bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource Utilization Following Anterior Versus Posterior Cervical Decompression and Fusion for Acute Central Cord Syndrome
Authors: Du Jerry Y. , Shafi Karim , Blackburn Collin W. , Chapman Jens R. , Ahn Nicholas U. , Marcus Randall E. , Albert Todd J.
Published: March 2024

Study Design:

Retrospective cohort study.

Objective:

The purpose of this study is to compare the impact of anterior cervical decompression and fusion (ACDF) versus posterior cervical decompression and fusion (PCDF) for the treatment of acute traumatic central cord syndrome (CCS) on hospital episodes of care in terms of (1) cost, (2) length of hospital stay, and (3) discharge destination.

Summary of Background Data:

Acute traumatic CCS is the most common form of spinal cord injury in the United States. CCS is commonly treated with surgical decompression and fusion. Hospital resource utilization based on surgical approach remains unclear.

Methods:

Patients undergoing ACDF and PCDF for acute traumatic CCS were identified using the 2019 Medicare Provider Analysis and Review Limited Data Set and Centers for Medicare and Medicaid Services 2019 Impact File. Multivariate models for hospital cost of care, length of stay, and discharge destination were performed, controlling for confounders. Subanalysis of accommodation and revenue center cost drivers was performed.

Results:

There were 1474 cases that met inclusion criteria: 673 ACDF (45.7%) and 801 PCDF (54.3%). ACDF was independently associated with a decreased cost of $9802 (P<0.001) and a 59.2% decreased risk of discharge to nonhome destinations (adjusted odds ratio: 0.408, P<0.001). The difference in length of stay was not statistically significant. On subanalysis of cost drivers, ACDF was associated with decreased charges ($55,736, P<0.001) compared with PCDF, the largest drivers being the intensive care unit ($15,873, 28% of total charges, P<0.001) and medical/surgical supply charges ($19,651, 35% of total charges, P<0.001).

Conclusions:

For treatment of acute traumatic CCS, ACDF was associated with almost $10,000 less expensive cost of care and a 60% decreased risk of discharge to nonhome destination compared with PCDF. The largest cost drivers appear to be ICU and medical/surgical-related. These findings may inform value-based decisions regarding the treatment of acute traumatic CCS. However, injury and patient clinical factors should always be prioritized in surgical decision-making, and increased granularity in reimbursement policies is needed to prevent financial disincentives in the treatment of patients with CCS better addressed with posterior approach-surgery.
Somatic CDKN2A copy number variations are associated with the prognosis of esophageal squamous cell dysplasia
Authors: Fan Zhiyuan , Zhou Jing , Tian Yuan , Qin Yu , Liu Zhaojun , Gu Liankun , Dawsey Sanford M. , Wei Wenqiang , Deng Dajun
Published: March 2024

Background:

Somatic copy number variations (SCNVs) in the CDKN2A gene are among the most frequent events in the dysplasia-carcinoma sequence of esophageal squamous cell carcinoma. However, whether CDKN2A SCNVs are useful biomarkers for the risk stratification and management of patients with esophageal squamous cell dysplasia (ESCdys) is unknown. This study aimed to investigate the characteristics and prognostic value of CDKN2A SCNVs in patients with mild or moderate (m/M) ESCdys.

Methods:

This study conducted a prospective multicenter study of 205 patients with a baseline diagnosis of m/M ESCdys in five high-risk regions of China (Ci County, Hebei Province; Yanting, Sichuan Province; Linzhou, Henan Province; Yangzhong, Jiangsu Province; and Feicheng, Shandong Province) from 2005 to 2019. Genomic DNA was extracted from paraffin biopsy samples and paired peripheral white blood cells from patients, and a quantitative polymerase chain reaction assay, P16-Light, was used to detect CDKN2A copy number. The cumulative regression and progression rates of ESCdys were evaluated using competing risk models.

Results:

A total of 205 patients with baseline m/M ESCdys were enrolled. The proportion of ESCdys regression was significantly lower in the CDKN2A deletion cohort than in the diploid and amplification cohorts (18.8% [13/69] vs. 35.0% [28/80] vs. 51.8% [29/56], P <0.001). In the univariable competing risk analysis, the cumulative regression rate was statistically significantly lower (P = 0.008), while the cumulative progression rate was higher (P = 0.017) in ESCdys patients with CDKN2A deletion than in those without CDKN2A deletion. CDKN2A deletion was also an independent predictor of prognosis in ESCdys (P = 0.004) in the multivariable analysis.

Conclusion:

The results indicated that CDKN2A SCNVs are associated with the prognosis of ESCdys and may serve as potential biomarkers for risk stratification.
Single-incision laparoscopic surgery transabdominal preperitoneal approach for hernia in elderly: A cross-sectional study
Authors: Pham Van Thuong , Vu Ngoc Son , Do Minh-Tung
Published: March 2024

Background

Only a few studies on single-incision laparoscopic surgery for transabdominal preperitoneal (SILS-TAPP) inguinal hernia (IH) repair have been conducted. Thus, we aimed to verify whether SILS-TAPP IH repair in elderly patients (≥65 years old) is safe and effective for nonelderly patients (<65 years old).

