bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Serum Biomarkers Associated With Pediatric Hepatic Encephalopathy: A Systematic Review
Authors: Krishnan Kavita , Rao Mahil , Chang Nathan , Casazza May , Rasmussen Lindsey K.
Published: April 2023

Background:

The pathophysiology of pediatric hepatic encephalopathy (HE) is not well understood. Various serum biomarkers associated with HE may provide insight into its pathology, but their use and interpretation in clinical practice for diagnosis and prognostication remain undetermined. We sought to investigate reported correlations of serum biomarkers with presence and degree of HE in children.

Methods:

We conducted a systematic review of studies examining novel serum biomarkers and cytokines in association with HE that included children on PubMed, Embase, Lilacs, and Scopus. We utilized Covidence for abstract and text review by 2 independent reviewers for each study.

Results:

We reviewed 2824 unique publications; 15 met criteria for inclusion. Categories of biomarkers reported were inflammatory cytokines, products of amino acid metabolism, trace elements and vitamins, and hepatic and neuro biomarkers. Of 19 individual biomarkers, only 5 were measured in more than 1 study. Elevations in interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were most commonly reported as associated with HE. Notably, we observed lower average IL-6 and TNF-alpha levels in pediatric-only studies compared to mixed age studies. Overall, high bias and poor applicability to our review question was observed. We encountered low numbers of studies with pediatric focus, and few conducted with low bias study designs.

Conclusion:

Investigated biomarkers span a large range of categories and suggest potentially useful correlations with HE. Further well-designed prospective biomarker research is necessary to better elucidate the pathogenesis of HE in children and improve early detection and clinical care.
An extended SEIRDV compartmental model: case studies of the spread of COVID-19 and vaccination in Tunisia and South Africa
Authors: Tamasiga Phemelo , Onyeaka Helen , Umenweke Great C. , Uwishema Olivier
Published: April 2023

In the wake of the unprecedented health crisis triggered by the global COVID-19 pandemic, countries are still grappling with the pandemic’s immediate health and socioeconomic consequences. This paper presents an extended SEIRD model with vaccination to study the evolution of COVID-19 in South Africa and Tunisia since the commencement of the vaccination campaign in each country, respectively. Epidemiologists often quantify a risk reduction following the implementation of non-pharmaceutical containment measures and vaccines when attempting to stem the spread of pandemics. However, an important question they often ask is the effectiveness of the non-pharmaceutical containment measures (social distancing and lockdowns) and the efficacy of such measures, including vaccines. Africa’s COVID-19 vaccine roll-out stands at 16% as of April 2022; however, the continent lags behind many developing countries even though it harbours about 16% of the world population. While proliferating literature quantifies the efficacy and effectiveness of COVID-19 vaccines, very little has been done using the SEIRDV model in African countries. This study compares the model-predicted results with the available data to estimate the dynamics of the infected population, using data from 20-03-2021 to 30-12-2021. A simulation of the SEIRDV model is performed and fitted to the data. Simulating the model involves solving a system of Ordinary Differential Equations numerically by taking the initial values for the key model parameters as inputs. After simulating the SEIRDV model, the model parameters are compared with real-world COVID-19 and vaccination data in order to estimate the values of the different parameters that best fit the observed data. The results of the study showed an inverted U-shaped trend for the infection rate after vaccination, indicating that increasing the vaccination rates reduces the transmission rates. Therefore African countries must continue to scale up the vaccination campaigns, and the world needs to endeavour to ensure an equitable vaccination roll-out to developing countries.
Rising trends of foodborne illnesses in the U.S.: short communication
Authors: Nazir Abubakar , Ochani Sidhant , Nazir Awais , Fatima Bilquees , Ochani Khushi , Hasibuzzaman Md. Al , Ullah Kaleem
Published: April 2023

Foodborne illness is caused by the intake of food and water contaminated by different bacteria, viruses, and parasites, as well as poisons or toxins. Approximately 31 different pathogens are documented as causative organisms for causing foodborne illness outbreaks. Climatic changes and varying agricultural practices contribute significantly to the increased incidence of foodborne illness. Foodborne illness can also occur due to the utilization of improperly cooked food. The symptoms of food poisoning may appear sooner or later after contaminated food intake. Symptoms may vary among individuals depending on the disease severity. Despite continuous preventive measures, foodborne illness is still a significant public health threat in the United States. Frequent dining at fast-food restaurants and the use of processed foods present an immense risk of foodborne illness. The food supply in the United States is among the safest in the world, yet we see a surge in foodborne illnesses. People should be encouraged to wash their hands before cooking, and the utensils in which food is being prepared should be kept clean and washed properly before using them. Physicians and other healthcare professionals are facing a host of new challenges in responding to foodborne illnesses. Patients should seek a doctor immediately when they experience symptoms like blood in the stool, hematemesis, prolonged diarrhea for 3 or more days, severe abdominal cramping, and high fever.
Percutaneous coronary intervention versus coronary artery bypass grafting among patients with left ventricular systolic dysfunction: a systematic review and meta-analysis
Authors: Jaiswal Vikash , Ang Song Peng , Shrestha Abhigan Babu , Joshi Amey , Ishak Angela , Chia Jia Ee , Kanakannavr Sanchita Suresh , Naz Sidra , Doshi Neel , Nanavaty Dhairya , Gera Asmita , Kumar Vikash , Daneshvar Farshid , Song David , Rajak Kripa
Published: April 2023

Background:

Current guidelines have shown the superiority of coronary artery bypass grafting (CABG) over medical therapy. However, there is a paucity of data evaluating the optimal revascularization strategy in patients with ischemic left ventricular systolic dysfunction (LVSD).

