bluuebunny/crossref_metadata_2025 huggingface dataset:
Eugenol suppresses VEGF-dependent angiogenesis by JAK2/STAT3 pathway in non-small cell lung cancer
Authors: Su Yifan , Wang Yurong , Yu Qian , Wu Zhijian , Zhang Dawei , Yan Chunyan
Published: July 2024

Background:

Non-small cell lung cancer (NSCLC) is a highly vascularized solid tumor, and tumor angiogenesis is closely associated with the metastasis and progression of NSCLC. Antiangiogenic drugs can target the tumor microenvironment to degrade existing tumor blood vessels while inhibiting tumor angiogenesis and have become one of the indispensable treatments for patients with advanced NSCLC. Although various new drugs have been tested in different settings of NSCLC, none of them have shown the desired therapeutic effects so far. Therefore, the search for new and effective therapeutic modalities has become a new goal for treating NSCLC.

Objective:

Eugenol is a phenolic aromatic compound derived from Eugenia caryophyllata, Cinnamomum cassia, etc., which has historically been used for various medical purposes. Studies have shown that eugenol exhibits significant anticancer effects against several types of cancer; however, its therapeutic effect on angiogenesis remains a mystery. In this study, the in vitro and in vivo antiangiogenic effects of eugenol in NSCLC and the underlying molecular mechanism were explored, which could provide a promising strategy for the treatment of NSCLC.

Methods:

The effects of eugenol on the proliferative capacity of human umbilical vein endothelial cells (HUVECs) and A549 cells were examined by methyl thiazolyl tetrazolium assay. The migration and invasion of eugenol-treated HUVECs were evaluated by wounding-healing and transwell assay, and the angiogenesis was measured by tube formation assay. The expression of angiogenesis-related genes and proteins, as well as the JAK2/STAT3 pathway, was evaluated by real-time quantitative PCR and western blot. Flow cytometry was performed to detect the effect of eugenol on the apoptotic profile of A549 cells. Finally, the A549 tumor-bearing nude mice were constructed to evaluate the in vivo anti-NSCLC activity of eugenol.

Results:

Eugenol inhibited the migration, invasion, and tube formation of HUVECs. Meanwhile, eugenol blocked the phosphorylation of vascular endothelial growth factor reporter-2 and inhibited the expression of other angiogenesis-related proteins. In addition, eugenol suppressed the expression of p-JAK2 and p-STAT3 in HUVECs and A549 cells. Eugenol also suppressed the proliferation of A549 cells by promoting apoptosis and inhibited tumor growth and microvessel formation in A549 cell xenograft-bearing nude mice.

Conclusions:

Eugenol could be a potential lead compound for the treatment of NSCLC by blocking the vascular endothelial growth factor/vascular endothelial growth factor reporter-2 and JAK2/STAT3 signaling pathways.
Glycoalkaloids: Structural diversity and pharmacological activities
Authors: Jia Yuelin , Xia Guiyang , Wang Lingyan , Xia Huan , Wei Xiaohong , Lin Sheng
Published: July 2024

Glycoalkaloids (GAs) are a class of special secondary metabolites found in plants. Studies have found that they have a wide range of pharmacological activities, such as antiviral, antifungal, and anticancer properties, with significant potential for development and utilization value. At present, alkaloid glucosides mainly fall into 2 categories: indole alkaloid glucosides and steroid alkaloid glucosides. In addition, there are small amounts of quinolines, isoquinolines, isoguanines, and other alkaloids. At present, only a few of the GAs have been found, which is inconsistent with the diversity of alkaloids. In addition, only a few GAs have been isolated and identified. This paper reviews the natural alkaloid glycosides from the perspectives of structural classification and pharmacological activity. It analyzes the reasons for the limited number of isolated components and proposes a rational separation method based on the literature. To provide references for the separation, identification, and bioactivity of glycoalkaloids.
Alcohol-associated liver disease and public health policies
Authors: Sengupta Shreya , Gill Victoria , Mellinger Jessica L.
Published: July 2024

Alcohol-associated liver disease (ALD) rates have increased substantially in the United States and elsewhere around the globe. These increases are largely the result of increases in alcohol use. While there are many levels at which alcohol use interventions can be implemented in order to reduce alcohol use and its negative health consequences, public policy initiatives have emerged as a powerful way to intervene across a population. In this narrative review, we will review major US national as well as worldwide alcohol-associated public health policies with a particular focus on describing how such policies have influenced rates of ALD and its complications and outcomes. We will describe global alcohol public health policy frameworks, review key alcohol policy models, describe existing notable policies and their impacts, and highlight gaps in ALD policy literature where further research and policy interventions could reduce rates of mortality from ALD.
Small bowel occlusion due to congenital peritoneal encapsulation treated with laparoscopic resection of the hernia sac: A diagnostic and therapeutic challenge
Authors: Del Giudice Roberto , Mazzoni Gianluca , Tomassini Federico , Camperchioli Ida , Cisano Claudio , Di Cristofaro Loretta , Bellotti Annamaria
Published: July 2024

