bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart Rate Variability Biofeedback as a Treatment for Military PTSD: A Meta-Analysis
Authors: Kenemore Jordan , Benham Grant , Charak Ruby , Hernandez Rodriguez Juventino
Published: January 2024

Introduction

Emerging research has provided tentative support for the use of heart rate variability biofeedback (HRVB) as a treatment for several psychological disorders, with meta-analyses providing compelling evidence for HRVB as a promising treatment for anxiety, depression, and PTSD. Given the prevalence of PTSD in military veterans and the comparatively lower benefit and higher attrition rate of traditional psychological treatment for PTSD relative to civilian counterparts, it is important to examine complementary and alternative treatment approaches such as HRVB in this population. Although studies of HRVB for PTSD have been conducted with military veterans, they have involved relatively small sample sizes, limiting interpretation. To address this, the current article presents a comprehensive meta-analysis, consolidating existing literature to more accurately evaluate the efficacy of HRVB in reducing PTSD symptoms within military populations.

Materials and Methods

This meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and our protocol was registered with PROSPERO to increase review transparency. A literature search of HRVB interventions was conducted using PubMed, PsycINFO, Military Database, PTSDPubs, and EBSCO’s Psychological and Behavioral Sciences Collection.

Results

Five studies met eligibility criteria, providing a combined sample size of 95 military services members. For all studies, effect sizes were negative, indicating a reduction in PTSD symptoms. Effect sizes ranged from −1.614 to −0.414, resulting in an overall moderate to large mean effect for HRVB (Hedges’s g = −0.557; 95% confidence interval = −0.818 to −0.296; P < .001). Additionally, cumulative attrition was 5.8%, significantly lower than commonly reported rates for evidence-based treatments (16%–36%).

Conclusions

The present study is the first meta-analysis to examine HRVB as a treatment for military service members with PTSD. Results indicate that HRVB may be a viable treatment approach to reduce PTSD symptomatology. Low attrition rates, ease of accessibility, and favorable participant outlook serve as additional benefits for the use of HRVB.
Reintroduced Oriental Stork survival differed by mitochondrial DNA haplotype
Authors: Deguchi Tomohiro , Okahisa Yuji , Ohsako Yoshito
Published: January 2024

Long-lived territorial bird populations often consist of a few territorial breeding adults and many nonbreeding individuals. Some populations are threatened by anthropogenic activities, because of human conflicts for high-quality breeding habitat. Therefore, habitat restoration projects have been widely implemented to improve avian population status. In conjunction with habitat restoration, conservation translocations have been increasingly implemented. Adequate nonbreeder survival can be a key factor in the success of these attempts because nonbreeding birds may represent reservoirs for the replacement of breeders. The maintenance of breeding pair numbers is also influenced by the transition rate of nonbreeders to breeders. The reintroduction of Oriental Stork (Ciconia boyciana), a long-lived, territorial, endangered species, was initiated in Japan in 2005 using captive birds in hopes of increasing the population’s use of restored habitat. Our objective of this study was to elucidate the factors determining reintroduced stork survival and recruitment to the breeding populations. We estimated the survival rate and breeding participation rate by sex, age, generation, wild-born or not, haplotypes, and breeding status in storks reintroduced during 2005–2022 using Bayesian hierarchical models. There was no significant difference in survival rate between nonbreeders and breeders. However, the survival rate was lower in wild-born birds than released birds, which may be related to the longer-distance natal dispersal of new generations. Accelerated habitat restoration around breeding areas and preventive measures for collision with human-built structures should be implemented for the sustained growth of reintroduced populations. A low survival rate was also detected for a specific mitochondrial DNA (mtDNA) haplotype that accounts for the majority of the reintroduced population. This phenomenon might be explained by mtDNA-encoded mutations. Moreover, captive breeding and release history might contribute to an increase in the proportion of this haplotype in the wild.
Agent-based Modelling for Management Control and Management Accounting
Authors: Wall Friederike
Published: January 2024

Management control aims at conforming the behaviour of organizational members to organizational goals. To this aim, management control employs a multitude of control mechanisms—from performance measurements and incentive schemes to group norms and shared beliefs. This chapter focuses on the potential of agent-based modelling and simulation for theory building in management control. A core argument of the chapter is that the agent-based paradigm structurally corresponds to management control. The discussions provide examples of agent-based models contributing to emerging research topics in the field. The models are differentiated according to how they capture control mechanisms (i.e., as exogenously given and endogenously evolving). Models with exogenously given control mechanisms primarily focus on the effects and effectiveness of single mechanisms or combinations thereof, potentially differentiating for environmental contingencies. Agent-based models with endogenously evolving control mechanisms allow capturing the emergence of management control systems and the adaptation to potentially turbulent environments. The chapter discusses the promises and challenges of agent-based modelling for the domain and derives avenues for future research.
Trans-Species Mobility of RNA Interference between Plants and Associated Organisms
Authors: Nien Ya-Chi , Vanek Allison , Axtell Michael J
Published: January 2024

