bluuebunny/crossref_metadata_2025 huggingface dataset:
A Typology for Rural Residency Training
Authors: Longenecker Randall , Bell Darin , Patterson Davis G.
Published: November 2024

Until rural track program definitions were recently established in regulation and accreditation,1 there was no widely accepted classification system for rural graduate medical education (GME), making it difficult to conduct educational research, compare published results, or navigate the maze of options available to residency applicants. This typology for rural residency training, refined in use by rural medical educators, student applicants, and researchers2,3 over the past 2 decades, addresses varying degrees of required rurally located training, rural focus, and rural graduate placement outcomes. Acknowledging the range and differences across rural and frontier communities, this typology considers to be rural a geographic location that is rural by any 2 of the more than 75 federal definitions that exist (e.g., Core-Based Statistical Areas, Rural-Urban Commuting Area codes). For 8 common federal definitions, see RHIhub’s “Am I Rural?” Tool at https://www.ruralhealthinfo.org/am-i-rural.
Incidence and Long-term Follow-up of Pediatric Lateral Condyle Fractures: A Population-based Study
Authors: Wellings Elizabeth P. , Sullivan Mikaela H. , Thapa Prabin , Grigoriou Emmanouil , Stans Anthony A. , Shaughnessy William J. , Larson A. Noelle , Milbrandt Todd A.
Published: November 2024

Objective:

Lateral condyle fractures are the second most common pediatric elbow fracture after supracondylar humeral fractures. Early complications are frequent which can lead to development of long-term problems. Current literature has evaluated short-term outcomes, but few studies have investigated long-term outcomes into adulthood. Our hypothesis is that the majority of pediatric patients with a lateral condyle fracture will have minimal complications and few surgeries as they age.

Methods:

A population-based database was used to identify patients who sustained a lateral condyle fracture before the age of 18 between 1966 and 2012. Electronic medical records from all treatment centers in the county were reviewed for clinical and radiographic data. Analysis was performed to determine incidence and long term outcomes based on fracture type and treatment.

Results:

From 1966 to 2012, 227 pediatric lateral condyle fractures were identified. One hundred seventy-seven fractures (78%) had at least 10 year clinical follow up. Incidence was found to be 13.97 per 100,000. We identified 80 (45%) Weiss type 1, 61 (34%) type 2, and 37 (21%) type 3 fractures. The overall complication rate was 17%, of which 47% were identified >10 years from injury. There was no significant difference in complication rates based on fracture type (P = 0.18) or treatment type (P = 0.55). The most common complication was malunion (n = 15), followed by fishtail deformity (n = 4), stiffness (n = 3), lateral epicondylitis (n = 3), nonunion (n = 2), osteoarthritis (n = 2), and tardy ulnar nerve palsy (n = 1). Five patients underwent revision surgery for nonunion, cubitus valgus, malunion with loose bodies, capitellar osteochondral dessicans with malalignment, and ulnar nerve palsy.

Conclusions:

This population-based study estimated the overall incidence of pediatric lateral condyle fractures to be 14 per 100,000. Displaced fractures had a higher incidence than undisplaced fractures. Complications beyond 10 years are rare, but the need for future revision surgery is possible, therefore, proper patient and family education is necessary at the time of injury. This is the largest study with the longest follow-up for pediatric lateral condyle fractures. Complications were rare but resulted in a 17% complication rate and a 3% reoperation rate at a minimum.

Level of Evidence:

Level III.
Changes in Segmental and Lumbar Lordosis Following Lumbar Interbody Fusion
Authors: Lechtholz-Zey Elizabeth A. , Ayad Mina , Gettleman Brandon S. , Mills Emily S. , Shelby Hannah , Ton Andy , Karakash William J. , Shah Ishan , Wang Jeffrey C. , Alluri Ram K. , Hah Raymond J.
Published: November 2024

Study Design:

Systematic review and meta-analysis.

Objective:

To compare radiographic outcomes across lumbar interbody fusion (LIF) techniques, assessing segmental and global lumbar lordosis restoration.

Summary of Background Data:

LIF is a commonly utilized procedure to treat various spinal conditions, including degenerative pathology and adult spinal deformity. Common approaches include posterior LIF (PLIF), transforaminal LIF (TLIF), anterior LIF (ALIF), oblique LIF (OLIF), and lateral LIF (LLIF).

Methods:

A systematic review and meta-analysis were carried out using PRISMA guidelines with appropriate MeSH terms. Papers were included based on relevance, number of patients, and a minimum of 1-year radiographic follow-up. Radiographic outcomes included segmental lordosis (SL) and lumbar lordosis (LL). Only papers directly comparing SL restoration between two or more LIF techniques were utilized in the systematic review, while all articles meeting the aforementioned criteria were used in the meta-analysis.

Results:

Nineteen studies were included in the final systematic review, and 88 papers were included in the meta-analysis. Seven studies in the systematic review showed a significantly higher increase in SL with ALIF versus TLIF, and two showed significantly higher SL gain with ALIF compared with LLIF. When comparing ALIF versus OLIF, one study favored ALIF, while another favored OLIF for SL restoration. OLIF likewise demonstrated superior restoration of SL compared with TLIF. LLIF demonstrated improved SL restoration compared with TLIF in 2 of the 3 studies comparing the 2 procedures. Furthermore, both ALIF and OLIF demonstrated superior LL restoration compared with TLIF in 4 and 3 studies, respectively. The meta-analysis results demonstrated that ALIF provided significantly better restoration of SL than TLIF, LLIF, and OLIF, while TLIF conferred significantly lower SL restoration than ALIF and OLIF. Similarly, LL restoration was significantly reduced with TLIF relative to OLIF and LLIF (all P<0.05).

