bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study Between Single-limb Versus One-and-a-Half Hip Spica Cast in Fracture Femur in Young Children
Authors: Hamdy Mohamed S. , Sabry Ahmed O. , Helmy Bishoy A. , Hana Atef Z. , EL Zawahry Aly M.E. , Gamal Andrew
Published: August 2024

Introduction:

Femoral fractures account for ∼1% to 2% of all pediatric bone injuries and are a common occurrence in children. The conservative approach, employing either a single or one-and-a-half spica casts, has been traditionally favored, yielding satisfactory outcomes in select cases. This study aims to compare both procedures regarding functional and radiologic outcomes, complications, and parents’ satisfaction.

Methods:

In this randomized controlled trial, we enrolled 84 pediatric patients, aged between 2 and 6 years, presenting with femoral fractures. Participants were randomly allocated into 2 groups; one receiving single-limb spica cast fixation (n=42) and the other receiving one-and-a-half spica cast fixation (n=42). We assessed postprocedural functional and radiologic outcomes. Other evaluations focused on parental ease in maintaining hygiene for the casted child, the child’s mobility capabilities including standing and crawling, and the incidence of skin complications.

Results:

No significant variance was observed between the 2 groups concerning the time to bone union, and the overall complication rates. Parental satisfaction was notably higher in the single-limb spica group, particularly regarding the ease of maintaining hygiene for the casted child and the child’s mobility while encased in the cast (P<0.001). Furthermore, a significant correlation was identified between the one-and-a-half spica application and the increased occurrence of skin pressure ulcers (P<0.001).

Conclusion:

Both single-limb and one-and-a-half spica cast applications demonstrated comparable results in functional and radiologic outcomes, as well as in complication rates. However, parents favored the single-limb method due to its facilitation of a more manageable lifestyle for both the child and their parents. These considerations suggest that the single-limb hip spica cast fixation may be preferable in managing pediatric femoral fractures.

Level of Evidence:

Level II.
Rigid Thoracolumbar Orthosis Does Not Improve Outcomes of Acute Adolescent Spondylolysis as Compared with Placebo. Bony Union Predicts Improved Health-Related Quality of Life Outcomes at 2-year Follow-Up
Authors: Virkki Ella , Holstila Milja , Kolari Terhi , Lastikka Markus , Mattila Kimmo , Malmi Sari , Pajulo Olli , Helenius Ilkka
Published: August 2024

Study Design.

A prospective, comparative study on clinical, radiographic, and health-related quality of life (HRQoL) outcomes in adolescents with acute spondylolysis treated with a rigid thoracolumbar orthosis (Boston brace) or with a placebo (elastic lumbar support) with a 2-year follow-up time.

Objective.

To compare outcomes of acute adolescent spondylolysis treated with a rigid thoracolumbar orthosis or a placebo with a 2-year follow-up time.

Summary of Background Data.

The benefits of the use of rigid orthosis for treatment of spondylolysis and achieving bony union of spondylolysis remains unclear.

Methods.

Sixty consecutive patients with acute spondylolysis were prospectively enrolled. Three patients were excluded from analysis as they did not fulfill inclusion criteria. First 14 patients were randomized and the remaining 46 chose treatment method themselves. Treatment time was four months and follow-up time was two years. HRQoL was measured using Scoliosis Research Society-24 (SRS-24) outcome questionnaire. The primary outcome was the HRQoL at 24 months and whether treatment type, bony union of the spondylolysis or development of spondylolisthesis affected it.

Results.

Thirty (30/57) patients were treated with a Boston brace and twenty-seven (27/57) patients with a placebo. The bony union rate of spondylolysis did not differ between study groups (20/30 vs 17/27, respectively, P=0.789). The HRQoL did not differ between treatment groups in the SRS-24 domains through follow-up (P>0.05 for all). Five patients (5/57) developed spondylolisthesis (mean slip 4.2 mm) during two-year follow-up time. Non-union of the spondylolysis predicted development of spondylolisthesis (P=0.005), but treatment type did not affect it (P>0.05). Two years after treatment patients who had bony union had higher SRS-24 total (P=0.005) and satisfaction domain (P<0.001) compared to patients with non-union.

Conclusion.

A rigid brace is not necessary for treatment of acute spondylolysis. Achieving bony union of adolescent spondylolysis is desirable as their HRQoL is higher at two years.

Level of Evidence.

II
HIV-associated tuberculosis in infants, children, and adolescents younger than 15 years: an update on the epidemiology, diagnosis, prevention, and treatment
Authors: Lishman Juanita , Frigati Lisa J. , Rabie Helena
Published: August 2024

Purpose of review

HIV-associated tuberculosis (TB) remains a major driver of morbidity and mortality in children and adolescents younger than 15 years (CLWH). The purpose of this review is to highlight recent findings in the areas of prevention, diagnosis, and treatment of HIV-associated TB in CLWH and to highlight knowledge and implementation gaps.

Recent findings

We found that despite access to antiretroviral therapy (ART), high rates of HIV-associated TB are still reported, and with an unacceptably high mortality. There are no advances in screening for TB, but shorter courses of rifapentine-based TB preventive therapy are becoming available. The use of algorithms in TB diagnosis can potentially simplify the therapeutic decision making. There are more data supporting the use of dolutegravir (DTG) with rifampicin and a need to study unadjusted DTG especially in the youngest children. Short course therapy for nonsevere pulmonary TB is currently implemented and programmatic outcome should be studied in CLWH. Low uptake of ART and poor suppression remains an important driver of HIV-associated TB.

