bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-reported quality of life and working status outcomes in ambulatory patients with idiopathic inflammatory myopathy
Authors: Peng Zhao , Wang Yanhong , Liu Ning , Zhou Shuang , Zhao Jiuliang , Xu Dong , Li Mengtao , Wu Chanyuan , Zeng Xiaofeng , Wang Qian
Published: July 2023

Objective

To investigate the health-related quality of life (HR-QoL), work productivity and activity impairment and associated factors among patients with idiopathic inflammatory myopathy (IIM).

Methods

This was an observational, cross-sectional study. The 189 ambulatory patients with IIM were recruited from May 2019 to May 2022. HR-QoL was measured by the European Quality of Life 5-Dimension (EQ-5D) questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used to evaluate work productivity and activity impairment. The IIM-related parameters were assessed by the 8-item Manual Muscle Test (MMT-8), Myositis Disease Activity Assessment visual analogue scale (MYOACT), Myositis Damage Index (MDI), Disease Activity Score (DAS) and Physician/Patient Global Assessment (PhGA/PtGA). Quantile regression and ordinal logistic regression were performed to identify the factors, considering EQ-5D or WPAI scores as dependent variables, respectively.

Results

Of the 189 IIM patients enrolled, 60% had DM, 13% had PM and 27% had clinical amyopathic DM. The median EQ-5D score was 1.00 (95% CI 0.73, 1.00), 28% were employed and 45% of overall work was impaired due to health problems. EQ-5D values were positively associated with MMT-8 and negatively with MYOACT, DAS, MDI-global and PhGA/PtGA. For the WPAI, activity impairment was associated with a lower MMT-8 score, older onset age and higher PhGA only in 25th–75th percentile. Increased PtGA was associated with increased activity and overall working productivity impairment in most quantiles (P<0.05).

Conclusion

Multiple disease characteristics were associated with reduced HR-QoL or working productivity impairment in patients with IIM, especially for PtGA.
Multi-dimensional sleep and mortality: The Multi-Ethnic Study of Atherosclerosis
Authors: Chung Joon , Goodman Matthew , Huang Tianyi , Wallace Meredith L , Lutsey Pamela L , Chen Jarvis T , Castro-Diehl Cecilia , Bertisch Suzanne , Redline Susan
Published: July 2023

Study Objectives

Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality.

Methods

The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010–2013). 1726 participants were followed for a median of 6.9 years (Q1–Q3, 6.4–7.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori.

Results

After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index.

Conclusion

More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.
Diversity and Phenology of Soybean Seed Fungal Endophyte Communities in the Upper Midwest United States
Authors: Batzer Jean Carlson , Shirazi Amin , Lawson Maia , Dangal Nabin K. , Sureshbabu Bijula M. , Mathew Febina M. , Smith Damon L. , Mueller Daren S.
Published: July 2023

Infection over time by endophytic fungi in soybean seed and pods was documented in Iowa and Wisconsin in 2018. Three reproductive stages were sampled from six cultivars, with maturity groups (MG) ranging from 1.1 to 4.7, and included 216 blemish-free pods and 1,836 healthy seeds that were heavily disinfested to remove epiphytes. Thirty-five species and 11 genera were identified from 1,799 isolates using morphological and molecular evidence. Alternaria, Diaporthe, and Fusarium were dominant. The timing of endophyte infection was documented relative to MG. The lowest number of fungi were recovered from seed at R6, and infection sharply increased at R7. The abundance of Diaporthe and Fusarium isolates differed across MG and reproductive stage; shorter MGs had more Diaporthe isolates at earlier reproductive stages than longer MGs. Fusarium counts differed across MG but did not show consistent trends with seed maturity. Alternaria counts declined as seed matured but were not affected by MG. We used nonmetric multidimensional scaling to elucidate the phenology of seed infection within the endophyte community. This method helps represent the data in a lower dimension by measuring the similarity or dissimilarity between data points, making it a useful tool for grouping similar endophyte communities. The nonmetric multidimensional scaling ordination analysis of fungal taxa within endophyte communities revealed that the dominant genera in filled green pods were highly similar. However, this similarity was not observed among different stages of seed development, indicating that each taxon had distinct modes of infecting the seeds.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Constructing “Burnout”: A Critical Discourse Analysis of Burnout in Postgraduate Medical Education
Authors: Khan Rabia , Hodges Brian David , Martimianakis Maria Athina
Published: July 2023

Purpose

In 1974, Dr. Herbert Freudenberger coined the term burnout. With the creation of the Maslach Burnout Inventory in 1984, burnout went from a pop psychology term to a highly studied phenomenon in medicine. Exponential growth in studies of burnout culminated in its adoption into the International Classification of Diseases-11 in 2022. Yet, despite increased awareness and efforts aimed at addressing burnout in medicine, many surveys report burnout rates have increased among trainees. The authors aimed to identify different discourses that legitimate or function to mobilize burnout in postgraduate medical education (PGME), to answer the question: Why does burnout persist in PGME despite efforts to ameliorate it?

Method

Using a Foucauldian discourse analysis, this study examined the socializing period of PGME as an entry point into burnout’s persistence. The archive from which the discourses were constructed included over 500 academic articles, numerous policy documents, autobiographies, videos, documentaries, social media, materials from conferences, and threads in forums including Reddit.

