bluuebunny/crossref_metadata_2025 huggingface dataset:
Ketorolac Dosing and Outcomes in Neonates Following Congenital Heart Surgery: A Retrospective Analysis
Authors: Kiskaddon Amy L. , Goldenberg Neil A. , Abel Trent , Fierstein Jamie L. , Khayat Delia , Quintessenza James A. , Stock Arabela C.
Published: April 2024

BACKGROUND:

Pain management is essential for postoperative surgery. Given the association of opioids with adverse outcomes, interest in the use of nonopioid analgesics, such as ketorolac, has increased. Published data on use in neonates are limited.

OBJECTIVES:

To describe ketorolac dosing and safety and efficacy outcomes in the first 48 hours postcardiac surgery in neonates.

DESIGN:

We performed a single-center retrospective cohort study of neonates (ages < 28 d) who received ketorolac following cardiac surgery from November 2020 to July 2023 (inclusive). The primary safety outcome was a clinically significant decline in renal function, as defined by the composite of an increase in serum creatinine by greater than or equal to 0.3 mg/dL from baseline within 96 hours of ketorolac initiation and urine output less than or equal to 0.5 mL/kg/hr for 6 hours. The secondary safety outcome was clinically significant bleeding, defined as the composite of major bleeding by the International Society on Thrombosis and Hemostasis pediatric criteria and severe/fatal bleeding by the criteria of Nellis et al (2019). Efficacy was measured by opioid utilization based on a standardized pain score-driven analgesia protocol.

INTERVENTIONS:

Ketorolac was administered at 0.5 mg/kg every 6 hours as per an institutional clinical management algorithm.

MEASUREMENTS AND MAIN RESULTS:

Thirty-nine patients met the eligibility criteria. The median ketorolac dose was 0.5 mg/kg/dose, and median (interquartile range [IQR]) duration of therapy was 48 hours (6–48 hr). No patients experienced a significant decline in renal function, and there were no clinically significant bleeding events. The median (IQR) IV morphine milligram equivalents (MMEs)/kg/d of opioid administration was 0.2 MME/kg/d (0.1–0.25 MME/kg/d) at the time of ketorolac initiation and 0.1 MME/kg/d (0.1–0.2 MME/kg/d) at 48 hours post-ketorolac initiation.

CONCLUSIONS:

If validated prospectively, these findings suggest that a ketorolac regimen of 0.5 mg/kg/dose every 6 hours in neonates postcardiac surgery may be safe with regard to renal function and bleeding risk. Additional randomized studies would be needed to determine efficacy with regard to opioid-sparing capacity.
Effect of Inpatient Pulmonary Rehabilitation on Pulmonary Outcomes in Individuals With COVID-19: A Systematic Review and Meta-Analysis
Authors: Pathare Neeti , Harrod Clark Helen , Marks Kara
Published: April 2024

Purpose:

Guidelines advocate the use of pulmonary rehabilitation (PR) in individuals with COVID-19. However, there is a lack of concrete information on inpatient PR. Therefore, we synthesized literature on the efficacy of inpatient PR on pulmonary outcomes in individuals with COVID-19.

Methods:

Using PubMed, Web of Science, Cochrane Library and Embase, three researchers screened 474 articles for eligibility with the search terms: (covid-19 or coronavirus or 2019-ncov or sars-cov-2 or cov-19 *) AND (respiratory or pulmonary) AND (physical therapy or physiotherapy or rehabilitation). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. Nine articles were finalized using the inclusion criteria: diagnosis of COVID-19, age >18 years and inpatient PR. Reviewers extracted relevant information and appraised using the Robins-I tool and the Newcastle Ottawa Scale.

Results:

The pooled sample consisted of 718 participants (F = 35.2%, age = 36-71 y). Study quality for non-randomized trial was moderate, while cohort studies had a mean score of 7/9. The pooled estimate showed that inpatient PR could improve the exercise capacity with clinical importance for individuals with COVID-19. Within group changes were noted in FEV1 and FVC values (n = 4) and HR-QoL (n = 3). Inpatient PR was reported to be safe (n = 4).

Conclusions:

Current review suggests that inpatient PR was safe, feasible and induced large improvements in exercise capacity in individuals with COVID-19. Given the high heterogeneity, sample sizes and quality of designs of the included studies, findings should be interpreted with caution. Our study provides valuable evidence that inpatient PR is safe and may accelerate improvement in exercise capacity in individuals with COVID-19.
Use of Imaging in Cutaneous Squamous Cell Carcinoma to Detect High-Risk Tumor Features, Nodal Metastasis, and Distant Metastasis: A Systematic Review
Authors: Libson Karissa , Sheridan Connor , Carr David R. , Shahwan Kathryn T.
Published: April 2024

BACKGROUND

Imaging has been shown to impact management and disease outcomes in cutaneous squamous cell carcinoma, but the literature on optimal modalities is lacking.

OBJECTIVE

To perform a systematic review evaluating the performance of various imaging studies for the detection of perineural spread, bony invasion, nodal metastasis (NM), and distant metastasis in cutaneous squamous cell carcinoma.

MATERIALS AND METHODS

Four databases were searched for relevant terms. Articles were included if they presented primary data on 5 or more subjects with cutaneous squamous cell carcinoma who underwent imaging to detect perineural spread, bony involvement, NM, or distant metastasis.

