bluuebunny/crossref_metadata_2025 huggingface dataset:
Pygopagus Twins Separation Using a Rectangular Fasciocutaneous Flap: Case Report From Beirut, Lebanon
Authors: Hakim Christopher , Emsieh Saif , Chrabieh Edwin , Zeineddine Jana , Ibrahim Amir
Published: January 2025

Conjoined twins, although rare, present unique challenges in surgical management, particularly regarding skin closure after separation. This case report details the successful separation of pygopagus conjoined twins using a rectangular skin flap technique. The twins, joined at the lumbar and sacral regions, underwent meticulous preoperative planning and collaborative effort from multiple medical teams. The surgery involved raising fasciocutaneous rectangular flaps over the buttocks, spine separation, rectal division, and reconstruction of pelvic floor muscles. The primary skin closure was achieved successfully. This case highlights the superior gluteal-based rectangular flap technique in such a separation and the importance of multidisciplinary approaches in improving outcomes for complex surgeries.
Treatment of the Induration of the Soft Tissue of the Lower Eyelids After Accidental Oil Injections
Authors: Safronov Vladimir
Published: January 2025

Injection cosmetic procedures have shown rapid continuing growth in the last 2 decades. Various substances are injected into the periorbital region for skin quality increase and correction of tear trough deformity, including hyaluronic acid, peptides, collagen, and others. Sometimes patients get accidentally injected with different substances that are not approved for cosmetic treatment in this anatomic area. The author presents a case of a 51-year-old woman, injected with unknown oil solution into the lower eyelid skin by the local dermatologist. Inflammation and induration of the skin of the lower periorbital region have occurred after these injections. The patient was treated conservatively until the acute process stopped, and then surgical correction was performed to correct skin and orbicularis oculi muscle induration changes. Surgical treatment included direct oil cyst excision and removal after injection changed tissues between skin and orbicularis oculi muscle. The patient was observed for scheduled appointments and conservative treatment to prevent unfavorable scar formation and lower eyelid deformity. Although different kinds of oil substances are not approved for skin injections for cosmetic purposes, accidental injections occur and may lead to terrible results. Methods to correct eyelid deformity after oil solution injections are not presented in the literature. In this article, the author presents a case report with the method of correction of induration of soft tissues of the lower eyelids occurring after oil injections. Although cases like this are rare, they require correct surgical solution to provide a good aesthetic result after the treatment.
Mitochondria-Targeted Antioxidant (MitoQ) and Nontargeted Antioxidant (Idebenone) Mitigate Mitochondrial Dysfunction in Corneal Endothelial Cells
Authors: Böhm Myriam , Parekh Mohit , Deshpande Neha , Cheung Queenie , Shatz Nathan , Kumar Varun , Jurkunas Ula V.
Published: January 2025

Purpose:

To investigate the effectiveness of mitochondrial-targeted antioxidant mitoquinone (MitoQ) and nontargeted antioxidant idebenone (Idb) in alleviating mitochondrial dysfunction in corneal endothelial cells (CEnCs).

Methods:

In vitro experiments were conducted using immortalized normal human corneal endothelial cells (HCEnC-21T; SVN1-67F) and Fuchs endothelial corneal dystrophy (FECD) cells (SVF5-54F; SVF3-76M). Cells were pretreated with MitoQ or Idb and then exposed to menadione (MN) with simultaneous antioxidant treatment. Mitochondrial parameters were evaluated through adenosine triphosphate viability assays, JC-1 staining for mitochondrial membrane potential, and Tom-20 antibody staining for fragmentation, with analysis performed using ImageJ software. HCEnC-21T cells were additionally exposed to ultraviolet-A (25 J/cm2) to assess drug effects under physiological stress. Mitochondrial fragmentation in FECD specimens was analyzed pre- and post-treatment with the drugs. Statistical analysis was conducted using 1-/2-way analysis of variance with post-hoc Tukey test.

Results:

MitoQ and Idb enhanced cell viability and mitochondrial membrane potential in both normal and FECD cells under MN-induced stress. Idb reduced MN-induced mitochondrial fragmentation by 32% more than MitoQ in HCEnC-21T cells and by 13% more in SVF5-54F cells. Under ultraviolet-A stress, Idb and MitoQ improved mitochondrial function by 31% and 25%, respectively, with MitoQ increasing mitochondrial function by 42% in FECD specimens.

Conclusions:

Differential responses in mitochondrial dysfunction across cell lines highlight disease heterogeneity. MitoQ and Idb protected CEnCs from oxidative stress and improved mitochondrial bioenergetics, suggesting that mitochondrial-targeted antioxidants could be considered for mitochondrial dysfunction in CEnCs.
Effectiveness of Nirsevimab Immunoprophylaxis Against Respiratory Syncytial Virus-related Outcomes in Hospital Care Settings: A Seasonal Cohort Study of Infants in Catalonia (Spain)
Authors: Perramon-Malavez Aida , Hermosilla Eduardo , Coma Ermengol , Fina Francesc , Reñé Anna , Martínez-Marcos Montserrat , Mendioroz Jacobo , Prats Clara , Soriano-Arandes Antoni , Cabezas Carmen
Published: January 2025

Background:

In Catalonia, infants <6 months old were eligible to receive nirsevimab, a novel monoclonal antibody against respiratory syncytial virus (RSV). We aimed to analyze nirsevimab’s effectiveness in hospital-related outcomes of the seasonal cohort (born during the RSV epidemic from October to January 2024) and compared them with the catch-up cohort (born from April to September 2023).

