bluuebunny/crossref_metadata_2025 huggingface dataset:
Super-resolution deep learning reconstruction to improve image quality of coronary CT angiography
Authors: Tomizawa Nobuo , Nozaki Yui , Sato Hideyuki , Kawaguchi Yuko , Kudo Ayako , Takahashi Daigo , Takamura Kazuhisa , Hiki Makoto , Fujimoto Shinichiro , Okai Iwao , Koga Seiji , Okazaki Shinya , Kumamaru Kanako K , Minamino Tohru , Aoki Shigeki
Published: March 2024

Purpose

To compare the objective and subjective image quality and diagnostic performance for coronary stenosis of normal-dose model-based iterative reconstruction and reduced-dose super-resolution deep learning reconstruction in coronary CT angiography.

Materials and Methods

This single-center retrospective study included 52 patients (mean age, 68 years ± 10 [SD]; 41 men) who underwent serial coronary CT angiography and subsequent invasive coronary angiography between January and November 2022. The first 25 patients were scanned with a standard dose using model-based iterative reconstruction. The last 27 patients were scanned with a reduced dose using super-resolution deep learning reconstruction. Per-patient objective and subjective image qualities were compared. Diagnostic performance of model-based iterative reconstruction and super-resolution deep learning reconstruction to diagnose significant stenosis on coronary angiography was compared per-vessel using receiver operating characteristics curve analysis.

Results

The median tube current of super-resolution deep learning reconstruction was lower than that of model-based iterative reconstruction (median [IQR], 890 mA [680, 900] vs. 900 mA [895, 900], P = 0.03). Image noise of super-resolution deep learning reconstruction was lower than that of model-based iterative reconstruction (14.6 Hounsfield units ± 1.3 vs. 22.7 Hounsfield units ± 4.4, P < .001). Super-resolution deep learning reconstruction improved the overall subjective image quality compared with model-based iterative reconstruction (median [IQR], 4 [3, 4] vs 3 [3, 3], P = .006). No difference in the area under the receiver operating characteristic curve in diagnosing coronary stenosis using super-resolution deep learning reconstruction (0.96; 95% CI, 0.92-0.99) and model-based iterative reconstruction (0.96; 95% CI, 0.92-0.98; P = .98) was observed.

Conclusion

Our exploratory analysis suggests that super-resolution deep learning reconstruction could improve image quality with lower tube current settings than model-based iterative reconstruction with similar diagnostic performance to diagnose coronary stenosis in coronary CT angiography.
CT trachea surface roughness is associated with chronic obstructive pulmonary disease symptoms
Authors: Bartlett Jason T , Hogg James C , Bourbeau Jean , Tan Wan C , Kirby Miranda
Published: March 2024

Background

Trachea structural abnormalities occur in patients with chronic obstructive pulmonary disease (COPD), yet there are few methods for quantifying trachea surface topology.

Purpose

To develop a method to quantify trachea surface roughness on CT imaging and investigate the association with airflow limitation and symptoms in COPD.

Materials and Methods

Participants from the multicenter prospective Canadian Cohort Obstructive Lung Disease study between 2009 and 2015 underwent CT imaging and analysis. Established CT measurements included: tracheal index (TI), defined as the smallest ratio of coronal-to-sagittal trachea diameter, low attenuation areas below –950 HU, and wall thickness of a theoretical 10-mm airway. Trachea surface roughness shape (SRS) was calculated as the percent fraction of the measurement box filled by the surface mesh. Multivariable regression models were used to determine association for CT measurements with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and Medical Research Council dyspnea scale (MRC)≥3, adjusting for covariates.

Results

A total of 1253 participants (mean age, 66 ± 10 years; 727 men) from 9 centers were investigated: n = 267 never smokers, n = 369 ever smokers, n = 352 mild COPD, and n = 265 moderate-to-severe COPD. There were no differences between groups for age or race (P < .05). In models including SRS and TI, a 1-standard deviation (SD) increase in SRS was independently associated with a 0.11-SD decrease in FEV1 (β = –0.11; P < .001) and a 0.16-SD decrease in FEV1/FVC (β = –0.16; P < .001); a 1-point increase in SRS was associated with a 13% increased likelihood of MRC ≥ 3 (odds ratio = 1.13; P = .003). In models including SRS, low attenuation areas below –950 HU and wall thickness of a theoretical 10-mm airway, a 1-SD increase in SRS was associated with a 0.21-SD decrease in FEV1 (β = –0.21; P < .001) and a 0.13-SD decrease in FEV1/FVC (β = –0.13; P < .001); a 1-point increase in SRS was associated with a 12% increased likelihood of MRC ≥ 3 (odds ratio = 1.12; P = .006).

Conclusion

Increased trachea surface shape roughness is independently associated with worse airflow and increased symptom burden in COPD.
Explainable AI to identify radiographic features of pulmonary edema
Authors: Danilov Viacheslav V , Makoveev Anton O , Proutski Alex , Ryndova Irina , Karpovsky Alex , Gankin Yuriy
Published: March 2024

Background

Pulmonary edema is a leading cause for requiring hospitalization in patients with congestive heart failure. Assessing the severity of this condition with radiological imaging becomes paramount in determining the optimal course of patient care.

Purpose

This study aimed to develop a deep learning methodology for the identification of radiographic features associated with pulmonary edema.

