bluuebunny/crossref_metadata_2025 huggingface dataset:
Postauricular versus systemic use of steroids for sudden hearing loss: A systematic review and meta-analysis of randomized controlled trials
Authors: Deng H.S. , Hou Y.W. , Zhang J.N. , Yang T.
Published: August 2023

Background:

Sudden sensorineural hearing loss (SSNHL) can be debilitating and is one of the most common otological diseases. Steroids play an important role in its treatment. There are many ways to administer steroids, and the efficacy and safety of different administration routes remain unclear. This meta-analysis aimed to investigate the effect and safety of different types of steroid delivery administration for the treatment of SSNHL.

Methods and analysis:

We searched the Weipu, Wanfang, Chinese Biomedical Literature, National Knowledge Infrastructure, Web of Science, Embase and PubMed databases for randomized controlled trials (RCTs) on glucocorticoid treatments for SSNHL to compare the efficacy of postauricular injection and systemic steroid administration. Review Manager 5.4 software was used for data synthesis, which included the recovery rate (RR) of reported hearing improvement and change level in pure-tone audiometry (PTA). Subgroup analyses were performed based on different drugs, basic treatment, initial PTA, drug administration methods, onset time, and treatment course. Stata 15.1 software was used for analyses of publication bias and sensitivity.

Results:

Our meta-analysis included 38 studies involving 3609 patients with SSNHL. In all included studies, the risk difference (RD) using reported improvement as an outcome measure was 0.12 for postauricular injection administration compared with systemic therapy (95% confidence interval [CI] = 0.008, 0.16, P < .00001, I2 = 59%). When examining PTA changes as an outcome measure (19 studies), the mean difference was 6.06 (95% CI = 3.96, 8.16, P < .00001, I2 = 70%). The RD for hearing improvement was compared among different factors, and the results showed that postauricular injection is superior to systemic steroid administration.

Conclusion:

Postauricular injection may be safer and more effective treatment than systemic therapy as a treatment for SSNHL.
The readmission of a parturient with natural delivery after discharge due to residual fetal membrane: A case report
Authors: Wang Yonghong , Li Juan , He Qiuyang , Ren Jianhua , Wang Guoyu
Published: August 2023

Rationale:

Placental residue is a relatively common and sophisticated disease among obstetric delivery complications. A failure to detect placental residue in time may cause poor outcomes such as postpartum hemorrhage and puerperal infection.

Patient concerns:

We present the case of a 33-year-old full-term singleton parturient with placental residue. Upon precipitate labor and childbirth, the placenta and fetal membranes were examined to be intact. However, 1 day after discharge, she felt that there was discharge from the vagina and thus presented to our emergency department.

Diagnoses:

The patient was diagnosed with residual membranes and readmitted to the hospital for uterine curettage.

Intervention:

Uterine curettage was performed under B-ultrasound guidance.

Outcome:

The patient was discharged smoothly without any postoperative complications.

Lessons:

This paper can provide significant enlightenment for the prevention and early treatment of placental residue, including enhancing the risk awareness of high-risk patients, standardizing the process of clinical examination of the placenta, and early uterine contraction promotion to assist in the discharge of residual tissue, so as to reduce the occurrence of placental residue.
Diabetes mellitus, its prevalence, awareness, and control in Panama: Data from ENSPA 2019, a national cross-sectional study
Authors: Quintana Hedley Knewjen , Moreno Velásquez Ilais , Montenegro Mendoza Roger , Niño Hall Cecilio , Motta Jorge , Roa Reina
Published: August 2023

Diabetes mellitus (DM) represents an important global burden of disease. In Panama, DM was investigated in 1 study utilizing questionnaires and in another using biomarkers, but at subnational level. Using data from a recent cross-sectional country-wide population-based study that included biomarkers, we estimated the prevalence of DM, its awareness, and control; evaluating possible risk factors. We used data from 4400 participants aged 18 years or older from the National Health Study of Panama (ENSPA) study conducted in 2019 at a national level. Weighted prevalence and 95% confidence intervals for DM, awareness, and control were estimated by sociodemographic factors, family history of DM, tobacco and alcohol use, nutritional status, and hypertension. Odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression models to assess the possible risk factors associated with DM prevalence and awareness. We generated OR estimates by pooling ENSPA data with a previous regional study, prevalence of cardiovascular risk factors. The prevalence of DM was estimated to be 12.4% (10.9%–14.05%). In both men and women, age, family history of diabetes (OR in men: 4.0 ([2.4–6.7]; OR in women 3.5 [2.5–4.8]), and obesity (OR in men: 2.6 [1.4–5.1]; OR in women: 2.0 [0.9–4.5]) were associated with DM. Diagnosed and controlled hypertension was associated with DM only in women (OR: 2.1 [1.2–3.6]). DM awareness was estimated to be 62.6% (56.3%–68.9%). In both men and women, DM awareness was associated with age and a family history of diabetes (OR in men: 6.6 [2.4–18.4]; OR in women 1.9 ([1.1–3.6]). In women, having secondary education (OR: 1.9 [0.9–3.9]) and being diagnosed with uncontrolled hypertension (OR: 3.3 [1.2–9.5]) was also associated to DM awareness. Men in the ENSPA study were less likely to be aware of DM than those in the prevalence of cardiovascular risk factors (OR: 0.2 [0.0–0.7]). Less than half of the individuals diagnosed with DM had their condition controlled (39.6% [31.4%–47.8%]). This study revealed that the prevalence, awareness, and control of DM were similar to recent estimates reported in other Latin American countries. It also provides a baseline regarding DM and associated risk factors in Panama at a country-level knowledge that is essential for health policy development and useful in clinical practice.
Single-cell and bulk RNA sequencing reveal cancer-associated fibroblast heterogeneity and a prognostic signature in prostate cancer
Authors: Liu Wen , Wang Miaomiao , Wang Miao , Liu Ming
Published: August 2023

