bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-stage Differential Template Technique for the Repair of Palpebral Neurofibromatosis With Severe Blepharoptosis in Adults
Authors: Naik Milind N. , Vasanthapuram Varshitha Hemanth , Joshi Anamika , Dharap-Wagh Richa
Published: August 2024

Purpose:

To report the surgical outcomes of single-stage differential template technique for the correction of palpebral neurofibromatosis associated with severe blepharoptosis in adults.

Methods:

This is a retrospective interventional case series. Adult patients with severe unilateral palpebral neurofibromatosis, severe blepharoptosis, and lateral canthal dystopia underwent a single-stage repair. The excess anterior and posterior lamellae of the eyelid tissue were excised in a differential manner, using the other eyelid as a template (differential template technique). The levator muscle was resected and reattached to the tarsus during the reconstruction. The surgical outcomes and complications were evaluated.

Results:

A total of 5 patients underwent the differential template technique. The median age at presentation was 24 years, and 4 were males. All had severe blepharoptosis, with excess upper eyelid and temporal plexiform neurofibroma. All underwent a single-stage procedure with an average follow-up of 17.8 months. The average palpebral fissure height improved from 0 mm preoperatively to 8.25 mm postoperatively, with a well-formed eyelid crease and an average lagophthalmos of 2 mm. Good functional and cosmetic outcome was noted in all patients, with no exposure keratopathy. Two patients had a lateral canthal “stand-off,” and 1 patient developed mild upper eyelid retraction, which was managed conservatively.

Conclusions:

A single-stage differential template technique can correct palpebral neurofibromatosis with severe blepharoptosis providing good cosmetic and functional outcomes.
Meta-Synthesis of Qualitative Studies
Authors: Hanline Mary Frances , Eldridge Jennifer Nicole , Robbins Audrey
Published: August 2024

The purpose of this meta-synthesis was to integrate findings from qualitative research studying the experiences and outcomes of children when they participate in inclusive early childhood (EC) classrooms. The goal was to promote a broader understanding of practices and outcomes in inclusive EC programs. Eight primary studies were included in the meta-synthesis. Evaluation of the eight qualitative studies indicated that all utilized methods to establish trustworthiness and ensure rigorous methodology for the type of data collected, indicating high-quality of the studies. Three themes resulted from the systematic coding of the results of the primary studies. These themes related to the outcomes of children’s access to and full participation in inclusive EC programs, the formation of positive relationships and friendships between the children with and without disabilities as a result of interactions over time, and the children’s autonomy in social interactions as reflected in when, how, and with whom the children chose to interact. The results support that EC inclusion can result in positive outcomes for children and should be expanded as a service delivery model. Implications for future research and the provision of services are discussed.
Measures and Influencers of Reintegration for the Stroke Patient: A Systematic Review
Authors: Wynja Kayla , Alexandrov Anne W. , Wicks Mona Newsome , Stanfill Ansley Grimes
Published: August 2024

BACKGROUND: Stroke survivors may experience continued difficulties with reintegration, including challenges participating in social roles and performing activities of daily living across settings (eg, home, work). This article assessed the reintegration measures currently used in this clinical population, defining factors that most influence reintegration for these persons. METHODS: A systematic review of PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases explored reintegration measures and factors influencing reintegration in stroke populations. Study inclusion criteria for this review were as follows: data-based articles (quantitative and qualitative), studies measuring reintegration or examining outcomes of reintegration, participants being adult stroke populations, and studies published in English. The resulting articles were critically analyzed, and common themes regarding barriers, facilitators, and influencers of reintegration were established. RESULTS: A total of 24 articles met the inclusion criteria and were synthesized for use in this systematic review. Across stroke populations, 13 reintegration tools were used. A few factors, including residual stroke impairments, unmet needs, social support, and sociodemographic characteristics, are currently known to influence reintegration for this population. CONCLUSION: Reintegration must be uniformly defined and measured to best support stroke survivors, and further investigation into influential factors is critical to advance this goal. This review defines current assessments and factors influencing reintegration within stroke populations. Achieving these goals is critical to optimizing reintegration efforts and designing quality-of-life–improving nursing interventions for affected persons.
Association Between Physical Work Environment During Work From Home and Sleep During the COVID-19 Pandemic
Authors: Hirashima Keiki , Okawara Makoto , Tateishi Seiichiro , Eguchi Hisashi , Tsuji Mayumi , Ogami Akira , Mori Koji , Matsuda Shinya , Fujino Yoshihisa ,   for the CORoNaWork Project
Published: August 2024

Objective

The work environment during work from home (WFH) may have a negative impact on workers' health. We investigated the effects of the physical work environment during WFH on sleep.

Methods

We conducted a 1-year cohort study of 2099 Japanese WFH workers. We used eight questions about the physical work environment during WFH as independent variables and the Athens Insomnia Scale as the dependent variable. We performed multilevel logistic regression with residence as a random effect.

Results

With the exception of one item, nonconformity with recommendations for the physical work environment during WFH was significantly associated with sleep problems. Further, the number of nonconformities and sleep problems showed a graded relationship.

