bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of allocative efficiency on grape farming (Vitis vinifera) in Alue Sijuek, Peudada district, Bireuen regency
Authors: Zuhra F , Pratiwi H , Sutoyo S
Published: June 2023

The purpose of this study was to determine the efficiency of grape farming allocation and how the relationship between production costs and income of grape farmers in Alue Sijuek Village, Peudada District, Bireuen Regency from January to June 2022. Responden were carried out by census. The survey was conducted by direct observation and interviews with 36 respondents of grape farmers. The results showed that the income of grape farmers in Alue Sijuek Village, Peudada District, Bireuen Regency was IDR 2.177.765.666,67 in year-1 with an average of IDR 60.493.490,74 in year-1 and allocative efficiency of 36 respondents achieved efficient income for costs of fertilizers, pesticides, depreciation of equipment and labor. The results of the analysis show the correlation coefficient value of 0.935, this indicates that there is a significant relationship between production costs and wine farmers' income. While the coefficient of determination shows a number of 0.875, which means that the production cost consisting of fertilizer, pesticide, labor and equipment depreciation affects farm income by 87.5% and the rest is influenced by other variables.
Study of ethnobotany as herbal plant in Aceh Besar District, Aceh Province
Authors: Fadhilah F , Gagarin Y , Abdullah A , Suhairi L , Hamid Y H
Published: June 2023

Plants in Aceh Besar District are used as medicine, food and other consumer goods. Efforts to disseminate knowledge and use of medicinal plants are things that need to be done. One of the jobs that must be done before spreading the use of medicinal plants is by introducing them to the community. The purpose of the study was to determine the species of medicinal plants based on the parts of the plant organs used by the community and to determine the utilization and use of medicinal plants by the people of Aceh Besar district. Exploratory survey data collection methods and Participatory Rural Appraisal methods. Analysis of the data obtained was carried out descriptively with a quantitative approach. The results showed that the most widely used plant parts were the leaves and shoots (20.7%), while the plant organs that were the least utilized by the community were the bark and tubers (5.7%). The people of Aceh Besar District use medicinal plants by boiling, mashing, eating, squeezing, smearing, burning and slicing before serving. The people of Aceh Besar Regency are included in the community group that uses medicinal plants on a family scale.
The Application of Bacillus thuringiensis to Treat Root Knots on Pogostemon cablin Benth
Authors: Chamzurni T , Savira I M , Oktarina H
Published: June 2023

Root knots, caused by Meloidogyne spp. is among the plant pathogens that lead to significant yield loss in patchouli plants. Farmers have used synthetic nematicides to control the pathogen for many years. In fact, the chemicals not only harm the environment but also might degrade quality of agriculture products. Therefore, in this study, we examined several dosages of Bacillus thuringiensis (Bt) to control Meloidogyne spp. on Pogostemon cablin Benth. Three dosages of Bt suspension (30, 40, and 50 ml/plant) were applied to the rhizosphere to observe the incubation period, disease intensity, number of galls, and the population of nematode. The results show that 40 ml/plant of Bt significantly prolongs the incubation time, reduces the disease intensity, and the number of root-knots. None of the dosages tested showed a significant impact on the nematode population. This study showcases the potential of Bt to control Meloidogyne spp. on patchouli plants. More research is required to confirm the efficacy of this approach.
The dynamics of changes in soil temperature due to the application of rice straw mulch on lettuce (Lactuca sativa L.)
Authors: Pratama R R , Zaitun Z , Erika C , Ikhsan I
Published: June 2023

Climate change that occurs globally in agriculture causes fail crops production, causing losses for farmers. This loss can be minimized by using rice straw mulch to reduce soil temperature and protect the soil from direct solar radiation on lettuce land. This study will examine whether treatment with rice straw mulch can affect soil temperature in lettuce land. The research was conducted at Nudira Fresh Green House PT. Nudira Sumber Daya Indonesia, Warnasari Village, Pangalengan Subdistrict, Bandung District, West Java. This research was conducted from March 1, 2022 to August 31, 2022. The data of this study used a factorial 4 x 2 Randomized Block Design with 3 replications. Factor I was the thickness of rice straw mulch 0 t ha−
1 (R0), 4 t ha−1 or 0.48 kg plot−1 (R1), 6 t ha−1 or 0.72 kg plot−1 (R2), and 8 t ha−1 or 0.96 kg plot−1 (R3) and factor II was the dose of cow manure (F1) and compost (F2) each 20 t ha−1 or 2.4 kg plot−1. The results showed that the application of rice straw mulch with the organic fertilizer has not significant effect on soil temperature in lettuce land. However, the application of rice straw mulch at a dose of 8 t ha−1 slightly better results in decreasing soil surface temperature at a depth of 0 cm, although not significantly different.
Analysis of Identification of Food Commodity Farmers’ Needs in utilizing Smart Farming Technology
Authors: Agussabti A , Rahmaddiansyah R , Farabi A Z , Munawar A A , Bagio B
Published: June 2023

Smart farming technology (SFT) is currently widely used by farmers around the world. Especially in Asia, the use of SFT is increasing. Before introducing SFT to farmers, it is necessary to research what kind of technology farmers need based on the commodities they cultivate. The research objectives are: (1) To find out the interest in the types of Smart Farming technology (SFT) for food commodity farmers in Aceh Province; and (2) To identify differences in interest between types of Smart Farming (SFT) technology by food commodity farmers in Aceh Province. This research was conducted in 2 districts of Aceh province, namely Bener Meriah and North Aceh. The research was carried out in January 2022. The method of determining the sample in this study uses a non-probability sampling method with quota sampling as a sampling technique. This study uses descriptive statistical methods, cross tabulation test analysis and the Kruskal Wallis test. The result is interest of food commodity farmers for each type of SFT is very varied. Corn and potato farmers are interested in 3 types of SFT Autonomous Machines, Recording/Mapping and FMIS/Apps. Paddy farmers are interested in 4 types of SFT, namely Autonomous Machines, Recording/Mapping, Tractor GPS/Connected Tools, and FMIS/Apps. The SFT in demand has significant differences for each food commodity farmer, such as Recording/Mapping and Tractor GPS/Connected Tools. For Autonomous Machines and FMIS/Apps, there are no significant differences in the interest of each food commodity farmer.
Blood flow characterization in nailfold capillary using optical flow-assisted two-stream network and spatial-temporal image
Authors: Chen Shupin , Wei Dan , Gu Shenming , Yang Zhangru
Published: June 2023

