bluuebunny/crossref_metadata_2025 huggingface dataset:
MNGA-05 INCREASED OCCURRENCE OF MENINGIOMA IN WOMEN: A META ANALYSIS
Authors: Fatade Eniola , Chiromo Mutsa , Fonkem Ekokobe
Published: October 2024

Meningiomas are the most prevalent primary Central Nervous System (CNS) tumors, accounting for 40% of brain tumors in America and nearly 30% of primary inter-cranial tumors in Africa. Meningiomas exhibit gender and racial disparities in their demographic distribution, with a higher incidence rate in women compared to men. Here we performed a meta-analysis to analyze this association. This meta-analysis aims to systematically review the existing literature to determine the prevalence of meningioma in women across different populations and geographical regions. A comprehensive search was conducted in electronic databases including PubMed, and Ovid, from inception to 2024. Studies reporting the prevalence of meningioma in women were included. Random-effects meta-analysis was used to estimate the pooled prevalence of meningioma in women. A total of 6 studies was included in the meta-analysis, comprising 568,184 women. The pooled prevalence of meningioma in women compared to men was estimated to be 2.75. The prevalence of meningioma in women varies across age groups, with the highest rate observed in the 4th -5th decades. This meta-analysis provides a comprehensive overview of the prevalence of meningioma in women, highlighting a higher occurrence of meningioma in women. There is need for further research to explore the underlying factors epidemiological and hormonal factors to improve the health outcome for women with meningioma and for effective prevention.
MNGA-07 CHARACTERISTICS AND OUTCOMES OF FOUR PARASAGITTAL TUMORS EXCISED AT PARIRENYATWA CENTRAL HOSPITAL, ZIMBABWE
Authors: Sanyamandwe Simbarashe , Kalangu Kazadi , Dzowa Maximilian , Zimani Nathaniel
Published: October 2024

OBJECTIVE

To investigate the clinical features and outcomes of patients undergoing excision of parasagittal tumors at Parirenyatwa Central Hospital, Zimbabwe over a six-month period between October 2023 to March 2024.

METHOD

The clinical and operation notes of patients with parasagittal tumors who underwent excision were retrieved from the hospital archives and used to populate a pre-developed tool.

RESULTS

Four cases were operated on with their ages ranging from 33 to 61 years. There were three males and one female with the average duration of presenting symptoms being 2 years 3 months from a range of 6 months to 4 years. Two of the tumors were located in the middle third of the superior sagittal sinus while there was 1 of each in the posterior and anterior third location. All of the masses were Sindou type I except for 1 case which was a type II Sindou classification. No preoperative embolization was done for all the patients and the masses were categorized as large with the masses measuring 6 x 7 x 9, 7 x 5 x 4.5, 7.3 x 5.6 x 7.4 and 7 x 8 x 9 centimeters. Intraoperatively 2 cases did not receive blood transfusion while one received 1 unit, and the Sindou type II patient received 2 units. The extent of resection was Simpson grade II for 3 cases and Simpson IV for the Sindou type II case. All the patients were discharged from in-hospital care. The immunohistopathology showed that the excised massed were 2 cases of type 1 meningiomas, a xanthomatous meningioma and a solitary fibrous tumor.

CONCLUSION

The parasaggital sinus tumors presenting at Parirenyatwa, Zimbabwe are large and outcomes of excision are generally good despite no preoperative embolization being undertaken.
OTHR-11 A CASE SERIES OF OUTER TABLE CALVARIAL DECORTICATION AS A VIABLE OPTION TO ACHIEVE SKULL COVER AFTER RESECTION OF LARGE SCALP TUMORS
Authors: Dzinotyiwei Daniel , Kalangu Kazadi , Zimani Nathaniel , Dzowa Maximilian
Published: October 2024

A showcase of a scalp cover technique that offers a simple solution to a unique challenge posed by excision of late presenting large scalp tumors in a third-world setting through a case series of 2 patients with extensive scalp malignancy requiring wide local excision with striping of the pericranium. Outer table skull drilling resulted in granulation tissue formation allowing for defect cover by wound contraction. Unique circumstances in a third-world setting compounded by the COVID-19 pandemic restrictions allowed for observation of the natural history of the progression of the scalp defect coverage by wound contraction over a decorticated granulation tissue bed. An adequate granulation bed can be achieved within 4-6 weeks. Closure of the defect by wound contraction over the granulation bed is possible, albeit over a protracted period of months. These two cases proved that outer table decortication offers a good option to cover denuded large scalp defects after the excision of scalp tumors. Although less than ideal, total defect closure can be achieved without subsequent grating.
PDOC-03 CASE SERIES ON PEDIATRIC PATIENTS WITH LEPTOMENINGEAL METASTASES FROM VARIOUS PRIMARY BRAIN TUMORS: FROM CLINICAL PRESENTATIONS TO OUTCOMES
Authors: Kwikima Ugumba , Kalinga Violeth , Mallango Atuganile
Published: October 2024

