bluuebunny/crossref_metadata_2025 huggingface dataset:
A Second Drain Decreases Seroma Formation in Prepectoral Immediate Breast Reconstruction with an Acellular Dermal Matrix
Authors: George Robert E. , Taege Sara M. , Seils Grant R. , Yoo Aran , Elwood Eric T. , Jones Glyn E.
Published: July 2023

Background:

Seroma formation is the most common complication after mastectomy. While the exact pathophysiology behind seroma development has not been entirely elucidated, seromas are associated with negative outcomes in breast reconstruction. The utilization of drains is one method to combat seroma. However, the current state of plastic surgery is divided as to whether one drain or two drains is optimal in reducing seroma formation. We hypothesized that using two drains instead of one drain would reduce the risk of seroma more so than one drain.

Methods:

This was a retrospective cohort study of patients who underwent prepectoral direct to implant reconstruction at a single institution by a single surgeon. Each patient underwent reconstruction with either one or two drains. Patients were followed postoperatively for rates of seroma formation. Seroma were classified as either minor or major. Secondary variables including drain duration, infection, and necrosis were also analyzed.

Results:

A total of 99 breasts and 71 patients experienced breast reconstruction with two drains, and 163 breasts corresponding to 135 patients received reconstruction with one drain. In the two drain cohort, 14 (14.1%) developed a seroma, with 11 (11.1%) being minor seromas and three (3.03%) being major seromas. In comparison, out of the one drain cohort, 41 (25.2%) developed a seroma, with 35 (21.5%) being a minor seroma and six (3.68%) being classified as major.

Conclusion:

This study suggests that two drains decreases the rate and risk of seroma formation compared to one drain in prepectoral breast reconstruction with an acellular dermal matrix.
Factors Associated With Receipt of Crosslinking for Keratoconus
Authors: Son Hyeck-Soo , Nugent Liam , Wang Jiangxia , Varadaraj Varshini , Smith Kerry , Bower Kraig S. , Mgboji Glory , Soiberman Uri S. , Srikumaran Divya
Published: July 2023

Purpose:

The aim of this study was to identify factors associated with receipt of standard fluence epithelium-off crosslinking (CXL) for keratoconus (KCN).

Methods:

This retrospective, cross-sectional study reviewed electronic health records of treatment-naive patients with KCN seen at the Wilmer Eye Institute between January 2017 and September 2020. Tomographic data were derived from Pentacam (Oculus, Wetzlar, Germany) devices. Multivariable population-average model using generalized estimating equations adjusting for age, sex, race, national area deprivation index, vision correction method, and disease severity was used to identify factors associated with receipt of CXL.

Results:

From 583 patients with KCN, 97 (16.6%) underwent CXL for KCN. Patients who received CXL in at least 1 eye were significantly younger (mean 24.0 ± 7.8 years) than patients who had never undergone CXL (33.4 ± 9.3 years) (P < 0.001). In multivariable analysis, Black patients had 63% lower odds of receiving CXL for KCN (OR: 0.37, 95% CI, 0.18–0.79) versus White patients, and older age was protective against receipt of CXL (OR: 0.89 per 1-year increase, 95% CI, 0.86–0.93). Comparison of characteristics by race demonstrated that Black patients presented with significantly worse vision, higher keratometric indices (K1, K2, and Kmax), and thinner corneal pachymetry at baseline versus White or Asian patients.

Conclusions:

In this clinical cohort of patients with KCN from a tertiary referral center, Black patients were less likely to receive CXL presumably because of more advanced disease at presentation. Earlier active population screening may be indicated to identify and treat these patients before they become ineligible for treatment and develop irreversible vision loss. Such strategies may improve health equity in KCN management.
Making Surgery as Safe as It Should Be: A Qualitative Study
Authors: Robinson David , Beaumont Graham
Published: July 2023

Existing literature supports the view that adverse outcomes from surgical interventions are more likely to be the result of degraded nontechnical skills (NTS) rather than the technical skills of surgeons. In the present context, NTS comprise the behaviors and cognitions deployed by surgeons to make decisions, maintain awareness of the operating environment, communicate with and lead supporting personnel. A contemporary safety thesis suggests that focusing on what makes things go right (eg, NTS) is far more productive than retrospective analysis (learning from mistakes). The present qualitative research explored how surgeons deploy NTS to facilitate safe and effective outcomes from surgical interventions. The thematic analysis revealed that this surgical cohort engaged specific self-regulated NTS along an intervention construct consisting of planning, implementation, monitoring progress, and deliberate learning through reflection during the preoperative, operative, and postoperative phases of care. Behaviors supporting these contentions were identified in the data and used to amplify use of the construct.
Scientometric analysis of trends in global research on acne treatment
Authors: Zolotarev Oleg , Khakimova Aida , Rahim Fakher , Senel Engin , Zatsman Igor , Gu Dongxiao
Published: July 2023

Background:

Acne or acne vulgaris is the most common chronic inflammatory disease of the sebaceous follicles.

Objectives:

The present study aims to identify the main lines of research in the field of acne treatment using reproducible scientometric methods. In this article, we reviewed the following research trends: facial acne, different antibiotics, retinoids, anti-inflammatory drugs, epidermal growth factor receptor inhibitors therapy, and associated diseases.