Trans-species RNA interference (RNAi) occurs naturally when small RNAs (sRNAs) silence genes in species different from their origin. This phenomenon has been observed between plants and various organisms including fungi, animals and other plant species. Understanding the mechanisms used in natural cases of trans-species RNAi, such as sRNA processing and movement, will enable more effective development of crop protection methods using host-induced gene silencing (HIGS). Recent progress has been made in understanding the mechanisms of cell-to-cell and long-distance movement of sRNAs within individual plants. This increased understanding of endogenous plant sRNA movement may be translatable to trans-species sRNA movement. Here, we review diverse cases of natural trans-species RNAi focusing on current theories regarding intercellular and long-distance sRNA movement. We also touch on trans-species sRNA evolution, highlighting its research potential and its role in improving the efficacy of HIGS.
Phytohormones in a universe of regulatory metabolites: lessons from jasmonate
Authors: Gasperini Debora , Howe Gregg A
Published: January 2024

Small-molecule phytohormones exert control over plant growth, development, and stress responses by coordinating the patterns of gene expression within and between cells. Increasing evidence indicates that currently recognized plant hormones are part of a larger group of regulatory metabolites that have acquired signaling properties during the evolution of land plants. This rich assortment of chemical signals reflects the tremendous diversity of plant secondary metabolism, which offers evolutionary solutions to the daunting challenges of sessility and other unique aspects of plant biology. A major gap in our current understanding of plant regulatory metabolites is the lack of insight into the direct targets of these compounds. Here, we illustrate the blurred distinction between classical phytohormones and other bioactive metabolites by highlighting the major scientific advances that transformed the view of jasmonate from an interesting floral scent to a potent transcriptional regulator. Lessons from jasmonate research generally apply to other phytohormones and thus may help provide a broad understanding of regulatory metabolite–protein interactions. In providing a framework that links small-molecule diversity to transcriptional plasticity, we hope to stimulate future research to explore the evolution, functions, and mechanisms of perception of a broad range of plant regulatory metabolites.
Multipotent bone marrow cell–seeded polymeric composites drive long-term, definitive urinary bladder tissue regeneration
Authors: Bury Matthew I , Fuller Natalie J , Wang Xinlong , Chan Yvonne Y , Sturm Renea M , Oh Sang Su , Sofer Laurel A , Arora Hans C , Sharma Tiffany T , Nolan Bonnie G , Feng Wei , Rabizadeh Rebecca R , Barac Milica , Edassery Sonia S , Goedegebuure Madeleine M , Wang Larry W , Ganesh Balaji , Halliday Lisa C , Seniw Mark E , Edassery Seby L , Mahmud Nadim B , Hofer Matthias D , McKenna Kevin E , Cheng Earl Y , Ameer Guillermo A , Sharma Arun K
Published: January 2024

To date, there are no efficacious translational solutions for end-stage urinary bladder dysfunction. Current surgical strategies, including urinary diversion and bladder augmentation enterocystoplasty (BAE), utilize autologous intestinal segments (e.g. ileum) to increase bladder capacity to protect renal function. Considered the standard of care, BAE is fraught with numerous short- and long-term clinical complications. Previous clinical trials employing tissue engineering approaches for bladder tissue regeneration have also been unable to translate bench-top findings into clinical practice. Major obstacles still persist that need to be overcome in order to advance tissue-engineered products into the clinical arena. These include scaffold/bladder incongruencies, the acquisition and utility of appropriate cells for anatomic and physiologic tissue recapitulation, and the choice of an appropriate animal model for testing. In this study, we demonstrate that the elastomeric, bladder biomechanocompatible poly(1,8-octamethylene-citrate-co-octanol) (PRS; synthetic) scaffold coseeded with autologous bone marrow-derived mesenchymal stem cells and CD34+ hematopoietic stem/progenitor cells support robust long-term, functional bladder tissue regeneration within the context of a clinically relevant baboon bladder augmentation model simulating bladder trauma. Partially cystectomized baboons were independently augmented with either autologous ileum or stem-cell-seeded small-intestinal submucosa (SIS; a commercially available biological scaffold) or PRS grafts. Stem-cell synergism promoted functional trilayer bladder tissue regeneration, including whole-graft neurovascularization, in both cell-seeded grafts. However, PRS-augmented animals demonstrated fewer clinical complications and more advantageous tissue characterization metrics compared to ileum and SIS-augmented animals. Two-year study data demonstrate that PRS/stem-cell-seeded grafts drive bladder tissue regeneration and are a suitable alternative to BAE.
‘There’s a little girl somewhere watching us who wants to be a police officer’: Strategies to attract more women into policing
Authors: DeWitt Amy L , Gasparini Janay M
Published: January 2024

