bluuebunny/crossref_metadata_2025 huggingface dataset:
Microfluidics—A novel technique for high‐quality sperm selection for greater ART outcomes
Authors: Bhat Ghulam Rasool , Lone Farooz Ahmad , Dalal Jasmer
Published: August 2024

Microfluidics represent a quality sperm selection technique. Human couples fail to conceive and this is so in a significant population of animals worldwide. Defects in male counterpart lead to failure of conception so are outcomes of assisted reproduction affected by quality of sperm. Microfluidics, deals with minute volumes (μL) of liquids run in small‐scale microchannel networks in the form of laminar flow streamlines. Microfluidic sperm selection designs have been developed in chip formats, mimicking in vivo situations. Here sperms are selected and analyzed based on motility and sperm behavioral properties. Compared to conventional sperm selection methods, this selection method enables to produce high‐quality motile sperm cells possessing non‐damaged or least damaged DNA, achieve greater success of insemination in bovines, and achieve enhanced pregnancy rates and live births in assisted reproduction—in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Besides, the concentration of sperm available to oocyte can be controlled by regulating the flow rate in microfluidic chips. The challenges in this technology are commercialization of chips, development of fully functional species‐specific microfluidic tools, limited number of studies available in literature, and need of thorough understanding in reproductive physiology of domestic animals. In conclusion, incorporation of microfluidic system in assisted reproduction for sperm selection may promise a great success in IVF and ICSI outcomes. Future prospectives are to make this technology more superior and need to modify chip designs which is cost effective and species specific and ready for commercialization. Comprehensive studies in animal species are needed to be carried out for wider application of microfluidic sperm selection in in vitro procedures.
Effect of Leishmania infantum infection on B cell lymphopoiesis and memory in the bone marrow and spleen
Authors: Dirkx Laura , Loyens Marlotte , Van Acker Sara I. , Bulté Dimitri , Claes Mathieu , Radwanska Magdalena , Magez Stefan , Caljon Guy
Published: August 2024

Visceral leishmaniasis (VL) is characterized by an uncontrolled infection of internal organs such as the spleen, liver and bone marrow (BM) and can be lethal when left untreated. No effective vaccination is currently available for humans. The importance of B cells in infection and VL protective immunity has been controversial, with both detrimental and protective effects described. VL infection was found in this study to increase not only all analyzed B cell subsets in the spleen but also the B cell progenitors in the BM. The enhanced B lymphopoiesis aligns with the clinical manifestation of polyclonal hypergammaglobulinemia and the occurrence of autoantibodies. In line with earlier reports, flow cytometric and microscopic examination identified parasite attachment to B cells of the BM and spleen without internalization, and transformation of promastigotes into amastigote morphotypes. The interaction appears independent of IgM expression and is associated with an increased detection of activated lysosomes. Furthermore, the extracellularly attached amastigotes could be efficiently transferred to infect macrophages. The observed interaction underscores the potentially crucial role of B cells during VL infection. Additionally, using immunization against a fluorescent heterologous antigen, it was shown that the infection does not impair immune memory, which is reassuring for vaccination campaigns in VL endemic areas.
Incidence and Risk Factors for Severe Postpartum Hemorrhage in Women With Anterior Low-Lying or Previa Placenta and Prior Cesarean: Prospective Population-Based Study
Authors: Pinton A , Deneux-Tharaux C , Seco A , Sentilhes L , Kayem G ,   on behalf of the PACCRETA Study Group
Published: August 2024

(BJOG. 2023;130(13):1653–1661. doi: 10.1111/1471-0528.17554)

The presence of an abnormally located placenta (either anterior low lying or previa) along with a history of prior cesarean section is associated with placenta accreta spectrum (PAS). Diagnostic tests for PAS are recommended for patients with this combination of risk factors to provide care at specialized, high resource institutions and limit maternal morbidity and mortality. Recommendations for referral to specialized centers in the setting of prior cesarean delivery and either anterior low lying or placenta previa vary due to lack of evidence in this group of patients. This population-based cohort study seeks to understand whether the incidence and risk factors for severe PPH can be found in women with an abnormally located placenta as well as a prior cesarean section in the absence of a prenatal PAS diagnosis.
Risk of Recurrent Severe Maternal Morbidity: A Population-Based Study
Authors: Ukah UV , Platt RW , Auger N , Lisonkova S , Ray JG , Malhamé I , Ayoub A , El-Chaâr D , Dayan N
Published: August 2024

(Am J Obstet Gynecol. 2023;229(5):545.e1–545.e11. doi: 10.1016/j.ajog.2023.06.010)

