bluuebunny/crossref_metadata_2025 huggingface dataset:
63 Utilization of vasopressin and norepinephrine in neonates with cardiorespiratory compromise: A multicenter retrospective cohort study in Canada
Authors: Abdulaziz Najlaa , Lalitha Renjini , Miller Michael , Mendham Kelly , Hébert Audrey , Ouellet Simon , Leclerc Marie-Eve , Kharrat Ashraf , Jain Amish , Deshpande Poorva , Bhattacharya Soume
Published: October 2024

Background

Data regarding neonatal clinical experience with Vasopressin (VA) and Norepinephrine (NE) are limited to small studies. The lack of large-scale studies with safety and efficacy data is preventing the widespread adoption of these agents.

Objectives

To describe epidemiological data on utilization of NE and VA in neonates including their indications, effectiveness and overall outcomes across 3 tertiary Neonatal Intensive Care Units (NICU) in Canada.

Design/Methods

This retrospective cohort study involved neonates who received NE or VA between January 1, 2015-December 31, 2020 at 3 tertiary NICUs. Data regarding demographic information, indications of use, dosing details, and clinical outcomes were described using mean, standard deviations (SD), frequencies and percentages. When appropriate, a comparative analysis was performed using Mann-Whitney U tests or the chi-square test as appropriate. Post-initiation changes in physiological variables and laboratory parameters over time were analyzed using repeated measure ANOVA.

Results

133 neonates (VA:70, NE:63) were included in this study. Baseline demographic features, clinical characteristics at initiation, indication of use, dosing details and clinical response in neonates exposed to both agents are summarized in Table 1. VA was commonly used for oxygenation failure due to persistent pulmonary hypertension of the newborn (PPHN), while NE was commonly used for hypotension due to septic shock. NE was frequently used as a 1st line inotropic agent, whereas VA was used more as an additive agent [30 (47.6%) vs 12 (18.6%); p=<0.001]. During treatment, lower sodium levels were recorded in the VA group vs the NE group [126.5 (8.6) vs 132 (7); p=.035], but other safety parameters were similar. The time to reach predefined stability parameters were similar in both groups. Significant improvement in physiological parameters were seen over time with both agents (Figure 1). Mortality within 7 days of use was high in the cohort, but comparable between VA and NE groups [18 (25.7%) vs 22 (34.9%), p=0.206]. Other neonatal morbidities were comparable between groups (Table 1).

Conclusion

This multicenter study provides pragmatic insights into the current use of NE and VA in neonates. Our study reports the effective use of each agent in distinct patient subgroups. This cohort represented neonates with high illness severity; however, exposure to either agent did not independently increase the risk of mortality or adverse outcomes. Further prospective studies exploring its optimal use and cardiopulmonary effects would be interesting.
81 mRNA COVID-19 vaccine safety among children and adolescents from the Canadian National Vaccine Safety Network
Authors: Vanderkooi Otto G , Bettinger Julie , Sadarangani Manish , Top Karina , Isenor Jennifer , Kellner James , Muller Matthew , McGeer Allison , Valiquette Louis , De Serres Gaston
Published: October 2024

Background

The Canadian National Vaccine Safety Network (CANVAS) expanded its active safety surveillance for COVID-19 vaccines among children and adolescents during the COVID-19 pandemic.

Objectives

This analysis aimed to determine whether the first or second dose of mRNA COVID-19 vaccination is associated with health events in children and adolescents.

Design/Methods

Adolescents 15-19 years of age or parents/guardians of children 5-14 years of age were recruited from seven Canadian provinces/territories and followed for the occurrence of health events seven days after doses 1 and 2 or for a seven-day period for unvaccinated participants. The primary outcome was a health event that prevented daily activities, resulted in school absenteeism, and/or required a medical consultation, including emergency department visits or hospitalization. Aged-stratified multivariable logistic regression examined health events associated with mRNA COVID-19 vaccines (BNT162b2, mRNA1273, and mixed [different products for doses 1 and 2]) for children aged 5 to 11 years and adolescents aged 12 to 19 years.

Results

Between January 2021 and February 2023, a total of 249,418 (Children BNT162b2: 205,744, mRNA-1273: 36, and Adolescent BNT162b2: 39,628, mRNA-1273: 4,010) completed the first dose survey and 128,599 (Children BNT162b2: 109,625, mRNA-1273: 3, mixed: 235, and Adolescent BNT162b2: 17,202, mRNA-1273: 1,155, mixed: 474) had completed the second dose survey. A total of 668 unvaccinated participants (Children 431 and Adolescent 237) completed the control survey. In the week following dose 1, health event rates among vaccinated children and adolescents were <4% and lower than in unvaccinated counterparts (6.9%), and neither BNT162b2 nor mRNA-1273 were associated with health events in either age group. Following dose 2, among vaccinated adolescents health events rates (BNT162b2 4.6%, mRNA-1273 8.5%, mixed 10.4%) were higher than unvaccinated adolescents (3.4%), but were self-limiting and resolved within 7 days. Among children, there was no difference in health event rates between vaccinated and unvaccinated groups.

