bluuebunny/crossref_metadata_2025 huggingface dataset:
Reversal of Propofol-induced Depression of the Hypoxic Ventilatory Response by BK-channel Blocker ENA-001: A Randomized Controlled Trial
Authors: Jansen Simone C. , van Lemmen Maarten , Olofsen Erik , Moss Laurence , Pergolizzi Joseph V. , Miller Thomas , Colucci Robert D. , van Velzen Monique , Kremer Philip , Dahan Albert , van der Schrier Rutger , Niesters Marieke
Published: January 2024

Background

The use of anesthetics may result in depression of the hypoxic ventilatory response. Since there are no receptor-specific antagonists for most anesthetics, there is the need for agnostic respiratory stimulants that increase respiratory drive irrespective of its cause. The authors tested whether ENA-001, an agnostic respiratory stimulant that blocks carotid body BK-channels, could restore the hypoxic ventilatory response during propofol infusion. They hypothesize that ENA-001 is able to fully restore the hypoxic ventilatory response.

Methods

In this randomized, double-blind crossover trial, 14 male and female healthy volunteers were randomized to receive placebo and low- and high-dose ENA-001 on three separate occasions. On each occasion, isohypercapnic hypoxic ventilatory responses were measured during a fixed sequence of placebo, followed by low- and high-dose propofol infusion. The authors conducted a population pharmacokinetic/pharmacodynamic analysis that included oxygen and carbon dioxide kinetics.

Results

Twelve subjects completed the three sessions; no serious adverse events occurred. The propofol concentrations were 0.6 and 2.0 µg/ml at low and high dose, respectively. The ENA-001 concentrations were 0.6 and 1.0 µg/ml at low and high dose, respectively. The propofol concentration that reduced the hypoxic ventilatory response by 50% was 1.47 ± 0.20 µg/ml. The steady state ENA-001 concentration to increase the depressed ventilatory response by 50% was 0.51 ± 0.04 µg/ml. A concentration of 1 µg/ml ENA-001 was required for full reversal of the propofol effect at the propofol concentration that reduced the hypoxic ventilatory response by 50%.

Conclusions

In this pilot study, the authors demonstrated that ENA-001 restored the hypoxic ventilatory response impaired by propofol. This finding is not only of clinical importance but also provides mechanistic insights into the peripheral stimulation of breathing with ENA-001 overcoming central depression by propofol.

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Pruritus Anesis in Dystrophic Epidermolysis Bullosa Pruriginosa with Dupilumab
Authors: Yang Dan-Yang , Jing Wen-Wen , Liu Xin , Li Li , Lu Tao , Li Xiao-Li
Published: January 2024

Dystrophic epidermolysis bullosa pruriginosa (DEB-Pr) is a rare subtype of dystrophic epidermolysis bullosa, and traditional treatments have limited efficacy. Dupilumab has demonstrated remarkable efficacy in relieving pruritus. In this case study, after traditional treatment failed, providers recommended the patient begin dupilumab to treat his pruritus. The patient was administrated a loading dose of 600 mg of dupilumab and a dose of 300 mg every 2 weeks. The Dermatology Life Quality Index and Pruritic Numeric Rating Scale were used to assess the patient’s situation. After several months, the patient’s DEB-Pr was considered in remission. Dupilumab may be a better choice than immunosuppressants for the treatment of pruritus in patients with DEB-Pr.
Intramedullary Impaction of the Basicervical Component is Determinant of Fixation Failure in a Simple Two-Part Pertrochanteric Fracture
Authors: Hong Seok Ha , Yu Kang Hun , Han Seung Beom
Published: January 2024

Objectives:

To evaluate initial fracture morphology influences on outcomes in simple two-part pertrochanteric fracture, with a focus on the basicervical component and its initial impaction.

Methods:

Design:

A retrospective cohort series

Setting:

Single Level I Trauma Center

Patients Selection Criteria:

Patients over 60 years of age with intertrochanteric fractures between 2011 and 2022 were retrospectively reviewed. Inclusion criteria comprised simple two-part pertrochanteric fractures (OTA/AO 31-A1.2) with a basicervical component who underwent cephalomedullary nailing and had a minimum follow-up of 6 months. Patients were divided whether the basicervical component was impacted into the medullary canal (intramedullary impaction (II) group) or displaced beyond the medullary canal (extramedullary (E) group). Exclusion criteria encompassed pathologic fractures, nondisplaced fractures, and basicervical neck fractures (OTA/AO 31-B3).

Outcome Measurements and Comparisons:

Reduction status was assessed as unacceptable if the head and neck (proximal) fragment was positioned intramedullary with respect to the distal fragment in either the AP or cross-lateral X-ray, and acceptable otherwise. Also, the degree of impaction on X-ray and CT scans (coronal, sagittal, axial) at injury were analyzed as a risk factor for failure. Revision rates and lag screw sliding over 15mm were compared between the II and E groups.

Results:

115 patients (95 female, average age 80 years) were included. The II group (n=58) compared to E group (n=57) showed more acceptable postoperative reductions (57% vs 81%, p=0.001), but significantly higher fixation failure (16% vs. 3.5%, p=0.048) and fracture collapse (28% vs. 7%, p=0.01). Intramedullary impaction was identified as a significant independent predictor for failure (OR 5.64, 95% CI 2.14-16.9, p<0.001) with more than 19.5mm impaction in sagittal CT scan as the threshold linked to increased failure risk.

