bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of Critically Ill COVID-19 Patients in Sweden During the First Two and a Half Years of the Pandemic*
Authors: Santosa Ailiana , Oras Jonatan , Li Huiqi , Nwaru Chioma , Kirui Brian , Nyberg Fredrik
Published: March 2024

OBJECTIVES:

Some studies have examined survival trends among critically ill COVID-19 patients, but most were case reports, small cohorts, and had relatively short follow-up periods. We aimed to examine the survival trend among critically ill COVID-19 patients during the first two and a half years of the pandemic and investigate potential predictors across different variants of concern periods.

DESIGN:

Prospective cohort study.

SETTING:

Swedish ICUs, between March 6, 2020, and December 31, 2022.

PATIENTS:

Adult COVID-19 ICU patients of 18 years old or older from the Swedish Intensive Care Register (SIR) that were linked to multiple other national registers.

MEASUREMENT AND MAIN RESULTS:

Survival probability and predictors of COVID-19 death were estimated using Kaplan-Meier and Cox regression analysis. Of 8975 patients, 2927 (32.6%) died. The survival rate among COVID-19 critically ill patients appears to have changed over time, with a worse survival in the Omicron period overall. The adjusted hazard ratios (aHRs) comparing older and younger ages were consistently strong but slightly attenuated in the Omicron period. After adjustment, the aHR of death was significantly higher for men, older age (40+ yr), low income, and with comorbid chronic heart disease, chronic lung disease, impaired immune disease, chronic renal disease, stroke, and cancer, and for those requiring invasive or noninvasive respiratory supports, who developed septic shock or had organ failures (p < 0.05). In contrast, foreign-born patients, those with booster vaccine, and those who had taken steroids had better survival (aHR = 0.87; 95% CI, 0.80–0.95; 0.74, 0.65–0.84, and 0.91, 0.84–0.98, respectively). Observed associations were similar across different variant periods.

CONCLUSIONS:

In this nationwide Swedish cohort covering over two and a half years of the pandemic, ICU survival rates changed over time. Older age was a strong predictor across all periods. Furthermore, most other mortality predictors remained consistent across different variant periods.
Nivolumab as a Promising Treatment Option for Metastatic Salivary Duct Carcinoma
Authors: Bugia Luis , Jungbauer Frederic , Zaubitzer Lena , Hörner Christian , Merx Kirsten , Yasser Abo-Madyan , Germann Thomas , Lammert Anne , Scherl Claudia , Rotter Nicole , Affolter Annette
Published: March 2024

Salivary duct carcinomas (SDC) of the parotid gland are rarely occurring highly malignant tumors. A 65-year-old man presented with a preauricular mass. After surgical treatment and histologic examination, the findings were interpreted as a squamous cell carcinoma (SCC) metastasis of the parotid gland deriving from a cancer of unknown primary DD primary SCC of the parotid gland. Adjuvant platinum-based radiochemotherapy was administered in domo. However, re-staging revealed multiple size-progressive pulmonary round lesions. After resection and histological examination of a pulmonary mass and in synopsis with the primary tumor, the initial diagnosis of SCC was revised to SDC of the parotid gland. With positive HER-2 status, off-label trastuzumab/docetaxel was initiated in an individual healing attempt, during which the pulmonary metastases showed clear progression. Consequently, the patient received immunotherapy with nivolumab according to his negative PD-L1 status. After 57 cycles of nivolumab, the patient presents with partial remission and in good condition. We report, for the first time, a robust response of metastatic SDC to checkpoint inhibition with nivolumab without additional radiotherapy.
Efficiency and tolerance of second-line triple BRAF inhibitor/MEK inhibitor/anti-PD1 combined therapy in BRAF mutated melanoma patients with central nervous system metastases occurring during first-line combined targeted therapy: a real-life survey
Authors: Fabre Marie , Lamoureux Anouck , Meunier Laurent , Samaran Quentin , Lesage Candice , Girard Céline , Du Thanh Aurélie , Moulis Lionel , Dereure Olivier
Published: March 2024

Although current systemic therapies significantly improved the outcome of advanced melanoma, the prognosis of patient with central nervous system (CNS) metastases remains poor especially when clinically symptomatic. We aimed to investigate the efficiency of CNS targets and tolerance of second-line combined anti-PD1/dual-targeted anti-BRAF/anti-MEK therapy implemented in patients with CNS progression after initially efficient first-line combined targeted therapy in patients with BRAF-mutated melanoma in a real-life setting. A monocentric retrospective analysis including all such patients treated from January 2017 to January 2022 was conducted in our tertiary referral center. The response of CNS lesions to second-line triple therapy was assessed through monthly clinical and at least quarterly morphological (according to RECIST criteria) evaluation. Tolerance data were also collected. Seventeen patients were included with a mean follow-up of 2.59 (±2.43) months. Only 1 patient displayed a significant clinical and morphological response. No statistically significant difference was observed between patients receiving or not additional local therapy (mainly radiotherapy) as to response achievement. Immunotherapy was permanently discontinued in 1 patient owing to grade 4 toxicity. Mean PFS and OS after CNS progression were 2.59 and 4.12 months, respectively. In this real-life survey, the subsequent addition of anti-PD1 to combined targeted therapy in melanoma patients with upfront CNS metastases did not result in significant response of CNS targets in most BRAF mutated melanoma patients with secondary CNS progression after initially successful first-line combined targeted therapy.
What's in a cure: designing a broad-spectrum HIV gene therapy
Authors: Berman Rachel E. , Dampier Will , Nonnemacher Michael R. , Wigdahl Brian
Published: March 2024

