bluuebunny/crossref_metadata_2025 huggingface dataset:
A Metabarcoding Approach to Investigate Fungal and Oomycete Communities Associated with Kiwifruit Vine Decline Syndrome in Italy
Authors: Savian Francesco , Marroni Fabio , Ermacora Paolo , Firrao Giuseppe , Martini Marta
Published: August 2022

Since 2012, kiwifruit vine decline syndrome (KVDS) has severely compromised all major kiwifruit-growing areas in Italy. Thus far, etiological studies were mainly focused on waterlogging effects or on the isolation of microorganisms from diseased plants; therefore, an all-encompassing picture of KVDS microbiota is still missing. This work aims to describe oomycete and fungal communities associated with KVDS and to identify key taxa potentially involved in the disease through a metabarcoding approach on root endosphere and rhizosphere samples. Two nearby fields with similar pedoclimatic conditions were identified based on KVDS spreading during a 4-year survey (2016 to 2019). In total, four sampling areas were selected, one from the control field with no sign of KVDS (asymptomatic site) and three from the KVDS-affected field (diseased site): (i) asymptomatic until the sampling date in 2018, (ii) symptomatic since 2018, and (iii) symptomatic since 2017. Total genomic DNA samples were subjected to a nested PCR approach separately targeting the internal transcribes spacer 2 regions of fungal and oomycete communities. The communities were compared in terms of α- and β-diversities, and key taxa were identified using univariate differential abundance tests. Major differences in taxa distribution were observed between samples from the different sites (asymptomatic and diseased) and were mostly linked to the oomycete community. Phytophthora sojae was the main taxa characterizing the diseased site and supposed to be involved in the disease and Phytopythium spp. were found related to the different plant health status. Finally, Dactylonectria macrodidyma, Phytopythium citrinum, and Thielaviopsis basicola were also proposed as new KVDS-related pathogens.
A modern roadmap for the use of simulation in regional anesthesiology training
Authors: Kumar Amanda H. , Sultan Ellile , Mariano Edward R. , Udani Ankeet D.
Published: August 2022

Purpose of review

A variety of educational modalities are used to teach regional anesthesia. Simulation is an educational tool that facilitates hands-on learning in a well tolerated, reproducible environment, eliminating potential harm to patients during the process of learning. Available literature and expert consensus statements support customizing simulation programs according to the level of training and experience of the learners.

Recent findings

Simulation is useful for learners of all levels of expertise, though the application and frequency of simulation must be adapted to meet the learners’ objectives.

This review presents recommendations for the use of simulation for residents, fellows, practicing anesthesiologists without formal training in regional anesthesia, and practicing anesthesiologists with regional anesthesia expertise. Passports and portfolio programs that include simulation can be used to verify training. Virtual applications of simulation are growing, expanding the scope of regional anesthesia simulation and increasing access to lower resource areas.
Ultrasound-guided fascial plane blocks for spine surgery
Authors: McCracken Stephen , Lauzadis Justas , Soffin Ellen M.
Published: August 2022

Purpose of review

The development of truncal and fascial plane blocks has created novel opportunities to apply regional analgesic techniques to patients undergoing spine surgery. This review will summarize recent literature devoted to evaluating candidate blocks for spine surgery, including erector spinae plane block, thoracolumbar interfascial plane block, midpoint transverse process to pleura block, and transversus abdominis plane block. Procedure-specific effects of blocks on patient and healthcare system outcomes will be presented and gaps in care and knowledge will be highlighted.

Recent findings

The most studied paradigm was bilateral erector spinae plane block for lumbar spine surgery. The most common outcomes assessed were early postoperative pain scores, opioid consumption and related side effects, and length of hospital stay. All candidate blocks were associated with mixed evidence for analgesic and opioid-sparing benefits, and/or reductions in length of hospital stay. The magnitude of these effects was overall small, with many studies showing statistically but not clinically significant differences on outcomes of interest. This may reflect, at least in part, the current state of the (emerging) evidence base on this topic.

Our understanding of the risks, benefits, and value of truncal and fascial plane blocks for spine surgery cohorts is evolving. Although the results derived from this body of literature are encouraging, further research is required before the widespread adoption of specified blocks into spine care can be recommended.
Cerebral metabolic derangements following traumatic brain injury
Authors: Demers-Marcil Simon , Coles Jonathan P.
Published: August 2022

Purpose of review

Outcome following traumatic brain injury (TBI) remains variable, and derangements in cerebral metabolism are a common finding in patients with poor outcome. This review compares our understanding of cerebral metabolism in health with derangements seen following TBI.

Recent findings

Ischemia is common within the first 24 h of injury and inconsistently detected by bedside monitoring. Metabolic derangements can also result from tissue hypoxia in the absence of ischemic reductions in blood flow due to microvascular ischemia and mitochondrial dysfunction. Glucose delivery across the injured brain is dependent on blood glucose and regional cerebral blood flow, and is an important contributor to derangements in glucose metabolism. Alternative energy substrates such as lactate, ketone bodies and succinate that may support mitochondrial function, and can be utilized when glucose availability is low, have been studied following TBI but require further investigation.