The blood flow velocity in the nailfold capillary is an important indicator of the status of microcirculation. The conventional manual processing method is both laborious and prone to human artifacts. A feasible way to solve this problem is to use machine learning to assist in image processing and diagnosis. Inspired by the Two-Stream Convolutional Networks, this study proposes an optical flow-assisted two-stream network to segment nailfold blood vessels. Firstly, we use U-Net as the spatial flow network and the dense optical flow as the temporal stream. The results show that the optical flow information can effectively improve the integrity of the segmentation of blood vessels. The overall accuracy is 94.01 %, the Dice score is 0.8099, the IoU score is 0.6806, and the VOE score is 0.3194. Secondly, The flow velocity of the segmented blood vessel is determined by constructing the spatial-temporal (ST) image. The blood flow velocity evaluated is consistent with the typical blood flow speed reported. This study proposes a novel two-stream network for blood vessel segmentation of nailfold capillary images. Combined with ST image and line detection method, it provides an effective workflow for measuring the blood flow velocity of nailfold capillaries.
Intramolecular proton transfer reaction dynamics using machine-learned ab initio potential energy surfaces
Authors: Raghunathan Shampa , Kashyap Nakirikanti Sai Ajay
Published: June 2023

Hydrogen bonding interactions, which are central to various physicochemical processes, are investigated in the present study using ab initio-based machine learning potential energy surfaces. Abnormally strong intramolecular O–H⋯O hydrogen bonds, occurring in β-diketone enols of malonaldehyde and its derivatives, with substituents ranging from various electron-withdrawing to electron-donating functional groups, are studied. Machine learning force fields were constructed using a kernel-based force learning model employing ab initio molecular dynamics reference data. These models were used for molecular dynamics simulations at finite temperature, and dynamical properties were determined by computing proton transfer free-energy surfaces. The chemical systems studied here show progression toward barrier-less proton transfer events at an accuracy of correlated electronic structure methods. Markov state models of the conformational states indicate shorter intramolecular hydrogen bonds exhibiting higher proton transfer rates. We demonstrate how functional group substitution can modulate the strength of intramolecular hydrogen bonds by studying the thermodynamic and kinetic properties.
Comprehensive mobility study of silicon nanowire transistors using multi-subband models
Authors: Medina-Bailon Cristina , Nedjalkov Mihail , Georgiev Vihar , Selberherr Siegfried , Asenov Asen
Published: June 2023

Spatial confinement is important in advanced More Moore devices, such as nanowire transistors (NWTs), where the basic charge transport properties must be revised beyond the bulk crystal assumptions. This work presents a comprehensive and general overview of the electron mobility in aggressively-scaled Si NWTs in order to demonstrate the effect of quantum confinement on this topic, establishing its dependence on numerous physical factors (shape, diameter, and orientation). The mobility evaluation makes use of a unique simulation framework and innovative multi-subband calculations of the scattering rates. We show that (1) the effect of surface roughness scattering is more pronounced at higher sheet densities, (2) ionized impurity scattering seriously degrades the mobility in highly-doped NWTs, and (3) the cross-section shape affects directly the subband parameters and the mobility, with the elliptical NWTs giving the best performance for the same cross-sectional area.
Genome Resource for Stemphylium beticola, One of the Causal Agents of Stemphylium Leaf Spot of Spinach (Spinacia oleracea)
Authors: Spawton K. A. , Peever T. L. , du Toit L. J.
Published: June 2023

Stemphylium leaf spot of spinach, caused by the seedborne fungi Stemphylium beticola and S. vesicarium, affects spinach grown for processing, fresh markets, and seed. Genomes of S. vesicarium, but not S. beticola, have been published. DNA was extracted from two isolates of S. beticola, St0030 and St1145, and used for Illumina sequencing to generate draft genome assemblies. This is the first reported genome sequence of S. beticola, which will provide a resource for population studies and development of molecular tools to differentiate S. beticola from other Stemphylium species infecting spinach leaves and seed. Additionally, these genomes will be useful for comparative genomic studies of other plant-pathogenic and non-pathogenic Stemphylium species.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Epoprostenol Exposure During Pregnancy
Authors: Naoum Emily E. , LaVita Carolyn , Lopez Natasha , Nardone Alexa , Soffer Marti D. , Shelton Kenneth T.
Published: June 2023

Institutional policies restricting pregnant providers from caring for patients receiving inhaled epoprostenol exist across the nation based on little to no data to substantiate this practice. Over the last 2 decades, the use of inhaled pulmonary vasodilators has expanded in patients with cardiac and respiratory disease providing more evidence for the safety of these medications in obstetrical patients. We propose a thoughtful consideration and review of the literature to remove this restriction to reduce the need to reveal early pregnancy status to employers, to alleviate undue stress for pregnant caregivers who are exposed to patients receiving epoprostenol, and to ensure safe, equal employment, and learning opportunities for pregnant providers.
Efficacy and Safety of Ciprofol Sedation in ICU Patients Undergoing Mechanical Ventilation: A Multicenter, Single-Blind, Randomized, Noninferiority Trial
Authors: Liu Yongjun , Peng Zhiyong , Liu Songqiao , Yu Xiangyou , Zhu Duming , Zhang Linlin , Wen Jianli , An Youzhong , Zhan Liying , Wang Xiaochuang , Kang Yan , Pan Aijun , Yan Jing , Zhang Lina , Liu Fengming , Zeng Jun , Lin Qinhan , Sun Renhua , Yu Jiangquan , Wang Huaxue , Yao Li , Chen Chuanxi , Liu Ning , Nie Yao , Lyu Jie , Wu Kun , Wu Jianfeng , Liu Xiao , Guan Xiangdong
Published: June 2023

OBJECTIVES:

To determine the effectiveness and safety of ciprofol for sedating patients in ICUs who required mechanical ventilation (MV).