Materials and Methods

A retrospective study of 91 patients who underwent SILS-TAPP for IH between November 2011 and April 2014 and were followed up until June 2018 was conducted. The inclusion criterion was SILS-TAPP for unilateral IH, regardless of primary or recurrent. The main variables of interest were age, body mass index, comorbidities, IH classification, operation time, perioperative and postoperative complications, postoperative visual analog scale pain score, long-term complications, and recurrence.

Results

Elderly patients had a higher prevalence of comorbidities and higher American Society of Anesthesiologists physical status scores than nonelderly patients. Intraoperative characteristics, including IH classification and size of the internal hernia ring, were similar. Operation time did not differ between the 2 groups (44.1 ± 14.7 minutes in the elderly versus 49.8 ± 19.7 minutes in the nonelderly). The postoperative pain score, short- and long-term complications, and recurrence rates were similar between the groups.

Conclusions

SILS-TAPP is safe, feasible, and an alternative treatment for IH in the elderly.
Bisphosphonate-related osteonecrosis of the jaw: Is the medication duration related to advanced disease stage?
Authors: Su Yu-Pin , Liu Wen-Chung , Lin Cheng-Ta , Chien Hsin-I , Yang Kuo-Chung
Published: March 2024

Background

Osteonecrosis of the jaw (ONJ) is a serious adverse effect of therapy with bisphosphonates (BP) and other antiresorptive agents. The aim of the study was to report 13 patient cases of bisphosphonates-related osteonecrosis of the jaw (BRONJ) at Kaohsiung Veterans General Hospital (VGHKS), Taiwan, and their medical history and disease outcomes.

Materials and Methods

Thirteen symptomatic patients with BRONJ were reviewed between 1985 and 2021 at VGHKS. We included symptomatic patients who were in advanced BRONJ stages 2 and 3: 4 multiple myeloma, 3 bone metastatic breast cancer, and 6 advanced osteoporosis patients.

Results

Seven patients were American Association of Oral and Maxillofacial Surgeons’ medication-related osteonecrosis of the jaw stage 3, and 6 were stage 2. The average antiresorptive medication duration was 25.83 ± 31.45 months in BRONJ stage 2 patients and 53.71 ± 31.25 months in BRONJ stage 3 patients, respectively. No correlation was found between the antiresorptive agent duration and BRONJ stage (P = 0.098; Mann-Whitney U test) among cancer (P = 0.157; Mann-Whitney U test) and osteoporosis patients (P = 0.184; Mann-Whitney U test).

Conclusions

Most of them died of terminal stage cancer disease or complications of being bedridden. The correlation between the duration of antiresorptive agents and BRONJ stage needs larger patient data to confirm the result.
Implementation of a standardized management protocol improved the survival of patients with necrotizing fasciitis
Authors: Tsai Shih-Chen , Cheng Yin , Fang Chi-Tai , Tai Hao-Chih , Cheng Nai-Chen
Published: March 2024

Background

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection requiring urgent interventions. This study aimed to investigate the effect of implementation of a standardized management protocol on the outcome of NF patients admitted to the intensive care unit.

Materials and Methods

We initiated a management protocol for NF patients in 2012 at our institution. The protocol consisted of early surgical intervention, initial board-spectrum antibiotic regimen, daily wound inspection, repeated debridement, and interprofessional collaboration. Herein, we reviewed the NF cases admitted between 2005 and 2018 and compared their clinical features and outcome before and after the protocol implementation. All of the NF cases were confirmed by intraoperative findings.

Results

We included 134 NF patients before (2005 to 2011, n = 62) and after (2013 to 2018, n = 72) the protocol implementation. The baseline patient profile from these 2 periods was largely similar, except that after protocol implementation, more patients presented with erythema (64.5% vs 84.7%) and a higher C-reactive protein level (65.5% vs 85.5%) on admission. Notably, the day 28–censored mortality was significantly lower after protocol implementation (40.3% vs 13.9%). By analyzing the 28-day mortality with univariate and multivariate model, initial presentation with neutropenia was identified as a risk factor [hazard ratio (HR) = 8.45, 95% confidence interval (CI) = 1.76–40.6], while protocol implementation (HR = 0.27, 95% CI = 0.11–0.71) was a protective factor.

Conclusions

A multidisciplinary bundle care protocol for NF including board-spectrum empirical antibiotic regimen and interprofessional collaboration was feasible, which was associated with improved overall and 28-day survival.
Genotype correlates with clinical course and outcome of children with tight junction protein 2 (TJP2) deficiency–related cholestasis
Authors: Lal Bikrant Bihari , Alam Seema , Sibal Anupam , Kumar Karunesh , Hosaagrahara Ramakrishna Somashekara , Shah Vaibhav , Dheivamani Nirmala , Bavdekar Ashish , Nagral Aabha , Wadhwa Nishant , Maria Arjun , Shah Aashay , Shah Ira , Nalwalla Zahabiya , Snehavardhan Pandey , Srikanth K.P. , Gupta Subhash , Sivaramakrishnan Viswanathan M. , Waikar Yogesh , Suchismita Arya , Ashritha A. , Sood Vikrant , Khanna Rajeev ,   Indian PFIC Registry
Published: March 2024

Background and Aims:

The study aimed to describe the clinical course and outcomes, and analyze the genotype-phenotype correlation in patients with tight junction protein 2 (TJP2) deficiency.