Materials and Methods

This retrospective study used a dataset from the Medical Information Mart for Intensive Care database comprising 1000 chest radiograph images from 741 patients with suspected pulmonary edema. The images were annotated by an experienced radiologist, who labeled radiographic manifestations of cephalization, Kerley lines, pleural effusion, bat wings, and infiltrate features of edema. The proposed methodology involves 2 consecutive stages: lung segmentation and edema feature localization. The segmentation stage is implemented using an ensemble of 3 networks. In the subsequent localization stage, we evaluated 8 object detection networks, assessing their performance with average precision (AP) and mean AP.

Results

Effusion, infiltrate, and bat wing features were best detected by the Side-Aware Boundary Localization (SABL) network with corresponding APs of 0.599, 0.395, and 0.926, respectively. Furthermore, SABL achieved the highest overall mean AP of 0.568. The Cascade Region Proposal Network network attained the highest AP of 0.417 for Kerley lines and the Probabilistic Anchor Assignment network achieved the highest AP of 0.533 for cephalization.

Conclusion

The proposed methodology, with the application of SABL, Cascade Region Proposal Network, and Probabilistic Anchor Assignment detection networks, is accurate and efficient in localizing and identifying pulmonary edema features and is therefore a promising diagnostic candidate for interpretable severity assessment of pulmonary edema.
A Theory of the Term Structure of Interest Rates under Limited Household Risk Sharing
Authors: Mitra Indrajit , Xu Yu
Published: March 2024

We present a theory in which the interaction between limited sharing of idiosyncratic labor income risk and labor adjustment costs (that endogenously arise through search frictions) determines interest rate dynamics. In the general equilibrium, the interaction of these two ingredients relates bond risk premiums, cross-sectional skewness of income growth, and labor market tightness. Our model rationalizes an upward-sloping average yield curve and predicts a negative relation between labor market tightness and bond risk premiums. We provide evidence for our theory’s mechanism and predictions.
Fractional Trading
Authors: Da Zhi , Fang Vivian W , Lin Wenwei
Published: March 2024

Fractional trading (FT)—the ability to trade less than a whole share—removes barriers to high-priced stocks and facilitates entry by capital-constrained retail investors. We observe a surge of tiny trades, measured using off-exchange one-share trades, among high-priced stocks compared to low-priced stocks after FT is introduced to the U.S. equity markets. These tiny trades, when coordinated during attention-grabbing events, are forceful enough to exert large price pressure on high-priced stocks. Further evidence suggests that FT can even fuel meme-stock-like trading frenzies and bubbles in high-priced stocks, for which the feedback effect likely plays a role. (JEL G10, G12, G14, G18, G32, G41)
Genetic prediction of modifiable lifestyle factors for erectile dysfunction
Authors: Xi Yu-Jia , Feng Yi-Ge , Bai Ya-Qi , Wen Rui , Zhang He-Yi , Su Qin-Yi , Guo Qiang , Li Cheng-Yong , Wang Zhen-Xing , Pei Liang , Zhang Sheng-Xiao , Wang Jing-Qi
Published: March 2024

Background

The causal relationship between certain lifestyle factors and erectile dysfunction (ED) is still uncertain.

Aim

The study sought to investigate the causal effect of 9 life factors on ED through 2-sample single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR).

Methods

Genetic instruments to proxy 9 risk factors were identified by genome-wide association studies. The genome-wide association studies estimated the connection of these genetic variants with ED risk (n = 223 805). We conducted SVMR, inverse variance-weighting, Cochran’s Q, weighted median, MR-Egger, MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier), and MVMR analyses to explore the total and direct relationship between life factors and ED.

Outcomes

The primary outcome was defined as self or physician-reported ED, or using oral ED medication, or a history of surgery related to ED.

Results

In SVMR analyses, suggestive associations with increased the risk of ED were noted for ever smoked (odds ratio [OR], 5.894; 95% confidence interval [CI], 0.469 to 3.079; P = .008), alcohol consumption (OR, 1.495; 95% CI, 0.044 to 0.760; P = .028) and body mass index (BMI) (OR, 1.177; 95% CI, 0.057 to 0.268; P = .003). Earlier age at first intercourse was significantly related to reduced ED risk (OR, 0.659; 95% CI, −0.592 to −0.244; P = 2.5 × 10−6). No strong evidence was found for the effect of coffee intake, time spent driving, physical activity, and leisure sedentary behaviors on the incidence of ED (All P > .05). The result of MVMR analysis for BMI (OR, 1.13; 95% CI, 1.01 to 1.25; P = .045) and earlier age at first intercourse (OR, 0.77; 95% CI, 0.56 to 0.99; P = .018) provided suggestive evidence for the direct impact on ED, while no causal factor was detected for alcoholic drinks per week and ever smoked.

Clinical implications

This study provides evidence for the impact of certain modifiable lifestyle factors on the development of ED.

Strengths and limitations

We performed both SVMR and MVMR to strengthen the causal relationship between exposures and outcomes. However, the population in this study was limited to European ancestry.