Leptomeningeal disease (LMD), also known as carcinomatous meningitis, is when cancer cells are found in the thin layers covering the brain and spinal cord, in the spaces between these layers, or in the fluid surrounding the brain and spinal cord. In children with brain tumors, LMD is rare, occurring in about 1% to 2% of cases. It’s most commonly seen in certain types of tumors like medulloblastoma and primary central nervous system lymphoma, but it can also occur in other types such as pineoblastoma, Atypical Teratoid Rhabdoid Tumor, and both low-grade and high-grade gliomas. Although pilocytic astrocytomas, a type of low-grade glioma, seldom spread, there have been a few reported cases of them spreading to the leptomeninges. The exact prevalence of LMD in pediatric brain tumors isn’t well-documented due to differences in how it’s screened for across different types of tumors and at different stages of the disease. Improved surgical methods and various treatments targeting specific areas or affecting the whole body have resulted in better survival rates for patients with LMD. Detecting LMD early is important for treatment options. It can be found either at the same time as the primary brain tumor, when the tumor comes back, or as LMD without an initial tumor. There’s concern that procedures to divert cerebrospinal fluid might spread cancer cells. MRI scans are important for diagnosing LMD, but it can still be challenging to diagnose based on these scans alone. Usually, confirmation is done by analyzing the fluid around the brain and spinal cord for cancer cells. Given that LMD is a complex and rare complication of pediatric brain tumors, more research is needed to improve diagnosis and treatment. In this article, we’ll discuss three cases of pediatric brain tumors with LMD, including how they were diagnosed, treated, and their clinical outcomes.
SPIN-01 PRIMARY MALIGNANT MELANOMA, AN ATYPICAL PRESENTATION IN THE CERVICAL SPINE: A CASE REPORT
Authors: Kamabu Larrey Kasereka , Kataka Louange Maha , Vivalya Bives Mutume Nzanzu , Sikakulya Franck Katembo , Lekuya Hervé Monka , Galukande Moses
Published: October 2024

BACKGROUND

Few studies have documented the occurrence of melanoma in the cervical spine. Of all malignant melanoma cases, 1% are primary melanoma of the central nervous system, which makes it extremely uncommon and nonspecific. We aim to report a case of the uncommon presentation of primary melanoma in the cervical spine. Case presentation: The patient was a 59-year-old Muganda male who presented with a 2-year history of anterior neck swelling as well as severe pain and a tingling sensation in the left shoulder and arm, which worsened in the recent 6 months. He developed weakness and paresthesia in the upper left arm and progressive gait disturbance of the left leg. A physical examination revealed masses in the left cervical and right submandibular region. Additionally, the upper and lower left extremities revealed hemiparesis and hemihypoesthesia. A magnetic resonance imaging scan showed a hyperintense lesion on TIWI and another hypointense lesion on T2WI, originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed the tumor to be malignant melanoma. The patient died within 1 month after the diagnosis and surgery.

CONCLUSION

This case is presented to highlight the significance and challenges associated with making a pre- and postoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1-weighted images and hypointensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.
SPIN-03 PROFILE OF MALIGNANT SPINAL CORD COMPRESSION AMONG CHILDREN AT A SINGLE CENTRE IN JOHANNESBURG, SOUTH AFRICA
Authors: Mauree Angidi , Laher Anees , Goodwin Bernard , Geel Jennifer
Published: October 2024

OBJECTIVE

Malignant spinal cord compression (MSCC) in children can lead to permanent neurological deficits and therefore warrants urgent referral, prompt diagnosis and treatment. There is limited data on paediatric MSCC in Sub-Saharan Africa. The objective was to assess the characteristics, aetiology, clinical presentation, treatment and long-term outcomes of MSCC.

METHODS

Records of 23 patients with MSCC were retrospectively assessed over a 15-year period (2008-2023) at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa.

RESULTS

The median age of MSCC diagnosis was four years (range: 5 months to 15 years). The median interval between symptom onset and confirmed diagnosis was three months (1 week to 20 months). MSCC’s leading causes were central nervous system tumours (30%), lymphomas (22%), sarcomas (17%), germ cell tumours (9%), teratoid tumours (9%), neuroblastomas (9%) and leukaemias (4%). Commonest presenting symptoms were motor deficits (96%), pain (35%) and sphincter dysfunction (22%). Magnetic resonance imaging (MRI) of the spine was diagnostic in all cases. The primary tumour was managed using a multimodality approach: 70% underwent neurosurgical intervention and 39% received radiotherapy. The median follow-up duration was two years (1 month to 15 years). There were six deaths (two cases of ependymoma and a case each of glioblastoma multiforme, alveolar rhabdomyosarcoma, acute lymphoblastic leukaemia and Burkitt lymphoma) at a median interval of 4.5 months from diagnosis (1 month to 2 years). The commonest long-term sequelae were motor deficits (52%) and sphincter dysfunction (26%) and 22% of patients were asymptomatic.

