bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthodontic and orthopedic management of dentofacial deformity from juvenile idiopathic arthritis: a systematic literature review
Authors: Rotolo Rossana Patricia , Aiyar Akila , Perillo Letizia , Pedersen Thomas Klit , Stoustrup Peter
Published: June 2024

Background

An update on the knowledge regarding the orthopedic/orthodontic role in treating JIA-related dentofacial deformities is relevant.

Objectives

This systematic review aimed to assess the level of evidence regarding the management of dentofacial deformity from juvenile idiopathic arthritis (JIA) with orthodontics and/or dentofacial orthopedics.

Search methods

The following databases were searched without time or language restrictions up to 31 January 2024 (Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature).

Selection criteria

Inclusion criteria were studies dealing with JIA subjects receiving treatment with orthodontic and/or dentofacial orthopedic functional appliances.

Data collection and analysis

After the removal of duplicate studies, data extraction, and risk of bias assessment according to ROBINS-I guidelines were conducted. Data extraction was conducted by two independent authors.

Results

The electronic database search identified 397 eligible articles after the removal of duplicates. Following the application of the pre-defined inclusion and exclusion criteria, 11 articles were left for inclusion. Two trials were associated with a severe risk of bias, four trials were at moderate risk of bias, and the other five presented a low risk of bias. Various research groups employed and documented the effects of different types of appliances and methodologies. The study heterogeneity did not allow for meta-analyses. In addition, a lack of uniformity in treatment objectives was observed across the included studies. After treatment with dentofacial orthopedics skeletal improvement was demonstrated in 10 studies, and a decrease in orofacial signs and symptoms was reported in 7 studies.

Conclusions

Across the available literature, there is minor evidence to suggest that dentofacial orthopedics may be beneficial in the management of dentofacial deformities from JIA. There is little evidence to suggest that it can reduce orofacial signs and symptoms in patients with JIA. Based on current evidence, it is not possible to outline clinical recommendations for specific aspects of orthopedic management in growing subjects with JIA-related dentofacial deformity.

Registration

PROSPERO (CRD42023390746).
Improved assembly of the Pungitius pungitius reference genome
Authors: Wang Dandan , Rastas Pasi , Yi Xueling , Löytynoja Ari , Kivikoski Mikko , Feng Xueyun , Reid Kerry , Merilä Juha
Published: June 2024

The nine-spined stickleback (Pungitius pungitius) has been increasingly used as a model system in studies of local adaptation and sex chromosome evolution but its current reference genome assembly is far from perfect, lacking distinct sex chromosomes. We generated an improved assembly of the nine-spined stickleback reference genome (98.3% BUSCO completeness) with the aid of linked-read mapping. While the new assembly (v8) was of similar size as the earlier version (v7), we were able to assign 4.4 times more contigs to the linkage groups and improve the contiguity of the genome. Moreover, the new assembly contains a ∼22.8 Mb Y-linked scaffold (LG22) consisting mainly of previously assigned X-contigs, putative Y-contigs, putative centromere contigs, and highly repetitive elements. The male individual showed an even mapping depth on LG12 (pseudo X chromosome) and LG22 (Y-linked scaffold) in the segregating sites, suggesting near-pure X and Y representation in the v8 assembly. A total of 26,803 genes were annotated, and about 33% of the assembly was found to consist of repetitive elements. The high proportion of repetitive elements in LG22 (53.10%) suggests it can be difficult to assemble the complete sequence of the species’ Y chromosome. Nevertheless, the new assembly is a significant improvement over the previous version and should provide a valuable resource for genomic studies of stickleback fishes.
Post-release survival of Whiteleg skate (Amblyraja taaf) caught as bycatch on demersal longlines in deep waters of the Southern Ocean (Crozet Archipelago)
Authors: Faure Johanna , Authier Matthieu , Massiot-Granier Félix , Plard Floriane , Péron Clara
Published: June 2024

Whiteleg skate (Amblyraja taaf) is a bycatch species commonly discarded in demersal longline fisheries targeting Patagonian toothfish around the Crozet archipelago (Southern Ocean). While there are global conservation issues on elasmobranchs, the post-release survival of this deep-sea species remains unknown. This study is the first tagging programme conducted on Whiteleg skates to investigate their fate after being released at sea. Almost 3000 skates were captured, double-tagged with conventional tags and released between 2020 and 2022 to assess survival using capture–mark–recapture (CMR) models. Our primary result was an estimated annual apparent survival rate higher than 92% for skates released in good condition (with 185 skates recaptured after up to 944 days at liberty). Low detection rate highlighted methodological challenges for CMR models. However, skate size and depth of capture had an effect on apparent survival probability with smaller individuals having lower values (<65 cm; 0.84 ± 0.04) as well as skates caught at shallower depths (<1200 m; 0.83 ± 0.04). Overall, this study suggests that the mandated release of skates in good condition is effective to limit fishing impact on skates in this fishery. To further limit this impact, we recommended changes in fishing practices (hauling speed and soak time).
Correlation of Genogroup I, Genotype 1 (GI.1) Norovirus Neutralizing Antibody Levels With GI.1 Histo-Blood Group Antigen–Blocking Antibody Levels
Authors: Atmar Robert L , Ettayebi Khalil , Neill Frederick H , Braun Ralph P , Sherwood James , Ramani Sasirekha , Estes Mary K
Published: June 2024

Background

The in vitro cultivation of human noroviruses allows a comparison of antibody levels measured in neutralization and histo-blood group antigen (HBGA)–blocking assays.