Cancer-associated fibroblasts (CAFs), the central players in the tumor microenvironment (TME), can promote tumor progression and metastasis via various functions. However, the properties of CAFs in prostate cancer (PCa) have not been fully assessed. Therefore, we aimed to examine the CAF characteristics in PCa and construct a CAF-derived signature to predict PCa prognosis. CAFs were identified using single-cell RNA sequencing (scRNA-seq) data from 3 studies. We performed the FindAllMarkers function to extract CAF marker genes and constructed a signature to predict the biochemical relapse-free survival (bRFS) of PCa in the Cancer Genome Atlas (TCGA) cohort. Subsequently, different algorithms were applied to reveal the differences of the TME, immune infiltration, treatment responses in the high- and low-risk groups. Additionally, the CAF heterogeneity was assessed in PCa, which were confirmed by the functional enrichment analysis, gene set enrichment analysis (GSEA), and AUCell method. The scRNA-seq analysis identified a CAF cluster with 783 cells and determined 183 CAF marker genes. Cell-cell communication revealed extensive interactions between fibroblasts and immune cells. A CAF-related prognostic model, containing 7 genes (ASPN, AEBP1, ALDH1A1, BGN, COL1A1, PAGE4 and RASD1), was developed to predict bRFS and validated by 4 independent bulk RNA-seq cohorts. Moreover, the high-risk group of the signature score connected with an immunosuppressive TME, such as a higher level of M2 macrophages and lower levels of plasma cells and CD8+ T cells, and a reduced reaction rate for immunotherapy compared with low-risk group. After re-clustering CAFs via unsupervised clustering, we revealed 3 biologically distinct CAF subsets, namely myofibroblast-like CAFs (myCAFs), immune and inflammatory CAFs (iCAFs) and antigen-presenting CAFs (apCAFs). In conclusion, the CAF-derived signature, the first of its kind, can effectively predict PCa prognosis and serve as an indicator for immunotherapy. Furthermore, our study identified 3 CAF subpopulations with distinct functions in PCa.
Assessment of corticospinal tract remodeling based on diffusion tensor imaging in the treatment of motor dysfunction after ischemic stroke by acupuncture: A meta-analysis
Authors: Zhu Weiming , Deng Shizhe , Jiang Hailun , Zhang Jieying , Li Boxuan , Jia Qingqing , Meng Zhihong
Published: August 2023

Background:

To investigate the efficacy of acupuncture in improving motor dysfunction after ischemic stroke (IS) and to investigate the effect of acupuncture on corticospinal tract (CST) remodeling using diffusion tensor imaging.

Methods:

Published literature on the effect of acupuncture on CST remodeling after IS using diffusion tensor imaging in the form of randomized controlled trials (RCTs) were systematically retrieved and screened from Cochrane Library, Web of Science, PubMed, Embase, CNKI, CBM, VIP, and Wanfang databases from inception to December 2022. The methodological quality of the included studies was critically and independently evaluated by 2 reviewers using the Cochrane Risk of Bias Assessment Tool for RCTs. The correlated data were extracted using the pre-designed form, and all analyses were performed using Reviewer Manager version 5.4.

Results:

Eleven eligible RCTs involving 459 patients were eventually included. The combined evidence results showed that the acupuncture group significantly improved patients’ National Institute of Health stroke scale, Fugl-Meyer Assessment Scale, and Barthel index compared with conventional medical treatment. The acupuncture group significantly promoted remodeling of the CST, as reflected by an increase in fractional anisotropy (FA) throughout the CST [MD = 0.04, 95% CI (0.02, 0.07),P= .001], and in addition, subgroup analysis showed that the acupuncture group significantly improved FA in the infarct area compared with conventional medical treatment at around 4 weeks [MD = 0.04, 95% CI (0.02, 0.06),P= .0002] and FA of the affected cerebral peduncle [MD = 0.03, 95% CI (0.00, 0.07),P= .02]. Also, compared with conventional medical treatment, the acupuncture group significantly increased average diffusion coefficient of the affected cerebral peduncle [MD = −0.21, 95% CI (−0.28, −0.13),P< .00001].

