bluuebunny/crossref_metadata_2025 huggingface dataset:
IOL scaffolding technique in Hypermature/ Morgagnian cataract in Manual Small Incision Cataract Surgery
Authors: Ramya Muthukrishnan Gomathi , Lokanathan Lakshana Malla , Shekhar Madhu , Murali Nivedita , Waghamare Shalaka Ramesh
Published: February 2023

Purpose:

To describe surgical technique of IOL scaffolding in hypermature / Morgagnian cataract in manual small incision cataract surgery.

Setting: charitable section of the hospital through direct availed services at free /subsidised cost.

Design:

Interventional study

Methods:

This study included 38 eyes of 38 patients operated at charitable section of the hospital through direct availed services at free /subsidised cost.

Results:

IOL scaffolding in manual small incision cataract surgery was executed in 38 patients out of which 25 patients were diagnosed as hypermature cataract, pseudoexfoliation syndrome with mature cataract in 5 patients, 5 patients had phacolytic glaucoma and 3 patients had lens induced uveitis. This technique was successful in 35 out of 38 patients and was not successful in three patients in whom traditional SICS was performed in 2 patients and retro haptic iris fixation in one patient

Conclusion:

We describe a technique which uses IOL as a scaffold in hypermature cataract in MSICS that provides a stable barrier by stretching the capsular bag in order to prevent the crumpling of the bag or whole bag removal following nucleus delivery.
Do “central sensitization” questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses
Authors: Adams Greig R. , Gandhi Wiebke , Harrison Richard , van Reekum Carien M. , Wood-Anderson Desmond , Gilron Ian , Salomons Tim V.
Published: February 2023

Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.
Health and Work Performance Consequences of Working From Home Environment
Authors: Okawara Makoto , Ishimaru Tomohiro , Igarashi Yu , Matsugaki Ryutaro , Mafune Kosuke , Nagata Tomohisa , Tsuji Mayumi , Ogami Akira , Fujino Yoshihisa ,   for the CORoNaWork project
Published: February 2023

Objectives

The physical work environment while working from home (WFH) is a key component of WFH, which, if inadequate, can impair workers’ health and work functioning. We investigated environmental factors in WFH and worsening of work functioning.

Methods

A 1-year prospective cohort study was conducted involving 2530 Japanese workers who worked from home. Environment while WFH was assessed using binary subjective assessments based on existing guidelines. Existence of impaired work function was assessed using the Work Functioning Impairment Scale. We performed multilevel logistic regression analysis nested in the prefecture of residence.

Results

Lack of room/space for concentration, lack of enough light and foot space, inadequate temperature and humidity, and use of a sitting table were associated with work functioning impairment.

Conclusions

An inappropriate environment while WFH can have a negative impact on workers’ health.
Association Between Carbon Emission and Low Birth Weight in Mainland China
Authors: Sun Qi , Zhang Ya , Wang Yuanyuan , Lu Jianbo , Ma Xu
Published: February 2023

Objective

The aim of this study is to investigate the relationship between carbon emission and low birth weight (LBW).

Methods

A nested case-control study was contacted in mainland China. Multilevel logistic regression was used to estimate the effect of carbon emission on LBW. Generalized additive mixed effect model was performed to assess no-linear trend between LBW and carbon emission.

Results

Carbon emission was a risk factor for LBW (odds ratio, 1.182; 95% confidence interval, 1.011–1.383). Carbon emissions from power, residence, aviation, and transport department were risk factors for LBW (all P < 0.05). Moreover, generalized additive mixed effect model has shown that the risk of LBW decreased first and then increased as carbon emissions increased.

Conclusions

Our study initially found that carbon emission may be a risk factor for LBW.
The Combined Effect of Elevated Blood Pressure and Occupational Noise Exposure on Bilateral High-Frequency Hearing Loss
Authors: Zhang Hua-Dong , Yuan Fang , Jin Nan , Deng Hua-Xin
Published: February 2023

Background

Combined effect of elevated blood pressure and occupational noise exposure on hearing loss have rarely been evaluated among Chinese population.

Methods

This cross-sectional study was conducted in 242,811 participants. Logistic regression model was performed to estimate the independent and combined associations.

Results

Compared with participants without occupational noise exposure, the risk of bilateral high-frequency hearing loss (BHFHL) was significantly higher for noise exposure 10 years or more (odds ratio [OR] = 1.29, 95% confidence interval [95% CI] = 1.23–1.35). Compared with no hypertension, participants with grade 1 hypertension had higher risk of BHFHL in all age groups (OR, 1.14; 95% CI, 1.09–1.20). As to the combined effect, the highest BHFHL risk was found in males (OR, 1.51; 95% CI, 1.37–1.67), especially among participants with grade 1 hypertension older than 50 years (OR, 1.65; 95% CI, 1.46–1.88).

Conclusions

Elevated blood pressure may synergistically influence hearing loss combined with occupational noise exposure.
Disparities in Access to Paid Sick Leave During the First Year of the COVID-19 Pandemic
Authors: Hawkins Devan
Published: February 2023

Objective

This study sought to assess disparities in access to paid sick leave in the first year of the COVID-19 pandemic based on demographic and socioeconomic factors.