Methods:

The analysis of publications from the PubMed collection was carried out from 1871 to 2022. All data were analyzed using Microsoft Excel. The evolution of the terminological portrait of the disease is shown.

Results:

Trends in the use of various groups of antibiotics, retinoids, anti-inflammatory drugs, and photodynamic therapy for acne treatment have been found. There is a growing interest in clindamycin and doxycycline (polynomial and exponential growth, respectively). The effects of isotretinoin are also being studied more frequently (active linear growth). The publication of studies on spironolactone is increasing (linear growth). There is also a steady interest in the use of epidermal growth factor receptor inhibitors in the recent years. There is active research on acne and polycystic ovary syndrome (exponential growth).

Limitations:

Only articles in English were selected. The most frequent terms were considered.

Conclusions:

The dynamics of publication activity in the field of acne was considered. The aim of the current scientometric study was to analyze the global trends in acne treatments. The trend analysis made it possible to identify the most explored areas of research, as well as indicate those areas in dermatology in which interest is declining.
Self-Stigma's Effect on Psychosocial Functioning Among People With Mental Illness
Authors: Qin Sang , Corrigan Patrick , Margaglione Maria , Smith Andrew
Published: July 2023

Consequences of self-stigma exhibit a four-step regressive model from being aware of public stigma, to agreeing with it, to applying it to oneself, to resulting harm on the self. We hypothesize the relationship between self-stigma and psychosocial functioning is mediated by three constructs: the why try effect, stigma stress coping resources, and personal recovery. Two hundred eight people with depressive and bipolar disorders participated the study. Data partially supported the regressive model of self-stigma. Awareness was not found to be associated with other regressive stages. The model representing the path between self-stigma-harm and psychosocial functioning was significant and robust. The path was mediated by the why try effect and personal recovery. Findings echo the growing body of research attempting to describe outcomes of self-stigma, in this case, psychosocial functioning. Programs meant to erase self-stigma, and its effect on functioning should incorporate the why try effect and personal recovery as strategic ingredients.
Cross-sectional Evaluation of Neurotology Fellowship Directors: A Present-day Snapshot of Leadership
Authors: Hullfish Haley , Schachner Benjamin , Zippi Zachary , Kamrava Brandon , Angeli Simon
Published: July 2023

Objective:

To identify demographic, training, and career trends of neurotology fellowship directors (FDs).

Study Design:

Cross-sectional study.

Setting:

United States.

Subjects:

All 26 neurotology FDs identified using the American Neurotology Society (ANS) ACGME Accredited Neurotology Fellowship Program Directory, accessed November 2021.

Main Outcome Measures:

Data were collected via CVs, institutional biographies, and emailed questionnaires. Data collected includes age, gender, race and ethnicity, residency and fellowship training institution, time since training completion until FD, length of time as FD, and Hirsch-index (h-index).

Results:

Twenty-six FDs were identified, and 17/26 (65.4%) FDs responded to the questionnaire. The majority (23/26; 88.5%) were male. The mean age of male and female FDs was 56 versus 47 years, respectively. Of the 17 that responded to the survey, 82.4% (14/17) self-identified as Caucasian. The mean h-index was 25.4. Older age correlated with a higher h-index (r = 0.46, P = 0.019). The duration (mean ± SD, years) from fellowship graduation to FD appointment was 10.7 ± 8.1 and 6.3 ± 4.8 from institutional hire. Six (23.1%) FDs had secondary graduate degrees, and 9 (34.6%) held a leadership position at a national otolaryngology organization.

Conclusion:

This observational study assesses demographic data on current neurotology FDs in the United States with an analysis of gender disparities. The objective measures identified can provide a baseline for growth in FD leadership.
Racial Discrimination and Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Adolescents With Overweight and Obesity: Does Context Matter?
Authors: Emlaw Jonel E. , Ajibewa Tiwaloluwa A. , Toledo-Corral Claudia M. , Hasson Rebecca E.
Published: July 2023

Objectives

In adolescents at higher risk for chronic disease, the role that context of a discriminatory event may play on cortisol dysregulation is unclear. The purpose of this study was to perform a cross-sectional analysis examining the association between racial discrimination context (peer, educational, institutional, and cumulative) and diurnal cortisol patterning in adolescents with overweight and obesity.

Methods

One hundred adolescents (13–19 years; 49% non-Hispanic Black; 65% female; body mass index percentile = 93.9% [4.14%]) were included in this analysis. Racial discrimination context was measured using the self-reported Adolescent Discrimination Distress Index. Salivary cortisol, collected across 3 days at five time points during the day, was used to calculate Δ 0–30 minutes, diurnal slope, and average total diurnal cortisol area under the curve. Sixteen separate multivariable linear regression models were performed to analyze the relationship between racial discrimination and diurnal cortisol patterns.

Results

Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004, p = .03; peer: β = 0.023 ± 0.010, p = .026).

