bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth dynamics of untreated meningiomas
Authors: Strand Per Sveino , Wågø Kathrine Jørgensen , Pedersen André , Reinertsen Ingerid , Nälsund Olivia , Jakola Asgeir Store , Bouget David , Hosainey Sayied Abdol Mohieb , Sagberg Lisa Millgård , Vanel Johanna , Solheim Ole
Published: December 2023

Background

Knowledge about meningioma growth characteristics is needed for developing biologically rational follow-up routines. In this study of untreated meningiomas followed with repeated magnetic resonance imaging (MRI) scans, we studied growth dynamics and explored potential factors associated with tumor growth.

Methods

In a single-center cohort study, we included 235 adult patients with radiologically suspected intracranial meningioma and at least 3 MRI scans during follow-up. Tumors were segmented using an automatic algorithm from contrast-enhanced T1 series, and, if needed, manually corrected. Potential meningioma growth curves were statistically compared: linear, exponential, linear radial, or Gompertzian. Factors associated with growth were explored.

Results

In 235 patients, 1394 MRI scans were carried out in the median 5-year observational period. Of the models tested, a Gompertzian growth curve best described growth dynamics of meningiomas on group level. 59% of the tumors grew, 27% remained stable, and 14% shrunk. Only 13 patients (5%) underwent surgery during the observational period and were excluded after surgery. Tumor size at the time of diagnosis, multifocality, and length of follow-up were associated with tumor growth, whereas age, sex, presence of peritumoral edema, and hyperintense T2-signal were not significant factors.

Conclusions

Untreated meningiomas follow a Gompertzian growth curve, indicating that increasing and potentially doubling subsequent follow-up intervals between MRIs seems biologically reasonable, instead of fixed time intervals. Tumor size at diagnosis is the strongest predictor of future growth, indicating a potential for longer follow-up intervals for smaller tumors. Although most untreated meningiomas grow, few require surgery.
Ataxic gait and dysarthria in a child: pantothenate kinase-associated neurodegeneration as a diagnosis
Authors: Naggar Amine , Laasri Khadija , Fadil Mohamed , Allali Nazik , El Haddad Siham , Chat Latifa
Published: December 2023

Pantothenate kinase-associated neurodegeneration (or previously known as Hallervorden-Spatz syndrome) is a very rare disorder that typically manifests in a child with neurological signs such as gait difficulties, dysarthria, and hyperreflexia, associated potentially with psychiatric symptoms such as cognitive decline. It demonstrates on MRI the typical ‘eye of the tiger’ appearance, which is due to gliosis and accumulation of iron in the globi pallidi. Other differentials can mimic this appearance on MRI, it is therefore important to search for the involvement of other basal ganglia nuclei and the cerebral cortex, and also to consider the clinical and biological context.
Case report: atypical presentation of acute disseminated encephalomyelitis after tick-borne encephalitis
Authors: Garkowski Adam , Okrzeja Jakub , Kubas Bożena , Czupryna Piotr , Zajkowska Joanna , Kuchta Adam , Moniuszko-Malinowska Anna
Published: December 2023

Acute disseminated encephalomyelitis (ADEM) is a rare and an immune- mediated inflammatory illness of the central nervous system that normally demonstrates as a monophasic disorder connected with multifocal neurologic symptoms. Herein, we report atypical presentation of ADEM presenting as single lesions in a middle-aged woman after tick-borne encephalitis.
Acute copper deficiency myelopathy after single-anastomosis gastric bypass
Authors: Taylor Georgia , Jeyarajan Eshwarshanker
Published: December 2023

Bariatric surgery is a well-established treatment for morbid obesity, combining both restrictive and malabsorptive mechanisms to achieve weight loss. Macro and micronutrient deficiencies are some of the most common complications of these operations, which in rare occasions can be unexpected, severe, and difficult to manage. We present a case of severe copper deficiency related myelopathy in a patient post single anastomosis gastric bypass, requiring parenteral copper replacement and eventual reversal. She presented with ascending lower limb paraesthesia and weakness, with copper levels on admission of 4 μmol/l, and ceruloplasmin 94 mg/l. She continued to have progressive neuropathy and visual deterioration, despite IV and enteral replacement, and eventually underwent reversal of her bypass, with normalization in her copper levels and incomplete improvement in symptoms. Copper deficiency myelopathy is a rare and severe complication of bariatric surgery. Early identification is key, as neurological symptoms are often not reversible.
Hedgehog Inhibitors Beyond Clinical Complete Response in Basal Cell Carcinoma: Should I Stop or Should I Go?
Authors: Alfieri Salvatore , Romanò Rebecca , Marceglia Sara , De Giorgi Vincenzo , Peris Ketty , Sollena Pietro , Piccerillo Alfredo , Moro Ruggero , Gualdi Giulio , Ascierto Paolo Antonio , Palla Marco , Paone Miriam , Eibenschutz Laura , Spagnolo Francesco , Queirolo Paola , Filippini Daria Maria , Cavalieri Stefano , Resteghini Carlo , Bergamini Cristiana , Manocchio Antonello , Licitra Lisa , Bossi Paolo
Published: December 2023

Introduction

In advanced basal cell carcinoma (BCC), the issue of whether Hedgehog inhibitors (HHIs) should be stopped or not after clinical complete response (cCR) achievement remains an unmet clinical need.

