bluuebunny/crossref_metadata_2025 huggingface dataset:
Downregulation of ALKBH5 rejuvenates aged human mesenchymal stem cells and enhances their therapeutic efficacy in myocardial infarction
Authors: Gao Xiaoyan , Liang Xiaoting , Liu Baojuan , Hong Yimei , He Haiwei , Shen Ying , Chen Jiaqi , Huang Xinran , Hu Bei , Li Weifeng , Li Xin , Zhang Yuelin
Published: November 2023

Despite promising results in myocardial infarction (MI), mesenchymal stem cell (MSC)‐based therapy is limited by cell senescence. N6‐methyladenosine (m6A) messenger RNA methylation has been reported to be closely associated with cell senescence. Nonetheless, its role in the regulation of MSC senescence remains unclear. We examined the role of ALKB homolog 5 (ALKBH5) in regulating MSC senescence and determined whether ALKBH5 downregulation could rejuvenate aged MSCs (AMSCs) to improve their therapeutic efficacy for MI. RNA methylation was determined by m6A dot blotting assay. MSC senescence was evaluated by senescence‐associated β‐galactosidase (SA‐β‐gal) staining. A mouse model of acute MI was established by ligation of the left anterior decedent coronary artery (LAD). Compared with young MSCs (YMSCs), m6A level was significantly reduced but ALKBH5 was greatly increased in AMSCs. Overexpression of ALKBH5 reduced m6A modification and accelerated YMSC senescence. Conversely, ALKBH5 knockdown increased m6A modifications and alleviated AMSC senescence. Mechanistically, ALKBH5 regulated the m6A modification and stability of CDKN1C mRNA, which further upregulated CDKN1C expression, leading to MSC senescence. CDKN1C overexpression ameliorated the inhibition of cellular senescence of ALKBH5 siRNA‐treated AMSCs. More importantly, compared with AMSCs, shALKBH5‐AMSCs transplantation provided a superior cardioprotective effect against MI in mice by improving MSC survival and angiogenesis. We determined that ALKBH5 accelerated MSC senescence through m6A modification‐dependent stabilization of the CDKN1C transcript, providing a potential target for MSC rejuvenation. ALKBH5 knockdown rejuvenated AMSCs and enhanced cardiac function when transplanted into the mouse heart following infarction.
Endotypic heterogeneity and pathogenesis in chronic rhinosinusitis
Authors: Bai Junqin , Tan Bruce K. , Kato Atsushi
Published: November 2023

Purpose of review

This review aims to provide updates in realms of endotypic heterogeneity, pathogenesis at the molecular level, potential of biomarkers, and cutting-edge scope of biologics in CRS.

Recent findings

High-dimensional analyses, such as transcriptomes, and machine learning, have significantly enhanced CRS endotyping, uncovering diverse pathogenetic mechanisms contributing to its heterogeneity. The dynamic process of epithelial remodeling in CRS pathogenesis has gained more clarity and support as exemplified by IL-13 and oncostatin M (OSM) that are shown intricately linked to epithelial barrier dysfunction. Moreover, anti-dsDNA autoantibody, BAFF, periostin, and cystatin SN show promise as potentials biomarkers, offering diagnostic and prognostic value for CRS.

The identification of inflammatory molecules involved in endotype specific signaling pathways provides insights into the underlying mechanisms and verifiable biomarkers for diagnosis and prediction of disease severity. More comprehensive clinical studies should be conducted to facilitate biologics from bench to bedside in treating CRS.
Effect of Repeated Exposure to Sevoflurane on Electroencephalographic Alpha Oscillation in Pediatric Patients Undergoing Radiation Therapy: A Prospective Observational Study
Authors: Madariaga Samuel , Devia Christ , Penna Antonello , Egaña José I. , Lucero Vanessa , Ramírez Soledad , Maldonado Felipe , Ganga Macarena , Valls Nicolás , Villablanca Nicolás , Stamm Tomás , Purdon Patrick L. , Gutiérrez Rodrigo
Published: November 2023

Background:

Pharmacological tolerance is defined as a decrease in the effect of a drug over time, or the need to increase the dose to achieve the same effect. It has not been established whether repeated exposure to sevoflurane induces tolerance in children.

Methods:

We conducted an observational study in children younger than 6 years of age scheduled for multiple radiotherapy sessions with sevoflurane anesthesia. To evaluate the development of sevoflurane tolerance, we analyzed changes in electroencephalographic spectral power at induction, across sessions. We fitted individual and group-level linear regression models to evaluate the correlation between the outcomes and sessions. In addition, a linear mixed-effect model was used to evaluate the association between radiotherapy sessions and outcomes.

Results:

Eighteen children were included and the median number of radiotherapy sessions per child was 28 (interquartile range: 10 to 33). There was no correlation between induction time and radiotherapy sessions. At the group level, the linear mixed-effect model showed, in a subgroup of patients, that alpha relative power and spectral edge frequency 95 were inversely correlated with the number of anesthesia sessions. Nonetheless, this subgroup did not differ from the other subjects in terms of age, sex, or the total number of radiotherapy sessions.

