bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Analysis of Alternative Calcium Chelators for the Treatment of Calcific Band Keratopathy
Authors: Guo Zhuojun , Henry Roger K. , Dastjerdi Mohammad H.
Published: August 2023

Purpose:

In this study, we compared clinically relevant biochemical properties of each chelator for pH, osmolarity, and calcium chelation potential.

Methods:

In total, 0.2 M K2EDTA and K3EDTA (BD vacutainer tubes by Becton, Dickinson and Company) and Na2EDTA (Sigma Aldrich) solutions were made. The pH of each solution was measured (Mettler Toledo pH meter), and the theoretical osmolarity was calculated. Next, we determined the calcium chelation potential of each EDTA salt by titrating it with 10 μmol of calcium hydroxyapatite or CaCl2 containing Patton–Reeder colorimetric indicator. Statistical significance was analyzed using analysis of variance.

Results:

The 0.2 M solutions of Na2EDTA, K2EDTA, and K3EDTA have pH values of 4.43, 5.71, and 9.191 and theoretical osmolarities of 600, 600, and 800 mOsm/L, respectively. Calcium chelation ability was similar among all 3 solutions: 0.94 to 0.98 mol of EDTA was needed to fully chelate 1 mol calcium ions of CaCl2 (P = 0.296), 0.100 to 0.108 mol of EDTA for 1 mol calcium ions of the hydroxyapatite aqueous suspension (P = 0.296), and 0.992 to 0.996 mol for 1 mol calcium ions of hydroxyapatite in acidic solution (P = 0.178). Compared with the clinical standard of 3% (30 mg/mL) Na2EDTA, approximately 3.3% (33 mg/mL) K2EDTA and 3.6% (36 mg/mL) K3EDTA are needed to chelate an equivalent amount of calcium.

Conclusions:

In this article, we provide clinically relevant biochemical properties of 2 alternatives to Na2EDTA and demonstrate comparable calcium chelation ability among all 3 solutions. In situations where sterile sources of Na2EDTA are unavailable, potassium EDTA may provide a convenient and equally effective method of treatment for band keratopathy.
The impact of full practice authority on nurse practitioner compensation, collaboration, and billing
Authors: Tracy Christine , Russell Nancy G. , DePriest Kelli , Knestrick Joyce , D'Aoust Rita , Slade Eric
Published: August 2023

Background:

Although there is a substantial body of evidence regarding full practice authority's (FPA) effects on health care access and quality, very little research has examined how nurse practitioner (NP) licensure laws affect the status of NPs as clinicians, employees, and leaders in health care organizations.

Purpose:

This study examined whether states’ implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs' and whether NPs' gains from FPA increase over time in states where FPA has been in effect longer.

Methodology:

Data from a nationwide survey of licensed NPs (N = 5,770) were used to compare NPs' employment conditions between FPA and non-FPA states. After balancing the FPA and non-FPA groups on demographic characteristics (e.g., urbanicity, education), adjusted mean differences in outcomes between the groups were estimated using weighted multivariable regression.

Results:

Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings (p < .05), were more likely to be practice owners or shareholders (p < .01), and billed a greater percentage of their patient visits under their own National Provider Identifier (p < .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA <10 years.

Conclusions:

States' adoption of FPA for NPs is associated with improved conditions of employment among NPs.

Implications:

Untethering NPs from physicians establishes a cascade of modest gains in income and practice ownership that may indicate changes over time. Additional research is needed to determine the trajectory of these increases and if they are consistent.
Clinical Guidelines for Routine Neuromonitoring in Neonatal and Pediatric Patients Supported on Extracorporeal Membrane Oxygenation
Authors: Pandiyan Poornima , Cvetkovic Mirjana , Antonini Marta Velia , Shappley Rebekah K. H. , Karmakar Swati A. , Raman Lakshmi
Published: August 2023

Disclaimer: These guidelines for routine neuromonitoring in neonatal and pediatric patients supported on extracorporeal membrane oxygenation (ECMO) are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/ECMO and describe what are believed to be useful and safe practice for ECLS and ECMO but these are not necessarily consensus recommendations. The aim of clinical guidelines was to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge, and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or being deemed inclusive of all proper methods of care nor exclusive of other methods of care directed at obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient considering all the circumstances presented by the individual patient, and the known variability and biologic behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.
Body contouring after bariatric surgeries in Jordan: Awareness, prevalence, and challenges: A multicentric cross-sectional study
Authors: Amarin Marzouq N. , Atallah Amani A. , Rashdan Mohammad Z.A. , Atallah Izdiad A. , Khrais Majdi M. , Jaber Yazan H. , Atallah Afnan A. , Ismail Omar M. , Jaber Kamel A. , Fkheideh Taima K. , Altaher Raed N.
Published: August 2023

