bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination of Extended Antivirals With Antiretrovirals for Severe Mpox in Advanced Human Immunodeficiency Virus Infection: Case Series of 4 Patients
Authors: Duong Michael T , Tebas Pablo , Ancha Bhavya , Baron Jillian , Chary Pallavi , Isaacs Stuart N , Szep Zsofia
Published: February 2024

To gauge the safety and utility of extended tecovirimat/cidofovir for severe mpox, here we report our experience caring for 4 patients with mpox and advanced human immunodeficiency virus (HIV) at the Hospitals of the University of Pennsylvania during the 2022 global outbreak. Three patients had recurrent courses complicated by superinfections, coinfections and insufficient nutrition/housing, requiring extended tecovirimat (5–16 weeks) and cidofovir (1–12 doses) with probenecid and fluids. At follow-up, patients had undetectable HIV RNA on antiretrovirals, improved ulcers and stable renal function on antivirals. Serology guided cessation for one 7-month cidofovir course. Overall findings support a comprehensive approach of prolonged tecovirimat/cidofovir with antiretrovirals for severe mpox, while addressing social factors.
The “four Ds” and support for Local Smart Grids: analysis from national surveys in the UK and Canada
Authors: Walker Chad , Rowlands Ian H , Devine-Wright Patrick , Soutar Iain , Wilson Charlie , Gupta Rajat , Devine-Wright Hannah , Bishwokarma Juli , Ford Rebecca
Published: February 2024

Local Smart Grids are emerging during the climate crisis, as governments and industry recognize the need to better integrate intermittent renewable energy, storage, transportation, heating, and smart technologies. Such projects can represent profound changes to the status quo of energy and citizen lifestyles. They are also being associated with the “four Ds,” whereby Local Smart Grids are decarbonizing, decentralizing, digitalizing, and potentially democratizing energy systems. Yet, due to their recent arrival, there is very little social scientific research that has aimed to better understand public views, expectations, and support for this change. We attempt to fill this important gap in the literature through the analysis of two nationally representative surveys in the UK (n = 3034) and Canada (n = 941). This analysis highlights within- and between-country trends, including how the variation in responses regarding the “four Ds,” demographic factors, and other variables may explain the differences we see in terms of support for energy system change in the UK and Canada. Our analysis also shows that there are common elements, including the importance of the decentralization, and especially the democratization of energy in shaping support. We hope that this study will help governments, industry, community groups, and local residents themselves in both countries come together to advance the kind of Local Smart Grids that address climate change and represent a supported, just energy transition.
Dynamics of nanocluster aerosol in the indoor atmosphere during gas cooking
Authors: Patra Satya S , Jiang Jinglin , Ding Xiaosu , Huang Chunxu , Reidy Emily K , Kumar Vinay , Price Paige , Keech Connor , Steiner Gerhard , Stevens Philip , Jung Nusrat , Boor Brandon E
Published: February 2024

Nanocluster aerosol (NCA: particles in the size range of 1–3 nm) are a critically important, yet understudied, class of atmospheric aerosol particles. NCA efficiently deposit in the human respiratory system and can translocate to vital organs. Due to their high surface area-to-mass ratios, NCA are associated with a heightened propensity for bioactivity and toxicity. Despite the human health relevance of NCA, little is known regarding the prevalence of NCA in indoor environments where people spend the majority of their time. In this study, we quantify the formation and transformation of indoor atmospheric NCA down to 1 nm via high-resolution online nanoparticle measurements during propane gas cooking in a residential building. We observed a substantial pool of sub-1.5 nm NCA in the indoor atmosphere during cooking periods, with aerosol number concentrations often dominated by the newly formed NCA. Indoor atmospheric NCA emission factors can reach up to ∼1016 NCA/kg-fuel during propane gas cooking and can exceed those for vehicles with gasoline and diesel engines. Such high emissions of combustion-derived indoor NCA can result in substantial NCA respiratory exposures and dose rates for children and adults, significantly exceeding that for outdoor traffic-associated NCA. Combustion-derived indoor NCA undergo unique size-dependent physical transformations, strongly influenced by particle coagulation and condensation of low-volatility cooking vapors. We show that indoor atmospheric NCA need to be measured directly and cannot be predicted using conventional indoor air pollution markers such as PM2.5 mass concentrations and NOx (NO + NO2) mixing ratios.
Containing misinformation: Modeling spatial games of fake news
Authors: Jones Matthew I , Pauls Scott D , Fu Feng
Published: February 2024

