bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of image-guided therapies in patients with adrenocortical carcinoma: a tertiary referral center retrospective study
Authors: Chahla Brenda , Pal Koustav , Balderrama-Brondani Vania , Yaylaci Feyza , Campbell Matthew T , Sheth Rahul A , Habra Mouhammed Amir
Published: June 2024

Background

Image-guided therapies (IGTs) are commonly used in oncology, but their role in adrenocortical carcinoma (ACC) is not well defined.

Materials and Methods

A retrospective review of patients with ACC treated with IGTs. We assessed response to therapy using RECIST v1.1, time to next line of systemic therapy, disease control rate (DCR), local tumor progression-free survival (LTPFS), and complications of IGTs (based on the Common Terminology Criteria for Adverse Events [CTCAE] version 5.0).

Results

Our cohort included 26 patients (median age 56 years [range 38-76]; n = 18 female) who had 51 IGT sessions to treat 86 lesions. IGTs modalities included cryoablation (n = 49), microwave ablation (n = 21), combined microwave and bland trans-arterial embolization (n = 8), bland trans-arterial embolization alone (n = 3), radio-embolization (n = 3), and radiofrequency ablation (n = 2). DCR was 81.4% (70 out of 86), of which 66.3% of tumors showed complete response, 18.6% showed progressive disease, 8.1% showed partial response, and 7.0% showed stable disease. LTPFS rates were 73% and 63% at 1 and 2 years, respectively. Fourteen lesions underwent re-ablation for incomplete response on initial treatment. Sixteen patients (61.5%) received new systemic therapy following IGTs, with a median time to systemic therapy of 12.5 months (95% CI: 8.6 months upper limit not reached). There was 1 reported CTCAE grade 3 adverse event (biloma) following IGT.

Conclusions

IGT use in properly selected patients with ACC is safe and associated with prolonged disease control and delay in the need for systemic therapy.
Light quality induces a shift in coccosphere morphology in Scyphosphaera apsteinii
Authors: Chauhan Nishant , Barton Samuel , Zarkogiannis Stergios , Rickaby Rosalind E M
Published: June 2024

The coccolithophore Schyphosphaera apsteinii produces distinct coccolith morphotypes and offers a unique insight into coccolith calcification, as the number of lopadoliths per cell increases under low light intensities. This study employs S. apsteinii to investigate the acclimated impact of light intensity and wavelength on cell physiology and coccosphere morphology. Our findings reveal a marked increase in lopadolith production when grown under reduced light intensity, with lower growth rates, higher chlorophyll concentration and elevated net photosynthetic rates. Reduced blue-light also caused an increase in lopadolith numbers, elevated chlorophyll concentrations and net photosynthetic rates. Conversely, such responses are less pronounced under reduced red-light. Moreover, reduced blue- and red-light treatments exhibited enhanced growth rates compared to the light-replete control, despite a reduction in light intensity. Our findings suggest that changes in light quality cause a shift in the coccosphere morphology, affecting cell physiology and potentially aiding light harvesting in S. apsteinii.
Large language models can infer psychological dispositions of social media users
Authors: Peters Heinrich , Matz Sandra C
Published: June 2024

Large language models (LLMs) demonstrate increasingly human-like abilities across a wide variety of tasks. In this paper, we investigate whether LLMs like ChatGPT can accurately infer the psychological dispositions of social media users and whether their ability to do so varies across socio-demographic groups. Specifically, we test whether GPT-3.5 and GPT-4 can derive the Big Five personality traits from users’ Facebook status updates in a zero-shot learning scenario. Our results show an average correlation of r=0.29 (range=[0.22,0.33]) between LLM-inferred and self-reported trait scores—a level of accuracy that is similar to that of supervised machine learning models specifically trained to infer personality. Our findings also highlight heterogeneity in the accuracy of personality inferences across different age groups and gender categories: predictions were found to be more accurate for women and younger individuals on several traits, suggesting a potential bias stemming from the underlying training data or differences in online self-expression. The ability of LLMs to infer psychological dispositions from user-generated text has the potential to democratize access to cheap and scalable psychometric assessments for both researchers and practitioners. On the one hand, this democratization might facilitate large-scale research of high ecological validity and spark innovation in personalized services. On the other hand, it also raises ethical concerns regarding user privacy and self-determination, highlighting the need for stringent ethical frameworks and regulation.
Border carbon adjustments in agri-food markets: Not as effective as one might think
Authors: Nordin Ida , Wilhelmsson Fredrik , Jansson Torbjörn , Fellmann Thomas , Barreiro-Hurle Jesús , Himics Mihaly
Published: June 2024

Using the EU as case study, we simulate the impact of border carbon adjustments on agri-food markets. While border carbon adjustments alleviate adverse carbon price impacts on EU agricultural competitiveness and emission leakage, our simulation results also reveal that (i) border carbon adjustments may diminish domestic mitigation efforts, thereby partly offsetting benefits from reduced emission leakage, and (ii) trade diversion further undermines global emission reduction. The results indicate that border carbon adjustments on agri-food products in major exporting countries with emission-efficient production systems may not reduce global emissions as effectively as commonly assumed, highlighting the importance of emission efficiency improvements especially in developing and emerging countries.
Genetic Implication of Prenatal GABAergic and Cholinergic Neuron Development in Susceptibility to Schizophrenia
Authors: Cameron Darren , Vinh Ngoc-Nga , Prapaiwongs Parinda , Perry Elizabeth A , Walters James T R , Li Meng , O’Donovan Michael C , Bray Nicholas J
Published: June 2024

Background

The ganglionic eminences (GE) are fetal-specific structures that give rise to gamma-aminobutyric acid (GABA)- and acetylcholine-releasing neurons of the forebrain. Given the evidence for GABAergic, cholinergic, and neurodevelopmental disturbances in schizophrenia, we tested the potential involvement of GE neuron development in mediating genetic risk for the condition.

