bluuebunny/crossref_metadata_2025 huggingface dataset:
Violence against Women—The Case of Divorced Palestinian-Arab women in Israel
Authors: Meler Tal
Published: March 2023

Focusing on divorced Palestinian-Arab women in Israel, this study aims to provide a nuanced examination of the different types of violence (physical, mental, and economic) these women experience from their ex-partners or relatives. The study emphasizes the presence in extreme cases of ex-partner violence ending in murder, recontextualizing crimes associated with so-called honor or tradition. The findings are based on interviews with thirty-five divorced women. The study also relies on a secondary analysis of data extrapolated from media surveillance. The findings indicate that a supportive institutional network is necessary to serve as a protective shield for women from minority communities who remain vulnerable when legislation and policy is detached from their civic status and their cultural context.
Deep learning based landmark detection for measuring hock and knee angles in sows
Authors: Jeon Ryan L , Peschel Joshua M , Ramirez Brett C , Stock Joseph D , Stalder Kenneth J
Published: March 2023

This paper presents a visual deep learning approach to automatically determine hock and knee angles from sow images. Lameness is the second largest reason for culling of breeding herd females and relies on human observers to provide visual scoring for detection which can be slow, subjective, and inconsistent. A deep learning model classified and detected ten and two key body landmarks from the side and rear profile images, respectively (mean average precision = 0.94). Trigonometric-based formulae were derived to calculate hock and knee angles using the features extracted from the imagery. Automated angle measurements were compared with manual results from each image (average root mean square error [RMSE] = 4.13°), where all correlation slopes (average R2 = 0.84) were statistically different from zero (P < 0.05); all automated measurements were in statistical agreement with manually collected measurements using the Bland–Altman procedure. This approach will be of interest to animal geneticists, scientists, and practitioners for obtaining objective angle measurements that can be factored into gilt replacement criteria to optimize sow breeding units.
A Novel Movement-Evoked Pain Provocation Test for Older Adults With Persistent Low Back Pain
Authors: Simon Corey B. , Hicks Gregory E. , Pieper Carl F. , Byers Kraus Virginia , Keefe Francis J. , Colón-Emeric Cathleen
Published: March 2023

Objectives:

Low back pain (LBP) is highly prevalent and disabling for older adults. Movement-evoked pain is an emerging measure that may help to predict disability; but is not currently a part of geriatric LBP clinical care. This study tested the safety and feasibility of a new Movement-Evoked Provocation Test for Low Back Pain in Older Adults (MEPLO). We also compared associations between movement-evoked pain via 2 different scoring methods and disability-associated outcomes.

Materials and Methods:

Thirty-nine older adults with persistent LBP provided baseline recalled and resting pain ratings, self-reported physical function, and usual gait speed. Participants then completed MEPLO, involving 4 tasks essential for functional independence: chair rises, trunk rotation, reaching, and walking. Movement-evoked pain was then quantified using the traditional change score (delta) method of pain premovement to postmovement; and also, a new aggregate method that combines pain ratings after the 4 tasks.

Results:

No safety or feasibility issues were identified. Compared with the delta score, the aggregate score was more strongly associated with self-reported physical function (beta: −0.495 vs. −0.090) and usual gait speed (beta: −0.450 vs. −0.053). Similarly, the aggregate score was more strongly associated with self-reported physical function than recalled and resting pain (beta: −0.470, −0.283, and 0.136, respectively).

Discussion:

This study shows the safety and feasibility of testing movement-evoked pain in older adults with persistent LBP, and its potential superiority to traditional pain measures. Future studies must validate these findings and test the extent to which MEPLO is implementable to change with geriatric LBP standard of care.
Surgical course of lateral femoral cutaneous nerve during anterior exposure of paediatric hips: an observational study
Authors: Gupta Anand Kumar , Gupta Sumit , Kanojia Rajesh K. , Nirala Ravikant , Sharma Durgesh , Kulshrestha Sanyam
Published: March 2023

Anterior approach to the hip joint is commonly used for paediatric hip disorders. Lateral femoral cutaneous nerve (LFCN) is always exposed and dissected in this approach before deep dissection is carried out. The course of this nerve has been described in adults but there is a lack of literature regarding this in the paediatric age group. This study aimed to find the surgical anatomy of LFCN in children during the anterior approach to the hip. A total of 51 paediatric hip surgeries were done in 45 children for various hip disorders. The anterior exposure was done by the Somerville approach (Bikini incision). During surgical exposure, LFCN was exposed and its relationship to Anterior Superior Iliac Spine (ASIS), inguinal ligament and sartorius muscle was observed. In most of the cases (45/51) it was found as a single trunk below the inguinal ligament and medial to the ASIS. In one hip, multiple branches of the nerve were found just below the inguinal ligament. In four hip exposures, the nerve was not found in the surgical field and in one case nerve was accidentally cut during surgery as it was lying adherent to ASIS. There was no significant correlation between the observational parameters of the nerve with anthropometric variables. Nerve was mostly seen in area 5–25 mm medial to ASIS and 10–50 mm below the ASIS in 80% of our surgical exposures where the nerve was isolated. We observed that once LFCN is dissected, the injury during further surgical procedures can be prevented.
Percutaneous K-wire reduction and cast immobilization for severely displaced radial neck fractures in children
Authors: Zhang Fuyong , Zhao Tantan , Liu Ya , Dai Jin , Liu Yao , Liu Wendong , Wang Xiaodong , Zhen Yunfang
Published: March 2023

