bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation
Authors: Oliver Cameron , Gupta Priya , Yeung Sonia N. , Iovieno Alfonso
Published: June 2023

Précis:

The XEN stent safely and effectively controls intraocular pressure in select patients with history of corneal transplantation.

Purpose:

Glaucoma is a common complication after corneal transplantation and can be difficult to manage in these patients. This study reports outcomes of XEN stent implantation in eyes with glaucoma in the setting of previous corneal transplantation.

Patients and Methods:

Noncomparative retrospective case series including eyes with a history of corneal transplantation and subsequent XEN stent implantation by a single glaucoma surgeon in Surrey, British Columbia, between 2017 and 2022. The analysis included patient demographics, pre and postoperative intraocular pressure (IOP), pre and postoperative glaucoma medications, peri and postoperative complications and interventions, and incidence of repeat corneal transplantation and additional glaucoma procedures to control IOP.

Results:

Fourteen eyes with previous cornea transplantation underwent XEN stent implantation. Mean age was 70.1 years (range: 47–85 y). Mean follow-up was 18.2 months (range: 1.5–52 mo). The most common glaucoma diagnosis was secondary open angle glaucoma (50.0%). There was a significant reduction in IOP and the number of glaucoma agents at all postoperative time points (P < 0.05). IOP decreased from 32.7 ± 10.0 mm Hg at baseline to 12.5 ± 4.7 mm Hg at the most recent follow-up. Glaucoma agents decreased from 4.0 ± 0.7 to 0.4 ± 1.0. Two eyes required additional glaucoma surgery to control IOP, with an average time to reoperation of 7 weeks. Two eyes underwent repeat corneal transplantation, with an average time to reoperation of 23.5 months.

Conclusions:

In selected patients with previous corneal transplants and refractory glaucoma, the XEN stent was safely implanted and effectively reduced IOP in the short term.
Train Drivers’ Work Related Stress and Job Satisfaction
Authors: Fredin-Knutzén Johan , Olsson Niklas , Rosberg Tomas , Thorslund Birgitta , Lidestam Björn
Published: June 2023

Objectives

This study investigated which work-related stressors are rated highest by train drivers and which are strongest correlated with consideration to change profession.

Methods

In a questionnaire, a total of 251 Swedish train drivers rated 17 work-related stressors, to which extent they had considered quitting their profession, and if they had experienced a PUT (person under train) accident.

Results

PUTs (when experienced) and irregular work hours are the main stressors, but the strongest predictors of consideration to change profession are those that are encountered often, and last over time (eg, irregular work hours,r= 0.61, and major organizational changes,r= 0.51).

Conclusions

For effective reduction of stress and improved job satisfaction, focus should be on aspects that affect everyday life for drivers, such as better working shifts, less delays, and improved social climate.
Seeking Treatment Profile of Male Shift Workers With Hypertension and Diabetes
Authors: Adi Nuri Purwito , Nagata Tomohisa , Mori Koji , Kubo Tatsuhiko , Fujimoto Kenji , Ohtani Makoto , Odagami Kiminori , Nagata Masako , Kajiki Shigeyuki , Fujino Yoshihisa , Matsuda Shinya
Published: June 2023

Objective

This study was identified seeking treatment for hypertension and diabetes among male shift workers.

Method

This retrospective cohort study included nine large companies in Japan. Data were collected from health checkup, health insurance records, and self-administered questionnaires in 2017 and 2020. Data were analyzed using Kaplan-Meier curves and Cox regression.

Result

Person-days shift workers and day workers seeking treatment for hypertension were 41,604 and 327,301, respectively and, for diabetes, were 7326 and 60,735, respectively. The log ranks were statistically significant. Shift workers were 46% and 56% less likely to seek treatment for hypertension and diabetes, respectively, than day workers were after adjustment for age, marital status, education level, and intention to modify lifestyle (model 2) (P< 0.01).

Conclusions

Male shift workers are less likely to seek treatment for hypertension and diabetes compared with day workers.
Adenosine response and failure to convert paroxysmal supraventricular tachycardia in the emergency department
Authors: Alghadeer Sultan M. , Almohammed Omar A. , Alshaya Abdulrahman I. , Alsaif Sara , Albogami Sara , Althunayyan Saqer M.
Published: June 2023

Background and importance

Although adenosine is the recommended first-line therapy for patients with paroxysmal supraventricular tachycardia (SVT), it may fail to restore normal sinus rhythm. The factors associated with this failure remain unclear.

Objective

To assess the response rate to adenosine and identify the factors causing adenosine failure in the management of paroxysmal SVT.

Design, setting, and participants

This retrospective study was conducted on adult patients diagnosed with paroxysmal SVT and treated with adenosine in the emergency departments of two large tertiary hospitals between June 2015 and June 2021.

Outcome measure and analysis

The primary outcome of the study was the patient response to adenosine, defined as the restoration of sinus rhythm documented in the patients’ files. Backward-stepwise multivariate logistic regression was used to examine the predictors of adenosine failure based on the overall response to adenosine therapy.

Main results

A total of 404 patients, with a mean age of 49 (SD 15) years and a BMI of 32 (SD 8) kg/m2, and treated with adenosine for paroxysmal SVT, were included. Sixty-nine percent of patients were women. The overall response rate to any adenosine dose was 86% (n = 347). The baseline heart rate did not significantly differ between adenosine responders and non-responders (179.6 ± 23.1 vs. 183.2 ± 23.4). An association was observed between the history of paroxysmal SVT and successful response to adenosine (odds ratio = 2.08; 95% confidence interval 1.05–4.11).