Although screening and diagnosis remains challenging, there are several advances in the prevention and treatment of HIV-associated TB. Effective implementation of these strategies is needed to advance the outcomes of CLWH.
Assessing Stroke and Mortality Risk in Heart Failure: The CHA2DS2-VASc Score’s Prognostic Value in Patients With and Without Atrial Fibrillation: A Meta-Analysis
Authors: Abouzid Mohamed Riad , Kamel Ibrahim , Saleh Amr , Vidal Margenat Alejandro , Hariharan Ramesh
Published: August 2024

The CHA2DS2-VASc [congestive heart failure, hypertension, age (≥75 years earns 2 points, 65–74 years earns 1 point), diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism (2 points), vascular disease (eg, prior myocardial infarction, peripheral artery disease), and female sex category] score has demonstrated potential as a prognostic indicator for adverse outcomes in patients with heart failure (HF). This systematic review and meta-analysis aimed to assess the predictive accuracy of the CHA2DS2-VASc score in determining the occurrence of stroke and mortality in HF patients. We did a thorough search of electronic databases until December 2023. Included studies examined the correlation between the CHA2DS2-VASc score and the likelihood of stroke or death in patients with HF. The meta-analysis showed a substantial correlation between elevated CHA2DS2-VASc scores and heightened risks of both stroke and mortality in HF patients. Patients with CHA2DS2-VASc scores ≥4 had a greater stroke risk than those with scores <4 (odds ratio, 0.38, 95% confidence interval, 0.33–0.43, P < 0.00001). Similarly, patients with CHA2DS2-VASc scores ≥4 had a higher mortality risk (OR, 0.49, 95% confidence interval, 0.30–0.80, P = 0.05). The CHA2DS2-VASc score is a useful predictive tool for identifying HF patients who are at a high risk of both stroke and mortality. Additional investigation is necessary to confirm these findings and examine the incorporation of the CHA2DS2-VASc score into risk assessment algorithms for tailored patient management.
Association of longitudinal changes in 24-h blood pressure level and variability with cognitive decline
Authors: Melgarejo Jesus D. , Vatcheva Kristina P. , Mejia-Arango Silvia , Charisis Sokratis , Patil Dhrumil , Mena Luis J. , Garcia Antonio , Alliey-Rodriguez Ney , Satizabal Claudia L. , Chavez Carlos A. , Gaona Ciro , Silva Egle , Mavarez Rosa P. , Lee Joseph H. , Terwilliger Joseph D. , Blangero John , Seshadri Sudha , Maestre Gladys E.
Published: August 2024

Objective:

A high office blood pressure (BP) is associated with cognitive decline. However, evidence of 24-h ambulatory BP monitoring is limited, and no studies have investigated whether longitudinal changes in 24-h BP are associated with cognitive decline. We aimed to test whether higher longitudinal changes in 24-h ambulatory BP measurements are associated with cognitive decline.

Methods:

We included 437 dementia-free participants from the Maracaibo Aging Study with prospective data on 24-h ambulatory BP monitoring and cognitive function, which was assessed using the selective reminding test (SRT) and the Mini-Mental State Examination (MMSE). Using multivariate linear mixed regression models, we analyzed the association between longitudinal changes in measures of 24-h ambulatory BP levels and variability with cognitive decline.

Results:

Over a median follow-up of 4 years (interquartile range, 2–5 years), longitudinal changes in 24-h BP level were not associated with cognitive function (P ≥ 0.09). Higher longitudinal changes in 24-h and daytime BP variability were related to a decline in SRT-delayed recall score; the adjusted scores lowered from −0.10 points [95% confidence interval (CI), −0.16 to −0.04) to −0.07 points (95% CI, −0.13 to −0.02). We observed that a higher nighttime BP variability during follow-up was associated with a decline in the MMSE score (adjusted score lowered from −0.08 to −0.06 points).

Conclusion:

Higher 24-h BP variability, but not BP level, was associated with cognitive decline. Prior to or in the early stages of cognitive decline, 24-h ambulatory BP monitoring might guide strategies to reduce the risk of major dementia-related disorders including Alzheimer's disease.
Hematological Second Primary Malignancy in Pediatric Retinoblastoma: A Case Report and Systematic Review
Authors: Hyun Park Seung , Young Park Hyun , Kim Heejin , Woo Han Jung , Sook Yoon Jin
Published: August 2024

Purpose:

The impact of heredity and treatment modalities on the development of hematologic second primary malignancies (SPMs) is unclear. This study primarily reviewed the literature on patients with hematologic SPMs after retinoblastoma.

Methods:

The PubMed and Web of Science databases were searched to identify all cases of hematologic SPMs after retinoblastoma through December 2023 (International prospective register of systematic reviews CRD42023488273).