Study Design

We combined data from a recent large-scale genome-wide association study of schizophrenia with single-cell RNA sequencing data from the human GE to test the enrichment of schizophrenia risk variation in genes with high expression specificity for developing GE cell populations. We additionally performed the single nuclei Assay for Transposase-Accessible Chromatin with Sequencing (snATAC-Seq) to map potential regulatory genomic regions operating in individual cell populations of the human GE, using these to test for enrichment of schizophrenia common genetic variant liability and to functionally annotate non-coding variants-associated with the disorder.

Study Results

Schizophrenia common variant liability was enriched in genes with high expression specificity for developing neuron populations that are predicted to form dopamine D1 and D2 receptor-expressing GABAergic medium spiny neurons of the striatum, cortical somatostatin-positive GABAergic interneurons, calretinin-positive GABAergic neurons, and cholinergic neurons. Consistent with these findings, schizophrenia genetic risk was concentrated in predicted regulatory genomic sequence mapped in developing neuronal populations of the GE.

Conclusions

Our study implicates prenatal development of specific populations of GABAergic and cholinergic neurons in later susceptibility to schizophrenia, and provides a map of predicted regulatory genomic elements operating in cells of the GE.
Comparative Efficacy and Acceptability of Treatment Strategies for Antipsychotic-Induced Akathisia: A Systematic Review and Network Meta-analysis
Authors: Furukawa Yuki , Imai Kota , Takahashi Yusuke , Efthimiou Orestis , Leucht Stefan
Published: June 2024

Background

Antipsychotics are the treatment of choice for schizophrenia, but they often induce akathisia. However, comparative efficacy of treatment strategies for akathisia remains unclear.

Design

We performed a systematic review and network meta-analyses (PROSPERO CRD42023450720). We searched multiple databases on July 24, 2023. We included randomized clinical trials comparing 1 or more treatment strategies for antipsychotic-induced akathisia against each other or control conditions. We included adults with schizophrenia or other psychiatric disorders treated with antipsychotics. The primary outcome was akathisia severity at posttreatment. Secondary outcomes included akathisia response, all-cause dropout, psychotic symptoms, and long-term akathisia severity. We synthesized data in random effects frequentist network meta-analyses and assessed confidence in the evidence using CINeMA.

Results

We identified 19 trials with 661 randomized participants (mean age 35.9 [standard deviation 12.0]; 36.7% [195 of 532] women). No trials examined dose reduction or switching of antipsychotics. Findings suggested 5-HT2A antagonists (k = 6, n = 108; standardized mean difference [SMD] −1.07 [95% confidence interval, −1.42; −0.71]) and beta-blockers (k = 8, n = 105; SMD −0.46 [−0.85; −0.07]) may improve akathisia severity, but confidence in the evidence was deemed low. We also found that benzodiazepines (k = 2, n = 13; SMD −1.62 [−2.64; −0.59]) and vitamin B6 (k = 3, n = 67; SMD −0.99 [−1.49; −0.50]) might also be beneficial, but confidence in the evidence was very low. Analyses of secondary outcomes did not provide additional insights.

Conclusions

Our findings suggest that 5-HT2A antagonists, beta-blockers, and with a lesser certainty, benzodiazepines, and vitamin B6 might improve akathisia. Given the low to very low confidence in the evidence of add-on agents and the absence of evidence of their long-term efficacy, careful consideration of side effects is warranted. These recommendations are extremely preliminary and further trials are needed.
Shorter sleep duration and lesser sleep efficiency are associated with poorer memory functions among non-demented, middle-aged, and older rural Indians
Authors: Rai Pooja , Sundarakumar Jonas S
Published: June 2024

Introduction

Sleep is known to be involved in cognitive processes, such as memory encoding and consolidation, and poor sleep is a potential risk factor for dementia. This study aims to investigate the effect of sleep quality on memory functions among middle-aged and older adults from a rural Indian population.

Methods

Participants were non-demented, rural Indians (≥45 years) from an ongoing, prospective, aging cohort study, namely Srinivaspura Aging, NeuroSenescence, and COGnition (SANSCOG) study. Cross-sectional (baseline) data on seven sleep dimensions was obtained using the Pittsburgh Sleep Quality Index (PSQI). Memory functions were assessed using immediate recall, delayed recall, name-face association, and semantic association from a culturally validated, computerized, neurocognitive test battery. Linear regression models, unadjusted and adjusted for cognitive status, age, sex, and depression were used to analyze the association between each sleep dimension and the memory tests.

Results

A total of 1195 participants, with a mean age of 57.10 years, were included. Out of the seven sleep dimensions of the PSQI, only two dimensions, namely sleep duration and sleep efficiency, were significantly associated with memory functions. In the fully adjusted model, shorter sleep duration was significantly associated with poorer performance in delayed recall, and lesser sleep efficiency was significantly associated with poorer delayed recall and semantic association performance.

