bluuebunny/crossref_metadata_2025 huggingface dataset:
Meta-analysis on the effectiveness of SGLT2 inhibitors in heart failure
Authors: Albalushi S , Rashid Nadeem R N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Aims

We aimed to carry out a meta-analysis on the effectiveness of sodium-glucose co transporter 2 (SGLT2) inhibitors in heart failure patients (HF) with preserved and reduced ejection fraction.

Methods and results

From their inception till September 2022, MEDLINE, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov were searched for placebo-controlled randomized controlled trials of SGLT2 inhibitors. Randomized controlled studies were chosen if they included HF patients and reported at least one of the predetermined outcomes. A random effects model was used to pool hazard ratios (HRs) or risk ratios together with the appropriate 95% confidence intervals. There were fourteen trials in total, with 42409 HF patients participating (N = 21678 in the SGLT2 inhibitor arms and N = 20731 in the placebo arms). In the overall HF cohort, SGLT2 inhibitors significantly reduced the composite of first HF hospitalization or cardiovascular death [HR: 0.75 (0.71–0.79); P <0.001; I2 = 0%]. Also resulted in a significant reduction in total hospitalizations for heart failure [HR: 0.70 (0.66–0.75); P < 0.001; I2 = 0%] and reduced the occurrence of cardiovascular death [HR: 0.86 (0.81–0.92); P < 0.001; I2 = 43%]. Sub-group analysis was conducted to based on HF status at baseline, ejection fraction, diabetes status at baseline, and gender. SGLT2 inhibitors significantly reduced the composite heart failure hospitalization and cardiovascular death for all the subgroups except for patients with HFpEF at baseline [HR: 0.87 (0.74–1.03); P = 0.11; I2 = 60%] and no diabetes status at baseline [HR: 0.92 (0.73–1.16); P = 0.50; I2 = 78%]. SGLT2 inhibitors seemed to have no risk of hypovolaemia, hyperkalaemia, or hypotension when compared to the placebo.

Conclusions

In patients with HF, SGLT2 inhibitors substantially increase cardiovascular outcomes, including all-cause and cardiovascular mortality. In this meta-analysis, SGLT2 inhibitors did not show reduction in composite heart failure in patients with heart failure with preserved ejection fraction (HFpEF) at baseline.
Cardiac resynchronization therapy induced QRS narrowing: could it change the prognosis?
Authors: Duarte F , Santos I , Barradas M , Monteiro A , Dourado R , Martins D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac resynchronization therapy (CRT) responders should have symptomatic improvement and benefits in long-term outcomes. CRT is indicated in the treatment of heart failure (HF) patients with systolic dysfunction and prolonged QRS duration. There are conflicting results regarding QRS narrowing on CRT response.

Objective

We ought to access the impact of QRS narrowing after CRT implantation in clinical outcomes and arrhythmic events. The association between the QRS duration reduction in responders and non-responders was determined.

Methods

We retrospectively enrolled 110 consecutive patients with CRT. Native QRS duration and QRS duration at least 6 months after procedure were determined by EKG. Baseline clinical characteristics were accessed. Three outcomes were created. Primary outcome: hospitalization or emergency department admissions due to HF decompensation. Secondary outcome: sustained ventricular arrhythmic events. Tertiary MACE outcome (composite of cardiovascular death, hospitalization due to HF or acute coronary syndrome and cerebrovascular events).

Results

Out of 110 patients included, the mean age was 70.3 ± 10.7 years, 68.2% were male and mean body mass index was 29.1 ± 5.7 kg/m2. Baseline characteristics were similar between genders: 41.1% had atrial fibrillation, 10.3% peripheral arterial disease, 72.9% hypertension, 66.4% dyslipidemia, 44.9% diabetes and 20.7% chronic kidney disease. Ischemic etiology (p 0.001), pulmonary lung obstructive disease (p <0.001; r=0.35) and smoking habits (p <0.001; r=0.5) prevailed in male patients.

Responders by clinical and/or echocardiographic criteria were 62.7%.

Native QRS mean duration was 162.4 ± 22 ms and mean QRSd after CRT was 141.9 ± 37 ms, with a median QRS narrowing of 20 ± 30 ms.

Primary outcome occurred in 28.6%, secondary in 16.4% and MACE occurred in 31.8%. QRS narrowing was an independent predictor of primary and secondary outcomes (U 283; p 0.016 and U 110.5; p 0.043) as well as MACE (U 6.18; p 0.035).

ROC curve analysis compared native and post-CRT implantation QRSd and their impact on outcomes. The best cut-off values for hospitalization and MACE were 10 and 13, respectively (AUC 0.69; 95% CI 0.54 – 0.84; p 0.016 and AUC 0.64, 95% CI 0.52 – 0.76; p 0.035).