DESIGN:

A multicenter, single-blind, randomized, noninferiority trial.

SETTING:

Twenty-one centers across China from December 2020 to June 2021.

PATIENTS:

A total of 135 ICU patients 18 to 80 years old with endotracheal intubation and undergoing MV, who were expected to require sedation for 6–24 hours.

INTERVENTIONS:

One hundred thirty-five ICU patients were randomly allocated into ciprofol (n = 90) and propofol (n = 45) groups in a 2:1 ratio. Ciprofol or propofol were IV infused at loading doses of 0.1 mg/kg or 0.5 mg/kg, respectively, over 4 minutes ± 30 seconds depending on the physical condition of each patient. Ciprofol or propofol were then immediately administered at an initial maintenance dose of 0.3 mg/kg/hr or 1.5 mg/kg/hr, to achieve the target sedation range of Richmond Agitation-Sedation Scale (+1 to –2). Besides, continuous IV remifentanil analgesia was administered (loading dose: 0.5–1 μg/kg, maintenance dose: 0.02–0.15 μg/kg/min).

MEASUREMENTS AND MAIN RESULTS:

Of the 135 patients enrolled, 129 completed the study. The primary endpoint-sedation success rates of ciprofol and propofol groups were 97.7% versus 97.8% in the full analysis set (FAS) and were both 100% in per-protocol set (PPS). The noninferiority margin was set as 8% and confirmed with a lower limit of two-sided 95% CI for the inter-group difference of –5.98% and –4.32% in the FAS and PPS groups. Patients who received ciprofol had a longer recovery time (p = 0.003), but there were no differences in the remaining secondary endpoints (all p > 0.05). The occurrence rates of treatment-emergent adverse events (TEAEs) or drug-related TEAEs were not significantly different between the groups (all p > 0.05).

CONCLUSIONS:

Ciprofol was well tolerated, with a noninferior sedation profile to propofol in Chinese ICU patients undergoing MV for a period of 6–24 hours.
Assessment of lipid and pigment content in suspicious melanocytic lesions to improve melanoma detection
Authors: Amara Shivkar V. , Grbic Nicole , Melson Gabriella , Brem Candice E. , Almier Nedaa , Bhawan Jag , Alani Rhoda M. , Collard Marianne
Published: June 2023

Melanoma is a highly aggressive form of skin cancer and the most frequent lethal malignancy diagnosed by dermatologists. Although there have been advances for predicting melanoma prognosis, there are few highly sensitive and specific diagnostic tools for clinically evaluating suspicious melanocytic lesions prior to biopsy. We have recently determined that alterations in cellular lipid and pigment content are associated with tumor progression and melanoma metastasis. Here, we seek to determine if lipid droplet and pigment content assessments near the skin’s surface are able to distinguish benign from malignant melanocytic lesions. We obtained 14 benign melanocytic lesions, classified as Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) class 1, and 22 malignant melanomas, classified as MPATH-Dx class 4 or 5, from Boston Medical Center. The malignant melanomas had an average greatest thickness of 1.8 ± 2.1 mm with 7/22 biopsies showing the presence of ulceration. Tissues were stained with the Fontana Masson stain to detect pigment or immunohistochemically stained for adipophilin, the main protein component of lipid droplets, to detect lipid droplets. Pigment and lipid droplets were quantified using ImageJ and CellProfiler, respectively. We found no significant difference in total pigment area between benign melanocytic lesions and malignant melanoma, and a 66% decrease in lipid content and 68% reduction in lipid/pigment content between benign melanocytic lesions and malignant melanoma (P < 0.05). Our results suggest that lipid content and lipid/pigment content ratios may distinguish benign and malignant melanocytic lesions, which may be useful as a diagnostic tool for histopathologically challenging pigmented lesions.
Demodex Blepharitis: A Comprehensive Review of the Disease, Current Management, and Emerging Therapies
Authors: Rhee Michelle K. , Yeu Elizabeth , Barnett Melissa , Rapuano Christopher J. , Dhaliwal Deepinder K. , Nichols Kelly K. , Karpecki Paul , Mah Francis S. , Chan Arthur , Mun James , Gaddie Ian Benjamin
Published: June 2023

Demodex blepharitis is a common disease of the eyelid, affecting approximately 25 million Americans. This article reviews what is known about the mechanisms and impact of Demodex blepharitis, risk factors, signs and symptoms, diagnostic techniques, current management options, and emerging treatments. Demodex mites contribute to blepharitis in several ways: direct mechanical damage, as a vector for bacteria, and by inducing hypersensitivity and inflammation. Risk factors for Demodex blepharitis include increasing age, rosacea, and diabetes. The costs, symptom burden, and psychosocial effects of Demodex blepharitis are considerable. The presence of collarettes is pathognomonic for Demodex blepharitis. Redness, dryness, discomfort, foreign body sensation, lash anomalies, and itching are also hallmarks of the disease. Although a number of oral, topical, eyelid hygiene and device-based options have been used clinically and evaluated in studies for the management of Demodex blepharitis, none have been FDA approved to treat the disease. Recent randomized controlled clinical trials suggest that lotilaner ophthalmic solution, 0.25%, is a topical treatment with the potential to eradicate Demodex mites and eliminate collarettes and eyelid redness for an extended period.
Impact of Scleral Lens Front Surface Eccentricity on Visual Acuity, Contrast Sensitivity, and Higher-Order Aberrations in Eyes With Keratoconus
Authors: Badrinarayanan Aparna , Balakrishnan Akshaya C. , Dutta Ronit , Kumar R. Mahesh , Iqbal Asif
Published: June 2023

