bluuebunny/crossref_metadata_2025 huggingface dataset:
Joint and several liability at the interface of national and international law and the FIDIC conditions of contract
Authors: Mahasneh Nisreen
Published: October 2024

The international terms of the 2017 FIDIC Red Book (reprinted and amended in 2022) state that, when the contractor is a joint venture (JV), all members are jointly and severally liable to the employer. These terms also establish certain procedural rules—the most important ones being the submission to the employer of the JV undertaking and the appointment of a leader. However, these international terms do not provide for substantive rules pertaining to the plurality of the JV members. These require reference to the applicable law that governs the construction contract. The applicable law can be domestic law, such as Qatari law, or an international soft law, such as the Unidroit Principles. Comparing these two possibly applicable laws, it becomes evident that there are no significant differences between the two regarding the substantive rules concerning a plurality of obligors. Furthermore, it is argued that the majority of these substantive legal rules, whether national or international, are inoperative in a construction contract incorporating the international terms of the FIDIC Red Book.
Canker and Dieback of Alnus rubra Is Caused by Lonsdalea quercina
Authors: Iruegas-Bocardo Fernanda , Sutton Wendy , Buchanan Riley A. , Grünwald Niklaus J. , Chang Jeff H. , Putnam (retired) Melodie L.
Published: October 2024

Understanding the ecology of pathogens is important for disease management. Recently, a devastating canker disease was found on red alder ( Alnus rubra) planted as landscape trees. Bacteria were isolated from two groups of symptomatic trees located approximately 1 km apart, and one strain from each group was used to complete Koch's postulates. The results showed that these bacteria can cause disease not only on red alder but also on two other alder species. Unexpectedly, analyses of genome sequences of bacterial strains identified them as Lonsdalea quercina, a pathogenic species previously known to cause dieback of oak species, but not alder. Additionally, a core genome phylogeny clustered bacterial strains isolated from red alder within a subclade of L. quercina strains isolated from symptomatic oak trees. Consistent with the close phylogenetic relationship, there was no obvious evidence for divergence in genome composition of strains isolated from red alder and oak. Altogether, the findings indicate that L. quercina is a potential threat to Alnus species.
Effect of Intraoperative Midazolam on Postoperative Delirium in Older Surgical Patients: A Prospective, Multicenter Cohort Study
Authors: Li Hao , Liu Chang , Yang Yu , Wu Qing-Ping , Xu Jun-Mei , Wang Di-Fen , Sun Jing-Jia , Mao Meng-Meng , Lou Jing-Sheng , Liu Yan-Hong , Cao Jiang-Bei , Duan Chong-Yang , Mi Wei-Dong
Published: October 2024

Background:

Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium in older patients undergoing noncardiac surgery.

Methods:

This study included patients aged 65 yr and older who received general anesthesia between April 2020 and April 2022 in multiple hospitals across China. Postoperative delirium occurring within 7 days was assessed using the 3-min Diagnostic Interview for Confusion Assessment Method. Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of postoperative delirium, presented as the risk ratio and 95% CI. A Kaplan–Meier cumulative incidence curve was plotted to compare the distribution of time to postoperative delirium onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and postoperative delirium.

Results:

In all, 5,663 patients were included, of whom 723 (12.8%) developed postoperative delirium. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and postoperative delirium among older population (unadjusted risk ratio, 0.96; 95% CI, 0.90 to 1.30; P = 0.38; and adjusted risk ratio, 1.09; 95% CI, 0.91 to 1.33; P = 0.35). The Kaplan–Meier curve showed no difference in the distribution of time to postoperative delirium onset (hazard ratio, 1.02; 95% CI, 0.88 to 1.18; P = 0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with postoperative delirium in the specific subgroups of patients.

Conclusions:

Intraoperative administration of midazolam may not be associated with an increased risk of postoperative delirium in older patients undergoing noncardiac surgery.
VEXAS syndrome: an adult-onset autoinflammatory disorder with underlying somatic mutation
Authors: Kötter Ina , Krusche Martin
Published: October 2024

Purpose of review

VEXAS syndrome (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) was first described in 2020, where in a cohort of adults with unexplained fever or inflammation, systematic genetic testing was performed and 25 men with a median age of 64 years and somatic mutations in the UBA1 gene were identified. In the current review, we aim to discuss the relevant literature from January 2023 until July 2024 to give new insights into the pathophysiology, epidemiology, diagnosis and treatment of VEXAS.

Recent findings

VEXAS affects 1 : 4269 in men over the age of 50. Janus-Kinase-inhibitors (JAKi) and IL-6-inhibitors are more effective immunosuppressants against hyperinflammation. Ruxolitinib is more effective than other JAKi. Azacitidine induces remission in many patients, but only few MDS-associated patients were treated. Allogeneic stem cell transplantation is feasible for selected cases. Infections are the major cause of death. Prognosis is still poor with a 5-year mortality rate of 18–40%.

In the current review, we discuss the novelties for VEXAS, including pathogenic pathways, epidemiological data, diagnostic criteria and algorithms, treatment options and complications. We hope that this review may improve rheumatologists understanding of VEXAS. We strongly recommend enrolling VEXAS patients in registries and clinical trials, to improve prognosis of VEXAS in the future.
Endoscopic Posterior Cervical Craniolateral Inclinatory Foraminotomy
Authors: Wu Tsung-Mu , Hwang Jin-Ho , Kim Moon-Chan , Choi Dae-Jung
Published: October 2024

Study Design:

Case series.

