bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Adverse Maternal Outcomes Among Pregnant Health Care Workers [ID 2683462]
Authors: Collins Ana M. , Smith Andrew
Published: May 2024

INTRODUCTION:

The objective of this study was to examine whether pregnant health care workers at are increased risk for adverse maternal outcomes in pregnancy.

METHODS:

A retrospective cohort study from 2008 to 2023 was conducted using TriNetX Research platform (de-identified patient data from a network of health care organizations) to identify pregnant health care workers. Using ICD codes, CPT codes, and LOINC codes, individuals were diagnosed with the presence or absence of the following conditions: fetal growth restriction, gestational diabetes mellitus, chronic hypertension, gestational hypertension, preeclampsia (with and without severe features), and postpartum depression. Descriptive statistics were used to analyze the data. The University of Texas Medical Branch IRB approved this study as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent.

RESULTS:

Among 1,553,793 patients, 34,099 were health care workers. Health care workers had increased incidences for the following adverse maternal outcomes: diet-controlled gestational diabetes (12.88% versus 9.95%; P<.001), oral hypoglycemic agent-controlled gestational diabetes (1.56% versus 1.02%; P<.001), insulin-controlled gestational diabetes (2.88% versus 1.73%; P<.001), gestational hypertension (3.04% versus 2.73%; P<.001), and preeclampsia with severe features (5.95% versus 4.23%; P<.001). Health care workers were at decreased incidences for fetal growth restriction, preeclampsia without severe features, and postpartum hemorrhage.

CONCLUSION:

Given that health care workers are at increased risk of several adverse maternal outcomes, it may be important for providers to screen health care workers more frequently for these adverse outcomes. Additional studies will need to be conducted using current identifiable electronic medical records.
Living in a Neighborhood With Limited Access to Broadband Internet Is Associated With Adverse Pregnancy Outcomes [ID 2683563]
Authors: Stamilio David M. , Kline David , Sakowicz Allie , Miller-Fitzwater Anna , Jensen Elizabeth T. , Cochrane Anna C.
Published: May 2024

INTRODUCTION:

The internet is an essential tool for ensuring health care access and delivery. We aimed to estimate the association between living in an area with limited broadband internet access and specific adverse pregnancy outcomes.

METHODS:

We performed an electronic health record-based retrospective cohort study of pregnant people who delivered at a referral medical center between September 1, 2019, and June 1, 2022. Primary outcomes were preterm birth, low birth weight (less than 2,500 g) and birth weight z-score for gestational age. Neighborhood internet access was defined as the proportion of residents with internet access in the pregnant person’s census tract of residence, based on the 2020 American Community Survey estimate and determined by geocoding. We used multivariable logistic or linear regression analysis to estimate the independent effect of internet access and computed adjusted odds ratios (aOR) or mean differences with 95% CIs for a 5-unit increase in the proportion with internet access for a given census tract.

RESULTS:

Among 5,190 pregnant people included, 885 (17.1%) had a preterm birth, 728 (14.0%) delivered a low-birth weight neonate, and 515 (9.9%) had a small-for-gestational age neonate. After adjusting for relevant confounders, increasing internet access was associated with reduced odds of preterm birth (aOR 0.97; 95% CI, 0.93–1.00; P=.048), reduced odds of low birth weight (aOR 0.95; 95% CI, 0.91–0.98), and increasing birth weight z-score (Beta 0.02; 95% CI, 0.01–0.03).

CONCLUSION:

Living in neighborhoods with better broadband internet coverage was associated with reduced odds of preterm birth, decreased odds of delivering a low-birth weight neonate, and increasing birth weight.
Comparison of Obstetrical Randomized Controlled Trials in the United States and Abroad [ID 2683467]
Authors: Koelker-Wolfe Ellery , Whelan Anna R. , Moody Rachel , Gupta Megha , Wagner Stephen
Published: May 2024

INTRODUCTION:

Research priorities and governing regulations differ between the United States and other nations (non-United States). This study compared the characteristics of U.S. and non-U.S. obstetric randomized controlled trials (RCTs).

METHODS:

Original research articles published in seven journals (NEJM, JAMA, The Lancet, AJOG, AJOG-MFM, BJOG, and Obstetrics & Gynecology) from 2017 to 2022 were examined, and all RCTs with an obstetric focus were analyzed. Studies were categorized based on whether they were conducted in the United States.

RESULTS:

Of 238 RCTs in this study, 110 (46.2%) occurred in the United States. Compared to non-U.S. studies, U.S. RCTs were more likely to be published in obstetrics and gynecology journals (90.9% versus 73.4%; P=.001) and to be multicenter studies (59.4% versus 29.9%; P<.001). U.S. RCTs had a smaller median sample size (172 versus 335; P<.001) and a shorter median study length (19.9 versus 28.9 months; P=.026). U.S. RCTs were less likely to study the antepartum period (P<.001), to have a primary outcome examining the fetus/neonate (11.8% versus 37.8%; P<.001), and to study preventative interventions (51.6% versus 68.9%; P=.011). There was no difference in intervention type (drug, behavior, procedure, or device; P=.96) or whether the trial had a positive result (6.0% versus 3.7%; P=.52) between U.S. and non-U.S. studies.

