bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta‐analysis
Authors: Yao Kaiyi , Chen Yao
Published: July 2024

Purpose

Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta‐analysis to reconcile the divergent conclusions observed across studies.

Methods

We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy‐four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty‐nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design).

Results

Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80−46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high‐viscosity cement and the utilization of mobile‐bearing designs as risk factors for aseptic loosening post‐cemented TKA.

Conclusions

Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta‐analysis, we believe that higher‐level studies are necessary to clearly identify other risk factors.

Level of Evidence

Level III.
Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm
Authors: Ghirardelli Stefano , Scaggiante Federica , Troi Christina , Valpiana Pieralberto , Cristofolini Giovanni , Aloisi Giuseppe , Violante Bruno , Russo Arcangelo , Schaller Sebastian , Indelli Pier F.
Published: July 2024

Purpose

Pathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score‐based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.

Methods

A score‐based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.

Results

One hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%. Staphylococcus aureus and Enterococcus faecalis were the top two microorganisms identified by mPCR, while Staphylococcus epidermidis was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.

Conclusions

Molecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.

Level of Evidence

Level IV, case series.
Characterizing electronic messaging use among hospitalists and its association with patient volumes
Authors: Brickson Claire , Keniston Angela , Knees Michelle , Burden Marisha
Published: July 2024

Background

Secure electronic messaging is increasingly being utilized for communications in healthcare settings. While it likely increases efficiency, it has also been associated with interruptions, high message volumes, and risk of errors due to multitasking.

Objectives

We aimed to characterize patterns of secure messaging among hospitalists to understand the volume of messages, message patterns, and impact on hospitalist workload.

Methods

This was a retrospective cross‐sectional study of Epic Secure Chat secure electronic messages received and sent by hospitalists from April 1 to April 30, 2023 at a large academic medical center. Number of conversations per day, number of chats sent and accessed per hour, and average minutes between when a chat was sent and accessed (lag time) were analyzed using a Pearson correlation coefficient test. Measures were plotted against patient volume and time of day.

Results

Hospitalists sent or received an average of 130 messages per day with an average of 13 messages sent or received per hour. The median lag time was 39 s. There was a statistically significant correlation between hospital medicine morning census and number of conversations per day, number of chats sent per hour, and number of chats accessed per hour, but census did not impact lag time.

Conclusion

Secure messaging volumes may be higher than previously reported, which may affect hospitalist workload and workflow and have unintended effects on interruptions, multitasking, and medical errors. Additional work should be done to better understand local messaging patterns and opportunities to optimize volume of work and distractions.
CNS/PNS proteoglycans functionalize neuronal and astrocyte niche microenvironments optimizing cellular activity by preserving membrane polarization dynamics, ionic microenvironments, ion fluxes, neuronal activation, and network neurotransductive capacity
Authors: Melrose James
Published: July 2024

Central and peripheral nervous system (CNS/PNS) proteoglycans (PGs) have diverse functional roles, this study examined how these control cellular behavior and tissue function. The CNS/PNS extracellular matrix (ECM) is a dynamic, responsive, highly interactive, space‐filling, cell supportive, stabilizing structure maintaining tissue compartments, ionic microenvironments, and microgradients that regulate neuronal activity and maintain the neuron in an optimal ionic microenvironment. The CNS/PNS contains a high glycosaminoglycan content (60% hyaluronan, HA) and a diverse range of stabilizing PGs. Immobilization of HA in brain tissues by HA interactive hyalectan PGs preserves tissue hydration and neuronal activity, a paucity of HA in brain tissues results in a pro‐convulsant epileptic phenotype. Diverse CS, KS, and HSPGs stabilize the blood–brain barrier and neurovascular unit, provide smart gel neurotransmitter neuron vesicle storage and delivery, organize the neuromuscular junction basement membrane, and provide motor neuron synaptic plasticity, and photoreceptor and neuron synaptic functions. PG‐HA networks maintain ionic fluxes and microgradients and tissue compartments that contribute to membrane polarization dynamics essential to neuronal activation and neurotransduction. Hyalectans form neuroprotective perineuronal nets contributing to synaptic plasticity, memory, and cognitive learning. Sialoglycoprotein associated with cones and rods (SPACRCAN), an HA binding CSPG, stabilizes the inter‐photoreceptor ECM. HSPGs pikachurin and eyes shut stabilize the photoreceptor synapse aiding in phototransduction and neurotransduction with retinal bipolar neurons crucial to visual acuity. This is achieved through Laminin G motifs in pikachurin, eyes shut, and neurexins that interact with the dystroglycan–cytoskeleton–ECM‐stabilizing synaptic interconnections, neuronal interactive specificity, and co‐ordination of regulatory action potentials in neural networks.
From the kitchen to the medicine cabinet: Examples of food products and supplements used for therapeutic intent
Authors: Gura Kathleen M. , Chan Alvin , Zong Wenjing , Pai Nikhil , Duro Debora
Published: July 2024