Conclusion

For children, mRNA COVID-19 vaccines were not associated with health events preventing daily activities, resulting in school absenteeism and/or requiring medical consultation. Similar to vaccinated adults our findings found vaccinated adolescents reported higher rates of health events after dose 2 mRNA COVID-19 vaccines, but these were self-limiting and resolved quickly. Our findings can be used to inform adolescents and their parents of what to expect following COVID-19 vaccination.
82 Assessing the usage of and barriers to using language interpretation services in a Canadian tertiary paediatric center
Authors: Brochez Nicholas , Islam Bonnieca , Forbes Karen , Mian Qaasim
Published: October 2024

Background

Canada has one of the highest immigration rates worldwide per population with roughly 447,180 permanent residents welcomed in 2022. Limited-English proficiency (LEP) populations face barriers in accessing health care with implications including delayed presentation, misdiagnosis, poor compliance, decreased patient comprehension, and adverse events. Adequate health care provider training in using language interpretation services (LIS) is crucial to improve the quality of patient care and reduce miscommunication. There is a lack of research in this area in Canadian paediatric populations.

Objectives

To identify attitudes towards and usage of LIS among health care providers in a tertiary paediatric center, as well as levels of LIS training received.

Design/Methods

An online survey was developed and distributed to paediatric health care professionals including physicians, residents/fellows, nursing staff, and allied health providers. Survey completion was anonymous and voluntary; data collection occurred from October 2022–February 2023. Descriptive statistics were used for quantitative data and thematic analysis for free text responses.

Results

345 respondents accessed the survey and 281(81%) completed it. Multiple paediatric professions were surveyed with most responses stemming from nursing staff, residents and physicians, and other allied health. 52.8% of respondents encountered a paediatric patient and/or their caregivers with a language barrier in English once per week or more. LIS were used by 53.1% of respondents once per week or more. 51.5% of respondents reported no previous training in using LIS in patient care, and 3.6% reported previous formal training. 57.9% of respondents felt LIS training was very beneficial to their role and 53.7% reported this increased their LIS usage. Overall, in-person interpreters were perceived as the most effective LIS modality followed by video and telephone interpreters. Barriers to using LIS included: inability to access desired modality and/or language; insufficient time; and lack of comfort in effective usage.

Conclusion

It was evident respondents felt LIS was integral to patient care, especially with an increasingly diverse population. Multiple barriers to using LIS were identified with likely applicability to other Canadian paediatric facilities. Suggested improvements were themed around improving LIS accessibility, improving LIS education and awareness, and increasing access to rare languages. This study has important implications for LIS and paediatric care, including informing educational and advocacy initiatives, policy change, and LIS resource allocation.
The translation of transformative policy ambitions in funding research for climate change
Authors: Wicher Magdalena
Published: October 2024

This paper addresses how research and innovation (R&I) policy responds to global challenges, which demand fundamental transformations of societies and economies. The paper presents the case of a transnational, European funding call (SOLSTICE) for climate change research led by social sciences and humanities. Both the development of SOLSTICE and the research community’s responses are analysed in relation to the transformative R&I policy literature, identifying potential future avenues for improving the transformative outcomes of this type of funding. The study concludes that unlocking the value of transformative R&I policy concepts and approaches depends on wide stakeholder engagement in the funding instrument design phase and an active and sustained focus on achieving societal outcomes during project implementation. In addition, barriers to the effectiveness of (European) transnational funding programmes are identified, particularly when policies target community-level socio-technical transitions to address global challenges.
Exploring the link between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction: implications for male sexual health
Authors: Andersen Monica Levy , Gozal David , Tufik Sergio
Published: October 2024

Introduction

This review explores the interplay between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction (ED), 2 conditions that significantly impact men’s health. COMISA, a recently recognized condition characterized by the coexistence of insomnia and obstructive sleep apnea, has been shown to disrupt sleep architecture and cause intermittent hypoxia. These disturbances are increasingly linked to the exacerbation of ED, a prevalent issue among men. Understanding the connection between COMISA and ED is crucial for developing integrated treatment approaches that address both sleep and sexual health.

Objectives

We aim to explore the epidemiological, physiological, and potential therapeutic intersections of COMISA and ED. This review sets out to develop a better understanding of the relationship between these conditions and to emphasize the need for an integrated diagnostic and therapeutic approach that addresses both sleep and sexual health.

Methods

Through a comprehensive analysis, including a detailed examination of extant studies, we address the hormonal imbalances and alterations in neural pathways that collectively contribute to the complex pathophysiology of ED and how these are particularly susceptible to the concurrent presence of COMISA.

Results

Our analysis indicates that disruptions in sleep architecture and intermittent hypoxia associated with COMISA can exacerbate ED. Hormonal imbalances, endothelial dysfunction, autonomic imbalance, and increased inflammation and oxidative stress are key mechanisms through which COMISA influences ED. These factors collectively impair vascular health, reduce testosterone levels, disrupt neural control of erections, and contribute to the severity of ED.

