bluuebunny/crossref_metadata_2025 huggingface dataset:
Panniculitis, an uncommon skin manifestation in adult dermatomyositis
Authors: Xing Xiaojing , Wang Song , Li Anqi , Li Zihang , Lin Biwen
Published: February 2023

This case-cohort study was performed to investigate the skin manifestations of 205 adult inpatients with dermatomyositis (DM). We then analysed the association between the clinical characteristics and panniculitis in adult patients with DM. This study was conducted at the First Medical Centre of PLA General Hospital, Beijing, China from 1 March 2016 to 30 December 2020 with follow-up until 31 December 2021. This case-cohort study involved 205 eligible participants with DM who met the criteria for idiopathic inflammatory myopathy. Clinical data, cutaneous manifestations, and lesion locations were screened and analysed. Serum samples were collected, and immunoblotting was used to detect 16 types of myositis-specific antibodies and myositis-associated antibodies. The results showed that 16 (7.8%) of the 205 adult patients with DM had panniculitis. The panniculitis was mainly distributed in the subcutaneous fat of the abdomen, buttocks, and thighs. This condition was often accompanied by skin ulcers, atrophic scars, and calcinosis. Moreover, 9 (72.7%) of the 16 patients with panniculitis were positive for antibodies to nuclear matrix protein 2 (anti-NXP2 antibodies). In conclusion, our data showed that panniculitis is an uncommon skin manifestation in adult patients with DM, with a positivity rate of 7.8%. The appearance of panniculitis is likely associated with anti-NXP2 antibodies.
Analysis of clinical features of patients with psoriasis and metabolic syndrome in Xinjiang
Authors: Duan Man-Man , Ma Yun-Xia , Zhang Jing-Zhan , Luo Dong , Yu Shi-Rong , Kang Xiao-Jing , Ding Yuan
Published: February 2023

Objective:

The clinical characteristics of a large sample of patients with psoriasis and metabolic syndrome (MS) in Xinjiang were retrospectively analyzed.

Methods:

The prevalence of MS, age, height, weight, body mass index (BMI), red blood cell count (RBC), white blood cell count (WBC), platelet count, aspartate aminotransferase level, alanine aminotransferase (ALT) level, and other clinical data were analyzed in 2,492 inpatients with psoriasis in our hospital. The patients were divided into two groups based on the presence of MS.

Results:

Among the 2,492 patients, 349 had MS and 1,269 were considered overweight/obese. There were significant differences in sex, age, disease course, age at onset, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) between the two groups (P < 0.05). The RBC, WBC, erythrocyte sedimentation rate, blood urea nitrogen level, creatinine level, triglyceride level, total cholesterol level, and low-density lipoprotein cholesterol level were significantly higher in the MS group than in the psoriasis-only (PO) group (P < 0.05). The high-density lipoprotein cholesterol (HDL-C) level was significantly lower in the MS group than in the PO group (P < 0.05). The ALT and albumin levels were not significantly different between the two groups (P > 0.05). Binary logistic regression analysis showed that sex, age, BMI, SBP, DBP, and fasting plasma glucose (FPG) were independent risk factors for MS in patients with psoriasis, and HDL-C was considered a protective factor for these patients.

Conclusion:

The prevalence of MS in patients with psoriasis is high. Female sex, age, BMI, SBP, DBP, and FPG may be risk factors for psoriasis complicated by MS.
An Integrative Review of the Utilization of the Perceived Stress Scale in Stroke Recovery
Authors: Prather Jenifer G. , Stanfill Ansley Grimes
Published: February 2023

BACKGROUND: Stroke survivors (SS) may experience alterations in physical and cognitive processes that increase stress and reduce well-being. Timely and accurate measurement of stress throughout the continuum of recovery is necessary to inform targeted interventions that will improve quality of life for this group. OBJECTIVE: The aim of this study was to describe the utilization of the Perceived Stress Scale (PSS) during recovery in SS. METHODS: A comprehensive literature search was conducted using CINAHL, PsycINFO, PubMed, and Scopus databases. Studies were included if they captured primary data collection using any version of the PSS at any time point in the poststroke recovery period and were published in English between 2011 and 2022. Systematic reviews and meta-analyses were excluded. Evidence was synthesized, and themes were discussed. RESULTS: Among 397 studies, a total of 13 met inclusion criteria. Of these, 8 were cross-sectional studies, 3 were longitudinal studies, 1 was a randomized controlled trial, and the remaining study was a prospective nonrandomized trial. The PSS-10 (n = 7, 54%) was the most used version of the instrument, followed by the PSS-14 (n = 3, 23%) and PSS-4 (n = 2, 15.4%), with the modified PSS-10 being used in only 1 (7.6%) study. The PSS surveys were administered at various time points, ranging from the first day of admission to 3, 6, 9, or 12 months after discharge. Perceived stress may continue to negatively influence SS's psychological and physical well-being throughout the chronic phase of recovery. CONCLUSIONS: Stress is a unique and individualized experience that influences recovery trajectories in SS, an experience often overlooked or marginalized by clinicians and healthcare providers. To help mobilize strategies to achieve long-term health and wellness goals, future studies should explore and tailor interventions to minimize the influence of stress, as identified by the PSS, on well-being and quality of life during poststroke recovery.
Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes
Authors: Ponder Warren N. , Carbajal Jose , Whitworth James , Schuman Donna L. , Galusha Jeanine M. , Yockey R. Andrew
Published: February 2023

Objective

To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs).