Purpose:

To investigate the effect of front surface eccentricity (FSE) of scleral lenses (SLs) on corrected distance visual acuity (CDVA), contrast sensitivity (CS), and higher-order aberrations (HOAs) in keratoconic eyes.

Methods:

Fifteen keratoconic eyes fitted with BostonSight SCLERAL lenses of different eccentricity values (FSE0=0, FSE1=0.30, and FSE2=0.60). CDVA, CS, and HOAs were measured at baseline and after 30 min of SL wear. CDVA and CS were measured with the Early Treatment Diabetic Retinopathy Study and Pelli–Robson chart, respectively, and iTrace aberrometer was used to evaluate the HOAs.

Results:

Baseline CDVA was 0.30±0.29, which significantly improved to 0.10±0.11, 0.05±0.06, and 0.05±0.08 logMAR with FSE0, FSE1, and FSE2, respectively (P<0.05). The post hoc showed no significant difference between eccentricities. Baseline CS was 1.19±0.47, which improved to 1.54±0.12, 1.59±0.10, and 1.60±0.11 with FSE0, FSE1, and FSE2, respectively (P<0.01), but post hoc showed no significant difference between eccentricities. A statistically significant reduction was found in HOAs when compared with baseline (P<0.01). Comparison between eccentricities showed a significant difference only between FSE0 and FSE1 for RMS coma (P=0.01) and RMS spherical aberrations (P=0.004) where FSE1 showed better performance in reducing HOAs compared with FSE0. HO-RMS, RMS secondary astigmatism, and RMS trefoil showed no significant difference between eccentricities, but FSE1 and FSE2 performed superior to FSE0.

Conclusion:

BostonSight SCLERAL lenses with varying eccentricities corrected a significant amount of HOAs and improved CDVA and CS in keratoconus patients. Practitioners should be aware of this distinct feature of SLs and use it as needed to improve visual performance.
Radiation myositis and myonecrosis of the chest wall after stereotactic body radiation therapy for non-small cell lung cancer: A case report
Authors: Hirano Shoko , Shimizu Daisuke , Seri Sho , Suzuki Gen , Yamazaki Hideya , Yamada Kei
Published: June 2023

Rationale:

Stereotactic body radiation therapy (SBRT) for early-stage lung cancer, especially non-small cell lung cancer (NSCLC), is characterized by a high local control rate and low rate of severe toxicity. The adverse events of SBRT for NSCLC can involve the lung parenchyma, bronchi, central airway, esophagus, large vessels, and chest wall. Studies on muscle inflammation or necrosis caused by SBRT are relatively sparse compared to other tissues because muscles are in general resistant to radiation. Here we present a case of inflammation and necrosis of the pectoral muscle as an adverse event of SBRT.

Patient concerns:

A 90-year-old male patient with NSCLC of the left upper lung underwent an SBRT as a definitive therapy. His left anterior thorax swelled up and became hot and painful without obvious cutaneous injury 6 months after the radiation therapy.

Diagnosis:

Computed tomography and contrast-enhanced magnetic resonance imaging suggested inflammation and necrosis centered at the pectoral muscles.

Intervention:

none.

Outcome:

The pain and heat sensation spontaneously remitted within 6 weeks. However, the affected area became stiff, and the swelling partly remained for 18 months after radiation.

Lessons:

Radiation myositis and/or necrosis are rare adverse events of SBRT. Radiation myositis and necrosis that occurred in our patient was somewhat difficult to diagnose because he did not receive any chemotherapy. We should be aware of the fact that these adverse events could occur in patients without such specific backgrounds.
Complications and local recurrence of malignant liver tumor after ablation in risk areas: a retrospective analysis
Authors: Yang Dong , Yang Jundong , Zhu Fenghua , Hui Jing , Li Changlun , Cheng Shuyuan , Hu Dongyu , Wang Junye , Han Lei , Wang Huili
Published: June 2023

Introduction

Microwave ablation (MWA) is an effective local treatment for malignant liver tumors; however, its efficacy and safety for liver tumors adjacent to important organs are debatable.

Patients and methods

Forty-three cases with liver tumors adjacent to important organs were the risk group and 66 cases were the control group. The complications between two groups were compared by chi-square test and t-test. Local tumor recurrence (LTR) was analyzed by log-rank test. Factors affecting complications were analyzed by logistic regression and Spearman analyses. Factors affecting LTR were analyzed by Cox regression analysis. A receiver operating characteristic curve predicted pain treated with drugs and LTR.

Results

We found no significant difference in complications and LTR between two groups. The risk group experienced lower ablation energy and more antennas per tumor than control group. Necrosis volume after MWA was positively correlated with pain; necrosis volume and ablation time were positively correlated with recovery duration. Major diameter of tumor >3 cm increased risk of LTR by 3.319-fold, good lipiodol deposition decreased risk of LTR by 73.4%. The area under the curve (AUC) for necrosis volume in predicting pain was 0.74, with a 69.1 cm3 cutoff. AUC for major diameter of tumor in predicting LTR was 0.68, with a 27.02 mm cutoff.

