bluuebunny/crossref_metadata_2025 huggingface dataset:
Green banana flour as a novel functional ingredient in retorted feline diets
Authors: Hsu Clare , White Brittany , Lambrakis Leah , Oba Patricia M , He Fei , Utterback Pamela , Parsons Carl M , de Godoy Maria R C
Published: February 2024

Green banana flour (GBF) is a novel ingredient that is high in resistant starch and could be a dietary fiber source in companion animal nutrition. In addition, with its light brown color and pectin content, GBF could potentially serve as a natural color additive and thickening agent in pet food manufacturing. The purpose of this research is to evaluate different sources of GBF, the effect of GBF on texture and color in canned foods, and its effect on apparent total tract digestibility (ATTD), fecal characteristics, and fecal fermentative end-products in healthy adult cats. Prior to the feline study, different sources of GBF were analyzed for chemical composition, manufacturing properties, true metabolizable energy, and fermentability. For the feline feeding trial, all treatment diets were formulated to meet or exceed the Association of American Feed Control Officials (Association of American Feed Control Officials (AAFCO) 2020. Official Publication. Champaign, IL.) guidelines for adult cat maintenance. There were five dietary treatments: rice control (4% rice flour), potato control (4% dehydrated potato flakes), 1% GBF (1% GBF and 3% rice flour), 2% GBF (2% GBF and 2% rice flour), and 4% GBF. All treatment diets were analyzed for texture and color. The animal study was conducted using a completely randomized design with 39 adult domestic cats. There was a 7-d diet adaptation period followed by a baseline fresh fecal collection to determine fecal score, pH, short-chain fatty acid, branched-chain fatty acid, phenol, indole, ammonia, and microbiota. The treatment period lasted for 21 d and a total fecal collection was performed during the last 4 d of this period to determine the ATTD. A fresh fecal sample was also collected during the total fecal collection to evaluate fecal score, pH, metabolites, and microbiota. The MIXED model procedures of SAS version 9.4 were used for statistical analysis. Treatment diets containing GBF had a lower hardness from the texture profile analysis (P < 0.05). For color analysis, the 4% GBF diet was darker in color compared with the rice diet (P < 0.05). There was no difference in food intake, fecal output, or ATTD of macronutrients among the treatment groups (P > 0.05). There was no interaction of treatment and time or main effects shown in fecal score, pH, metabolites, or microbiota diversity (P > 0.05). In conclusion, adding GBF to canned diets may affect the texture and color of the product, but GBF was comparable to traditional carbohydrate sources, rice, and potato, from a nutritional aspect.
Factors Predicting 90-Day Readmissions for US Older Adult Burn Patients From the 2016-2018 Nationwide Readmissions Database
Authors: Yi Yangtian , Vrouwe Sebastian Q , Gottlieb Lawrence J , Rubin Daniel S
Published: February 2024

Older adults with burn injuries have a high risk of readmission after the initial burn admission. Frailty is associated with poor outcomes from the initial burn injury, however, it remains unknown if frailty impacts readmission in older adults after the initial index burn admission. Our study aims to examine patient, frailty, burn, surgical, and hospital factors that contribute to 90-day readmissions in older adults with an acute burn. Patients ≥ 50 years of age with an acute burn diagnosis in the Nationwide Readmissions Database (2016-2018) were included. Patients who died during index admissions were excluded from the readmission analysis. Patient, burn, hospital stay, and hospital characteristics were analyzed. Using variables significant from univariate logistic regression analysis, we performed a multivariable logistic regression analysis to identify factors associated with 90-day readmissions. A total of 41,500 weighted index burn admissions were included. The 90-day readmission rate was 25.6% (10,641/41,500). Almost all the readmissions were unplanned (96.5%). The most common primary readmission diagnoses based on Clinical Classifications Software Refined were burn injury and septicemia. Multivariable logistic regression analysis demonstrated an increased hospital frailty risk and lower-body-only burns were associated with an increased risk of readmission. Notably, surgical treatment of the burn injury during the index admission was associated with a decreased risk of readmission. This highlights the importance and challenges of surgical decision-making for older adults with high comorbidity burden. Future studies are needed to develop decision guides to help clinicians identify patients who would benefit from surgical treatment versus more conservative strategies in older adult patients with burns.
A205 PRACTICE PATTERNS FOR EOSINOPHILIC ESOPHAGITIS IN ADULTS VARY WIDELY AMONG CANADIAN GASTROENTEROLOGISTS: INTERIM ANALYSIS OF A NATIONWIDE SURVEY
Authors: Fetz A , Kim H , Moosavi S
Published: February 2024

Background

Eosinophilic esophagitis (EoE) is a chronic allergic, type 2 immune-mediated, condition of the esophagus with increasing prevalence in Canada. Practice patterns among Canadian gastroenterologists are not well described.

Aims

To identify practice variation among Canadian gastroenterologists who care for adults with EoE.

Methods

A cross-sectional, web-based survey was distributed to Canadian gastroenterologists through the Canadian Association of Gastroenterology as well as administrations at Canadian universities.

Results

Of 53 respondents, 68% currently work in an academic setting. 77% manage at least 6 patients with EoE per year, with 19% managing over 50 patients per year.