“Food as medicine” has existed for centuries as the foundation of health for many cultures around the globe. It is a practice built on the knowledge that food and diet play important roles in disease prevention and management. Foods that claim to have therapeutic properties are often referred to as functional foods. These foods contain a number of nutritional and nonnutritional compounds that can interact with pharmacologically relevant receptors, either directly or indirectly via their metabolites, to regulate cellular biochemical processes. Although opinions are changing, the concept of food as a therapeutic intervention goes against conventional Western medicine. To provide guidance to clinicians interested in using these products, members of the Food as Medicine working group of the Nutrition Committee NASPGHAN, as part of a two‐part review series, have created summaries of several frequently used nutritional products for therapeutic intent (i.e., fermented foods, fiber, and long‐chain omega‐3 fatty acids) that includes indications, doses, and caveats. Gaps in their use in pediatric patients are discussed. Evidence supporting their use for management of gastrointestinal conditions, especially in the pediatric population, is provided when available.
Antibiotic‐loaded bone cement is associated with a reduction of the risk of revision of total knee arthroplasty: Analysis of the Catalan Arthroplasty Register
Authors: Gil‐Gonzalez Sergi , Velasco‐Regúlez Borja , Cerquides Jesus , Hinarejos Pedro , Monllau Joan Carles , Pelfort Xavier
Published: July 2024

Purpose

The purpose of this study was to analyse the impact on peri‐prosthetic joint infection (PJI) rate and prosthetic survival using antibiotic‐loaded bone cement (ALBC) versus plain cement during total knee arthroplasty (TKA).

Methods

A retrospective cohort study was conducted. The main data source was the Catalan Arthroplasty Register (RACat). TKAs with surgery date between 1 January 2011 and 31 December 2020 were analysed and followed up until 31 December 2023. The main variable of interest was the type of cement (ALBC vs. plain cement), and several endpoints (septic revision, aseptic revision, and all‐cause revision) were considered. The analysed outcomes were revision rates, survival rates and risk factors' hazard ratios (HR).

Results

A total of 22,781 TKAs were analysed, 13,125 (57.6%) of them with plain cement and 9656 (42.4%) with ALBC. The septic revision rate was lower in the ALBC group after 3 months of follow‐up (0.52% vs. 0.78%, p value = 0.04). Prosthetic survival with respect to the aseptic revision endpoint was also higher for the ALBC group during the whole follow‐up period (~158 months). Regarding risk factors for infection, ALBC showed a protective effect, HR: 0.53 (0.44, 0.63), while sex (being male) and the analysed comorbidities increased the risk.

Conclusions

ALBC is associated with a reduction in both the septic revision and the aseptic revision rate after TKA, and thus with higher prosthetic survival.

Level of Evidence

Level III, Therapeutic, retrospective.
Artificial intelligence‐based assessment of leg axis parameters shows excellent agreement with human raters: A systematic review and meta‐analysis
Authors: Salzmann Mikhail , Hassan Tarek Hakam , Prill Robert , Becker Roland , Schreyer Andreas G. , Hable Robert , Ostojic Marko , Ramadanov Nikolai
Published: July 2024

Purpose

The aim of this study was to conduct a systematic review and meta‐analysis on the reliability and applicability of artificial intelligence (AI)‐based analysis of leg axis parameters. We hypothesized that AI‐based leg axis measurements would be less time‐consuming and as accurate as those performed by human raters.

Methods

The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Epistemonikos, and Web of Science were searched up to 24 February 2024, using a BOOLEAN search strategy. Titles and abstracts of identified records were screened through a stepwise process. Data extraction and quality assessment of the included papers were followed by a frequentist meta‐analysis employing a common effect/random effects model with inverse variance and the Sidik–Jonkman heterogeneity estimator.

Results

A total of 13 studies encompassing 3192 patients were included in this meta‐analysis. All studies compared AI‐based leg axis measurements on long‐leg radiographs (LLR) with those performed by human raters. The parameters hip knee ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint‐line convergence angle (JLCA) showed excellent agreement between AI and human raters. The AI system was approximately 3 min faster in reading standing long‐leg anteroposterior radiographs (LLRs) compared with human raters.

Conclusion

AI‐based assessment of leg axis parameters is an efficient, accurate, and time‐saving procedure. The quality of AI‐based assessment of the investigated parameters does not appear to be affected by the presence of implants or pathological conditions.