The spread of fake news on social media is a pressing issue. Here, we develop a mathematical model on social networks in which news sharing is modeled as a coordination game. We use this model to study the effect of adding designated individuals who sanction fake news sharers (representing, for example, correction of false claims or public shaming of those who share such claims). By simulating our model on synthetic square lattices and small-world networks, we demonstrate that social network structure allows fake news spreaders to form echo chambers and more than doubles fake news’ resistance to distributed sanctioning efforts. We confirm our results are robust to a wide range of coordination and sanctioning payoff parameters as well as initial conditions. Using a Twitter network dataset, we show that sanctioners can help contain fake news when placed strategically. Furthermore, we analytically determine the conditions required for peer sanctioning to be effective, including prevalence and enforcement levels. Our findings have implications for developing mitigation strategies to control misinformation and preserve the integrity of public discourse.
COVID-19 Spillover Effects onto General Vaccine Attitudes
Authors: Lunz Trujillo Kristin , Green Jon , Safarpour Alauna , Lazer David , Lin Jennifer , Motta Matthew
Published: February 2024

Even amid the unprecedented public health challenges attributable to the COVID-19 pandemic, opposition to vaccinating against the novel coronavirus has been both prevalent and politically contentious in American public life. In this paper, we theorize that attitudes toward COVID-19 vaccination might “spill over” to shape attitudes toward “postpandemic” vaccination programs and policy mandates for years to come. We find this to be the case using evidence from a large, original panel study, as well as two observational surveys, conducted on American adults during the pandemic. Specifically, we observe evidence of COVID-19 vaccine spillover onto general vaccine skepticism, flu shot intention, and attitudes toward hypothetical vaccines (i.e., vaccines in development), which do not have preexisting attitudinal connotations. Further, these spillover effects vary by partisanship and COVID-19 vaccination status, with the political left and those who received two or more COVID-19 vaccine doses becoming more provaccine, while the political right and the unvaccinated became more anti-vaccine. Taken together, these results point to the salience and politicization of the COVID-19 vaccine impacting non-COVID vaccine attitudes. We end by discussing the implications of this study for effective health messaging.
Bilingual Statutory Interpretation and the United Kingdom: Domestic Law and International Experiences
Authors: Huws Catrin Fflûr
Published: February 2024

This article explores the emerging need for bilingual statutory interpretation within the United Kingdom and explains the significance of the High Court and Court of Appeal judgments in R (on behalf of Driver) v Rhondda Cynon Tâf County Borough Council both in terms of the process of statutory interpretation and with regard to its potential impact on the future of England and Wales as a unified jurisdiction. It draws upon the UK’s approaches to multilingual obligations under international law, and on comparative experiences of multilingualism within a domestic legal system.
TRIP6 promotes neural stem cell maintenance through YAP‐mediated Sonic Hedgehog activation
Authors: Li Ming‐Yang , Yang Xiu‐Li , Chung Chia‐Chi , Lai Yun‐Ju , Tsai Jui‐Cheng , Kuo Ya‐Lin , Yu Jenn‐Yah , Wang Tsu‐Wei
Published: February 2024

In the adult mammalian brain, new neurons are continuously generated from neural stem cells (NSCs) in the subventricular zone (SVZ)‐olfactory bulb (OB) pathway. YAP, a transcriptional co‐activator of the Hippo pathway, promotes cell proliferation and inhibits differentiation in embryonic neural progenitors. However, the role of YAP in postnatal NSCs remains unclear. Here, we showed that YAP was present in NSCs of the postnatal mouse SVZ. Forced expression of Yap promoted NSC maintenance and inhibited differentiation, whereas depletion of Yap by RNA interference or conditional knockout led to the decline of NSC maintenance, premature neuronal differentiation, and collapse of neurogenesis. For the molecular mechanism, thyroid hormone receptor‐interacting protein 6 (TRIP6) recruited protein phosphatase PP1A to dephosphorylate LATS1/2, therefore inducing YAP nuclear localization and activation. Moreover, TRIP6 promoted NSC maintenance, cell proliferation, and inhibited differentiation through YAP. In addition, YAP regulated the expression of the Sonic Hedgehog (SHH) pathway effector Gli2 and Gli1/2 mediated the effect of YAP on NSC maintenance. Together, our findings demonstrate a novel TRIP6‐YAP‐SHH axis, which is critical for regulating postnatal neurogenesis in the SVZ‐OB pathway.
ChatGPT as a Source of Patient Information for Lumbar Spinal Fusion and Laminectomy
Authors: Nian Patrick P. , Saleet Jayson , Magruder Matthew , Wellington Ian J. , Choueka Jack , Houten John K. , Saleh Ahmed , Razi Afshin E. , Ng Mitchell K.
Published: February 2024

Study Design:

Retrospective Observational Study

Objective:

The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine.

Summary of Background Data:

ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose.

Methods:

The first 10 frequently asked questions (FAQs) related to the search terms “lumbar spinal fusion” and “lumbar laminectomy” were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT.

Results:

Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT’s responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT.