Conclusion

Patients with a larger decrease in QRS duration after CRT implantation revealed improved outcomes and it was independent of CRT response. This variable could be of interest in selecting HF patients for CRT.
Combined approach of carotid endarteriectomy and transcarotid transcatheter aortic valve implantation as a minimally invasive one-step treatment of aortic stenosis: a case report
Authors: Bourlond Baudouin , Dulguerov Filip , Longchamp Justine , Kirsch Matthias
Published: May 2023

Background

Despite the gold-standard approach for transaortic valve implantation (TAVI) remains transfemoral (TF), alternative approaches are needed in patients who present contraindications to transfemoral access.

Case summary

We report the case of a 79-year-old female with a symptomatic high-gradient severe aortic stenosis—mean gradient of 43 mmHg—and a significant supra-aortic trunk stenosis (left carotid artery: 90–99%; right carotid artery: 50–70%), and who was hospitalized for progressive dyspnoea New York Heart Association (NYHA) stage III. In this high-risk patient, it was decided to perform a TAVI. Because of a history of stenting of both common iliac arteries in a context of an arterial insufficiency of the lower limbs (Leriche classification stage III) and stenotic thoraco-abdominal aorta atheromatosis, an alternative approach to the transfemoral transaortic valve implantation (TF-TAVI) one was needed. It was decided to perform a combined transcarotid-TAVI (TC-TAVI) with EDWARDS S3 23 mm valve with a left endarteriectomy during the same operating time.

Discussion

Our case illustrates an alternative approach to perform a percutaneous aortic valve implantation, despite supra-aortic trunk stenosis, in a high-risk surgical patient contraindicated to a TF-TAVI. Transcarotid transaortic valve implantation remains a safe alternative when TF-TAVI is contraindicated, and the combined approach of carotid endarteriectomy and TC-TAVI offers a minimally invasive one-step treatment in high operative risk patients.
Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
Authors: Ellins Elizabeth A , Wareham Kathie , Harris Daniel E , Hanney Matthew , Akbari Ashley , Gilmore Mark , Barry James P , Phillips Ceri J , Gravenor Michael B , Halcox Julian P
Published: May 2023

Aims

Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear.

Methods and results

In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86–2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54–1.54; HR 1.07, 95% CI 0.66–1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4.

Conclusion

A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol.
A Crossed Analysis of Participations in Labor and Grain Markets: Evidence from Malawi
Authors: Camara Alhassane , Savard Luc
Published: May 2023

This study contributes to the literature on the identification of factors shaping the decision to participate in the grain market in Africa. Unlike previous studies, we introduce labor market participation into the farm household model to highlight heterogeneities in decision making. Empirically, we rely on an extension of Heckman's approach and introduce control functions to mitigate endogeneity issues related to the adoption of agricultural technologies. We find that limited access to transportation infrastructure, by discouraging the supply of grain, constrains households to experience an excess of labor; price incentives may have a reverse effect on the choice of market regimes, even though the effect on production may be positive for households that are already participants. We also show that farmers' responses to grain prices are not sensitive to their labor market position. The use of agricultural technologies encourages cereal production and employment of external agricultural labor. This study thus provides a better targeting when designing policies promoting marketing and rural employment.
Clomipramine inhibits dynamin GTPase activity by L-α-phosphatidyl-L-serine stimulation
Authors: Miyoshi Hiroshi , Otomo Masahiro , Takahashi Kiyofumi
Published: May 2023

Three dynamin isoforms play critical roles in clathrin-dependent endocytosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells via clathrin-dependent endocytosis. We previously reported that 3-(3-chloro-10,11-dihydro-5H-dibenzo[b,f]azepin-5-yl)-N,N-dimethylpropan-1-amine (clomipramine) inhibits the GTPase activity of dynamin 1, which is in mainly neuron. Therefore, we investigated whether clomipramine inhibits the activity of other dynamin isoforms in this study. We found that, similar to its inhibitory effect on dynamin 1, clomipramine inhibited the l-α-phosphatidyl-l-serine-stimulated GTPase activity of dynamin 2, which is expressed ubiquitously, and dynamin 3, which is expressed in the lung. Inhibition of GTPase activity raises the possibility that clomipramine can suppress SARS-CoV-2 entry into host cells.
Efficacy of deltamethrin and pirimiphos-methyl in proportionally layer-treated maize against the larger grain borer and the maize weevil
Authors: Quellhorst Hannah , Sakka Maria , Gourgouta Marina , Morrison William R , Zhu Kun Yan , Athanassiou Christos G
Published: May 2023