The purpose of the research was to examine challenges women face in policing that may serve as barriers to the recruitment of other women; identifying challenges is crucial for developing strategies that attract women to the profession. The study employed in-depth, qualitative interviews with 16 policewomen. Emergent themes suggest six initiatives that could aid in recruiting more women: (1) Create recruitment materials that highlight roles that are not gender specific; (2) Provide fitness guidance to alleviate fears of inadequacy; (3) Organize mentorships that engage women interested in the profession; (4) Ensure representation of women in leadership roles; (5) Ensure that leaders identify and address inequities immediately to foster belonging; and (6) Institute family-friendly accommodations that allow recruits to balance work and home life. The officers interviewed reported finding purpose in policing, but they recognized the need to attract women in a concerted effort. Nationwide police departments are challenged to recruit women. Creating images, opportunities, and environments that demonstrate appreciation for women in the profession may aid in recruitment.
The Climate in Climate Economics
Authors: Folini Doris , Friedl Aleksandra , Kübler Felix , Scheidegger Simon
Published: January 2024

To analyse climate change mitigation strategies, economists rely on simplified climate models—so-called climate emulators—that provide a realistic quantitative link between CO2 emissions and global warming at low computational costs. In this paper, we propose a generic and transparent calibration and evaluation strategy for these climate emulators that are based on freely and easily accessible state-of-the-art benchmark data from climate sciences. We demonstrate that the appropriate choice of the free model parameters can be of key relevance for the predicted social cost of carbon. The key idea we put forward is to calibrate the simplified climate models to benchmark data from comprehensive global climate models that took part in the coupled model intercomparison project, phase 5 (CMIP5). In particular, we propose to use four different test cases that are considered pivotal in the climate science literature: two highly idealized tests to separately calibrate and evaluate the carbon cycle and temperature response, an idealized test to quantify the transient climate response, and a final test to evaluate the performance for scenarios close to those arising from economic models, and that include exogenous forcing. As a concrete example, we re-calibrate the climate part of the widely used DICE-2016, fathoming the CMIP5 uncertainty range of model responses: the multi-model mean as well as extreme, but still permissible climate sensitivities and carbon cycle responses. We demonstrate that the functional form of the climate emulator of the DICE-2016 model is fit for purpose, despite its simplicity, but its carbon cycle and temperature equations are miscalibrated, leading to the conclusion that one may want to be skeptical about predictions derived from DICE-2016. We examine the importance of the calibration for the social cost of carbon in the context of a partial equilibrium setting where interest rates are exogenous, as well as the simple general equilibrium setting from DICE-2016. We find that the model uncertainty from different consistent calibrations of the climate system can change the social cost of carbon by a factor of 4 if one assumes a quadratic damage function. When calibrated to the multi-model mean, our model predicts similar values for the social cost of carbon as the original DICE-2016, but with a strongly reduced sensitivity to the discount rate and about 1 degree less long-term warming. The social cost of carbon in DICE-2016 is oversensitive to the discount rate, leading to extreme comparative statics responses to changes in preferences.
Suvorexant alters dynamics of the sleep-electroencephalography-power spectrum and depressive-symptom trajectories during inpatient opioid withdrawal
Authors: Reid Matthew J , Dunn Kelly E , Abraham Liza , Ellis Jennifer , Hunt Carly , Gamaldo Charlene E , Coon William G , Mun Chung Jung , Strain Eric C , Smith Michael T , Finan Patrick H , Huhn Andrew S
Published: January 2024

Study Objectives

Opioid withdrawal is an aversive experience that often exacerbates depressive symptoms and poor sleep. The aims of the present study were to examine the effects of suvorexant on oscillatory sleep-electroencephalography (EEG) band power during medically managed opioid withdrawal, and to examine their association with withdrawal severity and depressive symptoms.

Methods

Participants with opioid use disorder (N = 38: age-range:21–63, 87% male, 45% white) underwent an 11-day buprenorphine taper, in which they were randomly assigned to suvorexant (20 mg [n = 14] or 40 mg [n = 12]), or placebo [n = 12], while ambulatory sleep-EEG data was collected. Linear mixed-effect models were used to explore: (1) main and interactive effects of drug group, and time on sleep-EEG band power, and (2) associations between sleep-EEG band power change, depressive symptoms, and withdrawal severity.

Results

Oscillatory spectral power tended to be greater in the suvorexant groups. Over the course of the study, decreases in delta power were observed in all study groups (β = −189.082, d = −0.522, p = <0.005), increases in beta power (20 mg: β = 2.579, d = 0.413, p = 0.009 | 40 mg β = 5.265, d = 0.847, p < 0.001) alpha power (20 mg: β = 158.304, d = 0.397, p = 0.009 | 40 mg: β = 250.212, d = 0.601, p = 0.001) and sigma power (20 mg: β = 48.97, d = 0.410, p < 0.001 | 40 mg: β = 71.54, d = 0.568, p < 0.001) were observed in the two suvorexant groups. During the four-night taper, decreases in delta power were associated with decreases in depressive symptoms (20 mg: β = 190.90, d = 0.308, p = 0.99 | 40 mg: β = 433.33, d = 0.889 p = <0.001), and withdrawal severity (20 mg: β = 215.55, d = 0.034, p = 0.006 | 40 mg: β = 192.64, d = −0.854, p = <0.001), in both suvorexant groups and increases in sigma power were associated with decreases in withdrawal severity (20 mg: β = −357.84, d = −0.659, p = 0.004 | 40 mg: β = −906.35, d = −1.053, p = <0.001). Post-taper decreases in delta (20 mg: β = 740.58, d = 0.964 p = <0.001 | 40 mg: β = 662.23, d = 0.882, p = <0.001) and sigma power (20 mg only: β = 335.54, d = 0.560, p = 0.023) were associated with reduced depressive symptoms in the placebo group.

