bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Surgery Be Proposed to Adolescent Idiopathic Scoliosis Patients With Structural Lumbar Curves Associated With Nonreducible Iliolumbar Angle?
Authors: Focsa Laurentiu-Cosmin , Simon Anne-Laure , Finoco Mikael , Krausse Thomas , Ponchelet Louise , Ilharreborde Brice
Published: January 2025

Background:

Lower instrumented vertebra (LIV) selection for adolescent idiopathic scoliosis (AIS) with structural lumbar curves (Lenke 3, 5, and 6) remains debated. The iliolumbar angle (ILA) measurement is useful for assessing the lumbosacral junction flexibility. If it is nonreducible, surgeons need to make a difficult choice between a potential “imperfect” L4, associated with a residual lumbosacral curve, or a more distal fusion performed later in life due to poorer functional outcomes. The goal of this study was, therefore, to evaluate the postoperative radiographic and functional outcomes of AIS patients with nonreducible ILA.

Methods:

All consecutive AIS patients (2017 to 2022) with a structural lumbar curve and a posterior fusion ending on L4 were retrospectively included. Radiographic and functional outcomes (SRS-30 score) were reported with a minimum 2-year follow-up. Standing low dose stereoradiographs in both erect and maximum lateral bending positions were performed in all patients, and 2 groups of subjects were compared based on preoperative ILA flexibility [reducible group (R) or nonreducible group (NR)].

Results:

A total of 122 patients were included (30% NR and 71% R). At a mean follow-up of 2.3±0.1 years, surgery was efficient in correcting the major curve (77% reduction rate in the R group and 76% in the NR group, P<10-5), and significantly improved coronal balance (R, P<10-5 and NR, P=0.03) as well as the ILA [mean ILA gain 14 degrees (R group), P<10-5 and 16 degrees (NR group), P<10-5]. The proportion of excellent results was higher in the R group, but 97% of outcomes were either excellent or acceptable in the NR group, and only 1 case of poor result (residual ILA >10 degrees) was reported in each group. No significant difference was found in SRS 30 scores between groups, but scores were significantly improved in the NR group for the excellent outcomes’ subgroup [self-image (P=0.04) and satisfaction (P=0.02) domains].

Conclusions:

The current study confirms that posterior fusion ending on L4 can still be proposed to young AIS patients with structural lumbar curves, even if the lumbosacral flexibility is limited.

Level of evidence:

Level III—comparative study.
Effect of Low-Dose Methylprednisolone in Promoting Neurological Function Recovery after Spinal Cord Injury
Authors: Zhang Yu , Xiao Shining , Zhu Liangbo , Gan Xinrong , Huang Yongquan , Dan Fan , Chen Jiangwei , Zhou Rongping , Tang Wen , Liu Jiaming , Liu Zhili
Published: January 2025

Study Design.

Subgroup analysis of a retrospective clinical and animal trial [Study of different doses of methylprednisolone on functional recovery of spinal cord injury].

Objective.

The aimed to investigate the efficacy of low-dose methylprednisolone regimens in promoting neural repair after SCI.

Summary of Background Data.

Spinal cord injury (SCI) can result in sensory, motor, and autonomic nerve dysfunction, often leading to disability or death. Methylprednisolone (MP) is a preferred medication for clinical treatment of SCI. Low-dose regimen may be a safer and more effective approach.

Methods.

A subgroup comprising 705 patients with traumatic cervical SCI from four medical centers between January 2015 and December 2020 was retrospectively analyzed. Patients were stratified based on treatment regimen: low-dose methylprednisolone, high-dose methylprednisolone, or no methylprednisolone use. All patients underwent spinal decompression surgery. The degree of neurological recovery and the incidence of complications during follow-up were compared among these three groups. Additionally, we investigated the disparities in neurological function recovery, neuronal death, and neural axon regeneration between the low-dose and high-dose methylprednisolone treatment regimens using a SCI rat model.

Results.

Patients receiving the low-dose methylprednisolone regimen exhibited superior neurological recovery compared to those receiving the high-dose regimen and those not receiving methylprednisolone (82.0% vs. 74.0%, P=0.030; 82.0% vs. 63.4%, P=0.001). Moreover, patients in the low-dose methylprednisolone group demonstrated the lowest rates of perioperative pulmonary infections and gastrointestinal bleeding among these three groups. Evaluation of the SCI rat model through Basso-Beattie-Bresnahan (BBB) score, footprint analysis, electrophysiological tests, hematoxylin and eosin (H&E) staining, immunofluorescence staining, and Nissl staining further corroborated that the low-dose methylprednisolone treatment regimen enhanced transport function recovery, reduced neuronal death, and promoted neural axon regeneration.

Conclusion.

The low-dose methylprednisolone regimen may have a more positive therapeutic effect on the recovery of neurological function after SCI than other regimens.
Linking American Spine Registry (ASR) and Medicare Data:an analysis of 8,755 Lumbar Fusion Cases
Authors: Glassman Steven D. , Djurasovic Mladen , Asher Anthony L. , De Ayushmita , Murray Jayson , Safdar Aleeza , Porter Kimberly R. , Bydon Mohamad
Published: January 2025

Study Design.

Retrospective observational study.

Objective.