Conclusions

Specific sleep characteristics appear to influence memory functions in aging Indians well before the onset of dementia. In the backdrop of the non-availability of a definitive treatment for dementia, promptly identifying and addressing these problems could be an effective, community-level strategy for preventing dementia.
Switzerland: The Swiss Family Foundation—revival for family wealth and estate planning?
Authors: Weiss Kinga M , Weber Andrea Tina
Published: June 2024

Due to an increasingly strict interpretation of admissible purposes of family foundations, Swiss law lacks an effective legal instrument for a structured transfer of family wealth to future generations. As a result, foreign instruments such as trusts or foundations are often used for such purposes. Given that Switzerland’s strict approach to family foundations is no longer justified, a recent motion in the Swiss Parliament should be seen as an opportunity to introduce more modern options for estate planning that better reflect society’s needs.
Congenital Syphilis in Live Births
Authors: Chen Han-Yang , Klausner Jeffrey D. , Stafford Irene A.
Published: June 2024

OBJECTIVE:

To examine temporal trends and risk factors for congenital syphilis in newborn hospitalizations and to evaluate the association between adverse outcomes and congenital syphilis and health care utilization for newborn hospitalizations complicated by congenital syphilis.

METHODS:

We conducted a retrospective, cross-sectional study using data from the National Inpatient Sample to identify newborn hospitalizations in the United States between 2016 and 2020. Newborns with congenital syphilis were identified with International Classification of Diseases, Tenth Revision, Clinical Modification codes. Adverse outcomes, hospital length of stay, and hospital costs were examined. The annual percent change was calculated to assess congenital syphilis trend. A multivariable Poisson regression model with robust error variance was used to examine the association between congenital syphilis and adverse outcomes. Adjusted relative risks (RRs) with 95% CIs were calculated. A multivariable generalized linear regression model was used to examine the association between congenital syphilis and hospital length of stay and hospital costs. Adjusted mean ratios with 95% CIs were calculated.

RESULTS:

Of 18,119,871 newborn hospitalizations in the United States between 2016 and 2020, the rate of congenital syphilis increased over time (annual percent change 24.6%, 95% CI, 13.0–37.3). Newborn race and ethnicity, insurance, household income, year of admission, and hospital characteristics were associated with congenital syphilis. In multivariable models, congenital syphilis was associated with preterm birth before 37 weeks of gestation (adjusted RR 2.22, 95% CI, 2.02–2.44) and preterm birth before 34 weeks of gestation (adjusted RR 2.39, 95% CI, 2.01–2.84); however, there was no association with low birth weight or neonatal in-hospital death. Compared with newborns without congenital syphilis, hospital length of stay (adjusted mean ratio 3.53, 95% CI, 3.38–3.68) and hospital costs (adjusted mean ratio 4.93, 95% CI, 4.57–5.32) were higher among those with congenital syphilis.

CONCLUSION:

Among newborn hospitalizations in the United States, the rate of congenital syphilis increased from 2016 to 2020. Congenital syphilis was associated with preterm birth, longer hospital length of stay, and higher hospital costs.
Enhancing prognostic insights: myometrial invasion patterns in endometrial carcinoma, with emphasis on MELF pattern–a comprehensive review and meta-analysis
Authors: Guo Yuyuan , Li Luying , Yang Kaini , Song Yuhan , Xu Lu , Zhao Fangyi , Li Wenting
Published: June 2024

Purpose

The microcystic, elongated, and fragmented (MELF) pattern, characterized by myxoid and inflamed stroma, is readily identifiable as a form of myometrial infiltration. This meta-analysis endeavors to assess the prognostic significance of MELF infiltration patterns in patients diagnosed with endometrial cancer.

Methods

A comprehensive literature search, spanning until 11 October 2023, across PubMed, Embase, Cochrane, and Web of Science databases, identified 23 relevant studies involving 5199 patients. Data analysis was performed using Stata 16.0.

Results

Analysis indicates that MELF infiltration predicts a higher risk of lymph node metastasis in endometrial cancer patients [hazard ratios (HR) = 5.05; 95% confidence interval (CI), 3.62–7.05; P < 0.05]. Notably, this association remains consistent across various patient demographics, analytical approaches, study designs, and treatment modalities. However, MELF infiltration does not significantly correlate with recurrence (HR = 1.05; 95% CI, 0.73–1.52; P > 0.05), overall survival (HR = 1.24; 95% CI, 0.91–1.68; P > 0.05), or disease-free survival (HR = 1.40; 95% CI, 0.85–2.28; P > 0.05).

Conclusion

While MELF infiltration heightens the risk of lymph node metastasis in endometrial cancer, its impact on recurrence, overall survival, and disease-free survival remains statistically insignificant.
CYSTOID MACULAR EDEMA IN BIRDSHOT RETINOCHOROÏDITIS
Authors: Fardeau Christine , Breville Gautier , Jeannerot Arnaud-Louis , Herrmann François , Touati Meriem , Bonnin Sophie , Sales de Gauzy Thomas , Sadegh Ayria , Toumi Amira , Baglivo Edoardo , Cohen David , Karmochkine Marina , Bodaghi BAHRAM , Seebach Jörg D. , Le Hoang PHUC
Published: June 2024

Purpose:

To assess the long-term efficacy and safety of treatments for cystoid macular edema in birdshot retinochoroïditis.