Conclusions

Results highlight a complex and nuanced relationship between sleep-EEG power and symptoms of depression and withdrawal. Changes in delta power may represent a mechanism influencing depressive symptoms and withdrawal.
Electronic bills of lading, transnational and English law: blocking the blockchain?
Authors: Krebs Thomas
Published: January 2024

The dematerialisation of paper bills of lading has been a goal of the maritime trade community ever since the invention of the Internet, though reaching it had recently seemed increasingly unlikely. The development of blockchain technology has given new impetus to this enterprise, leading to UNCITRAL’s Model Law on Electronic Transferable Records. The recently passed Electronic Trade Documents Act 2023 implements many of the Model Law’s feature in English law and this may finally make electronic bills of lading a practical and not just a fanciful proposition. It is suggested, however, that the Act can achieve its goals without having to resort to the technology that inspired it – more pedestrian, centralised registry systems might be a safer bet than blockchain, at least for now.
Cercospora sojina Isolates from Kansas Soybean Fields with the G143A Mutation Conferring Resistance to Quinone Outside Inhibitor Fungicides
Authors: Onofre Rodrigo B. , Neves Danilo L. , Bradley Carl A.
Published: January 2024

Frogeye leaf spot, caused by Cercospora sojina, is one of the most important foliar diseases of soybean in the United States. Isolates of C. sojina with resistance to quinone outside inhibitor (QoI) fungicides were first identified in 2010 from Illinois, Kentucky, and Tennessee soybean fields and since have been found across multiple soybean-producing states. Resistance to QoI fungicides has been due to a mutation in the cytochrome b gene of C. sojina that leads to a substitution of glycine with alanine at position 143 (G143A mutation). Soybean leaf samples with symptoms of frogeye leaf spot were collected from soybean fields across multiple counties in Kansas during the 2022 growing season. Isolates of C. sojina from these soybean leaf samples were tested for the presence of the G143A mutation. The G143A mutation was found in isolates collected from soybean fields in seven Kansas counties, with a total frequency of 84.7% of the isolates having the G143A mutation for QoI fungicide resistance.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Fast MRI Techniques for Abdominal Imaging Simplified: Part 2—Newer Developments
Authors: Taneja Ranu , Goh Winfred Xi Tai
Published: January 2024

Motion is a major limiting factor in abdominal MRI. Rapid signal acquisition, fast and reduced k-space filling, and partial Fourier techniques, alone or in combination, can reduce scan time. In the previous article, we learnt basics of MR image generation and techniques for rapid signal acquisition and fast k-space filling. Some techniques for reduced k-space filling were also explained. In this second part, we continue to explore k-space and techniques that exploit its unique characteristics and other features inherent in MR signal acquisition such as data redundancy to further accelerate MR signal acquisition and enable ultrafast abdominal MRI.
Comparing the Performance of World Mental Health Composite International Diagnostic Interview Substance Abuse Module in Adolescents to Diagnoses Made by Pediatric Addiction Medicine Specialists
Authors: Levy Sharon , Minegishi Machiko , Brogna Melissa , Subramaniam Geetha , McCormack Jennifer , Weiss Roger , Weitzman Elissa R.
Published: January 2024

Objectives

The World Mental Health Composite International Diagnostic Interview Substance Abuse Module (WMH-CIDI-SAM) is commonly used as a criterion standard measure for substance use disorder (SUD) diagnoses, although the accuracy of this tool when used with adolescents is unknown. The objective of this study was to evaluate the agreement between SUD diagnoses for adolescents made by WMH-CIDI-SAM and those made by specialists based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) SUD criteria during an SUD evaluation.

Methods

Adolescents aged 12 to 17 years presenting to an outpatient SUD program for youth were administered the WMH-CIDI-SAM by a trained research assistant, and results were compared with diagnoses made by experienced clinicians based on DSM-5 SUD criteria during an initial SUD evaluation. Chance-corrected concordance was estimated using the κ coefficient for the comparisons.

Results

The level of concordance between the WMH-CIDI-SAM interview and the clinician diagnosis based on DSM-5 SUD criteria were fair to moderate for alcohol use disorder and tobacco use disorder and poor for cannabis use disorder. Three of 11 WMH-CIDI-SAM item constructs showed poor concordance with clinician diagnosis.

Conclusions

Interpreting the diagnostic criteria for SUDs, particularly cannabis use disorders, is nuanced, and the meaning of the criteria may be misunderstood by adolescents. Further evaluation of the performance of the WMH-CIDI-SAM diagnostic interview for identifying cannabis use disorders in adolescents is needed.
Comparative Analysis of Instrumental Variables on the Assignment of Buprenorphine/Naloxone or Methadone for the Treatment of Opioid Use Disorder
Authors: Homayra Fahmida , Enns Benjamin , Min Jeong Eun , Kurz Megan , Bach Paxton , Bruneau Julie , Greenland Sander , Gustafson Paul , Karim Mohammad Ehsanul , Korthuis P. Todd , Loughin Thomas , MacLure Malcolm , McCandless Lawrence , Platt Robert William , Schnepel Kevin , Shigeoka Hitoshi , Siebert Uwe , Socias Eugenia , Wood Evan , Nosyk Bohdan
Published: January 2024

Background:

Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD).