Results

This study identified 3 discourses of burnout from 1974–2019: burnout as illness, burnout as occupational stress, and burnout as existentialism. Each discourse was associated with statements of truth, signs and signifiers, roles that individuals play within the discourse, and different institutions that gained visibility as a result of differing discourses.

Conclusions

Burnout persists despite effort to ameliorate it because it is a productive construct for organizations. In its current form, it depoliticizes issues of health in favor of wellness and gives voice to the challenge of making meaning from the experience of being a clinician.
Recruitment-to-inflation Ratio Assessed through Sequential End-expiratory Lung Volume Measurement in Acute Respiratory Distress Syndrome
Authors: Grieco Domenico Luca , Pintaudi Gabriele , Bongiovanni Filippo , Anzellotti Gian Marco , Menga Luca Salvatore , Cesarano Melania , Dell’Anna Antonio M. , Rosá Tommaso , Delle Cese Luca , Bello Giuseppe , Giammatteo Valentina , Gennenzi Veronica , Tanzarella Eloisa S. , Cutuli Salvatore L. , De Pascale Gennaro , De Gaetano Andrea , Maggiore Salvatore M. , Antonelli Massimo
Published: July 2023

Background

Positive end-expiratory pressure (PEEP) benefits in acute respiratory distress syndrome are driven by lung dynamic strain reduction. This depends on the variable extent of alveolar recruitment. The recruitment-to-inflation ratio estimates recruitability across a 10–cm H2O PEEP range through a simplified maneuver. Whether recruitability is uniform or not across this range is unknown. The hypotheses of this study are that the recruitment-to-inflation ratio represents an accurate estimate of PEEP-induced changes in dynamic strain, but may show nonuniform behavior across the conventionally tested PEEP range (15 to 5 cm H2O).

Methods

Twenty patients with moderate-to-severe COVID-19 acute respiratory distress syndrome underwent a decremental PEEP trial (PEEP 15 to 13 to 10 to 8 to 5 cm H2O). Respiratory mechanics and end-expiratory lung volume by nitrogen dilution were measured the end of each step. Gas exchange, recruited volume, recruitment-to-inflation ratio, and changes in dynamic, static, and total strain were computed between 15 and 5 cm H2O (global recruitment-to-inflation ratio) and within narrower PEEP ranges (granular recruitment-to-inflation ratio).

Results

Between 15 and 5 cm H2O, median [interquartile range] global recruitment-to-inflation ratio was 1.27 [0.40 to 1.69] and displayed a linear correlation with PEEP-induced dynamic strain reduction (r = –0.94; P < 0.001). Intraindividual recruitment-to-inflation ratio variability within the narrower ranges was high (85% [70 to 109]). The relationship between granular recruitment-to-inflation ratio and PEEP was mathematically described by a nonlinear, quadratic equation (R
2 = 0.96). Granular recruitment-to-inflation ratio across the narrower PEEP ranges itself had a linear correlation with PEEP-induced reduction in dynamic strain (r = –0.89; P < 0.001).

Conclusions

Both global and granular recruitment-to-inflation ratio accurately estimate PEEP-induced changes in lung dynamic strain. However, the effect of 10 cm H2O of PEEP on lung strain may be nonuniform. Granular recruitment-to-inflation ratio assessment within narrower PEEP ranges guided by end-expiratory lung volume measurement may aid more precise PEEP selection, especially when the recruitment-to-inflation ratio obtained with the simplified maneuver between PEEP 15 and 5 cm H2O yields intermediate values that are difficult to interpret for a proper choice between a high and low PEEP strategy.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Successful fiberoptic orotracheal intubation by lifting large thyroid mass and tongue protrusion in left lateral position: a case report
Authors: Ahmad Sarfaraz , Kumar Neeraj , Kumar Ajeet , Palasevam Saravanan
Published: July 2023

Introduction

Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies. After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position, the decision to switch to the left lateral position was made. We present this case to propose the utilization of the lateral position for awake intubation.

Case presentation

We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision. The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue. The breathing difficulties subsided in the lateral position.

Conclusion

We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.
Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk
Authors: Almarzooq Zaid I. , Al-Roub Nora M. , Kinlay Scott
Published: July 2023

Purpose of review

Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI).

Recent findings

Patients with HBR after PCI include those with advanced age (e.g. >75 years of age), a prior history of major bleeding, anemia, chronic kidney disease, and those with indications for long-term anticoagulation. Strategies that successfully decrease bleeding risk in this population include shorter durations of dual antiplatelet therapy (DAPT; of 1–3 months) followed by single antiplatelet therapy with aspirin or a P2Y12 inhibitor, or de-escalating from a more potent P2Y12 inhibitor (prasugrel or ticagrelor) to less potent antiplatelet regimens (aspirin with clopidogrel or half-dose ticagrelor or half-dose prasugrel). Patients on DAPT, and a full dose anticoagulation for other indications, have a lower risk of major bleeding without an increase in 1–2-year adverse ischemic events, when rapidly switched from DAPT to a single antiplatelet therapy (within a week after PCI) with aspirin or clopidogrel. Longer term data on the benefits and risks of these strategies is lacking.

In patients with HBR after PCI, shorter durations of DAPT (1–3 months) decrease the risk of major bleeding without increasing the risk of adverse ischemic events.
Racial, Ethnic, and Socioeconomic Disparities in Glaucoma Onset and Severity in a Diverse Nationwide Cohort in the United States
Authors: Acuff Kaela , Radha Saseendrakumar Bharanidharan , Wu Jo-Hsuan , Weinreb Robert N. , Baxter Sally L.
Published: July 2023

Précis:

Racial/ethnic minorities are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. In addition, we highlight a gap in the use of diagnosis codes.

