bluuebunny/crossref_metadata_2025 huggingface dataset:
Tyrosine Kinase-2 Inhibitor (Deucravacitinib) for Psoriasis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Authors: Mahmoud Abdelrahman , Ahmed Ali A. S. , Naeem Ahmed , Abuelazm Mohamed , Elshinawy Mahmoud , Hassan Abdul Rhman , Rezq Hazem , Abdelazeem Basel
Published: July 2024

Objective:

Deucravacitinib is a tyrosine kinase-2 inhibitor that shows promise as an emerging treatment option for psoriasis. We aimed to evaluate the efficacy and safety of different doses of deucravacitinib vs. placebo or apremilast on psoriasis treatment.

Methods:

We performed a systematic review and pairwise and network meta-analyses of randomized controlled trials published in Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane Central databases from the inception of databases until March 31, 2023. We used the risk ratio for dichotomous outcomes, and the mean difference with corresponding 95% confidence interval for continuous outcomes. We registered our protocol in PROSPERO (ID: CRD42023413976).

Results:

We analyzed 4 randomized controlled trials involving 2,156 patients randomly assigned to receive placebo, 60 mg of apremilast once daily, or various doses of deucravacitinib (3 mg every other day, 3 mg once daily, 3 mg twice daily, 6 mg twice daily, or 12 mg once daily). Deucravacitinib achieved significantly better outcomes compared with placebo across multiple efficacy measures, including the Psoriasis Area and Severity Index score (P < 0.01), Static Physician’s Global Assessment score (P < 0.01), Psoriasis Symptoms and Signs Diary score (P < 0.01), Dermatology Life Quality Index score (P < 0.01), and scalp-specific Physician’s Global Assessment score (P < 0.01). When comparing 3 mg of deucravacitinib twice daily with 60 mg of apremilast once daily, deucravacitinib exhibited superior outcomes in terms of the Psoriasis Area and Severity Index (P < 0.01), Dermatology Life Quality Index (P < 0.01), Static Physician’s Global Assessment (P < 0.01), and scalp-specific Physician’s Global Assessment scores (P < 0.01). Deucravacitinib and apremilast were associated with a higher incidence of adverse events compared with placebo, including diarrhea, nausea, headache, and infections. However, no significant differences were observed between interventions regarding serious adverse events or adverse events leading to discontinuation.

Conclusion:

Deucravacitinib and apremilast show promising efficacy as psoriasis treatments. While adverse events were more common with these treatments compared with placebo, the incidence of serious adverse events did not significantly differ between the intervention and placebo groups.
Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Systematic Review of Case Reports
Authors: Trieu Ngan Hoang Kim , Nguyen Nam Nhat , Pham Huy Minh , Huynh Dai Quang , Mai Anh Tuan
Published: July 2024

Amniotic fluid embolism (AFE) is an obstetric complication that can result in acute circulatory failure during and after labor. The effectiveness of extracorporeal membrane oxygenation (ECMO) in AFE patients has not been established, especially in the context of coagulopathy. This review aims to evaluate the efficacy of ECMO support in AFE patients. We conducted a systematic review of case reports following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was performed using a standardized tool. Out of 141 studies screened, 33 studies included 79 AFE patients. The median age was 34 years, and the median gestational age was 37.5 weeks. The majority of AFE cases occurred during cesarean section delivery (55.2%), followed by labor before fetal delivery (26.7%). Extracorporeal membrane oxygenation configurations included venoarterial ECMO (81.3%) and extracorporeal cardiopulmonary resuscitation (CPR, 10.7%). The maternal survival rate was 72%, with 21.2% experiencing minor neurological sequelae and 5.8% having major neurological sequelae. Rescue ECMO to support circulation has demonstrated both safety and efficacy in managing AFE. We suggest early activation of local or mobile ECMO as soon as an AFE diagnosis is established. Further studies are needed to assess the benefits and implications of early ECMO support in AFE patients.
Development of Data Quality Indicators for Improving Hospital International Classification of Diseases–Coded Health Data Quality Globally
Authors: Otero-Varela Lucía , Sandhu Namneet , Walker Robin L. , Southern Danielle A. , Quan Hude , Eastwood Cathy A.
Published: July 2024

Background:

Hospital inpatient data, coded using the International Classification of Diseases (ICD), is widely used to monitor diseases, allocate resources and funding, and evaluate patient outcomes. As such, hospital data quality should be measured before use; however, currently, there is no standard and international approach to assess ICD-coded data quality.

Objective:

To develop a standardized method for assessing hospital ICD-coded data quality that could be applied across countries: Data quality indicators (DQIs).

Research Design:

To identify a set of candidate DQIs, we performed an environmental scan, reviewing gray and academic literature on data quality frameworks and existing methods to assess data quality. Indicators from the literature were then appraised and selected through a 3-round Delphi process. The first round involved face-to-face group and individual meetings for idea generation, while the second and third rounds were conducted remotely to collect online ratings. Final DQIs were selected based on the panelists’ quantitative and qualitative feedback.

Subjects:

Participants included international experts with expertise in administrative health data, data quality, and ICD coding.

Results:

The resulting 24 DQIs encompass 5 dimensions of data quality: relevance, accuracy and reliability; comparability and coherence; timeliness; and Accessibility and clarity. These will help stakeholders (eg, World Health Organization) to assess hospital data quality using the same standard across countries and highlight areas in need of improvement.

