bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating time-to-total knee replacement on radiographs and MRI: a multimodal approach using self-supervised deep learning
Authors: Cigdem Ozkan , Chen Shengjia , Zhang Chaojie , Cho Kyunghyun , Kijowski Richard , Deniz Cem M
Published: November 2024

Purpose

Accurately predicting the expected duration of time until total knee replacement (time-to-TKR) is crucial for patient management and health care planning. Predicting when surgery may be needed, especially within shorter windows like 3 years, allows clinicians to plan timely interventions and health care systems to allocate resources more effectively. Existing models lack the precision for such time-based predictions. A survival analysis model for predicting time-to-TKR was developed using features from medical images and clinical measurements.

Methods

From the Osteoarthritis Initiative dataset, all knees with clinical variables, MRI scans, radiographs, and quantitative and semiquantitative assessments from images were identified. This resulted in 895 knees that underwent TKR within the 9-year follow-up period, as specified by the Osteoarthritis Initiative study design, and 786 control knees that did not undergo TKR (right-censored, indicating their status beyond the 9-year follow-up is unknown). These knees were used for model training and testing. Additionally, 518 and 164 subjects from the Multi-Center Osteoarthritis Study and internal hospital data were used for external testing, respectively. Deep learning models were utilized to extract features from radiographs and MR scans. Extracted features, clinical variables, and image assessments were used in survival analysis with Lasso Cox feature selection and a random survival forest model to predict time-to-TKR.

Results

The proposed model exhibited strong discrimination power by integrating self-supervised deep learning features with clinical variables (eg, age, body mass index, pain score) and image assessment measurements (eg, Kellgren-Lawrence grade, joint space narrowing, bone marrow lesion size, cartilage morphology) from multiple modalities. The model achieved an area under the curve of 94.5 (95% CI, 94.0-95.1) for predicting the time-to-TKR.

Conclusions

The proposed model demonstrated the potential of self-supervised learning and multimodal data fusion in accurately predicting time-to-TKR that may assist physicians to develop personalize treatment strategies.
The frequency and clinical associations of opioid use in systemic sclerosis
Authors: Fairley Jessica L , Hansen Dylan , Proudman Susanna , Sahhar Joanne , Ngian Gene-Siew , Apostolopoulos Diane , Walker Jennifer , Host Lauren V , Stevens Wendy , Ferdowsi Nava , Tabesh Maryam , Nikpour Mandana , Ross Laura
Published: November 2024

Objective

To define the frequency and associations of opioid use in SSc.

Methods

Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc were included. Current or previous opioid use was recorded at each visit, with long-term use defined as use on two or more consecutive visits. Groups were compared using two-sample t-test, Wilcoxon rank sum test or chi-squared test. Generalised estimating equations were used to model longitudinal data.

Results

Of 1951 participants with a mean age of 46.7 years (s.d. 14.4), 88% were female and 12% had ever received any opioids since SSc onset. Of these, 46% recorded opioid use across multiple consecutive study visits. Digital ulcers (63% vs 52%), synovitis (57% vs 38%), interstitial lung disease (37% vs 27%), gastrointestinal (GI) symptoms (upper 97% vs 88%, lower 90% vs 80%) and immunosuppression (59% vs 46%) were all more frequent in opioid-exposed groups (P < 0.05). In multivariable modelling, current opioid use at each study visit was associated with digital ulcers [odds ratio (OR) 1.5 (95% CI 1.1, 2.0), P = 0.01], synovitis [OR 1.5 (95% CI 1.1, 2.1), P = 0.02], lower GI symptoms [OR 1.8 (95% CI 1.3, 2.6), P < 0.01] and poorer physical [OR 1.8 (95% CI 1.3, 2.4), P < 0.01] and mental [OR 1.8 (95% CI 1.1, 3.0), P = 0.02] quality of life (QoL). Current opioid use was associated with worse fatigue [regression coefficient (RC) 3.0 units (95% CI 1.2, 4.8), P < 0.01], functional disability [RC 0.2 (95% CI 0.2, 0.3), P < 0.01], dyspnoea [RC 2.0 (95% CI 0.8, 3.1), P < 0.01], depression [RC 2.5 (95% CI 0.9, 4.0), P < 0.01] and anxiety [RC 2.5 (95% CI 0.9, 4.0), P < 0.01].

Conclusions

Opioid use in SSc was associated with musculoskeletal, GI and lung involvement. Opioid prescription was associated with poorer QoL and physical function.
Simulated nitrogen deposition and precipitation events alter microbial carbon cycling during early stages of litter decomposition
Authors: Kroeger Marie E , Wang Renée Z , Suazo Dennis , Yoshida Thomas , Albright Michaeline B N , Dunbar John
Published: November 2024

Plant litter decomposition is a major nutrient input to terrestrial ecosystems that is primarily driven by microorganisms. Litter quality is considered a key drive of decomposition; however, human-induced global disturbance like nitrogen deposition and increasing extreme precipitation events will shift nutrient availability during litter decomposition. Little is known about how shifting nutrient availability will impact dissolved organic matter concentrations and microbially driven carbon cycling that are critical to soil organic matter formation. This study investigated the effect of simulated nitrogen deposition and repeated precipitation events on microbially driven carbon flow during short-term litter decomposition using a ‘common garden’ experiment with microcosms containing sand and blue grama grass litter inoculated with different microbial communities. Overall, nitrogen deposition decoupled respiration and dissolved organic carbon (DOC) by increasing respiration and not affecting DOC concentrations. Moreover, nitrogen deposition had no effect on microbial carbon use efficiency (CUE). Repeated simulated precipitation events significantly increased DOC concentrations, decreased microbial CUE, increased the microbial metabolic quotient (qCO2), and altered microbial composition and diversity. These findings highlight the complex interactions and responses of surface litter decomposers to shifting nutrient availability and contradicts previous findings that nitrogen deposition will increase soil carbon sequestration from a larger supply of DOC and reduced respiration.
Examining the influence of intolerance of uncertainty on (occupational) future time perspective and retirement-related outcomes in working adults
Authors: Laguerre Rick A , Barnes-Farrell Janet L
Published: November 2024