Conclusion

An inappropriate physical work environment during WFH may be associated with sleep problems.
Pulse Pressure and Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis
Authors: Kalra Andrew , Kang Jin Kook , Wilcox Christopher , Shou Benjamin L. , Brown Patricia , Rycus Peter , Anders Marc M. , Zaaqoq Akram M. , Brodie Daniel , Whitman Glenn J. R. , Cho Sung-Min ,   on behalf of the HERALD group
Published: August 2024

Low pulse pressure (PP) in venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a marker of cardiac dysfunction and has been associated with acute brain injury (ABI) as continuous-flow centrifugal pump may lead to endothelial dysregulation. We retrospectively analyzed adults (≥18 years) receiving “peripheral” VA-ECMO for cardiogenic shock in the Extracorporeal Life Support Organization Registry (January 2018-July 2023). Acute brain injury (our primary outcome) included central nervous system (CNS) ischemia, intracranial hemorrhage, brain death, and seizures. Multivariable logistic regressions were performed to examine whether PP ≤10 mm Hg was associated with ABI. Of 9,807 peripheral VA-ECMO patients (median age = 57.4 years, 67% = male), 8,294 (85%) had PP >10 mm Hg versus 1,513 (15%) had PP ≤10 mm Hg. Patients with PP ≤10 mm Hg experienced ABI more frequently versus PP >10 mm Hg (15% versus 11%, p < 0.001). After adjustment, PP ≤10 mm Hg was independently associated with ABI (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.06–1.48, p = 0.01). Central nervous system ischemia and brain death were more common in patients with PP ≤10 versus PP >10 mm Hg (8% versus 6%, p = 0.008; 3% versus 1%, p < 0.001). Pulse pressure ≤10 mm Hg was associated with CNS ischemia (aOR = 1.26, 95% CI = 1.02–1.56, p = 0.03) but not intracranial hemorrhage (aOR = 1.14, 95% CI = 0.85–1.54, p = 0.38). Early low PP (≤10 mm Hg) at 24 hours of ECMO support was associated with ABI, particularly CNS ischemia, in peripheral VA-ECMO patients.
PET/CT Response Assessment in Pediatric Hodgkin Lymphoma: Does Deauville Score 3 Reflect Negativity?
Authors: Semary Samah , Moussa Emad , Salama Maram , Fakhry Mona , Attia Asmaa , Mehesen Maha , Khorshed Eman , Elwekeel Madeeha , Elnashar Amr , Sedky Mohamed , Hamoda Asmaa
Published: August 2024

Background:

FDG PET is required for the staging and response evaluation of pediatric Hodgkin lymphoma. This study aimed to evaluate the outcomes of pediatric patients with Hodgkin’s lymphoma based on interim PET CT assessments of early response following second-cycle chemotherapy using the Deauville score (DS). It also determines whether DS–3 is providing an adequate or inadequate response.

Methods:

We conducted a retrospective cohort study including 504 pediatric patients with classic Hodgkin lymphoma who were treated with chemotherapy based on the Euro-Net protocol at the Children Cancer Hospital Egypt from March 2019 till the end of October 2022.

Results:

Patients with adequate response DS 1/2 and DS 3 showed nearly the same 3-year event-free survival (EFS) of 91.9% and 91.5%, respectively, compared with those patients with inadequate response DS 4/5, who showed an EFS of 80.4% (P=0.001). Patients with a DS 3 at interim PET evaluation were considered negative as DS 1/2. Patients of DS 3 group who did not receive radiotherapy had a much worse 3-year EFS by the existence of positive B symptoms, an ESR>30, or an advanced stage. Radiation therapy did not improve the 3-year EFS in patients with an inadequate response (DS4/5) and poor prognostic characteristics. They still need more advanced treatment.

Conclusion:

DS 1/2 and DS 3 had about the same 3-year EFS, which is better than the 3-year EFS of patients with DS 4/5. Therefore, we can classify DS 3 as having negative FDG PET CT uptake.
Closing the Provider Gap in Rural and Underserved Communities
Authors: Tapp Jannyse , Ketel Christian , Vick Rose , Zsamboky Marci , Pfieffer Mary Lauren , Gardner Virginia , Cole Shannon , Pitts Courtney
Published: August 2024

Background:

Health care disparities in rural and underserved areas necessitate quality primary care, especially in behavioral health management. Family nurse practitioners (FNPs) are critical in these regions, which often lack psychiatric specialists.

Problem:

Rural communities face unique challenges exacerbated by primary care and mental health provider shortages. The deficit in behavioral health specialists highlights the need to optimize FNP education programs.

Approach:

The Collaborative Academic Practice (CAP) program prepares FNP students for entry-to-practice through hybrid learning, immersive training, and comprehensive behavioral health integration, effectively training them to meet the health care needs of underserved populations.

Outcomes:

The CAP program prepares FNPs, resulting in increased practice in underserved areas and enhanced preceptor satisfaction. Key measures contribute to its effectiveness, including immersive training, telehealth education, and preceptor enhancement.

Conclusions:

Despite financial and communication challenges, the CAP program transforms FNP education, addressing mental health needs and bridging critical gaps in health care delivery.
Impact of COVID-19 and Public Health Measures on Positive Suicide Screens Among Emergency Department Children
Authors: Cafferty Rachel , Haasz Maya , Leonard Jan , Ambroggio Lilliam
Published: August 2024

Objective

The aim of this study was to examine the association between prolonged time in the COVID-19 pandemic and rates of positive routine suicide screens among youth accessing healthcare in the pediatric emergency department.

Methods

Participants were English- and Spanish-speaking youth aged 10–18 years presenting without an acute mental/behavioral health concern to the emergency department or urgent care of a large hospital system, serving a 7-state region, who completed routine screening for suicide risk. Visits between March 1, 2019 and December 31, 2021 were included. We conducted a quasi-experimental interrupted time series analysis and categorized visits into the prepandemic year, COVID-19 year 1 (Y1), and COVID-19 year 2 (Y2). The primary outcome measure was rate of positive suicide screen.

