bluuebunny/crossref_metadata_2025 huggingface dataset:
A83 PLANT-BASED ENTERAL NUTRITION: A POTENTIAL METHOD OF SECRETION MANAGEMENT IN A PALLIATIVE PATIENT WITH PROGRESSIVE MYOTONIC DYSTROPHY — A CASE REPORT
Authors: Nap Hill E F , Broening J , Sasson S , Ou G
Published: February 2025

Background

Degenerative neuromuscular conditions such as myotonic dystrophy is characterized by oropharyngeal dysfunction leading to reduced ability to eat orally and clear respiratory secretions. Enteral nutrition (EN) is often required in these patients but aspiration pneumonia remains a concern. Dairy-based EN are commonly used, but evidence suggests that casein digestion may stimulate mucin production in respiratory tissues, increasing secretions (Bartley 2010).

McClanahan et al. (2019) showed that switching patients to plant-based EN improved gastrointestinal outcomes and reduced medication use in chronically ill, tube-fed children. Viall et al. (1990) found soy-based EN led to fewer gastrointestinal issues, such as vomiting and gastric residuals, compared to casein-based EN. Goelen et al. (2021) also reported that plant-based EN resulted in faster gastric emptying compared to casein-based EN, which could reduce secretion-related complications.

Aims

To describe nutrition management in a palliative patient with myotonic dystrophy with recurrent aspiration pneumonia.

Methods

Case report.

Results

A patient with myotonic dystrophy type 1, was admitted with viral respiratory infection resulting in respiratory failure and prolonged hospitalization with marked deterioration in respiratory and swallowing functions. A nasogastric and then percutaneous gastrostomy feeding tubes were placed but feeding regimens remained suboptimal (50% caloric provision) due to recurrent aspiration pneumonia. A transgastric jejunal feeding tube was then placed without much clinical improvement despite trying various enteral feeding formula (including high-protein and high-calorie formulations) and maximal anti-secretory management as per palliative care team. Aggressive feeding was in line with patient’s goals of care after much discussion, so nutrition team was consulted for recommendations.

Patient was switched to plant-based EN due to concerns that dairy protein stimulated secretions. Patient experienced a reduction in secretion thickness and fewer aspiration events. Goal EN rate was achieved.

Conclusions

This case highlights the potential benefits of plant-based EN in managing secretions and reducing aspiration risk in a patient with progressive myotonic dystrophy. Transition from dairy-based to a plant-based alternative led to better secretion control, fewer aspirations, and reduced antibiotics. While this is a single case, the findings align with evidence that plant-based EN may improve gastrointestinal outcomes and alleviate secretion-related complications. Further studies are needed to explore the efficacy of plant-based EN in broader patient populations and its role in managing secretions and aspiration pneumonia.

Funding Agencies

None
A84 THE USE OF PHYTASE TO ENHANCE DIETARY IRON AND ZINC ABSORPTION - A SCOPING REVIEW
Authors: Hirota S , Adamidi N , Chondrou T , Lygouras D , Androutsos O , Svolos V
Published: February 2025

Background

Phytic acid is abundant in plant-based diets and acts as a micronutrient inhibitor for humans and non-ruminant animals. Phytases are enzymes that break down phytic acid, releasing micronutrients and enhancing their bioavailability, particularly iron and zinc. Deficiencies in iron and zinc are common in patients with the inflammatory bowel diseases and in those in developing countries consuming phytic acid-rich diets.

Aims

This literature review aimed to summarize findings from human intervention studies on the interactions between phytic acid, phytase and micronutrient bioavailability.

Methods

An extensive PubMed search (01/01/1990 to 08/02/2024) was conducted using MeSH terms (phytic acid, phytase, IP6, “inositol hexaphosphate,” micronutrient, magnesium, calcium, iron, zinc). Eligible studies included human intervention trials investigating the bioavailability of micronutrients following a) phytase supplementation, b) consumption of phytic acid-rich foods, or c) consumption of dephytinised foods. In-vitro, animal, cross-sectional, and non-English studies were excluded.

Results

3055 articles were identified. After title and full-text review 40 articles were eligible. Another 2 were identified after cross-checking reference lists from included papers, resulting in 42 included articles. Most studies exploring the efficacy of exogenous phytase (9 of 11, 82%) or the efficacy of food dephytinisation (11 of 14, 79%) presented augmented iron and zinc bioavailability. In agreement to this, most phytic acid-rich food feeding studies (13 of 17, 77%) showed compromised iron and zinc bioavailability.

Conclusions

Strong evidence supports decreased iron and zinc bioavailability in phytic acid-rich diets and the improvement potential with phytase interventions. Further studies are needed in larger populations.

Funding Agencies

None
A92 MULTIFACETED STRIDE II-BASED MONITORING FOR INFLAMMATORY BOWEL DISEASE ADVANCED THERAPY STARTS
Authors: Parsons D , MacKay S A , Hoque S , Hoentjen F , Dieleman L , Gozdzik M , Kroeker K , Wong K , McMullen T , Peerani F , Halloran B
Published: February 2025

Background

Inflammatory bowel disease (IBD) outreach monitoring has been shown to be cost-effective and reduce healthcare utilization. IBD STRIDE-II guidelines recommend monitoring patient-reported outcomes (PRO’s), biomarkers (e.g., fecal calprotectin (FCP), C-reactive protein (CRP)), and endoscopy to determine if patients achieve defined therapeutic targets. Previous monitoring in the literature has focused on PRO’s alone, which risks undertreating asymptomatic inflammation in spite of elevated flare and colorectal cancer risk. We designed a protocol to closely monitor biomarkers and PRO’s.