Uncertainty regulation models have recently challenged the assumption that uncertainty is inherently negative, describing ways that uncertainty regulation can lead to effectiveness. The goal of this study was to empirically test a small component of these dynamic frameworks. We accomplished this through measuring intolerance of uncertainty—a predisposition towards fearing an uncertain future—as a predictor of retirement-related outcomes, via future time perspective and occupational future time perspective. In Study 1, based on a heterogenous two-wave sample of working adults, (T1 N = 975, T2 N = 875), we tested intolerance of uncertainty as a predictor of financial risk tolerance towards retirement, retirement saving behaviors, and motivation to continue working,  via future time perspective. Study 1 revealed that intolerance of uncertainty had a significant indirect effect on motivation to continue working and financial risk tolerance towards retirement, via future time perspective—suggesting that tolerating uncertainty is beneficial for aging workers through shaping an open-ended future time perspective. In Study 2, we used a heterogenous three-wave sample of working adults (T1 N = 587, T2 N = 454, T3 N = 406) and evaluated intolerance of uncertainty as a predictor of perceived work ability, via occupational future time perspective. Consistent with expectations, Study 2 reinforced the conclusions of Study 1. Overall, we provide empirical support for aspects of these uncertainty regulation frameworks. We discuss our findings in the context of uncertainty regulation, (occupational) future time perspective, and successful workplace aging.
Comparative Analysis of Two Neighboring Conducive and Suppressive Soils Toward Plant Parasitism Caused by Phelipanche ramosa on Brassica napus
Authors: Martinez Lisa , Pouvreau Jean-Bernard , Jestin Christophe , Montiel Gregory , Gravot Antoine , Berardocco Solenne , Marnet Nathalie , Bouchereau Alain , Delage Erwan , Simier Philippe , Poulin Lucie
Published: November 2024

In Western France, rapeseed ( Brassica napus) cultivation faces substantial yield losses due to the root holoparasitic plant Phelipanche ramosa. However, recent observations have shown a reduction in parasitism within previously heavily infested fields. This study investigates two neighboring rapeseed soils with distinct levels of parasitic infestation, considered suppressive and conducive. Using a cocultivation system of Brassica napus and P. ramosa, we comprehensively examined rhizosphere exudates, parasitic plant attachment, and rhizosphere soil microbiota. Our findings revealed that the suppressive soil effectively reduced parasitism by impeding broomrape attachment and development, as well as inducing necrosis of tubercles. This suppressive effect was specific to postattachment stages, leaving germination and haustoriogenesis preattachment stages unaffected. Analysis of microbial structures suggested that the suppression of parasitism is predominantly of fungal rather than bacterial origin. Correlation network analyses identified three groups of amplicon sequence variants (ASVs) associated with suppression. Notably, seven ASVs were inversely correlated with parasitic attachments, and only one ASV, identified as Berkeleyomyces, a necrotrophic fungus responsible for black root rot, was positively correlated with necrosis and was more abundant in the suppressive soil. This study demonstrates the contrasting parasitic plant development on two physicochemically similar soils, highlighting the central role of fungal dynamics in the rhizosphere. These results provide valuable insights into the mechanisms underlying soil-mediated suppression of P. ramosa, offering potential strategies for mitigating the impact of this root holoparasite on rapeseed yields in the region.
Bone phenotyping of murine hemochromatosis models with deficiencies of Hjv, Alk2, or Alk3: The influence of sex and the bone compartment
Authors: Dogan Deniz Y. , Hornung Isabelle , Pettinato Mariateresa , Pagani Alessia , Baschant Ulrike , Seebohm Guiscard , Hofbauer Lorenz C. , Silvestri Laura , Rauner Martina , Steinbicker Andrea U.
Published: November 2024

Osteopenia is frequently observed in patients with iron overload, especially in those with HFE‐dependent hereditary hemochromatosis (HH). Interestingly, not all mouse models of HH show bone loss, suggesting that iron overload alone may not suffice to induce bone loss. In this study, the bone phenotypes of Hjv−/− and hepatocyte‐specific Alk2‐ and Alk3‐deficient mice as additional mouse models of HH were investigated to further clarify, how high iron levels lead to bone loss and which signaling mechanisms are operational. Neither male nor female 12‐week‐old Hjv−/− mice had an altered trabecular or cortical bone mass or bone turnover, despite severe iron overload. Male 12‐month‐old Hjv−/− mice even presented with a higher femoral trabecular bone volume compared to wildtype mice. Similarly, female mice with hepatocyte‐specific Alk2 or Alk3 deficiency did not show an altered bone phenotype at 3, 6, and 12 months of age. Male hepatocyte‐specific Alk3‐deficient mice also had a normal trabecular bone mass at all ages analyzed, despite showing increased bone resorption and decreased bone formation parameters. Interestingly, hepatocyte‐specific Alk2‐deficient mice showed reduced femoral trabecular bone at 6 months of age due to suppressed bone formation. Cortical thickness at the femur was reduced in both, 6‐month‐old male hepatocyte‐specific Alk2‐ and Alk3‐deficient mice. Raising hepatocyte‐specific Alk2‐deficient male mice on an iron‐deficient diet rescued the bone phenotype. Taken together, despite iron overload, trabecular bone microarchitecture was not altered in mice deficient of Hjv or Alk3. Only male hepatocyte‐specific Alk2‐deficient mice showed site‐specific lower trabecular and cortical bone mass at the femur, which was dependent on iron. Thus, bone loss does not correlate with the extent of iron overload in these mouse models, but may relate to the amount of iron‐loaded macrophages, as precursors of osteoclasts, in the bone marrow.
Trends in Cervical Laminoplasty Incidence in the United States
Authors: Rajan Prashant V. , Heo Kevin , Heller John G. , Yoon Sangwook Tim
Published: November 2024

Study Design:

Retrospective database study.