Conclusions:

This novel area of research will facilitate international comparisons of ICD-coded data quality and be valuable to future studies and initiatives aimed at improving hospital administrative data quality.
The Potential Clinical Benefits of Direct Surgical Transgastric Pancreatic Necrosectomy for Patients With Infected Necrotizing Pancreatitis
Authors: Timmerhuis Hester C. , Ngongoni Rejoice F. , Li Amy , McGuire Sean P. , Lewellen Kyle A. , Dua Monica M. , Chughtai Komal , Zyromski Nicholas J. , Visser Brendan C.
Published: July 2024

Objective

Surgical transgastric pancreatic necrosectomy (STGN) has the potential to overcome the shortcomings (ie, repeat interventions, prolonged hospitalization) of the step-up approach for infected necrotizing pancreatitis. We aimed to determine the outcomes of STGN for infected necrotizing pancreatitis.

Materials and Methods

This observational cohort study included adult patients who underwent STGN for infected necrosis at two centers from 2008 to 2022. Patients with a procedure for pancreatic necrosis before STGN were excluded. Primary outcomes included mortality, length of hospital and intensive care unit (ICU) stay, new-onset organ failure, repeat interventions, pancreatic fistulas, readmissions, and time to episode closure.

Results

Forty-three patients underwent STGN at a median of 48 days (interquartile range [IQR] 32–70) after disease onset. Mortality rate was 7% (n = 3). After STGN, the median length of hospital was 8 days (IQR 6–17), 23 patients (53.5%) required ICU admission (2 days [IQR 1–7]), and new-onset organ failure occurred in 8 patients (18.6%). Three patients (7%) required a reintervention, 1 (2.3%) developed a pancreatic fistula, and 11 (25.6%) were readmitted. The median time to episode closure was 11 days (IQR 6–22).

Conclusions

STGN allows for treatment of retrogastric infected necrosis in one procedure and with rapid episode resolution. With these advantages and few pancreatic fistulas, direct STGN challenges the step-up approach.
Metabolic Tumor Volume on 18-Fluorodeoxyglucose Positron Emission Tomography as a Prognostic Marker of Survival in Patients With Locally Advanced or Metastatic Neuroendocrine Neoplasms Treated With 177Lutetium-DOTA-Octreotate Peptide Receptor Radionuclide Therapy
Authors: De Silva Madhawa K. , Chan David L.H. , Bernard Elizabeth J. , Conner Alice J. , Mascall Sophie L. , Bailey Dale L. , Roach Paul J. , Clarke Stephen J. , Diakos Connie I. , Pavlakis Nick , Schembri Geoff
Published: July 2024

Objective

We investigated metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on pre-treatment FDG-PET as prognostic markers for survival in patients with metastatic neuroendocrine neoplasms (NENs) receiving peptide receptor radionuclide therapy (PRRT).

Methods

A retrospective review of patients with metastatic NENs receiving PRRT was undertaken. Pre-treatment FDG-PET images were analyzed and variables collected included MTV and TLG (dichotomized by median into high vs low). Main Outcomes were overall survival (OS) and progression-free survival (PFS) by MTV and TLG (high vs low).

Results

One hundred five patients were included. Median age was 64 years (50% male). Main primary NEN sites were small bowel (43.8%) and pancreas (40.0%). Median MTV was 3.8 mL and median TLG was 19.9. Dichotomization formed identical cohorts regardless of whether MTV or TLG were used. Median OS was 72 months; OS did not differ based on MTV/TLG high versus low (47.4 months vs not reached; hazard ratio, 0.43; 95% confidence interval [CI], 0.18–1.04; P = 0.0594). Median PFS was 30.4 months; PFS differed based on MTV/TLG high versus low (21.6 months vs 45.7 months; hazard ratio, 0.35; 95% CI, 0.19–0.64; P = 0.007).

Conclusions

Low MTV/TLG on pre-treatment FDG-PET was associated with longer PFS in metastatic NEN patients receiving PRRT.
From Their Perspective
Authors: Lapsa Julianne , O'Donnell Erin , Yanek Lisa , Ngo Thuy
Published: July 2024

Background

The pediatric emergency department (PED) is experiencing a rising volume of patients with mental health concerns, leading to prolonged boarding times and delays in initiating active therapeutic plans. A paucity of research exists for the self-reported pediatric patient experience during such boarding.

Objectives

To inform more individualized and patient-centered PED care for patients boarding for mental health admission, by learning the prior trauma experiences and patient perspective on prolonged PED mental health stays.

Methods

A convenience sample was collected at an urban hospital's PED among those boarding for mental health emergency greater than 24 hours. Demographic information, exposures to past trauma, and perceptions on and understanding of their care experience, were discussed. Descriptive and thematic content analysis were used for data analysis.

Results

A total of 99 youths were included in the study and the majority reported worsening mental health symptoms during PED boarding, notably increasing anxiety (72 [72.7%]). Patients were equivocal on efficacy of PED mental health intake on symptoms (41 [41.4%]). Personal suggestions were offered by these patients to guide the care of future children that would better mitigate their symptoms while boarding in the PED, such as group activities, electronics, and physical activity.