Objective:

Endoscopic posterior cervical foraminotomy gains attention for cervical radiculopathy due to its feasibility, better outcomes, and lower complications than traditional approaches, enabling efficient multilevel decompression in a single operation while avoiding anterior cervical diskectomy and fusion–related issues. However, with multilevel decompression, the remnant lamina becomes thin and fragile. We propose craniolateral inclinatory foraminotomy to minimize bone removal during laminotomy, reducing the risk of iatrogenic or postoperative lamina fractures in tandem decompression.

Materials and Methods:

From 2021 to 2022, 8 consecutive patients underwent the procedure and were followed up for at least 6 months. The VAS, NDI, and MacNab scores were recorded for clinical recovery and patient satisfaction evaluations. Preoperative and postoperative CT scans were utilized to measure the lamina preservation percentage at each level.

Results:

The clinical outcomes improved significantly in every patient. No postoperative neck pain, segmental instability, or lamina fracture were observed. The mean lamina preservation percentages of C5, C6, C7, and all vertebrae were 68.8%, 73.22%, 71.86%, and 72.18%, respectively.

Conclusions:

Ongoing technical adjustments will accompany endoscopic technique development to decrease complications and enhance benefits. Our reported technique avoids extensive laminotomy in multilevel tandem decompression, aiming to prevent lamina fractures and anticipate a reduction in postoperative neck pain.

Level of Evidence:

Level IV.
Polygenic risk score for drug-induced long QT syndrome: independent validation in a real-world patient cohort
Authors: Lopez-Medina Ana I. , Campos-Staffico Alessandra M. , Chahal Choudhary Anwar A. , Jacoby Juliet P. , Volkers Isabella , Berenfeld Omer , Luzum Jasmine A.
Published: October 2024

Objective

Drug-induced long QT syndrome (diLQTS) is an adverse reaction from over 150 FDA-approved medications, posing the risk of triggering torsades de pointes and sudden death. While common genetic variants may modestly impact QT interval individually, their collective effect can significantly amplify risk of diLQTS. Consequently, this study aimed to validate a polygenic risk score (PRS) for diLQTS previously proposed by Strauss et al.

Methods

A retrospective cohort study was conducted utilizing patients from the Michigan Genomics Initiative prescribed 27 high-risk QT-prolonging drugs and an ECG during the prescription. The primary outcome was marked prolongation of the QTc interval (either >60 ms change from baseline or >500 ms absolute value) during treatment with a high-risk QT-prolonging drug.

Results

The primary outcome occurred in 12.0% of n = 6070 self-reported White, 12.4% of 558 African American, and 8.2% of 110 Asian patients. The PRS significantly associated with diLQTS in White patients [adjusted odds ratio = 1.44 (95% CI: 1.09–1.89); P = 0.009]. However the study lacked sufficient statistical power to confirm the PRS as a risk factor in African Americans [adjusted odds ratio = 2.18 (95% CI: 0.98–5.49); P = 0.073] and Asians [adjusted odds ratio = 3.21 (95% CI: 0.69–16.87); P = 0.139] due to smaller sample sizes in these groups.

Conclusion

The previously published PRS for diLQTS was validated in a large, real-world cohort, demonstrating its potential as a tool for identifying high-risk patients. Incorporating this PRS into routine clinical practice could enable proactive measures to prevent life-threatening diLQTS.
CYP3A5 pharmacogenetic testing for tacrolimus in pediatric heart transplant patients: a budget impact analysis
Authors: Wang Jiaqi , Pasternak Amy L. , Maggo Simran , Mindanao Rochelle , Nguyen Jenny Q. , Gong Cynthia L.
Published: October 2024

Background

Pharmacogenomic testing can optimize drug efficacy and minimize adverse effects. CYP3A5 polymorphisms affect the metabolism of tacrolimus. We sought to estimate the budget impact of preemptive pharmacogenomic testing for CYP3A5 in pediatric heart transplantation patients from an institutional perspective.

Methods

A decision tree was constructed to estimate the budget impact of pediatric heart transplant patients (age ≤18 years) initiated on tacrolimus with and without CYP3A5 pharmacogenomic testing. The budget impact of preemptive pharmacogenomic testing versus no pharmacogenomic testing was calculated. One-way sensitivity analysis and alternative analyses were conducted to assess the robustness of results to changes in model parameters.

Results

CYP3A5 genotype-guided dosing provided savings of up to $17 225 per patient compared to standard dosing. These savings decreased to $11 759 when using another institution’s data for the standard-dosing group. The time to achieve therapeutic concentration in the poor metabolizer genotype-guided dosing group had the largest impact on cost savings while the cost of the pharmacogenetic test had the smallest impact on cost savings.

Conclusion

Implementing CYP3A5 testing could save $17 225 per pediatric heart transplant patient receiving tacrolimus. As pharmacogenomic testing becomes more widespread, institutions should track resource requirements and outcomes to determine the best implementation policies going forward.
The association between age at natural menopause and risk of asthma among postmenopausal women from the Canadian Longitudinal Study on Aging
Authors: Kesibi Durmalouk , Rotondi Michael , Edgell Heather , Tamim Hala
Published: October 2024

Objective

This study aimed to investigate the association between age at natural menopause and incidence of asthma among postmenopausal Canadian women.