Objective:

To leverage a commercial insurance claims database to explore trends in laminoplasty utilization and reimbursement in the United States. Secondarily, volume estimates were compared with data from the industry and from the Centers for Medicare and Medicaid (CMS).

Summary of Background Data:

With purported benefits of motion preservation and lower complication rates than fusion, cervical laminoplasty is an important surgical technique. However, current commercial database studies suggest that laminoplasty adoption in the United States has been slow.

Methods:

The primary outcome was the total volume of laminoplasty procedures performed in the United States per year. Truven, a large commercial insurance claims database, was used to estimate laminoplasty volume from 2009 to 2019. Volume estimates for posterior cervical fusions were also generated as a comparator. Reimbursement data for laminoplasty adjusted for inflation were also generated. Trends in national procedural volumes and reimbursement over time were assessed with the Pearson correlation test. CMS Part B national summary statistics from 2000 to 2022 and market data from laminoplasty device manufacturers from 2017 to 2024 were qualitatively compared with volume estimates from Truven.

Results:

Truven volume of laminoplasty remained stable throughout the study period with an estimated annual volume of 944–1590 cases. Posterior cervical fusion volume was much higher, ranging from 7930 to 11,874 cases with increased trend. When compared qualitatively, Truven volume estimates were similar to those from CMS data, although industry volume estimates were comparatively higher (estimated total volume of 8352–11,428 cases). There was no statistically significant trend in Truven reimbursement values for laminoplasty from 2009 to 2019.

Conclusions:

Industry market data suggest more laminoplasty procedures are being performed nationally than what is estimated by commercial/CMS databases. This suggests possible growth in laminoplasty usage, given purported advantages to fusion in the properly indicated patient, and possibly calls into question the epidemiological accuracy of commercial claims databases.

Level of Evidence:

IV—Retrospective study.
A rare EGFR exon 19 insertion mutation in metastatic lung adenocarcinoma: a favorable response to afatinib
Authors: Seven İsmet , Köş Fahriye Tuğba , Tatli Doğan Hayriye , Kişlal Mustafa Hayri , Sekmek Serhat , Karahan İrfan , Aktürk Esen Selin , Uncu Doğan
Published: November 2024

Epidermal growth factor receptor (EGFR) mutations like the common L858R and exon 19 deletions are well studied, but rarer mutations like exon 19 insertions have received less attention. This case report describes a patient with this uncommon EGFR exon 19 insertion mutation in metastatic lung adenocarcinoma. A 51-year-old male nonsmoker with metastatic lung adenocarcinoma and a rare EGFR exon 19 insertion mutation experienced disease progression on initial carboplatin–pemetrexed chemotherapy. However, treatment with the second-generation tyrosine kinase inhibitor afatinib led to a partial response, with significant regression of the primary tumor and bone metastases. This case highlights the favorable clinical response to afatinib treatment in a patient with metastatic nonsmall cell lung cancer harboring a rare EGFR exon 19 insertion mutation.
An Analysis of the Association of Whole Blood Transfusion With the Development of Acute Respiratory Distress Syndrome
Authors: Moreno Arianna R. , Fisher Andrew D. , Long Brit J. , Douin David J. , Wright Franklin L. , Rizzo Julie A. , April Michael D. , Cohen Mitchell J. , Getz Todd M. , Schauer Steven G.
Published: November 2024

OBJECTIVES:

To determine the association of whole blood and other blood products (components, prothrombin complex concentrate, and fibrinogen concentrate) with the development of acute respiratory distress syndrome (ARDS) among blood recipients.

DESIGN:

Retrospective cohort study.

SETTING:

American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2020 and 2021.

PATIENTS:

Patients 15 years old or older in the TQIP database between 2020 and 2022 who received at least one blood product.

INTERVENTIONS:

We compared characteristics and blood product administration between patients who developed ARDS versus those who did not.

MEASUREMENTS AND MAIN RESULTS:

There were 134,863 that met inclusion for this analysis. Within the included population, 1% (1927) was diagnosed with ARDS. The no ARDS group had a lower portion of serious injuries to the head/neck (31% vs. 46%), thorax (51% vs. 78%), abdomen (34% vs. 48%), and extremities (37% vs. 47%). The median composite Injury Severity Score was 21 (11–30) in the no ARDS group vs. 30 (22–41) in the ARDS group. Unadjusted survival of discharge was 74% in the no ARDS group vs. 61% in the ARDS group. In our multivariable model, we found that whole blood (unit odds ratio [uOR], 1.05; 95% CI, 1.02–1.07), male sex (odds ratio, 1.44; 95% CI, 1.28–1.63), arrival shock index (uOR, 1.03; 95% CI, 1.01–1.06), and composite Injury Severity Score (uOR, 1.03; 95% CI, 1.03–1.04) were associated with the development of ARDS. These persisted on sensitivity testing.