Two insecticides (deltamethrin and pirimiphos-methyl) were evaluated in laboratory assays as grain protectants when applied as a total percentage of a maize mass to control adult Prostephanus truncatus and Sitophilus zeamais. All experiments were conducted at the University of Thessaly in Greece at 30°C and 65% RH under continuous darkness. Either insecticide was applied to 20 g of maize placed in a vial or to the upper one half, one fourth, or one-eighth layer of the maize, then insects were either added to the vials before or after the maize in a completely randomized block design CRBD with n = 9 replicates. Mortality, progeny production, and insect damaged kernels (IDK) were then evaluated for each vial. Insect introduction method (before or after) did not have any impact on any of the variables. Mortality was nearly 100% for all treatments for both insecticides for P. truncatus. Subsequently, progeny production and the number of insect damaged kernels were very low or zero for P. truncatus. Mortality of S. zeamais remained low across layer treatments for deltamethrin. However, S. zeamais was easily controlled by pirimiphos-methyl. The results of this laboratory study show that while deltamethrin and pirimiphos-methyl have some effectiveness as a layer treatment on a column of maize, efficacy will be dependent on the target species, and the depth of the treated layer, as well as the location on which the insects are present.
Metabolic-associated fatty liver disease and risk of esophagogastric cancer: a systematic review and meta-analysis
Authors: Zou Qu , Tan Hao-Yang , Li Jun-Chi , Li Ya-Dong , Yang Kang
Published: May 2023

Introduction

Metabolic-associated fatty liver disease (MAFLD) has been found to be strongly linked to several diseases. Although previous studies have explored the association between MAFLD and extrahepatic cancers, research on the relationship between MAFLD and gastric carcinoma (GC) and esophageal carcinoma (EC) is relatively scarce and requires updating. Therefore, the objective of this study is to conduct a comprehensive investigation into the association between MAFLD and GC or EC.

Material and methods

We conducted a comprehensive search for relevant studies published up to 5 August 2022, using the PubMed, Embase and Web of Science databases. To estimate the risk ratio (RR) and the 95% confidence interval (CI), we employed a random-effects model. We also conducted subgroup analyses based on study characteristics. The protocol for this systematic review is registered in the Prospero database under the registration number CRD42022351574.

Results

Our analysis included eight eligible studies, comprising a total of 8 629 525 participants. We found that the pooled RR values for the risk of GC in patients with MAFLD were 1.49 (95%CI: 1.17–1.91), whereas the pooled RR values for the risk of EC in patients with MAFLD were 1.76 (95%CI: 1.34–2.32).

Conclusions

Based on our meta-analysis, we conclude that there is a significant association between the presence of MAFLD and the development of GC and EC.
Photo-crosslinking hydrogel for wound healing in a pilonidal sinus patient after open surgery
Authors: Yang Yiheng , Yang Haojie , Han Yilin , Wang Zhenyi , Han Changpeng
Published: May 2023

Pilonidal sinus is a chronic infectious disease with large incision and high risk of relapse after surgical management. Therefore, effective intervention strategies are urgently needed to reduce the relapse and shorten the wound healing time. Hydrogels have been widely used in regenerative medicine for its great biocompatibility, however, it remains challenging to integrate the material with wound tissues. Here, we reported a case of pilonidal sinus patient using a novel tissue integration material, Photo-crosslinking hydrogel after open surgery. A 38-year-old man with a pilonidal sinus for ˃5 years underwent open surgery. When the surgery was finished, the wound was injected with hydrogel that was irradiated with a ultraviolet light source until covered and solidified completely. Hydrogel needed to be changed 1–2 times per week. We evaluated the healing time as primary outcome and then followed up for ˃1 year to observe the relapse. The wound healed completely in 46 days after open surgery, which was shorter than that reported in other studies. Meanwhile, no recurrence was detected during follow-up. Photo-crosslinking hydrogel effectively promoted wound healing and has the potential to be easily applied in Pilonidal sinus patients after open surgery.
Hyperammonaemic encephalopathy: a remarkably rare complication after bariatric surgery
Authors: Jhamb Shaurya , Sidhu Tejminder S , Whiting Scott
Published: May 2023

Hyperammonaemia is a metabolic disorder with elevated blood ammonia levels. Here we describe a case of hyperammonaemia associated encephalopathy as an incredibly rare, potentially fatal and treatable complication associated with bariatric surgery. This case highlights the importance of longer-term follow-up after bariatric surgery.
Necrotizing fasciitis of the breast after bilateral breast reduction
Authors: Borg David , Chircop Kurt Lee , Aquilina Duncan
Published: May 2023

Necrotizing fasciitis is a rare infection that rapidly progresses through fascial planes. Due to the latter, diagnosis in a timely manner is imperative to ultimately decrease morbidity and mortality. Such a disease process can occur anywhere in the body; however, necrotizing fasciitis of the breast is extremely rare and not well documented in the available literature.