Conclusions:

FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.
A Retrospective Comparative Analysis on the Effect of Tranexamic Acid to Reduce Perioperative Blood Loss in Patients Undergoing Cervical Spine Surgery
Authors: Money Adam J. , Dumont Guillaume , Sheppard Sean , Jackson J. Benjamin , Spitnale Michael , Bakaes Yianni , Gauthier Chase , Grabowski Gregory
Published: February 2024

Study Design:

Retrospective Cohort Study

Objective:

The purpose of this study is to assess the impact of intravenous TXA on blood loss outcomes in anterior, posterior, and combined approaches for elective cervical spine surgery.

Summary of Background Data:

Tranexamic acid (TXA) has been shown to reduce blood loss in a variety of operations, such as lumbar spine surgery. However, limited studies have evaluated the efficacy of TXA in cervical spine surgery.

Methods:

We performed a retrospective review of a single surgeon’s elective cervical spine operations between September 2011 and March 2017. Patients were divided into 3 groups: anterior approach, posterior approach, or combined approach. Patients were then further subdivided into TXA versus control groups based on whether they received TXA treatment. We performed multiple linear regressions to assess the relationship between the use of TXA and other dependent variables (number of vertebral levels treated, need for a vertebral corpectomy) on total perioperative blood loss, intraoperative estimated blood loss, postoperative drain output, total operative time, postoperative change in hemoglobin, and occurrence of transfusion and/or postoperative deep venous thrombus (DVT).

Results:

We found that the use of TXA statistically significantly reduced total perioperative blood loss (P=0.04) and postoperative drain output (P=0.004) in posterior surgical approach cervical spine surgery but did not statistically significantly impact any blood loss variables in anterior or combined surgical approaches to elective cervical spine surgery. The use of TXA was a significant predictor for a decrease in intraoperative (P=0.02) and postoperative (P<0.01) blood loss.

Conclusions:

This study found that TXA statistically significantly decreased total blood loss and postoperative drain output when controlling for multiple confounding factors.

Level of Evidence:

Level III.
Elective Single-Level Primary Anterior Cervical Decompression and Fusion for Degenerative Spondylotic Cervical Myelopathy Is Associated With Decreased Resource Utilization Versus Posterior Cervical Decompression and Fusion
Authors: Du Jerry Y. , Shafi Karim , Blackburn Collin W. , Chapman Jens R. , Ahn Nicholas U. , Marcus Randall E. , Albert Todd J.
Published: February 2024

Study Design:

Retrospective cohort study.

Objective:

To compare elective single-level anterior cervical discectomy and fusion (ACDF) versus posterior cervical decompression and fusion (PCDF) for degenerative cervical myelopathy (DCM) in terms of (1) cost, (2) length of hospital stay, and (3) discharge destination in Medicare patients. A sub-analysis of potential cost drivers was also performed.

Background:

In the era of value-based medicine, there is substantial interest in reducing the cost of care. Both ACDF and PCDF are used to treat DCM but carry different morbidity and risk profiles that can impact hospital resource utilization. However, this has not been assessed on a national level.

Methods:

Patients undergoing single-level elective ACDF and PCDF surgery were identified using the 2019 Medicare Provider Analysis and Review (MedPAR) Limited Data Set (LDS) and Centers for Medicare and Medicaid Services (CMS) 2019 Impact File. Multivariate models of hospital cost of care, length of stay, and discharge destination were performed, controlling for confounders. A univariate sub-analysis of 9 revenue centers was performed.

Results:

In all, 3942 patients met the inclusion criteria. The mean cost of elective single-level cervical fusion for myelopathy was $18,084±10,783, and the mean length of stay was 2.45±2.95 d. On multivariate analysis, ACDF was independently associated with decreased cost of $5,814 (P<0.001), shorter length of stay by 1.1 days (P<0.001), and decreased risk of nonhome discharge destination by 58% (adjusted odds ratio: 0.422, P<0.001).

On sub-analysis of 9 revenue centers, medical/surgical supply ($10,497, 44%), operating room charges ($5401, 23%), and accommodations ($3999, 17%) were the largest drivers of charge differences.

Conclusions:

Single-level elective primary ACDF for DCM was independently associated with decreased cost, decreased hospital length of stay, and a lower rate of nonhome discharge compared with PCDF. Medical and surgical supply, operating room, and accommodation differences between ACDF and PCDF are potential areas for intervention. Increased granularity in reimbursement structures is warranted to prevent the creation of disincentives to the treatment of patients with DCM with pathology that is better addressed with PCDF.

