bluuebunny/crossref_metadata_2025 huggingface dataset:
Studying individual-level interactions can transform our understanding of avian mixed-species flocks
Authors: Vander Meiden Laura N , Shizuka Daizaburo , Johnson Allison E
Published: April 2023

Avian mixed-species flocks are ubiquitous across habitats and a model for studying how heterospecific sociality influences the behavior and composition of animal communities. Here, we review the literature on mixed-species flocks and argue that a renewed focus on individual-level interactions among flock members can transform our understanding of this iconic, avian social system. Specifically, we suggest that an individual perspective will further our understanding of (1) how inter- and intraspecific variation in flock participation links to fitness costs and benefits, (2) the implications of familiarity between individuals in structuring mixed-species flock communities, and (3) how social roles within mixed-species flocks are related to social behavior within and across species. We summarize studies that use an individual perspective in each of these areas and discuss knowledge from conspecific social behavior to posit more broadly how individuals may shape mixed-species flocks. We encourage research approaches that incorporate individual variation in traits, relationships, and social roles in their assessment of mixed-species flocking dynamics. We propose that the analysis of individual variation in behavior will be particularly important for explicitly identifying fitness outcomes that led to the evolution of mixed-species flocks, which in turn affect community structure and resilience.
The impact of music, play, and pet therapies in managing pain and anxiety in paediatric patients in hospital: a rapid systematic review
Authors: Goren Katherine , Cen Yuchen , Montemurri Vanessa , Moodley Dirusha , Sutton Arielle , Ahmed Alveena , Alphonsus Lotus , Denezis Peter , Fleming Courtney , Guertin Hailey , Hyland Kiley , Kalim Ayesha , Kim Harry Hyunteh , Krause Sarah , Liang Aileen , Maclean Eleanor , Neocleous Penelope , Patel Arjun , Pritchard Sharon , Purcell Victoria , Qaqish Michael , Ryall Stephanie , Shum Kathryn , Suwary Kylie , Vucetic Andrea , Skinner Jamila , Woolsey Amadene , Marcotte Emily
Published: April 2023

Background

Hospitalized children face pain and anxiety associated with the environment and procedures.

Objective

This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible.

Methods

Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies.

Results

A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety.

Conclusion

Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.
Trust, Distrust, and ‘Medical Gaslighting’
Authors: Barnes Elizabeth
Published: April 2023

When are we obligated to believe someone? To what extent are people authorities about their own experiences? What kind of harm might we enact when we doubt? Questions like these lie at the heart of many debates in social and feminist epistemology, and they’re the driving issue behind a key conceptual framework in these debates—gaslighting. But while the concept of gaslighting has provided fruitful insight, it's also proven somewhat difficult to adjudicate, and seems prone to over-application. In what follows, I argue that Katherine Hawley's theory of trust can provide a useful alternative lens for looking at contested testimony. To do this, I focus on a particularly complex—but increasingly popular—application of gaslighting: the physician/patient relationship, and the idea of ‘medical gaslighting’. I argue that, even though patients can experience harm when they are disbelieved, there are nevertheless good reasons for physicians not to trust patients about at least some of their own narratives.
Analytical solutions for Bloch waves in resonant phononic crystals: deep-subwavelength energy splitting and mode steering between topologically protected interfacial and edge states
Authors: Wiltshaw R , De Ponti J M , Craster R V
Published: April 2023

We derive analytical solutions based on singular Green’s functions, which enable efficient computations of scattering simulations or Floquet–Bloch dispersion relations for waves propagating through an elastic plate, whose surface is patterned by periodic arrays of elastic beams. Our methodology is versatile and allows us to solve a range of problems regarding arrangements of multiple beams per primitive cell, over Bragg to deep-subwavelength scales; we cross-verify against finite element numerical simulations to gain further confidence in our approach, which relies upon the hypothesis of Euler–Bernoulli beam theory considerably simplifying continuity conditions such that each beam can be replaced by point forces and moments applied to the neutral plane of the plate. The representations of Green’s functions by Fourier series or Fourier transforms readily follows, yielding rapid and accurate analytical schemes. The accuracy and flexibility of our solutions are demonstrated by engineering topologically non-trivial states, from primitive cells with broken spatial symmetries, following the phononic analogue of the Quantum Valley Hall Effect. Topologically protected states are produced and coexist along: interfaces between adjoining chiral-mirrored bulk media, and edges between one such chiral bulk and the surrounding bare elastic plate, allowing topological circuits to be designed with robust waveguiding. Our topologically protected interfacial states correspond to zero-line modes, and our topological edgestates are produced in accordance with the bulk-edge correspondence. These topologically non-trivial states exist within near flexural resonances of the constituent beams of the phononic crystal and hence can be tuned into a deep-subwavelength regime.
Supplementation of ambient lighting with a task lamp improves daytime alertness and cognitive performance in sleep-restricted individuals
Authors: Grant Leilah K , Crosthwaite Phoebe C , Mayer Matthew D , Wang Wei , Stickgold Robert , St. Hilaire Melissa A , Lockley Steven W , Rahman Shadab A
Published: April 2023

Study Objectives

We examined the impact of adding a single-high-melanopic-illuminance task lamp in an otherwise low-melanopic-illuminance environment on alertness, neurobehavioral performance, learning, and mood during an 8-h simulated workday.

