bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive Performance of Bayesian Dosing Software for Vancomycin in Intensive Care Unit Patients
Authors: Bai Gali , Qi Hui , Huang Yaqun , Zhang Jiao , Zhao Huiying , Wen Ruiting , Zhang Xiaohong
Published: February 2025

Background:

According to the updated guidelines, Bayesian-derived area under the curve estimation is recommended to guide vancomycin dosing. However, the Bayesian dosing software that facilitates this procedure has not been adequately assessed in intensive care unit (ICU) patients. This study evaluated the performance of 3 commonly used Bayesian software programs in predicting vancomycin concentrations in ICU patients before they could be utilized for personalized dosing in this population.

Methods:

Retrospective data from adult ICU patients who were administered vancomycin intravenously were obtained to predict serum concentrations a priori (based solely on patient characteristics) or a posteriori (Bayesian forecasting using measured concentrations). The predictive performance was evaluated via bias and precision using relative bias (rBias) and relative root mean squared error, respectively.

Results:

Data from 139 patients with 284 vancomycin concentrations were evaluated using 3 software programs: SmartDose (He model), Pharmado (Yasuhara model), and PrecisePK (Rodvald and Goti model). All 3 programs showed clinically acceptable bias with the exception of the Goti model of PrecisePK in an a priori estimation (rBias, 27.44%). A relatively low level of precision in terms of relative root mean squared error was observed in all these programs, but with a marked improvement in the a posteriori estimation (27.69%–37.64%) compared with the a priori situation (45.12%–68.59%).

Conclusions:

Bayesian dosing software is a potential tool for vancomycin dose optimization in ICU patients. Patients with different physiological and pathological features may be referred to specific Bayesian programs.
A Sensitive Ultrafiltration Plus RP-HPLC-FLD Method to Quantify Total and Free Perampanel Concentrations in the Plasma of Patients With Epilepsy: A Fully Validated Assay With Clinical Application
Authors: Dong Zhonghua , Wang Peng , Cui Xueyan , Liu Jinjuan , Shi Haiyan , Yang Yilei , Xu Jingya , Yi Qiaoyan
Published: February 2025

Background:

Perampanel (PER), a novel antiepileptic drug, exhibits high protein binding. Given the drug's susceptibility to various factors, including drug interactions, and the considerable variability in blood concentrations among individuals, solely measuring the total plasma concentration of PER may not provide comprehensive insights. This study aimed to establish an HPLC-FLD method to quantify both total and free PER in clinical samples.

Methods:

Analysis of total PER involved a straightforward sample preparation process involving plasma protein precipitation. Plasma samples were ultrafiltered to isolate the free portion of PER. Chromatographic separation was achieved on an InertSustain C18 column at a 1-mL/min flow rate using a gradient of acetonitrile and aqueous sodium acetate buffer at pH 4.4.

Results:

Calibration curves for total and free PER in plasma exhibited excellent linearity over the concentration ranges of 10–3000 and 0.5–100 ng/mL, respectively. The method was applied to analyze blood samples from patients with epilepsy quantitatively; the total concentration of perampanel in the plasma of the patients was in the range of 90.45–563.39 ng/mL, whereas the free concentration was in the range of 1.82–15.29 ng/mL. The plasma protein binding ratio of perampanel was normally between 97.09% and 99.29% and decreased in cases of hypoproteinemia.

Conclusions:

The method was rigorously validated for selectivity, accuracy, precision, and stability in accordance with established FDA and EMA guidelines. The developed method enables the rapid and accurate quantification of both total and free PER concentrations in the plasma of patients with epilepsy, offering technical support for its subsequent clinical application.
Outcomes of 32,019 Deep Inferior Epigastric Perforator Flap Reconstructions: Insights from the Largest National Readmission Data
Authors: Araya Sthefano , Peluso Heather , Doremus Nathan , Lane Jaina , Patel Heli , Talemal Lindsay , Najafali Daniel , Chang Alexander H. , Patel Sameer A.
Published: February 2025

Background:

We analyzed patient outcomes after deep inferior epigastric perforator (DIEP) flap reconstruction using a national database to assess readmission, mortality, morbidity, and length of stay (LOS).

Methods:

This retrospective cohort study utilized the 2017–2020 Nationwide Readmissions Database. Patients had an International Classification of Diseases, Tenth Revision procedure code for DIEP flap reconstruction from January to November each year. The primary outcome was the 30-day readmission rate, with secondary outcomes including in-hospital and 30-day mortality, reasons for admission and readmission, and complication rates. Multivariate regression adjusted for confounders.

Results:

A total of 32,019 DIEP flap reconstructions were identified, with a median patient age of 51 years. The most common indication was breast reconstruction after mastectomy. In-hospital, 30-day, and calendar-year mortality rates were all under 1% (95% confidence interval [CI]: 1.29–3.99). The 30-day readmission rate was 5.8% (95% CI: 5.4%–6.3%), with infection being the leading cause of readmission (2.0%), a previously unreported finding. Other causes included wound dehiscence (0.19%), pulmonary embolism (0.19%), sepsis (0.18%), and hematoma (0.18%). Reoperation rates were 7% during the index hospitalization and 11% during readmission. The average LOS was 3.7 days (95% CI: 3.65–3.82), consistent with current literature.