Methods

The percentage of workers with access to paid sick leave was calculated according to age group, sex, race/ethnicity, educational attainment, region, health insurance coverage, receiving public assistance, income, occupation, and industry.

Results

A total of 65.6% of workers had access to paid sick leave. Access was lowest among Hispanic workers, workers with less than a high school education, and workers without health insurance coverage.

Conclusions

There were wide disparities in access to paid sick leave during the first year of the COVID-19 pandemic, which may be associated with disparities in the risk for COVID-19. The introduction of mandatory paid sick leave may serve to protect workers from the spread of infectious diseases.
Characteristics of Occupational Environmental Heat Injuries/Illnesses
Authors: Hawkins Devan , Ibrahim Mariam
Published: February 2023

Objective

This study describes the characteristics of workers experiencing occupational heat-related injuries/illnesses in the United States and explores the associations between states’ average annual temperatures and heat-related injury/illness rates.

Methods

The number and rate of occupational environmental heat injuries/illnesses were calculated according to age group, gender, race/ethnicity, occupation group, and state from 2011 to 2019.

Results

Injury/illness rates were higher among Black and Hispanic workers. Workers in farming, fishing, and forestry; installation, maintenance, and repair; and construction/extraction occupations had the highest rates. There was a positive correlation between states’ average annual temperatures and heat-related injury/illness rates.

Discussion

There are demographic and occupational disparities in occupational environmental heat-related injuries/illnesses in the United States and a correlation between these injuries/illnesses and state average annual temperatures. There is a need for policies and other interventions to protect workers from occupational environmental heat injuries/illnesses.
Practical Management: A Standardized Aerobic Exercise Program for Adolescents With Concussion in the Absence of Graded Exercise Testing
Authors: Chizuk Haley M. , Haider Mohammad N. , Edmonds Jasmine Q. , Rawlings Alex , Willer Barry S. , Leddy John J.
Published: February 2023

Aerobic exercise is safe and beneficial for adolescent athletes recovering from sport-related concussion (SRC). The results of systematic graded exercise testing are used to create individualized, subsymptom heart rate threshold (HRt) aerobic exercise treatment programs for adolescents after SRC. Many clinicians, however, do not have access to graded exercise tests. This article presents a safe, systematic, evidence-based exercise program that clinicians can prescribe, progress, and modify to help manage acute pediatric SRC without the need for formal exercise testing. The exercise prescription accounts for sex and days since injury but not age because our analysis indicates age does not significantly affect the HRt on graded exercise testing. This article provides clinicians without access to graded exercise testing a viable option for prescribing exercise treatment to adolescents in the early phase after SRC.
Five-year follow-up of an interdisciplinary oral health education program: Clinical practice behaviors in working pediatric nurse practitioners
Authors: Pike Nancy A. , Love-Bibbero Laurie , Kinsler Janni J. , Verzemnieks Inese , Ramos-Gomez Francisco
Published: February 2023

Many interdisciplinary oral health education programs have been implemented for pediatric primary care providers (e.g., pediatric nurse practitioner [PNP]) to raise awareness and gain skills related to the prevention of early childhood caries (ECC). However, no studies have evaluated if these educational programs provided to PNPs during their training resulted in clinical practice behavior changes. A 33-item survey was designed on a web-based platform (Survey Monkey) and distributed to 71 PNP graduates. The survey included demographics, current clinical practice, clinical practice behaviors, and perceived barriers to practice. Descriptive statistics were used to assess the survey items and thematic analyses on the open-ended questions. The survey response rate was 70% (50/71 PNPs). Most practicing PNPs were in acute care or specialty clinics (n = 33; 66%) where oral health was not part of the focused visit. Majority used knowledge learned in assessment and anticipatory guidance skills. However, only 14% of primary care providers were applying fluoride varnish with 10% billing for this procedure. Barriers to application were time, available supplies, COVID protocols, lack of support staff, or not billing due to minimal reimbursement. Many primary care–trained PNPs were practicing in acute or subspecialty areas where prevention of ECC is not viewed as part of their focused visit. Pediatric nurse practitioners working in primary care demonstrated some clinical practice changes. However, areas for improvement are time to perform a risk assessment and application of fluoride varnish, access to these supplies, and standard billing and insurance reimbursement for these preventable services.
The effects of high-flow oxygen therapy on mortality in patients with COVID-19
Authors: Bianchi Mia
Published: February 2023

Background:

High-flow oxygen therapy (HFOT) has been successful in treating acute hypoxic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Successful treatment with noninvasive ventilation and avoidance of mechanical ventilation (MV) has been associated with decreased mortality and positive patient outcomes. It is unclear whether the evidence supports the use of HFOT to treat coronavirus disease 2019 (COVID-19)–induced AHRF and ARDS.

Objectives:

To determine whether the use of HFOT decreases the need for intubation or decreases mortality compared with MV in patients with AHRF due to COVID-19.