51% of respondents obtain biopsies in every new patient presenting with an acute food bolus, while 26% take biopsies in less than 50% of cases or never at all. 36% take less than 5 biopsies on initial endoscopy with 23% only taking biopsies from one location in the esophagus. 58% are either unaware of the EoE Endoscopic Reference Score (EREFS) or never use it in clinical practice.

Most respondents (72%) prefer proton pump inhibitors as initial therapy while 17% prefer starting multiple treatment modalities. 9% use topical steroids initially. Only 6% keep their patients on topical steroids indefinitely, if started. Preferred dietary approach vary with 36% choosing 6-food elimination diet (FED), 23% 2-FED, 19% 4-FED, 13% milk-only elimination diet, 6% allergy test-directed diet, and 4% elemental diet. Only 17% feel very comfortable starting biologic therapies.

When evaluating treatment effectiveness, 23% use improving patient symptoms alone, while 74% include repeat histological assessments. 42% do not regularly screen for adaptive behaviours, such as excessive chewing, or texture modification and avoidance. In those who perform repeat endoscopic evaluation, 13% do so in less than 3 months after starting therapy, 32% in 3-5.9 months, 28% in 6-11.9 months, and 8% after a year. 11% will only repeat endoscopic evaluation if a patient reports symptom recurrence. 64% do not regularly refer to an allergist.

For guidance, 59% follow the American Gastroenterology Association 2020 guidelines, 34% American Society of Gastrointestinal Endoscopy 2022 guidelines, 4% British Society of Gastroenterology 2022 guidelines, while 21% do not use any guidelines. 83% feel Canadian guidelines would be useful in their practice.

Conclusions

EoE practice patterns among Canadian adult gastroenterologists vary widely, with management differing from the current consensus guidelines. Strategies aimed at decreasing these variations, such as the development of Canadian guidelines, are needed to standardize practice.

Funding Agencies

None
Transgender patient undergoing Rezum therapy: a case report
Authors: Sakhalkar Om V , Scanlan Luke , Klaassen Zachary , King Sherita A , Simmons Matthew N , Terris Martha K , SantaMaria Pablo J
Published: February 2024

Rezūm is a relatively new, minimally invasive approach that utilizes vaporized water to ablate prostatic tissue surrounding the proximal urethra in patients with benign prostatic hyperplasia. However, of the many notable studies involving Rezūm’s effectiveness in men, none have documented use of Rezūm in the transgender community. With a growing population of transgender patients in the USA, prostate treatments will be offered for transgender women on a more regular basis. To the best of our knowledge, we introduce the first case of Rezūm being utilized to treat benign prostatic hyperplasia in a patient self-identifying as a woman.
Gastric necrosis secondary to gastric volvulus in a paraesophageal hernia: a case report
Authors: Bolliet Marine , Katuwal Binit , Kolachalam Ramachandra
Published: February 2024

Hiatal hernias are commonly encountered in clinical practice. In certain cases, especially in large hiatal hernias, gastric volvulus can occur. Patients with volvulus typically will present with vomiting, chest pain, shortness of breath, and dysphagia. In extreme cases, gastric volvulus can result in gastric necrosis requiring partial or total gastrectomy. Here we highlight a case of a 76-year-old female with a known large type IV hiatal hernia who was found to have gastric volvulus with necrosis requiring partial sleeve gastrectomy. This case demonstrates the rare, but possible complication of gastric necrosis secondary to gastric volvulus from a large hiatal hernia, prompting emergent surgical intervention.
Physician-Patient Face Masking’s Influence on Post-Intravitreal Injection Endophthalmitis Rates
Authors: Liddle Conner , Capone Antonio , Trese Matthew
Published: February 2024

Purpose:

We sought to determine if universal face mask guidelines implemented during the COVID-19 pandemic significantly influenced the incidence of endophthalmitis following intravitreal injections (IVI).

Methods:

This retrospective cohort study reviewed the electronic health records from a retina-only practice located in Michigan. The study evaluated patients receiving IVIs over two distinct time periods of April 2019-March 2020, and April 2020-March 2021, which made up our unmasked and masked groups, respectively. We then calculated the incidence of endophthalmitis following IVI and evaluated cases of post-injection endophthalmitis for both time periods.

Results:

There were a total of 121,384 intravitreal injections performed over the two year period of interest. Of these, there were 63,114 unmasked and 58,270 masked patient encounters. A total of 46 post-injection endophthalmitis cases were identified. Of these, 29 cases were from the unmasked period and 17 were from the masked period. This resulted in an incidence of endophthalmitis of 0.046% and 0.038% in the masked and unmasked groups, respectively. This difference did not rise to the level of statistical significance (p=0.1336).

Conclusion:

This study suggests that the incidence of post-injections endophthalmitis was not influenced by the implementation of ophthalmologist-patient face masking after intravitreal injection during the COVID-19 pandemic.
A dynamic nomogram for predicting intraoperative brain bulge during decompressive craniectomy in patients with traumatic brain injury: a retrospective study
Authors: Zhuang Dongzhou , Li Tian , Xie Huan , Sheng Jiangtao , Chen Xiaoxuan , Li Xiaoning , Li Kangsheng , Chen Weiqiang , Wang Shousen
Published: February 2024

Objective:

The aim of this paper is to investigate the risk factors associated with intraoperative brain bulge, especially the CT value of the diseased lateral transverse sinus, and to develop a reliable predictive model to alert neurosurgeons to the possibility of intraoperative brain bulge.

