bluuebunny/crossref_metadata_2025 huggingface dataset:
dECM restores macrophage immune homeostasis and alleviates iron overload to promote DTPI healing
Authors: Zhang Ju , Si Ruijuan , Gao Yu , Shan Hui , Su Qi , Feng Zujian , Huang Pingsheng , Kong Deling , Wang Weiwei
Published: January 2024

Due to its highly insidious and rapid progression, deep tissue pressure injury (DTPI) is a clinical challenge. Our previous study found that DTPI may be a skeletal muscle injury dominated by macrophage immune dysfunction due to excessive iron accumulation. Decellularized extracellular matrix (dECM) hydrogel promotes skeletal muscle injury repair. However, its role in polarizing macrophages and regulating iron metabolism in DTPI remains unclear. Here, porcine dECM hydrogel was prepared, and its therapeutic function and mechanism in repairing DTPI were investigated. The stimulus of dECM hydrogel toward RAW264.7 cells resulted in a significantly higher percentage of CD206+ macrophages and notably decreased intracellular divalent iron levels. In mice DTPI model, dECM hydrogel treatment promoted M1 to M2 macrophage conversion, improved iron metabolism and reduced oxidative stress in the early stage of DTPI. In the remodeling phase, the dECM hydrogel remarkably enhanced revascularization and accelerated skeletal muscle repair. Furthermore, the immunomodulation of dECM hydrogels in vivo was mainly involved in the P13k/Akt signaling pathway, as revealed by GO and KEGG pathway analysis, which may ameliorate the iron deposition and promote the healing of DTPI. Our findings indicate that dECM hydrogel is promising in skeletal muscle repair, inflammation resolution and tissue injury healing by effectively restoring macrophage immune homeostasis and normalizing iron metabolism.
Beyond Bites: Differential Role of Fall Armyworm Oral Secretions and Saliva in Modulating Sorghum Defenses
Authors: Shinde Sanket , Kundu Pritha , Louis Joe
Published: January 2024

Flavonoids are major plant secondary metabolites that provide defense against several insect pests. Previously, it has been shown that sorghum ( Sorghum bicolor) flavonoids are required for providing resistance to fall armyworm (FAW; Spodoptera frugiperda), which is an important chewing insect pest on several crops. We demonstrate here the role of FAW oral cues in modulating sorghum flavonoid defenses. While feeding, chewing insects release two kinds of oral cues: oral secretions (OS)/regurgitant and saliva. Our results indicate that FAW OS induced the expression of genes related to flavonoid biosynthesis and total flavonoids, thereby enhancing sorghum's defense against FAW larvae. Conversely, FAW saliva suppressed the flavonoid-based defenses and promoted FAW caterpillar growth, independent of the FAW salivary component, glucose oxidase (GOX). Thus, we infer that different oral cues in FAW may have contrasting roles in altering sorghum defenses. These findings expand our understanding of the precise modes of action of caterpillar oral cues in modulating plant defenses and help in designing novel pest management strategies against FAW in this vital cereal crop.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Gastric Volume and Antral Area in the Fasting State: A Meta-analysis of Individual Patient Data
Authors: Perlas Anahi , Arzola Cristian , Portela Natalia , Mitsakakis Nicholas , Hayawi Lamia , Van de Putte Peter
Published: January 2024

Background

Pulmonary aspiration of gastric content is a serious anesthetic complication. Gastric point-of-care ultrasound can determine the type and volume of gastric content when clinical information is equivocal. However, a cutoff value of either antral cross-sectional area or volume that may be considered as the upper limit of normal in fasting subjects is still controversial. The aim of this study is to characterize the distribution of baseline antral area and volume in fasting adult subjects and to identify an upper limit (95th percentile) of these distributions.

Methods

The authors conducted a meta-analysis of individual participant data of primary studies from an academic research network of investigators collaborating in gastric ultrasound. Studies between January 2009 and December 2020 were included.

Results

Twelve primary studies met inclusion criteria and were included in the analysis with a sample size of 1,203 subjects. The 95th percentile of area values (measured in the right lateral decubitus) was 9.9 cm2 (95% CI, 9.4 to 10.4), and of volume, 2.3 ml/kg (95% CI, 2.3 to 2.4). In addition, an antrum grade 0 or 1 indicates a 98% probability of an antral area below the 95th percentile.

Conclusions

An area of 10 cm2 measured in the right lateral decubitus could be a simple, data-driven upper limit of antral area that could serve as a surrogate of upper limit of normal gastric volume values in fasting adults. These results are limited by the highly selected sampling of the studies included.

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Considering the Influence of Social Determinants of Health on Parent Feeding Practices
Authors: LaManna Stefanie , Hatfield Brooke , McCann Eileen
Published: January 2024

Background:

Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. SDOH can be grouped into 5 domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. SDOH impact people's health and quality of life but may also contribute to disparities in access to food, education, and healthcare. SDOH uniquely influence parent feeding practices in the neonatal intensive care unit (NICU) in a variety of ways, ranging from logistical considerations for parent visitation to cultural beliefs such as family perception of human milk feeding.