This is a case report about a 49-year-old woman who developed severe necrotizing fasciitis of both breasts following elective bilateral breast reduction. The patient developed a severe soft tissue infection leading to destruction of local tissue and required management in a surgical high dependency unit. This case report outlines the immediate management and the ensuing steps in reconstruction.

Necrotizing fasciitis of the breast is a rare complication of breast reduction surgery. Early recognition and aggressive treatment with broad-spectrum antibiotics, hyperbaric therapy and repeated debridement are essential for successful management. The use of Integra Bilayer Wound Matrix and skin grafting can result in satisfactory outcomes. It is important to obtain tissue samples for culture and sensitivity testing to identify the offending organism in patients with suspected necrotizing fasciitis. This case report highlights the importance of early diagnosis and management of necrotizing fasciitis to prevent morbidity and mortality.
A rare cause of unilateral leg swelling: May–Thurner Syndrome
Authors: Channane Hamid , Spiliotis Panagiotis M , Sandica Andreea M , Snopok Iurii , Viebahn Richard
Published: May 2023

Common left iliac vein compression, otherwise known as May–Thurner Syndrome (MTS), is a medical condition that refers to chronic compression of an anatomical variant of the left iliac vein by the overlying right common iliac artery and is a predisposing factor for deep vein thrombosis of the left lower limb (LDVT). Although MTS is not often, its true prevalence is underestimated due to misdiagnose, fact that can result to life-threatening conditions such as the development of LDVT and pulmonary embolism. In this paper, we present a case of MTS presenting at our department with unilateral leg swelling without LDTV that was treated through endovascular management along with long-term anticoagulation. With this presentation, the authors wish to emphasise the importance of MTS as a frequently under-diagnosed condition that needs to be ruled out in unilateral left leg swelling with or without LDVT.
Kept apart: Routine family separation in the UK family immigration system as times of crises
Authors: Charsley Katharine , Wray Helena
Published: May 2023

The UK’s family immigration regime involves the routine separation of partners from their families. Most obviously, it keeps apart those who are unable to meet the income and other requirements for family (re)unification, and those refused visas. But separation for at least several months, and sometimes much longer, is the norm even for those whose applications are eventually successful. This article draws on creative, co-produced accounts of immigration-related separation to reveal multi-faceted temporalities of crisis in the ‘experiential migrantisation’ of British citizens seeking to reunite bi-national families in the UK. The bureaucratic temporalities of immigration control impede aspirations for life-course progression and shared futures, while increasing the tempo of working and caring lives. In exploring the accounts of British citizens kept apart from partners by the immigration regime through a temporal lens, we chart this experiential migrantisation through the varied and intersecting temporalities of bureaucracy and immigration control, and of biography and (transnational) family life. These can become intertwined with and compound other temporalities of crisis at different levels, from the global Covid-19 pandemic and other international geo-political events, to the more intimate and familial, leading to ‘times of crises’. Such crises are, moreover, often expressed through temporal tropes of key dates missed—birthdays, anniversaries, holidays—and phases of family life postponed.
Woodpeckers in the city: Abundances are highest in large green spaces with complex understories
Authors: Baz Adam , Murphy Michael T
Published: May 2023

We documented occurrence and relative abundance (henceforth abundance) of five woodpecker species in 36 forested green spaces in Portland, Oregon (USA), to estimate minimum area requirements (MAR; 0.5 probability of occurrence) and to test for potential influences of green space area and type (heavily treed manicured green spaces vs. undeveloped natural forests), habitat features, and landscape composition on the abundance of woodpeckers. Abundances of all species increased with green space area. Manicured and natural green spaces did not differ in canopy cover or total basal area, but woodpecker abundances were greater in natural than manicured green spaces for all species except Northern Flickers (Colaptes auratus). Flickers and Downy Woodpeckers (Picoides pubescens) were most abundant, MAR of both were under 1.5 ha, and both were found in essentially all green spaces. Hairy (P. villosus) and Pileated (Dryocopus pileatus) woodpeckers were least abundant, and with MAR of 34 and 51 ha, respectively, exhibited pronounced area sensitivity. Red-breasted Sapsuckers (Sphyrapicus ruber) were intermediate in abundance and MAR to the 2 former and 2 latter species. The most important habitat variables associated with variation in abundance among green spaces were the contribution of deciduous trees to the canopy (Downy Woodpecker [+], Pileated Woodpecker [+], and Northern Flicker [–]), canopy cover (Hairy Woodpecker [+] and Northern Flicker [+]), and log density (Hairy Woodpecker [+], Red-breasted Sapsucker [–]). At the landscape level, lower woodpecker abundance was associated with increased urbanization (Red-breasted Sapsucker and Northern Flicker), while increasing forest cover influenced abundance of Northern Flicker (–) and Pileated Woodpecker (+). Highest woodpecker abundances were thus found in large green spaces with complex understories that were embedded in relatively undeveloped treed landscapes. Management of forested urban green spaces should prioritize needs of the area-sensitive species because ensuring their continued presence benefits the entire avian community.
‘Virtual neonatal crash course’: quality improvement in neonatal teaching for paediatric trainees
Authors: Aghababaie Arameh , Downes Alexandra
Published: May 2023