Objective:

The authors aimed to evaluate the clinical outcomes of postpercutaneous coronary intervention (PCI) and CABG among patients with LVSD.

Methods:

The authors performed a systematic literature search using the PubMed, Embase, Scopus, and the Cochrane Libraries for relevant articles from inception until 30 November 2022. Outcomes were reported as pooled odds ratio (OR), and their corresponding 95% CI using STATA (version 17.0, StataCorp).

Results:

A total of 10 studies with 13 324 patients were included in the analysis. The mean age of patients in PCI was 65.3 years, and 64.1 years in the CABG group. The most common comorbidities included: HTN (80 vs. 78%) and DM (49.2 vs. 49%). The mean follow-up duration was 3.75 years. Compared with CABG, the PCI group had higher odds of all-cause mortality (OR 1.15, 95% CI 1.01–1.31, P=0.03), repeat revascularization (OR 3.57, 95% CI 2.56–4.97, P<0.001), MI (OR 1.92, 95% CI 1.01–3.86, P=0.048) while the incidence of cardiovascular mortality (OR 1.23, 95% CI 0.98–1.55, P=0.07), stroke (OR 0.73 95% CI: 0.51–1.04, P=0.08), major adverse cardiovascular and cerebrovascular events (OR 1.36, 95% CI 0.99–1.87, P=0.06), and ventricular tachycardia (OR 0.79, 95% CI 0.22–2.86, P=0.72) was comparable between both the procedures.

Conclusion:

The results of this meta-analysis suggest that CABG is superior to PCI for patients with LVSD. CABG was associated with a lower risk of all-cause mortality, repeat revascularization, and incidence of myocardial infarction compared with PCI in patients with LVSD.
Partial infraspinatus tear with bursitis following an mRNA vaccination: a case report
Authors: Chuaychoosakoon Chaiwat , Boonsri Pattira
Published: April 2023

Introduction and importance:

We report a case of a shoulder injury related to vaccine administration (SIRVA) that developed symptoms 2 weeks following a coronavirus disease 2019 (COVID-19) vaccination and improved after receiving both intraarticular and subacromial corticosteroid injections.

Presentation of case:

A 52-year-old Thai female without preexisting shoulder pathology and symptom had developed left shoulder pain for 3 days. Two weeks prior to shoulder pain, she received an mRNA COVID-19 vaccination. She positioned her arm in combined internal rotation with 60° of arm abduction. Her symptoms were pain in all directions of shoulder motion and tenderness at the bicipital groove and over the deltoid area. The testing of the rotator cuff power of the infraspinatus tendon showed pain.

Intervention and outcome:

An MRI showed infraspinatus tendinosis with a low-grade (almost 50%) bursal-surface tear at the footprint of the superior fiber with associated overlying subacromial–subdeltoid bursitis. She was treated with both intraarticular and subacromial corticosteroid injections (triamcinolone acetate (40 mg/ml) 1 ml+1% lidocaine with adrenaline 9 ml). She did not respond to oral naproxen but responded well to intraarticular and subacromial corticosteroid injections.

Relevance and impact:

The best way to deal with SIRVA is to prevent this condition by using the correct injection technique. First, the injection site should be two or three fingerbreadths below the mid-acromion process. Second, the needle’s direction should be perpendicular to the skin. Third, using the correct needle penetration depth.
Bowel obstruction in advanced tubo-ovarian cancer: a retrospective cohort study
Authors: Jansen Jolien , Oldenburger Eva , Jansen Jente , Wolthuis Albert , Van Nieuwenhuysen Els , Neven Patrick , Vergote Ignace , Han Sileny N.
Published: April 2023

Background:

Ten to fifty percent of women with advanced or recurrent ovarian cancer develop malignant bowel obstruction (MBO). We described the management and examined the complications and survival of MBO in primary epithelial tubo-ovarian cancer patients.

Materials and methods:

The authors conducted a retrospective monocentric cohort study of tubo-ovarian cancer patients diagnosed with MBO between January 1st, 2011 until August 31st, 2017 at the University Hospitals Leuven, Belgium.

Results:

Seventy-three patients with a total of 165 MBO episodes (median 1/patient; range 1–14) were included. The median time interval between cancer diagnosis and first MBO episode was 373 days (range 0–1937). The median time interval between MBO episodes was 44 days (range 6–2004). Complications were bowel perforation (n=5; 7%) and bowel ischemia (n=1; 1%). Conservative treatment was applied in 150 (91%) episodes, including gastrostomy in 4 (2%) episodes and octreotide in 79 (48%) episodes. Surgery was necessary in 15 (9%) episodes. Total parenteral nutrition was administered in 16 (22%) patients. During the study period 62 (85%) patients died (median 167 days since first MBO; range 6–2256). A significant difference in survival was found regarding the tumor marker CA 125 at cancer diagnosis, the use of palliative chemotherapy after the first episode of MBO and palliative surgical treatment for MBO in a group of well selected patients.