To evaluate whether the combined American Spine Registry and Medicare (ASR/CMS) data yields substantially different findings versus ASR data alone with regard to key parameters such as risk stratification, complication rates and readmission rates in lumbar surgery investigated through an analysis of 8,755 spondylolisthesis cases.

Summary of Background Data.

Medicare data correlation has been effective for determining revision rates for other procedures such as total hip replacement. Our aim is to determine whether these findings are translatable in the realm of lumbar spinal surgery investigated through an analysis of 8,755 spondylolisthesis cases.

Methods.

The American Spine Registry (ASR) was queried for Medicare-eligible patients who underwent lumbar spinal fusion for lumbar spondylolisthesis. This cohort was analyzed based upon ASR data alone in comparison to the same patients in the combined ASR/Medicare (ASR/CMS) dataset. The primary outcome of interest was readmission at 30 and 90 days postoperatively.

Results.

There were 8,755 Medicare-eligible cases with a diagnosis of spondylolisthesis within the ASR. The mean age was 72.7 years, 60.8% were female. Medical comorbidities were more frequently detected in the combined ASR/CMS dataset, reflected by a higher mean Charlson Comorbidity Index score (3.49 vs. 3.27, P<0.001). Hospital readmission rates were significantly higher in the combined ASR/CMS dataset at both 30 days (4.89% vs. 1.83%, P<0.001) and 90 days (7.68% vs. 2.66%, P<0.001), with notable increases in readmissions for infections and medical complications. Discharge disposition remained comparable across datasets, with most patients discharged to home or home health care.

Conclusion.

This study demonstrates that integrating patient-identified Medicare data with the ASR provides a more comprehensive assessment of outcomes for lumbar spinal fusion surgery as demonstrated through an analysis of 8,755 spondylolisthesis cases. These findings, establish the importance of multi-source data linkage to overcome the limitations of single-source registries, thereby enhancing data quality for clinical decision-making and quality improvement in spinal surgery.
Alcohol Abuse and Collagen Disruption
Authors: Chiapparelli Erika , Guven Ali , Amoroso Krizia , Lan Ranqing , Evangelisti Gisberto , Kohli Paul , Jan Hambrecht  , Verna Bruno , Tsuchiya Koki , Zhu Jiaqi , Shue Jennifer , Sama Andrew , Girardi Federico P. , Cammisa Frank P. , Hughes Alexander P.
Published: January 2025

Study Design.

Single-center cross-sectional analysis of a prospectively maintained database.

Background Context.

Alcohol abuse, defined by the NIAAA as excessive consumption leading to health risks, contributes significantly to tissue degeneration through the damaging effects of acetaldehyde. Collagen type I, a critical structural protein in skin and bone, degrades in parallel across tissue types. Recent studies have linked dermal ultrasound (US) echogenicity to bone quality, but evidence supporting its utility as a biomarker for tissue degeneration remains limited. This study hypothesizes that alcohol abuse correlates with increased dermal US echogenicity, decreased skin thickness (ST), and poor tissue quality, supporting the potential use of US for preoperative bone quality assessment.

Objective.

To investigate the relationship between skin US parameters and alcohol abuse in lumbar fusion patients.

Methods.

Patients undergoing lumbar fusion surgery with alcohol abuse (NIAAA criteria: >14 drinks/week in males, >8 in females) were included. Preoperative US measurements at two lumbar locations assessed echogenicity in the average dermal (AD), upper dermal (UD), and lower dermal (LD) layers. ST was measured at three dermal sites. Wilcoxon rank sum, Fisher’s Exact tests, and regression analyses adjusted for age, sex, and BMI were used (P<0.05).

Results.

Among 459 patients (50.5% male; median age 63.67 y; BMI 28.74 kg/m²), females exhibited higher US echogenicity (e.g., AD median 121 vs. 111.75, P<0.0001), while males had greater ST (2.97 vs. 2.65 mm, P<0.0001). Alcohol abuse was associated with increased LD echogenicity (14.86; P=0.038) and decreased ST (−0.35; P=0.034).

Conclusion.

Alcohol abuse correlates with dermal layer degradation, as indicated by increased echogenicity and reduced ST. These findings highlight the potential utility of skin US as a preoperative biomarker for bone quality in lumbar fusion patients, warranting further investigation to enhance clinical applications.
Treatment of Cutaneous Adnexal Carcinoma With Radiotherapy
Authors: Mohamed Nader , Mattessich Sarah , Gelblum Daphna Y. , Lee Nancy Y. , Barker Christopher A.
Published: January 2025

Objectives:

Cutaneous adnexal carcinomas (CACs) are rare skin cancers with no established treatment guidelines. Given the limited data, this study aims to explore the characteristics and outcomes of patients with CAC treated with radiation therapy (RT).

Methods:

Patients diagnosed with CAC between 2000 and 2020 who received RT were included. Kaplan-Meier methods measured time to local recurrence (LR), regional recurrence (RR), locoregional recurrence (LRR), distant metastasis (DM), and progression-free survival (PFS). Fisher exact test compared frequency distributions.