Conclusions:

Our results suggest that children undergoing repeated anesthesia exposure for radiotherapy do not develop tolerance to sevoflurane. However, we found that a group of patients exhibited a reduction in the alpha relative power as a function of anesthetic exposure. These results may have implications that justify further studies.
Corneal Melt Associated With Cancer Immunotherapy
Authors: Hsu Jerry , Dixit Lena , Jhanji Vishal , Ahmad Sumayya
Published: November 2023

Purpose:

The purpose of this study was to describe cases of corneal melt associated with systemic cancer immunotherapy.

Methods:

This is a case series of 6 patients.

Results:

Corneal melt was noted in all eyes, including 1 patient on an epidermal growth factor receptor (EGFR) inhibitor and another on a human epidermal growth factor 2 (HER2) inhibitor that resolved on serum tears; 1 patient on a fibroblast growth factor receptor (FGFR) inhibitor that stabilized on serum tears and amniotic membrane; 1 patient on a Bruton tyrosine kinase (BTK) inhibitor and another on a breakpoint cluster region protein-abelson murine leukemia viral oncogene homolog 1 (BCR-ABL) inhibitor that both had corneal thinning with perforation; and 1 patient with bilateral corneal thinning complicated by a fungal superinfection after long-term use of a programmed cell death protein 1 (PD-1) inhibitor.

Conclusions:

While primarily described with EGFR inhibitors, corneal melt may present with vision-threatening consequences in other classes of cancer immunotherapy including FGFR inhibitors, PD-1 inhibitors, and other tyrosine kinase inhibitors.
Anatomical Bases for Aesthetic Costal Surgery: Assessing the Thoracoabdominal Limits
Authors: Manzaneda Raul M. , Verdugo Juan P. , Vega Héctor Duran , Babaitis Ricardo , Viaro Maurício , Botelho Daniel L. , Adrianzen Gerardo A. , Michels Paulo , Parashar Sanjay
Published: November 2023

Background:

Knowing the anatomy of the ribs is crucial for understanding various rib procedures. The present study is aimed at describing radiological measurements and ratios of 83 Latin American patients undergoing thoracoabdominal computed tomography (CT).

Methods:

A total of 83 thoracoabdominal computed tomography scans of women aged 18–35 conducted at a medical center in Lima, Peru, were reviewed from January 2022 to January 2023. The resulting measurements and ratios were used to calculate frequency distributions. All data were stored in a Microsoft Excel database and analyzed using statistical analysis software SPSS version 28.

Results:

Ratios and measures of the tenth, eleventh, and twelfth ribs are shown in the different tables, and costal characteristics with an adequate statistical significance are defined.

Conclusions:

Using radiological measurements and rib ratios, we were able to find key anatomical relationships with an adequate level of significance, which could help establish objective results in rib procedures.
Equivalence in Color-coded Duplex Sonography Parameters before Complex Microsurgery
Authors: Rendón-Medina Marco Aurelio , Garcia-Gonzalez Ivan , Rojas-Ortiz Jorge Arturo , Hanson-Viana Erik , Mendoza-Vélez María de los Ángeles , Vargas Rocha Jesus Manuel , Hernández-Ordoñez Rubén , Vazquez Morales Hecly Lya , Sandoval-Rodriguez Jorge Isaac , Pacheco Lopez Ricardo Cesar
Published: November 2023

Background:

Color-coded duplex sonography (CCDS) is a widely proposed noninvasive diagnostic tool in microsurgery. CCDS has been applied to lower extremity salvage cases to define appropriate blood flow velocity criteria for achieving arterial success in diabetic foot and complex microsurgery cases. This study aimed to compare the success ratio of free flaps when using CCDS versus cases where CCDS was not used.

Methods:

We included complex microsurgery cases from 2019 to 2021. These cases were subsequently categorized into two groups: group A consisted of cases where CCDS parameters were applied, whereas group B comprised cases where CCDS was not performed at all.

Results:

The study encompassed 14 cases (11 men and three women). The age range varied from 23 to 62 years, with an average age of 42. Using CCDS analysis and planning demonstrated improved outcomes in comparison with cases where CCDS was not performed, albeit without statistical significance (P = 0.064).

Conclusions:

The application of CCDS proves to be beneficial in the realm of microsurgery. Although not achieving statistical significance, our data imply that CCDS utilization holds promise for enhancing microsurgical procedures.
Longitudinal Comparison of Orbital Volumes from Enucleated Eyes with Hydroxyapatite Orbital Implant in Unilateral Retinoblastoma Patients
Authors: Kruglov Aleksandr A. , Laplant Jacquelyn F. , Dryden Stephen C. , Kornblau Ilyse S. , Kaste Sue C. , Wang Fang , Wilson Matthew W.
Published: November 2023

Purpose:

To compare the orbital volume between enucleated and contralateral, uninvolved orbits over a 5-year period in patients with unilateral retinoblastoma who underwent enucleation with hydroxyapatite (HA) implant placement by a single surgeon.