The occurrence of severe maternal morbidity (SMM), a composite indicator of maternal wellness and care in pregnancy or up to 42 days following delivery, is increasing. SMM precedes over half of maternal deaths, is associated with extended hospital stays, and linked to long-term cardiovascular health concerns. Public health agencies prioritize monitoring SMM to drive better clinical care and outcomes. Understanding SMM recurrence is crucial for informed decision-making and complex care planning during subsequent pregnancies. Recent epidemiologic studies, several limited to privately insured populations, have found a 3 to 8 folds increased relative risk of SMM recurrence. However, diverse populations and individual SMM criteria have not been studied. This study aimed to understand SMM recurrence risk in a second pregnancy in patients with a history of SMM as a primary composite outcome and by disease-specific conditions secondarily, adjusting for known factors like age, health conditions, substance use, and socioeconomic status.
Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function
Authors: Metz TD , Allshouse AA , McMillin GA , Greene T , Chung JH , Grobman WA , Haas DM , Mercer BM , Parry S , Reddy UM , Saade GR , Simhan HN , Silver RM
Published: August 2024

(JAMA. 2023;330(22):2191–2199. doi: 10.1001/jama.2023.21146)

Cannabis use has steadily increased over the last decade and is now viewed by many pregnant individuals as relatively safe in many forms. Previously published research in pregnancy is limited by inaccurate assessment of exposure to cannabis, relying heavily on self-reported use, and significant confounding that influences pregnancy outcomes including tobacco use, anxiety, and depression. Researchers agree that the prevalence of cannabis use is chronically underestimated, due to the stigma associated with any drug use in pregnancy as well as potential legal consequences in states with mandatory reporting. Exposure to cannabis has been linked to placental dysfunction and poor fetal growth. This study was executed to evaluate an association between cannabis use and adverse pregnancy outcomes that are related to placental function, as well as to understand the strength of the association based on exposure timing and intensity.
Intrapartum Continuous Subcutaneous Insulin Infusion Versus Intravenous Insulin Infusion Among Pregnant Individuals With type 1 Diabetes Mellitus: A Randomized Controlled Trial
Authors: Wilkie GL , Delpapa E , Leftwich HK
Published: August 2024

(Am J Obstet Gynecol. 2023;229(6):680.e1–680.e8. doi: 10.1016/j.ajog.2023.07.003)

Type 1 diabetes mellitus (T1DM) requires life-long insulin management and is a component of pregestational diabetes, affecting 1% to 2% of all pregnancies. Maternal exposure to placental hormones heightens insulin resistance and the potential for poor glycemic control. Hypoglycemia, diabetes-related complications, diabetic ketoacidosis, congenital anomalies, stillbirth, macrosomia, cesarean delivery, polyhydramnios, and hypertensive disorders or pregnancy are known complications of T1DM, especially in the setting of poor glycemic management. Neonatal exposure to high maternal blood sugar during pregnancy can lead to severe complications like neonatal hypoglycemia, respiratory distress syndrome, polycythemia, and jaundice and maternal glucose control in labor is important for neonatal hypoglycemia reduction. Optimal intrapartum glycemic control methods vary among providers, ranging from continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion, with limited data on neonatal outcomes. This study sought to understand the effect of intrapartum CSII in comparison to IV insulin infusion on first neonatal blood glucose level in pregnant patients with T1DM utilizing CSII at baseline.
United States Rural Residence Is Associated With Increased Acute Maternal End-organ Injury or Mortality After Birth: A Retrospective Multistate Analysis, 2007-2018
Authors: Chaturvedi R , Lui B , Tangel VE , Abramovitz SE , Pryor KO , Lim KG , White RS
Published: August 2024

(Int J Obstet Anesth. 2023;56:103916. doi:10.1016/j.ijoa.2023.103916)

The maternal mortality rate in the USA rose from 7.2 to 23.8 deaths per 100,000 live births between 1987 and 2020. This increase, along with a 200% rise in severe maternal morbidity (SMM), may be partly due to increased comorbidity among expectant mothers. However, social determinants of health also play a role, including location, race/ethnicity, and age. Analysis of national data shows that women in highly urban or rural areas face higher risks of combined SMM and mortality compared with those in smaller cities. Anesthetic choice further influences outcomes, with neuraxial analgesia linked to lower SMM rates during vaginal births. Access to such anesthesia may vary based on social determinants like rural-urban disparities. This study aims to explore differences in maternal outcomes based on residency, anesthesia type, and mode of delivery, hypothesizing that rural residents face more significant risks and disparities in anesthesia access.
Oxytocin at Elective Cesarean Delivery: A Dose-finding Study in Pregnant People With Twin Pregnancy
Authors: Peska E , Balki M , Pfeifer W , Maxwell C , Ye XY , Downey K , Carvalho JCA
Published: August 2024

(Anesth Analg. 2024;138(4):814–820. doi:10.1213/ANE.0000000000006309)

Multiple pregnancies pose a well-known danger for postpartum hemorrhage (PPH). Compared with single pregnancies, individuals expecting multiples face heightened risks like uterine atony, severe PPH, blood transfusion, hysterectomy, prolonged hospital stays, and mortality, regardless of income level. Uterine atony, a significant cause of PPH, is more common in multiple pregnancies. Prophylactic oxytocin postdelivery is crucial in PPH prevention, though it can have adverse effects and should be given at the minimum effective dose. Studies suggest varying oxytocin requirements based on clinical scenarios like body mass index and cesarean delivery (CD) for labor complications in multiple pregnancies, prompting the need for tailored dosages for PPH prevention.
Cultivating Common Ground: The Intersection of Mental Health and Faith
Authors: Verduin Marcia L. , Tower Keith
Published: August 2024