Body-contouring surgeries are known to improve the quality of life and body image of patients undergoing bariatric surgery. However, only a small number of patients choose to undergo body-contouring surgeries. This study evaluated the prevalence of body-contouring surgeries among patients who underwent bariatric surgery in Jordan, and identified the limitations encountered. This study is an observational multicentric cross-sectional study. A validated questionnaire was distributed to patients who had undergone bariatric surgeries between July 2017 and June 2021 at the University of Jordan Hospital and a bariatric surgery private center in Amman, Jordan. Inclusion criteria were based on the type of bariatric surgery (Sleeve Gastrectomy or Roux-En-Y gastric bypass) and the surgery date falling within the study period, with participation requiring the completion of an online questionnaire. Collected data was analyzed using various statistical tests, with a predetermined alpha level of 0.05 to determine statistical significance. Of 451 eligible participants, a total of 305 patients completed the validated questionnaire. Of these, 11 responses were excluded due to incomplete data. The analysis focused on remaining 294 participants who underwent bariatric surgery between July 2017 and June 2021, with only 7 participants (2.4%) electing to undergo body-contouring surgeries. The primary barriers to body-contouring surgeries reported by participants were cost (62.7%) and fear of postoperative complications (31.8%). Females exhibited a significantly greater desire for body-contouring surgeries (P = .000), which was also related to the percentage of total weight loss following bariatric surgery (P = .025). However, no significant associations were observed between desiring body-contouring surgeries and marital status (P = .734) or employment status (P = .319). The low rate of body-contouring surgeries in Jordan reflects the importance of strengthening the patient-physician relationship through targeted education efforts that emphasize the expected consequences of bariatric surgery and the available solutions to address them. Additionally, encouraging collaboration among caregivers, healthcare authorities, and insurance providers is necessary to develop more inclusive treatment plans that are tailored to meet the diverse needs and socioeconomic backgrounds of patients.
Efficacy and safety of acupoint application in the treatment of ulcerative colitis: A systematic review and meta-analysis
Authors: Tong Yaling , Yu Yunfeng , Yin Shuang , Lin Shanzhi , Chen Yun , Su Xuan
Published: August 2023

Background:

The efficacy of acupoint application in the treatment of ulcerative colitis (UC) is still controversial. The purpose of this study is to systematically evaluate the clinical efficacy and safety of acupoint application in the treatment of ulcerative colitis.

Methods:

The databases of China National Knowledge Infrastructure (CNKI), Chinese Biology Medicine (CBM), VIP, Wanfang, Embase, PubMed, the Cochrane Library and Web of Science were searched. The time limit was from the establishment of the database to July 2022. The published randomized controlled trials of acupoint application in the treatment of UC were analyzed by meta-analysis and trial sequential analysis.

Results:

A total of 13 studies were included, with a total sample size of 878 cases. Compared with conventional western medicine, acupoint application can effectively improve the effective rates of clinical comprehensive (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.06–1.20, P = .0003), syndrome (RR 1.13, 95% CI 1.03–1.24, P = .009), and interleukin-4 (IL-4) (mean differences 2.62, 95% CI 1.96–3.28, P < .00001) in the treatment of UC, and reduce interferon-γ (mean differences −5.38, 95% CI −6.81 to −3.94, P < .00001). The effective rates of colonoscopy (RR 0.94, 95% CI 0.84–1.05, P = .25), pathological examination (RR 1.04, 95% CI 0.90–1.20, P = .60) and rate of adverse reaction (RR 0.55, 95% CI 0.25–1.21, P = .14) were the same. Trial sequential analysis indicated that the benefits of effective rates of clinical comprehensive and syndrome, IL-4, and interferon-γ were conclusive. Harbord regression showed no publication bias (P = .98). The evaluation of evidence quality suggested that the evidence quality of effective rates of clinical comprehensive and syndrome was moderate and the evidence quality of other indicators was low or very low.

Conclusion:

Acupoint application is a safe and effective method for the treatment of UC, and has the prospect of clinical application.
Effect of different analgesic treatments on the pulmonary function in elderly hip fracture patients: A prospective study
Authors: Wang Shunhong , Xu Yueming , Kang Yongjian , Qin Zhigang , Peng Chunyu , Lin Hong
Published: August 2023

Background:

To investigate the effect of different analgesic methods on lungs in elderly patients with hip fractures.

Methods:

A prospective study was conducted on 78 elderly hip fracture patients undergoing spinal anesthesia for surgery, where 3 analgesic methods were used: postoperative Patient-controlled intravenous analgesia pump (PCIA) (group I), pre and postoperative PCIA (group II), and preoperative fascia iliaca compartment block (FICB) + postoperative PCIA (group III). The following indicators were monitored at admission (T1), on the day of surgery before anesthesia (T2), and 7 days after surgery (T3): heart rate (HR), respiratory rate (RR), forced expiratory volume during the first second, arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), C-reactive protein (CRP), and interleukin 6 (IL-6). Pulmonary complications such as pulmonary atelectasis and respiratory insufficiency were analyzed.

Results:

The HR, RR, forced expiratory volume during the first second, PaO2, PaCO2, IL-6, and CRP levels at T1 after fracture did not significantly differ among the 3 groups (P > .05). After different analgesic treatments post-admission, all indicators at T2 were significantly higher in group I than in groups II and III (P < .05), while there was no significant difference between groups II and III (P > .05). At T3, there were no significant differences in RR, HR, PaO2, PaCO2, and CRP levels among the groups (P > .05), but IL-6 levels at T3 were significantly higher in group I than in groups II and III (P < .05).

