bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant Talazoparib in Patients With Germline BRCA1/2 Mutation-Positive, Early-Stage Triple-Negative Breast Cancer: Results of a Phase II Study
Authors: Litton Jennifer K , Beck J Thaddeus , Jones Jason M , Andersen Jay , Blum Joanne L , Mina Lida A , Brig Raymond , Danso Michael , Yuan Yuan , Abbattista Antonello , Noonan Kay , Niyazov Alexander , Chakrabarti Jayeta , Czibere Akos , Symmans William F , Telli Melinda L
Published: June 2023

Background

The undetermined efficacy of the current standard-of-care neoadjuvant treatment, anthracycline/platinum-based chemotherapy, in patients with early-stage triple-negative breast cancer (TNBC) and germline BRCA mutations emphasizes the need for biomarker-targeted treatment, such as poly(ADP-ribose) polymerase inhibitors, in this setting. This phase II, single-arm, open-label study evaluated the efficacy and safety of neoadjuvant talazoparib in patients with germline BRCA1/2-mutated early-stage TNBC.

Patients and Methods

Patients with germline BRCA1/2-mutated early-stage TNBC received talazoparib 1 mg once daily for 24 weeks (0.75 mg for moderate renal impairment) followed by surgery. The primary endpoint was pathologic complete response (pCR) by independent central review (ICR). Secondary endpoints included residual cancer burden (RCB) by ICR. Safety and tolerability of talazoparib and patient-reported outcomes were assessed.

Results

Of 61 patients, 48 received ≥80% talazoparib doses, underwent surgery, and were assessed for pCR or progressed before pCR assessment and considered nonresponders. pCR rate was 45.8% (95% confidence interval [CI], 32.0%-60.6%) and 49.2% (95% CI, 36.7%-61.6%) in the evaluable and intent-to-treat (ITT) population, respectively. RCB 0/I rate was 45.8% (95% CI, 29.4%-63.2%) and 50.8% (95% CI, 35.5%-66.0%) in the evaluable and ITT population, respectively. Treatment-related adverse events (TRAE) were reported in 58 (95.1%) patients. Most common grade 3 and 4 TRAEs were anemia (39.3%) and neutropenia (9.8%). There was no clinically meaningful detriment in quality of life. No deaths occurred during the reporting period; 2 deaths due to progressive disease occurred during long-term follow-up (>400 days after first dose).

Conclusions

Neoadjuvant talazoparib monotherapy was active despite pCR rates not meeting the prespecified threshold; these rates were comparable to those observed with combination anthracycline- and taxane-based chemotherapy regimens. Talazoparib was generally well tolerated.

ClinicalTrials.gov identifier

NCT03499353
Childhood Adversity and Emerging Psychotic Experiences: A Network Perspective
Authors: Qiao Zhiling , Lafit Ginette , Lecei Aleksandra , Achterhof Robin , Kirtley Olivia J , Hiekkaranta Anu P , Hagemann Noëmi , Hermans Karlijn S F M , Boets Bart , Reininghaus Ulrich , Myin-Germeys Inez , van Winkel Ruud
Published: June 2023

Background and Hypothesis

Childhood adversity is associated with a myriad of psychiatric symptoms, including psychotic experiences (PEs), and with multiple psychological processes that may all mediate these associations.

Study Design

Using a network approach, the present study examined the complex interactions between childhood adversity, PEs, other psychiatric symptoms, and multiple psychological mediators (ie, activity-related and social stress, negative affect, loneliness, threat anticipation, maladaptive cognitive emotion regulation, attachment insecurity) in a general population, adolescent sample (n = 865, age 12–20, 67% female).

Study Results

Centrality analyses revealed a pivotal role of depression, anxiety, negative affect, and loneliness within the network and a bridging role of threat anticipation between childhood adversity and maladaptive cognitive emotion regulation. By constructing shortest path networks, we found multiple existing paths between different categories of childhood adversity and PEs, with symptoms of general psychopathology (ie, anxiety, hostility, and somatization) as the main connective component. Sensitivity analyses confirmed the robustness and stability of the networks. Longitudinal analysis in a subsample with Wave 2 data (n = 161) further found that variables with higher centrality (ie, depression, negative affect, and loneliness) better predicted follow-up PEs.

Conclusions

Pathways linking childhood adversity to PEs are complex, with multifaceted psychological and symptom-symptom interactions. They underscore the transdiagnostic, heterotypic nature of mental ill-health in young people experiencing PEs, in agreement with current clinical recommendations.
Bringing the Walk with Ease Programme to the UK: a mixed-methods study to assess the relevance, acceptability, and feasibility of implementation for people with arthritis and musculoskeletal conditions
Authors: Martin Kathryn R , Stelfox Kevin , Macfarlane Gary J , McNamee Paul , Morrison Zoe , Smith Toby O
Published: June 2023