Conclusion

MWA on liver tumors in at-risk areas is safe and effective, this is largely affected by proper ablation energy, antennas per tumor, and experienced doctors. LTR is primarily determined by major diameter of tumor and lipiodol deposition status.
The impact of obesity on postoperative complications and short-term survival after liver transplantation
Authors: Tejedor-Tejada Javier , Garcia-Pajares Felix , Safadi Rifaat , Mauriz-Barreiro Violeta , Molina Esther , Juan-Casamayor Laura , Fernández-Prada Samuel , Helal Abdelaleem , Fuentes-Valenzuela Esteban , Alonso-Martin Carmen , Almohalla-Alvarez Carolina
Published: June 2023

Background and aims

Obesity is considered a risk factor for perioperative complications, but its effect on patients undergoing liver transplantation (LT) remains unclear. This study was conducted to analyze the impact of obesity on early morbidity and mortality risk following LT.

Methods

A multicenter study of outcomes in patients submitted to LT between 2009 and 2019 was conducted. Recipients were stratified into obese (BMI ≥ 30 kg/m2) and nonobese patients (BMI < 30 kg/m2). Early postoperative complications were compared and 30-day and 1-year patient and graft survival were assessed by Kaplan–Meier method. Primary graft nonfunction (PGNF) was defined as the presence of total bilirubin > 10 mg/dl, INR > 1.6 or ALT > 2000 U/l within the first week after LT.

Results

A total of 1608 patients were included after applying exclusion criteria, nonobese (1149, 71.46%) and obese patients (459, 28.54%). There were no significant differences in age, sex, Model for End-stage Liver Disease, Charlson comorbidity score, ethnicity, waiting list time and ischemia time. There were significantly higher rates of vascular (17.58% vs 23.53%, P = 0.021) and biliary complications (27.68% vs 35.73%, P = 0.006) and PGNF (11.40% vs 12.20%, P = 0.021) in obese patients. There was a significantly increased risk for long-term graft failure; however, there was no significant difference in patient survival after LT.

Conclusion

Obese patients have significantly increased morbidity in terms of vascular and biliary complications and PGNF after LT. They have a higher risk for worse 1-year graft survival in comparison to controls.
Low-dose ketamine or opioids combined with propofol for procedural sedation in the emergency department: a systematic review
Authors: De Vries Linda J. , Veeger Nic J.G.M. , Van Roon Eric N. , Lameijer Heleen
Published: June 2023

Procedural sedation is routinely performed for procedures in the emergency department (ED). Propofol is a commonly used sedative, frequently combined with an opioid or low-dose ketamine as an analgesic. However, there is still controversy on the optimal combination of agents in current guidelines. The objective of this systematic review is to identify and present studies comparing low-dose ketamine to opioids when combined with propofol for procedural sedation in the ED and to describe the dosing regimen, observed efficacy, and side effects. For this systematic review, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, EMBASE and PubMed databases were searched. Studies comparing propofol with opioids versus propofol with low-dose (es)ketamine in patients undergoing procedural sedation for procedures in the ED were included. Analyses were descriptive because of the high heterogeneity among included studies. The outcomes were dosing regimen, efficacy of analgesia, efficacy of sedation depth, efficacy of recovery and (adverse) events. We included four out of 2309 studies found in the literature search. Overall, the studies had a low risk of bias, but the Grading of Recommendations Assessment, Development, and Evaluation evidence profile was downgraded due to the imprecision and inconsistency of the studies. All studies compared low-dose ketamine with fentanyl. Dosing ranged from 0.3 to 1.0 mg/kg (ketamine), 1.0–1.5 μg/kg (fentanyl) and 0.4–1.0 mg/kg (propofol). The efficacy of analgesia was measured by two studies, one favoring the fentanyl group, and one favoring the ketamine group. The efficacy of sedation depth was measured by one study, with the fentanyl group having a deeper sedation score. Two studies showed shorter recovery time with low-dose ketamine. One study showed a higher incidence of cardio-respiratory clinical events and interventions in the fentanyl group. Two studies showed significant differences of overall sedation events in the fentanyl group. One study did not find any significant differences of the incidence of sedation events. This systematic review did not provide sufficient evidence that the combination of low-dose ketamine and propofol is associated with a shorter recovery time and fewer sedation events compared to the combination of opioids and propofol.
Differential diagnosis of lung cancer and tuberculosis based on 18F-fluorodeoxyglucose PET/CT multi-time points imaging
Authors: Luo Yongjun , Li Jicheng , Ma Wanjun , Tian Xiaoxue , Huang Lele , Yuping Han , Zhang Kai , Xie Yijing , Cui Zhencun , Feng Jianzhong , Zhou Junlin
Published: June 2023

Objective

To investigate the value of 18F-fluorodeoxyglucose(FDG) PET/CT multi-time points imaging (MTPI) on the differential diagnosis between lung cancer (LC) and tuberculosis (TB).

Methods

Sixty-four patients underwent 18F-FDG PET/CT MTPI. The stdSUVmax, stdSUVavg, retention index, metabolic tumor volume, total lesion glycolysis at four-time points and slope of metabolic curve were measured and calculated, and the sex, age, and uniformity of FDG uptake were recorded. The difference in each index between LC and TB was analyzed, and dynamic metabolic curves (DMCs) of LC and TB were fitted by significance indexes. Artificial neural network (ANN) prediction models were established between squamous cell carcinoma (SCC) and TB, as well as between adenocarcinomas and TB.