Methods:

Retrospective cohort study of all infants born between October 1, 2023, and January 21, 2024, according to their immunization with nirsevimab (immunized and nonimmunized). We followed individuals until the earliest of an outcome—hospital emergency visits, hospital admission or pediatric intensive care unit (PICU) admission due to RSV-associated or all-causes bronchiolitis—death or the end of the study. We used the Kaplan-Meier estimator and fitted Cox regression models using a calendar time scale to estimate hazard ratios (HRs) and their 95% confidence interval (CI). Sensitivity analysis was performed through matching.

Results:

Among 15,341 infants, a dose of nirsevimab led to an adjusted HR for hospital admission, PICU admission and emergency visits due to RSV bronchiolitis of 0.26 (95% CI: 0.17–0.39), 0.15 (95% CI: 0.07–0.28) and 0.46 (95% CI: 0.23–0.90), respectively. For all-causes bronchiolitis, the former adjusted HRs were 0.45 (95% CI: 0.31–0.63), 0.23 (95% CI: 0.13–0.41) and 0.49 (95% CI: 0.35–0.68), respectively.

Conclusions:

Nirsevimab was associated with reductions of 74% and 85% hospitalizations and PICU admissions regarding RSV-associated bronchiolitis, respectively. These percentages are slightly lower than those for the catch-up cohort. This information may help the implementation of RSV-immunization campaigns by public health authorities.
Chronic Lung Disease after Hospitalization with Adenovirus or Respiratory Syncytial Virus
Authors: Zaharov Tatjana , Franck Kristina Træholt , Nygaard Ulrikka , Kristensen Kim
Published: January 2025

Background:

Studies have shown a high risk of interstitial lung disease after hospitalization with adenovirus (AdV) and a high risk of asthma after hospitalization with respiratory syncytial virus (RSV).

Objective:

To clarify to what extent children hospitalized with respiratory tract infection caused by AdV or RSV develop pulmonary disease.

Design:

Register-based cohort study.

Methods:

Data on infections with AdV and RSV were coupled to data on asthma, asthma medication, bronchiectasia and interstitial lung disease, including bronchiolitis obliterans, during a follow-up time of 15–20 years. An age-matched control group was also generated. The risks of subsequent lung disease and/or having received asthma medication and hazard ratios (HRs) for asthma between the index groups and the control group were computed.

Findings:

In total 4704 children were included. Less than 5 cases of interstitial lung disease or bronchiectasia were found in any group. After hospitalization with AdV or RSV, the risk of acquiring an asthma diagnosis or having received asthma medication during follow-up was 29% and 65%, respectively, for AdV, and 22% and 51%, respectively, for RSV; corresponding to adjusted HRs of 2.16 (0.92–5.07), 2.60 (1.57–4.31), 2.87 (2.30–3.58), and 2.37 (2.07–2.71), respectively.

Conclusion:

We could not confirm an increased risk of interstitial lung disease after infection with AdV. However, there is a considerable risk of asthma after hospitalization with AdV or RSV and with respect to RSV, the risk is higher than previously reported as expressed by the fraction having received asthma medication during follow-up.
Could Intravenous Immunoglobulin Be an Alternative Therapy, for Treating Infant Botulism in Areas Where Human Botulism Immunoglobulin Is Not Easily Available?: Our Experience in Andalusia, Spain
Authors: Palomino-Fernandez Laura , Villarejo-Perez Alvaro , Fernandez-Fuentes Cecilia , Sanchez-Codez Maria I. , Del Valle-De Leon Noorelain , Gallego-Gutierrez Silvia , Peromingo-Matute Estrella , Carazo-Gallego Begoña , López-Laso Eduardo , Cano-Cabrera Marta , Falcon-Neyra Lola , Neth Olaf , Ruiz-Sáez Beatriz ,   on behalf of the GAIP (Grupo Andaluz de Infectología e Inmunopatología Pediátrica) Network
Published: January 2025

Background:

Infant botulism (IB) affects infants under 1 year of age, caused by the ingestion of Clostridium botulinum spores and subsequent neurotoxin production. IB is rare in Europe. This study aimed to analyze the epidemiology and management of IB over the past 25 years in Southern Spain.

Methods:

This is a retrospective, multicenter study of IB cases detected in Andalusia since 1997. Epidemiologic, clinical, diagnostic and outcome variables were analyzed.

Results:

Twenty-three patients from 7 different hospitals were included, with a median age of 3 months. Most of these patients presented with weak crying, constipation, arreactive mydriasis and loss of myotatic reflexes. Neurophysiological studies showed alterations in 74% of the cases at diagnosis. The diagnosis was confirmed in all cases by stool sample analysis. Only 4 patients received human botulism immunoglobulin (HBIG) and 10 received empirically intravenous immunoglobulin (IVIG). The median time to improvement in patients who received IVIG and HBIG was slightly shorter; however, no differences were observed. Significant differences were observed when IVIG was administered within the first 72 hours (14 vs. 25 days, P = 0.035). In addition, patients who received empirical antimicrobial therapy required longer hospitalization times secondary to observed exacerbated paralysis (20 vs. 12 days, P = 0.033).