Conclusion:

The current study highlights the significance of specific intertrochanteric fracture patterns, particularly intramedullary impaction of a basicervical component and impaction severity (≥19.5mm), as drivers of fixation failure.
Nivolumab combined docetaxel versus nivolumab in patients with previously treated nonsmall cell lung cancer: a phase 2 study
Authors: Wang Yang , Hao Qianyun , Nie Jun , Dai Ling , Hu Weiheng , Zhang Jie , Chen Xiaoling , Ma Xiangjuan , Tian Guangming , Han Jindi , Han Sen , Wu Di , Long Jieran , Zhang Ziran , Fang Jian
Published: January 2024

The current standard second-line treatment is immune checkpoint inhibitors monotherapy for nonsmall cell lung cancer (NSCLC) patients. The objective of this phase 2 study was to evaluate the efficacy and safety of nivolumab plus docetaxel compared with nivolumab monotherapy for second-line therapy in immunotherapy-naive patients with advanced NSCLC. Progression-free survival (PFS) was the primary endpoint of this phase 2 study. Patients were randomized to receive nivolumab plus docetaxel or nivolumab monotherapy. From July 2019 to June 2022, a total of 22 patients were recruited, with significantly longer median PFS observed in the nivolumab plus docetaxel group (4.0 months) compared to the nivolumab group (2.0 months), P = 0.0019. The study was closed in June 2022 due to slow recruitment. The objective response rate was 10.0% [95% confidence interval (CI), 0–28.6] in the nivolumab group and 25% (95% CI, 0.5–49.5) in the nivolumab + docetaxel group (P = 0.346). Disease control was significantly higher in the nivolumab plus docetaxel arm (40.0% versus 83.3%, P = 0.035). There was also an improvement in overall survival (OS) in the nivolumab + docetaxel arm, but this was not statistically significant (10.0 months versus 7.2 months, P = 0.129). The addition of docetaxel to nivolumab was well-tolerated, with adverse events more common in the combination group. Despite the small sample size, the results suggest that the addition of docetaxel to nivolumab may be a promising treatment option for NSCLC patients progressing on platinum-based chemotherapy, with trends towards improved OS observed.
M6A methylation of FKFB3 reduced pyroptosis of gastric cancer by NLRP3
Authors: Chen Wanyuan , Ye Xiaolin , Chen Yun , Zhao Tongwei , Zhou Hongying
Published: January 2024

Gastric cancer is a kind of malignant tumor that seriously endangers human life and health. Its incidence rate and mortality rate are among the highest in the global malignant tumors. Therefore, this study explored the role of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3) in the progression of gastric cancer and its underlying mechanism. Patients with gastric cancer were collected, and human GC cell lines (stomach gastric carcinoma 7901, stomach gastric carcinoma 823 , human gastric carcinoma cell line 803 and adenocarcinoma gastric stomach) were used in this study. We utilized glucose consumption, cell migration, and ELISA assay kits to investigate the function of GC. To understand its mechanism, we employed quantitative PCR (qPCR), western blot, and m6A methylated RNA immunoprecipitation assay. FKFB3 protein expression levels in patients with gastric cancer were increased. The induction of PFKFB3 mRNA expression levels in patients with gastric cancer or gastric cancer cell lines. Gastric cancer patients with high PFKFB3 expression had a lower survival rate. PFKFB3 high expression possessed the probability of pathological stage, lymph node metastasis or distant metastasis in patients with gastric cancer. PFKFB3 upregulation promoted cancer progression and Warburg effect progression of gastric cancer. PFKFB3 upregulation reduced pyroptosis and suppressed nucleotidebinding domain, leucinerich repeat containing protein 3-induced pyroptosis of gastric cancer. M6A-forming enzyme methyltransferase-like 3 increased PFKFB3 stability. Taken together, the M6A-forming enzyme methyltransferase-like 3 increased PFKFB3 stability and reduced pyroptosis in the model of gastric cancer through the Warburg effect. The PFKFB3 gene represents a potential therapeutic strategy for the treatment of gastric cancer.
Survival for Nonshockable Cardiac Arrests Treated With Noninvasive Circulatory Adjuncts and Head/Thorax Elevation*
Authors: Bachista Kerry M. , Moore Johanna C. , Labarère José , Crowe Remle P. , Emanuelson Lauren D. , Lick Charles J. , Debaty Guillaume P. , Holley Joseph E. , Quinn Ryan P. , Scheppke Kenneth A. , Pepe Paul E.
Published: January 2024

OBJECTIVES:

Cardiac arrests remain a leading cause of death worldwide. Most patients have nonshockable electrocardiographic presentations (asystole/pulseless electrical activity). Despite well-performed basic and advanced cardiopulmonary resuscitation (CPR) interventions, patients with these presentations have always faced unlikely chances of survival. The primary objective was to determine if, in addition to conventional CPR (C-CPR), expeditious application of noninvasive circulation-enhancing adjuncts, and then gradual elevation of head and thorax, would be associated with higher likelihoods of survival following out-of-hospital cardiac arrest (OHCA) with nonshockable presentations.

DESIGN:

Using a prospective observational study design (ClinicalTrials.gov NCT05588024), patient data from the national registry of emergency medical services (EMS) agencies deploying the CPR-enhancing adjuncts and automated head/thorax-up positioning (AHUP-CPR) were compared with counterpart reference control patient data derived from the two National Institutes of Health clinical trials that closely monitored quality CPR performance. Beyond unadjusted comparisons, propensity score matching and matching of time to EMS-initiated CPR (TCPR) were used to assemble cohorts with corresponding best-fit distributions of the well-established characteristics associated with OHCA outcomes.