Discussion

Patients in mental health crisis boarding in the PED have already experienced stressful life events. By listening to the personal stories of this vulnerable population, the PED can improve care delivery and design a more therapeutic environment, especially as the need for acute mental health management continues to increase.
Infant Modified Constraint-Induced Movement Therapy Paired With Neuromuscular Electrical Stimulation: A Feasibility Study
Authors: Grinde Kathy , Myhre Jayne , Nickel Amanda , Finch Michael D.
Published: July 2024

Purpose:

To determine the feasibility of modified constraint-induced movement therapy (mCIMT) paired with neuromuscular electrical stimulation (NMES) for infants with asymmetrical hand function (AHF).

Methods:

Five infants received an experimental ABA design: (A1) 3 weeks of our Standard AHF Care, (B) 3 weeks mCIMT-NMES, and (A2) 3 weeks of our Standard AHF Care. Parents tracked key data in a daily log, and infants were assessed 4 times using the Hand Assessment for Infants and Peabody Developmental Motor Scale-2.

Results:

There was a high level of participant enrollment, visit frequency adherence, and compliance with the treatment protocol. No adverse events were reported. Mean Hand Assessment for Infants Both Hands measure scores changed more after mCIMT-NMES than after our Standard AHF Care.

Conclusions:

mCIMT-NMES is a feasible early intervention for infants with AHF at risk for unilateral cerebral palsy. A future study in a larger sample should examine the efficacy of mCIMT-NMES in this population.
Self-Collection for HPV Testing: Potential Issues Related to Performance Measures and Quality Improvement Among Federally Qualified Health Centers
Authors: Le Amanda , Wheeler Stephanie B. , Lafata Jennifer Elston , Teal Randall , Giannone Kara , Smith Liisa S. , Zaffino MaryShell , Smith Jennifer S.
Published: July 2024

Context:

Most incident cases of cervical cancer in the United States are attributable to inadequate screening. Federally qualified health centers (FQHCs) serve a large proportion of women who are low-income, have no insurance, and are underserved—risk factors for insufficient cervical cancer screening. FQHCs must maintain quality measures to preserve their accreditation, address financial reimbursements, and provide quality care. Implementation of human papillomavirus (HPV) self-collection can improve cervical cancer screening coverage within FQHCs.

Objectives:

To understand perspectives from clinical personnel on current cervical cancer screening rates at FQHCs in North Carolina and the impact of implementing HPV self-collection among underscreened patients on screening rates and performance measures.

Design:

The study used focus groups and key informant interviews. Coding-based thematic analysis was applied to both focus group and interview transcripts. Emergent themes regarding perspectives on self-collection implementation were mapped onto Consolidated Framework for Implementation Research (CFIR) constructs to identify future barriers and facilitators to implementation.

Setting:

Two FQHCs in North Carolina and a cloud-based videoconferencing platform.

Participants:

Six FQHCs in North Carolina; 45 clinical and administrative staff from the 6 FQHCs; 1 chief executive officer (n = 6), 1 senior-level administrator (n = 6), 1 chief medical officer (n = 6), and 1 clinical data manager (n = 6) from each FQHC.

Main Outcome Measure:

Achievement of clinical perspectives.

Results:

Societal-, practice-, and patient-level factors currently contribute to subpar cervical cancer screening rates. HPV self-collection was expected to improve screening uptake among underscreened women at FQHCs, and thus quality and performance measures, by offering an alternative screening approach for in-clinic or at-home use. Implementation barriers include financial uncertainties and HPV self-collection not yet a Food and Drug Administration–approved test.

Conclusion:

HPV self-collection has potential to improve cervical cancer screening quality and performance measures of FQHCs. For a successful implementation, multilevel factors that are currently affecting low screening uptake need to be addressed. Furthermore, the financial implications of implementation and approval of HPV self-collection as a test for cervical cancer screening quality measures need to be resolved.
Strengthening the US Public Health Lab System: Summary of Coronavirus Disease (COVID-19) After Action Review Workshop
Authors: Shelton Shoshana R. , Nelson Christopher D. , Sullivan Maureen , Wroblewski Kelly , Mueller Erik , Wolford Tyler
Published: July 2024

Context:

The COVID-19 pandemic highlighted the significance of public health laboratories across the United States, while also revealing weaknesses in the laboratory system.

Objective:

To identify actionable recommendations for building a more resilient public health laboratory system based on previously published lessons learned from COVID-19.

Design, Setting, and Participants:

In April 2023, the Association of Public Health Laboratories, in cooperation with RAND , convened a 1.5-day after action review workshop of approximately 30 public health laboratory stakeholders to reevaluate priorities, improve processes, and affect policies.

Main Outcome Measures:

Analysis of workshop discussions identified 5 priority areas and 19 recommendations related to clarifying laboratories’ unique role and promoting workforce capacity/agility, technology, and collaboration with governmental and nongovernmental partners.

Results:

Within the identified priority areas, workshop participants described how the recommendations would address challenges encountered during COVID-19 and contribute to strengthening the system.