Conclusions

This review underscores the necessity for an integrated approach to diagnosis and therapy that considers both sleep and sexual health to improve overall outcomes. These insights should foster a deeper understanding of the relationship between COMISA and ED, encourage further research in this area, and potentially lead to the development of innovative treatment strategies to manage these closely intertwined health concerns.
Growth performance of neonatal calves fed milk replacer 2 vs. 3 times per day
Authors: Olagunju Lydia K , Casper David P , Anele Uchenna Y
Published: October 2024

Several calf studies demonstrated growth advantages when feeding greater protein and/or milk solids amounts, however, studies comparing 2 times per day vs. 3 times per day feeding are limited. The study objective was to evaluate feeding 2 times per day vs. 3 times per day thereby increasing milk solids intake. Forty 2- to 5-d old Holstein bull calves were blocked by body weight (BW) and randomly assigned to 1 of 2 treatments (N = 20/treatment) using a randomized complete block design. Treatments were 1) 2×: milk replacer (MR) fed 2 times per day; and 2) 3×: MR fed 3 times per day for increased solids intake. The MR was fed at 15% solids at 0630 and 1800 hours and the 3rd 3× feeding was at 1200 hours. Calves on 2× were fed MR at 0.567 kg/d for days 1 to 14, increased to 0.85 kg/d for days 15 to 35, and reduced to 1 time per day at 0.425 kg/d for days 36 to 42 to facilitate weaning at 42 d. Calves on 3× were fed MR 0.851 kg/d for days 1 to 14, increased to 1.275 kg/d for days 15 to 35, and reduced to 1 time per day at 0.425 kg/d for days 36 to 42 followed by weaning. Calf starter (CS; amounts and orts weighed daily) and water were offered for ad libitum intake. Initial BW was not a significant covariate and final BW (81.5 and 80.9 kg, for 2× and 3×, respectively) was similar. A treatment-by-week interaction (P < 0.01) indicated variable BW gains during the study with calves fed 3× demonstrating greater BW during weeks 4 (P < 0.10) and 5 (P < 0.05) compared with calves fed 2×. However, BW gains for calves fed 3× were reduced (P < 0.05) during the weaning period resulting in similar BW gains (36.8 and 36.4 kg) at the study end. Intake of CS (0.65 and 0.46 kg/d) was lower (P < 0.04) for calves fed 3× compared with calves fed 2×. Feed conversions (0.64 and 0.58 kg/kg) were greater (P < 0.02) for calves fed 2× compared with 3× fed calves. Calves fed 2× had less (P < 0.01) scours (fecal score = 0; 34.3 and 29.7 d) compared with 3× fed calves. Providing an additional MR feeding demonstrated minimal BW gains due to lower CS intake. Providing greater MR intake using a 3rd daily feeding reduces CS intake that can inhibit transition to dry feed when weaning calves.
Fludioxonil does not antagonize propiconazole activity against Geotrichum candidum
Authors: Zhao Bingyu , Zeng Zhezheng , Gelain Jhulia , Luo Chaoxi , Schnabel Guido
Published: October 2024

Fludioxonil and propiconazole are frequently used fungicides for managing fungal diseases in specialty crops. They are often used in mixture to manage brown rot caused by Monilinia fructicola and sour rot caused by the yeast-like fungus Geotrichum candidum,respectively, on stone fruits. Research indicated, however, that fludioxonil can increase the expression of the ATP-binding cassette transporters CDR1 and CDR2 in the yeast Candida albicans, leading to increased resistance to DMI fungicides. In this study, mycelial growth assays and detached fruit assays were conducted with G. candidum isolates of varying sensitivity to propiconazole to investigate potential antagonism between the two active ingredients. Isolates sensitive, reduced-sensitive, and resistant to propiconazole were able to grow with or without 20 µg/ml fludioxonil on PDA containing up to 0, 3, and 30 μg/ml propiconazole and on water agar containing up to 7.5, 7.5, and 30 μg/ml propiconazole, respectively, and no antagonistic interactions were detected. Propiconazole controlled disease with or without 20 µg/ml fludioxonil equally on detached cherry fruit caused by isolates with different DMI sensitivity phenotypes. Our results indicated no detectable antagonism between fludioxonil and propiconazole that would interfere with the mixture’s ability to manage sour rot of cherry.
First Detection of the Obligate Biotroph Phytophthora cyperi Causing Disease on Yellow Nutsedge in the United States, and Establishment of Molecular Barcoding Sequences for the Species
Authors: Bourret Tyler B. , Blomquist Cheryl L. , Mohan S. Krishna , Sampangi Ram , Ho Hon H. , Mohammed Israfiel A.
Published: October 2024

A pathogen causing disease on yellow nutsedge ( Cyperus esculentus) growing in and near irrigated areas of onion seed and bulb fields in Idaho and Oregon during July and August 1996 was morphologically and molecularly characterized. Plant symptoms included necrotic spots and blotches and blighting of leaves, stems (culms), and bracts. Symptomatic tissue contained glistening white masses of mycelium and oval semi-papillate sporangia emerging from stomata on sporangiophores. Later, subspherical oogonia with smooth oospores were found embedded in older infected tissue. Phytophthora cyperi was identified as the causal agent, and pathogenicity was confirmed by inoculating healthy nutsedge plants with sporangia from infected plants. Infected samples tested negative using Agdia's Phytophthora enzyme-linked immunosorbent assay (ELISA) kit, and all efforts to culture the organism on semi-selective or general fungal media failed. To aid future efforts to detect this species, sequences of the two primary barcoding loci, ITS rDNA and mitochondrial cox1, were obtained from the organism and analyzed, finding an unexpectedly large ITS sequence characterized by an approximately 1,300-bp insertion.

