bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Neighborhood Socioeconomic Deprivation with Utilization and Costs of Anterior Cervical Discectomy and Fusion
Authors: Lizzappi Malcolm , Bronheim Rachel S. , Raad Micheal , Hicks Caitlin W. , Skolasky Richard L. , Riley Lee H. , Lee Sang H. , Jain Amit
Published: July 2023

Study Design.

Retrospective analysis

Objective.

The aim of our study was to analyze the association of Area Deprivation Index (ADI) with utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery.

Summary of Background Data.

ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings.

Methods.

The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed.

Results.

A total of 13,362 patients (4,984 inpatient and 8,378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5,974 (44.71%) in ADI2, and 4,987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were: increasing ADI, outpatient surgical setting, non-hispanic ethnicity, current tobacco use, and diagnoses of: obesity, and gastroesophageal reflux disease (GERD). Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/ Medicaid insurance status, and diagnoses of cervical disc herniation or myelopathy. Factors associated with higher costs of care were: increasing ADI, older age, black/ African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease, and cervical myelopathy. Factors associated with lower costs of care were: outpatient surgical setting, female sex, and diagnoses of GERD and cervical disc herniation.

Conclusion.

Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI.

Level of Evidence.

3
Mortality from cerebrovascular diseases in China: Exploration of recent and future trends
Authors: Lv Bin , Song Ge , Jing Feng , Li Mingyu , Zhou Hua , Li Wanjun , Lin Jiacai , Yu Shengyuan , Wang Jun , Cao Xiangyu , Tian Chenglin
Published: July 2023

Background:

Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.

Methods:

We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention's Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models.

Results:

In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/105) and rural areas (123.0/105) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/105), the western region had a slightly lower mortality (123.5/105), and the eastern region had the lowest mortality (97.3/105). The age-specific mortality showed an accelerated upward trend from aged 55–59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02–3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030.

Conclusion:

The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control.
Survival benefit and impact of adjuvant chemotherapy following systemic neoadjuvant chemotherapy in patients with resected pancreas ductal adenocarcinoma: A retrospective cohort study
Authors: Pu Ning , Wu Wenchuan , Liu Siyao , Xie Yuqi , Yin Hanlin , Chen Qiangda , He Taochen , Xu Zhihang , Wang Wenquan , Yu Jun , Liu Liang , Lou Wenhui
Published: July 2023

Background:

Patients with pancreatic ductal adenocarcinoma (PDAC) are increasingly receiving systemic neoadjuvant chemotherapy (NAC), particularly those with borderline resectable and locally advanced disease. However, the specific role of additional adjuvant chemotherapy (AC) in these patients is unknown. The objective of this study is to further assess the clinical benefit and impact of systemic AC in patients with resected PDAC after NAC.

Methods:

Data on PDAC patients with or without AC following systemic NAC and surgical resection were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2006 and 2019. A matched cohort was created using propensity score matching (PSM), and baseline characteristics were balanced to reduce bias. Overall survival (OS) and cancer-specific survival (CSS) were calculated using matching cohorts.

Results:

The study enrolled a total of 1,589 patients, with 623 (39.2%) in the AC group and 966 (51.8%) in the non-AC group (mean age, 64.0 [9.9] years; 766 [48.2%] were females and 823 [51.8%] were males). All patients received NAC, and among the crude population, 582 (36.6%) received neoadjuvant radiotherapy, while 168 (10.6%) received adjuvant radiotherapy. Following the 1:1 PSM, 597 patients from each group were evaluated further. The AC and non-AC groups had significantly different median OS (30.0 vs. 25.0 mo, P=0.002) and CSS (33.0 vs. 27.0 mo, P=0.004). After multivariate Cox regression analysis, systemic AC was independently associated with improved survival (P=0.003, HR=0.782; 95%CI, 0.667-0.917 for OS; P=0.004, HR=0.784; 95%CI, 0.663-0.926 for CSS), and age, tumor grade, and AJCC N staging were also independent predictors of survival. Only patients younger than 65 years old and those with a pathological N1 category showed a significant association between systemic AC and improved survival in the subgroup analysis adjusted for these covariates.

Conclusion:

Systemic AC provides a significant survival benefit in patients with resected PDAC following NAC compared to non-AC patients. Our study discovered that younger patients, patients with aggressive tumors and potentially well response to NAC might benefit from AC to achieve prolonged survival after curative tumor resection.
In-Vitro Flow Validation of Third-Generation Ventricular Assist Devices: Feasibility and Challenges
Authors: Escher Andreas , Thamsen Bente , Strauch Carsten , Kertzscher Ulrich , Zimpfer Daniel , Thamsen Paul Uwe , Granegger Marcus
Published: July 2023