Methods

Sixteen healthy young adults [mean(±SD) age = 24.2 ± 2.9, 8F] participated in a 3-day inpatient study with two 8-h simulated workdays and were randomized to either ambient fluorescent room light (~30 melanopic EDI lux, 50 lux), or room light supplemented with a light emitting diode task lamp (~250 melanopic EDI lux, 210 lux) in a cross-over design. Alertness, mood, and cognitive performance were assessed throughout the light exposure and compared between conditions using linear mixed models.

Results

The primary outcome measure of percentage correct responses on the addition task was significantly improved relative to baseline in the supplemented condition (3.15% ± 1.18%), compared to the ambient conditions (0.93% ± 1.1%; FDR-adj q = 0.005). Additionally, reaction time and attentional failures on the psychomotor vigilance tasks were significantly improved with exposure to supplemented compared to ambient lighting (all, FDR-adj q ≤ 0.030). Furthermore, subjective measures of sleepiness, alertness, happiness, health, mood, and motivation were also significantly better in the supplemented, compared to ambient conditions (all, FDR-adj q ≤ 0.036). There was no difference in mood disturbance, affect, declarative memory, or motor learning between the conditions (all, FDR-adj q ≥ 0.308).

Conclusions

Our results show that supplementing ambient lighting with a high-melanopic-illuminance task lamp can improve daytime alertness and cognition. Therefore, high-melanopic-illuminance task lighting may be effective when incorporated into existing suboptimal lighting environments.

Clinical trials

NCT04745312. Effect of Lighting Supplementation on Daytime Cognition. https://clinicaltrials.gov/ct2/show/NCT04745312
Epidemiological and clinical features of the 2016–2018 Zika virus outbreak in northern Argentina
Authors: Byrne Alana B , Bonnin Florencia A , Bruno Agostina , Bono María Manuela , Contrini María Marta , López Eduardo L , Quipildor Marcelo O , Talarico Laura B
Published: April 2023

Background

During the American epidemic, Zika virus (ZIKV) expanded rapidly through dengue virus (DENV)-endemic regions. We analyzed the presentation of ZIKV infection in patients from the City of Orán, Argentina, and compared some of its features with dengue presentation in the same region.

Methods

A retrospective study was conducted at San Vicente de Paul Hospital during 2016–2018. Clinical and demographic characteristics, pre-existing immunity to DENV, viral load and type I interferon (IFN) responses were studied in 63 patients with ZIKV infection.

Results

Clinical manifestations of ZIKV infection were generally mild compared with dengue, although rash (p<0.001) and itching (p<0.001) were significantly more prevalent in ZIKV patients. ZIKV patients aged <15 y manifested relatively mild disease compared with older ZIKV patients, showing a decreased prevalence of headache (p=0.008), retro-orbital pain (p=0.001) and arthralgia (p=0.001). Increased Zika incidence was observed in female patients (60.3%). Serum viral load was low to undetectable in ZIKV patients and was not associated with serum anti-DENV IgG titers. Interferon-α and IFN-β serum levels did not correlate with serum viral load in ZIKV patients.

Conclusions

Clinical presentation of ZIKV and DENV infections is largely overlapping, presenting a challenge for diagnosis and risk assessment for uniquely at-risk populations.
MutaGAN: A sequence-to-sequence GAN framework to predict mutations of evolving protein populations
Authors: Berman Daniel S , Howser Craig , Mehoke Thomas , Ernlund Amanda W , Evans Jared D
Published: April 2023

The ability to predict the evolution of a pathogen would significantly improve the ability to control, prevent, and treat disease. Machine learning, however, is yet to be used to predict the evolutionary progeny of a virus. To address this gap, we developed a novel machine learning framework, named MutaGAN, using generative adversarial networks with sequence-to-sequence, recurrent neural networks generator to accurately predict genetic mutations and evolution of future biological populations. MutaGAN was trained using a generalized time-reversible phylogenetic model of protein evolution with maximum likelihood tree estimation. MutaGAN was applied to influenza virus sequences because influenza evolves quickly and there is a large amount of publicly available data from the National Center for Biotechnology Information’s Influenza Virus Resource. MutaGAN generated ‘child’ sequences from a given ‘parent’ protein sequence with a median Levenshtein distance of 4.00 amino acids. Additionally, the generator was able to generate sequences that contained at least one known mutation identified within the global influenza virus population for 72.8 per cent of parent sequences. These results demonstrate the power of the MutaGAN framework to aid in pathogen forecasting with implications for broad utility in evolutionary prediction for any protein population.
Occurrence of Root-Knot Nematode (Meloidogyne spp.) on Peppers in Hainan, China, and M. enterolobii and M. incognita Resistance of Common Cultivars
Authors: Long Haibo , Sun Yanfang , Chen Yuan , Pei Yueling , Feng Tuizi , Che Haiyan
Published: April 2023