Mitochondrial dysfunction and the use of alternative energy substrates are potential therapeutic targets, but improved understanding of the causes, impact and significance of metabolic derangements in clinical TBI are needed. Maintaining adequate oxygen and glucose delivery across the injured brain may accelerate the recovery of mitochondrial function and cerebral energy metabolism and remain important management targets.
Utility of 45S5 Bioactive Glass As Bone Graft Substitute for Cavitary Defects in Pediatric Bone Tumors: A Preliminary Study
Authors: Samade Richard , Jonard Brandon , Scharschmidt Thomas J.
Published: August 2022

Background:

Bioactive glass has become an increasingly used treatment of cavitary bone defects in a number of orthopaedic applications. The purpose of this study was to evaluate the clinical and radiographic outcomes of bioactive glass used for benign cavitary pediatric bone tumors. A specific focus was on radiographic filling of defects and occurrence of complications by tumor class.

Methods:

A single institution retrospective study was performed, which entailed review of the clinical and radiographic data of 21 patients who underwent surgical curettage and grafting of benign or low-grade malignant bone tumors from 2018 to 2020. In all the cases, 45S5 bioactive glass (Fibergraft; Prosidyan, New Providence, NJ) was used to fill the bone defects. For each patient, data on demographic, preoperative diagnosis, defect size, time to mobilization, radiographic filling grade, pain, and complications were obtained. The Wilcoxon-Mann-Whitney test and Kaplan-Meier survival analysis were used for comparisons between tumor classes.

Results:

In the 21 patients, 11 bone tumors were latent or active (class 1) and 10 were aggressive (class 2). The mean age was 13.0±3.7 years, 6 (28.6%) were female, and the median and interquartile range for initial tumor size were 18.8 (5.8 to 50.6) cm3. Tumors that were class 2 had significantly more complications with bioactive glass use compared with class 1 tumors [0 vs. 1 (0 to 1), P=0.040]. The time of persistent fill grade 1 or 2 defects up to final follow-up was less in class 1 versus class 2 lesions (P=0.048).

Conclusions:

Bioactive glass agents have utility for treating a broad variety of pediatric bone tumors after curettage. However, focusing these agents’ use in treating latent or active subtypes of bone tumors may be ideal in minimizing complications and time to higher fill grade.

Level of Evidence:

Level III—Therapeutic.
Lower Prevalence and Severity of Degenerative Changes in the Lumbar Spine in Elderly Hong Kong Chinese Compared with Age-matched Italian Caucasian Women
Authors: So Tiffany Y. , Diacinti Davide , Leung Jason C.S. , Iannacone Antonio , Kripa Endi , Kwok Timothy C.Y. , Diacinti Daniele , Wang Yi Xiang J.
Published: August 2022

Study Design.

Cross sectional observational study.

Objective.

To compare the prevalence and severity of radiographic lumbar spine degeneration between elderly Hong Kong Chinese and elderly Italian Caucasian women.

Summary of Background Data.

Rates of symptomatic low back pain and osteoporotic vertebral fracture have been shown to be lower in Asian and Chinese populations compared to Caucasians, but ethnic differences in spinal degeneration are less established.

Methods.

Lumbar spine lateral radiographs of 566 age-matched (mean: 73.6 y; range: 65-87 y) female subjects from two population-based epidemiological studies from Hong Kong (n=283) and Rome, Italy (n=283) were reviewed. Grading of degeneration categories: disc height loss (none, <30%, 30-60%, >60%), osteophyte formation (not present, minimal, small, large), endplate sclerosis (none, mild, moderate, severe), and antero/retrolisthesis (none, <25%, 25-50%, >50%) was performed for vertebral levels from L1/2-L5/S1 (5 levels). Each category was assigned a score (0, 1, 2, 3) at individual vertebral level according to severity. The total degeneration score was obtained by adding scores for all categories across the vertebral levels.

Results.

Italian subjects (total score [mean±SD], 7.0±5.5) had a higher severity of overall degenerative changes compared to Hong Kong subjects (5.7±4.4), P<0.01. Italian subjects had higher scores for individual findings of disc height loss (Italian, 3.6±2.8 vs. Hong Kong 2.5±2.1, P<0.01); antero/retrolisthesis (Italian 0.3±0.7 vs. Hong Kong 0.2±0.4, P=0.01); and end plate sclerosis (Italian 1.0±1.2 vs. Hong Kong 0.6±1.0, P<0.01). At each individual level from L1/2 to L5/S1, total degeneration scores were higher in Italian than Hong Kong subjects (P<0.01 to 0.04)

Conclusion.

Degenerative changes in the lumbar spine are less prevalent and less severe in elderly Hong Kong Chinese women than in age-matched Italian Caucasian women. The observed differences may reflect a foundational background influence of genetic predisposition that requires further studies.
Abaloparatide Enhances Fusion and Bone Formation in a Rabbit Spinal Arthrodesis Model
Authors: Morse Kyle W. , Moore Harold , Kumagai Hiroshi , Hahn William , Koo Alexander , Meyers Kathleen N. , Bouxsein Mary L. , Brooks Daniel J. , Lanske Beate , Iyer Sravisht , Cunningham Matthew
Published: August 2022

Study Design.