SETTING:

North American 9-1-1 EMS agencies.

PATIENTS:

Adult nontraumatic OHCA patients receiving 9-1-1 responses.

INTERVENTIONS:

In addition to C-CPR, study patients received the CPR adjuncts and AHUP (all U.S. Food and Drug Administration-cleared).

MEASUREMENTS AND MAIN RESULTS:

The median TCPR for both AHUP-CPR and C-CPR groups was 8 minutes. Median time to AHUP initiation was 11 minutes. Combining all patients irrespective of lengthier response intervals, the collective unadjusted likelihood of AHUP-CPR group survival to hospital discharge was 7.4% (28/380) vs. 3.1% (58/1,852) for C-CPR (odds ratio [OR], 2.46 [95% CI, 1.55–3.92]) and, after propensity score matching, 7.6% (27/353) vs. 2.8% (10/353) (OR, 2.84 [95% CI, 1.35–5.96]). Faster AHUP-CPR application markedly amplified odds of survival and neurologically favorable survival.

CONCLUSIONS:

These findings indicate that, compared with C-CPR, there are strong associations between rapid AHUP-CPR treatment and greater likelihood of patient survival, as well as survival with good neurological function, in cases of nonshockable OHCA.
Timely Cessation of Proton Pump Inhibitors in Critically Ill Patients Impacts Morbidity and Mortality: A Propensity Score-Matched Cohort Study*
Authors: Palmowski Lars , von Busch Alexander , Unterberg Matthias , Bergmann Lars , Schmitz Stefanie , Schlüter Andreas , Peters Jürgen , Adamzik Michael , Rahmel Tim
Published: January 2024

OBJECTIVE:

Proton pump inhibitors (PPIs) are among the drugs most commonly used in critically ill patients. Although mainly applied temporarily for stress ulcer prophylaxis, their application is frequently not terminated. Potential adverse effects of PPI treatment could impact the outcome in case of unnecessary and, therefore, avoidable long-term continuation. We tested the hypotheses that nonindicated PPI therapy continued beyond hospital discharge is associated with increased morbidity, rehospitalization rate, and mortality.

DESIGN:

Nationwide retrospective cohort study considering critically ill patients treated on German ICUs between January, 2017, and December, 2018 with a 2-year follow-up.

SETTING:

A total of 591,207 patient datasets of a German healthcare insurer were screened.

PATIENTS:

We identified 11,576 ICU patients who received PPI therapy for the first time during their index ICU stay without having an indication for its continuation.

INTERVENTIONS:

The cohort was stratified into two groups: 1) patients without further PPI therapy and 2) patients with continuation of PPI therapy beyond 8 weeks after hospital discharge.

MEASUREMENTS AND MAIN RESULTS:

Frequency of predescribed adverse events associated with PPI therapy, 1-year rehospitalization rate, and 2-year mortality were determined. The proportion of patients with continued PPI therapy without an objectifiable indication was 41.7% (4,825 of 11,576 patients). These patients had a 27% greater risk of pneumonia (odds ratio [OR] 1.27; 95% CI, 1.15–1.39; p < 0.001) and a 17% greater risk of cardiovascular events (OR 1.17; 95% CI, 1.08–1.26; p < 0.001). Continued PPI therapy was associated with a 34% greater risk of rehospitalization (OR 1.34; 95% CI, 1.23–1.47) and a nearly 20% greater 2-year mortality risk (hazard ratio 1.17; 95% CI, 1.08–1.27; p = 0.006).

CONCLUSIONS:

These data demonstrate that an unnecessary continuation of PPI therapy after hospital discharge may significantly impact morbidity and mortality. To avoid potentially harmful overuse of a PPIs, intensivists should ensure timely cessation of a temporarily indicated PPI therapy.
Aryl hydrocarbon receptor: Linking environment to aging process in elderly patients with asthma
Authors: Yang Tianrui , Wan Rongjun , Tu Wei , Avvaru Sai Nithin , Gao Peisong
Published: January 2024

Aging is a significant risk factor for various diseases, including asthma, and it often leads to poorer clinical outcomes, particularly in elderly individuals. It is recognized that age-related diseases are due to a time-dependent accumulation of cellular damage, resulting in a progressive decline in cellular and physiological functions and an increased susceptibility to chronic diseases. The effects of aging affect not only the elderly but also those of younger ages, posing significant challenges to global healthcare. Thus, understanding the molecular mechanisms associated with aging in different diseases is essential. One intriguing factor is the aryl hydrocarbon receptor (AhR), which serves as a cytoplasmic receptor and ligand-activated transcription factor and has been linked to the aging process. Here, we review the literature on several major hallmarks of aging, including mitochondrial dysfunction, cellular senescence, autophagy, mitophagy, epigenetic alterations, and microbiome disturbances. Moreover, we provide an overview of the impact of AhR on these hallmarks by mediating responses to environmental exposures, particularly in relation to the immune system. Furthermore, we explore how aging hallmarks affect clinical characteristics, inflammatory features, exacerbations, and the treatment of asthma. It is suggested that AhR signaling may potentially play a role in regulating asthma phenotypes in elderly populations as part of the aging process.
Cheek Reconstruction with a Nasolabial External-Rotation Flap
Authors: Ishii Nobuaki , Akimoto Masataka , Ogawa Rei
Published: January 2024