Methods

Women between the ages of 45-85 yr were followed for a 10-yr period. Analysis was restricted to naturally postmenopausal women who are nonsmokers and did not have asthma prior to menopause. Age at natural menopause was examined using the following categories: 40-44, 45-49, 50-54 (reference), and ≥55. Survival analysis was utilized to determine time to onset of asthma. Multivariable Cox regression analysis was performed to assess the relationship between age at natural menopause and asthma after adjusting for covariates.

Results

The multivariable Cox regression analysis showed a 30% decreased risk of asthma in women with age at natural menopause of 40-44 yr compared with age at natural menopause of 50-54 yr with a hazard ratio of 0.7 (95% confidence interval: 0.49-0.95).

Conclusions

Women with later ages at natural menopause may be at increased risk for asthma.
Clinical care guidance in patients with diabetes and metabolic dysfunction–associated steatotic liver disease: A joint consensus
Authors: Huang Jee-Fu , Chang Tien-Jyun , Yeh Ming-Lun , Shen Feng-Chih , Tai Chi-Ming , Chen Jung-Fu , Huang Yi-Hsiang , Hsu Chih-Yao , Cheng Pin-Nan , Lin Ching-Ling , Hung Chao-Hung , Chen Ching-Chu , Lee Mei-Hsuan , Lee Chun-Chuan , Lin Chih-Wen , Liu Sung-Chen , Yang Hwai-I , Chien Rong-Nan , Kuo Chin-Sung , Peng Cheng-Yuan , Chang Ming-Ling , Huang Chung-Feng , Yang Yi-Sun , Yang Hung-Chih , Lin Han-Chieh , Ou Horng-Yih , Liu Chun-Jen , Tseng Chin-Hsiao , Kao Jia-Horng , Chuang Wan-Long , Huang Chien-Ning , Chen Pei-Jer , Wang Chih-Yuan , Yu Ming-Lung
Published: October 2024

Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide, affecting >30% of the global population. Metabolic dysregulation, particularly insulin resistance and its subsequent manifestation as type 2 diabetes mellitus, serves as the fundamental pathogenesis of metabolic liver disease. Clinical evidence of the recent nomenclature evolution is accumulating. The interaction and impacts are bidirectional between MASLD and diabetes in terms of disease course, risk, and prognosis. Therefore, there is an urgent need to highlight the multifaceted links between MASLD and diabetes for both hepatologists and diabetologists. The surveillance strategy, risk stratification of management, and current therapeutic achievements of metabolic liver disease remain the major pillars in a clinical care setting. Therefore, the Taiwan Association for the Study of the Liver (TASL), Taiwanese Association of Diabetes Educators, and Diabetes Association of the Republic of China (Taiwan) collaboratively completed the first guidance in patients with diabetes and MASLD, which provides practical recommendations for patient care.
Association of mid-regional pro-adrenomedullin with office and 24-h ambulatory blood pressure in a Swiss general population sample
Authors: Baldwin Julia , Burnier Michel , Ponte Belen , Ackermann Daniel , Pruijm Menno , Vogt Bruno , Bochud Murielle
Published: October 2024

Objective:

Adrenomedullin (ADM) is a potent vasodilator. The association between plasma ADM levels and blood pressure (BP) remains unclear. We assessed the association between mid-regional-pro-ADM (MR-proADM) and BP in a multicenter population- and family-based cohort.

Methods:

We used data from the Swiss Kidney Project on Genes in Hypertension (SKIPOGH). We included participants present at both baseline and 3-year follow-up (N = 843). We examined the association of baseline MR-proADM with baseline office and 24 h ambulatory BP as well as the 3-year change in office BP. In secondary analyses, we studied the association between baseline MR-proADM and 3-year changes in pulse wave velocity (PWV), renal resistive index (RRI) and augmentation index (AI). Mixed-effects linear regression models were used.

Results:

In cross-sectional analyses, MR-proADM was negatively associated with office, 24-h and daytime diastolic BP (DBP). MR-proADM was positively associated with nighttime systolic BP (SBP). In longitudinal analyses, baseline MR-proADM was associated with an increase in office SBP and pulse pressure (PP) over 3 years [β (95% CI): 8.2 (0.4, 15.9) and β (95% CI): 6.4 (0.3, 12.4), respectively] but not with changes in PWV, RRI and AI.

Conclusions:

The cross-sectional negative association of MR-proADM with DBP is in line with known vasodilatory properties of ADM. The positive association between MR-proADM and nighttime SBP at baseline may reflect endothelial dysfunction believed to be part of the pathogenesis of nocturnal hypertension. The association of higher baseline MR-proADM levels with increased SBP and PP at 3-year follow-up suggests that ADM levels could be a marker of cardiovascular risk.
Comparison of Reference and Biosimilar Medications for Pediatric Noninfectious Uveitis
Authors: Valikodath Nita G. , Rathinavelu Jay , Deaner Jordan D. , Buckley Mary , Grewal Dilraj S.
Published: October 2024

Objective/purpose:

Compare outcomes and costs of TNF-alpha inhibitor biosimilars to reference medications in the treatment of pediatric NIU.

Methods:

Patients 18 years old or below treated with reference or biosimilar TNF-alpha inhibitor for noninfectious uveitis and had a history of active ocular inflammation with at least 1 month of ophthalmology follow-up from January 1, 2013, to June 1, 2023, were included. Retrospective chart review was performed.