Aims

We aimed to assess STRIDE-II based clinical response and facilitate responsive disease management for new advanced therapy start patients.

Methods

Patients complete 24 weeks of outreach monitoring. PRO’s are obtained on days 0, 3, and 7, and every 2 weeks thereafter. Serum labs are collected at baseline and weeks 4, 8, 12, 16, and 24. FCP is collected at baseline and weeks 8, 16, and 24. Medication adherence is assessed at baseline and weeks 12 and 24. Endoscopy is booked 6-12 months from the start date. Treating gastroenterologists receive granular clinical reports summarizing results, the date of last IBD review, and last flare.

Results

75 protocol patients on the following therapies: ustekinumab (n = 31), risankizumab (n = 17), tofacitinib (n = 14), upadacitinib (n = 10), vedolizumab (n = 2), and infliximab (n = 1) were monitored in our protocol so far. 51 patients (68.0%) had failed 1+ prior advanced therapies and 13 (17.3%) had prior IBD surgery. 7 (9.3%) were switched from their initial agent before 24 weeks due to lack of response. 1 (1.3%) had an adverse drug event. 64 patients (85.3%) complied with all FCP collections and 73 (97.3%) completed 95+% of PRO’s. Per STRIDE-II definitions, 47 patients (62.7%) demonstrated clinical response during the protocol and 25 (33.3%) achieved remission by 24 weeks. 15 (20.0%) received steroid courses, 9 (12.0%) presented to an emergency department, and 5 (6.7%) were hospitalized for IBD during monitoring.

Conclusions

Our proactive monitoring protocol provided granular real-world clinical response data to treating physicians. Patients were highly compliant with serial PRO, FCP, and serum labs collection. The protocol facilitates responsive disease management and may lead to treatment-specific monitoring recommendations. In future, we will compare protocol patients to standard of care managed patients to learn if the protocol reduces healthcare utilization and improves patient outcomes and quality of life.

Funding Agencies

None
A105 TRANSITION TO ADULTHOOD THROUGH COACHING AND EMPOWERMENT (TRACE): A FEASIBILITY RCT
Authors: Beaudoin K , McKean H , Nsamenang S , Bortolin K , Cellucci T , Dowhaniuk J , Heale L , Issenman R M , Pai N , Sherlock M , Zachos M , Beattie K , Batthish M , Prowse K
Published: February 2025

Background

Pediatric patients with chronic disease face challenges during the transition to adult care, including psychosocial and emotional stressors, as well as worsening disease.

Aims

Transition to Adulthood through Coaching and Empowerment (TRACE) assessed the feasibility of conducting a virtual transition coaching randomized controlled trial for adolescent patients and collected preliminary clinical outcomes.

Methods

Individuals aged 16-17 diagnosed with inflammatory bowel disease or juvenile idiopathic arthritis from the pediatric gastroenterology (GI) or rheumatology clinics at McMaster Children’s Hospital were recruited. Participants were randomized into control or Transition Coach Intervention (TCI) groups. TCI participants received 8 virtual coaching sessions; 6 with a child life specialist and 2 with a clinical psychologist. Electronic questionnaires were completed at baseline, 8 months, and 11 months. Feasibility outcomes, patient demographics, transition readiness, and quality of life were recorded. Descriptive statistics summarized feasibility outcomes and outcomes by group.

Results

Of all participants (n=27), 67% were male, and the mean (SD) age was 16.8 (0.5) years. The recruitment rate was 58% and 38% for the GI and rheumatology clinics, respectively. The overall dropout rate was 7%. All TCI participants attended at least 6/8 sessions, and 63% of participants had a complete data set (Table I). Figure 1 shows baseline and 8-month follow-up data for preliminary clinical outcomes, such as transition readiness and quality of life, which will inform the design of a future randomized controlled trial.

Conclusions

The TRACE study aims to show that a virtual TCI trial is feasible. Based on preliminary responses to this transition intervention, we plan to conduct a large-scale, randomized controlled trial.

Table I: Feasibility outcomes. (n=14 control group, n=13 TCI group, n=27 total). JIA = juvenile idiopathic arthritis, IBD = inflammatory bowel disease, TCI = transition coach intervention

Figure 1. Transition-Q and Peds-QL scores at baseline and 8-month follow-up. (n=13 for the control group, n=8 for the baseline TCI group; n=8 for the 8-month follow-up control group, and n=6 for the 8-month follow-up TCI group). F/U = follow-up, TCI = transition coach intervention

Funding Agencies: HAHSO
A136 MÉNÉTRIER’S DISEASE-LIKE PRESENTATION IN A PEDIATRIC PATIENT AS A FIRST PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Hussain M , Alsaffar Z , Ahmed N
Published: February 2025

Background

Ménétrier’s disease (MD) is an uncommon gastric disorder characterized by hypertrophic gastric mucosal folds, excess mucus secretion, and protein-losing gastropathy. It is mainly seen in adult patients, with around 100 pediatric cases reported to date, often associated with cytomegalovirus (CMV) infection. Systemic lupus erythematosus (SLE) is a autoimmune condition that can affect multiple systems. While MD and SLE are separately rare, there have been reports of MD preceding SLE in adult patients. However, no cases have documented MD as the initial presentation leading to a diagnosis of SLE in pediatric patients.

Aims

This case report aims to describe the first documented instance of a pediatric patient presenting with suspected Ménétrier’s disease, whose clinical course led to a diagnosis of systemic lupus erythematosus.

