bluuebunny/crossref_metadata_2025 huggingface dataset:
Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study
Authors: van Linschoten Reinier C A , van der Woude C Janneke , Visser Elyke , van Leeuwen Nikki , Bodelier Alexander G L , Fitzpatrick Claire , de Jonge Vincent , Vermeulen Hestia , Verweij K Evelyne , van der Wiel Sanne , Nieboer Daan , Birnie Erwin , van der Horst Daniëlle , Hazelzet Jan A , van Noord Desirée , West Rachel L
Published: April 2024

Background

Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals.

Methods

We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital were analyzed with intraclass correlation coefficients (ICCs) from case mix–adjusted (generalized) linear mixed models.

Results

We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: €8323 per 6 months), mainly attributed to advanced therapies (€6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations.

Conclusions

Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care.

Trial Registration Number

NL8276
Trade-offs between Winter Survival and Reproduction in Female Insects
Authors: Meuti Megan E , Fyie Lydia R , Fiorta Maria , Denlinger David L
Published: April 2024

Synopsis

In temperate environments, most species of insects enter an arrested state of development, known as diapause, that enables them to survive the adverse environmental conditions associated with winter. Although diapause is restricted to a single life stage within species of insects, there are examples of insects that overwinter in the egg, larval, pupal, and adult stages. Here we offer a targeted, non-systematic literature review examining how overwintering impacts subsequent reproduction in female insects. Several factors, including the lifestage at which insects overwinter, the type of energy investment strategy females use for breeding, elements of the winter environment, and contributions from male insects can influence trade-offs that female insects face between overwintering survival and post-diapause reproduction. Additionally, climate change and elements of the urban environment, including light pollution and higher temperatures in cities, can exacerbate or ameliorate trade-offs faced by reproducing female insects. Better understanding the trade-offs between overwintering survival and reproduction in insects not only enhances our understanding of the underlying physiological mechanisms and ecological processes governing diapause and reproduction, but also provides opportunities to better manage insect pests and/or support beneficial insects.
Experimental Infections Reveal Acquired Zoonotic Capacity of Human Schistosomiasis Trough Hybridization
Authors: Polack Bruno , Mathieu-Bégné Eglantine , Vallée Isabelle , Rognon Anne , Fontaine Jean-Jacques , Toulza Eve , Thomas Myriam , Boissier Jérôme
Published: April 2024

We are currently witnessing the endemization of urogenital schistosomiasis in southern Europe. The incriminated parasite is a hybrid between a human parasite and a livestock parasite. Using an experimental evolutionary protocol, we created hybrid lines from pure strains of both parasite species. We showed that the host spectrum of the human parasite is enlarged to the livestock parasite after genomic introgression. We also evidenced that the tropism of the parasites within the host changes and that some hybrid lines are more virulent than the parental strains. These results engage a paradigm shift from human to zoonotic transmission of urogenital schistosomiasis.
Serological Profiling of Pneumococcal Proteins Reveals Unique Patterns of Acquisition, Maintenance, and Waning of Antibodies Throughout Life
Authors: He Samantha W J , Voß Franziska , Nicolaie Mioara A , Brummelman Jolanda , van de Garde Martijn D B , Bijvank Elske , Poelen Martien , Wijmenga-Monsuur Alienke J , Wyllie Anne L , Trzciński Krzysztof , Van Beek Josine , Rots Nynke Y , den Hartog Gerco , Hammerschmidt Sven , van Els Cécile A C M
Published: April 2024

Streptococcus pneumoniae is a leading cause of morbidity and mortality in children and older adults. However, knowledge on the development of pneumococcal protein-specific antibody responses throughout life is limited. To investigate this, we measured serum immunoglobulin G (IgG) levels to 55 pneumococcal proteins in 11-month-old infants (n = 73), 24-month-old children (n = 101), parents (n = 99), adults without children <6 years of age (n = 99), and older adults aged >60 years (n = 100). Our findings revealed low IgG levels in infancy, with distinct development patterns peaking in adults. A decrease in levels was observed for 27 antigens towards older age. Adults and older adults had increased IgG levels during pneumococcal carriage and at increased exposure risk to S. pneumoniae. Carriage was a stronger predictor than exposure or age for antibody responses. These findings highlight the dynamic nature of naturally acquired humoral immunity to pneumococcal proteins throughout life, offering insights for age-targeted interventions.

Clinical Trials Registration

Participants were selected from three clinical studies (NTR3462, NTR5405 and NTR3386) conducted in the Netherlands by the National Institute for Public Health and the Environment (RIVM).
Serum Gasdermin D for Early Diagnosis of Bloodstream Infection and Differentiating Bacterial From Fungal Infections
Authors: Huang Jing , Shi Jing , Zhang Xiuyu , Tian Feng , Huang Juan , Zhao Qing , Wan Ningyi , Zhang Lijun , Hu Ying , Li Pu
Published: April 2024

Background

The role of gasdermin D (GSDMD) in bloodstream infection (BSI) diagnosis is unknown.

Methods

Serum GSDMD levels were measured in patients with BSI. Endothelial cells and peripheral blood mononuclear cells were isolated and infected with bacteria/fungi, and intracellular/extracellular GSDMD concentrations were measured. An animal model was established to investigate the association between serum GSDMD levels and BSI incidence or progression.

