bluuebunny/crossref_metadata_2025 huggingface dataset:
Don’t go chasing waterfalls: the phenology of Amblyomma americanum and increased collection of medically relevant ticks further away from hiking trails in the Piedmont of North Carolina, USA
Authors: Adams Dayvion R , Figurskey Anastasia C , Barbarin Alexis M , Reiskind Michael H
Published: May 2024

Hiking is a popular recreational activity in North Carolina that may expose people to ticks and tick-borne pathogens. However, there is a lack of knowledge on how ticks are distributed on and near trails. Our study tested the hypothesis that ticks are more likely to be encountered when moving further away from trails by measuring differences in relative abundance at various distances. We tested 4 distances (middle of trail, edge of trail, 5 m, 20 m), as well as an on-trail and off-trail grouping. We collected significantly more ticks and ticks were more likely to be collected at our 20 m and 5 m sampling distances rather than directly on or adjacent to trails, and significantly more were collected during off-trail collections than on-trails. When looking only at Amblyomma americanum, post hoc comparisons revealed that significantly more juvenile stages were collected at 5 m and 20 m distances, but not for adults. Our monthly sampling also allowed us to describe the phenology of A. americanum in North Carolina, which is consistent with the phenology of this species in the southeastern United States with adults peaking May–Jun, nymphs Jun–Jul, and larvae in Jul–Aug. These results generally demonstrate the importance of utilizing established trails when hiking to decrease tick-borne disease risk and should be communicated to the public as a recommendation for reducing tick-encounter risk.
Health insurance among survivors of childhood cancer following Affordable Care Act implementation
Authors: Kirchhoff Anne C , Waters Austin R , Liu Qi , Ji Xu , Yasui Yutaka , Yabroff K Robin , Conti Rena M , Huang I -Chan , Henderson Tara , Leisenring Wendy M , Armstrong Gregory T , Nathan Paul C , Park Elyse R
Published: May 2024

Background

The Affordable Care Act (ACA) increased private nonemployer health insurance options, expanded Medicaid eligibility, and provided preexisting health condition protections. We evaluated insurance coverage among long-term adult survivors of childhood cancer pre- and post-ACA implementation.

Methods

Using the multicenter Childhood Cancer Survivor Study, we included participants from 2 cross-sectional surveys: pre-ACA (2007-2009; survivors: n = 7505; siblings: n = 2175) and post-ACA (2017-2019; survivors: n = 4030; siblings: n = 987). A subset completed both surveys (1840 survivors; 646 siblings). Multivariable regression models compared post-ACA insurance coverage and type (private, public, uninsured) between survivors and siblings and identified associated demographic and clinical factors. Multinomial models compared gaining and losing insurance vs staying the same among survivors and siblings who participated in both surveys.

Results

The proportion with insurance was higher post-ACA (survivors pre-ACA 89.1% to post-ACA 92.0% [+2.9%]; siblings pre-ACA 90.9% to post-ACA 95.3% [+4.4%]). Post-ACA insurance increase in coverage was higher among those aged 18-25 years (survivors: +15.8% vs +2.3% or less ages 26 years and older; siblings +17.8% vs +4.2% or less ages 26 years and older). Survivors were more likely to have public insurance than siblings post-ACA (18.4% vs 6.9%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1 to 2.6). Survivors with severe chronic conditions (OR = 4.7, 95% CI = 3.0 to 7.3) and those living in Medicaid expansion states (OR = 2.4, 95% CI = 1.7 to 3.4) had increased odds of public insurance coverage post-ACA. Among the subset completing both surveys, low- and mid-income survivors (<$40 000 and <$60 000, respectively) experienced insurance losses and gains in reference to highest household income survivors (≥$100 000), relative to odds of keeping the same insurance status.

Conclusions

Post-ACA, more childhood cancer survivors and siblings had health insurance, although disparities remain in coverage.
COVID-19 vaccine fatigue in Scotland: how do the trends in attrition rates for the second and third doses differ by age, sex, and council area?
Authors: Muegge Robin , Jack Eilidh , Dean Nema , Lee Duncan
Published: May 2024

Vaccine fatigue is the propensity for individuals to start but not finish a vaccination program with several doses, which means they are less protected. Our study examines vaccine fatigue in the COVID-19 vaccination programme in Scotland. We model the attrition rates across multiple doses with a hierarchical binomial logistic regression model with correlated age- and area-specific random effects with conditional autoregressive priors, where inference uses integrated nested Laplace approximations. We find attrition rates smoothly decrease with increasing age, are much higher for the third dose than the second, and are generally higher for males than females.
Tobacco use Prevalence in the Military Health System: A Retrospective Study
Authors: Patrick Steven , Boyle Colleen , LaMorte Daniel , Dore Michael
Published: May 2024

Introduction

Tobacco use is prevalent and has traditionally been higher in the U.S. Military population than in the civilian population, but studies are limited. The goal of this study was to evaluate tobacco use and tobacco cessation counseling within the US Military health system (MHS).