Methods: Case Summary

A 13-year-old boy with a history of autism spectrum disorder, presented with anasarca and multiple systemic symptoms, including musculoskeletal pain, fatigue, mouth ulcers, non-productive cough, and generalized edema. On admission, he was hypotensive with mild conjunctival injection, peri-orbital edema, ascites, and non-pitting edema in the lower limbs. Lab tests showed leukopenia, neutropenia, thrombocytopenia, elevated ferritin, and hypoalbuminemia. Imaging revealed bilateral pleural effusions and ascites, along with thickened gastric folds on CT scan raising suspicion for Ménétrier’s disease. An upper GI endoscopy showed atypical thick folds with scaliness in the stomach, but the biopsy was negative for H. pylori, CMV, showed no significant inflammation, no foveolar metaplasia, no viral cytopathic changes and had well-preserved morphology in esophageal, gastric and duodenal biopsies. A kidney biopsy was done in the context of proteinuria and confirmed lupus nephritis.

Results

He was diagnosed with systemic lupus erythematosus (SLE) and treated with steroids, Plaquenil, and Mycophenolate Mofetil. Post-treatment, his symptoms, including ascites and edema, resolved, and his lab values, such as blood counts, albumin, and C3/C4 levels, normalized. The patient showed significant clinical improvement following SLE-targeted therapy.

Conclusions

This case highlights the complexity and diagnostic challenges in differentiating Ménétrier’s disease from systemic lupus erythematosus, particularly when both disorders present with overlapping features. In addition, it suggests that in rare instances, MD may be a manifestation of a broader systemic inflammatory process such as SLE. Multidisciplinary approach and comprehensive evaluation are essential for accurate diagnosis and management in such complex cases.

Funding Agencies

None
A163 DIETARY PATTERNS OF BREASTFEEDING POST-PARTUM MOTHERS WITH INFLAMMATORY BOWEL DISEASE AND THEIR ASSOCIATIONS ON INFANT GROWTH
Authors: Dang R , Wu R Y , O’Connor K , Epstein-Shapiro A , Xiao K , Srikanth V , Maiocco F , Huang V
Published: February 2025

Background

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC) is characterized by chronic intestinal inflammation. Since IBD is often diagnosed in young adulthood, many people will have IBD at the time of pregnancy and breastfeeding. Chronic inflammation can cause severe nutritional deficiencies; however, it is unclear whether nutrient deficiencies during postpartum affect patients with IBD.

Aims

To investigate the dietary patterns of breastfeeding mothers with IBD and correlate their dietary patterns with their infant growth within the first 6 months.

Methods

A total of 21 mothers with IBD (9 CD and 12 UC) were recruited from the Preconception and Pregnancy IBD clinic at Mount Sinai. Inclusion criteria include females between 18-45 years olds with a diagnosis of CD or UC, who are at least 24 weeks gestational age, and females with multi-fetal gestation, co-morbid intestinal disease, or autoimmune comorbidities were excluded. Mothers completed a 3-day food diary and clinical disease activity scores at 1-month (1M) and 3-months (3M) postpartum, and self-filled questionnaires related to infant growth over a 6-month follow-up. Food and dietary patterns were analyzed using a food analysis software called ESHA based on age, gender, weight and height. Infant growth was compared to the World Health Organization’s growth curve Z-scores.

Results

About half (52% at 1M and 48% at 3M) of mothers with IBD met the protein recommendation. Over half (62% at 1M and 3M) met their total fat recommendation. However, most did not meet the carbohydrate (33% at 1M and 19% at 3M) and fiber (24% at 1M and 10% at 3M) recommendations. All infants included in the analysis were breastfed at 1M and 3M postpartum. Breastfed infants born to mothers who met their total fat recommendation had higher length measurements compared to those who did not at 6 months.

Conclusions

Our study findings show that breastfeeding mothers with IBD may not meet their recommended carbohydrate and fiber dietary intake, and that infants breastfed by mothers who do not meet their macronutrient dietary intake and lengths in the lower percentile range. Future research will delineate the specific nutrient composition in mothers’ breastmilk.

Funding Agencies

American College of Gastroenterology, University of Toronto, CAN-TAP-TALENT
A217 OUTCOMES OF BALLOON ASSISTED ENDOSCOPIC STRICTURE DILATION IN PATIENTS WITH SMALL BOWEL CROHN’S DISEASE
Authors: Bowron J C , Fazal M , Reeson M , Halloran B , Zepeda-Gomez S
Published: February 2025

Background

Crohn’s Disease (CD) is a subset of inflammatory bowel disease (IBD) that has unique pharmacologic, endoscopic and surgical considerations secondary to chronic, transmural inflammation that affects the entire gastrointestinal tract. The natural history of this disease is complicated by formation of fibro-stenotic strictures, adhesions and penetrating fistulae. Balloon-assisted endoscopy (BAE) has significantly improved the ability to assess and treat small bowel CD.

Aims

We present a Canadian cohort of patients that have undergone BAE for stricture dilation of fibrostenotic CD. We retrospectively analyzed demographic, clinical and endoscopic risk factors that could be associated with increased risk of requiring surgical management.

Methods

Retrospective analysis of 157 patients undergoing BAE for stricture dilation of known CD from Apr 2012 – Jan 2024 at the University of Alberta Hospital. A total of 282 procedures were performed and 629 strictures dilated. Patients were then subdivided into two groups: patients that required surgery at any point after their first BAE compared with patients managed with balloon-assisted endoscopic stricture dilation alone.