Results

A total of 33,504 children completed routine suicide screening; 2689 children had a positive screen. The overall rate of positive suicide screens increased throughout the pandemic compared with baseline (7.5% prepandemic, 8.4% Y1, 9.3% Y2; P < 0.01). Rates of positive suicide screens in Y1 increased 0.04% per week and surpassed prepandemic rates, then decreased 0.1% per week throughout Y2 (P < 0.01), during a time when social distancing mitigation efforts decreased.

Conclusions

Cumulative time in the COVID-19 pandemic was associated with increased positive suicide screens in children. School reopening and normalization of social routines preceded an observed negative trend in rates of positive suicide screens in Y2 of the pandemic. This study demonstrates fluctuating trends in suicide screen positivity, potentially influenced by social distancing and public health measures. Our study may support that maintaining social connectedness and access to school-based or community resources may be a protective factor for youth suicide risk during a pandemic or other natural occurrence.
Decreasing Invasive Urinary Tract Infection Screening in a Pediatric Emergency Department to Improve Quality of Care
Authors: Paluck Felicia , Kestenbom Inbal , Test Gidon , Carscadden Emma , Ostrow Olivia
Published: August 2024

Objectives

Obtaining urine samples in younger children undergoing urinary tract infection (UTI) screening can be challenging in busy emergency departments (EDs), and sterile techniques, like catheterization, are invasive, traumatizing, and time consuming to complete. Noninvasive techniques have been shown to reduce catheterization rates but are variably implemented. Our aim was to implement a standardized urine bag UTI screening approach in febrile children aged 6 to 24 months to decrease the number of unnecessary catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs).

Methods

After forming an interprofessional study team and engaging key stakeholders, a multipronged intervention strategy was developed using the Model for Improvement. A urine bag screening pathway was created and implemented using Plan, Do, Study Act (PDSA) cycles for children aged 6 to 24 months being evaluated for UTIs. A urine bag sample with point-of-care (POC) urinalysis (UA) was integrated as a screening approach. The outcome measure was the rate of ED urine catheterizations, and balancing measures included ED LOS and RVs. Statistical process control methods were used for analysis.

Results

During the 3-year study period from January 2019 to June 2022, the ED catheterization rate successfully decreased from a baseline of 73.3% to 37.7% and was sustained for approximately 2 years. Unnecessary urine cultures requiring microbiology processing decreased from 79.8% to 40.7%. The ED LOS initially decreased; however, it increased by 17 minutes during the last 8 months of the study. There was no change in RVs.

Conclusion

A urine bag screening pathway was successfully implemented to decrease unnecessary, invasive catheterizations for UTI screening in children with only a slight increase in ED LOS. In addition to the urine bag pathway, an ED nursing champion, strategic alignment, and broad provider engagement were all instrumental in the initiative's success.
Impact of Surgical Team Involvement at the Time of Trauma Activation for Pediatric Patients With Motorized Cycle or All-Terrain Vehicle Injury Mechanism
Authors: Bergus Katherine , Srinivas Shruthi , Ligorski Celia , Castellanos Sydney , Thakkar Rajan , Schwartz Dana
Published: August 2024

Objectives

At our institution, level 2 trauma (L2T) activations are primarily managed by pediatric emergency medicine (PEM) physicians, whereas level 1 activations are co-managed by pediatric surgery and PEM. Starting in September 2019, the response to L2T activations due to all-terrain vehicles or motorized cycles (ATVs/MCs) changed to include surgical assessment upon patient arrival due to increased likelihood of significant injuries and need for higher level of care. The impact of PEM/surgery co-management of ATV/MC L2T patients on time to an admission decision is unknown.

Methods

We retrospectively reviewed patients <18 years of age presenting to our American College of Surgeons–verified level 1 pediatric trauma center as L2T activations with ATV/MC mechanism between 1/2016 and 10/2022. Patient demographics, injury characteristics, details of imaging, interventions, and emergency department (ED) course were recorded. The χ2 and Fisher exact tests were performed.

Results

One hundred fifty-five patients met the inclusion criteria prior to augmenting our response to include surgical presence at L2T-ATV/MC activations, and 216 patients were treated after our protocol change. There were no statistically significant differences in age, sex, race, transfer status, vehicle subtype, or Injury Severity Scores between groups. Trauma surgery was involved in the care of 74.8% of L2T-ATV/MC patients before protocol augmentation and 87% after (P = 0.003). Time to an admission decision significantly decreased by 22.5 minutes (117 minutes [interquartile range, 72–178] vs 94.5 minutes [interquartile range, 60–139]; P = 0.023) after protocol augmentation. There was a trend toward increased completion of mandated postsecondary survey communication huddles after protocol change (84.6% to 91.2%, P = 0.089). The median total ED length of stay did not differ between admitted and discharged patients.