Developed in the United States (US), Walk With Ease (WWE) is a popular evidence-based, 6-week community walking programme for adults with arthritis, delivered in either an instructor-led or self-directed format. While WWE has expanded into communities across the USA, it is relatively unknown in other countries across the globe. This study, in collaboration with community and patient partners, aimed to examine the relevance, acceptability and feasibility of introducing WWE into a UK context. After initial cultural adaptation, participants were recruited into the study. Eligible (≥18 years, doctor diagnosed arthritis (confirmed or self-report), self-reported joint symptoms in last 30 days, BMI ≥25 kg/m2, and <150 min/week of moderate/vigorous PA) and consented participants were randomized into two groups: WWE programme or usual care. A mixed-methods analysis approach integrated quantitative data (physical performance assessment; baseline and post-six week programme questionnaire) and qualitative data (narrative interviews exploring participants’ pre- and post-WWE experiences and stakeholders’ perceptions). Of 149 participants, the majority were women (70%) aged ≥60 years (76%). Among the 97 receiving the programme, 52 chose instructor-led; 45 chose self-directed. Participants found WWE relevant and acceptable—99% indicating they would recommend WWE to family/friends. Within both WWE formats, mixed differences representing improvement were observed at 6 weeks from baseline for physical performance and arthritis symptoms. Emergent themes included improved motivation, health, and social well-being. WWE is a relevant and acceptable walking programme with scope for wider implementation to support UK health and well-being policy strategies.
The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study
Authors: Adella Fidelis Jacklyn , Vanna Moul , Adhikari Bipin , Ol Sam , Tripura Rupam , Davoeung Chan , Callery James J , Sovann Yok , Chandna Arjun , Bunreth Voeunrung , Asnong Carina , von Seidlein Lorenz , Dondorp Arjen M , Maude Richard J , Lubell Yoel , Wills Bridget , Lek Dysoley , Peto Thomas J
Published: June 2023

Background

The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. The objective of this study was to assess the feasibility of point-of-care tests to diagnose acute febrile illnesses in primary care settings.

Methods

A mixed-methods study was conducted at nine rural health centres in western Cambodia. Workshops introduced health workers to the STANDARD(TM) Q Dengue Duo, STANDARD(TM) Q Malaria/CRP Duo and a multiplex biosensor detecting antibodies and/or antigens of eight pathogens. Sixteen structured observation checklists assessed users’ performances and nine focus group discussions explored their opinions.

Results

All three point-of-care tests were performed well under assessment, but sample collection was difficult for the dengue test. Respondents expressed that the diagnostics were useful and could be integrated into routine clinical care, but were not as convenient to perform as standard malaria rapid tests. Health workers recommended that the most valued point-of-care tests would directly inform clinical management (e.g. a decision to refer a patient or to provide/withhold antibiotics).

Conclusions

Deployment of new point-of-care tests to health centres could be feasible and acceptable if they are user-friendly, selected for locally circulating pathogens and are accompanied by disease-specific education and simple management algorithms.
Phyllosphere 2022: 11th International Symposium on Leaf Surface Microbiology
Authors: Leveau Johan H. J. , Coaker Gitta L. , Marco Maria L.
Published: June 2023

This Meeting Review article offers a synthesis of the science presented and discussed at the recently held 11th International Symposium on Leaf Surface Microbiology, also known as Phyllosphere 2022, at the University of California–Davis (UC Davis), 17 to 21 July 2022. Twice postponed due to Covid-19, this in-person conference covered wide-ranging but intersecting topics related to the microbiology of leaves (and other aboveground parts of plants), including phytopathology, food safety, plant physiology, microbial ecology, fluid physics, vegetation science, single-cell biology, canopy architecture, and human health. The overarching theme of the meeting (“understanding the rules of phyllospheric life”) was explored in 46 podium and 12 poster presentations. It also fueled the formal and informal discussions among 90-plus conference participants about existing and new questions in phyllosphere microbiology. Are there first principles underlying the acquisition, assembly and succession of microbial communities in the phyllosphere? How best to define, recognize, and exploit phyllosphere fitness of microscopic leaf dwellers? At what scales do or should we sample, interrogate, and understand the phyllosphere? What still needs to be learned that keeps us from new insights, resources, and tools to produce healthier or more nutritious plant foliage? Having the conference at UC Davis in the summer presented a unique opportunity to “vertically integrate” high school students from the COSMOS program into the Phyllosphere 2022 conference and allow face-to-face interactions with early-career scientists and prominent senior career professionals in phyllosphere microbiology. Students thus experienced first-hand the ways in which scientists address problems that affect society and seek understanding and solutions to those problems. It represented an effective approach to engage a younger generation into thinking about research and stewardship of plants and their foliage and, more generally, about the merits of a science career.
Evaluation of Stagonospora Nodorum Blotch Severity and Parastagonospora nodorum Population Structure and Genetic Diversity Across Multiple Locations and Wheat Varieties in Virginia
Authors: Kaur Navjot , Mehl Hillary L. , Langston David , Haak David C.
Published: June 2023