Purpose of review

The leading gene editing strategy for a human immunodeficiency virus type 1 (HIV-1) cure involves the delivery of SaCas9 and two guide RNAs (gRNAs) in an adeno-associated viral (AAV) vector. As a dual-component system, CRISPR is targeted to a genetic locus through the choice of a Cas effector and gRNA protospacer design pair. As CRISPR research has expanded in recent years, these components have been investigated for utilization in cure strategies, which will be discussed in this article.

Recent findings

Type II SpCas9 and SaCas9 have been the leading Cas effectors across gene editing therapeutics to date. Additionally, extensive research has expanded the potential to multiplex gRNAs and target them effectively to the highly genetically diverse HIV-1 provirus. More recently, the Type V family of Cas12 effectors opens a new opportunity to use a smaller Cas protein for packaging into an AAV vector with multiplexed gRNAs.

In understanding the individual components of a CRISPR/Cas therapeutic cure for HIV-1, it is important to know that the currently used strategies can be improved upon. Future areas will include alternative smaller Cas effectors, multiplexed gRNAs designs, and/or alternative delivery modalities.
A Mechanism for the Treatment of Cardiovascular and Renal Disease: TRPV1 and TRPA1
Authors: Gao Lu , Wang Qi , Li Min-yi , Zhang Meng-Meng , Wang Bin , Dong Tai-Wei , Wei Pei-Feng , Li Min
Published: March 2024

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. CVD and kidney disease are closely related, with kidney injury increasing CVD mortality. The pathogenesis of cardiovascular and renal diseases involves complex and diverse interactions between multiple extracellular and intracellular signaling molecules, among which transient receptor potential vanilloid 1 (TRPV1)/transient receptor potential ankyrin 1 (TRPA1) channels have received increasing attention. TRPV1 belongs to the vanilloid receptor subtype family of transient receptor potential ion channels, and TRPA1 belongs to the transient receptor potential channel superfamily. TRPV1/TRPA1 are jointly involved in the management of cardiovascular and renal diseases and play important roles in regulating vascular tension, promoting angiogenesis, antifibrosis, anti-inflammation, and antioxidation. The mechanism of TRPV1/TRPA1 is mainly related to regulation of intracellular calcium influx and release of nitric oxide and calcitonin gene–related peptide. Therefore, this study takes the TRPV1/TRPA1 channel as the research object, analyzes and summarizes the process and mechanism of TRPV1/TRPA1 affecting cardiovascular and renal diseases, and lays a foundation for the treatment of cardiorenal diseases.
The Protective Effects of Ruscogenin Against Lipopolysaccharide-Induced Myocardial Injury in Septic Mice
Authors: Wang Rui-yu , Wang Ming-gui , Tang Han-zhang , Du Hui , Luo Yue , Li Quan , Zhang Xiao-hong , Fu Jing , Lv Chuan-zhu
Published: March 2024

Sepsis-induced myocardial dysfunction commonly occurs in individuals with sepsis and is a severe complication with high morbidity and mortality rates. This study aimed to investigate the effects and potential mechanisms of the natural steroidal sapogenin ruscogenin (RUS) against lipopolysaccharide (LPS)-induced myocardial injury in septic mice. We found that RUS effectively alleviated myocardial pathological damage, normalized cardiac function, and increased survival in septic mice. RNA sequencing demonstrated that RUS administration significantly inhibited the activation of the NOD-like receptor signaling pathway in the myocardial tissues of septic mice. Subsequent experiments further confirmed that RUS suppressed myocardial inflammation and pyroptosis during sepsis. In addition, cultured HL-1 cardiomyocytes were challenged with LPS, and we observed that RUS could protect these cells against LPS-induced cytotoxicity by suppressing inflammation and pyroptosis. Notably, both the in vivo and in vitro findings indicated that RUS inhibited NOD-like receptor protein-3 (NLRP3) upregulation in cardiomyocytes stimulated with LPS. As expected, knockdown of NLRP3 blocked the LPS-induced activation of inflammation and pyroptosis in HL-1 cells. Furthermore, the cardioprotective effects of RUS on HL-1 cells under LPS stimulation were abolished by the novel NLRP3 agonist BMS-986299. Taken together, our results suggest that RUS can alleviate myocardial injury during sepsis, at least in part by suppressing NLRP3-mediated inflammation and pyroptosis, highlighting the potential of this molecule as a promising candidate for sepsis-induced myocardial dysfunction therapy.
Abatacept Decreases Renal T-cell Infiltration and Renal Inflammation and Ameliorates Progressive Renal Injury in Obese Dahl Salt-sensitive Rats Before Puberty
Authors: Ekperikpe Ubong S. , Mandal Sautan , Bhopatkar Anukool A. , Shields Corbin A. , Coley Chantell A. , Chambers Christy L. , Johnson Tyler D. , Cornelius Denise C. , Williams Jan M.
Published: March 2024