Results:

Forty-nine patients with an average age of 65 years were studied. Most were White males with head and neck tumors. Common subtypes were adnexal adenocarcinoma, sebaceous carcinoma, and microcystic adnexal carcinoma. Patients received RT diagnosis or recurrence. The median overall survival was 44 months, with a median follow-up of 41 months for surviving patients. For patients with de novo cancer treated with surgery and adjuvant RT (n=22), 2-year PFS, LR, RR, LRR, DM, and OS were 77%, 5%, 0%, 5%, 10%, and 95%, respectively, with all LRR occurring outside the irradiated area. Patients with de novo cancer who received definitive RT (n=9) experienced 2-year PFS, LR, RR, LRR, DM, and OS of 30%, 46%, 13%, 55%, 40%, and 67%, respectively, with all LRR events occurring within the irradiated area. LR within the irradiated volume was associated with immunosuppression (95% CI: 19-99). Patients treated at recurrence had inferior outcomes.

Conclusions:

Surgical resection and adjuvant RT effectively control CAC, while definitive RT shows lower disease control. Novel strategies are needed to improve outcomes in patients receiving definitive RT.
Mentorship in Plastic Surgery: A Systematic Review of the Current Literature and Elucidation of Recurring Themes
Authors: Stone Benjamin K. , Kung Theodore A. , Abbed Turkia , Lin Ines , Rao Vinay
Published: January 2025

Background:

Mentorship is an integral part of developing competent, passionate, and successful plastic surgeons and is an important element of surgeons’ wellness. Although mentorship programs have been described in the literature, this study aimed to elucidate the specific qualities of an effective mentor in plastic surgery.

Methods:

Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology was utilized to conduct a systematic review of the literature. A search of 3 electronic databases (PubMed including MEDLINE, Embase, and Cochrane Library) was performed for relevant studies up to June 15, 2024, using an advanced search for article titles and abstracts pertaining to plastic surgery and mentorship. Eligibility criteria included primary sources that explicitly commented on the qualities of an effective mentor in plastic surgery. A risk of bias assessment was performed using Joanna Briggs Institute critical appraisal checklists.

Results:

A total of 284 records were identified. After screening, the final sample contained 8 records. Conserved themes across studies included “time investment and accessibility” and “shared identities.” Effective mentors foster leadership, guide and teach mentees, and maintain accessibility. Underrepresented groups are more likely to publish with race-concordant mentors, and female mentees prioritize mentor-mentee concordance more than male mentees.

Conclusions:

Effective mentors are accessible to their mentees and invest time in developing their personal and professional goals. Identity concordances, such as shared values or shared life experiences, may be important in sustaining strong mentor-mentee relationships. The mentorship literature in plastic surgery would benefit from additional primary studies to better optimize mentorship programs.
Hepatocyte-derived liver progenitor-like cells attenuate liver cirrhosis via induction of apoptosis in hepatic stellate cells
Authors: Zhou Xu , Liu Wen-Ming , Sun Han-Yong , Peng Yuan , Huang Ren-Jie , Chen Cai-Yang , Zhang Hong-Dan , Zhou Shen-Ao , Wu Hong-Ping , Tang Dan , Huang Wei-Jian , Wu Han , Li Qi-Gen , Zhai Bo , Xia Qiang , Yu Wei-Feng , Yan He-Xin
Published: January 2025

Background:

Cell therapy demonstrates promising potential as a substitute therapeutic approach for liver cirrhosis. We have developed a strategy to effectively expand murine and human hepatocyte-derived liver progenitor-like cells (HepLPCs) in vitro. The primary objective of the present study was to apply HepLPCs to the treatment of liver cirrhosis and to elucidate the underlying mechanisms responsible for their therapeutic efficacy.

Methods:

The effects of allogeneic or xenogeneic HepLPC transplantation were investigated in rat model of liver cirrhosis. Liver tissues were collected and subjected to immunostaining to assess changes in histology. In vitro experiments used HSCs to explore the antifibrotic properties of HepLPC-secretomes and their underlying molecular mechanisms. Additionally, proteomic analysis was conducted to characterize the protein composition of HepLPC-secretomes.

Results:

Transplantation of HepLPCs resulted in decreased active fibrogenesis and net fibrosis in cirrhosis models. Apoptosis of HSCs was observed in vivo after HepLPC treatment. HepLPC-secretomes exhibited potent inhibition of TGF-β1-induced HSC activation and promoted apoptosis through signal transducer and activator of transcription (STAT)1-mediated pathways in vitro. Furthermore, synergistic effects between amphiregulin and FGF19 within HepLPC-secretomes were identified, contributing to HSC apoptosis and exerting antifibrotic effects via activation of the janus kinase-STAT1 pathway.

Conclusions:

HepLPCs have the potential to ameliorate liver cirrhosis by inducing STAT1-dependent apoptosis in HSCs. Amphiregulin and FGF19 are key factors responsible for STAT1 activation, representing promising novel therapeutic targets for the treatment of liver cirrhosis.
Adipokines regulate the development and progression of MASLD through organellar oxidative stress
Authors: Zhao Ke , Zhang Heng , Ding Wenyu , Yu Xiaoshuai , Hou Yanli , Liu Xihong , Li Xinhua , Wang Xiaolei
Published: January 2025

The prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), which is increasingly being recognized as a leading cause of chronic liver pathology globally, is increasing. The pathophysiological underpinnings of its progression, which is currently under active investigation, involve oxidative stress. Human adipose tissue, an integral endocrine organ, secretes an array of adipokines that are modulated by dietary patterns and lifestyle choices. These adipokines intricately orchestrate regulatory pathways that impact glucose and lipid metabolism, oxidative stress, and mitochondrial function, thereby influencing the evolution of hepatic steatosis and progression to metabolic dysfunction–associated steatohepatitis (MASH). This review examines recent data, underscoring the critical interplay of oxidative stress, reactive oxygen species, and redox signaling in adipokine-mediated mechanisms. The role of various adipokines in regulating the onset and progression of MASLD/MASH through mitochondrial dysfunction and endoplasmic reticulum stress and the underlying mechanisms are discussed. Due to the emerging correlation between adipokines and the development of MASLD positions, these adipokines are potential targets for the development of innovative therapeutic interventions for MASLD management. A comprehensive understanding of the pathogenesis of MASLD/MASH is instrumental for identifying therapies for MASH.
Discovery of a MET-driven monogenic cause of steatotic liver disease
Authors: e Vairo Filippo Pinto , Zimmermann Michael T. , Wagenknecht Jessica , Jorge Salomão Doria , Tian Shulan , Vierkant Robert A. , Luehrs Anthony C. , Milech de Assunção Thiago , Mathison Angela , Atwal Paldeep S. , Cao Yang , Allen Alina M. , Klee Eric W. , Urrutia Raul , Lazaridis Konstantinos N.
Published: January 2025

Background & Aims:

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects about a third of adults worldwide and is projected soon to be the leading cause of cirrhosis. It occurs when fat accumulates in hepatocytes and can progress to metabolic dysfunction-associated steatohepatitis (MASH), liver cirrhosis, and hepatocellular carcinoma. MASLD pathogenesis is believed to involve a combination of genetic and environmental risk factors. Single nucleotide polymorphisms have been implicated but non-syndromic monogenic causes are lacking.

Methods:

We identified a novel genetic variant in a familial case of MASH and performed deep variant functional analysis including protein modeling, dynamics, and cell-based assays to assess molecular mechanisms of dysfunction and altered cellular signaling. We analyzed exome sequencing data of 3,904 individuals with steatotic liver disease (SLD) to identify additional cases and establish the link between specific gene variants and SLD diagnosis.

Results:

We discovered and functionally validated the NM_000245.4:c.3505A>T; p.(Ile1169Phe) variant in the MET (mesenchymal epithelial transition) kinase domain as a monogenic cause of SLD. Subsequently, we detected additional ultra-rare, previously un-interpreted, and likely deleterious variants in MET from screening sequencing data. Among individuals with confirmed SLD based on electronic record review, 1.1% (45/3,904) had rare predicted deleterious MET variants. Eight of 45 (17.7%) individuals had predicted deleterious variants in the MET kinase domain confirmed to be functionally like the familial case variant.

Conclusions:

We report the first germline non-malignant rare MET-driven disease, a monogenic form of SLD.
Performance of Optic Disc Optical Coherence Tomography Normative Database in a Large, Diverse, Real-World Cohort
Authors: Ramachandran Rithambara , Lu Ming-Chen , Niziol Leslie M. , Woodward Maria A. , Elam Angela R. , Johnson Leroy , Kershaw Martha , Musch David C. , Bicket Amanda , John Denise , Dougherty Wood Sarah , Zhang Amy , Zhang Jason , O’Brien Joan , Newman-Casey Paula Anne
Published: January 2025

Precis:

Current optical coherence tomography normative sample data may not represent diverse human optic nerve anatomy to accurately classify all individuals with true glaucomatous optic neuropathy.

Purpose:

To compare optic nerve head (ONH) measurements between published values from an optical coherence tomography (OCT) normative database and a more diverse cohort of healthy individuals.

Patients and Methods:

ONH parameters from healthy participants of the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program and the Topcon Maestro-1 normative cohort were compared. Chi-square tests compared MI-SIGHT retinal nerve fiber layer (RNFL) quadrant color-code labels with the expected distribution and multinomial logistic regression identified factors associated with label classifications.

Results:

1084 MI-SIGHT and 399 Topcon eyes were evaluated. The MI-SIGHT cohort was older (54 v 46 y), with more individuals identifying as Black (61% v 20%), less as Hispanic (4% v 18%), and spherical equivalents closer to plano (−0.6 v −1.2 diopters) compared to the Topcon cohort (all P<0.001). Black/African American MI-SIGHT participants had larger cup-to-disc ratios and cup volumes, while White MI-SIGHT participants had smaller ONH values, except for rim area and rim volume, compared to Topcon participants (all P<0.001). The MI-SIGHT cohort’s RNFL color codes did not follow the expected distribution (P<0.05); more MI-SIGHT RNFL quadrant measurements were assigned as white (10.6% and 6.3% MI-SIGHT v 5% Topcon) and red codes (2.2% and 1.8% MI-SIGHT v <1% Topcon) than expected in the superior and inferior quadrants respectively.

Conclusion:

OCT normative databases should accurately reflect diverse populations to avoid misclassification by RNFL thickness color codes. Larger datasets should be leveraged to encompass the full spectrum of healthy optic nerve anatomy.
Is Well-being Associated with Burnout? From a Multi-center Cross-sectional Study in Taiwan
Authors: Wu Tse-Wei , Chuang Hung-Yi , Lin Chia-Pin , Lin Fa-Chen , Yang Chen-Cheng , Kazuhiro Watanabe , Kawakami Norito
Published: January 2025

Objective: This article aims to explore the correlation between well-being and burnout and analyze other potential predictors of burnout.