Conclusions

Early surgical assessment for pediatric patients with ATV/MC injuries improved time to an admission decision and trauma communication huddle compliance. Next steps include identifying process improvement opportunities to decrease ED total length of stay for patients with ATV/MC injuries.
Degradation of Unsintered Hydroxyapatite and Poly-L-Lactide Composite Sheets In Vivo and In Vitro
Authors: Kawabata Tomoya , Ikeda Mika , Miyakoshi Chisato , Matsuzoe Haruka , Oka Shungo , Kataoka Kazuya
Published: August 2024

Bioabsorbable sheet-shaped implants made of forged composites of unsintered hydroxyapatite and poly-L-lactide (F-u-HA/PLLA) have been used for orbital fracture repair with good results. This is the first report using multiple specimens implanted in the human orbit to demonstrate the biodegradation and loss of strength of F-u-HA/PLLA sheets. Among the patients who underwent various facial fracture repairs with F-u-HA/PLLA sheets implanted in their orbits, those whose sheets were subsequently extracted were included in the study. Viscosity-average molecular weight, crystallinity, and bending strength of the extracted implants were measured. An in vitro degradation test was also performed for comparison. Among the 111 patients who underwent F-u-HA/PLLA sheet implantation, 13 subsequently underwent surgical extraction of implants; the majority were due to secondary correction of complex fractures. One patient developed an infection; none developed foreign body reactions. Overall, 11 specimens from 10 patients with consent were examined. The time from implantation to extraction ranged from 43 to 632 days (median: 210 d). Compared with the results of the in vitro degradation test, the viscosity-average molecular weight and bending strength had a slower decrease. The F-u-HA/PLLA sheets retained more than 50% of their initial bending strength after 12 months. Crystallinity varied widely. F-u-HA/PLLA sheets implanted in human orbits did not degrade faster than those of in vitro testing. Sheet-shaped implants made of forged composites of unsintered hydroxyapatite and poly-L-lactide can be considered appropriate reconstructive materials for orbital fractures as they retained sufficient strength to support the orbital contents at 12 months postoperatively, and no case of delayed foreign body reactions was observed.
Identifying Risk Factors for Wound Complications Following Fronto-Orbital Advancement in Patients With Craniosynostosis: 3-dimensional Craniometrics Analysis
Authors: Jeon Sungmi , Kwon Dae Hyun , Han Mira , Oh Albert K. , Chung Jee Hyeok , Kim Sukwha , Kim Seung-Ki , Phi Ji Hoon , Lee Ji Yeoun , Kim Kyung Hyun , Kim Byung Jun
Published: August 2024

This study aims to identify 3-dimensional (3D) craniometric predictors of wound complications following fronto-orbital advancement (FOA) surgery in craniosynostosis patients. The authors conducted a retrospective review of medical records for 43 patients (25 female, 18 male) who underwent open FOA between 2006 and 2023, with an average follow-up duration of 91.8 months. The data collected included age at surgery, sex, whether the craniosynostosis was syndromic, involvement of multiple sutures, history of suturectomy, wound complications (categorized as minor or major), and preoperative and postoperative 3D CT scans. The authors quantified relative changes in intracranial volume (ICV), cranial area above the Frankfurt Horizontal plane, anteroposterior diameter (APD), and cranial height (CH) using Mimics software. A logistic regression analysis was performed to identify predictors of wound complications post-FOA. Among the 43 patients who underwent FOA, 10 experienced postoperative wound complications (4 minor, 6 major), revealing significant associations with multisuture involvement and changes in △cranial area, △APD, and △CH (all P<0.05). In the multivariable analysis with backward elimination, △cranial area, and △CH were identified as significant risk factors for wound complications (OR 1.17, 95% CI: 1.01–1.36, P=0.032; and OR 0.59, 95% CI: 0.38–0.92, P=0.019, respectively). The cutoff values for △cranial area and △APD were 5.95% and 7.93%, respectively. This study identified measurable craniometric changes, especially in the cranial area, as risk factors for wound complications following FOA. It underscores the necessity for personalized surgical planning and meticulous postoperative wound care in FOA to enhance patient outcomes through risk-aware strategies.
Temporoparietal Fascial Flap Combined With Vascularized Outer Table Calvarial Bone Graft and Entire Temporalis Muscle: A Stable Pedicled Flap for Orbital Floor Reconstruction After Total Maxillectomy
Authors: Imai Yoshie , Kadota Hideki , Kogo Ryunosuke
Published: August 2024

Orbital reconstruction after total maxillectomy is essential to maintain ocular function and facial contour. Free flap transfer with simultaneous orbital bone reconstruction is a straightforward approach; however, it is challenging in medically unstable patients with multimorbidity. The authors developed an easily harvested temporoparietal fascial flap combined with vascularized outer table calvarial bone and entire temporalis muscle. The authors applied this technique in an 81-year-old patient with multiple comorbidities who required orbital floor reconstruction following total maxillectomy. Intraoperative indocyanine green fluorescence imaging confirmed excellent perfusion of the temporoparietal fascia, entire temporalis muscle, and calvarial bone. Although the patient developed postoperative local wound infection, the vascularized bone graft resisted infection and preserved the orbital structure without bone exposure. Our technique is minimally invasive and results in a well-vascularized flap for orbital reconstruction after total maxillectomy involving the orbital bone, and particularly beneficial in patients with multimorbidity or at high risk of local infection.
POSTINJURY PNEUMONIA INDUCES A UNIQUE BLOOD MICROBIOME SIGNATURE
Authors: Munley Jennifer A. , Kelly Lauren S. , Park Gwoncheol , Pons Erick E. , Kannan Kolenkode B. , Bible Letita E. , Efron Philip A. , Nagpal Ravinder , Mohr Alicia M.
Published: August 2024