Evidence Acquisition:

A hypothetical case example of a preterm infant with a feeding disorder in the NICU is used to connect SDOH that influence prenatal health, parental lived experience, and postnatal medical care to maternal and infant outcomes with implications for feeding practices. Barriers and facilitators to successful feeding practices in the NICU and at discharge are considered for each SDOH domain.

Results:

This case example increases awareness of SDOH and how they influence parent feeding practices in the NICU, focusing on the intersection of SDOH, parent stress, and oral feeding outcomes. Examples were provided for how to support applying findings into practice.

Implications for Practice and Research:

By being creating a culture of SDOH awareness, NICU staff can assist families in overcoming barriers by putting supports in place to increase equitable participation in developmentally supportive feeding practices during the NICU stay.
Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*
Authors: Halpern Neil A. , Tan Kay See , Bothwell Lilly A. , Boyce Lindsay , Dulu Alina O.
Published: January 2024

OBJECTIVES:

The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians.

DESIGN:

Systematic search of PubMed, Embase, and Web of Science (2010–2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non–data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test.

SETTING:

U.S. adult ICUs and databases.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B–E) as their definition, 63 studies (60%) used more than one parameter (B–E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter “Works in ICU” (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001).

CONCLUSIONS:

There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.
Executive Summary: Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU
Authors: Honarmand Kimia , Wax Randy S. , Penoyer Daleen , Lighthall Geoffery , Danesh Valerie , Rochwerg Bram , Cheatham Michael L. , Davis Daniel P. , DeVita Michael , Downar James , Edelson Dana , Fox-Robichaud Alison , Fujitani Shigeki , Fuller Raeann M. , Haskell Helen , Inada-Kim Matthew , Jones Daryl , Kumar Anand , Olsen Keith M. , Rowley Daniel D. , Welch John , Baldisseri Marie R. , Kellett John , Knowles Heidi , Shipley Jonathan K. , Kolb Philipp , Wax Sophie P. , Hecht Jonathan D. , Sebat Frank
Published: January 2024

RATIONALE:

Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.

OBJECTIVES:

To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.

PANEL DESIGN:

The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.

METHODS:

We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).

RESULTS:

The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among “unselected” patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners’ concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients’ goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).

CONCLUSIONS:

The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.
Clinical Knowledge Model for the Prevention of Healthcare-Associated Venous Thromboembolism
Authors: Westra Bonnie L. , Whittenburg Luann , Lytle Kay S. , Tokareva Irina , Umberfield Elizabeth E. , Leverette Michelle , Buchleiter Rachel , Johnson Steve , Jobman Luke
Published: January 2024

Knowledge models inform organizational behavior through the logical association of documentation processes, definitions, data elements, and value sets. The development of a well-designed knowledge model allows for the reuse of electronic health record data to promote efficiency in practice, data interoperability, and the extensibility of data to new capabilities or functionality such as clinical decision support, quality improvement, and research. The purpose of this article is to describe the development and validation of a knowledge model for healthcare-associated venous thromboembolism prevention. The team used FloMap, an Internet-based survey resource, to compare metadata from six healthcare organizations to an initial draft model. The team used consensus decision-making over time to compare survey results. The resulting model included seven panels, 41 questions, and 231 values. A second validation step included completion of an Internet-based survey with 26 staff nurse respondents representing 15 healthcare organizations, two electronic health record vendors, and one academic institution. The final knowledge model contained nine Logical Observation Identifiers Names and Codes panels, 32 concepts, and 195 values representing an additional six panels (groupings), 15 concepts (questions), and the specification of 195 values (answers). The final model is useful for consistent documentation to demonstrate the contribution of nursing practice to the prevention of venous thromboembolism.
Off-label Use of Ceftazidime/Avibactam in Neonatal Intensive Care Unit: A Real-life Experience and Literature Review
Authors: Ftergioti Argyro , Degli Antoni Melania , Kontou Angeliki , Kourti Maria , Pantzartzi Kalliopi , Zarras Charalampos , Agakidou Eleni , Sarafidis Kosmas , Roilides Emmanuel , Iosifidis Elias
Published: January 2024

Background:

Multi/extensively drug-resistant bacterial infections have recently increased and new antimicrobial options are needed for difficult-to-treat infections. Ceftazidime/avibactam (CZA) has been approved for patients 3 months to 18 years of age, but real-life data on its off-label use in neonates and young infants are still scarce.

Materials: 

We report demographic, clinical and microbiologic data as well as outcome and safety of all cases of infants treated with CZA between January 1, 2021 and September 30, 2022 in a tertiary neonatal intensive care unit. We also review all neonatal cases previously reported.