There are limited Foundation Programme posts with rotations in paediatrics. Many junior paediatric trainees therefore start their neonatal jobs, including a mandatory 6-month tertiary neonatal placement during Level 1 training, without prior experience. The aim of this project was to improve trainees’ confidence in the practical aspects of neonatal medicine prior to their first neonatal jobs. A virtual course was delivered to paediatric trainees, on the core principles of neonatal intensive care medicine. Trainees’ confidence levels in different domains of neonatology were assessed with pre- and postcourse questionnaires, showing a significant improvement in confidence following the course. Trainees’ qualitative feedback was also overwhelmingly positive. Overall, there is evidently a desire for supplemental neonatal education for paediatric trainees. The long-term plan to address this is to build upon this course with a transition to face-to-face lectures paired with skills workshops for paediatric trainees in London.

Key messages

What is already known on this topic:

What this study adds:

How this study might affect research, practice, or policy:
Longitudinal study of COVID-19 stay-at-home orders’ impact on deaths of despair in the United States, January 2019 to December 2020
Authors: Kaslow Nadine J , Lewis Patricia C , Cheong Yuk F , Yount Kathryn M
Published: May 2023

Background

The COVID-19 pandemic led to increase in mental health problems and substance misuse. Yet, little is known about its impact on rates of deaths of despair (death by suicide and drug overdose). Our objective was to determine the impact of COVID-19 stay-at-home orders on deaths of despair using population-level data. We hypothesized that the longer duration of stay-at-home orders would increase rates of deaths of despair.

Methods

Utilizing quarterly suicide and drug-overdose mortality data from the National Center for Health Statistics from January 2019 through December 2020, we estimated fixed-effects models to examine the effects of the duration of stay-at-home orders as differentially implemented in 51 jurisdictions in the United States on each outcome.

Results

Controlling for seasonal patterns, the duration of jurisdictional-level stay-at-home order was positively associated with drug-overdose death rates. The duration of stay-at-home orders was not associated with suicide rates when adjusting for calendar quarter.

Conclusions

Findings suggest an increase in age-adjusted drug-overdose death rates in the United States from 2019 to 2020 possibly attributable to the duration of jurisdictional COVID-19 stay-at-home orders. This effect may have operated through various mechanisms, including increases in economic distress and reduced access to treatment programs when stay-at-home orders were in effect.
Field of Study and Financial Problems: How Economics Reduces the Risk of Default
Authors: Hvidberg Kristoffer Balle
Published: May 2023

This paper documents how extensive economic education can reduce the risk of getting into financial trouble by comparing people who enter business and economics programs with people who enter other higher education programs. To identify the causal effect, I exploit GPA admission thresholds that quasi-randomize applicants near the thresholds into different higher education programs. I find that admission to an economics program reduces the probability of loan default and delinquency by one half. This large reduction is associated with changes in financial behavior, but it is not associated with differences in the level or stability of people’s income.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
COVID-19 disease and vaccination in pregnancy: understanding knowledge, perceptions and experiences among pregnant women and community leaders in Uganda
Authors: Nalubega Phiona , Namugumya Ritah , Zalwango Flavia , Ssali Agnes , Mboizi Robert , Hookham Lauren , Seeley Janet , Le Doare Kirsty
Published: May 2023

Background

We investigated pregnant women and community leaders’ knowledge, perceptions and experiences of the coronavirus disease 2019 (COVID-19) vaccination program during pregnancy in Uganda and how this changed over the course of the pandemic.

Methods

We conducted 20 in-depth interviews (IDIs) and two group discussions (GDs) with pregnant women and four GDs with community leaders in Kawempe division of Kampala, Uganda. The first round of IDIs/GDs were carried out in March 2021. In July 2021, telephone IDIs were conducted with 7 pregnant women and 10 community leaders randomly selected from first-round interview participants. Themes were analysed deductively drawing codes from the topic guides.

Results

In the first round, the majority of participants thought COVID-19 was not real because of misconceptions around government messaging/motivation and beliefs that Africans would not be affected. In the second round, participants recognised COVID-19 disease, because of rising case numbers and fatalities. There was increased awareness of the benefits of the vaccine. However, pregnant women remained unsure of vaccine safety and quality, citing side effects like fevers and general body weakness. Role models and coherent public health messaging and healthcare workers were key enablers of vaccine uptake.