Background: Previous preclinical studies have demonstrated a pathobiome after traumatic injury; however, the impact of postinjury sepsis on gut epithelial permeability and bacterial translocation remains unknown. We hypothesized that polytrauma with postinjury pneumonia would result in impaired gut permeability leading to specific blood microbiome arrays. Methods: Male and proestrus female Sprague-Dawley rats were subjected to either polytrauma (PT), PT plus 2-hours daily chronic restraint stress (PT/CS), PT with postinjury day 1 inoculation with pseudomonas pneumonia (PT + PNA), PT/CS + PNA, or naive controls. Whole blood microbiome was measured serially using high-throughput 16S rRNA sequencing and QIIME2 bioinformatics analyses. Microbial diversity was assessed using Chao1/Shannon indices and principle coordinate analysis. Intestinal permeability was evaluated by plasma occludin and lipopolysaccharide-binding protein assays. Results: PT/CS + PNA had increased intestinal permeability compared to uninfected counterparts (PT/CS) with significantly elevated occludin (P < 0.01). Bacteria was not detected in the blood of naïve controls, PT or PT/CS, but was present in both PT + PNA and PT/CS + PNA on days 2 and 7. The PT/CS + PNA blood biome showed dominance of Streptococcus compared to PT + PNA at day 2 (P < 0.05). Females PT/CS + PNA had a significant abundance of Staphylococcus at day 2 and Streptococcus at day 7 in the blood biome compared to male counterparts (P < 0.05). Conclusion: Multicompartmental trauma with postinjury pneumonia results in increased intestinal permeability and bacteremia with a unique blood biome, with sexual dimorphisms evident in the blood biome composition. These findings suggest that postinjury sepsis has clinical significance and could influence outcomes after severe trauma and critical illness.
NETWORK ANALYSIS OF SINGLE-NUCLEOTIDE POLYMORPHISMS ASSOCIATED WITH ABERRANT INFLAMMATION IN TRAUMA PATIENTS SUGGESTS A ROLE FOR VESICLE-ASSOCIATED INFLAMMATORY PROGRAMS INVOLVING CD55
Authors: El-Dehaibi Fayten , Zamora Ruben , Yin Jinling , Namas Rami A. , Billiar Timothy R. , Vodovotz Yoram
Published: August 2024

Background: Critical illness stemming from severe traumatic injury is a leading cause of morbidity and mortality worldwide and involves the dysfunction of multiple organ systems, driven, at least in part, by dysregulated inflammation. We and others have shown a key role for genetic predisposition to dysregulated inflammation and downstream adverse critical illness outcomes. Recently, we demonstrated an association among genotypes at the single-nucleotide polymorphism (SNP) rs10404939 in LYPD4, dysregulated systemic inflammation, and adverse clinical outcomes in a broad sample of ~1,000 critically ill patients. Methods: We sought to gain mechanistic insights into the role of LYPD4 in critical illness by bioinformatically analyzing potential interactions among rs10404939 and other SNPs. We analyzed a dataset of common (i.e., not rare) SNPs previously defined to be associated with genotype-specific, significantly dysregulated systemic inflammation trajectories in trauma patients, in comparison to a control dataset of common SNPs determined to exhibit an absence of genotype-specific inflammatory responses. Results: In the control dataset, this analysis implicated SNPs associated with phosphatidylinositol and various membrane transport proteins, but not LYPD4. In the patient subset with genotypically dysregulated inflammation, our analysis suggested the co-localization to lipid rafts of LYPD4 and the complement receptor CD55, as well as the neurally related CNTNAP2 and RIMS4. Segregation of trauma patients based on genotype of the CD55 SNP rs11117564 showed distinct trajectories of organ dysfunction and systemic inflammation despite similar demographics and injury characteristics. Conclusion: These analyses define novel interactions among SNPs that could enhance our understanding of the response to traumatic injury and critical illness.
Risk of Incident Cardiovascular Events Following Roux en Y Gastric Bypass versus Sleeve Gastrectomy
Authors: Lewis Kristina H. , Argetsinger Stephanie , LeCates Robert F. , Zhang Fang , Arterburn David E. , Ross-Degnan Dennis , Fernandez Adolfo , Wharam James F.
Published: August 2024

Objective:

To compare the risk of incident cardiovascular disease (CVD) events following sleeve gastrectomy (SG) and Roux en Y gastric bypass (RYGB).

Summary Background Data:

Bariatric surgery is associated with reduced CVD risk but the differential effect of contemporary bariatric procedures is unclear.

Methods:

We used insurance claims to conduct a retrospective cohort study of CVD outcomes for patients who underwent RYGB versus SG between 2010 and 2021. Patients were followed for up to 5 years for a primary composite major adverse cardiovascular event (MACE) outcome as well as individual outcomes including myocardial infarction, stroke, heart failure, and arrhythmia. We compared cumulative risks of CVD events using multivariable Cox proportional hazards modeling, in overall cohorts and in sub-cohorts of older adults and those with type 2 diabetes (T2D) or pre-existing CVD and elevated morbidity.

Results:

Matched, weighted cohorts of 13,545 SG and RYGB patients were observed for an average of 2.5 years after surgery, with 26.2% not lost to follow-up by the end of 5 years. There was no difference in MACE risk between procedures (aHR 1.01 for RYGB vs. SG [95% CI 0.90, 1.12]) in the overall cohort or among the subgroup of older adults (aHR 0.97 for RYGB vs. SG [95% CI 0.85, 1.10]). Patients with T2D experienced lower risk of MACE following RYGB compared to SG (aHR 0.78 [95% CI 0.66, 0.92]), as did those with pre-existing CVD or elevated morbidity prior to surgery (aHR 0.81 [95% CI 0.70, 0.93]).