Methods:

A retrospective review was performed on the clinical records and radiographic images of unilateral retinoblastoma patients who underwent enucleation with primary HA implantation from 2003 to 2020 at a single institution. Bilateral orbital volume measurements were taken from the initial postoperative MRI scan and again at 1- and 5-years postenucleation. The main outcome measure was the longitudinal change in volume difference (∆𝑉). The implant size, age at enucleation, and sex were also evaluated. A linear mixed-effect model was used for analysis.

Results:

A total of 124 patients (73 males) with HA implants following enucleation were included. Overall, the unaffected orbit trended toward having a greater volume compared with the enucleated orbit, but this was not statistically significant (β = 0.003; p = 0.122). The mean age at enucleation was 2.4 years. The median time between enucleation and the initial, 1-year, and 5-year postoperative MRIs was 6 months, 17 months, and 55 months, respectively. There was no statistical correlation between age at enucleation, gender, implant size, or orbital volume at any time points (p > 0.05).

Conclusions:

Patients treated with enucleation and primary HA implant placement for unilateral retinoblastoma did not display significant asymmetry in orbital volume on 5-year postenucleation MRIs, suggesting that HA implants promote orbital growth comparable to a nonenucleated orbit in the pediatric population.
Predictive factors for severe outcomes in substance abuse-related emergency visits: A 5-year retrospective analysis at a medical center in Taiwan
Authors: Hsieh Chia-Ying , Hsu Jen-Yu , Yang Chen-Chang
Published: November 2023

Background:

Substance abuse is a considerable medical issue worldwide, yet current surveillance systems in Taiwan offer limited insights into the clinical characteristics and outcomes of substance abuse patients. This study aimed to delineate the epidemiology of emergency department visits related to substance abuse at a hospital in Taiwan and to identify factors predictive of severe complications or mortality.

Methods:

A retrospective analysis was conducted on substance abuse-related emergency department visits at a medical center in Taiwan between 2009 and 2013. Eligible participants were individuals aged 20 or older who had confirmed substance abuse through urinalysis. Variables such as patient demographics, substances abused, clinical characteristics, and outcomes were collected. Severe outcomes were defined as admission to the intensive care unit, requirement for endotracheal intubation, or in-hospital death. Logistic regression models were employed to identify factors contributing to severe outcomes.

Results:

The cohort consisted of 623 patients, of whom 64.0% were female and 67.1% were aged between 20 and 49 years. Benzodiazepines were detected in 75.3% of patients, while z-drugs (specifically zopiclone, zolpidem, or zaleplon) were found in 27.8%. Depressants, stimulants, and hallucinogens were present in 14.9%, 10.6%, and 0.6% of the cases, respectively. Of the patient, 121 (19.4%) experienced severe outcomes, including 116 (18.6%) intensive care unit admissions, 73 (11.7%) intubations, and 11 (1.8%) in-hospital deaths. Multivariable logistic regression analysis revealed multiple predictors of severe outcomes, such as emergency department triage level, aspiration pneumonia, leukocytosis, abnormal hepatic function, abnormal renal function, hypernatremia, and hypocalcemia.

Conclusion:

In Taiwan, benzodiazepines emerged as the most prevalent substance of abuse among emergency department visitors, and a significant proportion of these patients experienced severe outcomes. Continuous monitoring of severe outcome predictors is essential for enhanced understanding and management.
Evaluation of Serum Soluble CD27 and CXCL-10 Levels in Patients with Vitiligo
Authors: Aboelmagd Marwa A. , Assaf Hanan A. , Hassan Mohammed H. , Abdelmegeed Hanan A. , Abdelwahab Ashraf
Published: November 2023

Objectives:

Vitiligo is a relatively common skin disfiguring disorder that exhibits a fluctuating course between activity and stability, making monitoring and management challenging. Autoimmunity plays a crucial role in the pathogenesis of vitiligo. Numerous autoimmune disorders have been associated with both CD27 and chemokine (C-X-C motif) ligand 10 (CXCL10). However, trials evaluating their role in vitiligo are lacking in the Egyptian setting. We evaluated the circulating levels of these two biomarkers in patients with vitiligo and the possible correlation between their levels and disease activity.

Methods:

This cross-sectional study included 70 patients with vitiligo and 20 healthy controls. The patients were clinically assessed and then divided into active and stable groups according to clinical signs of activity and Vitiligo Disease Activity Scores. The levels of CD27 and CXCL10 in the serum were assessed using an enzyme-linked immunosorbent assay in both the patients and the controls, then the Mann-Whitney and Kruskal Wallis tests were used to analyze the data.