Root-knot nematodes (Meloidogyne spp.) are the most economically damaging group of plant-parasitic nematodes. They are considered to be a major constraint of pepper (Capsicum annuum L.) crops worldwide. In China, Hainan Island is the main producer of pepper, where the climatic conditions and cropping patterns are favorable for infection by Meloidogyne spp. In this study, we conducted a detailed investigation of the occurrence, severity, and population distribution of root-knot nematodes infesting pepper throughout Hainan Island. We also tested the level of resistance to M. enterolobii and M. incognita of the common pepper cultivars in Hainan. Our results showed that root-knot nematodes belonging to M. enterolobii, M. incognita, and M. javanica were found in Hainan, and the dominant population was M. enterolobii, which is the predominant species in the tropical area. Notably, all the pepper cultivars in this study were highly susceptible to M. enterolobii, which is probably a reason for its rapid spread throughout Hainan. The pepper cultivars exhibited different levels of resistance to M. incognita. This study promotes the comprehensive understanding of the root-knot nematode distribution and host resistance level of Meloidogyne in Hainan, which will guide the effective control of root-knot nematodes.
Understanding Academic Self-Concept and Performance in Medical Education
Authors: Harrell Kelly M. , Rawls Meagan , Stringer J.K. , Edwards Cherie D. , Santen Sally A. , Biskobing Diane
Published: April 2023

Problem

Medical students’ academic self-concept (ASC) is an important factor in better understanding noncognitive mediators of performance in medical school. However, research is limited on ASC in medical students across multiple phases of undergraduate medical education curriculum. This pilot study explored the relationship between ASC and academic performance across different phases of a U.S. medical school curriculum, specifically at the end of the second (preclinical) and third (clinical) years.

Approach

Medical students across 2 cohorts at Virginia Commonwealth University School of Medicine, Richmond, Virginia, were surveyed using an ASC confidence subscale in 2019. Multiple linear regression analysis was conducted using medical student ASC scores in preclinical (n = 190) and clinical (n = 149) phases and performance data. Clinical performance was calculated through a weighted mean of clerkship grades based on the number of weeks for each clerkship.

Outcomes

Preclinical performance was related to ASC, gender, and performance after year 1. ASC scores varied significantly by gender in the preclinical cohort (P < .01), with men reporting higher ASC than women (mean [SD], 2.94 [0.41] vs 2.78 [0.38]). Significant gender differences in performance were found at the end of year 3 (P < .01), with women performing more favorably compared with men (mean [SD], 94.1 [59.04] vs 124.24 [64.54]). The relationship between ASC and performance at the end of year 2 suggested students with higher ASC perform better during their preclinical phase.

Next Steps

This pilot study supports future scholarship in 2 areas: (1) identification and assessment of additional factors that influence the relationship between ASC and academic performance across the entire undergraduate medical education curriculum and (2) development and implementation of evidence-based interventions to support student ASC and performance and enhance the learning environment. Analyzing longitudinal trends across multiple cohorts will drive evidence-based interventions at learner and programmatic levels.
The Utility of a Novel, Combined Biofeedback-Virtual Reality Device as Add-on Treatment for Chronic Migraine
Authors: Cuneo Ami , Yang Robin , Zhou Haoran , Wang Ke , Goh Sarah , Wang Yuntao , Raiti John , Krashin Daniel , Murinova Natalia
Published: April 2023

Objectives:

To determine if the frequent use of a combined biofeedback-virtual reality device improves headache-related outcomes in chronic migraine.

Materials and Methods:

In this randomized, controlled pilot study, 50 adults with chronic migraine were randomized to the experimental group (frequent use of a heart rate variability biofeedback-virtual reality device plus standard medical care; n=25) or wait-list control group (standard medical care alone; n=25). The primary outcome was a reduction in mean monthly headache days between groups at 12 weeks. Secondary outcomes included mean change in acute analgesic use frequency, depression, migraine-related disability, stress, insomnia, and catastrophizing between groups at 12 weeks. Tertiary outcomes included change in heart rate variability and device-related user experience measures.

Results:

A statistically significant reduction in mean monthly headache days between groups was not demonstrated at 12 weeks. However, statistically significant decreases in the mean frequency of total acute analgesic use per month (65% decrease in the experimental group versus 35% decrease in the control group, P<0.01) and depression score (35% decrease in the experimental group versus 0.5% increase in the control group; P<0.05) were shown at 12 weeks. At study completion, more than 50% of participants reported device satisfaction on a 5-level Likert scale.

Discussion:

Frequent use of a portable biofeedback-virtual reality device was associated with decreases in the frequency of acute analgesic use and in depression in individuals with chronic migraine. This platform holds promise as an add-on treatment for chronic migraine, especially for individuals aiming to decrease acute analgesic use or interested in nonmedication approaches.
Measures of Information Content during Anesthesia and Emergence in the Caenorhabditis elegans Nervous System
Authors: Chang Andrew S. , Wirak Gregory S. , Li Duan , Gabel Christopher V. , Connor Christopher W.
Published: April 2023

Background

Suppression of behavioral and physical responses defines the anesthetized state. This is accompanied, in humans, by characteristic changes in electroencephalogram patterns. However, these measures reveal little about the neuron or circuit-level physiologic action of anesthetics nor how information is trafficked between neurons. This study assessed whether entropy-based metrics can differentiate between the awake and anesthetized state in Caenorhabditis elegans and characterize emergence from anesthesia at the level of interneuronal communication.

Methods

Volumetric fluorescence imaging measured neuronal activity across a large portion of the C. elegans nervous system at cellular resolution during distinct states of isoflurane anesthesia, as well as during emergence from the anesthetized state. Using a generalized model of interneuronal communication, new entropy metrics were empirically derived that can distinguish the awake and anesthetized states.