Conclusion:

Tubo-ovarian cancer patients with MBO have a poor prognosis: 85% of the study population died within a relatively short time interval since the first MBO. In our study population, the majority of patients with MBO were treated conservatively. Both palliative chemotherapy and palliative surgical management are considerable treatment options depending on the individual patient profile.
Clinical profile and dynamic magnetic resonance imaging in Hirayama disease: a single-centered cross-sectional study in Nepal
Authors: Ranabhat Kajan , Bhattarai Suman , Shrestha Ramesh , Maharjan Anzil Mani Singh , Bishokarma Suresh , Pudasaini Ashok , Thapa Lekh Jung
Published: April 2023

Introduction:

Hirayama disease (HD) is juvenile monomelic amyotrophy of the distal upper limb first described by Hirayama in 1959 AD. HD is a benign condition with chronic microcirculatory changes. The hallmark of HD is necrosis of the anterior horns of the distal cervical spine.

Materials and Methods:

Eighteen patients were assessed for clinical and radiological Hirayama disease. Clinical criteria included insidious onset nonprogressive chronic upper limb weakness and atrophy in teens or early twenties without sensory deficits and coarse tremors. MRI was done in a neutral position followed by neck flexion to evaluate cord atrophy and flattening, abnormal cervical curvature, loss of attachment between the posterior dural sac and subjacent lamina, anterior shifting of the posterior wall of the cervical dural canal, posterior epidural flow voids, and an enhancing epidural component with its dorsal extension.

Results:

The mean age was 20.33 years, and the majority, 17 (94.4%), were male. Neutral-position MRI revealed loss of cervical lordosis in 5 (27.8%) patients, cord flattening in all patients with asymmetry in 10 (55.5%), and cord atrophy was observed in 13 (72.2%) patients with localized cervical cord atrophy in only 2 (11.1%) and extension of atrophy to dorsal cord in 11 (61.1%) patients. Intramedullary cord signal change was seen in 7 (38.9%) patients. Loss of attachment of posterior dura and subjacent lamina and anterior displacement of dorsal dura was seen in all patients. A crescent-shaped epidural intense enhancement was noted along the posterior aspect of the distal cervical canal in all patients, with dorsal level extension in 16 (88.89%) patients. The mean thickness of this epidural space was 4.38±2.26 (mean±2SD), and the mean extension was 5.5±4.6 vertebral levels (mean±2SD).

Conclusion:

The high degree of clinical suspicion can guide additional contrast studies in flexion as a set MRI protocol for early detection and avoiding false negative diagnoses of HD.
Evidence-based guidelines on infection prevention and control in operation theatres for anesthetists in a resource-limited setting: systematic review/meta-analysis
Authors: Hailu Seyoum , Mulugeta Hailemariam , Girma Timsel , Asefa Amanuel , Regasa Teshome
Published: April 2023

Introduction:

Surgical site infections and nosocomial infections are the most frequent source of prolonged hospital stay and cross-contamination of infection in the operating room. Despite the perception, the operating rooms are not sterile environments as it has sterile and nonsterile areas, as well as sterile and nonsterile personnel. The contaminated environment, like the anesthesia environment, is the most potent transmission vehicle for pathogens.

Objective:

The objective of this review is to develop evidence-based guidelines on infection prevention and control in operation theaters for anesthesia care providers in a resource-limited setting.

Methodology:

This review is reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published in the English language were searched from different sources to identify studies for the review using the keywords. Database search was done by using Boolean operators like AND, OR, NOT, or AND NOT from Cochrane review, Hinari, PubMed, Google Scholar, and Medline databases, and filtering was made based on the intervention, outcome, data on population, and methodological quality. The conclusion was made based on the level of evidence that was referred to by the Oxford Center for Evidence-Based Medicine.

Results:

Generally, 1672 articles were identified through database searching strategies. Articles were searched by filtering systems such as publication year, level of evidence, and duplicates that were unrelated to the topics. Finally, 20 articles (9 randomized controlled trials, 4 meta-analyses and systematic reviews, 4 reviews, and 3 observational studies) were identified by using keywords from different databases by different search strategies from 10 July to 14 August 2022.

Conclusion:

As primary patient patrols anesthetists face significant infection risk and also contaminate the operating room environment. Precautions that are practical, affordable, and efficient in the anesthesia setting are needed considering the limited availability of personal protective equipment.
Surgical service and distance traveled drive patient preference for Care Hotel: a retrospective cohort study
Authors: Maniaci Michael J. , Chadha Ryan M , Fazio Jacey R. , Maita Karla C. , Love Ellen A. , Boyle Venessa L. , Heckman Michael G. , Johnson Patrick W. , Paulson Margaret R. , Forte Antonio J.
Published: April 2023

Background:

Mayo Clinic’s Care Hotel is a virtual hybrid care model which allows postoperative patients to recover in a comfortable environment after a low-risk procedure. Hospitals need to understand the key patient factors that promote acceptance of the Care Hotel if they are to benefit from this innovative care model. This study aims to identify factors that can predict whether a patient will stay at Care Hotel.