Prospective Randomized Placebo Controlled Animal Trial

Objective.

Determine the effect of daily subcutaneous abaloparatide injection on the intervertebral fusion rate in rabbits undergoing posterolateral fusion.

Study of Background Data.

Despite the wide utilization of spine fusion, pseudarthrosis remains prevalent and results in increased morbidity. Abaloparatide is a novel analog of parathyroid hormone-related peptide (1-34) and has shown efficacy in a rat posterolateral spine fusion model to increase fusion rates. The effect of abaloparatide on the fusion rate in a larger animal model remains unknown.

Methods.

24 skeletally mature New Zealand White male rabbits underwent bilateral posterolateral spine fusion. Following surgery, the rabbits were randomized to receive either saline as control or abaloparatide subcutaneous injection daily. Specimens underwent manual assessment of fusion, radiographic analysis with both x-ray and high-resolution peripheral quantitative computed tomography, and biomechanical assessment.

Results.

Rabbits that received abaloparatide had a 100% (10/10) fusion rate compared to 45% (5/11) for controls (P<0.02) as assessed by manual palpation. Radiographic analysis determined an overall mean fusion score of 4.17±1.03 in the abaloparatide group versus 3.39±1.21 for controls (P<0.001). The abaloparatide group also had a greater volume of bone formed with a BV of 1209±543 mm3 compared to 551±152 mm3 (P<0.001) for controls. The abaloparatide group had significantly greater trabecular bone volume fraction and trabecular thickness and lower specific bone surface and connectivity density in the adjacent levels when compared to controls. Abaloparatide treatment did not impact trabecular number or separation. There were no differences in biomechanical testing in flexion, extension, or lateral bending (P>0.05) between groups.

Conclusion.

Abaloparatide significantly increased the fusion rate in a rabbit posterolateral fusion model as assessed by manual palpation. Additionally, there were marked increases in the radiographic evaluation of fusion.
The Variability and Contributions to Cost of Anterior Cervical Discectomy and Fusion Constructs
Authors: Lindsey Matthew H. , Xiong Grace X. , Karhade Aditya V. , Lightsey Harry M. , Crawford Alexander M. , Schoenfeld Andrew J. , Simpson Andrew K.
Published: August 2022

Study Design:

This was a retrospective cohort study.

Objective:

To characterize the variability in cost for anterior cervical discectomy and fusion (ACDF) constructs and to identify key predictors of procedural cost.

Summary of Background Data:

ACDF is commonly performed for surgical treatment of cervical radiculopathy and myelopathy. Numerous biomechanical constructs and graft/biological options are available, with most demonstrating relatively equivalent clinical results. Despite the substantial focus on value in spine care, the differences and contributions to procedural cost in ACDF have not been well defined.

Materials and Methods:

We evaluated the records of patients who underwent a single level ACDF from 2016 to 2020 at 4 hospitals in a major metropolitan area. We abstracted demographics, insurance status, operative time, diagnosis, surgeon, institution, and components of procedural costs. Costs based on construct were compared using multivariable adjusted analyses using negative binomial regression. The primary outcome measures were cost differences between ACDF techniques.

Results:

Two hundred sixty-four patients were included, with procedures by 13 surgeons across 4 institutions. The total procedural cost for ACDF had a mean of US$2317 with wide variation (range, US$967–US$7370). Multivariable analysis revealed body mass index and use of polyether ether ketone to be correlated with increased cost while carbon fiber and autograft correlated with decreased cost. When comparing standalone device constructs to cases with anterior instrumentation (plate/screws), the total cost was significantly higher in the plate/screw group (US$2686±US$921 vs. US$1466±US$878, P<0.001).

Conclusions:

We encountered wide variation in procedural costs associated with ACDF, including as much as an 8-fold difference in the cost of constructs. The most important drivers included instrumentation type and implant materials. Here, we identify potential targets of opportunity for health care organizations that are looking to reduce variance in procedural expenditures to improve health care savings associated with the performance of ACDF.
Robot-assisted laparoscopic staging compared to conventional laparoscopic staging and laparotomic staging in clinical early stage ovarian carcinoma
Authors: Bouter E.L.M. , Lok Christianne , Trum Hans
Published: August 2022

Purpose of review

Robot-assisted laparoscopic staging (RALS) is increasingly used for staging epithelial ovarian cancer (EOC). Evidence of its safety is limited. The aim of this review is to compare the efficacy and safety of RALS in clinical early-stage EOC to conventional laparoscopy and laparotomy and to assess the level of evidence that is currently available to adopt this surgical technique.

Recent findings

Only retrospective studies comparing staging by minimally invasive surgery (MIS) to laparotomy are available. Both RALS and conventional laparoscopic staging shorten length of hospital stay (LHS, mean -2.9 days) and decrease estimated blood loss (EBL, mean -79 ml less) compared to laparotomy. Complication rates and number of lymph nodes collected are similar in all surgical staging techniques. Survival outcomes after staging by MIS cannot be compared to staging by laparotomy because of the lack of evidence but RALS is probably noninferior to conventional laparoscopic staging.