CONCLUSIONS:

We found an association between whole blood and the development of ARDS among trauma patients who received blood transfusions. Contrary to previous studies, we found no association between ARDS and fresh frozen plasma administration. The literature would benefit from further investigation via prospective study designs.
Rocking Motion Therapy for Delirious Patients in the ICU: A Multicenter Randomized Clinical Trial
Authors: Collet Marie Oxenbøll , Nielsen G. M. , Thorn Linette , Laerkner Eva , Fischer Susanne , Bang Benita , Langvad Anne , Granholm Anders , Egerod Ingrid
Published: November 2024

OBJECTIVES:

Rocking motion therapy has been shown to calm people with dementia but has never been investigated in delirious patients in the ICU. The aim of this clinical trial was to investigate the efficacy and safety of a rocking motion vs. nonrocking motion chair on the duration of delirium and intensity of agitation in ICU patients with delirium. We hypothesized that rocking motion therapy would increase the number of days alive without coma or delirium at 2 weeks of follow-up.

DESIGN:

This was a multicenter, investigator initiated, parallel-group randomized controlled trial.

SETTING/PATIENTS:

ICU patients 18 years or older with a positive delirium assessment.

INTERVENTIONS:

Participants were assigned to either a minimum of 20 minutes rocking motion therapy or a minimum of 20 minutes in the same chair without rocking motion therapy turned on daily.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was days alive without coma or delirium 2 weeks after randomization. We enrolled 149 patients; 73 were randomly assigned to rocking motion therapy and 76 to nonrocking motion therapy. Primary outcome data were available in 141 patients.

CONCLUSIONS:

Among patients with delirium in the ICU, the use of rocking motion therapy did not lead to a statistically significantly greater number of days alive without coma or delirium at the 2 weeks of follow-up than nonrocking motion therapy.
ABO Blood Group and Risk Associated With Sepsis-Associated Thrombocytopenia: A Single-Center Retrospective Study
Authors: Liufu Rong , Chen Yan , Wang Jing-Yi , Wang Yang-Yan-Qiu , Wu Yao , Jiang Wei , Wang Chun-Yao , Peng Jin-Min , Weng Li , Du Bin
Published: November 2024

OBJECTIVES:

This study aimed to investigate the relationship between ABO blood group and sepsis-associated thrombocytopenia (SAT).

DESIGN AND SETTING:

The primary outcome was SAT within the first 72 hours of ICU admission.

PATIENTS:

The retrospective study included 9113 patients diagnosed with sepsis from January 2014 to December 2022. A total of 6296 patients eventually were included into the study, who were divided into four groups based on ABO blood group.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 2494 patients (39.6%) were diagnosed with SAT, and 712 (11.3%) of them experiencing severe SAT. The occurrence of SAT among the ABO blood groups was significantly lower in AB blood group compared with the other groups (p = 0.032). Individuals in AB blood group were less likely to experience severe SAT (p = 0.028). In multivariate analysis, B blood group (odds ratio [OR], 1.32; 95% CI, 1.05–1.67) and O (OR, 1.37; 95% CI, 1.09–1.72) were significantly associated with a higher occurrence of SAT compared with AB blood group. In multivariate analyses, A blood group (OR, 1.68; 95% CI, 1.16–2.42), B blood group (OR, 1.74; 95% CI, 1.74–2.50), and O blood group (OR, 1.72; 95% CI, 1.20–2.48) remained significantly risk factors associated with a higher occurrence of severe SAT compared with AB blood group.

CONCLUSIONS:

B blood group and O were associated with an increased risk of SAT and severe SAT.
Effectiveness and safety of talimogene laherparepvec and granulocyte-macrophage colony-stimulating factor for metastatic melanoma: a systematic review and network meta-analysis of randomized controlled trials
Authors: Shen Yu-Chun , Huang Ya-Li , Kang Yi-No , Chiu Wen-Kuan , Hoang Khanh Dinh , Wang Hsian-Jenn , Chen Chiehfeng
Published: November 2024

Melanoma is an aggressive tumor that is challenging to treat. Talimogene laherparepvec (T-VEC), the first oncolytic virus treatment approved by the US Food and Drug Administration to treat unresectable melanoma, was recently used in recurrent tumors after initial surgery. Our network meta-analysis aimed to compare T-VEC treatment of metastatic melanoma with treatment of granulocyte-macrophage colony-stimulating factor (GM-CSF) and control group. The protocol for this network meta-analysis was retrospectively registered with PROSPERO (CRD42022363321). Three databases, namely Embase, PubMed, and Cochrane Library, were searched until 10 June 2024. The search terms used were a combination of ‘metastatic melanoma’, ‘melanoma’, ‘T-VEC’, ‘talimogene laherparepvec’, and ‘GM-CSF’. Seven studies, with 978 participants receiving T-VEC treatment, 649 participants receiving GM-CSF treatment, and 938 participants constituting the control group, were included in our meta-analysis. For 1-year overall survival (OS), the league table revealed significant differences between the control and T-VEC groups [0.90 (0.83, 0.99)]. The disease-free survival (DFS) over 2 years was also analyzed showing no difference between the groups in DFS in the league table. T-VEC may be a favorable treatment for metastatic melanoma owing to the notable increase in OS. Nevertheless, due to the side effects and limitations, the clinical benefits of T-VEC therapy in metastatic melanoma should be interpreted cautiously. This network meta-analysis demonstrates that T-VEC may be a favorable choice of treatment for metastatic melanoma.
The harmony of proportions: Exploring the golden ratio concept in nipple-sparing mastectomy through inframammary fold incision
Authors: Kaciulyte Juste , Sordi Silvia , Luridiana Gianluigi , Marcasciano Marco , Lo Torto Federico , Cavalieri Enrico , Cuomo Roberto , Ribuffo Diego , Casella Donato
Published: November 2024

Background:

The inframammary incision appears promising in nipple-areola-sparing mastectomies (NASM). The Golden Ratio principles may standardize the extension and position of this incision, placing it in the lateral 2/3 of the fold. The authors explored the inframammary approach within the Golden Ratio concepts, to standardize its usage.