Data Sources:

A literature search was conducted in March 2022 using CINAHL, Embase, PubMed, and Scopus bibliographic databases. Ten studies comparing HFOT and MV in COVID-19 respiratory failure met inclusion criteria.

Conclusions:

Nine studies found a statistically significant reduction in the need for intubation; eight studies found significantly decreased morality in patients who received HFOT. Study design and methodologies limited the findings.

Implications for Practice:

Based on the available evidence, the use of HFOT positively affected mortality and incidence of the need for intubation and MV. Further research needs to be conducted before HFOT is adopted as the standard of care for COVID-19–induced AHRF and ARDS. Nurse practitioners should be informed regarding the various respiratory support modalities and evaluate risk versus benefit when caring for patients with COVID-19–induced AHRF and ARDS.
Analysis of Postoperative Outcomes and Economic Behavior Trends of Tympanoplasty and Mastoidectomy With Expansion of High Deductible Health Plans
Authors: Africa Robert E. , Westenhaver Zack K. , Zimmerer René E. , McKinnon Brian J.
Published: February 2023

Hypothesis

With rising deductibles, patients will delay ear surgeries toward the end of the year, and there will be an increase in postoperative complications.

Background

The Affordable Care Act (ACA), passed on March 23, 2010, expanded high deductible health plans. The deductible can provide support for patients with high medical costs, but high deductibles deter patients from seeking necessary preventive health care and having elective procedures. Patients may defer care toward the end of the year until the deductible is met. The purpose of this study is to evaluate the relationship between expanding high deductible health plans and the repeal of the ACA's individual mandate on December 22, 2017, with the economic behavior trends of tympanoplasty and mastoidectomy in the fiscal year and surgical outcomes.

Methods

TriNetX was used to obtain summary statistics of patients who had tympanoplasty and/or mastoidectomy from 58 health care organizations. TriNetX is a global federated database that contains de-identified patient data from the electronic medical records of participating health care institutions. This study evaluated the trends in ear surgeries from 2005 to 2021 in the fiscal quarters 1 and 4. Relative risk of developing postoperative complications was statistically interrogated.

Results

The average rate of ear surgeries measured in cases/year was higher in Quarter 4 than in Quarter 1 after the expansion of higher deductible health plans (180; 124; p < 0.0001). After the repeal of the ACA's individual mandate, the rate of ear surgeries in Quarter 4 significantly decreased compared to post-ACA (−3.7; 287; p = 0.0002). No statistically significant differences were notable in postoperative complications.

Conclusions

The expansion of high deductible health plans with a rise in deductibles is associated with an increase in ear surgeries toward the end of the year. The repeal of the ACA's individual mandate is associated with a decreased rate of ear surgeries compared to post-ACA implementation. Despite financial concern, there was no increase in postoperative complications toward the end of the year.
The Effect of Universal Newborn Hearing Screening on Spoken Language after Cochlear Implantation
Authors: Amir Ida , Thomson Ben J. , Herrod Jenny , Souter Melanie Anne , Mustard Jill , Pearson John F. , Bird Philip
Published: February 2023

Background

The universal newborn hearing screening (UNHS) was fully implemented across New Zealand by 2010 to improve outcomes for children with prelingual deafness. A previous audit undertaken by our center, the Southern Cochlear Implant Programme (SCIP), demonstrated that UNHS has significantly reduced the time to referral and surgery for cochlear implants in these children.

Aims

This study aims to evaluate the relationship between earlier implantation and language development, the time taken to achieve age-appropriate language, and the effect of socioeconomic status on language skills.

Methods

This is a retrospective cohort study comparing prelingual children with severe to profound bilateral hearing loss who underwent cochlear implantation in SCIP before and after the introduction of the UNHS. The language outcomes were assessed using the Preschool Language Scale and/or the Peabody Picture Vocabulary Test. For the purpose of our study, the standard scores of these tests were expressed as global language scores (GLS). GLSs between 85 and 115 are considered within normal range for age. The socioeconomic status was categorized based on the New Zealand Index of Deprivation (NZDep).

Results

Children in the post-UNHS group (46/95 children) were referred to SCIP and received CI at a significantly earlier age (mean = 7 vs 20 mo, p = 8.95E−10, and mean = 13 vs. 24.7 mo, p = 1.43E−07). At 2 years postimplantation, the GLS was significantly higher in the post-UNHS group (mean scores = 93.3 vs. 79.1, p = 0.0213). The scores remained statistically higher in the post-UNHS group when assessed at 3 and 4 years postimplantation. At 2, 3, and 4 years postimplantation, there is a significant linear decrease in GLS with increasing age at cochlear implantation. We found no correlation between NZDep and GLS.