CONCLUSION:

U.S. RCTs had smaller sample sizes and shorter study lengths, perhaps because of multicenter recruitment. Despite being potentially more generalizable, U.S. studies are less likely to be published in general medical journals. Further research is warranted to pursue this discrepancy as broad dissemination of information is important for improving maternal and fetal outcomes.
Management of Fetal Hemolytic Disease Due to Anti-Rh17 With the D−Phenotype [ID 2683500]
Authors: Saikaly Kayla , Orzechowski Kelly
Published: May 2024

INTRODUCTION:

The rare blood D− haplotype produces multiple Rh antibodies against red blood cell antigens such as anti-Rh17 or anti-Hr0 antibodies if a patient is sensitized to Rh antigens.

METHODS:

This report discusses successful management of a pregnancy in a 28-year-old woman with high anti-Rh17 titers leading to hemolytic disease of the fetus (HDFN). The combination of a D− allele and the weak D 45 allele has not been reported previously, and it may be that the hybrid allele expresses D antigen epitopes such that the D antigen is not weakened. During the studied pregnancy, the patient received plasmapheresis and intravenous immunoglobulin (IVIG) infusions along with intrauterine transfusions (IUTs) when absolutely necessary. She underwent uncomplicated repeat cesarean delivery at 32 5/7 weeks of gestation resulting in a female infant weighing 2,020 g. Patient informed consent was obtained for this case report.

CONCLUSION:

This patient with the D−/D− blood phenotype leading to anti-Rh17 antibodies after her first pregnancy was managed successfully. Her baby with HDFN and several instances of hydrops fetalis, was successfully managed and treated. The patient’s blood donations for IUTs and maternal plasma exchange therapies promoted efficiency and favorable outcomes for the baby, but did put the mother in an anemic blood range.
The Association Between Maternal Body Mass Index and Spontaneous Preterm Birth Among Patients Prescribed Vaginal Progesterone for Short Cervix [ID 2683530]
Authors: Steelman Morgan , Park Jiwoo , Wang Kelly Z. , Warren Leslie , Fox Nathan , DeBolt Chelsea A.
Published: May 2024

INTRODUCTION:

Vaginal progesterone decreases the risk of spontaneous preterm birth (sPTB) and adverse neonatal outcomes in patients with short cervix (cervical length [CL] <2.5 cm) between 16 and 24 weeks. Few studies have assessed the efficacy of this intervention in patients with obesity. We evaluate the association between maternal body mass index (BMI) and sPTB among patients prescribed vaginal progesterone for short cervix.

METHODS:

This was an IRB-approved retrospective cohort study of patients prescribed vaginal progesterone for short cervix at Mount Sinai Hospital. Exclusion criteria included prior PTB, cerclage, or progesterone treatment in prior pregnancy, and multifetal gestation. Logistic regression models assessed the association between BMI categories (BMI less than 25, BMI 25.0–29.9, BMI 30 or higher) and PTB less than 37 weeks, PTB less than 34 weeks, and neonatal intensive care unit (NICU) admission adjusting for nulliparity, CL at diagnosis, and insurance status.

RESULTS:

Of the 210 patients included, 86 had BMI of less than 25 (41%), 72 had BMI of 25.0–25.9 (34.4%), and 52 had BMI of 30 or higher (24.8%), and 79 experienced sPTB (37.6%). Although BMI was not associated with sPTB less than 37 weeks, the odds of sPTB at less than 34 weeks among individuals with BMI of 30 or higher was 3.03 times the odds for those with BMI of less than 25 (95% CI, 1.13–8.14). The odds of NICU admission among those with BMI of 30 or higher is 2.82 times the odds among those with BMI of less than 25 (95% CI, 1.23, 6.46).

CONCLUSION:

This study demonstrates obesity is associated with sPTB at less than 34 weeks and NICU admission among those prescribed vaginal progesterone for short cervix. Larger studies are needed to evaluate the effect of BMI on efficacy of vaginal progesterone.
Neurologic Complication Rates in Obstetric Patients With Chiari Malformation Based on Mode of Delivery [ID 2683669]
Authors: Feldmar Blake , Nosova Kristin , Howard Erin , Bauer Isabel L. , Kellerhals Sarah , Nakaji Peter
Published: May 2024

INTRODUCTION:

Chiari malformation (CM) describes inferior displacement of hindbrain structures. Because of the theoretical effects of labor on cerebrospinal fluid dynamics, CM alone has historically been suggested as a sufficient indication for cesarean delivery because of concern for herniation. However, existing literature is limited and does not demonstrate increased adverse outcomes of vaginal delivery in this population. This novel work utilizes a national dataset to describe neurologic complication rates in CM parturients in relation to mode of delivery.