Computational fluid dynamics (CFD) is a powerful tool for the in-silico evaluation of rotodynamic blood pumps (RBPs). Corresponding validation, however, is typically restricted to easily accessible, global flow quantities. This study showcased the HeartMate 3 (HM3) to identify feasibility and challenges of enhanced in-vitro validation in third-generation RBPs. To enable high-precision acquisition of impeller torques and grant access for optical flow measurements, the HM3 testbench geometry was geometrically modified. These modifications were reproduced in silico, and global flow computations validated along 15 operating conditions. The globally validated flow in the testbench geometry was compared with CFD-simulated flows in the original geometry to assess the impact of the necessary modifications on global and local hydraulic properties. Global hydraulic properties in the testbench geometry were successfully validated (pressure head: r = 0.999, root mean square error [RMSE] = 2.92 mmHg; torque: r = 0.996, RMSE = 0.134 mNm). In-silico comparison with the original geometry demonstrated good agreement (r > 0.999, relative errors < 11.97%) of global hydraulic properties. Local hydraulic properties (errors up to 81.78%) and hemocopatibility predictions (deviations up to 21.03%), however, were substantially affected by the geometric modifications. Transferability of local flow measures derived on advanced in-vitro testbenches toward original pump designs is challenged by significant local effects associated with the necessary geometrical modifications.
The safety and efficacy of oral antiviral drug VV116 for treatment of COVID-19: A systematic review
Authors: Xiao Ningkun , Huang Xinlin , Kang Xiaotian , Zang Wanli , Li Bo , Kiselev Sergey
Published: July 2023

Background:

Recent trials have highlighted the potential of oral antiviral VV116 in the treatment of patients with mild COVID-19. However, no comprehensive studies have assessed the safety and efficacy of VV116. Therefore, we conducted a systematic review to assess the safety and efficacy of VV116.

Methods:

A comprehensive search was conducted on PubMed, Scopus, and Google Scholar websites, with a cutoff date of March 23, to identify pertinent studies.

Results:

The results from the 3 included studies indicated that no serious adverse events were reported in the VV116 experimental groups, which exhibited a 2.57-day faster time to viral shedding than the control group and demonstrated non-inferiority to the nirmatrelvir-ritonavir control group in alleviating major symptoms.

Discussion:

Collectively, available studies suggest a reliable safety and efficacy profile for VV116. However, the limited number of trials was insufficient for meta-analysis, and the included population consisted of younger individuals with mild and moderate symptoms, not encompassing the elderly who are severely affected by COVID-19. We hope that more studies will be conducted in the future to ensure that VV116 has a more reliable safety and efficacy profile in the clinical setting, especially in severe or critical patients.
Translation of paired fundus photographs to fluorescein angiographs with energy-based cycle-consistent adversarial networks
Authors: Kang Tae Seen , Shon Kilhwan , Park Sangkyu , Lee Woohyuk , Kim Bum Jun , Han Yong Seop
Published: July 2023

Fluorescein angiography is a crucial examination in ophthalmology to identify retinal and choroidal pathologies. However, this examination modality is invasive and inconvenient, requiring intravenous injection of a fluorescent dye. In order to provide a more convenient option for high-risk patients, we propose a deep-learning-based method to translate fundus photography into fluorescein angiography using Energy-based Cycle-consistent Adversarial Networks (CycleEBGAN) We propose a deep-learning-based method to translate fundus photography into fluorescein angiography using CycleEBGAN. We collected fundus photographs and fluorescein angiographs taken at Changwon Gyeongsang National University Hospital between January 2016 and June 2021 and paired late-phase fluorescein angiographs and fundus photographs taken on the same day. We developed CycleEBGAN, a combination of cycle-consistent adversarial networks (CycleGAN) and Energy-based Generative Adversarial Networks (EBGAN), to translate the paired images. The simulated images were then interpreted by 2 retinal specialists to determine their clinical consistency with fluorescein angiography. A retrospective study. A total of 2605 image pairs were obtained, with 2555 used as the training set and the remaining 50 used as the test set. Both CycleGAN and CycleEBGAN effectively translated fundus photographs into fluorescein angiographs. However, CycleEBGAN showed superior results to CycleGAN in translating subtle abnormal features. We propose CycleEBGAN as a method for generating fluorescein angiography using cheap and convenient fundus photography. Synthetic fluorescein angiography with CycleEBGAN was more accurate than fundus photography, making it a helpful option for high-risk patients requiring fluorescein angiography, such as diabetic retinopathy patients with nephropathy.
Case reports of primary lymphedema tarda in South Korea: Two case reports of unilateral primary lymphedema tarda in lower extremities
Authors: Dho Wonsik , Seo Zee Won , Son Ju Hyun , Lee Chang-Hyung
Published: July 2023

Rationale:

Primary lymphedema is a form of lymphedema marked by a dysfunction of the lymphatic system without preceding medical conditions. One rare subtype of primary lymphedema, lymphedema tarda, occurs in those older than 35 years and is difficult to diagnose. This paper reports 2 cases of unilateral lymphedema tarda in the lower extremities in South Korea.

Patient concerns:

The 2 patients complained of worsening swelling in the lower extremity for several months without any direct surgical or traumatic history related to the inguinal or lower extremity lymphatic system.

Diagnosis:

Primary lymphedema tarda may be determined by ultrasonography. Other vascular or infection-origin causes were excluded from further evaluations.