Results

This study derived three new entropy-based metrics that distinguish between stable awake and anesthetized states (isoflurane, n = 10) while possessing plausible physiologic interpretations. State decoupling is elevated in the anesthetized state (0%: 48.8 ± 3.50%; 4%: 66.9 ± 6.08%; 8%: 65.1 ± 5.16%; 0% vs. 4%, P < 0.001; 0% vs. 8%, P < 0.001), while internal predictability (0%: 46.0 ± 2.94%; 4%: 27.7 ± 5.13%; 8%: 30.5 ± 4.56%; 0% vs. 4%, P < 0.001; 0% vs. 8%, P < 0.001), and system consistency (0%: 2.64 ± 1.27%; 4%: 0.97 ± 1.38%; 8%: 1.14 ± 0.47%; 0% vs. 4%, P = 0.006; 0% vs. 8%, P = 0.015) are suppressed. These new metrics also resolve to baseline during gradual emergence of C. elegans from moderate levels of anesthesia to the awake state (n = 8). The results of this study show that early emergence from isoflurane anesthesia in C. elegans is characterized by the rapid resolution of an elevation in high frequency activity (n = 8, P = 0.032). The entropy-based metrics mutual information and transfer entropy, however, did not differentiate well between the awake and anesthetized states.

Conclusions

Novel empirically derived entropy metrics better distinguish the awake and anesthetized states compared to extant metrics and reveal meaningful differences in information transfer characteristics between states.

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The Fate of the Bent Rod in Children With Osteogenesis Imperfecta
Authors: Fralinger David J. , Kraft Denver B. , Rogers Kenneth J. , Thacker Mihir M. , Kruse Richard W. , Franzone Jeanne M.
Published: April 2023

Background:

Osteogenesis imperfecta (OI) is a genetic disorder characterized by brittle bones and long bone deformity. Realignment and intramedullary rodding with telescopic rods are indicated for progressive deformity and can help prevent fractures. Rod bending is a reported complication of telescopic rods and a common indication for revision; however, the fate of bent lower extremity telescopic rods in the setting of OI has not been reported.

Methods:

Patients with OI at a single institution who underwent lower extremity telescopic rod placement with at least 1-year follow-up were identified. Bent rods were identified, and for these bone segments, we collected the location and angle of bend, subsequent telescoping, refracture, increasing angulation of bend, and date of revision.

Results:

One hundred sixty-eight telescopic rods in 43 patients were identified. Forty-six rods (27.4%) bent during follow-up, with an average angulation of 7.3 (range: 1 to 24) degrees. In patients with severe OI, 15.7% of rods bent compared with 35.7% in nonsevere OI (P=0.003). The proportion of bent rods was different between independent and nonindependent ambulators (34.1% and 20.5%; P=0.035). Twenty-seven bent rods (58.7%) were revised, with 12 rods (26.0%) revised early (within 90 d). The angulation of rods that were revised early was significantly higher than rods not (14.6 and 4.3 degrees, P<0.001). Of the 34 bent rods not revised early, the average time to revision or final follow-up was 29.1 months. Twenty-five rods (73.5%) continued to telescope, 14 (41.2%) increased in angulation (average 3.2 degrees), and 10 bones (29.4%) refractured. None of the refractures required immediate rod revision. Two bones had multiple refractures.

Conclusions:

Bending is a common complication of telescopic rods in the lower extremities of patients with OI. It is more common in independent ambulators and patients with nonsevere OI, possibly because of the increased demand placed on the rods. Rods with a small bend and maintained fixation can telescope and need not be an indication for immediate revision.

Level of Evidence:

Level III—Retrospective review.
Occupancy Rate of Pedicle Screw Below 80% is a Risk Factor for Upper Instrumented Vertebral Fracture After Adult Spinal Deformity Surgery
Authors: Oe Shin , Yamato Yu , Hasegawa Tomohiko , Yoshida Go , Banno Tomohiro , Arima Hideyuki , Ide Koichirou , Yamada Tomohiro , Nakai Keiichi , Kurosu Kenta , Matsuyama Yukihiro
Published: April 2023

Study Design.

Retrospective study.

Objective.

To determine whether an occupancy rate of a pedicle screw (ORPS) <80% in an upper instrumented vertebra (UIV) is a risk factor for UIV fracture (UIVF).

Summary of Background Data.

The ratio of the length of the pedicle screw to the anteroposterior diameter of the vertebral body at the UIV is defined as ORPS. Previous studies showed that the stress on the UIV is reduced to the greatest degree when ORPS is >80%. However, it remains unclear whether these results are clinically valid.

Patients and Methods.

A total of 297 patients who had undergone adult spinal deformity surgery were included in the study. The group with an ORPS ≥80% and <80% was defined as the H (n = 198) and L (n = 99) group, respectively. Propensity score matching and logistic regression analysis were used to evaluate the association between ORPS and the development of UIVF adjusting for confounders.

Results.

The mean age of both groups was 69 years. The average ORPS in the L and H groups was 70% and 85%, respectively. The incidence of UIVF was 30% in group L and 15% in group H (P < 0.01). In addition, the 99 patients in group H were subdivided into 2 groups according to whether the screws penetrated the anterior wall of the vertebral body: 68 patients had no penetration (group U), whereas 31 patients showed evidence of penetration (group B). A total of 10% and 26% of the patients in the U and B groups, respectively, experienced UIVF (P < 0.05). Logistic regression analysis indicated that ORPS <80% was significantly associated with UIVF (P = 0.007, odds ratio: 3.9, 95% CI 1.4–10.5).