METHODS:

The 2016–2018 Nationwide Readmissions Datasets were queried for obstetric patients with and without documented CM. ICD-10 codes were used to identify parturients who experienced neurologic complications relevant to CM. Univariate and multivariate analyses were performed to assess associations between CM and mode of delivery.

RESULTS:

11,021,188 parturients were identified, including 1,210 with preexisting CM. The primary cesarean rate was 50.7% (n=479) in CM parturients compared to 20% (n=1,823,650) in the general population and CM independently predicted cesarean delivery (OR 3.8, CI, 3.1–4.7). There was no significant difference (P=.87) in the rate of herniation based on delivery method in CM parturients. The incidence of stroke, myelopathy, and hydrocephalus was zero regardless of delivery method.

CONCLUSION:

There is no significant difference in neurological complication rates in CM patients based on delivery method, yet CM patients are more than twice as likely to undergo cesarean delivery. Data suggest that vaginal delivery carries minimal risk to CM patients and should be considered during clinical decision making. Future studies should stratify risk based on type and severity of CM.
Assessing Patient Experiences With Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics [ID 2683581]
Authors: Bhuiyan Julia , Loder Charisse
Published: May 2024

INTRODUCTION:

Ensuring patient satisfaction remains an important objective for obstetrics and gynecology care. To address a research gap in this field, we aimed to assess patient satisfaction with culturally competent and respectful care in our obstetrics and gynecology clinics after initiation of diversity, equity, and inclusion programming.

METHODS:

From September 2021 to February 2022, we surveyed outpatient ob-gyn visitors about their experiences, using a 21-item survey that assessed cultural competency, treatment discussions, clinic accommodations, and comfort during sensitive exams, using a Likert scale. Participants also self-reported demographic information.

RESULTS:

Out of 246 returned surveys, participants generally reported positive interactions with clinic staff and health care providers, feeling heard (91%), respected (95%), and having their cultural/spiritual beliefs considered in treatment (95%). Most felt respected and comfortable during sensitive exams (96%) and were satisfied with treatment discussions (84%). However, those with a high-school education (79%) were less likely than college or graduate degree holders (93%) to feel administrative staff listened to them and their families (P<.05). Experiences with culturally competent care varied by race/ethnicity. Black/African American participants were less likely to feel staff understood their cultural experiences (55% versus 67–88%; P<.05) and that they recognized differences within their racial/ethnic group (50% versus 82–88%; P<.01). Black/African American individuals reported the highest incidence of race-based unfair treatment (20% versus 0–2%; P<.01).

CONCLUSION:

Lower satisfaction among Black/African American participants indicates care can be improved. Enhanced education for clinical teams can foster respectful, inclusive, and culturally competent care. Future qualitative research can offer further insights into inclusive practices in obstetrics and gynecology care.
Bleeding Risk in Women on Anticoagulants While Undergoing Minor Gynecologic Procedures [ID 2683602]
Authors: Santoso Joseph , Nthiga Lynda I.
Published: May 2024

INTRODUCTION:

The objective of this study was to determine the bleeding risk in women undergoing minor gynecologic procedures while concurrently taking various anticoagulants.

METHODS:

Patient charts from January 2008 to August 2013 were reviewed to identify patients who underwent minor procedures while taking anticoagulants. Bleeding complications were graded as none, mild, moderate, or severe. No-bleeding diagnoses were defined as a hemostatic biopsy site. Mild bleeding was classified as occasional spotting, requiring pressure for less than 5 minutes. Moderate bleeding required the use of suture for hemostasis. Severe bleeding complications required transfer to a tertiary center or blood transfusion.

RESULTS:

We reviewed 7,453 medical records yielding 269 minor procedures during which patients were concurrently taking anticoagulants. The mean age was 65 years (range, 30–96 years), with 148 African Americans and 121 Caucasian patients. Bleeding complications occurred in 14 patients: 13 mild and 1 moderate. Bleeding complications were not affected by age (P=.5576) or race (P=.1359) but were related to procedure type (P<.0001). Specifically, the loop electrosurgical excision procedure was the only procedure to result in a statistically significant mild complication rate (P=.0353). There was no association between the type of anticoagulant used (P=.6294) or medical diagnosis for anticoagulation (P=.7589) and bleeding risk.

CONCLUSION:

Minor gynecologic surgical procedures can safely be undertaken on women who are concurrently taking antiplatelet/anticoagulant medications.
“What I Wish I Knew”: Clinically Relevant Concerns Women Express on Social Media About Oocyte Cryopreservation [ID 2683486]
Authors: Moskalensky Liana , Hammi Mary C. , Nelson Anita L. , Fuchs Sebastien
Published: May 2024

INTRODUCTION:

This is the first study to assess the clinically relevant understandings, beliefs, and concerns expressed about oocyte cryopreservation in spontaneous and unfiltered social media platforms as diverse as Reddit and TikTok.