Conclusion

The findings of this retrospective study suggested that the use of adenosine restored normal sinus rhythm in 86% of patients with paroxysmal SVT. Furthermore, a history of paroxysmal SVT and older age were associated with an increased chance of adenosine success.
Computed tomography brain scan utilization in patients with headache presenting to emergency departments: a multinational study
Authors: Chu Kevin , Kelly Anne-Maree , Keijzers Gerben , Kinnear Frances , Kuan Win Sen , Graham Colin , Laribi Said , Roberts Tom , Karamercan Mehmet , Cardozo-Ocampo Alejandro , Kamona Sinan , Body Richard , Horner Daniel , Klim Sharon , Brown Nathan , Wijeratne Tissa ,   , on behalf of the HEAD study investigators
Published: June 2023

Background and importance

Recommended indications for emergency computed tomography (CT) brain scans are not only complex and evolving, but it is also unknown whether they are being followed in emergency departments (EDs).

Objective

To determine the CT utilization and diagnostic yield in the ED in patients with headaches across broad geographical regions.

Design

Secondary analysis of data from a multinational cross-sectional study of ED headache presentations over one month in 2019.

Setting and participants

Hospitals from 10 participating countries were divided into five geographical regions [Australia and New Zealand (ANZ); Colombia; Europe: Belgium, France, UK, and Romania; Hong Kong and Singapore (HKS); and Turkey). Adult patients with nontraumatic headache as the primary presenting complaint were included. Patients were identified from ED management systems.

Outcome measures and analysis

The outcome measures were CT utilization and diagnostic yield. CT utilization was calculated using a multilevel binary logistic regression model to account for clustering of patients within hospitals and regions. Imaging data (CT requests and reports) were sourced from radiology management systems.

Main results

The study included 5281 participants. Median (interquartile range) age was 40 (29–55) years, 66% were women. Overall mean CT utilization was 38.5% [95% confidence interval (CI), 30.4–47.4%]. Regional utilization was highest in Europe (46.0%) and lowest in Turkey (28.9%), with HKS (38.0%), ANZ (40.0%), and Colombia (40.8%) in between. Its distribution across hospitals was approximately symmetrical. There was greater variation in CT utilization between hospitals within a region than between regions (hospital variance 0.422, region variance 0.100). Overall mean CT diagnostic yield was 9.9% (95% CI, 8.7–11.3%). Its distribution across hospitals was positively skewed. Regional yield was lower in Europe (5.4%) than in other regions: Colombia (9.1%), HKS (9.7%), Turkey (10.6%), and ANZ (11.2%). There was a weak negative correlation between utilization and diagnostic yield (r = −0.248).

Conclusion

In this international study, there was a high variation (28.9–46.6%) in CT utilization and diagnostic yield (5.4–11.2%) across broad geographic regions. Europe had the highest utilization and the lowest yield. The study findings provide a foundation to address variation in neuroimaging in ED headache presentations.
Prediction of In-hospital Mortality Among Intensive Care Unit Patients Using Modified Daily Laboratory-based Acute Physiology Score, Version 2
Authors: Kohn Rachel , Weissman Gary E. , Wang Wei , Ingraham Nicholas E. , Scott Stefania , Bayes Brian , Anesi George L. , Halpern Scott D. , Kipnis Patricia , Liu Vincent X. , Dudley Raymond Adams , Kerlin Meeta Prasad
Published: June 2023

Background:

Mortality prediction for intensive care unit (ICU) patients frequently relies on single ICU admission acuity measures without accounting for subsequent clinical changes.

Objective:

Evaluate novel models incorporating modified admission and daily, time-updating Laboratory-based Acute Physiology Score, version 2 (LAPS2) to predict in-hospital mortality among ICU patients.

Research design:

Retrospective cohort study.

Patients:

ICU patients in 5 hospitals from October 2017 through September 2019.

Measures:

We used logistic regression, penalized logistic regression, and random forest models to predict in-hospital mortality within 30 days of ICU admission using admission LAPS2 alone in patient-level and patient-day-level models, or admission and daily LAPS2 at the patient-day level. Multivariable models included patient and admission characteristics. We performed internal-external validation using 4 hospitals for training and the fifth for validation, repeating analyses for each hospital as the validation set. We assessed performance using scaled Brier scores (SBS), c-statistics, and calibration plots.

Results:

The cohort included 13,993 patients and 107,699 ICU days. Across validation hospitals, patient-day-level models including daily LAPS2 (SBS: 0.119−0.235; c-statistic: 0.772−0.878) consistently outperformed models with admission LAPS2 alone in patient-level (SBS: 0.109−0.175; c-statistic: 0.768−0.867) and patient-day-level (SBS: 0.064−0.153; c-statistic: 0.714−0.861) models. Across all predicted mortalities, daily models were better calibrated than models with admission LAPS2 alone.

Conclusions:

Patient-day-level models incorporating daily, time-updating LAPS2 to predict mortality among an ICU population performs as well or better than models incorporating modified admission LAPS2 alone. The use of daily LAPS2 may offer an improved tool for clinical prognostication and risk adjustment in research in this population.
Pediatric intestine and multivisceral transplant
Authors: Maklad Mohamed , Mazariegos George , Ganoza Armando
Published: June 2023

Purpose of review

Intestinal and multivisceral transplantation (ITx, MVTx) is the cornerstone in treatment of irreversible intestinal failure (IF) and complications related to parenteral nutrition. This review aims to highlight the unique aspects of the subject in pediatrics.