Conclusions:

As the risk of novel infectious diseases persists and grows, the importance of maintaining laboratory response capabilities is likely to increase. Addressing the system’s weaknesses will require active engagement of laboratories and the many stakeholders who depend on them, along with consistent, adequate funding to strengthen and sustain capabilities.
Expected vs Reported Chronic Hepatitis B Infection Cases in Persons with Active Tuberculosis – California, 2016-2020
Authors: Bertumen J Bradford , Pascopella Lisa , Han Emily , Glenn-Finer Rosie , Wong Robert John , Chitnis Amit , Jaganath Devan , Jewell Mirna Ponce , Gounder Prabhu , McElroy Sara , Stockman Lauren , Barry Pennan
Published: July 2024

Epidemiologic data regarding persons with active tuberculosis (TB) and chronic hepatitis B virus (cHBV) infection are limited because of lack of routine surveillance of cHBV in persons with TB. Potential underdiagnosis of cHBV in California among those with TB is concerning. We matched TB and cHBV registries to identify cHBV infections among persons diagnosed with TB during 2016-2020 and described their demographic characteristics. We calculated expected cHBV cases among persons with TB for each demographic characteristic using published cHBV prevalence estimates for the locations of birth for persons with TB. Estimates were from general or emigrant adult and teen populations. Reported cHBV infection among persons with TB were 23% lower than expected, particularly among Asian persons, persons living in the two healthiest Healthy Places Index quartiles, and residents of less populated jurisdictions in California. Results show the possibility exists for underdiagnosis of cHBV in persons with TB in California.
Increasing Screening Rates for Comorbidities in Adolescents with Elevated Body Mass Index in Pediatric Primary Care
Authors: Karas David R. , Juszli Sharon , Walston Marnie , Love April , Bigham Michael T.
Published: July 2024

Introduction:

Adolescents with elevated body mass index are at increased risk for comorbidities such as dyslipidemia, diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease. Guideline-based screening can identify impacted patients early, allowing for lifestyle modifications and other treatments to improve long-term health. Unfortunately, only 20% of pediatric patients with obesity receive recommended screening.

Methods:

A multidisciplinary quality improvement team designed and implemented a project to improve comorbidity screening utilizing the Model for Improvement. Provider education and incentive, clinical decision support, and regular performance feedback were chosen as interventions. Screening rates were tracked on a statistical process control chart.

Results:

From March through December of 2022, 9547 pediatric patients aged 10 years and up with body mass index greater than or equal to the 95th percentile were seen for preventive care visits. Screening rates for comorbidities increased from a baseline of 19.5%–58% and were sustained for over 3 months. Numerous patients at risk for chronic disease were identified.

Conclusions:

Evidence-based clinical decision support, along with provider education and engagement, can effectively increase screening rates for comorbidities in pediatric patients with obesity.
Outcomes After Loss to Follow-Up for Pregnant and Postpartum Women Living With HIV and Their Children in Kenya: A Prospective Cohort Study
Authors: Humphrey John , Kipchumba Bett , Alera Marsha , Sang Edwin , Musick Beverly , Muli Lindah , Kipsang Justin , Songok Julia , Yiannoutsos Constantin , Wools-Kaloustian Kara
Published: July 2024

Background:

Many prevention of vertical transmission (PVT) studies assess outcomes within 12 months postpartum and exclude those lost to follow-up (LTFU), potentially biasing outcomes toward those retained in care.

Setting:

Five public facilities in western Kenya.

Methods:

We recruited women living with HIV (WLH) ≥18 years enrolled in antenatal clinic (ANC). WLH retained in care (RW) were recruited during pregnancy and followed with their children through 6 months postpartum; WLH LTFU (LW, last visit >90 days) after ANC enrollment and ≤6 months postpartum were recruited through community tracing. Recontact at 3 years was attempted for all participants. Primary outcomes were retention and child HIV-free survival. Generalized linear regression was used to estimated risk ratios (RRs) for associations with becoming LTFU by 6 months postpartum, adjusting for age, education, facility, travel time to facility, gravidity, income, and new vs. known HIV positive at ANC enrollment.

Results:

Three hundred thirty-three WLH (222 RW, 111 LW) were recruited from 2018 to 2019. More LW versus RW were newly diagnosed with HIV at ANC enrollment (49.6% vs. 23.9%) and not virally suppressed at study enrollment (40.9% vs. 7.7%). 6-month HIV-free survival was lower for children of LW (87.9%) versus RW (98.7%). At 3 years, 230 WLH were retained in care (including 51 previously LTFU before 6 months), 30 transferred, 70 LTFU, and 3 deceased. 3-year child HIV-free survival was 81.9% (92.0% for children of RW, 58.6% for LW), 3.7% were living with HIV, 3.7% deceased, and 10.8% had unknown HIV/vital status. Being newly diagnosed with HIV at ANC enrollment was the only factor associated with becoming LTFU (aRR 1.21, 95% CI: 1.11 to 1.31).

Conclusions:

Outcomes among those LTFU were worse than those retained in care, underscoring the importance of retention in PVT services. Some, but not all, LW re-engaged in care by 3 years, suggesting the need for PVT services must better address the barriers and transitions women experience during pregnancy and postpartum.
Advancing Medical Imaging Research Through Standardization
Authors: Jeon Kyulee , Park Woo Yeon , Kahn Charles E. , Nagy Paul , You Seng Chan , Yoon Soon Ho
Published: July 2024

Artificial intelligence (AI) has made significant advances in radiology. Nonetheless, challenges in AI development, validation, and reproducibility persist, primarily due to the lack of high-quality, large-scale, standardized data across the world. Addressing these challenges requires comprehensive standardization of medical imaging data and seamless integration with structured medical data.