Methods:

A retrospective analysis was performed on 937 patients undergoing traumatic decompressive craniectomy. A total of 644 patients from Fuzong Clinical Medical College of Fujian Medical University were included in the development cohort and 293 patients from the First Affiliated Hospital of Shantou University Medical College were included in the external validation cohort. Univariate and multifactorial logistic regression analyses identified independent risk factors associated with intraoperative brain bulge. The logistic regression models consisted of independent risk factors, and receiver operating characteristic curve, calibration, and decision curve analyses were used to assess the performance of the models. Various machine learning models were used to compare with the logistic regression model and analyze the importance of the factors, which were eventually jointly developed into a dynamic nomogram for predicting intraoperative brain bulge and published online in the form of a simple calculator.

Results:

Intraoperative brain expansion occurred in 93/644 (14.4%) patients in the developmental cohort, and 47/293 (16.0%) in the validation cohort. Univariate and multifactorial regression analyses showed that age, subdural hematoma, contralateral fracture, brain contusion, and CT value of the diseased lateral transverse sinus were associated with intraoperative brain bulge. A logistic regression model (full model) consisting of the above risk factors had excellent predictive power in both the development cohort (AUC=0.930) and the validation cohort (AUC=0.913). Among the four machine learning models, the Adaboost model showed the best predictive value (AUC=0.998). Factors in the Adaboost model were ranked by importance and combined with the full model to create a dynamic nomogram for clinical application, which was published online as a practical and easy-to-use calculator.

Conclusions:

The CT value of the diseased lateral transverse is an independent risk factor and a reliable predictor of intraoperative brain bulge. The online dynamic nomogram formed by combining logistic regression analysis models and machine learning models can more accurately predict the possibility of intraoperative brain bulge in patients undergoing traumatic decompressive craniectomy.
Change of indocyanine green clearance ability and liver function after transcatheter intraarterial therapies and its impact on outcomes of resectable hepatocellular carcinoma: a retrospective cohort study
Authors: Gan Yi-Xiang , Yang Zi-Liang , Pan Yang-Xun , Ou-Yang Li-Ying , Tang Yu-Hao , Zhang Yao-Jun , Chen Min-Shan , Xu Li
Published: February 2024

Background:

Indocyanine green (ICG) clearance test is a classical measurement of hepatic reserve, which involves surgical safety and patient recovery of hepatocellular carcinoma (HCC). We aim to compare effects of hepatic arterial infusion chemotherapy (HAIC) and transcatheter arterial chemoembolization (TACE) on liver function and outcomes of subsequent hepatectomy.

Material and Methods:

HCC patients receiving HAIC/TACE in SYSUCC with repeated ICG clearance tests were retrospectively enrolled. ICG eliminating rate (ICG-K), ICG retention rate at 15-minutes (ICG-R15) and ordinary laboratory tests were collected. Peri-therapeutic changes of values were compared between the groups. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) were employed to validate findings. Post-hepatectomy liver failure (PHLF), overall survival (OS) and recurrence-free survival (RFS) were analyzed in patients with subsequent curative hepatectomy.

Results:

204 patients treated with HAIC (n=130) and TACE (n=74) were included. ΔICG-R15 was greater in the HAIC arm before matching (mean, 3.8% vs. 0.7%, P<0.001), after PSM (mean, 4.7% vs. 1.1%, P=0.014) and IPTW (mean, 2.0% vs. –3.6%, P<0.001). No difference was found for ΔALB, ΔALBI, ΔTBIL, ΔALT, ΔAST and ΔPT-INR. Multivariable analyses revealed elder age, cirrhosis, HAIC, greater ΔTBIL and ΔALBI were associated with deteriorating ICG-R15. Among those (105 for HAIC and 48 for TACE) receiving hepatectomy, occurrence of grade B/C PHLF (4.8% vs. 8.3%, P=0.616), OS (median, unreached vs. unreached, P=0.94) and RFS (median, 26.7 vs. 17.1 mo, P=0.096) were comparable between the two arms. In subgroup analyses, preoperative HAIC yield superior RFS (median, 26.7 vs. 16.2 mo, P=0.042) in patients with baseline ICG-R15≤10%.

Conclusion:

Preoperative FOLFOX-HAIC caused apparent impairment of ICG clearance ability than TACE yet comparable impact on liver function and post-hepatectomy outcomes.
Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans
Authors: Hughes Charlotte Kaplan , Thapa Samrita , Theodoroff Sarah M. , Carlson Kathleen F. , Schultz James D. , Grush Leslie D. , Reavis Kelly M.
Published: February 2024

Objective

Identify associations between self-reported history of military and nonmilitary traumatic brain injury (TBI) on hearing loss and hearing difficulty from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study.

Study Design

Cross-sectional.

Setting

Multi-institutional tertiary referral centers.

Patients

Four hundred seventy-three Active-Duty Service members (ADSM) and 502 veterans.