METHODS:

We selected Reddit with its daily 56 million users to represent those aged 18–49 years and TikTok with its daily 1.6 billion users to represent those under 30 years. Search terms “Egg Freezing" and “Egg Freezing Support” as well as the subreddit thread “r/EggFreezing” were used on Reddit; search functions of “egg freezing” and “egg freezing journey” were used on TikTok. Exclusion criteria included having less than 10 relevant comments, non-U.S. account, embryo freezing, sponsored posts, and medical advice from non-patient medical professionals. Thematic saturation was achieved when 10 consecutive comments were reached with no new themes. Institutional review board approval was obtained, deemed as exempt.

RESULTS:

A total of 4,021 entries were evaluated, 355 were excluded, and 189 posts and 3,477 comments were included. Focusing on the 1,330 entries with clinically relevant themes, we found that the most common were “Recommended Age” (26%), “Out of Pocket Costs” (25%), “Side Effects” (18%), “What Can/Can’t I Do Before/During Egg Freezing” (18%), and “Number of Eggs Retrieved” (13%). Good examples addressing issues include “the hormonal roller coaster, the nightmare no one warns you about” and “I wish more doctors were more upfront about this.”

CONCLUSION:

Social media can be used to demonstrate educational gaps. In particular, physicians should be aware of unanswered questions women have about age and behaviors needed to maximize success in cryopreservation.
Virtual Interviews: The Format of the Future [ID 2683645]
Authors: White Joseph R. , Manorot Amanda , Lenze Nicholas , Benjamin William J. , Mihalic Angela , Marzano David
Published: May 2024

INTRODUCTION:

Residency interviews have transitioned from an in-person to a virtual format during the COVID-19 pandemic. Virtual interviews have helped applicants reduce spending costs, time, and greenhouse gas emissions related to travel. This study aims to assess the preferences of obstetrics and gynecology applicants in continuing a virtual format for residency interviews.

METHODS:

The Texas STAR database was queried for obstetrics and gynecology applicants who responded to “I would be in favor of continuing virtual interviews going forward” on a 5-item Likert scale from 2021 to 2023. Descriptive statistics (chi-square and ANOVA) were used to evaluate trends in responses over time and associations with applicant characteristics.

RESULTS:

A total of 1,348 obstetrics and gynecology applicants responded to the survey, among whom 924 (68.5%) agreed or strongly agreed that they would favor continuation of virtual interviews. The percentage of applicants who favored virtual interviews significantly increased each year (55.1% in 2021, 68.7% in 2022, and 81.1% in 2023; P<.001). Applicants who reported higher total spending on the residency application process were more likely to favor virtual interviews (mean [SD]: $2,637 [2,243] versus $2,240 [1,550]; P=.001). There were no significant differences in sex, race, or geographic region in applicants who favored virtual interviews compared to those who did not favor or were undecided.

CONCLUSION:

The majority of obstetrics and gynecology applicants favor continuation of virtual interviews, and this trend has been increasing each year. There do not appear to be any sociodemographic differences between applicants who do and do not favor virtual interviews.
Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program
Authors: Jones Bayley A. , Richman Joshua , Rubyan Michael , Wood Lauren , Harsono Alfonsus Adrian H. , Oslock Wendelyn , English Nathan , Smith Burkely P. , Hollis Robert , Hearld Larry R. , Scarinci Isabel , Chu Daniel I.
Published: May 2024

Objective:

This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.

Background:

ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.

Methods:

This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.

Results:

A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.

Conclusion:

Preoperative education is associated with adherence to ERP components and improved surgical outcomes.
Different Load-Induced Alterations in Intervertebral Discs Between Low Back Pain Patients and Controls
Authors: Torén Leif , Lagerstrand Kerstin , Waldenberg Christian , Brisby Helena , Hebelka Hanna
Published: May 2024

Study Design.

Prospective cohort study.

Objective.

Investigate load-induced effects in lumbar intervertebral discs (IVDs) and differences between low back pain (LBP) patients and controls.

Summary of Background Data.

T2-map values, obtained from quantitative MRI sequences, reflect IVD tissue composition and integrity. Feasibility studies with T2-mapping indicate different load-induced effects in entire IVDs and posterior IVD parts between LBP patients and controls. Larger studies are required to confirm these findings and increase the understanding of specific characteristics distinguishing IVD changes in LBP patients compared with controls.

Materials and Methods.

Lumbar IVDs of 178 patients (mean age: 43.8 yr; range: 20–60 yr) with >3 months of LBP and 74 controls (mean age: 40.3 yr; range: 20–60 yr) were imaged with T2-map sequence in a 3T scanner in supine position without axial load, immediately followed by a repeated examination, using the same sequence, with axial load. On both examinations, mean T2-map values were obtained from entire IVDs and from central/posterior IVD parts on the three midsagittal slices in 855 patient IVDs and 366 control IVDs. Load-induced effect was compared with Fold-change ratio and adjusted for IVD-degeneration grade.

Results.

Loading induced an increase in T2-map values in both patients and controls. Excluding most extreme values, the ranges varied between -15% and +35% in patients and -11% and +36% in controls (first to 99th percentile). Compared with controls, the T2-map value increase in patients was 2% smaller in entire IVDs (Fold-change: 0.98, P=0.031), and for central and posterior IVD parts 3% (Fold-change: 0.98, P=0.005), respectively, 2% (Fold-change: 0.9, P=0.015) smaller.