Conclusion

Children identified through UNHS have the advantage of earlier diagnosis, earlier hearing intervention, and longer duration with the implants, and they can achieve age-appropriate spoken language after 2 years of implantation.
The evaluation of reactive oxygen species generation and free mitochondrial DNA in platelet concentrates during 5 days of storage
Authors: Bagheri Saeede , Samiee Shahram , Zarif Mahin Nikougoftar , Deyhim Mohammad Reza
Published: January 2023

Oxidative stress and mitochondrial damage are causes of platelet storage lesions (PSLs). Mitochondrial damage causes mitochondrial DNA (mtDNA) to be released into the extracellular space. MtDNA in platelet concentrates is considered damage-associated molecular patterns (DAMPs) and is one of the major causes of PSLs. The mechanism of mtDNA release in platelet concentrates has not been thoroughly investigated. This study aimed to determine the effect of reactive oxygen species (ROS) on mtDNA release in platelet concentrates during storage. Ten platelet concentrates from healthy donors were obtained in this investigation. Platelet concentrates were prepared by platelet-rich plasma (PRP) and stored at 22 ± 2 C° with gentle agitation. Platelet concentrates were subjected to flow cytometry and real-time PCR to evaluate total ROS and free mtDNA on days 0, 3, and 5 of platelet concentrate storage. Total ROS detected significantly increased from day 0 to day 5 of platelet concentrate storage (P = 0.0079). The mean of copy numbers of free mtDNA on day 0 increased from 3.43 × 106 ± 1.57 × 106 to 2.85 × 107 ± 1.51 × 107 (molecules/μl) on the fifth day of platelet concentrate storage, and it was statistically significant (P = 0.0039). In addition, LDH enzyme activity significantly increased during platelet concentrate storage (P < 0.0001). Also, releasing mtDNA in platelet concentrates was directly correlated with total ROS generation (P = 0.021, r = 0.61) and LDH activity (P = 0.04, r = 0.44). The evidence from this study confirmed the increasing level mtDNA copy numbers in platelet concentrates during storage, and the amount of free mtDNA is directly correlated with ROS generation and platelet lysis during 5 days of platelet concentrate storage. Finally, these changes may be related to DAMPs in the platelet concentrates.
Vaccination-Based Immunoprevention of Colorectal Tumors
Authors: Jackson Katy , Samaddar Sohini , Markiewicz Mary A. , Bansal Ajay
Published: February 2023

Colorectal cancer (CRC) continues to be a significant public health problem worldwide. CRC screening programs have reduced the incidence rates of CRCs but still suffer from the problems of missed lesions and interval cancers. Chemopreventive strategies against CRC would benefit high-risk populations but trials testing synthetic and naturally occurring compounds have not yielded a front runner. Immune mechanisms promoting cancer have been modulated to develop immunotherapy for cancer treatment that has revolutionized cancer management, but could also be applied to cancer interception, that is, cancer immunoprevention. Cancer immunoprevention refers to approaches that can enhance the immune system, either directly or by removing natural breaks such as immune checkpoints, to survey and destroy tumor cells. In this primer, we aim to explain the concepts behind vaccine-based cancer immunoprevention. Multiple cancer vaccines have been tried in advanced cancer populations, but most have failed primarily because of an immunosuppressive environment that accompanies advanced cancers. Preventive vaccines in immunocompetent hosts may have a better clinical response compared with therapeutic vaccines in immunosuppressed hosts. The first randomized controlled trial testing the mucin1 vaccine against CRC in the prevention setting has been successfully completed. For the benefit of the clinician, we briefly discuss important concepts related to the workings of preventive vaccines. Prevention with vaccines is a highly attractive approach because of the potential for highly targeted therapy with minimal side effects that could theoretically provide lifelong protection.
The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019
Authors: Lee David Uihwan , Ponder Reid , Lee Ki Jung , Yoo Ashley , Fan Gregory Hongyuan , Jung Daniel , Chou Harrison , Lee Keeseok , Hofheinz Olivia , Urrunaga Nathalie Helen
Published: February 2023

Background and aims

Hepatitis C virus (HCV) is a prominent liver disease that often presents with mental illness. We stratify the HCV population and review its healthcare burden on the US hospital system.

Methods

The US National Inpatient Sample was used to select admissions related to HCV between 2016 and 2019. Weights were assigned to discharges, and trend analyses were performed. Strata were formed across demographics, comorbidities, psychiatric and substance use conditions, and other variables. Outcomes of interest included hospitalization incidences, mortality rates, total costs, and mean per-hospitalization costs.

Results

From 2016 to 2019, there were improvements in mortality and hospitalization incidence for HCV, as well as a decline in aggregate costs across the majority of strata. Exceptions that showed cost growth included admissions with multiple psychiatric, stimulant use, or poly-substance use disorders, and a history of homelessness. Admissions with no psychiatric comorbidities, admissions with no substance use comorbidities, and admissions with housing and without HIV comorbidity showed decreasing total costs. Along with per-capita mean costs, admissions with comorbid opioid use, bipolar, or anxiety disorder showed significant increases. No significant trends in per-capita costs were found in admissions without mental illness diagnoses.