Materials and Methods

This was a retrospective study assessing tobacco use and cessation counseling rates within the MHS from July 2016 to March 2022. Data for military tobacco use were obtained from the Defense Health Agency (DHA) Dashboard. US civilian tobacco rates were obtained from the Center for Disease Control and Prevention (CDC).

Population

Patients 18+ currently enrolled in direct care in military treatment facilities (MTFs) who had at least one direct primary care or well care gynecology encounter during the measurement years. Current tobacco use is defined as the presence of one coded indicator which included ICD 10CM codes, MEDCIN (a system of standardized medical terminology) Terms, and Vitals. Tobacco use is defined as the use of any form of tobacco (cigarette, cigar, vaping, or smokeless). The prevalence of tobacco use per month was analyzed from July 2016 through March 2022. After searching specifically for procedure codes for tobacco cessation counseling, a month-to- month trend of the rate of tobacco cessation counseling was also established.

Results

Data from 1.8 million patients were analyzed. Overall tobacco use within the MHS (including military dependents and retirees) decreased 1.68% (29.94 to 28.26%) from 2016 to 2022. Rates decreased by 3.24% (29.94 to 26.70%) from July 2016 to March 2021 before increasing by 1.56% (26.70 to 28.26%) from March 2021 to March 2022. Tobacco cessation counseling declined by 17.4% (28.4 to 11%) from July 2016 to March 2022. In comparison to the civilian population, tobacco use was 15.0% higher in the MHS.

Conclusions

Tobacco use remains common in the United States but is more prevalent in both active duty military and military retirees than civilians. Tobacco cessation counseling within the MHS steadily declined from 2016 to 2022. While there has been an overall reduction in rates of tobacco use in the military population over the last 5 years there was an increase over the last 2 years. Further research is needed to elucidate tobacco use, the effect of tobacco cessation counseling in the military, and the potential role of tobacco cessation medications in reducing tobacco use within the MHS.
Revolutionizing Combat Casualty Care: The Power of Digital Twins in Optimizing Casualty Care Through Passive Data Collection
Authors: Pamplin Jeremy C , Remondelli Mason H , Thota Darshan , Trapier Jeremy , Davis William T , Fisher Nathan , Kwon Paul , Quinn Matthew T
Published: May 2024

The potential impact of large-scale combat operations and multidomain operations against peer adversaries poses significant challenges to the Military Health System including large volumes of critically ill and injured casualties, prolonged care times in austere care contexts, limited movement, contested logistics, and denied communications. These challenges contribute to the probability of higher casualty mortality and risk that casualty care hinders commanders’ forward momentum or opportunities for overmatch on the battlefield. Novel technical solutions and associated concepts of operation that fundamentally change the delivery of casualty care are necessary to achieve desired medical outcomes that include maximizing Warfighter battle-readiness, minimizing return-to-duty time, optimizing medical evacuation that clears casualties from the battlefield while minimizing casualty morbidity and mortality, and minimizing resource consumption across the care continuum. These novel solutions promise to “automate” certain aspects of casualty care at the level of the individual caregiver and the system level, to unburden our limited number of providers to do more and make better (data-driven) decisions. In this commentary, we describe concepts of casualty digital twins—virtual representations of a casualty’s physical journey through the roles of care—and how they, combined with passive data collection about casualty status, caregiver actions, and real-time resource use, can lead to human–machine teaming and increasing automation of casualty care across the care continuum while maintaining or improving outcomes. Our path to combat casualty care automation starts with mapping and modeling the context of casualty care in realistic environments through passive data collection of large amounts of unstructured data to inform machine learning models. These context-aware models will be matched with patient physiology models to create casualty digital twins that better predict casualty needs and resources required and ultimately inform and accelerate decision-making across the continuum of care. We will draw from the experience of the automotive industry as an exemplar for achieving automation in health care and inculcate automation as a mechanism for optimizing the casualty care survival chain.
Predicting gene disease associations with knowledge graph embeddings for diseases with curtailed information
Authors: Gualdi Francesco , Oliva Baldomero , Piñero Janet
Published: May 2024

