bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device
Authors: Goffman Dena , Rood Kara M. , Bianco Angela , Biggio Joseph R. , Dietz Paul , Drake Kelly , Heilman Erica , Hopkins Maeve , De Four Jones Monique , Katz Tyler , Martin Courtney , Prasad Mona , Smid Marcela C. , Wine Kathryn D. , Ryan Robert , Yong Candice , Carney Patricia I. , Simhan Hyagriv N.
Published: September 2023

OBJECTIVE:

To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)–cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management.

METHODS:

Sixteen centers in the United States participated in this observational, postmarket registry medical record review (October 2020 through March 2022). The primary effectiveness outcome was treatment success, defined as bleeding control after insertion with no treatment escalation or bleeding recurrence. Additional outcomes included blood loss, time to device insertion, indwelling time, bleeding recurrence, and time to bleeding control. Treatment success and severe maternal morbidity measures (transfusion of 4 or more units of red blood cell, intensive care unit admission, and hysterectomy) were evaluated by blood loss before insertion. To assess safety, serious adverse events (SAEs) and adverse device effects were collected. All outcomes were summarized by mode of delivery; treatment success was summarized by bleeding cause (all causes, any atony, isolated atony, nonatony).

RESULTS:

In total, 800 individuals (530 vaginal births, 270 cesarean births) were treated with the device; 94.3% had uterine atony (alone or in combination with other causes). Median total blood loss at device insertion was 1,050 mL in vaginal births and 1,600 mL in cesarean births. Across all bleeding causes, the treatment success rate was 92.5% for vaginal births and was 83.7% for cesarean births (95.8% [n=307] and 88.2% [n=220], respectively, in isolated atony). Median indwelling time was 3.1 hours and 4.6 hours, respectively. In vaginal births, 14 SAEs were reported among 13 individuals (2.5%). In cesarean births, 22 SAEs were reported among 21 individuals (7.8%). Three (0.4%) SAEs were deemed possibly related to the device or procedure. No uterine perforations or deaths were reported.

CONCLUSION:

For both vaginal and cesarean births in real-world settings, rapid and effective bleeding control was achieved with an FDA-cleared intrauterine vacuum-induced hemorrhage-control device. The safety profile was consistent with that observed in the registrational trial (NCT02883673), and SAEs or adverse device effects were of the nature and severity expected in the setting of PPH. This device is an important new tool for managing a life-threatening condition, and timely utilization may help to improve obstetric hemorrhage outcomes.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04995887.
Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient
Authors: Acquisto Nicole M. , Mosier Jarrod M. , Bittner Edward A. , Patanwala Asad E. , Hirsch Karen G. , Hargwood Pamela , Oropello John M. , Bodkin Ryan P. , Groth Christine M. , Kaucher Kevin A. , Slampak-Cindric Angela A. , Manno Edward M. , Mayer Stephen A. , Peterson Lars-Kristofer N. , Fulmer Jeremy , Galton Christopher , Bleck Thomas P. , Chase Karin , Heffner Alan C. , Gunnerson Kyle J. , Boling Bryan , Murray Michael J.
Published: September 2023

RATIONALE:

Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI).

OBJECTIVES:

To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI.

DESIGN:

A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel’s inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process.

METHODS:

Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of “strong” or “conditional” were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist.

RESULTS:

From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence.

CONCLUSIONS:

Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.
Factors Associated with Treatment Outcome Satisfaction Six Months after Upper Blepharoplasty: A Large Cohort Study
Authors: Luong Kim Phi , Vissers Lieke C. M. , Domela Nieuwenhuis Ileen , Hazenkamp Lisa S. , Hummelink Stefan , Slijper Harm P. , Ulrich Dietmar J. O.
Published: September 2023

Background:

Upper blepharoplasty is the most popular facial cosmetic surgery. Although there are a variety of reasons to undergo this procedure, all patients expect an optimal cosmetic result. However, little is known about the factors that influence satisfaction with treatment outcome.

Objectives:

We assessed to what extent patient characteristics, clinician-rated and postsurgical outcome measures, and patient-reported satisfaction with facial appearance and quality-of-life are associated with patient-reported satisfaction with treatment outcome after a primary upper blepharoplasty.

Methods:

This study was performed in 583 patients with an upper blepharoplasty between 2016 and 2021. The primary outcome was satisfaction with treatment outcome 6 months postoperatively using the FACE-Q. Determinants were baseline patient characteristics (demographics), preoperative and postoperative clinician-rated and surgical outcome measures, and preoperative and postoperative FACE-Q appearance and quality-of-life scales. Hierarchical linear regression analysis was used to determine how much of the variance in satisfaction with outcome could be explained by these groups of determinants.

Results:

A total of 63% of the variance could be explained by the five groups of determinants of which 8% was explained by the baseline patient characteristics and clinician-rated and patient-reported outcomes together, another 8% by the postoperative clinician-rated outcomes, and the remaining 47% by the postoperative patient-reported outcomes.