During and following the COVID-19 pandemic, the world experienced a significant increase in the prevalence of mental health problems along with a concomitant increase in mental health service utilization rates. Even though the stigma associated with mental health problems has been decreasing and service utilization rates have increased, these have not been seen in all segments of the population; for instance, some religious beliefs have been associated with less frequent and lower rates of mental health service use. In this commentary, the authors, an academic psychiatrist and a community-based pastor, describe how their informal academic-community collaboration led to a series of speaking opportunities to help an international group of clergy members develop a better understanding of mental health and how mental health problems may intersect with faith. They reflect on lessons learned from these opportunities and their professions, discuss opportunities for academic faculty to apply these lessons in their daily practices, and encourage academic faculty to consider a “common ground” approach in their own community outreach efforts. The authors underscore the importance of building connections with people who might have beliefs, views, or understandings of medical concepts that differ from academic medicine’s and of teaching trainees how to build these connections. They challenge individual clinicians and academic faculty to identify spheres of influence that they have in their own lives through which they can create a positive impact for medicine and public health by finding shared experiences and common ground, clarifying misunderstandings, educating where needed, and serving as role models to encourage trainees to do the same.
Barriers Facing Undocumented Medical Students Without DACA
Authors: Fabi Rachel , Suleiman Halima , Kuczewski Mark
Published: August 2024

Despite predictions that the United States will experience a growing physician shortage in the coming decades, there remains a population of would-be clinicians who are barred from becoming licensed physicians because of their immigration status. Undocumented medical students who do not have Deferred Action for Childhood Arrivals (DACA) status have to overcome many barriers to gain admittance to medical school, but because they lack work authorization in the United States, they are unable to enter residency training. In this article, the authors highlight the implications of this dilemma for academic medicine. After detailing the experiences of an undocumented medical student, they examine the historical and policy background of this barrier to licensure and board certification. The authors consider the most immediate option available to academic medical institutions: to create a viable training program that is an alternative to residency. Such an alternative training program would need to be equivalent in quality to an accredited residency program and enable its trainees to become board-certified but not be a form of employment. Finally, the authors conclude with a call for academic medicine to engage in advocacy in support of legislative solutions for undocumented young people.
Is Next-day Discharge Safe After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?
Authors: Kirk Andrew M. , Barré Alyssa M. , Prusick Vincent W. , Conley Caitlin , Muchow Ryan D.
Published: August 2024

Objective:

While the implementation of enhanced recovery after surgery protocols and improvements in pain control have decreased the length of stay (LOS) after scoliosis surgery, adolescents are typically hospitalized for several days after posterior spinal instrumented fusion (PSF). The purpose of this study was to determine whether next-day discharge after PSF for adolescent idiopathic scoliosis (AIS) had an equivalent safety profile compared with longer LOS. The secondary purpose was to examine perioperative factors associated with next-day discharge.

Methods:

We performed a retrospective study of all patients who underwent PSF for AIS at a single institution from 2017 to 2022. We compared patients based on postoperative LOS with an early discharge group consisting of those who were discharged on the first postoperative day 1 (POD1; n = 40) and a standard discharge group consisting of those who were discharged after POD1 (n = 71). We documented preoperative variables, including patient demographics and curve characteristics, intraoperative variables, including levels fused, implant density, operative time, and blood loss, and postoperative variables, including emergency department (ED) visits within 30 days and hospital readmissions within 90 days.

Results:

One hundred eleven patients were included with a mean curve magnitude of 67 degrees. Forty patients (36%) were discharged on POD1. There were one (3%) ED visit and 2 (5%) readmissions in the early discharge group and 3 (4%) ED visits and 2 (3%) readmissions in the standard discharge group (P = 0.64 and 0.55, respectively). Patients in whom intravenous methadone was used intraoperatively were more likely to discharge POD1 (P = 0.02). There were no other significant differences in perioperative variables between the two groups including: BMI, distance from home to hospital, magnitude of main curve, curve flexibility, number of levels fused, estimated blood loss, implant density, operative time, or postoperative pain scores.

Conclusions:

Next-day discharge after PSF for AIS has an equivalent safety profile compared with longer LOS. Over one-third of patients were discharged on POD1, and there was no statistically significant difference in ED visits or hospital readmissions between the groups. Patients in whom intravenous methadone was used intraoperatively were more likely to discharge POD1.

Clinical Relevance:

In a retrospective study of posterior spinal fusions for AIS, we found no increase in ED visits or hospital readmissions for those discharged the next day.