Results:

Sixty-one patients from 35 independent publications and our case were included. Within the cohort, 15 patients (51.7%) were male, and 14 patients (48.3%) were female. Of the 43 cases with known heritability status, 27 (62.8%) were classified as heritable and 16 (37.2%) as nonheritable. The median age at diagnosis was 18 months (IQR: 7.00–36.00). The geographic distribution of patients was diverse, with North America accounting for 35.0% (21/60) of cases. The following treatment strategies were used: 11.9% (5/42) of patients received neither chemotherapy nor radiotherapy, 33.3% (14/42) received chemotherapy alone, 11.9% (5/42) received radiotherapy alone, and 42.9% (18/42) received a combination of chemotherapy and radiotherapy. The median delay between retinoblastoma diagnosis and SPM diagnosis was 40 months (IQR: 22.00–85.00). Among the 61 cases, acute myeloid leukemia accounted for 44.3% (27/61), followed by acute lymphoblastic leukemia in 21.3% (13/61), Hodgkin’s lymphoma in 11.5% (7/61), non-Hodgkin’s lymphoma in 9.8% (6/61), chronic myeloid leukemia in 3.3% (2/61), and acute natural killer cell leukemia in 1.6% (1/61).

Conclusions:

Vigilant systemic surveillance for hematologic SPMs in retinoblastoma survivors, especially those treated with systemic chemotherapy and those with hereditary conditions, is warranted to improve management strategies and patient outcomes.
Antipsychotic Treatment in People at Clinical High Risk for Psychosis
Authors: Di Lisi Alessandro , Pupo Simona , Menchetti Marco , Pelizza Lorenzo
Published: August 2024

Purpose

The “early intervention” paradigm in psychiatry holds significant promise for preventing psychosis. Recent evidence showed that individuals at clinical high risk for psychosis (CHR-P) with antipsychotic (AP) prescription at baseline have higher psychosis transition rates compared with those without AP, although the underlying cause remains unclear. In this article, we reviewed international guidelines on early intervention in CHR-P people, paying specific attention to clinical recommendations on AP treatment. Then, we comment on these suggestions in the light of recent empirical evidence examining AP prescription in CHR-P populations within “real-world” clinical settings.

Methods

This search was conducted on PubMed/MEDLINE, PsycINFO, EMBASE, and Google, looking for both “Guidelines AND CHR-P OR UHR OR Early Psychosis.”

Results

International guidelines generally recommend not using AP as first-line treatment, but only when psychosocial interventions have failed. CHR-P people with AP drug showed high prevalence rates and had more severe clinical picture at entry. Is this a “warning signal” for potentially higher psychosis transition risk? Is it a direct AP iatrogenic effect? Is it possible to detect specific CHR-P subgroup that may benefit from AP? These are the questions that this article seeks to explore.

Conclusions

The current framework for identifying CHR-P subjects has defined psychometric criteria mainly based on positive symptoms. In our opinion, this is reductive, especially for evaluating therapeutic outcomes and prognosis. A more comprehensive assessment considering quality of life, psychiatric comorbidity, persistent negative symptoms, subjective experience of CHR-P psychopathology, and social/personal recovery is thus needed.
Engaging Oncology and Occupational Medicine to Inform Design of a Total Worker Health® Intervention to Address Employment, Financial, and Well-being Outcomes in Cancer Survivors
Authors: Tenney Liliana , Brown Carol E. , Schilz Matthew , Goering Madison , Dally Miranda , Dye-Robinson Amy , Williams Brian , Newman Lee S. , Bradley Cathy
Published: August 2024

Objectives

Few Total Worker Health® studies and fewer interventions examine well-being in the work context of cancer survivorship. We investigated the possibility of occupation and oncology professionals working together to address employed survivors’ work-associated needs.

Methods

We employed a community-based participatory research approach to examine the educational, contextual, and workflow needs of oncology care team members to inform intervention design. Focus groups were conducted with oncology care team members and occupational medicine physicians. Key themes from each group were then examined.

Results

Themes included oncology care team’s role in helping patients navigate resources, providing psychosocial support, and educating patients. Major themes for ways to better provide employment-related support during treatment included referring patients to employment experts and providing education on employment support.

Conclusions

Occupational health professionals in collaboration with oncology clinics could play an important role in assisting cancer survivors’ ability to navigate employment challenges.
Comparison of Outcomes with the Use of Different Heat-Activated Crimping Prostheses in Stapedotomy
Authors: Ni Garrett , Monos Stylianos , Kortebein Sarah , Symms John , Ettyreddy Abhinav , Hillman Todd A. , Chen Douglas A.
Published: August 2024

Objective

To determine differences in failure rate and hearing outcomes of a completely encircling heat-activated crimping prosthesis (SMart 360°) compared to partially encircling prosthesis (SMart).

Study Design

Retrospective chart review.

Setting

Private neurotology tertiary referral center.

Patients

Patients who underwent stapedotomies performed by the senior authors from 2008 to 2019 using the SMart prosthesis and SMart 360° prothesis.

Interventions

Stapedotomy operations with placement of a SMart or SMart 360° prosthesis.

Main Outcome Measures

Incidence of early failure requiring revision surgery. Differences in preoperative air–bone gap (ABG) compared to postoperative ABG at 3 months, 1 year, and 2 years after surgery.

Results

A total of 228 stapedotomies were performed (SMart n = 48 and SMart 360° n = 180). Mean preoperative ABG for SMart and SMart 360° were 26.15 and 29 dB, respectively. The mean difference in ABG for the SMart at 3 months, 1 year, and 2 years were 17, 18, and 11 dB, respectively. The mean difference in ABG for the SMart 360° at 3 months, 1 year, and 2 years were 20, 20, and 19 dB. ABG differences at 3 months (p= 0.10) and 1 year (p= 0.36) were not statistically different. The failure rate for the SMart prosthesis was 12.5% and for the SMart 360° 2.2% (p= 0.002).