Methods:

This prospective study enrolled breast cancer patients eligible for NASM and implant-based breast reconstruction, excluding those with medium-severe breast ptosis. Incision lied in fold’s lateral 2/3 with a 1.618 ratio. Patient demographics, tumor characteristics, surgical complications, and aesthetic outcomes were recorded, with a minimum follow-up of 6 months.

Results:

A total of 108 patients were enrolled between August 2019 and December 2023. The inframammary fold averaged 11.8 cm, while the medium incision length was 7.3 cm. During an average follow-up of 20 months (range 6–47), six cases (5.5%) showed early postoperative complications. Two cases of severe capsular contracture necessitated implant replacement, and 4.6% of patients (5) developed rippling. Locoregional recurrence occurred in one case (0.9%). Aesthetic satisfaction scores were high: breast shape average score was 4.3, breast volume was 4.23, inframammary fold position was 4.1, and scar position was 4.8.

Conclusions:

NASM coupled with implant-based breast reconstruction allows the surgeon to focus on oncological safety without compromising aesthetic outcomes. As in all surgical procedures, patient selection is paramount, as well as thorough preoperative planning. To give an answer to “when,” “where” and “how” performing an inframammary incision in NASMs, the authors used the Golden Ratio principle achieving natural-looking reconstruction and high levels of patient satisfaction.
Management of Tomographically Suspicious Fellow Eyes of Young Patients With Unilateral Clinically Evident Keratoconus: Accelerated Epithelium-On Corneal Crosslinking Versus Observation
Authors: Abdel-Radi Mahmoud , Anwar Mohamed , Aly Momen Ahmad Mohammad , Eata Wael El Shazly , Goda Islam
Published: November 2024

Purpose:

To investigate the effectiveness and safety of accelerated epithelium-on crosslinking to stabilize tomographically suspicious fellow eyes of young patients with unilateral clinically evident keratoconus (KC) compared with observation alone.

Methods:

This retrospective observational study included 43 fellow eyes of 43 young patients with unilateral clinically evident KC who completed a 24-month follow-up. Twenty-four eyes underwent accelerated epithelium-on crosslinking [epi-on corneal crosslinking (CXL) group] and 19 eyes were observed (observation group). A third healthy control group was added for comparison. The primary outcome measures were tomographic parameters and topometric indices assessed by pentacam. Secondary outcome measures included corneal ectatic progression defined as 1-diopter or more increase in maximum or steep keratometry (Kmax or K2), visual & refractive outcomes, and complications.

Results:

Baseline demographic and tomographic characteristics were similar between the epi-on CXL and observation groups (P > 0.05). Almost all mean tomographic parameters and topometric indices showed insignificant differences between baseline and after 24 months in the epi-on CXL and control groups (P > 0.05), whereas a significant progression was documented in the observation group (P < 0.05). At the end of the follow-up, progression was documented in 1 eye (4.2%) and in 8 eyes (42.1%) in the epi-on CXL and observation groups, respectively. Visual and refractive outcomes were more favorable in the epi-on CXL group. No significant complications were reported after accelerated epi-on CXL.

Conclusions:

Accelerated epithelium-on CXL was safe and achieved better tomographic stability and less corneal ectatic progression in tomographically suspicious fellow eyes of young patients with unilateral clinically evident keratoconus compared with observation alone.
Is minimally invasive glaucoma surgery killing trabeculectomies?
Authors: Loon Seng Chee , Ang Bryan Chin Hou , White Andrew
Published: November 2024

Purpose of review

The introduction of minimally invasive glaucoma surgery (MIGS) has changed the surgical landscape of glaucoma surgery. For more than four decades, the most commonly performed glaucoma surgery around the world has been the trabeculectomy. This article examines whether trabeculectomy is still the predominant procedure in glaucoma today, in the context of rapidly emerging MIGS devices and procedures.

Recent findings

There is a growing trend of mild to moderate glaucoma cases undergoing MIGS procedures instead of trabeculectomy. Glaucoma drainage device implantation may also have taken away a significant share of the filtering surgery performed for more severe glaucoma. In addition, the availability and economics of implants has an influence on the prevalence of trabeculectomy.

Currently, trabeculectomy surgery is still the most common glaucoma surgery performed around the world. However, the proportion of glaucoma surgeries undergoing MIGS is increasing rapidly.
Temporal trends of transcatheter aortic valve replacement outcomes in a high-volume center from China
Authors: Li Wei-Ya , Li Hong-De , Peng Shi-Qin , Li Jun-Li , Chen Mao
Published: November 2024

Since the first transcatheter aortic valve replacement (TAVR) was performed in China in 2010, TAVR has developed rapidly. However, the temporal trends in the 1-year prognosis after TAVR in China have not been described. This study enrolled patients treated at a high-volume Chinese TAVR center, West China Hospital, between 2015 and 2022, to analyze and characterize the temporal trends in 1-year outcomes. After multivariate adjustment, the 30-day mortality, 1-year all-cause mortality, 1-year cardiac mortality, and 1-year permanent pacemaker implantation rates showed a significantly decreasing trend (adjusted p for trend < 0.05). The 1-year major adverse cardiovascular event and 1-year stroke incident rate also decreased but did not reach significance. In conclusion, this study, for the first time, reveals a declining trend in adverse prognosis among patients who underwent TAVR in China.
Development of a Smartphone-Based Self-Management Application for Patients With Left Ventricular Assist Devices
Authors: Shin Nara , Yoo Hye Jin
Published: November 2024

Background

For patients with left ventricular assist devices, self-management is essential for maintaining health. A smartphone-based self-management application may help them practice self-management.

