bluuebunny/crossref_metadata_2025 huggingface dataset:
H - 29 Delivering Culturally Sensitive Neuropsychological Assessment Feedback: a Case Study of Atypical Neurosyphilis
Authors: Grant Jeremy , Hamlet Kristin , Hu Calvin , Montalvo Mayra
Published: October 2023

Objective

To demonstrate the neuropsychological correlates of atypical neurosyphilis and the importance of delivering assessment results in a culturally sensitive manner.

Method

The patient was a 52-year-old African American male with 12 years of education who was raised in a rural, southern town and worked as a delivery driver. He was hospitalized after three weeks of altered mental status, memory loss, and seizures. Electroencephalography (EEG) showed left lateralized periodic discharges. Magnetic resonance imaging (MRI) showed hyperintensities in the left hippocampus and amygdala consistent with limbic encephalitis. Cerebrospinal fluid studies revealed lymphocytic pleocytosis and hypoglycorrhachia. Rapid plasma regain and venereal disease tests were positive for syphilis in serum and CSF. He was initially treated with empiric antibiotics and antiseizures medications with modest improvement. His mental status improved after penicillin treatment, and he was discharged after 14 days. Repeat MRI showed cortical atrophy in the left medial frontal lobe and left hippocampus.

Results

The patient demonstrated executive dysfunction (e.g., set-loss and source memory errors) and poor performance across verbal and visual memory tasks. He also demonstrated an inaccurate understanding of the possible causes of his illness. Feedback was delivered across two sessions: one session to discuss test results and a second session with the patient and his wife to discuss syphilis as a sexually transmitted infection and address the historical context of syphilis among African American men.

Conclusions

Neurosyphilis can present as limbic encephalitis and can mimic autoimmune encephalitis and other infectious diseases. Tailoring assessment feedback to a patient’s sociocultural context is vital for encouraging continued treatment.
H - 36 Identification and Management of Post-Concussion Syndrome within the Hispanic Population
Authors: Duarte Andres , Rios Guevara Linda V , Alcina Jorge , Gonzalez Dayron , Perez-Haddock Yanelee , Villafana Mei-Ling
Published: October 2023

Objective

This systematic literature review sought to investigate Post-Concussion Syndrome (PCS) considerations within Hispanic populations.

Method

A systematic review of the literature was conducted from 2001 to 2023. We conducted a bibliographical search of peer-reviewed articles through databases PubMed and Google Scholar using keywords Post-Concussion Syndrome, Hispanic Populations, and Traumatic Brain Injury. Included in the review were articles designated as literature reviews published in English examining PCS within the Hispanic population. From the initial search results, 10 articles were extracted for review. After this search, 4 articles were retained. Articles that were excluded were not in English, did not contain samples of Hispanic individuals, and/or did not include PCS.

Results

The literature highlighted clinical features, diagnosis, and management of PCS in athletes, and in individuals who had been admitted to an inpatient unit. Patients who reported higher levels of pre-injury depression and anxiety were more likely to develop PCS. Additionally, the severity of the initial injury was not a significant predictor of PCS.

Conclusions

The current literature suggests a lower incidence of PCS in Hispanic individuals may exist. However, more research is needed to confirm this relationship and explore potential underlying factors. A possible mediator for this relationship may be increased levels of familial social support. Limitations of the present review include scarce empirical literature in this area of study and small sample sizes of some of the available studies.
H - 38 Neuropsychological Evaluation and Cognitive Profile of Stiff Person Syndrome (SPS) in a Predominantly Spanish-Speaking Older Adult: Is Cognition Really Affected?
Authors: Saldana Daniel G , Suarez Paola
Published: October 2023

Objective

Stiff Person Syndrome (SPS) is a rare autoimmune disorder that affects approximately one in every million people. It is characterized by progressive muscle rigidity and intense, episodic muscle spasms triggered by environmental and psychosocial (i.e., emotional stress) factors. While original diagnostic criteria for classical SPS included the absence of frank cognitive impairment (aside from what would be expected from seizures), more recent literature suggests a number of neurocognitive difficulties potentially associated with reduced GABA levels.

Method

The following case study presents a 73-year-old, predominantly Spanish-speaking man with 14 years of education. His medical history is notable for over 20 years with diagnosed SPS, hypertension well managed with medications, and the absence of other medical conditions that may contribute to cerebrovascular burden. He completed a comprehensive neuropsychological evaluation in Spanish.

Results

Overall, his profile was notable for mild inefficiencies in frontal-subcortical functions, with a relative weakness in rote learning and retention. He performed remarkably well relative to his level of motor compromise. There was no evidence of either a mild or major neurocognitive disorder, and his clinical interview and behavioral inventories were suspicious for a personality disorder.