Approach and Results:

Data from all children with chronic cholestasis and either homozygous or compound heterozygous mutations in TJP2 were extracted and analyzed. The patients were categorized into 3 genotypes: TJP2-A (missense mutations on both alleles), TJP2-B (missense mutation on one allele and a predicted protein-truncating mutation [PPTM] on the other), and TJP2-C (PPTMs on both alleles). A total of 278 cases of genetic intrahepatic cholestasis were studied, with TJP2 deficiency accounting for 44 cases (15.8%). Of these, 29 were homozygous and 15 were compound heterozygous variants of TJP2. TJP2-A genotype was identified in 21 (47.7%), TJP2-B in 7 cases (15.9%), and TJP2-C in 16 cases (36.4%), respectively. Patients with the TJP2-C genotype were more likely to experience early infantile cholestasis (87.5% vs. 53.5%, p=0.033), less likely to clear jaundice (12.5% vs. 52.2%, p=0.037), more likely to develop ascites, and had higher serum bile acids. Patients with the TJP2-C genotype were more likely to die or require liver transplantation (native liver survival: 12.5% vs. 78.6%, p<0.001), with a median age at death/liver transplantation of 2.5 years. Cox regression analysis revealed that TJP2-C mutations (p=0.003) and failure to resolve jaundice (p=0.049) were independent predictors of poor outcomes.

Conclusions:

Patients with the TJP2-C genotype carrying PPTMs in both alleles had a rapidly progressive course, leading to early decompensation and death if they did not receive timely liver transplantation.
Suprachoroidal Space Injection Technique: Expert Panel Guidance
Authors: Wykoff Charles C. , Avery Robert L. , Barakat Mark R. , Boyer David S. , Brown David M. , Brucker Alexander J. , Cunningham Emmett T. , Heier Jeffrey S. , Holekamp Nancy M. , Kaiser Peter K. , Khanani Arshad M. , Kim Judy E. , Demirci Hakan , Regillo Carl D. , Yiu Glenn , Ciulla Thomas A.
Published: March 2024

Purpose:

To develop professional guidelines for best practices for suprachoroidal space (SCS) injection, an innovative technique for retinal therapeutic delivery, based on current published evidence and clinical experience.

Methods:

A panel of expert ophthalmologists reviewed current published evidence and clinical experience during a live working group meeting to define points of consensus and key clinical considerations to inform the development of guidelines for in-office SCS injection.

Results:

Core consensus guidelines for in-office SCS injection were reached and reported by the expert panel. Current clinical evidence and physician experience supported SCS injection as a safe and effective method for delivering retinal and choroidal therapeutics. The panel established consensus on the rationale for SCS injection, including potential benefits relative to other intraocular delivery methods, and current best practices in patient preparation, pre- and peri-injection management, SCS-specific injection techniques, and post-injection management and follow-up.

Conclusion:

These expert panel guidelines may support and promote standardization of SCS injection technique, with the goal of optimizing patient safety and outcomes. Some aspects of the procedure may reasonably be modified based on clinical setting and physician judgement, as well as areas requiring additional study.
Predischarge oxygen uptake efficiency slope has short and long-term value in the prognosis of patients after acute myocardial infarction
Authors: Tuan Sheng-Hui , Chung Jin-Hui , Tsai Yi-Ju , Huang Wei-Chun , Chen Guan-Bo , Tsai Yun-Jeng , Lin Ko-Long
Published: March 2024

Background:

Patients who survive an acute myocardial infarction (AMI) have a higher risk of having a major cardiovascular event (MACE). Cardiopulmonary exercise testing (CPET) could develop prognostic stratification and prescribing exercise prescription. Patients after AMI frequently terminate CPET early with submaximal testing results. We aimed to look at the characteristics of patients’ predischarge CPET variables after AMI intervention and find potential CPET variables with prognostic value.

Methods:

Between July 2012 and August 2017, we recruited patients who survived first AMI after primary percutaneous coronary intervention and received predischarge CPET retrospectively in a tertiary medical center of Taiwan. Patients were followed-up on a MACE or administrative censoring occurred (up to 5 years). To identify significant predictors of a MACE, a Cox regression model was used.

Results:

One hundred thirteen patients (103 men and 10 women) were studied, with an average age of 58.32 ± 12.49. MACE over 3 months, 2-years, and 5-years was 17.70%, 53.10%, and 62.83%, respectively. The oxygen uptake efficiency slope during the whole during of CPET (OUES 100) divided by body surface area (OUES 100/BSA) was found to be a significant event predictor for MACE at 3-month, 2- and 5-years. Cox regression analysis revealed that those with OUES 100/BSA <0.722 (p = 0.004), OUES 100/BSA <0.859 (p = 0.002), and OUES 100/BSA <0.829 (p = 0.002) had a 7.14-fold, 3.47-fold, and 2.72-fold increased risk of 3-month, 2-year, and 5-year MACE, respectively.