Level of Evidence:

Level—III Retrospective Cohort Study.
The efficacy and safety of adding anlotinib in gradual progression on third-generation EGFR-TKIs for EGFR-mutant advanced nonsmall cell lung cancer
Authors: Xiang Hai , Danna Ding , Xuefei Chen , Zhao Jinkai , Jin Guangjun
Published: February 2024

Acquired resistance is unavoidable with the approval of third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) for first-line therapy of advanced non small cell lung cancer (NSCLC). Some studies have found that combining antiangiogenesis medicines with EGFR-TKI may benefit clinical outcomes in EGFR-mutant NSCLC. However, it is unclear whether EGFR-TKI paired with antiangiogenesis therapy could further improve survival for patients with gradual progression. Thus, we comprised the clinical effectiveness and safety of continuous EGFR-TKI in combination with anlotinib and EGFR-TKI alone in patients who had gradual progression on third-generation EGFR-TKI treatment. The comparison of progression-free survival (PFS) and overall survival(OS) between two groups used the Kaplan–Meier method. Our study comprised 121 eligible patients in total. The objective response rates were 25.0% and 0%, and the disease response rate was 91.7% and 86.9% in the combination group and EGFR-TKIs monotherapy group. The median PFS of combined anlotinib and EGFR-TKI treatment was 6.7 months and the median PFS was 3.6 months in the EGFR-TKI monotherapy group (P < 0.001). There were no significant differences between the two groups in OS. The common adverse reactions were diarrhea (21.7%), hypertension (21.6%) and proteinuria (20.0%) in the combination group. Seven patients experienced a grade 3 or higher adverse event, no patients discounted the treatment or died due to the toxicity. Our study indicated that, when combined with anlotinib following gradual progression on EGFR-TKIs, it was more efficacious for EGFR-mutant NSCLC patients than EGFR-TKI monotherapy. And the toxicity was clinically manageable.
Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study
Authors: Saarinen Tiia , Savukoski Susanna M. , Pesonen Paula , Vaaramo Eeva , Laitinen Jaana , Varanka-Ruuska Tuulia , Ala-Mursula Leena , Niinimäki Maarit
Published: February 2024

Objective

To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions.

Methods

Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 study's 46-year follow-up in 2012. The participants' perceived work ability was investigated using the Work Ability Score (0-7 = poor vs 8-10 = good), along with potential covariates. Data concerning their consequent disability days, unemployment days, and disability pensions were collected from national registers. The association between their climacteric status at age 46 years, work ability, and working life participation was assessed using regression models.

Results

The climacteric women were more often smokers and more often had a lower level of education. The odds ratio for poor perceived work ability was 1.41 (95% CI, 1.06-1.87), and the incidence rate ratios for disability and unemployment days during the 2-year follow-up were 1.09 (95% CI, 1.07-1.11) and 1.16 (95% CI, 1.14-1.18), respectively, for the climacteric women compared with the preclimacteric women in models adjusted for smoking and education. The 7-year hazard ratio for disability pensions was 1.72 (95% CI, 1.02-2.91) for the climacteric women.

Conclusions

An earlier menopausal transition is associated with poorer perceived work ability, and it predicts lower recorded work participation and a higher disability pension rate in subsequent years.
Baseline Participant Characteristics at Enrollment in the Zoster Eye Disease Study
Authors: Prescott Christina R. , Cohen Elisabeth J. , Hochman Judith S. , Troxel Andrea B. , Lu Ying , Twi-Yeboah Alberta , Jimenez Carlos Lopez , Mian Shahzad I. , Mazen Choulakian Y. , Warner David B. , Baratz Keith H. , Jeng Bennie H. ,   on behalf of the ZEDS Trial Research Group
Published: February 2024

Purpose:

The Zoster Eye Disease Study (ZEDS) is the first randomized clinical trial to study the efficacy of long-term (1 year) suppressive valacyclovir treatment on herpes zoster ophthalmicus (HZO) outcomes. This article details the baseline characteristics of participants.

Methods:

Setting:

The study was set at 95 participating clinical centers in 33 states, Canada, and New Zealand.

Study Population:

Immunocompetent adults with a history of a characteristic HZO unilateral rash and documentation of an episode of active dendriform epithelial keratitis, stromal keratitis, endothelial keratitis, or iritis within the preceding year, enrolled in ZEDS from November 2017 to January 2023.

Intervention:

Participants were randomized to double-masked oral valacyclovir 1 gm daily versus placebo for 1 year of treatment and followed for 18 months.

Results:

Five hundred twenty-seven participants were enrolled across 4 strata according to age at HZO onset (younger or older than 60 years) and duration of HZO at enrollment (less or greater than 6 months), with an even distribution of men and women and a median age of 60 years. More participants with recent (57%, 300/527) than chronic HZO and younger than 60 years at HZO onset (54%, 286/527) were enrolled. Most participants were treated acutely with a recommended antiviral regimen (91%, 480/527) and had not been vaccinated against zoster (79%, 418/527).

Conclusions:

The broad ZEDS study population enhances the likelihood that ZEDS will provide generalizable high-quality evidence regarding the efficacy and safety of suppressive valacyclovir for HZO immunocompetent adults and whether it should become standard of care.

Trial Registration:

ClinicalTrials.gov Identifier: NCT03134196.
Safety and efficacy of capsular tension ring and capsular hook implantation for managing ectopia lentis in Marfan syndrome: real-world study
Authors: Chen Zexu , Jia Wannan , Chen Tianhui , Shen Xin , Wang Yalei , Sun Yang , Jiang Yongxiang
Published: February 2024

Purpose:

To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL).