Conclusions

Targeted and sustained COVID-19 communication and engagement strategies are needed, especially for pregnant women and others in their communities, to improve vaccine confidence during outbreaks.
Integrative taxonomy, larval biology and functional morphology of the little known gall-forming coral endoparasite Petrarca (Thecostraca: Ascothoracida)
Authors: Kolbasov Gregory A , Savchenko Alexandra S , Yu Meng-Chen , Tsao Yao-Feng , Ganmanee Monthon , Chan Benny K K
Published: May 2023

Petrarca is an ascothoracidan endoparasite in scleratinian dendrophyllid corals. Petrarca can stimulate coral growth, forming a gall chamber to house itself inside the coral skeleton. The diversity, molecular phylogeny and feeding ecology of Petrarca are understudied. This is the first study of Petrarca to be based on light and scanning electron microscopy to document the fine-scale external and functional morphology of its trophi and other structures. A combined molecular and morphological approach revealed at least four closely related species of Petrarca, P. goanna, P. morula, Petrarca nozawai sp. nov. and Petrarca rubus sp. nov. in Turbinaria and Astreopora corals in Asia. Carapace shape and fine morphology, ultrastructure of the antennular aesthetasc, morphological characteristics of the trophi and the shape and size of the penis rami are diagnostic characters. Several morphological characters, which are all probably synapomorphies, have been proposed to distinguish the genus Petrarca from other Ascothoracida. Mouthparts morphology of Petrarca are developed for cutting and chewing, rather than for piercing and sucking as in many other Ascothoracida. The external surface of the carapace of Petrarca is ornamented with densely packed secretory papillae used putatively for the chemical dissolution of the substrate necessary for the formation of the gall chamber.
Development of Primers Specific for Detection of Litylenchus crenatae, the Causal Agent of Beech Leaf Disease, in Plant Tissue
Authors: Burke David J. , Hoke Adam J. , Reed Sharon , Martin Danielle , Carrino-Kyker Sarah R. , Pitts Mary C. , Battagin Samantha
Published: May 2023

Beech leaf disease (BLD), an emerging threat to American beech (Fagus grandifolia) in the northern United States and Canada, was recently confirmed to be caused by the nematode Litylenchus crenatae subsp. mccannii (hereafter L. crenatae). Consequently, there is a need for a rapid, sensitive, and accurate method for detecting L. crenatae for both diagnostic as well as control purposes. This research developed a new set of DNA primers that specifically amplify L. crenatae and allow for accurate detection of the nematode in plant tissue. These primers have also been used in quantitative PCR (qPCR) to determine relative differences in gene copy number between samples. This primer set provides an improved, effective tool for monitoring and detecting L. crenatae in temperate tree leaf tissue which is necessary to understand the spread of this emerging forest pest and to develop management strategies.
Reliability of a Novel Classification System for Thoracic Disc Herniations
Authors: Farber S. Harrison , Walker Corey T. , Zhou James J. , Godzik Jakub , Gandhi Shashank V. , de Andrada Pereira Bernardo , Koffie Robert M. , Xu David S. , Sciubba Daniel M. , Shin John H. , Steinmetz Michael P. , Wang Michael Y. , Shaffrey Christopher I. , Kanter Adam S. , Yen Chun-Po , Chou Dean , Blaskiewicz Donald J. , Phillips Frank M. , Park Paul , Mummaneni Praveen V. , Fessler Richard D. , Härtl Roger , Glassman Steven D. , Koski Tyler , Deviren Vedat , Taylor William R. , Kakarla U. Kumar , Turner Jay D. , Uribe Juan S.
Published: May 2023

Study Design.

Cross-sectional survey.

Objective.

To assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).

Summary of Background Data.

TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions.

Methods.

Our proposed system classifies 5 types of TDHs using anatomical and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1-4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system’s reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types.

Results.

High agreement was found for the classification system, with 80% (range 62-95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches.

Conclusions.

This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represent lines of future study.
Pediatric Keloids and Review of the Efficacy of Current Treatment Modalities
Authors: Hirsch Yonatan , Waterman Christy L. , Haber Roger
Published: May 2023

BACKGROUND

Keloids and hypertrophic scars are the result of excessive fibroblast proliferation and collagen deposition in the wound healing process, leaving patients with irritating and cosmetically displeasing lesions. Despite there being numerous modalities for treatment, keloids are notoriously recalcitrant to therapy and recurrence rates are high.

OBJECTIVE

Because many keloids begin to develop during childhood and adolescence, it is important to better understand which treatment options may be best suited toward the pediatric population specifically.

METHODS

We reviewed 13 studies that focus specifically on effectiveness of treatment options for keloids and hypertrophic scars in the pediatric population. These studies cover 545 keloids in 482 patients, all aged 18 and younger.

RESULTS

Many treatment modalities were used, with multimodal treatment being the most common (76%). There were 92 instances of recurrence, with a total recurrence rate of 16.9%.