Congenital peritoneal encapsulation (CPE) is an extraordinarily rare condition characterized by an additional peritoneal membrane encasing part or whole of the small intestine. The etiology of CPE, believed to originate from atypical adhesions during fetal mid-gut development, remains uncertain. Clinical presentations involving intestinal obstruction are extremely rare. We report a case of a 39-year-old male of Egyptian origin who presented to our emergency department with abdominal pain and vomiting. Initial abdominal computed tomography scan showed no mechanical obstruction. However, worsening symptoms necessitated laparoscopic exploration, which revealed a mechanical obstruction in the jejunum due to a peritoneal-vessel band and CPE involving the initial segment of the small bowel. The peritoneal fold, encircling the first jejunal loops, was resected up to the Treitz ligament, releasing the jejunum. The patient had an uncomplicated postoperative recovery and was discharged on the fourth postoperative day.
Outcomes of Descemet Stripping Only Without Postoperative Use of Topical Rho-Associated Protein Kinase Inhibitors
Authors: Gustavson Britta P. , Kahuam-López Nicolás , Yeung Sonia N. , Iovieno Alfonso
Published: July 2024

Purpose:

Descemet stripping only (DSO) is a promising surgical option for select patients with Fuchs endothelial dystrophy (FED). There is growing support for the use of topical Rho-associated protein kinase inhibitors (ROCKi) to optimize DSO outcomes. However, in many settings, ROCKi are either unavailable or not approved to treat corneal diseases. This study sought to characterize patient outcomes after DSO in the absence of ROCKi and potentially broaden the settings where DSO can be offered to patients.

Methods:

Single-center retrospective case series of 15 eyes/11 patients (66 years; 52–74) that underwent DSO, alone or combined with cataract surgery, by one surgeon between August 2020 and January 2023. Patients included in analyses had FED with central guttae, no clinical evidence of corneal edema, and a clinically healthy peripheral corneal endothelium.

Results:

Mean follow-up time was 14 months (2–34). Fourteen of 15 eyes achieved corneal clearance (93.3%). Mean time to clearance was 8.5 weeks (3–23). Eleven eyes (73%) achieved corrected distance visual acuity of ≤0.2 with a significant postoperative improvement at 4 to 8 months (P < 0.05) and sustained improvements at >12 months. No significant astigmatism was introduced by the procedure. Two eyes developed cystoid macular edema postoperatively. A trend toward earlier clearance was observed in the <65 years old group.

Conclusions:

Despite a longer time to corneal clearance in this cohort compared with the few studies using ROCKi, the overall success rate and visual outcomes for the patients in our cohort supports the use of DSO in settings where ROCKi are not readily available.
Autonomy ranks as highest importance to dermatology physician assistants in Pennsylvania with highest compensations
Authors: Rodriguez Hannah , DuBois Brittany , Froman Richard , Patton Sarah B.W. , Griffith Cynthia F.
Published: July 2024

Introduction:

By exploring the relationship between compensation and job values, this research letter aims to contribute to the existing literature on health care professional compensation and job satisfaction, particularly within the context of dermatology physician assistants (PAs).

Objectives:

The authors aim to answer the question, “Does annual salary compensation correlate with any reported job values among dermatology PAs in Pennsylvania?”

Method:

This research letter presents a postsurvey analysis of a salary survey conducted among the members of the Pennsylvania Dermatology Physician Assistants (PDPA). The data used in this analysis were obtained from the previously published salary survey conducted by the PDPA. The survey asked participants to rank the factors most important in selecting a dermatology position.

Results:

Dermatology PAs in Pennsylvania who earned the highest income in a given year reported job autonomy as a top value [rs (79)=−0.2208, P=0.048].

Discussion:

Schedule flexibility may allow PAs to be more productive in seeing more patients and, therefore, result in higher compensations. PAs with freedom, independence, and discretion may feel respected and valued. This could result in positive effects on productivity and, as a downstream result, higher compensation.
Extracorporeal Carbon Dioxide Removal With the Hemolung in Patients With Acute-on-Chronic Respiratory Failure: A Multicenter Retrospective Cohort Study
Authors: Tiruvoipati Ravindranath , Akkanti Bindu , Dinh Kha , Barrett Nicholas A. , May Alexandra , Conrad Steven A.
Published: July 2024

Extracorporeal carbon dioxide removal (ECCO2R) devices are increasingly used in treating acute-on-chronic respiratory failure caused by chronic lung diseases. There are no large studies that investigated safety, efficacy, and the independent association of prognostic variables to survival that could define the role of ECCO2R devices in such patients. This multicenter, multinational, retrospective study investigated the efficacy, safety of a single ECCO2R device (Hemolung) in patients with acute on chronic respiratory failure and identified variables independently associated with intensive care unit (ICU) survival. The primary outcome was improvement in blood gasses with the use of Hemolung. Secondary outcomes included reduction in tidal volume, respiratory rate, minute ventilation, survival to ICU discharge, and complication profile. Multivariable regression analysis was used to identify variables that are independently associated with ICU survival. A total of 62 patients were included. There was a significant improvement in pH and partial pressure of carbon dioxide in arterial blood (PaCO2) along with a reduction in respiratory rate, tidal volume, and minute ventilation with Hemolung therapy. The complication profile did not differ between survivors and nonsurvivors. Multivariable analysis identified the duration of Hemolung therapy to be independently associated with survival to ICU discharge (adjusted odds ratio = 1.21; 95% confidence interval [CI] = 1.040–1.518; p = 0.01).
Validation of a novel professional automated auscultatory upper-arm cuff blood pressure monitor in a general population according to the AAMI/ESH/ISO Universal Standard: KOROT V2 Doctor (InBody BPBIO280KV)
Authors: Theodosiadi Aikaterini , Ntousopoulos Vasileios , Ntineri Angeliki , Stathopoulou Panagiota , Menti Ariadni , Kyriakoulis Konstantinos G. , Kollias Anastasios , Stergiou George S.
Published: July 2024

