Method for Thoracoscopic Overlap Esophagogastric Reconstruction With Pleural Closure following Minimally Invasive Ivor-Lewis Esophagectomy for Esophagogastric Junction Cancer
Authors: Sano Akihiko , Sohda Makoto , Hosoi Nobuhiro , Tateno Kohei , Watanabe Takayoshi , Nakazawa Nobuhiro , Shioi Ikuma , Shibasaki Yuta , Okada Takuhisa , Osone Katsuya , Shiraishi Takuya , Sakai Makoto , Ogawa Hiroomi , Okabe Hiroshi , Shirabe Ken , Saeki Hiroshi
Published: December 2023

Background:

Intrathoracic esophagogastric anastomosis following minimally invasive Ivor-Lewis esophagectomy is a technically demanding surgical technique that can result in serious intrathoracic infections when anastomotic leakage occurs. Herein, we report a novel side-overlap esophagogastric anastomosis with pleural closure for esophagogastric junction cancer.

Methods:

The 3 key points of our novel technique were the following: (1) overlap esophagogastric anastomosis and closure of the entry hole were all performed using a linear stapler; (2) the pleura was closed to separate the anastomotic site from the thoracic cavity; and (3) the mediastinal drain was inserted transhiatally from the abdominal cavity.

Results:

This modified anastomosis procedure was performed on 8 consecutive patients at our institution. The median overall/thoracoscopic operating time and estimated blood loss were 652.5/241.5 min and 89 mL, respectively. No mortality or serious postoperative complications occurred, and the median postoperative hospital stay was 22 days (range, 17 to 37 d).

Conclusion:

This novel thoracoscopic overlap esophagogastric reconstruction procedure with pleural closure is safe and feasible.
Risk Factors of Acute Pain in Elderly Patients After Laparoscopic Radical Resection of Colorectal Cancer
Authors: Zhu Qian-qian , Qu Li , Su Tao , Zhao Xuan , Ma Xue-ping , Chen Zhe , Fu Juan , Xu Gui-ping
Published: December 2023

Objective:

To investigate the risk factors of acute pain after laparoscopic radical resection of colorectal cancer (CRC) in elderly patients.

Methods:

Totally, 143 elderly patients (≥ 60 y old) who received laparoscopic radical resection of CRC in the People’s Hospital of Xinjiang Uygur Autonomous Region from March 2021 to August 2022 were retrospectively analyzed. The patients were divided into 2 groups according to visual analog scale (VAS) scores 24 h after surgery: mild pain group (VAS score ≤ 3, n=108) and moderate to severe pain group (VAS score >3, n=35). The data of the patients, including sex, age, height, body mass, intraoperative blood loss, intraoperative urine volume, intraoperative opioid dosage, operation duration, preoperative Hospital Anxiety and Depression Scale (HADS) scores, preoperative Mini-Mental State Examination scores, VAS scores, postoperative nausea and vomiting scores were recorded. Multivariate logistic regression analysis was used to screen the risk factors of postoperative acute pain in elderly patients undergoing laparoscopic radical resection of CRC.

Results:

The preoperative HADS score of the moderate to severe pain group was significantly increased compared with that of the mild pain group (10.8±2.4 vs. 6.2±1.9), as well as the operation duration (226.4±18.3 vs. 186.1±12.7), the intraoperative dosage of remifentanil (3.7±0.2 vs. 3.2±0.4), the preoperative VAS score [4(2, 7) vs. 2 (0, 4)] and postoperative VAS score [5 (4, 6) vs. 3 (2, 3)] (P<0.05). Multivariate logistic regression analysis showed that high preoperative HADS score, long operation duration, and high preoperative VAS score (P<0.05) were independent risk factors for acute pain after laparoscopic radical resection of CRC in elderly patients.

Conclusion:

Preoperative anxiety and depression, preoperative pain, and long operation duration are risk factors for acute pain in elderly patients after laparoscopic radical resection of CRC.
Head Turn During Visual Field Testing to Minimize the Influence of Prominent Facial Anatomy
Authors: Sadegh Mousavi Seyedmostafa , Jamali Dogahe Sepideh , Lyons Lance J. , Khanna Cheryl L.
Published: December 2023

Background:

Facial contour naturally decreases the visual field. Peripheral visual field defects caused by facial anatomy and ocular pathology can be missed in a routine standard of care. Mathematically calculating the true angle for turning the head to optimize the peripheral visual field has not been studied to date. The purpose of this study was to explore the utility of turning the head during perimetry to maximize the testable visual field.