Conclusion:

The use of effective pain relief during surgery can help protect the lung function of elderly patients with hip fractures. When using PCIA with FICB before surgery, respiratory performance may be better protected compared to using unsustained analgesia. This could be due to a decrease in the levels of inflammatory markers such as CRP and interleukin-6.
The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection
Authors: Wang Xu’an , Ma Jun , Lin Duomao , Dong Xiuhua , Wu Jinjing , Bai Yang , Zhang Dongni , Gao Junwei
Published: August 2023

Hypoxemia is one of the most common complications in patients after Stanford type A acute aortic dissection surgery. The aim of this study was to investigate the association of circulating ANG II level with postoperative hypoxemia and to identify the risk factors for postoperative hypoxemia in Stanford type A acute aortic dissection patients. In this study, 88 patients who underwent Stanford type A acute aortic dissection surgery were enrolled. Postoperative hypoxemia is defined by the oxygenation index (OI). Perioperative clinical data were collected and the serum ANG II and sACE2 levels were measured. The differences in the basic characteristics, intraoperative details, biochemical parameters, laboratory test data and clinical outcomes were compared between the hypoxemia group and the non-hypoxemia group by univariate analysis. Multivariate logistic regression analysis was performed on the variables with P < .1 in univariate analysis or that were considered clinically important to identify risk factors for postoperative hypoxemia. Twenty-five patients (28.4%) were considered to have postoperative hypoxemia (OI ≤ 200 mm Hg). The ANG II concentration remained a risk factor associated with postoperative hypoxemia [OR = 1.018, 95% CI (1.003–1.034), P = .022]. The other risk factors remaining in the logistic regression model were BMI [OR = 1.417, 95% CI (1.159–1.733), P = .001] and cTnI [OR = 1.003, 95% CI (1.000–1.005), P = .032]. Elevated levels of ANG II, BMI and cTnI are risk factors for postoperative hypoxemia in patients with Stanford type A acute aortic dissection.
Prognostic value and potential molecular mechanism of ITGB superfamily members in hepatocellular carcinoma
Authors: Xie Haixiang , Qin Chongjiu , Zhou Xin , Liu Junqi , Yang Kejian , Nong Jusen , Luo Jianzhu , Peng Tao
Published: August 2023

We analyzed the prognostic value and potential molecular mechanisms of the members of integrin β (ITGB)superfamily in hepatocellular carcinoma (HCC) using data from The Cancer Genome Atlas (TCGA), cBioPortal, Gene Expression Profiling Interactive Analysis (GEPIA), Human Protein Atlas (HPA) HPA, Search Tool for the Retrieval of Interacting Genes/Proteins, GeneMANIA, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), TIMER and Gene set enrichment analysis (GSEA) databases. ITGB4/5 mRNA was upregulated in HCC tissues in contrast to the normal liver tissues, whereas ITGB2/3/8 levels were lower in the former. ITGB4 was the most frequently mutated ITGB gene in HCC. Receiver operating characteristic curve (ROC) analysis showed that the expression levels of ITGB2/3/4/5/7/8 had significant diagnostic value in distinguishing HCC tissues from healthy liver tissues, ITGB8 had the highest diagnostic efficacy. The ITGB1/3/6/8 were also upregulated in the HCC tissues in contrast to healthy liver tissues. The expression of ITGB8 was verified by immunohistochemistry (IHC). Furthermore, ITGB6 and ITGB7 expression levels were strongly associated with the overall survival (OS) of HCC patients. The ITGB superfamily members exhibited homology and interactions in protein structure. In addition, ITGB6 together with ITGB7 were negatively related to the infiltration of multiple immune cell populations. GSEA results showed that ITGB6 was enriched in HCC migration and recurrence, whereas ITGB7 was significantly enriched in HIPPO, TOLL and JAK-STAT signaling pathways. In conclusion, ITGB6 and ITGB7 genes are possible to be prognostic biomarkers for HCC.
Can inflammatory indices predict sentinel lymph node status in patients with early-stage breast cancer?
Authors: Balbaloglu Hakan , Tasdoven Ilhan , Karadeniz Cakmak Guldeniz
Published: August 2023

Breast cancer research has focused on the early detection and treatment of breast cancer. Axillary lymph node status is essential for primary breast cancer staging, recurrence, and survival. The current quest for precision medicine is to identify predictive markers that offer the advantage of individualized treatment options. This study aimed to investigate the value of inflammatory indices in predicting positive sentinel nodes in breast cancer. We studied 602 patients with early-stage breast cancer who underwent sentinel lymph node biopsies (SLNB) at the Bülent Ecevit University General Surgery Clinic. We obtained data, including the clinical and demographic characteristics of the patients, such as age, histological type, and sentinel lymph nodes. Neutrophil, lymphocyte, platelet, and monocyte counts were obtained from preoperative complete blood count test data from the patient registry. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory index (SII), and sentinel lymph node biopsy were analyzed. Sentinel LAP was negative in 391 (65%) patients and positive in 211 (35%). In the receiver operating characteristic curve analysis, no significant difference was found between SLNB positivity and negativity in terms of NLR, PLR, LMR, or SII. In contrast to previous research, NLR, PLR, LMR, or SII did not affect SLNB positivity prediction in our study.
Astragaloside IV relieves IL-1β-induced human nucleus pulposus cells degeneration through modulating PI3K/Akt signaling pathway
Authors: Zhang Lu , Gao Junsheng , Li Zhentao , Liu Jun , Zhang Chong , Liu Jie , Dong Hui , Mei Wei
Published: August 2023

Background:

Intervertebral disc degeneration (IDD) is a multifactorial disease that is associated with nucleus pulposus (NP) apoptosis and extracellular matrix (ECM) degeneration and inflammation. Astragaloside IV (AS IV) has antioxidant, free radical scavenging, anti-inflammatory and anti-apoptosis effects. This study was to investigate whether AS IV could inhibit IL-1β-mediated apoptosis of HNP cells and its possible signal transduction pathway.