Setting:

Eye and ENT Hospital of Fudan University, Shanghai, China.

Design:

Retrospective propensity score–matched cohort study.

Methods:

This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM).

Results:

This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group (P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups (P = .057). The posterior capsular opacification took place earlier (P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage (P = .037) compared with the MCTR group.

Conclusions:

The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.
‘Evaluation of beta-2-microglobulin and neuron-specific enolase as prognostic factors in patients over 65 years of age with frailty syndrome hospitalized for acute coronary syndrome’
Authors: Nowak Wojciech , Kowalik Ilona , Stępińska Janina
Published: February 2024

Background

The aim of the study is to assess the value of beta-2-microglobulin (B2M) and neuron-specific enolase (NSE) as prognostic factors in the population of patients over 65 years of age with frailty hospitalized due to acute coronary syndrome (ACS).

Methods

Patients aged ≥65 years with ACS were included. Assessment of frailty was carried out using the FRAIL scale. The measurement of NSE and B2M was carried out three times during hospitalization: (1) at the time of admission, (2) on the second day of hospitalization, (3) on the seventh day of hospitalization, or the day of discharge if it was before the seventh day. The primary endpoint was all-cause mortality, and the secondary endpoint was unscheduled rehospitalization.

Results

Of the 127 patients, frailty was identified in 39.3%. Multivariate analysis of variance showed significantly higher levels of NSE (P = 0.012) and B2M (P < 0.001) in patients with frailty compared to the nonfrail group and significant changes in marker levels during hospitalization - decreased NSE (P < 0.001) and increased B2M levels (P < 0.001). Elevated B2M-1 level was an independent marker of the occurrence of frailty [odds ratio (OR), 1.98 (1.09–4.00); P = 0.044], and the optimal cutoff point for the diagnosis of frailty was 2.85 mg/l [area under the curve (AUC), 0.718 (0.632–0.795)] with sensitivity 52% and specificity 84.4% (P < 0.001). Elevated NSE-3 level was associated with all-cause mortality, and each 1 ng/ml increase in NSE-3 increased the risk of death by 1.07-fold [OR, 1.07 (1.03–1.10]). Meanwhile, elevated B2M-3 level was associated with unscheduled rehospitalization, and each 1 mg/l increase in B2M-3 increased the risk of unscheduled rehospitalization by 1.21-fold [OR, 1.21 (1.03–1.42)]. The Harrell’s C-index for all-cause mortality was higher for NSE-3 [0.820 (95% confidence interval {CI}, 0.706–0.934)] compared to frailty assessed by the FRAIL scale [0.715 (95% CI, 0.580–0.850)], which means that additional NSE-3 assessment may improve the prediction of all-cause mortality. However, Uno’s C-Statistic analysis showed that the difference was not statistically significant (Pr>chi-square 0.556). Harrell’s C-index for unscheduled rehospitalization was higher for frailty assessed by the FRAIL scale compared to B2M-3.

Conclusion

Monitoring NSE and B2M marker levels in patients over 65 years of age with frailty and ACS does not provide additional benefits in terms of prognostic ability compared to tests assessing frailty. B2M, assessed upon hospital admission and monitoring NSE and B2M levels during hospitalization may be considered in the diagnosis of frailty and risk stratification in a group of patients for whom currently available frailty diagnostic tools cannot be used.
The likelihood of detecting abnormal karyotypes in fetuses with a single major anomaly or “soft” marker on ultrasonographic scanning
Authors: Petrovic Bojana , Milicevic Srboljub , Sljivancanin Dragisa , Zdelar Stojanovic Ljiljana , Stamenkovic Jelena , Grk Milka , Dusanovic Pjevic Marija
Published: February 2024

Objective

Fetuses with abnormal karyotypes often exhibit distinctive ultrasonographic markers, including major anomalies and “soft” markers, indicating potential chromosomal issues. A crucial consideration arises when a single fetal anomaly is detected, raising the question of whether karyotyping is warranted, given the associated procedural risks. Our objective was to establish correlations between single fetal anomalies identified through ultrasound and chromosomal abnormalities.

Methods

A cross-sectional study analyzed the karyotype of 1493 fetuses and detected a single ultrasonographic anomaly over a 16-year period. Karyotyping was performed using the standard karyotype technique. Moreover, data regarding the type of anomaly detected ultrasonographically, karyotype results, and outcomes following interventions were collected. Among other methods, the use of positive likelihood ratios (LR+) was used to evaluate the diagnostic accuracy of ultrasound compared to karyotyping.