The purpose of this study was to compare outcomes between percutaneous K-wire reduction cast immobilization (PKRC) and percutaneous K-wire reduction elastic intramedullary nailing combined with cast immobilization (PKRNC) for the treatment of radial neck fractures in children. This was a retrospective analysis of 62 radial neck fractures in children treated with PKRC or PKRNC. Thirty-one children were treated with percutaneous K-wire reduction, K-wire removal after reduction, and cast immobilization while 31 radial neck fractures in controls were managed using PKRNC. There were no significant differences between PKRC and PKRNC with regard to preoperative angulation (P = 0.556). The operation time in the PKRC group was significantly shorter than that of the PKRNC group (P = 0.023). There was no significant difference in the displacement angle when compared between the two groups on the first day and 1 month after surgery (P = 0.617, 0.72). The Mayo elbow performance score of the elbow joint function did not differ significantly between the two groups (P = 0.587). Although the hospital stay was no significantly different between groups (4.81 ± 1.07 vs. 4.16 ± 1.59 days; P = 0.067), the PKRNC group required a second hospitalization to remove the elastic intramedullary nail 3 months after the operation. PKRC and PKRNC both achieved satisfactory outcomes for radial neck fractures in children. The operation time in the PKRC group was significantly lower than in the PKRNC group. PKRC does not require reoperation to remove internal fixation. Therefore, PKRC is recommended for radial neck fractures in children.
Comparison of Different Bone Age Methods and Chronological Age in Prediction of Remaining Growth Around the Knee
Authors: Breen Anne Berg , Steen Harald , Pripp Are , Hvid Ivan , Horn Joachim
Published: March 2023

Background:

Bone age (BA) has been shown to be superior to chronological age (CA) when predicting remaining growth. However, it is not known whether the calculations are more accurate when BA is assessed by the Greulich and Pyle (GP) or the Sauvegrain (SG) methods. The aim of our study was to identify the method which gives an estimate closest to actual growth in the lower extremities.

Methods:

Leg length radiographs, hand radiographs, and elbow radiographs were simultaneously obtained during the adolescent growth spurt (10 to 16 years) in 52 children treated for LLD, with radiographic follow-up of segmental length (femur, tibia, and foot) until skeletal maturity, were randomly selected from a local institutional register. BA, according to GP and SG, were manually rated, and BA based on the GP method was additionally assessed by the automated BoneXpert (BX) method. The remaining growth was calculated based on the White-Menelaus method for both BA methods (GP, SG), the combination of the 2 methods, GP by BX, CA, and the combination of CA and GP by BX. Estimated growth was compared with the actual growth in the distal femur and proximal tibia from the time of BA determination until skeletal maturity.

Results:

For all included methods, the average calculated remaining growth was higher compared with the actual growth. The mean absolute difference between calculated remaining growth and actual growth in the femur and tibia was lowest using GP by BX [0.66 cm (SD 0.51 cm) and 0.43 cm (SD 0.34 cm)] and highest using CA [1.02 (SD 0.72) and 0.67 (SD 0.46)]. It was a significant association between calculated growth and the difference between actual and calculated growth for the SG method (P=<0.001).

Conclusion:

During the adolescent growth spurt, the GP method compared with the SG method and CA gives the most accurate estimate of remaining growth around the knee according to our results.

Clinical relevance:

In calculations of remaining growth around the knee, BA assessment by the GP atlas or BX method should be used as the parameter of biological maturity.
Superior Antihelix Composite Graft for Repair of Nasal Ala and Lateral Nasal Tip Defects: A Retrospective Case Series
Authors: Riopelle Alexandria M. , Jeong Daehee , Kaliszewski Samantha L. , Bald Madeline P. , Schanbacher Carl F.
Published: March 2023

BACKGROUND

Deep defects on the nasal ala and lateral nasal tip may result in nasal valve insufficiency or alar notching and are often repaired with a 2-stage reconstruction. Previous literature has demonstrated high failure rates of composite grafts.

OBJECTIVE

Identify survival rates and cosmetic outcomes of nasal composite grafts harvested from the antihelix.

METHODS

A retrospective review of 52 patients who underwent ala or lateral nasal tip composite graft repair from April 2019 through May 2022, with statistical analysis of cosmetic outcomes graded by 2 surgeons.

RESULTS

Defect size ranged from 0.7 cm × 0.8 cm to 1.9 cm × 2.5 cm. 48 grafts survived (92.3% survival rate). Four patients sustained at least partial integument sloughing (epidermal necrosis), but the cartilage survived in all 52 cases. Overall, aesthetic results yielded the following: excellent (19.5%), very good (35.5%), good (11.5%), decent (16.5%), and poor (6%). In 93% of cases, there was no evidence of nasal collapse or retraction. Two patients (3.8%) required surgical revision. Donor site morbidity was low.

CONCLUSION

The antihelical composite skin graft is a 1-step reliable repair option for ala and lateral nasal tip defects with an acceptable cosmetic outcome.
Comparing Two-way Fixed Effects and New Estimators for Difference-in-Differences: A Simulation Study and Empirical Example
Authors: Goin Dana E. , Riddell Corinne A.
Published: March 2023

Background:

Two-way fixed effects methods have been used to estimate effects of policies adopted in different places over time, but they can provide misleading results when effects are heterogeneous or dynamic, and alternate methods have been proposed.

