bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Physician Motivation to Engage in Continuing Professional Development on Artificial Intelligence
Authors: Gavarkovs Adam G. , Kueper Jacqueline , Arntfield Robert , Myslik Frank , Thompson Keith , McCauley William
Published: January 2025

To realize the transformative potential of artificial intelligence (AI) in health care, physicians must learn how to use AI-based tools effectively, safely, and equitably. Continuing professional development (CPD) activities are one way to learn how to do this. The purpose of this article is to describe a theory-based approach for assessing health professionals' motivation to participate in CPD on AI-based tools. An online survey, based on an AI competency framework developed from existing literature and expert consultations, was administered to practicing physicians in Ontario, Canada. Across eight subcompetencies for using AI-based tools (eg, appraise AI-based tools for their regulatory and legal status), the survey measured physicians' perception they could successfully enact the competency, the importance of the competency in meeting their practice needs, and the desirability of participating in CPD activities on the competency. Motivation scores were calculated by multiplying the three scores together. Ninety-five physicians completed the survey. The highest motivation scores were for the subcompetency of identifying AI-based tools based on clinical needs, while the lowest motivation scores were for appraising tools' regulatory and legal status. All AI subcompetencies were generally rated as important, and CPD activities were generally perceived as desirable. This survey demonstrates the utility of a theory-based approach for assessing physicians' motivation to learn. Although the survey results are context specific, the approach may be useful for other CPD providers to support decision making about future AI-related CPD activities.
Association of estrogen and progesterone receptor polymorphisms with idiopathic thin endometrium
Authors: Lledo Belén , Hortal Mónica , Martínez María , Ortiz Jose A. , Morales Ruth , Bernabeu Andrea
Published: January 2025

The research question is as follows: Are estrogen and progesterone receptor genotypes associated with thin endometrium? We performed a prospective cohort study of 129 patients who underwent preimplantation genetic testing for aneuploidies. These patients were categorized according to endometrial thickness: >7 mm control group (n = 94) and ≤7 mm study group (n = 35). Polymorphisms in the genes ESR1 (rs9340799 and rs3138774), ESR2 (rs1256049 and rs4986938), and PGR (rs1042838) were analyzed. Regarding genotype distribution, the GA/AA genotype frequency for rs4986938-ESR2 was higher in the thin endometrium group (80% in the study group vs. 50% in the control group; P = 0.002), as well as the GG genotype of PGR (8.6% in the study group vs. 0% in the control group; P = 0.002). No differences were observed for the remaining genotypes. In terms of clinical data, the pregnancy rate after euploid embryo transfer was lower in patients with the AA genotype for rs4986938-ESR2 (18.2% AA vs. 40.8% GA vs. 44.0% GG; P = 0.039). Finally, a predictive pregnancy model was developed using clinical data and ESR2 and PGR genotypes, with an area under the curve of 0.76, sensitivity of 64%, and specificity of 76%. The genetic variants rs4986938 in the ESR2 gene and rs1042838 in the PGR gene seem to correlate with idiopathic thin endometrium. In addition, the rs4986938 polymorphism in the ESR2 gene is associated with pregnancy rate. Finally, a predictive model combining clinical data and patient genetic profiles has been proposed to predict clinical pregnancy outcomes.
Coping With Microaggressions and Gaslighting in the Surgical Learning Environment
Authors: Nguyen Daryn , Thrikutam Nikhitha , Bialowas Christie
Published: January 2025

Plastic surgery and plastic surgical training programs are institutions rife with rewards. However, these rewards can be tempered by general physical and psychosocial stressors inherent to a surgical specialty. Although progress has been made in addressing the physical demands of training, less attention is given to the psychosocial and interpersonal challenges faced by plastic surgeons and trainees. Two key stressors are microaggressions and gaslighting. Microaggressions are generally unintentional but highly impactful expressions of bias, whereas gaslighting involves deliberate psychological manipulation. The purpose of our article is to explain the influence of microaggressions and gaslighting on plastic surgery providers. Most importantly, we aim to provide a framework for recognizing and addressing them professionally.
Mental Health and Wellness Among Plastic Surgeons During Oral Board Certification Examination Preparation
Authors: Bergman Hannah J. , Jehle Charles C. , Khansa Ibrahim
Published: January 2025

Background:

The field of plastic and reconstructive surgery has recently made a dramatic shift toward attention to mental health, with residency curricula expanding to include training on burnout prevention and the promotion of well-being. After graduation, however, new surgeons face a difficult year of preparation for the oral board certification examination. This group of young surgeons remains largely unstudied and undersupported throughout what may be the most challenging period of their educational journey.

Methods:

In spring of 2024, an electronic survey was sent to members of the American Society of Plastic Surgeons who had completed their oral board examination within the past 3 years. Demographics, study habits, utilization of preparatory courses, and aspects of mental and physical health during the examination year were explored, and factors impacting well-being were identified.

Results:

Thirty-two respondents were included in the analysis, 85.7% of whom reported passing the examination on their first attempt. Most began in-earnest studying 1–3 months before the examination, with the majority studying 11–15 hours/week. The majority utilized study groups and preparatory courses. Half of the respondents reported that the examination was a financial burden. Anxiety and depression related to the examination were reported by 81.5% and 25.9% of respondents, respectively. Seeking medical attention and self-medicating was reported by 18.52% of respondents.