Conclusions

Findings from this study identified cross-sectional associations between racial discrimination experienced among peers and diurnal cortisol patterns in adolescents with overweight/obesity. If our findings were to be confirmed in longitudinal analyses, evidence-based programs should be considered to buffer the effects of discrimination on adolescent health, and more importantly, policy makers should work to eliminate discrimination exposure.
Radiologists' Expectations of Artificial Intelligence in Pancreatic Cancer Imaging: How Good Is Good Enough?
Authors: Chu Linda C. , Ahmed Taha , Blanco Alejandra , Javed Ammar , Weisberg Edmund M. , Kawamoto Satomi , Hruban Ralph H. , Kinzler Kenneth W. , Vogelstein Bert , Fishman Elliot K.
Published: July 2023

Background

Existing (artificial intelligence [AI]) tools in radiology are modeled without necessarily considering the expectations and experience of the end user—the radiologist. The literature is scarce on the tangible parameters that AI capabilities need to meet for radiologists to consider them useful tools.

Objective

The purpose of this study is to explore radiologists' attitudes toward AI tools in pancreatic cancer imaging and to quantitatively assess their expectations of these tools.

Methods

A link to the survey was posted on the www.ctisus.com website, advertised in the www.ctisus.com email newsletter, and publicized on LinkedIn, Facebook, and Twitter accounts. This survey asked participants about their demographics, practice, and current attitudes toward AI. They were also asked about their expectations of what constitutes a clinically useful AI tool. The survey consisted of 17 questions, which included 9 multiple choice questions, 2 Likert scale questions, 4 binary (yes/no) questions, 1 rank order question, and 1 free text question.

Results

A total of 161 respondents completed the survey, yielding a response rate of 46.3% of the total 348 clicks on the survey link. The minimum acceptable sensitivity of an AI program for the detection of pancreatic cancer chosen by most respondents was either 90% or 95% at a specificity of 95%. The minimum size of pancreatic cancer that most respondents would find an AI useful at detecting was 5 mm. Respondents preferred AI tools that demonstrated greater sensitivity over those with greater specificity. Over half of respondents anticipated incorporating AI tools into their clinical practice within the next 5 years.

Conclusion

Radiologists are open to the idea of integrating AI-based tools and have high expectations regarding the performance of these tools. Consideration of radiologists' input is important to contextualize expectations and optimize clinical adoption of existing and future AI tools.
Imaging Features of Idiopathic Interstitial Lung Diseases
Authors: Batra Kiran , Adams Traci N.
Published: July 2023

Idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unclear etiology and are distinguished from diffuse parenchymal lung diseases of known cause, such as connective tissue disease–related interstitial lung diseases or hypersensitivity pneumonitis by history, physical exam, imaging, serologic testing, and, when necessary, histopathology. The 2013 American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines are the most widely accepted classification of IIPs and include the following diagnoses: idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, idiopathic lymphocytic interstitial pneumonia, idiopathic pleuro-parenchymal fibroelastosis, respiratory bronchiolitis–interstitial lung disease, and desquamative interstitial pneumonia. The gold standard for diagnosis of IIP involves multidisciplinary discussion among pulmonologists, radiologists, and pathologists. The focus of this review will be to discuss the imaging features of the most common IIPs and the role of multidisciplinary discussion as the gold standard for diagnosis.
Comparisons of Two-dimensional Echocardiographic Aortic Dimensions Between Chinese, Japanese, and Europeans
Authors: Hu Xiaoxia , Lin Zongwei , Li Ying , Chen Xiangyun , Zhao Yuanyuan , Xu Hongxiao , Sun Hui , Sun Xiaoqian , Liu Yan , Zhang Mei , Zhang Yun , Lu Huixia , Yao Guihua
Published: July 2023

Purpose:

We aimed to investigate the impacts of age, gender, and race on aortic dimensions in healthy adults.

Methods:

We analyzed data from 3 large population-based sample studies, including Chinese Echocardiographic Measurements in Normal Chinese Adults, Japanese the Normal Values for Echocardiographic Measurements Project, and European Normal Reference Ranges for Echocardiography, to compare the two-dimensional echocardiography-derived aortic diameters at different levels and to explore the effects of age, gender, and race on aortic measurements. We also compared the values corrected by body surface area (BSA) or height.

Results:

The results are as follows: (1) Aortic diameters showed positive correlations with age (r=0.12-0.42, P<0.05), and there were significant inter-age group differences before and after indexing to BSA (P<0.05); (2) Men had greater measurements of aortic diameters than women, with the differences being the same when indexed to height. However, indexing to BSA reversed the differences; (3) The aortic diameters at annulus (Ao-a) and sinus (Ao-s) levels were very close with minor differences between the Chinese and Japanese regardless of whether BSA was used for correction; and (4) The aortic measurements at Ao-s and proximal ascending aorta (Ao-asc) levels in the Chinese were significantly lower than in the Europeans for both genders, with the differences remaining the same even after indexing to BSA or height (P<0.05).

Conclusion:

Aortic dimensions vary with age and gender, and there are significant differences between races or ethnicities even when stratified by gender and age. The indexation by BSA or height cannot eliminate these differences. Therefore, age-specific, gender-specific, race-specific, and nationality-specific reference values may be more appropriate at present for clinical practice to avoid misdiagnosis and misclassification of aortic dilation.
Safety and Feasibility of Mediastinoscopy-assisted Esophagectomy: A Meta-analysis
Authors: Zhang Zhan , He Houle , Lu Shengxun , Yang Mengnan , Luo Junhui
Published: July 2023

Background:

The objective of the current study was to investigate the safety and feasibility of mediastinoscopy-assisted esophagectomy (MAE).