Objective

A novel automated auscultatory upper arm cuff blood pressure (BP) monitor KOROT V2 Doctor (InBody BPBIO280KV) was developed for professional use. An electronic stethoscope embedded in the device cuff records the Korotkoff sounds, which are graphically displayed during deflation allowing visual evaluation by the healthcare professional. The device provides automated measurements of BP and this study evaluated its accuracy.

Methods

The requirements of the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) and its Amendment 1.2020-01 were applied. Participants were recruited to fulfill the age, sex, BP, arm circumference, and cuff distribution criteria of the Universal Standard and its Amendment in a general population using the same arm sequential measurement method. Three cuffs of the test device were tested for arm circumference 23–28, 28–35, and 33–42 cm.

Results

Data from 85 individuals were analyzed [mean age: 56.4 ± 16.0 (SD) years, 50 men, arm circumference 23–42 cm]. For validation Criterion 1, the mean difference ±SD between the test device and reference BP readings (N = 255) was −1.3 ± 6.0/1.5 ± 5.0 mmHg (systolic/diastolic; threshold ≤5 ± 8 mmHg). For Criterion 2, the SD of the averaged BP differences per individual (N = 85) was 4.61/3.48 mmHg (systolic/diastolic; threshold ≤6.82/6.78 mmHg).

Conclusion

The KOROT V2 Doctor (InBody BPBIO280KV) device for professional use, which provides automated auscultatory measurements with visual display of the Korotkoff sounds, comfortably fulfills all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in a general population and can be recommended for clinical use.
Body mass index, diet, and outdoor activity linked with meibomian gland abnormalities in children
Authors: Parikh Manisha , Sicks Lindsay A. , Pang Yi
Published: July 2024

SIGNIFICANCE

Dry eye disease is frequently underdiagnosed in pediatric patients. Meibomian gland morphology abnormalities (atrophy and tortuosity) may be associated with dry eye. This study examined risk factors for gland morphology abnormalities in children.

PURPOSE

This study aimed to characterize meibomian gland morphological abnormalities (atrophy and tortuosity) and identify risk factors for the same in children.

METHODS

A total of 160 children, primarily African American and Hispanic, aged 5 to <18 years underwent a comprehensive eye exam including slit-lamp examination to evaluate the meibomian glands, conjunctival papillae, and tear film. Infrared photography was performed including assessment of noninvasive tear film breakup time and tear meniscus height. Meibomian gland atrophy and tortuosity were assessed. A modified Ocular Surface Disease Index survey was administered along with surveys on screen time, diet, and outdoor activity. Linear multiple regression was performed to determine risk factors for meibomian gland abnormalities.

RESULTS

The average age of participants (76 male, 84 female) was 10.9 ± 3.0 years. Severe meibomian gland atrophy (score ≥2) was found in 31.0% of participants in at least one eyelid. Severe meibomian gland tortuosity (score ≥2) was found in 84.0% of participants in at least one eyelid. The median symptom score was 9.8 (range, 0 to 71), with 16.9, 8.8, and 12.5% of the children having mild, moderate, and severe dry eye symptoms, respectively. Elevated body mass index (p<0.001), reduced outdoor activity (p=0.02), and unhealthy diet (p=0.01) were found to be risk factors for meibomian gland abnormalities. Screen time, symptom score, age, gender, and race/ethnicity were not associated with gland abnormalities (all p values >0.05).

CONCLUSIONS

This study determined that meibomian gland morphological abnormalities were commonly found in children aged 5 to <18 years. Risk factors for these abnormalities include elevated body mass index, an unhealthy diet, and reduced outdoor activity.
Intraductal Implantation of Biliary Neoplasms
Authors: Zen Yoh , Akita Masayuki , Florou Evangelia , Fukumoto Takumi , Itoh Tomoo , Prassas Evangelos , Menon Krishna , Srinivasan Parthi
Published: July 2024