Prepubertal obesity is growing at an alarming rate and is now considered a risk factor for renal injury. Recently, we reported that the early development of renal injury in obese Dahl salt-sensitive (SS) leptin receptor mutant (SSLepRmutant) rats was associated with increased T-cell infiltration and activation before puberty. Therefore, the current study investigated the effect of inhibiting T-cell activation with abatacept on the progression of renal injury in young obese SSLepRmutant rats before puberty. Four-week-old SS and SSLepRmutant rats were treated with IgG or abatacept (1 mg/kg; ip, every other day) for 4 weeks. Abatacept reduced the renal infiltration of T cells by almost 50% in SSLepRmutant rats. Treatment with abatacept decreased the renal expression of macrophage inflammatory protein-3 alpha while increasing IL-4 in SSLepRmutant rats without affecting SS rats. While not having an impact on blood glucose levels, abatacept reduced hyperinsulinemia and plasma triglycerides in SSLepRmutant rats without affecting SS rats. We did not observe any differences in the mean arterial pressure among the groups. Proteinuria was markedly higher in SSLepRmutant rats than in SS rats throughout the study, and treatment with abatacept decreased proteinuria by about 40% in SSLepRmutant rats without affecting SS rats. We observed significant increases in glomerular and tubular injury and renal fibrosis in SSLepRmutant rats versus SS rats, and chronic treatment with abatacept significantly reduced these renal abnormalities in SSLepRmutant rats. These data suggest that renal T-cell activation contributes to the early progression of renal injury associated with prepubertal obesity.
Use of 3D Echocardiography Facilitates Analysis of Thrombolytic Efficacy in Patients With Persistent Atrial Fibrillation
Authors: Chen Yin Feng , Liu Nan Nan , Wang Jing Yun , Sun Jing Shu , Wang Yi Xiao , Jiang Hai Ying , Zhou Wei Wei , Wang Zu Lu , Liang Ming
Published: March 2024

This study seeks to identify the anticoagulant efficacy of rivaroxaban treatment on thrombi detected using echocardiography of the left atrial appendage in 275 patients with persistent atrial fibrillation. During follow-up after 9–24 weeks of rivaroxaban treatment, patients were divided into “effective group” (n = 143) and “ineffective group” (n = 132) according to the thrombolytic effect of the drug. Left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), mean diameter of left atrial appendage (LAADmean), angle between left atrial appendage and left atrium (LAA-A), velocity of blood flow in left atrial appendage (LAA-v), and thrombus size were compared before and after drug administration. Following treatment, LAEF, LVEF, and LAA-v values were greater and LAD and LAADmean values were lower in the effective (P < 0.05). Logistic regression analysis showed significant correlations of LAD, LAEF, LVEF, LAA-A, and LAA-v with anticoagulant efficacy (P < 0.05). The efficacy of rivaroxaban in treatment of left atrial auricular thrombosis in patients with persistent AF was correlated with LAD, LAEF, LVEF, LAA-A, and LAA-v. Multivariate logistic regression analysis further revealed LAEF [odds ratio (OR) 1.7, 95% confidence interval (CI), 0.45–16.9, P = 0.008], 3D-EF (OR 6.4, 95% CI, 1.06–16.9, P = 0.039) and left ventricular global longitudinal strain (OR 18.0, 95% CI, 1.38–35.68, P = 0.028) as factors related to left atrial appendage thrombus. Echocardiography with global longitudinal strain assessment could be effectively utilized to evaluate the functional parameters of LAA and thus aid in predicting the safety of rivaroxaban as an anticoagulation agent.
Nutritional aspects of prehabilitation in adults with cirrhosis awaiting liver transplant
Authors: Cruz Christofer , Prado Carla M. , Gillis Chelsia , Martindale Robert , Bémeur Chantal , Lai Jennifer C. , Tandon Puneeta
Published: March 2024