Results:

Nineteen patients met the inclusion criteria. Mean age was 9.3±4.0 years, and 47.4% (9/19) were female. Of the patients who were on infliximab at any time point in their disease course (n=9), the mean duration on infliximab was 3.6 years (42 mo). Of the patients on biosimilar infliximab (n=10), the mean duration was 0.82 years (9.8 mo). Mean flares/year was 0.22±0.3 on infliximab and 0.15±0.3 on biosimilar infliximab. The average annual cost was $42,298.97 for infliximab (n =9), $41,141 for infliximab-dyyb (n=9), and $40,950 for infliximab-axxq (n=1). Reasons for switching to biosimilar infliximab from adalimumab included a combination of insurance mandate (100%), worsening disease activity (37.5%), or other issues such as noncompliance (37.5%).

Conclusions:

The most common reason for biosimilar initiation was insurance mandate. Compared with the reference infliximab, pediatric patients had fewer number of flares per year on biosimilar infliximab, but they were also on the biosimilar for a shorter duration of time compared with the reference which may confound an accurate assessment. Biosimilar infliximab had a lower cost profile compared with reference infliximab.
Opportunities to Apply Human-centered Design in Health Care With Artificial Intelligence–based Screening for Diabetic Retinopathy
Authors: Bai Patricia , Beversluis Cameron , Song Amy , Alicea Nylani , Eisenberg Yuval , Layden Brian , Scanzera Angelica , Leifer Ariel , Musick Hugh , Chan Robison Vernon Paul
Published: October 2024

Diabetic retinopathy (DR) is a leading cause of blindness. Artificial intelligence (AI) has been proposed to provide a novel opportunity to increase screening for DR. While it is paramount to ensure AI has adequate technical capabilities to perform accurate screening, it is also important to assess how to best implement such technology into clinical practice. Human-centered design offers a methodology to understand the real-world context and behaviors of individuals, engage stakeholders, and rapidly prototype and test solutions, enhancing usability and avoiding unintended consequences. This review describes the methodology of human-centered design, examining how it has been used within a variety of health care contexts, with a particular focus on how it has been used to implement an AI-based DR screening program. Further research is needed to understand the best strategies to implement and evaluate AI in health care.
Implementation of Artificial Intelligence in Retinopathy of Prematurity Care: Challenges and Opportunities
Authors: Tsai Andrew S.H. , Yip Michelle , Song Amy , Tan Gavin S.W. , Ting Daniel S.W. , Campbell J. Peter , Coyner Aaron , Chan Robison Vernon Paul
Published: October 2024

The diagnosis of retinopathy of prematurity (ROP) is primarily image-based and suitable for implementation of artificial intelligence (AI) systems. Increasing incidence of ROP, especially in low and middle-income countries, has also put tremendous stress on health care systems. Barriers to the implementation of AI include infrastructure, regulatory, legal, cost, sustainability, and scalability. This review describes currently available AI and imaging systems, how a stable telemedicine infrastructure is crucial to AI implementation, and how successful ROP programs have been run in both low and middle-income countries and high-income countries. More work is needed in terms of validating AI systems with different populations with various low-cost imaging devices that have recently been developed. A sustainable and cost-effective ROP screening program is crucial in the prevention of childhood blindness.
Anti-inflammatory and anticancer effects of polysaccharides from Antrodia cinnamomea: A review
Authors: Lin Zhi-Hu , Phan Sang-Nguyen-Cao , Tran Diem-Ngoc-Hong , Lu Mei-Kuang , Lin Tung-Yi
Published: October 2024

Antrodia cinnamomea (Ac), also known as “Niu-Chang-Chih” in Chinese, is a valuable fungus that has been widely used as medicine and food among indigenous people in Taiwan. Ac is rich in polysaccharides (Ac-PS), making it a promising candidate for adjunctive therapy in cancer and inflammation conditions. There are two types of Ac-PS: general (non-sulfated) PS (Ac-GPS) and sulfated PS (Ac-SPS). This review highlights that both Ac-GPS and Ac-SPS possess immunomodulatory, anti-inflammatory, and anticancer properties. Each type influences interleukin signaling pathways to exert its anti-inflammatory effects. Ac-GPS is particularly effective in alleviating inflammation in the brain and liver, while Ac-SPS shows its efficacy in macrophage models. Both Ac-GSP and Ac-SPS have demonstrated anticancer effects supported by in vitro and in vivo studies, primarily through inducing apoptosis in various cancer cell lines. They may also synergize with chemotherapy and exhibit antiangiogenic properties. Notably, Ac-SPS appears to have superior anticancer efficacy, potentially due to its sulfate groups. Furthermore, Ac-SPS has been more extensively studied in terms of its mechanisms and effects on lung cancer compared with Ac-GPS, highlighting its significance in cancer research. In addition, Ac-SPS is often reported for its ability to activate macrophage-mediated responses. Clinically, Ac-GPS has been used as an adjunctive therapy for advanced lung cancer, as noted in recent reports. However, given the numerous studies emphasizing its anticancer mechanisms, Ac-SPS may exhibit greater efficacy, warranting further investigation. This review concludes that Ac-derived Ac-GPS or Ac-SPS have the potential to be developed into functional health supplements or adjunctive therapies, providing dual benefits of anti-inflammatory and anticancer effects.
Effect of exercise training in patients with angina with nonobstructive coronary arteries: a systematic review and meta-analysis
Authors: Wu Yuan , Zhu Haixiang , Xu Qijin , Li Yan , Tang Leiwen
Published: October 2024