Methods:

Six healthy study participants aged 18–52 were enrolled, prospectively; the dominant eye of each participant was tested. In total, 60-4 visual fields were obtained from each participant's dominant eye with the head in primary position. Then, the 60-4 tests were repeated with the head turned prescribed degrees toward and away from the tested eye (“manual method”). Based on a photograph of the participant's face, a convolutional neural network (CNN) was used to predict the optimal head turn angle for maximizing the field, and the test was repeated in this position (“automated method”).

Results:

Maximal visual field exposure was found at a head turn of 15° away from the tested eye using the manual method and was found at an average head turn of 12.6° using the automated method; maximum threshold values were similar between manual and automated methods. The mean of threshold in these subjects at the standard direction and the predicted optimum direction was 1,302, SD = 69.35, and 1,404, SD = 67.37, respectively (P = 0.02).

Conclusions:

Turning the head during perimetry maximizes the testable field area by minimizing the influence of prominent facial anatomy. In addition, our CNN can accurately predict each individual's optimal angle of head turn for maximizing the visual field.
Back in black: melanin-rich skin colour associated with increased net diversification rates in birds
Authors: Nicolaï Michaël P. J. , Vanisterbecq Raf , Shawkey Matthew D. , D'Alba Liliana
Published: December 2023

Evolutionary biologists have long been interested in understanding the factors that promote diversification in organisms, often focussing on distinct and/or conspicuous phenotypes with direct effects on natural or sexual selection such as body size and plumage coloration. However, multiple traits that potentially influence net diversification are not conspicuous and/or might be concealed. One such trait, the dark, melanin-rich skin concealed beneath the feathers, evolved more than 100 times during avian evolution, frequently in association with white feathers on the crown and UV-rich environments, suggesting that it is a UV-photoprotective adaptation. Furthermore, multiple species are polymorphic, having both light and dark skin potentially aiding occupation in different UV radiation environments. As such these polymorphisms are predicted to occur in species with large latitudinal variation in their distribution. Furthermore, by alleviating evolutionary constraints on feather colour, the evolution of dark skin may promote net diversification. Here, using an expanded dataset on bird skin coloration of 3033 species we found that more than 19% of species had dark skin. In contrast to our prediction, dark skinned birds have smaller distribution ranges. Furthermore, both dark skin and polymorphism in skin coloration promote net diversification. These results suggest that even concealed traits can influence large scale evolutionary events such as diversification in birds.
Single-cell genomics reveals new rozellid lineages and supports their sister relationship to Microsporidia
Authors: Thomé Pauline C. , Irisarri Iker , Wolinska Justyna , Monaghan Michael T. , Strassert Jürgen F. H.
Published: December 2023

The phylum Rozellomycota has been proposed for a group of early-branching holomycotan lineages representing obligate parasites and hyperparasites of zoosporic fungi, oomycotes or phytoplankton. Given their predominantly intracellular lifestyle, rozellids are typically known from environmental ribosomal DNA data, except for the well-studied
Rozella
species. To date, the phylogenetic relationship between rozellids and microsporidians (Microsporidia) is not fully understood and most reliable hypotheses are based on phylogenomic analyses that incorporate the only publicly available rozellid genome of
Rozella allomycis
. Here, we provide genomic data of three new rozellid lineages obtained by single-cell sequencing from environmental samples and show with a phylogenomic approach that rozellids form a monophyletic group that is sister to microsporidians, corroborating the previously proposed phylum Rozellomycota. Whereas no mitochondrial genes coding for the respiratory Complex I could be found, we discovered a gene coding for a nucleotide phosphate transporter in one of the three draft genomes. The scattered absence of Complex I genes and scattered presence of nucleotide transporter genes across diverse microsporidian and rozellid lineages suggest that these adaptations to a parasitic lifestyle, which reduce the parasite's capability to synthesize ATP but enables it to steal ATP from its host, evolved independently in microsporidians and rozellids.