bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions
Authors: Bauer Melissa E. , Fuller Matt , Kovacheva Vesela , Elkhateb Rania , Azar Kristen , Caldwell Morgan , Chiem Vanna , Foster Mindy , Gibbs Ronald , Hughes Brenna L. , Johnson Rebecca , Kottukapally Nobin , Rosenstein Melissa G. , Cortes Magdalena Sanz , Shields Laurence E. , Sudat Sylvia , Sutton Caitlin D. , Toledo Paloma , Traylor Austin , Wharton Kurt , Main Elliott
Published: December 2023

OBJECTIVE:

To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions.

METHODS:

This was a case–control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non–pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion.

RESULTS:

We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non–pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87–0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9–94.4%) but also had the highest false-positive rates (30.4–63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9–10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum.

CONCLUSION:

For admissions early in pregnancy and more than 3 days postpartum, non–pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. The overall false-positive rate remained high.
Abortion Trigger Laws Compared With the Emergency Medical Treatment and Labor Act
Authors: Cherry Steven B.
Published: December 2023

In 2022, the Supreme Court decision in Dobbs v Jackson Women's Health Organization reneged the Constitutional right to an abortion. Many states now enforce laws that ban abortions. There are significant conflicts between state abortion laws and federal regulations that mandate proper assessment, treatment, and stabilization of patients who present for emergency care. This conflict places physicians in an untenable position when treating patients who have a pregnancy that endangers their life. In states that deem abortion a felony, transfer of these patients can extricate the physician, who is in a difficult position. Currently, it is the only reasonable option for hospitals and physicians who are trapped between conflicting state laws and Emergency Medical Treatment and Labor Act rules and regulations.
Primary ovarian insufficiency: a toolkit for the busy clinician
Authors: Kapoor Ekta
Published: December 2023

Primary ovarian insufficiency (sometimes known as premature ovarian insufficiency) is a result of loss of ovarian follicular activity before the age of 40 years. It is an endocrine deficiency state in women, characterized by premature estrogen deprivation. In the absence of estrogen replacement, women experience bothersome menopause symptoms and a predisposition to accelerated aging and multimorbidity accumulation. Unless a true contraindication exists, estrogen therapy is recommended at least until the age of natural menopause. This Practice Pearl summarizes the clinical manifestations, diagnostic evaluation, and management of primary ovarian insufficiency.
Anaerobic and aerobic contributions to repeated supramaximal cycling exercises and their adaptation to high-intensity interval training in obese perimenopausal and postmenopausal women
Authors: Jabbour Georges , Iancu Horia D.
Published: December 2023

Objective

This study investigated the anaerobic and aerobic contributions to total energy release during repeated supramaximal cycling exercises (SCE) and their adaptation in response to 6 weeks of high-intensity interval training (HIIT) in obese perimenopausal and postmenopausal women.

Methods

Nineteen perimenopausal women and 21 postmenopausal women with an average age of 50.1 years participated in the 6-week HIIT intervention. Before and after the training, the accumulated oxygen deficits (mL·min−1) and anaerobic and aerobic contributions (%) were measured in all groups via repeated SCE.

Results

The results showed that, before training, the anaerobic contributions to repeated SCE did not differ between the perimenopausal and postmenopausal women for the first three repetitions. However, a higher decrease was reported for postmenopausal women at the fourth and fifth repetitions (P < 0.01, respectively). After HIIT, anaerobic contributions increased significantly in both groups (P < 0.01, respectively). Nevertheless, postmenopausal women still had significantly lower anaerobic contributions to repeated SCE compared with perimenopausal women (P < 0.01, respectively). Multiple linear regression analysis indicated that menopause status was an independent predictor of anaerobic contribution, accounting for 17%, 21%, 15%, 19%, and 22% of variations (β = 0.28, P = 0.03; β = 0.29, P = 0.04; β = 0.18, P = 0.05; β = 0.22, P = 0.05; and β = 0.33, P = 0.03 for the first to the fifth repetitions consecutively for perimenopausal vs postmenopausal groups).

Conclusions

A 6-week HIIT intervention increased the anaerobic contributions to energy in response to repeated SCE in obese perimenopausal and postmenopausal women. However, postmenopausal women had lower anaerobic contributions at the fourth and fifth repetitions mainly due to the effects of menopause.
m6A-mediated gluconeogenic enzyme PCK1 upregulation protects against hepatic ischemia-reperfusion injury
Authors: Yu Shanshan , Liu Xiao , Xu Yan , Pan Lijie , Zhang Yihan , Li Yanli , Dong Shuai , Tu Dan , Sun Yuetong , Zhang Yiwang , Zhou Zhuowei , Liang Xiaoqi , Huang Yiju , Chu Jiajie , Tu Silin , Liu Chang , Chen Huaxin , Chen Wenjie , Ge Mian , Zhang Qi
Published: December 2023

Background and Aims:

Ischemia-reperfusion (I/R) injury frequently occurs during liver surgery, representing a major reason for liver failure and graft dysfunction after operation. The metabolic shift from oxidative phosphorylation to glycolysis during ischemia increased glucose consumption and accelerated lactate production. We speculate that donor livers will initiate gluconeogenesis, the reverse process of glycolysis in theory, to convert noncarbohydrate carbon substrates (including lactate) to glucose to reduce the loss of hepatocellular energy and foster glycogen storage for use in the early postoperative period, thus improving post-transplant graft function.