Conclusion:

The results of the meta-analysis suggest that acupuncture therapy can improve the clinical manifestations of motor dysfunction in patients after IS and advance a possibly beneficial effect on CST remodeling. However, due to the number and quality of eligible studies, these findings need to be further validated in more standardized, rigorous, high-quality clinical trials.
Serum leucine-rich alpha-2 glycoprotein levels for predicting active ultrasonographic findings in intestinal lesions of patients with Crohn’s disease in clinical remission
Authors: Nasuno Masanao , Shimazaki Hiroshi , Nojima Masanori , Hamada Takahito , Sugiyama Kohei , Miyakawa Maki , Tanaka Hiroki
Published: August 2023

This study aimed to investigate the cutoff value of leucine-rich alpha-2 glycoprotein (LRG) in predicting active intestinal ultrasonography (IUS) findings in patients with Crohn’s disease (CD) in clinical remission. Data were retrospectively collected from patients with CD evaluated using LRG and undergoing IUS from September 2020 to August 2022. Patients with a Harvey–Bradshaw Index of ≤4 were included and those who underwent intestinal resection were excluded. Bowel wall thickness and stratification and blood flow signal using superb microvascular imaging (SMI) were used to assess ultrasonography findings. SMI signals were categorized into 4 grades following the Limberg score. Receiver operating characteristic curves were constructed and the area under the curve was calculated to determine the LRG cutoff values for predicting active IUS findings and were compared with those of C-reactive protein. This study included 213 patients. The LRG cutoff values to predict active bowel wall thickness, loss of bowel wall stratification, and SMI of ≥1, ≥2, and 3 were 14.6 μg/mL, 14.6 μg/mL, 14.6 μg/mL, 14.6 μg/mL, and 16.9 μg/mL, respectively, with significantly higher areas under the curve in SMI of ≥1 and 3 than in C-reactive protein. The best LRG cutoff value for predicting active IUS findings was 14.6 μg/mL in patients with CD in clinical remission, suggesting that LRG is better than C-reactive protein for detecting active IUS findings in CD.
Parenchymal microcalcifications in the thyroid gland: Clinical significance and management strategy
Authors: Yim Younghee , Park Hye Sun , Baek Jung Hwan , Yoo Hyunju , Sung Jin Yong
Published: August 2023

This study is firstly, to investigate the presence of microcalcification among the patients who underwent thyroid ultrasound and biopsy and to evaluate the incidence of intrathyroid lymphatic spread and cervical lymph node metastasis of thyroid cancer with thyroid microcalcifications. Also, we compared the diagnostic performance between fine needle aspiration (FNA) and core needle biopsy (CNB) for assessing parenchymal microcalcifications in the thyroid gland. We retrospectively assessed total 66 patients with thyroid microcalcifications on ultrasound. The histopathologic characteristics of the surgical specimens considered as the gold standard for diagnosing malignancy. Patients with surgically proven malignancy were evaluated for multifocality, intrathyroid lymphatic spread in the opposite lobe, or cervical lymph node metastasis. Among the 66 confirmed patients, 53 patients had malignant lesions (80.3%) and 13 patients had benign lesions (19.7%). The pathologic results of the 44 patients who underwent total thyroidectomy. Among them, 33 patients (75%) showed multifocality, 30 patients (68.2%) showed intrathyroid lymphatic tumor spread. CNB was performed on 41 patients, and FNA was performed on 54 patients. Both CNB and FNA were performed on 29 patients. There were no statistical differences in terms of diagnostic performance between CNB and FNA. Thyroid microcalcifications demonstrate a high prevalence of malignancy. Both CNB and FNA demonstrate similar diagnostic accuracies.
Prognostic risk factors for patients with hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids
Authors: Du Xiaofei , Liu Zhenli , Yu Haibin , Wang Yu , Zou Zhengsheng , Wei Hongshan , Liang Jing , Yang Daokun , Liu Yali , Zhang Jing , Pan Calvin Q.
Published: August 2023

Pyrrolizidine alkaloids induced hepatic sinusoidal obstruction syndrome (PA-HSOS) often occurs after consuming herbs or a dietary supplement containing the plant Tu-San-Qi. Limited data exists to identify patients with fatal outcomes for early interventions. We aimed to analyze the predictors for 3-month survival. We retrospectively enrolled PA-HSOS patients in 5 hospitals and extracted data from the onset of PA-HSOS to 36 months. Outcome measurements were 3-month and 36-month survival rates, baseline prognostic predictors for survival, and the effects of anticoagulant therapy. Among 49 enrollees, the median age was 60 and 49% male. At the onset of PA-HSOS, patients with Child-Turcotte-Pugh (CTP) class of A, B, or C were 8.2% (4/49), 42.8% (21/49) and 49.0% (24/49), respectively. None of them received a transjugular intrahepatic portosystemic shunt or a liver transplant. The 3-month and 36-month survival rates were 86% and 76%, respectively. Compared to the CTP class A or B, class C at baseline independently predicted lower survival rates at both 3 and 36 months. However, anticoagulation therapy treatment within the first 3 months independently predicted significantly higher survival rates at both time points. CTP class C and anticoagulant therapy were the independent predictors for short-term and long-term survival. Anticoagulant therapy could decrease mortality rate of CTP class C patients.