Conclusion:

It is critical to identify a submaximal predictor during CPET for patients who survive AMI. Our findings suggested that OUES could be a significant prognostic indicator in patients after first AMI in both the short and long term.
Disparities in 30-Day Readmission Between Medicare/Medicaid and Private Insurance Among Patients With Heart Failure Screened for Cognitive Impairment
Authors: Dzikowicz Dillon J. , Keady Karen G. , Carey Mary G.
Published: March 2024

Background

Racial disparities exist among patients with heart failure (HF). HF is often comorbid with cognitive impairment. Appropriate self-care can prevent HF hospital readmissions but requires access to resources through insurance. Racial differences exist between insurance types, and this may influence the disparity between races and patients with HF and cognitive impairment.

Objective

The objectives of this study were to examine the relationships between insurance type and self-care stratified by race and to assess for differences in time-to-30-day readmission among patients with HF with cognitive impairment.

Methods

This is a secondary analysis of data collected among hospitalized patients with HF with cognitive impairment. Patients completed surveys on self-care (Self-Care of Heart Failure Index), HF knowledge (Dutch Heart Failure Knowledge Scale), depression (Geriatric Depression Scale), and social support (Enhancing Recovery in Coronary Heart Disease Social Support Inventory). Socioeconomic data were collected. Linear models were created to examine the relationships between insurance type and self-care by race. Kaplan-Meier curves and Cox regression were used to assess readmission.

Results

The sample of 125 patients with HF with cognitive impairment was predominantly Black (68%, n = 85) and male (53%, n = 66). The sample had either Medicare/Medicaid (62%, n = 78) or private insurance (38%, n = 47). Black patients with HF with cognitive impairment and private insurance reported higher self-care confidence compared with Black patients with HF with cognitive impairment and Medicare/Medicaid (P < .05). Medicare/Medicaid was associated with a higher frequency of 30-day readmission and a faster time-to-readmission.

Conclusions

Patients with HF with cognitive impairment and Medicare/Medicaid insurance reported lower self-care confidence and more likely to be readmitted within 30 days.
Qualitative Description of Exercise Perceptions and Experiences Among People With Human Immunodeficiency Virus in the High-Intensity Exercise to Attenuate Limitations and Train Habits Study
Authors: Adhiambo Harriet Fridah , Cook Paul , Erlandson Kristine M. , Jankowski Catherine , Oliveira Vitor H. F. , Do Hoai , Khuu Vincent , Davey Christine Horvat , Webel Allison R.
Published: March 2024

Background

The benefits of physical activity (PA), specifically exercise, among older adults in general are well known. Yet globally, there is concern regarding limited engagement in PA, increased obesity, and frailty among older people with human immunodeficiency virus related to low levels of PA.

Methods

We conducted in-depth interviews among 30 older, sedentary people with human immunodeficiency virus participating in the ongoing High-Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH study, NCT04550676) between February 2021 and August 2022. A semistructured interview guide, informed by two minds theory, which frames behavior change as an intention-behavior gap between 2 neurocognitive systems, was used to elicit data from participants. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations, and PA goals. Thirty interviews from 33 participants were recorded and transcribed verbatim, and deductive and inductive thematic analysis were used using Dedoose.

Results

Physical activity was defined as maintaining daily living activities and addressing health goals. Previous experiences with PA varied among participants and were influenced by chronic illnesses, including human immunodeficiency virus; motivation; work commitments; interest; and social support. Reported barriers to PA included antiretroviral adverse effects, comorbidities, aging, and the COVID-19 pandemic. Changes in health status, body changes, and relationships were identified as benefits of PA. Conversations with healthcare providers supporting exercise goals were perceived to be important but rarely received by the participants.

Conclusion

Understanding how older people with human immunodeficiency virus perceive PA is crucial to developing tailored strategies and structuring service delivery within the healthcare setting to promote a physically active life.
Comparison of safety and efficacy of different positions in percutaneous nephrolithotomy: a network Meta-analysis
Authors: Li Puhan , Ma Yucheng , Liao Banghua , Jin Xi , Xiang Liyuan , Li Hong , Wang Kunjie
Published: March 2024

Objectives:

Various new positions for percutaneous nephrolithotomy (PCNL) were proposed to reduce the limitations of the traditional position. This study was aimed to evaluate the efficacy and safety of the different PCNL positions.

Methods:

PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) up to April 18, 2023. We collected five common surgical positions used for PCNL: oblique supine position (OSP), supine position (SP), flank position (FP), split-leg oblique supine/flank position (SLP), and prone position (PP). Paired and network meta-analysis were conducted to compare relevant outcomes, including complications, operative time, stone free rates, hospital stay and hemoglobin loss among these different positions.