Methods

We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide.

Results

Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs.

Limitations

These data are cross-sectional and should be modeled longitudinally over the course of treatment.

Conclusion

Separate constructs influence suicide for LEOs and FFs/EMTs.
Digital Stress. Effects of Different Intensities of Working From Home on Workers' Health
Authors: Rodríguez-Modroño Paula
Published: February 2023

Objective

Because hybrid and remote work models have exponentially expanded with digitalization and the COVID-19 pandemic, this study examines how different intensities of WFH impact workers' health.

Methods

Drawing on the job demands–resources model, we applied two-way analysis of variance and regression models to the sixth European Working Conditions Survey to examine how the type and magnitude of WFH effects on health depend on its intensity.

Results

A key aspect in relation to remote work is the frequency with which the worker carries out this type of work, with best results among those WFH only several times a month, for women, and several times a week, for men.

Conclusions

Reasonable intensity of WFH may have beneficial effects on health, but these positive effects are reduced when working fully home-based.
Using Kern’s Model to Redesign a Postgraduate Curriculum for Orthopaedic Physician Assistants
Authors: Chalupa Robyn L. , Kocher Benjamin K. , Douglas Matthew S.
Published: February 2023

Postgraduate physician assistant (PA) specialty training expands entry-level education, allowing PAs to work in concentrated fields. The United States Army – Baylor University Doctor of Science in PA Studies Orthopaedics program provides formal education to fill the capability gap caused by surgeon shortages in the military. Based on several sources of feedback, the authors recognized that the curriculum needed modernization and set forth to rewrite the curriculum. This article describes the use of Kern’s 6-Step Approach for Curriculum Development for Medical Education to redesign a curriculum for an 18-month postgraduate doctoral program for military orthopaedic PAs. The resulting formal curriculum enables 4 geographically separated sites to execute an orthopaedic PA degree program that addresses a critical specialty care access challenge for the military. Kern’s 6-Step approach could be used to design or redesign any PA educational content, from a single course to an entire degree program.
Meeting the Accreditation Standard for Diversity
Authors: Snyder Jennifer , Hills Karen , Alexander Lisa , Statler Michel , Straker Howard , Bowser Jonathan , Alesbury Elizabeth
Published: February 2023

While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.
Quality of Life and Well-being in Patients with Lower-limb Amputation Using a Prosthetic Limb: A Cross-sectional Study in a Major Center in Riyadh, Saudi Arabia
Authors: Alqusaiyer Faisal , Alsergani Abdullah , Aldarsouni Fayez , Aldawood Abdulrahman , Alkhayyal Yazeed , Alzaid Homoud , Al-hazmi Ali
Published: February 2023

Introduction

Quality of life (QoL) has been advocated for as an outcome measure for assessing the effect of treatment and quality of care given to prosthetic users. As such, it is necessary to assess the factors that play a role in influencing QoL to achieve better outcomes. Unfortunately, QoL has not been adequately studied in Saudi Arabia, which warranted further research. The objectives of this study were to estimate the QoL of prosthetic users in Riyadh and determine its association with Ambulation (AM), Social Burden (SB), and Appearance (AP).

Methods

A cross-sectional study design was used to achieve our objectives. Our participants were asked to fill out our self-administered questionnaire, which was composed of the Arabic versions of the Well-being (WB), AP, AM, and SB scales of the Prosthesis Evaluation Questionnaire (PEQ).

Results

A sample of 62 prosthetic users due to unilateral amputations were randomly selected from our sampling frame, 10 of which acted as outliers from the 95% confidence interval of QoL (CI) (56.13–67.94) and were omitted. The WB scale was shown to have a median of 57.5, whereas QoL had a mean of 62.58. In addition, a positive relationship was found between QoL and SB (P < 0.001; R
s = 0.657), AP (P < 0.001; R = 0.547), and AM (P < 0.001; R = 0.634).

Conclusion

Prosthetic users in Riyadh suffer from low QoL and satisfaction. Moreover, QoL was shown to be a multifactorial concept with many different elements and constituents. This suggests that a more comprehensive and inclusive method of prosthetic rehabilitation is required.

Clinical Relevance

There is a scarcity of QoL and well-being studies in Saudi Arabia regarding individuals with amputation and prosthetic users, given the number of prosthetic users, estimated to be around 2092 individuals. By estimating their QoL, we could identify what improvements are to be made to improve their lives.
Provider- and Facility-Level Variation in Pre-Cancerous Cervical Biopsy Diagnoses
Authors: Del Vecchio Natalie J. , Beaber Elisabeth F. , Garcia Michael P. , Wheeler Cosette M. , Kamineni Aruna , Chao Chun , Chubak Jessica , Corley Douglas A. , Owens Christopher L. , Winer Rachel L. , Pruitt Sandi L. , Raine-Bennett Tina , Feldman Sarah , Silverberg Michael
Published: February 2023

Objectives

Reproducibility of cervical biopsy diagnoses is low and may vary based on where the diagnostic test is performed and by whom. Our objective was to measure multilevel variation in diagnoses across colposcopists, pathologists, and laboratory facilities.