Results

Of 157 patients with confirmed stricturing CD, 65/157 (41.4%) required surgery between Apr 2012- Jan 2024 and 92/157 (58.6%) patients were managed with endoscopic intervention. The average age at the time of their first BAE was 55.9 years and mean disease duration was 20.76 years in the surgery group. Average patient age in the non-surgical group was 52 years and mean disease duration was 17.9 years. 43.08% (28/65) of patients were active smokers in the surgical group vs. 26.09% (24/92) in the non-surgical group. Concurrent or previous biologic use was comparable at 76.9% and 73.9% in the surgical and non-surgical groups, respectively. The average minimum diameter dilated was 15.2(+/- 0.25) mm in the surgical group vs. 16.2(+/- 0.16) mm in the non-surgical group. The incidence of non-traversable strictures post-dilation was higher in the surgical group (34/231, 14.72%) compared with the non-surgical group (16/398, 9.20%).

In total, 97 surgeries were performed and average time to surgery from first BAE was 32.22 months (excluding emergent/urgent surgeries). Average time from most recent BAE to surgery was 8.79 months. There were 3 emergent surgeries (<24 hours from BAE to surgery, including one perforation) and 7 urgent surgeries (<30 days from BAE to surgery).

Conclusions

BAE has revolutionized endoscopic management of small bowel stricturing CD. Based on our retrospective case cohort, most patients with symptomatic strictures in the small bowel secondary to CD can be successfully managed with balloon-assisted endoscopic dilation. BAE may also play an important role in preventing emergent/unplanned surgical interventions.

Funding Agencies

None
A246 EXPLORING THE ROLE OF LUMINAL PROTEASES IN NOCICEPTION MODULATION FROM PATIENTS WITH ACTIVE AND REMISSIVE INFLAMMATORY BOWEL DISEASE
Authors: Wood H M , Blazkova K , Faucher F F , Sheth P M , Vanner S J , Reed D E , Bogyo M , Lomax A E
Published: February 2025

Background

Abdominal pain poses a significant challenge for individuals with inflammatory bowel disease (IBD). Despite current treatments that target inflammation, IBD-associated abdominal pain often persists even in the absence of inflammation, negatively impacting patients’ quality of life. This persistence suggests that factors other than inflammation may be at play. Our previous research suggests that bacterial proteases can directly influence the excitability of dorsal root ganglia neurons, many of which are pain-sensing. Building on this, we hypothesize that proteases, both of host and bacterial origin, play a role in pain modulation during the active and remission phases of IBD.

Aims

Determine whether luminal proteases in IBD fecal samples induce changes in pain signalling.

Methods

The effects of fecal supernatants (FS) from patients with active or remissive IBD and healthy volunteers (HV), on pain-sensing neurons were assessed using ex-vivo single-unit afferent nerve recordings from mouse colons. A protease inhibitor cocktail (PIC; 1:1000) and a protease-activated receptor (PAR)-2 antagonist (GB83; 10µM) were independently applied in the bioassay to determine whether these inhibited the excitatory effect of the FS. In addition, the participant FS were tested for proteolytic cleavage of the N-terminal domain of protease-activated receptor PAR2 using a novel enzymatic assay.

Results

FS from HV [N=5] had no effect on afferent nerve excitability (p>0.05). FS from active IBD patients [N=15] increased action potential discharge from colonic afferent nerves by 85% (p<0.0001) and selectively increased the activation of high-threshold units, which are putative nociceptors, by 44% (p<0.01). A protease inhibitor cocktail and PAR2 antagonist both independently inhibited the excitatory effects of IBD FS (p>0.05) on afferent nerve activity. In contrast, FS from IBD patients in remission [N=15] did not excite colonic afferent nerves (p>0.05). Interestingly, these findings were found to be consistent when IBD was split into disease subtypes: Crohn’s disease and ulcerative colitis. Furthermore, when normalized to total protein content, active disease yielded significantly greater PAR2 cleavage activity (p<0.05), while the remission samples were not significantly different than the HV (p>0.05). This PAR2 cleavage activity was found to be correlated to neuronal excitation (R2=0.4721, p<0.001).

Conclusions

Our findings suggest that active IBD leads to the generation of luminal mediators, including proteases acting on PAR2, that activate visceral nociceptive neurons. These luminal mediators are less abundant when inflammation is in remission. These data suggest that targeting proteases could offer a promising therapeutic approach for pain management in IBD.

Funding Agencies

CIHR
Hospital environment as reservoir of Pseudomonas aeruginosa in human cases: a molecular epidemiology investigation in a hospital setting in central Italy
Authors: Lombardi Adele , Tamburro Manuela , Sammarco Michela Lucia , Ripabelli Giancarlo
Published: February 2025

Pseudomonas aeruginosa is one of the main causes of hospital infections that are difficult to manage because of multidrug resistance (MDR). The aim of this study was to describe a molecular investigation on 19 clinical and 14 isolates from the environment in the Hub hospital of the Molise region, central Italy. Antimicrobial susceptibility was evaluated using BD Phoenix™ Automated Microbiology System. Pulsed-field gel electrophoresis (PFGE) with SpeI, enterobacterial repetitive intergenic consensus (ERIC-PCR), and random amplified polymorphic DNA-PCR were performed for genotyping. All 33 P. aeruginosa showed MDR phenotype. PFGE had 0.99 discriminatory power, underlining high heterogeneity among the strains. The genetic relatedness between two human isolates (H12 and H15) from neonatal intensive care (NICU) and one environmental strain (E1) collected from siphon of sink in the delivery room was noticeable, as well as between one strain from faucet in NICU (E2) and siphon sink (E5) from delivery room. The link between H12, H15, and E1 strains was corroborated by ERIC-PCR showing epidemiological concordance, although with a lower discriminatory power. The study findings strengthened the critical correlation between clinical P. aeruginosa and environment, according to previous molecular surveys on outbreaks occurred in Italy.
Genomic investigation of an antifungal-resistant Aspergillus fumigatus outbreak in a French hospital
Authors: Joste Valentin , Delouis Maëlys , Mouhajir Abdelmounaim , Gera Denis-Petit Stuti , Moënne-Locoz Pierre , Kernéis Solen , Houzé Sandrine , Bonnal Christine , Coppée Romain
Published: February 2025

