bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate Results of the Use of Split-Thickness Skin Autografts With and Without Acellular Dermal Matrix in Patients with Burns: A Comparative Study in a Colombian Population
Authors: Ávila León Jorge Luis , Rivero Carlos Ramírez , Guerrero Serrano Linda , Alviar Juan Darío , Rodríguez María Angélica , Arocha Ana María , Pineda German Gómez
Published: September 2023

Dermal substitutes have become fundamental tools for covering skin defects, most recently with biological subtypes such as glycerolized acellular dermal matrix (GADM). However, literature regarding this matter is scarce in Latin America and Colombia. In this descriptive observational study, we compared the use of partial skin autografts (PSA) combined with GADM and autografts without GADM. Patients were selected from the burn unit of a hospital in northeastern Colombia between 2021 and 2022. Two study groups were defined: one receiving GADM plus PSA and the other control receiving only a partial split-thickness autograft. A total of 29 patients with 68 body areas were included, with an average age of 20 years. Most cases involved third-degree burns caused by flame. Hospitalization time was the same for both groups (41 days). The percentage of grafts taken was similar in both groups; in the GADM with autografts group, it was 94.7% compared with 96% in the control group. The presence of complications was similar in both groups. GADM produced in local tissue banks is a cost-effective alternative. It can be used in a single surgical procedure without increasing complications, providing a postsurgical course similar to autografts alone. Granting the potential long-term benefits that dermal matrices give for healing in these patients, which should be evaluated in subsequent studies.
The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD
Authors: Coward Stephanie , Benchimol Eric I , Kuenzig M Ellen , Windsor Joseph W , Bernstein Charles N , Bitton Alain , Jones Jennifer L , Lee Kate , Murthy Sanjay K , Targownik Laura E , Peña-Sánchez Juan-Nicolás , Rohatinsky Noelle , Ghandeharian Sara , Im James H B , Davis Tal , Weinstein Jake , Goddard Quinn , Gorospe Julia , Bennett Jennifer , Caplan Léa , Bergevin Maxime , Yang Xin Yu , Mason Kate , Sanderson Rhonda , Brass Colten , Kaplan Gilaad G
Published: September 2023

Inflammatory bowel disease (IBD), consisting of Crohn’s disease and ulcerative colitis, is recognized across the world, though Canada has among the highest burdens of IBD in the world. The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) led a six-province study that demonstrated the compounding prevalence of IBD in Canada from 400 per 100,000 in 2002 to 636 per 100,000 in 2014. The prevalence in 2023 is estimated at 825 per 100,000, meaning that over 320,000 people in Canada are living with IBD. Prevalence is forecasted to rise by 2.44% per year such that 1.1% of the population, 470,000 Canadians, will live with IBD by 2035. The overall incidence of IBD in 2023 is 30 per 100,000 person-years, indicating that over 11,000 Canadians will be newly diagnosed with IBD in 2023. Incidence is forecasted to rise by 0.58% per year up to 32.1 per 100,000 by 2035. The rising incidence of IBD is propelled by pediatric-onset IBD, which is rising by 1.23% per year from 15.6 per 100,000 in 2023 to 18.0 per 100,000 in 2035. In contrast, incidence rates among adults and seniors are relatively stable. Understanding the determinates of IBD has expanded through prospective cohort studies such as the Crohn’s and Colitis Canada Genetic, Environmental, Microbial (CCC-GEM) project. Consensus recommendations towards diet, lifestyle, behavioural and environmental modifications have been proposed by international organizations with the goal of optimizing disease control and ultimately preventing the development of IBD. Despite these efforts, Canadian healthcare systems will need to prepare for the rising number of people living with IBD.
Time to Grow Up? Adult Children as Determinants of Parental Labor Supply
Authors: Braga Breno , Malkova Olga
Published: September 2023

As children transition to adulthood, do they remain a major determinant of parental labor supply? To answer this question, we examine how college costs affect the labor supply of mothers and fathers by exploiting the roll-out of nine generous state merit aid programs in the United States from 1993 to 2004, which made college more affordable. Mothers of college-age children decreased their annual hours of work after the introduction of these state-wide programs, while fathers did not adjust their labor supply. Mothers of college-going children were entirely responsible for the decline in hours of work, where mothers of children who did not go to college experienced no change in hours of work. The decline in labor supply was mainly due to adjustments among high-income, married, more educated, and white mothers, whose labor supply was more elastic to college costs.
2D cross-hole electromagnetic inversion algorithms based on regularization algorithms
Authors: Li Xiaocui , Cao Ligang , Cao Hui , Wei Tongbiao , Liu Lei , Yang Xingtao
Published: September 2023