Results

Receiver operating characteristic curve analysis indicated that GSDMD could be a potential early diagnostic biomarker for BSI (area under the curve [AUC], .9885). Combining GSDMD with procalcitonin improved the differential diagnosis of gram-positive and gram-negative bacteria (AUC, 0.6699; 66.15% specificity) and early diagnosis of gram-positive bacteria (98.46% sensitivity), while procalcitonin was not significantly elevated. The combined GSDMD and (1-3)-β-D glucan test (G test) had higher sensitivity (AUC, 0.7174) for differential diagnosis of bacterial and fungal infections and early detection of fungal infections (98.44% sensitivity). In vitro and in vivo experiments confirmed that GSDMD levels increased significantly within 2 hours, peaked at 16 hours, and exhibited a time-dependent upward trend.

Conclusions

Serum GSDMD, alone or combined with other biomarkers, has potential for early diagnosis and differential diagnosis of BSI caused by various pathogens. This finding offers a new strategy for early detection and treatment of BSI.
Religion, Race, and Letterpress: Orthodox Christians in Nineteenth-Century New York City through the Lens of Kawkab America
Authors: Durmaz Reyhan
Published: April 2024

Kawkab America (Star of America) is the first Arabic-language newspaper in America, published in New York City from 1892 to 1908. Founded by Orthodox Christians from Ottoman Syria, the newspaper reported on historical and contemporary events across the globe. In this article, I analyze the representations of religion in Kawkab to reconstruct the ways a Middle Eastern immigrant community perceived religious diversity in nineteenth-century America. Kawkab engaged the contemporary discourses about “world religions” by expanding this category’s boundaries. And by downplaying the theological distinctions between Christian denominations, it represented Syrians as members of an ecumenical Christianity. To further reinforce the value of the Orthodox community as worthy American subjects, the newspaper also commented on morality and piety as universal, cross-confessional norms, which Syrians abided by and guarded. Kawkab’s use of these literary strategies testifies to Syrian Christians’ negotiation of religion, race, and culture in a transnational, diasporic space.
Population ecology of the intertidal xanthid crab Leptodius exaratus (H. Milne Edwards, 1834) (Decapoda: Brachyura: Xanthidae) on rocky shores in Kuwait, Arabian (Persian) Gulf
Authors: Al-Wazzan Zainab , Giménez Luis , Behbehani Manaf , Le Vay Lewis
Published: April 2024

Leptodius exaratus (H. Milne Edwards, 1834) is an exploited species that has been used as bait for recreational fishing in Kuwait. The biological and ecological aspects of the species required to manage this practice are limited. We investigated the life history and population ecology of L. exaratus in the northwestern Arabian (Persian) Gulf. The spawning season of the crab in Kuwait starts in the late spring and continues through the summer and ends in September. Fecundity is highly correlated to female body size and ranges 2,533–11,991 eggs clutch–1, with a mean number of 7,055 eggs clutch–1. Juveniles are generally recruited between July and September, with lower minor recruitment levels occurring in October and November. Growth is highly seasonal, being slow during the cold season (October-February) and high during the warmer season (March and September), with a higher growth rate in males than in females. The seasonality of growth and reproduction of L. exaratus in the region is strongly related to ambient air and water temperatures. Sexual dimorphism is highly significant between males and females with males, reaching reproductive maturity at 17.43 ± 0.53 mm carapace width (CW) and females at 9.58 ± 1.21 mm CW. The overall sex ratio for the species is 0.8:1 (males:females). Furthermore, the life span of 3–4 yr and an overall mortality slightly higher in males than in females. The results of our study could be used to determine fishery management strategies such as minimum catch sizes and closures periods. The results on life history and dynamics of the complex life cycle of L. exaratus contribute to conservation and sustainable exploitation of the species in Kuwait.
Resistance to initial starvation in stage I larvae of the American lobsterHomarus americanusH. Milne Edwards, 1837 (Decapoda: Astacidea: Nephropidae)
Authors: Annis Eric R , Howell Ruth R , Steneck Robert S
Published: April 2024

Greater embryo mass confers an advantage in the face of sub-lethal starvation for larvae of the American lobster, Homarus americanusH. Milne Edwards, 1837. We reared larvae in the laboratory and recorded body size, molt increment, stage duration, and mortality during the three larval instars and postlarval stages. Larvae were either fed continuously or subjected to starvation periods immediately after hatching. Larval mass increased with embryo mass suggesting that energetic advantages of heavier embryos are conferred to the larvae. Stage I larvae hatched from clutches with heavier embryos and had lower mortality after five days without food. Stage I duration decreased with increasing embryo mass in treatments with initial periods without food of three, four, and five days. We also observed greater size increase at first molt and larger postlarval size in some treatments. Our results suggest that larger embryos produce larvae that are more resistant to starvation, which may provide a survival advantage when experiencing variable food supply due to the patchy distribution of their planktonic prey.
Lime and lithiasis: a case of choledocholithiasis complicated by limy bile
Authors: Fahrenhorst-Jones Travis , Theodore Jane E , Aseervatham Ratna
Published: April 2024