Results:

Active and stable vitiligo patients have significantly higher median serum CXCL10 (385.9, and 245.2 pg/ml) and CD27 (61.6, and 66.5 ng/ml) levels compared to the controls (193 pg/ml, and 52.5 ng/ml respectively), p˂0.05 for all. In vitiligo cases, although CXCL10 levels significantly increased with disease activity (P < 0.001), CD27 levels were comparable between the two subgroups (P =0.953). CXCL10 positively correlated with disease activity (r=0.887, P < 0.0001). CXCL10 had higher sensitivity and lower specificity (95.7% and 60% respectively) compared to CD27 (71.4% and 75%, respectively) for differentiating cases from controls.

Conclusion:

There is a possibility that CXCL10 and CD27 are involved in the development and course of vitiligo.
Why Don’t Employees Participate in Well-being Programs? A Research-Informed Systems-Based Model
Authors: Sherman Bruce W. , Stiehl Emily , Wator Caroline , Pratap Preethi Lakshmi
Published: November 2023

Objective

Employee nonparticipation in well-being programs is common, but not well understood. Development of a systems-based framework to characterize reasons for nonparticipation can inform efforts to enhance engagement.

Methods

Following literature review and building on previous research, a systems-based model was developed to contextualize participation barriers.

Results

Well-being program nonparticipation is more frequent among low-wage workers as well as minority subpopulations. Contributors include employer factors, such as inequitable benefits design, and employee factors, such as lack of perceived relevance, barriers to access, and lower prioritization of personal health needs.

Conclusions

A systems-based approach to evaluating well-being program nonparticipation can help identify factors contributing to employee nonparticipation and lead to targeted policy and practice changes that encourage greater employee engagement.
Music Therapy for Pediatric Pain Management During Bedside Sclerotherapy
Authors: Tulin-Silver Sheryl , Asch-Ortiz Gabriela , Tsze Daniel S.
Published: November 2023

The management of pain is one of the primary concerns when administering sclerotherapy in children with vascular malformations. However, there is currently no standard of care and limited data regarding the effective treatment of pain associated with sclerotherapy. In this case report, we describe the successful management of pain using music therapy in a child undergoing bedside sclerotherapy for a lymphatic malformation. This report is novel in that it demonstrates the effectiveness of music therapy as an individualized integrative approach for providing pain management to children undergoing bedside sclerotherapy.
Implementing Guidelines for NICU Parent Presence
Authors: Horner Susan , Benbrook Keri , Hoffman Melissa , Libutti Lauren
Published: November 2023

Background:

Relationships between parents and infants are essential for mitigating stressors encountered in neonatal intensive care units (NICUs) and are supported by parent presence and engagement.

Purpose:

The purpose of this study was to compare NICU parent and infant outcomes pre- and postimplementation of an intervention aimed at increasing parent presence and engagement in the NICU. This family-centered care intervention consisted of communicating specific guidelines for parent presence.

Methods:

Data related to parent presence, skin-to-skin care, and breastfeeding; parental stress; infant outcomes including weight gain, length of stay, feeding status at discharge, and stress; and unit-level outcomes were collected from a convenience sample of 40 NICU families recruited preimplementation and compared with data for 38 NICU families recruited postimplementation of specific guidelines for parent presence. To establish comparability of groups, infants were assigned scores using the Neonatal Medical Index.

Results:

Parent presence, engagement in skin-to-skin care, and breastfeeding rates were not significantly different between groups. Stress-related outcomes were significantly decreased in NICU mothers, fathers, and infants, and infant feeding outcomes were improved in the postintervention group.

Conclusions:

Specific guidelines for parent presence may represent an invitation for parents to engage with their NICU infants and may positively impact parent and infant stress.
Functional Follow-Up After Cystectomy and Urinary Diversion: A Narrative Review
Authors: Kaufmann Ernest , Black Peter C. , Catto James W. F. , Djaladat Hooman , Ghodoussipour Saum , Hamilton-Reeves Jill M. , Jensen Bente Thoft , Kassouf Wassim , Lauridsen Susanne Vahr , Lerner Seth P. , Llorente Carlos , Loftus Katherine , Lucca Ilaria , Martini Alberto , Preston Mark A. , Psutka Sarah P. , Sfakianos John P. , Shah Jay , Wettstein Marian Severin , Williams Stephen B. , Daneshmand Siamak , Fankhauser Christian D. ,   on Behalf of the Enhanced Recovery After Surgery (ERAS) Cystectomy Committee
Published: November 2023

Introduction:

Follow-up after urinary diversion aims to detect functional complications to prevent harm and improve quality of life.

Methods:

We conducted a literature search and reviewed guidelines and institutional follow-up protocols.

Results:

We included 14 studies providing data of 3282 patients. Functional complications can be seen in up to 90% of all patients within 15 years after urinary diversion and mainly include impairment of urinary or sexual function as well as renal/metabolic disturbances, but only limited evidence supporting any functional follow-up recommendation was identified. Current guideline recommendation should be rephrased to ensure routine implementation of functional follow-up investigation.

Discussion:

Future research is required to assess whether, which, and how follow-up protocols after cystectomy affect functional results to inform optimal surveillance procedures after treatment.