Materials and methods:

This retrospective chart review of 1065 patients was conducted between 23 July 2020, and 31 December 2021. Variables examined included patient age, sex, race, ethnicity, Charlson comorbidity index, distance patient travelled to hospital, length of surgery, day of the week of surgery, and surgical service. Associations of patient and surgery characteristics with the primary outcome of staying at the Care Hotel were assessed using unadjusted and multivariable logistic regression models.

Results:

Of the 1065 patients who met criteria for admission to the Care Hotel during the study period, 717 (67.3%) chose to stay at the Care Hotel while 328 (32.7%) choose to be admitted to the hospital. In multivariable analysis, there was a significant association between surgical service and staying at the Care Hotel (P<0.001). Specifically, there was a higher likelihood of staying at the Care Hotel for patients from Neurosurgery [odds rato (OR)=1.86, P=0.004], Otorhinolaryngology (OR=2.70, P<0.001), and General Surgery (OR=2.75, P=0.002). Additionally, there was a higher likelihood of staying at the Care Hotel with distance travelled over 110 miles [OR (per each doubling)=1.10, P=0.007].

Conclusion:

When developing a post-surgical care model for patients following outpatient procedures, the referring surgical service is a primary factor to consider in order to ensure patient acceptance, along with patient distance. This study can assist other healthcare organizations considering this model, as it provides guidance on which factors are most indicative of acceptance.
Personality Traits Interact With Sleep and Biological Rhythm in Patients With Bipolar Disorder
Authors: Keleş Altun İlkay , Yildizhan Eren , Kurtses Gürsoy Betül , Önen Sinay , Taymur İbrahim , Balaban Özlem Devrim , Atagün Murat İlhan
Published: April 2023

Sleep disturbances and circadian rhythm changes in bipolar disorder (BD) may have behavioral components as well as biological components. This study aimed to examine the relationship between personality traits, sleep and circadian rhythm in BD. A total of 150 participants with BD, and 150 healthy controls completed the Big Five Personality Test-50 (B5PT-50-TR), Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), Functioning Assessment Short Test (FAST), Pittsburgh Sleep Quality Index (PSQI), Young Mania Rating Scale and Beck Depression Inventory. In the BD group, B5PT-50-TR emotional stability and openness subscale scores were significantly lower in comparison with the healthy control group. Agreeableness and emotional stability subscales were covariates for the BRIAN sleep subscale and emotional stability was a covariate for PSQI total score. Emotional instability might be a vulnerability factor for sleep disorders and biological rhythm abnormalities in BD. Improvement in emotional instability may relieve sleep disorders and biological rhythm, thereby leading to better treatment outcomes in BD.
Overexpression of Podoplanin Predicts Poor Prognosis in Patients With Glioma
Authors: He Jie , Zhang Guangtao , Yuan Qing , Wang Songquan , Liu Zhidan , Wang Mingrong , Cai Hongqing , Wan Jinghai , Zhao Bing
Published: April 2023

High podoplanin (PDPN) expression correlates with poor prognosis in various cancers. However, the expression and clinical value of PDPN in glioma are unclear. In this study, PDPN expression was compared in 227 glioma tissues and 22 paired non-neoplastic tissues, and its association with prognostic factors was statistically analyzed. The effect of PDPN knockdown on the proliferation ability of glioma cells (U87MG and U118MG cell lines) was assessed along with the underlying molecular mechanism. Overexpression of PDPN was observed in the majority of glioma tissues compared with the expression in normal tissues. PDPN overexpression was positively correlated with IDH wild-type status, TERT promoter mutation status, and ATRX retention status, and was negatively correlated with 1p/19q codeletion status. The expression level of PDPN was positively correlated with the glioma grade in the diffuse astrocytoma, IDH wild-type. High PDPN expression was also negatively correlated with survival in astrocytoma patients with IDH mutation or wild-type and in glioblastoma patients with IDH wild-type. Grade, radiochemotherapy, and PDPN overexpression emerged as independent indicators for a poor prognosis of glioma patients. PDPN knockdown suppressed proliferation and reduced p-Akt and p-mTOR protein expression in glioma cells. PDPN is a potential biomarker or therapeutic target for glioma that is closely associated with tumor grade and poor prognosis, which may play a role in enhancing cell proliferation via Akt/mTOR signaling.
Asthma Cases Treated With Inhaled Anesthetics or Extracorporeal Membrane Oxygenation: A Virtual Pediatric Systems Database Study of Outcomes
Authors: Pineda Erika Y. , Sallam Mohammad , Breuer Ryan K. , Perez Geovanny F. , Wrotniak Brian , Swayampakula Anil Kumar
Published: April 2023

OBJECTIVES:

Extracorporeal membrane oxygenation (ECMO) and/or inhaled anesthetics (IAs) are considered in the management of asthma when refractory to conventional therapy. We aimed to compare the outcomes of these two modalities in asthma PICU care and determine associated survival to hospital discharge among patients in a United States database.

DESIGN:

Retrospective analysis using the Virtual Pediatric Systems (VPS, LLC) database.

SETTING:

PICUs participating in the VPS database.