Knowledge graph embeddings (KGE) are a powerful technique used in the biomedical domain to represent biological knowledge in a low dimensional space. However, a deep understanding of these methods is still missing, and, in particular, regarding their applications to prioritize genes associated with complex diseases with reduced genetic information. In this contribution, we built a knowledge graph (KG) by integrating heterogeneous biomedical data and generated KGE by implementing state-of-the-art methods, and two novel algorithms: Dlemb and BioKG2vec. Extensive testing of the embeddings with unsupervised clustering and supervised methods showed that KGE can be successfully implemented to predict genes associated with diseases and that our novel approaches outperform most existing algorithms in both scenarios. Our findings underscore the significance of data quality, preprocessing, and integration in achieving accurate predictions. Additionally, we applied KGE to predict genes linked to Intervertebral Disc Degeneration (IDD) and illustrated that functions pertinent to the disease are enriched within the prioritized gene set.
Telemedicine for Prescribing Nirmatrelvir/Ritonavir: Safety, Logistics, and Challenges
Authors: Liebenstein Tyler , Mailig Miguel , Crnich Christopher J , Balasubramanian Prakash
Published: May 2024

Nirmatrelvir/ritonavir can be a useful COVID-19 treatment but is challenging to prescribe safely because of drug-drug interactions. This study describes our experience prescribing nirmatrelvir/ritonavir within a small interdisciplinary team with a specific focus on management of drug-drug interactions. Ascertaining and communicating modifications of concomitant medications is a key safety element.
Eco-theo-logical Hope: Subjectivity, Religions, and Human Rights—A Translational Approach
Authors: Vazquez Melisa Liana
Published: May 2024

Any determination of the human subject emerges from and represents one of innumerable and distinct worldviews. All worldviews depend on both holistic and relational conceptions, infused with specificities of language, kinship, and religious/spiritual ties and understandings. This is particularly evident when considering issues of human rights and the environment, another domain in which an interrelational understanding is inescapable. I will argue that an intercultural translation methodology is our best hope for moving beyond stale dichotomies that treat human rights and religions as isolatable oppositional categories and the environment as a reified set of resources meant to fuel relentless post-capitalist drives. Furthermore, learning to translate religious perspectives understood anthropologically can enfranchise a critically important relational understanding of human flourishing. To be gained are invaluable opportunities towards saving human rights from the semantic fog that otherwise obscures any possibility for their fulfilment.
Can Credibility Overcome Elite Polarization?
Authors: Hopkins Daniel J , Sigler Gall O
Published: May 2024

Political scientists Alexander Gazmararian and Dustin Tingley's incisive new book Uncertain Futures: How to Unlock the Climate Impasse contends that credibility is key to unlocking the deadlock over climate policy. They claim that fossil fuel communities have often been skeptical of any transition away from fossil fuels with good reason. In similar situations, policymakers have often failed to follow through on policies meant to mitigate economic dislocation. Drawing on a wealth of quantitative and qualitative evidence from energy-producing communities, including surveys of residents and officials alike, Gazmararian and Tingley find that different policy features that bolster credibility can build support for a transition to clean energy sources. The book provides a much-needed view of the energy transition from the ground-up. Yet the book pays less attention to a principal-agent problem at the heart of the clean energy transition: many of the elected representatives of the communities most affected by the transition don’t acknowledge any need for a transition. What's more, in a highly polarized environment, the impact of policy feedbacks is likely to be muted. Drawing on the experiences of the ACA and Canada's carbon tax, we suggest that even when the policy features that the authors propose are present, support for clean-energy policies may not rise dramatically.
Generator Coordinate Method with Proton–Neutron Pairing Fluctuations and Magnetic Properties of N = Z Odd–Odd Nuclei
Authors: Uzawa K , Hinohara N , Nakatsukasa T
Published: May 2024

Pairing correlations play an important role in a variety of nuclear phenomena. However, a quantitative understanding of proton–neutron (pn) pairing, especially isoscalar pn pairing (S = 1, T = 0), remains elusive. To clarify the property of pn pairing, we investigate the roles of pn pairing in the M1 transition of N = Z odd–odd nuclei. We develop a theoretical model based on the generator coordinate method (GCM) in which the isoscalar and isovector pn-pair amplitudes are used as the generator coordinates. Using the particle and the angular-momentum projections, the pn-pair GCM well reproduces the M1 transition of odd–odd nuclei for the exactly solvable SO(8) model. We apply the method to N = Z odd–odd nuclei and find that the experimental values of B(M1) are well reproduced. We also study the sensitivity of B(M1) to the strength of the isoscalar pairing interaction.
Preparation and evaluation of decellularized epineurium as an anti-adhesive biofilm in peripheral nerve repair
Authors: Li Xiao , Tao Meihan , Quan Liang , Zhang Hengtong , Xin Yuan , Wu Xixi , Fang Xinyu , Fan Jun , Tian Xiaohong , Wang Xiaohong , Wen Lili , Yu Tianhao , Ao Qiang
Published: May 2024