Methods:

Human nucleus pulposus cells (HNPCs) were stimulated with AS IV or LY294002 (PI3K inhibitor), followed by exposure to IL-1β for 24 hours. CCK8, TUNEL analysis and flow cytometry, ELISA and Western blotting were used to analyze the effects of AS IV on cell proliferation, apoptosis, inflammation, ECM and PI3K/Akt pathway signaling path-related proteins in IL-1β-induced HNPCs.

Results:

Compared with IL-1β-induced HNPCs, AS IV could improve the proliferation activity and the expressions of Collagen II, Aggrecan and Bcl-2 proteins, inhibit the apoptosis rate, inflammation and Bax and cleaved caspase-3 protein expression, and increase the activity of PI3K/Akt pathway. LY294002 attenuated the protective effect of AS IV against IL-1β-induced HNPCs degeneration.

Conclusion:

AS IV can inhibit IL-1β-induced HNPCs apoptosis inflammation and ECM degeneration by activating PI3K/Akt signaling pathway, which can be an effective drug to reduce disc degeneration.
Effect of surgery on sensory eye balance in patients with intermittent exotropia: An observational study
Authors: Li Qian , Zhao Shujing , Fu Te , Ma Jing , Li Zhongen
Published: August 2023

To evaluate the impact of strabismus surgery on sensory eye balance in patients with intermittent exotropia (IXT). In total, 112 IXT patients with ocular alignment at the first strabismus surgery and 34 controls were enrolled from January 2015 to December 2016 in this retrospective study. The effective contrast ratio (ECR) of non-dominant eyes was measured by binocular phase combination paradigm before and 3 months after surgery, and the degree of sensory eye balance was quantitatively evaluated and compared between IXT patients and controls. The preoperative and postoperative mean ECRs of IXT patients were 0.492 ± 0.182 and 0.684 ± 0.198, respectively, which were significantly lower than those of the control group (0.896 ± 0.214, both P < .001). In addition, the postoperative ECR was significantly higher than the preoperative ECR (P < .001). The ECR change was not correlated with age orstrabismus degree measured with a6 m accommodative target (both P > .05), while significant negative correlation was observed between the ECR change and strabismus degree measured with a 33 cm accommodative target (P = .002). Strabismus surgery can significantly reduce the degree of sensory eye imbalance in patients with IXT, while further treatment aimed at rebalancing the ocular dominance might be necessary for more efficient binocular visual processing in the long-term.
The immunology of PF4 polyanion interactions
Authors: Ngo Anh T.P. , Bochenek Veronica , Gollomp Kandace
Published: August 2023

Purpose of review

Platelet factor 4 (PF4, CXCL4), the most abundant α-granule platelet-specific chemokine, forms tetramers with an equatorial ring of high positive charge that bind to a wide range of polyanions, after which it changes conformation to expose antigenic epitopes. Antibodies directed against PF4 not only help to clear infection but can also lead to the development of thrombotic disorders such as heparin-induced thrombocytopenia (HIT) and vaccine-induced thrombocytopenia and thrombosis (VITT). This review will outline the different mechanisms through which PF4 engagement with polyanions combats infection but also contributes to the pathogenesis of inflammatory and thrombotic disease states.

Recent findings

Recent work has shown that PF4 binding to microbial polyanions may improve outcomes in infection by enhancing leukocyte-bacterial binding, tethering pathogens to neutrophil extracellular traps (NETs), decreasing the thrombotic potential of NET DNA, and modulating viral infectivity. However, PF4 binding to nucleic acids may enhance their recognition by innate immune receptors, leading to autoinflammation. Lastly, while HIT is induced by platelet activating antibodies that bind to PF4/polyanion complexes, VITT, which occurs in a small subset of patients treated with COVID-19 adenovirus vector vaccines, is characterized by prothrombotic antibodies that bind to PF4 alone.

Investigating the complex interplay of PF4 and polyanions may provide insights relevant to the treatment of infectious disease while also improving our understanding of the pathogenesis of thrombotic disorders driven by anti-PF4/polyanion and anti-PF4 antibodies.
Pembrolizumab in mCRPC – Combination therapies as breakthrough to success?
Authors: Plas Stefan , Pircher Andreas , Heidegger Isabel
Published: August 2023

Purpose of review

Immune checkpoint inhibitors (ICIs) have shown promising antitumor activity in various malignant diseases. This narrative review provides an update on ongoing clinical studies investigating the only FDA-approved ICI programmed death receptor 1 (PD-1) inhibitor pembrolizumab in mono- and combination therapy in patients with metastatic castration-resistant prostate cancer (mCRPC).