Level of Evidence

Level I.
Comparative study of two different horizontal stabilisation methods in arthroscopically assisted coracoclavicular stabilisation for acute acromioclavicular joint dislocations—Good clinical outcome and no correlation to recurrent anteroposterior instability
Authors: Kimmeyer Michael , Rapp Katharina , Rentschler Verena , Schieffer Christian , Schmalzl Jonas , Gerhardt Christian , Lehmann Lars‐Johannes
Published: July 2024

Purpose

The hypothesis of this study was that acromioclavicular K‐wire transfixation is noninferior to horizontal FiberTape cerclage in terms of vertical and horizontal stability in the short follow‐up period of acute acromioclavicular joint (ACJ) dislocations fixed with an arthroscopically assisted coracoclavicular single bundle endobutton cerclage system. The secondary aim was to investigate the impact of postoperative recurrent instability on clinical outcomes in these populations.

Methods

In this consecutive clinical trial, all patients who underwent surgery for acute AC joint dislocation between January 2017 and December 2021 were included. Two groups were formed according to the additional AC stabilisation technique (K‐wire group, cerclage group). Clinical examination and bilateral radiologic analysis (Zanca stress view, Alexander view) were performed with a follow‐up period of at least 12 months. Satisfaction, return to sports, active range of motion, global shoulder scores and specific shoulder scores including constant score, disabilities of the arm, shoulder and hand (DASH) score and ACJ instability score (ACJI) were evaluated. Complications, including recurrent instability, and revision rate were assessed.

Results

Included were 59 patients (32 K‐wire group, 27 cerclage group, 92% male, median follow‐up 33 months). No significant differences were found in the clinical outcome parameters between the different techniques, except for the DASH value (superior in the K‐wire group). Recurrent anteroposterior instability was radiographically detected in 27% of patients. No correlation was found between anteroposterior instability and clinical outcome parameters. There was no revision surgery due to chronic ACJ instability.

Conclusion

Horizontal ACJ stabilisation with temporary K‐wire transfixation does not appear to be inferior to a FiberTape cerclage technique in acute ACJ dislocations stabilised in an arthroscopically assisted single bundle DogBone technique. Recurrent ACJ instability detected radiographically does not necessarily correlate with the functional outcome and can be well compensated.

Level of Evidence

Level III.
Comparable bone penetration between antibiotic‐loaded and plain bone cement in total knee arthroplasty
Authors: Fontanellas‐Fes Albert , Hinarejos Pedro , Pérez‐Prieto Daniel , Martínez‐Lozano Jan , Sánchez‐Soler Juan , Torres‐Claramunt Raúl , Perelli Simone , Monllau Joan Carles
Published: July 2024

Introduction

One of the main concerns around the use of antibiotic‐loaded bone cement (ALBC) is the potential reduction in the mechanical properties of the cement when antibiotics are admixed. The purpose of this study was to determine whether there is a difference between plain cement and ALBC in terms of radiological intrusion into the bone in total knee arthroplasties (TKAs).

Methods

Prospective randomized study of 80 consecutive patients who underwent TKA. Depending on the cement used, patients were divided into two groups by a computer‐generated randomization programme: the cement without antibiotic (Group 1) or the ALBC (Group 2). Cement intrusion was measured in postoperative radiographs in eight different regions in the tibial component and six regions in the femoral component.

Results

The average cement intrusion was similar in both groups (p = nonsignificance [n.s.]). Group 1 (plain cement) had an average cement intrusion in the femur of 1.4 mm (±0.4) and 2.4 mm (±0.4) in the tibia. In Group 2 (ALBC), the average cement intrusion in the femur came to 1.6 (±0.5) and 2.4 mm (±0.5) in the tibia. In 80% of the patients, the cement intrusion in the tibia averaged a minimum of 2 mm, being similar in both groups (p = n.s.).

Conclusion

There are no differences in bone intrusion when comparing plain cement to ALBC. Therefore, the use of ALBC in primary TKA may be indicated, achieving optimal bone penetration.

Level of Evidence

Level I.
Incorporating straw‐derived biochars enhances soil nitrogen accumulation and mitigates nitrogen leaching to facilitates crop productivity of mulching farmland in semiarid regions
Authors: Wang Yuhao , Zhang Mengjie , Tian Zhonghong , Yang Jialin , Pang Jinwen , Fang Yujing , Liu Enke , Cai Tie , Ren Xiaolong , Jia Zhikuan , Siddique Kadambot H. M. , Zhang Weijun , Zhang Peng
Published: July 2024