Conclusions

Recent literature proposes SPS is related to impairment in verbal learning, retention, fluency, processing speed, and attention. The present case corroborated, at most, mild inefficiencies in these previously documented areas. Careful consideration should be used in the evaluation of studies on SPS and cognition, particularly in determining whether samples had high degrees of comorbid conditions (i.e., cerebrovascular burden) that could help explain positive findings related to cognition.
H - 42 Multivariate Base Rates for the NIH Toolbox Emotion Battery in the Spanish-Speaking Normative Sample
Authors: Leong Sharon E , Ingram Eric O , Karr Justin E
Published: October 2023

Objective

This study involved the calculation of multivariate base rates for the NIH Toolbox Emotion Battery (NIHTB-EB) for the Spanish-speaking normative sample, stratifying by sociocultural variables.

Method

Participants were 224 Spanish-speaking adults from the NIHTB norming study (M = 42.2 years-old, SD = 16.3; 40.2% Male; 100% Hispanic/Latinx). Frequencies of obtaining one or more “potentially problematic” emotion scores (i.e., either T60, depending on scale orientation) were calculated with stratifications by gender, education, country of birth and education, bilingualism, and household income. The NIHTB-EB includes 17 scales measuring negative affect, social satisfaction, and psychological well-being.

Results

When interpreting all 17 scales, 59.8% of participants had one or more potentially problematic score(s). Only education was related to problematic score frequencies (p < 0.014, phi = 0.19). Adults with less than high school education (68.4%) had the highest frequency scores compared to adults with a high school diploma (42.3%) or greater education (54.5%). Although non-significant, bilingual adults (66.7%) tended to have more potentially problematic scores than monolingual adults (56.8%; p = 0.16, phi = 0.09) and higher income (49.0%) was related to more potentially problematic scores than lower income (63.8%; p = 0.07, phi = 0.14).

Conclusions

Most Spanish-speaking adults obtained one or more potentially problematic NIHTB-EB scores, with more emotional difficulties associated with less education and modestly associated with lower socioeconomic status and bilingualism. Future research may explore how these variables interact with emotional health among Spanish-speaking Hispanic/Latinx adults.
H - 43 Uncovering the Impact of Childhood Sexual Trauma on Executive Functioning: a Case Study of ADHD Misdiagnosis
Authors: Obenauf Caterina
Published: October 2023

Objective

Numerous studies have reported executive function differences among victims of childhood sexual abuse. This case study aims to expand upon the existing literature on the intersection of neuropsychological symptoms and trauma from childhood sexual abuse.

Method

We present a case of an 18-year-old white woman with a history of sexual trauma and deficits in executive functioning. She first demonstrated deficits in executive functioning at age 10, around the beginning of her sexual abuse. She had been diagnosed with ADHD by her psychologist in early adolescence; results of diagnostic tests will be briefly described. According to this client, she was not assessed for trauma history. This client presented to the student counseling center of her university to be seen for individual therapy for depressive symptoms. The role of intersectionality of immigration, sexism, and military family systems in this client’s presenting concerns will be discussed.

Results

In addition to depressive symptoms, the client presented with symptoms of executive dysfunction, impaired decision-making skills (e.g., risky sexual behavior), and poor memory. Throughout therapy, it was evident that her symptoms resulted from posttraumatic stress from childhood sexual abuse.

Conclusions

This case highlights the role of poly-etiologic factors (childhood sexual abuse, immigration, sexism, military) in the development and progression of neuropsychological symptoms. It emphasized the importance of assessing for trauma as a potential cause of neuropsychological symptoms. Additionally, the case underscores the importance of understanding intersecting identities and oppressive systems when evaluating and treating individuals with neuropsychological symptoms and histories of trauma, sexism, and immigration.
H - 48 Preliminary Normative Data for a Letter Fluency (PAN) Test Via Teleneuropsychology for Puerto Rican Adults
Authors: Zambrana-Bonaparte Hjalmar M , Serrano-Roman Carolina F , Tapia-Nazario Glariangeliz , Padilla-Ruiz Alondra , Vega-Ortiz Antonio , Seguel-Jimenez Anais , Ramos Nicole , Pagan-Palermo Lymaris , Rodriguez-Beato Johanna , Puente Antonio E
Published: October 2023

Objective

Explore internal consistency, concurrent validity, and impact of demographic factors to provide preliminary normative data for a teleneuropsychological (TeleNP) and culturally-sensitive letter fluency (PAN) test based on Benton and Hamsher’s (1976) approach (two easy and one difficult letter) for Spanish-speaking Puerto Ricans.

Method

102 cognitively healthy Puerto Ricans (Female: 69%; Age: M = 63.2, SD = 6.1; Education: M = 16.2, SD = 3.6) residing on the island were administered the letters PAN and a category (Animal) fluency task via Zoom, as part of a larger neuropsychological battery. Cronbach’s alpha was applied to explore PAN’s internal consistency. Concurrent validity was examined through Pearson correlation between PAN and Animal fluency. Analyses of variance were used to explore the effect of age, education, and sex. Descriptive statistics were conducted to develop normative data stratified by statistically significant demographics.

Results

Cronbach’s alpha for PAN was α = 0.833. Each letter had a positive and significant correlation with Animal fluency (0.477, 0.471, 0.471; p < 0.001). Only age and education significantly impacted performance on all letters. M and SD raw scores among the sample were P (M = 14.0; SD = 4.5), A (M = 11.8; SD = 4.1), N (M = 8.8; SD = 3.5).