Conclusions:

These findings further support the preferential use of RYGB over SG for patients with T2D or who have pre-existing CVD. However, among other groups of patients, including older adults, we did not observe a relative benefit of RYGB during the time horizon in this study.
Sensor–Head Distance and Signal Strength in Whole-Head Magnetoencephalography: Report of 996 Patients With Epilepsy
Authors: Tanaka Naoaki , Ahlfors Seppo P. , Stufflebeam Steven M.
Published: August 2024

Purpose:

Although the sensor-to-head distance is theoretically known to affect the signal strength in magnetoencephalography (MEG), these values have not been reported for a whole-head MEG system in a large population. We measured the distance and signal strength in 996 patients with epilepsy.

Methods:

The MEG sensor array consisted of 102 measurement sites, each of which had two gradiometers and one magnetometer. The sensor–head distance was defined as the minimum distance between each site and a set of digitized scalp points. For the signal strength, we calculated the root-mean-square of the signal values in each sensor over a recording of 4 minutes. For analyses at the individual and sensor levels, these values were averaged over the sensors and patients, respectively. We evaluated the correlation between distance and signal strength at both individual and sensor levels. At the sensor level, we investigated regional differences in these measures.

Results:

The individual-level analysis showed only a weak negative correlation between the sensor–head distance and the signal strength. The sensor-level analysis demonstrated a considerably negative correlation for both gradiometers and magnetometers. The sensor–head distances showed no significant differences between the regions, whereas the signal strength was higher in the temporal and occipital sensors than in the frontal and parietal sensors.

Conclusions:

Sensor–head distance was not a definitive factor for determining the magnitude of MEG signals in individuals. Yet, the distance is important for the signal strength at a sensor level. Regional differences in signal strength may need to be considered in the analysis and interpretation of MEG.
Patients' Cognitive Potential Is Associated With Cognitive Performance After an Acute Course of Electroconvulsive Therapy
Authors: Massaneda-Tuneu Clara , Loo Colleen , Martin Donel
Published: August 2024

Objectives

Cognitive function after an acute treatment of electroconvulsive therapy (ECT) can highly vary between individuals. This study aimed to extend prior research on individual factors, which influence outcomes by assessing whether a combination of 2 individual factors, level of education and lifetime occupational attainment, may be informative.

Methods

A retrospective study was conducted using data from 24 patients with major depressive episode who underwent acute treatment with ECT. Cognitive functioning was assessed at pretreatment, during the acute course and 1–3 days after acute treatment. Participants were divided into higher and lower function groups based on a combination of their highest educational level and lifetime occupational attainment.

Results

Statistically significant differences were observed between the 2 groups in retrograde memory function after ECT, assessed as percentage of consistency scores of the Columbia Autobiographical Memory Short Form (F(1,15) = 4.66, P < 0.05) and recovery of orientation during the acute ECT course (F(1,25.33) = 7.99, P = 0.009). No significant differences were found between groups for the other outcomes, which included verbal and visual anterograde memory, verbal fluency, and processing speed.

Conclusions

Results from this preliminary study suggest that patients with higher educational and lifetime occupational attainment may experience less retrograde amnesia and have faster recovery of orientation after ECT. Identifying markers of higher and lower ‘cognitive potential’ before ECT may assist in customizing ECT treatment for each patient.
Leukocyte Telomere Length and Mitochondrial DNA Copy Number in Treatment-Resistant Depression and Response to Electroconvulsive Therapy
Authors: Squassina Alessio , Pisanu Claudia , Menesello Valentina , Meloni Anna , Congiu Donatella , Manchia Mirko , Paribello Pasquale , Abate Maria , Bortolomasi Marco , Baune Bernhard T. , Gennarelli Massimo , Minelli Alessandra
Published: August 2024

Objectives

In this study, we investigated if changes in leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNA-cn), 2 markers of cellular aging, are associated with treatment-resistant depression (TRD) and with response to electroconvulsive therapy (ECT).

Methods

LTL and mtDNA-cn were measured in 31 TRD patients before (T0), 1 week (T1), and 4 weeks (T2) after the ECT course, as well as in a sample of 65 healthy controls.

Results

TRD patients had significantly shorter LTL and higher mtDNA-cn compared with healthy controls at baseline. In the TRD sample, LTL was inversely correlated with Montgomery-Åsberg Depression Rating Scale scores at baseline. Baseline levels of LTL or mtDNA-cn were not correlated with response to ECT. Similarly, changes in LTL or mtDNA-cn were not associated with response to ECT either when considered as a dichotomous trait (responders vs nonresponders) or as a percentage change in symptoms improvements.

Conclusions

Ours is the first longitudinal study exploring the role of LTL and mtDNA-cn in response to ECT. Findings of this pilot investigation suggest that LTL and mtDNA-cn may constitute disease biomarkers for TRD but are not involved in response to ECT.
High-Field 7T MRI in a drug-resistant paediatric epilepsy cohort: image comparison and radiological outcomes
Authors: Vecchiato Katy , Casella Chiara , Dokumaci Ayse Sila , Carney Olivia , Cleary Jon O. , Ciò Pierluigi Di , Cleri Michela , Colford Kathleen , Piper Rory J. , Arichi Tomoki , Eyre Michael , Aitken Fraser , Tomi-Tricot Raphael , Wilkinson Tom , McGinnity Colm J , Yaakub Siti N , Giles Sharon L. , Malik Shaihan , Hammers Alexander , Bridgen Philippa , Carmichael David W. , O’Muircheartaigh Jonathan
Published: August 2024

Background and Objectives

Epileptogenic lesions in focal epilepsy can be subtle or undetected on conventional brain MRI. Ultra-high field (7T) MRI offers higher spatial resolution, contrast and signal-to-noise ratio compared to conventional imaging systems and has shown promise in the presurgical evaluation of adult focal epilepsy. However, the utility of ultra-high field MRI in paediatric focal epilepsy, where malformations of cortical development are more common, is unclear. This study compared 7T to conventional 3T MRI in children with epilepsy by comparing: (i) scan tolerability; (ii) radiological image quality; (iii) lesion yield.