The greatest benefit of anticoagulant evaluated by 3-month survival rate was in patients with CTP class C compared with those without treatment (93% vs 40%, P = .009). There were no bleeding complications reported in patients treated with the anticoagulant.
Optimizing individualized management of patients with ulcerative colitis: Identification of risk factors predicting ulcerative colitis-associated neoplasia
Authors: Jiang Wenyu , Lu Meijiao , Zhang Li , Xu Chenjing , Wang Ruohan , Xu Ying , Tang Wen , Zhang Hongjie
Published: August 2023

The risk of developing colorectal neoplasia in patients with ulcerative colitis (UC) is increased. The purpose of this study is to analyze the risk factors of UC-associated neoplasia (UCAN) in UC patients and establish a clinical prediction model. 828 UC patients were included in this retrospective study. 602 patients were in discovery cohort and 226 patients were in validation cohort (internal validation cohort/external validation cohort: 120/106). Clinical and endoscopic data were collected. The discovery cohort was divided into UC group and UCAN group for univariate and multivariate binary logistic analyses. The UCAN clinical prediction model was established and verified. In the univariate analysis, 7 risk factors were related to UCAN. Multivariate logistic regression analysis showed that age at diagnosis of UC (OR: 1.018, 95% CI: 1.003–1.033), Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score (OR: 1.823, 95% CI: 1.562–2.128), and size of polyps (size1: OR: 6.297, 95% CI: 3.669–10.809; size2: OR: 12.014, 95% CI: 6.327–22.814) were independent risk factors of UCAN. A mathematical equation was established. The area under the ROC curve (AUC) of this model was calculated to be 0.845 (95%CI: 0.809–0.881). The sensitivity was 0.884 and the specificity was 0.688. The AUC of internal validation cohort was 0.901 (95%CI: 0.815, 0.988), sensitivity was 75.0% and specificity was 92.6%. The AUC of external validation cohort was 0.842 (95%CI: 0.709, 0.976), sensitivity was 62.5% and specificity was 93.9%. This prediction model is simple, practical, and effective for predicting the risk of UCAN, which is beneficial to the individualized management of patients with UC.
Recurrent squamous cell carcinoma arising in ovary mature cystic teratoma: A case report
Authors: Ji Xuechao , Zhai Peiling , Yang Hanchao , Wang Hui , Wang Xinbo
Published: August 2023

Rationale:

Malignant transformation of mature cystic teratoma is very rare, of which squamous cell carcinoma (SCC) is the most common type. Prognosis of SCC arising in mature cystic teratoma of the ovary is very poor. Our experience may provide new ideas for the treatment of this disease.

Patient concerns:

The patient was a 56-year-old woman and was admitted for a lower abdominal pain. She underwent a laparoscopic surgery with 4 cycles of chemotherapy and had achieved a complete response; 10 months after the completion of initial treatment, her cancer relapsed. She underwent a cytoreductive surgery with concurrent chemoradiotherapy and has achieved a complete response again.

Diagnoses:

This patient was initially diagnosed with ovarian cancer (stage IIIB) arising from malignant transformation of mature teratoma; 10 months after the completion of initial treatment, she was diagnosed with recurrent ovarian cancer.

Interventions:

This patient was initially treated with laparoscopic bilateral salpingo-oophorectomy. After histopathological confirmation that she had ovarian cancer, she underwent laparoscopic total hysterectomy and omentectomy with 4 cycles of chemotherapy. After her ovarian cancer recurred, she underwent open cytoreductive surgery and concurrent chemoradiotherapy.

Outcomes:

The patient achieved complete response after both initial and relapsed treatment.

Lessons:

Optimal cytoreduction and concurrent chemoradiotherapy may be an option to improve the prognosis of patients with recurrent SCC arising in ovary mature cystic teratoma.
A comprehensive meta-analysis on the association between vitamin C intake and gestational diabetes mellitus: Insights and novel perspectives
Authors: Zhou Lili , Liu Junbo , Zhou Min
Published: August 2023

Background:

Gestational Diabetes Mellitus (GDM) is a significant health concern in pregnant women and their offspring. Although Vitamin C is known to play a role in maintaining normal physiological processes, its relationship with GDM has not been fully elucidated.

Methods:

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing data from 15 studies selected from PubMed, Embase, Web of Science, and the Cochrane Library up to May 16, 2023. These studies were selected based on inclusion criteria such as study design, outcome of interest, exposure factor, and data extractability. Quality assessment was performed using the Newcastle-Ottawa Scale. We assessed the heterogeneity between studies and conducted a sensitivity analysis.

Results:

Data from 10,131 subjects, including 1304 diagnosed GDM cases, were analyzed. The meta-analysis showed that women in the low Vitamin C exposure group had higher odds of developing GDM (odds ratio 2.72, 95% CI:1.24–4.19). There was a greater likelihood of increased GDM risk with lower Vitamin C exposure (standardized mean difference: −0.71, 95% CI [−1.07 −0.36]). Subgroup analysis revealed that both internal and external Vitamin C exposure, along with exposure during the second or third trimester of pregnancy, was associated with higher GDM incidence rates under low Vitamin C exposure. Sensitivity analysis confirmed the robustness of the results, and no significant publication bias was detected.