Results:

Twenty-one patients [17 males, with median gestational age 29+2 (IQR 6+6) weeks] received 31 CZA courses at a dose of 20–50 mg/kg/dose of ceftazidime q8h for suspected or proved multi/extensively drug-resistant infections. Median postnatal age at the onset of treatment was 44 days (IQR: 94 days). Twelve bacteremias, 2 urinary tract infections and 1 ventilator-acquired pneumonia were recorded. Twelve (39%) treatments were targeted, while 19 (61%) were empirically started due to known colonization with Klebsiella pneumoniae carbapenemase-producing Gram-negative bacteria. All patients had received multiple antibiotics prior and concomitantly with CZA. The most common pathogen identified at targeted administrations was carbapenem-resistant Klebsiella pneumoniae (83%). No serious adverse events attributed to the drug were detected. Twenty-one courses of CZA administration to 20 neonates with a median gestational age of 28.5 (IQR 3.5) weeks were previously reported without significant related adverse events.

Conclusions:

Favorable clinical and microbiologic responses in neonatal intensive care unit patients treated with CZA off-label were observed without significant and unexpected adverse events in critically ill neonates.
Quantitative Assessment of Periocular Autologous Fat Transfer Survival Using 3D Stereophotogrammetric Imaging
Authors: Murta Fabiola , Guevara Gabriella F. , Hyer Jonathan N. , Ezra Daniel G.
Published: January 2024

Purpose:

To assess periocular autologous fat transfer (AFT) survival by assessment of volume change with sequential 3D VECTRA imaging.

Objective:

Little is known about the patterns of graft survival of AFT in the periorbital region, especially in cases involving prior radiotherapy or trauma. The aim of this pilot study was to characterize fat survival following AFT in patients with a broad range of clinical indications, with and without a history of prior radiotherapy, for both periocular and orbital AFT, and in a subgroup of patients with an anophthalmic socket.

Method:

A single-institution, prospective cohort study involving 18 applications of AFT for volume augmentation in the periocular and orbital area. All patients had sequential 3D VECTRA photographs following a validated standardized protocol. Patient demographics, including gender, age, ethnicity, underlying diagnosis, and volume of fat injected, were also collected.

Results:

In total 13 patients were enrolled, 9 female (69.2%) and 4 male (31.0%). Mean age at the time of surgery was 47.8 years. Patients had volume deficiency secondary to a variety of causes; the most common cause was postenucleation socket syndrome following trauma in 6 patients (46.2%). The mean fat survival volume at the 1-month postoperative point was 70% and 55% by 6 months. AFT conducted with a multiport cannula for fat harvesting use had an initial higher rate of fat reabsorption with ANOVA p = 0.002, however, this was not observed at the later follow-up periods. There was no statistically significant difference in fat survival between abdominal or thigh donor fat sites. There was no statistically significant difference in residual injected volume at the early follow-up period between patients who had prior radiotherapy and those who did not p = 0.8496.

Conclusion:

AFT is an effective treatment for periorbital volume compromise with an acceptable survival rate in all categories of patients. Complex etiologies such as radiotherapy-related orbital and midface dysgenesis should not be a contraindication for AFT, with no difference in outcomes.
Long-Term Results of Oral Propranolol Treatment Protocol for Periocular Infantile Hemangioma: Should There Be Any Contraindication?
Authors: Ghahvehchian Hossein , Kashkouli Mohsen Bahmani , Ghanbari Shaghayegh , Karimi Nasser , Abdolalizadeh Parya , Abri Aghdam Kaveh
Published: January 2024

Purpose:

The authors report long-term results of the oral propranolol treatment protocol for periocular infantile hemangioma regardless of conventional indications.

Methods:

This is a retrospective study (2008–2018) on children with propranolol treatment protocol for periocular infantile hemangioma and last follow-up (FU) of ≥4 months after treatment and age of >24 months. After systemic evaluation, it was started with 0.5 and increased by 0.5 every 3 days to reach 2 mg/kg/day. If there was no good response, it would be gradually increased up to 3 mg/kg/day. Tapering (0.5 mg/kg/day every 4 weeks) was started when patients were on treatment for ≥6 months and ≥12 months old and there was no change in the infantile hemangioma size for ≥3 months. Rebound growth was based on the parents’ report and would be treated by increasing the dose to at least 2 mg/kg/day for 3 months. FU was either in-person or via social media. Change in periocular infantile hemangioma size on the photos was scored by 3 masked observers (visual analog scale) and presented as excellent (≥50% reduction), good (1%–49%), fair (no change), and failure (enlarged).

Results:

Forty-three patients were included. Orbital involvement was in 49%, ptosis in 58%, and risk of amblyopia in 63%. Mean treatment, tapering, and FU duration were 37, 13, and 74 months, respectively. Mean age at presentation, start of propranolol treatment protocol, tapering, stop, and last FU were 1.5, 5, 29, 42, and 78 months, respectively. Twenty-seven patients received 2, seven 2.5, and nine 3 mg/kg/day. Mean visual analog scale significantly increased from 43% (FU1) to 92% (last FU) when 97.6% of patients showed an excellent response. The remaining skin lesions were observed in 35%. No side effect was reported.