PATIENTS:

Patients less than 18 years old with diagnosis of asthma treated with IA and/or ECMO from January 2010 to December 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 221 patients were included; 149 (67%) received ECMO, 62 (28%) received IA, and 10 (5%) received both interventions. We failed to identify any difference between the ECMO and IA groups in demographics, Pediatric Index of Mortality 2 percentage, Pediatric Risk of Mortality 3 score, Pediatric Logistic Organ Dysfunction score, or pre-intervention pH and Paco
2 levels. Use of ECMO versus IA was associated with lower pre-intervention Pao
2 (60 torr [7.99 kPa] vs 78 torr [10.39 kPa]; p < 0.001) and higher utilization of high-frequency oscillatory ventilation. We failed to identify an association between type of intervention (IA vs ECMO) and greater odds of survival (57/62 [92%] vs 128/149 [86%]; odds ratio [OR], 1.87; 95% CI, 0.67–5.21; p = 0.23). However, these data do not exclude the possibility that IA use is associated with more than five-fold greater odds of survival. ECMO use was associated with longer duration of intervention (5 vs 1.3 d; p < 0.001) and PICU length of stay (LOS) (13 vs 7 d; p < 0.001). As expected, ECMO versus IA was also associated with greater odds of undergoing bronchoscopy (34% vs 11%; OR, 3.7; 95% CI, 1.5–9.4; p = 0.004).

CONCLUSIONS:

In the VPS database of asthma management cases, we failed to identify an association between ECMO versus IA use and survival to hospital discharge. However, ECMO was associated with longer duration of intervention and PICU LOS.
Biomarker-Based Risk Stratification in Pediatric Sepsis From a Low-Middle Income Country*
Authors: Ishaque Sidra , Famularo Stephen Thomas , Saleem Ali Faisal , Siddiqui Naveed Ur Rehman , Kazi Zaubina , Parkar Sadia , Hotwani Aneeta , Thomas Neal J. , Thompson Jill Marie , Lahni Patrick , Varisco Brian , Yehya Nadir
Published: April 2023

Objectives:

Most biomarker studies of sepsis originate from high-income countries, whereas mortality risk is higher in low- and middle-income countries. The second version of the Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) has been validated in multiple North American PICUs for prognosis. Given differences in epidemiology, we assessed the performance of PERSEVERE-II in septic children from Pakistan, a low-middle income country. Due to uncertainty regarding how well PERSEVERE-II would perform, we also assessed the utility of other select biomarkers reflecting endotheliopathy, coagulopathy, and lung injury.

Design:

Prospective cohort study.

Setting:

PICU in Aga Khan University Hospital in Karachi, Pakistan.

Patients:

Children (< 18 yr old) meeting pediatric modifications of adult Sepsis-3 criteria between November 2020 and February 2022 were eligible.

Interventions:

None.

Measurements and Main Results:

Plasma was collected within 24 hours of admission and biomarkers quantified. The area under the receiver operating characteristic curve for PERSEVERE-II to discriminate 28-day mortality was determined. Additional biomarkers were compared between survivors and nonsurvivors and between subjects with and without acute respiratory distress syndrome. In 86 subjects (20 nonsurvivors, 23%), PERSEVERE-II discriminated mortality (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.72–0.94) and stratified the cohort into low-, medium-, and high-risk of mortality. Biomarkers reflecting endotheliopathy (angiopoietin 2, intracellular adhesion molecule 1) increased across worsening risk strata. Angiopoietin 2, soluble thrombomodulin, and plasminogen activator inhibitor 1 were higher in nonsurvivors, and soluble receptor for advanced glycation end-products and surfactant protein D were higher in children meeting acute respiratory distress syndrome criteria.

Conclusions:

PERSEVERE-II performs well in septic children from Aga Khan University Hospital, representing the first validation of PERSEVERE-II in a low-middle income country. Patients possessed a biomarker profile comparable to that of sepsis from high-income countries, suggesting that biomarker-based enrichment strategies may be effective in this setting.
Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus
Authors: Rochlin Danielle H. , Sheckter Clifford C. , Brazio Philip S. , Coriddi Michelle R. , Dayan Joseph H. , Mehrara Babak J. , Matros Evan
Published: April 2023

Introduction

Surgical treatment of lymphedema has outpaced coding paradigms. In the setting of ambiguity regarding coding for physiologic procedures [(lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT)], we hypothesized that there would be variation in commercial reimbursement based on coding pattern.

Methods

We performed a cross-sectional analysis of 2021 nationwide hospital pricing data for 21 Current Procedural Terminology (CPT) codes encompassing excisional (direct excision, liposuction), physiologic (LVB, VLNT), and ancillary (lymphangiography) procedures. Within-hospital ratios (WHRs) and across-hospital ratios (AHRs) for adjusted commercial rates per CPT code quantified price variation. Mixed effects linear regression modeled associations of commercial rate with public payer (Medicare and Medicaid), self-pay, and chargemaster rates.

Results

270,254 commercial rates, including 95,774 rates for physiologic procedures, were extracted from 2,863 hospitals. Lymphangiography codes varied most in commercial price (WHR 1.76 – 3.89, AHR 8.12 – 44.38). For physiologic codes, WHRs ranged from 1.01 (VLNT; free omental flap) to 3.03 (LVB; unlisted lymphatic procedure), and AHRs ranged from 5.23 (LVB; lymphatic channel incision) to 10.36 (LVB; unlisted lymphatic procedure). Median adjusted commercial rates for excisional procedures ($3,635.84) were higher than for physiologic procedures ($2,560.40; p<0.001). Commercial rate positively correlated with Medicare rate for all physiologic codes combined, though regression coefficients varied by code.