Methods:

Observational retrospective study of 142 HLA-A29-positive patients with cystoid macular edema; the main outcome was the optical coherence tomography intraretinal cysts resolution.

Results:

During the mean follow-up of 75 months (12–178), 61.3% of patients were successfully treated using 1 to 3 treatment steps, while the others needed more steps. At 6 months, there were no significant effects on ME for anti-TNF (tumor necrosis factor) and IVIg (immunoglobulin) in contrast to antimetabolites (OR 1.98), systemic GCS (glucocorticosteroids), CsA (cyclosporine A) and tocilizumab (odds ratio closed to 2.7), intraocular injected GCS (odds ratio of 4.2), and interferon (odds ratio of 4.4). The percentages of therapeutic success trend to decrease from the initial three treatment steps to the subsequent treatment steps, for systemic GCS (84% to 70%), for anti-TNF (42% to 33%), and for CsA (71% to 33%); the success percentages did not decrease for injected GCS (83% to 89%). Macular edema recurrence occurred with the highest percentage for injected GCS (86.8%, P = 0.01) and the lowest for tocilizumab (10.5%, P = 0.001). Interferons-α and tocilizumab were associated with the lowest prednisone daily doses.

Conclusion:

The classical uveitic cystoid macular edema therapeutic algorithm could be adapted to birdshot retinochoroïditis.
Transcorneal Vitrectomy In Eyes With Regressed Retinoblastoma
Authors: Bao Yicheng K. , Sanchez Gisella M. , Lee Thomas C. , Berry Jesse L. , Nagiel Aaron
Published: June 2024

Purpose:

Current treatments for retinoblastoma facilitate globe salvage but can result in vitreoretinal disorders that may require surgery. There is controversy on surgical approaches in eyes with retinoblastoma. Here, we describe a transcorneal vitrectomy approach that avoids the use of chemotherapy or cryotherapy.

Methods:

Retrospective chart review was performed on five consecutive patients with regressed retinoblastoma for >12 months (Group D/ct2b) at Children's Hospital Los Angeles who had vitrectomy between November 2022 and December 2023.

Results:

Five patients underwent eight vitrectomies for various indications including intraocular lens fibrosis, vitreous hemorrhage, cataract, retinal detachment, and silicone oil removal. Mean age at first vitrectomy was 6.2 years (range: 2–9 years); mean time from last retinoblastoma treatment was 50.4 months (range: 20–82 months). Radially oriented corneal incisions were made with the 23-G or 25-G trocar system, and the Versa HD LenZ (Oculus) was used with the RESIGHT (Zeiss) for top-down visualization. Neither chemotherapy nor cryotherapy was used. Wounds were sutured parallel to the limbus with 10-0 polyglactin 910 suture (Vicryl, Ethicon), and a final water rinse was performed to lyse any potential retinoblastoma cells. Surgical objectives were achieved, vision remained stable, and no retinoblastoma spread was noted with a mean follow-up of 7.6 months (range: 3–12 months).

Conclusion:

This vitrectomy technique for eyes with regressed retinoblastoma permits top-down viewing with the Versa HD LenZ. Radial placement of corneal wounds avoids suturing through the uveal tract, and a postsurgical water rinse lyses any retinoblastoma cells. This approach may obviate the need for chemotherapeutics or cryotherapy.
SEQUENTIAL PARS PLANA VITRECTOMY AND INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENTS WITH PERIPHERAL BREAKS AND CONCOMITANT NONCAUSATIVE MACULAR HOLE IN NONHIGHLY MYOPIC PATIENTS
Authors: Baltă George , Tofolean Ioana Teodora , Tiu Tamara , Dinu Valentin , Alexandrescu Cristina-Mihaela , Baltă Florian , Voinea Liliana-Mary
Published: June 2024

Purpose:

To present the anatomical and functional results of sequential pars plana vitrectomy for treating rhegmatogenous retinal detachment with peripheral breaks and concomitant noncausative macular holes (MHs) in nonhighly myopic patients.

Methods:

Medical records of patients who underwent rhegmatogenous retinal detachment surgical repair between 2017 and 2023 were reviewed. Of 980 patients with rhegmatogenous retinal detachment, 10 had concurrent MH and underwent sequential pars plana vitrectomy for rhegmatogenous retinal detachment repair and air endotamponade, followed by MH repair using the inverted internal limiting membrane flap technique and C2F6 endotamponade after a minimum of 1 week. The main outcomes measured were best-corrected visual acuity change, retinal reattachment rate, MH closure rate, and closure type.

Results:

The retinal reattachment rate was 90% after the primary surgery and 100% after subsequent surgery. Macular hole closure was achieved in all cases. Macular hole diameters ranged from 291 to 702 µm. Anatomical recovery showed mainly 1A closure types (90%). Functional recovery demonstrated significant best-corrected visual acuity improvement, with a mean visual acuity gain of 1.58 ± 0.41 the logarithm of the minimum angle of resolution.

Conclusion:

For this infrequent pathology, sequential surgery using the inverted internal limiting membrane flap technique and air/gas endotamponade yielded favorable anatomical and functional outcomes. This controlled and standardized approach using sequential surgeries contributes to the achievement of consistent results.
Treatment for dry age-related macular degeneration: where we stand in 2024
Authors: Wheeler Sydney , Mahmoudzadeh Raziyeh , Randolph Jessica
Published: June 2024

Purpose of review

This review highlights treatment options, both under investigation and currently available, for the treatment of dry age-related macular degeneration (AMD). An update on current clinical studies for dry AMD has been summarized.