Purpose:

The purpose of this study was to analyze patterns of diagnosis coding usage and validate epidemiologic patterns of glaucoma onset and severity among primary glaucoma patients within the National Institutes of HealthAll of Usdatabase.

Patients and Methods:

We used International Classification of Disease diagnosis codes to build 4 cohorts of patients with mild, moderate, severe, and unspecified stage glaucoma (N=2982). Descriptive analyses were stratified by disease stage, and mean age at diagnosis was compared across racial and ethnic groups. Multivariable ordinal regression was used to examine risk factors for increasing glaucoma severity.

Results:

Of 2982 participants, 1714 (57%) had unspecified severity staging. Black/African Americans and other races were diagnosed with glaucoma at significantly younger ages compared with Whites (means 60 and 60 vs. 66 y;P<0.001). Hispanic/Latino participants also had an earlier mean age of diagnosis (61 vs. 65 y;P=0.001). Black/African Americans had higher odds of more severe glaucoma (odds ratio: 2.20, 95% CI, 1.62–3.30;P<0.001) than Whites when adjusting for socioeconomic characteristics.

Conclusions:

Black, Hispanic/Latino, and other minority participants are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. These findings validate prior population-based studies. Furthermore, we observed a gap in the use of diagnosis codes, as only 43% of participants had a specified severity stage in this national cohort. This may have implications for large-scale observational research concerning glaucoma severity, as electronic health records and claims databases typically lack other measures of disease progression, such as imaging and visual field data.
Examining Bias in Published Surgical Glaucoma Clinical Trials
Authors: Michael Reinemary , Zhang Hiuxin , McIntyre Sarah , Cape Leila , Toren Andrew
Published: July 2023

Précis:

Our results demonstrate that, among randomized clinical trials examining the use of surgical treatments for glaucoma, the majority were not registered. Publication bias (PB) was less likely. More than a third of registered trials presented outcome reporting bias (ORB).

Purpose:

Despite the optimum of quality evidence provided by randomized controlled trials (RCTs), biases may be introduced and hinder their application. The primary objective of this study was to investigate ORB and PB in RCTs assessing surgical treatments of glaucoma, as well as their registration status.

Materials and Methods:

A literature review was conducted in MEDLINE, EMBASE, and CENTRAL databases. Inclusion criteria were RCTs published in English between 2007 and 2021 that focused on surgical treatments of patients of all ages with glaucoma or elevated intraocular pressure. Exclusion criteria included cadaveric and animal studies. Registration status was correlated with entries from clinical trial registries. PB was determined by the proportion of trials presenting statistically significant results. ORB was evaluated by comparing the study’s primary outcome with that listed in the trial registry. Trials quality was assessed using the Jadad score.

Results:

After deleting duplicates, 7561 citations were screened. One hundred sixty-one RCTs were eligible and included between 13 and 556 participants. Of the total, 91% studied an adult population and 71% included patients suffering from primary open angle glaucoma. Among included studies, 63% were not registered and 47% had statistically significant results. An upward trend in registration was observed with time. However, 37% of the studies showed discrepancies between objectives in cited clinical trial registries and the published results.

Conclusion:

PB in surgical glaucoma trials was not obvious. Among the minority of trials that were registered, more than a third presented ORB. Unregistered trials had lower quality. RCT registration is crucial for the transparent interpretation of studies, improved patient care in surgery, and informed decision-making.
Impact of Monocular and Binocular Visual Function Parameters on Vision-Related Quality of Life in Glaucoma
Authors: Nagarajan Sangeetha , Negiloni Kalpa , Asokan Rashima , Meethal Najiya Sundus K. , George Ronnie
Published: July 2023

Précis:

This study describes the impact of monocular (M/O) and binocular (B/O) visual function decline, primarily the contrast sensitivity (CS) and visual field (VF) defect severity and its location, on the subjective perception of quality of life (QoL) among the Indian glaucoma population with spared central acuity.

Aim:

To investigate the influence of M/O and B/O visual function parameters on vision-related QoL (VRQoL) in glaucoma with spared central visual acuity.

Materials and Methods:

Glaucoma subjects underwent M/O and B/O visual acuity, CS assessment, followed by the M/O perimetry from which the integrated VF was estimated (B/O summation method). VRQoL was evaluated using the Glaucoma Quality Of Life-15 (GQL-15) and Visual Function Questionnaire–Utility Index (VFQ-UI) questionnaires. The relationship between CS and VF defect (VFD) with the composite VRQoL scores was analyzed.

Results:

A total of 154 glaucoma subjects with a median age of 61 (range: 24–83) years were enrolled. Subjects with severe VFD reported poor composite scores for GQL-15 and VFQ-UI when compared with unilateral and mild groups (P < 0.001, Dunn post hoc). Both the composite scores were negatively correlated with M/O and B/O CS and VF mean deviation (r range: −0.3 to −0.5, P < 0.001, Spearman rank correlation). B/O VFD in the inferior central zone contributed to poor GQL-15 score [odds ratio: 1.14 (95% CI: 1.10–1.29), P = 0.04] irrespective of sex, whereas females with increasing B/O VFD reported poor QoL score in VFQ-UI [odds ratio: 4.09 (95% CI: 1.77–9.43), p=0.003].