RESULTS

Thirty studies and 1,027 subjects were included in the pooled analysis. Magnetic resonance imaging had a 94.9% sensitivity in detecting perineural spread. Computed tomography (CT) demonstrated a sensitivity of 75.7% and specificity of 98.6% in detecting bony invasion. While ultrasound, positron emission tomography–computed tomography, and CT all performed reasonably well in detecting NM, CT demonstrated the highest sensitivity (96.4%) and specificity (100%). Imaging changed management in up to 33% of cases.

CONCLUSION

Imaging is useful in high-risk cutaneous squamous cell carcinoma. Magnetic resonance imaging performs best in the detection of perineural spread, and CT is the most accurate modality to detect bony invasion and NM.
THREE-DIMENSIONAL RETINAL DISPLACEMENT BEFORE AND AFTER MACULAR PUCKER SURGERY
Authors: Rossi Tommaso , Querzoli Giorgio , Cosimi Pamela , Ripandelli Guido , Placentino Luca , Steel David H. , Romano Mario R.
Published: April 2024

Purpose:

To measure the coronal and sagittal retinal displacement before and after surgery for epiretinal membranes in InfraRed horizontal foveal sections and optical coherence tomography scans and describe displacement tridimensionality, vision loss, and metamorphopsia.

Methods:

Retrospective series with greater than 6-month average follow-up before and after surgery. The record included best-corrected visual acuity, optical coherence tomography, M-charts, and InfraRed retinography. Overall, pre- and postoperative coronal and sagittal retinal displacement across the entire field, concentric circles at 0.5-, 1.5-, and 4.5-mm radii, and the central horizontal and vertical meridian were calculated as the optical flow of consecutive images.

Results:

This study comprised 10 patients (4 men, 6 women), with 22.7 ± 25.2 months follow-up before surgery and 16.2 ± 7.3 months after. Best-corrected visual acuity reduced before surgery (0.15 ± 0.67 logarithm of minimum angle of resolution to 0.38 ± 0.85 logarithm of minimum angle of resolution; P < 0.05) and increased afterward (0.086 ± 0.61 logarithm of minimum angle of resolution; P = 0.003). Preoperative coronal displacement was 30.1 ± 29.1 µm versus 67.0 ± 23.4 µm after (P = 0.002). Sagittal retinal displacement was 140.9 ± 84.6 µm before surgery, 339.7 ± 172.5 µm after (P = 0.017), and 357.6 ± 320.8 µm across the entire follow-up. Preoperative best-corrected visual acuity decreases correlated with the foveal coronal displacement. Vertical metamorphopsia correlated with the average coronal displacement within a 4.5-mm radius. Pre- and postoperative sagittal displacement correlated with horizontal metamorphopsia (P = 0.006 and P = 0.026). Postoperative sagittal displacement correlated with postoperative best-corrected visual acuity (P = 0.026) and foveal thickness (P = 0.009).

Conclusion:

This study confirms that postoperative displacement is greater than preoperative and that sagittal displacement is greater than coronal and correlates with best-corrected visual acuity and metamorphopsia changes.
Effect of Tranexamic Acid on Intra- and Postoperative Bleeding in Eyelid Surgery: A Prospective, Randomized, Multicenter, Double-Masked, Control Trial
Authors: Paramo Ricky , Cheng Tiffany , Malik Amina , Fan James , Barmettler Anne
Published: April 2024

Purpose:

Pilot studies suggest that waiting 15 minutes after a subcutaneous tranexamic acid injection is associated with decreased intraoperative bleeding and postoperative ecchymosis in eyelid surgery. The outcomes of commencing eyelid surgery immediately after injection without a waiting period remain unexplored.

Methods:

This prospective, randomized, multicenter, double-masked, controlled study examined bilateral symmetric upper and/or lower lid blepharoplasty or ptosis repair. Patients received tranexamic acid in 1 eyelid and control in the contralateral eyelid. The surgeon recorded the side with more intraoperative bleeding. Two masked graders evaluated periocular ecchymosis at postoperative day 0 and postoperative week 1 (POW 1) with a 5-point scale. At POW 1, patients reported subjective grading of bruising as increased on 1 side or similar on both sides. Results were analyzed with Wilcoxon signed-rank and sign tests.

Results:

Of 130 patients, there was less eyelid ecchymosis on the tranexamic side at postoperative day 0 (p = 0.001) and POW 1 (p < 0.001). By surgery type, the 69 levator advancement surgeries had significantly less ecchymosis at postoperative day 0 (p < 0.001) and POW 1 (p = 0.001), while upper eyelid blepharoplasty, combined upper and lower lid blepharoplasty, and conjunctivomullerectomy trended toward significance. Of 68 patients reporting a POW 1 grading, 69% reported less bruising on the tranexamic side (p < 0.001). Intraoperative bleeding was not significantly different between sides (p = 0.930).