Methods

We cross-sectionally examined variation in cervical biopsy diagnoses within the 5 sites of the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium within levels defined by colposcopists, pathologists, and laboratory facilities. Patients aged 18 to 65 years with a colposcopy with biopsy performed were included, with diagnoses categorized as normal, cervical intraepithelial neoplasia grade 1 (CIN1), grade 2 (CIN2), and grade 3 (CIN3). Using Markov Chain Monte-Carlo methods, we fit mixed-effects logistic regression models for biopsy diagnoses and presented median odds ratios (MORs), which reflect the variability within each level. Median odds ratios can be interpreted as the average increased odds a patient would have for a given outcome (e.g., CIN2 or CIN3 vs normal or CIN1) when switching to a provider with higher odds of diagnosing that outcome. The MOR is always 1 or greater, and a value of 1 indicates no variation in outcome for that level, with higher values indicating greater variation.

Results

A total of 130,110 patients were included who received care across 82 laboratory facilities, 2,620 colposcopists, and 489 pathologists. Substantial variation in biopsy diagnoses was found at each level, with the most occurring between laboratory facilities, followed by pathologists and colposcopists. Substantial variation in biopsy diagnoses of CIN2 or CIN3 (vs normal or CIN1) was present between laboratory facilities (MOR: 1.26; 95% credible interval = 1.19–1.36).

Conclusions

Improving consistency in cervical biopsy diagnoses is needed to reduce underdiagnosis, overdiagnosis, and unnecessary treatment resulting from variation in cervical biopsy diagnoses.
Experience of Nurses Caring for COVID-19 Patients Supported by Venovenous Extracorporeal Membrane Oxygenation (ECMO) After ECMO Educational Crash Course
Authors: Emmarco Amy K. , Toy Bridget K. , Pavone Jennifer M. , Keller Ronald K. , Smith Deane E.
Published: February 2023

During a 6 week period beginning early March 2020, 30 patients with severe coronavirus disease 2019 (COVID-19) were supported with venovenous extracorporeal membrane oxygenation (ECMO). This volume increase mandated rapidly training 116 nurses with no prior ECMO experience via a 2 hour crash course. A qualitative study using semistructured, in-depth interviews was conducted to evaluate the experiences of this unique nursing cohort. Fourteen registered nurses meeting inclusion criteria of no prior ECMO experience, attendance of ECMO educational crash course, direct assignment of COVID-19 patients requiring ECMO, and willingness to consent to recorded interviews participated in the study. Two semistructured interviews were conducted, audio recorded, and transcribed verbatim. Thematic analysis of the interviews was completed using Colaizzi’s phenomenological method. Six themes identified were anxiety and fear of patient harm, isolation and depersonalization, value of didactic education with reinforced clinical experience, professional growth, importance of team collaboration, and pride and gratitude. Subthemes were additionally extracted. Nurses faced multiple obstacles during the pandemic. ECMO added a layer of complexity, as these patients required labor-intensive, high acuity nursing care. The impact of the pandemic and its unique challenges on nursing and medical staff warrants further investigation.
Impact of Steroid on Macrophage Migration Inhibitory Factor During and After Cardiopulmonary Bypass
Authors: Kunihara Takashi , Shingu Yasushige , Wakasa Satoru , Shiiya Norihiko , Gando Satoshi
Published: February 2023

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine released in response to glucocorticoids, which counter-regulates the effects of glucocorticoids. This study was performed to determine the impact of steroids on the expression of MIF and other pro- and anti-inflammatory cytokines during and after cardiopulmonary bypass (CPB). Twenty adult patients (10 men, 64 ± 8 years old) who underwent elective cardiac surgery by CPB were given either 2000 mg (group-H, n = 10) or 500 mg of methylprednisolone (group-L, n = 10) during CPB. The serum concentrations of MIF, interleukin (IL)-1β, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) were measured at eight time points until 36 hours after skin closure. The early postoperative course was uneventful for all patients. There were no significant differences in duration of operation, CPB, or aortic cross-clamping (AXC) between the two groups. MIF and IL-10 levels peaked just after the conclusion of CPB and decreased gradually thereafter. IL-1β, IL-8, and TNF-α were undetectable throughout the study period. There were no significant differences in MIF or IL-10 levels between the two groups. Peak levels of MIF in all patients were significantly correlated with the duration of CPB and AXC, whereas no such correlation was observed for IL-10. MIF or IL-10 levels were significantly elevated during and after CPB, but there were no differences between the two doses of steroid administration. Both steroid doses sufficiently suppressed proinflammatory cytokines. MIF better reflected the invasiveness of the operation than IL-10.
Explainable Machine Learning Analysis of Right Heart Failure After Left Ventricular Assist Device Implantation
Authors: Bahl Arjun , Qureshi Binish , Zhang Kevin , Bravo Claudio , Mahr Claudius , Li Song
Published: February 2023