Methods:

A meta-analysis was conducted between MAE and traditional transthoracic esophagectomy (TTE). For a comparative analysis of MAE and TTE, we searched PubMed, the Cochrane Library, Embase, and Web of Science databases. We identified the relevant literature and extracted the relevant data. Finally, RevMan 5.3 software was applied to conduct a meta-analysis of the data.

Results:

A total of 1256 people were enrolled in 16 studies, comprising 575 patients with MAE and 681 with TTE. The findings revealed that the pulmonary complications, cardiac complications, and postoperative hospital stay in the MAE group were significantly better than those in the TTE group. No significant differences were found between the 2 groups in postoperative chylothorax, anastomotic fistula, and postoperative mortality. But the incidence of recurrent laryngeal nerve injury in the MAE group was higher than that in the TTE group (odds ratio=1.64, 95% CI, 1.15 to 2.35, P=0.006). The MAE group had less lymph node dissection than the TTE group (mean difference=−4.62, 95% CI, −5.97 to 3.45, P<0.00001).

Conclusions:

This meta-analysis presented that MAE was safe and feasible, reduced postoperative pulmonary and cardiac complications, and shortened hospital stay, but lymph node dissection was less, recurrent laryngeal nerve injury was higher, and the impact of long-term survival prognosis required more randomized controlled trials.
Comparison of Short-term Outcomes Between Esophageal Bypass Surgery and Self-expanding Stent Insertion in Esophageal Cancer: A Propensity Score-matched Analysis Using a Large-scale Inpatient Database
Authors: Yamamoto Yuta , Kitazawa Masato , Otsubo Tetsuya , Tokumaru Shigeo , Nakamura Satoshi , Koyama Makoto , Hondo Nao , Kataoka Masahiro , Seharada Kai , Soejima Yuji
Published: July 2023

Background:

Advanced esophageal cancer is occasionally accompanied by difficulty swallowing owing to esophageal stenosis or tracheoesophageal fistula formation. Esophageal bypass surgery and stent insertion are considered feasible palliative management options. The aim of this study was to evaluate the short-term outcomes of these palliative treatments.

Materials and Methods:

Patient data were obtained from a large-scale inpatient database of 42 National University Hospitals in Japan. Patients with advanced esophageal cancer who underwent esophageal bypass surgery or stent insertion between April 2016 and March 2021 were included in this study. One-to-one propensity score matching of patients who underwent bypass surgery or stent insertion was performed. The primary outcomes were time to diet resumption and length of hospital stay after surgery. The secondary outcome was the incidence of postoperative complications.

Results:

In 43 propensity score-matched pairs, the incidence of postoperative respiratory complications was significantly higher in the bypass group than in the stent group (32.6% vs. 9.3%, P = 0.008). Postoperative length of hospital stay was longer in the bypass group than in the stent group (24 vs. 10 d, P < 0.001). Logistic regression analysis revealed that stent insertion was associated with a decreased risk of respiratory complications (odds ratio 0.077, P < 0.007). Among patients who underwent the interventions (bypass surgery or stent insertion) and subsequently underwent anticancer therapy (chemotherapy/radiotherapy) during hospitalization, the interval between the intervention and anticancer therapy was longer in the bypass group than in the stent group (25 vs. 7 d, P = 0.003).

Conclusions:

Esophageal stent insertion provides better short-term outcomes than bypass surgery in patients with advanced unresectable esophageal cancer.
Spontaneous Pneumothorax
Authors: Alvarez Marlen , Evans Dian Dowling , Tucker Paula
Published: July 2023

The Research to Practice column critiques a current research article and translates the findings, in the context of a case, to a practice change within emergency settings. This article reviews the findings of a randomized controlled trial conducted by A. Theille et al. (2017) comparing the use of needle decompression versus chest tube insertion for management of spontaneous pneumothorax. The study found that use of needle aspiration was safe and effective and was associated with fewer procedure-related complications and significantly shorter hospital stays. The investigators concluded that needle aspiration be used as a first-line, definitive treatment in management of a spontaneous pneumothorax. As emergency providers examine improved and equally effective approaches to care that are associated with less costs and potential complications, needle aspiration offers a beneficial approach and should be shared with patients when discussing treatment options to ensure shared decision making.
Combining Oxygenated Cold Perfusion With Normothermic Ex Vivo Perfusion Improves the Outcome of Donation After Circulatory Death Porcine Kidney Transplantation
Authors: Mazilescu Laura Ioana , Goto Toru , John Rohan , Rosales Roizar , Ganesh Sujani , Yu Frank , Noguchi Yuki , Kawamura Masataka , Dezard Victoria , Gao Fei , Urbanellis Peter , Parmentier Catherine , Konvalinka Ana , Bagli Darius J. , Reichman Trevor W. , Robinson Lisa A. , Selzner Markus
Published: July 2023

Background.

Ex vivo machine perfusion is a novel preservation technique for storing and assessing marginal kidney grafts. All ex vivo perfusion techniques have advantages and shortcomings. The current study analyzed whether a combination of oxygenated hypothermic machine perfusion (oxHMP) followed by a short period of normothermic ex vivo kidney perfusion (NEVKP) could combine the advantages of both techniques.