Conclusion.

To reduce UIVF, screw length should be set with a target ORPS of 80% or higher. If the screw penetrates the anterior wall of the vertebral body, the risk of UIVF is greater.
Utility and Clinical Outcomes of Perioperative Inferior Vena Cava Filter Prophylaxis in Spine Surgery Patients
Authors: Makary Mina S. , Koso Mensur , Yoder Matthew
Published: April 2023

Study Design.

Single-center retrospective chart review study.

Objective.

This study aimed to assess the clinical outcomes of prophylactic inferior vena cava (IVC) filter use for pulmonary embolism (PE) prevention in spine surgery patients.

Summary of Background Data.

IVC filters can serve an important prophylactic role in preventing PE, though research involving spine surgery patients is sparse.

Materials and Methods.

This Institutional Review Board–approved single-center retrospective study assessed the characteristics and outcomes of patients who underwent spine surgery and received perioperative IVC filters for PE prophylaxis from January 2007 until December 2021. Clinical outcomes centered primarily on the occurrence of venous thromboembolism (VTE) as well as complications related to filter placement and retrieval. Thrombi that may have been entrapped by the filters were recorded incidentally on computed tomography or during the filter retrieval procedure.

Results.

This cohort included 380 spine surgery patients (female 51%/male 49%; median age, 61) who had received perioperative prophylactic IVC filters. The mean dwell time was 6.7 months (1–39 mo), with an overall 62% retrieval rate. Retrievals were further categorized by retrieval complexity, with 92% classified as routine and 8% as involving advanced removal techniques, while complications involved 1% (four retrievals) and were all minor. Regarding VTE event occurrence, deep vein thrombi (DVT) were experienced by 11% of patients in the postplacement period, with 1% (n=4) experiencing a PE. There were 11 incidences of thrombi that were found within or near the filters (2.9%). A multivariate analysis further assessed patient characteristics that correlated with the occurrence of PE, DVT, entrapped filter thrombi, advanced technique filter removal, and removal complications.

Conclusions.

IVC filters in this high-risk spine surgery cohort achieved a relatively low rate of DVT and PE as well as a low complication rate, whereas several patient characteristics were identified that correlated with VTE events and filter retrieval outcomes.
Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis
Authors: Ma Ye , You Wen , Cao Yang , He Xuxia , Wang Jing , Zhang Yuelun , Li Ji , Li Jingnan
Published: April 2023

Background:

Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents.

Methods:

We searched PubMed, Embase, and the Cochrane Library for studies published in English until October 31, 2021 that fit our inclusion criteria. We performed a systematic review and network meta-analysis to assess the comparative efficacy and safety of candidate agents (low-dose aspirin [Asp], high-dose Asp, cyclooxygenase-2 inhibitors [coxibs], calcium, vitamin D, folic acid, ursodeoxycholic acid [UDCA], estrogen, and progesterone, alone or in combination) for preventing colorectal adenoma and CRC. Cochrane risk-of-bias assessment tool was employed to evaluate the quality of each included study.

Results:

Thirty-two randomized controlled trials (278,694 participants) comparing 13 different interventions were included. Coxibs significantly reduced the risk of colorectal adenoma (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44–0.79, six trials involving 5486 participants), advanced adenoma (RR: 0.63, 95% CI: 0.43–0.92, four trials involving 4723 participants), and metachronous adenoma (RR: 0.58, 95% CI: 0.43–0.79, five trials involving 5258 participants) compared with placebo. Coxibs also significantly increased the risk of severe adverse events (RR: 1.29, 95% CI: 1.14–1.47, six trials involving 7109 participants). Other interventions, including Asp, folic acid, UDCA, vitamin D, and calcium, did not reduce the risk of colorectal adenoma in the general and high-risk populations compared with placebo.

Conclusions:

Considering the balance between benefits and harms, regular use of coxibs for prevention of colorectal adenoma was not supported by the current evidence. Benefit of low-dose Asp for chemoprevention of colorectal adenoma still requires further evidence.

Registration:

PROSPERO, No. CRD42022296376
Mismatched donor cell infusion-related syndrome following microtransplant in patients with acute myeloid leukemia
Authors: Cai Bo , Zou Xiaoyan , Ning Xin , Liu Tieqiang , Li Bingxia , Lei Yaqing , Qiao Jianhui , Hu Kaixun , Lei Yangyang , Liu Zhiqing , Yao Bo , Ai Huisheng , Wang Yi , Yu Changlin , Guo Mei
Published: April 2023

Background:

Immunotherapies such as adoptive immune cell infusion and immune-modulating agents are widely used for cancer treatment, and the concomitant symptoms, including cytokine release syndrome (CRS) or immune-related adverse events (irAEs), are frequently reported. However, clinical manifestations induced by mismatched donor granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell (GPBMC) infusion in patients receiving microtransplant (MST) have not yet been well depicted.

Methods:

We analyzed 88 cycles of mismatched GPBMC infusion in patients with acute myeloid leukemia receiving MST and 54 cycles of chemotherapy without GPBMC infusion as a comparison. Clinical symptoms and their correlation with clinical features, laboratory findings, and clinical response were explored.