Limy bile syndrome (LBS) is a condition in which the biliary tract is filled with radiodense calcium carbonate rich sludge. This rare condition can complicate the management of commonly encountered biliary conditions such as choledocholithiasis. We present a case of a male in his fifties who presented to hospital with a 12-day history of abdominal pain, nausea and jaundice. Imaging and laboratory findings demonstrated a dependent radio-dense substance within the biliary system as well as an obstructing calculus at the duodenal ampulla. Management with endoscopic retrograde cholangiopancreatography alone was insufficient and further surgical management was required. With no clear published guidelines on LBS and associated cholelithiasis, management is variable. We present this case as an addition to the literature on the management of choledocholithiasis complicated by LBS.
From benign to malignant: unveiling invasive squamous cell carcinoma following resection of perianal condyloma acuminatum: a case report
Authors: Ylli Kristali , ElJack Wala , Spillane Chloe , Cotter Mar , Killeen Shane
Published: April 2024

This case illustrates the surgical management of a perianal mass, initially misdiagnosed as condyloma acuminatum in a male patient in his late 50s, later identified as invasive squamous cell carcinoma following excision. Despite extensive preoperative evaluation, the lesion's malignancy was confirmed through histopathology. The significant, fungating mass required a multidisciplinary approach, culminating in a pT3 staging and additional wide excision with inferior gluteal artery perforator flap reconstruction. This case underscores the critical importance of surgical diligence and adaptability, highlighting the role of comprehensive surgery in both diagnosis and treatment of complex perianal malignancies, and reaffirms the value of a multidisciplinary team in achieving favourable outcomes.
The Role of Mental Health Conditions in Early Detection and Treatment of Veterans With Alzheimer’s Dementia
Authors: O’Connor Maureen K , Aguilar Byron J , Nguyen Andrew , Berlowitz Dan , Zhang Raymond , Tahami Monfared Amir Abbas , Zhang Quanwu , Xia Weiming
Published: April 2024

Introduction

The benefits of early detection of Alzheimer’s disease (AD) have become increasingly recognized. Veterans with mental health conditions (MHCs) may be less likely to receive a specific AD diagnosis compared to veterans without MHCs. We investigated whether rates of MHCs differed between veterans diagnosed with unspecified dementia (UD) vs. AD to better understand the role MHCs might play in establishing a diagnosis of AD.

Materials and Methods

This retrospective analysis (2015-2022) identified UD and AD with diagnostic code–based criteria. We determined the proportion of veterans with MHCs in UD vs. AD cohorts. Secondarily, we assessed the distribution of UD/AD diagnoses in veterans with and without MHCs.

Results

We identified 145,309 veterans with UD and 33,996 with AD. The proportion of each MHC was consistently higher in UD vs. AD cohorts: 41.4% vs. 33.2% (depression), 26.9% vs. 20.3% (post-traumatic stress disorder), 23.4% vs. 18.2% (anxiety), 4.3% vs. 2.1% (bipolar disorder), and 3.9% vs. 1.5% (schizophrenia). The UD diagnostic code was used in 84% of veterans with MHCs vs. 78% without MHCs (P < .001).

Conclusions

Mental health conditions were more likely in veterans with UD vs. AD diagnoses; comorbid MHC may contribute to delayed AD diagnosis.
The Portuguese Court’s Acquisition of Musical Scores from Italy in the Late Eighteenth and Early Nineteenth Centuries and the Fundo do Conde de Redondo
Authors: Woolley Andrew
Published: April 2024

The assembling of a library of musical scores of Italian music and libretti was an enterprise undertaken by the Portuguese court throughout the late eighteenth and early nineteenth centuries. The library served a practical need, especially in the wake of the 1755 Lisbon earthquake, and expressed the court’s musical taste; as a result, it received significant investment. Information concerning the growth of the library can be found in previous work on the composer Niccolò Jommelli and his heirs, who were involved in sending scores of the composer’s music to Portugal in the 1760s and 1770s. Drawing attention to evidence in Portuguese royal household correspondence that has not been considered fully to date, as well as some of the scores today preserved in two Lisbon libraries, this article offers a wider examination of how music manuscripts came to Portugal from Italy between c.1770 and c.1820.
Discovery and follow-up of ASASSN-23bd (AT 2023clx): the lowest redshift and luminosity optically selected tidal disruption event
Authors: Hoogendam W B , Hinkle J T , Shappee B J , Auchettl K , Kochanek C S , Stanek K Z , Maksym W P , Tucker M A , Huber M E , Morrell N , Burns C R , Hey D , Holoien T W -S , Prieto J L , Stritzinger M , Do A , Polin A , Ashall C , Brown P J , DerKacy J M , Ferrari L , Galbany L , Hsiao E Y , Kumar S , Lu J , Stevens C P
Published: April 2024