Methods.

Porcine kidneys were exposed to 30 min of warm ischemia followed by perfusion. Kidneys underwent either 16-h NEVKP or 16-h oxHMP. The third group was exposed to 16-h oxHMP followed by 3-h NEVKP (oxHMP + NEVKP group). After contralateral nephrectomy, grafts were autotransplanted and animals were followed up for 8 d.

Results.

All animals survived the follow-up period. Grafts preserved by continuous NEVKP showed improved function with lower peak serum creatinine and more rapid recovery compared with the other 2 groups. Urine neutrophil gelatinase-associated lipocalin, a marker of kidney injury, was found to be significantly lowered on postoperative day 3 in the oxHMP + NEVKP group compared with the other 2 groups.

Conclusions.

A short period of NEVKP after oxHMP provides comparable short-term outcomes to prolonged NEVKP and is superior to oxHMP alone. A combination of oxHMP with end-ischemic NEVKP could be an attractive, practical strategy to combine the advantages of both preservation techniques.
Old muscle, new tricks: a clinician perspective on sarcopenia and where to next
Authors: Schütze Katie , Schopp Madeline , Fairchild Timothy J. , Needham Merrilee
Published: July 2023

Purpose of review

This review offers a contemporary clinical approach to the recognition, prevention and management of sarcopenia, and discusses recent clinically relevant advances in the aetiopathogenesis of muscle ageing that may lead to future therapeutic targets.

Recent findings

The key recent directions for sarcopenia are in the diagnosis, understanding molecular mechanisms and management. Regarding the recognition of the condition, it has become increasingly clear that different definitions hamper progress in understanding. Therefore, the Global Leadership in Sarcopenia has been established in 2022 to develop a universally accepted definition. Moreover, substantial work is occurring to understand the various roles and contribution of inflammation, oxidative stress, mitochondrial dysfunction and metabolic dysregulation on skeletal muscle function and ageing. Finally, the role of resistance-based exercise regimes has been continually emphasised. However, the role of protein supplementation and hormone replacement therapy (HRT) are still under debate, and current clinical trials are underway.

With the global ageing of our population, there is increasing emphasis on maintaining good health. Maintenance of skeletal muscle strength and function are key to preventing frailty, morbidity and death.
The distribution of fitness effects of plasmid pOXA-48 in clinical enterobacteria
Authors: Fernández-Calvet Ariadna , Toribio-Celestino Laura , Alonso-del Valle Aida , Sastre-Dominguez Jorge , Valdes-Chiara Paula , San Millan Alvaro , DelaFuente Javier
Published: July 2023

Antimicrobial resistance (AMR) in bacteria is a major public health problem. The main route for AMR acquisition in clinically important bacteria is the horizontal transfer of plasmids carrying resistance genes. AMR plasmids allow bacteria to survive antibiotics, but they also entail physiological alterations in the host cell. Multiple studies over the last few years have indicated that these alterations can translate into a fitness cost when antibiotics are absent. However, due to technical limitations, most of these studies are based on analysing new associations between plasmids and bacteria generated in vitro, and we know very little about the effects of plasmids in their native bacterial hosts. In this study, we used a CRISPR-Cas9-tool to selectively cure plasmids from clinical enterobacteria to overcome this limitation. Using this approach, we were able to study the fitness effects of the carbapenem resistance plasmid pOXA-48 in 35 pOXA-48-carrying isolates recovered from hospitalized patients. Our results revealed that pOXA-48 produces variable effects across the collection of wild-type enterobacterial strains naturally carrying the plasmid, ranging from fitness costs to fitness benefits. Importantly, the plasmid was only associated with a significant fitness reduction in four out of 35 clones, and produced no significant changes in fitness in the great majority of isolates. Our results suggest that plasmids produce neutral fitness effects in most native bacterial hosts, helping to explain the great prevalence of plasmids in natural microbial communities.
Axonal stimulation affects the linear summation of single-point perception in three Argus II users
Authors: Hou Yuchen , Nanduri Devyani , Granley Jacob , Weiland James D. , Beyeler Michael
Published: July 2023

Purpose

Retinal implants use electrical stimulation to elicit perceived flashes of light (“phosphenes”). Single-electrode phosphene shape has been shown to vary systematically with stimulus parameters and the retinal location of the stimulating electrode, due to incidental activation of passing nerve fiber bundles. However, this knowledge has yet to be extended to paired-electrode stimulation.

Methods

We retrospectively analyzed 3548 phosphene drawings made by three blind participants implanted with an Argus II Retinal Prosthesis. Phosphene shape (characterized by area, perimeter, major and minor axis length) and number of perceived phosphenes were averaged across trials and correlated with the corresponding single-electrode parameters. In addition, the number of phosphenes was correlated with stimulus amplitude and neuroanatomical parameters: electrode-retina and electrode-fovea distance as well as the electrode-electrode distance to (“between-axon”) and along axon bundles (“along-axon”). Statistical analyses were conducted using linear regression and partial correlation analysis.

Results

Simple regression revealed that each paired-electrode shape descriptor could be predicted by the sum of the two corresponding single-electrode shape descriptors (p <.001). Multiple regression revealed that paired-electrode phosphene shape was primarily predicted by stimulus amplitude and electrode-fovea distance (p <.05). Interestingly, the number of elicited phosphenes tended to increase with between-axon distance (p <.05), but not with along-axon distance, in two out of three participants.