Aspergillus fumigatus is associated with various invasive, chronic, and allergic fungal diseases. The emergence of environmental azole-resistant strains complicates the treatment of these infections. The use of whole-genome sequencing (WGS), which is widely used to study bacterial and viral outbreaks, could be beneficial for characterizing azole-resistant A. fumigatus outbreaks. Here, nine azole-resistant cyp51A TR34/L98H A. fumigatus strains isolated during an outbreak in a French hospital between November 2021 and October 2022 were studied. The genetic relatedness of these strains was assessed using microsatellites, high-quality single-nucleotide polymorphisms (SNPs) from WGS data, phylogenetic reconstruction, and principal component analysis. Multiple sequenced but independently cultured A. fumigatus strains were used as identical strain controls. Among the nine unrelated patients infected by TR34/L98H A. fumigatus, five had previously isolated A. fumigatus strains without the cyp51A TR34/L98H mutation. Both microsatellites and WGS confirmed that the initial cyp51A wild-type strains for these five patients were genetically different from the new mutant strains. Eight of the nine TR34/L98H strains were genetically close, with a number of SNPs similar to the controls. These resistant strains were not related to four environmental strains isolated in the hospital. Altogether, the results suggest that at least eight patients were exposed to a common source, although its exact origin could not be determined. The presence of antifungal-resistant strains in healthcare settings underscores the need for active research into resistant strains and that both microsatellites and WGS techniques have their place in the management of A. fumigatus epidemics.
Compact protoplanetary discs can be produced by dead zones
Authors: Tong Simin , Alexander Richard
Published: February 2025

Radially compact protoplanetary discs ($\lesssim$ $50\, \mathrm{au}$) are ubiquitous in nearby star-forming regions. Multiple mechanisms have been invoked to interpret various compact discs. In this paper, we propose that fragmentation of fragile dust grains in moderate turbulence, as expected beyond the dead zone, provides an effective alternative mechanism to form compact discs which are consistent with current observations. We run 1D dust transport and collision models with dustpy and generate synthetic observations, and find that discs formed by this mechanism have sizes determined by the radial extent of their dead zones. Accounting for dust porosity and considering less fragile dust do not change disc sizes significantly. The smooth dust morphology can be altered only when pressure bumps are present in the dead zone. However, when present at small radii ($\lesssim$ 10 au), pressure bumps cannot effectively trap dust. Dust in these bumps fragments and replenishes the inner discs, effectively hiding dust traps in the optically thick inner disc from observations. We note a striking resemblance in the radial intensity profile between our synthetic observations and some recent high-resolution observations of compact discs. We discuss how such observations can inform our understanding of the underlying disc physics.
Obesity reduces the urate-lowering efficacy among patients with primary gout: a prospective cohort study
Authors: Cheng Zan , Xu Xinmiao , Qi Han , Li Xiaoyu , Li Yushuang , Jiang Chang , Miao Xinyuan , Ji Xiaopeng , Wang Yunyang , Dong Bingzi , Li Changgui , Lu Jie
Published: February 2025

Objectives

Obesity affects 53% of gout patients, while its effect on urate-lowering therapy (ULT) is unclear. This study aimed to compare the response to febuxostat among different BMI catalogs of male gout patients.

Methods

A prospective study recruited 633 men with gout, classified by BMI into normal-weight, overweight and obese groups. Baseline age, disease duration and serum urate (SU) levels were matched simultaneously. All participants received febuxostat for 12 weeks, increasing the dosage from 20 to 40 mg daily. We compared the efficacy of ULT and the incidence of gout flares in three groups. Cox regression analysis was used to identify risk factors for achieving target SU levels before and after matching. Restricted cubic spline (RCS) curves were used to illustrate the relationship between BMI and hazard ratio (HR) for SU achievement.

Results

The proportion of participants achieving SU < 6.0 mg/dl in the obese group was 38.9%, significantly lower than the overweight (54.2%) and normal-weight groups (63.8%) (P < 0.05), with no significant difference between the overweight and normal-weight groups at week 12. High BMI (HR = 0.92, 95% CI 0.89–0.96, P < 0.001) independently prevented achieving the SU target, with a similar effect after matching. Obese and overweight individuals had a higher cumulative incidence of gout flares compared with the normal-weight group (P < 0.05). The linear relationship between BMI and HR for achieving the SU target was suggested by RCS (nonlinear P > 0.05).

Conclusion

Obesity significantly reduces the efficacy of febuxostat-based ULT in male gout patients rather than being overweight.