Recent findings

Although most clinical trials investigating pembrolizumab as mono- or combinational therapy did not meet their primary endpoints, there exist subgroups of patients that demonstrate impressive responses rates justifying further investigation of ICI in prostate cancer. Beside combination of pembrolizumab with approved mCRPC agents, innovative approaches, like combining pembrolizumab with radioligands, deoxyribonucleic acid vaccines or innovative immunotherapeutic agents (i.e., ONC-392, AMG160, BXCL701) are ongoing exerting promising preliminary findings.

ICI monotherapy seems to be effective in a small biomarker-preselected population, however, there is evidence that especially novel ICI combination approaches can improve patient survival, which could ultimately refocus and revolutionize the treatment of mCRPC.
Selected nursing interventions for systemic lupus erythematosus
Authors: Pullen Richard L. , Hammond Lori
Published: August 2023

This article presents the pathogenesis, signs, symptoms, and management of systemic lupus erythematosus.
Creating a proactive CLABSI prevention culture
Authors: Plaskonka Abby , Breda Karen Lucas
Published: August 2023

It may seem like “mission impossible,” but improving CLABSI prevention is indeed possible through proper education and encouragement.
A nurse's guide to hypovolemic shock
Authors: Terzulli Dawn
Published: August 2023

Quick action from the nursing team is vital to treating the underlying causes of the most common form of shock. Use this case study approach to learn more.
Analysis of predictive factors for the poor prognosis of peripheral facial paralysis
Authors: Frutos-Reoyo Emilio Javier , López-Izquierdo Raúl , Luque-Linero Paula , Cantalapiedra-Puentes Esther , Antón-Andrés María Jesús , Hernández-Gajate José Mario , Candau-Pérez Ernesto Domingo
Published: August 2023

PURPOSE

To evaluate the predictive factors for a poor prognosis in patients with facial paralysis evaluated in the rehabilitation department of a tertiary hospital.

METHODS

We have conducted a prospective cohort study. Patients who required elective botulinum toxin infiltration, surgical treatment, or follow-up appointments longer than 6 months due to incomplete recovery were considered to have a poor prognosis. Descriptive and analytical analyses of clinical and epidemiological variables were performed. The follow-up period was six months.

RESULTS

A total of 47 adult patients were analysed, 54.2% of whom were women. The mean age was 53.2 (SD: 15.5) years. Twenty-five percent had an unfavourable prognosis. A statistically significant association with prognosis was observed for neurophysiological results and the scores of the House-Brackmann scale and the Sunnybrook Facial Grading System.

CONCLUSION

Neurophysiological tests are especially useful when evaluating prognosis. Likewise, Sunnybrook Facial Grading System is a useful and accessible tool with prognostic value, especially within a month of initial diagnosis, when a score lower than 65 indicates a poor prognosis with high sensitivity and specificity. These tools can be especially useful to reduce the clinical and psychological impact and to provide patients with early therapeutic management.
Photo-Assisted Anthropometric Analysis of Double Eyelid Blepharoplasty in Young Chinese
Authors: Lu Menglin , Lin Wentao , Liu Jia , Wei Dayong , Shen Xiao
Published: August 2023

Background:

Double eyelid blepharoplasty has gained popularity over decades among Asians. Quantitative assessment of the morphologic changes after double eyelid blepharoplasty remains obscure. A photo-assisted digital method was introduced to measure the outcomes of double eyelid surgery in young Chinese.

Methods:

A total of 168 Chinese patients who underwent esthetic upper blepharoplasty were recruited from October 2018 to October 2020. The participants were divided into mini-incision, full-incision, and full-incision double with epicanthoplasty (FIDE) groups. Changes in the eyeball exposure area (EEA), brow eyelid margin distance [brow eyelid distance (BED)], and palpebral crease height after surgery were analyzed using ImageJ software.

Results:

There was an overall increase in EEA in the 3 groups after upper blepharoplasty surgery. The FIDE group showed the most increase in EEA among these groups. Furthermore, BED was significantly decreased in each group after upper eyelid blepharoplasty; however, the mini-incision double group showed the least BED reduction. The palpebral crease height at 90 days was significantly lower than that at 7 days after surgery.

Conclusions:

The photo-assisted anthropometric analysis offers a simple and objective measurement for double eyelid blepharoplasty. The eyes appear larger because of the increase in EEA and decrease in BED after double eyelid blepharoplasty. Distinct results were produced by different surgical techniques. The FIDE group showed the maximum increase in EEA and a decrease in BED. These findings provide important references for preoperative planning and postoperative measurement.
Orbital Reconstruction Using a Polyetheretherketone Patient-Specific Implant After Removal of a Mucocele Developing After Orbital Fracture Repair
Authors: Lee Junho , Choi Young Jae , Rha Eun Young
Published: August 2023

A few mucoceles developing secondary to facial bone fractures have been reported. Mucocele formation is thought to be attributable to displacement of the respiratory mucosa with obstruction of the sinus opening, especially if untreated. Accurate diagnosis and management are required; a growing mucocele will gradually destroy adjacent bony structures and cause irreversible complications. The authors describe a patient who presented with diplopia and mild discomfort when gazing upward. She had undergone reconstruction of medial and inferior orbital fractures 20 years previously. The patient was diagnosed with a mucocele developing after orbital fracture repair. The patient underwent mucocele removal and orbital reconstruction using a polyetheretherketone patient-specific implant. In a patient with orbital symptoms but without acute trauma, a mucocele should be among the differential diagnoses if history-taking reveals past orbital trauma and surgery. A polyetheretherketone patient-specific implant was effective for orbital reconstruction after mucocele removal.
Establishment of a Model for Human Hypertrophic Scar Using Tissue Engineering Method
Authors: Li Yawei , Shan Xiaofeng , Liang Jie , Cai Zhigang
Published: August 2023

Background

Treatment of human hypertrophic scar (HS) is a challenge for plastic surgeons, whereas the clinical and experimental research has been limited due to the lack of an ideal model of human HS tissue.