Conclusions.

This quantitative study confirmed diverse load-induced behaviors between LBP patients and controls, suggesting deviant biomechanical characteristics between IVDs in patients and controls not only attributed to the global grade of degeneration. These findings are an important step in the continuous work of identifying specific IVD phenotypes for LBP patients.

Level of Evidence.

Level II.
Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on 5-Year Prognosis in Lumbar Spine Surgery
Authors: Taniwaki Hiroshi , Hoshino Masatoshi , Kinoshita Yuki , Matsumura Akira , Namikawa Takashi , Kato Minori , Takahashi Shinji , Nakamura Hiroaki
Published: May 2024

Study Design.

Retrospective cohort study.

Objective.

To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the 5-year clinical outcomes following lumbar spine surgery.

Summary of Background Data.

Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking.

Methods.

A total of 189 patients who underwent lumbar surgery (≤3-disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75 to 3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and 1, 2, and 5 years postoperatively.

Results.

Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain (P=0.013), walking ability (P=0.005), social life function (P=0.010) of JOABPEQ, and physical component summary of the SF-36 (P=0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse 5-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score.

Conclusion.

A high preoperative VBQ score is a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and healthcare costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes.

Level of Evidence.

3
Role of Colchicine in Cardiovascular Disorders
Authors: Moras Errol , Subramanian Lakshmi , Romeo Francisco , Gandhi Kruti , Prabhakaran Sivaguha Yadunath , Moras Adlyn , Krittanawong Chayakrit , Frishman William H. , Aronow Wilbert S.
Published: May 2024

Inflammation has played a pivotal role in atherosclerosis and other cardiovascular disorders, prompting the exploration of anti-inflammatory therapies to improve cardiovascular outcomes. Colchicine, a well-established agent in conditions such as gout and familial Mediterranean fever, has emerged as a promising novel anti-inflammatory agent in the realm of cardiovascular diseases. Its ability to target both traditional risk factors and residual inflammatory risk marks a significant advancement in cardiovascular prevention strategies, indicating a new era in cardiovascular care. Landmark trials have supported the efficacy and safety of low-dose colchicine in reducing major adverse cardiovascular events when combined with standard therapies. In addition, its endorsement by major cardiovascular societies underscores its significance as the first targeted anti-inflammatory therapy for cardiovascular disease. However, careful monitoring for drug interactions and adverse effects, particularly on kidney and liver function, is essential for safe use. In this review, we aim to comprehensively summarize the mechanisms of action of colchicine, its molecular and biochemical targets in various cardiovascular conditions, and its pharmacokinetics, and delve deeply into the existing evidence on its safety and efficacy in the treatment of cardiovascular disorders, including coronary artery disease, pericarditis, atrial fibrillation, and heart failure.
A Pediatric Case of Encephalopathy With Hypoglycemia Induced by Coxsackievirus A4 Infection
Authors: Ishii Masahiro , Hoshina Takayuki , Fujimoto Tsuguto , Hanaoka Nozomu , Konagaya Masami , Shimbashi Reiko , Takanashi Sayaka , Arai Satoru , Tanaka-Taya Keiko , Kusuhara Koichi
Published: May 2024

We report a pediatric case developing hypoglycemic encephalopathy during the acute phase of coxsackievirus (CV)-A4 infection. A part of the sequence of the virus detected from our patient was completely identical to that in other CV-A4 strain reported as a recombinant strain with lethal CV-A2, suggesting that the properties of CV-A4 might be associated with the severe hypoglycemic encephalopathy.
Concomitant Central and Peripheral Nervous System Involvement Associated With Mycoplasma pneumoniae Infection in Pediatric Patients: Two Case Reports and Literature Review
Authors: Xue Yuan , Yu Zhiwei , Cheng Min , Li Xiujuan , Jiang Li , Han Wei
Published: May 2024

Background:

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen for community-acquired pneumonia and is also implicated in a broad array of extra-pulmonary manifestations. M. pneumoniae infection is rarely associated with concurrent central nervous system (CNS) and peripheral nervous system (PNS) involvement in children.

Methods:

We report 2 patients who presented with acute encephalitis and polyradiculitis due to M. pneumoniae infection and review the literature to discuss the pathogenesis and treatment of concomitant CNS and PNS involvement associated with M. pneumoniae infection.

Results:

We report two 6-year-old boys with M. pneumoniae antecedent infection who presented initially with impaired consciousness followed by limb weakness, limb pain and urinary retention, and responded well to immunotherapy.