Level of Evidence:

Level III.
Do ChatGPT and Gemini Provide Appropriate Recommendations for Pediatric Orthopaedic Conditions?
Authors: Pirkle Sean , Yang JaeWon , Blumberg Todd J.
Published: August 2024

Background:

Artificial intelligence (AI), and in particular large language models (LLMs) such as Chat Generative Pre-Trained Transformer (ChatGPT) and Gemini have provided additional resources for patients to research the management of healthcare conditions, for their own edification and the advocacy in the care of their children. The accuracy of these models, however, and the sources from which they draw conclusions, have been largely unstudied in pediatric orthopaedics. This research aimed to assess the reliability of machine learning tools in providing appropriate recommendations for the care of common pediatric orthopaedic conditions.

Methods:

ChatGPT and Gemini were queried using plain language generated from the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines (CPGs) listed on the Pediatric Orthopedic Society of North America (POSNA) web page. Two independent reviewers assessed the accuracy of the responses, and chi-square analyses were used to compare the 2 LLMs. Inter-rater reliability was calculated via Cohen’s Kappa coefficient. If research studies were cited, attempts were made to assess their legitimacy by searching the PubMed and Google Scholar databases.

Results:

ChatGPT and Gemini performed similarly, agreeing with the AAOS CPGs at a rate of 67% and 69%. No significant differences were observed in the performance between the 2 LLMs. ChatGPT did not reference specific studies in any response, whereas Gemini referenced a total of 16 research papers in 6 of 24 responses. 12 of the 16 studies referenced contained errors and either were unable to be identified (7) or contained discrepancies (5) regarding publication year, journal, or proper accreditation of authorship.

Conclusion:

The LLMs investigated were frequently aligned with the AAOS CPGs; however, the rate of neutral statements or disagreement with consensus recommendations was substantial and frequently contained errors with citations of sources. These findings suggest there remains room for growth and transparency in the development of the models which power AI, and they may not yet represent the best source of up-to-date healthcare information for patients or providers.
The Lack of Reporting Social Determinants of Health in Pediatric Orthopaedic Randomized Controlled Trials
Authors: Megafu Michael , Guerrero Omar , Yendluri Avanish , Uwefoh Michelle , Li Xinning , Kocher Mininder S. , Ganley Theodore J. , Parisien Robert L. ,   Investigation Performed By The Scientific Collaborative For Orthopaedic Research And Education (SCORE) Group
Published: August 2024

Background:

Social determinants of health (SDOHs) affect health outcomes outside the hospital, and understanding them can enhance postoperative outcomes in orthopaedic surgery patients. This study aimed to describe the prevalence of randomized controlled trials (RCTs) in pediatric orthopaedic journals reporting on the SDOHs of their patient cohorts. We hypothesize that many SDOHs will be underreported in RCTs investigating pediatric orthopaedic surgery.

Methods:

Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the authors queried the PubMed database to examine SDOHs from 2 pediatric orthopaedic journals: Journal of Pediatric Orthopaedics and Journal of Pediatric Orthopaedics: Part B. The inclusion criteria incorporated RCTs published between 2005 and April 2024. The exclusion criteria included any articles that were not RCTs published in this period.

Results:

One hundred thirteen articles met the search criteria, with 31 excluded because they did not fall from 2005 to 2024. Eighty-two were published from 2005 to 2024, but 6 RCTs were excluded, as 3 were non-RCTs, and 3 examined cadavers. Seventy-six RCTs were included for analysis, with 65 articles from the Journal of Pediatric Orthopaedics and 11 articles from the Journal of Pediatric Orthopaedics: Part B. Articles originated from 17 countries, with the United States producing 61.8% (47) of the included studies. Of all 76 included studies, 96.1% (73) reported age, 88.2% (67) reported sex/gender, 30.3% (23) reported BMI, 21.1% (16) reported race/ethnicity, 5.3% (4) reported educational level, 2.6% (2) reported stress, and 2.6% (2) reported insurance. Smoking status, socioeconomic status, income levels, and employment status were each reported by only 1 study.

Conclusions:

The RCTs examining pediatric orthopaedic surgery tend to scarcely report SDOHs. Future RCTs should expand beyond demographic characteristics such as age, race/ethnicity, sex/gender, and BMI and incorporate other relevant SDOHs. This will allow us to develop a more comprehensive understanding of health outcomes in the pediatric orthopaedic population.

Level of Evidence:

I; Therapeutic Studies.
Exploring the Experiences and Expectations of Adolescent Females Undergoing Periacetabular Osteotomy
Authors: Luck Connor L. , Disantis Ashley E. , Spaid Victoria C. , Kazmerski Traci M. , McClincy Michael P.
Published: August 2024

Background:

Adolescents presenting with symptomatic acetabular dysplasia (AD) complain of pain and reduced participation in activities of daily living (ADLs). Periacetabular osteotomy (PAO) is widely accepted as the preferred treatment for AD. Understanding the patient experience can lead to improvements in psychosocial and physical burden in adolescents. We sought to explore the experiences and expectations of adolescent females with AD who underwent a PAO.