The long‐term use of film mulching and conventional chemical fertilizers in semiarid regions has resulted in soil degradation and suboptimal fertilizer utilization, necessitating a reevaluation of agricultural practices to enhance resource utilization efficiency and ensure the sustainability of dryland crop production. We conducted a 5‐year study (2017–2021) field experiment in northwest of China, to assess the impact of straw or biochar incorporation on soil water accumulation, crop nitrogen transport, and maize yield under film mulching field. The experiment had six treatments (flat planting without mulching [NN], flat planting with straw incorporation [NS], flat planting with biochar incorporation [NB], film mulching [MN], film mulching with straw incorporation [MS], and film mulching with biochar incorporation [MB]). We undertook a comprehensive assessment over the two growing seasons in 2020–2021. The film mulching and straw/biochar treatments improved soil water storage. The MB treatment significantly decreased 60–200 cm soil NO3−‐N content by 28.37% compared with MN. Biochar incorporation significantly increased soil total and alkali‐hydrolyzable N contents, whereas MS decreased soil alkali‐hydrolyzable N content compared with MN. The maize plant N transportation and grain contribution rates were significantly higher under MS (17.46% and 29.84%) and MB (28.00% and 31.69%) than under MN, respectively. Straw and biochar incorporation significantly increased water use efficiency, nitrogen fertilizer recovery efficiency, and maize yield, on average, by 9.62%, 9.14%, and 14.6%, respectively. In conclusion, incorporating biochar, in particular, positively mitigated N losses, enhanced N utilization efficiency, and increased maize yield in long‐term film mulching farmland in semiarid region.
Reclamation of coastal marshes to croplands shifts molecular composition of soil organic matter in the Bohai Rim
Authors: Xu Haijing , Zhu Yuanshan , Yang Xi , Guo Changcheng , Zhang Zhigang , Shang Yuntao , Zhou Jingyun , Song Zhaoliang , Wang Yidong
Published: July 2024

Reclamation of coastal marshes to croplands lost massive reserves of soil organic matter (SOM). However, it is uncertain how reclamation shifts chemical composition of SOM and its size fractions. Here, we investigated this issue at two coastal marshes (Qilihai, degradation with seasonal waterlog; Beidagang, annual long‐term waterlog) along with adjacent long‐term reclaimed croplands on the coast of the Bohai Bay, China. Three SOM fractions: coarse particulate (cPOM, >250 μm), fine particulate (fPOM, 53–250 μm), and mineral‐associated organic matter (<53 μm) were analyzed by pyrolysis‐gas chromatography–mass spectrometry. Compared with the Qilihai marsh, the Beidagang marsh had higher SOM contents and lower proportions of microbial‐derived N‐containing compounds, which was attributed to the waterlogging‐induced weaker decomposition. Reclamation decreased the SOM contents (−53.6% to −63.3%) and proportions of lignin in cPOM (−44% to −52%) at both sites. However, reclamation‐induced shifts of molecular composition of SOM between the two sites diverged. At the Qilihai site, reclamation decreased the relative abundances of N‐containing compounds (−28%) but increased the proportions of lipids (+17%) and phenolics (+40.7%) in mineral‐associated organic matter. At the Beidagang site, reclamation decreased the proportions of monocyclic aromatics (−60.3% to −70.2%), but increased the relative abundances of N‐containing compounds (+175% to +407%) in all fractions. By contrast, the molecular composition of SOM at the two croplands had covergent pattern. In conclusion, despite of marsh locations with different waterlogging conditions, long‐term reclamation of wetlands to croplands generated convergent patterns in storage and molecular composition of SOM, which was attributed to the similar cropland cultivation.
Regeneration of post‐mining and post‐fire soil function by assessment of tree nutrient status: Evidence from pioneer and N‐fixing species
Authors: Woś Bartłomiej , Chodak Marcin , Likus‐Cieślik Justyna , Misebo Amisalu Milkias , Pietrzykowski Marcin
Published: July 2024