Conclusions:

We described 2 patients who presented symptomatic combined CNS and PNS involvement with persistent urinary retention associated with M. pneumoniae infection. We found autoimmunity plays an important role and recommend that antibiotics and immunomodulators should be administered with concurrent CNS and PNS involvement associated with M. pneumoniae.
Where Birth Month, Sex and Age Matters: The Burden of Severe Respiratory Disease in Danish Children <5 Years, 2016–2022
Authors: Flach de Neergaard Ebba Emilie , Egeskov-Cavling Amanda Marie , Rytter Dorte , Johannesen Caroline Klint , Fischer Thea K.
Published: May 2024

Background:

In light of the substantial impact that respiratory diseases in young children poses on healthcare systems globally, and in the wake of the recent COVID-19 pandemic, there is a growing urgency to obtain reliable estimates on the burden of respiratory disease.

Objectives:

The aim of this study is to quantify the overall burden of respiratory disease requiring hospitalizations and explore the trends in these admissions in Danish children <5 years, January 1, 2016–October 31, 2022.

Methods:

The number of hospitalizations attributed to respiratory infections in children <5 years, was extracted from the Danish National Patient Register, and stratified into subgroups based on age, gender and birth month, and presented on a month-to-month basis.

Results:

A total of 48,194 children under the age of 5, were hospitalized due to respiratory infections within the study period and the annual hospitalization incidence exhibited a noteworthy variation. Risk factors associated with the highest hospitalization incidence were young age, male gender and in children under 1-year-old, birth months falling in the period of November to January. Younger age and admission during the winter months were linked to longer hospital stays. The seasonal pattern of hospitalizations and the distribution of hospitalizations across various subgroups were greatly influenced by the COVID-19 pandemic.

Conclusion:

This study describes and quantifies the importance of factoring in specific child demographics and seasonal variations in hospitalizations when devising preventive healthcare strategies such as the use of monoclonal antibody therapy and vaccines.
SARS-CoV-2 Infection in Children Less Than Forty Days Hospitalized in Belgium Between 2020 and 2022
Authors: Demey Milena , Bruyneel Arnaud , Chatzis Olga , Christiaens Christelle , Cossey Veerle , De Crombrugghe Gabrielle , De Lille Lieve , Goetghebuer Tessa , Gueulette Emmanuelle , Hainaut Marc , Heijmans Catherine , Hubinont Hortense , Lé Phu-Quoc , Lecomte Laurie , Mattijs Inge , Mignon Céline , Mondovits Bénédicte , Rodesch Marine , Rooze Shancy , Schelstraete Petra , Stroobant Diane , Thielemans Laurence , Thomas Ingrid , Valbona Selimaj K. , Van Damme Emmi , Van der Linden Dimitri , Van Praet Jens , Vermeulen Françoise , Weynants David , Tilmanne Anne
Published: May 2024

Our study aimed to assess the severity of severe acute respiratory syndrome coronavirus 2 infection in hospitalized infants under 40 days old, across 21 Belgian hospitals between 2020 and 2022. Of the 365 infants studied, 14.2% needed respiratory support. The median hospital stay was 3 days (interquartile range, 2–4), and there were no deaths. Infection severity was similar during the Omicron and Alpha/Delta periods.
Long-term comparison of image-guided thermal ablation vs. lobectomy for solitary papillary thyroid microcarcinoma: a multi-center retrospective cohort study
Authors: Yan Lin , Li WenHui , Zhu YaLin , Li Xinyang , Li Yingying , Li Yiming , Song Qing , Che Ying , Wang Hui , Luo Yukun
Published: May 2024

Background:

Image-guided thermal ablation has been applied in patients with papillary thyroid microcarcinoma (PTMC) who refuse surgery or active surveillance. However, evidence to support ablation is limited by single-center designs and a lack of long-term data. The purpose of this study was to compare long-term outcomes between ablation and lobectomy for patients with solitary PTMC.

Materials and methods:

This multi-center retrospective study included 1021 consecutive patients with solitary PTMC who underwent ablation (n=444) or lobectomy (n=577) at the four university-affiliated hospitals. The primary outcomes were disease progression [lymph node metastasis (LNM), recurrent tumors, persistent tumors and distant metastasis] and disease-free survival (DFS). Secondary outcomes were complications, hospitalization, procedure time, estimated blood loss and cost. The two groups were compared using propensity score matching.

Results:

After matching, no significant differences were observed in disease progression (4.7% vs. 3.4%, P=0.307), LNM (1.6% vs. 1.6%, P=1.000), recurrent tumors (2.9% vs. 1.8%, P=0.269), persistent tumors(0.2% vs. 0%, P=0.317) and DFS (95.5% vs. 97.1%, P=0.246) between the ablation and lobectomy groups during the median follow-up of 96.5 months. The ablation group had significantly lower complication rates (0.7% vs. 5.2%, P<0.001), shorter post-treatment hospitalization {median [interquartile range (IQR)], 0 vs. 4.0 [3.0] days, P<0.001}, shorter procedure time [8.5 (2.8) vs. 90.0 (43.8) min, P<0.001], reduced estimated blood loss [0 vs. 20.0 (10.0) ml, P<0.001], and lower cost [$1873.2 (254.0) vs. $2292.9 (797.8), P<0.001] than the lobectomy group.