Conclusions:

Long-term results of the propranolol treatment protocol for periocular infantile hemangioma showed an excellent response in 97.6% of patients with no side effects. A residual skin lesion was observed in 1/3 of the patient.
Orbital Abscess Secondary to Nasolacrimal Duct Obstruction in an Extremely Preterm Infant
Authors: Ohana Oded , Maeng Michelle M. , Johnson Thomas E.
Published: January 2024

Orbital abscesses are rarely encountered in children younger than 1 year. The literature is limited to isolated case reports and a few case series. Most such cases are reported in infants born at term, with the earliest reported gestational birth age at 34 weeks. Children are more prone to orbital cellulitis compared with adults due to their underdeveloped sinuses and immature immune systems, and the origin is most commonly an ethmoid sinus infection. Orbital cellulitis secondary to dacryocystitis is even less common, with only a few isolated cases reported in infants and children. Herein, the authors present a case of a large extraconal and intraconal orbital abscess secondary to nasolacrimal duct obstruction and dacryocystitis in an extremely preterm infant. We discuss the diagnosis and multidisciplinary management of this challenging case.
Precise and safe pulmonary segmentectomy enabled by visualizing cancer margins with dual-channel near-infrared fluorescence
Authors: Jeon Ok Hwa , Bao Kai , Kim Kyungsu , Wang Haoran , Yokomizo Shinya , Park G. Kate , Choi Byeong Hyeon , Rho Jiyun , Kim Chungyeul , Choi Hak Soo , Kim Hyun Koo
Published: January 2024

Background:

Segmentectomy is a type of limited resection surgery indicated for patients with very early-stage lung cancer or compromised function because it can improve quality of life with minimal removal of normal tissue. For segmentectomy, an accurate detection of the tumor with simultaneous identification of the lung intersegment plane is critical. However, it is not easy to identify both during surgery. Here, the authors report dual-channel image-guided lung cancer surgery using renally clearable and physiochemically stable targeted fluorophores to visualize the tumor and intersegmental plane distinctly with different colors; cRGD-ZW800 (800 nm channel) targets tumors specifically, and ZW700 (700 nm channel) simultaneously helps discriminate segmental planes.

Methods:

The near-infrared (NIR) fluorophores with 700 nm and with 800 nm channels were developed and evaluated the feasibility of dual-channel fluorescence imaging of lung tumors and intersegmental lines simultaneously in mouse, rabbit, and canine animal models. Expression levels of integrin αvβ3, which is targeted by cRGD-ZW800-PEG, were retrospectively studied in the lung tissue of 61 patients who underwent lung cancer surgery.

Results:

cRGD-ZW800-PEG has clinically useful optical properties and outperforms the FDA-approved NIR fluorophore indocyanine green and serum unstable cRGD-ZW800-1 in multiple animal models of lung cancer. Combined with the blood-pooling agent ZW700-1C, cRGD-ZW800-PEG permits dual-channel NIR fluorescence imaging for intraoperative identification of lung segment lines and tumor margins with different colors simultaneously and accurately.

Conclusion:

This dual-channel image-guided surgery enables complete tumor resection with adequate negative margins that can reduce the recurrence rate and increase the survival rate of lung cancer patients.
Real-time classification of tumour and non-tumour tissue in colorectal cancer using diffuse reflectance spectroscopy and neural networks to aid margin assessment
Authors: Nazarian Scarlet , Gkouzionis Ioannis , Murphy Jamie , Darzi Ara , Patel Nisha , Peters Christopher J. , Elson Daniel S.
Published: January 2024

Background:

Colorectal cancer is the third most commonly diagnosed malignancy and the second leading cause of mortality worldwide. A positive resection margin following surgery for colorectal cancer is linked with higher rates of local recurrence and poorer survival. The authors investigated diffuse reflectance spectroscopy (DRS) to distinguish tumour and non-tumour tissue in ex-vivo colorectal specimens, to aid margin assessment and provide augmented visual maps to the surgeon in real-time.

Methods:

Patients undergoing elective colorectal cancer resection surgery at a London-based hospital were prospectively recruited. A hand-held DRS probe was used on the surface of freshly resected ex-vivo colorectal tissue. Spectral data were acquired for tumour and non-tumour tissue. Binary classification was achieved using conventional machine learning classifiers and a convolutional neural network (CNN), which were evaluated in terms of sensitivity, specificity, accuracy and the area under the curve.

Results:

A total of 7692 mean spectra were obtained for tumour and non-tumour colorectal tissue. The CNN-based classifier was the best performing machine learning algorithm, when compared to contrastive approaches, for differentiating tumour and non-tumour colorectal tissue, with an overall diagnostic accuracy of 90.8% and area under the curve of 96.8%. Live on-screen classification of tissue type was achieved using a graduated colourmap.

