bluuebunny/crossref_metadata_2025 huggingface dataset:
Speciation in Coastal Basins Driven by Staggered Headwater Captures: Dispersal of a Species Complex, Leporinus bahiensis, as Revealed by Genome-wide SNP Data
Authors: Ramirez Jorge L , Machado Carolina B , de Mello Affonso Paulo Roberto Antunes , Galetti Pedro M
Published: May 2023

Past sea level changes and geological instability along watershed boundaries have largely influenced fish distribution across coastal basins, either by dispersal via palaeodrainages now submerged or by headwater captures, respectively. Accordingly, the South American Atlantic coast encompasses several small and isolated drainages that share a similar species composition, representing a suitable model to infer historical processes. Leporinus bahiensis is a freshwater fish species widespread along adjacent coastal basins over narrow continental shelf with no evidence of palaeodrainage connections at low sea level periods. Therefore, this study aimed to reconstruct its evolutionary history to infer the role of headwater captures in the dispersal process. To accomplish this, we employed molecular-level phylogenetic and population structure analyses based on Sanger sequences (5 genes) and genome-wide SNP data. Phylogenetic trees based on Sanger data were inconclusive, but SNPs data did support the monophyletic status of L. bahiensis. Both COI and SNP data revealed structured populations according to each hydrographic basin. Species delimitation analyses revealed from 3 (COI) to 5 (multilocus approach) MOTUs, corresponding to the sampled basins. An intricate biogeographic scenario was inferred and supported by Approximate Bayesian Computation (ABC) analysis. Specifically, a staggered pattern was revealed and characterized by sequential headwater captures from basins adjacent to upland drainages into small coastal basins at different periods. These headwater captures resulted in dispersal throughout contiguous coastal basins, followed by deep genetic divergence among lineages. To decipher such recent divergences, as herein represented by L. bahiensis populations, we used genome-wide SNPs data. Indeed, the combined use of genome-wide SNPs data and ABC method allowed us to reconstruct the evolutionary history and speciation of L. bahiensis. This framework might be useful in disentangling the diversification process in other neotropical fishes subject to a reticulate geological history.
Rights of beneficiaries: building foundations and trusts, a Czech perspective
Authors: Ronovská Kateřina , Pihera Vlastimil , Dobrovolná Eva
Published: May 2023

The aim of this article is first to briefly outline the current Czech legal regulation of the position of beneficiaries of trust funds and private foundations and the breadth of knowledge in this area. The authors point out crucial questions and also suggest possible directions for further consideration, many of which are well known in other jurisdictions where the possibility to create trusts/trust-like and foundation structures for private purposes has been introduced. Hopefully, the Czech perspective (and experience so far) can also be of use to other legal systems which are dealing with similar issues.
Revising Reflection Assignments to Align With Clinical Judgment Measurement Model Language: Maximizing Critical Thinking, Feedback, and Measurement in Simulation
Authors: Williams Marcella S. , Hence Michelle S.
Published: May 2023

Student reflection stimulates self-awareness, deep learning, insight into patient care challenges, and professional role development. As such, reflection assignments are an ideal target for revision using language associated with the steps of the clinical judgment measurement model (CJMM) to maximize critical thinking. Tanner’s clinical judgment model aligns with the CJMM and underpins the curriculum in many nursing programs. Faculty used the model to update a simulation reflection assignment template, incorporating CJMM language and facilitating improved measurement of clinical judgment. Substantially improved student responses resulted during an initial quality improvement pilot study.
Collaborating With Service Users to Select Psychiatry Residents Committed to Health Equity and Social Justice
Authors: Agrawal Sacha , Nicoll Gina , Carr Rachel H. , Cooper Rachel B. , Fefergrad Mark , Hanson Mark D. , Munro Lauren
Published: May 2023

Problem

Advocates have called for health services to be delivered equitably to all. Academic psychiatry must play a role in this work, given its history of creating and perpetuating the marginalization of people experiencing mental health issues. While medical educators have started teaching concepts such as structural competency and cultural safety, careful consideration of who enters the medical workforce and what values they bring is also important.

Approach

The authors report on the first 5 years (2016–2021) of a collaboration with individuals who have used mental health or addiction services or identify as having lived experiences of mental health and/or substance use issues (i.e., service users) to select residents to the general adult psychiatry residency program at the University of Toronto who are committed to working toward health equity and social justice and who bring diverse personal, academic, and community-based experiences. Starting in 2016, a working group of service users and faculty iteratively refined the selection process to add personal letter and interview day writing sample prompts centered on social justice and advocacy.