Recent findings

Etiology of intestinal failure (IF) in children shares some similarity with adults but several unique considerations when being evaluated for transplantation will be discussed. Owing to significant advancement in IF management and home parenteral nutrition (PN), indication criteria for pediatric transplantation continues to be updated. Outcomes have continued to improve with current long-term patient and graft survival in multicenter registry reports reported at 66.1% and 48.8% at 5 years, respectively. Pediatric specific surgical challenges such abdominal closure, post transplantation outcomes, and quality of life are discussed in this review.

ITx and MVTx remain lifesaving treatment for many children with IF. However long-term graft function is still a major challenge.
Associative Network Method
Authors: Peroni Lea , Armaingaud Didier , Henry-Ducos Charlotte , Rothan-Tondeur Monique
Published: June 2023

Background

The associative network method is a technique for studying social representations of a phenomenon. Although it is little known and used, it can be widely used in nursing research, particularly to understand the representations of a population on a disease or a professional practice.

Objectives

This article aims to describe the associative network method, proposed by De Rosa in 1995, through a concrete example.

Methods

The associative network is a technique that allows us to identify the content, structure, and polarity of social representations of a phenomenon. It was used with 41 participants to describe their representations of urinary incontinence. First, the data were collected following the four steps described by De Rosa. The analysis was then carried out manually and using Microsoft Excel. The different themes evoked by the 41 participants, the number of words in each theme, the rank of appearance of the themes, the indices of polarity and neutrality, and the rank of hierarchy were thus analyzed.

Results

We were able to describe in depth the representations of caregivers and people from the general population on urinary incontinence and, more specifically, their content and structure. The spontaneous answers of the participants allowed us to explore several dimensions of their representations. We were also able to obtain rich information, both qualitatively and quantitatively.

Discussion

The associative network—which is easy to understand and implement—is a method that can be adapted to various studies.
Triple-negative Breast Carcinoma With Apocrine and Histiocytoid Features
Authors: Wang Yihong , Hacking Sean M. , Li Zaibo , Graff Stephanie L. , Yang Dongfang , Tan Lu , Liu Fang , Zhang Tom , Zhao Zhixin , Luo Shujun , Du Pan , Jia Shidong , Cheng Liang
Published: June 2023

Triple-negative breast cancer (TNBC) is a heterogenous group of tumors. Most TNBCs are high-grade aggressive tumors, but a minority of TNBCs are not high grade, with relatively indolent behavior and specific morphologic and molecular features. We performed a clinicopathologic and molecular assessment of 18 non–high-grade TNBCs with apocrine and/or histiocytoid features. All were grade I or II with low Ki-67 (≤20%). Thirteen (72%) showed apocrine features, and 5 (28%) showed histiocytoid and lobular features. In all, 17/18 expressed the androgen receptor, and 13/13 expressed gross cystic disease fluid protein 15. Four (22.2%) patients were treated with neoadjuvant chemotherapy, but none achieved a pathologic complete response. In all, 2/18 patients (11%) had lymph node metastasis at the time of surgery. None of the cases had a recurrence or disease-specific death, with an average follow-up time of 38 months. Thirteen cases were profiled by targeted capture-based next-generation DNA sequencing. Genomic alterations (GAs) were most significant for PI3K-PKB/Akt pathway (69%) genes, including PIK3R1 (23%), PIK3CA (38%), and PTEN (23%), and RTK-RAS pathway (62%) including FGFR4 (46%) and ERBB2 (15%). TP53 GA was seen in only 31% of patients. Our findings support those on high-grade TNBCs with apocrine and/or histiocytoid features as a clinicopathologic and genetically distinct subgroup of TNBC. They can be defined by features including tubule formation, rare mitosis, low Ki-67 (≤20%), triple-negative status, expression of androgen receptor and/or gross cystic disease fluid protein 15, and GA in the PI3K-PKB/Akt and/or RTK-RAS pathway. These tumors are not sensitive to chemotherapy but have favorable clinical behavior. Tumor subtype definitions are the first step to implementing future trial designs to select these patients.
Which Trauma Severity Scores Are Useful in Predicting Pediatric Mortality?
Authors: Chedid Imane , Bachir Rana , Rizk Jennifer , El Sayed Mazen , Sawaya Rasha Dorothy
Published: June 2023

Background and Objectives

Trauma is the leading cause of death in children. Several trauma severity scores exist: the shock index (SI), age-adjusted SI (SIPA), reverse SI (rSI), and rSI multiplied by Glasgow Coma Score (rSIG). However, it is unknown which is the best predictor of clinical outcomes in children. Our goal was to determine the association between trauma severity scores and mortality in pediatric trauma.

Design and Methods

A multicenter retrospective study was performed using the 2015 US National Trauma Data Bank, including patients 1 to 18 years old and excluding patients with unknown emergency department dispositions. The scores were calculated using initial emergency department parameters. Descriptive analysis was carried out. Variables were stratified by outcome (hospital mortality). Then, for each trauma score, a multivariate logistic regression was conducted to determine its association with mortality.

Results

A total of 67,098 patients with a mean age of 11 ±5 years were included. Majority of the patients were male (66%) and had an injury severity score <15 (87%). Eighty-four percent of patients were admitted: 15% to the intensive care unit and 17% directly to the operating room. The mortality at hospital discharge was 3%.

There was a statistically significant association between SI, rSI, rSIG, and mortality (P < 0.05). The highest adjusted odds ratio for mortality corresponded to rSIG, followed by rSI then SI (8.51, 1.9, and 1.3, respectively).