Methods: The analyses included 242 Taiwanese workers with a balanced gender ratio. Our study used the Chinese version of the Workplace PERMA (Positive Emotion, Engagement, Relationship, Meaning, Accomplishment) -Profiler for well-being assessment and the Chinese version of the Copenhagen Burnout Inventory (CBI) to assess the participants' burnout condition. The results of the questionnaire were analyzed for their correlations using linear regression.

Results: The well-being subscales significantly related to personal burnout were Positive Emotion and Engagement. For work-related burnout, the significantly associated well-being subscales were Positive Emotion, Engagement, and Relationships.

Conclusions: The results indicate that workplace well-being indeed correlates significantly with burnout. Different domains of well-being play different roles in burnout of workers.
Fragments of Community: Physician Assistant Student Perspectives on Experience of Community With Faculty
Authors: Romero Kaley , Love Elissa , Keyes Sarah-Ann
Published: January 2025

Introduction

Burnout is prevalent among both physician assistant (PA) students and faculty in the United States. Theories concerning the root cause of this burnout include a breakdown of community, which, in this context, serves as a framework comprising membership, influence, integration and fulfilment of needs, and shared emotional connection. A community framework has yet to be formally applied to the PA learning environment. The objective of this study was to explore the ways in which PA students experience community with faculty and how this perceived sense of community affects those students’ perceived well-being.

Methods

This was a qualitative study completed using semistructured, one-on-one virtual interviews with PA students of the graduating class of 2024 at one institution devised by using an interview guide created by the investigators based on a community framework. Interviews were recorded and transcribed by Microsoft Teams and analyzed using thematic analysis.

Results

Three major themes were produced from four participant interviews: (1) Students felt interactions with faculty were uniquely positioned to affect their well-being as influenced by their level of vulnerability as a student in a rigorous program; (2) students observed a wide range of faculty actions, values, and personality qualities that promoted a sense of community with faculty; and (3) students perceived a fragmentation between faculty members and the class itself, as well as between the two entities, which impaired their sense of community.

Discussion

PA students are vulnerable community members with a wide range of needs. Faculty interactions are crucial to meeting those needs. Future research can involve the recruitment of additional students, cohorts, or programs for diversified perspectives.
Retinal oculomics and risk of incident aortic aneurysm and aortic adverse events: a population-based cohort study
Authors: Li Cong , Huang Yu , Chen Jian , Hua Guangyao , Yang Fan , Cai Dongqin , Kuang Yu , He Xue , Wang Yan , Jiang Jianrong , Du Zhenchao , Peng Jingyan , Li Heng , Peng Zhishen , Huang Tengda , Ren Yun , Zhang Wenli , Liu Lei , Shi Danli , Luo Jianfang , Yu Honghua , Yang Xiaohong
Published: January 2025

Background:

The asymptomatic onset and extremely high mortality rate of aortic aneurysm (AA) highlight the urgency of early detection and timely intervention. The alteration of retinal vascular features (RVFs) can reflect the systemic vascular properties, and be widely used as the biomarker for cardiovascular disease risk prediction. Therefore, we aimed to investigate associations of RVFs with AA and its progression.

Methods:

In this prospective population-based cohort study, participants with eligible fundus images and without a history of AA at recruitment were included for analysis. A fully automated Retina-based Microvascular Health Assessment System was used to quantify multidimensional RVFs including the branching angle, caliber, complexity, density, length, and tortuosity. Univariable and multivariable Cox regressions were used to estimate the association of RVFs with the incidence of AA and aortic adverse events (AAE). Furthermore, propensity score matching was performed to mitigate the confounding effects of baseline characteristics.

Results:

During a median follow-up of 11.0 years, 306 incident AA (164 with abdominal AA and 108 with thoracic AA) and 48 incident AAE were documented. In the fully adjusted model, the retinal arterial branching angle (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.99) and the central tendency and variability of minimum venular caliber were significantly associated with the risk of incident AA (HR 1.13-1.15), while the venular minimum angular asymmetry (0.48, 0.30 to 0.77) was significantly associated with the incidence of AAE. Moreover, specific alterations of RVFs were observed in different AA subtypes (caliber in abdominal AA [HR 1.21]; caliber [HR 1.21-1.28], complexity, length, and tortuosity [HR 0.77-0.82] in thoracic AA). Similar results were obtained after propensity score-matched analysis, confirming the stability of these associations.

Conclusions:

We identified a significant association of certain RVFs with incident AA and AAE, implying that noninvasive, and convenient fundus photography could be a promising tool to facilitate the early detection of AA and subsequent preventative interventions.
Incidence and treatment of anastomotic leakage after esophagectomy in German acute care hospitals: a retrospective cohort study
Authors: Weber Marie-Christin , Jorek Nicolas , Neumann Philipp-Alexander , Bachmann Jeannine , Dimpel Rebekka , Martignoni Marc , Feith Marcus , Friess Helmut , Novotny Alexander , Berlet Maximilian , Reim Daniel
Published: January 2025

Background:

Anastomotic leakage (AL) is a major concern following esophagectomy due to the associated morbidity and mortality. The impact of hospital volume on postoperative outcomes after esophagectomy has previously been reported. The aim of this study was to analyze the current trends in postoperative anastomotic leakage and associated failure-to-rescue after esophagectomy in relation to hospital volume in German acute care hospitals using real-world data from the German Diagnosis-Related Groups (G-DRG) database.