Conclusion:

A high diagnostic accuracy for a DRS probe and tracking system to differentiate ex-vivo tumour and non-tumour colorectal tissue in real-time with on-screen visual feedback was highlighted by this study. Further in-vivo studies are needed to ensure integration into a surgical workflow.
Prognostic Impact of Left Compared to Right Heart Function in Sepsis and Septic Shock
Authors: Forner Jan , Weidner Kathrin , Rusnak Jonas , Dudda Jonas , Behnes Michael , Akin Ibrahim , Schupp Tobias
Published: January 2024

This study investigates the prognostic impact of left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) in patients with sepsis and septic shock. Consecutive patients with sepsis and septic shock were included from 2019 to 2021. LVEF and TAPSE were assessed during the first 24 hours of intensive care unit (ICU) treatment. Patients were stratified by LVEF of less than 45% and greater than or equal to 45%. The primary endpoint was 30 day all-cause mortality. Two hundred ninety-two consecutive patients were included, of which 26% presented with LVEF of less than 45%. Within the entire study cohort (60% vs. 48%; hazard ratio [HR] = 1.414; 95% confidence interval [CI] = 0.999–2.001; p = 0.050) and specifically in patients with sepsis (58% vs. 36%; HR = 1.919; 95% CI = 1.148–3.208; p = 0.013), LVEF of less than 45% was associated with an increased risk of 30 day all-cause mortality, whereas TAPSE of less than 17 mm was not (56% vs. 52%; log rank p = 0.798). Even after multivariable adjustment, LVEF of less than 45% was accompanied by a worse prognosis in septic patients (HR = 1.944; 95% CI = 1.084–3.485; p = 0.026). Contrarily, LVEF < 45% was not accompanied with increased mortality in septic shock patients (63% vs. 67%; log rank p = 0.847; HR = 0.956; 95% CI 0.596–1.533; p = 0.853). In conclusion, impaired LVEF was associated with increased mortality in septic patients without shock, but not in patients with septic shock. In contrast, impaired right ventricular function was not associated with adverse prognosis in both conditions.
Noninvasive Ventilation Before Intubation and Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for COVID-19: An Analysis of the Extracorporeal Life Support Organization Registry
Authors: Giani Marco , Rezoagli Emanuele , Barbaro Ryan P. , Riera Jordi , Bellani Giacomo , Brochard Laurent , Combes Alain , Foti Giuseppe , Brodie Daniel
Published: January 2024

Bilevel-positive airway pressure (BiPAP) is a noninvasive respiratory support modality which reduces effort in patients with respiratory failure. However, it may increase tidal ventilation and transpulmonary pressure, potentially aggravating lung injury. We aimed to assess if the use of BiPAP before intubation was associated with increased mortality in adult patients with coronavirus disease 2019 (COVID-19) who received venovenous extracorporeal membrane oxygenation (ECMO). We used the Extracorporeal Life Support Organization Registry to analyze adult patients with COVID-19 supported with venovenous ECMO from January 1, 2020, to December 31, 2021. Patients treated with BiPAP were compared with patients who received other modalities of respiratory support or no respiratory support. A total of 9,819 patients from 421 centers were included. A total of 3,882 of them (39.5%) were treated with BiPAP before endotracheal intubation. Patients supported with BiPAP were intubated later (4.3 vs. 3.3 days, p < 0.001) and showed higher unadjusted hospital mortality (51.7% vs. 44.9%, p < 0.001). The use of BiPAP before intubation and time from hospital admission to intubation resulted as independently associated with increased hospital mortality (odds ratio [OR], 1.32 [95% confidence interval {CI}, 1.08–1.61] and 1.03 [1–1.06] per day increase). In ECMO patients with severe acute respiratory failure due to COVID-19, the extended use of BiPAP before intubation should be regarded as a risk factor for mortality.
Outcomes of Interfacility VV-Extracorporeal Membrane Oxygenation Transfers: A Multicenter Study
Authors: Olson Conner , Wothe Jillian , Braaten Jacob , Evans Danika , Damroth Karl , Bohman John , Seelhammer Troy , Saavedra-Romero Ramiro , Prekker Matthew , Brunsvold Melissa
Published: January 2024

As the availability of extracorporeal membrane oxygenation (ECMO) expands, so has the need for interfacility transfer to ECMO centers. However, the impact of these transfers is unknown. We hypothesized that interfacility transfers would be associated with increased complications and mortality. This retrospective cohort study includes adult patients treated with venovenous (VV) ECMO at all four adult ECMO centers comprising our statewide registry. Complications, mortality, ECMO duration, length of stay, and disposition were compared based on cannulation at an ECMO center versus outside hospital and transferred by air versus ground after adjusting for baseline covariates/parameters. The study included 420 adult patients, 36% of whom were cannulated at an outside institution before transfer. Of these, 63% were transported by ground and the remainder by air. Risk adjusted logistic regression revealed similar odds of mortality between those cannulated at ECMO centers versus referring hospital and then transported (odds ratio [OR] = 0.77, confidence interval [CI] = 0.49–1.22). This study supports the practice of interfacility ECMO transfer.
Zhishi Xiebai Guizhi Decoction for coronary heart disease: A systematic review and meta-analysis
Authors: Li Ming , Song Shengqiang , Rong Yuanhang , Wu Di , Yin Yongtian
Published: January 2024

Background:

Coronary heart disease (CHD) is a type of cardiovascular disease (CVD) caused by coronary atherosclerosis. It is a main cause of medical burden and cardiovascular related death. Zhishi Xiebai Guizhi Decoction (ZXGD) is a representative prescription of traditional Chinese medicine (TCM) in the treatment of CHD, but there is poor systemically evidence-based appraisal.