We report the All-Sky Automated Survey for SuperNovae discovery of the tidal disruption event (TDE) ASASSN-23bd (AT 2023clx) in NGC 3799, a LINER galaxy with no evidence of strong active galactic nucleus (AGN) activity over the past decade. With a redshift of z = 0.01107 and a peak ultraviolet (UV)/optical luminosity of (5.4 ± 0.4) × 1042 erg s−1, ASASSN-23bd is the lowest-redshift and least-luminous TDE discovered to date. Spectroscopically, ASASSN-23bd shows H α and He i emission throughout its spectral time series, there are no coronal lines in its near-infrared spectrum, and the UV spectrum shows nitrogen lines without the strong carbon and magnesium lines typically seen for AGN. Fits to the rising ASAS-SN light curve show that ASASSN-23bd started to brighten on MJD 59988$^{+1}_{-1}$, ∼9 d before discovery, with a nearly linear rise in flux, peaking in the g band on MJD $60 \, 000^{+3}_{-3}$. Scaling relations and TDE light curve modelling find a black hole mass of ∼106 M⊙, which is on the lower end of supermassive black hole masses. ASASSN-23bd is a dim X-ray source, with an upper limit of $L_{0.3-10\, \mathrm{keV}} \lt 1.0\times 10^{40}$ erg s−1 from stacking all Swift observations prior to MJD 60061, but with soft (∼0.1 keV) thermal emission with a luminosity of $L_{0.3-2 \, \mathrm{keV}}\sim 4\times 10^{39}$ erg s−1 in XMM-Newton observations on MJD 60095. The rapid (t < 15 d) light curve rise, low UV/optical luminosity, and a luminosity decline over 40 d of ΔL40 ≈ −0.7 dex make ASASSN-23bd one of the dimmest TDEs to date and a member of the growing ‘Low Luminosity and Fast’ class of TDEs.
Evolution of spin in the intermediate polar CC sculptoris
Authors: Paice John A , Scaringi S , Castro Segura N , Sahu A , Iłkiewicz K , Coppejans Deanne L , De Martino D , Knigge C , Veresvarska M
Published: April 2024

We report on spin variations in the intermediate polar and cataclysmic variable CC Scl, as seen by the Transiting Exoplanet Survey Satellite (TESS). By studying both the spin period and its harmonic, we find that the spin has varied since it was first observed in 2011. We find the latest spin value for the source to be 389.473(6) s, equivalent to 0.00450779(7) d, 0.02 s shorter than the first value measured. A linear fit to these and intermediate data give a rate of change of spin (Ṗ) ∼ −4.26(2.66)× 10−11 and a characteristic time-scale τ ∼ 2.90 × 105 yr, in line with other known intermediate polars with varying spin. The spin profile of this source also matches theoretical spin profiles of high-inclination intermediate polars, and furthermore, appears to have changed in shape over a period of three years. Such ‘spin-up’ in an intermediate polar is considered to be from mass accretion on to the white dwarf (the primary), and we note the presence of dwarf nova eruptions in this source as being a possible catalyst of the variations.
FHL2 in arterial medial calcification in chronic kidney disease
Authors: Liao Yuan-Ru , Tsai Yu-Cheng , Hsieh Tsung-Han , Tsai Ming-Tsun , Lin Feng-Yen , Lin Shing-Jong , Lin Chih-Ching , Chiang Hou-Yu , Chu Pao-Hsien , Li Szu-Yuan
Published: April 2024

Background

Arterial medial calcification (AMC) is a common complication in individuals with chronic kidney disease (CKD), which can lead to cardiovascular morbidity and mortality. The progression of AMC is controlled by a key transcription factor called runt-related transcription factor 2 (RUNX2), which induces vascular smooth muscle cells (VSMCs) transdifferentiation into an osteogenic phenotype. However, RUNX2 has not been targeted for therapy due to its essential role in bone development. The objective of our study was to discover a RUNX2 coactivator that is highly expressed in arterial VSMCs as a potential therapy for AMC.

Methods

We employed transcriptomic analysis of human data and an animal reporter system to pinpoint four and a half LIM domains 2 (FHL2) as a potential target. Subsequently, we investigated the mRNA and protein expression patterns of FHL2 in the aortas of both human and animal subjects with CKD. To examine the role of FHL2 in the RUNX2 transcription machinery, we conducted coimmunoprecipitation and chromatin immunoprecipitation experiments. Next, we manipulated FHL2 expression in cultured VSMCs to examine its impact on high phosphate-induced transdifferentiation. Finally, we employed FHL2-null mice to confirm the role of FHL2 in the development of AMC in vivo.

Results

Among all the potential RUNX2 cofactors, FHL2 displays selective expression within the cardiovascular system. In the context of CKD subjects, FHL2 undergoes upregulation and translocation from the cytosol to the nucleus of arterial VSMCs. Once in the nucleus, FHL2 interacts structurally and functionally with RUNX2, acting as a coactivator of RUNX2. Notably, the inhibition of FHL2 expression averts transdifferentiation of VSMCs into an osteogenic phenotype and mitigates aortic calcification in uremic animals, without causing any detrimental effects on the skeletal system.

Conclusion

These observations provide evidence that FHL2 is a promising target for treating arterial calcification in patients with CKD.
Impact of the Reverse 2-Step Algorithm forClostridioides difficileTesting in the Microbiology Laboratory on Hospitalized Patients
Authors: Hilt Evann E , Vaughn Byron P , Galdys Alison L , Evans Michael D , Ferrieri Patricia
Published: April 2024

Background

Multistep laboratory testing is recommended for the diagnosis of Clostridioides difficile infection (CDI). The aim of this study was to present the impact of multistep CDI diagnostic testing in an academic hospital system and evaluate the toxin B gene polymerase chain reaction (PCR) cycle threshold (Ct) values of PCR-positive tests.