Conclusion

Several trauma scores may help predict mortality in children with trauma, the best being rSIG. Introduction of these scores in algorithms for pediatric trauma evaluations can impact clinical decision-making.
Role of microRNAs in embryo–endometrial interactions: biological functions and clinical applications
Authors: Qi Shiwen , Kodithuwakku Suranga P. , Pang Ronald T.K. , Chiu Philip C.N. , Tang Mary H.Y. , Lee Kai-Fai
Published: June 2023

The human endometrium and embryo both produce microRNAs (miRNAs), which are involved in various physiological activities. Accumulating evident suggested that endometrial miRNAs are regulated by steroid hormones that modulate endometrial functions, whereas embryo-derived miRNAs play vital roles in maternal–embryo communication. The aberrant expression of endometrium- or embryo-derived miRNAs can cause early pregnancy and gestational disorders, including repeated implantation failure, recurrent miscarriage, and pathological conditions such as endometriosis. miRNAs are, therefore, ideal candidates for conducting clinicopathological tests. Potential diagnostic and prognostic tests using miRNAs are under development; however, the therapeutic applications of miRNAs in regulating gestational disorders require further investigation.
Treatment of Concomitant Congenital Pseudarthrosis of the Fibula With Propeller Periosteal Flap
Authors: El-Gammal Tarek Abdalla , Ali Amr El-Sayed , Kotb Mohamed Mostafa , Saleh Waleed Riad , Ragheb Yasser Farouk , Refai Omar Ahmed , Morsy Mohamed Mohamed , El-Gammal Yousif Tarek
Published: June 2023

Introduction

Congenital pseudarthrosis of the fibula is not an uncommon condition to accompany congenital pseudarthrosis of the tibia. Persistence of the fibular pseudarthrosis has been linked to inferior outcomes including tibial union and alignment, refractures, and ankle alignment. In this report, we present the results of a pedicled periosteal propeller flap technique for the treatment of fibular pseudarthrosis.

Methods

Ten children with an average age at surgery of 5.3 years who had congenital pseudarthrosis of both tibia and fibula were studied. The tibia was treated with free vascularized fibular grafting, and the ipsilateral fibula was treated with a technique after resection of the pseudarthrosis. A periosteal flap from the proximal healthy part of the fibula is harvested off the bone, rotated 180° based on a branch from the peroneal vessels to cover the fibular defect and fashioned in the form of a tube filled with bone fragments.

Results

The periosteal flap size ranged from 5 to 7 cm. Follow-up averaged 37.2 months. The tibia was united in all cases; in 2 of them, refractures occurred and healed with conservative management. The fibula was united in 8 cases. At final follow-up, 5 cases showed residual tibial deformity, and 5 showed residual ankle deformity. Average leg-length discrepancy was 1.4 cm (0–3 cm).

Conclusion

The pedicled periosteal propeller flap presents a useful new technique for managing concomitant congenital fibular pseudarthrosis.
Omitting Foley Catheter Use in Mastectomy Patients With or Without Immediate Reconstruction
Authors: Huang Siu-Yuan , Panuccio Alexandria , Mohabbatizadeh Borna , Chu Michael , Leung Anna , Carre Antoine L.
Published: June 2023

Background

Foley catheter placement is often advised in surgeries anticipated to exceed 3 hours; however, this time cutoff does not take into account the type of surgery. Complications from Foley catheter placement include urinary tract infections and genitourinary trauma that may be costly to healthcare systems. Our objective was to determine whether mastectomy with or without reconstruction can be done without Foley use, without an increase in urinary retention risk.

Methods

One hundred eighty-seven patients who underwent unilateral or bilateral mastectomies with or without reconstruction in 2020 and 2021 were reviewed. Chart review included intraoperative fluids given, estimated blood loss, lymph node dissection, and duration of procedure.

Results

After excluding patients with case duration under 180 minutes, 145 remained. Ninety-four patients did not have a Foley and 51 patients had an intraoperative Foley. None of the patients without a Foley experienced postoperative urinary retention, including 3 patients who also underwent lymphatic microsurgical preventive healing approach. Eighty-six percent of patients were discharged on the day of surgery. Patients with or without a Foley did not differ significantly in terms of race, rate of axillary lymph node dissection, body mass index, rate of same-day discharge, presence of hypertension or diabetes, estimated blood loss, or age.

Conclusions

Patients undergoing unilateral and bilateral mastectomies with or without reconstruction or lymphatic microsurgical preventive healing approach may avoid Foley catheter placement without increased risk of urinary retention, even if the case is anticipated to exceed 3 hours. Advantages include elimination of catheter-associated urinary tract infections and their associated hospital costs, as well as avoiding genitourinary trauma.
NARROWING THE GAP: PRECLINICAL TRAUMA WITH POSTINJURY SEPSIS MODEL WITH INCREASED CLINICAL RELEVANCE
Authors: Munley Jennifer A. , Kelly Lauren S. , Gillies Gwendolyn S. , Pons Erick E. , Coldwell Preston S. , Kannan Kolenkode B. , Whitley Elizabeth M. , Bible Letitia E. , Efron Philip A. , Mohr Alicia M.
Published: June 2023