Conclusions:

Without a postinjection waiting period, subcutaneous tranexamic acid for eyelid surgery significantly decreased postoperative ecchymosis on postoperative day 0 and POW 1 but did not affect intraoperative bleeding. Subcutaneous tranexamic acid was not associated with any complications.
Secondary Intention Healing After Debridement for Bilateral Periorbital Necrotizing Fasciitis
Authors: Blanchard Cody C. , Gupta Lalita , Timoney Peter J.
Published: April 2024

A 75-year-old male with a history of poorly controlled diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and obesity presented with severe bilateral periorbital edema with necrosis and purulent discharge. Although hemodynamically stable, laboratory markers indicated systemic toxicity. Imaging showed bilateral periorbital edema extending into the frontal scalp, temporal fossa, and right orbit. Suspected to have necrotizing fasciitis, the patient underwent urgent debridement of bilateral upper and lower eyelids and was found to have postseptal extension of necrosis into the right orbit. During his hospitalization, he was treated with broad-spectrum antimicrobials and underwent a second surgery for exploration and debridement. The patient was lost to follow-up and found to have healed by secondary intention without any surgical reconstruction. Our case demonstrates not only a rare case of necrotizing fasciitis involving all 4 eyelids, but also an exceptional cosmetic and functional result after secondary intention healing.
Postcataract surgery gray-white lines of the corneal endothelium viewed with confocal microscopy and review of literature
Authors: Han Jonathan , Wright Nathan , Davis Farhat Sydni K. , Yeh Florencia , Fintelmann Robert E.
Published: April 2024

Introduction:

Cataract surgery rarely causes 1-day postoperative corneal endothelial changes visibly seen as patches or linear streaks. Previously described as “snailtracks,” these changes have been studied using slitlamp examination (SLE), scanning electron microscopy, and specular microscopy, but to the best of the authors' knowledge, it has yet to be analyzed using confocal microscopy.

Patient and Clinical Findings:

3 patients who underwent cataract surgery through phacoemulsification with intraocular lens implant were found to have snailtracks on the corneal endothelium during postoperative day 1 examination.

Diagnosis, Intervention, and Outcomes:

The corneal endothelium of the 3 identified patients underwent SLE and in vivo confocal microscopy on postoperative day 1 and postoperative week 1. On day 1, linear opacities were visible on the corneal endothelia and confocal microscopy revealed disruptions of the regular polygonal endothelial pattern with cell aggregation. At 1 week, opacities had resolved and confocal microscopy demonstrated reorganization of the endothelia and appearance of hyperreflective nuclei.

Conclusions:

Confocal microscopy of postcataract surgery snailtracks supports the hypothesis that such endothelial opacification is secondary to trauma to the endothelium.
3D auto-segmentation of biliary structure of living liver donors using magnetic resonance cholangiopancreatography for enhanced preoperative planning
Authors: Oh Namkee , Kim Jae-Hun , Rhu Jinsoo , Jeong Woo Kyoung , Choi Gyu-Seong , Kim Jong Man , Joh Jae-Won
Published: April 2024

Background:

This study aimed to develop an automated segmentation system for biliary structures using a deep learning model, based on data from magnetic resonance cholangiopancreatography (MRCP).

Materials and methods:

Living liver donors who underwent MRCP using the gradient and spin echo technique followed by three-dimensional modeling were eligible for this study. A three-dimensional residual U-Net model was implemented for the deep learning process. Data were divided into training and test sets at a 9:1 ratio. Performance was assessed using the dice similarity coefficient to compare the model’s segmentation with the manually labeled ground truth.

Results:

The study incorporated 250 cases. There was no difference in the baseline characteristics between the train set (n=225) and test set (n=25). The overall mean Dice Similarity Coefficient was 0.80±0.20 between the ground truth and inference result. The qualitative assessment of the model showed relatively high accuracy especially for the common bile duct (88%), common hepatic duct (92%), hilum (96%), right hepatic duct (100%), and left hepatic duct (96%), while the third-order branch of the right hepatic duct (18.2%) showed low accuracy.

Conclusion:

The developed automated segmentation model for biliary structures, utilizing MRCP data and deep learning techniques, demonstrated robust performance and holds potential for further advancements in automation.
Association of copeptin levels with patient prognosis and survival in sepsis syndromes: a meta-analysis
Authors: Bhattarai Abhinav , Shah Sangam , Baidya Sujata , Thapa Ranjana , Bhandari Suyog , Tuladhar Eans T. , Acharya Subhash P. , Sah Ranjit
Published: April 2024

Background:

Sepsis syndromes are a major burden in the ICU with very high mortality. Vasopressin and copeptin are released in response to hypovolemia and have shown potential significance in diagnosing sepsis.

Objective:

To investigate the levels of copeptin in patients with sepsis syndromes and evaluate its relation with patient prognosis and mortality.

Methods:

Four databases were searched for literature published from inception to the 8th of November 2022. Original research articles where copeptin was measured in sepsis patients and compared with controls were included. Data extraction and synthesis: study characteristics, levels of copeptin in the participants, and copeptin assay description were extracted. Levels of copeptin in patients were pooled and compared with controls in terms of the standard mean difference (SMD) generated using a random-effects model.

Results:

Fifteen studies met the selection criteria. Copeptin levels were significantly higher in patients with sepsis, severe sepsis, and septic shock as compared to controls [(SMD: 1.49, 95% CI: 0.81–2.16, P<0.0001), (SMD: 1.94, 95% CI: 0.34–3.54, P=0.02), and (SMD: 2.17, 95% CI: 0.68–3.66, P=0.004), respectively]. The highest copeptin levels were noted in septic shock patients. The admission copeptin levels were significantly lower in survivors as compared to nonsurvivors (SMD: −1.73; 95% CI: −2.41 to −1.06, P<0.001).

Conclusion and Relevance:

Copeptin was significantly elevated in sepsis, severe sepsis, and septic shock. Survivors had a significantly lower copeptin during admission. Copeptin offered an excellent predictability to predict 1-month mortality. Measuring the copeptin in sepsis patients can aid treating physicians to foresee patients’ prognosis.
The efficacy of extracorporeal shock wave therapy for knee osteoarthritis : an umbrella review
Authors: Tang Peiyuan , Wen Ting , Lu Wenhao , Jin Hongfu , Pan Linyuan , Li Hengzhen , Zeng Biyun , Zhou Yang , Xiao Wenfeng , Li Yusheng
Published: April 2024

Background:

An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA).