Interventions:

To confirm primary lymphedema tarda, lymphangiography was performed. In each case, lower extremity lymphangiography indicated dermal backflow and no lymph node uptake at the inguinal node of the affected side, which was compatible with lymphedema.

Outcomes:

The patients reported slight improvement in the symptoms after several weeks of rehabilitation.

Lessons:

This paper is the first report of the unilateral primary lymphedema tarda in South Korea. Further investigations are warranted to find the related etiology of this rare disease and a multimodality regimen is needed for improvement of symptoms.
Case report: Plastic bronchitis associated with Bordetella parapertussis
Authors: Li Zhongjie , Xu Yao , Shen Weirong
Published: July 2023

Rationale:

Bordetella parapertussis caused by a severe infection is rare in clinical practice. Here, we report a case of plastic bronchitis (PB).

Patient concerns:

A 4-year-old girl with a 2-day history of fever, paroxysmal cough, and subconjunctival hemorrhage.

Diagnoses:

The diagnoses were (1) B parapertussis, (2) pulmonary atelectasis, and (3) PB.

Interventions:

The patient received azithromycin and underwent bronchoscopy.

Outcomes:

Symptoms disappeared after treatment. The patient had an outpatient follow-up of 2 months without respiratory symptoms.

Lessons:

PB can lead to respiratory failure if not intervened in the early stages.
The efficacy of different interventions in the treatment of sarcopenia in middle-aged and elderly people: A network meta-analysis
Authors: Geng Qian , Zhai Haiting , Wang Liming , Wei Hongwen , Hou Shilun
Published: July 2023

Background:

In this study, a meta-analysis system was used to evaluate the effects of 7 methods of treating sarcopenia, including resistance exercise, aerobic exercise, mixed exercise, nutrition, resistance combined with nutrition, mixed exercise combined with nutrition, and electric stimulation combined with nutrition, and their effects on physical function.

Methods:

According to the PRISMA guidelines, PubMed, Web of Science, Embase, and other foreign databases, as well as Chinese databases such as China National Knowledge Infrastructure and Wan Fang, the literatures of randomized controlled trials with different intervention measures were searched. ADDIS software was used to compare and rank the results of the network meta-analysis.

Results:

A total of 2485 patients were included in the 30 randomized controlled trial items. According to the clinical manifestations of sarcopenia, 7 different forms of exercise and nutrition interventions can improve muscle strength, muscle mass, and physical function; in terms of improving muscle strength, resistance exercise has the most significant effect on improving grip strength (MD = 2.58, 95% confidence interval [CI] [1.06–4.07]); resistance exercise combined with nutrition lifting performed best in chair standing test (MD = −2.37, 95% CI [−4.73 to −0.33]). For muscle mass gains, resistance training increased appendicular skeletal muscle mass significantly (MD = 0.90, 95% CI [0.11–1.73]), while resistance exercise combined with nutrition significantly increased fat-free mass (MD = 5.15, 95% CI [0.91–9.43]). For physical activity, resistance training improved walk speed best (MD = 0.28, 95% CI [0.15–0.41]), and resistance exercise combined with nutrition in the best results were seen in the timed up and go test (MD = −2.31, 95% CI [−4.26 to −0.38]).

Conclusion:

Compared with aerobic exercise, mixed exercise, nutrition, resistance combined with nutrition, mixed exercise combined with nutrition, and electric stimulation combined with nutrition, resistance exercise has more advantages in improving muscle mass, strength, and physical function performance. The clinical treatment of sarcopenia with resistance exercise intervention has a better curative effect.
Solitary fibrous tumor resembling pulmonary fractionation disease: A case report
Authors: Yoshino Ryusei , Yoshida Nana , Ito Akane , Nakatsubo Masaki , Yuzawa Sayaka , Kitada Masahiro
Published: July 2023

Rationale:

Preoperative differentiation between pulmonary fractionation and solitary fibrous tumors (SFTs) is challenging. Diaphragmatic primary tumors are relatively rare among SFTs, with limited reports of abnormal vascularity.

Patient concerns:

A 28-year-old male patient was referred to our department for surgical resection of a tumor near the right diaphragm, Thoracoabdominal contrast-enhanced computed tomography (CT) scan revealed a 10 × 8 cm mass lesion at the base of the right lung. The inflow artery to the mass was an anomalous vessel in which the left gastric artery bifurcated from the abdominal aorta, and its origin was the common trunk and right inferior transverse artery.

Diagnosis:

The tumor was diagnosed as right pulmonary fractionation disease based on the clinical findings. The postoperative pathological examination determined a diagnosis of SFT.

Interventions:

The pulmonary vein was used to irrigate the mass. The patient was diagnosed with pulmonary fractionation and underwent surgical resection. Intraoperative findings revealed a stalked, web-like venous hyperplasia anterior to the diaphragm, contiguous with the lesion. An inflow artery was found at the same site. The patient was subsequently treated using a double ligation technique. The mass was partially contiguous with S10 in the right lower lung and stalked. An outflow vein was identified at the same site, and the mass was removed using an automatic suture machine.