Conclusions

Commercial payer-negotiated rates for physiologic procedures were highly variable both within and across hospitals, reflective of variation in CPT codes. Physiologic procedures may be undervalued relative to excisional procedures. Consistent coding nomenclature should be developed for physiologic and ancillary procedures.
Use of Virtual Touch Tissue Quantification Elastography Technique in Fetal Lung Maturation
Authors: Arslan Harun , Küçükbaş Gökçe Naz , Türkoğlu Saim , Akdemir Zülküf , Yokuş Adem , Gündüz Ali Mahir , Karaman Erbil , Şahin Hanım Güler
Published: April 2023

This study is an analysis of fetal lung stiffness by virtual touch tissue quantification (VTTQ) elastography to predict fetal lung maturation. Evaluation of fetal lungs was first performed in B mode, and fetal lungs were analyzed at 3 different periods at third trimester in each pregnant woman, at 28 to 31, 32 to 36, and 37 to 41 weeks. Fetal lung elastography was performed at regions with the least acoustic shadow and far from ribs and heart. Each fetal lung assessment were done by taking mean lung stiffness obtained by measuring stiffness of both left and right fetal lungs. T test analysis showed no significant difference in fetal lung stiffness between male and female fetuses among 3 gestational periods. Analysis of variance was performed to evaluate fetal lung stiffness of the fetuses at 3 different gestational periods (28–31, 32–36, and 37–41 weeks). This analysis showed significant difference (P < 0.01). Duncan multiple comparison analysis did not show significant difference in fetal lung stiffness between 28 and 31 weeks and 32 and 36 weeks, whereas fetal lung stiffness of fetuses at 37 to 41 weeks were significantly greater (P < 0.01). This study is first step to analyze fetal lung maturation noninvasively using VTTQ elastography technique by measuring fetal lung stiffness.
False Absence of the Anterior Communicating Artery and a Median Artery of Corpus Callosum
Authors: Rusu Mugurel Constantin , Lazăr Mihai , Toader Corneliu
Published: April 2023

The anterior communicating artery (AComA) normally joins the anterior cerebral arteries (ACAs) when they change their directions from horizontal to vertical. Each postcommunicating segment of the ACAs commonly sends off the callosomarginal artery (CMA) and continues as the pericallosal artery. While documenting the archived computed tomography angiogram of a 61-year-old male patient, a rare anatomic variant was found to be associated with a previously unreported one. Both ACAs had symmetrical horizontal and vertical segments, but the AComA was absent from the usual location. The right ACA continued as CMA without sending off a pericallosal artery. A median artery of corpus callosum (MACC) left from the horizontal segment of the left ACA. Then the left ACA continued as CMA. At 1.9 cm from its origin, the MACC was united to the right CMA by a high, interhemispheric AComA. Therefore, an AComA should be regarded as absent only after documenting the bilateral anastomoses within the interhemispheric fissure. A third interhemispheric main artery, such as a rarely occurring MACC, could be accurately documented by computed tomography angiogram to avoid unpleasant intraoperative hemorrhage or to establish a personalized endovascular route to the anterior cerebral system.
Shewanella septentrionalis sp. nov. and Shewanella holmiensis sp. nov., isolated from Baltic Sea water and sediments
Authors: Martín-Rodríguez Alberto J. , Thorell Kaisa , Joffré Enrique , Jensie-Markopoulos Susanne , Moore Edward R. B. , Sjöling Åsa
Published: April 2023

Two bacterial strains, SP1W3T and SP1S2-7T, were isolated from samples of water and sediments collected in Vaxholm, a town located on the Stockholm archipelago in the Baltic Sea, in November 2021. The strains were identified as novel genomic species within the genus

Shewanella

, based upon comparative analysis of whole genome sequence data. Strain SP1W3T (genome size, 5.20 Mbp; G+C content, 46.0 mol%), isolated from water, was determined to be most closely related to

S. hafniensis

ATCC-BAA 1207T and

S. baltica

NCTC 10735T, with digital DNA–DNA hybridization (dDDH) values of 61.7% and 60.4 %, respectively. Strain SP1S2-7T (genome size, 4.26 Mbp; G+C content, 41.5 mol%), isolated from sediments, was observed to be most closely related to

S. aestuarii

JCM17801T, with a pairwise dDDH value of 33.8 %. Polyphasic analyses of physiological and phenotypic characteristics, in addition to genomic analyses, confirmed that each of these two strains represent distinct, novel species within the genus

Shewanella

, for which the names Shewanella septentrionalis sp. nov. (type strain SP1W3T=CCUG 76164T=CECT 30651T) and Shewanella holmiensis sp. nov. (type strain SP1S2-7T=CCUG 76165T=CECT 30652T) are proposed.
Streptomyces beihaiensis sp. nov., a chitin-degrading actinobacterium, isolated from shrimp pond soil
Authors: Xie Junjie , Zhang Hongyan , Xu Xia , Li Shiyong , Jiang Mingguo , Jiang Yi , Shen Naikun
Published: April 2023