Materials and methods:

A retrospective secondary data analysis of the G-DRG database was performed for all in-hospital cases of patients undergoing esophagectomy from 2013 to 2021. AL and in-house mortality rates were assessed in relation to hospital case volume and endoscopic treatment modalities.

Results:

The study included 32 335 cases. The mean reported AL rate was 17.1% with a mean failure-to-rescue rate of 18.9%. AL rates did not differ between hospitals with an annual case-volume ≤ 25 procedures/year vs. >25 procedures/year (16.8% vs. 17.6%, OR 1.06, P = 0.07). However, in high-volume centers (> 25 procedures/year), in-hospital mortality for cases with AL (failure-to-rescue) was lower compared to medium-volume (10-25 cases/year) and low-volume (1-9 cases/year) centers (14.2% vs. 21.5% vs. 25.1%). The use of EVT increased over time, reaching 58.1% of AL cases in 2021 compared to 14.2% in 2013, while the use of self-expanding metal stents (SEMS) decreased from 37.0% in 2013 to 9.3% in 2021.

Conclusions:

AL rates after esophagectomy remain high. In-house mortality is significantly lower in high-volume hospitals highlighting the importance to consider improvements in centralization of procedures. Further efforts are needed to reduce AL rates and improve outcomes after esophagectomy.
A Brief Intervention for Injury-Related Traumatic Stress: Results From a Feasibility Study
Authors: Bull Chelsey , Urban Kelly , Rohm Laura , Rohrer Stephanie , McBain Sacha A.
Published: January 2025

BACKGROUND:

Post-traumatic stress disorder (PTSD) significantly impacts post-injury quality of life; however, many injured patients struggle to access necessary psychosocial care. A brief intervention, Talk, Listen, Communicate to Recover (TLC to Recover), may facilitate access to psychosocial care in low resource trauma centers.

OBJECTIVE:

This study assessed staff and patient perceptions regarding the feasibility and acceptability of implementing TLC to Recover at a Level I trauma center.

METHODS:

This study used a mixed methods approach to examine the implementation of a brief dyadic intervention intended to mitigate the effect of potential post-injury mental health sequelae. The study took place from April 2021 to April 2024. Participants included adult patients who received post-injury care and were at risk for post-injury PTSD and/or depression. Outpatient trauma clinic staff participated in formative and summative evaluations of the intervention. Recruitment, retention rates, and engagement were assessed. Symptom measurements were administered to patients at baseline, two week follow-up, and one month to measure the effectiveness of TLC to Recover. Semistructured interviews and focus groups explored the acceptability of TLC to Recover among staff and patients. Summative template analysis was utilized to analyze qualitative data and integrated with the theoretical framework of acceptability.

RESULTS:

A total of N = 26 participants were included in the summative and formative evaluations, of which n = 15 were patients and n = 11 were clinic staff. The surgical clinic was an acceptable and feasible context to deliver a brief intervention to patients at risk for post-injury PTSD and/or depression.

CONCLUSION:

This study offers insight into opportunities for implementation of brief post-injury psychosocial interventions in a surgical context.
Gender-Based Analysis of Injury Types and Risk Factors in Professional Tennis Players – Insights for Prevention: A Concise Review
Authors: Nunes Espat Nikita , Breeding Tessa , Nasef Hazem , Amin Quratulain , Chin Brian , Elkbuli Adel
Published: January 2025

BACKGROUND:

Tennis is a globally popular sport offering physical benefits but poses a high risk of injury due to its demands and prolonged gameplay. While injuries are common among professional players, detailed injury data for this group is limited.

OBJECTIVE:

This review aims to analyze trends in the incidence, type, region, and onset of injuries in professional tennis players, with particular attention to gender distribution, to improve guidelines and reduce injury impacts on performance and career longevity.

DATA SOURCES:

PubMed, Google Scholar, Cochrane, ProQuest, and Embase were reviewed for relevant literature.

STUDY SELECTION:

Included studies evaluated various features of injuries in professional tennis players.

DATA EXTRACTION:

Studies were selected and included by agreement among the authors. The extracted data included incidence, type, affected body regions, and timing of onset of injuries in professional tennis players.

DATA SYNTHESIS:

Tennis is widely popular and physically beneficial but carries a high injury risk, with limited detailed data on professional players.

CONCLUSION:

The findings indicate a high incidence of acute lower limb, muscle, and tendon injuries among professional tennis players, with significant gender differences in injury patterns. These insights highlight the need for improved injury prevention strategies and further research into gender-specific injury mechanisms.
Value of Spleen Dynamic Contrast-enhanced Ultrasound Parameters in Predicting Hepatic Vein Pressure Gradient for Patients With Liver Cirrhosis
Authors: Zhou Tie , Zhou Yan , Zhao Lin , Kan Yanmin , Ding Jianmin , Sun Cheng , Jing Xiang
Published: January 2025

Goals:

To explore dynamic contrast-enhanced ultrasound (CEUS) parameters in predicting hepatic vein pressure gradient (HVPG) for patients with liver cirrhosis (LC).