Patient Summary:

In this review of recommended follow-up protocols after cystectomy, we observed different recommendations and discuss future research areas.
Kidney function assessment in the geriatric population
Authors: Muzaale Abimereki , Khan Adnan , Glassock Richard J. , Tantisattamoa Ekamol , Ahdoot Rebecca S. , Al Ammary Fawaz
Published: November 2023

Purpose of review

Kidney function declines with normal aging. But it also declines with the progression of some diseases. This review calls for a more nuanced interpretation of kidney function in the geriatric population, who may have frailty and comorbidities.

Recent findings

GFR declines with healthy aging kidneys. Aging kidney changes include decreased cortical volume, senescent global glomerulosclerosis, and reduced nephron numbers. Yet normal aging is not associated with increased glomerular volume or single-nephron GFR. The prevalence of GFR less than 60 ml/min/1.73 m2 in the geriatric population is high. However, the decline in GFR with normal aging may not reflect true CKD without albuminuria. Although the risk of ESKD and mortality increases in all age groups when eGFR less than 45 ml/min/m2, there is no significant increased relative risk of ESKD and mortality in the geriatric population when eGFR 45–59 ml/min/m2 in the absence of albuminuria. Innovative approaches are needed to better estimate GFR and define CKD in the geriatric population.

The expected GFR decline in the geriatric population is consistent with normal aging kidney changes. To avoid CKD overdiagnosis and unnecessary referrals to nephrology for possible CKD, age-adapted definitions of CKD in the absence of albuminuria are needed.
Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk
Authors: Waldrop Stephanie W. , Wang Daisy , Kancherla Devin , Stanford Fatima Cody
Published: November 2023

Purpose of review

Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence.

Recent findings

Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth.

Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
Narrative review: food as medicine across the pediatric age continuum
Authors: Fischer Laura , Muleta Hemen , Essel Kofi
Published: November 2023

Purpose of review

Poor diet and food insecurity contribute to the dramatic rise in diet-related chronic disease and increasing cost of healthcare. The Food as Medicine (FAM) framework describes food-based interventions designed to prevent, manage, and treat diet-related diseases. However, FAM interventions have not been widely implemented or evaluated in pediatric populations, so critical questions remain about their optimal delivery and design, efficacy, and funding opportunities. We have reviewed the recent literature and offer insights into potential funding and implementation strategies for pediatric healthcare providers.

Recent findings

Data from adult and population-level interventions provide evidence that FAM interventions positively impact diet quality, food security, health outcomes, and healthcare utilization and cost in adults and households with children. Evidence from recent pediatric-based FAM interventions and population data from recent changes to federal nutrition programs support the use of food-based interventions to improve child diet quality, food insecurity, and potentially impact long-term health and healthcare utilization and cost.

Applying the entire spectrum of evidence-based FAM interventions in pediatric settings from prenatal to adolescent stages will offer the greatest opportunity to ensure all children have access to enough healthful food so they can achieve their highest potential in life.
The Impact of Race on Pancreatic Cancer Treatment and Survival in the Nationwide Veterans Affairs Healthcare System
Authors: Khalaf Natalia , Xu Ann , Nguyen Wenker Theresa , Kramer Jennifer R. , Liu Yan , Singh Hardeep , El-Serag Hashem B. , Kanwal Fasiha
Published: November 2023

Objectives

Among patients with pancreatic cancer, studies show racial disparities at multiple steps of the cancer care pathway. Access to healthcare is a frequently cited cause of these disparities. It remains unclear if racial disparities exist in an integrated, equal access public system such as the Veterans Affairs healthcare system.

Methods

We identified all patients diagnosed with pancreatic adenocarcinoma in the national Veterans Affairs Central Cancer Registry from January 2010 to December 2018. We examined the independent association between race and 3 endpoints: stage at diagnosis, receipt of treatment, and survival while adjusting for sociodemographic factors and medical comorbidities.

Results

We identified 8529 patients with pancreatic adenocarcinoma, of whom 79.5% were White and 20.5% were Black. Black patients were 19% more likely to have late-stage disease and 25% less likely to undergo surgical resection. Black patients had 13% higher mortality risk compared with White patients after adjusting for sociodemographic characteristics and medical comorbidities. This difference in mortality was no longer statistically significant after additionally adjusting for cancer stage and receipt of potentially curative treatment.

Conclusions

Equal access to healthcare might have reduced but failed to eliminate disparities. Dedicated efforts are needed to understand reasons underlying these disparities in an attempt to close these persistent gaps.
Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*
Authors: Lee Laurie A. , Martin Dori-Ann , Mahoney Meagan , James Lee , Avitzur Yaron , Carroll Allison , Piggott Bailey , Tomlinson Christopher , Urschel Simon , Hamiwka Lorraine
Published: November 2023

OBJECTIVES:

To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers.

DESIGN:

A cross-sectional survey carried out 2021–2022.

SETTING:

Canadian PICUs affiliated with a donor physician network.

SUBJECTS:

Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution.