Materials and Methods

We conducted a retrospective, multicenter study across 7 Italian dermato-oncology units including patients with BCC who continued vismodegib after cCR between 2012 and 2019. We assessed the relationship between the duration of vismodegib intake (days to cCR [DTCR], days to stop after cCR [DTS], total treatment days [TTD]), and disease-free survival (DFS). Reasons to stop vismodegib were (R1) toxicity and (R2) disease recurrence. The relationship between DTCR, DTS, TTD, and DFS in the whole population and in R1 subgroup was assessed by Pearson’s correlation coefficient (P < .05) and Bayesian statistics (BF10).

Results

Sixty-eight BCC patients with a median (m) age of 75.5 years (39-100) were included. Most patients were male (N = 43, 63%), without Gorlin syndrome (N = 56, 82%) and with head and neck area as primary site (N = 51, 75%). After cCR, out of 68 patients, 90% (N = 61/68) discontinued vismodegib: 82% (N = 50/61) due to toxicity (R1), and 18% (N = 11/61) due to recurrence (R2). Conversely, 10% (N = 7/68) continued vismodegib until last follow-up. In the whole population (N = 68), cCR was achieved with a mDTCR of 180.50 days. DFS showed a significant correlation with DTS (P < .01, BF10 = 39.2) and TTD (P < .01, BF10 = 35566), while it was not correlated to DTCR (BF10 < 0.1). The analysis of R1 subgroup (N = 50) confirmed these results. DFS correlated with DTS in all recurrent patients (N = 38, r = 0.44, P < .01) and in the recurrent patients who stopped vismodegib for toxicity (N = 26, r = 0.665, P < .01). DFS was longer when vismodegib was maintained for >2 months after cCR (mDFS > 2 months, N = 54 vs. ≤ 2 months, N = 14: 470 vs. 175 d, P < .01).

Conclusions

Our retrospective results suggest that HHIs should be continued after cCR to improve DFS in BCC.
Statistical mechanics approach to the holographic renormalization group: Bethe lattice Ising model and p-adic AdS/CFT
Authors: Okunishi Kouichi , Takayanagi Tadashi
Published: December 2023

The Bethe lattice Ising model—a classical model of statistical mechanics for the phase transition—provides a novel and intuitive understanding of the prototypical relationship between tensor networks and the anti-de Sitter (AdS)/conformal field theory (CFT) correspondence. After analytically formulating a holographic renormalization group for the Bethe lattice model, we demonstrate the underlying mechanism and the exact scaling dimensions for the power-law decay of boundary-spin correlations by introducing the relation between the lattice network and an effective Poincaré metric on a unit disk. We compare the Bethe lattice model in the high-temperature region with a scalar field in AdS2, and then discuss its more direct connection to the p-adic AdS/CFT. In addition, we find that the phase transition in the interior induces a crossover behavior of boundary-spin correlations, depending on the depth of the corresponding correlation path.
Annual gamma-ray background dose rates in dwellings of rural Tumkur
Authors: Udagani Chikkappa
Published: December 2023

The exposure to high levels of ionising radiation can cause severe health risks including cancer. The monitoring of background radiation is a primary task of nuclear scientists and researchers in the present day. The aim of the present work is to measure effective annual dose rate due to gamma-ray background radiation in dwellings of selected villages around Tumkur. It is very important to monitor background radiation in dwellings to safeguard from the harmful effects of gamma-ray background radiation. The dose rates in dwellings were measured using a German-made portable gamma dosemeter, Gamma-Scout. The measured annual dose rates were in the range of 1.103—2.824 mSv/y. From this survey, it was observed that the average annual dose rate for dwellings under study area with concrete ceiling and tiles floor are comparatively higher than the dwellings with griddle ceiling and stone floor.
An innovative approach for estimating energy absorption buildup factors (EABF) with HVL and TVL
Authors: Nagaraja Narayanappa , Manjunatha Holaly C , Sridhar Krishnachari Nagarathnamma , Sowmya Nagarajan , Seenappa Lakshmaiah , Munirathnam Rajachari , Soundar Renu
Published: December 2023

The current study proposes an empirical formula for absorption buildup factors as a function of target thickness. The present formula produces absorption buildup factors of compounds and mixtures with simple inputs of linear attenuation coefficient (μ), tenth value layer (TVL) and half value layer (HVL) of interacting target for the atomic number region 29 < Z < 92 for the energies 0.2 MeV < E < 1.5 MeV. This method is used to compute the energy absorption buildup factors using HVL and TVL.
Sustained polyphasic sleep restriction abolishes human growth hormone release
Authors: Rosenblum Yevgenia , Weber Frederik D , Rak Michael , Zavecz Zsófia , Kunath Nicolas , Breitenstein Barbara , Rasch Björn , Zeising Marcel , Uhr Manfred , Steiger Axel , Dresler Martin
Published: December 2023

Study Objectives

Voluntary sleep restriction is a common phenomenon in industrialized societies aiming to increase time spent awake and thus productivity. We explored how restricting sleep to a radically polyphasic schedule affects neural, cognitive, and endocrine characteristics.