Recent findings

Advanced dry AMD, characterized by geographic atrophy (GA), is a leading cause of blindness in the developed world, though prior to 2023 there was no approved treatment. There are now two approved treatments in the United States for GA. Additionally, there are several studies and trials to investigate therapeutic potential and effects of therapies for earlier intervention in dry AMD. Approaches to therapy include inhibiting the complement system, utilizing gene therapy, stem cell therapy, laser therapy, and surgical implants.

While there has been notable prior advancement in the treatment for neovascular or wet AMD, for the first time there are Food and Drug Administration (FDA) approved treatments for GA. Clinical studies have shown promise for additional methods for managing dry AMD both medically and surgically.
Substitute or coexistence? Mediastinoscopy-assisted versus thoracoscope-assisted esophagectomy in esophageal cancer: a meta-analysis of perioperative outcomes and long-term survival
Authors: Fang Pinhao , Zhou Jianfeng , Liu Yixin , Liang Zhiwen , Yang Yushang , Luan Siyuan , Xiao Xin , Li Xiaokun , Zhang Hanlu , Shang Qixin , Chen Longqi , Zeng Xiaoxi , Yuan Yong
Published: June 2024

Background:

Currently, mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) represent two prevalent forms of minimally invasive esophagectomy extensively employed in the management of esophageal cancer (EC). The aim of this meta-analysis is to assess and compare these two surgical approaches concerning perioperative outcomes and long-term survival, offering valuable insights for refining surgical strategies and enhancing patient outcomes in this field.

Methods:

Adhering to PRISMA guidelines, the authors systematically searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI databases until 1 March 2024, for studies comparing MAE and TAE. Outcomes of interest included perioperative outcomes (intraoperative outcomes, postoperative recovery, postoperative complications) and survival rates. Statistical analyses were performed using RevMan 5.4, with heterogeneity dictating the use of fixed or random-effects models.

Results:

A total of 21 relevant studies were finally included. MAE was associated with significantly shorter operation times [mean difference (MD)=−59.58 min, 95% CI: −82.90 to −36.26] and less intraoperative blood loss (MD=−68.34 ml, 95% CI: −130.45 to −6.23). However, MAE resulted in fewer lymph nodes being dissected (MD=−3.50, 95% CI: −6.23 to −0.78). Postoperative recovery was enhanced following MAE, as evidenced by reduced hospital stays and tube times. MAE significantly reduced pulmonary complications [odds ratio (OR)=0.59, 95% CI: 0.44, 0.81] but increased the incidence of recurrent laryngeal nerve injury (OR=1.84, 95% CI: 1.30, 2.60). No significant differences were observed in anastomotic leakage, chylothorax, cardiac complications, wound infections, and gastric retention between MAE and TAE. The long-term survival outcomes showed no statistical difference [hazard ratio (HR)=1.05, 95% CI: 0.71, 1.54].

Conclusions:

MAE offers advantages in reducing operation time, blood loss, and specific postoperative complications, particularly pulmonary complications, with a shorter recovery period compared to TAE. However, it poses a higher risk of recurrent laryngeal nerve injury and results in fewer lymph nodes being dissected. No difference in long-term survival was observed, indicating that both techniques have distinct benefits and limitations. These findings underscore the need for personalized surgical approaches in EC treatment, considering individual patient characteristics and tumor specifics.
Effect of local prolonged-release incisional doxycycline on surgical site infection prophylaxis in abdominal colorectal surgery: the SHIELD 1 randomized clinical trial
Authors: Zmora Oded , Fleshner Phillip , Barie Philip S. , Segev Lior , Viola George M. , Senagore Anthony J. , Spinelli Antonino , Belotserkovsky Olga , Sharoni Shmuel , Emanuel Noam ,   for the SHIELD 1 Investigators
Published: June 2024

Introduction:

Despite advanced infection control practices including preoperative antibiotic prophylaxis, surgical site infection (SSI) remains a challenge. This study aimed to test whether local administration of a novel prolonged-release doxycycline-polymer-lipid encapsulation matrix (D-PLEX) before wound closure, concomitantly with standard of care (SOC), reduces the incidence of incisional SSI after elective abdominal colorectal surgery.

Materials and methods:

This was a phase 3 randomized, controlled, double-blind, multinational study (SHIELD 1) between June 2020 to June 2022. Patients with at least one abdominal incision length greater than 10 cm were randomized 1:1 to the investigational arm (D‐PLEX+SOC) or control (SOC) arm. The primary outcome was a composite of incisional SSI, incisional reintervention, and all-cause mortality.

Results:

A total of 974 patients were analyzed, of whom 579 (59.4%) were male. The mean age (±SD) was 64.2±13.0 years. The primary outcome occurred in 9.3% of D-PLEX patients versus 12.1% (SOC) [risk difference estimate (RDE), −2.8%; 95% CI (−6.7%, 1.0%), P=0.1520]. In a pre-specified analysis by incision length, a reduction in the primary outcome was observed in the greater than 20 cm subpopulation: 8% (D-PLEX) versus 17.5% (SOC) [RDE, −9.4%; 95% CI (−15.5%, −3.2%), P=0.0032]. In the greater than 10 to less than or equal to 20 cm subgroup, no reduction was observed: 9.9% versus 7.9% [RDE, 2.0%; 95% CI (−2.8%, 6.7%), P=0.4133]. Exploratory post hoc analyses of patients with increased SSI risk (≥1 patient-specific comorbidity) indicated a reduction in the incidence of the primary outcome: 9.0% (D-PLEX) versus 13.7% (SOC) [RDE, −4.8%; 95% CI (−9.5%, −0.1%), P=0.0472]. The D-PLEX safety profile was good (no difference in treatment-emergent adverse events between the groups).