Objective:

To establish a model of human HS using tissue engineering method, to improve the research for HS in the clinic and laboratory.

Methods:

Hypertrophic scar fibroblasts (HSFBs) were transferred to polylactic acid (PLA)/polyglycolic acid (PGA) scaffolds. Biocompatibility of HSFBs-PLA/PGA composites was evaluated using scanning electron microscopy. Composites of HSFBs-PLA/PGA were implanted in subcutaneous pockets in athymic mice after 4 weeks in vitro culture. A re-entry operation was performed to obtain the HS-like tissues after 12 weeks of in vivo culture. The histological stain, the expression of type I collagen, the proliferation ability, and vitality of HSFBs were compared between human HS tissue and HS-like tissue.

Results:

The structure of PLA/PGA scaffolds facilitates HSFBs adhesion and proliferation. The HSFBs-PLA/PGA composites were in vivo cultured for 12 weeks, and then HS-like tissues were harvested from nude athymic mice. There was no statistical significance in the expression of type I collagen, cell cycle, and cell proliferation between human HS tissue and HS-like tissue.

Conclusion:

The authors successfully established a model of human HS using the tissue engineering method, which could provide HS-like tissue for research. And it also could provide enough HS-like tissues to help reduce experimental variability within groups. This model can be used to investigate in prevention and treatment of HS and further explore the mechanisms of HS.
Should surgeon-performed intraoperative ultrasound be the preferred test for detecting main pancreatic duct injuries in operative trauma cases?
Authors: Ball Chad G. , Biffl Walter L. , Moore Ernest E. , Hagopian Ellen J.
Published: August 2023

BACKGROUND

The diagnostic performance of multiple tests for detecting the presence of a main pancreatic duct injury remains poor. Given the central importance of main duct integrity for both subsequent treatment algorithms and patient outcomes, poor test reliability is problematic. The primary aim was to evaluate the comparative test performance of computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative ultrasound (IOUS) for detecting main pancreatic duct injuries.

METHODS

All severely injured adult patients with pancreatic trauma (2010–2021) were evaluated. Patients who received an IOUS pancreas-focused evaluation, with Grades III, IV, and V injuries (main duct injury) were compared with those with Grade I and Grade II trauma (no main duct injury). Test performances were analyzed.

RESULTS

Of 248 pancreatic injuries, 74 underwent an IOUS. The additional mix of diagnostic studies (CT, MRCP, ERCP) was variable across grade of injury. Of these 74 IOUS cases for pancreatic injuries, 48 (64.8%) were confirmed as Grades III, IV, or V main duct injuries. The patients were predominantly young (median age = 33, IQR:21–45) blunt injured (70%) males (74%) with severe injury demographics (injury severity score = 28, (IQR:19–36); 30% hemodynamic instability; 91% synchronous intra-abdominal injuries). Thirty-five percent of patients required damage-control surgery. Patient outcomes included a median 13-day hospital length of stay and 1% mortality rate. Test performance was variable across groups (CT = 58% sensitive/77% specific; MRCP = 71% sensitive/100% specific; ERCP = 100% sensitive; IOUS = 98% sensitive/100% specific).

CONCLUSION

Intraoperative ultrasound is a highly sensitive and specific test for detecting main pancreatic duct injuries. This technology is simple to learn, readily available, and should be considered in patients who require concurrent non–damage-control abdominal operations.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level III.
A pilot clinical trial of the Screening and Tool for Awareness and Relief of Trauma for survivors of gun violence
Authors: O'Neill Kathleen M. , Schenck Christopher , Vega Pepe , Gawel Marcie , Dodington James
Published: August 2023

BACKGROUND

Survivors of gun violence have significant sequelae including reinjury with a firearm and mental health disorders that often go undiagnosed and untreated. The Screening and Tool for Awareness and Relief of Trauma (START) is a targeted behavioral mental health intervention developed for patients who come from communities of color with sustained and persistent trauma.

METHODS

In this pilot study, we evaluate the feasibility of completing a randomized controlled trial to test the START intervention. Using a mixed methods study design, we used both quantitative and qualitative data collection to assess the START intervention and the feasibility of completing a randomized controlled trial. The purpose of this study was to estimate important study parameters that would enable a future randomized controlled trial.

RESULTS

We were able to make conclusions about several crucial domains of a behavioral intervention trial: (1) recruitment and retention—we had a high follow-up rate, but our recruitment was low (34% of eligible participants); (2) acceptability of the intervention—the addition of audiovisual resources would make the tools more accessible; (3) feasibility of the control—more appropriate for a stepped wedge cluster randomized controlled trial design; (4) intervention fidelity—there was an 81% concordance rate between the fidelity survey results and the audio recordings; (5) approximate effect size—there was a 0.4-point decrease in the PTSD Checklist—Civilian Version in the control compared with a 10.7-point decrease in the treatment group for the first month.