Nutrient concentrations in the foliage of particular tree species can identify growth‐limiting factors. Therefore, the adaptability and usefulness of certain trees in the afforestation of barren soils after disturbances could be based on nutrient supply and stoichiometry. In this study, we investigated the macronutrient supply to (i.e., nitrogen [N], phosphorus [P], potassium, sulfur, calcium [Ca], and magnesium [Mg]) and C:N:P (carbon:nitrogen:phosphorus) stoichiometry of the foliage of black alder (Alnus glutinosa), common birch (Betula pendula), and Scots pine (Pinus sylvestris) in two different regeneration scenarios—a reclaimed mine site with primary succession and an afforested post‐fire (PF) site with secondary succession. The control plot was on an undisturbed forest site hosting stands of the studied tree species. The lower concentrations of elements in the post‐mining soils developed from “point zero” were enough to supply the trees with a similar level of nutrition to those in the PF and undisturbed soils. The studied tree species differed in their foliage chemistry and had different effects on the soil properties. The alder and birch foliage contained more nutrients than the pine foliage. In particular, the birch foliage contained the highest concentrations of Ca, Mg, and P, thus enhancing the biogeochemical cycling of these elements. The alder foliage had the highest N concentration, albeit the soil total N contents under this species were not higher than those under birch. Thus, its phytomeliorative effect may have been overestimated. The pine foliage contained the lowest concentrations of nutrients, indicating the high nutrient use efficiency of this species. On the sites degraded after disturbance, pine and birch grew under N‐limitation stress, while the alder—a N‐fixing species—grew under P‐limitation stress, especially at the PF site. The PF soils under alder were also characterized by higher acidity, P depletion, and higher C:P and N:P ratios compared to the PF soils under the other studied species. We found that birch should be the most common tree species in the first phase of area regeneration after disturbances. Introducing alder into afforestation should take place in admixtures, especially at the PF site.
Expiratory Velopharyngeal Obstruction: Sleep Endoscopy‐Guided Treatment Strategies to Prevent Oral Breathing During Sleep
Authors: Hsu Ying‐Shuo , Ke Yuan‐Kai , Kuo Terry B. J. , Chang Yi , Jacobowitz Ofer , Lin Chia‐Mo , Lo Shih‐Chieh , Yang Cheryl C. H.
Published: July 2024

Objective

Obstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug‐induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE.

Study Design

Case series.

Setting

Tertiary Medical Center.

Methods

Seventy‐two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO.

Results

The results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs 35.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01‐1.06). However, no other baseline characteristics were significantly associated the odds of EVO.

Conclusion

Our study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.
Precision‐Targeted Injection Laryngoplasty and Longitudinal Biomaterial Effects Evaluation Using High‐resolution Ultrasonography in a Rat Model
Authors: Tseng Wen‐Hsuan , Hsiao Tzu‐Yu , Yang Tsung‐Lin
Published: July 2024

Objective

Current laryngeal injection models rely on the transoral route and are suboptimal due to limited view, narrowed working space, and the need to sacrifice animals for investigation of the injectables. In the present study, a novel surgical model for laryngeal intervention therapy utilizing an ultra‐high frequency ultrasound imaging system was proposed. Based on this system, we developed a systemic evaluation approach, from guidance of the injection process, documentation of the injection site of the material, to in vivo longitudinal follow‐up on the augmentation and medialization effect by analyzing the ultrasonography data.

Study Design

In vivo animal study.

Setting

Academic institution.

Methods

Injection laryngoplasty with hyaluronic acid under ultrasonography guidance was performed on Sprague‐Dawley rats one week after induced unilateral vocal paralysis. Ultrasonography was performed at preinjection, immediately postinjection, on Day 2, Day 7 and then weekly for 4 weeks to obtain measurements, including the glottic area, angle between bilateral folds, and vocal fold width ratio. Laryngoscopic and histologic studies were also performed.

Results

Unilateral injections to the paralyzed fold were successfully performed as demonstrated by ultrasonographic, laryngoscopic, and histologic studies. The width ratio was significantly increased after injection for 4 weeks, while the glottic airway area was unchanged.

Conclusion

Here, a novel surgical model for laryngeal injection utilizing ultrasonography in rats was established. In addition to providing visual guidance for precise localization of the injection, robust documentation of the treatment effect was also demonstrated. This methodology could be beneficial for screening therapeutic agents for treatment of glottic insufficiency.
Exploring Diversity in North American Academic Pediatric Otolaryngology
Authors: Abdallah Zahra , Sodhi Emily , Davidson Jacob , Lawlor Claire M. , Wilson Claire A. , Strychowsky Julie E. , Graham M. Elise
Published: July 2024

Objective

Representation of women and minority groups is traditionally low in Otolaryngology–Head & Neck Surgery (OHNS). This cross‐sectional study aims to assess the difference in gender and racial/ethnic representation within Academic North American pediatric OHNS.

Study Design

Cross‐sectional study of North American pediatric OHNS faculty websites.

Setting

North America.

Methods

Canadian and American residency program registries were searched for accredited OHNS programs. Pediatric OHNS faculty were identified through program websites. Information regarding gender, race/ethnicity, time in practice, research productivity, academic title, and leadership positions was extracted from public profiles and Scopus. Demographic and academic data was also extracted for OHNS and pediatric OHNS department/division chairs.

Results

North American academic pediatric OHNS websites listed 516 surgeons, of whom 39.9% were women. Most surgeons were perceived as White (69.0%), followed by Asian (24.0%), Hispanic (3.7%), and Black (3.3%). Women surgeons had lower h‐indices, less publications, and less citations than men (P < .001). Despite women surgeons having fewer years in practice (median 8.0 vs 13.0, P < .001), gender‐differences in h‐index persisted when controlling for years in practice (P < .05). Men surgeons had higher academic titles (P < .001), but there was no gender difference in leadership roles while accounting for years in practice (P = .559). White surgeons had higher academic titles than non‐White surgeons (P = .018). There was no racial/ethnic difference in leadership roles (P = .392).