[Formula: see text] Copyright © 2025 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Where AIRE we now? Where AIRE we going?
Authors: Bez Patrick , Ceraudo Martina , Vianello Fabrizio , Rattazzi Marcello , Scarpa Riccardo
Published: October 2024

Purpose of review

The purpose of the review is to describe the most recent advancement in understanding of the pivotal role of autoimmune regulator (AIRE) gene expression in central and peripheral tolerance, and the implications of its impairment in the genetic and pathogenesis of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) manifestations with insight into possible treatment options.

Recent findings

AIRE gene expression has an important role of central and peripheral tolerance. Different AIRE gene mutations cause APECED, whereas polymorphisms and some variants may be implicated in development of other more frequently autoimmune diseases. Impaired negative T cell selection, reduction of T regulatory function, altered germinal center response, activated B cells and production of autoantibodies explain the development of autoimmunity in APECED. Recent data suggest that an excessive interferon-γ response may be the primer driver of the associated organ damage. Therefore, Janus kinase (JAK)-inhibitors may be promising therapies for treatment of broad spectrum of manifestations.

AIRE has a pivotal role in immune tolerance. Disruption of this delicate equilibrium results in complex immune perturbation, ranging from severe autoimmunity, like APECED, to more common organ-specific disorders. Therefore, a deeper understanding of the correlation between AIRE function and clinical phenotype is warranted given the potential translational implication in clinical practice.
Heterogeneity in the Effect of Early Goal-Directed Therapy for Septic Shock: A Secondary Analysis of Two Multicenter International Trials
Authors: Shah Faraaz Ali , Talisa Victor B. , Chang Chung-Chou H. , Triantafyllou Sofia , Tang Lu , Mayr Florian B. , Higgins Alisa M. , Peake Sandra L. , Mouncey Paul , Harrison David A , DeMerle Kimberley M. , Kennedy Jason N. , Cooper Gregory F. , Bellomo Rinaldo , Rowan Kathy , Yealy Donald M. , Seymour Christopher W. , Angus Derek C. , Yende Sachin P.
Published: October 2024

OBJECTIVES:

The optimal approach for resuscitation in septic shock remains unclear despite multiple randomized controlled trials (RCTs). Our objective was to investigate whether previously uncharacterized variation across individuals in their response to resuscitation strategies may contribute to conflicting average treatment effects in prior RCTs.

DESIGN:

We randomly split study sites from the Australian Resuscitation of Sepsis Evaluation (ARISE) and Protocolized Care for Early Septic Shock (ProCESS) trials into derivation and validation cohorts. We trained machine learning models to predict individual absolute risk differences (iARDs) in 90-day mortality in derivation cohorts and tested for heterogeneity of treatment effect (HTE) in validation cohorts and swapped these cohorts in sensitivity analyses. We fit the best-performing model in a combined dataset to explore roles of patient characteristics and individual components of early goal-directed therapy (EGDT) to determine treatment responses.

SETTING:

Eighty-one sites in Australia, New Zealand, Hong Kong, Finland, Republic of Ireland, and the United States.

PATIENTS:

Adult patients presenting to the emergency department with severe sepsis or septic shock.

INTERVENTIONS:

EGDT vs. usual care.

MEASUREMENTS AND MAIN RESULTS:

A local-linear random forest model performed best in predicting iARDs. In the validation cohort, HTE was confirmed, evidenced by an interaction between iARD prediction and treatment (p < 0.001). When patients were grouped based on predicted iARDs, treatment response increased from the lowest to the highest quintiles (absolute risk difference [95% CI], –8% [–19% to 4%] and relative risk reduction, 1.34 [0.89–2.01] in quintile 1 suggesting harm from EGDT, and 12% [1–23%] and 0.64 [0.42–0.96] in quintile 5 suggesting benefit). Sensitivity analyses showed similar findings. Pre-intervention albumin contributed the most to HTE. Analyses of individual EGDT components were inconclusive.

CONCLUSIONS:

Treatment response to EGDT varied across patients in two multicenter RCTs with large benefits for some patients while others were harmed. Patient characteristics, including albumin, were most important in identifying HTE.
Circulating DNA in Rectal Cancer to Unravel the Prognostic Potential for Radiation Oncologist
Authors: Fiorica Francesco , Mandarà Marta , Giuliani Jacopo , Tebano Umberto , Franceschetto Antonella , Gabbani Milena , Rampello Elvira , Condarelli Giorgia , Napoli Giuseppe , Luca Nicoletta , Mangiola Daniela , Muraro Marco , Singh Navdeep , Remo Andrea , Giorgi Carlotta , Pinton Paolo
Published: October 2024

Objectives:

Liquid biopsy, with its noninvasive nature and ability to detect tumor-specific genetic alterations, emerges as an ideal biomarker for monitoring recurrences for locally advanced rectal cancer (LARC). Completed studies have small sample sizes and different experimental methods. To consolidate and assess the collective evidence regarding the prognostic role of circulating DNA (ctDNA) detection in LARC patients undergoing neoadjuvant chemoradiotherapy (nCRT).