Conclusions:

The SHIELD 1 study did not meet its primary outcome of reduced incisional SSI, incisional reinterventions, or all-cause mortality. Pre-specified and post hoc analyses suggested that D-PLEX may reduce the incidence of the primary outcome event in patients with increased SSI risk, including lengthy incisions.
Public Health Involvement in United States’ Vision Zero Initiatives: A Mixed-Methods Study
Authors: Evenson Kelly R. , Kintigh Jordan M. , Neuroth Lucas M. , LaJeunesse Seth , Naumann Rebecca B.
Published: June 2024

Context:

Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through multidisciplinary coordination. While public health officials are often recognized as critical to VZ, their involvement in VZ across the United States has not been quantified.

Objective:

To explore how United States public health officials were involved in VZ development and implementation.

Design:

We used a mixed-method design including a quantitative assessment of VZ plans and in-depth interviewing with VZ coordinators.

Setting:

United States

Participants:

Twenty-two in-depth interviews with municipal (n = 12) and regional (n = 10) VZ coordinators and 43 VZ plans were reviewed.

Main Outcome Measure:

Public health involvement in VZ development and implementation.

Results:

In the United States, 64 municipalities and 21 regional entities had first-time VZ plans published between 2014 and 2022. We abstracted a sample of municipal (n = 22) and all (n = 21) regional plans. Most plans described key groups involved in plan development (municipal 81.8%, regional 100%). About two-thirds (67.4%; 59.1% municipal, 76.2% regional) of the plans noted public health officials in the plan development. Most plans described the principles forming the foundation of their plan (83.7%), but few mentioned public health as part of the plan principles (22.7% municipal, 14.3% regional). Public health officials were involved in engaging the community (9.1% municipal, 33.3% regional) and providing data (22.7% municipal, 52.4% regional) for plan development, as documented in the plans. For proposed implementation, public health officials were identified as involved in: community engagement (31.8% municipal, 42.9% regional), sharing/analyzing data (40.9% municipal, 33.3% regional), and identifying/providing funding sources (13.6% municipal, 4.8% regional). The in-depth interviews provided further context and a more detailed understanding of public health involvement in VZ.

Conclusions:

Evidence from the VZ plans and interviews provided examples of how public health officials engaged in the development and implementation of VZ initiatives.
Rapid Forehead Ossification due to a Subperiosteal Hematoma in a Patient With Neurofibromatosis Type 1
Authors: Anan Kentaro , Kadota Hideki , Oryoji Chikafumi
Published: June 2024

Rapid ossification due to a subperiosteal hematoma in extremities has occasionally been documented in patients with neurofibromatosis type 1, but it has not been reported in the maxillofacial region. The authors present the first case of a subperiosteal hematoma in the forehead. A 36-year-old man presented with a rapidly swelling firm, fixed, 8×10 cm forehead mass. It became evident shortly after a fine-needle aspiration biopsy. Computed tomography imaging 2 months after the biopsy showed a hematoma that was encapsulated by a surrounding layer of ossification. Magnetic resonance imaging displayed a fluid-fluid level under the ossified area. These characteristic images led us to diagnose this rare lesion as a subperiosteal hematoma with ossification. Rapid ossification is a characteristic imaging finding of subperiosteal hematoma, which makes definitive diagnosis easy. It becomes imperative to underscore the potential risks of fine-needle aspiration in proximity to the periosteum in patients with neurofibromatosis type 1.
Myxoid Liposarcoma Metastasizing to the Parotid Gland
Authors: Ding Tonghui , Chen Hongyuan , Wen Wu
Published: June 2024

Myxoid liposarcoma (MLPS) of the parotid gland is very rare, and only a few cases have been reported worldwide. It can be difficult to diagnose this disease when there is only a single lesion in the patient’s body. A 56-year-old man was diagnosed with an MLPS in the left calf and was treated with wide resection. Two months after the surgery, a painless mass appeared in the man’s left parotid gland area. Both fine-needle aspiration biopsy before surgery and intraoperative frozen sections suggested that the tumor was likely to be a pleomorphic adenoma. Both parotid ultrasound and CT indicated the same result. However, this mass was confirmed to be metastasis of MLPS through immunohistochemistry and multicolor fluorescence in situ hybridization. The authors report a case in which an MLPS metastasized to the parotid gland; this type of lesion is extremely rare and highly worthy of consideration because the authors misdiagnosed it.
Benefits of Aerosolized, Point-of-care, Autologous Skin Cell Suspension (ASCS) for the Closure of Full-thickness Wounds From Thermal and Nonthermal Causes
Authors: Hultman C. Scott , Adams Ursula C. , Rogers Corianne D. , Pillai Minakshi , Brown Samantha T. , McGroarty Carrie Ann , McMoon Michelle , Uberti M. Georgina
Published: June 2024

Objective:

To determine the utility of Autologous Skin Cell Suspension (ASCS) in closing full-thickness (FT) defects from injury and infection.