Angina with nonobstructive coronary arteries (ANOCA) is a highly prevalent heart disease. The evidence on exercise training (ET) for the treatment of ANOCA, however, is still inadequate. This meta-analysis aims to provide a comprehensive assessment of the effect of ET in patients with ANOCA. Studies were searched from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, and WanFang from inception to 15 January 2024. The quality of included studies was assessed using the Cochrane risk of bias tool. Heterogeneity among the studies was evaluated using Cochran’s Q test and I
2 statistic, and subgroup analysis based on gender was performed to explore potential sources of heterogeneity. A total of 12 studies were included in this meta-analysis. The pooled results showed that ET significantly increased the peak oxygen uptake (peak VO2) [weighted mean difference (WMD) = 6.11, 95% confidence interval (CI): 4.73 to 7.50], left ventricular ejection fraction (WMD = 7.66, 95% CI: 5.53 to 9.78), and 6 min walking test (WMD = 55.55; 95% CI: 16.23 to 94.87). Nitric oxide (WMD = 20.18, 95% CI: 19.16 to 21.21) and peripheral arterial tonometry (WMD = 0.16, 95% CI: 0.11 to 0.21) were higher, and matrix metalloproteinase-9 (WMD = −8.02, 95% CI: −9.21 to −6.84) was lower in ET group. In conclusion, our findings indicated that ET could improve cardiopulmonary function, exercise capacity, and endothelial function, which could be recommended for the treatment of ANOCA patients.
Pulmonary embolism work-up in chronic obstructive pulmonary disease exacerbations: what is the best strategy for clinicians?
Authors: Jiménez David , Bertoletti Laurent , Bikdeli Behnood
Published: October 2024

Purpose of review

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural course of COPD, as they increase morbidity and mortality. Acute pulmonary embolism may mimic the symptoms of COPD exacerbations. However, the exact prevalence of pulmonary embolism in unexplained exacerbations of COPD is unclear based on the current data. This review provides a practical approach to patients with COPD complaining of worsening respiratory symptoms.

Recent findings

A randomized clinical trial has shown that a routine pulmonary embolism diagnostic work-up does not improve care of patients with acute exacerbations of COPD. However, review of the recent literature suggests that a nonnegligible proportion of otherwise unexplained exacerbations of COPD may be caused by pulmonary embolism. To date, nevertheless, there are limited studies developing and validating clinical models that might aid in the identification of patients requiring additional tests for the diagnosis of pulmonary embolism.

Until new evidence becomes available, we believe that a routine diagnostic strategy for pulmonary embolism is not appropriate for patients with acute exacerbations of COPD. Recommendations for routine pulmonary embolism diagnostic work-up necessitate further development of prognostic models and conduct of clinical trials that assess important health outcomes.
The real experiences of nurses after patient suicide: A meta-synthesis of qualitative studies
Authors: Yang Mengying , Yu Peipei , Zhang Hui , Zheng Yingying
Published: October 2024

Objectives:

To systematically evaluate the qualitative study of nurses’ real experience after patient suicide, and to provide theoretical basis for reducing the influence of patient suicide on nurses and reducing the incidence of patient suicide.

Design:

A systematic review and meta-synthesis of qualitative studies.

Methods:

These databases including The Cochrane Library, CINAHL, PubMed, Embase, Web of Science, CMB, CNKI, Wanfang, and VIP were searched by computer to collect relate qualitative researches. The retrieval time was from database established to February 2024. Joanna Briggs Institute Qualitative Research Quality Evaluation Form was used to evaluate the literature quality and Meta-integration.

Results:

A total of 12 studies were included and 47 results were obtained, which were summarized into 8 new categories and 3 integrated results were obtained. Theme 1: impact on nurses themselves; Theme 2: the nurse’s thoughts and suggestions of patient suicide; Theme 3: coping strategy.

Conclusions:

Nursing managers should fully pay attention to nurses’ feelings and cognitive attitudes after patients’ suicide events, strengthen psychological counseling for nurses, so as to reduce the impact of patients’ suicide events on nurses.
The application of basic SMAS rhytidectomy and comprehensive SMAS rhytidectomy
Authors: Ao Yin-Jie , Yi Yan , Nie Yun-Fei , Wu Guo-Hui
Published: October 2024

Rhytidectomy has made great progress in the past 50 years, especially after the proposition of the concept of superficial musculoaponeurotic system (SMAS). Our previous research had classified SMAS rhytidectomy into basic SMAS rhytidectomy (B-SMAS) and comprehensive SMAS rhytidectomy (C-SMAS) according to whether the treatment of SMAS aponeurosis is combined with retaining ligament, fat pad, mimetic muscles, etc. The purpose of this paper is to compare the outcomes of the 2 methods. Through multicenter collaborative research, 21 cases of B-SMAS and 18 cases of C-SMAS were collected. Photographs were taken pre- and post-operation for each patient, and the facial width of the lateral canthus level (upper face), the alar base level (middle face), and the oral commissure level (lower face) were measured. We compared the statistics of upper, middle, and lower face pre- and post-B-SMAS and C-SMAS to assess the ramifications of each operation. We used preoperative measurements minus corresponding postoperative measurements of specific operation to assess which position would acquire superior improvements. We also recruited 3 professional plastic clinicians to rate the ramifications of specific positions and approaches after pre- and post-photo comparing. Through comprehensive analyzing, we compared the improvements between B-SMAS and C-SMAS to assess which method is more beneficial concerning facial rejuvenation. Both B-SMAS and C-SMAS would acquire optimal changing concerning facial width in middle and lower face after operation (P < .05). Two methods all harvested better width changing effects in middle and lower face than upper face (P < .05). However, C-SMAS acquired better effects in middle and lower face than B-SMAS (P < .05). Both B-SMAS and C-SMAS are beneficial to facial rejuvenation. The effects in middle and lower face are better than upper face. In addition, C-SMAS may be more effective than B-SMAS.
Association between gout and cancers: A systematic review and meta-analysis
Authors: Tian Lin , Wang Youjiao , Zhang Ying , Tian Lv , Wang Huijing
Published: October 2024

Background:

This study aimed to investigate the association between gout and cancer risk.