Results

Differences between SCC and TB, stdSUVmax/avg at four-time points, total lesion glycolysis, stdSUVmax/avg slope (1–2 h,1–3 h and 1–4 h), uniformity of FDG uptake and age were significant. stdSUVavg has the largest area under the 4 h curve; age was only significant between adenocarcinomas and TB. DMCs at 1–4 h fitted by stdSUVavg were more helpful in differentiating LC and TB than stdSUVmax. stdSUVavg(1 h and 4 h), stdSUVavg slope 1–4 h, age, and uniformity of FDG uptake were selected to establish an ANN prediction model between SCC and TB; the area under the curve (AUC) was 100.0%. The same indices were used to establish the prediction model between adenocarcinomas and TB; the AUC was up to 83.5, and after adding stdSUVavg (2 and 4 h) to adenocarcinomas and TB models, the AUC was 87.7%.

Conclusion

18F-FDG PET/CT MTPI fitting DMCs and establishing an ANN prediction model would distinguish SCC from TB relatively accurately and provide certain help in the differentiation between adenocarcinomas and TB.
The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis
Authors: Chan Tak Kwong , Li Wai Ip , Lau Jeremy Hugh Yen-hey , Chu King Sun , Au Yong Ting Kun , Kung Boom Ting
Published: June 2023

Introduction

Brain metastases may manifest as hypermetabolism or hypometabolism compared with normal brain activity on 18fluorine-fluorodeoxyglucose PET (18F-FDG PET). We aim to undertake a systematic review and meta-analysis to determine the diagnostic accuracy of FDG PET for detecting brain metastases from different extracranial primary cancers.

Methods

PubMed and EMBASE were searched systematically. Study selection and quality assessment were performed independently by two authors. Meta-analysis was performed using a bivariate random-effects model. Subgroup analysis and meta-regression would be performed if heterogeneity was found.

Results

A total of 2227 patients from 11 studies were included in the review and analysis. Using the bivariate random-effects model, summary patient-based sensitivity and specificity for all 11 studies were estimated to be 0.440 [95% confidence interval (CI)] 0.295–0.597) and 0.997 (95% CI, 0.977–1.000). In view of significant between-study heterogeneity (I
2 = 74.0% for sensitivity and I
2 = 67.3% for specificity), subgroup analyses were performed. Meta-regression showed significantly higher patient-based summary sensitivity for the three better-quality studies (a total of 1037 patients) with satisfactory index test (counting both hypermetabolism and hypometabolism as positive index test) and satisfactory reference standards (other imaging and clinical follow-up) compared with other included studies [0.735 (95% CI, 0.601–0.836) vs 0.304 (95% CI, 0.223–0.400), P value = 0.000].

Conclusion

Our systematic review and meta-analysis showed that FDG PET has overall limited sensitivity and excellent specificity in the detection of brain metastases from extracranial primary cancers. Importantly, subgroup analyses showed that the sensitivity can be significantly improved by raising awareness of asymmetrical hypometabolism. Further studies are warranted to assess the benefits of including the brain in FDG PET studies for all or certain groups of oncological patients.
Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy
Authors: Ledder Oren , Woynarowski Marek , Kamińska Diana , Łazowska-Przeorek Izabella , Pieczarkowski Stanislaw , Romano Claudio , Lev-Tzion Raffi , Holon Magdalena , Nita Andreia , Rybak Anna , Jarocka-Cyrta Elżbieta , Korczowski Bartosz , Czkwianianc Elzbieta , Hojsak Iva , Szaflarska-Popławska Anna , Hauser Bruno , Scheers Isabelle , Sharma Shishu , Oliva Salvatore , Furlano Raoul , Tzivinikos Christos , Liu Quin Y. , Giefer Matthew , Mamula Petar , Grossman Andrew , Kelsen Judith , Edelstein Brian , Antoine Matthieu , Thomson Mike , Homan Matjaž
Published: June 2023

Objectives:

Iatrogenic viscus perforation in pediatric gastrointestinal endoscopy (GIE) is a very rare, yet potentially life-threatening event. There are no evidence-based recommendations relating to immediate post-procedure follow-up to identify perforations and allow for timely management. This study aims to characterize the presentation of children with post-GIE perforation to better rationalize post-procedure recommendations.

Methods:

Retrospective study based on unrestricted pooled data from centers throughout Europe, North America, and the Middle East affiliated with the Endoscopy Special Interest Groups of European Society for Paediatric Gastroenterology Hepatology and Nutrition and North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Procedural and patient data relating to clinical presentation of the perforation were recorded on standardized REDCap case-report forms.

Results:

Fifty-nine cases of viscus perforation were recorded [median age 6 years (interquartile range 3–13)]; 29 of 59 (49%) occurred following esophagogastroduodenoscopy, 26 of 59 (44%) following ileocolonoscopy, with 2 of 59 (3%) cases each following balloon enteroscopy and endoscopic retrograde cholangiopancreatography; 28 of 59 (48%) of perforations were identified during the procedure [26/28 (93%) endoscopically, 2/28 (7%) by fluoroscopy], and a further 5 of 59 (9%) identified within 4 hours. Overall 80% of perforations were identified within 12 hours. Among perforations identified subsequent to the procedure 19 of 31 (61%) presented with pain, 16 of 31 (52%) presented with fever, and 10 of 31 (32%) presented with abdominal rigidity or dyspnea; 30 of 59 (51%) were managed surgically, 17 of 59 (29%) managed conservatively, and 9 of 59 (15%) endoscopically; 4 of 59 (7%) patients died, all following esophageal perforation.

Conclusions:

Iatrogenic perforation was identified immediately in over half of cases and in 80% of cases within 12 hours. This novel data can be utilized to generate guiding principles of post-procedural follow-up and monitoring.