CONCLUSION

We documented longer diagnostic delays than published in the literature and recommend increased awareness and rapid referral to decrease permanent sequelae. Patients presenting with new-onset neurological deficits suggestive of MSCC should have urgent radiological imaging; preferably MRI, followed by prompt referral to a specialised centre with an experienced multidisciplinary team.
SPIN-05 A CASE PRESENTATION ON ASTROCYTOMA
Authors: Girisa Peres , Michelle Obat , Sarah Muma , Musau Helena
Published: October 2024

Patient initially presented to our facility with a 3 year history of limb weakness. The limb weakness started mainly with the right upper limb associated with pains that were radiating to the neck region. They had visited several local hospitals for treatment but had no improvement. One year later he developed low limb weakness, was on physiotherapy for a long time with no improvement, until 1/12 ago when he developed complete paralysis of both low limbs making him bound to use of wheelchair. He had an accompanied history of cervical and thoracic spine pains that were radiating to the chest. No history of trauma. MRI showed an expansile intramedullary cystic lesion seen throughout the length of the spinal cord with inhomogeneous post contrast enhancement, highly suggestive of astrocytoma. Ddx: Hemangioblastoma. On examination, he was not pale, no jaundice no edema, wheelchair bound, with Scoliosis. Vitals were within normal limit, with muscle atrophy and muscle power- RUL ⅗. LUL ⅘, RLL ⅗. LLB ⅖, with bilateral knee hyperreflexia with significant disuse atrophy. Pain scale 6/10. He was a secondary school student. His parents do menial jobs to support their family and would delay clinic reviews due to lack of finances.
TRLR-01 THE PROGNOSTIC UTILITY OF TEMPORALIS MUSCLE THICKNESS MEASURED ON MAGNETIC RESONANCE SCANS IN PATIENTS WITH INTRA-AXIAL MALIGNANT BRAIN TUMOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Daniel Jeremiah , Osunronbi Temidayo , Olukoya Olatomiwa , Jesuyajolu Damilola , Thorne Lewis
Published: October 2024

OBJECTIVE

Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms.

METHODS

Following the PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Cochrane databases for relevant studies from inception until June 17, 2022. Event ratios with 95% confidence intervals (CI) were analyzed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence.

RESULTS

Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progression-free survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19–0.60) (GRADE moderate) and progression-free survival (HR 0.23; 95% CI 0.09–0.56) (GRADE high).

CONCLUSION

TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision-making between patients and clinicians.
Implementing the Infectious Diseases Society of America Antimicrobial Stewardship Core Curriculum: Survey Results and Real-World Strategies to Guide Fellowship Programs
Authors: Hojat Leila S , Patel Payal K , Ince Dilek , Kang Amy Y , Fong Gary , Cherabuddi Kartik , Nori Priya , Al Lawati Hawra , Stohs Erica J , Beeler Cole , Van Schooneveld Trevor C , Lee Matthew S , Hamilton Keith W , Justo Julie Ann , Spicer Jennifer O , Logan Ashleigh , Bennani Kenza , Williams Rostam , Shnekendorf Rachel , Bryson-Cahn Chloe , Willis Zachary I , Moenster Ryan P , Brennan-Krohn Thea , Paras Molly L , Holubar Marisa , Gaston David C , Advani Sonali D , Luther Vera P
Published: October 2024

Background

The Infectious Diseases Society of America (IDSA) developed the Core Antimicrobial Stewardship (AS) Curriculum to meet the increasing demand for infectious diseases (ID) providers with AS expertise. Notable diversity in implementation approaches has been observed among ID fellowship programs using the curriculum. We sought to describe individual approaches and develop a curriculum implementation roadmap.

Methods

We surveyed ID fellowship programs that had previously implemented the IDSA Core AS curriculum. The survey included questions regarding program characteristics, curriculum participants and presentation format, resources and barriers, and implementation strategies. Commonly reported program features were summarized in the context of the self-reported implementation strategies. Implementation guides were developed based on the most common characteristics observed.

Results

Of 159 programs that had purchased the curriculum, 37 responded, and 34 (21%) were included in the analysis. The curriculum was primarily taught by AS physicians (85%) and AS pharmacists (47%). The most common conference structure was a longitudinal conference series (32%), and eLearning was the most common presentation format. Limited AS faculty time (76%) and limited first-year fellow availability (62%) were frequently reported as barriers, and dedicated AS curricular time was a resource available to most programs (67%); implementation guides were created for these 3 program features.

Conclusions

Programs reported a variety of implementation barriers and resources, with several common themes emerging, allowing for the development of tailored curriculum planners for 3 commonly observed program characteristics. This work will equip fellowship programs with curriculum implementation strategies and guide future enhancements of the IDSA Core and Advanced AS curricula.
Field-Scale Gene Flow of Fungicide Resistance in Pyrenophora teres f. teres and the Effect of Selection Pressure on the Population Structure
Authors: Hodgson Leon M. , Lopez-Ruiz Francisco J. , Gibberd Mark R. , Thomas Geoff J. , Zerihun Ayalsew
Published: October 2024