Trial registration

China Clinical Trial Registry, #ChiCTR2300078804.
Contrasting Roles of Plant GATA21/22 Transcriptional Regulators in Defense Against Fungal and Bacterial Pathogens
Authors: Dhar Nikhilesh , Anchieta Amy , Arnold Isaac , Eriksen Renee L. , Subbarao Krishna V. , Raina Ramesh , Klosterman Steven J.
Published: February 2025

The GATA family of transcriptional regulators is broadly conserved between plant and animal kingdoms. Here, we report that some of the GATA genes are suppressed in Arabidopsis during fungal and bacterial infections. But strikingly, GATA21 and GATA22 encode positive regulators of defense against necrotrophic fungal pathogens while acting antagonistically against hemibiotrophic bacterial pathogens. Following infection by Verticillium dahliae, the gata21 and gata22 mutants exhibit defective growth in bolt length and in total silique number. These results suggest that GATA21 and GATA22 regulate growth and reproduction in Arabidopsis both during normal growth and in response to infection by pathogens. Since the GATA family is conserved, our findings have broad implications for the role of GATA transcription regulators in integrating signals from biotic interactions with those for growth and development.
Cast Wedging in Pediatric Forearm and Tibia Fractures—A Safe Way to Avoid Surgery
Authors: Pathangey Sachin , Canizares Maria F. , Greenberg Michael , Miller Patricia E. , Watkins Colyn , Hedequist Daniel , Shore Benjamin J.
Published: February 2025

Background:

Cast wedging is an established technique used to improve the alignment of pediatric fractures. The purpose of this study was to review the effectiveness of cast wedging to treat malaligned pediatric fractures and report the incidence of complications and failure associated with cast wedging.

Methods:

A retrospective review of a level one pediatric trauma center was performed. Children aged 3 to 18 who underwent cast wedging following a forearm shaft, distal radius, or tibia shaft fracture (January 2005 to January 2021) were reviewed. A total of 294 patients were identified for analysis. Coronal and sagittal angles were measured throughout the course of fracture management. Improved radiologic correction was defined as at least a 50% correction of malalignment in the plane of maximum deformity. Complications associated with cast wedging were recorded, and wedging failure was defined as patients who underwent a secondary procedure. Multivariable logistic regression analysis was used to identify variables affecting outcomes and odds ratios (ORs) with 95% CIs were estimated for final model effects.

Results:

Cast wedging generated a median 56% correction in angulation, with 74% of the cohort (217/294) achieving at least 50% correction. Twenty-two patients (7%) failed wedging treatment, with half undergoing a repeat closed reduction (12/22, 55%). Eighteen patients (6%) experienced at least 1 complication. Nine patients (3%) sustained a refracture after wedging an average of 8.9 months from the initial injury. Multivariable analysis identified older patients and those who did not achieve 50% radiologic correction after wedging to have increased odds of repeat surgery (OR=1.17; P=0.04 and OR=11.1; P=0.001, respectively).

Conclusions:

Cast wedging is a safe and effective method to correct malaligned pediatric fractures with a low incidence of complications and refracture. Cast wedging remains an important skill for orthopaedic surgeons managing pediatric fractures.

Level of Evidence:

Level IV.
Pediatric Chiari Malformation Management
Authors: Gepp Ricardo , Lee June Ho , Parthiban Jutty , Costa Francesco , Dantas Fernando , Sampaio Francisco , Chen Zan , Oertel Joachim , Sharif Salman , Klekamp Jörg , Botelho Ricardo , Zileli Mehmet , Alves Óscar L.
Published: February 2025

Study Design.

A systematic literature review and consensus using Delphi method.

Objective.

This review aims to provide an overview on Chiari malformation in pediatric patients, highlighting the specific clinical manifestations and surgical treatment options.

Summary of Background.

Chiari malformation in children presents a real difficulty to the general neurosurgeon because children are not smaller adults. In the absence of pediatric neurosurgeons, as in many countries of the world, a need for education of general neurosurgeons on the management of Chiari malformation in children was identified.

Material and Methods.

The authors carried out an extensive review of the literature in PubMed database of the last 10 years addressing the topic of Chiari malformation in children. A total of 64 studies were selected for analysis and five statements were drawn to be voted by a panel of expert spine surgeons in two consensus meetings organized by the World Federation of Neurosurgical Societies (WFNS) Spine Committee. A consensus was reached using the Delphi method.

Results.

In children with CM1, a decompressive surgery with duraplasty before puberty may avoid scoliosis progression. In Chiari type 2, the recommendation is to perform urgently extensive decompression of the craniovertebral junction and cervical canal if there is no decompensation of hydrocephalus. Cranial vault expansion may be recommended in pediatric Chiari malformation associated with craniosynostosis. Children with Chiari type I can play sports because of the low risk of worsening.

Conclusion.

Pediatric age is a modifier for the management of Chiari Malformation (CM). Prompt diagnosis and appropriate decompressive surgery with duraplasty before puberty are essential to mitigate the impact of the condition on the child’s well-being. Increased awareness among healthcare professionals, timely access to specialized expertise in neurosurgical interventions are crucial, especially for type 2 CM patients that require urgent decompression of CVJ and cervical spine.
Digital Detox Among Adolescents at Summer Camp
Authors: Reed Janet M. , Gies Ashley
Published: February 2025

Computer and internet addiction as well as compulsive social media use have become significant problems for adolescents. Residential summer camps offer the opportunity for campers to experience a digital detox in a supportive setting where digital devices are not available. A retrospective chart analysis of health clinic logs for campers ages 8-18 at an 8-day residential Christian athletic summer camp in 2023 asked: What percentage of summer camp health clinic visits were due to symptoms consistent with technology withdrawal, and did health clinic utilization differ based on gender? Visits for sleep (6%) and anxiety (2%) symptoms had the highest likelihood of being consistent with symptoms of technology withdrawal; female campers had more clinic visits than males. Nursing interventions for camp health concerns and the relevance of biblical spiritual care for adolescent campers are discussed.
Evaluation of Control Arm Quality in Recent Radiation Oncology Randomized Clinical Trials
Authors: Ekpunobi Ifeanyi O. , Flores Laura E. , Jagsi Reshma , McClelland Shearwood
Published: February 2025

Background:

For randomized controlled trials (RCTs) to provide the highest levels of evidence for clinical practice, it is ethically imperative for patients assigned to the control arm to receive standard-of-care treatment. Oncologic medical trials investigating new systemic agents have demonstrated a high proportion of RCTs with inadequate control arms. It is unknown whether this finding is prevalent in oncologic trials investigating radiation therapy (RT) for cancer.