Methods:

We compared methods for estimating the average treatment effect on the treated (ATT) under staggered adoption of policies, including two-way fixed effects, group-time ATT, cohort ATT, and target-trial approaches. We applied each method to assess the impact of Medicaid expansion on preterm birth using the National Center for Health Statistics’ birth records. We compared each estimator’s performance in a simulation parameterized to mimic the empirical example. We generated constant, heterogeneous, and dynamic effects and calculated bias, mean squared error, and confidence interval coverage of each estimator across 1000 iterations.

Results:

Two-way fixed effects estimated that Medicaid expansion increased the risk of preterm birth (risk difference [RD], 0.12; 95% CI = 0.02, 0.22), while the group-time ATT, cohort ATT, and target-trial approaches estimated protective or null effects (group-time RD, −0.16; 95% CI = −0.58, 0.26; cohort RD, −0.02; 95% CI = −0.46, 0.41; target trial RD, −0.16; 95% CI = −0.59, 0.26). In simulations, two-way fixed effects performed well when treatment effects were constant and less well under heterogeneous and dynamic effects.

Conclusions:

We demonstrated why new approaches perform better than two-way fixed effects when treatment effects are heterogeneous or dynamic under a staggered policy adoption design, and created simulation and analysis code to promote understanding and wider use of these methods in the epidemiologic literature.
Composite dietary antioxidant intake and osteoporosis likelihood in premenopausal and postmenopausal women: a population-based study in the United States
Authors: Zhang Ruyi , Ni Zemin , Wei Muhong , Cui Yuan , Zhou Haolong , Di Dongsheng , Wang Qi
Published: March 2023

Objective

Osteoporosis is a skeletal disease characterized by low bone mass, reduced bone strength, and increased fracture risk. We aimed to investigate the association between combined dietary antioxidant intake and the likelihood of osteoporosis in premenopausal and postmenopausal women, based on data from the National Health and Nutrition Examination Survey.

Methods

Nutrient intake data were obtained using two 24-hour recalls. Composite dietary antioxidant index (CDAI), which refers to the intake amounts of β-carotene, vitamin A, vitamin C, vitamin E, selenium, zinc, copper, and iron, was then constructed. Prevalent osteoporosis was defined according to bone mineral density T scores of ≤ −2.5 and self-reports. Multiple logistic and Poisson regression models were used for association analyses.

Results

A total of 3,418 participants (1,157 premenopausal and 2,261 postmenopausal women) 40 years or older were included, 776 (22.70%) of whom had prevalent osteoporosis. In terms of individual nutrients, postmenopausal women in the highest CDAI quartiles for dietary β-carotene, vitamin A, vitamin C, and iron intakes had a low likelihood of osteoporosis. Regarding the CDAI-osteoporosis association, postmenopausal women in the highest quartile were less likely to have osteoporosis (ORQ3vsQ1, 0.64; 95% CI, 0.43–0.96; ORQ4vsQ1, 0.56; 95% CI, 0.35–0.89; P for trend = 0.013), after controlling for covariates.

Conclusions

CDAI was negatively associated with the likelihood of osteoporosis in postmenopausal women. Our findings suggest that the combined intake of antioxidant nutrients can help reduce the likelihood of osteoporosis in women.
Identifying geographic atrophy
Authors: Clevenger Leanne , Rachitskaya Aleksandra
Published: March 2023

Purpose of review

Age-related macular degeneration (AMD) is one of the leading causes of blindness and can progress to geographic atrophy (GA) in late stages of disease. This review article highlights recent literature which assists in the accurate and timely identification of GA, and monitoring of GA progression.

Recent findings

Technology for diagnosing and monitoring GA has made significant advances in recent years, particularly regarding the use of optical coherence tomography (OCT). Identification of imaging features which may herald the development of GA or its progression is critical. Deep learning applications for OCT in AMD have shown promising growth over the past several years, but more prospective studies are needed to demonstrate generalizability and clinical utility.

Identification of GA and of risk factors for GA development or progression is essential when counseling AMD patients and discussing prognosis. With new therapies on the horizon for the treatment of GA, identification of risk factors for the development and progression of GA will become critical in determining the patients who would be appropriate candidates for new targeted therapies.
Use of primary and piggyback toric intraocular lenses for treatment of high myopic astigmatism
Authors: Thomson Andrew C. , McAnnis Kathryn E. , Ambati Balamurali K.
Published: March 2023

Introduction:

High myopic astigmatism often presents a challenge for cataract surgeons. Procedures such as limbal relaxation incisions may also be impossible in the setting of an extensive refractive surgical history.

Patient and Clinical Findings:

A 61-year-old woman for cataract surgery with a history of automated lamellar keratoplasty, 4-incision radial keratotomy, and arcuate incisions in the left eye. Astigmatism was 8.00 diopters (D) by manifest refraction, and on optical biometry, corneal topography, and auto keratometry, astigmatism was 9.01 D, 7.52 D, and 8.25 D, respectively.