Conclusions:

Patient characteristics, clinician-rated outcome measures, and baseline FACE-Q appearance and quality-of-life scores were of limited value in explaining satisfaction with treatment outcome. However, the postoperative FACE-Q appearance scale and the decision to undergo a blepharoplasty were strongly associated with satisfaction with treatment outcome.
In vivo CRISPR screen identifies LTN1 as a novel tumor suppressor ubiquitinating insulin–like growth factor 2 mRNA–binding protein 1 in hepatocellular carcinoma
Authors: Peng Rui , Cao Jun , Zhang Chi , Zhou Jie , Su Bing-Bing , Tu Dao-Yuan , Jiang Guo-Qing , Jin Sheng-Jie , Xu Ya-Ping , Bai Dou-Sheng
Published: September 2023

Background and Aims:

Hepatocellular carcinoma (HCC) is a frequent and aggressive kind of cancer. Although E3 ligases play important roles in HCC development, several E3 ligases remain unknown.

Approach and Results:

Through in vivo CRISPR knockout (KO) screens targeting related E3 ligase genes in HCC nude mice models, we discovered LTN1 as a novel tumor suppressor in HCC. Co-IP paired with 2D-LC-MS/MS and subsequent western blotting in HCC cells were used to identify the interactome of LTN1. Compared to matched normal tissues, the expression of LTN1 was decreased in human HCC tissues (ANT) (157/209). Clinically, patients with HCC who expressed low levels of LTN1 had a poor prognosis. Forced expression of LTN1 decreased cell growth in vitro and in vivo, whereas knockdown of LTN1 increased cell growth. Mechanistically, elevated LTN1 expression inhibited HCC cell growth by ubiquitinating and destabilizing the IGF2BP1 protein, which inhibited the c-Myc and IGF-1R signaling pathways. There was a negative correlation between the LTN1 protein expression and the IGF2BP1 protein expression in HCC tissues (R2=0.2799, P=0.0165).

Conclusions:

LTN1 may be a crucial tumor suppressor for determining the prognosis and a possible therapeutic target since it inhibits the proliferation of HCC cells by ubiquitinating IGF2BP1.
Knockdown of CXCL1 improves ACLF by reducing neutrophil recruitment to attenuate ROS production and hepatocyte apoptosis
Authors: Tang Shima , Zhang Junlei , Zhang Lingjian , Zhao Yalei , Xiao Lanlan , Zhang Fen , Li Qian , Yang Ya , Liu Qiuhong , Xu Jinxian , Li Lanjuan
Published: September 2023

Background:

Acute-on-chronic liver failure (ACLF) is an acute decompensated syndrome based on chronic liver disease, while neutrophil recruitment is the most critical early step. C-X-C motif chemokine ligand 1 (CXCL1), a cytokine that recruits neutrophils, was significantly upregulated in both ACLF mice and patients with ACLF. This present study aims to explore the role of CXCL1 in the pathogenesis of ACLF.

Methods:

We established an ACLF mouse model induced by carbon tetrachloride, lipopolysaccharide, and D-galactosamine, and used adeno-associated virus to achieve overexpression and knockdown of Cxcl1. We employed mass cytometry, flow cytometry, multiplex cytokine and chemokine analysis, Western blot, and reactive oxygen species (ROS) detection in mice blood and liver. ACLF patients (n = 10) and healthy controls (n = 5) were included, and their liver samples were stained using multiplex immunohistochemistry techniques.

Results:

CXCL1 was significantly elevated in both ACLF mice and patients. CXCL1 recruits neutrophils by binding to the C-X-C motif chemokine receptor 2 on the surface of neutrophils, affects ACLF prognosis by generating ROS and mitochondrial depolarization and modulating caspase3-related apoptotic pathways. We found that the knockdown of CXCL1 attenuated the infiltration of neutrophils in the mouse liver, reduced the expression of inflammatory cytokines, and also significantly downregulated ROS production and caspase3-related hepatocyte apoptosis, thereby ameliorating the liver injury of ACLF.

Conclusions:

CXCL1 is a core player in the mobilization of neutrophils in ACLF, and the knockdown of Cxcl1 improves neutrophil infiltration, reduces ROS levels, and reduces hepatocyte apoptosis, thereby attenuating inflammation and liver injury in ACLF. Our results revealed a previously unknown link between CXCL1-induced neutrophil recruitment and ACLF, providing evidencing for potential therapies targeting ACLF.
Ten-year longitudinal morphological changes in dome-shaped maculas in highly myopic eyes
Authors: Hsu Cherng-Ru , Igarashi-Yokoi Tae , Liang I-Chia , Ohno-Matsui Kyoko
Published: September 2023

Purpose:

To determine the longitudinal changes in the morphologic features of dome-shaped macula (DSMs) in highly myopic eyes.

Methods:

Patients with a DSM and high myopia (spherical equivalent <-8 diopters [D] or axial length ≥26.5 mm) were retrospectively studied. The medical records, optical coherence tomographic (OCT) images, and ultra-widefield OCT images were analyzed.