Conclusions:

This study revealed comparable disease progression and survival outcomes between ablation and lobectomy for solitary PTMC. Imaged-guided thermal ablation could be effective and safe alternatives to lobectomy for properly selected patients with PTMC.
Case Series
Authors: Phenegar Griffin C. , Kallan Jamie E. , Corliss Robert F.
Published: May 2024

Titanium dioxide is a versatile compound that is found in a variety of consumer products, medical hardware, and pharmaceuticals. Although oral and topical ingestion of this compound is common, intravenous introduction is much less common. We present three cases where significant titanium dioxide deposits were identified in liver and splenic tissue of three decedents, all of whom died of illicit drug overdose in the same geographic area and had fentanyl and its metabolites in blood on postmortem toxicologic testing. At autopsy, liver sections had a granular texture with fine white stippling grossly, and histologic examination of hepatic and splenic tissues showed scattered patches of black granular material with pink birefringence. Energy-dispersive x-ray spectroscopy performed on these tissues revealed the presences of clusters of titanium dioxide. Immunohistochemical staining of both the liver and spleen with CD68 confirmed the titanium dioxide clusters were within macrophages. Intravenous titanium dioxide nanoparticle elimination studies in rats suggest a time sensitive period for this elimination, with a transient period of pigment deposition between 1–58 days following injection. If a time-dependent link between titanium dioxide pigment deposition within tissues and intravenous drug use can be shown, this could be a valuable tool for Pathologists.
Bone Metastases
Authors: Cook Gary J. R. , Thorpe Matthew P.
Published: May 2024

Bone metastases occur frequently in common malignancies such as breast and prostate cancer. They are responsible for considerable morbidity and skeletal-related events. Fortunately, there are now several systemic, focal, and targeted therapies that can improve quality and length of life, including radionuclide therapies. It is therefore important that bone metastases can be detected as early as possible and that treatment can be accurately and sensitively monitored. Several bone-specific and tumor-specific single-photon emission computed tomography and positron emission tomography molecular imaging agents are available, for detection and monitoring response to systemic therapeutics, as well as theranostic agents to confirm target expression and predict response to radionuclide therapies.
PSMA-Targeted Radiopharmaceuticals for Prostate Cancer Diagnosis and Therapy
Authors: Oldan Jorge D. , Almaguel Frankis , Voter Andrew F. , Duran Alfonso , Gafita Andrei , Pomper Martin G. , Hope Thomas A. , Rowe Steven P.
Published: May 2024

Prostate cancer (PCa) is the most common noncutaneous malignancy in men. Until recent years, accurate imaging of men with newly diagnosed PCa, or recurrent or low-volume metastatic disease, was limited. Further, therapeutic options for men with advanced, metastatic, castration-resistant disease were increasingly limited as a result of increasing numbers of systemic therapies being combined in the upfront metastatic setting. The advent of urea-based, small-molecule inhibitors of prostate-specific membrane antigen (PSMA) has partially addressed those shortcomings in diagnosis and therapy of PCa. On the diagnostic side, there are multiple pivotal phase III trials with several different agents having demonstrated utility in the initial staging setting, with generally modest sensitivity but very high specificity for determining otherwise-occult pelvic nodal involvement. That latter statistic drives the utility of the scan by allowing imaging interpreters to read with very high sensitivity while maintaining a robust specificity. Other pivotal phase III trials have demonstrated high detection efficiency in patients with biochemical failure, with high positive predictive value at the lesion level, opening up possible new avenues of therapy such as metastasis-directed therapy. Beyond the diagnostic aspects of PSMA-targeted radiotracers, the same urea-based chemical scaffolds can be altered to deliver therapeutic isotopes to PCa cells that express PSMA. To date, one such agent, when combined with best standard-of-care therapy, has demonstrated an ability to improve overall survival, progression-free survival, and freedom from skeletal events relative to best standard-of-care therapy alone in men with metastatic, castration-resistant PCa who are post chemotherapy. Within the current milieu, there are a number of important future directions including the use of artificial intelligence to better leverage diagnostic findings, further medicinal chemistry refinements to the urea-based structure that may allow improved tumor targeting and decreased toxicities, and the incorporation of new radionuclides that may better balance efficacy with toxicities than those nuclides that are available.
Positron Emission Tomography Imaging of Tumor Proliferation and DNA Repair
Authors: Shields Anthony F. , Chen Delphine L.
Published: May 2024

Positron emission tomography (PET) is an established tool for molecular imaging of cancers, and its role in diagnosis, staging, and phenotyping continues to evolve and expand rapidly. PET imaging of increased glucose utilization with 18F-fluorodeoxyglucose is now entrenched in clinical oncology practice for improving prognostication and treatment response assessment. Additional critical processes for cancer cell survival can also be imaged by PET, helping to inform individualized treatment selections for patients by improving our understanding of cell survival mechanisms and identifying relevant active mechanisms in each patient. The critical importance of quantifying cell proliferation and DNA repair pathways for prognosis and treatment selection is highlighted by the nearly ubiquitous use of the Ki-67 index, an established histological quantitative measure of cell proliferation, and BRCA mutation testing for treatment selection. This review focuses on PET advances in imaging and quantifying cell proliferation and poly(ADP-ribose)polymerase expression that can be used to complement cancer phenotyping approaches that will identify the most effective treatments for each individual patient.
Implementation of the Versius Surgical System in Complex Abdominal Wall Repair: First Reported Case of an Robotic ETEP/TAR Procedure
Authors: Pinto Renato D. , Trauczynski Pedro , Lima Diego L. , Cavazzola Leandro T.
Published: May 2024