Background:

Noninvasive diagnosis of HVPG remains a challenge.

Study:

This prospective study included patients with LC undergoing hepatic vein catheterization and pressure measurement at the hospital from May 2021 to January 2023. The CEUS images (Mindray Resona R9, 1-6-MHz probe frequency; mechanical index=0.08; image depth=10 cm; focus at the lowest point of the diaphragm; dynamic range=70 dB; optimal gain; single SonoVue bolus injection) were taken for 60 seconds after injection and analyzed using VueBox. HVPG (ie, the gold standard for portal hypertension) was measured routinely by catheterization.

Results:

Fifty patients with LC were included in the study. The rise time (r=0.6, P<0.01), the fall time (r=0.7, P<0.01), the peak time (r=0.6, P<0.01), wash-in area under the curve (AUC) (r=0.5, P<0.01), the wash-out phase AUC (r=0.4, P<0.01) and wash-in and wash-out phase AUC (r=0.4, P<0.01) of the dynamic spleen CEUS were positively correlated with HVPG. The optimal fall time cutoff levels to predict HVPG ≥10 mm Hg and ≥12 mm Hg were 27.0 and 36.4 seconds, with the AUC being 0.958 and 0.941, respectively. The optimal area under the wash-in area cutoff level to predict HVPG ≥10 mm Hg and ≥12 mm Hg was 1,658,967.38 (a.u) and 4,244,015.90 (a.u), with the AUC being 0.865 and 0.877, respectively.

Conclusions:

The fall time and wash-in AUC obtained by dynamic CEUS may help diagnose HVPG in patients with LC without requiring invasive hepatic vein catheterization.
Updated Adjustment of the HCAHPS Survey for New Modes of Survey Administration and Patient Mix
Authors: Elliott Marc N. , Beckett Megan K. , Hambarsoomian Katrin , Brown Julie , Cleary Paul , Lehrman William G. , Goldstein Elizabeth , Giordano Laura A. , Parast Layla
Published: January 2025

Background:

Web-first multimode survey protocols increase HCAHPS survey response rates and representativeness but may result in different HCAHPS scores because of survey mode effects and selective email address availability. A variable absent from many patient-mix adjustment models that may result in more positive patient experiences is whether the hospital admission was planned; adjustment for planned stays may better measure hospital performance.

Objectives:

Develop adjustments for new Web-first survey protocols and planned admissions to facilitate comparisons across hospitals.

Research Design:

Using 2021 survey mode experiment data, we estimate survey protocol effects in linear models predicting HCAHPS top-box outcomes from protocol indicators (which incorporate email availability for Web-first protocols), patient-mix adjustors, and hospital intercepts. We evaluate the unique effect on scores of whether a stay was planned.

Results:

Phone-only and Web-Phone without email produce more positive responses than Mail-only, requiring negative adjustments. All other survey protocol effects and adjustments are mixed in direction and generally small. Planned stays are associated with more positive experiences for otherwise similar patients and make a unique contribution beyond other current patient-mix adjustment variables.

Conclusions:

It is important to adjust HCAHPS scores for survey protocol effects to ensure fair comparisons across hospitals and to enable hospitals to choose the survey protocol that best represents their patients. Incomplete email address availability necessitates that HCAHPS survey protocol adjustment control for email address availability when a Web-first protocol is used. Accounting for differences associated with planned stays may improve patient-mix adjustment.
Retrospective comparative cohort analysis of Darn and Lichtenstein repair methods for bilateral inguinal hernias in adult males in a low-resource setting: a single-centre study in Sudan
Authors: Suliman Alsadig , Mohamed Osman Reem , Suliman Hiba
Published: January 2025

Background:

Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair – a mesh-free technique – offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment.

Materials and methods:

With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n = 30) and Group B (Darn, n = 45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up.

Results:

Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P = 0.014). It also had shorter operative times (mean 30 minutes less), reduced hospital stays (1.5 vs. 2.8 days, P < 0.0001), and lower costs. Recurrence rates were comparable across both groups.

Conclusion:

While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings
Wavefront aberrations in aging measured with Hartmann-Shack at 3- and 5-mm pupil sizes
Authors: Clark Christopher A. , Parimi Vamsi , Elsner Ann E.
Published: January 2025

SIGNIFICANCE

Visual acuity (VA) depends on many factors. When the goal is to assess retinal health rather than performance, then using a 3-mm pupil reduces unwanted wavefront aberrations. The axis of astigmatism can still potentially change with age.

PURPOSE

When VA measurements are intended to quantify the status of the retina, extraneous optical aberrations can make the measured VA worse and introduce variability, particularly in aging eyes. Our study quantifies wavefront aberrations for a 3-mm pupil, which is similar to the theoretical optical size for best VA, versus a 5-mm pupil.

METHODS

The wavefront aberrations of normally sighted adults (N = 39; age, 41.9 ± 16.3 years) were measured for a 3- and 5-mm pupil setting without pupil dilation, using a commercially available and semiautomatic instrument (Pentacam AXL WAV; Oculus Optikgeraete GmbH, Wetzlar, Germany). The mean wavefront errors from the average of three measurements with three samples each were computed for each Zernike term orders 1 to 6 and correlated with age. The difference of measurement 1 and measurement 2 provided the test-retest values.