Diagnosis, Intervention, and Outcomes:

A primary in-the-bag toric intraocular lens (IOL) and piggyback toric IOL with reverse optic capture were used. A surgically induced astigmatism of 6.59 D, magnitude of error of −1.41 D, angle of error 5.6 degrees, and correction index of 0.82 were achieved. Owing to limited potential improvement with IOL rotation, additional enhancement with photorefractive keratectomy (PRK) of −0.61 −1.78 × 69 degrees was performed to achieve desired results and high patient satisfaction. Preoperative corrected distance visual acuity was 20/50, and the uncorrected visual acuity achieved after cataract surgery and PRK enhancement was 20/25.

Conclusions:

The use of double toric IOLs for treating high astigmatism in patients with prior keratorefractive surgery is reported.
Conflicts hurt: social stress predicts elevated pain and sadness after mild inflammatory increases
Authors: Madison Annelise A. , Renna Megan , Andridge Rebecca , Peng Juan , Shrout M. Rosie , Sheridan John , Lustberg Maryam , Ramaswamy Bhuvaneswari , Wesolowski Robert , Williams Nicole O. , Noonan Anne M. , Reinbolt Raquel E. , Stover Daniel G. , Cherian Mathew A. , Malarkey William B. , Kiecolt-Glaser Janice K.
Published: March 2023

Individuals respond differently to inflammation. Pain, sadness, and fatigue are common correlates of inflammation among breast cancer survivors. Stress may predict response intensity. This study tested whether breast cancer survivors with greater exposure to acute or chronic social or nonsocial stress had larger increases in pain, sadness, and fatigue during an acute inflammatory response. In total, 156 postmenopausal breast cancer survivors (ages 36-78 years, stage I-IIIA, 1-9 years posttreatment) were randomized to either a typhoid vaccine/saline placebo or the placebo/vaccine sequence, which they received at 2 separate visits at least 1 month apart. Survivors had their blood drawn every 90 minutes for the next 8 hours postinjection to assess levels of interleukin-6 and interleukin-1 receptor antagonist (IL-1Ra). Shortly after each blood draw, they rated their current levels of pain, sadness, and fatigue. Women also completed the Test of Negative Social Exchange to assess chronic social stress and the Trier Inventory of Chronic Stressors screen to index chronic general stress. At each visit, a trained experimenter administered the Daily Inventory of Stressful Events to assess social and nonsocial stress exposure within the past 24 hours. After statistical adjustment for relevant demographic and behavioral covariates, the most consistent results were that survivors who reported more chronic social stress reported more pain and sadness in response to IL-1Ra increases. Frequent and ongoing social stress may sensitize the nervous system to the effects of inflammation, with potential implications for chronic pain and depression risk among breast cancer survivors.
Correlation of Q223R and K109R polymorphisms in leptin receptor gene with susceptibility of breast cancer: A systematic review and meta-analysis
Authors: Zhu Shaoliang , Tang Zhenyong , Tang Yi , Tan Tingting , Chen Bin , Xie Dongyi , Xie Shaowei , Luo Honglin , Jiang Wenyu , Tang Yuntian , Yang Jianrong
Published: March 2023

Background:

Increasing evidence has suggested a strong association of Q223R (rs1137101) and K109R (rs1137100) polymorphisms in leptin receptor (LEPR) gene with susceptibility of breast cancer (BC), but inconsistent results were obtained. To provide a quantitative assessment of this association, a systematic review and meta-analysis was performed.

Methods:

A literature search of PubMed, EMBASE, Google Scholar, and the Chinese National Knowledge Infrastructure was collected. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

Results:

A total of 20 case-control studies for Q223R polymorphism and 8 case-control studies for K109R polymorphism were included. Significant association between Q223R polymorphism and BC risk was not found in total, Asian or Caucasian population, but in African population: allelic model, OR = 0.72, 95% CI = 0.60-0.86, p < 0.001; recessive model, OR = 0.67, 95%CI = 0.52-0.87, P = 0.003; dominant model, OR = 1.58, 95% CI = 1.15-2.17, p = 0.004; homozygous model, OR = 0.51, 95% CI = 0.36-0.78, p < 0.001. Significant association between K109R polymorphism and BC risk was not found in total or Caucasian population, but in Asian population: dominant model, OR = 0.24, 95% CI = 0.07-0.84, p = 0.03; heterozygous model, OR = 1.87, 95% CI = 1.07-3.26, p = 0.03.

Conclusion:

The available evidence suggests that Q223R polymorphism may be significantly associated with BC risk in African population. K109R polymorphism may be significantly associated with BC risk in Asian population.
Bivalirudin Compared to Heparin as the Primary Anticoagulant in Pediatric Berlin Heart Recipients
Authors: Freniere Victoria , Salerno David M. , Corbo Heather , Law Sabrina , McAllister Jennie , Neunert Cindy , Chen Justin K.
Published: March 2023