It remains difficult to reconstruct large preauricular defects in a single step with good cosmetic outcomes. We describe here the nasolabial external-rotation (NER) flap, which was combined with a cervical-rotation flap to reconstruct a large skin defect on the preauricular area that included the malar prominence. The patient in case 1 was a 91-year-old man who had a large defect on his right cheek after excision of a squamous cell carcinoma. Three weeks after excision, the 6.5 × 5.5 cm defect was covered with a 5 × 3 cm NER flap, which had a cephalad base and was rotated so its caudal tip covered the malar prominence. The resulting nasolabial defect and the remaining defect occupied the entire buccomandibular area, which was then covered with a 13 × 10 cm cervical-rotation flap. Revision surgery has not been needed for 8.5 months and the cosmetic outcomes are good. The patient in case 2 was a 90-year-old man who had a large defect on his right cheek after excision of a squamous cell carcinoma. Four weeks after excision, the 4.7 × 4 cm defect was covered with an 8 × 3 cm NER flap. The buccomandibular defect was covered with a 9.5 × 5 cm cervical-rotation flap. The flaps survived completely. The NER flap is unique because the flap is moved from the midface to the lateral face. It can reconstruct the malar prominence with thick skin tissue, and it is particularly suitable for older patients. Combining it with a cervical-rotation flap allows for natural subunit reconstruction in a relatively minimally invasive manner with good aesthetic outcomes.
TMR for Peripheral Sensory Nerve Neuroma around the Wrist Utilizing the Distal Anterior Interosseous Nerve
Authors: Muneer Mohammed
Published: January 2024

Injury to the peripheral sensory nerves of the hand and wrist is common and can lead to debilitating neuromas and significantly impair patients’ quality of life. Target-muscle reinnervation (TMR) is a novel method for treating neuromas that can result in significant clinical improvement. However, TMR for the peripheral sensory nerves in the hand and wrist is restricted by the limited options for motor branches. The adaptability of the anterior interosseous nerve (AIN) as a target for TMR treating peripheral sensory neuroma has not been thoroughly investigated or implemented therapeutically. This study aimed to evaluate the use of AIN as a viable recipient of TMR for treating peripheral sensory neuromas around the wrist. In this retrospective study, eight patients were included over 18 months from June 2021 to January 2023 at Hamad Medical Corporation. The average follow-up time after TMR was 13 months. The peripheral sensory nerves involved were the radial sensory nerve in five cases, the palmar cutaneous branch of the median nerve in one case, and the median nerve in one case. The preoperative average VAS pain score was 7 of 10 compared with the postoperative pain score of 2 of 10. In conclusion, the AIN can be used as a first-choice motor target for all peripheral sensory neuromas around the wrist for the following reasons: first, it can be reached by the peripheral sensory nerves around the wrist; second, the pronator quadratus muscle is expandable; and third, the AIN can be taken with a long proximal tail for flexible coaptation with the peripheral sensory nerves.
Primary Periocular Orofacial Granulomatosis: Case Series and Systematic Review
Authors: Plemel David J. A. , Weis Ezekiel , Punja Karim G. , Ashenhurst Michael E. , Mai Derek D. , Kulaga Andrzej
Published: January 2024

Purpose:

There is no known optimal treatment for primary periocular orofacial granulomatosis (PPOFG), a disorder that results in periocular edema. This case series and systematic review identifies management strategies and their reported improvement.

Methods:

Systematic review and case series. PubMed and MEDLINE databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify published cases of PPOFG. Cases were included when edema involved the periocular tissues and when a biopsy was interpreted to be PPOFG. Cases were excluded when edema did not involve the periocular tissues or when the edema was secondary to another process. The electronic medical records of the pathology department were studied to identify cases that were in keeping with PPOFG. The clinical charts were examined to confirm the diagnosis and provide a local case series.

Results:

There are 38 published cases of PPOFG. An additional 9 cases were identified locally. These cases were combined and analyzed. Most PPOFG has eyelid swelling in isolation, without other facial swelling (36/47; 76.6%). It is most commonly a bilateral disease (30/47; 63.8%). Fissured tongue and facial nerve palsy occur, just as they do in other cases of orofacial granulomatosis. Treatment with surgical debulking or intralesional steroids resulted in high rates of symptomatic improvement of eyelid swelling, but recurrences were common.

Conclusions:

In light of no curative or highly successful treatment currently available, intralesional steroids and/or surgical debulking are therapies in the treatment of eyelid swelling associated with PPOFG that demonstrate reasonable short- and medium-term results. There is no established therapy that can offer disease remission or long-term symptom improvement.
Tarsal Buckling and Entropion after Levator Aponeurosis Advancement in Patients with Floppy Eyelid Syndrome
Authors: Gregerson Celestine H. , Cho Raymond I.
Published: January 2024

Two patients with floppy eyelid syndrome presented with severe eye pain and foreign body sensation after recent levator aponeurosis advancement. The examination in both patients was notable for entropion of the upper eyelid, and upper lid eversion revealed deformity of the tarsus in both patients. Surgical revision with full-thickness horizontal tarsotomy and limited excision of the abnormal tarsus corrected the deformity. The authors propose a mechanism for this phenomenon and a modification of surgical technique that may prevent this complication.
Orbital Trapdoor Fracture With Extraocular Muscle Entrapment in Adults: A Case Series
Authors: Miyazaki Hidetaka , Someda Steffani Krista , Yokoyama Tatsuro , Vaidya Aric , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: January 2024

Purpose:

To report adult patients with an orbital trapdoor fracture with extraocular muscle entrapment.