Conclusions:

This study provides valuable insights into DIEP flap reconstruction outcomes, revealing a 2.0% infection readmission rate. It shows a higher overall readmission rate (7% versus 5.6%) and a lower dehiscence rate (0.2% versus 2.8%) compared with previous data. These findings, derived from the largest nationally representative readmission database in the United States, also demonstrate comparable reoperation rates and LOS.
Multivariate Determinants of Emotional Compromise and Subjective Functional Quality of Life in Surgery-Naïve Patients With Keratoconus as Measured With the Keratoconus End Points Assessment Questionnaire
Authors: Balparda Kepa , García-Onrubia Luis , Valentín-Bravo Francisco Javier , Acera Arantxa , Merayo-Lloves Jesus , Fernández-Vega-Cueto Luis , Franco-Sánchez Isabela , López-Velásquez Mariana , Galarreta David J.
Published: February 2025

Purpose:

Keratoconus affects patients' quality of life. No study has assessed the multivariate determinants of quality of life using the keratoconus end points assessment questionnaire (KEPAQ).

Methods:

This study included patients with keratoconus with no history of ocular surgery, who underwent clinical evaluation and tomographic imaging using a dual Scheimpflug/Placido device (Galilei G6). Emotional and functional quality of life was assessed using the KEPAQ. Multiple linear regression models were constructed for each KEPAQ subscale to adjust for confounding variables.

Results:

A total of 140 surgery-naïve patients with keratoconus were included, with a median age of 39 years and a male predominance (57.1%). For the KEPAQ-E subscale, the multivariate model was significant [F(84,10) = 2.79; adjusted R2 = 0.160, P = 0.005], showing that female sex (β = −0.41) and worse corrected distance visual acuity in the better-seeing eye (β = −0.29) were associated with lower quality of life. Including the functional subscale score significantly enhanced the model's performance (adjusted R2 = 0.464, β = 0.60). For the KEPAQ-F subscale, the model was also significant [F(84,10) = 2.37; adjusted R2 = 0.127, P = 0.016], with corneal astigmatism in the better-seeing eye (β = −0.30) reducing quality of life. Adding the emotional subscale score improved the model (adjusted R2 = 0.442, β = 0.62).

Conclusions:

Female sex, reduced vision, and corneal astigmatism negatively affect quality of life in patients with keratoconus. Nonetheless, patients' perceived impairment as measured in 1 subscale is a stronger predictor of overall quality of life than clinical and tomographic factors alone.
Clinical Factors Predicting Favorable Response to Intense Pulsed Light Therapy for Refractory Meibomian Gland Dysfunction: A 6-Month Cohort Study
Authors: Yang Chi-Chun , Chen Meng-Jou , Cheng Ming-Hsuan , Fan Nai-Wen
Published: February 2025

Purpose:

Meibomian gland dysfunction (MGD) is a global health disorder, which can have a deleterious effect on visual function and quality of life. Intense pulsed light (IPL) therapy has been shown to ameliorate MGD. However, the optimal candidates who would benefit most from IPL remain undetermined. Therefore, we aimed in this study to identify the clinical factors associated with favorable outcomes in patients with MGD after IPL therapy.

Methods:

This single-center retrospective study included patients with refractory MGD treated with a course of IPL therapy combined with meibomian gland expression, with a follow-up period of 6 months. The outcome measures were the standardized patient evaluation of eye dryness (SPEED) score, tear breakup time, lid telangiectasia, meibum quality, and expressibility. Good responders were defined as those with at least a 1-point reduction in SPEED score and a 1-grade decrease in meibum quality at 6 months. Data were analyzed using the t test, chi-square test, and binary logistic regression analysis.

Results:

A total of 90 eyes in 90 patients (good responders: 48 eyes, nonresponders: 42 eyes) were included. Univariate analysis revealed that the good responders had a higher SPEED score at baseline than the nonresponders. Multivariate logistic regression analysis showed that more severe symptoms, more inspissated meibum, better expressibility, and milder degree of lid telangiectasia were independently associated with a favorable response.

Conclusions:

Our findings suggest that patients with worse symptoms, poorer meibum quality, milder telangiectasia, or less obstruction are more likely to have a good response to IPL therapy.
Centering Survivor Experiences in Human Trafficking and Sexual Exploitation Simulation Training to Improve Patient Care
Authors: Ellis Stephanie , Heisterkamp Breanna , Fliegel Abigail , Puckett Brittany
Published: February 2025

Background

Human trafficking and sexual exploitation are pervasive issues in society. Forensic nurse examiners are skilled at identifying and assisting victims of trafficking and exploitation, who frequently seek healthcare. However, forensic nurse examiners often lack specialized training for trafficking cases, unlike their training for sexual assault, and may hold biases regarding a trafficking victim's appearance, complicating their response.

Aim

To bridge this knowledge gap, a Human Trafficking/Sexual Exploitation (HT/SE) Skills Lab was created and piloted by a multistate forensic nurse education program in a Midwest metropolitan area.

Methods

A survivor-centered approach was employed by collaborating with a human trafficking advocacy agency and a youth survivor panel to design curriculum, review scenarios, and co-instruct the lab. The lab used a combination of didactic and hands-on training to address gaps in both knowledge and skill.

Results

Nearly all participants reported an increase in knowledge, and over half showed skill improvement. Self-assessments showed 25% of learners progressed from “advanced beginner” to “competent” in handling trafficking cases. Facilitators rated learners' competence, with most participants showing advancement.