Methods

Serum samples collected during the evaluation of an investigational norovirus vaccine (HIL-214 [formerly TAK-214]) were assayed for neutralizing antibody levels against the vaccine's prototype Norwalk virus/genogroup I, genotype 1 (GI.1) (P1) virus strain. Results were compared with those previously determined using HBGA-blocking assays.

Results

Neutralizing antibody seroresponses were observed in 83% of 24 vaccinated adults, and antibody levels were highly correlated (r = 0.81; P < .001) with those measured by HBGA blocking.

Conclusions

Genogroup I, genotype 1 (GI.1)–specific HBGA-blocking antibodies are a surrogate for neutralization of GI.1 norovirus.

Clinical Trials Registration.  Clinicaltrials.gov NCT02475278
Wolbachia populations across organs of individual Culex pipiens: highly conserved intra-individual core pangenome with inter-individual polymorphisms
Authors: Trouche Blandine , Schrieke Hans , Duron Olivier , Eren A Murat , Reveillaud Julie
Published: June 2024

Wolbachia is a maternally inherited intracellular bacterium that infects a wide range of arthropods including mosquitoes. The endosymbiont is widely used in biocontrol strategies due to its capacity to modulate arthropod reproduction and limit pathogen transmission. Wolbachia infections in Culex spp. are generally assumed to be monoclonal but the potential presence of genetically distinct Wolbachia subpopulations within and between individual organs has not been investigated using whole genome sequencing. Here we reconstructed Wolbachia genomes from ovary and midgut metagenomes of single naturally infected Culex pipiens mosquitoes from Southern France to investigate patterns of intra- and inter-individual differences across mosquito organs. Our analyses revealed a remarkable degree of intra-individual conservancy among Wolbachia genomes from distinct organs of the same mosquito both at the level of gene presence–absence signal and single-nucleotide polymorphisms (SNPs). Yet, we identified several synonymous and non-synonymous substitutions between individuals, demonstrating the presence of some level of genomic heterogeneity among Wolbachia that infect the same C. pipiens field population. Overall, the absence of genetic heterogeneity within Wolbachia populations in a single individual confirms the presence of a dominant Wolbachia that is maintained under strong purifying forces of evolution.
‘Tis new to thee’: response to Gruenewald, Knijp, Schoenmaker, and van Tilburg
Authors: Demekas Dimitri , Grippa Pierpaolo
Published: June 2024

In ‘Embracing the Brave New World: A Response to Demekas and Grippa’, a response to our article ‘Walking a Tightrope: Financial Regulation, Climate Change, and the Transition to a Low-Carbon Economy’, both published in the Journal of Financial Regulation, Gruenewald, Knijp, Schoenmaker, and van Tilburg claim that climate risk is a clear and present danger to financial stability that justifies imposing higher capital requirements on supervised firms. Until the current prudential risk framework is revised to fully capture climate risk, they advocate ad hoc measures, such as adjustments to risk weights, which, they believe, would have the desired effect. In this article, we argue that these claims are misguided. Given the nature of climate risk, risk assessment models cannot provide a reliable basis for calibrating capital requirements. On the basis of the evidence, prudential tools would have only a negligible impact on the transition. And the idea of adjusting risk weights for climate exposures has been abandoned—for good reasons. Ultimately, there is nothing financial regulation can do about the energy transition that an appropriately designed carbon tax cannot do better. Central banks and financial regulators should resist the pressure to take on additional responsibilities that are essentially political and that they cannot properly discharge.
On alert for Ebola: public health risk assessment of travellers from Uganda to the USA during the 2022 outbreak
Authors: Fowler Jennifer J , Preston Leigh Ellyn , Gearhart Shannon L , Figueroa Argelia , L  Christensen Deborah , Mitchell Colby , Hernandez Estephania , Grills Ardath W , Morrison Stephanie M , Wilkinson Melanie , Talib Tahab , Marie Lavilla Kayla , Watson Tureka , Mitcham Dionne , Nash Ronnae , Veguilla Maria A Colón , Hansen Sabrina , Cohen Nicole J , Nu Clarke Seseni A , Smithson Ar'reil , Shearer Emma , Pella Danielle Gilliard , Morris Joseph D , Meehan Sarah , Aboukheir Mahmoud , Adams Kara , Sunavala Zenia , Conley Jake , Abouattier Maeva , Palo Matthew , Pimentel Linda Capewell , Berro Andre , Mainzer Hugh , Byrkit Ramona , Kim Daniel , Katebi Volha , Alvarado-Ramy Francisco , Roohi Shahrokh , Wojno Abbey E ,   Viral Special Pathogens Group, Brown Clive M , Gertz Alida M
Published: June 2024

Background

On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus.