Objective:

To evaluate the efficacy and safety of ZXGD for CHD.

Methods:

Eight databases were retrieved for randomized controlled trials (RCTs). Data was extracted independently by 2 reviewers. The quality of the included studies was assessed by Cochrane Collaboration risk of bias tool. Clinical efficacy, blood lipid, vascular endothelial function, inflammatory factor and homocysteine (Hcy) were prespecified outcome measures.

Results:

Twenty-four studies (2272 patients) were included. Meta-analysis showed that compared with conventional western medicine (WM) alone, ZXGD was associated with a greater symptom improvement rate with a relative risk (RR) of 1.21 [95% CI (1.16, 1.26), P < .00001] and a greater electrocardiogram (ECG) improvement rate with a RR of 1.27 [95% CI (1.16, 1.40), P < .00001]. In terms of blood lipid, ZXGD reduced total cholesterol (TC) with a mean difference (MD) of −1.15 [95%CI (−1.75, −0.55), P = .0002] and triglyceride (TG) [MD = −0.72, 95%CI (−0.99, −0.45), P < .00001], reduced low-density lipoprotein cholesterol (LDL-C) [MD = −0.93, 95% CI (−1.17, −0.69), P < .00001], and increased high-density lipoprotein cholesterol (HDL-C) [MD = 0.31, 95%CI (0.20, 0.42), P < .00001]. In terms of vascular endothelial function, ZXGD decreased the level of endothelin-1 (ET-1) [MD = −7.81, 95%CI (−9.51, −6.10), P < .00001], and increased nitric oxide (NO) [MD = 8.90, 95%CI (7.86, 9.93), P < .00001]. ZXGD also reduced high-sensitivity C-reactive protein (hs-CRP) [MD = −1.73, 95% CI (−2.63, −0.83), P < .00001] and Hcy [MD = −2.03, 95%CI (−2.78, −1.28), P < .00001]. No significant differences were found in adverse event rate between the 2 groups with a RR of 0.77 [95% CI (0.44, 1.34), P = .36].

Conclusion:

ZXGD is effective and safe in the treatment of CHD. However, more rigorous and high-quality RCTs are needed to verify the conclusion.
Pure white cell aplasia before and after thymectomy in the rare conundrum of thymoma: A case report and review of the literature
Authors: Yang Yang , Chen Chunmei , Zheng Bingrong , Fan Liping , Chen Xiajun , Hu Meiwei
Published: January 2024

Rationale:

Pure white cell aplasia (PWCA) is a rare paraneoplastic syndrome that occurs in patients with thymomas. Currently, the pathogenesis and treatment of this disease remain in the exploratory stage.

Patient concerns:

We report a 68-year-old woman with thymoma experienced PWCA involvement as her first presentation. The patient had high fever and agranulocytosis at the onset of the disease. The white blood cell count in the complete blood count was 1.9 × 109/L with a neutrophil of 0.1 × 109/L. The bone marrow aspirates showed decreased granulocyte proliferation. Computed tomography showed a large mass in the anterior mediastinum.

Diagnoses:

The final diagnosis of our patient was PWCA and thymoma.

Interventions:

She underwent a thymectomy and cyclosporine A administration during first remission.

Outcomes:

Long-term remission was achieved following the readministration of cyclosporine A after the disease recurrence.

Lessons:

PWCA or agranulocytosis with thymoma has been confirmed to be an extremely rare disease. Thymomas with PWCA correlate with autoimmunity. From this case study and the literature review, we concluded that the pathogenesis of thymomas in PWCA is mainly related to the activation of autoreactive T cells. Thymectomy and the immunosuppressive drug, cyclosporine A, were chosen for treatment. The patient’s granulocyte levels were unable to recover after surgery because of the inability to promptly clear activated T cells. After surgery, cyclosporine A continued to take for a long time. Thymectomy combined with prolonged cyclosporine A administration may be an effective method for treating this rare disease.
A deep learning approach using an ensemble model to autocreate an image-based hip fracture registry
Authors: Oosterhoff Jacobien H.F. , Jeon Soomin , Akhbari Bardiya , Shin David , Tobert Daniel G. , Do Synho , Ashkani-Esfahani Soheil , Ghaednia Hamid , Schwab Joseph H.
Published: January 2024

Objectives:

With more than 300,000 patients per year in the United States alone, hip fractures are one of the most common injuries occurring in the elderly. The incidence is predicted to rise to 6 million cases per annum worldwide by 2050. Many fracture registries have been established, serving as tools for quality surveillance and evaluating patient outcomes. Most registries are based on billing and procedural codes, prone to under-reporting of cases. Deep learning (DL) is able to interpret radiographic images and assist in fracture detection; we propose to conduct a DL-based approach intended to autocreate a fracture registry, specifically for the hip fracture population.