Methods:

We retrospectively reviewed 566 adult patients (>18 years) with a pure orbital fracture who were referred to us from January 2016 to May 2023. The following data were collected: age, sex, affected side, causes of injury, concomitant ocular injury and nasal bone fracture, presence or absence of oculocardiac reflex and infraorbital nerve hypesthesia, period from injury to surgery, follow-up period, and pre- and postoperative limitation of extraocular muscle motility and fields of a binocular single vision.

Results:

We found 5 patients (0.9%) with an orbital trapdoor fracture with extraocular muscle entrapment (age range, 19–47 years; all males; 2 right and 3 left). Causes of injury included performing a bench press, fall, assault, boxing, and bicycle accident. Entrapment of the inferior and medial recti muscles was seen in 2 and 3 patients, respectively. None of the patients had any sign of oculocardiac reflex. After surgical reduction, the field of binocular single vision became normal in 3 patients and was incompletely recovered in 2 patients, in whom consultation with us was delayed.

Conclusion:

Adults with extraocular muscle entrapment may not present with an oculocardiac reflex. Urgent release of an entrapped muscle is, however, still recommended to avoid permanent limitation of extraocular muscle motility.
Quantitative Assessment of Subjective Symptoms and Corneal Sensitivity in Chronic Orbital Pain Patients
Authors: Lee Grace , Kardon Randy H. , Nellis Julie K. , Pham Chau M. , Sales Christopher S. , Carter Keith D. , Shriver Erin M.
Published: January 2024

Purpose:

To objectively evaluate the subjective symptoms and characteristics of chronic orbital pain as well as to quantify sensitization of peripheral trigeminal nerves.

Methods:

In this prospective cohort study, patients who previously showed a response to peripheral trigeminal nerve blocks for unilateral, idiopathic chronic orbital pain and healthy subjects completed validated questionnaires assessing headaches, neuropathic signs and symptoms, photophobia, and pain qualities. Corneal sensitivity was measured in both eyes for all subjects with a Cochet-Bonnet aesthesiometer. For pain patients, the full assessment protocol was repeated 2–4 weeks after the study injection, and corneal sensitivity was also measured 30 minutes postinjection. Outcomes assessed were headache, neuropathic pain, and photophobia scores; pain qualities; and corneal sensitivity.

Results:

Six female chronic orbital pain patients (mean age 48.2 years) and 11 female controls (mean age 47.5) were included. The mean headache, neuropathic pain, and photophobia questionnaire scores were significantly higher for pain patients than for controls (p < 0.001). On sensory testing, 5 pain patients (83.3%) endorsed allodynia, and all 6 (100%) had hyperalgesia in the ipsilateral frontal nerve dermatome. No controls had allodynia or hyperalgesia. Corneal sensitivity was similar between eyes in pain patients and between groups. Questionnaire scores and corneal sensitivity did not change significantly after the injection.

Conclusions:

Chronic orbital pain patients have a measurable reduction in quality of life due to headaches and photophobia. The supraorbital and supratrochlear nerves are sensitized, resulting in cutaneous hypersensitivity in the corresponding dermatome, but corneal nerves have normal sensitivity.
Polymer-Coated Urinary Catheter Reduces Biofilm Formation and Biomineralization: A First-in-Man, Prospective Pilot Study
Authors: Kalenderski Kiril , Dubern Jean-Frédéric , Lewis-Lloyd Christopher , Jeffery Nicola , Heeb Stephan , Irvine Derek J. , Sloan Tim J. , Birch Brian , Andrich Daniela , Humes David , Alexander Morgan R. , Williams Paul
Published: January 2024

Purpose:

Biofilm formation and biomineralization on urinary catheters may cause severe complications including infection and obstruction. Here, we describe an in vitro evaluation and prospective pilot clinical study of a silicone catheter coated with a biofilm-resistant polymer.

Materials and Methods:

Biofilm biomass and biomineralization on uncoated and coated catheters were quantified by confocal microscopy using fluorescently tagged bacteria or stained for biofilm and minerals. Biomineral identity was determined using scanning electron microscopy and X-ray spectroscopy. Biofilm formation and biomineralization were evaluated in vitro using uropathogens Proteus mirabilis and Pseudomonas aeruginosa and on catheters recovered from hospitalized patients. Fibrinogen in patient urine and on catheters was quantified using an immunofluorescence assay.

Results:

In vitro P. mirabilis and P. aeruginosa formed significantly less biofilm and biomineral and failed to block coated compared with uncoated catheters in a bladder model after 89 h. Biofilm-resistant polymer-coated catheters (n = 83) recovered from hospitalized patients exhibited significantly lower biofilm biomass and biomineralization compared with uncoated silicone catheters (n = 78). Electron microscopy with elemental analysis of recovered catheters revealed calcium oxalate crystals on coated compared with the struvite and apatite crystals on uncoated catheters associated with catheter blockage. Lower levels of biofilm-promoting fibrinogen in postcatheterization urine and on catheters from patients receiving coated catheters was observed compared with those receiving uncoated catheters indicative of a reduced inflammatory response.