Conclusions

Most strata demonstrated decreases in hospitalization incidences and total costs surrounding HCV; however, HCV cases with mental illness diagnoses saw expenditure growth. Cost-saving mechanisms for these subgroups are warranted.
Liver stiffness-spleen diameter to platelet ratio score (LSPS model) predicts variceal rebleeding for cirrhotic patients
Authors: Wang Xixuan , Han Hao , Yang Jian , Cheng Yang , Yin Xiaochun , Gu Lihong , Xiao Jiangqiang , Wang Yi , Zou Xiaoping , Wang Lei , Zhang Ming , Zhuge Yuzheng , Zhang Feng
Published: January 2023

Purpose

The liver stiffness- spleen diameter to platelet ratio score (LSPS model) can identify a high risk of decompensated events in cirrhotic patients. We aimed to evaluate the value of the LSPS model as a risk stratification strategy in the secondary prevention for cirrhotic patients with esophageal and gastric variceal bleeding (EGVB).

Methods

Consecutive EGVB patients who underwent liver stiffness measurement by acoustic radiation force impulse, platelet count and ultrasonography were enrolled between January 2013 and December 2019. We calculated the LSPS of all patients and followed up for over 2 years. The primary outcome was rebleeding. Transplant-free survival and overt hepatic encephalopathy (OHE) were the secondary outcomes.

Results

A total of 131 patients were analyzed. The median value of the LSPS model is 0.1879. We developed risk stratification based on the LSPS model and divided the patients into two groups: the high-LSPS (LSPS > 0.1879) group and the low-LSPS (LSPS ≤ 0.1879) group. Sixty-two (47.33%) patients suffered rebleeding, in which there were 21 (31.92%) patients with low LSPS and 41 (63.08%) patients with high LSPS (hazard ratio 2.883; 95% confidence interval, 1.723–4.822, P < 0.001). For the whole cohort, the rates of transplant-free survival and OHE were consistently similar between the two groups at 2 years.

Conclusion

The LSPS is a reliable, noninvasive method for the detection of a high risk of rebleeding for the secondary prevention of EGVB.
The fifth edition of the World Health Organization Classification and the International Consensus Classification of myeloid neoplasms: evolving guidelines in the molecular era with practical implications
Authors: Zheng Gang , Li Peng , Zhang Xiaohui , Pan Zenggang
Published: February 2023

Purpose of review

There have been major advances in our understanding of molecular pathogenesis of myeloid neoplasms, which prompt the updates in the classification of myeloid neoplasms in the fifth edition of World Health Organization Classification (WHO-5) and the new International Consensus Classification (ICC). The purpose of this review is to provide an overview of these two classification systems for myeloid neoplasms.

Recent findings

The definition, classification, and diagnostic criteria in many myeloid entities have been refined in WHO-5 and ICC with improved understanding of morphology and integration of new genetic findings. Particularly, molecular and cytogenetic studies have been increasingly incorporated into the classification, risk stratification, and selection of therapy of myeloid neoplasms. Overall, despite some revisions and discrepancies between WHO-5 and ICC, the major categories of myeloid neoplasms remain the same. Further validation studies are warranted to fine-tune and, ideally, integrate these two classifications.

Integration of clinical information, laboratory parameters, morphologic features, and cytogenetic and molecular studies is essential for the classification of myeloid neoplasms, as recommended by both WHO-5 and ICC.
VEXAS: where do we stand 2 years later?
Authors: Sujobert Pierre , Heiblig Maël , Jamilloux Yvan
Published: February 2023

Purpose of review

Two years after the recognition of VEXAS (for Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, we propose an extensive review of the current understanding of VEXAS pathophysiology and therapeutic options.

Recent findings

Among the nearly 150 articles published about VEXAS, some have provided determinant insights into VEXAS pathophysiology and treatment. Clinical data from retrospective series support the JAK inhibitor ruxolitinib as the most efficient strategy to control inflammation, and interesting results were also described with azacytidine. Allogeneic stem cell transplantation remains the only curative option, but should be proposed to carefully selected patients.

Although waiting for more robust evidence from prospective clinical trials, therapeutic options emerge from retrospective studies. We propose a set of criteria that should be systematically reported to harmonize the evaluation of therapeutic outcomes. This will allow the collection of high-quality data and facilitate their subsequent meta-analysis with the overall aim of improving the management of VEXAS patients.
Molecular landscape of myelodysplastic neoplasms in disease classification and prognostication
Authors: Maggioni Giulia , Della Porta Matteo G.
Published: February 2023

Purpose of review

The aim of this review is to provide a complete perspective of the evidence that led to the three recent new landmarks of myelodysplastic syndromes (MDS) definition and prognostication: the WHO 2022 and International Consensus Classification (ICC) 2022 classification and the Molecular Intermational Prognostic Scoring System (IPSS-M) score.

Recent findings

The molecular founding lesions of MDS are strongly linked with disease phenotype and prognosis, therefore the genetic assessment have become part of MDS classifications and prognostication.