Methods:

We conducted semistructured interviews with adolescent females who underwent a PAO >6 months ago. Questions focused on exploring their experiences with AD and their PAO expectations and decision-making. Participants also completed a 7-item Likert-scale questionnaire related to factors they considered in their decision-making, which was followed by a ranking of those considerations. We utilized an inductive and deductive coding approach to identify key themes from interviews and descriptively analyzed questionnaire responses.

Results:

Eighteen adolescent females between 13 and 19 years (17.2±1.9 y) at the time of PAO participated in the study. Time from surgery to interview ranged from 203 to 1534 days (927.7±320.8 d). Key themes included (1) prolonged time from symptom onset to PAO, with many seeing several providers; (2) major preoperative apprehensions of surgical outcome and setbacks in school and recreational activities; (3) discussion with the physician and people who underwent PAO were the most beneficial sources of information; (4) Postoperative worries include surgical outcome and return to daily living. Eighty-nine percent of participants reported that return to daily activities and sustaining long-term hip health were very important factors in their PAO decision-making, and 61% ranked their return to daily activities as their top priority.

Conclusions:

Adolescent females with AD report frustrating delays in diagnosis and appropriate intervention and value their return to daily living in their decision to undergo PAO. The development of future patient-centered interventions may improve the PAO decision-making process and should include information related to surgical recovery and anecdotes of others who underwent this procedure.

Level of Evidence:

Level IV, therapeutic study.
Medial Patellofemoral Ligament Reconstruction in Adolescents: What Parents Care About
Authors: Culpepper Sylvia , Rajendra Ravi , Suwak Patrik , Clement R. Carter
Published: August 2024

Introduction:

Numerous techniques exist for pediatric medial patellofemoral ligament (MPFL) reconstruction (MPFL-R). Pediatric orthopaedic surgeons and patient families must navigate choices between allograft and autograft, incision type, and surgery cost. While previous research has found similar surgical outcomes among different MPFL-R techniques, minimal data exists on what patients and their families prefer. To engage in shared decision-making (SDM), pediatric orthopaedic surgeons must understand family preferences, including between incision type and cost. We conducted a study utilizing choice-based conjoint (CBC) analysis to explore these preferences.

Methods:

A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) to gather demographic information and preferences on surgical scenarios via CBC analysis. Anonymous participants, recruited via the Prolific crowdsourcing platform, qualified if they were US residents over 18 years of age with children aged 13 to 17. Data analysis involved the Hierarchical Bayes (HB) method to generate utility scores to determine the desirability of attributes.

Results:

The study included 496 participants who prioritized surgical success (average importance 48.8%) followed by co-pay amount (21.5%), incision size (17.4%), and return to sport (12.3%). Participants earning over $200,000 annually prioritized incision size over cost (25.8% vs. 12.1%, P<0.0053). Those with incomes below $50,000 valued recovery time at a lesser extent than other income groups (10.4% than 12.3% overall importance P<0.0003). The sex of the child significantly influenced preferences: incision size was more important to parents of girls (21.1%) than boys (14.0%, P<.0001). The importance of surgery success and recovery time also differed by sex, being higher for boys (50.4%, 13.1%) than girls (47.0%, 11.7%; P=0.025, 0.026, respectively).

Conclusions:

This CBC analysis suggests parents of adolescent patients undergoing MPFL-R most value surgical success (avoiding revision surgery), followed by copay, incision size, and time to return to sport. Of note, parent income level and sex of the child significantly influenced parental preferences. We hope this information will assist orthopaedic surgeons in SDM in MPFL-R surgery.

Level of Evidence:

Level III.
Socioeconomic Status Impacts Length of Stay and Nonhome Discharge Disposition After Posterior Cervical Decompression and Fusion
Authors: Opara Olivia A. , Narayanan Rajkishen , Issa Tariq , Tarawneh Omar H. , Lee Yunsoo , Patrizio Harrison A. , Glover Abbey , Brown Bergin , McCormick Christian , Kurd Mark F. , Kaye Ian D. , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D.
Published: August 2024

Study Design.

Retrospective cohort study

Objective.

To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.

Summary of Background Data.

The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed.

Materials and Methods.

Retrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes, including length of stay, home discharge, complications, and readmissions.

Results.

Patients living in at-risk/distressed communities were more likely to be Black (53.3%). Patients living in at-risk/distressed communities had the longest hospitalization (6.24 d vs. prosperous: 3.92, P=0.006). Significantly less at-risk/distressed patients were discharged home without additional services (37.3% vs. mid-tier: 52.5% vs. comfortable: 53.4% vs. prosperous: 56.4%, P<0.001). On multivariate analysis, residing in an at-risk/distressed community was independently associated with nonhome discharge [odds ratio (OR): 2.28, P=0.007] and longer length of stay (E:1.54, P=0.017).

Conclusions.