Right heart failure (RHF) remains a common and serious complication after durable left ventricular assist device (LVAD) implantation. We used explainable machine learning (ML) methods to derive novel insights into preimplant patient factors associated with RHF. Continuous-flow LVAD implantations from 2008 to 2017 in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) were included. A total of 186 preimplant patient factors were analyzed and the primary outcome was 30 days of severe RHF. A boosted decision tree ML algorithm and an explainable ML method were applied to identify the most important factors associated with RHF, nonlinear relationships and interactions, and risk inflection points. Out of 19,595 patients, 19.1% developed severe RHF at 30 days. Thirty top predictors of RHF were identified with the top five being INTERMACS profile, Model for End-stage Liver Disease score, the number of inotropic infusions, hemoglobin, and race. Many top factors exhibited nonlinear relationships with key risk inflection points such as INTERMACS profile between 2 and 3, right atrial pressure of 15 mmHg, pulmonary artery pressure index of 3, and prealbumin of 23 mg/dl. Finally, the most important variable interactions involved INTERMACS profile and the number of inotropes. These insights could help formulate patient optimization strategies prior to LVAD implantation.
Interventricular-Septal Output While Supported on Left Ventricular Assist Device Therapy
Authors: Inglis Sara S. , Villavicencio Mauricio T. , Spencer Philip J. , Schettle Sarah D. , Stulak John M. , Clavell Alfredo L. , Kushwaha Sudhir S. , Behfar Atta , Rosenbaum Andrew N.
Published: February 2023

The effects of left ventricular unloading on septal function in patients with left ventricular assist devices (LVADs) have not been well characterized in vivo. The purpose of this study was to evaluate the relationship between markers of septal function with echocardiography in relationship to RV dysfunction and late RV failure after LVAD implantation. A retrospective study was conducted of patients supported on centrifugal-flow LVADs implanted over a 10-year period. Echocardiographic data were collected pre-operatively and up to 2 years after implantation. Interventricular septum (IVS) measurements were taken at end-systole and end-diastole. Interventricular-septal output (ISO) was calculated using the formula: (IVSs–IVSd)×heart rate. A total of 110 patients were included. An immediate and sustained reduction in both lateral annulus systolic velocity (RVS’) and TAPSE were observed after implant (p < 0.0001). However, ISO gradually decreased over time (p < 0.0001). While ISO was not predictive of late RV failure, a decrease in ISO by 25% or greater from pre-implant to hospital discharge was associated with late RV failure (OR 4.8; 95% CI, 1.4–16.5; p = 0.012) even after adjusting for relevant clinical variables (p ≤ 0.01 for each model). RV function is known to be influenced by mechanical ventricular interdependence and we demonstrate that measurement of ISO may be a useful marker in assessing RV dysfunction and predicting RV failure in patients following LVAD implantation.
Continuous-Flow Ventricular Assist Device Support in Adult Congenital Heart Disease: A 15-Year, Multicenter Experience of Temporary and Durable Support
Authors: Broda Christopher R. , Frankel William C. , Nair Ajith P. , Dreyer W. Jeffrey , Tunuguntla Hari P. , Frazier O. Howard , Dolgner Stephen J. , Anders Marc M. , Tume Sebastian C. , Qureshi Athar M. , Parekh Dhaval R. , Hickey Edward J. , Adachi Iki , Civitello Andrew B.
Published: February 2023

Heart failure (HF) is common in adult congenital heart disease (ACHD) patients; however, use of continuous-flow ventricular assist devices (CF-VADs) remains rare. We reviewed outcomes of patients with congenital heart disease greater than or equal to 18 years of age at the time of CF-VAD implant at the affiliated pediatric and adult institutions between 2006 and 2020. In total, 18 ACHD patients (15 with great anatomical complexity) received 21 CF-VADs. Six patients (median age 34 years) received seven percutaneous CF-VADs with a median duration of support of 20 days (3–44 days) with all patients survived to hospital discharge and two patients were bridged to durable CF-VADs. Fourteen patients (median age 38 years) received durable CF-VADs. Thirteen patients (93%) survived to hospital discharge and the median duration of support was 25.8 months (6.4–52.1 months). Estimated survival on durable CF-VAD at 1, 3, and 5 years was 84%, 72%, and 36%, respectively. Three patients were successfully bridged to transplantation. Device-related complications include cerebrovascular accident (n = 5), driveline infection (n = 3), device infection requiring chronic antibiotic therapy (n = 4), gastrointestinal bleeding (n = 6), and presumed pump thrombosis (n = 5). These results show percutaneous and durable CF-VADs can support ACHD patients with advanced HF.
Clinical Validation of a Neointima-Inducing Inflow Cannula in a Continuous Flow Left Ventricular Assist Device
Authors: Yamada Yukiko , Kikuchi Noriko , Yoshizawa Saeko , Ichihara Yuki , Hattori Hidetoshi , Saito Satoshi , Nunoda Shinichi , Niinami Hiroshi
Published: February 2023