Methods

In October 2022, our system began reflex testing all PCR-positive stool samples with the C. DIFF QUIK CHEK COMPLETE (Techlab), an enzyme immunoassay–based test with results for the glutamate dehydrogenase antigen (GDH) and C difficile toxin A/B. Hospital-onset (HO) CDI and CDI antibiotic use before and after testing were tracked. Ct values were obtained from the Infectious Diseases Diagnostic Laboratory. Receiver operating curve analysis was used to examine the sensitivity and specificity for identifying GDH+/toxin+ and GDH−/toxin− at various Ct thresholds.

Results

The HO-CDI rate decreased from 0.352 cases per 1000 patient-days to 0.115 cases per 1000 patient-days post–reflex testing (P < .005). Anti-CDI antibiotics use decreased, but the decrease was not commensurate with CDI rates following reflex testing. PCR+/GDH+/toxin+ samples had a lower mean Ct value than PCR+/GDH–/toxin– samples (23.3 vs 33.5, P < .0001). A Ct value of 28.65 could distinguish between those 2 groups. Fifty-four percent of PCR+/GDH+/toxin− samples had a Ct value below that cut-off, suggesting the possibility of CDI with a negative toxin test.

Conclusions

Reflex testing for a laboratory diagnosis of CDI results in rapid, systemwide decreases in the rate of HO-CDI. Additional research is needed to distinguish CDI from C difficile colonization in patients with discordant testing.
Ectopic adrenal tissue in the mesosalpinx of an older female: the fourth case report in the literature
Authors: Al-Janabi Moatasem Hussein , Salamah Doaa , Suleiman Marah , Mansour Marah , Salloum Rabab
Published: April 2024

Ectopic adrenal tissue is a rare finding often encountered incidentally during histopathological examinations. The most common site is the genitourinary tract and pelvis, and more frequently in males than females. Ectopic adrenal tissue is primarily found in neonates and is extremely rare in adults. Although it is an unexpected entity, pathologists should be aware of it because it may be confused with metastasis of clear cell renal carcinoma. To the best of our knowledge, only three cases of ectopic adrenal tissue in the mesosalpinx of the fallopian tube have been reported in the medical literature, making this case the fourth one. In our report, we discussed an ectopic adrenal tissue that was discovered incidentally in the mesosalpinx of an older female.
Primary small lymphocytic lymphoma of the breast: a rare presentation of non-Hodgkin’s lymphoma
Authors: Passeggiata Matthew , Badaro Geovanna , Kim Hui Un , Umbu Landry , Mashburn Penelope , Nath Manju
Published: April 2024

Primary Small Lymphocytic Lymphoma of the breast is a rare presentation of Non-Hodgkin’s lymphoma. In this report, we present the case of primary small lymphocytic lymphoma of the breast in a 65-year-old female who presented with an abnormal breast ultrasound significant for a nodule of the right breast consistent with BI-RADS 4, indicating follow-up with ultrasound-guided biopsy for further diagnostic evaluation. The patient had no prior history of extramammary lymphoma or widespread disease. A sample of the breast mass was obtained via ultrasound-guided core needle biopsy and the pathology report revealed low-grade B-cell Lymphoma. After discussion with medical oncology and the explanation of risks, benefits and alternatives to surgery, a lumpectomy was performed, and the final pathology report of the mass revealed primary low-grade B-cell lymphocytic lymphoma of the breast. On follow up, the PET scan was unremarkable and showed no evidence of abnormal glucose metabolism or adenopathy.
Identifying the clinical and histopathological characteristics of amelanotic melanoma: a case series
Authors: Sohail Aroon , Kavaklieva Svetlana
Published: April 2024

Amelanotic melanoma (AM) is a subtype of melanoma where the lesion demonstrates no pigmentation. This can lead to delays in referral with studies showing a higher mortality rate. To determine the characteristics of AM lesions, we conducted a retrospective analysis of patients with confirmed AM. Of the 16 patients, 68.75% were male and the mean age at diagnosis was 78 years. The most common location for AM was the head (37.5%) which also demonstrated a higher mitotic rate (10.67 mm2) compared to the average (7.31 mm2). More than half of the lesions (56%) had been present for more than 1 year. With a misdiagnosis rate of 87.5%, the likelihood of delays were evident. There was no unifying feature on clinical assessment, however conspicuous vessel findings were noted on 62.5% of lesions. We have demonstrated that AM continues to remain a missed diagnosis with the potential for a more lethal cancer to form.
Refractory status epilepticus in a pediatric patient: Exploring the association with thyroid dysfunction
Authors: Hmeedan Alaa , Rabee Hadi Adnan , Doudein Mahmoud , Shubietah Abdalhakim R M
Published: April 2024