Methods:

Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber’s preference IV in analyzing the treatment assignment–treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses.

Results:

The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD.

Conclusions:

Our results suggest that prescriber’s preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.
Novel Identification of Cysteinyl Derivatives of Toxic Clozapine Nitrenium Ions and the Effect of Valproic Acid on Metabolite Formation: A Study Using Reprocessed High-Resolution Mass Spectra of Analyzed Therapeutic Drug Monitoring Samples
Authors: Wollmann Birgit M. , Haugen Aina G. , Smith Robert L. , Molden Espen
Published: January 2024

Background:

Clozapine (CLZ) use is hampered by the risk of granulocyte toxicity, which is associated with the formation of nitrenium ions and the concurrent use of valproic acid (VPA). These highly reactive nitrenium ions cannot be measured in vivo. Instead, deactivated cysteinyl conjugates may potentially be detected. The aim of this study was to develop a novel method for identifying cysteinylated derivates of CLZ nitrenium ions to investigate the effect of VPA on their formation using therapeutic drug monitoring data.

Methods:

A population comprising 93 VPA comedicated and 162 control patients from a therapeutic drug monitoring (TDM) service in Oslo, Norway, was included. Reprocessing of ultraperformance liquid chromatography high-resolution mass spectra (UHPLC-HR-MS) of previously analyzed TDM samples, combined with the assessment of MS/MS fragmentation patterns, was performed to identify the CLZ cysteinyl conjugates. Smoking, which induces CLZ metabolism, was assessed by detecting cotinine in the reprocessed mass spectra.

Results:

By reprocessing the UHPLC-HR-MS files of the TDM analyses and reviewing the MS/MS fragment profiles, four cysteinyl conjugates of CLZ were identified. The formations of CLZ cysteinyl (CLZ-Cys1+) and CLZ-N-oxide cysteinyl (CLZ-NOX-Cys1+) were 1.5-fold (P = 0.038) and 2.1-fold (P < 0.001) higher in VPA-treated patients than those in the controls. In agreement with previous studies, a 45% reduction in N-desmethylclozapine formation was observed in VPA-treated patients (P < 0.001).

Conclusions:

A novel method for detecting cysteinyl conjugates of CLZ was developed. Application of this method indicated that VPA significantly increased the formation of CLZ-Cys1+ metabolites, which might explain the granulocyte toxicity reported after adding VPA to CLZ treatment. The developed method opens new avenues for investigating CLZ toxicity, e.g. by correlating cysteinyl conjugates and granulocyte counts in patients.
Analysis of Factors Affecting Concentrations and Concentration-To-Dose Ratios of Trazodone
Authors: Song Yang , Chang Luyao , Lun Yang , Chen Chaoli , Fu Ran , Wang Donghan , Zhou Chunhua
Published: January 2024

Background:

Trazodone is prescribed for several clinical conditions. Multiple factors may affect trazodone to reach its therapeutic reference range. The concentration-to-dose (C/D) ratio can be used to facilitate the therapeutic drug monitoring of trazodone. The study aimed to investigate factors on the concentrations and C/D ratio of trazodone.

Methods:

This study analyzed the therapeutic drug monitoring electronic case information of inpatients in the First Hospital of Hebei Medical University from October 2021 to July 2023. Factors that could affect the concentrations and C/D ratio of trazodone were analyzed, including body mass index, sex, age, smoking, drinking, drug manufacturers, and concomitant drugs.

Results:

A total of 255 patients were analyzed. The mean age was 52.44 years, and 142 (55.69%) were women. The mean dose of trazodone was 115.29 mg. The mean concentration of trazodone was 748.28 ng/mL, which was in the therapeutic reference range (700–1000 ng/mL). 50.20% of patients reached the reference range, and some patients (36.86%) had concentrations below the reference range. The mean C/D ratio of trazodone was 6.76 (ng/mL)/(mg/d). A significant positive correlation was found between daily dose and trazodone concentrations (r2 = 0.2885, P < 0.001). Trazodone concentrations were significantly affected by dosage, sex, smoking, drinking, and concomitant drugs of duloxetine or fluoxetine. After dosage emendation, besides the above factors, it was influenced by age (P < 0.05, P < 0.01, or P < 0.001).

Conclusions:

This study identified factors affecting trazodone concentrations and C/D ratio. The results can help clinicians closely monitor patients on trazodone therapy and maintain concentrations within the reference range.
Role of Anterior Segment Optical Coherence Tomography in Staging and Evaluation of Treatment Response in Infectious Keratitis
Authors: Abdelghany Ahmed A. , Alio Jorge L. , AttaAllah Heba Radi
Published: January 2024

Purpose:

The aim of this study was to evaluate the role of anterior segment optical coherence tomography during follow-up of infectious keratitis and to assess response to treatment.