The WHO 2022 now recognizes the class ‘MDS with defining genetic abnormalities’. It includes ‘MDS with SF3B1 mutation’, and ‘MDS with biallelic TP53 inactivation’. The ICC 2022 further introduces the category ‘MDS/acute myeloid leukemia (AML)’ emphasizing the biological continuum existing between the diseases, with the aim to expand therapeutic possibilities for MDS patients with more than 10% of blasts; it further identifies 9 MDS-funding lesions, defying the ‘MDS/AML with myelodysplasia-related gene mutations’ class. In recent years, many efforts have been done in order to specify and weight the role of mutations in disease prognostication; the IPSS-M proposed in 2022 finally integrates the molecular profile of the disease with the clinical and cytogenetic data, providing a better prognostication at patient level compared to IPSS-R.
Navigating the marrow sea towards erythromyeloblastic islands under normal and inflammatory conditions
Authors: Josselsohn Rachel , Barnes Betsy J. , Kalfa Theodosia A. , Blanc Lionel
Published: January 2023

Purpose of review

Terminal erythroid differentiation occurs in specialized niches called erythroblastic islands. Since their discovery in 1958, these niches have been described as a central macrophage surrounded by differentiating erythroblasts. Here, we review the recent advances made in the characterization of these islands and the role they could play in anaemia of inflammation.

Recent findings

The utilization of multispectral imaging flow cytometry (flow cytometry with microscopy) has enabled for a more precise characterization of the niche that revealed the presence of maturing granulocytes in close contact with the central macrophage. These erythromyeloblastic islands (EMBIs) can adapt depending on the peripheral needs. Indeed, during inflammation wherein inflammatory cytokines limit erythropoiesis and promote granulopoiesis, EMBIs present altered structures with increased maturing granulocytes and decreased erythroid precursors.

Regulation of the structure and function of the EMBI in the bone marrow emerges as a potential player in the pathophysiology of acute and chronic inflammation and its associated anaemia.
Hemostasis in endoscopic sinus and skull base surgery
Authors: Vuncannon Jackson R. , Wise Sarah K.
Published: February 2023

Purpose of review

Bleeding during endoscopic endonasal procedures can quickly obscure critical anatomic landmarks. This increases both the difficulty of the surgical procedure and the risk of complications faced by the patient. As the indications for surgical management of sinonasal pathology grow, it is important to review techniques to minimize bleeding and facilitate safe surgery.

Recent Findings

Evidence continues to accumulate for best practices in the surgical management of sinonasal disease. Recently, international guidelines have attempted to summarize this body of evidence, lending further support to several interventions which have been advocated as methods to decrease bleeding during endoscopic endonasal surgery. Additional studies have specifically investigated the safety of certain commonly employed techniques. The utility of preoperative corticosteroid therapy and the use of total intravenous anesthetic techniques in increasingly validated. Further evidence supports the safety of reverse Trendelenburg positioning for surgical management of inflammatory disease.

Recent wide scale systematic review of the literature regarding perioperative and intraoperative management of hemostasis has reinforced the utility of certain interventions, while others remain ambiguous.
The link between allergic rhinitis and chronic rhinosinusitis
Authors: Grimm David , Hwang Peter H. , Lin Yi-Tsen
Published: February 2023

Purpose of review

Allergic rhinitis and chronic rhinosinusitis (CRS) are common disorders affecting millions of people worldwide. Although allergic rhinitis and CRS are distinct clinical entities, certain CRS endotypes share similar pathological mechanisms as those seen in patients with allergic rhinitis. This review assesses the literature behind the similarities and differences seen in patients with CRS and allergic rhinitis, and the role atopy might play in the pathophysiology of CRS.

Recent findings

In examining the associations between allergic rhinitis and CRS, most studies have focused primarily on CRS with nasal polyps and type 2 inflammation in CRS. Recent studies have demonstrated the similarities and differences in pathologic mechanisms behind allergic rhinitis and CRS, with an emphasis on patient endotypes, genetics, and the nasoepithelial immunologic barrier. Related immunopathology shared by allergic rhinitis and type 2 inflammation in CRS has allowed for therapeutic overlap with biologic treatments.

Allergic rhinitis and CRS often present as comorbid conditions, and understanding the relationship between allergic rhinitis and CRS is important when considering treatment options. Advances in understanding the genetics and immunology, as well as biologic and immunotherapeutic treatments have improved outcomes in patients with CRS, especially in the setting of atopy.
Current methods facilitating diagnosis of upper tract urothelial carcinoma: a comprehensive literature review
Authors: Krajewski Wojciech , Łaszkiewicz Jan , Nowak Łukasz , Szydełko Tomasz
Published: February 2023

Purpose of review

Currently, kidney-sparing surgeries are considered the preferred approach in low-risk tumours and in selected high-risk patients. Therefore, accurate diagnosis of UTUC is crucial for further management. The purpose of this review is to summarize available methods facilitating the diagnosis of upper tract urothelial carcinoma (UTUC).

Recent findings

Recent articles propose numerous techniques of UTUC diagnosis. In this review, imaging, as well as, urine-based and endoscopic methods have been described and assessed.