Hashimoto’s thyroiditis is an autoimmune thyroid disease characterized by lymphocytic infiltration and thyroid-specific autoantibodies. Hashimoto’s encephalopathy, a rare entity associated with these antibodies, presents as a relapsing encephalopathy with neuropsychiatric manifestations and seizures. A 15-year-old girl, initially healthy, experienced a tonic-clonic seizure. Despite unremarkable initial assessments, she returned with generalized convulsive status epilepticus. Hashimoto’s thyroiditis was suggested by elevated thyroid-stimulating hormone levels, low thyroxine levels, and high anti-thyroid antibodies, and was confirmed by ultrasound. Steroids were not used initially due to seizure cessation with anesthesia. Post-treatment with levothyroxine and antiepileptics, she was seizure-free at follow-up and eventually maintained solely on levothyroxine. Hashimoto’s encephalopathy, characterized by diverse symptoms, often necessitates corticosteroids, immunoglobulins, and plasmapheresis, as traditional anti-seizure medications fail. Further research into its etiology and pathophysiology is essential. Consider Hashimoto’s encephalopathy in unexplained seizures, especially with ineffective standard treatments. Pediatric diagnostic criteria need to be revisited.
Cystic adrenal pheochromocytoma, a very exceptional form: case report
Authors: Kabila Badr , Imrani Kaoutar , Kaddouri Soufiane , Riad Amal , Boujida Ismail , Rifai Kaoutar , Iraqi Hind , Gharbi Hassan , Bernoussi Zakia , Nassar Itimad , Billah Nabil Moatassim
Published: April 2024

A pheochromocytoma is a tumor that typically originates within the chromaffin cells of the adrenal glands, resulting in excessive production of catecholamines. Cystic forms are exceptional and pose a diagnostic challenge, especially those that are non-secreting. The most prevalent symptom associated with this condition is arterial hypertension, which can be either persistent or, more commonly, intermittent. The Ménard triad, comprising headaches, excessive sweating, and palpitations, may accompany episodes of hypertension. The presence of elevated levels of methoxylated derivatives serves to confirm the diagnosis of an adrenal pheochromocytoma. We report the case of a woman who presented with arterial hypertension associated with the Ménard triad, along with elevated methoxylated derivative levels. Imaging modalities revealed a predominantly cystic left retroperitoneal mass. The diagnosis of a cystic pheochromocytoma was established and confirmed through histological examination of the surgical specimen after adrenalectomy.
Neutrinos from Core-Collapse Supernova Explosions
Authors: Suzuki Hideyuki
Published: April 2024

The observation of supernova neutrinos from SN1987A by Kamiokande was an epoch-making event for both neutrino astronomy and supernova physics. Basic points in the standard pictures of stellar evolution and core-collapse supernovae were verified and research on them entered new advanced stages. In this article we give an overview of the supernova neutrinos emitted from core-collapse supernova explosions as well as the significance of their observations.
Development of a machine learning model and nomogram to predict seizures in children with COVID-19: a two-center study
Authors: Liu Yu-Qi , Yuan Wei-Hua , Tao Yue , Zhao Lian , Guo Wan-Liang
Published: April 2024

Objective

This study aimed to use machine learning to evaluate the risk factors of seizures and develop a model and nomogram to predict seizures in children with coronavirus disease 2019 (COVID-19).

Material and methods

A total of 519 children with COVID-19 were assessed to develop predictive models using machine learning algorithms, including extreme gradient boosting (XGBoost), random forest (RF) and logistic regression (LR). The performance of the models was assessed using area under the receiver operating characteristic curve (AUC) values. Importance matrix plot and SHapley Additive exPlanations (SHAP) values were calculated to evaluate feature importance and to show the visualization results. The nomogram and clinical impact curve were used to validate the final model.

Results

Two hundred and seventeen children with COVID-19 had seizures. According to the AUC, the RF model performed the best. Based on the SHAP values, the top three most important variables in the RF model were neutrophil percentage, cough and fever duration. The nomogram and clinical impact curve also verified that the RF model possessed significant predictive value.

Conclusions

Our research indicates that the RF model demonstrates excellent performance in predicting seizures, and our novel nomogram can facilitate clinical decision-making and potentially offer benefit for clinicians to prevent and treat seizures in children with COVID-19.
Common and Uncommon Mimics of Thoracic Malignancy on PET/CT: Part 2—Pearls and Pitfalls of Lung Parenchyma and Mediastinum
Authors: Lima Carol , Abuelroos Dena , Odisho Luke , Kolderman Nathan , Lin David , Nandalur Kiran , Moore Megan , Al-Katib Sayf
Published: April 2024

In the thorax, there are multiple benign entities that may demonstrate hypermetabolism of fluorodeoxyglucose (FDG) leading to false-positive interpretation. Part 2 of this article aims to provide an overview of some benign thoracic entities that may mimic malignancy on positron emission tomography (PET)/CT in the lung parenchyma and mediastinum. Clinical history, anatomical correlation, and imaging features can help in narrowing the differential diagnosis. This review is divided into two parts: part 1 covers the pleura and chest wall; part 2 will cover lung parenchyma and mediastinum.
Incidence and Risk Factors of Chronic Postoperative Pain in Same-day Surgery: A Prospective Cohort Study
Authors: Boko Melodie Fanay , Khanna Ashish K. , D’Aragon Frederick , Spence Jessica , Conen David , Patel Ameen , Ayad Sabry , Wijeysundera Duminda N. , Choinière Manon , Sessler Daniel I. , Carrier Francois Martin , Harlock John , Koopman Josèph S. H. A. , Durand Madeleine , Bhojani Naeem , Turan Alparslan , Pagé Gabrielle , Devereaux P. J. , Duceppe Emmanuelle ,   for the VALIANCE Study Collaborators
Published: April 2024

Background

The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.