Conclusions:

IVIG may be an effective treatment for shortening the duration of illness in regions that are not readily accessible for HBIG, but further studies are needed. Although IB is rare, when it is suspected, antimicrobial therapy should be avoided as it may exacerbate paralysis by increasing the availability of neurotoxin for absorption.
Characteristics of Invasive Pneumococcal Diseases Cases Among U.S. Children With Hematologic Malignancies Before and After Introduction of Thirteen-valent Pneumococcal Conjugate Vaccine, 2005–2019
Authors: Hamilton Katie , Luvsansharav Ulzii-Orshikh , Xing Wei , Gierke Ryan , King Jessica , Farley Monica M. , Schaffner William , Thomas Ann , Chai Shua J. , Harrison Lee H. , Holtzman Corinne , McGuire Suzanne M. , Petit Susan , Barnes Meghan , Angeles Kathy M. , Chochua Sopio , McGee Lesley , Kobayashi Miwako
Published: January 2025

Background:

Children with hematologic malignancies (HMs) are at increased risk of invasive pneumococcal disease (IPD). Data on long-term IPD trends in U.S. children with HM after 13-valent pneumococcal conjugate vaccine (PCV13) introduction are limited. We assessed IPD trends in children with HM before and after PCV13 introduction and the proportion of IPD cases caused by serotypes contained in new pneumococcal conjugate vaccines (PCV15 and PCV20, introduced after 2019).

Methods:

During 2005–2019, IPD cases among children aged <18 years were identified through the Active Bacterial Core surveillance. We characterized IPD cases by underlying conditions (HM, other IPD risk factors, no IPD risk factors) and time periods [pre-PCV13 (2005–2009), early-PCV13 (2010–2014) and late-PCV13 (2015–2019)]. We estimated incidence rate ratios (IRRs) in children aged <5 years with and without HM and during 2010–2019.

Results:

We identified 5912 cases of IPD in children aged <18 years; 215 (3.6%) were among children with HM. The proportion of IPD cases with PCV13 serotypes decreased over time in all risk groups; however, IRRs among children with vs. without HM were 215.8 [95% confidence interval (CI): 146.1–292.4] and 240.9 (95 CI: 152.3–341.1) in early and late-PCV13 periods, respectively. In late-PCV13 period, PCV15/non-PCV13 serotypes and PCV20/non-PCV15 serotypes caused 19.4% and 4.8% of IPD cases among children with HM.

Conclusions:

The proportion of PCV13-type IPD decreased in all children after PCV13 introduction. However, children with HM remain at an increased risk of IPD. Continued monitoring of the impact of PCV15 and PCV20 use among children with HM is needed.
Real world experience in treatment outcome and genomic insights for metastatic prostate neuroendocrine carcinoma
Authors: Lai Jiun-I , Peng Yu-Ching , Chang Peter Mu-Hsin , Chang Yen-Hwa , Chung Hsiao-Jen , Huang Yi-Hsiu , Lin Tzu-Ping , Huang William J , Wei Tzu-Chun , Huang Tzu-Hao , Yen Chueh-Chuan
Published: January 2025

Background:

Neuroendocrine prostate cancer (NEPC) (de novo or treatment related [t-NEPC]) is a rare and deadly variant of prostate cancer. While de novo NEPC is rare, t-NEPC occurs more frequently in patients with castration-refractory prostate cancer.

Owing to the rarity of NEPC, no standard treatment has been established, and the outcomes are generally unsatisfactory.

Methods:

This study retrospectively reviewed NEPC cases at Taipei Veterans General Hospital between 2018 and 2023. Clinical outcomes, treatment modalities, and related genomic profiles were recorded. We also performed a literature review of case series reporting the outcomes of chemotherapeutic regimens for NEPC.

Results:

From 2158 cases of prostate cancer cases diagnosed during the study period, only seven had pathologically proven NEPC (0.3%), and the median overall survival was 364 d. Three patients who underwent multi-gene panel sequencing had mutations in RB1, and DLL3 immunohistochemical staining showed a positivity rate of 50%. We performed a literature review on chemotherapy outcomes in patients with NEPC. In six studies with 104 patients, etoposide + platinum treatment was most commonly used. The progression free survival (PFS) and overall survival ranged from 3.4 to 9.3 and 8.4 to 22.4 months, respectively. The response rates ranged from 44% to 69.2%. These studies were consistent with a dismal overall survival rate, despite a high response rate to the initial chemotherapy regimen.

Conclusion:

Our study reported poor outcomes with chemotherapy, with a high frequency of RB loss and DLL3 positivity. Further clinical developments targeting DLL3 are warranted.
Two novel SNPs Rs1736952 and Rs17354984 are highly associated with uveitis in ankylosing spondylitis
Authors: Huang Ssu-Cheng , Hwang De-Kuang , Fang Wei-Chieh , Hsieh Ai-Ru , Shih Mei-Lin , Zhuang Zi-Qing , Gao Chong-En , Lin Tai-Chi , Chen Shih-Jen , Hsu Chih-Chien
Published: January 2025

Background:

Noninfectious anterior uveitis shares genetic factors, including HLA-B27, with ankylosing spondylitis (AS). The aim of this study was to identify significant single nucleotide polymorphisms (SNPs) associated with noninfectious anterior uveitis in AS patients, which could help predict the risk of developing this condition and provide deeper insights into its genetic underpinnings.

Methods:

A genome-wide association study (GWAS) was conducted utilizing the genomic data of 468 AS patients, including 90 with noninfectious anterior uveitis and 378 without it, from the Taiwan Precision Medicine Initiative. This study identified associated genes via SnpXplorer and developed a polygenic risk score (PRS) model to identify AS patients with increased risk of noninfectious anterior uveitis. Biological pathways were analyzed via Enrichr-KG and various databases.