Background:

Although ASCS has documented success in closing partial-thickness burns, far less is known about the efficacy of ASCS in FT defects.

Methods:

Fifty consecutive patients with FT defects (burn 17, necrotizing infection 13, crush 7, degloving 5, and other 8) underwent closure with the bilayer technique of 3:1 widely meshed, thin, split-thickness skin graft and 80:1 expanded ASCS. End points were limb salvage rate, donor site reduction, operative and hospital throughput, incidence of complications, and re-epithelialization by 4, 8, and 12 weeks.

Results:

Definitive wound closure was achieved in 76%, 94%, and 98% of patients, at 4, 8, and 12 weeks, respectively. Limb salvage occurred in 42/43 patients (10 upper and 33 lower extremities). The mean area grafted was 435 cm2; donor site size was 212 cm2, representing a potential reduction of 50%. The mean surgical time was 71 minutes; the total operating room time was 124 minutes. The mean length of stay was 26.4 days; the time from grafting to discharge was 11.2 days. Four out of 50 patients (8%) required 6 reoperations for bleeding (1), breakdown (4), and amputation (1). Four out of 50 patients (8%) developed hypertrophic scarring, which responded to silicone sheeting (2) and laser resurfacing (2). The mean follow-up was 92.7 days.

Conclusions:

When used for the closure of FT wounds, point-of-care ASCS is effective and safe. Benefits include rapid re-epithelialization, high rate of limb salvage, reduction of donor site size and morbidity, and low incidence of hypertrophic scarring.
Psychosocial Evaluation of Living Kidney Donors: A Survey of Current Practices in the United States
Authors: Clifton Erin , Winder Gerald Scott , Lentine Krista L. , Zimbrean Paula C. , Yadav Anju , Rubman Susan , Kalil Roberto , Kumar Vineeta , Prashar Rohini , Gan Geliang , Deng Yanhong , Joyce Michael , Holmes Rachel , Laflen Jennie , Bakhai Darsh , Liapakis AnnMarie , Doshi Mona D.
Published: June 2024

Background.

Best practices in psychosocial evaluation and care of living donor candidates and donors are not well established.

Methods.

We surveyed 195 living kidney donor (LKD) transplant centers in United States from October 2021 to April 2022 querying (1) composition of psychosocial teams, (2) evaluation processes including clinical tools and domains assessed, (3) selection criteria, and (4) psychosocial follow-up post-donation.

Results.

We received 161 responses from 104 programs, representing 53% of active LKD programs and 67% of LKD transplant volume in 2019. Most respondents (63%) were social workers/independent living donor advocates. Over 90% of respondents indicated donor candidates with known mental health or substance use disorders were initially evaluated by the psychosocial team. Validated psychometric or transplant-specific tools were rarely utilized but domains assessed were consistent. Active suicidality, self-harm, and psychosis were considered absolute contraindications in >90% of programs. Active depression was absolute contraindication in 50% of programs; active anxiety disorder was excluded 27%. Conditions not contraindicated to donation include those in remission: anxiety (56%), depression (53%), and posttraumatic stress disorder (41%). There was acceptance of donor candidates using alcohol, tobacco, or cannabis recreationally, but not if pattern met criteria for active use disorder. Seventy-one percent of programs conducted post-donation psychosocial assessment and use local resources to support donors.

Conclusions.

There was variation in acceptance of donor candidates with mental health or substance use disorders. Although most programs conducted psychosocial screening post-donation, support is not standardized and unclear if adequate. Future studies are needed for consensus building among transplant centers to form guidelines for donor evaluation, acceptance, and support.
Defect pairs in nematic cell alignment on doubly connected domains
Authors: Miyazako Hiroki , Sakajo Takashi
Published: June 2024

We consider the orientational order that arises from the alignment of anisotropic biological cells confined in bounded domains. Especially, it is known that topological defects, where the orientation angles are not well-defined, play an important role in the global pattern formation of cell alignment. Hence, it is important to investigate the relationship between the shape of the region and the location of the defects. The orientational order of cells is theoretically modelled as a harmonic function achieving the minimum elastic energy state of the nematic liquid crystal, and an analytical formula in simply connected domains is given by Miyazako & Nara (Miyazako, Nara 2022
R. Soc. Open Sci
. 9, 211663 (
doi:10.1098/rsos.211663
)). In this paper, we extend this study to construct an analytic formula of cell angle in the doubly connected domains, where topological defects and boundary shapes are represented as the positions of logarithmic singularities and as conformal maps from a given region to a standard annular region, respectively. In addition, using this analytical formula, we propose a numerical algorithm to minimize elastic energy, from which we investigate cell alignment in doubly connected domains with anisotropic quadrilateral boundaries. Our numerical simulations suggest that pairs of topological defects tend to be located around corners of the boundaries, which will be a design principle of the boundary geometry for controlling the defect positions and cell alignment.
Alzheimer’s disease CSF biomarkers correlate with early pathology and alterations in neuronal and glial gene expression
Authors: Ropri Ali S. , Lam Tiffany G. , Kalia Vrinda , Buchanan Heather M. , Bartosch Anne Marie W. , Youth Elliot H. H. , Xiao Harrison , Ross Sophie K. , Jain Anu , Chakrabarty Jayanta K. , Kang Min Suk , Boyett Deborah , Spinazzi Eleonora F. , Iodice Gail , McGovern Robert A. , Honig Lawrence S. , Brown Lewis M. , Miller Gary W. , McKhann Guy M. , Teich Andrew F.
Published: June 2024

INTRODUCTION

Normal pressure hydrocephalus (NPH) patients undergoing cortical shunting frequently show early AD pathology on cortical biopsy, which is predictive of progression to clinical AD. The objective of this study was to use samples from this cohort to identify CSF biomarkers for AD-related CNS pathophysiologic changes using tissue and fluids with early pathology, free of post-mortem artifact.