Conclusion

Ever smoked, alcoholic drinks per week, BMI, and age first had sexual intercourse were causally related to ED, while the potential connection between coffee intake, physical activity, recreational sedentary habits, and increased risk of ED needs to be further confirmed.
Advances in 3D Bioprinted Cardiac Tissue Using Stem Cell-Derived Cardiomyocytes
Authors: Bliley Jacqueline M , Stang Maria A , Behre Anne , Feinberg Adam W
Published: March 2024

The ultimate goal of cardiac tissue engineering is to generate new muscle to repair or replace the damaged heart. This requires advances in stem cell technologies to differentiate billions of cardiomyocytes, together with advanced biofabrication approaches such as 3D bioprinting to achieve the requisite structure and contractile function. In this concise review, we cover recent progress in 3D bioprinting of cardiac tissue using pluripotent stem cell-derived cardiomyocytes, key design criteria for engineering aligned cardiac tissues, and ongoing challenges in the field that must be addressed to realize this goal.
Genetic Diversity of Ralstonia solanacearum Causing Tobacco Bacterial Wilt in Fujian Province and Identification of Biocontrol Streptomyces sp.
Authors: Wang Rongbo , Li Benjin , Cai Songling , Ding Yingfu , Shi Mingyue , Jin Ting , Lin Wei , Liu Peiqing
Published: March 2024

Tobacco bacterial wilt is a highly destructive soilborne disease caused by the Ralstonia solanacearum species complex, exhibiting a significant risk to global flue-cured tobacco cultivation and resulting in substantial economic loss. In this study, 77 isolates were collected from three prominent flue-cured tobacco cultivation areas in Fujian, China (Nanping, Sanming, and Longyan), in 2021 and 2022. The isolated strains were classified through phylotype-specific multiplex polymerase chain reaction (Pmx-PCR) and physiological tests. The analysis showed that all the strains were associated with phylotype I, race 1, and biovar III. Subsequent phylogenetic analysis using partial egl gene sequences classified the 77 isolates into 5 distinct sequevars: 13, 15, 16, 17, and 34. Notably, a remarkable predominance of sequevar 15 was observed in Fujian Province, while sequevar 16 was first reported on tobacco in China, which was identified in other plants, expanding the understanding of its host range and distribution in the country. In addition, a Streptomyces strain extracted from the rhizosphere soil of tobacco was found to inhibit the growth of multiple sequevars of tobacco R. solanacearum, indicating its broad-spectrum antagonistic properties. Furthermore, pot experiments showed that the strain St35 effectively controlled tobacco bacterial wilt. The isolate St35 was conclusively identified as Streptomyces gancidicus according to the morphological and genetic features. In summary, the present study demonstrated the genetic diversity and distribution of tobacco R. solanacearum strains in the Fujian province of China, as well as the identification of a candidate biological control agent for the management of tobacco bacterial wilt.
Teaming Up for Community Health Simulation Intervention: A Quasi-Experimental Study
Authors: Powers Kelly , Brandon Jamie , Chen Fei
Published: March 2024

AIM

The aim of this study was to examine whether participating in a team-based simulation intervention would improve nursing students’ empathy and commitment to addressing social determinants of health (SDOH) and interprofessional teamwork attitudes, beliefs, and behaviors. Outcomes were compared for intraprofessional versus interprofessional team participation.

BACKGROUND

Nursing students must learn strategies to address SDOH, but this content is not well integrated in curricula. Teaming Up for Community Health was created to provide SDOH experiential team learning.

METHOD

Eighty-five nursing students participated in the intraprofessional comparison group or interprofessional intervention group. Surveys were completed before and after the intervention and two months later.

RESULTS

Participants had heightened empathy and commitment to addressing SDOH at baseline. Interprofessional teamwork beliefs and behaviors improved for both groups.

CONCLUSION

Experiential learning about SDOH should focus on improving students’ self-confidence and performance. Based on the study results, experiential team learning should be threaded through curricula.
Scoliosis Research Society-22r and Ceiling Effects
Authors: Stone Lauren E. , Ames Christopher P. , Pellise Ferran , Newton Peter O. , Upasani Vidyadhar V. ,   Harms Study Group, Kelly Michael P.
Published: March 2024

Study Design.

Retrospective registry analysis.

Objective.

To examine predictions of individual Scoliosis Research Society-22r (SRS-22r) questions one year after surgery for adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

A precision-medicine approach to AIS surgery will inform patients of the likelihood of achieving particular results from surgery, specifically individual responses to the SRS-22r questionnaire.

Methods.

A multicenter AIS registry was queried for surgical AIS patients treated between 2002 and 2020. Preoperative data collected included standard demographic data, deformity descriptive data, and SRS-22r scores. Postoperative one-year SRS-22r scores were modeled using ordinal logistic regression. The highest probability was the most likely response. Model performance was examined by c-statistics, where c>0.8 was considered excellent. Ceiling effects were measured by the proportion of patients reporting “5” to each question.

Results.

A total of 3251 patients contributed data to the study; mean age 14.4 (±2.2) years, female 2631 (81%), major thoracic coronal curve 53°, mean lumbar 41°. C-statistic values ranged from 0.6 (poor) to 0.8 (excellent), evidence of varied predictive capabilities. Q17 (“days off work/school,” c = 0.84, ceiling achieved 75%) and Q15 (“financial difficulties,” c = 0.86, ceiling achieved 82%) had the greatest predictive capabilities while Q11 (“pain medication,” c=0.73, ceiling achieved 67%), Q10 (“appearance,” c=0.72, ceiling achieved 35%), and Q19 (“attractive,” c=0.69, ceiling achieved 37%) performed poorly.

Conclusions.

Prediction of individual SRS-22r item responses, perhaps most germane to AIS treatment, was poor. The prediction of less relevant outcomes, where ceiling effects are present, was greater as the models chose “5” for all responses. These ceiling effects may limit discrimination and hamper efforts at personalized outcome predictions.

Level of Evidence:

Level 3.
Variation in Use of Medications for Opioid Use Disorder in Critically Ill Patients Across the United States
Authors: Feeney Megan E. , Law Anica C. , Walkey Allan J. , Bosch Nicholas A.
Published: March 2024

OBJECTIVES:

To describe practice patterns surrounding the use of medications to treat opioid use disorder (MOUD) in critically ill patients.