The cross-hole electromagnetic (EM) method, which is currently at the forefront of electric logging technology, fundamentally solves the problems of the lateral imaging ability of single-well logging and the lack of detection of inter-well physical properties. However, due to the complexity of underground reservoir distribution and the non-uniqueness problem of geophysical inversion, there remains a lack of practical and effective cross-hole electromagnetic inversion methods. Our goal is to develop an efficient method to reduce the non-uniqueness of the physical property model recovered in the inversion. It is worth noting that the regularization algorithm, as a means to approximately solve inversion problems, can obtain different solutions by changing the form of the regularization function, so as to ensure the stability of inversion results and conform to the smooth or non-smooth characteristics in known geology or geophysics. We adjust the features of the final inversion model in a defined framework by changing the values of the $\alpha $ coefficient in the regularization and using the Lawson norm as a ${l}_p$-norm approximation form for $p \in [ {0,2} ]$. At the same time, the iteratively reweighted least-squares method is used to solve the optimization problem, and the gradient in the Gauss–Newton solution is adjusted successively to ensure that every term in the regularization contributes to the final solution. Compared with the traditional ${l}_2$-norm inversion method, the sparse inversion method can make more effective use of information regarding known physical properties and obtain better inversion results. Then, the effectiveness of our inversion method is verified by model tests and inversion of measured data in a mining area.
Balancing Legalism and Pragmatism: A Qualitative Content Analysis of Human Rights Language in Peace Agreements
Authors: Lacatus Corina
Published: September 2023

In recent decades, the role of human rights in peacebuilding has been the object of scholarly and practitioner debate. Some commentators criticize human rights for being inflexibly legalist and for lacking pragmatism regarding the domestic implementation of international law. Other scholars support the inclusion of human rights provisions in peace agreements, as central to sustainable peace. Which account—the legalist or the pragmatist—is indeed more accurate in the context of the language of peace agreements? This research draws on the scholarship on peacebuilding and human rights to offer a qualitative content analysis of human rights provisions in 357 peace agreements signed from 1990 to 2020. The analysis finds that, in peace agreements, some human rights provisions can serve a wider range of peace-related purposes that go far beyond a legalist purpose while still advancing the importance of alignment with international law. The findings are important, suggesting that our quest for the causes of human rights implementation failures might have to move past a critique of the language of human rights and look elsewhere for factors explaining non-compliance with international human rights.
Pressure-sensitive paint measurements on the cavity with passive control devices under transonic flow
Authors: Ouyang Jun-Kai , Liao Yi-Ting , Hsu Yen-Ting , Lee Cheng-Chi , Lin Yu-Hung , Chen Chung-Lung , Wang Wei-Hsiang
Published: September 2023

In this study, the pressure-sensitive paint (PSP) technique, specifically the mesoporous-particle-based PSP, was employed to compare rectangular cavities with varying length-to-depth ratios (L/D) and different trailing edge shapes under transonic conditions. By utilizing PSP, comprehensive and quantitative pressure data were obtained, enabling the simultaneous observation of surface flow field distribution. The results obtained using PSP were found to be consistent with those obtained from conventional pressure sensors. The study revealed that the pressure distribution within the cavities changed with increasing L/D, and cavities with different trailing edge shapes demonstrated a reduction in pressure at the bottom region. Furthermore, the comparison of results obtained through the oil flow method corroborated the PSP findings, indicating that a beveled or sawtooth-shaped trailing edge of the cavity induced air flow deflection, effectively disrupting the upstream shear flow structure and altering the pressure distribution at the cavityʼs bottom.
Barley shows reduced Fusarium head blight under drought and modular expression of differentially expressed genes under combined stress
Authors: Hoheneder Felix , Steidele Christina E , Messerer Maxim , Mayer Klaus F X , Köhler Nikolai , Wurmser Christine , Heß Michael , Gigl Michael , Dawid Corinna , Stam Remco , Hückelhoven Ralph
Published: September 2023

Plants often face simultaneous abiotic and biotic stress conditions; however, physiological and transcriptional responses under such combined stress conditions are still not fully understood. Spring barley (Hordeum vulgare) is susceptible to Fusarium head blight (FHB), which is strongly affected by weather conditions. We therefore studied the potential influence of drought on FHB severity and plant responses in three varieties of different susceptibility. We found strongly reduced FHB severity in susceptible varieties under drought. The number of differentially expressed genes (DEGs) and strength of transcriptomic regulation reflected the concentrations of physiological stress markers such as abscisic acid or fungal DNA contents. Infection-related gene expression was associated with susceptibility rather than resistance. Weighted gene co-expression network analysis revealed 18 modules of co-expressed genes that reflected the pathogen- or drought-response in the three varieties. A generally infection-related module contained co-expressed genes for defence, programmed cell death, and mycotoxin detoxification, indicating that the diverse genotypes used a similar defence strategy towards FHB, albeit with different degrees of success. Further, DEGs showed co-expression in drought- or genotype-associated modules that correlated with measured phytohormones or the osmolyte proline. The combination of drought stress with infection led to the highest numbers of DEGs and resulted in a modular composition of the single-stress responses rather than a specific transcriptional output.
Emulating radiative transfer with artificial neural networks
Authors: Sethuram Snigdaa S , Cochrane Rachel K , Hayward Christopher C , Acquaviva Viviana , Villaescusa-Navarro Francisco , Popping Gergö , Wise John H
Published: September 2023