The effectiveness of fungicides to control foliar fungal crop diseases is being diminished by the increasing spread of resistance to fungicides. One approach that may help to maintain efficacy is remediation of resistant populations by sensitive ones. However, the success of such approaches can be compromised by re-incursion of resistance through aerial spore dispersal, although knowledge of localized gene flow is lacking. Here, we report on a replicated mark-release-recapture field experiment with several treatments set up to study spore-dispersal-mediated gene flow of a mutated allele that confers demethylase inhibitor resistance in Pyrenophora teres f. teres ( Ptt). Artificial inoculation of the host, barley ( Hordeum vulgare), was successful across the 12-ha trial, where the introduced sensitive and resistant populations were, respectively, 6- and 13-fold the DNA concentration of the native Ptt population. Subsequent disease pressure remained low, which hampered spread of the epidemic to such an extent that gene flow was not detected at, or beyond, 2.5 m from source points. In the absence of gene flow, plots were assessed for treatment effects; fungicide applied to populations that contained 14.3% of allele mutation increased in frequency to 24.5%, whereas sensitive populations had no change in structure. Untreated controls of the native Ptt population remained genetically stable, yet untreated controls that were inoculated with sensitive Ptt had half the resistance frequency of the native population structure. The trial demonstrates the potential for management to remediate fungicide-resistant pathogen populations, where localized gene flow is minimal, to safeguard chemical crop protection into the future.
Developing and Validating a Multimodal Dataset for Neonatal Pain Assessment to Improve AI Algorithms With Clinical Data
Authors: Yang Nannan , Zhuang Ying , Jiang Huiping , Fang Yuanyuan , Li Jing , Zhu Li , Zhao Wanyuan , Shi Tingqi
Published: October 2024

Background:

Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain.

Purpose:

To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment

Methods:

An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates’ pain reactions on site. After 2 weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL.

Results:

The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96.

Implications for Practice and Research:

MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.
Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review
Authors: Geng Ryan S. Q. , Sibbald R. Gary , Slomovic Jacqueline , Toksarka Olivia , Schultz Gregory
Published: October 2024

GENERAL PURPOSE

To review the therapeutic indices of topical antiseptics for bacterial species commonly isolated from chronic wounds.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Explain the mechanisms underlying chronic wound physiology and their implications for effective wound healing and management.

2. Evaluate the role of therapeutic index values for topical antiseptics in chronic wound management.

3. Apply evidence-based treatment strategies for chronic wound management.

BACKGROUND

Chronic wounds place a heavy burden on healthcare systems and reduce patients’ activities of daily living. Increased bacterial bioburden (local infection, covert infection) impairs wound healing. With increased antimicrobial resistance, alternative antimicrobial strategies are important.

OBJECTIVE

To determine the topical antiseptic therapeutic index values for common wound bacterial species. The therapeutic index is a ratio comparing lowest concentration that causes mammalian cell cytotoxicity to the minimum bactericidal concentration; higher values indicate greater safety / clinical benefit.

DATA SOURCES

MEDLINE and EMBASE databases were searched from conception to June 2023. Common wound bacterial species and their in-vitro minimum bactericidal concentrations were compared to the minimum mammalian cell cytotoxicity concentration.

STUDY SELECTION

The authors identified 37 qualifying articles.

DATA EXTRACTION

Antiseptic, bacterial organism, mammalian cell type, minimum bactericidal concentration, and mammalian cell cytotoxicity concentration values.

DATA SYNTHESIS

The therapeutic indices for the topical antiseptics were generally low, with most ranging between 0.5 and 3.0. The highest therapeutic index values for Escherichia coli (5.49), Staphylococcus aureus (6.31) and Pseudomonas aeruginosa (8.81) were achieved by hypochlorous acid. The highest therapeutic index value for methicillin resistant S aureus (12.1) was achieved by polyhexamethylene biguanide.

CONCLUSIONS

Antibiotic stewardship principles need to be applied to topical antiseptics due to some isolated topical antiseptic resistance and cross-resistance to oral antimicrobials. The choice of antiseptic should not be made solely based on therapeutic index values but individualized with the wound healing condition including covert infection.
Toward Analytical Performance Specifications for Immunosuppressive Drug Quantification in Transplantation: An Opinion Article
Authors: Shipkova Maria , Wieland Eberhard , Schütz Ekkerhard
Published: October 2024

Background:

Analytical methods require performance that meets the clinical needs. Different approaches for setting up permissible analytical imprecision goals (pCVA%) for drug analyses have been reported. The aim of this study was to calculate the pCVA% for cyclosporine, tacrolimus, everolimus, sirolimus, and mycophenolic acid using 4 alternative approaches, to compare the results and to critically discuss advantages and disadvantages of each model.

Methods:

The approaches to evaluate pCVA% were (A) based on biological variation observed in routine measurement results between 2022 and 2023 in the authors' laboratory, (B) derived from the terminal elimination half-life and dosing interval of the drugs, and (C and D) explored from the width of the therapeutic ranges (TR) by the 2 methods. For approach A, routine measurement data for cyclosporine and tacrolimus, obtained through liquid chromatography–tandem mass spectrometry and electrochemiluminescence immunoassays, were evaluated separately.