Methods

Ten young healthy participants were restricted to one 20-minute nap opportunity at the end of every 4 hours (i.e. six sleep episodes per 24 hours) without any extended core sleep window, which resulted in a cumulative sleep amount of just 2 hours per day (i.e. ~20 minutes per bout).

Results

All but one participant terminated this schedule during the first month. The remaining participant (a 25-year-old male) succeeded in adhering to a polyphasic schedule for five out of the eight planned weeks. Cognitive and psychiatric measures showed modest changes during polyphasic as compared to monophasic sleep, while in-blood cortisol or melatonin release patterns and amounts were apparently unaltered. In contrast, growth hormone release was almost entirely abolished (>95% decrease), with the residual release showing a considerably changed polyphasic secretional pattern.

Conclusions

Even though the study was initiated by volunteers with exceptional intrinsic motivation and commitment, none of them could tolerate the intended 8 weeks of the polyphasic schedule. Considering the decreased vigilance, abolished growth hormone release, and neurophysiological sleep changes observed, it is doubtful that radically polyphasic sleep schedules can subserve the different functions of sleep to a sufficient degree.
Reconstructing the phylodynamic history and geographic spread of the CRF01_AE-predominant HIV-1 epidemic in the Philippines from PR/RT sequences sampled from 2008 to 2018
Authors: Polotan Francisco Gerardo M , Salazar Carl Raymund P , Morito Hannah Leah E , Abulencia Miguel Francisco B , Pantoni Roslind Anne R , Mercado Edelwisa S , Hué Stéphane , Ditangco Rossana A
Published: December 2023

The Philippines has had a rapidly growing human immunodeficiency virus (HIV) epidemic with a shift in the prevalent subtype from B to CRF01_AE. However, the phylodynamic history of CRF01_AE in the Philippines has yet to be reconstructed. We conducted a descriptive retrospective study reconstructing the history of HIV-1 CRF01_AE transmissions in the Philippines through molecular epidemiology. Partial polymerase sequences (n = 1144) collected between 2008 and 2018 from three island groups were collated from the Research Institute for Tropical Medicine drug resistance genotyping database. Estimation of the time to the most recent common ancestor (tMRCA), effective reproductive number (Re), effective viral population size (Ne), relative migration rates, and geographic spread of CRF01_AE was performed with BEAST. Re and Ne were compared between CRF01_AE and B. Most CRF01_AE sequences formed a single clade with a tMRCA of June 1996 [95 per cent highest posterior density (HPD): December 1991, October 1999]. An increasing CRF01_AE Ne was observed from the tMRCA to 2013. The CRF01_AE Re reached peaks of 2.46 [95 per cent HPD: 1.76, 3.27] in 2007 and 2.52 [95 per cent HPD: 1.83, 3.34] in 2015. A decrease of CRF01_AE Re occurred in the intervening years of 2007 to 2011, reaching as low as 1.43 [95 per cent HPD: 1.06, 1.90] in 2011, followed by a rebound. The CRF01_AE epidemic most likely started in Luzon and then spread to the other island groups of the country. Both CRF01_AE and Subtype B exhibited similar patterns of Re fluctuation over time. These results characterize the subtype-specific phylodynamic history of the largest CRF01_AE cluster in the Philippines, which contextualizes and may inform past, present, and future public health measures toward controlling the HIV epidemic in the Philippines.
Survey of Phytophthora Diversity Reveals P. abietivora as a Potential Phytophthora Root Rot Pathogen in Québec Christmas Tree Plantations
Authors: Charron Guillaume , Yergeau Julie , Van der Heyden Hervé , Bilodeau Guillaume J. , Beaulieu Carole , Tanguay Philippe
Published: December 2023

Christmas trees are an economically and culturally important ornamental plant in North America. Many microorganisms are pathogens of firs cultivated as Christmas trees. Among those, Phytophthora causes millions of dollars in damage to plantations annually. In Canada, it is unknown which species are responsible for Phytophthora root rot (PRR) of cultivated Abies species. Between 2019 and 2021, soil and root samples were collected from 40 Christmas tree plantations in Québec province. We used soil baiting and direct isolation from unidentified root fragments to assess the diversity of culturable Phytophthora spp. The obtained isolates were identified using a multilocus sequencing and phylogenetic approach. A total of 44 isolates were identified, including eight P. chlamydospora, eight P. abietivora, seven P. gonapodyides, three P. gregata, six P. megasperma, and two P. kelmanii isolates, plus 10 isolates belonging to a previously unknown taxon that is phylogenetically close to P. chlamydospora and P. gonapodyides. Among the known species, P. abietivora was the most prevalent isolated species associated with trees showing aboveground PRR-like symptoms. Pathogenicity trials confirmed the pathogenicity potential of P. abietivora on both Fraser fir and balsam fir seedlings. Our study provides a first snapshot of the Phytophthora diversity in Québec’s Christmas tree productions and describes multiple potential first associations between Phytophthora species and Abies balsamea and A. fraseri.