Materials and methods:

Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Meta-analysis of outcome indicators was performed using Revman 5.4 software.

Results:

A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)=−2.94, 95% CI: −5.52, −0.37, P=0.03, I²=60%], Visual Analog Scale (VAS) (MD=−2.0, 95% CI: −2.5, −1.5, P<0.01, I²=0%), range of motion (ROM) (MD=17.55, 95% CI: 13.49, 21.61, P<0.00001, I²=0%), and Lequesne index (MD=−2.85, 95% CI: −3.64, −2.07, P<0.00001, I²=48%).

Conclusion:

Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA.
Bibliometric analysis and global trends in uterus transplantation
Authors: Wu Tong , Wu Yangyang , Nie Kebing , Yan Jinfeng , Chen Ying , Wang Shixuan , Zhang Jinjin
Published: April 2024

Aim:

The purpose of this study was to characterize publication patterns, academic influence, research trends, and the recent developments in uterus transplantation (UTx) across the globe.

Methods:

The Web of Science Core Collection database was searched for documents published from the time the database began to include relevant articles to 15 December 2023. With the use of VOSviewer, Citespace, BICOMB, and Incites, a cross-sectional bibliometric analysis was conducted to extract or calculate the evaluative indexes. Publications were categorized by country, institution, author, journal, highly cited papers, and keywords. The variables were compared in terms of publication and academic influence, which further included citation count, citation impact, Hirsh index, journal impact factor, total link strength, collaboration metrics, and impact relative to the world.

Results:

A total of 581 papers concerning UTx were initially identified after retrieval, and 425 documents were included. Of the 41 countries participating in relevant studies, the USA and Sweden were in leading positions in terms of publications, citations, and academic influence. The most versatile institution was the University of Gothenburg, followed by Baylor University. The most productive scholars and journals were Brännström M. and Fertility and Sterility, respectively. Five groups of cutting-edge keywords were identified: venous drainage, donors and donation, women, fertility preservation, and fertility. Topics about surgery, first live birth, risk, and in vitro fertilization remain hot in this field.

Conclusions:

UTx is anticipated to enter a golden era in the coming years. This study provides some guidance concerning the authors involved in promoting UTx research, the current development of UTx, and journals to submit their innovative research. This also helps to reach a comprehensive insight and prospect in the near future. In order to establish recognized standards and benefit more patients who are disturbed by uterine infertility, large-scale and well-designed clinical trials are required.
The value of transitory protective stomas during primary debulking surgery for advanced epithelial ovarian cancer: a retrospective cohort study
Authors: Ni Sha , He Jiaqi , Ouyang Ling
Published: April 2024

Objectives:

Limited data are available on patients with advanced-stage epithelial ovarian cancer (OC) who require ostomy during primary cytoreductive surgery. This study aimed to investigate the application of postoperative and long-term oncological results from transitory protective stoma (TPS) formation during primary debulking surgery for OC.

Methods:

This is a retrospective cohort study with a single center. The authors identified patients with stage III–IV OC who underwent colon resection and anastomosis. Depending on the methods used after colorectal anastomosis and the outcomes of surgical resection, the patients were stratified into three groups: resection and end-to-end anastomosis, resection and ostomy, or R1 resection. Demographic and clinical data were analyzed.

Results:

Eighty-four patients underwent colorectal resection during cytoreduction for FIGO stage III–IV OC. Patients undergoing ostomy were more likely to have a longer mean operative time (266 vs. 283 vs. 236 min; P=0.003) and to undergo rectosigmoid resection at the time of cytoreductive surgery (56.0 vs. 22.7%, P=0.007). Their postoperative feeding (7 vs. 1 vs. 3 days, P<0.001) and exhaustion (6 vs. 3 vs. 3, P<0.001) times were similar to those of patients with R1 resection and much earlier than those of patients with intestinal anastomosis. The first normal time (35 days) and half-life (14.68 days) of CA125 after surgery were significantly better in patients with TPS group. The overall incidence of complications was the same, and there was no significant difference in the 30-day readmission rate. The overall quality of life assessment was significantly lower in the R1 resection group.

Conclusions:

TPSs can accelerate postoperative recovery and the initiation of postoperative chemotherapy, reduce the risk of mortality and disease progression and limit the incidence of complications.
Surgical interventions for intractable migraine: a systematic review and meta-analysis
Authors: Alrahbeni Tahani , Mahal Ahmed , Alkhouri Anas , Alotaibi Hadil F. , Rajagopal Vineet , Behera Ashish , AL-Mugheed Khalid , Khatib Mahalaqua N. , Gaidhane Shilpa , Zahiruddin Quazi S. , Shabil Muhammed , Bushi Ganesh , Rustagi Sarvesh , Kukreti Neelima , Satapathy Prakasini , Mohapatra Ranjan K. , Dziedzic Arkadiusz , Padhi Bijaya K.
Published: April 2024

Background:

Migraine affects ~14–15% of the global population, contributing to nearly 5% of the world’s health burden. When drug treatments prove ineffective for intractable migraines, highly specific surgical interventions emerge as potential solutions. The authors aimed to analyze surgical approaches for these refractory or intractable migraines through a systematic review and meta-analysis.