Methods:

Computerized bibliographic searches of MEDLINE and CANCERLIT (2000 to 2023) were supplemented with hand searches of reference lists. Study selection: studies evaluating oncological outcomes of patients with LARC treated with a nCRT comparing patients with positive and negative liquid biopsy at baseline and after nCRT. Data extraction: data on population, intervention, and outcomes were extracted from each study, in accordance with the intention to treat method, by 2 independent observers, and combined using the DerSimonian method and Laird method.

Results:

Nine studies follow inclusion criteria including 678 patients treated with nCRT. The pooled RD rate of ctDNA negative between measure at baseline and after nCRT is statistically significant 61% (95% CI: 53-70, P=0.0002). The hazard ratio (HR) of progression-free survival between ct-DNA negative and positive is significant 7.41 (95% CI: 4.87-11.289, P<0.00001).

Conclusions:

ctDNA can identify patients with different recurrence risks following nCRT and assess prognosis in patients with LARC. Further prospective study is necessary to determine the utility of ctDNA in personalised therapy for patients with LARC.
Epidural anesthesia as a sole anesthetic for a parturient with cardiac disease and low ejection fraction – a case report in resource limited setup
Authors: Hailu Seyoum , Regasa Teshome , Yohannes Bereket
Published: October 2024

Introduction and importance:

The effective care of pregnant women with cardiac conditions relies on collaboration among the obstetrician, cardiologist, and anesthesiologist throughout the peripartum period. Limited research exists regarding the safety of specific anesthetic approaches for patients with congestive heart failure (CHF), particularly in the context of pregnancy.

Case presentation:

This was a 28-year-old woman who was pregnant with her third child (gravida III, para II) and has not had a menstrual period for the past 8 months. She had been receiving antenatal care at a local health center. Currently, she was experiencing symptoms including coughing, difficulty breathing, epigastric pain, and chest pain, which had been present for 1 week. Upon examination, she was diagnosed with New York Heart Association class IV CHF with pulmonary edema, and preeclampsia with severe features, and she was in the third trimester of pregnancy.

Clinical discussion:

Pre-existing medical conditions can adversely affect pregnancy outcomes for women and their offspring, especially in resource-poor settings in Africa. The goals of anesthetic management are avoidance of myocardial depression, maintaining normovolemia, avoiding an overdose of drugs during induction as the circulation time is slow, and avoiding sudden hypotension when regional anesthesia is the choice.

Conclusion:

We believe that successful management of anesthesia for this critical case depends on a thorough understanding of the pathophysiology of the disease condition, the selection of anesthetic techniques, and the decision-making of our team. We showed epidural anesthesia could be safely used to manage high-risk cardiac patients, however, further interventional study is needed to prove safety.
COMPARING STAGES OF DIABETIC RETINOPATHY WITH SYSTEMIC VASCULAR STATUS USING FINGER PHOTOPLETHYSMOGRAPHY
Authors: Ab Rahman Nurshazwani , Chellapan Kalaivani , Ong Poh Yan , Adnan Azian , Md Din Norshamsiah
Published: October 2024

Purpose:

To evaluate systemic vascular fitness measured by finger photoplethysmography in diabetic retinopathy (DR).

Methods:

This was a cross-sectional observational study on patients with Type II diabetes mellitus from October 2020 to May 2021. Data collected include systolic/diastolic blood pressure, visual acuity, glycated hemoglobin, and central macular thickness. Diabetic retinopathy severity was categorized using the Early Treatment Diabetic Retinopathy Study classification. Photoplethysmography signals were acquired using pulse-oximeter modules (OEM-60; Dolphin Medical, Inc) measured for 90 seconds at 275 Hz sampling rate and 16-bit resolution, which records photoplethysmography fitness index, vascular risk prediction index, and vascular age.

Results:

One hundred and forty-one patients were equally distributed into six DR categories. Mean age was 58.8 ± 9.9 years, with female-to-male ratio of 1.27. There were significant differences in mean systolic (125.5 ± 10.0 mmHg, P = 0.007) and diastolic blood pressure (80.0 ± 8.8 mmHg), mean glycated hemoglobin (7.6 ± 1.9%, P = 0.005), median log unit of minimal angle of resolution (0.3, interquartile range: 0.2–0.5, P < 0.001), and central macular thickness (P = 0.003) across DR severity. Significant differences were also seen in photoplethysmography fitness index (P = 0.001), vascular risk prediction index (P < 0.001), and vascular age (P = 0.001), with poorer values in severe compared with mild/moderate DR. After adjusting for age, blood pressure, and glycated hemoglobin, photoplethysmography fitness reduces by 3.3% (regression coefficient, b = −3.27, P < 0.001), vascular age increases by 2.5 years (b = 2.54, P = 0.002), and vascular risk prediction index increases by 3.1 (b = 3.08, P < 0.001) with every DR worsening.