Conclusions:

Many examinees experience mental health concerns during the preparation period for the oral board examination. Nevertheless, measures to support well-being may exist and should be offered both during and after the examination preparation period.
Familial Steep Corneas in Posterior Polymorphous Corneal Dystrophy 3 Due to a Novel ZEB1 Gene Mutation
Authors: Koval Tal , Banne Ehud , Neimark Eli , Spierer Oriel
Published: January 2025

Purpose:

To present 4 family members with posterior polymorphous corneal dystrophy (PPCD), nonkeratoconic steep corneas, and myopia caused by a previously unknown genetic alteration in the ZEB1 gene.

Methods:

Ophthalmic examinations and corneal curvature analyses were performed for all patients. Whole-exome targeted gene panel sequencing was performed for 1 patient. Pathogenic variant confirmation and segregation of the variant were performed for all 4 patients using Sanger sequencing.

Results:

A mother and her 3 children presented with bilateral diffuse corneal opacities, vesicular aggregates at the Descemet membrane level, and endothelial stippling, compatible with the diagnosis of PPCD. All patients had steeper than average keratometry readings with normal globe axial lengths and refractive moderate to extremely high myopia, ranging from −2 to −16.5 diopters (spherical equivalent). The younger patients had more severe findings, with the youngest, an 11-month-old girl, presenting with keratometry readings of 66.72 × 69.48 @ 132 degrees and 66.10 × 67.32 @ 34 degrees in the right and left eyes, respectively. The ZEB1:c.794-1G>A; chr10-31809053G>A; NM_001174096.2 mutation was detected in all patients.

Conclusions:

We describe a novel ZEB1 mutation associated with PPCD, nonkeratoconic steep corneas, and myopia. PPCD3 should be considered not only as an endothelial pathology but also as an ectatic disorder and should be ruled out in young children presenting with high myopia.
Intermediate-Term Outcomes and Complications of Ahmed Glaucoma Valve in Type 1 Keratoprostheses
Authors: Kolipaka Gowri Pratinya , Sastry Ramyashri , Nukala Naveen , Shanbhag Swapna S. , Senthil Sirisha
Published: January 2025

Purpose:

To evaluate intermediate-term outcomes and complications associated with Ahmed glaucoma valve (AGV) implantation in eyes with type 1 keratoprosthesis (KPro).

Methods:

We retrospectively reviewed records of 43 eyes of 43 Indian patients with type 1 KPro and AGV from 2009 to 2021 with a minimum of 6-months of follow-up. Five eyes that had AGV before KPro were excluded, leaving 38 eyes for analysis. Primary outcome measure was postoperative complications. Secondary outcome measure was stability of glaucoma, assessed by Humphrey visual fields, intraocular pressure, and best-corrected visual acuity (BCVA). Sight-threatening complications, implant removal, or repeat glaucoma surgery was considered failure.

Results:

Median age (interquartile range) at AGV implantation was 36.5 (23–49) years, with median post-AGV follow-up of 30.5 (6.5–53) months. Preoperative logarithm of minimal angle of resolution median BCVA was 0.6 (0.4–1). Post-AGV, median intraocular pressure as measured by scleral Schiotz reduced significantly from 30.4 (20.6–30.4) to 13.5(12.2–14.8) mm Hg (P < 0.0001), and the mean number of antiglaucoma medications significantly decreased from 3.4 to 1.7 (P < 0.0001). Mean BCVA (P = 0.24) remained stable. Humphrey visual fields mean deviation progressed from −13.5 dB (−25, −9) to −26 dB (−30, −13) at final follow-up (P = 0.05) and progression occurred in 10 eyes. Seven eyes (18.4%) had postoperative complications needing surgical intervention, including tube block [5 eyes (13.1%)] and tube exposure [2 eyes (5%)]. One failed AGV needed additional glaucoma surgery after 8 years. None had implant extrusion/explanation or endophthalmitis.

Conclusions:

Ahmed glaucoma valve implantation offered promising results in managing glaucoma in eyes with type 1 KPro, particularly in relatively young Indian population. However, close monitoring for tube-related complications and glaucoma progression is warranted.
Diagnostic Efficiency of Tongue-Coating Microbiome in Patients With SARS-CoV-2 Omicron Variant Infection and Recovery
Authors: Sun Junyi , Sun Ying , Zou Yawen , Wang Haiyu , Rao Benchen , Zhang Xinyue , Liu Liwen , Zhang Guizhen , Cui Guangying , Liu Qi , Xing Jiyuan , Xu Ning , Zheng Chunfu , Yu Zujiang , Ren Zhigang
Published: January 2025