CONCLUSION

Data from the combined studies suggest that keloid development is less common before adolescence and that higher rates of recurrence are observed among patients who have received monotherapy compared with those who received multimodal treatments. More well-designed studies with standardized ways of assessing outcomes are needed to expand our understanding on how to optimally treat keloids in the pediatric population.
What Physician Assistants Prefer in a Postprofessional Doctorate Program: A Cross-Sectional Rating and Rankings Study
Authors: Gillette Chris , Bodner Gayle B. , Bell Sisson Caroline Grey , Bates Nathan , DeTroye Alisha , Hussaini Sobia S. , Crandall Sonia
Published: May 2023

Purpose

The physician assistant (PA) literature has focused on the implications of creating an entry-level doctoral degree; however, there is scant primary literature on postprofessional doctorates, which are becoming more popular as the number of institutions offering them increases. The purposes of this project were to: (1) describe interest and motivation of currently practicing PAs to enroll in a postprofessional doctorate program and (2) identify the most- and least-preferred attributes of a postprofessional doctorate program.

Methods

This was a quantitative cross-sectional survey of recent alumni from one institution. Measures included interest in obtaining a postprofessional doctorate, a nonrandomized Best-Worst Scaling (BWS) exercise, and motivators for enrolling in a postprofessional doctorate. The main outcome of interest was the BWS standardized score for each attribute.

Results

The research team received 172 eligible responses (n = 172, response rate = 25.83%). Results indicate that 47.67% of respondents (n = 82) expressed interest in a postprofessional doctorate. The most preferred doctorate program attribute was a clinically based program, ending with a residency, conferring a Doctor of Medical Science (DMSc) degree, with a hybrid course delivery.

Discussion

This sample included various interests, motivations, and preferred program attributes. Understanding these factors may help inform the design and redesign of doctoral programs.
Turning HEADSS: Utilizing Coached Role-Play to Increase Student Self-Efficacy with Adolescent Interviewing Skills
Authors: Fernandez Tanya , Kaul Paritosh
Published: May 2023

Introduction

Adolescent patients make up a significant number of the primary care population, yet medical training specific to adolescents is inadequate and challenging.
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Medical trainees report feeling less competent caring for adolescents compared to caring for infants and children.
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Framed after an adolescent HEADSS (Home, Education/employment, peer group Activities, Drugs, Sexuality and Suicide/depression) interview role-play activity for pediatric clerkship students,
1,2
this study sought to investigate the impact that facilitated role-play would have on physician assistant (PA) students' self-perceived knowledge, skills, and comfort in interviewing adolescents.

Methods

A coached role-play focused on skills used during a HEADSS interview was used to demonstrate the communication skills inherently important to adolescent encounters. Pre- and postintervention surveys were administered.

Results

Data from 2 sequential cohorts (n = 88) showed statistically significant improvement in pre- versus postsession self-perception of knowledge (p ≤ 0.0001) and skills (p ≤ 0.0001), but not in comfort (p = 0.1610).

Discussion

Teaching PA students how best to engage with adolescents can be done effectively via coached role-play.
Cephalic inferior vena cava non-clamping technique versus standard procedure for robot-assisted laparoscopic level II–III thrombectomy: a prospective cohort study
Authors: Zhang Yu , Bi Hai , Fu YunJie , Zhang HongXian , Zhang ShuDong , Liu Ke , Liu Lei , Li Nan , Liu Cheng , Tian XiaoJun , Ma LuLin
Published: May 2023

Background:

Renal tumour can invade the venous system and ~4–10% patients with renal tumour had venous thrombus. Although the feasibility of robot-assisted laparoscopic inferior vena cava thrombectomy (RAL-IVCT) in patients with inferior vena cava (IVC) thrombus has been validated, the wide application is still a challenge due to the complexity of IVC control. The objective was to describe our novel cephalic IVC non-clamping technique and to compare the outcomes versus standard RAL-IVCT.

Materials and methods:

A prospective single-centre cohort containing 30 patients with level II–III IVC thrombus was established since August 2020. Fifteen patients underwent cephalic IVC non-clamping approach and 15 patients received standard RAL-IVCT. The authors decided the surgical technique according to the echocardiographic assessment of the right heart and IVC.

Results:

The non-clamping group had less operative time (median 148 versus 185 min, P=0.04), and lower Clavien-grade II complication rate (26.7% versus 80.0%, P=0.003). The median intraoperative blood loss were 400 ml [interquartile range (IQR) 275–615 mL] and 800 ml (IQR 350–1300 ml), respectively (P=0.05). The most common complication in standard RAL-IVCT group was liver dysfunction. No gas embolism, hypercapnia or tumour thrombus dislodgment occurred in non-clamping group. After a median follow-up of 17.0 months (IQR 13.5–18.5 months) and 15.5 months (IQR 13.0–17.0 months), two patients (16.7%) in the non-clamping group and 3 patients (20.0%) in the standard RAL-IVCT group died (hazard ratio 0.59, 95% CI 0.10–3.54, P=0.55).