PLAIN LANGUAGE SUMMARY

Bowel perforation following pediatric gastrointestinal endoscopy is very rare with no evidence to base post-procedure follow-up for high-risk procedures. We found that half were identified immediately with the large majority identified within 12 hours, mostly due to pain and fever.
Comparison of Clinical Outcomes in Pediatric Patients with Ileocolonic Crohn Disease Treated with Infliximab Versus Adalimumab
Authors: Fanous Eliana , Marshanski Tal , Tal Noa , Matar Manar , Weintraub Yael , Shamir Raanan , Shouval Dror S.
Published: June 2023

Objectives:

Infliximab is considered superior to adalimumab in patients with ulcerative colitis, especially in severe cases. Whether this is true for Crohn disease (CD) patients with colonic involvement is unclear. Our aim was to compare the clinical effectiveness of infliximab versus adalimumab in pediatric ileocolonic (L3) CD.

Methods:

This retrospective study included patients <18 years with ileocolonic CD treated with infliximab or adalimumab between 2014 and 2021. Primary outcome was steroid-free clinical remission by week 52. Secondary outcomes were treatment modifications, drug discontinuation, inflammatory bowel disease (IBD)-associated hospitalizations, and surgery during the first year of treatment.

Results:

We identified 74 patients treated with adalimumab and 41 with infliximab, with comparable demographic features. Concomitant immunomodulator therapy at biologic initiation was significantly lower in the adalimumab group (28% vs 85%, P < 0.001). Rates of drug intensification were higher in the infliximab group at end of induction (EOI) and at 52 weeks (55% vs 32% and 88% vs 46%, P < 0.001). Given significant differences between initial median Pediatric Crohn Disease Activity Index scores (20.0 [interquartile range, IQR 15.0–27.5] vs 11.0 [IQR 7.5–20.0] for infliximab and adalimumab groups, respectively, P < 0.001), propensity score matching was performed. Following matching, the rate of patients in steroid-free clinical remission by EOI was significantly higher in the adalimumab group (93.8% vs 46.9%, P < 0.001), but comparable by 1 year. Moreover, inflammatory markers and fecal calprotectin values were also similar at these time points. Rates of drug discontinuation, IBD-associated admissions, and surgery were similar between groups.

Conclusions:

In a retrospective study of patients with ileocolonic CD, adalimumab and infliximab had comparable outcomes by 52 weeks.
Nipple Adenoma
Authors: Weigelt Maximillian A. , Sciallis Andrew P. , McIntire Patrick J. , Ko Jennifer S. , Billings Steven D. , Ronen Shira
Published: June 2023

Nipple adenoma (NA) is a rare, benign proliferation of the nipple ducts. It may be clinically mistaken for Paget disease or squamous cell carcinoma; thus, microscopic evaluation is paramount. A large case series of NA has not been undertaken since the 1980s. Therefore, we undertook this study to evaluate the clinicopathologic characteristics of NA, emphasizing differential diagnoses and follow-up data. We retrieved 50 cases from our in-house archives or consultation files between 2003 and 2022. Available slides were reviewed, and clinical data and follow-up information were obtained. Cases must have exhibited a dense ductal proliferation in the breast tissue with proximity to the nipple epidermis. All patients were women; median age was 56 years. In all, 68% of patients were symptomatic; 53% demonstrated a skin growth. Overall, 67% were excised completely, either primarily (33%) or via re-excision after biopsy (33%). Four histologic patterns were noted: adenosis (dense proliferation of small-to-medium ducts); large duct (medium-to-large caliber ducts); papillary-like (frond-like architecture with branching, slit-like lumens); and pseudoinfiltrative (ducts squished and distorted by dense stromal fibrosis). Follow-up in 44 patients (88%) with a median time of 66 months showed no evidence of recurrence. NA demonstrates a wide spectrum of histopathologic variation. Subtyping of this entity is unlikely to be clinically relevant. Differentiation from invasive carcinoma or other histologic mimics (syringocystadenoma papilliferum, syringomatous adenoma) may be difficult. Simple excision is curative, and recurrence is rare. A definitive link to invasive carcinoma has not been established.
Comparison of Pediatric Trauma Scoring Tools That Incorporate Neurological Status for Trauma Team Activation
Authors: Reppucci Marina L. , Cooper Emily , Stevens Jenny , Meier Maxene , Nolan Margo M. , Moulton Steven L. , Bensard Denis D. , Acker Shannon N.
Published: June 2023

Background

Two novel pediatric trauma scoring tools, SIPAB+ (defined as elevated SIPA with Glasgow Coma Scale ≤8) and rSIG (reverse Shock Index multiplied by Glasgow Coma Scale and defined as abnormal using cutoffs for early outcomes), which combine neurological status with Pediatric Age-Adjusted Shock Index (SIPA), have been shown to predict early trauma outcomes better than SIPA alone. We sought to determine if one more accurately identifies children in need of trauma team activation.

Methods

Patients 1 to 18 years old from the 2014–2018 Pediatric Trauma Quality Improvement Program database were included. Sensitivity and specificity for SIPAB+ and rSIG were calculated for components of pediatric trauma team activation, based on criteria standard definitions.

Results

There were 11,426 patients (1.9%) classified as SIPAB+ and 235,672 (39.0%) as having an abnormal rSIG. SIPAB+ was consistently more specific, with specificities exceeding 98%, but its sensitivity was poor (<30%) for all outcomes. In comparison, rSIG was a more sensitive tool, with sensitivities exceeding 60%, and specificity values exceeded 60% for all outcomes.

Conclusions

Trauma systems must determine their priorities to decide how best to incorporate SIPAB+ and rSIG into practice, although rSIG may be preferred as it balances both sensitivity and specificity.