Forward-modeling observables from galaxy simulations enables direct comparisons between theory and observations. To generate synthetic spectral energy distributions (SEDs) that include dust absorption, re-emission, and scattering, Monte Carlo radiative transfer is often used in post-processing on a galaxy-by-galaxy basis. However, this is computationally expensive, especially if one wants to make predictions for suites of many cosmological simulations. To alleviate this computational burden, we have developed a radiative transfer emulator using an artificial neural network (ANN), ANNgelina, that can reliably predict SEDs of simulated galaxies using a small number of integrated properties of the simulated galaxies: star formation rate, stellar and dust masses, and mass-weighted metallicities of all star particles and of only star particles with age <10 Myr. Here, we present the methodology and quantify the accuracy of the predictions. We train the ANN on SEDs computed for galaxies from the IllustrisTNG project’s TNG50 cosmological magnetohydrodynamical simulation. ANNgelina is able to predict the SEDs of TNG50 galaxies in the ultraviolet (UV) to millimetre regime with a typical median absolute error of ∼7 per cent. The prediction error is the greatest in the UV, possibly due to the viewing-angle dependence being greatest in this wavelength regime. Our results demonstrate that our ANN-based emulator is a promising computationally inexpensive alternative for forward-modeling galaxy SEDs from cosmological simulations.
Measuring the photoionization rate, neutral fraction, and mean free path of H i ionizing photons at 4.9 ≤ z ≤ 6.0 from a large sample of XShooter and ESI spectra
Authors: Gaikwad Prakash , Haehnelt Martin G , Davies Fredrick B , Bosman Sarah E I , Molaro Margherita , Kulkarni Girish , D’Odorico Valentina , Becker George D , Davies Rebecca L , Nasir Fahad , Bolton James S , Keating Laura C , Iršič Vid , Puchwein Ewald , Zhu Yongda , Asthana Shikhar , Yang Jinyi , Lai Samuel , Eilers Anna-Christina
Published: September 2023

We measure the mean free path ($\lambda _{\rm mfp,H\, \small {I}}$), photoionization rate ($\langle \Gamma _{\rm H\, \small {I}} \rangle$), and neutral fraction ($\langle f_{\rm H\, \small {I}} \rangle$) of hydrogen in 12 redshift bins at 4.85 < z < 6.05 from a large sample of moderate resolution XShooter and ESI QSO absorption spectra. The fluctuations in ionizing radiation field are modelled by post-processing simulations from the Sherwood suite using our new code ‘EXtended reionization based on the Code for Ionization and Temperature Evolution’ (ex-cite). ex-cite uses efficient Octree summation for computing intergalactic medium attenuation and can generate large number of high resolution $\Gamma _{\rm H\, \small {I}}$ fluctuation models. Our simulation with ex-cite shows remarkable agreement with simulations performed with the radiative transfer code Aton and can recover the simulated parameters within 1σ uncertainty. We measure the three parameters by forward-modelling the  Lyα forest and comparing the effective optical depth ($\tau _{\rm eff, H\, \small {I}}$) distribution in simulations and observations. The final uncertainties in our measured parameters account for the uncertainties due to thermal parameters, modelling parameters, observational systematics, and cosmic variance. Our best-fitting parameters show significant evolution with redshift such that $\lambda _{\rm mfp,H\, \small {I}}$ and $\langle f_{\rm H\, \small {I}} \rangle$ decreases and increases by a factor ∼6 and ∼104, respectively from z ∼ 5 to z ∼ 6. By comparing our $\lambda _{\rm mfp,H\, \small {I}}$, $\langle \Gamma _{\rm H\, \small {I}} \rangle$ and $\langle f_{\rm H\, \small {I}} \rangle$ evolution with that in state-of-the-art Aton radiative transfer simulations and the Thesan and CoDa-III simulations, we find that our best-fitting parameter evolution is consistent with a model in which reionization completes by z ∼ 5.2. Our best-fitting model that matches the $\tau _{\rm eff, H\, \small {I}}$ distribution also reproduces the dark gap length distribution and transmission spike height distribution suggesting robustness and accuracy of our measured parameters.
Lopsidedness as a tracer of early galactic assembly history
Authors: Dolfi Arianna , Gómez Facundo A , Monachesi Antonela , Varela-Lavin Silvio , Tissera Patricia B , Sifón Cristóbal , Galaz Gaspar
Published: September 2023

Large-scale asymmetries (i.e. lopsidedness) are a common feature in the stellar density distribution of nearby disc galaxies both in low- and high-density environments. In this work, we characterize the present-day lopsidedness in a sample of 1435 disc-like galaxies selected from the TNG50 simulation. We find that the percentage of lopsided galaxies (10  per cent–30  per cent) is in good agreement with observations if we use similar radial ranges to the observations. However, the percentage (58  per cent) significantly increases if we extend our measurement to larger radii. We find a mild or lack of correlation between lopsidedness amplitude and environment at z = 0 and a strong correlation between lopsidedness and galaxy morphology regardless of the environment. Present-day galaxies with more extended discs, flatter inner galactic regions, and lower central stellar mass density (i.e. late-type disc galaxies) are typically more lopsided than galaxies with smaller discs, rounder inner galactic regions, and higher central stellar mass density (i.e. early-type disc galaxies). Interestingly, we find that lopsided galaxies have, on average, a very distinct star formation history within the last $10\, \mathrm{Gyr}$, with respect to their symmetric counterparts. Symmetric galaxies have typically assembled at early times (∼8–$6\, \mathrm{Gyr}$ ago) with relatively short and intense bursts of central star formation, while lopsided galaxies have assembled on longer time-scales and with milder initial bursts of star formation, continuing building up their mass until z = 0. Overall, these results indicate that lopsidedness in present-day disc galaxies is connected to the specific evolutionary histories of the galaxies that shaped their distinct internal properties.
Coping Strategies and Associated Symptom Burden Among Patients With Advanced Cancer
Authors: Dev Rony , Agosta Monica , Fellman Bryan , Reddy Akhila , Baldwin Sarah , Arthur Joseph , Haider Ali , Carmack Cindy , Hui David , Bruera Eduardo
Published: September 2023

Background

Few studies examine how patients with advanced cancer cope with stress. The objective of our study was to evaluate coping strategies adopted by patients with cancer and their relationship with symptom burden.