[Formula: see text] Copyright © 2024 His Majesty the King in Right of Canada, as represented by the Minister of Natural Resources Canada. This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Missed Opportunities: Substance Use Hotline Operator Uncertainty of State Buprenorphine Prescribing via Telemedicine
Authors: Haley Danielle F. , Agoos Eleanor R. , Yarbrough Courtney R. , Suen Leslie W. , Beletsky Leo
Published: December 2023

Objectives

We examined substance use hotline operator certainty of each US state and Washington, DC's endorsement of buprenorphine (initiation and continuation) prescribing via telemedicine.

Methods

Between March and May 2021, we called hotlines in 50 US states and Washington, DC, requesting information on whether practitioners in that state could initiate or continue buprenorphine treatment for opioid use disorder (OUD) via telephone or video conference. We compared operator responses to state implementation of buprenorphine telemedicine initiation. This study was designated as not human subjects research by the Boston University Institutional Review Board.

Results

We spoke with operators in 47 states and Washington, DC. Operators could not be reached in Alaska, California, and Montana. Most operators were uncertain (don't know, probably yes, probably no) whether the state permitted buprenorphine initiation (81%, n = 39) or continuation (83%, n = 40) via telemedicine. Practitioners could initiate buprenorphine prescribing via telemedicine in 7 states (100%) where operators were certain practitioners could initiate buprenorphine, 1 state (100%) where the operator was certain practitioners could not, and 6 states (86%) where operators indicated practitioners probably could not.

Conclusions

Most US states and Washington, DC, expanded the role of telemedicine in OUD treatment. However, most operators expressed uncertainty and sometimes communicated inaccurate information regarding whether practitioners could initiate buprenorphine treatment via telemedicine. There is an urgent need for policy mandates institutionalizing the role of telemedicine, and of buprenorphine specifically, in OUD treatment and for resources to train and support substance use hotline operators in this evolving policy environment.
Improving Arterial Puncture Success in Neonatal Patients Using Transillumination
Authors: Rhoads Sarah C. , Purdy Andrea , Fox Emily , Anspaugh Hannah
Published: December 2023

Background:

Arterial punctures are a common procedure used to obtain blood samples for lab tests that guide treatment of neonatal patients. These punctures can be painful and have associated risks, emphasizing the importance of keeping attempts to a minimum.

Purpose:

The purpose of this quality improvement initiative was to determine whether using transillumination to visualize arteries before and while obtaining a blood sample would improve outcomes in neonatal patients.

Methods:

Quantitative data were collected pre- and postimplementation of education for the use of a transillumination device for arterial punctures on neonates in a level III neonatal intensive care unit (NICU). Outcomes followed included the success rate, average time to obtain a blood sample, and the average number of sticks to obtain a blood sample. Data were collected on 47 blood draw attempts in the control group (preimplementation) and 19 blood draw attempts in the experimental group (postimplementation).

Results:

A statistical analysis concluded that the use of the studied transillumination device does positively affect the incidence of successful blood draws, particularly for the novice NICU nurse. In addition, the average number of sticks to obtain a blood sample significantly decreased in the experimental group. Finally, the average time to obtain a blood sample using the device was not impacted in this study.

Implications for Practice and Research:

Use of a transillumination device does appear to result in improved outcomes for arterial punctures in neonatal patients. More research is needed to confirm these findings due to the small sample size of the study.
Estimated National Cost of Pelvic Organ Prolapse Surgery in the United States
Authors: St Martin Brad , Markowitz Melissa A. , Myers Evan R. , Lundsberg Lisbet S. , Ringel Nancy
Published: December 2023

OBJECTIVE:

To estimate the national cost of pelvic organ prolapse (POP) surgery in the United States.

METHODS:

In this cross-sectional, population-based study, we used the 2016–2018 Healthcare Cost and Utilization Project National Inpatient Samples and National Ambulatory Surgery Samples to identify patients undergoing POP surgery using International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes, ICD-10 procedural codes, and Current Procedural Terminology codes. Cost-to-charge ratios and weighted estimates were used to calculate nationwide costs. Descriptive analysis was used to identify the sociodemographic, clinical, and surgical characteristics of the population undergoing POP surgery.

RESULTS:

Between 2016 and 2018, there were 140,762 POP surgical cases annually with an annual national cost estimated at $1.523 billion per year. The median cost per procedure increased slightly from $8,837 in 2016 to $8,958 in 2018. Overall, 82.5% of the total surgeries and 78% of the total national costs associated with POP surgery came from the ambulatory setting over this time period. Of these surgeries, 44.7% included an apical repair, and 42.3% included a concomitant hysterectomy. The average age of the population was 62 years, and 20% of the total population receiving prolapse surgery were younger than age 50 years.