Following peripheral nerve anastomosis, the anastomotic site is prone to adhesions with surrounding tissues, consequently impacting the effectiveness of nerve repair. This study explores the development and efficacy of a decellularized epineurium as an anti-adhesive biofilm in peripheral nerve repair. Firstly, the entire epineurium was extracted from fresh porcine sciatic nerves, followed by a decellularization process. The decellularization efficiency was then thoroughly assessed. Subsequently, the decellularized epineurium underwent proteomic analysis to determine the remaining bioactive components. To ensure biosafety, the decellularized epineurium underwent cytotoxicity assays, hemolysis tests, cell affinity assays, and assessments of the immune response following subcutaneous implantation. Finally, the functionality of the biofilm was determined using a sciatic nerve transection and anastomosis model in rats. The result indicated that the decellularization process effectively removed cellular components from the epineurium while preserving a number of bioactive molecules, and this decellularized epineurium was effective in preventing adhesion while promoting nerve repairment and functional recovery. In conclusion, the decellularized epineurium represents a novel and promising anti-adhesion biofilm for enhancing surgical outcomes of peripheral nerve repair.
Advancements and Future Directions in Prevention Based on Evaluation for Individuals With Clinical High Risk of Psychosis: Insights From the SHARP Study
Authors: Zhang TianHong , Xu LiHua , Wei YanYan , Cui HuiRu , Tang XiaoChen , Hu YeGang , Tang YingYing , Wang ZiXuan , Liu HaiChun , Chen Tao , Li ChunBo , Wang JiJun
Published: May 2024

Background and Hypothesis

This review examines the evolution and future prospects of prevention based on evaluation (PBE) for individuals at clinical high risk (CHR) of psychosis, drawing insights from the SHARP (Shanghai At Risk for Psychosis) study. It aims to assess the effectiveness of non-pharmacological interventions in preventing psychosis onset among CHR individuals.

Study Design

The review provides an overview of the developmental history of the SHARP study and its contributions to understanding the needs of CHR individuals. It explores the limitations of traditional antipsychotic approaches and introduces PBE as a promising framework for intervention.

Study Results

Three key interventions implemented by the SHARP team are discussed: nutritional supplementation based on niacin skin response blunting, precision transcranial magnetic stimulation targeting cognitive and brain functional abnormalities, and cognitive behavioral therapy for psychotic symptoms addressing symptomatology and impaired insight characteristics. Each intervention is evaluated within the context of PBE, emphasizing the potential for tailored approaches to CHR individuals.

Conclusions

The review highlights the strengths and clinical applications of the discussed interventions, underscoring their potential to revolutionize preventive care for CHR individuals. It also provides insights into future directions for PBE in CHR populations, including efforts to expand evaluation techniques and enhance precision in interventions.
What’s on the Cayman Islands regulatory horizon for trustees?
Authors: Galletly Sara
Published: May 2024

The article outlines the main regulatory changes on the horizon in the Cayman Islands that are of relevance to trustees. It provides an update as to Cayman Islands Monetary Authority’s (CIMA) priorities, based on a presentation given by the Managing Director of CIMA at Mourant’s 2024 Regulatory Seminar, the overriding concern being to ensure that the Cayman Islands remains at the forefront of technical compliance with the Financial Action Task Force 40 Recommendations. It also considers one of the larger regulatory changes on the horizon, the incoming changes to the Cayman Islands beneficial ownership regime.
miR‐4645‐3p attenuates podocyte injury and mitochondrial dysfunction in diabetic kidney disease by targeting Cdk5
Authors: Zhang Yue , Xia Shunjie , Tian Xiaoxi , Yuan Liming , Gao Yuan , Liu Dan , Qi Huimin , Wang Shuo , Liu Zanchao , Li Yang , Zhao Zhe , Liu Wei
Published: May 2024

Podocyte injury plays a critical role in the progression of diabetic kidney disease (DKD), but the underlying cellular and molecular mechanisms remain poorly understanding. MicroRNAs (miRNAs) can disrupt gene expression by inducing translation inhibition and mRNA degradation, and recent evidence has shown that miRNAs may play a key role in many kidney diseases. In this study, we identified miR‐4645‐3p by global transcriptome expression profiling as one of the major downregulated miRNAs in high glucose‐cultured podocytes. Moreover, whether DKD patients or STZ‐induced diabetic mice, expression of miR‐4645‐3p was also significantly decreased in kidney. In the podocytes cultured by normal glucose, inhibition of miR‐4645‐3p expression promoted mitochondrial damage and podocyte apoptosis. In the podocytes cultured by high glucose (30 mM glucose), overexpression of miR‐4645‐3p significantly attenuated mitochondrial dysfunction and podocyte apoptosis induced by high glucose. Furthermore, we found that miR‐4645‐3p exerted protective roles by targeting Cdk5 inhibition. In vitro, miR‐4645‐3p obviously antagonized podocyte injury by inhibiting overexpression of Cdk5. In vivo of diabetic mice, podocyte injury, proteinuria, and impaired renal function were all effectively ameliorated by treatment with exogenous miR‐4645‐3p. Collectively, these findings demonstrate that miR‐4645‐3p can attenuate podocyte injury and mitochondrial dysfunction in DKD by targeting Cdk5. Sustaining the expression of miR‐4645‐3p in podocytes may be a novel strategy to treat DKD.
Fragmentation in Bowman Layer: An In Vivo Confocal Microscopy Study
Authors: Szalai Eszter , Csutak Adrienne , Belin Michael W.
Published: May 2024

Purpose:

The aim of this study was to study the in vivo ultrastructure of Bowman layer with confocal microscopy in keratoconus patients with a spectrum of disease severity.