Methods:

ClinicalTrials.gov was queried for registered clinical trials investigating RT in patients with cancer from 2013 to 2023. Each control arm was analyzed, with the standard of care determined by National Comprehensive Cancer Center Network (NCCN) guidelines at the time of initial trial posting.

Results:

Five hundred eight interventional studies with results registered were included, of which 12 met inclusion criteria for final analysis. Two trials each investigated RT usage in central nervous system, prostate, head and neck, and breast disease sites, and 1 each for lung, hepatobiliary, rectal, and bone disease sites. Most trials were industry-funded (83%); 75% of studies took place in the United States. Hundred percent of trials had an adequate control arm per the corresponding NCCN guidelines.

Conclusion:

All recently completed oncologic RCTs investigating RT for cancer involved an adequate control arm. This finding contrasts with the high proportion of inadequate control arms in medical oncology trials. These findings suggest that adequate control arm treatments are feasible to achieve in trial design, emphasizing both the need for continued focus on improving the quality of ethical oncologic research trials and a possible subspecialty that may serve as an exemplar.
The Freestyle Multiperforator Island Flap: Beyond the Keystone Flap
Authors: Gómez Oswaldo J. , Espinel Pinzón Daniel Alejandro , Duque David F. , Moreno Harold D. , Beltrán Pachón Paloma
Published: February 2025

Background:

This study aimed to introduce freestyle multiperforator island flaps as a technical advancement beyond keystone perforator flaps. These flaps represent a fully free-design approach, supplied by multiperforators in small subcutaneous pedicles randomly located, allowing for customized designs tailored to anatomical regions of diverse complexity.

Methods:

We present a retrospective cohort study of 150 patients with coverage defects, without distinction of anatomical location or age, treated between 2012 and 2021. The study assessed the clinical presentation, flap characteristics, additional procedures, and postoperative outcomes. We used the chi-square test to assess the relationship between pedicle area size and the incidence of partial or complete necrosis.

Results:

We performed 211 flaps on 184 defects, with a mean follow-up of 8.7 months. Tumors (30.4%) and trauma (23.3%) were the most common etiologies. Most flaps were performed on the head and neck (31%) and lower limbs (30.4%). The mean pedicle area was 33%, and the flap-to-defect size ratio was between 1:1 and 3:1 in 82% of cases. Complications occurred in 29.8% of the flaps, with only 8.1% needing surgical reintervention. The most common occurrences were dehiscence (18.5%), partial necrosis (9%), and total necrosis (1.9%). The pedicle area of the flap did not demonstrate a statistically significant relationship with the necrosis outcome (P = 0.813; 95% confidence interval, 0.17–0.926).

Conclusions:

Freestyle multiperforator island flaps are a safe and versatile tool with low necrosis rates, excellent aesthetic results, and unmatched cost-effectiveness.
The impact of integrated care on clinical outcomes in patients with alcohol-associated liver disease: Early outcomes from a multidisciplinary clinic
Authors: Sengupta Shreya , Anand Akhil , Yang Qijun , Reagan Meghan , Husted Mariah , Minnick Austin , Nagy Laura E. , Dasarathy Srinivasan , Sims Omar T. , Mellinger Jessica L.
Published: February 2025

Background:

We analyzed early outcomes regarding the impact of our integrated alcohol-associated liver disease (ALD) clinic on patients with ALD and alcohol use.

Methods:

We conducted a retrospective study of patients with ALD who were evaluated in our integrated clinic from May 1, 2022, to December 31, 2023. Primary outcomes included differences in baseline clinical/demographic data between patients who accepted versus declined an appointment and changes in the severity of ALD, alcohol consumption, functional status, hospital utilization, and remission in alcohol use disorder for evaluated patients.

Results:

Patients who declined appointments (n=66) had higher median no-show rates (15.0 [8.0,30.0] vs. 8.5 [3.25,15.0], p<0.001), social vulnerability index (0.53 [0.26,0.79] vs. 0.38 [0.17,0.63], p=0.033), and proportions of cirrhosis (78.8% vs. 59.8%, p=0.017) versus evaluated patients. Comparison of baseline to first follow-up visit for evaluated patients (n=102) demonstrated significant reductions in median AST (59.5 [41.75, 89] vs. 44.5 [33.5, 56.25], p<0.001), alanine-aminotransferase (33.5 [20,45.25] vs. 26.5 [18.75,33.0], p=0.017), total bilirubin (1.6 [0.7,3.3] vs. 1 [0.5,1.9], p=0.001), phosphatidylethanol (263 [35, 784] vs. 0 [0, 163], p<0.001), MELD-3.0 and Sodium scores for patients with alcohol-associated hepatitis and cirrhosis (16 [11, 18.75] vs. 12 [9, 14], p<0.001), 14 [9.25, 17.75] vs. 11 [8.5, 14], p<0.001), and Child-Turcotte-Pugh scores for patients with cirrhosis (9 [6, 10.5] vs. 7 [6, 9], p<0.001). The proportion of patients with active-severe alcohol use disorder significantly decreased (85.2% vs. 51.9%, p<0.001). Additionally, patients had significant reductions in emergency department utilization (incidence rate ratio of 0.64 emergency department visits/month (p=0.002) and 0.71 hospital admissions/month (p=0.025). However, after considering the false discovery rate, the reduction in hospitalization admissions/month was not statistically significant (False Discovery Rate adjusted p=0.056).