Developed by the Observational Health Data Sciences and Informatics community, the OMOP Common Data Model enables large-scale international collaborations with structured medical data. It ensures syntactic and semantic interoperability, while supporting the privacy-protected distribution of research across borders. The recently proposed Medical Imaging Common Data Model is designed to encompass all DICOM-formatted medical imaging data and integrate imaging-derived features with clinical data, ensuring their provenance.

The harmonization of medical imaging data and its seamless integration with structured clinical data at a global scale will pave the way for advanced AI research in radiology. This standardization will enable federated learning, ensuring privacy-preserving collaboration across institutions and promoting equitable AI through the inclusion of diverse patient populations. Moreover, it will facilitate the development of foundation models trained on large-scale, multimodal datasets, serving as powerful starting points for specialized AI applications. Objective and transparent algorithm validation on a standardized data infrastructure will enhance reproducibility and interoperability of AI systems, driving innovation and reliability in clinical applications.
An Approach to Selection of Face-Lift Techniques for Different Types of Faces
Authors: Kim Do Gon , Lee Sung Ha , Bae Sung Gun
Published: July 2024

Background

A face-lift or rhytidectomy is the procedure most directly associated with rejuvenation. There are several surgical techniques for face-lifts, but criteria for the selection of techniques, based on the patient's face shape, are lacking. In this study, we report on our experience with specific indication criteria for each technique and the consequent achievement of good outcomes.

Methods

From 2015 to 2023, 1 surgeon performed face-lifts on 1000 patients. Three different superficial musculoaponeurotic system (SMAS) techniques (SMAS dissection, SMASectomy, and SMAS plication) were applied depending on the degree of sagging of the patient's lower face, lateral facial profile, and SMAS mobility and condition. Superficial musculoaponeurotic system dissection was considered for the improvement of a square face, sagging jowls, and marionette lines. Superficial musculoaponeurotic system plication was applied with patients with less sagging jowls and prominent zygoma with concave lateral facial profile. SMASectomy was applied with patients with convex lateral facial profiles or when the SMAS was too thin or damaged. Patient postoperative satisfaction was surveyed using the FACE-Q score 1 year post surgery.

Results

Most of the patients attained natural-looking and long-lasting aesthetic outcomes and exhibited high satisfaction. The patients indicated that they looked about 11.2 ± 5.2 years younger than their actual age after the surgery. The mean satisfaction scores for each facial feature were as follows: cheeks (91.1 ± 7.8), marionette lines (88.5 ± 13.6), lower face and jawline (92.5 ± 14.2), under chin (87.8 ± 15.1), and neck (86.2 ± 18.5). Complications such as facial nerve injury, infection, hematoma, and flap necrosis were very rare.

Conclusions

Establishing criteria for the selection of face-lift surgical techniques based on the degree of lower face sagging, lateral facial profile, and SMAS mobility and condition led to good outcomes. These criteria can be used by physicians to determine the most effective face-lift surgery technique based on a patient's individual features, which may improve surgical outcomes.
Limitations of Patient-Controlled Epidural Analgesia Following Abdominoplasty
Authors: Pfeiler Peter Paul , Rieder Paulina , Kimelman Michael , Moog Philipp , Dornseifer Ulf
Published: July 2024

Background

Effective postoperative pain management is essential for patient satisfaction and an uneventful postoperative course, particularly in body contouring procedures. Systemic analgesic regimens can be supported by regional procedures, such as the transverse abdominis plane (TAP) block, but these have a limited duration of action. In contrast, thoracic epidural analgesia offers the possibility of a longer-lasting, individualized regional anesthesia administered by a patient-controlled analgesia pump.

Objectives

The aim of this study was to investigate the effects of a patient-controlled epidural analgesia to better classify the clinical value of this procedure in abdominoplasties.

Materials and Methods

This work reviewed the digital medical charts of patients who underwent selective abdominoplasty without combined surgical procedures between September 2018 and August 2022. Evaluated data comprise the postoperative analgesia regimen, including on-demand medication, mobilization time, inpatient length of stay, and clinical outcome. The patients were grouped by the presence of a thoracic epidural catheter. This catheter was placed before anesthetic induction and a saturation dose was preoperatively applied. Postoperative PCEA patients received a basal rate and could independently administer boluses. Basal rate was individually adjusted during daily additional pain visits.

Results

The study cohort included 112 patients. Significant differences in the demand for supportive nonepidural opiate medication were shown between the patient-controlled epidural analgesia (PCEA) group (n = 57) and the non-PCEA group (n = 55), depending on the time after surgery. PCEA patients demanded less medication during the early postoperative days (POD 0: PCEA 0.13 (±0.99) mg vs non-PCEA 2.59 (±4.55) mg, P = 0.001; POD 1: PCEA 0.79 mg (±3.06) vs non-PCEA 2.73 (±3.98) mg, P = 0.005), but they required more during the later postoperative phase (POD 3: PCEA 2.76 (±5.60) mg vs non-PCEA 0.61 (±2.01) mg, P = 0.008; POD 4: PCEA 1.64 (±3.82) mg vs non-PCEA 0.07 (±2.01) mg, P = 0.003). In addition, PCEA patients achieved full mobilization later (PCEA 2.67 (±0.82) days vs non-PCEA 1.78 (±1.09) days, P = 0.001) and were discharged later (PCEA 4.84 (±1.23) days vs non-PCEA 4.31 (±1.37) days, P = 0.005).