Outcomes

The working group, coled by service users since 2019, defined the problem (lack of attention to health equity and social justice in resident selection) and codesigned the solution by revising writing prompts used in the selection process and their assessment rubrics to emphasize these missing areas. Further, service users directly participated in the implementation by reviewing candidates’ personal letters and interview day writing samples alongside faculty and residents. This work serves as an example of meaningful service user engagement in action.

Next Steps

To ensure the needs of service users are prioritized, future work must aim for long-term institutional commitment to strengthen service user involvement and power sharing with service user communities in resident selection and at other points along the medical education pathway.
A Survey on Monitoring and Management of Cerebral Vasospasm and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Mantra Study
Authors: Picetti Edoardo , Bouzat Pierre , Bader Mary Kay. , Citerio Giuseppe , Helbok Raimund , Horn Janneke , Macdonald Robert Loch. , McCredie Victoria , Meyfroidt Geert , Righy Cássia , Robba Chiara , Sharma Deepak , Smith Wade S. , Suarez Jose I. , Udy Andrew , Wolf Stefan , Taccone Fabio S.
Published: May 2023

Introduction:

Cerebral infarction from delayed cerebral ischemia (DCI) is a leading cause of poor neurological outcome after aneurysmal subarachnoid hemorrhage (aSAH). We performed an international clinical practice survey to identify monitoring and management strategies for cerebral vasospasm associated with DCI in aSAH patients requiring intensive care unit admission.

Methods:

The survey questionnaire was available on the European Society of Intensive Care Medicine (May 2021–June 2022) and Neurocritical Care Society (April - June 2022) websites following endorsement by these societies.

Results:

There were 292 respondents from 240 centers in 38 countries. In conscious aSAH patients or those able to tolerate an interruption of sedation, neurological examination was the most frequently used diagnostic modality to detect delayed neurological deficits related to DCI caused by cerebral vasospasm (278 respondents, 95.2%), while in unconscious patients transcranial Doppler/cerebral ultrasound was most frequently used modality (200, 68.5%). Computed tomography angiography was mostly used to confirm the presence of vasospasm as a cause of DCI. Nimodipine was administered for DCI prophylaxis by the majority of the respondents (257, 88%), mostly by an enteral route (206, 71.3%). If there was a significant reduction in arterial blood pressure after nimodipine administration, a vasopressor was added and nimodipine dosage unchanged (131, 45.6%) or reduced (122, 42.5%). Induced hypertension was used by 244 (85%) respondents as first-line management of DCI related to vasospasm; 168 (59.6%) respondents used an intra-arterial procedure as second-line therapy.

Conclusions:

This survey demonstrated variability in monitoring and management strategies for DCI related to vasospasm after aSAH. These findings may be helpful in promoting educational programs and future research.
Rate of Cardiovascular Events and Safety Outcomes Seven Years Following Gastric Bypass Versus Sleeve Gastrectomy
Authors: Wildisen Alessia , Peterli Ralph , Werder Gabriela , Mueller Beat , Schuetz Philipp , Kaegi-Braun Nina , Kutz Alexander
Published: May 2023

Objective:

The study aimed to assess major adverse cardiovascular events (MACEs), complications requiring revision surgery, and bariatric conversion surgery 7 years after gastric bypass (GB) and sleeve gastrectomy (SG) using real-world data.

Background:

GB and SG both result in weight loss and improved cardiometabolic health. Whether the long-term rate of MACE differs between the 2 bariatric procedures is unclear.

Methods:

In this population-based retrospective cohort study, we used inhospital National Health Registry data from January 2012 to December 2018. Patients undergoing GB were 1:1 propensity score-matched with patients who had SG. The primary outcome was the incidence of MACE, defined as acute myocardial infarction, ischemic stroke, cardiac arrest, or hospitalization for heart failure. Secondary outcomes encompassed individual MACE components, postoperative complications, and the need for bariatric conversion surgery.

Results:

Among 5240 propensity score-matched pairs, the incidence rate per 1000 person-years of MACE was 2.8 among patients undergoing GB and 3.2 among those undergoing SG (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.62–1.37). Single components of MACE were not different between both groups. Patients after GB had a higher risk of long-term postoperative complications requiring a revision surgery compared with those after SG (HR, 3.53 [95% CI, 2.78–4.49]). Bariatric conversion surgery was less frequently performed among patients undergoing GB compared with patients undergoing SG (HR, 0.09 [95% CI, 0.06–0.13]).

Conclusions:

In this study, the performance of GB versus SG was associated with a similar risk of MACE. While postoperative complications were more frequent among patients undergoing GB, patients following SG had a higher probability of bariatric conversion surgery.
An analysis of 32 orthopaedic society costs and benefits
Authors: Rasmussen Janae , Cannada Lisa , Balch Samora Julie
Published: May 2023

Background:

Many orthopaedic surgeons belong to specialty groups or societies at the local, state, and national levels. We sought to understand costs and benefits of orthopaedic society memberships.