CONCLUSION

While it was feasible to conduct a randomized controlled trial, our findings suggest that a stepped wedge cluster randomized controlled trial design may be the most successful trial design for the START intervention. In addition, the inclusion of a “credible messenger” to recruit participants into the study and the development of audiovisual resources for START would improve recruitment and effectiveness.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
JMM Profile: Bacillus anthracis
Authors: Wales Andrew , Mackintosh Adrienne
Published: August 2023

Graphical abstract

Principal routes of

Bacillus anthracis

infection and stages of anthrax pathogenesis, consistent with current understandings. Depending on the route of infection, germination of spores may happen in extracellular tissue fluid, or following phagocytosis (a). Successful infection of host cells leads to toxin-associated cell death and release of vegetative cells and toxin (b). Toxin binds and enters other host cells (c), including those of the immune system, disrupting function. In some cases this leads to systemic disease, which typically is fatal.
Adjusting for hidden biases in sexual behaviour data: a mechanistic approach
Authors: Knight Jesse , Wang Siyi , Mishra Sharmistha
Published: August 2023

Background

Two required inputs to mathematical models of sexually transmitted infections are the average duration in epidemiological risk states (e.g., selling sex) and the average rates of sexual partnership change. These variables are often only available as aggregate estimates from published cross-sectional studies, and may be subject to distributional, sampling, censoring, and measurement biases.

Methods

We explore adjustments for these biases using aggregate estimates of duration in sex work and numbers of reported sexual partners from a published 2011 survey of female sex worker in Eswatini. We develop adjustments from first principles, and construct Bayesian hierarchical models to reflect our mechanistic assumptions about the bias-generating processes.

Results

We show that different mechanisms of bias for duration in sex work may “cancel out” by acting in opposite directions, but that failure to consider some mechanisms could over- or underestimate duration in sex work by factors approaching 2. We also show that conventional interpretations of sexual partner numbers are biased due to implicit assumptions about partnership duration, but that unbiased estimators of partnership change rate can be defined that explicitly incorporate a given partnership duration. We highlight how the unbiased estimator is most important when the survey recall period and partnership duration are similar in length.

Conclusions

While we explore these bias adjustments using a particular dataset, and in the context of deriving inputs for mathematical modelling, we expect that our approach and insights would be applicable to other datasets and motivations for quantifying sexual behaviour data.
Strategic use of SARS-CoV-2 wastewater concentration data could enhance, but not replace, high-resolution community prevalence survey programmes
Authors: Mills Cathal , Chadeau-Hyam Marc , Elliott Paul , Donnelly Christl A.
Published: August 2023

Wastewater-based epidemiology (WBE) has been proposed as a tool for public health authorities to monitor community transmission of SARS-CoV-2 and other agents. Here, we review the utility of WBE for estimating SARS-CoV-2 prevalence using wastewater data from the Environmental Monitoring for Health Protection (EMHP) programme and prevalence data from the REal-time Assessment of Community Transmission-1 (REACT-1) study in England. Our analysis shows a temporally evolving relationship between wastewater and prevalence which limits the utility of WBE for estimating SARS-CoV-2 prevalence in high spatial resolution without a concurrent prevalence survey. We further characterise WBE for SARS-CoV-2 prevalence as i) vaccination-coverage-dependent and ii) variant-specific. Our work provides a gesopatial framework to map wastewater concentrations to public health boundaries, enabling public health authorities to interpret the relationship between wastewater and prevalence. We demonstrate that WBE can improve the cost efficiency and accuracy of community prevalence surveys which on their own may have incomplete geographic coverage or small sample sizes.
PABPN1loss-of-function in oculopharyngeal muscular dystrophy primarily impacts APA-shift in muscle transcripts
Authors: Shademan Milad , Mei Hailiang , Ariyurek Yavuz , Kloet Susan , Raz Vered
Published: August 2023

Alternative polyadenylation (APA) at the 3’UTR of transcripts contributes to the cell transcriptome. APA is suppressed by the nuclear RNA binding protein, PABPN1. Aging-associated reduced PABPN1 levels in skeletal muscles lead to muscle wasting. Muscle weakness in oculopharyngeal muscular dystrophy (OPMD) is caused by short alanine expansion in PABPN1 exon1. The expanded PABPN1 forms nuclear aggregates, an OPMD hallmark. Whether the expanded PABPN1 affect APA and how contributes to muscle pathology is unresolved.