Wedge thrombus formation around the inflow cannula of a continuous left ventricular assist device (LVAD) is a source of systemic thromboemboli. We previously reported the potential advantages of a new inflow cannula wrapped with titanium mesh (GU30) over the standard smooth surface oblique cut cannula (GU10). The objective of the present study was to clinically validate this new cannula. A retrospective cohort analysis of patients with implanted LVAD (EVAHEART) comparing the GU10 to the GU30 was conducted. Clinical outcomes, including survival, the incidence of thromboembolism, and bleeding events, were compared. Gross and histopathological analyses of explanted GU30 cannula were conducted following transplant or patient death. No significant differences in the survival rate, severe emboli, or cerebral bleeding were observed during the LVAD implantation. However, severe emboli occurred earlier after LVAD implantation when using the GU30 cannula compared with the GU10. In cases of long LVAD support, the neointima fully covered the inflow of the GU30 cannulae without wedge thrombus formation. The titanium mesh-wrapped inflow cannulae did not reduce the overall incidence of neurological events significantly. However, the titanium mesh-wrapped inflow cannula induced autologous neointimal growth over the cannula and prevented wedge thrombus formation in late-phase LVAD implantation.
Factor XII Silencing Using siRNA Prevents Thrombus Formation in a Rat Model of Extracorporeal Life Support
Authors: Umei Nao , Shin Suji , Lai Angela , Miller Jennifer , Roberts Kalliope , Strelkova Daria , Chaudhary Namit , Ichiba Shingo , Sakamoto Atsuhiro , Whitehead Kathryn , Cook Keith
Published: February 2023

Heparin anticoagulation increases the bleeding risk during extracorporeal life support (ECLS). This study determined whether factor XII (FXII) silencing using short interfering RNA (siRNA) can provide ECLS circuit anticoagulation without bleeding. Adult male, Sprague-Dawley rats were randomized to four groups (n = 3 each) based on anticoagulant: (1) no anticoagulant, (2) heparin, (3) FXII siRNA, or (4) nontargeting siRNA. Heparin was administered intravenously before and during ECLS. FXII or nontargeting siRNA were administered intravenously 3 days before the initiation of ECLS via lipidoid nanoparticles. The rats were placed on pumped, arteriovenous ECLS for 8 hours or until the blood flow resistance reached three times its baseline resistance. Without anticoagulant, mock-oxygenator resistance tripled within 7 ± 2 minutes. The resistance in the FXII siRNA group did not increase for 8 hours. There were no significant differences in resistance or mock-oxygenator thrombus volume between the FXII siRNA and the heparin groups. However, the bleeding time in the FXII siRNA group (3.4 ± 0.6 minutes) was significantly shorter than that in the heparin group (5.5 ± 0.5 minutes, p < 0.05). FXII silencing using siRNA provided simpler anticoagulation of ECLS circuits with reduced bleeding time as compared to heparin.

http://links.lww.com/ASAIO/A937
Defecation Symptoms in Relation to Stool Consistency Significantly Reflect the Dyssynergic Pattern in High-resolution Anorectal Manometry in Constipated Patients
Authors: Ingemansson Anna , Walter Susanna A. , Jones Michael P. , Sjödahl Jenny
Published: February 2023

Goals:

To evaluate the usefulness of a 2-week patient-completed bowel habit and symptom diary as a screening tool for disordered rectoanal coordination (DRC).

Background:

DRC is an important subgroup of chronic constipation that benefits from biofeedback treatment. Diagnosis of DRC requires a dyssynergic pattern (DP) of attempted defecation in high-resolution anorectal manometry (HRAM) and at least 1 other positive standardized examination, such as the balloon expulsion test or defecography. However, HRAM is generally limited to tertiary gastroenterology centres and finding tools for selecting patients for referral for further investigations would be of clinical value.

Study:

Retrospective data from HRAM and a 2-week patient-completed bowel habit and symptom diary from 99 chronically constipated patients were analyzed.

Results:

Fifty-seven percent of the patients had a DP pattern during HRAM. In the DP group, 76% of bowel movements with loose or normal stool resulted in a sense of incomplete evacuation compared with 55% of the non-DP group (P=0.004). Straining and sensation of incomplete evacuation with the loose stool were significantly more common in the DP group (P=0.032). Hard stool was a discriminator for non-DP (P=0.044). Multiple logistic regression including incomplete evacuation and normal stool predicted DP with a sensitivity of 82% and a specificity of 50%.

Conclusions:

The sensation of incomplete evacuation with loose or normal stool could be a potential discriminator in favor of DP in chronically constipated patients. The bowel habit and symptom diary may be a useful tool for stratifying constipated patients for further investigation of suspected DRC.
Reflux Symptoms Increase Following Sleeve Gastrectomy Despite Triage of Symptomatic Patients to Roux-en-Y Gastric Bypass
Authors: Patel Parth , Hobbs Paul , Rogers Benjamin D. , Bennett Michael , Eckhouse Shaina R. , Eagon J. Chris , Gyawali C. Prakash
Published: February 2023

Background and Aims:

Bariatric surgical options in obese patients include sleeve gastrectomy (SG) and roux-en-Y gastric bypass (RYGB), which may not be equivalent in risk of postoperative reflux symptoms. We evaluated risk and predictive factors for postbariatric surgery reflux symptoms.

Methods:

Patients with obesity evaluated for bariatric surgery over a 15-month period were prospectively followed with validated symptom questionnaires (GERDQ, dominant symptom index: product of symptom frequency and intensity from 5-point Likert scores) administered before and after SG and RYGB. Esophageal testing included high-resolution manometry in all patients, and ambulatory reflux monitoring off therapy in those with abnormal GERDQ or prior reflux history. Univariate comparisons and multivariable analysis were performed to determine if preoperative factors predicted postoperative reflux symptoms.