Conclusions:

These data provide evidence that polymer-coated urinary catheters exhibit enhanced resistance to fibrinogen deposition, biofilm formation, and encrustation, reducing the risks associated with catheter-associated urinary tract infections and obstruction.
Futility and poor outcomes are not the same thing: A clinical perspective of refined outcomes definitions in liver transplantation
Authors: Rolak Stacey , Elhawary Ahmed , Diwan Tayyab , Watt Kymberly D.
Published: January 2024

The term “futility” in liver transplantation is used inappropriately and inaccurately, as it is frequently applied to patient populations with suboptimal outcomes that are often not truly “futile.” The term “futile” is used interchangeably with poor outcomes. Not all poor outcomes fulfill a definition of futility when considering all viewpoints. Definitions of “futility” are variable throughout the medical literature. We review futility in the context of liver transplantation, encompassing various viewpoints, with a goal to propose focused outcome definitions, including futility, that encompass broader viewpoints, and improve the utilization of “futility” to truly futile situations, and improve communication between providers and patients/families. Focused, appropriate definitions will help the transplant community develop better models to more accurately predict and avoid futile transplants, and better predict an individual patient’s posttransplant outcome.
The Effect of Electrode Position on Behavioral and Electrophysiologic Measurements in Perimodiolar Cochlear Implants
Authors: Collins Aaron , Foghsgaard Søren , Druce Edgar , Margani Valerio , Mejia Olivia , O’Leary Stephen
Published: January 2024

Background

The shape and position of cochlear implant electrodes could potentially influence speech perception, as this determines the proximity of implant electrodes to the spiral ganglion. However, the literature to date reveals no consistent association between speech perception and either the proximity of electrode to the medial cochlear wall or the depth of insertion. These relationships were explored in a group of implant recipients receiving the same precurved electrode.

Methods

This was a retrospective study of adults who underwent cochlear implantation with Cochlear Ltd.’s Slim Perimodiolar electrode at the Royal Victorian Eye and Ear Hospital between 2015 and 2018 (n = 52). Postoperative images were obtained using cone beam computed tomography (CBCT) and analyzed by multi-planar reconstruction to identify the position of the electrode contacts within the cochlea, including estimates of the proximity of the electrodes to the medial cochlear wall or modiolus and the angular depth of insertion. Consonant-vowel-consonant (CVC) monosyllabic phonemes were determined preoperatively, and at 3 and 12 months postoperatively. Electrically evoked compound action potential (ECAP) thresholds and impedance were measured from the implant array immediately after implantation. The relationships between electrode position and speech perception, electrode impedance, and ECAP threshold were an analyzed by Pearson correlation.

Results

Age had a negative impact on speech perception at 3 months but not 12 months. None of the electrode-wide measures of proximity between electrode contacts and the modiolus, nor measures of proximity to the medial cochlear wall, nor the angular depth of insertion of the most apical electrode correlated with speech perception. However, there was a moderate correlation between speech perception and the position of the most basal electrode contacts; poorer speech perception was associated with a greater distance to the modiolus. ECAP thresholds were inversely related to the distance between electrode contacts and the modiolus, but there was no clear association between this distance and impedance.

Conclusions

Speech perception was significantly affected by the proximity of the most basal electrodes to the modiolus, suggesting that positioning of these electrodes may be important for optimizing speech perception. ECAP thresholds might provide an indication of this proximity, allowing for its optimization during surgery.
Perception of Specific Musical Attributes in Dependence of the Insertion Depth of Cochlear Implant Electrodes Using the Montreal Battery of Evaluation of Amusia
Authors: Heitkötter Felix S. , Krämer Bianca A. , Spiekermann Christoph O. , Beule Achim G. , Rudack Claudia
Published: January 2024

Hypothesis

The insertion angle of the electrode array has an influence on the perception of different musical features.

Background

A deeper insertion of the electrodes is associated with a greater coverage of the cochlea with possible stimulus locations. This could lead to an improved or extended perception of pitches and pitch changes as well as to a better perception of contours in musical pieces.

Methods

A Montreal Battery of Evaluation of Amusia test battery was conducted with a collective of 19 cochlear implant (CI) users and 9 normal-hearing subjects. For the CI users, the insertion angles of the intracochlear electrode arrays were calculated using Otoplan software.

Results

Compared with normal-hearing users, CI users performed worse in the detection of melodic features of music. CI users performed better with temporal features than with melodic features. An influence of the insertion depth of the electrodes on the results of the Montreal Battery of Evaluation of Amusia could be proven neither for Cochlear nor for MED-EL CI users.

Conclusion

Deeper insertion of electrode arrays may only better approximate the spatial-frequency map. Alone, it does not have an effect on better detection and identification of pitch and tonality and, consequently, better perception of musical attributes. Anatomy-based calculation of electrode locations and matching to characteristic frequencies will be sought in subsequent studies.
Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery
Authors: Gidumal Sunder , Saade Mia , Schwam Zachary G. , Govindan Aparna , Mavrommatis Maria , Wong Kevin , Perez Enrique R. , Wanna George B. , Cosetti Maura K.
Published: January 2024

Objective

To determine whether surgeon use of a soft cervical collar during endoscopic and microscopic otologic surgery is feasible and impacts surgeon ergonomics as measured by inertial sensors.

Study Design

Prospective crossover trial.

Setting

US-based otolaryngology training program.

Patients

Otolaryngology residents and fellows.

Interventions

Therapeutic—use of a soft cervical collar during simulated otologic surgery.

Main Outcome Measures

Time spent in high-risk angles of neck and back flexion and extension; average angle of neck flexion, extension, rotation, and lateral bending; validated assessment of neck pain; average daily phone use.