Conclusions:

The included studies demonstrated superior SL and LL restoration with ALIF, OLIF, and LLIF compared with TLIF. ALIF improved SL to a greater extent when directly compared with all other interbody techniques.
Induction Agents for Tracheal Intubation in Critically Ill Patients
Authors: Kotani Yuki , Russotto Vincenzo
Published: November 2024

OBJECTIVES:

Concise definitive review of the use of induction agents in critically ill patients undergoing tracheal intubation and their association with outcomes.

DATA SOURCES:

Original publications were retrieved through a PubMed search with search terms related to induction agents for tracheal intubation in critically ill patients.

STUDY SELECTION:

We included randomized controlled trials and observational studies that reported patient outcomes.

DATA EXTRACTION:

Data from included studies, including choice of induction agents and clinically relevant outcomes, were extracted.

DATA SYNTHESIS:

Etomidate and ketamine have been the most studied induction agents in critical care during last years. Recent studies on etomidate investigated the clinical impact of its recognized adrenal suppression in terms of morbidity and mortality. Etomidate may carry a non-negligible mortality risk without definitive hemodynamic benefits compared with ketamine. Available data then support the use of ketamine over etomidate, since the difference in the hemodynamic profile seems to be of minor clinical relevance. No multicenter randomized studies are available comparing propofol to other induction agents but evidence from a large observational study identified an association of propofol with post-intubation cardiovascular instability in critically ill patients. Despite the observational nature of these findings cannot exclude the role of confounders, the association of propofol with post-induction cardiovascular instability is pharmacologically plausible, justifying its avoidance in favor of drugs with a better safety profile in critical care such as ketamine.

CONCLUSIONS:

Although no definitive conclusions can be drawn based on the available evidence, recent evidence pointed out the potential negative effect of etomidate on survival and the association of propofol with cardiovascular instability. Ketamine may be considered the drug with a safer profile, widespread availability and low cost but future research should provide definitive data on optimal drug selection, its dosage in the context of critical illness and concomitant interventions to minimize the risk of peri-intubation complications.
Advancing Delirium Treatment Trials in Older Adults: Recommendations for Future Trials From the Network for Investigation of Delirium: Unifying Scientists (NIDUS)
Authors: Devlin John W. , Sieber Frederick , Akeju Oluwaseun , Khan Babar A. , MacLullich Alasdair M. J. , Marcantonio Edward R. , Oh Esther S. , Agar Meera R. , Avelino-Silva Thiago J. , Berger Miles , Burry Lisa , Colantuoni Elizabeth A. , Evered Lis A. , Girard Timothy D. , Han Jin H. , Hosie Annmarie , Hughes Christopher , Jones Richard N. , Pandharipande Pratik P. , Subramanian Balachundhar , Travison Thomas G. , van den Boogaard Mark , Inouye Sharon K. ,   on behalf of the Network for Investigation of Delirium: Unifying Scientists (NIDUS) Writing Group
Published: November 2024

OBJECTIVES:

To summarize the delirium treatment trial literature, identify the unique challenges in delirium treatment trials, and formulate recommendations to address each in older adults.

DESIGN:

A 39-member interprofessional and international expert working group of clinicians (physicians, nurses, and pharmacists) and nonclinicians (biostatisticians, epidemiologists, and trial methodologists) was convened. Four expert panels were assembled to explore key subtopics (pharmacological/nonpharmacologic treatment, methodological challenges, and novel research designs).

METHODS:

To provide background and context, a review of delirium treatment randomized controlled trials (RCTs) published between 2003 and 2023 was conducted and evidence gaps were identified. The four panels addressed the identified subtopics. For each subtopic, research challenges were identified and recommendations to address each were proposed through virtual discussion before a live, full-day, and in-person conference. General agreement was reached for each proposed recommendation across the entire working group via moderated conference discussion. Recommendations were synthesized across panels and iteratively discussed through rounds of virtual meetings and draft reviews.

RESULTS:

We identified key evidence gaps through a systematic literature review, yielding 43 RCTs of delirium treatments. From this review, eight unique challenges for delirium treatment trials were identified, and recommendations to address each were made based on panel input. The recommendations start with design of interventions that consider the multifactorial nature of delirium, include both pharmacological and nonpharmacologic approaches, and target pathophysiologic pathways where possible. Selecting appropriate at-risk patients with moderate vulnerability to delirium may maximize effectiveness. Targeting patients with at least moderate delirium severity and duration will include those most likely to experience adverse outcomes. Delirium severity should be the primary outcome of choice; measurement of short- and long-term clinical outcomes will maximize clinical relevance. Finally, plans for handling informative censoring and missing data are key.