Results:

GWAS revealed two novel SNPs, rs1736952 and rs17354984, with p values < 5x10-8, and seventy-four SNPs with p values < 1x10-4. The associated genes were involved mainly in antigen presentation, interferon signaling, immune regulation pathways, ciliary movement, and neurodegeneration. An optimal PRS model was built using nineteen SNPs with an area under the curve of 0.907.

Conclusion:

Our results revealed that two novel and significant SNP loci, rs1736952 and rs17354984, are strongly associated with noninfectious anterior uveitis in patients with ankylosing spondylitis. However, their roles in uveitis and other immune disorders warrant further investigation.
Partial Nephrectomy Versus Tumor Ablation for T1 Renal Cell Carcinoma: Equally Effective?
Authors: Zeelenberg A. M. , KleinJan G. H. , van der Meer R. W. , Bevers R. F. M.
Published: January 2025

Purpose:

Partial nephrectomy (PN) is the standard of care for T1 renal cell carcinoma (RCC). Percutaneous tumor ablation (TA) is advised only as an alternative. Research into the oncological outcomes after TA has been conflicting and lacking in quality. Our intent was to compare oncological outcomes after TA with PN.

Materials and Methods:

A single-center, retrospective data analysis was performed. Patients who received a PN or TA between 2006 and 2019 were included. Treatment choice was based on tumor characteristics, comorbidity, and patients' preference. Only patients with histologically proven RCC, who would have been eligible for both treatments, were included. Outcomes were analyzed using the Kaplan-Meier survival curve.

Results:

One hundred twenty patients after PN and 48 patients after TA were included. Age in the TA group was significantly higher (58 vs 70 years, P < .001). Residual tumor and local recurrence was similar for PN vs TA (residual tumor 0% vs 2.1%, P = .113 and local recurrence 1.7% vs 6.3%; P = .114). PN resulted in longer local recurrence–free survival (P = .017). Complications were similar with a total of 20% (PN) vs 18.8% (TA) (P = .854). Limitations include retrospective design and a smaller TA group.

Conclusions:

PN did not result in fewer local recurrences; however, local recurrence–free survival is longer. TA is a safe treatment of localized RCC, with an efficacy close to that of PN. Patients who are eligible for both treatments should be counseled to reach a well-informed decision. More prospective research is needed.
Self-Efficacy Assessment of Women With Stress Urinary Incontinence Undergoing Pelvic Floor Muscle Training: A Secondary Analysis of a Randomized Clinical Trial
Authors: de Figueiredo Vilena B. , Moreira Mayle A. , Sousa Ana Jéssica dos S. , do Nascimento Simony L. , Driusso Patricia
Published: January 2025

Purpose:

Pelvic floor muscle training (PFMT) is the first-line treatment for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) in women. As low adherence to PFMT affects the clinical evolution of patients, understanding the self-efficacy (performance expectation and results expectation) of women undergoing PFMT can contribute to developing strategies for improving treatment adherence. This study aimed to analyze the self-efficacy of women with SUI before and 6 months after completion of PFMT.

Methods:

This secondary analysis of a randomized clinical trial was conducted in 2 regions in Brazil. The participants performed a PFMT protocol supervised by a physical therapist and answered the Self-Efficacy Scale for Practicing Pelvic Floor Exercises (SESPPFE) at baseline, after 12 weeks of supervised training, and after 3 and 6 months of unsupervised training.

Results:

Altogether, 90 women with a mean age of 53 (±12.5) years were enrolled. Scores for performance expectation and total SESPPFE decreased after the unsupervised training compared to after 12 weeks of supervised training. Performance expectation scores also decreased after 6 months of supervised PFMT.

Discussion:

Women with SUI and MUI had high self-efficacy scores (performance expectation and results expectation) for supervised PFMT at treatment initiation. These high self-efficacy levels were maintained even after 12 weeks of supervision. However, scores for both total SESPPFE and performance expectation declined after 3 months of unsupervised training and further decreased after 6 months, indicating a drop in participants’ self-efficacy during the unsupervised PFMT period.
Prevalence of Pelvic Health Conditions and Associated Factors in a Male Population
Authors: Woodard Chad , Krakowsky Mackenna , Widawsky Jolie , Wolkenfeld Tzvi
Published: January 2025

Purpose:

Much of the published pelvic floor literature concerns female pelvic health. A gap exists for understanding male pelvic health conditions, prevalence, and associated factors. There is little published research on a younger population of men experiencing pelvic health conditions, unrelated to prostatectomy. This study was to determine the prevalence of pelvic health conditions within a male sample, and to identify associated factors with these conditions such as age, income, smoking history, and mental health.

Methods:

This study was a cross-sectional design utilizing survey responses. Data was collected using an anonymous self-reported survey. Data collection took place over a span of 18 months and concluded in November 2022. Participants inclusion criteria was biologically born males 18 years and older.

Results:

479 participants met the inclusion criteria. Significant results included a high percentage reporting multiple pelvic floor conditions (P < .001), and significant prevalence of urinary complaints among 25- to 34-year-old males with 32% reporting dysfunction (P < .001). The rate of urinary complaint was reported at a high percentage for those with a higher household income, while higher reports of bowel dysfunction were reported in those participants with a history of smoking (P < .05). Mental health conditions also strongly associated to reports of pelvic health conditions.