CONCLUSION:

The annual national cost associated with surgical correction of POP is substantial, and the majority of cases occur in an ambulatory setting. These findings will contribute to enhancing cost-effectiveness analyses and decision-making processes for both health care professionals and policymakers as the national population continues to age.
Long-term safety of biologic and targeted synthetic disease modifying drugs in rheumatology
Authors: Barth Kaia , Gill Harsimrat , Singh Namrata
Published: December 2023

Purpose of review

The landscape for treatment of rheumatic diseases is ever evolving, with several new drugs recently approved across diseases and more in the pipeline. This timely review aims to highlight the latest literature on long-term safety profiles of salient established and emerging biologic (b) and targeted synthetic (ts) disease modifying antirheumatic drugs (DMARDs).

Recent findings

The risk of infection remains elevated with the use of most b and tsDMARDs, with specifically risk of hepatitis B reactivation with rituximab and zoster infection with JAK inhibitors (JAKi). The results of the ORAL surveillance trial led to new black box warnings for JAKi and evoked critical risk-benefit discussions surrounding JAKi and DMARDs overall.

Such well conducted trials are needed to gather long term comparative safety data of DMARDs. In the interim, real world observational studies also have a role to play in our understanding of long-term drug safety, provided that detailed attention is paid to minimize biases inherent in observational studies.
Application of Cardiovascular Physiology to the Critically Ill Patient
Authors: Bronicki Ronald A. , Tume Sebastian , Gomez Hernando , Dezfulian Cameron , Penny Daniel J. , Pinsky Michael R. , Burkhoff Daniel
Published: December 2023

OBJECTIVES:

To use the ventricular pressure–volume relationship and time-varying elastance model to provide a foundation for understanding cardiovascular physiology and pathophysiology, interpreting advanced hemodynamic monitoring, and for illustrating the physiologic basis and hemodynamic effects of therapeutic interventions. We will build on this foundation by using a cardiovascular simulator to illustrate the application of these principles in the care of patients with severe sepsis, cardiogenic shock, and acute mechanical circulatory support.

DATA SOURCES:

Publications relevant to the discussion of the time-varying elastance model, cardiogenic shock, and sepsis were retrieved from MEDLINE. Supporting evidence was also retrieved from MEDLINE when indicated.

STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS:

Data from relevant publications were reviewed and applied as indicated.

CONCLUSIONS:

The ventricular pressure–volume relationship and time-varying elastance model provide a foundation for understanding cardiovascular physiology and pathophysiology. We have built on this foundation by using a cardiovascular simulator to illustrate the application of these important principles and have demonstrated how complex pathophysiologic abnormalities alter clinical parameters used by the clinician at the bedside.
Stress and Infant Media Exposure During COVID-19: A Study Among Latino Families
Authors: Zanzoul Sarah , Strickland Pamela Ohman , Mendelsohn Alan L. , Malke Keanaan , Bator Alicja , Hemler Jennifer , Jimenez Manuel E.
Published: December 2023

Objective:

The COVID-19 pandemic disproportionately harmed Latino families; however, its effects on their stress and media routines remain understudied. We examined economic and parenting stress patterns during the COVID-19 pandemic and estimated associations between these forms of stress and nonadherence to American Academy of Pediatrics (AAP) infant media exposure recommendations among Latino families. We also explored how nonadherence with AAP recommendations varied with COVID-19 cases.

Methods:

We analyzed baseline data from an ongoing clinical trial recruiting low-income Latino parent-infant dyads. Nonadherence with AAP media exposure recommendations (ScreenQ) and economic and parent stress were measured using parent reports. Additional variables included epidemiological data on COVID-19 cases. Linear models examined associations between the pandemic and both stress variables as well as between stress and ScreenQ. Using locally weighted scatterplot smoothing curve fitting, the rise and fall of NJ COVID-19 cases were overlayed with ScreenQ scores over time to visualize and explore trends.

Results:

All parents identified as Latino (62.6% unemployed, 91.5% limited English proficiency). Mean infant age was 8.2 months. Parent stress increased over time during the COVID-19 pandemic (r = 0.13,p= 0.0369). After covariate adjustment, economic and parent stress were associated with increased nonadherence with AAP recommendations (standardized beta = 0.16, 95% confidence interval [CI], 0.03–0.29; standardized beta = 0.18, 95% CI, 0.04–0.31, respectively). Nonadherence to media exposure recommendations seemed to track with rises in the number of COVID-19 cases with a lag of 7 days.

Conclusion:

Parent and economic stress were associated with nonadherence to infant media exposure recommendations among Latino families. These findings highlight the need for practitioners to support families from under-resourced communities and to promote healthy media routines.
Anal Adenocarcinoma Treated in the Era of Total Neoadjuvant Therapy and Nonoperative Management
Authors: Feferman Yael , Rosen Roni , Gebran Selim , Yuval Jonathan B. , Kerioui Marion , Gonen Mithat , Wei Iris H. , Widmar Maria , Nash Garrett M. , Weiser Martin R. , Paty Philip B. , Hajj Carla , O’Brien Diana Roth , Romesser Paul B. , Crane Christopher , Smith J. Joshua , Aguilar Julio Garcia , Pappou Emmanouil P.
Published: December 2023

BACKGROUND:

Anal adenocarcinoma bears a treatment strategy unique to other anal cancers.