Outcomes:

The patient received follow-up examinations that involved a chest CT scan every 6 months, and no tumor recurrence was reported during 1 year of postoperative follow-up.

Lessons:

Differentiating between SFT and pulmonary fractionation disease may be challenging during preoperative diagnosis; therefore, aggressive surgical resection should be considered as SFTs may be malignant. Identification of abnormal vessels using contrast-enhanced CT scans may be effective in reducing surgical time and improving the safety of the surgical procedure.
Physical activity is associated with walking and balance ability but not fatigue, knee extension strength, or body composition in adults with cerebral palsy: a pilot cross-sectional study
Authors: Sato Yui , Tashiro Hideyuki , Fukumoto Kanta , Hirosaki Sota , Toki Megumi , Kozuka Naoki
Published: July 2023

Common secondary impairments associated with aging in adults with cerebral palsy (CP) decrease physical functions, including walking and balance ability, and increase the sense of fatigue. This motor dysfunction results in decreased physical activity (PA) and could be associated with obesity and sarcopenia. This study examined the association of daily PA levels with fatigue, physical function, and body composition in 22 adults with CP (age, 37.4 ± 14.7 years; Gross Motor Function Classification System level, I: 6, II: 16). The level of daily PA was divided into percent of sedentary behavior, light PA, and moderate-to-vigorous PA (%MVPA) per day. These outcomes were examined for correlation with the Fatigue Severity Scale, knee extension strength, comfortable and maximum walking speed, Timed-Up-and-Go-Test (TUG), and body fat percentage and skeletal muscle mass using Spearman’s rank correlation coefficient. An additional partial correlation analysis with sex and age adjustment was performed. The %MVPA correlated positively with comfortable walking speed (rs = 0.424, P = 0.049) and negatively with TUG (rs = −0.493, P = 0.020). The partial correlation revealed associations of %MVPA with maximum walking speed (r = 0.604, P = 0.022) and TUG (r = −0.604, P = 0.022). The results show that among adults with CP, increased PA is associated with improvements in mobility but not in perceived fatigue or body composition, regardless of sex and age. Maintaining and improving %MVPA and walking and balance ability in adults with CP have a positive impact on each other, and potentially on overall health management.
Weaning from Tube Feeding Post Stroke by Eating, Swallowing, and Nutritional Support In-Home
Authors: Inayama Miku , Goto Tomoyuki , Kokabu Shoichiro , Okubo Masahiko
Published: July 2023

In many cases, enteral tube feeding is begun after stroke without adequate assessment of feeding ability, swallowing function, and nutritional status. A 72-year-old man was recovering at home after a stroke and consulted us because he wanted to resume taking food by mouth. He had tube feeding for 13 months after the stroke. We offered him feeding and swallowing training and proper nutrition guidance by visiting dental staff and managerial dietitians at home and concluded the patient was sufficiently able to take oral food. After 4 months, the patient was completely weaned from tube feeding.
Hospice and Palliative Care for Undergraduate Nursing Education
Authors: Osakwe Zainab Toteh , Jacobowitz William , Horton Jay R. , Klainberg Marilyn , Calixte Rose , Jacobs Charleen , Hickey Mary T.
Published: July 2023

There is an urgent need to strengthen the nursing workforce through hospice and palliative care education to support patients living with serious illness. The aim of this study was to identify skills/topics in hospice and palliative care for undergraduate nursing education. We conducted a two-round online Delphi Survey of hospice and palliative care leaders and clinicians in New York State between June and August 2022. Participants were asked to list and rate the importance of clinical skills and topics in hospice and palliative care for undergraduate nursing education. Twenty-eight participants completed Round One and 21 participants completed Round Two. Topics ranked as extremely important were goals of care, patient/family education, communication skills, advance directives, medication management, pain management, and symptom management. Our findings highlight the importance of including the perspective of healthcare systems leaders and clinicians in discussions about training of future nurses to meet the needs of patients with serious illness and their families.
Measles immunity gaps among children and adolescents with HIV in zambia despite high measles vaccination and antiretroviral therapy coverage
Authors: Mutembo Simon , Yang Yangyupei , Carcelen Andrea , Winter Amy Kaye , Mwansa Francis Dien , Chilumba Innocent , Mutale Irene , Chongwe Gershom , Monze Mwaka , Mulundu Gina , Nkamba Hope , Mulenga Lloyd , Hayford Kyla , Moss William John
Published: July 2023

Objective:

The study objective was to identify measles and rubella immunity gaps among people living with HIV (PLHIV) in Zambia despite high measles vaccine coverage and widespread access to antiretroviral therapy.

Design:

Nationally representative cross-sectional serosurvey using biorepository specimens.

Methods:

Blood specimens collected in the Zambia Population HIV Impact Assessment survey (ZAMPHIA) of 2016 were tested for measles and rubella IgG antibodies by enzyme immunoassay. Hierarchical generalized additive models were fit to characterize age-specific measles and rubella seroprevalence profiles by HIV infection status. Log-binomial regression was performed to identify factors associated with seronegativity.