Conclusions:

The cephalic IVC non-clamping technique can be performed safely with acceptable surgical outcomes and short-term oncologic outcomes in patients with level II–III IVC thrombus. Compared with standard procedure, it had less operative time and lower complication rate.
Clinical evaluation of the first semi-active total knee arthroplasty assisting robot made in China: a retrospective propensity score-matched cohort study
Authors: Yang Pengfei , He Rui , Lei Kai , Liu Liming , Yang Liu , Guo Lin
Published: May 2023

Objective:

The precision of overall alignment and knee morphotype after robot-assisted total knee arthroplasty has been fully confirmed. This study aims to conduct a clinical evaluation of the first China-made semi-active total knee arthroplasty assisting robot.

Methods:

After a 1 : 2 propensity score matching, that is, a matched cohort study, patients were matched to the robot group (52 cases) and the conventional group (104 cases). The robot group received osteotomy according to preoperative planning, while the conventional group adopted preoperative planning based on the full-length radiograph and received conventional osteotomy. Perioperative clinical indicators, such as operation time, tourniquet time, hospitalization days, intraoperative bleeding, and hemoglobin level of the two groups were recorded; radiological indicators of postoperative prosthesis position, including hip-knee-ankle angle, frontal femoral component angle, frontal tibial component angle, lateral femoral component angle, and lateral tibial component angle were also recorded; deviations and outliers of the radiological indicators were calculated.

Results:

Compared with the conventional group, the operation time and tourniquet time of the robot group were longer, and the postoperative hemoglobin level decreased less, the differences were statistically significant; the lateral tibial component angle of the conventional group was 80.9°±3.6°, which was smaller than 86.7 °±2.3° of the robot group, the difference was statistically significant (P<0.001); except for lateral femoral component angle, the absolute deviations of the radiological indicators in the robot group were significantly smaller than that in the conventional group (P≤0.001); the outliers of the radiological indicators in the robot group were significantly smaller than that in the conventional group with a statistical difference (P<0.05).

Conclusion:

Compared with the conventional group, the operation time of the robot group was relatively longer, but the perioperation blood loss was less. The robot group could better control the posterior inclination of the tibial prosthesis, and the absolute deviations and outliers of the prosthesis position were relatively smaller. There was no difference in short-term clinical score between the two groups.
Bibliometric analysis of academic journal recommendations and requirements for surgical and anesthesiologic adverse events reporting
Authors: Sholklapper Tamir N. , Ballon Jorge , Sayegh Aref S. , La Riva Anibal , Perez Laura C. , Huang Sherry , Eppler Michael , Nelson Gregg , Marchegiani Giovanni , Hinchliffe Robert , Gordini Luca , Furrer Marc , Brenner Michael J. , Dell-Kuster Salome , Biyani Chandra Shekhar , Francis Nader , Kaafarani Haytham M.A. , Siepe Matthias , Winter Des , Sosa Julie A. , Bandello Francesco , Siemens Robert , Walz Jochen , Briganti Alberto , Gratzke Christian , Abreu Andre L. , Desai Mihir M. , Sotelo Rene , Agha Riaz , Lillemoe Keith D. , Wexner Steven , Collins Gary S. , Gill Inderbir , Cacciamani Giovanni E.
Published: May 2023

Background:

Standards for reporting surgical adverse events (AEs) vary widely within the scientific literature. Failure to adequately capture AEs hinders efforts to measure the safety of healthcare delivery and improve the quality of care. The aim of the present study is to assess the prevalence and typology of perioperative AE reporting guidelines among surgery and anesthesiology journals.

Materials and methods:

In November 2021, three independent reviewers queried journal lists from the SCImago Journal & Country Rank (SJR) portal (www.scimagojr.com), a bibliometric indicator database for surgery and anesthesiology academic journals. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. Quartile 1 (Q1) was considered the top quartile and Q4 bottom quartile based on the journal impact factor. Journal author guidelines were collected to determine whether AE reporting recommendations were included and, if so, the preferred reporting procedures.

Results:

Of 1409 journals queried, 655 (46.5%) recommended surgical AE reporting. Journals most likely to recommend AE reporting were: by category surgery (59.1%), urology (53.3%), and anesthesia (52.3%); in top SJR quartiles (i.e. more influential); by region, based in Western Europe (49.8%), North America (49.3%), and the Middle East (48.3%).

Conclusions:

Surgery and anesthesiology journals do not consistently require or provide recommendations on perioperative AE reporting. Journal guidelines regarding AE reporting should be standardized and are needed to improve the quality of surgical AE reporting with the ultimate goal of improving patient morbidity and mortality.