Background: Overall outcomes for trauma patients have improved over time. However, mortality for postinjury sepsis is unchanged. The use of relevant preclinical studies remains necessary to understand mechanistic changes after injury and sepsis at the cellular and molecular level. We hypothesized that a preclinical rodent model of multicompartmental injury with postinjury pneumonia and chronic stress would replicate inflammation and organ injury similar to trauma patients in the intensive care unit. Methods: Male and proestrus female Sprague-Dawley rats (n = 16/group) were subjected to either polytrauma (PT) (lung contusion, hemorrhagic shock, cecectomy, and bifemoral pseudofracture), PT with daily chronic restraint stress (PT/CS), PT with postinjury day one Pseudomonas pneumonia (PT + PNA), PT/CS with pneumonia (PT/CS + PNA) or naive controls. Weight, white blood cell count, plasma toll-like receptor 4 (TLR4), urine norepinephrine (NE), hemoglobin, serum creatinine, and bilateral lung histology were evaluated. Results: PT + PNA and PT/CS + PNA groups lost more weight compared with those without sepsis (PT, PT/CS) and naive rats (P < 0.03). Similarly, both PT + PNA and PT/CS + PNA had increased leukocytosis and plasma TLR4 compared with uninfected counterparts. Urine NE was elevated in PT + PNA and PT/CS + PNA compared with naive (P < 0.03), with PT/CS + PNA exhibiting the highest levels. PT/CS + PNA exhibited worse acute kidney injury with elevated serum creatinine compared with PT/CS (P = 0.008). PT/CS + PNA right and left lung injury scores were worse than PT + PNA (P < 0.01). Conclusions: Sepsis, with postinjury pneumonia, induced significant systemic inflammation, organ dysfunction following polytrauma and chronic stress. Advanced animal models that replicate the critically ill human condition will help overcome the classic limitations of previous experimental models and enhance their translational value.
Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery
Authors: Guerra Francesco , Coletta Diego
Published: June 2023

Background:

Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is still mainly approached by conventional celiotomy.

Materials and Methods:

A video vignette is presented showing the details of an emergent laparoscopic right colectomy as performed to treat a 59-year-old woman who presented with clinical signs of peritonitis, and radiologic findings suggestive of acute right-colon diverticulitis complicated by perforation of the hepatic flexure and periduodenal abscess. We also aimed to evaluate the relative outcomes of laparoscopic versus conventional surgery by meta-analyzing the currently available comparative evidence on the argument.

Results:

A total of 2848 patients were included in the analysis, of which 979 patients received minimally invasive surgery and 1869 had conventional surgery. Laparoscopic surgery had a longer operating time and resulted in an abbreviated hospital stay. Overall, patients receiving laparoscopy had significantly lower morbidity than those whose surgery was undertaken by laparotomy, while there was no statistically significant difference in terms of postoperative mortality.

Conclusions:

According to the existing literature, minimally invasive surgery improves the postoperative outcomes of patients receiving surgery for right-sided colonic diverticulitis.
Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Gasless Transaxillary Endoscopic Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study
Authors: Zhang Wei-dong , Dai Lei , Le Qi , Yu Ke-jie , Wang Ying-chun , Wu Xian-jiang
Published: June 2023

Background:

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and gasless transaxillary endoscopic thyroidectomy (GTET) are 2 newly applied technologies. This study is to compare the 2 approaches from the aspects of effectiveness and safety.

Materials and Methods:

A total of 339 patients who underwent TOETVA or GTET with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2022. The 2 groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative outcomes.

Results:

The operative time of the TOETVA group was significantly longer than the GTET group (141.39±16.11 vs. 98.45±12.24, P<0.05). The TOETVA group had advantages over GTET group when the reduction of parathyroid hormone was compared (19.18±17.43 vs. 23.07±15.72, P<0.05). Meanwhile, more parathyroids were detected in central neck specimens in GTET group (40/181 vs. 21/158, P<0.05). TOETVA had an advantage on total number of central lymph nodes over GTET (7.65±3.11 vs. 4.99±2.45, P<0.05), whereas the number of positive central lymph nodes was similar (P>0.05). No differences were found between the 2 groups on other data.

Conclusions:

TOETVA and GTET are both safe and effective for unilateral papillary thyroid carcinomas. TOETVA has advantage on protection of inferior parathyroid glands and harvest of central lymph node dissection. Meanwhile, GTET can save more time compared with TOETVA. Surgeons and patients should freely choose the approaches based on their demands.
Exploring New Electroencephalogram Parameters in Electroconvulsive Therapy
Authors: Schreiner Jakob Emil , Kessler Ute , Oedegaard Ketil Joachim , Mardal Kent-Andre , Oltedal Leif
Published: June 2023

Background

Electroconvulsive therapy (ECT) is an effective treatment against severe depressive episodes, which has been shown to induce volume changes in the hippocampus. The power spectrum of the electroencephalogram (EEG) follows a characteristic power-law relation, but its utility as a metric of ECT-induced seizures has not been explored.

Objective

This pilot study aims to evaluate a novel metric based on the power spectrum of the EEG recordings from ECT-induced seizures—its association to volume changes in the hippocampus after ECT and improvement in depression rating scores.

Methods

Depressed patients treated with ECT underwent brain magnetic resonance imaging before and after treatment and the EEG from each seizure was recorded (N = 29). Hippocampal volume changes and EEG parameters were recorded in addition to clinician-rated and self-reported measures of depressive symptoms. The slope of the power law in the power spectral density of the EEG was calculated. Multivariate linear models relating seizure parameters to volume change or clinical outcome were systematically and successively simplified. The best models were selected according to Akaike information criterion.

Results

The slope of the power law was steeper in the right than the left hemisphere (P < 0.001). Electroencephalogram measures were included in the best models of volume change for both hippocampi as well as in the models explaining clinical outcome (P = 0.014, P = 0.004).