Multiple biliary tumors rarely develop in patients without underlying chronic hepatobiliary disease. Those lesions are regarded as multifocal neoplasms if there is no interconnecting dysplasia. This study aimed to determine whether 2 separate tumors in the biliary tract represent true multifocal independent tumorigenesis or intraluminal implantation of a single neoplasm. Two separate biliary tumors without intervening dysplasia were identified in 9 cases: biliary intraductal papillary neoplasm (IPNB; n=5) and extrahepatic cholangiocarcinoma (n=4). The 2 tumors were histologically similar in all cases. In 5 metachronous cases, the second tumor developed 2 to 13 years after the complete resection of the first tumor. In 4 synchronous cases, 2 separate neoplasms were identified in a surgical specimen. The metachronous presentation was more common in IPNB cases, whereas the synchronous development was more frequent in cholangiocarcinoma cases. The second tumors in 4 metachronous cases (4/5; 80%) and smaller lesions in all synchronous cases (4/4; 100%) were located in a lower part of the biliary. Immunophenotypes of cytokeratins and mucin core proteins were almost identical between the 2 lesions. Next-generation sequencing also confirmed that the 2 neoplasms shared gene mutations involving KRAS, GNAS, APC, BRAF, CTNNB1, SMAD4, TP53, or ARID1A in all cases. In conclusion, multiple biliary tumors without underlying chronic biliary disease are most likely due to intraductal implantation of a single neoplasm. Thick mucinous bile in IPNB and increasing use of trans-ampullary biliary interventions may contribute to this unique form of tumor extension.
Changes in Urine Drug Screen Sensitivity in Adolescent Opioid Presentations to the Emergency Department
Authors: Sidlak Alexander , Dhaliwal Mannet
Published: July 2024

Introduction

Adolescent overdoses have been rising over the past decade. Emergency department (ED) visits for both acute overdoses and for adolescents in opioid withdrawal have risen post-COVID. Urine drug screens have poor utility in the ED but are routinely obtained for medical clearance and in the management of patients with substance use disorder. Our primary goal was to measure the sensitivity of the opiate urine drug assay over time in opioid-related presentations to the ED.

Methods

We reviewed ED presentations at all EDs within our health system that were directly related to opioids from 1/1/2014 to 12/31/2022. For each patient included over the time frame, we identified whether a urine drug screen was obtained and the results from this screen. The urine drug screen available at all sites was an enzyme-multiplied immunoassay with an opiate screen (morphine antibody), but no fentanyl screen. The percent positivity for each drug category on enzyme multiplied immunoassay technique testing was calculated. Chi-squared tests were used to compare positivity rates between years.

Results

Opiate positivity declined over the last 9 years. Positivity rates from 2020 to 2022 were 5% ± 2% vs 82% ± 6% from 2014 to 2019 (P < 0.001) Performance of UDS also declined over time (76% from 2014 to 2019 vs 46% from 2020 to 2022; P < 0.001). UDS was more likely to be performed in patients after a suicide attempt or when presenting after illicit use (66% vs 38%; P = 0.004).

Conclusion

Opiate screen positivity decreased the last 9 years and may reflect wider use of fentanyl among this population starting in 2020.
Clinical Practice Guideline Development in Pediatric Emergency Medicine Departments Across the United States: A Cross-sectional Study
Authors: Ugwu Chidiebere V. , Jergel Andrew , Murray Brittany , Rees Chris A. , Jain Shabnam
Published: July 2024

Objective

This cross-sectional study aimed to assess the process of clinical practice guideline (CPG) development in pediatric emergency medicine departments (PEDs) across the United States, with a focus on identifying areas for improvement to enhance the quality of CPGs.

Methods

An electronic survey was distributed to PEDs with pediatric emergency medicine fellowship programs. Respondents were asked about their CPG development processes (ie, guideline committee composition, consideration of conflicts of interest, grading recommendations, guideline training opportunities) based on the Appraisal of Guidelines, Research, and Evaluation (AGREE II) tool as well as implementation and monitoring. Univariate analysis was used to assess associations between the number of AGREE II elements adhered to and annual patient volume.

Results

Of the 84 PEDs surveyed, 44 (52.4%) responded, representing institutions from 28 states. Most PEDs (97.7%, n = 43) reported developing their own guidelines, citing the need to improve care quality and standardize patient care as primary reasons. Although most guideline committees included multidisciplinary team members (74.4%, n = 32), routine patient involvement in committees was rare (11.6%, n = 5), and barriers such as time and resource constraints hindered their inclusion. Formal training for committee members in guideline development was uncommon (18.6%, n = 8). There was an association between higher annual patient volume and the number of AGREE II elements adhered to (P = 0.03). Few PEDs considered potential conflicts of interest among committee members (13.6%, n = 6). Over half of surveyed PEDs (54.5%, n = 24) lacked a systematic approach to grading recommendations. Educational materials and workshops were the most common guideline implementation strategies.

Conclusions

Our findings highlight need for improvement in the CPG development process in PEDs. Including patients in committees, providing formal training for committee members, and adopting a rigorous approach to grading recommendations are crucial steps toward enhancing guideline quality. Emphasizing these improvements has the potential to improve the quality of CPGs for pediatric emergency care.
Impact of a Helmet Distribution Program in the Pediatric Emergency Department
Authors: Delacruz Nicolas , Varghese Kathryn , Pulliam Allan , Almader-Ruiz Angelica , Tay Ee Tein
Published: July 2024

Objective

Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets.

Methods

This was a prospective cohort study of children aged 3 to 17 years presenting to the ED of an urban, tertiary care hospital. Participants were surveyed on their helmet use habits and perceptions regarding the efficacy and importance of helmets. Participants then received a bicycle helmet along with safety counseling in the ED and bicycle safety handouts provided by the American Academy of Pediatrics. Participants were contacted for follow-up 8 weeks after enrollment.