DESIGN:

Retrospective, multicenter, observational study using the Premier AI Healthcare Database.

SETTING:

The study was conducted in U.S. ICUs.

PATIENTS:

Adult (≥ 18 yr old) patients with a history of opioid use disorder (OUD) admitted to an ICU between 2016 and 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 108,189 ICU patients (658 hospitals) with a history of OUD, 20,508 patients (19.0%) received MOUD. Of patients receiving MOUD, 13,745 (67.0%) received methadone, 2,950 (14.4%) received buprenorphine, and 4,227 (20.6%) received buprenorphine/naloxone. MOUD use occurred in 37.9% of patients who received invasive mechanical ventilation. The median day of MOUD initiation was hospital day 2 (interquartile range [IQR] 1–3) and the median duration of MOUD use was 4 days (IQR 2–8). MOUD use per hospital was highly variable (median 16.0%; IQR 10–24; range, 0–70.0%); admitting hospital explained 8.9% of variation in MOUD use. A primary admitting diagnosis of unintentional poisoning (aOR 0.41; 95% CI, 0.38–0.45), presence of an additional substance use disorder (aOR 0.66; 95% CI, 0.64–0.68), and factors indicating greater severity of illness were associated with reduced odds of receiving MOUD in the ICU.

CONCLUSIONS:

In a large multicenter, retrospective study, there was large variation in the use of MOUD among ICU patients with a history of OUD. These results inform future studies seeking to optimize the approach to MOUD use during critical illness.
Persistent HIV-1 transcription during ART: time to reassess its significance?
Authors: Fombellida-Lopez Céline , Berkhout Ben , Darcis Gilles , Pasternak Alexander O.
Published: March 2024

Purpose of review

Despite suppressive antiretroviral therapy (ART), HIV-1 reservoirs persist and reignite viral replication if therapy is interrupted. Persistence of the viral reservoir in people with HIV-1 (PWH) is the main obstacle to an HIV-1 cure. The reservoirs are not transcriptionally silent, and viral transcripts can be detected in most ART-treated individuals. Here, we review the recent progress in the characterization of persistent HIV-1 transcription during ART.

Recent findings

Evidence from several studies indicates that, although cell-associated unspliced (US) HIV-1 RNA is abundantly expressed in ART-treated PWH, intact full-length US transcripts are rare and most US RNA is derived from defective proviruses. The transcription- and translation-competent defective proviruses, previously considered irrelevant, are increasingly being linked to residual HIV-1 pathogenesis under suppressive ART. Recent data suggest a continuous crosstalk between the residual HIV-1 activity under ART and the immune system. Persistent HIV-1 transcription on ART, despite being mostly derived from defective proviruses, predicts viral rebound upon therapy interruption, suggesting its role as an indicator of the strength of the host antiviral immune response that is shaping the viral rebound.

In light of the recent findings, the significance of persistent HIV-1 transcription during ART for the long-term health of PWH and the cure research should be reassessed.
Nurse-Led Cardiac Rehabilitation Care Coordination Program
Authors: Boggess Kristi , Hayes Emily , Duffy Mary “Lizzie” , Indranoi Chayawat , Sorey Andrew B. , Blaine Tamara , McKeon Leslie
Published: March 2024

Purpose:

The aim of this investigation was to evaluate the impact of automated cardiac rehabilitation (CR) referral and nurse care coordination on patient and program outcomes. Specifically, the aim was to identify whether differences exist in physical and psychological function at CR Phase 2 enrollment and completion and CR Phase 2 participation and completion for hospitalized patients who receive in-person CR nurse visits versus phone consultation. Using a retrospective pre-/post-intervention descriptive design, a purposive sampling technique was used to select groups with matching clinical attributes. Dates were selected to mitigate the impact of COVID-19 on CR program enrollment and completion.

Methods:

Data were abstracted from the patient electronic medical record, telemetry documentation, and CR referral tracking tool. Patient descriptors included age, sex, cardiac diagnosis/procedure (post-coronary artery bypass graft surgery, myocardial infarction, percutaneous coronary intervention, heart failure, and aortic valve repair and replacement) and cardiac risk stratification category. Patient functional outcomes included the 6-min walk test and metabolic equivalents of task levels for functional capacity; psychological function was measured by the Patient Health Questionnaire assessment. Program outcomes included discharge to CR Phase 2 enrollment, CR sessions, and completion.

Results:

Each group had 52 patients. Age was 64 ± 12 yr, 68% were male. Perhaps indications for CR included coronary artery bypass graft surgery (44%), myocardial infarction (19%), percutaneous coronary intervention (20%), heart failure (10%), aortic valve repair and replacement (8%). Cardiac risk was low in 30%, intermediate in 65%, and high in 5%. The post-intervention group compared with the pre-intervention group had a shorter discharge to CR Phase 2 enrollment (35 ± 18 d vs 41 ± 28 d, P= .078) and significantly fewer sessions required for CR completion.

Conclusion:

Automated CR referral and nurse care coordination visits for hospitalized patients decreased the transition period between CR Phase 1 and 2. Patients were physically and psychologically prepared for earlier CR Phase 2 enrollment and successfully completed the program in fewer days than the pre-intervention group.
PREDNISOLONE EYE DROPS AS A POTENTIAL TREATMENT IN NONNEOVASCULAR PACHYCHOROID-RELATED DISEASES
Authors: van den Tillaart Femke M. , Temmerman Irene M. , Hartgers Franca , Yzer Suzanne
Published: March 2024

Purpose:

To investigate the functional and structural outcomes after treatment with prednisolone eye drops in the following pachychoroid-related diseases: chronic central serous chorioretinopathy, pachychoroid pigment epitheliopathy, and peripapillary pachychoroid syndrome.