OBJECTIVE:

To describe oncologic outcomes of total neoadjuvant therapy followed by watch and wait for anal adenocarcinoma.

DESIGN:

Retrospective analysis.

SETTING:

This study was conducted at a comprehensive cancer center.

PATIENTS:

Patients with anal adenocarcinoma treated between 2004 to 2019 were selected.

INTERVENTIONS:

Fifty-four patients received neoadjuvant therapy and were divided into two groups according to their treatment strategy: total neoadjuvant therapy versus single-neoadjuvant modality therapy.

MAIN OUTCOME MEASURES:

Organ preservation, tumor regrowth, local failure, distant metastasis rates, recurrence-free, and overall survival.

RESULTS:

The study included 70 patients with anal adenocarcinoma. Fifty-four patients (77%) received neoadjuvant therapy, of whom 30 (42%) received total neoadjuvant therapy and 24 (34%) received single neoadjuvant modality. Twenty-three (33%) patients achieved complete clinical response and were managed by watch-and-wait. The proportion of patients able to continue to watch-and-wait was higher after receiving total neoadjuvant therapy (60%) compared to single neoadjuvant modality therapy (20%) (p = 0.004). A tumor regrowth rate of 22% was observed in the total neoadjuvant therapy group. The 5-year overall survival rate was 70% (95% CI: 59%, 83%), including 61% (95% CI: 42%, 88%) for the total neoadjuvant therapy and 65% (95% CI: 48%, 88%) for single neoadjuvant modality groups. Colostomy was avoided in 50% of patients that received total neoadjuvant therapy and 83% watch and wait patients. Five-year recurrence-free survival rates of 55% (95% CI: 39%, 79%) and 30% (95% CI 15%, 58%) were observed in the total neoadjuvant therapy and single neoadjuvant modality groups, respectively.

LIMITATIONS:

Retrospective nature.

CONCLUSIONS:

This is the first report in the literature describing the safety and feasibility of non-operative management for anal adenocarcinoma. Anal adenocarcinoma treated with total neoadjuvant therapy and nonoperative management achieve comparable regrowth rates to those observed in rectal cancer, with similar oncologic outcomes to traditional treatment strategies. See Video Abstract.
Predictive Factors for Successful Same-Day Discharge Following Minimally Invasive Colectomy and Stoma Reversal
Authors: Paradis Tiffany , Robitaille Stephan , Wang Anna Y. , Gervais Camille , Liberman A. Sender , Charlebois Patrick , Stein Barry L. , Fiore Julio F. , Feldman Liane S. , Lee Lawrence
Published: December 2023

BACKGROUND:

Same-day discharge following minimally invasive colorectal surgery is a safe, effective practice in specific patients that can enhance the efficiency of enhanced recovery pathways.

OBJECTIVE:

To identify predictive factors associated with success or failure of same day discharge.

DESIGN:

Prospective cohort study from January 2020 to March 2023.

SETTINGS:

Tertiary colorectal center.

PATIENTS:

Adult patients eligible for same day discharge with remote postdischarge follow-up included those with minimal comorbidities, residing neat the hospital, having sufficient home support, and owning a mobile device.

INTERVENTIONS:

Patients were discharged on the day of surgery upon meeting specific criteria, including adequate pain control, tolerance of oral intake, independent mobility, urination, and the absence of complications. Successful same-day discharge was defined as discharge on the day of surgery without unplanned visits in the first 72 hours.

MAIN OUTCOME MEASURES:

Factors associated with successful or failed same day discharge after minimally invasive colorectal surgery.

RESULTS:

A total of 175 (85.3%) patients were discharged on the day of surgery with 14 (8%) patients having an unplanned visit within 72 hours. Overall 161 (78.5%) patients were categorized as same-day discharge success and 44 (21.5%) patients as same-day discharge failure. The same-day discharge failure group had a higher Charlson Comorbidity Index (3.7, 2.8, p = 0.03). Mean length of stay (0.8, 3.0, p = 0.00), 30-day complications (10%, 48%, p = 0.00) and readmissions (8%, 27%, p = 0.00) were higher in the same-day discharge failure group. Regression analysis showed that failed same-day discharge was associated with higher comorbidities (OR 0.79, 95% CI 0.66, 0.95) and prolonged postanesthesia-care-unit time (OR 0.99, 95% CI 0.99, 0.99). Individuals who received a regional-nerve-block (OR 4.1, 95% CI 1.2, 14) and those who did not consume postoperative opioids (OR 4.6, 95% CI 1-21) were more likely to have successful same-day discharge.

LIMITATIONS:

Single center study.