SARS-CoV-2 variants still pose threats to human public health. However, there has been little research regarding alterations in the tongue-coating microbiome in patients infected with the Omicron variant (PIOVs). Herein, we collected 963 tongue-coating samples prospectively, including 349 samples from PIOVs, 242 samples from recovered PIOVs (RPs), 300 samples from healthy controls (HCs) and 72 samples from patients infected with the original strain (PIOSs). We randomly selected tongue-coating samples from PIOVs and HCs as the discovery cohort and validation cohort. Tongue-coating microbiota was analyzed using Miseq sequencing. Our results showed that the tongue-coating microbial diversity of PIOVs was increased. We found that in PIOVs, the abundance was increased in 20 genera, including Prevonella and Atopobium, while the abundance was decreased in 23 genera, including Neisseria and Haemophilus. The classifier based on six optimal microbial markers had high diagnostic efficiency in the discovery cohort (area under the curve of 97.73%) and the validation cohort (area under the curve of 93.06%) between the PIOV and HC groups. Importantly, compared with PIOSs, PIOVs showed an increase in Fusobacterium. Recovery of patients was associated with the restoration of the tongue-coating microbiota. In conclusion, this study is the first to characterize the tongue-coating microbiota in PIOVs, and to construct non-invasive diagnostic models, providing new strategies for the prevention and control of coronavirus variants.
The comparative effectiveness of medicinal cannabis for chronic pain versus prescription medication treatment
Authors: Wasan Ajay D. , O'Connell Brian , DeSensi Rebecca , Bernstein Cheryl , Pickle Elizabeth , Zemaitis Michael , Levy Oren , Jeong Jong-Hyeon , Cooper Gregory F. , Douaihy Antoine
Published: January 2025

Reviews of the effectiveness of medicinal cannabis for chronic pain vary in their conclusions. IASP has identified that a key missing evidence in this debate is data from observational cohort studies, analyzed with comparative effectiveness methods. In a medically supervised context to the use of marijuana for chronic pain, we identified 440 patients certified for medical marijuana by pain specialists in a single healthcare system. They were characterized by a battery of patient-reported outcomes stored electronically in the University of Pittsburgh Patient Outcomes Repository for Treatment (PORT). At 3 months, 38.6% were responders, based on clinically meaningful improvements in pain, function, or global impression of change, and maintained this response at 6 months. In the 157 patients who were coprescribed opioids, at 6 months there was a mean 39.3% decrease in morphine milligram equivalents (P < 0.05 for the difference vs baseline). In addition, 8114 patients treated in the same pain clinics with prescription pain medications instead (nonopioid or opioid) during the same timeframe were selected from PORT as a control group for comparison. They had a 34.9% rate of response at 3 months. Using the causal inference method of stratified modeling, logistic regression revealed an odds ratio of 2.6 in favor of medical marijuana vs medication treatment (P < 0.01). Potential harms data were not available in the PORT registry. Medical marijuana was comparatively more effective than prescription medications for the treatment of chronic pain at 3 months, although the populations compared were slightly different.
Persistent changes in the dorsal root ganglion nociceptor translatome governs hyperalgesic priming in mice: roles of GPR88 and Meteorin
Authors: Sankaranarayanan Ishwarya , Kume Moeno , Mohammed Ayaan , Mwirigi Juliet M. , Inturi Nikhil Nageswar , Munro Gordon , Petersen Kenneth A. , Tavares-Ferreira Diana , Price Theodore J.
Published: January 2025

Hyperalgesic priming is a model system that has been widely used to understand plasticity in painful stimulus–detecting sensory neurons, called nociceptors. A key feature of this model system is that following priming, stimuli that do not normally cause hyperalgesia now readily provoke this state. We hypothesized that hyperalgesic priming occurs because of reorganization of translation of mRNA in nociceptors. To test this hypothesis, we used paclitaxel treatment as the priming stimulus and translating ribosome affinity purification to measure persistent changes in mRNA translation in Nav1.8+ nociceptors. Translating ribosome affinity purification sequencing revealed 161 genes with persistently altered mRNA translation in the primed state. Among these genes, we identified Gpr88 as upregulated and Metrn as downregulated. To provide functional evidence for these changes in hyperalgesic priming in a related priming model, we used the interleukin-6 priming model. A GPR88 agonist injection into the paw had no effect in naive mice but caused mechanical hypersensitivity and grimacing responses in female primed mice. Systemic Meteorin treatment in primed mice completely reversed established hyperalgesic priming mechanical hypersensitivity and grimacing responses to prostaglandin E2 in female mice. Our work demonstrates that altered nociceptor translatomes are causative in producing hyperalgesic priming in multiple models in female mice.
Optimizing Workplace Violence Reporting in a Multisite Hospital Setting: A Quality Improvement Initiative
Authors: Skippon Johanna , Pullan Caroline , Ballarino Emilie , Farrukh Maaha , Topolovec-Vranic Jane
Published: January 2025

Introduction:

Workplace violence (WPV) is a significant concern in healthcare settings and indicates the need for accurate reporting to plan and implement effective interventions. This article presents the results of a quality improvement (QI) initiative implemented at a large academic health sciences center to improve the reporting of WPV events.

Methods:

The Plan-Do-Study-Act (PDSA) model was adopted to optimize the electronic reporting process, reduce inaccuracies of WPV reporting, and ensure appropriate follow-up from leadership and the Workplace Health, Safety, and Wellness (WHSW) team. Over two PDSA cycles, modifications of an electronic incident reporting form were made.

Results:

The proportion of inaccurate reporting was significantly lower (χ2 (1, N = 1,219) = 111.86, p = .001), after the QI initiative. In addition, the revisions increased staff follow-up and support from WHSW.

Conclusions:

Our QI initiative demonstrated that simple adjustments to our WPV reporting, with the revision of an electronic reporting form, had a significant improvement on incident data accuracy and staff follow-up. These findings will contribute to our organization's staff and patient safety.
Introducing Medical Educators to Interpersonal Theory: Its Application to Emotional Intelligence
Authors: Jordan Kevin D. , Thimling Emily , Lampkins Andrew J.
Published: January 2025

Introduction

Interpersonal theory can be used to better understand the personal and social manifestations of individual difference variables in physician assistant (PA) students. Emotional intelligence (EI) is characterized by self and social awareness that facilitates effective communication. While EI has been examined in PA students, a theoretical framework for describing why and how EI has beneficial effects has not been articulated. Interpersonal theory can be used to generate hypotheses about EI and expected correlates.