Results

In total, an aberrant karyotype was identified in 99 fetuses (6.6%). This was most commonly observed in cases involving a “soft” marker, occurring in 27 out of 218 fetuses (12.4%). The most frequently detected aberrant karyotype resulted from aneuploidies (80.6% of cases), notably trisomy 21 (50.5%). “Soft” markers predicted chromosomal issues (LR+ = 1.9; OR = 2.4), and isolated polyhydramnios (LR+ = 1.54; OR = 1.6) showed significance in predicting fetal chromosomal aberrations.

Conclusion

When assessing the necessity for karyotyping in fetuses with single major anomalies or “soft” markers, it is crucial to consider individual risks for chromosomopathies, including the LR+ of the detected marker. In cases where fetuses exhibit isolated anomalies with a normal karyotype, additional diagnostic measures, such as molecular cytogenetic and molecular genetics techniques, may become necessary.
Lung infections due to emerging fungal pathogens
Authors: Machiavello Roman Francisco J. , Pischel Lauren , Azar Marwan M.
Published: February 2024

Purpose of review

This review highlights the epidemiology, pathogenesis and clinical management of pulmonary infections caused by emerging fungal organisms.

Recent findings

Emerging fungal infections have arisen as a result of population and environmental changes. An enlarging pool of immunocompromised hosts on triazole antifungal prophylaxis has led to an increased incidence of non-Aspergillus molds, such as Fusarium, Scedosporium and Lomentospora spp. Advances in diagnostic capabilities led to the identification of the Emergomyces genus and non-dermatitidis Blastomyces species, which have a significant disease burden in Africa and the Middle East. Climate change has contributed to changing the distribution of previously confined endemic mycoses, like coccidioidomycosis and talaromycosis. These emerging organisms pose important diagnostic and therapeutic challenges.

Newly recognized pathogenic fungi and established endemic mycoses with expanding geographic boundaries have become important agents of pulmonary disease. There is a dearth of clinical evidence on the appropriate management of these infections.
The changing landscape of infections in the lung transplant recipient
Authors: Lum Jessica , Koval Christine
Published: February 2024

Purpose of review

Infections in lung transplant recipients remain a major challenge and can affect lung allograft function and cause significant morbidity and mortality. New strategies for the prevention and treatment of infection in lung transplantation have emerged and are reviewed.

Recent findings

For important vaccine preventable infections (VPIs), guidance has been updated for at risk solid organ transplant (SOT) recipients. However, data on the efficacy of newer vaccines in lung transplant, including the respiratory syncytial virus (RSV) vaccine, are limited. Studies demonstrate improved vaccination rate with Infectious Diseases consultation during pretransplant evaluation. Two new antiviral agents for the treatment and prevention of cytomegalovirus (CMV) in SOT, letermovir and maribavir, are being incorporated into clinical care. CMV-specific cell-mediated immune function assays are more widely available. Antibiotics for the management of multidrug resistant pathogens and Burkholderia cepacia complex have been described in case series and case reports in lung transplant.

Although new vaccines and novel therapies for preventing and treating infections are available, larger studies evaluating efficacy in lung transplant recipients are needed.
Disparities across the continuum of lung cancer care: a review of recent literature
Authors: Kearney Lauren , Nguyen Tatyana , Steiling Katrina
Published: February 2024

Purpose of review

Lung cancer remains the leading cause of cancer mortality worldwide. Health disparities have long been noted in lung cancer incidence and survival and persist across the continuum of care. Understanding the gaps in care that arise from disparities in lung cancer risk, screening, treatment, and survivorship are essential to guiding efforts to achieve equitable care.

Recent findings

Recent literature continues to show that Black people, women, and people who experience socioeconomic disadvantage or live in rural areas experience disparities throughout the spectrum of lung cancer care. Contributing factors include structural racism, lower education level and health literacy, insurance type, healthcare facility accessibility, inhaled carcinogen exposure, and unmet social needs. Promising strategies to improve lung cancer care equity include policy to reduce exposure to tobacco smoke and harmful pollutants, more inclusive lung cancer screening eligibility criteria, improved access and patient navigation in lung cancer screening, diagnosis and treatment, more deliberate offering of appropriate surgical and medical treatments, and improved availability of survivorship and palliative care.

Given ongoing disparities in lung cancer care, research to determine best practices for narrowing these gaps and to guide policy change are an essential focus of future lung cancer research.
Jejunal angiodysplasia: surgery can be life-saving – a case report
Authors: Dabora Abderrahaim A. , Nogoud Alaedeen , Abdulsakhi Muntasir , Rafei Ahmed , Khalifa Hossam A.
Published: February 2024

Introduction:

Angiodysplasia, a rare cause of gastrointestinal (GI) bleeding, presents a spectrum of clinical manifestations from anemia to life-threatening hemorrhage. This case study emphasizes the significance of considering intestinal vascular malformations as a differential diagnosis, especially in the context of chronic anemia and GI bleeding. Jejunal angiodysplasia, though infrequent, poses diagnostic challenges due to the hidden nature of the small bowel in the GI system.