Bivalirudin has been used in increasing frequency as an alternative to unfractionated heparin (UFH) in pediatric recipients of Berlin Heart EXCOR ventricular assist devices (VAD). This single-center, retrospective review characterizes anticoagulant trends and outcomes in pediatric Berlin Heart VAD recipients implanted between September 1, 2013, and August 31, 2021, anticoagulated with either bivalirudin or UFH. Thirty-one patients were included; 65% who received bivalirudin and 35% who received UFH. The median age was 2.9 years, included 64.5% females, with 61.3% of patients diagnosed with dilated cardiomyopathy and 25.8% of patients with congenital heart disease. Therapeutic anticoagulation was achieved sooner in the bivalirudin group compared to UFH via anti-Xa monitoring (median 5.7 and 69.5 hours, respectively, p < 0.001). Bivalirudin had a greater number of therapeutic values comparatively to UFH (52% and 24%, respectively; p < 0.001) and a superior number of hours in the therapeutic range (67% and 32%, respectively; p < 0.001). Secondary outcomes were similar among the two groups, apart from greater chest tube output (UFH), more frequent events of elevated plasma-free hemoglobin (bivalirudin), and more frequent elevated inflammatory markers postimplant (bivalirudin). Prevalence of pump replacements secondary to significant clot burden and prevalence of stroke was comparable. In this patient cohort, bivalirudin demonstrated greater anticoagulation stability comparatively to UFH. Multicenter collaboration would be necessary to identify whether this further translates into improved patient outcomes.
Baseline Peripheral Eosinophil Count Independently Predicts Proton Pump Inhibitor Response in Eosinophilic Esophagitis
Authors: Muftah Mayssan , Barshop Kenneth , Redd Walker D. , Goldin Alison H. , Lo Wai-Kit , Chan Walter W.
Published: March 2023

Goals:

To assess the predictive value of baseline peripheral absolute eosinophil counts (AECs) for proton pump inhibitor (PPI) response in eosinophilic esophagitis (EoE).

Background:

PPI leads to histologic remission in ~50% of EoE patients, although there are few distinguishing clinical features between PPI-responsive (PPI-r-EoE) and nonresponsive (PPI-nr-EoE) diseases. Peripheral eosinophilia is present in ~50% of EoE cases and is associated with eosinophil density on esophageal biopsy and worse clinical outcomes. The association between peripheral eosinophilia and PPI-responsiveness in EoE remains unclear.

Study:

This is a retrospective cohort study of adult EoE patients at a tertiary center between 2012 and 2016. All patients underwent twice daily PPI trials for ≥8 weeks followed by repeat esophageal biopsies and were classified as PPI-r-EoE or PPI-nr-EoE based on histologic response (<15 eosinophils/high power field). Baseline peripheral AEC was obtained within 1 month before index endoscopy. Analyses were performed using Fisher exact/Student t test (univariate) and logistic regression (multivariable).

Results:

One hundred eighty-three patients (91 PPI-nr-EoE and 92 PPI-r-EoE) were included. Mean peripheral AEC was higher among PPI-nr-EoE patients (0.41 vs 0.24 K/µL, P = 0.013). Baseline peripheral eosinophilia (>0.5 K/µL) was more prevalent among patients with PPI-nr-EoE (70.4% vs 45.5%, P = 0.023) and a history of food impaction (51.9% vs 23.7%, P = 0.0082). On multivariable analyses, peripheral eosinophilia remained an independent predictor for PPI response (adjacent odds ratio = 2.86, CI: 1.07-7.62, P = 0.036) and food impaction (adjacent odds ratio = 2.80, CI: 1.07-7.35, P = 0.037).

Conclusions:

Baseline peripheral eosinophilia independently predicts PPI nonresponse and food impaction in EoE patients. Peripheral AEC may help therapy selection in EoE and prevent delays in achieving histologic remission.
Dietary protein and muscle wasting in chronic kidney disease: new insights
Authors: Gungor Ozkan , Kara Ali Veysel , Hasbal Nuri Baris , Zadeh Kamyar Kalantar
Published: March 2023

Purpose of review

Muscle wasting is an important health problem in chronic kidney disease (CKD) patients. Protein restriction in the diet can be one of the main causes of muscle wasting in this population. In this review, we aimed to investigate the relationship between dietary protein intake and muscle wasting in CKD patients according to recent literature.

Recent findings

The one of the main mechanisms responsible for the muscle wasting is the disturbances in skeletal muscle protein turnover. Muscle wasting primarily occurs when the rates of muscle protein breakdown exceed the muscle protein synthesis. Dietary protein intake represents an important role by causing a potent anabolic stimulus resulting a positive muscle protein balance. Compared to studies made in healthy populations, there are very limited studies in the literature about the relationship between dietary protein intake and muscle wasting in the CKD population. Majority of the studies showed that a more liberal protein intake is beneficial for muscle wasting in especially advanced CKD and hemodialysis population

Although evaluating muscle wasting in CKD patients, the amount of protein in the diet of patients should also be reviewed. Although excessive protein intake has some negative consequences on this patient group, a more liberated dietary protein intake should be taken into account in this patient group with muscle wasting and especially in dialysis patients.
Impact of complementary feeding on obesity risk
Authors: Kittisakmontri Kulnipa , Fewtrell Mary
Published: March 2023

Purpose of review

To discuss recent evidence on the influence of complementary feeding (CF) timing, content and feeding methods on childhood obesity risk.