Methods

One hundred nine PA students completed questionnaires assessing EI, social behavior (ie, dominance and affiliation), interpersonal efficacy, social support, loneliness, and negative social experiences. Regression analysis was used to determine interpersonal style and efficacy associated with EI. Correlation analyses were used to determine bivariate associations.

Results

Emotional intelligence was associated with a friendly interpersonal style and confidence in one’s ability to establish relationships. As expected, EI was positively correlated with social support and negatively correlated with loneliness. While in the expected direction, EI was not associated with fewer negative social experiences.

Discussion

Emotional intelligence is a potentially valuable personal resource in the lives of PA students, and there may be implications related to EI and its impact on the medical encounter. Results are discussed in terms of curriculum in PA programs and how cultivating EI could be of benefit for students. Additional research is proposed to determine which aspects of EI facilitate an effective medical encounter.
Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial
Authors: Cao Weibo , Ren Fan , Li Tong , Ma Fei , Shi Yuan , Li Xuanguang , Cao Cancan , Zhou Ning , Li Hanyi , Yu Haochuan , Mao Fuling , Chen Gang , Zu Lingling , Wei Li , Li Qing , Zhang Yuanyuan , Su Lin , Cui Wei , Wu Li , Zheng Yuxin , Li Jing , Wang Chunyan , Ju Renhua , Fang Chongliang , Yin Ling , Lu Yi , Zhang Qiang , Xu Song
Published: January 2025

The study investigates the effectiveness of immersive virtual reality (VR) as a nonpharmaceutical approach to manage postoperative pain in patients following thoracoscopic surgery. In this single-center, triple-arm pilot randomized controlled trial (RCT), 61 postsurgical patients with a postoperative pain numerical rating scale (NRS) score ≥4 after receiving standard analgesia were included and assigned to either a quantum clinics-VR (QTC-VR) group, a Placebo-VR group, or a control group. The QTC-VR group engaged in a daily 10-minute interactive pain relief 3D-VR program, while the Placebo-VR group watched a daily 10-minute relaxation-based 2D film through VR headsets for three days following surgery. 61 postsurgical patients were randomized and allocated (21 in the QTC-VR group, 20 in the Placebo-VR group, and 20 in the control group) in the final intention-to-treat (ITT) analyses. Compared with patients receiving Placebo-VR intervention, patients reported significantly lower pain scores following the daily QTC-VR intervention on postoperative days 1 (mean difference, −0.889; 95% CI, −1.464 to −0.314; P < 0.001), 2 (mean difference, −0.631; 95% CI, −1.211 to −0.051; P = 0.014), and 3 (mean difference, −0.798; 95% CI, −1.345 to −0.251; P < 0.001), respectively. Additionally, patients receiving QTC-VR intervention also reported high satisfaction and tolerable adverse events with their treatment. In conclusion, this pilot RCT demonstrates that QTC-VR might be a promising intervention for pain management post-thoracoscopic surgery, warranting further validation in ongoing phase III trials.
Evaluation of the comparative efficacy and safety of surgical strategies for long bone defects: a network meta-analysis
Authors: Shen Yuanli , Yang Qihong , Cheng Hui , Feng Yitian , Liu Yuan , Hu Jun
Published: January 2025

To evaluate the safety and efficacy of various surgical treatments for long bone defects. Despite numerous observational studies, randomized controlled trials (RCTs), and meta-analyses, the optimal surgical treatment for long bone defects remains undetermined.

Methods:

A network meta-analysis (NMA) was conducted. PubMed, Embase, and the Cochrane Library were searched for articles published between 1 January 2000, and 12 January 2023, on surgical treatments for long bone defects. RCTs and observational studies comparing five surgical treatments were selected: the Masquelet technique (MT), bone transport (BT), vascularized bone graft (VBG), non-VBG (NVBG), and bone tissue engineering (BTE). Data were extracted by two independent reviewers. The NMA aggregated direct and indirect evidence. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA) scores. Data are presented as mean differences and 95% confidence intervals. The primary outcomes were the postoperative healing rate, with subgroup analysis based on defect size (4–8 cm and >8 cm). The secondary outcomes included postoperative complications.

Results:

This NMA included 23 studies (3 RCTs and 20 observational studies) with 930 participants (median age, 35 years). There were no significant differences in clinical outcomes among the treatments. VBG (SUCRA, 75.1%) was rated as optimal for healing, and BTE (SUCRA, 28.5%) was the least effective. BTE had the highest complication rate (SUCRA, 90.9%), whereas NVBG had the lowest complication rate (SUCRA, 27.6%). Subgroup analysis showed reduced heterogeneity: for 4–8 cm defects, VBG (SUCRA, 80.4%) was optimal, and for >8 cm defects, BT (SUCRA, 76.2%) was optimal.