CONCLUSIONS:

Our findings indicate that comorbidities and prolonged post-anesthesia care unit stays were associated with same day discharge failure, while regional nerve blocks and minimal postoperative opioids were related to success. These factors may inform future research aiming to enhance colorectal surgery recovery protocols. See Video Abstract.
The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction–associated steatotic liver disease and alcohol-associated liver disease
Authors: Younossi Zobair M. , Stepanova Maria , Al Shabeeb Reem , Eberly Katherine E. , Shah Dipam , Nguyen Veronica , Ong Janus , Henry Linda , Alqahtani Saleh A.
Published: December 2023

Background:

The high prevalence of obesity in the United States drives the burden of NASH, recently renamed as metabolic dysfunction–associated steatohepatitis (MASH). We assessed the most recent trends in liver transplantation in the United States.

Methods:

The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant.

Results:

There were 116,292 candidates who underwent liver transplant with known etiology of chronic liver disease. In candidates without HCC, the most common etiology was alcohol-associated liver disease (ALD), increasing from 23% (2013) to 48% (2022), followed by NASH/MASH, which increased from 19% to 27%; the rates of viral hepatitis decreased (chronic hepatitis C: 28%–4%; chronic hepatitis B: 1.8%–1.1%) (all trend p<0.01). The proportion of HCC decreased from 25% (2013–2016) to 17% (2021-2022). Among HCC cohort, the proportion of chronic hepatitis C decreased from 60% (2013) to 27% (2022), NASH/MASH increased from 10% to 31%, alcohol-associated liver disease increased from 9% to 24% (trend p<0.0001), and chronic hepatitis B remained stable between 5% and 7% (trend p=0.62). The rapid increase in the proportion of NASH/MASH in HCC continued during the most recent study years [20% (2018), 28% (2020), 31% (2022)]; the trend remained significant after adjustment for age, sex, ethnicity, obesity, and type 2 diabetes.

Conclusions:

Liver transplant etiologies in the United States have changed over the last decade. Alcohol-associated liver disease and NASH/MASH remain the 2 most common indications for transplantation among those without HCC, and NASH/MASH is the most common in patients with HCC.
Relationship Between Electronic Health Literacy and Self-Management in People With Type 2 Diabetes Using a Structural Equation Modeling Approach
Authors: LEE Eun-Hyun , LEE Young Whee , KANG Eun Hee , KANG Hyun-Jung
Published: December 2023

Background

Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management.

Purpose

This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes.

Methods

A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 (N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples.

Results

Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (β = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (β = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management.

Conclusion/Implications for Practice

This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.
PCO2 Gradient Between Inlet and Outlet Blood of Extracorporeal Respiratory Support Is a Reliable Marker of CO2 Elimination
Authors: Charbit Jonathan , Courvalin Elie , Dagod Geoffrey , Laumon Thomas , Hammani Samy , Molinari Nicolas , Capdevila Xavier
Published: December 2023

Our objective was to assess the relationship between the pre-/post-oxygenator gradient of the partial pressure of carbon dioxide (∆EC PCO2; dissolved form) and CO2 elimination under extracorporeal respiratory support. All patients who were treated with veno-venous extracorporeal membrane oxygenation and high-flow extracorporeal CO2 removal in our intensive care unit over 18 months were included. Pre-/post-oxygenator blood gases were collected every 12 h and CO2 elimination was calculated for each pair of samples (pre-/post-oxygenator total carbon dioxide content in blood [ctCO2] × pump flow [extracorporeal pump flow {QEC}]). The relationship between ∆EC PCO2 and CO2 elimination, as well as the origin of CO2 removed. Eighteen patients were analyzed (24 oxygenators and 293 datasets). Each additional unit of ∆EC PCO2 × QEC was associated with an increase in CO2 elimination of 5.2 ml (95% confidence interval [CI], 4.7−5.6 ml; p < 0.001). Each reduction of 1 ml STPD/dl of CO2 across the oxygenator was associated with a reduction of 0.63 ml STPD/dl (95% CI, 0.60−0.66) of CO2 combined with water, 0.08 ml STPD/dl (95% CI, 0.07−0.09) of dissolved CO2, and 0.29 ml STPD/dl (95% CI, 0.27−0.31) of CO2 in erythrocytes. The pre-/post-oxygenator PCO2 gradient under extracorporeal respiratory support is thus linearly associated with CO2 elimination; however, most of the CO2 removed comes from combined CO2 in plasma, generating bicarbonate.
Large Single-center Experience with Long-term Outcomes of EUS-guided Transmural Gallbladder Drainage
Authors: Trieu Judy A , Gilman Andrew J. , Hathorn Kelly , Baron Todd H.
Published: December 2023

Goals:

To describe the long-term outcomes of patients after EUS-guided gallbladder drainage (EUS-GBD), including those who underwent standardized stent exchanges for permanent plastic stents.

Background:

EUS-GBD has become one of the first-line alternatives for gallbladder decompression, with outcomes and safety profiles comparable to that of percutaneous gallbladder drainage. However, the long-term outcomes of EUS-GBD are not well-described. We report our single-center experience of a large cohort who underwent EUS-GBD.