Exposure

Self-reported history of no TBI, military TBI only, nonmilitary TBI only, both military and nonmilitary TBI.

Main Outcome Measures

Pure-tone hearing thresholds, Speech Recognition In Noise Test (SPRINT), Hearing Handicap Inventory for Adults (HHIA), and Speech, Spatial and Qualities of Hearing Scale (SSQ)-12.

Results

25% (120/473) of ADSM and 41% (204/502) of veterans self-reported a TBI. Military TBI was associated with poorer hearing thresholds in all frequency ranges in veterans (adjusted mean difference, 1.8 dB; 95% confidence interval [CI], 0.5–3.0; 3.3, 0.8–5.8; 5.1; 1.7–8.5, respectively), and in the high frequency range in ADSM (mean difference, 3.2 dB; 95% CI, 0.1–6.3). Veterans with military TBI only and nonmilitary TBI only had lower odds of correctly identifying speech in noise than veterans with no TBI (odds ratio [OR], 0.78; 95% CI, 0.72–0.83; 0.90; 0.84–0.98). ADSM with a military TBI (OR, 5.7; 95% CI, 2.6–12.5) and veterans with any TBI history (OR, 2.5; 95% CI, 1.5–4.3; OR, 2.2; 95% CI, 1.3–3.8; OR, 4.5; 95% CI, 2.1–9.8) were more likely to report hearing difficulty on HHIA. SSQ-12 results corroborated HHIA findings.

Conclusions

Military TBI was associated with poorer hearing thresholds in veterans and ADSM, and poorer SPRINT scores in veterans. Military TBI was associated with poorer self-perceived hearing ability in ADSM. All types of TBI were associated with poorer self-perceived hearing ability in veterans, although the strength of this association was greatest for military TBI.
The Role of Motion Sensitivity and Headaches on Vestibular Rehabilitation Outcomes in Pediatric Vestibular Migraines
Authors: Vesole Adam S. , Bachmann Katheryn R. , Mueller Gretchen A. , Lavender Violette H. , Castiglione Micheal , Greinwald John H.
Published: February 2024

Objective

To determine the utility of the motion sensitivity quotient (MSQ) in diagnosing pediatric vestibular migraine (VM) and to characterize the role of motion sensitivity and headache control on vestibular rehabilitation (VR) outcomes in pediatric VM.

Study Design

Retrospective cohort analysis.

Setting

Pediatric tertiary referral center.

Patients

Children (≤18 years old) with dizziness who completed vestibular testing from January 2016 to August 2022, diagnosed with either VM or another vestibular disorder.

Interventions

VR, which included MSQ testing.

Main Outcome Measures

Initial MSQ, number and duration of vestibular physical therapy (PT) sessions, PT goals met, and posttreatment MSQ.

Results

Two hundred fifty-seven patients met study criteria. MSQ was not a reliable diagnostic marker in pediatric VM as there was no difference in initial MSQ between VM and non-VM patients (9.4 vs. 7.8 in non-VM, p = 0.014). Both VM (n = 116) and non-VM (n = 141) patients demonstrated significant improvement in MSQ after VR (p = 0.004). However, VM patients tended to be less likely to meet at least one PT goal (60 vs. 77% in non-VM, p = 0.016, d = 0.37), although not significant. VM patients with more frequent headaches had significantly higher initial MSQ (p = 0.008). VM patients with more frequent headaches or higher initial MSQ tended to require increased number and longer duration of VR (small/medium effect size although not statistically significant after Bonferroni correction).

Conclusion

VR is an effective treatment for both VM and non-VM pediatric patients. VM patients, especially those with severe motion sensitivity or poorly controlled headaches, may be less responsive to VR and may require increased frequency and duration of VR. Our findings propose the importance of counseling pediatric patients with severe motion sensitivity or uncontrolled migraines regarding realistic expectations of their VR course.
NLRP3 Inflammasome Activation During Acute Negative Pressure Injury in the Middle Ear of Mice
Authors: Liu Shanshan , Tang Tiantian , Liu Wei , Chen Min , Qi Kemin , Ni Xin , Zhang Jie
Published: February 2024

Hypothesis

The present study was conducted to explore the role of the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome in mouse otic barotrauma models.

Background

Previous studies suggest that the NLRP3 inflammasome plays an important role in the pathogenesis of middle ear disease. However, whether middle ear negative pressure injury underlies NLRP3 inflammasome activation remains unclear.

Methods

Wild-type and Nlrp3−/−
mice were randomly assigned to control and pressure injury groups, respectively. Pressure loading was performed using a pressure cabin with the pressure level set to 20 kPa higher than that of the ambient atmosphere. This was achieved in approximately 15 seconds and maintained for 10 minutes. Hematoxylin and eosin staining was performed to detect morphological changes of the middle ear mucosa, tissue IL-1β was measured via an enzyme-linked immunosorbent assay, and cleaved caspase-1 was detected by Western blot.

Results

We found that the maturation of caspase-1 and IL-1β production in the middle ear significantly increased after otic barotrauma. In Nlrp3−/−
mice, inflammasome activation is downregulated and mucosal hyperplasia is reduced compared with those of wild-type mice during recovery.