Methods

From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21 days. CDC also recommended that state, local and territorial health departments (‘health departments’) conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes.

Results

Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified.

Conclusion

Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers’ potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.
The WTO Agreement on Sanitary and Phytosanitary Measures
Authors: Gruszczynski Lukasz , Scott Joanne
Published: June 2024

The 1995 World Trade Organization (WTO) Agreement on Sanitary and Phytosanitary Measures (SPS) is concerned with trade and food safety regulation and with the regulation of pests and diseases in agriculture. It establishes legal standards while affirming the right of each Member to choose its own level of SPS protection. However, the question of whether the balance has been properly struck remains a matter of ongoing debate. The commentary has been updated to reflect 15 years of change in the SPS case law and practice since publication of the first edition in 2007. It critically examines current issues, such as use of experts in the dispute settlement process, applicable standards of review, or legal treatment of private standards in the area of food safety, and assesses the suitability of the current regime to address the existing needs of developing countries. The commentary also examines how science-based criteria and the traditional General Agreement on Tariffs and Trade (GATT) standards (i.e. non-discrimination and least trade-restrictive means) are used to discipline national SPS measures. It explores the transparency obligations and procedural rules that govern control, inspection, and approval processes in importing countries. A separate section is dedicated to the operation of the SPS Committee as a site for transnational governance in the SPS field. The book also investigates the agreement’s attempt to establish a framework to draw together the diverse institutions and regulatory regimes already populating the food safety arena. The updated commentary has been extended by two new chapters, one that reviews Article 5.7 SPS in greater detail and one that deals with the SPS rules in the selected regional trade agreements.
Additional Obligations
Authors: Gruszczynski Lukasz
Published: June 2024

This chapter covers the additional obligations laid down in the Agreement on the Application of Sanitary and Phytosanitary Measures (the SPS Agreement). These particularly include: non-discrimination and consistency (Articles 2.3 and 5.5), least trade-restrictive means (Articles 5.4 and 5.6), equivalence (Article 4) and regionalization (Article 6). For consistency, equivalence and regionalization, the agreement has been supplemented by more detailed guidelines adopted by the SPS Committee, which are analyzed here as well. The chapter explains how these additional obligations aim to inculcate regulatory reflexivity by requiring Members to explain their choices by reference to specified benchmarks. It also looks into the correlation between the public perceptions of risk and relative levels of public fearfulness that may justify different levels of protection.
International Standards
Authors: Gruszczynski Lukasz
Published: June 2024

This chapter explores the nature and role of international standards in the Sanitary and Phytosanitary (SPS) system. Although the SPS Agreement does not confer binding force on international standards, it does constitute them as benchmarks against which Members justify their SPS measures. The chapter looks at the activities of the SPS ‘sister organizations’ identified in Annex A(3), including the Codex Alimentarius Commission, the World Organization for Animal Health (OIE), and International Plant Protection Convention (IPPC). Following an overview of the activities of these bodies, the chapter examines the relationship between them and the SPS Agreement. It looks both at the stance of the AB in articulating this relationship, and at the monitoring activities of the SPS Committee.
The International Law Commission's Draft Conclusions on Peremptory Norms
Authors: Tladi Dire
Published: June 2024

In 2022, the ILC adopted the Draft Conclusions on Peremptory Norms of General International Law. The text of the Draft Conclusions consists of twenty-three Draft Conclusions and addresses two aspects, namely the identification of peremptory norms and their legal consequences. Attached to the Draft Conclusions is an Annex with a non-exhaustive list of jus cogens norms previously identified by the Commission. The International Law Commission’s Draft Conclusions on Peremptory Norms examines the ILC’s Draft Conclusions. It serves, in part, as a commentary on the ILC’s work and provides a broader understanding of the Draft Conclusions from the perspective of an insider. The book goes beyond a commentary as it provides an analysis and evaluation of the legal issues raised by the Draft Conclusions. Relying inter alia on the debates within the Commission and the doctrinal debate surrounding the concepts covered, the book will not only offer commentary on what is addressed in the Draft Conclusions but also an assessment of the choices made by the Commission and the consequences of those choices.
Definitional Issues
Authors: Tladi Dire
Published: June 2024