Methods:

In this retrospective study, 54 eyes of 48 patients with pachychoroid-related disease were treated with prednisolone acetate 1% eye drops 3 times a day. Change in macular volume and retinal central subfield thickness on optical coherence tomography was measured. In addition, the foveal or complete resolution of fluid and the change in visual acuity were studied.

Results:

The follow-up visit was at a mean of 41.2 ± 14.5 days. In the 44 eyes with chronic central serous chorioretinopathy, a significant reduction in retinal central subfield thickness (P < 0.001) and macular volume (P < 0.001) was observed. Foveal intra- or subretinal fluid resolved completely in 22% of the eyes. In the 8 peripapillary pachychoroid syndrome eyes, a reduction in the nasal retinal thickness was observed (P = 0.025). One of the 2 pachychoroid pigment epitheliopathy eyes showed structural improvement. No significant change in visual acuity was observed in any of the pachychoroid spectrum diseases.

Conclusion:

In patients with chronic central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid pigment epitheliopathy, anatomical improvement was observed after therapy with prednisolone eye drops. Visual acuity did not change significantly.
Emerging Role of Plasma Microbial Cell-free DNA in the Diagnosis of Pediatric Mucormycosis
Authors: Gracia Michael , Hadley Emma , Ramchandar Nanda , Coufal Nicole G.
Published: March 2024

Mucormycosis is a rare and devastating angioinvasive infection that can be challenging to diagnose due to the low sensitivity of current noninvasive diagnostics and the lack of a “gold standard” reference test. We describe a retrospective case series of children with suspected mucormycosis where plasma microbial cell-free DNA testing was utilized in the diagnostic evaluation to illustrate the ways in which microbial cell-free DNA testing can noninvasively contribute to the evaluation and management of at-risk, immunosuppressed patients suspected of mucormycosis.
Music during cataract surgery: effect on anxiety
Authors: Rivera Paola A. , Linderman Wendy L. , Miguez Sofia , Chow Jessica , DeBroff Brian , Diaz Vicente
Published: March 2024

Purpose:

To determine the effect of playing patient-selected music intraoperatively on patient self-reported anxiety and the amount of sedative administered during cataract surgery.

Setting:

Yale New Haven Hospital health system, New Haven, Connecticut.

Design:

Prospective, randomized, controlled clinical trial.

Methods:

Patients were randomized to either a music group or a control group, which had no music played. Patients were blinded to the purpose of the study. On postoperative day 1, patients were consented to participate in the study and asked to complete a 6-question Likert-style survey (modified from the State-Trait Anxiety Inventory) assessing anxiety at baseline and during surgery. Patients' intraoperative and postoperative vitals were recorded. The medication, dosage, and number of sedative injections given were also recorded. Paired t tests were used to assess for significant differences between the 2 groups.

Results:

107 patients (mean age 71.2 years) were enrolled in the study. There was no significant difference in baseline anxiety between the 2 groups. Patients randomized to the music group had significantly lower total self-reported anxiety (mean 5.98) than the control group (mean 7.13, P = .006). Moreover, patients exposed to music felt significantly less frightened, nervous, and confused during surgery (P = .002, .007, and 0.017, respectively). There was no significant difference between the groups in number and dosage of sedatives given.

Conclusions:

Playing patient-selected music during cataract surgery is an effective way to decrease anxiety. Music directly affects patient experience and is an inexpensive, low-risk method of reducing patient anxiety during surgery.
Efficacy of mitral valve repair in combination with coronary revascularization for moderate ischaemic mitral regurgitation: a systematic review and meta-analysis of randomized controlled trials
Authors: Li Xin , Hou Biao , Hou Shuwen , Jiang Wenjian , Liu Yuyong , Zhang Hongjia
Published: March 2024

Background:

The efficacy of mitral valve repair (MVR) in combination with coronary artery bypass grafting (CABG) for moderate ischaemic mitral regurgitation (IMR) remains unclear. To evaluate whether MVR + CABG is superior to CABG alone, the authors conducted a systematic review and meta-analysis of existing randomized controlled trials (RCTs).

Methods:

The authors searched PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for eligible RCTs from the date of their inception to October 2023. The primary outcomes were operative (in-hospital or within 30 days) and long-term (≥ 1 year) mortality. The secondary outcomes were postoperative stroke, worsening renal function (WRF), and reoperation for bleeding or tamponade. The authors performed random-effects meta-analyses and reported the results as risk ratios (RRs) with 95% CIs.

Results:

Six RCTs were eligible for inclusion. Compared with CABG alone, MVR + CABG did not increase the risk of operative mortality (RR, 1.244; 95% CI, 0.514–3.014); however, it was also not associated with a lower risk of long-term mortality (RR, 0.676; 95% CI, 0.417–1.097). Meanwhile, there was no difference between the two groups in terms of postoperative stroke (RR, 2.425; 95% CI, 0.743–7.915), WRF (RR, 1.257; 95% CI, 0.533–2.964), and reoperation for bleeding or tamponade (RR, 1.667; 95% CI, 0.527–5.270).