Results:

The 4 alternative approaches for deriving pCVA% yielded similar results, for cyclosporine and tacrolimus in an analytical method dependent manner. The average pCVA% was 5.2%, 5.6%, 5.1%, 4.8%, and 7.7% for cyclosporine, tacrolimus, everolimus, sirolimus, and mycophenolic acid, respectively. The most challenging goals were those using TR-related approaches, while those using the biological variation approach were most easily achievable. Approach B resulted in more stringent goals for drugs with longer elimination half-lives (eg, everolimus and sirolimus).

Conclusions:

There is no single ideal approach for setting goals of drug analysis. However, the pCVA% values derived from the various approaches are similar and confirm that a <6% target proposed by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology is adequate and realistic in combination with state-of-the-art measurement technologies. In the authors' opinion, approaches based on the width of the TR are preferable, as they represent a common basis for clinical decisions and reflect elements of biological variation and analytics used to establish the TR.
Getting Tacrolimus Dosing Right
Authors: Marquet Pierre
Published: October 2024

Tacrolimus (TAC) dosing is typically guided by the trough concentration (C0). Yet, significant relationships between TAC C0 and clinical outcomes have seldom been reported or only with adverse events. Large retrospective studies found a moderate correlation between TAC C0 and the area under the curve (AUC), where, for any given C0 value, the AUC varied 3- to 4-fold between patients (and vice versa). However, no randomized controlled trial evaluating the dose adjustment based on TAC AUC has been conducted yet. A few observational studies have shown that the AUC is associated with efficacy and, to a lesser extent, adverse effects. Other studies showed the feasibility of reaching predefined target ranges and reducing underexposure and overexposure. TAC AUC0–12 h is now most often assessed using Bayesian estimation, but machine learning is a promising approach. Microsampling devices are well accepted by patients and represent a valuable alternative to venous blood sample collection during hospital visits, especially when a limited sampling strategy is required. As AUC monitoring cannot be proposed very frequently, C0 monitoring has to be used in the interim, which has led to fluctuating doses in patients with an AUC/C0 ratio far from the population mean, because of different dose recommendations between the 2 biomarkers. We proposed estimating the individual AUC/C0 ratio and derived individual C0 targets to be used in between or as a replacement for AUC monitoring. Existing technology and evidence are now sufficient to propose AUC monitoring interspersed with individualized-C0 monitoring for all patients with kidney transplants while collecting real-world data to strengthen the evidence.
Implementing an Updated Alcohol Withdrawal Symptom Management Order Set Focused on Patient Safety
Authors: Lorbiecki Meghan , Gidal Alexander , Hagle Mary , Smith Tina , Ragen-Pease Kelly , Peterson Kyle , Matye Michael , Kowol Mary-Anne , Lampe Elise
Published: October 2024

Background

Patients experiencing alcohol withdrawal often receive care on inpatient mental health units. Registered nurses on one such unit had several concerns and questions about the existing alcohol withdrawal symptom management order set. To address these issues, a multidisciplinary team including nurses, psychiatrists, and pharmacists was formed.

Objectives

The aims for this project were to review and revise the existing order set, educate staff, implement the changes, and evaluate outcomes.

Methods

The Plan–Do–Study–Act quality improvement framework guided the project. Five phases were completed to revise the order set and implement: a survey of nurses on the unit, community practice evaluation, and order set revisions. A simulation escape room facilitated nursing education. Patient records were reviewed to identify adverse events.

Results

Diazepam replaced lorazepam as the primary medication choice, and a front-loading protocol was added. Order set clarity was improved, education increased nursing staff confidence to competently complete a patient assessment with the Clinical Institute Withdrawal Assessment Alcohol Scale Revised, and no adverse patient events occurred after implementation.

Conclusion

A revised order set for symptom management of patients experiencing alcohol withdrawal reflected up-to-date evidence while maintaining patient safety. All nurses agreed the revised order set was clear and easy to follow; pharmacists and physicians were satisfied with the revisions. Implications for leaders include having a multidisciplinary team, sufficient resources to answer clinical questions, and regular discussions by all involved disciplines to review any adverse events as well as newly published evidence. Close monitoring of patients early in implementation is recommended to detect adverse events.
Barriers and Facilitators to Recruitment of a Multifaceted Population of Opioid Use Disorder Community Stakeholders
Authors: Avery-Desmarais Shannon , Schuler Monika , Viveiros Jennifer , McCurry Mary , Tyo Mirinda , Kauranen Brianna
Published: October 2024

Background

Opioid use disorder (OUD) research is essential to inform evidence-based responses to the OUD crisis in the United States. Individuals with OUD, their caregivers, and support group leaders are historically difficult to recruit for research studies. The purpose of this study was to describe barriers and facilitators in recruitment during the implementation of a qualitative study that sought to explore stigma, barriers, and facilitators to healthcare.

Method

Researchers engaged in the original study completed a retrospective reflection of their experience recruiting members of the OUD community. Recruitment data were analyzed thematically, and facilitators and barriers for recruitment were identified.

Results

Three key barriers to recruitment were identified: choice of community partners, access to technology, and impractical incentives. One key facilitator to recruitment was identified: being patient yet persistent and flexible.