Methods:

The authors conducted a literature search across databases such as PubMed, Scopus, Web of Science, and Embase, focusing on studies related to migraines and surgical outcomes. The authors considered clinical trials or observational studies that included any surgical intervention for refractory or intractable migraines, emphasizing key outcomes such as reductions in migraine intensity, Migraine Disability Assessment scores (MIDAS), and 50% Migraine Headache Index (MHI) reduction rates. Statistical analyses were performed using R version 4.3.

Results:

Eleven studies were included in the systematic review. A meta-analysis of four studies involving overall 95 patients showed a significant reduction in mean migraine intensity scores using ONS (−2.27, 95% CI: −3.92 to −0.63, P=0.021). Three studies with 85 patients showed an average MIDAS score reduction of −52.3, though this was not statistically significant (95% CI: −136.85 to 32.19, P=0.116). Two additional studies corroborated these reductions in MIDAS scores. Nerve decompression surgery showed a substantial decrease in the average migraine intensity (from 8.31 down to 4.06). Median MIDAS score dropped from 57 to 20. Two studies indicated a success rate of 40 and 82%, respectively, in achieving a 50% reduction in the migraine MHI through nerve decompression. Findings from two studies suggest that septorhinoplasty and sinus surgery effectively decrease migraine intensity scores.

Conclusion:

The existing evidence emphasizes the potential advantages of surgical interventions as a promising approach to managing intractable or refractory migraines. However, robust and comprehensive research is crucial to refine and solidify the efficacy of these surgical methods, aiming for widespread benefits for patients, considering cost-effectiveness factors.
Student Pedagogical Consultants: A Strategy for Increasing Diversity, Equity, Inclusivity, and a Sense of Belonging in Curricular Approaches in Physical Therapist Education
Authors: Hayward Lorna M. , Golub-Victor Ann C. , Cheerman Heidi , Kiami Sheri , Addison Isabella , Bhattrai Mona , Wang Serena , Miroshnik Evgeniya
Published: April 2024

Background and Purpose.

Diversity within the physical therapy profession lags in comparison to the United States population. As the profession strives to diversify, faculty must pay attention to diversity, equity, inclusion, and belonging (DEI-B) in curricular approaches, including classroom materials, instruction, and assessment. With critical application, students from equity-deserving groups (EDGs) can provide unique perspectives to faculty about curricular approaches. Case study purposes were to 1) enable students from EDGs to partner with faculty, as student pedagogical consultants (SPCs), in 2 courses in a Doctor of Physical Therapy program to provide feedback on DEI-B efforts related to curricular approaches and 2) describe the outcomes of SPCs experience.

Case Description.

Eight female students from EDGs partnered with 3 White, female, faculty members in 2 courses: pediatrics and neurorehabilitation. Two SPCs teams observed the classrooms, met with faculty, and administered two-minute papers to classmates to gather feedback on DEI-B curricular approaches. Faculty and student SPCs wrote reflective papers, postproject, documenting their experiences.

Outcomes.

Themes informed a conceptual framework describing SPCs: 1) motivation for engaging in partnership; 2) creation of a pedagogical partnership space to promote dialogue and problem-solve barriers to DEI-B; 3) deeper understanding of teaching; 4) transfer of learning from the SPC experience to future work locations; and 5) faculty modification of teaching.

Discussion and Conclusion.

Students raised awareness regarding the pain of exclusion and provided suggestions for modifying curricular approaches to consider DEI-B. Curriculum redesign using innovative strategies can meet the contemporary needs of students from EDGs.
Enhancing the usability of older DCD donors through strategic approaches in liver transplantation in the United States
Authors: Akabane Miho , Melcher Marc L. , Esquivel Carlos O. , Imaoka Yuki , Kim W. Ray , Sasaki Kazunari
Published: April 2024

The use of older donors after circulatory death (DCD) for liver transplantation (LT) has increased over the past decade. This study examined whether outcomes of LT using older DCD (≥50 y) have improved with advancements in surgical/perioperative care and normothermic machine perfusion (NMP) technology. A total of 7602 DCD LT cases from the United Network for Organ Sharing database (2003–2022) were reviewed. The impact of older DCD donors on graft survival was assessed using the Kaplan-Meier and HR analyses. In all, 1447 LT cases (19.0%) involved older DCD donors. Although there was a decrease in their use from 2003 to 2014, a resurgence was noted after 2015 and reached 21.9% of all LTs in the last 4 years (2019–2022). Initially, 90-day and 1-year graft survivals for older DCDs were worse than younger DCDs, but this difference decreased over time and there was no statistical difference after 2015. Similarly, HRs for graft loss in older DCD have recently become insignificant. In older DCD LT, NMP usage has increased recently, especially in cases with extended donor-recipient distances, while the median time from asystole to aortic cross-clamp has decreased. Multivariable Cox regression analyses revealed that in the early phase, asystole to cross-clamp time had the highest HR for graft loss in older DCD LT without NMP, while in the later phases, the cold ischemic time (>5.5 h) was a significant predictor. LT outcomes using older DCD donors have become comparable to those from young DCD donors, with recent HRs for graft loss becoming insignificant. The strategic approach in the recent period could mitigate risks, including managing cold ischemic time (≤5.5 h), reducing asystole to cross-clamp time, and adopting NMP for longer distances. Optimal use of older DCD donors may alleviate the donor shortage.
Expansion of effector regulatory T cells in steroid responders of severe alcohol-associated hepatitis
Authors: Kang Min Woo , Lee Soon Kyu , Jang Eun Ji , Park Jong Geun , Seo Deok Hwa , Han Ji Won , Yoo Jae Sung , Kwon Jung Hyun , Nam Soon Woo , Jang Jeong Won , Choi Jong Young , Yoon Seung Kew , Sung Pil Soo
Published: April 2024