Methods:

We collected data on the cost of membership and benefits for 32 different orthopaedic societies in 2020 and 2021 by using website information and contacting the society’s administration. We grouped benefits into distinct categories: annual conference, continuing education, educational resources, leadership opportunities, career job listings, research grants, mentorship program, resident/fellow resources, medical student resources, and journal affiliation.

Results:

On average, attending surgeons pay $460 and residents/fellows pay $300 for a single annual membership. However, some organizations, such as the American Academy of Orthopaedic Surgeons (AAOS), the American Orthopaedic Association (AOA), and the Hip Society have higher annual dues ($1,115, $1,100, and $1,500, respectfully). Over 20 years, a physician belonging to both the AOA and the AAOS pay $44,300 in fees at the current cost. All 32 societies offer an annual conference, continuing education credit opportunities, other educational resources, leadership opportunities, and journal affiliations.

Conclusions:

Membership fees vary and benefits are often difficult to assess without becoming a member. The COVID-19 pandemic has moved society activities online, decreasing opportunities for in-person networking and education, with some societies considering reduced fees. The pandemic has also strained hospital budgets resulting in loss of funds for many physicians at academic organizations that would normally be used toward membership fees. Perhaps increased opportunities for resource pooling, with group access to educational opportunities and mentorship, should be considered.

Level of Evidence:

Level V.
Outcomes of Limb Lengthening With Computer-assisted Hexapod External Fixators in the Treatment of Fibular Hemimelia
Authors: Bakircioglu Sancar , Goker Barlas , Yilmaz Abdurrahman , Aksoy Taha , Aksoy Mehmet Cemalettin , Yilmaz Guney
Published: May 2023

Background:

Fibular hemimelia (FH) represents the most common deficiency of the long bones and is associated with multiple deformities. Reconstructive treatment with external fixators in FH restores normal lower extremity alignment and length with plantigrade feet for a balanced and effective gait. The aim of this study is to evaluate the outcomes of lower limb lengthening and simultaneous tri-plane deformity correction with a computer-assisted hexagonal external fixator in children with FH.

Methods:

A retrospective review was performed for FH cases treated with a computer-assisted hexagonal external fixator in a tertiary referral center. Leg length discrepancy (LLD), interphyseal angles, tibiocalcaneal distances, healing index (HI), and callus shapes were analyzed for radiologic evaluation, and the Pediatric Quality of Life Inventory (PedsQL) was used for functional assessment. Limbs with HI <50 days/cm, PedsQL >75, and without regenerate fractures were considered successful lengthenings.

Results:

Twenty-four limbs of 23 patients were included. The limbs were lengthened for a mean of 7.24 cm (range, 4.7 to 15.6). The initial LLD of 5.6 cm (range, 0.5 to 19 cm) increased to 1.7 cm (range, 0.1 to 6 cm), and the mean interphyseal angle was 12.7 degree (range, 1.5 to 54.2 degree), tibiocalcaneal distance was 0.85 cm (range, 0.1 to 1.7) at final follow-up. The most common regenerated bone morphology was cylindrical, as seen in 11 limbs (45.8%). The average PedsQL score was 83.5 (range, 69.5 to 96.7). Sixteen limbs (66.7%) had successful lengthening at their first, and 4 limbs (80%) had successful lengthening at their second surgeries. Seven limbs had complications requiring surgical intervention (29.1%), with 3 (12.5%) regenerate fractures after external fixators removal.

Conclusions:

Limb reconstruction with computer-assisted hexapod fixators is a successful and reliable option for the treatment of LLD in FH, and patients demonstrate good functional outcomes. Surgeons should be aware of potential complications and should utilize prophylactic measures when necessary.

Levels of Evidence

Level III, retrospective comparative study
Achilles Tendon Injuries in the Pediatric Population
Authors: Ashebo Leta , Stevens Alexandra C. , MacAlpine Elle M. , Wittstein Jocelyn R. , Bradley Kendall E. , Lawrence J. Todd R.
Published: May 2023

Background:

Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries.

Methods:

A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings.

Results:

Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9).

Conclusions:

We found that older adolescents (≥14 y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12 y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population.

Level of Evidence:

Level—IV.
Trade-off Between Quarantine Length and Compliance to Optimize COVID-19 Control
Authors: Zou Kaiyue , Hayashi Michael , Simon Sophia , Eisenberg Joseph N.S.
Published: May 2023

Background:

Guidance on COVID-19 quarantine duration is often based on the maximum observed incubation periods assuming perfect compliance. However, the impact of longer quarantines may be subject to diminishing returns; the largest benefits of quarantine occur over the first few days. Additionally, the financial and psychological burdens of quarantine may motivate increases in noncompliance behavior.