Methods

This study assessed pain 90 days after ambulatory surgery in an international, multicenter prospective cohort study of patients at least 45 yr old with comorbidities or at least 65 yr old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change of more than 1 point in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain was defined as a score greater than 4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression.

Results

Between November 2021 and January 2023, a total of 2,054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain before surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were active smoking (odds ratio, 1.82; 95% CI, 1.20 to 2.76), orthopedic surgery (odds ratio, 4.7; 95% CI, 2.24 to 9.7), plastic surgery (odds ratio, 4.3; 95% CI, 1.97 to 9.2), breast surgery (odds ratio, 2.74; 95% CI, 1.29 to 5.8), vascular surgery (odds ratio, 2.71; 95% CI, 1.09 to 6.7), and ethnicity (i.e., for Hispanic/Latino ethnicity, odds ratio, 3.41; 95% CI, 1.68 to 6.9 and for First Nations/native persons, odds ratio, 4.0; 95% CI, 1.05 to 15.4).

Conclusions

Persistent postsurgical pain after same-day surgery is common, is usually moderate to severe in nature, and occurs mostly in patients without chronic pain before surgery.

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Single-dose Intraoperative Methadone for Pain Management in Pediatric Tonsillectomy: A Randomized Double-blind Clinical Trial
Authors: Einhorn Lisa M. , Hoang Julia , La Jong ok , Kharasch Evan D.
Published: April 2024

Background

More than 500,000 elective tonsillectomies are performed in U.S. children annually. Pain after pediatric tonsillectomy is common, often severe, and undertreated. There is no consensus on the optimal management of perioperative tonsillectomy pain. Methadone, with an elimination half-life of 1 to 2 days, has a longer duration of effect than short-duration opioids such as fentanyl. The primary objective of this study was to investigate the intraoperative use of methadone for pediatric tonsillectomy. It tested the hypothesis that methadone would result in less postoperative opioid use compared with short-duration opioids in children after tonsillectomy.

Methods

This double-blind, randomized, parallel group trial in children (3 to 17 yr) undergoing tonsillectomy compared single-dose intravenous methadone (0.1 mg/kg then 0.15 mg/kg age-ideal body weight, in a dose escalation paradigm) versus as-needed short-duration opioid (fentanyl) controls. Opioid use, pain, and side effects were assessed in-hospital and 7 days postoperatively via electronic surveys. The primary outcome was total 7-day opioid use in oral morphine equivalents per kilogram (kg). Secondary outcomes were opioid use in the postanesthesia care unit, daily pain scores, and total number of 7-day opioid doses used.

Results

Data analysis included 60 children (20/group), age 5.9 ± 3.7 yr (mean ± SD; median, 4; range, 3 to 17). Total 7-day opioid use (oral morphine equivalents per kg median [interquartile range]) was 1.5 [1.2, 2.1] in controls, 0.9 [0.1, 1.4] after methadone 0.1 mg/kg (P = 0.045), and 0.5 [0, 1.4] after methadone 0.15 mg/kg (P = 0.023). Postanesthesia care unit opioid use (oral morphine equivalents per kg) in controls was 0.15 [0.1, 0.3], 0.04 [0, 0.1] after methadone 0.1 mg/kg (P = 0.061). and 0.0 [0, 0.1] after methadone 0.15 mg/kg (P = 0.021). Postoperative pain scores were not different between groups. No serious opioid-related adverse events occurred.

Conclusions

This small initial study in children undergoing tonsillectomy found that single-dose intraoperative methadone at 0.15 mg/kg age ideal body weight was opioid-sparing compared with intermittent fentanyl.

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The Intrarater and Interrater Reliability of the OMT Classification Among Physicians With a Different Background
Authors: ten Cate Feikje Julia , Don Griot Johan Peter William , Alewijnse Juul Vera , Alsem Mattijs Willibrord , Warnink-Kavelaars Jessica , van der Zeeuw Frederique Theresia , Dekker Sarah , Lachkar Nadia , van Doesburg Margriet Harmke Maria
Published: April 2024

Background:

The Oberg–Manske–Tonkin (OMT) classification established excellent reliability scores in several validation studies. However, one study published in 2022 found much lower scores in a subanalysis of their sample when very simple anomalies were excluded. Our study assessed the reliability of the OMT among physicians with a different background, all involved in congenital hand anomaly care, and analyzed codes with less agreement. Time required for classification was recorded to give an indication on its usability.

Methods:

One hundred digital cases were classified twice with a minimal 1-month time interval, with the use of the 2020 version of the OMT. Two pediatric hand surgeons, 2 rehabilitation specialists, and 2 plastic surgery residents participated in this reliability analysis. The use of multiple codes was allowed. The intra- and interrater reliability was assessed for all 15 possible rater couples by calculating percentage of agreement. Cohen's kappa was calculated along with a 95% confidence interval. For the analysis of individual codes with less agreement, we calculated positive agreement with the use of a summed agreement table. Time necessary for classification was documented in seconds.