Conclusions:

VBG and BT may offer superior clinical outcomes for long bone defects compared to MT, NVBG, and BTE. However, BTE is associated with a high risk of complications. Further high-quality, large-sample RCTs are required to confirm these findings.
Individualized blood pressure regulation and acute kidney injury in older patients having major abdominal surgery: a pilot randomized trial
Authors: Pang Zhaohua , Liang Shuang , Zhou Nannan , Zhu Xiaoyan , Guo Qulian , Sessler Daniel I. , Zou Wangyuan
Published: January 2025

Background:

Acute kidney injury (AKI) is a common postoperative complication, and hypotension may contribute. We therefore tested the primary hypothesis that individualized intraoperative blood pressure regulation reduces postoperative AKI in older surgical patients.

Methods:

We enrolled patients ≥60 years old scheduled for elective major abdominal surgery with invasive arterial pressure monitoring. All had goal-directed fluid management based on stroke volume variation and cardiac output, and administration of a starch. Participants were randomly assigned to: 1) individualized blood pressure management targeting a systolic blood pressure (SBP) within −20% and + 10% if baseline SBP was ≥ 130 mmHg or diastolic blood pressure was ≥ 80 mmHg, or otherwise, to target SBP within ± 10% of the baseline value; 2) maintenance of SBP ≥ 90 mmHg and MAP ≥ 65 mmHg. Metaraminol was used to achieve the blood pressure target. AKI incidence was assessed by Kidney Disease Improving Global Outcomes criteria during the initial 7 postoperative days.

Results:

192 patients were assigned to individualized (n = 96) or routine (n = 96) pressure management. 179 patients were included in the intention-to-treat analysis. Age averaged 68 ± 5 (SD) yr and 64% were male. Randomization to the individualized management reduced the area under MAP <65 mmHg [median difference: − 37 (−47 to −25) mmHg-min, P < 0.001]. The incidence of the AKI was 11% in patients assigned to individualized management versus 16 % in those assigned to routine management: relative risk 0.72 [95% CI 0.34 to 1.54], P = 0.396. Patients assigned to individualized pressure management had more urine output, a shorter postoperative mechanical ventilation duration, and faster recovery of bowel function.

Conclusion:

Individualized blood pressure management markedly reduced hypotension. As expected in a pilot trial, the 28% reduction in AKI was not statistically significant. However, the reduction was clinically meaningful and suggests that a full trial is warranted.
Acellular Dermal Matrices in Reconstructive Pediatric Complex Lower Limb Trauma: An Observational Study
Authors: Adegboye Oluwatobi , Pillay Kamlen , Adams Saleigh
Published: January 2025

BACKGROUND:

Contemporary research has shown that acellular dermal matrices can benefit adult lower extremity traumatic injuries; however, its use in children has not been explored.

OBJECTIVE:

This study aims to explore the use of acellular dermal matrices in pediatric complex lower extremity trauma.

METHODS:

This single-center retrospective observational cohort study of children with complex lower extremity trauma treated with Pelnac™, commercial acellular dermal matrices, was conducted at a tertiary hospital in South Africa from 2010 to 2017. Demographic and clinical data were collected from medical records. The primary outcome was the rate and type of acellular dermal matrices-related complications. Secondary outcomes included the usage of negative pressure wound therapy.

RESULTS:

A total of 54 children were studied; 30 (55%) were male, and the median age was six. Forty-five children healed without complications, while nine experienced complications – four acute and five chronic. Four patients had complete loss of acellular dermal matrices, and three developed acute infections. More than 30 days post-acellular dermal matrices application, five patients had hypertrophic scarring, four had joint contractures, and two had non-healing wounds. All patients who healed without complication received negative pressure wound therapy (n = 45), while those who did not (n = 5) developed complications. Three of the five patients without negative pressure wound therapy had acute acellular dermal matrices loss, compared to only one of the 49 patients who received negative pressure wound therapy.

CONCLUSION:

Our findings suggest that acellular dermal matrices may be an effective and safe reconstructive adjunct or alternative when used with negative pressure wound therapy.
The Effectiveness of Budesonide Once Daily as Maintenance Treatment of Eosinophilic Esophagitis
Authors: Raymenants Karlien , Wauters Lucas , Tack Jan , Vanuytsel Tim
Published: January 2025

Background:

Swallowed topical corticosteroids (STC) are an effective first-line therapy for patients with eosinophilic esophagitis (EoE), both for induction and maintenance of remission. All interventional trials with STC used twice-daily dosing regimens. However, in other inflammatory gastrointestinal disorders, corticosteroids are given once daily (OD) with equal outcomes and improved compliance.

Goals:

To evaluate the effectiveness of topical budesonide maintenance treatment in a once-daily dosing schedule.

Study:

Retrospective analysis of confirmed patients with EoE, treated with topical budesonide as maintenance therapy OD, with adequate follow-up available. Patients currently treated with budesonide were contacted to fill out online questionnaires regarding symptoms and health-related quality of life (HRQOL). The primary end point was histologic remission, defined as peak eosinophil count (PEC) <15 eosinophils per high power field (HPF) after >12 weeks of budesonide OD.

Results:

We included 29 patients on STC OD (1 mg, N=28; 0.5 mg, N=1), either budesonide orodispersible tablet (BOT, Jorveza, Dr. Falk Pharma; N=12) or budesonide viscous solution (BVS; N=17). After a median follow-up of 767 days on OD dosing (range: 103 to 2396), 86% of patients were in histologic remission. Four patients had histologic disease activity, of which one was treated with BOT. Two patients experienced a slight increase in PEC after dose reduction of BVS to OD (to PEC of 25 and 35/HPF, respectively). However, after switching the formulation to BOT OD they achieved histologic remission.