Methods:

Fifteen eyes of 12 patients with keratoconus were enrolled in this study. Patients were stratified into 2 severity groups (mild to moderate and advanced) based on maximum keratometry, posterior radius of curvature, and thinnest pachymetry obtained with anterior segment tomography. All study subjects underwent in vivo confocal microscopy (Heidelberg Retina Tomograph III Rostock Cornea Module, Heidelberg Engineering GmbH, Heidelberg, Germany) of the cornea.

Results:

Seven eyes were classified as having mild-to-moderate keratoconus (mean age 29.14 ± 8.32 years) and 8 eyes were advanced (mean age 31.00 ± 8.62 years). In vivo confocal microscopy showed intact Bowman layer in all eyes with mild-to-moderate keratoconus. Fragmentations in Bowman layer were seen in 20% of eyes (3 eyes) with advanced keratoconus.

Conclusions:

We did not document ruptures in Bowman layer in mild-to-moderate keratoconus suggesting that Bowman layer fragmentation is a late manifestation of keratoconus and not a sign of early ectatic disease as historically reported.
Noncultured Trypsinized Epidermal Cell Suspension Transplantation After Cryoblebbling Versus Noncultured Nontrypsinized Epidermal Cell Graft Homogenized With Plasma Gel After Dermabrasion for Stable Vitiligo
Authors: Elmorsy Eman Hamed , El Garem Yehia Farouk , Affara Sara Mohamed , Halwag Dalia Ibrahim
Published: May 2024

BACKGROUND

Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes.

OBJECTIVE

Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment.

MATERIALS AND METHODS

Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy.

RESULTS

The plasma gel group showed a significantly earlier onset of repigmentation and faster healing (p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group (p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper.

CONCLUSION

Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation.
Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria
Authors: Michael Afieharo I. , Okoli Chinedu , Olusanya Adeola A. , Akintayo Akintunde J. , Onah Ifeanyichukwu I. , Yiltok Simon , Oluwatosin Odunayo M.
Published: May 2024

Background:

This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria.

Methods:

A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late).

Results:

Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach’s palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu.

Conclusions:

This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.
Livestreaming Microsurgery Education: An Avenue to Expand Global Plastic Surgery
Authors: Eftekari Sahand C. , Zeng Weifeng , Shaffrey Ellen C. , Reuter Munoz Katherine D. , Donnelly D’Andrea T. , Dingle Aaron M. , Poore Samuel O.
Published: May 2024

Microsurgery is a complex subspecialty requiring fine manual dexterity and a thorough understanding of microsurgical techniques, requiring years of training to reach proficiency. On a global scale, trainees may not have access to a longitudinal microsurgery curriculum and instead attend brief courses to learn microsurgical techniques, limiting their ability to practice the nuances of microsurgery. There remains a gap in global microsurgical education for trainees to have consistent educational exposure. This article presents a novel and easy to use software-based microsurgical system for virtual microsurgical teaching. In doing so, this system provides a free-of-cost and highly accessible avenue to deliver consistent microsurgical education worldwide.
Bilateral Implant-based Breast Reconstruction with Unilateral Radiotherapy: A Matched Cohort Study Comparing Nipple-sparing Mastectomy and Skin-sparing Mastectomy
Authors: Amador Ricardo O. , Taylor Erin M. , Leung Nicholas , Sokol Bradford , Lafleur Emily H. , Hashemian Tara , Dey Tanujit , Chun Yoon S.
Published: May 2024

Background:

Nipple-sparing mastectomy (NSM) preserves the natural nipple–areola complex and entire native breast skin, with the goal of better cosmetic outcomes in breast reconstruction. In bilateral TE/implant-based reconstruction requiring unilateral postmastectomy radiotherapy (PMRT), progressive radiation-induced fibrosis can lead to increasing nipple asymmetry with cosmetic dissatisfaction. Thus, PMRT may ultimately negate the intended positive cosmetic value of NSM compared with skin-sparing mastectomy (SSM). This study compares (1) surgical complications, (2) patient satisfaction, and (3) aesthetic outcomes between NSM versus SSM in bilateral implant-based reconstruction with unilateral PMRT.