Patients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.
Comparison of Titanium Mesh Cage, Nano-Hydroxyapatite/Polyamide Cage, and Three-Dimensional–Printed Vertebral Body for Anterior Cervical Corpectomy and Fusion
Authors: Li Jing , Zhang Junqi , Wang Beiyu , Huang Kangkang , Yang Xi , Song Yueming , Liu Hao , Rong Xin
Published: August 2024

Study Design.

A prospective nonrandomized controlled study.

Objective.

To compare the clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMCs), nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cages, and three-dimensional–printed vertebral bodies (3d-VBs).

Background.

Postoperative subsidence of TMCs in ACCF has been widely reported. Newer implants such as n-HA/PA66 cages and 3d-VBs using biocompatible titanium alloy powder (Ti6Al4V) have been introduced to address this issue, but their outcomes remain controversial.

Patients and Methods.

We enrolled 60 patients undergoing ACCF using TMCs, n-HA/PA66 cages, or 3d-VBs from January 2020 to November 2021. For each group, there were 20 patients. Follow-up was conducted for a minimum of 2 years. Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index, and Visual Analog Scale scores, and radiographic outcomes, including function of spinal unit (FSU) height, fusion rate, and cervical alignment, were collected preoperatively and at each follow-up. A loss of FSU height ≥3mm was deemed implant subsidence. One-way analysis of variance was used for comparisons of mean values at different time points within the same group, with pairwise comparisons performed using the least significance difference method. The Mann-Whitney test was used for comparisons between groups. Categorical data such as sex, smoking status, implant subsidence, and pathology level were analyzed using the χ2 test. 

Results.

Postoperative FSU height loss at 2 years differed significantly among the TMC, n-HA/PA66, and 3d-VB groups, measuring 3.07 ± 1.25mm, 2.11 ± 0.73mm, and 1.46 ± 0.71mm, respectively (P < 0.001). The rates of implant subsidence were 45%, 20%, and 10%, respectively (P = 0.031). All patients obtained solid fusion at a 2-year follow-up. We observed statistically significant differences in Visual Analog Scale and JOA scores at 3 months postoperatively, and JOA scores at 2 years postoperatively among the 3 groups. At a 2-year follow-up, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. No severe postoperative complications were observed in any of the patients, and no patient required reoperation.   

Conclusion.

At a 2-year follow-up after ACCF, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. Longer-term observation of implant subsidence in ACCF using TMC, n-HA/PA66, and 3d-VB is necessary.

Level of Evidence.

Level III—therapeutic.
Resistance mechanisms and potential therapeutic strategies in relapsed or refractory natural killer/T cell lymphoma
Authors: Wang Chengji , Wang Liang
Published: August 2024

Natural killer/T cell lymphoma (NKTCL) is a malignant tumor originating from NK or T cells, characterized by its highly aggressive and heterogeneous nature. NKTCL is predominantly associated with Epstein–Barr virus infection, disproportionately affecting Asian and Latin American populations. Owing to the application of asparaginase and immunotherapy, clinical outcomes have improved significantly. However, for patients in whom first-line treatment fails, the prognosis is exceedingly poor. Overexpression of multidrug resistance genes, abnormal signaling pathways, epigenetic modifications and active Epstein–Barr virus infection may be responsible for resistance. This review summarized the mechanisms of resistance for NKTCL and proposed potential therapeutic approaches.
Perdanakusuma Score in Pressure Injury Compared with Falanga Score: A New Qualitative Wound Assessment Tool
Authors: Sari Kartika Puspa , Saputro Iswinarno D. , Handriani Ira , Perdanakusuma David S.
Published: August 2024

Background:

Effective wound assessment is crucial for managing pressure injuries, necessitating a valid and reliable wound bed scoring system that is practical for clinicians. The Falanga score was replaced with the Perdanakusuma score at the Dr. Soetomo General Hospital. However, the accuracy of the Perdanakusuma score remains unclear. This study aimed to assess the accuracy of the Perdanakusuma score compared with the Falanga score, the gold standard for pressure injury assessment.

Methods:

We reviewed the medical records of 142 patients with pressure injuries who consulted for wound management at the department of plastic, reconstructive, and aesthetic surgery at Dr. Soetomo General Hospital between 2015 and 2019. We compared the accuracy of the Perdanakusuma and Falanga scores using receiver operating characteristic curves and area under the curve.

Results:

Of the total 142 patients with pressure injuries, 76 were men and 66 were women. The mean age was 47.61 years. Of the pressure injuries, 55.6% were stage III pressure injuries. The area under the curve for the Perdanakusuma scores from D-0 to D-15 treatment were 0.702, 0.724, 0.644, and 0.697, whereas the Falanga scores were 0.769, 0.721, 0.631, and 0.576, respectively.