Conclusions:

In this retrospective study, we demonstrated favorable results in the majority of patients treated with budesonide 1 mg OD as maintenance treatment for eosinophilic esophagitis.
A 14-year-old child with a benign osteoma tumor in the external ear canal: a rare case report
Authors: Othman Abdulrahman Ahmad , Ismaeil Samah Khirou , Nasser Sabine Ali , Al Mahmoud Hala Akef , Alhussain Aya Yasser , Alshikha Mohammad Nasoh , Hmrawy Batool Ayman , Haydar Ali Housein , Mousa Ayham Ameen , Alsaudi Mona Mahmoud , Sleiay Bilal
Published: January 2025

Introduction:

A benign osteoma is a non-cancerous bone tumor in the external ear canal that can cause hearing loss. Treatment may require surgery if symptoms arise.

Case presentation:

A 14-year-old child severed right ear pain, thick discharge, and hearing loss for a week after unsuccessful treatment elsewhere. Examination showed swollen ear canal and purulent discharge. After antibiotic treatment, thick debris remained. The osteoma was excised through its pedicle to minimize the risk of recurrence.

Clinical discussion:

Osteomas are benign ear growths that can cause hearing loss and blockage. Severe symptoms may require surgery, with the endoscopic transcanal method being effective for osteomas. Blockage can also occur from wax buildup or foreign bodies, potentially leading to cholesteatoma. Osteomas are typically asymptomatic and identified through CT scans, predominantly located in the external auditory canal (EAC). Surgery is advised for symptomatic cases, while regular check-ups are recommended for asymptomatic patients.

Conclusion:

Additional research is necessary to fully comprehend the causes and optimal treatment strategies for benign osteoma in the EAC.
Persistent Oscillating Vertigo From Extracranial Venous Compression
Authors: Cha Yoon-Hee , Gharib Mahmood , Chan Kayla , Karam Joseph
Published: January 2025

Background:

Persistent oscillating vertigo (POV) can be triggered by motion, when it is called mal de débarquement syndrome (MdDS) but can also occur from nonmotion triggers such as neck injury, inflammation, or homeostatic derangements (nonmotion POV [nmPOV]). The pathology underlying MdDS and nmPOV is unknown but shared symptoms include rocking/bobbing/swaying vertigo, headache, cognitive slowing, and fatigue.

Methods:

We present a case series of patients with MdDS and nmPOV whose symptoms were relieved after treatment of extracranial venous compression in the neck and thoracic outlet.

Results:

POV, regardless of the trigger, was associated with compressions at one or more of the following locations: 1) internal jugular vein (IJV) between the transverse process of the atlas and the styloid process, 2) IJV under the sternocleidomastoid muscle (SCM), and 3) subclavian vein at the thoracic outlet. Compressions were typically bilateral and in tandem. Catheter venography showed dynamic obstruction and shunting of venous blood to the petrosal sinuses around the inner ear and the vertebral veins. Relief of these obstructions with styloidectomy, stenting, neurotoxin to SCM and anterior scalene, SCM partial myotomy, and thoracic outlet decompression significantly relieved POV even with unilateral decompression.

Conclusions:

Oscillatory perceptions of POV whether MdDS or nmPOV may be from the detection of low amplitude pulsations induced by venous outflow obstruction in areas of high freedom of motion (occipito-atlanto junction, mid-neck, and thoracic outlet). Impaired venous outflow and raised venous pressure around the inner ear could lead to continuous peripheral stimulation of the vestibular system and downstream central effects.
Smoking’s Impact on 30-Day Complications in Mesh and Nonmesh Prolapse Surgery
Authors: Marczak Tara D. , Anand Mallika , Hsieh Yi , Ajayi Ayodele , Hacker Michele R. , Winkelman William D.
Published: January 2025

Importance

Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood.

Objectives

This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used.

Study Design

We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use.

Results

Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24).

Conclusions

Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.
Volitional spatial attention is lateralized in crows
Authors: Hahner Linus , Nieder Andreas
Published: January 2025

Like humans and many other animal species, birds exhibit left–right asymmetries in certain behaviours due to differences in hemispheric brain functions. While the lateralization of sensory and motor functions is well established in birds, the potential lateralization of high-level executive control functions, such as volitional attention, remains unknown. Here, we demonstrate that carrion crows exhibit more pronounced volitional (endogenous) attention for stimuli monocularly viewed with the left eye and thus in the left visual hemifield. We trained four crows on Posner-like spatial cueing tasks using informative cues to evaluate their volitional top-down attention. The crows detected cued targets using either the left or right eye. As a measure of volitional attention, we calculated reaction time differences for detecting targets that were correctly (validly) and incorrectly (invalidly) cued, separately for the left and right visual hemifields. We found that cued targets were detected more quickly and efficiently in the left visual field compared with the right visual field. Because the left-eye system of the crow’s brain processes information primarily from the left visual hemifield, these findings suggest that crows, like humans, exhibit superior executive control of attention in the left-eye/right hemisphere system of their brains.
Fungal positivity seen in tertiary care hospital during COVID-19 pandemic
Authors: Kaur Ravinder , Rawat Deepti , William Ashish , Singh Pradeep Kumar , Kandir Neelam S.S. , Sharma Akanksha
Published: January 2025