Methods:

We use a deterministic transmission model to identify the optimal length of quarantine to minimize transmission. We modeled the relation between noncompliance behavior and disease risk using a time-varying function of leaving quarantine based on studies from the literature.

Results:

The first few days in quarantine were more crucial to control the spread of COVID-19; even when compliance is high, a 10-day quarantine was as effective in lowering transmission as a 14-day quarantine; under certain noncompliance scenarios a 5-day quarantine may become nearly protective as 14-day quarantine.

Conclusion:

Data to characterize compliance dynamics will help select optimal quarantine strategies that balance the trade-offs between social forces governing behavior and transmission dynamics.
Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California
Authors: McBrien Heather , Rowland Sebastian T. , Benmarhnia Tarik , Tartof Sara Y. , Steiger Benjamin , Casey Joan A.
Published: May 2023

Background:

People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.

Methods:

We obtained 2016–2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM)2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.

Results:

Among 236,732 DME users, 10 µg/m3 increases in wildfire PM2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03–1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.

Conclusions:

Our results support the hypothesis that wildfire smoke or proximity interrupts DME users’ routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.
Examining the Relationship Between Extreme Temperature, Microclimate Indicators, and Gestational Diabetes Mellitus in Pregnant Women Living in Southern California
Authors: Teyton Anais , Sun Yi , Molitor John , Chen Jiu-Chiuan , Sacks David , Avila Chantal , Chiu Vicki , Slezak Jeff , Getahun Darios , Wu Jun , Benmarhnia Tarik
Published: May 2023

Introduction:

Few studies have assessed extreme temperatures’ impact on gestational diabetes mellitus (GDM). We examined the relation between GDM risk with weekly exposure to extreme high and low temperatures during the first 24 weeks of gestation and assessed potential effect modification by microclimate indicators.

Methods:

We utilized 2008–2018 data for pregnant women from Kaiser Permanente Southern California electronic health records. GDM screening occurred between 24 and 28 gestational weeks for most women using the Carpenter-Coustan criteria or the International Association of Diabetes and Pregnancy Study Groups criteria. Daily maximum, minimum, and mean temperature data were linked to participants’ residential address. We utilized distributed lag models, which assessed the lag from the first to the corresponding week, with logistic regression models to examine the exposure-lag-response associations between the 12 weekly extreme temperature exposures and GDM risk. We used the relative risk due to interaction (RERI) to estimate the additive modification of microclimate indicators on the relation between extreme temperature and GDM risk.

Results:

GDM risks increased with extreme low temperature during gestational weeks 20–-24 and with extreme high temperature at weeks 11–16. Microclimate indicators modified the influence of extreme temperatures on GDM risk. For example, there were positive RERIs for high-temperature extremes and less greenness, and a negative RERI for low-temperature extremes and increased impervious surface percentage.

Discussion:

Susceptibility windows to extreme temperatures during pregnancy were observed. Modifiable microclimate indicators were identified that may attenuate temperature exposures during these windows, which could in turn reduce the health burden from GDM.
Cobicistat as a Potential Booster of Ponatinib and Dasatinib Exposure in a CML Patient: A Case Study
Authors: Hofman Susan , Touw Daan J. , Span Bart F. R. , Oude Munnink Thijs H.
Published: May 2023

The authors present a case of a 57-year-old patient with chronic myeloid leukemia who was treated with ponatinib and subsequently treated with dasatinib. The patient showed a major molecular response; however, the BCR-ABL1 signal increased with low ponatinib and dasatinib trough concentrations. Cobicistat was used as a pharmacokinetic booster to increase ponatinib and dasatinib exposure, as opposed to increasing the dose. However, ponatinib exposure was not sufficiently increased by cobicistat. The peak dasatinib concentration was successfully increased with cobicistat treatment. Dasatinib and cobicistat cotreatment induced a response in BCR-ABL1 PCR signal, was well tolerated, and led to a substantial reduction in drug costs.
Surrogate and modified endpoints for immunotherapy in advanced hepatocellular carcinoma
Authors: Lim Mir , Muquith Maishara , Miramontes Bernadette , Lee Chieh-Ju , Espinoza Magdalena , Huang Yi-Hsiang , Hsiehchen David
Published: May 2023

Background and Aims:

Immunotherapies have altered the treatment paradigm in HCC. Surrogate and modified endpoints are used to assess early success in clinical studies and guide clinical practice. We sought to determine whether surrogate endpoints and modifications to the conventional criteria for tumor response (RECIST), including modified RECIST (mRECIST) and immune-modified RECIST (imRECIST), are valid measures to predict overall survival (OS) in HCC treated with immunotherapies.