CONCLUSIONS:

By addressing key delirium treatment challenges and research gaps, our recommendations may serve as a roadmap for advancing delirium treatment research in older adults.
Myoclonus After Cardiac Arrest: Need for Standardization—A Systematic Review and Research Proposal on Terminology
Authors: De Stefano Pia , Leitinger Markus , Misirocchi Francesco , Quintard Hervé , Degano Giulio , Trinka Eugen
Published: November 2024

OBJECTIVES:

Although myoclonus less than or equal to 72 hours after cardiac arrest (CA) is often viewed as a single entity, there is considerable heterogeneity in its clinical and electrophysiology characteristics, and its strength of association with outcome. We reviewed definitions, electroencephalogram, and outcome of myoclonus post-CA to assess the need for consensus and the potential role of electroencephalogram for further research.

DATA SOURCES:

PubMed, Embase, and Cochrane databases.

STUDY SELECTION:

English-language adult (≥ 18 yr) studies from 1966 to May 31, 2024, reporting myoclonus, myoclonic status/status myoclonus (MyS/SM), myoclonic status epilepticus (MSE), and/or early Lance-Adams Syndrome (eLAS) less than or equal to 72 hours post-CA. All study designs were independently screened by two authors.

DATA EXTRACTION:

Data on patients presenting myoclonus, MyS/SM, MSE, and eLAS less than or equal to 72 hours post-CA, along with their definitions, electroencephalogram, and outcomes were extracted. The Newcastle-Ottawa Scale and Cochrane-Risk-of-Bias Assessment tool were used to evaluate study quality (PROSPERO n.CRD42023438107).

DATA SYNTHESIS:

Of 585 identified articles, 119 met the inclusion criteria, revealing substantial heterogeneity in definitions, electroencephalogram, and outcomes. Among 3881 patients, myoclonus was reported in 2659, MyS/SM in 883, MSE in 569, and eLAS in 40. Among patients with a defined outcome, a Cerebral Performance Category (CPC) scale of 1–2 was reported in 9.8% of patients with myoclonus, 5.8% with MyS/SM, 5.7% with MSE, and 82.0% with eLAS. Electroencephalogram was recorded in 2714 patients (69.9%). CPC of 1–2 was observed in 1.6% of patients with suppression/suppression burst (SB)/unreactive (U) electroencephalogram, 11.3% with non-SB/U electroencephalogram and status epilepticus (SE), and 22.3% with non-SB/U electroencephalogram without SE.

CONCLUSIONS:

Heterogeneity in definitions resulted in weak associations with outcomes. We propose to investigate myoclonus by including related electroencephalogram patterns: myoclonus associated with suppression/SB background electroencephalogram, myoclonus with nonsuppression/SB background but SE-electroencephalogram, and myoclonus with nonsuppression/SB background without SE-electroencephalogram. This pragmatic research approach should be validated in future studies.
Microneedling in Localized Acquired Hypomelanosis: A Randomized Controlled Trial
Authors: Elhoshy Khaled , Ibrahim Julbahar , Hafez Vanessa
Published: November 2024

BACKGROUND

Several insults can cause acquired localized hypomelanosis which can be a therapeutic challenge. Microneedling is a minimally invasive procedure that stimulates melanogenesis with the benefit of short downtime and a low risk of scarring.

OBJECTIVE

To determine the efficacy and safety of microneedling in localized acquired hypomelanosis.

MATERIALS AND METHODS

This is a randomized controlled trial. Twenty patients aged 18 years and older had their lesions randomized into either a single session of microneedling with 1.5-mm needles or no treatment. Three months later, peripheral tanning, patient satisfaction, surface tanning grade of improvement, Vitiligo Extent Score for a Target Area (VESTA), patient and physician global assessment of improvement (GAI) were evaluated.

RESULTS

Median peripheral tanning was observed in 80% of lesions in the microneedling arm versus 85% in the no-treatment arm. Median physician GAI was 37.5% versus 33.33%, respectively. Median VESTA was 37.5% versus 29%, respectively. Median Patient GAI was 50% in both arms. Surface tanning showed a median increase of +3 grades in both arms.

CONCLUSION

Medium-depth microneedling deserves a place in the armamentarium of therapeutic tools for localized acquired hypomelanosis in normal-texture and scarred skin. The authors suggest repetitive sessions at intervals of 1 to 2 months to offer better coverage. Interestingly, a possible systemic effect of microneedling deserves further investigation.
Low-level PM2.5 Exposure, Cardiovascular and Nonaccidental Mortality, and Related Health Disparities in 12 US States
Authors: Peralta Adjani A. , Castro Edgar , Danesh Yazdi Mahdieh , Kosheleva Anna , Wei Yaguang , Schwartz Joel
Published: November 2024

Background

Investigations into long-term fine particulate matter (PM2.5) exposure’s impact on nonaccidental and cardiovascular (CVD) deaths primarily involve nonrepresentative adult populations at concentrations above the new Environmental Protection Agency annual PM2.5 standard.

Methods

Using generalized linear models, we studied PM2.5 exposure on rates of five mortality outcomes (all nonaccidental, CVD, myocardial infarction, stroke, and congestive heart failure) in 12 US states from 2000 to 2016. We aggregated predicted annual PM2.5 exposures from a validated ensemble exposure model, ambient temperature from Daymet predictions, and mortality rates to all census tract–years within the states. We obtained covariates from the decennial Census and the American Community Surveys and assessed effect measure modification by race and education with stratification.