Conclusions

In this pilot study, novel EEG measures were explored and contributed in models explaining the variation in volume change in the hippocampus and in clinical outcome after ECT.
What Our Patients and Their Families Are Reading
Authors: Ekinci Okan
Published: June 2023

Objectives

The Internet is now more widely used than before by psychiatric patients and their families to search for medical conditions and treatments. To our knowledge, no study has addressed the quality and readability of online information about electroconvulsive therapy (ECT). We aimed to examine the quality and readability of English-language Internet information related to ECT.

Methods

An advanced search of Internet Web sites containing information about ECT was conducted by using the search term “ECT or electroconvulsive therapy.” The resulting Web sites were categorized into 1 of 3 categories (commercial, nonprofit, or professional organizations). Their quality was evaluated using Health on the Net code certification, the Journal of the American Medical Association (JAMA) benchmark criteria, and the DISCERN tool. The readability of the Web sites was assessed using the Flesch Reading Ease, Flesch-Kincaid Grade Level Formula, Simple Measure of Gobbledygook, and Gunning Fog indexes.

Results

A total of 86 Web sites were included in the analysis. Of all these Web sites, 18 (20.9%) had a Health on the Net code certificate, and 16 (18.6%) were accepted as high quality (JAMA total score ≥3). The commercial Web sites had significantly lower DISCERN and JAMA benchmark scores compared with the other Web sites. A total of 30.23% of all the Web sites reached the recommended readability level (Flesch-Kincaid Grade Level Formula ≤ 8). Moreover, only 4 scored at the grade 5 to 6 reading level, which is considered ideal for patient educational materials.

Conclusions

Our study indicates that both the quality and readability of online information about ECT are not at the desired level. Physicians, patients, and their families should consider this failure in relation to online information about ECT. In addition, Web site creators and health authorities should be aware of their responsibilities for providing quality and readable health information to the public.
Virulence-associated type III secretion systems in Gram-negative bacteria
Authors: Pais Sara Vilela , Kim Eunjin , Wagner Samuel
Published: June 2023

Virulence-associated bacterial type III secretion systems are multiprotein molecular machines that promote the pathogenicity of bacteria towards eukaryotic host cells. These machines form needle-like structures, named injectisomes, that span both bacterial and host membranes, forming a direct conduit for the delivery of bacterial proteins into host cells. Once within the host, these bacterial effector proteins are capable of manipulating a multitude of host cell functions. In recent years, the knowledge of assembly, structure and function of these machines has grown substantially and is presented and discussed in this review.
Monitoring of azathioprine metabolite concentrations and cytokine levels in neuromyelitis optica spectrum disorder
Authors: Huang Qingmeng , Wei Junjie , Luo Chunfang , Qin Junhui , Tang Chunnv , Li Lijing , Zhou Huijie , Zhong Kang , Lin Bailing , Tang Yulan
Published: June 2023

Background

The pathogenesis of NMOSD has been linked to the cytokines interleukins (IL) -6, NOD-, LRR-and pyrin domain-containing 3 (NLRP3) and IL-18 that contribute to development of inflammatory reactionsmay. Although azathioprine (AZA) is efficacious in preventing NMOSD recurrence, it may have adverse effects (AEs) maybe related to the plasma concentrations.

Objective

We would monitor the blood concentrations of azathioprine in NMOSD, and their relationship with cytokines, severity, efficacy, and safety range of the drug.

Methods

A total of 53 NMOSD patients were included in the study, which included 20 patients who had received AZA treatment within one month, and 16 patients who had received AZA treatment within six months, as well as 17 patients who had received AZA treatment over one year. The patient’s immunotherapy regimen was low-dose hormone combined with AZA. AZA was started at small doses and added every two weeks after no AEs, namely 50 mg qd for two weeks, 50mg bid for two weeks, and maintained at 50mg tid. The following clinical data were collected: gender, age, clinical symptoms, EDSS score, number of recurrences and AEs, etc. Healthy controls (HC) comprised 10 individuals. AZA metabolite concentrations 6-thioguaninenucleotides (6-TGN) and 6-methylmercaptopurine nucleotides (6-MMPN) were measured by High-performance liquid chromatography (HPLC). Levels of IL-6, NLRP3 and IL-18 were measured by Enzyme-linked immunosorbent assay (ELISA).

Results

Treatment with AZA decreased the EDSS score and the ARR. The 6-TGN and 6-MMPN concentrations gradually increased as the medication time increased, and was basically stable by 6 months of medication. EDSS score improvement was positively correlated with 6-TGN concentrations. Patients with AEs had higher concentrations of 6-TGN and 6-MMPN than those without. The serum levels of IL-6, NLRP3, and IL-18 were higher in the patients than in the HC. NLRP3 level was higher in neuropathic pain (NP) patients than in those without NP.