RALS probably improves perioperative outcomes in patients with clinical early stage EOC similar to conventional laparoscopic staging. Whether oncologic outcomes of RALS are comparable to open and conventional approaches is uncertain as there is only level C evidence and randomized controlled trials are urgently needed to confirm the current retrospective findings.
Advances in the treatment of light chain amyloidosis
Authors: Palladini Giovanni , Milani Paolo
Published: August 2022

Purpose of review

After many years, the management of systemic light chain (AL) amyloidosis is entering the era of evidence-based medicine, with three recently published randomized clinical trials, a regimen (daratumumab, cyclophosphamide, bortezomib, and dexamethasone, daratumumab-CyBorD) labeled for upfront therapy, more clinical trials ongoing, and published guidelines. In this review, we discuss how current practice is changing based on this data.

Recent findings

Daratumumab-CyBorD grants unprecedentedly high rates of hematologic and organ response and became the novel standard-of-care in AL amyloidosis. The International Society of Amyloidosis and the European Hematology Association issued common guidelines for autologous stem cell transplant (ASCT) in this disease. Improved patient selection and effective induction regimens greatly reduced ASCT-related mortality. Venetoclax is emerging as a very effective option in patients harboring the common t(11;14) abnormality. Rapid and profound reduction of the amyloid free light chain can improve survival also at advanced stages.

Daratumumab-CyBorD is being integrated into the treatment flow-chart whereas the role of ASCT is being redefined. New approaches are being tested in clinical trials. Treatment of daratumumab-refractory patients and validation of criteria of hematologic progression to be used in clinical trials and in individual patient management are current areas of research.
The Contribution of Health Behaviors to Depression Risk Across Birth Cohorts
Authors: Gueltzow Maria , Bijlsma Maarten J. , van Lenthe Frank J. , Myrskylä Mikko
Published: August 2022

Background:

More recent birth cohorts are at a higher depression risk than cohorts born in the early 20th century. We aimed to investigate to what extent changes in alcohol consumption, smoking, physical activity, and obesity contribute to these birth cohort variations.

Methods:

We analyzed panel data from US adults born 1916–1966 enrolled in the Health and Retirement Study (N = 163,760 person-years). We performed a counterfactual decomposition analysis by combining age-period-cohort models with g-computation. We thereby compared the predicted probability of elevated depressive symptoms (CES-D 8 score ≥3) in the natural course to a counterfactual scenario where all birth cohorts had the health behaviors of the 1945 birth cohort. We stratified analyses by sex and race-ethnicity.

Results:

We estimated that depression risk of the 1916–1949 and 1950–1966 birth cohort would be on average 2.0% (–2.3 to –1.7) and 0.5% (–0.9 to –0.1) higher with the alcohol consumption levels of the 1945 cohort. In the counterfactual with the 1945 BMI distribution, depression risk is on average 2.1% (1.8 to 2.4) higher for the 1916–1940 cohorts and 1.8% (–2.2 to –1.5) lower for the 1950–1966 cohorts. We find no cohort variations in depression risk for smoking and physical activity. The contribution of alcohol is more pronounced for Whites than for other race-ethnicity groups, and the contribution of BMI more pronounced for women than for men.

Conclusion:

Increased obesity levels were associated with exacerbated depression risk in recent birth cohorts in the United States, while drinking patterns only played a minor role.
GPR171 activation regulates morphine tolerance but not withdrawal in a test-dependent manner in mice
Authors: Afrose Leela , McDermott Max V. , Bhuiyan Ashif I. , Pathak Sanjai K. , Bobeck Erin N.
Published: August 2022

A newly deorphanized G protein-coupled receptor, GPR171, is found to be highly expressed within the periaqueductal gray, a pain-modulating region in the brain. Our recent research has shown that a GPR171 agonist increases morphine antinociception in male mice and opioid signaling in vitro. The objective of this study was to evaluate the effects of combination treatment in females as well as whether chronic treatment can be used without exacerbating morphine-induced tolerance and withdrawal in female and male mice. Our results demonstrate that activation of GPR171 with an agonist attenuates morphine tolerance in both female and male mice on the tail-flick test, but not the hotplate test. Importantly, the GPR171 agonist in combination with morphine does not exacerbate morphine-induced tolerance and withdrawal during long-term morphine treatment. Taken together, these data suggest that the GPR171 agonist may be combined with morphine to maintain antinociception while reducing the dose of morphine and therefore reducing side effects and abuse liability. The outcome of this study is clearly an important step toward understanding the functional interactions between opioid receptors and GPR171 and developing safer therapeutics for long-term pain management.
Therapeutic Drug Monitoring and Dosage Adjustments of Immunosuppressive Drugs When Combined With Nirmatrelvir/Ritonavir in Patients With COVID-19
Authors: Lemaitre Florian , Budde Klemens , Van Gelder Teun , Bergan Stein , Lawson Roland , Noceti Ofelia , Venkataramanan Raman , Elens Laure , Moes Dirk Jan A. R. , Hesselink Dennis A. , Pawinski Tomasz , Johnson-Davis Kamisha L. , De Winter Brenda C. M. , Pattanaik Smita , Brunet Mercè , Masuda Satohiro , Langman Loralie J.
Published: August 2022