Methods:

This study was registered with the Prospective Registry for International Systematic Reviews (ID: CRD42023465587). We searched PubMed, Embase, Scopus, Cochrane, and Web of Science databases for studies related to gout and cancer risk, with a timeframe from the date the database was created to September 2023. We assessed the methodological quality of the included studies using the Newcastle-Ottawa scale and assessed heterogeneity between studies using the I
2 statistic. Depending on the heterogeneity, we calculated pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using fixed-effects or random-effects models. In addition, we performed sensitivity analyses and publication bias tests.

Results:

In this study, we conducted a meta-analysis of 6 studies encompassing a total of 1279,804 participants. Our analysis revealed that individuals with gout are at a heightened risk of developing cancer in general (HR = 1.18, 95% CI = 1.04–1.34, P < .001). Moreover, specific types of cancer displayed a significant correlation with gout, including gastric cancer (HR = 1.31, 95% CI = 1.07–1.62, P = .012), liver cancer (HR = 1.24, 95% CI = 1.01–1.52, P < .001), lung cancer (HR = 1.26, 95% CI = 1.03–1.53, P = .001), and bladder cancer (HR = 1.57, 95% CI = 1.02–2.41, P < .001). Furthermore, gout exhibited a marginally increased risk for other cancer types, such as head and neck cancer and esophageal cancer, although these associations did not attain statistical significance.

Conclusion:

Our study suggests that gout is a risk factor for cancer, especially for stomach, liver, lung, and bladder cancers. Patients with gout have an increased risk of developing overall cancers, lung cancer, liver cancer, stomach cancer, and bladder cancer. However, more high-quality epidemiologic studies are needed to explore the association between gout and individual cancers more accurately.
An examination of caregiver burden and contributing factors in cases of congenital microtia deformity
Authors: Yang Qing-Min , Yang Min-Li
Published: October 2024

This study aimed to assess the burden and influencing factors among primary caregivers of children with congenital microtia. A total of 153 primary caregivers of children with congenital microtia who underwent auricular reconstruction surgery at a tertiary A-grade hospital in Xi’an between October 2019 and August 2022, were recruited using convenience sampling. The Zarit Caregiver Burden Interview (ZBI) was employed to evaluate caregiver burden. While convenience sampling allowed for the practical recruitment of participants, its limitations include potential selection bias, which may affect the generalizability of the results. The mean total ZBI score was 30.07 ± 12.29. Among the participants, 26 caregivers (17.0%) reported no burden, 102 caregivers (66.7%) reported mild burden, 22 caregivers (14.4%) reported moderate burden, and 3 caregivers (2.0%) reported severe burden. Multivariate regression analysis identified several significant factors influencing caregiver burden, including the location and severity of the lesion, educational level, method of medical payment, monthly household income, communication with others about the child’s condition, caregiver self-blame or guilt, and family support (all P < .05). Primary caregivers of children with congenital microtia face substantial burdens, emphasizing the need for targeted healthcare interventions. Strategic approaches are essential to address the psychological, social, and financial challenges they encounter. Future research should focus on longitudinal studies and interventions to enhance caregiver well-being and patient outcomes. However, caution is advised when generalizing these findings due to the sampling limitations.
Association between sleep and tinnitus in US adults: Data from the NHANES (2007–2012)
Authors: Wang Chao , Li Shulin , Shi Mengdi , Qin Zhu , Wang Dianyi , Li Wentao , Wang Rui , Xie Liangzhen , Li Yan
Published: October 2024

We evaluated the relationship between sleep factors and tinnitus risk using data from the US National Health and Nutrition Examination Survey (2007–2012), focusing on adults aged 20 to 80 years. Our analysis included 4354 participants, with sleep patterns categorized as healthy, intermediate, or poor. We observed that both short (odds ratio [OR]: 1.43) and long (OR: 1.48) sleep durations increased the risk of tinnitus compared with the healthy range (7–9 hours). Additionally, sleep disturbances were significantly correlated with tinnitus (OR: 1.52), with the strongest association occurring in individuals with poor sleep patterns (OR: 1.71). The results of the weighted logistic regression analysis underscored these findings.
Assessing the Quality and Accuracy of Syphilis-Related Content on TikTok and YouTube: A Comprehensive Analysis
Authors: Alkhodair Rayan , Alfawzan Abdulrahman , Alharthi Sawsan A. , AlOmair Abdulrahman , Alqerafi Abdulrahman , Alfaleh Abdullah
Published: October 2024

Background

Sexually transmitted infections, including syphilis, pose a significant public health challenge. The advent of social media platforms has revolutionized health information dissemination, with YouTube and TikTok emerging as prominent sources. However, concerns persist regarding the reliability of syphilis-related content on these platforms. This study aimed to evaluate the quality and accuracy of syphilis-related content on TikTok and YouTube, using established tools such as DISCERN, Accuracy in Digital-health Instrument (ANDI), and Global Quality Scale (GQS).