This chapter covers two Draft Conclusions, namely Draft Conclusion 2 and Draft Conclusion 3. It begins with Draft Conclusion 3 which contains the definition of jus cogens, which in turn is taken from Article 53 of the Vienna Convention. It then provides a comment on Draft Conclusion 2, which describes the general nature of jus cogens. The chapter also provides an analysis of the relationship between Draft Conclusion 2 and Draft Conclusion 3. Through this relationship a tension is revealed in the work of the Commission, namely the tension between the positivist inclination of Article 53 of the Vienna Convention, reflected in Draft Conclusion 3, and the natural law foundations of jus cogens, as reflected in Draft Conclusion 2.
The First CriterionA Norm of General International Law
Authors: Tladi Dire
Published: June 2024

This chapter is concerned with Draft Conclusion 5, which addresses the first criterion, namely that the norm in question must be a norm of general international law. The Draft Conclusion identifies three possible bases of jus cogens, namely customary international law, treaty law, and general principles of law. According to the Draft Conclusion, customary international law is the most common basis of jus cogens, while treaty law and general principles of law may also serve as bases of jus cogens. The chapter provides a commentary and analysis on the Commission’s decision to adopt this bifurcated approach. In particular, the chapter assesses the Commission’s decision to treat treaty law and general principles of law as less likely bases of jus cogens.
Consequences of Jus Cogens for Treaties
Authors: Tladi Dire
Published: June 2024

Chapter 8 concerns the consequences of jus cogens for treaties. The consequence most synonymous with peremptory norms is invalidity of a treaty conflicting with jus cogens as provided for in the Vienna Convention. These consequences are addressed in four separate Draft Conclusions, namely Draft Conclusion 10 on invalidity, Draft Conclusion 11 on separability, Draft Conclusion 12 on termination, and Draft Conclusion 13 on reservations. These Draft Conclusions are, in the main, sourced from the Vienna Convention. As such the chapter is more descriptive, while also assessing the choices the Commission made between sticking to the Vienna Convention and moving beyond the text.
Consequences of Jus Cogens for Other Sources of Obligations
Authors: Tladi Dire
Published: June 2024

Chapter 9 addresses consequences of jus cogens for other sources of obligation. These are addressed in Draft Conclusion 14 (customary international law), Draft Conclusion 15 (unilateral acts), and Draft Conclusion 16 (decisions of international organisations). These Draft Conclusions essentially apply the Vienna formula, discussed in Chapter 8, to other sources of obligations. Particular issues addressed in the chapter concern the possibility of modification of jus cogens if customary international law conflicting with jus cogens does not arise. With respect to decisions of international organisations, the chapter provides an analysis of the Commission’s treatment of decisions of the Security Council. It might be noticed that there is no provision for general principles of law as a source of obligations. The chapter provides some insight as to why the Commission might have left general principles of law unaddressed.
Non-Exhaustive List of Jus Cogens Norms
Authors: Tladi Dire
Published: June 2024

Chapter 14 concerns Draft Conclusion 23 which refers to a list of jus cogens in an Annex. It is the only Draft Conclusion in the whole set that dedicates itself to primary rules of international law. The list was a source of criticism from the very beginning of the Commission’s work. The chapter traces the debates and assesses the Commission’s decision to persist with the list notwithstanding the criticism. It does so by evaluating the main arguments against the list as against the arguments for the list. In the process, the chapter also describes the methodology for arriving at the list, which is meant to respond to the criticism directed at the list.
Prospects and Concluding Thoughts
Authors: Tladi Dire
Published: June 2024

Chapter 15 is the concluding chapter. It provides an account of how the Draft Conclusions were received in the Sixth Committee of the General Assembly subsequent to the adoption and discusses the prospects for the Draft Conclusions to influence the development of international law in the long term. While the Draft Conclusions received significant support from the majority of States, a handful of States opposed them and blocked consensus on the adoption of the customary General Assembly resolution to take note of the Draft Conclusions and the Annex containing the list of jus cogens norms. The future prospects of the Draft Conclusions are considered in the context of this reception.
Intrathecal methotrexate, central nervous system toxicity, and response to N-methyl-D-aspartate antagonism: An adult case series
Authors: Donaghy Ryan , Singer Lauren , Dixit Karan
Published: June 2024

Background

Methotrexate (MTX) is administered for the treatment of central nervous system (CNS) hematologic cancers, prophylaxis of CNS dissemination of certain hematological cancers, and in solid tumor leptomeningeal disease. MTX treatment can be limited by CNS toxicity. Dextromethorphan is used to treat MTX neurotoxicity, with most data derived from pediatric case series. In this report, we profile 4 adult patients who developed intrathecal (IT) MTX neurotoxicity to better characterize their response to dextromethorphan treatment.

Methods

A case series of 4 patients who developed neurologic symptoms attributed to IT MTX neurotoxicity subsequently treated with dextromethorphan was devised. Demographic data, clinical characteristics, electroencephalography results, magnetic resonance imaging, cerebrospinal fluid (CSF) characteristics, and dextromethorphan treatment outcomes were described.