Conclusions

The shape of phosphenes elicited by paired-electrode stimulation was well predicted by the shape of their corresponding single-electrode phosphenes, suggesting that two-point perception can be expressed as the linear summation of single-point perception. The notable impact of the between-axon distance on the perceived number of phosphenes provides further evidence in support of the axon map model for epiretinal stimulation. These findings contribute to the growing literature on phosphene perception and have important implications for the design of future retinal prostheses.
Age- and sex-specific differences in immune responses to BNT162b2 COVID-19 and live-attenuated influenza vaccines in UK adolescents
Authors: Jay Cecilia , Adland Emily , Csala Anna , Lim Nicholas , Longet Stephanie , Ogbe Ane ,   Consortium PITCH, Ratcliff Jeremy , Sampson Oliver , Thompson Craig P , Turtle Lance , Barnes Eleanor , Dunachie Susanna , Klenerman Paul , Carroll Miles , Goulder Philip
Published: July 2023

Key to understanding COVID-19 correlates of protection is assessing vaccine-induced immunity in different demographic groups. Sex- and age-specific immune differences have a wide impact on outcomes from infections and immunisations. Typically, adult females make stronger immune responses and have better disease outcomes but suffer more adverse events following vaccination and are more prone to autoimmune disease. To understand better the mechanisms underlying these differences in vaccine responses, we studied immune responses to two doses of BNT162b2 Pfizer COVID-19 vaccine in an adolescent cohort (n=34, ages 12-16), an age group previously shown to make significantly greater immune responses to the same vaccine compared to young adults. At the same time, we were able to evaluate immune responses to the co-administered live attenuated influenza vaccine, which has been shown to induce stronger immune responses in adult females. Blood samples from 34 adolescents taken pre- and post-vaccination with COVID-19 and influenza vaccines were assayed for SARS-CoV-2-specific IgG and neutralising antibodies, and cellular immunity specific for SARS-CoV-2 and endemic betacoronaviruses. IgG targeting influenza lineages contained in the influenza vaccine was also assessed. As previously demonstrated, total IgG responses to SARS-CoV-2 Spike antigens were significantly higher among vaccinated adolescents compared to adults (aged 32-52) who received the BNT162b2 vaccine (comparing infection-naïve, 49,696 vs 33,339; p=0.03; comparing SARS-CoV-2 previously-infected, 743,691 vs 269,985; p<0.0001) by MSD v-plex assay. However, unexpectedly, antibody responses to BNT162b2 and the live-attenuated influenza vaccine were not higher among female adolescents compared to males; among infection-naïve adolescents, antibody responses to BNT162b2 were higher in males than females (62,270 vs 36,951 p=0.008). No sex difference was identified in vaccinated adults. These unexpected findings may result from the introduction of novel mRNA vaccination platforms, generating patterns of immunity divergent from established trends, and providing new insights into what might be protective following COVID-19 vaccination.
Industry payments to anesthesiologists in the United States between 2014 and 2022
Authors: Murayama Anju
Published: July 2023

Background

Financial relationships between physicians and the healthcare industry could be beneficial to improve patient care, but could lead to conflicts of interest. However, there was no study specifically evaluating the extent of financial relationships between anesthesiologists and the healthcare industry in the United States.

Methods

Using the Open Payments Database between 2014 and 2022, this longitudinal cross-sectional study examined the size, prevalence and trends of general (non-research) payments made by the healthcare industry to all anesthesiologists in the United States.

Results

Over the nine-year period, 67.0% of all anesthesiologists received general payments totaling $272.0 million over nine years, while 21.0% to 35.3% of anesthesiologists received one or more general payments each year. Median annual general payments to anesthesiologists ranged from $57 to $115. The top 1%, 5%, and 10% of anesthesiologists received 73.4%, 90.3%, and 94.8% of all general payments, respectively. There were no constant yearly trends in the total amounts and per-anesthesiologist general payments between 2014 and 2019, but significant declines occurred in 2020, likely due to the COVID-19 pandemic. Pain medicine physicians received the highest median general payments of $4,426 in nine-year combined total amounts, followed by addiction medicine ($431), critical care medicine ($277), and general anesthesiology ($256).

Conclusion

This study reveals significant financial relationships between the healthcare industry and anesthesiologists, with a disproportionate concentration of payments among a minority of anesthesiologists. While no clear trends in payments were evident before the pandemic, there was a substantial reduction during the COVID-19 outbreak.
Concomitant Use of VA-ECMO and Impella Support for Cardiogenic Shock
Authors: Modi Shan P. , Hong Yeahwa , Sicke McKenzie M. , Hess Nicholas R. , Klass Wyatt J. , Ziegler Luke A. , Rivosecchi Ryan M. , Hickey Gavin W. , Kaczorowski David J. , Ramanan Raj
Published: July 2023

Background

VA-ECMO with concomitant Impella support (ECpella) is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with ECpella support have not been well-described.

Methods

This study was a retrospective, single-center analysis of patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with ECpella from December 2020 to January 2023. Primary outcomes included 90-day survival post-discharge and destination after support. Secondary outcomes included complications post-ECpella support.