Results:

A total of 113 eyes of 82 patients were studied with a mean follow-up of 122.32 ± 6.36 months. During the follow-up, the mean dome height was significantly increased from 181.51 ± 105.55 to 209.85 ± 130.84 μm (P<0.001). There was also a significant increase in the axial length (30.83 ± 1.82 to 31.16 ± 1.86 mm; P<0.001). Subgroup analyses showed that the dome height increased more than 50 μm in 78 (69%) eyes, decreased in 23 (20%) eyes, and was stable in 12 (11%) eyes. The change in the axial lengths was significantly greater in the increased dome height group than in the decreased and stable dome height groups (P=0.042). Multivariable analysis showed that the greater axial length change (OR, 8.73; P=0.017) and horizontal type DSM (OR, 4.14; P=0.026) were significantly associated with the increase in the dome height.

Conclusion:

The direction of change in the DSM height varies and 69% of the eyes had an increase in height while 20% of the eyes had a decrease in height. The variations in the dome height may result from the difference between the deepening of the peri-dome scleral excavation and the changes of the axial length.
Working Status of First-Time Postpartum Mothers and Telomere Length—A 1-Year Prospective Study
Authors: Houminer-Klepar Nourit , Bord Shiran , Epel Elissa , Lin Jue , Sultan Linoy , Baron-Epel Orna
Published: September 2023

Objective

Transitioning to motherhood can create work family conflicts affecting mothers’ health. Although employment is generally associated with longer telomeres, this may diminish during the early years of child-rearing. This study aimed to assess the impact of work reentry on telomere length (TL) among first-time mothers.

Methods

In this 1-year prospective study, a total of 103 first-time postpartum mothers participated from two medical institutions in Northern Israel; they completed validated questionnaires, reported their current working status, and provided dried blood spots measuring TL.

Results

We found that working status significantly predicted change in TL and was negatively correlated with change in TL over time (β = −0.245; 95% confidence interval, −0.169, −0.018; P = 0.016).

Conclusions

Identifying ideal timing of work reentry is recommended for first-time postpartum mother’s optimal health and TL.
Epidemiology of Work-Related Traumatic Brain Injury and COVID-19 Pandemic Lockdown Consequences: Experience in a Reference Center in Chile
Authors: Wimmer Del Solar Jonathan , Rojas-Líbano Daniel , Bastías Barra Pablo , Cisternas Vera Constanza , Chávez Martel Paulina , Rozas Vidal Juan Pablo , Rodríguez Ibáñez Pamela , Fontecilla Villalobos Estefanía
Published: September 2023

Introduction

Work-related traumatic brain injury is a frequent cause of chronic morbidity, mortality, and high treatment costs. Its causes are highly environmentally determined and were affected by COVID-19 pandemic lockdowns.

Objective

We aimed to describe traumatic brain injury (TBI) epidemiology in working population and evaluate its modifications during the COVID-19 pandemic.

Methods

We performed a 2-year retrospective epidemiological analysis of TBI patients hospitalized in a tertiary work-related hospital before and during the COVID-19 pandemic.

Results

In the prepandemic period, TBI patients were predominantly men, with a bimodal age distribution. Crash accidents were the leading work-related traumatic brain injury cause. During COVID-19 pandemic lockdowns, there was a positive correlation between street traffic and TBI rate, presenting increased motor crash accidents as a cause of TBI.

Conclusions

These results are relevant for planning and focalization of resources for TBI prevention.
Effect of Subsensory Vibration on Postural Control of Healthy Elderly and Subjects with Simulated Reduced Plantar Feet Sensation: A Randomized Crossover Controlled Trial
Authors: Aboutorabi Atefeh , Arazpour Mokhtar , Hadadi Mohamad , Veiskarami Masoumeh
Published: September 2023

Introduction

Postural instability is considered a normal result of aging and is caused by some diseases such as neuropathy.

Aim

The purpose of the present study was to analyze and compare the effect of subthreshold vibration that was applied to the plantar surface of feet on balance control of healthy elderly and young subjects with simulated decreased plantar feet sensation.

Methods

Twenty-four subjects (12 elderly persons and 12 young persons with decreased plantar feet sensation) were included in this randomized, double-blinded crossover study. Participants were divided into two intervention groups: 1) orthopedic shoe with vibration mechanism on; and 2) orthopedic shoe with vibration off. Primary outcomes were center of pressure (COP) parameters including mean velocity, phase plane portrait, standard deviation (SD) of amplitude, and SD of velocity. Secondary outcomes were Berg Balance Scale (BBS) score and timed up and go test (TUG). The standing balance was tested with different conditions: eye opened/closed and foam/rigid surface. General linear mixed models tests were used for statistical analysis. The level of statistical significance was set at 0.05 for all analyses.

Discussion

This study showed very large effect sizes (partial η2 > 0.2) with application of vibration as compared with vibration off for COP parameters with greater effects in condition with more baseline fluctuations. There was significant change in BBS test (Cohen d, 0.6; confidence interval [CI], −0.215 to −1.421). The time on TUG test was decreased and approached significance (P = 0.06).

Conclusions

The immediate effect of the study showed that subthreshold vibration can improve static and dynamic balance in healthy elderly people and people with decreased plantar feet sensation. However, long-term studies are needed to establish the clinical value of the subthreshold vibration on balance control.