MEASUREMENTS AND MAIN RESULTS:

A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units.

CONCLUSIONS:

Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.
From Pandemic to Epidemic: Lessons Learned From COVID-19 Applied to Mpox Outbreak Response, Westchester County, Metropolitan New York
Authors: Keller Marina , Hellman Melissa , Hewlett Dial , Chaturvedi Vishnu , Chen Donald S. , Watson Judith , Huang Ada , Recchia Renee , Amler Sherlita , Garrick Renee
Published: November 2023

The COVID-19 pandemic vaccination infrastructure was redeployed to address the Mpox epidemic. The Westchester County Department of Health coordinated an effective vaccine distribution, tracking, and data collection process with community partners with real-time feedback of operational challenges and updated public health directives. Westchester County, which comprises 9% of the New York State population, administered 24% (6770 doses) of JYNNEOS (smallpox and monkeypox vaccine) across the state. Among first-dose recipients, 13% were Black and 25% were Hispanic, approaching countywide US Census race and ethnicity breakdowns. The operational template designed during COVID-19 can be readily redeployed for subsequent epidemics of even seemingly dissimilar infections like Mpox.
Effects of the First Year of the COVID-19 Pandemic on Utilization of Emergency Medical Services in Maryland
Authors: Hossain Sharmin , Jackson Alice , Burkom Howard , Boyd Christine
Published: November 2023

Background:

The opioid epidemic in the United States has devastated the lives of individuals and imposed decades-long opportunity costs on the community.

Methods:

We analyzed Emergency Medical Services (EMS) data from the Maryland Department of Health installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE) to assess the impact of COVID-19 on EMS call volume and how COVID-19 impacted patients' decisions whether to accept transport to a hospital following an EMS call.

Results:

The rate of patients accepting transportation via EMS to a hospital emergency department (ED) declined for both opioid-related and non–opioid-related calls from prepandemic (before April 2020) to mid-pandemic (mid-March 2020 to mid-April 2020). The opioid-related call volume increased more from pre- to mid-pandemic for male patients than for female patients, and this “gender gap” had not returned to prepandemic levels by April 2021.

Conclusion:

Consistent with reports from other states, the pandemic worsened the opioid crisis in Maryland, impacting some populations more than others while also decreasing the likelihood that individuals experiencing an opioid-related overdose would seek further medical care following an EMS call.
Sexually transmitted infections in people with multidrug-resistant HIV
Authors: Clemente Tommaso , Lolatto Riccardo , Papaioannu Borjesson Rebecka , Fabbiani Massimiliano , Manzillo Elio , Fronti Elisa , Di Giambenedetto Simona , Gagliardini Roberta , Rusconi Stefano , Santoro Maria M. , Castagna Antonella , Spagnuolo Vincenzo
Published: November 2023

Retrospective, cohort analysis including people with four-class drug-resistant HIV. Bacterial sexually transmitted infections (STIs) had an incidence of 1.3/100-person-years-of-follow-up (PYFU) in men (3.5/100-PYFU in MSM) whereas no STIs were diagnosed in women. The occurrence of STIs in this fragile population might be related to the achievement of good HIV infection control; however, given the remaining risk of virological failure and possible transmission of a multidrug-resistant virus, STI prevention counselling and HIV viremia monitoring should be prioritized.
External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems
Authors: Buchholz Carl J. , D’Aquila Madeline L. , Lollar Daniel I.
Published: November 2023

BACKGROUND

This study aims to compare and externally validate the previously developed Revised Intensity Battle Score (RIBS) against other proposed scores for predicting poor outcomes after rib fractures.

METHODS

An external validation set was assembled retrospectively, comprising 1,493 adult patients with one or more rib fractures admitted to a Level 1 trauma center between 2019 and 2022. The following rib fracture scores were calculated for each patient: RIBS, Injury Severity Score, Rib Fracture Score, Chest Trauma Score, and Battle score. Each was investigated to assess utility in predicting mortality, intensive care unit upgrade, unplanned intubation and ventilator days. Performance was measured by area under the receiver operating characteristic curve.

RESULTS

Of the 1,493 patients who met inclusion criteria, 239 patients (16%) experienced one of more of the investigated outcomes. Generally, scores performed best at predicting mortality and ventilator days. The RIBS stood out as best predicting “any complication” (AUC = 0.735) and “>7 ventilator days” (AUC = 0.771).

CONCLUSION

The RIBS represents an externally validated triage score in patients with rib fractures and compares favorably to other static scoring systems. Use of this score as a triage tool may allow stratifying patients who may benefit from direct intensive care unit admission, neuraxial anesthesia and aggressive respiratory care. Next steps include prospective investigation of how pairing these interventions with score directed triage impacts outcomes

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Impact of Co-occurring Cancer-Related and Wound-Specific Symptoms on Functional Performance Among Patients With Advanced Cancer and Malignant Fungating Wounds
Authors: Tilley Charles P. , Yu Gary , Comfort Christopher , Li Zujun , Axelrod Deborah , Colon-Cavallito Kim , Wholihan Dorothy , Fu Mei Rosemary
Published: November 2023

PURPOSE:

The purpose of this study was to examine the impact of co-occurring symptoms in patients with advanced cancer and malignant fungating wounds (MFWs) on palliative and functional performance, and the feasibility of collecting self-reported data in this population.