Conclusion

Investigators must design research studies mindful of avoiding societal privilege and cognizant of the lens of the individual living with OUD.
Perspectives on Death and Dying by the Bereaved Designated Personal Representatives of Women Diagnosed With Metastatic Breast Cancer
Authors: Brazee Rachel L. , Alsbrook Karen E. , Lindell Kathleen O. , Seaman Jennifer B. , Rosenzweig Margaret Q.
Published: October 2024

Metastatic breast cancer (MBC) is a complex disease with variability in disease subtype, length of survival, treatment selection, symptom burden, and, ultimately, end-of-life (EOL) care. Influencing factors that contribute to the complexity of this disease are socioeconomic factors, provider differences, and patient and family preferences. Because of this variability, it is challenging for health care providers to know when treatments are no longer helpful but contribute to a poor quality of end-of-life care and a poor death experience for both patients and their families. Determining the unique point, based on their own values and goals, at which patients and their family members feel that MBC treatment becomes unhelpful and unwanted, is difficult to ascertain. Of the 25 individuals who participated in the Quality of Death and Dying survey, 16 individuals participated in an interview to provide a reflection of the patient’s EOL experience and its congruence with their wishes. Four major categories emerged as primary priorities essential to high quality end-of-life care, that is, resilience, communication, support, and knowledge. Without tailored and precise care, patients with MBC will continue to receive prolonged, inappropriate, and costly treatment, resulting in a potentially unacceptable poor-quality EOL and death experience.
Expression of B7-H3 and B7-H4 in Gastric Gastrointestinal Stromal Tumors
Authors: Mochizuki Kunio , Oishi Naoki , Tahara Ippei , Inoue Tomohiro , Kondo Tetsuo
Published: October 2024

Gastric gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms with variable behavior characterized by differentiation toward the interstitial cells of Cajal occurring anywhere in the gastrointestinal stromal tract. The management of GIST was revolutionized by the introduction of imatinib, a KIT inhibitor, which has become the standard first-line treatment for metastatic GIST. However, despite a clinical benefit rate of 80%, the majority of patients with GIST experience disease progression after 2 to 3 years of imatinib therapy. This shows the need for novel treatment approaches for imatinib refractory GISTs. The checkpoint proteins B7-H3 and B7-H4 inhibit the activation and function of T cells by potently suppressing the proliferation, cytokine production, and cytotoxicity of activated T cells, which is a mechanism for immune escape. This study aims to clarify B7-H3 and B7-H4 expression in gastric GISTs using immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). We confirmed B7-H3 expression (H-score ≥50 points) in 92% and B7-H4 expression in 0% of GIST samples. We examined B7-H3 mRNA expression in 3 representative GIST samples, each having their respective immunostained areas detected by RT-PCR. B7-H3 is expressed at a particularly high rate in GISTs. This suggests that B7-H3 might operate as part of an immune checkpoint in GISTs.
Increased Uptake of 68Ga-DOTA-IBA in Multiple Subcutaneous Metastases of Prostate Cancer
Authors: Liu Huipan , Liu Yuhong , Wang Wei , Shang Xiaoyan , Chen Yue
Published: October 2024

Subcutaneous metastases are rare in prostate cancer. Herein, we present a case of a 66-year-old man with prostate cancer, who underwent 68Ga-labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) PET/CT to explore the possibility of 177Lu-DOTA-IBA treatment. 68Ga-DOTA-IBA PET/CT demonstrated intensely increased uptake in the multiple osteoblastic bone metastases. Unexpectedly, 68Ga-DOTA-IBA uptake in multiple subcutaneous metastases was also noted.
Specifically Decreased Thalamic Blood Flow Following COVID-19 Infection
Authors: Matsubayashi Taiki , Yokoyama Kota , Tateishi Ukihide , Yokota Takanori , Sanjo Nobuo
Published: October 2024

Although long COVID refers to numerous COVID-19–related symptoms after infection, including depression, fatigue, anosmia, sleep disturbances, and brain fog, the etiology of long COVID remains largely unknown. A 41-year-old woman presented with a 3-week history of complete insomnia without drowsiness throughout the day after contracting COVID-19. SPECT using N-isopropyl-p-[123I] iodoamphetamine showed a significant regional cerebral blood flow reduction in the bilateral thalamus. We diagnosed her as having insomnia accompanied by thalamic hypoperfusion related to COVID-19 infection. To our knowledge, this is the first case of reduced regional cerebral blood flow specifically confined to the thalamus.
Lymphedema
Authors: Chaker Sara C. , James Andrew J. , King Daniella , Karagoz Huseyin
Published: October 2024

Lymphedema (LE) is characterized by the accumulation of lymph in the extremities, impairing functionality and quality of life. Despite its prevalence, accurate diagnoses and management remains complex because of inconsistencies in diagnostic criteria and limited epidemiological studies. This review aims to address this gap by providing a comprehensive overview of LE classifications, diagnostic approaches, and current management strategies. By synthesizing existing knowledge, this study seeks to contribute to a deeper understanding of LE for improvement of clinical consistency and education.
Choke Anastomosis
Authors: Cao Zilong , Jiao Hu , Gan Cheng , Zhang Tiran , Tian Jia , Li Rui , Yue Qiang , Yin Ningbei , Liu Liqiang
Published: October 2024

Background

Choke anastomosis is commonly recognized as a resistance factor that detrimentally affects the hemodynamics of the skin flap; however, its additional potential physiological roles in normal skin function are currently not fully understood.