Clinical Relevance

Subthreshold vibration applied to the feet soles via custom-made shoes can reduce the postural sway in subjects with decreased feet sensation. By conducting more studies with conclusive results in the field of vibration effectiveness in the elderly, we can hope to reduce the rate of falls in the elderly.
Racial Disparities in Utilization of Emergency Medical Services and Related Impact on Poststroke Disability
Authors: Wu Yuqi , Xirasagar Sudha , Nan Zixiao , Heidari Khosrow , Sen Souvik
Published: September 2023

Background:

Prompt seeking of emergency medical services (EMS) assistance at stroke onset is critical to minimize poststroke disability.

Objective:

The aim was to study how racial differences in EMS decision-relevant factors and EMS use impact stroke care and disability outcomes.

Design:

A prospective observational study.

Participants:

A total of 1168 acute ischemic stroke patients discharged from April 2016 to October 2017 at a safety net hospital were included; 108 patients were surveyed before discharge.

Measures:

(1) Prehospital delay: EMS use, timely hospital arrival; (2) Stroke care: alteplase receipt and inpatient rehab; (3) Outcomes: Functional improvement at discharge (admission minus discharge scores on National Institutes of Health Stroke Scale), 90-day modified Rankin Scale; (4) EMS decision-relevant factors: Stroke symptom knowledge, source of knowledge, unfavorable past EMS/care experiences, and financial barriers to EMS use.

Results:

Despite more Black patients using EMS than Whites/Asians (56% vs. 48%, P=0.003), their timely hospital arrival was 30% less likely. Adjusted for stroke severity, receipt of alteplase, and inpatient rehab were similar, but Black patients fared worse on functional improvement at discharge (among severe strokes, 2.4 National Institutes of Health Stroke Scale points less improvement, P<0.01), and on functional normalcy at 90 days (modified Rankin Scale score 0–1 being 60% less likely across severity categories) (P<0.01). Fewer Black patients knew any stroke symptoms before the stroke (72% vs. 87%, P=0.03), and fewer learned about stroke from providers (P=0.01). Financial barriers and provider mistrust were similar.

Conclusions:

Black patients had less knowledge of stroke symptoms, more care-seeking delay, and poorer outcomes. Including stroke education as a standard of chronic disease care may mitigate stroke outcome disparities.
Potential utility of renal functional reserve testing in clinical nephrology
Authors: Mueller Thomas F. , Luyckx Valerie A.
Published: September 2023

Purpose of review

The aim of this review is to discuss the concept of renal functional reserve (RFR) and its potential relevance in clinical practice.

Recent findings

The RFR is a measure of the change in glomerular filtration rate (GFR) from baseline to a peak value when the kidney is stimulated to increase its function. This concept has a strong physiologic basis in nephrology and the presence, magnitude or absence of RFR capacity may have prognostic significance in many clinical scenarios where individuals are at risk of hyperfiltration or kidney dysfunction. Unlike in other medical specialties, where organ reserve function is reliably measurable and used routinely, measurement of RFR in nephrology has not been integrated into clinical care. Methodologic challenges including standardization of methods to stimulate GFR and the ability of measures of GFR to discriminate acute dynamic changes in GFR upon kidney stimulation have hampered the robustness and use of RFR measurements in research and clinical care.

Given the emergence of many new disease-modifying therapies in nephrology, it is imperative that we move forward and develop more robust tools to further our understanding of kidney physiology and pathophysiology, such as the RFR, which should be integrated into research and clinical care to support optimal personalization of therapeutic kidney care strategies.
PET/CT in treatment response assessment in lung cancer. When should it be recommended?
Authors: Bin Essa Noora , Kaplar Zoltan , Balaji Nikita , Alduraibi Alaa , Bomanji Jamshed , Groves Ashley M. , Lilburn David M.L. , Navani Neal , Fraioli Francesco
Published: September 2023

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Different treatment options are now possible both for surgical candidates and for those NSCLC patients deemed not suitable for surgery. Despite the treatments available, only a limited number of less advanced stages are potentially curable, with many patients suffering local recurrence or distant metastases. FDG-PET/CT is commonly used in many centers for post-treatment evaluation, follow-up, or surveillance; Nonetheless, there is no clear consensus regarding the indications in these cases. Based upon the results of a literature review and local expertise from a large lung cancer unit, we built clinical evidence-based recommendations for the use of FDG-PET/CT in response assessment. We found that in general this is not recommended earlier than 3 months from treatment; however, as described in detail the correct timing will also depend upon the type of treatment used. We also present a structured approach to assessing treatment changes when reporting FDG-PET/CT, using visual or quantitative approaches.
Optimizing stress-only myocardial perfusion imaging: a clinical prediction model to improve patient selection
Authors: Martineau Patrick J , Pelletier-Galarneau Matthieu , Slomka Piotr , Goertzen Andrew L , Leslie William D
Published: September 2023

Background

Stress-only single photon emission computed tomography myocardial perfusion imaging (MPI) offers numerous advantages in terms of improved workflow, cost and radiation reduction but is currently not widely utilized due to challenges in selecting appropriate patients for this technique.