Conclusions:

Our integrated approach led to reductions in liver injury, degree of liver decompensation, alcohol use, and ED utilization, and remission in AUD in a population of both non-transplant ALD and post-transplant patients.
Assessing the relationship between sex, gender, and hypertension: A federated analysis of European and Canadian Public Health Surveys
Authors: Azizi Zahra , Linder Simon , Ruiz María del Carmen Macías , Alipour Pouria , Raparelli Valeria , Norris Colleen M. , Kublickiene Karolina , Kautzky-Willer Alexandra , Klimek Peter , El Emam Khaled , Fernandez Villalba Emiliano , Herrero Maria Trinidad , Pilote Louise
Published: February 2025

While gendered psycho-socio-cultural factors are recognized as major determinants of cardiovascular health, their contribution to our understanding of their effect on hypertension (HTN) in each country is poorly understood. Therefore, we investigated the role of these factors in HTN prevalence, focusing on sex- and gender-specific differences across countries. Data from the Canadian Community Health Survey (2015–2016, N = 109,659, women: 56.6%) and the European Health Interview Survey (2013–2015, N = 316,333, women: 51.3%) were analyzed. Primary endpoint was defined as HTN prevalence within 1-year. Relationship and interaction between sex, gender, and country with HTN prevalence were assessed using multivariate models. Federated analysis was conducted using DataShield. Prevalence of HTN was higher in Canada compared to Europe (30.1% vs 22.4%, P < .001). Amongst European countries, living in the Central-East region was associated with a greater risk of developing HTN. Women in the southern and central-east regions had higher prevalence of HTN. There was a significant interaction between socioeconomic status and sex in country-stratified analysis. This was more evident in central-east and southern countries compared to northern, western nations and Canada, where women with lower socioeconomic status, income, and education had a greater risk of developing HTN. Similar trends were observed regardless of country in women who were divorced or widowed. While immigrants were at higher risk of HTN, those in northern and southern Europe were at lower risk compared to central-east region. Sex- and gender-related factors and country should be considered in the prevention and control of HTN.
TTF-1 and p40 co-expressing non-small cell lung cancer with ERBB2 and TP53 gene mutations: A case report and review of the literature
Authors: Sun Jiachun , Shi Haolin , Sun Bo , Wei Tingting , Su Jingxiang , Liu Hongyan , Wang Dengkui , Li Xinyang
Published: February 2025

Rationale:

Non-small cell lung cancer (NSCLC) that co-expresses thyroid transcription factor-1 (TTF-1) and p40 represents a distinct subtype of lung cancer. This case report details a 53-year-old male patient with NSCLC exhibiting co-expression of TTF-1 and p40, highlighting the need for further investigation into this unique presentation of NSCLC.

Patient concerns:

A 53-year-old male, nonsmoker, presented to our hospital in November 2023 with complaints of cough, expectoration, chest pain, and dyspnea.

Diagnoses:

Computed tomography scans revealed perihilar lesions in the upper lobe of the right lung with distal obstructive pneumonia, invasion into adjacent mediastinal structures, multiple pulmonary metastases, possible mediastinal and right hilar lymph node metastases, pleural effusion, and a slightly thickened pleura in the right lung, along with multiple metastatic lesions in the liver. Immunohistochemical analysis showed positive staining for CK (AE1/AE3), TTF-1, and p40, while CK56, CD68, CD45 (LCA), D2-40, and Ki-67 (50%+) were negative, leading to the diagnosis of lung adenocarcinoma. Second-generation sequencing identified mutations in ERBB2 (EXON20.p.Y772-A775dup) and TP53 (EXON5.c.404G-Tp.C135F).

Interventions:

The patient underwent 6 cycles of chemotherapy with a regimen consisting of bevacizumab, pemetrexed, and carboplatin.

Outcomes:

Posttreatment evaluations on December 28, 2023, and February 25, 2024, indicated stable disease. The patient is currently on a maintenance chemotherapy regimen of bevacizumab and pemetrexed, and his condition is stable.

Lessons:

The co-expression of TTF-1 and p40 in NSCLC may define a novel subtype of lung cancer. Further research is imperative to elucidate its characteristics, molecular mechanisms, and to establish its morphological features and therapeutic strategies.
Application and effect evaluation of microsurgical resection combined with intensity-modulated radiation therapy in the treatment of intracranial solitary fibrous tumor/hemangiopericytoma
Authors: Jiang Jingcheng , Qu Xiaoqin , Wang Han , Zhang Chao , Deng Qingshan , Xu Xiaoping , Qiu Jun , Qu Lihua , Yi Yong
Published: February 2025

Intracranial solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) are rare mesenchymal tumors with significant vascularization, often misdiagnosed as meningiomas. Surgical resection is the primary treatment, with postoperative radiotherapy increasingly recognized for its role in improving recurrence-free survival. However, standard radiotherapy regimens remain undefined. We retrospectively analyzed clinical data from 12 patients diagnosed with SFT/HPC who underwent surgical resection and postoperative intensity-modulated radiotherapy. Clinical information, imaging findings, treatment methods, and outcomes were reviewed. Surgical resection achieved complete or subtotal tumor removal in all cases. Postoperative radiotherapy was administered to 8 patients. During follow-up, 3 patients experienced tumor recurrence, necessitating reoperation, while 1 patient died due to complications. Those who received radiotherapy showed a trend towards reduced recurrence. Surgical resection remains the cornerstone of SFT/HPC treatment, with adjuvant radiotherapy potentially improving outcomes. However, individualized treatment strategies and long-term follow-up are crucial due to the tumor’s propensity for recurrence. Further research is needed to optimize treatment approaches and enhance patient survival and quality of life.