Approach and Results:

By analyzing human liver specimens before and after hepatic I/R injury, we found that the rate-limiting enzyme of gluconeogenesis, PCK1, was significantly induced during liver I/R injury. Mouse models with liver I/R operation and hepatocytes treated with hypoxia/reoxygenation confirmed upregulation of PCK1 during I/R stimulation. Notably, high PCK1 level in human post-I/R liver specimens was closely correlated with better outcomes of liver transplantation. However, blocking gluconeogenesis with PCK1 inhibitor aggravated hepatic I/R injury by decreasing glucose level and deepening lactate accumulation, while overexpressing PCK1 did the opposite. Further mechanistic study showed that methyltransferase 3-mediated RNA N6-methyladinosine modification contributes to PCK1 upregulation during hepatic I/R injury, and hepatic-specific knockout of methyltransferase 3 deteriorates liver I/R injury through reducing the N6-methyladinosine deposition on PCK1 transcript and decreasing PCK1 mRNA export and expression level.

Conclusions:

Our study found that activation of the methyltransferase 3/N6-methyladinosine-PCK1-gluconeogenesis axis is required to protect against hepatic I/R injury, providing potential intervention approaches for alleviating hepatic I/R injury during liver surgery.
Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction
Authors: Barbosa Renato Correia , Lemos José Alberto
Published: December 2023

Introduction:

Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years.

Patient and Clinical Findings:

A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches.

Diagnosis, Intervention and Outcomes:

The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition.

Conclusions:

In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.
Initial results of DMEK combined with cataract surgery and implantation of the light-adjustable lens
Authors: Price David A. , Dudasko Kathleen N. , Hall Taylor A. , Price Marianne O. , Price Francis W.
Published: December 2023

Purpose:

To evaluate the use of light-adjustable intraocular lenses (LALs) to maximize visual acuity (VA) postoperatively in eyes undergoing combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery.

Setting:

Private practice, tertiary referral center.

Design:

Retrospective review of initial case series.

Methods:

Patients with Fuchs endothelial dystrophy had DMEK combined with phacoemulsification and LAL implantation. Lenses were adjusted based on postoperative manifest refraction and locked-in 3 to 6 months postoperatively. Adjustments to the LAL were started after stabilization of refraction at sequential examinations. Outcomes were uncorrected near and distance VA and manifest refraction 3 to 6 months after locking the lens.

Results:

A total of 27 eyes in 17 patients with mean age of 65 years (range 53 to 75 years) were included in this study. 6 eyes (22%) had either a near or intermediate target, and 21 eyes (78%) had a distance target. After lock-in, 57% of eyes with a distance target had uncorrected distance VA (UDVA) of 20/20 or better, 90% were 20/25 or better, and 100% were 20/40 or better. After lens lock-in, 100% of eyes had corrected distance VA (CDVA) of 20/20 or better, 86% had postoperative UDVA the same or better than preoperative CDVA, and 100% of eyes had UDVA within 1 line of the preoperative CDVA. In total, 93% of eyes were within 1 diopter (D) of spherical target, and 93% of eyes had ≤0.5 D of refractive cylinder postoperatively.

Conclusions:

Combining DMEK with LAL implantation provided significantly better UDVA and refractive outcomes than previously reported data on combined implantation of a standard monofocal lens.
Exposure to Fine Particulate Matter Increases Risk of Diabetes Mellitus
Authors: Chung Wei-Sheng , Lin Cheng-Li
Published: December 2023

Objective

This nationwide cohort study aimed to examine the association between PM2.5 and diabetes mellitus (DM) risk.

Methods

We recorded annual average PM2.5 exposure levels at participants’ locations. PM2.5 concentrations were categorized into quartiles: Q1 (<29.5 μg/m3), Q2 (29.5–33.3 μg/m3), Q3 (33.4–41.2 μg/m3), and Q4 (>41.2 μg/m3).

Results

A total of 158,038 patients (69,688 men and 88,350 women) were enrolled. Diabetes mellitus incidence increased with higher annual PM2.5 concentrations (2.81 in Q1, 3.06 in Q2, 3.65 in Q3, and 3.89 in Q4 per 10,000 person-years). After adjusting for confounders, patients exposed to PM2.5 in Q2, Q3, and Q4 had adjusted hazard ratios of 1.14 (95% CI: 1.05–1.23), 1.40 (95% CI: 1.30–1.50), and 1.42 (95% CI: 1.32–1.53), respectively, for developing DM compared with those exposed to Q1-PM2.5 concentrations.

Conclusions

This study observed an increased risk of DM associated with PM2.5 exposure.
Early identification of delayed wound healing in complex diabetic foot ulcers treated with a dermal regeneration template: A novel clinical target and its risk factors
Authors: Tai Ting-Yu , Lin Kuan-Jie , Chang Hao-Yun , Wu Yi-Chun , Huang Ching-Uen , Lin Xin-Yi , Tsai Feng-Chou , Tsai Ching-Sung , Chen Yu-Han , Wang Fu-Yu , Chang Shun-Cheng
Published: December 2023

Background:

The dermal regeneration template (DRT), a tissue-engineered skin substitute composing a permanent dermal matrix and an upper temporary silicone layer that serves as the epidermis, has demonstrated efficacy in treating uncomplicated diabetic foot ulcers (DFUs). Our institution has obtained good outcomes with DRT in patients with more complicated DFUs. Because of its chronicity, we are working to identify a clinical target that anticipates delayed healing early in the treatment in addition to determining the risk factors linked to this endpoint to increase prevention.