Nirmatrelvir/ritonavir (Paxlovid) consists of a peptidomimetic inhibitor (nirmatrelvir) of the SARS-CoV-2 main protease and a pharmacokinetic enhancer (ritonavir). It is approved for the treatment of mild-to-moderate COVID-19. This combination of nirmatrelvir and ritonavir can mediate significant and complex drug–drug interactions (DDIs), primarily due to the ritonavir component. Indeed, ritonavir inhibits the metabolism of nirmatrelvir through cytochrome P450 3A (CYP3A) leading to higher plasma concentrations and a longer half-life of nirmatrelvir. Coadministration of nirmatrelvir/ritonavir with immunosuppressive drugs (ISDs) is particularly challenging given the major involvement of CYP3A in the metabolism of most of these drugs and their narrow therapeutic ranges. Exposure of ISDs will be drastically increased through the potent ritonavir-mediated inhibition of CYP3A, resulting in an increased risk of adverse drug reactions. Although a decrease in the dosage of ISDs can prevent toxicity, an inappropriate dosage regimen may also result in insufficient exposure and a risk of rejection. Here, we provide some general recommendations for therapeutic drug monitoring of ISDs and dosing recommendations when coadministered with nirmatrelvir/ritonavir. Particularly, tacrolimus should be discontinued, or patients should be given a microdose on day 1, whereas cyclosporine dosage should be reduced to 20% of the initial dosage during the antiviral treatment. Dosages of mammalian target of rapamycin inhibitors (m-TORis) should also be adjusted while dosages of mycophenolic acid and corticosteroids are expected to be less impacted.
Assessment of patient’s perception and knowledge towards anesthesia services at Dilla University Referral Hospital, South Ethiopia, 2021: a cross-sectional study
Authors: Hailu Seyoum , Girma Timsel , Regasa Teshome
Published: August 2022

Background:

The poor community understanding of anesthesia professionals and their discipline has been a long-standing and obvious problem. Many studies have been done in the developed countries investigating public awareness of anesthetists but there are few publications from the developing countries including Ethiopia. Patients’ knowledge of anesthetists and their roles inside and outside the operation theatre is poor worldwide.

Objective:

This study is aimed to assess patients’ perception and knowledge of anesthesia service among patients admitted for surgery at Dilla University Referral Hospital (DURH), Southern Ethiopia, 2021.

Methods:

An institutional-based cross-sectional questionnaire survey was carried out on consecutive adult patients aged 18 years and above that had undergone surgery at DURH, conducted over four months. Data were presented using tables, and graphs and summarized by using dummy tables. After carefully analyzing the collected data, a conclusion was made with constructive recommendations.

Result:

A total of 396 patients were initially included in the study while 27 patients declined to participate with a 93% response rate. The mean age of participants was 39.5±14.9 years, and more than half of the respondents 225 (61%) were male. Regarding the type of surgery done 238 (64.6%) respondents were emergency the rest of 35.4% were elective surgery. Of 369 respondents, only 42% knew that anesthetist is the one who gives anesthesia and 38% knew that a doctor does.

Conclusion:

The perception of most patients is that anesthesia is all about “putting patients to sleep and waking them up.” There was poor knowledge of patients regarding the role of anesthetists beyond the confines of the operating theater. Therefore, there is a need for intensified public education on the importance of anesthesia and the diverse roles anesthetists play in ensuring holistic health care delivery.
Influential Factors for Selecting a Plastic Surgeon: A National Survey in Saudi Arabia
Authors: Al Qurashi Abdullah A. , Mortada Hatan , Abuthiyab Noorah , Al Zaid Nura , Aletani Tala , Arab Khalid
Published: August 2022

Introduction:

Knowing what attracts cosmetic patients to a specific surgeon can help current cosmetic surgeons and aspiring ones improve themselves and better market their practice. Hence, this study aimed to investigate the influential factors when selecting an aesthetic surgeon for a cosmetic procedure in Saudi Arabia.

Methods:

This is a cross-sectional, nationwide study targeting the public from all regions of Saudi Arabia. The study was conducted between September 21 and October 29, 2021. The self-structured electronic survey was based on previously published studies and was revised by two academic plastic surgeons.

Results:

This study included a total of 7190 participants from all regions of Saudi Arabia. The most influential factor for choosing an aesthetic surgeon was the surgeon’s qualifications (39.9%), followed by friends and relatives’ advice (24%) and hospital/clinic environment (10.2%), while the number of social media followers was the least favorable factor (0.8%). Additionally, the most preferred aesthetic surgeon was a surgeon with international board certification (mean score, 4.17).

Conclusions:

This study showed that the most common factor for choosing an aesthetic surgeon was the surgeons’ qualifications. Thus, Saudi aesthetic surgeons and aspiring Saudi aesthetic surgeons must focus on obtaining high qualifications to attract more patients. Furthermore, an internationally board-certified surgeon is the most preferred surgeon for Saudi Arabian patients; thus, traveling abroad to world-renowned institutions is recommended.
Yogurt Technique for Descemet Membrane Endothelial Keratoplasty Graft Preparation: Early Clinical Outcomes
Authors: Moramarco Antonio , Romano Vito , Modugno Rocco Luigi , Coco Giulia , Viola Pietro , Fontana Luigi
Published: August 2022

Purpose:

The aim of this study was to evaluate the efficacy and safety of the Yogurt technique for Descemet membrane endothelial keratoplasty (DMEK) graft preparation.