Results

A total of 44 patients were included (AMI-CS,n =20, and ADHF-CS,n= 24). Patients with AMI-CS and ADHF-CS had similar survival 90 days post-discharge (p= .267) with similar destinations after ECpella support (p =.220). Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS (p=.013;p= .030). Patients with initial Impella support were more likely to survive ECpella support and be bridged to transplant (p=.033) and less likely to have a cerebrovascular accident(p=.016). Sub-analysis of ADHF-CS patients into acute-on-chronic decompensated heart failure and de novo heart failure demonstrated no difference in survival or destination.

Conclusion

ECpella can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS in patients with ECpella support. Patients with initial Impella support are more likely to survive ECpella support and bridge to transplant. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with ECpella support.

Clinical Perspectives

What is New?

ECpella support is a feasible support strategy for allcomers in severe cardiogenic shock. This study demonstrates that ECpella can be utilized not only as a salvage therapy and venting strategy for those in cardiogenic shock on VA-ECMO, but also can be utilized as a method for additional cardiac support for patients with initial Impella support. There were no differences in survival between cardiogenic shock secondary to acute myocardial infarction and cardiogenic secondary to acute decompensated heart failure.

What are the clinical implications?

Although ECpella patients that received initial Impella support have higher success in bridging to heart transplant, allcomers on ECpella support should be evaluated for advanced therapies early in their clinical course. Further studies are required to ascertain the differences in pathophysiology between cardiogenic shock secondary to acute myocardial infarction and cardiogenic secondary to acute decompensated heart failure and determine appropriate support strategies for differing cardiogenic shock phenotypes.
Knowledge and practice of road safety measures among motor-bikers in Bangladesh: a cross-sectional study
Authors: Das Sadhan Kumar , Tamannur Tahazid , Nesa Arifatun , Noman Abdullah Al , Dey Piue , Kundu Shuvojit Kumar , Sultana Hafiza , Riaz Baizid Khoorshid , Islam ANM Shamsul , Sharower Golam , Dhar Bablu Kumar , Rahman Mohammad Meshbahur
Published: July 2023

Introduction

Road traffic accidents (RTAs) including motorbike accidents are the leading cause of death for teenagers between 15 and 29 and have been a serious concern in low- and middle-income countries like Bangladesh. Therefore, this study aims to assess the level of knowledge and practice on road safety measures among motorbikers in Bangladesh.

Methods

This cross-sectional study was conducted from January 2022 to December 2022 among 350 motor-bikers of Dhaka, the capital of Bangladesh via a series of face-to-face interviews. Motor bikers who regularly ride a motorcycle were interviewed about their road rafety knowledge and practices through two-stage cluster sampling technique. Frequency distribution, independent sample t-test, and One-way ANOVA were performed.

Results

Out of the 350 motorbikers, only 54.6% had good knowledge and 16.9% had poor knowledge on the signs and safety regulations of roads. Moreover, only 50.6% of respondents followed good practices while 23.4% followed poor practices of road safety measures. One way ANOVA analysis demonstrates that the average knowledge score was significantly (p<0.05) higher among higher-educated, unmarried and non-smokers. Additionally, higher education level, non-smoking status and being Muslim were significantly (P<0.05) associated with good road safety practices.

Conclusions

The overall good knowledge level and practices of road safety measures among the motorbikers were not satisfactory albeit the majority of them knew individual signs and regulations. Therefore, this study suggests that education and strict enforcement of traffic rules may increase their knowledge and practice behavior regarding road safety which in turn would minimize traffic injuries and fatalities.
Bioinformatics Unravels the Epigenetic Mechanisms of Hashimoto’s Thyroiditis: Deciphering Molecular Complexity
Authors: de Oliveira Andrade Luis Jesuino , de Oliveira Luís Matos , de Oliveira Luisa Correia Matos , de Oliveira Gabriela Correia Matos
Published: July 2023

Introduction

Recent research in the field of epigenetics has shed light on the impact of epigenetic modifications in the development and progression of Hashimoto’s thyroiditis (HT). However, the epigenetic roles in HT are still not fully elucidated.

Objective

To exhibit anin silicorepresentation of the epigenetic mechanism in HT development and explicate their function in the pathogenesis of the ailment.

Methods

Genetic data were retrieved from GEO database (NCBI) for DNA methylation assessment through bioinformatics. We evaluated 6 HT samples from GSE29315 dataset. Normalization of the data was performed to identify differentially expressed genes (DEGs). Standardization of all expression data was accomplished using the R programming language. The R package was employed for the analysis of DEGs. Genes exhibiting an expression fold change greater than 4 and a P-value less than 0.05 were considered to be DEGs.