DESIGN:

This was an exploratory, observational study. Quantitative surveys and qualitative semistructured interviews using a phenomenological approach were employed.

SUBJECTS AND SETTING:

The sample comprised 5 adults with advanced breast, oral, and ovarian cancer and MFWs. Participants were recruited from an urban outpatient cancer center, hospice, and wound center located in the Northeastern United States.

METHODS:

Demographic and clinical characteristics were collected, and self-reported symptom and functional performance data measured. Descriptive statistics, T scores, confidence intervals, and standard deviation were calculated for quantitative data. One-to-one semistructured interviews were conducted by the first author to gain deeper understanding of participants' symptom experience. Qualitative data were analyzed using an iterative and inductive thematic data analysis method to identify major themes.

RESULTS:

The mean cancer-related and wound-specific symptom occurrence was 17 (SD = 5.56) and 4 (SD = 1.26), respectively. Distressing, extensive co-occurring symptom burdens were experienced by all participants; they also reported poor functional performance and diminished palliative performance. Qualitative findings supported quantitative results.

CONCLUSIONS:

Findings suggest that co-occurring cancer-related and wound-specific symptoms have incremental and negative impact on functional performance. The use of multiple data collection methods was feasible, including self-reported data in this advanced cancer population.
A Scoping Literature Review on Patient Education in Intermittent Catheterization
Authors: Quallich Susanne , Lajiness Michelle , Engberg Sandra , Gray Mikel
Published: November 2023

PURPOSE:

To summarize evidence related to (1) research studies examining patient/caregiver educational interventions related to intermittent self/caregiver catheterization (ISC), (2) studies examining issues related to teaching ISC, and (3) evidence-based clinical practice guidelines addressing ISC.

PROBLEM:

Avoiding lower urinary tract trauma during catheter insertion, adequate frequency of catheterization, and complete emptying of the bladder are essential to prevent and reduce complications associated with ISC. Consequently, proper patient/caregiver education is essential to achieving good outcomes.

METHODS:

Scoping review of literature.

SEARCH STRATEGY:

We searched PubMed, EMBASE, and CINAHL databases, and the reference lists of background and included studies for quantitative and qualitative research studies and professional and healthcare organization–generated evidence-based clinical practice guidelines published between 2005 and September 2021. Eleven studies and 2 clinical practice guidelines met our eligibility criteria and are included in the review.

FINDINGS:

Research conducted in the United States examining the effectiveness of educational interventions for patients needing ongoing ISC is extremely limited. The single study identified was a small pilot feasibility study. Eight studies examining issues potentially related to patient/caregiver ISC education were identified, suggesting that catheter characteristics, patient barriers, and complications, particularly urinary tract infections, adherence, and upper extremity function, are important considerations when developing education interventions. The small number of studies and limitations in the methodologies limit the current evidence base to support patient/caregiver education about ISC. We also identified 2 evidence-based guidelines generated by European professional organizations that included recommendations related to ISC education.

CONCLUSIONS:

Additional research is needed to support the development of patient/caregiver educational interventions and to examine their effectiveness.
Improved Performance With the Micro-Hole Zone Intermittent Catheter
Authors: Landauro Malene Hornbak , Tentor Fabio , Pedersen Troels , Jacobsen Lotte , Bagi Per
Published: November 2023

PURPOSE:

To assess the performance of a new urinary intermittent catheter (IC) prototype designed with a micro-hole drainage zone compared to a conventional eyelet catheter (CEC) in terms of flow-stop, bladder emptying, and hematuria.

DESIGN:

Randomized controlled crossover studies.

SUBJECT AND SETTING:

The sample comprised 15 male healthy volunteers (HV) and 15 IC users, along with 15 female HV and 15 IC users. The age range was lower for HV participants than for IC users (range: 20-57 years for HV vs 21-82 years for IC users). The study setting was the Department of Urology, located in Rigshospitalet, Copenhagen.

METHODS:

Number of flow-stop incidents, residual urine volume at first flow-stop (RV1), and dipstick hematuria were measured during and after catheterization by a health care professional (HCP) and by IC-users. Results from the 3 studies were combined for HV and IC users on RV1 and number of flow-stop incidents but separated on sex. For incidents of hematuria, an effect of underlying condition was assumed, and a combined analysis on sex was performed, separating HV and IC users.

RESULTS:

When compared to the micro-hole drainage zone design, catheterizations with CEC resulted in a significantly higher mean RV1 (mean difference: 49 mL in males and 32 mL in females, both P < .001) and average number of flow-stop incidents (8 and 21 times more frequent for males and females, respectively, both P < .001). The likelihood for hematuria was 5.84 higher with CEC than with micro-hole drainage hole design, P = .053, during normal micturition in HV postcatheterization. No serious adverse events were reported.