While steroid therapy is the preferred treatment for severe alcohol-associated hepatitis, the role of effector regulatory T (eTreg) cells and their association with steroid response and clinical outcomes in these patients remains to be elucidated. We prospectively enrolled 47 consecutive patients with alcohol-associated hepatitis, consisting of severe alcohol-associated hepatitis treated with steroids (n=18; steroid-treated group) and mild alcohol-associated hepatitis (n=29; nontreated group). After isolating peripheral blood mononuclear cells from the patients at enrollment and again 7 days later, the frequency of eTreg cells was examined using flow cytometry. Single-cell RNA sequencing analysis was conducted using paired peripheral blood mononuclear cells. In vitro experiments were also performed to assess phenotype changes and the suppressive function of Treg cells following steroid treatment. The steroid-treated group exhibited significantly higher Model for End-Stage Liver Disease scores than the nontreated group (p < 0.01). Within the steroid-treated group, the proportion of eTreg cells significantly expanded in the steroid responders (n=13; p = 0.01). Furthermore, a significant positive correlation was observed between the decrease in the Model for End-Stage Liver Disease score and the increase in eTreg cells (p < 0.05). Single-cell RNA sequencing using paired peripheral blood mononuclear cells (pre-steroid and post-steroid therapy) from a steroid responder revealed gene expression changes in T cells and monocytes, suggesting enhancement of Treg cell function. In vitro results showed an elevation in the proportion of eTreg cells after steroid therapy. In conclusion, our findings suggest that the efficacy of steroid therapy in patients with severe alcohol-associated hepatitis is mediated by an increase in the number of eTreg cells.
Identifying Sources of Inter-Hospital Variation in Episode Spending for Sepsis Care
Authors: Sankaran Roshun , Gulseren Baris , Prescott Hallie C. , Langa Kenneth M. , Nguyen Thuy , Ryan Andrew M.
Published: April 2024

Objective:

To evaluate inter-hospital variation in 90-day total episode spending for sepsis, estimate the relative contributions of each component of spending, and identify drivers of spending across the distribution of episode spending on sepsis care.

Data sources/study setting:

Medicare fee-for-service claims for beneficiaries (n=324,694) discharged from acute care hospitals for sepsis, defined by MS-DRG, between October 2014 and September 2018.

Research Design:

Multiple linear regression with hospital-level fixed effects was used to identify average hospital differences in 90-day episode spending. Separate multiple linear regression and quantile regression models were used to evaluate drivers of spending across the episode spending distribution.

Results:

The mean total episode spending among hospitals in the most expensive quartile was $30,500 compared with $23,150 for the least expensive hospitals (P<0.001). Postacute care spending among the most expensive hospitals was almost double that of least expensive hospitals ($7,045 vs. $3,742), accounting for 51% of the total difference in episode spending between the most expensive and least expensive hospitals. Female patients, patients with more comorbidities, urban hospitals, and BPCI-A-participating hospitals were associated with significantly increased episode spending, with the effect increasing at the right tail of the spending distribution.

Conclusion:

Inter-hospital variation in 90-day episode spending on sepsis care is driven primarily by differences in post-acute care spending.
Noninvasive measurement of tracer extraction efficiency in tissue, illustrated with Tc-99m-MAG3
Authors: Wicks Sarah , Levart Danielle , Conway Lauren , Heraghty Neil , Peters A. Michael
Published: April 2024

Objective

The aim of this study is to develop a noninvasive technique for measuring tissue tracer extraction efficiency (E) and illustrate it for Tc-99m-mercaptoacetyltriglycine (MAG3) and kidney.

Methods

E was measured in 10 patients with normal MAG3 renography. E is the ratio of tissue clearance-to-blood flow (Ki/F). For single-photon tracers, attenuation constants are unknown, so Ki and F cannot be separately measured. However, by deriving attenuation-uncorrected Ki’ and F’ from the same regions of interests (ROIs), these constants cancel out, giving E. Using a lung ROI for blood activity, F was measured from first-pass and Ki’ from Gjedde–Patlak–Rutland (GPR) analysis up to 130 s. Because of interference from right ventricle, a left ventricular ROI (LV) is unsuitable for F’ but was used in GPR analysis, making an adjustment for the ratio of respective blood pool signals arising from lung and LV ROIs in early frames (60–90 s).

Results

A lung ROI underestimates F’ by 4% at normal LV function. Chest wall interstitial activity (I), which does not affect F’, amounted to 53 and 30% of the lung and LV signals at 20 min, and 12 and 6% at 130 s, resulting in underestimations of Ki of 4 and 2%, respectively. Ignoring these opposing errors, E based on lung ROI for left and right kidneys was 43.5 (SD 8)% and 47.3 (9)%, and based on LV ROI for GPR analysis was 44.5 (10.9)% and 48.3 (10.6)%.