Conclusions:

The findings of this meta-analysis suggest that MVR + CABG fails to improve the clinical outcomes of patients with moderate IMR compared to CABG alone.
How to assess the long-term recovery outcomes of patients with cauda equina syndrome before surgery: a retrospective cohort study
Authors: Wang Qiushi , Hou Guangdong , Wen Mengyuan , Ren Zhongwu , Duan Wei , Lei Xin , Yao Zhou , Zhao Shixian , Ye Bin , Tu Zhipeng , Huang Peipei , Xie Fang , Gao Bo , Hu Xueyu , Luo Zhuojing
Published: March 2024

Background:

Factors influencing recovery after decompression surgery for cauda equina syndrome (CES) are not completely identified. The authors aimed to investigate the most valuable predictors (MVPs) of poor postoperative recovery (PPR) in patients with CES and construct a nomogram for discerning those who will experience PPR.

Methods:

Three hundred fifty-six patients with CES secondary to lumbar degenerative diseases treated at Xijing Hospital were randomly divided into training (N=238) and validation (N=118) cohorts at a 2:1 ratio. Moreover, 92 patients from the 970th Hospital composed the testing cohort. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used for selecting MVPs. The nomogram was developed by integrating coefficients of MVPs in the logistic regression, and its discrimination, calibration, and clinical utility were validated in all three cohorts.

Results:

After 3 to 5 years of follow-up, the residual rates of bladder dysfunction, bowel dysfunction, sexual dysfunction, and saddle anesthesia were 41.9, 44.1, 63.7, and 29.0%, respectively. MVPs included stress urinary incontinence, overactive bladder, low stream, difficult defecation, fecal incontinence, and saddle anesthesia in order. The discriminatory ability of the nomogram was up to 0.896, 0.919, and 0.848 in the training, validation, and testing cohorts, respectively. Besides, the nomogram showed good calibration and clinical utility in all cohorts. Furthermore, the optimal cutoff value of the nomogram score for distinguishing those who will experience PPR was 148.02, above which postoperative outcomes tend to be poor.

Conclusion:

The first pretreatment nomogram for discerning CES patients who will experience PPR was developed and validated, which will aid clinicians in clinical decision-making.
Effect of Vasopressors and Vasodilators on Kidney Medulla Oxygenation
Authors: Honore Patrick M , Blackman Sydney , Perriens Emily , Oueslati Ilann , Al-Sammour Christophe , Bankier David Vidal , Bendoumou Maha , Ramos-Prieto Maya , Bulpa Pierre , Robert Arnaud , Nendumba Gauthier , Vornicu Ovidiu , Evrard Patrick , Dincq Anne-Sophie , Michaux Isabelle
Published: March 2024

This narrative review provides a comprehensive summary of research findings up to 2023 regarding the impact of vasopressors and vasodilators on medullary oxygenation during cardiopulmonary bypass and septic shock. It encompasses a thorough evaluation of all current vasopressors and vasodilators. Among vasodilators, levosimendan demonstrates superior efficacy, particularly in cases of heart failure following cardiac surgery. In the context of hypotension during such procedures, vasopressin emerges as the most effective vasopressor. In cases of hypotensive septic shock, both vasopressin and angiotensin II appear to be superior in preserving medullary oxygenation. However, it is imperative to emphasize the need for more robust data and randomized controlled human trials to validate these initial findings. Currently, it would be premature to offer definitive clinical recommendations on this matter.
Antibiotic Prophylaxis in Patients on Extracorporeal Membrane Oxygenation: A Systematic Review
Authors: Sah Ranjit , Shah Sangam , Subedi Prativa , Kashyap Ashutosh , KC Anil , Wosti Deepa , Sanghavi Devang , Bhattacharyya Anirban , Guru Pramod , Chaudhary Sanjay
Published: March 2024

Despite the frequent use of prophylactic antibiotics in hospitals for extracorporeal membrane oxygenation (ECMO) patients, the Extracorporeal Life Support Organization (ELSO) Infectious Disease Task Force does not recommend routine antibiotic prophylaxis due to a lack of compelling evidence. We assessed the effectiveness of prophylactic antibiotics in ECMO patients. We conducted a comprehensive search of multiple databases from their inception up to September 6, 2023, on various databases using keywords like “antibiotics,” “prophylaxis,” “extracorporeal membrane oxygenation,” and “ECMO.” Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included research. We collected data using Microsoft Excel version 2016, mean and standard deviations were calculated for continuous data, while frequencies and percentages were calculated for binomial data. A total of three studies was included in the review with a total of 8,954 participants, of which 4,483 (50.06%) received antibiotic prophylaxis, and 1,131 (25.22%) were female. The administration of antibiotics prophylactically was associated with reduction in rate of mortality, the risk of infections, and complications like acute kidney injury and diarrhea. Although there have been some benefits on antibiotic prophylaxis, prospective research, and possibly the creation of tailored, ECMO-specific bundles will be needed to identify efficient ways to prevent ECMO infection.
Practice Trends among US Gastroenterologists following the 2020 American Gastroenterological Association Guidelines on Gastric Intestinal Metaplasia
Authors: Rouphael Carol , Elkin Baila , El Dahdah Joseph , Moufawad Michelle , Yang Qijun , Bena James , Shah Shailja , Kim Michelle K.
Published: March 2024

Background and Aims:

Studies show variability in gastroenterologists’ management of gastric intestinal metaplasia (GIM) in the United States. In 2020, the American Gastroenterological Association published GIM guidelines, recommending physician-patient shared decision-making on GIM surveillance based on risk factors. We compared gastroenterologists’ communication trends of a GIM finding and surveillance recommendations before and after 2020 and evaluated patient and provider factors associated with a surveillance recommendation.

Methods:

A sample of patients diagnosed with GIM on biopsies from upper endoscopies performed in 2018 (cohort A) and 2021 (cohort B) were included. Logistic regression analysis assessed the association between patient/provider characteristics and surveillance recommendations in the overall cohort and over time.