Conclusion

The NLRP3 inflammasome likely plays an important role in the pathogenesis of otic barotrauma. Controlling activation of the NLRP3 inflammasome may promote middle ear recovery after negative pressure injury.
Idiopathic hypersomnia with a video recording of a spontaneous sleep attack: A case report
Authors: Asaga Takamasa , Hashimoto Kenichi , Kawamura Yusuke , Fujita Naoya , Kimata Motohiro , Sekizawa Akinori , Ono Yosuke , Obuchi Yasuhiro , Kobayashi Nanase , Hirasawa Hideto , Kanbayashi Takashi , Tanaka Yuji
Published: February 2024

Rationale:

Although patients with central disorders of hypersomnolence (CDH) exhibit characteristic symptoms of hypersomnia frequently, it takes 5 to 15 years from the onset for its diagnosis due to the lack of symptom recognition. Here, we present a case of idiopathic hypersomnia (IH), a CDH, wherein early diagnosis was aided by a video footage of a spontaneous sleep attack.

Patient concerns:

A 21-year-old man lost consciousness while driving and experienced an accident. He had complained of excessive daytime sleepiness (EDS) over half a year. During his hospitalization for close monitoring of the loss of consciousness, an in-room surveillance camera captured a 14-minutes long spontaneous sleep attack, during which he experienced general muscle weakness and loss of consciousness without warnings or convulsions leading to a fall from the bed. There were no abnormalities in vital signs.

Diagnoses:

There was no significant cataplexy and less than 2 sleep-onset rapid eye movements (SOREM) in 2 sleep latency tests, with a mean sleep latency of 2.1 and 4.6 minutes. Other sleep deprivation syndromes were excluded from differential diagnosis and finally, a diagnosis of IH was confirmed according to the criteria of the Third Edition of the International Classification of Sleep Disorders. During the course of the disease, attention-deficit/hyperactive disorder (ADHD) and a gaming disorder also diagnosed.

Interventions:

Pharmacological treatment with modafinil was administered for IH and methylphenidate for ADHD. Cognitive behavioral therapy was performed for the gaming disorder.

Outcomes:

The EDS improved, and sleep attacks were no longer observed. The disruption of daily life caused by the gaming disorder was also reduced.

Lessons:

Video recordings of sleep attacks are beneficial for identifying the cause of loss of consciousness. Home video recordings may be helpful in the early diagnosis of IH.
Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review
Authors: Gogovor Amédé , Zomahoun Hervé Tchala Vignon , Ben Charif Ali , Ekanmian Giraud , Moher David , McLean Robert K. D. , Milat Andrew , Wolfenden Luke , Prévost Karina , Aubin Emmanuelle , Rochon Paula , Rheault Nathalie , Légaré France
Published: February 2024

Background:

Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items.

Methods:

We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics.

Results:

Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections.

Conclusion:

Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.
The efficacy of gastric aspiration in reducing postoperative vomiting after oral and maxillofacial surgery: A meta-analysis
Authors: Zhang Xushu , Xie Xiaojuan , Shi Min , Yao Yao , Feng Zhen , Yang Jian , Guo Tao
Published: February 2024

Background:

Gastric aspiration is applied in oral and maxillofacial procedures to reduce postoperative vomiting (POV), yet its clinical benefit remains largely uncertain. Our study aimed to determine the role of gastric aspiration in the amelioration of POV by a meta-analysis.

Methods:

With adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, global recognized databases, including PubMed, Embase, and Cochrane Central, were searched to obtain randomized controlled trials (RCTs) investigating the effects of gastric aspiration in oral and maxillofacial surgery. The incidence and the number of episodes of POV and the frequency of rescue antiemetic use were extracted as parametric data for pooled estimation. Funnel plots and Egger’s test were utilized to assess bias. The recommendation of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results:

After detailed evaluation, 5 RCTs containing 274 participants were eventually included. The results of pooled estimation indicated that gastric aspiration could not reduce the incidence of POV (risk ratio [95% CI] = 0.94 [0.73, 1.21], P = .621), the number of episodes of POV (standard mean difference [95% CI] = −0.13 [−0.45, 0.19], P = .431) or the frequency of rescue antiemetic use (RR [95% CI] = 0.86 [0.49, 1.52], P = .609). No publication bias was detected by the funnel plot and Egger test. The overall recommendation of evidence was rated low regarding each outcome.

Conclusion:

Based on current evidence, gastric aspiration is not recommended for oral and maxillofacial surgery. Meanwhile, more large-scale high-quality RCTs are needed.
Generation of red blood cells from induced pluripotent stem cells
Authors: Gunawardena Naomi , Chou Stella T.
Published: February 2024

Purpose of review

Human induced pluripotent stem cells (iPSCs) are an attractive source to generate in-vitro-derived blood for use as transfusable and reagent red cells. We review recent advancements in the field and the remaining limitations for clinical use.

Recent findings

For iPSC-derived red blood cell (RBC) generation, recent work has optimized culture conditions to omit feeder cells, enhance red cell maturation, and produce cells that mimic fetal or adult-type RBCs. Genome editing provides novel strategies to improve cell yield and create designer RBCs with customized antigen phenotypes.