Results

Of the 4 patients developing MTX neurotoxicity, neurologic symptoms developed over a timeframe of 2 to 14 days from the precedent MTX exposure. Radiologic phenotypes included subcortical white matter diffusion-restricting lesions, bi-hemispheric subcortical white matter T2-FLAIR hyperintensities, as well as other findings described in the report. Time elapsed from initiation of dextromethorphan to neurologic symptom resolution ranged from 1 to 2 days.

Conclusions

The profiles of 4 adult patients developing suspected IT MTX neurotoxicity syndromes with subsequent response to Dextromethorphan add further data to guide the management of such patients.
Vocational rehabilitation for Long Covid: a roadmap for recovery
Authors: Parkin A , Rayner C , Mir G , O'Connor R J
Published: June 2024

Long Covid continues to impact many people’s workability; some have lived with it for years, experiencing return-to-work attempts followed by redeployment, contractual changes—even capability proceedings. For those in low-paid work or self-employment, contractual or financial insecurity, work retention options are likely to be reduced even further. New cases of Long Covid continue, and the need to support workers earlier in their trajectory with return to work as a key outcome remains crucial. Support for people with Long Covid has been lacking to date; here we introduce a practical tool that can be utilized by rehabilitation and occupational health professionals alike.
Evaluation of Chemical-Inducible Gene Expression Systems for Beet Cyst Nematode Infection Assays in Arabidopsis thaliana
Authors: Liu Xunliang , Mitchum Melissa G.
Published: June 2024

Cyst nematodes co-opt plant developmental programs for the establishment of a permanent feeding site called a syncytium in plant roots. In recent years, the role of plant developmental genes in syncytium formation has gained much attention. One main obstacle in studying the function of development-related genes in syncytium formation is that mutation or ectopic expression of such genes can cause pleiotropic phenotypes, making it difficult to interpret nematode-related phenotypes or, in some cases, impossible to carry out infection assays due to aberrant root development. Here, we tested three commonly used inducible gene expression systems for their application in beet cyst nematode infection assays of the model plant Arabidopsis thaliana. We found that even a low amount of ethanol diminished nematode development, deeming the ethanol-based system unsuitable for use in cyst nematode infection assays, whereas treatment with estradiol or dexamethasone did not negatively affect cyst nematode viability. Dose and time course responses showed that in both systems, a relatively low dose of inducer (1 μM) is sufficient to induce high transgene expression within 24 h of treatment. Transgene expression peaked at 3 to 5 days post-induction and began to decline thereafter, providing a perfect window for inducible transgenes to interfere with syncytium establishment while minimizing any adverse effects on root development. These results indicate that both estradiol- and dexamethasone-based inducible gene expression systems are suitable for cyst nematode infection assays. The employment of such systems provides a powerful tool to investigate the function of essential plant developmental genes in syncytium formation.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Essential Review of Oncological Emergencies
Authors: Bekele Sara , Kuhnly Nicole , Chen Leon L.
Published: June 2024

Innovations in oncology have expanded treatment eligibility, leading to a rise in cancer patients requiring critical care. This necessitates that all critical care clinicians possess a fundamental knowledge of prevalent oncological conditions and identify emergent scenarios requiring immediate action. This article will explore key oncological complications and their management approaches.
Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic
Authors: Jarrad Reem Ahmad , ALdasoqi Khadeejeh Yousef Abdul Aziz , ALnatsheh Malak Tareq Talib
Published: June 2024

This is a qualitative phenomenological study that was designed to navigate through nurses’ lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses’ lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses’ eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.
A novel objective evaluation method, shear wave elastography, in the treatment of atrophic vaginitis by nonablative intravaginal Er:YAG laser, a randomized-sham controlled pilot study
Authors: Bayraktar Elif , Erel C.Tamer , Akturk Hayedeh , Erkan Ipek Betul Ozcivit , Hamid Rauf , Alper Ebru , Adaletli Ibrahim , Urfalioglu Mert
Published: June 2024

Objective

The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography.

Methods

In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (Emean) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia.

Results

Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and Emean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final Emean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline Emean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment.

Conclusions

Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
Report on three cases of familial primary aldosteronism type IV
Authors: Zhang Wen , Li Qi-yan , Guo Zi-hong , Zhang Cai-yan , Zhou Ming-shuang , Zhao Ya-jing
Published: June 2024

Primary aldosteronism is the most common cause of secondary hypertension, which is caused by increased aldosterone secretion in the adrenal cortex and contains many subtypes, among which familial hyperaldosteronism is relatively rare. Familial hyperaldosteronism can be divided into four subtypes based on its clinical manifestations and mutated genes: FH-I, FH-II, FH-III, and FH-IV. This article reports on three patients with FH-IV: a mother and her two sons. They were diagnosed with hypertension in other hospitals, and hypokalemia was found during hospitalization in our department. Diltiazem and terazosin were used for elution for 1 month. Renin and aldosterone levels in standing or supine positions improved, and the aldosterone-to-renin ratio was positive. Primary aldosteronism was diagnosed based on improved saline and captopril inhibition tests. As the three patients were blood-related immediate family members, gene screening was performed, diagnosing them with FH-IV. This article reports the clinical characteristics of the three cases in combination with related literature to improve the understanding of FH-IV.
Comparison of low-energy FLACS and conventional cataract surgery: meta-analysis and systematic review
Authors: Yeh Cyuan-Yi , Fang Hwa-Shin , Ou You-Ci , Cheng Cheng-Kuo , Wu Tzu-En
Published: June 2024