Methods:

This was a prospective, consecutive, observational clinical series of cases. Twenty-three eyes of 23 patients with clinically proven fungal keratitis were included in the study. The patients received medical treatment according to clinical diagnosis, and follow-up was performed weekly. Slit-lamp examination and photography, and anterior segment optical coherence tomography were performed at initial and follow-up visits until corneal healing occurred. The main outcome measures included infiltrate depth, width, and density; central corneal thickness; minimal corneal thickness; corneal thickness at the site of the lesion; and stromal thickness at the center of the lesion.

Results:

Twenty-three eyes of 23 patients (17 men and 6 women), mean age 42.5 ± 19 (8–66) years, were clinically diagnosed with fungal keratitis. Localization was central in 14 cases and paracentral/peripheral in 9 cases. Healing time was 6 to 12 weeks. Minimal corneal thickness, corneal thickness at the site of lesion, and stromal thickness at the center of lesion, and also infiltrate width and depth changed significantly from the first visit to the healing stage at the last follow-up (0.009, 0.001, 0.007, 0.001, and <0.001, respectively).

Conclusions:

In cases of fungal keratitis, anterior segment optical coherence tomography can provide the clinician with a quantitative assessment of a number of corneal parameters that can be used to determine effectiveness of therapy and confirm complete healing of the lesions that cannot be achieved by clinical evaluation.
Immediate and Delayed Effects of Punctal Plug Insertion on Tear Meniscus Height in Severe Aqueous-Deficient Dry Eye
Authors: Hallali Gabriel , Guindolet Damien , Gabison Eric E. , Cochereau Isabelle , Doan Serge
Published: January 2024

Purpose:

The aim of this study was to assess the immediate and delayed effects of tear punctal occlusion with punctal plugs on tear meniscus height (TMH) in severe aqueous-deficient dry eye (ADDE) disease.

Methods:

Consecutive patients with severe ADDE related to Sjögren syndrome or ocular graft-versus-host disease underwent inferior and superior occlusion with punctal plugs. TMH was measured using the LacryDiag ocular surface analyzer platform before, 10 minutes, and at least 1 month after punctal occlusion. The corneal fluorescein staining (CFS) score was graded with the Oxford scale (from 0 to 5). Ocular symptoms were graded with a visual analog scale (from 1 to 10).

Results:

We included 24 eyes of 24 patients (mean age 61 ± 9 years; mean follow-up 7 ± 5 months). The mean TMH was 0.19 ± 0.06 mm at baseline and increased significantly to 0.41 ± 0.13 mm (P < 0.001) and 0.46 ± 0.17 mm (P < 0.001) at 10 minutes after punctal plug insertion and at the end of follow-up, respectively. The median CFS score decreased from 3 ± 1 before plug insertion to 1 ± 2 at the end of follow-up (P < 0.001). Many patients (67%; n = 16) reported subjective improvement of symptoms. TMH was negatively correlated with the CFS score and visual analog scale score assessing symptoms.

Conclusions:

Upper and lower punctal occlusion increased TMH in patients with severe ADDE as soon as 10 minutes after plug insertion. TMH remained stable over time, which led to the relief of symptoms and reduced corneal staining.
Using Total Corneal Astigmatism With Femtosecond Laser Cataract Surgery and Arcuate Keratotomy(ies) to Treat Low Amounts of Astigmatism
Authors: Cohen Kenneth L. , Patel Neel K.
Published: January 2024

Purpose:

The aim of this study was to evaluate outcomes using total corneal astigmatism (TCA) to calculate arcuate keratotomy(ies) (AK) parameters performed with femtosecond laser-assisted cataract surgery to reduce low corneal astigmatism.

Methods:

Patients who had femtosecond laser-assisted cataract surgery and AK with 0.50 diopter (D) to 1.30 D of TCA were included. Exclusion criteria were intraoperative complications, preexisting corneal surgery, and comorbidities that might adversely affect outcomes. Corneal tomography (Galilei G4, Zeimer Ophthalmic Systems AG) was performed preoperatively and 1 month postoperatively. TCA was input into the Donnenfeld limbal relaxing incisions nomogram to calculate the AK parameters. Preoperative and postoperative tomographic and subjective refractive measurements were compared. The Alpins method for vector analysis evaluated results.

Results:

Eighty-two eyes of 82 patients were included. Mean preoperative TCA was significantly reduced from 0.80 ± 0.19 D to 0.51 D ± 0.26 D (P < 0.001). Preoperative posterior corneal astigmatism, −0.28 ± 0.13 D, was unchanged, postoperative posterior corneal astigmatism, −0.28 ± 0.14 D (P = 0.653). Target-induced astigmatism arithmetic mean (0.82 ± 0.21 D) was greater than that of the surgically induced astigmatism (0.70 ± 0.40 D), resulting in an arithmetic mean difference vector of 0.51 ± 0.27 D with a summated mean at 0.16 D at 20 degrees. The correction index was 0.87, indicating undercorrection. Angle of error arithmetic mean, −1.27 ± 23.27 degrees, indicated good alignment.