Results:

Sixty-four patients (median age 49.0 years, 84% female, median BMI 46.5 kg/m2) fulfilled inclusion criteria and underwent follow-up assessment 4.4 years after bariatric surgery. Baseline GERDQ and dominant symptom index for heartburn were significantly higher in RYGB patients (P≤0.04). Despite this, median GERDQ increased by 2 (0.0 to 4.8) following SG and decreased by 0.5 (−1.0 to 5.0) following RYGB (P=0.02). GERDQ became abnormal in 43.8% after SG and 18.8% after RYGB (P=0.058); abnormal GERDQ improved in 12.5% and 37.5%, respectively (P=0.041). In a model that included age, gender, BMI, acid exposure time, and type of surgery, multivariable analysis identified SG as an independent predictor of postoperative heartburn (odds ratio 16.61, P=0.024).

Conclusions:

Despite preferential RYGB when preoperative GERD was identified, SG independently predicted worsening heartburn symptoms after bariatric surgery.
Patients With Autoimmune Hepatitis and Nonalcoholic Fatty Liver Disease
Authors: Strzepka Jessica , Schwartz Benjamin A. , Ritz Ethan M. , Aloman Costica , Reau Nancy
Published: February 2023

Goal:

The objective of this study was to characterize an autoimmune hepatitis (AIH)/nonalcoholic fatty liver disease (NAFLD) overlap cohort, determine if they received standard of care treatment, and delineate their outcomes in comparison with patients with AIH or NAFLD alone.

Background:

AIH is a relatively rare and heterogeneously presenting liver disease of unknown etiology. NAFLD is a leading cause of liver disease worldwide. AIH treatment includes steroids, which have adverse metabolic effects that can worsen NAFLD. No treatment guidelines are available to mitigate this side on AIH/NAFLD overlap patients. Few studies to date have examined these patients’ characteristics, management practices, and outcomes.

Materials and Methods:

A single-center, retrospective chart review study examining biopsy-proven AIH/NAFLD, AIH, and NAFLD patients. Characteristics, treatment, and 1- and 3-year outcomes (all-cause mortality, need for liver transplantation, or decompensated cirrhosis) were evaluated.

Results:

A total of 72 patients (36.1% AIH/NAFLD, 34.7% AIH, and 29.2% NAFLD) were included. AIH/NAFLD patients were found to be more often Hispanic/Latino, female, and with lower liver aminotransaminases, immunoglobulin G, and anti–smooth muscle antibody positivity. AIH/NAFLD patients were less likely to receive standard of care treatment. No significant differences in outcomes were seen between AIH/NAFLD and either AIH or NAFLD.

Conclusions:

Our study demonstrated that AIH/NAFLD patients have unique characteristics and are less likely to receive standard of care treatment compared with patients with AIH alone. Despite this, no difference in outcomes (all-cause mortality, need for liver transplantation, or decompensated cirrhosis) was seen. Given NAFLD’s rising prevalence, AIH/NAFLD cases will likely increase, and may benefit from alternative treatment guidelines to prevent worsening of NAFLD.
Trends of Hepatocellular Carcinoma (HCC) Inpatients Mortality and Financial Burden From 2011 to 2017
Authors: Wakil Ali , Wu Yi-Chia , Mazzaferro Natale , Greenberg Patricia , Pyrsopoulos Nikolaos T.
Published: February 2023

Introduction:

Liver cancer, including Hepatocellular carcinoma (HCC) is the seventh most common tumor worldwide. Previously, the financial burden of HCC in the United States between 2002 and 2011 was noted to be continuously increasing. This study aims to evaluate temporal trends of hospitalizations due to HCC.

Method:

This is a retrospective analysis utilizing the National Inpatient Sample (NIS) database. All subjects admitted between 2011 and 2017 with a diagnosis of HCC were identified. The primary trend characteristics were in-hospital mortality, hospital charges, and length of stay.

Results:

An increase in hospitalization from 67,779 (0.18%) admissions in 2011 to 84,580 (0.23%) admissions in 2017(P<0.05) was noted. Most patients were 45 to 64 years old (median 50%), predominantly men (median 68%) (P<0.05). The primary health care payer was Medicare (Median 49%) and Medicaid (Median 18%) (P<0.05). The most common geographical location was the south (Median 36%) (P<0.05). Most patients were admitted to large hospitals (Median 62%) in urban areas (P<0.05). The median inpatient mortality was estimated to be 9% in 2017 (P<0.05), which has decreased from 10%(P<0.05) in 2011. The total charges per admission have increased steadily from $58,406 in 2011 to $78,791 in 2017 (P<0.05). The median length of stay has increased from 5.79 (SD 6.93) in 2011 to 6.07 (SD 8.3) in 2017(P<0.05). The most common mortality risk factor was sepsis, Acute renal failure, and GI hemorrhage.

Conclusion:

HCC-related admissions continue to be on the rise. HCC mortality has decreased across the years with earlier diagnoses and advances in therapy. However, we observed a significant increase in financial burden on health care with increasing in-hospital costs, a finding that needs to be verified in prospective trials.
Protein supplementation in critical illness: why, when and how?
Authors: Bels Julia L.M. , Ali Abdelhamid Yasmine , van de Poll Marcel C.G.
Published: February 2023

Purpose of review

In critically ill patients, optimal protein provision remains a challenge given the wide range in recommended protein delivery in international guidelines and the lack of robust, high quality evidence. As patients are confronted with poor functional outcomes after admission, often attributed to muscle wasting and persisting for multiple years, there is a pressing need for optimal nutritional strategies in the ICU, particularly including protein. This review will discuss the recent literature with regard to purpose, timing and mode of protein delivery.