A Gram-stain-positive actinobacterium, designated strain GXMU-J5T, was isolated from a sample of shrimp pond soil collected in Tieshangang Saltern, Beihai, PR China. The morphological, chemotaxonomic and phylogenetic characteristics were consistent with its classification in the genus

Streptomyces

. The organism formed an extensively branched substrate mycelium, with abundant aerial hyphae that differentiated into spores. Phylogenetic analysis of 16S rRNA gene sequences showed that strain GXMU-J5T was most related to

Streptomyces kunmingensis

DSM 41681T (similarity 97.74 %) and

Streptomyces endophyticus

YIM 65594T (similarity 96.80 %). However, the values of digital DNA–DNA hybridization, average nucleotide identity and evolutionary distance of multilocus sequence analysis between strain GXMU-J5T and its closest relatives indicated that it represented a distinct species. Strain GXMU-J5T contained ll-diaminopimelic acid and the major whole-cell hydrolysates were xylose and galactose. The predominant menaquinones of strain GXMU-J5T were revealed as MK-9(H4), MK-9(H6) and MK-9(H8). The polar lipids consisted of diphosphatidylglycerol, phosphatidylmethylethanolamine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol mannosides and phospholipids of unknown structure containing glucosamine. The predominant cellular fatty acids were iso-C15 : 0, anteiso-C15 : 0, iso-C16 : 0, iso-C17 : 0 and anteiso-C17 : 0. The whole genome size of strain GXMU-J5T was 6.79 Mbp with a 71.39 mol% G+C content. Genomic analysis indicated that strain GXMU-J5T had the potential to degrade chitin. On the basis of these genotypic and phenotypic data, it is supported that strain GXMU-J5T represents a novel species of the genus

Streptomyces

, for which the name Streptomyces beihaiensis sp. nov. is proposed. The type strain is strain GXMU-J5T (=MCCC 1K08064T=JCM 35629T).
SCGAN: Sparse CounterGAN for Counterfactual Explanations in Breast Cancer Prediction
Authors: Zhou Siqiong , Islam Upala J. , Pfeiffer Nicholaus , Banerjee Imon , Patel Bhavika K. , Iquebal Ashif S.
Published: April 2023

Imaging phenotypes extracted via radiomics of magnetic resonance imaging have shown great potential in predicting the treatment response in breast cancer patients after administering neoadjuvant systemic therapy (NST). Understanding the causal relationships between the treatment response and Imaging phenotypes, Clinical information, and Molecular (ICM) features are critical in guiding treatment strategies and management plans. Counterfactual explanations provide an interpretable approach to generating causal inference. However, existing approaches are either computationally prohibitive for high dimensional problems, generate unrealistic counterfactuals, or confound the effects of causal features by changing multiple features simultaneously. This paper proposes a new method called Sparse CounteRGAN (SCGAN) for generating counterfactual instances to reveal causal relationships between ICM features and the treatment response after NST. The generative approach learns the distribution of the original instances and, therefore, ensures that the new instances are realistic. We propose dropout training of the discriminator to promote sparsity and introduce a diversity term in the loss function to maximize the distances among generated counterfactuals. We evaluate the proposed method on two publicly available datasets, followed by the breast cancer dataset, and compare their performance with existing methods in the literature. Results show that SCGAN generates sparse and diverse counterfactual instances that also achieve plausibility and feasibility, making it a valuable tool for understanding the causal relationships between ICM features and treatment response.
How enhanced surveillance is helping Zanzibar get one step closer to malaria elimination: description of the operational platforms and resources for real-time case-based malaria surveillance
Authors: Mkali Humphrey R. , Lalji Shabbir M. , Al-mafazy Abdul-wahid , Joseph Joseph J. , Mwaipape Osia S. , Ali Abdullah S. , Abbas Faiza B. , Ali Mohamed H. , Hassan Wahida S. , Reaves Erik J. , Kitojo Chonge , Serbantez Naomi , Kabula Bilali I. , Nyinondi Ssanyu S. , McKay Mike , Cressman Gordon , Ngondi Jeremiah M. , Reithinger Richard
Published: April 2023

Testing and treating asymptomatic populations has the potential to reduce the population’s parasite reservoir and reduce malaria transmission. Zanzibar’s electronic malaria case notification (MCN) platform collects detailed socio-demographic and epidemiological data from all confirmed malaria cases to inform programmatic decision-making. This Field Action Report describes the design and operationalization process of the platform, as well as other malaria surveillance resources that are enabling Zanzibar to progress toward malaria elimination.

The MCN platform consists of an interactive short message service (SMS) system for case notification, a software application for Android mobile devices, a visual question set and workflow manager, a back-end database server, and a web browser-based application for data analytics, configuration, and management. Malaria case data were collected from August 2012 to December 2021 and reported via SMS from all public and private health facilities to a central database, and then to District Malaria Surveillance Officers’ mobile devices. Data included patient names, shehia and date of diagnosis, which enabled the officers to track patients, ideally within 24 hours of reporting. Patients’ household members were tested for malaria using conventional rapid diagnostic tests (RDTs). Treatment using artemisinin-based combination therapy was provided for persons testing positive.

Between 2012 and 2021, a total of 48,899 index malaria cases were confirmed at health facilities, 22,152 (45.3%) of whom within 24 hours of reporting; 41,886 (85.7%) cases were fully investigated and followed up to household level. A total of 111,811 additional household members were tested with RDTs, of whom 10,602 (9.5%) were malaria positive.