Objective

In this study, we aimed to develop an application to facilitate the self-management of patients with left ventricular assist devices and evaluate its usability.

Methods

A group of investigators developed a smartphone-based self-management application using the ADDIE model, between March and July 2023 in South Korea. Ten healthcare professionals and 5 pairs of patients with left ventricular assist devices and their family caregivers used the application for 5 days. The application's usability was verified using the Mobile Application Rating Scale and the user version of this scale. The participants' evaluations of the experience of using the application were collected using semistructured interviews.

Results

The application was composed of functions such as self-management information and a health diary. The score for application usability was 4.6 of 5 on both scales. Two themes were derived from qualitative interviews: “establishment of an essential self-management system for patients with LVADs” and “suggestions to make the app tailored to the patient.”

Conclusions

The developed application's usability was highly evaluated in quantitative and qualitative aspects. Therefore, introducing this application into healthcare could be a useful strategy to help patients improve their self-management.
Nipple-areolar complex sensory recovery based on incision placement after nipple-sparing mastectomy: a prospective nonrandomized controlled trial
Authors: Kook Yoonwon , Kim Dooreh , Park Soeun , Chu Chihhao , Jang Ji Soo , Baek Seung Ho , Bae Soong June , Ahn Sung Gwe , Jeong Joon
Published: November 2024

Introduction:

Nipple-sparing mastectomy (NSM) aims to improve patient satisfaction by preserving the nipple-areola complex (NAC) while ensuring oncologic safety. Different surgical incisions, such as inframammary fold (IMF) and periareolar/radial incisions, are used in NSM; however, their impact on NAC sensory loss remains unclear. In this study, the authors aimed to assess NAC sensation after NSM and compare the results of different incisional approaches, specifically IMF versus periareolar/radial.

Methods:

In this prospective, single-center, nonrandomized controlled trial, 105 post-NSM patients were recruited from October 2019 to November 2021 and followed up at 24–48 months postsurgery. Of these, 97 (IMF: 65; periareolar/radial: 32) were analyzed for sensory assessment. NAC sensation was measured using the pin-prick test, with scores ranging from 0 (no sensation) to 2 (sharp sensation) across five NAC areas. Sensory loss was defined as a total score below 3.

Results:

The median total score on the pin-prick test for NAC sensation was significantly higher in the IMF incision group than in the periareolar/radial incision group (3.77±3.11 vs. 2.47±2.51; P=0.043). The rate of NAC sensory loss was significantly lower in the IMF group than in the periareolar/radial group (36.9% vs. 62.5%; P=0.017). Multivariable analysis revealed that the incisional approach (95% CI: 0.14–0.97; P=0.044) and radiotherapy (95% CI: 0.05–0.36; P<0.01) were independent determinants of NAC sensory loss.

Conclusion:

Our study emphasized the importance of incision placement during NSM in preserving NAC sensation and may provide a valuable perspective for clinicians and patients considering this surgical approach.
The role of fluorescent cholangiography to improve operative safety in different severity degrees of acute cholecystitis during emergency laparoscopic cholecystectomy: a prospective cohort study
Authors: Pesce Antonio , Fabbri Nicolò , Bonazza Luca , Feo Carlo
Published: November 2024

Background:

Currently, there is limited scientific evidence regarding the effectiveness of fluorescent cholangiography in emergency cholecystectomy for acute cholecystitis. The primary aim of this study was to assess the efficacy of near-infrared fluorescent cholangiography (NIRF-C) in different severity degrees of acute cholecystitis.

Materials and methods:

Inclusion criteria were patients with a clinical and radiological (abdominal ultrasound and/or computed tomography) diagnosis of acute cholecystitis based on the revised 2018 Tokyo guidelines who underwent laparoscopic cholecystectomy within 24–72 h from the onset of symptoms and patients with ASA score of 0–3. NIRF-C was performed at three-time points during laparoscopic cholecystectomy: (i) following exposure of Calot’s triangle, prior to any dissection; (ii) after partial dissection of Calot’s triangle; and (iii) after complete dissection of Calot’s triangle. The intraoperative severity degree of acute cholecystitis was assessed according to the American Association of Surgery for Trauma (AAST) classification.

Results:

NIRF-C was successfully performed in all 81 consecutive patients who underwent emergency laparoscopic cholecystectomy. The cystic duct was identified by NIRF-C in 46 (56.8%) and 77 (95.1%) of the 81 patients before and after Calot’s dissection, respectively. The common hepatic duct and common bile duct were successfully identified in 11 (13.6%) and 32 patients (39.5%) before Calot’s dissection, respectively, and in 45 (55.6%) and 76 patients (93.8%) after complete Calot’s dissection, respectively. When comparing the visualization rate of biliary structures before and after Calot dissection in different severity degrees of cholecystitis, the authors found a statistically significant difference in nongangrenous (AAST I) versus gangrenous and complicated forms (AAST II–V) for all biliary structures, both before and after Calot’s dissection.