Coronavirus disease 2019 (COVID-19) pandemic has been prevailing for more than a year, associated with an increased number of opportunistic invasive fungal infections in patients who have been critically ill or immunocompromised. In this retrospective study, details of various clinical specimens received from suspected patients of fungal infections were studied. Fungal cultures were positive in 64% (51 out of 79) of COVID-19-positive patients and 43% (163 out of 381) of COVID-19-negative patients during the second wave of COVID-19 in 2021. Among COVID-19-infected patients, the most commonly isolated fungi were Candida spp. (63%), followed by Aspergillus spp. (15%) and Mucor spp. (6%). The majority of samples that tested positive in COVID-19-infected patients were urine (17% from COVID-19-positive and 83% from COVID-19-negative patients), followed by serum (tested for Aspergillus galactomannan). Candida isolation was observed in 27% (21/79) of urine samples and 15% (12/79) of respiratory samples [bronchoalveolar lavage (BAL), tracheal aspirate, and sputum] from COVID-19-positive patients. Rhizopus arrhizus and Rhizopus homothallicus were isolated from nasal and tissue samples in 6% of COVID-19-positive patients. There was an overall increase in fungal co-isolations during the COVID-19 pandemic (64% in COVID-19-positive and 43% in COVID-19-negative patients), which is a matter of great concern. The correlation of clinical symptomatology and laboratory isolation is important for the diagnosis and effective management of these patients.
International Committee on Systematics of Prokaryotes Subcommittee on the taxonomy of Chlamydiae: minutes of the closed meeting, Zoom meeting, 24 September 2024
Authors: Borel Nicole , Greub Gilbert ,   for the ICSP Subcommittee on the taxonomy of
Published: January 2025

Subcommittee on the taxonomy of Chlamydiae: minutes of the closed meeting, Zoom meeting, 24 September 2024.
Low cluster of differentiation 4+ T-cell count associated with thrombocytopenia among people living with human immunodeficiency virus-1 receiving antiretroviral in West Papua
Authors: Adiningsih Setyo , Widiyanti Mirna , Hermawan Asep , Idrus Hasta Handayani , Fitrianingtyas Rizki
Published: January 2025

Introduction. Anaemia and thrombocytopenia are blood-related irregularities linked to an increased likelihood of disease progression, leading to death in people living with human immunodeficiency virus 1 (PLHIV).

Gap statement. Severe clinical conditions associated with human immunodeficiency 1 (HIV-1) infection may be related to blood irregularities among PLHIV.

Aim. The study aimed to examine the factors correlated with blood irregularities among PLHIV receiving antiretroviral treatment in West Papua.

Methodology. We conducted a study at hospitals in West Papua involving 80 participants who received antiretroviral therapy (ART) and agreed to provide informed consent. Standardized and validated questionnaires were used for data collection. Sequential assessment of haematological and immunological parameters was performed using Sysmex haematology and PIMA CD4+ analyser. Fisher’s exact test and logistic regression analysis were applied, with a significance level set at P<0.05, to identify the key factors positively associated with blood irregularities.

Results. The overall incidences of anaemia and thrombocytopenia were 56.3 and 40%, respectively. Fisher’s exact test indicated that anaemia [adjusted odds ratio (AOR): 3.02; 95% confidence interval (CI): 1.160–7.866; P<0.05] and low CD4+ T-cell count (AOR: 3.81; 95 % CI: 1.485–9.820, P<0.05) were significantly associated with thrombocytopenia. Logistic regression analysis revealed that the most influential factor contributing to thrombocytopenia-related blood irregularities was the clinical CD4+ T-cell count (B=3.818; 95% CI: 1.485–9.820, P<0.05).

Conclusion. CD4+ T-cell count was indicated as the main factor causing thrombocytopenia among PLHIV receiving ART in West Papua. It is crucial to conduct screening and regular haematological assessments among PLHIV having low CD4+ T-cell counts to mitigate morbidity and mortality risks.
Association of memory function with COVID-19 outcomes in adults aged 50 years and older: Analysis of three prospective cohorts
Authors: Shi Juanjuan , Shen Xin , Tian Yan , Lu Rui , Li Jia , Geng Xiaozhen , Zhai Song , Jia Xiaoli , Ji Fanpu , Dang Shuangsuo , Wang Wenjun
Published: January 2025

Background

Patients with Alzheimer’s disease or dementia are at increased risk for COVID-19 hospitalization and mortality. However, no study has examined whether memory function is associated with COVID-19 outcomes in general older adults.

Methods

Data were obtained from SHARE (the Survey of Health, Ageing and Retirement in Europe), HRS (the Health and Retirement Study), and ELSA (the English Longitudinal Study of Ageing), three prospective and representative cohorts of non-institutionalized adults aged 50 years and older in 25 European countries plus Israel, the United States, and the United Kingdom, respectively. Memory function was measured with immediate and delayed 10-words recall tests. Associations of 10-words recall with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, race, body mass index, smoking, physical activity, household income, education level, and chronic conditions.