Results

Fifteen subjects met criteria for inclusion. Ten of 15 (67%) were male. Seven of 15 (47%) were postgraduate year 1–2. Seven of 15 (47%) reported a history of neck pain. None reported prior spinal steroid injections or surgery. Across all subjects, use of the soft cervical collar significantly reduced time spent in high-risk angles of neck flexion/extension during both endoscopic (56% vs. 35%, p < 0.05) and microscopic (60% vs. 32%, p < 0.05) otologic surgery. There was no effect on back flexion or extension. There was no difference in time spent in high-risk neck or back angles between endoscopic and microscopic surgery. Average angles of neck or back flexion, extension, lateral bending, and rotation were not significantly different for subgroups with more operative experience, increased phone use, perception of good posture, or history of neck pain.

Conclusions

Use of a soft cervical collar during simulated otologic surgery significantly reduced time spent in high-risk neck positions. These data support feasibility of soft collar use during otologic surgery and hold promise for reduction in the high rates of neck pain reported by neurotologists.

Professional Practice Gap and Educational Need

Improving surgeon ergonomics for otologic surgery.

Learning Objective

To identify a therapeutic intervention to mitigate neck pain in surgeons caused by assumption of high-risk cervical neck flexion and extension.

Desired Result

To demonstrate that use of a readily available soft cervical collar reduces risk of neck pain in otologic surgeons.

Level of Evidence

II.

Indicate IRB or IACUC

Exempt.
Hypoxemia secondary to thymoma excision with 1-lung ventilation: A case report
Authors: Xu Hao
Published: January 2024

Introduction:

Acute respiratory distress syndrome (ARDS) is an acute respiratory illness characterized by bilateral chest radiographic opacities and severe hypoxemia due to noncardiogenic pulmonary edema. However, ARDS due to sing lung injury is rare. In this article, we describe a case of a female patient who developed ARDS during surgery and 1-lung mechanical ventilation.

Methods:

A 53-year-old woman developed hypoxemia 2 days after undergoing thymoma excision. Antibiotics, diuretics, expectorants, and supportive treatment strategies (noninvasive positive-pressure breathing, high-flow nasal oxygen) were used for approximately 3 days after admission to the intensive care unit (ICU), but the patient’s oxygen index continued to deteriorate. Considering the possibility of ARDS being induced by 1-lung mechanical ventilation, prone positioning, methylprednisolone, nintedanib, and acetylcysteine were administered.

Result:

Oxygenation improves greatly after 23 days admitted to ICU. Chest computed tomography shows a real reversal of the disease. The patient was discharged from ICU 29 days after admission to the ICU and was discharged from the hospital after 36 days admitted to ICU.

Conclusion:

In this report, we describe a rare case of ARDS involved 1 lung, in which we successfully used noninvasive positive-pressure breathing, high-flow nasal oxygen, and prone positioning to succeed improvement of clinical outcomes. The use of the prone position has benefits in nonintubated patient with ARDS even involved 1 lung.
Effects of adding neuromuscular electrical stimulation to functional training on muscle recruitment, pain reduction, and knee joint function in patellofemoral pain syndrome patients
Authors: Nie Qiu , Yu Yaming , Yuan Zheng , Chen Jian
Published: January 2024

Background:

Impaired lower extremity motor function and knee pain are common concerns in patients with patellofemoral pain syndrome (PFPS). It is essential to plan therapeutic techniques to therapy PFPS. The objective of this study was to determine the effect of neuromuscular electrical stimulation (NMES) combined with functional training on pain, lower extremity function and muscle recruitment in patients with PFPS.

Methods:

Twenty-four PFPS patients (male-13, female-11) were selected to conduct this study finally. Two groups were formed: the control group (n = 12) which included functional training only and the experimental group (n = 12) which functional training along with NMES-in both groups interventions were performed for 45 minutes/session, 3 days/weeks for 6 weeks. The functional training consisted of warm-up activities, strength training, balance training, and relaxation activities. All patients were evaluated with surface electromyography testing system for the root mean square and integrated electromyography of vastus medial oblique (VMO), vastus lateralis (VL), and VMO/VL ratio, visual analog scores (VAS) for pain, and Kujala functional score for knee joint function before and after 6 weeks. Normality was tested for all outcome variables using Shapiro–Wilk test. Nonparametric (Mann–Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data. A 2-way analysis of variance with repeated measures (group*time) was applied to analyze the data.

Results:

A significant increases (P < .001) root mean square and integrated electromyography of VMO, VMO/VL ratio, and Kujala score in both groups, For VAS scores, significant decreases was observed in both groups. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison the control group for both knee pain, lower extremity function and muscle recruitment. However, there was no difference in VL muscle recruitment between the 2 groups.

Conclusions:

Functional training and NMES combined with functional training are helpful to improve pain, knee function and muscle recruitment of PFPS patients. NMES combined with functional training was more effective compared to the control group. This may help clinical trialists to use different NMES to synchronize other interventions in future studies to enhance rehabilitation efficacy in PFPS patients through passive training versus active stimulation.
Evaluating the dependability of reference-driven citation forecasts amid the COVID-19 pandemic: A bibliometric analysis across diverse journals
Authors: Ho Sam Yu-Chieh , Chow Julie Chi , Chou Willy
Published: January 2024

Background:

The journal impact factor significantly influences research publishing and funding decisions. With the surge in research due to COVID-19, this study investigates whether references remain reliable citation predictors during this period.