Conclusion

E can be measured by combining blood flow from first-pass with clearance from GPR analysis, and has potential value both clinically and in clinical research.
Prediction of immune molecules activity during burn wound healing among elderly patients: in-silico analyses: experimental research
Authors: Zabihi Mohammad Reza , Akhoondian Mohammad , Tamimi Pegah , Ghaderi Aliasghar , Mazhari Seyed Amirhossein , Farhadi Bahar , Karkhah Samad , Ghorbani Vajargah Pooyan , Mobayen Mohammadreza , Norouzkhani Narges , Farzan Ramyar
Published: April 2024

Introduction:

Burn injuries lead to dysregulation of immune molecules, impacting cellular and humoral immune pathways. This study aims to determine the prediction of immune molecule activity during burn wound healing among elderly patients.

Methods:

The current study utilized the Gene Expression Omnibus (GEO) database to extract the proper gene set. Also, the literature review was conducted in the present study to find immune signatures. The study used the “enrich r” website to identify the biological functions of extracted genes. The critical gene modules related to mortality were identified using the weighted gene co-expression network analysis (WGCNA) R package.

Results:

The appreciated GSE was extracted. According to the data, the most upregulated signatures were related to natural killer (NK) cells, and the most downregulated signatures were associated with M1 macrophages. Also, the results of WGCNA have shown that the most related gene modules (P<107 and score 0.17) to mortality were investigated, and the modules 100 first genes were extracted. Additionally, the enrich r analysis has demonstrated related pathways, including the immune process, including regulation of histamine secreted from mast cell (P<0.05), T helper 17 cell differentiation (P<0.05), and autophagy (P<0.05) were obtained. Finally, by network analysis, the critical gene “B3GNT5” were obtained (degree>ten and “betweenness and centrality”>30 were considered).

Conclusion:

The study identified significant changes in macrophage and NK cell expression patterns post-burn injury, linking them to potential improvements in clinical outcomes and wound healing. The gene B3GNT5, associated with mortality, was highlighted as a key marker for prognostic evaluation.
Perioperative management of surgical procedure during pregnancy: a systematic review
Authors: Zeleke Mulualem Endeshaw , Chekol Wubie Birlie , Kasahun Habtamu Getinet , Mekonnen Zemenay Aynie , Filatie Tesera Dereje , Melesse Debas Yaregal , Admassie Belete Muluadam , Admass Biruk Adie
Published: April 2024

Background:

Approximately 1–2% of pregnant women undergo non-obstetric surgery under anaesthesia during their pregnancy. This review specifically targets anaesthesia management for pregnant women undergoing non-obstetric surgery in resource-limited settings.

Methods:

Following the delineation of primary questions, scope, and inclusion criteria, a comprehensive search strategy utilizing advanced techniques was implemented across electronic sources, databases, and websites to identify relevant articles. A rigorous screening process was applied during the literature evaluation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guided the conduct of this review, ensuring adherence to standardized reporting practices.

Results:

A total of 240 articles were initially identified from databases and websites. After screening titles and abstracts, 85 papers were excluded, and an additional 43 were removed due to duplication. Subsequently, 68 items were subjected to eligibility screening. Finally, 30 papers that specifically addressed anaesthetic considerations for pregnant women undergoing non-obstetric operations were reviewed.

Conclusion:

Thorough preoperative evaluation is essential for all patients, with particular attention to modifications in anaesthetic management to accommodate physiological changes during pregnancy. Urgent and emergent surgeries should proceed promptly during pregnancy to optimize outcomes for both the mother and foetus. Maintaining uteroplacental perfusion generally involves avoiding maternal hypoxaemia, hypotension, hyper- and hypocapnia, temperature extremes, and stress. When deemed safe, regional anaesthesia may offer favourable outcomes for both the mother and foetus.
Treatment and Rehabilitation for Esophageal Cancer—Striving to Meet Obstacles and Long-term Impacts
Authors: Andreasen Trine Kromann , Boje Ida Rübot , Tolstrup Lærke Kjær , Missel Malene , Larsen Malene Kaas
Published: April 2024

Background

Following esophagogastric cancer treatment, patients with esophageal cancer and their relatives struggle with adjusting to a new everyday life as they experience various challenges after treatment requiring rehabilitation. Health professionals must address long-term impacts on patients’ health, everyday life, family functioning, and support needs.

Objective

This qualitative descriptive study aimed to explore patients’, relatives’, and health professionals’ experience with long-term impacts and rehabilitation after treatment for esophageal cancer.

Methods

A qualitative approach based on a phenomenological-hermeneutical methodology was used. Two methods were selected in the study: focus group interviews with health professionals and individual interviews with patients and relatives. Inductive thematic analysis with inspiration from Braun and Clarke was used for data analysis.

Results

Three main themes emerged from the data analysis: (1) forced into limitations in everyday life, (2) learning and navigating a new everyday life, and (3) rehabilitation accepting new normality.

Conclusion

Patients and relatives experience persistent long-term impacts after treatment for esophageal cancer, making rehabilitation strenuous and demanding. Relatives take considerable responsibility for the patients’ rehabilitation but feel invisible and unsupported by health professionals. Health professionals acknowledge the severity of long-term impacts but fail to prepare patients and relatives for the impacts and do not see the relatives’ need for support.