Conclusions:

The study indicates that the use of fluorescence cholangiography during emergency laparoscopic cholecystectomy for acute cholecystitis may represent a valuable and useful tool for intraoperative visualization of the extrahepatic biliary tract.
Biceps Femoris Long Head Fascicle Length Not Associated With Hamstring Injury Risk in NCAA Football Athletes
Authors: Krystofiak Jason , Asselstine Sydney , Toto Diana , Rybak Katelan , Zhao Yihong , Misuraco Anthony , McCune David
Published: November 2024

Objective:

To determine whether biceps femoris long head (BFlh) fascicle length (FL) is related to hamstring injury (HSI) risk in collegiate football athletes.

Design:

Retrospective cohort.

Setting:

University athletic medical center.

Participants:

Division I Collegiate football athletes (n = 129, age = 20.03 ± 1.68 years, body mass index = 29.50 ± 5.06 kg/m2).

Interventions:

Biceps femoris long head FL measurements were previously taken on the nondominant leg of each athlete. Presence or absence of HSI for 2 playing seasons and training camps was evaluated through retrospective review of medical records.

Main Outcome Measures:

Whether a shorter BFlh FL was associated with increased risk for any HSI.

Results:

Biceps femoris long head FL was not associated with HSI risk. Body mass index ≥30 kg/m2 was incidentally found to be protective (odds ratio = 0.27, 95% confidence interval, 0.08–0.84, P = 0.03).

Conclusions:

Biceps femoris long head FL is not an ideal measurement for predicting risk of HSI in American football athletes.
Risk of Home Falls Among Older Adults After Acute Care Hospitalization: A Cohort Study
Authors: Adams Christy M. , Tancredi Daniel J. , Bell Janice F. , Catz Sheryl L. , Romano Patrick S.
Published: November 2024

BACKGROUND:

Acute care hospitalization has been associated with older adult home falls after discharge, but less is known about the effects of hospital- and patient-related factors on home fall risk.

OBJECTIVES:

This study compares the effects of hospital length of stay, medical condition, history of falls, and home health care on period rates of home falls after discharge from acute care hospitalization.

METHODS:

This was a retrospective cohort study comparing period rates of home injury falls among older adults (age ≥ 65) occurring after discharge from an acute care hospitalization. Data were collected from state health care utilization administrative records between January 1, 2016, and December 31, 2018. We used log-linear Poisson regression to model post-discharge injury fall incidence rates as a function of days since discharge and patient-level covariates.

RESULTS:

A total of 736,230 older adults were included in the study cohort. Absolute risk for post-discharge home falls was 7%. Fall rates were highest the first week after discharge at 0.05 per 100 person-days, with a period incidence rate 74.29 times higher than the >90-day discharge period. Fall risk increased with age, with the highest risk in the ≥85 age group. Fall risk increased for a 2-day hospital stay but decreased for 5- to 30-day stays, compared to a 1-day length of stay. Discharge to home health care and history of falls were associated with increased risk.

CONCLUSIONS:

Older adults are at highest risk for a home fall the first 7 days after discharge from acute care hospitalization. These findings describe patient-related risk factors that acute care hospitals can use to develop geriatric-specific discharge guidelines intended to reduce home fall risk during the early care transition to home.
How Does Transitioning to Primary Human Papillomavirus Screening Impact Colposcopy Services? Lessons From an Australian National Program
Authors: Jennett Chloe J. , Smith Megan A. , Machalek Dorothy A. , Sultana Farhana , Prang Khic-Houy , McDermott Tracey , Nightingale Claire E. , Zammit Claire M. , Pagotto Amy , Rankin Nicole M. , Wrede C. David H. , Brotherton Julia M. L.
Published: November 2024

Objective

In 2017, Australian's National Cervical Screening Program changed from 2-yearly cytology to 5-yearly primary human papillomavirus (HPV) testing. The Stakeholder Opinions of Renewal Implementation and Experiences Study (STORIES) aimed to capture stakeholder perspectives during implementation of the renewed National Cervical Screening Program.

Materials and Methods

Qualitative semistructured interviews were conducted with key National Cervical Screening Program stakeholders 11–20 months following the change, either face-to-face, online, or via phone. Data related to colposcopy services were thematically analyzed using Proctor's conceptual framework for implementation outcomes.

Results

We identified 4 overarching themes: non-adherence to guidelines, lack of preparedness, unintended consequences, and mitigation strategies. While an initial increase in colposcopy referral was expected following transition, many stakeholders found increased referrals to be inequitably spread across services and exacerbated by confusion about, or overuse of testing for, symptoms.

Conclusions

The study provides the first assessment of stakeholder perceptions and experiences relating to colposcopy services during a transition from cytology to HPV screening. Significant preparation is required to ensure equitable and timely access to colposcopy when transitioning cervical screening programs, including wide stakeholder communication to build confidence; clear guidelines, especially around symptoms; and adequate resourcing for colposcopy services to meet projected referral rates.
Survival and Neurocognitive Outcomes After Noncardiac Illness Indications for Extracorporeal Membrane Oxygenation in Young Children
Authors: Ryan Lauren A. , Bond Gwen Y. , Khademioureh Sara , Dinu Irina A. , Granoski Don , Lequier Laurance , Robertson Charlene M. T. , Joffe Ari R.
Published: November 2024