Results:

The study included 17 RCTs with a total of 1841 patients. The result demonstrated that SLP significantly outperformed in terms of decreasing operation time (FP vs SLP MD- MD-41.65; OSP vs SLP MD 28.97; PP vs SLP MD 34.94), hospital stay, and hemoglobin loss. Ranking probabilities showed SLP had highest stone-free rate. Prone position was more likely to occur complications than others. Based on SMAA model, the benefit-risk analysis suggested the SLP was the optimal position in PCNL.

Conclusions:

For PCNL, the split-leg, flank, supine, and oblique supine positions are as secure as the prone position. Further RCTs are necessary to confirm the outstanding safety and efficacy of split-leg position. Besides, the position should be selected regard for the patient’s demands, the surgeon’s preference and learning curve.
Portal vein thrombosis and liver transplantation: management, matching, and outcomes: a retrospective multicenter cohort study
Authors: Di Benedetto Fabrizio , Magistri Paolo , Di Sandro Stefano , Boetto Riccardo , Tandoi Francesco , Camagni Stefania , Lauterio Andrea , Pagano Duilio , Nicolini Daniele , Violi Paola , Dondossola Daniele , Guglielmo Nicola , Cherchi Vittorio , Lai Quirino , Toti Luca , Bongini Marco , Frassoni Samuele , Bagnardi Vincenzo , Mazzaferro Vincenzo , Tisone Giuseppe , Rossi Massimo , Baccarani Umberto , Ettorre Giuseppe Maria , Caccamo Lucio , Carraro Amedeo , Vivarelli Marco , Gruttadauria Salvatore , De Carlis Luciano , Colledan Michele , Romagnoli Renato , Cillo Umberto
Published: March 2024

Background and aims:

Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients.

Methods:

Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant.

Results:

Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.

Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present.

Conclusions:

Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3–4.
Deep learning-based multimodel prediction for disease-free survival status of patients with clear cell renal cell carcinoma after surgery: a multicenter cohort study
Authors: Chen Siteng , Gao Feng , Guo Tuanjie , Jiang Liren , Zhang Ning , Wang Xiang , Zheng Junhua
Published: March 2024

Background:

Although separate analysis of individual factor can somewhat improve the prognostic performance, integration of multimodal information into a single signature is necessary to stratify patients with clear cell renal cell carcinoma (ccRCC) for adjuvant therapy after surgery.

Methods:

A total of 414 patients with whole slide images, computed tomography images, and clinical data from three patient cohorts were retrospectively analyzed. The authors performed deep learning and machine learning algorithm to construct three single-modality prediction models for disease-free survival of ccRCC based on whole slide images, cell segmentation, and computed tomography images, respectively. A multimodel prediction signature (MMPS) for disease-free survival were further developed by combining three single-modality prediction models and tumor stage/grade system. Prognostic performance of the prognostic model was also verified in two independent validation cohorts.

Results:

Single-modality prediction models performed well in predicting the disease-free survival status of ccRCC. The MMPS achieved higher area under the curve value of 0.742, 0.917, and 0.900 in three independent patient cohorts, respectively. MMPS could distinguish patients with worse disease-free survival, with HR of 12.90 (95% CI: 2.443–68.120, P<0.0001), 11.10 (95% CI: 5.467–22.520, P<0.0001), and 8.27 (95% CI: 1.482–46.130, P<0.0001) in three different patient cohorts. In addition, MMPS outperformed single-modality prediction models and current clinical prognostic factors, which could also provide complements to current risk stratification for adjuvant therapy of ccRCC.

Conclusion:

Our novel multimodel prediction analysis for disease-free survival exhibited significant improvements in prognostic prediction for patients with ccRCC. After further validation in multiple centers and regions, the multimodal system could be a potential practical tool for clinicians in the treatment for ccRCC patients.
Management for degenerative lumbar spondylolisthesis: a network meta-analysis and systematic review basing on randomized controlled trials
Authors: Jia Hao , Zhang Zhuo , Qin Jianpu , Bao Lipei , Ao Jun , Qian Hu
Published: March 2024

Background:

Consensus on the various interventions for degenerative lumbar spondylolisthesis (DLS) remains unclear.

Materials and methods:

We searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites until Nov 01, 2023, to screen eligible randomized controlled trials (RCTs) involving the treatment of DLS. The seven most common DLS interventions (non-surgical [NS], decompression only [DO], decompression plus fusion without internal fixation [DF], decompression plus fusion with internal fixation [DFI], endoscopic decompression plus fusion [EDF], endoscopic decompression [ED], and circumferential fusion [360F]) were compared. The primary (pain and disability) and secondary (complications, reoperation rate, operation time, blood loss, length of hospital stay, and satisfaction) outcomes were analyzed.