Conclusions:

Poor GQL-15 and VFQ-UI scores were reported with increasing disease severity. B/O VFD in the inferior central region was found to contribute predominantly to the poor GQL-15 scores while both disease severity and sex influenced VFQ-UI scores.
Optical Coherence Tomography–Derived Measurements of the Optic Nerve Head Structure of Aboriginal and Torres Strait Islander Children
Authors: Cox Rebecca A. , Read Scott A. , Hopkins Shelley , Alonso-Caneiro David , Wood Joanne M.
Published: July 2023

Précis:

This study demonstrated significant differences in optic nerve head characteristics in Aboriginal and Torres Strait Islander children compared with non-Indigenous children, which has implications for glaucoma risk and diagnosis in Aboriginal and Torres Strait Islander populations.

Purpose:

The purpose of this study was to examine the optic nerve head (ONH) characteristics of visually normal Aboriginal and Torres Strait Islander children and non-Indigenous Australian children.

Materials and Methods:

Spectral domain optical coherence tomography imaging was performed on the right eye of 95 Aboriginal and Torres Strait Islander children and 149 non-Indigenous Australian children (5–18 years). Horizontal and vertical line scans, centered on the ONH, were analyzed to determine the dimensions of the ONH (Bruch membrane opening diameter), optic cup diameter, Bruch membrane opening minimum rim width, and the peripapillary retinal nerve fiber layer thickness.

Results:

The vertical but not horizontal Bruch membrane opening diameter of Aboriginal and Torres Strait Islander children was significantly larger than non-Indigenous children (mean difference: 0.09 mm, P = 0.001). The horizontal (mean difference: 0.12 mm, P = 0.003) and vertical cup diameter (mean difference: 0.16 mm, P < 0.001) were also significantly larger in Aboriginal and Torres Strait Islander children, as were the horizontal and vertical cup-to-disc ratios (both P < 0.01). Aboriginal and Torres Strait Islander children also had a significantly thinner Bruch membrane opening minimum rim width in the superior, nasal, and temporal meridians (all P < 0.001). Peripapillary retinal nerve fiber layer thickness did not differ between groups.

Conclusions:

Differences exist in the ONH structure between Aboriginal and Torres Strait Islander children and non-Indigenous children, which may have implications for the detection and monitoring of ocular disease in this population and highlights the need to extend this research to the adult population.
Cytomegalovirus Active Infection in Critically Ill Children
Authors: Schwab Sarah Cazella , Yamamoto Aparecida Yulie , Aragon Davi Casale , Carlotti Ana Paula de Carvalho Panzeri
Published: July 2023

Objective:

To describe the epidemiology, clinical characteristics and outcomes of children with cytomegalovirus (CMV) active infection in the pediatric intensive care unit (PICU) and to investigate risk factors for mortality.

Methods:

This was a retrospective cohort study of patients who had CMV DNA detected in blood samples and/or tracheal aspirates by polymerase chain reaction (PCR) during stay at 2 PICUs of a university hospital. Suspected cases without etiological confirmation and patients with laboratory-confirmed CMV infection before PICU admission were excluded.

Results:

Demographic, clinical and outcome data were collected from medical records. From January 1, 2012, to December 31, 2019, 4748 children were admitted to the PICUs. Thirty-five (0.74%; 95% CI 0.51%–1.02%) had laboratory-confirmed CMV active infection; 71.4% were immunocompromised and 11 (31.4%) died. Patients who died were older than those who survived (median age 65 vs. 5.5 months, respectively; P = 0.048), and they received antiviral therapy for a shorter time (median 12 vs. 23 days, respectively; P = 0.001). The main causa mortis was septic shock (82%) and in most deceased patients (73%) the last CMV PCR before death was positive. PELOD score >6 was a risk factor for death (RR 2.96; 95% CI 1.07–8.21). Viral load in blood had a poor ability for the prediction of death (area under the receiver operating characteristic curve 0.62; 95% CI 0.37–0.84).

Conclusions:

The incidence of CMV active infection during PICU stay was 0.74% in an upper-middle income country with a high CMV seroprevalence. PELOD score higher than 6 was a risk factor for death. No association was observed between CMV viral load and mortality.
Hospitalizations and Clinical Severity of COVID-19 Among Infants Under 1-Year-old
Authors: Alshech Roy , Shoob Hanna , Stein-Zamir Chen
Published: July 2023

This study evaluated COVID-19 hospitalizations and clinical severity in infants (<1-year-old, n = 2,667), March 2020–March 2021. Hospitalizations were associated with younger age [OR (95%CI): <1 month, 26.3 (16.1–43.1), 1–2 months, 4.7 (3.1–7.34), 3–11 months, 1.0 (referece, 1.0–1.0)] and symptomatic disease, mainly with fever. Moderate-severe COVID-19 disease was associated with infants age above 3 months [OR (95% CI): 4.0 (1.4–11.1)], ethnicity and underlying conditions.
The changing employment of physicians, nurse practitioners, and physician associates/assistants
Authors: Hooker Roderick S. , Christian Robert L.
Published: July 2023