Materials and methods:

This retrospective single-center study analyzed patients with DFUs who underwent wound reconstruction using DRT between 2016 and 2021. The patients were categorized into poor or good graft-take groups based on their DRT status on the 21st day after the application. Their relationship with complete healing rate at day 180 was analyzed. Variables were collected for risk factors for poor graft take at day 21. Independent risk factors were identified after multivariable analysis. The causes of poor graft take were also reported.

Results:

This study examined 80 patients (38 and 42 patients in the poor and good graft-take groups, respectively). On day 180, the complete healing rate was 86.3% overall, but the poor graft-take group had a significantly lower complete healing rate (76.3% vs. 95.2%, P = 0.021) than the good graft-take group. Our analysis identified four independent risk factors: transcutaneous oxygen pressure < 30 mmHg (odds ratio, 154.14), off-loading device usage (0.03), diabetic neuropathy (6.51), and toe wound (0.20). The most frequent cause of poor graft take was infection (44.7%), followed by vascular compromise (21.1%) and hematoma (15.8%).

Conclusion:

Our study introduces the novel concept of poor graft take at day 21 associated with delayed wound healing. Four independent risk factors were identified, which allows physicians to arrange interventions to mitigate their effects or select patients more precisely. DRT represents a viable alternative to address DFUs, even in complicated wounds. A subsequent split-thickness skin graft is not always necessary to achieve complete healing.
Pancreatic ductal adenocarcinoma staging: a narrative review of radiologic techniques and advances
Authors: Chu Linda C. , Fishman Elliot K.
Published: December 2023

Radiology plays an important role in the initial diagnosis and staging of patients with pancreatic ductal adenocarcinoma (PDAC). CT is the preferred modality over MRI due to wider availability, greater consistency in image quality, and lower cost. MRI and PET/CT are usually reserved as problem-solving tools in select patients. The National Comprehensive Cancer Network (NCCN) guidelines define resectability criteria based on tumor involvement of the arteries and veins and triage patients into resectable, borderline resectable, locally advanced, and metastatic categories. Patients with resectable disease are eligible for upfront surgical resection, while patients with high-stage disease are treated with neoadjuvant chemotherapy and/or radiation therapy with hopes of downstaging the disease. The accuracy of staging critically depends on the imaging technique and the experience of the radiologists. Several challenges in accurate preoperative staging include prediction of lymph node metastases, detection of subtle liver and peritoneal metastases, and disease restaging following neoadjuvant therapy. Artificial intelligence (AI) has the potential to function as ‘second readers’ to improve upon the radiologists’ detection of small early-stage tumors, which can shift more patients toward surgical resection of potentially curable cancer. AI may also provide imaging biomarkers that can predict disease recurrence and patient survival after pancreatic resection and assist in the selection of patients most likely to benefit from surgery, thus improving patient outcomes.
Impact of intravenous dexmedetomidine on postoperative gastrointestinal function recovery: an updated meta-analysis
Authors: Lai Yi-Chen , Wang Wei-Ting , Hung Kuo-Chuan , Chen Jen-Yin , Wu Jheng-Yan , Chang Ying-Jen , Lin Chien-Ming , Chen I-Wen
Published: December 2023

Background:

Postoperative ileus (POI) is a complication that may occur after abdominal or nonabdominal surgery. Intravenous dexmedetomidine (Dex) has been reported to accelerate postoperative gastrointestinal function recovery; however, updated evidence is required to confirm its robustness.

Methods:

To identify randomized controlled trials examining the effects of perioperative intravenous Dex on gastrointestinal function recovery in patients undergoing noncardiac surgery, databases including MEDLINE, EMBASE, Google Scholar, and Cochrane Library were searched on August 2023. The primary outcome was time to first flatus. Secondary outcomes included time to oral intake and defecation as well as postoperative pain scores, postoperative nausea/vomiting (PONV), risk of hemodynamic instability, and length of hospital stay (LOS). To confirm its robustness, subgroup analyses and trial sequential analysis were performed.

Results:

The meta-analysis of 22 randomized controlled trials with 2566 patients showed that Dex significantly reduced the time to flatus [mean difference (MD):−7.19 h, P<0.00001), time to oral intake (MD: −6.44 h, P=0.001), time to defecation (MD:−13.84 h, P=0.008), LOS (MD:−1.08 days, P<0.0001), and PONV risk (risk ratio: 0.61, P<0.00001) without differences in hemodynamic stability and pain severity compared with the control group. Trial sequential analysis supported sufficient evidence favoring Dex for accelerating bowel function. Subgroup analyses confirmed the positive impact of Dex on the time to flatus across different surgical categories and sexes. However, this benefit has not been observed in studies conducted in regions outside China.