Results

A total of 4062 participants with COVID-19 infection from SHARE, 1349 from HRS, and 278 from ELSA were included in the analysis. 610 (15.0%) in SHARE, 142 (10.5%) in HRS, and 39 (14.0%) in ELSA were hospitalized, and 102 (2.5%) died of COVID-19 or related complications in SHARE. The adjusted odds ratios (aORs) for COVID-19 hospitalization were 1.15 (95% CI, 1.09-1.22) in SHARE, 1.07 (95% CI, 0.94-1.21) in HRS, and 1.34 (95% CI, 1.02-1.77) in ELSA, per word decrease in immediate 10-words recall. For delayed 10-words recall, the corresponding aORs were 1.11 (95% CI, 1.06-1.17), 1.12 (95% CI, 1.01-1.24), and 1.25 (95% CI, 1.01-1.55), respectively. The aORs for COVID-19 mortality were 1.07 (95% CI, 0.94-1.21) and 1.14 (95% CI, 1.01-1.28) per word decrease in immediate and delayed 10-words recall in SHARE, respectively. Results were relatively robust to missing data of covariates, exclusion of cases based on symptoms alone, or exclusion of cases with Alzheimer’s disease or dementia.

Conclusions

This study shows that low memory performance, as measured by 10-words recall, is independently associated with an increased risk of COVID-19 hospitalization and mortality in adults aged 50 years and older.
The genetics of TDP43-Type-C neurodegeneration: a whole genome sequencing study
Authors: Nassan Malik , Ayala Ivan Alejandro , Sloan Jennifer , Bonfitto Anna , Stark Bobbi , Song Serena , Naymik Marcus , Geula Changiz , Gefen Tamar , Barbieri Elena , Piras Ignazio S. , Mesulam M-Marsel , Huentelman Matt J.
Published: January 2025

Frontotemporal lobar degeneration-TDP Type C (TDP-C) is a unique neurodegenerative disease that starts by attacking the anterior temporal lobe leading to language and/or behavioral syndromes. Current literature on the genetic associations of TDP-C, which we have reviewed here, is uneven and lacks a discernible corpus of robust findings. In our study, we completed genome wide hypothesis-free analyses utilizing artificial Intelligence (AI) to identify rare and common variants associated with TDP-C. We then investigatedANXA11andTARDBPin a hypothesis-driven analysis, since it was recently shown that TDP-43 and Annexin A11 co-aggregate in all TDP-C cases.

1) Whole genome sequencing was completed to identify pathogenic rare variants prioritized with Illumina’s AI-based Emedgene software on 37 confirmed or probable TDP-C cases from the Northwestern-University Cohort. 2) A genome wide association study was then completed to identify common variants associated with TDP-C cases vs 290 controls. 3) Next, common and rare variants inTARDBP, and ANXA11were investigated in TDP-C vs controls.

These analyses identified novel genetic associations betweenFIG4,UBQLN2,INPP5A, andANXA11with TDP-C. Of theseFIG4, UBQLN2 and ANXA11have been associated previously with Amyotrophic lateral sclerosis (ALS). To further assess the observed potential genetic overlap between ALS and TDP-C, we leveraged Mendelian randomization (MR) to assess if the ALS genetic load is associated with TDP-C risk, and found evidence supporting this association.

The genetic association ofANXA11with TDP-C is particularly interesting in view of the recently discovered role ofAnnexin A11in forming heterodimers with TDP-43 in all abnormal precipitates, a feature not found in TDP-A or TDP-B, which have no similar predilection for the anterior temporal lobe. In addition to the observed overlap between ALS genetics/ genetic load and TDP-C, it is worth mentioning thatFIG4, INPP5A and ANXA11have been implicated in the inositol metabolism pathway, a feature that remains to be elucidated mechanistically. Our TDP-C genetic literature review identified a surprising paucity of neuropathologically confirmed cases in published investigations. Nonetheless, the literature offers support for some of our findings and reemphasizes the absence of dominant or major pathogenic genes for TDP-C, another feature that sets this neuropathologic entity apart from TDP-A and TDP-B.
Long COVID affects working memory: Assessment using a single rapid online test
Authors: Asghar Aziz UR , Yuen Hong Kiu , Aksoy Murat , Salawu Abayomi , Baseler Heidi A
Published: January 2025

Long COVID, or post-COVID-19 syndrome, is characterized by persistent symptoms following SARS-CoV-2 infection, including cognitive impairments such as brain fog that adversely affects quality of life. The aim of this study was to evaluate the impact of long COVID on working memory using a single rapid online anonymous survey and working memory quiz. We analyzed working memory scores in relation to long COVID status (clinically diagnosed, self-reported, and non-long COVID), age, number of COVID-19 infections and long COVID duration, and subjective ratings of brain fog severity and overall life impact of symptoms. The study recruited 1064 participants aged 16 to over 85 years (83% from the United Kingdom) with 39% reporting long COVID. The results demonstrate that long COVID significantly impairs working memory, with the greatest deficits observed in clinically diagnosed cases. In addition, we found that working memory declined with age and multiple COVID-19 infections particularly in the diagnosed long COVID group. Moreover, individuals in the diagnosed long COVID group reported experiencing the most severe brain fog and the greatest impact of long COVID symptoms on their lives, and both of these factors were strongly correlated with lower memory scores. Participants who had been living with long COVID for a longer duration had lower memory scores. However, this relationship was likely influenced by the SARS-CoV-2 variant, as individuals with prolonged long COVID symptoms were more likely to have been infected with earlier variants (alpha and wild-type) which are linked to more severe disease outcomes. Our results suggest that long COVID is associated with significant working memory impairments, emphasizing the need for targeted interventions and support strategies for those with long COVID to address memory problems.