METHODS

We analyzed Simoa, proteomic, and metabolomic CSF data from 81 patients with previously documented pathologic and transcriptomic changes.

RESULTS

AD pathology on biopsy correlates with CSF β-amyloid-40/42, neurofilament light chain (NfL), and phospho-tau-181(p-tau181)/β-amyloid-42, while several gene expression modules correlate with NfL. Proteomic analysis highlights 7 core proteins that correlate with pathology and gene expression changes on biopsy, and metabolomic analysis of CSF identifies disease-relevant groups that correlate with biopsy data..

DISCUSSION

As additional biomarkers are added to AD diagnostic panels, our work provides insight into the CNS pathophysiology these markers are tracking.
Evaluating Cervical Spine Mobility and Fitt's Law Compliance: The DidRen Laser Test Adapted for Virtual Reality with Age and Sex Effects
Authors: Dierick Frederic , Hage Renaud , Estievenart Wesley , Bruno Joey , Nocent Olivier , Bertucci William , Buisseret Fabien
Published: June 2024

Cervical spine mobility assessment is crucial in rehabilitation to monitor patient progress. This study introduces the DidRen VR test, a virtual reality (VR) adaptation of the conventional DidRen laser test, aimed at evaluating cervical spine mobility. We conducted a cross-sectional study involving fifty healthy participants that underwent the DidRen VR test. The satisfaction of Fitts' law within this VR adaptation was examined and we analyzed the effects of age and sex on the sensorimotor performance metrics. Our findings confirm that Fitts' law is satisfied, demonstrating a predictable relationship between movement time and the index of difficulty, which suggest that the DidRen VR test can effectively simulate real-world conditions. A clear influence of age and sex on performance was observed, highlighting significant differences in movement efficiency and accuracy across demographics, which may necessitate personalized assessment strategies in clinical rehabilitation practices. The DidRen VR test presents an effective tool for assessing cervical spine mobility, validated by Fitts' law. It offers a viable alternative to real-world method, providing precise control over test conditions and enhanced engagement for participants. Since age and sex significantly affect sensorimotor performance, personalized assessments are essential. Further research is recommended to explore the applicability of the DidRen VR test in clinical settings and among patients with neck pain.
Global access to speech hearing tests
Authors: Polspoel Sigrid , Moore David R. , Swanepoel De Wet , Kramer Sophia E. , Smits Cas
Published: June 2024

Understanding speech in noisy settings is one of the biggest challenges for individuals with hearing loss. Traditional speech-in-noise tests play a crucial role in screening for and diagnosing hearing loss, but are resource-intensive to develop, limiting accessibility, particularly in low and middle-income countries. This four-part study introduces an innovative approach using artificial intelligence (AI) to automate the development of such tests. By leveraging text-to-speech (TTS) and automatic speech recognition (ASR) technologies, this approach significantly reduces the cost, time, and resources required for high-quality speech-in-noise testing accessible worldwide. The procedure, named “Aladdin” (Automatic LAnguage-independent Development of the Digits-In-Noise test), creates digits-in-noise (DIN) hearing tests through synthetic speech material and ASR-based level corrections to perceptually equalize the digits, demonstrating characteristics comparable to traditional tests. Notably, Aladdin provides a universal guideline for developing DIN tests across languages, addressing the challenge of comparing test results across variants. This approach, with its potential for broad application in audiology, represents a significant advancement in test development and offers a cost-effective and efficient enhancement to global screening and treatment for hearing loss.
A protocol for the co-creation and usability/acceptability testing of an evidence-based, patient-centred intervention for self-management of urinary incontinence in older men
Authors: Olagundoye Olawunmi , Gibson William , Wagg Adrian
Published: June 2024

Male urinary incontinence (UI) is most prevalent in older men, with one in three men aged 65 and above having problems maintaining continence. Addressing health inequalities, male-female disparities in continence services, and low health-seeking behavior among men emphasizes the necessity for co-creating an intervention that empowers them to self-manage their UI.

We aim to co-create a self-management intervention with an older men and Health care provider (HCP) group and assess its usability/acceptability among older men with UI.

The intervention mapping (IM) framework, a co-creation strategy, will be used to co-create a self-management tool, followed by usability/acceptability testing. The study will be guided by the first four IM steps: the logic model of the problem, the logic model of change, program/intervention design, and program/intervention production, followed by preliminary testing. A participatory group of older men with UI recruited from an existing group of patient partners, and continence care experts will be involved in all steps of the IM process. Usability/acceptability testing will be conducted on a sample of 20 users recruited through seniors’ associations and retirement living facilities. After accessing the self-management tool for a week, participants will complete a product usability testing scale (aka System Usability Scale-SUS) and/or an acceptability test, depending on the preferred mode(s) of intervention delivery. Data will be analyzed using descriptive statistics. A benchmark overall mean usability score of 70 represents a good/usable product, based on the large database of SUS scores.