Approach and Results:

We performed an individual-level post hoc analysis of patients treated with atezolizumab and bevacizumab in the IMbrave150 trial (N = 279) and a cross-sectional analysis of a multicenter real-world patient cohort treated with immunotherapy (N = 328). Landmark analyses showed that objective response rates by RECIST were associated with greater OS including among Child-Pugh A and B patients and among patients treated with immunotherapies in the first- or second-line setting (IMbrave150: HR 0.24, 95% CI, 0.17–0.33; RW: HR 0.25, 95% CI, 0.15–0.43). Objective response rates by mRECIST or imRECIST were not associated with the greater predictive power of OS benefit (mRECIST: HR 0.30, 95% CI, 0.22–0.42; imRECIST: HR 0.36, 95% CI, 0.30–0.51). Progression-free survival determined by RECIST was only moderately correlated with OS, and this association was not improved using mRECIST or imRECIST.

Conclusions:

Our results clarify the utility of surrogate and modified endpoints in HCC treated with immunotherapies and support the use of RECIST objective response rates as an appropriate signal-finding measure for the evaluation of emerging treatments. Contrary to their intended purpose, mRECIST and imRECIST did not provide meaningful improvements in predicting OS benefits.
Convulsive Syncope as a Complication of Outpatient Procedures: A Case Series and Review of the Literature
Authors: Carino Mason Marisa R. , Vu Ly , Horn Danielle , Tiu Timothy
Published: May 2023

Sports medicine providers often perform various outpatient procedures to manage musculoskeletal and neuropathic conditions. Vasovagal syncope is a rare but a possible complication. Convulsive syncope is one subtype that involves brief extensor stiffening and nonsustained myoclonus and can be easily mistaken for seizures. We present a case series of convulsive syncope as a complication of common sports medicine outpatient procedures. We aim to describe how to identify this condition, and offer risk stratification and management strategies to mitigate the risks of this complication. Sports medicine providers who routinely practice outpatient procedures should be aware of this complication. Simple changes in approaching the procedure may mitigate these risks. High- and intermediate-risk features of the syncopal episode should prompt physicians to seek further evaluation by a specialist to rule out more serious conditions. In all instances, appropriate on-site support and equipment for emergent resuscitation and management should be prepared.
Association between Cannabis Use and Tinnitus in US Adults
Authors: Reyes Orozco Francis , Lin Matthew , Clark Bhavishya , Doherty Joni K. , Oghalai John S. , Voelker Courtney C.J. , Choi Janet S.
Published: May 2023

Objective

Assess the association between cannabis use and tinnitus in a nationally representative sample of US adults.

Study Design

Cross-sectional.

Setting

Population-based.

Patients

Adults aged 20 to 59 years who participated in 2011 to 2012 and 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) with available data on tinnitus, audiometry, and substance use.

Intervention

None.

Main Outcome Measure

Tinnitus, demographic information, and medical history were obtained from NHANES questionnaires. Tinnitus was defined as bothersome tinnitus in the past year. Cannabis use was categorized as never use, low-volume use (1–2 pipes/joints per day), and high-volume use (3+ pipes/joints per day). Multivariable regression models with interaction and mediation analyses were conducted. Sampling weights were incorporated to yield results generalizable to the US population.

Results

Tinnitus prevalence was significantly higher among high-volume cannabis users (odds ratio [OR], 20.5%; 95% confidence interval [CI], 16.0–26.0%]) and low-volume users (OR, 17.0%; 95% CI, 14.3–20.0%) than nonusers (OR, 12.0%; 95% CI, 10.4–13.9%). High-volume cannabis use was significantly associated with tinnitus relative to nonusers in multivariable models adjusting for demographics, cardiovascular factors, hearing loss, noise exposure, and depression (OR, 2.05; 95% CI, 1.1–3.9). Tinnitus severity was comparable among high volume, low volume, and noncannabis users. There was no significant mediation or interaction of depression affecting the association between cannabis use and tinnitus.