Conclusions

The pilot lab's success indicates that this HT/SE Clinical Skills Lab can be replicated across healthcare disciplines, potentially improving responses to HT/SE survivors beyond sexual assault contexts, but more practice is needed to reach true competence.
Acute intestinal necrosis in a patient receiving tocilizumab: A case report and literature review
Authors: Xing Naizhong , Yang Shiju , Zhang Xiaoling , Wu Xinhui , Zhao Chai , Zhao Congcong , Han Linan , Hu Zhenjie , Yan Xin , Chen Yuhong
Published: February 2025

In this article, we report a case of acute intestinal necrosis associated with tocilizumab use. A 68-year-old female was admitted to the intensive care unit (ICU) with a history of rash for 20 days and dyspnea for 15 days. She was diagnosed with severe pneumonia with type I respiratory failure, which deteriorated to acute respiratory distress syndrome (ARDS). The possibility of immune-related pneumonia secondary to dermatomyositis was considered. The patient received tocilizumab treatment. Eight days after the second tocilizumab dose, the patient developed fever and abdominal distention and finally died due to acute intestinal compromise. This case may provide insight into the occurrence of acute intestinal necrosis related to tocilizumab administration and can help prevent similar occurrences.
Quality of Information Provided by Artificial Intelligence Chatbots Surrounding the Management of Vestibular Schwannomas: A Comparative Analysis Between ChatGPT-4 and Claude 2
Authors: Borsetto Daniele , Sia Egidio , Axon Patrick , Donnelly Neil , Tysome James R. , Anschuetz Lukas , Bernardeschi Daniele , Capriotti Vincenzo , Caye-Thomasen Per , West Niels Cramer , Erbele Isaac D. , Franchella Sebastiano , Gatto Annalisa , Hess-Erga Jeanette , Kunst Henricus P.M. , Marinelli John P. , Mannion Richard , Panizza Benedict , Trabalzini Franco , Obholzer Rupert , Vaira Luigi Angelo , Polesel Jerry , Giudici Fabiola , Carlson Matthew L. , Tirelli Giancarlo , Boscolo-Rizzo Paolo
Published: February 2025

Objective

To examine the quality of information provided by artificial intelligence platforms ChatGPT-4 and Claude 2 surrounding the management of vestibular schwannomas.

Study design

Cross-sectional.

Setting

Skull base surgeons were involved from different centers and countries.

Intervention

Thirty-six questions regarding vestibular schwannoma management were tested. Artificial intelligence responses were subsequently evaluated by 19 lateral skull base surgeons using the Quality Assessment of Medical Artificial Intelligence (QAMAI) questionnaire, assessing “Accuracy,” “Clarity,” “Relevance,” “Completeness,” “Sources,” and “Usefulness.”

Main Outcome Measure

The scores of the answers from both chatbots were collected and analyzed using the Student t test. Analysis of responses grouped by stakeholders was performed with McNemar test. Stuart-Maxwell test was used to compare reading level among chatbots. Intraclass correlation coefficient was calculated.

Results

ChatGPT-4 demonstrated significantly improved quality over Claude 2 in 14 of 36 (38.9%) questions, whereas higher-quality scores for Claude 2 were only observed in 2 (5.6%) answers. Chatbots exhibited variation across the dimensions of “Accuracy,” “Clarity,” “Completeness,” “Relevance,” and “Usefulness,” with ChatGPT-4 demonstrating a statistically significant superior performance. However, no statistically significant difference was found in the assessment of “Sources.” Additionally, ChatGPT-4 provided information at a significant lower reading grade level.

Conclusions

Artificial intelligence platforms failed to consistently provide accurate information surrounding the management of vestibular schwannoma, although ChatGPT-4 achieved significantly higher scores in most analyzed parameters. These findings demonstrate the potential for significant misinformation for patients seeking information through these platforms.
Bacteriophage Therapy for Chronic Mastoiditis
Authors: Casazza Julia , Tan Donald , Newcomer Mark , Sakano Hitomi , Isaacson Brandon , Hunter Jacob B.
Published: February 2025

Objective

To provide the first description of intratympanic bacteriophage therapy for chronic mastoiditis from multidrug-resistant Pseudomonas aeruginosa in the United States.

Patients

A 47-year-old woman with chronic mastoiditis in the setting of ciliary dysfunction from cystic fibrosis and immunosuppression from lung transplantation.

Interventions

Ten concurrent parenteral and intratympanic doses of two custom phages targeting P. aeruginosa followed by IV antibiotic therapy.

Main Outcome Measures

Resolution of infection confirmed by symptomatology, cultures, and imaging.

Results

At 5 months after phage treatment, the patient reported resolution of otorrhea, headaches, and hearing impairment. Subsequent cultures showed no growth.

Conclusions

Bacteriophages can enhance antibiotic activity in cases of drug-resistant chronic mastoiditis.
Dynamic Cone-Beam CT of the Middle Ear for Determining Excursion of the Ossicles: Technical Proof of Concept
Authors: Andersen Steven Arild Wuyts , Akram Bilal Hussain
Published: February 2025

Objective

Conductive hearing loss can be caused by fixation or discontinuity of the ossicles. Current noninvasive methods such as tympanometry and conventional clinical imaging might indicate mobility and/or pathology but cannot quantify the excursion. The objective of this study is to measure the excursion of the malleus and incus using timed pressurization during clinical cone-beam CT (CBCT) of the middle ear.

Patients

Five human cadaveric heads.

Intervention

CBCT imaging obtained at an isotropic resolution of 0.08 mm of five cadaveric heads (10 ears). A tympanometer was used to pressurize the ear drum and change pressure during the scan.