Results:

Data involving 3,273 patients in 16 RCTs comparing the efficacy of different interventions for DLS were reported. In terms of improving patient pain and dysfunction, there was a significant difference between surgical and NS. EDF showed the greatest improvement in short-term and long-term dysfunction (probability, 7.1% and 21.0%). Moreover, EDF had a higher complication rate (probability 70.8%), lower reoperation rate (probability, 20.2%), and caused greater blood loss (probability, 82.5%) than other surgical interventions. Endoscopic surgery had the shortest hospitalization time (EDF: probability, 42.6%; ED: probability, 3.9%). DF and DFI had the highest satisfaction scores.

Conclusions:

Despite the high complication rate of EDF, its advantages include improvement in pain, lower reoperation rate, and shorter hospitalization duration. Therefore, EDF may be a good option for patients with DLS as a less invasive surgical approach.
Whether surgical procedure can improve the prognosis of endometrial cancer arising in adenomyosis (EC-AIA)? a systematic review and meta-analysis
Authors: Sun Yi , Lin Shitong , Wu Weijia , Nie Fangfang , Liu Yuchen , Wen Jing , Cheng Xiaoran , Liu Qianwen , Wang Yuanpei , Ren Fang
Published: March 2024

Purpose:

Endometrial cancer arising in adenomyosis (EC-AIA) is frequently detected accidentally following a general hysterectomy for adenomyosis. Whether supplemental lymphadenectomy in patients with EC-AIA can improve the survival outcome remains inconclusive. Herein, we summarized the data of patients with EC-AIA and further explored the impact of lymphadenectomy on the prognosis of these patients.

Methods:

Five electronic databases, namely MEDLINE, Web of Science, PubMed, Embase, and the Cochrane Library were employed for searching articles from inception to May 2023.

Results:

In total, 38 eligible studies enrolling 56 patients were included. Of these, 44 patients had a traceable prognosis. Kaplan–Meier curves demonstrated that patients who had undergone lymphadenectomy had a better progression-free survival (PFS) compared with those who had not undergone lymphadenectomy (P=0.016), but there was no difference in overall survival (OS). Univariable (P=0.025, HR=0.25, 95%CI=0.08–0.84) and multivariable (P=0.042, HR=0.13, 95%CI=0.020–0.930) Cox regression analyses revealed that lymphadenectomy was an independent protective factor for PFS.

Conclusion:

For patients diagnosed with EC-AIA following hysterectomy for benign disease, further supplementary lymphadenectomy is recommended to improve PFS.
Resuscitating the macro- vs. microcirculation in septic shock
Authors: González Rafael , Urbano Javier , López-Herce Jesús
Published: March 2024

Purpose of review

This review summarizes current literature about the relationships between macro and microcirculation and their practical clinical implications in children with septic shock.

Recent findings

Current evidence from experimental and clinical observational studies in children and adults with septic shock reveals that the response to treatment and resuscitation is widely variable. Furthermore, there is a loss of hemodynamic coherence, as resuscitation-induced improvement in macrocirculation (systemic hemodynamic parameters) does not necessarily result in a parallel improvement in the microcirculation. Therefore, patient-tailored monitoring is essential in order to adjust treatment requirements during resuscitation in septic shock. Optimal monitoring must integrate macrocirculation (heart rate, blood pressure, cardiac output, and ultrasound images), microcirculation (videomicroscopy parameters and capillary refill time) and cellular metabolism (lactic acid, central venous blood oxygen saturation, and difference of central venous to arterial carbon dioxide partial pressure).

There is a dire need for high-quality studies to assess the relationships between macrocirculation, microcirculation and tissue metabolism in children with septic shock. The development of reliable and readily available microcirculation and tissue perfusion biomarkers (other than lactic acid) is also necessary to improve monitoring and treatment adjustment in such patients.
Mediastinal Germ-cell Tumors Relapse in a Male With Klinefelter Syndrome. Is Longer Surveillance Needed?
Authors: Stefanachi Francesca , Affinita Maria Carmen , Fichera Giulia , Tagarelli Arianna , De Corti Federica , Rea Federico , Bisogno Gianni
Published: March 2024

Germ cell tumors (GCTs) are a heterogeneous group of pediatric cancers. In up to one-third of male patients, a primary mediastinal location is associated with the presence of Klinefelter syndrome (KS). We describe a case of mediastinal GCT in a patient, with unacknowledged KS, that presented a relapse 7 years from diagnosis, that is, 2 years after the end of the follow-up program usually recommended for patients with GCT. There are no recommendations for screening for KS in patients with mediastinal GCT and there are no specific guidelines for surveillance of GCT in KS patients. Our experience suggests that KS should be suspected in patients with mediastinal GCT, and a longer follow-up plan should be implemented when GCT occurs in patients with KS.
Recurrence Patterns and Surveillance Imaging in Pediatric Brain Tumor Survivors
Authors: Cacciotti Chantel , Lenzen Alicia , Self Chelsea , Pillay-Smiley Natasha
Published: March 2024