Conclusion

Most pediatric OHNS surgeons are men and/or White. Significant gender‐differences in research productivity and academic title exist, however surgeons of racial/ethnic minority have similar research productivity as their racial/ethnic majority counterparts.
Longitudinal Success of Tonsillectomy for Obstructive Sleep Apnea in Children with Down Syndrome
Authors: Diala Obinna R. , Polat Pinar , Pickett‐Nairne Kaci , Friedman Norman R.
Published: July 2024

Objective

Obstructive sleep apnea is common in children with Down syndrome (DS). Tonsillectomy is recommended as the first‐line approach in treating children with obstructive sleep apnea (OSA), however, there is limited data on the long‐term outcomes in children with DS who undergo tonsillectomy. In this retrospective study, we examined the long‐term polysomnographic and symptomatic outcomes in children with DS who underwent tonsillectomy with or without an adenoidectomy (T&A). We hypothesize that the success of T&A to treat OSA in children with DS will diminish with time.

Study Design

A retrospective chart review of children with DS who underwent T&A between 2009 and 2015 was conducted. Inclusion criteria were children with at least 1 postoperative polysomnogram (PSG) within 6 months of T&A with an obstructive apnea/hypopnea index (OAHI) < 5. Outcomes were determined by subsequent clinic visits and postoperative polysomnograms: OAHI ≥ 5, snoring reported during clinic visit and time to reoccurrence.

Setting

Childrens Hospital Colorado.

Results

Of the 57 children with mild OSA at 1st (initial) PSG, 13/40 (33%) children had OAHI ≥ 5 at the 2nd postoperative PSG. Of the 18 patients who underwent a 3rd PSG, 4 (22%) progressed to moderate/severe OSA. A total of 17 patients out of the original 57 (30%) progressed to moderate/severe OSA with the median time for the additional post‐op PSG's being 2.3 years.

Conclusion

Children with DS who have at most mild OSA (OAHI < 5) following a T&A are at risk for progressing to at least moderate OSA within 2 years after their T&A. A surveillance PSG 2 years following surgery will identify these children.
Serum Levels of Stereocilin as a Hearing Biomarker
Authors: Malesky Carly , Daniel Diana , Skoe Erika , Parham Kourosh
Published: July 2024

Noise‐induced hearing loss (NIHL) often presents with an insidious onset, resulting from the cumulative effect of chronic, high‐level noise exposure regardless of etiology. Stereocilin (STRC) is a protein that supports stereocilia attachment and cochlear hair cell function, 2 common targets of noise trauma. In this study, we explored the relationship between STRC and daily noise exposure in young, healthy adults. We found that higher noise exposure levels were associated with lower serum levels of STRC, as was the case for another inner‐ear protein, prestin. There was a statistically significant positive correlation between serum STRC and prestin levels. These results support a biomarker approach for the diagnosis and monitoring of NIHL. The ability to detect and measure STRC in the blood also has implications for targeted gene therapy. STRC mutations are known to be associated with autosomal recessive deafness, a condition that is now amenable to targeted gene therapy.
Current State of Safe Pregnancy Policies for the US Surgical Trainee
Authors: Mann Hayley , Glazer Tiffany
Published: July 2024

Objective

Define current practices and protocols in surgical training programs for pregnant trainees.

Study Design

Cross sectional.

Setting

Academic surgical training programs in the United States.

Methods

A validated 20‐question survey was sent via email to program directors and coordinators of US surgical training programs, including otolaryngology head & neck surgery (OHNS), plastic surgery, vascular surgery, and general surgery. The survey was issued in November and December 2022 and data were collected until January 2023. This study was approved for exemption by the Minimal Risk Research IRB at the University of Wisconsin Madison (ID number 2022‐1370).

Results

Surveys were emailed to 608 surgical programs, and the response rate was 23.5% (143/608) including 45 OHNS programs. When asked if their program has a policy in place for pregnant trainees, 84.4% responded yes, and 82.4% responded that they were satisfied with their policy. Subsequent questions addressed individual policies and risk factors facing pregnant trainees. 60.3% of programs report providing protected time off for miscarriages. Only 36.9% provide information to pregnant trainees regarding workplace exposures that pose a risk of fetal anomaly or miscarriage. Only 47.1% incorporate rest breaks for pregnant trainees, and only 20% protect the number of hours a pregnant trainee operates per week. 24.2% adjust overnight shifts or call schedules for pregnant trainees, and of those that adjust call shifts, 20% require pregnant trainees to “make up” these missed call shifts. Less than half (40%) of programs have a contingency plan in place for supporting nonchild‐bearing residents who may take on the work of their colleagues during pregnancy or postpartum.