Methods

A secondary data analysis of a prospective cross-sectional survey of patients with cancer and tobacco use was conducted, which examined demographics, symptom burden (Edmonton Symptom Assessment System), and coping strategies (the Brief COPE Questionnaire). Demographic characteristics were summarized by standard summary statistics; we also examined associations between patient characteristics and coping strategies using t-test, rank-sum test, chi-squared test, or Fisher’s exact test depending on the distribution of data.

Results

Among 399 patients, the majority were female (60%), Caucasian (70%), the mean age was 56.5 (±12.0) years, and the most common malignancies were gastrointestinal (21%) and breast (19%). Patients with cancer adopted multiple adaptive coping strategies, most frequently acceptance (86.7%) and emotional support (79.9%), with humor (18.5%) being the least. Common maladaptive strategies included venting (14.5%) and self-distraction (36.6%), while substance use (1.0%) was infrequently reported. Of the adaptive strategies, female gender was significantly associated with higher engagement with emotional and instrumental support, positive reframing, religious coping, and acceptance (P < .05 for all). College educated patients reported significantly higher implementation of humor, planning, and acceptance. Maladaptive coping strategies such as denial were associated with increased pain and depression, while patients adopting emotional-focused strategies rated decreased emotional distress.

Conclusions

The majority of patients with advanced cancer reported adopting multiple, adaptive coping strategies, and a minority utilized maladaptive or avoidant strategies, rarely substance use, and may need additional psychological support.
Molecular evidence for enhancer–promoter interactions in light responses of soybean seedlings
Authors: Huang Mingkun , Zhang Ling , Yung Wai-Shing , Hu Yufang , Wang Zhili , Li Man-Wah , Lam Hon-Ming
Published: September 2023

Interactions of enhancers with promoters and transcription factors mediate chromatin loop formation to regulate downstream gene expression in response to environmental stimuli such as light.
Large vessel involvement in antineutrophil cytoplasmic antibody-associated vasculitis
Authors: Kaymakci Mahmut S , Elfishawi Mohanad M , Langenfeld Hannah E , Hanson Andrew C , Crowson Cynthia S , Bois Melanie C , Ghaffar Umar , Koster Matthew J , Specks Ulrich , Warrington Kenneth J
Published: September 2023

Objectives

ANCA-associated vasculitis (AAV) is currently categorized under the small vessel vasculitides. There is limited knowledge about large vessel involvement in AAV (L-AAV), mainly described in case reports and small series. L-AAV can involve temporal arteries (TA-AAV), aorta (A-AAV), and periaortic soft tissue (PA-AAV). We sought to characterize the features of patients with L-AAV.

Methods

Patients older than 18 years at diagnosis of TA-AAV, A-AAV and PA-AAV seen at the Mayo Clinic, Rochester between 1 January 2000 and 31 December 2021 were identified through a proprietary medical text search algorithm. Patients were included if diagnosed with L-AAV, fulfilled 2022 ACR/EULAR classification criteria for GPA, MPA or EGPA, had positive ANCA test results, and had more than one outpatient or inpatient visit.

Results

The study cohort consists of 36 patients with L-AAV. Of those, 23 had p-ANCA and/or MPO-ANCA, and 13 had c-ANCA and/or PR3-ANCA. Mean (s.d.) age at AAV diagnosis was 63.4 (12.79) years; 20 (56%) were male. Seventeen patients had TA-AAV, 10 had A-AAV and 9 had PA-AAV. Most patients (n = 25, 69%) were diagnosed with large vessel vasculitis and AAV within a 1-year timespan. Twenty-five (69%) patients had histopathological confirmation of AAV diagnosis in a location other than temporal artery, aorta or periaortic soft tissue. Glucocorticoids (36/36), rituximab (19/36) and methotrexate (18/36) were the most frequent treatments.

Conclusion

This is the largest single-centre cohort of patients with L-AAV to date. AAV can involve large arteries, albeit infrequent. AAV-targeted therapy should be considered in patients with L-AAV.
A Heterolepidoderma and Halichaetoderma gen. nov. (Gastrotricha: Chaetonotidae) riddle: integrative taxonomy and phylogeny of six new freshwater species from Central Europe
Authors: Rataj Križanová Františka , Vďačný Peter
Published: September 2023