This referral center prospective inception cohort study included 84 consecutive children having extracorporeal membrane oxygenation (ECMO) for noncardiac illness indications at the age of less than 6 years from 2000 to 2017. Long-term outcomes were survival, neurocognitive (Wechsler Preschool and Primary Scales of Intelligence) and functional (General Adaptive Composite) scores, and disability, with optimal outcome defined as scores greater than or equal to 80 and without disability. Age at cannulation was 551 (standard deviation [SD] = 571) days, 40 (47.6%) were male, 12 (14.3%) had known chromosomal abnormality, and 15 (17.9%) had nonchromosomal congenital abnormality. Survival was 45 (53.6%) to hospital discharge, and 41 (48.8%) to age 6 years. In 40/41 (97.6%) survivors with follow-up, at mean age of 56.1 (SD = 5.1) months, neurocognitive and functional scores were shifted to the left, with 30–42.5% having a score greater than 2 SD below population norms. Optimal outcome occurred in 11/40 (27.5%) survivors, and 11/84 (13.1%) overall. On multiple regression full-scale intelligence quotient was associated with longer time in pediatric intensive care unit (PICU) pre-ECMO (OR per hour −0.02, 95% confidence interval [CI] = −0.03 to −0.01; p = 0.005), known chromosomal abnormality (odds ratio [OR] = −18.99, 95% CI = −29.04 to −8.04; p = 0.001), and seizure pre-ECMO (OR = −17.00, 95% CI = −30.00 to −4.00; p = 0.012). Predictors of mortality included peak lactate on ECMO and nonchromosomal congenital abnormality. Findings may help with ECMO decision-making and counseling.
Dry Needling Plus Cervical Interlaminar Epidural Steroid Injections: Do We Have More Favorable Results in Cervical Disc Herniation? A Randomized Sham-Controlled Clinical Study
Authors: Yolcu Günay , Toprak Canan Sanal , Sencan Savas , Gunduz Osman Hakan
Published: November 2024

Objective

Trigger point-related myofascial pain commonly accompanies cervical disc herniation. The aim of the study is to investigate the effect of dry needling for accompanying trigger points on cervical interlaminar epidural steroid injection treatment outcomes.

Design

Among the patients scheduled for interlaminar epidural steroid injection for cervical disc herniation, those with active trigger points were randomly divided into three groups: interlaminar epidural steroid injection + dry needling, interlaminar epidural steroid injection + sham dry needling, and only interlaminar epidural steroid injection group. Outcome measures were determined as the change in Numeric Rating Scale, number of active trigger points, and the pressure-pain threshold measurement.

Results

A total of 66 patients, 22 per group, were included in the final evaluation. While significant decrease in Numeric Rating Scale scores was observed in all three groups at 3rd week and 3rd month, this decrease was significantly more pronounced in the interlaminar epidural steroid injection + dry needling group (P < 0.001). There was a significant decrease in the number of active trigger points in all three groups (P < 0.001). While a significant increase was observed in the pressure-pain threshold value only in the interlaminar epidural steroid injection + dry needling group at the 3rd week, this increase was found to be significant in all three groups at the 3rd month (P < 0.001).

Conclusions

Combination therapy with dry needling has superiority to interlaminar epidural steroid injection + sham dry needling and only interlaminar epidural steroid injection groups in reducing pain and increasing pressure-pain threshold values.
Migration is Associated With Increased HIV Vulnerability Among Young Transgender Women in Lima, Peru
Authors: Perez-Brumer Amaya , Apedaile Dorothy , León-Morris Franceska , Huerta Leyla , Leon Segundo , Konda Kelika , Reisner Sari L. , Silva-Santisteban Alfonso
Published: November 2024

Background:

Latin America—amid its largest mass migration—has seen minimal progress in curbing new HIV infections. Transgender women (TW) in the region are disproportionately affected, but scant data examine HIV vulnerabilities alongside migration.

Methods:

Between February and July 2022, 211 young TW ages 16–24 in Lima participated in a cross-sectional quantitative study accompanied by serological testing (HIV, syphilis, chlamydia, gonorrhea, hepatitis B). Bivariate tests compared HIV and STI prevalence and related vulnerabilities among migrants to nonmigrants. Poisson regression modeling estimated the association between time in Lima (nonmigrant, 0–1 years, 2–5 years, ≥6 years) and HIV vulnerabilities (condom use).

Findings:

Of 204 young TW, 110 were migrants to Lima (54%); 45% arrived in Lima ≤5 years ago. Most migrants were Peruvian (70% from Jungle regions); 14% were from Venezuela. HIV prevalence was 44% among migrants and 39% among nonmigrants (P = 0.67). Compared with nonmigrants, migrants had higher prevalence of lifetime syphilis (65% vs 41%; P < 0.01) and poor health care access (29% vs 12% no medical insurance), lifetime sex work (78% vs 55%; P < 0.01) and sex work in past 30 days, (42% vs 8%; P < 0.01), and client violence (23% vs 6%; P < 0.01). Migrants arriving in Lima 0–1 years ago were more likely to report past 6-month condomless anal sex compared with nonmigrants (adjusted prevalence ratio = 1.54; 95% confidence interval = 1.02 to 2.32).

Conclusions:

Young TW face high rates of HIV and STIs, with vulnerabilities persisting even after resettlement for migrants. There is an urgent need for expanded HIV prevention and care for these women and sustained health and social services for migrants in urban centers postmigration.
Publishing a Plastic Surgery Paper
Authors: Lineaweaver William C. , Chaker Sara C. , Saad Mariam , Torres-Guzman Ricardo , James Andrew J. , Nemani Sriya
Published: November 2024

This article provides a roadmap for plastic surgeons on how to successfully conceptualize, draft, and publish a paper. By publishing papers, authors will not only add to their professional standings but gain a deeper understanding of their topics and become artful at communicating their expertise to others. The processes of composition, submission, and revisions of manuscripts are an interlocking set of steps, and this essay describes the steps and their relationships to each other and final successful publications.