CONCLUSION:

The micro-hole drainage zone catheter provides IC users fewer premature flow-stops. This design feature reduces modifiable urinary tract infection risk factors, such as residual urine and micro-trauma; additional research is needed to determine its effects on bladder health.
Comparison of Adjustment or Adaptation to the Formation of a Temporary Versus a Permanent Ostomy
Authors: Whiteley Ian , Randall Sue , Stanaway Fiona F.
Published: November 2023

PURPOSE:

The aim of this systematic review was to review evidence on adjustment or adaptation to an ostomy in persons with a temporary versus permanent ostomy.

METHOD:

Systematic review.

SEARCH STRATEGY:

We comprehensively searched the following bibliographic databases: MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO, CINAHL, Joanna Briggs, Scopus, and EThOS and ProQuest dissertations from inception to July 21, 2021. We located 570 studies. Data were extracted into Covidence, and the risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs tool.

FINDINGS:

Thirty-one studies met inclusion criteria and were included; only 2 assessed adjustment using a validated adjustment tool (Ostomy Adjustment Inventory, OAI-23). One found better adjustment in those with a permanent ostomy at 6 months; the second did not formally test for statistically significant differences between groups. Other included studies assessed aspects of adjustment such as health-related quality of life and psychological symptoms. Findings differed between studies; the majority of studies were deemed at a high risk of bias.

CONCLUSIONS:

The quality of evidence among studies evaluating adjustment to an ostomy in permanent versus temporary stomas was poor; the majority did not measure adjustment using a validated adjustment instrument. Therefore, differences in the ways those with a temporary ostomy or permanent ostomy adjust or adapt remain largely unknown.

IMPLICATIONS:

Further high-quality studies are needed that compare adjustment to a temporary or permanent ostomy using a validated instrument. An understanding of differences in adjustment in those with a temporary and permanent ostomy is important for planning how health care services can be better tailored to meet the needs of ostomy patients beyond the initial postoperative period of recovery.
Robust evidence for bats as reservoir hosts is lacking in most African virus studies: a review and call to optimize sampling and conserve bats
Authors: Weber Natalie , Nagy Martina , Markotter Wanda , Schaer Juliane , Puechmaille Sébastien J. , Sutton Jack , Dávalos Liliana M. , Dusabe Marie-Claire , Ejotre Imran , Fenton M. Brock , Knörnschild Mirjam , López-Baucells Adrià , Medellin Rodrigo A. , Metz Markus , Mubareka Samira , Nsengimana Olivier , O'Mara M. Teague , Racey Paul A. , Tuttle Merlin , Twizeyimana Innocent , Vicente-Santos Amanda , Tschapka Marco , Voigt Christian C. , Wikelski Martin , Dechmann Dina K.N. , Reeder DeeAnn M.
Published: November 2023

Africa experiences frequent emerging disease outbreaks among humans, with bats often proposed as zoonotic pathogen hosts. We comprehensively reviewed virus–bat findings from papers published between 1978 and 2020 to evaluate the evidence that African bats are reservoir and/or bridging hosts for viruses that cause human disease. We present data from 162 papers (of 1322) with original findings on (1) numbers and species of bats sampled across bat families and the continent, (2) how bats were selected for study inclusion, (3) if bats were terminally sampled, (4) what types of ecological data, if any, were recorded and (5) which viruses were detected and with what methodology. We propose a scheme for evaluating presumed virus–host relationships by evidence type and quality, using the contrasting available evidence for Orthoebolavirus versus Orthomarburgvirus as an example. We review the wording in abstracts and discussions of all 162 papers, identifying key framing terms, how these refer to findings, and how they might contribute to people's beliefs about bats. We discuss the impact of scientific research communication on public perception and emphasize the need for strategies that minimize human–bat conflict and support bat conservation. Finally, we make recommendations for best practices that will improve virological study metadata.
Formica fusca
ants use aphid supplemented foods to alleviate effects during the acute phase of a fungal infection
Authors: Rissanen Jason , Nyckees Danaë , Will Torsten , Helanterä Heikki , Freitak Dalial
Published: November 2023

The modulation of nutritional intake by animals to combat pathogens is a behaviour that is receiving increasing attention. Ant studies using isolated compounds or nutrients in artificial diets have revealed a lot of the dynamics of the behaviour, but natural sources of medicine are yet to be confirmed. Here we explored whether
Formica fusca
ants exposed to a fungal pathogen can use an artificial diet containing foods spiked with different concentrations of crushed aphids for a medicinal benefit. We show that pathogen exposed colonies adjusted their diet to include more aphid supplemented foods during the acute phase of the infection, reducing the mortality caused by the disease. However, the benefit was only attained when having access to a varied diet, suggesting that while aphids contain nutrients or compounds beneficial against infection, it is a part of a complex nutritional system where costs and benefits of compounds and nutrients need to be moderated.