Discussion:

The results of this study offer insights into the prevalence of male pelvic health, associated factors, and that men are experiencing pathology at younger ages. The findings will advance the field of pelvic floor physical therapy specific to a male population.
Unmasking the Toll of COVID-19 on Physical and Mental Health of Caregivers of Young Children in the United States
Authors: Havens Kathryn L. , Starnes Catherine P. , Bagwell Jennifer J.
Published: January 2025

Purpose:

The COVID-19 pandemic has had a profound impact on perinatal health. While much research has focused on this topic, few studies have compared lived experiences during the pandemic to a truly pre-pandemic time point, which has limited our understanding of the pandemic’s influence. In this study, we asked caregivers about their physical health, including symptoms of back pain, urinary incontinence, and pelvic organ prolapse, all common dysfunctions postpartum, and their mental health. We hypothesized that participants would identify similar physical but worsened mental health during the pandemic.

Methods:

We conducted an anonymous, voluntary survey in spring 2019 (pre-pandemic group) and readministered similar questions in fall 2021 to understand the pandemic’s impact (pandemic group).

Results:

A total of 3483 responded to the first survey and 318 during the pandemic. Compared to pre-pandemic, participants reported worsened scores for back pain, urinary incontinence, and pelvic organ prolapse during the pandemic. They also reported worsened stress, anxiety, and depression. For the pandemic group, the greater perceived impact of COVID on daily life was related to greater (worse) scores for urinary incontinence, and all mental health measures.

Discussion:

This study adds to the body of literature showing the effects of COVID on maternal mental health and further shows that physical health, particularly areas of common postpartum dysfunction, has been detrimentally affected by the pandemic as well. This study highlights the need for health care providers and policymakers to prioritize flexible perinatal health support during times of crisis and in the long term.
Inadequate awareness and attention to non-HDL cholesterol: undertreatment of high-risk patients in cardiology practice in Turkey
Authors: Mert Gurbet Özge , Mert Kadir Uğur , Başaran Özcan , Doğan Volkan , Rencüzoğullari İbrahim , Özlek Bülent , Çinier Göksel , Özlek Eda , Biteker Murat , Kayikçioğlu Meral ,   on behalf of EPHESUS Investigators
Published: January 2025

Background

The relationship between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) is well-established. Recently, non-high-density lipoprotein cholesterol (non-HDL-C) has been validated as a superior predictor of ASCVD, especially in individuals with mild to moderate hypertriglyceridemia. The EPHESUS study evaluated real-life hypercholesterolemia management and awareness of non-HDL-C in cardiology outpatient practices.

Methods

Data from 1868 patients with ASCVD or high-risk primary prevention were analyzed to assess cholesterol goal attainment, statin adherence, and physician perceptions. This analysis focused on awareness of non-HDL-C as an ASCVD predictor, adherence to lipid-lowering therapy, and clinicians’ perceptions. Associations between patient demographics, clinical characteristics, and statin adherence were examined.

Results

Among patients, 20.2% achieved non-HDL-C and 16.5% achieved LDL-C goals. In primary prevention, 18.1% reached non-HDL-C and 10.6% reached LDL-C goals, while in secondary prevention, 20.8% and 18.0% met these goals. High-intensity statin therapy was observed in 21.2% of patients, with 30.3% and 24.3% achieving non-HDL-C and LDL-C targets, respectively. Statin use was lower in women than men (54.0% vs 66.9%, P < 0.001). Women less frequently achieved non-HDL-C and LDL-C goals in both prevention groups.

Conclusions

Non-HDL-C goal attainment remains suboptimal in both primary and secondary prevention of hypercholesterolemia, particularly in women who had lower statin use and goal achievement. These findings highlight the need for improved awareness, education, and treatment strategies to reduce residual cardiovascular risk and improve outcomes.
Bacteriophage therapy in the era of bacterial resistance: future prospects
Authors: Yang Fan , Zhou Churu , Tan Yurong , Wu Guojun
Published: January 2025

Antibiotic misuse escalates antibacterial resistance. Bacteriophages are being explored as a viable solution. They not only destroy pathogens but also promote bacterial community homeostasis. This manuscript outlines bacteriophage therapeutic strategies, including cocktail therapy, synergistic therapy, and artificial phage modification. Also addressed are the phage effects on bacterial efflux pumps and their role in quorum sensing. The delivery methods and precautions of bacteriophage preparations are also listed. Potential future research may involve further exploring uncultured phage mechanisms using machine learning from the expanding phage gene database; or probe specific phage physiological activities and mechanisms using multiomics techniques.
Factors Associated With Fear of Cancer Recurrence in Colorectal Cancer Patients: A Meta-analysis in Health Ecological Perspective
Authors: Sheng Yanlei , Li Qingyi , Shen Fan , Hu Luhong , Li Jie , Wang Qianyun , He Li
Published: January 2025

Background

Fear of cancer recurrence is a major source of stress and unmet need for colorectal cancer patients.

Objective

This review aimed to identify factors influencing fear of cancer recurrence in colorectal cancer patients.

Methods

Multiple electronic databases were systematically searched for studies from inception to January 2024 using concepts “colorectal neoplasm,” “fear,” and “recurrence.” Two authors independently screened, assessed the quality of eligible studies, and extracted relevant data. The synthesis of effect sizes was conducted using R software version 4.3.1.

Results

A total of 20 studies were included, of which 11 were of moderate quality and 9 were of high quality. The studies reported on 22 potential influencing factors across 5 levels of the health ecological model, including innate personal traits, psychobehavioral factors, interpersonal network factors, living and working conditions, and policy environment factors. After synthesizing the data, it was found that all 22 factors were significantly associated with fear of cancer recurrence in colorectal cancer patients. Of these, 9 factors showed a moderate correlation with fear of cancer recurrence (0.3 < r ≤ 0.6), whereas 13 factors showed a lower level of correlation (r ≤ 0.3).