Conclusions

Data suggest good internal reliability and moderate concurrent validity. Results supports that each consecutive letter is more difficult. This study provides preliminary normative data for cognitively healthy Puerto Rican adults, which can improve diagnostic accuracy while providing clinicians with a TeleNP and culturally-appropriate testing tool. Future research with PAN should include clinical samples.
H - 50 Fetal Alcohol Spectrum Disorders and the Criminal Justice System: a Case Study
Authors: Zavala Jorge Guzman , Solomon Yene , Safi Diomaris
Published: October 2023

Objective

Research has identified notable features when considering a diagnosis of FASD. Gestational exposure to alcohol significantly increases the probability of FASD; with Attention Deficit Hyperactive Disorder (ADHD) being the most frequent comorbidity. Both disorders share commonalities in their behavioral phenotype which may likely lead to have negative life outcomes including secondary disabilities when compared to their ADHD-only diagnosed counterparts. This case study provides a process for diagnostic clarification and treatment recommendations within a forensic setting.

Method

Starwars, a minor with a documented history of probable intrauterine polysubstance exposure, whose symptoms were noted at age 4, included hyperactivity, attentional, and behavioral deficits. In the absence of medical records, a detailed developmental history was established to opine on the juvenile’s Mental State at the Time of the Offense (MSE- offense) of criminal threats on school property.

Results

Objective testing noted difficulty with executive function, verbal and non-verbal learning, and attention. In addition, independent school-based testing identified deficits in learning, behavior, and emotion regulation which is consistent with expected neuropsychological assessment results.

Conclusion

In the case of Starwars, the referral question sought to establish an MSE-Offense. Considering the probable prenatal alcohol exposure, established behavioral deficits, neurodevelopmental disorder, and cognitive profile - Starwars’ ADHD and probable Alcohol- Related Neurodevelopmental Disorder, may have significantly impacted Starwars’ ability to appreciate the nature and quality or wrongfulness of his actions.
H - 52 Impact of Spanish Dialect on Artificial Intelligence in Assessing Expressive Language
Authors: Nieves Emmanuel Rosario , Rosenstein Leslie D , Zaldua Carla , Hernando Xabier , Gabirondo Peru , Lacritz Laura , Kaser Alyssa N , Cullum C Munro
Published: October 2023

Objective

AcceXible is a new Artificial Intelligence (AI) tool that identifies speech biomarkers for cognitive impairment that was developed in Spain. Good sensitivity (85.7%) and specificity (92.8%) in distinguishing patients with mild cognitive impairment from individuals with normal functioning have been established with populations in Spain, and preliminary data are similar in the United States and the United Kingdom. In this study, we assessed transcription accuracy for Spanish speakers in the US originating from Latin American countries (LAC) and the effect it may have on the performance of Accexible’s AI model.

Method

AcceXible involves participants completing several verbal tasks via computer interface, including Animal Naming (AN). Transcription accuracy for 16 Spanish-speaking patients from LAC in Texas was assessed by comparing data obtained from hand scoring of AcceXible AN to data from different customized expressive language transcription tools used in AcceXible’s platform. The transcription tool was updated based on inconsistencies found.

Results

AcceXible’s customized transcription tool was initially found to miss 34% of total items on AN due to differences in vocabulary and pronunciation between LAC and Spain. The transcription tool was modified to recognize the LAC vocabulary and pronunciations, which resulted in 25.84% increased accuracy for an overall transcription accuracy of 91%.

Conclusions

AcceXible is a useful tool for efficiently assessing expressive language, and the current findings highlight the need to consider not just language, but also nationality when adapting tests across cultures.
H - 63 Desarrollo de Habilidades Clínicas del Idioma Español
Authors: Judd Theodore L , Zavala Jorge Guzman , Safi Diomaris , Sanchez Orlando
Published: October 2023

Objetivo

Mejorar los servicios neuropsicológicos para hispanoparlantes y al mismo tiempo cultivar las habilidades lingüísticas de los neuropsicólogos que proveen servicios en español. Los profesionales que hablan español e inglés, pero cuya educación clínica fue primordialmente en inglés, generalmente necesitan apoyo para desarrollar sus habilidades clínicas en español. En busca de este objetivo, este póster se presentará y se discutirá en español, excepto con aquellos cuyas habilidades lingüísticas prohíban dicha discusión.

Método

Los autores han desarrollado sus propias competencias clínicas de español y han ayudado a otros a hacerlo. Comparten aquí sus experiencias y técnicas para hacerlo. Estos incluyen: apoyo institucional; apoyo de la comunidad de hispanoparlantes; el establecimiento de metas; experiencia de inmersión lingüística; aprendizaje de español dirigido clínicamente; acceso a literatura, pruebas y otros recursos profesionales en español; supervisión/consulta en español; y trabajo clínico progresivo en español.

Resultados

El apoyo institucional para el aprendizaje de competencia clínica en español es variable, desde discriminación lingüística hasta apoyo lingüístico competente. El estado de aprendizaje de idiomas del practicante puede lograr habilidades y servicios competentes en español, prevenirlos o presentar dilemas éticos.