Methods:

This study included patients who underwent DMEK combined or not with phacoemulsification surgery using donor tissues prepared by a surgeon with the DMEK Tzamalis disposable punch at 2 referral hospitals between October 2019 and June 2021. Primary outcomes were duration of graft preparation, surgeon grading of graft quality, and endothelial cell density measured at 1 and 6 months after surgery. Secondary outcomes were best-corrected visual acuity (BCVA) measured at 1 and 6 months postoperatively and DMEK intraoperative and postoperative complications.

Results:

Forty-nine patients were included in this study. The mean DMEK graft preparation time was 7.2 ± 1.4 minutes. Donor grafts were rated good in 67.3% of cases (33 of 49), sufficient in 24.5% (12 of 49), and poor in 8.2% (4 of 49). Donor mean endothelial cell density was 2580 ± 155 preoperatively, which were reduced to 2269 ± 191 (P < 0.000) and 1697 ± 142 (P < 0.0001) at 1 and 6 months, respectively. No significant difference was found in graft preparation outcome (P = 0.543). The preoperative BCVA was 0.65 ± 0.44 logMAR, which improved to 0.31 ± 0.43 logMAR (P < 0.0001) and 0.12 ± 0.14 logMAR (P < 0.0001) at 1 and 6 months after surgery, respectively.

Conclusions:

This study shows that the DMEK Tzamalis punch can be used as an effective and safe method for DMEK graft preparation with a shallow learning curve that allows it to be successfully performed by relatively inexperienced surgeons.
Effect of Single-dose Azithromycin on Pneumococcal Carriage and Resistance: A Randomized Controlled Trial
Authors: Coulibaly Boubacar , Kiemde Dramane , Zonou Guillaume , Sié Ali , Dah Clarisse , Bountogo Mamadou , Brogdon Jessica , Hu Huiyu , Lebas Elodie , Porco Travis C. , Doan Thuy , Lietman Thomas M. , Oldenburg Catherine E.
Published: August 2022

We evaluated antibiotic resistance selection in Streptococcus pneumoniae isolates from children participating in an individually randomized trial of single-dose azithromycin versus placebo. After 14 days, the prevalence of resistance to erythromycin, oxacillin, and clindamycin was elevated in the azithromycin versus placebo group. There was no difference at 6 months.
Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review
Authors: Sharifi Ali , Akbari Zahra , Shafie’ei Mohammad , Nasiri Naser , Sharifi Meraj , Shafiei Mohadeseh , Zand Amin
Published: August 2022

Purpose:

Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM).

Methods:

The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants.

Results:

A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases.

Conclusions:

Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.
Mucoepidermoid Carcinoma Ex Pleomorphic Adenoma of Lacrimal Gland: Case Report and Review of Literature
Authors: Khademi Behzad , Zia Zahra , Kohandel-Shirazi Mahsa
Published: August 2022

Carcinoma ex pleomorphic adenoma (Ca ex PA) is defined as an infiltrative carcinoma arising from a primary or recurrent benign pleomorphic adenoma. Ca ex PA with the histologic subtype mucoepidermoid carcinoma is extremely uncommon. Only 2 previous reports in the lacrimal gland have been documented. We reported a 55-year-old lady with a firm, solid, nontender mass in the supralateral quadrant of the right orbit at the area of the lacrimal gland. After wide excision of mass, pathology revealed high-grade mucoepidermoid carcinoma Ex pleomorphic adenoma. To reduce tumor recurrence 60 Gray radiation was delivered to the orbital cavity. She is still tumor-free 1 year after completion of treatment.
High Temperature and Its Association With Work-Related Injuries by Employment Status in South Korea, 2017–2018
Authors: Choi Bokyoung , Choi Hayon Michelle , Choi Youngeun , Kim Inah , Hwang Seungsik
Published: August 2022

Objective

This study aimed to determine the association between maximum daily temperature and work-related injuries according to employment status in South Korea.

Methods

Data on workers’ compensation claims and daily maximum temperature between May 20 and September 10, 2017–2018, were collected and analyzed. The absolute temperature risk effect (ATR) was evaluated by comparing the risk effect at 2 temperatures (30°C vs 33°C) across all communities using 2-stage time-series analysis.

Results

The association between high temperatures and work-related injuries was statistically significant in the construction sector (ATR, 1.129; 95% confidence interval [CI], 1.010–1.261). In addition, the findings of this study also demonstrated a higher risk effect among nonpermanent workers (ATR, 1.109; 95% CI, 1.013–1.214) at 33°C versus 30°C when compared with permanent workers (ATR, 0.963; 95% CI, 0.891–1.041).