Surveillance magnetic resonance imaging (MRI) is routinely used to detect recurrence in pediatric central nervous system (CNS) tumors. The frequency of neuroimaging surveillance varies without a standardized approach. A single-institutional retrospective cohort study evaluated the frequency of recurrences. This study included 476 patients with the majority diagnosed with low-grade glioma (LGG) (n=138, 29%), high-grade glioma (HGG) (n=77, 16%), ependymoma (n=70, 15%), or medulloblastoma (n=61, 13%). LGG, HGG, and ependymoma patients more commonly had multiply recurrent disease (P=0.08), with ependymoma patients demonstrating ≥2 relapses in 47% of cases. Recurrent disease was identified by imaging more often than clinical symptoms (65% vs. 32%; P=<0.01). Patients diagnosed with meningioma demonstrated the longest mean time to first relapse (74.7 mo) whereas those with atypical teratoid rhabdoid tumor and choroid plexus carcinoma tended to have the shortest time to relapse (8.9 and 9 mo, respectively). Overall, 22 patients sustained first relapse >10 years from initial diagnosis. With a higher tendency toward detection of tumor recurrence/progression on MRI surveillance in comparison to clinical progression, surveillance imaging is necessary in routine follow up of pediatric CNS tumor survivors. With some relapses >10 years from initial diagnosis, imaging beyond this time point may be useful in particular tumor types. While the study is limited in outcome analysis, earlier detection of recurrence would lead to earlier initiation of treatment and implementation of salvage treatment regimens which can impact survival and quality of life.
Relationship of Day-by-Day Blood Pressure Variability and Admission Stroke Severity in Acute Ischemic Stroke
Authors: Zhu Yuan , Wu Minghua , Zheng Yawei , Wang Xintong , Xiayang Jingyi , Zhang Tianrui , Wang Shana , Fang Zhuyuan
Published: March 2024

Objectives:

Research on the association between stroke severity and day-by-day blood pressure variability (BPV) in acute ischemic stroke (AIS) is rare as the majority focus on the blood pressure (BP) or the short-term BPV. Our study aims to explore the exact roles of daily BPV through the 7-day commencement on stroke severity in AIS.

Methods:

The study included 633 patients with AIS, defining AIS as the time from the beginning of symptom up to 7 days with recording BP twice a day as well as calculating the daily BPV, and then matching them to the stroke severity. The logistic regression models were used to evaluate associations between stroke severity and day-by-day BPV. We used the smooth curve fitting to identify whether there was a nonlinear association. In addition, the subgroup analyses were performed using the logistic regression.

Results:

According to the modified National Institutes of Health Stroke Scale score, 301 (47.5%) patients were allocated to the mild stroke group and 332 (52.5%) to the moderate-to-severe stroke group. In terms of stroke categories, we found no significant difference between BP at admission or mean BP. However, the moderate-to-severe stroke group exhibited higher daily BPV. The multiple logistic regression analysis indicated that day-by-day BPV was positively correlated to stroke severity [odds ratio (OR)=1.05, 95% CI:1.01–1.1, P=0.03 for SBP-SD; OR=1.08, 95% CI:1.01–1.15, P=0.03 for SBP-CV; OR=1.04, 95% CI:1.01–1.07, P=0.015 for SBP-SV).

Conclusions:

High day-by-day BPV in AIS was associated with more severe stroke independent of BP levels.
How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation
Authors: Haynes Joanna C. , Rettedal Siren I. , Ushakova Anastasia , Perlman Jeffrey M. , Ersdal Hege L.
Published: March 2024

Introduction

Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.

In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level.

Methods

Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.

Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes.

Results

A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent.

Conclusions

Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.
The Effects of Combined Use of Linaclotide and Polyethylene Glycol Electrolyte Powder in Colonoscopy Preparation for Patients With Chronic Constipation
Authors: Song Jian , Xu Yuemei , Chen Changxi , Qi Xufei , Hu Pingping , Ying Xianhao , Li Hongliang
Published: March 2024

Objective:

The purpose of this study is to evaluate the safety and efficacy of linaclotide and polyethylene glycol (PEG) electrolyte powder in patients with chronic constipation undergoing colonoscopy preparation.

Patients and Methods:

We included 260 patients with chronic constipation who were scheduled to undergo a colonoscopy. They were equally divided into 4 groups using a random number table: 4L PEG, 3L PEG, 3L PEG+L, and 2L PEG+L. The 4 groups were compared based on their scores on the Boston Bowel Preparation Scale (BBPS) and Ottawa Bowel Preparation Quality Scale (OBPQS), adverse reactions during the bowel preparation procedure, colonoscope insertion time, colonoscope withdrawal time, detection rate of adenomas, and their willingness to repeat bowel preparation.

Results:

In terms of the score of the right half of the colon, the score of the transverse colon, the total score using BBPS, and the total score using OBPQS, the 3L PEG (polyethylene glycol)+L group was superior to groups 3L PEG and 2L PEG+L (P<0.05), but comparable to the 4L PEG group (P>0.05). The incidence rate of vomiting was higher in the 4L PEG group than in the 2L PEG+L group (P<0.05). There was no statistically significant difference in the insertion time of the colonoscope between the 4 groups. The colonoscope withdrawal time in the 3L PEG+L group was shorter than in groups 4L PEG and 3L PEG (P<0.05) and comparable to that in the 4L PEG group (P>0.05). There was no statistically significant difference in the rate of adenoma detection among the 4 groups (P>0.05). The 4L PEG group was the least willing of the 4 groups to undergo repeated bowel preparation (P<0.05).