Results:

Fever (58.0% [51/88]) and chills (43.2% [38/88]) were the significant early-onset symptoms after GPBMC infusion. Patients possessing less human leukocyte antigen-matching loci with the donor or those with unrelated donors experienced more chills (3 [2–5] loci vs. 5 [3–5] loci, P = 0.043 and 66.7% [12/18] vs. 37.1% [26/70], P = 0.024). On the other hand, those with decreased CD4+/CD8+ T-cell ratio developed more fever (0.8 [0.7–1.2] vs. 1.4 [1.1–2.2], P = 0.007). Multivariable analysis demonstrated that younger patients experienced more fever (odds ratio [OR] = 0.963, 95% confidence interval [CI]: 0.932–0.995, P = 0.022), while patients with younger donors experienced more chills (OR = 0.915, 95% CI: 0.859–0.975, P = 0.006). Elevated ultra-sensitive C-reactive protein levels in the absence of cytokine storm were observed following GPBMC infusion, which indicated mild and transient inflammatory response. Although no predictive value of infusion-related syndrome to leukemia burden change was found, the proportion of host pre-treatment activated T cells was positively correlated with leukemia control.

Conclusions:

Mismatched GPBMC infusion in MST induced unique infusion-related symptoms and laboratory changes, which were associated with donor- or recipient-derived risk factors, with less safety and tolerance concerns than reported CRS or irAEs.
Associations of cholecystectomy with the risk of colorectal cancer: a Mendelian randomization study
Authors: Chen Lanlan , Fan Zhongqi , Sun Xiaodong , Qiu Wei , Mu Wentao , Chai Kaiyuan , Cao Yannan , Wang Guangyi , Lv Guoyue
Published: April 2023

Background:

Cholecystectomy is a standard surgery for patients suffering from gallbladder diseases, while the causal effect of cholecystectomy on colorectal cancer (CRC) and other complications are still unknown.

Methods:

We obtained genetic variants associated with cholecystectomy at a genome-wide significant level (P value <5 × 10−8) as instrumental variables (IVs) and performed Mendelian randomization (MR) to identify the complications of cholecystectomy. Furthermore, the cholelithiasis was also treated as the exposure to compare its causal effects to that of cholecystectomy, and multivariable MR analysis was carried out to judge whether the effect of cholecystectomy was independent of cholelithiasis. The study was reported based on Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines.

Results:

The selected IVs explained 1.76% variance of cholecystectomy. Our MR analysis suggested that cholecystectomy cannot elevate the risk of CRC (odd ratio [OR] =1.543, 95% confidence interval [CI]: 0.607–3.924). Also, it was not significant in either colon or rectum cancer. Intriguingly, cholecystectomy might decrease the risk of Crohn's disease (OR = 0.078, 95% CI: 0.016–0.368) and coronary heart disease (OR = 0.352, 95% CI: 0.164–0.756). However, it might increase the risk of irritable bowel syndrome (IBS) (OR = 7.573, 95% CI: 1.096–52.318). Cholelithiasis could increase the risk of CRC in the largest population (OR = 1.041, 95% CI: 1.010–1.073). The multivariable MR analysis suggested that genetic liability to cholelithiasis could increase the risk of CRC in the largest population (OR = 1.061, 95% CI: 1.002–1.125) after adjustment of cholecystectomy.

Conclusions:

The study indicated that cholecystectomy might not increase the risk of CRC, but such a conclusion needs further proving by clinical equivalence. Additionally, it might increase the risk of IBS, which should be paid attention to in clinical practice.
Breast Implant-associated Anaplastic Large Cell Lymphoma after Breast Reconstruction for Breast Cancer
Authors: Mesa Felipe , Bernal Arrubla Julián , Javier Gallón Luis , Matute Turizo Gustavo , Caicedo Ruiz Diana Marcela
Published: April 2023

A patient initially operated on for aesthetic breast augmentation had a round-textured silicone gel prosthesis, Poly Implants Prothèse, placed in a subglandular plane. The patient developed a bilateral capsular contracture, and 4 years later, underwent a complete bilateral capsulectomy with an exchange of Mentor 215 cm3 textured cohesive silicone-gel ultra-high profile breast implants in the same subglandular plane. One year later, the patient developed cancer in the right breast, so it was decided to perform a bilateral mastectomy and reconstruction with 265 cm3 (left) and 310 cm3 (right) Natrelle (Allergan) round-textured silicone-gel implants in a submuscular plane. Seven years after the last surgery, the patient developed a seroma in the left breast (breast opposite to the one that developed the cancer), and seroma studies reported a CD30-positive anaplastic large cell lymphoma associated with the breast prosthesis. Therefore, bilateral capsulectomy and explantation of both implants with breast reconstruction with autologous tissue were performed.
The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population
Authors: van Kleef Laurens A. , de Knegt Robert J. , Ayada Ibrahim , Pan Qiuwei , Brouwer Willem Pieter
Published: April 2023

Background:

Noninvasive tests are important in the initial risk stratification of people at risk of fibrosis. The recently developed steatosis-associated fibrosis estimator (SAFE) score may have such potential but awaits external validation.