Study:

Patients who underwent EUS-GBD from August 2014 to December 2022 were included in the study. Patient demographics, comorbidities, and procedure details were recorded. Patients were followed until complete stent removal, end of study period, or death. Short and long-term outcomes include technical and clinical success, stent patency, recurrent cholecystitis, cholecystectomy, and death.

Results:

During the study period, 128 patients were included. One hundred and one patients had benign indications for EUS-GBD, including cholecystitis and choledocholithiasis. Of those with malignant indications, 23 of 27 had distal malignant biliary obstruction. Technical and clinical successes were 95.3% and 95.1%, respectively. Stents were exchanged for 2 permanent double pigtail plastic stents in 43.0%. The mean stent patency was 421 days (488 d among those still alive) without any recurrent cholecystitis.

Conclusion:

EUS-GBD demonstrates prolonged stent patency and minimal long-term adverse events, particularly among patients who underwent stent exchanges for permanent plastic stents. EUS-GBD is also promising for patients presenting with choledocholithiasis and biliary colic who are not surgical candidates.
Fluid therapy in diabetic ketoacidosis
Authors: Ramanan Mahesh , Delaney Anthony , Venkatesh Balasubramanian
Published: December 2023

Purpose of review

To evaluate recent evidence (2021–2023) on fluid therapy in diabetic ketoacidosis. Key evidence gaps which require generation of new evidence are discussed.

Recent findings

Balanced crystalloid solutions, compared to the commonly recommended and used 0.9% sodium chloride solution (saline), may result in better outcomes for patients with diabetic ketoacidosis, including faster resolution of acidosis, less hyperchloremia and shorter hospital length of stay. Upcoming results from randomized trials may provide definitive evidence on the use of balanced crystalloid solutions in diabetic ketoacidosis. Evidence remains scarce or conflicting for the use of “two-bag” compared to conventional “one-bag” fluid, and rates of fluid administration, especially for adult patients. In children, concerns about cerebral oedema from faster fluid administration rates have not been demonstrated in cohort studies nor randomized trials.

Fluid therapy is a key aspect of diabetic ketoacidosis management, with important evidence gaps persisting for several aspects of management despite recent evidence.
Controversies and future directions in the management of gallbladder cancer
Authors: Lendoire Javier , Gil Luis
Published: December 2023

Gallbladder cancer (GBC) is a rare malignancy worldwide, with 140,000 new patients each year and more than 100,000 deaths annually. The review aims to address the controversial aspects of managing GBC. Regional differences of the study worldwide remain pending, and comparative mutational profiles will provide more information on the pathogenesis of GBC. However, certain pathologic aspects are discussed, such as the staging of early GBC, outcome differences between T2 pathologically staged patients, and the necessity of a uniform pathologic report. The surgical management of GBC is still under debate. The extent of liver resection, type of lymphadenectomy, and selection of patients for extended resection are aspects of the disease that require revision. Laparoscopic and robotic approaches were initially slow to develop. However, with time, they have demonstrated their value in the surgical management of GBC. The OMEGA survey, performed to analyze the management practice of surgical treatment of GBC worldwide, demonstrated differences from the recommended guidelines. The OMEGA study, the largest cohort study, examined the outcomes of surgical intervention in 3676 patients from 133 centers. Regarding future directions, the value of collaborative efforts between centers and regions must be emphasized to better understand the different aspects of the disease and globally improve therapeutic strategies for GBC.
Early Mobility and Crawling: Beliefs and Practices of Pediatric Physical Therapists in the United States
Authors: Kretch Kari S. , Dusing Stacey C. , Harbourne Regina T. , Hsu Lin-Ya , Sargent Barbara A. , Willett Sandra L.
Published: December 2023

Purpose:

To characterize beliefs of pediatric physical therapists (PTs) in the United States regarding the role of crawling in infant development and clinical practice.

Methods:

Pediatric PTs reported their beliefs about early mobility and crawling, clinical approaches related to early mobility and crawling, and agreement with the removal of crawling from the Centers for Disease Control and Prevention (CDC)'s updated developmental milestone checklists in an online survey. Analyses examined associations between information sources and beliefs, between beliefs and clinical approaches, and between beliefs and CDC update opinions.

Results:

Most participants believed that crawling was important (92%) and linked to a variety of positive developmental outcomes (71%-99%) and disagreed with its removal from the CDC checklists (79%). Beliefs were linked with clinical approaches focused on promoting crawling and discouraging other forms of mobility.

Conclusions:

Further research is needed to determine whether pediatric PTs' beliefs and clinical practices are supported by evidence.
Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion
Authors: Koh Jung-Min , Song Keeho , Kwak Mi Kyung , Suh Sunghwan , Kim Beom-Jun , Sung Tae-Yon , Hong Jun Hyuk , Jeong Byong Chang , Kim Jae Hyeon , Lee Seung Hun
Published: December 2023

Objective:

To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS).

Background:

Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date.

Methods:

A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing’s syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP).

Results:

Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3–66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09–51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08–1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30–1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63–17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34–27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87–5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65–31.81, P<0.001) demonstrated associations with improved BP control.

Conclusions:

Adrenalectomy improved weight, glucose, and BP control in patients with MACS.