Conclusions:

Inputting TCA for calculation of femtosecond laser AK parameters can reduce low amounts of preoperative corneal astigmatism, thereby improving uncorrected vision.
Thought Blocking as a Manifestation of Catatonia
Authors: Elmarasi Omar , Abdelhady Safaa , Mahgoub Yassir
Published: January 2024

Catatonia is an underrecognized disorder that has been widely described as a psychomotor syndrome, with little emphasis on its thought and cognitive dimensions. The current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision describes only motor and behavioral presentations, whereas a few catatonia scales describe only one form of thought disorders, which is thought perseveration. Thought blocking, a disorder of the thought process, is characterized by regular interruptions in the thought stream. It was described by several scholars as a sign of schizophrenia, with few reports describing thought blocking in association with catatonia. In this article, we describe the course of a patient with bipolar I disorder who presented with catatonia and demonstrated thought blocking. Her catatonic symptoms and thought blocking improved with the addition of lorazepam, recurred upon lorazepam discontinuation, and improved with resumption of lorazepam, demonstrating a clear on/off phenomenon. This report highlights the importance of recognizing thought and cognitive manifestations of catatonia, as it can enhance recognition and improve treatment.
A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients
Authors: Singh Aaron , Kotzur Travis , Vivancos-Koopman Irene , Emukah Chimobi , Brady Christina , Martin Case
Published: January 2024

Introduction:

Hip fractures are a common injury associated with significant morbidity and mortality. In the United States, there has been a rapid increase in the prevalence of metabolic syndrome (MetS), a condition comprised several common comorbidities, including obesity, diabetes mellitus, and hypertension, that may worsen perioperative outcomes. This article assesses the impact of MetS and its components on outcomes after hip fracture surgery.

Methods:

Patients who underwent nonelective operative treatment for traumatic hip fractures were identified in the 2015–2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics between groups were compared, and significant differences were included as covariates. Multivariate regression was performed to assess the impact of characteristics of interest on postoperative outcomes. Patients with MetS, or a single one of its constitutive components—hypertension, diabetes, and obesity—were compared with metabolically healthy cohorts.

Results:

In total 95,338 patients were included. Patients with MetS had increased complications (OR 1.509; P < 0.001), but reduced mortality (OR 0.71; P < 0.001). Obesity alone was also associated with increased complications (OR 1.14; P < 0.001) and reduced mortality (OR 0.736; P < 0.001). Both hypertension and diabetes alone increased complications (P < 0.001) but had no impact on mortality. Patients with MetS did, however, have greater odds of adverse discharge (OR 1.516; P < 0.001), extended hospital stays (OR 1.18; P < 0.001), and reoperation (OR 1.297; P = 0.003), but no significant difference in readmission rate.

Conclusion:

Patients with MetS had increased complications but decreased mortality. Our component-based analysis showed had obesity had a similar effect: increased complications but lower mortality. These results may help surgeons preoperatively counsel patients with hip fracture about their postoperative risks.
Interposing Rectus and Gracilis Muscle Flaps for Pelvic Reconstruction in Bladder Exstrophy after Bladder Neck Closure
Authors: Harris Thomas G. W. , Crigger Chad B. , Suresh Visakha , Haffar Ahmad , Sholklapper Tamir N. , Nasr Isam W. , Gearhart John P. , Yang Robin , Redett Richard J.
Published: January 2024

Background:

The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy and cloacal exstrophy (CE). Patients undergo multiple soft-tissue procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterward for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed.

Methods:

A retrospective cohort study of patients with exstrophy-epispadias complex who underwent BNC and had a muscle flap was performed. Indication for flap use; surgical technique; and risks for BNC failure, including mucosal violations (MVs), were reviewed. MVs were previous bladder mucosa manipulation for exstrophy closure, repeat closures, and bladder neck reconstruction. Success was defined as BNC without fistula development.

Results:

Thirty-four patients underwent reconstruction. Indications included fistula prophylaxis during BNC (n = 13), fistula closure after BNC (n = 17), fistula prophylaxis after BNC during open cystolithotomy (n = 1), or fistula closure after open cystolithotomy (n = 3). A vesicourethral fistula developed most frequently in classic bladder exstrophy (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flaps were used, with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success, and 2 patients with CE required a second flap.

Conclusions:

The rectus flap is preferred as it covers the anteroinferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs increase the risk of fistula formation and may influence the need for prophylactic flaps.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A European Multicenter Outcome Study of Perioperative Airway Management Policies following Midface Surgery in Syndromic Craniosynostosis
Authors: Cuperus Iris E. , Mathijssen Irene M. J. , van Veelen Marie-Lise C. , Bouzariouh Anouar , Stubelius Ingrid , Kölby Lars , Lundborg Christopher , Das Sumit , Johnson David , Wall Steven A. , Larysz Dawid F. , Dowgierd Krzysztof , Koszowska Małgorzata , Schulz Matthias , Gratopp Alexander , Thomale Ulrich-Wilhelm , Zafra Vallejo Víctor , Redondo Alamillos Marta , Ferreras Vega Rubén , Apolito Michela , Vergnaud Estelle , Paternoster Giovanna , Khonsari Roman H. ,   Workgroup Craniosynostosis, European Reference Network CRANIO
Published: January 2024

Background:

Perioperative airway management following midface advancements in children with Apert and Crouzon–Pfeiffer syndromes can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications.