Conclusions:

Perioperative intravenous Dex may enhance postoperative gastrointestinal function recovery and reduce LOS, thereby validating its use in patients for whom postoperative ileus is a significant concern.
Cochlear Implant Outcomes: Quality of Life in Prelingually Deafened, Late-Implanted Patients
Authors: Rizkou Fatima Ezzahra , Benhoummad Othmane , Rochd Sara , Lakhdar Youssef , Rochdi Youssef , Raji Abdelaziz
Published: December 2023

Aims

Reevaluating and expanding cochlear implantation's (CI) indication while measuring the quality of life (QoL) outcomes regarding the parent's point of view of prelingually deafened, late-implanted patients, which are widely known to showcases a limited improvement in speech recognition.

Materials and Methods

A retrospective descriptive and analytic study to assess QoL outcomes from CI in 64 early deafened, late-implanted patients, according to their parent's perspective, between January 2009 and December 2019, using the Nottingham Pediatric Cochlear Implant Program (Nottingham University Hospital, Nottingham, United Kingdom) “Children with cochlear implantation: parents perspective.”

Results

The most represented age interval is the 5 and 7 interval and the mean age is 10.09 years. There was no sex predominance, with rural origin and high school academicals level preponderance. Fourteen children had experienced neonatal icterus, eight had meningitis, and seven were the result of related marriage. The age of the first consultation was typically over 2 years old, with only 45 schooled children. Age had a significantly statistic correlation between Self-reliance and Well-being and happiness subscales. History of receiving aid and speech therapy has a clear correlation with Self-reliance, Well-being and happiness, and Communication and Education. Schooling statuses, sex, age of appearance, and communication mode were not correlated to any subscale score, and with the exception of Effect of implantation, all the other “Children with cochlear implantation: parent's perspective” subscales were intercorrelated.

Conclusion

Properly validated QoL assessments for CI are a must, as outcomes of CI expand beyond audiometric performances to include the improvement of QoL.
Identifying Tumor Microenvironment Biomarkers in Adherent and Cystic Vestibular Schwannomas
Authors: Zhang Lisa , Kuo Hsuan-Chih , Duhon Bailey H. , Adunka Oliver F. , Dodson Edward E. , Hardesty Douglas A. , Prevedello Daniel M. , Otero Jose J. , Ren Yin
Published: December 2023

Objective

A subset of vestibular schwannomas (VSs), including cystic tumors, have higher postoperative morbidity because of the presence of adhesions between the tumor, facial nerve (FN), and brainstem. We identify tumor microenvironment (TME) biomarkers to better classify these tumors and predict the degree of tumor adherence.

Study Design

Retrospective case series.

Setting

Tertiary skull base referral center.

Methods

Adult patients with cystic and solid VS matched in tumor size who underwent surgical resection were included. Expressions of seven biomarkers of extracellular matrix remodeling and tumor immune response were quantified via immunohistochemistry. The distribution of CD45+ immune cells was evaluated in intratumoral and perivascular compartments. The degree of tumor adherence was categorized as none, adherent to FN, or adherent to both FN and brainstem.

Results

Twenty-eight patients were included. Cystic VSs were significantly more adherent than solid VSs (p = 0.02). Patients with adherent VS had shorter duration of symptoms and were more likely to undergo subtotal resection. In solid tumors, matrix metalloproteinase (MMP)-2 expression (p = 0.02) and CD163+ macrophage infiltration (p = 0.007) were correlated with tumor size. Linear discriminant analyses (LDAs) demonstrated MMP-2, MMP-14, CD80, CD163, and perivascular CD45 to be individually predictive of the degree of tumor adherence (all p < 0.05), with perivascular CD45 being the best independent predictor (p = 0.005). An LDA model including these biomarkers demonstrated 100% accurate discrimination of all three levels of tumor adherence (p = 0.04).

Conclusions

Adherent VS have a distinct proinflammatory TME characterized by elevated MMP expression, enrichment of tumor-associated macrophages, and perivascular immune cell infiltration.
Setting positive end-expiratory pressure: role in diaphragm-protective ventilation
Authors: Wennen Myrte , Claassen Wout , Heunks Leo
Published: December 2023

Purpose of review

With mechanical ventilation, positive end-expiratory pressure (PEEP) is applied to improve oxygenation and lung homogeneity. However, PEEP setting has been hypothesized to contribute to critical illness associated diaphragm dysfunction via several mechanisms. Here, we discuss the impact of PEEP on diaphragm function, activity and geometry.

Recent findings

PEEP affects diaphragm geometry: it induces a caudal movement of the diaphragm dome and shortening of the zone of apposition. This results in reduced diaphragm neuromechanical efficiency. After prolonged PEEP application, the zone of apposition adapts by reducing muscle fiber length, so-called longitudinal muscle atrophy. When PEEP is withdrawn, for instance during a spontaneous breathing trial, the shortened diaphragm muscle fibers may over-stretch which may lead to (additional) diaphragm myotrauma. Furthermore, PEEP may either increase or decrease respiratory drive and resulting respiratory effort, probably depending on lung recruitability. Finally, the level of PEEP can also influence diaphragm activity in the expiratory phase, which may be an additional mechanism for diaphragm myotrauma.

Setting PEEP could play an important role in both lung and diaphragm protective ventilation. Both high and low PEEP levels could potentially introduce or exacerbate diaphragm myotrauma. Today, the impact of PEEP setting on diaphragm structure and function is in its infancy, and clinical implications are largely unknown.
Setting positive end-expiratory pressure: using the pressure-volume curve
Authors: Mojoli Francesco , Pozzi Marco , Arisi Eric
Published: December 2023

Purpose of review

To discuss the role of pressure–volume curve (PV curve) in exploring elastic properties of the respiratory system and setting mechanical ventilator to reduce ventilator-induced lung injury.