Methodology

We conducted a thorough search on TikTok and YouTube on November 26, 2023, using the keyword “syphilis.” Inclusion criteria comprised videos in English, less than 20 minutes in duration, and relevance to syphilis. Two dermatologists independently rated 98 eligible videos using DISCERN, ANDI, and GQS. Statistical analyses included χ
2 tests, mean comparisons, and interclass correlation.

Results

TikTok videos exhibited higher mean views (222,519 ± 412,746) compared with YouTube (127,527 ± 223,622). However, TikTok videos had lower mean GQS (2.3 ± 0.9), ANDI (2.19 ± 0.99), and DISCERN (28.7 ± 6.56) scores compared with YouTube (GQS: 2.9 ± 1.1, ANDI: 2.90 ± 0.97, DISCERN: 38.8 ± 9). Nonprofessional uploaders were 40.8% on TikTok, whereas the value was 53.1% on YouTube.

Conclusion

This study reveals disparities in the quality and accuracy of syphilis-related content on TikTok and YouTube. Despite higher popularity on TikTok, content quality, as assessed by DISCERN, ANDI, and GQS, was generally lower compared with YouTube. Targeted interventions are needed to improve the reliability of syphilis-related information on social media platforms.
Vision corrections used by presbyopic orienteers
Authors: Latham Keziah , Abbott Louis P. H. , Timmis Matthew A.
Published: October 2024

SIGNIFICANCE

Evaluating the visual challenges and refractive correction solutions of presbyopic orienteers identifies features of relevance to optometric management of the visual needs of active presbyopes.

PURPOSE

Orienteering is a unique sport requiring visual clarity at a range of viewing distances and has a high proportion of presbyopic participants. This study evaluates the vision corrections used by presbyopic orienteers, specifically aiming to characterize the prevalence of different vision correction options used and to explore the strengths and limitations of different vision correction solutions.

METHODS

Orienteers 40 years or older completed an online questionnaire consisting of multiple-choice questions covering personal demographics, orienteering participation, and visual corrections worn in everyday life and for orienteering. Free-text questions asked for further information about the corrections used and advice received from eye care practitioners were analyzed using content analysis.

RESULTS

There were 469 respondents (195 women, 274 men; median age category, 55 to 59 years). For the 187 people without distance refractive correction, the most frequent corrections for orienteering were “off the shelf” reading spectacles (n = 95) or use of a compass magnifier (n = 24), and for the 277 people with distance refractive correction, they were progressive addition spectacles (n = 96) and monovision contact lenses (n = 63). The main visual challenges faced by orienteers were seeing map detail, lens obstruction from fogging and rain, and difficulty orienteering in low light in the daytime. An ideal correction needed to provide visual clarity for both map and terrain. No visual correction type consistently addressed all challenges. Orienteers valued personalized discussion with eye care practitioners to address their needs.

CONCLUSIONS

Optimal visual corrections for presbyopic orienteers are individual, but higher reading additions to clarify map detail, contact lenses to avoid lens obstruction, additional light, and solutions that provide clear vision at all viewing distances while avoiding the reading add blurring the ground at the orienteer's feet should be considered. Personalized care is necessary to optimize visual correction solutions.
At-home Administration of Opioid Analgesia in Children After Reduction of Forearm Fracture
Authors: Stein Ariel B. , Lammers Shea M. , Ortega Henry W. , Reid Samuel R.
Published: October 2024

Objective

Controversy exists surrounding which agents best provide analgesia in children with fractures. Prior studies have demonstrated that ED visits for fracture-related pain have the highest rates of opioid prescribing. Studies have also found that NSAIDs are equivalent at controlling acute fracture-related pain. In a time when one must balance the risk of inadequate pain control with potential opioid misuse, providers have little data to guide them in terms of the best recommendations for adequate pain control at home.

Methods

This prospective observational study investigates parental pain management practices after ED discharge for children who underwent a forearm fracture reduction. Surveys filled out by parents were used to gather data on the proportion of children discharged with an opioid prescription, the number of doses of opioid that were administered after discharge, and parental satisfaction with their child's pain control.

Results

We analyzed data for 61 patients who completed the postdischarge survey. Of these, 62% received a prescription for oxycodone at discharge, and 50% used at least 1 dose of oxycodone at home. The median number of doses administered at home, 1.5 (IQR, 0–3), was significantly lower than the number of doses of oxycodone prescribed, 10 (IQR, 5–12) (P < 0.001). Parents reported a high level of satisfaction with the medications received at discharge with nearly all ranging between 4 (satisfied) and 5 (very satisfied) (median, 5; IQR, 4–5). No significant difference was detected in the satisfaction between families who received a prescription for oxycodone at discharge (median, 5; IQR, 4–5) and those who did not (median, 5; IQR, 4–5) (P = 0.28).