Conclusion:

More severe DR stages were associated with poorer photoplethysmography vascular markers.
Comparing Traditional and Newer Glaucoma Procedures by Physician Experience and Practice Location in the United States
Authors: Xiao Grace , Boland Michael V.
Published: October 2024

Précis:

Analysis of Centers for Medicare and Medicaid Services (CMS) Physician Payment data found that physician certification year, degree of urbanization, and estimated income by zip code were significant in predicting the proportion of traditional glaucoma procedures performed by each provider in the United States.

Objective:

The prevalence of microinvasive glaucoma surgery (MIGS) compared with traditional procedures has been increasing in glaucoma management. It is important to understand whether the uptake of new glaucoma procedures is associated with aspects of the physician practice.

Methods:

In this cross-sectional study, data on glaucoma procedure distribution, degree of urbanization, and physician certification in the United States were extracted from the 2019 CMS Physician Payment and American Board of Ophthalmology databases. The distribution of traditional and MIGS procedure numbers for metropolitan versus non-metropolitan providers was visualized with boxplots and statistically compared using Mann-Whitney U tests. We used two-dimensional histograms and regression analyses to assess the relationship between certification year and volume of traditional versus MIGS procedures. A multivariable linear regression model was created using certification year, rural-urban commuting area code, and estimated income by practice zip code to predict the number and proportion of each type of glaucoma procedure.

Results:

This study included 2625 providers from the CMS physician payment data who performed only traditional procedures (n = 370), MIGS procedures (n = 1727), or both procedure types (n = 528) in 2019. The median number of MIGS procedures performed by each provider was greater in non-metropolitan areas (31 vs 29, P = 0.015), whereas the proportion of traditional procedures performed by each provider was greater in metropolitan areas (0.24 vs 0.08, P < 0.001). Regression analysis showed a positive relationship between the certification year and the proportion of traditional procedures performed by each provider (P < 0.001). Multivariable regression models found that certification year, rural-urban commuting area code, and estimated income of practice location were all significant predictors (P < 0.02) of the proportion of traditional procedures performed by each provider.

Conclusion:

In the United States, physicians in metropolitan areas and more recent certification years are more likely to perform a larger proportion of traditional procedures. This finding suggests that the distribution of glaucoma procedure types is related to physician factors such as degree of urbanization and duration of practice. More research is needed to better understand how such differences affect patient access and outcomes.
The learning curve for robotic living donor right hepatectomy: Analysis of outcomes in 2 specialized centers
Authors: Cheah Yee L. , Yang Hye Yeon , Simon Caroline J. , Akoad Mohamed E. , Connor Ashton A. , Daskalaki Despoina , Han Dai Hoon , Brombosz Elizabeth W. , Kim Jae K. , Tellier Maureen A. , Ghobrial R. Mark , Gaber A. Osama , Choi Gi Hong
Published: October 2024

Robotic surgery is an emerging minimally invasive option for living donor hepatectomy. Currently, there are no studies on the learning curve of robotic donor hepatectomy. Thus, we evaluated the learning curve for robotic donor right hepatectomy. We retrospectively reviewed prospectively collected data from consecutive living donors who underwent robotic hepatectomy at 2 specialized centers between 2016 and 2022. We estimated the number of cases required to achieve stable operating times for robotic donor right hepatectomy using cumulative sum (CUSUM) analysis. The complication rates were similar between the 2 centers (22.8% vs. 26.7%; p = 0.74). Most complications were graded as minor (70.4%). Analysis of the total operative time demonstrated that the learning curves reached a peak at the 17th case in center 1 and the 9th case in center 2. The average operation times for cases 1–17 versus 18–99 in center 1 were 603 versus 438 minutes (p < 0.001), and cases 1–9 versus 10–15 in center 2 were 532 versus 418 minutes (p = 0.002). Complication rates were lower after the learning curves were achieved, although this did not reach statistical significance. A comparison of outcomes between centers suggests that a standardized approach to this complex operation can be successfully transferred.
Classic yet challenging case of stump appendicitis: a case report
Authors: Bastakoti Aashish , Khatiwada Abhikanta , Luitel Prajjwol , Panthi Bishal , KC Soniya , KC Sharada
Published: October 2024

Introduction:

Stump appendicitis is a rare complication of appendectomy in which residual appendiceal tissue becomes inflamed, mimicking acute appendicitis. This case report highlights the classic clinical presentation, diagnosis, and management of stump appendicitis.

Case presentation:

A 61-year-old male presented with abdominal pain and a past history of open appendectomy performed 4 years prior. Clinical examination, laboratory, and radiological findings were highly suggestive of stump appendicitis. Surgical exploration confirmed an inflamed appendiceal stump, which was resected, and the patient had an uneventful recovery postoperatively.