Methods:

A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc or Le Fort III procedures.

Results:

A total of 275 patients (monobloc surgery, n = 129; Le Fort III surgery, n = 146) were included. Sixty-two patients received immediate extubation and 162 received delayed extubation; 42 had long-term tracheostomies, and 9 had perioperative short-term tracheostomies. In most centers, short-term tracheostomies were reserved for selected cases. Patients with delayed extubation remained intubated for 3 days (interquartile range, 2 to 5 days). The rate of no or only oxygen support after extubation was comparable between immediate and delayed extubation groups (58 of 62 patients [94%] and 137 of 162 patients [85%], respectively). However, the immediate extubation group developed fewer cases of postoperative pneumonia than did the delayed group (0 of 62 [0%] versus 24 of 161 [15%]; P = 0.001). Immediate extubation also appeared safe in moderate to severe obstructive sleep apnea, as 19 of 20 patients (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation.

Conclusions:

Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no or mild obstructive sleep apnea, and should be the aim in moderate to severe obstructive sleep apnea cases after careful assessment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Treatment Durability of Limited Fasciectomy versus Percutaneous Needle Fasciotomy for Dupuytren Disease
Authors: van den Berge Bente A. , Omar Fatuma M. A. , Werker Paul M. N. , Zhan Zhuozhao , van den Heuvel Edwin R. , Broekstra Dieuwke C.
Published: January 2024

Background:

Patients with Dupuytren disease (DD) are mostly surgically treated by percutaneous needle fasciotomy (PNF) or limited fasciectomy (LF), but data on time intervals to retreatment are lacking. The authors aimed to estimate the risk of retreatment within certain time periods after treatment with PNF and LF.

Methods:

The authors used data of participants of a cohort study on the course of DD who were treated only with PNF or LF. The primary outcome measure was time to retreatment of DD. The authors included sex, age at first treatment, and having a first-degree relative with DD as confounders in our analysis. A bivariate gamma frailty model was applied to estimate the risk of retreatment within 1, 3, 5, 10, and 20 years after treatment with PNF and LF.

Results:

The time to retreatment was significantly shorter after treatment with PNF than after LF (Wald test statistic, 7.56; P < 0.001). The estimated 10-year risk of retreatment for men who underwent their first treatment at a younger age and with a first-degree relative with DD was 97% after PNF and 32% after LF. The estimated 10-year risk for women who underwent their first treatment at an older age without a first-degree relative with DD was 20% after PNF and 6% after LF.

Conclusions:

The results show that the patients treated with PNF have a higher risk of retreatment. The results of this study could contribute to individualized information on the treatment durability in the future, which would improve patient counseling about the expected retreatment needs.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer
Authors: Yang Liu , Li Wen
Published: January 2024

Background and Objective

Patients with local advanced hypopharyngeal combined with esophageal cancer often require total laryngectomy and cervical esophagectomy, which result in big-sized upper aerodigestive tract defects and neck deformities. Although free flap is widely used to reconstruct aerodigestive defects, the aesthetic results especially that of neck contour have not brought to the forefront or discussed extensively. This article aims to report the preliminary aesthetic results of free flap reconstruction for local advanced hypopharyngeal cancer combined with cervical esophageal cancer defects, highlighting the thickness of subcutaneous fat of the flap.

Methods

A retrospective study of 21 patients with local advanced hypopharyngeal combined with cervical esophageal cancer from July 2010 to August 2022 was conducted. After completing total laryngectomy, bilateral neck dissection, and removal of the tumor with safe margin, a free thigh flap of subcutaneous fat greater than 1 cm in thickness was used to reconstruct the hypopharyngeal and cervical esophageal defects. In addition to general demographic, oncological, and reconstructive data, preoperative and postoperative neck circumferences were recorded and compared. A subjective questionnaire survey was conducted on patients' satisfaction with postoperative neck contour. The patients were followed up from 3 to 10 years, with an average of 3 years.

Results

There were 2 cases (2/21) of free flap loss because of flap necrosis and secondary repair with a pedicled pectoralis major flap. Nineteen flaps (19/21) survived. Three cases (3/21) developed a pharyngeal fistula and one case (1/21) experienced salivary fistula, all of the fistulae healed after drainage and dressing change. There was a relatively high satisfaction rate among patients (16/21) with the postoperative neck contour. A paired sample t test showed no statistically significant difference between the preoperative and postoperative values (t = 2.002, P > 0.05). Patients with a thicker subcutaneous fat flap (≥1.5 cm) had a more symmetrical and fuller neck contour during long-term postoperative follow-up.

Conclusions

The application of a fat-rich subcutaneous free thigh flap to reconstruct the defect of local advanced hypopharyngeal combined with cervical esophageal cancer can achieve better neck aesthetic contour.