Parastagonospora nodorum is a necrotrophic pathogen that causes Stagonospora nodorum blotch (SNB) in wheat. Wheat varieties grown in Virginia vary in susceptibility to SNB, and the severity of SNB varies across locations and years. However, the impacts of wheat genetic backgrounds and environments on SNB severity and the structure of P. nodorum populations in the region have not been well studied. Thus, a population genetic study was conducted utilizing P. nodorum isolates collected from different wheat varieties and locations in Virginia. A total of 320 isolates were collected at seven locations over 2 years from five wheat varieties. Isolates were genotyped using multilocus simple sequence repeat markers, and necrotrophic effector (NE) and mating type genes were amplified using gene-specific primers. Wheat varieties varied in susceptibility to SNB, but site-specific environmental conditions were the primary drivers of disease severity. Fungal populations were genetically diverse, but no genetic subdivision was observed among locations or varieties. The ratio of the two mating type idiomorphs was not significantly different from 1:1, consistent with the P. nodorum population undergoing sexual reproduction. Three major NE genes were detected within the P. nodorum population, but not with equal frequency. However, NE gene profiles were similar for groups of isolates originating from different varieties, suggesting that wheat genetic backgrounds do not differentially select for NEs. There was no evidence of population structure among P. nodorum populations in Virginia and, thus, no support for wheat genetic backgrounds shaping these populations. Finally, although varieties only exhibited moderate resistance to SNB, current levels of resistance are likely to be durable over time and remain a useful tool for integrated management of SNB in the region.

[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 .
Beyond the Malleoli: Part 2—Avulsion Fractures of the Hindfoot
Authors: Kani Kimia , Davis Derik L. , Jo Stephanie , Chew Felix S.
Published: June 2023

Avulsion fractures of the ankle and hindfoot are a diverse group of injuries occurring at level of retinacular, capsuloligamentous, and tendinous attachments. Accurate identification of avulsion fractures and their origins is based on understanding the relevant soft-tissue anatomy. In the first part of this two-series article, avulsion fractures at level of the ankle retinacula and distal tibiofibular syndesmosis were reviewed. The second part of this series of two articles is dedicated to reviewing the relevant anatomy, injury mechanisms, classification, nomenclature, imaging, treatment, and complications of hindfoot avulsion fractures occurring at level of the lateral ankle ligament complex (distally), posterior talar process, tendinous attachments, and miscellaneous soft-tissue attachments not otherwise specified.
Sex and Race Representation in Temporal Bone Histopathology Studies in the United States: A Systematic Review
Authors: Krishnan Pavan S. , Lauer Amanda M. , Ward Bryan K. , Seal Stella M. , Nieman Carrie L. , Andresen Nicholas S.
Published: June 2023

Objectives:

The author’s objective was to evaluate sex and race representation in temporal bone histopathology studies.

Design:

PubMed, Embase, Cochrane, Web of Science, and Scopus were searched for studies written in English examining temporal bone histopathology specimens from U.S.-based institutions from January 1, 1947, to September 1, 2021. Two authors then performed “snowballing” by reviewing references from the initial search and included the studies that fulfilled the inclusion criteria. For each study, the following information was collected: publication details, study design, funding, institution from where temporal bone specimens were procured, number of study specimens, and donor demographical information.

Results:

The authors found that out of 300 studies, 166 (55%) report sex while only 15 (5%) reported race information. Over the past 70 years, the ratio of studies reporting sex to those that do not has increased from 1.00 to 2.19 and the number of female temporal bone histopathology subjects relative to male has increased from 0.67 to 0.75. Over 90% of studies that do report this information feature participant racial compositions that do not reflect the diversity of the U.S. population.

Conclusions:

Studies of temporal bone histopathology often do not report participant sex or race. The reporting of participant sex and the inclusion of specimens from female donors have both increased over time. However, temporal bone histopathology study cohorts are not representative of the racial diversity of the U.S. population. The otolaryngology community must strive to build temporal bone histopathology libraries that are representative of the diverse U.S. population.
A Hybrid Deep Learning Approach to Identify Preventable Childhood Hearing Loss
Authors: Jin Felix Q. , Huang Ouwen , Kleindienst Robler Samantha , Morton Sarah , Platt Alyssa , Egger Joseph R. , Emmett Susan D. , Palmeri Mark L.
Published: June 2023

Objective:

Childhood hearing loss has well-known, lifelong consequences. Infection-related hearing loss disproportionately affects underserved communities yet can be prevented with early identification and treatment. This study evaluates the utility of machine learning in automating tympanogram classifications of the middle ear to facilitate layperson-guided tympanometry in resource-constrained communities.

Design:

Diagnostic performance of a hybrid deep learning model for classifying narrow-band tympanometry tracings was evaluated. Using 10-fold cross-validation, a machine learning model was trained and evaluated on 4810 pairs of tympanometry tracings acquired by an audiologist and layperson. The model was trained to classify tracings into types A (normal), B (effusion or perforation), and C (retraction), with the audiologist interpretation serving as reference standard. Tympanometry data were collected from 1635 children from October 10, 2017, to March 28, 2019, from two previous cluster-randomized hearing screening trials (NCT03309553, NCT03662256). Participants were school-aged children from an underserved population in rural Alaska with a high prevalence of infection-related hearing loss. Two-level classification performance statistics were calculated by treating type A as pass and types B and C as refer.