Recent findings

Recent studies on the effect of dose and timing of protein on clinical and functional outcomes are largely observational in nature and the protein delivery considered as “high” still often only nears the lower end of current recommendations. The majority of trials observed no effect of protein supplementation on mortality, muscle strength or function, though some report attenuation of muscle volume loss, especially when combined with muscle activation. There is no strong evidence that ICU patients should receive supplementation with any specific amino acids.

Though adequate protein provision is likely important, it is difficult to come to a uniform conclusion regarding dosing and timing due to conflicting results in mostly observational studies as well as different cut-off values for high, moderate and low protein intake. This topic is currently subject to large clinical trials.
Recurrence of hepatocellular carcinoma in noncirrhotic patients with nonalcoholic fatty liver disease versus hepatitis B infection
Authors: Lee Jungnam , Chang Jong-In , Jin Young-Joo , Lee Jeong-Hoon , Kim Ju Yeon , Sinn Dong Hyun , Kim Soon Sun , Lee Hyun Woong , Yoo Sun Hong , Yu Jung Hwan , Lee Jin-Woo
Published: February 2023

Background and aims

This study aimed to compare the long-term cumulative recurrence rates of hepatocellular carcinoma (HCC) and prognosis after curative resection for HCC in noncirrhotic patients with nonalcoholic fatty liver disease (NAFLD) versus hepatitis B virus (HBV) infection.

Methods

We retrospectively analyzed the data of 791 patients without recurrence within 1 year after curative resection for HCC from January 2005 to December 2015. Of these, 63 and 728 were NAFLD and HBV patients without cirrhosis, respectively.

Results

Recurrence of HCC was observed in 6 (9.5%) and 210 (28.8%) patients in the NAFLD and HBV groups, respectively, during median follow-ups of 69.9 and 85.2 months. Cumulative recurrence rates in the NAFLD group at 2, 4, 6, 8 and 10 years (3.6, 9.4, 12.4, 12.4 and 12.4%, respectively) were significantly lower than in the HBV group (1.7, 16.9, 27.2, 37.1 and 44.4%, respectively) (P = 0.008). Cumulative overall survival (OS) rates in the NAFLD group at 2, 4, 6, 8 and 10 years (98.2, 96.0, 84.0, 84.0 and 84.0 %, respectively) were significantly lower than in the HBV group (99.3, 98.4, 97.3, 95.7 and 93.6%, respectively) (P = 0.003). HBV infection, with or without fatty liver compared to NAFLD, were significant predictors for the recurrence of HCC (P < 0.05 for all) and OS (P < 0.05 for all), respectively.

Conclusions

Noncirrhotic NAFLD patients showed lower recurrence rates of HCC but poorer survival outcomes than noncirrhotic HBV patients with or without fatty liver. The recurrence risk of HCC remains even in noncirrhotic NAFLD patients.
Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes
Authors: Bradley Patrick J.
Published: February 2023

Purpose of review

The practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer.

Recent findings

Peristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (para- and pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention.

Research is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.
What is appropriate management for the contralateral uninvolved side in unilateral allergic fungal rhinosinusitis?
Authors: Bitner Benjamin F. , St. John Maie A. , Kennedy David W. , Kuan Edward C.
Published: February 2023

Purpose of review

The aim of this article is to review the current literature regarding development of new or recurrent inflammation of uninvolved contralateral sinuses in unilateral allergic fungal rhinosinusitis (AFRS) and discuss management strategies.

Recent findings

AFRS is a subtype of chronic rhinosinusitis with nasal polyposis (CRSwNP) that can manifest as either unilateral or bilateral disease. Particular to AFRS compared with other CRSwNP subtypes is the high propensity for recurrence. Multiple recent studies have evaluated the recurrence rate of uninvolved contralateral sinuses in unilateral AFRS and demonstrated eventual involvement of the nondiseased side. Additionally, postoperative medical therapy of the nondiseased side reduced recurrence rates overall.

Recurrence of AFRS is high in both the ipsilateral and contralateral sinuses. Upfront bilateral medical and/or surgical treatment of patients presenting with unilateral AFRS may be considered to improve long-term inflammatory control.
Systematic Review of Diagnostic Delay for Children With Inflammatory Bowel Disease
Authors: Vernon‐Roberts Angharad , Aluzaite Kristina , Khalilipour Bahareh , Day Andrew S.
Published: February 2023

Objectives:

Pediatric inflammatory bowel disease (IBD) is a complex inflammatory condition of the gut. Diagnosing IBD involves distinct longitudinal periods from first symptoms to primary care assessment, tertiary care referral, and then endoscopic confirmation. The term diagnostic delay (DD) is used if these periods are prolonged. The aim of this review was to amalgamate DD data for children with IBD, and identify factors associated with prolonged DD.