Results:

Of the 25,383 specimens, a subsample of 11,500 were selected and 9,852 (85%) were successfully tested. Measles seroprevalence was lower among PLHIV compared with HIV-uninfected individuals until approximately 30 years of age. Among children younger than the age of 10 years, measles seroprevalence was 47.2% (95%CI: 32.7%, 61.7%) in PLHIV and 76.4% (95%CI: 74.9%, 78.0%) in HIV-uninfected children in same age category. In contrast, rubella seroprevalence was higher among PLHIV than HIV-uninfected individuals, particularly for children younger than 10 years (68.6% vs. 44.3%, p < 0.001). Having a detectable viral load was associated with being measles seronegative (adjusted PR 0.15, 95%CI: 0.06, 0.38).

Conclusions:

These results from a nationally representative serosurvey demonstrate persistence of measles immunity gaps among PLHIV younger than 30 years of age. There is need to implement the World Health Organization's recommendation to revaccinate children living with HIV against measles following immune reconstitution with antiretroviral therapy to protect these children and prevent measles outbreaks.
Impact of ART intensification with CCR5 antagonist maraviroc on HIV-associated neurocognitive impairment
Authors: Shikuma Cecilia M. , Wojna Valerie , De Gruttola Victor , Siriwardhana Chathura , Souza Scott , Rodriguez-Benitez Rosa J. , Turner Emilee H. , Kallianpur Kalpana , Bolzenius Jacob , Chow Dominic , Matos Miriam , Shiramizu Bruce , Clements Danielle M. , Premeaux Thomas A. , Ndhlovu Lishomwa C. , Paul Robert
Published: July 2023

Objectives:

Chemokine receptor CCR5 is the principal co-receptor for entry of M-tropic HIV virus into immune cells. It is expressed in the central nervous system and may contribute to neuro-inflammation. The CCR5 antagonist maraviroc (MVC) has been suggested to improve HIV-associated neurocognitive impairment (NCI).

Design:

A double-blind, placebo-controlled, 48-week, randomized study of MVC vs placebo in people living with HIV (PLWH) on stable antiretroviral therapy (ART) > 1 year in Hawaii and Puerto Rico with plasma HIV RNA <50 copies/mL and at least mild NCI defined as an overall or domain-specific neuropsychological (NP) Z score < -0.5.

Methods:

Study participants were randomized 2:1 to intensification of ART with MVC vs placebo. The primary endpoint was change in global and domain-specific NP Z scores (NPZ) modeled from study entry to week 48. Covariate adjusted treatment comparisons of average changes in cognitive outcome were performed using winsorized NPZ data. Monocyte subset frequencies and chemokine expression as well as plasma biomarker levels were assessed.

Results:

Forty-nine participants were enrolled with 32 individuals randomized to MVC intensification and 17 to placebo. At baseline, worse NPZ scores were seen in the MVC arm. Comparison of 48-week NPZ change by arm revealed no differences except for a modest improvement in the Learning and Memory domain in the MVC arm which did not survive multiplicity correction. No significant changes between arms were seen in immunologic parameters.

Conclusions:

This randomized controlled study found no definitive evidence in favor of MCV intensification among PLWH with mild cognitive difficulties.
Computed Tomography and Magnetic Resonance Imaging Findings Contribute to Differentiating Solid- and Nonsolid-Type Adenoid Cystic Carcinoma in Maxillary Sinus
Authors: Wang Yifan , Ji Yanping , Guo Linying , Wang Yuzhe , Sha Yan
Published: July 2023

Purpose

This study aimed to evaluate the imaging features of maxillary sinus adenoid cystic carcinoma (ACC) on computed tomography (CT) and magnetic resonance imaging (MRI) and to investigate the imaging differences between solid and nonsolid maxillary sinus ACC.

Methods

We retrospectively reviewed 40 cases of histopathologically confirmed ACC of the maxillary sinus. All the patients underwent CT and MRI. Based on the histopathological characteristics, the patients were classified into 2 groups: (a) solid maxillary sinus ACC (n = 16) and (b) nonsolid maxillary sinus ACC (n = 24). Imaging features such as tumor size, morphology, internal structure, margin, type of bone destruction, signal intensity, enhancement changes, and perineural tumor spread on CT and MRI, were evaluated. The apparent diffusion coefficient (ADC) was measured. Comparisons of imaging features and ADC values were performed between the solid and nonsolid maxillary sinus ACC using χ2 and nonparametric tests.

Results

The internal structure, margin, type of bone destruction, and degree of enhancement significantly differed between solid and nonsolid maxillary sinus ACC (all P < 0.05). The ADC of the solid maxillary sinus ACC was considerably lower than that of the nonsolid maxillary sinus (P < 0.05).