Results:

The inter- and intrarater agreement was moderate with a mean Cohen's kappa of 0.45 and 0.60 retrospectively. On average, 39 seconds per case were necessary for the first and 24 seconds for the second rating. Background did not influence the level of agreement. Lowest agreement levels (ie, lowest positive agreement) were observed with all the arthrogryposis multiplex congenita subgroups, the “other” subgroups of isolated congenital contractures, syndromic syndactyly, and synpolydactyly. Codes commonly used interchangeably were symbrachydactyly and transverse deficiency and the distinction between these anomalies of only the hand or the entire upper limb; symbrachydactyly and brachydactyly; and camptodactyly and distal arthrogryposis.

Conclusions:

Our study showed a moderate reliability, emphasizing the complexity of this heterogeneous patient population. Despite its imperfections, the OMT remains the best and most versatile classification tool at hand. Its main purpose may lie in contributing to a universal language for research.

Level of Evidence:

I
Long-term Outcomes of Surgically Treated Congenital Dislocation of the Knee
Authors: Honcharuk Erin M. , Jeans Kelly A. , Polk Jordan L. , Johnston Charles E.
Published: April 2024

Background:

Congenital dislocation of the knee (CDK) may be idiopathic or associated with another condition, such as Larsen syndrome or arthrogryposis. Surgical reduction of type-3 dislocation may require quadricepsplasty (QP) or femoral diaphyseal shortening (FS). Because it is unknown which treatment is more effective, we evaluated long-term outcomes using patient-reported questionnaires and gait analysis, comparing results by surgery type and underlying diagnosis.

Methods:

Twelve patients (mean age, 19 mo) were treated surgically for CDK from 1985 to 2015 and studied 9 to 30 years postoperatively. Three participants had idiopathic CDK, 5 had Larsen syndrome, and 4 had arthrogryposis. Eleven knees underwent QP and 7 underwent FS. Participants were evaluated in our movement science laboratory and completed patient-reported outcome questionnaires. Data were compared with healthy, age-matched control values at the same visit.

Results:

Surgically treated knees had less flexion during swing (P<0.01), less overall motion (P<0.01), greater coronal instability (P<0.04), and slower gait (P<0.01) compared with controls. QP knees had more instability in midstance (P=0.03) and less flexion during gait compared with FS knees, less sagittal power generation than controls (P<0.01), and trended toward lower scores on Knee Injury and Osteoarthritis Outcome and Lysholm Knee Questionnaires than FS patients did. The idiopathic group had the gait most similar to that of controls, followed by the Larsen syndrome group and then the arthrogryposis group. The idiopathic group also had a better UCLA Activity Score (P=0.03) than the arthrogryposis group did.

Conclusions:

Surgical treatment of type-3 CDK will not likely restore normal knee function, suggesting teratologic joint abnormality. In this small series, FS produced better gait mechanics and patient-reported outcomes compared with QP. Not surprisingly, patients with idiopathic CDK had better outcomes than those with a syndromic diagnosis, likely related to having only a single joint affected.

Level of Evidence:

Level III.
Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study
Authors: Beagle Alexander J. , Prasad Priya A. , Hubbard Colin C. , Walderich Sven , Oreper Sandra , Abe-Jones Yumiko , Fang Margaret C. , Kangelaris Kirsten N.
Published: April 2024

OBJECTIVES:

To evaluate the relationship between early IV fluid volume and hospital outcomes, including death in-hospital or discharge to hospice, in septic patients with and without heart failure (HF).

DESIGN:

A retrospective cohort study using logistic regression with restricted cubic splines to assess for nonlinear relationships between fluid volume and outcomes, stratified by HF status and adjusted for propensity to receive a given fluid volume in the first 6 hours. An ICU subgroup analysis was performed. Secondary outcomes of vasopressor use, mechanical ventilation, and length of stay in survivors were assessed.

SETTING:

An urban university-based hospital.

PATIENTS:

A total of 9613 adult patients were admitted from the emergency department from 2012 to 2021 that met electronic health record-based Sepsis-3 criteria. Preexisting HF diagnosis was identified by the International Classification of Diseases codes.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 1449 admissions from patients with HF. The relationship between fluid volume and death or discharge to hospice was nonlinear in patients without HF, and approximately linear in patients with HF. Receiving 0–15 mL/kg in the first 6 hours was associated with lower likelihood of death or discharge to hospice compared with 30–45 mL/kg (odds ratio = 0.61; 95% CI, 0.41–0.90; p = 0.01) in HF patients, but no significant difference for non-HF patients. A similar pattern was identified in ICU admissions and some secondary outcomes. Volumes larger than 15–30 mL/kg for non-HF patients and 30–45 mL/kg for ICU-admitted non-HF patients were not associated with improved outcomes.

CONCLUSIONS:

Early fluid resuscitation showed distinct patterns of potential harm and benefit between patients with and without HF who met Sepsis-3 criteria. Restricted cubic splines analysis highlighted the importance of considering nonlinear fluid outcomes relationships and identified potential points of diminishing returns (15–30 mL/kg across all patients without HF and 30–45 mL/kg when admitted to the ICU). Receiving less than 15 mL/kg was associated with better outcomes in HF patients, suggesting small volumes may be appropriate in select patients. Future studies may benefit from investigating nonlinear fluid–outcome associations and a focus on other conditions like HF.