Conclusion:

Low Vitamin C exposure during pregnancy may increase the risk of GDM. Given these findings, it could be beneficial for pregnant women to increase their intake of Vitamin C-rich foods and to ensure adequate blood Vitamin C levels as a preventive measure against GDM.
A comparison of effectiveness between Posisep and Merocel nasal packing after endoscopic sinus surgery: Findings from a randomized, double-blinded, controlled trial
Authors: Pham Huu Kien , Nguyen Trong , Tran Tai Thanh , Thai Truc Thanh
Published: August 2023

Background:

The effectiveness of nonabsorbable and biodegradable nasal packing is still controversial, and the choice of nasal packing type can alter the outcome of endoscopic sinus surgery. This study compared the effectiveness of Posisep and Merocel as nasal packing materials with regard to hemostasis, adhesion, wound healing, patient’s satisfaction and health-related quality of life after endoscopic sinus surgery (ESS).

Methods:

A prospective, randomized, double-blinded, controlled trial was conducted in patients with chronic rhinosinusitis refractory undergoing symmetrical bilateral ESS. At the completion of surgery, a nasal packing (either Merocel or Posisep) was randomly chosen and placed into the middle meatus of each nasal cavity. All patients were scheduled for follow-up visits at 24 hours, 5 days, 3 weeks, and 5 weeks days after surgery. Health-related quality of life was measured using the Sino-Nasal Outcome Test (SNOT-22). The overall inflammatory burden of chronic rhinosinusitis was measured by the Lund-Mackay postoperative endoscopic score (LMES).

Results:

Among 62 patients included in data analysis (n = 31 for each group), the mean age was 42.4 years and 54.8% were females. Patients with Posisep after ESS had more improvement and better symptoms measured through SNOT-22 and LMES at 24 hours, 5 days, and 3 weeks than those with Merocel after ESS. While some aspects measured by LMES such as discharge and scarring were still better until 5 weeks after surgery, all symptoms measured by SNOT-22 were similar between the 2 groups 5 weeks after surgery.

Conclusion:

Posisep containing chitosan provided patients with a better quality of life throughout the early recovery period compared with Merocel. Although more studies are needed, our findings support the use of Posisep after ESS.
Can Enterococcus faecium prevent NEC in preterm infants?: A systematic review and meta-analysis
Authors: Men Guangguo , Wang Lili , Lu Xudan , Wen Gang , Lü Qin
Published: August 2023

Objective:

Previous some systematic reviews reported that probiotics may benefit the prevention of NEC in preterm infants. But dissimilar bacterial strains and taxa used in included studies possibly result in bias. There is not a rounded systematic review which has estimated the benefit and safety of Enterococcus faecium to prevent NEC in preterm infants to date before we conducted.

Methods:

This systematic review of randomized controlled trials and retrospective studies analyzing the benefit of Enterococcus faecium to prevent NEC in preterm infants was performed using PubMed, Web of Science, Cochrane Library, EMBASE, Wanfang data and China National Knowledge Infrastructure databases from inception to April 14, 2023. The search terms were “preterm” AND “necrotizing enterocolitis” AND “Enterococcus faecium OR probiotics.” Studies reporting NEC involving preterm infants who were given Enterococcus faecium were included in this systematic review. A sensitivity analysis was conducted to assess the stability of results. A funnel plot was generated to identify publication bias. Two authors appraised studies quality and extracted data independently. This work has been reported according with preferred reporting items for systematic reviews and meta-analyses and assessing the methodological quality of systematic reviews. Statistical analysis was conducted using Review Manager 5.3 software. Risk ratio (RR) with 95% confidence intervals (CI) was calculated and analyzed.

Results:

Seven studies (N = 1487 participants) were included in this systematic review, and 6 randomized, controlled trials (N = 1237 participants) were included in the meta-analysis. Comparing with the control groups, the Enterococcus faecium groups had a significant decline in the incidence of NEC Bell stage II or higher (RR: 0.3138, 95% CI: 0.1983–0.4965; P < .00001; 6 studies, n = 1237) and infection (RR: 0.4818, 95% CI: 0.2950–0.7869; P = .004; 3 studies, n = 710).

Conclusions:

Enterococcus faecium is effective and safe in preventing NEC (Bell stage II or higher) in preterm infants. But all studies included came from China. The dosages and durations of taking Enterococcus faecium were various.
Feasibility, Outcomes, and Perceptions of a Virtual Group Exercise Program in Multiple Sclerosis
Authors: Garg Hina , Rutherfurd Charlotte , Labrum Jared , Hawley Bet , Gard Emily , Davis James
Published: August 2023

Background and Purpose:

Individuals with multiple sclerosis (MS) frequently report low physical activity and psychosocial support due to concerns with transportation, time, finances, access to services, and lack of caregiver support. These barriers can be addressed by online group interventions; however, utility of such programs in individuals with MS has not been examined yet. The purpose of this retrospective study was, therefore, to (a) investigate the feasibility, safety, and outcomes of a virtual group exercise program in individuals with MS, and (b) explore the participant perceptions after the program.