Heterolepidoderma is a widely distributed gastrotrich genus encompassing 22 freshwater and 15 marine species. In the present study, two new Heterolepidoderma and four new Heterolepidoderma-like species were discovered in the inland waters of Central Europe. Although Heterolepidoderma-like species exhibited all the morphological features typical of Heterolepidoderma, both nuclear and mitochondrial genes robustly showed their sister-group relationship to the marine genus Halichaetonotus. Most Heterolepidoderma species, including the new ones, were grouped with some Chaetonotus and Ichthydium species in a strongly supported cluster (so-called Heterolepidoderma s.l. clade). Since statistical tree topology tests robustly refuted the close affinity of Heterolepidoderma-like species to the Heterolepidoderma s.l. clade, a new genus, Halichaetoderma gen. nov., was proposed for them. Stochastic mapping suggested that the last common ancestor (LCA) of the Chaetonotidae‒Neogosseidae‒Dasydytidae clade had scales carrying keels with spines. Scales became oblong in the LCA of the Halichaetoderma + Halichaetonotus clade and three times independently within the Heterolepidoderma s.l. clade. Spines were lost in the LCAs of the Halichaetoderma + Halichaetonotus and Heterolepidoderma s.l. clades convergently. State-by-state associations of cuticular characters suggested that particular scale morphologies tend to be correlated with particular numbers of keels and the presence/absence of spines during the chaetonotid phylogeny.
Treating rheumatoid arthritis
Authors: Korol Ihor , Baumeister Robin H.
Published: September 2023

Rheumatoid arthritis (RA) affects about 1% of the world's population and can lead to loss of joint function, reduced mobility, and permanent damage to cartilage and bone. Treatment options for RA primarily include disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, but the development of new drugs has complicated treatment decisions. Weighing treatment options for patients with RA largely depends on three major factors: efficacy, adverse reaction profile, and cost. A review of the literature supports methotrexate monotherapy as the current best-practice model for treating RA, compared with combination therapy of methotrexate and/or other DMARDs.
Recognizing and treating patients with Ewing sarcoma
Authors: Windheuser Ashley , Gardner Nathan
Published: September 2023

This article reviews the cause, presentation, diagnosis, and management of Ewing sarcoma, the second most common primary bone malignancy in children and young adults. Recent research has provided advances in understanding the cause of Ewing sarcoma as well as improved treatment regimens. However, much is still unknown and additional research is needed to continue to improve the overall prognosis, which ranges from 70% to 80% 5-year survival for patients with localized disease. Improving clinician knowledge about Ewing sarcoma will help shorten time to diagnosis and improve survival rates.
PAs in Poland
Authors: Fron Karol , Waszak Jacek , Chrapek Marcin , Bareja Sylwia
Published: September 2023

After many years of consultations with the international physician assistant (PA) community and a successful pilot program, in November 2021, the Polish Ministry of Health approved a specialty training program for surgical PAs. The inaugural class began studies in July 2022. This article details the circumstances and the process that led to the creation of this new program.
Should all asthma patients be switched to single maintenance and reliever therapy?
Authors: Smicherko Gabriela , Albright Amanda , Nguyen Kimmy
Published: September 2023

Recent data indicate that overuse of short-acting beta2-agonists (SABAs) results in an increased risk of asthma exacerbations and mortality. The use of inhaled corticosteroid-formoterol as both maintenance and reliever therapy has become a preferred regimen for asthma management. Clinicians should be aware of the pharmacology, dosing, and prescribing considerations regarding the use of budesonide-formoterol as the available combination in the United States.
Evaluation and management of avoidant/restrictive food intake disorder
Authors: Wirth Jessica M.
Published: September 2023

Avoidant/restrictive food intake disorder (ARFID) is an uncommon but complex eating disorder characterized by extreme picky eating without poor body image or fear of weight gain. Intake is limited by volume or variety of food, driven by fear of adverse consequences associated with ingestion, sensory sensitivities to food properties, or a lack of interest in eating. Avoidance or restriction of food intake can lead to low body weight or failure to thrive, nutritional deficiencies, reliance on enteral feeding, and psychosocial impairment. The presentation of ARFID varies depending on severity, variety, and volume of diet; therefore, medical evaluation should be comprehensive, should be tailored to patient needs, and should include screening for commonly co-occurring psychiatric conditions. Cognitive behavioral therapy and/or family-based therapy, in conjunction with pharmacotherapy and/or hospital refeeding, have demonstrated therapeutic benefit. Available literature is sparse and largely limited to children and adolescents. Additional studies are needed to evaluate therapeutic interventions, medical follow-up, and prognosis.
Use of cryotherapy in the postoperative management of paediatric anterior cruciate ligament reconstruction: a prospective randomised controlled trial
Authors: Wong Joel Yat Seng , Ashik Mohammad Bin Zainuddin , Mishra Neeraj , Lee Nicole Kim Luan , Mahadev Arjandas , Lam Kai Yet
Published: September 2023