Main Outcome Measures

The excursion of the manubrium of malleus and the long process of incus was determined based on manual segmentation of the imaging series.

Results

It was technically feasible to change pressure midways during scan and use 180° virtual reconstructions of the negative and positive pressure phase to quantify the mobility of the malleus and incus. In ears with normal impedance of the tympanic membrane (type A tympanogram), we found an average excursion of the manubrium of malleus of 0.61 mm and the long process of incus of 0.27 mm.

Conclusion

Dynamic CBCT of the middle ear can be used to quantify the excursion of malleus and incus in ears with normal ear drum impedance. This might provide additional information compared with conventional static imaging at atmospheric pressure and other current in vivo methods such as wideband tympanometry. Further studies are needed to explore the clinical value of the method.
Transnasal Fluoroscopic-Guided Eustachian Tube Obliteration With a Liquid Embolic Agent for a Recurrent Cerebrospinal Fluid Leak After Translabyrinthine Schwannoma Surgery: A Case Series
Authors: Suutari Angelica , Isokangas Juha-Matti , Palosaari Kari , Tikkakoski Tapani , Nieminen Peter , Knuutinen Oula , Laitakari Jaakko
Published: February 2025

Objective

Postoperative cerebrospinal fluid (CSF) leak after schwannoma surgery occurs in up to 10% of patients. Conventional surgical treatment including fat and muscle packing can prove unsuccessful. We describe a minimally invasive, imaging-guided approach to CSF fistula treatment.

Patients

We describe two patients and three procedures with recurrent CSF rhinorrhea after translabyrinthine vestibular or facial nerve schwannoma surgery. First-line procedures including CSF diversion and repeat middle ear packing failed to close the leaks.

Intervention

Endonasal endoscopic, fluoroscopic-guided obliteration of the Eustachian tube with n-butyl cyanoacrylate.

Main Outcome Measure

Recurrence of a CSF leak.

Results

After treatment, the CSF leak ceased with no recurrence. One patient's facial nerve dysfunction worsened after the procedure.

Conclusions

This case series highlights a recently described technique of imaging-guided Eustachian tube obliteration using liquid embolic agent. The procedure was effective in treating recurrent CSF leaks but might cause facial nerve dysfunction.
Remote Care: The Future of Cochlear Implants
Authors: Holcomb Meredith A. , Coto Jennifer , Stern Tina , Sarangoulis Christina M. , Cejas Ivette , Sanchez Chrisanda M.
Published: February 2025

Objective

The aims of this study were to 1) evaluate whether remote cochlear implant (CI) programming has comparable outcomes to traditional in-person CI management, 1) determine the effects of remote programming on family burden and associated costs, and 1) demonstrate feasibility and satisfaction of remote programming by patients and families for both the adult and pediatric CI populations.

Study design

Prospective study of one CI program.

Patients and intervention

Adult and pediatric patients with at least one CI underwent CI programming via in-person and remote visits.

Main outcome measures

CI programming parameters (impedances, neural response telemetry, upper and lower stimulation levels, datalogging), technology comfort self-report, visit burden and satisfaction, mental health and quality of life.

Results

Fifteen pediatric participants (mean age: 4.17 yr; SD = 3.24) and 15 adult participants (mean age: 56.73 yr; SD = 21.11) were enrolled. In-person and remote programming sessions yielded comparable results for measuring CI programming parameters. Adult and parent participants were highly satisfied with remote programming and reported receiving excellent care. Listening effort was significantly less for the remote visit as compared to the in-person visit for adults. Burden of care to attend the in-person visit was greater for the pediatric population in terms of expenses incurred, unpaid time off work, and coordination of care for other children.

Conclusions

Remote programming is a feasible and effective service delivery model for the adult and pediatric CI population. Inclusion of remote services into postoperative CI protocols should be considered as a means of reducing barriers to hearing healthcare.
A Massive Ear Canal Mass Resulting from an Embedded Arthropod
Authors: Grimes Rachel , Stockton Savannah , Barrett Amanda , Moideen Pramila , Hodge Sarah
Published: February 2025

Objective

To describe a case of a massive ear mass obstructing the external auditory canal (EAC) attributed to an embedded arthropod, highlighting the diagnostic and therapeutic challenges posed by unusual etiologies of ear masses.

Patients

The case was a 35-year-old female prisoner who presented with a 5 × 5.5 cm palpable exophytic mass obstructing the right EAC, accompanied by progressive hearing loss, bloody discharge, and persistent tinnitus.

Interventions

Surgical excision of the infiltrating mass involving mastoidectomy and canaloplasty.

Main Outcome Measures

Initial pathology suggested a pyogenic granuloma, but further analysis revealed a degenerating arthropod within reactive myofibroblastic and vascular changes. The patient was lost to follow-up despite a multidisciplinary treatment approach and primary surgical excision of the mass.

Results

After surgical excision, the mass was confirmed as a florid reactive myofibroblastic and vascular mass enveloping a degenerating arthropod. The patient responded well to treatment without signs of infection or recurrence during follow-up.