Methods

Data from 5959 individuals were used to derive (N = 4018) and validate (N = 1941) a binomial logistic regression model to predict normal stress MPI studies (stress total perfusion deficit  < 4%, ejection fraction ≥ 50%). Model performance was analyzed using receiver operator characteristic curves. A simplified point-scoring system was developed and its impact on imaging workflow was assessed.

Results

Significant predictors of abnormal vs. normal stress MPI included male sex, age > 65 years, cardiomyopathy, congestive heart failure, myocardial infarction, angina, and pharmacological stress. The final model and simplified scoring system were associated with areas under the curve of 0.81 (95% CI 0.79–0.83) and 0.80 (95% CI 0.79–0.82) in the validation group, respectively. Use of the scoring system was estimated to result in a decrease of 56.5% in the number of non-contributory imaging studies acquired with minimal patient rescheduling.

Conclusion

A prediction tool derived from simple clinical information can identify candidates for stress-only MPI studies with a beneficial impact on departmental workflow.
Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization
Authors: Kebeh Martha , Dlott Chloe C. , Tung Wei Shao , Kurek Donna , Johnson Charla B. , Wiznia Daniel H.
Published: September 2023

Preoperative optimization programs for total joint arthroplasty identify and address risk factors to reduce postoperative complications, thereby improving patients' ability to be safe surgical candidates. This article introduces preoperative optimization programs and describes the role of orthopaedic nurse navigators. This foundation will be used to produce an article series with recommendations for optimization of several modifiable biopsychosocial factors. We consulted orthopaedic nurse navigators across the United States and conducted a literature review regarding preoperative optimization to establish the importance of nurse navigation in preoperative optimization. The responsibilities of nurse navigators, cited resources, and structure of preoperative optimization programs varied among institutions. Optimization programs relying on nurse navigators frequently demonstrated improved outcomes. Our discussions and literature review demonstrated the integral role of nurse navigators in preoperative optimization. We will discuss specific risk factors and how nurse navigators can manage them throughout this article series.
Early Central Venous Catheter Replacement After Candida in Pediatric Intestinal Failure Patients
Authors: Katz Daphna , Jelen Natalia , Xavier de Almeida Alana , Cruz Alberto , Chatani Brandon , Fifi Amanda
Published: September 2023

Background:

Deferred central venous catheter (CVC) replacement places children with intestinal failure (IF) at risk of complications. We hypothesized that early CVC replacement after uncomplicated candidemia is safe and beneficial.

Methods:

We performed a retrospective review of children with IF. Patients were divided into early (<7 days after their first negative culture), and late (≥7 days after their first negative culture) CVC replacement following uncomplicated candidemia. We calculated the median time to CVC removal, clearance of infection, CVC replacement or exchange, and duration of the initial hospitalization. The proportion of patients readmitted within 30 days was also calculated, taking note of the number of candida reinfections.

Results:

Early replacement occurred in 18 encounters and late replacement in 21 encounters. The median time in both groups to CVC removal was 3 days (P = 0.949), and clearance of infection was 4 days (P = 0.466). The median time to CVC replacement or exchange in the early group was 4 days, compared to 10 days in the late group (P < 0.001). The median duration of the hospitalization in the early group was 12 days compared to 21 days in the late group (P = 0.011). In total 39% of patients from the early group were readmitted within 30 days compared to 57% from the late group (P = 0.359). None of the patients were reinfected with candida within 30 days.

Conclusion:

Early CVC replacement after uncomplicated candidemia in children with IF decreases hospital stay without increased risk of readmission or reinfection.
The effect of rehabilitation therapies on quality of life and function in individuals with phantom limb pain after lower-limb amputation: A systematic review
Authors: Gane Elise , Petersen Phoebe , Killalea Taylor , Glavinovic Paige , Nash Isabel , Batten Heather
Published: September 2023

Purpose:

To evaluate the existing evidence surrounding the effect of rehabilitation therapies on quality of life (QOL) and function of individuals with a lower-limb amputation and experiencing phantom limb pain (PLP).

Methods:

This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology. Four databases were searched with key terms that covered 4 broad areas: phantom limb, lower-limb amputation, rehabilitation interventions, and randomized controlled trial (no date limits). Outcomes of either function or QOL in people receiving rehabilitation for PLP were included. The RoB2.0 risk-of-bias tool was used to rate quality.

Results:

Five studies were included, reporting on QOL (n = 5) and function (n = 3), using interventions including mirror therapy, phantom exercises, and muscle relaxation. The evidence was mixed in direction and significance, and this was likely attributed to by the heterogeneity of interventions and types of outcomes as well as incomplete reporting. There was very low certainty in the effect of these rehabilitation interventions to affect QOL or function.

Conclusion:

The overall effect of rehabilitation interventions on QOL and function is inconclusive because of the variable results across the included randomized controlled trials. More research is needed to explore the impact of interventions beyond the outcome of pain and to establish a clearer conclusion. Including measures of QOL and function as well as pain in studies with people with PLP is encouraged.
The effect of orthosis management on joint instability in knee joint disease: A systematic review
Authors: Murata Kenji , Sakakida Takuma , Kawabata Sora , Yokoyama Moeka , Morishita Yuri , Kita Shunsuke , Kubota Keisuke , Kano Takuma , Kojima Takuma , Terada Hidenobu , Takasu Chiharu , Kanemura Naohiko
Published: September 2023

Introduction:

Joint instability is a common finding of clinical importance in patients with knee disease. This literature review aimed to examine the evidence regarding the effect of orthosis management on joint instability in knee joint disease.