Conclusions

There were no statistically significant differences in ABG changes for SMart compared to SMart 360°. The Smart 360 corrects the problem with early failure seen with the Smart prosthesis.

Professional Practice Gap and Educational Need

Determination of most efficacious stapes prosthesis.

Learning Objective

Which stapes prosthesis produces better hearing results with fewer failures.

Desired Result

To disseminate information necessary to choose the best stapes prosthesis for patients.

Level of Evidence

Level III

Indicate IRB or IACUC

2022-029-agh
Differentiating Definite and Probable Ménière Disease: A Comprehensive Evaluation of Audio-Vestibular Function Testing Combined with Inner Ear MRI
Authors: Guo Xiaojing , Xiao Heng , Huang Gengliang , Lin Chenxin , Lin Jianwei , Cai Huimin , Ke Xiaoying , Lu Yang , Ye Shengnan
Published: August 2024

Objectives

To evaluate the differences between audio-vestibular function testing and inner ear gadolinium magnetic resonance imaging (MRI) in distinguishing definite Ménière disease (DMD) and probable Ménière disease (PMD), and to provide a reference for early clinical diagnosis and intervention.

Methods

A total of 116 patients diagnosed with DMD (n = 80) and PMD (n = 36) were enrolled. The differences in the results of pure tone audiometry, caloric test, and tympanic injection of gadolinium for contrast-enhanced MRI between the two groups were compared and analyzed. Parameters that could differentiate between the two conditions were identified, and the sensitivity and specificity and the area under the curve (AUC) of individual and combined indices in the differential diagnosis of DMD and PMD were evaluated.

Results

The hearing threshold and hearing asymmetry rate of the DMD group were significantly higher than those of the PMD group (p < 0.001), 98.8% and 30.6%, respectively. The abnormal rates of canal paresis (CP) and severity of endolymphatic hydrops in the DMD group were higher than those in the PMD group (p < 0.05). When combined with high-frequency hearing thresholds, hearing asymmetry, hearing curve type, endolymphatic hydrops, and abnormal CP, the diagnostic accuracy of DMD was improved compared to using high-frequency alone (p < 0.05).

Conclusion

This study showed that PMD and DMD may represent two different stages in the development of MD disease. The comprehensive assessment of audio-vestibular function testing and inner ear MRI proves beneficial for early diagnosis, potentially contributing to the preservation of inner ear function.
Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: A Prospective Study
Authors: Maas Britta D.P.J. , Hacarlioglugil Emre , van Leeuwen Roeland B. , Kamphuis Stephan , Schermer Tjard R. , van Benthem Peter Paul G. , Bruintjes Tjasse D.
Published: August 2024

Objectives

Benign paroxysmal positional vertigo (BPPV) can be treated successfully in most cases. However, recurrences are common. We aimed to prospectively investigate demographic and clinical risk factors for BPPV recurrence. Our second aim was to investigate whether seasonality affects recurrences.

Methods

We recruited adult Dutch patients presenting at our dizziness clinic with a diagnosis of definite or possible BPPV for a prospective observational study with 1-year follow-up. Factors collected from patient history and questionnaires were age, sex, ethnicity, previous treatment for BPPV, duration of BPPV symptoms, number of treatment sessions for the initial BPPV episode, the affected canal, recent head trauma, and a history of vestibular neuritis, Menière's disease, (vestibular) migraine, gout, diabetes mellitus, and chronic renal failure. Factors derived from blood samples were uric acid, glycated hemoglobin, and 25-hydroxyvitamin D.

Results

We included 139 subjects with a mean age of 65 (SD, 13) years, of whom 70% was female. A total of 48 subjects (34.5%) suffered from at least one recurrence during the 1-year follow-up. Independent risk factors for recurrence of BPPV were “multiple treatment sessions for the initial BPPV episode” (incidence rate ratio, 1.74; 95% confidence interval 1.06–2.85; p = 0.027) and history of gout (incidence rate ratio, 1.90; 95% confidence interval, 1.01–3.57; p = 0.045).

Conclusion

One-third of patients presenting in a tertiary dizziness clinic develop at least one recurrence of BPPV within 1 year. Multiple treatment sessions and a history of gout are independent risk factors for recurrence.
Association Between the Inflammatory Potential of Diet and Constipation Among Adults in the United States
Authors: Lu Wang Feng , Liu Lei , Zhang Yong Hong , Liu Huanxian
Published: August 2024

Objective:

To investigate the potential association between Dietary Inflammatory Index (DII) scores and constipation among a sample of adults in the United States.

Methods:

This cross-sectional study used data from adult participants in the 2005 to 2010 National Health and Nutrition Examination Survey (ie, “NHANES”). Self-reported information was used to identify cases of constipation. The DII was used to assess inflammatory potential of the diet. Odds ratios (ORs) and corresponding 95% CIs for the association between the DII and constipation were determined using multivariate logistic regression modeling. Stratified analyses explored whether there was effect modification to influence the relationship between DII and constipation.