RESULTS

Each 3-mm pupil measurements had a reduced average aberration for all 26 aberrations Zernike values, and 21 of 26 were statistically significant (p<0.05). The variability of the Zernike values was less for the 3-mm pupil than for the 5-mm pupil for all 26 measured aberrations pooled (Zernike orders 1 to 6), which was statistically significant (F = 54.625, p<0.001). Most mean aberrations did not vary significantly with age for a 3-mm pupil, except for vertical astigmatism, horizontal coma, spherical aberration, and vertical quadrafoil. Against-the-rule astigmatism was more common in subjects >60 than <40 years old (p=0.05).

CONCLUSIONS

The findings of this study indicate that measurements of VA to assess retinal health could be made less dependent on unrelated and unwanted anterior segment factors by using a 3-mm pupil, because the wavefront aberrations for a 3-mm pupil were less than those for a 5-mm pupil. The change with age in vertical astigmatism more than oblique is consistent with the expected increase in proportion of against-the-rule astigmatism.
Ultrasound-Guided Maxillary Nerve Block in Nasal Surgery
Authors: Vu Cindy , Willens Sierra Hewett , Alaniz Leonardo , Humphrey Ja’Neil G. , Shah Nikhil , Vyas Raj M. , Pfaff Miles J.
Published: January 2025

Summary / Unstructured Abstract:

Emphasis on enhanced recovery after surgery (ERAS) protocols and opioid use reduction have led to a growing interest in alternative pain management strategies. This study describes and evaluates the ultrasound-guided suprazygomatic maxillary (SZM) nerve blocks for patients undergoing functional and cosmetic nasal surgery as an adjunct to postoperative pain management. A retrospective, multicenter analysis was conducted on patients who underwent functional nasal surgery and rhinoplasty and evaluated the impact of SZM blocks on intraoperative anesthetic and opioid use, postoperative pain scores recorded in the PACU, and PACU length. A total of 64 patients met inclusion criteria. Twenty-five patients received a SZM block prior to undergoing the procedure while the remaining patients underwent standard local anesthetic use. SZM blocks significantly reduced the amount of intraoperative pain medication used (p = 0.02), including hydromorphone (p=0.007), when compared to a traditional approach to local anesthetic use. SZM blocks also significantly reduced post-anesthesia PACU stay at one institution (p=0.016). SZM nerve blocks are a simple and effective way to deliver local anesthetic and are associated with decreased intraoperative opioid use and PACU stay.
Spectrum of Otological Manifestations in Treacher Collins Syndrome: A Case Series of 9 Patients
Authors: Ansari Shehbaz , Basappa Eric R. , Markee Peter C. , Dixon Chanae , Bhabad Sudeep H.
Published: January 2025

Treacher Collins syndrome (TCS) is an uncommon congenital disorder predominantly involving craniofacial, orbital, and otological structures. The various ear malformations seen in 9 patients with TCS are described. TCS predominantly affects the external and middle ear structures, with inner ear structures being relatively spared, not unexpected given the dual embryological origin of the human ear. The external and middle ear malformations were categorized and graded as those involving the ear pinna, external auditory canal, tympanic cavity, ossicles, facial nerve canal, oval window, and bony labyrinth for all 9 patients. The ear malformations were symmetric in the majority, and the patients with higher grades of microtia were found to have a more severe category of other otological malformations.
Dynamic Contrast-enhanced MRI Processing Comparison for Distinguishing True Progression From Pseudoprogression in High-grade Glioma
Authors: Amer Ahmad , Ansari Shehbaz , Krayyem Apollo , Kundu Suprateek , Khose Swapnil , Pokhylevych Halyna , Calle Susana , Patel Chirag B. , Yang Zixi , Liu Ho-Ling “Anthony” , Johnson Jason M.
Published: January 2025

Background:

Treatment-related changes may occur due to radiation and temozolomide in glioblastoma and can mimic tumor progression on conventional MRI. DCE-MRI enables quantification of the extent of blood-brain barrier (BBB) disruption, providing information about areas of suspicious postcontrast T1 enhancement. We compared DCE-MRI processing methods for distinguishing true disease progression from pseudoprogression in high-grade gliomas (HGGs).

Methods:

We identified 110 patients with HGG treated with surgery and chemoradiation who underwent DCE-MRI to further interrogate areas of new/increasing enhancement. All patients had confirmatory surgery/biopsy with pathology-confirmed progression or pseudoprogression. Scans were performed at 3T and analyzed using nordicICE. The MCA, SSS, and Parker models are three standardized processing methodologies used to create ktrans maps, a parameter that quantifies BBB permeability. Three equal regions of interest were placed at sites of peak contrast enhancement within each lesion. Data from each method was processed for mean and maximum ktrans. We conducted several rounds of analysis and finalized a strategy on penalized support vector machines based on engineered features with bootstrap sampling.

Results:

The Parker method was significant for ktrans maximum in the combined pathology and clinical as well as the pathology-only data sets. MCA and SSS did not perform well under the SVM classifier for pathology only. For clinical follow-up subjects, the Parker method yielded statistically significant results for maximum and mean ktrans.

Conclusions:

The Parker method was effective in distinguishing PD and PsP for pathology and clinical data sets. MCA and SSS techniques were effective for the clinical data set.