Conclusions:

The Perdanakusuma score is a more accurate diagnostic tool for assessing pressure injuries than the Falanga score. Implementing a reliable wound bed scoring system such as the Perdanakusuma score would permit appropriate and timely treatment and improve communication on wound progress, thereby improving the healing rate.
Airway Events and Critical Care Requirements in Patients with Robin Sequence after Palatoplasty
Authors: Cohen Stephanie M. , Kanack Melissa , Nussbaum Lisa , Nguyen Tyler T. , Resnick Cory M. , Park Raymond , Evans Faye , Rogers-Vizena Carolyn R. , Ganske Ingrid M.
Published: August 2024

Background:

Patients with Robin sequence (RS) are often thought to be at high-risk for airway complications after cleft palate repair, and may be routinely admitted to the intensive care unit after surgery. This study compares frequency of postoperative airway events in patients with and without RS undergoing palatoplasty, and assesses potential risk factors for needing intensive care.

Methods:

A matched cohort study of patients with and without RS undergoing palatoplasty from February 2014 to February 2022 was conducted. Variables of interest included prior management of micrognathia, comorbidities, polysomnography, age and weight at the time of palatoplasty, operative techniques, intubation difficulty, anesthesia duration, and postoperative airway management. Airway events were defined as airway edema, secretions, stridor, laryngospasm, obstruction, and/or desaturation requiring intervention. Logistic regression was performed to identify factors predictive of airway events.

Results:

Thirty-three patients with RS and 33 controls were included. There were no statistically significant differences in airway events between groups (eight RS, four controls, P = 0.30). Anesthetic duration over 318 minutes was associated with increased risk of postoperative airway events [(OR) 1.02 (1.00–1.04) (P = 0.04)] for patients with RS, but not for patients in the control cohort.

Conclusions:

Postoperative intensive care unit admission is not universally necessary for patients with RS after palatoplasty if intubation was straightforward and there were no concomitant procedures being performed. Patients with longer anesthesia durations were more likely to have postoperative airway events and may need a higher level of care postoperatively.
Artificial Intelligence–Based Indocyanine Green Lymphography Pattern Classification for Management of Lymphatic Disease
Authors: Ozmen Berk B. , Pandey Sonia K. , Schwarz Graham S.
Published: August 2024

Background:

Lymphedema diagnosis relies on effective imaging of the lymphatic system. Indocyanine green (ICG) lymphography has become an essential diagnostic tool, but globally accepted protocols and objective analysis methods are lacking. In this study, we aimed to investigate artificial intelligence (AI), specifically convolutional neural networks, to categorize ICG lymphography images patterns into linear, reticular, splash, stardust, and diffuse.

Methods:

A dataset composed of 68 ICG lymphography images was compiled and labeled according to five recognized pattern types: linear, reticular, splash, stardust, and diffuse. A convolutional neural network model, using MobileNetV2 and TensorFlow, was developed and coded in Python for pattern classification.

Results:

The AI model achieved 97.78% accuracy and 0.0678 loss in categorizing images into five ICG lymphography patterns, demonstrating high potential for enhancing ICG lymphography interpretation. The high level of accuracy with a low loss achieved by our model demonstrates its effectiveness in pattern recognition with a high degree of precision.

Conclusions:

This study demonstrates that AI models can accurately classify ICG lymphography patterns. AI can assist in standardizing and automating the interpretation of ICG lymphographic imaging.
Clinical Outcomes of Cardiogenic Shock Due to Spontaneous Coronary Artery Dissection Versus Cardiogenic Shock Due to Coronary Artery Disease
Authors: Krittanawong Chayakrit , Qadeer Yusuf Kamran , Ang Song Peng , Wang Zhen , Alam Mahboob , Sharma Samin , Jneid Hani
Published: August 2024

Spontaneous coronary artery dissection (SCAD) can be treated conservatively. However, some SCAD patients can develop cardiogenic shock (CS). We evaluated the outcomes of SCAD-related CS using data from a national population-based cohort study from January 1, 2016, to December 30, 2019. In our study of 32,640 patients with SCAD, about 10.6% of patients presented with CS. We found that SCAD patients with CS had higher mortality and greater complications including use of mechanical circulatory devices, arrhythmias, respiratory support, and acute heart failure compared to those without CS. When comparing CS due to SCAD with that due to coronary artery disease, we found that although mortality rates were similar, those with CS due to SCAD were associated with higher risk of use of mechanical circulatory support, major bleeding, blood transfusion, and respiratory failure.
Occurrence of Transient Myocardial Ischemic Events Among Non-ST Segment Elevation Acute Coronary Syndrome Patients Before or After Invasive Coronary Angiography
Authors: Suba Sukardi , Carey Mary G. , Pelter Michele M.
Published: August 2024

Background:

The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay by TMI group (before or after ICA).

Methods:

Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic Holter. Patient records were reviewed to assess ischemic burden [TMI time (min) ÷ hours recording duration], outcomes, and TMI timing, before or after ICA.

Results:

In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29 ± 8.82 min/h) compared to before ICA (2.54 ± 2.11 min/h), P = 0.039. Hospital length of stay by TMI group was 113 ± 113 (before), 226 ± 244 (after), and 85 ± 65 hours (no ICA); P = 0.172.