Conclusiones

El apoyo apropiado para el aprendizaje de un español-clínico, al nivel competente, es una estrategia importante; aun, es implementada de manera inconsistente, poco reconocida y poco desarrollada, para mejorar los servicios neuropsicológicos para los hispanoparlantes. Es un componente crítico de la diversidad en neuropsicología, que debe implementarse para lograr importantes objetivos de equidad en el servicio.
H - 68 Effects of Depression, Apathy and Anxiety in Hispanic Parkinson Disease Individuals’ Cognition
Authors: Lauren Santos G , Bowers Dawn , Kenney Lauren E , Ratajska Adrianna M , Rodriguez Katie , Schade Rachel
Published: October 2023

Objective

Previous research in individuals with Parkinson’s disease (PD) found that heightened apathy is associated with worse executive function. Most studies to-date have involved primarily White, non-Hispanic individuals. Indeed, recent research suggests that mood/motivation’s relationship to cognitive decline differs between Hispanic and non-Hispanic individuals (Thakur et al., 2021). In this study, we examined relationships between depression, apathy, anxiety, and cognition in Hispanic PD participants who were seen in a specialized movement disorders center.

Methods

Participants included 31 non-demented Hispanic individuals with PD (age mean = 59.94, SD = 8.49 years; education mean = 14.39, SD = 2.79; 83.9% male) who completed neuropsychological and mood measures (Beck Depression Inventory-II, Apathy Scale, STAI-Trait Anxiety Scale). Prevalence estimates were calculated using established cut-offs (BDI-II:14, AS:14, STAI-Trait:40). Cognitive raw scores were z-scored and averaged into the composites: attention (WAIS-III Digit Span Forward, Backward), processing speed (Stroop Word, Trails A), executive function (Trails B, Stroop Color-Word), and memory (Hopkin’s Verbal Learning Test, WMS-III Logical Memory delayed recalls). Non-parametric partial correlations (correcting for age/education) assessed mood and cognitive composite relationships.

Results

17% had clinically significant depressive symptoms, 12% had apathy, and 35% had anxiety. More depressive symptoms were significantly associated with worse memory (r = −0.54, p = 0.007). Greater anxiety symptoms trended with worse processing speed (r = −0.41, p = 0.065) and memory (r = −0.38, p = 0.094). Apathy did not relate to cognition (p’s > 0.05).

Conclusion

This pattern of associations differs from existing studies with predominantly White, non-Hispanic samples (Butterfield et al., 2010; Ratajska, et al.,2022), highlighting the importance of further investigating ethnic differences in PD.
H - 69 Making Diagnostic Decisions Using Linguistically Congruent Neuropsychological Assessment in a Monolingual Low Education Latino: a Single Case
Authors: Ventura Melanie , Metzler Alison
Published: October 2023

Objective

As life expectancy and Latino populations increase in the United States, it is important to provide linguistically congruent neuropsychological assessments to assist in the treatment and diagnosis of neurodegenerative processes. This case used a linguistically congruent evaluation and appropriate norms in a 72-year-old Latin male with low education, to inform treatment recommendations.

Method

A 72-year-old Latin male with five years of education was referred by his neurologist in the context of cognitive, behavioral, and functional decline over the past several years. He was educated outside of the United States, in a Spanish-speaking country, and speaks limited English. Therefore, testing was administered in Spanish. All test data were compared to other Spanish-speaking clinical patients with low education levels from his country of origin when available (11 articles).

Results

Overall given the evidence, he was diagnosed with Mild Neurocognitive Disorder due to Multiple Etiologies, with behavioral disturbance. His profile revealed weaknesses in verbal learning and memory, attention, and psychomotor processing speed. However, when compared to non-corrected norms, he performed significantly different (at least 1 SD) across several measures.

Conclusions

Using a linguistically congruent evaluation, in addition to a compilation of age and education-corrected norms, we came to a diagnostic conclusion of a Mild Neurocognitive Disorder. If the normative data not been corrected for age and education, his impairments in visuospatial abilities and attention would have been inflated. As the Latino population continues to age, it becomes increasingly important to develop ways to assess this population appropriately.
H - 71 Development and Implementation of a Neuropsychology Program for Spanish-Speaking Patients at Cleveland Clinic Nevada
Authors: Wong Christina G , Barreto Abrams Jesús O , Pudumjee Shehroo B , Cobos Kimberly L , Miller Justin B , Suarez Paola
Published: October 2023

Objective

There is a significant need for culturally-informed neuropsychology services for patients from underrepresented communities, particularly those with limited English proficiency. Given the finite number of bilingual neuropsychologists, working with interpreters and bilingual psychometrists is important for increasing access to equitable care, though many neuropsychologists lack training in these approaches. We present a model for the development and implementation of a neuropsychology program for Spanish-speaking patients in an outpatient academic medical setting.

Method

To develop our service, we first identified the primary patient population to be served and common referral questions. We then consulted with national and international experts to identify best practices for establishing a new clinical service line for Spanish-speaking patients, which included a survey of available Spanish-language tests and normative data, resources for interpretation, and case consultation.