Methods:

This retrospective matched cohort study included consecutive NSM patients with bilateral TE/implant breast reconstruction + unilateral PMRT matched 1:2 to SSM group. Patients completed PMRT and TE exchange to implants. Demographics, oncologic stage, comorbidities, and complications were collected. Patient satisfaction was evaluated by BREAST-Q. Aesthetic outcomes were assessed by blinded reviewers with a five-point Likert scale.

Results:

Among 58 patients who underwent bilateral TE/implant reconstruction with unilateral PMRT, 17 NSM patients were matched to 41 SSM patients by age, body mass index, and comorbidities. No significant differences existed in overall surgical complications and individual BREAST-Q questionnaire scores between cohorts. However, aesthetic outcomes scores were higher in SSM compared with NSM.

Conclusions:

Although NSM is generally associated with superior cosmetic outcomes compared with SSM, it has far less impact in bilateral implant-based breast reconstruction with unilateral PMRT due to the negative postradiotherapy effect on nipple symmetry.
The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis
Authors: Chambers Christine T. , Dol Justine , Tutelman Perri R. , Langley Charlotte L. , Parker Jennifer A. , Cormier Brittany T. , Macfarlane Gary J. , Jones Gareth T. , Chapman Darlene , Proudfoot Nicole , Grant Amy , Marianayagam Justina
Published: May 2024

Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem. The objective of this study was to conduct an updated systematic review and meta-analysis on the prevalence of chronic pain (ie, overall, headache, abdominal pain, back pain, musculoskeletal pain, multisite/general pain, and other) in children and adolescents. EMBASE, PubMed, CINAHL, and PsycINFO were searched for publications between January 1, 2009, and June 30, 2023. Studies reporting population-based estimates of chronic nondisease related pain prevalence in children or adolescents (age ≤ 19 years) were included. Two independent reviewers screened articles based on a priori protocol. One hundred nineteen studies with a total of 1,043,878 children (52.0% female, mean age 13.4 years [SD 2.4]) were included. Seventy different countries were represented, with the highest number of data points of prevalence estimates coming from Finland and Germany (n = 19 each, 4.3%). The overall prevalence of chronic pain in children and adolescents was 20.8%, with the highest prevalence for headache and musculoskeletal pain (25.7%). Overall, and for all types of pain except for back pain and musculoskeletal pain, there were significant differences in the prevalence between boys and girls, with girls having a higher prevalence of pain. There was high heterogeneity (I299.9%). Overall risk of bias was low to moderate. In summary, approximately 1 in 5 children and adolescents experience chronic pain and prevalence varies by pain type; for most types, there is higher pain prevalence among girls than among boys. Findings echo and expand upon the systematic review conducted in 2011.
Outcome comparison of meniscal allograft transplantation (MAT) and meniscal scaffold implantation (MSI): a systematic review
Authors: Dong Jize , Huang Moran , Lin Jinrong , Sun Yaying , Zhang Xingyu , Chen Jiwu
Published: May 2024

Background:

Although numerous studies have reported successful clinical outcomes of meniscal allograft transplantation (MAT) or meniscal scaffold implantation (MSI), the difference between the outcome of MAT and MSI remains unclear.

Purpose:

To compare the overall outcomes and survival rates of MAT and MSI, aiming to provide comprehensive evidence for determining the optimal treatment strategy for meniscal defects.

Methods:

A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of MAT or MSI were included according to the inclusion and exclusion criteria. The Lysholm score was chosen as the primary outcome measure, while secondary outcomes encompassed patient-reported outcome measures (PROMs), return to sports (RTS) rates, survival rates, and complication rates. The outcomes were stratified into two groups: MAT group and MSI group, followed by statistical comparison (P<0.05). The quality of the included studies was assessed by the Cochrane Risk of Bias 2 (RoB2) assessment tool for randomized controlled trials (RCTs) and the Coleman Methodology Score (CMS) for non-randomized controlled trials.

Results:

A total of 3932 patients (2859 MAT, 1073 MSI) in 83 studies (51 MAT, 32 MSI) had the overall significant improvement in all clinical scores. The group MSI had a higher Lysholm score of both preoperative (P=0.002) and postoperative (P<0.001) than group MAT; however, the mean improvements were similar between the two groups (P=0.105). Additionally, MSI had higher improvements of IKDC (P<0.001), KOOS symptom (P=0.010), KOOS pain (P=0.036), and KOOS ADL (P=0.004) than MAT. Interestingly, MAT had higher preoperative (P=0.018) and less postoperative VAS pain (P=0.006), which was more improved in MAT (P<0.001). Compared with MAT, MSI had a higher 10-year survival rate (P=0.034), a similar mid-term survival rate MAT (P=0.964), and a lower complication rate (P<0.001).

Conclusion:

Both MAT and MSI could have good clinical outcomes after surgery with a similar improvement in Lysholm score. MSI had a higher 10-year survival rate and fewer complications than MAT.