To investigate the efficacy of cryotherapy in relieving postoperative pain and restoring knee range-of-motion (ROM) after paediatric anterior cruciate ligament reconstruction (ACLR). Patients undergoing primary ACLR were randomised into cryotherapy or non-cryotherapy groups. Those receiving cryotherapy were subjected to a standardised icing protocol. Icing schedules were used to assess compliance. Standard postoperative rehabilitation protocol was followed for both groups. Outcome measurements were visual analogue scale at rest and movement and knee ROM. Patients were assessed on postoperative day 1 (POD1), 1, 4 and 6 weeks. Twenty-one out of 42 patients received cryotherapy. Both groups were similar in demographics, surgical technique and use of intraoperative anaesthesia. Patients in the cryotherapy group reported lower overall mean pain scores throughout the study duration at rest (0.61 ± 1.70, 95% CI = 0.23–0.99 vs. 1.06 ± 2.03, 95% CI = 0.60–1.53) and on movement (2.19 ± 2.68, 95% CI = 1.59–2.79 vs. 3.13 ± 2.75, 95% CI = 2.51–3.75; P = 0.032). Knee flexion in the cryotherapy group showed better recovery of knee flexion from week 4 onwards. Improvement of knee flexion from POD1 is statistically significant at week 6 (98.7 ± 19.1°, 95% CI = 89.5–107.9 vs. 65.4 ± 49.9°, 95% CI = 42.7–88.1; P = 0.010) and overall mean (71.2 ± 35.9°, 95% CI = 61.2–81.1 vs. 45.3 ± 55.5°, 95% CI = 30.4–60.2; P = 0.005). The cryotherapy group reported statistically significant better degree of overall mean knee extension (1.2 ± 3.3°, 95% CI = 0.5–2.0 vs. 2.6 ± 4.6°, 95% CI = 1.6–3.7; P = 0.032). The use of cryotherapy in postoperative ACLR recovery in paediatrics is a simple yet effective measure resulting in short-term pain relief and improvement in knee flexion.
Serum uric acid and the risk of colorectal cancer: a meta-analysis
Authors: Liao Wenqiang , Wang Yuxiang , Zhang Wenpeng
Published: September 2023

Background

A meta-analysis was performed in this study to evaluate the association between serum uric acid and the risk of colorectal cancer (CRC).

Methods

Relevant observational studies observing the relationship between uric acid and the incidence of CRC were obtained by the search of electronic databases, including Medline, Embase, Cochrane Library and Web of Science. A randomized-effects model was selected to pool the data by incorporating the influence of potential heterogeneity.

Results

Eight observational studies involving 1,226,379 adults were included. During a mean follow-up duration of 12.8 years, CRC was developed in 12349 (1.0%) participants. Pooled results showed that compared to those with the lowest category of serum uric acid at baseline, participants with the highest category of serum uric acid had an increased incidence of CRC during follow-up [risk ratio (RR), 1.28; 95% confidence interval (CI), 1.17–1.42; P < 0.001; I
2 = 0%]. Sensitivity analysis limited to prospective cohort studies retrieved similar results (RR, 1.32; 95% CI, 1.19–1.47; P < 0.001; I
2 = 0%). Subgroup analyses showed consistent results in men and women, in estimates of the incidence of colon cancer and rectal cancer and in studies with different follow-up durations and quality scores (P for subgroup differences all > 0.05).

Conclusion

Although the cutoff for defining a high uric acid varied among the included studies, results of the meta-analysis suggest that a high serum uric acid may be associated with an increased risk of CRC in an adult population.
Association of radiotherapy for stage I–III breast cancer survivors and second primary malignant cancers: a population-based study
Authors: Shi Jin , Liu Jian , Tian Guo , Li Daojuan , Liang Di , Wang Jun , He Yutong
Published: September 2023

Purpose:

With life span extending, breast cancer survivors may face the possibility of developing second primary cancers (SPCs). The objective of this research is to investigate the risk factors, risk attribute to radiotherapy and the survivalship for SPCs.

Methods:

A total of 445 523 breast cancer patients were enrolled from Surveillance, Epidemiology, and End Results database in 2000–2018. The risk factors for SPCs development were confirmed by competing risk model, and then were integrated to the nomogram establishment. The cumulative incidence of SPCs including SBC (second breast cancer), SGC (second gynecological cancer), and SLC (second lung cancer) were estimated. The radiotherapy-associated risk for SPCs were evaluated by Poisson regression in radiotherapy and no-radiotherapy. Propensity score matching was used to reduce possible bias for survival comparison.

Results:

There were 57.63% patients in radiotherapy. The risk factors for developing SPCs were age, year, race, tumor size, stage, radiotherapy, grade, surgery, and histology. The cumulative incidence of SPCs was 7.75% in no-radiotherapy and 10.33% in radiotherapy. SLC, SBC, and SGC also appeared the similar results. The increased risk of developing SPCs were associated with radiotherapy in majority subgroups. The dynamic radiotherapy-associated risk for SPCs by age slightly increased risk was observed. Regardless radiotherapy or no-radiotherapy, the 10-year overall survival for SBC (radiotherapy: 59.41%; no-radiotherapy: 55.53%) and SGC (radiotherapy: 48.61%; no-radiotherapy: 35.53%) were worse than that among matched patients with only primary cancers.

Conclusions:

Breast cancer survivors remained a high radiotherapy-associated risk for developing SPCs. The prognosis in radiotherapy was better than in no-radiotherapy for some specific SPCs. Largely attention should be paid to these patients.
Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis
Authors: Bahardoust Mansour , Mousavi Safa , Ziafati Hassan , Alipour Homan , Haghmoradi Meisam , Olamaeian Faranak , Tayebi Ali , Tizmaghz Adnan
Published: September 2023

Purpose

Nutrient deficiency is one of the common complications in patients who undergo gastrectomy, especially those vitamins and minerals absorbed in the stomach or by substances in the gastric juice, such as vitamin B12. Hence, this systematic review and meta-analysis were conducted for the first time to investigate the prevalence of vitamin B12 deficiency and its symptoms in gastric cancer (GC) patients who underwent gastrectomy.