Results

After consulting with colleagues at Cleveland Clinic Ohio and UCLA, we established a formal consultation agreement with a multilingual neuropsychologist with expertise in program development. Consultation focused on best practices for working with interpreters and Hispanic patients, selection of tests and normative sources, and ongoing clinical case consultation. The new service was initiated in March 2023 and includes conducting clinical interviews with virtual interpreters and testing by a bilingual psychometrist. Comprehensive assessments are currently being provided for Spanish-speaking patients, and trainees also receive experience and supervision with these cases.

Conclusions

Developing clinical neuropsychology services for culturally- and linguistically-diverse patients is critically needed. In addition to addressing barriers to care, ensuring high-quality evaluations through prospective consultation with dedicated experts is important for program development.
Paradoxical disease flare, skin infection and hypogammaglobulinaemia in patients with pemphigus vulgaris treated with rituximab
Authors: Padhiyar Jignaben K , Patel Nayan H , Lakum Megha P , Patel Jahnvi R , Patel Kathak A , Patel Harisiddhi B , Chaudhary Prashant B
Published: October 2023

Patients with pemphigus vulgaris can develop hypogammaglobulinaemia after an infusion of rituximab, which manifests clinically as a paradoxical disease flare accompanying skin lesion infection.
Selection of centrality measures using Self-consistency and Bridge axioms
Authors: Chebotarev Pavel
Published: October 2023

We consider several families of network centrality measures induced by graph kernels, which include some well-known measures and many new ones. The Self-consistency and Bridge axioms, which appeared earlier in the literature, are closely related to certain kernels and one of the families. We obtain a necessary and sufficient condition for Self-consistency, a sufficient condition for the Bridge axiom, indicate specific measures that satisfy these axioms and show that under some additional conditions they are incompatible. PageRank centrality applied to undirected networks violates most conditions under study and has a property that according to some authors is ‘hard to imagine’ for a centrality measure. We explain this phenomenon. Adopting the Self-consistency or Bridge axiom leads to a drastic reduction in survey time in the culling method designed to select the most appropriate centrality measures.
Emotion recognition and false belief in deaf or hard-of-hearing preschool children
Authors: Akkaya Emrah , Doğan Murat
Published: October 2023

This study aims to examine emotion recognition and false belief performances of 4–5-year-old (48–71 months) deaf or hard-of-hearing (DHH) children. The performances have been assessed using the Turkish Version of the Theory of Mind Task Battery for Children. The DHH children have been continuing schooling in inclusive settings with an auditory-oral approach. The emotion recognition performances of hearing children (n = 100) and DHH (n = 100) children have appeared to be similar. The ANOVA analysis has revealed that the groups do not differ concerning false belief performances between the ages of 4 and 5.5. However, from the age of 5.5, hearing children have performed better than DHH children. According to correlation analysis, parental education has been determined as a remarkable factor in DHH children’s false belief development. The findings point to the need for research across a wide range of ages to better understand the developmental course of false belief in DHH children.
Trans-oesophageal echocardiography-guided implantation of a cardiac resynchronization therapy pacemaker and successful ablation of the atrioventricular node after TriClip: case report
Authors: Tuohinen Suvi , Aro Aapo , Karvonen Jarkko
Published: October 2023

Background

Edge-to-edge intervention is the most common trans-catheter procedure performed for isolated severe tricuspid regurgitation in high-surgical-risk patients. However, it creates an obstacle for future right ventricular (RV) procedures such as implantation of cardiac implantable electronic devices (CIEDs). Reports of the management of CIED implantation after tricuspid edge-to-edge therapy are scarce.

Case summary

A 76-year-old woman suffered from severe tricuspid regurgitation with New York Heart Association three symptoms despite optimal medical therapy. After a thorough evaluation, the heart team recommended the TriClip procedure as the treatment of choice. However, 12 months after a successful TriClip procedure, rapid atrial fibrillation needed to be addressed with CIED implantation and atrioventricular (AV) node ablation. Pre-procedural planning included the intended posterior location of the CIED to avoid interference with the implanted clip and future AV node ablation. With an additional left ventricular lead positioned anteriorly to the RV lead, the posterior position of the RV lead was secured. Under peri-procedural trans-oesophageal echocardiography (TEE), the planned procedures were performed successfully.

Discussion

A blind manoeuvring of the RV lead may damage the edge-to-edge tricuspid device. In addition, friction due to an overly close contract between the RV lead and the edge-to-edge device may damage the RV lead. A successful and safe CIED implantation and atrioventricular node ablation can be performed after tricuspid edge-to-edge therapy with careful planning and its precise execution under TEE surveillance.
Clinical features and pregnancy outcomes in women with aortopulmonary window defect: case series
Authors: Sefiyeva Giunai Gahraman , Malishevskaya Diana Sergeevna , Chynybekova Aigul Nasiridinovna , Bautin Andrey Evgenievich , Shadrina Ulyana Mikhailovna , Alekseeva Daria Vladimirovna , Urumova Ekaterina Leonidovna , Irtyuga Olga Borisovna
Published: October 2023

Background

Aortopulmonary window is a rare congenital heart defect that results in severe pulmonary arterial hypertension (PAH), Eisenmenger syndrome, and congestive heart failure in the first months of life. Pregnancy is absolutely contraindicated in the patients with this condition.