Results

For each 1-µg/m3 increase in annual PM2.5, we found positive associations with all five mortality outcomes: all nonaccidental (1.08%; 95% confidence interval [CI]: 0.96%, 1.20%), all CVD (1.27%; 95% CI: 1.14%, 1.41%), myocardial infarction (1.89%; 95% CI: 1.67%, 2.11%), stroke (1.08%; 95% CI: 0.87%, 1.30%), and congestive heart failure (2.20%; 95% CI: 1.97%, 2.44%). Positive associations persisted at <8 µg/m3 PM2.5 levels and among populations with only under 65. In our study, race, but not education, modifies associations. High-educated Black had a 2.90% larger increased risk of CVD mortality (95% CI: 2.42%, 3.39%) compared with low-educated non-Black.

Conclusion

Long-term PM2.5 exposure is associated with nonaccidental and CVD mortality in 12 states, below the new Environmental Protection Agency standard, for both low PM2.5 regions and the general population. Vulnerability to CVD mortality persists among Black individuals regardless of education level.
Knowledge and awareness about inflammatory articular diseases: a cross sectional survey from a Syrian population
Authors: Ali Diaa H. , Debiat Moussab , Kudsi Maysoun
Published: November 2024

Introduction:

Inflammatory articular diseases are autoimmune diseases that affect mainly joints, muscles, and systemic organs, leading to a public health challenge for the world. Patient participation in health care is essential, especially regarding chronic or life-threatening diseases. In inflammatory articular diseases, educating patients contributes positively to their psychological well-being, adherence to therapy, global assessment, rate of depression, and functional disability. The overall level of information about these diseases is low among patients living as demonstrated by studies. We aim in our research to assess the knowledge and awareness of these diseases in a sample of the Syrian population.

Methods:

The survey was conducted in Damascus, Syria, between 1 December 2021 and 1 December 2022 on participants. The validity and reliability of the survey were confirmed in a pilot test with 30 participants. After confirmation, participants were directed to the survey to complete questions around socio-demographic data, and knowledge and awareness questions about inflammatory articular diseases. We ranked our participants into five levels: excellent, good, average, bad, and very bad. Fisher’s exact test, and the Chi-squared test for comparison between the groups. Tests are considered statistically significant when P < 0.05.

Results:

A total of 641 participants with a mean age of 28.5 were included. 54.45% of them were female. 50.39% of participants related to the medical field, 23.09% have a family history of inflammatory articular diseases, and 17.94% described themselves as having an inflammatory articular disease. Rheumatoid arthritis was the most frequently reported disease among our study sample participants. Finally, the respondents gave the right answer to a mean of 8.45 statements out of 20 statements.

Conclusion:

More educational programs by healthcare professionals are needed to increase the knowledge and awareness about these diseases in Syria.
Medical treatment of primary sclerosing cholangitis: What have we learned and where are we going?
Authors: Karlsen Tom H. , Kaasen Jørgensen Kristin , Bergquist Annika
Published: November 2024

It has proven difficult to establish robust evidence for significant clinical benefits of medical treatment in primary sclerosing cholangitis (PSC). For ursodeoxycholic acid, clinical practice guidelines only offer vague recommendations, leading to a situation of variable prescription rates depending on local reimbursement policies and physician preference. The difficulty in drug development in PSC is partly related to a poor understanding of critical disease processes with failure to identify relevant mechanisms of action of putative drugs. The variable disease course, both intra-individually and between individuals, and the lack of robust definitions of what success looks like for clinical trials in PSC have also contributed to the negative outcomes of trials performed. In this review article, we will discuss these uncertainties and challenges, building on key previous and ongoing clinical trials. Despite the lack of consensus for ideal phase II and phase III study designs, several trials for diverse compounds are currently ongoing, indicating a shift from therapeutic nihilism toward hope for people with PSC. While waiting for robust efficacy data for drugs currently being tested, the current lack of effective interventions should not motivate the prescription of compounds to people with PSC based on low-quality evidence.
National Trends, Mortality and Outcomes in Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in the United States
Authors: Krittanawong Chayakrit , Ang Song Peng , Qadeer Yusuf Kamran , Wang Zhen , Alam Mahboob , Jneid Hani , Sharma Samin
Published: November 2024

Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have become increasingly utilized in patients undergoing percutaneous coronary intervention (PCI). Despite these purported advantages, prior reports regarding the use of IVUS and OCT have indicated that contemporary use of intravascular imaging remains low with significant regional variation. Here, we present the findings of an updated contemporary analysis regarding the use of IVUS/OCT-guided PCI versus angiography-guided PCI in the United States. We also evaluated in-hospital mortality and clinical outcomes between IVUS/OCT-guided PCI versus angiography-guided PCI-only over million patients in the United States. There has been a significant decrease in the number of PCIs performed, while there has been increasing in the trend of IVUS/OCT-guided PCI over this period. Most importantly, we found that IVUS/OCT-guided PCI was associated with better clinical outcomes in terms of in-hospital mortality, compared with angiography-guided PCI.
Impact on Distance and Near Contrast Sensitivity of Multifocal Contact Lenses: A Systematic Review
Authors: Mena-Guevara Kevin J. , de Fez Dolores , Piñero David P.
Published: November 2024

Purpose:

To investigate the impact on distance and near contrast sensitivity (CS) after fitting multifocal contact lenses (MFCLs) for presbyopia correction according to the scientific evidence already published.