Results:

Of 8272 subjects, 759 reported constipation, and 7513 did not, corresponding to a prevalence of 9.2%. After adjusting for age, gender, race/ethnicity, marital status, education level, smoking status, alcohol consumption, physical activity, body mass index (BMI), cardiovascular diseases (CVD), hypertension, stroke, diabetes, energy intake, carbohydrate intake, and selective serotonin reuptake inhibitor (SSRI) use. Compared with lower DII scores group T1 (−5.28 to ≤0.72), the adjusted OR values for DII scores and constipation in T2 (>0.72 to ≤2.50) and T3 (>2.50 to 5.24) were 1.27 (95% CI: 1.02–1.58, P=0.029) and 1.43(95% CI: 1.14–1.8, P=0.002). Subgroup analyses showed that there were effect modification of gender and physical activity factors on DII scores and constipation.

Conclusions:

Results of this cross-sectional study suggest that a higher dietary inflammatory index score was associated with increased risk of constipation after adjustment for confounding in a multivariable analysis. gender and physical activity were found to be an effect modifier of this relationship.
Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-Term Institutional Care
Authors: Bouldin Erin D. , Brintz Ben J. , Hansen Jared , Rupper Rand , Brenner Rachel , Intrator Orna , Kinosian Bruce , Viny Mikayla , Dang Stuti , Pugh Mary Jo ,   on behalf of the Elizabeth Dole Center of Excellence for Veteran and Caregiver Research Team
Published: August 2024

Background:

We aimed to identify combinations of long-term services and supports (LTSS) Veterans use, describe transitions between groups, and identify factors influencing transition.

Methods:

We explored LTSS across a continuum from home to institutional care. Analyses included 104,837 Veterans Health Administration (VHA) patients 66 years and older at high-risk of long-term institutional care (LTIC). We conduct latent class and latent transition analyses using VHA and Medicare data from fiscal years 2014 to 2017. We used logistic regression to identify variables associated with transition.

Results:

We identified 5 latent classes: (1) No Services (11% of sample in 2015); (2) Medicare Services (31%), characterized by using LTSS only in Medicare; (3) VHA-Medicare Care Continuum (19%), including LTSS use in various settings across VHA and Medicare; (4) Personal Care Services (21%), characterized by high probabilities of using VHA homemaker/home health aide or self-directed care; and (5) Home-Centered Interdisciplinary Care (18%), characterized by a high probability of using home-based primary care. Veterans frequently stayed in the same class over the three years (30% to 46% in each class). Having a hip fracture, self-care impairment, or severe ambulatory limitation increased the odds of leaving No Services, and incontinence and dementia increased the odds of entering VHA-Medicare Care Continuum. Results were similar when restricted to Veterans who survived during all 3 years of the study period.

Conclusions:

Veterans at high risk of LTIC use a combination of services from across the care continuum and a mix of VHA and Medicare services. Service patterns are relatively stable for 3 years.
Genetic testing for pediatric sensorineural hearing loss in the era of gene therapy
Authors: Shearer A. Eliot
Published: August 2024

Purpose of review

To summarize indications, methods, and diagnostic yields for genetic testing for pediatric hearing loss.

Recent findings

Genetic testing has become a cornerstone of clinical care for children with sensorineural hearing loss. Recent studies have shown the efficacy of gene panels and exome sequencing for any child with sensorineural hearing loss. Recent findings have underscored the importance of a diagnosis in clinical care. Clinical trials for gene therapy for hearing loss have begun.

Genetic testing has become critical for personalized care for children with hearing loss. Recent studies have shown a 43% overall diagnostic yield for genetic testing for pediatric hearing loss, though the diagnostic yield may range from 10 to 60% depending on clinical features. Syndromic diagnoses comprise 25% of positive genetic tests for pediatric sensorineural hearing loss. While diagnostic yield is lower for children with unilateral or asymmetric sensorineural hearing loss, the likelihood of syndromic hearing loss finding is higher. An early and accurate genetic diagnosis is required for participating in clinical trials for gene therapy for hearing loss.
Biomarkers in Pediatric Hemophagocytic Lymphohistiocytosis With Central Nervous System Involvement: A Cohort Study
Authors: Zhao Yunze , Ou Wenxin , Wei Ang , Ma Honghao , Zhang Liping , Lian Hongyun , Zhang Qing , Wang Dong , Li Zhigang , Zhang Rui , Wang Tianyou
Published: August 2024

Background:

The aim of this study was to analyze the clinical significance of cerebrospinal fluid (CSF) cytokines in hemophagocytic lymphohistiocytosis associated with central nervous system (CNS-HLH).

Methods:

CSF cytokine levels, including interferon (IFN)-γ, soluble CD25 (sCD25), interleukin (IL)-6, IL-10, IL-18, and CXCL9 were measured at disease onset and during the treatment. Five newly diagnosed patients with demyelination disease were enrolled for comparison.

Results:

Sixty-five samples from 36 patients (13 in the CNS group and 23 in the non-CNS group) were detected. Levels of CSF IFN-γ, sCD25, IL-10, IL-18, and CXCL9 in the CNS group were higher than those in the non-CNS group (P=0.038, <0.001, <0.001, 0.005, and <0.001), and levels of CSF sCD25, IL-10, IL-18, and CXCL9 in the CNS group were higher than those in the demyelination group (P=0.001, 0.008, 0.004, and 0.003). There was no significant difference in IL-6 levels among the 3 groups (P=0.339). CSF IFN-γ, sCD25, IL-10, IL-18, and CXCL9 could assist in diagnosing CNS-HLH. The diagnostic efficiency of CSF sCD25, IL-10, and CXCL9 was better, with a cutoff value of 154.64, 1.655, and 19.54 pg/mL, respectively. The area under the curve was >0.9, with sensitivity and specificity >80%. Correlation analysis suggested that in the CNS group, IFN-γ levels in CSF and serum correlated positively (R=0.459, P=0.007), while there was no correlation between CSF CXCL9 and serum IFN-γ (P=0.915).