Current protocols support red cell production that mimics embryonic and fetal hematopoiesis and cell yield sufficient for diagnostic RBC reagents. Ongoing challenges to generate RBCs for transfusion include recapitulating definitive erythropoiesis to produce functional adult-type cells, increasing scalability of culture conditions, and optimizing high-density manufacturing capacity.
Changing the Landscape of the Neighborhood
Authors: Sartor Nicole , Bass Alice K. , Overstreet Kayla
Published: February 2024

There is a dearth of information on the role of the pediatric palliative advanced practice registered nurse (APRN) reported in the literature, and yet, the role is expanding. Advances in technology and health care are helping children with medical complexity live longer, and the demand for pediatric palliative care is growing. As programs expand to meet this need, there are new opportunities for pediatric palliative APRNs to practice outside acute care consultative models, within large children's hospitals. The aim of this article was to describe the expanding role of the pediatric palliative APRN using a progressive case study that describes how these expanding roles can collaborate using evidence-based practice and expert consensus to define their roles. If pediatric palliative APRNs hesitate to define their practice, others will define it for them.
Noninvasive Neuromodulation Combined With Rehabilitation Therapy Improves Balance and Gait Speed in Patients With Stroke
Authors: Tangjade Anamon , Suputtitada Areerat , Pacheco-Barrios Kevin , Fregni Felipe
Published: February 2024

Objective

This study aimed to determine repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial nerve noninvasive neuromodulation affect functional balance, gait speed, and walking cadence in stroke patients.

Methods

We searched PubMed, Embase, Cochrane, and Scopus (June 22, 2022) for randomized controlled trials. Three reviewers independently performed data extraction and assessed the risk of bias. Network and pairwise meta-analyses were performed to assess indirect and direct comparisons.

Results

We included 34 studies (N = 915 patients). Sixty percent had moderate-to-high methodological quality. The meta-analyses showed positive effects of repetitive transcranial magnetic stimulation combined with rehabilitation therapy compared with sham on gait speed, walking cadence, and balance function with weighted mean differences and 95% confidence interval of 0.08 (0.03 to 0.13), 7.16 (3.217 to 11.103), and 3.05 (0.52 to 5.57), respectively. Transcranial direct current stimulation showed improvement on the time up and go test (−0.88 [−1.68 to −0.08]). From the surface under the cumulative ranking analyses, repetitive transcranial magnetic stimulation is the best ranked treatment for gait speed and functional balance improvement compared with transcranial direct current stimulation and sham interventions. There were not enough studies to include cranial nerve noninvasive neuromodulation in the meta-analysis.

Conclusions

Walking cadence and speed, functional balance significantly improved after repetitive transcranial magnetic stimulation with short-term effects, which were superior to that of transcranial direct current stimulation and sham treatments. Transcranial direct current stimulation showed short-term beneficial effects on the Time Up and Go test.
Pitfalls of Amyloid-Beta PET
Authors: Ishibashi Kenji , Kurihara Masanori , Toyohara Jun , Ishii Kenji , Iwata Atsushi
Published: February 2024

We present 3 patients as pitfalls of amyloid-beta (Aβ) PET, who underwent 11C-PiB (Aβ), 18F-MK-6240 (Alzheimer disease [AD]-tau), and 18F-THK5351 (astrogliosis) PET examinations. Despite negligible or tiny Aβ pathology, patients 1 and 2 were diagnosed with AD as the cause of symptoms. Despite widespread Aβ pathology, patient 3 was not diagnosed with AD as the cause of symptoms. However, if we had only conducted Aβ PET, patients 1 and 2 might not have been diagnosed with AD, whereas patient 3 might have been diagnosed with AD. Hence, both Aβ and AD-tau assessments are necessary to relate clinical symptoms to AD pathology.
Puncture and Drainage Surgery for Intracerebral Hemorrhage Guided by 3D Printing Puncture Guide Plate
Authors: Kang Shengyu , Zhao Chengle , Fan Yifeng
Published: February 2024

Objectives:

Accurate puncture is the key to ensure the effect of puncture and drainage surgery for intracerebral hemorrhage. It usually uses CT to guide the drainage tube to reach the center of the hematoma cavity, which has the problems of inaccurate positioning using 2D images and high requirements for surgeon’s experience in brain anatomy and imaging diagnosis. The aim of this study was to use a 3D printing puncture guide plate to guide the puncture and drainage surgery for intracerebral hemorrhage.

Methods:

The CT images were imported into 3D Slicer software to reconstruct 3D models of the head skin and intracerebral hematoma. The target was set in the center of the hematoma and the puncture path from the target to the entry point was designed, the 3D model of puncture guide plate was constructed and saved as stereolithography format file, which was imported into 3D printer to print. During surgery, the drainage tube was placed in the center of the hematoma guided by the 3D printing puncture guide plate, and the blood clot was extracted by the suction syringe.

Results:

Eight patients with hypertensive intracerebral hemorrhage were treated with puncture and drainage surgery guided by 3D printing puncture guide plate. The average operation time of the 8 surgeries was 17.63 minutes. The drainage tubes were all precisely placed in the center of the hematoma, and the blood clots were all successfully extracted. The positioning errors of the 8 drainage tubes were between 1.76 mm and 2.68 mm, and the mean value was 2.10±0.32 mm. The hematoma clearance rate of the 8 patients was between 74.18% and 96.73%, and the mean value was 85.14±6.71%.