Malnutrition, sarcopenia (low muscle mass), and physical frailty have gained increasing recognition in candidates for liver transplant (LT) as these conditions can impact postoperative functional capacity. Multidimensional prehabilitation programs have been proposed as a safe intervention in adults awaiting LT but the nutritional pillar of prehabilitation has been understudied. This review summarizes the nutritional recommendations for prehabilitation for individuals with cirrhosis awaiting LT. Three major aspects of nutritional prehabilitation are discussed: (1) Assess: Evaluate nutritional status and assess for malnutrition, sarcopenia, and frailty to guide the nutritional prehabilitation intervention intensity, increasing across universal, targeted, and specialist levels; (2) Intervene: Prescribe a nutritional prehabilitation intervention to meet established nutrition guidelines in cirrhosis with a targeted focus on improving nutritional status and muscle health; (3) Reassess: Follow-up based on the required intensity of nutritional care with as needed intervention adjustment. Topics covered in the review include nutritional care levels for prehabilitation, energy prescriptions across body mass index strata, detailed considerations around protein intake (amount, distribution, and quality), carbohydrate and fat intake, other nutritional considerations, and the potential role of dietary supplements and nutraceuticals. Future research is warranted to more accurately evaluate energy needs, evaluate emerging dietary supplementation strategies, and establish the role of nutraceuticals alongside food-based interventions. While the general principles of nutritional prehabilitation are ready for immediate application, future large-scale randomized controlled trials in this space will help to quantify the benefit that can be gained by transitioning the LT approach from passive “transplant waitlist time” to active “transplant preparation time.”
Mesenchymal stem cells alleviate mouse liver fibrosis by inhibiting pathogenic function of intrahepatic B cells
Authors: Feng Xudong , Feng Bing , Zhou Jiahang , Yang Jinfeng , Pan Qiaoling , Yu Jiong , Shang Dandan , Li Lanjuan , Cao Hongcui
Published: March 2024

Background and Aims:

The immunomodulatory characteristics of mesenchymal stem cells (MSCs) make them a promising therapeutic approach for liver fibrosis (LF). Here, we postulated that MSCs could potentially suppress the pro-fibrotic activity of intrahepatic B cells, thereby inhibiting LF progression.

Approach and Results:

Administration of MSCs significantly ameliorated LF as indicated by reduced myofibroblast activation, collagen deposition, and inflammation. The treatment efficacy of MSCs can be attributed to decreased infiltration, activation, and pro-inflammatory cytokine production of intrahepatic B cells. Single-cell RNA sequencing revealed a distinct intrahepatic B cell atlas, and a subtype of naive B cells (B-II) was identified, which were markedly abundant in fibrotic liver, displaying mature features with elevated expression of several proliferative and inflammatory genes. Transcriptional profiling of total B cells revealed that intrahepatic B cells displayed activation, proliferation, and pro-inflammatory gene profile during LF. Fibrosis was attenuated in mice ablated with B cells (μMT) or in vivo treatment with anti-CD20. Moreover, fibrosis was recapitulated in μMT after adoptive transfer of B cells, which in turn could be rescued by MSC injection, validating the pathogenic function of B cells and the efficacy of MSCs on B cell-promoted LF progression. Mechanistically, MSCs could inhibit the proliferation and cytokine production of intrahepatic B cells through exosomes, regulating the Mitogen-activated protein kinase and Nuclear factor kappa B signaling pathways.

Conclusions:

Intrahepatic B cells serve as a target of MSCs, play an important role in the process of MSC-induced amelioration of LF, and may provide new clues for revealing the novel mechanisms of MSC action.
Optical Coherence Tomography Versus Optic Disc Photo Assessment in Glaucoma Screening
Authors: Beniz Luiz Arthur F. , Campos Veronica P. , Medeiros Felipe A.
Published: March 2024

Précis:

Optical coherence tomography (OCT) and optic disc photography present valuable but distinct capabilities for glaucoma screening.

Objective:

This review article examines the strengths and limitations of OCT and optic disc photography in glaucoma screening.

Methods:

A comprehensive literature review was conducted, focusing on the accuracy, feasibility, cost-effectiveness, and technological advancements in OCT and optic disc photography for glaucoma screening.

Results:

OCT is highly accurate and reproducible but faces limitations due to its cost and less portable nature, making widespread screening challenging. In contrast, optic disc photos are more accessible and cost-effective but are hindered by subjective interpretation and inconsistent grading reliability. A critical challenge in glaucoma screening is achieving a high PPV, particularly given the low prevalence of the disease, which can lead to a significant number of false positives. The advent of artificial intelligence (AI) and deep learning models shows potential in improving the diagnostic accuracy of optic disc photos by automating the detection of glaucomatous optic neuropathy and reducing subjectivity. However, the effectiveness of these AI models hinges on the quality of training data. Using subjective gradings as training data, will carry the limitations of human assessment into the AI system, leading to potential inaccuracies. Conversely, training AI models using objective data from OCT, such as retinal nerve fiber layer thickness, may offer a promising direction.