Results:

For layperson-acquired data, the machine-learning model achieved a sensitivity of 95.2% (93.3, 97.1), specificity of 92.3% (91.5, 93.1), and area under curve of 0.968 (0.955, 0.978). The model’s sensitivity was greater than that of the tympanometer’s built-in classifier [79.2% (75.5, 82.8)] and a decision tree based on clinically recommended normative values [56.9% (52.4, 61.3)]. For audiologist-acquired data, the model achieved a higher AUC of 0.987 (0.980, 0.993), had an equivalent sensitivity of 95.2 (93.3, 97.1), and a higher specificity of 97.7 (97.3, 98.2).

Conclusions:

Machine learning can detect middle ear disease with comparable performance to an audiologist using tympanograms acquired either by an audiologist or a layperson. Automated classification enables the use of layperson-guided tympanometry in hearing screening programs in rural and underserved communities, where early detection of treatable pathology in children is crucial to prevent the lifelong adverse effects of childhood hearing loss.
Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults
Authors: Gao Qiannan , Li Liuxin , Bai Jingjing , Fan Luyun , Tan Jiangshan , Wu Shouling , Cai Jun
Published: June 2023

Background:

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population.

Methods:

Participants with stage 1 hypertension (n = 69,509) or normal BP (n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130–139 mmHg or a diastolic blood pressure of 80–89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis.

Results:

During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13–1.25) for primary outcome, 1.24 (95% CI, 1.05–1.46) for MI, 1.45 (95% CI, 1.33–1.59) for stroke, and 1.11 (95% CI, 1.04–1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85–0.96).

Conclusion:

Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.
Dermal Thickness Increase and Aesthetic Improvement with Hybrid Product Combining Hyaluronic Acid and Calcium Hydroxyapatite: A Clinical and Sonographic Analysis
Authors: Bravo Bruna Souza Felix , Almeida Thamires Silva Cavalcante de , Carvalho Raquel de Melo , Machado Carla Jorge , Bravo Leonardo Gonçalves , Elias Mariana Calomeni
Published: June 2023

Background:

Hyaluronic acid filler injections are regarded as the gold standard procedure for facial rejuvenation. Standing as the second most injected cosmetic filler, calcium hydroxyapatite-based fillers are also widely used worldwide. However, to our knowledge, prospective studies assessing patient satisfaction and sonographic changes in dermal thickness after a single session of a hybrid filler combining hyaluronic acid and calcium hydroxyapatite have not been previously published.

Methods:

This was a single-center, prospective, quasi-experimental study comprising 15 participants between 32 and 63 years of age. Each participant received a single-session treatment based on facial subcutaneous injections of HArmonyCa, a hybrid combination filler comprising hyaluronic acid and calcium hydroxyapatite. This study involved an intrapatient control design and a 120-day follow-up with clinical and sonographic assessment. For this purpose, standardized photographic images, high-frequency ultrasound evaluations, and physician- and patient-oriented overall aesthetic improvement scores were recorded at 0, 30, 90, and 120 following the procedure.

Results:

According to our findings, 20% of the subjects had an exceptional improvement; 20%, “very improved”; and 60%, “improved.” Intrapatient sonographic comparison showed a significant increase in dermal thickness, at 90 and 120 days, only on the side treated (P < 0.001).

Conclusion:

In our clinical study, a single-session treatment with a hybrid product combining hyaluronic acid and calcium hydroxyapatite resulted in positive cosmetic satisfaction and increased dermal thickness.
Transfacial Two-pin External Mandibular Distraction Osteogenesis: A Technique for Neonatal Airway Obstruction from Robin Sequence
Authors: Babiker Haithem Elhadi , Runyan Christopher M. , Bins Griffin P. , Oliver Jeremie D. , Massary Dominic A. , Lor Lyfong S. , Rapp Scott J. , Pan Brian S. , Gordon Christopher B.
Published: June 2023

Background:

Surgical management in those with moderate-to-severe airway obstruction includes tongue-lip adhesion, tracheostomy, and/or mandibular distraction osteogenesis. This article describes a transfacial two-pin external device technique for mandibular distraction osteogenesis, utilizing minimal dissection.

Methods:

The first percutaneous pin is transcutaneously placed just inferior to the sigmoid notch parallel to the interpupillary line. The pin is then advanced through the pterygoid musculature at the base of the pterygoid plates, toward the contralateral ramus, and exits the skin. A second parallel pin is placed spanning the bilateral mandibular parasymphysis distal to the region of the future canine. With the pins in place, bilateral high ramus transverse corticotomies are performed. Using univector distractor devices, the length of activation varies, with the goal of overdistraction to achieve a class III relationship of the alveolar ridges. Consolidation is limited to a 1:1 period with the activation phase, and removal is performed by cutting and pulling the pins out of the face.

Results:

To guide optimal transcutaneous pin placement, transfacial pins were then placed through twenty segmented mandibles. Mean upper pin (UP) distance was 20.7 ± 1.1 mm from the tragus. The distance between the cutaneous entry of the UP and lower pin was 23.5 ± 0.9 mm, and the tragion-UP-lower pin angle was 118.7 ± 2.9°.