Materials and Methods

Children with drug-resistant focal epilepsy and healthy controls were recruited prospectively and imaged at both 3T and 7T. Safety and tolerability during scanning was assessed via a questionnaire. Image quality was evaluated by an expert paediatric neuroradiologist and estimated quantitatively by comparing cortical thickness between field strengths. To assess lesion detection yield of 7T MRI, a multi-disciplinary team jointly reviewed patients’ images.

Results

41 patients (8-17 years, mean=12.6 years, 22 male) and 22 healthy controls (8-17 years, mean=11.7 years, 15 male) were recruited. All children completed the scan, with no significant adverse events. Higher discomfort due to dizziness was reported at 7T (p=0.02), with side-effects more frequently noted in younger children (p=0.02). However, both field strengths were generally well-tolerated and side-effects were transient. 7T images had increased inhomogeneity and artefacts compared to those obtained at 3T. Cortical thickness measurements were significantly thinner at 7T (p<0.001). 8/26 (31%) patients had new lesions identified at 7T which were not identified at 3T, influencing the surgical management in 4/26 (15%).

Discussion

7T MRI in children with epilepsy is feasible, well-tolerated and is associated with a 31% improvement in lesion detection rates.
The Impact of In Utero Tobacco Exposure on Cardiovascular Disease Risk and All-cause Mortality in Adulthood: a UK Biobank Study
Authors: Zheng Yanxu , Xiong Xinyu , Bao Jing , Liu Jingyu , Wang Jin , Chen Zixi , Zou Fang , Guo Yang , Wang Qingyao , Qiu Yixuan , Zhu Zhaowei
Published: August 2024

Aim

The negative impacts of in utero tobacco exposure (IUTE) on cardiovascular disease (CVD) have been insufficiently described. This study aims to assess the association between IUTE and the risks of CVD incidence and all-cause mortality, discuss the inter-group difference based on genetic susceptibility and smoking behaviors after birth, and explore the potential mediating factors.

Methods

Utilizing a total of 375,024 participants from the UK Biobank, the outcomes include myocardial infarction, stroke, chronic ischemic heart disease, nonrheumatic aortic valve disorders, cardiomyopathy, heart failure, atherosclerosis, aortic aneurysm and dissection, and all-cause mortality.

Results

During a median follow-up period of 14.6 years, 50,434 cases of CVD were recorded. IUTE was significantly associated with increased CVD incidence (HR 1.10, 95% CI 1.08-1.12) and all-cause mortality (HR 1.11, 95% CI 1.09-1.14). Interaction effects between IUTE, smoking behaviors after birth, and genetic risk scores for CVD were observed significant (P for interaction < 0.005). The results of the cross-sectional study revealed a significant positive association between IUTE and smoking behaviors after birth (OR 1.08, 95% CI 1.06-1.09). Mediation analysis indicated that smoking behaviors (Proportion = 12.40%, P < 0.001) and HDL-c levels (Proportion = 14.20%, P < 0.001) partially mediated the IUTE-CVD relationship.

Conclusions

This study demonstrated that individuals with IUTE have a higher risk of developing CVD, and smoking behaviors after birth have multifaceted influence on this correlation. These findings underscore the importance of mothers avoiding smoking during pregnancy to mitigate adverse effects on their offspring.
Health-Seeking Behavior and Anxiety of Cancer Patients in Bangladesh during the COVID-19 Pandemic: A Cross-Sectional Study
Authors: Rahman Nur-A-Safrina , Mustafa Munmun , Tabassum Tahsin Tasneem , Simu Sumona Haque , Gupta Mridul , Afrin Sumaiya , Samiha Maisha , Moulee Shahra Tanjim , Abdullah Faisal , Sharmin Sifat , Loken Bilkis Akhter , Trisha Sadia Mahmud , Saimon Md. , Podder Vivek , Singhania Priya , Islam ANM Shamsul
Published: August 2024

Abstract

Background

The COVID-19 pandemic has posed unique challenges for cancer patients, who not only require ongoing medical care but also face an elevated risk of infection. Investigating the health-seeking behavior and barriers among adult cancer patients during this global crisis is crucial for ensuring their access to essential care amidst the pandemic’s complexities.

Objective

This cross-sectional study aimed to assess the health-seeking behavior, perceived barriers, and anxiety among adult cancer patients during the COVID-19 pandemic.

Materials and Methods

The study, conducted from August 2020 to December 2020, involved 210 participants purposively selected from the National Institute of Cancer Research and Hospital and Ahsania Mission Cancer and General Hospital in Dhaka. Data was collected through face-to-face interviews using a pre-tested semi-structured questionnaire and analyzed using SPSS (Version 26).

Results

Among the 210 participants, 56.2% were male, 28.6% aged 46-55, and 36.7% had no formal education. Approximately 52.3% preferred public healthcare facilities, while 6.2% sought homeopathy or pharmacy advice for symptoms. Significant differences emerged in post-pandemic healthcare provider contact (p-0.0). Notably, 88.1% missed appointments, with 78.3% taking no action. Barriers included transport issues (77.1%), reduced income (59%), and lacking financial (53.4%) and mental support (56.6%). Conversely, respondents downplayed public awareness (80%), infection risk from others (84.7%), healthcare provider infection risk (82.4%), and hospital overcrowding (64.8%). Fear of hospitals correlated with public awareness (p-0.0). On the GAD-7 scale, most had minimal anxiety (53.8%), with a weak provider contact-anxiety correlation (p-0.03). Healthcare providers excelled in precautions (99.5%) and health status communication (85.3%).