Conclusion

Consequently, AZA was confirmed to be an effective drug used to treat NMOSD. AEs increased when 6-TGN reached 155.604 pmol/8×108RBC or 6-MMPN reached 2583.168 pmol/8×108RBC. In NMOSD remission, IL-6 and NLRP3 levels were significantly higher than in normal subjects, suggesting that they may contribute to the pathogenesis of NMOSD. A high level of NLRP 3 may lead to NP.
From Answers to Insights: Unveiling the Strengths and Limitations of ChatGPT and Biomedical Knowledge Graphs
Authors: Hou Yu , Yeung Jeremy , Xu Hua , Su Chang , Wang Fei , Zhang Rui
Published: June 2023

Large Language Models (LLMs) have demonstrated exceptional performance in various natural language processing tasks, utilizing their language generation capabilities and knowledge acquisition potential from unstructured text. However, when applied to the biomedical domain, LLMs encounter limitations, resulting in erroneous and inconsistent answers. Knowledge Graphs (KGs) have emerged as valuable resources for structured information representation and organization. Specifically, Biomedical Knowledge Graphs (BKGs) have attracted significant interest in managing large-scale and heterogeneous biomedical knowledge. This study evaluates the capabilities of ChatGPT and existing BKGs in question answering, knowledge discovery, and reasoning. Results indicate that while ChatGPT with GPT-4.0 surpasses both GPT-3.5 and BKGs in providing existing information, BKGs demonstrate superior information reliability. Additionally, ChatGPT exhibits limitations in performing novel discoveries and reasoning, particularly in establishing structured links between entities compared to BKGs. To overcome these limitations, future research should focus on integrating LLMs and BKGs to leverage their respective strengths. Such an integrated approach would optimize task performance and mitigate potential risks, thereby advancing knowledge in the biomedical field and contributing to overall well-being.
A participatory approach to designing and implementing an occupational health intervention for the nail salon community in the Greater Philadelphia region
Authors: Hùynh Trân B , Nguyễn Dương T , Vũ Nga , Robinson Lucy , Trần Emily , Nguyễn Nancy , Carroll-Scott Amy , Burstyn Igor
Published: June 2023

Background

The nail salon industry in the US comprises mostly immigrant-owned, small mom-and-pop salons that employ primarily first-generation immigrant workers from Asia. Because of the cultural and language barriers, both owners and workers may not avail themselves of the occupational safety resources. We formed an academic-community partnership to co-design a feasibility study and multi-level occupational health intervention for Vietnamese-speaking salon owners, workers, and community-based organization.

Methods

The intervention for each salon included 1) two-hour in-person training covering chemical safety, infection control, musculoskeletal prevention, and workers’ rights for both the owners and their employees, 2) a tailored recommendation report for the owner, and 3) check-ins with the owners during the three-month follow-up. Community partner was trained to deliver the in-language training with technical assistance from the research team. Baseline and post-intervention individual data about health symptoms and behaviors, as well as personal chemical exposures were collected and analyzed.

Results

A total of 44 participants from 12 consented salons enrolled in the study. One salon dropped out follow-up due to change of ownership. Analysis of the differences between post-and pre-intervention showed a tendency toward reduction in self-reported symptoms in the respiratory system, skin, and eyes, neurotoxicity score, as well as some chemical exposures. We could not rule out seasonality as an explanation for these trends. Increase in self-efficacy in some areas was observed post-intervention.

Conclusions

Our study demonstrated a successful academic-community partnership to engage community members in the intervention study. While the intervention effects from feasibility study should be interpreted with caution, our preliminary results indicated that our community-based intervention is a promising approach to reduce work-related exposures among nail salon worker workers from Asia.
Effects of recurrence of illness and adverse childhood experiences on effector, cytotoxic, and regulatory T cells, and cannabinoid receptor-bearing B cells in major depression, an autoimmune disorder
Authors: Maes Michael , Rachayon Muanpetch , Jirakran Ketsupar , Sughondhabirom Atapol , Sodsai Pimpayao
Published: June 2023

Background

Major depressive disorder (MDD) is characterized by increased T helper (Th)1 polarization, T cell activation (e.g., CD71+ and CD40L+), and cannabinoid receptor type 2 bearing CD20+ B cells; and lower T regulatory (Treg) numbers.

Aims

To delineate the effects of adverse childhood experiences (ACEs) and recurrence of illness (ROI) on activated T and CB2-bearing B populations, and Tregs, including FoxP3+CD152+, FoxP3+GARP+, and FoxP3+CB1+ cells.

Methods

We measured ROI, ACEs, the number of activated T cells, Tregs, and CD20+CB2+ B cells, in 30 MDD patients and 20 healthy controls.

Results

A larger part of the variance in the depression phenome (40.8%) was explained by increased CD20+CB2+ and activated T cells, and lowered Tregs. ROI and lifetime suicidal behaviors were significantly and positively associated with CD20+CB2+, CD3+CD71+, CD3+CD40L+, CD4+CD71+, CD4+CD40L+, and CD4HLADR+ numbers. ROI was significantly correlated with CD8+CD40L+ numbers. The sum of ACEs was significantly associated with CD20+CB2+, CD3+CD40L+, CD4+40L+ numbers, T cell activation (positively) and Treg (inversely) indices. One replicable latent vector could be extracted from activated T cells, lifetime and current suicidal behaviors, number of depressive episodes, and severity of depression, and 48.8% of its variance was explained by ACEs.

Conclusions

ACE-induced activation of T effector and cytotoxic cells and B cells with autoimmune potential, coupled with lowered Treg numbers are a key component of depression. The findings indicate that increasing ROI, the phenome of depression and suicidal behaviors, are caused by autoimmune processes, which are the consequence of ACEs and increasing sensitization of immune responses.
Novel autoantibody targets identified in patients with autoimmune hepatitis (AIH) by PhIP-Seq reveals pathogenic insights
Authors: Klepper Arielle , Asaki James , Kung Andrew F. , Vazquez Sara E. , Bodansky Aaron , Mitchell Anthea , Mann Sabrina A. , Zorn Kelsey , Avila-Vargas Isaac , Kari Swathi , Tekeste Melawit , Castro Javier , Lee Briton , Duarte Maria , Khalili Mandana , Yang Monica , Wolters Paul , Price Jennifer , Perito Emily , Feng Sandy , Maher Jacquelyn J. , Lai Jennifer C. , Weiler-Normann Christina , Lohse Ansgar W. , DeRisi Joseph , Tana Michele
Published: June 2023

Background and Aims

Autoimmune hepatitis (AIH) is a severe disease characterized by elevated immunoglobin levels. However, the role of autoantibodies in the pathophysiology of AIH remains uncertain.