Conclusions

The factors associated with the fear of cancer recurrence in colorectal cancer patients are complex and partially modifiable.

Implications for Practice

This study suggests that healthcare providers can use a health ecological perspective to provide interventions targeting these factors for colorectal cancer patients to effectively alleviate their fear of cancer recurrence and improve their quality of life.
Resilience in Newly Hired Nursing Faculty
Authors: Sandiford Dione , Birnbaum Shira
Published: January 2025

Background:

Resilience plays a role in workforce retention and has been linked to job satisfaction, quality of life, and organizational commitment in nursing faculty. Research on the nature of faculty resilience, however, remains sparse.

Purpose:

The purpose of this study was to contribute to the understanding of nurse faculty resilience by describing examples of specific ways that a group of newly hired nursing faculty enacted resilience during their first few years on the job.

Methods:

Transcripts from one-on-one interviews with 23 faculty in 7 U.S. states were analyzed in a secondary analysis, which generated exemplars of resilience in practice.

Results:

Faculty expressed resilience through specific measures that included positive self-talk, reframing of adverse events, drawing analogies to familiar experience, asserting self-worth by helping others, and extensive social networking.

Conclusion:

These actions enabled faculty to find meaning and support in difficult circumstances.
Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery?
Authors: Cho Elizabeth , House Hanna , Marten Andrew , Feffer Marina , Agel Julie , Scolaro John , Marmor Meir , Levack Ashley E. ,   OTA Classification & Outcomes Committee
Published: January 2025

Objectives:

The purpose of this investigation was to evaluate the utility of the Centers for Disease Control (CDC) Surgical Wound Classification (SWC) in predicting surgical site infection (SSI) after orthopaedic trauma procedures.

Design:

Retrospective cohort study.

Setting:

Level I academic trauma center.

Patients/Participants:

Adult patients with operatively treated fractures of the leg, ankle, and hindfoot between 2007 and 2022.

Intervention:

N/A.

Main Outcome Measurements:

Presence of SSI was determined by selective chart review of patients who met the screening variables for repeated procedures, open fracture, abscess or wound debridement, intraoperative cultures, or infectious disease consultation (n = 551).

Results:

Two thousand seven hundred ninety-one fractures among 2780 patients (n = 11 with bilateral fractures) were included. The overall infection rate was 2.3% (n = 63), and SWC was significantly associated with infection rates (I/clean: 1.0%, II/clean-contaminated: 3.4%, III/contaminated: 6.2%, IV/dirty: 9.8%, P < 0.001). When compared with Class I, Classes II through IV had increased odds of infection (odds ratio [OR] II: 3.5, P = 0.012; OR III: 6.8, P < 0.001; OR IV: 11.0, P < 0.001). Subgroup analysis of Classes II and III demonstrated no difference in odds of infection. When stratifying open versus closed fractures, there was no statistical association between CDC SWC and odds of infection.

Conclusions:

The CDC SWC has notable limitations for patients with orthopaedic trauma, with ambiguity of classification assignment and decreased discriminatory ability within the central classes. While overall SWC is associated with infection, the relationship seems to be confounded by the effect of open versus closed fractures. Alternative classification systems may have improved utility for stratifying risk in orthopaedic patients.

Level of Evidence:

III.
Situational Analysis of the Medication Practices in Brazilian Hospitals: A Multicenter Study
Authors: Guimarães Pedro Henrique﻿ , Rosa Mário Borges﻿ , Reis Adriano Max Moreira﻿ , Detoni Kirla Barbosa﻿ , Rodrigues Gabriela de Paula Guimarães , Nascimento Mariana Martins Gonzaga
Published: January 2025

Objective:

To carry out a situational analysis of the medication practices in Brazilian hospitals through the Medication Safety Self-Assessment for Hospitals and the factors associated with better performance in the evaluation.

Methods:

This is a multicenter cross-sectional study in which the results of the application of the Medication Safety Self-Assessment for Hospitals, between 2015 and 2020, in 30 Brazilian hospitals were described. In addition, whether the institutional profile was associated with higher self-assessment scores (better performance in the evaluation) was also evaluated.

Results:

An average proportion of points obtained of 36.7±10.9% was identified (minimum=11.5%; maximum=59.7%), from a score ranging from 0 to 1826 points. The need to improve the use of devices for the preparation and administration of drug solutions, professional development, and patient education was highlighted. A positive association was identified between higher scores and the large or very large size of the hospitals (P=0.026) and having accreditation certification (P=0.007).

Conclusions:

The study made it possible to identify the main weak points and opportunities for improvement of the medication system in the evaluated hospitals, bringing important reflection to national institutions.
Childhood, adolescents and young adults cancer survivors: health promotion and wellbeing interventions
Authors: Dionisi-Vici Margherita , Giacoppo Ilenia , Zucchetti Giulia , Fagioli Franca , Felicetti Francesco
Published: January 2025

Purpose of review

Childhood, adolescent and young adult cancer (CAYAC) can impact on survivors’ physical but also psycho-social sphere, especially on educational and occupational outcomes. The purpose of this review is to identify the interventions that have been implemented to address these critical developmental stages, which are essential for survivors’ wellbeing.

Recent findings

A cancer diagnosis can delay or interrupt educational achievements, work placement and financial independence. Risk factors for unemployment are: female gender, younger age at diagnosis, survivors of central nervous system cancer, neuro-cognitive dysfunction, chronic health conditions. Social support systems and resilience, instead, can positively impact on occupational functioning of survivors.