Conclusions:

The puncture and drainage surgery for intracerebral hemorrhage guided by 3D printing puncture guide plate helps to quickly and effortlessly localize intracerebral hematoma and achieves satisfactory hematoma clearance rate.
Baseball Injury Prevention Through a Community Outreach Initiative
Authors: Kaplan Nate , Mirsky Nicholas Alexander , Taylor Ruby , Thaller Seth R.
Published: February 2024

Sports-related craniofacial injuries account for 10% to 42% of facial fractures in the US pediatric population, with the incidence of injury peaking at ages 6 to 7 and 12 to 14. The National Survey of Children’s Health reported ~5.6 million children between the ages of 6 and 17 participated in baseball in 2021. National Electronic Injury Surveillance System reported 861,456 injuries resulting from baseball and 511,117 injuries resulting from softball in 2021, with ~500,000 of those injuries being to the face/head/neck. While participation in baseball and other youth sports has tremendous physical and mental health benefits, facial and other athletic injuries are concerning beyond the pain and disability caused by the incident itself. Severe injury can result in lost time from school as well as other social activities. Players and their families often experience financial strain as a result of physical trauma as well. The use of protective equipment has decreased the incidence of emergency department visits due to baseball-related trauma, especially mouthguards. However, adherence to using mouthguards is relatively low in baseball, with over 80% of players reporting not being told by a coach to wear mouthpieces. Youth from low-income areas often lack financial means to provide protective equipment and health insurance in the case of injury. The authors, along with the University of Miami Miller School of Medicine Division of Plastic and Reconstructive Surgery and Miami Marlins RBI Program, created an outreach program by which over 400 mouthguards were given to players and caretakers at inner-city baseball and softball programs. Two community outreach events took place in South Florida. One event was held at a University of Miami Men’s Baseball Game, and another was held on the opening day of the Miami Marlins RBI Program youth baseball league. In addition to handing out protective equipment and informational pamphlets, a question and answers session was held to discuss injury prevention. In conclusion, our community safety initiative created an interactive dialogue and message to hundreds of youth baseball players about the importance of protective gear to prevent injuries.
Oral Plasmablastic Lymphoma: A Rare Manifestation of HIV-Related Neoplasm—A Brief Clinical Study
Authors: Ramyasri Manimaran , Singh Vikram , Mohan Rangan Natarajan , Roy Indranil Deb , Tomar Kapil , Desai Ajay P. , Yadav Rekha , Krishnan Mukesh
Published: February 2024

Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency virus-positive patients. Though the oral cavity is a common site for PBL, this condition is not commonly reported in the literature as an oral manifestation. Most oral PBLs presented as an asymptomatic swelling, frequently associated with ulcerations and bleeding. No standard treatment is yet advocated for oral PBL. Five-year survival rate was recorded not more than 33.5%. This presentation emphasizes on oral manifestation of plasmablastic lymphoma (PBL) as a rare entity, which was provisionally diagnosed for carcinoma (CA) oral cavity. A simple presentation of ulcerated growth in the upper jaw was excised for histopathologic evaluation. Subsequently, it turned out to be a rare oral manifestation of HIV-related lymphoma. It is imperative to understand simple oral presentation as a manifestation of an underlying systemic condition. With this interest, this case presentation is published with a literature review.
Heterozygous FGFR3 c.138G>A Mutation Presenting With Achondroplasia and Hemifacial Microsomia
Authors: Kwon Hyok Jun , Farmer Lachlan D.M. , Moore Mark H.
Published: February 2024

We present a case of a patient with achondroplasia, hemifacial microsomia and an fibroblast growth factor receptor3 c.138G>A mutation. An association between the 2 conditions has not been previously described, but there is biological plausibility that the etiology of the 2 conditions is linked.
Organ Nonutilization Following Revision to the Public Health Service Donor Risk Criteria for HIV, HCV, or HBV Transmission
Authors: Patel Suhani S. , Kim Jacqueline I. , Stewart Darren E. , Segev Dorry L. , Massie Allan B.
Published: February 2024

Background.

Organs from Public Health Service criteria (PHSC) donors, previously referred to as PHS infectious-risk donors, have historically been recovered but not used, traditionally referred to as “discard,” at higher rates despite negligible risk to recipients. On March 1, 2021, the definition of PHSC donors narrowed to include only the subset of donors deemed to have meaningfully elevated risk in the current era of improved infectious disease testing.

Methods.

Using Scientific Registry of Transplant Recipients data from May 1, 2019, to December 31, 2022, we compared rates of PHSC classification and nonutilization of PHSC organs before versus after the March 1, 2021, policy change among recovered decedents using the χ2 tests. We performed an adjusted interrupted time series analysis to examine kidney and liver recovery/nonuse (traditionally termed “discard”) and kidney, liver, lung, and heart nonutilization (nonrecovery or recovery/nonuse) prepolicy versus postpolicy.

Results.