Conclusions

This study found a significant association between high temperatures and work-related injuries among nonpermanent workers in South Korea.
Evidence-based treatment recommendations for OTC management of chronic constipation
Authors: Rao Satish S.C. , Brenner Darren M.
Published: August 2022

Chronic constipation is a common gastrointestinal condition, and most individuals self-treat with multiple over-the-counter (OTC) laxatives prior to consulting a health care provider. This brief report is a synopsis of an updated systematic review the authors conducted of published data on the efficacy and safety of OTC treatments to provide evidence-based recommendations. After applying the selection criteria, 41 randomized controlled clinical trials of ≥ 4-week duration were identified and analyzed. Standardized definitions of constipation were applied across these studies; however, definitions for stool frequency and consistency varied. Overall, the short- and long-term efficacy of polyethylene glycol-based preparations and senna were supported by good (grade A) evidence suggesting their use as first-line laxatives. Modest evidence (grade B) supported the use of other agents including the stimulants bisacodyl and sodium picosulfate, fiber, fruit-based laxatives, and magnesium oxide. Additional evidence from rigorously designed studies is needed to support the use of other options for chronic constipation. The OTC products studied were generally well tolerated with common adverse effects being abdominal pain, cramping, bloating, diarrhea, and nausea.
Polyunsaturated fatty acids and metabolic health: novel insights
Authors: Djuricic Ivana , Calder Philip C.
Published: August 2022

Purpose of review

This review aims to discuss the potential roles of omega-3 (ω-3) and omega-6 (ω-6) polyunsaturated fatty acids (PUFAs) in the prevention and treatment of metabolic diseases, to provide the latest evidence from epidemiological and clinical studies, and to highlight novel insights into this field.

Recent findings

Higher dietary or circulating ω-3 PUFA levels are related to a lower risk of metabolic syndrome. Novel findings in obesity indicate higher proportions of ω-6 and ω-3 PUFAs, a modulated oxylipin profile and an altered transcriptome in subcutaneous white adipose tissue, that seem resistant to the effects of ω-3 PUFAs compared with what occurs in normal weight individuals. ω-3 PUFAs may improve the blood lipid profile and glycemic outcomes in patients with type 2 diabetes mellitus and reduce liver fat in nonalcoholic fatty liver disease (NAFLD); the findings of several recent meta-analyses support these effects. Genetic background affects inter-individual variability in the insulin sensitivity response to ω-3 PUFA supplementation. ω-3 PUFAs have prebiotic effects, altering the gut microbiota.

Although evidence for health benefits of ω-3 PUFAs is strong, recent findings suggest a more personalized approach to ω-3 PUFA intake for individuals at high risk for metabolic diseases.
Value of clinical tests in diagnosing anterior cruciate ligament injuries: A systematic review and meta-analysis
Authors: Huang Zhihao , Liu Zhihao , Fan Changfeng , Zou Miao , Chen Jiyan
Published: August 2022

Objectives:

This study compared 4 clinical tests with reference to magnetic resonance imaging and arthroscopic visualization to comprehensively evaluate their diagnostic value for anterior cruciate ligament injuries.

Methods:

We systematically searched 10 electronic databases from January 1, 2010, to May 1, 2021. Two reviewers collected data in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses 2020 guidelines. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using Meta-Disc version 1.4 and Stata SE version 15.0.

Results:

Eighteen articles involving 2031 participants were included. The results of the meta-analysis showed that for the Lachman test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, area under the curve (AUC) of summary receiver operating characteristic (SROC), and Q* were 0.76 (95% CI, 0.73–0.78), 0.89 (95% CI, 0.87–0.91), 5.65 (95% CI, 4.05–7.86), 0.28 (95% CI, 0.23–0.36), 22.95 (95% CI, 14.34–36.72), 0.88, and 0.81, respectively. For the anterior drawer test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.64 (95% CI, 0.61–0.68), 0.87 (95% CI, 0.84–0.90), 3.57 (95% CI, 2.13–5.96), 0.44 (95% CI, 0.32–0.59), 8.77 (95% CI, 4.11–18.74), 0.85, and 0.78, respectively. For the pivot shift test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.59 (95% CI, 0.56–0.62), 0.97 (95% CI, 0.95–0.98), 13.99 (95% CI, 9.96–19.64), 0.44 (95% CI, 0.35–0.55), 29.46 (95% CI, 15.60–55.67), 0.98, and 0.94, respectively. For the lever sign test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.79 (95% CI, 0.75–0.83), 0.92 (95% CI, 0.87–0.95), 9.56 (95% CI, 2.76–33.17), 0.23 (95% CI, 0.12–0.46), 47.38 (95% CI, 8.68–258.70), 0.94, and 0.87, respectively.

Conclusions:

Existing evidence shows that these clinical tests have high diagnostic efficacy for anterior cruciate ligament injuries, and that every test has its own advantages and disadvantages. However, the above results should be validated through additional studies, considering the limited quality and quantity of our sample.
Acupuncture and moxibustion for chronic fatigue syndrome: A systematic review and network meta-analysis
Authors: Fang Yang , Yue Bo-Wen , Ma Han-Bo , Yuan Yi-Peng
Published: August 2022

Background:

Research into acupuncture and moxibustion and their application for chronic fatigue syndrome (CFS) has been growing, but the findings have been inconsistent.