Topic:

To systematically compare the effectiveness of conventional phacoemulsification surgery (CPS) and low-energy femtosecond laser–assisted cataract surgery (FLACS) in patients with cataract.

Clinical Relevance:

Cataract surgery is a common procedure, and comparing different techniques such as CPS and low-energy FLACS is crucial for optimizing patient outcomes.

Methods:

The PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library databases were searched for clinical trials. Outcomes of procedure time, effective phacoemulsification time, balanced salt solution usage, cumulative dissipated energy, mean change of corrected distance visual acuity, endothelial cells reduction, central corneal thickness (CCT), and aqueous cytokine level were evaluated. The effect measures were weighted mean differences with 95% CI. The protocol was registered at the Prospective Register for Systematic Reviews (registration number CRD42023420173).

Results:

11 studies were included in this meta-analysis, of which 1680 eyes were analyzed (637 eyes in the low-energy FLACS group and 1043 eyes in the CPS group). Low-energy FLACS demonstrated significantly fewer reductions in endothelial cell count at 6 months (P < .001) compared with CPS. It also exhibited a shorter effective phacoemulsification time (P < .001) and less balanced salt solution usage (P < .001). However, there were no differences in cumulative dissipated energy, corrected distance visual acuity, CCT changes, or aqueous cytokine levels between the 2 groups.

Conclusions:

Both low-energy FLACS and CPS are effective in treating cataracts, but low-energy FLACS may offer advantages such as reduced phacoemulsification time and less endothelial cell loss.
The impact of carbohydrate restriction-induced elevations in low-density lipoprotein cholesterol on progression of coronary atherosclerosis: the ketogenic diet trial study design
Authors: Javier Denise Alison R. , Manubolu Venkat S. , Norwitz Nicholas G. , Kinninger April , Aldana-Bitar Jairo , Ghanem Ahmed , Ahmad Khadije , Vicuna Will D. , Hamidi Hossein , Bagheri Marziyeh , Elsayed Tasneem , Villanueva Bea , Ichikawa Keishi , Flores Ferdinand , Hamal Sajad , Feldman David , Budoff Matthew J.
Published: June 2024

Background

Despite innovations in pharmacotherapy to lower lipoprotein cholesterol and apolipoprotein B, risk factors for atherosclerotic cardiovascular disease (ASCVD), ASCVD persists as the leading global cause of mortality. Elevations in low-density lipoprotein cholesterol (LDL-C) are a well-known risk factor and have been a main target in the treatment of ASCVD. The latest research suggests that ketogenic diets are effective at improving most non-LDL-C/apolipoprotein B cardiometabolic risk factors. However, ketogenic diets can induce large increases in LDL-C to >190 mg/dl in some individuals. Interestingly, these individuals are often otherwise lean and healthy. The influence of increased levels of LDL-C resulting from a carbohydrate-restricted ketogenic diet on the progression of atherosclerosis in otherwise metabolically healthy individuals is poorly understood. This observational study aims to assess and describe the progression of coronary atherosclerosis in this population within 12 months.

Methods

Hundred relatively lean individuals who adopted ketogenic diets and subsequently exhibited hypercholesterolemia with LDL-C to >190 mg/dl, in association with otherwise good metabolic health markers, were enrolled and observed over a period of 12 months. Participants underwent serial coronary computed tomography angiography scans to assess the progression of coronary atherosclerosis in a year.

Results

Data analysis shall begin following the conclusion of the trial with results to follow.

Conclusion

Ketogenic diets have generated debate and raised concerns within the medical community, especially in the subset exhibiting immense elevations in LDL-C, who interestingly are lean and healthy. The relationship between elevated LDL-C and ASCVD progression in this population will provide better insight into the effects of diet-induced hypercholesterolemia.
Influence of Preterm Birth and Environmental Context on Academic Performance and Neurodevelopmental Outcomes
Authors: Kelly Michelle M. , Brace Margaret
Published: June 2024

Background

Preterm birth affects 10% of all births annually in the United States. Outcomes of people born preterm are challenging to predict because of multiple influences, including gestational age, birth weight, and social and environmental contexts, that contribute to an individual’s growth and developmental trajectory. The influence of toxic stress is underrepresented in the literature assessing preterm birth outcomes.