Conclusion

While a majority of training programs report a pregnancy policy in place for trainees, most of these policies appear to be severely deficient in addressing critical aspects of surgical training that place both fetus and mother at significant risk of complications. This data indicates a need for a safe pregnancy protocol in order to protect both surgeon and fetus.
Customized Music Therapy Combined With the Counseling and Follow‐Up System: Stratified Results for Tinnitus Efficacy
Authors: Ni Tianyi , Liu Yuehong , Xie Hongbo , Yang Siyi , Wang Yulu , Jiang Yun , Han Zhao
Published: July 2024

Objective

Chronic subjective tinnitus is a worldwide intractable problem. In our previous studies, customized music therapy combined with a follow‐up system can reduce tinnitus perception and improve anxiety/depression. This study aims to explore which characteristics of tinnitus patients are more likely to benefit from our therapy.

Study Design

This study included 1031 patients with chronic subjective tinnitus, all of whom completed customized music therapy with the follow‐up system. Population demographics, tinnitus characteristics, and tinnitus‐related scales at pretherapy and posttherapy were collected.

Setting

Huadong Hospital affiliated Fudan University, Department of Otorhinolaryngology–Head & Neck Surgery from 2018 to 2022.

Methods

A paired t test and the one‐way analysis of variance were utilized to the overall efficacy and stratified difference based on tinnitus duration/age/tinnitus frequency.

Results

There were significant statistical differences in the Tinnitus Handicap Inventory (THI), Tinnitus Loudness Visual Analog Scale (VAS), and Hospital Anxiety and Depression Scale (HADS)‐A/D scores between pretherapy and 3 months posttherapy. THI and HADS (A/D) scores decreased the most in the 1‐year duration tinnitus group. The most significant decrease in THI and VAS scores was observed in the 31‐ to 50‐year‐old tinnitus group. Patients with high‐frequency tinnitus and extended high‐frequency tinnitus had greater decreases generally than those with low‐frequency tinnitus though no significance.

Conclusion

Group with severe and prolonged tinnitus, shorter duration of tinnitus onset, and 31 to 50 years old benefit more from our therapy. Therefore, standardized personalized music and consulting and follow‐up systems while promoting early treatment can reduce tinnitus and its comorbidities.
Acquiring musical knowledge increases music liking: Evidence from a neurophysiological study
Authors: Hou Yingying , Song Bei , Zhu Yi , Yu Linwei , Hu Yi
Published: July 2024

People possessing musical knowledge tend to enjoy music more, but the linkage remains to be determined. Based on the shared affective motion experience model for music appreciation, we hypothesized that acquiring musical knowledge about the music itself, for example, an analytical understanding of music elements and the related emotional expressions, would increase music liking. To test the hypothesis, we asked 48 participants to learn analytical or historical information about a piece of music by watching a pre‐recorded teaching video. Learners' physiological responses, such as skin conductance and heart rate, were recorded during learning. The increase of music liking was observed after both types of knowledge acquisition, but more so for analytical knowledge. Notably, acquiring analytical knowledge made learners' skin conductance more similar, indicating the alignment of physiological responses. This physiological similarity, correlated with analytical knowledge similarity, could mediate the effect of knowledge acquisition on music liking. In sum, this study reveals the impact of analytical knowledge on music enjoyment and the associated neurophysiological mechanism. It extends the theoretical framework of shared affective motion experience to explain how musical knowledge influences music appreciation.
The association between social support and prosocial behavior: A three‐level meta‐analysis
Authors: Wang Yinlan , Ran Guangming , Zhang Qi , Zhang Qiongzhi
Published: July 2024

Numerous studies have examined the relationship between social support and prosocial behavior and have concluded that social support is an important factor in generating prosocial behavior. However, different studies have produced different conclusions, and the moderating effect on the relationship is not entirely clear. The current study uses a three‐level meta‐analysis method to clarify the relationship between social support and prosocial behavior, and explores the moderating variables that affect the relationship between the two variables. Through a systematic literature search, a total of 92 studies, 418 effect sizes, and 74,378 participants were obtained. The main effects test found a significant positive correlation between social support and prosocial behavior. Tests of the moderating effects indicated that the relationship between social support and prosocial behavior was moderated by year of publication, source of social support, measurement of social support and measurement of prosocial behavior. In summary, social support plays an important role in prosocial behavior, and exploring their relationship is beneficial to families, schools and society in guiding individuals' prosocial behavior.
Design of parallel 𝛽‐sheet nanofibrils using Monte Carlo search, coarse‐grained simulations, and experimental testing
Authors: Sarma Sudeep , Sudarshan Tarunya Rao , Nguyen Van , Robang Alicia S. , Xiao Xingqing , Le Justin V. , Helmicki Michael E. , Paravastu Anant K. , Hall Carol K.
Published: July 2024