Level of evidence:

Level IV, systematic review.
Pancreatic Body and Tail Adenocarcinoma
Authors: Masuda Hiro , Bhimani Nazim , Chou Angela , Gill Anthony J. , Samra Jaswinder S. , Mittal Anubhav
Published: May 2024

Objectives

There is a paucity of data regarding the use of neoadjuvant therapy in pancreatic body or tail ductal adenocarcinomas. Given the differing tumor biology and aggressive nature of pancreatic body or tail adenocarcinomas, patients presenting with these tumors may benefit from upfront resection.

Methods

A retrospective cohort study was performed analyzing patients who underwent distal pancreatectomy for pancreatic ductal adenocarcinoma between January 2013 and June 2022. Patients who underwent upfront resection were compared with those who underwent neoadjuvant therapy.

Results

Forty-one patients underwent upfront distal pancreatectomy, whereas 40 patients underwent neoadjuvant therapy before curative intent resection. Neoadjuvant therapy did not improve overall survival (37 vs 34 months, P = 0.962) or disease-free survival (13 vs 15 months, P = 0.414), as compared with upfront resection. There was no significant difference in the rate or R0 resection or postoperative outcomes.

Conclusion

No significant improvement in survival was demonstrated for patients undergoing neoadjuvant therapy for pancreatic ductal adenocarcinoma of the pancreatic body or tail when compared with upfront resection. Considering the potential for disease progression given the more aggressive tumor biology of pancreatic body and tail adenocarcinomas, appropriate surgical candidates should be offered upfront resection to provide the best chance of survival and cure.
Recent trends in septic shock management: a narrative review of current evidence and recommendations
Authors: Nofal Mariam Akram , Shitawi Jawad , Altarawneh Hashem Bassam , Alrosan Sallam , Alqaisi Yanal , Al-Harazneh Al-Mothaffer , Alamaren Ammar Masoud , Abu-Jeyyab Mohammad
Published: May 2024

Septic shock stands for a group of manifestations that will cause a severe hemodynamic and metabolic dysfunction, which leads to a significant increase in the risk of death by a massive response of the immune system to any sort of infection that ends up with refractory hypotension making it responsible for escalating the numbers of hospitalized patients mortality rate, Organisms that are isolated most of the time are Escherichia coli, Klebsiella, Pseudomonas aeruginosa, and Staph aureus. The WHO considers sepsis to be a worldwide health concern; the incidence of sepsis and septic shock have been increasing over the years while being considered to be under-reported at the same time. This review is a quick informative recap of the recent studies regarding diagnostic approaches using lactic acid (Lac), procalcitonin (PCT), Sequential Organ Failure Assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, as well as management recommendations for using vasopressors, fluid resuscitation, corticosteroids and antibiotics that should be considered when dealing with such type of shock.
Effect of erythropoietin on SOFA score, Glasgow Coma Scale and mortality in traumatic brain injury patients: a randomized-double-blind controlled trial
Authors: Boskabadi Seyyed Javad , Heydari Fatemeh , Mohammadnejad Farhad , Gholipour Baradari Afshin , Moosazadeh Mahmood , Dashti Ayat
Published: May 2024

Background:

Recent studies suggest that erythropoietin has an anti-inflammatory effect on the central nervous system. The authors aimed to investigate the effect of erythropoietin on Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores, and the mortality rate of traumatic brain injury (TBI) patients.

Methods:

Sixty-eight patients with available inclusion criteria were randomly allocated to the control or intervention groups. In the intervention group, erythropoietin (4000 units) was administrated on days 1, 3, and 5. In the control group, normal saline on the same days was used. The primary outcomes were the GCS and SOFA score changes during the intervention. The secondary outcomes were the ventilation period during the first 2 weeks and the 3-month mortality rate.

Results:

Erythropoietin administration significantly affected SOFA score over time (P=0.008), but no significant effect on the GCS, and duration of ventilation between the two groups was observed. Finally, erythropoietin had no significant effect on the three-month mortality (23.5% vs. 38.2% in the erythropoietin and control group, respectively). However, the mortality rate in the intervention group was lower than in the control group.

Conclusion:

Our finding showed that erythropoietin administration in TBI may improve SOFA score. Therefore, erythropoietin may have beneficial effects on early morbidity and clinical improvement in TBI patients.
Surgical management of a thoraco-lumbar extradural cyst in a pediatric patient with Klippel–Trenaunay syndrome: a case report
Authors: Zaino Basem , Ibrahem Hayyan , Joha Mohamad , Jabbour Georges , Abdulrahman Mohammed , Ahmad Ghanem
Published: May 2024

Introduction and importance:

Klippel–Trenaunay syndrome (KTS) is a congenital disorder characterized by the abnormal development of blood vessels, soft tissues, bones, and the lymphatic system. The syndrome is rare, with few cases reported worldwide, especially those describing an association between KTS and spinal extradural meningeal cysts (SEMC). This report highlights a rare case of a pediatric patient with KTS who underwent successful surgical decompression of a thoraco-lumbar extradural cyst, highlighting the importance of reevaluating surgical interventions in KTS patients.