Vocational counselling service, career support, as well as employment programs guided by guidance counsellor, are tailored intervention measures that can enhance psycho-social wellbeing and fill the unique needs of CAYACS survivors’ population. Rehabilitation and long-term follow-up paths should include a multidisciplinary team.
Computational methodology to study the effect of cable-stabilized knee brace on anterior cruciate ligament strain during single-leg jump landing
Authors: Gupta Pratishtha , Rao Harish , Chandrashekar Naveen
Published: January 2025

Knee bracing is commonly used for rehabilitation after ligament surgery. However, the effectiveness of knee bracing in preventing ligament injuries is not widely studied. This study aimed to develop a computational methodology to investigate the effectiveness of a novel type of cable-stabilized knee brace on anterior cruciate ligament (ACL) strain during single-leg jump landing. The brace features a compliant design with nonextensible pretensioned cables integrated within a compression tight garment. A combined in vivo/in silico method was developed for this purpose. A computational model of the cable-stabilized knee brace was developed with linked truss elements used to simulate the cable. The cables were integrated into an existing computational model of the knee. Subsequently, single-leg jump landing simulations were conducted on the model, using muscle forces and joint kinematic/kinetic profiles from 10 participants. Anterior cruciate ligament strain behaviors were then compared between the braced and unbraced configurations. The computational methodology was successful in simulating the differences in ACL strain because of the brace. The average peak ACL strain in the braced configuration was 4.99% ± 2.36% and in the unbraced configuration was 3.23% ± 2.31% (p = 0.091). The methodology developed lays the groundwork for future advancements in optimizing the cable-stabilized knee brace design and refining its potential in preventing ligament injuries.
Is the subischial socket better than others in subjects with transfemoral amputation? A systematic review of randomized and controlled clinical trials
Authors: Bevacqua Nicolas , Navarro Ticiana E. , Dell Elce Gabriela B. , Intelangelo Leonardo
Published: January 2025

Rehabilitation is often complex for persons with transfemoral amputation, and poor socket fit is one of the main factors affecting gait re-education, rehabilitation, and quality of life. The present study systematically reviewed the literature to test whether the subischial socket provides better outcomes in comfort, quality of life, and mobility than other transfemoral sockets. Systematic review and meta-analysis. We searched MEDLINE, Physical Therapy Evidence Database Scale, Epistemonikos, Cochrane, BIREME, Web of Science, and Scopus from inception to January 2024 to identify randomized and controlled trials. Two authors independently screened records and assessed the risk of bias. We performed a narrative synthesis of the evidence and used the standardized mean difference and mean difference for meta-analyses and the Grading of Recommendations, Assessment, Development, and Evaluation approach for recommendations. We identified 7 randomized and controlled clinical trials. Five studies compared the subischial socket with the ischial containment socket (IC), 1 study compared the IC with the Marlo anatomical socket, and 1 study compared the IC with the quadrilateral. Very low certainty showed a difference in comfort (1 study: mean difference = 1.4 [95% CI 0.61, 2.19]), but no in quality of life (2 studies: standardized mean difference = 1.28 (95% CI −1.04, 3.59), and mobility (2 studies: mean difference = 0.11 (95% CI −1.08, 1.29). We observed differences between the subischial socket and the IC in comfort but not in quality of life, mobility, and stability. Furthermore, we found a very low certainty that the subischial socket provides better outcomes than the IC in comfort, quality of life, and mobility.
Unequal Access and Overall Scarcity of Apical Suspension in Native Tissue Prolapse Repair
Authors: Schmidt Eleanor M. , Nicola-Ducey Lauren , Osmundsen Blake , Cichowski Sara
Published: January 2025

Importance

Evaluation of racial and ethnic differences in apical suspension during prolapse repair is crucial for equitable gynecological care.

Objective

The objective was to assess racial and ethnic disparities in apical suspension during native tissue prolapse repair.

Study Design

We analyzed data from the 2019 Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample, using Current Procedural Terminology and International Classification of Diseases, Tenth Revision, codes. Bivariate analysis identified demographic and hospital-based differences between native tissue apical suspension procedures versus non-apical suspension during vaginal hysterectomy for prolapse, further analyzed with multivariable logistic regression. A separate analysis examined posthysterectomy prolapse surgical procedures.

Results

Of the 62,553 vaginal hysterectomies, 26,094 (41%) were for prolapse. Among these, 14,027 (54%) included apical suspension. The cohort's racial and ethnic identity was 73% non-Hispanic White, 5% Black, 15% Hispanic, 3% Asian, 0% Native American, and 3% other. Multivariable analysis confirmed Black patients were more likely to receive apical suspension compared to non-Hispanic White patients (adjusted odds ratio [aOR] 1.26, 95% CI: 1.04–1.53, P = 0.02), and Hispanic patients were less likely to receive apical suspension (aOR 0.74, 95% CI: 0.63–0.87, P < 0.001). Among 60,074 posthysterectomy prolapse surgical procedures, only 18% included apical suspension. Compared to non-Hispanic Whites, Black, Hispanic, and Asian patients were less likely to receive apical suspension (Black: aOR 0.8, 95% CI: 0.68–0.95, P = 0.013; Hispanic: aOR 0.89, 95% CI: 0.77–1.04, P = 0.14; Asian: aOR 0.52, 95% CI: 0.41–0.66, P < 0.001).