Conclusions

Computed tomography and MRI may aid in the differentiation of solid and nonsolid types of maxillary sinus ACC.
VEXAS Syndrome With Tracheal Involvement but Absence of Vasculitis in FDG PET/CT
Authors: Lohaus Niklas , Schaab Jan , Schaer Dominik , Balabanov Stefan , Huellner Martin W.
Published: July 2023

In early 2022, a 77-year-old man presented with weight loss and recurrent subfebrile temperatures since 6 months. Workup with CT revealed a lung infiltrate. Despite antibiotic treatment, serum inflammation markers remained high. The patient further developed eczematous skin changes, uveitis (sequentially on both eyes), and macrocytic anemia. Finally, an autoinflammatory disease was suspected, and FDG PET/CT was performed. The examination revealed metabolically active foci in several tissues (tracheal cartilage, bone marrow, muscles). Bone marrow aspiration revealed anUBA1mutation, which is pathognomonic for VEXAS syndrome.
Intrathecal Baclofen Therapy and the Role of the Rehabilitation Nurse
Authors: Duraski Sylvia A.
Published: July 2023

Spasticity is a common problem encountered by those who have suffered a neurological injury either cerebral or spinal in origin. Multiple interventions are utilized to manage spasticity to decrease the pain and stiffness. These interventions can include an implanted device that delivers medication directly to the spinal cord. This clinical consultation reviews a patient case and the important information regarding the care of this individual with an intrathecal baclofen pump and important key points of education that all rehabilitation nurses need to know.
Nasal and Sellar Anatomic Variations in Pituitary-Dependent Cushing Disease
Authors: Wang Baofeng , Sun Yuhao , Sun Qingfang , Zhong Zhihong , Bian Liuguan
Published: July 2023

Objective:

Adrenocorticotrophic hormone excessive secretion in pituitary-dependent Cushing disease (CD) patients may lead to anatomic variations of the nasal-sphenoidal corridor as a result of hormone-induced abnormal soft tissue change. However, there is still a lack of data on anatomic dimensions in CD patients. In this study, magnetic resonance images were analyzed to determine the anatomic variations of the nasal cavity and sphenoid sinus in CD patients.

Methods:

A retrospective radiographic analysis was conducted on CD patients undergoing endonasal transsphenoidal surgery as primary treatment between January 2013 and December 2017. A total of 97 CD patients and 100 controls were included. The nasal and sphenoidal anatomic dimensions of CD patients were compared with the control group.

Results:

Both sides of nasal cavity height, middle nasal meatus width, and inferior nasal meatus width in CD patients were narrower than that of controls. When compared with controls, the ratio of the middle turbinate to middle nasal meatus and the ratio of inferior turbinate to inferior nasal meatus was found to increase on both sides in CD patients. Intercarotid distance of CD patients was shorter than that of controls. The most prevalent pneumatization pattern of CD patients was postsellar, followed by sellar, presellar, and conchal.

Conclusions:

Cushing disease patients have nasal and sphenoidal anatomic variations affecting the endonasal transsphenoidal surgical corridor, especially the shorter intercarotid distance. The neurosurgeon should be aware of these anatomic variations, and adapt surgical techniques and optimal approaches to reach the sella safely.
Distribution and Phenotype of Goldenhar Syndrome and Its Association With Other Anomalies
Authors: Park Juhwan , Yang Il-Hyung , Choi Jin-Young , Chung Jee Hyeok , Kim Sukwha , Baek Seung-Hak
Published: July 2023

The purpose of this study was to investigate the distribution and phenotype of Goldenhar syndrome (GS) and its association with other anomalies. The samples consisted of 18 GS patients (6 males and 12 females; mean age at investigation, 7.4 ± 4.8 y) who were treated or followed up at the Department of Orthodontics, Seoul National University Dental Hospital between 1999 and 2021. The prevalence of side involvement and degree of mandibular deformity (MD), midface anomalies, and association with other anomalies were evaluated using statistical analysis. The prevalence of unilateral and bilateral MD did not differ (55.6% versus 44.4%). In unilateral MD cases, there was a tendency for higher prevalence of more severe Pruzansky-Kaban types than mild ones (type I, 10%; type IIa, 10%; type IIb, 50%; type III, 30%). Despite hypoplasia of the condyle/ramus complex, compensatory mandibular body growth occurred in 33.3% of GS patients (more severe side in bilateral MD cases, 37.5%, and ipsilateral side in unilateral MD cases, 30%). Class II molar relation was more prevalent than class I and class III molar relations (72.2% versus 11.1% versus 16.7%, P<0.01). Al total of 38.9% of patients had congenitally missing tooth. #7 facial cleft was found in 44.4% of patients. In midface anomalies, ear problem was the most common anomaly, followed by hypoplasia/absence of zygomatic arch and eye problem (88.9% versus 64.3% versus 61.1%, P<0.01). Association with the midface, spine, cardiovascular, and limb anomalies did not differ between unilateral and bilateral MD cases. These results might provide a basic guideline for diagnosis and treatment planning for GS patients.
Statistical Power of Randomized Controlled Trials in Trauma Surgery
Authors: Berg Arthur , Lyons Nicole B , Badami Abbasali , Reynolds John , Pizano Louis , Pust Gerd Daniel , Meizoso Jonathan , Namias Nicholas , Yeh Daniel Dante
Published: July 2023

BACKGROUND:

Our purpose was to conduct a bibliometric study investigating the prevalence of underpowered randomized controlled trials (RCTs) in trauma surgery.