Conclusions:

The two-pin technique has potential advantages regarding nerve injury and mandibular growth, given an intraoral approach with limited dissection. It may safely be performed on neonates whose small size may preclude the use of internal distractor devices.
Surgical techniques - Capsule dynamics, implantation and explantation of the smaller incision, new generation implantable miniature telescope, a Miyake-Apple study
Authors: Hammer Maximilian , Schickhardt Sonja , Zhang Lu , Munro Donald , Yildirim Timur M , Auffarth Gerd U
Published: June 2023

Purpose:

The smaller incision, new generation implantable miniature telescope is a novel implant to optimize vision in retinal patients with central vision loss. Using Miyake-Apple techniques we visualized the device implantation, repositioning and explantation while noting capsular bag dynamics.

Methods:

Using the Miyake-Apple technique, we assessed capsular bag deformation after successful implantation of the device in human autopsy eyes. We assessed rescue strategies for converting a sulcus implantation to a capsular implantation as well as explantation strategies. We noted the occurrence of posterior capsule striae, zonular stress and the haptics’ arc of contact with the capsular bag after implantation.

Results:

Acceptable zonular stress was observed during the successful implantation of the SING IMT. When it was implanted in the sulcus, one could reposition the haptics into the bag with two spatulas using counter-pressure in an effective strategy despite inducing tolerable, medium zonular stress. A similar technique, in reverse, allows safe explantation without damaging the rhexis or the bag while inducing similar medium, tolerable zonular stress. In all eyes we examined, the implant considerably stretches the bag inducing a capsular bag deformation and posterior capsule striae.

Conclusion:

The SING IMT can be safely implanted without significant zonular stress. In sulcus implantation and explantation, repositioning of the haptic is achievable without perturbing zonular stress using the presented approaches. It stretches average-sized capsular bags to support its weight. This is achieved by an increased arc of contact of the haptics with the capsular equator.
Novel Mechanisms Guide Innovative Molecular-Based Therapeutic Strategies for Fuchs Endothelial Corneal Dystrophy
Authors: Chan Matilda F. , Pan Peipei , Wolfreys Finn D.
Published: June 2023

Major advances in genomics have dramatically increased our understanding of Fuchs endothelial corneal dystrophy (FECD) and identified diverse genetic causes and associations. Biomarkers derived from these studies have the potential to inform both clinical treatment and yield novel therapeutics for this corneal dystrophy.
Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy
Authors: Zhu Lingyu , Gao Suizhi , Wu Xinqian , Li Bo , Shi Xiaohan , Yin Xiaoyi , Wang Huan , Shi Meilong , Li Penghao , Li Yikai , Zhong Chaoliang , Teng Chuanqi , Han Jiawei , Ren Yiwei , Wang Jian , Fu Zhendong , Liu Xinyu , Zheng Kailian , Guo Shiwei , Jin Gang
Published: June 2023

Objective:

To evaluate the survival outcomes of patients who underwent conversion surgery for metastatic pancreatic ductal adenocarcinoma (mPDAC) after neoadjuvant therapy (NAT) and to identify potential candidates that may benefit from this treatment strategy.

Background:

The role and eligibility population of conversion surgery for mPDAC remains controversial in the era of NAT.

Methods:

A consecutive cohort of patients diagnosed with mPDAC and treated with NAT followed by conversion surgery between 2019 and 2021 were confirmed from a prospective database maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai Hospital. In accordance with residual metastases and technical resectability after NAT, patients were classified as the complete pathological response of metastases (ypM0) resection group, residual metastases (ypM1) resection group, and exploration group. Median overall survival (mOS) was calculated using the Kaplan-Meier method, uni- and multivariable cox regression was performed to identify clinicopathological predictors of OS.

Results:

A total of 244 patients with mPDAC were identified from the prospective database, with 19 (7.8%) patients who underwent ypM0 resection, 22 (9.0%) underwent ypM1 resection, and 23 (9.4%) underwent explorative laparotomy. The mOS was 32.6 months for ypM0 resected patients, 15.1 months for ypM1 resected patients, and 13.4 months for those who underwent explorative laparotomy (P < .001). Univariable and multivariable Cox regression analyses confirmed that ypM0 resection, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent prognostic factors of conversion surgery for mPDAC after NAT. Subgroup analyses revealed that oligometastases and continued adjuvant therapy were associated with improved prognosis in the ypM1 resection group.

Conclusion:

In patients with mPDAC who underwent NAT followed by conversion surgery, the complete pathological response of metastases, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent risk factors for prognosis. Patients with residual oligometastases after treatment were expected to prolong survival through resection. These patients may benefit from conversion surgery and should be potential candidates for this treatment strategy.
Risk factors of epidural hematoma in patients undergoing spinal surgery: a meta-analysis of 29 cohort studies
Authors: Luo Mingjiang , Cao Qi , Zhao Zhiming , Shi Yuxin , Yi Qilong , Chen Jiang , Zeng Xin , Wang Zhongze , Wang Haoyun , Yang Yuxin , Chen Juemiao , Yang Gaigai , Zhou Beijun , Liang Can , Tan Ridong , Wang Di , Tang Siliang , Huang Jinshan , Xiao Zhihong , Mei Zubing
Published: June 2023

Objective

We conducted this meta-analysis to identify risk factors for spinal epidural hematoma (SEH) among patients following spinal surgery.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library for articles that reported risk factors associated with the development of SEH in patients undergoing spinal surgery from inception to July 2, 2022. The pooled OR was estimated using a random-effects model for each investigated factor. The evidence of observational studies was classified as high-quality (Class I), moderate-quality (Class II or III) and low-quality (Class IV) based on sample size, Egger’s P value and between-study heterogeneity. In addition, subgroup analyses stratified by study baseline characteristics and leave-one-out sensitivity analyses were performed to explore the potential sources of heterogeneity and the stability of the results.