Methods:

Three bibliographic search was conducted on PubMed, Web of Sciences, and Scopus. Inclusion criteria were articles written in English evaluating distance and/or near CS in presbyopic patients using MFCLs, controlled clinical trials, and articles published from 2000 to 2024. After reading and analyzing carefully the articles that were finally included, the Critical Appraisal Skills Programme (CASP) tool for clinical trials was used to evaluate the quality of the research.

Results:

A total of eight articles were considered. One study did not find significant changes in binocular contrast sensitivity function (CSF) after fitting center-distance MFCL (CD) in the dominant eye and a center-near (CN) in the nondominant eye. Another research did not detect significant differences comparing CN MFCLs with monovision. However, another study found significant differences when comparing CN MFCL with spectacles. Half of studies only reported the comparison in CSF among different MFCL designs, with two studies confirming worse visual performance with MFCLs compared to pinhole contact lenses. Concerning the CASP analysis, some level of variability in the quality scores was found, with 5/13 in three studies, 6/13 in three studies, 7/13 in one study, and 8/13 in one study.

Conclusions:

The limited evidence on the impact on CS of using MFCLs does not allow to extract consistent generalizable conclusions, with only three studies suggesting a variable impact and no evidence of the real clinical benefit of using this metric for the evaluation and optimization of MFCL fitting. More research is needed on this topic.
Pilot Study of Weighted Blankets on Agitation
Authors: Dimas Adrianne , Lober Angela , Reeves Renae
Published: November 2024

BACKGROUND: Hospitalized patients who have had neurological trauma often require interventions to reduce agitation. Weighted blankets deliver deep pressure touch stimulation, which influences parasympathetic activity through increased vagal tone, to induce calmness and reduce sympathetic activation and reduction of the stress response. The purpose of this study was to investigate the effect of weighted blankets as an intervention on agitation scores in hospitalized adults who have experienced neurologic trauma. METHOD: This was a quasi-experimental design, pilot study with a convenience sample of patients who experienced neurological trauma. Participants who met the inclusion criteria received a weighted blanket that remained in place for 30 minutes. The Agitated Behavior Scale was used to measure the effect of the weighted blanket before and after the intervention with each participant serving as their own control. RESULTS: Twelve participants were included in the study. Related-samples Wilcoxon signed rank test indicated a significant difference for heart rate (P = .05) and Agitated Behavior Scale scores (P = .005). There were no significant differences with blood pressure or oxygen saturation levels. CONCLUSION: This pilot study demonstrated a reduction in agitation scores with the use of a weighted blanket. The deep pressure touch stimulation provided by a weighted blanket may provide a low-risk intervention to decrease agitation and prevent escalation. Future studies with larger sample sizes may demonstrate weighted blankets to decrease agitation and provide an adjunct therapy for patients.
Dynamic gene expression pattern in zebrafish gallbladder: an experimental study
Authors: Tanwar Pranay , Bhattacharya Debashruti , Dasari Abhilash , Bijwe Manthan , Rana Rashmi , Gupta Ishaan , Minocha Shilpi
Published: November 2024

Gallbladder cancer (GBC) is one of the common biliary tract malignancies that is often associated with late presentation of clinical symptoms resulting in poor prognosis, thereby considerably increasing the mortality rate. Geographic and ethnic variations are one of the major causes of GBC incidence. However, in addition to genetic susceptibility to GBC, other factors like age, obesity, sex, and exposure to certain heavy chemicals may also lead to the incidence of GBC. Most of GBC research has so far used traditional cell culture systems. Recently, newer approaches using 2D and 3D cultures, xenograft models, and organoids are also becoming popular. However, whole organism model systems for GBC research have not yet been established. In this study, the authors propose the use of zebrafish as a model organism to study GBC. However, the zebrafish gallbladder is relatively unexplored besides the anatomical features. Here, the authors unravel and then compare the unique transcriptomic profile of zebrafish gallbladder with humans to identify genes consistently expressed in both species. The authors provide a comprehensive list of all gallbladder specific genes in zebrafish that also have their orthologous counterparts in humans. Therefore, they can be used as potential biomarkers for gallbladder transcriptomic profile. To the best of our knowledge, this is the only study so far to provide a complete genomic expression profile of zebrafish gallbladder along with an exhaustive cross-species comparison, thus paving the path for using zebrafish as a model organism to study GBC and help identify novel biomarkers for its early detection and diagnosis.
Feasibility of long-range telesurgical robotic radical gastrectomy in a live porcine model
Authors: Chia Daryl Kai Ann , Suda Koichi , Ho Wei-En , Lee Bu Sung , Suzuki Kazumitsu , Shibasaki Susumu , Harada Tatsuhiko , Murai Jun , Oe Masafumi , Asai Hirochika , Tomine Takashi , Sato Hirotaka , Yoro Masahiro , Ohashi Masanao , Kitatsuji Hiroaki , Green Simon Peter , Xiong Ying , Shabbir Asim , Lomanto Davide , So Jimmy Bok Yan , Kim Guowei , Uyama Ichiro
Published: November 2024

Background:

Telesurgery has been made increasingly possible with the advancements in robotic surgical platforms and network connectivity. However, long-distance transnational complex robotic surgeries such as gastrectomy have yet to be attempted.