Methods

Ten cadaveric forehead flap specimens pedicled with unilateral STAs were perfused with lead oxide-gelatin mixture, and then dissected into 3 layers, including the super temporal fascia-frontalis-galea aponeurotica layer, the subcutaneous adipose tissue layer, and the “super-thin flap” layer. The forehead flap and stratified specimens underwent molybdenum target x-ray and subsequent transparent processing to effectively visualize the microscopic spatial architecture of arterial vessels across all levels.

Results

Based on the different anastomoses near the midline area of the flap, 2 types of arterial perfusion were identified: choke anastomosis type (8/10) and true anastomosis type (2/10). The former formed multiple choke anastomoses near the midline. In the “super-thin flap” layer, arterial perfusion density on the ipsilateral side was significantly higher compared to that on the contralateral side. The arterioles on the ipsilateral side exhibited a dense and uninterrupted distribution, whereas those on the contralateral side appeared sparse and dispersed. The latter exhibited an alternative perfusion pattern; the bilateral arterial vessels were connected with 3 to 5 true anastomoses near the midline. Furthermore, the microscopic architecture confirmed a uniform distribution of arterioles that remained continuous from ipsilateral to contralateral sides in the “super-thin flap” layer.

Conclusion

This study demonstrated that choke anastomosis not only impairs blood perfusion in the adjacent angiosomes but also acts as a shunt converter to impact the blood supply of distal skin flaps at different levels through the “trans-territory diversion phenomenon.” This results in necrosis of the superficial dermis while preserving survival of the deep subcutaneous adipose tissue.
Relationship Between Dysbiotic Wound Microbiota and Critical Colonization
Authors: Kunimitsu Mao , Minematsu Takeo , Koudounas Sofoklis , Sanada Hiromi , Nakagami Gojiro
Published: October 2024

Introduction

Detection of critical colonization is gaining importance in wound management, but its pathophysiology remains unclear. We previously clarified that a dysbiotic wound microbiota differing from skin commensal microbiota may be involved in critical colonization and that such wounds contain fewer Forkhead box protein P3 (FOXP3)–positive cells in the tissue. However, it is not clear whether FOXP3-positive cells contribute to the development of critical colonization. Here, we examined whether inhibition of FOXP3-positive cell could induce critical colonization when the commensal microbiota was present in the wounds.

Methods

Sprague-Dawley rats were administered FK506 or vehicle to inhibit differentiation into FOXP3-positive cells. Full-thickness wounds were made on the dorsal skin and inoculated with bacterial solution (dysbiosis group) or Luria-Bertani medium (commensal group). A bacterial solution was prepared by anaerobically culturing bacteria from the skin of donor rats on an artificial dermis in Luria-Bertani medium for 72 hours. Tissues were collected on day 4 postwounding for histological evaluation.

Results

After microbiota transplantation, excessive inflammation occurred in the FK506 + commensal group. In contrast, wounds with transplanted dysbiotic microbiota showed the same level of neutrophil infiltration, regardless of FK506 administration. Furthermore, the wound area was larger in the FK506 + commensal group than in the vehicle + commensal group on day 4 postwounding (P = 0.01). This area was also significantly larger in both the vehicle + dysbiosis (P = 0.01) and FK506 + dysbiosis groups (P = 0.03) than in the vehicle + commensal group.

Conclusions

This study has shown that dysbiosis may be at least related to developing critical colonization, and the results suggest that FOXP3-positive cells are involved in this process. Our study may contribute to establishing new interventions that prevent critical colonization by correcting wound microbiota.
Hypoxia and Normoxia Preconditioned Olfactory Stem Cells Against Noise-Induced Hearing Loss
Authors: Durna Yusuf M. , Yigit Ozgur , Edizer Deniz T. , Durna Daştan Sevgi , Gul Mehmet , Ovali Ercument
Published: October 2024

Objective:

Noise-induced hearing loss is one of the leading causes of permanent hearing loss in the adult population. In this experimental study, the authors aimed to investigate the effectiveness of hypoxia and normoxia preconditioned olfactory stem cells against noise trauma.

Methods:

Twenty-seven female guinea pigs were enrolled. Two guinea pigs were sacrificed for harvesting olfactory tissue and 1 for examining the architecture of the normal cochlea. The remaining 24 guinea pigs were exposed to noise trauma for 1 day and then randomly divided into 3 groups: intracochlear injection of (i) normoxic olfactory stem cells, (ii) hypoxic olfactory stem cells, and (iii) physiological serum. Auditory brainstem response (ABR) measurement was performed before and 2 weeks after noise trauma and weekly for 3 weeks following intracochlear injection. Both click and 16 kHz tone-burst stimuli were used for detection of ABR.