Recent findings

The evidence-base is limited by heterogeneity, risk of bias and the predominance of observational studies. The content of the diet and feeding practices are more influential than timing for obesity risk. There is limited evidence that CF introduction before 4 months may be associated with increased risk. Intake of animal protein, particularly dairy protein, may contribute to rapid weight gain; protein from infant/follow-on formula shows the most robust association with later obesity risk. Evidence linking sugar intake to obesity risk is limited, but intake should be as low as possible given there is no nutritional requirement. Responsive feeding (RF) practices may promote appropriate infant growth and reduce risk. The effect of baby-led weaning (BLW) is inconclusive.

Recent evidence supports current recommendations to avoid high protein intakes, especially from infant/follow-on formula, for infants in high income countries; and to promote RF practices for all infants. Studies in low- and middle-income countries are required to define optimal CF practices given increasing rates of child obesity alongside double-burden malnutrition.
Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet
Authors: Klassen Pamela , Schiessel Dalton L. , Baracos Vickie E.
Published: March 2023

Purpose of review

Systemic cancer therapy-associated skeletal muscle wasting is emerging as a powerful impetus to the overall loss of skeletal muscle experienced by patients with cancer. This review explores the clinical magnitude and biological mechanisms of muscle wasting during systemic cancer therapy to illuminate this adverse effect. Emerging strategies for mitigation are also discussed.

Recent findings

Clinical findings include precise, specific measures of muscle loss over the course of chemotherapy, targeted therapy and immunotherapy. All these therapeutic classes associate with quantitatively important muscle loss, independent of tumor response. Parallel experimental studies provide understanding of the specific molecular basis of wasting, which can include inhibition of protein synthesis, proliferation and differentiation, and activation of inflammation, reactive oxygen species, autophagy, mitophagy, apoptosis, protein catabolism, fibrosis and steatosis in muscle. Strategies to mitigate these muscle-specific adverse effects of cancer therapy remain in the earliest stages of development.

The adverse side effect of cancer therapy on skeletal muscle has been largely ignored in the development of cancer therapeutics. Given the extent to which loss of muscle mass and function can bear on patients’ function and quality of life, protection/mitigation of these side effects is a research priority.
Hepatic dysfunction in patients receiving intravenous lipid emulsions
Authors: Miles John M.
Published: March 2023

Purpose

Until recently, intravenous lipid emulsions (ILEs) have consisted of soybean oil (SO) only. This review addresses recent developments in the field, including the problem of intestinal failure associated liver disease (IFALD) that can occur with the use of ILEs in children and adults, and newer ILEs that may minimize and reverse IFALD.

Recent findings

Cholestasis is the primary manifestation of IFALD in premature infants receiving ILEs, whereas in older children and adults, steatosis is predominant. Two alternative ILEs have been extensively investigated for both safety and efficacy. SMOF, an ILE containing medium chain triglyceride, soybean oil, olive oil and fish oil (FO), is now widely used in both children and adults. A newer FO ILE is approved for use in children only. However, in case reports FO ILE has been shown to improve IFALD in adults. A number of new studies suggest that cholestasis from ILEs is dose-related. IFALD does not improve in many patients after transition from SO to SMOF, but partial or complete replacement with FO can halt and reverse IFALD.

Adverse hepatic effects from ILEs are to some extent dose-related. Overfeeding with fat or with carbohydrate, or simply providing excessive calories in general, may be responsible. More research is needed investigating dose-related effects of macronutrients on liver injury.
Gut microbiota in relation to frailty and clinical outcomes
Authors: D’Amico Federica , Barone Monica , Brigidi Patrizia , Turroni Silvia
Published: March 2023

Purpose of review

The gut microbiota is involved in several aspects of host health and disease, but its role is far from fully understood. This review aims to unveil the role of our microbial community in relation to frailty and clinical outcomes.

Recent findings

Ageing, that is the continuous process of physiological changes that begin in early adulthood, is mainly driven by interactions between biotic and environmental factors, also involving the gut microbiota. Indeed, our gut microbial counterpart undergoes considerable compositional and functional changes across the lifespan, and ageing-related processes may be responsible for – and due to – its alterations during elderhood. In particular, a dysbiotic gut microbiota in the elderly population has been associated with the development and progression of several age-related disorders.

Here, we first provide an overview of the lifespan trajectory of the gut microbiota in both health and disease. Then, we specifically focus on the relationship between gut microbiota and frailty syndrome, that is one of the major age-related burdens. Finally, examples of microbiome-based precision interventions, mainly dietary, prebiotic and probiotic ones, are discussed as tools to ameliorate the symptoms of frailty and its overlapping conditions (e.g. sarcopenia), with the ultimate goal of actually contributing to healthy ageing and hopefully promoting longevity.
Heterogeneity in the response to n-3 polyunsaturated fatty acids
Authors: Shaikh Saame Raza , Bazinet Richard P.
Published: March 2023

Purpose of review

A central goal in the study of long chain n-3 polyunsaturated fatty acids (PUFA) is to translate findings from the basic sciences to the population level to improve human health and prevent chronic diseases. A tenet of this vision is to think in terms of precision medicine and nutrition, that is, stratification of individuals into differing groups that will have different needs across the lifespan for n-3 PUFAs. Therefore, there is a critical need to identify the sources of heterogeneity in the human population in the dietary response to n-3 PUFA intervention.

Recent findings

We briefly review key sources of heterogeneity in the response to intake of long chain n-3 PUFAs. These include background diet, host genome, composition of the gut microbiome, and sex. We also discuss the need to integrate data from newer rodent models (e.g. population-based approaches), multi -omics, and analyses of big data using machine learning and data-driven cluster analyses.