Method

PubMed, Scopus, Google Scholar, and Web of Science databases were searched to find related studies. After screening, studies were selected based on the abstract and title of related studies. The heterogeneity and inconsistency between studies were evaluated using Cochran’s Q, I2 tests. Egger’s test analyzed publication bias for studies. A 95% confidence interval (95% CI) was used to estimate the overall prevalence of vitamin B12 deficiency.

Results

Fourteen studies, including 2627 GC patients who underwent surgery, were included in the study. The mean age of the patients in this study was 61.2 ± 4.93 years. The pooled estimate of meta-analysis results showed that the prevalence of vitamin B12 deficiency after gastrectomy in patients with GC was 48.8% (95% CI:32.4, 65.2%, I2: 98.85, τ2 = 0.05, Q (13) = 1127.8, P < 0.001). The most important symptoms were anemia, fatigability, cold feet or legs, numbness, and dizziness.

Conclusion and recommendation

Vitamin B12 deficiency has a high prevalence among patients who have undergone gastrectomy, and it is necessary to pay enough attention to treating these patients after surgery to prevent its complications.
Management of retinal detachment with coexistent macular hole: Submacular placement of retinal autograft through macular hole
Authors: Karabaş Levent , Seyyar Sevim Ayça , Tokuç Ecem Önder
Published: September 2023

Purpose:

In this article, submacular autologous neurosensory retinal transplantation technique is presented in patients with large macular hole (MH) accompanying retinal detachment (RD).

Methods:

In the surgical procedure, 23-G pars plana vitrectomy (PPV) and peripheral vitrectomy were carried out. An autologous neurosensory retinal patch, which should be larger than the diameter of the MH, was released from a suitable quadrant. The retinal patch was grasped with 23 Gauge micro forceps and then passed through the MH and placed under the macula. Fluid perfluorocarbon (PFCL) was injected, and the retina was reattached. A subfoveal autologous neurosensory retinal patch was repositioned in the center of the MH with gentle manipulation under PFCL, if necessary. Laser retinopexy was applied to peripheral tears under PCFL. Subsequently, a 5000-cst silicone oil-PFC exchange was also performed.

Results:

Four eyes of four patients were operated on with the technique described above. Silicone oil was removed from two patients and the macular holes were closed in all patients at the last follow-up.

Conclusion:

This technique has been beneficial in refractory MHs and can improve the visual potential in eyes with MHs.
Combined Photorefractive Keratectomy and Corneal Cross-Linking for Keratoconus and Ectasia: The Athens Protocol
Authors: Kanellopoulos Anastasios John
Published: September 2023

Customized photorefractive keratectomy with minimal tissue ablation combined with corneal cross-linking seems to be a long-term safe and effective strategy for anatomical and visual management of keratoconus, postsurgical ectasia, and other ectasia management. Multiple published studies, many with long-term follow-up, have supported the Athens Protocol and its various forms as a means to manage corneal ectatic disorders, which not only stabilize corneal shapes but also improve functional vision.
Comparison of the Choroid in Primary Open Angle and Angle Closure Glaucoma Using Optical Coherence Tomography
Authors: Wang Dingqiao , Xiao Hui , Lin Shufen , Fang Lei , Gan Yuhong , Zhang Yuxin , Chen Xiangxi , Huang Zhihong , Zheng Shaoyang , Shi Huanyang , Xu Zixing , Li Yixuan , Li Junyi , Liu Xing , Zuo Chengguo
Published: September 2023

Précis:

The current study highlights distinct choroidal alterations in primary open angle (POAG) and primary angle closure (PACG) glaucomas, underscoring the potential of the Choroidal Vascularity Index (CVI) as a valuable indicator for understanding glaucoma pathogenesis.

Purpose:

To evaluate choroidal structural changes in patients with POAG and PACG and healthy controls utilizing the CVI and subfoveal choroidal thickness by enhanced depth imaging optical coherence tomography.

Methods:

This study was cross-sectional. A total of 171 eyes of 171 subjects, comprising 69 eyes with untreated POAG, 58 eyes with untreated PACG, and 44 healthy eyes, were enrolled in this study. Subfoveal choroidal thickness, luminal area (LA), stromal area (SA), and total choroidal area were measured on enhanced depth imaging–optical coherence tomography scans. The CVI parameter is calculated as the proportion of LA to the total choroidal area.

Results:

This study included 69 patients with POAG with a mean age of 51.4 ± 13.3 years, 58 patients with PACG with a mean age of 57.0 ± 7.3 years, and 44 healthy subjects with a mean age of 51.11 ± 10.7 years. The CVI in the POAG and PACG groups was significantly lower than that in the control group (P = 0.001 and P = 0.005, respectively); however, not significantly different between the two glaucoma groups (P = 1.000). POAG eyes had significantly lower LA than PACG and controls (P = 0.014 and P = 0.049, respectively), whereas PACG eyes had significantly greater SA than controls (P = 0.041).

Conclusions:

The CVI of POAG and PACG eyes was significantly lower than that of normal eyes. A reduced LA was observed mainly in eyes with POAG, and an increased SA was observed mainly in eyes with PACG. The role of the choroid may differ between POAG and PACG eyes.
Factors Affecting Healthcare Provider Referral to Heart Function Clinics
Authors: Mamataz Taslima , Lee Douglas S. , Turk-Adawi Karam , Hajaj Ahmad , Code Jillianne , Grace Sherry L.
Published: September 2023

Background

Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics.