Materials:

In all, 347 patients were included: 175 in cohort A and 172 in B. Median age was 65.7 (56.0, 73.4), and 54.5% were females. Communication to patients about GIM findings and surveillance recommendations increased from 24.6% <2020 to 50% >2020 (P<0.001) and 20% <2020 to 41.3% >2020 (P<0.001), respectively. Overall, endoscopy >2020, family history of gastric cancer, autoimmune gastritis, female providers, and gastroenterologists with 10 to 20 years of experience were associated with a surveillance recommendation. The effect of family history of gastric cancer and the effect of the patient’s female sex on surveillance was significantly different between both cohorts [Odds ratio (OR): 0.13, 95% (Confidence interval) CI: 0.02, 0.97 and OR 3.39, 95% CI: 1.12, 10.2, respectively).

Conclusions:

Despite a 2-fold increase in surveillance recommendations after 2020, there was no meaningful effect of any of the patients’ factors on a recommendation for surveillance over time, which raises the question as to whether surveillance is being offered to both average and high-risk patients without thorough risk stratification.
The effect of electromyography triggered electrical stimulation to abdominal muscles on sitting balance, respiratory functions, and abdominal muscle thickness in complete spinal cord injury: a randomized controlled trial
Authors: Bayraktar Handan E.N. , Yalçin Elif , Şipal Meriç S. , Akyüz Müfit , Akinci Meltem G. , Ü. Delialioğlu Sibel
Published: March 2024

Complete thoracic spinal cord injury (SCI) results in a loss of innervation to the abdominal muscles, which affects trunk stability and performance of activities of daily living from a sitting position. Respiratory function is also affected, leading to frequent pulmonary complications. Given the importance of trunk stability and respiratory function, we investigated the effects of electromyography triggered electrical stimulation (EMG-ES) applied to the abdominal muscles on sitting balance, respiratory functions and abdominal muscle thickness in individuals with complete thoracic SCI. This randomized controlled study included 34 participants with complete thoracic SCI who were randomly allocated to the experimental group (n = 17) and the control group (n = 17). During the 4-week intervention period, the experimental group received EMG-ES to their abdominal muscles, while the control group received isometric abdominal exercises three times per week. Both groups continued with their routine rehabilitation program (active or passive range of motion exercises, stretching, and balance coordination exercises). The primary outcome measures were the modified functional reach test (mFRT) and trunk control test (TCT). Secondary outcome measures included a pulmonary function test (PFT) and the bilateral abdominal muscle thicknesses using ultrasonography. At the end of the study, the experimental group showed significantly greater improvements in both primary outcomes. The mean difference in pre-post changes between the groups for the mFRT area was 242.8 cm² [95% confidence interval (CI): 181.3–329.8; effect size 0.92; P < 0.001] and 5.0 points for TCT (95% CI: 3.9–6.0; effect size 0.98, P < 0.001). The increase in the abdominal muscle thickness was also significantly greater in the experimental group (P < 0.001) without significant differences in the PFT (P > 0.05). We conclude that adding EMG-ES of abdominal muscles may further improve sitting balance and abdominal muscle thickness in individuals with complete thoracic SCI.
Role of a Nursing Informatics Specialist in a Clinical Simulation Laboratory
Authors: Hall Eric S. , Holt Jo Ellen , Sengstack Patricia
Published: March 2024

Background:

Technology in health care is pervasive and growing exponentially. Simulation in academic settings also continues to expand with the use of advancing technologies.

Problem:

Technology appropriate usage and implementation can become problematic without experts with the right skills in nursing simulation labs. Gaps in technology utilization, simulation best practices, and data analytics now exist.

Approach:

A school of nursing employed a nurse informaticist in its simulation laboratory to address the complexities of technology usage and aid in data analytics.

Outcomes:

The nurse informaticist was effective at promoting simulation use, increasing faculty and learner usage of the simulation space. The initiation of data capturing was also achieved.

Conclusions:

Highly trained nurse informaticists are ready to address the unique complexities of advanced simulation environments.
Recurrent Tuberous Sclerosis Complex/Mammalian Target of Rapamycin Mutations Define Primary Renal Hemangioblastoma as a Unique Entity Distinct From Its Central Nervous System Counterpart
Authors: Wang Xiao-tong , Fang Ru , He Hui-ying , Zhang Wei , Li Qing , Sun Su-an , Wang Xuan , Zhang Ru-song , Teng Xiao-dong , Zhou Xiao-jun , Xia Qiu-yuan , Zhao Ming , Rao Qiu
Published: March 2024

Renal hemangioblastoma (HB) is a rare subset of HBs arising outside of the central nervous system (CNS), with its molecular drivers remaining entirely unknown. There were no significant alterations detected in previous studies, including von Hippel-Lindau gene alterations, which are commonly associated with CNS-HB. This study aimed to determine the real molecular identity of renal HB and better understand its relationship with CNS-HB. A cohort of 10 renal HBs was submitted for next-generation sequencing technology. As a control, 5 classic CNS-HBs were similarly analyzed. Based on the molecular results, glycoprotein nonmetastatic B (GPNMB) immunohistochemistry was further performed in the cases of renal HB and CNS-HB. Mutational analysis demonstrated that all 10 renal HBs harbored somatic mutations in tuberous sclerosis complex 1 (TSC1, 5 cases),TSC2(3 cases), and mammalian target of rapamycin (2 cases), with the majority classified as pathogenic or likely pathogenic. The CNS-HB cohort uniformly demonstrated somatic mutations in the von Hippel-Lindau gene. GPNMB was strong and diffuse in all 10 renal HBs and completely negative in CNS-HBs, reinforcing the molecular findings. Our study reveals a specific molecular hallmark in renal HB, characterized by recurrentTSC/mammalian target of rapamycinmutations, which defines it as a unique entity distinct from CNS-HB. This molecular finding potentially expands the therapeutic options for patients with renal HB. GPNMB can be considered for inclusion in immunohistochemical panels to improve renal HB identification.
Dollars and Sense
Authors: Gore Amy , Huck Gary , Bongiovanni Soyon , Labagnara Susan , Soto Ilona Jacniacka , Yonclas Peter , Livingston David H.
Published: March 2024