Objective:

To evaluate the existing randomized clinical trials (RCTs), compare the efficacy of acupuncture, moxibustion and other traditional Chinese medicine (TCM) treatments.

Data sources:

Three English-language databases (PubMed, Embase, Web of Science, and The Cochrane Library) and 4 Chinese-language biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were searched for RCTs published from database inception through August 2021.

Study selection:

RCTs include acupuncture, moxibustion, traditional Chinese herbal medicine, western medicine and no control.

Data extraction and synthesis:

Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. We conducted a random-effects network meta-analysis within a frequentist framework. We assessed the certainty of evidence contributing to network estimates of the main outcomes with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Main outcomes and measures:

The primary outcomes were the overall response rate and FS-14 scale.

Results:

A total of 51 randomized controlled trials involving 3473 patients with CFS were included in this review. Forty one studies indicate low risk or unknown risk, and the GRADE scores of the combined results show low levels. Among the main indicators, traditional Chinese medicine therapies have excellent performance. However, the overall response rate is slightly different from the results obtained from the Fatigue Scale-14 total score. Moxibustion and traditional Chinese medicine (Odds ratios 48, 95% CrI 15–150) perform better in the total effective rate, while moxibustion plus acupuncture (MD 4.5, 95% CrI 3.0–5.9) is better in the FS-14 total score.

Conclusions:

The effect of acupuncture and moxibustion in the treatment of CFS was significantly higher than that of other treatments. Traditional Chinese medicine should be used more widely in the treatment of CFS.
The correlation of BTLA rs1982809 polymorphism with cancer susceptibility: A meta-analysis of 8634 participators
Authors: Chen Jian , Wang Jun , Liu Ruihao , Xiong Haiwei , Liu Yingying , Zha Mingzhi , Li Qiang , Liu Xuan , Shang Mingjun , Li Yingliang
Published: August 2022

Background:

The connection between B and T lymphocyte attenuator rs1982809 polymorphism and cancer risk has been investigated by several studies and yielded different results. Therefore, we adopted the meta-analysis method to assess the association of rs1982809 polymorphism with the susceptibility of cancers synthetically.

Methods:

Eligible publications were gathered by retrieving PubMed, Web of Science, Embase, Wan Fang, and China National Knowledge Infrastructure. We utilized odds ratio (OR) and 95% confidence intervals (95% CI) to assess correlation intensity and performed subgroup analyses, sensitivity analyses, and publication bias assessments.

Results:

Six researches that encompassed 3678 cases and 4866 controls were incorporated into our meta-analysis. The rs1982809 polymorphism was proved to be connected with cancer risk by the meta-analysis in the additive model (G vs A: OR=1.11, 95% CI=1.04–1.19,Pheterogeneity=.096). Subgroup analyses revealed that this SNP is regarded as a susceptible factor for cancers in the dominant, heterozygous, and additive model (AG + GG vs AA: OR=1.46, 95% CI=1.19–1.80,Pheterogeneity=.592; AG vs AA: OR=1.47, 95% CI=1.19–1.82,Pheterogeneity=.536; G vs A: OR=1.32, 95% CI=1.12–1.55,Pheterogeneity=.745) in Caucasians; And this SNP may increase the susceptibility to lung cancer (GG vs AG+AA: OR=1.20, CI=1.01–1.44,Pheterogeneity=.854; G vs A: OR=1.17, CI=1.02–1.33,Pheterogeneity=.232).

Conclusion:

The paper concludes that B and T lymphocyte attenuator rs1982809 polymorphism may contribute to cancers, especially in Caucasians, and it may associate with lung cancer.
Male nurses’ work performance: A cross sectional study
Authors: Shen Jinhua , Guo Yafen , Chen Xiang , Tong Li , Lei Guangfeng , Zhang Xueqing
Published: August 2022

Background:

Nursing performance is closely related to the success of hospital and patient outcome. Recently, the proportion of male nurses has gradually increased. However, we do not know how these male nurses perform in clinical work. The purpose of this study was to understand the job performance of male nurses in China and to identify their risk factors.

Methods:

This is a cross-sectional study. We contacted all the 30 public tertiary hospitals in Hunan Province and 26 of them cooperated. All the 647 male nurses in these hospitals were given questionnaires face-to-face between April 7 and August 8, 2020. The questionnaire included demographic information and the Schwirian’s Six Dimension Scale. We also collected the family attitude and the main reason for choosing nursing. We then performed descriptive analyses and liner regressions on the collected data.

Results:

We obtained valid questionnaires from 599 individuals. The median age of these male nurses was 26 years old and the nursing age was 4 years. They were mainly distributed in intensive care unit (ICU) (36.12%), operating room (27.42%), and emergency department (23.08%). And the means of the total scores for work performance was 176.42 (standard deviation (SD) = 20.62). The result of the regression shows that length of service, relationship status, educational level, department, main reason for choosing nursing, and family attitude are all risk factors of male nurses’ work performance.

Conclusion:

Chinese male nurses are younger and have shorter working years. They mainly work in departments with higher work intensity and greater pressure. In addition, we found that years of service, education, marital status, department and main reasons for choosing nursing as factors influencing the job performance of male nurses.