Objective

The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic.

Methods

An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale.

Results

Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals (Ps < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns).

Conclusion

Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.
Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary Approach
Authors: Michaels Maria
Published: September 2023

The Centers for Disease Control and Prevention’s Adapting Clinical Guidelines for the Digital Age initiative aims to redesign and improve guideline development, implementation, and standardization. Historically, aspects of guideline development and implementation have been siloed. This leads to long lag times for guidelines to reach patient care, unnecessary redundancy, and potential for misinterpretation, leading to inconsistencies in how the recommendations are applied. A multidisciplinary, multiorganizational holistic approach brought together experts in guideline development, informatics, communication, implementation, and evaluation to understand and identify problems in guideline development and implementation, define an ideal state with no constraints, and then design a future state that advances the process close to the ideal state. The Adapting Clinical Guidelines for the Digital Age workgroups each worked on one focus area and included experts from the other areas to help analyze the current state and develop holistic solutions for the future state. Each workgroup produced interrelated standards, processes, and tools that can be used across the continuum of guideline development and implementation.
Factors Associated With HIV-Related Stigma Among Indonesian Healthcare Workers: A Cross-Sectional Online Survey
Authors: HIDAYAT Jufri , CHEN Miao-Yen , MAULINA Rufidah , NURBAYA Sitti
Published: September 2023

Background

Despite worldwide advances in HIV care and growing scientific knowledge about HIV, stigma and prejudice continue to hinder people living with HIV/AIDS (PLWHA) from seeking treatment and care. HIV-related stigma among healthcare workers in Indonesia has been investigated and measured in only a few empirical studies.

Purpose

This study was developed to identify factors related to holding stigmatizing attitudes toward PLWHA among professional healthcare providers in Indonesia.

Methods

A cross-sectional survey approach using convenience and snowball sampling techniques was used. Data were collected in February and March 2022. All of the participants were healthcare workers in Indonesia who had completed an online survey that collected demographic data and measured HIV-related stigma, fear of HIV transmission, and HIV-related knowledge. Bivariate analysis and multiple linear regression were used to investigate the association between the independent and dependent variables.

Results

The study enrolled 252 participants, including eight physicians (3.2%), 200 nurses (79.4%), and 44 midwives (17.5%). Over two thirds of the participants (65.1%) had no formal HIV training. Stigmatizing attitudes were associated with lower levels of HIV knowledge (B= −0.480,p< .01), fear of becoming infected with the HIV virus (B= 0.354,p< .05), and type of HIV care setting (B= −2.913,p< .05). Of the three participant categories, physicians had the highest levels of both HIV knowledge and PLWHA-related stigma.

Conclusions

The findings indicate many healthcare workers in Indonesia receive limited formal training on HIV, have low levels of HIV knowledge, and fear HIV transmission. Therefore, providing comprehensive and up-to-date education about HIV for health workers and proper personal protective equipment should be incorporated into programs aimed at reducing stigmatizing attitudes against patients with HIV among healthcare workers in Indonesia.
Efficacy and Safety of Vedolizumab and Tumor Necrosis Factor Inhibitors in the Treatment of Steroid-refractory Microscopic Colitis
Authors: El Hage Chehade Nabil , Ghoneim Sara , Shah Sagar , Pardi Darrell S. , Farraye Francis A. , Francis Fadi F. , Hashash Jana G.
Published: September 2023

Background:

Tumor necrosis factor (TNF-α) inhibitors and the α4β7 integrin antagonist, vedolizumab, have been investigated as treatment options for patients with steroid-refractory microscopic colitis.

Aims:

To evaluate the benefit of vedolizumab and TNF-α inhibitors in patients with steroid-refractory microscopic colitis.

Methods:

Retrospective studies and case series involving patients with steroid-refractory MC who either received vedolizumab, adalimumab, or infliximab were eligible for inclusion. Pooled proportional meta-analyses were used to calculate the rate of clinical remission at induction, clinical response, maintenance of remission, histologic remission, and overall medication related adverse effects. Statistical analysis was performed in R using the metafor and meta packages.

Results:

A total of 14 studies involving 164 patients were included. Pooled analysis showed a clinical remission rate of 63.5% [95% CI (0.483; 0.776), I2=43% P=0.08], 57.8% [95% CI (0.3895; 0.7571), I2=0%, P=0.7541], and 39.3% [95% CI (0.0814; 0.7492), I2=66%, P=0.02] for vedolizumab, infliximab, and adalimumab, respectively. The maintenance of remission rates were 65.9% [95% CI (0.389; 0.889), I2=67%, P=0.02], 45.3% [95% CI (0.1479; 0.7747), I2=0%, P=0.36] and 32.5% [95% CI (0.000; 0.8508), I2=53%, P=0.14] in patients who received vedolizumab, infliximab, and adalimumab, respectively. Rate of biological-related adverse events warranting discontinuation of therapy was 12.2%, 32.9%, and 23.0% for the vedolizumab, infliximab, and adalimumab groups, respectively.

Conclusion:

Vedolizumab and anti-TNF-α agents demonstrated a clinical benefit in the treatment of steroid-refractory microscopic colitis and with a tolerable safety profile. Future randomized controlled trials are needed to compare vedolizumab with TNF-α inhibitors and examine treatment effect on patients’ quality of life.