Results

Of 21791 articles screened, 29 unique cohort studies comprising 150,252 patients were included in the data synthesis. Studies with high-quality evidence showed that older patients (≥60 y) (OR, 1.35; 95% CI, 1.03-1.77) were at higher risk for SEH. Studies with moderate-quality evidence suggested that patients with a BMI ≥25 kg/m² (OR, 1.39; 95% CI, 1.10-1.76), hypertension (OR, 1.67; 95% CI, 1.28-2.17), and diabetes (OR, 1.25; 95% CI, 1.01-1.55) and those undergoing revision surgery (OR, 1.92; 95% CI, 1.15-3.25) and multilevel procedures (OR, 5.20; 95% CI, 2.89-9.37) were at higher risk for SEH. Meta-analysis revealed no association between tobacco use, operative time, anticoagulant use or American Society of Anesthesiologists (ASA) classification and SEH.

Conclusions

Obvious risk factors for SEH include four patient-related risk factors, including older age, obesity, hypertension, and diabetes, and two surgery-related risk factors, including revision surgery and multilevel procedures. These findings, however, must be interpreted with caution because most of these risk factors had small effect sizes. Nonetheless, they may help clinicians identify high-risk patients to improve prognosis.
Algorithmic Bias and Research integrity; the role of non-human authors in shaping scientific knowledge with respect to Artificial Intelligence (AI); a perspective
Authors: Olatunde Oduoye Malik , Javed Binish , Gupta Nikhil , Valentina Sih Che Mbali
Published: June 2023

Artificial intelligence (AI) technologies were developed to assist authors in bettering the organization and calibre of their published papers, which are both growing in quantity and sophistication. Even though the usage of artificial intelligence tools in particular Chat GPT’s natural language processing systems has shown to be beneficial in research, there are still concerns about accuracy, responsibility, and transparency when it comes to the norms regarding authorship credit and contributions. Genomic algorithms quickly examine large amounts of genetic data to identify potential disease-causing mutations. By analyzing millions of medications for potential therapeutic benefits, they can quickly and relatively economically find novel approaches to treatment. Researchers from several fields can collaborate on difficult tasks with the assistance of non-human writers, promoting interdisciplinary research. Sadly, there are a number of significant disadvantages associated with employing non-human authors, including the potential for algorithmic prejudice. Biased data may be reinforced by the algorithm since machine learning algorithms can only be as objective as the data they are trained on. It is overdue that scholars bring forth basic moral concerns in the fight against algorithmic prejudice. Overall, even if the use of non-human authors has the potential to significantly improve scientific research, it is crucial for scientists to be aware of these drawbacks and take precautions to avoid bias and limits. To provide accurate and objective results, algorithms must be carefully designed and implemented, and researchers need to be mindful of the larger ethical ramifications of their usage.
Multi-level effective surgical workflow recognition in robotic left lateral sectionectomy with deep learning: Experimental research
Authors: Liu Yanzhe , Zhao Shang , Zhang Gong , Zhang Xiuping , Hu Minggen , Zhang Xuan , Li Chenggang , Zhou S. Kevin , Liu Rong
Published: June 2023

Background:

Automated surgical workflow recognition is the foundation for computational models of medical knowledge to interpret surgical procedures. The fine-grained segmentation of the surgical process and the improvement of the accuracy of surgical workflow recognition facilitate the realization of autonomous robotic surgery. This study aimed to construct a multi-granularity temporal annotation dataset of the standardized robotic left lateral sectionectomy (RLLS) and develop a deep learning-based automated model for multi-level overall and effective surgical workflow recognition.

Methods:

From Dec 2016 to May 2019, 45 cases of RLLS videos were enrolled in our dataset. All frames of RLLS videos in this study are labeled with temporal annotations. We defined those activities that truly contribute to the surgery as effective frames, while other activities are labeled as under-effective frames. Effective frames of all RLLS videos are annotated with three hierarchical levels of 4 steps, 12 tasks and 26 activities. A hybrid deep learning model were used for surgical workflow recognition of steps, tasks, activities and under-effective frames. Moreover, we also carried out multi-level effective surgical workflow recognition after removing under-effective frames.

Results:

The dataset comprises 4,383,516 annotated RLLS video frames with multi-level annotation, of which 2,418,468 frames are effective. The overall accuracies of automated recognition for Steps, Tasks, Activities, and Under-effective frames are 0.82, 0.80, 0.79, and 0.85, respectively, with corresponding precision values of 0.81, 0.76, 0.60, and 0.85. In multi-level effective surgical workflow recognition, the overall accuracies were increased to 0.96, 0.88, and 0.82 for Steps, Tasks, and Activities, respectively, while the precision values were increased to 0.95, 0.80, and 0.68.