Results:

No significant difference was noted between the groups before and 2 weeks after noise trauma. ABR thresholds detected after intracochlear injections were significantly higher in the control group compared with stem cell groups. However, no significant difference was detected between the stem cell groups. Fluourescence microscopy revealed better engraftment for hypoxic stem cells. Light and electron microscopy examinations were consistent with predominant degenerative findings in the control group, whereas normoxic group had more similar findings with normal cochlea compared with hypoxic group.

Conclusion:

Olfactory stem cells were demonstrated to have the potential to have beneficial effects on noise trauma.
Self-Perceived Burden as a Mediator Between Perceived Partner Responsiveness and Fertility Intentions in Women With Inflammatory Bowel Disease
Authors: Liu Qiaomei , Shi Chongqing , Yu Qiang , Hu Xia , Cai Chan , Le Meixian , Zhang Hua
Published: October 2024

This study investigates the role of self-perceived burden as a mediating factor in the association between perceived partner responsiveness and fertility intentions in women of reproductive age diagnosed with inflammatory bowel disease. A sample of 366 female inflammatory bowel disease patients from Changsha, China, was recruited using convenience sampling. Participants completed assessments, including the Impact of Perceived Partner Responsiveness Scale, Self-Perceived Burden Scale, Fertility Intentions Questionnaire, and a demographic questionnaire. Results indicated a moderate-to-low level of fertility intentions (mean score: 5.33 ± 2.21), with corresponding moderate levels of self-perceived burden (mean score: 30.01 ± 10.02) and perceived partner responsiveness (mean score: 52.80 ± 17.03). Positive correlations were observed between perceived partner responsiveness and fertility intentions and negative correlations between self-perceived burden and fertility intentions. The relationship between perceived partner responsiveness and fertility intentions was found to be partially mediated by self-perceived burden. These findings highlight the significance of perceived partner responsiveness and self-perceived burden in shaping fertility intentions among women with inflammatory bowel disease.
In-Person Healthcare Simulation
Authors: Palaganas Janice C. , Mosher Cynthia , Wawersik Dawn , Eller Susan , Kirkpatrick Amanda J. , Lazarovici Marc , Brown Kristen M. , Stapleton Stephanie , Hughes Patrick G. , Tarbet Amanda , Morton Alex , Duff Jonathan P. , Gross Isabel T. , Sanko Jill
Published: October 2024

Summary Statement

Given the large accumulation of research focused on the effectiveness of in-person simulation-based education (SBE), this umbrella review—or systematic review of systematic reviews—was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to analyze collective findings and close identified literature gaps. This study presents a descriptive analysis of the most effective modalities, methods, and measurements of in-person SBE, as well as major themes that emerged during analysis as it relates to SBE outcomes.

The major patterns or themes that emerged confirm for the first time a longstanding sentiment in the literature, specifically the following: a need to produce higher-quality research with greater rigor, larger sample sizes, more randomized controlled trials, mixed methods, and longitudinal studies. These findings suggest a need to redirect scientific efforts in SBE. Despite the nearly ubiquitous issues noted across the systematic reviews' findings, results of this umbrella review seem to support the notion that in-person simulation-based education improves learning outcomes including technical and nontechnical skills and behavioral and attitudinal change. Analyses highlighted the need to improve overall research approaches and reduce redundancy, as well as the need to standardize terminology, broaden global diversity, and push for further research funding opportunities to support these efforts.
Classifying High-Frequency Oscillations by Morphologic Contrast to Background, With Surgical Outcome Correlates
Authors: Qing Kurt , Von Stein Erica , Yamada Lisa , Fogarty Adam , Nuyujukian Paul
Published: October 2024

Purpose:

Ictal high-frequency oscillations (HFOs) are a reliable indicator of a seizure onset zone for intracranial EEG recordings. Interictal HFOs often are also observed and may be a useful biomarker to supplement ictal data, but distinguishing pathologic from physiologic HFOs continues to be a challenging task. We present a method of classifying HFOs based on morphologic contrast to the background.

Methods:

We retrospectively screened 31 consecutive patients who underwent intracranial recordings for epilepsy at Stanford Medical Center during a 2-year period, and 13 patients met the criteria for inclusion. Interictal EEG data were analyzed using an automated event detector followed by morphologic feature extraction and k-means clustering. Instead of only using event features, the algorithm also incorporated features of the background adjacent to the events. High-frequency oscillations with higher morphologic contrast to the background were labeled as pathologic, and “hotspots” with the most active pathologic HFOs were identified and compared with clinically determined seizure onset zones.

Results:

Clustering with contrast features produced groups with better separation and more consistent boundaries. Eleven of the 13 patients proceeded to surgery, and patients whose hotspots matched seizure onset zones had better outcomes, with 4 out of 5 “match” patients having no disabling seizures at 1+ year postoperatively (Engel I or International League Against Epilepsy Class 1–2), while all “mismatch” patients continued to have disabling seizures (Fisher exact test P-value = 0.015).

Conclusions:

High-frequency oscillations with higher contrast to background more likely represent paroxysmal bursts of pathologic activity. Patients with HFO hotspots outside of identified seizure onset zones may not respond as well to surgery.