The MCN platform reports malaria case data in near real-time, enabling prompt testing and treatment of members in index case households. Along with routine testing and treatment and other preventive interventions, combined with comprehensive reactive-case detection efforts, the continued use of the MCN platform is likely to reduce malaria transmission and malaria morbidity even further, thereby enhancing malaria elimination in Zanzibar.
Usability and acceptability of a corneal-plane α-opic light logger in a 24-hour field trial
Authors: Balajadia Eljoh , Garcia Sophie , Stampfli Janine , Schrader Björn , Guidolin Carolina , Spitschan Manuel
Published: April 2023

Exposure to light fundamentally influences human physiology and behaviour by synchronising our biological clock to the external light-dark cycle and controlling melatonin production. In addition to well-controlled laboratory studies, more naturalistic approaches to examining these “non-visual” effects of light have been developed in recent years. As naturalistic light exposure is quite unlike well-controlled stimulus conditions in the laboratory, it is critical to measure light exposure in a person-referenced way, the ‘spectral diet’. To this end, light loggers have been developed to capture personalised light exposure. As an alternative to light sensors integrated into wrist-worn actimeters, pendants or brooch-based light loggers, a recently developed wearable light logger laterally attached to spectacle frames enables the measurement of biologically relevant quantities in the corneal plane. Here, we examine the usability and acceptability of using the light logger in an undergraduate student sample (n=18, mean±1SD: 20.1±1.7 yrs; 9 female; Oxford, UK) in real-world conditions during a 24-hour measurement period. We probed the acceptability of the light logger using rating questionnaires and open-ended questions. Our quantitative results show a modest acceptability of the light logger. A thematic analysis of the open-ended questions reveals that the form factor of the device, in particular, size, weight and stability, and reactions from other people to the wearer of the light logger, were commonly mentioned aspects. In sum, the results indicate the miniaturisation of light loggers and “invisible” integration into extant everyday objects as key areas for future technological development, facilitating the availability of light exposure data for developing personalised intervention strategies in both research, clinical and consumer contexts.
Acute heart failure patients with a high red blood cell distribution width-to-albumin ratio have an increased risk of all-cause mortality
Authors: Wang Shiwei , Xiao Qiang , Lin Quanqiang , Li Yuanmin
Published: April 2023

Background

Many studies have shown that specific blood markers, such as red cell distribution width (RDW) and albumin levels, can provide valuable information about the prognosis of patients with acute heart failure (AHF). In light of these findings, the current study aims to investigate the relationship between another blood marker, RDW to albumin ratio (RAR), and the prognosis of AHF patients.

Methods

Data on patients diagnosed with AHF were extracted from the MIMIC-IV database version 2.1. Patients were divided into three groups based on RAR tertiles.

Multiple imputation was used for missing data, and pooled analysis was performed for imputed data sets. This study used Cox regression analysis to evaluate the impact of RAR on Clinical Outcomes in AHF patients. To further assess the prognostic ability of RDW, RAR, and albumin, the study also used time-dependent receiver operating characteristic (time-ROC) analysis.

Results

This study enrolled 1432 patients with AHF, with a mean age of 72.4 years and a mean RAR of 5.07 ± 1.51% /g/dl. Patients with AHF had increased all-cause mortality when their RAR was higher (HR = 1.16, 95% CI: 1.10 ∼ 1.23, P < 0.001), and RAR and mortality from all causes were linearly related in patients with AHF (P non-linearity = 0.643). Based on time-ROC curves, it was discovered that RAR had a higher prognostic accuracy compared to RDW and albumin.

Conclusions

An increased level of RAR was associated with a poor all-cause mortality prognosis for patients with AHF, and there is a significant linear relationship. RAR was a better predictor of all-cause mortality in AHF patients than RDW and albumin.
Development of a Novel Serological Assay for the Detection of Mpox Infection in Vaccinated Populations
Authors: Yates Jennifer L. , Hunt Danielle T. , Kulas Karen E. , Chave Karen , Styer Linda , Chakravarthi Sandhya T. , Cai Gianna Y. , Bermúdez-González Maria C. , Kleiner Giulio , Altman Deena , Srivastava Komal ,   PVI study group, Simon Viviana , Feihel Dennis , McGowan Joseph , Hogrefe Wayne , Noone Philip , Egan Christina , Slifka Mark K. , Lee William T.
Published: April 2023

In 2022 the World Health Organization declared a Public Health Emergency for an outbreak of mpox, the zoonotic Orthopoxvirus (OPV) affecting at least 103 non-endemic locations world-wide. Serologic detection of mpox infection is problematic, however, due to considerable antigenic and serologic cross-reactivity among OPVs and smallpox-vaccinated individuals. In this report, we developed a high-throughput multiplex microsphere immunoassay (MIA) using a combination of mpox-specific peptides and cross-reactive OPV proteins that results in the specific serologic detection of mpox infection with 93% sensitivity and 98% specificity. The New York State Non-Vaccinia Orthopoxvirus Microsphere Immunoassay is an important diagnostic tool to detect subclinical mpox infection and understand the extent of mpox spread in the community through retrospective analysis.