Case summary

This paper describes two clinical cases of pregnancy in patients (28 and 20 years old) with aortopulmonary window defect, severe PAH, and Eisenmenger syndrome that ended in preterm delivery by caesarean section. One patient died in the postpartum period due to progression of right ventricular heart failure. The younger patient survived childbirth and the postpartum period; later, she continued therapy at the PAH centre.

Discussion

We describe unusual cases of clinical features in pregnant women with aortopulmonary window defect. Due to the rare occurrence and low survival rate of patients with uncorrected aortopulmonary window defect, descriptions of clinical cases of this defect in adults are very rare. It is very important to note the necessity of observation of these patients in specialized centres by a multidisciplinary team of healthcare professionals, due to the high risk of cardiovascular, obstetric complications, and death.
Acoustic ecology of harbour porpoise (Phocoena phocoena) between two U.S. offshore wind energy areas
Authors: Holdman A K , Tregenza N , Van Parijs S M , DeAngelis A I
Published: October 2023

Offshore wind energy is set to develop rapidly in waters off the east coast of the United States. There is considerable overlap between areas proposed for offshore wind development and harbour porpoise habitats in the Gulf of Maine (GOM) and Southern New England waters. Baseline data on the occurrence and foraging activity of porpoises was collected using 10 echolocation-click detectors (F-PODs) from 2020 to 2022. Porpoises were present year-round in the GOM with peak detections in the summer and fall. In line with previous reported distribution patterns, porpoise occurrence in Southern New England was high in fall, winter and spring, but porpoises were largely absent in the summer. One site in the GOM, Mount Desert Rock (MDR), was an anomaly as porpoise detections here were highest in the winter. On average, foraging was identified in 29% of all porpoise detections, with the most foraging occurring at MDR (53%). Results from generalized additive models suggest that time of year, hour of day, lunar illumination, and temperature are significant contributors to porpoise presence and/or foraging effort. European studies show that harbour porpoises exhibit behavioural changes, disruption of foraging and displacement due to wind energy development. Therefore, early identification of areas of importance, mitigating impacts, and monitoring changes is essential for the protection of this species in US waters.
A survey of American residential garden conservation programs
Authors: Fogel Nina S , Zwarun Lara , Schrock Cody D , Camilo Gerardo R
Published: October 2023

Residential gardens constitute a large percentage of the greenspace in urbanized areas. In aggregate, these gardens can provide a significant amount of habitat if they are managed with the aim of supporting wildlife. Recognizing this, there has been an increase in the number of programs that seek to guide homeowners to reform their landscaping practices to create habitat within their yard. These programs offer certification to participants once they have implemented the suggested criteria, which usually consist of installing native plants, providing habitat elements, and eliminating practices that degrade habitat. We used systematic Google searches to identify 115 such residential garden conservation programs in the United States, with the intention of determining how they differ or are the same across their aims, affiliations, certification criteria, and rigor. Results indicate that programs vary greatly across these measures, making collective evaluation of programs to advance the field of residential conservation difficult. Further, the programs vary in how they connect to enrollees and the community through their social media usage, language on yards signs that are awarded with certification, and support they provide through the certification process. These programs may have the potential to engage a substantial number of homeowners and increase urban habitat in the process, but at this juncture more investigations into their conservation outcomes and their interactions with potential and current enrollees are warranted. We follow our analysis with a self-assessment for managers to consider as they design and improve their program’s conservation potential and outreach.
Follow that Spore! Airborne Inoculum Detection as a Decision Aid
Authors: Thiessen Lindsey D.
Published: October 2023

Plant disease management requires early intervention, which has traditionally required extensive scouting and surveillance to guide decision-making. Visual inspection, unfortunately, requires conditions for disease symptom expression and expertise in identifying causal organisms and may delay management strategies that prevent losses associated with a given plant pathogen. Advances in spore trap technology and molecular diagnostic technologies provide opportunities for greater confidence in pathogen detection and implementation by scientists, farmers, and regulatory agencies.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management
Authors: Cheruku Sreekanth R. , Raphael Jacob , Neyra Javier A. , Fox Amanda A.
Published: October 2023

Acute kidney injury (AKI) is a common complication in cardiac surgery patients, with a reported incidence of 20 to 30%. The development of AKI is associated with worse short- and long-term mortality, and longer hospital length of stay. The pathogenesis of cardiac surgery–associated AKI is poorly understood but likely involves an interplay between preoperative comorbidities and perioperative stressors. AKI is commonly diagnosed by using increases in serum creatinine or decreased urine output and staged using a standardized definition such as the Kidney Disease Improving Global Outcomes classification. Novel biomarkers under investigation may provide earlier detection and better prediction of AKI, enabling mitigating therapies early in the perioperative period. Recent clinical trials of cardiac surgery patients have demonstrated the benefit of goal-directed oxygen delivery, avoidance of hyperthermic perfusion and specific fluid and medication strategies. This review article highlights both advances and limitations regarding the prevention, prediction, and treatment of cardiac surgery–associated AKI.
e-GLR Score Predicts Early Graft Loss in Adult Live-Donor Liver Transplantation
Authors: Pamecha Viniyendra , Patil Nilesh Sadashiv , Gattu Tharun , Kumar Guresh , Pattnaik Bramhadatta , Mohapatra Nihar , Sindwani Gaurav , Choudhury Ashok
Published: October 2023

Objective:

This study aimed to analyze risk factors and develop a predictive model for early allograft loss due to early graft dysfunction (EGD) in adult live-donor liver transplantation (LDLT).