Conclusions

We observed a large range in the number of doses of oxycodone prescribed at discharge and a significant difference between the number of doses being prescribed and those being used by families. A prescription of 2 doses of oxycodone would be sufficient to treat postreduction pain in the majority of children.
Finesse in Primary Open Rhinoplasty
Authors: Rohrich Rod J. , Chiodo Michael V. , Lisiecki Jeffrey L.
Published: October 2024

Rhinoplasty remains one of the most technically demanding operations in plastic surgery, and it continues to be one of the top 5 aesthetic surgical procedures performed. The focus of this article is open rhinoplasty, the central focus of the practice of the senior author (R.J.R.) over the past 3 decades. The authors provide a step-by-step video guide to the typical sequence of the senior author’s technique.
Update on Management of Scaphoid Fractures
Authors: Pickrell Brent B. , Dowlatshahi Arriyan S. , Kim Peter S.
Published: October 2024

Learning Objectives:

After studying this article, the participant should be able to: 1. Accurately diagnose scaphoid fractures through examination and appropriate imaging selection. 2. Recognize those fractures that can be treated with nonoperative management. 3. Outline the different surgical approaches for scaphoid fractures. 4. Appreciate the surgical options for management of scaphoid nonunion.

This article includes the most up-to-date information on the diagnosis, work-up, and treatment of scaphoid fractures.
Tracer-Separator
Authors: Sanaat Amirhossein , Hu Yiyi , Boccalini Cecilia , Salimi Yazdan , Mansouri Zahra , Teixeira Eliluane Pirazzo Andrade , Mathoux Gregory , Garibotto Valentina , Zaidi Habib
Published: October 2024

Introduction

Multiplexed PET imaging revolutionized clinical decision-making by simultaneously capturing various radiotracer data in a single scan, enhancing diagnostic accuracy and patient comfort. Through a transformer-based deep learning, this study underscores the potential of advanced imaging techniques to streamline diagnosis and improve patient outcomes.

Patients and Methods

The research cohort consisted of 120 patients spanning from cognitively unimpaired individuals to those with mild cognitive impairment, dementia, and other mental disorders. Patients underwent various imaging assessments, including 3D T1-weighted MRI, amyloid PET scans using either 18F-florbetapir (FBP) or 18F-flutemetamol (FMM), and 18F-FDG PET. Summed images of FMM/FBP and FDG were used as proxy for simultaneous scanning of 2 different tracers. A SwinUNETR model, a convolution-free transformer architecture, was trained for image translation. The model was trained using mean square error loss function and 5-fold cross-validation. Visual evaluation involved assessing image similarity and amyloid status, comparing synthesized images with actual ones. Statistical analysis was conducted to determine the significance of differences.

Results

Visual inspection of synthesized images revealed remarkable similarity to reference images across various clinical statuses. The mean centiloid bias for dementia, mild cognitive impairment, and healthy control subjects and for FBP tracers is 15.70 ± 29.78, 0.35 ± 33.68, and 6.52 ± 25.19, respectively, whereas for FMM, it is −6.85 ± 25.02, 4.23 ± 23.78, and 5.71 ± 21.72, respectively. Clinical evaluation by 2 readers further confirmed the model's efficiency, with 97 FBP/FMM and 63 FDG synthesized images (from 120 subjects) found similar to ground truth diagnoses (rank 3), whereas 3 FBP/FMM and 15 FDG synthesized images were considered nonsimilar (rank 1). Promising sensitivity, specificity, and accuracy were achieved in amyloid status assessment based on synthesized images, with an average sensitivity of 95 ± 2.5, specificity of 72.5 ± 12.5, and accuracy of 87.5 ± 2.5. Error distribution analyses provided valuable insights into error levels across brain regions, with most falling between −0.1 and +0.2 SUV ratio. Correlation analyses demonstrated strong associations between actual and synthesized images, particularly for FMM images (FBP: Y = 0.72X + 20.95, R
2 = 0.54; FMM: Y = 0.65X + 22.77, R
2 = 0.77).

Conclusions

This study demonstrated the potential of a novel convolution-free transformer architecture, SwinUNETR, for synthesizing realistic FDG and FBP/FMM images from summation scans mimicking simultaneous dual-tracer imaging.
Assessing Artificial Intelligence in Oral Cancer Diagnosis: A Systematic Review
Authors: Veeraraghavan Vishnu P. , Minervini Giuseppe , Russo Diana , Cicciù Marco , Ronsivalle Vincenzo
Published: October 2024

Background:

With the use of machine learning algorithms, artificial intelligence (AI) has become a viable diagnostic and treatment tool for oral cancer. AI can assess a variety of information, including histopathology slides and intraoral pictures.

Aim:

The purpose of this systematic review is to evaluate the efficacy and accuracy of AI technology in the detection and diagnosis of oral cancer between 2020 and 2024.

Methodology:

With an emphasis on AI applications in oral cancer diagnostics, a thorough search approach was used to find pertinent publications published between 2020 and 2024. Using particular keywords associated with AI, oral cancer, and diagnostic imaging, databases such as PubMed, Scopus, and Web of Science were searched. Among the selection criteria were actual English-language research papers that assessed the effectiveness of AI models in diagnosing oral cancer. Three impartial reviewers extracted data, evaluated quality, and compiled the findings using a narrative synthesis technique.

Results:

Twelve papers that demonstrated a range of AI applications in the diagnosis of oral cancer satisfied the inclusion criteria. This study showed encouraging results in lesion identification and prognostic prediction using machine learning and deep learning algorithms to evaluate oral pictures and histopathology slides. The results demonstrated how AI-driven technologies might enhance diagnostic precision and enable early intervention in cases of oral cancer.

Conclusion:

Unprecedented prospects to transform oral cancer diagnosis and detection are provided by artificial intelligence. More resilient AI systems in oral oncology can be achieved by joint research and innovation efforts, even in the face of constraints like data set variability and regulatory concerns.