Conclusions

We report a case that emphasizes the importance of considering unusual etiologies for ear masses, especially in at-risk populations. It underscores the necessity for refined diagnostic and therapeutic strategies to manage similar clinical scenarios in the future.
Patterns of Pneumatization of Parts of Temporal Bone in High-Resolution Computed Tomography and Its Implications
Authors: Eugine Reshma , Bhardwaj Abhishek , Malhotra Manu , Priya Madhu , Saxena Sudhir , Semwal Ankita , Vetrivel G , Kumar Anil
Published: February 2025

Objective

Investigate the pneumatization pattern of parts of the temporal bone in high-resolution computed tomography (HRCT) and their associations with age, gender, and squamous chronic otitis media (COM) in the contralateral ear. To investigate the symmetry of pneumatization and correlations between pneumatization patterns of parts of the temporal bone.

Study design

Prospective study.

Setting

Tertiary care center.

Patients

Two hundred sixty patients who underwent HRCT temporal bone.

Interventions and main outcome measures

Evaluation of pneumatization of mastoid and petrous apex as per Han et al. and infralabyrinthine as per Marchioni et al. classification.

Results

The commonest pneumatization patterns were group 4 (32.8%), group 1 (69.7%), and type C (76%) for mastoid, petrous apex, and infralabyrinthine parts, respectively. Group 4 pneumatization of the petrous apex (w = 0.487) and type A infralabyrinthine pneumatization (w = 0.315) were significantly associated with group 4 mastoid pneumatization (p < 0.001) but not vice versa. Significant association was observed between age and pattern of mastoid pneumatization (w = 0.25; p = 0.002) but not for other parts. No significant gender difference was observed in the temporal bone's pneumatization pattern. A significant symmetry was seen in the pneumatization of two ears for all parts. COM in the contralateral ear was significantly associated with group 3 mastoid pneumatization (w = 0.16; p = 0.036).

Conclusion

Mastoid shows hyperpneumatization, and other parts show absent pneumatization as commonest pattern, with only one-way correlation between increased pneumatization of other parts and mastoid. COM in the contralateral ear and age show a significant association with the type of mastoid pneumatization, but not other parts.
Silk Devices for Tympanic Membrane Repair Show No Ototoxicity in a Rat Model
Authors: Barry Kristin M. , Redmond Sharon L. , Mulders Wilhelmina H.A.M. , Valente Filippo
Published: February 2025

Hypothesis

Implantation of ClearDrum®, a biodegradable silk fibroin device, into the middle ear (ME) cavity in a rat model will not affect hearing thresholds as measured by auditory brainstem response.

Background

Chronic otitis media (COM) is a recurrent middle ear infection often accompanied by tympanic membrane perforation. Our laboratory has developed a biodegradable silk fibroin device (ClearDrum®) designed to treat tympanic membrane perforations in COM. ClearDrum® acts as a prosthetic eardrum, providing a substrate on which tympanic membrane cells can grow and acts as a long-lasting implant.

Methods

Two formulations were tested based on silk/glycerol and silk/polyurethane blends. Animals were anesthetized, and either a ClearDrum® formulation or an autologous cartilage graft was surgically implanted into the middle ear. Thresholds of the auditory brainstem response (ABR) were measured at the time of implantation and at 4 and 12 weeks post-implantation to assess hearing after the implantation. After the final measurements at 12 weeks, middle ear and cochlea were harvested for histological assessment.

Results

No significant differences in ABR thresholds between male and female animals were found at any timepoint. Results showed that there were no detrimental effects of either Cleardrum® formulation on ABR thresholds as compared with implantation of autologous cartilage and no presence of inflammation within the middle ear or cochlea.

Conclusion

Our ABR data suggest no substantial ototoxic effects on outer or inner hair cells and provides some support toward clinical translation of ClearDrum devices.
Improving the quality of donor human milk to take advantage of more of the health benefits of mother's own milk composition
Authors: Beggs Megan R. , Unger Sharon , O’Connor Deborah L.
Published: February 2025

Purpose of review

Pasteurized donor human milk (PDHM) is the recommended supplement when there is inadequate volume of mother's own milk (MOM) for very low birth weight (<1500 g, VLBW) infants. Differences in the composition of these milks may impact growth, morbidities or long-term development of infants. The aim of this review is to highlight current trends in understanding compositional differences between MOM and PDHM, technological advances in processing PDHM, and infant outcomes when VLBW infants are fed these milks.

Recent findings

Reported differences in the composition between MOM and PDHM are due to several factors including when and how milk is collected, sampled for analysis, and processed. Systematic reviews and primary research studies demonstrate that PDHM reduces the risk of necrotizing enterocolitis in VLBW infants but is also associated with slower postnatal growth. Work is ongoing to determine if alternative approaches to processing PDHM can improve milk composition and thereby infant growth and neurodevelopment and reduce morbidity.

PDHM is a key component of feeding VLBW infants when there is inadequate volume of MOM. Recent developments aim to optimize this source of nutrition and bioactive compounds for VLBW infants while further understanding limitations of its use.
Isolated adrenocorticotrophic hormone (ACTH) deficiency presenting with recurrent hypoglycemia and hyponatremia
Authors: Rehman Saif Ur , Aisha Marium , Badshah Aliena , Hassan Laila , Noor Habiba , Khan Qaisar Ali , Verma Ravina
Published: February 2025

Introduction:

Isolated adrenocorticotropic deficiency (IAD) is a rare disorder characterized by secondary adrenal insufficiency (AI) with low or absent cortisol production, normal secretion of pituitary hormones other than ACTH, and the absence of structural pituitary defects. This case report highlights the atypical presentation of IAD, presenting with recurrent hypoglycemia and hyponatremia.