Objective:

To demonstrate that the creation of a Center for Trauma Survivorship (CTS) is not cost-prohibitive but is a revenue generator for the institution.

Background:

A dedicated CTS has been demonstrated to increase adherence with follow-up visits and improve overall aftercare in severely injured patients discharged from the trauma center. A potential impediment to the creation of similar centers is its assumed prohibitive cost.

Methods:

This pre and post-cohort study examines the financial impact of patients treated by the CTS. Patients in the PRE cohort were those treated in the year before CTS inception. Eligibility criteria are trauma patients admitted who are ≥18 years of age and have a New Injury Severity Score ≥16 or intensive care unit stay ≥2 days. Financial data were obtained from the hospital’s billing and cost accounting systems for a 1-year time period after discharge.

Results:

There were 176 patients in the PRE and 256 in the CTS cohort. The CTS cohort generated 1623 subsequent visits versus 748 in the PRE cohort. CTS patients underwent more follow-up surgery in their first year of recovery as compared with the PRE cohort (98 vs 26 procedures). Each CTS patient was responsible for a $7752 increase in net revenue with a positive contribution margin of $4558 compared with those in the PRE group.

Conclusions:

A dedicated CTS increases subsequent visits and necessary procedures and is a positive revenue source for the trauma center. The presumptive financial burden of a CTS is incorrect and the creation of dedicated centers will improve patients’ outcomes and the institution’s bottom line.
Characterization of Pancreatic Fistula after Post-pancreatectomy Acute Pancreatitis
Authors: Chen Haoda , Wang Weishen , Fu Ningzhen , Xia Wentao , Li Hongzhe , Ji Yuchen , Zhong Jingyu , Wang Jiancheng , Deng Xiaxing , Xu Zhiwei , Weng Yuanchi , Shen Baiyong
Published: March 2024

Objective:

This study aimed to investigate the clinical significance and risk factors of postoperative pancreatic fistula (POPF) after post-pancreatectomy acute pancreatitis (PPAP) in patients who underwent pancreaticoduodenectomy (PD).

Summary Background Data:

PPAP has been recognized as a critical factor in the pathophysiology of POPF after PD.

Methods:

A total of 817 consecutive patients who underwent elective PD between January 2020 and June 2022 were included. PPAP and POPF were defined in accordance with the International Study Group for Pancreatic Surgery (ISGPS) definitions. Multivariate logistic analyses were performed to investigate the risk factors for POPF. Comparisons between PPAP-associated POPF and non-PPAP-associated POPF were made to further characterize this intriguing complication.

Results:

Overall, 159 (19.5%) patients developed POPF after PD, of which 73 (45.9%) occurred following PPAP, and the remaining 86 (54.1%) had non-PPAP-associated POPF. Patients with PPAP-associated POPF experienced significantly higher morbidity than patients without POPF. Multivariate analyses revealed distinct risk factors for each POPF type. For PPAP-associated POPF, independent risk factors included estimated blood loss >200 mL (OR 1.93), MPD ≤3 cm (OR 2.88), and soft pancreatic texture (OR 2.01), largely overlapping with FRS (Fistula Risk Score) elements. On the other hand, non-PPAP-associated POPF was associated with age >65 years (OR 1.95), male (OR 2.10), and MPD ≤3 cm (OR 2.57). Notably, among patients with PPAP, the incidence of POPF consistently hovered around 50% regardless of the FRS stratification.

Conclusions:

PPAP-associated POPF presents as a distinct pathophysiology in the development of POPF after PD, potentially opening doors for future prevention strategies targeting the early postoperative period.
A two-step penalization and shrinkage approach for binary response data that is jointly separated and correlated: The effects of social networks on diarrheal disease
Authors: Hegde Sonia T. , Eisenberg Joseph , Beesley Lauren J. , Mukherjee Bhramar
Published: March 2024

Epidemiologic data often violate common modeling assumptions of independence between subjects due to study design. Statistical separation is also common, particularly in the study of rare binary outcomes. Statistical separation for binary outcomes occurs when regions of the covariate space have no variation in the outcome, and separation can negatively impact the validity of logistic regression model parameters. When data are correlated, we generally use multi-level modeling for parameter estimation, and statistical approached have also been developed for handling statistical separation. Approaches for analyzing data withbothseparation and complex correlation, however, are not well-known. Extending prior work, we demonstrate a two-stage Bayesian modeling approach to account for both separated and highly correlated data through a motivating example examining the effect of social ties on Acute Gastrointestinal Illness (AGI) in rural Ecuador. The two-stage approach involves fitting a Bayesian hierarchical model to account for correlation using priors derived from parameter estimates from a Firth-corrected logistic regression model to account for separation. We compare estimates from the two-stage approach to standard regression methods that only account for either separation or correlation. Our results demonstrate that correctly accounting for separation and correlation when both are present can potentially provide better inference.