Conclusion

Despite the barriers and risks posed by the pandemic, cancer patients prioritized their care. Given the need for continued cancer care and the elevated risk of COVID-19 among cancer patients, adapting measures to align with the population’s real needs could prove highly beneficial.
Structural brain correlates of depression and anxiety in middle-aged and older adults: A systematic review
Authors: Johns Sasha , Maharani Asri , Lea-Carnall Caroline , Shryane Nick
Published: August 2024

Depression and anxiety are associated with structural brain changes, however, research in middle-aged and older adults is inconclusive regarding the regions implicated and the magnitude or direction of changes. We hypothesised that the impact on brain structure may be greater in this age group. We conducted a systematic review on the associations between brain structure with depression and anxiety separately to determine: i) if there are brain regions consistently implicated in depression and/or anxiety, ii) if these are the same for depression and anxiety or distinct, and iii) the extent to which research has dealt with both disorders together. Brain regions consistently associated with depression include the hippocampus, orbitofrontal cortex, prefrontal cortex, insula and temporal lobe. Relationships were mostly negative, with diminished brain structure being associated with increased depression. We were unable to identify regions consistently implicated in anxiety due to a lack of studies investigating its links with brain structure. This review has highlighted the urgent need for research into brain structure and anxiety in middle-aged and older adults.
Association between sleep-disordered breathing and moderate to severe depression in systemic lupus erythematosus: the TRUMP2-SLE study
Authors: Ishikawa Yuichi , Oguro Nao , Ichikawa Takanori , Kishida Dai , Sakurai Natsuki , Hidekawa Chiharu , Shidahara Kenta , Hayashi Keigo , Miyawaki Yoshia , Shimojima Yasuhiro , Yoshimi Ryusuke , Sada Ken-ei , Yajima Nobuyuki , Kurita Noriaki
Published: August 2024

Objective

Depression is the most frequent mood disorder that impairs quality of life and medication adherence in patients with systemic lupus erythematosus (SLE). Although sleep-disordered breathing (SDB) is a contributor to depression in the general population, its prevalence in SLE patients and its impact on depression are not clear. We employed a clinical epidemiologic approach to examine them in a multicenter cohort of SLE patients.

Methods

This was a cross-sectional study of 414 Japanese adults with SLE at five university hospitals. The main exposure was high-risk SDB, assessed with the Berlin Questionnaire. The main outcome was moderate to severe depression assessed using the Patient Health Questionnaire-9. Poisson regression models were fitted with a robust error variance to estimate adjusted prevalence ratios (aPRs).

Results

The mean age was 47.5 years and the mean body mass index (BMI) was 22.1 kg/m2. The prevalence of high-risk SDB was 15.2% (95% confidence interval [95% CI] 11.9%–19.0%). The prevalence of moderate or severe depression was 19.1% (95% CI 15.4%–23.2%). High-risk SDB was associated with a greater likelihood of moderate to severe depression (aPR 2.62, 95% CI 1.62–4.24). All the 1-, 2-, and 3-positive risk categories for SDB were associated with moderate to severe depression, in a dose-dependent manner.

Conclusion

Among patients with SLE, SDB is common, and high-risk SDB is strongly associated with moderate to severe depression. The signs and symptoms of SDB should prompt a simultaneous evaluation for concomitant depression.

KEY MESSAGES

SDB and depression are common among SLE patients with relatively low disease activity.

High-risk SDB was associated with a greater prevalence of moderate to severe depression.

SDB should be evaluated in SLE patients with concomitant depression.
Disentangling the relationship between biological age and frailty in community-dwelling older Mexican adults
Authors: Fermín-Martínez Carlos A. , Ramírez-García Daniel , Antonio-Villa Neftali Eduardo , López-Teros Miriam Teresa , Seiglie Jacqueline A. , Castrejón Pérez Roberto Carlos , García Peña Carmen , Gutiérrez-Robledo Luis Miguel , Bello-Chavolla Omar Yaxmehen
Published: August 2024

OBJECTIVE

Older adults have heterogeneous aging rates. Here, we explored the impact of biological age (BA) and accelerated aging on frailty in community-dwelling older adults.

METHODS

We assessed 735 community-dwelling older adults from the Coyocan Cohort. BA was measured using AnthropoAge, accelerated aging with AnthropoAgeAccel, and frailty using both Fried’s phenotype and the frailty index. We explored the association of BA and accelerated aging (AnthropoAgeAccel ≥0) with frailty at baseline and characterized the impact of both on body composition and physical function. We also explored accelerated aging as a risk factor for frailty progression after 3-years of follow-up.

RESULTS

Older adults with accelerated aging have higher frailty prevalence and indices, lower handgrip strength and gait speed. AnthropoAgeAccel was associated with higher frailty indices (β=0.0053, 95%CI 0.0027-0.0079), and increased odds of frailty at baseline (OR 1.16, 95%CI 1.09-1.25). We observed a sexual dimorphism in body composition and physical function linked to accelerated aging in non-frail participants; however, this dimorphism was absent in pre-frail/frail participants. Accelerated aging at baseline was associated with higher risk of frailty progression over time (OR 1.74, 95%CI 1.11-2.75).

CONCLUSIONS

Despite being intertwined, biological accelerated aging is largely independent of frailty in community-dwelling older adults.