Conclusion

Because the postoperative benefits of PCEA are limited to potent analgesia immediately after abdominoplasty, less cumbersome, time-limited regional anesthesia procedures (such as TAP block) appear not only adequate but also more effective.
The Satisfaction and Quality of Life of Patients After Breast Reconstruction
Authors: Alghamdi Hisham , Alhefdhi Amal , Fayi Khalid A. , Alshaalan Sultan F. , Alsuhaim Abdulaziz K. , Almutairi Rahaf H. , Alkilani Najla , Aolayan Hayfa , Awad Mohamed R.
Published: July 2024

Background

Breast reconstruction following mastectomy can be performed through various surgical techniques that prioritize the patient's safety and quality of life. Plastic surgeons are trained to choose the most appropriate surgical approach based on the individual patient's needs and medical history. The safety of the patient is always the primary concern, followed by considerations such as aesthetic outcomes and long-term health implications.

Objectives

The aim of this study was to assess and document patients' satisfaction and quality of life after breast reconstruction across Saudi Arabia.

Methods

This is a cross-sectional multicenter study among female patients who underwent mastectomy with or without breast reconstruction between 2015 and 2022. Two hundred eighty patients participated in this study through a call-based Arabic version of the BREAST-Q questionnaire to analyze the quality of their lives and satisfaction.

Results

Our results showed that patients who underwent delayed reconstruction had lower satisfaction than those who underwent immediate reconstruction. The average BREAST-Q score was lower in patients who used tissue expanders than those with implant-based reconstruction, autologous reconstruction, or combined approaches. Patients who underwent simple mastectomy had lower satisfaction (M = 66.1) than those who had a skin-sparing mastectomy (M = 71.1) and/or nipple-sparing mastectomy (M = 72.6).

Conclusions

This retrospective multicenter study observed a significant association between the time of the reconstructive surgery and patient's satisfaction; patients who underwent immediate reconstruction had higher satisfaction rate. Lower satisfaction rate was associated with tissue expander breast reconstruction. There is a significant association between satisfaction rate and smoking history.
The Most Cited Publications in Abdominal Wall Reconstruction—A Bibliometric Analysis
Authors: Daneshi Kian , Imantalab Kordmahaleh Delaram , Rupra Roshan S. , Butler Charles E. , Khajuria Ankur
Published: July 2024

Background

Abdominal wall reconstruction (AWR) is a treatment option for structural defects of the abdominal wall. The most frequently cited publications related to AWR have not been quantitatively or qualitatively assessed. This bibliometric analysis characterizes and assesses the most frequently cited AWR publications, to identify trends, gaps, and guide future efforts for the international research community.

Methods

The 100 most cited publications in AWR were identified on Web of Science, across all available journal years (from May 1964 to December 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence-Based Medicine levels of evidence (LOE) of each study were also assessed.

Results

The 100 most cited publications in AWR were cited by a total of 9674 publications. Citations per publication ranged from 43 to 414 (mean 96.7 ± 52.48). Most publications were LOE 3 (n = 60), representative of the large number of retrospective cohort studies. The number of publications for LOE 5, 4, 3, 2, and 1 was 21, 2, 60, 2, and 12, respectively. The main content focus was surgical technique in 44 publications followed by outcomes in 38 publications. Patient-reported outcome measures were used in 3 publications, and no publications reported validated esthetic outcome measures.

Conclusions

Overall, 3 was the LOE for most frequently cited AWR publications, with more publications below LOE 3 than above LOE 3. Validated outcome measures and patient-reported outcome measures were infrequently incorporated in the studies evaluated.
Nonbinary and Transgender Male Patient Preferences for Gender-Affirming Top Surgery
Authors: Schafer Rachel E. , Fodor R'ay , Marlar Riley , Jensen Kate K. , Meyers Abigail , Isakov Raymond , Ferrando Cecile , Rampazzo Antonio , Gharb Bahar Bassiri
Published: July 2024

Background

This study aimed to identify patient preferences and outcomes of chest masculinization surgery in patients identifying as nonbinary versus transgender (trans-) males.

Methods

Patients who underwent chest masculinization (2003–2022) were included. Demographics, medical comorbidities, surgical approaches, complications, secondary procedures, and BODY-Q chest module survey responses were compared between cohorts.

Results

Three hundred two patients were included. Thirteen percent identified as nonbinary and 87% as trans-male. The most common surgical approach in both groups was double incision with free nipple-areola graft (63% vs 71%, P = 0.33). Nonbinary patients more frequently opted for double incision without free nipple areola graft compared to trans-male patients (18% vs 2.7%, P < 0.001). Other unique surgical requests of nonbinary patients included nipple areola preservation and small breast mound preservation (5.2%) and balance between losing bulk and achieving a more androgynous appearance (5.3%). The survey response rate was 31% (93/302). Both groups reported improved quality of life postoperatively (P = 0.16). Three nonbinary patients elected not to keep their nipple-areola complexes (P = 0.005). Trans-male patients were more likely to report having a male chest as very important for their gender identity (82% vs 95%, P = 0.043). Nonbinary patients were less likely to prefer small nipples (82% vs 95%, P = 0.033) and 18% stated that they preferred no nipples (vs 2.7% trans-male patients, P < 0.001).