Conclusions

Bothersome tinnitus prevalence was significantly higher among cannabis users relative to nonusers. High-volume cannabis use was independently associated with tinnitus in a multivariable model accounting for relevant factors including depression. Future study is warranted to elucidate the impact of various levels of cannabis use on tinnitus.
The Relationship between the Subjective Visual Horizontal and Ocular Vestibular Evoked Myogenic Potentials in Acute Vestibular Neuritis
Authors: Hannigan Imelda P. , Nham Benjamin , Wang Chao , Rosengren Sally M. , Kwok Belinda Y.C. , McGarvie Leigh A. , Reid Nicole M. , Curthoys Ian S. , Halmágyi Gabor Michael , Welgampola Miriam S.
Published: May 2023

Object

Vestibular evoked myogenic potentials (VEMPs) and the subjective visual horizontal (SVH) (or vertical [SVV]) have both been considered tests of otolith function: ocular-VEMPs (oVEMPs) utricular function, cervical VEMPs (cVEMPs) saccular function. Some studies have reported association between decreased oVEMPs and SVH, whereas others have not.

Design

A retrospective study of test results.

Setting

A tertiary, neuro-otology clinic, Royal Prince Alfred Hospital, Sydney, Australia.

Method

We analyzed results in 130 patients with acute vestibular neuritis tested within 5 days of onset. We sought correlations between the SVH, oVEMPs, and cVEMPs to air-conducted (AC) and bone-conducted (BC) stimulation.

Results

The SVH deviated to the side of lesion, in 123 of the 130 AVN patients, by 2.5 to 26.7 degrees. Ninety of the AVN patients (70%) had abnormal oVEMPs to AC, BC or both stimuli, on the AVN side (mean asymmetry ratio ± SD [SE]): (64 ± 45.0% [3.9]). Forty-three of the patients (35%) had impaired cVEMPs to AC, BC or both stimuli, on the AVN side, [22 ± 41.6% (4.1)]. The 90 patients with abnormal oVEMP values also had abnormal SVH. Correlations revealed a significant relationship between SVH offset and oVEMP asymmetry (r = 0.80, p < 0.001) and a weaker relationship between SVH offset and cVEMP asymmetry (r = 0.56, p < 0.001).

Conclusions

These results indicate that after an acute unilateral vestibular lesion, before there has been a chance for vestibular compensation to occur, there is a significant correlation between the SVH, and oVEMP results. The relationship between SVH offset and oVEMP amplitude suggests that both tests measure utricular function.
Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada
Authors: Robinson Joan L. , Donovan Anna , Gratrix Jennifer , Smyczek Petra , Tse-Chang Alena
Published: May 2023

Background

Data were collected on the incidence and characteristics of stillbirths attributed to congenital syphilis (CS).

Methods

Data were extracted on stillbirths in Edmonton Zone January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery.

Results

Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (one of whom was treated early in pregnancy and presumably reinfected), and one had a stillbirth in the week following one dose of benzathine penicillin G.

Conclusion

Stillbirths due to CS were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.
Upper Extremity Spasticity: The Quality of Online Patient Resources
Authors: Larkin Tyler , Martinez Victor , Scully Thomas , Martinez Diego , Hayes Corey , Verduzco-Gutierrez Monica
Published: May 2023

Objective

To assess the quality, readability, content, accessibility, and structure of online resources for patients with upper-extremity spasticity.

Design

This was a cross sectional study examined internet searches across three search engines related to patient resources for upper extremity spasticity. Search phrases for either hand or upper-extremity spasticity were used. The top 20 websites from each search were evaluated using the four-readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software.

Results

Thirty-six websites and thirty-three videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the websites was 11.7 ± 3.1, showing low website readability. According to this index, only two websites were written at the suggested 6th-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both websites and videos scored in the "good" range (53.5 ± 8 and 50.5 ± 6.6), respectively.

Conclusion

Current online resources for upper extremity spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.
Incidence and Risk Factors of Systemic Adverse Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections
Authors: Lavigne Alexandre , Nguyen Don , Chartrand-Oberoi Olivier , Noyon Brandon , Spiliotopoulos Stevie , Kfoury Céline , Vanasse Lorence , Chamieh Ralph , Bouhadana Haïm , Boudier-Revéret Mathieu , Denis Isabelle , Mares Christopher
Published: May 2023

Objectives

The aims of the study are to assess the incidence of systemic adverse effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections and to identify associated risk factors.

Design

This retrospective cohort study compared participants who received a glucocorticoid injection at the outpatient clinic and participants who had an appointment but did not receive a glucocorticoid injection. Participants were called to verify whether they had experienced any of the predetermined systemic adverse effects and complications. Multiple binary logistic regression was used to identify systemic adverse effect and complication risk factors.

Results

There were 1010 participants in the glucocorticoid injection group and 328 in the nonglucocorticoid injection group. There was no statistically significant difference in the occurrence of systemic infection and decompensated heart failure between the two groups. More participants in the glucocorticoid injection group developed abnormal uterine bleeding and erectile dysfunction, but the differences did not reach statistical significance. Female participants were 1.9 times more likely to develop systemic adverse effects (P < 0.001). Younger age (P < 0.001), diabetes (P = 0.012), and higher glucocorticoid injection doses (P = 0.024) were also associated with an increased risk of developing systemic adverse effects.