Results

We enrolled a total of 94 patients. Post-intervention surveys were obtained from 47% of participants. Our helmet program resulted in a statistically significant increase in the amount of time children reported wearing bicycle helmets. Prior to ED intervention, 48% of participants reported wearing a helmet “most of the time” or “all of the time.” After participating, 86% of participants indicated that they wore a helmet “most of the time” or “all of the time.” Participants indicated a variety of reasons for not wearing helmets. Of all patients contacted for follow-up, 16% indicated that they were involved in an accident after participating where the helmet they were given prevented a head injury.

Conclusions

Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention.
Do Bicycle Helmets Protect Against Facial Fractures? An Observational Study From a Level 1 Trauma Centre
Authors: Galteland Pål , Døving Mats , Sehic Amer , Paaske Utheim Tor , Næss Ingar , Eken Torsten , Skaga Nils Oddvar , Helseth Eirik , Ramm-Pettersen Jon
Published: July 2024

This study investigates the impact of helmet use on the incidence of facial fractures in bicycle accidents. Analyzing data from hospitalized bicyclists between 2005 and 2016, the research focused on the correlation between helmet usage and various facial fractures. The study included 1256 bicyclists with known helmet use, among whom 277 individuals (22%) were identified with a total of 521 facial fractures. The findings revealed a significant reduction in the likelihood of facial fractures among helmeted cyclists compared with those without helmets (odds ratio, 0.65; confidence interval, 0.50-0.85; P=0.002). Specifically, the odds of sustaining fractures in the zygoma, orbit, nose, and maxilla were decreased by 47%, 46%, 43%, and 33%, respectively, among helmeted cyclists. However, helmet use did not significantly alter the odds of mandible fractures. Overall, the use of helmets in bicycling significantly lowered the risk of midface fractures but showed no notable effect on mandible fractures in severe cycling incidents.
The Ethmomaxillary Sinus—A False Duplicate Maxillary Sinus
Authors: Geamănu Aida , Rusu Mugurel Constantin , Mureşan Alexandru Nicolae , Vrapciu Alexandra Diana
Published: July 2024

Functional endoscopic sinus surgery consistently benefits from good anatomical knowledge and modern imaging techniques. Ethmoid air cells migrate in specific topographical sites near the ethmoid. Posterior ethmoid air cells that descend into the maxillary sinus (MS) are ethmomaxillary sinuses (EMSs) that into the superior nasal meatus. Few previous studies found EMSs in 0.68% to 16.48% of cases. An EMS differs from a Haller’s infraorbital cell nearing the ethmoidal infundibulum. A posterior ethmoid air cell intercalated between the ethmoid, MS and sphenoidal sinus is a Sieur’s cell, but it could also be regarded as an EMS. An EMS should be discriminated from a maxillary recess of the sphenoidal sinus. An EMS could determine Onodi’s maxillary bulla into the MS. The false duplicate MS described by Zuckerkandl consists of a MS draining into the middle nasal meatus adjoined by an EMS draining into the superior nasal meatus. These are separated by the ethmomaxillary septum. The latter may be confused with an intrasinus septum of the MS if the drainage pathways are not adequately documented. Therefore, a case-by-case anatomic identification of the pneumatic spaces nearing the MS should be performed before surgical endoscopic approaches of the nose and sinuses.
A Novel Nasal Endoscopy-Assisted Method for Sealing Cerebrospinal Fluid Rhinorrhea
Authors: Wu Qi , Song Ning-ying
Published: July 2024

Cerebrospinal fluid (CSF) rhinorrhea is one of the most common complications after trans-sphenoidal surgery. At present, transcranial or endoscopic surgery for CSF leakage requires general anesthesia to remove autologous fat or fascia to repair the leak, which is traumatic and costly. The authors present a case of a 25-year-old male patient with pituitary adenoma who experienced CSF rhinorrhea 10 days after undergoing endoscopic resection of the tumor. The authors innovatively sequential filled the leak with a gelatin sponge soaked in povidone-iodine solution and iodinated gauze under outpatient nasal endoscopy. The follow-up of 6 months showed no recurrence of CSF leakage. CSF leakage is the most common complication of trans-sphenoidal surgery. The authors suggest that for small cerebrospinal fluid leaks in the early stage after trans-sphenoidal surgery, the leakage should be first filled with gelatin sponge and iodoform gauze sequentially under outpatient nasal endoscopy, which may achieve a complete cure.
Does the Implementation of Virtual Planning has a Significant Impact on Reducing the Revision Rate in Orthognathic Surgery?
Authors: Guzel Ceylan , Ozel Abdullah , Uckan Sina
Published: July 2024

Purpose:

Conventional orthognathic surgical planning has limitations in accurately transferring the relationship between soft tissue and bone. Virtual planning offers enhanced accuracy and visualization through computer simulation. This study aimed to compare the need for reoperation between patients who underwent conventional and virtual surgical planning for orthognathic surgery.

Material and Methods:

The study included 352 patients who underwent orthognathic surgery. Reoperation rates and reasons for reoperation were evaluated in patients with conventional model surgery planning (143 patients) and virtual planning (209 patients).

Results:

The reoperation rate was 7.69% for conventional surgery patients and 3.82% for virtual planning patients. Malocclusion was the most common reason for reoperation in both groups. Bilateral sagittal split ramus osteotomies (BSSO) and genioplasty were the most frequently performed revision procedures.