Level of Evidence

Level III.
Cango Lyec (Healing the Elephant): HIV Prevalence and Vulnerabilities Among Adolescent Girls and Young Women in Postconflict Northern Uganda
Authors: Muyinda Herbert , Jongbloed Kate , Zamar David S. , Malamba Samuel S. , Ogwang Martin D. , Katamba Achilles , Oneka Alex , Atim Stella , Odongpiny Tonny O. , Sewankambo Nelson K. , Schechter Martin T. , Spittal Patricia M.
Published: June 2023

Objectives:

Adolescent girls and young women younger than 25 years (AGYW) account for disproportionate HIV infections in sub-Saharan Africa. Impacts of war in Northern Uganda continue to affect HIV-related health and wellbeing of young people postconflict. Prevalence and incidence of HIV infection were estimated, and factors associated with HIV prevalence among sexually active AGYW in Northern Uganda were investigated.

Methods:

Cango Lyec is a cohort involving conflict-affected populations in Northern Uganda. Nine randomly selected communities in Gulu, Nwoya, and Amuru districts were mapped. House-to-house census was conducted. Consenting participants aged 13–49 years were enrolled over 3 study rounds (2011–2015), of whom 533 were AGYW and had ever had sex. Data were collected on trauma, depression, and sociodemographic–behavioral characteristics. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression determined baseline factors associated with HIV prevalence.

Results:

HIV prevalence among AGYW was 9.7% (95% CI: 7.3 to 12.6). AGYW living in Gulu (adjusted risk ratio, aRR: 2.48; 95% CI: 1.12 to 5.51) or Nwoya (aRR: 2.65; 95% CI: 1.03 to 6.83) were more likely than in Amuru to be living with HIV. Having self-reported genital ulcers (aRR: 1.93; 95% CI: 0.97 to 3.85) or active syphilis (aRR: 3.79; 95% CI: 2.35 to 6.12) was associated with increased risk of HIV infection. The likelihood of HIV was higher for those who experienced sexual violence in the context of war (aRR: 2.37; 95% CI: 1.21 to 4.62) and/or probable depression (aRR: 1.95; 95% CI: 1.08 to 3.54). HIV incidence was 8.9 per 1000 person-years.

Conclusion:

Ongoing legacies of war, especially gender violence and trauma, contribute to HIV vulnerability among sexually active AGYW. Wholistic approaches integrating HIV prevention with culturally safe initiatives promoting sexual and mental health in Northern Uganda are essential.
177Lu-DOTATATE Therapy in a Case of Castrate-Resistant Prostate Cancer With Neuroendocrine Differentiation
Authors: Shu Qiaoqiao , Li Xianjun , Chen Xi , Chen Yue , Cai Liang
Published: June 2023

An 84-year-old man with prostate cancer with neuroendocrine differentiation underwent PET/CT for staging. 68Ga–prostate-specific membrane antigen PET/CT did not show significant abnormal tracer accumulation, whereas 18F-OC (18F-AlF-NOTA-octreotide) PET/CT showed elevated tracer uptake at multiple sites throughout the body. Therefore, the patient opted to receive 1 cycle of 177Lu-DOTATATE peptide receptor radionuclide therapy with a dose of 200 mCi. Encouragingly, radiographic tumor remission and improvement of clinical symptoms were observed after only 1 cycle of treatment.
68Ga-FAPI-04 PET/MRI in a Case of Tuberous Sclerosis Complex With Extrarenal Retroperitoneal Angiomyolipoma
Authors: Dong Aisheng , Yang Bo , Yang Qinqin , Cheng Chao , Zuo Changjing
Published: June 2023

Extrarenal retroperitoneal angiomyolipomas are rare benign tumors that may mimic other benign or malignant retroperitoneal tumors. We describe 68Ga-FAPI-04 PET/MRI findings in a case of tuberous sclerosis complex with an extrarenal retroperitoneal angiomyolipoma and multiple angiomyolipomas involving bilateral kidneys. The extrarenal retroperitoneal angiomyolipoma and most of the renal angiomyolipomas were 68Ga-FAPI-04–avid. One left renal angiomyolipoma with extensive hemorrhage and fibrosis had no significant 68Ga-FAPI-04 uptake. Angiomyolipoma should be included in the differential diagnosis of FAPI-avid renal or extrarenal retroperitoneal lesions.
Risk Factors for Postoperative Infection After Maxillary Reconstruction Using Skeletal Grafts
Authors: Hidaka Takeaki , Tanaka Kentaro , Minami Munetaka , Mori Hiroki , Okazaki Mutsumi
Published: June 2023

Skeletal grafts are usually required to reconstruct defects after maxillectomy for acceptable aesthetic and functional results. Postoperative infection is a serious complication; however, few studies have evaluated the vulnerability to infection of various skeletal reconstructive materials used for maxillary reconstruction. A retrospective study was conducted on 53 cases in which maxillary skeletal reconstruction was performed between 2010 and 2021. The postoperative infection rate was compared between various skeletal reconstructive materials, including costal cartilage, scapula, fibula, ilium, cranium, and titanium mesh. In addition, the risk factors for postoperative infection were evaluated using 2-group comparison tests. Of 53 patients, 14 (25.4%) contracted an infection postoperatively. No significant differences were observed in the infection rates among the materials used for skeletal reconstruction. Cases undergoing secondary reconstruction tended to have a higher infection rate (34.4%) than primary reconstruction (14.3%). For nonvascularized skeletal grafts (41 cases), the concomitant use of soft-tissue flaps decreased the infection rate from 30.8% to 17.9%. Costal cartilage was the most frequently used material (31 cases), primarily for orbital floor reconstruction. Regarding the costal cartilage, nasal wall reconstruction had a higher infection rate (100%) than reconstruction of other parts of the maxilla (0.0%–17.9%). Nonvascularized skeletal grafts, mainly costal cartilage grafts, were safely used for maxillary reconstruction. However, caution should be exercised for postoperative infection in secondary cases and in cases where costal cartilage is used for nasal wall reconstruction. Covering nonvascularized skeletal grafts with soft-tissue flaps may be an effective countermeasure.