Methods:

Multiple transnational network connections by Science Innovation Network (SINET), Japan Gigabit Network (JGN), and Arterial Research and Education Network in Asia-Pacific (ARENA-PAC) were established and tested by multiple surgeons in a dry box model. Surgeons’ perceptions of the different networks were recorded. Three robotic radical D2 gastrectomies in live porcine models were performed at a hospital in Toyoake, Japan, by a surgical team in a hospital in Singapore ~5000 km away, using the hinotori Surgical Robot System (Medicaroid Corporation).

Results:

The live porcine robotic gastrectomies were all completed in under 205 min with no intraoperative complications. From the different networks that were tested, the differences in latency ranged from 107 to 132 ms and did not translate to any significant differences in surgeon timings and perceptions.

Conclusions:

Transnational telesurgical radical D2 gastrectomy is feasible in a porcine model. There is no appreciable difference between surgeon performance and perception with network latencies of 107–132 ms. Long-range telesurgery as clinical practice may become possible in the future.
Cardiac Arrest in the Setting of Left Lung Herniation Following Combined Heart-Lung Transplant: Case Report
Authors: ElSaban Mariam , Radosevich Misty A. , Pennington Kelly M. , Spencer Philip J. , Wittwer Erica D.
Published: November 2024

A 40 year old woman who underwent combined heart-lung transplant for familial severe pulmonary hypertension experienced episodes of nonsustained ventricular tachycardia followed by sudden ventricular fibrillation arrest 8 days after transplant. Postarrest investigations revealed left lower lobe herniation into the right lower hemithorax, prompting emergent reoperation, and hernia reduction. Arrhythmias resolved following reduction of the herniated lung and facilitated rapid weaning from vasopressor and ventilatory support. To our knowledge, this is the first reported case of cardiac arrest due to lung herniation after combined heart-lung transplantation. Herein, we describe this rare presentation and offer insights and management strategies for the cardiac intensivist.
The triglyceride-glucose index as a new predictor of coronary artery complexity in elderly patients with non-ST-segment elevation acute coronary syndrome
Authors: Erbay Ilke , Gudul Naile Eris , Kokturk Ugur , Avci Ahmet
Published: November 2024

Background

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has a significant impact on cardiovascular mortality in elderly patients. Identification of high-risk patients is essential to optimize clinical management. This study investigates the relationship between the TyG index and CAD complexity, as measured by the SYNTAX score, in elderly patients with NSTE-ACS.

Methods

We performed a retrospective analysis of 216 patients aged >65 years undergoing coronary angiography stratified according to tertiles of the TyG index and the SYNTAX score (SYNTAX score ≤ 22 versus SYNTAX score > 22).

Results

After adjustment for confounders, the TyG index was identified as an independent predictor of moderate/high scores (SYNTAX score > 22). As a continuous variable, it was significantly associated with moderate/high SYNTAX scores in both diabetic (P = 0.003) and nondiabetic groups (P = 0.004). When presented as a categorical variable, the TyG index remained a significant predictor after adjustment for sex, hypertension, BMI, and glomerular filtration rate. Compared with the T1 group, the risk of a moderate/high SYNTAX score was 5.410-fold (95% CI: 1.034–28.315; P = 0.046) and 7.774-fold (95% CI: 1.836–32.916; P = 0.005) higher in the T2 and T3 groups, respectively. The TyG index showed superior predictive ability for CAD complexity with an AUC of 0.747 compared with the AUC of 0.624 for HbA1c (P = 0.005).

Conclusion

This study showed that the TyG index is an independent predictor of moderate/high SYNTAX scores in elderly patients with NSTE-ACS, demonstrating superior predictive performance compared to HgA1c and highlighting its potential as a valuable tool for assessing CAD severity in this population.
Patient-Reported Outcome Measures in Routine Hematology Cancer Care
Authors: Kirkpatrick Suriya , Campbell Karen , Harding Samantha , Rudd Sarah
Published: November 2024

Background

Hematological cancers have devastating effects on patients’ physical, emotional, and psychosocial health. There is growing evidence to support the use of patient-reported outcome measures (PROMs) through validated tools. Although PROMs are widely adopted in oncology, uptake in hematology remains limited in routine clinical care.

Objective

This review seeks to explore the utility of PROMs in routine hematology clinical practice and to understand the extent and type of evidence in relation to benefits of PROMs to patients.

Methods

The review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analysis scoping review model for organizing information.

Results

Ten thousand and seventy-one articles were identified, 110 full texts were reviewed, and 14 articles met the final inclusion criteria. More than 20 individual outcome measures were identified that fell into the following categories: accessibility and usability, self-efficacy, shared decision-making, and implementation.

Conclusions

Studies focused primarily on the choice of PROM, acceptability and usability, motivation for use, patient and healthcare professionals’ experience of using PROMs, the stated value of PROMs, and implementation advice. However, there are limited published studies supporting how PROMs can be adopted into routine care for people with hematological cancer.