Conclusion:

Virtual planning in orthognathic surgery may lead to a reduced reoperation rate compared with conventional planning methods. The accuracy, visualization, and interdisciplinary collaboration offered by virtual planning can improve surgical outcomes.
Application of Cross-Groin Flap for Coverage of Large Skin and Soft Tissue Defects of the Foot and Ankle in Children
Authors: Hu Yungang , Zhang Cong , Du Weili , Zhao Xiaozhuo , Shen Yuming
Published: July 2024

In children with large soft tissue defects of the foot and ankle, it is difficult to cover the wound completely using a local skin flap, and skin grafting of the donor area for repair causes secondary damage. Free skin flaps require good vascular anastomoses and are prone to vascular crises. The authors evaluated the effectiveness and safety of cross-inguinal flaps for the repair of large soft tissue defects of the foot and ankle in children. The records of 15 children who underwent cross-groin flap transplantation between June 2017 and June 2021 were analyzed retrospectively. All the flaps survived without infection, necrosis, or other complications. The flap shape was good, the donor area was sutured directly, and the damage was minimal. This surgical method is simple, effective, and safe and can replace microsurgery, making it suitable for use in primary-level hospitals that are not equipped for microscopic surgery.
Evolution of Virtual Surgical Planning Use Among Craniofacial Surgeons
Authors: Moscarelli Jake , Hu Kevin G. , Alper David , Rancu Albert , Salib Andrew , Ihnat Jacqueline M.H. , Parikh Neil , Persing John A. , Alperovich Michael
Published: July 2024

Virtual surgical planning (VSP) has benefits in craniofacial surgery with growing popularity. However, while specific use cases are highlighted in the literature, no studies exist providing an overview of VSP use among craniofacial surgeons, and little is known about the extent of exposure to VSP during plastic surgery training. This study surveyed members of The American Society of Maxillofacial Surgeons (ASMS) to better characterize both the landscape of VSP use among practicing craniofacial surgeons and the extent of exposure to VSP throughout surgical training. An electronic survey was administered in the fall of 2023. Response data included surgeon demographics, VSP usage, including the use in residency/fellowship, procedures for which VSP is used, and assessment of VSP’s impact on the surgeon’s practice. Demographics and VSP use were analyzed using descriptive statistics, while categorical and continuous variables were analyzed using χ2 tests and t-tests, respectively. Of the 44 respondents, 40 (90.9%) completed a craniofacial surgery fellowship, and 18 (40.9%) utilized VSP in either residency or fellowship. In respondents’ current practice, VSP is utilized most commonly for orthognathic surgery (n=32, 91.4%), postablative reconstruction (n=23, 82.1%), and facial feminization (n=11, 73.3%). Shorter operative time and improved esthetic outcomes were frequently reported as benefits derived from VSP use. Finally, surgeons in practice for less than 10 years were significantly more likely to have used VSP in both residency (OR=20.3, P<0.01) and in fellowship (OR=40.6, P<0.01) than those practicing for more than 10 years. These findings suggest that craniofacial surgeons apply VSP more commonly for certain procedure types. Our results additionally suggest that incorporation of VSP into residency and fellowship training has become significantly more common over time, with a pivot towards integration in the last decade.
The Effects of Presurgical Orthodontic Treatment on the Outcome of Secondary Bone Graft for Individuals With Cleft Lip and Palate
Authors: Fu Moyu Lara , Aldosari Malak , Chakraborty Archak , Ko Jaemin , Tahir Peggy , Oberoi Snehlata
Published: July 2024

Background/Objective:

Alveolar bone graft (ABG) or repair has become a routine part of treatment protocols for individuals with cleft lip and/or palate. However, the necessity and potential benefits of presurgical orthodontic treatment in influencing the outcomes of secondary alveolar bone grafting remain inconclusive. This systematic review aimed to assess the impact of presurgical orthodontics on preparing patients for secondary alveolar bone grafts.

Study Design:

The authors systematically searched for relevant articles in PubMed, Web of Science, and Embase databases spanning the period from January 1, 2000, to December 31, 2023, using keywords related to alveolar bone grafting and orthodontic treatment for patients with cleft lip and/or palate. The review encompassed various study designs, including prospective and retrospective studies, observational studies, cross-sectional studies, randomized and nonrandomized clinical trials, cohort studies, and case-control studies. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the risk of bias was evaluated in studies selected for full-text review.

Results:

The search strategy identified 809 publications. After initial screening and application of exclusion criteria, 11 studies were included for final review. Three were prospective studies, 8 were retrospective studies, and 3 were cross-sectional cohort studies. On the basis of ROBINS-I and RoB 2 risk assessment, 9 studies were found to be of moderate risk of bias, one study was categorized as of high risk of bias, and 1 study was categorized as low risk of bias.