Case presentation:

A 15-year-old girl diagnosed with KTS 4 days postnatally, was referred to our clinic due to chronic back pain and spastic paraparesis. These symptoms were attributed to a compressive extradural thoraco-lumbar cyst. Diagnostic evaluations confirmed the presence of the cyst, leading to the decision to proceed with surgical intervention.

Clinical discussion:

The surgical approach involved a laminoplasty at T11–T12–L1, resulting in the total removal of the cystic lesion. The patient exhibited a complete resolution of symptoms postoperatively, with no significant complications reported during the surgery.

Conclusion:

With this case, the authors question the fear of surgical intervention in KTS patients, which is often avoided due to concerns of high-risk complications like excessive bleeding or poor wound healing, and hint at a possible association between KTS and extradural meningeal cysts.
SMARCA4 (BRG1)-deficient carcinoma invading the skull base: report of two cases and literature review
Authors: Zhu Hongji , Liu Ying
Published: May 2024

Introduction and importance:

SMARCA4 (BRG1)-deficient carcinomas in the head and neck are a rare and highly aggressive group of malignant tumors. They lack typical clinical and imaging features and are often misdiagnosed.

Case presentation:

The authors report two male patients with a history of smoking. Case 1 presented with nose bleeding as the first symptom, whereas case 2 presented with headache with blurred vision. Preoperative computed tomography (CT) and MRI suggested a highly aggressive malignant tumor of the head and neck with invasion of the skull base. Case 1 could not be operated on because of the large size of the punctured tumor. Case 2 underwent the surgery. The final pathological diagnosis was SMARCA4 (BRG1)-deficient carcinoma. At the 6-month follow-up, case 1 died. After completing the full course of chemotherapy, case 2 reported progressively worsening headaches and hearing loss.

Discussion and conclusion:

SMARCA4 (BRG1)-deficient carcinoma in the head and neck is a rare and highly aggressive malignant tumor that is advanced at diagnosis, prone to invasion of adjacent structures, difficult to operate on, and has a poor prognosis. CT and MRI play a vital role in evaluating the size and extent of the tumor, invasion of adjacent structures, and distant metastasis. It provides a significant reference for clinical diagnosis and therapeutic decision-making. Different patients of SMARCA4 (BRG1)-deficient carcinoma in the head and neck respond differently to radiotherapy and chemotherapy. Early use of next-generation sequencing (NGS) or immunohistochemistry(IHC) techniques is helpful in guiding treatment planning.
Handing Off Electronic Prescription Data From Prescribers to Community Pharmacies: A Qualitative Analysis of Pharmacy Staff Perspectives
Authors: Whitaker Megan , Lester Corey , Rowell Brigid
Published: May 2024

Objectives

The aims of the study are to understand the process of how community pharmacies handle electronic prescriptions (e-prescriptions) and learn about different errors or potential errors encountered.

Methods

Fifteen remote, semistructured interviews were conducted with community pharmacy staff. Interview analysis was done with two adapted Systems Engineering Initiative for Patient Safety methods to understand the workflow and an affinity wall, which led to key words that were tallied to understand the frequency of different issues.

Results

Data entry in community pharmacies is a process that varies based on the different software platforms receiving e-prescriptions. Data entry of a medication product is typically a human-reliant process matching an e-prescription with an equivalent medication product. Current automated safety supports focus on matching the dispensed medication to the medication chosen at data entry. Substitutions may be required for a variety of reasons, however, pharmacists’ comfort and permissions in doing so without provider involvement fluctuates.

Conclusions

Prescription errors remain that could be prevented with additional support at the data entry step of e-prescriptions. Few studies demonstrate where these errors originate and what role current technology plays in contributing to or preventing these errors. Future work must consider how these matches between prescribed medications and pharmacy fulfilled medications occur. There is a need to identify potential tools to support data entry and prevent medication errors.
The relationship between anti-LGBTQ+ legislation and HIV prevention among sexual and gender minoritized youth
Authors: Kelly Nicole K. , Ranapurwala Shabbar I. , Pence Brian W. , Hightow-Weidman Lisa B. , Slaughter-Acey Jaime , French Audrey L. , Hosek Sybil , Pettifor Audrey E.
Published: May 2024

Objective:

The aim of this study was to estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth.

Design:

Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13–34) at increased risk of HIV throughout the United States from 2017 to 2022.

Methods:

Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome.

Results:

Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09).

Conclusion:

More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.