Conclusion:

Both OCT and optic disc photography present valuable but distinct capabilities for glaucoma screening. An approach integrating AI technology might be key in optimizing these methods for effective, large-scale screening programs.
How do we expand the lung donor pool?
Authors: Levvey Bronwyn J. , Snell Gregory I.
Published: March 2024

Purpose of review

Lung transplantation activity continues to be limited by the availability of timely quality donor lungs. It is apparent though that progress has been made. The steady evolution of clinical practice, combined with painstaking scientific discovery and innovation are described.

Recent findings

There have been successful studies reporting innovations in the wider use and broader consideration of donation after circulatory death donor lungs, including an increasing number of transplants from each of the controlled, uncontrolled and medically assisted dying donor descriptive categories. Donors beyond age 70 years are providing better than expected long-term outcomes. Hepatitis C PCR positive donor lungs can be safely used if treated postoperatively with appropriate antivirals. Donor lung perfusion at a constant 10 degrees appears capable of significantly improving donor logistics and ex-vivo lung perfusion offers the potential of an ever-increasing number of novel donor management roles. Bioartificial and xenografts remain distant possibilities only at present.

Donor lungs have proved to be surprisingly robust and combined with clinical, scientific and engineering innovations, the realizable lung donor pool is proving to be larger than previously thought.
Medicare Advantage and Home Health Care
Authors: Ma Chenjuan , Rajewski Martha , Smith Jamie M.
Published: March 2024

Objectives:

Home health care serves millions of Americans who are “Aging in Place,” including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees.

Methods:

A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist.

Results:

Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits.

Conclusions:

Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.
Noninvasive assessment of liver fibrosis and portal hypertension
Authors: Duarte-Rojo Andres , Patel Keyur , Rockey Don C.
Published: March 2024

Purpose of review

The result of ongoing liver injury – and disease, regardless of cause – is fibrosis, and fibrosis appears to be a critically important result of ongoing injury. Further, in a number of different liver diseases, the presence of fibrosis has prognostic value. Therefore, the assessment of fibrosis is of critical clinical importance. Given the importance of fibrosis, there has been a rapid evolution in the use of noninvasive liver tests. This review highlights a number of the core principles surrounding.

Recent findings

The use of noninvasive test has progressed rapidly over the last decade and data are rapidly accumulating. New terminology has been adapted by the American Association for the Study of Liver Disease (AASLD) for noninvasive assessment of liver disease and termed ‘NILDA’ (Non-Invasive Liver Disease Assessment). Blood based such as APRI and or FIB-4 and imaging tests such as liver stiffness measurement (LSM) have moderate to high degrees of accuracy for detection of advanced liver fibrosis (≥ F2) and even higher accuracy for detection of severe fibrosis (F4 or cirrhosis). NILDA are particularly effective at the ends of the liver disease spectrum. For example, a very low LSM (less than 7 kPa) essentially excludes significant fibrosis or portal hypertension, and a very high LSM (> 25 kPa) makes significant fibrosis with portal hypertension (cirrhosis) highly likely.

NILDA are currently front and center in terms of assessment of the severity of liver disease. In all patients with known or suspected liver disease, noninvasive blood tests, including APRI and or FIB-4, should be the initial choice to assess the severity of liver fibrosis and/or portal hypertension. In most patients, these tests should be followed with imaging evaluation. The most commonly available imaging is LSM, which appears to be more accurate in predicting fibrosis severity, and is superior to blood tests in the assessment of portal hypertension. In situations in which there is diagnostic uncertainly, liver biopsy with or without HVPG remains an important consideration.
Proprotein convertase subtilisin/kexin type 9-inhibition across different patient populations
Authors: Stürzebecher Paulina Elena , Laufs Ulrich
Published: March 2024

Purpose of review

Monoclonal antibodies (mAb) targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) have been established in cardiovascular risk prevention. The purpose of this review is to summarize the effects of PCSK9 inhibitors across different patient populations.

Recent findings

Long-term data on the use of evolocumab and alirocumab shows persisting low- density lipoprotein cholesterol (LDL-C) lowering and good tolerability. PCSK9 inhibitors are effective and safe in both sexes, in pediatric patients as well as in the elderly. Initiation of PCSK9 mAb during acute myocardial infarction is safe and leads to beneficial morphological plaque changes. The PCSK9 inhibitors evolocumab, alirocumab and inclisiran lower LDL-C in patients with heterozygous familial hypercholesterolemia (FH), while the response of patients with homozygous FH is heterogeneous. New areas of application beyond lipid lowering are currently investigated.

PCSK9 inhibitors are safe, well tolerated, and effective in primary and secondary prevention in a wide range of patient populations.
Sustainable equipment donation in otolaryngology in low-resource settings
Authors: de Cates Catherine , Guéroult Aurélien M. , Narantsolmon Gan-Erdene
Published: March 2024

Purpose of review

The purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs.

Recent findings

LMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding.

Sustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.
Twenty-Five Years (Plus!) and an Impact Factor
Authors: Powell Suzanne K.
Published: March 2024

Professional Case Management Journal: has been published for more than 25 years. In those years, important content has helped build the foundation of case management itself. Through the years, the articles in this journal have been cited in other articles—and in other journals globally. Now this journal has been bestowed with an “impact factor.”
A Rare Case of Hereditary Multiple Exostoses in a Woman
Authors: Ghamri Ranya Alawy
Published: March 2024

Hereditary multiple exostosis (HME) is a rare genetic disorder characterized by multiple bony spurs or lumps, commonly affecting the long bones. This case report exposes the clinical presentation, diagnosis, and management of HME in a 28-year-old female nurse, who initially presented with persistent bilateral knee pain. After extensive evaluation involving orthopaedic and oncology specialists, the diagnosis of HME was made. Despite the discovery of multiple exostoses, the patient reported improvement following a tailored physiotherapy regimen. This case study underscores the complexity and broad spectrum of symptoms associated with HME. It emphasizes the importance of a multidisciplinary approach in diagnosing and managing such conditions, which can lead to better patient outcomes and an improved quality of life. By shedding light on the role of physiotherapy in managing rare genetic disorders such as HME, this case report contributes to the growing body of literature exploring noninvasive treatment options for these diseases.
Myopia control: Seeing beyond efficacy
Authors: Bullimore Mark A. , Jong Monica , Brennan Noel A.
Published: March 2024

SIGNIFICANCE

The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.

Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors—compliance, quality of vision, quality of life, and safety—are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.
Nonconventional Dysplasia is Frequently Associated With Goblet Cell Deficient and Serrated Variants of Colonic Adenocarcinoma in Inflammatory Bowel Disease
Authors: Xiao Andrew , Yozu Masato , Kővári Bence P. , Yassan Lindsay , Liao Xiaoyan , Salomao Marcela , Westerhoff Maria , Sejben Anita , Lauwers Gregory Y. , Choi Won-Tak
Published: March 2024

Various subtypes of nonconventional dysplasia have been recently described in inflammatory bowel disease (IBD). We hypothesized that goblet cell deficient dysplasia and serrated dysplasia may be the primary precursor lesions for goblet cell deficient (GCDAC) and serrated (SAC) variants of colonic adenocarcinoma, respectively. Clinicopathologic features of 23 GCDAC and 10 SAC colectomy cases were analyzed. All dysplastic lesions found adjacent to the colorectal cancers (n = 22 for GCDACs and n = 10 for SACs) were subtyped as conventional, nonconventional, or mixed-type dysplasia. As controls, 12 IBD colectomy cases with well to moderately differentiated adenocarcinoma that lacked any mucinous, signet ring cell, low-grade tubuloglandular, or serrated features while retaining goblet cells throughout the tumor (at least 50% of the tumor) were evaluated. The cohort consisted of 19 (58%) men and 14 (42%) women, with a mean age of 53 years and a long history of IBD (mean duration: 18 y). Twenty-seven (82%) patients had ulcerative colitis. GCDACs (57%) were more often flat or invisible than SACs (10%) and controls (25%; P = 0.023). The GCDAC and SAC groups were more likely to show lymphovascular invasion (GCDAC group: 52%, SAC group: 50%, control group: 0%, P = 0.001) and lymph node metastasis (GCDAC group: 39%, SAC group: 50%, control group: 0%, P = 0.009) than the control group. Notably, GCDACs and SACs were more frequently associated with nonconventional dysplasia than controls (GCDAC group: 77%, SAC group: 40%, control group: 0%, P < 0.001). Goblet cell deficient dysplasia (73%) was the most prevalent dysplastic subtype associated with GCDACs (P = 0.049), whereas dysplasias featuring a serrated component (60%) were most often associated with SACs (P = 0.001). The GCDAC group (75%) had a higher rate of macroscopically flat or invisible synchronous dysplasia compared with the SAC (20%) and control (33%) groups (P = 0.045). Synchronous dysplasia demonstrated nonconventional dysplastic features more frequently in the GCDAC (69%) and SAC (40%) groups compared with the control group (0%; P = 0.016). In conclusion, goblet cell deficient dysplasia and dysplasias featuring a serrated component could potentially serve as high-risk markers for GCDACs and SACs, respectively.
Pain Neuroscience Education Following Arthroscopic Rotator Cuff Repair for Patients With Rotator Cuff Tears
Authors: Kararti Caner , Özyurt Fatih , Kodak Muhammed İhsan , Basat Hakkı Çağdaş , Özsoy Gülşah , Özsoy İsmail , Tayfur Abdulhamit
Published: March 2024

Objective

This trial examines the efficacy of the pain neuroscience education on clinical outcomes in patients with arthroscopic rotator cuff repair.