Discussion:

Stump appendicitis is a rare but important differential diagnosis in patients with a history of appendectomy who present with acute abdominal pain. Delayed diagnosis can result in complications such as perforation and peritonitis. Imaging plays a crucial role in diagnosis, and surgical resection, typically performed through open-completion appendectomy, remains the treatment of choice.

Conclusion:

Although stump appendicitis is rare, it should always be considered in patients with a prior appendectomy who present with acute abdomen. Early recognition and prompt surgical intervention are essential to prevent morbidity and mortality.
Predictive Model Based on Texture Analysis of Noncontrast Cardiac Magnetic Resonance Images for the Prognostic Evaluation of Cardiac Amyloidosis
Authors: She Jiaqi , Guo Jiajun , Sun Yi , Chen Yinyin , Zeng Mengsu , Ge Meiying , Jin Hang
Published: October 2024

Objectives

We aimed to develop a predictive model based on textural features of noncontrast cardiac magnetic resonance (CMR) imaging for risk stratification toward adverse events in patients with cardiac amyloidosis (CA).

Methods

A cohort of 78 patients with CA was grouped into training (n = 54) and validation (n = 24) sets at a ratio of 7:3. A total of 275 textural features were extracted from the CMR images. MaZda and a support vector machine (SVM) were used for feature selection and model construction. An SVM model incorporating radiological and textural features was built to predict endpoint events by evaluating the area under the curve.

Results

In the entire cohort, 52 patients experienced major adverse cardiovascular events and 26 patients did not. By combining 2 radiological features and 8 texture features, extracted from cine and T2-weighted imaging images, the SVM model achieved area under the curves of the receiver operating characteristic and precision-recall curves of 0.930 and 0.962 in the training cohort and that of 0.867 and 0.941 in the validated cohort, respectively. The Kaplan-Meier curve of this SVM model criterion significantly stratified the CA outcomes (log-rank test, P < 0.0001).

Conclusions

The SVM model based on radiological and textural features derived from noncontrast CMR images can be a reliable biomarker for adverse events prognostication in patients with CA.
Node Reporting and Data System Combined With Computed Tomography Radiomics Can Improve the Prediction of Nonenlarged Lymph Node Metastasis in Gastric Cancer
Authors: Jiang Changqin , Fang Wei , Wei Na , Ma Wenwen , Dai Cong , Liu Ruixue , Cai Anzhen , Feng Qiang
Published: October 2024

Objectives

To investigate the diagnostic performance of Node Reporting and Data System (Node-RADS) combined with computed tomography (CT) radiomics for assessing nonenlargement regional lymph nodes in gastric cancer (GC).

Methods

Preoperative CT images were retrospectively collected from 376 pathologically confirmed of gastric adenocarcinoma from January 2019 to December 2023, with 605 lymph nodes included for analysis. They were divided into training (n = 362) and validation (n = 243) sets. Radiomics features were extracted from venous-phase, and the radiomics score was obtained. Clinical information, CT parameters, and Node-RADS classification were collected. A combined model was built using machine-learning approach and tested in validation set using receiver operating characteristic curve analysis. Further validation was conducted in different subgroups of lymph node short-axis diameter (SD) range.

Results

Node-RADS score, SD, maximum diameter of thickness of tumor, and radiomics were identified as the most predictive factors. The results demonstrated that the integrated model combining SD, maximum diameter of thickness of tumor, Node-RADS, and radiomics outperformed the model excluding radiomics, yielding an area under the receiver operating characteristic curve of 0.82 compared with 0.79, with a statistically significant difference (P < 0.001). Subgroup analysis based on different SDs of lymph nodes also revealed enhanced diagnostic accuracy when incorporating the radiomics score for the 4- to 7.9-mm subgroups, all P < 0.05. However, for the 8- to 9.9-mm subgroup, the combination of the radiomics did not significantly improve the prediction, with an area under the receiver operating characteristic curve of 0.85 versus 0.85, P = 0.877.

Conclusion

The integration of radiomics scores with Node-RADS assessments significantly enhances the accuracy of lymph node metastasis evaluation for GC. This combined model is particularly effective for lymph nodes with smaller standard deviations, yielding a marked improvement in diagnostic precision.

Clinical Relevance Statement

The findings of this study indicate that a composite model, which incorporates Node-RADS, radiomics features, and conventional parameters, may serve as an effective method for the assessment of nonenlarged lymph nodes in GC.
Comparing Provider and ChatGPT Responses to Breast Reconstruction Patient Questions in the Electronic Health Record
Authors: Soroudi Daniel , Gozali Aileen , Knox Jacquelyn A. , Parmeshwar Nisha , Sadjadi Ryan , Wilson Jasmin C. , Lee Seung Ah , Piper Merisa L.
Published: October 2024

Background

Patient-directed Electronic Health Record (EHR) messaging is used as an adjunct to enhance patient-physician interactions but further burdens the physician. There is a need for clear electronic patient communication in all aspects of medicine, including plastic surgery. We can potentially utilize innovative communication tools like ChatGPT. This study assesses ChatGPT's effectiveness in answering breast reconstruction queries, comparing its accuracy, empathy, and readability with healthcare providers' responses.