Accounting for vast heterogeneity in the human population, particularly with the use of big data integrated with preclinical evidence, will drive the next generation of precision nutrition studies and randomized clinical trials with long-chain n-3 PUFAs.
Intraoral flaps for oral cavity and oropharyngeal reconstruction
Authors: Sandilands Jessica , Somers Miles , Winters Ryan
Published: March 2023

Purpose of review

Oral cavity reconstruction using local flaps is an area of head and neck surgery that has been overshadowed since the introduction of free flaps. Here, we discuss new developments, predominantly modifications to existing techniques for intraoral reconstruction, the utility of different local flaps and a review of functional outcomes.

Recent findings

The facial artery musculomucosal (FAMM) flap has seen the greatest number of modifications to technique, most notably the extended double-pedicled, kite-shaped tunnelized and osseous myomucosal approaches. The tunnelled buccal fat pad flap has gained popularity as well as the use of combining two flaps such as the buccal fat pad and palatal island flap to reconstruct oral cavity defects with good effect. There is still a paucity of literature surrounding functional outcomes post reconstruction. Despite this, the complication rate for local flaps remains low.

The value of intraoral flaps for oral cavity reconstruction is undisputed. However, they are potentially underutilised in the modern era of expanding availability and indications for free tissue transfer. As many practices see greater numbers of aging patients, often with multisystem comorbidities, local flaps are an important tool that can provide the surgeon with a greater number of reconstructive options.
Use of a Rubric for Pediatric Emergency Medicine Fellowship Application Review
Authors: Ruscica Alice , Dessie Almaz , Jamal Nazreen , Roskind Cindy
Published: March 2023

Background

There is a need to review a large number of applications for pediatric emergency medicine fellowship in a holistic and systemic, unbiased manner. There exists a need to restructure the application process. We sought to develop and implement a rubric screening rubric for initial evaluation of pediatric emergency medicine fellowship applications that avoided traditionally used metrics that may be biased against racially underrepresented groups who are historically excluded from medicine.

Methods

An interactive process was used by key program leadership with review of prior literature and input from Diversity, Equity, and Inclusivity departmental chair to develop a holistic screening rubric with consensus reached around key factors that aligned with our fellowship program mission. All applications were reviewed with the rubric by the program director or the associate program director. A subset of applications being considered for review were additionally scored by members of the fellowship selection committee.

Results

Numerical scores ranged from 2 to 14, with the maximum potential score being 14. Seventy percent of those applicants invited for interview scored 9 or higher. Reliability of scores between the program director and the associate program director was high (intraclass coefficient, 0.89); however, reliability between the program director or associate program director and the selection committee members was low to moderate (intraclass coefficient, 0.46).

Conclusions

Developmental and use of a rubric screening allowed our institution to reflect on our priorities, as well as avoid potential bias. The use of the tool allowed us to communicate about applications in an objective and consistent manner. As we continue to iterate on the rubric, we hope to incorporate additional criteria to better identify highly qualified applicants who may otherwise be overlooked in a traditional screening process and gain familiarity in reviewers use.
Weaving and Layering Funding: A Territorial Health Agency's Guide to Effective Health Financing
Authors: Cruz Casierra , Wheatley Alex , Ensign Karl , Fraser Michael R. , Gilmartin Sharon , Bailey Amy , Mendiola Amber
Published: March 2023

Context:

State and territorial health agencies can optimize programmatic funding through braiding and layering strategies.

Implementation:

The Commonwealth Healthcare Corporation, a territorial health agency located on the Pacific Island of Saipan, Commonwealth of the Northern Mariana Islands (CNMI), restructured its Non-Communicable Disease Bureau into 4 new units. Existing funding streams were braided and layered to support the restructuring. A shared vision of strengthening crosscutting connections to improve population health outcomes helped guide the restructuring process. Vision planning with leaders and funding partners, establishing buy-in within agency and external partners, and assessing immediate impacts were a few of the steps taken by the agency to ensure a successful restructuring.

Impact:

The immediate impact of the restructure has been positive. In both the CNMI and select states that have undertaken similar efforts, braiding and layering funding has facilitated more streamlined processes, coordinated approaches across programs and funding partners, and provided deeper levels of trust in partnerships. Although it is still too early to draw long-term assessments in the CNMI, the agency projects that coordinated funds will strengthen its foundational capabilities and promote a more community-centered, collaborative, and effective approach to public health. Restructuring the Non-Communicable Disease Bureau through braiding and layering funds gives the agency the flexibility it needs to more effectively address the social determinants of health and local population health priorities through a client-centered approach, ultimately improving health outcomes for the commonwealth.

Lessons Learned and Implications:

The agency experienced several challenges throughout the restructuring process that offer lessons learned for addressing effective health financing. For example, ample time is needed at the beginning of the braiding and layering process to establish policies and procedures for efficient accounting, documenting, and reporting. In addition, ongoing support and training opportunities for programmatic teams can smooth out the transition from siloed to braided and layered funding structures. These lessons, in addition to key elements mapped out by experienced state health agencies, can guide and prepare other agencies interested in implementing innovative funding mechanisms.
Lengthening Phalloplasty with division of the suspensory ligament and distally based fat flaps in Penis Enlargement operations.
Authors: Deskoulidi Parthena I. , Caminer David
Published: March 2023

Background:

Small penile size is worrying for most men and leads to poor self-esteem, anxiety and depression. A penis can be enlarged in two ways: by increasing the length and by increasing the circumference. The purpose of this article is to present a new procedure of augmentation phalloplasty which combines these two parts in the same operation with a new technique to fill in the dead space created by the suspensory ligament division.