Conclusion:

The 3L PEG+L is optimal among the 4 procedures. It can facilitate high-quality bowel preparation, reduce the incidence of nausea during the bowel preparation procedure, and encourage patients to undertake repeated bowel preparation.
The fission yeast NDR kinase Orb6 and its signalling pathway MOR regulate cytoplasmic microtubule organization during the cell cycle
Authors: Kume Kazunori , Nishikawa Kenji , Furuyama Rikuto , Fujimoto Takahiro , Koyano Takayuki , Matsuyama Makoto , Mizunuma Masaki , Hirata Dai
Published: March 2024

Microtubule organization and reorganization during the cell cycle are achieved by regulation of the number, distribution and activity of microtubule-organizing centres (MTOCs). In fission yeast, the Mto1/2 complex determines the activity and distribution of cytoplasmic MTOCs. Upon mitosis, cytoplasmic microtubule nucleation ceases; inactivation of the Mto1/2 complex is triggered by Mto2 hyperphosphorylation. However, the protein kinase(s) that phosphorylates Mto2 remains elusive. Here we show that a conserved signalling network, called MOR (morphogenesis Orb6 network) in fission yeast, negatively regulates cytoplasmic MTOCs through Mto2 phosphorylation to ensure proper microtubule organization. Inactivation of Orb6 kinase, the most downstream MOR component, by attenuation of MOR signalling leads to reduced Mto2 phosphorylation, coincident with increased number of both Mto2 puncta and cytoplasmic microtubules. These defects cause the emergence of uncoordinated mitotic cells with cytoplasmic microtubules, resulting in reduced spindle assembly. Thus, the regulation of Mto2 by the MOR is crucial for cytoplasmic microtubule organization and contributes to reorganization of the microtubule cytoskeletons during the cell cycle.
Unstable cores are the source of instability in chemical reaction networks
Authors: Vassena Nicola , Stadler Peter F.
Published: March 2024

In biochemical networks, complex dynamical features such as superlinear growth and oscillations are classically considered a consequence of autocatalysis. For the large class of parameter-rich kinetic models, which includes generalized mass action kinetics and Michaelis–Menten kinetics, we show that certain submatrices of the stoichiometric matrix, so-called unstable cores, are sufficient for a reaction network to admit instability and potentially give rise to such complex dynamical behaviour. The determinant of the submatrix distinguishes unstable-positive feedbacks, with a single real-positive eigenvalue, and unstable-negative feedbacks without real-positive eigenvalues. Autocatalytic cores turn out to be exactly the unstable-positive feedbacks that are Metzler matrices. Thus there are sources of dynamical instability in chemical networks that are unrelated to autocatalysis. We use such intuition to design non-autocatalytic biochemical networks with superlinear growth and oscillations.
Generating new gravitational solutions by matrix multiplication
Authors: Cristina Câmara M. , Lopes Cardoso Gabriel
Published: March 2024

Explicit solutions to the nonlinear field equations of some gravitational theories can be obtained, by means of a Riemann–Hilbert approach, from a canonical Wiener–Hopf factorization of certain matrix functions called monodromy matrices. In this paper, we describe other types of factorization from which solutions can be constructed in a similar way. Our approach is based on an invariance problem, which does not constitute a Riemann–Hilbert problem and allows to construct solutions that could not have been obtained by Wiener–Hopf factorization of a monodromy matrix. It gives rise to a novel solution generating method based on matrix multiplications. We show, in particular, that new solutions can be obtained by multiplicative deformation of the canonical Wiener–Hopf factorization, provided the latter exists, and that one can superpose such solutions. Examples of applications include Kasner, Einstein–Rosen wave and gravitational pulse wave solutions.
Early-acting inbreeding depression can evolve as an inbreeding avoidance mechanism
Authors: Brandvain Yaniv , Thomson Lia , Pyhäjärvi Tanja
Published: March 2024

Despite the potential for mechanical, developmental and/or chemical mechanisms to prevent self-fertilization, incidental self-fertilization is inevitable in many predominantly outcrossing species. In such cases, inbreeding can compromise individual fitness. Unquestionably, much of this inbreeding depression is maladaptive. However, we show that when reproductive compensation allows for the replacement of inviable embryos lost early in development, selection can favour deleterious recessive variants that induce ‘self-sacrificial’ death of inbred embryos. Our theoretical results provide numerous testable predictions which could challenge the assumption that inbreeding depression is always maladaptive. Our work is applicable any species that cannot fully avoid inbreeding, exhibits substantial inbreeding depression, and has the potential to compensate embryos lost early in development. In addition to its general applicability, our theory suggests that self-sacrificial variants might be responsible for the remarkably low realized selfing rates of gymnosperms with high primary selfing rates, as gymnosperms exhibit strong inbreeding depression, have effective reproductive compensation mechanisms, and cannot evolve chemical self-incompatibility.