Methods:

Conventional radiographs (n = 18,834) from 2919 patients from Massachusetts General Brigham hospitals were extracted (images designated as hip radiographs within the medical record). We designed a cascade model consisting of 3 submodules for image view classification (MI), postoperative implant detection (MII), and proximal femoral fracture detection (MIII), including data augmentation and scaling, and convolutional neural networks for model development. An ensemble model of 10 models (based on ResNet, VGG, DenseNet, and EfficientNet architectures) was created to detect the presence of a fracture.

Results:

The accuracy of the developed submodules reached 92%–100%; visual explanations of model predictions were generated through gradient-based methods. Time for the automated model-based fracture–labeling was 0.03 seconds/image, compared with an average of 12 seconds/image for human annotation as calculated in our preprocessing stages.

Conclusion:

This semisupervised DL approach labeled hip fractures with high accuracy. This mitigates the burden of annotations in a large data set, which is time-consuming and prone to under-reporting. The DL approach may prove beneficial for future efforts to autocreate construct registries that outperform current diagnosis and procedural codes. Clinicians and researchers can use the developed DL approach for quality improvement, diagnostic and prognostic research purposes, and building clinical decision support tools.
Estimating the economic impact of complications after open tibial fracture: A secondary analysis of the pilot Gentamicin Open Tibia trial (pGO-Tibia)
Authors: Flores Michael J. , Brown Kelsey E. , Haonga Billy , Morshed Saam , Shearer David W.
Published: January 2024

Objectives:

To estimate the indirect economic impact of tibial fractures and their associated adverse events (AEs) in Tanzania.

Design:

A secondary analysis of the pilot Gentamicin Open (pGO)-Tibia randomized control trial estimating the indirect economic impact of suffering an AE, defined as a fracture-related infection (FRI) and/or nonunion, after an open tibial fracture in Tanzania.

Setting:

The pGO-Tibia trial was conducted from November 2019 to August 2021 at the Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania.

Patients/Participants:

One hundred adults with open tibial shaft fractures participated in this study.

Intervention:

Work hours were compared between AE groups. Cost data were analyzed using a weighted-average hourly wage and converted into purchasing power parity–adjusted USD.

Main Outcome Measurements:

Indirect economic impact was analyzed from the perspective of return to work (RTW), lost productivity, and other indirect economic and household costs. RTW was analyzed using a survival analysis.

Results:

Half of patients returned to work at 1-year follow-up, with those experiencing an AE having a significantly lower rate of RTW. Lost productivity was nearly double for those experiencing an AE. There was a significant difference in the mean outside health care costs between groups. The total mean indirect cost was $2385 with an AE, representing 92% of mean annual income and an increase of $1195 compared with no AE. There were significantly more patients with an AE who endorsed difficulty affording household expenses postinjury and who borrowed money to pay for their medical expenses.

Conclusions:

This study identified serious economic burden after tibial fractures, with significant differences in total indirect cost between those with and without an AE.

Level of Evidence:

II.
Identification of neutrophil phenotype categories in geriatric hip fracture patients aids in personalized medicine
Authors: Nijdam Thomas M.P. , Jukema Bernard N. , de Fraiture Emma J. , Spijkerman Roy , Schuijt Henk Jan , Spoelder Marcia , Bongers Coen C.W.G. , Hopman Maria T.E. , Koenderman Leo , Hietbrink Falco , van der Velde Detlef
Published: January 2024

Objectives:

The number of geriatric hip fracture patients is high and expected to rise in the coming years, and many are frail and at risk for adverse outcomes. Early identification of high-risk patients is crucial to balance treatment and optimize outcome, but remains challenging. Previous research in patients with multitrauma suggested that neutrophil phenotype analysis could aid in early identification of high-risk patients. This pilot study investigated the feasibility and clinical value of neutrophil phenotype analysis in geriatric patients with a hip fracture.

Methods:

A prospective study was conducted in a regional teaching hospital in the Netherlands. At the emergency department, blood samples were collected from geriatric patients with a hip fracture and analyzed using automated flow cytometry. Flow cytometry data were processed using an automated clustering algorithm. Neutrophil activation data were compared with a healthy control cohort. Neutrophil phenotype categories were assessed based on two-dimensional visual assessment of CD16/CD62L expression.

Results:

Blood samples from 45 geriatric patients with a hip fracture were included. Neutrophils showed an increased activation profile and decreased responsiveness to formyl peptides when compared to healthy controls. The neutrophil phenotype of all patients was categorized. The incidence of severe adverse outcome was significantly different between the different categories (P = 0.0331). Moreover, patients with neutrophil phenotype category 0 developed no severe adverse outcomes.