Conclusions

Nonbinary patients have distinct surgical preferences regarding nipple-areola complexes. Chest masculinization planning can differ for this group of patients compared to their trans-male counterparts.
Integral theorems for the gradient of a vector field, with a fluid dynamical application
Authors: Lilly Jonathan M. , Feske Joel , Fox-Kemper Baylor , Early Jeffrey J.
Published: July 2024

The familiar divergence and Kelvin–Stokes theorem are generalized by a tensor-valued identity that relates the volume integral of the gradient of a vector field to the integral over the bounding surface of the tensor product of the vector field with the exterior normal. The importance of this long-established yet relatively little-known result is discussed. In flat two-dimensional space, it reduces to a relationship between an integral over an area and that over its bounding curve, combining the two-dimensional divergence and Kelvin–Stokes theorems together with two related theorems involving the strain, as is shown through a decomposition using a suitable tensor basis. A fluid dynamical application to oceanic observations along the trajectory of a moving platform is given. The potential extension of the generalized two-dimensional identity to curved surfaces is considered and is shown not to hold. Finally, the paper includes a substantial background section on tensor analysis, and presents results in both symbolic notation and index notation in order to emphasize the correspondence between these two notational systems.
On the well-posedness of Eringen’s non-local elasticity for harmonic plane wave problems
Authors: Pham Chi Vinh , Vu Thi Ngoc Anh
Published: July 2024

In this paper, we establish a criterion for well-posedness of Eringen’s non-local elasticity theory for problems of harmonic plane waves in domains with non-empty boundaries, and introduce a novel method for solving well-posed problems. The criterion for well-posedness says that for problems of harmonic plane waves, Eringen’s non-local elasticity theory is well-posed when the constitutive boundary conditions contain all equilibrium boundary conditions, otherwise it is ill-posed in the sense of no solutions. With this well-posedness criterion, it is easy to check whether a non-local harmonic plane wave problem is well-posed or not. If it is a well-posed problem, its solution will be found by employing the novel method. It has been shown that Eringen’s method, which has been used widely to solve problems of non-local harmonic plane waves, does not give their correct solutions. Therefore, it must be replaced by the novel method. As an application of the criterion for well-posedness and the novel method, two well-posed problems of harmonic plane waves are considered including Rayleigh waves and SH waves propagating in traction-free non-local isotropic elastic half-spaces. Exact solutions of these problems have been obtained including explicit expressions of displacements, local and non-local stresses and dispersion equations.
Characteristics of soil origin Pseudomonas batumici Koz11 isolated from a remote island in Japan
Authors: Zuo Hui , Morimoto Yuh , Muroi Kenzo , Baba Tadashi
Published: July 2024

Soil samples from a remote Japanese island (Kozushima) were processed and investigated for organisms exhibiting antimicrobial activity against pathogenic strains. A Pseudomonas strain demonstrating antimicrobial activity against Staphylococcus aureus (S. aureus) was observed, leading to further investigation. Whole-genome sequencing was used to identify species and phylogenetic analysis, followed by in silico molecular analysis. Chemotaxonomic and biochemical analyses were conducted to characterize the strain further. Genomic analysis identified a strain of interest, Pseudomonas batumici (P. batumici), a strain initially isolated from soil of the Black Sea coast of the Caucasus in 1980. P. batumici Koz11 is the second P. batumici strain isolated and identified outside the area where it was first found. Similar to the type strain, P. batumici Koz11 showed antimicrobial activity against various S. aureus strains, including vancomycin-resistant S. aureus. However, the previously reported gene cluster known as the "batumin gene cluster," which synthesizes antimicrobial compounds, was absent from P. batumici Koz11. This study provides insights on P. batumici that were not previously known. Since the type of strain of P. batumici is exclusively deposited in the Ukrainian Collection of Microorganisms, the Koz11 strain may be a surrogate to facilitate continued study of P. batumici.
Evaluation of reported claims of sex-based differences in treatment effects across meta-analyses: A meta-research study
Authors: Kastrati Lum , Farina Sara , Gris Angelica-Valz , Raeisi-Dehkordi Hamidreza , Llanaj Erand , Quezada-Pinedo Hugo G. , Bally Lia , Muka Taulant , Ioannidis John P.A.
Published: July 2024

Importance

Differences in treatment effects between men and women may be important across diverse interventions and diseases.

Objective

We aimed to evaluate claims of sex-based differences in treatment effects across published meta-analyses.

Data Sources

PubMed (searched up to January 17, 2024).

Study Selection

Published meta-analyses of randomized controlled trials (RCTs) that had any mention of sex (male/female) subgroup or related analysis in their abstract.

Data Extraction and Synthesis

We determined how many meta-analyses had made claims of sex-based differences in treatment effects. These meta-analyses were examined in depth to determine whether the claims reflected sex-treatment interactions with statistical support or fallacious claims and categorized the frequency of different fallacies. For claims with statistical support, we examined whether they were considered and discussed in UpToDate. Whenever possible, we re-analyzed the p-value for sex-treatment interaction.

Main Outcomes and Measures

Number of claims with statistical support and fallacious claims; clinical implications of subgroup differences.