To investigate these questions, we developed a procedure including RNA library preparation and a simple pipeline calculating ‘APA-shift’ ratio as a readout for PABPN1 function. Using the mouse OPMD model we demonstrate similar results between previously published PAS utilization and ‘APA-shift’ results. Studying APA-shift in two OPMD models and in OPMD patients we show that the expression of the expanded PABPN1 does not correlate with APA-shift. Instead, APA-shift is correlated with reduced expression levels of PABPN1 isoforms, amongst the isoform lacking exon1. Further we show that with our protocol APA-shift is enriched in muscle transcripts, moreover in OPMD patients. We suggest that muscle weakness in OPMD is caused byPABPN1loss-of-function leading to APA-shift that primarily affects in muscle transcripts.
The role of exercise in limiting progression from liver inflammation and fibrosis to cirrhosis and carcinoma: a systematic review with meta-analysis of human and animal studies
Authors: Stanhope E.N. , Drummond A.E. , Swain C.T.V. , Teoh N. , Farrell G. , Vallance J.K. , Lahart I.M. , Lynch B.M.
Published: August 2023

Background

Exercise may prevent the progression of liver disease and protect against liver cancer. This review with meta-analysis synthesised the evidence from both human and animal studies to better understand whether exercise has the capacity to (i) promote regression of early fibrosis; (ii) decrease and/or delay progression to cirrhosis; and (iii) progression to carcinoma.

Methods

A systematic search was performed to identify studies comprising of humans and animals with liver disease that compared exercise to an inactive or less active control. Outcomes included liver disease regression and progression, and markers of liver function and damage.

Results

We found 18 human and 29 animal studies. A single study provided direct evidence that exercise can reverse NAFLD and decrease progression to cirrhosis. Meta-analysis of human studies identified decreases in liver enzymes; ALT (SMD = -0.28, 95%CI = -0.53, -0.03), AST (SMD = -0.12, 95%CI = -0.32, 0.07), GGT (SMD = -0.23, 95%CI = -0.36, -0.10), as well as a small increase in ALP (SMD = 0.23, 95%CI = -0.13, 0.59), and liver triglycerides (SMD = -0.24, 95%CI = -0.66, 0.18). Meta-analysis of animal studies identified decreases in liver enzymes; ALT (SMD = -2.85, 95%CI = -4.55, -1.14), AST (SMD = -2.85, 95%CI = -4.55, -1.14), and liver triglycerides (SMD = -1.36, 95%CI = -2.08, -0.65), liver weight (SMD = -1.94, 95%CI = -2.78, - 1.10), and the NAFLD activity score (SMD = -1.36, 95%CI = -2.08, -0.65).

Conclusion

Only one study provided direct evidence that exercise has the capacity to regress early fibrosis, as well as delay the progression to cirrhosis. Several studies, however, indicate that exercise intervention reduce markers of liver function and damage.
Qualitative protocol to support detection of the early presentation and diagnosis of mycetoma in Sudan
Authors: Ackley Caroline , Hall Victoria , Ahmed Eiman Siddig , Hounsome Natalia , Elsheikh Mohamed Nasr , Zaman Shahaduz , Bakhiet Sahar
Published: August 2023

The neglected tropical disease (NTD) mycetoma is a chronic and progressively destructive infectious disease endemic in Sudan. There is a growing body of scientific research on mycetoma -causes, transmission, treatment, and impact from a clinical and biomedical perspective. However, there is further need for in-depth medical anthropology research on the disease to successfully translate biomedical advances into elimination and control programmes. Given this background the NIHR Global Health Research Unit on NTDs at Brighton and Sussex Medical School is leading multidisciplinary research on skin NTDs, including mycetoma, with a medical anthropology research component exploring how community engagement can lead to earlier presentation of mycetoma in Sudan. This protocol paper sets out the research aims and approaches to generate new knowledge on mycetoma in Sudan once the political situation becomes stable and it is safe to carry out global health research once again. We continue to develop appropriate community engagement intervention strategies, while activities like training and capacity strengthening get underway remotely.
Additively manufactured multiplexed electrochemical device (AMMED) for portable sample-to-answer detection
Authors: Jahromi Arash Khorrami , Moakhar Roozbeh Siavash , Yedire Sripadh Guptha , Shieh Hamed , Rosenflanz Katia , Bricks Amber , de Vries Justin , Lu Yao , Shafique Houda , Strauss Julia , Mahshid Sara
Published: August 2023

Portable sample-to-answer devices with applications in point-of-care settings have emerged to obviate the necessity of centralized laboratories for biomarker analysis. In this work, a smartphone-operated and additively manufactured multiplexed electrochemical device (AMMED) is presented for the portable detection of biomarkers in blood and saliva. AMMED is comprised of a customized portable potentiostat with a multiplexing feature, a 3D-printed sample collection cartridge to handle three samples of saliva and blood at the same time, a smartphone application to remotely control the potentiostat, and a 3D-printed-based multiplexed microfluidic electrochemical biosensor (test chip). Here, by employing additive manufacturing techniques, a simple, cleanroom-free, and scalable approach was proposed for the fabrication of the test chip. Moreover, these techniques can bring about easy integration of AMMED components. Additionally, the test chip can be compatible with different affinity-based bioassays which can be implemented in a multiplexed manner for detection. The AMMED components were successfully characterized in terms of electrochemical and fluidic performance. Particularly, to demonstrate the biosensing capabilities of the device, the spike protein of the SARS-CoV-2 omicron variant and a well-established aptameric assay were selected as the representative biomarker and the bioassay, respectively. The proposed device accurately and selectively detected the target of interest in a rapid (5 min) and multiplex manner with a dynamic detection range of 1–10,000 pg. ml-1in different media; and the clinical feasibility was assessed by several saliva patient samples. AMMED offers a versatile sample-to-answer platform that can be used for the detection of various biomarkers present in biofluids.