Methods:

We analyzed 6973 participants aged 18–80 in the National Health and Nutrition Examination Survey 2017-2020 cycle with data on liver stiffness and SAFE score without prevalent heart failure. Fibrosis was defined as liver stiffness ≥8.0 kPa. Accuracy was evaluated by AUC and assessment of test characteristics at the prespecified cutoffs for ruling out/ruling in fibrosis.

Results:

The SAFE score categorized 14.7% of the population as high risk, 30.4% as intermediate risk, and 54.9% as low risk for fibrosis. The actual fibrosis prevalence in these groups was 28.0%, 10.9%, and 4.0%, respectively, translating into a positive predictive value of 0.28 at the high-risk cutoff and a negative predictive value of 0.96 at the low-risk cutoff. The AUC of the SAFE score (0.748) was significantly higher than the fibrosis-4 index (0.619) or NAFLD fibrosis score (0.718). However, test performance strongly depended on age categories: 90% of participants aged 18–40 years were considered at low risk for fibrosis, including 89/134 (66%) of clinically significant fibrosis cases. In the oldest group (60–80 y), fibrosis could only be safely ruled out among 17%, corresponding to a high referral rate of up to 83%. The best SAFE score performance was found in the middle-aged group (40–60 y). The results were consistent in target populations with metabolic dysfunction or steatosis.

Conclusions:

The SAFE score has overall good diagnostic accuracy in detecting fibrosis but was highly dependent on age. The SAFE score lacked sensitivity in younger populations and the ability to rule out fibrosis in older populations.
Intravitreal Fluocinolone Acetonide Implant for Radiation Retinopathy: Report of Preliminary Findings
Authors: Singaravelu Janani , Oakey Zackery B. , Wrenn Jacquelyn M. , Singh Arun D.
Published: April 2023

Purpose:

To assess the efficacy of a 0.18 mg intravitreal fluocinolone acetonide (FA) implant (Yutiq, EyePoint Pharmaceuticals, Watertown, MA) as a treatment option for patients with radiation retinopathy-related cystoid macular edema (CME)

Methods:

A retrospective review of 7 patients treated for uveal melanoma who developed radiation retinopathy-related CME. They were initially treated with intravitreal anti-VEGF and/or steroid injections and then transitioned to intravitreal FA implant. Primary outcomes include BCVA, central subfield thickness (CST), and number of additional injections.

Results:

After FA implant insertion, BCVA and CST remained stable in all patients. The variance in BCVA decreased from 75.5 ETDRS letters (range 0-199 letters) to 29.8 (range 1.2-134) following FA implant insertion. Mean CST was 384 μm (range 165-641) and 354 μm (range 282-493) before and after FA implant insertion, resulting in a 30 μm mean reduction. The number of intravitreal injections (average 4.9, range 2-10) decreased following intravitreal FA implant insertion with only two patients requiring one additional FA implant (average 0.29, range 0-1) over a mean of 12.1 months (range 0.9-18.5) follow-up.

Conclusions:

Intravitreal FA implant is an effective treatment for CME radiation retinopathy. The slow release of steroid allows for sustained control of macular edema, which correlated with stable visual acuity and decreased injection burden for patients.
GROWTH OF A FOCAL SCLERAL NODULE
Authors: Fung Adrian T. , Li Ye
Published: April 2023

Purpose:

To report a case of a focal scleral nodule (FSN) that demonstrated growth over three years.

Methods:

Case report.

Results:

An asymptomatic emmetropic 15-year-old female patient was referred with an incidental finding of a left fundus lesion on routine examination. On examination, there was an isolated 1.9-mm (vertical) × 1.4-mm (horizontal) diameter-raised, circular, pale, yellow-white lesion with an orange halo located along the inferotemporal vascular arcade. Enhanced-depth imaging optical coherence tomography (EDI-OCT) demonstrated a focal protrusion of the sclera with thinning of the overlying choroid, consistent with focal scleral nodule (FSN). On EDI-OCT, the horizontal basal diameter measured 3138 μm, and its height was 528 μm. Three years later, the lesion had increased in size to 2.7-mm (vertical) × 2.1-mm (horizontal) diameter on color fundus photography and a horizontal basal diameter of 3991 μm and height of 647 μm on EDI-OCT. The patient remained systemically well without visual complaints.

Conclusion:

FSN can increase in size over time, suggesting that scleral remodeling within and around the lesion can occur. Longitudinal observation of FSN can help to inform its clinical course and shed insight into its pathogenesis.
Local analgesia of electroacupuncture is mediated by the recruitment of neutrophils and released β-endorphins
Authors: Shi Jing-tao , Cao Wan-ying , Zhang Xiao-Ning , Wan Hong-Ye , Su Yang-Shuai , Qu Zheng-Yang , Wang Rui , He Wei , Jing Xiang-Hong , Wang Xiao-Yu
Published: April 2023