Information on the employment of patient-care clinicians is needed for policy planning and human resource management. The 2021 Bureau of Labor Statistics employment data were probed for occupational settings of 698,700 physicians and surgeons, 246,690 nurse practitioners (NPs), and 139,100 physician associates/assistants (PAs). These three health care professionals accounted for approximately 1.1 million medical and surgical clinicians serving a US population of 331.5 million. Clinician demographics differ—in 2021, the median age of physicians was 45 years; NPs, 43 years; and PAs, 39 years. The largest employment location is “office of a physician” (physician, 53%; NP, 47%; PA, 51%), followed by hospitals (physician, 25%; NP, 25%; PA, 23%), and outpatient centers (physician, 4%; NP, 9%; PA, 10%). The 10-year job outlook predicts physician growth at 3%, NPs at 46%, and PAs at 28%. NP and PA employment is growing more than physicians because of constrained physician postgraduate education funding. Other factors influencing employment changes include medical practice mergers, the rising value of team-based care, the cost of new medical schools, and task shifting.
Machine Learning Predicts Patients With New-onset Diabetes at Risk of Pancreatic Cancer
Authors: Khan Salman , Bhushan Bharath
Published: July 2023

Background:

New-onset diabetes represent a high-risk cohort to screen for pancreatic cancer.

Goals:

Develop a machine model to predict pancreatic cancer among patients with new-onset diabetes.

Study:

A retrospective cohort of patients with new-onset diabetes was assembled from multiple health care networks in the United States. An XGBoost machine learning model was designed from a portion of this cohort (the training set) and tested on the remaining part of the cohort (the test set). Shapley values were used to explain the XGBoost’s model features. Model performance was compared with 2 contemporary models designed to predict pancreatic cancer among patients with new-onset diabetes.

Results:

In the test set, the XGBoost model had an area under the curve of 0.80 (0.76 to 0.85) compared with 0.63 and 0.68 for other models. Using cutoffs based on the Youden index, the sensitivity of the XGBoost model was 75%, the specificity was 70%, the accuracy was 70%, the positive predictive value was 1.2%, and the negative predictive value was >99%. The XGBoost model obtained a positive predictive value of at least 2.5% with a sensitivity of 38%. The XGBoost model was the only model that detected at least 50% of patients with cancer one year after the onset of diabetes. All 3 models had similar features that predicted pancreatic cancer, including older age, weight loss, and the rapid destabilization of glucose homeostasis.

Conclusion:

Machine learning models isolate a high-risk cohort from those with new-onset diabetes at risk for pancreatic cancer.
Malnutrition in aged care: interplay between dysphagia and diet
Authors: Wu Xiaojing Sharon , Miles Anna , Braakhuis Andrea
Published: July 2023

Purpose of review

This review aims to deliver expert insights on the current advances and challenges in managing malnutrition in aged care settings, with a specific emphasis on the interaction between dysphagia and diet.

Recent findings

Several reviews identify the high prevalence of dysphagia in aged care facilities and highlight the correlation between dysphagia and malnutrition. Recent studies underscore the importance of nutrition and cancer screening and assessment, yet highlight the lack of consensus on the definitive tools to be used. There is a growth in employing innovative implementations for enhancing swallowing function and optimizing texture-modified foods.

Early identification and strategic interventions are vital for managing malnutrition and dysphagia in aged care facilities, as these conditions are widespread and lead to a higher risk of complications. Although nutritional strategies have shown potential in enhancing oral intake for residents requiring texture-modified foods, lack of investigation on functional outcomes and long-term impact have been highlighted, emphasizing the need for continued research and development of effective assessment tools and targeted interventions to optimize the care for this at-risk group.
EARLY PREDICTION OF UNEXPECTED LATENT SHOCK IN THE EMERGENCY DEPARTMENT USING VITAL SIGNS
Authors: Chang Hansol , Jung Weon , Ha Juhyung , Yu Jae Yong , Heo Sejin , Lee Gun Tak , Park Jong Eun , Lee Se Uk , Hwang Sung Yeon , Yoon Hee , Cha Won Chul , Shin Tae Gun , Kim Taerim
Published: July 2023

Objective/Introduction: Sequential vital-sign information and trends in vital signs are useful for predicting changes in patient state. This study aims to predict latent shock by observing sequential changes in patient vital signs. Methods: The dataset for this retrospective study contained a total of 93,194 emergency department (ED) visits from January 1, 2016, and December 31, 2020, and Medical Information Mart for Intensive Care (MIMIC)-IV-ED data. We further divided the data into training and validation datasets by random sampling without replacement at a 7:3 ratio. We carried out external validation with MIMIC-IV-ED. Our prediction model included logistic regression (LR), random forest (RF) classifier, a multilayer perceptron (MLP), and a recurrent neural network (RNN). To analyze the model performance, we used area under the receiver operating characteristic curve (AUROC). Results: Data of 89,250 visits of patients who met prespecified criteria were used to develop a latent-shock prediction model. Data of 142,250 patient visits from MIMIC-IV-ED satisfying the same inclusion criteria were used for external validation of the prediction model. The AUROC values of prediction for latent shock were 0.822, 0.841, 0.852, and 0.830 with RNN, MLP, RF, and LR methods, respectively, at 3 h before latent shock. This is higher than the shock index or adjusted shock index. Conclusion: We developed a latent shock prediction model based on 24 h of vital-sign sequence that changed with time and predicted the results by individual.
Impact of the Surgical Approach for Neoadjuvantly Treated Gastro-Esophageal Junction type II Tumors- a Multi-National, High-Volume Center Retrospective Cohort Analysis
Authors: Wirsik Naita M. , Schmidt Thomas , Nienhüser Henrik , Donlon Noel E. , de Jongh Cas , Uzun Eren , Fuchs Hans F. , Brunner Stefanie , Alakus Hakan , Grimminger Peter , Schneider Martin , Reynolds John V. , van Hillegersberg Richard , Bruns Christiane J.
Published: July 2023

Objective:

To explore oncologic outcomes of transhiatal gastrectomy (THG) or transthoracic esophagectomy (TTE) for neoadjuvantly treated gastroesophageal junction (GEJ) Siewert type II adenocarcinomas, a multi-national, high-volume center cohort analysis was undertaken.