Case presentation:

A 20-year-old female presented to the emergency department with a loss of consciousness. Initial laboratory evaluation revealed hypoglycemia and hyponatremia. She had a history of recurrent hospitalization for the same problem for 4 months. Further investigations showed deceased cortisol and adrenocorticotrophic (ACTH) levels. The rest of the pituitary hormones were normal. The patient was diagnosed with a case of Isolated ACTH deficiency and was started on oral prednisolone, and her symptoms resolved with no recurrence of the symptoms.

Clinical Discussion:

The etiology of acquired IAD remains largely unclear. However, it is sometimes associated with other autoimmune diseases, such as Hashimoto’s thyroiditis. Idiopathic isolated ACTH deficiency (IIAD) is a rare condition that can present either congenitally (CIIAD) or later in life as adult idiopathic isolated ACTH deficiency (AIIAD).

Conclusion:

Isolated ACTH deficiency can rarely present with hyponatremia concurrent with recurrent hypoglycemic episodes and hypotension. However, further research is needed to find the pathophysiology behind it.
Using Kamishibai Cards to Identify Barriers and Display Adherence to the Central Line–Associated Bloodstream Infection Prevention Bundle
Authors: Brown Shelly L. , Klemanski Dori L. , Tornwall Joni , Ross Michelle M. , Browning Kristine K.
Published: February 2025

Purpose

Central line–associated bloodstream infection (CLABSI) rates have been consistently high at an academic comprehensive cancer hospital. CLABSI prevention bundles can mitigate central line infections, and many components focus on nursing practice. Identification of barriers to maintaining adherence to these elements is not always assessed or addressed. The purpose of this project was to increase adherence to CLABSI prevention nursing practices and to implement a sustainable program to elevate nurses’ skills and documentation of CLABSI prevention bundle components.

Description

Pre-implementation/post-implementation chart reviews, post-implementation visual audits, and a survey for nurses post project were completed over a 9-week period. This project identified and addressed barriers to CLABSI prevention bundle compliance. Audits assessed nursing practice elements of the CLABSI prevention bundle. Evidence-based Kamishibai cards (K-cards) were used as a visual audit tool to display compliance of CLABSI bundle elements.

Outcomes

Compliant documentation of daily chlorhexidine gluconate (CHG) bathing increased to 75%. Inconsistent communication practices and knowledge gaps were frequent barriers to compliance. Seventy-five percent of nurses reported the K-card display changed their own CLABSI prevention practices.

Conclusion

This project increased knowledge, adherence to CLABSI prevention practices, and awareness of components most often missed.
Implementing the Clinical Nurse Specialist Role in Hospital Settings
Authors: Bachiller-Barquín Alejandra , Martín-Martín Jesús , Vázquez-Calatayud Mónica
Published: February 2025

Purpose/Aims

To understand, based on the literature, how to implement the role of a clinical nurse specialist (CNS) in the hospital setting.

Design

A scoping review was conducted following the methodological framework of Arksey and O’Malley and the Joanna Briggs Institute.

Method

The search was conducted during March and April 2023 and was updated in November 2023. Electronic searches were conducted in the following major databases: PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Cochrane Library. Additionally, a “snowballing” strategy was used. A critical reading was conducted using the Joanna Briggs Institute methodological quality criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for the Scoping Review guidelines were used.

Results

Eleven relevant studies were included in this review. The primary results are presented in 4 sections related to the framework, process, components, and evaluation of the implementation of the CNS role. The findings of the reviewed studies suggest that the implementation process of the CNS is cyclical, variable, context-dependent, and multifactorial and can be assessed using the indicators of structure, process, and outcome.

Conclusions

This scoping review provides relevant information to support the design of implementation and evaluation strategies for the role of the CNS in the hospital context. Based on the findings of the reviewed studies, a comprehensive strategy is suggested for implementing the role of the CNS in a hospital setting.
Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source
Authors: Herb Thomas , Jentzen Jeffrey , Schmidt Carl
Published: February 2025

Iatrogenic infections of cadaveric bone grafts have led to 2 outbreaks of Mycobacterium tuberculosis (Mtb) infection in the United States that have resulted in multiple fatalities. We report a case of one of the bone graft recipients from the 2023 outbreak. A 57-year-old immunocompromised female with a history of renal failure status post 3 kidney transplants underwent a laminectomy with a cadaveric bone graft due to spinal stenosis. She was later hospitalized with diffuse lymphadenopathy and surgical site purulent ulceration. The workup included positive cultures for Mtb. Despite appropriate therapy, the patient died in the hospital. Autopsy findings included purulent discharge from the surgical site, medullary abscesses of one of the transplanted kidneys, diffuse pinpoint areas of softening in the liver, and lung congestion. Histology of the liver and right lung demonstrated loose granulomas with abundant acid-fast organisms. The kidney abscesses were due to Candida species infection. Overall, findings were consistent with disseminated Mtb infection. Additional investigation found similar infections in recipients of the same bone graft source. We compare the Mtb outbreaks to similar outbreaks, including cases of fungal meningitis due to steroid injections, and discuss our approach and strategy in cases of iatrogenic infection.
Evaluating a User-centered Redesign of the NYC Environment and Health Data Portal Website
Authors: Montesano Matthew , Gettings Chris , Torem Emily
Published: February 2025

Context:

Public health agencies publish data so that data can influence public health policy and practice and improve the public health. But when these websites are difficult to use, they present barriers to this goal. Working to make data websites easier to use can add value to public health work.