Case presentation:

A 23-year-old male presented with acute hematochezia and melena, necessitating prompt intervention. Despite a normal esophagogastroduodenoscopy, colonoscopy was hindered, CT angiography could not be performed due to the patient’s unstable condition, leading to a planned exploratory laparotomy. Surgical exploration revealed a mucosal vascular lesion in the jejunum, prompting resection, and anastomosis. The patient’s postoperative course was uneventful, reinforcing the importance of swift diagnosis and intervention.

Clinical discussion:

Angiodysplasia’s pathogenesis remains unclear, with hypotheses implicating vascular endothelial growth factor and submucosal changes. Challenges in management revolve around lesion localization and stabilizing hemodynamics, necessitating a multidisciplinary approach. While endoscopy is often diagnostic and therapeutic, advanced modalities such as CT angiography may be required. Literature review highlights diverse presentations and successful interventions, including embolization and surgical resection.

Conclusion:

Jejunal angiodysplasia demands a comprehensive diagnostic and therapeutic strategy. The presented case underscores the pivotal role of endoscopy, embolization, and surgery in managing this condition. Timely diagnosis and intervention are crucial for mitigating the impact of angiodysplasia, necessitating further research and collaborative efforts for improved management of this rare condition.
Comparison of cystectomy and lobectomy of lung hydatid cyst in pediatrics: a retrospective study
Authors: Behnia Kaveh , Shojaeian Reza , Mazandarani Fasihe , Bahrami Taqanaki Pegah , Ameri Leila , Shirzadeh Sepehr , Parvizi Mashhadi Mahdi
Published: February 2024

Objective:

Hydatid cyst is an endemic disease in Iran. The treatment of choice for pediatric lung hydatid cysts is surgical removal of the cyst. However, due to its high prevalence the risk of recurrence after the surgery, cystectomy with capitonnage, which preserves the lung tissue, is a favorable surgical approach compared to lobectomy. Herein, we compared the outcome of cystectomy and lobectomy of lung hydatid cysts.

Methods & Materials:

This is a retrospective study conducted in the pediatric surgery department. Pediatric patients who had undergone surgery due to pulmonary hydatid cysts were enrolled. The patients were divided into two groups including cystectomy and non-anatomic lobectomy. Then, the length of surgery, length of hospitalization, postoperative complications, and the time required to remove the chest tube were calculated in each group.

Results:

A total of 32 patients were enrolled in this retrospective study. Age, sex, location, and size of cysts were not significantly different between the two groups. The duration of surgery in the lobectomy and cystectomy groups was 116.3±33.7 versus 116.1±28.2 minutes, respectively (P=0.53). Surgery complications including the need for blood transfusion, pneumothorax, need for bronchoscopy and atelectasis were not different between the study groups. The mean time for first chest tube removal was significantly different between the groups with the lobectomy group having a shorter time (P=0.02). The length of hospital and ICU stay were not different between the two surgical procedures. The time to remove the first chest tube was significantly higher in cystectomy compared to lobectomy (P=0.02).

Conclusion:

The complications and outcome of the cystectomy are comparable to the lobectomy technique. However, the cystectomy method has the advantage of preserving the lung tissue, therefore it’s a favorable technique in endemic areas for hydatid cysts where reoperation may be indicated.
Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: a systematic review and Meta-analysis
Authors: Ambari Ade M. , Radi Basuni , Dwiputra Bambang , Arityanti Dean , Rikl Thomas , Inggriani Maria P. , Qhabibi Faqrizal Ria , Susilowati Eliana , Makes Indira Kalyana , Rudiktyo Estu , Cramer Maarten J. , Doevendans Pieter , Setianto Budhi , Santoso Anwar
Published: February 2024

Background:

Penicillin is essential for secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). However, the incidences of ARF recurrence and RHD progression remain high, particularly in endemic countries. This meta-analysis evaluated the effectiveness of penicillin adherence in secondary prevention of ARF recurrence and RHD progression.

Methods:

We included original articles employing an observational study design in which the study population included patients with ARF or RHD and documented adherence to secondary prophylaxis with penicillin for secondary prevention. Systematic searches of the PubMed, Scopus, and Cochrane databases were performed. Moreover, we also conducted a snowballing literature search from Europe PMC to expand the included studies. The quality of each study was assessed using the National Institute of Health Quality Assessment Tool. The statistical analyses were conducted using Review Manager 5.4.1 software developed by Cochrane. In addition, we utilized pooled odds ratios (ORs) to compare the adherence techniques.

Results:

A total of 310 studies were identified, of which 57 full-text articles were assessed for eligibility. We included six studies with 1,364 patients for the qualitative synthesis and meta-analysis. Good adherence to penicillin for the secondary prophylaxis of ARF and RHD, significantly reduced the odds of ARF recurrence or RHD progression by up to 71% compared to that associated with poor adherence (pooled OR 0.29 [0.21−0.40]; I²=0% [p=0.56]; Z=7.64 [p <0.00001]).