Methods:

Data of patients who underwent LDLT from 2011 to 2019 were reviewed for EGD, associated factors, and outcomes. A homogeneous group of 387 patients was analyzed: random cohort A (n = 274) for primary analysis and random cohort B (n = 113) for validation.

Results:

Of 274 recipients, 92 (33.6%) developed EGD. The risk of graft loss within 90 days was 29.3% and 7.1% in those with and without EGD, respectively (P < 0.001). Multivariate logistic regression analysis determined donor age (P = 0.045), estimated (e) graft weight (P = 0.001), and the model for end-stage liver disease (MELD) score (0.001) as independent predictors of early graft loss due to EGD. Regression coefficients of these factors were employed to formulate the risk model: Predicted (P) early graft loss risk (e-GLR) score = 10 × [(donor age × 0.052) + (e-Graft weight × 1.681) + (MELD × 0.145)] − 8.606 (e-Graft weight = 0, if e-Graft weight ≥640 g and e-Graft weight = 1, and if e-Graft weight < 640 g). Internal cross-validation revealed a high predictive value (C-statistic = 0.858).

Conclusions:

Our novel risk score can efficiently predict early allograft loss following graft dysfunction, which enables donor-recipient matching, evaluation, and prognostication simply and reliably in adult LDLT.
Wide Resection for Pediatric Extremity Vascular Malformation—A Tertiary Hospital’s Experience
Authors: Wong Kenneth P.L. , Tan Tessa W.X. , Chan Lester W.M. , Mahadev Arjandas , Cheng Mathew H.W.
Published: October 2023

Background:

Vascular malformations of the extremities (VM) are common benign lesions that tend to grow throughout the patient’s lifetime. They can cause various issues like pain, swelling, and even limb length discrepancies. Sclerotherapy was the preferred treatment choice in previous studies. However, sclerotherapy and many other treatments have the potential to result in higher recurrence rates. Surgical treatment has been shown to be effective and safe in many cases. Hence, this study aims to evaluate the suitability of wide resection surgery for VM to reduce recurrence.

Methods:

Fort-seven VM cases that underwent wide resection were identified retrospectively in the institution of study. Demographics, depth of malformation, whether malformations were local or diffuse, location and size of malformations, and histology records were taken note of. Records of recurrence and postoperative function were also gathered. We utilized self-reported questionnaires, QuickDASH and Lower Extremity Functional Scale, to determine patients’ postsurgical physical function.

Results:

Out of 47 cases that underwent wide resection, we found a recurrence rate of 2.1%. No patients sustained any loss of function postsurgery, with few patients experiencing minor complications like tenderness, hypertrophic scars/keloids, as well as numbness. Good functionality posttreatment was also seen through self-reported questionnaires, with an average score of 2.12 for QuickDASH and 99.96% for LEFS.

Conclusion:

Where margins can be obtained without functional impairment, surgical-wide resection for VM is a viable treatment option to minimize recurrence.

Level of Evidence:

Level—IV.
Rate and Duration of Bone Union for Conservative Treatment in Pediatric Lumbar Spondylolysis
Authors: Kuroshima Kohei , Miyazaki Shingo , Hiranaka Yoshiaki , Ryu Masao , Inoue Shinichi , Yurube Takashi , Kakutani Kenichiro , Tadokoro Ko
Published: October 2023

Study Design.

Retrospective case series.

Objective.

To report the detailed bone fusion rates and duration of treatment in unilateral and bilateral cases of pediatric lumbar spondylolysis (LS).

Summary of Background Data.

Early diagnosis and optimal conservative management for LS are crucial for achieving bony healing without surgery. However, existing research on the conservative treatment of pediatric LS, particularly regarding bone union rates and treatment duration for each stage of bilateral spondylolysis, is limited.

Methods.

We retrospectively analyzed 590 pediatric patients (522 boys and 68 girls) under 18 years of age diagnosed with LS and treated conservatively from 2015 to 2021. The diagnosis was based on computed tomography scans and magnetic resonance imaging findings, with stages classified as very early, early, progressive, or terminal. Patient background, sports history, level and stage of spondylolysis, presence of spina bifida occulta, bone union rate, duration of conservative treatment, and recurrence rate were retrospectively analyzed.

Results.