STUDY DESIGN:

A medical librarian conducted a search of RCTs in trauma published from 2000 to 2021. Data extracted included study type, sample size calculation, and power analyses. Post hoc calculations were performed using a power of 80% and an alpha level of 0.05. A CONSORT checklist was then tabulated from each study as well as a fragility index for studies with statistical significance.

RESULTS:

In total 187 RCTs from multiple continents and 60 journals were examined. A total of 133 (71%) were found to have “positive” findings consistent with their hypothesis. When evaluating their methods, 51.3% of articles did not report how they calculated their intended sample size. Of those that did, 25 (27%) did not meet their target enrollment. When examining post hoc power, 46%, 57%, and 65% were adequately powered to detect small, medium, and large effect sizes, respectively. Only 11% of RCTs had complete adherence with CONSORT reporting guidelines and the average CONSORT score was 19 out of 25. For positive superiority trials with binary outcomes, the fragility index median (interquartile range) was 2 (2 to 8).

CONCLUSIONS:

A concerningly large proportion of recently published RCTs in trauma surgery do not report a priori sample size calculations, do not meet enrollment targets, and are not adequately powered to detect even large effect sizes. There exists opportunity for improvement of trauma surgery study design, conduct, and reporting.
Evolution of hierarchy and irreversibility in theoretical cell differentiation model
Authors: Nakamura Yoshiyuki T. , Himeoka Yusuke , Saito Nen , Furusawa Chikara
Published: July 2023

The process of cell differentiation in multicellular organisms is characterized by hierarchy and irreversibility in many cases. However, the conditions and selection pressures that give rise to these characteristics remain poorly understood. By using a mathematical model, here we show that the network of differentiation potency (differentiation diagram) becomes necessarily hierarchical and irreversible by increasing the number of terminally differentiated states under certain conditions. The mechanisms generating these characteristics are clarified using geometry in the cell state space. The results demonstrate that the appearance of these characteristics can be driven without assuming the adaptive significance. The study also provides a new perspective on the structure of gene regulatory networks that produce hierarchical and irreversible differentiation diagrams. These results indicate some constraints on cell differentiation, which are expected to provide a starting point for theoretical discussion of the implicit limits and directions of evolution in multicellular organisms.
Consensus gene modules strategy identifies candidate blood-based biomarkers for primary Sjogren's disease
Authors: Boudjeniba Cheima , Soret Perrine , Trutschel Diana , Hamon Antoine , Baloche Valentin , Chassagnol Bastien , Desvaux Emiko , Bichat Antoine , Aussy Audrey , Moingeon Philippe , Lefevbre Celine , Hubert Sandra , Alarcon-Riquelme Marta , Ng Wan-Fai , Gottenberg Jacques-Eric , Schwikowski Benno , Bombardieri Michele , van Roon Joel A.G. , Mariette Xavier , Guedj Mickael , Birmele Etienne , Laigle Laurence , Becht Etienne
Published: July 2023

Primary Sjogren disease (pSD) is an autoimmune disease characterized by lymphoid infiltration of exocrine glands leading to dryness of the mucosal surfaces and by the production of autoantibodies. The pathophysiology of pSD remains elusive and no treatment with demonstrated efficacy is available yet. To better understand the biology underlying pSD heterogeneity, we aimed at identifying Consensus gene Modules (CMs) that summarize the high-dimensional transcriptomic data of whole blood samples in pSD patients. We performed unsupervised gene classification on four data sets and identified thirteen CMs. We annotated and interpreted each of these CMs as corresponding to cell type abundances or biological functions by using gene set enrichment analyses and transcriptomic profiles of sorted blood cell subsets. Correlation with independently measured cell type abundances by flow cytometry confirmed these annotations. We used these CMs to reconcile previously proposed patient stratifications of pSD. Importantly, we showed that the expression of modules representing lymphocytes and erythrocytes before treatment initiation is associated with response to hydroxychloroquine and leflunomide combination therapy in a clinical trial. These consensus modules will help the identification and translation of blood-based predictive biomarkers for the treatment of pSD.
The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic counseling in racially and ethnically diverse families
Authors: Suckiel Sabrina A. , Kelly Nicole R. , Odgis Jacqueline A. , Gallagher Katie M. , Sebastin Monisha , Bonini Katherine E. , Marathe Priya N. , Brown Kaitlyn , Biase Miranda Di , Ramos Michelle A. , Rodriguez Jessica E. , Scarimbolo Laura , Insel Beverly J. , Ferar Kathleen D.M. , Zinberg Randi E. , Diaz George A. , Greally John M. , Abul-Husn Noura S. , Bauman Laurie J. , Gelb Bruce D. , Horowitz Carol R. , Wasserstein Melissa P. , Kenny Eimear E.
Published: July 2023

Background

Digital solutions are needed to support rapid increases in the application of genetic and genomic tests (GT) in diverse clinical settings and patient populations. We developed GUÍA, a bi-lingual web-based platform that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial evaluated GUÍA’s impact on understanding of GT results.