Methods:

The detailed protocol for this study was published in the International Prospective Register of Systematic Reviews in the field of health and social welfare (CRD 42022335360). A literature search was conducted on May 2023, using the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Physiotherapy Evidence Database (PEDro), and Institute of Electrical and Electronics Engineers (IEEE) Xplore. A secondary search was manually conducted using Google Scholar to address publication bias. Each database search strategy was described, and the search was conducted by independent reviewers.

Results:

A total of 281 studies were retrieved, 11 articles were included in the systematic review. Of the 11 articles selected, the number of included diseases was 2 for osteoarthritis, 7 for anterior cruciate ligament injuries, and 3 for posterior cruciate ligament injuries. In result, orthosis management may improve self-reported instability and functional assessment in patients with osteoarthritis, anterior cruciate ligament injury, and posterior cruciate ligament injury. However, an objective evaluation of anatomical instability did not indicate an improvement in joint instability.

Conclusion:

The effects of orthosis management on knee instability might improve physical function and self-reported instability.
Going to the Source: Discussions With Early and Mid-Career Faculty From Groups Underrepresented in Biomedical Research to Develop and Enhance CFAR Services
Authors: Delamerced Joseph , Ramirez Leslie , Kimberly Judy A. , Vargas Sara I. , Flanigan Timothy P. , Sanchez Martha C. , Bruciati Kaylyn , So-Armah Kaku
Published: September 2023

Background:

To include, sustain, and retain HIV-focused early career faculty from groups historically excluded from biomedical research, the Providence/Boston Center for AIDS Research (CFAR) conducted focus groups and individual interviews with early and mid-career faculty to discern their needs.

Methods:

We conducted focus groups and interviews with 15 faculty at institutions affiliated with Providence/Boston CFAR from groups underrepresented in biomedical research. The discussion was guided using the domains of an Asset Bundle Model encompassing scientific human capital, social capital, and financial capital.

Result:

Participants' identities, including their race, ethnicity, gender, sexual orientation, and being a parent affected their vision of themselves as scientists. Participants reported confusion or limited training on or access to resources for professional development, hiring staff, meeting NIH reporting requirements, international research, support for working parents, sabbaticals, and addressing workplace conflict or unsupportive work environments. Some described feeling like they were a burden on their mentors who seemed overextended. They identified attributes of effective mentors, such as believing in and investing in the mentee; having the requisite content area expertise and self-confidence; being able to identify mentees needs and meet them where they are; and being consistent, communicative, respectful, and kind. They described a need for additional education and support preresearch and postresearch grant award management.

Conclusions:

To learn how to equitably serve all interested in HIV research, CFARs should engage and include perspectives from scientists who have historically been excluded from biomedical research. Our future work will test, implement, and disseminate the ideas generated by these focus group discussions.
Evidence2Practice (E2P): Leveraging Implementation Science to Promote Careers in HIV Research Among Students From Historically Black Colleges and Universities
Authors: Okeke Nwora Lance , Ware Kenric B. , Campbell Russell , Taylor Jamilah , Hung Frances , Questell Caroline , Brickler Mildred P. , Smith Ukamaka D. , Nawas George T. , Hanlen-Rosado Emily , Chan Cliburn , Bosworth Hayden B. , Aifah Angela , Corneli Amy
Published: September 2023

Background:

The HIV research workforce is not representative of populations most affected by the epidemic. Innovative educational programs are needed to motivate diverse student populations to pursue careers in HIV research.

Methods:

The Duke University Center for AIDS Research Evidence2Practice (E2P) program is a 3-day interactive workshop that introduces students from Historically Black Colleges and Universities (HBCU) to HIV pre-exposure prophylaxis, implementation science, and human-centered design. Participants develop 1-page action plans to increase awareness and uptake of pre-exposure prophylaxis on their campus. The program was evaluated using a partially mixed-method concurrent equal status study design with pre-program and post-program surveys and in-depth interviews.

Results:

Among the 52 participating students, 44 completed the preworkshop survey, 45 completed the postworkshop survey, and 10 participated in an in-depth interview. Most participants identified as Black or African American and cisgender female. Participating in the E2P program was associated with: (1) an increase in median interest in pursuing a career in HIV research (P < 0.01) and (2) a decrease in median perceived difficulty in starting a career in HIV research (P < 0.01). Several students described that a lack of knowledge about initiating an HIV research career, a perceived lack of qualifications and knowledge about HIV science, and limited experience were major barriers to considering careers in HIV research.