Conclusions:

CSF IFN-γ, sCD25, IL-10, IL-18, and CXCL9 levels were significantly higher in HLH patients with CNS involvement than those without and could predict HLH patients with CNS involvement. CSF CXCL9 might be a more sensitive biomarker to CNS-HLH than IFN-γ, while CSF IL-6 does not seem to play a vital role.
Determinants of Surgical Approach for Benign Outpatient Hysterectomy
Authors: Whiteside James L. , Tumin Dmitry , Hildebrand Jason P. , Harris Alyssa
Published: August 2024

(Abstracted from J Minim Invasiv Gynecol 2024;31(2):123–130.e2

Hysterectomy is the most common nonobstetric major surgery among women, accounting for roughly 400,000 surgeries in the United States annually. Minimally invasive approaches to this surgery are becoming more common, with many factors influencing the decision about the approach for the procedure.
Ovarian Torsion: A Review of the Evidence
Authors: Zhu Ting-Wei , Li Xue-Lian
Published: August 2024

Importance

Ovarian torsion is a gynecological emergency caused by the twisting of the ovary and/or fallopian tube, further resulting in ischemic changes of the adnexa. Early diagnosis is likely to preserve ovarian function.

Objective

The purpose of this review is to review the current findings of ovarian torsion including clinical presentations, diagnostic criteria, surgical procedures, and prognosis.

Evidence Acquisition

The literature search is mainly available in PubMed and Web of Science platforms by searching “ovarian torsion” combined with one or several terms including “diagnosis” “risk factors” “surgery” and “torsion recurrence.”

Results

Abdominal pain, nausea, and vomiting were normal clinical presentations. In order to increase the accuracy of diagnosis, it is necessary to integrate clinical presentation and the findings of imaging and laboratory examinations. Computed tomography findings, plasmad-dimer level, and the time from pain onset play a critical role in distinguishing ovarian necrosis. The efficiency of oophoropexy on preventing recurrent ovarian torsion is controversial.

Conclusion

Most patients with early diagnosis of ovarian torsion may have a better prognosis with conservative surgery.

Relevance

Better understanding of ovarian torsion is critical for gynecologists to promote accuracy of diagnosis and select the optimal surgical procedure.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner will be better able to explain clinical manifestations and findings of imaging; identify signs of ischemic necrosis in twisted ovaries; and discuss the optimal surgery for different populations of women with ovarian torsion.
Analgesia Using Transcutaneous Electric Nerve Stimulation in Office Bladder Chemodenervation, A Randomized Controlled Trial
Authors: Hernandez-Aranda Diego , Panza Joseph , Eigg Marc , Greenstein Marc , Li Dongmei , O’Brien Jeanne , Warren Gareth , Doyle Paula Jaye
Published: August 2024

(Abstracted from Urogynecology 2024;30:498–504

Onabotulinumtoxin A injections can be performed as a third-line therapy option to those who are unresponsive to first line treatments for overactive bladder. Modifications to the procedure and environment have historically been used to improve patient experience and comfort in the office procedure; one method of analgesia for office bladder chemodenervation that has yet to be fully investigated is transcutaneous electric nerve stimulation (TENS).
Patterns of HIV Treatment Preferences Among People With Diverse Demographic, Social, and Behavioral Characteristics Who Are Living With HIV in the United States
Authors: Russell Elizabeth S. , Zhou Mo , Song Yan , Barak Narquis , Gao Yipeng , Mast T. Christopher
Published: August 2024

Background:

New dosage form and frequency options may improve HIV treatment outcomes and reduce disparities in access and use.

Methods:

People with HIV in the United States completed a demographic and discrete choice experiment survey of preference for 13 hypothetical HIV treatment options: daily and weekly oral tablets; 1-, 3-, or 6-monthly injections by self or a health care provider (HCP); yearly implant; or combinations. Best-Worst Scaling and a latent class model were used to analyze overall preference choices and for groups of individuals with similar patterns of preferences; the model also predicted uptake of products.

Results:

Among the diverse 829 respondents, weekly oral tablets and 6-monthly injections by an HCP were significantly more favored than daily oral tablets. Convenience of the treatment and being tired of taking pills were the top drivers of preference responses. Latent class analysis identified 4 groups of respondents with distinct preference patterns; approximately two-thirds belonged to groups strongly preferring products other than daily oral tablets. The modelled uptake of a weekly pill, yearly implant, 6-monthly HCP injection, oral daily pill, and 3-monthly HCP injections were 24%, 24%, 24%, 18%, and 11%, respectively.

Conclusions:

Patterns of HIV medication preference can inform development of new forms of HIV therapy products because the majority of patients do not prefer the currently most available treatment option of daily oral tablets. Looking beyond population-level preferences and into similar groups of people with HIV increases the ability to develop patient-centered products to fill gaps in care and increase treatment effectiveness.
Comprehensive Potential of Artificial Intelligence for Predicting PD-L1 Expression and EGFR Mutations in Lung Cancer: A Systematic Review and Meta-Analysis
Authors: Wu Linyong , Wei Dayou , Chen Wubiao , Wu Chaojun , Lu Zhendong , Li Songhua , Liu Wenci
Published: August 2024

Objective

To evaluate the methodological quality and the predictive performance of artificial intelligence (AI) for predicting programmed death ligand 1 (PD-L1) expression and epidermal growth factor receptors (EGFR) mutations in lung cancer (LC) based on systematic review and meta-analysis.