Objectives

The current analyses use the eco-bio-developmental model of poverty and preterm birth as a framework to model the pathways among toxic stress, preterm birth, and neurodevelopmental outcomes. Poverty and toxic stress were hypothesized to increase the risk for impaired neurodevelopmental and academic outcomes—both directly and indirectly.

Methods

The analytic sample of 55,873 children aged 6–17 years was derived from the National Survey of Children’s Health 2020–2021. Structural equation models with combined measurement and path models for each dependent variable were constructed using latent toxic stress variables. The structural path equations included direct paths from the latent measure of prenatal toxic stress, preterm birth status, and the latent measure of childhood toxic stress to the neurodevelopmental outcome, as well as an indirect, mediated path from prenatal toxic stress through preterm birth status to the outcome.

Results

Across models, higher levels of prenatal toxic stress were significantly associated with preterm birth and lower birth weight ranges. Preterm low birth weight status was associated with a greater likelihood of neurodevelopmental impairment, repeating a grade, and special education plans. The predicted probabilities of neurodevelopmental impairment, repeating grades, and special education plans are significantly higher with above-average levels of exposure to prenatal and childhood toxic stress.

Discussion

There is a need for prospective studies that assess predictors and outcomes of preterm birth that are stratified by gestational age and consider the timing, chronicity, and influence of toxic stress and environmental exposures. There is an imperative for public health programs and policies designed to support families, caregivers, and children to address the individual and structural social determinants of health that contribute to toxic stress, thereby increasing preterm birth rates and negatively affecting the outcomes of children born preterm.
Scoping review: Mobility aids for people with sight loss across the ICF domains of functions, activities, and participation
Authors: Knights Holly M. , Benham Alex E. , Durrans Rachael M. , Burton Kim
Published: June 2024

SIGNIFICANCE

There is little literature linking mobility aids for people with sight loss to the functions, activities, and participation domains of the International Classification of Functioning, Disability and Health (ICF). Future studies on this relationship should be funded and pursued to better understand ways to maximize the benefit of mobility aids.

PURPOSE

The ICF domains of functions, activities, and participation are potentially health-supporting aspects of daily living that may be impeded for people with sight loss. Although mobility aids facilitate safely navigating obstacles to optimize independence, it is not clear if they have any effect on functions, activities, or participation. This review explores the current literature to establish the associations between mobility aids and ICF domains.

METHODS

An established scoping review methodological framework was used to systematically search, select, and synthesize the existing literature.

RESULTS

Of 116 unique retrieved articles, three observational studies were eligible for inclusion with a total of 124 participants. A small experimental study found that blind adults had slower Timed Up and Go times than sighted and better performance with a long cane than without. One observational study found that physical activity was strongly related to level of visual acuity but with no independent impact of mobility aids. A single mixed-methods study explored travel frequency for blind people with assistance dogs and considered constraints to participation.

CONCLUSIONS

Despite the included studies involving some aspect of mobility aid use by people with sight loss, to date, no study has focused exclusively on mobility aid intervention for people with sight loss within the physical function, physical activity, and participation domains of the ICF. There is no reliable evidence on the associations between mobility aids and physical function, physical activity, and participation. This is an important knowledge gap for determining the most suitable aids, as well as their use, to best facilitate health-supporting activities.
Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with Bronchopulmonary Dysplasia
Authors: Brumer Eliaz , Godse Sanjiv , Chandrasekar Leela , Kockar Kizilirmak Tuba , Blythe Eleanor , Gozzo Yeisid , Peterec Steven , Kandil Sarah , Grossman Matthew , Chen Laura , Weiss Pnina , Sheares Beverley
Published: June 2024

Introduction:

Bronchopulmonary dysplasia (BPD) is a chronic lung disorder affecting many premature infants. Infants with BPD have higher hospital readmission rates due to respiratory-related morbidity. We aimed to increase the rates of outpatient pulmonary follow-up and attendance of premature babies with moderate and severe BPD to above 85% within 6 months.

Methods:

We conducted a quality improvement project at Yale New Haven Children’s Hospital. Key interventions included developing a BPD clinical pathway integrated into the electronic medical record to assist providers in correctly classifying BPD severity, assigning the appropriate International Classification of Diseases, 10th Revision code (P27.1), and providing standardized treatment options. The outcome measures included correct diagnosis and classification of BPD, the percentage of patients with BPD scheduled for pediatric pulmonology appointments within 45 days, and the percentage attending those appointments.

Results:

There were 226 patients in our study, including 85 in the baseline period. Correct diagnosis of BPD increased from 49% to 95%, the percentage of scheduled appointments increased from 71.9% to 100%, and the percentage of appointments attended increased from 55.6% to 87.1%.