Background:

Neoadjuvant radiochemotherapy (RCTx) or perioperative chemotherapy (CTx) followed by surgery is the standard therapy for locally advanced GEJ. However, the optimal surgical approach for type II GEJ tumors remains unclear, as the decision is mainly based on individual experience and assessment of operative risk.

Methods:

A retrospective analysis of five prospectively maintained databases was conducted. Between 2012-2021, 800 patients fulfilled inclusion criteria for type II GEJ tumors and neoadjuvant RCTx or CTx. The primary endpoint was median overall survival (mOS). Propensity score matching (PSM) was performed to minimize selection bias.

Results:

Patients undergoing THG (n=163, 20.4%) had higher ASA classification and cT-stage (P<0.001) than patients undergoing TTE (n=637, 79.6%). Neoadjuvant therapy was different as the THG-group were mainly undergoing CTx (87.1%,P<0.001). The TTE-group showed higher tumor regression (P=0.009), lower ypT-/ypM-categories (bothP<0.001), higher nodal yield (P=0.009) and higher R0-resection rate (P=0.001). The mOS after TTE was longer (78.0 versus 40.0 months (P=0.013). After PSM a higher R0-resection rate (P=0.004) and mOS benefit after TTE remained (P=0.04). Subgroup analyses of patients without distant metastasis (P=0.037) and patients only after neoadjuvant chemotherapy (P=0.021) confirmed the survival benefit of TTE. TTE was an independent predictor of longer survival.

Conclusions:

Awaiting results of the randomized CARDIA-trial, TTE should in high-volume centers be considered the preferred approach due to favorable oncologic outcomes.
Living Donor Liver Transplantation (LDLT) for Hepatocellular Carcinoma (HCC) within and Outside Traditional Selection Criteria
Authors: Ivanics Tommy , Claasen Marco PAW , Samstein Benjamin , Emond Jean C , Fox Alyson N , Pomfret Elizabeth , Pomposelli James , Tabrizian Parissa , Florman Sander S , Mehta Neil , Roberts John P , Emamaullee Juliet A , Genyk Yuri , Hernandez-Alejandro Roberto , Tomiyama Koji , Sasaki Kazunari , Quintini Cristiano , Nagai Shunji , Abouljoud Marwan , Olthoff Kim M , Hoteit Maarouf A , Heimbach Julie , Taner Timucin , Liapakis AnnMarie H , Mulligan David C , Sapisochin Gonzalo , Halazun Karim J
Published: July 2023

Objective:

We evaluated long-term oncologic outcomes of patients post-LDLT within and outside standard transplant selection criteria and the added value of the incorporation of the New York-California (NYCA) score.

Summary Background Data:

LDLT offers an opportunity to decrease the liver transplant waitlist, reduce waitlist mortality and expand selection criteria for patients with HCC.

Methods:

Primary adult LDLT recipients between Oct-1999 and Aug-2019 were identified from a multicenter cohort of twelve North American centers. Post-transplant and recurrence-free survival were evaluated using the Kaplan-Meier method.

Results:

Three-hundred-and-sixty LDLTs were identified. Patients within Milan criteria (MC) at transplant had a 1-,5-, and 10-year post-transplant survival of 90.9%,78.5%, and 64.1% vs. outside MC 90.4%,68.6%, and 57.7%(P=0.20). For patients within the UCSF criteria, respective post-transplant survival was 90.6%,77.8%, and 65.0%, vs. outside UCSF 92.1%,63.8%, and 45.8%(P=0.08). Fifty-three (83%) patients classified as outside MC at transplant would have been classified as either low- or acceptable risk with the NYCA score. These patients had a 5-year OS of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplant would have been classified as low- or acceptable risk with a 5-year OS of 65.3%.

Conclusions:

Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-years rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.
Western Diet Induced Transcriptional Changes in Anastomotic Tissue is Associated with Early Local Recurrence in a Mouse Model of Colorectal Surgery
Authors: Vigneswaran Janani , Keskey Robert C. , Morgan Ryan B. , Alverdy John C. , Alpert Lindsay , Chang Eugene , Weichselbaum Ralph , Zaborina Olga , Shogan Benjamin D.
Published: July 2023

Objective:

To determine the timeframe and associated changes in the microenvironment that promote the development of a diet-induced local-regional recurrence in a mouse model of colorectal surgery.

Summary Background Data:

Postoperative recurrence and metastasis occur in up to 30% of patients undergoing attempted resection for colorectal cancer (CRC). The underlying mechanisms that drive the development of postoperative recurrences are poorly understood. Preclinical studies have demonstrated a diet and microbial-driven pathogenesis of local-regional recurrence, yet the precise mechanisms remain undefined.