PHSC classification dropped sharply from 24.5% prepolicy to 15.4% postpolicy (P < 0.001). Before the policy change, PHSC kidney recovery/nonuse, liver nonuse, lung nonuse, and heart nonuse were comparable to non-PHSC estimates (adjusted odds ratio: kidney = 0.981.061.14, P = 0.14; liver = 0.850.921.01, P = 0.07; lung = 0.910.991.08, P = 0.83; heart = 0.890.971.05, P = 0.47); following the policy change, PHSC kidney recovery/nonuse, liver nonuse, lung nonuse, and heart nonuse were lower than non-PHSC estimates (adjusted odds ratio: kidney = 0.770.840.91, P < 0.001; liver = 0.770.840.92, P < 0.001; lung = 0.740.810.90, P < 0.001; heart = 0.610.670.73, P < 0.001).

Conclusions.

Even though PHSC donors under the new definition are a narrower and theoretically riskier subpopulation than under the previous classification, PHSC status appears to be associated with a reduced risk of kidney and liver recovery/nonuse and nonutilization of all organs. Although historically PHSC organs have been underused, our findings demonstrate a notable shift toward increased PHSC organ utilization.
Marginal Zone B Cells Are Necessary for the Formation of Anti-donor IgG After Allogeneic Sensitization
Authors: Kallarakal Melissa A. , Cohen Gregory S. , Ibukun Francis I. , Krummey Scott M.
Published: February 2024

Background.

The formation of anti–major histocompatibility complex (MHC) antibodies is a significant barrier for many patients awaiting organ transplantation. Patients with preformed anti-MHC antibodies have limited options for suitable donors, and the formation of donor-specific anti-MHC antibodies after transplantation is a harbinger of graft rejection. Despite the recognized importance of anti-MHC antibodies, the mechanisms responsible for the differentiation of B cells after exposure to allogeneic antigens are poorly understood.

Methods.

To evaluate the differentiation of B cells in response to allogeneic antigen, we used a model of H-2b C57Bl/6 sensitization with H-2d antigen. We used a class I MHC tetramer-based approach to identify allogeneic B cells and flow cytometric crossmatch to identify allogeneic IgM and IgG.

Results.

We found that although the formation of anti-H-2d IgG was robust, few class-switched B cells and germinal center B cells were formed. Antigen-specific B cells did not express classical memory B-cell markers after sensitization but had an IgM+CD21+ marginal zone B-cell phenotype. The frequency of marginal zone B cells increased after sensitization. Depletion of marginal zone B cells before sensitization or skin grafting resulted in a significant diminution of anti-H-2d IgG and fewer germinal center B cells. Adoptive transfer experiments revealed that marginal zone B cells more efficiently differentiated into germinal center B cells and anti-donor IgG-producing cells than follicular B cells.

Conclusions.

These results demonstrate an important role for marginal zone B cells as a reservoir of alloreactive B cells that are activated by allogeneic antigens.
Genomic and metabolic versatility of Pseudomonas aeruginosa contributes to its inter-kingdom transmission and survival
Authors: Ambreetha Sakthivel , Zincke Diansy , Balachandar Dananjeyan , Mathee Kalai
Published: February 2024

Pseudomonas aeruginosa is one of the most versatile bacteria with renowned pathogenicity and extensive drug resistance. The diverse habitats of this bacterium include fresh, saline and drainage waters, soil, moist surfaces, taps, showerheads, pipelines, medical implants, nematodes, insects, plants, animals, birds and humans. The arsenal of virulence factors produced by P. aeruginosa includes pyocyanin, rhamnolipids, siderophores, lytic enzymes, toxins and polysaccharides. All these virulent elements coupled with intrinsic, adaptive and acquired antibiotic resistance facilitate persistent colonization and lethal infections in different hosts. To date, treating pulmonary diseases remains complicated due to the chronic secondary infections triggered by hospital-acquired P. aeruginosa. On the contrary, this bacterium can improve plant growth by suppressing phytopathogens and insects. Notably, P. aeruginosa is one of the very few bacteria capable of trans-kingdom transmission and infection. Transfer of P. aeruginosa strains from plant materials to hospital wards, animals to humans, and humans to their pets occurs relatively often. Recently, we have identified that plant-associated P. aeruginosa strains could be pathologically similar to clinical isolates. In this review, we have highlighted the genomic and metabolic factors that facilitate the dominance of P. aeruginosa across different biological kingdoms and the varying roles of this bacterium in plant and human health.
Twists and turns: 40 years of investigating how and why bacteria swim
Authors: Armitage Judith P.
Published: February 2024

Fifty years of research has transformed our understanding of bacterial movement from one of description, based on a limited number of electron micrographs and some low-magnification studies of cells moving towards or away from chemical effectors, to probably the best understood behavioural system in biology. We have a molecular understanding of how bacteria sense and respond to changes in their environment and detailed structural insights into the workings of one of the most complex motor structures we know of. Thanks to advances in genomics we also understand how, through evolution, different species have tuned and adapted a core shared system to optimize behaviour in their specific environment. In this review, I will highlight some of the unexpected findings we made during my over 40-year career, how those findings changed some of our understanding of bacterial behaviour and biochemistry and some of the battles to have those observations accepted.