Conclusions:

Our quality improvement initiative improved the accuracy of diagnosis, severity classification, and outpatient pulmonary follow-up of children with moderate and severe BPD.
Measuring the Interprofessional Health of the Pediatric Cardiovascular Operating Room Work Environment
Authors: Thornton Jason M. , Connor Jean A. , Dwyer Patricia A. , Porter Courtney L. , Hartwell Lauren P. , DiPasquale Zachary , Chiloyan Araz , Hickey Patricia A.
Published: June 2024

Introduction:

Pediatric cardiac surgery is complex and has significant risk, requiring interprofessional teamwork for optimal outcomes. Unhealthy work environments have been linked to poor patient outcomes, staff dissatisfaction, and intention to leave. We describe the interprofessional health of pediatric cardiovascular operating room (CVOR) work environments in the United States and the establishment of a healthy work environment (HWE) benchmark score.

Methods:

Utilizing the American Association of Critical Care Nurses Healthy Work Environments Assessment Tool (HWEAT), interprofessional staff from 11 pediatric CVORs were surveyed. Responses were aggregated, summarized, and stratified by role to examine differences. The following phase used an e-Delphi approach to obtain expert consensus on a benchmark target.

Results:

Across 11 centers, 179 (60%) completed surveys were reviewed. The interprofessional mean HWEAT score was 3.55 (2.65–4.34). Mean scores for each standard were within the “good” range. Participants reported the highest scores for effective decision-making, with a mean of 3.69 (3.00–4.20). Meaningful recognition scored lowest, mean 3.26 (2.33–4.07). When stratified, surgeons reported higher overall HWE scores (M = 3.79, SD = 0.13) than nurses (M = 3.41, SD = 0.19; P = 0.02, two-tailed). The proposed benchmark was 3.50.

Conclusions:

This is the first time the American Association of Critical Care Nurses HWEAT has been used to describe the interprofessional health of work environments in pediatric CVORs in the United States. The targeted benchmark can support pediatric CVOR improvement strategies. Creating and sustaining an HWE is an interprofessional opportunity to support high-quality patient outcomes and clinical excellence.
68Ga-PSMA Versus 18F-FDG PET/CT in the Evaluation of Epithelioid Hemangioendothelioma
Authors: Şenses Veysi , Kaplan İhsan , Kaya Fulya , Ibiloğlu İbrahim , Can Canan
Published: June 2024

A 32-year-old man with epithelioid hemangioendothelioma was imaged with 68Ga-PSMA PET/CT to evaluate the potential of 177Lu-PSMA radionuclide therapy after progression findings were observed on follow-up 18F-FDG PET/CT imaging. Liver lesions showed low FDG SUVmax. The lesion-to-background ratio (TBR) was calculated as 5.1/2.9 on 18F-FDG PET/CT imaging. However, 68Ga-PSMA PET/CT showed moderate PSMA SUVmax. TBR was calculated as 4.5/1.1. In conclusion, in this case report, we demonstrated that 68Ga-PSMA with moderate TBR in epithelioid hemangioendothelioma may be promising for 177Lu-PSMA radionuclide therapy.
18F-FDG Brain PET/MRI in Granulomatous Primary Angiitis of the Central Nervous System
Authors: Sagnelli Matthew , Alkabie Samir , Franceschi Ana M.
Published: June 2024

An 18-year-old man presented with encephalopathy, headache, tremor, and left hemiparesis. 18F-FDG brain PET/MRI revealed pronounced hypometabolism in the right cerebral hemisphere corresponding to extensive T2/FLAIR signal abnormality, with accompanying miliary enhancement and microhemorrhages in this region. The differential diagnosis favored an autoimmune or inflammatory origin, rather than an infectious or neoplastic etiology. Brain biopsy demonstrated nonnecrotizing granulomatous inflammation affecting the vessel walls, without evidence of glial neoplasm, lymphoma, or infection. Treatment with corticosteroids was subsequently initiated, with favorable clinical response.
Otology and Audiology: Complications, Challenges, and Concerns in the Patient With Cleft Lip and/or Palate
Authors: Smerica Abel M. , Amer Rida , Edmonds Joseph , Edmonds Joseph L.
Published: June 2024

Cleft lip and/or palate, a treatable congenital condition, affects around 1 in 700 births, placing a large burden of care on those affected. A multidisciplinary approach to treating the patient involves not only cleft surgery but also a wide array of treatments and preventative therapies to prevent further disease. In this review, the otolaryngology subspecialties, otology and audiology, are discussed in relation to orofacial clefts. As patients with clefts carry a higher risk of permanent hearing loss and speech complications caused by the pathology of their cleft, management of additional diseases such as otitis media with effusion, conductive hearing loss, or infections requires timely evaluation, treatment, and follow-up. The current practice in otology and audiology is discussed with the challenges faced in delivering timely care—in any setting, low or higher income. Lack of consensus and controversies surrounding the use and timing of tympanostomy tubes are reviewed, as well as the palatoplasty types that show significant benefit for otitis media with effusion, audiometry, and speech outcomes. Lastly, a call for further research in clefts and otology and the urgency for its awareness and advocacy in low and middle-income countries is imperative.