Recent findings

Nowadays, quasi-static PV curves and loops can be easily obtained and analyzed at the bedside without disconnection of the patient from the ventilator. It is shown that this tool can provide useful information to optimize ventilator setting. For example, PV curves can assess for patient's individual potential for lung recruitability and also evaluate the risk for lung injury of the ongoing mechanical ventilation setting.

In conclusion, PV curve is an easily available bedside tool: its correct interpretation can be extremely valuable to enlighten potential for lung recruitability and select a high or low positive end-expiratory pressure (PEEP) strategy. Furthermore, recent studies have shown that PV curve can play a significant role in PEEP and driving pressure fine tuning: clinical studies are needed to prove whether this technique will improve outcome.
The Efficacy and Safety of Regimens for Helicobacter pylori Eradication Treatment in China
Authors: Li Jing , Shi Huiying , Zhou Fang , Xie Li , Lin Rong
Published: December 2023

Background:

With Helicobacter pylori’s increasing antibiotic resistance, evidence of more effective treatments is lacking in China, where H. pylori prevalence is nearly 50%. Thus, we performed a network meta-analysis to compare therapeutic regimens.

Methods:

Data extracted from eligible randomized controlled trials from January 2000 to September 2021 were entered into a Bayesian hierarchical random-effects model to evaluate the efficacy and safety of H. pylori eradication regimens.

Results:

This study included 101 trials involving 21,745 patients. Vonoprazan-bismuth–containing quadruple therapy (VBQT) ranked the highest [surfaces under cumulative ranking curve (SUCRA), 83.64%], followed by high-dose amoxicillin dual therapy (HDDT) [SUCRA, 79.70%, odds ratio (OR)=1.31, 95% credible interval (CrI) (0.36, 4.72)] and proton pump inhibitor-based bismuth-containing quadruple therapy (BQT) [SUCRA, 63.59%, OR=1.59, 95% CrI (0.48, 5.24)]. HDDT [OR=2.47, 95% CrI (1.51, 4.06)], BQT [OR=2.04, 95% CrI (1.69, 2.47)], concomitant quadruple nonbismuth therapy (CT) [OR=1.93, 95% CrI (1.19, 3.15)], and sequential therapy (ST) [OR=1.86, 95% CrI (1.50, 2.32)] had higher eradication rates than standard triple therapy (TT). ST (SUCRA, 82.52%) and VBQT (SUCRA, 83.89%) had the highest eradication rate before and after 2010 in the effectiveness ranking, respectively. Furthermore, the H. pylori eradication rate of patients receiving 14-day BQT treatment was higher than that of 10-day BQT regimen [OR=2.55, 95% CI (1.84, 3.53)] and 7-day BQT regimen [OR=3.64, 95% CI (2.64, 5.01)].

Conclusions:

The TT regimen was not an optimal choice in China for H. pylori eradication; VBQT, HDDT, and BQT showed better efficacy. After 2010, there is a trend toward significance that VBQT provided a higher H. pylori eradication rate in China, but with only 1 randomized controlled trial. Thus, more supportive real-world data are needed to confirm its effectiveness.
Tailoring and Evaluating Treatment with the Patient-Specific Needs Evaluation: A Patient-Centered Approach
Authors: de Ridder Willemijn A. , van Kooij Yara E. , Slijper Harm P. , Arends Grada R. , de Roode Aaltje , MacDermid Joy C. , Vermeulen Guus M. , Hovius Steven E.R. , Selles Ruud W. ,   Hand-Wrist Study Group, Wouters Robbert M.
Published: December 2023

Background:

No patient-reported instrument assesses patient-specific information needs, treatment goals, and personal meaningful gain (PMG), a novel construct evaluating individualized, clinically relevant improvement. This study reports the development of the Patient-Specific Needs Evaluation (PSN) and examines its discriminative validity (ie, its ability to distinguish satisfied from dissatisfied patients) and test-retest reliability in patients with hand or wrist conditions.

Methods:

A mixed-methods approach was used to develop and validate the PSN, following Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines, including pilot testing, a survey (pilot, n = 223; final PSN, n = 275), cognitive debriefing (n = 16), expert input, and validation. Discriminative validity was assessed by comparing the satisfaction level of patients who did and did not achieve their PMG (n = 1985) and test-retest reliability using absolute agreement, the Cohen kappa, and intraclass correlation coefficients (n = 102). The authors used a sample of 2860 patients to describe responses to the final PSN.

Results:

The PSN has only 5 questions (completion time, ±3 minutes) and is freely accessible online. The items and response options were considered understandable by 90% to 92% of the end-users and complete by 84% to 89%. The PSN had excellent discriminative validity (Cramer V, 0.48; P < 0.001) and moderate to high test-retest reliability (kappa, 0.46 to 0.68; intraclass correlation coefficients, 0.53 to 0.73).