The overall bone union rate was 81.9%, with a mean conservative treatment duration of 53.7 days. Unilateral LS cases showed decreased bone union rates with stage advancement (very early; 98.2%, early; 96.0%, progressive; 64.3%). Bilateral LS cases with progressive or terminal stage demonstrated low bone union rates (very early/very early; 100%, early/very early; 94.1%, progressive/very early; 66.7%, early/early; 82.9%, progressive/early; 32.3%, progressive/progressive; 23.7%, very early/terminal; 0%, early/terminal; 50.0%, progressive/terminal; 11.1%). The duration of conservative treatment extended as the stage of the main and contralateral lesions progressed, ranging from 39.1 days (very early/none) to 105 days (progressive/terminal). The recurrence rate after bone fusion was 16.6%, with no differences based on lesion stage.

Conclusions.

In this series of 590 patients, conservative treatment yielded high bone union rates for pediatric LS. However, union rates decreased with stage advancement, especially in bilateral cases. These findings provide valuable insights for prognosticating natural history and outcome regarding LS treatment, bone union, and return to activity.
Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediate stage hepatocellular carcinoma with microvascular invasion: A multicenter cohort study
Authors: Xiang Cailing , Shen Xianbo , Zeng Xinxin , Zhang Yuzhong , Ma Zhongzhi , Zhang Guocan , Song Xin , Huang Tao , Yang Juan
Published: October 2023

Background:

Intermediate-stage hepatocellular carcinoma (HCC) with microvascular invasion (MVI) is associated with high recurrence rates and poor survival outcomes after surgery. This study aimed to evaluate the efficacy of postoperative transarterial chemoembolization (TACE) on prognosis of intermediate-stage HCC patients with MVI after curative liver resection (LR).

Materials and Methods:

Patients who had intermediate-stage HCC with MVI and underwent curative liver resection between January 2013 to December 2019 at three institutions in China were identified for further analysis. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients treated with and without postoperative TACE by propensity score–matching (PSM).

Results:

A total of 246 intermediate-stage HCC patients with MVI were enrolled, 137 entered into the LR group and 109 entered into the LR+TACE group. The 1-, 3-, and 5-year RFS rates were 42.0%, 27.2% and 17.8% in LR+TACE group, and 31.8%, 18.2% and 8.7% in LR group. The 1-, 3-, and 5-year OS rates were 81.7%, 47.2% and 26.1% in LR+TACE group, and 67.3%, 35.6% and 18.5% in LR group. Compared with LR alone, LR+TACE was associated with significantly better RFS (hazard ratio [HR], 1.443; 95% confidence interval [CI], 1.089-1.914; P=0.009) and OS (HR, 1.438; 95% CI, 1.049-1.972; P=0.023). No difference was observed with RFS and OS in single TACE and multiple TACE in the matched cohort.

Conclusion:

Postoperative adjuvant TACE could be beneficial for intermediate-stage HCC patients with MVI.
Metal ureteral stents for ureteral stricture: 2 years of experience with 246 cases
Authors: Gao Xiaoshuai , Di Xingpeng , Chen Guo , Wang Wei , Peng Liao , Chen Jixiang , Wei Xin
Published: October 2023

Background:

Metal ureteral stents (MUS) has gained popularity as an endoscopic treatment alternative for the management of ureteral strictures. The aim of this study was to evaluate the safety, efficacy, and tolerability of MUS for treating ureteral strictures and to identify any factors that could influence the success of this intervention.

Methods:

This study is a prospective analysis of the efficacy and safety of MUS for treating ureteral strictures in a single-center setting. The study enrolled 246 patients who had been diagnosed with ureteral strictures and had undergone MUS placement between January 2019 and July 2021. The patients were followed up for a duration of 2 years.

Results:

The overall success rate of MUS placement was 71.7%. Furthermore, the success rate of ureteral strictures after kidney transplantation (78.2%) was significantly higher than common ureteral strictures (73.0%) or recurrent ureteral strictures (67.6%). Additionally, post-surgery, there was a considerable reduction in hydronephrosis volume (68.9±96.1 vs. 32.1±48.8 cm3), blood creatinine level (103.7±49.8 vs. 94.4±47.5 mol/L) and urea nitrogen level (6.7±7.2 vs. 5.1±2.4 mmol/L). The study also reported that the rate of adverse events associated with MUS was relatively low, included hematuria (7.9%), pain (6.8%), urinary tract infection (6.4%) and lower urinary tract symptoms (5.3%).

Conclusion:

MUS appear to be a safe and effective treatment option for ureteral strictures, with a high success rate and low complication rate. These results have important implications for the management of ureteral strictures and can help guide clinical decision-making in the selection of treatment options.
Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey
Authors: Le Borgne Pierrick , Alamé Karine , Chenou Aline , Hoffmann Anne , Burger Véronique , Kepka Sabrina , Bilbault Pascal , Le Bastard Quentin , Martin Maelle , Lascarrou Jean-Baptiste
Published: October 2023

Background and importance

Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation.

Objectives

The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs).

Settings and participants

We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022.

Intervention

A single questionnaire was sent to a sole referent physician in each ED.

Outcome measures and analysis

The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet.

Main results

Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%).

Conclusion

In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.