Methods:

The lengthening of the penis is achieved with an inverted V-Y plasty followed by a division of the suspensory ligament of the penis all the way down the pubic symphysis. Two distally based fat flaps are advanced into this area to fill in the dead space. The widening of the circumference is performed with fat injections.

Results:

The penile length gain postoperatively is 2-4 cm in the flaccid state and the widening component with the fat grafting technique gives an approximate circumference increase of 1cm with excellent natural results. Sexual self-esteem and functioning improvement was reported by the patients, 75 in total. Three patients returned after the operation for revision of fat injections 6-12 months after the operation.

Conclusion:

The literature regarding the long-term results after augmentation phalloplasty is poor and it is difficult to compare results with other techniques. Penile enlargement when performed for the appropriate reasons, can have a positive effect on the lives of many men.

After fifteen years of experience this procedure gives very pleasing results with minimal complications.
CranioRate TM: An Image-Based, Deep-Phenotyping Analysis Toolset and Online Clinician Interface for Metopic Craniosynostosis
Authors: Beiriger Justin W. , Tao Wenzheng , Bruce Madeleine K , Anstadt Erin , Christensen Cameron , Smetona John , Whitaker Ross , Goldstein Jesse
Published: March 2023

Introduction:

The diagnosis and management of metopic craniosynostosis involves subjective decision-making at the point of care. The purpose of this work is to describe a quantitative severity metric and point-of-care user interface to aid clinicians in the management of metopic craniosynostosis and to provide a platform for future research through deep phenotyping.

Methods:

Two machine-learning algorithms were developed that quantify the severity of craniosynostosis – a supervised model specific to metopic craniosynostosis (Metopic Severity Score) and an unsupervised model used for cranial morphology in general (Cranial Morphology Deviation). CT imaging from multiple institutions were compiled to establish the spectrum of severity and a point-of-care tool was developed and validated.

Results:

Over the study period (2019-2021), 254 patients with metopic craniosynostosis and 92 control patients who underwent CT scan between the ages of 6 and 18 months were included. Scans were processed using an unsupervised machine-learning based dysmorphology quantification tool, CranioRate TM. The average Metopic severity score (MSS) for normal controls was 0.0±1.0 and for metopic synostosis was 4.9±2.3 (p<0.001). The average Cranial Morphology Deviation (CMD) for normal controls was 85.2±19.2 and for metopic synostosis was 189.9±43.4 (p<0.001). A point-of-care user interface (craniorate.org) has processed 46 CT images from 10 institutions.

Conclusion:

The resulting quantification of severity using MSS and CMD has shown an improved capacity, relative to conventional measures, to automatically classify normal controls versus patients with metopic synostosis. We have mathematically described, in an objective and quantifiable manner, the distribution of phenotypes in metopic craniosynostosis.
Effect of Dolutegravir and Multimonth Dispensing on Viral Suppression Among Children With HIV
Authors: Mugo Cyrus , Zubayr Bashir , Ezeokafor Nnenna , Oyawola Babatunde , Ekele David Ochedomi , Madueke Leila , Kpamor Zipporah , Semo Bazghina-werq
Published: March 2023

Background:

Few studies in sub-Saharan Africa have assessed the impact of multimonth dispensing (MMD) of antiretroviral therapy (ART) and dolutegravir (DTG) beyond clinical trials among children with HIV (CWHIV). We assessed the effect of the 2 interventions on achieving undetectable viral load (VL) among CWHIV in the age group of 0–15 years in Nigeria.

Methods:

We used longitudinal routine records and cross-sectional survey data from caregivers of a subsample of children. VLs were considered suppressed at <1000 copies/mL and undetectable at <50 copies/mL. Multimonth dispensing (MMD) was defined as ART refill for >84 days. The effect of MMD and DTG on VL levels and associations between social factors and VL were estimated using generalized linear models, reporting adjusted relative risks/prevalence ratios and 95% confidence intervals (CIs).

Results:

Of 2490 CWHIV, 52% were male, with a median age of 10 years (interquartile ranges: 6–13) and a median duration on ART of 4.6 years (interquartile ranges: 2.8–7.1). Overall, 73% were on DTG and 55% received MMD. At baseline, 63% were suppressed, while 79% and 56% were suppressed and undetectable in their last VL, respectively. We found no differences in undetectable VL between those on MMD and not on MMD (adjusted relative risks: 1.05 [95% CI: 0.94–1.18]) and between those on DTG and not on DTG (1.07 [0.92–1.25]). In secondary analyses, poor adherence and being in a support group were associated with a lower likelihood of undetectable VL (adjusted prevalence ratios: 0.85 [95% CI: 0.74–0.96] and 0.81 [0.68–0.96], respectively).

Conclusion:

MMD did not compromise treatment outcomes for CWHIV. Poor adherence, however, remains a barrier to achieving treatment targets.