Regarding imaging, computed tomography urography remains a gold standard, while PET is superior in search for small lesions and nodal metastases. However, contrast-enhanced ultrasonography also shows promise. On the contrary, available urine tests, such as urinary cytology, fluorescent in-situ hybridization, Xpert, DNA methylation analysis, urine-based liquid biopsy, p16/Ki-67 dual immunolabelling, ImmunoCyt and NMP22 are either poorly researched, or not accurate enough to use solely. Finally, during ureterorenoscopy, photodynamic diagnosis and narrow-band imaging can facilitate proper visualization of the tumor. Endoluminal ultrasonography and confocal laser endomicroscopy can potentially improve staging and grading of UTUC. Also, the ‘form tackle’ biopsy should be performed using a basket in papillary lesions and cold-cup biopsy of flat or sessile lesions. Even though cryobiopsy shows promise in UTUC diagnosis, in-vivo studies are necessary before it is introduced into clinical practice.
Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
Authors: Ambartsumyan Lusine , Patel Dhiren , Kapavarapu Prasanna , Medina-Centeno Ricardo A. , El-Chammas Khalil , Khlevner Julie , Levitt Marc , Darbari Anil
Published: January 2023

Children with Hirschsprung disease have postoperative long-term sequelae in defecation that contribute to morbidity and mortality and significantly impact their quality of life. Pediatric patients experience ongoing long-term defecation concerns, which can include fecal incontinence (FI) and postoperative obstructive symptoms, such as constipation and Hirschsprung-associated enterocolitis. The American Pediatric Surgical Association has developed guidelines for management of these postoperative obstructive symptoms and FI. However, the evaluation and management of patients with postoperative defecation problems varies among different pediatric gastroenterology centers. This position paper from the Neurogastroenterology & Motility Committee of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition reviews the current evidence and provides suggestions for the evaluation and management of postoperative patients with Hirschsprung disease who present with persistent defecation problems.
Cord Blood Transplantation in 2 Infants Presenting Monosomy 7 Clonal Hematopoiesis: SAMD9/SAMD9L Germline Mutation
Authors: Hirai Maiko , Yagasaki Hiroshi , Kanezawa Koji , Ueno Masaru , Shimozawa Katsuyoshi , Imai Kohsuke , Morio Tomohiro , Kato Motohiro , Gocho Yoshihiro , Narumi Satoshi , Ebihara Yasuhiro , Morioka Ichiro
Published: February 2023

Recently, germline mutations in SAMD9 and SAMD9L were increasingly found in children with monosomy 7. We report the outcomes in 2 infants with the SAMD9/SAMD9L variant, who presented with anemia and thrombocytopenia (patient 1), and neutropenia and nonsymptomatic white-matter-encephalopathy (patient 2). Both patients received cord blood transplantation and experienced critical post–cord blood transplantation adverse events; patients 1 and 2 developed fulminant engraftment syndrome and life-threatening graft-versus-host disease, respectively. Of note, selective loss of chromosome 7 in bone marrow–derived CD34+ cells was inferred.
Prolonged Elevations of Factor VIII and von Willebrand Factor Antigen After Multisystem Inflammatory Syndrome in Children
Authors: Boucher Alexander A. , Knutson Stacie , Young Luke , Evans Michael D. , Braunlin Elizabeth , Zantek Nicole D. , Sharon Bazak , Binstadt Bryce A. , Ryan Meghan , Greene Ryan , Mahmud Shawn , Marmet Jordan , Fischer Gwenyth , Steiner Marie E.
Published: February 2023

Multisystem Inflammatory Syndrome in Children (MIS-C) is a late systemic inflammatory response to a recent mild or asymptomatic coronavirus disease of 2019 infection. The pathophysiology is incompletely understood but it often features significant coagulopathy along with cardiac and endothelial dysfunction. Endothelial inflammation has been primarily described in acute coronavirus disease of 2019 infection, with less characterization in MIS-C. Here we describe novel findings of nearly universal severe and prolonged factor VIII (FVIII) and von Willebrand factor antigen elevations in an institutional cohort of patients with MIS-C ages younger than or 21 years old (N=31). All patients had elevated acute phase reactants and D-dimer at presentation and met published criteria for MIS-C. FVIII was high at presentation in 97% of patients but continued to rise during the ensuing weeks of treatment to a mean 429%, peaking on median day 17 of illness as an outpatient. FVIII levels were >600% in multiple patients. von Willebrand factor antigen was measured less frequently but showed similar trends. These escalations occurred amidst resolving cardiac dysfunction and acute phase reactant normalization and despite patients receiving multimodal anti-inflammatory treatments and aspirin and enoxaparin thromboprophylaxis. No thrombotic events occurred. Endothelial dysfunction represented by very elevated FVIII levels may persist longer than other acute phase reactants may reflect.
Patterns of Extraneural Metastases in Children With Ependymoma
Authors: Chan Priya P. , Whipple Nicholas S. , Ramani Biswarathan , Solomon David A. , Zhou Holly , Linscott Luke L. , Kestle John R.W. , Bruggers Carol S.
Published: February 2023