Results

216 meta-analysis articles fulfilled the eligibility criteria. Of them, 99 stated in the abstract that that there was no sex-based difference, and 20 mentioned a sex-based subgroup analysis without reporting results in the abstract. 97 meta-analyses made 115 claims of sex-based differences. Of them, 27 claims across 21 articles had statistical support at p<0.05. 4/27 claims were mentioned in UpToDate, but none led to different recommendations for men and women. 35 articles had 39 fallacious claims where the sex-treatment interaction was not statistically significant (significant effects in one sex (29 claims in 25 articles), larger effects in one sex (7 claims in 7 articles), other (3 claims in 3 articles)). Another 44 articles made claims based on potentially fallacious methods (39 based on meta-regression of percentage of one group and 5 providing the results of only one group), but proper data were unavailable to assess statistical significance.

Conclusions and relevance

Few meta-analyses of RCTs make claims of sex-based differences in treatment effects and most of these claims lack formal statistical support. Statistically significant and clinically actionable sex-treatment interactions may be rare.
Anti-inflammatory effects of electrostimulation
Authors: Di Pietro Biagio , Villata Simona , Dal Monego Simeone , Degasperi Margherita , Ghini Veronica , Guarnieri Tiziana , Plaksienko Anna , Liu Yuanhua , Pecchioli Valentina , Manni Luigi , Tenori Leonardo , Licastro Danilo , Angelini Claudia , Napione Lucia , Frascella Francesca , Nardini Christine
Published: July 2024

The therapeutic usage of physical stimuli is framed in a highly heterogeneous research area, with variable levels of maturity and of translatability into clinical application. In particular, electrostimulation is deeply studied for its application on the autonomous nervous system, but less is known about the anti-inflammatory effects of such stimuli beyond theinflammatory reflex. Further, reproducibility and meta-analyses on existing results are extremely challenging, owing to the limited rationale on dosage and experimental standardization. In this work we propose a series of controlled experiments on the effects of electrical stimuli (in direct and alternate current) delivered on a standardized 3D bioconstruct constituted by fibroblasts and keratinocytes in a collagen matrix. Transcriptomics backed by metabolomics at selected time points allow to obtain a first systematic overview of the biological functions at stake, highlighting the differential anti-inflammatory potential of such approaches, with promising results for 5V direct current stimuli. We hope that our results will trigger an interest and a facilitation in the study of the anti-inflammatory effects of physical stimuli, highlighting not only the potential but also the limitations of such approaches, offering, ultimately, solid evidence for future translation into the clinic.
A microvascularizedin vitroliver model for disease modeling and drug discovery
Authors: Bonanini Flavio , Dinkelberg Roelof , Torregrosa Manuel Caro , Kortekaas Nienke , Hagens Tessa M. S. , Treillard Stéphane , Kurek Dorota , van Duinen Vincent , Vulto Paul , Bircsak Kristin
Published: July 2024

Drug discovery for complex liver diseases faces alarming attrition rates. The lack of non-clinical models that recapitulate key aspects of liver (patho)-physiology is likely contributing to the inefficiency of developing effective treatments. Of particular notice is the common omission of an organized microvascular component despite its importance in maintaining liver function and its involvement in the development of several pathologies. Increasing the complexity ofin vitromodels is usually associated with a lack of scalability and robustness which hinders their implementation in drug development pipelines. Here, we describe a comprehensive liver MPS model comprising stellates, liver-derived endothelial cells and hepatocytes conceived within a scalable and automated platform. We show that endothelial cells self-organize in a microvascular network when co-cultured with stellates in a hydrogel. In a tri-culture, hepatocytes polarize accordingly, with a basolateral side facing blood vessels and an apical side facing bile-canaliculi-like structures. Stellates interact and surround the hollow microvessels. Steatosis was induced by exogenous administration of fatty acids which could be prevented by co-administration of firsocostat. Administration of TGF-β resulted in an activated stellate cells phenotype which could be prevented by the co-administration of SB-431542. The model was implemented on a microtiter plate format comprising 64 chips which enabled the development of a fully automated, multiplexed fibrosis assay with a robust Z’ factor suitable for high-throughput applications.
DNA Origami Signal Amplification in Lateral Flow Immunoassays
Authors: Ijäs Heini , Trommler Julian , Nguyen Linh , van Rest Stefan , Nickels Philipp C. , Liedl Tim , Urban Maximilian J.
Published: July 2024

Lateral flow immunoassays (LFIAs) enable a rapid detection of analytes in a simple, paper-based test format. Despite their multiple advantages, such as low cost and ease of use, their low sensitivity compared to laboratory-based testing limits their use ine.g. many critical point-of-care applications. Here, we present a DNA origami-based signal amplification technology for LFIAs. DNA origami is used as a structurally precise adapter to connect detection antibodies to tailored numbers of signal-generating labels. As a proof of concept, we apply the DNA origami signal amplification in a sandwich-based LFIA for the detection of cardiac troponin I (cTnI) in human serum. We show a 55-fold improvement of the assay sensitivity with 40 nm gold nanoparticle labels and an adjustable signal amplification of up to 125-fold with fluorescent dyes. The technology is compatible with a wide range of existing analytes, labels, and sample matrices, and presents a modular approach for improving the sensitivity and reliability of lateral flow testing.