Conclusions

The study highlights persistent racial and ethnic disparities in apical suspension provision. There is a notable lack of apical suspension in native tissue repairs, especially after hysterectomy.
Outcomes of Coccidioides Seropositive Solid Organ Transplant Recipients After Self-discontinuation of Antifungal Prophylaxis: The EIA-IgM-only Conundrum
Authors: Gupta Simran , Biondi Matt V. , Shah Priyal J. , Buras Matthew R. , Kodali Lavanya , Chascsa David M.H. , Vikram Holenarasipur R. , Blair Janis E.
Published: January 2025

Background.

Solid organ transplant recipients are at risk of severe coccidioidomycosis and are given prophylaxis to mitigate the risk. Patients with seropositive testing typically receive lifelong prophylaxis; currently, this prophylaxis strategy includes patients who are positive only for IgM by enzyme immunoassay (EIA-IgM-only), although this result may be falsely positive.

Methods.

We conducted a retrospective study at a large-volume transplant center in an endemic coccidioidomycosis region to compare outcomes of non–lung transplant recipients who were seropositive for Coccidioides but discontinued prophylaxis (case patients) to outcomes of patients who continued prophylaxis (controls).

Results.

No case or control patients developed active coccidioidomycosis during the follow-up period. Before transplant, 62 of 77 case patients (80.5%) had a single positive serologic test, of whom 27 of 62 were EIA-IgM-only positive (43.5%). In contrast, 57 of 77 controls (74.0%) had a single seropositive result (16/57 [28.1%] were EIA-IgM-only). The single EIA-IgM-only result was classified as falsely positive by infectious disease consultants in 20 of 43 patients (46.5%) compared with all other Coccidioides serologic results (13/111 [11.7%], P < 0.001). Lifetime antifungal prophylaxis was felt to be unnecessary for 28 of 43 patients (65.1%) who were EIA-IgM-only versus 31 of 111 patients (27.9%) with other serologic results (P < 0.001).

Conclusions.

For patients repeatedly positive for EIA-IgM-only and no evidence of seroconversion, compatible clinical illness, or radiographic findings, discontinuing antifungal prophylaxis may be reasonable after the first posttransplant year.
Electroencephalography in Clinical Practice: Neurology Professionals' Views on Optimal Standards of Care
Authors: Nascimento Fábio A. , Katyal Roohi , Kass Naomi R. , Yuan Doyle , Sirven Joseph I. , Westover M. Brandon , Beniczky Sándor
Published: January 2025

Purpose:

Delivering optimal care to patients with seizures and epilepsy requires all EEGs to be interpreted accurately and reliably. This study investigated neurology professionals' opinions on the ideal standards for EEG in clinical care.

Methods:

We developed an anonymous e-survey targeting practicing and trainee neurologists focused on participants' demographics, clinical practice characteristics, and views on optimal EEG standards of care—including whether an EEG certification test is needed and whether postresidency/fellowship training in EEG/epilepsy is necessary for neurologists who interpret outpatient/routine EEGs in practice. The survey was hosted by the Neurology Clinical Practice—Practice Current, and it was distributed online through the American Academy of Neurology, American Epilepsy Society, American Clinical Neurophysiology Society, and International League Against Epilepsy, and through social media.

Results:

Two hundred eighty-three responses were included: 119 from EEG/epilepsy-trained neurologists, 83 from non-EEG/epilepsy-trained neurologists, 75 from trainees, and 6 from advanced care providers. Most participants (78%) agreed that “an objective certification test of ability to interpret EEGs is needed for all those who interpret EEGs in clinical practice.” Most participants (71%) believed that outpatient/routine EEGs may be read only by neurologists with EEG/epilepsy training; this opinion was more prevalent among EEG/epilepsy-trained (83%) versus non-EEG/epilepsy-trained neurologists (55%).

Conclusions:

Our neurology community should discuss the need to develop and implement a certification test of ability for all neurologists who wish to interpret EEGs in clinical practice. In addition, it is imperative to improve in-residency EEG education to ensure that neurology graduates achieve EEG competence before entering the workforce.
In the face of competition, imperfect knowledge can lead to sustainable exploitation of a shared resource
Authors: Aarts Geert , Fieberg John R. , Richter Andries , Poos Jan Jaap , Hintzen Niels T. , Bijleveld Allert I. , Hengeveld Geerten M. , van Kooten Tobias , van Leeuwen Anieke , Matthiopoulos Jason , van Langevelde Frank , Riotte-Lambert Louise
Published: January 2025

Overexploitation of a shared resource is a frequent phenomenon among groups of selfish consumers, known as the ‘tragedy of the commons’. To avoid “self-damage through self-interest”, humans may either defend exclusive access to resources, or collectively adopt advanced cooperative behaviour and carefully designed spatial harvesting strategies to exploit a shared resource sustainably. However, why do many non-human species that are neither social nor territorial also appear to avoid overexploiting resources? This study shows that, even under highly competitive scenarios, cooperation is not necessary to sustainably exploit shared resources if individuals have imperfect knowledge about the distribution of those resources. Poorly informed individuals are more likely to inadvertently exploit resources in peripheral habitats, which may allow for higher resource renewal in the nearby and low-cost habitats, enhancing the sustainability of resource use. As a result, those consumers can achieve a long-term yield that approaches that of cooperative consumers and is higher than omniscient consumers. Ironically, while there might be an evolutionary drive for individuals to make well-informed decisions, consumers of shared resources may be collectively more prosperous when they make decisions based on less information. These findings might explain why apparently sub-optimal consumer behaviour appears so prevalent in nature.