Conclusions

Identified risk factors for developing glucocorticoid injection systemic adverse effects were younger age, female sex, diabetes, tobacco use, and high glucocorticoid injection doses.
Non-living vs. living animal models for microvascular surgery training: a randomized comparative study.
Authors: Le Hanneur Malo , BouchÉ Pierre-Alban , Vignes Jean-Luc , Poitevin Nathalie , Legagneux Josette , Fitoussi Franck
Published: May 2023

Background

Ethical and financial considerations have encouraged the use of non-living models for simulation-based training in microsurgery, such as commercially available chicken thighs. The purpose of this study was to compare the non-living chicken thigh model to the one currently considered as the gold standard, namely the living rat model, in the setting of an initiation microsurgery course.

Methods

Applicants to the 3-day basic microsurgery course of our School of Surgery were randomly assigned to either one group that received the regular training of the School (RT group), including 4 hands-on sessions using only living rat models, or one group that received a modified curriculum in which a non-living chicken thigh model was used for the first hands-on session (CT group). During the following session, all trainees were evaluated on living rat models, using a global rating scale (GRS) and two task-specific scales (TSS – knot-tying and anastomosis); rates of anastomosis patency, animal survival, and technique completion were recorded.

Results

Ninety-three residents were enrolled. GRS, knot-tying and anastomosis TSS scores were significantly higher in the CT group (n=51), with mean differences of 2.6 points (p=.0001), 1.3 points (p<.0001) and 1.4 points (p<.0001), respectively. Patency and survival rates were significantly higher in the CT group, with mean differences of 22% (p=.0020) and 27% (p<.0001), respectively; completion rates were not statistically different.

Conclusions

Subject to the use of validated models, such as the chicken thigh, non-living animal models are a suitable alternative to the living rat model in microsurgery initial training.

Level of evidence:

Not applicable – Animal study.
“Modifiable Risk Factors for Prevention in Dupuytren’s Disease: A UK Biobank Case-Control Study.”
Authors: Kang Youngjoo , Stewart Max , Patel Manal , Furniss Dominic , Wiberg Akira
Published: May 2023

Background:

Dupuytren’s disease is associated with significant co-morbidity and mortality, and has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren’s disease, and to investigate associations with other diseases.

Methods:

Using UK Biobank data, this case-control study analysed the association between phenotypic variables and Dupuytren’s disease through multivariable logistic regression. Exposures assessed were Age, Sex, Body Mass Index, Waist-Hip Ratio, Townsend Deprivation Index, Smoking status, Alcohol intake, Diabetes Mellitus, Hypertension, Cancer, Liver disease, Respiratory disease, Rheumatoid arthritis, Epilepsy, Psoriasis, and Gout.

Results:

There were 4,148 cases and 397,425 controls. Male sex (OR 3.23, 95%CI 2.90 – 3.60, P=1.07×10 -100), increasing age (OR 1.08, 95% CI 1.07 – 1.08, P=6.78×10 -167), material deprivation (OR 1.01, 95%CI 1.00 – 1.02, P=0.0305), HDL cholesterol (OR 1.76, 95%CI 1.58 – 1.96, P=3.35×10 -24), smoking exposure and alcohol intake were all associated with increased odds of Dupuytren’s disease. With increasing obesity class, there was approximately 25% decreased odds (OR 0.774, 95% CI 0.734 – 0.816, P=4.71×10 -21). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren’s disease (OR 2.59, 95%CI 1.92 – 3.44, P=1.92×10 -10). Within this group, increasing HbA1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR 1.31 95%CI 1.13 – 1.51, P=2.19×10 -4).

Conclusions:

Diabetes and poor glycemic control are major risk factors for Dupuytren’s disease, which present an opportunity for prevention.
Three-dimensional comparative changes in the pharyngeal airway of patients with cleft after two-jaw orthognathic surgery
Authors: Chen Pin-Ru , Kwon Soo-Ha , Lo Lun-Jou , Chou Pang-Yun
Published: May 2023

Background:

The present study evaluated the three-dimensional changes of the pharyngeal airway after orthognathic surgery (OGS) in patients with unilateral and bilateral clefts, and in unilateral cleft patients with and without pharyngeal flap (PF).

Methods:

Forty-five patients with unilateral or bilateral clefts receiving OGS were enrolled. Cone-beam computed tomography images were obtained before (T0) and after (T1) OGS. We measured the pharyngeal airway volumes, minimal cross-sectional area, and the horizontal displacement of facial landmarks.