Conclusions:

Using point-of-care fully automated flow cytometry to analyze the neutrophil compartment in geriatric hip fracture patients is feasible and holds clinical value in determining patients at risk for adverse outcome. This study is a first step toward immuno-based precision medicine for identifying geriatric hip fracture patients that are deemed fit for surgery.
Implementation of Hospital Mortality Reviews: A Systematic Review
Authors: Schönfeld Moritz Sebastian , Härter Martin , Schröder Ann Sophie , Kokartis Katrin , Bartz Hans-Jürgen , Kriston Levente
Published: January 2024

Objective

The objective of this study was to give an overview of the published literature on the implementation of mortality reviews in hospital settings.

Methods

We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Web of Science databases up to August 2022 for studies describing implementation or results of implementation of hospital mortality reviews published in English or German. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. Two independent reviewers screened the title/abstract and the full text of potentially relevant records and extracted data using a standardized form. We synthesized and integrated quantitative and qualitative findings narratively following a convergent segregated mixed methods review approach.

Results

From the 884 studies screened, 18 publications met all inclusion criteria and were included in the review. Observed mortality rates reported in 10 publications ranged from 0.4% to 7.8%. In 10 publications, mortality reviews were implemented as a multistep process. In 7 publications, structured mortality review meetings were implemented. Key aspects of success in developing and implementing mortality reviews in hospitals were involvement of multiple stakeholders, providing enough resources for included staff, and constant monitoring and adaption of the processes.

Conclusions

Although awareness of hospital mortality reviews has increased over the last decades, published research in this area is still rare. Our results may inform hospitals considering development and implementation of mortality reviews by providing key aspects and lessons learned from existing implementation experiences.
The Effects of Sex Hormones on Postoperative Pain in Patients with Laparoscopic Cholecystectomy
Authors: Koraş Sözen Kezban , Bolat Haci , Güntürk İnayet
Published: January 2024

Objective:

There are many factors that affect postoperative pain. This study determines the effect of preoperative sex hormone levels on postoperative pain levels in patients undergoing laparoscopic cholecystectomy.

Patients and Methods:

This study included a total of 89 patients who met the study inclusion criteria. The patients were divided into 3 groups based on their sex and pre and postmenopausal periods: male patients (n = 28), postmenopausal female patients (n = 31), and female patients with normal cycles (n = 30). Normal-cycle women were also regrouped based on their follicular and luteal phases. Data were collected using a descriptive characteristics form, a patient follow-up form, and the Visual Analog Scale.

Results:

Venous blood samples taken from the patients before surgery were used to measure their levels of estradiol (EST), testosterone (TES), and progesterone levels. Male patients had lower pain levels than female patients. The male patients’ Visual Analog Scale scores were inversely related and correlated strongly with their TES levels (P < 0.05). However, subgroup analyses suggested that their EST level played a primary role in males and that the EST/TES ratio was determinant in the late postoperative period. In female patients, the EST/progesterone ratio was the most determining factor for the level of pain felt in the postmenopausal period, whereas there was no change in the premenopausal period at different stages of the menstrual cycle.

Conclusions:

Sex hormones were found to be effective in predicting postoperative pain severity.
Microbulbifer bruguierae sp. nov., isolated from sediment of mangrove plant Bruguiera sexangula, and comparative genomic analyses of the genus Microbulbifer
Authors: Long Meng , Chen Dakun , Fan Huimin , Tang Shaoshuai , Gan Zhen , Xia Hongli , Lu Yishan
Published: January 2024

A Gram-negative, non-motile, strictly aerobic, rod-shaped bacterium, designated as H12T, was isolated from the sediments of mangrove plant Bruguiera sexangula taken from Dapeng district, Shenzhen, PR China. The pairwise 16S rRNA gene sequence analysis showed that strain H12T shared high identity levels with species of the genus

Microbulbifer

, with the highest similarity level of 98.5 % to

M. pacificus

SPO729T, followed by 98.1 % to

M. donghaiensis

CN85T. Phylogenetic analysis using core-genome sequences showed that strain H12T formed a cluster with type species of

M. pacificus

SPO729T and

M. harenosus

HB161719T. The complete genome of strain H12T was 4 481 396 bp in size and its DNA G+C content was 56.7 mol%. The average nucleotide identity and digital DNA–DNA hybridization values among strain H12T and type species of genus

Microbulbifer

were below the cut-off levels of 95–96 and 70 %, respectively. The predominant cellular fatty acids of strain H12T were iso-C15 : 0 (22.5 %) and C18 : 1
 ω7c (13.9 %). Ubiquinone-8 was detected as the major respiratory quinone. The polar lipids of strain H12T comprised one phosphatidylglycerol, one phosphatidylethanolamine, one unidentified aminoglycophospholipid, one unidentified glycophospholipid, three unidentified glycolipids, two unidentified aminolipids, and one unidentified lipid. Based on polyphasic evidence, strain H12T represents a novel species of the genus

Microbulbifer

, for which the name Microbulbifer bruguierae sp. nov. is proposed. The type strain is H12T (=KCTC 92859T=MCCC 1K08451T). Comparative genomic analyses of strain H12T with strains of the genus

Microbulbifer

reveal its potential in degradation of pectin.