Methods:

Retrospective data from the medical records of 17 individuals with MS (mean [SD] age = 53.5 [12.3] years, body mass index = 28.2 [7.2]) who completed the virtual 13-week group exercise program, pre- and posttraining functional status questionnaires, and the end-of-program feedback were extracted. The exercise program included aerobic, resistance, balance, and flexibility training components recommended for people with MS. Feasibility, safety, outcomes, and participant perceptions were determined by adherence to the prescribed daily exercise dosage, number of adverse events, within-group differences in self-reported functional status, and thematic analysis of the participant feedback, respectively.

Results:

Participants were adherent (79%), reported minimal adverse effects, and demonstrated significant changes (P < 0.05) in functional status posttraining. Several themes on the perceived barriers, facilitators, and suggestions for improvement were identified.

Discussion and Conclusions:

A virtual 13-week group exercise program can be feasible, safe, effective, and well received by individuals with MS. Future research should investigate the dose-response effectiveness of telehealth and compare various telehealth models of exercise training using large randomized controlled trials.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A434, which demonstrates an overview of the study).
Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma
Authors: Kha Stephanie T. , Sharma Jigyasa , Kenney Deborah , Daldrup-Link Heike , Steffner Robert
Published: August 2023

Objectives

The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis.

Methods

We conducted a retrospective review of pediatric patients (aged 1–18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis.

Results

Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4–18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1–84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0–4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0–493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0–493; P = 0.018).

Conclusions

We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.
Operational Considerations for Using Deer-Targeted 4-Poster Tick Control Devices in a Tick-borne Disease Endemic Community
Authors: Hornbostel Victoria L. , Meek James I. , Hansen AmberJean P. , Niesobecki Sara A. , Nawrocki Courtney C. , Hinckley Alison F. , Connally Neeta P.
Published: August 2023

Context:

In the northeastern United States, recommendations to prevent diseases spread by black-legged ticks (Ixodes scapularis) and lone star ticks (Amblyomma americanum) often rely on individuals to use personal protection or yard-based strategies. The 4-Poster deer treatment stations (4-Posters) suppress tick populations by treating deer hosts with acaricide, potentially offering a community-wide approach for reducing tick-borne diseases in endemic areas. The 4-Poster deployment logistics in mainland community settings are not well documented but are needed for future public health tick control efforts.

Program:

As part of a public health research effort to design a population-based 4-Poster effectiveness study aimed at reducing tick-borne disease incidence, TickNET researchers partnered with the Town of Ridgefield (Connecticut) to understand the feasibility and operational logistics of deploying 4-Posters on public land within a residential community to inform future public health interventions by municipalities or vector control agencies.

Implementation:

We deployed three 4-Posters on a municipal property from July to December 2020 and used motion-activated cameras to record wildlife activity nearby. We documented per-device operational details, costs, materials consumed, and animal activity.

Evaluation:

Operation of 4-Posters was feasible, and device challenges were easily remedied. Deer visitation and heavy nontarget animal use were documented at all devices. Unexpectedly, monthly corn consumption was not correlated with monthly deer-view days. The monthly cost per device was US $1279 or US $305 per hectare with an average 21 minutes of weekly service time.

Discussion:

Use of 4-Posters by communities, public health agencies, or vector control programs may be a practicable addition to tick management programs in tick-borne disease endemic areas in the Northeast. Such programs should carefully consider local and state regulations, follow manufacturer and pesticide label guidelines, and include wildlife monitoring. High labor costs incurred in this project could be mitigated by training vector control agency or municipality staff to service 4-Posters.
The Impact of Neighborhood and Socioeconomic Disparities on Distal Radius Fracture Follow-Up Adherence
Authors: Moura Steven P. , McLaughlin Matthew T. , Gowda Madhu , Shaffrey Ellen C. , Edalatpour Armin , Chu Daniel Y. , Michelotti Brett F.
Published: August 2023

Background:

The aims of this retrospective cohort study were (1) to assess whether the Area Deprivation Index (ADI), a novel neighborhood-level socioeconomic disparities metric, is associated with follow-up nonadherence, and (2) to determine the individual-level socioeconomic factors associated with follow-up nonadherence after treatment of distal radius fractures (DRFs).

Methods:

The authors included all patients who underwent nonoperative or operative management of DRFs at an academic level I trauma center between 2019 and 2021. A manual chart review was performed to collect data on ADI, sociodemographic factors, injury characteristics, conservative and surgical interventions, and health care utilization.

Results:

There was a significant weak negative Spearman-ranked correlation between ADI state deciles and clinic attendance rates (r

s
[220] = −0.144 [95% CI, −0.274 to −0.009]; P = 0.032). Socioeconomic factors associated with significant differences in clinic attendance rates were having a spouse or partner (protective) (P = 0.007), Medicaid insurance (P = 0.013), male sex (P = 0.023), and current smoking (P = 0.026). Factors associated with differences in no-show rates were having a spouse or partner (odds ratio [OR], 0.326 [95% CI, 0.123 to 0.867]; P = 0.025), Medicaid insurance (OR, 7.78 [95% CI, 2.15 to 28.2]; P = 0.002), male sex (OR, 4.09 [95% CI, 1.72 to 9.74]; P = 0.001), and cigarette use (OR, 5.07 [95% CI, 1.65 to 15.6]; P = 0.005).