Methods:

BALB/C mice were fed a western (WD) or standard diet (SD), underwent a colon resection and anastomosis, given anEnterococcusfaecalis enema on post-operative day (POD) 1, and subjected to a CT26 cancer cell enema (mimicking shed cancer cells) on POD 2. Mice were sacrificed between POD3-7 and cancer cell migration was tracked. Dynamic changes in gene expression of anastomotic tissue that were associated with cancer cell migration was assessed.

Results:

Tumor cells were identified in mice fed either a SD or WD in both anastomotic and lymphatic tissue as early as on POD3. Histology demonstrated that these tumor cells were viable and replicating. In WD fed mice, the number of tumor cells increased over the early perioperative period and was significantly higher than in mice fed a SD. Microarray analysis of anastomotic tissue found that WD fed mice had 11 dysregulated genes associated with tumorigenesis.

Conclusions:

A WD promotes cancer cells to permeate a healing anastomosis and migrate into anastomotic and lymphatic tissue forming viable tumor nodules. These data offer a novel recurrence pathogenesis by which the intestinal microenvironment promotes a CRC local-regional recurrence.
A Prognostic Model To Predict Survival After Recurrence Among Patients With Recurrent Hepatocellular Carcinoma
Authors: Moazzam Zorays , Alaimo Laura , Endo Yutaka , Lima Henrique A. , Woldesenbet Selamawit , Rueda Belisario Ortiz , Yang Jason , Ratti Francesca , Marques Hugo P , Cauchy Francois , Lam Vincent , Poultsides George A , Popescu Irinel , Alexandrescu Sorin , Martel Guillaume , Guglielmi Alfredo , Hugh Tom , Aldrighetti Luca , Shen Feng , Endo Itaru , Pawlik Timothy M
Published: July 2023

Objective:

We sought to develop and validate a preoperative model to predict survival after recurrence (SAR) in hepatocellular carcinoma (HCC).

Summary Background Data:

Although HCC is characterized by rates of recurrence as high as 60%, models to predict outcomes after recurrence remain relatively unexplored.

Methods:

Patients who developed recurrent HCC between 2000-2020 were identified from an international multi-institutional database. Clinicopathologic data on primary disease, and laboratory and radiologic imaging data on recurrent disease were collected. Multivariable cox regression analysis and internal bootstrap validation (5,000 repetitions) were used to develop and validate the SARScore. Optimal Survival Tree (OST) analysis was used to characterize SAR among patients treated with various treatment modalities.

Results:

Among 497 patients who developed recurrent HCC, median SAR was 41.2 months (95% CI 38.1–52.0). Presence of cirrhosis, number of primary tumors, primary macrovascular invasion, primary R1 resection margin, AFP>400 ng/mL on diagnosis of recurrent disease, radiologic extrahepatic recurrence, radiologic size and number of recurrent lesions, radiologic recurrent bilobar disease and early recurrence (≤24 months) were included in the model. The SARScore successfully stratified 1-, 3- and 5-year SAR and demonstrated strong discriminatory ability (3-year AUC: 0.75, 95% CI 0.70–0.79). While a subset of patients benefitted from resection/ablation, OST analysis revealed that patients with high SARScore disease had the worst outcomes (5-year AUC; training: 0.79 vs. testing: 0.71). The SARScore model was made available online for ease-of-use and clinical applicability (https://yutaka-endo.shinyapps.io/SARScore/).

Conclusion:

The SARScore demonstrated strong discriminatory ability and may be a clinically useful tool to help stratify risk and guide treatment for patients with recurrent HCC.
Different Approaches of Laparoscopic Mesohepatectomy for Centrally Located Hepatocellular Carcinomas
Authors: Hongpeng Chu , Guannan Wang , Shangfei Pan , Zhengchao Shen , Yongyou Wang , Xiaoming Wang
Published: July 2023

Background:

This study aimed to describe a simple and novel positional classification system for centrally located hepatocellular carcinoma (CL-HCC), based on which different surgical approaches for laparoscopic mesohepatectomy (LMH) were chosen.

Materials and Methods:

The data of patients with CL-HCC who underwent LMH between January 2017 and December 2021 were retrospectively analyzed. The positional classification method was used to locate tumors. In addition, different approaches were used during the surgery according to the classification type.

Results:

All 98 patients underwent LMH, of whom 4 were converted to open surgery. Types I, Ⅱ, and Ⅲ were 24, 37, and 37, respectively. Blood transfusions were performed in only 7 patients, of which the amount was 800 (600, 900) mL. All the patients underwent R0 resection. The complication rate was 9.2% in all cases. No deaths occurred.

Conclusions:

Our proposed classification system and corresponding surgical approach in LMH is conducive to the successful completion of surgery.
Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery
Authors: Walton Gregory F. , Broussard Toby D.
Published: July 2023

Background:

As laparoscopic bariatric surgical techniques have matured, the incidence of complications has decreased over time. Surgical stapling devices are commonly used for resection and anastomosis of gastric tissue during bariatric surgery. The purpose of this study is to assess and compare complication rates and clinical outcomes between patient cohorts using 2 different approved stapling devices.

Materials and Methods:

Clinical outcomes were retrospectively compared for patients undergoing bariatric surgery between April 2019 and December 2020 using laparoscopic surgical stapling device A (LSSD-A) against outcomes between January 2017 and September 2018 using laparoscopic surgical stapling device B (LSSD-B). Tradenames for LSSD-A and LSSD-B were AEON Endostapler and Endo GIA with Tri-Staple Technology, respectively.