Design

A total of 36 participants undergoing arthroscopic rotator cuff repair were assigned to either the experimental group (n = 18) or control group (n = 18) in this randomized study. A 6-wk-long conventional physiotherapy program was administered for both groups. In addition, a pain neuroscience education protocol was administered for the experimental group for a whole period of 6 wks (1 session/week, 15–60 mins per session). The primary outcomes were to compare pretreatment and posttreatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and posttreatment.

Results

The improvement in pain catastrophizing, anxiety, depression, and kinesiophobia was greater in the experimental group (P < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures.

Conclusions

This study showed that the pain neuroscience education improved only psychological aspects of the chronic pain in arthroscopic rotator cuff repair. Therefore, adding pain neuroscience education to the conventional program might be useful to improve pain catastrophizing, anxiety, depression, and kinesiophobia in patients with arthroscopic rotator cuff repair.
True Incidence of Marginal Mandibular Nerve Palsy following Neonatal Mandibular Distraction Osteogenesis
Authors: Myers Sarah , Beiriger Justin W. , Bruce Madeleine K. , Matinrazm Sayna , Dvoracek Lucas , Raghuram Anjali , Irgebay Zhazira , Glenney Anne E. , Mocharnuk Joseph , Kass Nicolás M. , Smetona John , Losee Joseph E. , Goldstein Jesse A.
Published: March 2024

Background:

In children with Pierre Robin sequence (PRS), mandibular distraction osteogenesis (MDO) is routinely performed to alleviate airway obstruction; however, it involves risk of injury to the marginal mandibular nerve (MMN). The authors hypothesize that MMN palsy incidence following MDO, reported at 1% to 15%, is underestimated. This study investigates the true incidence of MMN palsy after MDO to better guide follow-up care and improve treatment of this complication.

Methods:

A retrospective review of PRS patients who underwent MDO at a single, tertiary pediatric hospital between September of 2007 and March of 2021 was conducted. Patients who underwent MDO younger than 1 year of age and had postoperative clinical evaluations detailing MMN function were included. Logistic regression analysis was performed to investigate predictors of MMN injury.

Results:

Of 93 patients who underwent MDO, 59.1% met inclusion criteria, 56.4% were female, 43.6% were syndromic, and average age at MDO was 1.52 ± 2.04 months. The average length of mandibular distraction was 17.3 ± 4.36 mm, the average duration of intubation was 6.57 ± 2.37 days, and the average time until hardware removal was 111.1 ± 23.6 days. Sixteen patients (29.1%) presented with permanent MMN dysfunction, consisting of 8 patients with bilateral weakness and 8 with unilateral weakness. An additional 5 patients (9.1%) presented with transient MMN weakness that resolved within 1 year. Average length of follow-up postoperatively was 6.02 years, and no significant predictors of nerve injury were found.

Conclusion:

In this 14-year review of patients with PRS who underwent MDO, 38.2% demonstrated evidence of MMN palsy (permanent, 29.1%; transient, 9.1%), which is much greater than previously described.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Travel Burden to American Cleft Palate and Craniofacial Association–Approved Cleft and Craniofacial Teams: A Geospatial Analysis
Authors: Brown Madyson I. , Kuyeb Boris K. , Galarza Laura I. , Benedict Katherine C. , Hoppe Ian C. , Humphries Laura S.
Published: March 2024

Background:

Despite the existence of cleft and craniofacial teams approved by the American Cleft Palate and Craniofacial Association (ACPA), access to multidisciplinary team-based care remains challenging for patients from rural areas, leading to disparities in care. The authors investigated the geospatial relationship between US counties and ACPA-approved centers.

Methods:

The geographic location of all ACPA-approved cleft and craniofacial centers in the United States was identified. Distance between individual US counties (n = 3142) and their closest ACPA-approved team was determined. Counties were mapped based on distance to nearest cleft or craniofacial team. Distance calculations were combined with US Census data to model the number of children served by each team and economic characteristics of families served. These relationships were analyzed using independent t tests and analysis of variance.

Results:

Over 40% of US counties did not have access to an ACPA-approved craniofacial team within a 100-mile radius (n = 1267) versus 29% for cleft teams (n = 909). Over 90% of counties greater than 100 miles from a craniofacial team had a population less than 7500 (n = 1150). Of the counties more than 100 miles from a cleft team, 64% had a child poverty rate greater than the national average (n = 579). Counties with the highest birth rate and more than 100 miles to travel to an ACPA team are in the Mountain West.

Conclusions:

Given the time-sensitive nature of operative intervention and access to multidisciplinary care, the lack of equitable distribution in certified cleft and craniofacial teams is concerning. Centers may better serve families from distant areas by establishing satellite clinics, conducting telehealth visits, and training local primary care providers in referral practices.
A Geospatial Analysis of Hand Trauma Care: A Statewide Cross-Sectional Study
Authors: Florczynski Matthew M. , Zhang Yahui , Cichocki Meghan N. , Chung William T. , Wang Lu , Hemmila Mark R. , Chung Kevin C.
Published: March 2024

Background:

Traumatic hand injuries often present with high acuity, but little is known about the influence of geospatial and socioeconomic factors on the timely delivery of care.