Conclusions:

ADI has a weak, negative correlation with clinic attendance rates after DRF treatment. Significant disparities in clinic follow-up adherence exist between patients on the basis of marital status, insurance, sex, and cigarette use.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
A Patient Who Developed Lagophthalmos Following Rhinoplasty
Authors: Ural Alper , Gümüş Koray
Published: August 2023

Lagophthalmos, impairment of closing upper eyelids, can result from various reasons. However, lagophthalmus after a rhinoplasty is both unusual and frustrating. We report a patient experiencing lagophthalmos following rhinoplasty and its management.
Micro-compartmentalized strand displacement reactions with a random pool background
Authors: Mayer Thomas , Givelet Louis , Simmel Friedrich C.
Published: August 2023

Toehold-mediated strand displacement (TMSD) is a widely used process in dynamic DNA nanotechnology, which has been applied for the actuation of molecular devices, in biosensor applications, and for DNA-based molecular computation. Similar processes also occur in a biological context, when RNA strands invade secondary structures or duplexes of other RNA or DNA molecules. Complex reaction environments—inside cells or synthetic cells—potentially contain a large number of competing nucleic acid molecules that transiently bind to the components of the strand displacement reaction of interest and thus slow down its kinetics. Here, we investigate the kinetics of TMSD reactions compartmentalized into water-in-oil emulsion droplets—in both the presence and absence of a random sequence background—using a droplet microfluidic ‘stopped flow’ set-up. The set-up enables one to determine the kinetics within thousands of droplets and easily vary experimental parameters such as the stoichiometry of the TMSD components. While the average kinetics in the droplets coincides precisely with the bulk behaviour, we observe considerable variability among the droplets. This variability is partially explained by the encapsulation procedure itself, but appears to be more pronounced in reactions involving a random pool background.
On biochemical constructors and synthetic cells
Authors: Maerkl Sebastian J.
Published: August 2023

Is it possible to build life? More specifically, is it possible to create a living synthetic cell from inanimate building blocks? This question precipitated into one of the most significant grand challenges in biochemistry and synthetic biology, with several large research consortia forming around this endeavour in Europe (European Synthetic Cell Initiative), the USA (Build-a-Cell Initiative) and Japan (Japanese Society for Cell Synthesis Research). The mature field of biochemistry, the advent of synthetic biology in the early 2000s, and the burgeoning field of cell-free synthetic biology made it feasible to tackle this grand challenge.
Biomimetic construction of phospholipid membranes by direct aminolysis ligations
Authors: Souto-Trinei Federica A. , Brea Roberto J. , Devaraj Neal K.
Published: August 2023

Construction of artificial cells requires the development of straightforward methods for mimicking natural phospholipid membrane formation. Here we describe the use of direct aminolysis ligations to spontaneously generate biomimetic phospholipid membranes from water-soluble starting materials. Additionally, we explore the suitability of such biomimetic approaches for driving the
in situ
formation of native phospholipid membranes. Our studies suggest that non-enzymatic ligation reactions could have been important for the synthesis of phospholipid-like membranes during the origin of life, and might be harnessed as simplified methods to enable the generation of lipid compartments in artificial cells.
DNA droplets for intelligent and dynamical artificial cells: from the viewpoint of computation and non-equilibrium systems
Authors: Takinoue Masahiro
Published: August 2023

Living systems are molecular assemblies whose dynamics are maintained by non-equilibrium chemical reactions. To date, artificial cells have been studied from such physical and chemical viewpoints. This review briefly gives a perspective on using DNA droplets in constructing artificial cells. A DNA droplet is a coacervate composed of DNA nanostructures, a novel category of synthetic DNA self-assembled systems. The DNA droplets have programmability in physical properties based on DNA base sequence design. The aspect of DNA as an information molecule allows physical and chemical control of nanostructure formation, molecular assembly and molecular reactions through the design of DNA base pairing. As a result, the construction of artificial cells equipped with non-equilibrium behaviours such as dynamical motions, phase separations, molecular sensing and computation using chemical energy is becoming possible. This review mainly focuses on such dynamical DNA droplets for artificial cell research in terms of computation and non-equilibrium chemical reactions.
Engineering DNA-based cytoskeletons for synthetic cells
Authors: Jahnke Kevin , Göpfrich Kerstin
Published: August 2023