Peptide self‐assembly into amyloid fibrils provides numerous applications in drug delivery and biomedical engineering applications. We augment our previously‐established computational screening technique along with experimental biophysical characterization to discover 7‐mer peptides that self‐assemble into “parallel β‐sheets”, that is, β‐sheets with N‐terminus‐to‐C‐terminus 𝛽‐strand vectors oriented in parallel. To accomplish the desired β‐strand organization, we applied the PepAD amino acid sequence design software to the Class‐1 cross‐β spine defined by Sawaya et al. This molecular configuration includes two layers of parallel β‐sheets stacked such that N‐terminus‐to‐C‐terminus vectors are oriented antiparallel for molecules on adjacent β‐sheets. The first cohort of PepAD identified peptides were examined for their fibrillation behavior in DMD/PRIME20 simulations, and the top performing sequence was selected as a prototype for a subsequent round of sequence refinement. The two rounds of design resulted in a library of eight 7‐mer peptides. In DMD/PRIME20 simulations, five of these peptides spontaneously formed fibril‐like structures with a predominantly parallel 𝛽‐sheet arrangement, two formed fibril‐like structure with <50% in parallel 𝛽‐sheet arrangement and one remained a random coil. Among the eight candidate peptides produced by PepAD and DMD/PRIME20, five were synthesized and purified. All five assembled into amyloid fibrils composed of parallel β‐sheets based on Fourier transform infrared spectroscopy, circular dichroism, electron microscopy, and thioflavin‐T fluorescence spectroscopy measurements.
A physiologically‐based pharmacokinetic modeling approach for dosing amiodarone in children on ECMO
Authors: Yellepeddi Venkata K. , Hunt John Porter , Green Danielle J. , McKnite Autumn , Whelan Aviva , Watt Kevin
Published: July 2024

Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device commonly used to treat cardiac arrest in children. The American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care recommend using amiodarone as a first‐line agent to treat ventricular arrhythmias in children with cardiac arrest. However, there are no dosing recommendations for amiodarone to treat ventricular arrhythmias in pediatric patients on ECMO. Amiodarone has a high propensity for adsorption to the ECMO components due to its physicochemical properties leading to altered pharmacokinetics (PK) in ECMO patients. The change in amiodarone PK due to interaction with ECMO components may result in a difference in optimal dosing in patients on ECMO when compared with non‐ECMO patients. To address this clinical knowledge gap, a physiologically‐based pharmacokinetic model of amiodarone was developed in adults and scaled to children, followed by the addition of an ECMO compartment. The pediatric model included ontogeny functions of cytochrome P450 (CYP450) enzyme maturation across various age groups. The ECMO compartment was parameterized using the adsorption data of amiodarone obtained from ex vivo studies. Model predictions captured observed concentrations of amiodarone in pediatric patients with ECMO well with an average fold error between 0.5 and 2. Model simulations support an amiodarone intravenous (i.v) bolus dose of 22 mg/kg (neonates), 13 mg/kg (infants), 8 mg/kg (children), and 6 mg/kg (adolescents). This PBPK modeling approach can be applied to explore the dosing of other drugs used in children on ECMO.
Public Health Challenges and Responses to the Growing Ageing Populations
Authors: Khan Hafiz T. A. , Addo Kwaku Mari , Findlay Helen
Published: July 2024

Background

Human populations are rapidly ageing worldwide due to declining birth rates and rising life expectancies. This profound demographic shift presents complex public health challenges. Synthesizing evidence on key public health issues impacting ageing populations and policy strategies is required to address these needs.

Methods

The study employs narrative literature review based on the PubMed database. Data have been extracted on public health challenges to ageing populations and its recommended policy solutions.

Results

The key public health challenges identified include rising chronic disease burden, risks for preventable multi‐morbidities and co‐morbidities, disability and dependencies, mental health issues, caregiving gaps, long‐term care system deficiencies, health inequities, healthcare access barriers, end‐of‐life care needs, financial instability, ageism/elder abuse, adverse built environments, climate/disaster threats, and social isolation. Evidence‐based policy responses span interventions in healthcare, social services, urban planning, emergency preparedness, economics, technology, anti‐ageism advocacy and so on.

Conclusions

Proactively addressing the array of public health challenges faced by rapidly growing ageing populations globally requires implementing collaborative, multisectoral policy solutions focused on promoting healthy, equitable, and socially engaged ageing. Healthcare systems, communities, and policies must be optimized to meet the needs of elderly people and tap into their strengths.