Program:

In 2022, the NYC Department of Health and Mental Hygiene redesigned the Environment and Health Data Portal website to communicate data more effectively by improving usability. The redesigned website lets users browse datasets, visualize them, and includes companion explanatory material to communicate key public health findings.

Implementation:

We evaluated the usability as an outcome of the redesign and compared it to the usability of the prior website. Using a cross-over design, participants did simple tasks on both old and new websites, then filled out the Post-Study System Usability Questionnaire, a standard usability instrument.

Evaluation:

Participants scored the new site better than the old site, with statistically significant improvements in overall usability, system usefulness, and information. Additionally, web analytics show steadily increasing traffic to the new site, indicating that improved usability might have led to increased use.

Discussion:

This evaluation indicates a successful redesign: a measurable increase in usability and a substantial increase in web traffic. It suggests that designing data products for a wide range of users can be a successful strategy and demonstrate a viable method for evaluating public health data communication websites using a standard usability instrument.
“A Comparative Study of Septal Extension Graft versus Derotation Graft for Short Nose Correction in Asian Rhinoplasty”
Authors: Namgoong Sik , Yoon Yukyeong , Park Sangjun , Suh Man-Koon
Published: February 2025

Background:

Precise nasal tip refinement is a cornerstone of Asian rhinoplasty that addresses characteristics such as bulbous tips, short columellas, and flared nostrils. Septal extension grafts (SEG) and derotation grafts (DRG) are commonly employed to enhance tip projection; however, comparative analyses are lacking. We assessed the outcomes of SEGs and DRGs in Asian patients who underwent tip-plasty.

Methods:

In this retrospective study, we analyzed 729 patients who underwent nasal tip-plasty using SEG or DRG between January 2011 and December 2017. Postoperative complications were assessed after a minimum follow-up of 6 months. For patients with long-term follow-up (≥24 months), nasal tip projection (NTP) and columellar-labial angle (CLA) were measured preoperatively and postoperatively using Goode’s and Byrd’s methods.

Results:

Among 287 SEG and 142 DRG cases, both techniques showed significant postoperative improvements: SEG (Δ NTP-Goode=0.036, p=0.001; ΔNTP-Byrd=0.036, p<0.001) and DRG (ΔNTP-Goode=0.047, p=0.005; ΔNTP-Byrd=0.053, p<0.001). No significant differences were noted for NTP ratios (Goode: p=0.954; Byrd: p=0.452) or CLA (p=0.116). Complications included more tip-columella deviations in SEG (5.23% vs. 1.41%) and higher tip drooping (4.53% vs. 8.45%; adjusted p=0.040) and supratip deformity (0% vs. 2.82%; adjusted p=0.010) in DRG.

Conclusions:

Longitudinal analysis shows that both SEG and DRG effectively preserve tip projection over time. SEG is more prone to tip and columellar deviations, while DRG is associated with tip drooping and supratip deformity, with no difference in tip shortening relapse. Technique selection should be customized to the patient’s anatomical features and the surgeon’s experience to minimize complications.

Level of Evidence:

IV
“Accessible Presurgical Orthopedics: Nasal Elevator and Lip Taping as a Cost-Effective Solution for Cleft Care in Low-Resource Settings.”
Authors: Tanikawa Daniela Y. S.
Published: February 2025

Background:

This study evaluates the use of a nasal elevator plus lip taping as an option for presurgical infant orthopedics (PSIO) in patients with complete unilateral cleft lip with or without cleft palate (CL±P).

Methods:

From 2014 to 2019, 112 patients with unilateral CL±P underwent the studied presurgical treatment. Anthropometric measures from pre- and post-PSIO were compared within the treatment group. Postsurgical nasal morphology was compared to patients who did not receive presurgical treatment (N=62). The dental arch relationship for both groups was assessed using the 5-year-olds’ index.

Results:

The nostril width ratio and the columellar angle significantly improved after PSIO (p<0.001). Post-surgically, nasal asymmetry was observed in 20% of the treatment group compared to 59.7% in the control group (p<0.001). Dental arch relationship analysis in 78 patients showed no significant difference between the treatment and control groups (p=0.271 for CL+P, p=0.545 for CL-P).

Conclusions:

Nasal elevator plus lip taping is an effective, reliable, and simple PSIO method. It is less invasive, easier for parents to manage, cost-effective, and allows for monthly follow-up by the surgeon. Thus, it provides an effective alternative for teams without access to Nasoalveolar Molding (NAM) therapy.
“Do Surgeons Treat Their Patients’ Upper Extremity Nerve Palsies, Like They Would Treat Their Own?”
Authors: Krijnen Nienke A. , Arellano Jose Antonio , Wu Kitty Y. , Ring David , Teunis Teun ,   Science of Variation Group
Published: February 2025

Background:

Early surgical intervention in nerve palsies with a high probability of nerve integrity and natural recovery risks unnecessary surgery. Understanding the variables influencing surgeons to offer surgery might provide insight into variations in surgeon beliefs and guide treatment recommendations.

Methods:

Sixty-nine surgeons of the Science of Variation Group participated in a survey consisting of six traumatic and three non-traumatic nerve palsy scenarios. Participants were asked what their preferred treatment was and how likely they were to offer surgery on a scale from 0 to 10. Participants were randomized to choose for themselves (n=31) or for a patient of their age and gender (n=38).