Conclusion:

In this study, we created a dataset of 45 RLLS cases with multi-level annotations and developed a hybrid deep learning model for surgical workflow recognition. We demonstrated a fairly higher accuracy in multi-level effective surgical workflow recognition when under-effective frames were removed. Our research could be helpful in the development of autonomous robotic surgery.
The International Standard Set of Outcome Measures for the Assessment of Hearing in People with Osteogenesis Imperfecta
Authors: Goderie Thadé , Hendricks Sebastian , Cocchi Chiara , Maroger I. Diane , Mekking Dagmar , Mosnier Isabelle , Musacchio Angela , Vernick David , Smits Cas
Published: June 2023

Objective

The aim is to recommend a minimum standard set of clinician-reported outcome measures (CROMs) and patient-reported outcome measures (PROMs) on hearing for people with osteogenesis imperfecta (OI). This project is part of the larger “Key4OI” project initiated by the “Care4BrittleBones foundation” of which the goal is to improve quality of life of people with OI. Key4OI provides a standard set of outcome measures and covers a large set of domains affecting the well-being of people with OI.

Methods

An international team of experts in OI, comprising specialists in audiological science, medical specialists, and an expert patient representative, used a modified Delphi consensus process to select CROMs and PROMs to evaluate hearing problems in people with OI. In addition, focus groups of people with OI identified key consequences of their hearing loss. These criteria were matched to categories of preselected questionnaires to select a PROM that matched their specific hearing-related concerns best.

Results

Consensus on PROMs for adults and CROMs for adults and children was reached. The focus of the CROMs was on specific audiological outcome measures and standardized follow-up.

Conclusions

This project resulted in a clear consensus statement for standardization of hearing-related PROMs and CROMs and follow-up management of patients with OI. This standardization of outcome measurements will facilitate comparability of research and easier international cooperation in OI and hearing loss. Furthermore, it can improve standard of care in people with OI and hearing loss by incorporating the recommendations into care pathways.
Percutaneous Bone-Anchored Hearing Implant Surgery: Do Syndromic Children Have More Adverse Perioperative Outcomes?
Authors: Salameh Samer , El-Khoury Sabine , Bezdjian Aren , Roy Catherine F. , Khneisser Edwina , Bianchi Marco , Daniel Sam J.
Published: June 2023

Objective

To evaluate and compare perioperative outcomes of percutaneous bone-anchored hearing implant (BAHI) surgery in syndromic and nonsyndromic pediatric patients.

Study Design

Retrospective cohort study

Setting

McGill University Health Centre in Montreal, Quebec, Canada.

Patients

Forty-one pediatric patients (22 syndromic, 19 nonsyndromic) who underwent percutaneous BAHI surgery between March 2008 and April 2021.

Intervention

Percutaneous BAHI surgery.

Main Outcome Measures

Patient demographics (age at surgery, gender, implant laterality), operative information (American Society of Anesthesia [ASA] score, anesthesia type, surgical technique, implant/abutment characteristics), and postoperative outcomes (implant stability, soft tissue integrity, surgical revisions, implant failure).

Results

The most frequent syndromes among implanted patients were Treacher Collins (27.3%), Goldenhar (13.6%), Trisomy 21 (13.6%), and Nager (9.1%). Syndromic patients were more frequently given higher ASA scores: 2 (p = 0.003) and 3 (p = 0.014). All cases of implant extrusion were in syndromic patients: two posttraumatic and two failures to osseointegrate. Nine (40.9%) syndromic patients experienced a Holgers Grade 4 skin reaction at one of their postoperative follow-up visits as compared to 0% of nonsyndromic patients (p < 0.001). Implant stability was similar between cohorts at all postoperative time-points, except for significantly greater nonsyndromic implant stability quotient scores at 16 weeks (p = 0.027) and 31+ weeks (p = 0.016).

Conclusions

Percutaneous BAHI surgery is a successful rehabilitation option in syndromic patients. However, it presents a relatively higher incidence of implant extrusion and severe postoperative skin reactions as compared to nonsyndromic patients. In light of these findings, syndromic patients may be great candidates for novel transcutaneous bone conduction implants.
Correlation Between Laterality of Hearing Loss and Migraine Features in Menière's Disease
Authors: Tawk Karen , Kim Joshua K. , Frank Madelyn , Goshtasbi Khodayar , Abouzari Mehdi , Djalilian Hamid R.
Published: June 2023

Objectives

The objective of this study is to understand whether the hearing loss laterality in Menière's disease (MD) correlates with migraine symptoms laterality such as headache, neck stiffness, and otalgia.

Methods

We performed a retrospective review of prospectively obtained data on patients presenting between September 2015 and October 2021 with definite or probable MD. A custom-designed, comprehensive questionnaire was used to identify patients' migraine-related symptoms. The clinical and audiometric data were used to diagnose patients with definite or probable MD using criteria set by the American Academy of Otolaryngology–Head and Neck Surgery.

Results

In total, 113 patients with definite or probable MD were included in the study. The mean age of the patients was 60 ± 15 years with no gender predominance (49.6% male and 50.4% female). A total of 57 (50%) patients were presented with headaches. Among the migraine headache cohort, headache and otalgia were on the same side as the MD ear affected by hearing loss. In addition, in patients who present with otalgia as the primary feature of headache, otalgia was more likely to be on the same side as the ear affected by the hearing loss.