The development and bottom-up assembly of synthetic cells with a functional cytoskeleton sets a major milestone to understand cell mechanics and to develop man-made machines on the nano- and microscale. However, natural cytoskeletal components can be difficult to purify, deliberately engineer and reconstitute within synthetic cells which therefore limits the realization of multifaceted functions of modern cytoskeletons in synthetic cells. Here, we review recent progress in the development of synthetic cytoskeletons made from deoxyribonucleic acid (DNA) as a complementary strategy. In particular, we explore the capabilities and limitations of DNA cytoskeletons to mimic functions of natural cystoskeletons like reversible assembly, cargo transport, force generation, mechanical support and guided polymerization. With recent examples, we showcase the power of rationally designed DNA cytoskeletons for bottom-up assembled synthetic cells as fully engineerable entities. Nevertheless, the realization of dynamic instability, self-replication and genetic encoding as well as contractile force generating motors remains a fruitful challenge for the complete integration of multifunctional DNA-based cytoskeletons into synthetic cells.
Characteristics of Cerebellar Cognitive Affective Syndrome (CCAS) in patients with acute cerebellar stroke and its impact on outcome
Authors: Shinya Tokuaki , Kota Yamauchi , Tanaka Shota , Goto Kei , Arakawa Shuji
Published: August 2023

Background

Recently, cerebellar cognitive affective syndrome-scale (CCAS-S) was developed to assess CCAS—a syndrome in which cognitive impairment is caused by cerebellar lesions. Literature regarding CCAS in patients with stroke is scarce, and its impact on outcomes is unclear. This study aimed to evaluate CCAS in patients with acute cerebellar stroke and examine its relationship with the outcomes.

Methods

Patients who experienced acute cerebellar stroke for the first time and were hospitalized in Steel Memorial Yawata Hospital within 7 days of stroke onset between April 2021 and April 2023 were included in this observational study. CCAS-S, Mini-Mental State Examination (MMSE), and Scale for the Assessment and Rating of Ataxia (SARA) scores were measured 1 week after stroke onset, and Functional Independence measure (FIM)/Barthel Index (BI) at discharge, physical function, activities of daily life (ADL), length of hospital stay, and outcome (discharge destination) were evaluated. The Mann–Whitney U test was used to compare CCAS-S scores and variables.

Results

Thirteen consecutive patients with acute cerebellar stroke (9 women) and age-and sex-matched healthy controls (7 women) were included. The MMSE score was within the normal range in all patients; however, patients with stroke had a lower total CCAS-S score (median 72, interquartile range [IQR] 66–80) and a higher number of failed tests (median 4, IQR 3–5) than those of healthy controls. Significant deficits were observed in semantic fluency (p=0.008), category switching (p=0001), and similarity (p=009). Possible, probable, and definite CCAS were diagnosed in 2, 1, and 10 patients, respectively. Patients discharged home showed better SARA and FIM/BI scores but similar CCAS-S scores compared to those discharged to rehabilitation hospitals.

Conclusion

CCAS along with impaired executive and language functions is frequently observed in patients with acute cerebellar stroke; however, impaired motor function, and not CCAS, influences the outcome.
Effectiveness of Switching CGRP monoclonal antibodies in non-responder patients in the UAE: A retrospective study
Authors: Suliman Reem , Santos Vanessa , Qaissi Ibrahim Al , Aldaher Batool , Fardan Ahmed Al , Barrawy Hajir Al , Bader Yazan , Supena Jonna Lyn , Alejandro Kathrina , Alsaadi Taoufik
Published: August 2023

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promising effectiveness in migraine management compared to other preventative treatment options. Currently there are several studies related to the efficacy and tolerability of CGRP mAbs in the management of mgraine. However, many questions remain unanswered when it comes to switching between antibody classes as a treatment option in patients with migraine headaches. The present study seeks to explore and assess the treatment response to CGRP mAb in patients who have previously failed other CGRP mAbs.

This was a retrospective, real-world, exploratory study. The participants included within the study were adult (≥18 years) patients diagnosed with migraine. Patients who were treated with two or more GCRP mAbs were retrospectively analyzed. Data was collected from one site, 53 patients with migraine headache switched between three CGRP mAb types (Eptinezumab, Erenumab, and Glacanezumb) due to lack of efficacy of the original prescribed CGRP mAb. Efficacy of switching between types of CGRP mAb’s was evaluated through documented MMD’s in patient diaries and clinical records. Non-parametric analysis was used to compare efficacy of the first six months of each prescribed medication. The analysis of efficacy demonstrated that some improvements were seen in both class switch cohorts (CGRP/R to CGRP/L and CGRP/L to CGRP/R). However, the most noticeable improvement in efficacy of the prescription switch was found in patients who switched between different medications of the CGRP/L class. Both chronic migraine and episodic migraine patients showed improved MMD’s, however chronic migraine patients demonstrated higher responsiveness of efficacy following this lateral switching, The safety of switching between CGRP classes was well observed as any adverse events presented pre-class switch did not lead to the discontinuation of treatment following the later switch. The findings of this study suggest that switching between different classes of CGRP mAbs is a potentially safe and clinically viable practice that may have some applications for those experiencing side effects on their current CGRP mAb or have suboptimal response. This is especially true for patients initiating treatment on ligand targeted CGRP mAb who experience side effects or lack of meaningful efficacy, as the ligand-ligand cohort seems to demonstrate the best outcome. Larger cohort studies and longer follow ups are needed to validate our findings.