Conclusion:

Good adherence to penicillin for secondary prophylaxis in patients with ARF or RHD is essential for reducing the risk of ARF recurrence or RHD progression.
Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low grade glioma patients
Authors: Ahmed Khan Robert , Rahman Md Moshiur , Ziauddin Md. , Chowdhury Muhtamim , Hasan Mahbub
Published: February 2024

Introduction:

Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas which can be preserved if the tumor or lesions are involved eloquent areas.

Objective:

The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not.

Method:

We present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low grade glioma patients. Here two neurosurgeons were involved and the minimum follow-up was twelve months.

Results:

We achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. We used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. We found 3 cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks.

Conclusion:

Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low grade glioma a steep learning curve is needed to find out the negative areas, though we emphasize positive mapping of areas to secure the maximum eloquence.
Post-traumatic gastroduodenal artery pseudoaneurysm in paediatrics: a compelling case report highlighting early diagnosis and successful endovascular embolization
Authors: katwal Shailendra , Chataut Dinesh , Suwal Sundar , Thapa Ajit , Paudel Pratiksha , Bhandari Sushmita
Published: February 2024

Introduction and importance:

This manuscript underscores the critical significance of prompt diagnosis and intervention in cases of post-traumatic gastroduodenal artery pseudoaneurysms. Such occurrences, particularly in the paediatric population, are rare but potentially life-threatening complications following abdominal trauma, necessitating heightened clinical awareness. Despite their rarity, the devastating consequences of delayed recognition and management emphasize the necessity for advanced imaging modalities and individualized treatment strategies.

Case presentation:

A 17-year-old male presented with severe epigastric pain following a football fall. Despite initial stability, persistent symptoms prompted further investigation. Conventional screening methods proved inconclusive, leading to a contrast-enhanced computed tomography (CT) scan that revealed a gastroduodenal artery pseudoaneurysm. The subsequent fluoroscopy-guided angiography and successful embolization using glue exemplify the importance of timely intervention in such cases.

Conclusion:

This case highlights the importance of early recognition and appropriate intervention in post-traumatic gastroduodenal artery pseudoaneurysms. The successful outcome achieved through endovascular embolization underscores the necessity for vigilant monitoring and tailored management strategies in similar clinical scenarios.
A rare case of pancreatic adenocarcinoma accompanied by venous thrombosis, pleural and pericardial effusions
Authors: Shawakh Husam , Bdeiwi Hassan , Aljundi Rashed , Kashkash Fateh , Khoury Abdullah
Published: February 2024

Introduction:

Pancreatic cancer is a deadly type of cancer with few symptoms until metastasis. It poses a high risk of cancer-associated thrombosis.

Case presentation:

A 73-year-old male presented with fatigue, shortness of breath, weight loss since 9 months, and blood clots recently in his legs. Chest radiography revealed fluid accumulation in pleural and pericardial cavities. Later, a fluid examination revealed the presence of malignant cells in the pericardial fluid. After immunological tests and an upper gastrointestinal endoscopy were performed, a pancreatic tumor was suspected. The patient was administered anticoagulant treatment and palliative care, which resulted in improvement after one month.

Discussion:

Pancreatic adenocarcinoma is a highly aggressive cancer with a strong tendency to metastasize, leading to pericardial and pleural effusion, thrombophlebitis, and poor prognosis.

Conclusion:

This case indicates that venous thrombosis, pleural and pericardial effusions could be symptoms related to a pancreatic tumor.
Intraoperative electrocorticography-guided resection of the epileptogenic zone in an unusual porencephalic cyst: case report and literature review
Authors: Dahal Riju , Gurung Pritam , Kayastha Jessica , Malla Samridha , Badinski Tina , Rajbhandari Pravesh , Pant Basant
Published: February 2024

Introduction:

Porencephalic cysts resulting from perinatal artery infarctions typically manifest as large cysts accompanied by pre-existing neurological deficits. A small porencephalic cyst without any neurological deficit is a rare cause of medically refractory epilepsy.

Case Presentation:

A 23-year-old female presented with a history of medically refractory epilepsy secondary to a small right parieto-temporal porencephalic cyst. Despite optimal anti-seizure medications, seizures persisted. Surgical intervention was planned, and intraoperative electrocorticography (ioECoG) was used to delineate the epileptogenic zone (EZ), which was found to be two gyri posterior to the cyst.

Discussion:

Very focal ischemia resulting in a small porencephalic cyst from perinatal artery infarction exhibits a distinct organization of the EZ involving wider area posteriorly indicating involvement of arterial territory distal to the cyst. This contrasts with the typical peri-lesional EZ observed in other lesional epilepsy causes.

Conclusion:

Our findings emphasize the need to consider etiology during interpretation of ioECoG to better define the electrophysiological border between the normal and epileptogenic brain, aiding in achieving a better surgical outcome.