Results:

The patients with bilateral cleft exhibited smaller initial velopharyngeal volume (unilateral: 8623 mm 3; bilateral: 7781 mm 3; p = 0.211), while the velopharyngeal volume increased significantly with median of 744 mm 3 after OGS (p = 0.031). The median horizontal displacement of A point was 2.9 and 2.6 mm among the patients with unilateral and bilateral clefts, respectively (p = 0.276), and the median horizontal displacement of B point was −2.9 and −3.3 mm among patients with unilateral and bilateral clefts, respectively (p = 0.618). The unilateral cleft patients with PF exhibited lower initial velopharyngeal volume (PF+: 7582 mm 3; PF–: 8756 mm 3; p = 0.129) and a lower increase in velopharyngeal volume (PF+: 437 mm 3; PF–: 627 mm 3; p = 0.739) after OGS.

Conclusions:

Midface hypoplasia and the decrease in the velopharyngeal volume were more prominent among the bilateral cleft patients and the unilateral cleft patients with PF. After OGS, the velopharyngeal volume considerably increased among the bilateral cleft patients, but no considerable differences were noted among the unilateral cleft patients with PF.
Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments
Authors: Chen Peter Ruei-Feng , Chuang Kai-Ti , Hsu Sam Sheng-Pin , Chen Yu-Ray , Chen Chien-Tzung
Published: May 2023

Background:

Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry.

Methods:

This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups.

Results:

Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients (P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients (P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment.

Conclusion:

The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Kaban–Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia
Authors: Barrero Carlos E. , Pontell Matthew E. , Ryan Isabel A. , Wietlisbach Larissa E. , Wagner Connor S. , Salinero Lauren , Swanson Jordan W. , Liao Eric C. , Bartlett Scott P. , Taylor Jesse A.
Published: May 2023

Background:

Children born with hemifacial microsomia (HFM) can experience airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between the degree of micrognathia and airway insufficiency in the HFM population.

Methods:

Patient demographics, airway function, Kaban–Pruzansky (KP) grade, and Cormack–Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.

Results:

Seventy patients underwent 365 operations with KP grading as follows: 34% KP grade I, 23% KP grade IIA, 11% KP grade IIB, and 33% KP grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade (P < 0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status (P < 0.001), with 75% of difficult airways in KP grade III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age (P > 0.05). Most CL grades were I (61%) or IIA (13%), with fewer grade IIB, grade III, and grade IV (4% to 7%). KP grade predicted CL grade (P < 0.001), with 71% of grade IV views and 64% of grade III views seen in KP grade III patients.

Conclusions:

KP grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP grade III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for a challenging airway is a critical part of caring for patients with HFM.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Comparative Assessment of Orthodontic and Aesthetic Outcomes after Orthognathic Surgery with Clear Aligner or Fixed Appliance Therapy
Authors: Liou Yu-Jia , Chen Pin-Ru , Tsai Tzong-Yueh , Lin Susie , Chou Pang-Yun , Lo Chiu-Mei , Chen Yu-Ray
Published: May 2023

Background:

Clear aligner therapy has an aesthetic advantage over fixed appliance therapy. However, to our knowledge, no study has objectively compared patient orthodontic and aesthetic outcomes between clear aligner and fixed appliance therapies administered after orthognathic surgery (OGS).

Methods:

This study included patients with no history of congenital craniofacial deformities who underwent surgery-first OGS and received clear aligner or fixed appliance therapy. The patients’ grades on the Dental Health Component (DHC) and Aesthetic Component of the Index of Orthodontic Treatment Need and scores on the Peer Assessment Rating (PAR) index were calculated before OGS (T0), after OGS (T1), and after orthodontic therapy (T2).

Results:

This study included 33 patients (clear aligner therapy, n = 19; fixed appliance therapy, n = 14). No considerable between-group differences were noted in the DHC and AC grades at T0, T1, or T2. Furthermore, percentage of reduction in the PAR index score was more significant in the clear aligner group (74.4%) than in the fixed appliance group (63.2%) from T0 to T1 (P = 0.035); however, no between-group differences were noted from T1 to T2 or from T0 to T2. Both groups exhibited substantially improved DHC grades, Aesthetic Component grades, and PAR index scores at T1 and T2.

Conclusions:

Patient outcomes were similar between the clear aligner and fixed appliance groups after orthodontic therapy. However, the former group exhibited more favorable immediate results after OGS than did the latter group. Thus, as an adjunct therapy for patients with malocclusion, clear aligner therapy may be more effective than fixed appliance therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.