Results

The expression data from the 6 HT specimens in GSE29315 (GSM724489, GSM724490, GSM724491, GSM724492, GSM724493, GSM724494) were patterned. In total, 71 DEGs, including 63 positively regulated genes and 7 negatively regulated genes, were identified. An expression density plot was used to display the clustering of DEGs, and average log-expression was constructed to visually display all DEGs in the HT sample. In thein silicosimulation of the methylated regions in gene GSE29315, we identify specific CpG sites within the analyzed regions that showed significant methylation changes: Region 1 - Promoter Region: CpG site 1: Hypomethylated (40% methylation), CpG site 2: Hypomethylated (35% methylation), and CpG site 3: Hypomethylated (38% methylation); Region 2 - Enhancer Region: CpG site 4: Hypermethylated (80% methylation). CpG site 5: Hypermethylated (75% methylation), and CpG site 6: Hypermethylated (85% methylation); Region 3 - Transcription Start Site: CpG site 7: Hypomethylated (30% methylation), CpG site 8: Hypomethylated (25% methylation), and CpG site 9: Hypomethylated (28% methylation); Region 4 - Intronic Region: CpG site 10: Hypermethylated (70% methylation), CpG site 11: Hypermethylated (65% methylation), and CpG site 12: Hypermethylated (75% methylation.

Conclusion

Our analysis of the GSE29315 gene revealed significant hypermethylation in specific regions, which could lead to gene silencing or altered gene expression. Additionally, we identified regions of hypomethylation that may upregulate gene activity.
Trend, multivariate decomposition and spatial distribution of perinatal mortality in Ethiopia using further analysis of EDHS 2005-2016
Authors: Agimas Muluken Chanie , Kefale Demewoz , Tesfie Tigabu Kidie , Kefale Demewoz , Necho Worku , Munye Tigabu , Abeje Gedefaw , Tesfahun Yohannes , Simegn Amare , kassaw Amare , Zeleke Shegaw , Demis Solomon , Hailemeskel Habtamu Shimels
Published: July 2023

Background

Perinatal mortality is the global health problem, especially Ethiopia has the highest perinatal mortality rate. Studies about perinatal mortality were conducted in Ethiopia, but which factors specifically contribute to the change in perinatal mortality across time is unknown.

Objectives

To assess the trend, multivariate decomposition and spatial analysis of perinatal mortality in Ethiopia using EDHS 2005 to 2016.

Methods

A community-based cross-sectional study design was used. EDHS 2005-2016 data was used and weighting has been applied to adjust the difference in the probability of selection. Logit based multivariate decomposition analysis was used using STATA version 14.1. Moran’s I statistics using ArcGIS was also used to identify the significant clustering of perinatal mortality.

Result

The trend of perinatal mortality in Ethiopia decreased from 37 per 1000 births in 2005 to 33 per 1000 births in 2016. About 83.3% of the decrease in perinatal mortality in the survey was attributed to the difference in the endowment (composition) of the women. Among the differences in the endowment, the difference in the composition of ANC visits, take TT vaccine, urban residence, occupation, secondary education, birth attendant significantly decreased the perinatal mortality in the last 10 years. Among the differences in coefficients, skilled birth attendant significantly decreased the perinatal mortality. The spatial distribution of perinatal mortality was randomly distributed.

Conclusion

The perinatal mortality in Ethiopia has declined over time. Variables like ANC visit, taking TT vaccine, urban residence, have occupation, secondary education and skilled birth attendant reduce perinatal mortality. Perinatal mortality was distributed randomly in Ethiopia. To reduce perinatal mortality more, scaling-up the maternal and newborn health services has a critical role.
Healthcare Providers’ Satisfaction and associated factors with clinical laboratory service at government hospitals in Southwest Shewa Zone Oromia, Ethiopia
Authors: Asaye Sintayehu , Alemu Getachew , Gebre Dejene , Teshager Lule , Yadesa Girma
Published: July 2023

Background

Healthcare providers are vital clients of the clinical laboratory. Problems in laboratory services have a significant impact on healthcare providers’ diagnosis, intervention, or prevention strategies during patient healthcare. Healthcare providers’ satisfaction wasn’t assessed in the study area. So, the study aimed to evaluate their satisfaction, which helps improve laboratory services and serves as a prerequisite for accreditation.

The study aims to assess healthcare providers’ satisfaction associated factors with laboratory services among all government hospitals in the southwest Shewa zone, Oromia, Central Ethiopia 2022.

Methods

A cross-sectional study was conducted on 314 healthcare providers from June to July 2022. Healthcare providers who met the eligibility criteria and volunteers were included. Before being exported to SPSS version 25, the data were coded and entered into Epi Data version 3.1 for completeness checks. After descriptive statistics were performed, variables were subjected to bivariate and multivariable logistic regression analysis to identify associated variables, and variables with a p. value < 0.05 were considered statistically significant. Finally, the results were shown in the text and table.

Results

According to the study, 54 % of healthcare providers were satisfied with laboratory services. The assistance of the lab. Handbook (AOR=1.676, 95% CI=1.002, 2.801), notification of the change in services (AOR=1.735, 95% CI=1.029, 2.925), getting urgent test results in time (AOR=2.349, 95% CI=1.39, 3.68), courtesy of lab. Staff (AOR=1.924, 95% CI=1.115, 3.321), reliable/quality of lab. result (AOR=3.69, 95% CI= 2.083, 6.538), and consistency of laboratory quality services (AOR=1.706, 95% CI=1.012, 2.875) were factors significantly related to satisfaction.

Conclusion

About half of the healthcare providers were dissatisfied with laboratory services. Therefore, to increase the satisfaction of healthcare providers’ hospital administrative and laboratory staff, they should work together on the identified factors. In order to determine overall clients’ satisfaction with laboratory services, an assessment of patient satisfaction will be required