Conclusions:

The PSN is a freely available, patient-centered decision support tool that helps clinicians tailor their consultations to patients’ individual needs and goals. It contains the PMG, a novel construct evaluating individualized, clinically relevant treatment outcomes. The PSN may function as a conversation starter, facilitate expectation management, and aid shared decision-making. The PSN is implementation-ready and can be readily adapted to other patient populations.
Cortiva versus AlloDerm in Prepectoral and Partial Submuscular Implant-Based Breast Reconstruction: A Randomized Clinical Trial
Authors: Keane Alexandra M. , Chiang Sarah N. , Tao Yu , Pierce Andrew , Gagne Jason , Margenthaler Julie A. , Tenenbaum Marissa M. , Myckatyn Terence M.
Published: December 2023

Background:

Several acellular dermal matrices (ADMs) are used for soft-tissue support in prosthetic breast reconstruction. Little high-level evidence supports the use of one ADM over another. The authors sought to compare Cortiva 1-mm Allograft Dermis with AlloDerm RTU (ready to use), the most studied ADM in the literature.

Methods:

A single-blinded randomized controlled trial comparing Cortiva with AlloDerm in prepectoral and subpectoral immediate prosthetic breast reconstruction was performed at 2 academic hospitals from March of 2017 to December of 2021. Reconstructions were direct to implant (DTI) or tissue expander (TE). Primary outcome was reconstructive failure, defined as TE explantation before planned further reconstruction, or explantation of DTI reconstructions before 3 months postoperatively. Secondary outcomes were additional complications, patient-reported outcomes (PROs), and cost.

Results:

There were 302 patients included: 151 AlloDerm (280 breasts), 151 Cortiva (277 breasts). The majority of reconstructions in both cohorts consisted of TE (62% versus 38% DTI), smooth device (68% versus 32% textured), and prepectoral (80% versus 20% subpectoral). Reconstructive failure was no different between ADMs (AlloDerm 9.3% versus Cortiva 8.3%; P = 0.68). There were no additional differences in any complications or PROs between ADMs. Seromas occurred in 7.6% of Cortiva but 12% of AlloDerm cases, in which the odds of seroma formation were two-fold higher (odds ratio, 1.93 [95% CI, 1.01 to 3.67]; P = 0.047). AlloDerm variable cost was 10% to 15% more than Cortiva, and there were no additional cost differences.

Conclusion:

When assessing safety, clinical performance, PROs, and cost, Cortiva is noninferior to AlloDerm in immediate prosthetic breast reconstruction, and may be less expensive, with lower risk of seroma formation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Magnetic Resonance Imaging Features for Differentiating Low-Grade and High-Grade Malignant Peripheral Nerve Sheath Tumors
Authors: Yamada Nao , Kato Hiroki , Kawaguchi Masaya , Suzui Natsuko , Miyazaki Tatsuhiko , Nagano Akihito , Noda Yoshifumi , Hyodo Fuminori , Matsuo Masayuki
Published: December 2023

Objective

This study aimed to assess the usefulness of magnetic resonance imaging (MRI) findings for differentiating low-grade and high-grade malignant peripheral nerve sheath tumors (MPNSTs).

Methods

This study included 31 patients (onset age range, 19–83 years; mean onset age, 57 years; 9 men and 22 women) with 36 histopathologically proven MPNSTs (7 low-grade MPNSTs and 29 high-grade MPNSTs) who underwent preoperative MRI between December 2007 and October 2022. Quantitative and qualitative MRI findings were retrospectively evaluated and compared between the 2 subtypes.

Results

The maximum tumor diameter (106.1 ± 64.0 vs 54.9 ± 19.8 mm, P = 0.032) and tumor-to-muscle signal intensity ratio (SIR) of fat-suppressed gadolinium-enhanced T1-weighted images (2.69 ± 1.40 vs 1.62 ± 0.40, P = 0.005) were significantly higher in high-grade MPNSTs than in low-grade MPNSTs. The receiver operating characteristic analysis revealed that the tumor-to-muscle SIR of fat-suppressed gadolinium-enhanced T1-weighted images exhibited the highest area under the curve value (0.88), followed by the maximum tumor diameter (0.76). The sensitivity and specificity of the tumor-to-muscle SIR of fat-suppressed gadolinium-enhanced T1-weighted images for diagnosing high-grade MPNST at an optimal SIR threshold of greater than 1.73 were 90% and 83%, respectively. However, other MRI findings showed no significant differences between the 2 subtypes (P = 0.16–1.00).

Conclusions

Although the MRI findings of low-grade and high-grade MPNST overlapped considerably, the maximum tumor diameter and degree of contrast enhancement can be used to differentiate low-grade MPNST from high-grade MPNST.
The PRIMARY Score
Authors: Guo Shikuan , Kang Fei , Ma Shuaijun , Jiao Jianhua , Ren Jing , Wang Jing , Zhang Jingliang , Qin Weijun
Published: December 2023

Purpose

Multiparametric MRI is the current standard for detecting clinically significant prostate cancer (csPCa). However, men with negative or equivocal MRI often undergo unnecessary biopsies due to concerns about false-negative results. The recently proposed 68Ga-PSMA PET/CT-based PRIMARY score exhibited good diagnostic performance for csPCa. This study aimed to externally validate the performance of the PRIMARY score and evaluate its added diagnostic value to MRI triage in detecting csPCa.

Patients and Methods

This retrospective cohort study included 431 men who underwent both 68Ga-PSMA PET/CT and MRI before biopsy. Performance was assessed using the area under the receiver operating characteristic curve and the decision curve analysis. The PRIMARY score + MRI was considered positive for either PRIMARY score 3–5 or Prostate Imaging Reporting and Data System (PI-RADS) 4/5.