Background:

Robotic ventral hernia repair has been increasing globally, with comparable outcomes to laparoscopic repair and lower rates of conversion to open surgery. Robotic surgery is increasing in popularity, and there is a number of new robotic systems entering the marketing. We report the first case of a Roboic eTEP using the Versius robotic system in a patient with an incisional hernia.

Methods:

Surgery was performed using the Versius system from CMR surgical which consists of bedside units for each instrument and a console. The patient presented with an incisional hernia measuring 9.5×5 cm in the left flank.

Results:

The patient was discharged on postoperative day (POD) 2 with a drain. There was no need for opioids. The drain was removed at POD 7. The patient presented at POD 10 with erythema and cellulitis in the area that previously had tape on it, and it was resolved with a short course of oral antibiotics.

Conclusion:

The eTEP technique for hernia surgery was safe and feasible using the Versius robotic system. Implementation is possible in experienced hands with minimal changes to the surgical techniques.
A Grading System for Assessing the Status of the Sphincter of Oddi During Intraoperative Choledochoscopy: A Surgeon’s Perspective
Authors: Chen Hai Chuan , Wang Zhe Jin , Song Hong Liang
Published: May 2024

Background:

The aim of this study was to establish a simple and practical grading system for evaluating the status of the sphincter of Oddi (SO) during intraoperative choledochoscopy. This system helps identify relevant variables that influence the status of the SO and provides recommendations for preventing stone recurrence.

Methods:

Ninety-three patients were selected retrospectively from a total of 316 patients diagnosed with choledocholithiasis between July 2020 and June 2023. All patients underwent common bile duct (CBD) exploration surgery and intraoperative choledochoscopy. The status of the SO was assessed during choledochoscopy. According to the severity of the condition, the patients were categorized into 4 groups. Data from each group, grades 1, 2, 3, 4, was analyzed statistically.

Results:

The number of patients in grade 1 was significantly lower than that of the other 3 groups. Except for grade 1, patients in grade 4 exhibited significant differences compared with the other 2 groups in terms of the diameter of the CBD, size of stones, presence of pneumobilia, and history of endoscopic retrograde cholangiopancreatography (ERCP) (P<0.05). There were no significant differences between the groups in terms of sex, age, liver function, number of stones, history of gastrectomy, cholecystectomy, or CBD exploration.

Conclusions:

The grading system helps us classify different sphincter functions and better understand the formation of choledocholithiasis by subdividing the status of the SO. Endoscopic sphincterotomy (EST) treatment can easily result in the loss of SO function, which increases the risk of stone recurrence.
Successful Recovery of Cardiac Function Following 20 min of a No-touch Period in a Donation After Circulatory Death: A Case Report
Authors: Zanatta Paolo , Linassi Federico , Gasparetto Nicola , Polesello Luigi , Bussola Matteo , Nascimben Ennio , Minniti Giuseppe , Cernetti Carlo , Angelini Matteo , Feltrin Giuseppe , Romano Maurizio , Zanus Giacomo , Benazzi Francesco , Gerosa Gino
Published: May 2024

Background.

Withdrawal of life-sustaining therapy (WLST) performed in the circulatory determination of death (DCD) donors leads to cardiac arrest, challenging the utilization of the myocardium for transplantation. The rapid initiation of normothermic regional perfusion or extracorporeal membrane oxygenation after death helps to optimize organs before implantation. However, additional strategies to mitigate the effects of stress response during WLST, hypoxic/ischemic injury, and reperfusion injury are required to allow myocardium recovery.

Methods.

To this aim, our team routinely used a preconditioning protocol for each DCD donation before and during the WLST and after normothermic regional perfusion/extracorporeal membrane oxygenation. The protocol includes pharmacological treatments combined to reduce oxidative stress (melatonin, N-acetylcysteine, and ascorbic acid), improve microcirculation (statins), and mitigate organ’s ischemic injury (steroids) and organ ischemia/reperfusion injury (remifentanil and sevoflurane when the heart is available for transplantation).

Results.

This report presents the first case of recovery of cardiac function, with the only support of normothermic regional reperfusion, following 20 min of a no-touch period and 41 min of functional warm ischemic time in a DCD donor after the preconditioning protocol.

Conclusions.

Our protocol seems to be effective in abolishing the stress response during WLST and, on the other hand, particularly organ protective (and heart protective), giving a chance to donate organs less impaired from ischemia/reperfusion injury.