Conclusions:

Drawing from the latest and most reliable studies, 7 out of 11 included studies provided compelling evidence that presurgical orthodontics preceding alveolar bone grafting (ABG) leads to significantly improved outcomes compared with cases without presurgical orthodontic intervention. Notably, individuals with specific conditions, such as severely collapsed upper arch and mispositioned upper incisors, appear to derive the greatest benefits from presurgical orthodontic treatment. However, a call for additional studies characterized by high methodological quality and with longer follow-up periods is emphasized to enhance the safety considerations for both practitioners and patients concerning the utilization of presurgical orthodontics in the treatment of individuals with cleft lip and palate.
The Applicability of Polyetheretherketone and Titanium Mesh in Cranioplasty: A Retrospective Comparative Analysis
Authors: Peng Yao-Nan , Liu Zhen-Zhen , Qiao Liang
Published: July 2024

Objective:

To compare the clinical application effect and safety of polyetheretherketone (PEEK) and titanium mesh (TM) in cranioplasty.

Methods:

Four-year retrospective comparison of patients (96 cases) undergoing synthetic cranioplasty with PEEK or TM. The patients were divided into the PEEK group (24 cases) and the TM group (72 cases) according to the implants, and the patient demographics, general conditions before the operation, postoperative complications, length of postoperative hospital stay, total costs, satisfaction with shaping and long-term complications were compared between the 2 groups.

Results:

Patients in the PEEK group were younger than those in the TM group (P=0.019). Hospitalization costs were significantly higher in the PEEK group than in the TM group (P<0.001). The incidence of postoperative subcutaneous effusion was 33% in the PEEK group and 6.9% in the TM group, which suggests that patients in the PEEK group had a higher risk of postoperative subcutaneous effusion (P=0.001). There was no significant difference in the incidence of long-term complications and cosmetic satisfaction between the 2 groups at 4 years postoperatively.

Conclusions:

In this study, both titanium mesh and PEEK are reliable implants for cranioplasty. Titanium mesh is widely used in cranioplasty due to its cost-effective performance. PEEK has gradually gained recognition due to the characteristics of the material and surgical procedure, but the price needs to be further reduced, and attention should be paid to the occurrence and treatment of early postoperative subcutaneous effusion.
Maryland’s Global Budget Revenue Payment Model and Shifts in the Surgical Site of Care Among Medicare Beneficiaries
Authors: Lin Yu-Li , Herring Bradley , Melamed Alexander , Hassan Abbas M. , Petrillo Laura A. , Keating Nancy L. , Offodile Anaeze C.
Published: July 2024

Objective:

To assess the association between the Global Budget Revenue (GBR) payment model and shifts to the outpatient setting for surgical procedures among Medicare fee-for-service beneficiaries in Maryland versus control states.

Summary Background Data:

The GBR model provides fixed global payments to hospitals to reduce spending growth and incentivize hospitals to reduce the costs of care while improving care quality. Since surgical care is a major contributor to hospital spending, the GBR model might accelerate the ongoing shift from the inpatient to the outpatient setting to generate additional savings.

Methods:

A difference-in-differences (DiD) design was used to compare changes in surgical care settings over time from pre-GBR (2011-2013) to post-GBR (2014-2018) for Maryland versus control states for common surgeries that could be performed in the outpatient setting. A cross-sectional approach was used to compare the difference in care settings in 2018 for total knee arthroplasty which was on Medicare’s Inpatient-Only List before then.

Results:

We studied 47,542 surgical procedures from 44,410 beneficiaries in Maryland and control states. GBR’s 2014 implementation was associated with an acceleration in the shift from inpatient to outpatient settings for surgical procedures in Maryland (DiD: 3.9 percentage points, 95% CI: 2.3, 5.4). Among patients undergoing total knee arthroplasty in 2018, the proportion of outpatient surgeries in Maryland was substantially higher than that in control states (difference: 27.6 percentage points, 95% CI: 25.6, 29.6).

Conclusions:

Implementing Maryland’s GBR payment model was associated with an acceleration in the shift from inpatient to outpatient hospital settings for surgical procedures.
Infiltration of Common Myeloid Progenitor (CMP) Cells is Associated With Less Aggressive Tumor Biology, Lower Risk of Brain Metastasis, Better Response to Immunotherapy, and Higher Patient Survival in Breast Cancer
Authors: Oshi Masanori , Wu Rongrong , Khoury Thaer , Gandhi Shipra , Yan Li , Yamada Akimitsu , Ishikawa Takashi , Endo Itaru , Takabe Kazuaki
Published: July 2024

Objective:

To investigate the clinical relevance of common myeloid progenitor (CMP) cells in breast tumor microenvironment (TME).

Background:

The role of rare cells in TME is less studied. In Silico transcriptomic analyses of real-world data enable us to detect and quantify rare cells, including CMP cells.

Methods:

A total of 5176 breast cancer (BC) patients from SCAN-B, METABRIC, and 5 single-cell sequence cohorts were analyzed using the xCell algorithm. The high group was defined as more than two-thirds of the CMP scores in each cohort.

Results:

CMP cells consist of 0.07% to 0.25% of bulk breast tumor cells, more in estrogen receptor-positive (ER+) compared with triple-negative (TN) subtype (0.1% to 0.75%, 0.18% to 0.33% of immune cells, respectively). CMP cells did not correlate with any of the myeloid lineages or stem cells in TME. CMP infiltration was higher in smaller tumors, with lower Nottingham grade, and in ER+/HER2− than in TNBC consistently in both SCAN-B and METABRIC cohorts. High CMP was significantly associated with a lower risk of brain metastasis and with better survival, particularly in ER+/HER2−. High CMP enriched epithelial-to-mesenchymal transition and angiogenesis pathways, and less cell proliferation and DNA repair gene sets. High CMP ER+/HER2- was associated with less immune cell infiltration and cytolytic activity (P<0.001). CMP infiltration correlated with neoadjuvant chemoimmunotherapy response for both ER+/HER2- and TNBC in the ISPY-2 cohort (AUC=0.69 and 0.74, respectively).