Methods

AI studies based on PET/CT, CT, PET, and immunohistochemistry (IHC)–whole-slide image (WSI) were included to predict PD-L1 expression or EGFR mutations in LC. The modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the methodological quality. A comprehensive meta-analysis was conducted to analyze the overall area under the curve (AUC). The Cochrane diagnostic test and I
2 statistics were used to assess the heterogeneity of the meta-analysis.

Results

A total of 45 AI studies were included, of which 10 were used to predict PD-L1 expression and 35 were used to predict EGFR mutations. Based on the analysis using the QUADAS-2 tool, 37 studies achieved a high-quality score of 7. In the meta-analysis of PD-L1 expression levels, the overall AUCs for PET/CT, CT, and IHC-WSI were 0.80 (95% confidence interval [CI], 0.77–0.84), 0.74 (95% CI, 0.69–0.77), and 0.95 (95% CI, 0.93–0.97), respectively. For EGFR mutation status, the overall AUCs for PET/CT, CT, and PET were 0.85 (95% CI, 0.81–0.88), 0.83 (95% CI, 0.80–0.86), and 0.75 (95% CI, 0.71–0.79), respectively. The Cochrane Diagnostic Test revealed an I
2 value exceeding 50%, indicating substantial heterogeneity in the PD-L1 and EGFR meta-analyses. When AI was combined with clinicopathological features, the enhancement in predicting PD-L1 expression was not substantial, whereas the prediction of EGFR mutations showed improvement compared to the CT and PET models, albeit not significantly so compared to the PET/CT models.

Conclusions

The overall performance of AI in predicting PD-L1 expression and EGFR mutations in LC has promising clinical implications.
Speech Acoustic Analysis in Adult Patients With Cleft Palate After Cleft Palate Repair and Speech Therapy
Authors: Lou Qun , Wang Xudong , Wan Teng , Wang Bixia
Published: August 2024

Objective:

This study aims to evaluate the enhancement of speech functionality in adult patients with cleft palate through acoustic analysis, assessing pronunciation level improvements before and after palatopharyngoplasty and speech treatment. The findings aim to provide an objective assessment of the treatment efficacy for older patients with cleft palate.

Participants and Intervention:

The study involved acoustic comparisons encompassing vowel formants, voice onset time (VOT) of consonant syllables, syllable duration, and voice characteristic analysis. Speech functionality in each adult cleft palate patient was evaluated thrice: before palatopharyngoplasty, after palatopharyngoplasty, and following speech therapy, using a self-comparative analysis method to discern phonological differences.

Results:

No significant alteration in vowel formants was observed in adult cleft palate patients pre-palatopharyngoplasty and post-palatopharyngoplasty. Post-speech treatment, the F2 and F3 values for the anterior high vowel /i/ significantly improved, aligning closely with those of the normal adult group. Similarly, while consonant parameters (VOT value and syllable duration) remained unchanged post-surgery, both metrics showed significant improvement after speech therapy. Except for the prolonged syllable duration of /s/ compared with normal adults, other indicators were not significantly different. Voice parameter analysis revealed no significant change post-operation; however, both HNR and CPPS values post-speech treatment notably increased, matching those of normal adults.

Conclusion:

Surgical intervention addresses the physical closure of the cleft palate and reconstructs the resonator’s structure. Conversely, consonant improvement predominantly occurs through targeted speech therapy aimed at rectifying pronunciation habits and tutoring patients on the effective utilization of repaired articulatory organs. The combined intervention of cleft palate surgery and speech therapy plays a complementary role in speech restoration for cleft palate patients.
Influence of Socioeconomic Deprivation on Surgical Outcomes for Patients With Sigmoid Diverticulitis in France
Authors: Alves Arnaud , Sabbagh Charles , Ouaissi Mehdi , Zerbib Philippe , Bridoux Valérie , Manceau Gilles , Panis Yves , Buscail Etienne , Venara Aurélien , Khaoudy Iman , Gaillard Martin , Viennet Manon , Thobie Alexandre , Menahem Benjamin , Eveno Clarisse , Bonnel Catherine , Mabrut Jean-Yves , Badic Bogdan , Godet Camille , Eid Yassine , Duchalais Emilie , Lakkis Zaher , Cotte Eddy , Laforest Anaïs , Defourneaux Véronique , Maggiori Léon , Rebibo Lionel , Christou Niki , Talal Ali , Mege Diane , Bonnamy Cécile , Germain Adeline , Mauvais François , Tresallet Christophe , Roudie Jean , Laurent Alexis , Trilling Bertrand , Bertrand Martin , Massalou Damien , Romain Benoit , Tranchart Hadrien , Pellegrin Alexandra , Beyer-Berjot Laura , Dejardin Olivier ,   on behalf of the French Surgical AssociationΦ
Published: August 2024

Objectives:

To evaluate the relationship between socioeconomic deprivation and postoperative outcomes in patients who underwent colonic resection for sigmoid diverticulitis (SD).

Background:

The potential impact of socioeconomic inequalities on the management of SD has been scarcely studied in the literature. Considering other gastrointestinal pathologies for which lesser access to optimal treatment and poorer survival have been shown, we hypothesize that deprivation could be associated with outcomes for SD.