Conclusions:

The E2P program enhanced HBCU students' interest in careers related to HIV research and improved their self-efficacy to pursue such careers. On-campus educational enrichment initiatives, led by active HIV researchers and clinicians, should be a critical part of diversifying the HIV workforce.
Impact of a Multi-Institutional Initiative to Engage Students and Early-Stage Scholars From Underrepresented Racial and Ethnic Minority Groups in HIV Research: The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative
Authors: Magnus Manya , Segarra Lorena , Robinson Brandi , Blankenship Kim , Corneli Amy , Ghebremichael Musie , Irvin Nathan , McIntosh Roger , Favor Kevin E. , Jordan-Sciutto Kelly L. , Kimberly Judy , Sluis-Cremer Nicolas , Koethe John R. , Newell Alana , Wood Christine , Rana Aadia , Stockman Jamila K. , Sauceda John , Marquez Carina , Chi Benjamin H. , Orellana E. Roberto , Wutoh Anthony , Bowleg Lisa , Greenberg Alan E.
Published: September 2023

Background:

The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) aims to establish programs to develop pathways for successful careers in HIV science among scholars from underrepresented racial and ethnic populations. This article describes cross-site evaluation outcomes during the first 18 months (July 2021–December 2022) across 15 programs.

Methods:

The aims of the evaluation were to characterize participants, describe feasibility, challenges, and successes of the programs and provide a basis for the generalizability of best practices to Diversity, Equity, and Inclusion (DEI) programs in the United States. Two primary data collection methods were used: a quarterly programmatic monitoring process and a centrally managed, individual-level, participant quantitative and qualitative survey.

Results:

During the first year of evaluation data collection, 1085 racially and ethnically diverse scholars ranging from the high school to postdoctoral levels applied for CDEIPI programs throughout the United States. Of these, 257 (23.7%) were selected to participate based on program capacity and applicant qualifications. Participants were trained by 149 mentors, teachers, and staff. Of the N = 95 participants responding to the individual-level survey, 95.7% agreed or strongly agreed with statements of satisfaction with the program, 96.8% planned to pursue further education, and 73.7% attributed increased interest in a variety of HIV science topics to the program. Qualitative findings suggest strong associations between mentorship, exposure to scientific content, and positive outcomes.

Conclusions:

These data provide evidence to support the feasibility and impact of novel DEI programs in HIV research to engage and encourage racially and ethnically diverse scholars to pursue careers in HIV science.
Fat Fractions of the Rotator Cuff Muscles Acquired With 2-Point Dixon MRI
Authors: Feuerriegel Georg C. , Marcus Roy P. , Sommer Stefan , Wieser Karl , Bouaicha Samy , Sutter Reto
Published: September 2023

Objectives

The aim of this study was to quantify and compare fat fraction (FF) and muscle volume between patients with failed and intact rotator cuff (RC) repair as well as a control group with nonsurgical conservative treatment to define FF cutoff values for predicting the outcome of RC repair.

Materials and Methods

Patients with full-thickness RC tears who received magnetic resonance imaging (MRI) before and after RC repair including a 2-point Dixon sequence were retrospectively screened. Patients with retear of 1 or more tendons diagnosed on MRI (Sugaya IV–V) were enrolled and matched to patients with intact RC repair (Sugaya I–II) and to a third group with conservatively treated RC tears. Two radiologists evaluated morphological features (Cofield, Patte, and Goutallier), as well as the integrity of the RC after repair (Sugaya). Fat fractions were calculated from the 2-point Dixon sequence, and the RC muscles were segmented semiautomatically to calculate FFs and volume for each muscle. Receiver operator characteristics curves were used to determine FF cutoff values that best predict RC retears.

Results

In total, 136 patients were enrolled, consisting of 3 groups: 41 patients had a failed RC repair (58 ± 7 years, 16 women), 50 patients matched into the intact RC repair group, and 45 patients were matched into the conservative treatment group. Receiver operator characteristics curves showed reliable preoperative FF cutoff values for predicting retears at 6.0% for the supraspinatus muscle (0.83 area under the curve [AUC]), 7.4% for the infraspinatus muscle (AUC 0.82), and 8.3% for the subscapularis muscle (0.94 AUC).

Conclusions

Preoperative quantitative FF calculated from 2-point Dixon MRI can be used to predict the risk of retear after arthroscopic RC repair with cutoff values between 6% and 8.3%.
Surgical Treatment for Extensive Postburn Facial Deformity Using Tube Flap and Cervicofacial Flap
Authors: Duan Ran , Liu Caiyue , Gao Bowen
Published: September 2023

The current concept of facial unit reconstruction has evolved from simple coverage of defects to the reconstruction of the 3-dimensional structure and delicate features. The reshaping of the middle third of the face, including the nose and cheek, remains a challenge for plastic surgeons due to its complex structure and the dynamic relationship between each part. In this article, the authors describe a clinical report of extensive facial burns with skin lesions in the middle third of the face. The 30-year-old female patient sustained burns throughout the full thickness of the skin burns on the entire nose and left cheek with hypertrophic scar. The authors performed an expanded cervical-facial flap and tube flap of the upper extremity to reconstruct the entire nasal and cheek region. The patient underwent 8 stages of the operation successively resulting in a satisfactory level of appearance and function.
Adult consequences of repeated nicotine and Δ9-tetrahydrocannabinol (THC) vapor inhalation in adolescent rats
Authors: Gutierrez Arnold , Creehan Kevin M. , Grant Yanabel , Taffe Michael A.
Published: September 2023

The use of Electronic Drug Delivery Systems (EDDS, “e-cigarettes”) to ingest nicotine and Δ9-tetrahydrocannabinol (THC) has surged in adolescent populations in the United States, as five times as many high-school seniors vape nicotine daily as use tobacco. At the same time 19.5% of seniors use cannabis at least monthly, with 12% using EDDS to deliver it. This study was conducted to examine the impact of repeated adolescent vapor inhalation of nicotine and THC in rats.