Implications for Practice

There are various validated PROMs but limited research on how to meaningfully implement them to improve clinical and patient outcomes in the routine care of hematology patients.
The Chief Nurse Executive as a Commissioner
Authors: Pappas Sharon
Published: November 2024

The Chairperson of the Commission on Magnet®, Dr Sharon Pappas, discusses her history in leadership and the role of Magnet designation on her trajectory. Dr Pappas presents her thoughts about the direction of the Commission on Magnet for the future, based on the successes of the past.
Practical Steps Supporting Professional Publications for Leadership and Teams
Authors: Kim Hannah Jang , Latham Christine , Krom Zachary , Failla Kim , Kawar Lina Najib
Published: November 2024

Disseminating research or evidence-based practice is not straightforward. As more clinical nurses, executive nurse leaders, nurse scientists, and faculty contribute to new knowledge, there is an increasing need to support the processes to publish and disseminate manuscripts to advance healthcare. Nurse administrators and leaders are key influencers and supporters to bolster expertise and resources to publish. This article provides nurse leaders and administrators clear, actionable steps to enable successful publication outcomes.
Self-Regulated and Strategic Learning Practices as Predictors of Academic Performance in Novice Nursing Students
Authors: Eilts Jennifer S.
Published: November 2024

Background:

Promoting the success and retention of novice nursing students requires a better understanding of how self-regulated and strategic learning approaches impact academic performance.

Purpose:

The purpose of this correlational study was to determine if there was a predictive relationship between the results of a self-regulated learning assessment and final grades in a foundational nursing course.

Methods:

The Learning and Study Strategies Inventory (LASSI) was used to collect data from a convenience sample of 75 students enrolled in an entry-level nursing course across 4 prelicensure programs. Scores were analyzed alongside demographic data and numeric grades at the end of the semester.

Results:

Results demonstrated the significant predictive abilities of LASSI scores related to Anxiety, Concentration, Information Processing, Motivation, and Test Strategies. Additionally, non-native English speakers experienced significantly lower course grades.

Conclusions:

Nurse educators can improve student performance in an introductory course by teaching and modeling self-regulated and strategic learning practices.
Predicting deep infection in pilon and tibial plateau fractures: a secondary analysis of the VANCO and OXYGEN trials
Authors: Overmann Archie L. , Carlini Anthony R. , O'Toole Robert V. , Castillo Renan C. , O'Hara Nathan N. ,   METRC
Published: November 2024

Objectives:

To develop and validate a prediction model for a deep surgical site infection (SSI) after fixation of a tibial plateau or pilon fracture.

Design:

Pooled data from 2 randomized trials (VANCO and OXYGEN).

Setting:

Fifty-two US trauma centers.

Patients:

In total, 1847 adult patients with operatively treated tibial plateau or pilon fractures who met criteria for a high risk of infection.

Intervention:

We considered 13 baseline patient characteristics and developed and externally validated prediction models using 3 approaches (logistic regression, stepwise elimination, and machine learning).

Main Outcomes and Measures:

The primary prediction model outcome was a deep SSI requiring operative debridement within 182 days of definitive fixation. Our primary prognostic performance metric for evaluating the models was area under the receiver operating characteristic curve (AUC) with clinical utility set at 0.7.

Results:

Deep SSI occurred in 75 VANCO patients (8%) and in 56 OXYGEN patients (6%). The machine learning model for VANCO (AUC = 0.65) and stepwise elimination model for OXYGEN (AUC = 0.62) had the highest internal validation AUCs. However, none of the external validation AUCs exceeded 0.64 (range, 0.58 to 0.64).

Conclusions:

The predictive models did not reach the prespecified clinical utility threshold. Our models' inability to distinguish high-risk from low-risk patients is likely due to strict eligibility criteria and, therefore, homogeneous patient populations.
Iron Deficiency Anemia in Children During and After PICU Stay: Single-Center Retrospective Cohort, 2021–2022
Authors: Vadivelan Akhila , Nemeth Elizabeta , Ganz Tomas , Bulut Yonca
Published: November 2024

OBJECTIVES:

The primary objective was to determine iron deficiency (ID) anemia (IDA) monitoring practices in children during PICU stay. A secondary objective was to determine the current follow-up practices for IDA after PICU discharge.

DESIGN:

Retrospective observational study of 2 years (2021–2022).

SETTING:

Single-center academic PICU in the United States.

SUBJECTS:

All patients younger than 18 years and excluded patients who died in the PICU or within 6 months of PICU discharge.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Anemia was defined by a hemoglobin concentration of less than 11 g/dL. ID was defined by either a ferritin of less than 30 ng/mL or a transferrin saturation (TSAT) of less than or equal to 20%. Suspicion for functional iron deficiency (SID) was defined by ferritin greater than or equal to 30 ng/mL and TSAT less than or equal to 20%, given the hyperferritinemic effect of inflammation. We documented serum iron, total iron binding capacity, TSAT, ferritin, and hemoglobin at PICU admission and discharge and 3 and 6 months after discharge. Overall, 913 of 1275 met the inclusion criteria, and 492 patients had a hemoglobin of less than 11 g/dL. Only 93 of 492 (18.9%) had iron studies at any time during the PICU stay. Among the 93 patients with iron studies, 20 patients (22%) were lost to follow-up. Of the remaining 73 patients, 67 of 73 had a hemoglobin checked at 3 months, of which 37 of 67 (55%) were still anemic. At 6 months, there were 64 of 73 patients who had a hemoglobin checked, of which 32 of 64 (50%) were still anemic. At 3 months, 39 of 73 (53%) had iron studies performed; of these, 13 of 39 had ID, 12 of 39 had SID, and 14 of 39 had neither ID nor SID. At 6 months, 35 of 73 (48%) had iron studies; of these, ten of 35 had ID, 11 of 35 had SID, and 14 of 35 had neither ID nor SID.