Methods:

This multicenter retrospective study was conducted at 41 French hospitals between January 1, 2010, and August 31, 2021. The main outcome was the occurrence of severe postoperative complications on postoperative day 90, according to the Clavien-Dindo scale (≥3). The European Deprivation Index was used to approximate deprivation for each patient. Multiple imputations by a chained equation were performed to consider the influence of missing data on the results.

Results:

Twenty percent of the 6415 patients operated on had severe postoperative complications at 90 days. In the multivariate regression analysis, increasing age, male sex, American Society of Anesthesiologists score ≥3, conversion to laparotomy or upfront open approach, surgical procedures, and perioperative transfusion were independent risk factors for severe postoperative complications. After adjusting for age, sex, body mass index, American Society of Anesthesiologists score, emergent setting, blood transfusion, indications for surgery, surgical approach, and procedures, the probability of severe postoperative complications increased with socioeconomic deprivation (P=0.026) by day 90.

Conclusions:

This study highlights the potential influence of socioeconomic deprivation on the surgical outcomes of SD. Socioeconomic deprivation should be considered as a risk factor for severe postoperative complications during the preoperative assessment of the patient’s medical conditions.
Combining Gram stain and 16S qPCR improved diagnostic accuracy for suspected pneumonia and could become a new metric in the rapid diagnosis of lower respiratory tract infections
Authors: Hamza Yunas Panikkaveettil , Kacem Mohamed Ali Ben Hadj , Al Molawi Naema Hassan , Yassine Hadi Mohamad , AlKhatib Hebah Atef Mohammad , Benslimane Fatiha , Al-Remaihi Hanan Ibrahim Kh. B. , El Kahlout Reham Awni , El Kahlout Basema Ibrahim Ahmed , Al Khalili Hajar , Al Khalili Makiyeh Ahmed , Doiphode Sanjay H. , Elmagboul Emad Bashier Ibrahim , Akhter Javed , Al Kuwari Einas A/Aziz Eid , Coyle Peter V.
Published: August 2024

Introduction. The frequency of multidrug-resistant organisms (MDROs) in hospitals and the risk of delaying effective treatment result in the culture of respiratory secretions for nearly all patients with suspected pneumonia. Culture delays contribute to over prescribing and use of broader spectrum antibiotics.

Gap statement. The need for improved rapid diagnostics for early assessment of suspected hospital pneumonia.

Aim. To validate a new metric, enhanced Gram stain (EGS), to provide a rapid diagnostic test of high diagnostic accuracy that could be assessed in clinical trials of the use of antibiotics in suspected pneumonia.

Methodology. Ninety-two residual lower respiratory samples previously tested by culture and Gram stain were re-tested by 16S ribosomal DNA real-time polymerase chain reaction (16S qPCR) and reported as a combined metric with Gram stain termed EGS. The EGS was assessed for diagnostic accuracy, standard performance measurements and correlation against culture. For samples with discordance between culture and EGS, 16S ribosomal DNA whole operon sequencing (16S rDNA WOS) was used for test resolution. An amended EGS (A-EGS was reassessed against culture.

Results. Gram stain, 16S qPCR, EGS and A-EGS had respective diagnostic accuracies of 77.01 %, 82.76 %, 84.04 % and 94.19 %. The same platforms had respective correlation with culture of r = 0.67, r = 0.71, r = 0.81 and r = 0.89. EGS had the highest negative predictive value (NPV) of 93.18 % (81.99 %–97.62 %). Adding an 16S qPCR result is achievable in most routine laboratories and, combined with Gram stain, could improve early decision-making in patients with suspected hospital pneumonia.

Conclusion. EGS could improve early decision-making in patients with suspected hospital pneumonia and could be assessed in clinical trials. The 16S rDNA WOS results in the A-EGS also supported the use of pathogen genomic sequencing in early decision making of suspected pneumonia.
End-to-end simulation of nanopore sequencing signals with feed-forward transformers
Authors: Beslic Denis , Kucklick Martin , Engelmann Susanne , Fuchs Stephan , Renard Bernhard Y. , Koerber Nils
Published: August 2024

Motivation Nanopore sequencing represents a significant advancement in genomics, enabling direct long-read DNA sequencing at the single-molecule level. Accurate simulation of nanopore sequencing signals from nucleotide sequences is crucial for method development and for complementing experimental data. Most existing approaches rely on predefined statistical models, which may not adequately capture the properties of experimental signal data. Furthermore, these simulators were developed for earlier versions of nanopore chemistry, which limits their applicability and adaptability to the latest flow cell data. Results To enhance the quality of artificial signals, we introduce seq2squiggle, a novel transformer-based, non-autoregressive model designed to generate nanopore sequencing signals from nucleotide sequences. Unlike existing simulators that rely on static k-mer models, our approach learns sequential contextual information from the signal data. We benchmark seq2squiggle against state-of-the-art simulators on real experimental R10.4.1 data, evaluating signal similarity, basecalling accuracy, and variant detection rates. Seq2squiggle consistently outperforms existing tools across multiple datasets, demonstrating superior similarity to real data and offering a robust solution for simulating nanopore sequencing signals with the latest flow cell generation. Availability and Implementation seq2squiggle is freely available on GitHub at: github.com/ZKI-PH-ImageAnalysis/seq2squiggle