Ependymomas account for 10% of all malignant pediatric central nervous system tumors. Standard therapy includes maximal safe surgical resection, followed by focal radiation. Despite the aggressive therapy, progression-free survival is poor. Most ependymoma relapses occur locally at the original tumor site. Extraneural presentations of ependymoma are extremely rare, and no standard of care treatment exists. We present a single-institution case series of 3 patients who experienced extraneural relapses of supratentorial ependymoma and describe their treatment and outcome. These cases of extraneural relapse highlight the possible modes of extraneural spread, including hematogenous, lymphatic, and microscopic seeding through surgical drains and shunts. In addition, they illustrate the increase in histologic grade and mutational burden that may occur at the time of relapse. These cases illustrate the role of aggressive, individualized treatment interventions using a combination of surgery, radiation, and chemotherapy.
Success of Trametinib in the Treatment of Langerhans Cell Histiocytosis With Novel MAPK Pathway Mutations
Authors: Orr Kaci , Hustak Samantha , Beaudoin Rebecca , Ray Anish
Published: February 2023

Approximately a third of patients with Langerhans cell histiocytosis (LCH) experience recurrence of disease. Genomic analysis has revealed that this condition is often driven by oncogenic mutations in the MAP kinase (MAPK) pathway, and agents that target components of this pathway have been explored as a second-line treatment for LCH. Here, we examine 2 pediatric patients with LCH and confirmed but rarely reported MAPK pathway mutations treated with trametinib, a MAP2K inhibitor approved to treat several cancers with a BRAF
V600E mutation. Each patient achieved or maintained complete resolution of disease and remain on the drug with no adverse effects.
Thirteen Nonpharmacological Interventions for Increasing the Quality of Life in Patients with Advanced Cancer
Authors: Tang Ying , Wang YuYang , Tian JinHui , Zhou ShuRong
Published: February 2023

Background

A variety of nonpharmacological interventions that improve the quality of life of patients with advanced cancer have been difficult for medical staff to select through randomized controlled trials or traditional meta-analyses. Thus, a network meta-analysis is necessary.

Objective

This study used network meta-analysis to analyze the effect of 13 different nonpharmacological interventions on improving the living quality of patients with advanced cancer.

Methods

Five English databases were searched up to January 2019. The search strategy only included terms relating to or describing the intervention.

Results

The study included 13 different nonpharmacological interventions. The overall efficacy was summarized through a holistic study of quality of life. The study found that the combined effect sizes of 13 nonpharmacological interventions crossed the invalid line (weighted mean difference, −13 [95% confidence interval, −33 to 8.5] to 1.7 [95% confidence interval, −18 to 22]), indicating that none of the intervention was significantly different from each other. By evaluating the heterogeneity of this outcome, no significant evidence of heterogeneity (P > .05) was observed. Probability ranking according to the surface under the cumulative ranking curve showed that there was a great possibility for the CanWalk intervention and structured multidisciplinary intervention to improve outcomes for cancer patients.

Conclusions

Thirteen nonpharmacological interventions did not significantly impact quality of life. Regarding the probability rank, CanWalk intervention may be the most promising way that advanced cancer patients can help themselves to a better life. Because of the limitations of the current studies, the conclusion needs further evidence.

Implications for Practice

Nurses should consider recommending moderate physical activity for patients with advanced cancer.
Patient-Family Caregiver Concordance of Symptom Assessment for Esophageal Cancer Patients Undergoing Esophagectomy
Authors: Chen Yu-qing , Zhong Jiu-di , Hong Yu-tong , Yuan Juan , Zhang Jun-e
Published: February 2023

Background

Esophageal cancer patients suffer from multiple and severe symptoms during the postoperative recovery period. Family caregivers play a vital role in assisting patients to cope with their symptoms.

Objective

To examine the concordance of esophageal cancer patients and their caregivers on assessing patients’ symptoms after surgery and identify predictors associated with the symptom concordance.

Methods

In this cross-sectional study, 213 patient-caregiver dyads completed general information questionnaires, the Memorial Symptom Assessment Scale, the Depression Subscale of Hospital Anxiety and Depression Scale, the Mutuality Scale, and the Zarit Burden Interview (for caregivers). Data were analyzed using intraclass correlation coefficients, paired t tests, and binary logistic regression.

Results

At the dyad level, agreement of patients’ and caregivers’ reported symptoms ranged from poor to fair. At the group level, patients reported significantly higher scores than caregivers in most symptoms. Of the 213 dyads, 119 (55.9%) were identified as concordant on symptom assessment. Patients’ nasogastric tube, perceived mutuality, caregivers’ educational background, and dyad’s communication frequency with each other could predict their concordance of symptom assessment.

Conclusions

There were relatively low agreements between esophageal cancer patients and caregivers on assessing patients’ symptoms, and caregivers tended to underestimate patients’ symptoms. The dyad’s symptom concordance was influenced by patient-, caregiver-, and dyad-related factors.

Implications for Practice

Having an awareness of the incongruence on assessing symptoms between esophageal cancer patients and caregivers may help healthcare professionals to comprehensively interpret patients’ symptoms and develop targeted dyadic interventions to improve their concordance, contributing to optimal symptom management and health outcomes.