Methods

NYCKidSeq enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GT. Families were randomized to genetic counseling with GUÍA (intervention) or standard of care (SOC) genetic counseling for results disclosure. Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6-months later. Survey measures assessed the primary study outcomes of perceived understanding of and confidence in explaining their child’s GT results and the secondary outcome of objective understanding. We used regression models to evaluate the association between the intervention and the study outcomes.

Results

The analysis included 551 participants, 270 in the GUÍA arm and 281 in SOC. Participants’ mean age was 41.1 years and 88.6% were mothers. Most participants were Hispanic/Latino(a) (46.3%), White/European American (24.5%), or Black/African American (15.8%). Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR=2.8, CI[1.004,7.617],P=0.049) and maintained higher objective understanding over time (OR=1.1, CI[1.004, 1.127],P=0.038) compared to those in the SOC arm. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR=3.9, CI[1.6, 9.3],P=0.003), confidence (OR=2.7, CI[1.021, 7.277],P=0.046), and objective understanding (OR=1.1, CI[1.009, 1.212],P=0.032) compared to SOC.

Conclusions

This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions. These findings build a case for utilizing GUÍA to deliver complex and often ambiguous genetic results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics.
Treatment of cutaneous leishmaniasis with sodium stibogluconate and allopurinol in a routine setting in Ethiopia: clinical and patient-reported outcomes and operational challenges
Authors: van Henten Saskia , Bialfew Fentaw , Hassen Seid , Tilahun Feleke , van Griensven Johan , Abdela Seid Getahun
Published: July 2023

Cutaneous leishmaniasis (CL) is common in Ethiopia, but the national guideline does not offer specific treatment recommendations. Consequently, different treatment regimens are used in the country, without quality evidence. In Boru Meda Hospital, sodium stibogluconate (SSG) is routinely used combined with allopurinol for systemic CL treatment, although evidence on effectiveness is limited.

An observational cohort study was done to document clinical treatment outcomes in patients receiving SSG/allopurinol at the end of each 28-day treatment cycle and after 180 days. Patient-reported outcomes were assessed by asking patients to rate lesion severity and by the dermatological life quality index.

A total of 104 patients were included. After one treatment cycle only four patients were clinically cured, although patient-reported outcomes significantly improved. The majority (88) of patients were appointed for a second treatment cycle, of which only 37 (42%) came. Among 36 patients who came for final outcome assessment, 50% was cured. Follow-up and treatment was severely affected by conflict; drug stockouts and insufficient ward capacity for treatment were additional challenges.

Treatment outcomes of SSG/allopurinol were relatively poor, and most patients required more than one cycle of treatment. Shortage of drugs and beds indicates the existing gaps in providing CL treatment in Ethiopia.
Co-production of a Neurodiversity-Affirmative Anxiety Intervention for Autistic Children
Authors: Cullingham Tasha , Rennard Una , Creswell Cathy , Milton Damian , Buckle Karen Leneh , Godber Lucie , Gordon Kate , Larkin Michael , Green Jonathan
Published: July 2023

Background

Mental health difficulties are common for autistic people; however, few interventions have been co-produced with the autistic community. Mental health interventions constructed with a ‘non-autistic lens’ likely miss key understandings from autistic experiences and priorities of the autistic community. Additionally, the style and aims of intervention may be prone to unconscious bias around the pathologisation of autism. Currently, there are limited methodological and practical examples of how to rigorously co-produce mental health interventions with autistic people. This paper details the methodology and processes of co-adapting an intervention for autistic children with anxiety problems. Providing a worked example of co-producing a neurodiversity-affirmative mental health intervention which reflects autistic, parental, academic, and clinical, experience and expertise.

Methods

We co-adapted content from a brief, parent-led, CBT approach for non-autistic children with anxiety problems to meet the needs of autistic children and their parents. The adaptation for autistic children was co-constructed using processes and strategies adopted from Experience-Based Co-Design (EBCD). The research team, comprising autistic and non-autistic members, worked alongside an expert reference group (ERG). The ERG comprised parents (autistic and non-autistic) of autistic children with anxiety problems, autistic adults with experience of anxiety problems, and clinicians with experience supporting autistic children with mental health difficulties. Data were obtained from qualitative research interviews with autistic children with anxiety problems and parents. These data were considered reciprocally by the research team and the ERG.

Results

The resulting intervention includes a neurodiversity-affirmative perspective that considers how anxieties for autistic children can emerge from being neurodivergent in a neurotypical world integrated with traditional CBT techniques and understandings of anxiety.

Conclusion

Successful co-production can help to integrate multiple theoretical backgrounds and result in the creation of interventions that are potentially acceptable to clinicians, autistic people and their family members.