Results:

There was no difference in the overall likelihood of offering surgery or in the types of treatment offered to patients compared to oneself. Surgery was least recommended for idiopathic palsies and most for ulnar (β 0.91 95% CI 0.10-1.7, p=0.027) or radial (β 0.92, 95% CI 0.12-1.7, p=0.025) nerve palsy following closed distal radius or humerus fractures. Longer symptom duration increased the likelihood of offering surgery.

Conclusions:

Surgeons were moderately likely to recommend surgery for nerve palsies, with notable variation in opinions regardless of whether they were deciding for themselves or for patients. For specific nerve palsies with a documented benign natural history this likely represents overtreatment. Future studies can assess if balancing awareness of a benign natural history with the pressure to act and the sense that recovery is “taking too long” might limit the rate of unnecessary surgery.
Immediate-release vs. prolonged-release lithium formulations in bipolar disorder: a 2-year comparative study
Authors: Barbuti Margherita , Moriconi Martina , Bartolini Daria , De Rosa Ugo , Elefante Camilla , Schiavi Elisa , Perugi Giulio
Published: February 2025

The aim of this study is to evaluate the therapeutic outcomes, tolerability, and adherence to immediate-release (IR) and prolonged-release (PR) lithium formulations in patients with bipolar disorder (BD) over a 2-year follow-up. This naturalistic study included 143 BD patients who initiated IR (48%) or PR (52%) lithium treatment at the inpatient and outpatient services of the University Hospital of Pisa. During follow-up, data were collected on side effects, treatment adherence, blood lithium levels, and creatinine and thyroid stimulating hormone concentrations. Clinical efficacy and functioning were assessed using the Clinical Global Impressions for Bipolar Disorder and Functioning Assessment Short Test scales. Approximately 50% of patients completed the 2-year follow-up, with similar dropout rates between the two groups. Both groups showed significant clinical improvement with comparable efficacy. PR lithium, however, was associated with fewer side effects, particularly tremors and gastrointestinal issues, leading to better adherence. Additionally, PR lithium administration resulted in more stable blood lithium levels. Despite its limitations, including the observational design, potential confounders such as concomitant medications, and a high dropout rate, these findings suggest that PR lithium formulations provide similar clinical efficacy to IR formulations but offer superior tolerability. Therefore, PR lithium represents a favorable option for improving adherence, particularly in patients at risk of treatment discontinuation.
Adolescent boys’ sociocultural beliefs and attitudes toward menstruation in selected high schools in Ghana: Mediation and moderation effect of knowledge
Authors: Wuresah Israel , Klutse Priscilla , Mantey Sarah Odi , Agorinya Isaiah , Hennegan Julie , Gbogbo Sitsofe
Published: February 2025

Adolescent boys can reinforce negative societal attitudes towards menstruation and make it difficult for adolescent girls to achieve optimal menstrual health and hygiene (MHH) which defeats Sustainable Development Goals 3, 5.1, 5.2 and 5.6. This study investigated how knowledge mediates/moderates the association between sociocultural beliefs (SB) and attitudes of adolescent boys regarding menstruation in senior high schools in Ghana. A cross-sectional study was conducted in five mix-sex public senior high schools (SHS) in Volta region, Ghana. Probability proportional to size was used to distribute 431 study subjects among the schools, and surveys were conducted using structured questionnaires. Structural equation modeling (SEM) and generalized least square (GLS) modeling were conducted. The mean age of the sample was 17.3 (±1.0). Majority (60.6%) were between 15-17 years old, and Christians (95.4%). Half of them had low knowledge; 38% had moderate, and 11% had high knowledge. Meanwhile, negative SB (55.2%) outweighed positive SB, which reflected in their attitudes towards menstruation with 52.7% exhibiting poor attitudes. The SEM revealed that knowledge had a significant negative effect on SB and attitudes, with coefficients of -0.06 (SE = 0.01, p < 0.001), and -0.28 (SE = 0.06, p < 0.001) respectively. The GLS model indicated that knowledge also moderates the relationship between SB and attitudes. Male students in Ghana have a tendency to stigmatize menstruation among their female counterparts because they have inadequate knowledge about it and this may affect the achievement of optimal MHH by their female colleagues. It is evident that effective menstrual education reduces negative attitudes.
StarTrace: A Multiplex Organoid Avatar Drug Testing Platform for Personalized Medicine
Authors: Khalili Sana , Patel Shrey , Patel Nidhi , Moy Victoria , Lyons Sawyer , Gray Emma , Brents Riley , Banister Carolyn E. , Morrison Sidney E. , Buckhaults Phillip J.
Published: February 2025

The goal of precision medicine is to improve clinical outcomes of cancer patients by choosing treatments most likely to work. One idea is to match tumor response to cancer-causing somatic mutations, but this strategy still faces limitations in colorectal cancer due to poorly understood genetic influences on drug resistance. We describe here a simple direct drug sensitivity assay platform applied to mixtures of patient-derived organoid avatars as a practical solution for choosing therapy, sidestepping the need for exhaustive knowledge of drug-genetic interactions. This approach rank orders individual patient’ organoid avatars’ responses to various drugs to be used to guide treatment choices. The platform multiplexes organoids using a clonal barcoding method, called StarTrace, which simultaneously tests pools of multiple patients’ organoid avatars for sensitivity or resistance to small molecule inhibitors. We utilized both quantitative real-time PCR-based and single-molecule sequencing assays to track the relative Darwinian fitness of each barcoded organoid within the pool. StarTrace offers a rapid, cost effective and sensitive testing platform that could be useful for either preclinical drug development or tailoring personalized therapy.