Methods:

This cross-sectional study used the Michigan Trauma Quality Improvement Program database, a statewide registry with 35 level I or II trauma centers. Adult patients sustained hand trauma requiring urgent operative treatment between 2016 and 2021. Zip codes of injury location were linked with the corresponding percentage score on the Area Deprivation Index (ADI), a comprehensive measure of neighborhood disadvantage. Multiple regression analyses were used to determine associations of patient, injury, and geospatial characteristics with the odds of sustaining acute hand trauma and time to operative treatment.

Results:

Among 1826 patients, the odds of sustaining acute hand trauma based on the ADI followed a bimodal distribution. Female sex, smoking, obesity, work-related injury, and residence in a minor city were associated with increased odds, whereas younger age, comorbidities, and rural residence were associated with decreased odds. For 388 patients who underwent surgery within 48 hours, time to treatment was significantly increased in the highest ADI quintile, for patients who underwent fracture fixation, and for those with severe global injury severity. Multisystem injuries, moderate global injury severity, and direct admission to an orthopedic service were associated with shorter times to treatment.

Conclusions:

Patients in areas with greater neighborhood disadvantage may experience delayed operative care after acute hand trauma. This study highlights the importance of considering underserved populations and geospatial factors when determining the allocation of hand surgery resources.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
LigaSure-Assisted Submandibular Gland Excision in Deep-Plane Neck Lift: Review of 83 Patients
Authors: Basaran Karaca , Comert Mehmet
Published: March 2024

Background:

In performing a neck lift, the size and location of the submandibular gland (SMG) must be evaluated to achieve the ideal neck contour. Many surgeons, however, avoid SMG excision because of the technical difficulty and risks of hematoma and nerve damage. LigaSure (Valleylab, Boulder, CO) is a bipolar energy–based instrument that permanently seals vessels and connective tissue. Its use can make the SMG excision step easy and safe by reducing surgical risks.

Methods:

A total of 83 patients who underwent SMG excision between 2018 and 2022 were included in the study. All patients’ SMGs were partially excised using the LigaSure device, and the complication rates were documented.

Results:

Patients were followed up for an average period of 21 months (range, 9 months to 2.4 years). No perioperative intraglandular bleeding or postoperative hematoma was observed in any patient. No sialoma cases were observed postoperatively. Only 3 patients underwent repeated seroma aspirations. Transient lower lip weakness was observed in 7 patients, who all recovered in the first 6 months postoperatively.

Conclusion:

LigaSure-assisted SMG excision in deep-plane neck lift surgery was found to be technically easier to perform, time saving, safe, and highly effective in preventing hematoma and intraoperative bleeding.

CLINCAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Prevalence of Concomitant Distal Suprascapular Nerve Injury in Patients with Root-Level Brachial Plexus Palsy: A Clinical Anatomic Study of Injury Pattern
Authors: Bertelli Jayme A. , Lanzarin Leonardo D. , Ghizoni Marcos F. , Hill Elspeth J. R.
Published: March 2024

Background:

Root-level suprascapular nerve palsy is commonly reconstructed by means of spinal accessory nerve transfer in brachial plexus injury, but some patients do not recover. The authors hypothesize that this relates to concomitant undetected lesions distal to the nerve transfer coaptation.

Methods:

A total of 67 patients with plexus injury and C5/C6 root involvement were included in this prospective study between March of 2021 and October of 2022. During spinal accessory to suprascapular nerve transfer, the entire suprascapular nerve was explored using cresenteric clavicular osteotomy, and anatomic variations and injury patterns categorized.

Results:

Proximal root involvement was C5 to C6 (n = 8), C5 to C7 (n = 13), C5 to C8 (n = 17), or C5 to T1 (n = 29). Mean time from injury to surgery was 5.6 months. The suprascapular nerve was found to be injured in 16 of 67 cases (24%). In 9 cases (13%), the lesion was proximal to the suprascapular fossa. In 3 cases (4%), the suprascapular nerve was injured both proximally and within the fossa, and in 4 cases (6%), in the fossa or distal to it. Therefore, in 7 cases (10%), a traditional suprascapular nerve transfer would not successfully bypass the zone of injury of the suprascapular nerve in the fossa. Of the 16 cases of concomitant suprascapular nerve injury, 1 of 8 in occurred in C5 to C6 root injury, 4 of 13 of C5 to C7 root injury, 5 of 17 of C5 to C8 root injury, and 6 of 39 in total paralysis.

Conclusions:

Concomitant distal suprascapular nerve injury in brachial plexus stretch palsy occurred in 24% of the cases. This warrants attention from the surgeon to identify distal lesions and to perform the nerve transfer beyond any secondary lesions.