Methods:

Six health literature databases were searched (December 2020). Inclusion criteria for papers were children diagnosed with IBD before the age of 18 years, DD central tendency data, and to report a central tendency of their DD data, cohort >10 children. For analysis, all data were weighted by cohort sample size.

Results:

Searches identified 236 papers, and 26 were included in the final analysis with a pooled cohort of 7030 children. The overall DD periods were IBD 4.5 months [Interquartile range (IQR) 3.6–8.7 months], Crohn disease (CD) 5 months (IQR 4–7.2 months), and ulcerative colitis/indeterminate colitis/IBD‐unclassified (UC/IC/IBDU) 3 months (IQR 2.2–4.9 months). The difference between subtypes was significant (P < 0.001), with shorter DD for UC/IC/IBDU than CD (P < 0.001) and IBD (P < 0.001). DD periods were longer for CD than IBD (P < 0.001). DD decreased over time for IBD (P < 0.001) and UC (P < 0.001) but the trend suggested an increase for CD (P 0.069).

Conclusions:

This data can be used to benchmark DD for children with IBD. Individual centers could determine whether improvements to awareness or infrastructure may reduce DD in order to minimize the risk of poor outcomes.
Untargeted, High‐Resolution Metabolomics in Pediatric Eosinophilic Esophagitis
Authors: Sinclair Elizabeth M. , Cohen Catherine C. , Tran ViLinh , Jones Dean P. , Alvarez Jessica A. , Kamaleswaran Rishikesan , Rad Milad Ghiasi , Kruszewski Patrice G. , Vos Miriam B.
Published: February 2023

Background/Objectives:

Eosinophilic esophagitis (EoE) is an inflammatory disease of unclear etiology. The aim of this study was to use untargeted plasma metabolomics to identify metabolic pathway alterations associated with EoE to better understand the pathophysiology.

Methods:

This prospective, case‐control study included 72 children, aged 1–17 years, undergoing clinically indicated upper endoscopy (14 diagnosed with EoE and 58 controls). Fasting plasma samples were analyzed for metabolomics by high‐resolution dual‐chromatography mass spectrometry. Analysis was performed on sex‐matched groups at a 2:1 ratio. Significant differences among the plasma metabolite features between children with and without EoE were determined using multivariate regression analysis and were annotated with a network‐based algorithm. Subsequent pathway enrichment analysis was performed.

Results:

Patients with EoE had a higher proportion of atopic disease (85.7% vs 50%, P = 0.019) and any allergies (100% vs 57.1%, P = 0.0005). Analysis of the dual chromatography features resulted in a total of 918 metabolites that differentiated EoE and controls. Glycerophospholipid metabolism was significantly enriched with the greatest number of differentiating metabolites and overall pathway enrichment (P < 0.01). Multiple amino and fatty acid pathways including linoleic acid were also enriched, as well as pyridoxine metabolism (P < 0.01).

Conclusions:

In this pilot study, we found differences in metabolites involved in glycerophospholipid and inflammation pathways in pediatric patients with EoE using untargeted metabolomics, as well as overlap with amino acid metabolome alterations found in atopic disease.
Factors Affecting Delayed Gastric Emptying and Long-Term Outcomes of Children With Gastric Emptying
Authors: Roberts Christopher , Hussein Maryam , Poole Esme , Kolimarala Vinod , Erlewyn-Lajeunesse Mich , Beattie R. Mark , Sundrum Francis , Afzal Nadeem
Published: February 2023

Objectives:

Our study attempted to identify what factors best predict for delayed gastric emptying (DGE) and whether children respond to treatment.

Methods:

Children aged between 0 and 18 were included who had a gastric emptying scintigraphy (GES) study performed between 2009 and 2018. Baseline clinical details were recorded from clinic visit records regarding symptoms, medication, and past medical history. Results were analyzed using multivariate regression analysis and coefficient analysis. Children were followed up at 2 years to assess their symptoms and medication usage.

Results:

Two hundred and eighty-five children were included in the study of which 174 demonstrated DGE. All children had symptoms prior to GES, the most common symptom being that of vomiting and reflux symptoms which were present in over 90% of patients; other common symptoms like abdominal pain and nausea were seen commonly in around 30%. A genetic disorder and prior surgery were more common in children with DGE but there was no difference in presenting symptoms between normal and DGE groups. Regression analysis showed prior surgery and particularly prior abdominal surgery predicted for DGE and additionally predicted for those with highly DGE. Improvement in symptoms and reduction in medication usage was seen after 2 years.

Conclusions:

This study provides one of the largest data sets looking at DGE in children. Prior surgery was found to be a key factor in predicting for highly DGE. Symptoms and medication usage did significantly reduce substantially after 2 years.
Successful Treatment of Central Nervous System Involvement in Posttransplant EBV-related Lymphoproliferative Disease With Intrathecal Rituximab Therapy
Authors: Aslan Fatma , Güler Salih , Sezgin Evim Melike , Aslier Mustafa , Yazici Zeynep , Öztürk Nazlioğlu Hülya , Meral Güneş Adalet
Published: February 2023

The posttransplant lymphoproliferative disease is a severe cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation. Central Nervous System involvement in EBV-related PTLD is rare, and there is no standard treatment recommendation. We present our patient and discuss other previously reported cases of EBV-associated PTLD with CNS involvement.