Conclusions

The high prevalence of migraine symptoms on the same side of the ear affected by MD among this cohort could suggest a shared pathophysiology in both MD and migraine, possibly involving migraine-related changes in both the cochlea and vestibule.
Gastric Intestinal Metaplasia in Children: Natural History and Clinicopathological Correlation
Authors: Mansuri Ishrat , Goldsmith Jeffrey D. , Liu Enju , Bonilla Silvana
Published: June 2023

Introduction:

Gastric intestinal metaplasia (GIM) is defined as the replacement of the normal gastric epithelium by intestinal-type epithelium. GIM is considered a preneoplastic lesion for gastric adenocarcinoma in adults and is found in 25% of Helicobacter pylori (H pylori) exposed adults. However, the significance of GIM in pediatric gastric biopsies is still unknown.

Methods:

We conducted a retrospective study of children with GIM on gastric biopsies at Boston Children’s Hospital between January 2013 and July 2019. Demographic, clinical, endoscopic, and histologic data were collected and compared to age and sex-matched cohort without GIM. Gastric biopsies were reviewed by the study pathologist. GIM was classified as complete/incomplete based on Paneth cell presence or absence and limited/extensive based on its distribution in the antrum or both antrum and corpus.

Results:

Of 38 patients with GIM, 18 were male (47%), mean age of detection was 12.5 ± 5.05 years (range, 1–18 years). The most common histologic was chronic gastritis (47%). Complete GIM was present in 50% (19/38) and limited GIM was present in 92% (22/24). H pylori was positive in 2 patients. Two patients had persistent GIM on repeat esophagogastroduodenoscopy (2/12). No dysplasia or carcinoma was identified. Proton-pump inhibitor use and chronic gastritis were more common in GIM patients compared to control (P = 0.02).

Conclusion:

Most children with GIM had low-risk histologic subtype (complete/limited) for gastric cancer; GIM was rarely associated with H pylori gastritis in our cohort. Larger multicenter studies are needed to better understand outcomes and risk factors in children with GIM.
Award Recipients for Pediatric Gastroenterology: A Descriptive Analysis of Gender Distribution
Authors: Sanghavi Rinarani M. , Nurko Samuel , Silver Julie K. , Rosen Rachel
Published: June 2023

Society awards are an important component of recognition in medicine and for career advancement such as promotion. Multiple studies conducted in pediatrics and gastroenterology have shown underrepresentation of women awardees even in fields with a higher proportion of women than men. To our knowledge, no such studies have been conducted in pediatric gastroenterology. We hypothesized that among all recipients, women would be underrepresented when compared to men and that women were more likely to be given teaching awards compared to other career achievement awards. We collected data on recipients of major recognition award presented by The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition from 1987 to 2022. We found that 80.90% of the awards had been given to men and that most nominators were men. This study highlights inequities in women recipients for major awards and presents an opportunity for a call for action to examine and address the factors contributing to this gender inequity.
Prognostic Factors Among Colonic Adenocarcinomas Invading Into the Muscularis Propria
Authors: Paulsen John D. , Polydorides Alexandros D.
Published: June 2023

Depth of invasion through the intestinal wall, categorized as primary tumor stage (pT), is an important prognostic factor in colorectal cancer. However, additional variables that may affect clinical behavior among tumors involving the muscularis propria (pT2) have not been examined at length. We evaluated 109 patients with pT2 colonic adenocarcinomas (median age: 71 y, interquartile range: 59 to 79 y) along various clinicopathologic parameters, including invasion depth, regional lymph node involvement, and disease progression after resection. Tumors extending to the outer muscularis propria (termed pT2b) were associated in multivariate analysis with older patient age (P=0.04), larger tumor size (P<0.001), higher likelihood of lymphovascular invasion (LVI; P=0.03) and higher lymph node stage (pN; P=0.04), compared with tumors limited to the inner muscle layer (pT2a), and LVI was the single most important variable predicting regional lymph node metastasis at resection in these tumors (P=0.001). The Kaplan-Meier analysis during a median clinical follow-up of 59.7 months (interquartile range: 31.5 to 91.2) revealed that disease progression was more likely in pT2 tumors that exhibited, at the time of staging: size >2.5 cm (P=0.039), perineural invasion (PNI; P=0.047), high-grade tumor budding (P=0.036), higher pN stage (P=0.002), and distant metastasis (P<0.001). Proportional hazards (Cox) regression identified high-grade tumor budding (P=0.02) as independently predicting shorter progression-free survival in pT2 tumors. Finally, among cases that would not ordinarily be candidates for adjuvant treatment (ie, pT2N0M0), the presence of high-grade tumor budding was significantly associated with disease progression (P=0.04). These data suggest that, during the diagnosis of pT2 tumors, pathologists may wish to pay particular attention and ensure adequate reporting of certain variables such as tumor size, depth of invasion within the muscularis propria (ie, pT2a vs. pT2b), LVI, PNI, and, especially, tumor budding, as these may affect clinical treatment decisions and proper patient prognostication.