Implications for Practice

The study emphasizes the need for a proactive approach in the healthcare system, addressing patients’ and relatives’ physical and psychological vulnerability. Cancer nurses need to prepare and involve patients and relatives in treatment, long-term impacts, and rehabilitation.
The “Other” Uterine Mesenchymal Neoplasms: Recent Developments and Emerging Entities
Authors: Bennett Jennifer A. , Pinto Andre
Published: April 2024

Uterine mesenchymal neoplasms are a challenging group of tumors that often show overlapping morphologic features and immunohistochemical profiles. The increasing use of molecular testing in these tumors has enabled a better appreciation of their pathobiology, resulting in a wave of emerging neoplasms and improved characterization of ones previously considered exceptionally rare. Identification of specific molecular alterations has permitted targeted therapy options in tumors that were typically unresponsive to conventional therapies, as well as recognition that a subset can have a hereditary basis. This review will discuss the more “common” of the uncommon uterine mesenchymal neoplasms, including inflammatory myofibroblastic tumor, perivascular epithelioid cell tumor, uterine tumor resembling ovarian sex cord tumor, and embryonal rhabdomyosarcoma. This will be followed by an overview of emerging entities, including NTRK-rearranged uterine sarcoma, SMARCA4-deficient uterine sarcoma, KAT6B/A::KANSL1 fusion uterine sarcoma, and MEIS1::NCOA2/1 fusion sarcoma.
Imaging of Neuroendocrine Neoplasms; Principles of Treatment Strategies. What Referring Clinicians Want to Know
Authors: Asmundo Luigi , Ambrosini Valentina , Mojtahed Amirkasra , Fanti Stefano , Ferrone Cristina , Hesami Mina , Sertic Madeleine , Najmi Zahra , Furtado Felipe S. , Dhami Ranjodh S. , Anderson Mark A. , Samir Anthony , Sharma Amita , Campana Davide , Ursprung Stephan , Nikolau Konstantin , Domachevsky Liran , Blake Michael A. , Norris Evan C. , Clark Jeffrey W. , Catalano Onofrio A.
Published: April 2024

Neuroendocrine neoplasms (NENs) are a diverse group of tumors that express neuroendocrine markers and primarily affect the lungs and digestive system. The incidence of NENs has increased over time due to advancements in imaging and diagnostic techniques. Effective management of NENs requires a multidisciplinary approach, considering factors such as tumor location, grade, stage, symptoms, and imaging findings. Treatment strategies vary depending on the specific subtype of NEN. In this review, we will focus on treatment strategies and therapies including the information relevant to clinicians in order to undertake optimal management and treatment decisions, the implications of different therapies on imaging, and how to ascertain their possible complications and treatment effects.
Prevalence of Sexual Function and Vibrator Use Among Urogynecology Patients
Authors: Roberts Brittany , Rogers Rebecca , Husk Katherine , Walia Jessmehar , Jacobs Bradley , Wolff Gillian , Deverdis Erin C.
Published: April 2024

Importance

Urogynecology patients often present with sexual dysfunction; limited information on vibrator utilization to improve sexual function in this population exists.

Objective

The aim of this study was to assess patient knowledge of and receptivity to vibrator use.

Study Design

We conducted a cross-sectional, survey-based cohort study. The survey included patient characteristics, Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form 12, and vibrator use questions. Our primary outcome was vibrator utilization rates comparing younger (<65) and older (≥65 years) urogynecology patients.

Results

Of 213 distributed, 165 (78%) surveys were analyzed. Of these, 104 participants (63%) were aged <65 years and 61 (37%) were ≥65 years. Baseline characteristics were similar between groups (all P's > 0.05). Older patients reported less vibrator utilization than younger patients (30% vs 64%, P ≤ 0.001) and were less likely to be sexually active with a partner (36% vs 62%, P = 0.002) or masturbate (23% vs 51%, P ≤ 0.001). Most patients (76%) thought physicians should discuss vibrators with patients who would like to improve their sexual function with no differences between age groups (71% vs 80%, P = 0.17). Among women receptive to vibrator use, in a multivariable analysis, patients who reported masturbation (odds ratio [OR], 13.8; 95% confidence interval [CI], 2.80–67.71), vibrator use in the past (OR, 24.4; 95% CI, 6.65–89.53), or who believed physicians should discuss vibrators in a clinical setting (OR, 11.66; 95% CI, 2.9–46.81) were more receptive to vibrator use to improve sexual function. Age did not influence receptivity.

Conclusions

Vibrator utilization is greater among younger than older patients. Most urogynecologic patients think health care providers should discuss vibrator use with patients who wish to improve sexual function.
Unveiling the submerged secrets: bumblebee queens' resilience to flooding
Authors: Rondeau Sabrina , Raine Nigel E.
Published: April 2024

In a previous study, an experimental oversight led to the accumulation of water filling a container housing diapausing bumblebee queens. Surprisingly, after draining the water, queens were found to be alive. This observation raises a compelling question: can bumblebee queens endure periods of inundation while overwintering underground? To address this question, we conducted an experiment using 143 common eastern bumblebee (
Bombus impatiens
) queens placed in soil-filled tubes and subjected to artificially induced diapause in a refrigerated unit for 7 days. Tap water was then added to the tubes and queens (
n
= 21 per treatment) were either maintained underwater using a plunger-like apparatus or left to float naturally on the water’s surface for varying durations (8 h, 24 h or 7 days) while remaining in overwintering conditions. Seventeen queens served as controls. After the submersion period, queens were removed from water, transferred to new tubes with soil and kept in cold storage for eight weeks. Overall, queen survival remained consistently high (89.5 ± 6.4%) across all treatments and did not differ among submersion regimes and durations. These results demonstrate the remarkable ability of diapausing
B. impatiens
queens to withstand submersion under water for up to one week, indicating their adaptations to survive periods of flooding in the wild.