Results

The prevalence of csPCa was 51.7% (223/431). The area under the receiver operating characteristic curve of the 5-level PRIMARY score for csPCa was significantly higher than that of MRI (0.873 vs 0.786, P < 0.001). For the entire group, sensitivity, specificity, positive predictive value, and negative predictive value of the PRIMARY score were 90.6%, 61.1%, 71.4%, and 85.8%, respectively, which outperformed 87.9%, 49.0%, 64.9%, and 79.1% of PI-RADS on MRI. The PRIAMRY score + MRI improved sensitivity (96.0% vs 87.9%, P < 0.001) and negative predictive value (91.5% vs 79.1%, P < 0.001) without compromising specificity and positive predictive value compared with MRI alone. This combined approach avoided 24.6% (106/431) of unnecessary biopsies, while missing 4.0% (9/223) of csPCa cases. The addition of the PRIMARY score in men with PI-RADS 1–3 showed a net benefit, but not in men with PI-RADS 4/5.

Conclusions

The PRIMARY score was superior to MRI in detecting csPCa, and its added diagnostic value was in men with negative or equivocal MRI results. The PRIMARY score + MRI improved negative predictive value and sensitivity for csPCa compared with MRI alone. Further prospective trials will validate whether men with clinical suspicion of csPCa but negative PRIMARY score + MRI can safely avoid unnecessary biopsies.
Cognitive Symptom Awareness Among Patients With Multiple Sclerosis Using a Mobile Application
Authors: Miller Dena , Okai Annette , Scott Kathleen , Reynolds Staci S.
Published: December 2023

Purpose

Cognitive impairment is a common complication in persons with multiple sclerosis (MS). Using a mobile application has been shown to improve patient’s awareness of cognitive symptoms. The purpose of this quality improvement project was to improve awareness of cognitive symptoms in adult patients with MS using a mobile application.

Design

A pre/post-implementation quality improvement design was used.

Methods

Patients were instructed to download the application MS Care Connect. Patients completed a pre/post-questionnaire regarding their awareness of cognitive symptoms and if they were likely to discuss symptoms with providers. They were instructed to use the application to rate the severity of their cognitive symptoms at least weekly.

Results

Thirty-two patients completed both pre- and post-implementation questionnaires. No significant change in awareness of cognitive symptoms was found; however, patients were more likely to discuss cognitive changes with their healthcare team. In the 18 patients who used the application, a total of 60 cognitive symptom ratings were reported.

Clinical Relevance to the Practice of Rehabilitation Nursing

Nurses may recommend use of a mobile application for patients to track their cognitive symptoms; however, further research is needed.

Conclusion

This project showed that adding a mobile application did not change awareness of patients’ cognitive symptoms.
Trajectory Analysis of Healthcare Utilization Before and After Major Surgery
Authors: Tarnasky Aaron , Ludwig Justin , Bilderback Andrew , Yoder Don , Schuster James , Kogan Jane , Hall Daniel
Published: December 2023

Objective:

To characterize patterns of healthcare utilization before and after surgery and determine any association with pre-operative frailty.

Summary Background Data:

Frail patients experience worse post-operative outcomes and increased costs during the surgical encounter. Evidence is comparatively lacking for longer-term effects of frailty on post-operative healthcare utilization.

Methods:

Retrospective, longitudinal cohort analysis of adult patients undergoing any elective surgical procedure following pre-operative frailty assessment with the Risk Analysis Index (RAI) from 02/2016-12/2020 at a large integrated healthcare delivery and financing system. Group-based trajectory modeling of claims data estimated distinct clusters of patients with discrete utilization trajectories. Multivariable regression predicted membership in trajectories of interest using preoperative characteristics, including frailty.

Results:

Among 29,067 surgical encounters, four distinct utilization trajectories emerged in longitudinal data from the 12 months before and after surgery. All cases exhibited a surge in utilization during the surgical month, after which most patients returned to “low” [25,473 (87.6%)], “medium” [1,403 (4.8%)], or “high” [528 (1.8%)] baseline utilization states established before surgery. The fourth trajectory identified 1,663 (5.7%) cases where surgery occasioned a transition from “low” utilization before surgery to “high” utilization afterward. RAI score alone did not effectively predict membership in this transition group, but a multivariable model with other preoperative variables was effective (c=0.859, max re-scaled R-squared 0.264).

Conclusions and Relevance:

Surgery occasions the transition from low to high healthcare utilization for a substantial subgroup of surgical patients. Multivariable modeling may effectively discriminate this utilization trajectory, suggesting an opportunity to tailor care processes for these patients.
Drug-Coated Balloon Versus Drug-Eluting Stent for Treating De Novo Large Vessel Coronary Artery Disease: A Systematic Review and Meta-Analysis of 13 Studies Involving 2,888 Patients
Authors: Caminiti Rodolfo , Vizzari Giampiero , Ielasi Alfonso , Vetta Giampaolo , Parlavecchio Antonio , Della Rocca Domenico Giovanni , Montonati Carolina , Pellegrini Dario , Pellicano Mariano , Tespili Maurizio , Micari Antonio
Published: December 2023

Introduction

Drug-coated balloon (DCB) is an established treatment option for in-stent restenosis and small vessel, de novo, coronary artery disease (CAD). Although the use of this tool is increasing in everyday practice, little is known about its performance in the treatment of de novo, large vessel CAD (LV-CAD). A systematic review and meta-analysis were conducted to evaluate the efficacy and safety of DCB versus drug-eluting stent (DES) in this setting.