Female Sprague-Dawley rats were exposed to 30-minute sessions of vapor inhalation, twice daily, from Post-Natal Day (PND) 31 to PND 40. Conditions included vapor from the propylene glycol (PG) vehicle, Nicotine (60 mg/mL in the PG), THC (100 mg/mL in the PG) or the combination of Nicotine (60 mg/mL) and THC (100 mg/mL). Rats were assessed on wheel activity, heroin anti-nociception and nicotine and heroin vapor volitional exposure during adulthood.

Nicotine exposed rats exhibited few differences as adults, but were less sensitive to anti-nociceptive effects of heroin (1 mg/kg, s.c.). THC- and THC+Nicotine-exposed rats were less spontaneously active, and obtained fewer nicotine vapor deliveries as adults. In contrast, THC exposed rats obtained volitional heroin vapor at rates indistinguishable from the non-THC-exposed groups. Repeated THC exposure also caused tolerance to temperature-disrupting effects of THC (5 mg/kg, i.p.).

These studies further confirm that the effects of repeated vapor exposure to THC in adolescence last into early to middle adulthood, including decreased volitional consumption of nicotine. Effects of repeated nicotine in adolescence were comparatively minor.
Asymmetric framework motion of TCRαβcontrols load-dependent peptide discrimination
Authors: Chang-Gonzalez Ana C. , Mallis Robert J. , Lang Matthew J. , Reinherz Ellis L. , Hwang Wonmuk
Published: September 2023

Mechanical force is critical for the interaction between anαβT cell receptor (TCR) and a peptide-bound major histocompatibility complex (pMHC) molecule to initiate productive T-cell activation. However, the underlying mechanism remains unclear. We use all-atom molecular dynamics simulations to examine the A6 TCR bound to HLA-A*02:01 presenting agonist or antagonist peptides under different extensions to simulate the effects of applied load on the complex, elucidating their divergent biological responses. We found that TCRαandβchains move asymmetrically, which impacts the interface with pMHC, in particular the peptide-sensing CDR3 loops. For the wild-type agonist, the complex stabilizes in a load-dependent manner while antagonists destabilize it. Simulations of the CβFG-loop deletion, which reduces the catch bond response, and simulations within silicomutant peptides further support the observed behaviors. The present results highlight the combined role of interdomain motion, fluctuating forces, and interfacial contacts in determining the mechanical response and fine peptide discrimination by a TCR, thereby resolving the conundrum of nearly identical crystal structures of TCRαβ-pMHC agonist and antagonist complexes.
Microfabrication-based engineering of biomimetic dentin-like constructs to simulate dental aging
Authors: Álvarez Simon , Morales Jose , Tiozzo-Lyon Paola , Berrios Pablo , Barraza Valentina , Simpson Kevin , Ravasio Andrea , Vila Xavier Monforte , Teuschl-Woller Andreas , Schuh Christina MAP , Aguayo Sebastian
Published: September 2023

1.

Human dentin is a highly organized dental tissue displaying a complex microarchitecture consisting of micrometer-sized tubules encased in a mineralized type-I collagen matrix. As such, it serves as an important substrate for the adhesion of microbial colonizers and oral biofilm formation in the context of dental caries disease, including root caries in the elderly. Despite this issue, there remains a current lack of effective biomimeticin-vitrodentin models that facilitate the study of oral microbial adhesion by considering the surface architecture at the micro- and nanoscales. Therefore, the aim of this study was to develop a novelin-vitromicrofabricated biomimetic dentin surface that simulates the complex surface microarchitecture of exposed dentin. For this, a combination of soft lithography microfabrication and biomaterial science approaches were employed to construct a micropitted PDMS substrate functionalized with mineralized type-I collagen. These dentin analogues were subsequently glycated with methylglyoxal (MGO) to simulate dentin matrix agingin-vitroand analyzed utilizing an interdisciplinary array of techniques including atomic force microscopy (AFM), elemental analysis, and electron microscopy. AFM force-mapping demonstrated that the nanomechanical properties of the biomimetic constructs were within the expected biological parameters, and that mineralization was mostly predominated by hydroxyapatite deposition. Finally, dual-species biofilms ofStreptococcus mutansandCandida albicanswere grown and characterized on the biofunctionalized PDMS microchips, demonstrating biofilm specific morphologic characteristics and confirming the suitability of this model for the study of early biofilm formation under controlled conditions. Overall, we expect that this novel biomimetic dentin model could serve as anin-vitroplatform to study oral biofilm formation or dentin-biomaterial bonding in the laboratory without the need for animal or human tooth samples in the future.