Methods

Ten deidentified questions regarding breast reconstruction were extracted from electronic messages. They were presented to ChatGPT3, ChatGPT4, plastic surgeons, and advanced practice providers for response. ChatGPT3 and ChatGPT4 were also prompted to give brief responses. Using 1–5 Likert scoring, accuracy and empathy were graded by 2 plastic surgeons and medical students, respectively. Readability was measured using Flesch Reading Ease. Grades were compared using 2-tailed t tests.

Results

Combined provider responses had better Flesch Reading Ease scores compared to all combined chatbot responses (53.3 ± 13.3 vs 36.0 ± 11.6, P < 0.001) and combined brief chatbot responses (53.3 ± 13.3 vs 34.7 ± 12.8, P < 0.001). Empathy scores were higher in all combined chatbot than in those from combined providers (2.9 ± 0.8 vs 2.0 ± 0.9, P < 0.001). There were no statistically significant differences in accuracy between combined providers and all combined chatbot responses (4.3 ± 0.9 vs 4.5 ± 0.6, P = 0.170) or combined brief chatbot responses (4.3 ± 0.9 vs 4.6 ± 0.6, P = 0.128).

Conclusions

Amid the time constraints and complexities of plastic surgery decision making, our study underscores ChatGPT's potential to enhance patient communication. ChatGPT excels in empathy and accuracy, yet its readability presents limitations that should be addressed.
Resection Weight Formulas for Reduction Mammoplasty
Authors: Gupta Nisha , Lava Christian X. , Ferdousian Sami , Li Karen R. , Bekeny Jenna C. , Fan Kenneth L.
Published: October 2024

Purpose

Estimating resection weight for patients undergoing reduction mammoplasty (RM) informs surgical planning and outcomes. Existing formulas have limitations that make insurance coverage and accurate surgical planning challenging. We identified the most commonly used scales to evaluate their accuracy in estimating resection weight by applying them to a database of patients to compare calculated and actual resection weights.

Methods

A database search was conducted using combinations of relevant terms. A regression analysis was conducted using formulas with strong R
2 values (0.72–0.93) on a cohort of 1128 RM patients at a single institution.

Results

A total of 570 articles were identified. Fourteen manuscripts (n = 2232 patients [3320 breasts]) were ultimately included for review. Data on incisional patterns, pedicle supply, and breast measurements, such as sternal notch to nipple distance (n = 8 [57.1%]) or nipple to inframammary fold distance (n = 5 [35.7%]), were recorded. R
2 values in our cohort (>500 g, n = 891; <500 g, n = 237) were calculated via regression analyses with five formulas: Appel (0.391 vs 0.146), Boukovalas (0.3552 vs 0.043), Descamps (0.391 vs 0.238), Eder (0.328 vs 0.114), and Kocak (0.3283 vs R
2 indeterminate).

Conclusions

Our analysis suggests that formulas reporting strong R
2 values may have resulted from tailoring to surgeons' technique. Variation between cohorts is inevitable; however, we expect reliable results given our large sample. It is reasonable to conclude that existing formulas are not accurate representations of resection weights and thus are unreliable for surgical planning.
Concordance of ChatGPT With American Burn Association Guidelines on Acute Burns
Authors: Pandya Sumaarg , Alessandri Bonetti Mario , Liu Hilary Y , Jeong Tiffany , Ziembicki Jenny A. , Egro Francesco M.
Published: October 2024

Burn injuries often require immediate assistance and specialized care for optimal management and outcomes. The emergence of accessible artificial intelligence technology has just recently started being applied to healthcare decision making and patient education. However, its role in clinical recommendations is still under scrutiny. This study aims to evaluate ChatGPT's outputs and the appropriateness of its responses to commonly asked questions regarding acute burn care when compared to the American Burn Association Guidelines. Twelve commonly asked questions were formulated by a fellowship-trained burn surgeon to address the American Burn Association's recommendations on burn injuries, management, and patient referral. These questions were prompted into ChatGPT, and each response was compared with the aforementioned guidelines, the gold standard for accurate and evidence-based burn care recommendations. Three burn surgeons independently evaluated the appropriateness and comprehensiveness of each ChatGPT response based on the guidelines according to the modified Global Quality Score scale. The average score for ChatGPT-generated responses was 4.56 ± 0.65, indicating the responses were exceptional quality with the most important topics covered and in high concordance with the guidelines. This initial comparison of ChatGPT-generated responses and the American Burn Association guidelines demonstrates that ChatGPT can accurately and comprehensibly describe appropriate treatment and management plans for acute burn injuries. We foresee that ChatGPT may play a role as a complementary tool in medical decision making and patient education, having a profound impact on clinical practice, research, and education.
Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review
Authors: Morkuzu Suat , Bayezid K Can , Ozmen Berk B , Eren Seyma Fatima , Farhat Souha , McLennan Alexandra L , James Andrew J , Nikkhah Dariush , Azoury Saïd C , Djohan Risal S , Bishop Sarah N. , Schwarz Graham S
Published: October 2024

Background:

The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery.

Methods:

A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale.

Results:

Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3 cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures.

Conclusion:

Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.