Methods

A comprehensive literature search was performed including Medline, Embase and Cochrane electronic databases up to October 24th2023, for studies which compared efficacy and safety of DCB versus DES in the treatment of de novo lesions in large vessels (≥ 2.5 mm), reporting at least one clinical outcome of interest (PROSPERO ID: CRD42023470417). The outcomes analysed were cardiovascular death (CVD), myocardial infarction (MI), target lesion revascularization (TLR), all cause death (ACD) and late lumen loss (LLL) at follow-up. The effect size was estimated using a random-effect model as risk ratio (RR) and mean difference (MD) and relative 95% confidence interval (CI).

Results

A total of 13 studies (6 randomized controlled trials and 7 observational studies) involving 2,888 patients (DCB n=1,334; DES n=1,533) with de novo LV-CAD were included in this meta-analysis following our inclusion criteria. A DCB-only strategy was non inferior to percutaneous coronary intervention (PCI) with DES in terms of CVD (RR 0.49; 95% CI [0.23 - 1.03]; p=0.06), MI (RR 0.48; 95% CI [0.16 - 1.45]; p=0.89), TLR (RR 0.73; 95% CI [0.40 - 1.34]; p=0.32), ACD (RR 0.78; 95% CI [0.57 - 1.07]; p=0.12) and LLL (MD −0.14; 95% CI [−0.30 - 0.02]; p=0.18) at follow-up.

Conclusion

Our meta-analysis showed that DCB PCI might provide a promising option for the management of selected, de novo LV-CAD compared to DES. However, more focused RCTs are needed to further prove the benefits of a “metal free” strategy in this subset of CAD.
Molecular Characterization of the Sea Lamprey Retina Illuminates the Evolutionary Origin of Retinal Cell Types
Authors: Wang Junqiang , Zhang Lin , Cavallini Martina , Pahlevan Ali , Sun Junwei , Morshedian Ala , Fain Gordon L. , Sampath Alapakkam P. , Peng Yi-Rong
Published: December 2023

The lamprey, a primitive jawless vertebrate whose ancestors diverged from all other vertebrates over 500 million years ago, offers a unique window into the primordial formation of the retina. Using single-cell RNA-sequencing, we characterized retinal cell types in lamprey and compared their molecular differentiation and regulatory networks with those in mouse and other jawed vertebrates. Our analysis revealed six cell classes and 74 distinct cell types. We discovered multiple conserved cell types shared between jawless and jawed lineages, including notably rods and cones, ON and OFF bipolar cells, and starburst amacrine cells. The conservation of these cell types indicates their emergence early in vertebrate evolution, highlighting the primal designs of retinal circuits for the rod pathway, ON-OFF discrimination, and direction selectivity. In contrast to this evidence for conservation, the pathways of diversification for amacrine cells and retinal ganglion cells appear to have distinctly diverged between the two lineages. Furthermore, we inferred master regulators in specifying retinal cell classes in both lamprey and macaque and identified common regulatory elements across species, underscoring the ancestral nature of the molecular origins governing retinal cell classes. Altogether, our characterization of the lamprey retina illuminates the evolutionary origin of visual processing in the retina.
Transcriptional complexity in the insect central complex: single nuclei RNA-sequencing of adult brain neurons derived from type 2 neuroblasts
Authors: Epiney Derek , Morales Chaya Gonzalo N , Dillon Noah R , Lai Sen-Lin , Doe Chris Q.
Published: December 2023

In both invertebrates such asDrosophilaand vertebrates such as mouse or human, the brain contains the most diverse population of cell types of any tissue. It is generally accepted that transcriptional diversity is an early step in generating neuronal and glial diversity, followed by the establishment of a unique gene expression profile that determines morphology, connectivity, and function. InDrosophila, there are two types of neural stem cells, called Type 1 (T1) and Type 2 (T2) neuroblasts. In contrast to T1 neuroblasts, T2 neuroblasts generate intermediate neural progenitors (INPs) that expand the number and diversity of cell types. The diversity of T2-derived neurons contributes a large portion of the central complex (CX), a conserved brain region that plays a role in sensorimotor integration. Recent work has revealed much of the connectome of the CX, but how this connectome is assembled remains unclear. Mapping the transcriptional diversity of neurons derived from T2 neuroblasts is a necessary step in linking transcriptional profile to the assembly of the adult brain. Here we perform single nuclei RNA sequencing of T2 neuroblast-derived adult neurons and glia. We identify clusters containing all known classes of glia, clusters that are male/female enriched, and 161 neuron-specific clusters. We map neurotransmitter and neuropeptide expression and identify unique transcription factor combinatorial codes for each cluster (presumptive neuron subtype). This is a necessary step that directs functional studies to determine whether each transcription factor combinatorial code specifies a distinct neuron type within the CX. We map several columnar neuron subtypes to distinct clusters and identify two neuronal classes (NPF+ and AstA+) that both map to two closely related clusters. Our data support the hypothesis that each transcriptional cluster represents one or a few closely related neuron subtypes.