Results:

In all, 814 patients underwent laparoscopic bariatric operation using LSSD-A and 1034 using LSSD-B. Laparoscopic surgery included sleeve gastrectomy (n=1359, 73.5%), Roux-en-Y gastric bypass (RYGB) (n=425, 23.0%), and single anastomosis duodenoileostomy with gastric sleeve (n=64, 3.5%). Stapler-related complications were evenly distributed over the 20.9-month LSSD-B study period. No stapler-related complications were seen in the last 13 months of the LSSD-A study period, during which time 428 (52.5%) laparoscopic bariatric operations were performed. One staple line leak was observed, occurring in the LSSD-B group. Patients undergoing laparoscopic RYGB with LSSD-A had fewer overall complications, fewer transfusions, and fewer reoperations for staple line bleeding.

Conclusions:

Both LSSD-A and LSSD-B were safe and effective in the performance of laparoscopic bariatric operations with low complication rates and comparable clinical performance in sleeve gastrectomy and single anastomosis duodenoileostomy with gastric sleeve. Statistically significant differences in complication rates were observed in RYGB favoring LSSD-A.
Retinal Thickness in Essential Tremor and Early Parkinson Disease: Exploring Diagnostic Insights
Authors: Terravecchia Claudio , Mostile Giovanni , Chisari Clara G. , Rascunà Cristina , Terranova Roberta , Cicero Calogero E. , Giuliano Loretta , Donzuso Giulia , Sciacca Giorgia , Luca Antonina , Preux Pierre-Marie , Jankovic Joseph , Zappia Mario , Nicoletti Alessandra
Published: July 2023

Background:

Essential tremor (ET) represents a heterogeneous condition which may overlap with Parkinson disease (PD) even at early stages, by sharing some subtle clinical aspects. Longstanding ET demonstrated also higher risk of developing PD, especially with a Tremor-dominant (TD-PD) phenotype. Therefore, differential diagnosis between ET and early PD could be quite challenging. Optical coherence tomography (OCT) has been recognized as a reliable tool to assess the retina as a proxy of neurodegeneration. We aimed to explore the possible role of retinal assessment in differential diagnosis between ET and early PD.

Methods:

Macular layers and peripapillary retinal nerve fiber layer (RNFL) thickness among ET, early PD, and healthy controls (HCs) were assessed using OCT.

Results:

Forty-two eyes from 23 ET, 41 eyes from 21 early PD, and 33 eyes from 17 HCs were analyzed. Macular RNFL, ganglion cell layer, inner plexiform layer, and inner nuclear layer were thinner in PD as compared with ET and even more in HCs. Differences between ET and PD were more evident when considering the TD-PD subgroup, especially for RNFL. Among ET patients, thickness of the inner macular layers showed negative linear relationship with both age at onset and disease duration. Peripapillary temporal quadrant thinning was found in ET compared with HCs.

Conclusions:

Macular inner retina was thinner in patients with ET and early PD compared with HCs. These findings suggest that the retinal assessment may have a utility in the differential diagnosis between ET and PD.
Perivascular and peribronchiolar granuloma-associated lymphoid tissue and B-cell gene expression pathways identify asymptomaticMycobacterium tuberculosislung infection in Diversity Outbred mice
Authors: Koyuncu Deniz , Tavolara Thomas , Gatti Daniel M. , Gower Adam C. , Ginese Melanie L. , Kramnik Igor , Yener Bülent , Niazi Muhammad Khalid Khan , Gurcan Metin , Alsharaydeh Anas , Beamer Gillian
Published: July 2023

Humans are highly genetically diverse, and most are resistant toMycobacterium tuberculosis.However, lung tissue from genetically resistant humans is not readily available to identify potential mechanisms of resistance. To address this, we modelM. tuberculosisinfection in Diversity Outbred mice. Like humans, Diversity Outbred mice also exhibit genetically determined susceptibility toM. tuberculosisinfection: Progressors who succumb within 60 days of a low dose aerosol infection due to acute necrotizing granulomas, and Controllers who maintain asymptomatic infection for at least 60 days, and then develop chronic pulmonary TB with occasional necrosis and cavitation, over months to greater than 1 year. Here, we identified specific regions of granuloma-associated lymphoid tissue (GrALT) and B-cell gene expression pathways as key features of asymptomatic lung infection using cytokine, antibody, granuloma image, and gene expression datasets. Cytokines and anti-M. tuberculosiscell wall antibodies discriminated acute vs chronic pulmonary TB but not asymptomatic lung infection. To find unique features of asymptomatic lung infection, we trained a weakly supervised, deep-learning neural network on lung histology images. The neural network accurately produced an interpretable imaging biomarker: perivascular and bronchiolar lymphocytic cuffs, a type of GrALT. We expected CD4 T cell genes would be highly expressed in asymptomatic lung infection. However, the significantly different, highly expressed genes in lungs of asymptomatically infected Diversity Outbred mice corresponded to B-cell activation, proliferation, and antigen-receptor signaling, includingFcrl1, Cd79, Pax5, Cr2,andMs4a1. Overall, our results suggest that genetically controlled B-cell responses are important for establishing asymptomaticM. tuberculosislung infection.