Methods

Phage Immunoprecipitation-Sequencing (PhIP-seq) was employed to identify autoantibodies in the serum of patients with AIH (n= 115), compared to patients with other liver diseases (metabolic associated steatotic liver disease (MASH)n= 178, primary biliary cholangitis (PBC),n= 26, or healthy controls,n= 94).

Results

Logistic regression using PhIP-seq enriched peptides as inputs yielded a classification AUC of 0.81, indicating the presence of a predictive humoral immune signature for AIH. Embedded within this signature were disease relevant targets, including SLA/LP, the target of a well-recognized autoantibody in AIH, disco interacting protein 2 homolog A (DIP2A), and the relaxin family peptide receptor 1 (RXFP1). The autoreactive fragment of DIP2A was a 9-amino acid stretch nearly identical to the U27 protein of human herpes virus 6 (HHV-6). Fine mapping of this epitope suggests the HHV-6 U27 sequence is preferentially enriched relative to the corresponding DIP2A sequence. Antibodies against RXFP1, a receptor involved in anti-fibrotic signaling, were also highly specific to AIH. The enriched peptides are within a motif adjacent to the receptor binding domain, required for signaling and serum from AIH patients positive for anti-RFXP1 antibody was able to significantly inhibit relaxin-2 singling. Depletion of IgG from anti-RXFP1 positive serum abrogated this effect.

Conclusions

These data provide evidence for a novel serological profile in AIH, including a possible functional role for anti-RXFP1, and antibodies that cross react with HHV6 U27 protein.
Choroid plexus defects in Down syndrome brain organoids enhance neurotropism of SARS-CoV-2
Authors: Shaker Mohammed R. , Slonchak Andrii , Al-mhanawi Bahaa , Morrison Sean D. , Sng Julian D. J. , Cooper-White Justin , Khromykh Alexander A. , Wolvetang Ernst J.
Published: June 2023

Why individuals with Down Syndrome (DS, trisomy 21) are particularly susceptible to SARS CoV-2 induced neuropathology remains largely unclear. Since the choroid plexus (CP) performs important barrier and immune-interface functions, secretes the cerebrospinal fluid and strongly expresses the ACE2 receptor and the chromosome 21 encoded TMPRSS2 protease, we hypothesized that the CP could play a role in establishing SARS-CoV-2 infection in the brain. To investigate the role of the choroid plexus in SARS-CoV-2 central nervous system infection in DS, we established a new type of brain organoid from DS and isogenic euploid control iPSC that consists of a core of appropriately patterned functional cortical neuronal cell types that is surrounded by a patent and functional choroid plexus (CPCOs). Remarkably, DS-CPCOs not only recapitulated abnormal features of DS cortical development but also revealed defects in ciliogenesis and epithelial cell polarity of the developing choroid plexus. We next demonstrate that the choroid plexus layer facilitates SARS-CoV-2 replication and infection of cortical neuronal cells, and that this is increased in DS-CPCOs. We further show that inhibition of TMPRSS2 and Furin activity inhibits SARS-CoV-2 replication in DS CPCOs to the level observed in euploid organoids. We conclude that CPCOs are a useful model for dissecting the role of the choroid plexus in euploid and DS forebrain development and enables screening for therapeutics that can inhibit SARS-CoV-2 induced neuro-pathogenesis.
Simultaneous LC-MS determination of glucose regulatory peptides secreted by stem cell-derived islet organoids
Authors: Olsen Christine , Wang Chencheng , Aizenshtadt Aleksandra , Abadpour Shadab , Lundanes Elsa , Skottvoll Frøydis Sved , Golovin Alexey , Busek Mathias , Krauss Stefan , Scholz Hanne , Wilson Steven Ray
Published: June 2023

For studying stem cell-derived islet organoids (SC-islets) in an organ-on-chip platform, we have developed a reversed phase liquid chromatography tandem mass spectrometry (RPLC-MS/MS) method allowing for simultaneous determination of insulin, somatostatin-14, and glucagon, with improved matrix robustness compared to earlier methodology. Combining phenyl/hexyl-C18 separations using 2.1 mm inner diameter LC columns and triple quadrupole mass spectrometry, identification and quantification were secured with negligible variance in retention time and quantifier/qualifier ratios, negligible levels of carry-over (< 2%), and sufficient precision (± 10% RSD) and accuracy (± 15% relative error) with and without use of internal standard. The here developed RPLC-MS/MS method showed that the SC-islets have an insulin response dependent on glucose concentration, and the SC-islets produce and release somatostatin-14 and glucagon. The RPLC-MS/MS method for these peptide hormones was compatible with an unfiltered off-line sample collection from SC-islets cultivated on a pump-less, recirculating organ-on-chip (rOoC) platform. The SC-islets background secretion of insulin was not significantly different on the rOoC device compared to a standard cell culture well-plate. Taken together, RPLC-MS/MS is well suited for multi-hormone measurements of SC-islets on an organ-on-chip platform.