CONCLUSIONS:

Detection of ID and follow-up after PICU stay remain inadequate. We recommend that future studies assess the value of screening all critically ill patients for ID at the time of discharge and followed up, as necessary.
Current State of Stereotactic Body Radiation Therapy for Genitourinary Malignancies
Authors: Sherry Alexander D. , Desai Neil , Tang Chad
Published: November 2024

Stereotactic body radiation therapy (SBRT) involves the delivery of high-dose, highly precise radiation therapy to focal sites of gross tumor involvement. Recent advances in radiation planning and image guidance have facilitated rapid growth in the evidence for and use of SBRT, particularly for genitourinary malignancies, where the underlying radiobiology often suggests greater tumor sensitivity to SBRT than to conventionally fractionated radiation. Here, we review the evolution of SBRT for patients with prostate adenocarcinoma and renal cell carcinoma. We discuss state-of-the-art trials, indications, and future directions in the SBRT-based management of both localized and metastatic disease. With rapidly growing enthusiasm and evidence, clinical and translational research efforts on the biology and outcomes of SBRT over the coming decade will be crucial to refining the indications, technical approach, and synergistic combinations of SBRT with highly active systemic therapies and improve the efficacy and quality-of-life outcomes for patients with genitourinary malignancies.
Differences in multidimensional phenotype of 2 joint pain models link early weight-bearing deficit to late depressive-like behavior in male mice
Authors: Hestehave Sara , Florea Roxana , Fedorec Alexander J.H. , Jevic Maria , Mercy Lucile , Wright Annia , Morgan Oakley B. , Brown Laurence A. , Peirson Stuart N. , Géranton Sandrine M.
Published: November 2024

Introduction:

Chronic pain is a hallmark of joint diseases. Although these conditions are often accompanied by negative affective symptoms including depression and anxiety, these comorbidities are rarely studied simultaneously in preclinical models where they are poorly characterised. Moreover, how affective symptoms relate to the more obvious sensory and functional symptoms of joint diseases is not well understood. Here, we have addressed these gaps in knowledge.

Methods:

We used 2 preclinical models of joint pain in male mice and an array of behavioural and molecular assays to fully characterise functional deficits, mechanical hypersensitivity, affective symptoms, and nociceptive signaling in joint pain, as well as investigate their relationship.

Results:

Ankle joint inflammation and knee osteoarthritis induced mechanical hypersensitivity that lasted at least 3 months and that was not different between the 2 models on most days. However, the models presented with markedly different weight-bearing deficits, molecular profiles, and affective outcomes. Specifically, only the model of knee osteoarthritis was accompanied by an increase in negative affective behaviors, including early changes in circadian patterns, persistent cognitive impairments, and late development of depressive-like behavior. Importantly, the early weight-bearing deficit strongly correlated with the emotional profiles and the hypersensitivity at 3 months, suggesting that early objective functional measures may be used as predictors of long-term affective symptoms and pain.

Conclusion:

The predictive value of early weight-bearing deficit could prove useful in the clinical setting for adapted therapeutic approaches for the prevention of emotional comorbidities and better pain management for patients with joint pain.
Bone metabolism in complex regional pain syndrome
Authors: Harnik Michael A. , Sodmann Annemarie , Hartmannsberger Beate , Kindl Gudrun , Becker Juliane , Reinhold Ann-Kristin , Herrmann Eva , Buck Andreas K. , Dischinger Ulrich , Birklein Frank , Brack Alexander , Sawalma Abdelrahman , Rittner Heike L.
Published: November 2024

Introduction:

Patients with complex regional pain syndrome (CRPS) often show disturbed bone metabolism, assessed using three-phase bone scintigraphy (TPBS). However, current methods lack automation and standardisation. Bone serum markers have been proposed as biomarkers, but their utility is unclear.

Objectives:

This study aimed to evaluate bone metabolism in CRPS using TPBS and bone serum markers.

Methods:

A deep learning model for automated segmentation quantified tracer enhancement in TPBS images. Serum markers analysed included alkaline phosphatase (AP), 25-OH vitamin D, osteoprotegerin, procollagen type I N-terminal propeptide (PINP), and β-C-terminal telopeptide, compared to 48 healthy controls (HC). The study included 114 patients with CRPS, 41 of whom underwent TPBS.

Results:

Of the 41 patients with CRPS with TPBS, 39 (95.1%) displayed radiotracer enhancement in the bone phase across CRPS subtypes. Serum markers of 114 patients did not significantly differ between patients and HC, nor did they correlate with TPBS enhancement, except in warm CRPS. In these patients, TPBS accumulation in the metacarpophalangeal region correlated with PINP (Spearman ρ = 0.63, P = 0.038), and AP levels were elevated at 78 U/L (interquartile range 64–88) compared to cold CRPS at 66 U/L (51–77; P = 0.003) and HC at 60 U/L (53–69; P < 0.001).

Conclusion:

Automated TPBS quantification revealed widespread bone metabolism alterations, common in CRPS and detectable beyond qualitative assessment. Although most serum markers remained unchanged, patients with warm CRPS exhibited unique features, suggesting distinct pathophysiological profiles. Integrating novel image analysis with other biomarkers may enhance diagnostic precision and patient stratification for targeted therapies.