Conclusions:

CMP in BC is inversely associated with cell proliferation and brain metastasis, better response to immunotherapy, and survival. This is the first to report the clinical relevance of CMP infiltration in BC.
Rejection Surveillance After Heart Transplantation: Is Paired Noninvasive Testing the New Gold Standard?
Authors: Moayedi Yasbanoo , Teuteberg Jeffrey J.
Published: July 2024

Rejection surveillance after heart transplantation has traditionally relied on numerous endomyocardial biopsies, most of which occur during the first posttransplant year. With the introduction of gene expression profiling and, more recently, donor-derived cell-free DNA, a great proportion of surveillance is being performed noninvasively with both tests. Although patients have welcomed the use of paired testing because of the decreased risk and inconvenience, interpretation of both tests can sometimes be challenging, particularly when the test results are discordant. Growing evidence from both single-center experiences and large national databases has given insights that have allowed the field to operationalize dual testing and provide physicians with algorithms to approach paired testing. The increased use of noninvasive testing has also begun to challenge the role of biopsy as the gold standard for graft monitoring, not only for rejection but over the life of the heart transplant. In a growing number of circumstances, cell-free DNA not only may be a better means of assessing rejection but could also redefine how clinicians approach the diagnosis and even treatment of graft injury. As the heart transplant community garners more experience and generates more data, the current paradigms of heart transplant surveillance will continue to be challenged.
Oxidized ATP Suppresses B Lymphocyte Activity to Attenuate Antibody-mediated Rejection of Kidney Allografts in Mice
Authors: Yu Yi , Bi Zirong , Jiang Qifeng , Huang Shangjin , He Yingzhen , Gai Jingci , Huang Huiting , Liu Longshan , Gao Yifang , Li Xirui , Wang Changxi , Wu Chenglin
Published: July 2024

Background.

Antibody-mediated rejection (AMR) is a major cause of renal allograft dysfunction and loss. Targeting B cells and/or donor-specific antibody removal using plasma exchange and anti-CD20 antibodies are increasingly used in clinical practice, but the efficacy remains limited. Recent studies suggest that targeting purinergic P2X7 receptor/ATP axis can have profound immune regulatory effects in transplant models, but the mechanisms involved remain incompletely defined.

Methods.

Purified B cells were isolated from the spleen of Balb/C mice and cultured with oxidized ATP at different concentrations. Proliferation and differentiation of B cells were examined. Effects of oxidized ATP were examined in a presensitized animal model where kidney allograft rejection mimics aspects of clinical AMR. Histopathology was assessed at the time of rejection or on day 5 after kidney transplantation. Infiltrating immune cells in renal allografts were detected by flow cytometry.

Results.

Oxidized ATP inhibited B-cell activation and proliferation in vitro, significantly attenuated histological signs of graft injury and prolonged kidney allograft survival. Mechanistically, oxidized ATP inhibited antibody secretion by activated B cells in response to lipopolysaccharide stimulation and markedly suppressed the production of donor-specific antibody in kidney allograft recipients. Oxidized ATP also reduced graft infiltration by other inflammatory cells.

Conclusions.

These findings provide evidence for the involvement of the purinergic P2X7 receptor pathway in AMR and suggest that targeting this pathways may have important clinical implications.
Frailty management in older patients: a best practice implementation project
Authors: Chen Chih Wen , Lee Mei-Chen , Liu Kuei Fen , Lin Li-Ju , Wu Shu-Fang Vivienne
Published: July 2024

Introduction:

Frailty in older adults can lead to a gradual decline in organ function. Without timely diagnosis and intervention, this condition can progress rapidly, increasing the risk of disability and mortality.

Objectives:

The aim of this project was to implement evidence-based practices for managing frailty in the medical ward to prevent disability in older patients.

Methods:

This project was conceptually informed by the JBI Evidence Implementation Framework. This framework uses an audit and feedback approach and a pre- and post-test design to measure baseline compliance, develop implementation strategies responsive to gaps in compliance, and conduct a final evaluation to measure changes in compliance. JBI PACES and JBI GRiP situational analysis software were used to support data collection and implementation planning. Ten audit criteria were used with a sample of 30 patients in a regional teaching hospital in southern Taiwan.

Results:

The baseline audit showed poor compliance, with rates below 30% for all ten audit criteria. Through strategies such as professional training and education, the implementation of evidence-based care guidelines, and interdisciplinary consensus-building, the follow-up audit revealed an increase in compliance to over 90% for each audit criterion.

Conclusions:

Frailty management strategies based on evidence-based audit criteria were implemented and routinely measured. The most effective strategies for improving compliance included the development of a training course, a digitized assessment tool, team meetings, interdisciplinary collaboration, communication, and consensus-building.

Spanish abstract:

http://links.lww.com/IJEBH/A225