Methods:

Four multidisciplinary journals (PLoS One, Medicine [Baltimore], J. Formos. Med. Assoc., and Eur. J. Med. Res.) were analyzed using the Web of Science database for 2020 to 2022 publications. The study employed descriptive, predictive, and diagnostic analytics, with tools such as 4-quadrant radar plots, univariate regressions, and country-based collaborative maps via the follower-leading cluster algorithm.

Results:

Six countries dominated the top 20 affiliations: China, Japan, South Korea, Taiwan, Germany, and Brazil. References remained strong citation indicators during the COVID-19 period, except for Eur. J. Med. Res. due to its smaller sample size (n = 492) than other counterparts (i.e., 41,181, 12,793, and 1464). Three journals showed higher network density coefficients, suggesting a potential foundation for reference-based citation predictions.

Conclusion:

Despite variations among journals, references effectively predict article citations during the COVID-19 era, underlining the importance of network density. Future studies should delve deeper into the correlation between network density and citation prediction.
Identifying prognostic factors for pulmonary embolism patients with hemodynamic decompensation admitted to the intensive care unit
Authors: Peng Yanbin , Chen Zhong , Luo Zhongkai , Luo Gaosheng , Chu Yunfeng , Zhou Bo , Zhu Siqi
Published: January 2024

We aimed to determine prognostic indicators of PE patients with hemodynamic decompensation admitted to the ICU. PE patients with hemodynamic decompensation at ICU admission from Medical Information Mart for Intensive Care IV database were included. Least absolute shrinkage and selection operator with 2 specific lambdas were performed to reduce the dimension of variables after univariate analysis. Then we conducted multivariate logistic regression analysis and 2 models were built. A total of 548 patients were included, among whom 187 died. Lactate, creatine-kinase MB, troponin-T were significantly higher in death group. Eight common factors were screened out from first model statistically mostly in consistent with second model: older age, decreased hemoglobin, elevated anion gap, elevated International Standard Ratio (INR), elevated respiratory rate, decreased temperature, decreased blood oxygen saturation (SpO2) and the onset of cardiac arrest were significantly risk factors for in-Hospital mortality. The nonlinear relationships between these indicators and mortality were showed by the restricted cubic spline and cutoff values were determined. Our study demonstrated that age, hemoglobin levels, anion gap levels, INR, respiratory rate, temperature, SpO2 levels, the onset of cardiac arrest could be applied to predict mortality of PE patients with hemodynamic decompensation at ICU admission.
Role of microRNAs deregulation in initiation of rheumatoid arthritis: A retrospective observational study
Authors: Li Zengxin , Zhao Wen , Wang Mengchang , Hussain Muhammad Zahid , Mahjabeen Ishrat
Published: January 2024

Rheumatoid arthritis (RA) is a joint disorder and is considered an important public health concern nowadays. So, identifying novel biomarkers and treatment modalities is urgently needed to improve the health standard of RA patients. Factors involved in RA pathogenesis are genetic/epigenetic modification, environment, and lifestyle. In the case of epigenetic modification, the expression deregulation of microRNAs and the role of histone deacetylase (HDAC) in RA is an important aspect that needs to be addressed. The present study is designed to evaluate the expression pattern of microRNAs related to the HDAC family. Five microRNAs, miR-92a-3p, miR-455-3p, miR-222, miR-140, and miR-146a related to the HDAC family were selected for the present study. Real-time polymerase chain reaction was used to estimate the level of expression of the above-mentioned microRNAs in 150 patients of RA versus 150 controls. Oxidative stress level and histone deacetylation status were measured using the enzyme-linked immunosorbent assay. Statistical analysis showed significant downregulation (P < .0001) of selected microRNAs in RA patients versus controls. Significantly raised level of HDAC (P < .0001) and 8-hydroxy-2’-deoxyguanosine (P < .0001) was observed in patients versus controls. A good diagnostic potential of selected microRNAs in RA was shown by the receiver operating curve analysis. The current study showed a significant role of deregulated expression of the above-mentioned microRNAs in RA initiation and can act as an excellent diagnostic marker for this disease.
Are patients with knee osteoarthritis aware that platelet-rich plasma is a treatment option?
Authors: Klein Joel , Soni Chirag , Ayotte Brian , Castro-Nunez Cristian , Feketeova Eleonora
Published: January 2024

Osteoarthritis (OA) is a prevalent joint disease, particularly affecting the knees. This condition is often managed through various treatments, including intra-articular injections such as corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). PRP has shown promising outcomes in recent studies although it does lack strong endorsement in some clinical guidelines due to inconsistent results and lack of standardized results. This study was conducted to assess patient awareness and the frequency of PRP offered for the treatment of knee OA, compared to CS and HA. In a cross-sectional study, 46 knee OA patients were surveyed regarding their knowledge and experiences of CS, HA, and PRP injections. The questionnaires were administered between September 2022 and February 2023. Additionally, the study evaluated the severity of patients knee OA, using the Western Ontario and McMaster Universities Arthritis Index, and gathered demographic information from the participants. CS injections were offered to 93.5%, and 100% of participants had previously heard of this type of injection. HA injections were offered to 37%, and 65.9% of participants had heard of them. PRP was offered to 2%, and 6.5% had ever heard of it. This study underscores the limited awareness and utilization of PRP among knee OA patients. Patients and physicians need to be more informed of all of the treatment options available for knee OA, especially orthobiologics such as PRP. Future research in larger, diverse populations is needed.