Conclusions:

Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had a higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.
Comparative Effectiveness of Alternate Antibiotic Therapies for Intrapartum Group B Streptococcus Colonization
Authors: Swayze Emma J. , Liske Emily J. , Henry Lydia M. , Dolvin Erin G. , Swailes Alexa L.
Published: August 2024

Background

Intrapartum antibiotic therapy is imperative to minimize maternal-to-fetal transmission of group B Streptococcus (GBS). Penicillin is the gold standard for treatment, but there is a paucity of data on alternate antibiotic therapies for penicillin-allergic patients. This study evaluates the effectiveness of alternate antibiotic therapies in this population.

Methods

This was a retrospective cohort analysis of GBS-positive pregnant patients at a single safety-net hospital from 2019 through 2022. GBS-positive penicillin-allergic patients were matched 1:2 with nonallergic controls. The primary outcomes were as follows: GBS-positive neonates, neonatal length of stay, GBS septicemia, Apgar scores, fetal demise, and 30-day neonatal complications (sepsis, deafness, pneumonia, or meningitis). χ2 and Fisher exact analyses were performed on Stata version 16.1 (StataCorp, College Station, TX).

Results

Two hundred twenty-three GBS-positive pregnant patients were analyzed, including 78 penicillin-allergic (35.0%) and 145 nonallergic (65%). Patients were treated with vancomycin (n = 64, 28.7%), clindamycin (n = 7, 3.1%), cephalosporins (n = 6, 2.7%), or penicillin (n = 146, 65.5%). Rates of GBS-positive infants were low but varied by antibiotic treatment (P < 0.01): penicillin, 0/146 (0%); vancomycin, 0/64 (0%); clindamycin, 1/7 (14.3%); and cephalosporins, 1/6 (16.7%). There was also a significant difference in 30-day neonatal complications (P = 0.03): penicillin, 3/146 (2.1%); vancomycin, 0/64 (0%); clindamycin, 1/7 (14.3%); and cephalosporins, 1/6 (16.7%) but no difference in length of stay (P = 0.07), 5-minute Apgar scores (P = 0.32), or fetal demise (P = 1.00).

Conclusions

Antibiotic effectiveness for GBS-positive pregnant patients varied slightly by medication, but the risk was low in all cohorts. Vancomycin appears to be effective for penicillin-allergic patients, but alternative antibiotic therapies may also provide adequate coverage with a lower risk of promoting antibiotic resistance.
Chlorhexidine gluconate versus povidone-iodine for nasal bacteria decolonization before transsphenoidal surgery in patients with pituitary neuroendocrine tumors: a prospective, randomized, double-blind, noninferiority trial
Authors: Qian Jinyu , Lin Jie , Liu Jin , Gong Yali , Zheng Shufang , Mei Lu , Tang Xin , Xie Lina , Li Hong , Zhang Chao , Wang Feilong , Yang Xue , Hu Rong , Feng Hua , Xian Jishu , Tan Binbin , Chen Yujie
Published: August 2024

Background:

This study aimed to compare the nasal decolonization efficacy and comfort between chlorhexidine gluconate (CHG) and povidone-iodine (PVP) to provide an evidence basis for clinical guidance.

Methods:

A prospective, randomized, single-blinded, noninferior clinical trial was conducted in 174 patients with pituitary neuroendocrine tumors (PitNETs) who were scheduled to undergo transsphenoidal surgery. The noninferiority margin was δ=−0.1. The primary outcome was the effective rate of disinfection. The secondary outcomes included postoperative inflammatory indicators, the intracranial infection rate, and the proportion of intracranial infection.

Results:

The effective clearance rate of postoperative nasal bacteria was nonsignificantly different between the CHG and PVP groups (88.64% vs. 82.56%; between-group difference 6.10%; 95% CI [−5.30 to 17.50]). There was no significant difference in the incidence of postoperative central nervous system infections or serum inflammation-related indications between the two groups, but sterilization tended to occur quicker and last longer in the CHG group. CHG seemed to have advantages in terms of comfort, including less nasal irritation, less pungency, and better intranasal coloration.

Conclusion:

CHG and PVP have equal efficacy in nasal decolonization before transsphenoidal surgery, but CHG seems to have comfort-related advantages in terms of less nasal irritation, less pungency, and better intranasal coloration.
Ultrasound-Guided Hematoma Block for Distal Forearm Fracture Reduction in Adolescent With History of Difficult Airway
Authors: Gawel Richard J. , Chen Aaron E.
Published: August 2024

Distal forearm fractures are frequently encountered in the pediatric emergency department and often require reduction. Procedural sedation is commonly used to facilitate reduction of these injuries, although it can be associated with potentially severe complications, particularly in patients with cardiorespiratory comorbidities. The ultrasound-guided hematoma block has been gaining popularity as an analgesic alternative in adult patients, but literature supporting its use in pediatric patients is limited. We describe a point-of-care ultrasound-guided hematoma block used to facilitate successful reduction of a distal radius fracture in an adolescent patient with a history of a difficult airway for whom procedural sedation would have posed considerable risk.