The efficacy of acupuncture in treating pain diseases has been recognized in clinical practice, and its mechanism of action has been a hot topic in academic acupuncture research. Previous basic research on acupuncture analgesia has focused mostly on the nervous system, with few studies addressing the immune system as a potential pathway of acupuncture analgesia. In this study, we investigated the effect of electroacupuncture (EA) on the β-endorphins (β-END) content, END-containing leukocyte type and number, sympathetic neurotransmitter norepinephrine (NE), and chemokine gene expression in inflamed tissues. To induce inflammatory pain, about 200 µL of complete Frester adjuvant (CFA) was injected into the unilateral medial femoral muscle of adult Wistar rats. Electroacupuncture treatment was performed for 3 days beginning on day 4 after CFA injection, with parameters of 2/100 Hz, 2 mA, and 30 minutes per treatment. The weight-bearing experiment and enzyme-linked immunosorbent assay showed that EA treatment significantly relieved spontaneous pain-like behaviors and increased the level of β-END in inflamed tissue. Injection of anti-END antibody in inflamed tissue blocked this analgesic effect. Flow cytometry and immunofluorescence staining revealed that the EA-induced increase in β-END was derived from opioid-containing ICAM-1+/CD11b+ immune cells in inflamed tissue. In addition, EA treatment increased the NE content and expression of β2 adrenergic receptor (ADR-β2) in inflammatory tissues and upregulated Cxcl1 and Cxcl6 gene expression levels. These findings provide new evidence for the peripheral analgesic effect of acupuncture treatment by recruiting β-END–containing ICAM-1+/CD11b+ immune cells and increasing the β-END content at the site of inflammation.
Risk factors for refracture after proximal femur fragility fracture
Authors: Lourenço Beatriz C. , Amorim-Barbosa Tiago , Lemos Carolina , Rodrigues-Pinto Ricardo
Published: April 2023

Introduction:

Proximal femur fragility fractures (PFFFs) are a growing worldwide concern. Recognizing the risk factors for subsequent fracture is essential for secondary prevention. This study aimed to analyze the risk factors for refracture and mortality rates in patients who suffered a PFFF.

Methods:

Patients aged 65 years or older with PFFF who underwent surgical treatment during the year of 2017 in the same institution were retrospectively analyzed and at least four years after the index fracture were evaluated.

Results:

From a total of 389 patients, 299 patients were included, with a median age of 83 years, and 81% female. Thirty-two (10.7%) suffered a refracture, with a mean time to refracture of 19.8 ± 14.80 months, being the female sex a risk factor for refracture (OR-4.69; CI [1.05–20.95]). The 1-year mortality rate was 15.4%. Seventy-three (24.4%) patients had previous fragility fractures. After the index fracture, 79% remained untreated for osteoporosis. No statistical association was found between antiosteoporotic treatment and refracture. Patients with refracture had higher prefracture functional level compared with patients without refracture (OR-1.33; CI [1.08–1.63]) and were discharged more often to rehabilitation units (31% versus 16%, P =.028). After 4 years of follow-up, patients with refracture had lower functional level compared with patients without. Chronic kidney disease was a risk factor (P = .029) for early refracture (<24 months).

Conclusion:

Female sex and higher prefracture functional level may increase the risk of refracture. Chronic kidney disease was associated with a shorter refracture time. Despite having a PFFF or other fragility fractures, the majority of patients remained untreated for osteoporosis.
Total knee arthroplasty coronal alignment and tibial base stress—a new numerical evaluation
Authors: Vale João , Pinto Luisa V. , Barros Bianca , Diniz Sara , Rodrigues Filipe , Marques Marco , Belinha Jorge , Vilaça Adélio
Published: April 2023

Background:

Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures. The correct positioning and alignment of the components significantly affects prosthesis survival. Considering the current controversy regarding the target of postoperative alignment of TKA, this study evaluated the tension at tibial component interface using two numerical methods.

Methods:

The stress of the prosthesis/bone interface of the proximal tibial component was evaluated using two numerical methods: the finite element method (FEM) and the new meshless method: natural neighbor radial point interpolation method (NNRPIM). The construction of the model was based on Zimmers NexGen LPS-Flex Mobile® prosthesis and simulated the forces by using a free-body diagram.

Results:

Tibiofemoral mechanical axis (TFMA) for which a higher number of nodes are under optimal mechanical tension is between 1° valgus 2° varus. For values outside the interval, there are regions under the tibial plate at risk of bone absorption. At the extremities of the tibial plate of the prosthesis, both medial and lateral, independent of the alignment, are under a low stress. In all nodes evaluated for all TFMA, the values of the effective stresses were higher in the NNRPIM when compared with the FEM.

Conclusion:

Through this study, we can corroborate that the optimal postoperative alignment is within the values that are currently considered of 0 ± 3° varus. It was verified that the meshless methods obtain smoother and more conservative results, which may make them safer when transposed to the clinical practice.
Identifying Individual and Clinic Characteristics Associated With Primary Care Provider Turnover During Implementation of the Veterans Health Administration Patient-Centered Medical Home
Authors: Reddy Ashok , Maynard Charles , Kaboli Peter , Rinne Seppo T. , Henrikson Nora B. , Nelson Karin M. , Liu Chuan-Fen , Sterling Ryan , Wong Edwin
Published: April 2023

Understanding which factors predict primary care provider (PCP) turnover can help organizations prepare for PCP shortages. We conducted a retrospective cohort study of Veteran Health Administration PCPs between 2012 and 2016. We analyzed whether 7 domains of the patient centered medical home (PCMH) implementation—including access, care coordination, comprehensiveness, self-management support, communication, shared decision-making, and team-based care—were associated with PCP turnover. We found that 2 domains of PCMH (access and self-management) were associated with lower turnover, which may reflect that practice cultures that support these characteristics may lower PCP turnover.